Ghana Trip to Study Tuberculosis: Day Six

by Kaila Helm, Biological Basis of Behavior ’20; Kathleen Givan, Bioengineering and Political Science, ’20; Kathryn Cocherl, Bioengineering ’20; Hope McMahon, Chemical and Biomolecular Engineering ’18; and Dave Pontoriero, Biotechnology MS ’18

Ghana 6.1
Students speak with a clinician about the X-ray machine used for chest X-rays as a preliminary technique for diagnosing tuberculosis among other respiratory infections.

David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.

Our day started early. We woke up for a 7:00 a.m. breakfast of our usual combination of rolls with jam, sausages, omelets, and a beverage. After breakfast, we headed for the bus, where Uncle Ebo (our bus driver) was waiting to take us to a rural hospital about an hour away. We soon arrived at the Agogo Presbyterian Hospital. We were amazed by the organization and structure. At our previous hospital visit, we only saw a TB clinic. Today, we got to see a hospital that served a very different community. After spending some time in an old Presbyterian church, an administrator greeted us to begin our tour. We entered the main atrium, a large waiting room filled with more than a hundred people. We even saw a sheet used to characterize patients’ symptoms — a comprehensive list of numerous traits and experiences. We then continued our tour by entering the various wings and sections affiliated with TB treatment. This provided a wonderful opportunity to see a different side of the hospital’s operations.

Ghana 6.2
Penn students wait to enter the tuberculosis clinic of the Agogo Presbyterian Hospital. (Left to right: Katharine Cocherl, Danielle Tsougarakis, Kaila Helm, Hope McMahon)

Initially, we were allowed to peek into the diagnosing wing. The first room was small and was purposed for smear microscopy tests. It had a few light microscopes and many technicians. Adjacent to this room was the GeneXpert room. Tucked away in the back corner was a small box (the GeneXpert), maybe 18 inches high. We were surprised at how small and streamlined it was — finally seeing the machine we have talked about for a solid semester was an almost surreal experience. It seems that they value it highly and therefore keep it well maintained and protected. We learned more about how they use the GeneXpert and the limitations they face, such as a limited number of cartridges, problems with overuse, and slow maintenance.

We then went into the X-ray room. As per our past lectures, this is the preferred initial screening methodology, so it was exciting to see how well established their systems are. There were two X-ray machines that were donated and used by the entire facility. The nurse also showed us how they store all the scans and showed us a scan of a pneumonia patient’s lung. They hope to introduce digital X-rays in the future, which will be better for analyzing and diagnosing. She taught us what to look for on the scans, saying that pneumonia is differentiated from TB because it is localized at the bottom lobes of the lung, whereas TB is more widespread and present in the top lobes as well. The tour concluded with a trip to the isolation room for TB patients, but time was limited, so we didn’t spend much time there.

Once we took the bus back to KCCR, we attended a lecture by Dr. David Issadore, who spoke about his research to a packed room filled with Ghanaian clinicians and researchers. They were very interested in his work, especially in how microfluidic chips could be used as a diagnostic for TB. Interestingly, the room was filled with clinicians and research scientists, but engineers were poorly represented. Dr. Issadore definitely made us proud!

Ghana 6.3
Students taking a tour of the Agogo Presbyterian Hospital complex.
(Left to right: Hope McMahon, Salim)

After the presentation, our group scattered. Some of us took control and hand-washed our clothes. A few numb fingers made for a very nice reminder about the little things we take for granted back in the States. After we worked up an appetite, we introduced the American classic of peanut butter and banana sandwiches to the Ghanaian students and Nana. We received some mixed responses, and we won’t be getting many returning customers, but it was nice to have a little bit of role reversal. Considering how much we have learned about Ghanaian culture through their food, it was nice to help them see a little bit of what America has to offer.

Ghana Trip to Study Tuberculosis: Day Five

by Danielle Tsougarakis, Bioengineering ’20; Jason Grosz, Bioengineering ’19; Ethan Zhao, Bioengineering ’19; and Kate Panzer, Bioengineering ’18

Ghana 5.1
Dr. Anthony Enimil (left) and Nana Yaa (right) in the pediatric tuberculosis clinic at Komfo Anokye Teaching Hospital (KATH), Kumasi.

David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.

The first thing we did today was visit the Komfo Anokye sword, which is a sword buried in the ground that represents the power and stability of the Ashante Kingdom. Rumor has it that, if the sword is removed from the ground, the Ashante Kingdom will collapse. To this date, no one has been able to remove the sword from the ground, and it is a tourist site frequented by famous visitors, including Muhammad Ali.

After seeing the Komfo Anokye sword, we visited a pediatric tuberculosis clinic at Komfo Anokye Teaching Hospital (KATH), the major hospital in Kumasi, which is well equipped with medical infrastructure. Upon entering the clinic, we were immediately struck by the appearance of the waiting area and check-up room. The check-up room was small and consisted of a wooden desk and plastic chairs. The windows and doors remained open to the outside and waiting area such that any passers-by could listen to the check-up. The clinic was not very busy while we were there, but the doctor said that that was atypical; typically, he is completely booked and has to rush from appointment to appointment.

The first patient was a five-year-old child who was referred from another doctor for persistent coughing, weight loss, fever, and vomiting. These are all classic symptoms of tuberculosis, so the doctor ordered a smear microscopy diagnostic on the patient’s sputum and a digital X-ray. If the sputum sample is viable, it will also be sent for molecular diagnostics with the GeneXpert. One thing that we found surprising was that the cost to the patient for the diagnostics and the check-up was $0 — it is all funded by the government and NGOs.

Dr. David Issadore with students at a rural high school in Kumasi, following his physics tutoring session.

The second patient was also a five-year-old child currently being treated with anti-tuberculosis medication and anti-retroviral therapy for HIV. His symptoms included wheezing, coughing, and an extremely rapid heartbeat. Given the patient’s history of HIV, the doctor suspected acute pneumonia and/or drug-resistant tuberculosis and admitted him to the emergency room for observation and treatment. One thing that we found surprising was that infant patients in the emergency room usually share beds with up to seven other infant patients. This makes hospital-borne infections extremely common and dangerous. We also found it interesting that only the mother was allowed to accompany the child to the emergency room, but the father was given the final say for all important medical decisions.

After the clinic visit, we went to a nearby rural high school, where we planned to tutor the students in science and math. Upon arrival, we were told which subject we would be teaching just before we were essentially thrown into the classrooms without much preparation. This tutoring session was held after the usual class period, but the students were eager to stay, learn, and interact with us. The school was split into two forms similar to the British school system, with the underclassmen in Form 1 and the upperclassmen in Form 2.

The high school has about 900 students, split into eight classrooms with sides that open to the warm Ghanaian air. The rooms hold classes of varying sizes from 25 to 50 students, with ages between 13 and 18 years. Some of the subjects taught in the different classrooms include physiology (the cardiovascular system), math (algebraic expressions, change of subject, quadratic equations, etc.), and language arts (article and essay writing). Each room was filled with goofy, lively students who would occasionally break out in giggles and applause to encourage their classmates who volunteered to come to the board.

We all had a blast interacting with the students, attempting different teaching techniques on the spot and brainstorming ways to get the students excited about the class topics. Despite the initial nerves of not knowing what we would be teaching until just before entering the classrooms, we look back at this experience with excitement, and we are looking forward to returning to the classrooms to tutor on Friday.

Ghana 5.3
Students lining up for a dinner of fish, boiled plantains, (white) yams, and palaver sauce.

Ghana Trip to Study Tuberculosis: Day Four

by Kaila Helm, Biological Basis of Behavior ’20; Kathleen Givan, Bioengineering and Political Science ’20; Kathryn Cocherl, Bioengineering ’20; Hope McMahon, Chemical and Biomolecular Engineering ’18; Dave Pontoriero, Biotechnology MS ’18

Ghana 4.1
Dr. Anthony Enimil (local pediatrician) giving a lecture on tuberculosis in Ghana.

David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.

Our team woke up and hit the floor with some Zumba. Following this exercise, we went to the campus cafeteria for breakfast. The food consisted of rolls with jam, sausages, omelets, and coffee, tea, or Milo (Australian chocolate milk).

Ghana 4.2
Students pose with Dr. Anthony Enimil following his lecture on tuberculosis in Ghana. (From left to right: Salim, Katharine Cocherl, Ethan Zhao, Danielle Tsougarakis, Kate Panzer, Kathleen Givan, Kaila Helm, Dr. Anthony Enimil, Jason Grosz, David Pontoriero, Dr. Miriam Wattenbarger, Hope McMahon, Dr. David Issadore, Priscilla, Benjamin)

Our first academic activity of the trip was after breakfast! We made it back to the house for a lecture from Dr. Anthony Enimil, a local pediatrician. During his initial lecture, he spoke about Ghanaian culture and how it related to our group, both as tourists and and as medical professionals. Dr. Enimil said that misconceptions mostly stemmed from tourists who think they are above Ghanaians. Ghanaians are multilingual, intelligent, and very proud of their culture. This pride is particularly prevalent in Kumasi and the Ashanti region, which is considered the cultural capital of Ghana. The question and answer period was particularly interesting, considering that we have spent a semester learning about tuberculosis without necessarily having any ability to learn specifics about the situation in Ghana. One fact that we found remarkable was that the WHO estimate of tuberculosis prevalence was found to be only one-quarter of the actual prevalence in Ghana.

The next portion of the day was critically important, if somewhat futile: a tour to get us oriented around campus. The KNUST campus is, according to a casual guestimation poll of the Ghana Nine (the nine Penn students on the trip), approximately five times bigger than the Penn campus. To make matters worse, large parts of the campus are, to our untrained eyes, identical stretches of unkempt jungle. We ended our tour with fufu for lunch at a chop bar, a casual Ghanaian restaurant that apparently serves the purpose as Wawa: keeping the Ghanaian students happily fed for cheap. We knew the food was spicier when our right hands (used in Ghana as utensils) tingled for a solid hour post-exposure. However, the fufu we ate was legitimate and delicious, and there were no complaints from the Ghana Nine about the food, particularly when we had a lovely post-meal Icy Cup (a tangy yogurt smoothie). It distantly reminded most of us of yogurt.

Ghana 4.3
Students enjoy fufu at the chop bar nearby the campus of Kwame Nkrumah University of Science and Technology (KNUST). (From left to right: Katharine Cocherl, Danielle Tsougarakis, Kathleen Givan, Priscilla)

Our second academic activity of the day was a continuation of the lecture led by Dr. Enimil. This time we got into the nitty-gritty details of the tools that are used to diagnose TB. Even with the progress made with technological advances, a recurring issue is stigma. TB is curable, but the perception of it as a “disease of death” has made it highly stigmatized. Much work needs to be done to reach some of the benchmarks set. For example, the hope is to eliminate the disease burden by 2035. To do this, Ghanaians must continue strengthening diagnostic methods. We discussed the microscopic culture molecular examination, chest radiographic findings, and sputum sample usage with the Gene Xpert. After another very stimulating question and answer session, the Ghana Nine took a 90-minute break, filled with naps and a competitive game of cards.

We then enjoyed a delicious dinner that consisted of salted fish, plantains and (white) yams (collectively called ampesi), palaver sauce, and avocado. After dinner, the whole group took a walk to the shopping mall on campus to get an ice cream treat to cool us off. We ended the night reflecting on our day, speed friending, and discussing all the new information we learned about TB in Ghana to prepare for our visit to the clinics.

Ghana Trip to Study Tuberculosis: Day Two

by Kaila Helm, Biological Basis of Behavior ’20; Kathleen Givan, Bioengineering and Political Science ’20; Kathryn Cocherl, Bioengineering ’20; Hope McMahon, Chemical and Biomolecular Engineering ’18; and Dave Pontoriero, Biotechnology MS ’18

Ghana 2.1
Grilled beef kebabs at a street side market, on the way from Accra to Kumasi.

David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.

Our day started early: at 6 A.M. We were startled to see an aerobic fitness class outside our hotel room door. Participants were sweating and dancing with smiling faces to high-energy rhythmic music — a definite contrast to the decidedly low-energy sleeping state we were hoping to enjoy further.

Breakfast was a lovely, carbohydrate-heavy smorgasbord of avocado, pancakes, and flower-shaped chicken sausages. We then boarded our bus for our trip to Kumasi. Along the way, we noticed the changing landscape as we headed out to the rural area. On the bus, Ethan played his ukulele. Due to construction, the traffic sides switch slightly at random. This could be hair-raising at times: suddenly, the bus would simply divert to the side of the road where, mere moments before, the traffic was streaming along merrily in the opposite direction.

We also stopped at a rest area, and we tried guinea fowl, goat, and banana milk. As we continued, we saw more goats and churches and fewer vendors on the side of the street. It was also interesting to see more and more mosques as we passed in to the more Muslim northern/central area. We arrived at the exceedingly spacious KNUST campus, lush and green, and also, not the bus (we were very ready to be off after four hours of driving!). We set up our rooms and prepared for the rest of the night.

The afternoon was hot and lazy, filled with unpacking and chatting about the wild experiences that we’d already had. A definitive highlight was a run that some students took on campus. The group was lucky enough to see the computer lab and a Ghanaian wedding and to meet up with some Ghanaian friends who helped with the program last year. After a shower and perhaps a quick nap for the lucky ones among us, we were ready for the next stage of the evening: the welcome party.

At the welcome party, we met the Ghanaian students who will be with us during our time here. We then watched a performance by drummers and traditional Ghanaian dancers. They pulled us in their circle and taught us some of their dance moves. We met some of the KCCR staff members who told us more about the work we will be starting this week. We ended the night in the lounge, reflecting on our day and getting to know each other better.

Ghana 2.2
Students enjoying snacks at a market on the road between Accra and Kumasi.

Ghana Trip to Study Tuberculosis: Day One

by Danielle Tsougarakis, Bioengineering ’20; Jason Grosz, Bioengineering ’19; Ethan Zhao, Bioengineering ’19; and Kate Panzer, Bioengineering ’18

Ghana 1.0

David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course,  he and Miriam Wattenberger from CBE,
 have taken nine Penn students, most of them majoring in Bioengineering,  to Kumasi, Ghana to study the diagnosis of pediatric Tuberculosis. While in Ghana, these students will be blogging daily on their experiences.


Our trip began with a 10-hour flight, departing from JFK Airport on Thursday and arriving in Accra on Friday. Infrared cameras scanned us as we walked through customs at the Accra Airport (our guess was for fever), and we exited the airport to meet our contacts from Kwame Nkrumah University of Science and Technology (KNUST).
Ghana 1.1
(Left to right) Dr. Wattenbarger, Jason Grosz, Ethan Zhao, Hope McMahon, Katharine Cocherl, Kaila Helm

As soon as we walked out of the airport, we were hit with our first wave of hot and humid Ghanaian air. Shortly after driving out of the hectic airport traffic, we approached a coconut stand and hydrated with freshly cut coconuts. Many of us had coconut meat for the first time, with the coconuts hacked open by machetes.  The meat had an unexpectedly sweet and gooey texture, as opposed to dry and flaky texture of coconut shavings.

Ghana 1.2
(Left to right) Kaila Helm, David Pontoriero

As we were driving around Accra, we were surprised by the abundance of street vendors selling items on the side of the road. In order to sell their goods (gum, sunglasses, peanuts, fried bread, shampoos, etc.), the vendors dodged oncoming traffic and balanced their items in baskets on their heads.

Next, we went on a bus tour of the University of Ghana, admiring the expansive campus, green lawns, and beautiful whitewashed buildings with terracotta roofing. The remainder of the day was spent swimming in the hotel pool and eating our first Ghanaian meals of rice, chicken, fish, plantains, and banku — a Ghanaian dish made of fermented corn and cassava dough cooked in hot water into a paste.

Ghana 1.3
(Left to right) Kathleen Givan, Danielle Tsougarakis

Pressure Sores Targeted by Flysole

Among the myriad medical complications caused by diabetes, pressure sores of the feet are among the most troubling. Because of the common  complication of peripheral neuropathy, people with diabetes are often unable to determine how much pressure is being exerted on their feet. As a result, they cause foot ulcers, which can become infected, leading in the worst cases to amputation.

pressure sores
The Flysole combines an insole with five sensors (top) and an ankle band (bottom) to house the electrical components, including the circuit for the pressure sensors as well as the microcontroller and SD card to log the pressure data.

One of the senior design teams from the Department of Bioengineering at the University of Pennsylvania developed a project to address this problem. Their solution was Flysole (right), a prognostic implant that diabetic patients can wear to collect data on foot pressure so that the doctor can prescribe an optimal orthotic to prevent sores from developing. The team was named one of the three winners of this year’s competition.

The team, which consisted of Parag Bapna, Karthik Ramesh, Jane Shmushkis, and Amey Vrudhula, designed the Flysole as a lightweight insole with ankle band paired with software that generates a profile of the pressure on the sole of the patient’s foot. The insole has five sensors to collect these data. The cost is approximately $75 per pair.

In addition, the team made the Flysole to be reusable by including a polyurethane laminate sleeve for the individual patient. Future improvements envisioned by the students include improving the software to include recommendations for orthotics and alternate arrangements for the sole sensors.

Project Builds on Breast Cancer Screening Tech

breast cancer
An embedded 11×11 cluster of 100-micron objects (which models a cluster of microcalcifications — one of the earliest indicators of breast cancer). (A) shows the results from the current standard of imaging only along the chest wall. (B) shows the results of our method that considers the patient’s unique breast geometry using a Custom V imaging pattern. (B) resolves the embedded cluster as a distinct cluster of objects while (A) appears to blur the final image.

Breast cancer continues to affect more than 10% of all women — and a small percentage of men — despite significant advances in diagnosis and treatment. While a majority cases today can be successfully treated, early detection is essential to beginning treatment before it’s too late.

Among the more recent innovations in screening has been three-dimensional mammography. However, this modality has lacked the ability to personalize the scan to the individual patient’s breast, instead only acquiring several two-dimensional images along the chest wall, resulting in a lack of individualization for the patient.

A senior design project team at the University of Pennsylvania’s Department of Bioengineering, however, has helped to develop a more personalized 3D imaging technology, which acquires a series of images but instead following the contour of the breast itself. With their efforts, the team earned one of the three awards given to student teams yearly.

The four-student team, consisting of Lucy Chai, Elizabeth Kobe, Margaret Nolan, and Sushmitha Yarrabothula, picked up a project begun last year (a common practice with senior design projects) and demonstrated with their work that the imaging technique could be applied using a digital phantom (a computerized breast model) with great clarity, including successful resolution of a simulated mass just one-tenth of a millimeter in size.

Now, the four seniors will hand off the project to another team, continuing this multi-year research. Ultimately, before it can be applied in actual patients, the modality will need to be tested against the current standard of care in terms of its ability to detect small masses in the breast. Nevertheless, this year’s team moved the ball downfield significantly.

Broad Street Run Is a Day Out for BE Students

Four students from the Bioengineering Department at the University of Pennsylvania participated in this year’s Blue Cross Broad Street Run, which was held on Sunday, May 7, in Philadelphia.

broad street run
(left to right) Melissa Schweizer, Mike Patterson, Kyle O’Neil, Margaret Schroeder

The four students (right) ran the annual event, which begins at Broad Street and W. Fisher Avenue, in the Logan section of North Philadelphia and runs almost the entire length of Broad to the Navy Yard in South Philadelphia. Broad Street is one of Philadelphia’s main thoroughfares and runs 11 miles along the city’s north-south axis. This year was the 38th year that the Broad Street Run has taken place.

“The Broad Street Run is one of the greatest Philadelphia running traditions,” department chair David Meaney, PhD, said, “and it is remarkable that our students would take time from their finals for an ‘easy’ ten-mile run — remarkable but not surprising.”

Cataract Surgery Instrument With an Eye on India

Cataracts are a leading cause of vision loss worldwide. In the world’s more developed countries, laser is commonly used for cataract removal. However, in much of the developing world, lasers are expensive or difficult to acquire. In these countries, cataract surgeries are still largely performed freehand, with all of the attendant risks that such procedures involve.

One of this year’s senior design projects in the Department of Bioengineering at Penn was a surgical tool for ophthalmic surgeons to perform capsulorhexis, the fancy term for the circular incision necessary to remove a cataract. The team, which included seniors Akshatha Bhat, Nimay Kulkarni, Steven Polomski, and Ananya Sureshkumar, collaborated with the Aravind Eye Hospital in Puducherry, India, created a surgical device called the Rhex to create this round incision

A) The Rhex (top), compared to forceps (center) and a scalpel (bottom); B) Rhex inserted into a model eye.

The Rhex (right) consists of a stem with a ring at the end, into which a blade is fitted. It can be inserted into a scleral incision, pressed, and rotated to perform the capsulorhexis. Initial testing indicated the Rhex could create a circulation incision approximately 6.7 mm in diameter, with eccentricity (indicating deviation from a perfect circle) of 0.254±0.08, which was within the acceptable range determined by the team.

The students designed the Rhex to be autoclavable and to use disposable blades. The next step will be to decrease the size of the instrument further and perhaps to use translucent or even transparent material to produce newer prototypes, which could be particularly useful, since cataract surgeries are open performed using backlighting.


Design Project Offers Help for Parkinson’s Patients

ShuffleAssist demonstrated by a student

With increasing age in the population, Parkinson’s disease has become increasingly common. One of the most frustrating effects of the disease is freezing of gait (FOG), in which a patient will suddenly stop while walking and find it difficult to begin again. Falls are a common consequence.

Despite intensive research, FOG is poorly understood. However, studies have shown that certain external stimuli, including metronomes and devices that provide visual cues, can be helpful. With this knowledge, a team of bioengineering students set to tackle this issue with their senior design project.

The team whose members were Priyanka Ghosh, Fiona La, Laurel Leavitt, and Lia Lombardi — came up with ShuffleAssist, a wearable device that uses force sensors and an internal measurement unit to detect FOG and automatically provide a cue for the patient. The patient can choose a metronome beat or visual laser cue that can be provided either as determined by the device or continually, for patients who so choose.

ShuffleAssist tested well among normal subjects, detecting FOG correctly 98% of the time within approximate one second. In addition, the students were able to create their prototype for a cost of $107 per unit, compared to similarly intended products already on the market costing more than twice that much.

The next step for the team is to test the device in actual patients with Parkinson’s. The students have left the device with a faculty member in the Perelman School of Medicine who treats patients with motor disorders. This faculty member will offer the device to patients for testing.

See below for a video demonstration of ShuffleAssist.