Posted by Rajan Patel
Fri, 27 Aug 2010 14:46:00 GMT
About a week ago, everyone suddenly quieted down and listened anxiously as Kamalika, our clinical researcher, took a phone call in the middle of the afternoon. Her voice slowly escalated and filled with excitement during the conversation; by the end she was jumping up and down with joy exclaiming, “We’re on our way now!” like an expectant parent. It was the call we had been waiting for: news that the first eligible low-birth weight (LBW) baby for our clinical trial had just been delivered and was ready to be put into the Embrace Infant Warmer.
We were all elated, considering how hard the team has been working to get to this moment: in addition to getting the product ready, preparing our clinical trial protocol, getting it approved by an ethical review board, and then coordinating the study with the doctors and nurses as the hospital. The clinical trial is comparing the Embrace Infant Warmer’s ability to maintain LBW babies’ temperatures against the current standard of care (including radiant warmers, incubators, and other practices that help babies stay warm).
As soon as she hung up the phone, she, Rahul, and I headed over to the hospital to observe the first baby of the study using our device. While I love the stimulating work atmosphere of Embrace, I was far more excited in this moment than any other. It suddenly struck me that what we’ve been working on for so long for was about to become a reality in use!
Nisha, a 2.3kg, rosy-cheeked baby girl, was placed into the Warmer. Luckily, any tense feelings diffused once she was put into the device. Nisha was initially experiencing cold stress, but was safely brought to normal body temperature after being put into the warmer! Also, our device successfully maintained its temperature of 35°C – 38°C for the full four-hour duration. Nisha had a twin brother who was not low birth weight. Interestingly enough, after she had been placed in the Embrace warmer, we observed that Nisha’s temperature was actually higher than her healthy brother’s. As you can see below, she comfortably slept while in the warmer (I’d be willing to bet it was THE most comfortably she’d ever slept in her life!):
Sleeping cozily in the Embrace warmer
Nisha and her twin brother
She stuck her tongue out in this picture just to be cute :-p
To get to this point, it’s been critical for us to do constant prototyping, testing, feedback, and iteration over the last year.This is even more important and difficult with medical devices such as ours, since the efficacy and safety of the product need to be thoroughly assessed before it can be tested in real use case scenarios. The validity and gratification that came from seeing our product effectively work on Nisha was unparalleled. It has taken a tremendous amount of time and effort from the team, and achieving this huge milestone has made it all worth it. But this is just the start.
As I was sitting in the auto rickshaw leaving the hospital at the end of the day, something suddenly struck me: we are one step closer to getting this product out—in fact, we’re one step away from launching. This early success has been a feeling of relief and fulfillment for us, and has inspired and energized our team to do everything we can to get this product to the millions of babies in need.
In 2000, 189 countries pledged to reduce the mortality of children under 5 years of age by two-thirds by 2015, as part of the Millennium Development Goals (MDGs). While significant progress has been made over the last 10 years, neonatal mortality (within the first 28 days of life) still accounts for nearly 40% of all deaths of children.
The situation is especially dire in India, where one out of every 3 babies is low birth weight, and over 1 million babies die every year. I see this harsh reality every time I go into villages here. Last week, I went to Kulumadodi (a village outside of Bangalore), where I met a grandmother, who’s daughter had 3 babies whom died, one after another. The first baby was born in a Primary Health Care Center, where minimal care is offered to babies who suffer from any complications. This baby died three days after coming home. The second baby was born at home, 2 months premature. Without adequate care, this baby also died. The third baby lived until she was 8 months, and then passed away. Imagine what a mother goes through when she suffers the loss of one child—let alone three.
My colleagues went to Rajasthan, in northern India, a few months ago. There, they heard similar stories. Sunila, one of the women they met, had a sister who had a premature baby who passed away, with no medical care available to her. Her brother also had a sick baby, delivered in the village. They traveled for hours to take the baby to the nearest city hospital. But the care came too late, and the baby passed away. It cost this family $200 to place their baby in an incubator. Another man in the village paid $1,000 to place his baby in an incubator. These are inordinate amounts of money for people living in these villages, and they often have to borrow from relatives, friends, neighbors, or take out loans. They financial toll of a having a sick baby is huge, given that no low cost solutions currently exist.
Stories like this fuel our motivation. The first version of the Embrace Infant Warmer will be launched this fall, and it will be orders of magnitude less expensive than what currently exists today. It will provide a means to care for sick babies for those who don’t have one—and drastically reduce the financial burden to parents who will do anything to save their babies. We hope it will allow countries to achieve the goal they so boldly set 10 years ago. And that mothers will no longer need to experience the tragedy their babies dying, one after another.
A devastating yet emotional letter from from a doctor who recently moved to Zambia. Her stories of the NICU are saddening, but these letters are testaments to why Embrace exists. They push us to work more determined than ever.
I’ve now been in Zambia just 12 days, but wow, what a week or two. It’s been a real baptism of fire with good, bad, ugly.. and truly tragic parts to it..hospital life here is mad and grim. Really and truly grim. I’ve seen babies and children die here EVERY DAY of diseases that are 100% preventable or treatable. I see children every day who are so malnourished that their skin is falling off them, forming terrible open painful sores, and whose whole bodies are swollen from lack of sufficient good food.
There is a SCBU here (special care baby unit- for premature babies) but it simply consists of wooden boxes with a light bulb for heat and a bowl of water to humidify the air.. and cockroaches crawling through them and these poor scrawny scraps of babies desperately fighting to stay alive against the odds.
I’ve been put on the pediatric ward- which is chaotic- kids are brought in unconscious every day. All day, every day. More kids who are floppy, lethargic or just plain old unconscious. One was even brought in dead. That was a shock..and then to have to tell the parents..
The nurses are their mum’s (or worse their grandmas) who have very different ideas about what their children need. They hate oxygen and nasogastric tubes because they associate them with the sick children who they see die, so they think that the oxygen kills the babies.
I was recently introduced to this idea by Bill Carter of Ashoka. There are a lot of social enterprises in the world, yet most of us working in the space do not use partnerships and alliances to our advantage. Sure, we do work together from time to time, but it is not frequently seen as a critical tool for creating a business advantage. Can we learn from looking at how purely commercial enterprises cooperate to create competitive advantage?
On the flip side of the coin, in the social enterprise world we also tend to avoid direct competition with other social enterprises. While we all know that competition is good and drives us to be better, there is stigma attached to competing with other companies that are also trying to “do good”. What we don’t consider however is whether this lack of competition is actually helping the other social enterprise (or our own) to succeed?
(2) What is the life-blood of the social-enterprise ecosystem?
When evaluating the commercial enterprise ecosystem (also called the “business world”) it is evident that money is the life-blood that connects all the pieces of the system, facilitates transactions, drives movement and allows the system to self-regulate. When looking at the social enterprise ecosystem I have been unable to find anything which fills the same role. Is it the warm fuzzy feeling one gets when “doing good”? Is it the physical health of the society members? Can a real “ecosystem” exist around social enterprise if there isn’t a life-blood connecting all the parts of the system?
We can’t wait to expand to Africa and help rural villages. Charcoal stoves to heat babies?!?! Oh no =(
I recently returned from Uganda where I was caring for a premature baby with no incubator or way of warming him other than a small space heater in the hospital. He came from an extremely poor village called Masese where there are a high number of premature babies born each year. A few days ago I found out that the baby passed away. The town that I was working in has no incubators. The main hospital uses charcoal stoves to heat babies. Now that I am back in the US I am working to provide a way for the voluteers that are there in Masese to help care for these babies. Right now, my primary concern in their body temperature. In my research for a sustainable way to heat infants, I came across your organization. I would like to hear more about your product and if it is something that could be availble to provide for this community. Thank you,Jenny
Posted by Rahul Panicker
Mon, 22 Mar 2010 09:00:00 GMT
I was hoping to see a tiger. But the only indication that we were in a tiger reserve was a huge sign welcoming us to Achanakmar Tiger Reserve. We were in the heart of Chattisgarh, about three hours outside Bilaspur. Our destination - Bamni, a tribal village a few kilometers within the sanctuary. Navigable roads were hard enough to come by, let alone electricity. So you can imagine our surprise when Komal and Elyse spotted a mud hut with a satellite dish antenna sticking out.
I ask our driver to stop the jeep, and go poke around. ‘Koi ho?’ (Anyone home?). A boy, about 13 years of age, steps out. Golu looks at me just as curiously as I look at the antenna. I peer into the courtyard and spy a few solar panels laid out, charging some LED lanterns. Golu proceeds to explain to me that the government provided these lights and panels. I press further. Surely, the government didn’t also give them a satellite dish? Nope. That’s them. So, they have a TV? Yes, it’s inside. Golu invites me in. It’s mid day, and the house is pretty dark. But I see a truck battery charging. Great. But I don’t see any more gadgetry around. The engineer in me is curious - something doesn’t add up.
You see, a truck battery puts out 12 volts DC. A TV needs 220V AC (what you get in the mains). Most homes that have battery backups manage this conversion with a device called an inverter. It costs a few thousand rupees. I don’t see anything of that sort here. Instead of asking more questions, I ask Golu if he could set up the TV. Of course, happy to. Out comes a 15 inch TV. Black and white. There are wires dangling from the back side, and Golu proceeds to hook it up to the battery. I’m still puzzled. Where’s the inverter?? I peer at the backside of the TV. What I saw was sheer brilliance! The TV’s entire internal power supply unit had been ripped out, and in its place was a hole with two wires coming out.
What does the power supply unit of the TV do? It takes power from the mains and converts it to a level appropriate for the TV’s electronics. Which is what? 12V DC. So, instead of converting DC from the battery to AC with an inverter, and converting back to DC with the TV’s power supply, they’d just bypassed the whole process. Brilliant.
And as I’m still taking this in, he brings out a speaker system. And a VCD player. Gingerly ties together the wires, carefully matching polarity. And pops in a VCD of ‘Karan Arjun’, a Bollywood block buster starring both Salman Khan and Shah Rukh Khan. A black and white image appears on screen with the duo dancing in a quarry, music blaring. All of sudden, heads appear near the courtyard. ‘Cinema?’. Neighbors streaming in for the film show. My economist friend was right. TV clearly is a public good.
Another example of the famous Indian Jugaad. Another engineer in the making. Incredible India.
The concept of personal space in India is much different than the USA. Crowds stand closer. People are more at ease with touching each other and this leads to different expectations in commercial environments.
Shoppers sometimes want to be crowded in. Many shops have to provide direct access to the product, because their customers won’t be comfortable buying a product unless they can touch and hold it first and there is a crowd of other people doing the same. It may be important for our product to be touchable before it’s sold.
So, what is the “butt brush test”? When designing shopping space or any shared public space (restaurants, lobbies, bookstores, grocery stores, etc) for a Western audience, the butt brush test is a quick evaluation tool used to check that two people could pass one another back-to-back in the aisles without bumping into each other. Thanks to the folks at Idiom here in Bangalore for introducing me to this concept.
How does the target market’s perception of personal space affect your product design? Marketing? Point-of-sale design?
Back in the States we have had a poster presentation in Stanford giving us the opportunity to have our data peer reviewed AND (drum roll!) we have put our first 2 babies in our product to be warmed!
Our first baby girl was born on the 4th of March at 9:45am, and our second baby, also a girl, was born the next morning. The pictures below are proudly hung on our office walls. Depending on the frequency of births, we hope to have put ten babies in our product by the end of this month, and eventually an additional 50 babies for the purpose of this feedback study.
Our pride and joy in this progress stands in stark contrast to the frustrations we feel at our current inability to assist in instances of widespread and urgent need. The earthquake in Haiti still has severe effects till today, and it kills us to read stories such as these from doctors on the ground in Haiti where we KNOW that if we had a ready and tested product, we would be of tremendous value to needy families and save lives. But the fact of the matter is that while we have a technology that the Embrace team has personal confidence in, the product remains clinically untested. Doctors we have contacted in Haiti concur with us that despite the obvious need, now is not the time in Haiti to be experimenting with an untested infant warmer, no matter its potential.
If we went ahead anyway and put our product on the ground in Haiti would we be helping and serving babies in need? Yes we believe so. But for a delicate case like Haiti we will only move if we can do so in a way that is thoroughly responsible and in a way that we can guarantee the safety of babies put in our product.
As an organization we have a deeper duty to the bigger picture. Four million newborns die every year, one million in India alone, mostly from preventable or treatable causes. This is the problem that we are seeking to address, and we hope that the logic of this rationale allows us to make the choices and decisions that are right by those who need us the most, regardless the sick feeling we have when the pictures and e-mail from Haiti come streaming in.
(1)A brainstorm is not the right approach for every question. A well executed brainstorm can be an effective approach to get a lot of ideas, quickly and fluidly. However, a brainstorm is not the right solution to every problem!Sometimes there is a tendency to try and brainstorm around problems that should be solved by other methods. Another frequent mistake is to use the term brainstorm to vaguely describe a wide variety of problem-solving approaches.
How can we be sure to select the right problem-solving approach to apply in any given situation?
How can we build out or company lexicon to accurately describe our various problem-solving approaches?
(2)Creativity versus problem-specific expertise: Depending on the problem to be addressed, sometimes it is more helpful to have brainstorm participants with in-depth technical, market, or other problem-specific knowledge. Other times you may want to cast a very wide net by focusing on getting “out there ideas”.
How can we enrich our brainstorms by intentionally selecting the right participants?
How much contextual knowledge do the participants and facilitator need?
(3)The brainstorm is all about asking the right question.In order for a brainstorm to be useful, the question to be answered needs to be well worded. If you start the question with “how might we….”, and you are able to think of four or five ideas immediately, you probably have a good brainstorming question.
How might we ensure that we have good “how might we” questions BEFORE the brainstorm begins?
Does the brainstorm facilitator need to frame the “how might we” questions or can we find good ways for participants to contribute as well?
(4)A suggested list of rules to follow when brainstorming. Here is a brief list of rules which can be quite helpful to ensure the brainstorm stays quick, fluid and produces a lot of ideas.
Encourage wild ideas
Defer judgment
Build on each other’s ideas
Focus on quantity
For more resources on how to conduct good brainstorms, a quick internet search will turn up more than you can handle!
My only regret I had when moving to India was not having enough room in my luggage to pack my Whole Earth Catalog (the book that Steve Jobs mentions at the end of his speech). I used to have this book next my contact case so that it would always be the first thing I saw clearly every morning.
Fortunately for me when I moved into my apartment, I see this every morning from my room:
The picture is a bit blurry but the sign says "Hungry and Foolish". Now I don’t believe in fate but sometimes I question if it really does exist. What are the chances that a company would call themselves this and then decide to setup shop across my window?
At any rate, the team decided to pay these guys a visit and I was extremely impressed. They are a bunch of ex-marketing folks who now do a range of designs from products to services. They don’t take themselves too seriously even though they do great work and are extremely creative.
It’s great to see that there are good designers in this city and a community in which we can call upon. I realize having lived here for a few months now that it’s critical that we don’t lose our creative spirit.
You see, a truck battery puts out 12 volts DC. A TV needs 220V AC (what you get in the mains). Most homes that have battery backups manage this conversion with a device called an inverter. It costs a few thousand rupees. I don’t see anything of that sort here. Instead of asking more questions, I ask Golu if he could set up the TV. Of course, happy to. Out comes a 15 inch TV. Black and white. There are wires dangling from the back side, and Golu proceeds to hook it up to the battery. I’m still puzzled. Where’s the inverter?? I peer at the backside of the TV. What I saw was sheer brilliance! The TV’s entire internal power supply unit had been ripped out, and in its place was a hole with two wires coming out.
And as I’m still taking this in, he brings out a speaker system. And a VCD player. Gingerly ties together the wires, carefully matching polarity. And pops in a VCD of ‘Karan Arjun’, a Bollywood block buster starring both Salman Khan and Shah Rukh Khan. A black and white image appears on screen with the duo dancing in a quarry, music blaring. All of sudden, heads appear near the courtyard. ‘Cinema?’. Neighbors streaming in for the film show. My economist friend was right. TV clearly is a public good.
