Hope in a Bag

It wasn’t too many years ago that an HIV-positive diagnosis was equivalent to a death sentence. Since then, progress in analysis and treatment has allowed millions to live with the disease, at least in the industrialized West. The situation is starkly different in the developing world. But it’s not because of the price of drugs. “The lifesaving drugs used to treat HIV are no longer too expensive,” says Bill Rodriguez, CEO
of Daktari Diagnostics, a two-year-old medical start-up in Cambridge, Massachusetts. “But they need to be administered before the disease has progressed too far. And people in remote places rarely have access to the right diagnostics.”

In 2008, moonlighting from research positions at Mass General Hospital and Harvard Medical School, Rodriguez founded Daktari in order to develop an HIV diagnostic device that could offer laboratory precision but was small and rugged enough to be carried to remote villages in a backpack. One year later he took a rudimentary prototype to Continuum, a design consultancy headquartered in the western suburbs of Boston. “He brought us something out of Rube Goldberg,” recalls Doug Kroncke, Continuum’s vice president for program development. “About the size of a boot box, with pistons and exposed computer drives and circuit boards glued onto acrylic plates.”

With close to 200 employees in five offices around the globe, Continuum offers design, engineering, and branding services across a broad range of industries and, with recent products like the Daktari CD4, a broad range of economies. The firm collaborated with General Dynamics on the design of a smart display for Humvees and helped Pampers refashion its disposable diapers for the Chinese market. In health care, Continuum Advanced Systems has partnered with Avedro on a nonlaser vision-corrective device and worked with ophthalmologists at Boston’s Children’s Hospital on a prototype for an early-detection diagnostic device for lazy eye in children. “Continuum brings design, manufacturing, and marketing experience from all sorts of fields that a medical company might not consider,” says Aaron Oppenheimer, the vice president for product design and development at Daktari and a former Continuum employee. “Technology changes in different markets at different times. With Continuum, a start-up like us can tap into a much wider range of skills and services than we would normally have access to.”

The Daktari CD4 machine assesses the quantity of CD4 cells in blood, a key measure in determining the progression of AIDS and the schedule of treatment. The flow cytometers used in hospitals for this test are far too finicky for field work. And testing in remote, resource-challenged environments requires a more streamlined method of collecting and processing blood samples. An infectious-disease specialist with substantial experience in global health, Rodriguez thought the solution was a two-part device: the first, a small rechargeable analytic machine; the second, a “lab-on-a-chip”—a disposable sealed cartridge with a finger stick that would collect, prepare, and submit the blood sample for analysis.

For the cartridge, Daktari turned to thinXSS, a German technology company that specializes in microfluidics. For the interaction between the cartridge and the mother device, Daktari asked Continuum. “We needed to engineer a system that would get the cartridge in and out every time, that would handle the precise interactions, and would get it exactly right,” says Phillip Walker, a mechanical engineer and a principalof Continuum. “We considered a drive similar to a CD player, and another similar to a cassette deck. In the end, we went with the cassette-deck model because it had a much lower failure rate.”

Continuum also took the lead in the design of the mother device. Made of white plastic with a built-in handle at the top and rubber moldings at the base to absorb shocks, the Daktari CD4 has the dimensions and contours of a traditional doctor’s bag. The machine’s prominent LCD screen with touch icons provides a nearly seamless user interface. “The message this device needed to send was that it was simple and intuitive but that it was also going to get the test right,” says Allan Cameron, a Continuum principal. “It’s important that the device inspire confidence but just as important that it inspire hope.”

Continuum has a strong record in medical innovation and design. In 2001 the consultancy helped develop a small wire-less insulin pump with Insulet, a medical-device manufacturer in nearby Bedford. “I went to Continuum with a core concept and design,” says Rob Campbell, Insulet’s vice president for clinical services and research. “What I needed to know was whether it was feasible, both from a manufacturing and a marketing standpoint. They helped us out on both fronts.”

Standard insulin pumps also come with a tangle of wires and tubes, complicating simple tasks like dressing, bathing, and sleeping. Not content to rely on interviews or published research, Continuum filmed the daily routines of Type I–diabetes patients at home and in clinics. Michael Arney, a principal of Continuum, went one step further, inserting a standard pump’s cannula—a sharp, hollow tube—into his own skin. “In a matter of seconds I was stretched out on the couch,” says Arney, whose son suffers from Type I diabetes. Arney’s work helped the company develop a needle-insertion device that is hidden from sight and virtually painless.

Continuum’s work in health care has produced some interesting crosscurrents. Last spring two Continuum designers, Jake Childs and Jung Geun Tak, were approached by Amos Winter, a graduate engineering student at MIT. Winter had recently returned from a trip to Tanzania, where he was struck by the plight of people with physical disabilities. “These people often had to travel multiple kilometers every day on very rough terrain,” he says. “It was virtually impossible to do that in a conventional wheelchair. What was needed was a mountain bike for your arms.”

Working with spare bicycle parts—parts readily available in developing countries—Winter fashioned a chair propelled by two extended push levers. Users change gears by sliding their hands up and down the levers—higher for greater torque, lower for greater speed. Two large rear wheels and a small single front steering wheel offer a three-point stance for stability on uneven terrain.

Even after Winter worked with Continuum designers to whittle down his invention, the chair would still have cost $200—a marked savings from full-priced chairs but still too much for the developing market. “We decided to brainstorm, just to see what this thing could be,” recalls Childs, who worked pro bono on the project. “In the end we didn’t even know who it was for. But it looked very cool.”

The result was the Leverage Freedom Chair, a high-performance, high-priced “second chair” that offers industrialized-world users access to places they couldn’t otherwise reach: hiking trails, rocky terrain, even isolated fishing spots. The business plan calls for a part of the proceeds from the chair to be channeled toward building chairs for the developing world. Though they’re made of different materials, both chairs feature Winter’s original propulsion system. “Usually ideas are incubated and hatched in the developed world, then applied to the developing world,” says Childs. “This time the transfer went the other way.”

Bridging disciplines is part of Continuum’s philosophy. “The original notion was that creation is not just the work of one person but of overlapping skills and creative sensibilities,” says Gianfranco Zaccai, the cofounder and president of Continuum. “And that you can’t rely on someone else’s brief but have to do your own research.”

Over the past 15 years, these tenets have been applied more frequently to the developing world in both pro-bono and fee-based work. “There are compelling ethical reasons to design products for the eighty percent of the world’s inhabitants we don’t normally think of as consumers,” says the Italian-born Zaccai. “But there are also compelling business reasons. If you can provide goods and services in a developing region and increase the people’s chances of earning a livelihood, you will build loyalty around your brand. Yes, cost is certainly an issue. But the bigger issue is value. If we can design something of great value, we can find a creative way to provide it, even if it’s expensive.”

At last July’s International AIDS Conference in Vienna, Rodriguez and his colleagues presented the Daktari. Many attendees were stunned by the low price—at just under $1,000, the “hope-in-a-bag” costs just a fraction of standard CD4 analytics. But even more people were bowled over by the precision engineering, sleek lines, and bold design. “I’ve helped design my share of consumer electronics that make one person happy for a week and then end up in landfill,” says Continuum’s Walker. “I know that everyone on this team feels a greater satisfaction designing something that can help prolong a person’s life.”

Rodriguez plans to test about a dozen beta versions of the Daktari CD4 across Africa in 2011 before bringing the device to market. His business plan sees revenues coming from sales, with governments as his primary clients. He hopes the device—named, like his company, for the Swahili word for “doctor”—will help not only slow the pace of AIDS but also change conventional thinking about design for the developing world. “There really aren’t many quality products being developed for remote parts of the globe,” he says. “It’s mostly cheap, throwaway stuff. In part it’s because we think we can’t afford to make these things. But we can if they’re designed well. We’re trying to make a statement here, that everyone should feel they’re getting the best product available, and not some hand-me-down.”