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Looking into the future of healthcare

Thys Cronje of SensiCardiac on empowering rural clinics and expanding the business, which began as a Master’s Thesis, into the US market.

MORGAN BARNARD: Welcome to the Moneyweb Grindstone podcast series, in partnership with Grindstone, Moneyweb has created this series to get to know the 13 selected companies and the entrepreneurs behind them. With me today is Thys Cronje, who is the founder of the Stellenbosch-based start-up, SensiCardiac. Thank you for joining us today, Thys.

THYS CRONJE: Thank you very much for the opportunity.

MORGAN BARNARD: Firstly can you explain a bit more in detail what SensiCardiac is and how it came about?

THYS CRONJE: It’s a project that started actually in 2003 as a Master’s Thesis at Stellenbosch University, between the engineering faculty and Tygerberg, the medical faculty. So it started out of a need to create or empower nurses, especially in the rural clinics, or those who don’t have the skill to do cardiac assessments, to listen to the heart, to empower them to make better diagnosis. We all know that cardiac diseases are the leading cause of death globally. There are many programmes that do exist to prevent and reduce cardiac-related death but still the stethoscope is the primary way to listen or do an assessment on a patient and it’s one of the basic steps but it’s also very challenging. If you don’t have the skill or training to do that then it can become problematic and you can miss defects or what can happen is you can undo unnecessary referrals. Now what we’ve done as part of the study is we’ve looked at how one can record those heart sounds that come from a stethoscope and interpret it, just like a physician will do when he listens to your heart and he must make a decision if it’s a good sound or if there is something wrong or not. So we basically do sound analysis on that sound and then tell the physician or the nurse that there is something wrong or not and should that patient go to a cardiologist or is it fine, can they go home and that’s in principle what we are doing.

MORGAN BARNARD: Where can this device be used, is it realistic for a travelling clinic in rural areas to have one, who benefits and why?

THYS CRONJE: When we started off our main goal was to develop it for rural clinics, so that a nurse at a rural clinic or at a mobile clinic can use a handheld device like a smartphone and connect the stethoscope, it’s a normal electronic stethoscope that you buy off the shelf, it’s nothing special, it looks like a normal stethoscope, it works like one, the only difference is it’s electronic. So it can connect with wireless, with blue tooth to either a computer or a mobile handheld device and record those sounds. Now those sounds are uploaded to our server, analysis is done in the cloud and an answer is sent back immediately, we say yes it’s normal or no it’s abnormal, that patient should go to a cardiologist. That analysis is as accurate as a cardiologist would do it. So yes, it’s for rural nurses and those people who are using a stethoscope every day to listen to somebody’s heart. It’s made for them, it’s not for the specialist sector which has big machines that can actually do further analysis, it’s not for them, it’s for those guys out there in the field who are using a stethoscope to listen to the heart.

MORGAN BARNARD: What sort of conditions can be diagnosed using this device?

THYS CRONJE: We are mainly focusing on structural defects of the heart, now structural defect could be a congenital defect where you are born with a heart defect and about eight out of every 100 children is born with a heart defect. It could be an acquired defect like rheumatic heart disease where the prevalence is quite high in South Africa or it can be like an endocarditis infection in the heart where bacteria attacks the valves or when you become older, let’s say about 70, 75, even at about 65 your chances for a leaking valve becomes bigger. So those kinds of structural defects we are able to pick up. So it’s any defect in the heart, a normal heart sounds like lip, dip, lip, dip, now if there are any other sounds like lip, shup, lip, then we will be able to pick it up and analyse it. Now what we are actually doing is we can distinguish that sound from what we call a functional murmur, now everyone one of us at some point in our lives do have a functional murmur, especially when you are smaller, let’s say you’ve got a little bit of flu, your body is under stress and your heart must work a little bit harder and then you can get a functional murmur within the heart, it’s basically turbulence of the blood in the heart and that can also make a murmur. Most of those children or adults with those kinds of murmurs are also referred to a cardiologist and that results in an unnecessary referral. We’ve seen that in some cases up to 90% of referrals to a cardiologist are unnecessary and just because that healthcare provider in the clinic wasn’t able to distinguish between the pathological murmur and the functional murmur.  

MORGAN BARNARD: You previously mentioned that this programme is available globally, how many medical professionals are using it?

THYS CRONJE: We’re focusing on the nursing population, so our main market is the USA, there we’ve got quite a few hundred nurses and in that market even private practice are using our device because they’re allowed to do sports screenings, occupational health screenings, they’ve got school nursing there and that kind of market. We do have users on nearly all the continents of the world but our marketing at this moment is only focusing on the US, so that’s where we’ve got the biggest growth as well.

MORGAN BARNARD: And for these users how cost effective is it?

THYS CRONJE: If you’ve got an unnecessary screening and they refer you to a cardiologist and it will cost you anything between US$500 and $1 000, it can actually go up to $3 000 in some cases to do a cardiologist visit. Now with our system if you need to go to a cardiologist or not for about $1, so that’s the cost efficiency.

MORGAN BARNARD: Why is early detection for these cardiac problems important?

THYS CRONJE: Like in most diseases the earlier you detect it the better you can treat it, especially when it’s an acquired disease you can repair the heart valves if there’s a bacteria, it’s easier to correct it when the damage is not that big. Even for a small child, if let’s say there’s a big hole between the ventricles or between the artery then it’s necessary to correct that as early as possible so that the oxygen flow within the blood can be restored to as normal as possible because the lack of oxygen or deoxygenated blood that then circulates in your body can influence the growth of a young child. Then for an older person you must detect as early as possible if you need a valve replacement or not, later in life it becomes more difficult to replace it.

MORGAN BARNARD: How do you plan on expanding SensiCardiac?

THYS CRONJE: At this moment, as I said, we are focusing mainly on the USA market, we are looking for strategic partners in the USA to assist us with the growth. Then the next step in South Africa is also to work with preventive screening, the school health sector to screen kids for cardiac defects because we believe that a lot of defects are missed in South Africa because it’s not part of the procedure at this moment to screen young kids for heart defects. In South Africa there’s only 24 paediatric cardiologists, now if you go to a city like Boston and in one hospital you’ve got about 100 paediatricians, where in South Africa there are only 24 treating about…and there are about 8000 kids annually born in South Africa with a heart defect, and only 500 of them are treated. So we want it to grow in that sector in South Africa, get uptake from our Department of Health and see how we can grow this to every clinic to get that into the current procedures to screen for heart defects.

MORGAN BARNARD: What role do you see the Grindstone initiative playing in your business?

THYS CRONJE: Well, they are already playing a big role in assisting us to identify our partner universe, to see how can strategically partner, with whom we can partner and work out a strategy to accelerate our growth, especially in South Africa and then globally.

MORGAN BARNARD: Lastly, what is your number one tip for South African entrepreneurs?

THYS CRONJE: I would say choose your partners very well and with a view on growth and on scaling. I think what we do too often is we choose our partners for funding and that must not be your main goal, your main goal must be to choose your partners for scaling.

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