A doctor in Bangladesh has found a simple way to treat infant pneumonia

https://www.economist.com/science-and-technology/2018/09/08/how-a-shampoo-bottle-is-saving-young-lives

by sohkamyung • 8 years ago

304 51 8 years ago

PakG1• 8 years ago

All in all, the Chisti bottle-based ventilator shows what can be achieved by stripping an idea down to its basic principles. Effectiveness, it neatly demonstrates, need not always go hand in hand with high tech.

Can't be said enough.

nine_k• 8 years ago

It's the typical path of "crude conceptual prototype -> complicated advanced solution -> highly optimized stripped-down late version" constantly seen in engineering, especially in software where iterations are fast.

I hope that much of today's advanced, complicated, and expensive tech will eventually make that next step to simplification based on huge accumulated experience and knowledge.

yostrovs• 8 years ago

Last year's news: https://www.bbc.com/news/business-40498395

akavel• 8 years ago

This article actually contains the link to the paper too: https://www.thelancet.com/journals/lancet/article/PIIS0140-6... — though behind a Lancet register-wall apparently

edit: though based on the abstract available at the URL, it's not clear to me which of the mentioned methods is the innovative one, if any (??)

edit 2: Found a youtube video with some actual description of how the machine is built, from the doctor himself, from 2015 (google keywords: "Chisti bubble CPAP"): https://www.youtube.com/watch?v=HM1E8yMJd5Q

tuxguy2• 8 years ago

pdf of the paper : https://www.researchgate.net/profile/Mohammod_Chisti/publica...

dang2• 8 years ago

This is news that lasts more than a year. It's nice to see that article, though, because it adds more background—thanks!

dmix• 8 years ago

The materials needed to make his version of a bubble-CPAP ventilator cost a mere $1.25.

One of the situations where a lack of strict health regulations on medical devices is saving lives.

bena5• 8 years ago

It could also be the situation where the loss due to complications due to the equipment are far less than the loss due to the disease.

If you lose 10% to contaminated bottles, 15% to various malfunctions, and another 5% for things related to the procedure I can't even begin to consider, that's 30% mortality rate for this procedure.

But if another has 0% mortality rate but due to some other factor is not available in appropriate quantities, let's say there are only enough resources to service 10 cases a day, then your 11th case can either take a 100% mortality rate for doing nothing, or a 30% mortality rate with the other procedure. You take the better chance.

manmal• 8 years ago

Why should there be a loss due to a contaminated bottle when the children are only breathing INTO the bottle?

nraynaud• 8 years ago

I think there is confusion, on the videos and picture they are using medical equipment, it's just used in a different way.

vkou• 8 years ago

You are, both literally and figuratively, looking at an example of survivorship bias.

Lack of health regulations can bring about low-cost innovations, but it also bring about all sorts of useless quackery. As a consumer of medicine, I'd first prefer the treatments being performed on me to be proven to work. If that's not an option, due to cost, or lack of data, that's another thing.

fipple2• 8 years ago

If this is reproducible and legit I’d love to see him win the Nobel Prize in Medicine instead of the basic science people who usually win.

dingdingdang• 8 years ago

Absolutely, the humanitarian implications of making this widely available/accessible are tremendously positive (whereas your average brilliant idea may or may not ever see practical use and additionally the use it eventually sees may be a net negative for mankind on the whole)

fipple2• 8 years ago

Well, I think there's also a pretty great track record of basic medical research making it to practical use.

shriphani• 8 years ago

Tu Youyou won the nobel prize in medicine for a recipe she found and worked on from nearly 1500 years ago. From Wikipedia:

its preparation was described in a 1,600-year-old text, in a recipe titled, "Emergency Prescriptions Kept Up One's Sleeve". At first, it was ineffective because they extracted it with traditional boiling water. Tu Youyou discovered that a low-temperature extraction process could be used to isolate an effective antimalarial substance from the plant; Tu says she was influenced by a traditional Chinese herbal medicine source, The Handbook of Prescriptions for Emergency Treatments, written in 340 by Ge Hong, which states that this herb should be steeped in cold water. This book contained the direction to immerse a handful of qinghao in the equivalent of two litres of water, wring out the juice and drink it all. After rereading the recipe, Tu realised the hot water had already damaged the active ingredient in the plant; therefore she proposed a method using low-temperature ether to extract the effective compound instead. The animal tests showed it was completely effective in mice and monkeys.

rainhacker• 8 years ago

[Dupe] of https://news.ycombinator.com/item?id=17931801

dang2• 8 years ago

On HN it doesn't count as a dupe if the story hasn't had significant attention yet. This is in the FAQ (https://news.ycombinator.com/newsfaq.html). More explanation at https://news.ycombinator.com/item?id=16403654 and https://news.ycombinator.com/item?id=16344002.

aftbit• 8 years ago

Here's a schematic of how traditional bubble CPAP works: http://www.i-ma.com/images/INCA-Setup-Components.jpg

anotheramala2• 8 years ago

I didn't understand from the article about a "shampoo bottle with bubbles left in it". This diagram seems simple enough.

qwerty456127• 8 years ago

I can't even understand the diagram: how is exhaling into a glass of water supposed to make breathing easier?

linfocito3• 8 years ago

He and his team should be praised and prized for the achievement and results.

On the other side, this shows how slowly ideas can spread even in globalization times. I'm a pediatrician in Brazil and have used and been taught to use improvised bubble CPAP, with great results, since the nineties. I've heard reports of its successful use since, at least, the 80's decade.

I hope those devices can swiftly be fully scientifically validated and reach all needing regions of the world.

edited: grammar

dstroot• 8 years ago

I am always amazed at the quality, intelligence and experience of HN readers on any topic you can imagine. I love being in a community where a pediatrician from Brazil can comment on a medical discovery. I’ll probably be downvotes for a silly comment but feel like HN elevates my life.

denzil_correa• 8 years ago

I’ll probably be downvotes for a silly comment

I don't see how your comment is "silly".

azhenley• 8 years ago

I'm always pleasantly surprised by this too. There are experts and hobbyist in every field in this community. It is one of the reasons why I look forward to the comments more than the articles themselves.

apo• 8 years ago

That's surprising. Why do you think this kind of information diffuses so slowly?

linfocito3• 8 years ago

I don't know for sure, but I think two important factors are:

1) The lack of proper/popular communication channels between medical communities (apart from the academic ones)

2) The fact that these improvisations are often deemed as undesirable or inadequate (even shameful) without the due scientifical scrutiny, only because they are cheap or simple

F_J_H• 8 years ago

Reminds me of the great story of the ingenious baby incubator developed from Toyota 4 Runner parts: https://wheels.blogs.nytimes.com/2010/11/23/neonurtures-car-...

univalent• 8 years ago

Absolutely brilliant! Take a bow, Dr. Chisti.

whiddershins• 8 years ago

I feel like there are deep implications in this article about healthcare costs.

If hospitals don’t compete on price, what really motivates them to find a cheaper ventilator?

If they aren’t all that motivated to find a cheaper ventilator, are the ventilator manufacturers motivated to develop a simpler and cheaper version of their technology? Not so much. They might be more motivated to lobby for regulations making cheaper solutions illegal to protect their business.

And so forth.

Fascinating. Demoralizing.

gascan• 8 years ago

If a $15k hospital grade ventilator has a fifty year service life, perhaps the developed world sees little benefit to finding a cheaper ventilator, regardless of competition.

samfisher832• 8 years ago

I think this article forgets to mention it took him close to 20 years to make this.

https://www.bbc.com/news/business-40498395

People like him should win the Nobel Peace prize.

sohkamyung• 8 years ago

Agree that people like him should get more recognition, maybe even the Nobel Peace prize.

In reading the article, though, I don't think it took him 20 years to make it. Instead, I think it means he made a promise to do something about children dying from pneumonia and it took him 20 years to figure out how to do it. I base this on the following paragraphs in the article:

In 1996, Dr Mohammod Jobayer Chisti was working in the paediatric department of the Sylhet Medical College Hospital in Bangladesh. That evening he made a promise that he would do something to stop children dying from pneumonia.

When asked how he feels to be fulfilling that promise he made 20 years ago he replies: "I have no language to express this."

samfisher832• 8 years ago

The article said the following:

After two decades of research, Dr Chisti has now come up with a low-cost device with the potential to save thousands of babies' lives.

epynonymous• 8 years ago

powerful, this puts everything i do in pale comparison, this person's acts are really changing the world and directly saving lives. i also don't see him trying to profit on this, but instead he's trying to replicate this work in another 3rd world country.

this does put a massive black mark on the medical device industry and medical industry as a whole, trying to profit off what should be basic needs of hospitals. in general, companies making profits is only natural, and some of their research does require heavy research funding, but to the extent where their pricing may be killing off people is a little contradictory. i imagine the device costs have been subsidized by some governments of rich countries, but these standards cannot be applied to all countries. this is certainly a political issue, where are all the funds for bangledesh heading?

this also reminds me of the efforts going on at fourthievesvinegar.org we need more open source medicine and medical devices, this seems to be a lot more meaningful than creating enterprise software or social apps.

yablak• 8 years ago

The shampoo bottle CPAP is described here in diagram form:

https://www.semanticscholar.org/paper/CPAP%3A-a-guide-for-cl...

linfocito3• 8 years ago

In my experience, most facilities that have oxigen flow also have compressed air flow with cheap controllable fluxometers, but a blender is often lacking or too expensive.

In those cases we use a Y piece connecting air and oxigen flows to the inspirarory limb.

The role of the blender is to control the percentage of oxigen offered. With the Y piece we can control that by the equation:

%O2 = (O2flow + Airflow * 0.21) / Total flow

If you can use Total flow of 8L/min (reasonable in most cases) the approximations table below is of easy memorization and precise enough:

  O2 flow - Air flow - %O2

    8 - 0 - 100%
    7 - 1 - 90%
    6 - 2 - 80%
    5 - 3 - 70%
    4 - 4 - 60%
    3 - 5 - 50%
    2 - 6 - 40%
    1 - 7 - 30%
    0 - 8 - 21%

Edited:formatting

A doctor in Bangladesh has found a simple way to treat infant pneumonia

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