I am going to talk a little bit about global health because that's the domain

I'm in, as soon as we get the slide up.

There we go.

But I wanted to give you a little bit of background about my background and

informed where we've come.

So This was my first job.

It was summer 1998, and it was really an internship, so

I don't know if you'd count that as a job.

I count it as a job because it was the first time I had real responsibility and

had to figure things out on my own.

Does anyone know what this might be?

It's sort of a trick question.

I'll give you a hint.

It's Nairobi, mild steel.

Do we have any engineers here?

Okay. I'll go easy.

I'm not going to go so easy on you.

Okay.

So these are water pumps, actually.

So, I don't know if you've heard of Kickstart.

Kickstart makes treadle pumps, which look like stair stepping machines, for

small scale farmers.

And my first real job was a manufacturing engineer.

These are what the pumps look like.

The picture, for those of you who have a lot of Africa experience,

will know this is not Kenya, this is Mali.

But I worked in Kenya, and you can see the pump here, and it's a pressure pump.

And what that means is you could pull water from up to six meters and

push it another six meters.

If you did that, you'd have to be heavy and pumping really hard.

But this was actually pretty revolutionary for farmers at that time.

Now, this is about 15 years ago or more.

And what would happen with farmers is they could increase their,

they would have more rain cycles or more water cycles.

So instead of just relying on rain, you could have three growing seasons a year.

You can increase the quality of the crops.

And you could have better quality in general.

So, you might wonder what this has to do with where I'm going.

On August 7th of 1998,

some of you may recognize this, the US Embassy in Nairobi was bombed.

And this was my first summer in Kenya.

And it kind of changed my world.

And also it changed my world in a way that I could see the product development I was

working on with the pump had real impact on people, but so did this.

And to give you a picture of what Nairobi was like at the time.

I was on the outskirts.

We knew something had happened.

We didn't know what.

We couldn't figure out what had happened.

We actually thought it was a coup, because there were riots in the streets,

cars were getting burned.

It was utter chaos.

We did learn it was amnesty bombing.

And I actually remember sitting with a colleague, who's Somali,

trying to listen to the BBC world service, which was in Somali at the time of

day trying to figure what the hell was going on.

Several days later, I went down to the site.

I have a friend who's a BBC reporter, and we were trying to deliver her a meal,

because she had not eaten in about three days, or slept.

And what I remember was a picture like this.

Just people everywhere.

The smell, the smell of death.

The smell of body parts, and the smell of burning.

What it left me with, though, was making sure that whatever I worked on,

I wanted to feel like I was actually doing something.

I think those of us who have come up through the international community,

we feel like we're doing good, we're part of the system, but are we really?

And I can see the farmers increasing their acreage, but this was a whole new level of

feeling helpless and hopeless, and feeling like what can you do with your life?

So I left this experience with a very new perspective.

And I came to D-Rev in 2009.

A few things happened in the middle,

and if those of you stay later in the class you'll hear about that.

But I became very focused on how can you have sustainable impact.

How can the work you do not just help, but how do you actually change systems?

How do you empower people?

I know people don't love the word empower, but

how do empower people to change their own lives,

to overcome barriers like poverty and to take advantage of opportunities?

So D-Rev is short for Design Revolution.

And we started out as a product development company focused on people

living on less than $4 a day.

But it became quickly evident that healthcare really needs a lot of help,

particularly in low-income economies.

So we began to focus more on closing the gap in quality healthcare.

And we do this by, and I love how I can see the slides in the back.

You don't have to turn around and see what's on there.

You do this by designing and delivering user-centric products.

I'm going to talk a little bit about that more towards the end, but

I'm going to focus on one of our product areas.

You'll notice the design and delivery.

Designing and delivering is in italics.

I think one of the things that's unique about D-Rev is when we think about design,

it's not just the design of the product,

it's making sure that the product gets to the users, has sustainable impact.

So some of you may have seen this photo in the New York Times last month.

It is a teenage girl.

She is chained to a wall at the Dhaka train station, the Dhaka railway station.

And she has Cerebral Palsy, which the photographer found out later.

And I want to read you a quote, if I can find my piece of paper.

There we go, okay.

So she's chained to a wall.

Her mother has to go out everyday to collect recyclables that she can sell

to get enough food on the table for her and her daughter.

But I wanted to read you the quote from the photographer.

And this is an amazing set of photographs in general.

It's not just Molly, this is the girl in her family, her mother.

But other families.

The quote from the photographer is a fourteen year old girl being chained from

morning to evening looks inhumane and cruel.

But this is completely out of love.

They don't have anyone to take care of her where she can be safe, and

the mother has to work or they don't eat.

So this is a horribly disturbing image.

And the reason why it struck with me is because we work

with neonatologists all around the world.

Neonatologists are doctors who focus on little humans that are less

than 30 days old.

And we have heard time and time again, Nigeria, India, Bangladesh about how

families, if they have a child who has brain damage, sometimes they let them die.

Or they're chained to walls.

Jaundice, which many of those don't think about as a problem, if it's not treated,

can lead to cerebral palsy.

I don't know if that's what Molly has.

She was actually diagnosed, thanks to the photographer.

But it's a very avoidable condition.

And just to give you a bit of a primer,

jaundice is a build up of bilirubin in the blood.

So, this is a neurotoxin.

The baby's liver is trying to get going, trying to work, and

sometimes it doesn't work so well.

So this neurotoxin, bilirubin, can accumulate in the brain.

And if it's not treated it, can lead to death or brain damage.

For example, cerebral palsy.

Also, deafness.

The medical community actually does not understand the lower spectrum,

so they think it's learning disabilities.

They know there's an impact on plaque on teeth.

But a whole host of problems.

The interesting thing about jaundice, though, is that probably about 60%

of you had it, and probably about 12% percent of you were treated it.

It's just blue light.

So you can see the baby here had a blue light.

Blue light shines through the skin, breaks down the bilirubin and

the baby pees it out.

Very, very simple.

It's about two days after birth.

The thing to know about jaundice, though, is that it is time sensitive, so

that when a child has a severe case that needs to be treated,

they really need to be rushed or they can suffer brain damage.

I mentioned that about 12% of you were probably treated for jaundice.

In low income countries, it's as high as 17%.

And this is for a number of reasons,

but the main reason is that there's more pre-term babies.

And about 70 to 75% of pre-term babies need to be treated for jaundice.

So, how big a problem is this?

There's a yearly unmet need, we estimate it about seven million.

And I say we, we work with Standford University to establish this.

And I think, Alex mentioned that my background is in engineering.

One of my big surprises coming into the health space is how little is actually

known about some conditions like jaundice.

And so, Doctor Vinny Butony, who's like the worlds except in jaundice, in fact,

if you look at the risk chart, it's called the Butony nomogram.

But he thinks this could be as three times as high as seven million babies per year.

But the problem is it's very difficult to collect data,

particularly around brain damage with an infant.

So why is this a problem?

It's because most phototherapy devices cost more than $3,000 a year.

So you can imagine in hospitals in low-income parts of the world,

this is just simply unaffordable.

So what do you see?

This is taken at one of the premier public hospitals in a large Indian city.

It's a pediatrics hospital.

These two children are healthy, they're underweight,

and they need to be treated for jaundice.

But the thing to notice is that there should be six long tube bulbs.

So, those long fluorescent tube bulbs blue medical grade blue.

They're six and you can see here about three are burned out.

This is pretty typical.

This is another thing we see.

Bulbs just burned out again, or being replaced with white bulbs.

So blue light, it's the spectrum that actually breaks down the bilirubin.

Many of you know from physics and

other things that white light has blue in it, but you need high intensity.

And that's not obvious to the naked eye.

So this is basically what Dr. Boutani, the world's expert, would call homeopathic.

So why is this such a problem?

It's not just a problem of the cost of the device, but

it's also the cost of the replacement bulbs.

Those six bulbs that you just saw, need to be replaced every three to five months.

This is the cost of those units in different parts of the world.

So it ranges, I know it's hard to see, from anywhere about $23,

we've seen them $6 in Delhi, India, varying quality,

all the way up to almost $200 in Kampala, Uganda.

And so.

This is the replacement cost per year.

So, you have anywhere from over $2,000 in Kampala just with bulb replacement costs,

so you're getting up close to the cost of the devices.

To almost 300 in Deli.

But this is the big thing, they're hard to source.

It's not just a cost issue, but

from a user standpoint, it's difficult to source these bulbs.

Bulbs are fragile, they're difficult to get, there's knock offs,

you don't know if it's good quality.

In fact, a colleague of mine in a Nigeria hospital saw white

bulbs that had been painted blue to try and replicate.

So at D-Rev we developed a phototherapy device called Brilliance,

and you see it here.

The thing to note is that it uses LEDs.

So, getting rid of the bulbs, just bulbs all together.

And those of you who know LEDs, they last 50,000 hours which, depending on usage,

can be anywhere from 10 years to 30 years.

And so, no bulb changing costs.

We also designed it so that it fit into the local system.

No fans that will break, it can handle voltage surges,

which many of you I know who work in places where there's a lot of voltage

surges, this is what can derail a product.

And the best part about it is that it costs $500 US.

It's actually, if you're in India and you order it for

an Indian hospital, which is our target market, it's $400.

And India's our target market because it's 20% of all live births.

And actually, if you want to dig a little bit deeper in India,

there's three states that represent 48% of India's births, which is 10% of the world.

So India, if you can just make a dent in newborn health in India,

you're making a dent in the world's health.

So I wanted to show this picture because I feel like when we talk about design,

we're always talking about the product.

This is the first batch of brilliance units.

A little over two years ago.

And even though our partners aren't smiling, this is Phoenix Medical Systems.

We licensed it to the biggest maker of neonatal equipment in India.

Which, by global standards, still isn't very big.

But they have an extremely good reputation in India.

Very high quality products, which is why we chose them.

But they actually were really psyched,

despite the not smiling, [LAUGH] which is very typical.

But it actually quickly became back-ordered,

which in some ways wasn't a surprise, but it also was a surprise.

But the reason I put this photo here, too, and if you're here later you'll

hear more about it, is things do not end when the product is designed.

There's a whole lot of work making sure that the units get to costumers.

And we wouldn't be able to do this without a partner like Phoenix.

All right.

So, from an impact statement where are we now?

I mentioned that we've been focused on India.

About 85% of our units have been sold in India.

To date, we've sold over 1200 units.

And I'll talk more about selling in a minute.

And we're in over 25 countries.

And so, this is a little bit more than two years on the market.

And we've treated over 50,000 newborns since going to market.

Our goal, though, is to treat over a million newborns in the next five years.

So, one other things, too, I mentioned, is things just don't end with the product.

We actually very quickly planned for

the next generation of Brilliance, even after Brilliance had just come to market.

So we actually just launched What we call Brilliance Pro.

We improve some usability.

We improved some usability, we improved some manufacturability.

But we had really learned very quickly from our users where improvements

could be made.

And an example of that, with the original Brilliance,

you had to have two hands to lift the head up and down.

And if If you use the device, for example, with an incubator or a warmer,

you have to be able to adjust the device.

You can't just have a device that's fixed.

Before you needed two hands to do this, and

sometimes you had to put your foot on the [LAUGH] put your foot on the base.

And this, it's just a tilt, it's counter-balanced.

So a lot of improved usability since we would see nurses holding things and

trying to adjust things, and not wanting to set stuff down.

We were really excited, though, because we won best in show at a conference called

Neocon, which is India's biggest neonatal conference, in general.

And we won across all product categories.

And this was also very encouraging, too.

Because we beat out the big players.

And it was also a sign that there is market pull,

particularly in the Indian health community, for more sophisticated devices.

I think there's been this tendency, at least in international development,

to think, good enough products are good enough.

And what we're seeing is much savvier and demanding customers, which is great,

because that means that the mindsets are changing,

not just with the medical practitioners, but hopefully soon with the patients.

So I wanted to talk about, then I'm going to end basically with this, but

three principles that we use for design at D-Rev.

The first is that we design world class products.

So not products that are good enough, products that perform on par or

better than the best products on the market.

And so, here you actually see some early testing of one of our

prototypes that we eliminated in a hospital just outside of Deli.

And for the photo therapy device, it's very in for any product.

It's very easy to say, well we're world class.

But what does that mean?

That means that if there is some kind of third party standard, for

example, regulatory approval, we get that.

With phototherapy, we have both c e mark and

it also exceeds the American Academy of Pediatrics standards.

So, we're actually able to point to that to our customers and

say we've achieved this, and here's the certification.

The second thing to know about this, which I've alluded to,

is that we believe in market, using the market to deliver our products.

So this means not only do the products need to bring value to our users and

they want to purchase this, but they have to be able to purchase it.

It has to be affordable.

And I like these photos because the one with the market is typically how

westerners think about markets in low income economies.

But the other photo, too, is, it's a medical device for an Indian.

You can see one of our engineers working with one of Phoenix's engineers.

And this was when Brilliance was getting launched.

Lastly, we say we're user obsessed.

I know from Alex's syllabus that you guys are looking at

the human centered design tool kit, which is fantastic.

All of D-Rev's products are user driven, which means that a user has come to us and

said this is a problem.

And, in fact, with jaundice, that's how the project started.

We had an Indian doctor that approached one of my colleagues and

said everyone's kind of focused on the big ticket items, sepsis, asphyxia,

pre-term health, but we have kids who have brain damage and are dying from jaundice.

And this is low hanging fruit.

There should be no child who has brain damage from untreated jaundice.

So I want to end with this story.

This is actually data fresh from the field.

This is a Brilliance unit.

What we now call Brilliance classic, now that Brilliance Pro is on the market.

This is a government hospital outside of, actually in Chandagar, India.

And the wife of one of my colleagues was a post-graduate Institute Chandagar,

which is one of the best universities for newborn health in India.

And we said, hey, we've got a unit at a nearby hospital.

Will you go collect data off of it?

And she said sure.

Because we design Brilliance so that it collects data about itself, and

then we can estimate the number of babies treated.

And so she said to her colleague, I'm going over to this hospital.

And he said, that's where people go to die.

And so she told us this.

And my response was, well,

at least we know we're hitting the high need hospitals.

She went over there, and the doctors were really happy.

They were very busy.

And she didn't want to interrupt them very much.

But we're always looking for feedback, not just the data, but

how it's being used, and what the perception is.

And she said that often multiple babies are being treated at once,

under a single unit.

And the exchange transfusions went down from two to three a day, and

what an exchange transfusion is, is when there's so much bilirubin in a baby's

blood that they have to cycle out the baby's blood with donor blood twice.

Keep in mind these are babies that are a little bit bigger than the palm

of your hand.

These are pre-term babies.

It's a very difficult, just to execute and

it's often done manually with a doctor standing there pumping.

The exchange transfusions went down from two to three a day, which I have never

heard of exchange transfusions that high anywhere, to one every three days.

So my colleague's wife came back and she said I was so happy to see this.

And the doctors were so happy.

And so, that was very gratifying for us, because we're based in California.

We do do a lot of work everywhere.

But being able to stay connected to our users and

get data like this was phenomenal.

The one thing I will also point out is there's a lot

of talk about the affordability.

And we've also heard that governments, for example, do have money to purchase units.

If you look at the top of this unit,

you can see it was donated by a foundation which was also another learning.

Again, thinking about delivery, how do people purchase?

It would surprise us to see that units were being purchased and

donated to a government hospital.

All right.

So, that's it.

Thank you very much.

Our goal is to obviously have everyone live a healthy and productive life because

we believe that that's where you can live to your greatest potential.

If you've interested in D-Rev, here's a few resources.

We have a nutritious blog.

That's actually what our friends at Kiva called our blog because they said that

we're so nerdy.

But we also, you can find us in other places, too.

So, thanks.

>> [APPLAUSE]

Design Case Study: Fighting Jaundice

Innovation and Design for Global Grand Challenges

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