Maybe we can step back a bit; I’m really fascinated by what I’ve read about you in our research. It seems that you’ve travelled the world with a purpose, and what I detected from the overview you’ve given us, is that there is a sense of injustice driving your efforts. If so, how would you describe that in terms of the work you do?

Yeah, it certainly started as that, this sense of “The world we live in is incredibly unfair and I’m one of the unbelievably lucky ones”. I was incredibly uncomfortable with being one of the lucky ones. I was really moving internally from a place of just feeling guilty to being proactive and committing to doing what I can with the rest of my life to try and change this – even if it’s a small part, hopefully it’ll be a worthy contribution. I think it just comes from a deep sense of realising that we’re all part of the same world and that we are very much connected. Just because I’ve been fortunate, it doesn’t give me the right to ignore all those who haven’t.

I qualified as a doctor at the same time the tsunami hit Sri Lanka, so I went out there with a couple of friends to help with some of the medical relief work. I was just totally blown away by the experience and by the people. I have this one particular memory of a nurse who had worked with us tirelessly the whole time we were there. It was only in the last few days of our stay that I actually knew her story, and it turned out she had lost pretty much her whole family to the tsunami – most of them killed, her father had become mentally ill and her brother wasn’t doing very well at all. She invited us to a meal in her home – a kind of tin-roofed shack in a camp, since her house had been destroyed, it was literally a single room – I remember going in with my friends and she had bought us fizzy drinks and food and I knew that what she was being paid only just covered what she had spent on us.

I recall falling apart at the time. I was in the process of buying my first home in the UK with my wife, and I just thought, how can we be thinking about buying a home when this is going on? It’s very easy to just switch off a TV. But, when you go and live it and share it with people, it becomes something you can’t ignore. I used my holidays to travel and spend more time in different places to try and understand the issues on the ground, I didn’t want to forget my prior experiences.

It seems like a very emotionally challenging job. I suppose you have to distance yourself sometimes, especially going to the places you’ve been.
In Australia, one of our national heroes is an ophthalmologist, Fred Hollows. I also recently heard about a doctor called Sanduk Ruit, a well known eye doctor doing work in Nepal. So, we have these ophthalmologists who are well celebrated and loved, and I feel like you’re the next in line; you’ve narrowed a gap with this new technology and changed the parameters for helping people in inaccessible parts of the world.

I certainly wouldn’t compare myself with people by the likes of Fred Hollows; there are people in my department at the International Centre for Eye Health who are genuine heroes that I look up to and hope to emulate. I am aware that the work we’ve done has generated public interest, and I’m surprised by the level of engagement the public has had with what we’re trying to do. It’s really exciting that it’s clearly something that matters to a lot to people. I think the technology aspect of it all has maybe brought in people who previously weren’t aware, so, it’s my responsibility to create awareness within other audiences about the ridiculousness of the situation that people are in – where most of the world’s blind don’t need to be.

I saw this map on the IAPB website that broke down the demographics of adults over 50 with visual impairment. It’s incredible how stark the contrast is between developing nations and developed nations. I’m sure the reasons are very clear, but, in your own words, why do think that medical technology today – even with our own access to technology and the way that our world’s changing so much – is still so pervasively low? Is it local policy or perhaps just the physical landscapes they live in?

I think it’s quite a complex one; there are multiple reasons. A system that allows healthcare to be a major and central part of a country is strongly required. To date, a lot of the investment hasn’t been in building the healthcare system. There is usually a demand to do things quickly and demonstrate short-term results; in my experience the best way is to just build things really slowly and carefully and with people who will own it, because it’s theirs and it’s their country and their people. I think that this is one of the issues that’s been around aid for a long time. But people are becoming aware of this issue now, and that things need to be done in a different way.

This quote used to be by my desk and defines how I think leadership and development work should be done, “Go to the people, live with them, learn from them, love them. Start with what they know, build with what they have, but, with the best leaders, when the work is done, the task accomplished, the people will say, ‘we have done this ourselves'”, and that’s two and a half thousand years old, by Lao Tsu. So, this is not new thinking. For me, this is the model that we should be using and what inspired me and my wife to move to Kenya and not just doing things from a distance.

There is a quote by Melinda Gates, I came across when doing some research for this interview, describing third-world homes, “Dirt floors, no running water, no electricity and… coca-cola. If we can understand what makes something like Coca-Cola so ubiquitous, we can apply those lessons to aspects of healthcare delivery. In the developing world, as in the US, there has been a concerted effort to make healthcare perpetually accessible at a low price and as reliable as the taste of Coca-Cola.”  I would love to know what your thoughts are on that?

That’s great. I think you could add on the end of that pause, “mobile phones”. That’s what I love being part of now; delivering healthcare through methods that are not healthcare driven. Because, as doctors and healthcare workers, we’re not really trained in marketing and business, or changing behaviours; these are all skills that are far more refined and developed in other sectors. So, for me, having the opportunity to look at how other people are doing this – Coco-Cola being an example of that – is key to how we can start to deal with these problems.

Going back to Peek Vision and the work you’re doing at the moment, what’s the marketplace saying to you, where is it sitting right now and what’s the response been from the developing nations?

We’re getting interest from all over the world. Peek isn’t solving the problem, it’s the eye-care workers and the NGOs and the government organisations who are doing this. Our role really is to support them to do more and reach further than they’re currently able to. A lot of people are saying, “This is what I’ve been looking for”, the problem was that they couldn’t get to the most challenging places and couldn’t get to the people who needed it most. This is certainly a way for them to get to the people, particularly those who were in the most vulnerable groups. We’re getting a huge amount of interest, and our challenge now is to grow our team to make it available to everyone.

Has there ever been a particular response you’ve received  that surprised you, particularly with Peek Vision? Because the work you’ve done across the world is incredible. I’d be interested to know if there’s been one government in particular who has given you a response that opened your eyes?

From quite a few locations now, we’re working with the ‘Queen Elizabeth Diamond Jubilee Trust’, who are our main funders, and they’re  fantastic; they’re not just giving us the money but they’re really supporting the work that we’re doing and opening doors on a policy level. So, I was fortunate enough to go to Geneva and speak at a meeting, prior to the World Health Assembly, to lots of ministers of health. There’s a lot of awareness of these kinds of technologies. Just to give you a recent example, the majority of my work has been in Kenya, working with a brilliant doctor called Dr. Hillary Rono. He has a team of people who work around him in Kenya and we designed a trial in schools to see if when using Peek, teachers could identify children who are visually impaired rather than having to send the very few eye-care workers we have from the hospital.

Since we were fortunate enough to get the funding from ‘Seeing is Believing’, we did the training and ran the trial. The teachers did an amazing job, in just under 2 weeks 25 teachers were able to screen almost 21,000 children and they found 900 with visual impairment. Each one of those children having been someone like me all those years back. What was great was that the Ministry of Health and Education were really supportive of it and keen to scale this to a much wider area. There have been definite positive responses and people understand the potential this has when used in the right way. We’re working hard to collaborate and try to make this a reality.

So, for our readers, Peek is essentially a little clip-on that you can add to the back of your phone to look at the back of the retina?

That’s actually only one small component of what Peek does. We have software tests, hardware adapters and patient management systems. The software tests are ways of using the phone screen to measure different aspects of vision. The hardware clips onto the phone, such as the one you just described, which allows us to see inside the eye. Then we have systems that connect people who have just been diagnosed, using a software test or a hardware test or a combination, and making sure their information goes to the right person, and that the patients receive instructions on referral. For example, in that school study, they didn’t use the hardware adapter, they used a vision test and if they failed it the hospital was instantly notified, their parents received a personalised SMS and the headteacher received a list of people in their school who were visually impaired. We don’t just want to have a set of tools that help you diagnose; we need to make sure that those who have been diagnosed receive treatment, otherwise the diagnosis hasn’t really had any value.

I feel as though you are a specific connector in the dialogue between healthcare in developing nations and us living in Europe or America where we already have these systems in place.  I get the feeling that, around issues such as ebola for example, there still is a massive demonisation and stigmatisation. When you ask someone to think of a reference point of somewhere in Africa, they might think of something like HIV. How do we mitigate that issue?  Maybe the reason why healthcare hasn’t grown so well in developing nations is because we’re still stigmatising that area of the world, does that make sense?

Yeah, it does, completely. For a long time, we’ve had this view of ‘poor Africa’, but, there are so many incredible people and things happening across Africa. The reality is, in low-income countries, there are often more incredible things going on, because people are pushed to the edge and this can unleash amazing creativity. It’s often in those scenarios that incredible things happen; people do things that are totally unexpected and can change current practice. I think we need to push towards telling the triumphs and the success stories of what people are achieving rather than continue to look at things that aren’t going well or not to a standard that we expect. Again, we need to move away from this philosophy that people in Africa need us; I really don’t think that they do. Some of the best people I’ve ever worked with come from and live in Africa; they’re talented, skilled and incredibly passionate about what they’re doing, I continue to learn a lot from them and I very much see our role going forward is to find leaders and change-makers and then to do more, then real change can happen.

Let’s just turn to the future of healthcare and technology – I’m interested to know what your thoughts are. A lot of the research I’m reading is based on predictive intelligence, technology, machines, hardware, etc, so much so that the Sun Micro-Systems co-founder, Vinod Khosla, said that machines will replace 80% of doctors in the future. Parts of this discussion play very much into what you’re doing. What are the biggest obstacles for healthcare overall at the moment, and what does the future of technology in healthcare look like, how excited can we get?

I think there’s huge potential; if you look at how life expectancy has increased: from the stone-age to 1980, our life expectancy increased by 20 years, from 1980 to now, it has increased by another 20 years!. The future is already here, we’ve achieved incredible things, but it’s very easy to not see what we’ve already done, our memories are very short. We’re already in a phase of revolution where things are how they never have been. I think it’s very exciting in terms of the potential that there is. I appreciate people are concerned about big data and so on, but the bigger concern for me is that we become less compassionate and less connected as people, because there’s more technology between us and other people.

I’m already seeing that; we get very busy and there’s this unfortunate continued pattern where patients don’t feel listened to or cared for. I think by just being more human, that can have an immeasurable affect. As long as we continue to be very human in how we do things and use computing, as appose to trying to replace the need for human contact, then I think it could be great. But, there’s also this danger that people are taken out of the picture; ultimately all of this is about relationships, and if we break those down it will be a problem.

I’m reminded of another quote that I think sums up our talk today: “Many of our innovations will improve the lives of hundreds of millions of people, that will come from a new breed of frugal innovators in the working world; working with few resources but working with huge ambitions to meet highly unmet needs, they will develop unconventional solutions precisely because they make their lack of resources work for them.”
It really goes back to your point, which was, “allow them to do it for themselves and not to let us do it for them”. You are giving them the tools to continue on into a healthy future for themselves.

Exactly, I think our role is to support, not to be the answer.

You’re quite young, but you’ve done a lot of great work already. I really admire that and I think it’s fantastic. I’m interested to know what you would like your legacy to be?

Hmm, I don’t know. I don’t think I necessarily want a legacy for me. I would like a legacy which is that avoidable blindness is something of the past. That’s never going to be something that I’ll do on my own, so I’d like this to be a collective legacy, that so many people have come together and made happen – to be part of that would be a privilege.

http://www.lshtm.ac.uk/aboutus/people/bastawrous.andrew