How a rapid field testing device could help head off future epidemics

Mechanical engineer Juan Santiago is an expert in microfluidics — compact chemistry labs that are increasingly being used to test various liquids for toxins, pollution, parasites, microbes and more.

Santiago and graduate student Ashwin Ramachandran are working to adapt one of his microfluidic tests for tuberculosis to detect the presence of the SARS-CoV-2 virus that causes COVID-19. Here’s an excerpt of a conversation with him about his project.

What is microfluidics?

Microfluidics is, essentially, a tiny medical lab that fits in the palm of your hand. There are very small tubes and pumps and so forth that move fluids — like those from a nasal swab, a teardrop amount is all it takes — through a series of chemical reactions. There’s a computer processor monitoring everything and a USB connection relays information to and from a computer. In fact, our test can be controlled in the field using a smartphone. It’s very mobile. Very compact. And very fast.

What is the advantage of your system over existing tests?

The advantages are several. First, it’s portable and could be used by any doctor, nurse or technician in the field at the point of care. Second, it’s fast. Existing tests can take eight hours or longer and samples must be sent to a central facility. No such point-of-care assay currently exists for SARS-CoV-2.

Lastly, and perhaps most importantly, our test can detect an active COVID-19 infection — which is key to early detection and treatment. The current rapid assays are based on antibodies to the virus, not the virus itself. So, those tests can tell the caregiver that the person has had the infection. Ours will tell them whether the patient is currently infected — and, therefore, infectious. This is a big distinction in isolating people who can infect others.

How does your test work?

In technical terms, the lab first looks for traces of genetic material in the sample — a corollary to DNA known as RNA. RNA is the protein that decodes DNA to create the proteins necessary for life. Viruses leave little traces of themselves wherever they go in the form of RNA.

If you find RNA, you can actually recreate the DNA that produced it — a process known as reverse transcription. Next, we need to create a lot of the DNA, that is we need to “amplify” it. Then, we do another process where we tag the DNA from the virus with tiny fluorescent molecules, so that when we illuminate the sample with an ultraviolet light the samples with coronavirus glow green. That’s how we would know the patient has the SARS-CoV-2 virus that causes COVID-19. In a sample where no virus RNA is present, the sample does not glow.

It’s actually quite a bit more complicated than this, because a sample always contains lots of RNA — from the patient themselves, from any microbes present, even from other viruses that aren’t life-threatening.

We want to know specifically that the patient has SARS-CoV-2, and not the common cold or the flu. That’s quite tricky as you can imagine, especially to do it fast enough to keep up with the virus.

All that transcribing, amplifying and tagging takes place in this compact package that can be taken into the field pretty much anywhere. We hope to get the test down to under 45 minutes or so, start to finish.

How quickly do you think you can have test kits ready to go?

Well, we think the window is too narrow to help out much with COVID-19, but we’re working as fast as we can. However, a microfluidic test kit like this could be easily reconfigured to head off future epidemics much more quickly than with COVID-19. You could quickly email the new RNA you were looking for and the kits could be reconfigured on the spot to look for any new virus or microbe of concern. We use the tuberculosis bacterium in our test now — it’s not safe to use the SARS-CoV-2 virus at this time — but the technology is applicable to any RNA, so you can imagine quick tests for bacteria like E. coli, MRSA, anthrax or viruses like the flu, Ebola or HIV, even parasites like malaria, schistosomiasis and others. It would be a very powerful tool.

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With Homegrown Menstrual Cups, This Duo is Helping Women Get Rid of Period Discomfort

As leading citizen activists of waste management, the problem of Bengaluru’s growing mountains of garbage was well-understood by  environmentalists.

For years, the two have been key members of citizen-led movements which aim to raise awareness about the city’s garbage problems and propose sustainable solutions, while also influencing urban waste management policy.

Several landmark legislations including household-level waste segregation and the expedited implementation of Karnataka’s ban on manufacture, sale and use of single-use plastics were made possible by the sustained efforts of these groups.

We realised that even after segregation, the volume of garbage was huge and a Herculean task for the authorities to manage,” say one of them.

This set into motion initiatives like Borrow-A-Bag implemented at the ward-level, to reduce the use of plastic carry bags by making reusable cloth bags easily accessible.

With the efforts of volunteers supported  and elected representatives, the programme effectively reached 20 wards in the city, which declared themselves plastic-free. It reduced plastic bag usage by up to 50 per cent,she says. Through community events, the groups demonstrated that it was possible to organise zero-waste celebrations on a large scale.

Also gaining steam was a citizen’s movement called ‘Green The Red’, which launched the Cup and Cloth Campaign, earlier this year, to raise awareness among urban and rural women about sustainable menstrual hygiene products, and promote their inclusion in government health schemes.

With these initiatives, the duo learnt that it was possible to change attitudes towards consumption and disposal on a large scale, just by showing that an alternative way was possible.

What was needed, however, was a consolidated platform—of solutions that were affordable and accessible to all. This turned them from activists into entrepreneurs.

They started StoneSoup in 2015. The name harks back to an old folk tale that encapsulates the collective contribution which goes into creating something of value. In it, a hungry traveller convinces the people of a town to each share an ingredient that goes into making a hearty soup to feed the village folk.
Today, StoneSoup offers a range of products and services—sustainable alternatives that replace daily use products—composting kits, natural cleaners, cloth diapers and cloth bags.

Their most popular offerings, however, are menstrual cups—a substitute for single-use pads and tampons, that are superior, both from the standpoint of women’s health and from an environmental perspective.

“We wanted to create an Indian brand of menstrual cups,” she explains.

The awareness sessions they were already conducting as advocates of ‘Green The Red’ gave them a wealth of data from actual and potential users.

“That really put us in a good place by giving us insights on how to design the product, market it, and address people’s concerns,” she says.

Their design is innovative and intuitive—no rim lines and stain-causing grooves; no vestigial parts like the stem—nothing that can confuse users. A StoneSoup cup is smooth and bell-shaped, with a few grip lines.

“We made a cup that was the smallest size—to fit most women, and changed the shape from a V to a U to increase the volume,” she says  about what makes the StoneSoup cups more functional.

With design done, the next step was to put these cups within the easy reach of Indian women. One obvious solution was to be visible on major e-commerce platforms and mainstream retail stores—places well-suited to Indian buying behaviour. StoneSoup is also working to make cups available in chemist shops.

The other was to change the packaging so that the cup looked less like a medical device and more like an accessory—compact, attractive, portable and premium.

Manufactured in Bengaluru, the cups are available in a range of firmness—from soft to hard—making them suitable for various body types, levels of physical activity and flow.

StoneSoup cup users include women who are athletes, cyclists, gymnasts, and frequent travellers. The cups are priced between Rs 550 and Rs 1,200 and can be used for up to ten years.

The benefits of cups are well known. They’re safer for women’s reproductive health than plastic pads whose chemical fragrances and absorbents have been linked to allergies, irritations and discomfort.

For civic agencies, a switch from disposables could make garbage management easier and more cost-effective by reducing the expenditure on transport, treatment and disposal, and eliminating such practices as open burning, burying and incineration, and the health hazards they pose.

Reusable menstrual care products have been steadily gaining popularity in India with a number of homegrown and foreign brands available in the market. “But,” she says  “a majority of women buy cups for environmental reasons.”

“We wanted to reach out to others who are doing it for convenience,” says one of them.

And cups do offer all the convenience of disposables, plus they’re safe, economical and durable.

StoneSoup sisterhood

As new entrepreneurs, the duo was keen to start a business that created livelihoods for women. As a first step, they tapped into – a network of citizen volunteers, who, as part of the Green The Red Movement, help women adopt sustainable menstruation practices through awareness sessions and demonstrations.

They also serve as resellers of these products and receive a portion of the margins. Leveraging the vast Saathi Network helps to reduce the adoption barrier, especially among women who want to understand usage patterns from existing users, and need hand-holding, once they become adopters.

StoneSoup cups are priced lowest with Saathis to reduce the price barrier, especially in rural areas and among the urban poor, says Malini. StoneSoup also organises large-scale cup donation drives with its basic variant—the Pratham cup.

The entrepreneurs say that all their efforts are focused on building a viable business that reduces garbage.
“But sustainable businesses are not ones that make billion dollars and then donate those billions to charity. We believe in giving along the way, without fighting to be the cheapest in the market,” says Smita.

StoneSoup’s cup-storage pouches come from the rural parts of South India and its period pride earrings are handmade by Dalit women artisans. The duo also supports and promotes NGOs and SHGs that manufacture other sustainable menstrual health solutions such as cloth pads.

The global menstrual cup market is expected to grow at 3.50% between 2018 and 2023, with India among the significant contributors. For now, however, the uptake of menstrual cups in the country is low due to a variety of reasons including taboos against insertables, high cost, and lack of awareness, especially in rural India, about the existence of these products.

Today, close to 50 per cent women aged 15-24 years in rural India and 77 per cent in urban India use locally prepared sanitary napkins and disposable menstrual hygiene products.

In a context where sewage and waste management infrastructure is rudimentary at best, the rise in non-biodegradable pads signals great health and environmental risks.

StoneSoup is attempting to change this narrative by showing that garbage need not only be managed by quick fixes, but it can also be reduced; that rashes, allergies and discomfort during periods need not just be treated, they can be done away with, for good.

“All we’re saying is that women have the right to alternatives so that they can choose what’s best for their health, environment and pocket,” the duo say.

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