Since 2018, Creating Hope in Conflict: A Humanitarian Grand Challenge has provided proof of concept (Seed) and transition to scale (TTS) funding to 75 innovations intended for use with conflict-affected populations in over 20 countries. We embarked upon a learning journey to better understand how innovative products and processes could be tested and pointed towards scale in humanitarian settings, in order to help solve some of the most complex problems and barriers within the humanitarian sector.
This post is one of many SEED Stories: a series of blogs reflecting on what HGC-funded innovators have achieved and key lessons learned during the duration of their seed grant periods.
Low-Cost Non-Electrical Instrument for Treating Large Wounds
Large open wounds accompanied by tissue loss pose a huge medical challenge in conflict zones where blasts, shelling, and building collapses regularly cause devastating physical trauma. Wounds should be left open until they develop enough blood supply for safe closure, and close medical management is required to ensure that patients do not develop infections or complications.
Negative pressure (NP) suction is a proven method for treating large wounds, but current methods make the practice unfeasible in conflict-affected settings. The current standard for NP wound therapy uses electrical devices that cost between $3000 and $20,000 CAD, with each patient requiring a dedicated device and treatment monitoring. In conflict settings with large casualty numbers, the use of NP wound therapy is practically impossible for various reasons, including poor power supplies, funding shortages, insufficient hospital bed capacity. Without proper treatment and medical attention, infected wounds rapidly progress to become life-threatening. Preventing large-scale loss of life caused by large wounds in conflict settings requires improved methods for efficient treatment and infection control that can be deployed at scale in contexts with relative resource scarcity.
How Pragmatic Innovation Tackled this Challenge
Pragmatic was awarded a $250,000 CAD seed grant to test and develop a low-cost manually powered vacuum pump known as PragmaVAC to help accelerate the treatment of large wounds in conflict zones. An air-tight dressing is placed over the wound and attached to a manually operated suction pump and drainage tube, facilitating the efficient healing of acute and chronic wounds while preventing infection. PragmaVAC is also a single-use disposable device that does not require maintenance, servicing, or electrical supply, making it cost-effective and accessible in conflict-affected settings. It also reduces the burden on healthcare systems by requiring less time for wound dressing changes and fewer patient visits to healthcare facilities.
Seeing promise in their innovation, CHIC provided seed funding to Pragmatic to finetune PragmaVAC and test its effectiveness in Syria and Palestine where conflict-driven displacement, wounds, injuries, and related surgical trauma are commonplace. After transforming the workbench prototype into a fully functional medical device, Pragmatic conducted a series of randomized controlled trials that produced remarkable results. During the CHIC funding period, a total of 71 patients benefited from life-improving wound care, having their injuries effectively treated and closed with PragmaVAC. Primary outcomes included:
- A 60% reduction in the duration of wound healing to an average of 15.3 days using PragmaVAC compared to standard treatment methods
- An almost 70% reduction in the number of required dressing changes from an average of once every 1-2 days (0.73/day) to one per 4-5 days (0.22/day)
By reducing dressing changes, PragmaVAC was also shown to improve patient compliance and reduce pain scores. Trials provided further evidence that PragmaVAC can be effective in chronic diabetic wound care, having achieved remarkably quick rates of wound closure in the patients studied. Most importantly, PragmaVAC was widely reported as being easy to use, which improves the likelihood of its widespread adoption even in compromised healthcare settings.
Over the course of their CHIC funding period, Pragmatic established numerous promising partnerships. To execute their pilot in Syria, Pragmatic partnered with Union of Medical Care and Relief Organizations (UOSSM) Canada, which purchased and distributed $24,178 CAD worth of NP wound treatment dressings and drapes to treat the most vulnerable patients with open and/or chronic wounds in Northwest Syria. In Palestine, Pragmatic worked with MedGlobal USA to pioneer the implementation of PragmaVAC in two hospitals. Followingthe CHIC grant period, Pragmatic also received interest for the PragmaVAC from an NGO working in humanitarian response in Ukraine, who ordered 1,000 devices 2,000 dressings for use in the country’s conflict-affected regions.
On the supply-chain side, Pragmatic:
- Signed a deal with a local manufacturer (Kabalcioğlu) in Gaziantep, Turkey for serial production of PragmaVAC at a very reasonable cost
- Met with several medical technology companies to discuss potential collaborations on production and new channels for securing high-quality components at a lower cost
- Engaged with other potential end users by pitching their innovation to representatives from relevant humanitarian organizations; this has led to new requests to purchase and implement the innovation in new geographies
Key lessons learned from Pragmatic’s seed grant include:
- Revolutionizing the status quo for emergency medical treatment in conflict-affected settings by (a) introducing a low-cost, low maintenance medical device to a resource constraint context; (b) decreased pressure on local health systems and reduced exposure to infection; and (c) improved patient pain management
- Addressing barriers of funding and logistical complexity, , while locally scaling supply lines for cost-efficient production thereby demonstrating good value for money
Pragmatic is actively working to deploy PragmaVAC in Ukraine and has shipped 1,000 PragmaVAC devices to the country to pilot. Given the promising results achieved during the seed grant, CHIC has also awarded Pragmatic Transition to Scale funding to scale up PragmaVAC across target populations in Syria and Palestine while expanding the company’s development of new innovative wound treatment technologies. Pragmatic is now:
- Working on developing the second generation of PragmaVAC, which will be enhanced with ‘smart feedback’ features and an online server to support caregiver decision-making and early intervention
- Continuing to harness market feedback to improve the PragaVAC’s design and ergonomic features, such as ease of use, portability, and compactness
- Exploring new products, such as portable chambers of hyperbaric oxygen that can be used in conjunction with PragmaVAC in certain cases (in addition to negative pressure wound treatment)
- Focusing on establishing their own private specialized diabetic foot ulcer clinics, first in Syria and Palestine, and later in other countries.
Long term, Pragmatic’s goal is to make PragmaVAC the standard of care for at least 50% of open wounds in the southern hemisphere.