First transatlantic surgery

On September 7, French and American surgeons performed the first-ever surgery across the Atlantic Ocean. Sitting in a New York hospital, they removed the gall bladder of a 68-year-old French woman, using a computerized surgical robot connected to a transatlantic fiber optic link. “It was a bit difficult to explain to my patient in Strasbourg that I was going to New York to operate on her,” said professor Jacques Marescaux of the University of Strasbourg.

Jacques Marescaux and Michael Gagner of New York’s Mount Sinai Hospital belong to an elite group of surgeons that are pioneering a new type of medicine – robot surgery. They use sophisticated robots to perform more efficient operations, which in principle can be done from anywhere in the world, hence the name telesurgery. ”In the future, using satellite clinics, we will be able to operate on patients in poor countries, onboard ships at sea, remote islands, the Antarctica, and even in a space station – anywhere where there is a lack of experienced experts,” says Dr. Gagner.

Before this operation, few experts thought it was possible to perform surgery over more than a few hundred kilometers, because of the time delay when electronic signals travel between the surgeon’s workstation, and his robotic counterpart. This was a real problem during trial operations on pigs, but was later solved when France Telecom provided the scientists with a dedicated fiber optic connection.

The entire operation took 54 minutes, of which 16 was used to prepare the patient in Strasbourg. Drs. Gagner and Marceaux took turns in directing the robot using two thin, pen-shaped controls. A third surgeon was at hand in Strasbourg ready to take over in case anything went wrong, but did not need to take action.

With telesurgery, the patient can leave the hospital in only two days, and has a good chance of recovering faster than after traditional surgery, since the robot’s incisions are smaller, and there is less bleeding. Authorities in the EU and Canada have already cleared these kind of robotic systems for human surgery, while the more conservative American authorities are still evaluating them. There are also a number of legal aspects that may slow down the introduction of robot surgeons. Who bears the responsibility if anything goes wrong? The manufacturer of the robot, or the doctor? And from which country?

“(Telesurgery) is a new science where robots act as the new interface between the doctor and patient,” says Dr. Gagner, who intends to start a professional association of robot surgeons. Asked whether he has any doubts about the use of robots surgery, he says that he hopes that there will always be a doctor standing behind the controls.

Hans Sandberg

Hawaii: Testbed for Telemedicine

(This reportage was published by the Metro newspaper syndicate in 2001.)

“We are geographically challenged,” says Dr. Greigh Hirata.
 
A remote ultrasound examination of a pregnant woman.

Dr. Hirata at his telemedicine station. Photo: Hans Sandberg

The last thing a woman who is going through a difficult pregnancy wants to do, is fly to another city to have her ultrasound taken - but until recently, those Hawaiians living far from Honolulu had little choice. “We are geographically challenged,” says Dr. Greigh Hirata, an expert on high-risk pregnancies. Over the last few years, Hawaii has invested in telemedicine, allowing specialists to “see” their patients via videoconferences and the Internet. The goal is to make Hawaii a center of “tele-health” in the Pacific Ocean.

Hawaii is proud of its health care system, and the fact that 85 percent of its citizens have health insurance. Oahu -- the home of Honolulu, as well as 75 percent of the state’s 1.2 million inhabitants -- has several large, modern hospitals - including the huge army veteran’s hospital, Tripler Medical Center. But while most medical specialists are concentrated in Honolulu, a quarter of the state’s population is spread out over seven other major islands.

Each year, some 3,000 Hawaiian women experience complicated pregnancies, and many of them consult the Kapiolani Medical Center for Women and Children in Honolulu. The center’s Fetal Diagnostic Clinic is lead by Dr. Hirata, a firm believer in telemedicine. Dr. Hirata travels regularly to visit with his patients on Maui, Kauai and the Big Island (Hawaii,) but if there is an emergency, the patient would usually do the traveling – something that telemedicine could change.

“We want to spare our patients the expense,” says Dr. Hirata. “The patient and her husband usually have to take a whole day off from work, fly out here, rent a car, and so forth,” he says. Patients come to Kapiolani from as far away as Guam - an eight-hour flight that costs $1,500. “When these people get here, everything could look perfectly normal, or maybe we have to tell them that there is nothing we can do, because it is a lethal birth defect. It would be better if we could do this all via tele-ultrasound,” Hirata adds.

This and other Hawaiian telemedicine programs are paid for by a combination of federal money and private donations. Kapiolani only needed to raise half of the $1.2 million it needed for its tele-ultrasound network - that today reaches seven remote clinics: two on Oahu, one on Maui, one on Kauai, and three on the Big Island.

On a Wednesday morning in August, Dr. Hirata has an appointment with a 33-year old patient at a clinic in Hilo, the capital city of Hawaii’s Big Island. He consults with the attending physician via videoconference, while the nurse prepares the patient. Sitting in front of two high-resolution monitors, he can see the remote office and the ultrasound images. Because of the high-speed connection, the picture and sound are of good quality.

It takes a while getting used to working with video conferencing equipment, but he feels that the live connection makes it easy to tell the local doctor exactly how he wants to position the instruments. He can study the chambers of the baby’s heart in detail, and listen to its heartbeat as clear as if he was in Hilo. In this case, both the mother and her baby were fine, which means that a trip to Honolulu would have been an unnecessary expense.

Dr. Hirata dreams of expanding the program to even more remote locations, like American Samoa, 3,700 km to the southwest, and Guam, 6,000 km to the south. “Over time we hope to expand the service to the entire South Pacific. The need is definitively there, since Guam, for example, has only a few obstetricians but a very high pregnancy rate,” he says. He is not quite sure if tele-ultrasound would work in all places, but believes in genetic counseling through videoconferences, and wants to get more pediatric cardiologists involved - a rarity on many smaller islands.

Col. Donald Person is medical director of the U.S. Army’s Pacific Island Health Care Project, which is headquartered at Tripler Medical Center in Honolulu – not far from Pearl Harbor. He has been involved in providing medical services to the half million people who live on U.S. islands in the Pacific.


Donald Person medical director of the U.S. Army’s Pacific Island Health Care Project. Photo: Hans Sandberg

To get the hospital’s telemedicine project -- named Akamai -- started, Tripler provided four remote hospitals with computers and communications links, costing about $14,000 each. Funding came from a grant from the National Science Foundation in1998, and soon after they began providing free medical care to Pacific islanders, as long as their cases could be used to further research and education. “We are now working over five time zones, from the island of Yap in the east, to the Republic of Palau in the west,” says Person, and to date, the hospital has about 1,850 telemedicine patients in their database.

Tripler is also involved in futuristic high-tech projects -- like long-distance radiation treatments using satellites that connect distant hospitals with Maui’s military supercomputer center -- but most of Col. Persons work is done via the Internet. Local medical officers and doctors send e-mail and pictures, or upload their cases into a database, which Col. Person and his colleagues regularly visit. “This lady from the Marshall Islands thought she was pregnant, but it turned out that she had a 90 lb. benign ovarian tumor,” he says, pulling a patient from his database.

Many of the islands of Polynesia are very poor and sparsely populated, and their hospitals lack medical experts, supplies and medicines. For example, the island of Yap got electricity for the first time in 2001, thanks to a $100,000 gift from France. They put in solar panels to give power to 50 homes, which can now have a radio and two lights each.

For the local medical staff, the connection to the specialists in Honolulu provides not only critical medical advice, but also a means of education. “It is a wonderful exchange,” says Person. “Being able to talk to specialists, and other colleagues makes them feel not nearly as isolated.” And it’s not just one doctor that they can talk to, but hospitals full of specialists. “A little girl fell out of a second story window in Yap - probably the only such building in town. She fractured her femur, and I forwarded her information to an orthopedic surgeon, who didn’t like the position of the traction,” says Person. Thanks to his advice, she was treated at home, and Tripler saved between $24,000 and $40,000 in evacuation costs. Overall, he estimates that the Akamai project has saved his hospital up to $8 million over the three and a half year since it started.


Daniel Davies and Rodney Moriyama from Queens Medical Center in Honolulu.
Photo: Hans Sandberg

Drs. Daniel Davies and Rodney Moriyama from Queens Medical Center in Honolulu are developing a business model to make telemedicine profitable for medical centers. Dr. Davies, who is the head of the hospital’s Department of Medicine, also runs a small company that developed “eCare” – an Internet-based “home nursing” service which helps patients manage their health in-between visits to the doctor. “What they do at home is probably more important than what happens during their visit with the doctor,” he says. Patients can register their preferences online, and take Internet “classes” in self-care.

“This self-monitoring includes sending reminders to patient’s cell-phones and pagers,” he says. The system can also use wireless local area networks to connect to the patient’s home or office. By having fewer face-to-face visits, nurses can handle more cases, and the software is designed so that she can pull up information in an interactive session with the patient and drop it right onto their desktop.

Thanks to a state telemedicine initiative, some Hawaiians are now able to taking tele-home nursing to an even higher level. Using in-home, or clinic-based blood pressure/pulse meters, stethoscopes connected to the Internet, and small Web cameras, patients can send their blood pressure, pulse rate, and heart and lung sounds -- as well as high-resolution digital images of their wounds -- directly to the specialist they need in Honolulu. If the results are alarming, a software agent will immediately alert a physician.

Advances in telemedicine are good news for this natural paradise, which depends mainly on its tourists, and needs alternative industries. Frank Fukunaga, a telemedicine consultant, is betting on a high-tech future for Hawaii: “The market is too small here, which is why we need to find ways to export our expertise.” Telemedicine could turn Hawaii into a regional (medical) center, eventually serving the entire South Pacific, Japan - and even Asia’s emerging economic giant, China.

Hans Sandberg

Cables Connect the Tropics

It was Governor Benjamin Caetano of Hawaii who launched the state’s telemedicine program back in 1997. “We realized that we were just a dot in the Pacific region. We were isolated, and needed a high-quality telecommunications infrastructure, so that we could communicate with the rest of the world,” says Frank Fukunaga, a consultant at Tripler Medical Center in Honolulu. “As it turned out, Hawaii had an abundance of trans-Pacific fiber optic cables running through the state,” says Fukunaga, who played a key role in the telemedicine program as the state’s leading information technology-official during the 1990’s.

Fiber optics and satellite links helped bolster Hawaii’s information technology industry, and subsequent distance learning and telemedicine projects. In 1994, a telecommunications network called STAN (State of Hawaii tele-health Access Network,) was established, and now connects 16 hospitals and 7 clinics on 22 Pacific islands. “The over 125,000 veterans in the Pacific Region are the largest beneficiaries - we have veterans in places like Guam and Samoa, and they had to fly to get service,” says Fukunaga. “Why not use technology to increase their access to health care, improve quality, and in the long run even reduce costs?” he adds.


Frank Fukunaga, a hawaiian expert at telemedicine.
Photo: Hans Sandberg


Long distance videoconferencing between doctors and patients was initially used, but it was found by many to be expensive and cumbersome to use: “We tried interactive videoconferencing in the early 1990’s between Hawaii and the Marshall Islands -- where the missile command has a very fancy system -- but it wasn’t helping those people out much, and it was exceedingly expensive,” says Col. Donald A Person of Honolulu-based Tripler Medical Center. “We realized that we didn’t need any of the bells and whistles – we could do almost everything using still photos (of the patients,)” he adds.

Sharing Col. Person’s skeptical view of videoconferencing are Drs. Daniel Davies and Rodney Moriyama of Queens Medical Center in Honolulu, who are instead trying to develop easy-to-use Internet-based applications. “We had an emergency videoconferencing system between Molokai General Hospital and our emergency room here. The technology worked fine, but nobody used it,” says Dr. Davies. “Nobody knew where the equipment was, and when I went looking for it, I found it in a closet covered in cobwebs, and a mop leaning on it,” says Dr. Davis, noting that the last thing doctor’s want is to work with a technical person beside them.

But even before the Internet -- which can now be accessed locally on remote islands for under $30 a month -- there was a “tele”-medicine of sorts: the telephone. “Part of the problem working by phone is that long distance phone calls are very expensive in this region - $5 to $10 dollars per minute. And islands who don’t have money for medicine certainly don’t have the money for long distance phone bills,” says Person. “Besides, the telephone would also sometimes disconnect, and we were sometimes unable to get back to them the same day. The Internet has cut through all of that,” he adds.

Hans Sandberg

Mauna Kea’s Amazing Gazing

(Syndicated article for the Metro newspaper group).

The building that hosts the Gemini North telescope.
It's twin sibling sits on top of a mountain in Chile.
                                                        Photo: Hans Sandberg


At 13,796 feet, not much grows and the air is mostly clear. 
                                                                  Photo: Hans Sandberg

There is probably no better place on Earth for stargazing than on the summit of Hawaii’s Mauna Kea (Hawaiian for “white mountain.”) The long dormant volcano climbs 4,205 meters (13,796 feet) over the Pacific Ocean on the Big Island of Hawaii, and its clear and stable atmosphere has attracted the largest collection of telescopes in the world. Giants such as the Keck twin observatories, Gemini, and Subaru, are there to help us understand the birth of planets, stars and galaxies, and to search for celestial objects so far away that their faint light may reveal secrets about the beginning of time.

The island of Hawaii is the biggest and most southern of the state’s eight islands. It’s twice as large as all of the others combined, hence the nickname - “The Big Island.” It is also the youngest -- and still growing -- as nearby Kilauea pours huge amounts of molten lava into the sea on the island’s southern shore. Mauna Kea has not erupted in 3,000 years however, which explains why eleven countries dared over the last four decades to spend more than a billion dollars building thirteen telescopes on it’s summit.

Way up there, astronomers and their expensive telescopes may be safe from eruptions, but not necessarily from Mother Nature. It is not uncommon for winter storms to deliver winds reaching over 160 km (100 miles) per hour, sometimes dumping a thick layer of snow on the volcano’s peak. Most of the time however, it is not heavy winds, but the height of Mauna Kea itself -- with its cold and thin air -- that threatens human life, as well as most other life forms.

“If you drop anything when you are exiting the car, don’t pick it up,” says Peter Michaud, a press and community relations manager for the Gemini Observatory, which runs two of the most sophisticated telescopes in the world – one on Mauna Kea, the other in Chile. With 40 percent less oxygen to breathe, bending down can lead to fainting.

The trip from Hilo to Mauna Kea starts on Saddle Road – a roller coaster-like ride that becomes a bit nauseating after driving on it for an hour. Halfway to the other side of the island, another small road continues upward to the Onizuka Center for International Astronomy. At 2,800 meters (9,300 feet) above sea level, this quaint visitor’s center is named after the Hawaiian astronaut who perished when the space shuttle “Challenger” exploded in 1986, but is also known to the Hawaiians as Hale Pohaku (“stone house”). The view is stunning during the day, and evening stargazers are in for a treat – seeing the Milky Way as never before. Most tourists shy away from driving the extra 1400 meters up to Observatory Hill, which is at the end of a steep, narrow, eight-mile dirt road, and can be treacherous at night.

Since both the visitor’s center and the summit are open to the public, some experienced off-road drivers do take their four-by-fours up to the top (most car rental companies explicitly prohibit taking their vehicles anywhere near Mauna Kea,) but not before pausing for at least one hour at the Onizuka Center to allow the body to adjust to the high altitude. A dedicated weather and road condition telephone hotline is updated each day for potential visitors. Hale Pohaku also has a lodge that sleeps 72, and is used for astronomers and staffers who work on the summit during the night – so that they’ll have a place to rest during the day without having to repeat the altitude adjustment over and over again.

To prevent altitude sickness, it’s suggested that visitors don’t smoke, drink alcohol or coffee -- or go scuba diving -- the day before, and eat no heavy meals right before the ascent. Drinking a lot of water is also necessary to prevent severe headaches. Warm clothing (including hats and gloves) is a must, and like airline pilots who are exposed to strong sunlight in the upper atmosphere, extra strong sunglasses (preferably with UV-filters,) and sunscreen with a factor of at least 15, is needed.

It’s a lot to remember, especially for an oxygen-starved brain. Michaud warns that people become forgetful sometimes, and wander off aimlessly. That is, until they lose their breath, and their heart starts pounding like that of an 85-year old. A photographer visiting the summit admits to opening his camera without rewinding the film while on the summit, thereby ruining his entire photo shoot.

The landscape at the summit is completely barren, except maybe for black, gray, and rust colored stones. There are no trees, no bushes, no visible vegetation or animals - but for a stray mountain goat. The area is often compared to the planet Mars, and in fact, NASA used the area to train its Mars Lander equipment. Looking down, one can see several copper red cinder cones shooting up from the steep lava slopes. And peeking out from the clouds in the distance is the active volcano Mauna Loa (of macadamia nut fame,) and Haleakala (“House of Sun,”) a 3,049 meter (10,000 ft.) high volcano on the neighbor island of Maui.

Once the sun sets, the temperature quickly approaches the freezing level -- even during the summer months -- as there are few clouds to lock in the heat. This is good news for astronomers however, who would if possible, prefer do all of their observing from the crisp clarity of outer space.

Sitting above 40 percent of the Earth’s atmosphere, Observation Hill has few clouds, and benefits from strict local laws against light pollution on the sparsely populated island. Its location in the middle of the Pacific Ocean also creates an unusually stable and clean atmosphere (something that may not be obvious as you drive through the Kona district on the island’s west coast, where coffee growers complain that ashes from ongoing eruptions cloud the sky and block the sun.)

“There is no getting around the fact that the Earth’s atmosphere is a pain to have to work through,” says Matt Mountain, director of the Gemini Observatory. But if space observation has to be earthbound, Mauna Kea is the place to be.


Hans Sandberg (at Mauna Kea)

Stairway to the Stars

(Syndicated article for the Metro newspaper group).


Some of the telescopes at Mauna Kea's peak.

Interest in building an astronomical center on Hawaii caught on in the 1950’s, but the location of choice was Maui’s Haleakala, which had one thing the Big Island’s Mauna Kea did not have -- a road to the top. A solar observatory was built, but it soon became clear that Haleakala was not ideal, as clouds reached its summit, and its crater sometimes filled with fog that spilled over. Surrounded by fog, the scientists looked outward, and across the Pacific waters saw Mauna Kea rising tall above the clouds.

It took a lot more than clear air and a tall mountain to make a home for telescopes however, all of which is detailed in Barry Parker’s 1994 book Stairway to the Stars. Building on the mighty White Mountain took money and politics, as well as daring individuals willing to take risks. And in the case of Mauna Kea, tragedy also played a role, as the nearby city of Hilo was almost totally destroyed by a huge tidal wave on May 22, 1960.

With its capital city’s downtown in ruins, the mayor of Hilo began to look for new ways to generate income and jobs. Astronomy was one solution, and the governor of Hawaii was soon convinced to fund the building of a road up to Mauna Kea’s summit. (This decision would later translate into hundreds of new jobs and $80 million annually to Hawaii’s economy.)

The first big telescope to open on Observatory Hill was the 2.23-meter (88-inch) telescope built by the University of Hawaii, which opened in 1970, but wasn’t fully operational until 1976. In 1979, a 3.6 meter Canada-France-Hawaii telescope went into operation, followed by several more - including both infrared and radio telescopes.


The Keck Twins at Mauna Kea.  Photo: Hans Sandberg.

But the project that put Mauna Kea on the world map was the Keck observatory. This revolutionary giant telescope had a “honeycomb” mirror with a diameter of 10 meters (33 feet). Such a large disk would have been almost impossible to build and operate using the technology of the time: a single mirror. Keck designer Jerry Nelson instead opted for 36 smaller mirrors, which would all work together as one. To do this, it was necessary to develop a highly innovative system that could change the shape of every single mirror segment continuously, and then align them with extreme precision. This technology is called active optics (adjusting the shape of the mirrors.) By combining active optics with another new technology: adaptive optics (where computers calculate disturbances in the Earth’s atmosphere and “correct” them by continuously adjusting the telescope’s mirrors and lenses,) Keck began a new era for astronomers everywhere.

Behind the $76 million Keck project was the University of California and Caltech (California Institute of Technology,) and the Keck Foundation. Later on, the fund paid for a second Keck-telescope -- which today sits next to the first. The idea is to get them to function as a single telescope, thereby doubling the power. This technique -- which is common in radio astronomy -- is called interferometer. Since it is however much, much harder to perfectly match up optical images than it is radio signals, this goal has yet to be completed.

One problem that the new telescopes did not solve was the shortage of telescope time. Two-thirds of the observation requests made by astronomers were routinely turned down, which is why some of the world’s leading associations for astronomy proposed building two new large telescopes – one in the northern hemisphere and one in the south. The National Science Foundation (NSF), which funds most of the industry’s basic research in the US, financed half of the $176 million needed to build twin telescopes in Hawaii and Chile. Six other countries also funded the Gemini plan: Argentina, Australia, Brazil, Canada, Chile, and the UK.

Like Keck, Gemini broke new ground in many ways. They decided to use a single piece of glass, but a much thinner disk than those of previous generations. The 8.1 meter mirror is flexible, and is coated with a super-reflective silver solution, instead of aluminum. “Our thin mirror, which is basically a twenty-ton contact lens, no longer relies only on glass and steel to keep it aligned. Behind it, there are 120 computers, which constantly monitor the shape of the mirror, and adjust it as it moves across the sky,” says Matt Mountain, director of the Gemini Observatory on Mauna Kea. The result is a telescope that in some respects can match both the Hubble Space Telescope, and the Keck twins – a “fly-by-wire airplane” as Mountain calls it.

When completed in late 2001, Chile’s Gemini South will work with Hawaii’s Gemini North to give researchers a chance to study the entire hemisphere from remote locations - via super fast computer networks. “For example, the Magellan Cloud, our nearest galaxy, is not visible from the north. The center of that galaxy is very low down in north, and we have to look at a lot of atmosphere to see it, while in the south it goes straight overhead,” says Mountain. So theoretically, a team of observers -- one sitting in Brazil, one in Washington, and one in Hawaii -- can collaborate over a network using both telescopes. “It will be a long night if we get the right overlap, because you can get one twelve hour night, and then another seven hour (night) for certain parts of the sky,” he adds.

Gemini is designed to look far into the universe, and is especially good at capturing infrared light. Though infrared heat radiation is invisible to the human eye, it is tremendously important for modern astronomy. Infrared telescopes for example, can see right through the vast, dark clouds that obscure our view, and allow astronomers see the universe at its very early beginnings. “You can see into the heart of stellar nurseries, and can catch information about planets and planetary disks that you couldn’t catch (before.) You can also see into the heart of our own galaxy - to the galactic center where there is probably a black hole hidden,” says Mountain.

As telescopes get bigger and optics more precise, demands on the rest of the system increase as well. The machinery that moves the telescope and the dome, must do so without causing any vibrations. In an almost surreal act, Gemini’s 673-metric ton shiny silver dome rotates almost without a sound. Vertical “doors” open to expose the sky, while the rest of the dome splits horizontally in half and rises up in order to circulate the air. Another impressive sight is the cable room below the telescope, which holds its “spinal cord” in the form of hundreds of wires nested into dozens of thick bundles.

For an astronomer, it is essential to have good resolution as you focus on smaller and smaller objects. To give an idea of how sensitive the Gemini telescope is, Gemini’s Peter Michaud explains that it would be like seeing a pair of headlights on a car driving on the Golden Gate Bridge in San Francisco from the top of Mauna Kea 2,000 miles away. “That is assuming however, that the Earth had no atmosphere, and was completely flat,” adds Michaud.

As for the future, Matt Mountain foresees a new generation of 30 to 100-meter telescopes, one of which is actually slated to be built on Mauna Kea. This enormous telescope will however, be Mauna Kea’s last, he adds.

Hans Sandberg

“Garage Attendant” Astronomy

(Syndicated by Metro World News in 2001)

Three of the more than dozen telescopes at Mauna Kea.
                                                             Photo: Hans Sandberg

New technology for observing the sky is rapidly changing the way astronomers work. The lonely genius standing by his telescope and smoking a pipe is harder and harder to find these days, as satellite links and fiber optic data networks make it possible to use telescopes from afar. For example, most of the astronomers using the Keck twin observatories do their viewing from the city of Waimea, on the north shore of the Big Island. And Gemini North’s telescope is operated from its base camp in nearby Hilo, as well as from the top of Mauna Kea.

“It is changing the way we do science. Not only can we access these big telescopes over the net, but we also have access to huge databases from other areas,” says Matt Mountain, director of the Gemini observatory. “Sociologically it’s a radically different way of doing astronomy, which makes some of the traditional astronomers uncomfortable – they even call remote observing ‘garage attendant astronomy,’” says Mountain. He compares Gemini to the Hubble Space Telescope, where an astronomer submits an application, and someone on Gemini’s staff does the observing (when the conditions are just right.) Besides, it is easier and cheaper for Mountain’s staff and visiting astronomers to remain on sea level in the city of Hilo, rather than 13,796 feet up.

In the future, even amateur astronomers and school children may get to peek over the shoulders of astronomers. Mountain dreams of the day when school classes visiting New York’s Rose Center for Earth & Space will hook-up with Mauna Kea’s telescopes via the internet. “Astronomy has got to get more accessible - people are fascinated by it,” he says.

Hans Sandberg

Half Mann, Half Computer

(Syndicated article for the Metro newspaper group).


Steve Mann in his lab at Toronto U 2001.


Steve Mann has been wearing his computer for decades. He even wore it on his wedding day, recording the ceremony literally from the groom’s point of view, with the help of a tiny, head-mounted camera. “I have created this machine…or kind of myself as a machine,” says the eccentric professor.

Professor Mann’s students at the engineering school at Toronto University call themselves “Photoborgs,” (derived from the “Borgs” of Star Trek fame whose computers were permanently implanted into their bodies.) But alas, Mann’s wearable computers are taken off sometimes - before showering or going to bed, for example. “It feels funny not having it on,” says aspiring Photoborg, and research student, James Fung,

Mann’s wearable computer is worn as a pair of glasses and is connected to a processor in the form of a “fanny pack” - or attached to an item of clothing. It takes commands by voice, or via a handheld input-device, and displays information either on tiny screens inside the eyewear, or projects it directly into the user’s retina.

It may sound impractical, but many companies are already using wearable computers, especially for their blue collar and service employees. Costing between US$3,000 and $6,000, these small and powerful computers are expensive, but there are many situations where donning a hands-free, mobile, and wearable computer could be money well spent.

Take, for example, the airplane mechanic who is working in a tight space and needs to check something in a manual. A laptop computer would be hard to juggle next to a jet engine, and besides, it would delay the repair. The same thing goes for the surgeon performing a complex operation. Here a wearable computer could display critical data -- like MRI images -- right in front of the doctor’s eyes, so that she can continue without having to put down the scalpel.

Using Mann’s experimental ENGware system (read: Electronic News Gathering Wearable) a journalist could draw on his news organization’s resources while out on the field. His editors could instantly send information about related people, events, and places directly into his view.

Mann built his first wearable system three years after Apple launched it’s personal computer -- the Apple II -- and the same year as IBM came out with its first PC.
“Many people consider what I built in 1981 to be the first true wearable computer,” Mann says.

Using a cathode ray tube from a camera viewfinder, and a small TV tube, he created a “personal viewing system” that was hands-free, and had a display that could be viewed while walking around. “It also used wireless communications,” he adds.

Since then, he has more or less lived each day with various models of the contraption, something he has written about in a new book, soon to be published by Random House. “The whole idea of attaching a computer to the body is really strange. When I did this, people thought it was totally crazy,” he explained during an interview in his lab.

On July 5th, he and the student Photoborgs celebrated the opening of an art exhibit dedicated to his wearable computers at one of downtown Toronto’s trendy art galleries, TPW. The fact that he exhibits his inventions as artwork, is only logical to Steve Mann. His first wearable was inspired by a desire to see the world in a new light. These high-tech “rose-colored glasses” that could change the color of selected objects in his view. “I was interested in seeing things differently - in getting different interpretations of the world,” he says.

Looking into Mann’s eyes, it seems as if a camera lens has taken the place of his right pupil, and he talks as if it actually has. (It’s only an optical illusion.) The camera in his “EyeTap” system sits close to his nose, capturing the images in front of him. These images are then sent to an on-body computer, where it can be modified, added to, or subtracted from, before a final “virtual” picture is projected into his eye. He refers to this as a “mediated reality.”

The capability to delete objects that we see everyday can be useful if, for example, advertisements are perceived as an eyesore. In the future, a wearable computer can be programmed to replace the “Marlboro Man” on the billboard with something more to one’s liking – be it Mona Lisa, or Claudia Schiffer.

“Your view is already muddled with all these billboards blocking your view as you walk down the street,” says Mann. “You can’t see the truth because it’s obscured by all these lies. By putting on the glasses you can see your own reality,” he adds.

The same principle for “mediated reality” that lies behind Mann’s EyeTap can be found in his “EarTap” system, which works in a similar fashion, but using sound instead of light. Another related invention is “Blind Vision,” the idea of which is to help blind people navigate by using radar, and a vibrating “VibraVest.” As the radar senses nearby objects, it sends “warning” vibrations to the wearer of the vest.
Mann claims that the radar can even detect if a pickpocket is approaching, by evaluating the speed and pattern of movement.

Few people understood this Canadian prodigy back in high school. He stripped camcorders for parts to include in weird looking hockey helmets with antennas, and had dozens of wires coming out of his eyeglasses, only to disappear under his jacket behind his neck.

He attended Toronto’s McGregor University, but later transferred to the Massachusetts Institute of Technology (MIT). But even MIT’s nerd-laden Media Lab found it hard to accept Mann, who couldn’t part with his wearables, not even for a day. “I was the first person to broadcast my life (from a wearable computer) on the Web in 1994,” he says.

Eventually the idea caught on. He co-founded the Wearable Group at the Lab and his inventions became something of a showpiece. Late in 1997, the Media Lab held a glitzy fashion show with professional models - using sexy, but non-working mock-up wearables.

In 1999, he parted ways with the Media Lab and returned to Toronto, where he now runs the show. The Media Lab continues its wearable program, and the Lab’s founder, Nicholas Negroponte, has recognized him as a “pioneer” in his field.

While the computer industry is fast commercializing the wearable technology, it is not quite clear where Steve Mann is heading. He recently started a company called Existech that designs wearable computers, but it is run by volunteers, and is rooted as much in existentialism as it is in technology.

While there are many commercial niches for wearables, Steve Mann sees his invention as a general, all-purpose tool - much like the PC itself. He sometimes uses it to do mundane chores like grocery shopping. It works like this: As Steve walks down supermarket aisles, his wife Betty Lo logs-on to her husband’s wearable, sees what he sees through his eyeglass-camera, and with her mouse, shows him on his mini-display, which brand of cereal she wants him to pick-up.

Hans Sandberg

“For your own protection”

Living with a wearable computer opens-up a range of questions, from the practical to the political - and even philosophical. What happens to privacy if we are always accessible and “connected”? What happens to individual experience if other people can see and hear what we see and hear?

Early in his career, Steve Mann focused on the practical and moral implications of strapping a computer to one’s body. His conclusion: the wearable computer is a defense weapon against a society that seeks ever more control and surveillance.

Mann loves to show video recordings of himself walking into department stores and asking cashiers or security guards about the cameras hidden behind domes in the ceiling. When they answer that it is for the customer’s safety, he pulls out his own video camera -- or points his wearable at them -- and informs them that he is monitoring them to, for safety’s sake of course.

“For your protection a video recording of you and your establishment may be transmitted and recorded at remote locations,” reads one of Mann’s T-shirts displayed at a recent art exhibition at the TPW gallery in Toronto.

“We already have smart floors, smart ceilings, smart toilets, and smart light switches. We have all this artificial intelligence (AI) around us,” says Mann, pointing to “humanistic intelligence” (HI) as a “counterpoint.”

He wants to empower individuals by adding computer power “to go,” and by connecting them wirelessly, so that they can share information and experiences with each other. “It is the idea of empowering individuals with intelligence in the computational feedback loop. It’s a new way of thinking, and it may solve a lot of problems we have with the reduction of human value through surveillance and A.I,” expands Professor Mann.

“I refer to this as existential technology, where existence comes before essence,” says Mann. “I invented this for some reason, and it took me years to figure out why I was motivated to do that. First you bring something into existence, and the essence comes later,” he adds.

Hans Sandberg

From McDonalds to Mars

Two of the best-known companies building “wearable computers” are ViA Technologies in Minnesota, and Xybernaut in California - but giants like IBM have also developed wearable computers, and recently agreed to manufacture wearable computer systems for Xybernaut.

ViA recently introduced a 20-ounce wearable the size of two walkmans that they are testing for order taking at McDonald’s drive-thru restaurants. They are also testing a mobile security system, together with the U.S. Navy, that uses face recognition software called “FaceIt” (by Visionics) to make it easier for military police to monitor who gets onboard navy ships while in port. The security guard takes a digital photo of the person in question using his eyeglass-based camera, and instantly matches it to a government database. The whole process takes a matter of seconds.

Xybernaut announced on June 12, that their Mobile Assistant system had been chosen by NASA to be worn by humans in a training project – for a trip to Mars. “Wearable computers may be the future for many space missions,” says Dr. Pascal Lee, the project scientist.

Hans Sandberg

Isn’t a Palm Pilot also a wearable computer?

Though the world is full of nerds and businesspeople who carry around small computers and cell phones in their pockets or purses, the wearable computer is a different kind of beast - it is always on, and it is always accessible.

It doesn’t require the user to sit down to use it. It displays its content either on a small screen an inch away front your eyes - or projects it directly onto your retina. You tell it what to do, either by talking to it (voice recognition), or by fiddling with a special device for single-handed typing, like the commercially available Twiddler.

While you have to (or ought to) stop what you are doing while using a Palm computer or Pocket PC, the wearable computer is designed to assist you at the same time you are doing other things.

Hans Sandberg

Freedom to Dial

(Syndicated article for the Metro newspaper group).


Cellphone user in Beijing 2001.

When an elementary school in southeast China exploded in March -- killing over 40 students and teachers -- it was a blast heard round the world, with its story told via telephone and the Internet. And had this tragedy occurred a few years ago, the world may have never known what really happened.

“Everybody knows it was caused by the fireworks,” Zhang Chenggen told the Associated Press by telephone just after the accident. “The government is trying to cover the facts. Please do not believe them,” said this father of an 11-year old boy killed in the explosion.

But as the government officials in the province of Jiangxi erected roadblocks, detained roving reporters, bulldozed the school, and began -- formulating its official account of the blast -- Zhang, spoke candidly to the media and the world: “I was among the first batch of people to rush to the explosion site, and I saw the hands of some dead children still holding fuses.”

The Washington Times reported its phone conversation with man named “Chen” from the local fire department, who said, “debris at the site was littered with firecracker wrapping papers.” And according to the New York Times, reporters reached parents by dialing random numbers within the town’s telephone area code.

Several days later, Chinese Foreign Ministry spokesman Zhu Bangzao called news reports like these “irresponsible…absurd and erroneous,” according to the state news agency Xinhua. “Some overseas media even attacked China by carrying these untrue stories with elaboration distorting the facts,” he added.

Chinese Premier Zhu Rongji would later explain in detail how a 33-year old suicide bomber -- nicknamed Psycho -- had blown up the school and himself.

But while in-person or snail-mail exchanges may have in the past slowed or halted the gossip and anger over this tale of child labor and death, the government was unable to stop the flow of information. “Today people can communicate instantly…200 to 300 million people (in China) have access to one way or another of staying in touch,” said Simon Cartledge of the South China Morning Post. “They can call…page…and they can e-mail,” he added.

It is now possible for residents to buy a temporary cell phone number without registering with the government, and numerous cyber-cafes offer anonymous Internet access (although chat-rooms are on time-delay and are censored by the government.)

“Allowing a huge swathe of its population to communicate openly and freely is perhaps the most astounding change China has undergone over the past decade,” Cartledge wrote.

Perhaps this free exchange of information is what prompted the Premier to later retract his earlier explanation of the cause of the blast. Ten days after the tragedy, Zhu told a live television audience: “No one can cover up historical truth. I want to apologize and review and reflect on my own work.”

Hans Sandberg

Characters and Computers

(Syndicated article for the Metro newspaper group).


Legend's Beijing factory 2001.

In the 1980’s, China opened the door to foreign investments. At first, they tried attracting export industries -- imitating Asia’s “tigers” like Singapore, Malaysia and Taiwan -- but today, it is as much of a priority to build industries that will serve the Chinese market. And at the same time, economic reforms have helped create several very successful Chinese IT (information technology) companies.

China’s economy continues its steady growth, and the IT sector plays a large role, especially in the cities. From Beijing and Shanghai in the east, to Guangzhou and Shenzhen in the south, city dwellers have money to spend, and although these 250 million people represent only a small minority of the country’s 1.3 billion people, their increasing demand for consumer goods is boosting a number of high-tech industries.

For those Chinese who already have TVs, refrigerators, and cellular phones, a personal computer -- or at least a Web TV -- is the next logical step. In Beijing, Shanghai, and Guangzhou, the PC-penetration is said to have reached 25 percent.

China developed their first computer systems in the mid 1950’s, but these were mostly used in scientific and military circles. It was not until hundreds of thousands of personal computers were imported into China nearly three decades later, that the public became aware of them. Many computers however, would remain unused because of software applications were scarce, computer literacy was low, and there were few systems that could deal with Chinese characters (input/output.)

This was soon to change because of China’s economic reforms, not the least within the research sector. Suddenly entrepreneurs emerged, acting more independently even though many still worked in state-owned companies. Most of these highly qualified computer researchers came from Beijing’s many universities and research institutes, including the Chinese Academy of Science’s (CAS) Institute of Computing Technology (ICT) which felt increasing pressure to generate their own income.

China’s leading computer maker -- Legend -- was founded in 1984 by Liu Chuanzhi and ten of his colleagues at ICT. (In the beginning the company was called ICT Company.) These spun-off researchers retained their salaries from ICT, used its resources, and borrowed $25,000 in capital for their new venture. (The government still owns two-thirds of the company.)


Legend's founder Li Chuanzi.
(Photo curtesy of Legend.)

An important reason behind the success of China’s leading PC manufacturers -- such as China Great Wall Computer Corp., Founders Group, and Legend -- was that they all attacked the issue of Chinese input/output. It was a very difficult problem, as they needed large amounts of computer memory to work with the thousands of unique characters instead of the 26 letters of the English alphabet. (Alternatively you needed new mathematical methods to digitally represent Chinese characters.) High-resolution computer screens were also needed to clearly display Chinese characters. Each computer company approached the problem differently.

In 1985, Great Wall Computers introduced its own version of IBM’s PC XT that managed to handle Chinese characters and show them in a higher resolution than their rivals, including a model developed in Japan, that IBM planned to introduce in China.

Founders Group was born out of a large-scale government research project that began in1974 with a goal to modernize the country’s printing business. At that time, it could take up to 500 days to print a book, and daily newspapers were produced by lead-based printing technology.

The company had access to brilliant researchers who developed their own system to produce newspapers and books in either Chinese or Japanese. This system soon became a world leader. Founders is owned by the local Beijing government and Beijing University (which has the nickname Beida,) but is run quite independently.

Legend also understood that Chinese characters were a key problem for the industry and soon found a researcher at ICT that had created a system for Chinese “word processing.” He was brought over and helped them to develop an add-on card for Chinese characters, which during the first three years generated one-third of the company’s income.

Despite their advances in adapting computer technology for the Chinese language, it seemed in the early 1990’s as if Chinese computer makers would be an easy take for the Japanese, Korean, Taiwanese, and American competitors. Foreign brands controlled 66 percent of the Chinese computer market in 1992, and one after another built factories in China to avoid import tariffs, as well as to take advantage of the low Chinese salaries.

“Foreign PC companies dominated the market up to 1996,” says Legend’s spokesperson Catherine Lee. Before this, the Chinese government protected the domestic IT business with import tariffs and other regulations. When the government abolished the protection, the country was flooded with foreign products – a shock for the domestic industry. But this soon changed to competitiveness for many Chinese PC companies.


Legend's spokeswoman Catherine Lee.

“It took some time for our companies to reform and improve their productivity, but after four years Legend started a price war against the foreign companies,” says Ms. Lee. “Before 1996, a PC in China cost about 10,000 Renminbi ($1,200,) which was unreasonable. Besides, the computers that were sold here were not very good,” she adds. In a surprise “attack,” Legend lowered the price on four occasions, and soon became the number one vendor.

“We price cuts, but we were not only competing on price alone -- there are several low cost brands -- but the others offered hardly any service, few application programs, and sometimes not even an operating system,” says Ms. Lee. (This is not as strange as it sounds, since 90 percent of all programs sold in China are pirated copies, and you can buy a copy of Windows on the street for $1 or $2.) “It’s unacceptable for the average customer not to have good service and applications, since their level of computer knowledge is quite low,” says Ms. Lee.

Legend instead went for good-looking and well-designed computers for the mass market. They offered free Internet access for one year, and ran massive advertising campaigns (including one featuring the star of the Academy Award Winning movie: Crouching Tiger, Hidden Dragon.) While foreign companies focused on the corporate market, Chinese brands like Legend kept their eye on the consumer. There is no doubt that the strategy has been successful, both in terms of marketing shares and profits.

Driving today’s Chinese PC market however, is the Internet. “Eighty percent of those we surveyed say that they want to go online,” says Ms. Lee. It may be, as the head of Ericsson China says, that mobile phones and hand-held computers will eventually give people access to the Web. And Liu Chuanzhi recently told Reuters that Legend will “gradually move from personal computers to areas such as Internet access, mobile phones and servers.”

But that doesn’t change the fact that very few Chinese own a PC. With only 24 million computers in China today -- one for every 50 people -- companies like Legend will most probably need their new factories to keep up with consumer demand.

Hans Sandberg

Legend Has It…

(Syndicated article for the Metro newspaper group).

Legend's spokeswoman Catherine Lee showing one of the company's new computers for children.

Legend is a shining star among China’s young and fast-growing computer companies. It has leapfrogged the competition – both domestic and foreign – and captured 31 percent of the PC market in China, as well as 12 percent of the Asian market (outside Japan.) Last December, it opened a new $200 million PC factory, which can build 2 million desktop computers each year.

The factory is located just east of the Summer Palace, in Zhongguancun, an area that is also known as Beijing’s “Silicon Valley”. This is the Haidian district where many of China’s leading universities and research institutes including Tsinghua University and the Institute for Computing Technology (ICT) are located.

This is where eleven ICT researchers set-up a small consulting shop in 1984, and that shop later became Legend. At that time, Legend was among only a few dozen computer stores and small start-up companies in the district. Today, Zhongguancun is hard to recognize. Last year alone, the zone generated $19 billion in income (up 40 percent from 1999,) and 2,400 new companies were added to the thousands that already existed.

Zhongguancun boasts modern factories, office skyscrapers, new apartment complexes, luxury hotels, restaurants, bars and trendy Internet cafes. Traffic crawls on its noisy streets, while bulldozers flatten the old single-story Chinese houses to make room for things new.


Catherine Lee.

Legend’s spokesperson Catherine Lee tells us about the company’s new Intranet, and its new Enterprise Resource Planning system (ERP, i.e. a computer system that integrates all facets of a business, from sales and marketing to corporate planning and manufacturing.) Her company’s elegant meeting room, laptop, and her snappy PowerPoint presentation may not sound like much, but it does reflect a the new style of doing business in China, where previously a reporter would have to “make due” with a party secretary’s political platitudes, while sitting in a meeting room with spittoons and under-stuffed doily-covered armchairs.


A Legend PC for the modern office worker.

Legend has 12,000 employees and a turnover of $2.3 billion. Sales have increased by 72.4 percent on average for the past three years, and profits have gone up 53 percent. “We sold 1.5 million PCs in 1999 and reached our goal of 2.6 million for 2000,” says Ms. Lee, and adds that Legend has been China’s leading PC manufacturer since 1996.

Access to the factory floor is strictly controlled, and photos are not allowed. Past the production flowchart, racks of ready-mounted PCs, and six assembly lines, lies a colossal room - the likes of which you’d find in an IKEA store. The aisles between the huge metal shelves are barely ten-feet wide however, as they are navigated by computer-controlled robots, and not by humans.

On three of the assembly lines (dubbed “satellite” lines,) one worker puts together one computer at a time – start to finish. Ms. Lee says that the average Chinese consumer is still not ready for custom-made computers, but Legend’s vast network of distributors can place custom orders into the company’s e-commerce network via the Internet. The orders are then sent to the company’s ERP system, and will end up on an assembly worker’s computer screen.

It takes 50 minutes to build a desktop PC at Legend’s new factory, plus an additional 1 hour and 10 minutes to test it. “No other local producer has such an advanced capacity,” writes Richard Lo of the Hong Kong-based financial company Ing-Barings, in a report published in February.

The other three assembly lines are called streamlines where, according to the company, computers can be mounted in as little as 20 seconds.

“We have a factory outside of Shenzhen and we are building a new one in Shanghai…so Legend’s capacity should be 4.5 million next year,” says Ms. Lee.

They will need the increased capacity and new factories to face future competition as China joins the World Trade Organization (WTO.) But Legend shouldn’t fear WTO since they already have access to cheap labor (about 70 cents per hour,) and -- as more electronics manufacturers invest in China -- cheap components as well. This combination is hard to beat, so long as China manages to combine economic reforms with political and social stability.

Gone are the days it seems, where the iron rice bowl was a worker’s only incentive. All employees who have worked at Legend for two years are entitled to buy stock options in the company, which is listed both in Hong Kong and NASDAQ. But in case this is not enough motivation, a red banner facing the assembly lines boldly reads: “If you love your country, you have to love your factory.”

Hans Sandberg