Why is anemia such a problem when it is such a preventable disease?
More than 2 billion people worldwide suffer from anemia. The World Bank estimates that anemia causes up to $50 billion in productivity losses across the world. Most of the 2 billion cases of anemia are in the developing world (a problem closely linked to nutrition) — and not fatal!
However, more than 1 million women and children die annually from undiagnosed anemia. Anemia is perfectly treatable and can be controlled by changes in diet, iron tablets and folic acid and, in extreme cases, blood transfusions. However, when it goes undiagnosed — and more importantly, if the treatment cycle goes unmonitored — then it can lead to severe problems. In developing nations like India, more than 50 percent of women are anemic — so every single pregnant women who reports to a government clinic is given free iron tablets. This is good, but not enough. India still has one of the highest infant and maternal mortality rates in the world.
My friends Dr. Abhishek Sen and Dr. Yogesh Patil, who interned in different rural districts in Western and Central India, had seen and lived through this problem. The real problem, they told me, was not just the diagnosis or the treatment, but the lack of active monitoring, the absence of data, and of feedback to the patient or the caregiver on how well or badly they were responding to treatment. Compliance is shocking in most places.
Is it just a question of access?
Anemia’s symptoms of lethargy, nausea, tiredness are often mistaken as normal for pregnant women, and its negative impacts aren’t well understood among rural populations. And in many cases, pregnant women are expected to forsake a day’s wages and walk 30 to 40 miles across poor muddy roads to the nearest government healthcare center for a blood test. Why would she do this when there are so many reasons in her mind not to? She doesn’t feel sick, is afraid of needles and does not really trust the healthcare system. So she will likely wait for something to go wrong before seeking care.
The idea is that with the ToucHb, a volunteer health worker — the sole face of healthcare for most Indian village women — can test for anemia in the field without having to draw blood, giving an immediate diagnosis, which could potentially save lives.
How does the ToucHb work?
The ToucHb measures blood hemoglobin, oxygen saturation, temperature and pulse rate. Total blood hemoglobin is used for anemia diagnosis. The WHO qualifies any pregnant woman with a Hb level of less than 11 grams per deciliter of blood as anemic.
The ToucHb works by shining light of different wavelengths through the tissue of the patient’s finger. Hemoglobin has a characteristic absorbance. Understanding the spectrum, and understanding what signals to filter out, ToucHb is able to determine the concentration of hemoglobin present in tissue. The technique is similar to the one used in pulse oximeters, for the estimation of oxygen saturation. While a pulse oximeter isn’t able to measure total hemoglobin, the ToucHb does.
You grew up around medicine in a unique and remote setting. What was your childhood experience like, and how did your interest in healthcare and technology develop?
I was born in Pune, India, but spent my early childhood near the sea: first in a coastal village called Umbergaon in Western India, and then in Mauritius, an island off the coast of Africa. My mother worked as a pediatrician. Most of the villagers in Umbergaon were poor fishermen. My first experiences with healthcare were me “playing pharmacist” for my mother, who attended to patients. As a 5-year-old I’d happily run to the dispensary — the front room of our house — to fetch medicines for her.
I remember my mother would often treat the poor for free, but they, not wanting to accept charity, would still come over and pay us in fish, freshly caught from the Arabian sea! Apart from fish, our house was filled with interesting things like microspopes and blood centrifuges, as my mother had to improvise and be doctor, pharmacist and pathology laboratory technician all-in-one in this low-resource setting.
I always liked to play with technology: I still have my Lego collection, my prized possession! But I started learning about electronics in high school, and I loved to build small electronic gadgets for school projects — light dimmers, alarm clocks and so forth. Not surprisingly, I ended up at engineering school, at the National Institute of Technology in Bhopal, where I built interesting things like an escalator-accessible wheelchair, a touchscreen information kiosk (which was cool at the time; remember — 2004!) and a PC interface that could control a home’s electric system.
I then started a PhD at the Indian Institute of Management (IIM), Calcutta, studying how article quality is formed in Wikipedia. I’ve always been fascinated by how Wikipedia — for all its critics — still manages to retain relatively high quality in much of its content. I downloaded the xml data dump of each and every edit ever made in the history of six different language Wikipedias, and reconstructed this into an interaction network of contributors and articles.
You said in your TED Fellows talk that it took 32 tries to get the ToucHb right. What were some of the obstacles you had to overcome?
Well, all this “optical method” stuff for a bunch on relatively inexperienced doctors and engineers meant that we were walking in the dark. We learned that every small thing has its own complexities. As the saying goes, you can see the world in a grain of sand. We learned as we went along — how to identify signs of error, filters, how to make the hardware reliable. In other words, we learned the hard way — by being wrong!
Have you started manufacturing and selling the ToucHb yet? And if so, are you getting any feedback about its effect?
We have released the devices to a few clinics in India. But it’s early days yet. We are a long way off being satisfied with our fabrication and assembly processes. We are planning to scale the production from 30 to 40 per batch to more than 1,000 per batch. But this involves putting in place quality management systems.
Apart from the production side, one of the big next steps for us is to partner with different international and national health agencies to properly understand the best way to create impact with this. The healthcare ecosystem is a complex thing — protocols are designed for good reasons, and we need to work jointly with experienced public health experts to modify the existing system, make small incremental tweaks in the way point of care community health works. Many challenges ahead, but we are looking forward!
You were designing electric bikes before you started working on ToucHb. Are you also interested in bicycle innovation?
Actually, I was motivated by laziness! While I was living in Bhopal, the hostel dorm was 3 miles away from my classrooms and labs. Bhopal gets to be really hot in the summer – more than 113°F. I wanted to build a power assist for my pedal bike, to help me on my way to class. This was my first attempt at building an electrically powered bicycle. It worked, sort of, but not very well. Its top speed was a magnificently slow 3.1 miles per hour. Later, I worked on the Copenhagen Wheel at MIT, a smart bicycle wheel that stores kinetic energy for use when you need a boost.
Tell us about Biosense. What is the company working on now?
We came together as five friends — three doctors and two engineers — to create ToucHb, just trying to fix a problem we saw in the field. We’re excited by the words “non-invasive” and “point of care.” I truly believe that there is a revolution underway in medical technologies. Similar to what mobile phones have enabled, there is a decentralization — a better word is democratization, I suppose — in the way things can be done. Simply, you have more processing power in the palm of your hand today than the most corporations had five decades ago. Similarly, I am sure that non-invasive, point-of-care diagnostics will increase in power exponentially, become all-pervasive — and, specifically, enable preventive healthcare in a meaningful way for a large proportion of humankind.
We’ve started some interesting new projects looking for other molecules in the direction that ToucHb has taken with hemoglobin. Hopefully we will have something to report on that in a few months.
There are hundreds of fixable problems all around us, and that’s what we’re working on. We’ve learned quite a bit of what NOT to do in product development thanks to ToucHb. We hope to use some of these lessons for developing more innovative, high-impact products.
What next for you on the personal front?
I remain a big fan of bicycles. I am working on a project idea for a fabrication system that enables anyone to design a bicycle for themselves, from frame to finish. That’s shaping up to be good fun!
What’s your experience of being a TED Fellow been like?
Completely and absolutely amazing.