Medical Student Project Supplies Needed Equipment
A team of Moi University medical students teamed up with visitors and staff at IU House to solve a sustainability and affordability challenge in a project aimed at improving care for people with chronic lung diseases.
The project utilizes a simple test called spirometry to measure airflow through the lungs when a person inhales and exhales. Participants use a 6-inch cylinder, called a spacer, in order to take an inhaled medication before the test. Spacers are difficult to obtain and costly in western Kenya, but the AMPATH team created more than 240 by reusing plastic water bottles.
The project, based at Webuye Hospital, is entitled, “Implementation of Quality Spirometry to Improve Diagnosis of Airway Disease in the Primary Care Setting in Kenya.” Caitrin Kelly, MD, MPH, assistant professor of medicine at IU School of Medicine, and Kenyan collaborators received a grant from the Indiana Clinical and Translational Sciences Institute to pilot integration of spirometry services in the primary care setting and train and mentor healthcare workers to conduct spirometry for referred patients.
“Spirometry is the gold standard diagnostic test and will allow clinicians to better categorize people who might have chronic obstructive pulmonary disease (COPD), asthma or some other illness,” said Dr. Kelly.
“By producing spacers locally at a fraction of the market cost, the initiative enabled more effective and accessible medication delivery during spirometry,” said Amina Mohammad, a student who worked on the project.
“Using a spacer with a metered-dose inhaler is important because it significantly improves the delivery of medication to the lungs,” said student Aisha Bereki. “When an inhaler is used alone, much of the medicine can get trapped in the mouth or throat, leading to less effective treatment and potential side effects like oral thrush. A spacer acts as a holding chamber, giving the patient more time to inhale the medicine properly and deeply into the lungs. It also helps eliminate the need to perfectly coordinate pressing the inhaler and inhaling at the same time, which can be difficult for children, the elderly, or those experiencing breathing distress.”
The spacer project grew from a dinner conversation between Dr. Kelly and the Moi medical students who were visiting Indiana University last summer. The students divided themselves into three teams: community partnerships, education and production. The spacer production involved many steps including collecting the bottles, cleaning them and removing the labels, designing and creating the right size hole and distributing the finished spacer back to clients.
Leonard Otieno, a staff member at IU House, provided valuable support in demonstrating how to make the wire loops to melt a hole for the inhaler as well as the process of assembling the spacers. He also helped to identify any issues or design flaws and guided the students in correcting mistakes and overcoming challenges during the process.
Connor Murphy, a visiting IU resident, helped to coordinate the IU House guests who assisted with taking the labels off the bottles, burning the holes in the bottles and filing the edges of the holes.
The students created infection prevention guidelines, along with written, graphic, and video instructions on how to use, clean, and dispose of the spacers. In addition to Dr. Kelly, the students received mentorship from MTRH nursing leads, Emily Nyaga, Mary Kwambai, and Dr. Imran Jahadhmy (a third-year medicine registrar) and infection control expert Mary Kay Foster and asthma education specialist Debbie Khoel.
The students were grateful for the experience. “I gained a deeper understanding of how spacers help asthma patients use inhalers more effectively and developed basic problem-solving and design skills along the way,” said Bereki. “It also made me more aware of the importance of resourcefulness and sustainability in healthcare, especially in low-resource settings.”
“One thing I’ve learned is to say yes to opportunities, even the small ones,” said Mohammad. “Be intentional, stay open-minded, and show up fully. I had the chance to work with incredible, driven people and it reminded me just how powerful teamwork can be. When we bring our strengths together, we can achieve something greater than we ever imagined.”
“Sometimes all you have to do is to show up and try to work to the best of your ability and you will be surprised by what you can learn, do, and what opportunities can open up,” said student Ibrahim Kalema. “We plan to continue making spacers for the patients in Webuye and Eldoret who cannot afford commercial options, and to identify additional local groups to produce the spacers for sale at low cost in local pharmacies,” he continued.
Research poster about the project was presented at Indiana University’s Global Health Scholars Day.
Kenyan collaborators on the spirometry project include Bungoma County Ministry of Health and Webuye Hospital leadership and doctors Jeremiah Laktabai, MBChB, MMed, and Hussein Elias, MD, MMed, with the Moi University Department of Family Medicine. Spirometry training and mentorship will be conducted with Lusweti Carolyne Khisaan, MBChB, MMed, internal medicine consultant and pulmonology researcher at MTRH, and Neelima Navuluri, MD, MPH, a Duke University pulmonology and critical care physician conducting research at MTRH with significant experience in spirometry.
Reflecting on the spacer project, Dr. Kelly said that it has been a great collaboration from everyone involved. “I think it’s really just been a wonderful way to really work across the partnership to make something happen that can improve patient care at a low cost.”
The students created a research poster about the project and have presented at IU Global Health Scholars Day and at the Undergraduate Health Research Conference by York University.
“I unlearned the belief that I have to do something grand or monumental to make a meaningful contribution to my community,” concluded student Camilla Amunga. “It starts with just one small step-helping one person, solving one problem, showing up consistently. That small impact grows over time. It spreads. Before you know it, it becomes a village and the effect multiplies.”