Mtonga Invents Solutions

Eighty percent of medical equipment in developing countries is donated,” says Timothy Mtonga (PhD ’20), “and only 10–30% of it is ever operationalized.” Shortages of skilled technicians and spare parts are only part of the story—many devices are already broken when they’re donated.

Growing up in Malawi, where his mother and sister are nurses, Mtonga had seen firsthand the piles of dusty, abandoned machines. As the pandemic made medical oxygen scarce, Mtonga took another look at those devices to engineer new ways to help people breathe. His OpenO2 project launched in August 2020 to resurrect oxygen concentrators across Malawi. The concentrators are portable electrical units that purify oxygen from the atmosphere and deliver it through a nasal cannula or face mask.

Compared to compressed oxygen cylinders, says Mtonga, “Concentrators provide an infinite and more sustainable oxygen supply.” They also cost less. A cylinder might last eight hours before it has to be refilled by a technician at a cost of $82; a concentrator can run indefinitely on just $2/day in electricity.

Trained as a software engineer, Mtonga now develops affordable information technology interventions to improve health care delivery in low-resource settings. As a Pitt Med master’s student, Mtonga worked with Gerry Douglas (PhD ’09), Pitt assistant professor of biomedical informatics and of health policy and management, and Arielle Fisher (PhD ’17) to build RxMAGIC, a pharmaceutical inventory management system at Pittsburgh’s Birmingham Free Clinic.

For his dissertation, Mtonga returned home to develop and pilot a computer on wheels (COW) at Kamuzu Central Hospital in Lilongwe. Clinicians use the COW to update electronic health records, order lab tests and review results from a patient’s bedside. This is a first-world health care approach, says Douglas, who was Mtonga’s PhD advisor and directs Pitt’s Center for Health Informatics for the Underserved. “There’s no other hospital in Africa that has what he has implemented.”

Mtonga defended his dissertation by videoconference in April 2020. In May, he was hired to direct the Global Health Informatics Institute (GHII) in Lilongwe, founded in 2015 by Douglas and his spouse, Thuy Bui, Pitt associate professor of medicine and director of the Internal Medicine Track in Global Health and Underserved Medicine. OpenO2 is a center within GHII.

Mtonga initially envisioned OpenO2 as tech support: Identify the makes and models of concentrators, aggregate the product manuals, write repair guides and post it all online for free (www.openo2.org). That approach extended a project Mtonga oversaw in 2019, when he mentored an engineering intern at GHII who was developing a generic control board, the most common (and expensive) source of failure among oxygen concentrators, which are also used to treat pneumonia, emphysema and COPD.

When a second COVID-19 wave was cresting in Malawi in February 2021, the OpenO2 team—five technicians and four interns with bachelor’s degrees in engineering—began site visits to hospitals around the country. They hit the road in a donated bus retrofitted as a mobile workshop. At each hospital, they analyze and certify every concentrator, repair what they can and scavenge parts. At this writing, they’ve visited 35 hospitals and repaired 310 concentrators. “Enough to support 1,800 adult patients or 9,000 pediatric patients with a continuous flow of oxygen for one week,” says Mtonga.

In Lilongwe, the team tests fixes for common problems they see in the field. They developed a hand-held analyzer for clinicians to spot-check unit performance. They also devised a way to pair concentrators to meet the high-flow needs of severe COVID-19 patients.

This spring, Mtonga fielded inquiries from people in Nigeria and Ghana hoping to replicate OpenO2. “We’re not just helping our people,” he says. “We’re sharing and helping to solve a global problem.”