From the Magazine Healthcare International Affairs

The Global Healthcare Revolution Will Be Technologized

Illustration for Techonomy by Jon Han

Tech innovations are helping improve healthcare in places with few resources and immature health systems.

Githurai in southern Kenya is known for its hot sun and high crime. About 11 miles away from the outskirts of Nairobi, much of Githurai is off the electrical grid. So residents typically don’t have reliable access to lighting to help them feel safe at night, or clean water and energy to power healthcare systems round-the-clock.

In Githurai, if a pregnant woman needs to deliver her baby at night, she must travel to a medical facility with electricity more than 13 miles away. Sometimes, the distance and the logistics are too great and minor complications turn serious—or fatal.

So the community wanted to install its own healthcare facility with 24-hour water and electricity. To do that, it turned to something Githurai already had: the sun.

Collaborating with Dutch healthcare innovator Philips, neighborhood residents and officials co-created a Community Life Center (CLC) that runs primarily on solar power. That energy supply is strong enough to refrigerate vaccines and medicines, run laboratory equipment, connect to the internet, and light the area.

As a result, the number of patients treated in Githurai has increased from 1000 per month before the CLC was installed in 2014 to around 4,000 per month—a 400 percent increase.

“If we want to strengthen the health system, then we need to start at the community level,” says Eddine Sarroukh, head of Philips Research in Africa, who adds that more than three-quarters of patient deaths occur in such local facilities. “We need to make sure that the access to primary care is in place, because that is the key for global development.”

The message is clear, then: globalized health care depends upon localized health care. So instead of endlessly shuttling patients, doctors, and supplies back and forth across long, sometimes unnavigable, and often dangerous distances, why aren’t we doing more to apply exponential technologies to bypass them?

Besides solar-powered clinics, other technologies are also helping prove scalable change is possible in under-resourced facilities around the world. They include 3D printing, virtual reality, and new forms of telecommunications.

To get to Gumdi, Nepal from Kathmandu requires a long drive and can mean braving monsoon-induced mudslides and oftentimes impassable roadways. A disastrous 7.8-magnitude earthquake devastated the region in 2015, compounding the challenges of maintaining supplies and devices for the region’s basic health service, Health Post. Until recently, when Gumdi needed a replacement part to fix a medical suction pump, for example, it faced a three-week delay.

Nonprofit Field Ready is bringing 3D printers to resource-challenged regions to make medical supplies and
repair devices on demand. Courtesy of Field Ready

But then Chicago-based nonprofit Field Ready brought in a solar-powered 3D printer. Now it can model and print the part on-site in just one hour. Partnering with the World Vision International Innovation Lab and other humanitarian initiatives, Field Ready harnesses the maker movement to localize production in low-resource countries like Nepal, Syria, Kenya, Myanmar, and Haiti. It prints umbilical cord clips, IV hooks, tweezers, kidney trays, and replacement parts for broken medical and other equipment. It even can 3D print prosthetic hands.

“We’re taking manufacturing and putting it where it’s needed, rather than using a long supply chain that’s expensive, cumbersome, and slow,” says Field Ready Director Eric James. “It’s hyper-local manufacturing.”

According to James, supply-chain logistics eat up almost two-thirds of medical aid budgets. And manufacturing supplies locally saves costs not only in transportation, but also in actual production. In Nepal, for example, the device that doctors use to look inside people’s ears, known as an otoscope, costs from $35 to $150. But the cost to 3D print one is only $7, explains Field Ready innovation advisor Ben Britton.

“Humanitarian supplies made in the field build resilience in the system,” he says.

Another tool drastically shortening the supply chain is drone technology.

Silicon Valley-based Matternet is testing its drones for medical deliveries in several countries, including here in Malawi. Courtesy of Matternet

In Bhutan, Papua New Guinea, Malawi, and the Dominican Republic, Menlo Park-based startup Matternet is starting to use unmanned aerial vehicles to expedite the transport of diagnostics like pap smears and HIV and tuberculosis testing. Some of these countries have only a few testing facilities nationwide, and it can sometimes take months to transport samples to and results from the lab. That delays urgent treatment and care.

Drones can bring that time down to less than a week, says Matternet cofounder and CEO Andreas Raptopoulos, and, in the not-too-distant future, as little as a day.

According to Raptopoulos, drones promise to be a “transformation technology for logistics,” because their efficiency creates a “leapfrog” effect, much as cell phones did in communications at the turn of the century. This translates into decreased cost and potentially widescale impact.

“The system is fully electric and the components are mechanically simple. Most of the complex things are in the software,” says Raptopoulos. “So you have systems that are much more cost-efficient than a slow truck on a bad road.”

Long distances inhibit not only supply-chain logistics, but also professional training and knowledge sharing. To remedy this, Médecins Sans Frontières (MSF) is tapping into telehealth and virtual reality technologies.

For its operations around the world, MSF uses VR to train logistics staff to build new modular hospitals, geeking out in state-of-the-art fashion by combining VR helmets and 360-degree visualization to create immersive experiences.

According to Elvina Motard, MSF’s technical team leader, VR helps the organization “be operational faster,” by engaging staff with the hospital environment and teaching space-management skills before it’s time to construct. And while VR speeds up construction, it doesn’t compromise long-term sustainability: MSF’s modular prefabricated hospitals take just three weeks to build, Motard says, but last at least 30 years.

“We want them to be deployed fast, we want them to be high quality, and we want them to last long,” she continues. “Virtual reality technology is used on site to show the people how.”

After a successful pilot in the Philippines in 2016 with a 3D VR model, MSF is using similar technology for projects in South Sudan, Mauritania and Haiti.

MSF is also using telemedicine to connect more than 300 projects around the globe, however rural and remote, with the best specialized medical expertise at any time.

The organization’s remote platform, called Intersectional Telemedicine, fields about 200 clinical cases a month, with the help of human coordinators like Daniel Martínez, a pediatric and vaccination advisor with MSF in Geneva. These coordinators analyze incoming medical questions, determine their urgency, and match them with a qualified expert (taking into consideration medical background, language skills, and understanding of the local context).

When an expert receives an alert, which Martínez says is “like a 911,” they then reply using the same platform within a specified timeframe.

This system not only saves the time and money of sending a physical team to each site, but MSF gets additional value from the data it aggregates. “We find out how to solve one case in one country, and it gives us a clue as to how to solve it in other places, too,” says Martínez. With this data, MSF can analyze which diseases are most in need of additional expertise and can also improve guidelines for MSF support staff.

Printing underway in Haiti (above) and Sudan. Courtesy of Field Ready

Field Ready, too, is working to build local knowledge and expertise. It’s focusing on increasing capacity in the many countries where it operates, by training community stakeholders how to use 3D printers in ways that make sense for them.

“We’re certainly not showing up with 3D printers and saying, ‘Look, isn’t this cool?’” says Director James. “Instead, we’re finding ways to help them sustainably maintain the projects they have.”

Rather than entering a community with preconceived notions of what it needs, James says, Field Ready partners with people on the ground to listen to their concerns and make an assessment, collaborating with them from the beginning.

“We believe there’s a huge human component to this. It’s about working with people,” James says. “We’re not just going out there to fix one thing; we’re training people in all of these different methodologies and technologies.”

Field Ready also hopes its solutions can help other communities around the world by ensuring any knowledge gathered is iterative.

To that end, Field Ready shares open-source electronic files of its 3D printing designs so that anyone can use, adapt, and benefit from them—and someday make a living. “We’re trying to support 3D printing to be a viable business here,” says Field Ready’s Britton from Nepal. “That’s the way it’s going to be sustainable.”

He says that when India shut down the India-Nepal border in 2015, it shut off Nepal’s lifeline. The blockade put millions at risk, leading to violent protests. “People were unable to get medical supplies just because of politics,” Britton says. “Imagine, though, if there had been 100 3D printers in Kathmandu.”

Back in Kenya, Philips agrees the “holistic” community-centered approach is paramount, says Sarroukh, who is based in the company’s Nairobi research lab.

In addition to Githurai’s Community Life Center, Philips started to build one in Mandera, Kenya—a single county which accounts for 25 percent of the nation’s maternal mortalities. It also put one in Tadu, Democratic Republic of Congo. Philips plans to install others across Africa.

But before it does, it aims to talk with the people it’s trying to serve. Prior to building Githurai’s CLC, Philips assessed 17 different primary-care centers across the county to ask local community members what they wanted to see in their medical facilities.

Many said they needed more than just a healthcare center. They wanted a real “community hub,” says Sarroukh, that feels connected and safe. So Philips designed the CLC with LED area lighting, an entertainment and media player, and space for social, sporting, and educational events.

In the future, other exponential technologies like artificial intelligence, remote robotic surgery, and advanced microchips for on-site diagnostics are likely to become central to healthcare in developing countries. But, with all of this exciting, sometimes dizzying, tech, it’s crucial not to lose sight of what matters most.

“It is about technology,” says Philips’s Sarroukh, “but it is also about community needs and making sure we are addressing the needs that matter.”

ANN BABE writes about community, identity, and tech-enabled social change around the world.

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