Vital Sings: Future of Medecine

Premieres: February 24, 2020.

00:25 Sanjay Gupta:

When you think of the future of technology, what comes to mind? Maybe robots, or flying cars. What about technology’s role in medicine? Well, in many ways, the future is already here. This is Vital Signs. I’m Dr Sanjay Gupta.

Technology and medicine are a powerful combination. Take emergency response systems, for example. Ever since 1968, when there’s a medical emergency here in the United States, you call 911. An ambulance arrives, equipped with trained first responders and medical supplies, to take you to the hospital.

00:58 On the way there, you’re already receiving care. Those precious minutes can make all the difference in saving your life. But in many countries, that’s not the case. There is no emergency response infrastructure. But a software program called Beacon is ready to change that.

Alongside Lake Victoria in East Africa, this is Mwanza, Tanzania. More than 800,000 people live here, making it Tanzania’s second largest city. But infrastructure here is unreliable. Bad roads and heavy congestion make traffic accidents the leading cause of trauma in the city.

01:36 And there’s no modern emergency response system in place here. Or anywhere in Tanzania.

Marko Hingi:

So, this is the dispatching room.

Marko Hingi is a recent medical school graduate here. At just 27 years’ old, he’s also the founder and Executive Director of the Tanzania Rural Health Movement.

MARKO HINGI, Founder, Tanzania Rural Health Movement

Marko Hingi:

We decided to look for a partner who we can work with and try to start a good coordinated hospital care. That is where Trek Medics stepped in.

02:08 Sanjay Gupta:

Trek Medics International is a non-profit started by first responder Jason Freeson back in 2009. Using a software system they developed, called Beacon, Trek Medics provide the foundation for emergency response systems in places that don’t have one. Like Mwanza.

Marko Hingi:

So, this office is a control room, where we receive calls from communities. Emergency calls, where we put that information in our software in the laptop.

02:40 Sanjay Gupta:

Marko partnered with Trek Medics to bring Beacon here, as one of two pilot programmes funded by a Google grant. The other one is in the Dominican Republic.

In Tanzania, it’s Mwanza’s Fire Station that serves as a dispatch office for Beacon.

Marko Hingi:

So, right now, the system tells me there are ten active first responders.

Sanjay Gupta:

So, here’s how it works: when a medical emergency happens, a traffic accident, for example, someone at the accident scene calls the local emergency number.

03:09 A dispatcher takes all the relevant information and enters it into Beacon. Here’s the critical part to understand: in Mwanza, and across much of Africa, nearly everyone has a cell phone. So Beacon sends out a text message to first responders in the system.

The first responders reply via text, and the ones closest to the scene are dispatched. Along the way they text information back to Beacon, like the number of patients, the type of trauma, and estimated time to the hospital.

03:40 Marko Hingi:

In putting first responders, we have three focused areas right now. So, first, we focus on fire and rescue officers and also we focus on road traffic officers and also we focus on motorcycle drivers.

Sanjay Gupta:

The other thing to know about Mwanza is that there are a lot of motorcycle drivers.

SCOTT CAMPBELL, Trek Medics International

04:03 Scott Campbell:

The problem we faced at the start was, we didn’t have any vehicles. We didn’t have a lot of funding, so we had to come up with a way that we could get responders to the patient in a timely manner.

The roads in Mwanza aren’t the best so, it’s very easy move a motorcycle through congested traffic. 

04:26 Sanjay Gupta:

The Beacon project isn’t just about the software. It’s also about the training. Focusing on a few key areas, like major bleeding and airway obstruction.

Nothing too advanced – just enough to stabilise the patient before they arrive at the hospital. This program is only a month old, but in that short time, Marko says they have saved 11 patients and counting. Nine of the 11 were involved in traffic accidents.

The biggest challenge now is raising awareness that the service exists.

05:01 Scott Campbell:

It’s a new system. People have never had this for free before so, they are used to putting a relative in a car.

Sanjay Gupta:

To raise that awareness, and to assist in training the first responders, Marko and Trek Medics run simulations. The first responders don’t know the simulation is scheduled for today. That’s part of the training.

They are simulating a severe leg injury after a traffic accident. Don’t worry: that’s fake blood. Marko places the call to Beacon, starting the simulation.

05:36 Marko Hingi:

Soon, we expect to have them here, responding.

Sanjay Gupta:

It doesn’t take long before a crowd gathers, and that’s what Marko is banking on. It’s part of the awareness aspect of the simulation. He passes out flyers describing the service, and most critically, providing the emergency number.

In this case, it’s an ambulance that arrives first on the scene. The responders stabilise the patient, applying a tourniquet to the thigh, getting him on a stretcher and into the ambulance.

06:09 Then it’s off to the hospital. During that critical time, care is being provided, where it wasn’t before.

Marko Hingi:

Here is the hospital, where it is the end of today’s simulation. And there was a very good job done by first responders as they responded on the call.

Just in ten minutes already we arrived to the hospital.

06:36 Sanjay Gupta:

Marko says so far they have trained 55 first responders. The goal: to train 90 responders and 15 dispatchers here in the next few months. So far, Beacon covers roughly 100,000 people in Mwanza, but Marko plans to expand to the city’s full 800,000+ population within the next six months.

Marko Hingi:

My dream for this program is to make it successful. To ensure each individual, even in rural areas, to have access to this pre-hospital care.

07:11 Sanjay Gupta:

Infrastructure is key here, but what happens when roads just aren’t an option? That’s the case in a lot of places around the world, and for timely responses like medical specimen testing, it’s time to look to the sky.

Is there a future in Healthcare for drones?

07:31 You might not realise it, but non-communicable diseases are now responsible for more deaths than infectious diseases. According to the World Health Organisation, non-communicable diseases kill 38 million people worldwide every year.

07:44 We’re talking about heart disease, cancer, diabetes. Diseases that are not passed from person to person. These chronic diseases also require continued testing, often over the lifetime of a patient. That means access to labs, for things like blood and urine samples.  Again, it’s a matter of infrastructure and again, technology could provide the solution. This time, however, we’re not looking to the roads, but to the sky.

08:13 In the Core Laboratory at Johns Hopkins Hospital in Baltimore, lab technicians are busy testing everything, from hair to blood samples. Some 10,000 samples come through here every day. Dr Timothy Amukele is a pathologist here. After visiting labs around the world and particularly in sub-Saharan Africa, Tim had an idea: if transporting samples for medical testing was one of the biggest hurdles because of traffic, poor roads, lack of accessibility, why not remove those factors altogether? Why not fly them in a drone?

DR TIMOTHY AMUKELE, Assistant Professor of Pathology, Johns Hopkins Medicine

08:48 Timothy Amukele:

The idea for using drones first came from the problems of moving samples internationally. There’s a lot of places in the world where there’s no road. It’s trouble getting specimens to places that can actually do the testing.

However, the advantage of drones is that they don’t need roads.

09:09 Sanjay Gupta:

When you get your blood drawn, or give a urine sample at the doctor’s office, testing is rarely done at that location. There are roughly 200,000 registered labs in the United States, but Tim says most of them are primarily collection sites that can perform a few key tests but not the full range, and that requires the samples to be moved.

How important is speed when it comes to testing these samples?

09:33 Timothy Amukele:

Speed is everything, for biological reasons, because it’s not like moving a shoe or a book, right? Where, if it sits there for a day, it’s ok.

If it sits there for a long time, at some point the specimen itself starts deteriorating, and it’s not so useful anymore.

Sanjay Gupta:

A lack of obstructions would speed up the process, and that’s where the drones come in.

09.57 Timothy Amukele:

So, a drone is a transport mechanism and I think in 5 or 10 years it’ll be just like having a motorcycle, or something, where it doesn’t matter what you put on it: as long as you package it safely and transport it according to regulations, it’ll be just fine.

10.15 Sanjay Gupta:

The first of its kind, Tim ran a proof-of-concept study, to see if blood samples, in this case, could be successfully transported via drone. Tim took six blood samples each from 56 volunteers. Half the samples were taken to the Hopkins lab. The other half were loaded on a drone and flown around for varying time periods between six and 38 minutes.

10:37 Timothy Amukele:

My biggest concern, and this is why we addressed it first, is that the drone transport itself would deteriorate the samples. That the pressure of the air would destroy some of the blood samples. They are really that sensitive. So, my initial fear was that transport in the drone, because of the engine, and the way it’s launched – it’s launched by hand, and the shaking and all that, would deteriorate the blood specimens.

Sanjay Gupta:

What did you find?

11:05 Timothy Amukele:

We found that they didn’t. They worked just fine. It was great!

Sanjay Gupta:

I wanted to see the drone in action, so we drove an hour, from Johns Hopkins to an FAA approved drone field, where Tim performed the original study.

Waiting for us with a couple of drones is Jeff Street, an engineer who helped him with the study.

11.31 So this is it, huh? This is the drone?

11:34 Jeff Street:

Yeah.

Sanjay Gupta:

I guess I am not entirely sure what I expected, but here we have… this is styrofoam and there are rubber bands that are holding the wings to the overall drone itself. Then you’ve got the compartment here for the battery and, I guess, the specimens. That’s pretty much it.

11:51 These are not that expensive, and that’s exactly the point. Jeff says this hobby-grade drone cost less than $100. That’s important, because if you’re supplying these to developing areas, you don’t want something incredibly expensive to replace or repair.

How much does this thing weigh?

12.07 Jeff Street:

This weighs about 2kg or so; 4lbs. 

Sanjay Gupta:

That’s pretty light. Is it challenging to fly?

Jeff Street:

No. It’s quite easy. I could teach you to do it in probably two days.

Sanjay Gupta:

Is that right?

JEFF STREET, Unmanned Vehicles Engineer and Pilot

12.17 Jeff Street:

At a basic level, yeah. And with a few weeks of work, to fly in complicated wind conditions.

12:25 Sanjay Gupta:

Alright. Shall we give this thing a try? I’m kind of excited.

Jeff goes through the pre-flight checks, including balancing the drone. Then he arms it, so he can communicate with the controller.

Jeff Street:

So, now we’re ready to fly.

Sanjay Gupta:

The drone launches by hand, into the wind.

Imagine that, and to seeing those all across these remote areas of the world, carrying specimens, medicines…

12.56  Timothy Amukele:

Exactly.

Sanjay Gupta:

That changes the game.

12.59 Timothy Amukele:

Absolutely.

13.01 Sanjay Gupta:

Tim acknowledges this is just the first in a long line of steps. The regulations for drones differ in every country, and in many cases, are still being worked out. There are other questions as well, like who would fly it? And how do they make it secure?

The samples are packed in this foam with a special sponge, so that if does crash or a tube breaks, the specimen is fully absorbed.

13:23 Timothy Amukele:

It doesn’t answer all the other questions. But the key question was, ‘does the blood arrive ok?’, because if it doesn’t arrive ok, then none of it matters.

13.35 Sanjay Gupta:

The other hurdle, and perhaps the largest one, is the drone itself. Or, rather, the word ‘drone’.

13.42 Timothy Amukele:

When we say the word ‘drones’, people think of things that fly over their heads and kill their children. That’s not what we’re talking about here. We’re talking about small, unmanned flying systems. So, we’re talking about essentially a different way to transport goods.

13.58  Sanjay Gupta:

It’s a perception issue.

Timothy Amukele:

It’s a perception issue.

Sanjay Gupta:

The next step is more testing. Tim estimates he will have trials up and running in the United States and abroad within the next six months.

Timothy Amukele:

What’s been impressive for me, travelling around and talking about the possibility of using drones and sharing some of the video, some the work we’ve done in countries in Africa is how open the people are.

14:25  People are very open to the idea of it, of new technology. There hasn’t been pushback in that way at all.

Sanjay Gupta:

That represents the future to you, doesn’t it?

Timothy Amukele:

Yeah, absolutely.

14.38 Sanjay Gupta:

That’s pretty neat.

In many ways, the future is already here. That’s the case for some kids at Children’s Hospital in St. Louis, Missouri, where a visit from Doctor Robot means a much-needed virtual escape beyond the hospital walls.

15:01 Past the dinosaurs, across the room, even on to the elevator. Celia, the robot, is becoming a familiar sight here, at the Saint Louis Science Centre in Missouri.

15:23 But perhaps what makes Celia so interesting in not the fact that she’s here – it is a Science Museum, after all – it’s why she’s here.

And to understand that, you need to meet Robert.

15.37 Lin Casper:

He is a very easy-going kid. Nothing bothers him, he just goes with the flow.

Randall Evans:

He liked outdoor stuff – fishing, me and him would go fishing, of course, his mom, too. And he’d like to play ball. He loved playing ball

15.55  Sanjay Gupta:

Robert was a curious kid who loved being outside. So when he suddenly wasn’t interested in doing that anymore, his mother knew something was wrong.

DEE EVANS, Robert’s mother

16.04 Dee Evans:

He just wasn’t Robert. He didn’t go outside and play, like he normally does, he kind of sat on the couch and watched TV and he was kind of pale. He had mentioned he had a little bit of a headache. So I said, ‘well ok, we’d better take you to the doctor.’

16:21 Sanjay Gupta:

Right away their doctor noticed Robert’s spleen was enlarged. A test revealed he also had a white blood cell count of nearly 200,000. That’s 20 times higher than normal. Robert was diagnosed with leukaemia.

Dee and Randall Evans:

Devasted.

RANDALL EVANS, Robert’s father

16.34 Randall Evans:

It’s one of the worst news a parent can hear. And I would just hate for any parent to have to hear that news.

16:46 Sanjay Gupta:

Robert was flown by helicopter to St Louis Children’s hospital, while his parents made the three-hour drive to meet him there.

Randall Evans:

It was the longest three hours we’d ever spent in our life.

16.56 S Sanjay Gupta:

Robert started chemotherapy, and in the past three years he’s already had two bone marrow transplants. His little brother was the donor for both. And in just a few days, Robert is having his third transplant. He’s only 14 years old.

17.13 Randall Evans:

I think if he lives through this, it will change him in the future. He may not know it now, but he will when he grows up.

17:23 Sanjay Gupta:

Remembering to enjoy life can sometimes be tough when you’re stuck in a hospital for a long time. Robert’s parents say he’s spent more time here in the last three years than at home.

He does school work, trying to keep pace with his friends in class back at home. To get some exercise, he walks laps around the hospital floor.

17.43 But today, there’s a special treat in store for him.

Meccanoid:

Hello, human companion! I am Meccanoid G15KS. Please tell me your name.

17.57 Robert:

Robert.

Sanjay Gupta:

This is Meccano.

Meccano:

I believe it is customary to shake upon meeting a new acquaintance.

18.05 Sanjay Gupta:

And this is Keith Miller, a professor at the University of Missouri-St Louis. Here at the hospital, he’s affectionately known as ‘Dr Robot’.

Celia, the robot cruising around the Science Centre, was his idea.

KEITH MILLER, Professor, University of Missouri-St. Louis

18:18 Keith Miller:

Robots have the kind of potential computers always had. But robots have this physical dimension: they can also go, they can move, they can have an effect in the world that computers, your PC just sitting there can’t have.

It’s slotted here, so we pull it down.

18.36 I had never met Robert, and everyone I talked to said ‘Robert’s a great guy, he’s really smart, he’s really quick, but he’s real quiet – don’t take it personal’.

When that Meccano got going, he wanted to make that robot work. He lit up. And I loved to see that.

18.55 Sanjay Gupta:

Meccano is just a warm up. The real aim for this visit is to get Robert out of this hospital room. He can’t physically do that, but Keith found a way to do so, virtually.

19.06 Keith Miller:

We had just ordered these VGo robots, and the robots, one of their selling points is, if a child is sick, the child can attend school using one of these robots. And I thought ‘whoa, there are a lot of sick kids in that Children’s Hospital – maybe we can get them hooked up for a virtual visit to the Science Centre’.

19:25 Trey:

If you want to move the camera, up and down, you can use ‘A’ and ‘S’.

Sanjay Gupta:

Keith’s assistant, Trey, helps Robert set up the laptop.

19.32 Trey:

Hello! Can you say ‘hi’?

Robert:

Hi!

Woman on screen:

Hi!

Trey:

Can you hear us alright?

19.39 Sanjay Gupta:

In no time at all, Robert is virtually controlling the robot in the St Louis Museum Centre down the road.

Christian:

So, these guys over here are making parachutes.

19:49 Sanjay Gupta:

He is driving it from the laptop. He can see what it sees through the camera. He can have conversations with people on the museum site, including his tour guide for today, Christian.

Christian:

Let’s head our way to the Paleo Lab, see if we can find some dinosaurs.

20.09 Chemistry teacher:

Strontium, Sodium Chloride, Lithium, and Copper. Which one’s your favourite? Which colour?

Robert: Green.

20:20 Chemistry teacher:

The green. Yeah, the copper is one of my favourites.

Keith Miller:

Even though we’re just a few miles from where their robot is, you can do this from here to Tokyo, and it would have pretty much the same kind of effect.

And in fact, we’re looking into that, is getting robots all over the place to talk to kids in lots of different hospitals.

20.40 Sanjay Gupta:

On the museum end, kids at the Science Centre notice the robot and come over to say ‘hi’.

Jayden:

Hi, Robert, my name is Jayden [?].

20:47 Keith Miller:

They’re making a connection, they’re getting tied together. What a great use of technology, to get a kid who has to be at the hospital and a kid who’s at the Science Centre and they make a connection via the robot. How cool is that?!

21.01 Sanjay Gupta:

Robert, via his robot, travels through the Science Centre. From the Makers Lab, to the Dinosaur exhibit, and everywhere in between.

21.12 Museum guide?:

This is one of his brow horns, so this would have been right above his eye.

Sanjay Gupta:

The entire time, a smile, year to year, on Robert’s face.

21:22 Randall Evans:

I’ve noticed my son’s lost in shyness.

LIN CASPER, School Program Coordinator, St. Louis Children’s Hospital

21.26 Lin Casper:

This is one of the few opportunities I have found to have the kids be out of this place. Emotionally, he’s not here right now, he’s not in that bed, he’s not in the schoolroom one on one with an adult. He is out with those kids in the Science Centre, being the coolest thing in the room, not being the sick kid that everyone feels sorry for.

Sanjay Gupta: After his tour, a bit of Robert’s shyness returns, but that smile remains.

21.52  Keith Miller:

It’s interesting to see the technology surrounding these children, because some of them are in intensive care, some of those machines are helping to keep them alive or helping to cure them, whereas ours are almost toys or communication devices.

22.08 At first I thought, ‘oh, how trivial’. But when we did the VGo, and hooked up kids at the Children’s Hospital with kids at the Science Centre, the kind of engagement that took place surprised me, and I didn’t feel so trivial anymore; that sometimes technology gets people together and maybe that’s pretty important, too.

22:32 Sanjay Gupta:

Less than a week after we met Robert, he had his third bone marrow transplant. We’re happy to report that it’s been a success so far.

From a patient’s medical care, to morale, it’s clear that technology has a big role to play in the future of medicine. For Vital Signs, I’m Dr Sanjay Gupta.

END