RentCheck.me, a new website created by TED Fellow Yale Fox, aims to make renting an apartment in New York less of a guessing game. Image: RentCheck
Cockroaches. Moldy walls. Stolen deposits. Bad landlords happen to all of us, and it can be impossible to tell before moving into a property whether the experience will be a good one, especially in housing-short cities like New York, where landlords seem to hold the cards. But TED Fellow Yale Fox is looking to change that with RentCheck — a new rental search engine that not only finds apartments but rates properties and landlords based on consumer reviews and the city’s open data.
RentCheck launches today in New York City, and will ultimately be rolled out in San Francisco, Chicago, Los Angeles, Dallas, Toronto and Vancouver, too. On launch day, the TED Blog asks Fox to tell us more.
Did RentCheck come out of a bad personal experience with renting?
Yeah — every place I’ve ever rented in my entire life, especially in New York. When my fiancée and I first moved to New York from Los Angeles, we rented a place and put down three months up front — our entire nest egg. It was a brand-new building, three years old. I had a broker check it out for me, and he said everything was okay. But when we got there, after a minute or two of looking around, we said, “What the hell happened in here?” The bathroom was disgusting. There was a dead bird, and insects rolled up in the blinds. It was vile. But all the management said was, “Sorry, man. Welcome to New York.” Because of our contract, we ended up having to stay for six months before we could finally leave.
To put this in perspective, I’m talking about a new building. There are many people who live in far worse conditions in New York — people who have to turn on their stove or oven to heat their place because the landlord won’t fix the radiator, for example. That can cause fires. With RentCheck, we’ve created a platform that increases the amount of transparency involved in a simple, common real estate transaction — the signing of a lease. The whole idea is that RentCheck can help renters avoid these bad situations in the first place. Additionally, it’s a place for renters to report problems publicly — all backed up by official city data.
How does RentCheck work?
RentCheck is an apartment rental search engine, but what makes us unique is that we give renters information about that property and landlord that has never before been easily available — such as cleanliness, pest problems, maintenance problems, landlord responsiveness and even information on whether or not they returned a security deposit on time, or at all. To express this, we compute a “RentCheck Rating” — a letter grade from A to F, which describes the quality of life in the building. The rating has nothing to do with the quality of the building itself; it’s not about whether it’s a fancy high rise or a brownstone. It’s about what will happen if you have a problem — how issues are handled. If you live in a B building, for example, it’s going to be fine. Repairs will likely be handled appropriately.
Everything you’d want to know about your future home: RentCheck shows available properties and scores landlords based on publicly available city data. It also lets renters post reviews. Image: RentCheck
Where do you get this information?
Much of the information comes from New York City’s open data and public records. In fact, RentCheck would not have been possible two years ago: I was inspired to create it when New York City made its city data open in September 2013. You see, in New York, if you have a problem with the landlord, you call 311 to register your complaint. You say, “Hey, there are roaches, and my landlord won’t get rid of them.” A day or two later, the city will send an inspector, and if they find the roaches, they’ll mark it as a violation. Typically, it stops there. If landlords don’t want to do anything about a problem, they don’t really have to. Most tenants either accept it, deal with it themselves, or go to court. But all this information gets filed in the city records. So at RentCheck, we take all that information and score every residential building in New York — and there are 1.1 million of them.
We’ve also gathered our own information based on renter reviews we solicited ourselves prior to launch. We hold contests where if you post a review about your landlord you’re automatically entered to win a year’s supply of unlimited MetroCards. The response has been great. Some people go on Yelp to write reviews of property managers and properties. But Yelp has a few thousand reviews in the New York City real estate space, whereas we have 10,000 — and that’s on launch day.
To read the full interview, visit the TED Blog >>>
The TED Fellows have found a new home on Medium.com, where they’ll be sharing their stories in their own voices. Here, a piece of art created by Safwat Saleem for a story on what to pack for TED. Illustration: Safwat Saleem
The TED Fellows are an extraordinary group of 368 people — artists, scientists, entrepreneurs and more — each at the beginning of a landmark career, and each with a story to tell, a truly unique voice. So when the folks at Medium.com asked us to create a publication for the TED Fellows, we jumped at the chance. Created by Twitter founder Evan Williams, Medium is a publishing platform that celebrates the act of writing and reading, and champions high-quality long-form journalism online.
The TED Fellows have been publishing on Medium for a few weeks now, and you’re invited to come check out what they’ve been up to. Every other week, you’ll find fresh stories and essays made by the TED Fellows just for Medium, like:
Above, Christine Sun Kim and Renée Hlozek share a snippet of conversation using American Sign Language and the Big Words app. Christine has been teaching Renée American Sign Language so they can communicate more directly.
Renée Hlozek is a cosmologist from South Africa who studies the cosmic microwave background, radiation left over from the Big Bang. Christine Sun Kim is a deaf artist who investigates the relationships between sound and silence. What could they possibly have to talk about?
When the two TED Senior Fellows first met at TED2013, the pair decided to try and communicate with each other directly as much as possible using American Sign Language (ASL). Kim attends TED with ASL interpreters and often relies on text, such as the app Big Words, to communicate. In the last two years, Hlozek has continued learning ASL to better communicate with Kim. Here at TED2015, we asked them to let us in on their friendship — and to tell us more about how Hlozek’s insistence on learning ASL has affected their relationship. Read the interview below, then watch the videos above for some simple ASL lessons between the two.
Renée Hlozek: When I met CK, I wanted to be able to communicate better on my own, like if the interpreter wasn’t around” But the more I got to know her, and thought about it. I realized: if I don’t learn sign language, how involved am I in our relationship? Or rather, how am I communicating that involvement in our relationship? It became much more of an imperative for me, rather than a fun thing to do.
Christine Sun Kim: That’s why I appreciate our relationship and what’s it’s evolved into. You serve as a reminder for me that ASL is fundamental to my being. In the art world I’m often interacting with people that don’t know ASL, so I rely on textual communication, be it BIG words or email and electronic communication. But I’m signing less in my everyday life, and that’s a pity.
RH: I think it’s really important that the tools improve your ability to interact with random strangers and make your access to the world much larger. But at the same time, it makes it much easier for hearing people to pretend you’re not deaf and pretend you don’t sign.
I have the technology to type to you. It’s easy – but then I’m always looking at the screen, not at you — and there’s a delay because you have to read and then type in the response. I much prefer when you sign, because it’s all your personality, all the time, and it’s very visible. That’s why I like ASL. Even though the interpreters are fantastic — it’s different for me when you and I sign. It’s different, right? Do you feel isolated sometimes, behind the texting and the interpreters?
CSK: I’m not sure if I would say isolated… maybe I feel a bit less connected on interaction level, but that’s reality. I can’t expect that everyone will learn ASL.
RH: I’m militant. THEY MUST!
CSK: That’s right. You’re fighting for me! <laughs> But the reason I focus on textual means of communication is that it makes it easier for hearing people to interact with me. Especially in the art world, I feel I can go to places far and wide if I meet them where they’re at, rather than them meeting me where I’m at.
RH: I kind of want to be an ally. Sometimes I see it’s difficult for you to see your interpreter, or someone doesn’t appreciate that if they slow down when they speak it will help you. Just little things. People are lazy, because they know if they mess up, YOU can get out the Big Words app, and it will be okay. But that’s not fair, because you do all the work.
CSK: I think I also have this messed-up idea about how the world should perceive me. I want the world to treat me as “normal,” but sometimes that comes at a cost. But sometimes when people treat me just like everyone else, I’m actually losing information, or denied access to information.
For example, when the interpreter is present, I’m treated as just another person at an event. People view that accommodation as “filling in the gap” — but that’s not enough, because placement of the interpreters, and thus where I can sit, is restricted. I do need some flexibility in terms of accommodation that allow me to access the environment.
RH: I like what you just said about redefining “normal.” Why is it not normal that I learn to sign? If you were French and I wanted to talk to you, I would learn French. I would think about it. But because you’re Deaf it’s a BIG thing that I’m doing. People say to me, “Why are you learning ASL?” and I say, “Because my friend speaks ASL.” It’s a no-brainer.
CSK: Yeah, what is normal anyway? One great thing is that you are very active in asking for signs, “What’s the sign for this?” Sometimes I’ll remind you to sign when we’re out. But also it’s become the norm that if you don’t know a sign, you will ask for it.
I think my attitude has changed in terms of how I interact with people because of your willingness to learn ASL. Because you are so assertive in your learning I have to learn to put the phone away to make sure I’m signing with you. And I appreciate that, even if it takes a bit longer to get through a conversation. So much more information get across, and it helps us connect better because we are looking at each other.
RH: Sometimes I feel shy because it’s super slow and you’re very patient. Like when I’m spelling… you’re like…ugh… and you wait for me, but I like it because it forces me to learn.
CSK: You always say, “Thank you for being patient.” But you are also patient when you’re communicating with me, so it’s a two-way street.
I’ve noticed that when I text with someone for four or five days at a conference, our relationship is temporary and can be superficial. But when I sign with someone like you, someone motivated to learn ASL, I develop a deeper and more meaningful relationship and friendship because you took the time to connect with me on my level.
Rooming with you has given me the opportunity to learn about myself, too. Sometimes we have opposite schedules, so I’ll be coming into the room after you’re already asleep. And I had warned you to bring earplugs because of my snoring.
RH: One funny thing is, you are very considerate about making noise. You sent me an email saying, “I snore a bunch,” so I brought earplugs. But I’ve never needed to use them. Also you woke up really early one morning but were typing super softly. It’s interesting because I think your understanding is that any noise will wake me — or you just entrenched consideration about not wanting to make noise.
CSK: It’s because I’m obsessed with the range and volume of sound. I don’t know if something is loud or something is quiet. But at the same time, how people hear and perceive sound vary. So I don’t know if that typing sound wouldn’t bother you, but might bother another hearing person. I have to figure out how to accommodate your sound needs. … I just wanna be a good hotel roommate!
It’s interesting — David Eagleman just spoke [watch his talk, “Can we create new senses for humans?”] about the advancements that have been made with sensory technology, and now there’s a vest that can translate sound (or speech) into vibration patterns. Which was really cool. And I have to say, I fell for it. Then I looked at you and said “That’s a politically smart move.” Because with cochlear implants, the Deaf community can be vocal about their opposition of the device. But now, David Eagleman, has shifted the focus from the ear to sense of touch and these vibration patterns. But then you came in with your observations.
RH: I said no. It’s making it the Deaf person’s problem. “You must perceive sound.” So that means a hearing person has even less reason to learn ASL.
CSK: Right. And then I caught myself. Why should I receive training on how to recognize speech through vibration patterns? I’m falling into that same behavioral trap again. The vest is mediating communication, but the problem is that it’s only mediating it one way, making the hearing person understood by me. Still, I was thinking that vest could be a cool tool in terms how to localize sound. For example, if someone came in from behind me making a sound, I could receive a vibration pattern alerting me to that, and I would be able to localize.
RH: That’s actually why I subtitle videos. I want to make sure all people can watch my science videos. I want everyone to have access to them by default. We often talk about “helping” Deaf people. But I don’t want to help you. I want to include you. I want you and other Deaf people to learn science. And astronomy.
CSK: But also I mean, both Deaf people and hearing people have privilege. And all people benefit from accessible design.
In Session 2 of the TED Fellows talks, we learn about the FBI’s use of informants in counterterrorism operations, how giant pouched rats are helping to save lives, laser-delivered HIV drugs, how Silicon Valley companies are working to protect our privacy — and that’s not to mention the piano solo, percussive dance and opera!
Sri Lankan opera singer Tharanga Goonetilleke opens Session 2 with Magda’s aria from the opera La Rondine by Puccini, accompanied on piano by Tina Chang. “The character sings of true and passionate love that is better than all the riches of the world,” says Goonetilleke.
“The FBI is responsible for more terrorism plots in the United States than any other terrorist organization” begins investigative journalist Trevor Aaronson. After 9/11, the FBI were instructed to find terrorists before they strike — and this pursuit of terror has consumed the agency to the tune of $3.3 billion a year. While there have been only a handful of successful domestic terror attacks, the FBI boasts that it’s foiled dozens of terrorism plots in their undercover sting operations, and have arrested more than 175 people in counterterrorism stings. According to Aaronson, many of these are orchestrated by the FBI itself, who pay informants $100,000 or more to seek out and “inform” on often-impoverished and mentally ill Muslim-Americans. The FBI then provide the suspects with all they need to execute a terrorist plot — weapons, a martyrdom video, and money — which are then stopped, just in time, by the FBI. Until now, Aaronson has drawn his startling conclusions from years of poring over domestic terrorism prosecution files. But in an article published this morning in Intercept, Aaronson has revealed the transcript of a secret recording of FBI agents, proving they knew would-be terror suspect Sami Osmakac — who has schizoaffective disorder and was lured by an undercover FBI agent into plotting a bombing — was incapable of the crime. Osmakac was subsequently arrested, convicted, and sentenced to 40 years in prison, an unwitting victim of what Aaronson calls the theater of national security.
Meet David Lang’s hero John Dobson, the amateur astronomer who created the Dobsonian telescope and was a pioneer in the realm of amateur science who spent his life teaching people the joy of constructing their own telescopes. It’s been hard for other scientific disciplines to replicate amateur activity, says Lang. But now, low-cost, accessible tools like cheap sensors, the rise of open standards, and the ability for fellow enthusiasts to connect over the internet is creating what he calls the era of Connected Exploration. As the tools for science, conservation and innovation have gotten more accessible and powerful, communities in Borneo are using drones to monitor their forests; in Japan, makers and hackers built Geiger counters to monitor the impact of Fukushima in real time; DIY biologists are competing with each other to design engineered microbes. In this context, science and discovery is not about efficiency and convenience, but wonder and adventure. One thing is clear, says Lang, ”When you give people the tools to ask questions, they will surprise you with what they ask and what they discover.”
Choreographer Camille A. Brown performs a passionate and percussive solo dance excerpted from BLACK GIRL: Linguistic Play, accompanied on piano by Scott Patterson. “This dance reveals the complexity of carving out a self-defined identity as a black female in urban American culture,” says Brown.
TED Fellows and Senior Fellows have just opened TED2015 with a bang in the beautiful Kay Meek theatre in Vancouver. In the first session, discover: how bacteria can be programmed to detect and treat cancer, a yellow legal pad that smuggles transgressive data into the halls of power, what makes non-state armed groups tick, hyperactive supermassive black holes — and much more.
East African singer Somi sets the mood for the TED2015 Fellows talks with Abbey Lincoln’s “Should Have Been,” accompanied on double bass by Jodi Proznick. (Read more about Somi and her album The Lagos Music Salon on the TED Blog.
There are more bacteria in our bodies than stars in our galaxy, says bioengineer Tal Danino, and they are an integral part of our health. But did you know that we can program bacteria as though they were computers? Danino first engineered bacteria to produce fluorescent proteins in a rhythmic fashion, and generated a molecule that allows bacteria to communicate and synchronize. Danino next turned his attention to using programmable bacteria to detect and treat diseases like cancer. He programmed a bacteria to alert to the presence of liver cancer by producing a molecule that changes the color of urine in cancer’s presence. Another bacteria can be programmed to produce molecules that cause tumors to shrink. Danino also produces beautiful works of art using bacteria engineered to form complex patterns; he shows an image of a colorful and intricate mandala, a symbol of the universe, that speaks to the power and beauty of the invisible.
Some people are moved by sunsets, weddings, a child’s birth. But for artist Sarah Sandman, marching band parades make the tears flow. Why? It’s the magical togetherness of people moving in sync that pulls her heartstrings, she says. An artist who designs ways to bring people together, Sandman cares less about personal expression than about creating human connection, “extracting a collective voice.” Her projects have included designing black hand-shaped protest signs with her HOSTOS South Bronx students to join the Hands Up, Don’t Shoot movement, Human Scrabble games where total strangers race to form words together, and Gift Cycle — in which she and her collaborator rode 75 miles a day from community to community all the way across the United States, carrying local art from one location to exchange with artists in the next community. A narrative of togetherness emerged, unexpected acts of kindness, fun, and generosity — building social capital through the sweat of altruism.
TED2015 Fellows and Senior Fellows circle up. Click photos to view large.
It’s (almost) time for TED2015, and the newest class in our global network of trailblazers and innovators has, in the last few hours, touched down in Vancouver from as far afield as Vietnam, London, South Africa, Kenya, and Slovenia.
If you’re headed to Vancouver for TED2015, please join us at the TED Fellows talks at the Kay Meek Centre on Monday afternoon. Always one of the conference’s most talked-about highlights, it’s definitely not to be missed! You’ll also certainly want to check out WTF to pack, as counseled by our own inimitable Safwat Saleem.
If you can’t join us live, read more about all our TED2015 Fellows as well as our Senior Fellows in this beautifully designed program guide – then keep an eye on this space for a full recap of the talks on Monday evening, as well as highlights from an exciting week to come.
Eco-entrepreneur Alasdair Harris is passionate about conserving marine biodiversity, and he’s doing it in unusual ways. While most marine conservationists focus on what’s in the water, Harris’ company Blue Ventures works with people in poverty-stricken coastal communities to engage them in rebuilding tropical fisheries and in the process of protecting both their ecosystems and livelihoods. The company’s approach: eco-tourism.
We spoke to Harris about why humanity’s marine conservation efforts to date haven’t worked — and his vision to change that.
How did Blue Ventures get started?
I was studying zoology in 2000, learning about the enormous threats that were wreaking havoc on the world’s coral reefs, which are the rainforests of the ocean. I was already a keen scuba diver, and this got me asking myself: how on Earth can an undergraduate student in Scotland do something meaningful to help tackle the mass extinction that’s taking place beneath the waves?
I set to work raising money to take a group of fellow students to the Indian Ocean to learn more about what was happening, and contribute in some small way to studying these unprecedented changes. My initial focus was on coral reefs in Madagascar, because this part of the Indian Ocean is one of those regions where we just didn’t know what’s there — there’s a huge gap in the literature. Sadly, this is true for many places; we understand tragically little about so much of our oceans, and marine biodiversity is being lost before we even know it exists.
This isn’t just a tragedy for nature. It’s also a critical issue for many of the world’s poorest and most vulnerable people. Almost 1-and-a-half billion of us live around our tropical coasts. Hundreds of millions of these people depend on fishing for survival. Our planet’s so-called small-scale fisheries are anything but small — they’re a lifeline underpinning cultures, food security and livelihoods. So tropical marine conservation isn’t just about conserving marine wilderness to satisfy the curiosity of biologists. It’s a human issue of enormous global importance, at the intersection of food security, conservation, and development. It’s an issue on the front line of climate change.
That first trip was an old-fashioned expedition, funded by Edinburgh University and the Royal Geographical Society, among others. Our goal then was simply — perhaps naively — to put these reefs on the map. But it quickly became apparent that we couldn’t hope to change anything simply by carrying out research. The money was spent and we put together some species lists, but we didn’t achieve anything practical in terms of helping either the reefs or the people that depended on them. The only real winners were those of us getting to dive in these fabulous seas.
This troubled me — it was clear that conservation was about much more than simply indulging a scientific interest in these extraordinary underwater ecosystems. Conservation today is about people, markets and behavioral change. And making change happen requires a totally different approach to simply publishing papers and hoping someone might read them: it means listening to what communities need, developing a deep understanding of local issues — and all that requires a permanent presence and commitment — plus funding for the long haul.
After that first trip, I decided to raise the bar. Each summer for over the next two years, our team went back to the Indian Ocean — to Madagascar and the adjacent republics of Comoros and Tanzania. We raised money during the year as students, running marathons and shaking buckets in the streets of Edinburgh and Oxford.
Madagascar was then recovering from political turmoil following disputed elections in 2002, and there was an overwhelming need to build capacity in the environmental sector. This provided the impetus for me to bite the bullet. It was really just saying, “I’m setting up an organization that will continue the work we’ve started.” That was Blue Ventures. It kicked off the day I left university.
The reef octopus is a cash crop for tens of thousands of subsistence fishers in the Indian Ocean. Blue Ventures looks to get them invested in the conservation process. Photo: Garth Cripps
Why did you decide to set up a tourism business to fund conservation programs, rather than just start a conservation organization?
Having the idea was one thing, but finding the means to finance the vision was a whole new challenge. No donor or philanthropic foundation in their right mind would give a 23-year-old support for this kind of vision. So by default I had to look at entrepreneurship. And the solution was there all along. Those expeditions I’d been running were incredible opportunities for people from all walks of life to learn about the ocean, to experience new cultures and the enormous challenges of making conservation work on the ground. We had a business opportunity in our hands. So Blue Ventures Expeditions went live with £500 from my student overdraft, and the business was born.
Since then, we’ve welcomed hundreds of volunteers every year to our field programs around the world. These volunteers contribute to the running costs of our conservation work. They learn to dive with us, play a key role collecting data underwater and participate in our research and outreach work. Crucially, they also provide year-round financial sustainability to the organization, helping keep the lights on as we support a global team of more than 100 conservationists.
Any profits we make get reinvested in the charity, strengthening our conservation programs. It’s this social business that’s provided the catalyst for all our conservation work. We’ve expanded our reach beyond Madagascar — to Malaysia, Fiji and Belize — and we’re launching new country programs later this year.
How does the tourism enterprise work?
We accept volunteers who want to come and learn about conservation. Say you want a career break, or you want to learn to scuba dive for six weeks, or reboot your career in conservation or development. We even get families looking for a new experience. Each expedition lasts six weeks and involves a series of intensive training programs in diving, marine science and underwater surveying. You then live and work alongside our conservation staff, getting hands-on experience of the issues that we confront on a daily basis, in incredibly remote settings.
Another great thing is the network Blue Ventures has formed. We have an inspiring community of more than 2,000 alumni around the world, all of whom have lived and worked with us for extended periods of time and are very close to the spirit and culture of the enterprise.
By making conservation work for people, Blue Ventures works to mobilize fishing communities to support marine protection. Photo: Garth Cripps
Your view of marine conservation today must have been very different 11 years ago.
Absolutely. By approaching conservation as an entrepreneur, the challenges and limitations of “conventional” funding models are made very apparent to us. Marine reserves — areas of ocean protected from fishing, within which ecosystems can recover and help rebuild and replenish fisheries — are the end goal for any marine conservationist. They’re our currency. And given the threats our seas are facing — from overfishing and pollution to climate change — science tells us that we need to be setting aside about 30% of our seas within these marine reserves if we’re to have any hope of safeguarding our seas from the soaring stresses that humankind is unleashing.
But we have some serious problems in reaching that 30% target. Firstly, these conservation zones are typically funded by donors or governments in short-term project cycles, with no real hope of attaining financial sustainability for the protected area. Compounding this is the issue of scale: despite tireless efforts and commitment from thousands of conservationists and marine park managers working for this cause from the Arctic to the Southern Ocean, at best we’re fully protecting barely 1% of our seas. Worse still, the funding available for conservation isn’t growing in any significant way
Mohammed Dalwai shares his idea for a Mobile Triage App at TEDGlobal 2014. Photo: Ryan Lash/TED
Every day, emergency room workers use triage to prioritize patient care — but exhausted personnel in under-resourced hospitals can easily make deadly errors in diagnostic tests and symptom scoring. South African emergency room doctor Mohammed Dalwai witnessed such avoidable tragedy firsthand while working with Médicins sans Frontières in Pakistan. He resolved never to let it happen again.
Dalwai urged MSF to apply a standard triaging system — the paper-based South African Triage Scale — in his emergency room in Pakistan. This led to an 86% improvement in successful triaging, and to MSF adopting this standard in emergency rooms around the world. It also led to a big idea for Dalwai. Now, with The Open Medicine Project (TOMPSA), he and his team have made an app that is freely available. They are planning to roll it out across many regions.
Here, Dalwai tells the TED Blog about the app’s development, and its possible future uses — including the ability to track realtime data of disease outbreak.
How did you end up joining Médicins sans Frontières and creating the Mobile Triage App?
I actually always wanted to be a biomechanical engineer! But then I started studying medicine, and fell in love with it after the third year, when I began seeing patients. That was it for me. I finished med school at Stellenbosch University, and afterwards went into rural medicine. I went into the bush to work at Manguzi Hospital, on the border of Mozambique and South Africa.
There, I met an MSF doctor, who told me about the organization. The idea of going into low-resource settings and helping to make an impact in the system appealed to me, and I wanted to experience medicine outside of South Africa. So I went on multiple missions with MSF — to Pakistan, Afghanistan, Libya, Syria, Haiti and Sierra Leone.
It was in Pakistan in 2011, on my first assignment, that I saw patients dying due to incorrect triaging. One day, I lost a patient. A young woman, 22 years old, came in with abdominal pain. She was incorrectly triaged, and she waited for eight hours. She had something called an ectopic pregnancy — a pregnancy outside the uterus — and she was bleeding internally. When I found her, she was barely alive, and we tried everything to resuscitate her. But she died — and it really affected me. She was a woman, she was sidelined, she was put in a corner — no one cared, no one did the triage properly. If she’d been triaged correctly, we would have realized she was pregnant, and we would have prioritized her.
From that day on, I became determined to sort out the triage problem. I was part of a team that implemented the South African Triage Scale in my emergency room, and it was the first time it had been used in an MSF hospital. It was the first time the South African Triage Scale was ever implemented in Southeast Asia.
Villagers from Hhohho, Swaziland, wait outside to get their vitals taken before seeing a physician or dentist. Photo: Air Force Staff Sgt. Lesley Waters
What is the South African Triage Scale?
It’s a paper-based system based on a composite score — including complaints and vital signs — and one of the only triage scales made for the developing world to evaluate both adults and children. It was developed in a small but busy hospital in Cape Town in a low socio-economic area in response to massive patient loads, understaffing and high death rates. It was introduced in 2008, and shown to be effective when implemented.
MSF had never had a standard triage system in place before this. We lobbied hard for change and standardization. They let us try it, and we did a study that showed a successful implementation. It was at that point that MSF realized how valuable it was, and they started implementing it in every emergency center around the world.
But this is not necessarily a one-size-fits-all solution. The South African Triage Scale (SATS), being relatively new, has been tested extensively in South Africa, but not yet rigorously tested outside of the country. I’m now working on my PhD, documenting the SATS’s validity and reliability in other sectors and countries. For the last two years, I’ve been collecting data on the SATS and how it’s been implemented globally. We proved that it works in Pakistan, and we proved that it works in certain African countries. But Afghanistan and Haiti are different. What are those differences, and how can we adapt the system for local circumstances? In Sierra Leone, for instance, there was a massive malaria population, which has lower hemoglobin levels. Because of that, the triage scale wouldn’t pick up certain patients, so we would have to adjust one or two discriminators after research so that the triage scale is more sensitive for these people. Small things like that make a massive difference in patient care.
A look at TOMPSA’s Mobile Triage App. Photo: Makkia da Costa
Why create a mobile app, when it sounds like the paper-based system works very well to correct the possibility of human error?
Even though the SATS works, it still needs to be implemented correctly across a variety of situations, so we need to standardize the format to further avoid human error. Health care workers are trained to various degrees across different countries. One of the easiest ways to standardize things is through technology. When I came home from Pakistan, I discussed my experiences with my friend Yaseen Khan. Together we decided we had to tackle health system problems using technology — and that’s how we formed The Open Medicine Project (TOMPSA).
When you look at the way the nurses or health care workers make mistakes, it’s usually one of two areas: it’s either they don’t understand the discriminator — so the first symptom that the patient comes in with. The paper-based version of the SATS offers no additional information, whereas a mobile app can. They also make mistakes in calculation. In the SATS, the vital signs are all linked to a composite score, and each one is different. So say, for example, you have a heart rate of 98 beats per minute, that’s zero point. If you have a heart rate of 101, that’s one point. It’s easy to make mistakes, and a massive number of errors are happening in that scoring system alone. So digitizing systems offers more information as prompts for medical care depending on the score. Nurses were forgetting to do pregnancy tests, for example.
The app is essentially a digital checklist. Checklists make massive differences in both the airline aviation industry as well as in medicine. You see the same thing with the WHO surgical checklist. It saves lives.
Graffiti artist and TED Fellow Mundano describes his project “Pimp My Carroça,” in which he transforms the trash carts of Brazil’s rubbish pickers into works of art – while providing them with essential services and public recognition. Watch this talk, then read about how Mundano made a statement with election-waste art on the eve of this talk at TEDGlobal 2014!
Andrew Bastawrous shares the idea behind Peek at TED2014. Photo: Ryan Lash/TED
Around 39 million people in the world are affected by blindness — 80% of which could be avoided if people had timely access to diagnosis and proper treatment. The problem is that in many developing countries, most eye care providers are in cities, while the majority of patients live in hard-to-reach rural areas. To bridge this gap, London-based opthalmologist Andrew Bastawrous createdPeek — an app and adapter that turn a smartphone into a comprehensive, easy-to-use, accurate eye-exam tool. Peek makes eye tests affordable and easy to administer, bypassing the need for expensive, fragile equipment. (Watch his TED Talk, “Get your next eye exam on a smartphone.”)
Bastawrous developed and extensively road-tested Peek during a research expedition in Kenya, and has now launched an Indiegogo campaign to set up manufacturing process for the Peek Retina adapter, which allows health workers to peer into the eye and capture images for diagnosis. If successful, Peek will soon be rolled out worldwide with the help of eye NGOs. Here, he tells the TED Blog how his own childhood experiences with poverty, inequality and impaired vision led him to devote his life to restoring sight to the world.
How long has Peek been in development?
I’ve been working on it for around three years, and the team came together about two years ago. We’re now at the point where we’ve got a proven, tested prototype, and we want to make it available. We’ve had so much demand — over 4,000 eye organizations in 180 countries are asking to use it, and we want to make it available and keep the cost low. We evaluated options, and recently won the TED Mazda Rebels award. We’ve used the majority of that to fund set-up of the manufacturing pipeline to develop the adapter, and that takes us to about the halfway point.
You grew up in England. What made you want to practice in developing countries?
I was born in York, but my parents are both from Egypt, and I grew up between cultures. We spent most of our holidays in Egypt, and I always felt a little like I didn’t know where home was. When I visited Egypt, I witnessed things I didn’t see in the UK. My father’s a doctor, and he’d always visit the village where he grew up whenever we went back. He would be inundated with requests for medical attention.
It really inspired me, the way he never said no to anyone. Once a woman complained to him that she couldn’t have a child. My father, who is actually a bone doctor, did some general blood tests, and said, “Look, as far as I can see, everything’s okay.” When we went back the following year, she had a child with her — and everyone else in the region who couldn’t have babies started coming to see my dad to get it sorted out.
So I think seeing such things left me with a very deep sense of inequality. I also realized I’d had a very privileged upbringing. Within Egypt, my relatives are quite well off. But my grandma lived on the first floor, and the family that lived on the basement floor were effectively working for the apartment block. There was a kid there the same age as me, and every year we’d diverge more in terms of our opportunities. When we first met, we both just wanted to play football, but by the time we were 18, he’d had a kid, and his opportunities were very limited. Meanwhile, I had so many fantastic options for my university, career. It just seemed deeply unfair.
A Peek healthcare worker examines patient in her own home. Photo: Courtesy of Peek
But why eye care?
I grew up very short-sighted. I was at the bottom of my class until I was about 12, when my mum dragged me kicking and screaming to the optician’s and insisted I get some glasses. Suddenly I could suddenly see everything perfectly — and I don’t think I’ve ever forgotten that moment. So I’ve always been struck with the power of being able to have sight returned, the impact it can have. After that, I started to do well at school, and was better at sport. I looked a bit more geeky, but I was doing better in a lot of other ways.
So it had always been in my mind at medical school to go into ophthalmology. I spent my summer holidays traveling, visiting people who were doing eye care in resource-poor settings, and just really fell in love with the possibilities. There are so many people who are unnecessarily blind. Had they been living in the UK, they would have never have gotten to the point where their vision problems were anything more than a nuisance. I knew this would be how I’d spend my life.
Untreated eye disease must be a problem in many developing countries. Why did you choose to focus on Kenya?
I’d worked in various countries short term, from Uganda, Sierra Leone and Madagascar to Peru and Belize. I then got the opportunity to work at the International Center for Eye Health on a PhD program. We were to do a large trial in Kenya, for which we’d be required to take lots of expensive equipment to 100 different locations to try and work out why people were going blind. I was excited because I knew this research would result in change, as opposed to only lead to papers and publications.
The most common causes of blindness are the same everywhere in the world — with cataract the top cause. In developing countries, blindness is an issue of access to healthcare, not usually a result of weird and wonderful tropical diseases, although there are certain infectious diseases that are more prevalent in Africa.