Field Survey Report

for the Global South E-Health Observatory

Meeting with CerviScan (Cameroon)

The CerviScan digital microscope, 90% printed in 3D (Bamenda)

Samir Abdelkrim (April 2018)

Genesis of the project

The CerviScan team and four female beneficiaries outside the start-up’s office in Bamenda

I finally arived in Bamenda. The small aircraft consisting of twenty seats owned by the

national company lands heavily on the provincial-looking airfield. Welcome to the English-

speaking part of Cameroon. Everything here is nothing but hills and green fields. It is hard to

imagine that behind this ideal postcard image, this region is currently facing heavy political

turmoil. It is in the midst of an identity crisis with the French-speaking central government

that causes the armed separatist groups present in the area to rise in power. Such groups

continue to carry out more raids to kidnap senior government officials or foreigners. Conrad

Tankou, the developer of the CervisCan project, comes to pick me up from the Bamenda

airport. On the way, he explains to me that his project is now more necessary than ever in

this region where public services are desperately lacking. Especially in the healthcare

domain.

He further explains to me, while driving through the city, that cervix and breast cancers are

among the leading causes of death in sub-Saharan Africa. “Studies show that these two

types of cancer represented nearly 45% of new cases of cancer among women in

2012”. Before becoming an e-health social entrepreneur, Conrad Tankou is firstly a

Cameroonian doctor. He notes each day the medical realities of his country. According to

him, in Cameroon, breast cancer rates among Cameroonian women are very high, with more

than 2,625 new cases per 100,000 women each year. The principal cause of these deaths

being late diagnoses, particularly in the zones less covered by medical infrastructures.

Conrad is convinced that many lives could be saved through early detection of precancerous

lesions among women, only 5% of the population have access to “screening” programs such

as mammography in Cameroon. This is the reason why Conrad developed a simple and

ingenious technology solution for the detection of breast and cervical cancers targeting the

most vulnerable populations. A little further down the road, I learned during our discussion

that there are only 21 radiology physicians specialized in mammography in Cameroon.

"Mammogram screenings are centralized mainly in large Cameroonian cities, and

yet only few hospitals specialize in the procedure. In other words, those

screenings are inaccessible for people residing in rural and suburban areas.

Additionaly, the cost of the procedure constitutes a major barrier for women living

in the countryside."

Conrad Tankou provided a demonstration of CerviScan with his team

What is CerviScan? How does the system work?

CerviScan collects, enlarges and analyses microscope images directly on a smartphone

We arrived at the CerviScan office, located in a narrow street of Bamenda. Conrad Tankou

introduced me to his teammembers (10 staff members, 4 full-time and 6 part-time

employees). Among them, Nkwelle Clinton Joseph, one of the developers of the mobile

application, as well as Lemi Clarisse, who in charge of advocacy and communication. Several

women benefitting from the CerviScan initiative were also present. They are all coverd by

the framwork that provides breast cancer screening in rural areas. Conrad explains to me

how his initiative works. Everything starts with the physician manually detecting breast

cancer in patients. The physician carries out palpations in order to try to detect cysts or

nodules which could prove to be malignant tumors. Each patient is registered in the

CerviScan mobile application. The physician then conducts a fine-needle biopsy, which is

usually painless, in order to collect cells or fluid contained in cysts and lymph nodes. The

sample is placed on a coverslip and that's when the CerviScan microscope comes into

play: Conrad Tankou has developed a digital microscope - with affordable and

expendable materials, printed in 3D (90% of its components, fully assembled in

Kenya, Nairobi). This microscope, which is ultralight, portable and battery-operated

(therefore needs no electrical outlets, which is necessary in rural areas lacking electrical

power) - is equipped with a digital camera that can be "connected to a computer or a

smartphone, where real-time images can be viewed and saved." This technology

makes it possible to scan each coverslip (biopsy) using the microscope, by producing images

that can then be zoomed in and analyzed in very high resolutions via smartphones,

computers or tablets.

Once the images, as well as the videos, are collected on a device (PC, smartphone, or

tablet), they get downloaded to a secure server where they are analyzed in real time by

Cameroonian specialists. "We already have 3 physicians who operate using our

platform to diagnose patients," Conrad explained to me.

What are the impacts and the benefits, in terms of

health?

Conrad Tankou explains to female beneficiaries the different stages of image analysis

This project is well integrated, particularly, in rural areas. Today, in less than a year nearly

1,276 Cameroonian women aged 30 to 70 years have benefited or are benefiting from a

follow-up conducted by CerviScan. The number of new patients varies from 20 to 200 per

month. Peak periods occur when the CerviScan team arrives in new villages to raise

awareness. From a general point of view, CerviScan allows solving the issue related to the

lack of physicians who specialize in diseases linked to breast and cervical cancer in rural

areas, as well as in small towns and suburban areas. The increase in the number of manual

palpation and cytological punctures of the breast carried out by Conrad Tankou and his

teams makes it possible to detect breast cancer sufficiently early, thanks to CerviScan, and

to act quickly by ensuring appropriate treatment.

Mobile penetration allows CerviScan to spread and extend throughout the entire territory,

including in the most remote enclaves, where it becomes possible to be

diagnosed by the best specialists.

In terms of beneficiaries, the women I interviewed on site all emphasized the painless nature

of the operation: "needles frightened and discouraged me, but eventually, I realized

you feel almost nothing when the sample is being extracted. Results are made

available very quickly. We no longer have to travel to big cities to perform such

tests."

Conrad Tankou with a female recipient of CerviScan services.

At the end of each screening campaign, the meta-data collected through CerviScan is

analyzed as a whole to produce regional statistics (which were previously unavailable) on the

prevalence rate of breast and cervical cancer in the covered areas.

Moreover, Conrad Tankou told me during my mission that the basis of images and videos

collected via his digital microscope and saved on the Cloud allows a very quick and acute

analysis (delays in receiving biopsies by physical medium are eliminated) by

specialists who can provide quality diagnosis (or who may even ask for a second

opinion by sharing those images with colleagues). This important basis can also

constitute a signficant medically educational database that can be used to conduct

research studies, or to raise awareness for other health professionals.

Images being analyzed on a tablet thanks to CerviScan

What about funding, as well as the business

model? CerviScan’s economic model - which is currently being tested in different pilot sites - is as

follows: For each screening, female recipients must pay the equivalent of 2 US

Dollars. The startup gets a 50% commission based on the fees paid by the recipients to use

the service. The remaining 50% goes to partner hospitals that analyze medical data

collected on the Cloud. Depending on the number of biopsies performed and the use of the

microscope, various compensation percentages may be applied. For the moment, the startup

is still in the "ideation" phase, in terms of its search for a business model. CerviScan plans to

offer medical treatments costing approximately 25 USD for recipients diagnosed with cancer,

in partnership with hospitals.

The patient file where images are stored and secured in the CerviScan application

What are the suitable partnerships for CerviScan? Nowadays, and at an international level, CerviScan is part of a telemedicine program

developed by the MIT, the Global Innovation and Creativity Space (GIC Space). GIC Space

provides advice, networking and mentoring to Conrad Tankou and his team.

Additionally, several members of the MIT's International Development Innovative Network

have joined CerviScan's board of directors to provide knowledge and expertise.

CerviScan is mainly developing partnerships with local health centers that can support the

startup in its deployment in rural areas. Conrad Tankou wishes to connect his country's

health policies in order to make the collected data available to "policy makers" in the fight

against breast and cervical cancer. Conrad Tankou is equally seeking partners who

can help him optimize the use of his database of images and medical data

through by mastering artificial intelligence.

Two members of the CerviScan team: Nkwelle Clinton Joseph and Lemi Clarisse

Conclusion CerviScan is a very disruptive Cameroonian project with high value-added in terms of local

needs. Conrad Tankou is currently - and actively - seeking funding to recruit new developers

who will be essential to continuously improve the application, with regard to user feedback

received daily by his team. During our discussions, Conrad Tankou passed me his

roadmap covering the next 3 years: in addition to a scalable expansion that

would result in up to 50 new sites by 2020, he wishes to extend CerviScan’s

scope to other specialties such as hematology or parasitology. On a broader level,

Conrad Tankou wants to penetrate neighboring African markets that encounter the same

health issues as the ones currently present in Cameroon’s rural and remote areas. This

market penetration plan would start with Central Africa at first, followed by the entire

continent within 5 years.

CerviScan in action: a physician in a partner hospital will soon analyze images in real-time