One pebble at a time

Patience, determination and seeds of change in Ghana

According to the World Health Organization,1,500 women die every day due to complications of pregnancy or childbirth. The vast majority of those deaths happen in developing countries – and most are avoidable.

When University of Michigan student Joseph Perosky went to Ghana for the first time in 2008, he wanted to figure out what he could do to change those numbers. Perosky and the other members of his Global Intercultural Experience for Undergraduates (GIEU) cohort watched how Ghanian hospitals and clinics approach maternal care, and Perosky brought back an idea for a senior design project – a portable pelvic exam table that could be folded and carried in a backpack.

Perosky has been back to Ghana every summer since – developing, testing, refining and seeking manufacturers for equipment he hopes will someday help health workers save lives. But he’s also learned that if change were easy, it would have happened already. He’s become wiser, more patient, more determined. He’s wary of romanticizing the work he does in Ghana because it can be deeply frustrating at times. Mothers and babies still die. There’s a long, long way to go. But he’s committed to the journey.

“When you’re trying to make a change, you’re building a mountain one pebble at a time,” said Perosky. “I wanted to do so many things so quickly, and a lot of the reason things are the way they are is because things have been built up over time.”

No ordinary Joe

Perosky, now a graduate student in biomedical engineering, has long been interested in healthcare, particularly in regions of the world where resources – money, doctors, supplies and equipment – are scarce.

As an undergrad he helped found a student-run nonprofit, United2Heal, that gathers surplus medical supplies from hospitals and ships them to places where they’re needed. So far two major shipments have gone to Ghana, and one to Tanzania. Smaller shipments have also been sent to Haiti, Cuba, Guatemala, Iraq, Jamaica, Nicaragua, and Peru.

Perosky grew up in Sterling Heights, in a family that walks the walk when it comes to serving others. His mom, he says, was always involved in service programs at their church, and always dragging Joey and his two younger sisters along. So when Perosky got to Michigan, he channeled his interest in global health into a minor in gender and health through the Women’s Studies program. As a sophomore he took what is still his favorite class at U-M – Introduction to women’s health.

“It really opened my eyes to a lot of things going on in the U.S and globally in women’s health – specifically in reproductive care,” he said. “The gap in access to care resources, the difference in quality of care… Based on that class – I talked a lot with (instructor) Lisa Kane-Low and some of the other midwives in the School of Nursing – for a while I was going back and forth between midwifery and going down the MD route.”

Midwifery offered the clinical care setting he loves, but ultimately he decided he could make a bigger impact as a physician. He plans to start applying to medical schools in June.

In the meantime, Perosky has combined his engineering studies and his passion for designing things with the healthcare needs he’s seen abroad. He became the first student in the Global Health Design specialization of Michigan’s Multidisciplinary Design minor. Last summer the program sent a cohort of nine students to Ghana.

“In the background there’s always the question, ‘Why are things like this, and how can we change that?’ “ Perosky said. “It’s not necessarily to make the change myself, but to try to empower some of the women who don’t have a voice.”

Digging deeper

In Ghana, it’s not uncommon for a woman to travel 5-6 hours from her village just to reach a district hospital. As a result, most reproductive healthcare takes place in villages, in clinical settings that are often makeshift at best.

Maternal deaths in Ghana range from 500-1,000 per 100,000 births. That’s not the worst rate in Africa, but the U.S. rate, by comparison, is seven deaths per 100,000 births.

When he returned to Ghana with the exam table prototype in 2009, Perosky gathered feedback and suggestions from midwives and doctors in hospitals and clinics, then visited two villages to examine how it might fit into the actual cultural setting for which it was designed. He talked with mothers, daughters, midwives, family members and community healthcare workers and found that every perspective brought something to the design.

“One thing that stands out is his openness to embracing the extremely important non-engineering aspects of doing work in these areas,” said engineering professor Kathleen Sienko. “After that first trip he came back and went through doula training. From the standpoint of having an engineer who’s willing to immerse themselves to that extent in the process, that’s amazing.”

Perosky peer-mentors a group of students who are designing a reconfigurable labor and delivery bed, and last summer he had a chance to pass some wisdom on to the latest group of Global Health Design students.

“It’s one thing to sit in a classroom in Ann Arbor and talk about the value of getting local perspectives on a design,” Sienko said. “It’s another to go and do it – to directly engage with another culture, in another country, on another continent, in order to achieve a design that will work.”

Perosky told students: “’Take in everything possible; write down everything possible, because when you come back you’re not going to have that access. When you talk to people in these settings, there’s a huge takeaway.”

Spreading knowledge, saving lives

The exam table went through another round of evaluation last summer, and Perosky plans to submit his findings in the International Journal of Service Learning in Engineering.

Meanwhile, he also designed a simulator to train birth attendants to manage post-partum bleeding, which is responsible for a quarter of maternal deaths in sub-Saharan Africa. Perosky’s simulator lets birth attendants practice compressing and massaging the uterus with their hands to control bleeding – a simple physical measure with huge potential impact, since most women give birth at home, far from the uterotonic drugs and medical equipment needed to stop the bleeding. Without intervention, they can die in a matter of hours.

A system of switches and LED lights tells the trainee if they’re applying the right pressure in the right places on a neoprene model of a uterus. As with the exam table Perosky was able to use his time in Ghana to make the design meet the need, running workshops with nurse midwifery students, practicing midwives and traditional birth attendants.

He spent part of his most recent visit to Ghana looking for materials and manufacturing capability so his devices could be produced close to where they’re needed. Perosky published his findings in Simulation in Healthcare, the journal of the Society for Simulation in Healthcare, in August. He’s applied for a Fulbright fellowship in hopes of spending the year before medical school in Ghana, working on childbirth simulation.

“Everyone we’ve worked with wants things to change,” he said. “They want their mothers and daughters and sisters to stop dying; they want them to have better access to care. It’s really (about) meeting everyone where they are so we can work together.”

Amy E. Whitesall is editor of Global Michigan’s Explore Magazine and owner of Active Voice Media.