Something small might be the next big thing …

[This was originally posted on  This is an open community – all interested in improving health and well-being are welcome, particularly at the system level, are welcome.]

If you want to read some good news, check out the NYT special section in Tuesday’s edition: The Small Fixes Challenge. There are a series of great examples of elegantly simple solutions to some important health needs.

Because the Fannie E Rippel foundation was a sponsor, I was fortunate to attend the Transform Conference at the Mayo Clinic earlier this month. Here’s the agenda. You can click on the names of speakers to see their bios and get access to videos of their TED-like talks.

I was particularly interested in the “small” innovations coming from parts of the world where resources are scarce and only simple solutions will make a difference. (Probably why I noticed the NYT special section!) One of these featured approaches to getting care to native Americans and others in rural New Mexico was told by Sanjeev Arora. It started with treating HepC patients with the goal of the same outcomes in outlying areas as a patient might receive at a major medical center. The results are astounding – and at a practical level merit attention in terms of the outcomes relative to the healthcare costs. I appreciated Dr. Arora’s examples because they were all about engaging community health workers to leverage very few available physicians. It’s a great example where working within what seems to be an unreasonable constraint produces “impossible” results.

At the same time, in the spirit of The Small Fixes Challenge, there were fabulous examples of technical innovations like the Embrace infant warmer pictured below.

This mini-sleeping bag uses simple technology as a replacement for an unavailable incubator at 1% of the cost.

Similarly, modified CPAP machines (normally prescribed for sleep apena) are being used for infants where ventilators are not available. (See the CPAP solution described in the NYT supplement.)

Finally, compare the Noelle birthing simulator ($37,995) with the MamaNatalie ($150). The latter has virtually eliminated deaths due to maternal hemorrhaging when used to train rural health workers.

This last example is one I find most engaging because it’s both a social and technical innovation – relatively simple technology in the hands of those with a largely natural education supplemented with skilled expertise again produces dramatic increases in health and well-being.

To be a honest, the systems thinker in me is still concerned – the fabulous news for a family who now has an infant child or father who will live to old age also means that society has two more people who are likely to suffer other effects of poverty. I continue to imagine that it is possible to shift the resources that have been saved from healthcare to things like education and other investments. But that will require some political innovation that eludes me – at least today! For now, I will hold the image of the new life safely cocooned as a metaphor for the small fixes that hold enormous promise for all of us.

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