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