If necessity is the mother of invention, Paul Polak is one of its fathers.

For 30 years Dr. Polak, a 78-year-old former psychiatrist, has focused on creating devices that will improve the lives of 2.6 billion people living on less than $2 a day. But, he insists, they must be so cheap and effective that the poor will actually buy them, since charity disappears when donors find new causes.

Inventing a new device is only the beginning, he says; the harder part is finding dependable manufacturers and creating profitable distributorships. The “appropriate technology” field, he argues, is “dominated by tinkerers and short of entrepreneurs.”

His greatest success has been a treadle pump that lets farmers raise groundwater in the dry season, when crops fetch more money. He has sold more than two million, he said.

He also helped develop a $25 artificial knee and a $400 hospital lamp to save newborns with life-threatening jaundice. He is field-testing a reprogrammable “talking poster” that gives mini-lectures in local languages, with pictures, on topics as varied as rice-planting and hand-washing. And he has an ambitious project to create franchises through which Indian village shopkeepers will purify polluted water and sell it. We spoke at a convention of young inventors in Arlington, Va.; what follows is an edited version of our conversation.

Q. What in your past led you into this unusual specialty?

A. My dad comes from a peasant background in Czechoslovakia; he lived in a house with the people upstairs and animals downstairs, so I have an innate affinity for peasants. Also, we were Jewish, and in 1938 refugees were streaming across the border from Germany with broken heads.

Pretty much anybody could see what was coming. My dad said, “There’s going to be hell to pay soon,” and made plans to escape. But when he tried to tell our family and friends, they said things like “But what would we do with the furniture?” I got from him an eye for seeing the obvious.

He also had an entrepreneur’s streak, which I inherited. He had a high school education, but he started a plant nursery and was doing very well. He sold everything at 10 cents on the dollar, and we escaped to Canada.

I went to medical school, got a degree in psychiatry, and in 1959 I moved to Denver and got a job at Fort Logan Mental Health Center. In my spare time, I invested in real estate. I bought mismanaged apartment buildings. I also owned a small oil company drilling stripper wells. I invented a pump jack for the oilfield industry — I’ve always knocked around in that kind of stuff. By 1981, I’d worked for 22 years as a psychiatrist, and I’d cleared about three million bucks, mostly in real estate.

Q. What got you interested in poverty?

A. I was one of the pioneers in treating people more effectively in real-life settings. The conventional assumption is that patients are admitted to psychiatric institutions because a therapist or family member says they’re mentally ill. But I talked to a lot of our patients as if they were customers, and they defined something going on in their family or workplace as the primary reason they were there. So I started going into patients’ homes or workplaces.

At the time, there was a lot of emphasis on making the wards a lot more like a family. I came to the astonishing conclusion that the most familylike setting was a family. So we recruited nine healthy private families and admitted acutely ill patients to them.

It was much more effective. If you’re a guest in somebody’s nice home, you ain’t going to break the furniture. We provided the support — the physicals, the lab tests, rapid tranquilization. But the deinstitutionalization model that followed that dumped people out with no follow-up was in some cases worse than being institutionalized.

I also noticed that a lot of these people were very poor, and that had a big impact on their symptoms. That got me interested in poverty.

Q. And in third-world poverty?

A. My wife’s a Mennonite, and they had programs in Bangladesh. It had hit me between the eyes that homeless people in Denver were living on $500 a month, but there were people overseas living on $30 a month. So I took a trip to Bangladesh.

Some farmers were using hand pumps, but biomechanically, that’s a lousy way to raise water. A Mennonite guy had invented a rower pump that would pull up enough to water a half-acre of vegetables. They had installed 2,000 over five years, and those farmers seemed to be making a lot of money, so I said, “Why don’t we do a project, with an objective of selling 25,000 a year?”

We hit that pretty quickly. One or two Mennonites objected — they considered the idea of selling something to poor people immoral. But we kept at it, and then we found the treadle pump. It was brilliantly simple, it could be manufactured by local workshops, and a local driller could dig a 40-foot well and install it for $25. Studies showed that farmers made $100 in one season on that investment.

We talked to 75 little welding shops where they make things like bedsprings, and jawboned them into making treadle pumps. We went to people who sold things like toilet bowls, and cut a deal with them to be dealers. We trained 3,000 tinkerers to be well-drillers. We hired troubadours to write songs about treadle pumps, and we’d pass out leaflets when they performed. We even produced a 90-minute Bollywood movie.

Q. About treadle pumps?

A. Yeah. People in these little villages couldn’t read or write. We hired the top director in Bangladesh and two top actors. It cost us 25 grand of our Canadian government grant. The plot was “boy meets girl, but they can’t marry because her father can’t afford a dowry.” Then she falls into the hands of dowry bandits, then there’s a near-suicide. By now, with lots of singing and dancing, you’re 60 minutes in.

At the climactic moment, the movie stops. Our dealers get customers up on model pumps. The movie resumes, the father buys a pump, makes enough for the dowry, they live happily ever after. Somewhat cheesy, but we bought a van with a video setup, and took it to villages — a typical open-air audience was 2,000 to 5,000 people.

Q. What’s the biggest mistake aid agencies make?

A. As we were developing our pump, the World Bank was subsidizing deep-well diesel pumps that could cover 40 acres. The theory was that you’d get a macroeconomic benefit, but it was also very destructive to social justice. The big pumps were handed out by government agents; the government agent was bribeable. The pump would go to the biggest landholder, and he’d become a waterlord.

Q. There have been some well-known failures in this field, like One Laptop Per Child and the Playpump. Can you say why?

A. The laptop was a middle-class device that doesn’t communicate with people who don’t read and write. It cost $100, plus it used the charity model — buy two, give one away. The Playpump, which was a children’s merry-go-round that pumps water, cost $11,000. Women in Africa walk for hours to a well, and then jiggle the pump handle for 60 seconds. This replaces the jiggling. How important is that? And they break. For $11,000, you could dig five wells and eliminate the walk.

Q. What are your principles for success?

A. In 1981, I said, “I’m going to interview 100 $1-a-day families every year, come rain or shine, and learn from them first.”

Over 28 years, I’ve interviewed over 3,000 families. I spend about six hours with each one — walking with them through their fields, asking what they had for breakfast, how far their kids walk to school, what they feed their dog, what all their sources of income are. This is not rocket science. Any businessman knows this: You’ve got to talk to your customers.

http://www.nytimes.com/2011/09/27/health/27conversation.html

Sept. 26, 2011