None of these innovations will individually revolutionize health care in Central America or Africa, but together they amount to a radical departure from the top-down initiatives that the World Health Organization has prescribed for decades. Gomez-Marquez calls it “supply chain arbitrage” — modifying existing materials to improve people’s lives today.
“The gridlock that exists in public health is ridiculous,” he argues. “Do you try to change the whole system, or do you work within the system and try to usurp it with technology?” Gomez-Marquez believes that modifying a pill bottle — and helping locals to do so for themselves — is a powerful way to change the ground rules of health care.
Over the past few years, Gomez-Marquez — without a professorship, doctorate or even a bachelor’s degree — has converted some prominent researchers, including Harvard Medical School virologist Lee Gehrke. “The DIY stuff that Jose does forces us to think that you don’t have to do things expensively,” Gehrke says.
And Gomez-Marquez is having fun doing it on the cheap. “I don’t know many people who can buy a lot of toys with their lab budget,” he says, handing his school credit card to the cashier. “It drives the MIT accountants crazy.”
Born to Build
The unlikely career of Jose Gomez-Marquez began with the distinct likelihood that he would die. Medical technology — or the lack of it — was to blame. In 1976, he was born months ahead of schedule at a hospital in Honduras, prematurely induced because the doctors didn’t have ultrasound and assumed his mother was carrying twins. His intestine collapsed as he took his first breath, requiring immediate surgery. “My family was on the fence about whether to let me live,” he says. “My grandfather was the director of the hospital, and basically said, ‘We’ll bury him in the morning.’ ” They bought the boy a coffin.
The surgery was successful. But his body was fragile, giving him ample opportunity to observe Central American health care firsthand as a child. He became interested in health care gadgets and, eventually, decided to become an engineer. A Rotary Foundation scholarship funded his way to Georgia Tech, Oglethorpe University and then to Louisiana State, where he was studying mechanical engineering when Hurricane Mitch struck in 1998. “The hurricane decimated Honduras,” says Gomez-Marquez. “It also decimated my parents’ finances.” He and his sister (who was also studying in the U.S.) would have had to go home, but the American government offered refugee status to all Hondurans giving them the right to work.
At about the same time, a conversation he had with some Honduran friends provided the impetus to persevere in the U.S. “They were well-off, not in the position we were in,” he recalls. “Their moms and dads ran the country, and they were going to be the captains of industry.” The group was chatting about what technology could do for development, and Gomez-Marquez remarked that simply by installing a CD-ROM in a small village, you could provide a whole library of resources. “They all said, ‘Why would you want to do that? All you’re going to achieve is that they’ll know what they can never have.’ ” As soon as the conversation ended, Gomez-Marquez turned to his sister and remarked, “I knew there was a disparity between the classes, but they really don’t give a shit about the poor.”
Without the family wealth his friends enjoyed, Gomez-Marquez ended up quitting college for a series of marketing jobs, falling back on the computer skills he’d picked up in high school. By 2001, he was earning enough to save a little money. But he was deeply unhappy, frustrated to be drifting ever further away from engineering.
"Do you try to change the whole system, or do you work within the system and try to usurp it with technology?"
In 2004, Gomez-Marquez moved to Boston to study engineering at Worcester Polytechnic Institute. He supplemented his savings by temping. A few businesses wanted to hire him as a full-time marketer, but he resisted. He scoured the city for engineers who shared his ideals. He found them at an MIT meetup in 2005.
It was a gathering for an annual contest then called the MIT IDEAS Competition, in which teams tackled big problems in the developing world. Nonprofit organizations in fields ranging from public health to water management presented problems that might be addressed with technology. Teams could choose any problem, or come up with one of their own based on what they saw in the news. The team Gomez-Marquez joined decided to crack the problem of vaccinating children for measles without a needle. His team’s solution was to nebulize the vaccine with a bicycle pump. Unlike injections, which require more skill to administer, an aerosol system delivers the vaccine through inhalation and can be operated by anyone with minimal training. Their concept won the competition’s Lemelson-MIT Award for International Technology.
Gomez-Marquez entered again in 2006. The new challenge was of a different order: To treat tuberculosis effectively, a daily dose of medication must be administered consistently for at least six months. But the symptoms disappear much sooner, so many patients stop taking their pills midcourse. They then suffer a relapse far more difficult to treat than the initial infection. (As with all bacterial infections, not finishing treatment allows some tuberculosis microbes to survive, evolving resistance.) In many developing countries, the standard solution has been to send community health workers into villages to verify patient compliance. But absenteeism is high. According to a study conducted in India, for example, health workers skip work 43 percent of the time. Another study suggested 88 percent of nurses at some remote clinics were MIA during work hours. The challenge posed to Gomez-Marquez and his colleagues was to ensure that more patients took the full course of meds.
For the non-government organization (NGO) that brought the challenge to MIT, the obvious approach was to improve management of community health workers through some kind of logistical software. Gomez-Marquez was skeptical. “I realized this was no longer the romantic ideal of workers devoted to community health,” he says. “It was people not wanting to do their job.” He and his teammates probed deeper, learning that the medication makes patients’ sweat and urine redden.
“That’s what did it for us,” he recalls. “What if we could remotely track whether people’s sweat or urine was red?” They found reagents that would chemically react with the urine of someone medicated for TB, turning blue on contact. Spots of the substance were selectively applied to a strip of filter paper printed with numbers; medicated urine would highlight some of the digits but not others. Supplied with these cheap paper diagnostics, the patient could text these codes daily to a central database and be rewarded with cell phone minutes for doing so.
The NGO was not pleased — the team essentially created a workaround that made the community health workers they were funding irrelevant. “They took it as an affront,” says Gomez-Marquez. But the judges loved it, giving Gomez-Marquez his second Lemelson award. “To me, that was great because it’s inventing something that challenges the establishment,” he says. “It’s using technology to hack the system.”
At about the same time that Gomez-Marquez was working on the tuberculosis challenge, MIT was developing an Innovations in International Health program (IIH). The fledgling enterprise needed an organizer willing to work as a volunteer and scramble for funding. “Jose was really good at finding strategic partnerships,” recalls Laura Sampath, who was managing MIT’s International Development Initiative at the time. “Also, he’s particularly gifted at problem identification. He sees problems differently from the beginning, and then he’s able to see the problem through to a solution.” With two Lemelson awards behind him, and a willingness to do practically anything, Gomez-Marquez was appointed IIH director and given a lab.
It was actually a small storage space next to a loading dock, but the exposed pipes served as makeshift racks from which he could hang his TB diagnostic filter papers to dry. “The lab was a simulation of the developing world,” he remarks. “I realized that if we could make diagnostics in a place like this, we could make them anywhere.”