Any fool can make it complicated

In 1968, a young American doctor, David Nalin, was working in Bangladesh where yet another cholera outbreak was killing tens of thousands.

The main symptom of cholera was diarrhoea.

The main cause of death from diarrhoea was dehydration.

The only known treatment for dehydration was an intravenous drip, to replace lost fluids.

This was fine in urban hospitals, but most people were dying in rural villages.

They didn’t have access to intravenous drips in the villages.

Nalin had what he calls an epiphany.

Intravenous drips had been considered the only way to replace fluid without it going straight through the body and out the other end.

But what if there was another way?

He knew salt could retain fluid, the problem was the body wouldn’t absorb salt.

So what could help the body absorb salt?

He found glucose would help the body absorb salt.

So now he had the beginnings of a formula: sugar helps absorb salt, salt helps absorb water.

And, in a tent in the jungle, he and a colleague, Dr Richard Cash, began to work out the proportions needed.

And through trial and error they did – the proportions were: half a teaspoon of salt, to six teaspoons of sugar, to a litre of clean water.

In their tent in the jungle they found it worked, they began saving lives.

The proportions were right, but a teaspoon might not mean much in the villages.

They knew that simple is powerful, so they made the formula simpler: a pinch of salt, to a fistful of sugar, to a litre of boiled water.

Even if the villagers didn’t know a teaspoon, everyone knew a pinch and a fistful.

And that formula began saving lives in remote villages.

So much so that, between 1993-94, every letter that went through the Bangladesh post office was stamped with a rhyme.

Translated into English it read: "Good water, a pint. A fistful of sugar. A pinch of salt. End the menace for good."

Since it was developed, it has become known as Oral Rehydration Therapy (ORT).

The Lancet said of ORT: "Since the adoption of this inexpensive and easily applied intervention, the worldwide mortality rate for children with acute infectious diarrhoea has plummeted from five million to about 1.3 million deaths per year. Over fifty million lives have been saved in the past 40 years by the implementation of ORT."

In 1987, Unicef said: "No other single medical breakthrough of the 20th century has had the potential to prevent so many deaths over such a short period of time at so little cost."

Journalist Jeremy Laurance said: "Which medicine has saved more lives than any other and can be made by anyone in their kitchen, back bedroom, shantytown hut or dwelling built of sticks? The answer is: six teaspoons of sugar, half a teaspoon of salt, and one litre of water. Mix. Drink. It requires no specialised equipment; uses ingredients that are ubiquitous and have a long shelf life; and can be made up in any quantity – the perfect medicine."

Nalin’s colleague, Cash, put it slightly differently.

He put it in terms that we could all learn from.

Something that goes against the grain for most of us in our business.

Something that many of us would feel threatened by.

Something that makes it really difficult to achieve creativity in our work.

But it is the secret that separates the mundane from the truly brilliant.

Cash said: "It really is much harder to make something simple than it is to make it complicated."

Dave Trott is the author of Creative Blindness and How to Cure It, Creative Mischief, Predatory Thinking and One Plus One Equals Three.

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