Inspiration often strikes in the most unusual places and the latest innovation to enter clinical trials at AKU has been developed by a fourth-year student at AKU’s Medical College, Ibrahim Sajid, who stumbled upon the idea after an accident on the basketball court!
Over the past four years, Ibrahim has balanced his studies alongside his passion project. He has worked with a range of emergency medicine specialists, product designers, phlebotomists and nurses to develop a prototype ‘pain-free, in
A close-up of the prototype: a detachable sleeve with a cardboard shield
visible’ method to deliver injections that will begin human trials soon.
In this interview, Ibrahim opens up about the ups and downs on his innovation journey and shares how life has changed since his prototype saw him win the Global Pediatrics Research Investigator award from Paediatrics Research, one of the publications run by the prestigious weekly journal, Nature.
What problem are you looking to solve with your prototype?
Many adults and children suffer from trypanophobia – the extreme fear of needles – which leads to them resisting or denying simple procedures like an intravenous drip and even essential vaccinations.
Research shows that the sight of needles accounts for 70 per cent of the fear while the actual prick sensation contributes to the remaining 30 per cent. Any proposed solution aimed at treating trypanophobia needs to account for both the visual and sensory stimuli.
How common is trypanophobia?
A team of researchers in the US conducted
a meta-analysis on the fear of needles in 2019. They found that between 20 to 50 per cent of adolescents, and between 20 to 30 per cent of young adults suffer from the fear of needles.
No one likes needles and the reality is that many parents actually worsen the fear of needles in their children! That’s because the threat of an injection is used to discipline children. For example, when I was young, my cousins were frequently told: ‘If you don’t go to sleep, we’ll take you to the doctor for an injection!’
On a more serious note, most parents have stories about the struggle of keeping their child calm during vaccinations. Even taking children to the hospital for a regular visit becomes daunting because of the association of needles with doctors, and so it is definitely an issue that needs exploration.
When and where did you first get the idea for your prototype?
We were playing basketball at the Sports Centre in my first year at AKU when one of my friends suffered an injury after a fall. Even though she needed treatment, she kept on refusing the doctor’s efforts to administer an intravenous drip due to her aversion to needles.
But the inspiration to divest the fear of needles in children goes further back to when I was in school. I spent a lot of my summer vacations with my parents, who are both doctors, at the hospital, especially in the paediatric wards. The accident reminded me of the fear I had seen in children during their encounter with physicians, especially during injections. That was the lightbulb moment and it led to me and a group of colleagues pitching the idea at
AKU’s HackPaeds hackathon in 2017.
How was the hackathon and how was your idea received?
It was an incredible experience and our team made so much progress over the three-day event! We developed a dual chamber watch-like device that could be worn by a child. The device’s upper chamber could be turned up to hide the needle from the child’s view and to eliminate the visual trigger of trypanophobia.
Even though our idea did not win a prize at the Hackathon, we received a lot of support and encouragement from Dr Asad Mian, chair of AKU’s Critical Creative Innovative Thinking Forum, who introduced us to Mr Imtiaz Ahmed at the Aga Khan Development Network and his team, who helped us 3D print our prototype.
What happened next?
One of our funniest failures! We were all looking forward to seeing the 3D printed, plastic prototype. But the watch turned out to be the size of a tiny coin since we had mistakenly given the measurements in centimeters rather than inches! It was so small that it barely fit on our fingers and was too tiny to test. So we had to start over with the right measurements this time.
When we finally got the printed model, the next step was to test the device. I approached the Centre for Innovation in Medical Education and asked a phlebotomist to trial the device on the arm of a patient mannequin.
How was the response to the first test?
Well, we learned a lot. In other words, there was a lot of feedback! All the phlebotomists believed that it was difficult to find a vein since they just had a tiny area to work with. The device was also difficult to maneuver around the patient’s wrist making it inconvenient to use. This raised the likelihood of a phlebotomist making multiple pricks, which would be uncomfortable for a patient, especially a child.
What did you do next?
We had to find another design that would be visually appealing for a child and that would successfully hide the needle. For a while we experimented with the idea of a ‘Japanese’ hand fan, the type that opens up when moved. The idea was that the phlebotomist would press a button that would unfurl the blades of the fan and distract the child. So the child wouldn’t see the needle being put into the vein.
Since the phlebotomist was working on the other side of the fan, s/he would have more room to find the vein. After many attempts, we found that procuring the materials for this design would be too expensive and challenging. Since our goal was to develop a low-cost device that could be used in low and middle-income countries, we tried something else.
So we came up with the idea of a detachable sleeve with a cardboard ’shield’. To do this we attached a sleeve to a square piece of cardboard and drew cartoons on the edges of the cardboard. The sleeve makes the prototype easy to wear while the shield is both high enough to obscure the view of the child and attractive enough to catch the child’s eye as the phlebotomist inserts the needle. This is one of two parts of our innovation that will undergo trials in children in a clinical setting.
What is the other part of your innovation?
We are looking to do two things: hide the needle and prevent pain. In order to prevent pain, we tried numbing the area with a balm. Unfortunately, the cream took 20 minutes to numb the area, which was too long a wait. Our experiments with topical biofreeze – the cold spray used to treat sportsmen’s injuries – were more successful. We tried it out on a few volunteers who experienced immediate numbness in their wrist, which dramatically reduced the pain of the needle.
Through the clinical trial, we are hoping to explore how our prototype device, which will be used alongside topical biofreeze, addresses both causes of fear. Through a three-arm clinical trial, we’ll evaluate whether the shield alone could be useful in preventing trypanophobia, or whether we also need biofreeze.
What are some of the common criticisms of your prototype?
One of the most common observations is that the prototype is too simple. Our view is that we want the device to be both simple to use and low-cost. The prototype currently costs just Rs 30 to produce which means that it’s workable for low and middle-income countries.
Another criticism is whether this prototype would be as effective in the emergency department as it might be in ward settings. This is a valid concern, and something we will perhaps have to wait for the clinical trials to find out. Fingers crossed!
How has life been like after the global award?
It’s been quite an experience! I have received so many messages from friends since winning the award and even more attention from strangers. There has been huge media interest too and I have done eight interviews with national television stations in Pakistan so far. I have also faced some unusual situations as more and more people heard about the prototype and the award.
Like what?
Well, news of the award was featured alongside my photo on a matrimonial page! Marriage is the last thing I am thinking about now!
Also, there was this odd incident at a petrol pump where a lady recognised me, as the ‘needle guy’. Her two-day-old newborn was in the car who she had named after me. Since she wanted her son to train to become a doctor, she asked me to bless him! That is the biggest piece of admiration I’ve ever received!
As I mentioned before, there has been some negative coverage about the device but I am taking it all in my stride. I welcome all feedback as it will only help us improve the prototype. I am fortunate to have very supportive parents, as well as mentors and friends at AKU, who encourage me to just keep on keeping on.
What are your future plans?
At the moment, I’m focused on my studies and on the clinical trial and I’m looking forward to the next steps in the innovation journey. I look forward to a day when there’s no need for children to dread doctors because of the fear of injections.
In the meantime, I am also really enjoying my fourth year, particularly my extensive research work and surgical rounds. In the future, I hope to work towards becoming a paediatric orthopaedic surgeon and thereby make a significant impact in children’s lives.
