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Huh? Say That Again?

Hundreds of millions of people around the world have lost their hearing. In Africa, Dirk Koekemoer wants to help by getting them to sit in the shade of a tree.

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It was an idea that inspired a doctor to walk out of his practice. Dirk Koekemoer, the founder of biomedical engineering company eMoyo, spent the next 18 years building a device that helps tens of thousands to hear – all they have to do is sit under a tree and listen.

“It was 1999, I literally sat in practice and realized this is going to go on forever. I was going to see 30 patients a day for the rest of my life. I wanted to be able to treat thousands. I cancelled all my appointments that day and took the bold move to start a company,” says Koekemoer.

It cost Koekemoer $1.2 million and saw the birth of the KUDUwave, a mobile audiometer that looks like a set of headphones. Its size and the fact you can use it under a tree made it a game changer.

“A basic sound booth, at minimum, would cost R35,000 ($2,600). They can be the size of a fridge and are good for screening. But, the moment you want to do proper audiology the booths go up to R250,000 ($18,700). Then the moment you look at mobile audiology you need two booths on a mobile trailer, with a 4×4 and on a heavy trailer. You are looking at costs of R500,000 ($37,000).”

The R65,000 ($4,800) headphones are cheap and smart. They won’t operate unless the conditions are just right. One of the best places to use them is under the shade of a tree, just as well as Africa has plenty of them. They are used in the rural areas, like Zambia, where audiologists need to get around.

“Open air testing, in an area with open windows or under a tree, is the best for ear testing. A booth needs ventilation, it needs soundproofing and probably doubles the costs.”

“There are 3.5 billion people in the world that don’t have access to adequate equipment. I thought let’s create devices that can actually do the tedious things that a doctor and a nurse have to do that don’t need brainpower,” says Koekemoer.

According to the World Health Organization (WHO), 360 million people have hearing loss and most of them live in low- and middle-income countries.

“It’s a huge need. There are 30 million people in this country with hearing problems, 2 million need hearing aids. There are not enough audiologists and there are not enough facilities,” says Koekemoer.

“Hearing loss is a serious problem. It causes dementia and depression. Also isolation, especially in the elderly; literally their life expectancies shorten if they are unable to hear well.”

In Khayelitsha, a township 28 kilometers south east of Cape Town, this is a common challenge. This is also where we follow Koekemoer to meet with head audiologist Shireen Martin, of the Khayelitsha Hospital, who has been working with the device since July.

Koekemoer’s device has transformed the way audiologists, like Martin, work. Employed by the South Africa’s Department of Health, Martin uses the device to test patients’ hearing loss in multi-drug-resistant tuberculosis (MDR-TB).

“At first I was against the idea. I think there was a lot of speculation about it. It has to do with changing the way people work and think. I was used to sitting in a booth, sitting with a patient one-on-one. It kind of made me adverse to the idea of a mobile audiometer.”

The department employs decentralized TB treatment, which means Martin needs to travel to treat patients.

“I don’t have access to any other audio equipment. With many TB clinics that decentralized their treatment and initiation of MDR-TB, many patients are not able to go to an audiologist, with them being so far away,” she says.

Martin is the only audiologist who operates here and sees up to 60 MDR-TB patients a month.

“[Patients] do appreciate it. Because it is not far away from home, they don’t have to wait long for transport to take them to far-away hospitals. Bringing the service to them is the importance of primary healthcare, not just audiology.”

MDR-TB patients need to be monitored carefully. Hearing loss can be a side effect of the drug used to treat the disease.

“Some can lose their hearing in as short a space as a month,” says Martin. “It’s devastating, especially if it happens in a short space of time. That’s why counseling is very important; so patients know what the early signs are and the importance of them coming back.”

Koekemoer believes Martin’s work is a mere drop in the ocean, considering there are 20,000 MDR-TB patients in South Africa and the disease is very infectious.

“It’s scary. Patients can’t just jump into a taxi with their disease. They need special transport. It’s why it makes sense that the audiologists go to them,” says Koekemoer.

Koekemoer’s dream started on an even grander scale – a full mobile body scanner. It was a eureka moment in his small home office in Pretoria.

“One night at two or three o’clock in the morning, I was sitting at my desk and I started drawing a picture. It was a horrible picture. It was a full solution on how to examine a patient as good as a GP would examine a patient. Things you had to put on a patient. It wasn’t like the Star Trek scanner version you see in movies, but we are getting there,” says Koekemoer.

Koekemoer has learned the business of building medical equipment is tough.

“In 2001, when I started developing these medical devices, it was so difficult. Voice over IP wasn’t even legal then. In that type of environment, it was difficult just to find information on audiometers. At that stage I was doing deep searches on university FTP sites. I had to invent my own software to actually find the information. Now it’s easy. The rate of inventiveness increases significantly.”

Patents are expensive. According to Koekemoer a single patent costs R1 million ($75,000), and a further R500,000 ($37,000) every year after. It still doesn’t protect your devices; poached product designs are common. It can be as simple as changing a small part. Koekemoer says that in the field the headphones have a two-year advantage before similar devices appear.

“The problem is KUDUwave had got about 16 patents. It’s better to take that money and get first-mover advantage. If I can give any advice to any entrepreneur, just give up on thinking you are going to protect yourself on patents. Just get the flipping thing in the field.”

“You need to be fast, constant improvement and add additional things to the KUDUwave. In the next few days we are adding a crosscheck that will allow calibration of the device in the field.”

Next is getting the product certified. With huge backlogs worldwide, inventors struggle to get their products on shelves. The process can add years of painful delay. The South African Bureau of Standards (SABS), the governing body which approves devices in the country, has no facilities to test the device as it is so unique.

“We need alternative European certification which can take five months just to get a quote for audit. It is really difficult to say no every day and not go to the US, where it is so easy to get FDA (Food and Drug Administration) approval. FDA registration doesn’t count in South Africa, but it’s accepted in the rest of the world,” says Koekemoer.

Despite the uphill battles, Koekemoer is adamant that Africa is the place where his device can make the most difference.

“Re-engineering healthcare, that is what we are doing.”

So, when you see a patient with a set of headphones on while sitting under a tree, chances are they are taking a test that could change their lives.

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