Fellow Spotlight: Josh Coyle BreathAlert Study Malawi

Rice360 Institute for Global Health Technologies offers post-baccalaureate fellowships for exceptional early-career engineers with an interest in medical technology for low-resource settings. During their time as Rice360 fellows, they become part of our international teams and often travel to support the development of Rice360 supported projects.


Recently, Rice360 fellow, Josh Coyle, went to Malawi to work with our colleagues at Queen Elizabeth Central Hospital on BreathAlert. The following is his account of his time in Malawi. This article has been cross-posted on NEST360.org.

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BreathAlert Project

The BreathAlert project seeks to provide reliable, accessible respiratory monitoring for premature infants no matter where they are born. The device empowers caregivers to detect, diagnose, and treat respiratory illnesses which often occur in small and sick newborns and can cause disproportionate harm in low-resource settings.

When I joined Rice360 as a fellow nearly a year ago, I recognized this as one of those rare chances to combine my skills and passion into a cause that unequivocally matters. I had aspired for an opportunity like this since high school; and I had spent my years at the University of Washington working to become qualified for it. Joining Rice360 meant moving from aspiration to action. The transition required frequent confrontation with challenges, but soon the process of improving the BreathAlert became truly rewarding. A few weeks ago, it culminated with a study in Malawi.

During my first few months at Rice360, we completely redesigned BreathAlert. Our team made a cautious leap to an entirely new sensor design, straying from one that had been in development since 2014, when undergraduates conceived the device.

The next few months were defined by meticulous questioning, testing, and questioning again. If this sensor is too bulky, will it still detect the smallest baby’s smallest breath? If that cable is too long, will we lose the signal? And what if it is too short? The uncertainties compounded. I approached them with the best of my technical ability, often meeting my limits and relying on teammates in Houston, California, and Malawi for support.


Figure 1.The BreathAlert’s progression since 2014. The original design is shown on the left, the most recent optical design is shown in the middle, and the newest design with a different type of sensor is shown on the right.
















Figure 2. Rowland, David, me, and Prince in the QECH office.


BreathAlert Team in Malawi

In May, it was finally time to put this effort to the test in Malawi. We aimed to compare BreathAlert’s performance to the gold-standard patient monitor used in the US, which costs upwards of $3,000 per unit. We had, for months, coordinated and planned our study with Rice360’s Malawi-based team entirely over Zoom. I worked with Prince, a nurse at Queen Elizabeth Central Hospital who enables all things clinical for our studies in the neonatal ward. Maureen, my counterpart in Malawi and the first woman engineer from her hometown. We also worked with Rowland, another Malawi-based colleague and one of the first graduates from the newly-minted Biomedical Engineering department at Malawi University of Science and Technology.

Before I left Houston with two other Houston based fellows, we built four polished prototypes, wrapped them in copious amounts of bubble wrap, and stowed them gingerly in our suitcases. After a blur of layovers, melatonin, and excitement, I found myself seated at the long wooden table of the Rice360 office at Queen Elizabeth Central Hospital (QECH) in Blantyre. Prince, Maureen, Rowland, and my Houston teammates sat around me. Outside, a rooster crowed, and the afternoon sun shone across the table, confusing my internal clock – it was roughly bedtime in Houston. Finally, our conversations were no longer limited by bandwidth or battery. We quickly transitioned from technical talk to that of our lives, customs, aspirations, and mutuality. Soon, an environment filled with newness and firsts began to feel familiar.

Enrolling participants and watching the prototype work!


So much of Rice360’s success has been due to partnerships built in-country. As we kicked off our study, I was able to rely upon these partnerships. It was my first time in a neonatal ward, and as I busied myself with feigning a sense of calm and collectedness, Prince and Maureen were busy making this significant milestone a reality. Prince tactfully conversed with a new mother about enrolling her child in our study. Before long, we had consent to enroll our first newborn. Maureen nimbly constructed our complex setup, and soon, our device was monitoring an infant’s breathing.



Figure 3. Maureen testing out study setup. The pink and green stickers on the BreathAlert sensors help us to count breaths visually.


I stared at the BreathAlert as the cyclic breath signals rolled across the screen. I looked at the small infant at the end of the cables as she breathed life into the last year of testing, stakes, and teamwork. As the pressure and novelty of the moment began to wear off, I was left with the realization that it worked. The device was working. This type of innovation for the greatest need with the greatest constraint is possible. These revelations were tenable now in a way they could not be in the lab or conference room.

We went on to enroll five participants in the BreathAlert study in Malawi. Now in Houston, I am busy analyzing data while we work towards the goal of a CE mark within the next few years.

Looking towards the engineering challenges ahead, I know the second year of my fellowship will be as demanding as the first. However, as I’ve come to find my place in the network of incredible people behind the BreathAlert project, I’ve learned that its these partnerships which can differentiate between aspiration and action in global health innovation. Together, I know we can deliver for the smallest and most vulnerable among us.