Kenya pilots Paper Analytical Device to identify counterfeit drugs

Story and photos by Jessica Campbell

Reporting by Jessica Campbell and Allylah Msenya

ELDORET, KENYA — At the Moi University Teaching and Referral Hospital (MTRH), it is not uncommon to see the same patient more than once. But what if it is not sickness causing the patient to return to the waiting room once a week? What if it is because the drugs given do not actually contain medication?

The supplies needed to run a Paper Analytical Device for counterfeit drugs.

The supplies needed to run a Paper Analytical Device for counterfeit drugs.

In a 2005 survey conducted by National Quality Control Laboratories, 30 percent of all drugs distributed to the public were counterfeit. Counterfeit drugs are a huge problem.

But now a device called the Paper Analytical Device (PAD) is being piloted in Kenya by the pharmacists employed at the MTRH.

The device provides an easier, faster and far less expensive way to assess the drug’s authenticity, and provides a more sustainable schedule for taking and keeping track of one’s medication.

The main method for testing counterfeit drugs is to use a high performance machine. It’s a technology that cannot be found in Kenyan hospitals.Because it cost nearly $500 to test a batch of drugs with this method, there was virtually no way to determine if an imported pharmaceutical was genuine. A cheaper screening system has been sorely needed.

The PAD, designed and manufactured at the University of Notre Dame in Indiana, is a small, easily transported paper-based device that costs about 40 cents to manufacture in the U.S. Testing with the PAD is done on an individual basis, with one drug at a time.

The tester takes a pill and scrapes it horizontally across the paper, leaving the pill’s residue. The PAD is then placed in a small cup of water, which ignites a reaction between the water and chemicals constructed within the pad. The water rises slowly, producing various colored lines. Each color represents a substance inside the pill.

Currently, the PADs are only being used to test a few specific drugs, such as Amoxycillin, Ampicillin and Acetaminophen. There is also a separate PAD designed to screen tuberculosis drugs.

As of now, the PAD is being made in Indiana and shipped to Kenya. At the MTRH, pharmacists on the project are collecting samples of the drugs, testing them, and then taking photographs to send back to Notre Dame for validation.

One of the managers working on the PAD project in Kenya, Mercy Maina, views the device as progress for the health and well being of many patients throughout the world.

“When you see someone [a patient] after giving them medication and they do not improve and you find out it might actually be the medication, it is very frustrating,” Maina said. “We are hoping to change that with this project.”

Maina describes the project in two parts, optimization and validation.

“The optimization is just talking about making it [PAD] better in terms of the format, its sustainability and testing that out,” she said. “After we optimize the test we hope to validate it because there is no way to guarantee the results yet.”

According to Maina counterfeiters increasingly dilute the amount of active ingredient in the drug by adding fillers.

“Counterfeiters are evolving with us,” she said.

The resulting Paper Analytical Device after running a counterfeit test on an antibiotic drug.

The resulting Paper Analytical Device after running a counterfeit test on an antibiotic drug.

If the drug has been tampered with, the colors that are supposed to appear when tested show incorrect intensities.

Unfortunately, the PAD only tests the quality of a counterfeit drug, not the quantity of fake substances, so the degree to which counterfeiters have tampered with the pills cannot be determined by those testing the drug.

“It is not less accurate, it just won’t tell you the exact amount of the foreign substance,” Maina said. “That is why we are promoting it as a screening device now.”

Ashley Scott, a master’s student in global health, worked on the PAD project while a Notre Dame. She is currently in Kenya teaching other pharmacists and students how to conduct and accurately read the tests.

“What is great about them [the tests] is that you do not need any pharmaceutical expertise,” she said. “It takes about an hour for others to learn how to use the PAD.”

But with so many people testing, the interpretations of the PAD results can be diverse. Removal of the bias is the next step in making the device more stable. In the future, the tester will take a photo with a cell phone and send it to a link established on a universal website. Then computer software will analyze the test and send back the result. The software will also confirm any results deemed positive or negative that may have falsely been identified.

Maina said the tests work fairly well, with less than 10 percent of them giving false indications.

Sonak Pastakia, a pharmacist working with AMPATH, brought the idea from Notre Dame to Kenya. AMPATH is the Academic Model Providing Access to Healthcare, a consortium of ten North American universities lead by Indiana University in partnership with Moi University and the MTRH.

“I loved the idea and thought it could dramatically improve the situation with regards to counterfeit medication detection,” he said, “Ever since I set foot in Kenya and realized how incredibly difficult it is to treat patients when you can’t trust the products you are giving them, I have wanted to convert the technology to Kenya.”

Patients can lose trust in their doctors when they are given drugs but do not get well. according to Maina.

“You can die, there are people who have had serious allergic reactions and it affects the larger public health spectrum,” she said. “Why the hell should a patient trust me as a public healthcare provider if the drugs I am giving them are counterfeit?”

Once the distribution of the PADs expands, which Maina said she hopes is by the end of the 2013 year, the members on the project hope to expand the technology of the paper-based devices to other uses, such as evidence testing.

For those patients on medication, teaching them how to test their own urine may allow them to monitor their condition more accurately.

“You ask people, ‘are you taking your drugs?’ and they say yes, even when they aren’t” Maina said. “So, I can tell you to pee in a cup and I can test for the certain drugs and tell if you are or are not taking the drugs.”

Maina said patient in the future could test themselves at home, then text or send in a sequence of numbers generated by the test that would confirm whether the prescribed drugs are being taken.

“Creating specific pads for specific drugs and diseases, that is where we are going in the future,” Maina said.


Food program termination decreases security

Story and photos by Jessica Campbell

Reporting by Jessica Campbell and Allylah Msenya

ELDORET, KENYA — Weighing in at 32 kilograms, or about 70 pounds, Emily Meli registered as a HIV-positive client of AMPATH, and added her name to a list of more than 30,000 families receiving food prescriptions in addition to the antiretroviral drugs that also treat her infection.

In early 2012 Meli visited Module Four of the AMPATH center and was handed a four-pound package of cornmeal. But when she returned, two months later, she was given nothing.

Emily Meli awaits in her home for her family after attending a GISE group in her home town of Kepseret, Kenya.

Emily Meli awaits in her home for her family after attending a GISE group in her home town of Kepseret, Kenya.

AMPATH is the Academic Model Providing Access to Healthcare, a consortium of ten North American universities, lead by Indiana University in partnership with Moi University and the Moi Teaching and Referral Hospital (MTRH), both located in Eldoret in western Kenya.

From 2005 to 2012, AMPATH had partnered with the World Food Program (WFP), to provide food to the clients and families of clients living with HIV. That ended when the WFP greatly reduced their funding last year.

The program was initiated after AMPATH workers realized that the antiretroviral medication given to those living with HIV was not properly treating malnourished clients.

With the decline of the donated food necessities, the importance of nutrition and diet has increased among clients and their families. The result has been a greater dependency on supplemental food, a higher number of diagnoses of communicable diseases and an increase demand for education about sustainable practices for growing and providing food.

The WFP funded program had delivered about 250 metric tons of food per day to individual clients of AMPATH. The goal was to support an entire family of one HIV positive client while creating more long-term food secure situations through education. A family was considered “food secure” when its members no longer lived with hunger or fear of starvation.

Now that the WFP has reduced it’s funding of the program, food donations are given only to the HIV positive client, not the entire family.

“Before we used to cover them almost like a blanket and ensure food security,” said Jennifer Kigen, the assistant nutrition manager of AMPATH, “but now we are only dealing directly to the clients.”

Nutritionists and doctors working at AMPATH must now assess a patient on a scale of malnourishment-mild, moderate or severe-based on the person’s Body Mass Index rating, height, weight and size of the middle upper arm. Photographs are taken before and after the start of treatment to track his or her progress. Each client of AMPATH is given an identification number and card, and all interactions with the program is documented and recorded at the center.

A client is then issued the only two supplements. Its all AMPATH has available to distribute now that WFP is gone. The primary contribution from WFP is Plumpynut, a therapeutic feed given more commonly to children, and corn-soy blend (CSB), a special type of flour containing specific nutrients and minerals.

Plumpynut, a gel like supplement made of powered sugar, peanut paste, skimmed milk power, vegetable oil, vegetable fat, vitamins and minerals, is given to severely malnourished children. It is distributed through the government in Nairobi by the U.S. Agency for International Development (USAID) and is sent to Eldoret for AMPATH’s use.

Tekla, an AMPATH client who asked that we do not use her last name so as to remain anonymous, recently found out her status after taking her nine-year-old daughter, Joy, to the hospital for chest pain. She and her daughter both tested positive for HIV and received Plumpynut and CSB rations.

“We eat any time we get, food usually ugali (a cornmeal staple of the local diet) or a mixture of corn and beans,” Tekla said. “We have a small farm so we are able to grow food to eat or sell, but we cannot sustain her [Joy] diet without dairy or meat.”

Because the virus made the child severely malnourished, the therapeutic food was immediately administered and just the one package a day has improved her weight.

“It depends on the age,” said Mary Chelimo, a pediatric nutritionist at AMPATH. “Children six to 23 months take one packet, but as a child gets older they can take two or three a day. For mild to moderate levels of malnourishment, we give the corn flour supplement.”

Originally, the WFP distributed CSB in certain amounts to specific groups of clients, such as pregnant or lactating mothers, young children and teenagers. Though it has decreased, the WFP program continues to provide about 19 pounds for mothers and adults, and 13 pounds for children ages two through seventeen years.


AMPATH nutritionist, Mary Chelimo, advises proper nutrition and diet to clients of all ages living positively with HIV.

AMPATH nutritionist, Mary Chelimo, advises proper nutrition and diet to clients of all ages living positively with HIV.

Mothers to be, and those currently lactating are special cases in terms of dispensing therapeutic feed. It is recommended that mothers either choose to breast-feed or formula feed their baby for six months without changing methods. According to Chelimo, before 2007, all children were on formula to decrease the chance of spreading HIV through breast milk. Because the percentage of children surviving up to six years old was low, breast-feeding only while on medication for six months is now recommended.

“I can say when children were on formula most mothers were not all faithful,” she said. “They were mixing feeds, maybe giving milk, formula, porridge because they did not know there was a difference.”

After six months, mothers can begin to switch from formula or milk and begin therapeutic feed if necessary.

The Plumpynut packages, cost AMPATH 300 Kenyan shillings, ($4), are free of charge to the clients. They are given to families on a weekly basis, for a maximum of three months, unless adequate weight gain is not achieved.

One of the problems of the therapeutic feed is that it is not an entire meal replacement; it only corrects the body, it does not completely sustain it said Chelimo.

Malnutrition among those taking ARVs is the largest problem Chelimo and her colleagues face.

For Emily Meli, inadequate amounts of food result in more severe side effects from her ARV therapy.

“I am taking the drugs, but without the correct amount of food it is hard,” she said. “The drugs make me weak and sick.”

Before the drugs, Meli was able to plant and harvest produce from her farm regularly, but now that she’s on medication she cannot work due to the persistent dizziness, and frequent coughing, chest pains and spitting up blood.

Another problem the nutritionists at AMPATH see is the sharing and distribution of the free supplements to one’s entire household and others throughout town. If a food insecure mother is given supplemental feed due to her positive HIV status, the probability she will share the feed with family members is very high.

Kigen described the situation as useless, especially if it is the mother living with HIV.

“The mother goes home and one or many of the children are malnourished, she will definitely share and it would not be adequate according to our prescription or according to the dietary allowance,” she said. “So, it poses a great challenge for us… You cannot help, because they [the mother] go back to their homes and share.”

With the introduction of antiretroviral treatment, the discovery was made, that without adequate food the medication for HIV is far less effective.

Before initial ARVs are issued, the first thing measured is the nutrition of the client. Because the drugs and side effects are very strong and can last for weeks, the guarantee that nutrition is available is important to the doctors and nutritionists.

Without adequate food to go around, advice is the only other thing that can be distributed to clients.

Chelimo said they make sure the person receiving the ARVs has knowledge of good nutrition and is aware that the drugs will not work without food.


Even for food secure families, knowledge and education is the first step taken in assessing patients. At the Moi University Teaching and Referral Hospital, the nutritionists working with diabetes and hypertension preach good nutrition through posters and pamphlets given to all of their patients. Diabetes and hypertension are two common diseases in the Eldoret area.

Chelimo, who works exclusively with HIV-positive clients at AMPATH, may have one diabetic person per month, but has a difficult time working with him or her because of the restricted diet they must adhere to.

“You can get a patient with HIV, diabetes and cancer, so we have to sit and come up with a decent meal plan,” she said. “We have to look at diet, blood sugar, and CD4 count.” CD4 count is an indicator of the HIV virus’ impact on the body.

At the MTRH, where a patient’s HIV status may or may not be disclosed to the doctors, most of the patients seen in the nutrition office are known to have been diagnosed with diabetes and hypertension. Though the majority of the patients are food secure, they still lack the knowledge of how to maintain proper nutrition for optimal health.

Type 2 diabetes is the most common type seen by the officers working with the hospital patients. Found in both teenagers and adults, it more frequently affects women than men. It is caused by obesity or stress. Type 1 diabetes can be present at birth or developed during childhood. Type 3 diabetes is induced diabetes, usually developed in adults during pregnancy and among people with dangerous highly blood sugar levels.

A Diabetes Care Diary is given to all diabetic patients so they can track their blood sugar at home for three months. The diary helps the doctors see how patients is doing and teaches the patients how to control the disease and sustain themselves.

Helen Chemoiwo, a nutrition officer working at the MTRH, says nearly 75 percent of all of her diabetic and hypertensive patients are overweight.

“Family history and improper nutrition are the main causes of diabetes and hypertension,” she said. “They just do not know much about proper amounts and how to track their blood sugar.”

According to Chemoiwo, education about exercise and diet is the only way to help prevent these diseases. She recommends regular exercise, such as walking, jogging, and cycling to help maintain proper weight.

At MTRH, the doctors are focusing on preventative techniques, reaching out to individuals and entire villages at a time. They make home visits along with workers doing HIV testing in homes to check the blood sugar of clients.

Deborah Tulienge, an officer of the Chronic Disease Management office at the MTRH, said they are setting up blood sugar readings in towns throughout the region to test people as well as to teach them about how to control and prevent diabetes.

“We do a lot of education,” Tulienge said. “The city worker cannot just go up to a house and prick. They first bring a lot of information on prevention, diet and exercise.”

Preventative care is the number one focus for the CDM office. For those already diagnosed with diabetes or hypertension, prevention of further complications is the next step Tulienge said.

The CDM office began training workers during the past year to go out and screen patients in towns throughout western Kenya, at several clinics that are closer to villages, but far away from the hospital and AMPATH center.

Every few months, physicians and nutritionists travel to each of the clinics to check on patients and reinforce that everyone is being well taken care of.

“We used to think diabetes was a rich man’s disease, but it is not,” she said. “Down in the rural, life has its own stresses that will pre-expose them to these conditions. They are eating what they have on hand and find they are still predisposed to diabetes because it is not a balanced meal.”


A harvested gourd lays in the farm of Emily Meli in Kepseret, Kenya.

A harvested gourd lays in the farm of Emily Meli in Kepseret, Kenya.

Working with the Kenyan Ministry of Health, Tulienge said the officers go to the clinics to teach, and encourage people to grow their own fruits and vegetables to sell and to eat themselves, so they can get a secure meal.

“We educate them and train them on how to grow vegetables,” she said. “We also tell them that they should find ways of making money by planting fruits and selling their fruits.”

For most families, farming and producing their own vegetables and fruits is the only option. Now confronted with this realization, AMPATH has made it a mission to help families and those living with HIV and other communicable diseases become more sustainable food producers.

In the wake of the termination of the WFP donations, Moses Makaya, the nutrition manager at AMPATH, said lessons have definitely been learned from the loss of food support.

“Our focus now is to teach people how to fish and show them where the lake is,” he said, “instead of us just giving people food.”

Programs, such as farming training sessions and Group Integrated for Savings Empowerment (GISE), have been established throughout the local towns promoting a more supportable lifestyle for those unable to afford much.

Specific groups are organized that put together people suffering from similar conditions. There are groups for those who are HIV positive, who are caring for orphans and vulnerable children, who are diabetic patients and so on. The sessions occur from every week to once a month, and provide a dependable teaching atmosphere.

Monica, a mother of five children, lives with her own mother and has to travel many miles by motorcycle to get to the AMPATH clinic every two months. She receives her ARVs each visit and a small bag of CSB.

“I get a little flour when I come to the clinic,” said. “I am able to plant. I grow beans and corn at home.”

According to Chelimo, who worked with Monica when she first came to the clinic, Monica was very weak but has made huge progress during her seven months of treatment. She has learned how to farm and grow her own food.

“I have three meals a day,” Monica said, “The main is rice or ugali. I have milk, meat and eggs and vegetables too.”

With the elimination of the food from the World Food Program in 2012, the amount of pressure to help care for the patients and clients of the MTRH and AMPATH center increased within a couple of months.

Chelimo describes the ending of the donations as a huge blow when the program pulled out, but said there is another way to look at it.

“It helps everyone in the long run to become more self-sufficient,” she said. “Yes, it is a big blow, but maybe some will wake up now and start to look for ways to help their families because organizations cannot feed you forever.”

IU Swimming holds 8 new “unofficial” records

Unofficial, yet legit.

The Indiana University swim team competed in an unofficial swim meet at the Counsilman-Billingsley Aquatic Center Thursday night, setting 8 “unofficial” world records in men and women mixed relays.

The team was racing to establish world records of mixed, men and women, freestyle and medley relays in short and long course meters (SCM, LCM).

The records will not be official until certified by the Federation Internationale de Natation (FINA).

For proof of swims, the pool was measured before and immediately after the meet and the swimmers were drug tested throughout the night.

Eric Demlinger and his assistant work for Bledsoe Riggert Guerrettaz a land surveying organization in Bloomington, Ind.

“We were called to measure the pool before and after,” Demlinger said. “It has to be immediately after

to certify the records.”

Demlinger measured each individual lane, for 25 and 50 meters, making sure the measurement stayed within 3 cm.

“We had to do it touchpad to touchpad,” he said. “It was hard because it was underwater.”

The meet was an informal match-up against IU and local swim teams such as, Councilman Center Swim Team, Bloomington Swim Club and Martinsville Swim Club.

Coach Ray Looze came into the pool without exact line-ups, but excited for the event.

“We kept it on a down-low to other teams,” he said. “We didn’t want them to know, because these records will be short-lived.”

The events consisted of the mainly focused events, the mixed relays, but also women and men only relays and individual events.

Allie Day, a junior, said the meet was “a once in a lifetime opportunity,” for herself and everyone who competed.

“It let me feel like a world record holder,” she said. “which is an awesome feeling.”


New FINA World Records Set:

Hoosiers compete for 8 new world records in  LCM and SCM relays.

Hoosiers compete for 8 new world records in LCM and SCM relays. Photo By Jessica Campbell

4×100 LCM mixed freestyle relay

Lindsay Vrooman, Kait Flederbach, Steve Schmuhl, Jackson Miller – 3:45.38

4×100 LCM mixed medley relay

Allie Day, Mike Hurley, Tanner Kurz, Haley Lips – 4:13.47

4×50 SCM mixed medley relay

James Wells, Cody Miller, Gia Dalesandro, Olivia Barker – 1:49.87

4×50 SCM mixed freestyle relay

Bailey Pressey, Stephanie Armstrong, Tanner Kurz, Cody Miller – 1:41.16

4×50 SCM women’s freestyle relay

Stephanie Marchuk, Claudia DiCapua, Audrey Scott, Grace Padget – 1:54.97

4×50 SCM men’s freestyle relay

Cody Miller, James Wells, Matt Gerth, Philip Butler – 1:36.81

4×50 SCM women’s medley relay

Grace Padget, Heather Hayes, Bailey Pressey, Claudia DiCapua – 2:04.34

4×50 SCM men’s medley relay

Curtis Goss, Blaine Nichols, Kyle Johnson, Tanner Kurz – 1:50.07

-Photos, and Tweets and Instagram pictures were all provided live during the event by Jessica Campbell

Indiana Diving Club wins team title at national championships

IDS Reports

POSTED AT 11:29 PM ON Aug. 19, 2013


Four IU divers joined together to form the Indiana Diving Club and took the overall team title Sunday at the AT&T USA Diving National Championships in Iowa City, Iowa.

The Indiana Diving Club featured IU graduate Amy Cozad and seniors Kate Hillman, Darian Schmidt and Conor Murphy. The group won three silver medals and a bronze medal during the six-day competition, with a total score of 244 points. Second-place Miami Diving finished with 97 points.

Saturday’s events included Cozad taking silver in the 10-meter platform. After competing in the World Championships in Barcelona, Spain, last month, Cozad earned second with 340.45 points. Hillman finished eighth in the event with a score
of 266.45.

The duo of Murphy and IU graduate Casey Johnson finished third in the 10-meter synchronized event Saturday, scoring 321.15 points. Taking fourth place in the synchronized event were sophomore Andrew Hull and junior Danton Rogers with a score of 281.28.

Schmidt also competed Saturday, finishing fourth in the 3-meter springboard event with 441.15 points.

IU’s divers capped the competition Sunday with strong performances from Schmidt, Cozad and Hillman, as each took home silver in his or her events.

Schmidt, along with teammate Michael Hixon, totaled 385.26 points in the 3-meter springboard synchronized competition. Cozad and Hillman also contended as a synchro event on the platform with a score of 286.08 points to take home silver. Both teams finished just five points from first place.

Murphy also ended the meet with a sixth-place finish in the 10-meter platform event with a score of 372.90.

For the overall individual titles, Schmidt took fourth place and Cozad finished sixth.

Jessica Campbell

Yogafest embraces cold weather

By Jessica Campbell | IDS

POSTED AT 08:01 PM ON May. 12, 2013  (UPDATED AT 10:01 AM ON May. 13, 2013)

Despite the chilly wind, cloudy skies and cars whizzing by their “studio,” the devoted participants at Saturday’s Yogafest were not deterred from their practice and support for Pets Alive.

At 9 a.m., an unprecedented installment of Bloomington Yogafest began its day on the lawn of the Monroe County Courthouse.

The festival, coordinated by Ingrid Skoog, owner of the Art of Connection and Charlotte Walker, the Pets Alive development and communications director, acted as a fundraiser for Pets Alive.

The day was broken up into hour-long yoga practices with live music and demonstrations at 11 a.m. The events officially concluded at 2 p.m.

As part of Be Kind to Animals Week, the festival was organized to raise money for Pets Alive’s low-cost spay and neuter services.

The bridge between Skoog and the yoga community with Pets Alive was established in the planning of the Dancing with the Celebrities event later this month.

“We are bridging yoga and the community with Pets Alive for an inspiring combination,” said Skoog, a long-time yoga practitioner. “Pets Alive is an extraordinary organization. All proceeds we received today went to them.”

Divided into four sections, the lawn was split into different styles of yoga, taught by various yoga instructors from Bloomington studios.

Yoginis from Vibe Yoga, Know Yoga Know Peace, Yoga Mala and Mukti Yoga volunteered their time and expertise for the festival.

Georgia Boonshoft,a recent graduate of the Jacobs School of Music, is an instructor for Know Yoga Know Peace and participated in Saturday’s activities.

“This is the highlight of my month,” Boonshoft said. “It is a great mix of teachers and styles here.”

Skoog said she was surprised that despite the cold temperatures, the turnout was sizeable.

Walker said she agreed, confirming the future plans of making the event an annual yoga festival.

“(Yoga) is a pretty big hobby in the community,” Walker said. “There are a lot of yoginis in Bloomington and it definitely seems like people are interested.”

In addition to the yoga sessions, tables were set up in the yard presenting donated items for a silent auction. There was also a box welcoming donations for Pets Alive.

The animal shelter offers low-cost spay and neuter services to animals in the Bloomington area, as well as over 20 more counties in southern Indiana.

“We want to expand our services to more counties and get pets new and other services,” Walker said.

In each yoga session, an instructor recommends devoting the practice to a person or thing.

On Saturday, the participants were asked to devote his or her practice to the lives of animals and the problem of over-breeding.

Incorporating yoga, the festival addressed a serious issue with a fun and powerful activity.

Christine Eartheart, a participant and teacher during the festival said she  believes in the powers of laughter and joy and uses them within her yoga practice.

“Joy is in every being,” she said. “It has no boundaries.”

Though Saturday was the last day of Be Kind to Animals Week, those working at Pets Alive still advise people to make donations in support of animals.

Those who wish to make a donation can visit the Pets Alive website,