My 150-hour experience is working on a Bass Connections team, specifically the Pocket Colposcope Project, which is described as an analysis of bringing elements of referral services to primary/community care. The Bass Connections Pocket Colposcope team is an extension of the Duke Center for Global Women’s Health Technologies. The Pocket Colposcope is a novel cervical cancer screening device that is low cost, portable, and makes the cervical cancer screening process painless. The project’s aim is to evaluate the barriers to the implementation of this device in low-income community health settings throughout rural Peru. Despite being a highly preventable cancer, cervical cancer still affects 500,000 women worldwide each year. The current care paradigm includes: 1) screening in a community care setting, 2) confirmatory diagnosis by colposcopy and biopsy in a referral setting and 3) treatment for screen-positive women in a facility equipped for such care. Up to 90% of women can be lost at each stage of the follow-up process, especially in medically underserved regions. Overall, this experience is incredibly innovative and exactly the type of work I want to pursue.

For this project, there are three main workstreams: the policy implications, clinical acceptability, and cost-effectiveness of bringing the device to community health providers in the Andean region of Peru. The policy workstream works to understand the political climate in Peru and the regulations relevant to our medical device. This workstream is also in charge of understanding the policy mechanisms and payment systems in place that might affect implementation, such as insurance codes that determine how providers get paid for services. Our ultimate goal on the policy side is to devise a strategy to ensure that the health policies in Peru enable the Pocket will become an acceptable screening device. The Pocket is currently FDA approved in the United States, but needs to be approved by Peru’s regulatory body, Digemid. So far, I’ve be involved in preparing the Digemid application, such as compiling relevant testing, finding certified translator services to translate our documents in a way that meets the requirements, understanding the licensing needed for the application, etc. Preparing the Digemid application has been a full team effort because it is a necessary first step to implementation that needs to happen before we can focus on other barriers. The acceptability workstream focuses on stakeholder assessments to understand the less formal barriers to the device being accepted in Peru. Stakeholders include the doctors, midwives, nurses, community health workers, and other providers. The last work-stream is cost-effectiveness, which aims to understand the economics of the Pocket in the Peruvian low-income context, including how providers are reimbursed and what to charge for the device so that it is a sustainable model. My team will be leveraging the frameworks developed in past years and continue with developing a strategy for widespread scaling. Once the Digemid application is completed, I will take on a more specific role in the cost-effectiveness workstream due to my background in economics and work in finance. Responsibilities for this will include research and analysis into the market size, cost base, and what margin is necessary for sustainability. It is a small team, so while we get assigned workstreams to focus on, each person acts more as a “jack-of-all-trades” worker to ensure everything that needs to be done gets done, similar to a start-up.



One of my learning objectives for this project is to gain hands-on experience working in a small team to implement an innovative technology. Through this experience, I hope to better understand some common barriers to implementation and the nuances of technology acceptability. In some of my I&E coursework, I learned about common barriers that might need to be overcome to successfully commercialize a technological innovation, but this experience provides insight into the reality of such a process. For example, obtaining Digemid approval is much more complex of a process than the application first appeared, and is nuanced with different licensing, translating, and other approval requirements, as well as difficulties managing the project budget. Ultimately, I will know if I achieved this learning objective if I come away from this experience being able to explain a high-level overview of such barriers, including the ones that might not be the most obvious on paper or in a classroom. My team is planning to together a presentation at the end of our project to cover what we learned and worked on, which will be a good test of whether I have achieved this learning objective.

I am pursuing the Social Innovation & Policy pathway through the I&E Certificate. I chose this experience because it really epitomizes applying what I have studied in my coursework to a real problem. First, this project relates to my Social Innovation class because the project has clear positive social goals and through this work our team has the potential to make a real impact on women’s health. In order to be successful, my team has to make sure we really understand the local context, which is a major lesson I learned in my Social Innovation class. To this end, my team is working directly with Peruvian organizations and stakeholders to really understand the care continuum in low-income community health settings in the Andean region of Peru. Secondly, this project is very related to what I learned in my Technology Commercialization class. In fact, I first heard about the Pocket Colposcope through that class and wrote a paper analyzing the device. Because this project is dealing with a novel medical device, I am able to apply a lot of what I learned in this class, particularly regarding patents and licensing, regulation, and stakeholder analysis. This experience relates to my overall Social Innovation & Policy pathway because it is a great opportunity to work on the implementation of a real innovative product in low-income community settings. As is often the case with social innovation, the actual implementation of innovations is much more complex than it seems with unexpected barriers and consequences. This is a great opportunity to gain hands-on experience learning how to approach such complex problems and use human-centered design to construct appropriate solutions with the aim of positive social change.



The artifact I will use for my e-portfolio is the final presentation that my team makes to give a comprehensive overview of what we worked on in regard to the three workstreams (policy, acceptability, costing). This presentation will go in depth into the analyses we performed and conclusions we found from our work. The team has done this for the past three years of the Bass Connection cycles, and each presentation has provided a great foundation for the next year’s team to understand what has been done and what still needs to be accomplished in order to fully implement the device.