Anything But A Toy
Toying with the idea of making ‘science accessible’, here is how an oncologist has ended up giving many throat cancer patients their voice back.
What is the connection between Tipu Sultan and oncology?
It began in a tiny town in Karnataka where, as you enter, the sign says “Gombegala Uru”. Or “toy town” in Kannada.
It's official name? Channapatna.
The earliest mention of Channapatna is in a Vijayanagar record in 1387 AD as “Channapatna Rajya”, but the area’s historical importance is much older, going back to the Ganga dynasty (350 to 1000 CE), whose kings once had their capital in a place called Makunda in Channapatna taluk. But its toymaking tradition started much later – 4 centuries later when someone gifted the then ruler, Tipu Sultan, a set of lac coated toys from Persia. Tipu was so enchanted by them, he asked for the Persian toymakers to come to his kingdom and train local artisans from Channapatna to make these toys. (Tipu’s personal toy, a life-size tiger, now stands on display in London’s Victoria and Albert Museum.)
I’m not telling you this story because the over 200-year-old Channapatna toy industry is dying. Look at the irony, though. In 2015, when the then United States president Barack Obama was visiting India, the then president Pranab Mukherjee’s gift to him was a bagful of Channapatna toys. And as Barack and Michele Obama sat watching the Republic Day parade that January, the Karnataka state’s tableaux that went past was entirely made up of giant-sized Channapatna toys. Microsoft is one of the biggest buyers of these toys, sourcing mathematical games and puzzles as part of educational tools for underprivileged children the world over. And in 2017, when Sushma Swaraj went on a state visit to Sikkim, her gift to the little Bhutanese Prince was....enough said.
And yet, the Channapatna toy industry is dying.
Felled by the “glitter” of plastic toys, by lack of awareness (there was a time, my mum tells me, when every railway station in Karnataka had a Channapatna toy outlet) and of course, cheap imitations from China.
But I am telling you this story because there may be hope that Channapatna toys won’t go the way of the dodo. And the hope comes from nearby Bengaluru, not from a toy manufacturer or even an educationalist but from a weirdo.
Actually, an oncologist, who specialises in head and neck surgery at the HCG hospital in the city.
Dr Vishal Rao. And “weirdo” because in the medical profession, where increasingly everything, even a doctor’s attitude to his profession, is getting commercialised, Dr Rao is driven by other things, strange things.
For example, as a result of his area of specialisation, he treats hundreds of patients who lose their voice to throat cancer. And like the first great irony in this story, the other one is that India is the birthplace of Dr Aseema Chatterjee. The first female recipient of the Shanti Swarup Bhatnagar award whose research more than 50 years ago on a class of plant-sourced compounds called vinca alkaloids led to the development of chemotherapy drugs that are used even today. Yet the cost of the treatment of cancer is so exorbitant that it financially debilitates thousands of Indians. For example, the cost of chemo drugs can often go into lakhs. And it’s no different with devices used to replace body parts lost to cancer. So, when a throat cancer patient loses his/her voice, the artificial voice box that can give back speech costs a minimum of 30,000 rupees, sometimes going as high as 1.5 lakhs. And it has to be replaced annually, at a further cost of 20,000 rupees. So many throat cancer patients (there are 25,000 new cases every year in India and around 80 per cent of them come from economically backward sections) simply lose their ability to talk.
For Dr Rao, that was unacceptable. “Speech and communication is a right, not a privilege. It is also the right to freedom, dignity, justice and peace.” And the loss of speech, for him, was the loss of all that. So he set himself the task to design a device that satisfied what he calls the three A’s.
The first two “A’s” are understandable, even predictable.
He makes it a point to tell you that he deliberately does not use the word “cheap” because it implies poor quality and in his book, “even the poorest of the poor deserve the best quality.” So, to design the basic device, he imported platinum-cured silicon from Germany.
Cancer is a democratic disease and India is a huge country and Dr Rao dreams of this device being available not just in the remotest corners of India but to the poorest sections of Indians.
But it was the third 'A' that drove home the point – that the good doctor is indeed a weirdo.
Affable. How the hell –and why – would a medical prosthesis need to be affable? That’s a social nicety that you’d need to win friends and influence people.
Well, here’s Dr Vishal Rao’s reason why...
He wanted to design this device not just for his patients but for the medical fraternity to which he belonged.
I know. I warned you – weirdo
But actually, if you listen to his explanation, it’s not weird at all. Like all of us, Dr Rao saw that the medical profession is increasingly blamed for becoming callous and commercialised. He uses the word “blamed” because while he admits that a section of the medical fraternity has gone rogue (for we the public, it seems a very large section), a majority of doctors are dedicated, passionately committed to their patients and to what they were doing, often at a great personal cost. And it makes them very bitter to be perceived this way. So, Dr Rao wanted this not just to be a Vishal Rao innovation but an innovation on behalf of and from the thousands of doctors who strive tirelessly to heal and cure; to tell us that they care and that they are here for us.
So the process began.
It took Dr Rao, his co-inventor Shashank Mahesh and their team about 2 years to develop the basic device and Dr Rao had done the first impossible – it cost just fifty rupees! (Or, as it sounds even more dramatic, it cost less than a dollar.) But Dr Rao was still in search of a dispenser to insert it into the patient’s throat without surgical intervention. (That would save the patient the annual replacement cost of 20,000 rupees.) The “aha” moment came as it always does - in the oddest of places. Archimedes had his in his bathtub, Newton under the apple tree and for Dr Rao, it happened in the “feminine hygiene” section of a supermarket where he was chasing his baby son, trying to prevent him from grabbing things from the shelves and toppling them on to the floor! But he could not prevent the next thing the little fellow had grabbed and thrown down - a box of tampons!
And that was the moment when the apple dropped, the water spilled out of the bathtub and Dr Rao found his answer - in a tampon.
Weirdo, right? (Even his wife thought the same when he rushed to tell her.)
But when he explains it to you, it’s blindingly simple sense. A tampon is tissue friendly, affordable and something that a woman inserts into her body without medical intervention with a very simple inserting device. Exactly what our young doctor was looking for. When he went to his design team and shared his Eureka moment, one of the members teasingly told him “You’re talking about it as if you are talking about a toy.”
Which is when Dr Rao had his second and third “Aha” moments.
Of course. It had to be as simple as a toy. So that anyone could make it and use it. Because Dr Rao believes in the concept of “copyleft”, not copyright. Meaning, you innovate to share - Dr Rao’s website’s opening message is “Making Science accessible”. (And according to him, you only complicate for intellectual copyright.) Or as Manoj Night Shyamalan would have put it – Dr Rao wanted to pay it forward. (Okay, I won’t say “I told you – weirdo”.)
Because, like so many Kannadigas, he associated toys with Channapatna. And because his brother is a fourth-generation dealer in plywood and so, he knew wood. And finally, because the Channapatna toy industry is gasping for breath, desperately in need of help to stay alive.
And so, the next step was to go to Channapatna and find the right toymaker. Accompanied by a friend, he set off to the little “gombegala uru” where over 70 per cent of the town’s population of about 70,000 people depend in some way on toy making for a living. And there are around 5000 toymakers.
So how did Dr Rao find his needle in this haystack? First, with the help of his friend, he narrowed his search to master toymakers, who not just made toys but taught this amazing craft to future toymakers. Then, among them, he looked for signs in their work that showed that they didn’t just make the usual toys, but innovated, tried out new things. And he found his answer in Kouser Pasha. Kouser has been making toys for over 30 years, but his passion to make “something different”, to step off the beaten track made the Karnataka government appoint him as one of the trainers in the local toy factory to train other toymakers.
But it was toys in his shop had that made Dr Rao realise he’d found his man. Among the usual suspects were toys that went beyond being just toys to something more. And among them, what stood out like a beacon was an educational solar system, made entirely of wood, the Channapatna way. Kouser was also the perfect choice because he is a master in creating vegetable dyes, something he has perfected over the years. So the dye that he would use for the voice box dispenser would be perfectly safe for the human body.
The briefing began. It was verbal – no drawings, no blueprints, just Dr Rao talking about his vision. And of course, a tampon! And within a space of a couple of hours, Kouser had designed what would have taken qualified design engineers months if not years to design. A beautiful dispenser made out of ivory wood (the traditional wood used in Channapatna toys, chosen for its softness and smoothness) and painted a gorgeous red colour from a vegetable dye.
(The final dispenser has very little changes from the first prototype.)
The device was ready, and now, so was the dispenser. And Dr Rao inserted it into the first patient, a watchman who up till couldn’t speak because he had lost his voice box to throat cancer surgery and couldn’t afford the artificial one. And the first words he spoke were, “Om Manjunath!”
And Dr Rao got his name for his device – Aum. The first primordial sound and the beginning of everything. And befittingly, he named Kouser Pasha’s dispenser “Susruth” after the sage Susrutha, one of the founders of Ayurveda.
The Aum has gone into clinical trials and 150 have been successfully inserted. But the next step is a huge and a tricky one – making the device commercially available. To their credit, both the central government as well as the Karnataka state government have given Dr Rao a lot of assistance.
But he waits to be absolutely sure before he takes the big leap – the commercial launch of Aum. He treads slowly, warily; afraid because everyone can see a best seller, a money-maker and everyone wants a piece of the pie, hopefully, the largest one and in that “goldrush”, that his original intention of creating Aum will be lost...
It’s difficult to describe what I felt when I started talking to Dr Rao about the Aum. There was an unsullied, innocent enthusiasm in everything that he said that transported me. It filled crevices inside me that till now had been filled with cynicism with a strange excitement, a joy, a wonder that I have not felt for a long time.
But most of all, it filled me hope. That, inspired by this story, somewhere in India, another Dr Vishal Rao and another Kouser Pasha will find a way to make cancer drugs that are as affordable – wait, wait, wait. Let me say it in Dr Rao’s words - cancer drugs that are as affordable, accessible and affable to the average Indian as Aum will hopefully be....
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