Vayu was born with the mission to develop VTOL, long-range, payload capable, fully autonomous medical delivery drones. My interest in this wasn’t academic. I spent ten years as a journalist covering issues relating to poverty and conflict in the Middle East, Africa, and South Asia, traveling most of the time by motorcycle, train, public bus, or on foot. I then worked at a hospital for the poor in rural India for a year, and later attended medical school in the United States. The magnitude of the need was always clear, as was the idea for the solution. How to get there, was anything but.

On the second of the two long flights over to Madagascar, I tried to recall the last time I visited Africa. It was back as 2008, when I wrote about the Congo. That was eight years after I first arrived in Africa (Cape Town, South Africa) to study anthropology for a semester through my college, the University of Chicago. I returned in 2003 as a photojournalist to photograph the economic struggles of cotton farmers in West Africa for a story about the impact of US cotton subsidies, traveling to Senegal, Mali, Burkina Faso, Benin, Togo and Ghana. And returned many times to write about the genocide in the Darfur region of Sudan. In between I bounced around Zimbabwe, Rwanda, and a few other countries.

Eight years is a long time. And yet despite the heralded advent of mobile technology, in some regions poverty rates and health indicators haven’t improved. In Madagascar in particular, even though the country has been relatively stable and peaceful, health and other development indicators have actually slid backwards in the past 40 years — it’s one of the only countries in the world to have gotten worse off, without any major conflicts, internal or external.

Traveling around Madagascar in mid-July and seeing its gut-wrenching poverty up close was like a hard kick in the head. Madagascar is the third poorest country on the planet. During that trip I felt like a dim light bulb was turned on fast and hard, illuminating memories that were long dormant. The bleak isolation of the rural Congo. The privation of a Sudanese refugee camp in Chad. The toddler urinating blood in the lake Volta region of Ghana. It’s such a stark, harsh reminder of why I was attracted to medicine, and later started Vayu. It also shines a clear spotlight on one of the reasons Vayu struggles: because it was never meant to be a billion-dollar business; it was meant to help serve the healthcare needs of the rural poor.