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Portable Baby Warmer Goes from Classroom Project to Nascent Organization

A quest for a low-cost warmer leads from a Stanford design class to production and distribution in the developing world.

by Margaret Steen

To make a low-cost warmer that could save infants in poor, rural areas, Jane Chen, MBA '08, and her teammates in a Stanford design course started with crude prototypes that used old sleeping bags, baby dolls, and blankets from the Salvation Army.

Four years and many design changes later, in April 2011 Chen and three other Stanford alumni cofounders of an organization called Embrace began selling their ThermPod to hospitals in India. A version of the baby warmer for home use is slated to launch at the end of this year. In both products, a phase-changing material that looks like wax is first melted, then releases heat over six hours that keeps the baby warm as the material solidifies.

The story of how Embrace went from Stanford to India begins in 2007, when Embrace's cofounders were students taking a six-month-long course taught by a multidisciplinary faculty team that included the Graduate School of Business' Jim Patell. Called Entrepreneurial Design for Extreme Affordability, it brings together students from different disciplines to design low-cost products for customers in the developing world. In the 8 years since the course was started, about 265 students have done 70 projects with 18 partner organizations in 11 countries.

Students work in teams to answer a design challenge: In this case, create a baby incubator that would cost less than 1% of the price of
a traditional, $20,000 incubator. The challenge in such a team project is not just designing a useful product or service but also solving distribution problems in getting it to the intended markets. Chen, who had been a management consultant and then did nonprofit work on HIV/Aids in rural China and Tanzania, was hooked.

"Around the world, 4 million low-birthweight babies die within the first 28 days of life because they are so tiny they don't have enough fat to regulate their body temperature," she said. Traditional incubators are the most common solution to this problem, but in addition to their cost, they require a constant supply of electricity, not available in many rural villages.

During their 2007 spring break, a member of Chen's team traveled with other students to Nepal, where they toured hospitals on visits arranged by a collaborating organization, Patell said. "The students pushed back and said, 'We want to talk to real mothers and fathers.' In doing so, they found that 80% of babies in Nepal were
born at home."

As Chen and her teammates considered the needs of poor, rural parents, they realized that just making a cheaper incubator wouldn't help: They needed one that could work without electricity. "The
'aha' moment for us was talking about who the user was," Chen said. "The user was defined as desperate parents in a rural area without access to a major hospital."

"Part of the secret sauce of our course is this deep empathy for the real user," Patell said.

Chen's team urged Design that Matters, one of the organizations that collaborated on the class, to continue the project after the course ended. But because governments in developing countries are trying to get women to give birth in hospitals instead of at home, the group thought Embrace was "too much for a home setting," Chen said.
"You can design for the world as it is today, or you can design for the world as it should be."

 

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She and her cofounders — Linus Liang, who has a master's in computer science; Rahul Panicker, who has a master's and doctorate in electrical engineering; and Naganand Murty, who has a master's
in management science and engineering — decided to continue on their own, first working at Stanford and then moving to Bangalore.

Before deciding to go it alone, they consulted with Vinod K. Bhutani, professor of pediatrics in neonatology at the Lucile Packard Children's Hospital at Stanford, to see whether he thought the idea had viability beyond a school project.

"I thought it was a breakthrough innovation and that if they had the motivation to work with this product, then they could take it far," Bhutani said. "For over 150-odd years, we have been keeping babies warm by warming the air around the baby." But when mothers hold their babies close, heat is transferred by conduction rather than through the air. Putting the baby in a sleeping bag both warms the baby directly and warms a small amount of air around it. And the fact that the device could hold its heat for 6 hours without an external heating source "made it an ideal device for the developing world."

Early versions of the warmer had many problems. The team originally tried heating the wax-like material with tubes of hot water running through the sleeping bag. "It's not a good idea to have boiling water near a baby," Chen said. They changed the design so that a separate heater melts the phase-change material.

The team had to learn about how its target audience would actually use the device. For example, initially the team used a numerical display to let users know when the temperature was right. But the mothers didn't trust Western medicine's emphasis on numbers, so the team changed the numerical scale to symbols indicating "OK" or "not OK."

Bhutani arranged for team members to talk with focus groups of nurses, pediatricians, and neonatologists. One high-priority issue was cleanliness: The warmth means "the baby keeps warm, but so do the bugs. Infection becomes a huge risk. The design of this was very important," Bhutani said. In addition, in many developing countries, babies don't wear diapers, so easy cleaning was a must.

By listening to doctors, the team realized doctors need to watch babies breathe and assess their color. So they added a clear window in the front of the sleeping bag. They also made the clinical version compatible with safe access to an intravenous line.

Running through multiple versions quickly is part of the course's "prototyping culture," Patell said. Course leaders teach students skills such as sewing and welding to facilitate rapid prototypes. "Embrace is one of the projects that we can point to and say learning to sew was a big part of what happened."

The team needed clinical studies to prove Embrace was safe and effective so that it could be used in hospitals as an incubator alternative. A study in India demonstrated Embrace's safety and efficacy on 10 infants. A more extensive clinical study of 160 babies is under way. At Lucile Packard Children's Hospital, another study is exploring Embrace as an adjunct to incubators. Babies are taken out of incubators when they're stable so they can be held. With Embrace used as a blanket to keep the babies' backs warm, they could be taken out of the incubator earlier and get more skin-to-skin time with their mothers.

As Embrace moved from being a student project to an organization with employees — currently about two dozen — the team also faced management challenges. About three years ago the cofounders decided they needed a more traditional management structure with a CEO, and they chose Chen.

"We'd end up getting into these lengthy conversations on practically everything. It started resembling a parliamentary democracy instead of a startup," Murty said. "Jane is really good at synthesizing opinions and setting direction, so we decided that Jane should be CEO."

Embrace launched its clinical product, the Embrace ThermPod, in April with a comedy of errors, Chen said: The wash tags were printed incorrectly and had to be sewn on by hand, the power went out at the integration facility, and a driver got a flat tire on the way to deliver the first unit. The team quickly piled out of the car, got into an auto rickshaw, and made sure the unit was delivered to its first customer at Little Flower Hospital. "It was symbolic," Chen said. "Nothing is going to stop us from doing this."

Now, however, "we've just gotten to the hard part," Chen said this summer. "We're still in the infancy of what we're doing."

Distribution is a major challenge. Reaching the "bottom billion" — the more than 1 billion people who live on less than $2 a day — is challenging for several reasons. How will people hear about the product? How can they save enough money to buy it? "The informal economy in the developing world works in livestock and gold," Murty said. "Most of them don't have savings accounts."

Finally, there is the logistical problem of getting the product to the user in an area that may not have stores or good roads. For many goods, up to 30% of the cost is the cost of getting it to the user.

"If your product can't be carried around on a bike, you're not done yet," Patell said. "A big, boxy incubator is not easy to ship, but a fabric one is." Embrace also is trying to innovate by using distribution partnerships such as a sales force that General Electric is building to serve emerging markets.

Ed McKinley, a Stanford undergraduate from the Class of '74 and a private investor in groups working on social justice, said the original thesis was that the product design would have the most impact, but "I actually think the innovation that they will become known for is solving the distribution to the bottom billion — if they can solve that. The real nut to crack here is how do you get very low-cost devices into the hands that use them in a cost-effective way?"

Bill Meehan, Racoon Partners Lecturer in Strategic Management at the GSB, has written a case study about Embrace that considers when it makes sense to invest in an organization like this one. "I think Embrace is at the vanguard of a movement to create products for the bottom billion that, because of market failure, would not otherwise find funding," Meehan said.

Shortly after the launch, Chen heard from one of her teammates who had visited a hospital that was using one of the units. A 2-pound baby had been born to parents from a village outside Bangalore who had lost two babies previously. The baby, kept in the Embrace device for 20 days, was gaining weight, and the mother's face was joyful as she held her child. Such stories show why Embrace has become "the poster child" for the idea of designing for extreme affordability, Meehan said. Because most people can relate to warming a cold baby, "the human connection with a baby warmer is profound and emotional."

Chen's long-term goal is not just to sell baby warmers but to create other products to improve health care for the rural poor. In May, she spoke about her journey at the GSB's Women in Management banquet. When she faces a new hurdle requiring one resource or another, she said, she has learned to tell herself that the worst that can happen is someone will say no. "And in my case, when that happens, I guilt them about being a baby-hater," she said to laughter from the audience, which later gave her a standing ovation.