Rice MBA Team Visits Rural Poor

A tiny hut in rural Rwanda (photo by Vicki Chang)

Child with leg infection (photo by Vicki Chang)

Kigali, Rwanda (March 4 & 5, 2010) -- Morning meetings at regional hospitals and afternoon field trips to rural communities, one of them one of the poorest of Rwanda, characterized Friday's work for Rice MBAs who are working to commercialize Rice technology in Africa.

"I have seen poverty, but this was incredible," said Sharad Malhautra of the backpack team. "We drove out of Kigali on a paved road. Then we turned off road on to a rutted path. Finally we stopped and hiked for an hour to the village. The people there had little to eat. We saw a man who looked like he was dying and a little boy with serious infection on both legs."

Many villagers in remote areas suffer from infection, malaria, and lung diseases like TB.

Despite claims by the Rwandan government that every village has a community health volunteer, villagers in this community told Malhautra they had never seen a health volunteer.

CPAP and IV Drip Monitor Big Hits with Doctors

Meantime in Kigali on Friday morning the SmartDrip IV Drip monitor and "Baby Bubbles" CPAP device both received enthusiastic approval from doctors at University Central Hospital of Kigali ("CHK" or "Chuck" as its called by locals), the second largest hospital in Rwanda.

Of all the Rice medical devices, the IV "SmartDrip" device consistently met with enthusiastic reception. It's portability, ease-of-use, and low cost make it a winner to doctors and nurses who currently pay top dollars for comparable devices. Doctors want the SmartDrip now.

Shelley Cao demos popular SmartDrip IV Monitor

The CPAP controlled air pressure device which is designed to inflate newborn's lungs when they have difficulty breathing was also popular, but doctors wanted to see the device modified to use oxygen as well.

Hospitals were less enthusiastic about the backpack and c-clamp dosing devices, although the backpack was popular with community health clinics and in rural areas (like the one mentioned above at the beginning of this posting).

Kathik Alagappan demos EasyDose C-Clamp for Controlled Oral Dosing

Rwandan health officials had the most reservations about the c-clamp device that regulates the amount of medicine that can administered from one dosing syringe. Health workers were concerned about the clamp being sold apart from a dosing syringe. Some nurses expressed concerned about cleanliness of any kind of reusable dosing device. Although currently, most Rwandans re-use spoons or dosing cups to give medication to their children, an unsanitary practice, especially in villages where clean water is rare.

Power, Water, Remote Regions, Maintenance

(Saturday morning, March 6, over breakfast, Hotel Gorillas) -- Dr. Jeffrey Rose, MD, of Ascension Health told the MBA teams that despite great improvements in health care, Rwanda still faces incredible infrastructure challenges -- non existent or unreliable power, untreated water in rural districts, and non-existent or poor roads.

"But beyond the problems with infrastructure, Rwanda needs a plan for maintaining the medical equipment it has," said Rose, whose organization gathers and refurbishes donated medical equipment only to see it break down and never be fixed. "Maintenance is a huge problem for any medical community, but in Rwanda the problem is worse because there are no trained maintenance people to work on equipment."

Rose challenged students to develop business models for a countrywide solution to its maintenance deficit.

----------------------------------------

This post ends the blog until the students return midweek. Many students will be hiking or taking tours to see the gorillas in the wild.

The MBAs will spend the rest of spring term developing their business plans for each of their products.

A Proud Lioness Watching Her Pride

Two of Dr. Agnes' nine million charges.

Kigali, Rwanda (Thursday, March 3) -- It may have been their most important meeting during their stay in Rwanda.

Representatives from the SmartDrip, EasyDose, infantAIR, and Lab-in-a-Backpack teams sat nervously waiting for their meeting with the permanent secretary of Rwanda's health ministry, Dr. Agnes Binagwaho, aka "Doctor Agnes."

Students reasoned that if Doctor Agnes supported their bio-tech products, they might have a better chance of those products getting in the hands of the Rawandan medical commuunity.

But as Dr. Agnes told the MBAs, impressing her doesn't guarantee anything.

As Dr. Agnes and many others explained to the Rice students, Rwanda prides itself on rigorous honesty and attention to the rules.

Before the teams' products can become a part of health care in Rwanda, they must pass rigorous inspection and testing. Doctors and hospitals must be convinced of the devices' value. Pricing must be fair in a country where most citizens earn less than a dollar a day.

Never misses a beat

Dr. Agnes is smart, inquisitive, honest, funny, and critical. She is the perfect person for the complicated job of administering health care for nine million Rwandans, a role she takes on like a lioness protecting her pride.

Dr. Agnes Binagwaho, permanent secretary of Rwanda's healthy ministry, meets with Rice MBAs and bio-engineers

Although her assistants interrupted her for her signature several times during the hour and a half meeting, Dr. Agnes never missed a beat.

She explained Rwanda's rigorous purchasing process to approve medicines and medical devices. She eyed the students' product demos with a critical eye, asking questions and making observations. And she volunteered names and phone numbers for contacts who could help Rice teams introduce their products in to Rwanda's medical pipeline.

You had the impression that she is the steady hand guiding Rwanda's health services into the 21st century.

Dr. Agnes about the Rice program:
Sharing knowledge and saving lives is "really Christian"

Land of a Thousand NGOs

Rice Professor Marc Epstein and Josh Ruxin at Heaven

by Gale Wiley

Kigali, Rwanda (March 2 & 3, 2010) -- Here in the "land of a thousand hills" it has been a real world learning experience for Rice MBAs and undergraduate engineers as they navigate Rwanda's health care system, identifying its dizzying number of suppliers, distribution channels, officials, certifications, regulations, and what seems like a thousand NGOs.

For example, on Tuesday, the C-clamp "EasyDose" team visited hospitals where doctors said the team's device for regulating oral dosage of drugs "has potential." On Wednesday the team interviewed health care management and supply chain consultants. Thursday, it met with the President's Emergency Plan for AIDS Relief (PEPFAR), the Bureau des formations médicales agrées du Rwanda (BUFMAR), and the AIDS Foundation.

Wednesday the CPAP (infantAIR, Inc) team met officials from UNICEF, the Center for Disease Control (CDC), and the Columbia School of Public Health. They met with organizations that train Rwandans how to use drugs. They met with organizations that serve as a bridge between health care workers and patients.

On Tuesday the backpack team toured a tiny health clinic in the Bugesera district where they saw the efforts of Project Access to modernize rural clinics by using computers, record keeping, inventory management, and refrigeration. Earlier in the week the team met with a physician who formed an organization of Rwandan doctors focsuing on something they call "mobile health care."

Using QuickBooks at Bugesera health clinic

Tuesday, the SmartDrip team showed its battery-powered IV monitor to doctors at Rwanda's biggest hospital where the team learned that over hydration is not as serious a problem as the team had thought.

On Thursday each team sent a representative to meet with Rwanda's minister of health.

Monday night at his wife's restaurant, Heaven, Josh Ruxin, a five-year resident of Rwanda and a well known authority on comprehensive approaches to fighting poverty with emphasis on scaling up national health programs, met with the Rice teams. Ruxin is the country director for the Millennium Village Project and founder of the Access Project for the Global Fund to Fight AIDS, Tuberculosis and Malaria.

His advice to the students was practical and to the point: if you want your products to succeed, find a market and a revenue stream.

Wednesday the teams dined at the Bridge2Rwanda house, not far from Hotel Gorillas.

Bridge2Rwanda is a Christian NGO that advises Rwanda's government, builds schools, and encourages entrepreneurship at all levels.

Breakthrough for Backpack Team

Beds and mosquito nets in Nyamata rural clinic

by Gale Wiley

Kigali, Rwanda (Tuesday, March 2, 2010) -- The backpack team is exploring a deal to supply its "community hospital in a backpack" to entrepreneurs who are launching a business in Burundi.

"Two entrepreneurs from Florida have trained 16 Burundi nurses who will provide basic mobile medical care on a fee-for-services basis," said EMBA Leonard Yowell, a backpack team member. "The nurses would use a micro finance loan to pay for their backpacks that the nurses would use to carry their medical supplies."

Presumably, as the nurses earn money by providing basic health care, they could pay back their loans, replenish their community backpacks with supplies, and have income -- all at the same time.

The Burundi deal is exactly the kind of business Professor Marc Epstein would like to see for his teams of MBAs who are working to commercialize four Rice-developed bio-medical devices:

• a backpack
• a C-clamp that controls oral syringe doses
• an IV drip monitor, and
• a battery- powered device for helping babies to breathe.

The Burundi deal would create jobs, improve basic health care, and most of all not rely on foreign aide -- a truly sustainable model for an emerging economy.

More good news

On a tour of Utexrwa, the only textile plant in Rwanda, the backpack team confirmed from Raj Rajendran, Utexrwa's managing director, that his company could produce backpacks for the team, thus generating jobs for Rwandans.

In his native Hindi, backpack team leader, Sharad Malhautra, confirmed with a production manager that not only could Utexrwa provide waterproof material but it could also produce backpacks.

Of course, the backpack team still has many hurdles before them.

• Will the Rwanda's testing labs provide the stamp of approval for the backpack's many medical devices. (Just because a microscope has been approved in the United States, for example, does not mean the device will pass Rwanda's testing laboratories.)
• How do medical suppliers operate in Rwanda?
• Outside of the Burundi deal, who in Rwanda would be the ultimate consumer for the backpack in Rwanda? NGOs? The Rwandan government? Entrepreneurs like the two orlano businessmen?
  
• Can the backpack team develop a flexible business model that will entice an entrepreneur to invest in or run this company?

Monday a Big Day for Rice Teams

Backpack team

by Gale Wiley

Kigali, Rwanda (March 1, 2010) -- On their first working day here, Rice teams of MBAs and engineering undergraduate technical advisors met with government officials, heard sobering advice from local entrepreneurs, and visited district hospitals to show their products.

"It was a good day for everyone," said Professor Marc Epstein, who is leading his class on their mission to commercialize Rice bio-medical devices designed for emerging countries like Rwanda. "The students heard lots of promising news."

To improve the efficiency of their quest to meet as many medical officials as possible, the CPAP and IV Drip teams created two new teams, half of its members joining half the members of the other team.

IV "SmartDrip" Drip and CPAP "Baby Bubbles" Team Join Forces

The SmartDrip and CPAP infantAir teams joined forces, a move that paid off.

“We went to King Faisal Hospital with no expectations,” said Sachin Agrawal. “But we ended up getting a four-hour tour of the hospital which led to lots of exposure to doctors who were curious about our products.”

As the two combined teams toured the hospital, doctors started appearing.

As David Tipps put his team’s CPAP device through its paces, doctors made suggestions for how the unit could be improved.

“They really really loved the device,” said Agrawal.

The SmartDrip team showed their battery powered, low-cost IV monitor to doctors.

“One doctor said he could use 15 or 20 IV monitors now," said Agrawal. "He said he has five infusion pumps and 30 patients who need the pump, each of which costs several thousands dollars."

The doctor told us our device could replace his current pumps, Agrawal said. "The doctor liked our device's simplicity, cost, and portability."

The other IV/CPAP team visited Mahima district hospital where they saw HIV and neo-natal clinics.

“We saw several babies that could have used our CPAP device,” said Will Pike. “They had about 35 babies on the wing, from newborns in kangaroo pouches to babies under bilirubin lights for treating jaundice."

"The doctors loved our CPAP device," said Pike. "They made several suggestions for improving it. They wanted to order one now for testing."

Backpack Team

At Gikondo district hospital, the backpack team met up with a head nurse who stood in awe at the diagnostic portable backpack's many medical devices incuding a microscope, centrifuge, and lab tools.

“She said there was a pressing need for the backback because the clinic sends medical teams into the field to attend to serious cases,” said Leonard Yowell.

Later, the head of a local NGO of 20 local Rwandan physicians gave more insight on how medical care is delivered and organized.

Undergraduate Engineer Vani Rajendran demos backpack

At the end of the day, the backpack team met with Manna Energy, a water purification venture using carbon credits and a "for profit" model.

C-clamp Team

“On one of our visits to a local district hospital, one doctor told us that our C-clamp device alone doesn’t make sense without the oral syringe,” said Jan Goetgeluk. “We think it makes sense to offer the c-clamp as part of the oral syringe package.”

Medical officials told Goetgeluk's C-clamp team that Rwanda needs more oral syringes. A clinic nurse who monitors HIV patients told the team that many parents use spoons to give doses of medicine to their children, a practice fraught with error.

The C-clamp device which regulates the amount of medication a patient receives via an oral syringe is a practical and cheap way to manage the dosing problem, said Goetgeluk.

CEO Praises Rice MBAs Work in Rwanda

Kigali, Rwanda (Sunday, February 28) -- The CEO of one of Urwego Opportunity Bank in Kigali congratulated four teams of Rice MBAs and engineering undergraduates for finding ways to commercialize their Rice bio-medical ideas.

"You are looking to present those ideas to venture capitalists to see whether you can get their support," said Lee. "This work is real and applicable, and I know you appreciate that."

The four teams have brought four bio-technologies to Rwanda to find markets, establish prices, seek suppliers and distributers in Rwana -- all in an effort to create business plans for potential investors.

Click arrow below to see video.

Jeffrey Lee, CEO of Urwego Bank in Kigali

Jeffrey Lee, who describes himself as a financial enterpreneur, has worked from branch banking to project finance, from community banking to corporate banking.

From February 1, 2009, he has been leading Urwego Opportunity Bank in Kigali, Rwanda as CEO.

Teams set to work today

Kigali, Rwanda (Monday, March 1) -- Over breakfast the teams will hear from Dano Jukanovich of Karisimbi Partners and Clare Akamanzi of the Rwanda Development Board.

Karisimbi Business Partners seeks to alleviate poverty by developing ambitious and strategically-placed Rwandan entrepreneurs. "We pick up where micro-finance, business incubation and small business development models leave off," reports their Web site. "Karisimbi Business Partners builds businesses by developing the management capacity of promising mid-sized ventures with untapped potential."

After the meeting, teams begin the legwork of their projects, spreading out across Rwanda to determine market need, potential suppliers and distributors, and see firsthand the face of Rwanda's health care system.

In the evening the teams will report what they learned and will plan their next day's work.

Thoughts On Rwanda

-- Quote from a placard at Belgium's Genocide Museum in Kigali

by Gale Wiley
February 27, 2010

To understand this post, first look at a video clip showing global health professor Hans Rosling* describe perceptions and then facts about the differences between the so-called developed and developing worlds:

First Hans Rosling Lecture

Next, look at Professor Rosling's second lecture:

Second Hans Rosling Lecture

Now visit Rosling's Gapminder site and do the following:

1. Click on the "Explore the World" graphic.
2. Next, select Rwanda from the list of countries.
3. Click "Play" to see how Rwanda compares with the rest of the world on two dimensions -- life expectancy and per capita income.

Results?

In 1997, the average Rwandan could (1) expect to live to 46 and (2) earn less than $1,000 a year. -- this the toll of ignorance, disease, tribalism, colonialism, corruption, genocide and AIDs.

While each year the rest of the world lives longer and earns more, Africa lags far behind, its citizens dying much younger and living much poorer.

But if the history of the rest of the world is any predictor, Africa -- and Rwanda in particular -- is changing for the better.

Although only 6 percent of Rwanda has electricity, the government plans to provide electricity to 16 percent by 2012.

Today I see Kigali planted firmly in the future and rural Rwanda trying to pull away from the mire of the middle ages.

Kigali, Rwanda's capital, is pushing its way to modernity.

When I was a correspondent in Europe, I had a hobby of counting the number of building cranes hovering over a city skyline. The more cranes, I reasoned, the more economic development for the city.

Kigali shows lots of cranes -- new government buildings, a major hotel/conference center, business buildings.

A major project to make use of an estimated $20 billion in natural gas beneath Lake Kivu is underway.

Our little project is one of hundreds in Rwanda, but the cumulative effect is significant.

Over the next decade I hope to see Rwanda move up on Hans Rosling's charts, affording Rwanda's citizens better health, longer lives, and more income.

--------------
* "Even the most worldly and well-traveled among us will have their perspectives shifted by Hans Rosling. A professor of global health at Sweden’s Karolinska Institute, his current work focuses on dispelling common myths about the so-called developing world, which (he points out) is no longer worlds away from the west. In fact, most of the third world is on the same trajectory toward health and prosperity, and many countries are moving twice as fast as the west did." -- TED.com