January 5, 2006
Engineers design nutrition delivery system for Kenyan AIDS victims
WEST LAFAYETTE, Ind. Purdue University engineering professors are building a nutritional supply chain to help fight AIDS in Africa.
Mark Lawley and Yuehwern Yih (YOU-wern YEE) say that without proper nutrition the drugs used to treat AIDS patients won't work. The two industrial engineering professors are putting together a system for food delivery that includes both flown-in dry food and locally grown produce. They are working with the Indiana University-Kenya Partnership and retired physician Dr. Joe Mamlin, who runs a dozen AIDS clinics treating 400 patients per month around Eldoret in western Kenya.
Lawley and Yih spent two weeks at the clinics in September and returned at the end of November. The two started the project as faculty fellows at the Regenstrief Center for Healthcare Engineering at Purdue's Discovery Park. The center's mission is to apply interdisciplinary principles to health-care delivery, and faculty fellows spend a semester working on solutions to large problems.
"We met Salina, Dr. Mamlin's first patient to whom he provided a nutrition supplement," Lawley says. "When he started treating her, she was so malnourished that the anti-retroviral drugs weren't working. So, Dr. Mamlin realized nutrition had to be part of successful treatment."
Lawley says Mamlin gave Salina money for food, the medicine began to work, and Salina is now healthy and robust. Mamlin then began acquiring farmland and growing fresh produce for his patients. There are now four operating farms and plans to expand.
The clinics are part of the Academic Model for the Prevention and Treatment of HIV, or AMPATH, which provides treatment for 14,000 HIV-infected Kenyan adults, as well as a program to prevent mother-to-child HIV transmission.
"The AMPATH program has farming expertise," Yih says. "What we're doing is solving operational issues to turn the flown-in dry food and produce from the food operation into a smooth system that delivers the correct amount and variety of food in an appropriate amount of time."
She estimates it will take two years to take the components and complexities of the delivery of nutrition to the AIDS patients and turn them into a smoothly running machine. When she and Lawley complete the project, she says there will be a brand new model that can be used to deliver food to other impoverished areas.
"We will eventually link the food distribution database with the patient medical record system so that nutritional researchers can study the effects of nutrition on AIDS treatment," Yih says. "To our knowledge, no one has done this before."
The program was receiving 19 metric tons of dry food, such as corn, beans and soybean powder, each month from the World Food Program to feed 2,200 people. The farms produce 800 eggs and 450 500-ml packets of milk product per day.
Lawley says there are many variables to evaluate, account for and ultimately coordinate: farm crops and production, yield and perishability; dry goods packing center operation and its weighing, packaging and tracking operations; the condition, reliability and mileage of delivery vehicles and how they are maintained; the generally bad road conditions; and distribution centers, supply chain and scheduling. The list goes on.
While the challenge sounds agricultural, Lawley and Yih say they look at the problems in terms of applying industrial engineering principles to the medical field in what's termed health-care engineering, which concerns itself with delivery of required treatments, medications and services to patients in as timely and efficient a manner as possible.
Yih was initially approached about becoming involved in the IU-Kenya Partnership by Dr. Thomas Inui, president and CEO of the Regenstrief (REE-gen-streef) Institute Inc., the Indianapolis informatics and health-care research organization located at the Indiana University medical campus.
The Regenstrief Foundation provided start-up funding for Purdue's Regenstrief Center for Healthcare Engineering in Discovery Park, the university's interdisciplinary research and enterprise hub. Lawley and Yih are both associated with Purdue's Regenstrief Center, which has supported their work with the IU-Kenya Partnership.
Yih says that while most people wouldn't initially think of applying industrial engineering methods to curing AIDS in an impoverished country, it is just what the doctor ordered.
"We can use the principles of industrial engineering to solve complex problems," she says. "This is important work that needs to be done. Purdue and the Regenstrief Center are making it possible for us to donate our time to this project."
Lawley says they learned from Mamlin that the project is even more complex than he and Yih had originally thought, and it is expanding rapidly.
"Dr. Mamlin realized that even feeding the patient properly wasn't enough. You have to feed the family, too, or the patient will share food with family members and not get sufficient nutrition for the medicine to be effective," he says. So the 400 patients represent 2,200 mouths to feed.
"And as the clinics have grown, there are questions of how to scale up the food operation and all the components that go into it."
On Jan. 1 the food program expanded to feed 3,000 patients and a total of 17,000 mouths per month, requiring 150 metric tons of food to be distributed. Also, there is more production from the farms due to an increased amount of farmland and the addition of a continuous-drip irrigation system.
Lawley says the final piece of the puzzle for the project's AIDS sufferers is the Family Preservation Initiative, which teaches former patients skills in agriculture and industry and offers "microloans" so they can start new businesses.
Kenya, located on the east coast of Africa, has a population of 34 million. According to U.S. government figures, 6.7 percent of the adult population is infected with AIDS. The population is desperately poor, with 50 percent living below the poverty line and 40 percent unemployed. Adult life expectancy averages less than 48 years.
"You don't see real suffering when you see scenes of Africa on television," Lawley says. "It has always been important to me to alleviate suffering, but I've appreciated that so much more deeply since we made the trip. We'll stay as long as they want us to."
Yih says that despite the country's impoverishment, "the Kenyan people are happy and welcoming."
And Yih and Lawley are already looking at the next phase.
Three of the professors' students are capturing all the numbers involved in systematizing food delivery and putting them in a database for future research work.
Writer: Mike Lillich, (765) 494-2077, firstname.lastname@example.org
Sources: Mark A. Lawley, (765) 494-5415, email@example.com
Yuehwern Yih, (765) 494-0826, firstname.lastname@example.org
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