
A doctor in Bangladesh has found a simple way to treat infant pneumonia - sohkamyung
https://www.economist.com/science-and-technology/2018/09/08/how-a-shampoo-bottle-is-saving-young-lives
======
linfocito
He and his team should be praised and prized for the achievement and results.

On the other side, this shows how slowly ideas can spread even in
globalization times. I'm a pediatrician in Brazil and have used and been
taught to use improvised bubble CPAP, with great results, since the nineties.
I've heard reports of its successful use since, at least, the 80's decade.

I hope those devices can swiftly be fully scientifically validated and reach
all needing regions of the world.

edited: grammar

~~~
dstroot
I am always amazed at the quality, intelligence and experience of HN readers
on any topic you can imagine. I love being in a community where a pediatrician
from Brazil can comment on a medical discovery. I’ll probably be downvotes for
a silly comment but feel like HN elevates my life.

~~~
azhenley
I'm always pleasantly surprised by this too. There are experts and hobbyist in
every field in this community. It is one of the reasons why I look forward to
the comments more than the articles themselves.

------
whiddershins
I feel like there are deep implications in this article about healthcare
costs.

If hospitals don’t compete on price, what really motivates them to find a
cheaper ventilator?

If they aren’t all that motivated to find a cheaper ventilator, are the
ventilator manufacturers motivated to develop a simpler and cheaper version of
their technology? Not so much. They might be more motivated to lobby for
regulations making cheaper solutions illegal to protect their business.

And so forth.

Fascinating. Demoralizing.

~~~
gascan
If a $15k hospital grade ventilator has a fifty year service life, perhaps the
developed world sees little benefit to finding a cheaper ventilator,
regardless of competition.

------
aftbit
Here's a schematic of how traditional bubble CPAP works:
[http://www.i-ma.com/images/INCA-Setup-
Components.jpg](http://www.i-ma.com/images/INCA-Setup-Components.jpg)

~~~
anotheramala
I didn't understand from the article about a "shampoo bottle with bubbles left
in it". This diagram seems simple enough.

~~~
qwerty456127
I can't even understand the diagram: how is exhaling into a glass of water
supposed to make breathing easier?

~~~
FooHentai
My understanding is that having water at the terminal side of the air flow
creates back-pressure, which helps prevent the lungs collapsing.

~~~
selimthegrim
Is this sort of system used for gunshot or stabbing victims where the lung was
punctured?

------
fipple
If this is reproducible and legit I’d love to see him win the Nobel Prize in
Medicine instead of the basic science people who usually win.

~~~
dingdingdang
Absolutely, the humanitarian implications of making this widely
available/accessible are tremendously positive (whereas your average brilliant
idea may or may not ever see practical use and additionally the use it
eventually sees may be a net negative for mankind on the whole)

~~~
fipple
Well, I think there's also a pretty great track record of basic medical
research making it to practical use.

------
samfisher83
I think this article forgets to mention it took him close to 20 years to make
this.

[https://www.bbc.com/news/business-40498395](https://www.bbc.com/news/business-40498395)

People like him should win the Nobel Peace prize.

~~~
sohkamyung
Agree that people like him should get more recognition, maybe even the Nobel
Peace prize.

In reading the article, though, I don't think it took him 20 years to make it.
Instead, I think it means he made a promise to do something about children
dying from pneumonia and it took him 20 years to figure out how to do it. I
base this on the following paragraphs in the article:

 _In 1996, Dr Mohammod Jobayer Chisti was working in the paediatric department
of the Sylhet Medical College Hospital in Bangladesh. That evening he made a
promise that he would do something to stop children dying from pneumonia._

 _When asked how he feels to be fulfilling that promise he made 20 years ago
he replies: "I have no language to express this."_

~~~
samfisher83
The article said the following:

After two decades of research, Dr Chisti has now come up with a low-cost
device with the potential to save thousands of babies' lives.

------
dmix
> The materials needed to make his version of a bubble-CPAP ventilator cost a
> mere $1.25.

One of the situations where a lack of strict health regulations on medical
devices is saving lives.

~~~
bena
It could also be the situation where the loss due to complications due to the
equipment are far less than the loss due to the disease.

If you lose 10% to contaminated bottles, 15% to various malfunctions, and
another 5% for things related to the procedure I can't even begin to consider,
that's 30% mortality rate for this procedure.

But if another has 0% mortality rate but due to some other factor is not
available in appropriate quantities, let's say there are only enough resources
to service 10 cases a day, then your 11th case can either take a 100%
mortality rate for doing nothing, or a 30% mortality rate with the other
procedure. You take the better chance.

~~~
nraynaud
I think there is confusion, on the videos and picture they are using medical
equipment, it's just used in a different way.

~~~
bena
The point dmix makes is that "a lack of regulation is saving lives". The
device doesn't have to be tested, it doesn't require licensed operators, etc.

And I was agreeing that it is saving lives, but that it is not particularly
indicative that regulation is killing people.

That the incident of a disease may be so prevalent or that access to modern
hospitals may be so scarce that in certain cases, taking an unregulated
approach is better than no approach.

This _is_ in India. This would never be discovered in a developed nation
because there is no need for it. A ventilator has a far better success rate.
However, in India, in other developing nations, this is necessary. And the
fact that it is simple to set up, that it can be set up by someone with little
training, etc are all benefits in those situations. That even with what would
be considered a pretty poor mortality rate, it's still better than the
alternatives at their disposal.

~~~
kragen
You say, "A ventilator has a far better success rate." I am skeptical of this
statement; what are your sources? I would expect this setup to have the same
success rate as any other bubble CPAP machine.

~~~
omegabravo
it would be hard to cite source on a new device/discovery/method such as this
as there would not be any.

The comment higher up the chain covered some of the potential failure methods
of the new system.

> If you lose 10% to contaminated bottles, 15% to various malfunctions, and
> another 5% for things related to the procedure I can't even begin to
> consider, that's 30% mortality rate for this procedure.

~~~
kragen
There's no reason to expect that those rates would be higher for this
equipment design than for the $15000 one, rather than lower.

That comment also seems to demonstrate a fundamental lack of understanding of
what's being discussed, since contaminated bottles are vanishingly unlikely to
infect the patient — the air goes _from_ the patient _to_ the bottle, through
a dry plastic tube, not vice versa.

~~~
bena
You do understand the numbers and examples were made up to illustrate a point,
that _even if_ it weren't as good as a modern hospital that it's better than
the current alternative.

Discussing the minutiae is immaterial.

------
yostrovs
Last year's news:
[https://www.bbc.com/news/business-40498395](https://www.bbc.com/news/business-40498395)

~~~
akavel
This article actually contains the link to the paper too:
[https://www.thelancet.com/journals/lancet/article/PIIS0140-6...](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(15\)60249-5/fulltext)
— though behind a Lancet register-wall apparently

 _edit:_ though based on the abstract available at the URL, it's not clear to
me which of the mentioned methods is the innovative one, if any (??)

 _edit 2:_ Found a youtube video with some actual description of how the
machine is built, from the doctor himself, from 2015 (google keywords: "Chisti
bubble CPAP"):
[https://www.youtube.com/watch?v=HM1E8yMJd5Q](https://www.youtube.com/watch?v=HM1E8yMJd5Q)

~~~
tuxguy
pdf of the paper :
[https://www.researchgate.net/profile/Mohammod_Chisti/publica...](https://www.researchgate.net/profile/Mohammod_Chisti/publication/281552002_Bubble_continuous_positive_airway_pressure_for_children_with_severe_pneumonia_and_hypoxaemia_in_Bangladesh_An_open_randomised_controlled_trial/links/59e1b993458515393d57b423/Bubble-
continuous-positive-airway-pressure-for-children-with-severe-pneumonia-and-
hypoxaemia-in-Bangladesh-An-open-randomised-controlled-trial.pdf)

------
PakG1
_All in all, the Chisti bottle-based ventilator shows what can be achieved by
stripping an idea down to its basic principles. Effectiveness, it neatly
demonstrates, need not always go hand in hand with high tech._

Can't be said enough.

~~~
nine_k
It's the typical path of "crude conceptual prototype -> complicated advanced
solution -> highly optimized stripped-down late version" constantly seen in
engineering, especially in software where iterations are fast.

I hope that much of today's advanced, complicated, and expensive tech will
eventually make that next step to simplification based on huge accumulated
experience and knowledge.

------
F_J_H
Reminds me of the great story of the ingenious baby incubator developed from
Toyota 4 Runner parts:
[https://wheels.blogs.nytimes.com/2010/11/23/neonurtures-
car-...](https://wheels.blogs.nytimes.com/2010/11/23/neonurtures-car-parts-
baby-incubator/)

------
epynonymous
powerful, this puts everything i do in pale comparison, this person's acts are
really changing the world and directly saving lives. i also don't see him
trying to profit on this, but instead he's trying to replicate this work in
another 3rd world country.

this does put a massive black mark on the medical device industry and medical
industry as a whole, trying to profit off what should be basic needs of
hospitals. in general, companies making profits is only natural, and some of
their research does require heavy research funding, but to the extent where
their pricing may be killing off people is a little contradictory. i imagine
the device costs have been subsidized by some governments of rich countries,
but these standards cannot be applied to all countries. this is certainly a
political issue, where are all the funds for bangledesh heading?

this also reminds me of the efforts going on at fourthievesvinegar.org we need
more open source medicine and medical devices, this seems to be a lot more
meaningful than creating enterprise software or social apps.

------
yablak
The shampoo bottle CPAP is described here in diagram form:

[https://www.semanticscholar.org/paper/CPAP%3A-a-guide-for-
cl...](https://www.semanticscholar.org/paper/CPAP%3A-a-guide-for-clinicians-
in-developing-Duke/cfebb0dbed8643ab2dcb996076e10bc69cc392b3)

~~~
linfocito
In my experience, most facilities that have oxigen flow also have compressed
air flow with cheap controllable fluxometers, but a blender is often lacking
or too expensive.

In those cases we use a Y piece connecting air and oxigen flows to the
inspirarory limb.

The role of the blender is to control the percentage of oxigen offered. With
the Y piece we can control that by the equation:

%O2 = (O2flow + Airflow * 0.21) / Total flow

If you can use Total flow of 8L/min (reasonable in most cases) the
approximations table below is of easy memorization and precise enough:

    
    
      O2 flow - Air flow - %O2
    
        8 - 0 - 100%
        7 - 1 - 90%
        6 - 2 - 80%
        5 - 3 - 70%
        4 - 4 - 60%
        3 - 5 - 50%
        2 - 6 - 40%
        1 - 7 - 30%
        0 - 8 - 21%
    

Edited:formatting

------
univalent
Absolutely brilliant! Take a bow, Dr. Chisti.

------
rainhacker
[Dupe] of
[https://news.ycombinator.com/item?id=17931801](https://news.ycombinator.com/item?id=17931801)

~~~
dang
On HN it doesn't count as a dupe if the story hasn't had significant attention
yet. This is in the FAQ
([https://news.ycombinator.com/newsfaq.html](https://news.ycombinator.com/newsfaq.html)).
More explanation at
[https://news.ycombinator.com/item?id=16403654](https://news.ycombinator.com/item?id=16403654)
and
[https://news.ycombinator.com/item?id=16344002](https://news.ycombinator.com/item?id=16344002).

