v3 ReMotion Knee

Drumroll please…after months of hard work, we’re very excited to announce the v3 ReMotion Knee, redesigned from the ground up. The new design represents the most significant step to date in the ReMotion Knee’s transition to global availability, with a host of new features, a shift to high volume manufacturing, and a completely revised design aesthetic (think Toyota reliability meets Ferrari sexy).

As we like to say here at D-Rev, we are user-obsessed, and as always user-feedback (both direct and indirect) weighed heavily on the v3 design. Here are some examples of the needs that factored into our redesign:

v1 JaipurKnee

Amputees in India were not satisfied with the appearance of the knee when worn under clothing. Previous, blocky designs formed an unnatural profile with visible corners when worn under dresses or pants, especially when patients were seated.  The profile now is curved, and more closely resembles an anatomical knee cap. There is often a large social stigma attached to being an amputee in the countries where we work. We focused on designing the knee so that amputees won’t be singled out.

Patients felt ostracized by the noise produced by the knee as they walked. We added a rubber noise dampener to reduce loud clicking noises during gait, which previously acted as an announcement to the world that the patient is an amputee.

The number of amputees is as high as ever, and they are dispersed across the world. The v3 knee is designed for high-volume injection molding instead of low-volume machining, meaning that we can produce in bulk, keep costs low, and control quality for our users, key steps on the road to global accessibility.

v2 ReMotion Knee

Prosthetists cannot maximize their efficiency with supplies of donated, previously used components that often require examination and repair. Central manufacturing allows us to implement thorough yet cost-effective quality control, leading to consistent parts that allow prosthetists to spend their time doing what they do best: fitting patients.

Users need a high-end product they can be proud of. We devoted significant time to develop a new aesthetic and design style for the v3. An aesthetically pleasing device is more likely to be chosen by patients and prosthetists, increasing ReMotion’s impact.

Aesthetics are not always at the top of the priority list for international development programs, but for D-Rev, anything that leads to increased impact is considered a must-have. From our field work we know that the aesthetics of the knee are crucial to making the patient feel comfortable and confident, increasing the likelihood that they will use and maintain their prosthesis.

So what’s next for the v3 ReMotion knee? In the upcoming weeks we’ll be launching some small scale trials with multiple clinical partners, to really do a thorough investigation of users’ (patients’ and prosthetists’) experiences with the ReMotion Knee, so stay tuned for more exciting updates!

Locations of the first 42 Brilliance units sold

Measuring impact is at the core of D-Rev’s work. Not only does user feedback help us to iterate in the design process and continually improve our products for our users, but more than that impact is the heart of our mission – it justifies our work, publishing our impact data gets you, our supporters and colleagues, in on the action, and it allows us to be transparent and honest about both our achievements and our challenges.

We try, wherever we can, to integrate impact collection into our designs themselves. We don’t think of impact as something to tack on later, it’s not a nice-to-have, but an integral element in our design process and our work overall. With Brilliance, our phototherapy device to treat neonatal jaundice, we outfitted the device with an LCD screen and an internal counter that tracks the total time that the machine has been turned on. We also added a “reset button” and instructed doctors and nurses to use the reset button each time he or she begins treatment with a new baby.

Baby being treated with Brilliance in India

Except data collection is never that simple. Even when the technical infrastructure is in place how do we convince partners in the field, doctors and nurses with competing priorities, tight schedules, and limited resources, not only to care, but to take that care and build a habit around it, to commit themselves to a process focused not just on outputs, but on positive outcomes for their patients and for others? How do we best connect with them to extract the data that lives in the unit and also gain an understanding of their experiences with patients? This is something that we are still working on and would love the input of others tackling similar challenges.

Brilliance is our first formal data collection effort so over the next year we are piloting 3 methods of data collection: Phone calls, in-person visits, and SMS messaging. We are hoping to learn A LOT in these pilots – about what gives us the most informative and richest data, but also about what is easiest for a doctor or nurse and most likely to garner a response. For our first round of data collection – for the first 11 units sold into 9 hospitals – we called the mobile phones of the doctors who use each unit.

In order to compensate for the inevitable gaps in what we are able to receive from partners on the ground, we have developed mathematical models based on research with doctors and partners about the effects of jaundice. Even with this research in hand we are very conservative in our calculations and assumptions.

For Brilliance we are focused on 3 main data points:

1. Total Babies Treated with a Brilliance Device: 324

We can derive this from use of the reset button on the devices, reports from doctors and nurses, and by reading the total treatment time off of the machine and (using our field-confirmed average treatment time of 48 hours) determine the total number of babies who have been treated with each unit. We compare these data from different sources to determine the most accurate count.

Total Machine Time /48 hrs (average treatment time) = total babies treated

2. Babies treated who otherwise would not have received effective treatment: 283

Babies treated who otherwise would not have received effective treatment (or internally “Babies Otherwise”) is at the crux of what we do, this is where we can begin to trace the power of Brilliance. This number captures babies who are receiving care in a clinic or hospital that did not previously have effective treatment. We consider ineffective treatment to be either no phototherapy devices, or phototherapy devices that are below the treatment standard determined by the American Academy of Pediatrics (>30 µW/cm2/nm peak spectral irradiance at treatment distance).

Using published data that we have collected with our partners, we have determined three classifications for medical facilities (high or medium/low income, public or private, and rural or urban) that each have a different probability of being able to provide effective jaundice treatment. We expect to adjust these weights over time as we collect more data and expand to new markets. We apply these probabilities to the total number of babies treated at each hospital to determine how many babies would not have received effective treatment without Brilliance. To see some of the data we have collected from hospitals about the effectiveness of their existing phototherapy devices, see Phototherapy Device Effectiveness in Nigeria.

Total Babies Treated * probability of not receiving effective treatment without Brilliance = “babies otherwise”

3. Deaths and disabilities averted because of the treatment received: 7

Severe jaundice, when left untreated or ineffectively treated, can lead to severe brain damage, a condition called Kernicterus (KI) or death. Using published data by our research partners we determine the number of newborns who have avoided death and disabilities from ineffective treatment by multiplying the total newborns treated who otherwise would not have received treatment (2), by the kernicterus rate for the region – for our current units in India that is 2%. From our conversations with Dr. Vinod Bhutani of Stanford University, we have seen this number vary widely from as low as 2.2/100,000 births in North America to as high as 1,749 (95% confidence interval: 1,649–1,849) per 100,000 live births in Iraq.

Babies Otherwise * .02 = Deaths & Disabilities Averted

Despite the challenges of going beyond simple output measures for determining the success of its products, D-Rev is determined to do just that: to measure and communicate, in quantitative and qualitative ways, the human impact of our work and how that work is improving people’s lives around the world. Furthermore, we aim to do it in such smart, informative, and compelling ways that D-Rev becomes an exemplary model for impact assessment in our field – because impact assessment isn’t just about proving effectiveness, but also about demonstrating transparency in our operations and results, being held accountable for our work, and gaining and maintaining long-term credibility. We hope to be part of a new era of transparency.

[This post was originally published as part of LinkedIN's Influencer Posts on 13 March 2013. Go to the post to see all the awesome comments!]

If you have ever made a donation, let alone are in the social sector – you need to watch Dan Pallotta’s TED talk “The way we think about charity is dead wrong”. If you haven’t seen it, watch it now. (Yes, now.)

Dan, the founder of the AIDS Rides, delivers a staggeringly on-target analysis of the key “ethical” roadblocks that prevent non-profits from achieving our missions effectively, among them: tying nonprofit salaries to impact, advertising, and taking risk. Non-profit social enterprises are not supported to deliver what we promise – and what many of us are so passionate about – social impact. We need to change that.

One of the areas he tackles is the issue of an organization’s overhead. There is an unspoken rule of thumb with most donors that a “good” nonprofit’s overhead (G&A and fund-raising) needs to be less than 25%. I learned this last year when the organization I lead, D-Rev, had its first audit and we were at 25.7%. Despite our rapid growth and what we’ve accomplished while being “lean” (euphemism for “totally under-resourced”), we are actually penalized for great practices, like having an audit. Audits count as part of overhead – significantly so, in our case.

By positioning overhead versus cause, he says donors are pitting “frugality versus morality” by not recognizing that overhead supports the cause. AIDS Rides had a 40% overhead with an aggressive marketing campaign, and as a result were skewered in the media and lost major sponsors. Nevermind that they had raised $581M for their cause.

What makes his talk powerful is that he doesn’t just take on one of the standard maxims of philanthropy, like overhead, but many – some of which support an industry that measures philanthropic effectiveness. He does this richly and backed up with real and painful examples. What I love most though is that he speaks for those of us who are trying to innovate in the social sector in untraditional ways, and provides a stellar example of how to raise the conversation to the next level – for our causes. People will be talking about this talk for a long time.

Bottomline: Donate to organizations that are achieving real and measurable impact, and trust them to spend your money effectively doing that.

Imagine a world where everyone, everywhere could have access to world-class innovation that could change – or save – lives, without the barriers of price or functionality. Those barriers are what almost always accompany medical technology, designed for high-income environments, when it arrives in most parts of the world.

Until recently, ‘imagine’ was the key word in this vision. Sure, donated and recycled medical devices do often find their way to the far reaches of humanity, fueled by good intentions and the desire to improve global living conditions. But often these devices, designed to perform where power is constant and temperatures don’t fluctuate, don’t deliver the needed impact in their new settings. Expensive and often unavailable replacement parts, as well as servicing and training complexities, limit the ability of these devices to do the good work they were intended – and designed – to do.

Photo from the New York Times of three newborns being treated with ineffective white light phototherapy - 9 November 2012. Credit: Jes Aznar for the International Herald Tribune

If a medical device is providing negligible care – the impact is negative care. Take for example, this photo (left) from the New York Times in November 2012 of three babies being treated for jaundice in white light – rather than the needed high-intensity blue light.  Jaundice is extremely time sensitive – and while many children recover without treatment – many also do not. Dr. Praveen Kumar, a leading neonatologist at India’s PGI-Chandigarh Medical College, has reported patients arriving with kernicterus (brain damage) even though they had already been treated with phototherapy. (As a sidenote, the NYT caption reads “Newborn babies with skin discoloration are treated in a makeshift photo therapy box. [sic]”, reflecting the widespread lack of knowledge around hyperbilirubinemia, or severe jaundice.)

For our medical devices, D-Rev uses design to bring affordable innovation to people in all corners of the globe and in all layers of the economic pyramid. Committed to uncompromising safety, quality, performance and usability, we uphold the highest design and engineering standards while rethinking the products that deliver medical solutions.

The results? High-impact, affordable products that bring value to our customers and users, reflecting our commitment to world-class quality and market-driven solutions to medical problems.

Brilliance, for example, outshines other phototherapy devices when it comes to reliably and affordably treating jaundice – and preventing the lifelong damage of kernicterus – in hospitals. Brilliance entered the market in India in November, and has already treated more than 250 babies. We receive reports of units being sold through private sector distributers to hospitals in other countries, like the Philippines – and now our partner Phoenix is back-ordered.  The need – and the demand – are great.

Vishumbar sits cross-legged wearing the JaipurKnee.

In India and in other countries – Ecuador, Senegal, Iraq, and Fiji to name a few – D-Rev’s ReMotion Knee, is helping to remobilize above-knee amputees. Not only can they walk (and work, or study, or care for their families) again, they can do things that standard prosthetics often don’t enable: riding a bike, comfortably sitting cross-legged, squatting and praying.

This is only the beginning. Our commitment to think globally and design powerfully is making a difference with people who might not otherwise have access to world-class products – and with that, real life-changing opportunities. We too are inspired by others in the medical device community who challenge their own assumptions about what makes great user-centric design. Our passionate belief that revolutionary design changes the lives of people living on less than $4 per day delivers another form of impact: designing for global access can result in great products in every market – and improved health for everyone.

Life and economies are constantly evolving, especially in the low-income areas where D-Rev focuses its work, places where agility is critical for survival.

Most medical devices today, however, are designed for Western hospitals – places that are large, well-powered, elevator-serviced, and reliably able to provide good, if not great, healthcare.  But that’s not reality in most of the world.

At D-Rev, we’re seeing something in our ongoing fieldwork that’s surprisingly under-discussed in global health and medical device communities: the increase in rural roadside private hospitals. These medical facilities– Krista, our CEO, has nicknamed them “micro-hospitals” – are exactly what they sound like: small destinations that provide local hospital-level care, usually in urban and peri-urban areas. Services offered can include emergency treatment, antenatal care, basic check-ups and vaccines.

If the micro-hospital has a neonatal intensive care unit (NICU), it is probably small: no more than 10 by 4 feet in size.  Standard NICU medical devices, when these micro-hospitals can afford them, are out of context in these settings. They’re oversized and bulky, too big for these small rooms. Nurses struggle to move around them, sometimes squeezing into tight spaces simply to plug in a power cord.  Even when things are “plugged in,” power is rarely reliable. Access to electricity often falls as low as 8-16 hours a day in many locations.

When we visit these hospitals – such as the one shown in this recent photo taken Ghaziabad, India – we ask: Is anyone thinking about these micro-hospitals when they design products? If a well-intended product is rendered impractical or even worthless by market realities, its impact can actually be more negative than no product at all – and these are the most vulnerable populations in the world.

Micro-hospitals are emerging and proliferating in India and in other countries with large low-income populations.  Many times they are across the street or around the corner from a large public clinic that is supposed to treat patients for free but simply lacks resources or funds to provide care beyond vaccines.  Our research shows that even families well below local poverty lines are paying out-of-pocket for this type of private care. It’s critical that these facilities have access to affordable, appropriate medical devices designed to function with market realities in mind.

D-Rev is building for the evolving societies, lives, and economies emerging in today’s global reality. In our view, there is no other way.

We love that Bill Gates is banging the measurement gong. Looooove it! For those of you who may have missed it, Mr. Gates’ 2013 Annual letter came out a few days ago.  He mentioned measurement or variations of it of 38 times (compare to 23 times for innovation, last year’s theme).  His letter was preceded by a high-visibility My Plan to Fix The World’s Biggest Problems on front page of the Wall Street Journal’s Review section last Saturday.

The need and desire for measurement isn’t an issue in the social sector. Not supporting measurement is sort of like not liking babies. The challenge is: how do we as a global community use data and measurement to fix problems, as Mr. Gates writes, not just talk about it? At D-Rev, we want to support and push our and our communities’ efforts in getting the most out of measurement. We love that Mr. Gates simplified measurement to the actionable and digestible: you have a goal, you figure out the best approach, you measure and you refine. (In design-speak though we’d say iterate rather than refine allowing for more risk.) Yet believing and measuring isn’t enough. The issue isn’t should we measure, it is the measuring the right thing to understand impact – and funding.

Measuring the right thing(s) – what would fall under ‘approach’ – is about getting and using the right data. (Insider test: Who is famous in the social sector for saying ‘Measure the right thing’?  Answer here.) From my perspective, there are three areas where the “right thing” translates to useful data and measurement:

1. What you are measuring – and what it means. Linking meaningful data to your goal is key. While that sounds obvious, impact and outcomes aren’t necessarily simple to measure even with a clear intervention. Too often, we see activities (output) used as a measure of impact. Activities are indicators of potential impact and often provide context to the work, but they aren’t measures of impact.  For example, too much impact reporting cites the number of nurses trained or libraries/schools/hospitals built when we wish they also reported outcome metrics like reduced maternal mortality or increased literacy. The metrics must be meaningful for the goal.
2. What is being used for comparison. No one talks openly about poor or inaccurate baseline or control data – or poor conclusions drawn from perfectly good data.  Sometimes poor data means meaningful data isn’t available or readily collectable (think: kernicterus – brain damage or death from severe jaundice – in rural areas of low-income regions).  Insufficient data doesn’t mean there isn’t a problem – it means we need to collect more and better data. Inaccurate data are data that were never fully vetted in first place – statistics that sound compelling, may even often be cited, but once digging in, can’t be verified or are lacking valid references.  It benefits our sector and our users if we are transparent about these real challenges.
3. What the data means to users and the problem. DALYs (Disability Adjusted Life Years), a public health measure for impact, is useful with meta-data analysis – but it is unhelpful to 99.9% of doctors and patients on the ground.  Similarly, the Millennium Development Goals have united professional communities and given us much-needed common goals, but we can’t lose sight of what we are doing and why.  Too often in our work at D-Rev, we see a focus on a single MDG (#4.2, infant mortality or death), at the expense of infant morbidity (sickness/disease).  The on-the-ground reality is that morbidity issues can be easier to solve and bring as great or better benefit to families living in poverty.  We’d like to see better goals and measurements that benefit our users.

Finally – and most critical for our and others’ ability to use measurement effectively – the reality is that there is next to no funding to support impact assessment in the social sector. The only way we have found to fund it is through unrestricted grants or by forward-thinking groups like Stanford’s SEED program that partially supports our Director of Impact.  If measurement is going to be (better) used in social sector, there needs to be specific and directed funding of it. From a practitioner standpoint, particularly a young and innovative one, funding to support great measurement with meaningful data is – hands down – the greatest challenge to truly addressing some of the world’s biggest problems.

Related + recommended (Send us yours!):

• Glance at how D-Rev thinks about impact (ReMotion Knee, Brilliance)
• The Mulago Foundation’s ‘How We Think about Impact’
• Want to support impact assessment?  We have a new “Impact Dashboard” initiative with Medic Mobile

Starting 2012, our small team of five full-time D-Rev-ers, looked ahead and said: This is going to be an exciting year!

And we had noooo idea… We have had a most excellent year at D-Rev – and I feel humbled, hopeful, challenged, thankful, and inspired from the past twelve months.

Here’s why:

30 – Brilliance units made available to the market in September. All 30 units were sold immediately, requiring the next batch to move into production early.

4,250 – Above-knee amputees wearing our knee thanks to our partnership with the Jaipur Foot Clinic in India.

7 – New incredible hires on staff in 2012 – we’re building a solid team to deliver the best products to our customers.

50&100 – Designers in Fast Company’s Co.Design 50, and the Public Interest Design lists – and while I got named, credit goes to our amazing team at D-Rev.

2 – Patents granted for our technology development.

4 – New countries where we’ve conducted due diligence and expanded our reach.

100-1,000 – Amputees to be fitted during the ReMotion field trials starting in early 2013

23 – Times Bill Gates mentioned “innovation” or some derivative of the word in his 2012 annual letter for his foundation.  I used that as a starting point for talking about designing for impact – and innovation in context – at TEDxStanford.

525 – Facebook “reach” of our most-read blog post: Thinking about a career in design and social impact? Here are some resources. We‘re thrilled there is so much interest in the sector!

22,000 – Rupees it costs to purchase a Brilliance (That’s $400!).

75 – New hospitals and clinics we hadn’t visited before.

250,000 – Dollars we were awarded through a Saving Lives at Birth seed grant for Comet, a phototherapy device for remote clinics. This allowed R&D to begin right away – and is our first federal grant.

4 – engagements and marriages of D-Rev-ers!

7 billion – People in the world and the topic of TEDxSanFrancisco, where D-Rev’s Design Engineer Sam Hamner spoke about the ReMotion Knee changing lives around the world.

2,284 – Steps an amputee takes in a day.  Stay tuned in 2013 for a blog post on how we calculate these numbers, and insight into how we think and look at impact.

Infinite – Thank yous we owe to 6 amazing board members, 20 advisors, and countless donors, family members, supporters, team members, and partners like Eastwick, Wilson-Sonsini, Exponent, Zao Tech, and Smarter Good. We could not have achieved the success of this year without you and your encouragement and help.

Here’s to 2012 – and to an even better 2013!

In honor of World Prematurity Day, here at D-Rev we are taking the opportunity to think about the issues that premature babies face around the world, what D-Rev is currently doing to help, and what we could all be doing to reduce the burden on these tiny (but resilient!) people.

David, a Nigerian boy with kernicterus. Photo credit: PICK Parent

Each year, 12 million infants worldwide require jaundice treatment and over 5.5 million1 infants in developing countries do not receive effective treatment. That leaves nearly 7 million children in the developing world who have a severe form of jaundice that goes untreated. In the developed world, jaundice is considered rather benign as it is widely recognized and generally treated swiftly and effectively, but if jaundice is left untreated, severe cases can result in kernicterus (a type of brain damage) or even death.

When pregnant mothers are not subject to diligent prenatal screening, for example when a mother gives birth at home, the risk of having a child with brain damage from jaundice could be as much as three to a thousand times higher according to our advisor, Dr. Vinny Bhutani of Stanford University’s School of Medicine. Children with kernicterus require special care that costs valuable time and money, which is especially taxing in already resource-strapped regions. The burden can have devastating effects on the child, the family, and the whole community.

A mother sitting with her baby, who is being treated for jaundice with daylight. Photo credit: Ben Cline

This situation does not have to be so dire. Jaundice is a treatable condition – with phototherapy. Blue light shined on a baby’s skin breaks down dangerous bilirubin in the blood to a low, non-toxic level. Phototherapy is effective, it is simple, and it is relatively affordable in the context of the care we have here in North America. That is why D-Rev launched its Neonatal Jaundice Initiative to design and deliver products like Brilliance, which aim to provide affordable, world-class jaundice treatment to the populations who need it most.

Dr. Okolo, a neonatologist at a district-level hospital in Nigeria, spoke with a D-Rever this past year about the impact of jaundice in her home country. Dr. Okolo explains, “In my country, at least 40% [of] infant mortality is contributed by neonatal mortality. When we say the policymakers think the causes of neonatal mortality would just be prematurity, would just be bad asphyxia, yes, these are causes of neonatal mortality. But neonatal jaundice is an important cause of mortality and morbidity.” Watch Dr. Okolo’s full interview in the links below.

If you want to learn more about jaundice and kernicterus, please check out:

• PICK, a group of mothers of children with severe neurological conditions resulting from kernicterus
• World Prematurity Day
• Global Prevention of Kernicterus Network
• Interview with Dr. Okolo on the prevalence of jaundice
• Interview with Dr. Okolo on the effect of Jaundice on vulnerable families

We get a lot of inquiries at D-Rev about the type of work we do, how we got started – and how to get into the field of design for social impact.  We’re thrilled with the interest by so many motivated and talented people, and thought it would make sense to list some of our collective lessons learned and recommended resources.  So this represents not just my opinions (although you can blame me for bad ones), but all of D-Rev’s staff (we had a brainstorm).

With everything and everyone recommended below, we have first – or nearly firsthand – experience.  Keep in mind that our focus is on populations where people live on less than $4 a day, therefore most of our recommendations pertain to those users, customers and markets.  And like good designers – we want to acknowledge our biases: D-Rev has an orientation based on our individual and organizational experiences (see Our team for everyone’s backgrounds), with a good dose of (North American) West-Coast/Silicon Valley/design-thinking ethos thrown in.  This also is far from comprehensive – so if you have recommendations based on your experience, please add your comments.

Garrett testing a electro-surgery unit in Honduras as part of Engineering World Health in 2009.

We recommend:

1. Get familiar with the space. Organizations have varying missions, personalities, track records and cultures.  Besides websites, there are various other resources you can pull to learn more about organizations and social innovation as a field.  Specifically with organizations, consider:

• Impact: What is an organization’s reported impact?  Is the impact actually impact or is it really demographics about users?  If the organization is young, it may not yet have reportable impact – but how are they thinking about it?  This is usually on a website and in annual reports.  In terms of what we mean by impact – the best resource there we think is Kevin Starr’s PopTech talk: Lasting Impact

• Culture: At D-Rev, our focus is on producing the best possible products for our customers, strengthening markets and giving users choice – in some ways a very Silicon Valley approach.  Our culture is a tech startup or design group – not so much a typical NGO or nonprofit.  How to get a sense of an organization’s culture?  Good indicators are an organization’s (and staff’s) twitter feeds, or if the organization has a Facebook page and blog.  To get a sense of the leadership and how the organization thinks, look for TED or TEDx talks by CEOs and founders.  (As a sidenote, keep in mind that smaller organizations and those of us still in startup mode don’t post as much as we’d like given bandwidth.)

• Structure: Consider if you want to work for a non-profit, for-profit or hybrid.  Naturally, at D-Rev we are biased toward non-profits because that structure allows us to prioritize long-term sustainable and scalable impact – but there are real trade-offs with each.  If you are considering working with a US-registered non-profit or foundation, you can look at the organization’s 990 (tax filing).  Transparent organizations tend to post them directly on their websites, but you can (usually) find them through Guidestar or googling the name of the organization and “990”.

• Tools.  Any user-centric design exposure and application. For great hands-on tools: Human-Centered Design Toolkit. The thing to keep in mind though is that users are far from homogenous and not all design tools work in all cultures or use settings. Design is about creating, but it is more about solving problems – and we are big believers in integrating the business, delivery and any servicing models into product development as early as possible.

To learn more about social innovation as a field, dig into:

• The bigger picture: Garrett Spiegel, our R+D engineer, recommends reading about and researching international aid and social impact work in order to develop your own philosophies on aid and design.  Says Garrett: “If you are like me [an engineer] you didn’t read books and take classes through school.”

Sara meeting with a chief in Makeni, Sierra Leone, in 2003 as part of her work with the Truth and Reconciliation Commission. (The chair was given to him by Queen Elizabeth!)

• Customers. Jayanth Chakravarthy, who leads our neonatal jaundice work, recommends having a regional or topical focus that aligns with your work interest.  For example, if you are most interested in Indian markets, be plugged into India-related groups, news and organizations.  Sara Tollefson, our Director of Impact, volunteered with the International Center for Transitional Justice in New York while in law school, and this led her to work on transitional justice issues in Ghana, Sierra Leone, and Liberia.

• The history. Social innovation as a concept actually isn’t so new – it has benefited from lessons of the early days of foreign and domestic aid, the era of “structural adjustment” – and above all the “Appropriate Technology” movement.  It pains us to see reinvention of the wheel and the same mistake made for the n-th time (although we – sigh – do that too.)  From our perspective, the early movers in social innovation were Practical Action (formerly ITDG, started by E.F. Schmuacher who is credited with starting Appropriate or “Intermediate Technology”), International Development Enterprises (IDE) and KickStart (formerly ApproTEC).  We will likely post a list of recommended readings soon – so stay tuned for that.

2. Get field experience. Field experience to us is working directly with users and customers in their environment long enough that some of your preconceived notions have been turned upside down.  It also helps you figure out if this is the type of work you really want to do – and be more hirable.

Jenny as a Kiva Fellow visiting a group of women borrowers in Kisumu, Kenya, in 2010. These women were part of a group of 15 farmers and bag weavers.

• Look into fellowship and internship programs. Here are a few we recommend:
  • IDEO.org, Kiva.org (Jenny Jin, our Marketing & Communications Specialist was a kiva.org fellow), and One Acre Fund.
  • Garrett recommends “34 Places To Find That New Job: Social Innovators Edition” via Forbes.
  • Many excellent small and far-flung groups like myAgro and Proximity Designs also often post amazing in-country internships and fellowships; to find them you need to go directly to their websites.
  • Who are the up+comers in social innovation?  Look through the portfolios of the Mulago Foundation, PopTech Social Innovation and Echoing Green.
  • Paul Polak (@outofpoverty) and Heather Fleming of Catapult Designs (@Catapult_Design) often forward interesting job announcements in their Twitter feeds.
  • If you are interested in policy and have advanced degrees and/or good experience in science or engineering, consider also the American Association for the Advancement of Science Fellowships. It’s not design per se – but it is invaluable experience as to how the government works relative to technology and society.  I was one in 2004-2005 and as an Iraq economic officer at the US Dept of State.  Some other former fellows in the social sector: Alex Dehgan, now Science and Technology Advisor to the USAID Administrator. Jeff Albert and Rajiv Khush (founders of Aquaya Institute), Alexander Nicholas (program officer at the Lemelson Foundation).

• If you are a university student:
  • Take classes that give impact-minded international exposure.  Our favorites are Design for Extreme Affordability in the d.school at Stanford (Samuel Hamner, our design engineer, is an alum, and I teach in it), and Kara Palamountain’s Global Health Initiative course at Northwestern’s Kellogg School of management (D-Rev Business analysts and advisors Marney Binns, Amy Schellpfeffer and Dorothy Zhuomei are alums of).  Garrett was a program associate at Rice, and coached teams from the Global Health Technologies minor (see Rice 360).
  

  Sam took Stanford's Extreme class in 2009. His team worked with IDE-Ethiopia.

  • Student competitions, Sam suggested BPC (Biz Plan Competitions) with a database of social innovation business plan competitions.  The ReMotion Knee won Stanford BASES Social-E Challenge and UC-Berkeley’s Global Social Innovation Challenge.
  • Extracurriculars. When hiring, we look for strong involvement in social organizations.  In undergrad (yes, eons ago), I was active in Vanderbilt’s Alternative Spring Break program – my good friend, Mike MacHarg, a co-founder of Simpa Networks, was also an active ASBer way back when.
  • Mix it up. More and more schools are offering great new and interdisciplinary class and programs, but we think all policy, international development, and language experiences are a great mix with a technical degree.

The site leader journal for Vanderbilt's Alternative Spring Break program 1995 - the year I was a co-chair. (Check out the clip art, y'all!)

3. Get networked. There are resources available if you have an internet connection already. We like keeping up with the nuances in our and related fields through Twitter and blogs.

Online:

• Twitter: We like ones that aren’t the usual blah-blah.  Here are some of my favorites: Fast Company (and Fast Co.Design), (Co.Create and Co.Exist); Jim Frutcherman of Benetech (@JRandomF), Meg Wirth of Maternova (@maternova). Garrett recommends (and some are repeats): @EchoingGreen, @SSIReview, @GOOD, @medic, @stanforddschool, @engineer4change, @designother90, @whiteafrican, @catapult_design, @nytimesfixes, @IDEOorg.

• Blogs: Stanford Social Innovation Review (@SSIReview) – we particularly love posts from Kevin Starr and Laura Hattendorf of the Mulago Foundation.  Other fab resources: Paul Hudnut’s BOPreneur, Paul Polak’s Out of Poverty and John Cary’s Public Interest Design.

• Forums: We like Engineering For Change. Sam says: “From webinars to a network of experts to jobs postings, the site does a good job of pulling a lot of great information together in one place.”

• Groups: There are lots of great professional groups on LinkedIn and Google.  We like the Design for America Network and several medical device and regional groups (e.g. Indo-US Coalition for Low-Cost Medical Technologies).  Nicole Rappin, our office manager, recommends the Social Innovation Google group – that’s how she found her job at D-Rev!

Get up and go to:

• An exhibit: There are several museum-style exhibits on design and social innovation: the Cooper-Hewitt’s Design for the Other 90%, and the Autodesk Gallery’s Public Interest Design (San Francisco).

• A function: It can be difficult for smaller organizations like ours to host visitors, but you should be on the look out for organizations having Open Studios or fundraisers. Those functions – usually a few times a year – are a great way to meet staff and learn more about an organization’s work (and be sure to donate – even a small amount!).

4. Be flexible. You probably already know this, but a few things to be aware of when thinking about joining the social sector:

• The salaries in social enterprises aren’t (yet) comparable to the private sector – or even the public sector.  We hope that changes; we would love to see good work earn market-par salaries.

• Volunteering to an organization isn’t free – we, of course, love smart and talented people contacting us and saying they have a funding to work with us pro bono.  We’ll still put you through our hiring process – in addition to ensuring you have a great experience, we want to make sure you are a strong and productive member of our team.

• The longer you can commit to working and the more flexible you can be in the type of work you do (well), the more likely you’ll find a great match!

Naivasha District Hospital, a public hospital in Naivasha, Kenya

My colleague Dorothy Zhuomei and I have been in East Africa on a short-term assignment to better understand neonatal healthcare and delivery. We’ve learned a great deal and have had the good fortune of witnessing a transforming Africa.

Let me start by describing for you the situation as we see it. There exists a wide range of healthcare facilities in East Africa. The public systems are the most commonly used, given their affordability to patients, yet oftentimes are the least resourced financially. This in turn affects the quality of medical devices – like phototherapy lights – used. In contrast, there also exist strong private hospital networks. Care at these facilities is affordable only to the region’s affluent residents.

The high cost of service means private hospitals have the spending power to obtain the latest and greatest medical technologies, like LED phototherapy lights. Somewhere in the middle of the two extremes lie faith-based and NGO hospitals. These hospitals are run as non-profit centers and can therefore plow back the small fees they charge patients into improving the quality of service.

Jamaa Mission Hospital, a faith-based hospital in Nairobi

More than once, I caught myself mid-interview with a healthcare worker thinking, “OK – so when I get back to the U.S., I’ll pack up a box of blue bulbs and ship it here so they can at least start using blue instead of white light to treat jaundice.” After pulling myself back from wandering thoughts, my rational mind reminded me that continuing the trend of unsustainable solutions is not the answer.

Once I stopped and listened to the inspiring, hard-working, tireless doctors and nurses in front me, I could hear clearly that these people are in fact not helpless. They are resourceful and determined and also want run-down, unfixable, and donated equipment to become a thing of the past.

The stories of our new friends Christine and Margaret are just two examples that Dorothy and I witnessed of passionate people defying old norms and using innovative approaches to improve neonatal care.

The author (left) with Sister Christine (right), who single-handedly built her hospital’s Newborn Unit

Sister Christine single-handedly built her hospital’s Newborn Unit. After months of persistent requests, the hospital gave her a small space to establish the unit. After being told multiple times that there were no funds to purchase equipment, she started pulling old, used equipment from corners of the hospital, then took the initiative to seek out donors who could help outfit her ward.

She uses anti-microbial curtains for walls, insists all who enter her unit wear hairnets, masks, and robes (unfortunately not common practice as we’ve seen) and improvises wherever necessary (see the photo showing the “octopus” she made to split oxygen lines). Through her diligence in operations and data management, she has effectively driven infant mortality at her hospital to zero.

Determined health workers improvise where they can. Above, the “octopus” that Nurse Christine made to split oxygen lines.

Margaret, another inspiring healthcare worker we met, is a pediatrician who specializes in infant care. She recently left her high-profile job at the local public hospital and is now building her own affordable care children’s hospital. During our time with her she talked about her dislike for the words “low-resourced” and “developing”. She believes that Africa has ample resources, and that purchasing devices versus receiving donations is an important part of a hospital’s ability to sustain itself appropriately.

These are just two of the many examples we saw of a transformation in the mentality and actions of healthcare workers in East Africa. We have been inspired to be a part of D-Rev’s mission to deliver user-driven design to those in need, and in a way that supports their desire for sustainability.

Lastly, a thank you to the National Collegiate Inventors and Innovators Alliance for supporting our work with a Sustainable Vision Grant.