Top 2023 IEEE Biomedical Engineering Awardee Professor Nimmi Ramanujam Shares Deep Insights

AI Top 2023 IEEE Biomedical Engineering Awardee Professor Nimmi Ramanujam Shares Deep Insights Stephen Ibaraki Contributor Opinions expressed by Forbes Contributors are their own. Following New! Follow this author to stay notified about their latest stories. Got it! Sep 3, 2022, 10:48am EDT | New! Click on the conversation bubble to join the conversation Got it! Share to Facebook Share to Twitter Share to Linkedin Professor Nimmi Ramanujam — top awardee 2023 IEEE Biomedical Engineering.

Biomedical Engineering . . .

[+] transforming global health for the benefit of humanity. Credit: DepositPhotos ID: 321824840 Author/Copyright: bsd Professor Nimmi Ramanujam is the recipient of the IEEE Biomedical Engineering Award—the highest award for outstanding contributions to biomedical engineering. Professor Ramanujam outstandingly exemplifies the measurement criteria that includes impact on the profession and/or society; succession of significant technical or other contributions; leadership in accomplishing worthwhile goals; previous honors; added achievements as evidenced by publications, patents, and more.

Professor Ramanujam’s remarkably compelling deep insights, lessons, innovations, inventions, and exciting narratives of discovery are explored in this extensive interview which is unscripted and provided in full below. The IEEE , Institute of Electrical and Electronic Engineers, its roots dating back to 1884, and with more than 420,000 members in 160-plus countries, is the world’s largest technical professional organization dedicated to advancing technology for the benefit of humanity. Professor Ramanujam embodies all of the excellence in this iconic organization.

This article is based upon insights from my daily pro bono work, across more than 100 global projects and communities, with more than 400,000 CEOs, investors, scientists, and notable experts. Professor Nimmi Ramanujam’s Brief Profile Professor Ramanujam’s profile is so extensive that a summary is provided with the non-profit IEEE TEMS (see interview series – Stephen Ibaraki – “Transformational Leadership and Innovation. .

. ”). This direct link to the interview page contains the profile and video interview.

MORE FOR YOU Black Google Product Manager Stopped By Security Because They Didn’t Believe He Was An Employee Vendor Management Is The New Customer Management, And AI Is Transforming The Sector Already What Are The Ethical Boundaries Of Digital Life Forever? Here’s an abstract from the profile summary. Professor Nimmi Ramanujam is the Robert W. Carr Professor of Engineering and Professor of Cancer Pharmacology and Global Health at Duke University and co-program leader of the Radiation Oncology and Imaging Program (ROIP) at the Duke Cancer Institute.

She founded the Center for Global Women’s Health Technologies (GWHT) in 2013 where she leads the creation of impactful solutions to improve the lives of women and girls globally. Integral to her work is the training and empowerment of a new generation of problem solvers who are able to work across multiple disciplines, cultures and countries. She also fosters collaborations between engineers and non-engineers to harmonize their expertise to tackle complex global challenges.

Professor Ramanujam is the co-founder of Calla Health Foundation that has commercialized products globally. Professor Ramanujam has more than 20 patents and 150 publications and has raised over $40M for her center initiatives. Her exemplar contributions include the imaging device called the Pocket colposcope, which transforms the complex clinical colposcope (for cervical cancer diagnosis) used in specialized settings to a simple, inexpensive, and hand-held device, which can be deployed in a local clinic.

A companion deep learning algorithm that her team has developed has the capacity to assist primary care providers, particularly, midwives and nurses, when there is limited access to specialists. In low-income countries in particular, access to surgery or radiation for cancers is few and far between. This necessitates continued innovation and has inspired Professor Ramanujam’s team to create a liquid-based ablation therapy for solid tumors—Tri-solve.

Professor Ramanujam and her team have created a device called the Callascope that utilizes the concept self-examination as a learner-centered methodology for health promotion. In the hands of women, the Callascope can be used to privately explore the inner reproductive anatomy and facilitate self-awareness and a deeper understanding of the cervix and cervical cancer. Professor Ramanujam has used her passion for innovation, the arts and storytelling to create the (In)visible Organ, a platform to share and archive stories of growth, pain, resilience and beauty surrounding the inner reproductive anatomy through the voices of women, nonbinary and transgender people.

Inspired by the Callascope, she worked with collaborators with expertise in film making, on a documentary called the (In)visible Organ featuring personal stories related to cervical cancer and health inequities. Professor Ramanujam has established a train-the trainer-model called Ignite, where Duke students work alongside learners (typically high school students) to solve local challenges within their communities. Professor Ramanujam’s growing list of honors are a model for commitment, dedication, creativity, talent, hard work, and much more.

I include a partial list in our interview. Interview with Professor Nimmi Ramanujam AI is employed to generate the transcript which is then edited for brevity, clarity while staying with the cadence of the chat. AI has an approximate 80% accuracy so going to the full engaging video interview is recommended for full precision.

Time stamps are provided however with the caveat that they are approximate. The interview is recommended for all audiences from students to global leaders in government, industry, investments, NGOs, United Nations, scientific and technical organizations, academia, education, media, translational research and development, interdisciplinary and multidisciplinary work and much more. Stephen Ibaraki 00:00 Nimmi, thank you for coming in today.

You have so many different accomplishments and contributions for global good, Tech for Good, including inclusion, diversity, and equity. It spans pretty much everything. And I love the aspect of the interdisciplinary.

That’s really the nature of work today to be really totally effective. You’re an entrepreneur. I’m an investor, so I understand that entrepreneur side as well.

You just won this major achievement, the 2023 IEEE Biomedical Engineering Award. Congratulations on this marvelous career and that’s continuing. One of the questions I’m always curious about and my audience as well.

You have decades of contribution in so many different areas. What were maybe two or three inflection points that trigger this passion, commitment, and innovation? Nimmi Ramanujam 01:11 Yes; I will say that a lot of my interest in what I do today, was through, I guess, what I consider as an engineering unconventional path. I was a reluctant .

. . engineer.

If I had my way, I would have gone into the arts. I was a musician. I am still sometimes a musician.

I think that was a space that I could have for myself, to create, to aspire, to not have to have any boundaries. I liked that sort of open ended thought process. At the same time, I was very analytical.

I think that at the time, I had good problem solving skills, which was obviously relevant to music. I took what I would say, is the conventional path. In college, I think there was an expectation from my parents that I pursue engineering or some sort of STEM career.

And I really didn’t enjoy it. I didn’t connect with it in any way. I think that in part, it was context.

It’s like learning the scales on a piano, but not seeing the bigger piece, and being able to appreciate what you need to know. I always use that analogy, because when I think about interdisciplinary work or being inclusive, I realized that engineering, like a piano or any other instrument is a tool. And once you can imagine that; that is one of many tools that can be utilized to make a difference.

That changes your perspective on education. That changes your perspective of what you can do. I think that was an inflection point for me.

Another inflection point was working in women’s health. I think that healthcare, cancer, all of these terminologies, can be very two dimensional. When it’s two dimensional, it’s hard to empathize.

But if you are at the level of the problem, then you’re able to better understand and appreciate it, the nuances of the complexities of health, and the lack of it. And growing up in a country where I think the experiences I had at the time did not seem so unusual. But now reflecting back and being in the countries that I am, I think, Gosh, I can relate.

Having those experiences, and then having the tools allowed me to keep synthesizing. There are always these tools, that you learn. But when they’re just in time.

When they’re informed by the larger context. It sparks your creativity, your passion, your desire to bring everybody to the table, because you know, creative talents are everywhere. And so I can’t say that was one inflection point.

But I can say that the kinds of things that made me evolve in my career, have a lot to do with these basic ideas. Stephen Ibaraki 04:34 That’s really fascinating. This spectrum—being part of this career.

You have this interest in music, but you also are analytical. You go to college, and you get immersed on the analytical side, but then you realize your context is important, and this aspect of women health. It’s sort of multi-dimensional with this multidisciplinary, interdisciplinary aspect.

I can see that pervade all the work that you do. That drives your passion and commitment and so on. You mentioned your family would be so pleased that you went into engineering.

Do they have an engineering background? Or are there elements that was a catalyst for your analytical side? Nimmi Ramanujam 05:25 I will say that inherently, it’s interesting that you bring that up. My mother is a musician. My father was an accountant.

So perhaps you could argue that some of that (passed) down. But I think the reason for why they pushed me into engineering is the notion that I want better for my children than I had for myself. I think that engineering was meant to be emblematic of that.

If I had said, I want to study music, it may not have been received as well. Because the idea was, I want your life to be better than ours. I think I did that.

Because that’s what I knew. I understood. I didn’t think of music as a career.

There was both the interests of my parents, obviously, that, I was exposed to. It perhaps informed the way I think and do things. But the other was cultural.

Just that notion that I need to do things that give me security. That I have to be independent, which was not the case with my mother, or her mother. There needed to be a shift.

And she recognized that, which was pretty progressive at the time. Stephen Ibaraki 06:52 You decided to get into engineering. You have a marvelous career in this area.

But women are still underrepresented in engineering. What was that path like? Was it more difficult in a sense? There are challenges along that path, because still, we don’t have enough balance — inclusion, diversity and so on. I’d like to hear about your thoughts on this area? Nimmi Ramanujam 07:23 Well, definitely was challenging.

We all want to see people who we can relate to. I will say, that I had many of those experiences for one coming to this country. I mean, you start to lose the number of relatable people that you can associate with.

And then I think in engineering, I definitely felt that I was inferior. Because there were sort of two hits, right? One that you are amongst the minority, but also this preconception that perhaps women are not as good. I think it both made me feel very insecure about what I did.

Then I had a female role model in my advisor. That made a huge difference. Just having someone you can relate to.

Just made a world of difference. There’s implicit trust. When you get advice, you know that it’s coming from a place where they can relate to your own personal experiences and perspective.

That’s what maybe was the first step in making me believe that I didn’t necessarily need to conform or behave in ways that people expected. That didn’t mean that it was extremely hard at every step of the way in my career, including promotion and tenure. Because, you know, I expected failure.

Somehow, I managed to get through all of that. It was an arduous task. Nothing trivial about that.

But I will say that as I progressed through that path; when you’re part of a minority group, in some strange way, maybe not so strange, that you build closer bonds with a few people that you can relate to. A smaller group. It’s a more intimate group.

I think that was where the strength caves. Perhaps if there are lots of people in the room, it’d be hard to really connect. But if you have a small group of people, you’re able to express more openly your thoughts, your feelings and share perspective.

So I think that’s the other thing that actually it was ironic, but it actually helped paradoxical perhaps, but it actually helped in having the scaffold, the support to basically deal with the circumstances. There’s not always a solution, but at least you can vent. You can share your experience .

. . commiserate .

. . the power of commiseration.

Stephen Ibaraki 10:11 I can see this story arc. You have this facet of being a minority, a woman. And yet you had a mentor.

That mentor was able to provide this extra platform, or, concept, a path as well. That’s what you’re doing too. I noticed throughout your career, all your mentoring on so many different levels.

You’re paying it forward, right? I can see how that’s guiding what you’re doing today. But now, you’re Robert W. Carr Professor of Engineering and Professor of Cancer Pharmacology and Global Health at Duke University and co-program leader of the Radiation Oncology and Imaging Program (ROIP) at the Duke Cancer Institute.

You founded the Center for Global Women’s Health Technologies (GWHT) in 2013 where you lead the creation of impactful solutions to improve the lives of women and girls globally. Can you talk about all of those elements? What led you to those roles? Once you give some narrative of the history of moving into these roles, then, what are you are focusing on? What are some of the big challenges that you want to address? Nimmi Ramanujam 11:34 That requires a pause. I talked about women’s health.

I also think back to the work that I did in my graduate career and beyond. While I’d like to do everything in the world, to make it a better place, I also have to leverage my assets. The things, the words, or the features, or the common elements that emerged; where I was working on cancer.

I was focusing on women’s cancers. I was looking at cancer from a biological perspective. I was looking at it from a translational perspective.

I was looking at it from an implementation perspective. I was dabbling in all the spaces. There’s nothing like exposure.

When given an opportunity to be affiliated with a department or entity outside of your space, it gives you the opportunity to connect. To understand these different spaces. In my case, I wanted to weave my own narrative.

I guess what I realized in all of this, and nothing was linear, right? This is all happening in a very convoluted way. I realized that there’s an underlying theme. Again, I think I mentioned it earlier, there’s this vision.

You want to make the world more equitable. You have to start addressing the disparities to make it equitable. The disparities can exist in health.

That can also exist in the training the workforce. That can address those inequities by closing the disparity gap. Once I had that anchor, then it was a question of what are the skill sets? Who are the people I need to be.

. . understand and work with? How do you create a collaborative environment because you cannot do this by yourself? I think that’s what basically led me to create the center, but also to build these branches, because I knew that I might have a hub.

But without these different spokes and different branches and different connections, it was not going to be very productive. While they didn’t all happen in an intentional way, I think sometimes without necessarily being intentional, you do the things that intuitively make sense to you. When I was asked to be a co-program leader, I said, Yes.

When I wanted to do some biological work relating to response to cancer therapy in breast cancer, I realized that being in the pharmacology space would give me an opportunity to work with researchers there and thereby build relationships and open up new collaborations. Similarly, in global health, I didn’t know what that meant. I mean, I wanted to be a global health researcher, but what did it really mean? So being in that space, and understanding the perspectives of those researchers, again, influenced what I did.

I thought about people and how people inform aspirations. Once I had a notion of what it is I wanted to do, and that keeps evolving too . .

. I then was able to reach out and see what it really means to be in pharmacology. To work with someone in researching pharmacology.

What it’s like to work as I want to in global health. Today, my center is about all of those things. It’s about fundamentally, how do I improve women’s health? Now, that seems very broad, but then you can break it down.

There’s health inequity. There’s educational inequity. There’s of course, gender inequity.

How do you tackle each of those? For all of those things to happen, you need a number of skill sets and relationships. Think of that as a third layer. That’s where all of these entities come in.

And these collaborators come in. To make it whole. My collaborators span a spectrum from a researcher that is in immunology to a program planner, or implementer, in Kisumu, Kenya.

That’s what I enjoy. Lifelong learning never stops. It’s challenging, but very rewarding, because you’re never bored.

Stephen Ibaraki 16:07 That’s really fascinating. I can see you building communities. There’s a Venn diagram of overlap.

But they’re also concentric circles as well, as you’re leveraging and amplifying, almost like force multipliers, of having these different communities. The Robert W. Carr Professor of Engineering, this analytical engineering side; Professor of Cancer Pharmacology, as you mentioned, that’s an important aspect of all of this.

And then there’s Global Health at Duke and the Center there. And co-program leader, Radiation Oncology, and Imaging (ROIP) backgrounds. There’s going to be all those areas of AI, machine learning and so on.

You have an anchor, an institute. You have these outreach programs all over the world. And that’s where the Global Women’s Health Technologies group that you are the center, that you created, as well.

I can see all of these angles coming together, about research, education, community, multiple disciplines, and cultures and countries. You mentioned, equity and inclusion, and all of those areas. And I can see also this idea of marrying engineers and non-engineers, so you can do more you.

Because problems are complex, and the more interdisciplinary facets you can bring to the table, then you can address some of these complex problems. Again, just amazing, very unique. I wish more people would look at what you’re doing, because it’s such an amazing model, to get things done, and to have this sort of fairness, globally.

But you are also into ventures and partnerships. You co-founded a company called Calla Health Foundation. Can you talk about Calla Health Foundation? Nimmi Ramanujam 18:07 Yes.

I will admit, I started a company before that, and we did fine, but it wasn’t successful based on conventional biggest metrics. So when I think of starting a company, if I could, I would start a not-for-profit. The reason for that is when I develop technologies, for addressing, health disparities; I’m not suggesting you shouldn’t profit or make money, because that’s what keeps the world going.

But I have an obligation to make things affordable. Sometimes, when you want to do that, it doesn’t align with the stakeholders who might give you that funding, right? That becomes very difficult. I told myself, that I need to be able to competitive.

Be competitive and apply for grants to continue to sustain a company that can essentially follow its mission. But at the same time, not be strapped for funding. I was very successful in raising money through SBIR / STTRs (Small Business Innovation Research / Small Business Technology Transfer programs).

I mean, I’ve raised more than 10 million that way, and it allows me to have autonomy. That’s what I mean when I say I wanted to create a not-for-profit, but I didn’t want to make it such that I couldn’t apply for these different funding mechanisms. Now I’m considering branching that out into a for-profit and not-for-profit.

Because of that interest, it was very hard for me to just license technology out. I mean, it’s designed it for a particular population. You could always almost consider them as non consumers, right? Which is not a big market in the conventional sense.

I had to essentially think about that. That’s why I started a company. I wanted to do things on my own terms.

It’s a very slow process. I recognize that, right? Because if you don’t have a huge influx of funding, or if you have to wait a year to get a grant, it can delay things. But I feel that I have been able to achieve the things I want, albeit at a slower rate.

I’m able to work closely with the countries and partners that I want to meet their needs, and be small focused than just trying to distribute a lot of products. That’s not my mission, right? It’s not one product. I’m going to get it everywhere.

It’s more like one problem. Let’s say it’s gynecology. I’m going to develop the tools to make that better.

But I also need to raise the funding. I’m going to think about the company structure in a way that allows me to be autonomous. To make all of that happen, I had to do two things.

I had to make sure that the ship was well built as possible to leave the harbor. And there are funding mechanisms, now to universities, that allow you to do that. I mean, of course, you have to make a case for it.

Which means that you can go all the way to get some regulatory clearance for a technology before it leaves the harbor. Once you get the clearance, of course, you have to leave the harbor. By doing that, I preemptively said to myself, How can I de-risk what I have? I did clinical studies all over the world.

Again, just seek the market. But to seek the market to the non consumers. By doing all of that, a priori, when I went to the company, I knew that what I have to do now is get a good product.

Go through the process of going from a product prototype, to design, to product development, and then the regulatory pieces, and then of course commercialization. But it’s just a different model. One that required some sort of creative thinking that I think that would have been very hard to put together, if I had just licensed it to someone.

The long story is, I wanted to make sure I got it to the right end users. I needed to figure out how to do that. I would say the second piece of it.

A very selfish perspective is; I’m okay, if this doesn’t work out, right? Because in the best case scenario, I save the world. In the worst case scenario, I have some important lessons to bring back to academia to my students. So it’s just a win win.

Stephen Ibaraki 23:06 This whole idea of translational research. I work with academic institutions (organizations). I’m part of a group called ACM, Association for Computing Machinery.

Definitely number one in computing science. Translational research is really important, right? If there’s research, but you got to do something with it. Ultimately, if you want to benefit the Earth’s ecosystems.

So I want to say more than humanity which encompasses people. You’re doing that. What you’re doing also reminds me of a group called, The Terasaki Institute for Biomedical Innovation (TIBI—see my Forbes article , Terasaki Institute Top Biomedical Innovations Transforming The World In 2022).

There’s so much confluence between what you’re doing—I will send you a link. Nimmi Ramanujam 24:07 I would love that. The conversations go wonderful, right? The world just gets a little bit smaller.

Stephen Ibaraki 24:15 Yes. They’re very much focused on translational research as well. They’ve got a mechanism in which to do this commercialization.

Because ultimately, you want it to be sustainable. So you’re not just dependent on grants. That’s the way that you can get a total sort of adoption globally if you make it sustainable on its own as well.

I can see the company aspect or the Calla Health Foundation being part of that. You developed a network of over 50 partners. You have local and international academic institutions, hospitals, and non- governmental institutions and organizations.

Ministries of Health. In your profile you got countries such as Serbia, Peru, Brazil, Kenya, Mozambique and so on. I can see all of this coming together.

And then tied with that you have more than 20 patents and 150 publications. And overall, you raised over $40 million. Do you work with the Gates Foundation at all? Have you? Nimmi Ramanujam 25:18 The short answer is no.

They do support cervical cancer. They have an organization . .

. (mentions, was called Global Good) . .

. They are working on cervical cancer with the intent of bringing deep learning as a way to make surveillance much easier and more efficient. I personally have not worked with them on this particular problem, but I completely appreciate what you’re saying.

I think, concept to impact, obviously, scaling and sustainability is critical. I think that’s an area where I could learn a lot. I think that’s one of the challenges is being able to even ask the questions, understanding what the questions are.

For me, part of that was going through this process, and I can appreciate what you say now, because, as I said, it’s very slow, very inefficient, and it’s rewarding. But I wonder often, in trying to make this sustainable, and also scalable—What do I need to do? To accelerate? Right? That’s the challenge for me. I think being able to get advice and understand the space better, is, I think, an important piece that I see as a gap.

I do recognize that and I hope that can change. Stephen Ibaraki 27:14 (We discuss the Gates Foundation; prior head of Global Good Fund / Labs, Maurizio Vecchione; other entities and doing intros. ) Stephen Ibaraki 28:53 I am really fascinated by these different devices you’ve created.

This technology innovation for cervical cancer prevention. Can you talk more about these different devices? There’s a number of them: imaging device called the Pocket colposcope , which transforms the complex, costly, and cumbersome clinical colposcope (for cervical cancer diagnosis) used in specialized settings to a simple, inexpensive, and hand-held device, which can be deployed in a local clinic. Callascope, that utilizes the concept self-examination as a learner-centered methodology for health promotion.

Tri-solve , liquid-based ablation therapy for solid tumors, is unique in that it uses an ethanol injection to injure the tissue, local chemotherapy to poison the cells (which minimizes systemic effects), both of which are mixed in a solution with a cellulose polymer that gels upon contact with tissue confining treatment and preventing off-target effects. Can you talk about how they came about? How they’re building out globally? And what the gaps were? Maybe somebody in the audience will say; You know what, I can accelerate that by learning about what you’re doing. Nimmi Ramanujam 29:35 Yes.

I think that one way to describe it holistically is the continuum of care. Every time I go out and do one thing, you find out that there’s some something else missing, and in order to reach . .

. to do what’s best for the patient, you have to address the continuity of care. Coming back to the Pocket colposcope ; I mean, these are based on stories, right? I was in Tanzania and a gynecologist there who’s running a cervical cancer screening program said, “You know, women hate speculums.

And we can’t afford colposcopes. Can you? Can you do something about it. ” The original, I think vision was, let’s bring them two together.

Let’s make a speculum free colposcope. That was dead on arrival, because I was trying to make a very complex problem simple. But then that sort of bifurcated.

I said, Okay, you know, can’t do everything. At the same time, let’s focus on a technology that can really bring the colposcope into someone’s pocket. And he also said something very interesting.

He said, “Can you build a camera that can just be put inside . . .

”. And that’s, some of these words, just stay with me. And then I remember coming back to the US and talking to a colleague in environmental sciences.

He showed me this little slender camera that he had purchased from Taiwan. I put the two and two together and said, Gosh, a tampon colposcope. That’s what I originally called it.

So point of care, tampon, colposcope. Basically, that’s how the word sort of the “Pocket” word came about. And so it’s just surrendered .

. . (to these) .

. . moments when I had this concept in my head, and all of the pieces came together.

And lo and behold, we made a colposcope. I’m very proud of it. That is as good as the best colposcope in the market.

It’s a very simple way of thinking about things. Don’t do sustaining innovations. Don’t build on something that’s been built before.

Build something new. So colposcopes are built around speculums. You got to be outside, not inside, because that speculum that was invented 200 years ago, dictated everything that came after it.

But what if you said, I’m going to just, start afresh, have a new canvas? How would I do things? How would I make it women’s centered because everything that was developed for gynecology was developed by men. So that’s how the Pocket colposcope came about. They’re excited about that.

But then my vision was to make it speculum free. So again, I think that going to these countries was eye opening, in that it’s not enough to just build a technology, portable or effective or whatever. You have to have people .

. . have to use it.

There has to be demand. And if there’s fear and trepidation, that’s not going to bode well. One of the biggest challenges and it’s not unique to low and middle income countries, I’d say it’s universal is the fear of a gynecological exam.

Speculum is not something you can write home about, and many women don’t go. I see that here. I see that in other countries.

I thought, What if a woman could be empowered to reverse the gifts from the physician to herself? What would that do? And that’s how the Callascope was born. Very, very difficult project. I mean, there’s no precedent.

There’s no benchmark to tell you. This is the pressure. This is how long it has to be.

It was all empirical. Sometimes it was, myself being a guinea pig. But lo and behold, it did work.

It was amazing. I can’t tell you enough about how amazing it is … So it got a lot of awards, as it should have. I’ve been recognized.

Both were, and I prefer to get to Tri-Solve, because there’s a similar theme here. Nimmi Ramanujam 34:03 While I’ve got all these awards, there was this discordance. There was a reluctance for many people to use these technologies.

I realized something that I wasn’t aware of before. When you build something completely new. When it’s not the way; doesn’t look like what you’re used to doing.

It doesn’t work like what you’re used to having think how things work. If you’re not an early adopter, that’s a problem. So for example, one thing that I was told by particular provider is women are scared; they’ll never use it.

Or this is too different from what I’m used to. I can’t operate it even though they were operating much more complex devices. So those are the kinds of feedback I was getting.

Which is also another reason why I had to shepherd this. It wasn’t a simple thing of okay, I’ve got this technology. Let’s sell it.

There has to be some sort of process by which I had to convince the providers, or the program planners that this was a good thing. So I just wanted to say that, in thinking about these innovations, we were very much patient centered. But in that process, we realized that change is hard to make.

And now what we’re doing is we’re working directly with the people that will use these products to skip this inertia that usually happens when something you develop is not something that people can associate with. That’s been another reason for this company to raise money to distribute these tools to those communities to get feedback from the end user and get their perspective on what they think. The results have been transformative.

What we’ve heard is very different from what they feel. How do you do that without being able to get these technologies off and send it to the people who need it. With respect to treatment, I will say that Tri-solve , it was born out of a trip to Zambia.

There’s very little surgery. There’s only like one person actually, this is true in Kenya as well, if you go to the western part of Kenya, there’s perhaps one surgeon that can do a hysterectomy. Probably no colposcope, and no expert providers to do any of the things that you want, and certainly no radiation.

You just got run of the mill chemotherapy, which we know very well is not effective. So what do you do? I saw ethanol on the table being used to disinfect the table and I thought, well, they can get access to ethanol. Let’s use it.

Seems pretty simple. But ethanol, while it is very, very effective, is very leaky. It has actually been used in the US and other places for treating inoperable cancers, but not very effective, because it leaks all over the place, and therefore, especially if you have a stiff tumor, and it doesn’t really do a good job .

. . we wanted to put a polymer.

Something that could make it viscous, like cornstarch. We looked at the polymers that were considered by the FDA as safe and we came across this apple cellulose polymer; my student did. In our efforts to make it viscous, we were cleaning off the apple cellulose and ethanol in the sink, and realized it became a gel.

Like what? It turns out that it went through a phase change. We didn’t even know. Lo and behold, you have this little capsule that forms the tissue that sequestered the ethanol.

It’s liquid when you inject, but when you put it in, it’s like this cotton like gel. The ethanol basically is confined to that. So by creating, just like tuning the size of the gel, you can tune where you treat, without the off target, toxic toxicity, but also enough of a concentration to treat effectively.

It was remarkable. We’ve been building on that. We’ve been using it as an immunomodulator, with a lot of success.

We’ve been using it, as a what I call, a double hit. So you have polymers that carry chemo agents, right? Nimmi Ramanujam 38:36 What if you could have a polymer with ethanol and the chemo agent where you can destroy the membranes with the ethanol; basically cause necrosis and just decimate the tissue. And then you have the cytotoxic agent that can go in and actually kill the cells.

Prevent them from proliferating. These are all the avenues that have come out. I think that you can’t get that in a lab.

You have to go up there, and just look for those elements that seem like they’re so obvious, so simple. They may not be, but to come back and use that inspiration to come up with your new tools. That’s why .

. . like in a way, it’s like art.

You have these skill sets, but you have a blank canvas. If you’re the artist, you have to be inspired. The Pocket colposcope, the Callascope, Tri-solve—these are all inspired by experiences in the world.

And all I have to do is observe and listen, and they pretty much tell you how to invent. That’s the long and short of the story, perhaps more than you have asked to know, but there you go. Stephen Ibaraki 39:54 Yes, that’s a great narrative.

I know that you’re using deep learning with your Pocket colposcope. A companion deep learning algorithm that your team has developed has the capacity to assist primary care providers, particularly, midwives and nurses, when there is limited access to specialists. Which means it’s great for the global south and with much more deployment capability.

Are you using deep learning as well in your Callascope? Nimmi Ramanujam 40:26 That’s the vision. We’re using it now with the Pocket colposcope. We just got a grant to do that in Kenya.

Yes, so we’re developing these deep learning algorithms as assistive technologies to health providers for telemedicine , because again, there’s an adoption phase, right? We think that because there’s no standardization. There’s high turnover. You start by making it assistive, and then maybe even for annotation.

Which has done a lot in the space; and then move into perhaps having it be the primary tool. As people adopt and accept its value. Just like with the pocket, you kind of have to deploy it, and see how people use it, work with them to modify it.

And then ultimately say, this is a tool that can be used as standard of care. I think that’s kind of how we’re approaching the deep learning process as well. Ideally, it would first serve as an aid.

We’re doing two sorts of things. We’re doing deep learning for the purposes of diagnosis. But we’re also doing a lot of unsupervised image segmentation, as a way of annotating these images so that people can be trained quicker.

There’s a lot of anatomical features that can confound your diagnosis that people don’t often know about them. Usually, there’s just a slew of images on a website saying this is what things look like. But in reality, somebody’s annotating for you.

How can we do what that expert does? Deep learning is one element that really in the bigger space, it’s about understanding what the expert does. Knowing that there’s some things they see that are important. But, also there are things that they don’t see that the deep learning algorithms will see.

The other is to see how they even describe the images. What they do with those images physically? What did they identify as being important? What are . .

. circled? And then trying to develop the tools to automate that process. So thinking about deep learning and image segmentation, both as a training tool, and assistive tool, and maybe for diagnosis.

Ultimately a standalone tool that can bring experts to the hardest to reach places for cervical cancer screening. Stephen Ibaraki 42:53 There’s quite a bit of work being done in this area, especially in the deep learning side, and then marrying imaging capability. There’s a professor, Alex Wong.

He’s the Canadian Research Chair for AI and Medical Imaging at the University of Waterloo. I would recommend him. I don’t know if you have ever talked to him, but he’s done lots of work.

(We discuss added entities that can be introduced due to alignment with Nimmi’s work. ) Nimmi Ramanujam 45:39 Oh, that’s wonderful. Stephen Ibaraki 45:43 The other thing, which I find fascinating in your work, together with all the awards you won — just remarkable list of awards.

But this idea, (In)visible Organ, a platform to share and archive stories of growth, pain, resilience, and beauty surrounding the inner reproductive anatomy — can you talk about (In)visible Organ? Nimmi Ramanujam 45:58 Yes. I think I mentioned earlier, a tool is only as good as, you know, if someone uses it. What I learned with the Callascope, and been using it in Ghana, Peru, in the US.

Both in the home and the clinic for self use. Is that maybe 10% of the women no matter where they were, in some places, less, even (know) what they were looking at. They have no idea.

Here’s the portal to life. A very important part of your body. And if you’re unaware, how do you take care of it? I think my colleague says; “Well, if you have a mole on your skin that looks cancer, you have to go to the doctor.

But if you can’t see it, how would you know?” That inspired me to think about a way to make that a narrative that could be shared with a broader community. The word I thought, in this . .

. was asked because it is truly invisible. What happened was a few things that came out of those trips.

One was, I wanted to do, an art exhibit. Basically, this important narrative. And wanted to see how this could be expressed in different ways; stories.

As I certainly have always been interested in art and storytelling. I approached a colleague in the Center for Documentary Studies and asked her how we might do this. We decided that we were going to solicit art from artists that in a space that who are interested in this narrative.

We got works from all over the world that were able to exhibit at the Rubenstein Arts Center at Duke University. I think that somewhere upwards of 500 people show up over the course of three hours. It was there for a month and many people visited.

I think then we moved it as a digital gallery with the stories of the various artists. That was my first effort to say, what are the things I can do to build community? And then I recruited a documentary documentarian into my center. Actually a student who’s interested in doing a thesis and she said, we should make this into a documentary.

We worked with my colleague in the Center for Documentary Studies and the student who’s now at MIT in the media studies world. We create a 45 minute documentary on the Callascope of cervical cancer. Our experiences internationally.

Having different individuals to speak about their experiences; just a story. But with an anchor Callascope, (In)visible Organ, called (In)visible Organ documentary. That was featured in one of the largest HPV conferences, which is very exciting.

I don’t know how many people appreciated it. But since then, it’s been screened by many students and individuals at high schools, universities. So ultimately, what I realized is .

. . not unlike a course in the classroom, it’s educational.

It’s a way of imparting information, sharing knowledge, not in the conventional way. But being able to get it out to the community, having safe spaces, but in that process, being able to create awareness. As simple as you have a service; take care of it.

It’s surprising how few people know about it. That’s what the (In)visible Organ is. It’s meant to be an educational initiative that is not one dimensional.

It’s inspired by technology, but it includes storytelling. It includes art, and any other type of media that could bring that across. If you look at the website, there are pictures.

There are stories by artists, photographers, from Morocco, or Ghana. The idea is let’s pull up those stories. Let’s curate this site of just the beautiful things, .

. . of women’s health and reproductive health.

Stephen Ibaraki 50:28 I can see the value of what you’re doing. It’ll resonate with Gen Z, those born from 1997 (-2011) and the Alpha generation from 2012. And including Millennials (Gen Y, 1981-1996) as well.

I could see all of this being very attractive to these groups. I can also see it integrating with the work that’s being done on the metaverse. (I mention entities producing metaverses that are founded in positive social impact and well-being).

I can see the integration of what you’re doing, especially on this (In)visible Organ work, where there are narratives and stories, and then you can have avatars that can help in that storytelling and an immersive environment. And keep in mind that the work on this kind of Metaverse is much more all-encompassing digital representation of what’s out there. And incorporating any kind of accessibility device.

So it doesn’t have to be complex headwear … We don’t have that much time left. I got to get to these last couple of questions. I’m really fascinated by your work with the train-the trainer-model called Ignite , where Duke students work alongside learners (typically high school students) to solve local challenges within their communities .

And the reason is, I’m working with a lot of CEOs right now who are very much working on diversity, equity, inclusion (DEI)—working with the trainer the trainer idea. This mentorship concept where other students can mentor other students and so on — cascading mentorship. This is going to help with diversity, equity, inclusion (DEI).

But I could see that in your models. Can you talk more about this Ignite program that you created? It’s just fascinating. Nimmi Ramanujam 52:48 Yes.

It’s also is part of this umbrella of the different ways of educating. When my students do design . .

. able to solve problems, for example, during COVID, right? When there were lack of resources, students could immediately start designing solutions, ultimate solutions. But as you know, I am working with collaborators to design solutions for them, and hopefully with them, but why aren’t we giving these skills? Or why aren’t these skills being taught to the students or people who are at level of the problem? Like everything else, it’s a big experiment.

I applied for funding. Send some students to Kenya. Ask the teachers there in the school, what do you want? What do you want your students to learn? That they aren’t able to learn? They said, “Tinker — Being able to build things.

” I said, Great—what do they want to know? So, survey the students and they said, “We need light to study at night. ” They don’t have reliable access to electricity. I taught a class, to students of design thinking, for community development.

We build tools that can solve a problem. I said, I don’t want you to build a product. That’s not my goal here.

Besides products take a long time. What you can do is create a product that’s a (participatory learning) curriculum that you can do in a semester. So they created a product (participatory learning curriculum).

They went to Kenya to Muhuru Bay. Everything they had imagined, had to be scrapped. They had to start over but they knew fundamentally what they were trying to do.

50 students, all girls. Learned, making a good renewable energy flashlight. It’s still being used today.

Instead of 2014, and now . . .

they continue to develop flashlights and other solutions. But the idea was they could take this and immediately apply it to problem. Didn’t have to go and get batteries for a lamp that barely worked.

That’s what inspired it. And then we expanded to other countries. I tend to do a lot of rapid prototyping, try it in different countries and learn quickly what happens.

We hit a sweet spot in Guatemala. I had a student who took our class and said, “I’ve got to do this in Guatemala. ” She’s very entrepreneurial.

She set up a foundation in Guatemala and is Guatemalan. She learned about this renewable flashlight program. She said, “why don’t we do water?” So we designed a program around clean water.

It’s now been scaled to about 500 schools and reached over a couple of 1000 students. The idea was to grow the indigenous community . .

. and teach them about water, and how to build solutions to clean water. It turns out that they had reason to believe that the water was dirty because of spiritual reasons, that they are either supernatural reasons that they had no control over, or they were told something different than what was actually the truth.

And organizations were making policies that they could not contribute to. So through this whole process, what happened was, they work with a local NGO, and they start to educate the community about the issues of water to actually influence policy change, because they gave people voices that they didn’t have. I think that’s the power of this very simple initiative.

And now it’s got a life of its own. We now are doing it locally here. To essentially bring that .

. . as a way of being able to tinker, but around the idea of doing something so good.

It doesn’t necessarily have to be something halfway across the globe. It could be for someone here . .

. that’s the fundamental notion, provide context, and you will learn the tools. Stephen Ibaraki 57:02 I can see this now being part of something called Startups Without Borders, which is a very inclusive global program.

There’s another program called GoodWall, where maybe this will be a great fit. And then also, there’s something called the Innovation Factory, which is part of the (United Nations) ITU, open innovation platform for AI for good. I can see this, also tying in with the Imagine Cup from Microsoft (see Forbes on 2022 Imagine Cup Junior and 2022 Imagine Cup ).

So just a number of ideas. We’re, down to the last minutes. I encourage the audience to take a look at all of the recognitions you have received , because it’s just a small indication of the magnitude of the work you’re doing and the impact it’s having.

It is just remarkable, and it’s also meaningful. ( Note on the multitude of recognitions: Professor Ramanujam is internationally recognized for her contributions in innovation, education, and entrepreneurship. She is a Fulbright scholar, a member of the National Academy of Inventors, and a fellow of international professional societies in her field.

She has also been invited for speaking engagements at the United Nations, as a TEDx speaker, and been invited to give plenary talks on her work all over the world. Professor Ramanujam has received a number of awards for her outstanding contributions in the field of biomedical engineering, including the MIT TR100 Young Innovator award, the MIT Global Indus Technovator award, the Duke Stansell Family award, the Department of Defense Era of Hope Scholar award. Awards from her professional societies include the Women in Molecular Imaging Leadership Award, the Biophotonics Technology Innovator Award, the Michael S.

Feld Biophotonics Award, the IEEE Biomedical Engineering award, and the IEEE Distinguished Lectureship. The impact of her social innovations has been recognized through the Consortium of Universities in Global Health Emerging Leader in Global Health Award, the Social Impact Abie Award from Grace Hopper Foundation, and Duke Wom C Global Impact Award. Her MacArthur Foundation 100&Change proposal, Women-Inspired Strategies for Health: A Revolution against Cervical Cancer (WISH) was recognized as one of the Top 100 proposals submitted to this $100M grant competition (Macarthur 100&Change).

The WISH Revolution is an innovative implementation initiative created for the purpose of addressing cervical cancer worldwide. ) And now to the last question, we covered so many different areas, do you have some recommendations you want to provide to the audience? And that’s the last question . Nimmi Ramanujam 58:19 Do as many things as you can.

Divergent thinking. Don’t make judgments before you’ve tried it. Keep all doors open.

And you might land on something that you really like and really care about, and then you’ll figure out how to do it. Stephen Ibaraki 58:42 Yes, that’s marvelous and wonderful advice for the audience. I really appreciate you coming and just doing outstanding remarkable work, and it’s continuing and it’s making the planet better and the ecosystems of the world better and definitely for the benefit of humanity.

Thank you again for sharing some of your insights with our audience today. Nimmi Ramanujam 59:06 Thank you, and I look forward to all those introductions. It’s a pleasure meeting you Steve and I really enjoyed this.

Thank you so much for all of the advice and recommendations and I’m very excited to pursue them. Follow me on Twitter or LinkedIn . Check out my website .

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