HEALTH

TOMORROW
50 HEALTH PIONEERS 
INNOVATING AROUND THE WORLD

HEALTH

HEALTH TOMORROW
In Cameroon, Arthur Zang is designing the Cardiopad to help screen
for heart disease in villages without a doctor. In the United States,
Ellen Goodman is helping families ensure that the wishes of their
loved ones are fulfilled in end-of-life care. In Egypt, Hisham Khar-
ma has launched a social network for blood donations to address

TOMORROW
blood shortages in hospitals. These pioneers are just a few of the
health innovators redefining and reshaping our health systems,
using holistic approaches that are not limited to hospital walls.  

Health Tomorrow  explores new global health strategies through

a series of 50 portraits and interviews, uncovering brilliant and
unexpected social innovations that leverage concepts like empathy,
well-being and inclusion. This collection of inspiring stories will
introduce you to a network of pioneers who are breathing new life BILL DRAYTON AUMA OBAMA
into healthcare. JORDI MARTI ELLEN GOODMAN
FRANK HOFFMAN KRYSTIAN FIKERT
GENEVIEVE MOREAU MARTIN GUZMAN
PIYUSH TEWARI MICHELLE LEM
ANIL PATIL JOÃO PAULO NOGUEIRA
ALAIN CARPENTIER SAMEER SAWARKAR
ERIC CHEYSSON HISHAM KHARMA
UWE DIEGEL PHILIPPE DE ROUX
BERTIN NAHUM ANDREAS HEINECKE
JUNTO OHKI KATHERINE FREUND
MIGUEL NEIVA HEIDI WANG
MATHIEU LEHANNEUR JOËL DE ROSNAY
JOS DE BLOK FRANCESCA FEDELI
EDITH ELLIOTT ANDREA COLEMAN
AND MANY MORE…
 HEALTH
TOMORROW
Under the direction of Côme Bastin and Fleur Weinberg

HEALTH
Based on an original idea by Guillaume Deprey, (founder of Perfethic)
http://www.perfethic.com

Artistic direction and Graphic Design:

Pauline Sautelet 

TOMORROW
Interviews and Portraits:
Côme Bastin, Fleur Weinberg, Perrine Massy, Charlotte Sarrola, Timothée Vinchon, Charles Faugeron, Hélène Martinez 

Contributors:
Yeleka Barrett, Sarah Jefferson, Lee Lashaunte, Jutta Luetzeler, Arnaud Mourot, Manuela Pastore

Cover:
Photo by Arthur Bondar 
Ginevra Sanguigno a clown volunteer from Italy, plays with a Blind girl at an orphanage for blind and deaf children in Sergiyev
Posad, Russia, (2013). Visits to this orphanage are organised each year by Patch Adams (American physician, comedian,
social activist and clown) as part of the Patch Adams Clown Trip. These trips lead volunteers to the world’s most distressed
regions to engage in a unique form of social and medical activism known as Clowning. Adams and his band of merry clowns visit
hospitals and schools around the world, bringing laughter and wellness to people suffering from illness and oppression.

English translation:
Noam Assayag, Daniel Goriounov, Bernard Evans

Copy editor:
Agnès Blondel

In partnership and with the support of Ashoka, the Making More Health initiative and Boehringer Ingelheim
More information : https://www.makingmorehealth.org

Thanks
We wish to thank all the pioneers who have agreed to be present in this book,
Bill Drayton and Auma Obama, who have accepted to be the great opening witnesses.

The New Hippocrates
hat is innovation in health today?”
Confronted with this question, many
would respond: new miracle drugs,
robotic surgery or maybe gene therapy.
There is no denying that nanomedicine,
artificial intelligence and progress in
genetics open perspectives that are both
dizzying and exalting. The Hippocratic
Oath (4th century BC), the discovery of
vaccines (1796), the first in-vitro ferti-
lization (1978), DNA sequencing (2003)
– all these are certainly landmark medi-
cal discoveries during the eras in which
they were made. But the history as well
as the future of health should not be
confined to a series of milestones in
the field of medicine but should rather
encompass something broader and
more systematic than individual events.
Even the preamble of the World
Health Organization (WHO) Consti-
4 HEALTH TOMORROW
PREFACE
tution, adopted in 1946 encourages
us to distinguish health from medi-
cine: “Health is a state of complete phy-
sical, mental and social well-being and
not merely the absence of disease or
infirmity”. Thus, health is “much more
than medicine”.1 Medicine itself is
evolving beyond its original vocation
– curing the sick – to embrace a more
inclusive definition, both holistic and
preventative.
Health, in the 21st century, is not
defined by the struggle against a new
virus but rather by the explosion of
chronic illnesses resulting from our
lifestyles. Cancer, diabetes, cardio-
vascular and respiratory diseases now
account for 63 % of deaths worldwide.2
Many of these non-communicable
diseases are more easily prevented than
cured, and are linked in part to a global
aging population where life expectancy
has risen from 52 to 72 years3 between
1960 and 2016. Thinking that this is a
“first world problem”, however, would be
entirely incorrect. In India, the Philip-
pines and Venezuela, chronic illnesses
are now responsible for more than 50 %
of deaths annually. In China and Egypt,
this number exceeds 80  %. Further-
more, economic and social disparities
can intensify the issues in healthcare
infrastructure and access to treatment.
What is the point of developing new
medicines if they cannot reach those
who need them?
The real challenges facing health
actors and institutions today are food,
water, energy, pollution, access to care,
social inclusion and patient adhesion.
Accordingly, we should remember this
quote by the founder of the Charité
hospital in Berlin,4 Rudolph Virchow:
“if medicine is really to accomplish its great
task, it must intervene in political and
social life. Medicine is a social science”.
So what do innovations in health
look like? This book is built on the
conviction that the answers to this
question are found scattered around
the planet and often go unnoticed by
the medical community. In this book,
you will meet fifty exceptional inno-
vators – social entrepreneurs, doctors,
inventors, humanitarians, thinkers
and everyday global citizens  – who
have developed new solutions to tackle
the health challenges that face them
and their communities. For example,
Andrea Coleman and her NGO Riders
For Health allow medication to be
transported to those in need by equip-
ping and maintaining vehicles in iso-
lated communities across Africa. Jordi
Marti has organized massive screening
campaigns throughout South America,
thanks to low-cost blood and saliva
tests of his own design. Sameer Sawar-
kar is addressing the lack of health pro-
fessionals in the Indian countryside by
developing telemedicine call centers.
Bruktawit Tigabu is animating series
and radio shows in Ethiopia, raising
awareness on food hygiene education
among millions of children. Miguel
Neiva, in Portugal, has created a sym-
bolic language that lets the color-blind
“read” the colors they can’t see.
These innovators and the others
that you will meet in this book have
not necessarily attended medical
school. Some of them have left high-
paying jobs in order to accelerate social
change. However, all are designing
answers to their communities’ needs
by making prevention and treatment
simpler, cheaper and more accessible.
They are extending the roles of health
providers, and bringing more trans-
parency to the patient’s journey. In
many cases, the democratization of
the Internet and of digital tools has
allowed them to considerably amplify
their impact. From India to South
Africa, to France and many other
countries, these social entrepreneurs
are establishing the “four As to health
access”: affordability, availability (of
care), awareness (of one’s health) and
adherence (to treatments).
Today, many institutions and cor-
porations find inspiration in these
pragmatic solutions, which all strive
for positive social change. Launched
in 2011, the Making More Health5 ini-
tiative identifies, supports and scales
innovative entrepreneurial solutions
to global health challenges. Making
More Health (MMH) is a partnership
between Ashoka – the world’s leading
network of social entrepreneurs –
and Boehringer Ingelheim – a global
healthcare company. This book was
produced under the MMH partnership
and many of the changemakers you
will discover here are supported by
this initiative, working at the intersec-
tion of the social and business sectors.
There are five major themes to this
book. Prevent, because faced with an
PREFACE
explosion in chronic illness, tomor-
row’s healthcare solutions will have
to keep people healthy. Cure, because
this will always be medicine’s funda-
mental purpose. Improve, as we must
optimize the use of existing resources.
Build, for all those who are enabling
the environment required for health
solutions. And finally Care, because,
although we can’t always cure, our
societies must work for the dignity
and the autonomy of those in need.
This book does not seek to be exhaus-
tive – the list would be too long – but it
will give you a new perspective on the
groundwork of social entrepreneurs as
they breathe inspiration into the field
of global health care. 
1. See Detlev Ganten’s interview, p. 84-85.
2. According to the World Health
Organization.
www.who.int/topics/chronic_diseases/fr/
3. According to the World Bank’s online
data.
4. Founded in 1710 as a care home for
patients suffering from the plague, this hos-
pital has become an important teaching and
research center with a humanistic calling.
5. See Manifesto, pages 134-138 and
makingmorehealth.org
5
 CONTENTS
INTRODUCTION
010. Bill Drayton
The Founder of Social Entrepreneurship
1. PREVENT
020. Bruktawit Tigabu 028. Krystian Fikert
Lifesaving Tales The Virtual Psychiatrist
022. Jordi Marti 030. Geneviève Moreau
One Drop, Two Lives Nutrition for Better Health
024. Ellen Goodman 032. Martin Guzman
The Talk Watching Out
for Venezuela
026. Frank Hoffman
Cancer in the Dark
2. CURE
042. Arthur Zang
Healing Africa’s
Beating Heart
044. Michelle Lem
Emergency Veterinarians
048. Anil Patil
We Are All “Carers”
050. Jos De Blok
A Nurses Revolution
052. João Paulo
Nogueira Ribeiro
014. Auma Obama
Yes, We Can!
036. Piyush Tewari
A Licence to Save Lives
038. Joël de Rosnay
Being Human, Tomorrow
Volunteer Doctors
Seek Patient
054. Alain Carpentier
Heart at Work
056. Shamona Kandia
Next Station: Hope
058. Sameer Sawarkar
The Country Teledoctor
060. Francesca Fedeli
Family Therapy
3. IMPROVE
070. Rey Faustineo
One Degree, “The Yelp
of Social Services”
078. Ansgar Jonietz
“What’s up, Doc?”
080. Vivek Gilani
084. Detlev Ganten
Much More Than Medicine
086. Uwe Diegel
072. Hisham Kharma One Man’s Crusade Restoring
The Blood Donation Social for Ecology in India the Connection...
Network
082. Krishna
074. Edith Elliott Udayakumar
From Stanford to Indian Necessity is the Mother
Hospitals of Invention
4. BUILD
090. Tony Meloto 096. Flaviano Bianchini 102. Nicolas Métro
The Plan to End Poverty Data Worth Back to the Trees!
Its Weight in Gold
092. Andrea Coleman 104. Shona McDonald
Health’s Angels 098. Dara Dotz Heal on Wheels
Short Circuit
094. Philippe de Roux Emergency Response 106. Chai lo
The Shanty Town Water Springs for the People
Dowser 100. Jan In’t Veld
Universal Eyecare 108. Bertin Nahum
Mister Robot
5. CARE
112. Andreas Heinecke
Take the Blind Test
118. Junto Ohki
Dialogue of the Deaf
124. Miguel Neiva
The Esperanto of Colors
062. Kyriakos Souliotis 114. Bolewa Sabourin 120. Katherine Freund 126. Heidi Wang
Healthcare in Time The Man Who Makes Senior Transportation Guiding Through
of Crisis People Dance Dementia
122. Bernadette
064. Éric Cheysson 116. Bindeshwar Pathak Rwegara 128. Mathieu Lehanneur
The Chain of Hope He Frees the Untou- This Is Your House Unidentified
chables with Toilets Therapeutical Object
MANIFESTO
134. The Story of Making More Health 136. Hubertus von Baumbach
“We will continue to work at
the intersection of socially and
business-focused goals”
© CHRIS WILLAN PHOTOGRAPHY

INTRO
DUCTION
INTRODUCTION
BILL DRAYTON
The Founder of Social
Entrepreneurship
Bill Drayton has been a Civil Rights advocate, studied
at Harvard, Yale and Oxford, worked for the United
States government at the Environmental Protection
Agency and driven from Germany to India
in a minibus. Yet, he is best known for being
the founder of Ashoka. Since the early eighties,
his global organization has been focused on creating
a movement where everyone can be a changemaker,
working for the social good of all. Ashoka has
supported nearly 4,000 social entrepreneurs – called
Ashoka Fellows – who address global issues in  Oxford, before studying law at Yale. It
health, environment, human rights, education,
civic commitment and economic development.
In this interview, Bill Drayton shares his insights
on the challenges and opportunities of social
entrepreneurs for this century.
E
veryone knows you as the founder
of Ashoka, but who is the man
behind the movement?
B. D. : I
was privileged to grow up with
an immigrant mother from Australia,
whose parents originally came from
Bohemia. My father’s family had been
American for a long time. Since elemen-
tary school, I have always been fasci-
nated by the way human society works.
I loved history and geography, but can’t
say as much for math! Growing up in
Manhattan was another gift. Four cen-
10 HEALTH TOMORROW
INTRODUCTION
turies of immigrants have created a
powerful culture where you believe you
can be successful with what you start
with. When I was a young student, I
took part in the Civil Rights move-
ment, which was inspired by Gandhi’s
nonviolent philosophy. It was a his-
toric moment, and that environment
explains what I became, much more
than my degrees and everything else.
Can you tell us what you did after
that?
B. D.  : I graduated from Harvard, then
was a very special school, with a small
number of students and a philosophy of
understanding what the purpose of the
law is, instead of learning whole texts
by heart. I had the opportunity to work “Our first job was
at McKinsey in New York on regulatory
and tax systems. A government expe-
to popularize social
rience followed. I worked at the EPA1 entrepreneurship. In order
under President Jimmy Carter where
we designed and implemented several
to do that, we needed
laws regulating toxic substances, hazar- to find the best social
dous waste, air and water pollution. entrepreneurs and let them
What triggered the creation of be role models, so as
Ashoka? to recruit others in
B. D.  : When Ronald Reagan followed
Jimmy Carter as President, I left the their wake.”
government and received a fellowship
from the MacArthur foundation. The
fellowship allowed me to work full time
on Ashoka. It was the late seventies. The
time had come for the citizen sector to
be thoroughly revolutionized like com-
© DR
© DR
merce had been in the 18th century: it
11

was starting to become conquering and
modern. Our first job was to popularize
social entrepreneurship. In order to do
that, we needed to find the best social
entrepreneurs and let them be role
models, so as to recruit others in their
wake. That is how our system of iden-
tifying and supporting Fellows2 came to
be. We believed the time had come to
build a world where each of us could be
a changemaker.
You are speaking about
the historical context in the USA,
but Ashoka was born in India.
Why is that?
When I was 18, I purchased a
B. D.  :
minivan with some of my friends in
Munich, and we drove to India. This
amazing trip changed us. We met
Bayard Rustin, a key figure in the Civil
Rights movement who had spent twelve
years with Gandhi. He introduced us to
some wonderful people. When I foun-
ded Ashoka in 1980, I already had this
interest for Gandhi’s Land. I did create
it with several Indian friends. Starting
in India increased our means of action
several times. We could support a social
entrepreneur for 2,500 dollars a year,
ten times less than in the United States.
Little by little, Ashoka expanded to
other nations: Indonesia, Nigeria, Bra-
zil… Our strategy was to start with the
biggest country on each continent and
then go to the next-sized countries, and
12 HEALTH TOMORROW
“The whole model
where the doctor
controls everything
with his pills reminds
me of Henry Ford
on the assembly line.
The power is going
from the doctors
to the patients,
their family, friends,
neighbours…”
then the next, like Thailand, Venezuela,
Bangladesh, and so on.
Today, Ashoka is present in almost
a hundred countries. What is
fundamentally different for social
entrepreneurship?
B. D. : In 1980, an idea from Bangladesh
would not travel to Brazil or France.
Now, with the Internet, everyone is
connected to others around the planet.
The key feature of our time is the expo-
nential speed of change. The more it
affects the world, the stronger the need
for social entrepreneurs. To achieve
their goals and be successful, social
entrepreneurs can no longer apply an
old recipe. The world is changing at
an accelerating speed, and they need
to imagine solutions that are adapted
to where the world will be at twenty
years from now. Ashoka now has over
3,600 Fellows. This allows us to predict
the direction in which various domains
are headed.
How can someone be a
changemaker in this new world?
B. D. : The old pattern was giving people
a skill which they would repeat for life,
sitting in a cubicle. This has become
fully dysfunctional today, despite
the fact that whole chunks of our
society keep operating according to
this pattern. People must now mas-
ter different sets of skills, even pro-
foundly opposite skills, and organize
in fluid and open teams. The distinc-
tion between an organization’s staff,
inside, and the public, on the outside,
is nonsensical. Approximately 95% of
the Fellows who deal with children put
them in charge. The same revolution is
going on in the environmental field or
any other sector. Value creation needs
to be shared between all actors, and it
increasingly is.
Since this is the subject of
this book, what are
the specific challenges that social
entrepreneurs face in the field
of health today?
B. D. : Whatever field we are considering,
a profound transformation of how we
think and operate has to happen. Four
skills need to be taught from childhood
through practice: cognitive empathy,3
teamwork, collaborative leadership and
the ability to be a changemaker. These
are the skills of entrepreneurs and
intrapreneurs, the skills of Changema-
kers. Every health organization has to
go through these changes. If part of the
population is disadvantaged, you can’t
help them with their health. They are
going to be depressed, they are going
to be angry, some members may even
be affected by substance abuse. Instead,
if you give them the ability to change
things, they become real changemakers
in the health field.
So we are moving towards more
horizontal models?
B. D.  : The whole model where the
doctor controls everything with his
pills reminds me of Henry Ford on
the assembly line. Watson –  IBM’s
software  – is on the path to replacing
50 % of doctors. For a hundred dollars,
23andMe –  a Californian startup  –
offers to analyze your genome. Apps
let you know what kind of nutrients
you need to protect against illnesses
like cancer. We are all in the process
of becoming health changemakers.
The power is going from the doctors
to the patients, their family, friends,
neighbours.
Research is going in the same direc-
tion. In the big data era, compartmen-
talized research and development just
doesn’t work. One of our Fellows based
in Seattle, Stephen Friend, works to
push towards the sharing of data and
open collaboration in the field of health
research. He succeeded in making seven
universities pool their research in order
to generate better articles. Everyone
working in health must go through
these kinds of changes if they want to
remain in the game.
Is this why you launched the
Making More Health initiative
with Boehringer Ingelheim?
B. D.  : Yes. It is a remarkable family-
owned company, upholding solid
values, that has always cared about
research and health. We have learned
a lot by working together. Boehringer
Ingelheim finds inspiration from social
entrepreneurs to rethink how to inno-
vate and interact with its partners and
employees. On our side, a large part of
our understanding of how to help com-
panies comes from working with them.
Together we can invest in the most pro-
mising changemakers in health.
Changemakers are more numerous
today, but many people predict the
collapse of our civilization under
the weight of its externalities.
B. D.  : The environment is in a terrible
state, and I don’t understand the denial
that is taking place, especially among
politicians. I worry about the efficiency
of governments. It is terrifying that we
haven’t had competent global finan-
cial regulations since the thirties. How
many trillions of dollars did we lose ins-
tead of investing them in education?
I do think, though, that we are at a
tipping point, with deep and irrever-
INTRODUCTION
sible change happening right now in
the way we think. When I graduated
from Harvard College, there were
1,200  people in my class, and eleven
thought about going into what we now
call the citizen sector. Now, the biggest
student group at Harvard Business
School goes there. Since 1980, the
citizen sector has caught up. It is now
growing jobs at two and a half times the
rate of other OECD sectors. And that
doesn't even include the growing num-
ber of people doing volunteer work.
Social entrepreneurs have incorpo-
rated the best aspects of business and
use them to improve the world and not
for profit. In fact, social entrepreneurs
are in it for the good of all and dedicate
their lives to it. They have understood
that if we want our societies to conti-
nue, we need to invent new ways to
grow. Ashoka’s methodology helps them
work together to speed up the rate of
change in the world and succeed in
their initiatives.
By Côme Bastin
1. United States Environmental Protection
Agency (EPA).
2. Ashoka "Fellows" are identified through
a rigorous selection process. These social
entrepreneurs are changing systems for
the benefit of all and improving the lives of
millions of people.
3. The ability to understand and feel not
only someone else’s feelings, but also
their thoughts.
13

AUMA OBAMA
Yes, We Can!
Auma Obama didn’t wait for her last name
to be synonymous with global leadership to start
changing the world. After completing her studies
in sociology in Germany, she returned
to her homeland, Kenya, where a passion
for humanitarian work led to the launch of the
Sauti Kuu foundation. This sports-based, life skills
and career training organization is focused on
education, counseling and the promotion of local
agriculture. The foundation works towards giving
children and youth a voice and allowing them
to be part of the decision-making process to improve
their lives. Auma Obama is helping to build a new,
“Thanks to self-confident Africa.
T
the World Wide Web,
today, on the African
continent, we have access to
as much knowledge ell us about your life before
as the rest of the world. the creation of the Sauti Kuu
foundation?
This means that A. O. : I was born in Kenya and grew up
opportunities are there. I studied in Germany and com-
pleted my master’s degree at the Hei-
unlimited for us.” delberg University and my doctorate at
the University of Bayreuth. Parallel to
that, I studied at the Berlin Film and
Television Academy. I lived and worked
in Germany for several years before
moving to England, where I worked in
the Children’s Services. I then returned
© SAUTI KUU
home to Kenya to work for CARE Inter-
national, an international aid organi-
14 HEALTH TOMORROW
INTRODUCTION
zation. An important part of my work
at CARE was the establishment and
coordination of the network “Sport for
Social Change”. This initiative brought
together organizations from different
countries in East Africa, from Egypt
and Bangladesh, all using sport to rein-
force positive social behavior among
the youth, girls in particular.
Why did you leave this position to
create your own foundation?
A. O. : I moved back to Kenya because I
knew that I needed to give back to my
community. Before I started my foun-
dation, I did not feel that the work I
was doing was really effective, because
it was not sustainable. We were donor
driven, constantly chasing after funds,
because if they dried up, the work stop-
ped. We were not driven by the impact
we had on our beneficiaries. I wanted
to develop a model that focused on the
children and youth we worked with; a
model that worked holistically and for
the long term, enabling children and
young people to take responsibility
for their lives, with a focus on moving
them away from poverty and helping
them become responsible, financially
independent and stable young adults. I
am very proud that Sauti Kuu is uphol-
ding these values.
What kind of project are you
putting forward?
A. O.  : Sauti Kuu works to enable disad-
vantaged children and young people,
particularly in the rural areas and
15
INTRODUCTION
urban slums in Kenya, to recognize
their potential and the power of using
their voice (Hence Sauti Kuu, meaning
“Powerful Voices” in Kiswahili). To reco-
gnize the power of one’s own voice also
means to become aware of, and appre-
ciate, one’s self. This leads to taking a
stand and actively participating in what
happens with one’s life. One is no longer
a passive victim waiting for someone
from outside to save them.
Currently the foundation is buil-
ding a sports, resources and vocational
center that will implement Sauti Kuu’s
three-key program in Western Kenya:
Personality Development, as well as
Character Building, Education and Trai-
ning and Sustainable Economic Growth.
There, we will provide children and
youth with a physical and mental space,
where they will be able to train, learn,
fulfill their potential. Within these
facilities they will be able to develop
their social and technical skills through
sports, vocational training and income
generating activities.
How do Sauti Kuu’s actions relate
to the issue of health?
A. O.  : The Sauti Kuu foundation works
to develop an awareness about healthy
living in rural children, young people
and their families by creating an awar-
eness about the value of the land, and
about the cultivation of local indige-
16 HEALTH TOMORROW
“The West must
start speaking to us
as equals. It should
no longer feel
obligated to give us
fish, nor teach us
how to fish.
The West must ask
us whether or not
we eat fish!”
nous crops, vegetables and food, to
improve nutrition and food security.
What is your perception of
relationships between Western
countries and Africa?
A. O.  : Thanks
to the World Wide Web,
today, on the African continent, we
have access to as much knowledge as
the rest of the world. This means that
opportunities are unlimited for us. We
just have to grab them. The West must
start speaking to us as equals. It should
no longer feel obligated to give us fish,
nor teach us how to fish. The West
must ask us whether or not we eat fish!
This is when real conversation starts
and domination stops.
In your opinion, what are
the characteristics of a project
striving for more equality
in this world?
A. O.  : A project that will enable all to
access healthcare, quality education
and a good standard of living must
ensure that these activities recognize
INTRODUCTION
and address real challenges. In close
and active collaboration with benefi-
ciaries, the program must address the
realities they face, and not, in the case
of Africa, a Western pre-conception of
it. Most importantly, the project must
be holistic and embrace a socio-eco-
nomic approach to the situation. As
a result, the beneficiaries will enjoy a
better standard of living in harmony
with each other, but also in harmony
with the environment.
What advice would you give
to someone willing to get
involved in improving the health
of tomorrow?
A. O. : Do not destroy your planet with
chemicals and pesticides. Preserve it
for yourself and future generations.
And, where possible, grow your own
food – organically.
Where did you find the inspiration
to improve the life of others?
A. O. : Many different people from very
different walks of life give me inspira-
tion and have played a key part in hel-
ping me realize my vision and do my
work. They are not necessarily “famous”
or “personalities” in the conventional
way, but they all are stars! There are
also, among others, children, including
my own daughter.
© DR
By Fleur Weinberg
17
© CHRIS WILLAN PHOTOGRAPHY

CHAPTER 1

PREVENT

C
ould you introduce
yourself?
My name is
B. T.  :
Brukty Tigabu, and I
am a wife, a mother
and the CEO of my
own children educational media com-
pany. I studied at Kotebe Teacher’s
College and taught school for three
years. During that time as a teacher, I
wanted to find a way to reach millions
of children with quality education and
make an impact in their lives.
Why did you create Whiz Kids
Workshop?
B. T.  : Ethiopian kids face a lot of diffi-
culties: poverty, disease, poor nutrition,
limited access to quality education, har-
mful traditional beliefs, etc. My hus-
band and I created Whiz Kids Workshop
together because we saw millions of
preschool-age children across Ethio-
pia lacking the necessary readiness to
enter school with the chance of succee-
ding. We also learned that, in Ethiopia,
around 300,000 children under the
age of 5 annually die from preventable
diseases: pneumonia, diarrhea, malaria,
measles and malnutrition. These child-
ren deaths are mostly the result of one
thing – health illiteracy. We used exis-
ting research on mass-media education
– radio, print and cell phones – to put
that belief into practice.
BRUKTAWIT TIGABU What kind of content do you
broadcast?
Lifesaving Tales B. T. : Whiz Kids Workshop has produced
four television series that engage, ins-
pire and empower Ethiopian children:
What better way is there to catch the attention of a child than cartoons? Tibeb Girls, Involve Me, Little Investiga-
tors, and its flagship series, our first
In Ethiopia, Bruktawit Tigabu has used cartoons to raise awareness ever children education show, Tsehai
amongst young viewers on the topics of hygiene, nutrition and education. Loves Learning. Tsehai Loves Learning
targets children ages 3-8 and currently
Today, millions passionately follow the animated series and radio shows produced broadcasts on the Ethiopian television
by Whiz Kids Workshop – the social business Bruktawit founded. and the Amhara Mass Media broadcas-
ting channel every Saturday, reaching
up to five million viewers, and another
© DR
whizkidsworkshop.com ten million listeners through our radio
20 HEALTH TOMORROW
“At first it was
just the two of
us in 2005 doing
every single aspect
of the production
by ourselves.”
productions, airing on both networks.
In 2010, I won the Rolex Award for this
enterprise.
Tell us about an episode
of Tsehai Loves Learning?
B. T.  : We created an episode about
handwashing. Tsehai and her little bro-
ther, Fikir, finished playing and rush
to eat their lunch, cooked by their dad.
Dad tells them to wash their hands pro-
perly. Tsehai and Fikir rush again and
don’t use soap. We then introduce the
rudimentary concepts of what germs
are, how they make us sick and how
handwashing with soap is the solution
to stop germs dead in their tracks.
How did you produce all
these TV series?
B. T.  : At first, it was just the two of
us in 2005 doing every single aspect
of the production by ourselves: wri-
ting the script, composing the music,
making the puppets, filming in our
living-room, editing, etc. Once we
started broad­casting on national TV
and demonstrated the learning outco-
mes, we began attracting support from
donors. We are currently supported by
USAID Ethiopia, running a five-year
project under Tsehai Loves Learning.
What has been the impact
of your work?
We brought this basic health
B. T.  :
information to millions of kids
nationwide. We see that children who
watch our program not only have fun,
but also gain precious knowledge from
it that in some cases can actually save
their lives. A randomized controlled
trial of children’s learning from the
Tsehai Loves Learning Healthy Whiz
Kids program found that children’s
health knowledge doubled after expo-
sure to the television episodes.
1 | PREVENT
What are some challenges
that you are currently facing?
B. T. : We have to educate the public on
the value of educational media such
as books, videos and games. We are
constantly searching for ways and
means to get funding to keep our pro-
ductions going and get our much needed
content out to the millions who need it.
Also, we are committed to improving
the marketing and distribution of our
products to move us in the direction
of becoming financially self-sustaining.
Another challenge is finding quality
media professionals who share the same
passion that we do for improving the
lives of children and youth.
Do you think it is possible
to apply your method
in other countries?
B. T. : Most African countries face simi-
lar challenges. Culturally appropriate
educational programs that are created
on the continent are needed eve-
rywhere. First, we want to continue our
success by scaling up all our programs
nationwide. In the last few years, we
began adapting some of our videos and
books to specific regions, languages and
cultures. Then we will be able to repli-
cate our methods across the African
continent and ultimately all around the
world, wherever it is needed.
What are your plans
for the future?
B. T.  : One of our latest innovations is
Tibeb Girls, an animation and comic
book series featuring three teenage
girls acting as agents of change. Sadly,
one fifth of Ethiopian girls still marry
before age 15, one third of girls don’t
go to school, one third of girls can’t
read, and two thirds of girls believe
that wife-beating is justified. Using the
TV series and comic books, Tibeb Girls
will bravely seek to foster much needed
conversations about previously uns-
poken taboos. By Fleur Weinberg
21
1 | PREVENT 4. CARE

JORDI MARTI
One Drop, Two Lives
With his organization DBS Screening, Jordi Marti – a Spanish researcher –
is developing revolutionary methods to diagnose diseases like diabetes before it is
too late. Using needleless blood tests, low-cost genetic tests and telediagnostics,
DBS Screening’s business model ensures that for every test carried out in developed
countries, the same life-saving tests are made available in under-resourced regions.

1drop2lives.org

“When you go

Y
ou often speak of
silent assassins,
what are you
referring to?
J. M. : They are all the
diseases that have
no symptoms until it is too late. When
diabetes becomes noticeable with cir-
culatory problems, you may already
be blind. When kidney disease occurs
with blood in the toilet, you will have
to live on dialysis. However, ten years
earlier, these diseases could be pain-
lessly prevented. It is enough to walk a
bit more, drink more water or eat more
healthy foods to drastically diminish
the probability of being affected by dia-
betes. Each year, according to UNICEF,
7.1  million people die from hyperten-
sion, 4.4 million from high cholesterol,
2.6  million from obesity, 1.5  million
from diabetes. Sadly, in developing
countries, the authorities concentrate
on transmissible infectious diseases
like malaria.
How did you come to be interested
in the issue of prevention?
J. M.  : I have training in chemical
an intensive care unit in Barcelona. All
the patients repeated: “Had known ear-
lier, I would have changed a lot of things
in my life”. In 2008, I read in the news-
paper that 40 % of the people who die of
cardiovascular disease could have been
saved if their level of cholesterol had
been controlled during childhood. Later
on, when we were vaccinated before
leaving for South Africa, my 8-year-old
son started crying when he saw the
needles. I slowly realized that making
people who believe themselves to be
in perfect health take blood or genetic
tests is not that simple. A new method
was needed.
And so you imagined your
needleless blood test.
J. M.  : What can a sample be easily
obtained from? Blood. We have there­
fore developed, with Dr. Juan Fidel
Bencomo, a lancet that can take a drop
of blood from the finger in a totally
painless way. The blood is then preser-
ved on a piece of paper. Several pro-
blems are thus resolved. No need for a
punctured vein or specialized person-
nel. No need for a refrigerated environ-
loses all its characteristics and it is no
longer possible to analyze it. AIDS, for
example, dies after one hour. But when
blood dries on paper, it keeps its pro-
perties. The sample can even be sent
by mail and then used to detect a great
number of diseases. All of this cuts the
cost of a test by ten.
That seems easy. Why doesn’t
everyone use this technique?
With one single drop of blood,
J. M.  :
only three or four parameters can be
tested. In developed countries, it is
often preferred to take more blood
and keep it refrigerated in a tube. And
it is indeed better to detect diseases
from A to Z. But in many Southern
countries, adequate equipment for the
cold chain is not available. 90 % of the
population lives far from a hospital or
dispensary. Also, getting pricked by a
needle isn’t sexy, so it is rare that the
population would decide to do it wit-
hout an apparent reason. We won an
award from Singularity University,1
but it isn’t because our solution is the
most elaborate. It is rather because it
is simple and can change the lives of
© DR
to the doctor, or if
a pharmaceutical
company sells
its products
too well, it means
that the system
of prevention
has failed.”
Where has this solution been
tested so far?
J. M. : We first worked with the Brazilian
government two years ago, with 84,000
pregnant women in the favelas of Rio.
We worked with a federal laboratory to
train the local staff and open laborato-
ries. 4,000 pregnant women tested posi-
tive in our tests. It is very important:
when the mother has AIDS, the child has
a 98 % chance of escaping it if detected
in time. Thanks to the program Making
More Health, we then made a campaign
to test cholesterol and glucose levels of
the employees of Boehringer Ingelheim,
in Sao Paulo and Manilla. For every test
taken, another was given for free in the
Therefore the richest finance
the poorest?
J. M.  : Yes. We call this method “one
drop for two lives”. We have thus tested
10,000 students in Madrid, Spain.
With the funds received, we bought
backpacks containing solar panels, a
computer and blood test instruments
for the jungles of Guatemala. It is all
connected to a doctor capable of doing
a telediagnostic, like a sort of mobile
hospital. We now want to do low-cost
genetic testing. That has never been as
easy as testing lactose intolerance. On
our platform,2 for 25 euros, you receive
a kit to collect your saliva, you send it
in, and we run the test. For each test, we
distribute forty glasses of milk in coun-
tries in difficulty like Syria. This solida-
rity mechanism allows us to incite even
more people to take the plunge. Our
goal is to distribute 600,000 glasses by
Is prevention to be
further developed
in the 21st century?
J. M.  : When you go to the doctor, or
if a pharmaceutical company sells
its products too well, it means that
the system of prevention has failed.
Sadly, some organizations still prefer
to sell medicine rather than preven-
ting diseases over time. I nonetheless
believe that there is a growing awar-
eness of the fact that prevention,
as well as the promotion of healthy
habits, can save a countless number of
lives. We hope to develop partnerships
with major groups that will finance
our laboratories.
By Côme Bastin
1. A California innovation center seeking
“to apply exponential technologies to
address humanity’s grand challenges.”
2. Go to http ://dbs-screening.org to take

engineering and I had been assigned to ment either. When blood coagulates, it millions of people. shanty towns and favelas. Christmas 2017. the test.

22 HEALTH TOMORROW 23

T
o talk about the
end of the life of
a loved one is also
to talk about their
death. How can
one overcome the
reluctance to address this issue?
E. G.  : There is indeed a taboo about
death. But knowing how a loved one
wants to live the end of his or her life is
a different thing and I think it is impor-
tant to emphasize that. We have to
acknowledge what happens in our ever
more technological societies. The good
news is that we live longer and longer
and push the boundaries of death. The
bad news is that with the last days also
comes a series of hard choices. We did a
survey that shows that 90 % of Ameri-
cans agree that it is important to have
a conversation about this subject. It
is a significant number, especially in
ELLEN GOODMAN the United States, where Americans
never agree on anything, including the
national anthem. However, only 30 %
The Talk have had this conversation. We quickly
understood that they needed help to
take the first step. This is the goal of
After having stayed by her mother’s side until her last moments, The Conversation Project.
the American journalist Ellen Goodman realized to what extent the end You are such a renowned
of life discussion is a taboo subject for her fellow Americans. In 2010, journalist, why did you move from
journalism to this project?
she launched The Conversation Project, a series of guides and tools for talking E. G.  : I went through this situation
with loved ones about the necessary choices in that painful moment. with my mother. Her health and awar-
eness were seriously declining. She was
not in a capacity to make a conscious
© DR
theconversationproject.org choice anymore, in particular about
24 HEALTH TOMORROW
“90% of Americans
agree that it is
important to have a
conversation about
this subject [...].
However, only
30% have had this
conversation.”
the therapies she wanted to continue
or interrupt. I was convinced that phy-
sicians would decide everything. But
to my big surprise, I was the one who
had to face this flood of decisions! With
my mother, we had always talked about
everything, except for this one ques-
tion. It mesmerized me. I quickly rea-
lized that I wasn’t the only one going
through this and I started devising
something to change it.
What tools have you created to
help with this conversation?
E. G. : The first tool we devised was our
“Conversation Starter Kit”. Today, this
dialogue tool is available in ten lan-
guages and has been used by close to
one million people. It remains relevant
for all those who need a framework to
initiate the conversation. After this
tool, we developed others with the
constant goal of better preparing the
end of one’s life and tackling more spe-
cific situations. In particular, we have
a guide to talk to your doctor, ano-
ther one for families with seriously ill
kids, or families of people with Alzhei-
mer’s disease. Our latest guide was a
huge success. It helps you determine
who will be the health care proxy for
a dying person. You might not realize
this, but in the United States, half of
the hospitalized patients over 65 years
of age can no longer make their own
decisions. So it is really important that
everyone chooses somebody they trust
before the question comes up.
1 | PREVENT
How do medical teams react
to your approach?
E. G. : They react very well. They are even
the first to support our approach. On the
one hand, they know that having this
conversation helps to handle the end
of the life of a loved one. On the other
hand, physicians often end up having to
push it upon patients and families at the
last moment. Incidentally, they tend to
make our kits available in their hospital
or practice. Religious communities also
welcomed our approach very positively
and take part in the dissemination of
our tools, because the end of life is not
just a medical question. Believers often
turn to faith leaders when their time is
near. This is why we have set up many
discussion groups with priests, imams
and rabbis.
Do treatments work better thanks
to this conversation?
E. G.  : That is not really the goal. What
matters is that people get what they
want, rather than not having a say. It is
mostly the relatives that benefit from
it. Physicians tell us that much: families
are frequently torn apart because of the
choices they have to make in that critical
moment. They wonder if they made the
right decision. When the conversation
takes place beforehand, it reduces the
risk of depression, guilt and doubt. The
patient states his or her last wishes and
the loved ones can only respect them. It
makes a lot of things easier.
By Perrine Massy
25
1 | PREVENT

FRANK HOFFMAN way to grow, this has become a reality.

We have managed to set up our first
franchise in Austria, with Syncon2 and
Cancer in the Dark SINN-STIFTER,3 and we now benefit
from an international reach. We have
already trained the first MTE in Colum-
To detect breast cancer, palpation is often the first step. bia, in cooperation with the CAF (Deve-
lopment Bank of Latin America) and
This German doctor realized that by entrusting this exam to the visually impaired, Mexico will be the next state to support
one can leverage their exceptional sense of touch. More precise and less the initiative. Another pilot project has
expensive, their diagnoses allow early intervention to stop the evolution started in India, financed by the CSR
funds of a major pharmaceutical com-
of this illness, which kills more than 500,000 women each year.1 pany. I am convinced that
Discovering Hands can have
a wider social impact in “For every
discovering-hands.de/en/ developing countries, where
insurance systems are not
examination
always trustworthy and conducted by
access to treatment is some- Discovering Hands,

W
hat was the
starting
point of the
Discovering
Hands project?
F. H. : I have been
a gynecologist since 1993. In my prac-
tice, in Duisberg (Germany), I have
always focused on early detection
of breast cancer. I wanted to make it
more efficient, I was convinced that
the examination I did on my patients
wasn’t optimal. The threat is not the
tumor, but the cells that metastasize
throughout the body and affect the
bones, the lungs, the liver or even
the brain. Detecting and treating the
tumor before it metastasizes conside-
rably improves the chances of survival.
How can medical examination for
breast cancer be improved?
F. H. : The best way to improve the tac-
tile examination for breast cancer is to
spend more time on it than the usual
three minutes, and to hire people with
a highly developed sense of touch.
When I came to that conclusion, I
figured it would be the ideal work for
How did Discovering Hands
start?
F. H. : When I had the idea of Discovering
Hands, I started developing a program
from 2006 to 2008, in cooperation with
the BFW (a vocational training center
for the visually impaired) in Düren.
After two years of work, we were able to
offer them quality instruction. Initially,
it was just a test to know if they could
be taught to become Medical Tactile
Examiners (MTE) in nine months. After
the success of the operation, we opened
other training centers in Germany. At
the end of 2010, we had four centers:
Halle, Nuremberg, Düren and Mainz !
What does this method have
that the traditional examination
doesn’t?
F. H.  : Early detection of breast cancer
relies on three steps: physical exa-
mination, echography and radiology
(mammography). Our objective wasn’t
to replace one of them, but to opti-
mize the physical examination. It is
the first stone in a string of diagnoses.
If the doctor has no suspicion at this
stage, he won’t take additional action
evolve into a metastasis, thus lesse-
ning the patient’s chances of survival.
Honestly, I believe the usual physical
examination is not viable, because we
lack time during the observation. For
every examination conducted by Dis-
covering Hands, the MTE spends thirty
to fifty minutes using their highly
developed sense of touch. It makes a
big difference.
How effective is this technique?
F. H.  : Essen University completed
research in 2008. They discovered that
our MTE, thanks to the quality of their
senses, can find tumors inside the
breast as tiny as six to eight millime-
ters, versus one to two centimeters for
doctors. It is very important, because
a tumor that is a few millimeters in
size hasn’t sent its cells throughout
the body yet. The special skills of the
visually impaired examiners are a gift
for women affected by this pathology.
They save lives.
Have you started to expand your
project?
F. H.  : Thanks to the Ashoka Globalizer
© DR
times difficult.
the MTE spends
What is your financial
strategy?
30 to 50 minutes
F. H.  : To guide themselves using their highly
and to examine the breast developed sense
in its entirety, the MTE
use copyrighted orienta- of touch. It makes
tion tapes. Each screening a big difference.”
brings in additional funds
to our company, since the
tapes are sold by Discovering Hands. It is
one of the strengths of our model. Since
2016, we have created our own training
center, Discovering Hands Academy, in
Berlin, and we have become a profes-
sional integration company, because
we hire the visually impaired examiners
that we train. They can also practice in
medical offices or clinics. Thanks to this
academy, we can recruit more and more
MTE and provide them with a better
social security. I hope that in ten years,
they will be associated with breast can-
cer detection in the same way a midwife
is with birth.
By Charlotte Sarrola
1. According to the American Cancer Society.
2. Austrian agency specialized in the deve-
lopment of franchises.
3. Group of Austrian philanthropic

visually impaired individuals. and a neglected tumor might then program, which determines the best foundations.

26 HEALTH TOMORROW
 1 | PREVENT

service while remaining
financially viable?
K. F.  : Actually, our project has come
to fill a gap between the public and
the private sector. MyMind’s social
enterprise model is innovative and
transparent. We apply a price scale to
our services: people with a full-time
job pay the highest fees. The income
generated by these sessions allows us
to offer lower fees to the unemployed,
the retired people and the students.
As our organization grows and helps
more clients, we are getting close to a
balance in the budget.
In what way is access to
psychological and psychiatic care
unsatisfactory?
K. F.  : Mental health problems are
among the main causes of illness and
defend multiculturalism in Ireland,
notably because we propose our ser-
vices in ten languages and give support
to ethnic minorities. We do all we can
to offer individuals the means to get
past the difficulties in their path.
How do you collaborate with other
mental health actors?
K. F.  : Today, we enjoy a commercial
footing and a good reputation with
regards to mental health in Ireland.
It is important to attach ourselves to
existing care services. Wherever we
may open centers, we have to establish
solid relations with the authorities and
the professionals. Furthermore, the
Irish government has taken the crea-
“Within 72 hours
tion of MyMind quite favorably, and
we have received the support of several
political leaders.
What challenges do you face?
K. F. : MyMind has a strong potential for
growth and we must respond to ever
more numerous demands. We not only
have to enlarge our existing centers,
but also open others to become profi-
table. We intend to expand our Inter-
net services and to reinforce our team
by hiring psychologists and attracting
volunteers. However, even if online
therapies are in full development,
people remain apprehensive of this
method in Ireland. In the coming years,
we would like for views to change and
for more research and financing in this
sector. We want to prove that MyMind
is effective, in terms of social impact

KRYSTIAN FIKERT handicap in the world. According to

the WHO, one in four people will suffer
from them at some point in their life.
and in several
languages, these
as well as value. Our model is quite
flexible and could easily be reproduced
in other countries.
The Virtual Psychiatrist In Ireland, one in five people will suffer
from depression, and still the health consultations By Perrine Massy

system hasn’t changed. The allotted by videoconference

To fight against the poor handling of mental health issues in Ireland, budget is insufficient and reserved for
extreme cases. As a consequence, an
allow us to reach
Krystian Fikert launched the online counselling service MyMind in 2006. individual with slight to moderate psy- a maximum number
Thanks to fees adapted to the patient’s income and a network chiatric troubles has difficulty acces-
sing professional help. It is nonetheless
of beneficiaries.”
of multilingual counselors, his social enterprise makes psychiatric services vital to intervene as early as possible if
widely accessible, with more than 62,000 sessions conducted to date. we want to avoid much more serious In addition to on-site psychiatric
consultations, MyMind offers
pathologies. From an economic pers-
consultations online.
pective, the European Union estimates
mymind.org the cost of untreated mental illness
in its members states o be between 3
and 4 % of GDP. Tackling depression,
anxiety or stress reduces the suicide

H
rate and the number of hospitaliza-
tions. It is a way of saving public money
ow does MyMind all. To achieve this, our organization reach a maximum number of beneficia- and increasing productivity.
work to address bypasses the classical care pathway, ries. Technology is central to our social
mental health reducing waiting lists and bringing enterprise. It is what enables us to eli- How do we fight societies'
issues? down high consultation fees. We have minate obstacles such as time, distance prejudices to mental health
K. F.  : In Ireland, the four clinics in the country. But in addi- and cost. Today, thanks to MyMind, challenges?
handling of people tion to physical appointments, we offer 62,000 sessions have been provided to MyMind normalizes psychiatric care
suffering from mental health issues online appointments. Within 72 hours those in need. and reduces the stigma around it. We
is insufficient. I launched MyMind in and in several languages, these consul- help with the integration of those
© DR

2006 to make psychiatry accessible to tations by videoconference allow us to How can you provide an affordable suffering from mental problems and

28 HEALTH TOMORROW 29
1 | PREVENT 2 | MAKE

GENEVIÈVE MOREAU gent Nutrition, for the professionals

who trained at the Institute.
Among the laureates: the Pasteur
Nutrition for Better Health clinic in Toulouse, which SIIN helped to
gain a “sustainable nutritional health”
certification. The specifications state
As a general practitioner, Geneviève Moreau became increasingly interested in that meals must include foods with
well-known nutritional properties. To
the impact that nutrition had on her patients. In 2009, she launched the Scientific achieve that goal, the establishment
Institute for Intelligent Nutrition (SIIN). Her organisation fights converted some of the nearby fields to
to raise awareness for the link between diet, good health and the environment. organic agriculture. People in rehabili-
tation programs are employed to farm
them. SIIN also works in French terri-
tories overseas, as well as in Belgium,
siin-nutrition.com Switzerland and Portugal. “A pharma-
cist has even taken our movement to the
United States,” rejoices Geneviève.

SUPERMARKETS AND THE

A
general practi-
tioner for years,
Geneviève Moreau
is now a nutrition
specialist. Between
these two expe-
riences lies the story of a growing awar-
eness of the importance of nutrition,
which started with her son’s food aller-
gies. “When he was 2, I realized that our
first medicine was what we eat, and I had
studied medicine,” Geneviève admits. “In
a normal university curriculum, nutrition
is covered over only eight hours, when diet
is at the core of everything else.” In her
practice, Geneviève gave nutrition an
increasingly central place in the treat-
ment of common pathologies. “For ins-
tance, instead of always prescribing an
anti­hypertensive, I looked for the causes of
the hypertension and lowered it by adjus-
ting the diet.” Her patients noticed an
improvement in their health and qua-
lity of life. However, when they went
shopping or to a restaurant, they risked
reverting back to their old habits.
That is why Geneviève decided to
get additional training in nutrition.
Travelling to Dijon (France) Geneviève
the University of Burgundy. During
this time, she met Olivier Coudron, a
nutrition health professor. Together
they launched the Scientific Institute
for Intelligent Nutrition (SIIN) with one
clear objective: to promote a sustai-
nable diet that respects our body, our
health and our planet. “What we eat
affects our well-being and can prevent
a lot of illnesses,” explains Geneviève.
Without replacing medication, food
can indeed facilitate a treatment’s
success. “In the case of a cancer and in
conjunction with anti-cancer drugs, che-
motherapy or radiotherapy, intelligent
nutrition can help heal and prevent recur-
rence. The same goes for cardiac illness
and diabetes, which can be alleviated by
an appropriate diet.”
WHITE PAPER AND
COLLEGIAL PRACTICE
To give credibility to their fight, both
doctors have written a white paper
on “sustainable nutrition health” and
created the International College for
Intelligent Nutrition. This allows them
to have their work vetted by resear-
chers, professors and nutritionists from
also plays an advisory role for the Bel-
gium Senate and many political groups.
For example, the College provided infor-
mation during a vote on legislation on
trans fats. Much of the advice provi-
ded by the College is aligned with the
guidelines and values of SIIN. “In this
College, we have a center dedicated to the
food-processing industry which recently
helped a manufacturer develop a soup,”
explains Geneviève Moreau. “This com-
pany wanted their product to have a real
nutritional and environmental impact,
so we audited their recipe.” Sometimes,
the College intervenes in deliberations.
Geneviève shares one case where a
manufacturer wanted to produce “nutri-
tion health” bread, but opposed SIIN’s
recommendations. “We called upon
researchers studying cereal grains to give
more weight to our audit.”
SIIN, a fully independent scienti-
fic organization, provides training to
accelerate the transition to sustainable
nutrition. “We are training people in
the middle of the chain, those who feed
us, such as private restaurant owners or
dining services: clinics, retirement homes,
schools or companies.” The two doctors
© DR
FOOD-PROCESSING INDUSTRY
Sadly, the public “has gotten used to
quickly eating food almost entirely devoid
of nutritional properties”. If malnutrition
is still rampant in many poor countries,
rich countries need to make sure they
don’t fall victim to “proteinic undernu-
trition”. “We think our diet is balanced
but we are wrong. Most of the products
in supermarkets are not good for health.”
Hence the importance of training pro-
fessionals to be local ambassadors,
through talks in city halls, schools and
sports centers. “Our daily work is B2B
(business to business), but the end result
is B2C (business to customer). The public
need to think: my diet impacts my health
and my environment.” Geneviève still
needs to work with supermarkets so
that “people don’t need a master’s degree
to read the labels and tell the good products “What we eat
from the bad”. At SIIN, the work is trans- affects our well-being
versal, from pitchfork to fork, with far-
mers, doctors, pharmacists and other
and can prevent a lot
members of the healthcare community. of illnesses.”
To go further, the Institute is focusing
on the food-processing industry. Gene-
viève considers that “industrial groups
now have enough technical knowledge and
historical perspective to make the change
to more sustainable practices”. 

earned a degree in Micronutrition at various European countries. The College also created a European label, Intelli- By Fleur Weinberg

30 HEALTH TOMORROW
 1 | PREVENT

MARTIN GUZMAN
Watching Out for Venezuela
When they are not identified early, vision problems can have dire medical
and scholastic consequences for children. To avoid this, Martin Guzman
is training teachers in Venezuela to test the vision of their students yearly,
with the help of a vision kit. The objective of his project – Lumen –
is to invite every citizen to become an actor for change.

proyectolumen.org

W
hat is Lumen?
Lumen is a
M. G.  :
communi­ty social
program whose
objective is to
train teachers, in
order to make them front line influen-
cers in the fight against visual impair-
ment. By nature, teachers are actors
of change, but they don’t necessarily
know it and they feel powerless. So we
chose to put them at the heart of our
project, to re-establish the role of pre-
ceptor that they once had in communi-
ties. By having an impact on teachers,
we can impact the whole of society. We
also involve universities, medical and
optometry schools to create a network
capable of taking care of vision pro-
blems in the long term.
How do you train these teachers
to detect ophthalmological
pathologies in children?
M. G. : Eachteacher first receives a kit. It
is made up of an optical chart that we
developed and a brochure with all the
necessary information. With this kit, it
is possible to renew the detection pro-
© DR
“Developing people’s
skills and spirit of
initiative is
essential if we want
to grow socially.”
gressive: it is thus imperative to follow
the children throughout their time at
school. The next step – one of the cen-
tral parts of the project – is the visual
health roundtable. All the teachers meet
to go over the needs of their students
and then bring the information to the
local government. We teach them to be
actors in the situation, to go negotiate
with the authorities and the private sec-
tor. Be they public citizens or high offi-
cials, Venezuelans often confuse charity
and social development, while they are
two very different things. With Lumen
we want to address a societal problem.
How did you succeed in involving
teachers?
M. G.  : Since we started in November
2012, we have worked with 15 com-
zuela. We have gone into 25 schools
and have trained 424 teachers, who
are now certified Lumen representa-
tives. We also work with civil organiza-
tions such as Fé y Alegria. This Jesuit
network, deeply implanted in Latin
America, oversees 175 establishments
and over 200,000 children.
How does Lumen fit within
the Venezuelan healthcare system?
M. G.  : Our healthcare system is very
dependent on the welfare state and
puts the emphasis more on disease
than prevention. It was this situation
that pushed me to create Lumen. We
offer a different approach: we don’t see
health as a problem but rather as an
equilibrium to maintain.
Why did you choose to take
on vision problems as a matter
of priority?
M. G.  : Sight is the principal sense that
we use in our interactions. Humans can
even be defined as visual beings. But
visual impairment is just a technical
aspect of our project. We have a larger
objective: we encourage people to par-

cess each year. Vision problems are pro- munities, in 7 of the 22 states of Vene- ticipate and organize themselves to put

32 HEALTH TOMORROW 33
1 | PREVENT

“Xoxoxo
xoxoxoxooxo
xoxoxoxo
xoxoxoxo
xoxoxox.”
The kit distributed by Lumen allows teachers
to test the vision of their students.

“My wish is for Lumen
to become systematic, that every
teacher would master
the kit and test the vision
of their students throughout
their time at school.”
their problems on the table, analyze
them and find solutions that involve all
the actors of society. I did a doctorate
in Health Management and developed
this concept, which became the basis
of Lumen, in my dissertation. Today, it
is more than an idea: it has become a
method.
So it is possible to apply Lumen’s
© DIANA VILERA
chers use the roundtable methodology
to resolve other challenges, such as
universal water access or the struggle
against domestic violence. Sometimes
it is enough to identify the difficulty,
then go speak with the authorities.
Developing people’s skills and spi-
rit of initiative is essential if we want
to grow socially. They must be able to
take their problems in hand without
What future do you see for Lumen,
now that Venezuela is in a violent
political crisis?
M. G. : The situation was already compli-
cated when we were getting started. So
it is proof that with a little willpower
nothing is impossible! Lumen will go on,
because a whole generation has made
it their own. I am 53, and I meet young
people around 20 years old who are
vision of their students throughout
their time at school. I would like our
method to give birth to other public
policies, not only to prevent vision pro-
blems, but also to bring up the challen-
ges with which we are confronted.
Maybe the project will even be deve-
loped in neighbouring countries.
By Perrine Massy

method to areas other than waiting for someone to come and solve heavily involved. My wish is for Lumen
visual health? them in their place. The solution lies in to become systematic, that every tea-
M. G.  : Of course. We observe that tea- this cultural change. cher would master the kit and test the

34 HEALTH TOMORROW 35
1 | PREVENT 2 | MAKE

PIYUSH TEWARI by a car. He was lying on the ground,

but no help came. At the time, I was
the Indian CEO of an American capi-
Texte courant

A Licence to Save Lives tal investment fund. My career was

quite fulfilling, but I decided to dedi-
cate myself full-time to road safety. I
After his cousin died in a car accident, Piyush Temari decided to leave a high- realized with fright that little had been
done to fight against this public health
level position to launch The SaveLife Foundation. First-aid training, legislative problem which has killed one million
advocacy, licensing reform: Piyush’s foundation works on all fronts to improve road people in India in the last ten years.
safety in India, where two million new vehicles are on the road every year. You are based in New Delhi,
the capital. But what is
it like in other cities and,
savelifefoundation.org more importantly,
in the countryside?
P. T. : We are now present in five states,
and are working on five more for next

W
hy is road
safety in India
a problem?
P. T.  : In Delhi,
where I live,
around 400,000
additional vehicles hit the road every
year. That number is 2 million on a
national scale. However, neither road
infrastructure, nor driver training,
nor construction standards are suffi-
cient to face this growing flow of traf-
fic. Emergency care is also very poorly
organised. As a result, India is the
country with the most car accidents
in the world. In the last ten years, 1.2
million people died on the roads and 6
million were severely injured and han-
dicapped. That makes almost 400 a day.
How does the SaveLife
Foundation intend to improve
this situation?
P. T.  : First, through fieldwork. 50 % of
the deaths could be avoided if the vic-
tims were taken care of quickly. So we
it evolve by being an example and by
getting the necessary measures started.
How do the training sessions
unfold and what do you teach
volunteers?
P. T.  : We have two programs. One
teaches the basics for saving lives:
controlling bleeding, CPR or immo-
bilizing the spinal column. It is
intended for police officers and citizen
volunteers. We use mobile technolo-
gies to connect them with each other
and to be able to mobilize them rapidly
to the scene when a call signals an acci-
dent. We have trained 10,000 people in
the last three years. The other program
targets truck drivers. We teach them to
drive more defensively and to prevent
tragedies through videos, games and
case studies. All is free and financed
uniquely through donations.
And at the legislative level?
P. T.  : The Indian Parliament is getting
ready to adopt an important law in
and more attention will be given to
the most vulnerable populations. The
public administration has also recently
guaranteed the defense of “good Sama-
ritans”. Concretely, a set of directives
were approved to avoid legal troubles
for people who help the wounded. Both
of these bills were supported in India
by the SaveLife Foundation.
What can be done to improve
the training of drivers?
P. T. : Mostof them haven’t had classes
worthy of the name. Many learn at
home and bribe the examiners to get
their license. Our legislative work aims
at reforming the entire system of trai-
ning and testing so that it is professio-
nal, transparent and corruption-free.
The objective is quite simply that only
those who really know how to drive
would have the right to do so. It is
essential, since driving a vehicle is like
carrying a loaded gun. A vehicle can kill
when not handled by a trained person.
© SAVELIFE FOUNDATION
year. Delhi has the largest number of
deaths on the road compared to other
Indian cities. In recent years, this figure
has been reduced by 20 %. We hope
that our action will contribute to the
same results in all megalopolises. In
the countryside, the problem is that
there is no infrastructure for crossing
the highways that are near the vil-
lages. Many farmers die while trying to
cross them. These individuals are often
disadvantaged, and their death plunges
their families into utter destitution.
Improving road safety is thus also figh- “Driving a vehicle
ting against poverty and inequality.
is like carrying
Do you think that the situation
will improve?
a loaded gun.
P. T.  : Yes, I am confident of it. We are
A vehicle can
a very young democracy, and orga- kill when not
nizing the lives of 1.3 billion people
is not an easy thing to do. We have
handled by a
brought many problems under control trained person.”
in terms of health care, such as polio
or AIDS. Road mortality can also be
reduced by means of appropriate poli-
cies combined with civic engagement.
The media and public opinion are now

organize basic first aid training, open to
all. Then, at the legislative level, we fight
for the adoption of decisions reinfor-
cing road safety. The idea is not to take
over the role of the state, but to make
the domain of road safety. As a result,
drivers’ licensing will be more deman-
ding, commercial drivers will be better
trained, there will be new construc-
tion norms for roads and vehicles,
One of your family members, aware of the size of the problem, while
for that matter, was the victim no one was even talking about it when
of an accident? we started our fight. In the coming
P. T. : That is right. My little cousin died years, the change could be massive.
from his wounds after having been hit By Côme Bastin

36 HEALTH TOMORROW
 1 | PREVENT

JOËL DE ROSNAY
communicate directly with these digital
devices using their own brain impulses.
Artificial organs, electronic implants,

Being Human, Tomorrow robotic limbs, etc. This path may lead
to the apparition of “supermen” or a
“transhuman”, but it will also create a
dangerous gap between human beings.
Scientist, writer, speaker, as well as the CEO of Biotics International,1 Right now, some limits are already being
Joël de Rosnay is one of the great popularizers of biology, pushed back. Will we be able to “print a
digital technologies and cybernetics. In this column, he imagines heart”? Will a human composed of spare
parts still be human? We must really
the future of mankind, between cyborg and symbiont, the “cybiont”. think about what we do lest we alter
what is most natural within the human
race, what makes its originality and its
carrefour-du-futur.com strength: the capacity of any individual
to resemble his fellow human being
while remaining unique. But a trans-
formed human being with its implants,

W
hat will
the man
of tomor-
row  be like?
Scientists
and sci-fi
writers have imagined the advent of the
cyborgs, cybernetic men, half-human,
half-robot. Bruce Mazlish predicts the
coming of “combots”, or computer-ro-
bots, a new generation of man-made
beings that will live and collaborate
with us and possess the ability to repli-
cate on their own. Hans Moravec consi-
ders that these future androids will
reach such a high level of intelligence
that they will be able to persuade us to
do otherwise, should we ever want to
“unplug” them.
I would rather consider Man, society
and the technosphere as a co-evolutio-
nary whole. This is why I imagine the
men of tomorrow as symbiotic. They
won’t differ much from the 20th-cen-
tury men physically or mentally, but
their biological, psychological or biotic
connections with the digital ecosystem
will give them extraordinary means of
knowledge and action. With the term
cybiont (from cyb-, cybernetics, and
tary superorganism, this technologi-
cal ecosystem living in symbiosis with
the brains of men, interconnected as
neurons are by synapses. The union of
biology, nanotechnology and computer
science has already led to many pro-
ducts used in healthcare.
TOWARDS THE CYBIONT
Amongst the most spectacular ones,
we find diagnostics based on nanotech
and micro-sensors linked to smart-
phones, using sample-collecting sys-
tems. These are only the beginnings
of the promising and already booming
e-health area, relying on numerous
smartphone apps. We have also wit-
nessed the development of smart pills
that travel throughout the body and
communicate in real time with digital
interfaces. We are already able to grow
stem cells on biodegradable scaffolds
imitating the shape of the organ, as is
currently done for bladders. We also
have produced functioning tiny liver
buds, kidneys and brain parts. And
let’s not forget the revolution of 3D
bio-printing for regenerative medicine.
Organovo’s device can project stem cells
on a nutritive surface and build organic
the Wake Forest Institute has managed
to produce cardiac valves that could
potentially be grafted. The advances of
nanomedicine will not only expand the
field of diagnostic tests, but also that of
implants. Devices such as biosensors
will be able to measure specific parame-
ters of cellular metabolism and confirm
the correct assimilation of drugs or, on
the contrary, detect any anomaly.
REGULATING TOMORROW
I have been trying to raise aware-
ness since the eighties on what I call
“biotic”, or the union of biology and
computer science. In this area, “brain
activated technologies” (BAT) will play
a crucial role. A few years ago, Profes-
sor Miguel Nicolelis demonstrated the
possibility of transmitting information
coming from the brain of a monkey
to a robotic arm located hundreds of
kilometers away. More recently, resear-
chers from the University of Washing-
ton have established for the very first
time a connection between two human
brains. These technologies will have a
fundamental role in the years to come.
They will empower disabled people as
well as enable scientists and engineers
© DR
transformations and explants might
not meet the same criteria. How can we
channel the advances in this area?
Several levels of regulation are
conceivable. The scientific community,
which publishes its research according
to certain rules, acts as a preliminary fil-
ter for possible deviance. This first level
of vigilance must go hand in hand with
a threefold reflection on ethics: from
bioethics (biology) to infoethics (infor-
mation) and ecoethics (ecology). This
is necessary to prevent mindless expe-
rimentations from altering the human
being and to reflect on the kind of
world we want to leave to our children.
This undertaking must bring together
scientific, moral, religious and political
authorities. The second level is that of
citizen consensus, able to influence sub-
jects that directly concern individuals in
society. Thirdly, political regulation, in “I would rather
the highest acceptance of the term, is consider Man, society
mandatory. Faced with constant debates
around societal choices, the budgets and the technosphere
they need and the men and women able as a co-evolutionary
to carry them out, those in the political
arena make decisions and assessment whole.”
that weigh heavily on our future.
By Joël de Rosnay
1. Biotics specialize in new technology
consulting and trend forecasting in digital

bios-, biology), I refer to this plane- tissues. Professor Anthony Atala from or smartphone and computer users to education and biotechnologies.

38 HEALTH TOMORROW
CHAPTER 2

CURE

H
ow much of a
threat to public
health are
cardiovascular
diseases?
A. Z. : According to
the WHO, 17.5 million people die from
cardiovascular diseases each year. In
Africa it is the second cause of death
after malaria. In Cameroon, one out
of every three women is affected by
it, and 4,000 newborns die each year
because of a congenital heart defect.
Several factors explain this. The first is
poverty. The recommendation is to do
an exam every two years, but it costs
a minimum of 15,000 CFA francs.1 The
second factor is the small number of
cardiologists: sixty for 23 million inha-
bitants, and they are mainly in the big
cities. The extreme lack of specialists
condemns rural areas and their popu-
lations. Finally, health coverage is res-
tricted in Cameroon. Someone affected
by heart disease requires a lifelong
medical monitoring. As a result, insu-
rance companies see them as a series of
checkups and medication – thus a lot of
money to lose – and exclude them from
the reimbursement system.
How did you innovate to come up
with a solution?
A. Z. : I was in the process of writing
the dissertation for my computer
ARTHUR ZANG engineer studies. Then, in 2009, I did
an internship at the Yaoundé general
hospital, where I met a cardiologist
Healing Africa’s Beating Heart who trained me in the digital proces-
sing of the heart rate’s signal. I started
by writing software that would digitize
For 23 million Cameroonians, there are only sixty cardiologists, the parameters of a cardiac exam to
send them wirelessly. But it is hard to
mainly located in the big cities. When he was still a computer science student, transport a computer from one village
Arthur Zang imagined a tablet that would let you do a heart exam to the next. So I designed a tablet that
© M. LATZEL / ROLEX AWARDS
connects to sensors. This lets you per-
and transfer the results wirelessly to a specialist. A promising invention form an exam and send the data to a
to support health systems struggling to keep up with need and demand. doctor for diagnosis. The CardioPad was
born. The full kit, which includes the
tablet and all the necessary equipment,
himore-medical.com costs 2,800 dollars today. In 2014, my
42 HEALTH TOMORROW
company, Himore Medical, received a
Rolex Award for this invention.
Who is this tablet meant for?
Right now, 64 tablets are in use in
Cameroon and around the world. We
are in touch with about twenty car-
diologists that interpret the results
and have already diagnosed seve-
ral hundred patients. In Cameroon,
our first clients are arrondissements2
and village hospitals which have no
cardiology department. So we have
partnered with the State to equip these
hospital centers with CardioPads. It is a
public-private alliance, without which
we would not be able to move forward.
We are also working with NGOs in
Gabon, Nepal, Malaysia, the Comoros
and Kenya.
“You have to be
enthusiastic about
what you do.
That was the spirit
in which I started
the CardioPad.
It then became
a citizen’s duty.”
Are you working on other projects
at the moment?
A. Z. : Our CardioPad order book is well
filled up. In order to make the device
available to hospitals and patients with
limited resources, we launched the
Africa Cardiac Care program. For only
fifty dollars a year, it lets you do an
unlimited number of heart, glycaemia
or blood pressure exams. We are also
working on other medical and techni-
cal projects. For instance, individual
portable devices that patients could
use at home to control and keep track
of several heart values.
2 | CURE
A box containing the CardioPad
and its sensors.
What would you say to a young
person who wants to innovate in
the health sector?
A. Z. : You have to be enthusiastic about
what you do. That was the spirit in which
I started the CardioPad. It then became
a citizen’s duty towards the abandoned
patients in my country. However, it is
challenging to be an entrepreneur. To
keep an unwavering motivation, you
need much more than the lure of profit.
The biomedical sector is also particu-
larly technical. You cannot innovate in
it without doing research: you have to
roll up your sleeves to find funding and
partners. Health problems are legion
in Africa. There is extensive negligence
and lack of commitment on the part of
governments towards their healthcare
systems. Most government officials
stay in the big cities and have no awar-
eness of the hardships in the villages.
It is up to the private sector to try pro-
posing solutions and to make a move
towards the State to influence public
policies positively.
By Timothée Vinchon
1. Approximately 27 dollars.
2. A territorial division of Cameroon.
43
2 | CURE 2 | CURE

MICHELLE LEM
Emergency Veterinarians
Community Veterinary Outreach’s mission is to care for the pets
of the marginalized and homeless people and facilitate better healthcare
for their owners in the process. Founded in 2003 in Canada by Michelle Lem,
this network of mobile veterinary clinics relies on the deep bond between people
and their faithful companions to keep them both healthy.

vetoutreach.org

H
ow did you come
up with the
idea to create
Community
Veterinary
Outreach?
It all started in 2003, when I
M. L.  :
offered my veterinary services at a
homeless shelter in Ottawa, in the
Southeast of Canada. During my years
of volunteering, I saw that homeless
people care more for the health of
their animal companion than their
own. But since pets are banned from
most institutions, shelters or hos-
pitals, these services remain out of
reach for many homeless people.
Moreover, this population has often
given up on social and health services.
However, once you have taken care of
their companion, they are more likely
to accept being taken care of themsel-
ves. Community Veterinary Outreach
was launched in 2009 to use veteri-
nary clinics as a point of contact with
marginalized people. In 2012, we were
granted the charitable organization
© G2 BARANIAK
Inside the clinics, how does the
transition between the animal and
the person take place?
M. L. : The beneficiaries are sent by social
services and health professionals.
When they show up at one of our
clinics, they sit down in the waiting
room, and we take this opportunity to
talk to them, establish a connection and
try to understand their situation. Then,
during the veterinary consultation
“When someone
says to me: ‘Don’t
you think homeless
people shouldn’t
have pets?”
animals are examined, vaccinated,
microchipped and de-wormed. Surgery
can also be planned if needed. Then,
in a second stage, we provide care to
the human. Depending on the clinic:
dental care, smoking cessation help or
can pick up products that were donated
such as leashes, collars, toys or pet food.
Where are your clinics located and
who works there?
M. L. : In fact, we don’t seek to establish
ourselves anywhere in particular, we
support activists who want to set up a
“clinic”. Our dispensaries are therefore
set up temporarily, in partnership with
local associations and social organiza-
tions. In each city, several “clinics” are
set up every year. A team of volunteer
veterinarians get involved in each of
these communities. Community Vete-
rinary Outreach is currently predomi-
nantly located in major Ontario cities.
New “clinics” have popped up this year
in Vancouver, Winnipeg and Halifax.
And yet, some people might think
that taking care of animals is not a
priority?
M. L.  : I remember that at first many
people didn’t understand why I
started this project. Many believe that
those with no financial means should

status. The pets we attend to reveal distribution of overdose prevention not own pets. But when someone
the invisible forms of exclusion their kits. After this step, masters and pets says to me: “Don’t you think homeless
owners suffer from. take a walk in what I call the “shop”. They people shouldn’t have pets?” I always

44 HEALTH TOMORROW 45
2 | CURE 2 | MAKE
Community Veterinary
Outreach helps both
marginalized people
and their pets.

say, “don’t you think there should be no

homeless people?”
In Canada, 63 % of the homeless
youth have experienced childhood mal-
treatment or trauma. 28 % come from
the foster care system and did not grow
up with a family. For them, owning a cat
or dog is the first opportunity to expe-
rience unconditional love and be accep-
ted. Their companions show empathy
for them while they often have a very
low self-esteem of their own. They
might learn to take care of themselves
primarily because they feel obligated
to take care of their companion. Some
even reduce their alcohol or drug use to
this end. Similarly, in some cases indi-
viduals start looking for a place to live
in, so as to protect their animals. Pets
undeniably have a positive impact.

Since clinic attendants don’t

have the means to pay, how does
Community Veterinary Outreach
function economically?
M. L. : The most difficult thing for us is
to find long-term financing. We raise
funds for one-off projects, so we have to
start again every year. If we are able to
continue, it is mainly because all veteri-
nary clinics are run by volunteers. And
we are lucky to be helped by companies
that supply most of the medical equip-
ment we need.

What are your plans

for the future?
M. L.  : I would like to duplicate our
model of care. Right now we are wor-
king with homeless people in cities, but
I would like to do the same thing in rural
areas with isolated farmers and try it
in developing countries. In summary, I
would say that wherever humans have
relationships with animals, not only as
pet but also farm animals, it is possible
to improve the health of humans by
caring for their animals.
By Perrine Massy
© DR

© DR
© DR

46 HEALTH TOMORROW
2 | CURE 2 | CURE

ANIL PATIL
We Are All “Carers”
They are essential to the healing process, but often go unnoticed
and underappreciated. “They” are carers: the parents, children and devoted
friends of a sick or disabled person. Anil Patil has decided to make
their voices heard with his NGO, Carers Worldwide, which, in three years,
has supported more than 5,000 carers in India, Bangladesh and Nepal.

carersworldwide.org

“Whether we are A group of carers in Nepal.

S
o, who are these
carers that your
NGO supports?
A. P. : They are all those
who, without being
paid for it, take care
of a loved one: a parent suffering from
a chronic pathology, a child suffering
from a mental disorder or a disabled
friend. The majority of healthcare
organizations focus uniquely on the
sick person. However, he or she that
makes the difference is often the carer.
85 % of support work is done by the
relatives, but doctors often pepper
them with information for a half-hour.
With my NGO, Carers Worldwide, we
give a voice to this population that
doesn’t get any recognition. The pro-
blem is even more urgent, since the
family unit is exploding in developing
countries. People used to live together
and help each other. Today, agricul-
ture is no longer a profitable trade and
the children move from city to city
to study or find work. The extended
family1 hardly exists anymore, except
in villages. When a member of the
household falls ill, those who have to
lated and invisible, as if they were shut
away in their own world.
How do you help them
to break this isolation?
A. P. : We have created nearly 300 psy-
chological support groups in different
regions of India and Nepal, to give
them the opportunity to meet other
learn by sharing their experiences. Fur-
thermore, 85 % of the carers face phy-
sical or mental problems due to their
status, which is often precarious. To
remedy this, we collaborate with diffe-
rent health centres and have trained
seventy doctors to better respond to
their needs. We also provide them with
information on how to deal with family
and relationship problems. We started
three years ago with 150 carers; we are
now at 5,500. This betters the lives of
27,000 individuals.
Beyond this psychological support,
what can be done to improve their
material situation ?
Because their role as caregivers
A. P. :
is extremely time-consuming, 90  %
of the carers lose their income, their
job, not to mention that the sick per-
son can no longer work either. Some-
times, when children have to take care
of relatives, they can no longer go to
school. We have therefore developed
an alternative system with the creation
of community care centers in which
two paid carers take care of several
sick people. This way, 255 children and
© DR
to work or school. We also do lobbying,
by launching carers’ associations. In
Nepal, we have created two coopera-
tives with over 600 members that save
money by helping each other. There
and in India, we also initiated the first
Carers Day two years ago. Discussions
are taking place with the UN to extend
it throughout the world.
Do you work with or in
the place of government and
the healthcare system?
A. P. : In the place of, sadly. In a country
of 1.3 billion people like India, there
are statistics on everything – mental
illness, AIDS, handicap – but abso-
lutely none on carers. These people
are often women who don’t have the
choice. Already vulnerable, they must
also keep house and spend their nights
asking themselves what would happen
to the loved one if they died. However,
as they seem in good health, doctors
continue to think that it is useless to be
concerned with their fate. We sensitize
and train medical personnel to take the
family of the sick person into account.
We dialog with public and university
rich or poor, a king
or an untouchable,
on this planet,
we will all one day
be the carers or
the cared for.”
Recently, the state of Jharkhand, one
of the poorest in India, asked us for
help to get closer to 20,000 carers in
the territory. This proves to what point
our model has a positive influence on
the quality of care and the quality of life.
What pushed you
to get involved?
A. P. : I had long worked in the domain
of mental health in India and observed
how carers were isolated. Then, when
our second daughter was born, we dis-
covered that she suffered from a form
of Down’s syndrome. Despite all our
knowledge, we really needed the sup-
port of our friends and family. Without
them, I don’t think we would be where
we are today. This is what made me
reflect on the situation of carers in less
In the long run, what would be
the solution to better recognize
the roles these individuals play?
A. P. : These aids represent a veritable
volunteer army. For doctors, and for
pharmaceutical companies, they are
the ones that allow for a treatment to
be successful. For patients, they are
the brothers and the friends who are
indispensable for living from one day
to the next. There are also human and
economic stakes: 90 % of carers can
no longer work, which deprives the
nation of their productivity. We must
therefore collaborate with the deciders
and actors in healthcare to take care
not only of the sick, but also of the
care­givers. And not only in India and
Nepal: a study by the World Health
Organization estimates that with the
increase in life expectancy, many more
carers will be needed in developed
countries. Whether we are rich or poor,
a king or an untouchable, on this pla-
net, we will all one day be the carers or
the cared for.
By Côme Bastin
1. Traditionally, several generations

take care of them find themselves iso- people in the same situation and to 2,460 adults have been able to return administrations to act on a large scale. developed countries. of a family lived under one roof.

48 HEALTH TOMORROW 49
2 | CURE

JOS DE BLOK “A group of at most

twelve nurses is
Texte courant

A Nurses Revolution assigned to each

neighbourhood
Frustrated by the increasing commercialization where Buurtzorg
of home care, Jos de Blok founded Buurtzorg in 2007, is implanted.”
which supports small associations of self-organized nurses. In ten years,
Buurtzorg1 has brought together more than 14,000 nurses and
is now the leading service for home care in the Netherlands.

buurtzorg.com Can your model inspire

other businesses beyond
the social sector?
J. D. B.  : Yes! Our model has already

W
hy did you get
involved in
home care?
J. D. B.  : In the
Netherlands, home
care was being
ruled by the laws of the market and
obsessed with productivity. Having
worked as a nurse for several years,
I had witnessed first-hand the slow
deterioration of our working condi-
tions. All the services were organized
around huge call centers. With each
call, a different nurse was assigned to a
patient. I told myself that home care’s
first priority should not be profitabi-
lity. Better to deliver quality care and
to focus on prevention, so that even-
tually people wouldn’t need this sort of
help. I opted for an entirely horizontal
organization, which is more beneficial
to the employees. Buurtzorg is the fruit
of this reflection.
How does Buurtzorg work?
J. D. B.  : Our not-for-profit company
delivers self-management based health
services in many neighbourhoods of
the Netherlands, as well as in other
nurses is assigned to each neighbou-
rhood where Buurtzorg is implanted.
They decide everything: care, planning,
recruiting, financial management. It
is an entirely horizontal organization
without a managerial structure: the
only role of our headquarters is to pro-
vide the necessary expertise.
How do you explain
its rapid success?
J. D. B.  : When our first group of
nurses was formed back in 2007, I
wasn’t expecting this. Ten years later,
we have 14,000 nurses in 950 teams
throughout the Netherlands! Several
studies have shown that the care provi-
ded by Buurtzorg is of better quality and
less costly than that of its competitors.
During the same period, the number
of hours spent with the patients has
decreased. They appreciate being able to
talk directly to a person instead of going
through a call center. By emphasizing
professional ethics, we have been able
to attract the best talents. Doctors and
hospitals recommend us. The nurses
themselves are more satisfied, as they
can do their work in peace while buil-
Many think that a hierarchical
organization and a sense of
competitiveness are the key
to efficient work. You seem to
demonstrate the contrary.
J. D. B.  : Market logic is precisely what
has led to the rising cost and the decline
in quality of home care in the Nether-
lands. We want to fix the damage done
and return to a public service philo-
sophy. We are a private company, but
we think like a public one. Many com-
panies have followed in our footsteps.
Buurtzorg is now considered the stan-
dard for home care in the Netherlands.
Despite the success
of Buurtzorg, do you meet
any difficulties?
Of course, sometimes nurses will quit
Buurtzorg because our method doesn’t
suit them. But most of the time they
integrate our working environment
quite easily. Teams meet frequently,
and employees have a say in the deci-
sion-making process. Their input has
a direct impact on their daily work. It
doesn’t always go entirely smoothly,
but the essential point is that everyone
© DR
spread to over eighty countries.2 It was
conceived with healthcare in mind,
but it can be applied to many diffe-
rent sectors, since the questions are
always the same: which values should
be upheld by our management sys-
tem? How do we deal with complexity?
How can we improve the quality of
our work and our relationship with
our customers? Most organizations
are divided between those who make
the decisions and those who are sup-
posed to mindlessly execute them. I
tend to think that organizations could
be structured in a more horizontal way
in order to come up with more sustai-
nable answers to existing challenges.
To come back to healthcare, what will
we do in the future should we lack
qualified workers because they don’t
want to work like this any more? A
lot of people are used to hierarchical
decision-making, with big strategies
coming from above. I think that on
the contrary we should focus on our
everyday practice. And we will conti-
nue to spread our ideas and tp support
those who are inspired by our action.
By Perrine Massy
1. “Neighbourhood care” in Dutch.
2. Buurtzorg is considered as a good exam­

countries. A group of at most twelve ding a relationship with their patients. feels involved. ple for new organizational work models.

50 HEALTH TOMORROW
4. CARE
JOÃO PAULO NOGUEIRA RIBEIRO
Volunteer Doctors Seek Patient
In Brazil, public hospitals are so overwhelmed that those who can’t afford a private
establishment may decide to not seek treatment at all. Realizing that many doctors
were ready to give free consultations, João Paulo Nogueira Ribeiro launched Horas
da Vida to connect available doctors with individuals in need of health services.
Since 2012, 45,000 patients have benefitted from Horas da Vida.
T
he Brazilian health
system (SUS)1
theoretically
guarantees
universal coverage.
So why are so many
people without access to care?
J. P. N. R.  : This public system does
52 HEALTH TOMORROW
horasdavida.org.br
indeed exist, but the demand is so
great that the waiting time for consul-
tations and exams is very long. For exa-
mple, in 2014, in São Paulo, 600,000
patients were on waiting lists. Fur-
thermore, only a quarter of Brazilians
benefit from the insurance needed to
access private clinics. The goal of Horas
da Vida is to provide basic care to this
population.
What solution have you
developed?
J. P. N. R.  : We let numerous health
care professionals offer hours of free
© DR
consultations, exams and products
(like medicine or glasses). In the begin-
ning, a model of one consultation per
person in difficulty was attributed. But
in Brazil, 150 million people are living
without private insurance, so it is dif-
ficult to determine who is truly poor.
So we decided to propose free consul-
tations to the beneficiaries of the pro-
grams of other NGOs. We started with
one important São Paulo organiza-
tion, and now fifteen NGOs work with
us. Thanks to this network, 45,000
patients benefit from care provided by
1,800 volunteers in 35 specialties.
How do you get these volunteer
doctors to work with you?
J. P. N. R.  : Simplifying and organizing
their tasks has been one of the great
successes of Horas da Vida. I often hear
doctors say, “I would like to volunteer,
but I don’t know how”. When I arrived
in São Paulo, I presented a platform
in two of the most recognized medi-
cal schools in the city, and I was thus
able to build a substantial network.
I always considered that important
people must be made aware of the idea
in order to better propagate it. Journa-
lists, medical big shots and influential
politicians support me. Several have
proposed their help to negotiate deci-
sive support. For example, with uni-
versities or laboratories that can offer
blood workups, MRIs or even more
complex tests.
What are your ambitions on the
national and international levels?
J. P. N. R.  : For the moment, we are
concentrated on the optimization of
our procedures. We want to be present
in the principal cities of Brazil, which
is a gigantic country. We have already
been able to extend the activity of
Horas da Vida to the city of Curitiba,
and we have made targeted interven-
tions in the cities of Rio de Janeiro,
Porto Alegre and Florianopolis – the
great Brazilian metropolises. I believe
that the model could be replicated in
“Many doctors at
Horas da Vida give
free conferences and
we share scientific
publications on
our website or
on social networks.”
other zones, and I would be quite happy
about that, but for the moment it is
still a dream. One of the main challen-
ges is to reach an equilibrium, all while
maintaining free consultations. For
that, we have developed a platform to
sell different services relating to health
care systems. Furthermore, several
funds and companies finance the pro-
ject, notably Brazilian corporations to
whom we propose our methodology for
improving the health care process.
Where did you get the idea to
facilitate the connection between
patients in need and doctors?
J. P. N. R.  : After my specialization in
2 | CURE
geriatrics, I decided to create an
interface to make appointments
online named ConsultaClick. It tar-
geted all those able to pay and was
implemented in Brazil, Portugal,
Spain and Romania. At the end of
2012, I said to myself that it was
possible to use this tool for people
who don’t have the means to pay for
a consultation. Like other doctors, I
performed them pro bono, but in a
disorganized way. With my interface,
I already had the technology to sim-
plify the relationship between doctor
and patient, so I submitted the idea
to some colleagues. We then decided
to take the plunge. To my great sur-
prise, it rapidly took off. We started
without any real procedures: we used
a fax machine to send documents, a
lot of things were on paper. It seems
incredible, looking back!
What are tomorrow’s challenges
in access to health care?
J. P. N. R. : The best way to avoid the col-
lapse of the system is to improve care
and people’s quality of life. But one of
the main challenges in my eyes is to
first understand who needs what. In
Brazil, many resources exist in terms
of tests, hospitals and products, but
they are not used correctly. Educating
the population in prevention is essen-
tial. Many doctors at Horas da Vida give
free conferences and we share scienti-
fic publications on our website or on
social networks. Cooperation between
the public and the private sectors
must also be encouraged. As an NGO,
we are there to inspire people and to
propose models that can be adopted
on a larger scale. And even more so in
public health systems, within which it
is difficult to innovate and to change
entrenched habits.
By Timothée Vinchon
1. The Unified Health System (SUS) was
established in 1988 as an administrative
body responsible for the stewardship of both
the public and the private health systems.
53
2. CURE
“As far as I know,
no dogma forbids
helping others
or caring for your
neighbor. It is
ALAIN CARPENTIER even a duty.”
Heart at Work For the French Agency for the Safety
of Health Products (ANSM), this phase
would determine if the treatment could
Professor Alain Carpentier has transformed the dream of an entirely artificial move beyond the experimental phase.
The condition was that at least half of
heart into a reality. To achieve this feat, it took him a lifetime of research the patients survive one month after
on materials, miniature computing and portable batteries. It also took the transplant or more. The contract
was respected, and the ANSM ended
convincing investors, as well as the medical authorities. Today, his invention up approving this first step. A second
is on the verge of revolutionizing medicine throughout the world. phase, which began in July 2016, fore-
sees operating on around twenty indi-
viduals in France. If successful, the
carmatsa.com artificial heart will be declared to meet
European standards and will spread
beyond the borders of France. This will
lead to the publication of important

W
hat pushed
me to throw
myself into
this crazy
endeavour
forty years
ago was nothing else than my vocation as
a doctor: the overwhelming need to save
people on the edge of death,” confides
Alain Carpentier. At 84 years old, this
surgeon is known for being the crea-
tor of the first French artificial heart.
Twenty million individuals in Europe
and the United States suffer from ter-
minal heart failure. They could conti-
nue to live for a long time if they could
get a transplant. “Sadly, we would need
3,000 transplantable donor hearts per
year in France, but we only get around
350. Only an artificial heart can make up
for this lack,” says Alain Carpentier.
“Bitten by the research and innovation
bug,” he became famous at the end of the
sixties for the fabrication of prosthetic
heart valves from animal tissue. A suc-
cess that prefigured a much larger pro-
ject: a 100 % artificial heart. He got to
Jean-Luc Lagardère, then head of the
group Matra (the future EADS), would
be decisive. From this encounter, an
Economic Interest Grouping (GIE) was
born. It was dubbed Carmat, a fusion of
Carpentier’s name and that of Matra.
A PROTOTYPE
CEASELESSLY IMPROVED
Together, they succeeded in further
miniaturizing the onboard computer
of the prosthesis which, on arrival,
now weighs no more than 900 grams
– versus around 300 for the human
heart. The integrated microprocessor
detects changes in blood pressure at
the ventricles – blood’s entrance to
the organ – and accordingly modulates
the pumps that impulse the cardiac
rhythm. The pumps are powered by a
battery carried around the patient’s
waist. In the current version, there are
two batteries, each with a life of four
hours. Professor Carpentier says that
Carmat is doing everything they can to
replace them with fuel cells that would
last at least twelve hours. The device
eight hours can be perfectly integrated,”
notes the professor, “but it wasn’t the
case twenty years ago.” A monitoring
device at the waist directly links the
subject to a hospital that remotely
ensures the proper functioning of the
device and reacts in case of emergency.
The design of the prosthesis has
been the object of special attention.
Developed by computer, its form clo-
sely imitates that of the human heart.
The stakes are high, since it must
find its place within an organism in
which it must remain for at least five
years. Its architecture, texture and the
materials from which it is made led to
numerous patents between 1999 and
2004. Carmat’s teams of engineers
are now reflecting on how to further
miniaturize the device, which is cur-
rently adapted to the chest cavities of
only 70 % of men and 25 % of women.
“Today’s model won’t be that of the
future,” assures Alain Carpentier.
THE DAWN OF A NEW ERA
The prosthesis has already been
© CARMAT, DR
scientific literature and the beginning
of a process of industrialization of the
prosthesis followed by its commerciali-
zation. The selling price is estimated at
160,000 euros. Expensive? “Much less
than a transplant, which requires expen-
sive immunosuppression treatments, and
well below the cost of the hospitalization
and monitoring of a patient suffering
from chronic heart failure,” underlines
the professor.
With the announcement, Carmat
stock, on the market since 2010, will
shoot up, after having fluctuated for
Carmat’s artificial heart.
years due to uncertainties concerning
the results of the experiment. For
their part, the Public Investment Bank
(BPI) would regain its confidence in
the project, granting it new subsidies.
“The corporation would then reach eco-
nomic equilibrium by finally selling the
product of its research,” predicts Alain
Carpentier. Today, the artificial heart
exists. A scientific feat that takes on a
© MARC LATZEL / ROLEX AWARDS nearly mystical dimension due to the
symbolism surrounding the organ. “Is
it a progress? Are we entering forbidden
territory?” the professor wonders. “As
far as I know, no dogma forbids helping

work in the eighties with the help of the sends a signal to avoid the risk of run- implanted in four patients between others or caring for your neighbor. It is
Technical Center for Mechanical Indus- ning down the battery. “Today, with September 2013 and January 2016, even a duty.” 
try (CETIM). In 1993, his meeting with mobile phones, having to plug in every during an initial “feasibility” phase. By Charles Faugeron

54 HEALTH TOMORROW 55

W
hat motivated
Transnet
to get the
Phelophepa
rolling?
S. K.  : It all began
in 1994. At the time, South Africa’s
inequalities were glaring, especially
concerning health care access. One of
the country’s universities turned to
Transnet to make ophthalmological
care and optometry services accessible
to the low-income populations living
in the rural areas. Since we had the
railway network at our disposal, they
suggested using some of our trains to
reach those remote populations and
provide on-board care. And so a first
locomotive with three cars set off down
the tracks.
How did the project grow?
S. K. : The following year, we decided to
provide an even larger array of medical
services to meet the specific needs of
the underprivileged populations. They
were especially suffering from a lack of
dentists and a shortage of basic medi-
cal supplies and drugs, overstretching
the South African healthcare system.
Today, we have two trains with nineteen
The Phelophepa train brings health
to South African villages cars each! Along with the ophthalmo-
logy and optometry car, you will find
a full-service dental care center, an
infirmary, a psychological center and a
SHAMONA KANDIA pharmacy. We also organize screening
campaigns to detect diabetes as well as
cervical, breast and prostate cancers. It
Next Station: Hope is a real hospital on rails.
How do you handle such logistics?
S. K.  : We are entirely autonomous: we
For 23 years, the Phelophepa has been criss-crossing South Africa to bring
have on-board kitchens where we cook
medical care to populations living in remote rural areas. Designed as a true mobile up to 450 meals a day. We have our
hospital, this “train of hope” is backed up by Transnet, the country’s public railway own laundry and accommodations for
22 crew members. We also generate
company. Health Director of the Transnet Foundation, Shamona Kandia our own electricity. The only external
explains how this medical express train got rolling and where it is headed. resource we depend on –  wherever
we go  – is water. Fortunately, Trans-
net owns the majority of the railway
© DR
trainofhope.org network in South Africa. The Phe-
56 HEALTH TOMORROW
“We would like
to stop the train.
But that would mean
that South Africa’s
health system is able
to provide care
to everyone
in the country.”
lophepa’s movements are organized in
between its regular commercial and
passenger traffic.
What is the cost for the patients?
S. K.  :It all depends: the infirmary
and the psychological clinic are free of
charge. If you use our dental car for a
tooth extraction, it will cost you ten
rands.1 If you have eyesight issues, the
eye exam is free, but a pair of glasses
will cost you thirty rands. A prescrip-
tion for several boxes of medicine will
cost you five rands. In order to lower the
prices, the universities that have joined
this effort send us interns (nurses,
dentists, optometrists, psychologists,
pharmacists) to give us a hand.
How do you reach populations
living far from the railway?
S. K.  : When the train makes a stop
somewhere, people get in line and we
2 | CURE
give them a ticket to ensure they will be
seen to during the day. We have a team
dedicated to the populations living wit-
hin a thirty to fifty kilometers radius
of the station. These mobile units visit
schools, nursing homes, prisons, etc.
Since we started our operation, we have
taken care of over 611,000 people.
Are you able to meet everyone’s
expectations?
S. K.  : It is a never-ending challenge.
We are often unable to attend to every
single person who turns up. Yet, even if
we cannot provide care for everyone, the
medical services delivered by Phelophepa
are meant to supplement those of the
state. The use of a train enables us to
reach areas where the traditional health
care system is not working at its best.
How do you finance the operation?
S. K.  : Last year, each patient that we
treated cost about eighteen rands (1.3
dollars). Maintaining a train in wor-
king order costs us around fifty million
rands a year. We benefit from a lot of
support from the private sector, such
as the pharmaceutical lab Roche and
Colgate Palmolive South Africa. Still,
the largest share of the funding, at 9 %,
comes from Transnet. I am very proud
of this project.
What do you see for the future
of the Phelophepa?
S. K.  : We would like to stop the train.
But that would mean that South Afri-
ca’s health system is able to provide
care to everyone in the country. In the
meantime, the train of hope will never
stop improving itself in order to attend
to the needs of the most vulnerable
and marginalized populations of this
country. Our goal is for everyone to be
able to access medical care, regardless
of their social level or their place
of residence.
By Perrine Massy
1. South Africa’s official currency. One dol-
lar is worth approximately forteen rands.
57
2 | CURE

SAMEER SAWARKAR add that we do not receive any subven-

tion for our activities.
The Country Teledoctor What are you most proud of?
S. S. : Many of our visitors are women or
old people that had never seen a doctor
By leveraging long-distance diagnostic devices, videoconferencing, in their entire lives! Some of them have
shown up with a fracture of the leg and
and digital medical files, Neurosynaptic enables Indians from rural areas our doctors were able to direct them
to access quality healthcare through telemedicine. towards the nearest hospital in order
to receive a plaster cast. Thanks to our
Thanks to founder Sameer Sawarkar, the Neurosynaptic model and equipment, some patients have discove-
technology is being adopted by countries across Asia and Africa. red that they had a serious heart condi-
tion. Others have learned that they
suffered from diabetes or hypertension.
neurosynaptic.com
Do you have an
international strategy?
S. S. : Neurosynaptic is present in seven
Asian and three African countries, and
we hope to expand very soon into eight
new countries. Each nation has its own
requirements and health standards
and we try to get past these discrepan-
cies by establishing local partnerships
and reinforcing the international certi-
fications of our products. We also wish
to continue expanding our action in
countries where we are already active.
In India, we estimate that 20,000 new
ReMeDi access centers will appear in
the next two years.
Do you think India will be able
to generalize access to primary
healthcare in the near future?
S. S.  : Yes, there are some very encou-
raging early signs. The government is
acknowledging the necessity for a public
health system. Interesting partnerships
between public and private institutions
have sprung up. In the field, things are
evolving rapidly. Infrastructures are
being modernized, access to the power
grid and Internet coverage are more
widespread. The cost of consultations
and treatments is going down, while
salaries are increasing. In the last five
years, health insurance coverage has
been on the rise in India: 30 % of the
population has a health insurance
policy. But this coverage has still to
extend to the poor, and the medical
standards can still progress. Telemedi-
cine alone cannot solve everything.
By Côme Bastin
1. Remote Medical Diagnostics.

W
hat is the
problem that
your company
is responding
to?
S. S.  : In India,
there is a tragic problem of access to
healthcare in rural areas, where three
quarters of the population live. 60 %
of the hospitals and medical offices
are concentrated in cities, as well as
80 % of all doctors, since they would
rather practice in an urban area. India’s
government does run 140,000 medical
centers in villages, but this only covers
20 % of the population’s total need. At
the end of the day, 700 million Indians
do not have access to basic medical care
worthy of the name. They have to rely
on poorly trained practitioners and
sometimes buy their medicine on the
black market.
What solutions did you
come up with?
S. S. : To bring quality healthcare to the
poorest areas in India, our ReMeDi1
technology rests on three pillars. First,
we have developed reliable long-dis-
can provide electrocardiograms, mea-
sure a patient’s body temperature or
blood-pressure and can act as stethos-
copes. We have also created videoconfe-
rence software that functions even with
a quite limited bandwidth. Finally, we
centralized the medical files from every
single patient in our digital archiving
system. Thanks to these three prin-
ciples we have succeeded in connecting
villagers with qualified doctors who
can in turn examine them and pres-
cribe treatments from a distance. We
have recently launched ReMeDi-Nova,
a kit containing a set of instruments
for general medical care which fits in a
backpack and relies on Bluetooth tech-
nology. All of it is connected to our web
platform and can easily be carried whe-
rever it is needed.
Is this technology alone enough
to resolve the problem?
S. S. : No. We realized as early as 2008
that we needed to build an entire
ecosystem. If there is no available
medication, if there is no lab to per-
form tests, a consultation is useless!
We had to conceive the supply-chain
ported the creation of 2,300 “village
centers”, within which doctors can “More than
use videoconferencing to perform a a million patients
diagnosis on their patient, with the
help of the local medical personnel.
have used our
Since then, several telemedicine cli- facilities and
nics have appeared within cities and
slums. Our digital mainframe allows
fifty million people
us to assess in real-time each loca- live within
tion’s stock of drugs, and to locate
the nearest available supply in case
four kilometers of
of shortage. More than a million one of our centers.”
patients have used our facilities and
fifty million people live within four
kilometers of one of our centers.
What is your business model?
S. S. : At first, we wanted to set up the
centers in the villages by ourselves,
but we lacked the skills. So we found
partners with real experience in the
field, such as hospitals or NGOs, and we
continue to work closely with them to
this day. They are in charge of opening
the health centers while we provide the
technology. When a patient pays for a
medical test or a consultation, we take
a commission. The hosting of all these
transactions is cloud-based, making
© DR

tance diagnostic devices. These devices down to the last mile. We have sup- our system very easy to adopt. I might

58 HEALTH TOMORROW 59
2 | CURE 4. CURE

FRANCESCA FEDELI
Family Therapy
When they were told that their baby had suffered from a stroke in utero,
Francesca Fedeli and Roberto d’Angelo felt abandoned
by the Italian medical community. Determined not to give up,
they founded Fight The Stroke in 2013, to raise awareness among families
and spread information about rehabilitation through telemedicine.

fightthestroke.org
“Our first challenge
was to get accepted
by the medical

I
Francesca Fedeli, Roberto
d’Angelo and their child,

t was in the wake of a tragic
event that Francesca Fedeli
and Roberto d’Angelo foun-
ded Fight The Stroke. In 2011,
Francesca had a difficult pre-
gnancy and stayed bedridden
for seven months. The delivery went
seemingly well yet, unfortunately, ten
days after Mario’s birth, the parents
were told that their baby had suffered
a stroke. After the trials of this compli-
cated pregnancy, the parents felt dis-
couraged. “We weren’t ready. We asked
ourselves: ‘Why is this happening to us?
What have we done wrong?’”
When the couple tried to find out
more about the diagnosis or possible
treatments, they discovered how
hard it was to find suitable answers,
whether from doctors or the scientific
literature. After two years of oscilla-
ting between distress and anger, they
eventually decided to take things into
their own hands. Thus, the association
Fight the Stroke was created to help all
the little Marios of the world. In 2016,
it became a social company.
Around 3.5 million children in the
world have suffered from a stroke. The
consequences vary depending on the
cerebral area damaged by the stroke.
The most frequent and most visible
is physical disability. “For Mario, for
example, the right brain was affected,”
explains Francesca. “As a result, he can-
not move his left side, whether the arm
or the leg.”
A COMMUNITY
OF FAMILIES
“Our first challenge was to get accep-
ted by the medical community,” relates
the mother. “We had an excellent rela-
© ANDREA RUGGERI, RYAN LASH
who suffered a prenatal stroke.
renowned scientists who agreed to help us
face this challenge. Thanks to a number of
grants, we were able to travel a lot, only
to discover there was a global lack of infor-
mation and solutions on the subject.”
With Fight The Stroke, Francesca and
her husband are raising awareness of
perinatal and pediatric strokes. “We
are working in particular on early dia-
gnosis methods. We opened the first cen-
ter dedicated to this problem in Italy, in
the country’s largest hospital.” The two
parents also work towards improving
the long-term care that stroke victims
require, since children who survived a
stroke need rehabilitation throughout
their life. This is what led to the crea-
tion of the Mirrorable program, to
offer to others the treatment that
Mario receives.
on the activation of mirror neurons,
this therapy was validated by scientists.
“Each day, for four weeks, the kids settle
down in front of the screen and watch a
magician showing them magic tricks,”
describes Francesca. “As they observe
his gestures and try to repeat them, they
re-educate their paralyzed hand and learn
some movements.”
MIRROR NEURONS
The digital interface evaluates their
performance, congratulates them or
encourages them to start over. The
children also have the option to inte-
ract with a peer. “They connect to ano-
ther child’s home through the platform,
and repeat the magic tricks through the
screen,” explains Francesca. “It enables
them not only to activate their mirror neu-
community.
But we were only
two parents and we
could feel a certain
degree of scepticism
on their end.”
children during the learning period.
The results will be published at the end
of the year. “I cannot reveal the details at
this stage, but I can already tell you they
are very promising,” assures Francesca.
For the two parents, the main objec-
tive is to make this program accessible
to the largest number of families as
soon as possible. To this end, they are
studying the idea of selling their solu-
tion to other kinds of patients wanting
to improve their motor skills. “This
money would enable us to ensure that the
children’s program remains free for pedia-

tionship with public research institutions
and the main Italian hospitals. But we
were only two parents and we could feel a
The parents created a small certain degree of scepticism on their end.”
company to share their testimony
and raise awareness on the subject
Little by little, the couple succeeded
of pediatric strokes. in building a cohesive community of
pediatric stroke families. “We contacted
Mirrorable is an interactive plat-
form accessible through a kit including
a computer, a motion detector and a
magic tricks box set. Delivered at the
parents’ request, this kit enables child-
ren who survived a stroke to follow an
Action Observation Treatment. Based
rons, but also to identify with the other
kid.” Launched in 2016, this pilot pro-
gram already received applications from
fifty families. The program rests on
three evaluation criteria: improvement
of motor skills, participation and degree
of connection between the “pairs” of
tric stroke families.” When they reached
the point where they ceased to consider
their son’s condition as a problem, they
learned a valuable life lesson, and they
wish to share it with as many parents
as they can. 
By Perrine Massy

60 HEALTH TOMORROW 61
2 | CURE

KYRIAKOS SOULIOTIS K. S. : Our research measures, reports

and underlines obstacles met by
patients when accessing healthcare
Healthcare in Time of Crisis as well as the impact of the econo-
mic crisis on their
living conditions.
With public budgets cut by 50 %, austerity policies deeply affected Our “HOPE” stu- “In a country with
the Greek healthcare system. A doctor of Health Economics and Public Policies,1
dies have looked
into the challenges
over one million
Kyriakos Souliotis was on the front lines to study the effects of the crisis. faced by patients unemployed, it is
For this researcher, community initiatives aren’t enough to overcome the crisis. with rheumatoid
arthritis, multiple
paradoxical to link
Instead, the funding and structure of care must be reinvented. sclerosis, cancer healthcare access to
or Hepatitis C. We
also submitted a
job status and
uop-gr.academia.edu/KyriakosSouliotis proposal to reform expect universal
the health system coverage.”
and published a
book on an alter-

T
he Greek healthcare
system was rocked
by the economic
crisis. What is the
situation for Greeks
and for health
professionals today?
K. S. :Our new reality is defined by a
loss of almost 100 billion dollars in
GDP over four years (2009–2013),
the biggest loss amongst OECD coun-
tries. This led to an unemployment
rate of well over 20 %, and even higher
amongst the young. Under these cir-
cumstances, public health policy is
mostly limited to the application of
the Memorandum of Understanding2
provisions to control expenditure. Per
capita public health expenditure has
decreased by 25 % (2010–2013) and
public health funding by over five bil-
lion euros (2009–2013). It is now one
of the lowest amongst EU members in
relation to the country’s GDP.
How does this situation impact the
access to healthcare services?
K. S. : The Greeks are reporting in
increasing numbers an inability to
Public pharmaceutical expenditures
have decreased from 5.3 billion euros
in 2008 to 2 billion euros in 2015
– raising questions about what and
who can be covered. Patients suffe-
ring from life-threatening conditions
increasingly face access hurdles.3 It
has also impacted healthcare profes-
sionals, because of the “no new hires”
policy and of challenges with sup-
plies. The extensive reduction in the
number of doctors in 2014 made the
much-needed reform of the system
virtually impossible.
Are mutual support initiatives the
best way to face the health crisis?
K. S. : Self-managed community health
clinics and pharmacies, initiatives led
by universities, municipalities or by
the Church, are the best possible civil
society responses to the crisis. Simi-
lar initiatives were also deployed wit-
hin the NHS,4 such as the community
practice within the SOTIRIA Hospital
Cancer Unit, which provides care to
the uninsured. However, this citizen
commitment cannot replace the State,
and volunteers have begun to show
How can Greece build
a fairer future?
K. S. : It is critical that we start with
funding. Most health inequalities stem
from income inequality. In a country
with over one million unemployed, it
is paradoxical to link healthcare access
to job status and expect universal
coverage. Therefore, it is essential to
address the needs of the uninsured,
who are in excess of two million
people. Greece is the only country
with a health system funded equally
by taxes and social contributions. Shif-
ting healthcare funding to a purely tax-
based system would cut employment
costs, reduce the unemployment rate
and raise the income of the employed.
Equally critical to restoring equality
is the integration of primary care ser-
vices, a need persisting within the NHS
for over thirty years. It is urgent that
we assign a single attending physician
as an initial contact to each citizen in
order to better respond to the needs
of those who do not have the means to
cover their healthcare costs.
What role do you play in this
© DR
native, one that would better respond
to the obvious lack of patient parti-
cipation in health decisions over the
past decades. A pan-European study
that we have just completed confirms
the improved health outcomes due to
patient group involvement.
Is the reconstruction of the
health system a priority
for the new government?
K. S. : Despite the bad practices and bud-
get cuts that resulted from the Memo-
randums, the healthcare sys­ tem has
been modernized over the past five years
through the introduction of e-prescri-
bing, e-diagnosis, treatment protocols
and patient registries. New discussions
are foreseen on pharmaceutical reim-
bursement. The current government
cannot merely look for ways to reduce
spending, but needs to prioritize the
needs of vulnerable patients.
By Hélène Martinez
1. University of the Peloponnese, Tripoli,
Greece.
2. A number of reforms that Greece is
committed to implement in exchange of a
support from the European Union.
3. To know more, see the series of “HOPE”
studies, University of Peloponnese.

pay, even for a mere doctor visit. signs of exhaustion. ongoing reflection? 4. National Health System.

62 HEALTH TOMORROW 63
 2 | CURE

ÉRIC CHEYSSON
The Chain of Hope
As a young intern in vascular surgery, Éric Cheysson met Bernard Kouchner
and embarked on a cargo ship on its way to rescue migrants in
the South China Sea. Out of this mission, a humanitarian calling was born,
soon to be followed by an organization: La Chaîne de l’Espoir.1 Since then,
his NGO has built hospitals and trained doctors in the poorest countries of the world,
making it possible for 6,000 children each year to access surgical care.

chainedelespoir.org

J
une 2017. In Mossul,
the Iraqi Army and
their allies have freed
the city from the Isla-
mic State’s control.
Amongst those who are
getting ready to rebuild the battered
city, Professor Éric Cheysson. At 66, he
is the Head of Vascular Surgery at the
Pontoise hospital, and he has dedicated
his life to humanitarian medicine.
It all started when he was a young
intern. Éric met Bernard Kouch-
ner, co-founder of Médecins Sans
Frontières2 and already famous as
the “French Doctor” who started
the operation A Ship for Vietnam.
It was 1979 and intellectuals such
as Simone Signoret, Yves Montand,
Jean-Paul Sartre or Raymond Aron
had called on the President of France,
Valéry Giscard d’Estaing, to save the
Sino-Vietnamese who were fleeing the
communist regime. Médecins Sans
Frontières was authorized to charter a
boat: L’Île de Lumiere.3 Éric embarked
with doctors and journalists. Their
goal was not only to save the migrants
© DR
the world’s attention to the ongoing
human rights violations in the area.
“That first mission was a staggering
experience. I was so young. The monsoon,
the Khmer Rouge and, in the middle of
the South China Sea, all those migrants
to save. We went up the Mekong until we
reached Phnom Penh.”
FROM VIETNAM
TO AFGHANISTAN
Following his expedition, Cheys-
son co-founded Médecins du Monde
in 1980 with Bernard Kouchner and
others. Éric became one of the first
humanitarian doctors to treat both
civilians and Mujahideen groups in
Afghanistan, which was at the time
suffering from the invasion by the Red
Army. He then operated in Cambodia,
Chad and Kosovo.
Over the course of his missions,
Éric realized that in order to fix bodies,
you have to rebuild hospitals and train
doctors. “When you have a pathology
but no surgery can be performed because
you have no operating theater, no resus-
citation and no anesthetist, it is the
this observation, the organization La
Chaîne de l’Espoir was born, launched
with Professor Alain Deloche in 1988.
Its mission: to heal the poorest of
children. Today, 100,000 children are
examined each year and 6,000 are ope-
rated on, thanks to the organization.
“Initially, we would bring children
all the way to France to treat them,”
Éric tells us. “We would cover the cost
of the operation and volunteer families
would host them post-operation.” But
in accordance with its goals the NGO
now favors local action and is buil-
ding hospitals in Asia, Africa and the
Middle East.
For instance, in Kabul, La Chaîne de
l’Espoir is rebuilding the only hospital
respecting Western norms and is trai-
ning its staff. “Imagine this: open heart
surgery can be performed despite the
situation Afghanistan has come to,” the
professor shares. “This means access to
water and electricity in order to power
operating theaters and an intensive care
unit.” Thanks to their efforts, a new
generation of Afghan surgeons is now
operating in Kabul. The main mission

© DR

fleeing by boat;4 they wanted to draw ultimate congenital inequality.” Out of of La Chaîne de l’Espoir is to support

64 HEALTH TOMORROW 65
 2 | CURE
“When you have
a pathology
but no surgery can
be performed
because you have no
operating theater,
no resuscitation
and no anesthetist,
it is the ultimate
congenital
inequality.”
and train local surgeons throughout
their career, to guarantee the quality
of healthcare. “The French school of
medicine is held in such high regard that
it makes all these adventures possible,”
according to Éric. “It is a kind of magic
touch, the envy of the whole word.” But
to guarantee its presence in 35 coun-
tries, the NGO has to call upon doc-
tors from all of Europe. “By finding
candidates willing to join us abroad, we
can alleviate our failing medical demo-
graphy. We are lacking anesthetists,
pediatricians, obstetricians, at a time
when we are about to open a maternal
care unit in Abidjan.”
ROBIN HOOD
For the most high-risk areas, La
Chaîne de l’Espoir develops specific
programs. “Our doctors might be taken
hostage. When we can’t guarantee their
security, we use remote digital solutions
to train local doctors.” It is especially
the case in Africa. “The French Foreign
Office, sometimes strongly, advises
against travelling to 80 % of African
countries. Five years ago, there was no
warning against many of them.”
Beyond the security risks, very few
NGOs dare to get involved in running
a hospital, which is excessively costly.
“From the second you turn a hospital’s
66 HEALTH TOMORROW
lights on, it is complicated to turn them
off. You need to think about opera- The professor is very active
ting costs. Without a proper budget, a in Southeast Asia.
hospital doesn’t cure, it kills.” To gua-
rantee this balance, Éric supports a
“Robin Hood policy” – in other words,
making the rich pay. “We have a well-
tried concept: to set up right next to the
hospital a ward welcoming the poorest
of the poor, at no cost to them.” Fun-
draising and financial partnerships
finance these operations. But these
sources have been weakened by the
worldwide decline of public fundings.
To add insult to injury, “Donald Trump
has decided to diminish the budget going
to the big agencies.”
WHITE ELEPHANT
Access to surgical care remains
however a key marker for the health of
millions of people in the 21st century.
Éric saw it coming when he launched
La Chaîne de l’Espoir.
“We used to focus on pandemics like
malaria or AIDS. Fortunately, foun-
dations like the Bill & Melinda Gates
Foundation have hugely improved the
situation.” However, very few organiza-
tions or social entrepreneurs have the
necessary experience to build, equip
and run a hospital. The market belongs
de facto to profitable private compa-
nies. “China delivers turnkey hospitals,
which end up closing fifteen days after
their opening due to lack of staff.”
“If you don’t have the adequate human
resources, a hospital is a white elephant.”
Thus, the colossal work initiated by
La Chaîne de l’Espoir remains crucial.
“We started as caregivers, but we became
builders and trainers. And now, we also
employ architects, administrators and
engineers.” In an age of upheaval, every
JEAN-FRANÇOIS MOUSSEAU / CDE
single link of the chain matters.
By Fleur Weinberg
1. “The Chain of Hope” in French.
2. “Doctors Without Borders.”
3. “The Island of Light.”
4. After the capture of Saïgon by the
© DR
© DR
People’s Army of Vietnam.
67
 CHAPTER 3

IMPROVE
3 | IMPROVE

REY FAUSTINEO have to work three jobs and are at the

mercy of the first economic shock. The
results are pockets of silent misery and
One Degree, a great many homeless people living
side by side with opulence. We plan on

“The Yelp of Social Services” expanding to other cities soon, chiefly

Los Angeles.

What are the upcoming challenges

A child of immigrants, Rey Faustino had an extremely difficult time when his family for One Degree?
started applying for social assistance in the United States. To prevent this R. F.  : We want to continue facilita-

from happening to anyone else, he launched a digital platform in the heart of Silicon ting access to social organizations and
understand why people use them or not.
Valley, providing disadvantaged people – new immigrants, the homeless, One of our biggest projects is to create a
single mothers – with easy access to services that could improve their situation. single form for applying to several entit-
lements. For now, poor families looking
for housing must fill out forty requests
1degree.org for forty different apartments. Another
challenge: make our economic model
sustainable. In the beginning, we raised
funds by calling on philanthropy. But

Y
ou introduce
yourself as “the
Yelp of social
services”. Can you
enlighten us about
this concept?
R. F. : We wanted to use an analogy with
the well-known application that allows
people to look for restaurants or bars
nearby and leave a review. One Degree,
based on the same model, gives access
to relevant NGOs and social services,
depending on your situation. In the
San Francisco Bay, where we are based,
there are over 1,500 of them. Despite
that, we realized that there is no cen-
tralized directory to help underprivile-
ged people find organizations and thus
get the resources that will truly change
their life. We also want to allow users
to report on the quality of the social
sector, in the same way we leave online
restaurant reviews.
How does the platform work?
R. F. : We facilitate access to a full range of
social or non-profit services: healthcare,
housing, as well as help fighting against
domestic abuse, assistance to LGBT
or suicide prevention hotlines. Users
can choose to provide their location
and more information: their income,
the size of the household, languages
spoken. Depending on these parame-
ters, we point them towards the appro-
priate structure, specify its address, its
hours of operation and, above all, help
them to apply. It is important because
each organization in the USA has its
own procedure to follow. One may ask
to fill three pages of forms, another to
spend some time talking around a desk,
and yet another one to book an appoint-
ment way ahead of time. With One
Degree, this information is super easy to
find and share.
Is One Degree only for people
living in poverty?
R. F.  : As a technological organization,
we had to focus our energy on a specific
population to build a reliable product.
So we started with single underprivile-
ged mothers as well as isolated indivi-
could be useful to others, in particular
social workers and health professio-
nals. We work with hundreds of NGOs.
We train them to use our platform as
a search tool for digital resources. We
also launched One Degree Referrals,
which allows them to send referrals
to the people they assist, directly by
email, text message or post. They can
then see if their audience follows up or
not. Eventually, the digitization helps
social workers do their job better.
Why develop this app in a very
prosperous area like California?
R. F.  : It is the wealthiest area in the
USA, and maybe in the world, and this
is the way it is perceived from the out-
side. But it is exactly the reason why
One Degree is legitimate there: this
wealth is concentrated in the hands of a
tiny portion of the population and ine-
qualities are extremely high. 1.3 mil-
lion people here live under the poverty
line and cannot even meet basic needs
such as healthcare. Rent has become
outrageous, and we have lost count
© DR
we recently launched One Degree Plus, a
paid offer that allows NGOs and social
services to have access to statistics and
to measure their impact, because the
data we collect is valuable.
Does the election of Donald
Trump, who has promised serious
cuts in assistance and health
programs, affect your work?
R. F.  : It is simple: we have four times
more requests linked to legal immigra-
tion and 40 % more users in Spanish. It
is also one of the strengths of this plat-
form to be able to obtain information
about our community and know their
needs. To be honest, we are prepared
for anything with this government.
But many social services in the USA do
not depend on federal financing. What
“We want to allow
Trump will destroy will be made up for users to report on
by philanthropy and local policies. I was
a Filipino immigrant myself, arriving in
the quality of the social
the United States at 8 years old, in 1990. sector, in the same
My parents worked several jobs to put way we leave online
food on the table. Our family has strug-
gled a lot to navigate the many social restaurant reviews.”
benefits. I would have liked to have had
One Degree back then!

food, banking, affordable or temporary duals. Then, we realized that One Degree of the number of single mothers who By Côme Bastin

70 HEALTH TOMORROW
4. CARE
W
hy did you
create Law
3andak Dam?
H. K.  : In Egypt,
there is a signifi-
cant blood shor-
tage because of the corruption at work
in blood banks and some hospitals,
especially the private ones. When a
Texte courant person is in vital need, his or her loved
ones are often asked to pay for or
even to provide bags of hemoglobin.
I endured this myself eight years ago
when one of my cousins was hospita-
lized. As a consequence, many Egyp-
tians no longer trust blood banks and
have become reluctant to give their
blood. So most of the time friends or
family find themselves having to send
an emergency SMS to their entourage
to ask them to give blood. This hap-
pens in a disorganized manner and
limited scope. The objective of the Law
3andak Dam platform is to eliminate
the middleman – whom Egyptians
don’t trust anyway – in order to effec-
tively connect donors and patients.
And it is all free.
How does this platform work?
HISHAM KHARMA H. K.  : On the one hand, our portal
includes a register on which people can
The Blood Donation Social Network
sign up as donors. On the other hand,
it is possible to send us a request for
blood which we then distribute widely.
Many partners, such as celebrities or
Faced with corruption and the shortage of blood supply institutions, share these requests on
social networks, thus reaching a great
in Egyptian hospitals, Hisham Kharma launched Law 3andak Dam in 2011, number of potential donors who can
a website that matches patients to donors. By eliminating the middleman, then contact the patient or their family
this system lets those in urgent need of blood connect with hundreds directly. Our system is quick and easy
to use. There is no need to download
of thousands of potential donors through the power of social networks. an application or to fill out registration
forms: we cannot allow ourselves to
impose all these procedures when it is
© DR
law3andakdam.com a matter of life or death. It is hard to
72 HEALTH TOMORROW
calculate with precision the impact of
Law 3andak Dam, but we estimate that
a request could reach a million poten-
tial donors.
So the power of social networks is
at the heart of your model.
H. K.  : Exactly. During the 2011 revo-
lution, I noticed how much Egyptians
were using the Internet, Facebook
and Twitter. Even my grandmother
was connected! The number of Inter-
net users in Egypt tripled during this
period. I am not a doctor. I have a
degree in computing, and I work as a
musician and director. So I told myself
that it was the right moment to set up
Law 3andak Dam. I launched the pro-
ject on social networks, and it worked
right from the start. Proof that it res-
ponds to an important need.
Through the name of the project
as well as the graphics of the site,
you have chosen a rather light
tone of communication which
contrasts with the gravity
of the subject. Why?
H. K.  : Law 3andak Dam has a double
meaning. In the Egyptian dialect, the
literal translation is “if you have some
blood”. But it is also an expression that
means “if you have a conscience”. So it
is a willingly provocative name. Clearly,
the message is: “If you have blood, give
it.” What’s more, Egyptians, especially
in times of crisis, love humor. I thought
that it was a good way to attract atten-
tion and make the project go viral. And
it worked: people and the media were
curious to know what was behind the
name and graphics.
How did the National Blood Bank
react when you launched the
project?
3 | IMPROVE
“Law 3andak Dam
has two meanings.
In the Egyptian
dialect, the literal
translation is ‘if you
have some blood’.
But it is also
an expression that
means ‘if you have
a conscience’”.
H. K. : At first, I was worried about their
reaction because, like many Egyptians,
I believed them to be corrupt. But I
realized that the corruption was lar-
gely the work of a few individuals in
private establishments. The National
Blood Bank has in fact proved itself to
be a very good support. When its direc-
tor called to meet me, I immediately
explained that the people didn’t trust
them. I told him that if they wanted to
help us, it must be done discreetly, wit-
hout using the logo, for example.
How do you reach people who don’t
have Internet access?
H. K.  : We run awareness campaigns
about blood donations in the field, in
partnership with public authorities. We
also speak in certain businesses that
wish to organize a campaign for their
employees. Today, we are in discus-
sion with telephone operators to inte-
grate them into Law 3andak Dam and
send requests for blood by SMS. After
having brought donors and demanders
together, we would like to put the ins-
titutions in relation with each other.
Another of our projects is about the
creation of a blood bank network. Its
goal: to invite people to give blood in
rural areas where the Internet is little
developed and where blood is needed.
By Perrine Massy
73
3 | IMPROVE
EDITH ELLIOTT
From Stanford to Indian Hospitals
When she was studying design at Stanford University, Edith Elliott received
an invitation from Professor Devi Shetty to go to India. He suggested that she apply
design thinking to improve the operation of Narayana Health, the chain
of low-cost hospitals he founded. As a result, Noora Health was born: an NGO
that trains Indian families to provide care to hospitalized family members.
noorahealth.org
H
ow did an
American end up
launching an NGO
in India?
E. E. : I met the people
I founded Noora
Health with five years ago, when we
were students at Stanford University.
Each of us came from different disci-
plines. I was studying global health and
foreign policies, Shahed Alam and Jessie
Liu were to become doctors, and Katy
Ashe was completing a master’s degree
in Engineering. We were however fol-
lowing a common course that we were
passionate about: “design for extreme
affordability”. We then met Professor
Devi Shetty, the founder of Narayana
Health1, a chain of low-cost hospitals
in India. He invited us to his country
and suggested we use design thinking
to solve some of the problems he was
facing. He was our first contact with
India and its healthcare system. After
that, everything happened quite fast.
What problems did you identify at
that point?
E. E. : First, we visited many public and
© DR
private hospitals, starting with Dr
74 HEALTH TOMORROW
The NGO teaches the patient’s
relatives health gestures
and reflexes.
Shetty’s. We then realized that in all
of them – this applies to the United
States as well – the patient and his or
her family don’t really know what they
are supposed to be doing once they get
back home. In India, families travel far
to get to a hospital and they live there
for five to ten days while their relative
is being treated. They wait for hours,
praying and eating in hallways. So we
asked ourselves how to mobilize these
relatives that want to be helpful, but
do not know how. This idea gave birth
to Noora Health. After getting started
in the Y Combinator2, we moved to
Bangalore, India.
How did design
thinking help you?
E. E. : Once the problem was identified,
we swiftly went on to experimenting.
We started working with a nurse who
has since become head of training
programs at Noora Health. Together,
we developed educational materials
that healthcare workers could use to
teach family members some health
gestures. These tools were designed
with and for relatives. We also liste-
ned to doctors, of course, to be certain
“We are working
with twenty-five
hospitals and should
soon intervene in
twelve more, thanks
to a partnership
with the States
of Karnataka
and Punjab.”
to include the right content. Today, we
have set up many training courses for
different types of diseases. Our core
work remains the same: we go to hos-
pitals, train nurses, with the help of
videos for instance, then they in turn
train patients and their families for
the purpose of caring for the patients
at home.
Can you give us a few examples of
what you teach families?
E. E.  : Noora Health covers cardiology,
oncology, neonatal care, maternal
health and diabetes. For instance, after
a heart surgery, we train families to
recognize the warning signs of a heart
attack. This leads to a 70 % reduction
3 | IMPROVE
in post-surgical complications. We also
train them to check vitals such as tem-
perature or blood pressure. We focus as
well on administering medication. They
are simple things, but knowing them
improves the care that patients receive
at home and their healing process.
What is Noora Health’s
impact today?
E. E. : We are working with twenty-five
hospitals and should soon intervene in
twelve more, thanks to a partnership
with the States of Karnataka and Pun-
jab. In total, we have trained 90,000
relatives of patients. It is a lot, but it
remains a drop in the ocean of India’s
1.3 billion inhabitants. We want to
develop our model and our programs so
that other organizations and govern-
ments can adopt them. We also hope to
be part of several pilot programs out-
side of India.
In India, languages vary from
one state to the other. How do you
successfully communicate
with all families?
E. E. : We work on all educational mate-
rial with our teams of experienced
75
 3 | IMPROVE

A man takes the pulse of his father under

the supervision of an instructor.

designers. Whether we develop videos treated fast enough, the child became How do you finance your system, we will be able to work more
“When given or printed documents, we favor a blind. It was only afterwards that he programs? closely with the government. We are
the right information visual communication that doesn’t was diagnosed with jaundice. “If only I E. E. : At the moment, we mostly rely on involved in a highly technical environ-
require literacy. With regard to more had been informed, I would have known philanthropy, but we hope to develop ment that we are trying to make more
in the right way complex information, videos can easily how to react,” the father regretted. our own economic model. We already simple. The challenge is to avoid getting
and at the right be dubbed. Every day, we see how much impact have a team of paid instructors for sucked in by bureaucracy, and to remain
moment, the family How do families react
our programs have. When given the
right information in the right way and
some private hospitals that we partner
with. Our objective is now to collect
flexible in order to accompany the deve-
lopment of healthcare in India.
becomes to your work? at the right moment, the family beco- data to quantify the impact of our inter- By Côme Bastin
an extension of Last weekend, for instance, we
E. E.  :
faced a tough story. A woman had
mes an extension of the health system.
Inversely, failing to instil them with a
ventions. We have to show that Noora
Health diminishes the risks of complica-
1. Read Krishna Udayakumar, p. 82-83.
2. This Californian start-up incubator is
the health system.” given birth to a sick baby and did not few basic health reflexes can cause a tions and readmission. When we prove considered one of the most demanding and
© DR

know how to react. Because he wasn’t lot of damage. that we reduce the cost of the health prestigious in the world.

76 HEALTH TOMORROW 77
2 | MAKE
SURTITRE
Y
« TITRE » ou have placed the
patient-doctor
relationship at
the center of your
Chapeau
project, why?
It has changed
A. J.  :
a lot in recent years. Patients want
to participate more in the decisions
that concern them. They need intel-
ligible information to do so. Sadly,
doctors use very technical termino-
Texte courant logy in their reports, often with Gre-
co-Latin roots. It is a jargon that the
patients are unable to understand.
A word like “gastritis” doesn’t exist
in modern German: we would say
“Magenschleimhautentzündung”.
So we put into place a simple solu-
tion to this problem: we translate
medical documents into clear terms.
The person anonymously uploads his
or her medical file to the Was hab’ ich
platform or submits it by fax. It is then
translated by a medical student or a
doctor from one of our teams, spread
throughout Germany. These volunteers
have received a complete training
from our employees to learn to sim-
plify reports. Since 2014, we also give
classes on the subject in the universi-
ties of Hamburg, Marburg and Dres-
ANSGAR JONIETZ den, where we have our head office.
Are you saying that before
“WHAT’S UP, DOC?”
Was hab’ ich, no universities
were teaching doctors how to
communicate with patients?
Who hasn’t been confused by a complicated prescription? A. J. : It was taught, but not sufficiently.
The problem isn’t that professors dis-
In 2011, Ansgar Jonietz thought up Was hab’ ich, a platform that helps regard the question or that they lack
patients “translate” medical jargon into accessible terms. As a result, 32,000 empathy. In reality, it is the doctor-pa-
simplified diagnoses have been written by the organization, which also trains tient relationship that is in question.
In Germany, general practitioners only
German doctors to have a smoother relationship with their patients. have seven minutes per person in their
office, on average. When they are at a
consultation, patients are often afraid
washabich.de to ask questions or simply don’t know
© DR
© DR
what to ask. Add to this some abstruse
78 HEALTH TOMORROW
“Patients forget
up to 80 % of the
information given
at the doctor’s
office because the
medical language is
incomprehensible.”
terms and by the time they get home,
patients forget up to 80 % of the infor-
mation given to them at the doctor’s
office because the medical language is
incomprehensible.
Many universities are starting to
measure the importance of this pro-
blem and are trying to respond to it
with new approaches. Was hab’ ich
offers one of them. Medical language
must be taught, of course, but you
should also learn to express yourself
in a way that is smooth and accessible
for the patients. The road is long, but
we are optimistic: our classes get really
good feedback from students.
On the medical level, what
are the advantages of a better
understanding by the patient?
A. J. : A better understanding of the dia-
gnosis enables them to ask pertinent
questions. For example, patients can
make informed decisions when a surgi-
cal procedure is being considered. In the
long run, participating in discussions
has a positive impact on their health
itinerary, on their morale and on their
overall well-being. On the other hand,
patients who don’t understand their
medical reports are often uneasy with
their therapy. As a result, treatments
are followed haphazardly or recommen-
dations are read approximately. This can
have a negative impact on the well-being
of the patient. It also costs the German
3 | IMPROVE
healthcare system billions of euros per
year. The same amount of money could
be saved with better communication.
What is the project’s impact?
A. J. : Two indicators are essential for us.
First, on the level of the patients: 3,000
have received an understandable expla-
nation of their medical reports thanks
to our platform since its launch in 2011.
Second, on the level of the professionals:
more than 600 students in Germany
and Switzerland have been trained in
smooth communication. We have also
succeeded in building a good network
within the German healthcare system
by cooperating with health insurance
companies and the Ministry of Health.
How can the platform be
developed to reach more people?
A. J.  : Of course, we are trying to
enlarge our field of action. Doing more
translations means collaborating with
more doctors and students and devo-
ting a lot of effort to their training. This
will not only allow us to integrate them
into our platform, but also to improve
their future relationships with their
patients. To take it even further, we are
working on a new project. In Germany,
when you leave a hospital, you receive a
medical discharge report, which is also
difficult to decipher.
We have therefore developed sof-
tware, that care centers are charged
for, which makes the speedy transla-
tion of these documents possible. The
first results of this pilot program show
that patients are more satisfied with
their treatment and give hospitals a
more positive evaluation. We have high
hopes for this project, as its impact
could be very important. In Germany,
there are 2,000 structures treating
over nine million people each year that
are likely to benefit from it. 
By Timothée Vinchon
79
 2 | MAKE
I
ndian TV has described
you as a “green crusader”.
Do you see yourself as a
crusader?
V. G.  : I do not subscribe to
a warlike vision of ecology,
yet it is true that I feel vested with a
mission. Cbalance, which I founded,
helps companies to put a real inter-
nally sustainable development policy
into place. To do so, we thought up an
ecological calculator that measures not
only carbon emissions, but also the
resources used by an organization. At
the moment, the majority of Indian
companies outsource the management
“Developing of these tasks to a third-party, which
renewable energies explains why environmental concerns
are always perceived in terms of cost
will allow us to rely and constraints. However, their eco-
much less on external logical footprint should be considered
a non-negotiable imperative, in the
sources of energy same way we make sure that a building
and to diminish conforms to safety standards. Ano-
ther project of ours, Green Signal, is a
the number of label that helps ecologically committed
premature deaths.” consumers to spot the products and
services that respect the environment.
How do you evaluate the impact
that these companies and products
have on the environment?
V. G.  :We apply the GHG protocol,1
developed by the World Resources Ins-
VIVEK GILANI titute. First, we calculate all the green-
house gas emissions coming directly
from a company’s activities, which we
One Man’s Crusade call the attributable carbon footprint.
The same goes for an individual: if you
for Ecology in India drive your own car, you are personally
responsible for the vehicle’s CO2 emis-
sions. But we also focus on the emis-
sions that are partially or indirectly
With eco-labels and an ecological footprint calculator, this enthusiastic activist caused by the company. For example,
develops tools to help Indian companies and citizens to move toward a less when electricity is used, a coal plant
carbon-hungry growth. The objective: to fight against climate change and diminish somewhere might have produced it.
So we evaluate the suppliers, who also
pollution-related mortality, in a time of rapid economic growth for India. have an environmental impact.
Tell us more about this eco-label:
© DR
cbalance.in how is health taken into account?
80 HEALTH TOMORROW
V. G.  :Every product likely to contain
chemical components, like paint,
kitchen utensils, cosmetics or textiles,
is analyzed to detect toxins and endo-
crine disruptors. So far, we have awar-
ded this label to one hotel, one school
and one online store. A company pro-
ducing compost and another one spe-
cialized in an ecological additive for
fuel should receive it soon as well. It is
our desire to be able to grant the label
to plants and factories. Green Signal
is still very recent, but it is definitely
going to grow in the years to come.
Are Indian consumers really
responsive to these
environmental indicators?
V. G.  : We are witnessing a shift in
public awareness. The megalopolises
have entered the age of mass consump-
tion: today, individuals define themsel-
ves through what they buy. In India,
we already have a star-rating system
indicating how much energy a product
consumes. As the population sees its
purchasing power increase, it becomes
gradually more aware of the environ-
ment. These labels are crucial in order
to avoid “greenwashing”.
Do you practice carbon footprint
reduction in your everyday life?
V. G. : Yes I do, because I believe that a
more responsible individual accounta-
bility is the key to improving things on
the global scale. Unfortunately, many
self-styled environmental advocates
don’t follow a very eco-responsible
lifestyle. At our Bombay premises, we
practice what we preach. We turn our
left-overs into compost, we favor day-
light as much as possible and we turn
on LED lamps when it gets too dark.
Even when we travel, we opt for trains
instead of planes. It is slower but much
more relaxing .
We often hear that India should
not feel so concerned about
climate change since it is only
3 | IMPROVE
releasing a small amount of CO2
proportionally to its population.
V. G.  : This is a widespread but falla-
cious argument that consists in hiding
behind the poor. But it simply ignores
India’s global responsibility, which is
now the world’s third most polluting
country, after the US and China and
in front of Europe. This is not going
to improve with the combination of
population increase and the multiplica-
tion of cars and air conditioners. It also
fails to see that India is one of the most
vulnerable countries to climate change
and the rise in sea-level.
Even more to the point, this ecolo-
gical turning-point is a golden oppor-
tunity for India. Developing renewable
energies will allow us to rely much less
on external sources of energy, like oil,
and to diminish the number of pre-
mature deaths linked to the levels of
pollution.
With that goal in mind, how
do you reconcile India’s
future growth with the
environmental imperative?
As the saying goes: “a negawatt2
V. G.  :
will always be cheaper than a megawatt”.
The first thing to do is to curb the
demand for energy, which will rise dra-
matically as our GDP increases. People
often think in terms of individual
emissions or of the ecological cost of an
activity, but it is important to unders-
tand that our ultimate goal is to lower
our total greenhouse gas emissions.
Next, we have to ensure that the lar-
gest possible proportion of the energy
consumed comes from renewable and
non-polluting sources. And last but
not least, the benefits of the econo-
mic growth must be distributed equi-
tably among the population, for social
inequalities foster inequalities in the
access to energy which in turn contri-
bute to environmental problems.
By Côme Bastin
1. Greenhouse Gas Protocol.
2. A unit of saved energy.
81
3 | IMPROVE
KRISHNA UDAYAKUMAR
Necessity is the Mother of Invention
With the NGO Innovations in Healthcare, Krishna Udayakumar
studies and supports promising innovations in the domain of healthcare access
– mainly in emerging nations. The objective: use these innovative models
as an inspiration and duplicate them in developed countries.
I
ntroduce us to your work?
I am in charge of global
K. U.  :
innovation at the Global Health
Institute, which is attached
to Duke University. Six years
ago, with Mackenzie and the
World Economic Forum, we launched
the NGO Innovation in Healthcare. Our
objective is to study the best advances
in healthcare across the planet, to
figure out what works, what doesn’t,
and to help scale them up. To this end,
we seek the most talented inventors
and give them tools: funding, skill
development, networking, etc. Concur-
rently, we work with many multinatio-
nals or foundations, with the aim of
transforming how they operate based
on the model of social enterprises.
We also try to push public policies and
healthcare systems towards providing
a better access to care.
Why do you show a specific
interest in developing countries?
K. U. : The most significant innovations
often emerge from an environment
where resources are limited or reser-
ved for the rich. When people have low
income, technology must be deployed
sparingly. Community social workers
82 HEALTH TOMORROW
Innovationsinhealthcare.org
also play a key role in supporting the
most isolated populations. There is
a huge opportunity of inverse inno-
vation: understanding the solutions
imagined in developing countries and
adapting them to reform our own
healthcare system. Within our NGO, a
group of thirty members, composed of
hospital practitioners, scholars or even
backers, analyzes these new models.
Can you give us a few examples of
the solutions you study?
K. U. : We work with 74 organizations
in 70 different countries. A good exa-
mple is Narayana Health, in Banga-
lore, India. Thanks to telemedicine,
economies of scale, and an innovative
internal structure, this hospital has
developed procedures for low cost and
high quality surgery. Thus, an open
heart operation costs them 2,000 dol-
lars instead of the usual 100,000. Ano-
ther example: the North Star Alliance,
in South Africa. This chain of clinics
has set up its dispensaries in shipping
containers to provide basic health and
well-being services to workers such as
truck drivers. In the end, the innova-
tion is not so much in the technology
as in the way needs are met.
“There is a huge
opportunity of
inverse innovation:
understanding the
solutions imagined
in developing
countries and
adapting them to
reform our own
healthcare system.”
Can these models be useful outside addressing and to build the model
of the context where they were based on their needs. Next, you have
originally imagined? to use technology in a disruptive way,
K. U.  : Absolutely! The North Star including mobile. Mobile phones have
Alliance model is now being copied in spread across the planet and have
Africa. As for Narayana Health, they become the main tool to reach every
are opening a hospital with a cardiology community. Finally, you have to avoid
and pediatrics services in the Cayman activities that are too costly. Bring
Islands, and they are partnering with care from hospital to clinic, from cli-
Ascension Health, the biggest Health nic to community, from community
NGO in the USA. There is also the NGO A low-cost clinic, to home. Give power to patients and
Basic Needs, which operates in seve- part of the Narayana Health their families so that they are able to
ral Asian and African countries. This chain, in India. act and take control of their health.
organization relies on local and com-
munity development to care for mental And the obstacles?
illness victims. We have worked with K. U.  : Access to funding is always a
them on an adjustment plan that will major challenge. In low or middle
allow them to set themselves up in the income countries, there is a lack of
USA, which we are really proud of. year-round business, of investment
funds, of public markets. It makes
With everything you survey, have matching supply and demand com-
you found the recipe plicated. A second challenge: unders-
for innovation? tanding your ecosystem. Sometimes,
K. U.  : This is what we are trying to social entrepreneurs have good inten-
determine: what are the criteria to tions but lack real knowledge of all the
innovate succesfully in healthcare, inner workings of healthcare systems.
© ADAM PLOWRIGHT / DR
and what are the common obstacles? They require help to operate in what
There is no miracle recipe, but recur- is a very regulated environment, with
ring ingredients. First, you need many actors. It is not always easy to
to be centered on the consumer, to find your way and kick into high gear.
© DR
truly understand the people you are By Côme Bastin
83

bility. We have never known as much
about health and disease as we do
today. But this scientific progress
doesn’t even reach half of the people
in the world. We cannot accept this
situation, and therefore I organized
the World Health Summit on the occa-
sion of the 300-year anniversary of the
Charité to raise awareness and to forge
alliances across political and sectoral
borders. Since 2009, it has gathered
more than 1,600 leaders from aca-
demia, politics, civil society, and the
private sector, under the patronage of
Germany, France and the European
Union. The World Health Summit’s aca-
demic think tank is provided by the
“M8 Alliance”, a unique collaborative
network of leading international medi-
cal universities and the InterAcademy
Partnership (IAP) for Health.
DETLEV GANTEN
How is civil society being
included and how are you
making sure that a gathering
Much More Than Medicine like this doesn’t seem out of touch
with societal concerns?
D. G.  : We enjoy a very lively coopera-
tion with major organizations in civil
Since 2009, this German researcher has chaired the World Health Summit, society, like Médecins sans Frontières,
which brings together 1,600 leaders from all horizons to tackle the great health Gavi, The Wellcome Trust, The Glo-
bal Fund, CEPI, Save the Children,
challenges of the 21st century. For Professor Ganten, it is time to move to a more UNICEF, Transparency International,
holistic approach to health including environment, education and well-being. WWF, and many more. It is our mission
to bring in their perspectives at the
World Health Summit and discuss them.
worldhealthsummit.org You will never find a keynote session or
a workshop that does not feature spea-
kers from these different sectors. The
World Health Summit is an open and
T
democratic event that welcomes every-
body. We could not endeavour to try to
ell us about your on hypertension. One of my central I became Chief Executive Officer at the find answers to global challenges if we
© WORLD HEALTH SUMMIT / S.KUGLER
career prior to topics of interest in recent years has Charité – Universitätsmedizin Berlin didn’t acknowledge the expertise from
becoming the been Evolutionary Medicine and Glo- and merged the Medical Faculties of every health-related sector.
president of the bal Health. I was born in Lüneburg, the Humboldt University in East Berlin
World Health Germany. I earned my PhD at McGill and the Free University in West Berlin. From your point of view,
Summit? University, Canada. In 1991, I became what are the great changes
D. G. : I
worked for many years in phar- the Founding Director and President of Why did you launch the World and challenges in health since
macology and molecular medicine and the Max Delbrück Center for Molecular Health Summit in 2009? the end of the 20th century?
contributed to the global research Medicine (MDC) Berlin-Buch. In 2004, D. G.  : Academia has to take responsi- D. G.  : We have tackled the challenges
84 HEALTH TOMORROW
“We have never
known as much
about health and
disease as we do
today. But this
scientific progress
doesn’t even reach
half of the people
in the world. ”
of communicable diseases pretty well
– at least in theory. Pandemic prepare-
dness and antimicrobial resistance are
still urgent problems. Bacteria that
acquired an antibiotic resistance have
the potential to catapult us back to the
pre-penicillin era. Much remains to be
done to improve vaccination for many
diseases. We still suffer from an insuf-
ficient access to healthcare in many
areas of the world and urgently need
to find answers to the infrastructural
issues. To add to that, noncommuni-
cable diseases (NCDs) have become an
equally important burden in both rich
and poor countries. NCDs like heart
diseases, stroke, cancers, diabetes,
chronic kidney disease, and Alzhei-
mer’s disease kill 38 million people
each year.
How does climate change
affect health challenges
on a planetary scale?
D. G. : Global warming affects health in
many ways: in the future we will expe-
rience more disasters like floods and
storms. Vectors like mosquitoes will
transport diseases in areas they did not
occur in before. People will leave their
countries when safe drinking water,
clean air or sufficient food supplies
cannot be guaranteed anymore. We
have to do everything in our power to
slow down climate change and to mini-
mize its effects.
For you, what is the difference
between health and medicine?
D. G. : Health is much more than medi-
cine. It is above all a matter of educa-
tion. We must not focus exclusively
on fighting diseases, we should also
3 | IMPROVE
pay more attention to keeping people
healthy. This, in turn, calls for better
education and changes in our lifestyles:
access to clean water and sanitation,
healthier diets, more physical activity,
greener cities, etc. We need a change of
perspective from disease and medicine
to health and well-being.
Where does health innovation
come from today? Do you believe
in the potential of
social entrepreneurs
to bring new solutions?
D. G.  : Innovation begins with every
single person. They might be working in
a lab between Petri dishes and micros-
copes or in a health startup. They might
be a parent, a teacher, a sports trainer,
a cook, a sociologist, a politician or the
CEO of a company. One innovation
may become the next breakthrough in
therapy, another may help children get
a healthy diet. We all have our areas of
influence in which we can bring inno-
vation and initiate change. This is why
we want everyone to attend the World
Health Summit: health is one of the
most complex issues of our time –  if
not the most complex. We need a holis-
tic concept of Health. Policy, ideas and
creativity from all sectors and areas of
the world must unite to achieve better
health for all.
What figures have inspired you?
D. G.  : Many influential thinkers and
wonderful people have inspired me:
Rudolf Virchow, Professor at the Cha-
rité, who created the concept of public
health in the 19th century, or the
20th-century philosopher Karl Popper,
who argued that the source of our opti-
mism is our vision for a better world.
My personal inspiration also comes
from my grandson Jasper, 12 years
of age, who participated in the World
Health Summit and told his friends that
his grandfather was doing something
important.
By Côme Bastin
85
 3 | IMPROVE

2 | MAKE

UWE DIEGEL
Restoring the Connection...
Uwe Diegel settled in Paris a few years ago and has contributed
to the rise of connected health by developing iHealth Lab Europe.
At 50, he is turning the page and launching a new entrepreneurial adventure,
more connected than ever. His mission remains however unchanged –
lower the cost of managing chronic pathologies.

lifeina.com

I
felt that I had become a plas-
tic salesman,” confesses Uwe
Diegel while explaining why
he left iHealth Lab Europe,
the connected health giant
that he had launched. He also
blames his midlife crisis, that turned
towards altruism: “When you have a
company, you are not just trying to make
money. You also have a social responsibi-
lity as a business manager”. After clim-
bing Kilimanjaro, Uwe took on a new
challenge: LifeinaBox. “The company
started somewhat by accident,” begins
Uwe. A few years ago, his brother from
New Zealand decided to visit France.
“My brother is kind of a special traveller,
because he is diabetic. But he loves to
travel around, so he always carries insu-
lin.” One night, in a little hotel in the
Loire Valley, the owner had trouble
understanding English, so when Uwe’s
brother asked him to keep his insulin
in the fridge, he put it… in the freezer.
At 11 PM, Uwe’s brother daily injec-
tion time, he got back frozen and use-
less doses. “Luckily, we were in France:
police opened the on-duty pharmacy and
supplied him with his insulin in twenty
this linguistic misadventure, though,”
teases Uwe.
TRAVEL FRIDGE
Uwe then had the idea to draw up
the plans of a travel mini-fridge, the
size of a smartphone, to store medi-
cation. With a recovered battery, he
even built a prototype. “Every person I
talked to about it told me: ‘It’s amazing.’
But at the time, I had other things in the
pipeline, mainly the launch of iHealth.”
Today, this project is out in the open.
LifeinaBox is now a real life USB rechar-
geable pocket refrigerator, connected
to a mobile app that controls the tem-
perature and sends you notifications
when you need to take your medica-
tion. For the entrepreneur, “chronic
illness defines your lifestyle. Might as well
lighten the load”. Diabetes, multiple
sclerosis, cancer: his invention might
be a relief for the 3.5 million people
in France who are “prisoners” of their
medication. Looking beyond his misad-
venture, Uwe also considered all those
who commute to work on a daily basis.
Thus, an employee won’t have to put
their medication in the shared fridge
remain protected. Having a micro
fridge dedicated to medication also
protects children. “When a child ingests
a pill by accident, nine times out of ten,
it happens because it was stored in the
fridge. For instance, chemotherapy pills
can be mistaken for candy.” Enthusias-
tic about the project, Uwe says he has
already won prizes and got an encou-
raging reception from patients for this
invention, whose release is imminent.
A CONNECTED PIANIST
Nothing in his life suggested that
Uwe would reshape connected health.
Born in New Zealand in 1965, he
was a concert pianist until the age of
26. But an accident partially limited
movement in his right arm. He then
became a caterer, the manager of a
jazz club and an entrepreneur in South
African dairy production. In 1992 he
started a career in medical measuring
devices. His areas of focus: blood pres-
sure, body temperature, asthma and
diabetes. Uwe launched Microlife in
1994, developing new technologies
and taking an interest in industrial
design. He slowly became a market
© DR
“Nothing in
his life suggested
that Uwe would
reshape connected
health. Born in
New Zealand in 1965,
he was a concert
pianist until
the age of 26.”
chronic diseases and designing dia-
gnostic devices. In 2009, when smart-
phones and 3G rose to prominence, he
naturally moved towards connected
health and created the iHealth Lab in
the United States. “I went to see Apple
to offer them to connect my tensiometer
to the iPhone. Apple gave me the authori-
zation to register the iHealth trademark,”
he first met with success in 2014, the
year when connected objects started
to become more widespread. “In one
or two years, you won’t be able to buy a
device that isn’t connected. Everything
that can be connected will be.”
TOWARDS PREVENTIVE
HEALTHCARE
“Connected and assisted health is not
the future, it is the present,” analyzes
Uwe, who thinks health systems must
embrace what is already available.
And that is “a sum of technologies that
can manage the patient, not just their
illnesses”. He criticizes Europe’s social
system, which is too slow at moving
towards preventive medicine. “In
go to see the doctor three times as much
as on the other side of the Atlantic.”
Convinced that the trend is changing,
Uwe adds that “connected health encou-
rages the user to become a public health
actor”. Connected health gives practi-
tioners time for prevention. The goal:
teaching patients to manage themsel-
ves. “Diabetes, cardiovascular diseases,
cancer, obesity and asthma: the majority
of these pathologies are caused by our
lifestyle. Technology offers an entertai-
ning way to visualize and keep an eye on
data like blood pressure or body fat.” The
“Steve Jobs of connected health” then
concludes: “I am not here to save the
world, but I would like to be proud to have
done something to make it better.”

minutes. My brother is still annoyed by at work, and their confidentiality will leader and a world expert on managing reminisces Uwe. Ahead of his time, France, medicine is mostly curative. We By Fleur Weinberg

86 HEALTH TOMORROW 87
CHAPTER 4

BUILD
4 | BUILD
TONY MELOTO
The Plan to End Poverty
Through the construction of villages, NGO Gawad Kalinga wants to give
the poorest populations the keys to food sufficiency as well as economic and
intellectual self-reliance. The next stage will be to foster a whole generation
of social entrepreneurs ready to face the challenges of today’s inequalities.
S
ome midlife crises are
insignificant; others
can change a person.
Tony Meloto has faced
such a turning point.
In 1985, he had no
idea of what was to come as he laid
the foundation for a house destined
to a poor family from a neighboring
Filipino slum. “I wasn’t happy to just
be making money in the business world,”
remembers the former senior manager
at Procter & Gamble. “So I got in touch
with a Christian humanitarian organiza-
tion.” Thirty years later, Tony Meloto
has quit his job and now heads one of
the most famous movements against
poverty, Gawad Kalinga.
The goals of Gawad Kalinga (“taking
care” in Tagalog, one of the Filipino
dialects) can be summed up in three
phrases: “providing land for the lan-
dless, home for the homeless and food for
the hungry”. Tony Meloto’s solution?
To build ecological and self-sufficient
communities to take in the poorest of
Filipinos. Some 3,000 such communi-
ties have been created since the first
one was born in 1999, enabling more
than a million people to step out of
extreme poverty.
90 HEALTH TOMORROW
gk-europe.org
Tony Meloto has always felt that
“you cannot solve the problem of poverty
without a global approach: health, safety,
food and education.” This explains why
Gawad Kalinga isn’t solely concerned
with providing homes. It also creates a
whole eco-system for community deve-
lopment. Each community includes
a farm, health facilities, schools and
cultural centers. People inhabiting
informal settlements face the daily
dangers from unhealthy living envi-
ronments; for example, the proximity
of dumping sites and contact with
tainted water.
A HOLISTIC APPROACH
By providing communities with
shelter, toilets, clean drinking water
and an energy source, by teaching
children the basic rules of food safety
and hygiene, Gawad Kalinga conside-
rably improves the health and well-
being of populations. “By transforming
the physical environment, you transform
the behaviors and the habits of the inha-
bitants. You create people that take care
of themselves and others.”
The considerable amount of work
initiated by Gawad Kalinga is just
a starting point. “Our objective is to
help not 1 but 24 million people escape
poverty by 2024,” foresees Tony
Meloto. In order to reach this number,
he wants to shift from a philanthropic
mission to a cost-effective business
model. Aside from the construction
of villages, the NGO has begun to
train social entrepreneurs among the
locals, in order to create profitable
economic prospects for the inhabi-
tants. Spearheading this program are
“enchanted farms”, which function
as both agricultural production cen-
ters and business incubators. Why
are these two activities combined
together ? Because Gawad Kalinga
believes that the development of the
countryside is the first requirement
for the development of the Philip-
pines, which is why the organization
targets entrepreneurial business
using agricultral raw materials.
Extending over 86 acres, the first
enchanted farm to see the light of day
was born North of Manilla, in Bulacan.
Several social businesses have already
been founded there. Bayani Brew sells
an ice-tea brand using the crops from
local farmers. Gourmet Keso’s cheese
is renowned all across the Philippines.
© DR
Plush & Play uses ecological mate-
2 | MAKE
rials to make hand-sewn stuffed toys
for children inspired by farm life. 24
new enchanted farms are in develop-
pement “to help communities emanci-
pate themselves, in collaboration with
engineers and marketing people”. The
goal: to foster an ever-growing number
of social businesses.
A WIN-WIN SITUATION
The strength of Gawad Kalinga lies
in the way it characteristically brings
several actors to work together. The
inhabitants take part in the building
and the maintenance of their own
infrastructure. Volunteers from all
around the world (many of whom
are students) come to contribute to
the life of communities. Businesses
also take part in construction or give
financial support to the NGO. Moreo-
ver, the Filipino state praises this
approach on its end as complementary
to public policies.
Through this reasoning, Tony
Meloto wants to refute the idea of
globalization being the mother of
all inequalities. “We develop social
businesses which could one day become
multinationals. We collaborate with big
companies to support our programs.
And when we help people come out of
poverty, we also open new markets. It is
a win-win situation when the poor and
the wealthy work together!”
Communities following this model
have been built in Cambodia and
Papua New Guinea. But for the NGO,
Indonesia seems to be the most pro-
mising ground. Jakarta’s governor
has signed a partnership with Gawad
Kalinga in order to help 3,000 fami- “When we help people
lies access social housing. In Australia, come out of poverty,
the suburbs of Melbourne will soon
witness the construction of a village
we also open new
intended to improve the living condi- markets. It is a win-win
tions of the Aboriginal population.
This goes to show that Gawad Kalinga’s
situation!”
model can spread far beyond the bor-
ders of the Philippines.
By Côme Bastin

Y
ou often speak of
the importance of
the “last mile” in
healthcare access.
What do you mean
by that?
A. C. :On one side, there are the inha-
bitants of certain isolated zones. Most
of the time, they have to travel over
thirty  kilometers to get care for their
children. So they do without care, which
puts them in danger. On the other side,
public health organizations do not have
the means to come to them. Twenty-eight
years ago, we decided to create Riders for
Health,1 an NGO entirely dedicated to
transport. It wasn’t the most passionate
part of development aid, nor the most
selling. But it is absolutely essential, wit-
hout transport, nothing is possible!
How can these problems
of conveyance be resolved
in the field?
A. C. : The objective is to use existing
vehicles in an optimal way and to ensure
their maintenance. This means managing
A rider stops by a village.
everything: lubricants, fuel or even repla-
cement parts. So we train in mechanics
ANDREA COLEMAN
and spare parts management to optimize
transport and maintenance. We also
train riders, thanks to celebrities from
Health’s Angels
the motorcycling world. These “ambas-
sadors” participate in our program by
contributing to qualification. But the
people we train are more than just mecha-
In numerous African countries, rural inhabitants find themselves isolated nics and riders: they are full-fledged tech-
from health services due to battered roads and a lack of vehicle access. nicians who work with the care provider
on arrival. We also try to promote parity,
To repair these issues, Andrea Coleman founded Riders for Health in 1989. by working with both men and women.
The organization equips rural communities with cars and motorcycles and Thanks to all this, medical centers come
ensures their maintenance so they can gain access to health services. Twenty-eight to isolated populations and not the other
© RIDERS FOR HEALTH
way around.
years later, it counts 2,500 vehicles and 24 million people served.
Beyond healthcare access,
what impact does your action
ridersintl.org have on distant communities?
92 HEALTH TOMORROW
“We have reached
24 million people
who otherwise
would not
have been able
to receive care.”
A. C. : At the moment, we have a fleet of
2,500 vehicles present in seven African
countries: Lesotho, Zimbabwe, Malawi,
Kenya, Liberia, Nigeria and Gambia.
We have reached 24 million people who
otherwise would not have been able
to receive care. But training people in
mechanical maintenance and delivery
also creates economic opportunities!
Individuals who were unemployed
before are now earning money. They are
proud to be part of an innovative pro-
ject and to contribute to the improve-
ment of the healthcare system. Finally,
ensuring a predictable and trustworthy
service means showing that, for the
first time, the state is doing something
for them.
4 | BUILD
Transport logistics are expensive.
How do you find the needed
funding ?
A. C. : Most of our revenue comes from
collecting funds during the MotoGP
races. We organize events around the
courses and auction off memorabilia
donated by the riders. The Health Minis-
tries also contribute. We charge them a
per kilometer fee that includes fuel, spare
parts and the training of personnel. We
chose this strategy from the beginning:
we are an NGO and cannot pay for all the
vehicles across Africa. However, it is not-
for-profit, the funds for the race events
and our internal functioning are covered
by other revenue sources.
Are the authorities conscious
of the impact of your work?
A. C. : It depends on the value they
attach to their “distant” communities.
The healthcare budgets are often feeble,
and it is easier to reach people in urban
zones than in far-off regions. Happily,
other organizations use our services.
for example, the Centers for Disease
Control and Prevention (CDC). We were
able to put this collaboration to the test
during the Ebola epidemic in Liberia.
Usually, we are faced with rather slow
pandemics such as AIDS or tuberculosis.
With Ebola, we had to detect the virus in
a hurry. So we set up a dedicated sample
transport program. By using relays and
motorcycle delivery, we were able to run
our diagnostics in far-off communities
and send them to laboratories. Reaching
these zones permitted a complete and
effective action. In the end, the CDC
was quite clear: without our work, they
wouldn’t have been able to bring the cri-
sis under control like they did.
By Timothée Vinchon
1. The organization is today separated in two
entities: Riders for Health (operational) and
Two Wheels for life (fundraising).
93
4 | BUILD

PHILIPPE DE ROUX
The Shanty Town Water Dowser
In 2008, he co-founded Water and Life, an NGO that today has developed
social enterprises enabling access to clean drinking water and garbage collection
in shanty towns in the Philippines, Bangladesh and Ivory Coast.
This effective social business model is now being tested in Northern countries,
also confronted with issues of urban inclusion.

Eauetvie.fr

Water and Life brings drinking

water to shanty towns.

T
he poorer one is,
the dearer one pays,
is it this “double
penalty” that your
NGO, Water and
Life, is tackling?
P. D.  R. : Exactly. Having worked seve-
ral years in microcredit, I noticed that
the most underprivileged dealt with
loan sharks when they needed to bor-
row money. It is also true for water in
shanty towns, where inhabitants go
and buy it from illegal resellers that
pirate the network, corrupting com-
pany agents and expensively reselling
water stocked in dirty cans. In 2008,
I began our water action with Valé-
rie Dumans, co-founder of Water and
Life. The option taken by the majority
of NGOs is to create hydrants where
women and children can supply them-
selves. But this solution is unsatisfac-
tory: we observe conflicts of interest
between communities, non-payment
of providers and, in the end, domina-
tion by the most powerful. In reality,
managing water is a skilled trade. We
said to ourselves that people were
ready to pay to have water in their
service, and that we would trust them
and adapt to their situation.
How does your solution work?
P. D. R. : In each country, Water and Life
relies on two structures. On the one
hand, there is an NGO that deals with
advocacy, community mobilization and
raising awareness of hygiene or fire pre-
vention. On the other, there is a local
operator that provides each home
with running water, organizes garbage
collection, cleans the streets, forms a
volunteer fire brigade and installs clean
public toilets. In exchange for these
services, the populations make regular
per household payments of mutualized
bills. The social enterprise is situated
in the shanty town and 80 % of its
employees are also recruited on site. In
case of non-payment, a secure indivi-
dualized account system allows them
to control, or eventually cut, the flow
to those who refuse to play the game. It
is this alliance between the proximity
of the service and professional mana-
gement that explains the success of
our solution.
To what extent does this
management by a social
enterprise impact the price
of water?
P. D. R. : Our prices are five times lower
than those of canned water on average
and currently benefit 22,000 people. In
the Philippines, water represents 25 %
of a family’s budget, but only 6 % with
our system. In Bangladesh, it is diffe-
© DR
water is of poor quality, which results
in significant health care expenses.
The water that we distribute is a little
more expensive, but clean! When spea-
king about impact, everything must
be taken into account: the diminution
of healthcare costs, the gain of time,
the decrease in school absenteism…
Near slums districts, water losses due
to pirating and leaks make up nearly
80%. With Water and Life, we are at
around 6 %. When your networks are
under your control, you control the
quality. That is what we often say to
city mayors: rich and poor share the
same germs.
Do you only work in
developing countries?
P. D. R. : Historically, we are established
in the Philippines, in Bangladesh and
in Ivory Coast. But we are also invol-
ved in a process of “reverse innova-
tion”, seeking to apply what we have
learned in developing countries in
Europe. In this way, we work in France,
in La Grande Borne in Grigny, the lar-
gest housing project in Europe. In this
urban enclave, the problems pile up:
“People are
ready to pay to have
water in their homes,
provided that there
is a real service,
and that we trust
them and adapt
to their situation.”
order, colossal debt of the condomi-
nium syndicate… all while the costs
are higher than in Paris. Just as we
did in shanty towns, we will create a
social enterprise, charged with acting
as a multi-service operator, with 850
people to start with. The inhabitants
of the area will be recruited and trained
to insure the proper functioning of the
services, to collect bills and to conduct
awareness campaigns. The common
water units will be renovated, the cur-
rent services individualized and billed
according to use: water, electricity, gas.
We have also been asked by Veolia to
support a large Romani camp in Sofia,
It seems that water having
a price is important to you.
Don't you think water should be
free?
P. D.  R. : I am a member of the Water
Coalition, which fights against cutting
off of water. But it is necessary to be
aware that all that is free is not sustai-
nable, it is as simple as that. A contri-
bution by the people is essential to
control consumption and put an eco-
nomic model into place. At the same
time, the costs must of course be par-
tially subsidized, as “water doesn’t pay
for water”. In Europe, the installation
of the network was paid with taxes. The
rich zones paid for the poor ones, as
has been done with education, and that
is great. Did you know that during fifty
years Paris consecrated 40 % of its bud-
get to clean up its water supply? Mont-
martre and Butte aux Cailles used to be
shanty towns in 1860. Thanks to public
policy, they are now ranked amongst
the most prized neighborhoods of
Paris. In a world that tends to put up
walls with massive urbanization, the
city must be treated as a whole. Urban
inclusiveness is the key.

homes, provided that there is a real social enterprise, a true multi-service rent: the prices are subsidized, but the building degradation, elevators out of Bulgaria. By Côme Bastin

94 HEALTH TOMORROW 95
4 | BUILD 4. BUILD

FLAVIANO BIANCHINI employees. The difference in price

comes from the mining technique,
which respects neither human rights
Texte courant

Data Worth Its Weight in Gold nor the environment. You still have
to dig a huge hole in the ground to
extract something, and it inevitably
Too often, communities fail in their legal battles against polluting companies impacts the ecosystem. It is costlier,
but we can implement standards to
because of a lack of scientific evidence. In 2005, Italian researcher limit the damage and enforce a few
Flaviano Bianchini created Source International which helps community basic principles.
members assert their social and environmental rights by providing science Is it easy to deal with
experts to collect and interpret data. the authorities?
F. B. : Our actions regularly go against
the State. In theory, it has the duty to
source-international.org protect its citizens, but in reality, it is
often the accomplice of the polluting
company because of lobbying or cor-
ruption. The first step is always to go

W
hat impact
do mining
activities
have on
health and the
environment?
F. B. :Extracting activities are amongst
the most polluting in the world. For
instance, in the United States, the EPA1
considers mining waste as their leading
environmental problem, even before
nuclear waste or chemical products.
And this, despite the fact that it is one of
the countries with the strictest norms
and for which we have the most data.
It is already alarming, but the situation
in other countries is much worse. In
some remote areas of South America
or Africa, there is neither control nor
data, although we witness a child mor-
tality up to twelve times higher than
the country’s average. For instance, in
the city of Cerro De Pasco,2 100 % of
the inhabitants should be rushed to the
How can a community go up
against these giants?
F. B. : We provide NGOs and advocacy
groups with the scientific proof they
need for their fights. When a com-
munity considers itself the victim of
a mine’s pollution and wants to halt
its activities or at least seek financial
compensation, it needs to prove the
loss it is suffering. That is what our
team of scientists do. We go on site,
collect data and establish reports that
are then used to make social and envi-
ronmental progress. A lot of citizens
contact us. We choose those we work
with in accordance with our resources
and with our team. The length of
those missions varies a great deal.
Sometimes we stay a few weeks, we
train them and come back. Sometimes
we spend up to two or three consecu-
tive months there. Right now, we are
working in sixteen countries, most of
the time on mining problems.
or dangerous. You must provide tan-
gible proof of what you are arguing.
Our data helps citizen groups to stren-
gthen their arguments in order to get
compensation. If an NGO proves that
a river is polluted, the company, faced
with irrefutable scientific statements,
will no longer be able to deny its impact.
For instance, in Mexico, the Carriza-
lillo community received an important
compensation from a gold-mining
company – around fifty million dollars
over five years. We have also induced a
change of the mining law in Honduras,
where the Supreme Court declared it
unconstitutional, following the publi-
cation of one of our studies, because it
violated human and sanitary rights.
Is it possible to transform mining
extraction into a responsible
activity?
F. B. : More or less. Producing an ounce
of gold in Canada, a country where
© SOURCE INTERNATIONAL
see the company and tell them: “we have
scientific proof, now you have two choices:
either we talk, or we end up in court and
we organize international support cam-
paigns.” It usually works because they
have a reputation to protect.
How do you see the future?
F. B. : With population growth, the
demand for materials from the mining
industry will rise and lead to more pol-
lution. One of the main challenges is
thus to tackle this public health issue
by learning from previous cases. In El
Salvador, after sixty years of mining,
there is a city that is considered dead
because of the pollution. After too
many ravages, the same country
became the first to ban metal mines on
its territory. It is our duty to prevent “Imagine you must
the same situation from happening to
others in sixty years.
take legal action
By Timothée Vinchon or start a lobbying
1. The United States’ Environmental
Protection Agency (US EPA) is an agency
campaign against
independent from the US government, an activity you deem
polluting or dangerous.

hospital. Their blood tests show a level
of heavy metals that is way too high!
Beyond the sanitary risks, the issue is
also political. Mining companies often
abuse their influence over local popula-
tions and governments.
How does the data you collect help
communities?
F. B. : Imagine you must take legal
action or start a lobbying campaign
against an activity you deem polluting
standards are observed, costs about created in 1970 with the task to study
600 dollars. In Honduras, it costs and protect nature and the United States’
200 dollars. You often hear that it is citizens’ health. You must provide
because salaries are lower, but that is
false. They are even higher in Hondu-
2. This Peruvian mining city is located at an
altitude of 4,300 meters and has high levels
tangible proof of what
ras, because you have to pay expatriate of lead and arsenic pollution. you are arguing.”

96 HEALTH TOMORROW 97
4 | BUILD
H
ow did you get the
idea to mix techno-
logy with humani-
tarian aid?
D. D.  : I graduated
from an industrial
design school. Two years after the ear-
thquake in Haiti,1 I went there to take
part in the rebuilding. I noticed supply
problems everywhere. Machines were
in ruins because of something as simple
as a missing bolt, and water treatment
facilities would break down because
nobody knew how to maintain them.
In Port-au-Prince, I met a nurse
that had performed five deliveries in a
single night! She had just used her last
latex glove to cut an umbilical cord.
Left without sterile tools, she was at
risk of contracting diseases like AIDS.
This truly shocked me. I wondered if I
could use 3D printing to make certain
items like the gloves directly in the field.
Indeed, importing supplies can be long,
costly and uncertain. I had a 3D printer
shipped by boat from New York and
that is how I started mixing technology
with humanitarian aid.
When I came back to California,
I met Eric James. He had worked in
the field for years. He was the ideal
partner! We launched Field Ready – our
NGO – in 2014.
Since then, where have been your
DARA DOTZ “fields” of operation?
D. D. : We have intervened in places like
Short Circuit Emergency Response
Kenya and South Sudan. We are now
focusing on an R&D program based
in Kathmandu (Nepal) in partnership
with the NGO World Vision. On site,
In a disaster area, importing supplies can be long, costly and uncertain. our designer, Ram Changra Thapa,
works with Abi Bush, a 3D printing
Dara Dotz, cofounder of Field Ready uses new technologies like engineer. Together, they started by
3D printing to assemble and repair tools directly in the field. Since 2014, making spare parts for equipment that
this innovative NGO has intervened throughout the world, had been damaged in the earthquake,
before devizing tools for doctors in
most notably in Sudan, Nepal and Syria. isolated communities. They then 3D
printed otoscopes, fetoscopes2 or
tweezers. Ram also designed pieces
© DR
fieldready.org that improve incubators.
98 HEALTH TOMORROW
“In each case,
the objective is
to invent solutions
that we can then
share with the rest
of the world.
Everything
we design is
open source.”
Do you work in war zones as well?
D. D.  : Thanks to a grant from the
FabFoundation, Field Ready is now
present in Syria. We create search and
rescue equipment, which is otherwise
prohibitively expensive and hard to get
in the field. We have notably designed
a lifting airbag to rescue people from
collapsed buildings by lifting debris
weighing several tons. We have found
a way to make them on site with locally
available materials, such as tires. This
airbag costs around fifty dollars – one
tenth of the regular cost – while mee-
ting international standards. This pro-
duct has already saved two people in
Syria, but this innovation could also be
used in the rest of the world.
You are often associated with 3D
printing. Is it the only technology
you are using?
D. D. : 3D printing is fashionable at the
moment, and it is true that it helped
make us known. So much the better,
but it is just one of many tools. When
we get to a new place, we start by liste-
ning to the locals’ needs instead of for-
cing predetermined answers on them.
In the case of Syria, it was almost
impossible to cross the border, which
put us in danger. We had to impro-
vize and use local resources: so long,
3D printing! After the earthquake in
Nepal, we used laser cutting to build
model houses to show people how to
rebuild their homes.
How are you ensuring that local
populations use these technologies
after your departure?
D. D. : It is a key point. When we develop
humanitarian solutions, we remain on
4 | BUILD
the spot as long as necessary to involve
the survivors and ensure that they can
keep up the work afterwards. We orga-
nize many classes and workshops to
train them in the techniques we use.
In Nepal, over 400 inhabitants have
thus been trained in 3D printing since
our arrival.
You are a young NGO. What do you
want to work on in the future?
D. D. : I am really proud to see how far
we have gone in such a short time! We
will set up in ten new disaster areas
shortly. In each case, the objective is to
invent solutions that we can then share
with the rest of the world. Everything
we design is open source.3
We are also looking for innova-
tive technologies that would allow us
to manufacture more items. We are
especially enthusiastic about 3D metal
printing. It is still expensive, but the
costs should come down in the years to
come. We would then be able to make
equipment and medical devices direc-
tly in the field.
How big is your team at Field
Ready and how do you fund your
work?
D. D. : We have 25 full-time workers but
when a natural disaster occurs, we are
joined by a great number of volunteers.
We are also in touch with the maker
community4 involved in humanitarian
work. We have been funded by innova-
tion grants, partnerships and private
donations. Field Ready is a not-for-pro-
fit humanitarian NGO, so everything
we make is free.
By Côme Bastin
1. The earthquake struck on January 12,
2010, and killed 300,000 people, injured
another 300,000 and left 1.2 million people
homeless.
2. A type of stethoscope used to listen to the
fetus’ heart rate.
3. The data and the blueprints can be down-
loaded and used for free.
4. DIY and digital making enthusiasts.
99
4 | BUILD

JAN IN’T VELD associations in Africa. But our main

means of distribution remains our own
missions. Focus On Vision is a founda-
Universal Eyecare tion and collects donations as such to
intervene in Panama, Tanzania, Kenya,
Ghana or even Nepal.
Exhuming a forgotten invention, the “adjustable glasses”,
Where does your funding
Jan In’t Veld designed a polyvalent glasses frame. Costing less than ten dollars, come from?
these glasses can correct up to 93 % of vision problems. J. I. V.  : It is actually quite hard for us

Working in Africa, Asia and South America, his foundation, to find funding. Wearing glasses has
become so commonplace for Western
Focus on Vision, has already equipped 350,000 people. people that they have a hard time
imagining the difficulty of obtaining
them in other parts of the world. In
focusonvision.net thirteen years, our foundation has
collected two million euros in dona-
tions. Two million euros for 350,000
beneficiaries is only around six euros

Y
ou made a career
in steel, what
brought you to the
question of vision
conditions?
Fifteen years
J. I. V.  :
ago, my son-in-law visited Dar es-Sa-
laam, the capital of Tanzania. He is
myopic and wears glasses, but he
noticed that none of the students at the
university wore them. In comparison,
30 % of all students attending univer-
sity in the Netherlands wear glasses.
When he came back, we studied the
numbers from the World Health Orga-
nization (WHO) and its “Vision 2020”
program, whose goal is to get rid of the
main avoidable causes of blindness. We
learned that one billion people in the
world need glasses. Unfortunately, they
either don’t have the means to obtain
them, or they re simply not available
where they live. In the Netherlands,
you can find an optician anywhere. But
in some parts of Africa, Asia or South
America, there are very few opticians.
How did Focus on Vision start?
J. I. V.  : In “Vision 2020”, we also
table glasses”. It attracted our atten-
tion. We made some further research
and discovered that a certain Luis
Alvarez, who won the Nobel Prize in
Physics in 1968, had invented them.
At the time, the technologies used to
make optical lenses were limited. The
material available was so heavy and the
resulting glasses so thick that it would
have been impossible to actually wear
“I am not so young
anymore, I have
grey hair, but before
I pass away I would
like my glasses
to benefit at least
one million people.”
them. So Luis Alvarez patented the
technology, which has since entered
the public domain. My son-in-law, Fre-
derik van Asbeck, having the technical
knowledge at his disposal, decided to
unearth this invention and went on to
lenses. As for me, I am more skilled in
the commercial aspect, so I developed
the mass production of these glasses.
How do these glasses work?
J. I. V.  : Once you are wearing the
glasses, you can adjust them by moving
little wheels on each side of the lens. We
have developed a model designed to fix
myopia, correcting vision ranging from
-1 to -5, and a model for hypermetro-
pia (or long-sightedness), ranging from
+0.5 to +4.5. These two models cover
93 % of vision conditions. I regret the
fact that we cannot cover all of them,
but this allows us to fix most cases of
poor eyesight. We are also set on lowe-
ring production costs to a minimum:
under ten dollars.
Who benefits from
your adjustable glasses?
J. I. V. : More than 350,000 people! We
use several channels of distribution. For
example, ophthalmologists who work
with NGOs and perform free cataract
surgery in developing countries carry
these adjustable glasses with them to
distribute them to their patients. We
© DR
per person. It is a really small sum!
We wouldn’t need much to resolve the
problem once and for all. To be honest,
I think that some groups are lobbying
against us, trying to slow down our
development. Some ophthalmologists
and opticians see my activity as com-
petition. But that is ridiculous, since
Focus on Vision operates precisely
where they don’t.
What is your strategy
for the coming years?
J. I. V.  : Until now, our glasses have
been distributed in 45 countries. To
be more efficient, we have decided to
concentrate our efforts on three of
these countries: Ghana, Kenya and
Tanzania. For example, in Ghana,
we focus on cacao farmers. Ghana’s
median annual income is 1,768  dol-
lars. But for those farmers, it is only
325 dollars. This amounts to less than
one dollar a day. In my own life, I am
not lacking anything; there is always
food on the table. I created Focus on
Vision with these people in need in
mind. I am not so young anymore, I
have grey hair, but before I pass away
I would like my glasses to benefit at
least one million people. 

stumbled on the expression “adjus- design adjustable glasses using plastic also collaborate with a number of small By Perrine Massy

100 HEALTH TOMORROW


D
eforestation happen
at a rate of one foot-
ball field every three
seconds,” explains
Nicolas Métro. “And
yet trees are essen-
tial to life, and there is an undeniable link
between forests and our health. 40 % of
our food is pollinated by insects that live
almost exclusively in forests. And half of
all anticancer drugs come from there!”.
To make up for this ecocide, “all
each of us would have to do is plant two
trees”. Simple on paper, not so easy in
real life. “Most reforestation projects fail
because locals don’t see trees as valuable
enough.” And forbidding their destruc-
tion “only works if you give people a good
reason not to do it”. In 2005, Nicolas
founded Kinomé – the eye of the tree in
Japanese – based on this premise.
A LEVER FOR DEVELOPMENT
The social enterprise rejects “band-
aid solutions”. To put a stop to the
destruction of ecosystems, it uses the
idea of forests as a powerful lever for
human and economic development.
Kinomé’s core business isn’t limited to
planting trees; rather, it is to give birth
to sustainable industries. Large corpo-
rations, NGOs and institutions call on
its expertise with three main goals: to
encourage local employment and agro-
NICOLAS MÉTRO forestry, to conserve cultivated forests
and to produce first-rate raw materials.
Back to the Trees!
Since its beginnings, the social
enterprise has planted 4.5 million trees
in Africa, Latin America, Asia but also
France and Romania. In 2010, they
How do we reverse the deforestation that is tearing the planet apart? launched Forest and Life, a campaign to
involve the public in its actions. On its
Nicolas Métro is adamant that planting trees isn’t enough: “We need to rekindle website, anybody can donate to send
the primal link between humans and their forests.” His social enterprise – plants to villages or support a family.
Kinomé – organizes sustainable agroforestry networks that protect The goal is not to beautify the
landscape, but rather to better the life
the environment while providing economic opportunities to local populations. of millions of people. Trees maintain
MALARD
groundwater, which in turn fills wells
and rivers. This allows children to go
© FABRICE
kinome.fr to school instead of fetching water
DR
from far away. The trees feed families
102 HEALTH BOOK
and provide revenue as well as stable
jobs. Not to mention that they regu-
late climate.
In addition to its agroforestry ope-
rations, Kinomé leads several applied
research programs, notably with the
“Kinomé uses
forests as
a powerful lever for
human and
economic
development.”
French National Institute for Agricultu-
ral Research and the CEA.1 Among the
subjects they are working on: soil micro-
biology, the link between trees and cli-
mate or the social and environmental
impact of reforestation. “Kinomé is
trying to have a better understanding of
everything forests can bring, including
regarding health,” Métro explains. “We
involve local institutions, NGOs, agencies
such as the AFD2 and large corporations in
our programs.”
PROFESSIONAL
TURNAROUND
After graduating from a top
business school, Nicolas worked for
twenty years as a senior manager at
LVMH, M6 and Ubisoft. But then
something clicked as he was marketing
and strategy director at the French
video games developer.
“Human resources suggested that I
work on life skills as work skills. One
thing led to the next, and I ended up trai-
ning in ethical leadership, which gave
me an understanding of fundamental
human needs, which are universal and
timeless.” He gave himself six months
to change his life and came up with
Kinomé. Today, with a third of his for-
mer salary, Nicolas says he is happy to
reconnect with what truly matters to
4 | BUILD
him: nature, the forest and, above all,
the human being.
One of Kinomé’s current develop-
ment goals is the cultivation of Moringa
leaves. They are known for their medi-
cinal virtues, notably antibacterial,
“but they also offer hyper-nutritive pro-
perties that are under­ utilized today,”
adds Nicolas. “After one year of growth,
without the need for fertilizers or pesti-
cides, the tree produces its first shoots.
They represent a quickly available source
of food and income for households.”
THE MORINGA LEAF
In West Africa, many children suffer
from malnutrition, and thirty  grams
of Moringa powder a day are enough
to eliminate stunted growth. “Right
now, the World Food Program favors local
agriculture over import. We work with the
Togolese government to distribute this
powder at schools and directly to fami-
lies.” The NGO has also established a
partnership with the Red Cross in Togo
to generate jobs for women, who sell a
portion of their crop.
Ensuring the smooth operation of
the network remains a daily challenge.
“In the case of Moringa, we came to rea-
lize that drying the leaves could lead to
bacterial contamination,” admits Nico-
las Métro. “So we had to rework the way
we ground, treated and stored them.”
Indeed, Moringa has now begun to be
exported to Northern countries for
plant-based protein, sports drinks or
anti-diabetic foods.
What is Nicolas most proud of?
“Improving the lives of populations in the
long-term by providing them with jobs
and food.” Between Asia and Africa,
he hasn’t forgotten the forests of
his native France. He regularly visits
schools to plant trees with the child-
ren. Maybe one day they will care for
the Earth as adults too.
By Fleur Weinberg
1. The French Alternative Energies and
Atomic Energy Commission.
2. French Agency for Development.
103
2 | MAKE
SURTITRE
« TITRE » tion. However, she refused to accept
defeat and decided instead to prove
Chapeau the medical field wrong by using her
knowledge of sculpture to assemble an
adjustable wheelchair that was tailored
to suit her daughter’s everyday life. By
making her posture more ergonomic,
Shona’s daughter was now able to use
her hands more efficiently, “and above
Texte courant
all to communicate and play”.
Working with a picture of a Swedish
wheelchair as the basis, Shona solicited
the help of the division of Biomedical
Engineering from the University of
Cape Town. Her perseverance even-
Shonaquip makes tailored tually paid off when –  for Shelly’s
wheelchairs for every type second birthday  – Shona was able to
of handicap. give her a small, tailor-made, moto-
rized buggy.
SHONA MCDONALD MUTUAL SUPPORT AND
RESOURCEFULNESS
Heal on Wheels The story could have ended there.
But Shona was deeply involved in
mutual support groups for parents of
In 1992, Shona McDonald decided to assemble a wheelchair adapted to her children with disabilities and she qui-
ckly understood that others could use
daughter’s disability. Twenty-five years later, she is the founder and CEO of this kind of tailored equipment. This is
Shonaquip, a social business of sixty employees that has produced more than 70,000 how Shonaquip was born, in 1992 – the
fusion of Shona and equipment.
ergonomic wheelchairs in South Africa. In addition, this self-taught wheelchair Like Steve Jobs, Shona McDonald’s
engineer created a foundation dedicated to changing mindsets and public policies. story began in a garage with two asso-
ciates. She had successfully raised a
little money when the first wheelchair
shonaquip.co.za orders began to come in.
Twenty-five years later, Shonaquip
has more than sixty employees (one
W
fourth of whom have a disability),
with branches in four South African
hen she year was 1982 and South Africa was correctly. We might as well have tried to provinces.
discovered under an embargo, which made it put her on a bike,” states Shona. Doc- The company hasn’t lost an iota
that her impossible for her to import a wheel- tors advised her to lock her daughter at of its original philosophy: a mix of
newborn chair adjusted to her child’s disability. home, and to have another baby soon mutual support and resourcefulness.
b a b y The only option given to her at the “to get over it”. “The making of these wheelchairs is not an
–  Shelly  – time was to accept a standard hospital Confronted by a society that wilfully individual work. It is community-based,”
suffered from paralysis, Shona McDo- wheelchair. “It was impossible to make overlooked her daughter’s condition, explains Shona. Engineers and desi-
© DR
nald found herself in a dire strait. The her sit in it, or even to position her arms Shona experienced anger and frustra- gners, as well as doctors and occupatio-
104 HEALTH TOMORROW
4 | BUILD
Like Steve Jobs,
Shona McDonald’s
story begins in a the disabled are not devils, but individuals
garage with two who need support,” explains Shona. We
associates. She had regularly organize talking circles with
leaders from rural communities to discuss
successfully raised the rights of handicapped people.”
a little money Through these meetings, Shonaquip
is also able to identify the families who
when the first might need their wheelchairs. Moreo-
wheelchair orders ver, it brings them closer to public ser-
began to come in. vices: learning and medical centers or
social services. “At the other end of the
chain, we must do our best to ensure that
nal therapists work together to design doctors are sufficiently informed when a
wheelchairs and buggies suited to the parent comes to see them,” concludes the
specific needs of each child. More than business woman.
70,000 children have already been
issued a wheelchair. AWAY WITH CHARITY
Shona is striving to ensure that
TALKING IN CIRCLES disability ceases to solely inspire pity
“Creating wheelchairs is but the intro-
duction to a much larger mission,” adds
this self-taught engineer. Energized by
and charity. She aspires to make it an
area for social and medical innova-
tion. Her determination has already
the Uhambo Foundation, which backs
her company, Shona’s teams mobi-
allowed her to strike a deal for a
public-private partnership that keeps
lize to fight prejudice against disabled the company’s order books full. This
people. “You have to make it clear that in turn encourages the government to
take the needs of children with disabi-
lities into account in its policies and to
make them a reality.
Asked about her view of the future,
Shona won’t mention the imminent
launch of a new innovation. She sim-
ply states that her main goal is to “keep
doing what [she is] doing”. The same goes
for a potential international expan-
sion. Shonaquip is already present in
seven African countries,1 but it favors
a sustainable development rather than
spreading its business at any cost. “We
must get involved at the governmental
level for any of these solutions to be fully
effective, this represents a huge challenge.”
Hopefully, as the proverb goes: great
oaks from little acorns grow.
By Timothée Vinchon
1. Zimbabwe, Botswana, Namibia, Mozam-
bique, Uganda, Lesotho and Swaziland.
105
4 | BUILD

CHAI LO trade. The platforms are managed by

local NGOs that partner with 1001
Fontaines: O-we in Cambodia, Ranont-
Springs for the People sika in Madagascar and Sulabh Inter-
national in India.2
Each month, a member of the orga-
In each village, a water purification station, and behind every station, nization visits the facility. The operator
shares their concerns and the challen-
an entrepreneur. It is with this business model that the NGO ges they face. Using this essential fee-
1001 Fontaines hopes to bring drinkable water to over one million people dback, the NGO regularly improves
before 2020, especially in the rural areas of developing countries. the stations’ set-up. For instance, since
August 2013, it has launched a mobile
app for the entrepreneurs. It helps
them register their clients and mea-
1001fontaines.com sure the quantities of water that are
treated and distributed. This app was-
designed with one of 1001 Fontaines’
many partners: a consulting firm called

W
Accenture.

e want to give
local entrepre-
neurs the means
to improve the
general health of
the population
by providing it daily with clean water,”
declares Chai Lo, who co-founded 1001
Fontaines in 2005 with the help of Fran-
çois Jaquenoud and Virginie Legrand.
He started in Cambodia, then quickly
set up in Madagascar and then in India
by 2014. The NGO intervenes in rural
areas of developing countries. “These
regions are excluded from the water sup-
ply network, which is destined for cities as
a matter of priority,” explains Chai Lo.
“Access to clean water is still very far
from being universal,” he adds. Thus,
800 million people in the world still
suffer from drinking stagnant or pol-
luted water. In the villages where the
absenteeism by four among school
children ages 6 to 12.
The set-up looks relatively simple.
The station must be located near a
water source: a pond, a stream or a
well. An electric generator activates
the pump, and the unclean water accu-
mulates in a tank, keeping the largest
particles in suspension. The water then
passes through progressively finer fil-
ters, until the final step: disinfection
through ultraviolet rays, thanks to a
solar-powered lamp. Once the water
is free from discoloration, odor and,
most importantly, bacteria, the now
drinkable water is ready to be bottled.
“Our system guarantees that this water is
clean and ready for consumption, in accor-
dance with WHO standards,” proudly
concludes Chai Lo.
A NETWORK OF MICRO-
portation, delivery and logistics. They A HYBRID BUSINESS MODEL
fill up the containers and begin their
tour of the local shops, inhabitants
“With our system, One of the specificities of 1001
Fontaines is its business model, which
and collectivities – starting with the clean water isn’t Chai Lo eagerly defines as “hybrid”.
schools. On the way back, they retrieve
the empty containers before washing
expensive to produce. Though each water purification center
is conceived to work as an autonomous
and disinfecting them, to reuse them We can fix the price unit, they could not exist without the
the next day. at a cent per liter, financial backing of donors. Among
“With our system, clean water isn’t these donors are many individuals,
expensive to produce. We can make it which makes it but also large industrial groups acting
accessible to all, by setting the price accessible to all.” through their respective foundations.
around one cent for one liter.” Even at The NGO also owes a great deal to
this rate, the station operator’s work international organizations, notably
is cost-effective. The profit from the the World Bank and Unicef. Not to
sale of water makes their whole ope- forget the public sector, the Ministry
ration profitable, increasing its long- of Rural Development in Cambo-
term durability. “Our aim is to make dia, Madagascar’s Ministry of Water
each water station independent. A pro- Resources, and their counterparts in
cess that rests on a successful transfer of India. “We are very proud that our work
skills toward a member of the community, has been recognized as useful to the public
in each village. We accompany them for good.” confides Chai Lo. Indeed, new
a whole year, in order to teach them how countries are expressing their interest
© FONDATION CHAMPITTET , ARNAUD TINEL

organization’s water purification sta-
tions have been installed, the inha-
bitants can benefit daily from almost
1.5 liters1 of water per person. The
health benefits are quickly visible: an
independent study showed that in
these communities, drinking clean
water reduces the risks of diarrhea
for babies and divides the rate of
ENTREPRENEURS
“It is very important that we act
locally, by inspiring someone from the
community to become an entrepreneur,”
resumes the founder. “It reduces the cost
of delivery for example.” Each station
can be managed by a single operator,
who takes care of every step of the pro-
cess: pumping, filtration but also trans-
to purify water, but also how to do the for the project, following in Burma
accounting of the operation.” and Bangladesh’s footsteps, which now
At the end of the training period, look favorably on the private initiative.
the operator is almost independent. To this day, 1001 Fontaines has 350,000
They are still attached to the regional beneficiaries and hopes to reach the
platform, ideally located within less million before 2020. 
than a day’s journey. Every month, By Charles Faugeron
they pay a royalty to eventually 1. 0.4 gallons.
Access to clean water reduces school absenteeism.
become the owner of the tools of their 2. See pages 116-117.

106 HEALTH TOMORROW 107


E
ven though Medtech
was thriving, you
left it for Quantum
Surgical. Why?
B. N.  : For over twelve
years, Medtech has
designed robots for assisting in mini-
mally invasive surgery on the central
nervous system, on the brain and
spinal column. The corporation has
earned twenty million euros, joined
the Stock Market and gained a world-
wide reputation. Despite this success,
we sold Medtech to the Zimmer Bio-
met group last year to develop Quan-
tum Surgical. We want to explore the
potential of minimally invasive surgi-
cal assistance in parts of the body that
remain inaccessible. Personally, it is
the desire to endeavor, to create and to
take up challenges that made me want
to embark on this adventure.
Robotized assistance presents
numerous advantages over
classical surgical techniques.
What are they?
B. N.  : Robotics occupies an increasingly
important place in modern medicine.
It can be applied to most surgical acts,
on almost all the zones of the body. For
practitioners, this technology makes
operations more precise, shorter and less
risky. From the patient’s side, these ope-
BERTIN NAHUM rations are less painful, as the incisions
are quite small. Thus, brain surgery can
Mister Robot
be done through a tiny hole in the skull
thanks to robotic assistance. In terms of
post-operative recovery, it changes eve-
rything! The risk of infection is limited,
With his famous robots, Rosa and Brigit, Bertin Nahum has made his mark pain is reduced, as well as the length of
hospitalization. Lastly, for health sys-
on the surgical robotics sector. Avid to further explore the medicine of tems, it is time and money saved.
the future, this Franco-Beninese genius has now left his corporation,
Medtech, to launch Quantum Surgical. Here is an interview and an exercise in What place do robots currently
occupy in medicine?
looking forward with France’s “Mister Robot.” Can they really benefit everyone?
B. N. : These
tools are already present in
many hospitals and clinics throughout
fr.wikipedia.org/wiki/Bertin_Nahum the world. In many countries, particu-
© DR
© DR
larly in so-called developed countries,
108 HEALTH BOOK
“To prepare for
the surgical act,
some foresee
the coming of 3D
virtual clones
of the patient.”
the number of patients has risen due to
the lengthening of life expectancy. In
addition, patients have become actors
in their care pathway and now demand
excellent, trustworthy solutions.
It is within this framework that
robotic assistants often find their use-
fulness and their meaning: they allow
us to adapt to the growth and democra-
tization of minimally invasive surgery
that we have seen over the last twenty
years. These tools can also compen-
sate for the lack of medical personnel.
However, large opportunities remain
to be taken advantage of. The current
challenge is to make these technologies
accessible in all countries and to make
them a common good.
How exactly can we build
a more egalitarian planet,
notably in access to care?
B. N. : Innovation must not be reserved
for the privileged, but, on the contrary,
should be a solution to better distri-
bute care. For cutting-edge techno-
logies and for healthcare in general,
these challenges call for strong politi-
cal action. By developing telemedicine
and outpatient surgery, by opening
up medicine, we can contribute to the
creation of a more egalitarian world.
Although it is imperative to continue
to invent. I think that is essential to
reach as many people as possible.
How do you imagine the evolution
of surgery?
B. N.  : The influence of computing and
artificial intelligence will grow. Projects
are already underway to develop minia-
4 | BUILD
turized robots that will further reduce
the invasive character of operations.
Some nanobots could even be program-
med to navigate inside our organism, to
deliver medicine exactly where the doc-
tors wish or to confirm a diagnosis.
There are teams working on creating
enhanced reality glasses to better assist
the surgeon. Finally, to prepare for the
surgical act, some foresee the coming
of 3D virtual clones of the patient.
Intelligent tools are starting to become
indispensable in hospital blocs. With
Quantum Surgical, we are fully involved
in this tendency to respond to the great
challenges of medicine.
What advice would you give
someone who wanted to invest
themselves in the healthcare
of tomorrow?
B. N. : I would advise them above all to
keep the patient in mind. By taking
an interest in people, in their needs
and hopes, you can create solutions
to improve lives. I also think that it
is essential to “get your hands dirty”
at some point during your career. My
experiences in the operating room have
been decisive for me, which is why I
always made sure that my collabora-
tors, from software developer to assis-
tant, get to observe an operation.
Who are the people who have
inspired you?
B. N. : In my life, I was forged by Denise
Avédiguian, an important figure in
the world of savate.1 She instilled me
with essential and imperishable values
that accompany me in daily life. On
a less personal level, I am inspired by
the strength and vision of Elon Musk,
whose endeavors and inventions I fol-
low very closely. More largely, I am sin-
cerely and profoundly moved by each
patient that we have been able to help
get better. They are encounters that you
never forget and that transform you.
By Fleur Weinberg
1. French boxing.
109
CHAPTER 5

CARE
5. CARE
H
ow are blind
people taken
care of in the
world today?
A. H. : There are over
285 million visual-
ly-impaired people in the world. Among
them, 39 million are permanently
blind. In developing countries, two
thirds of those cases could be avoided
or cured through surgery or education.
In developed countries, where most
people affected with blindness are over
65, the situation is different. There have
been considerable medical and techno-
logical advances in recent years. Nowa-
days, GPS technology helps visually
impaired people move more easily. A
charter from the United Nations and
anti-discrimination legislation are also
facilitating the inclusion of blind people.
Nevertheless, a majority of the
population is still reluctant to interact
with anyone who is visually-impaired.
But there is no better way to fight this
prejudice than to meet someone who
developed special skills because of
their blindness. This is exactly what
we are doing. Our goal is that a blind
man or woman might be considered as
someone with different abilities rather
than as a disabled person to be pitied.
Dialogue in the Dark turns the
tables. How does that switch
between roles happen?
ANDREAS HEINECKE
A. H. : First you buy your ticket. The
experience takes place with groups of
eight sighted people, each getting a
Take the Blind Test white walking stick of the kind used by
blind people. After a short introduction,
you walk through a series of pitch-black
rooms. Each of these rooms was speci-
With Dialogue in the Dark, professor Andreas Heinecke puts sighted people in fically designed: scents, sounds, wind,
the shoes of the visually impaired and blind, by immersing them in the dark during temperature and texture recreate speci-
temporary exhibitions. It is an extraordinary experience which reveals the everyday fic environments of everyday life, like a
park, a city, a market, or a boat cruise.
challenges and the exceptional abilities of visually impaired people. In the beginning, you are scared, diso-
© G2 BARANIAK
riented, because of course this is new to
you. You can no longer make out the
Dialogue-in-the-dark.com people around you and worry that you
112 HEALTH TOMORROW
won’t make it to the end. It is brutal, but
it is crucial for experiencing the world of
the visually impared. Guides assist you
along your journey. As they are visually
impaired, they share their experience as
well as their skills with you.
Little by little – and this is where it it
gets incredible – engaging in a dialogue
with the blind guides helps you adapt
and move around despite the darkness.
It is through this exchange of roles that
you can really acknowledge the excep-
tional nature of the skills they have
developed because of their condition.
The concept has become famous,
have you ever doubted its success?
A. H. : Many people thought I was crazy,
whatever did I want to put people in
dark rooms for ? People also questioned
the ability of the blind helpers to carry
“Little by little –
and this is where
it gets incredible –
engaging in a
dialogue
with the blind guides
helps you adapt
and move around.”
out their task, as well as their safety. Yet
these reactions are better understood as
signs of interest towards the project.
Aside from public opinion, on a per-
sonal level, it took me ten years to deve-
lop this project, especially to ensure its
profitability despite my total lack of
business skills. I didn’t have a penny to
my name, but deep down I knew that it
mattered to make this experience pos-
sible. Today, Dialogue in the Dark has
toured in over 44 countries throughout
Europe, North America, Africa and
Asia. More than nine million visitors
have been guided through the exhibi-
5 | CARE
tion and have learned to see in the dark,
with the help of thousands of visually
impaired guides.
How do you reinvent
the exhibition’s experiences
after 27 years?
A. H. : They are in constant develop-
ment, because each experience is
unique. Every time, we have to adapt to
the context and conditions of our local
partners. You don’t organize a Dialogue
in the Dark the same way for a multi-
national worth billions or for a Kenyan
NGO struggling to pay its bills. It is a
totally different story. The experience
has to have a balanced and positive
outcome for each partner.
Our approach has been introduced
in business schools and in many
companies. We propose several for-
mats of events, supervized by visually
impaired people: personal development
workshops, leadership training, com-
munication or debates on diversity.
Within our own structure, we try to
strengthen the self-esteem and skills
of visually impaired people. We have
also adapted our methodology in order
to work with profoundly deaf people
and seniors.
How did the idea for this project
come to you?
A. H. : I was finishing my PhD and wor-
king in a radio station. One day, my
boss asked me to train a young journa-
list who had recently lost his sight in a
car accident. At the time, I had no idea
what a blind person was capable of.
During the two-year training period I
spent with him, I was impressed by his
abilities. It helped me become aware
of the tragic misunderstandings sur-
rounding visually impaired people in
German society. I decided to leave the
station and join an organization wor-
king with blind people. This is how
Dialogue in the Dark began. I became an
entrepreneur by accident.
By Timothée Vinchon
113
5 | CARE
BOLEWA SABOURIN
The Man Who Makes People Dance
At 32 years of age, Bolewa is using dance to help Congolese women
reconstruct their lives after rape. This renowned artist has created
the association Loba around the marriage of art and activism, which crystallised
as the result of an encounter with Doctor Denis Mukwege.
T
he son of a Congolese
dance instructor
and of a mother who
was a student of his
father's, Bolewa was
born in Paris. He
spent a few months there before his
father took him from his mother to
“perfect his education in Congo”. Soon
after his return to his hometown at the
age of 6, he left to spend several years
in Martinique. It was a childhood in
motion, sometimes even of wandering.
He says he turned it into a strength: “I
love to move; being in constant motion
has become a drug for me.”
Bolewa has another drug: dance.
Dancing allows him to express what he
feels and make up for his lack of sta-
bility. Dancing has also allowed him to
find love. “Although the color of my skin
has sometimes scared people, I became
a sex-symbol as soon as I danced,” jokes
Bolewa. “Through dance, I shined eve-
rywhere, which built me up.”
ACTIVISM
The dancer has always tried to raise
awareness. When he first sought to
change his surroundings, he turned
to politics, setting up several collec-
114 HEALTH TOMORROW
facebook.com/recreationloba
tives to train young people from Pari-
sian working-class neighborhoods in
citizenship. “The way you are seen as a
young person from the hood gives you the
impression that you are living in a parallel
world where some have the right to pass
unperceived while others would always
be seen as dangerous,” analyzes Bolewa,
who fights against this servitude with
his association Loba. He refuses the
notion that these young people should
grow up thinking that they are a threat
and helps them to expel this mindset
through dance.
Charged with a youth mission for
the city of Paris, he left everything
in 2012 to better discover Congo and
Africa. He wanted to see Africa again,
this place that people did not stop talk-
ing to him about but of which he had
very few memories. The road-trip was
challenging, physically and psychologi-
cally. “I found myself alone with my pro-
blems, reflecting.”
“I came back to Paris metamorphosed,
reconciled with all that I was.” Bolewa
continued dancing and working for
three years in social integration. He
also returned to school, to validate
his experience, and obtain a master’s
degree in political science.
After having discovered a film by
Doctor Denis Mukwege, The Man Who
Mends Women, Bolewa attended one of
his conferences in Paris, on March 8th,
2016.1 “It was a revelation.” The doctor
spoke of his work for the psychological
reconstruction of Congolese women
who were victims of rape and mutila-
tion. He noted that the Western aid
intended for them did not free their
voices in the same way as in better-off
countries. “Dancing and singing have
always been the means for women to libe-
rate themselves, it is universal. I decided
that this is what I would do with this
man,” confides Bolewa, who reached
out to the doctor during the confe-
rence. “I told him that I couldn’t intervene
in the political field, that I wasn’t a doctor,
but that I wanted to help with something
new.” Mukwege did not react immedia-
tely. However, after the conference,
the doctor sought Bolewa out directly,
questioned him on his art therapy pro-
ject and asked for a detailed proposal.
80 % of the world’s coltan reserves
are found in the East of Congo. It is an
indispensable resource for digital tech-
nology which allows the fabrication
of the chip that safeguards our infor-
© DR
mation when a telephone runs out of
“Dance has always
been my guiding light
and has permitted
battery. “To chase inhabitants away from
coltan quarries, militias rape and muti-
late very young girls,” explains Bolewa.
me to exteriorize
what I feel.”
According to a study by the American
Journal of Public Health, an estimated
1,152 Congolese women are victims of
sexual violence every day. Traumatized,
families flee and abandon their lands.
“Involving myself in the question of these
Congolese women brings it all together:
my origins, dance and the way women are
treated.” After his encounter with Denis
Mukwege, Bolewa decided to leave his
job, fine-tune his project, and brought
aboard two friends, a journalist and a
photographer. They then headed for
Congo. They arrived at the Panzi Foun-
dation, founded by Doctor  Mukwege
in Bukavu. It is a place where women
come to rebuild their lives, to take per-
maculture and computing classes and,
above all, to learn to read and write.
ART THERAPY
Dr Mukwege treats the bodies woun-
ded by these atrocities but too often the
psychological wounds remain. To treat
these wounds, Bolewa is convinced that
dance is a solution. He thus developed
a six-month dance program, in parallel
with a course of therapy, allowing
women to work on their self-esteem.
Bolewa relied on crowdfunding from
France – over 15,000 euros for this pro-
ject, baptized Re-Creation by Loba.
“In the beginning, the women who
followed the course of treatment were
impressed that a young Black person
came to dance with them and was inte-
rested in their fate.” But this curiosity
soon transformed into success. “Some
women volunteers, once they were surer
of themselves, created a dance company
to pass it on to other women and to call
out to all the populations of the world
concerning their condition,” explains
Bolewa, thinking back to the clamour
of 200 women who, on a dance set, let
out an immense cry of deliverance.
By Fleur Weinberg
1. International Women’s Day.
115
5 | CARE 4. CARE

BINDESHWAR PATHAK therefore a profitable investment, and

some turn to microfinance to equip them-
selves with it. We haven’t received any
He Frees the Untouchables subvention or donation.”

with Toilets FROM TOILETS

TO EDUCATION
But the devil is in the details, since
installing clean toilets can sadly
Born into the high caste of Brahmins, Bindeshwar Pathak deprive the untouchables of a source
has dedicated his life to the emancipation of the untouchables in India. of revenue, acknowledges the doctor.
His weapon: low-cost and ecological toilets that free them from degrading “This is why it is important to let them
practice another trade. We have opened
cleaning tasks. Today, 1.3 million of these toilets have already been installed. an education center where we teach them
to read and write English for free. We also
train them, in sewing or rug weaving,
sulabhinternational.org for example. We organize meetings and
exchanges with members of other castes.”
Of course, it is a question of providing
them with a livelihood, but also with

W
hen he was
a child, a
w o m a n
from the
Dalit caste,
also known
as the untouchables, often came to drop
off bamboo utensils near Bindeshwar
Pathak’s home. Every time, his grand-
mother sprinkled the house with holy
water and reminded him never to
touch her, for he would be sullied. “I
was curious,” recounts Pathak. “One
day, I ventured to touch her. Obviously, I
didn’t fall ill. Nevertheless, my grandmo-
ther wanted to punish me. On the advice
of the Pandit,1 she made me swallow cow
urine and dung. That was when my revolt
was born.”
After studies in sociology in the
state of Bihar, Bindeshwar Pathak
initially had a string of odd jobs. In
1968, he joined the committee for the
celebration of Gandhi’s centenary. To
perpetuate the Mahatma’s struggle,
they asked him to work to improve the
conditions of the untouchables, who
often earn a living by cleaning up the
three months, I lived with the untou-
chables in the region of Bettiah. My father,
who is like me a member of the high caste
of Brahmins, was furious, but I continued,
and it was in 1969 that I developed a sys-
tem of low-cost toilets that allowed the
problem to be tackled.” A year later, he
launched his NGO Sulabh International
to spread this technology.
DOUBLE TANK TOILETS
Doctor Bindeshwar Pathak tackled
an old problem. Since the Vedic
period, 3,000 years ago, Indians were
taught not to defecate near human
dwellings. “This cultural heritage is still
present, and the practice of defecating
in the open is very widespread in rural
India, where 65 % of the population is
lacking basic sanitation,” he explains.
The result: major water pollution pro-
blems that foster the development of
numerous illnesses such as cholera,
diarrhea, dysentery or typhoid. It can
also undermine the security of women,
who must leave the village alone and
expose themselves to insect attacks or
rape. Some children give up on going to
But how do Bindeshwar Pathak’s
famous toilets work? “My toilets are
composed of two tanks that are used in
rotation. When one is full, generally at
the end of three years, we let it rest and
use the other. The accumulated excrement
in the first tank then decomposes little by
little into an odourless and safe mud that
can be used as a fertilizer for agriculture.”
The tank also produces biogas, which
can be used for cooking or lighting.
As a bonus, only 1.5 liters of water are
needed for rinsing each time someone
uses the toilet. “It is therefore a solution
both economical and ecological,” deems
Bindeshwar Pathak.
The proof is that around 1.3 mil-
lion of these toilets now equip homes
in India. “The government has financed
the construction of 54 million toilets, ins-
pired by our model,” adds Bindeshwar
Pathak. China, Bangladesh, Vietnam
and many other countries also adop-
ted this technology. “In the beginning,
it was unusual for Indians to pay for
toilets. But the biogas and fertilizer pro-
duced by our technology make it possible
to fully reimburse the cost of emptying
© DR
autonomy and self-confidence. “It is
only in this way that we will succeed in
emancipating the untouchables.”
Enormous problems of discrimi-
nation subsist, and not only against
Dalits. Bindeshwar Pathak therefore
wants to work to improve the fate
of widows. “Some are stigmatized,
they do not have the right to work or
to participate in religious festivities.
They aren’t untouchables, but it is as if
they were.” Sulabh International gives
them food and healthcare, and offers
them an education. The NGO has also
gotten the law changed so that they
could participate in Holi, the Indian
festival of colors. At the ripe old age
of 74, the man is confident for the
future of his country. “Untouchables
have entered Parliament, they occupy
skilled professions and today they eat a toilet museum
with Brahmins.” Just as these lines in new delhi
are written, Indian members of Par- Time magazine has ranked The International
liament are getting ready to decide Museum of Toilets among the ten strangest
between two candidates for the pre- museums in the world. Launched by Sulabh
International, it brings together historical pieces,
sidency of India. Whatever the out-
documents and anecdotes concerning sanitation
come of the vote is, it will be a victory
from 2 500 B.C. to today. There, one can discover
for the doctor’s cause: both men are Louis XIV’s “toilet-throne” or learn that the most
untouchables. expensive toilet in the world was bought for
By Côme Bastin 19 million dollars by an extravagant billionaire.

trash and excrement of others. “For school because there are no toilets. the tank and even to turn a profit. It is 1. A Pandit is a Brahmin scholar or teacher.

116 HEALTH TOMORROW


SURTITRE How do you help the deaf
communicate with others?
J. O.  : Imagine that you are deaf, and
« TITRE » you want to buy clothing in a store.
You want to know if a size or color is in
stock, but you can’t ask the salesperson.
Chapeau Thanks to the Internet and a touchpad,
you can connect with our sign language
interpreters visually. Then they “trans-
late” your request orally for the sales-
person. In the same way, if you need to
call the police or emergency services,
you can contact our call center to have
them transmit your request orally. Our
Texte courant technology can also be used at work or
in a public service.
What is your business
economic model?
Today, ShuR Group is based in
J. O.  :
Tokyo with thirty employees, two of
JUNTO OHKI whom have impaired hearing. Our
particularity is to be a business and a
non-profit organization at the same
Dialogue of the Deaf time. We work with structures that pay
a fee for our service.
Many businesses want to recruit
Although able to talk amongst themselves through sign language, it is often deaf people but they need quality trans-
lation at an affordable price, in particu-
impossible for the deaf to communicate with others. In Japan, Junto Ohki lar for the signature of a contract. Thus
has set up a platform to allow them to make themselves understood at work or JNTO, the principal Japanese rail com-
to call for help by telephone. In parallel, his business ShuR Group pany, calls on us, but so does Adidas as
well as banks and department stores. It
has initiated a participative dictionary that could soon benefit the hearing... is fundamental for deaf persons to be
integrated. We also work with govern-
mental offices, which use our services
shur.jp/en to be able to communicate with all of
their citizens.
You speak of an online dictionary.
Y
J. O.  : It is a video database that lists
the different signs used by the deaf to
ou aren’t deaf. interpreted songs into sign language In 2008, I launched Shuwa1 Net. express words in Japanese. We have
How did you for a musical competition. Thanks to a group of volunteer trans- identified over 3,000 words, which
become interested As I progressed, I became aware of lators, this platform let the deaf com- makes it the biggest in the world. It
in sign language? the numerous problems that the deaf municate with hearing interlocutors resembles a dictionary, but it is more
J. O.  : I was 20 years community faces in daily life. For exa- and vice versa. Then, I realized that than that, as we use crowdsourcing.
old and a student at mple, to make a telephone call, they volunteer work wasn’t enough if we In practical terms, all the users can
© G2 BARANIAK
Keiō University. I started to learn sign could use video to talk with another really wanted to change the daily lives participate in the improvement of the
language out of curiosity, but little by deaf person, but they could not call the of these people. I decided to make a database, somewhat like Wikipedia. It
little it became a passion. Notably, I police or an ambulance. business out of it, ShuR Group. is important because, in sign language,
118 HEALTH TOMORROW
“In the same way
that radio and
TV have contributed
to unifying
oral languages,
the Internet will
contribute to the
unification of sign
languages.”
there is less vocabulary than in spoken
language.
So the users can add new signs
to the platform.
J. O. : Yes, but they aren’t satisfied just
adding current signs. They create new
ones for words that exist in oral lan-
guage but not in sign language. For
example, Sony hasn’t imagined a sign
for the PlayStation. The same goes
for the iPad, Microsoft or Ashoka. So
who should invent them? Who has the
legitimacy to decide for the deaf as a
whole? On our platform, the users can
propose a sign by recording it by web-
cam. Others can then react to the video
and add suggestions. The objective is to
think up a democratic process to enrich
the language. Last year, we won the
Rolex Award for our work.
There are over a hundred
different sign languages
in the world. How come?
J. O.  : For the same reason that there
are numerous spoken languages. Two
or three centuries ago, the deaf started
to come together in different schools,
country by country. Sometimes, there
were several schools –  and therefore
several sign dialects  – within a single
nation. In fact, the deaf use a voca-
bulary deeply anchored in the culture
they were born into. To say thank you,
the Japanese were inspired by a sumo
5 | CARE
salute, while Americans “blow” a kiss.
All in all, 45 million people use a sign
language. If they were brought together
into a single nation, they would be the
28th most populous in the world! The
problem is that there is no common
sign language to allow them to unders-
tand each other from one country to
another. This impedes working, or even
travelling, internationally.
Can the Internet change things
for deaf people?
J. O.  : The history of spoken language
is very different. To write a word,
we have long had letters. However,
until the arrival of video, the deaf
were unable to “write” their signs.
The media is also different. We have
a newspaper and a radio station to
spread our vocabulary and our ideas.
In Japan, there is a daily program for
the deaf, but it is only fifteen minutes
per day. With the Internet, all that has
completely changed. It is now pos-
sible to easily exchange videos dubbed
in sign language. In the same way that
radio and TV have contributed to the
unification and spreading of oral lan-
guages, the Internet will contribute
to the unification of the languages of
the deaf.
How does your platform
accelerate the process?
J. O.  : In this interview, we are using
Skype to speak in English, although
you are French and I am Japanese. We
want to develop our platform in order
to make the same thing possible for the
deaf. If tomorrow we have Japanese,
American, French and Indian versions,
our dictionary will allow the exchange
from one language to another. And
then, who knows? Maybe someone will
find a way to use artificial intelligence
or virtual reality to go even further.
The time has come for sign language to
be broadcasted!
By Côme Bastin
1. The Japanese word for “sign language”.
119
5 | CARE 4. CARE

KATHERINE FREUND Texte courant

Senior Transportation
In the United States, a lack of public transport services forces the elderly
to continue driving, putting themselves and the lives of others at risk.
Katherine Freund launched ITNAmerica, a community-based transportation
network for seniors. Present in 27 cities, this “Uber-like” service has totalled
four million kilometers on board its vehicles.

itnamerica.org
“In 2030, one out
of five Americans
will be over the

F
or Katherine Freund,
this project was born
from an accident. In
1988, her three-year-
old son was seriously
injured by a visually
impaired senior driver who mistook
him for a stray dog. Instead of let-
ting hatred overcome her, she decided
The community-based mobility
network enables people too old
to drive to move around.
to analyze the cause of this tragic
event: the glaring lack of public trans-
portation in a nation with an aging
population.
In 2030, one out of five Americans
will be over 65 years old. Yet, in the
land of the automobile, cities are built
around road networks that are ill-
suited to the needs of older people. As
for buses and subways, they are rare
and concentrated in heavily populated
areas. As a result, “people are forced
to drive, even when they shouldn’t, in
order to remain independent,” explains
Katherine Freund. “After losing their
driver’s license, they are left with an ave-
rage life expectancy of only ten years.”
How can we avoid choosing between
road safety and the mobility of seniors?
After studying Public Policy at the
Edmund S. Muskie School, Katherine
Freund came up with an alternative:
ITNAmerica. This community-based
independent transportation network
boasts over 4,000 active members who
drive elderly people and adults with
visual impairment living in remote
areas of the United States.
PRESENT IN 27 CITIES
Isolated seniors can reach “Rides
in Sight”’s call center 7 days a week,
24 hours a day. The drivers, often
volunteers, help them visit friends,
shop or see their doctor. A pioneer in
the sharing economy and a spokes-
person for inclusive mobility, Kathe-
rine Freund is convinced that “the
© DR
crossroads of technology, information
and social capital.”
Launched in Portland, ITNAmerica
is now present in 27 cities throughout
the United States, and has logged
over four million kilometers1 driven
on board its vehicles. It has even been
nicknamed “Uber for grannies,” which
Katherine Freund is not really fond of.
“We provide seniors with the ability to
move around safely for half the cost of a
taxi, using private cars, but that is not all
we do.”
ITNAmerica is a non-profit commu-
nity whose members pay dues accor-
ding to their means. To finance their
daily trips, passengers can, among
others, prepay online or trade the rides
they no longer use for credits. “Some
cities can subsidize our local activity,”
details the founder. “Stores and health
centers can help pay for rides to get to
them using our network.” If you are a
volunteer driver, you get credits that
can be stored for later use, given to
relatives, or gifted to the Road Scho-
larship program, which helps low-in-
come seniors pay for their rides.
The movement that Katherine
age of 65. Yet, in
the land of the
automobile, cities
are built around road
networks that are
ill-suited to the needs
of older people.”
communities of drivers, connec-
ted through the ITNRides software.
It links them to a central network
that manages transport logistics,
volunteers and planning rides.
In addition to seeking new drivers,
ITNAmerica works with partner orga-
nizations. “In the last two years, we have
added twenty-one transportation compa-
nies as our trusted partners and we will
add more. They complete our fifteen exis-
ting affiliated communities.”
FREE HEALTH SERVICES
The social enterprise also develops
partnerships to ease seniors’ access to
health services. “We get funding to pro-
vide them with free medical care, notably
work on a program to help seniors bring
their pets to the vet.”
But for ITNAmerica, the big challenge
is to cover the rural areas, where there is
a lack of both public transportation and
drivers likely to help seniors. “Population
is sparse, trips are longer, and thus less
profitable,” explains Katherine Freund.
In 2010, she launched ITNCountry to
remedy this.
Built on ITNAmerica’s software
suite, it offers a customizable ver-
sion. Local communities can buy it at
reduced costs to set up their own ser-
vice of car pooling, shared cars and
volunteer driving. Here, every trip and
every car seat also helps getting aging
populations out of their rural isolation.
“We need to become to mobility what
eBay is to sales,” the founder sums up.
More than a transport network for
seniors, ITNAmerica is now a societal
expertise tool. Length of trips, desti-
nations, types of vehicles used: its sof-
tware stores all the details in a secure
data center. Once anonymized, this
data is being used in studies to better
understand seniors’ needs.
By Charlotte Sarrola

hope for low-density areas lies at the Freund launched encompasses various ophthalmological treatment. And we 1. Over 2.3 million miles.

120 HEALTH TOMORROW 121

5 | CARE
W
hat led you
to launch
Ikambere?
B. R. : When I was a
child in Butare, in
Rwanda, I wanted
to become a doctor to save lives. But in
our country, we don’t choose our stu-
dies, instead the government decides. I
arrived in France in 1989 to take classes
in anthropology. Within the framework
of my master’s thesis, I met numerous
women with AIDS in Paris.
I was thus confronted with people
in distress, vulnerable to the worst
infections on the planet. Being black-
skinned like them, I succeeded, little
by little, in gaining their trust. I helped
them within the framework of the orga-
nization Sol en Si.1 In 1997, I decided
to launch Ikambere –  “The Welcoming
House” in Rwandese  – to break their
isolation. Back then, we only had a tiny
apartment of 74 square meters, not far
from the “cité des Cosmonautes” in St.
Denis. We just wanted these women
to be able to sit somewhere, take their
medicine, and see that others shared
their fears, such as infecting the child
they were carrying.
Tell us more about the situation
of the women you help.
B. R.  : For them, being far from their
BERNADETTE RWEGARA country adds to the spiral of lies told
to their families. In addition to being
This Is Your House
HIV-positive, they are often migrants,
illiterate and quite precarious. Some of
them have left their native land, des-
pite having a comfortable situation, to
In 1989, Bernadette Rwegara arrived in France for her studies in anthropology. be treated in France. Once here, they
find themselves without resources.
During her research, she was outraged by the fate reserved to African women They fight, for better or for worse, to
suffering from AIDS. To help them rebuild their lives, she opened a small home, make a place for themselves in a society
Ikambere, “The Welcoming House” in Rwandese. The organization, based in where women have a hard time getting
recognition and where those carrying
Seine-Saint-Denis, has helped 2,500 HIV-positive women since...
© HERBERT EJZENBERG
the AIDS virus are excluded.
What are Ikambere’s fields
ikambere.com of action?
B. R. : Solidarity is the very essence of
122 HEALTH BOOK
“The irrational fear
of HIV is still quite
strong, and many
of the women that
we take in feel
ashamed. There is
still a lot of work
to do, but we are here
to change things!”
our action. Ikambere allows women
to have a job, social aid and housing
to manage their sickness in peace.
We have developed several projects
to guide them toward autonomy: job
placement, halfway houses, preven-
tion, education, and more. Ikambere
offers global care to these vulnerable
women. The objective is to lead them
to a realistic professional project, so
that they can have a roof over their
heads and pay for their own needs.
Since 1997, Ikambere has helped over
2,500 of them.
What happens in the activities
that you share with them?
B. R.  : Every day, several workshops
allow women to form a community and
to build a social network. We propose
activities such as fitness, sewing, hair
styling, cooking, esthetics, reading or
computing. This gives them the much
needed self-confidence to begin rebuil-
ding their lives.
Lunch is a high point of the day
when the women come together. It is a
moment of conviviality, meant for sha-
ring experiences, but also for raising
awareness. Prevention is indeed ano-
ther pillar of Ikambere, not only for the
women we take in, but also for several
hospitals and migrant shelters.
How do you work with public
authorities and the hospital
system?
B. R. : We work with thirteen hospitals
in the Paris region, above all during
office hours, when we introduce our
mediators. We meet the sick people
coming in for a consultation who
wouldn’t dare turn to an association
and break their isolation. We offer them
5 | CARE
a space of listening and support. This
allows them to speak of their anxieties
and to better live with their disease.
Those who are hospitalized also receive
visits from the health mediators, who
can bring them a much-needed meal.
Sometimes, they even ask doctors to
clear up certain situations.
Is there a story you are
particularly proud of? 
B. R.  : In 2004, a woman who didn’t
know how to read or write showed up
in Ikambere. She had lost her husband
and her two children. It was difficult
at first because the organization had
housed her in a hospital. Her obstacle
race started with learning to read and
speak French. She progressed very qui-
ckly and then began the training pro-
grams. At the end of two years, she had
her papers in order and passed a job
interview to work at Carrefour super-
market. Today, she is a cashier and
earns a living. She perfectly masters
computing, she writes about exotic
products, and she wants to evolve pro-
fessionally. Recently, she even obtained
professional certification to work in
early childhood care. It is this kind of
story that gives us the strength to keep
fighting to develop the organization.
How has the way people look at
AIDS changed since you began
your action?
B. R.  : The preventive actions led in
recent years have alerted the general
public to the dangers of the disease
and the risks of infection. But sadly,
I don’t get the feeling that the way
HIV-positive people are seen has
changed much in twenty years. The
irrational fear of HIV is still quite
strong, and many of the women that
we bring in feel ashamed. There is still
a lot of work to do, but we are here to
change things.
By Côme Bastin
1. Created in 1990, this french association
helps children with AIDS and their families.
123
5 | CARE

MIGUEL NEIVA
The Esperanto of Colors
Although 350 million people in the world suffer from color blindness,
science remains powerless in the face of this handicap. To address this challenge,
Portuguese designer Miguel Neiva has developed a language that turns colors
into symbols. From the Porto metro to colored pencils, this code, already used in
250 media outlets, simplifies the daily lives of color-blind people.

coloradd.net
The NGO ColorADD
often performs free
interventions in schools.

W
hy is color
blindness such
a complex
condition?
M. N.  : Because
there are many
types of color blindness. Some people
cannot tell two colors from one ano-
ther, while others only perceive black
and white. 350 million people in the
world are color-blind, and only 20 %
of them realize it before the end of
their twenties. Neither medicine nor
technology has succeeded in addres-
sing this question. I told myself that I
had to look at the problem differently.
Rather than trying to treat the condi-
tion, why not try to improve the way
society integrates color-blind people?
I began my research by interviewing
150 color-blind people from all over
the world in order to understand their
needs. I asked them about the everyday
life-hacks they used to succesfully iden-
tify a color they didn’t perceive, while
picking up clothes, spotting a specific
medication or reading a traffic sign.
for the color-blind.
How does it work?
M. N. : I simply went back to the things
we all learn in nursery school: the
combination of primary colors, black,
and white is enough to obtain every
imaginable colour. While the color-
blind cannot correctly identify some
colors, they have no trouble at all
identifying shapes. So I associated a
visual symbol to each primary color.
Shapes can be mixed in the same way
colors are. With the help of these
three symbols, it is possible to indi-
cate any possible color. The thickness
of the frame helps to point out diffe-
rent shades. Of course, it is still hard
to identify the specific shade of red of
a Ferrari, but at least we can know its
general color.
What makes
this method universal?
M. N.  : If our sole purpose was to ima-
gine a code limited to Portugal, we
might just as well have written out
the names of the colors on the objects
themselves. But we wanted to create
a system that evryone in the world
could understand, through the use of
universal symbols. However, this lan-
guage will only become prescriptive if
society adopts it, if it gets integrated
into locations and situations where
colors matter. To pursue this goal,
we have trained a team and set up a
business model. In order to be able to
© COLORADD
Do you collaborate
with public authorities?
M. N.  : Of course. We are already col-
laborating with municipalities to
schedule awareness programs in
schools through our NGO, ColorADD.
To work closely with the authorities
is essential in order to help our pro-
ject grow. We also cooperate with the
Ministry of Education, Health, Sports
and Youth, as well as directly with the
Presidency of the Republic. It is fun-
damental for such public entities that
everyone is able to understand them.
They have a duty of exemplarity in
terms of inclusiveness and anti-discri-
mination policies.
How can you ensure
the widest adoption
of the system?
M. N.  : We try to progress cluster by
cluster, to show that this new idea is
already brilliantly put to use by other
structures. For example, the subway
system of Porto has integrated our
code into its boards and signs. Every
“While the color-
blind cannot
correctly identify
some colors, they
have no trouble at
all identifying
shapes. So I
associated a visual
symbol to each
primary color.”
helps us attract other public trans-
portation systems in the world: at
the moment, we are working on the
implementation of ColorADD in the
underground railway systems of Lon-
don and Madrid. As of today, we are
approaching five or six large interna-
tional groups working in transport,
school materials, textiles, healthcare
and games. These have come up as the
What is the impact of
the project so far?
M. N. : It remains difficult to precisely
calculate the number of beneficiaries,
because the code is not only spread
to the color-blind, but to everyone.
But we started four years ago with
colored pencils; and today we have
established more than 250 different
partnerships, in order to maximize
the chances of reaching every color-
blind person.
Can design solve a public
health issue?
M. N.  : I have always thought that
designing should not be reduced to
making beautiful objects. I see it as
a tool for building a better world. In
my case, colors were my raw mate-
rials, and I decided that I had to do
something with them. A few months
ago, one of the greatest ophthalmolo-
gists in the world declared that Colo-
rADD was the very first remedy ever
conceived by a designer. And he added
that it was a non-toxic, democratic,

display ColorADD on their products, single metro line has a different color key sectors to reach in order to ensure a inclusive and free piece of medication.
This is how you came up companies pay us a royalty, according code and those symbols are very use- massive adoption of the code by a large I was quite touched.
with the ColorADD language to their size. ful, even to foreigners. Porto’s success section of the color-blind public. By Timothée Vinchon

124 HEALTH TOMORROW 125

2. MAKE
W
hat exactly is
dementia?
H. W.  : Dementia
is a degenerative
brain disease
that makes it
impossible for the patient to manage
his daily life on his own. Recent dis-
coveries concerning dementia have
attracted more scientific attention
than ever before. But when it comes to
the experience of living with demen-
tia, our knowledge is still embryonic.
No one survives dementia to tell us
about it.
Furthermore, loved ones are often
so overwhelmed by symptoms such
as passivity or incontinence that they
might suffer from mental illness them-
selves. This is due to the complexity
of the patient being unable to request
adequate support, while relatives often
fail to understand or answer their
needs. There are roughly 80,000 people
suffering from dementia in a small
country like Norway.
What got you interested
in this field?
H. W. : I used to work for an innovation
center helping entrepreneurs to scale
up their technology. Then, one day, my
father was diagnosed with dementia.
I founded Noen to hire people to help
HEIDI WANG me support my father so that he could
carry on his daily life with dignity, as
Guiding Through Dementia
public social security and healthcare
did not offer such a service. The three
people who became my employees are
the true entrepreneurs of Noen: their
When an elderly person suffers from dementia, their family often doesn’t know efforts made me believe in and conti-
nue this unconventional form of care
how to react. In Norway, Heidi Wang has developed a method for persons with dementia. My father
of home care to help victims of neurodegenerative diseases. Having successfully never became the child we were told
attracted the attention of the government, her company, Noen, has already he would, he did not have anxiety nor
depression, he never became violent –
trained numerous “guides” who help patients and their loved ones in daily life. contrary to what the nurse had told us
to expect. After he died, people asked
me to continue Noen to provide a simi-
noen-as.no lar service to other families coping
© DR
with dementia.
126 HEALTH BOOK
What method does Noen use
in its work?
H. W.  : Our model and method use a
documented individual activity-based
treatment approach for persons with
dementia and their closest relatives.
The solutions we have come up with
are called the Noen model and the
KuPA method. They were developed
in partnership with SINTEF, one of
Europe’s largest independent research
organizations, and funded by the
Research Council of Norway.
The Noen model coordinates the
efforts of all the most critical people
involved in the patient’s care to ensure
the most effective and efficient treat-
ment possible. The KuPA method
ensures that the patient is treated with
“The Noen model
thus has a triple
upside, empowering
and bringing
health benefits
to patients, their
close relatives
and the guides.”
dignity and from a salutogenic1 pers-
pective, through person-centered care
and an empowering health-promoting
environment.
How would you describe the path
of a typical “guide”?
H. W. : Noen recruits and certifies indi-
viduals as “guides” qualified to use the
KuPA method. They are then hired by
families with all sorts of neurological
diseases leading to cognitive failure.
Our most successful guides are often
people who have been out of full-time
work, some of them for health reasons,
but who recovered the ability to work
part-time. The Noen model thus has a
triple upside: empowering and brin-
5 | CARE
ging health benefits to patients, their
close relatives and the guides.
What kind of reception do
the families give to the work
of the “guides”?
H. W. : Patients and their families have
given an unmitigatedly positive res-
ponse to the service. Our approach
consists in giving back dignity and
power to patients and their families.
However, customer surveys have told
us that this service was neither well-
known nor easily available when they
first could have used it. The surveys also
underline that the service is too expen-
sive, as families pay all the subscription
costs themselves. To cut costs, we deve-
loped a unique approach in partnership
with municipalities, combining tax
deductions with traditional “salaries”
paid to family members that together
reduce the yearly out-of-pocket cost of
home care to one thousand dollars.
What is next for Noen?
H. W.  : The biggest challenge is the
relatives’ lack of knowledge. If they
knew about the benefits of empowe-
ring people with dementia, they would
request it. We must communicate bet-
ter and find partnerships to reach out
to families with proven information
and customer testimonials. We also
want to certify KuPA guides all over
Norway (1,200 persons) to spread the
use of our service. Norwegian health-
care system must ensure that the
Noen treatment model and the KuPA
method are available as soon as demen-
tia is detected. In the future, Noen’s
method could be applied everywhere.
The model is modular, digitized and
adaptable to different organizational
and financial conditions.
By Fleur Weinberg
1. From salus- (“health” in Greek) and
-genic (“able to create”). The term “salu-
togenesis” was coined by Prof. Aaron
Antonovsky and focuses on the factors that
support human health and well-being.
127
 5 | CARE
MATHIEU LEHANNEUR
Unidentified Therapeutical Object
Whether they simulate the sky in a palliative care unit, produce pure oxygen
in a living space or stimulate the immune system, Mathieu Lehanneur’s creations are
designed to do you good. At the crossroads of science, art and technology,
this “therapist designer” wants to renew the ties between medicine and its users.
W
hy did you
become a
designer?
What would
you have done,
had you not
chosen this path?
M. L.  : I like that this profession has
both generalist and specialist sides to
it. We work in various sectors and at
the same time we have to give detailed
expertise. I like this constant back and
forth. I am concerned with the human
being, whether he is called a patient
or a consumer, to understand who
he really is. Maybe, had I not been a
designer, I would have been a doctor,
although I am not sure what I would
have specialized in.
How would you define
your approach?
M. L.  :I don’t try to draw objects or
facilities according to my vision. I try
to imagine them from the user’s brain.
It is not about leaving my mark or my
style, it is about adapting to very diffe-
rent contexts.
Your diploma project,
Therapeutical Objects, dealt with
128 HEALTH TOMORROW
mathieulehanneur.fr
the ergonomics of medication.
Why did you choose this subject?
M. L. :I was looking for a territory not
yet explored by design, which tends
to focus on furniture. Strangely, the
medical and pharmaceutical sectors
have hardly changed, or else in the
wrong direction. The more complex,
efficient and precise they have become,
the more they have pulled away from
the human being. So I looked into a
way to rethink therapeutical objects,
medication for instance. My approach
was not to focus on the molecule, but
on the entirety of the product we have
to ingest, drink or inject ourselves
with. I started with an observation
that is well-known in the pharmaceu-
tical world: today, one drug out of two
is not taken correctly. The reason lies
not with the object itself, but with
compliance, the capacity of the indivi-
dual to take responsibility and invest
himself in the treatment. I wondered
whether design could repair this rela-
tionship between the human, the body,
the illness and the cure.
Since then, health and well-being
have remained at the center of
your concerns. What is the driving
force behind these creations?
M. L. : The starting and end point is the
human being. No matter what marke-
ting services say, it is not a stable and
coherent entity that could be catego-
rized. It is a complex ensemble that is
sensitive to its environment and that
breathes, interacts and thinks. This
diversity feeds my inspiration. Pro-
jects like Tomorrow Is Another Day,
The Island or Local River imitate life
and play a reactive game. These objects
are not just made to be contemplated,
they evolve when faced with exter-
nal constraints or with what I eat, for
instance.
You have now been cooperating
for several years with the
biomedical engineering
© STUDIO MATHIEU LEHANNEUR / JUSTIN CREEDY SMITH
researcher David Edwards.
M. L.  : We are both convinced that
scientists and creators share a reflec-
tive mode that is guided by intuition,
demonstration and imagination. We
met at the launch of the Laboratory1
in Paris, in 2007. We wanted to work
together on projects2 by bringing in
our respective skills. This collaboration
allowed me to draw Café ArtScience. It
© DR
opened in Boston in 2014 and is simul-
129

Local River is a small fresh
water fish storage combined
with a home garden
taneously an art and science gallery, an
auditorium, a concept store and a res-
taurant. We are thinking about desi-
gning more.
Are science and design two
inseparable allies for tomorrow’s
health?
M. L. : They are not yet. Design doesn’t
require science to make a coffee table
or a bedside lamp. However, if I plan
on drawing objects that have a real
impact on the rest of the world, I will
need to summon scientific knowledge.
It goes at such a speed today – in par-
ticular neuroscience – that I would be
remiss not to use it. For science, design
has become essential in all aspects of
130 HEALTH TOMORROW
health, at the level of medication, a
hospital room, or home care. In this
case, its role is to improve understan-
ding. The most advanced scientists see
science as being more than just scien-
tific. If it doesn’t inspire each of us, it
hasn’t reached its goal.
How does this research around
well-being influence your role
as the lead designer for Huawei
in Paris?
M. L.  : In this case, it is not about
science but technology. These two
worlds intersect, because health is
more and more present in technology,
whether it is connected on my wrist or
through my phone. We are now close
5 | CARE
With Tomorrow is Another Day, Mathieu
Lehanneur has imagined in each room a
window open on tomorrow’s sky.
to elements that capture our physical
effort or cardiac rhythm. We carry with
“The medical and
us small digital doctors. My position of pharmaceutical
creative director allows me to give the
impulsions, the innovations needed for
sectors have hardly
a group the size of Huawei. changed, or else in
By Hélène Martinez the wrong direction.
1. Center for artistic and design
experimentation Paris and Cambridge, The more complex,
USA, founded in 2007. It invites visitors efficient and precise
to discover cultural creation at the frontiers
of science. they have become,
2. Mathieu Lehanneur and David Edwards the more they have
collaborated in 2008 to create Andrea,
a living filter that sucks ambient air in and
pulled away from
absorbs harmful components. In 2011 the the human being.”
created the CellBag, a backpack destined to
© DR
transport water for humanitarian purposes.
131
© CHRIS WILLAN PHOTOGRAPHY
MANI
FESTO
MANIFESTO MANIFESTO

The Story of Making More Health

Making More Health (MMH) was born out of a shared vision to combine Boehringer
Ingelheim’s “Value Through Innovation” with Ashoka’s over thirty years of
experience in social entrepreneurship. It was created upon the recognition that
social entrepreneurs are a powerful source of innovation and insight into the future
of health; these individuals leverage cutting-edge trends to implement new solutions
in their communities. The Making More Health partnership works across three
distinct but integrated pillars: Social Innovation, Changemaker Talent and Social &
Business Co-Creation. Together, these pillars lay the foundation for how Ashoka and
Boehringer Ingelheim aim to improve healthcare access throughout the world.

SOCIAL AND (MMH Fellows), connect them to WHAT THEY LEARN

BUSINESS CO-CREATION
Healthcare challenges are growing
in complexity and size, and no single
entity is equipped to solve them
single-handedly. Instead, solving them
requires a diversity of perspectives,
approach and capability through
non-traditional partnerships. MMH
is exploring win-win collaborative,
cross-sector models that address
health challenges for vulnerable
populations and increase the impact of
social entrepreneurs.
SOCIAL INNOVATION
A network of social innovators is
a powerful source for understanding
the major trends transforming the
future of healthcare. Boehringer
Ingelheim and Ashoka use two
strategies to identify and support a
critical mass of social entrepreneurs.
First, they use an open source global
platform to invite the general public
to share innovative health ideas
through online competitions. Second,
they identify top social entrepreneurs
an international network of peers,
and provide their organizations with
financial and professional support to
scale and grow.
Since 2010, Boehringer Ingelheim
and Ashoka have been supporting
87 social entrepreneurs in 37 coun-
tries around the world.
CHANGEMAKER TALENT
In order to navigate through a
world of rapid change, today’s leaders
need to master skills such as learning
agility, complex problem-solving,
managing diverse teams, and change-
making (empathy, new leadership and
teamwork). Ashoka and Boehringer
Ingelheim spread a culture of
intra/entrepreneurship by cross-
pollinating talent and diverse
perspectives between the corporate
and social sectors. Activities include:
Skills Based Volunteering, the Exe-
cutive in Residence program, Social
Intrapreneurship Courses and the
Youth Venture program.
Engaging with a critical mass of
social innovation gives Boehringer
Ingelheim and Ashoka a unique lens
into healthcare trends. Common
ways of tackling health challenges are
beginning to emerge.
Social entrepreneurs are improving
healthcare by:
Broadening the role
of the “healthcare provider”:
Anil Patil, Carers Worldwide (page 48)
Michelle Lem, Community Veterinary
Outreach (page 44)
Making detection
simpler and cheaper: © DR, PREVIOUS PAGES: UN PHOTO / TOBIN JONES
Jordi Marti, DBS Screening (page 22)
Frank Hoffman, Discovering Hands
(page 26)
Increasing transparency
for the patient:
Francesca Fedeli, Fight The Stroke
(page 60)
Geneviève Moreau, SiiN (page 30)

134 HEALTH TOMORROW 135

MANIFESTO MANIFESTO

HUBERTUS VON BAUMBACH “Through Making

“We will continue to work at
the intersection of socially and
business-focused goals”
One of them is among the most prestigious companies reach patients, particularly
pharmaceutical companies in the world. The other is
those in lower income populations,
will be different than it has been until
the most comprehensive worldwide network of social now. Boehringer Ingelheim must
entrepreneurs. How and why did they decide to team continue to innovate in regards to its
products but also needs to bring solu-
up? Hubertus von Baumbach, Boehringer Ingelheim’s tions for health to patients in all geo-
CEO, brings us back to the origin and the objectives of graphic regions and at all economic
levels. Through Making More Health,
the company’s partnership with Ashoka. we are learning from leading social
entrepreneurs and health innovators
duals, many of whom were impacted
at a very personal level, are touching
millions of beneficiaries and transfor-
ming healthcare at a systemic level.
For example, take Riders for Health,
founded by Andrea Coleman, which
manages trained fleets of motorcycles
and 4x4 vehicles to travel out to the
most remote rural areas to bring “last-
mile” health supplies and services to
communities. Through partnerships
More Health, we are
learning from leading
social entrepreneurs
and health
innovators around
the world how to
address changing
needs and create
more health for norms. Large institutions working in
individuals, families the field of health are ideal partners
for social entrepreneurs because they
and communities.” allow them to break out of small, incre-
mental impact and attempt to improve
the system.
Boehringer Ingelheim will continue
the long-term commitment of our Do you think we are really
shareholders to bring “more health undergoing a revolution in
to mankind” and to feel socially res- people’s attitudes?
ponsible (Leitbild). We will continue Is civil society in the

W
hy did Boehringer Ingelheim
choose to establish the Making
More Health initiative?
More Health is built on
H. V. B. : Making
the belief that the most pressing and
complex problems in health require a
new collaborative approach between
market-based companies, NGOs,
public administrations and other
stakeholders. It requires business
partnering with the social sector to
co-create scalable and sustainable solu-
tions that improve health care access
helping companies like Boehringer
Ingelheim to prepare for the future. As
such, Boehringer Ingelheim has embar-
ked on a journey, under the umbrella
of Making More Health, to explore and
support the field-based activities of
people around the world, known as
social entrepreneurs. In partnership
with Ashoka, the world’s largest
network of social entrepreneurs, we
seek to source and scale these social
innovations, while building bridges to
Boehringer Ingelheim’s business and
engaging the intrapreneurial spirit of
our employees.
This is an important investment
in terms of time and commitment;
how will MMH influence the
market and the development of
the business?
H. V. B.  : This is a transformative time
around the world how to address chan-
ging needs and create more health for
individuals, families and communities.
We seek out new win-win partnership
approaches with the social sector.
This requires much more than inves-
ting money; it requires committing
human resources, industry expertise,
and operations to scale. It involves
moving beyond the traditional “fun-
der/service provider” approach to true
co-creation across unlikely sectors
and industries. And it is our contri-
bution to improving health beyond
researching, developing, producing
and distributing innovative medicine
for humans and animals.
What is your opinion of the
initiatives supported by Making
More Health? Which impressed
you the most?
H. V. B. : All the 87 and counting social
entrepreneurs that we support,
called Making More Health Fellows,
© DR
with large health organizations and
Ministries of Health, Riders for Health
has scaled its solution in up to eight
African countries and is allowing
health workers to see six times more
people, as they can travel four times
further than anyone can by foot or
bicycle. I am particularly inspired by
social entrepreneurs that are using the
power of crowdsourcing to increase
access to health and well-being. For
example Junto Ohki. He is a young
Japanese social entrepreneur in his
early twenties who, after forming
a sign language club on his college
campus, is now developing an online
database, or “dictionary”, for all sign
languages used around the world
where users can upload, edit and share
sign language videos as well as search
for a word or an expression.
How can you improve and
expand Making More Health
at a global level?
to invest in social entrepreneurs and
support young changemakers, which
we see as critical agents of social
change. We believe that this effective
combination of “socially-focused” and
“business-focused” goals makes this
initiative unique. We will continue to
work at this intersection, which we
feel holds the greatest opportunity for
“shared value” impact.
Should global, international
organizations like the WHO
support these types of initiatives?
H. V. B.  : Social entrepreneurs are
unique in their understanding of the
patient, or end “consumer”; they have
deep insights into their needs and
the reality they live in and thus the
relevance of any solution that might
be implemented. Furthermore, they
have gained the trust of communities.
However, social entrepreneurs often
lack the means to scale their proven
solutions and gain the necessary sup-
process of taking “care”
into its own hands?
H. V. B. : The healthcare sector is under-
going many changes related to cost,
personalized medicine, the surge in
non-communicable disease, a growing
aging population. All of these shifts
and others will force the health care
industry as well as the governments
to change the traditional approaches
to care. This will partially include figu-
ring out how to decentralize “care” in
its broadest sense from hospitals and
doctors into the hands of communities
and individuals. At some level, we all
need to be empowered to play a role in
our health and well-being. In the inte-
rest of sustainability of the system, the
healthcare industry – which has tradi-
tionally focused on treating people
being sick – will need to increasingly
focus on prevention and keeping
people well. Civil society, government
and business will all play an important
role in this shift. 

for underserved communities while for the health sector. The way health are truly inspirational. These indivi- H. V. B.  : Through Making More Health, port to influence policy and industry Interview by Côme Bastin

136 HEALTH TOMORROW 137

Photo credits

P8-9
Photo by Lynn Johnson, NG Creative
Lancaster, Pennsylvania. A woman floats in a swimming hole, hoping that a stress-free pregnancy will help her child's brain
development in utero.

P 18 - 19
Photo by Diana Vilera Diaz
Girl at school, Proyecto LUMEN, Martin Guzman, South America

P 40-41
Photo by Albert Gonzalez Farran / UNAMID
6 December 2010. Nyala: A doctor examines a family in Kalma camp for displaced people, South Darfur, Sudan, before
returning to their original village in West Darfur. Hundreds of displaced people returned to Tandusa, Andi, Gido, Sullu and
Urum villages after years of displacement due to the violence and insecurity.

P 68 - 69
Photo by Maciej Dakowicz
Maasai men help carrying medical equipment to Cessna airplane operated by Flying Medical Service NGO in Tanzania

P 88 - 89
Photo by James Howlett, 3DFund.org
Senior midwife attends to her malaria and primary health patients by motorbike. This is often the only mode of transport for
the uneven roads she has to use to reach her remote communities in the Thanintharyi region, Southern Myanmar. 2011.

P 110 - 111
Photo by Lynn Johnson, NG Creative
Fayetteville, Arkansas. A woman comforts her adopted 6-year-old daughter, who has behavioral and cognitive deficits, partly
from neglect in a Ukrainian orphanage.

P 132 - 133
Photo by Tobine Jones/AU UN IST Photo
Mogadishu, Somalia. A girl takes a shot during a basketball training session in Mogadishu, Somalia, on June 6. Banned under
the extremist group, Al Shabaab, basketball is once again making a resurgence in Mogadishu. Today at least a dozen teams in
the city play in a league and both men and women are coming out to play the sport.

138 HEALTH TOMORROW 139

140 HEALTH TOMORROW