How device to save lives was invented, by doctor

A young Nigerian doctor, Dayo Olakulehin, has explained how he invented a cheap, portable, easily deployable, easy to use and rechargeable battery-powered solution to one of the major causes of death in developing nations-respiratory problems.

The D-Box is an innovative ventilator designed to automate Cardiopulmonary resuscitation (CPR) bags and deliver controlled breaths to patients with respiratory problems.

According to the World Health Organisation (WHO), heart disease, stroke, lower respiratory infections and chronic obstructive lung disease have remained the top major killers during the past decade.

A medical ventilator (or simply ventilator in context) is a machine designed to mechanically move breathable air into and out of the lungs, to provide the mechanism of breathing for a patient who is physically unable to breathe, or breathing insufficiently.

CPR is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone’s breathing or heartbeat has stopped.Olakulehin trained at the College of Medicine University of Lagos (CMUL)/Lagos University Teaching Hospital (LUTH),.

D-Box is a joint venture product of the Canadian product development firm Inertia Engineering + Design, headed up by Ray Minato and LigandCorp, owned by Dr. Dayo Olakulehin.

The product was also public endorsed at the Lagos launch by officials from CMUL/LUTH; National Orthopaedic Hospital Igbobi, Lagos; Lagoon Hospital; and Inertia Engineering + Design, Canada. Inertia is a product development service company.LigandCorp is a medical technology product solutions company.

What was the motivation? How was D-Box discovered?
Olakulehin explained: “In 2012, while I was at the Olikoye Ransome Kuti Children emergency ward, LUTH, I had manually ventilated a five year old boy for four hours and at about 2am, I fell asleep, only to be awaken by the boy’s father.

“If the child had continued without ventilation for longer than four minutes, it could have resulted in irreversible brain damage. This experience was common among hospital staff at LUTH and other medical facilities.

“It was after one of such incidents the idea for an alternative ventilation method came to my mind. I knew that this method eliminates the dependence on human operated ventilation.”

This experience drove Olakulehin to think of a better way, and the idea for the D-Box was born. Many other similar stories have surfaced since – of doctors, nurses and family members in areas of India and Africa having to manually squeeze CPR bags 24 hours a day for as long as an entire month to keep patients and family members alive.

The D-Box was just an idea until Dayo left Nigeria to come to Canada in August 2015. In Toronto he immersed himself within the rich entrepreneurial start-up ecosystem and found a partner who could help make his D-Box dream become reality. That partner was Ray Minato, President and CEO of Inertia Engineering + Design. “Inertia’s rigorous methodology, core values, and outstanding team with a passion for developing products that have an impact on the world made them the only choice,” said Olakulehin.

His urgency to find a solution to what he had experienced inspired Inertia’s team to apply their state-of-the-art design practices to deliver this product innovation in record time – from idea to proof-of-concept prototype in just over three months. “The key to this product innovation is not so technically complex but rather that it simply meets the user’s basic and critical needs (and only those needs) where there was previously nothing,” said Minato.

Olakulehin further explained: “I knew having the idea was not sufficient, I needed to find a way to make it a reality. I knew nothing about business, patenting or developing innovations I went online looking for help, and I found a course on ‘Healthcare innovation and entrepreneurship.’ This course taught me how to develop a patent.

“I approached a number of medical device companies and found out it was a lot easier to sell a product than to sell an idea. I literally sat on the idea for three years trying to take the next vital step until I met Mr. Kunle Soriyan and Thelma Ekiyor of Afrigrants.

“This led to the founding of LigandCorp and shifted my paradigm from focusing on one product to creating a company that drives medical innovation, particularly among young Nigerians.

“The search for a prototype developer began and while I was in Canada, a collaboration was formed with Inertia, an engineering and design company. They excitedly committed to partnering with LigandCorp and worked hard to get the prototype ready.”
Bridging the gaps

What we must appreciate is that Nigeria’s current estimated population is about 170 million people. This product was developed in Lagos and think this should give us food for thought. Lagos is supposed to be urban, supposed to be metropolitan, has some of the largest and most prestigious teaching hospitals and we still have these problems being very critical in these areas. Now lets think about the rural areas, the states where we don’t have most of the doctors, where we don’t have teaching hospitals, where we don’t have ventilators available. I think this problem is very critical for our population, size and the number of facilities that we have. We really need a lot of access to more ICUs.

But beyond that there is issue of cost, who is going to fund it? Who is going to pay the bills? The gap that this device fills is that it can be used in teaching hospitals, it can be used in general hospitals, it can be used in private clinics, it can be used in companies clinics, it can be used in ambulances.

It is the ubiquitous device; it is the basic. What we are doing is that we are raising the standard. What use to be the basic was having a health officer have to manually compress bags. But what we are doing is raising that standard that the basic of bag compression should be moved to the D-Box. Let us allow a machine to do that, do it efficiently, do it without fear or failure and then we can allow our trained health officers and doctors pay attention to other critical needs of the patients.

Are there specific disease conditions D-Box could be used for?
The reason why this is serious is that I cannot tie it to one disease. It is not a malaria disease; it is not a pneumonia issue. When you encounter unconscious patients, it happens to be the final pathway for a lot of illnesses. So irrespective of what has caused the patient’s problem- hypertension, diabetes, tuberculosis, pneumonia, whatever it is.

The major final common pathway for most diseases usually is cardiac arrest. We have an unconscious patient, for whatever reason. For a lot people also in our environment we have common trauma cases. So in our emergency rooms even whatever is responsible for the disease the first issue is that they are unconscious and that they need help. It should get us thinking that we are not addressing one disease, we are addressing the final common pathway for most diseases- once you talk about circulation and ventilation- those are the keys to life of any human being.

Is this a private healthcare initiative?
I would not want to be very specific. I am aware of a lot of initiatives by private sector. We would like to encourage them for what they are doing and would want to say there is a lot more private sector roles to be played. Apart from known private healthcare initiatives, a lot other stakeholders can come on board and help healthcare.

As I said earlier, entrepreneurship is important, let us not focus on technology and software and Information Technology (IT). Let us zoom into healthcare. Apart from the fact that there is amazing business opportunity, we will also be making contributions to humanity by saving lives.

How about patenting the product and protection from faking and intellectual property right abuses?
What we have done as a matter of due diligence is to patent this device. Initially when I got the idea I got a patent. When I did the product development I filled another patent. When we meet the prototype we had to also fill another patent. We have the best of intellectual property lawyers working with us. However, we know that intellectual property theft is a major issue especially for a product that has the tendency to go global. So all we can do is to ensure our due diligence and ensure adequate protection and also to take this product into some of these emerging markets, and that is what we are doing. We have had conversation with Chinese, with India. We want to take the D-Box to them such that them own it and are able to distribute and if necessary manufacture for their own regions.

What makes the D-Box different from existing ventilators?
The number one difference is sophistication. Existing ventilators are very sophisticated and the consequence of that is that they are very expensive. This is why big teaching hospitals have five, six units and that is a big challenge considering the population these hospitals have to serve. It is portable. It can be carried but existing ventilators cannot be carried. Existing ventilators are not only electricity dependent but are electricity sensitive. So you have to be sure you are getting the right amount of current, proper amount of voltage. The advantage of the D- Box is that during uncertain periods of electricity supply it can work for hours, up to twelve hours, so what we must not say is that this replaces existing ventilators. Existing ventilators exist for critical intensive care but pending that care we don’t want to leave our patients to chance or risk of human error. We are introducing this to improve the quality of care that is available for these patients.
Limitations

The limitation of these products for now is that it is automating the CPR bag. So what it does is that the volume it delivers is the standardized volume of the bag. Fortunately for us we have a pediatric version and we have taken into account the pediatric long volume. I mean we cannot connect this adult size to a child. The other unit is a bit technical but experts will understand it. Existing ventilators have different modes but this is only Intermittent Positive Pressure Ventilation (IPPV). There are other modes available. We are looking in the future we will do product improvement that will put into effect all those modes. But for now the current mode for this is IPPV, it has a slot for oxygen administration, it is extremely portable and works with all airway devices.

What is your specialization? Are you a biomedical engineer?
I have an MBBS that is medicine and surgery from the prestigious CMUL, so I am a doctor in general practice now, I have not specialized yet. But because of my passion for innovation and entrepreneurship biomedical engineering not as a specialty, we are encouraging myself and the innovation hub that we set up to encourage professionals think solutions. The reason why I am saying this clearly is that you don’t need to be a specialist in biomedical engineering for you to innovate a product solution. So for anybody anywhere with a brilliant idea that can save lives and make a difference, we are the people to talk to.
Are you planning to invent more solutions?

Yes! The journey up to this point has involved me talking to a lot of experts. Some of them say they have ideas for new products. I spent about one hour discussing with a neuro-anaesthetics in LUTH who was showing product solutions to use in theatres not only in Nigeria but all over the world. It is conversation we need to encourage, partnership between private and public sector to see how much we can focus on healthcare. So many problems will be solved, so many amazing opportunities for businesses to thrive.