Health post: Solar-powered hearing aids

I went to the offices of the “Botswana Innovation Hub” to meet with Deaftronics, the only local medical device start-up I’ve found in Botswana. Deaftronics makes the “Solar Ear” unit, a solar-powered charger for hearing aids. The small, handheld device has a solar panel and a port for a digital hearing aid as well as ports for rechargeable hearing aid batteries. In 3 hours of sun exposure, the unit can fully charge the batteries, which can be used for up to a week without needing to be charged again.

The Solar Ear unit with space for a standard hearing aid and two rechargeable hearing aid batteries.

Deaftronics’s mission is to provide hearing aids to all hearing-impaired people who need them, including people living in remote areas without consistent access to electricity. They emphasize empowerment of the deaf community not just by providing solar-powered hearing aids, but also by training and employing deaf people in their manufacturing and design processes.

Tendekayi Katsiga, the technical director of Deaftronics, is a firm proponent of co-design (participatory, user-based design) and believes that the best solutions come from the users. He told me that the idea of solar-powered hearing aids came from a school for the deaf in Botswana and that his role as the electronics engineer was to transform that idea into a product. For any sustainable project, he said, the process of “iteration and ideation” is key – improving upon the design of a product multiple times until it is exactly what the end users need and want.

Tendekayi Katsiga with the device (the hearing aid is inserted for charging here).

In addition to the benefits of co-design, combating stigma is a great reason to employ deaf people, said Tendekayi. There is a stigma that hearing-impaired people cannot work or be productive, and Tendekayi believes that it’s important to highlight that the opposite is true – hearing-impaired people might even be more productive than the average hearing employee, he said, because they can focus on the work with fewer distractions. (It’s certainly a controversial idea, but an interesting change from the usual underestimation of the abilities of hearing-impaired people. I couldn’t find a ton of backing for this, but this book and some other articles support the idea).

Tendekayi mentioned that a challenge of selling the Solar Ear in Botswana is that the government can afford hearing aids and batteries for the few hearing-impaired members of its small population. Very few people would opt to purchase a private product when they can get something from the government for free – and since the government is such a large force in Botswana, it is hard to be a private business there. This moment reminded me of the health worker’s complaint in Sekhutlane that the government spoon-feeds its citizens too much. He believed that if Botswana’s government didn’t provide so many services for free, more people would be motivated to work as well as spend money, thus stimulating the economy.

Thus while some people are using the Solar Ear unit in Botswana, Deaftronics is focusing on potential users in places where it can have more impact: Zimbabwe, Zambia, Mozambique, and other areas in sub-Saharan Africa where hearing-impaired people cannot get aids from their governments or purchase more expensive options. Deaftronics has been endorsed by UNICEF, which could pave a pathway for providing Solar Ear units for free in such areas. In future designs, Deaftronics hopes to add a USB port to its Solar Ear unit so that users can also charge their cellphones via the device.

Entrance to the Botswana Innovation Hub.

When I asked him why Deaftronics seems to be the only medical device start-up in Botswana, Tendekayi told me about another complicating local factor: the people of Botswana don’t believe in Botswana-made products. I’ve heard this a few times now, and it’s taught me the importance of local inspiration. Almost everything used in Botswana is imported from South Africa or further abroad. Botswana’s population is small; no great innovations, products, or companies have originated in the country. Of course, that doesn’t mean that great things cannot come from Botswana, but it isn’t exactly inspiring for Botswana’s citizens.

In America, we grow up with incredible success stories of companies like Ford Motors and Facebook as well as examples of revered entrepreneurs and so-called visionaries. These stories inspire generation after generation to keep building, to keep dreaming, and to keep trying, even after many failures. Part of this is due to the large population of the US; if there is a large enough number of start-ups, even if each has a very low chance of success, some of them will make it big. Representation matters: it’s hard to be inspired to make something in your country if there are no success stories to look up to.

I’ve heard this from a few Batswana now, and Tendekayi phrased it well – there’s a perception that when a product is home-grown or designed locally, it’s not the “real thing.” Now that Deaftronics has won a few awards, Tendekayi is confident that the perception will change. Especially with the establishment of the Botswana Innovation Hub, Tendekayi hopes that more Batswana will be inspired to innovate locally.

A rendering of the soon-to-be “Botswana Innovation Hub” – the space is moving to a completely new location to serve as a true hub for budding companies in Gaborone. (From this article).

Health post: App for Assistive Technologies

Last week, I visited the Botswana chapter of the South African Federation for the Disabled, SAFOD. SAFOD is an organization that supports disabled people in 10 countries in southern Africa, and the Botswana chapter is called BOFOD. They are currently working on the “AT-Info-Map,” a three-year project to develop a smartphone app with information about all the assistive technologies (AT) available in the country. It will be released to Batswana users in a year or two and ultimately made available in the other member countries as well (Angola, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe).

Mr. Kayange (left) holds a smartphone with the latest version of the AT-Info-Map app. To the right is Mr. Chiwaula, Director General of SAFOD.

I met with Mr. Chiwaula and Mr. Kayange at the BOFOD office in Gaborone to learn more about AT-Info-Map. The app, aimed towards disabled people and their caretakers or other stakeholders, will inform users of the location, availability, and cost of the assistive technologies they seek. Assistive tech, AT, includes hearing aids and wheelchairs, as well as tools not often thought of as technologies such as crutches, prosthetics, and glasses.

Mr. Kayange told me that all assistive technology in Botswana is imported from South Africa, Europe, and other areas – there are no local manufacturers. Thus the AT suppliers in Botswana sometimes have minimum order numbers that make it unfeasible for one person to get just one or two crutches, for example. Even though the government would supply those low quantities for free, said Mr. Kayange, the demand is still higher than the government’s supply, and some people still need to purchase their own assistive devices. He said that, as it is, the only people who know where to find reliable assistive technologies are wealthy people with expat connections – people who can order specific devices from abroad if need be. At least with the app, anyone with a smartphone could access the same information.

(Of course, I asked them what happens if people in their target user group don’t have smartphones. They agreed that this is a potential problem – it’s unrealistic to assume that everyone has a smartphone, which SAFOD discussed. They decided that it wasn’t enough of a reason not to make the app; those that do have smartphones will still benefit).

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A close-up of the app’s home page. Clicking “Start” opens another simple page that allows the user to search for assistive technologies in their region or by category.

A lot of our conversation centered around the issues of access and awareness – words that came up many times during my time in India. Especially in Botswana, where the population is so sparse, people may live very far away from a hospital or clinic (an access problem) and may have no idea what AT might be relevant to their needs, let alone where to get it (an awareness problem). Mr. Kayange and Mr. Chiwaula told me that the government’s idea of AT is essentially just wheelchairs and crutches. If nothing else, AT-Info-Map could inform people of other types of AT, ultimately increasing demand for better services. The AT-Info-Map app will store usage data such as the most-commonly-searched-for assistive technology, and if that data demonstrates an unaddressed need (for prosthetics, for example), SAFOD could take that data to the ministries and advocate for more government-funded prosthetics.

Without engaging the government, said Mr. Kayange and Mr. Chiwaula, they can’t be successful. In Botswana, probably because the country is so small and centralized, the government is involved in all health endeavors – so it’s crucial to partner with them if a project is going to be sustainable. However, like in most countries, this involves dealing with a lot of slow bureaucracy and government officials who are very cautious about new ideas.

There’s not as much “activity on the ground” as BOFOD would hope, and the status quo for disabled people largely stays the same year after year. Mr. Chiwaula pointed out that, as Botswana is a relatively stable and well-off Southern African country, it’s not a popular recipient of donations. Since international organizations tend to focus their resources on the neediest places, Botswana’s economic advantage has become a disadvantage – because, as Mr. Chiwaula was saying, such donations would still be welcome. This made a lot of sense to me, though it was sad to hear.

SAFOD was able to build the AT-Info-Map by collaborating with Washington University in the US for technology support, the international organization Dimagi for the mobile app design, and AfriNEAD, a network for disability research. Throughout the design process, SAFOD has also consulted with professionals, government officials in the Ministries of Health and Education and the President’s Office, and potential users. They went back and forth with potential users, performing user-centered design by returning to the field with multiple prototypes. Now, they are satisfied with the version they have and will begin deploying the app for use. Mr. Kayange and Mr. Chiwaula told me that their current concerns at the moment are how to get people to use the app once it’s available, as well as how to incentivize AT suppliers and service providers to register their information on the app. I was glad to hear that their final design is the result of several rounds of user feedback – hopefully that’s enough to guarantee a positive response on a more national scale. It will be interesting to see if the availability of AT in Botswana changes at all in the next few years once this app is in use.