November 13, 2020

Is South Africa Ready for Mobile-Driven Medical Devices

Life is what happens to you while you’re busy making other plans. A lot of calls for proposals filter through my e-mail, and most of them I hardly notice. However, when the Director of the Fitzpatrick Institute circulated a SEAD global health proposal, it caught my eye.  Perhaps it was the idea of new horizons or perhaps it was the brief application form.  Or perhaps it was the idea of making a small difference in some way, shape or form.

I had been looking for some sort of different project, something out of my area of comfort. As an anesthesiologist and biomedical engineer, my work has focused on the technological side of medical devices. My research interests have been in areas such as photonic properties of tissue, medical device standards development, and updating, improving developing, and miniaturizing current medical technology. Despite being involved in a couple of device startups, I have never been a financial or business savvy individual, and in addition I am still a more or less full time practicing anesthesiologist. I saw this as an opportunity to learn something in a new area, and perhaps get involved with a project that could help improve the quality of life for a certain set of individuals, even in a small way.

The Opportunity 
Medical technology is rapidly evolving, and there has been a growing trend to attempt to leverage the computational power of today’s smart phones against the dire need for medical technology in underdeveloped countries.  Today’s smart phone CPU is immensely more powerful than the computer that landed man on the moon.  In fact, that smart phone that most people use for texting, social networking and playing games has more computational power than all of NASA during the Apollo 11 mission. 

In contrast, many current medical monitors are large, single purpose, expensive devices well out of the reach of the underfunded medical facilities typically found in the developing world, including Sub Saharan Africa.  And yet, 80% of all sub Saharan Africans carry some sort of cellular phone, with smart phones comprising a minority but growing fraction.  My collaborators and I decided: why not look at the possibilities of leveraging this powerful, commonly available yet underutilized processor to help alleviate the urgent need for medical devices?

We decided to use South Africa as a model, mainly because of its well-developed mobile network, and its combination advanced technology resources juxtaposed with its large areas comprised of low resource and impoverished living conditions.  Using a forty dollar (USD) pulse oximeter designed to plug into the headphone jack of an iPhone, we set out to find a collaborator in the RSA that would give us access to phone distribution data across the rural areas of the country and a glimpse of how phone technology is being distributed and upgraded.  Cell phone technology has exploded across all parts of the globe, with Africa no different from anywhere else. In little more than a decade mobile technology has become ubiquitous and we wanted to know how cellular technology spread to all these rural areas. Is that distribution network still currently valid, and could other mobile or mobile driven technologies be piggybacked into this same network?

The Reality
What I rapidly found out about working in South Africa is that businesses are typically underexposed, with underwhelming internet presences and word of mouth/introductions serving as a significant door opener when doing business. Because we had an available introduction directly to its CEO, we started negotiating with a company in Johannesburg that specialized in text and SMS services throughout the RSA and surrounding countries. Each of the captured return texts/SMS messages contained the brand and model of phone, along with the operating system. Not only does this firm handle millions of text/SMS messages a month as part of their distribution of services, they also have intimate relationships with the major cellular providers, potentially giving us an inside track to obtain additional information from these companies. 

Our goal was to develop an understanding of the changes in user cell technology over time by mining the captured data for phone type, operating system, etc., and then by examining the changes in user phone type and computing capability over a number of years, develop a model forecasting some broad trends in the improvement of user cell technology in the future. The data we were hoping to obtain from the cellular providers were intended to add to this model documenting the past key elements in the physical/geographical spread of new technology, thus enabling us to forecast a physical model of the best way to introduce new technology, i.e., cellular driven medical devices along the same established distribution lines.

After an initial visit to discuss terms and options for access to their data, along with a set of sample data files from their archives, it appeared we had an agreement in principle, and were ready to get started. However, before long it became apparent that they were having second thoughts.  After several months of continued negotiation, they decided that they were being overwhelmed with their main business efforts, and did not have the resources to assist us with this project. That being said, they then provided us with an introduction to another firm specializing in the global cell network, which also proved fruitless. However, this firm suggested yet another company, specializing in data collection using cellular surveys and SMS texting. This third try proved successful, and once the international agreements were signed, we finally had a partner in South Africa.

However, in the process of locating our final partner, our planned retrospective data analysis of previous market segments to forecast future trends using previously captured hard data had morphed into a prospective survey of future market trends. One thing that became very apparent during this period of frustration was that we were going to have to remain flexible in our methods and goals. However, the prospect of doing survey work in the field was exciting to me, and also allowed us to examine the ease of medical data transmission from rural areas of the RSA.

The Findings
I interviewed people in representative rural areas like Grabouw, Manzamhlophe, Rawsonville, and Gamalakhe in order to get a sense of the need and desire for inexpensive medical devices driven by cellular technology. Out of the twenty individuals I personally interviewed, every one of them was interested in potentially obtaining such a device despite that fact that many of them lived in structures with dirt floors and open windows. Additionally, many of them surprised me with the amount of resources they might make available to purchase such a device. 

For us in the US, forty dollars might make for a short night out with friends. For many of my survey participants, forty dollars might be two to four weeks’ earnings. Of course, actual spending behavior is not guaranteed by previous answers to survey questions, so these numbers should be accompanied by a healthy, or perhaps unhealthy dose of salt. I believe the interest is present, the hunger for new, quality of life improving technology is real, but the logistics of providing this technology to the end users through the hurdles of finances and bureaucracy are the biggest remaining impediments.


In the professionally conducted surveys, participants were categorized as using either “dumb/brick” phones, “feature” phones which have limited apps and processing power, and smart phones. At least two thirds of all users planned to upgrade their phone technology within a year. In addition, a majority of feature/smart phone users were interested in purchasing an accessory device for their mobile phones, including inexpensive medical devices. When further questioned about purchasing an accessory medical device that could potentially help save a life, greater than seventy-five percent of feature/smart phone users would be “very likely” to purchase such a device. The amount that the participants would be willing to spend on such a device was greater than $20 for the majority of both feature/smart respondents, and greater than $40 for the majority of current smart phone users.
In addition, transmission of data files collected by our iPhone linked medical device proved quick and easy over the networks available even in rural South Africa, opening the door to potential remote diagnosis assisted by low level first responders or even medically untrained individuals.

Lastly, I was able to contribute in unexpected simple ways, such as using the mobile device to help examine an elderly woman with lung problems whom I met sleeping on a pallet on a dirt floor. 

I also helped set up a fund to buy toys and educational materials to help stimulate and educate children in a clean but barren township preschool after visiting the crèche they used as the local daycare.  

In conclusion, my experiences in South Africa suggest that rural Africa is ready for mobile-driven devices/hardware, as long as it is reasonably priced, simple to use and available for use with the most common operating system platforms. There already exists a burgeoning software/App market in medical and health care related Apps. For example, Find-A-Med was developed to allow users to find the nearest health facility while Hello Doctor allows access to free medical advice and even consultation with a physician. Given our experience, South Africa’s rural mobile networks appear more than robust enough to handle the data generated by modest mobile medical apps and related devices. Most of the rural Africans I met were very interested in new technology and are keenly aware of the potential benefits that it can offer. All that they are lacking are the resources that we take for granted.

My personal take away lessons are that even though local African companies might be eager to become involved with international research, not all of them are capable of doing so due to a myriad of different reasons. Also, have a backup plan in mind as you start to structure research in resource-limited settings. Many things can and will change during the course of your project. Success in modified projects is still achievable, but it may not be what you originally envisioned. Lastly, if time in Africa is involved, keep your eyes open for the opportunity to do a little good locally with the resources you have at hand.