Mobile Microscopes: Snapping The Future Of Health Care

Oto, the modern otoscope using a smartphone camera, automatically produces an image of the patient's ear, making it easy to detect infection.  Photo Courtesy of Subject.

Smartphone cameras can do so much more than capture selfies. They can detect everything from an ear infection to cervical cancer.

mHealth has been fixated on SMS-based applications.  Using texts, health workers catalog data and communicate with each other.  But, another breed of entrepreneurs have been tinkering with smartphone cameras, developing attachments that screen for cataracts, diabetes, cancer, and infections.  They’re testing them in developing countries to see if health workers, empowered with smartphones, can help diagnose patients remotely.

“As soon as cameras started appearing on phones, I began wondering how they differ from the scientific cameras that we use in lab and whether they could be converted into microscopes,” says Daniel Fletcher, a professor of Bioengineering at UC Berkeley.  Fletcher went on to develop a semester project for his students.  The goal?  To design amobile phone microscope.

That research flourished into a startup, CellScope, which has redesigned the otoscope- the tool doctors have long used to peek into your ear canals. This updated version, nicknamed Oto, attaches onto an iPhone, generating an image of the ear.  It’s not just for doctors: parents, school nurses, and caretakers can use it for a quick read of a child’s ear.  And it’s not limited to tech-friendly households in the Bay Area.  Given that most children suffer from an ear infection before they reach seven years of age, it’s targeted for a global audience.  One caveat, though.  It’s been designed with the iPhone, which is unlikely to be in the hands of health workers globally.

While Fletcher and his students are foraying into other applications of the mobile microscope, such as examining your skin or testing for malaria and Tb, MIT’s Ramesh Raskar has become known as the ‘Eye Guy.’  As the head of the MIT Media Lab’s Camera Culture research, Raskar surfaced first in 2011 with a mobile tool for doing eye exams in developing countries – EyeNetra.  EyeNetra was prototyped at MIT but went on to become a commercial startup, backed by Khosla Ventures.  The company, and its investors, however, declined to comment on the status of the company, its reach, and the price point of EyeNetra.

Two years later, the Indian-born scientist produced another camera-based diagnostic tool, EyeMITRA (MITRA: Mobile Retinal Imagining and Predictive Analytics).  This one, he argues, has the capacity to do much more than just fit you for glasses.  A quick glance through the attachment, placed on the camera lens of a smartphone, can detect diabetes – one of the leading causes of blindness globally.  Destined to be $20 to $50 per piece, he says, EyeMITRA is geared towards developing countries.

Dr. Ramesh Raskar showcases EyeMITRA, which detects diabetes using a smartphone camera lens and attachment.  Photo Credit: John Werner

For Raskar, technology needs to be low-cost and accessible.  As a scientist and a self-professed “world citizen,” he says, “it’s our responsibility to create tools that have impact.”

“A doctor can save a life at a time.  As a technologist, we can save tens of lives at a time with what we create.”

The Israeli startup, MobileOCT is doing just that, aspiring to help the nearly 500,000 women around the world who are diagnosed with cervical cancer every year.  They’ve transformed a smartphone camera into a mobile colposcope marked at $400 (compared to $10,000 for a traditional testing device).  Bruce Kahn of Scripps Clinic in San Diego, a partner for MobileOCT, says that the device could replace pap smears.  It’s not merely for developing countries but for women globally.

mobileOCT is a smartphone-based device to detect cervical cancer. The attachment snaps onto the camera of a smartphone.  Photo Courtesy of Subject.

At Stanford’s Prakash Lab, not too far from Fletcher’s cohort, Manu Prakash, a Bioengineering professor, and his students have developed another smartphone-based health tool: OScan.  Designed at two different price points, for developing and developed countries, OScan performs a scan of the oral cavity, using a smartphone camera and an attachment.  Prakash is an an advocate of frugal science, which he defines as “bringing scientific capabilities outside the lab and into the field.”  OScan will be tested in the US, India, and Botswana in clinical settings and non-traditional posts, such as a tobacco shop, he says.

Much like Raskar, Prakash’s foray into science stems from an upbringing in India that exposed him to health inequities, financial limits, and simply different behavioral patterns.  For instance, Prakash’s friends and classmates often chewed tobacco, starting at an early age.  With little dental care, and prolonged use, that damages the oral cavity.  Prakash explored the issue further, seeking a solution.

“I went and visited several clinics and screening centers in India to understand how they uncover patients– and was shocked to meet patients who show up so late that they have no options, with very little success rates for these surgeries,” he recalls.

While these smartphone-based innovations are quickly catching on, Prakash says they still have some hurdles to overcome, including closed APIs and limited specs. “Many parts used in smartphones are not available to be implemented in other applications. This closed approach hurts applications in new areas.”

Fletcher also recognizes the challenges with smartphone parts. “The lens is designed for conventional photography, not microscopy.  The optical performance could be improved if the lenses we add to covert the phone into a microscope were designed together with the camera lenses,” he says.

Plus, it’s not as simple as developing technologies and dumping them into new hands, Prakash argues.

“Too many times, we think technology, specially smartphones, is the answer. I strongly believe it’s a story that’s skewed.  It’s people who provide health care and we need to enable tools to give them capabilities in the field.”

Students at the new Srujana Innovation Center in Hyderabad explain their projects to  India's former president Dr. Abdul Kalam.  Photo  Credit: John Werner.

Raskar is trying to get closer to grassroots innovations.  He’s developed a collaboration with the Hyderabad-based LV Prasad Eye Institute to help local students engineer new solutions for better eye care.  Inventions with commercial viability will get support from the mentors, he says, and intellectual property rights will be provided to the inventor.  Raskar calls it “designing in context.”

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Social Impact Bonds: The ‘It Girl’ of Muni Finance

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A social impact bond, or SIB, is the next big thing in public-private partnerships, and could rewrite the rules of the game when it comes to government-funded social services. Essentially, it’s a financial instrument that enables government to partner with private investors to pay for social service programs. SIBs give the corporate world a financial stake in the well-being of the most vulnerable citizens. Perhaps most crucially, they provide the government a cushion against financial losses, allowing normally hamstrung taxpayer-funded agencies to take risks and innovate. Journalist Esha Chhabra gets answers to the difficult questions at the heart of this potentially paradigm-changing tool.

Go to to read the full 4,000 word feature on Social Impact Bonds.



A new, healthier “show and tell:” School gardens do more than feed

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Domino’s is now serving school lunches. Yes, that’s right. Sounds abysmal, doesn’t it?

It’s called the “smart slice” — more whole wheat, less fat, less sodium — and it’s available for your children to eat for lunch in 38 states, courtesy of Domino’s and the U.S. government.

In an age when there’s so much chatter about healthy eating, farm to fresh and the importance of educating children what real vegetables are, we now have a commercialized lunch. Domino’s marketing ploy is fooling (or buying) Washington, D.C., into serving more pizza to children — just what they needed.

Pizza is not the enemy. The challenge is how do you get kids, who already have too many starches and fats regularly, to appreciate the taste of a fresh tomato, squash, cucumber? It’s not an easy sell compared to pizza. Interestingly, the “smart slice” is not available to purchase at Domino’s restaurants. It’s only for schools.

While policymakers are making a muck of the school lunch, philanthropists are actually making inroads.

Ted Turner helped start Captain Planet Foundation in Atlanta, which educates young people about nutrition. In 2009, they started experimenting with school gardens in Atlanta, reaching about 60 schools in the area. This fall, they’re starting in Ventura County with a pilot of 10 schools.

Last week, I visited one of the gardens at Rio del Norte School in Oxnard.

Gena Mathwin is a teacher and the garden coordinator at the school. A passionate gardener herself, she was swapping ideas for cooking radishes with the Captain Planet gardens program manager, Kyla Van Duesen, who had flown in from Atlanta to check up on the local gardens.

Her crew of third-grade gardeners were busy plucking weeds and begging Mathwin to allow a snail race. One little boy had snatched a squash — he couldn’t wait for the harvest.

In about a dozen bins, donated by a local agricultural business, the children were growing tomatoes, cucumbers, squashes, carrots, radishes, eggplants and herbs. David White, a garden coordinator for Ojai-based Food for Thought, a healthy schools program, was hovering around the children, giving them tips while inspecting the irrigation.

It’s more than just an exercise in gardening, though, Duesen explained. Given the increased emphasis on meeting Common Core requirements in schools, Duesen has crafted lesson plans for teachers like Mathwin that fuse math and science with gardening: i.e., fractions, geometric shapes, angles or photosynthesis, development of organisms.

That way gardening isn’t merely an extracurricular — it’s a part of the classroom.

School gardens have been in vogue for some time now. They are not a novelty, per se. But the Captain Planet program is trying to minimize the cost of an average school garden.

For $2,500, each school gets a set of garden spaces (installed), Common Core-based garden lessons, gardening tools, seeds, plants, teacher learning, a mobile cooking cart with a stove, blender, pots and pans, and a sustainability kit (to prevent your garden from wilting as you transition from one academic year to another).

Compared to other gardening programs that can cost significantly more than $10,000, the kit is modestly priced. Schools just apply to the foundation; Captain Planet bears the costs.

At Rio del Norte, the children come from a mixture of households, some more affluent than others, some with more accessibility to fresh fruits and vegetables than others.

Ironically, children of farm workers are getting their first taste of fresh produce. While their parents may work on county farms, they don’t have the means to buy too many fruits and vegetables for the dinner table. The gardening bins are giving them their first exposure.

How did they select what to grow?

“It was everything we wanted to eat,” one third-grader quickly said. And then she took me over to the tomato bin to show her favorite bit of the garden. Another boy ran over with a solar pizza box oven; he was eager to test it out using the veggies.

The following day, the students would be preparing a meal for their parents using those ingredients. “Show and tell” just got much more exciting.

This originally appeared in the Ventura County Star.


Select Home Care Weighs New Wage and Labor Regulations

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This originally appeared in the New York Times.  Read full story here.

SELECT HOME CARE, based in Westlake Village, Calif., offers 24-hour non-medical care to elderly clients in California, Nevada, Utah, Colorado, Oregon and Texas. It has nine offices, 500 employees and more than $10 million in annual revenue.

THE CHALLENGE Select is confronting an array of regulatory changes. A federalrule will extend the minimum wage and overtime protections of the Fair Labor Standards Act to nonmedical caregivers when it takes effect in January. The company’s home state, California, has already enacted legislation that added a Domestic Worker Bill of Rights to the California Labor Code. Under the new guidelines, which went into effect Jan. 1, nonmedical home care employees are entitled to overtime pay for any more than 45 hours of work a week. In addition, California’s minimum wage will rise to $9 an hour on July 1. For home care companies like Select, these changes mean shorter shifts, more employees and higher wages.

Photo Courtesy of New York Times/ J. Emilio Flores


Impact Investing: Not Just For Billionaires

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Foundations just make grants, correct?   Not necessarily.  Grants are becoming one option in a more complex menu of financial tools for the social sector.

Judith Rodin, president of Rockefeller Foundation, is taking risks with philanthropic capital, risks she says have the potential for bigger impact long term.  These experiments come in different avatars: social impact bonds, impact investments, and crowdfunding – to name a few.

The coauthor of a new e-book, The Power of Impact Investing, with Margot Brandenburg, Rodin says that “impact investment” is not just for the 1%.

Wait, you don’t have to be filthy rich to be an investor?  Rodin explains.

Esha Chhabra: You state clearly that this book is not just for the 1%.  Explain.

Judith Rodin: There is a sense that when one is talking about investment, it’s only for the affluent.  This is a book for those who are interested in learning about how to make both a financial return as well as impact.  We think it’s critical and opportunities like crowdfunding are providing a way in to those who are not among the super affluent.

But, more so, it’s also of interest to those who are somewhere near the middle.  Hope Consulting did a survey last year, talking to more than 4,000 Americans living in households of $80,000 and up – so, clearly not billionaires. Forty-eight percent said they were interested in impact investing products.  But only 12% had any experience with these products.  We want to help those individuals learn about how their money can be used for social impact.

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Chhabra: So far impact investing has been associated mostly with established funds such as Acumen, Omidyar, Gray Ghost, and Echoing Green.  Are you suggesting that we could see that democratize down the road with angel investors or individual investors getting into the space?

Rodin: Yes, there are many funds.  But there are other options already.  We’re trying to show in the book an array of opportunities, ranging from equity investments to debt as well.  It just depends on the appetite and needs of the investor.

For instance, there are products such as Calvert Foundation’s community investment notes [a debt security of $1,000 or more], which is a very direct way of being involved and anyone can do so.

Chhabra: Social impact bonds are another financial tool and Rockefeller was one of the first foundations to experiment with them.  Where do SIBS fit into the impact investing scene?

Rodin: Yes, we’re big supporters of this.

We funded Social Finance UK, the office in the UK that developed the first social impact bond in Peterborough.  We also then invested in that bond – the Peterborough prison experiment.  Those SIBs have replicated in the UK and abroad.

Rockefeller wanted to systematically support the SIB infrastructure.  To do that, we funded Social Finance US which has facilitated social impact bonds in the US.

We worked to bring in investment banks, and local banks that want to create a product around social impact bonds.  The biggest in the US have been Goldman Sachs, JP Morgan, and Bank of America.  Social impact bonds are now being applied to so many issues beyond prison rehabilitation programs.  For example, it’s also being used for asthma, early childhood education, and diabetes programs.

Chhabra: Most foundations are generally risk averse.  How can Rockefeller Foundation get more foundations to experiment?

Rodin: Our grant funding should be used to promote the field.

For example, in impact investing, we funded Global Impact Investors Network (GIIN), which brings all these investors together.  We funded the development of metrics that measure the performance of social enterprises and impact investing funds.   This is all necessary infrastructure to help impact investing grow.

Essentially, we have to deliver social and environmental impact at scale.  At scale, that’s key.  And to do that, it requires more capital than what governments and philanthropy have alone.  So our effort has really been to unlock capital markets.

Plus, the timing is right.  We see a growing number of investors, particularly younger investors who don’t want to wait to achieve their philanthropic goals.

And the numbers are proving it.  A new study by GIIN and JP Morgan showed that surveyed participants had expected commitments of almost $13 billion, up from $10.6 billion last year, in impact investments.  That’s a 19% increase.  Thirty-one percent of investors anticipated an increase in the number of deals.  Over 90% of investors surveyed reported both financial and social/environmental returns that were in line with or above their expectations.

Chhabra: On a policy level, what is being done?

Rodin: Let me give you a few examples from our work on SIBs. We made a $1 million grant to the Harvard Kennedy School’s social impact bond technical assistance lab (SIB Lab) to conduct the SIB Lab National Competition which offered pro bono technical assistance to state and local governments considering the pay-for-success approach.

On December 30, New York Governor Cuomo announced New York as the first state in the nation to launch a pay for success project to reduce recidivism. The project will provide services to 2,000 formerly incarcerated individuals, who are at high risk of reoffending, soon after they are released from prison. The Rockefeller Foundation has provided a $1.32 million credit enhancement to the project.

We have also worked with the Obama Administration on pay-for-success models and have been pleased to see the Administration include a request for $300 million to create a Pay for Success Incentive Fund in its proposed 2015 budget.

Chhabra: So were do grants fit into all this going forward?  Is there ever a concern that there is too much focus on the quantifiable impact, not the qualitative impact?

Rodin: Grants are still a critical piece.  We will never stop being a philanthropic grant-giver.  But we’re looking for leverage from our grant dollar.  We need to leverage in other forms of capital.

Whether it’s a grant or an impact investment, we are looking for impact and metrics is one way to measure performance.   Because it’s measured, it doesn’t have to be quantitative.  I’m an empirical scientist and some of the most useful data is often qualitative data.  You can’t put a number to everything.

Still, there is much that is measurable and demonstrating impact.

Chhabra: When you were dipping into impact investing, did you face any changes early on?

Rodin: Yes, there were critics early on about measuring impact.  I had investors who said that I know how to do the financial due diligence but I don’t know how to do the social due diligence.  So, that’s why we worked on developing those metrics.

There was also the “either/or” category who felt that investments would take away from grant-giving, particularly grantees.   But our grant-making in this space has actually unleashed huge pools of capital that otherwise would not have been available.

And over the years, we’re seeing a huge mind shift in business, large-scale businesses like GE, who are making social impact part of their narrative.

Chhabra: How evolved is this conversation about impact investing globally, especially overseas?

Rodin: In Africa, there’s a chance to leapfrog and combine these goals early on.  But that’s TBD – we’re just at the beginning of the conversation as businesses start to merge impact with commercial practices.

In the developing world, where we are seeing a lot of innovation and acceptance of this is India.  India is putting together regulations for business and investors to work together on building the impact market.

It’s important to remember, though, this is still a market and set of practices in evolution.  One of the reasons we did this book was to help evolve the market more quickly.

This is not the solution to the world’s biggest problems.  It’s merely an arrow in our quiver.


When And How To Scale: DC Startup At Crossroads


A successful startup, TechChange is wrestling with the question of scale – be it in depth or breadth.  When should an enterprise scale and how?

TechChange is a DC-based for-profit online education company.  Think edtech for the development industry.  They train NGOs, the World Bank, and UN agencies on how to use technology for rural health care, delivering aid, mapping disasters, and dealing with humanitarian crisis. It’s part of an emerging industry termed “tech for good,” empowered by the expansive reach of cell phones in the developing world.

Nick Martin, a former web developer, is the founder of TechChange.  With friends Will Chester and Chris Neu, who quickly turned into colleagues as CTO and COO, respectively, Martin bootstrapped TechChange in 2010 with $150,000.  In 2013, they had a gross revenue of just under $500,000.  This year, Martin wants to double that, striking near the $1 million mark.  With nine full-time staff and about a dozen contractors, TechChange would be classified as a small business.

Read the full story at


Corporate Social Responsibility: Should It Be A Law?

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India is the first country to have corporate social responsibility (CSR ) legislation, mandating that companies give 2% of their net profits to charitable causes.

Innovative?  Perhaps on a policy level.  But some small-medium size enterprises within India have already embedded social impact into their company ethos.

The new CSR law is a massive 294-page act that requires companies to set up a CSR board committee, allocate 2% of net profits in the last three years to CSR, and be reviewed at the end of each financial year by the board’s director to ensure compliance.  Beyond that, enforcement is a bit vague.

The law applies to the following companies registered in India: those with net worth of 5 billion Rs. (approximately $80 million); turnover of 10 billion Rs. at least ($160 million); or net profit that exceeds 50 million Rs.  ($830,000).  According to the Economic Times, about 8,000 Indian companies meet this definition, which would equate to 12,000 -15,000 crore Rs. annually in giving (or nearly $2 billion).

The corporate giants such as Wipro WIT -0.52%, Reliance, Tata, Airtel already have foundations and partake in philanthropic activities aimed at poverty reduction.  But critics say that philanthropic funding is not always the smartest way to tackle India’s serious social issues.

In 2008, Bill Gates spoke at the World Economic Forum about “creative capitalism.”  He encouraged companies to identify their expertise- be it technology, agriculture, healthcare- and develop products that could “stretch the market forces.”  A slightly more nuanced take on “doing good,” it meant honing in on the business’ specialty, not just throwing money at various charities.

Can that be applied to India’s new CSR law? Is it merely about giving or does the kind of giving matter?

ZMQ Technologies is medium-sized company housed in Manesar, a community on the fringes of India’s new tech city, Gurgaon.   Founded by two brothers, Subhi and Hilmi Quraishi, ZMQ produces commercial software for schools, corporations, universities, and more.  Since inception in September 1998, the Quraishi brothers have been allocating 12% of their profits to tech tools.  Hilmi is keen to point out that they produce tech tools for development rather than donate directly to development organizations.  Why?

Read the rest of the story at