Discussion, Recommendations, and Conclusion - Medical Devices and Biomaterials for the Developing World - page 86

international bodies have recognized the importance of equipping facilities to treat
diseases that impact the developing world. This strategy is consistent with the goal
of integrating care of infectious diseases into primary health care, particularly in
areas where specialists are lacking. Evaluation of inventories (using a metric such
as the MTS) and testing of biomaterials for clinical use should use this concept as a
guide by prioritizing treatment of conditions that contribute significantly to mortal-
ity in specific regions.
Agriculture
The feasibility of corn- and soy-derived materials, each of which is developed from
a product of a naturally occurring organism, was the subject of Chap. 5 . Maize is
among the largest crops (in terms of production) in Ghana. While the soybean is not
produced on a commercial scale, Ghana has access to this crop via regional trade
within West Africa. Nicaragua's internal access is more limited because of a need
for nearly complete conversion of crop products into food, but the nation has access
to additional quantities (much more than Ghana) via trade within Mesoamerica and
with the United States.
The availability of these materials via agricultural production, similar in many
ways to the in vitro biocompatibility of their derivatives with clinically relevant cells
lines, is only the gatekeeper to a number of criteria that must be met before the nec-
essary agriculture-to-health conversion becomes viable (Fig. 6.2 ). The extraction of
PLLA from starch, processing of PLLA via electrospinning, and manufacture of
implantable devices using PLLA are all capabilities that would need to be present in
order for the corn-derived materials discussed here to become usable for clinical
applications. An additional concern is whether the clinical procedures that would
make use of these materials occur frequently enough to make the in-country manu-
facture of such devices economically feasible (excluding the possibility of produc-
tion for export, which comes with its own challenges).
A majority of the agriculturally derived household income in Ghana comes from
crop production. On the other hand, agricultural household income in Nicaragua is
more diverse, resulting from a mixture of crops, livestock, and wage employment
(Table 3.5 ) . This reflects the slight distinctions between the economies of the two
nations. Furthermore, it suggests that a crop-targeted strategy for linking the agri-
cultural and health sectors might have more impact in a country like Ghana. In both
the public and private sectors, Ghana has a lower median availability of essential
medicines (WHO 2012), making it an interesting candidate for a pilot version of the
strategy described above. Consideration of such factors must be included in a strat-
egy for the industrial manufacture of biomaterials, which should be coordinated
among all of the affected sectors in each country.