Health post: Cost & cooperative design

After meeting Dr. Maneesha, I talked to a few other interesting people at Amritapuri; here are some brief highlights. First, I met with Dr. Bipin Nair, who is working on a low-cost automated insulin pump for diabetes patients. Dr. Nair mentioned that his team is partnering with a company in Bangalore to develop an app for the device. I asked why a smartphone app would be appropriate for someone who needs a low-cost insulin pump, and Dr. Nair said that the target population for the device would be India’s middle class: people who are busy working and can’t afford automated insulin pumps, which could cost over $1000, but who also would certainly have smartphones – so that made sense. I think it’s always important to define the target population of a new device (the pump is still in development, so I couldn’t ask about public reactions to it yet).

Here is Dr. Bipin Nair with his patents (on the desk) for the automatic insulin pump as well as for a low-cost non-enzymatic glucose sensor strip.

Next, I met with Rahul, who showed me some prototypes for a wearable ECG monitor, which is one of the devices included in the remote patient monitoring system that I discussed with Dr. Maneesha. It was cool to see the evolution of the prototypes based on feedback received from Amma and other test users. The small controller, which turns the monitoring on and off, was designed to be worn around the waist as a belt. However, Amma pointed out that many Indians don’t wear clothes that could be worn with belts. Many men wear the traditional dhoti (fabric tied around the waist), which leaves no room for a belt or any belt loops. Amma suggested that the form factor of the controller be reduced to a smaller size so that it could be worn as a pendant around the neck, so that’s what Rahul and his team are working on now.

It’s not so easy to see on this background, but to the right you have the original design of the controller (you can see the 4 ECG leads coming out of it, which would be attached to the user’s chest). With user testing, the team found that the buttons were too close together and couldn’t be distinguished by the user, leading to many wrong button presses. On the left, you see an updated design with the buttons spaced farther apart. The next design will incorporate these button changes on a smaller controller, as mentioned above.

A day later, I met with engineering professor Dr. Rajesh Kannan to see his prototype for a wheelchair that can be controlled by partially paralyzed stroke patients, who are unable to use the joystick of a motorized wheelchair or the manual controls of a mechanical wheelchair. Dr. Kannan is working with various engineering students to develop software so that an app on a smartphone or tablet can be used to steer a motorized wheelchair over Bluetooth, bypassing the joystick. A patient rests their hand on the flat surface of the phone or tablet and uses simple gestures – sliding the palm forward to go forward, back to go backwards, etc. – to control the direction of the wheelchair. Shifting one’s palm on a flat surface like this is easier for many patients than manipulating a joystick. The wheelchair has only been tested with five stroke patients so far, but Dr. Kannan said that the reactions were highly positive, mostly for psychological reasons – these patients had always been dependent on others for movement, so finally having the independence to drive their wheelchair without help had great emotional benefits. The only problem with the wheelchair, of course, is cost – Dr. Kannan said that the motors for electric wheelchairs are imported, and so this type of product won’t be practically affordable until wheelchair motors are manufactured in India.

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Here is the motorized wheelchair with the stand for a tablet or phone where the joystick would be.

Finally, I had a brief chat about villager attitudes with Ranjit, the point person for Amrita University’s Live-in-Labs program. Live-in-Labs allows foreign students to live in a rural village for a period of 2 weeks to 6 months, working with the locals to build sustainable solutions to various problems. I asked him what would make a medical device succeed in these sort of villages, and he mentioned many important considerations. Most of all, he said, the success of a device depends on how well it fits the lifestyle of a particular village (and village lifestyles can vary enormously throughout the country). Ranjit gave the following example: if a device that uses fingerprints for patient identification is used in a population where people’s hands are too callused to read fingerprints, that device needs to have a backup ID method such as retina scanning. Designers have to make their medical devices modular so that they can adapt to different conditions, and they have to be humble and flexible – realizing that if a villager can’t figure out the device, it’s a problem with the design and not with the villager. The designer has to keep working with the villagers to iron out the kinks of their design at each stage in the process.

Again, this is the theme of codesign, which kept coming up in my meetings at Amritapuri, along with the importance of making medical technology affordable. Since Amrita University is a non-profit, researchers don’t have to worry about making money off the devices they design. Almost every project connection I’ve made in India tells me that affordability is the main factor necessary for acceptance of medical technology here. Often, when I ask people for the second most important factor, they either mention cost again (really!), or they mention usability. It was great to hear so many people at Amritapuri talk about the important of codesign and working closely with the end user to develop something easy-to-use. I’m glad to have an academic visit to contrast with the visits I’ve had with various companies in Mumbai and Bangalore, which naturally have more corporate and cosmopolitan perspectives.


2 thoughts on “Health post: Cost & cooperative design

  1. Hi Mercer, just read this and was amazed at how it related to my Dad! He has an insulin pump and we can now download all his sugar readings and just send the file to his doctor instead of keeping handwritten notes. He also has a motorized wheelchair with a joy stick that he can’t use well because of a broken shoulder. How cool that there are people all over the world working on helping the technology work!!!!


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