More than one thousand million people play videogames. More than 70% of them do it from their mobiles. At the same time, thousands of people die because of diseases which weren’t diagnosed. What if we could connect these two realities? Malaria Spot was born with the aim of solving this problem with citizen participation. How? Turning the diagnostic process into a video game and investigating techniques for combining player results so that we get a reliable result. The first research was with MalariaSpot back in 2012. Then the idea was applied to Tuberculosis in 2014 with the game TuberSpot. The last to arrive has been MalariaSpot Bubbles to try to differentiate between different species of parasites. We interviewed Maria Postigo, Biomedical Researcher at Malaria Spot.
1 How was founded and what is the objective of Malaria Spot?
MalariaSpot was born in 2012. Miguel Luengo Luengo was the founder and is the one who coordinates the project and the laboratory right now. Miguel is an engineer and doctor in telecommunications. When he did his PhD he came up with two ideas. On one hand, the number of people who become infected and die of malaria annually, in particular, 200,000 people are infected with malaria each year, a very shocking fact. Every minute a child under 5 dies from malaria. And then on the other side, a little more geeky if you want, had the other idea in the head: the amount of hours a day people can spend playing video games. How to bring these two concepts together to fight Malaria? That’s the amazing thing about the project that really impacts people when they know it.
According an estimation, the average number of hours a person spends playing video games resulted in an amazing amount: an hour and a half a day. With these two ideas, he thought: why not doing a video game in which instead of kill Martians you shoot malaria parasites into a blood sample?, and this idea that four years ago seemed completely crazy now is a reality. With this initiative we are able to send blood samples digitized from Mozambique now, and the results which are coming, are coming at a time that can be considered almost record, at very low cost and with good diagnostics. But hey, we are still in the research phase, we are still fighting for the project. We are a multidisciplinary group in the lab right now. 6 of us work in it on a daily basis and others collaborate sporadically.
For instance, all collaborator doctors do medical consultations or working through Skype, especially regarding the medical part and the veterinary part they are more contributors, but there also are engineers and developers, and communication and management people.
2 Malaria Spot works as a game. We want people to get the concept of it, How can we be malaria hunters?
Well, right now you can find the the game is in web format, through the website you can play MalariaSpot, y jugar supone empezar a cazar para los test de Malaria en estas muestras de sangre que vienen desde Mozambique, and playing is supposed to start hunting for Malaria tests on these blood samples coming from Mozambique. The other version, is much more entertaining because it has been redesigned in several concepts: is the application, both for Android and IOS, the application is called Malaria Spot, and also, because of the World Malaria Day, Last April, we launched a second version of spot malaria.
There is also another version in which players can collaborate to diagnose malaria, it is MalariaSpot Bubbles. in this second version we ask players to help us to identify what kind of malaria we are in front of, so we can give a much more specific and concrete diagnosis. The two games are in an app format, both MalariaSpot and MalariaSpot bubbles.
3 How do you think technology, and video games in particular, can help medical assistance and community impact in malaria affected areas?
The reality we found when we travelled to Mozambique and in general in developing countries, is that of course there are many needs and not enough doctors to meet them. Specifically, for example, in the case of malaria diagnosis. It is necessary to draw a blood sample, dye it for 20 minutes and look through a microscope. In the area where we act we realized that during high malaria season, 200 samples have to be checked everyday, and of course, 200 samples multiplied for 20 minutes to diagnose, was too long.
They did not have capacity enough to provide the diagnosis in the same day. And people have to travel a few kilometers from their villages for tests. With Malaria Spot we can greatly reduce all those times: provide faster diagnose, treatment and cure. Most cases cannot be diagnosed by using traditional methods. All of that in our particular case, so it is impressive. The results we are obtaining are very satisfactory.
Within the sample it is relatively easy to diagnose, a micro-task that can be easily learned and do not necessarily have to make a doctor out of you, everybody can learn visually, it is a task that can be done collaboratively and online.
4 Do you have real data obtained by remote diagnosis so far?
This is the first collaborative remote diagnosis obtained by people from outside the medical field. A clear example of this type of online collaboration was the last year in Mozambique. Two of our partners were in Mozambique, and we ask them to to start sending photos from their mobile at a certain exact time, which is from where we digitize blood samples to the game, and also on the other hand we asked our main players, the more established, to be there at the same time, rushing to diagnose these samples. From the laboratory, we were seeing the samples arrive to the server and how many players were playing at the same time, helping to diagnose samples.
Then, the objective fact is that from the moment that they sent it at three o’clock it took only 20 minutes to diagnose dozens of blood samples. Once implemented the cost of a server, is very cheap, like, infinitely cheaper compared to having a person, a microscopist technician, displaying the images behind the microscope and analyzing the samples.
5 How those shoots are transformed into a diagnosis in digitized blood samples?
It is fascinating. The idea is that players, after a tutorial and a little formation process, will be able to find and shoot all those parasites, it becomes information by an algorithm created to do that. The information we need to do the diagnosis is to find those parasites if there are, and saying how many of those there are, and with that information doctors are able to give a diagnosis.
However, we still need a lot of people “shooting” because only one shoot is not reliable. How many people do we need to set up so they can make an analysis as reliable as the one made by a microscopist? Miguel was doing a study in which he put together in a particular way the clicks of different people and he realized if he put together 22 clicks from different people who were playing Malaria Spot at the same time, diagnosis reliability is 98%, which is equivalent to the microscopist’.
In conclusion, we need to get 22 people playing at the same time. Miguel also realized that if those people had played Malaria Spot at least once, with only 13 people we get the same reliability in the diagnosis. This has Artificial Intelligence algorithms behind and those are hard to explain for digital image process.
6 You have a project for schools called EduSpot, what is that about?
The idea behind EduSpot is to bring all this information and the game itself to schools, having in mind the idea of raising awareness about the subject and about global health, developing countries throughout workshops and competitions between students. We made a competition between 15 schools all over Spain, 2000 Spanish students took part last year in this competition in the Malaria International Day, 25th April, with prizes for the best players.
Kids loved the experience, and they had fun and learnt at the same time. Feedback delighted us. They look very motivated to learn that by playing they can also help. You give them a game and instead of taking math classes they are shooting martians and are happy, imagine. It is a natural language for them.
For instance, one of the things we teach in the workshops is: what is the animal that causes more deaths in the whole world? Of course everybody said animals like sharks (nothing further from the truth, shark kills about only 20 people per year). When you tell them is the mosquito, because the mosquito is who carries the diseases inside him and he transmits these diseases from one person to another, and that he kills billions of people every year, they freaked out, and they took awareness about the real problem that malaria is.
7 Which are the global policies on health to make it 1st issue in the political agenda and universal for everyone?
Policies more or less already exist, and at a general level people talk about global health, about to take measures with global global policies, but then we see that in day to day it is not so. The problem is that there is no financial funding to do all that, and that is that you can talk all you want but, if you do not invest, then if you do not do tangible research projects that can really have repercussions in this regard, it the end with no investment nothing can be done.
We believe that rather than talking about policies, because policies already exist, we have to implement these policies, and that means more funding and resources fro investigation and research, as simple as that. It’s the next step in the policy so that makes sense.
8 Which new projects do you have in mind? How do you want to grow?
Since the moment Malaria Spot was founded, lots of projects have emerged, we are working with tuberculosis as well and we currently are also very involved in topics related to retina, to stop blindness, to diagnose blindness in developing countries. Our idealism and our passion for what we do is one of the main tools we can count with.
We have been mistaken many times, and we have started projects that, well, for one reason or another, did not work.
Also it is necessary to understand in research you try one hundred times but hit the mark once. But we are doing new alliances and collaborations in order to Malaria Spot gets into people’s hands. We will keep fighting for it.