 Aloha, and welcome to Business in Hawaii with Reg Baker. We're a show that broadcasts every Thursday from 2 to 2 Thursday, 2 to 2.30 in the downtown studios of Think Tech Hawaii. We focus on success stories in Hawaii about businesses. We've heard all the negativity. We've heard about how challenging it is to do business in Hawaii with the taxes and regulations and so forth and the high costs. But there are companies that have made a success of it. They are figuring out how to make it work. And we are a show that highlights those success stories. We also highlight individuals from time to time that have made an impact on Hawaii and continue to do so. Today is going to be one of those shows. I've got Dr. Walton Schem here who has a very distinguished career at the University of Hawaii Medical School and has decided at I think age 80 something, decided to actually start a new business and get started in a different direction. And we're here to talk a little bit about that today, but Dr. Schem, welcome to the show. Thank you. Thank you for having me. Now, you've been in Hawaii a long time. Were you born here? I was born here 87 years ago. 87 years ago. As of two days ago, by the way. Well, happy birthday. Thank you. Thank you. So you were born here, raised here. Where did you go to school? Well, I went to Iolani. And after Iolani, I attended Dartmouth, Dartmouth College in New Hampshire, far, far away. Yeah, cold country. Very cold. Actually, it was very nice there. I think one of the reasons I got in is because their leading question on their application was why do you want to go to Dartmouth? And I said, because it's far away from home. I got my wish. Well, you did. Apparently, you did very well there. And at that time, what was your major at Dartmouth? My major was one of pre-med. I was enrolled in a three-year college program and doubled my first year of medicine with my last year of college so that the fourth year was a combination of first year medicine and last year of college. So I got a degree on an A-B degree and got through two years of medical school. At that time, Dartmouth was just a two-year school. And I transferred to Columbia and finished my degree at Columbia. So you knew at an early age that you wanted to go into medicine? Yes, rather early. Right. Well, what convinced you? Does that run in the family? No, not really. As a matter of fact, I think I was a weak link in the chain. My great-grandfather was an Episcopal priest. And he started the church in St. John's Coola, the Episcopal Church. My father was an Episcopal priest and he was a pastor at St. Elizabeth's here in Honolulu. My uncle, Waissang Mark, was also a priest at St. Peter's right on Emma Street. So I come from a long line of ministers and I was the only one who became a doctor. So obviously, I was a weak link there. Well, was that something that they were happy with or did they expect you to follow in their footsteps? Well, I don't think that I can say that they were happy with it, but I don't think they were unhappy about it. The reason I chose medicine is I thought that my interests were in line with those of a physician. In other words, I was interested in science and biology and physics and mathematics more than I was with history and theology and religion. Well, I guess in a sense, though, both professions are healers. One heals the emotion and the psychology and the other one heals the body. I think that's a good way of looking at it. And I think that medicine should have a lot of personal contact and of interest in people's well-being, not only with their physical illnesses. So I think that's a good point. That's very good. And so after you went to Columbia, that's where you finished med school? Yes. And did you stay on the East Coast? I stayed on the East Coast. I attended Cornell for my internship residency. Oh, you got some real pedigree colleges there. Well, I thought since I was in New York, I'd sort of like to stay there. And I enjoyed New York. I thought it's a wonderful city. And then after my surgical residency, I spent two years in the Army down in Edgewood Arsenal in Maryland. I had a nice time there because it's a beautiful country. Did a lot of attending of auctions and various farm-related things. Really? Is that an ammunition depot? Yeah. That is a research organization. Edgewood Arsenal is a research. And what they were interested in that time was research in psychedelic things like LSD. Oh, interesting times. Also in production of nerve gases and stuff like that. I think the Arsenal is, I forget the name of it, but it's about five miles away. That was a place where I think WikiLeaks started. Then after two years in the Army, I went to Northwestern at the Children's Memorial Hospital to do my pediatric surgery residency. And how long were you there for that? I was there for a year and a half. And did that bring you back home afterwards? Yes. I was back in 1967 and set up practice there and became part of the university's teaching program on the faculty. But I was mainly, I was part-time faculty and part-time private practice and pediatric surgery. Wow. And where was the private practice based in? I had an office at Caheca Street, the professional center building. For the longest time until they built the new Capulani Medical Center for Women and Children, I had a private office there. And then when they had the office building built at KMCWC, then I had an office in the tower there. Oh, okay. So then the physician's building, the POV. Yes. Yeah. Right. That's good. All three of my boys were born there. I was born there too. Not in the physician's building, but in the Capulani maternity home. Right. Well, I don't know where it's at now, but I remember that it was in the basement before. Yes. You know, there was a two or three-story small building on Bingham Street. And that used to be the area where the maternity hospital was. Oh. And I was born there. And my office at the tower was about 200 feet away from there. Wow. So I made a grad circle from it. Exactly. It's from the circle of life. That's right. Right back again. Very good. And so you were practicing, and then you also were teaching at the medical school. Yes. And how long were you doing that? Well, I was part of the medical school ever since I got back. And I practiced for 47 years before retiring. I still have my appointment as a professor of surgery and pediatrics at the medical school. And it's under the auspices of the medical school that I developed smart tummy, which is what we're sort of here to talk about today. Right. And so it was from all these years of experience that kind of led you to the concept of smart tummy. But just out of curiosity, I mean, any idea at all, how many surgeries you performed? You know, it's a wild guess because I've never counted them. But I imagine it must be in the area of thousands over 47 years, yeah. But it's through my practice in treating children and realizing the importance of physical examination that I came upon the idea that we need a great deal of education, at least pre-medical students or medical students need a very good education in physical diagnosis. And that's how I sort of stumbled on the idea of creating a mannequin to teach medical students and young doctors. And so that's where we're going to be entering into now in today's discussion, is that after 47-year career and having performed thousands of surgeries, you're now in a position where you know where there's a need for improvement, where things can be made a little bit better and I guess allow for more development in the skills of the current surgeons. Yes, you're right. You know, one of the very important things to realize is that over the course of a century or two centuries that medicine has existed in its present state of being beyond the shaman or magicians that we've taken on a more scientific role in medicine, it's based on evidence and on physiology and on anatomy. And in this setting, say a century ago, most teaching was done on an indigent patient basis and medical schools in New York and the United States used indigent patients in Baltimore and New York and Philadelphia to teach upcoming generations of physicians and these patients who were not able to pay for themselves were used as teaching tools for medical students. Well, I think that as we've progressed, these indigent patients have become less and less available to us. First of all, I think we don't have very many quote, indigent patients anymore. They're all covered by insurance. They're private patients and private patients are their choices to whom they want to be exposed to and I think many of them don't want to be used as patient guinea pigs so to speak. And so I think this has deprived medical students of the ability to see firsthand how sickness is diagnosed and treated. And so I think because of this, we need to substitute a living human being with a simulator and I think that's where mannequins have come into the fore. Well, absolutely. And it just makes all the sense in the world because as the population gets reduced, that are willing to be, you know, practiced on, if you will, that we need to replace that with somebody or something. So we have to have, you know, I guess a mannequin that can replicate what a body would do and how it would feel and for different ailments to practice and get good at what you're doing. It's not only a matter of availability for teaching purposes, but it's also a matter of safety. If you remove the patient, the indigent patient as an example of a teaching tool for teaching, let's say the diagnosis of acute appendicitis or perforated ulcer, then you've got to substitute something for that. Otherwise, a young doctor goes into the field without any previous experience of how to make a diagnosis of acute gallbladder disease or perforated ulcer or some acute problem. And so it's a matter of patient safety. It's a very good point. We need to go on a short break and then when we come back, maybe we can go into a deep dive a little bit into the smart tummy concept and how you came up with it and how it works and that sort of thing. Sure. All right. But this is Business in Hawaii with Reg Baker. I'm here with Dr. Walter Shim, Walton Shim. And we are talking about, after 47 years of career in the University of Hawaii Medical School, he's decided to create this new mannequin and we're going to be talking about that here shortly. We'll be right back. Good afternoon. My name is Howard Wigg. I am the proud host of Code Green, a program on Think Tech Hawaii. We show at three o'clock in the afternoon every other Monday. My guests are specialists both from here and the mainland on energy efficiency, which means you do more for less electricity and you're generally safer and more comfortable while you're keeping dollars in your pocket. Welcome back. This is Business in Hawaii with Reg Baker. We're here today with Dr. Shim. We're talking a little bit about a mannequin that can be used to help teach and provide some experience for some surgeons or surgeon wannabes so that they can be a little bit more comfortable with their skill set. And Dr. Shim, thank you for being on the show today. Bringing this down to as much of a layman level as possible. After all these years of experience, you've seen a lot of things. You've taught at the university. You know what the teaching is like. And so you've come up with this concept of smart tummy, which is really a mannequin. Now from there, explain, you know, why are you coming up with this concept? Thanks, Reg. Well, as you know, one of the most common surgical problems or emergencies is appendicitis or acute appendicitis in both children and adults. And if you think about how this is, how the diagnosis is made, is made mainly on palpation or the feeling of the belly apart from the history that the patient complains of pain. You put your hand on the belly to see where it's tender, where it's firm or hard. And to try to create a mannequin that will replicate this is something that I try to do because this is the most basic problem or most basic concept in physical diagnosis, the feeling of the belly or the abdomen. And how do you replicate this in a mannequin or a dummy? Well, you have to have a belly wall that's fairly soft. And if you want an example of that, you can feel your own abdomen. Well, definitely. And that's fairly soft. So what's the difference between that and an acute appendicitis? Well, the acute appendicitis causes a hard stiffness or a lump in the right lower quadrant. And to make this, to portray this in a mannequin is what we tried to do. So what I've done or the origin of my mannequin was to create a mannequin of several inflatables, let's say 100 to 150 inflatable balloons that could be distended or made firm by infusing them with air in certain areas of the belly. So let's say we want to take the balloons in the right lower quadrant. And there could be a lot of balloons, a lot of little balloons. That's right, controlled by a compressor and a manifold. And so in designing this, you want to inflate certain balloons in certain areas to simulate a appendicitis or a distended bladder or a gall bladder or distend all of them, make them firm for the entire belly. Would a hernia be included in that? A hernia would be one. But in starting this, you have to sort of limit yourself. You can't make everything from the start. So we decided to do four things. A appendicitis, gall bladder disease, a distended bladder, such as you would see in a pregnant woman and general peritonitis, which would be from a perforated ulcer. Now how do we go about this? Well, I got my idea from talking to my organ repairman at St. Clement's Church. Okay, so the organ that you play to make music with. That's right. My pipe organ repair person. And the way the air is controlled is that you have a compressor. And when you depress a key on the keyboard, it allows air to go to a certain pipe. And if you press another key, it goes to another pipe and you get a difference in pitch. Now if we could create that to give you inflation of certain balloons in certain areas of the belly, it would be similar to the pipe organ and its distribution of air. So what we've done is gone ahead with two engineers at the School of Engineering. And I told them about this idea and we decided that maybe we could create something like this with a manifold, a compressor, and these balloons to represent the pipes in the organ. And so with this we went on and patented this idea of inflating certain balloons. We actually have a patent on this. Yes, we have four patents as a matter of fact. So that's a great advantage and the nice thing about it is that this was all done under the auspices of pace in the Pacific area for entrepreneurship. And we won the first prize of this in 2014 in this competition. And this went on then to spur us to further development of this which we are now undertaking with a manufacturing company. Right, and then the manufacturing company is local or is it on the mainland? It's on the mainland. We explored all sorts of manufacturing companies and we happened to meet these people. It's called One World Design and Manufacturing Group or One World DMG which is located in Warren, New Jersey. And so we're working with them now to produce this prototype mannequin. And hopefully it'll turn into a real product that can be used by thousands of medical schools, nursing schools, especially in the United States only, but it can be applied worldwide to other institutions that need to have this teaching process. It sounds like there's a huge opportunity here for people to integrate this concept into their teacher and certification programs and maybe even continuing education to some degree. But is there anybody else doing this in this way that you're describing? That's a good question and the surprising answer to that is no. And to me it's almost unbelievable that among the great number of mannequins that exist, none of them really look and feel like human beings. For instance, most mannequins are made out of plastic. They're hard, they're cold and they are only for inserting diagnostic instruments. So it's not very realistic. That's right, not very realistic. Whereas the mannequin that we're trying to create will attempt to simulate the human belly which is compressible and also to simulate different conditions that can be changed by the pressing of a key on a computer. It's kind of difficult to do because the skin itself is multiple layers thick and then you've got the organs with a different type of issues that you might be experiencing. You're right, it's a very difficult concept but if you know where you want to go, there's a hope that you can get there. The problem in the past is I think the people who needed to have these diagnostic tools were not the ones who created the mannequins. It was the mannequin manufacturers who didn't have the idea of what they were looking for and there was not the synthesis whereas I think that now we've got a clinician myself and our engineers in communicating with the manufacturer to see if we can bridge this gap between what we really want to create and the possibilities of creating it. So what I'm hearing is that there's a lot more collaboration going on now to try to get a product that actually is going to be a positive. You're quite correct in using the word collaboration because I think what I've learned in the past six years of being involved in this project is that you can't do it alone. An idea does not turn into a product and a good example of that is that only 2% of patents get manufactured which is a very small percentage. Even though you've got the patent which is the idea, turning it into a saleable product is not guaranteed. The conversion process of going from patent to monetization is where things start to get a little complicated. But the fact that you've got four patents for this indicate that it's unique. Nobody else has got something like this otherwise you wouldn't have been able to get the patent. That's right but that's only dealing with the idea. So now what you've got to do is convince people that the idea has merit and it's worth investing money into it to create a good product. And I think that's the key to collaboration. Right, well you've also got to sometimes you've got to educate the people particularly if there's nothing out there already. Yes. The potential end users of this have to be educated about the product itself that it even exists. That's a very good point and I think it's part of this show or this process that we're engaged in now to tell people that this is a very good concept. Right, to get the word out. Yes. And I guess that's one of the functions of going to trade shows is to help promote and educate the people that have an interest about the concept and how well it works. You know, when does that phase begin? You've been in the research and development side, you've got the patents, you're working on the mannequin and the prototype and things sound like they're starting to come together. When do you get to the point where you say, okay, now I've got a product that I'm ready to start educating people on and then you get the order pad out and start taking the orders. Yes. We've not mentioned one area that is also very important. That is one of finance because in order to promote something to be saleable, you need capital. Of course. And you can't get venture capitalists involved in it unless they see that this is a worthy project or a worthy product and are willing to put some money behind it. So we're in the process of trying to do that and the mechanism we're using is the federal government. So we are applying for an SBIR grant through the NIH and hope to get somewhere in the area of a million or a million and a half dollars in order to fund the development of this through the manufacturing company that we're working with. Then you'll have something tangible that you can go out and show how it works. Yes. But before that, now you've got to convince the NIH that this is a worthy product. So anyway, you've got to either convince private enterprise or venture capitalists, which is a little bit difficult to do because they don't see that as something as important as maybe a new energy drink. I mean, they see more value in an energy drink. It's more of a longer term investment for them. That's right. This is a more basic problem that nobody's convinced of yet. And so I think the federal government through the NIH has this kind of vision and I hope to maybe be able to get this grant in order to produce the product. Very good. Well, I wish you all the best in the world and it's a fantastic concept. It's something that I'm surprised nobody has really thought of before. Well, you know, until the paper clip was invented, I guess nobody thought about that either. Well, we are wrapping up. I appreciate you taking the time out of your schedule to come down and talk to us today. Well, thank you very much. You're very kind to say that. And I'm looking forward to maybe in six months you can bring a mannequin to the show and show us how it works. I think that's a wonderful idea, not dawn on me, but until now. But I think it's a great idea. Six months from now, we'll see you at this table here. All right. You heard it here, folks. This is Business in Hawaii with Reg Baker. We broadcast live every Thursday from 2 to 2.30. We highlight individuals and businesses that have success and have figured out how to make it work here in Hawaii. So hopefully I'll see you next week. Until then, aloha.