José Gómez-Márquez, 32

Gómez-Márquez and a team entered the IDEAS competition again the next year, this time focusing on strategies to improve drug compliance in tuberculosis treatment. Though TB can be treated with antibiotics, the disease killed 1.8 million people in 2007, according to WHO estimates, and 9.3 million new cases were diagnosed the same year. One of the biggest challenges in treating TB is making sure that patients stick with the lengthy course of medication required to clear the infection from the body.

A number of new technologies for monitoring drug compliance are being tested, but most of them rely to some degree on self-reporting; for example, patients may be given a phone number to call when they've taken their medicine. "I was the cynic," says Gómez-Márquez. "Patients had no incentive to tell us if they didn't take their drugs." His team developed a simple paper-based test that can be used in conjunction with an incentive program. The test strip is made from layers of coffee filters impregnated with chemicals that react with metabolites of the TB drug in urine, revealing a unique code. The patient texts the code to a central database every day to earn cell-phone minutes. The team launched a trial of the system in Karachi, Pakistan, earlier this year.

Amy Smith, cofounder of the International Development Initiative at MIT, was so impressed with Gómez-Márquez that she hired him to run the Innovations in International Health program, also at MIT, in 2007. He has since built a network of collaborators in countries around the world who can tell him about their populations' health-care needs. That kind of consultation, which lies at the heart of Gómez-Márquez's philosophy, reflects a growing trend in the field of appropriate technology: collaborating early on with the people who will use the devices. "José is really at the forefront of that," says Catherin­e Klapperic­h, director of the Biomedical Microdevices and Microenvironments Laboratory at Boston University. "Who is the customer, what do they want, what are they willing to use? You can't assume the answers--that's one of the things José teaches his students and his colleagues."

No toys: Gómez-Márquez is working on a number of new inhaler technologies for use in poor countries. A disposable cartridge for inhalable vaccine (top left) could make it easier to inoculate children against measles. A plastic helicopter (top right) inspired a new approach to delivering asthma medicine to children. And a paper spacer (center) to use with inhalers provides an easy and disposable way to get more medication into the lungs.
Credit: Steve Moors

Gómez-Márquez aims to push this approach even further by encouraging physicians and scientists in poor countries to design their own devices. He is now creating development kits for medical technolog­y--sort of like Erector sets for medical professionals--which will initially be used in Nicaragua. The kits will enable doctors and medical students to devise diagnostics, drug delivery devices, microfluidic chips, and more.

At least, that is the theory. But will busy medical professionals find the kits helpful? Are they too complicated to use or--c­onversely--too simple to yield u­seful technology? Gómez-Márquez and his students brought some to Nicaragua over the summer to find out. His hope is that the kits will help a new culture of invention take root. In the long term, it's this kind of approach that could truly revolutionize both medical care and technology in poor countries. --Emily Singer