Department of Chemistry, University of Toronto e-Distillations

Wheeler Group at Kakuma Refugee Camp in Kenya

Taking a technology from the lab bench to the field is never a minor task – and this is especially true when the field in question is an isolated refugee camp in East Africa. Yet, after developing a technology that they knew had the potential to make a positive impact, this is exactly what four members of the Wheeler Lab did, traveling to Kakuma Refugee Camp in Kenya for four weeks in May-June 2016.

At Kakuma, the team put their home-built DropBot digital microfluidics devices to work, testing for measles and rubella.  On board for the effort were PhD student Julian Lamanna, postdoc Alphonsus Ng, postdoc Ryan Fobel and research associate Christian Fobel – a small subset of a larger team of more than a dozen responsible for bringing the project to life.

“It was an enormous challenge,” Professor Aaron Wheeler says of the effort to build up the infrastructure and quality control systems necessary so that their devices were robust and usable in the field, halfway around the world without access to the tools and resources available in the carefully controlled environment of a university laboratory. “I knew this was going to be a risky thing to try,” he says, “but to our amazement everything worked and we were able to do all the tests.”

The technology in question emerged from work that Ng began during his PhD, developing an immunoassay for rubella as a proof-of-principle test.  The system relies on only a pinprick of blood, and uses single-use, printable credit card-sized devices safely contained within a cartridge, which are subsequently inserted into a shoebox-sized instrument for fluid manipulation and analysis.

“I think it is every researcher’s dream to develop a technology that can make a positive impact in someone’s life,” says Ng.  The team applied for a Grand Challenges grant, and soon found themselves in partnership with the US Centers for Disease Control and Prevention (CDC), with Kakuma Refugee Camp identified as the target field location.

There are many practical benefits to their diagnostic platform. Because it is a point-of-care device, keeping the samples refrigerated until they can reach a laboratory is not a concern, and it is much simpler to collect only a pinprick of blood.

At Kakuma, many of those being tested were children, some as young as 9 months. “It is actually very difficult to get an appreciable amount of blood,” recalls Ryan Fobel, “especially when it is hot and the child may be malnourished.” The level of miniaturization is also in stark contrast to the large, expensive robotic immunoassays or manual laboratory methods that are currently in use, and means that the device is quite portable.

Kakuma is one of two major refugee camps in Kenya, with a population of nearly 200,000. Accessible only by World Food Program-operated flights twice a week, Kakuma borders South Sudan and serves a large number of refugees from that country, as well as Somalia, the Democratic Republic of the Congo, Ethiopia, and other African countries. 

The realities of a refugee camp are harsh. Each day the team was escorted by emergency vehicle to a field hospital in Kakuma where they worked with staff from the CDC and the clinic, who were responsible for actually collecting the samples.  Their lab at the hospital overlooked a group of children being treated for malnutrition. Ng recalls watching their curious faces peering in the window, and how overjoyed they were when the team waved at them. “It was heartbreaking,” he says, “they have so much potential to learn and innovate but their situation and environment limits their opportunity.”

There were also challenges of a more technical nature. The very first day, they lost two pieces of equipment – one DropBot system and one transformer – due to voltage problems on the site.  They were able to fix the DropBot, but had they lost their remaining backup transformer, the team would not have been able to continue. Next-day FedEx deliveries are not something one can expect at an isolated refugee camp. Fortunately, things went off without a hitch after the rocky start and they were able to get their tests underway.

The effort coincided with a vaccination campaign at the camp, allowing the team to check for both high and low amounts of disease markers in recently vaccinated children and their caregivers.  Although their system only requires only a pinprick of blood, larger quantities were still taken to be analyzed by the central lab in Nairobi, operated by the Kenya Medical Research Institute. This will help verify the team’s own results. Months later, they are still awaiting the results from the lab in Nairobi, but having visited the site themselves, they have an idea as to why.

Although it is the national lab for Kenya, responsible for running all the measles and rubella tests for Kenya and 5 surrounding countries, the assays are run manually by a few graduate students and technicians, and the only automation in the lab is a washer for cleaning out the well plates.  Annually, the lab does 2000 tests, and the team asked them to perform an additional 600.

This further elucidates the usefulness of their diagnostic platform; not only is it a portable point-of-care device, but it has the potential to really free up laboratory resources in developing countries. The CDC recognizes this too, and their collaboration seems likely to continue.  They hope to further improve the portability and ease-of-use of their device such that it can be operated entirely by a health care worker.

Next stop? Maybe the Democratic Republic of the Congo, where measles outbreaks are still a reality. It’s pending funding, but is on their radar. With transformative advances in disease detection within their reach, if anything is certain, it is that it is an exciting time to be a member of the Wheeler Lab.

To learn more about the team’s activities, including footage from the lab and Kakuma, be sure to see the video produced by Lisa Ngo below.

By Mandy Koroniak
Posted November 8, 2016