How can we make critical care equipment accessible?
How do we ensure healthcare innovations reach the people who need it most? As a medical student and project manager Natasha Ali (East Africa & Linacre 2020) has grappled to understand why ideas often fail to progress beyond research and are not used at scale - even when the need was greatest. Here she describes research in Vietnam aimed at making equipment and knowledge available to those who need it most.
I have always grappled with understanding why healthcare start-ups and institution-derived innovations fail to scale-up beyond research if the need for new technologies, especially those that worked in rural areas is that high.
As a medical student I managed donor funded health innovations projects and accelerators. As a medical doctor I had worked in a semi urban Lutheran hospital as well as in malaria vaccine trials. Working as a project manager in Dar es Salaam, I have overseen two projects that were collectively worth £120,000, where 405 teams and companies submitted ideas and products, we successfully mentored 20 teams and 12 of them received seed money. Today only two teams are left standing. Most couldn’t translate ideas into products and products into services – something fintech startups achieve better.
Hence my quest has been to understand how successful health innovation firms, companies and industries manage the process of innovation all the way to implementation and profitability. Can non-profit-driven healthcare innovation teams learn from commercial firms and manufacturers? My research aimed to understand the management of innovation within the clinical settings using VITAL - Vietnam ICU Translational Applications Laboratory - as a case study.
VITAL is a multidisciplinary project with a mission to “improve critical illness care through new technologies and in the long run reduce morbidity and mortality from infectious diseases”. This is done by “developing and testing devices, algorithms and software that will firstly improve diagnosis of acute fever and deteriorating physiology and later on improve management, recovery and rehabilitation of patients from infectious diseases and extended hospital stays”. I aimed to understand what happens on the ground and how the project can roll out from the research facility to other facilities around the country.
I spent 10 weeks in Vietnam between different intensive care units (ICUs) specializing in infectious diseases, offices, as well as universities. My day-today work included meetings, interviews, structured and unstructured observations both in clinical and non-clinical settings. One of the most interesting experience was my Vietnamese language course; if negative capability came in pages, it would be in those of these classes. Eight weeks in, I was further behind than when I started. My sheer understanding of how the tones should be, made me more reluctant to try as I was becoming more painfully aware of how much I was incapable of doing it correctly. I also did not want to take so much more time from the kind individuals who had given me so much of it already. I have never waved a white flag in my life but this is the closest I came. (We shall try again in my next round of data collection).
Beyond my data collection activities, I got to participate in ward rounds at different infectious diseases wards, help in some of the research activities like trainings, doing ultrasounds on patients in both the main infectious diseases ICU as well as the COVID ICU. I got to take part in the mid-autumn festival celebrations where the office distributed food and lanterns to children admitted at the hospital.
The highlight for me was seeing their faces light up when characters from the legends of the moon festival joined the activities. I even got to send a post card for the first time in my life because it’s just not something I knew people do where I grew up.
Another highlight was my DPhil induction day. In OUCRU Ho Chi Minh City, there is a DPhil celebration day where every new DPhil student gets a bottle of Champagne with their name on it that goes on the shelves of the common area. This will be opened in the celebration for when you finish your PhD. Hence over the years, we celebrate old bottles being opened and new ones being added. I can almost taste mine at the end of wherever this DPhil journey will take me.
What I am looking at is how the roll out of innovations can happen; how supportive are policies, tangible and intangible structures that can make that happen. Most importantly, I am looking at general attitudes across the implementation team towards commercialization and adoption of such technologies.
By being in the field and having first-hand experience of how thin the line is between clinical trials and clinical care in research-forward hospitals it dawned on me that a commercial theory would not be applicable as is. In a clinical trials unit, what is being managed is clinical trials and patient flow and not innovations and equipment.
It was a shock at first as I realised how most of what I had done and learned might not be relevant - but it led me to ask better questions: what is the general end goal? Do the clinical and commercial process meet at any point? and, most importantly, how do other ICUs benefit from what is going well at VITAL?
As mixed methods/ social sciences researchers, being reflexive about our own positionality is a practice we are encouraged to develop. Most importantly, it is a reality we learn to be aware of as we do what we do. I severely underestimated how heavily language and cultural differences would impact on how I work - from obvious issues like completely not understanding conversations, sometimes for an hour straight, to being asked if I am from Malaysia or Indonesia.
The construct of being Black was a very interesting experience. Being photographed without one’s consent on the streets and asked if I knew a certain thing, or if I have ever seen certain fruits prompted me to be on high alert. However, the general attitude was that of wonder and fascination rather than condescension. The overall kindness I experienced was very dis-arming and reassuring. It made me reflect on the multitudes of realities we live in. The difference and similarities of our lived experiences from being woke and knowledgeable in Oxford to the level of thoughtfulness it takes to feel integrate and enjoy settings like those in Zanzibar and Vietnam.
Finally, the overall experience led me to my current research focus, which I believe has been informed by my experiences before and in Vietnam but also feedback and guidance from my supervisors, colleagues and clinicians who were kind enough to work with me while I was there. I am currently working on understanding how commercialisation can facilitate the adoption and diffusion of medical equipment for in-patient critical care. Through this work I hope to come up with recommendations on processes and resources that can likely aid translational research teams like VITAL to implement medical technologies beyond clinical trials’ phases and settings.
I cannot be grateful enough to the Murray Speight Grant for not only making this work possible, but within the best possible time. It was a long process, but it’s very reassuring seeing the how tiny steps add up to a path and points out to a certain direction