Frugal Innovations for Global Health

Global health opens up a plethora of opportunities, yet it encompasses in itself myriad challenges. Biomedical engineering students should embrace these challenges and make the most out of them through innovative projects aimed at solving real-world problems. An interesting observation when one sees the whole domain of biomedical innovations is that many innovations have been stemming out of emerging economies rather than only from the richly funded laboratories of the developed nations. As it has been said, “necessity is the mother of invention,” so the lack of crucial infrastructure and technologies often gives rise to local inventions that solve local problems, and health care has been no exception. Many grassroots innovations are often termed frugal innovations, developed by below-the-radar innovators representing low-cost solutions using homegrown or self-created technologies, often born out of dire need [1].
The process of frugal innovation has been hastened by several other factors, and understanding them is vital not only for sustainable development but also to create a healthy ecosystem for entrepreneurship and structured scientific research. During the past few years, when I have been involved in developing technologies for the base of the pyramid (BOP), it has become increasingly clear to me that one of the primary factors fueling the innovative spirit has been the percolation of education and information to the lowest strata of the society [2]. An important vehicle for this change has been the student community, especially the young people in science, technology, engineering, and math (STEM) programs, university students, and young professionals. The pervasiveness of communication technologies, especially the telecom revolution in India, brought the required outlook and encouragement for young people to conceptualize and execute their own dream projects.
Another important factor has been the constant endeavor of several corporations and universities to enter this space and reshape neighborhoods (often technically termed the field practice area). The Manipal BOP Program in the southern India state of Karnataka, in association with corporations such as Philips and Texas Instruments, the Dell Social Innovation Challenge, and the Bill and Melinda Gates Foundation, are all having a significant impact in reshaping global health in niche ecosystems [3]. Moreover, country-specific product development initiatives are being undertaken by multinational companies to tap the vast potential marketplace. The handheld (GE VScan) and portable ultrasound systems, point-of-care screening devices, and low-cost incubators stand testimony to the same.

There is also another side of the spectrum where technoenthusiastic physicians, equipped with an understanding of the ground realities of global health needs, devise their own equipment in their garages. The story that comes to mind is about the two consultant anesthesiologists at Morriston Hospital in Swansea, United Kingdom, who developed the Shakerscope, a light source for clinical examination of the eye, ear, and throat [4]. It uses the basic principles of electromagnetic induction and generates power in a coil by moving a magnet across it. Shaking the device for 30 s can generate enough electricity to power the light for up to 3 min. This innovation was inspired by the wind-up radio and the innovators’ personal experiences in Zambia, where most of the conventional devices failed to work because of the lack of a constant source of power—a problem that echoes around most of the developing world.
In the given context of biomedical innovations for global health, it is important to recognize the contributions that students have been making. To emphasize that point, we need go no further than our own IEEE Presidents’ Change the World Competition, won by Andrew Brimer, who is studying mechanical engineering, and Abigail Cohen, a bioengineering major, at the University of Washington in St. Louis, Missouri, for developing a low-cost spirometer [5]. The team developed a pocket-size spirometer for the diagnosis and monitoring of asthma, chronic obstructive pulmonary disease, and cystic fibrosis. By integrating the solution with a mobile device, they made a product that empowers the caregivers in rural health care and doubles up as a valuable consumer health care device for the developed nations. The Student Technology Prize for Primary Healthcare, initiated by the Center for Integration of Medicine and Innovative Technologies, provided additional encouragement for United States-based student innovators to explore opportunities in the global health space [6].
The Brazil, Russia, India, and China (BRIC) economies, especially China and India, are the new entrants to the medical technology field, yet they quickly emerged as important drivers of innovation. Many of these designs were presented in the first-ever IEEE Engineering in Medicine and Biology Society (EMBS) Special Topic Conference on Point-of-Care ­Healthcare Technologies in 2013 hosted by the EMBS of ­Bangalore, India. Point-of-care technologies are an area of biomedical engineering that I personally feel can highly impact early screening and fortify rural health services in countries such as India and sub-Saharan Africa. During the course of my endeavor to develop a heart sound analysis device for Indian villages, we faced challenges that were more diverse than those encountered in a technology laboratory. The lack of power, unavailability of technically skilled manpower, data connectivity issues, no soundproofing, noisy outpatient departments, and long commutes were only a few of the issues that challenged us. In the end, we were able to devise an ultralow-power cardiac prescreening device that can operate even in these hostile and noisy environments [7]. Such examples of student projects are not rare, but they still lack support.
However, an insight that has dawned upon me is that the emergence of frugal innovation also reduces the need for sophisticated labs and instead relies on clever brainstorming and a better grasp of basic engineering skills. This understanding can indeed stimulate growth of innovativeness and entrepreneurial sprit among the students of universities with not-so-well-equipped facilities and break down the barriers of academic elitism. Things have actually started looking up thanks to excellent IEEE initiatives such as the All IEEE-R10 Young Engineers’ Humanitarian Challenge 2013 (AIYEHUM), which provides a platform for students to showcase their solutions to be funded for development [8]. This initiative also helped our group in the EMB Student Club at IIT Kharagpur come up with an image analysis-based solution for malaria detection [9], among other very stimulating projects and success stories. The Web initiative Engineering for Change (E4C) is an efficient tool for collaboration that was used by AIYEHUM participants, and all IEEE Student Members are encouraged to use it to present their innovations to the world and increase their chances of picking up suitable funding opportunities [10].
Finally, touching upon the vibrant career opportunities that the emergent global health care technologies offer is simply exciting. The Stanford Biodesign Program in itself produced several successful ventures and funded student scholarships from several countries, including China, Singapore, and India. The Center for Bioengineering Innovation and Design at Johns Hopkins University and the Consortium for Affordable Medical Technologies (Harvard/Massachusetts Institute of Technology and partners) have been created to teach the next generation of medtech innovators, and they are collaborating with health care device companies to take the designs to emerging economies. In India, Forus Health, the developer of an affordable prescreening tool for glaucoma and retinopathy, and i2i Telesolutions, a technology innovation company in the telemedicine software space, have been an integral part of a larger shift in perspectives and engagements, providing examples of the changing dynamics rather than being the exceptions.
As I look back to recapitulate my experiences as a student and as part of the medtech community and talk with many brilliant innovators in a quest to navigate my way among the biomedical engineering academia and innovation networks, only one statement comes to my mind, that of EMBS President Bruce Wheeler: “There is no better time to be a biomedical engineer!’’; and I quip—“especially if you are a student and you have an open world of opportunities lying ahead.” Best wishes to all of my student friends, and happy innovating as we enter 2014.

References

1. A. McNicoll. (2013, Aug. 5). Enter India’s amazing world of frugal innovation, CNN. [Online].
2. M. Maiya, “Base of the Pyramid (BoP) program at Manipal University,” Information Technology in Developing Countries (Newsletter), vol. 18, no. 3, pp. 25, 26 Oct. 2008.
3. I. J. Roes and I. O. Such, “Private public collaborations in emergent innovation programs,” in Proc. 29th Annu. Int. Conf. IEEE Engineering in Medicine and ­Biology Society (EMBS) Aug. 2007, pp. 1806–1807.
4. S. Mundasad. (2013, Oct. 12). Can life-saving gadgets be made in garages?, BBC News. [Online].
5. IEEE. (2013). The IEEE Presidents’ Change the World Competition. [Online].
6. C. J. H. Brenan, “The center for integration of medicine and innovative technologies (CIMIT): A proven model to speed the cycle of health care innovation,” in Proc. 2011 Annu. Int. Conf. IEEE Engineering in Medicine and Biology Society (EMBC), Aug. 30–Sept. 3, 2011, p. 5593.
7. S. Mandal, K. Basak, K. M. Mandana, A. K. Ray, J. Chatterjee, and M. Mahadevappa,
   “Development of cardiac prescreening device for rural population using ­ultralow-power embedded system,” IEEE Trans. Biomed. Eng., vol. 58, no. 3, pp. 745–749, Mar. 2011.
8. IEEE. (2013). AIYEHUM [Online].
9. S. Mandal, A. Kumar, J. Chatterjee, M. Manjunatha, and A. K. Ray, ­“Segmentation of blood smear images using normalized cuts for detection of malarial parasites,” in Proc. 2010 Annu. IEEE India Conf. (INDICON), Dec. 17–19, 2010, pp. 1–4.
10. E4C. [Online].