Krista Donaldson, Chief Executive Officer, Equalize Health 
In conversation with: Kristen Bellstrom, FORTUNE


Brainstorm Design 2022 - Designing Our Way To Health Equity 

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Brainstorm Design 2022 - Health Equity 



Brainstorm Design 2022 - Designing Our Way To Health Equity 


new medical devices are seldom designed to be low cost and accessible. Equalized health is upending that paradigm and their innovative products are reducing health inequities around the world set up as a non profit charity equalizes focused on providing medical technology for everyone. Its products include a sweet photo therapy devices that treat severe jaundice which could be fatal to infants. Nearly 1.5 million patients worldwide have been treated with equalized products Of whom some 1.2 million would not be other not otherwise have had access to effective treatment. Let's turn out Equalized, maintains a relentless patient focus and delivers on the promise of design for social impact. With that. I would love to welcome to the stage Krista Donaldson, the chief executive Officer of Equalized Health in conversation with fortune. Executive editor Kristen Bell strong. Thank you. Mhm Welcome Krista. Thank you. Um So we we got a little bit of this and in the intro but I just like to start by having you know in your own words like what is the mission of Equalize health. Our mission is to create health technologies for everyone. And I know when we talk about medical devices are often thinking about our own experiences and hospitals here and I'm gonna show a few pictures soon. But if you think about low income areas in all parts of the world and health conditions that aren't being treated about like for example, 90% of babies when we started on the photo therapy project didn't have access to jaundice treatment, which is kind of crazy if you think about it's something we don't even think about here in the US and we're going to dive in. But I was just personally was was interested in your background because let's see, tell me if I get this right, you have a master's in product design and a PhD in mechanical engineering. Uh what I don't here and there is a global health anything. So um what was your what your journey? I think like so many people who work in health, I don't know how many people here work in health. Okay. Yeah, I I came in, my dad was a doctor, my mom was a social worker to Rachel, I really appreciate what you say and I kind of avoided all that stuff and then of course I found my way there and I found my way there originally equalized health was called which is short for design revolution and we had health products and um the more I dug in the more I was like this is such an area that needs design. Um and I think coming from mechanical engineering where things felt very concrete medicine was so interesting because it was more, it was an art, it was like science, it was all these different things coming together but such an opportunity to bring patient centered thinking like figuring out who the stakeholders are, who's the decision maker and how all that comes together and creating solutions and uh you're a nonprofit which you know, there are many medical device makers. Um, but obviously you're filling some sort of need that is not being filled by those companies. So why do you feel like why is nonprofit the approach for, for the kind of work that you do? You know the first thing I'll say is um, we are structured as a nonprofit. We have um a private limited in India and we're setting up one in kenya, but we like to say that we, we act like a regular medical device company except for our currency is impact. Um, we raise philanthropy for the R and D and then we can develop the product and they go to market. Um, we're searching as a nonprofit for a couple of reasons though. We are focused on problems that the typical for profit MedTech industry doesn't necessarily have the financial incentive to address, particularly in the design and development of products and what we're finding like from the design side raising the philanthropy to do really good user market research. It enables us to really dig in and understand the context. The last thing I'd add is that um, you know, compared to many medical device companies where you know, you have competition, we actually like competition. If we see for example more high quality, affordable, I don't like to say low cost, affordable photo therapy devices in rural Uttar Pradesh India. We're doing a good job because we want to see competition coming in. We want to see healthcare workers around the world have choice and we know that we're not going to be the only ones to provide that. Okay I think you have a slide that gives us a sense of where you work. Yes I do. Okay. There we go. So um our products are sold in 79 countries. Um you can see uh we mostly most of our market is in India, our largest offices in New Delhi and followed by the East African region. Um but if you can see we have sales across the world, largely low and middle-income countries. Mhm. Um and you touched on this already but you know these are not products that are going to like Mount Sinai, these are products that can be used in very specific types of um you know, caregiving hospitals and other places in in all these different countries. Uh So so give us a sense of like what what are the types of environments you're designing for and how does that affect how you look at the problem. Yeah. So we're really looking at where there's health disparities and where um where there's solutions that are needed. Um and in many cases the technology and the know how already exist but they're just not reaching some of these facilities. So you're looking at a photo here from a large hospital in Uganda. Um And just to point out a few things there, you can see it's overcrowded and that's what we've seen. So many of the hospitals that we work in, which is very different. I mean we had overcrowding here, we've got a real lesson with Covid, but this is the norm in many of the hospitals we work and if you look closely, I appreciate that John Maeda talked about respiratory distress is like the third area because that's an area we work as well. But if you look at these photos, the babies are actually sharing lines to CPAP device into oxygen. And this is how this hospital is addressing the need for respiratory support for babies. So let's take a look at some of what you've designed. What I thought I would do is share some design insights particularly around health equity and some of the lessons learned. So the first one we didn't talk about, which was part of my introduction is photo therapy. So photo therapy is blue light to treat severe neonatal jaundice in this case. Um when we started digging into the problem um no, 10 years ago, uh cost was an issue. And I think when people think about health equity, they often think like, oh it's just the devices need to be more affordable and that's true, but it's not just affordability and in fact what we typically see in this is a photo from a hospital um in Karnataka India, what we typically see is a medical device that has been designed for here or for europe and it's been de featured to make it more affordable and then sold in other markets. Um So when we dug in and really try to understand users markets everything related to photo therapy, we saw scenes like this. So does anyone know why this photo therapy devices not that effective? I just gave you a hint in the last slide. Yes, the fluorescent light but it's white light. Um and the blue light is what provides the treatment for severe jaundice and some of your will say, oh yeah, well white light has blue light in it but it's not intense enough to provide the treatment, but this is actually quite typical for what we see. So yes, someone said there's burned out bulbs and that's right. There's real supply chain issues around replacement bulbs for photo therapy. They're very expensive in India. You'd see them from like 12 to $20 per bald. Um Oops, can we go back a slide? I think I accidentally hit it. Um 12 to $20 in Kampala Uganda, they were almost $200 per bulb. And these are bulbs that need to be replaced every 3 to 6 months. You can imagine very quickly. It's not just the cost of the device but it's the operating costs. And so we were seeing this sort of scene over and over again if the facility even had a photo therapy device. So the first kind of aspect of design for health equity is really run designed for serviceability and so this is really what that's about. And the device we designed used L. E. D. S. So L. E. D. S. As many of you know last a really long time and in fact they last about seven years before they start to diminish a little bit beef. And also designed for that. Um Second insight is related to respiratory support. So we have a neonatal CPAP device who's familiar with CPAP. Yeah many people know about it because it's for COPD um particularly as we get on in our years but it is respiratory distress is the major killer of premature babies globally. Um and to give you a sense cpap for neonatal has been around for 50 years but yet it's still the major killer. When we dug into this problem. It was really interesting and I mentioned about how devices are G featured and sold into lower income areas. And this is really true with CPAP. Um As we did our user research though, what we found is it was an issue of staffing. So CPAP they're designed assuming there's one nurse per baby or one nurse for two babies. And that's typically what the device expects or the designers expect. But um in India and many of the other places we work it's one nurse per eight babies, one nurse per 10 babies. And you can imagine with a critical care device the device can't do they can't behave the same way it would necessarily if there's a nurse hovering around so we did a couple of things um with with this device and actually I should just point out in this photo. So some of the ways that hospitals manage it when they don't have access to affordable, affordable CPAP is will make homemade devices and this is actually a homemade CPAP device. You see a drainage bag at the bottom and that's actually how the pressure is set with the baby. They put a tube down into water and that sets the pressure that the baby is receiving which you can imagine is not great. Right? Can I ask you questions? So um do you look at those homemade devices to help inform? Thinking about like what works in this particular environment? Yeah. And in fact when we see how many devices I'm like wow this is really a high priority in this hospital. Right? Because if if clinicians are at a point where they are designing or getting someone to design a device, this is like a huge need. Right? 11 interesting side note to about your question um with bubble CPAP we designed a flow driven CPAP which means that there's a fan that drives the pressure um as compared to bubble which is the tube but so many clinicians were used to the bubbling that we actually considered a fake bubbler on our CPAP because that's what they expected in the end. We didn't go with it. But um that was interesting learning. Um this is just a quick picture of the CPAP. One thing I'll just mentioned with nurses were recognizing nurses were under so much stress, there's a lot of turnover. So our device is very clear on, you know, the settings like the oxygen, you know, starts to diminish. It alerts you, the nurse doesn't have to think so much. It says like oxygen. Um please please address. Um The other thing too is that there's instructions on it and that's because we saw such high nurse turnover and it was dependent on training, training being able to use it whereas if it's on the device as an option then the device can train the nurse. Um The last thing I just mentioned on this particular device is um many medical devices make a lot of money off of proprietary consumable. So you know, the tubes that you need for each patient. And we saw that that was a real barrier to health equity in this sense that we'd see functioning CPAP sitting for example in a rural hospital in Rwanda, but they didn't have the right consumables to go with the C path. So the device was sitting there. So with our device, we designed it to take any type of consumable. So I would say the lesson kind of coming out of this um example is really around designing what for reality as compared to what we think should be. And I think, you know, this aspect of there not being enough nurses is something in healthcare. We don't design enough for. Um, and I think your final, this is the final example is the maternal well trained also, maternal trade. Yeah. So the last example I wanted to give around health equity is that we've started to work with local innovators who have great ideas and these are often doctors or nurses or repair people. And so the maternal well trade, which you're looking at is for postpartum hemorrhage. So when women start to bleed after giving birth and this is the major killer of women globally, um, at birth. Um, but it was developed by this incredible doctor in South Africa who works in Botswana, but he has dedicated his life to saving women's lives. And so he had this idea, but he's not someone who can, you know, design a product, get through regular regulatory control, find a commercial partner, figure out all the distribution that we've partnered with him. And we're really excited because this device is going to come to market later this year. And what it is, is it just measures blood loss after birth because so often doctors are eyeballing the blood loss and if you slow blood loss or there's chaos during the delivery, which very often happens. Um, the attention goes away from the mom and the and the bleeding and you can lose the mom. Yes. Just let me just add one. Yeah, sorry. From, from a, from a health equity standpoint though. I think the last kind of point is, is being able to co design with innovators who are on the front lines. Uh, I wanted to ask you, you know, I'm sure you go into a lot of these situations and there are so many needs um how do you decide? This is what we're going to address? This is the place, we feel like we can make a difference. How do you make that decision? So we so care about what people are saying other problems. So I had a former Minister of Health and Rwanda say please work on CPAP and at the time we were like no, there's other devices out there, but we kept hearing about it. We actually had one doctor, I'm in a rural area who asked us for CPAP and he had been trained on CPAP had trained in Belgium and I asked him how do you, how do you care for babies now? And he said, I only pray for them. So we, we look we look to see where it's a problem, We work on problems that are global in scale and our team does due diligence in all different types of markets and then if it's a global problem and we think we can solve it will work on it. Um Thank you so much Crystal, that was Matthew, thanks everyone