WEBVTT

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Nine years ago, I worked

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for the U.S. government in Iraq,

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helping rebuild the electricity infrastructure.

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And I was there, and I worked in that job

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because I believe that technology

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can improve people's lives.

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One afternoon, I had tea with a storekeeper

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at the Al Rasheed Hotel in Baghdad,

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and he said to me, "You Americans,

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you can put a man on the moon,

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but when I get home tonight,

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I won't be able to turn on my lights."

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At the time, the U.S. government had spent

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more than two billion dollars

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on electricity reconstruction.

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How do you ensure technology reaches users?

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How do you put it in their hands

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so that it is useful?

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So those are the questions that my colleagues and I

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at D-Rev ask ourselves.

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And D-Rev is short for Design Revolution.

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And I took over the organization four years ago

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and really focused it on developing products

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that actually reach users,

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and not just any users,

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but customers who live on
less than four dollars a day.

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One of the key areas we've been working on recently

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is medical devices, and while it may not be obvious

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that medical devices have something in common

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with Iraq's electricity grid then,

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there are some commonalities.

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Despite the advanced technology,

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it's not reaching the people who need it most.

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So I'm going to tell you about one of
the projects we've been working on,

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the ReMotion Knee, and it's a prosthetic knee

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for above-knee amputees.

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And this project started when
the Jaipur Foot Organization,

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the largest fitter of prosthetic limbs in the world,

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came to the Bay Area and they said,

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"We need a better knee."

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Chances are, if you're living on
less than four dollars a day,

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and you're an amputee,

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you've lost your limb in a vehicle accident.

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Most people think it's land mines,

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but it's a vehicle accident.

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You're walking by the side of the road

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and you're hit by a truck,

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or you're trying to to jump on a moving train,

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you're late for work, and your pant leg gets caught.

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And the reality is that if
you don't have much money,

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like this young named Kamal right here,

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the option you really have

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is a bamboo staff to get around.

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And how big a problem is this?

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There's over three million amputees every year

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who need a new or replacement knee.

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And what are their options?

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This is a high-end. This is
what we'd call a "smart knee."

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It's got a microprocessor inside.

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It can pretty much do anything,

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but it's 20,000 dollars,

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and to give you a sense of who wears this,

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veterans, American veterans coming
back from Afghanistan or Iraq

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would be fit with something like this.

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This is a low-end titanium knee.

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It's a polycentric knee, and all that that means

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is the mechanism, is a four-bar mechanism,

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that mimics a natural human knee.

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But at 1,400 dollars, it's still too expensive

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for people like Kamal.

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And lastly, here you see a low-end knee.

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This is a knee that's been designed specifically

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for poor people.

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And while you have affordability,

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you've lost on functionality.

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The mechanism here is a single axis,

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and a single axis is like a door hinge.

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So you can think about how unstable that would be.

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And this is the type of mechanism

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that the Jaipur Foot Organization was using
when they were looking for a better knee,

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and I just wanted to give you a sense
of what a leg system looks like,

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because I'm showing you all these knees

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and I imagine it's hard to think 
how it all fits together.

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So at the top you have a socket,

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and this fits over someone's residual limb,

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and everyone's residual limb is a little bit different.

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And then you have the knee,

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and here I've got a single axis on the knee

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so you can see how it rotates,

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and then a pylon, and then a foot.

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And we've been able to develop a knee,

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a polycentric knee, so that type of knee

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that acts like a human knee, mimics human gait,

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for 80 dollars retail.

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(Applause)

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But the key is, you can have this great invention,

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you can have this great design, but how do you get it

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to the people who most need it?

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How do you ensure it gets to them
and it improves their lives?

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So at D-Rev, we've done some other projects,

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and we looked at three things that we really believe

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gets technologies to customers, to users,

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to people who need it.

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And the first thing is that the product 
needs to be world class.

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It needs to perform on par

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or better than the best products on the market.

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Regardless of your income level,

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you want the most beautiful,

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the best product that there is.

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I'm going to show you a video now

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of a man named Ash. You can see him walking.

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He's wearing the same knee system here

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with a single axis knee.

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And he's doing a 10-meter walk test.

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And you'll notice that he's struggling 
with stability as he's walking.

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And something that's not obvious, that you can't see,

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is that it's psychologically draining

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to walk and to be preventing yourself from falling.

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Now this is a video of Kamal.

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You remember Kamal earlier,
holding the bamboo staff.

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He's wearing one of the earlier versions of our knee,

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and he's doing that same 10-meter walk test.

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And you can see his stability is much better.

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So world class isn't just about
technical performance.

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It's also about human performance.

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And most medical devices, we've learned,

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as we've dug in, are really designed for Westerners,

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for wealthier economies.

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But the reality is our users, our customers,

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they do different things. They sit cross-legged more.

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We see that they squat. They kneel in prayer.

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And we designed our knee to have
the greatest range of motion

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of almost any other knee on the market.

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So the second thing we learned, and this leads

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into my second point, which is that we believe

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that products need to be
designed to be user-centric.

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And at D-Rev, we go one step further and we say

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you need to be user-obsessed.

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So it's not just the end user
that you're thinking about,

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but everyone who interacts with the product,

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so, for example, the prosthetist who fits the knee,

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but also the context in which the knee is being fit.

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What is the local market like?

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How do all these components get to the clinic?

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Do they all get there on time? The supply chain.

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Everything that goes into ensuring

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that this product gets to the end user,

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and it goes in as part of the system, and it's used.

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So I wanted to show you some of the iterations

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we did between the first version, the Jaipur Knee,

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so this is it right here.

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(Clicking)

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Notice anything about it?

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It clicks.

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We'd seen that users had actually modified it.

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So do you see that black strip right there?

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That's a homemade noise dampener.

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We also saw that our users had modified it

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in other ways.

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You can see there that that particular amputee,

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he had wrapped bandages around the knee.

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He'd made a cosmesis.

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And if you look at the knee,

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it's got those pointy edges, right?

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So if you're wearing it under pants or a skirt

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or a sari, it's really obvious

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that you're wearing a prosthetic limb,

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and in societies where there's social
stigma around being disabled,

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people are particularly acute about this.

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So I'm going to show you some
of the modifications we did.

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We did a lot of iterations, not just 
around this, but some other things.

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But here we have the version three, 
the ReMotion Knee,

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but if you look in here, you can see

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the noise dampener. It's quieter.

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The other thing we did is that
we smoothed the profile.

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We made it thinner.

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And something that's not obvious is that we

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designed it for mass production.

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And this goes into my last point.

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We really, truly believe that if a product

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is going to reach users at the scale that it's needed,

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it needs to be market-driven,

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and market-driven means that products are sold.

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They're not donated. They're not heavily subsidized.

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Our product needs to be designed to offer value

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to the end user.

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It also has to be designed to be very affordable.

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But a product that is valued by a customer

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is used by a customer,

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and use is what creates impact.

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And we believe that as designers,

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it holds us accountable to our customers.

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And with centralized manufacturing,

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you can control the quality control,

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and you can hit that $80 price point

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with profit margins built in.

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And now, those profit margins are critical,

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because if you want to scale, if you want to reach

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all the people in the world who possibly need a knee,

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it needs to be economically sustainable.

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So I want to give you a sense of where we are at.

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We have fit over 5,000 amputees,

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and one of the big indicators
we're looking at, of course,

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is, does it improve lives?

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Well, the standard is, is someone

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still wearing their knee six months later?

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The industry average is about 65 percent.

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Ours is 79 percent,

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and we're hoping to get that higher.

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Right now, our knees are worn in 12 countries.

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This is where we want to get, though,

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in the next three years.

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We'll double the impact in 2015,

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and we'll double it each of
the following years after that.

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But then we hit a new challenge,

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and that's the number of skilled prosthetists

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who are able to fit knees.

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So I want to end with a story of Pournima.

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Pournima was 18 years old

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when she was in a car accident
where she lost her leg,

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and she traveled 12 hours by train

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to come to the clinic to be fit with a knee,

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and while all of the amputees who wear our knees

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affect us as the designers,

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she's particularly meaningful to me 
as an engineer and as a woman,

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because she was in school,

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she had just started school to study engineering.

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And she said, "Well, now that I can walk again,

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I can go back and complete my studies."

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And to me she represents the next generation

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of engineers solving problems

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and ensuring meaningful technologies

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reach their users.

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So thank you.

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(Applause)