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How to Save a Million Lives

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by Joshua Robinson

A lack of a college degree or any engineering training didn’t stop Marc Koska, a speaker at The Daily Beast’s upcoming Reboot America conference, from seeing a problem—millions dying from reused needles—and doing something about it.

Marc Koska had always wanted to dig up one great idea, one major strategy for helping people in a global way. He didn’t know what it would look like or where it would come from. Like any cloud-headed student or barstool idealist, he just wanted to change the world.

Marc Koska

For the first 23 years of his life, Koska didn’t look around especially hard. The day after he graduated from the prestigious Stowe School in Buckingham, England, already set to forgo college, Koska became a garbage man. Just to pick up some money through the summer, not because of any calling in public sanitation. When he’d had enough of collecting trash, he looked at his options again and thought, “Well, I could go do something normal, which wasn’t really me. Or I could follow my nose and get on a train first.”

He chose the latter. For the next four years, aimless wandering carried him around the world, at times working on yachts and in ski resorts, until it landed him in front of a newspaper article one day in 1984. “It simply said, ‘One day syringes will be a major cause of the spread of HIV,’” he said in a telephone interview from England. “Sadly, that’s come horrifyingly true. Now we have a situation where, potentially, AIDS is spread as much by medical devices and poor practice as anything else.”

Indeed, unsafe injections are as serious as any epidemic in the developing world. According to a 2009 World Health Organization report, some 40 percent of injections worldwide are given with syringes and needles that are being reused without sterilization, causing an estimated 1.3 million deaths every year. HIV, Hepatitis B, and Hepatitis C are the main offenders. Educating patients to demand new needles is still a critical issue, as is the prevalence of dangerous medical practices—doctors who convince their patients they are breaking out fresh ones by rustling wrappers under their desks or nurses simply following orders.

“We’re told to,” one nurse in Faridabad, India, told the Times of London in 2009. “They tell us to use the syringes sometimes two times, three times, 10 times. I have seen them reused 30 or 40 times.”

“They are accustomed like this,” she added, referring to the doctors at her hospital. “They have practiced this way always, and they will continue. It may be they think if they reuse [syringes] they will save money.”

But the problem does not only stem from the economic interests of health-care providers.

"In developing countries, people go see the doctor and you can't get them out unless you give them an injection," said Dr. Ernest Drucker, an adjunct professor of epidemiology at Columbia University's School of Public Health. He cited a study dating as far back as the 1960s that showed that 80 percent of households in Uganda had a syringe, adding, "They feel like they haven't been treated if they don't get an injection. 'Magic shots,' they call them."

A syringe and needles in an Indian hospital, waiting to be reused

It is with these conditions unfolding throughout the developing world, that the idea Koska had been looking for began to crystallize 26 years ago. And by 1997, it turned into a patent for one of the first auto-disable syringes that also worked for curative injections. The name may sound complicated, but the idea is beautifully simple. How do you make sure people don’t use syringes twice? Make them impossible to refill. The K1, as Koska dubbed it, is equipped with a locking ring in the bottom of the barrel, so that when the plunger is fully depressed it stays there. Trying to pull the plunger back would snap the ring and effectively break the syringe.

The K1 model is not the only auto-disable syringe out there. When he first started working on it, there were more than 250 other patents around, and by the time he registered his, that number had grown to about 1,000. Of those, however, Koska says only about 20 had been made into prototypes and all of them were designed specifically for the small doses used in immunization. His design was also suitable for curative purposes, meaning the K1 could handle a whole range of doses.

Ultimately, it was a low-tech solution in a medical environment that is growing ever more expensive and sophisticated. Koska’s answer wasn’t a revolutionary apparatus, it was a small adjustment to existing technology with potentially massive impact. Not to mention a price tag for the developing world—K1 syringes sell for 5 cents, while many others go for as much as a $1 apiece.

“I always understood that what I was doing when I first came up with the design concept was going backward against the stream of thought,” says Koska. “The 270-odd patents, even 25 years ago, were all more complicated. I realized that none of them were going to get off the ground, because they were over-engineered. And over-engineering costs money to produce. I deliberately went to the simple end of the spectrum.”

Before he could even begin considering a design, Koska had to figure out exactly what he was dealing with. All he had in 1984 was a high-school science background and a newspaper clipping. So he spent over two years traveling, reading, and pestering anyone he could find who knew something about public health and had the technical know-how to help him. “I don’t think I even took any notes,” he says. “I just kept asking questions. I’d end up at the World Health Organization and ask them 20 questions about a trip I’d just taken to Kenya and watching immunization campaigns,” Koska says. “It was very random. But it built up a picture for me.”

Seventeen years after the idea first dawned on him, Koska sold his first syringe.

During that time, his efforts to popularize it did not make him any friends. Rival manufacturers, Koska suspects, were not especially pleased with his crashing the market. His first licensee in the developing world was suddenly and mysteriously bought out by an anonymous party and then bulldozed to the ground. Another factory in India simply failed to sell any. Finally, in late 2001, UNICEF placed an order. And soon after, he saw one of his syringes being used for the first time in Cambodia. (UNICEF has since made it a requirement of its campaigns to only use auto-disable syringes.)

Today, Koska runs Star Syringe, the company that owns his patents, alongside a nonprofit called Safe Point, which he started in 2006 for lobbying and education. His licensees are on the verge of selling their 2 billionth unit. Production is up to about 2 million a day, giving Star Syringe a 1 to 2 percent market share of all the syringes manufactured around the world, auto-disable and standard.

But beyond the worldwide numbers, Koska says that the real effect can be seen in places like the hospital in Tanzania, where the average stay has plummeted from seven days to three.

The only change it made was switching syringes.

Taken from The Daily Beast
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The TEDxProject: Marc Koska - 1.3m reasons to re-invent the syringe

by Christian Long

Reflection by Gabriella B.

You’ve been to the hospital, or the clinic before.

Think about it. It was probably immaculately clean, the walls were a neutral, mint green, or pale blue, perhaps, a nice beige. You can smell the antiseptic, and hear hushed muted noises all around.

The crinkle of white paper on examination tables, the ring of the phone from the office. The soft beeping and clicking of expensive machines you barely understand the purpose of. A few people are wandering about the ever frigid halls avoiding nurses and doctors hurrying about authoritatively in crisp white coats or pale blue scrubs. Worried relatives are sitting in plushy chairs leafing through decade old magazines.

Now imagine with me a hot stuffy room. The light is dim through the slightly grimy windows and you can hear the discordant cacophony of the busy street just outside the door. Besides that, the room is full to bursting with sickly people all desperate for a life saving injection, from doctors and nurses who may or may not be trained. It’s dusty and hot, the beds are little more than cots placed in rows to get as many as possible in the already small rooms.

That is what you’d see if you happened to be in any of the poorer sectors of Asia. AIDS and many other viruses are rampant in these areas and are spreading with the help of well meaning doctors and nurses.

How could this be happening? It’s really as simple as a syringe. You know what I’m talking about. You probably have one or two in your kitchen drawers. The issue most developing countries face is that not only are these syringes being reused but there is a business in the collection and repackaging of used syringes.

This places massive risks on a single, life saving shot. Aside from the obvious problem of sanitation there is also the issue of cross contamination of medicines and the side effects of a bad mix.

As Koska explains many of the patients view doctors as ‘next to God’ and trust them to do the right thing. He tells the story of some children in Pakistan whose job is to collect used syringes from the back of hospitals, wash them, repackage them and sell them for more than what a sterilized syringe costs. In china this is even more of a problem. One story of an Indonesian school is particularly appalling of children being given used syringes to play with and then using them to drink from.

So what can be done to prevent the annual death of 1.3 million people due to the reuse of syringes? The answer proved surprisingly simple. As Koska demonstrates the answer was there the entire time, we only needed someone who cared enough about the problem to start acting on the solution.

He has developed a syringe that looks and works just like an ordinary syringe, and is even made in the same machines as ordinary syringes at the same cost. The crucial difference is that his syringes lock in place and break if an attempt at reuse is made.

Simple, no?

So I guess the question we have to ask ourselves now, is why it took 1.3 million deaths for someone to care enough?

Excerpted from:
Marc Koska - 1.3m reasons to re-invent the syringe

Original TED page with speaker bio, links, comments, etc:
Marc Koska - 1.3m reasons to re-invent the syringe
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Marc Koska: 1.3m reasons to re-invent the syringe

Malaria kills 1 million people a year? Reused syringes kill 1.3 million a year? Holy crap. Those are the sort of numbers that remind me in no uncertain terms that I live in a privileged world.

OK, a few minutes in and I'm convinced this is one of the most terrifying TED talks I've seen.

Sometimes we joke about planned obsolescence, or about items breaking just as they come out of warranty. Marc Koska's one-time-use (enforced) syringes are that, but for the best of reasons. This is the kind of thing that will save lives.

Excerpted from reviewingted.posterous.com