Blag

Some Auto on Auto Action

2013-06-21T00:00:00-07:00

Auto Rickshaw drivers across India are notorious for trying to milk their customers, especially at night. And that’s only one of the many other problems.

Anatomy of an Auto

While I have been used to all the good and bad of the auto riding experience across India, yesterday was extraordinarily special. I boarded an auto from Jaaga, where I had just met a bunch of these people - Social Enterprise Happy Hours on the Lalbagh double road, to Koramangala and he agred to the standard one and a half times meter fare that is the law but not the norm after 10pm. The auto seemed new and well-maintained with a disco light arrangement on the roof of the auto thrown in for special effects. I took off my laptop backpack and umbrella and left it in the back side since 3 of us had already taken up all the sitting space in the auto. The auto stopped on the way to refill gas and that’s when I realized that this auto had a reverse gear as well as a modern fuel system relative to the other autos out there. While this all seemed like trivial information, it helped a lot in what was to happen next.

After a 15 minute smooth ride we reached our destination. We paid the fare with a little tip and the driver asked for feedback on the riding experience. I complemented his skills and the auto since it had been a very smooth night ride. He reversed and left. I walked into the house. That’s when I realized I had forgotten to pick my backpack and umbrella from the auto. So I turned around and ran. I could still see the auto in the distance. The friendly neighborhood street dog thought I was playing catch with him and ran with me jumping and obstructing my run. I ran about 300 meters only to see the auto disappear around a turn. There was no way I could chase him on foot. I saw two autos waiting outside Satya’s bar and restaurant chatting to each other. I approached them and asked if they were willing to chase an auto. One of them jumped in, no questions asked! Moreover he recollected this auto speeding past them. Since it was one of the modern autos with the green paint (Remember green paint = modern fuel gas autos), he knew it wasn’t a regular in this area. He also had observed the auto taking a turn at the junction which supposedly means the auto belongs to a different auto union kind of thing. And so we started the chase.

Black v/s Green autos

The auto was not in sight. We reached the next junction which was the Wipro junction. The auto could have gone on either of the 3 routes. A decision was to be made. I suggested we take the right, the auto driver decided to take a left and left we did go. A few autos passed by and the auto driver asked them a few questions to gather intelligence on which direction the other auto might have gone. Filled with intel, he headed straight towards a new micro-brew pub that had opened down the street and there he was, the disco lights revealing his identity. And that’s how I got back my backpack and umbrella. I had no cash left on me and so I asked the helpful auto driver to take me to an ATM where I treated him for his Sherlock Holmes style street smartness and chase.

This was definitely the best auto rickshaw experience I have had in a while. Just a few weeks ago we were blessed by an auto driver, who dropped us at Richmond Circle and spent 10 minutes talking to us about God, Banks and Blessings and ended up offering prayers on us by holding our foreheads. And then there were the other near-death experiences that made up for the lack of roller-coasters in India. But then I had never done a car chase, let alone an auto on auto rickshaw chase.

Later I also discovered that there exists something called the Rickshaw Challenge.

That’s one more reason to believe Bollywood is a reflection of reality.

P.S - All image credits to respective sources

Enabling better healthcare through mobile technology

2013-05-08T00:00:00-07:00

A few years back I got involved in a mobile based diagnostic project for oral cancer. The scope of the project was to identify high risk patients in semi-urban and rural communities who had developed symptoms of oral cancer. Oral cancer accounts for over 30% of all cancers recorded in India. People in resource poor environments seldom take the time off to visit the doctor in the city for minor symptoms since it means a day lost in travel and without income. When they do decide to travel, the tumour is normally in an advanced state of cancer and little can be done to save the patient. Moreover, since the government or the insurance provider has to subsidize the care of the patient, the disease burden on the state increases significantly in what could have been a preventable or treatable case of cancer if detected earlier.

The project involved community health workers (CHWs) going house to house with a low cost smartphone, with an application on it that ran the oral cancer screening questionnaire. At the end of it, if the case was shown to be high risk using the in-built decision support system, they would snap a picture with the phone camera that would automatically be transmitted via the phone network to doctors/dentists in city hospitals who would verify and recommend appropriate treatment/hospital visits to the patient. This helped bridge the urban-rural gap in access to healthcare, while lowering costs and improving the quality of life of patients who would have otherwise developed the lesion into full oral cancer.

This is just one instance of Modern Healthcare being practiced by leveraging low cost technology. Over the past few years, a lot of people have been working on using technology to solve problems using simple tools to diagnose, treat and prevent diseases and different conditions while keeping things affordable and accessible to larger sections of the population. And unlike the MRI machine that costs over a million US Dollars, most of the innovative modern day healthcare delivery systems are being developed through ubiquitous and low-cost mobile phone technology.

It is a well known fact that more people have phones than toilets in the world. That opens up a lot of avenues to make healthcare affordable to the masses. But at the same time, one has to ensure challenges like compliance, data privacy and effectiveness of modern day healthcare delivery systems are provided for in the mobile health ecosystem.

Scanadu is attempting to build a medical tricoder that is able to monitor body temperature, heart rate, oximetry, ecg, urine, stress and community outbreaks tailored to your needs, all in one small device that fits in the palm of your hand connected to your phone providing information in real time. Their video provides an insight into how the future of healthcare might look like and turn your mobile phones into an easy to access family doctor.

The Scanadu Medical Tricoder Concept Video

Then there are wearable devices that help solve specific problems. LUMOback is a wearable belt that provides you insant feedback on your posture, thereby helping you prevent injury and improve chronic back pain condition. Zeo is a headband that tracks your sleep and helps you sleep better. Fitbit helps you monitor and track your activity levels and meet wellness targets.

LUMOback - Improve your posture

There are several other such products that empower a patient or a caregiver to diagnose, monitor and track their state of wellbeing without visiting a hospital. However there are a lot of situations where empowering an individual might not be the best solution to their health problems and a community based solution is required.

In India a lot of people die due to poor delivery models of treatable and preventable diseases like Tuberculosis and other infectious diseases. While there is the Bacille Calmette Guerin (BCG) vaccine available for protecting children from Tuberculosis, it is not that effective in protecting adolescents and adults. Tuberculosis is treatable and curable through a standard six-month program of four antimicrobial drugs made available for free by the Indian government through clinics and primary health centres. The treatment however involves around 40 visits to a clinic over a 6 month period for periodic medication. This results in high dropout rates and people who do not complete the regimen are at risk for multidrug resistant tuberculosis (MDR-TB) which does not respond to normal treatment and is costly to treat.

Technology in this case has to simply play the role of education and compliance to ensure people follow and complete the program. Microsoft Research and Operation ASHA ran a pilot in India where they built a low cost biometric system along with a connected device to transmit and remotely monitor compliance. They trained health workers and setup the centres at places of religious worship which helped improve the frequency of patient visits. By moving the delievery centre away from the clinic and closer to the patient and keeping it discreet, the social stigma prevalent in many cases with taking medication is curbed, thereby increasign compliance.

Battling Tuberculosis Using Microsoft Technology

Mobile phones in maternal and neo-natal care have been used in several parts of India. Commcare, with deployments in the Indian states of Jharkhand, Uttar Pradesh, Madhya Pradesh, Rajasthan and Maharastra, is one such example. Their mobile workflow typically involves a community health worker periodically visiting houses of pregnant women and new mothers to impart education and monitor the health of the mother and the new-born with data synced to a central facility. Extending the phone’s capabilities by using external sensors is another area that mobile health has been experimenting with. The ODK Sensors project has tested out a framework to use mobile phone and sensor technology to reduce costs and standardize efficient workflows in the milk pasteurization process in milk banks for new borns in South Africa.

While a lot of innovation is happening in this space, it remains to be seen as to how these tools and technologies can be used to scale access to healthcare and integrate with existing provider networks like hospitals, clinics and pharmacies. The next decade of modern digital and mobile healthcare does look promising.

Are you at risk for Type II Diabetes?

2013-04-19T00:00:00-07:00

As is evident from the infographic above, Diabetes is turning out to be an epidemic of proportions unheard of before. While earlier health battles have been fought against bacteria and other infectious diseases, the growing change in our lifestyle has given rise to this chronic condition of epic proportions. The number of people living with, and dying of, diabetes across the world is shocking: 90 million Chinese live with diabetes and 1.3 million died in 2011; 23% of Qatari adults have developed diabetes. The situation in India is no better.

The above graphic is for type I and type II diabetes (T2DM). While the causes for Type I are unknown, Type II diabetes is caused by a combination of genetic and lifestyle factors.

T2DM in India has a prevalance rate of about 9% but in parts of South India, every fifth person is likely to be affected by Diabetes. Besides diabetes does not stop at itself but can cause further complications of the heart, kidney, eyes and feet. The interesting part here is that in most cases T2DM is preventable. If you are pre-diabetic i.e you are diagnosed to likely get diabetes in the next 5 or 10 years, there are ways to prevent yourself from getting it through lifestyle modification.

How do you know if you are pre-diabetic? If you are a woman and have had gestational diabetes during pregnancy, there is a strong chance you are going to develop T2DM. For other people of Indian origin, there is a screening questionnaire designed for Indians to identify their diabetes risk.

You might be surprised to know that this simple questionnaire is a very accurate measure of your T2DM risk score. If you have a high sugar score, you should definitely get your tests done and get on the road to prevention.

Indians have had an historical affinity to Diabetes, starting with the affluent people during the Aryan influx in India to the modern day corporate employee in cities (with a dip during the colonial period owing to poor lifestyle conditions of a vast majority of Indians). Indians also have a tendency to be prone to central obestity (i.e belly fat) which in many cases is seen as a sign of prosperity. The Hindu God Ganesha, whose choice of food is a sweet ladoo made of flour with sugar and ghee, is an indicator of our affinity to this. Remember that your waist size has a direct correlation with your risk for diabetes.

If you interested to learn more about the global health burden of Diabetes, the below TED-MED talk by Mark Hyman explains it all.

So have you got your SugarScore yet?