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TEDx Talks
Published: 2016-05-02
Source: https://www.youtube.com/watch?v=0g5Ol1xCwc0
so I have a question for you guys %HESITATION how many of you have passed gas today you have to go through a tense and okay the reason I ask that question is those of you who have I had surgery on had a loved one who has had who've heads with had surgery no that that's one of the questions we doctors ask first thing in the morning
you know they wake you up your groggy you pass gas %HESITATION in the reason for that is not an obsession with flatulence the reason for that is that that's simple on this question tells us about a much more complex phenomena which is that help a few of the digestive system right for about a decade or so I've been working on a complex problem I some would
say impossible which is bringing a reliable laboratory diagnosis to poor countries %HESITATION we have different governments different regulations different people got corruption we got attitude to get everything but what I've learned is that the only way we could make any headway in this morass is by asking simple questions and following them and see where they lead in two thousand eleven we collaborated with the ministry of
health in Uganda to answer a simple question and the question is was what is the state of laboratories income power at the time we picked Uganda because it was if you have a list of the countries in Africa ranked by per capita incomes Uganda was smack in the middle and so we had this question what was the citadel of of of maps in Kampala and we
wanted to know how many laps they were how weather services paid for and what was the quality of their work now for those of you that don't know Uganda is a country in East Africa and compile its its capital a city of one point five million people close to the shores of Lake Victoria if you look at Kampala from a distance or at night it's beautiful
city had it could be anywhere else in the world however what's he going close you realize it's a it's a bustling mass of activity and humanity and and itchy and we realize very quickly that a lot of the labs were trying to find would be on the streets like this without a name and they would be hard to identify or they would be on the back
of somebody's house and so we realize that the only way we could find these laboratories was to do the survey in person and mostly on foot so we got twenty three people and over three weeks we covered the city and we found nine hundred fifty seven laboratories doing fourteen thousand test this was way beyond anything that I had expected who tried %HESITATION just to give you
a sense of scale what this number suggests is that Kampala at the time had the same number of laboratories per capita as United States okay think about that for a minute it's amazing and the second question is how would these laboratories being paid for it turns out ninety six percent of them were in the private sector so they're being supported by out of pocket payments so
this is for those of you that are interested in development work or do development work you know this is the holy grail of development work you want a local industry that is financed financially self the however when we asked about quality what we saw was that only five percent of the laboratories met the lowest quality standards of the local region at this point we'd figured out
some pretty basic questions about this the state of labs in Kampala in much of sub Saharan Africa but we still left with a question which was how could people access the high appointed quality laboratories this is a real problem especially in rural areas to illustrate how pick an example from western Kenya this building is a building that was donated by the World Bank and it's in
western Kenya and inside this building is is quite a nice lab does also supported by a by the World Bank and the idea was to place this building in the center of this third district it's that is there blue icon you see in the Middle and it's suppose to support the forty five clinics that are spread around the district great idea the problem is some of
these clinics are up to forty miles away and almost all of them are inter groats like this so when you have months and months and months of of rainy season these roads are impassable wide best unpredictable so you have two problems you have a white elephants laboratory there was there was that where the money is now wasted and then you have patients who can't get had
the answers they need the broader so next the next question and that question was is there a way we can move laboratories samples from clinics to lapse that doesn't depend on the roads finance we came up with with drones Jones a small unmanned aerial vehicles %HESITATION that fly obviously so they don't need puts %HESITATION but blood specimens biological specimens laboratory specimens are not like a book
or shoes meaning they're not robust's enough to be transported anyway foot each mode of transportation you consider you have to do you have to vet to make sure that that mode of transportation doesn't destroy the blood Sam so to answer this question can drones muse for routine transfer of laboratory specimen we didn't experiment we we got several hundred %HESITATION paired blood samples from healthy volunteers and
we drove although all the specimens to a flight field about a hour north of Baltimore city and took half specimen want once said of the pairs and package them as you see put him in a drone and then %HESITATION we flew them around and around around and around and around for forty minutes and once the samples came back we took them back to the laboratory ended
a battery of thirty three tests on both the samples that had flown and the ones that had not flown and what we found with that the results were the same so it's great so this this was a green lights for the idea that we could use drones to transport laboratory specimens however it doesn't address the issues of regulation most countries in the world have no regulation
about drone transport so it's a non starter and also doesn't X. address the issues of public except however %HESITATION change happens fastest now %HESITATION if you look at the cellphone revolution in much of the developing world is a classic example of this so I'm optimistic %HESITATION I don't know that drones will be the answer to the problem diagnosis import countries but I know that if we
hadn't started attacking this complex problem by using questions would never have figured out that the problem would laboratories in sub Saharan Africa was not one of quantity but rather one of quality it wouldn't have figured out that what was needed was not warm more donations or stuff but better trained staff and point I've learned that every time I approach a complex problem with a question a
