Every year, sometime during the June-September monsoon season, a bunch of engineers and designers, fresh from a stimulating six months at Stanford University in California, step into one of India’s most chaotic medical establishments — the All India Institute of Medical Sciences (AIIMS). Over the next year, after hundreds of visits to wards, operation theatres, lecture halls, accident sites and consulting rooms, these aspirant medical craftsmen progress from shock, amazement and understanding to gain insight into India’s rather complex health-care needs.
"During the first year, the state of the wards and the general inefficiency with which people were handled as new patients was overwhelming. I couldn't help thinking that there had to be a better way to manage them," said Amit Sharma, among the first entrepreneurs to have trained on the Stanford Biodesign Program in India.
Sharma and his colleague worked on a device that was triggered by the desire to improve hygiene and preserve the patient's dignity, a factor that gets short shrift in a health system desperately trying to cope with huge numbers of people. Fecal incontinence is one of those conditions that overworked nursing staff may not be able to deal with in time. The device they developed works like a urinary catheter to collect a patient's stool via specialised bags and can be systematically, painlessly, quickly and — most importantly —hygienically disposed.
Unlike medical scientists and academic researchers looking for the next big drug molecule that can offer cures for India's diabetic or cardiovascular disease epidemics, the entrepreneurs at AIIMS are travelling a less glamorous and far more circuitous route to technological glory.
"Rather than products, we are looking at creating an ecosystem," said M.K. Bhan, secretary, Department of Biotechnology, and one of the key visionaries of the programme. By that, he means creating a "Silicon Valley-like" atmosphere in which individual inventors make products that venture capitalists will want to invest in, followed by private equity firms. The innovators are thus encouraged — financially and intellectually — to move on to more complex products like implants and, thereby, trigger a high-quality, self-sustaining Indian medical devices industry.
"I think the big impacts will register only about 5-10 years later," he said.
According to a report by BioSpectrum India, an industry journal, India's medical devices industry is estimated at $2.5 billion (Rs 11,500 crore) and is expected to cross $4 billion by 2012, growing at more than 15 per cent annually. While most of the volume comes from non-implantable devices (classified as Class I medical devices), much of the revenue comes from lower-volume Class II and Class III devices, many of which are implantables such as stents and pacemakers.
While India's numerous engineering colleges have been offering biomedical engineering courses for over a decade, the Stanford Biodesign Program — a collaborative enterprise involving the Department of Biotechnology, AIIMS, Indian Institute of Technology-Delhi, and Stanford University — is unique in the kind of talent mix it attracts.
Since 2007, when the India programme began, four candidates are selected every year to spend six months at Stanford, where they are taught that innovation isn't just about so-called eureka moments or flights of whimsy.
"We learn that innovation is a well-structured process. We are taught to break down health-care needs, zero in on which are most pressing, can be reasonably solved, and can be translated into a viable product," said Darshan Nayak, another fellow at the programme.
A doctor from Mumbai, Nayak had eschewed medical practice for a startup and had developed a device to quickly check haemoglobin levels without pin pricks and long-drawn blood tests. After the Stanford programme, he says he's much better informed of the regulatory and intellectual property laws regarding medical devices in the US and India. He's cagey about the specific devices that he's developed, saying it's "too early to discuss them." He and Pulin Raje, his inventor colleague, are focused on trauma care.
"We've spent lot of time outside AIIMS too, being in ambulances and observing how patients were handled and transported to accident sites.
Often, this handling was so bad that the patients were worse off by the time they reach(ed) the hospital," he said.
The innovations he's working on include devices to help prevent patients from deteriorating in such a situation and which can be modified to suit various kinds of accidents.
"We have a definite plan on how to bring products to the market. It's different from being in an academic environment where you work on a concept, prepare a power point presentation and then go on to something else," said Raje, who graduated in design from the Indian Institute of Science, Bangalore.
Being able to develop a viable business plan and encourage doctors to be entrepreneurs and inventors is one of the key motives of the programme.
Whether a product actually fails or succeeds is secondary, said Balram Bhargava, senior cardiologist at AIIMS, and a key architect and executive director of the Stanford programme.
Bhargava recounts his own attempts at developing a stent during the late 90s. "By the time the stent was somewhat ready, the design was outdated."
The realisation that the right ecosystem had to be fostered to encourage faster product development and a car ride with Paul Yock, who headed the Stanford Biodesign Program, laid the seed for the India venture.
Programme interns are already working on their own ideas. One group, Sharma said, is trying to solve a commonplace, universal problem of how to transfer patients among beds without having doctors and nurses having to physically haul them around.
"They are working on a bed spread, made of a different kind of material, that can be easily handled by one person," said Sharma.
Apart from the ability to spin off their own companies, the programme participants see participation as an opportunity to sharpen skills learnt in design school, apart from doing something that can benefit society.
That's partly what persuaded Pushkar Ingale and Nitin Sisodia to say goodbye to designing cars and bike parts at Maruti Suzuki India Ltd and Bajaj Auto Ltd. "I felt that this was an opportunity to do social good," said Sisodia, a graduate from the National Institute of Design, Ahmedabad. "If I can work on something that can touch a lot of people simultaneously, it's worth going after."