An expensive but broken centrifuge, an essential medical device for malaria and HIV diagnosis, found itself being used as a doorstop at a health clinic in rural Uganda. Necessary spare parts were unavailable and unaffordable. A professor of bioengineering, visiting from the United States, decided to brainstorm the problem.
Inspired by the whirligig, a children’s toy with a disc that spins when a person pulls on strings that pass though the center, Manu Prakash developed the “paperfuge,” achieving speeds of up to 125,000 revolutions per minute (RPM). Blood samples are applied to its polymer-based paper disc, which is then spun, separating the various blood cell types ready for analysis. The cost for this solution … a whopping 20 cents!
All too often healthcare in the developed world follows the mantra “more is better,” particularly more tests and more expensive equipment and facilities. This may help patients feel they are getting the best service but does it provide optimal healthcare? Doesn’t “more is better” guarantee the creation of an entrenched healthcare culture, mired in self-interest and increasingly resistant to change?
Given the chance to design a healthcare service from scratch today, would anyone (other than those with a vested interest in the current structure) come up with anything like the American system? Perhaps we can learn from societies that are creating a healthcare system largely from scratch? Developing countries in sub-Saharan Africa may be resource poor (hence the centrifuge doorstop) but they are reinventing healthcare every day.
The twin engines for this revolution are innovation born of necessity and mobile phones. In a classic case of technological “leapfrogging,” sub-Saharan Africa is eschewing the infrastructure-heavy version of healthcare with which we’re all familiar and going straight to a mobile health (mHealth) model. More than half a billion people across Africa have mobile phones. Nearly half of those are smartphones, a number that has doubled in the last two years. A 2016 report from the GSM Association (representing the global mobile phone industry) observed that more than 1,200 mobile health initiatives had been deployed in Africa.
Smartphones are being used as diagnostic tools for a wide variety of diseases and conditions, as well as for maintaining electronic health records and tracking epidemic outbreaks. Algorithm-based treatment apps enable healthcare professionals to deliver individual therapy that also decreases inappropriate antibiotic use. Patients and the wider public receive follow-up information and educational programs for family planning, malaria prevention, and many more health issues.
The infrastructure to support these mobile phones, and particularly the move to smartphones, is being developed because there is a demand. Solar-powered data transmission networks and AC power supply systems will soon make mHealth an everyday reality. This is complemented by the ‘frugal science’ approach that Manu Prakash has developed in his Stanford lab, designing solutions for resource-constrained environments based upon the old saying, “What a fool can do for a dollar, an engineer can do for a nickel.”
Prior to the paperfuge, Prakash developed the Foldscope, an origami-based microscope using the same polymer-based paper as the paperfuge and capable of detecting micro-organisms. Other projects currently under development in Prakash’s lab include a microfluidic device for diagnostic testing based on the mechanism of a child’s music box. Before we add more layers of technology, administration, and even patient care to the American healthcare onion perhaps we would be better off looking to see what we might learn from those creating a truly modern healthcare system.
Nowhere are the phrases “less is more” and “keep it simple, stupid” more instructive than in healthcare development in resource poor environments. The developed world might do well to look and learn.