TB-sniffing rats are just one example of healthcare innovation using available resources, writes Ashoka Ireland’s Fiona Koch.
Tuberculosis (TB) is an infection of the lungs that can be fatal if left undiagnosed and untreated with antibiotics. In parts of the world where healthcare is readily accessible, the disease has been relegated to a curable rarity. Yet, in many developing countries, it remains prevalent, with an estimated 9m new cases of TB diagnosed worldwide every year, and over 90pc of TB-related deaths occurring in low-income countries.
TB is also a leading killer of people living with HIV. This is partly because the Victorian-era microscope diagnosis test commonly used in developing countries correctly diagnoses only about 60pc of TB cases, but figures are as low as 20pc for patients also suffering from HIV.
HeroRats to the rescue
In the face of what the World Health Organisation is calling a global TB epidemic, an innovative tech startup named Apopo is attempting to reverse the harrowing statistics, using rodents to sniff out TB in cough and spit samples.
No ordinary lab rats, Apopo’s African giant pouched rats – affectionately named HeroRats – are extremely sensitive to smell, with more genetic material allocated to olfaction than any other mammal species. They are also highly social animals, and can be trained to communicate with humans.
In Apopo’s training centre, they are taught to sniff at cough samples submitted by hospital patients, and to make warning signals at the telltale scent of TB-infected bacteria.
According to a recent profile in The Guardian, the HeroRats’ correct diagnosis rate is 70 to 85pc. Plus their ability to trace TB in even HIV-infected samples makes them far more accurate than the antiquated technology mentioned above.
HeroRats are also a cheaper and more efficient investment for cash-strapped hospitals. A DNA-screening device that takes up to two hours to analyse each individual sample with 95pc accuracy costs $17,000 and thousands more in upkeep. By contrast, a HeroRat costs $6,500 to train, can probe through hundreds of samples every hour, and requires only food, water and cages for shelter.
The HeroPUPs will open their eyes any day but for now they rely on their little whiskers to feel their way around. pic.twitter.com/NWZux4AiBH
— APOPO's HeroRATs (@HeroRATs) August 11, 2016
Apopo is based in Tanzania which, like its sub-Saharan African neighbours, has some of the world’s highest rates of HIV and TB infection among its population.
Since launching in 2007, Apopo’s tuberculosis programme has grown from working with four hospitals to 21 in the Tanzanian capital, Dar Es Salaam. In that time, the rats have screened 342,341 samples and identified 9,127 previously undiagnosed patients as having TB.
‘HeroRats have been consistently increasing TB detection rates in Dar es Salaam between 30 and 40pc’
– BART WEETJENS, APOPO
“We have been consistently increasing case detection rates in Dar es Salaam between 30 and 40pc,” said Apopo’s founder, Bart Weetjens, in a 2010 talk at TEDxRotterdam. “Knowing that a [misdiagnosed] patient infects up to 15 healthy people per year, you can see that the impact is considerable.”
As of 2016, Apopo is working with partners in Addis Ababa in Ethiopia to begin trialling the programme there, and hopes to expand further afield in the future.
Rats of many talents
Impressive as it is, Apopo’s work with TB detection is not Weetjens’ first venture. Years before setting up the TB clinic, he gained recognition for training rats to detect landmines.
An industrial engineer and product designer by training, Belgian-born Weetjens was moved to action when he watched a documentary by the International Campaign to Ban Landmines in the late 1990s. A Dutch researcher who proposed using cockroaches to detect TNT exuding from hidden landmines inspired Weetjens to consider training animals that are indigenous to the countries in which landmines are common.
After securing funding from the Belgian government to begin testing his theory with rodents, Weetjens’ involvement with the African giant pouched rats began.
Much like their TB screening assignment, the rats scan fields of open land, sniffing for traces of TNT. When they find them, they begin scratching the ground. Weighing an average of 1kg, the rats are too light to set off mines, meaning that they are never harmed in the process. And they are incredibly efficient. They can scurry across and search 200 square metres of ground in 20 minutes, compared with 50 square metres per day for a person using a metal detector.
Training for Apopo’s landmine detection programme takes place at their headquarters in Tanzania and, since setting up in 2000, they have expanded their work to Angola, Mozambique, Cambodia, Laos and Vietnam. A huge victory came in September 2015, when Mozambique was declared officially mine-free, thanks in large part to Apopo’s work in deactivating 13,294 landmines and clearing over 11m square metres of land over the course of seven years.
‘A huge victory came in September 2015, when Mozambique was declared officially mine-free, thanks in large part to Apopo’s work in deactivating 13,294 landmines and clearing over 11m square metres of land over the course of seven years’
Apopo’s commitment to improving the lives of vulnerable people through locally optimised, sustainable programmes has been internationally recognised for decades. This year, think tank NGO Advisor ranked Apopo 16th in its annual Top 500 NGOs in the World.
Weetjens himself has gained recognition for his innovative vision and impact. He was selected as a fellow by Ashoka, a global network of leading social entrepreneurs, in 2007, and has also received funding and support from the Skoll Foundation and the World Economic Forum.
Despite its recognition, Apopo still relies on grants from governments, foundations and a few partners, as well as an adopt-a-rat funding programme (which it runs through its website).
Strength in numbers
Weetjens and Apopo can be considered as pioneers in a rapidly growing sector of healthcare innovation in the developing world. While no organisation can quite match Apopo’s uniquely groundbreaking approach (and their highly marketable hero mascots), several start-ups are making waves with impressive levels of impact and efficiency.
US-based Medic Mobile is capitalising on the ubiquity of mobile phones in developing countries. The health-tech start-up provides community health workers in remote regions of developing nations with an app to help them simply and rapidly collect and share data with patients and hospitals.
Founder Josh Nesbit’s own ‘a-ha’ moment came while he was working as a doctor in rural Malawi. He noticed that despite having incredibly limited health resources – some patients walked as far as 160km to see the hospital’s only doctor – the cell-phone connection was better than in his Californian hometown.
Founded in 2010, Medic Mobile has grown rapidly and currently serves over 10,000 healthcare workers and 8m people in 23 developing countries, with impressive results. In Uganda, for example, infant mortality rates have been falling ever since the implementation of the technology.
‘In Uganda, infant mortality rates have been falling ever since the implementation of Medic Mobile’s technology’
In India, where the healthcare system is overburdened with demand, another social enterprise is using technology to transform healthcare.
Noora Health provides recovering patients and their families with training videos and mobile apps to aid their post-hospital recovery. The videos are simple and educational, teaching skills like hygiene management, temperature-checking and post-surgery wound dressing, with dubbing in seven Indian languages.
“We’re making the information accessible to everyone,” founder and CEO Edith Elliott told the The Wall Street Journal last year, “regardless of literacy.”
‘We’re making the information accessible to everyone regardless of literacy’
– EDITH ELLIOTT, NOORA HEALTH
Since its founding in 2014, the Bangalore-based organisation has trained 25,000 family members through 20 Indian hospitals, and has found that the rate of 30-day post-surgery complications has declined by 36pc and hospital readmissions have dropped by 24pc since their programmes began.
As the numbers show, both Noora Health and Medic Mobile’s approach of using technology to empower untapped, existing actors has allowed them to scale their growth and impact on an unprecedented level, all while using limited resources. They have also gained international recognition for their work, with both organisations winning prestigious awards in the past year alone.
In all these respects, their success mirrors that of other fast-growing Silicon Valley-style health-tech startups – apart from one crucial difference.
Like Apopo, Medic Mobile and Noora Health are structured as non-profit social enterprises, choosing to put their social mission before a desire to drive a profit. They are just a few shining examples in a growing sector of health innovation that is changing lives – and indeed, entire systems – for the better.
By Fiona Koch
Fiona Koch is communications manager for Ashoka Ireland. She writes about trends and innovations in the social sector.
Bart Weetjens, Josh Nesbit and Edith Elliott are members of the Ashoka Fellowship, the world’s largest network of leading social entrepreneurs. Find out more about their work on Ashoka’s website.
Main image of brown rat via Shutterstock
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