Abstract
My project’s format is a series of letters to my grandfather (Venkatesh Reddy). Within the letters, I will address my questions about how he passed away, why he passed away, what he could have done to live a longer life, my journey of learning about these inequities in healthcare, and finally, how my engineering work is helping others like him overcome these obstacles in medicine. After conducting brief interviews with Janaki and Subamma Allu (my mother and grandmother respectively), I learned that Venkatesh passed away due to three main reasons: lack of access to affordable diagnostics, informative health education, and advanced treatments. Specifically, Janaki mentioned in my interview with her that if only one or two of these factors were present in Venkatesh’s environment, he may have survived; But, because all three were present, Venkatesh never knew the value of his health, never maintained it, and by the time he did realize its importance, it was already too late. For me, the last time I met Venkatesh was when I was 4 y/o, meaning I have practically no personal memory of him at all. When I was young, my parents wouldn’t tell me why Venkatesh had passed away, but as I grew older, I realized that his death in that living environment was only a matter of time. At around this age (16 y/o), I began working in Dr. Bhamla’s lab at Georgia Tech. Through my internship, I was exposed to numerous sub-1-dollar medical diagnostic devices that likely could have saved Venkatesh’s life. With this in mind, these letters chronicle my life experiences throughout the years, navigating the meaning of his death as I learned more about the healthcare inequities of the world and worked on innovating more life-saving devices.
**Venkatesh is called Tata in a few of the letters because it is Telugu for grandfather. Subamma is called Ammama because it is Telugu for grandmother. My nickname, when I was younger, among my family members was Pandu. Sharath is one of my cousins who lives in India**
Introductory Letter #1: April 2008 (6 y/o)
**Since I didn’t have a computer at this age, I had to handwrite the first letters**
Letter #2: January 2014 (13 y/o)
Letter #3: July 2017 (15 y/o)
**By this age, I had a computer, so I switched from handwriting to typing**
Grandpa,
I think I’m beginning to understand WHY you passed away so early, but first……Uhh……how did you not know daily drinking and smoking would harm you! I mean I get it, you’re not going to drop dead on the spot after one shot or one puff, but, over time, what about all that damage it does to your liver and lungs? When I asked Mom about this, she said you didn’t think it was a big deal, even though you knew it wasn’t good for you.
Nowadays, the only question racing through my mind is What If? What if you knew about all the damage that excessive alcohol consumption does on your liver? What if you knew about the life-threatening toxins you were smoking every time you opened a new pack of Gold Flakes or took another shot of Imperial Blue? (Mom told me those were your favoriteWhat if someone you trusted had told you these two habits could (and would) cut upwards of thirty years off your life?…maybe you could have lived longer? Maybe I could have met you again? Maybe we could have played cricket one last time? But I try not to think about that. It’s all in the past. I’ve accepted it (Have I?).
Anyway, I wanted to tell you about a trip I just went on with my school. I came back last Sunday, so basically a week and a half ago. We traveled to the Dominican Republic where we delivered medical supplies, conversed with local health professionals, and informed community officials of sanitary health practices. It really opened my eyes to the different states of healthcare that exist around the world. I mean, the DR isn’t even that far from Georgia yet it has one of the worst-maintained health systems in the world. Talking to the Dominican locals was also really surprising to me because many of them didn’t even have clean water and without any town-supported education campaigns, some didn’t even think it was important to sanitize contaminated water. Some of the health professionals didn’t even know how to respond to cardiac arrest! (I took a CPR certification last year, which was pretty cool)
It just makes me think about all the resources we have here in the U.S and how few those in LMDIC (low and middle-income countries) have. Hopefully, I can do something to change that in the future. It’s funny…a lot of the community and environmental conditions were actually pretty similar to the village back in Kurnool. If only a school like mine in India had visited you and talked to you about the life-threatening dangers of those bad habits…But I try not to think about that. It’s all in the past. I’ve accepted it (Ok, maybe not entirely).
I’m going to read a bit more about these things called “inequities” and see if there’s a way to fix them. My school recently introduced a joint program with Georgia Tech’s global health-engineering department…maybe I’ll get involved and check out the projects? As you probably know, Ammama’s birthday is coming up in a few weeks…we’ll all be thinking of you, both in our hearts and in our prayers.
Love, Sai
Letter #4: July 2018 (16 y/o)
Grandpa,
So, I took your advice. I think the 3.5 mm version for the 3D-Fuge diameter works better than the 2.5 one. I know, I know, the 3.5 mm model will create more drag and yield lower RPMs, but the 2.5 mm ones seem to break a lot more frequently. I mean, what would be the point of frugal medical diagnostics if it just broke after a few uses? But, I figured out how to cut the drag in half!
I was reading through that Chagas paper and talking with Dr. Bhamla at Georgia Tech and I realized we could just increase the infill and print it closer to the 3D-printing bed. So as of now, we are limited to 70,000 RPM. In any case, the people in Madagascar are probably not going to need 70,000 RPM anyway; After all, we only need it to spin at 20,000 RPM for it to detect malaria…and that’s what it’s always been about right? Getting it in the hands of those who need it as quickly as we can. Unfortunately, I can’t go with Dr. Bhamla and Elio (you remember, the post-doc) to Madagascar because I have a calculus test next week. But, like you always told Mom, find the silver lining. Luckily, I will have more time to design the new secret device that I’ve been so excited to tell you about…wait am I allowed to tell you about it? Let me ask Dr. Bhamla.
〜2 days later〜
Ok he said it should be fine as long as “he’s not an engineer working for the University of Georgia”. Those guys are always trying to steal our ideas. Anyway, the device is called the ElectroPen and it’s a sub-30-cent electroporator. It’s supposed to do the same things that an electroporator does, which is electrically transforming bacteria and inducing plasmid uptake. Didn’t catch that? Yea, neither did I the first time. Basically, we shock the bacteria and add genetic code that allows it to do cool things like fluoresce or produce medicines. And that’s exactly why I’m so excited about it! Imagine producing medicines like insulin in clinics and labs with low resources and then being able to distribute it to community members. Obviously, you would need regulation and safety, but without the middlemen and profit-hungry businessmen, imagine how many more people could afford them. Actually, this reminds me of two pretty interesting comics I saw the other day:
Yea, I thought you would get a good laugh out of it. But they weren’t that funny to me for some reason… maybe because they’re so true? But where was I? Oh right, the low-cost medical tools I have been working on to improve diagnostics for people in underprivileged countries. Speaking of which, I should probably tell you a little bit about how the field got started. You can probably read some of this history online too, but I know you would be more interested in hearing my side of the story. So, from my experience, the field of frugal science was first ushered in when Dr. Manu Prakash at Stanford developed the Foldscope: a 50-cent paper-based microscope capable of reaching magnifications of 2000X. Crazy right? In fact, I actually had an opportunity to build and test this out when I was working with Dr. Bhamla (Disclaimer: It took me
fiveten tries to get this image).
Kinda looks like a picture of a large rice paddy field of rice paddies taken from an airplane right? Well, this is actually just a picture of two grams of a plant leaf and hopefully, it shows just how powerful the microscope can be. As the peer-reviewed publication suggests, it can be used in real-time to detect pathogenic E. coli or Giardia, which is a really dangerous water parasite found in tropical climates.
Back to the device, after the Foldscope was invented, the post-doc of Dr. Prakash’s lab (Dr. Bhamla) worked on another device called the Paperfuge. Now this is where things really get interesting. As if making a microscope out of paper wasn’t hard enough, they decided the next logical thing to do was to make a 200,000 RPM centrifuge out of the same material. Hey, I would’ve thought it was impossible too! But by using the physics and mechanics of this really old toy called a whirlygig, they were able to do it. And this device had even greater impacts on the field of pathogen detection than the Foldscope! After the Prakash lab published the Paperfuge, Dr. Bhamla began working as a professor at the Georgia Institute of Technology and started working on the 3D-Fuge. Here we are again full circle!
But seriously, the Paperfuge and 3D-Fuge are so simple to use. Disregarding the fact that all these devices cost less than a dollar to produce, you don’t even need other machines to yield valid test results. Just to prove to you how simple it is to run, let me give you a quick run-through of how to use the device; First, take two ml of a sample, whether it be water or blood, and use the Paperfuge to separate it out into discrete components. Then a scientist can just look at the sample and tell you if a parasitic infection is present. If you couple that with public health information about what diseases are most common in the region, a health professional can easily narrow in on the specific parasite and provide treatment/medication on the spot. No electricity, no big machines, and no wait time.
Imagine that: a healthcare system where all you do is go to the nearest lab (bear in mind, without the crutch of electricity and supplementary machines, the lab can be outside as well) and within five minutes, you receive the treatment you need…the same treatment that would cost 5 times as much if facilitated by conventional hospital-doctor-lab-pharmacy medical care. With all of these benefits, do you think you would have gone to one of these “portable clinics” for your health? Maybe they could have detected the cardiac troponins in your bloodstream and deemed you as a patient at risk for cardiovascular complications? Maybe you would have lived for another 2 or 3 more decades?…which would mean you would have gotten to see me ride a bike for the first time…fail my first test…hit a game-winning shot…even graduate from high school?
But, I try not think about things like that…instead, I focus on the fact that my work may be able to help other grandpas live a few years longer, allowing them to see their grandchild one more time without the fear that it will be their last. And don’t worry, I’ll do my best to “find the silver lining” like you always used to say.
Well, I don’t want to leave you lugubriously once again, so I’ll continue to update you on my progress with the ElectroPen. And I need to get started on 3D-printing those 3.5 mm 3D-Fuges you recommended! As always, thanks for everything.
With Love and Full of Hope, Sai
Letter #5: December 2019 (17 y/o)
Grandpa,
Just got back from my internship at Northside Hospital and there’s something we urgently need to talk about: technology. Today, I had an opportunity to watch a real surgical procedure for the first time and there were SO MANY machines. From the X-Ray machine to the mechanized IV for drug delivery and even to that pulse detector thing you wear on your finger, they all had screens that displayed highly accurate, life-saving information. AND THE PROCEDURE WASN’T EVEN THAT COMPLEX…well relative to other surgeries. The whole surgery only lasted for about an hour and if I recall correctly, Dr. Dua, who is the head physician of the Northside Pain and Spine Center, said the procedure was called a lumbar facet nerve block, which was one of the least invasive anesthesiology procedures? Did you hear that? Least invasive and they still require all of that technology.
I actually asked Dr. Dua what the combined price of all the devices in the surgery room would be…he said it would be minimum 500,000. Yes that’s USD, not rupees. And just for the fun of it, let me tell you what 500 thousand dollars is in rupees. It’s 37 million rupees. And if that doesn’t seem like a big deal, Ammama told me your yearly income was only 1 million rupees (around 13 thousand USD). And keep in mind this is one department of the 20+ at Northside. And this hospital is one of the 10+ hospitals in my county. And there are 150+ counties in Georgia alone. And there are 50 states in America. You don’t need to be a mathematician to realize that while American healthcare is highly advanced, it is also extremely expensive. Ok, even considering the fact that you’re probably not going to be buying the technology and instead paying for the treatment, oftentimes basic tests cost at least 1000 dollars without insurance and it only goes up from there. And if the patients in America need these technologies, don’t the patients in India as well? What happens if they can’t afford it? Do they just walk away from the receptionist counter and ignore their health forever or shell out money for the care and spend the rest of their life paying the debts? I don’t know…to me, both seem like bad options.
Speaking of India, when I visited Nellore in India last year, Sharath had broken his arm and as a result, we had to go to the hospital. When we walked in, the waiting room was over capacity and understaffed, meaning that those already annoyed by having to spend a signficant percent of their income on healthcare also have to wait for an hour or more. But even once you walk in, the technology and equipment is clunky, often outdated, and sometimes even broken. Here’s a clear example of the difference between American and Indian healthcare: At Northside, almost all departments have electronic sphygmomanometers (you know those blood pressure machines); In rural India, almost every blood pressure measurement is done manually with a stethoscope and BP cuff. While this is just one example, it proves that the field of healthcare is not equal across the globe. And keep in mind that Nellore isn’t even the poorest city in Andhra Pradesh. And Andhra Pradesh isn’t even the poorest state in India. And India isn’t even the poorest country in the world.
But the fact that Nellore doesn’t have the worst healthcare in the world shouldn’t be something to brag about. Because it was still enough to take you away from me…from Mom…from Ammama…from everyone.
Take care, Sai
Concluding Letter #6 : April 2020 (18 y/o)
Tata,
I thought I would tell you first…I just got into Rice University! I know you’ve never been, but it’s in Houston, TX, so southwest US and it actually kind of reminds me of Andhra weather! While I’m not sure what I want to study yet, there’s a really cool Global Health program called Rice 360…maybe I’ll pursue a minor in it? In fact, I was just talking to Rahul, who’s a current sophomore at Rice, about the program and he said some of his friends were building frugal devices similar to the 3D-Fuge; I was also reading an article about how Rice students made a $300 ventilator to help medical professionals with COVID-19…wait, you don’t even know about the pandemic!
Well, this strain of coronavirus reportedly originated in China and from there, it began spreading via airborne transmission across the world. The first U.S cases, if I recall correctly, were in Washington and it slowly began spreading to other states. My school actually closed this week because someone in our county had it, but the superintendent assured us schools would open very soon. To be honest, I don’t think this virus will spread very far if everyone wears a mask and follows quarantine procedures, but I guess only time will tell. And of course, I’ll let you know anything else crazy happens around the world!
〜Update May 2020〜
So our school just shut down for the rest of the year. Looks like the American people don’t follow the rules as well as I thought. The good news is now I get a 5 month long vacation, but the bad news is I probably won’t get to say goodbye to most of my friends and teachers. Currently, we are instructed to limit our exposure to others and wear a mask if we need to go out…oh and can you believe some people are just outright refusing to wear masks in public? They think being forced to wear a mask is a violation of their rights…maybe they don’t understand that a little discomfort while wearing a mask is insignificant compared to the pain of losing a loved one.
But I understand. I know that pain.
At this rate, I’m not sure if this pandemic will ever end without rapid vaccination of high-risk communities. And get this…there are even people who refuse to take vaccines because they don’t trust what’s in it! But those same people trust the ingredients of vape and cigarettes. Anyway, our family is safe and we’ll try our best to avoid going out until the pandemic is over.
I’ll be sure to let you know how that Global Health coursework goes at Rice and hopefully we’ll have the chance to talk about cool, life-saving inventions once again. In regards to actually interacting with the community, I’ve signed up for a program called Civic Owlets that allows students to virtually interact with Houston social workers and other incoming undergraduates. From there, I can work with those same community members to make even bigger socioeconomic impacts on Harris county residents.
While these small steps are just a preview of what I plan to do at Rice, these goals have and will always stem from my past with the underprivileged and my past with you. Possibly one day, my work can be used to help others in a similar situation as you, take control of their health, live as long as they can, and even…spend those last few moments with their grandson. Even though my pain is and will always be there, I’ll continue trying to…like you always say…”find the silver lining”.
Signing off, your Pandu
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