The disparity in mortality rates and access to quality and affordable care, between rural and urban Pakistan, is hardly a revelation. Yet, we have resigned ourselves to accept it among the harder truths of life. While access may be a ubiquitous problem all over the world, the disparity need not be this stark.
So the question to ask is: what can we do to improve the situation? This was the same question I asked myself after a recent meeting at the World Health Organisation on affordable and quality medical devices in the developing world.
When you talk to doctors in the rural areas and sometimes even in urban centres, they would talk about lack of equipment or more precisely, lack of equipment that works. They may also tell you about lack of local capacity to maintain the equipment. All these are valid and legitimate concerns. Yet, what they often won’t tell you is the lack of local capacity to innovate. Probably, because they cannot imagine local solutions to these grand challenges. But local solutions are not only the right answer, they are the only answer. Yes, a world where we address (some, if not all) technical needs for diagnostic, cure and disease management is within reach. A world where our own engineers are able to innovate and come up with low cost and robust diagnostics is actually a lot closer than we may think.
I am not saying that in a country where manufacturing of electronics is non-existent, we will be able to manufacture large-scale CT scans, but I am proposing that we have the capacity, even now, to develop hardware and software for small-scale diagnostics. Things like small probes to monitor the pulse and oxygen of an acutely sick infant may be powered by a cell phone. This small probe, called a pulse oximeter, will be the difference between the life and death of a baby. Or maybe, a handheld device can be made available to distinguish between TB, typhoid and dengue that works without power and in poor sanitation conditions. If this can be done in sub-Saharan Africa, Southeast Asia, India and Latin America, it can be done in Pakistan. So why don’t we do it?
Well, it gets a bit tricky here. In our educational system, we ask our talented students to choose between pre-med and pre-engineering when they are barely 16. The physical and mental barriers that we create then, condemn the imagination to life imprisonment. I am not arguing about changing the educational system — though it desperately needs to change — but arguing about changing the mindset. It’s a call to arms for our doctors to tell our engineers, our innovators and our scientists about the tools that will help them save babies and cure the sick.
Now, two more questions are worth thinking about. First, how and where should we start? Well, for a change, let’s be bold. Imagine, that every week, just for half an hour, on primetime TV, a team of doctors give out challenges to the engineers and innovators of the nation about what their needs are. It is very likely that there will be a lot of people responding to that call. Some may succeed and many may fail, but at the very least, we will have a discussion, an exchange and hopefully a solution.
The second question is: how and who will fund the projects? I am certain that if we can get enough good ideas, there will be a market for these products. As an example, a couple of weeks ago, the Bill and Melinda Gates Foundation announced the recipients of their ‘Grand Challenges’ grants, which focused on innovation in global health. Half were from India, South Africa, Uganda, Botswana and other developing countries, each grantee getting a million dollars or more for the transformative change they will bring.
Bigger than an individual grant or a product, the outcome of the bridge between doctors and innovators will be a self-sustaining eco-system that will eventually improve the state of our healthcare system.
Published in The Express Tribune, January 5th, 2012.