Engineering is applied dreaming – theories rendered tangible, the methodical weaving of the textbook into reality.
I learned the art of dreaming as a middle-school student, while wandering through rows of modified bicycles and redesigned lanterns at an exhibit in New York celebrating “Design for the Other 90%” – the true global majority, legions of families subsisting on too little water and too much uncertainty.
The museum walls were plastered with glossy photos of children embracing over newly built pumps; tiny villages clustered around a single computer; a woman, her face creased in a sun-burned smile, weaving baskets by the light of a solar-powered bulb. To the other 90 per cent, invention wrought transformation. I was taught early on to dream without boundaries, grew up giddily nurturing the idea of a world of infinite possibility, but it was only there, amidst the exhibit aisles of innovation, that I discovered a population where engineering meant life.
Consider the cellphone.
As an engine of change, it is a romantically disruptive one, a technology that criss-crosses borders and thrives on connection in all its forms – to networks, to people, to the world. Already, in areas of Africa and India, mobile phones play every part at once, bankers, pharmacists and secretaries rolled into one. In developing countries, the path of least resistance to modernization is flung up one phone tower at a time.
Over lunch, as a high-school sophomore, I sketched out the blueprint of my dreams to a doctor from India. Even now, I told him, the technology exists to build a network linking patients everywhere to doctors anywhere, on the framework laid by millions of mobile phones. Think of the promise of letting a physician hold a virtual stethoscope or electrocardiogram leads to the chest of a patient from many miles away, I said.
There were pockets of change in India, he told me, and waxed rhapsodic about one of the better hospitals there – cutting-edge by local standards, it owned a newly purchased magnetic resonance imaging (MRI) machine. This was progress, I agreed, and asked whether anyone feared that cavernous scanner, whether patients new to the clinical strangeness of medicine found it uncomfortable lying for stretches of time on the hard surface of the MRI bed. He stared at me blankly. In this state of the art clinic, he said, they slid patients in on pallets of cardboard.
After lunch that day, I promised I would follow up soon, would send him an email. No, he told me, he did not use email. My contact information, my questions, ideas and dreams would need to be sent somewhere else.
He took out his phone.
Building for the developing world means peering into a box of paradoxes – here, mobile phones eclipsed computers first and then plumbing, and in some countries there have been more usable phones than toilets. As a high-school student, I developed mobile-phone-based diagnostic tools specifically for the developing world, including a series of low-cost cardiac monitors built to transmit stethoscopic heart sounds and later electrocardiogram data to a Bluetooth-enabled feature phone that could send those data to a physician. During that time, I quickly uncovered some of the bracing realities of mobile phones. Physicians working in developing countries, must recognize that serving the other 90 per cent – the world’s global majority – requires connecting our most vulnerable patients directly to doctors, wherever they are.
Developments on every front have steadily chipped away at traditional arguments against action. The question has never been one of a lack of demand – estimates from the World Health Organization peg those living in countries with low to non-existent access to medicines controlled under international drug conventions at a staggering 5.5 billion. And, increasingly, we can no longer claim that the problem is rooted in a lack of technology, or that the idea of using telecommunications networks to deliver health-care services too early for its time. As a student, I used little more than off-the-shelf parts – a repurposed audio amplifier board to magnify the minute electric pulse of the beating human heart into a detectable signal, an inexpensive microprocessor bought at my local electronics store – to build electronic stethoscopes and electrocardiograms. For less than US$100.00, I found it was possible to send the thump of a beating heart from a patient’s cellphone to a physician’s phone, with a clarity sufficient for most basic cardiac exams.
The pieces to bring telemedicine to the developing world, then, are already there – cellular networks and a skyrocketing population with access to phones, smaller and cheaper electronic components than ever before, and wireless technology baked directly into phones so that medical tools can send the beating pulse and biometrics of patients to doctors nearly anywhere. Even as a young person wallowing amidst dreams and questions, and tangles of wire, I understood the impact of harnessing mobile phones for medicine. Now, I believe that patients in the developing world might one day transmit pulses through text messages and send for a physicians’ consult with the technology they are already holding in their hands. The question is not how, but when.