ITU – David South Consulting

Mobile Phone Microscopes to Revolutionize Health Diagnostics

By David South, Development Challenges, South-South Solutions

Mobile phone usage has increased hugely across the global South in the past five years. In Africa, the number of mobile phone subscribers reached 545 million in 2013, while there are 3.5 billion mobile phone users in Asia and the Pacific (ITU). Some 93 million people in Africa and 895 million in Asia and the Pacific have mobile phone Internet access (ITU).

“Every day we are moving closer to having almost as many mobile-cellular subscriptions as people on earth,” Brahima Sanou, Director of the ITU Telecommunication Development Bureau, wrote in its latest report on their growth.

The number of mobile phone subscriptions in the developing world has surpassed 5 billion and the number in the world as a whole reached 6.8 billion in 2013 (ITU), out of a world population of more than 7.1 billion. This compares to considerably lower numbers of people with access to the Internet: 2.7 billion in the world (ITU).

While many people in poorer countries have basic versions of mobile phones, the next generation of smartphones has been growing in number as prices come down (http://en.wikipedia.org/wiki/Smartphone). Examples of these smart phones include the BlackBerry, Apple’s iPhone, the Samsung Galaxy, and the Nokia Lumia. Smartphones tend to have enormous computing power and an ability to run complex ‘apps’ or applications – including public transport options, maps, restaurant and store locators, banking services and market information and resources. They can also access the Internet through Wi-Fi, and have camera and video capability.

What people can do with these feature-packed phones is limited by little other than human imagination. With the ability to store large amounts of data and images, using apps that perform a limitless range of services and tasks, smartphones can be deployed as powerful tools to tackle problems.

Science fiction sagas have long fantasized about people being able to walk around with small electronic devices that can do immensely powerful tasks, including being a medical diagnostic tool. But this science fiction dream is rapidly becoming reality in the global South.

Various initiatives and innovators are using mobile phones and smartphones to conduct medical diagnosis and gather data for medical studies in real time.

Some innovations are even turning smartphones into mobile microscopes.

Developed by the University of California, Berkeley in the lab of Professor Daniel Fletcher (http://cellscope.berkeley.edu/), the CellScope (cellscope.com) is capable of turning the camera on a cell (mobile) phone into a diagnostic microscope with a magnification of 5x to 60x. Fletcher’s lab has also pioneered work on needle-free injection technology.

The CellScope can be used for ocular imaging (technologies for visualizing and assessing a range of diseases of the eye) and for detecting tuberculosis, blood-borne diseases and parasitic worms.

Fletcher is a bioengineer and was impressed with how much mobile phone technology has proliferated across the global South.

“You don’t have to put in these copper wires (for phone lines) anymore; you have the (cell) towers. It’s big business,” Fletcher told The Scientist Magazine.

“It’s leaping over the need for infrastructure.”

Fletcher and his colleagues experimented by attaching extra lenses to smartphones. They then used the phone to image cells that had been stained with fluorescent dyes to make them easier to see. The quality of the image was so good, they were able to diagnose malaria from blood samples and tuberculosis from sputum (spit) samples.

With the addition of image analyzing software, the phone was able to automatically count the number of Mycobacterium tuberculosis bacilli. They were trying to prove you did not need conventional microscopes to do this sort of diagnostic work.

Fletcher and his colleagues are currently trialling the technology in Vietnam, India, Cameroon and Thailand.

“Technology alone doesn’t create effective health care,” Fletcher emphasizes. “It’s got to be part of a context in which the information is captured and validated and is analyzed in the right way, and treatments are then available in response to information.”

Another group from Toronto General Hospital in Canada (http://www.uhn.ca/corporate/AboutUHN/OurHospitals/Pages/TGH.aspx) has ‘hacked’ an iPhone smartphone by placing a 1 millimeter ball lens on the phone’s camera. Isaac Bogoch, an infectious disease specialist, had been investigating parasitic worm infections in children on Pemba Island off the coast of Tanzania. Along with Jason Andrews of Massachusetts General Hospital, they had been inspired by a report about how a team of researchers from the University of California, Davis had created a simple microscope out of an iPhone with a 1 millimeter lens. This makeshift microscope was used to take pictures of blood smears at a 350 times magnification and giving a 1.5 micron resolution.

“We thought that was a great idea,” Bogoch told The Scientist Magazine. Bogoch regularly works as part of an international team around the world, often in remote locations.

“We thought … we could take it to the field and see if it accurately works in a more real-world setting.”

Inspired, Bogoch got together with his colleagues and created a similar microscope with a 3 millimeter ball lens and then got to work using it to identify soil-transmitted helminth eggs in stool samples in Tanzania. When examining the stool samples of 199 children in a clinical trial using the makeshift microscope, they were able to accurately identify helminth infections in 70 per cent of the cases. They also found the iPhone microscope did very well at spotting eggs of particular parasites, such as 80 per cent of Ascaris lumbricoides infections (http://en.wikipedia.org/wiki/Ascaris_lumbricoides). The success rate dropped significantly, however, when trying to detect whipworm parasites (just over half) and hookworm infections (14 per cent).

But this is early days and an experiment: “Obviously the results aren’t perfect and there’s definitely room for improvement,” Bogoch admits.

What stands out is the potential to completely revolutionize health care by continuing to develop the capability of smartphones. With their portability and low cost, they also have the advantage of not needing a trained physician to operate them, according to David Walker, president of the American Society of Tropical Medicine and Hygiene, in The Scientist Magazine.

One of the many advantages of combining a microscope with a digital smartphone is the ability to take a picture and send it straight away to someone to make a diagnosis.

Even more exciting, Sebastian Wachsmann-Hogiu at the University of California, Davis (http://cbst.ucdavis.edu/people/sebastian/) is adapting mobile phones to undertake spectroscopy (http://en.wikipedia.org/wiki/Spectroscopy), using diagnostic test software to analyze samples on the spot. This, when successful, would be akin to the capabilities first mooted in the science fiction television and film series Star Trek (startrek.com). In Star Trek, the doctor is able to use a small handheld digital device to quickly diagnose what ails somebody.

The potential for this technology in the global South is significant. Aydogan Ozcan at the University of California, Los Angeles, who is also working on mobile phone microscopes, believes this is as significant as the dawn of the personal computer: “If you look at the early computers, they were bulky, they were extremely expensive,” he says.

But now computers “are portable … and almost anyone can afford them. The same thing is going on today (with microscopy). We are miniaturizing our micro- and nano-analysis tools. We’re making them more affordable; we’re making them more powerful.”

It looks like this science fiction dream will soon become today’s reality.

Published: July 2013

Resources

1) World Telecommunication/ICT Indicators Database. Website: http://www.itu.int/en/ITU-D/Statistics/Pages/stat/default.aspx

2) HealthMap: HealthMap was founded in 2006 by a team of researchers, epidemiologists and software developers at Boston Children’s Hospital. It is an established global leader in utilizing online informal sources for disease outbreak monitoring and real-time surveillance of emerging public health threats. Website: http://www.healthmap.org/en/

3) A home-made portable microscope: A design developed in the 1970s by Chinese students who fashioned a microscope from a plastic bottle. Website: http://www.microscopy-uk.org.uk/mag/indexmag.html?http://www.microscopy-uk.org.uk/mag/artjul00/awscope.html

4) Ways to make simple homemade microscope lenses. Website: http://www.microscopy-uk.org.uk/mag/indexmag.html?http://www.microscopy-uk.org.uk/mag/artoct07/jd-lens.html

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ORCID iD: https://orcid.org/0000-0001-5311-1052.

© David South Consulting 2023

Record-breaking Wireless Internet to Help Rural Areas

By David South, Development Challenges, South-South Solutions

SOUTH-SOUTH CASE STUDY

Many initiatives seek to bring inexpensive access to the internet to rural and remote regions around the world. One of the most successful ways to rapidly expand access is to offer wireless internet so that anyone can use a laptop computer, a PC or a mobile phone to quickly access the Net. Access to wireless internet is being rolled out in cities around the world with so-called ‘hot spots’, but the thornier issue of improving access in rural or remote regions could get better, thanks to a Venezuelan team.

The rapid expansion of mobile phones has done much to reduce the digital divide in Africa, for example, where the number has grown from just 15 million in 2000 to more than 160 million by the end of 2006, according to the International Telecommunications Union. This rapid growth has paid off: Morocco, Senegal, Ghana, Gabon and Cote d’Ivoire are in the top ten gainers of the Digital Opportunity Index, 2004-2006 (http://www.itu.int). The proliferation of Wi-Fi-enabled mobile phones combined with the spread of inexpensive wireless access has the potential to close the digital divide between rural and urban areas.

The issue of inequality in access to the internet has stark consequences for global economic development. Already, according to the World Information Society Report 2007, “Europe has achieved the largest overall gain in digital opportunity over the last two years, followed by the Americas… Asia and Africa have witnessed smaller gains in digital opportunity. The implications for the digital divide are clear: digital opportunity is becoming more sharply divided by region, not less.”

As the Digital Divide campaign learned, it is more important to keep in mind “Internet kiosks or rental of cell phones and other devices hold great promise for the poor. But shared use is a complement to a strategy that involves giving each person their own wireless device. Eventually, the price of such devices will be low enough so that everyone can have their own device.”

A Venezuelan team led by Ermanno Pietrosemoli, president of the Latin American networking association Escuela Latinoamericana de Redes, has broken the world record for unamplified broadcasting of a Wi-Fi (wireless internet) signal. The signal was broadcast in June from two mountains 282 kilometres apart in the Venezuelan Andes. Importantly, they did this using equipment costing only just over US $360, while producing a signal strong enough to send video messages. The former record was 220 kilometres set in 2005.

The consequence of this achievement for entrepreneurs is important: It means inexpensive wireless signals can now reach further into remote and rural regions for a small investment.

“We we’re able to transmit voice and video with both,” said Professor Pietrosemoli. “280 kilometres is pushing the envelope, but the same technique can be used at distances of some 150 kilometres by people with some basic training provided there is uninterrupted line of sight between the end points. This usually means shooting from hills or using them as repeater points. For distances up to 80 kilometres, towers can be used to provide connectivity even in flat land”

Pietrosemoli is willing to train people in the techniques he has developed for transmitting wireless over large distances (https://wireless.ictp.it or www.eslareed.org.ve).

The advantages of this approach include cost and simplicity. The more commercial WiMax technology costs more and is usually installed by large companies. Pietrosemoli’s technique is for people who lack those technical and financial advantages.

“I have been installing wireless networks for some 20 years,” he continued, “and reckon that wireless is the only viable alternative to ameliorate the digital divide in developing countries. For rural areas, the challenge is to use as little repeater sites as possible, as each repeater adds costs, delay and powering issues.”

Pietrosemoli said the only other obstacle to setting these networks up is the availability of unlicensed radio frequency spectrum in the 2,4 and 5 Ghz bands. The International Telecommunications Union has recommended that countries make these free for the use of data networks, but some countries are still blocking this.

Published: July 2007

Resources

Wireless Networking in the Developing World: A Practical Guide to Planning and Building Low-cost Telecommunications Infrastructure
World Information Society Report 2007: A progress report on pledges to bring digital opportunity to all.
The Wireless Geographic Logging Engine: This is a website with maps tracking the presence of Wi-Fi access around the globe. So far it maps over 10 million separate Wi-Fi networks. Entrepreneurs only have to log into the website to start searching for wireless networks near them.