Imagine you live in a village deep in rural India.
Since your village lacks health care facilities, if you need quality care, you’ll most likely have to trek a long way to the nearest primary health center. You may also have to go to a diagnostics laboratory, which means you’ll have to use up a whole workday for a doctor’s visit.
So you end up waiting to visit the doctor until you deem your health problem serious enough to warrant it, by which time it could be too late to receive effective treatment. And you’re highly unlikely to journey to a health care center for lower-priority services like screenings and preventive care.
Now imagine having access to a device that can be used to test urine – even by non-medical professionals, and even in areas without electricity and Internet access – allowing for the screening of about 25 medical conditions and helping to manage diabetes, pregnancy, kidney, liver, bladder problems and urinary infections. Suddenly, diagnostics and health screening and monitoring would become vastly more accessible to the rural patients common at the BoP.
This is the scale of potential behind uChek, a mobile app that can carry out urine analysis using conventional dipsticks, converting a standard smartphone into a lab urinanalyzer. Created by Mumbai-based medical engineering firm Biosense Technologies, uChek is the firm’s second product after ToucHb – a non-invasive, portable and affordable anemia screening device adapted for poor communities.
The uChek app was developed first for the iPhone, and gained over 1000 individual users in India and the US a month after its launch in April. Last week, the company launched an Android version, allowing health workers to use the app on any affordable smartphone. Biosense intends to offer, to any organization working on health access issues, a complete urinalysis solution consisting of the technology (smartphone app and kit), data management (backup software) and logistics (dipsticks supply).
Laura Espiau of Villgro interviewed Abhishek Sen, doctor, biomedical engineer and CTO of Biosense, about the importance of preventive care and monitoring, and how uChek can impact patients at the BoP.
Laura Espiau: What are the main consequences of lack of prevention and monitoring when it comes to health?
Abhishek Sen: Diabetes has almost epidemic proportions in India, with more than 60 million diabetics in 2011 - and this number is predicted to nearly double by 2032. Detected on time, diabetes is treatable with relatively inexpensive medication, but the real burden of diabetes is its associated complications, which lead to increased morbidity and mortality. Without proper monitoring, it can evolve into life-threatening related diseases like nephropathy, which requires more sophisticated treatment, and renal replacement in the worst cases.
Maternal health is also a concern, as the lack of medical monitoring in under-served areas increases the risk of complications in pregnancy, like preeclampsia. Again, if not detected on time, preeclampsia can cause life-long health problems in both mother and child. It also accounts for about 15 percent of maternal mortality in developing countries.
Liver disorders and urinary tract infections are other health threats, especially in rural areas, because of a lack of prevention. We could go on with other examples, but at the end, the message is clear: They are all major diseases and could be treated effectively if detected on time and monitored, at the village level.
LE: What are the challenges of prevention at the village level?
AS: Today, the major noninvasive diagnostic tool available for clinicians is urinalysis. But villagers rarely visit doctors for screening or monitoring, and even if a health worker visits the villages, they won’t be able to carry accurate urinalysis equipment. So any screening tool needs to be portable, accurate, inexpensive and battery-operated.
There are manual urinalysis tools consisting of visual strips that can be compared with a color chart reading for screening. This solution is portable, relatively inexpensive and needs no electricity, but it provides only a semi-quantitative analysis and is subject to human interpretation, which leads to a less accurate diagnosis. There are also laboratory urinalysis machines which provide a reliable result, but they depend on electricity and are expensive for the public system to adopt them.
The challenge is to provide a tool uniting all the requirements, which is what we’ve been working on.
LE: Tell us about uChek.
AS: The uChek mobile app uses the smartphone’s camera to analyze conventional urine dipsticks. There’s also the uChek “cuboid,” a simple plastic contraption that acts as support for smartphone. Together, the smartphone, app, strips and cuboid perform the role of a lab urinalysis machine, at one-fourth the cost.
It can screen more than 10 patients an hour, measure 10 parameters in urine (leukocytes, ketone, nitrite, urobilinogen, bilirubin, protein, glucose, specific gravity, blood and pH) and screen for up to 25 medical conditions. The results are stored automatically in the smartphone and can be sent like an SMS through uChek’s backup software for monitoring purposes. You don’t need Internet access to perform the tests. Also, it is easy to use, making it accessible even to less educated health workers.
(Left: uChek urinalysis strips)
Another challenge in rural areas is that urinalysis strips are not always easily available, so we give the optional service of buying strips and sending them to any location where they are needed. The idea is to provide an end-to-end service as a sort of “urinalysis partner” to all NGOs and public or private organizations working to improve health access.
We are providing the technology (uChek device), the data management through our backup software (if required, also providing our own servers), and the logistics to make sure that uChek can be used anytime, anywhere.
LE: Who are uChek Android customers and what is the payment model?
AS: We are selling uChek as a complete urinalysis solution (technology, data management and strips) for NGOs and public or private health care organizations. The customer can choose to buy the full system, which includes a Samsung Ace phone, for around $200 (Rs 10000), or the solution without the phone for $30 (Rs2000). It’s a one-time cost.
For you to have an idea of costs, the commercial alternative for a urine test strip reader costs upwards of $800. In addition, we are selling either our own Biosense strips at Rs 11/unit, or Siemens strips, which are also compatible with our device, at Rs 15/unit (i.e. per test).
LE: How will you measure the impact of uChek?
AS: We provide our community health care customers a backup software for monitoring aggregate data. The data from the field is stored automatically, organized and analyzed to show logistical information (tests performed, strips remaining, etc), geographic locations and medical results (diseases identified, evolution of them). We will also add the option of including demographic information while performing the tests. This is going to be a powerful tool to measure the health and social impact of the organizations working to improve access to health care in underserved areas.
LE: What have you learned from working on uChek?
AS: First of all, surprisingly, that the urinalysis industry has practically not changed for the last 30 years. Second, that you can do almost everything with a smartphone. And the third point is more a hope than a learning, that people will learn how to monitor their health with urinalysis.
uChek for Android was launched in India on July 10. If you want to know more about how it could help your organization provide medical screening in rural areas, write to firstname.lastname@example.org
Biosense Technologies is in the incubation portfolio of Villgro, which supports innovators and social entrepreneurs in India during their early stages of growth. To learn more about Villgro, write to email@example.com
Laura Espiau has been working in Mumbai as a Villgro Social Enterprise Fellow, 2012-2013. She did communications and partnership development with Biosense Technologies, and she now collaborates directly with Villgro's communication team.