How artificial intelligence could solve the Kashmir problem

Affordable medicine from IndiaMoney or life?

"A solution that no one can afford is not a solution. Whatever options there are to alleviate suffering must be affordable."

That is the credo of Devi Shetty, heart surgeon and founder of the Indian hospital chain Narayana. It is pointless to talk about medical development when 80 percent of the world's population cannot afford this treatment. A report in the Narayana Hospital in Bangalore accompanies doctors, medical technicians and programmers on their way to better health care for the poorer population.

The lobby of the Narayana Hospital in Bangalore. Hundreds of patients and relatives are waiting for their admission interviews. Anyone who is familiar with the area will recognize the typical clothing from all corners of India in the hall: Dhotis from Kerala, Shawal Kamiz from Kashmir, turbans from Punjab.

A petite woman in a dark red sari kneels, her forehead pressed to the floor, in front of a statue of the god Narayana. Amutha, a day laborer, is waiting for her husband to come out of the operating room.

Medical treatment is not free

"The doctors told us he needed a new heart valve. All I could think about was, how are we going to pay for the operation? But then we heard from Dr. Shetty."

Devi Shetty is sitting at his desk two floors above the lobby. He wears a blue surgical gown and a hairnet, and the gauze mask hangs around his neck. While her little daughter watches in silence, the mother across from him cries with relief.

Shetty pats the woman on the head and assures her that everything will be fine. In a normal hospital, the woman would be sent away with her child with a heart condition.

"In a developing country, people have to pay for treatment out of their own pocket to save their lives. Two million Indians need heart surgery every year - but only 150,000 get one. The rest just die."

Medical care in India is a question of money for the people (Christian Nusch)

Heart surgery in India typically costs around $ 3,000. For most, this is simply priceless.

"We decided to cut costs so more patients could afford the procedure. Today we do it for $ 1,500, $ 1,800."

How is that possible? The hospitals founded by Shetty work according to the discount principle. The Narayana chain operates 24 hospitals; two and a half million people are treated here every year.

The mass makes the individual intervention cheaper, for example because consumables are bought in quantities. And also because the capacities of the hospital are used extremely efficiently.

"We work six days a week. Saturday is a full working day for our surgeons. Our operating theaters are in operation from seven in the morning until ten in the evening. This enables us to make optimal use of our expensive technology."

Save wherever possible

Operating tables, heart-lung machines and X-ray machines have to be imported from the USA or Europe and are expensive. But if the technology is less sophisticated, it will be checked again and again whether one or the other can not be obtained cheaper or even manufactured yourself.

"Take something as simple as surgical sutures, for example. This is not a high-tech device, but simply absorbable sutures. The fact that they are firmly attached to a needle accounts for a significant part of the cost. Both components are not manufactured by European or American companies who sell the sutures, they just connect them to each other. That can also be done in India - and that is exactly what we are doing. This has significantly reduced our expenditure on sutures. "

Doctors elsewhere in India are also paying close attention to where money can be saved. In many places, catheters are not disposed of after a single use, but sterilized and reused. So that a third of the suture does not always have to be thrown away, a clinic urged the manufacturer to offer shorter sutures for less money.

There are surgeons who instead of imported drainage hoses use gasoline hoses from the automotive industry, which cost only a fraction. Others do not work with a hernia with special gauze, but simply with cut apart, sterilized mosquito nets. A study from Great Britain confirms that the procedure can be performed just as well and safely with it.

But components from the water supply have probably made the steepest career.

Dr.D.R. Mehta, founder of Jaipur Foot, in the workshop (Christian Nusch)

Dr. D.R. Mehta takes me to Jaipur Foot's workshop in Rajasthan, India. For more than 80 years, the tall man is surprisingly upright. He knows every one of the many employees who hammer, screw, saw and file on prostheses here at the workbenches.

In one corner of the workshop, pipes are piled up next to a large furnace.

"It's a completely normal water pipe. Usually they are black, but for us they are made in skin color. Look how tough it is."

The old man strikes the pipe firmly several times on the edge of a workbench with astonishing force.

"Yes, that is our raw material for the artificial leg. The foot is manufactured separately. We heat the pipe here in this oven, it then becomes soft and easily malleable."

From the water pipe to the prosthesis: a Jaipur Foot employee producing the prosthesis (Christian Nusch)

An employee takes one of the wobbly plastic pipes out of the oven and pulls it over the imprint of a leg stump.

"The prosthesis is fitted exactly. If it doesn't fit to the millimeter, it will cause pain."

As in a small theater, the recipients of these prostheses sit on a bench or in wheelchairs in front of the workbenches and watch as the rubber feet are screwed onto their artificial legs.

Patient in the ehealth center Jaipur Foot (Christian Nusch)

"We insist that everyone who gets a prosthesis sits here and understands how it is made, because it should not be a mysterious object. If a screw loosens, then you can simply go to a bicycle workshop in your village, and get it fixed so they don't have to come here. "

Donors from around the world fund around 28,000 artificial limbs each year. This is only possible because the prostheses are incredibly cheap: a shin with rubber flow costs $ 65. What is the difference in quality compared to a German prosthesis, one wonders? But that seems marginal.The right prosthesis for everyone: rubber feet from Jaipur Foot (Christian Nusch)

German medical technicians, with whom I spoke about Jaipur Foot, think - of course - the German prostheses are better, but have no fundamental criticism of the Indian products.

Mehta's employees have just demonstrated in the courtyard how agile the patients can become. Many wear prostheses themselves. One climbed a tree, another easily won a race against a perfectly healthy 10-year-old.

Now Metha holds up an inconspicuous construction made of plastic and metal: the "Jaipur knee".

"Time Magazine from the USA named the Jaipur knee one of the 50 most important inventions in the world in 2009. It costs $ 20 - in the USA a comparable knee costs $ 10,000. We have now used 40,000 of these joints."

A knee completely from India

The artificial knee was developed in collaboration with students from Stanford University in the United States. Basically it is a very simple hinge that is built into the prosthesis at knee level.

The gag about it: When swinging forward, the artificial leg locks. The blockage only loosens when rolling, so that the movement is fluid. Five plastic parts, four screws and nuts, plus self-lubricating, oil-filled nylon.

All of these components are available in the local Indian market. No special tools are required to assemble the joint and it only takes a few hours to manufacture.

Mehta leads me to the next workshop, where a young man is working on the latest developments. The master of the prostheses leaves us to his colleague Prasnand Gade, who looks exactly as you would imagine a nerd - somewhat rounded, thick glasses - and completely immersed in the development of a bionic hand.

Prasnand Gade, engineer at Jaipur Foot, with an artificial hand (Christian Nusch)

"The fingers are controlled by the brain. Two sensors are incorporated into the prosthesis. They pick up the nerve impulses from the stump. When he wants to move a finger, he controls it with his thoughts. He can do many everyday things with it, water." drink or eat with a spoon. "

Jitu is currently adjusting a hand: You can see how much he has to concentrate - but: it works. He can move a finger and pick up a pen. As a little extra, Prasnand Gade has built a useful gadget into the artificial hand.

"When you don't need your hand, you can also charge your cell phone with the built-in battery. But the best thing about this hand is the price. Normally a prosthesis like this costs at least $ 8,000. This one only costs $ 250. What's new about this one Development."

The company's founder, Mehta, wants to answer the question of why it's cheaper himself. He tells of a UN conference at which he was also asked this question.

Prostheses don't have to be expensive

"The ambassadors asked, why is the price so low? I said you'd better ask those who sell the prostheses so dearly why their prices are so high. They pillage people."

To make medical care cheaper, first and foremost it takes the absolute will. And according to Devi Shetty, founder of the discount hospital chain Narayana, standardization.

"Think of an artist who creates a statue of a god. It takes him three or four months to do it. If I make one of them and cast the figures, I can make 1,000 pieces a day. For the person who prays in front of it, it makes no difference.

Each cast figure is exactly the same and costs a fraction of the original. Health care should not be an artistic one-off, but standardized assembly line production. "

This, he says, makes medical care not only cheap, but also safe because it is less prone to medical errors.

Data analysis reduces costs

Above all, however, data processing will revolutionize treatment.

"Today doctors make their decisions based on what they see and are told during an examination. They use their knowledge to make a diagnosis and prescribe medication. But the treatment is so complex that a human brain cannot provide all of this data can quickly process and evaluate which of the many options is the best. Data analysis can do that. It makes treatment safer and cheaper. "

To show me what he meant by that, Shetty sent me from the Heart Clinic to the Narayana Diabetes Department.

As in all hallways and waiting areas of Narayana, it is very busy all day long, and almost every seat is occupied.

Behind a curtain, a young woman records the data of a patient. She measures pulse and blood pressure, asks about family history, previous illnesses and previous medication. When was the last sugar shock? How was he treated? She does not put all this data on paper, but enters it into a tablet.

Social worker Ishrat Mahajan records patient data in the slums (Christian Nusch)

The young woman has just finished her bachelor's degree, she did not have any specific training, just attended a seminar in which she learned what is necessary. Her salary is much lower than that of Subramanian Kannan, who has direct access to all of this data in his small treatment room.

"This system is my personal assistant. I have a page with examination results, one with the patient's history, one for complications, one for secondary diseases, one for family history and social background. For complications, for example, information about nerves, eyes, Kidneys, feet, erectile dysfunction, strokes and heart attacks are stored. All complications that can arise in connection with diabetes. Any doctor or nurse who is registered in the system can access them. "

Privacy? No problem

And what about data protection? The diabetologist does not understand the question. When I tell him that my health insurance chip doesn't even have my blood type stored on it, he can hardly believe it. But why?

We talked about this for a long time after the interview and it quickly became clear that when it came to data protection issues between India and Germany, worlds collide. In any case, Kennan only sees advantages in the app. If only because he can treat a lot more patients. There are 70 to 75 per day.

How many patients would you have treated without the system? Probably 45-50 thinks Subramanian Kannan, a good third less.

30 percent more patients since the system was introduced, which means more stress and thus a higher probability of overlooking something and making mistakes. But the app evaluates all data in a flash and sounds the alarm in case of doubt.

“Green means everything is ok, red means there is an abnormality. For example, if there is a suspicion of depression, the screen lights up red, then I know that I should refer the patient to the psychologist so that he can himself take a closer look. "

Artificial intelligence is supposed to control medical professionals

So that the programmers at Narayana could develop this app, Subramanian Kannan and his colleagues have compiled their medical knowledge, sorted the information and linked it together in the app. The next step is to process information on medicines.

"We want to build an artificial intelligence into the system that tells the doctor whether a certain medication is contraindicated. If the doctor accidentally prescribes the wrong medication, a window pops up and the app asks whether he really wants to prescribe it. The doctor can make his own decision, but is given the opportunity to review it. "

Over time, technology will completely change medicine, says Vivek Rajagopal, who programmed the app.

"At some point the doctors will rely completely on the computer and only intervene in an emergency. Just like pilots do today."

In fact, technology in India is already taking on tasks that used to be carried out by doctors - if there were doctors.

A slum on the outskirts of the metropolis of Jaipur. On the edge of an alley, through which motor scooters are constantly honking their horns, a health worker is recording the data of a local resident.

Help for the poorest in India (Christian Nusch)

She measures weight, height and hip circumference and asks a few questions about age, family and health problems. Her name is Shakila, she is 65 years old and often tired, and she also suffers from hair loss. Next to the health worker is a rucksack filled to the brim with small electronic devices.

"Here, for example, we have a portable EKG machine that we can use to measure the heartbeat. It's a device to determine the iron level, you only need a drop of blood. We use this to do a glucose test. And then we have another Blood pressure monitor and a heart rate monitor included. "

Explains Dheeraj Bhatnagar, who is in charge of this project at Jaipur's Narayana Hospital. The heart of the mobile health check-up equipment is a tablet computer, no bigger than a cell phone.

"It is directly connected to the devices. Here you can see the measurement of the EKG coming in. It is immediately recorded and evaluated."

A heart curve appears on the small screen. Seconds later, the minicomputer announces the results of the examination.

"The device has not found any abnormalities. This is saved automatically. Now it's time for iron levels and blood sugar."

The health worker pokes her patient in the finger and presses the drop of blood onto a sensor. A moment later this evaluation is also there.

Those who have no money ignore diseases

Shakila is anemic - which explains why she is so exhausted and shedding hair all the time. Why hasn't she gone to a doctor long ago with these symptoms? She shrugs her shoulders.

"Slum dwellers who are not really seriously ill do not go to the doctor. If they do not feel well, they explain it simply by saying that it is all the hard work. That is why they ignore warning signs. That is why we offer all residents of this area to test themselves so that they at least have a health check-up. "

With 30 to 35 people living in slums, the team will do this basic investigation today.Usually every time they find one or two people who are seriously ill, and many who are diabetic or, like Shakila, iron deficiency - a consequence of poor diet.

The investigation is over, all data are saved. Shakila receives a printout of her results and advice to come to the health center. But does Shakila really go there and get medication?

In any case, your test results are digitally available there. So far, these check-ups have only been a social project by Narayana, which is being carried out in cooperation with two cities and two villages. But Shetty is already working to convince health policymakers to offer them everywhere in slums and rural areas.

Prostheses from the subcontinent - an export hit

The global challenge in health care is not that it keeps getting better, but rather making it affordable for the majority of the world's population. India is a pioneer and medicine from the subcontinent has become a real export hit. AIDS patients in developing countries are almost exclusively supplied with cheap generics from India.

Jaipur Foot operates prosthesis workshops in Africa, Central America and Southeast Asia. And the patients at Narayana not only come from India, but also from neighboring countries, the Arab region and Africa. They may find it cheaper to travel to India than to have an operation at home.

The discount hospital was also the only option for the Indian woman Amurtha and her husband with heart disease. The young woman wakes up at her husband's bedside and takes care of the care - another cost-saving measure that helps to lower the price. The procedure cost 1,500 US dollars, an amount that the newly introduced Indian micro-health insurance company is barely paying for.

"I'm just so grateful that my husband could have an operation at all. Otherwise he would have died. But he will live and our two children will have a father. That is all that matters."

Concerned about data protection? Do you have a bad feeling about the mass processing, which could possibly affect the quality? These are luxury problems that Amurtha cannot afford. And Devi Shetty does not accept such concerns either, on the contrary, he considers them to be exaggerated.

"Elites are indifferent to the suffering of the poor"

"There are many interests in health care, including those from the West. If someone wants to reform the system, they are fought off with the arguments 'security' and 'data protection'. That is the biggest problem. Otherwise health care would have changed a long time ago. "

In fact, the quality of Narayana's care meets the criteria of the Joint Commission International, which are also used as a basis for the certification of hospitals in Germany. Narayana's success rate is even higher than that of other Indian hospitals.

"The educated elites are indifferent to the suffering of millions of poor, they can buy good health care, so they do not speak out. Only when the elites no longer accept that young women die in childbirth, and millions around the world Children are carried away by simple diseases, only then will something change. But that does not happen, because we do not care. It is not our children who suffer. "