Portal de Periódicos da CAPES

Karachi Hackathon Takes on Emergency Medicine Challenges

2017; Elsevier BV; Volume: 69; Issue: 3 Linguagem: Inglês

10.1016/j.annemergmed.2017.01.017

1097-6760

Éric Berger,

Biomedical and Engineering Education

There was a tinge of nervousness in her voice and manner as Huba Atiq, MBBS, a pediatric emergency physician in the sprawling city of Karachi, stepped to a lectern last August on the campus of Aga Khan University. Speaking in front of a group of fellow Pakistani physicians and students, Dr. Atiq held aloft a photo of a mother struggling to provide manual ventilation to her child with a bag-valve-mask device. She explained that the picture had been taken in a Karachi public hospital, one of many in the region that are generally overburdened and scrape by with minimal resources. Karachi may be Pakistan’s most cosmopolitan city, and one of the largest metro areas in the world, but its public health facilities cannot adequately care for a population of more than 24 million people. “Due to a large volume of critically ill patients requiring ventilator support, they end up in the emergency department [ED] on manual Ambu bagging,” Dr. Atiq told her audience. “Because of the shortage of doctors and nurses in a public hospital, an attendant has to do the Ambu bagging.” Moreover, although it may be difficult to comprehend from a western perspective, in many instances, a parent has to step in to perform the task. Consider how the parents of an ill child might have come from a rural area, navigating through the sprawling metropolis, to find help treating an unknown illness. Finally, a physician sees the child and, postintubation and requiring bag-valve-mask resuscitation, hands the bag to a parent. How might that already overwhelmed parent feel? This was the precise, all-too-real problem Dr. Atiq sought to draw attention to, that of unskilled manual bag-valve-mask resuscitation and its failure to provide a uniform level of oxygenation and ventilation. This would lead to increased morbidity and mortality, not to mention the emotional toll it would take on family members of the patient. Fortunately, Dr. Atiq had a solution—because after all, the purpose of a medical “hackathon” isn’t just to identify problems. It’s to solve them. Dr. Atiq may practice pediatric emergency medicine in Pakistan, but the language of medicine is universal. From a rural ED in North Dakota to the dense urban core of Karachi, broken bones, chest pain, and trauma know no borders. And neither do problems faced by emergency physicians, from crowded EDs to timely access to vital data and effective evaluation tests. So when Asad Mian, MD, the director of pediatric emergency medicine at Aga Khan University Hospital, decided to hold an emergency medicine hackathon on campus in Karachi, the event looked a lot like hackathons held in the United States and elsewhere. Because resources in Pakistan for medicine in general, and emergency medicine in particular, are not as rich as in much of the developed world, the theme of the Pakistan hackathon was innovation for resource-limited EDs. Organizing such an event, the first medical hackathon at the Karachi-based university, and the first one specifically for emergency medicine in all of Pakistan, took some persistence, Dr. Mian said. “Novel events are always challenging in academically traditional places,” he explained. “The currency tends to be clinical research and publications. Innovation in emergency medicine through hackathons is so out-of-the-box that it took time for the organizing team to convince people here to proceed with it.” That the event occurred at all makes clear that hackathons have come a long way in less than 2 decades, from obscurity among a few coders all the way to medical universities in Karachi. So what are hackathons, and why did they spread so quickly into all manner of professional fields? These gatherings have become popular in part because they successfully force collaboration, bringing together people from disparate backgrounds and specialties. The combination of being able to focus on a problem, work under a deadline, and compete drives the development of new ideas and solutions to often old and troubling problems. A synthesis of the words hack and marathon, hackathons were first held in 1999. The word hack was not used in the sense of hacking illicitly into other computers, but rather in the sense of exploratory programming to solve software issues. In June 1999, 10 developers of a computer operating system called Open BSD came together in Calgary for a communal session to focus on the legal export of software. Two weeks later, the organizers of the JavaOne conference staged a competitive challenge to write code in Java for the Palm V personal digital assistant, which had been released earlier that year. Independently, both events were termed hackathons. During the course of the next decade, the concept slowly spread, becoming most widely associated with Internet startups and the writing of code to support new Internet companies. Some venture capital firms also held hackathons as a means to generate ideas and business plans. The medical community, too, began using the hackathon concept fairly early on. The Open Bioinformatics Foundation, a nonprofit organization devoted to developing open-source software for the biological research community, held its first hackathon as early as 2002. Other software developers for genomics, informatics, and other areas of medicine soon followed. By approximately 2010, the hackathon concept had begun to spill into fields beyond computer programming, including music, television, and almost all areas of science. A year later, a handful of faculty members and students at the Massachusetts Institute of Technology (MIT) held the first MIT Hacking Medicine event. In a 2013 interview with MedTech Boston, one of the leaders of the MIT hacking event, Andrea Ippolito, MS, PhD, explained how the event begins, often on a Friday afternoon or evening. “Really the foundation of what we do at these hackathons is ‘pitches,’” she said. “We really try to emphasize folks’ pitching ‘pain points’ in health care and medicine. Anybody who attends these hackathons can go in front of the crowd and give a short pitch, usually 2 to 3 minutes long. The pitch is a description of a problem that he or she sees in health care and medicine that is particularly painful and needs fixing. Usually the pitch will really resonate with different members of the crowd. And a team will form around the pitch, or the problem that everyone is interested in solving.” The concept has since proven wildly successful in medicine, which clearly has no shortage of problems that need solving. During its first 4 years, MIT Hacking Medicine organized more than 40 hackathon events across 9 countries and 5 continents, typically taking place during a weekend. After the pitch session during such an event, participants are encouraged to mingle, form teams, and choose problems to address. During the following days (and often nights), the teams work to try to find solutions. Mentors with expertise in health care, engineering, and business development step in to help guide teams, when needed. At the end of the event, each team makes a 3-minute presentation that identifies a solution for a particular clinical need, and possibly presents a prototype, and finishes with a business model. Winning teams often receive financial awards, internships, and funding for further studies or idea development. In a peer-reviewed overview1Mantzavino A, Ranger BJ, Gudapakkam S, et al. Health hackathons drive affordable medical technology innovation through community engagement. Available at: http://cooperation.epfl.ch/files/content/sites/cooperation/files/Tech4Dev%202016/1265-Mantzavinou-SE07-MED_Full%20Paper.pdf. Accessed February 3, 2017.Google Scholar of the MIT Hacking Medicine events, some MIT PhD students and members of the program offered a favorable assessment of the program’s overall goals and accomplishments. “Although one of the most exciting outcomes of a hackathon could be the start of a successful company, we acknowledge that this is a very rare occurrence,” the authors wrote. “Moreover, it is not our intent to imply that the primary goal of a hackathon is to start a company. Rather, at the core of these events is exposure to innovation and the establishment of new networks—we aim to inspire local stakeholders to take a stab at problems that intimately affect their lives and connect these individuals with others who are similarly interested in these endeavors within their community.” The primary criticism of hackathons is that they can generate short-lived excitement for particular ideas or solutions, but don’t offer the means to carry those ideas through to a meaningful effect. For example, a disparate group of graduate and undergraduate students may come together during an event, become enthused about a particular problem during a 48-hour period, but then go back to their regular lives when the weekend is over. As a result, MIT and other health hackathons have sought to devise ways to continue to foster collaboration long after a hackathon ends, such as offering awards weeks or even months after an event ends according to follow-up progress on a problem. The inaugural hackathon at Aga Khan University followed the MIT Hacking Medicine methodology and issued no specific challenges for care within the ED, said the organizer, Dr. Mian. Rather, the event’s overall theme focused on coming up with practical and sustainable ideas to improve ED efficiency, particularly for resource-limited EDs, as well as the patient’s or patient’s family’s ED experience. Approximately 80 “hackers” participated in the initial event, with 20 mentors and 6 judges, Dr. Mian said. After 48 hours of considering the manual bag-valve-mask resuscitation problem, Dr. Atiq and her team came up with a solution for the crowded Karachi hospitals. “We needed a device for our hospital, a public sector hospital,” she told the hackathon crowd during her team’s presentation. “It should be cost-effective, locally made, and reliable. So what we did is, we made it as simple as ABCD [Ambu bagging compression device].” The team came up with a concept for an automated bag-valve-mask device, which would keep children oxygenated and alive. They created a prototype of the device (made late the night before), and Dr. Atiq said it could be manufactured locally at a cost of approximately 2,000 rupees ($30), or considerably less if mass produced. For its work, the team finished among the prize winners, and some of its members are now working with the Aga Khan University eHealth Resource Center to scale it up. Overall, Dr. Mian said the event came off successfully and resulted in several ideas that merited further development. “The 4 winning ideas, out of a total of 11 final team pitches, were demonstrably implementable,” he said. Although he experienced some challenges of getting a new event up and running in a conservative environment, Dr. Mian said once the planning started, the hackathon took on a life of its own. “After the initial lag phase, and with MIT Hacking Medicine support and advice, we were able to get a lot of traction at AKU [Aga Khan University],” he said. Dr. Mian said he was able to get buy-in from the broader tech community in Pakistan, as well. One of the event’s judges, Athar Osama, PhD, an engineer who founded the Pakistan Innovation Foundation, said he welcomed the opportunity to harness young minds in Karachi. “Innovation within a society comes from the bottom up,” Osama said after the event. “It is the work of individuals who, when faced with constraints, take it upon themselves to find solutions. Emergency response is a very critical area for a volatile city like Karachi, and I’ve seen some great ideas at the Hackathon that are sorely needed. The participants have made great progress in just a few days, and I look forward to seeing how they build upon these ideas.” The event was such a success that planning is already under way for additional emergency medicine hackathons in Karachi in 2017, Dr. Mian said. The second event will help design the next-generation children’s hospital at Aga Khan University, and participants will be challenged to develop innovations for problems and solutions that will be relevant to children’s hospitals for resource-limited settings. A repeat of the original, emergency medicine–themed hackathon is also being planned for later in the year.