When thought of as a verb, the suffix ‘jack’ generally suffers from a nefarious connotation. For instance, the term ‘to hijack’ – or to seize any vehicle unlawfully, usually through force or the threat of it – would be what usually comes to mind. Similarly, in the context of technology and science, one may think of hacking, viruses and other cyber attacks when asked to reflect on the term – nothing good in both cases.
So what could the suffix be used for in terms of healthcare and medicine? What of the term ‘medjack’ in particular? In its most used form, the word is a contraction for ‘medical device hijack’, a type of cyber attack that targets weaknesses in the medical devices of a hospital. Over the course of 2015, 2016 and 2017, the word gained sinister prominence after a string of medjacking incidents targeted several hospitals in the fashion described.
The writers of the book ‘MEDJACK: the extraordinary journey of an ordinary hack’ seek to repurpose the word. Instead of the damaging disruption wrought by cyber crime and cyber warfare, they want readers to think of a more positive disruption – one that concerns inspired and innovative thinking. What if an entire healthcare system could be ‘medjacked’ into rethinking its entire mechanism and philosophy?
The topic may seem daunting to those like me – those with no expertise in the healthcare sector. Like its much of its potential audience, I had to jump into it despite zero experience as a healthcare professional or an entrepreneur for that matter. One may think, as I initially did, what benefit someone not directly linked to the field may gain from reading about startups. And yet, I have to admit, I was pleasantly surprised.
The book mainly chronicles the journey of Critical Creative Innovative Thinking (CCIT) forum, which was founded in 2013 by two fourth year medical school students at Agha Khan University (AKU) along with Dr Asad Mian, who was then an Associate Professor of Emergency Medicine there with a mission to promote biomedical and healthcare-related creative ideas and innovations. Each chapter of the book is penned by a different person however, all authors have been members of the CCIT from whereas the primary editor is the founder of CCIT himself.
In the beginning of the book, it is highlighted that the healthcare industry possesses an inherent reluctance to change. A significant point that was also highlighted early on in the book was the fact that developing countries tend to ‘leapfrog’ outdated technology. The developing world tends to skip past the bypassing stages of technologies in many cases and often ends up adapting the latest technology once its already been tried and tested. With this backdrop, the book sets the stage for what CCIT set out to do, which is create a forum to critically solve the healthcare problems of the world today.
While the first chapter outlines CCIT objectives and briefly touches on its journey over the years. Chapter two, three and four provide further insight into each of CCIT’s initiatives. In chapter two, authors Sarosh Irfan Madhani and Maryam Siddique talk about CCIT’s Ignite talks. Ignite talks, as is explained in this chapter, were initially begun by Brady Forrest and Stephen Lead and were later taken over by the O’Reilly group in the United States. The purpose of Ignite was to serve as a channel to present ideas that were both quick and innovative.
Each ‘Igniter,’ according to the rules set by its founders, gets five minutes and 20 slides to present their idea. However, CCIT’s Ignite sessions had one more requirement: all ideas presented at Ignite had to healthcare centric. CCIT held its first Ignite event in 2014 at AKU on the back of its success, held three more such events for the next two years. In one particularly interesting such Ignite session (held in 2016), CCIT conducted its session as part of a larger AKU conference National Health Science and Research Symposium, which was themed specifically around ‘Mind and Brain.’ For this purpose, this Ignite session was also focused specifically around that topic.
Chapter three on the other hand, authored by Waqaas Akmal, focuses on the Hackathons held by CCIT. Medical Hackathons, inspired by MIT’s Hacking Medicine Institute, are two to three-day events planned around a specific medical theme or a particular branch of medicine with the goal to come out of the event with plans for solutions around that theme.
Similarly, chapter four (written by Rafeh Ahmed and Muhammad Mohsin) focused on CCIT’s experience with incubation, which focused on the growth and development of entrepreneurial skills. The chapter highlights their learnings through the hackathons.
However, by the end of chapter four, one thing that seems to be missing in each of the chapters is that while each chapter chronicles the experiences of each of CCIT’s initiatives it doesn’t delve deep into each of these experiences but rather presents an overview of each of them.
As a reader, it would have been far more interesting if the chapters gave specific examples of ideas presented during Ignite events, hackathons or through incubation. If the journeys of any specific candidate or their particular ideas were chronicled as specific examples, then as a reader, it would have been far more interesting and engaging to learn about them.
For instance, at the end of chapter four, a list of Incubate teams is shared and along with each of the teams, a brief description of their ideas and the current status of those ideas is provided. However, if one or two of those specific ideas and their status thus far in completing those incubations was discussed in detail, then that would have been extremely fascinating to learn more about. Same was also done in chapter one, where a table outlining a few examples of the Ignite event titles and their respective content was shared. However, a detailed account of those Ignite ideas were not shared.
Another significant hurdle that is mentioned in the book is that at the outset, AKU’s policies when it came to Intellectual Property ownership policies were not in favour of innovators who may present their ideas at a forum that is part of AKU. This would massively impact the participator’s decision to share their ideas and would have been a huge obstacle in this process. While it is shared that since then, certain policies have been amended to favour innovators, it is not highlighted to what extent these policies impacted participants who shared their work with CCIT thus far.
Another interesting theme touched on in the book is that of narrative medicine. While the chapter covers CCIT’s inclusion of reflective writing into their programme what is extremely interesting is the point raised in the chapter about the importance of journaling in the field of medicine. As the authors of the chapter Komal Dayani and Haider Ali note, writing helps one better understand someone else’s mindset. Moreover, the practice of combining storytelling with medical education in medicine, as the authors explain, has been around for a few decades and is important in helping readers feel empathy and compassion.
Moreover, an ‘empathy gap’ is what is missing in contemporary medicine as is identified in the book. With this backdrop, the authors introduce CCIT’s joint initiative with Aga Khan University Hospital’s psychiatry department to conduct reflective writing workshops in 2016. Through the course of the chapter, other endeavors taken by the CCIT since then, to inculcate narrative medicine, along with the learnings from those initiatives, is shared. This includes a virtual course on innovation, creativity and entrepreneurship with narrative medicine being an integral part of it. Another important point noted here in the chapter is the importance of including art and science of story-telling into healthcare for the purpose of medical innovation. As explained here, it’s important to go farther than disease or profit based frameworks and shift to more patient-focused approaches.
One more thought-provoking theme of the book is ‘jugaar,’ which as is explained in the book, is a necessary tool in medicine for any developing country to survive, even more so now than ever during a global pandemic. Innovation and jugaar together can help create quick and cost-effective solutions to resolve urgent healthcare problems. With limited resources, jugaar has the potential to innovate in the pandemic.
Based around this theme, CCIT designed a ‘jugaar initiative challenge’ between March and April 2020 – during the first phase of the coronavirus pandemic. Since this was a virtual hackathon due to the pandemic, it enabled people from all across the world to participate and the virtual characteristic of the event, also made it cost effective and ‘jugaar’-like in a sense. A total of 1,441 participants were able to take part in the virtual hackathon and once again there were several qualitative learnings taken away from the project. Thus, this illustrates the importance of jugaar in innovation for a country like Pakistan.
Thus, through a myriad of approaches and varied themes, CCIT’s initiatives have set out to approach medicine differently. There’s an intentionality with which this project has been conceived, and conscientious and concentrated efforts have been made to address different aspects of medicine and moreover, it has provided people within medicine and outside the field of medicine, a platform to present, grow and nurture their ideas.