>>ELIZA WILLIS: I'm Eliza Willis, a professor of Political Science and a member of the Grinnell Prize Committee and it's my pleasure to introduce to you Jane Chen and Linus Liang, 2012 winners of the Grinnell Prize in Social Justice. Jane and Linus received this award in recognition of their innovations in designing and distributing a low cost baby warmer that has already saved the lives of thousands of premature and low-weight babies born in India, China and Zambia. And very soon, it will be introduced in Afghanistan. Their goal is to distribute their baby incubator to one million families in poor countries over the next 5 years. If you've had the opportunity and privilege of meeting Jane and Linus or hearing them talk over the past few days, you know that they will achieve or probably surpass this goal.
Jane and Linus have founded two companies – Embrace, a non-profit and Embrace Innovations, a for-profit. I'm sure they'll talk in more detail about the division of labor between these two companies. In examining their nomination, the Prize Committee was struck by Jane and Linus' innovation beyond their original invention to figuring out how they could continue to provide infant warmers to parents in need while also applying their creative energies to developing other affordable health products for poor communities in the developing world.
As a professor who teaches about poverty alleviation in the developing world, I was excited to learn that Embrace grew out of a class project. Jane who completed her undergraduate work at Pomona College and Linus who received his Bachelors in Computer Science at UC Berkeley were both working on their respective Master Degrees at Stanford when they enrolled in the course "Entrepreneurial Experience in Extreme Affordability." Their major class assignment entailed designing an extremely low cost incubator to be used in rural conditions across the globe. They met that challenge by designing a low cost incubator that cost just 1% of a traditional incubator and deciding to take their invention to the real world through Embrace.
While this week we are celebrating their selection as Grinnell Prize winners, Embrace and its founders have been honored with many awards and other forms of recognition. Embrace won gold at the International Design Excellence Awards and is a 2012 Tech Awards Laureate and one of twelve global innovators recognized for developing technology that benefits humanity and sparks global change. It is also a finalist for the 2012 Fast Company in Innovation by Design Award.
Jane has received several honors. She's a TEDIndia Fellow – I first got to know her by watching one of her TED presentations actually – TED Senior Fellow, an Echoing Green Fellow and was selected as a Young Global Leader by the World Economic Forum in 2012.
Linus was a recipient of Stanford's 2008 James W. Lyons Award for Service Contributions. He also received a First in the 2007 Charles River Entrepreneurship Idol Competition and a Second at the Stanford BASES Business Plan Symposium. He's received two patents – one of which involves the system and method used to regulate temperature in the Embrace incubator.
One of the goals of the Grinnell Prize is to identify young innovators for social justice whose accomplishments to date provide a strong predictor of future contributions. If past is prologue and the Prize Committee strongly believes it is, then we look forward to many more exciting and transformative innovations from Jane Chen and Linus Liang. Please join me in giving them a warm Grinnell welcome.
>>JANE CHEN: Alright, thank you so much for having us here today. I hope we're as exciting as ice cream. [Laughter] So I'd like to start by taking the audience through a short exercise. Please close your eyes and hold out your hands in front of you. Now imagine what you could place inside your hands – your keys, maybe your wallet? Open your eyes. What about a life? What you see here is a premature baby. He looks like he's sleeping peacefully when in fact he's struggling to stay alive because he can't regulate his own body temperature.
Sadly, 20 million low birth weight and premature babies are born every year around the world. 4 million babies die in the first 28 days of their life - that's 450 babies every hour. One of the biggest problems these babies face is staying warm because they are so tiny they don't have enough body fat to regulate their own body temperature, so as a result of that many either die or grow up with severe, long-term health problems. Baby incubators are the primary solution to this problem but they are expensive – they cost up to $20,000 – they require a constant supply of electricity and they are difficult to operate so you're not going to find them in rural areas where many of these babies are dying.
Instead you hear stories like this. This is a woman Sujapa who I met on one of my first trips to India. She lives in a village in South India. Sujapa gave birth to this premature baby. He was two months premature but she didn't have the means to access a hospital. So instead she and her husband, who grows silkworms for a living, placed their baby under a light bulb to provide him with warmth. He died about two days later. Even in places where there are hospitals and there are facilities, this is the scene that you often witness all across India.
>>NARRATOR IN VIDEO: She says her final goodbye to her son. Rikshana gave birth to Sirajathim just 8 days ago but his loss today will remain with her forever.
>>INTERPRETER FOR MOTHER: We couldn't afford to take him anywhere else. But if we knew he was going to be treated like this, we would never have brought him here.
>>NARRATOR: Sirajathin is among at least 41 children who've died at this hospital in Maltar District. In wards like these, mothers are left to take care of their sick children on their own. Almost all of them tell us there aren't any doctors here. Some, like this woman are too shocked to even take their dead babies back home. There's still no official explanation as to what's causing these deaths, but in wards like these, we see the inhuman conditions patients are treated in. Three or four babies crammed together on a single bed. No doctors are treating patients and families like these, lying on the floor.
>>REPORTER: This is what a typical day at this hospital looks like. This general ward can probably accommodate about 40 children at best but as you can see there are more than 200 children crammed into this tiny space. There's garbage strewn all over the place, the conditions here are extremely filthy but people say that despite these horrific hygienic conditions, they literally have no choice. That's because this state hospital services hundreds of villages across this area.
>>NARRATOR: This isn't the first time that infants have died here. Last year 120 infants died within a month from November to December. But despite those earlier deaths, this hospital hasn't upgraded its equipment. Nurses here tell us they got this machine just yesterday. Despite the alarm buzzing, they don't do anything. They just don't know how to use it.
>>LINUS LIANG: So as Jane was saying, this is the situation we've seen all through India. I actually travelled to Nepal to visit hospitals similar to these and talk to the doctors and the nurses and meet with them to really understand the issues and the constraints that they are dealing with. So I went to Nepal, I talked to a lot of these doctors and then eventually, I came back to Stanford. Jane and I formed a team along with two other co-founders to really try to figure out how we can really make progress in this. So we met in this class that is called Extreme Affordability. The idea of the class is to actually teach design but use that method of product design and apply it to a social cause. So the challenge was to build a low cost incubator –normal incubators as Jane was saying was $20,000 – and our challenge was to build it for 1% of the cost.
So sort of the first step in design is to really understand, observe, and really understand the problem. That is what I was doing in Nepal and that is what we did when we came back to California. What we realized was that most of the time, babies are often born one or two weeks premature and all they need is a constant supply of temperature – they need to stabilize their body temperature. Because even at one or two weeks premature, their systems are not developed enough to actually regulate their own temperature. So this is actually very, very harmful for them and if they get stabilized they can actually grow up very healthy and lead productive lives.
So we came and got together and we experimented with all these different types of ideas and we focused on temperature stabilization – the main function of an incubator. So here are some early sketches – very cliché – but back of a napkin type of sketches and we came up and we rapidly prototyped. In the picture on the right, we actually used butter to see how we could use that to store and release temperature easily.
Our first idea was actually – the thing they actually teach you in this design class is rapidly prototype, try different ideas, fail early and fail often. So what we actually did is that we got together and went to Salvation Army and got all these baby supplies and we actually put our first prototype – there's a pipe, if you can see it, where you can put hot water through and try to warm the baby up that way. But then we realized that that pipe is very dangerously close to the head so that was an idea we scrapped out. So we constantly iterated throughout that quarter at Stanford and we came up with other ideas. We realized that babies don't wear diapers oftentimes in these countries so we had to make something that was waterproof, that was easily cleanable. Here's another prototype as we went along the way – this one where we realized that, well, if they're going to go to the bathroom in the sleeping bag what we needed to do was actually make something that was very medical grade that was not going to gather bacteria. This is another prototype with a specialized material that is actually very easily cleanable and doesn't harbor bacteria.
Then when we were done with that, we actually started going into the field and testing these with mothers and users just for usability. We really believe that we have to be very close to the user to really understand them in order to build something that people want, our users will need and is easy to use. So we all moved to India shortly afterwards – the four co-founders – and began showing these prototypes to mothers and doctors and nurses.
When we got there, we realized that they didn't want to put our warming device directly on top of their babies. This was actually a big learning for us because we didn't have that problem in the US. Because doctors in the US said it should be as close to the warmth as possible but mothers were not very comfortable with that. So, we quickly changed that design. We also found later on that the doctors and the mothers wanted to see the baby's chest moving because that's how they actually tested that the baby was breathing correctly and that it didn't have any problems. In the US we have all these monitoring devices and electronics but in these countries, they don't really have that type of stuff so they want to do this visual inspection. So we created a window in the front of the device for that.
So again, more testing. We did fitting testing. This is a picture of actually Jane's nephew a couple of days after he was born and we put him in another prototype. So it's pretty cute.
And then finally, there are all these different things that we learned, that we didn't know about until we went into the field. For example, this was a temperature indicator. So we indicate the temperature of the device and we use this things called thermo-chromatic inks that sort of turn colors at a certain temperature. But we realized after talking to these mothers and doctors and nurses that when we told them that it should be at body temperature, which is 37 degrees Celsius, they oftentimes tried to warm it up higher which is really very interesting. Usually, they said, the reason is because when doctors tell them to take a certain amount of medicine, they don't believe really that. They'd rather do even better. It was a big learning that we had. What came out of that was that we needed to change it into something that was a little bit more visual, where it wasn't a certain number, where it was actually just a visual indicator. And these types of things you actually don't learn designing in the US. We actually had to go into the field and spend a lot of time talking to our users.
So here is a progression of all the different types of prototypes that we had. This is over a year or two of work, just to design a sleeping bag, which is very, very simple when you think about it, but when you have to deal with all these nuances it's actually very, very complicated. But here is our final product, the one that is saving babies around the world in 8 different countries right now.
I'm going to explain a little bit how it works. You saw some pictures of this wax and it's a very special sort of wax and it's called phase change material. When you heat it up, it actually melts. This is a solid right now but it eventually turns into a liquid. We engineered this wax to have a very special property. So, it releases, as it changes back into a solid, it releases its heat very, very slowly at a constant temperature of 37 degrees Celsius – which is body temperature - so this actually will stabilize the baby at body temperature. And then you put it back in the pouch behind here, and then you zip it up – to insulate it and insulate the baby and then you put the baby inside. So it's a very, very simple device but it actually solved a lot of constraints that we had. For example, you can melt this again with or without electricity, which was a very key component because in these developing countries, electricity is either non-existent or very intermittent. So, you might get, you know, one or two hours of electricity and then a couple of days of no electricity. Jane and I, we lived in Bangalore and even in a major city like that, we would still have power outages for four hours a day – and Bangalore is considered one of the tech hubs of India, which is kind of crazy if you think about it.
The device is also very portable, so as you can see you can hold it in your hand and that actually allows for two things. One is that if the baby needs to be transported to a major hospital with better equipment or better care, the baby can be transported very easily because most of these births are occurring in the rural areas. So that's one advantage. The other advantage is it allows the child to be very close to its mother and we got a lot of feedback that mothers really like this – so the mother can care for their child and give it proper care so this solves that. And then also, it is very reusable. So one thing that we wanted to make sure –to bring down the cost – we wanted to make sure that this can be re-used over and over again. It's not a one-time use thing. So this wax can actually last over 50,000 times and so pretty much the sleeping bag will probably wear out before this wax wears out. So these are some of the constraints that we had to deal with and then we were able to bring down the cost of the device from the $20,000 incubator to 1% of that. I'll pass it on to Jane now who can share some more stories about the device in the field.
>>JANE CHEN: As Linus said, it took us about two years to iterate, test, go into the field, do a new version of the product, test again and the most exciting part of this, has been now that we've launched the product, is seeing it in use in the field and seeing it affect the lives of babies and mothers. So I'll share just a few of those stories from the field with you guys.
This was one of the very first babies to be kept in the device. He weighed about 850 grams or 1.8 pounds and when I went to this hospital – it's a government hospital – the doctor said to me, 'There's no way this baby is going to live. In fact without your product, we would just leave him to die.' I went back and visited two weeks after this photograph was taken and the baby was still alive, he was gaining weight in fact and two weeks after that he had stabilized enough to go home with his family.
This is a woman Munjala who lives in a tribal area in the state of Karnataka. Munjala, like many of the women that we meet, lost her first two babies and then gave birth to a second baby that was about two pounds. What is unfortunate in many of these cases is not only do women lose their children but they are then blamed for the loss of their children and ostracized in their communities. In this particular case, as Munjula's baby got healthier as he was kept in our device, you could visibly see her confidence starting to come back and that's one of the most wonderful aspects of this product. It's not just about saving babies but empowering these women to save their children.
This is one of my favorite stories. This is Kirti. Kirti lost her first baby and gave birth to a second baby that was about three and a half pounds that was immediately put into the Embrace Warmer and this was the baby three months later. So you can see, she is at a very healthy weight now. The family was so excited about the product; they had gone back and told all of the local villagers about Embrace. So we were met with a very warm welcome when we went there including a dance that her 110 year old great grandmother did for us. [Laughter] And the mood was so festive in the house as they were debating what to name the baby at the nine-month naming ceremony. And yet it was also a stark reminder to us that in India, you don't even name your babies until nine months because it's so common that they'll die before then.
This is an orphanage that we work with in China that rescues abandoned babies. They rescued this baby literally off the side of the street in a village in Central China. They brought him back to the orphanage and kept him in our product for about 30 days and this is baby Long seven months later. I went and visited just a month ago and he was healthy, totally interactive – the nurses told me in fact he cries when he's not held – and I think that's because he was very comfortable in our warmer for the first 30 days of his life. It was so wonderful to see this. They informed us that this was the first time a baby of this size had survived in the orphanage.
Embrace today has helped over 2,000 babies. We are in eight countries as you see pictures here from our projects in Somalia, Uganda, we're in Guatemala. We're just about to start a project in Afghanistan. And our hope is to get this into the hands of every baby and every family who needs it. We get requests everyday from people all over the world asking to purchase the product and I won't read all of these but I'll read out one that's always touched my heart. This is from a woman Crystal in Uganda who wrote to us - "The majority of premature babies are never given a chance to make it out of the hospital. Because there are no incubators, these babies are left to die. They are put on a table or directly in the trash without the comforting touch of their mothers in those final moments." Again we are heartbroken every time we hear stories like this and hope to be able to get these products as quickly as possible to every child who needs them. We're so grateful for this Grinnell Prize that will help accelerate that process.
I would like to come back to end with Sujapa. Sujapa lost not only one but all three of her babies. And when we showed her the Embrace Warmer for the first time, she began to weep. She said to me, "Maybe if I had this, I could have saved my babies. Maybe I could have been a mother." Those words run over and over in my mind all the time and I know through my experiences over the last couple of years in India now that a mother – no matter how poor, no matter how uneducated, will do absolutely anything to save her baby. It is my hope, our hope that through simple, affordable and locally appropriate technologies, like Embrace, that we can help mothers save their children and help prevent innocent lives from being needlessly lost.
So with that, I'd like to show you one last video of our product being used and what doctors are saying about it today.
>>NARRATOR IN VIDEO: Almost every second of every day, a baby is born premature or with low birth weight. Where they're born makes all the difference as to what happens next. In the developed world, these babies are placed in an incubator until they are able to make it on their own. But for babies born in parts of the world without reliable electricity or modern medical equipment, desperate mothers and fathers wrap their babies in blankets, pack them in hot water bottles or place them under bare light bulbs to keep them from freezing to death.
>>SUJATHA: I delivered my baby at 8 in the night. That night, because the baby was cold, my husband tried to keep the baby warm with hot water bottles and a burning bulb. But my baby passed away after one day.
>>VIDEO: 15 million preterm babies are born every year. Over 4 million die within their first month of life.
>>NARRATOR: In 2008, graduate students at Stanford University were assigned the challenge of designing a baby incubator for the people who need it the most. Compelled by the cause, these students abandoned their career paths, moved to India and dedicated themselves to testing and developing their design. After dozens of iterations and years of testing, the Embrace Infant Warmer is being distributed to disadvantaged communities and is saving lives.
Using an innovative phase change material, a pouch is heated with a short burst of electricity or boiling water. Once activated, it maintains a constant temperature for up to 6 hours. One unit can save dozens of lives and it costs a fraction of the price of an incubator. Kirthi's baby weighed less than four pounds at birth and was in danger of dying. An Embrace Warmer kept her alive and three months later, the baby has doubled in weight and is doing well. When baby Long was abandoned at an orphanage in Beijing, he weighed only two pounds and was hypothermic. The orphanage had no incubator, but they did have an Embrace Nest. After 30 days in the Embrace Warmer, baby Long has stabilized and put on weight. He is now a healthy and happy 7-month old.
>>VIDEO: Yesterday we saw that there was a 1.9 kilogram baby who was wrapped very well but still had a temperature of 34 centigrade and that baby was not suckling. Two hours from the time of putting it into the Embrace Nest the baby spontaneously started to suck. The baby is doing well, and the rest of the babies from now on will be in good care.
The main advantage of the Embrace warmer is its portability, its ease of use and safety. There is no separation of the mother and the child. The mother can feed the baby and the bonding is improved.
We had a 900 gm [low birth weight] baby, we needed to put him on a radiant warmer, not a single warmer was available. Immediately we thought of Embrace and we put the baby inside that. As far as neonatal mortality in terms of low birth weight preterm babies, term babies with very low birth weight, all of them are safe, sound and comfortable in Embrace.
>>NARRATOR: Embrace has received international recognition and now has the manufacturing infrastructure in place to rapidly scale for global distribution. With your support, Embrace is poised to help one million babies in the next five years.
>> SUJATHA: I feel others should not face the tragedies that I have faced. The other mothers should benefit from the work at Embrace. This is what I wish for.
>>NARRATOR: Embrace. Every child deserved the opportunity to live, to grow, to dream.