How MedTech can truly democratize health access

okay so i have a confession to make

i don’t know how to ride a bicycle i

mean

i just don’t get the whole balance thing

you know

in my high school years when i wanted to

learn to fly a plane

through a school youth flying program my

mother said

no you don’t know how to ride a bicycle

you won’t be able to fly a plane it’s

all about

balance a few years later as a late teen

i wanted to learn to ride a motorbike

and my mother’s response again was no

you don’t know how to ride a bicycle you

can’t ride a motorbike

i injured my knee snowboarding once and

her response

it’s because you don’t know how to ride

a bicycle

now i got tired of people telling me

what i could and could not do

so i thought i’m going to challenge

myself

and prove to everybody that i can indeed

do

whatever i set out to do so i finally

decided

just two months ago to learn

wakeboarding

now i know what all of you are thinking

i don’t know how to ride a bicycle i

won’t be able to wakeboard

but i was determined to prove that it

could be done

so as i strapped my boots onto my feet

and on the board and got into the water

i thought to myself this is it there’s

no turning back

the first few times as the boat started

to move i would fall flat on my face in

the water

but by the sixth time i was determined

and as the boat started to move as the

rope

started to pull me as the board was

being lifted by the waves from

underneath

i thought to myself finally but before i

could think any further

my feet and board caught a wave and flew

in one direction

while my body flailed in another

direction

the result was a fractured ankle and i

was taken to hospital

that same day of course when my mother

visited me in hospital

the first thing she said was it’s

because you don’t know how to ride a

bicycle

i had a surgical fixation the next day

and was discharged the morning after

that

i was in and out of hospital in under

48 hours because i was fortunate

to have excellent access to health care

but as i lay in hospital bed recovering

post broken ankle

i couldn’t help but think that others

around the world were not so fortunate

that something else in this world was

truly broken

something that has bothered me often

enough

i thought back to december 26 2004

when many people around the world were

recovering from their christmas

festivities

when a massive 9.1 magnitude earthquake

hit the indian ocean floor resulting in

a devastating tsunami

that killed nearly a quarter of a

million people

in a single day in the countries and

islands surrounding the indian ocean

the boxing day tsunami it was shocking

and an utter tragedy

the world responded rapidly with an

outpouring of financial donations

relief supplies and equipment there were

those two who volunteered much-needed

relief services in the immediate

aftermath

but the tragedy didn’t end in that one

day

nor in the weeks two months after the

event

the tragedy continued to affect lives

many years after the world stopped

caring

even though the tsunami had shed light

on communities of people that

already before the event were living in

dire conditions

without proper access to basic health

care

the tsunami made this exponentially

worse and tipped many more

under the poverty line and years later

there was still hardly access to health

care for many communities

but by then the interest of most people

around the world was focused on newer

events

to the sufferers of the tsunami it was

as if

the world just watched

five years after the tsunami i joined

the team to provide medical relief to

villagers in padang indonesia

who are still suffering the effects of a

post-tsunami world

i witnessed firsthand the continual

struggle of people

living day by day without proper access

to health care for even their basic

needs in stark contrast we

volunteers had come from countries that

had many clinics every few kilometers

we had set up clinic near an isolated

village

and on the last day one of the patients

who had hobbled to us with a makeshift

walking stick

and a deformed lower leg was a 58 year

old farmer who had slipped in his field

a few days prior he had not sought

medical treatment

because the nearest hospital was many

many kilometers away

and he did not have the financial means

for the journey

even without an x-ray it was apparent

that his lower leg was broken

and would require surgery i advised him

he needed to go to a hospital

immediately

to avoid the risk of permanent

disability

he adamantly refused he was just not

going

he was afraid the cost of the journey

and hospitalization

would be too much for him to bear

with the limited resources that we had i

could only treat him with a splint and

painkillers

his non-surgical treatment which was not

uncommon in such low resource settings

would possibly lead to lifelong

disability

in plain contrast after my broken ankle

i was walking near normal in six weeks

we left that same night there was little

more that i could do for him

i felt completely helpless

the 2010 earthquake in haiti was no

different

and again i went with a team to provide

medical relief

and again the inequity was stuck

a one-year-old baby was brought to us

with a bout of severe diarrheal disease

she had sunken eyes a dry lips and

tongue and was lethargic

her veins were so tiny from her severe

dehydration

that we struggled to put an intravenous

drip for her and start her own fluids

we finally managed to on a neck vein

started her on fluids and transferred

her to the nearby u.s navy floating

hospital

she was fortunate but thousands others

were not

because healthcare just couldn’t reach

them

once again i felt completely helpless

with lack of resources once again people

started losing interest

and once again the world just

watched now in many low and middle

income countries

the continuing tragedy is that the

poorest and most

vulnerable have got inadequate access to

quality healthcare

people are dying unnecessarily of

diseases

that can and should have been treated

easily

this is not about inequality this is

about inequity

justice is broken these tragedies expose

these inequities for the whole world to

see

but we did little about it perhaps

because we just

did not know how

as i continued lying in bed thinking

about broken ankles and broken justice

i recalled how i had developed an

interest in medical technology

on medtech using innovative

technological or engineering solutions

to solve all sorts of traditional

medical problems

a few years ago i come across a company

that claimed to be able to perform an

array of blood tests rapidly

with just a single drop of blood

therenos wow imagine the number of lives

this technology could improve and this

could extend to low resource settings

unfortunately turned out to be

fraudulent but when i had realized the

potential of its impact

i had seen the power that met tech truly

could have

could medical technology offer a

solution to the problems i had seen

now it would seem somewhat intuitive

that our recent era of rapid innovation

of medical technology

could do so with

the potential for cheaper better faster

diagnostics and treatments of disease

with robotics 3d printed organs ai and

precision medicine

devices gene editing technology

our own lives too have improved with the

advent of wearable technologies

giving us real-time feedback of our

health status

but who are these solutions truly made

for

who are those that can afford these

solutions

without careful purpose these solutions

can actually widen the gap the same gap

that all these tragedies had exposed

the same gap that many people were

closing their eyes to because it just

didn’t affect them

the gap of health inequity

fast forward december 2019 a new virus

had spread across the globe to nearly

every single country

severe acute respiratory syndrome

coronavirus ii

or coronavirus as we know it had spread

well

virally we in singapore were lucky

early in the course of the disease i

went to work

every day with the fear of bringing back

an infection to my loved ones

but knowing that with proper and

available

personal protective equipment and

rigorous protocols

my risk of infection was decreased my

fears diminished however many people

around the world were not so lucky

economies were toppled health care

systems were challenged

people even health care workers and

politicians and leaders of countries

were being infected by a tiny virus that

knew no boundaries

no social economic class no creed nor

color

and now the world set up

we could no longer just watch because

covet 19

is affecting nearly every single one of

us

yet even here the inequities are

becoming ever clearer

richer countries are focusing on their

own survival while the gap with the

smaller countries and poorer countries

of the developing world

were continuing to widen much of the

progress that some of these countries

had made

in terms of health access was set back

years

in just a matter of weeks to months by a

tiny particle not even

visible to the naked eye yes

this is a global battle but although we

are all in the same fight

the harsh reality is that some are armed

with tanks and artillery while others

with

simple bows and arrows

in our modern world medical technology

has the ability

to level this battlefield to really

improve health access and to truly

democratize healthcare

if done purposefully this means the

intentional design of technologies and

solutions

aimed at lower resource settings this

means

thoroughly evaluating the social

implications and consequences of our

technological solutions

this means a rethink of the entire

concept of medtech

and instead of aiming to be the next

biggest exit

focusing instead on how many lives can

be saved or improved

but how do we do this how do we innovate

with purpose

let me leave you with three p’s

problem think first of the problem

specific to a low resource setting

person when you have identified the

problem in a low resource setting

think of the unique challenges that a

person with this problem would face

passion

you don’t need to be a doctor or an

engineer

you just need to have a passion to

innovate with purpose

let me give you a few examples

there are over 20 million people around

the world with limb amputations

as a result of trauma from natural

disasters accidents and war

a limb prosthesis costs anywhere from

six thousand

to a hundred thousand us dollars

depending on the level of sophistication

a team from stanford delve deep into

this problem and created an

innovative knee joint that addressed the

unique

needs of developing world amputees who

needed a highly durable

strong performance yet simple light and

affordable prosthesis

their product costs 40 us dollars

they had identified a need in a low

resource setting and understood the

unique challenges

that developing world amputees would

face

moving over to india a school dropout

who had become an

odd job laborer had realized his wife

was collecting

old rags and newspapers to use during

her menstrual cycle

as conventional sanitary pads were too

expensive

he developed a low-cost sanitary pad

making machine

despite being ridiculed for dealing with

such a taboo subject

but by understanding the unique

challenges that women face in such

situations

not only did the affordable sanitary

pads allow many women to continue

earning their livelihood during their

menstrual cycles

the machines too created jobs for many

women

these are just some examples of how med

tech can improve health access and truly

democratize health care

and anyone can realize this value

whether you’re a stanford team or a

school dropout

anyone with the passion and heart to

solve problems of health inequity

can do so but innovate purposefully

innovate intentionally innovate

for social impact in a world reimagined

our world we can no longer just watch

we urgently need to heal the fractures

of our world’s broken health delivery

system

and to do so you don’t need to know how

to ride a bicycle