From Medical Student to Tech Entrepreneur

How One Inventor is Transforming Health Care in Rural India

Through his startup company, Biosense, Abhishek Sen is helping remote communities in India get better testing for some of the country’s most pervasive diseases.

How do you solve a chronic, widespread generational health problem in places where money and resources are scarce?

That question led Abhishek Sen to co-found Biosense, a company based near Mumbai that designs point-of-care diagnostic equipment to detect some of India’s most prevalent and potentially devastating illnesses.

Like many tech startups, the idea for Biosense was hatched in a college dorm room. And like many inventors, Sen wasn’t picturing himself running a business when he and his classmates first began brainstorming. They were medical students, not entrepreneurs. But they’d identified a health challenge — the high rate of anemia in Indian women, particularly those who are pregnant — and they were determined to address it.

Biosense has since created and deployed a number of low-cost, portable diagnostic devices to tackle a range of chronic health issues in India. In 2019, they conducted 10 million tests and reached 5,000 clinics around the country, mostly in rural areas. This year, they were able to quickly pivot and help address a shortage of testing kids for the COVID-19 pandemic in India.

We spoke to Sen about how Biosense was born, the tools he and his co-founders developed, and the challenges they’ve met, and overcome, along their journey from inventors to entrepreneurs.

(This interview has been edited for length and clarity.)

What inspired you and your co-founders to create Biosense?

We were in medical school at the Indian Institute of Technology Bombay, and we were posted as interns in rural areas where we saw many common diseases go untreated. One we saw frequently was anemia. It seemed as though a lot of the cases had not been diagnosed at the right time because tools to do so didn’t exist.

So we started our journey with anemia. We wanted to build affordable tools and diagnostics that the local community could use for common diseases. We did not think about exports at that point, we did not think about the emerging world. We thought mostly about India. That was the inspiration.

How bad was the problem for women and mothers? What health effects were you seeing in communities?

A large number of females in India, more than 45%, are anemic. I remember a patient who had come in for a delivery, and her hemoglobin was very low. And there is no reason for that, because the treatment is not expensive. But the timing of the diagnostic test is important, so we thought that if we can make tools that people in rural communities can use to screen themselves, that could help.

And anemia affects not only mothers, but also the next generation. Girls born to anemic women tend to grow up to be anemic too. So this is truly a multigenerational problem, and at some point the chain has to break.

Why is diagnostic testing a problem in rural India?

Healthcare in India, as in most other countries, is largely centralized, which means that if you need to get a test, somebody takes your sample and sends it to a huge laboratory. But many parts of the country have broken supply chains, especially our rural areas and those that are sparsely populated. The model of centralized diagnostics is very difficult to pull off outside of cities, especially given the country’s scale and poor infrastructure. That’s the macro level.

At the micro level, for example, there is a tribal village called Melghat where we stayed for two months as part of a relief group. It’s in the Eastern part of the State of Maharashtra, and it has the highest infant mortality rate in Asia. We found a lot of anemia there, and we made some friends who were locals and we asked them, “Why don’t you test?” They said, “If I test once, how will I test again, unless testing is possible in the place where I am staying?” And where this community is, there is no electricity, there are no roads, there’s no refrigeration. So these places need a diagnostic tool that is adaptable to their constraints.

What kind of impact have you seen with your point-of-care diagnostic tools?

First, the testing happens right in the village or close to the village, and all of the data comes to the Cloud. So with anemia, for example, if we can test every child under five years old, and every female of childbearing age, that gives us a real shot at monitoring hemoglobin levels.

When you anonymize it and remove the identifiers, you can actually see the macro trends of hemoglobin improving. That gives that community hope. We have stronger children, and we have stronger mothers giving birth to stronger children. So it makes the community better as a whole.

With diabetes, I think India has a problem of not testing enough. Only when the symptoms get really bad, when the eyes and kidneys are affected, does someone go to a physician. But if you implement screening at the local level with devices like ours, you can actually detect disease a lot earlier, which lowers the cost and the complexity of treating it — and reduces the burden on the health care system.

You’re a native of India, designing for the Indian context. Talk about the value of local entrepreneurs versus outside experts.

When we are designing or even when running a business, there are many decisions — some minor, some major — that we have to make. A lot of these decisions are based on instinct that comes from having grown up in that environment. You unconsciously understand that environment better, and you’ll pick up nonverbal cues from your prospective customers better than somebody else. So I think that gives a local entrepreneur a very high edge over an expert coming in from some other country.

What other products are you currently developing?

We have a point of care product for urine analysis, and we have a product for measuring lipids — cholesterol, triglycerides, and HDL — in a finger prick. Recently we built a product that enables newborn screening for hypothyroidism and other common congenital anomalies.

Apart from this, we have a robust COVID portfolio now with magnetic kit based RNA extraction kits, rapid total antibody tests and UV disinfection boxes.

What made Biosense able to pivot and adapt so quickly to the pandemic?

The company that acquired us in November, Tulip Diagnostics, had a small division which was making viral test mediums. So we knew we could use that existing product, but the supply chain was a problem.

In March, when the pandemic started showing up in India, there was a severe shortage of nasal and oral flocked nylon swabs. Tulip Diagnostics already had the Viral Transport Medium — the liquid in which the swab is dipped to transport to a lab — but no swabs.

Biosense set up an end-to-end production line of nasal and throat swabs in three weeks, along with getting regulatory approval from the Indian Council of Medical Research. Since the pandemic, about one out of three tests are being done on our swabs.

We were able to adapt quickly because we had the resources, the factories, the labor, and a bit of raw material. And because we had the financial means, we were able to build the supply chain from the ground up.

What are the challenges for invention and hardware-based businesses like yours in India?

I think the biggest challenge, at least for a new med tech company like us, is getting the product distributed to the market after its made.

The second challenge is that the people who start the company are usually inventors with a technical background, who have no inkling for how to run a business. So a lot of things just hit out of left field because you imagine that you’re going to design the product and it’s going to sell itself. Mostly, it doesn’t. So it can be difficult to get the sales and marketing piece right, build the supply chain, make the profit and loss statement work.

The other big challenge [for] the person running the business himself or herself is working capital. Our banks are not equipped to help small and medium-sized enterprises. And the situation has not gotten better.

Many tech startups struggle to bridge the “Valley of Death” between conceptualization and commercialization. What support did Biosense receive that helped it move forward?

A company called Villgro incubated us in 2011, when we were straight out of medical school. So we received a lot of handholding in making our first prototype and first sale. We also received funding from a social impact investment firm called Menterra. One of their advisors, a man named Mukesh Sharma, was a constant support on multiple fronts, from cash flow to product development and even HR issues. There was a lot of coaching that went on there.

Without Villgro and Menterra, I don’t think we could have grown. It would have been an extremely tough journey. We also received a Masala Bond from The Lemelson Foundation, and [a guarantee against] a timely working capital line of credit.

You started the Biosense journey as medical students. How did you transform yourselves into inventors, then entrepreneurs?

I think that is probably the most difficult transformation for us, because when we started, we didn’t think that we would be running a company. And over time, there are plenty of different skills that have to be picked up — from figuring out supply chain, to building a team. These are things that are not taught in medical school or that even come intuitively to most people, including me.

So it was challenging, but we were extremely lucky. We’ve received a lot of help, at all the right inflection points, over the course of the last nine years. And in November we were acquired by an Indian diagnostics company called Tulip Diagnostics. It has been a tremendous journey, but we’ve also been extremely lucky.