In mid-2012, biomedical engineer Kanav Kahol and his team headed to Muktsar, a district in southwest Punjab, some 400 kms north of Delhi. They carried backpacks containing a telemedicine device, which Kahol had created six months earlier. It constituted a medical diagnostic machine, an android tablet that could be connected to it and a solar panel that powered the entire setup.
The previous year, eight women had died of eclampsia in Muktsar. It is a disorder that causes convulsions or coma during pregnancy. It is one of the leading causes of maternal deaths in the country. Pregnant women are rarely tested in India’s rural areas for pre-eclampsia or other pregnancy-related disorders and by the time symptoms become severe and a doctor is consulted, it is often too late.
Kahol and his team handed the devices to health workers in the district, who were able to test more than 1,000 pregnant women in a year. One hundred and twenty women were found to be pre-eclamptic, a condition characterised by high blood pressure and excessive protein in urine. They were treated on time. That year, nobody died.
Kahol’s device, called Swasthya Slate (Swasthya is Hindi for health) could do nine diagnostic tests at the time. Now, thanks to his team’s work at the Public Health Foundation of India(PHFI), the device can conduct 33 different medical tests. These tests are cheap and come with more than 95% accuracy. On widespread adoption, SS can save lives that would otherwise be lost due to late diagnosis or lack of access to healthcare.
“Pre-eclampsia accounts for 15% of maternal deaths in the country,“ said Kahol, team leader at affordable health technologies division at PHFI. “Before we arrived, most women were either detected with the condition too late or were not screened at all.”
Swasthiya Slate can perform tests such as blood pressure, ECG, syphilis, HIV, hepatitis, malaria, dengue, urine protein, and pregnancy. The kit can assess samples of blood and urine using disposable strips much like the ones used in popular devices to test blood sugar levels.
The tests can be conducted anywhere using the diagnostic box and the results are transmitted to the attached Android tablet via Bluetooth. They are later uploaded to a central database via 3G. Since it is equipped with a solar panel, the device can be used even in remote areas where there is no electricity. Physicians can download the results at any location, as long as they have an Internet connection.
Right now, millions of Indians do not have access to hospitals or clinical laboratories. They have to travel for hours to get even simple medical tests done and wait for days before they can have their test reports. Particularly for women who run households, taking time off to travel for diagnostics becomes less of a priority.
But as the pilot test in Muktsar illustrates, simple blood or urine tests on time can save lives. With the Slate, midwives or trained community health workers can conduct medical tests and provide basic treatment. Their initial assessment helps them decide which patients they should refer to doctors.
“The idea was to democratize diagnostics so that everyone has access to good healthcare,” said 35-year-old Kahol. “Right now this field is monopolized by very few players.”
Access to timely diagnosis
India has 0.7 physicians per 1,000 people, compared with 2.5 in USA and 1.9 in China.
In certain health indicators, Asia’s third largest economy performs as badly as some sub-Saharan countries. For instance, India and Nigeria account for the highest number of maternal deaths in the world. But affordable innovations that integrate information technology and medicine might just be what the doctor ordered.
Swasthya Slate costs Rs39,000 ($640). The tests conducted on SS cost a fraction of what they would cost in a pathology lab. For instance, a dengue test on SS is for Rs300 ($5), whereas it can cost between Rs1500-Rs5000($25-$80) in cities. The test results of the SS have 95 to 99% similarity to results delivered using conventional equipments used by path labs, says Kahol.
Pilot tests on SS are being conducted in 13 states in India in partnership with many voluntary organizations. In March 2014, Jammu and Kashmir became the first state to implement the use of SS in its Reproductive Maternal Newborn Child and Adolescent Health program. More than 3,000 ‘slates’ were given to healthcare providers in six remote districts all over the state.
“This will empower ANMs (auxiliary nurse midwife) to diagnose better and create a database for these patients.” said Anuradha Gupta, then mission director of the National Health Mission, Government of India, at the launch of the program.
Right now, SS is used by community health workers, but Kahol plans to make it commercially available by the end of this year.
Mapping health trends
Health monitoring is hard in India because of lack of real-time and relevant data. The last National Family Health Survey (NFHS), the country’s main source of health statics, was conducted in 2005-06. Such surveys are extremely laborious and require vast amount of paperwork and years of fieldwork.
The absence of actionable data makes it very challenging to formulate public health policy.
But in SS all the medical information is stored in a central server instantly and can serve as a database for both government and doctors.
For instance, SS has already helped Hyderabad government decide where to put information posters on diabetes in the city. Every time the tablet is used, it records the GPS coordinates of the patents and the health workers. This data helped heath officials in Hyderabad figure out the localities with the highest concentration of people suffering from high blood sugar level.
“The science that we will get from this data will be spectacular,” says Kahol.”We will create an information-driven health system instead of an intuition-driven system.”