New Office(s)

Sisu is still moving and shaking! More on the former, as Sisu now has a new office in Baltimore. We are now located on 2720 Sisson Street in the Remington neighborhood. We welcome visitors interested to learn more about medical devices in emerging markets, partnership opportunities and those interested in trying our products. 

Our Chief Marketing Officer, Katie Kirsch, is on the African continent for a majority of this year. She will be primarily based in Accra, but has plans to engage markets in Eastern and Southern Africa. She plans to set up direct channels for Hemafuse sales over the coming months. 

Blood Bag Hands

Expanding Our Scope

Sisu continues to expand application of Hemafuse, its first portfolio product, by approaching new clinical sites across the southern hemisphere. 

Hiccups happen.

In the past, we made the assumption that as a small team, we need a laser focus to push forward. This has been ingrained in us from the teachings of a US infrastructure with a clear path to market. The steps may be bureaucratic and long, but they are also consistent, documented, and well understood. Input produces an output. But we don’t work in the US, we work in Africa with a fluid landscape where the incentives are different.

This requires a new multi-approach to kicking off our initial pilot study for Hemafuse. Originally, our laser focus approach involved coordinating with a single clinical site in Sub-Saharan Africa. The partnership seemed to have the capability/titles/clinical experience to get Hemafuse in the hands that want to use it. Finding the hands wasn’t difficult. The trick is also finding clinicians with the time and support to truly scrutinize a medical device’s first time in surgery.

Systematic, research-focused protocols (like it sounds) are a lot of work. Feel free to ask any specialist in academia; their jobs are not easy. And without major incentives for publication, often a tool for career advancement, the cost/benefit of doing a small pilot study is not always available to all of our African partners.

Lucky for us, not all. It was time to seek a second opinion. And we were overwhelmed with the response.

Through several of our Baltimore-based partners, the Gates Foundation network and some cold calls, we discovered that these doctors are calling to do the research. We just needed to present them with the option. The quantity and quality of the responses has been massive; and our confidence in coordinating this study abroad has been restored.  And led to some significant realizations on our approach.

The research support and new leads generated by expanding our geographic scope for this initial pilot has not only enabled our clinical strategy, but begun to anecdotally increase demand. Unlike clinicians and researchers in other contexts, our current partners repeatedly ask questions on supply chain management and how they can build purchase capacity in their institution. Their intent is beyond the initial research study. They are excited by the possibility of such an innovation becoming a valuable tool in their practice, once it’s been proven.

Our original, narrow focus on a single country for smaller studies was a short-sighted assumption around speed through regulatory and first sales.  By looking beyond that single variable, we’ve reminded ourselves that we are building a system and rediscovered our mission: incentivizing stakeholders along the entire value chain. This engagement continues to be scarce as evidenced by our clinician’s entrepreneurial and multi-lateral concerns. Their hospitals, and the distributors that supply them, will eventually be our customers. Their investments in the innovation of Hemafuse at this early stage will influence our B2B relationships well into the future.

Want to hear more about Sisu's mission? Come see CMO, Katie Kirsch, talk at Light City's Health Innovation Conference

Made in the USA

If you tune into news about the economy, you’ve heard a lot of talk about the decline of US manufacturing. When I first arrived at Michigan in 2007, the Great Recession was hitting the region hard, as most everyone I met had a connection to automotive manufacturing . Every conversation I had was a personal tale of how their job was in jeopardy of offshoring.  

The past couple of years are in stark contrast to 2007. Due to soaring labor costs in China, US manufacturing is projected to be increasingly competitive in terms of costs. This has already caused a number of manufacturing jobs to be “reshored” back to the US and is projected to increase. While the manufacturing environment in the US is improving, the one thing that hasn’t changed is the strength of relationships between companies and their suppliers.  

Sisu Global Health has chosen manufacturing partnerships in the US because of these strong partners here at home. As a small company starting out, good suppliers are key to making it through the transition from idea to marketable product. Medical devices specifically require independent research, testing and regulated manufacturing, and tracking quality assurance. 

In dealing with US regulations, we have been able to find these partners that intimately know our difficulties and lend their expertise. We can meet in person and make adjustment utilizing their expertise in smaller batches of devices.

Because of our outstanding suppliers, our first production parts have come off the line and we are eager to start bio-compatibility and sterilization testing. This first lot of devices are planned for our first human patient clinical study. Our team has learned a lot from the process of choosing and collaborating with contract manufacturers. Many companies know the failure of bad partnerships. We have confidence them and they make our company stronger.

Written by CTO, Gillian Henker, and guest blogger, Kevin Lee. If you are interested in learning more about re-shoring, check out this articlethis other one, and the cities leading the charge

Misfits

Team Sisu often finds themselves to be the misfits at most networking events. With a geographically-diverse market neglected by the larger business world, many in the for-profit medical device industry find our aims improbable. At other events, the “do well by doing good” crowds sometimes gasp when we mention our business model; often implying that our monetary goals will always shadow our health impacts. We have found our niche and several have embraced our ability to negotiate the often divided realms of life science businesses and global health.

Yet, we continue to confront lines of questioning that are flavored by the audience. Below are two general examples of conversations that want to put Sisu in a specific category. The first, from a start- up business fellow at a pitch competition, and then, global health expert from a health system strengthening conference.

“In Africa, how do you know there’s money there until you’ve sold something? There are no rules, just sell it.”

One crowd is the US lean startup community- you know them, preachers of constant iteration. Iteration is king in this case and what we believe is truly innovative at Sisu. The lean startup model, however, can be iterative to the point of recklessness- not a quality that a medical device company should really value. The lean startup model also generates the long stream of half-hearted apps that continue to stream out of Silicon Valley- an industry with lots of money that appears to be thrown at underdeveloped projects destined to flop or be acquired. When the latter strategy succeeds, it's great for investors, but inserts the startup (which has been unable to build organization/system beyond an initial product) into the large companies and associated bureaucracy. New ideas are getting put into old structures too soon, often diluting original aims or negating long term system’s change.  

Acquisition can be a boon- but only once a startup has created something that reworks a system; single ideas treated this way will not survive.The original ideas for many apps/products solve big problems, but this cross pollination/acquisition game with the same group of people’s ideas is heading for stagnation.

“How are you delivering product to impoverished countries in the Global South and you’re actually reporting health impacts and making money off of it?”

This question comes in many forms, though most often a touch more subtlety. Yes, we are selling products in countries that have been given one dimension: “developing” and “poverty alleviation”. These words are slathered across them via media. Big Aid organizations and others have insinuated that capable, resourceful and talented local people (our current partners, future employees and customers) cannot live there.

Some large NGO’s and international organizations have made strides toward dissolving this image of foreign aid- but the philosophy is deeply embedded. Many have worked in some of the farthest reaches of the world with immense experience with both successes and many failures in delivering healthcare products and access worldwide. These organizations have a depth of knowledge in these areas, but have left us viewing these areas as primitively stationary in poverty, not as explosively growing economically.

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All teasing aside- both philosophies have incredible value in seeking a solution. Neither can claim to have found the correct process, either, and perhaps it’s because of the philosophy they share of only being able to have one priority.

We disagree. Monetary compensation and human-centered initiatives don’t have to be mutually exclusive. Emerging markets are a strategic choice and are repeatedly reported as having explosive growth. Exploding economic growth, often caused by a growing middle class, also creates greater demand on health systems. These health systems need a way to provide care that impacts patients in their own context, otherwise risking inaccessibility to healthcare for large swaths of their patient populations. 

Sisu has found that by following the threads of both business and impact- we can be most successful. Both philosophies seek to reach scale to solve problems and to sell products. The entire health system is important to both create profits and benefits. As Sisu formally opens its seed round, we find ourselves straddling the middle- socially minded with hard nose business outlook. 

Clinical Humility

OBGYN Residents at the University of Zimbabwe Medical School post-workshop with Sisu Global Health's first device,  Hemafuse. 

OBGYN Residents at the University of Zimbabwe Medical School post-workshop with Sisu Global Health's first device,  Hemafuse. 

If there’s something that sticks in our minds daily, it’s how little the medical community seems to know about the areas in which we work. Sisu is preparing for its first clinical pilot with its portfolio device, Hemafuse, later this year in Zimbabwe. All of our preparations through ISO standards and training regulations have led us to this momentous milestone - putting our intervention into human use.

This device is surgical - meaning that it can intervene during a pivotal moment in an individual’s care. Compared to most moments when autologous blood transfusion occurs, the Hemafuse, as an intervention, will be both more urgent and more evident in terms of results. Its handheld, sleek design reduces both blood flow issues and failure modes from a slippery, gloved hand mid-surgery. In many of the surgical suites that we’ve been in, space is at a premium. Improvements on hospitals and buildings are not keeping up with the increase in patient admittance and population growth, meaning smaller rooms for more people.

This device, as one Tanzanian doctor put it, will eliminate a ‘messy’ and sometimes futile process.  

All opinions from these doctors point to the success of this device, however, the glaring fact that autotransfusion, the recycling of a person’s own blood, has been debated solely in Western countries. Of all the published material concerning African healthcare, only 1-2%  have contributions from the continent’s own physicians. Additionally, these articles and the repository services that attempt to collect thousands of articles are often not internationally indexed to include African medical papers. They come from a continent that has been performing autotransfusion for years, but whose voices have not been given the mechanism to be heard in the medical community.

Doctors, clinicians, and innovators in these countries need to be heard. Many discussions at US-based and European-based forums expound large statistics or frameworks for short-term humanitarian relief. These are quickly shot through with expert comments - this is not single war or disaster, it’s a daily reality in many places. Concrete plans are sputtered out, but sound naïve. We know so little.

Working with our doctors in Zimbabwe and Ghana, our team is humbled by how much there is to learn. Their input is taken with utmost seriousness and integrated in everything we do. Our goal with this clinical pilot is not only initial results on the device’s performance, but to work with the University of Zimbabwe and National Blood Service in Harare to further a graduate student’s education and enable more publications about the issues of blood access. These are learned professionals with distinct sets of expertise that need to have their research heard across the medical community.

From right to left: Gillian Henker, Sisu's Chief Technology Officer; Dr. Tinashe Gede, Doctor of Internal Medicine at the University of Zimbabwe; and Katherine Kirsch, Sisu's Chief Marketing Officer.  

From right to left: Gillian Henker, Sisu's Chief Technology Officer; Dr. Tinashe Gede, Doctor of Internal Medicine at the University of Zimbabwe; and Katherine Kirsch, Sisu's Chief Marketing Officer.  

We're Hiring!

Interested in working for an up and coming startup? Like operations or engineering? Then check out our current openings below. If you like what you see, send a resume and brief cover letter explaining why you'd want to join our team to info@sisuglobalhealth.com

Research and Development-Sisu Global Health is looking for a product development engineer or researcher with technical and quality systems experience to aide in the development of products for emerging markets. This is a 3-month engagement with the potential for full-time. Sisu is seeking a biomedical engineer, mechanical engineer, mechanically-minded electrical engineer, or a biology/biomechanics researcher with mechanical inclinations.

Sound like you? Click here for the full listing.

Business Development- Sisu Global Health has an opening for a business development position to create systems for supply chain management and quality control in Sisu’s products. This is a 3-month engagement with the potential for a permanent position. Part-time/consultancy is negotiable during the 3-month engagement.  Sisu is seeking an individual with a graduate-level business education or systems engineering with an understanding of operations. A background in international business or industrial operational engineering is preferred.  Click here for the full listing. 

Sound like you? Click here for the full listing. 

CEO's Note: Dreaming It in Charm City

The field of blood study and blood-related product development is a small one, and the field of autotransfusion (blood recycling) is even smaller. It often seems like everyone knows everyone else. We've had a lot of great mentors in the blood space from afar, but it hasn't been until we tapped into the inner workings of the Baltimore/DC area that we realized quite how small.

Just six weeks ago, we moved to the Charm City for the DreamIt Health Accelerator program from our medical device manufacturing home in Grand Rapids, Michigan. We were looking for other resources and mentors in both the blood transfusion and global health community to take our company to the next level, and we've found them.

The DreamIt Health office is in the Power Plant Live building, just to the left of this photo. Not a bad view of the harbor, eh?

The DreamIt Health office is in the Power Plant Live building, just to the left of this photo. Not a bad view of the harbor, eh?

One of our new, wonderful mentors in Baltimore, Iris Sherman, runs a company called Kitchology, but her past is in autotransfusion. She invented an autotransfusion device used on Ronald Reagan after the 1981 assassination attempt. His punctured lung and subsequent internal bleeding was salvaged, filtered, and re-transfused promptly; saving the president’s life. We met Dr. Paul Ness and Dr. Steven Frank who have had their work on autotransfusion talked about in the New York times and in the Washington Post, about how autotransfusion is actually safer and better for the patient than using donor blood. Their commentary on autologous blood transfusion in the United States elicits thoughts of how a device such as the Hemafuse could be used in the US, not just developing countries, to save on health outcomes and costs. And the list of influencers continues: Keytech, World Vision, Catholic Relief Services, Jpheigo, Fyodor Biotechnologies are just a few of the organizations that we continue to engage.

These conversations have challenged us to think bigger, sooner. We are thinking how we can strategically get to our long-term vision as soon as possible. We aim to be a medical device company for the developing world: we seek a MNC-like strategy with a developing world focus, instead of and Ideo-like strategy with their focus solely on design. We aim to change the way medical device is designed: 80% of the world’s medical technology should not be designed for only the 10% of the developed world. Simple, elegant, medical device design and implementation can revolutionize healthcare across the globe. A number of organizations designing phenomenal technology including non-profits and universities. The problem is commercializing and scaling this technology. We will continue to develop Hemafuse; however, we are thinking strategically of how we can use the momentum we've already gained to commercialize not only our own devices, but those from other sources as well.

Carolyn Yarina is Sisu Global Health's CEO. You can learn more about her here or drop her a line at info@sisuglobalhealth.com 

Warm Hearts from Malawi

The New Year has brought us warm hearts, including Malawi: the “Warm Heart of Africa”. We were granted the opportunity to visit the beautiful Blantyre through a Grand Challenge for Development program. The Saving Lives at Birth community, including their network of global health aficionados from VentureWell, hosted an Xcelerator program in Malawi. Its intent is to jumpstart an incredible cohort of technologies into the global health system, be they non-profit, for-profit; university- based or independently-based.

Naïve goodness was not the pure fuel for our warm heart throughout the entire program- the grim failure rate of global health and development initiatives was established and re-established in the short days. The depth of that failure was also accentuated by visits to local hospitals, including the sprawling Queen Elizabeth Hospital, where nearly all of the cohort’s innovations could have made a tangible difference. Despite some of the dour learnings from the workshop, there was also a distinct understanding of our goals and pragmatic ways to reach them.  That global health insight is much rarer to find when talking to traditional healthcare groups in the United States.

Carolyn Yarina, Sisu's CEO, demonstrating an earlier prototype of the Hemafuse with Queen Elizabeth Hospital's surgical department, including Dr. Frank Taulo.

Carolyn Yarina, Sisu's CEO, demonstrating an earlier prototype of the Hemafuse with Queen Elizabeth Hospital's surgical department, including Dr. Frank Taulo.

The Malawi trip also lent to great connections for a clinical pilot we want to pursue later this year. We were able to make valuable connections with global health PI greats like Dr. Cyril Goddia, a past innovator with Gradian Health’s UAM inventor, Dr. Paul Fenton, and several other global health surgical devices. The Malawian Blood Transfusion Service also offered us a warm welcome and potentially helped to pave the way for doing a clinical pilot in Malawi later this year.

Katherine Kirsch, Sisu's CMO, with Dr. Cyril Goddia, Anesthesiologist and professor at the College of Medicine, at Queen Elizabeth Hospital in Blantyre, Malawi. 

Katherine Kirsch, Sisu's CMO, with Dr. Cyril Goddia, Anesthesiologist and professor at the College of Medicine, at Queen Elizabeth Hospital in Blantyre, Malawi. 

They also described some of the challenges that a particular religious group faces with each surgery: Jehovah’s Witnesses. From their religious view, blood transfusion from one patient to another is viewed as unhealthy and have seen blood conservation efforts to “to benefit all in the community… [by avoiding] blood-transfusion risks, such as blood-borne diseases, immune-system reactions, and human errors”. These connections (back to the US, actually) demonstrate the importance of being on the ground- to understand the outside forces that affect health institutions here in Sub-Saharan Africa.

Upon our return to the States, and once we are reunited in our new location in Baltimore, we look forward to contacting groups like these for strategic partnerships. Wish us luck in Zimbabwe as we meet up with Dr. Tinashe Gede and his colleagues at Parirenyatwa and Harare Central Hospital to demonstrate the Hemafuse in a simulation!

IndieGoGo Campaign- The Final Push

It's the final 40 hours for our IndieGoGo campaign and we have learned a few surprises about the process. As a for-profit company, there are a always questions about what role a crowdfunding site like IndieGoGo plays. As most of you noticed- we aren't terribly close to our goal of $45k, though I still have hope, I will not be upset if we don't fully reach our monetary goal. 

As of right now, we have nearly 100 supporters for our campaign- a huge victory in itself. The IndieGoGo campaign brought us a much larger reach- having doctors from many more Sub-Saharan African countries contact us about the Hemafuse and our other portfolio devices. Even Jim Harbaugh, University of Michigan's new football coach, came out to donate. He never gave a full response when we asked why he donated, but we are almost completely sure it was him....

Practical jokes aside- we've enjoyed the response. The money that we currently have (about $6.5k) is enough for us to pay for our flights, in-country housing and travel as well as some of the required equipment for the simulation workshop. Asking anyone who travels internationally, this may sound asininely low, but we've never been ashamed to do/live on the cheap. 

The invitation from doctors in Zimbabwe is a huge opportunity for us that came out of the blue and was not able to funded by our grant or other allocated funding (the downside to money with strings or most money available to startups). We knew that we had many people who wanted to know how they could help. The IndieGoGo campaign was a way to bring our supportive, international community together. Even though we haven't outright produced a product with this money, nor could we safely give that product  (a surgical device) to any random person who found us online, the support exhibited in this campaign demonstrates that many feel we are doing something right. And when you run on limited funds, survive on advice from all different sides and your gut intuition, it's good to know that many feel that an international medical device social venture is worth pursuing.  

Publishing White Papers on the Hemafuse

Many people like to talk about their white papers… and so do we. The Hemafuse, Sisu Global Health’s premiere product, was published this past fall in the International Journal of Gynecology Obstetrics. A huge honor that we are very excited about, as it adds more credibility to the technology behind our device. This important step forward in our progress was needed, however, it doesn’t mean the same to all of our stakeholders.

The debate about the need for published articles centers around the abyss between academia, industry and, well, the rest of the world.

Sisu’s main innovations have all spun out of the academic powerhouse of University of Michigan, but as we progress into seeking industrial connections, our clean tech transfer and removal from the University has actually helped us in the long run. Though many manufacturers and designers like the fact that we have previously had the backing of an institution- they usually sigh in relief when they realize our independence from the Big House.

This is not to say that the resources that universities offer are not significant. Many have environments that favor the cutting edge research that many companies can’t replicate. But once a piece of technology needs to expand- into manufacturing, scaling sales and beyond- many universities seem to gradually fade. Programming may exist in each of these disciplines, but few programs have mastered how to advance technology from basic prototype to autonomous business.

This all begins with the information surrounding cutting edge research. Articles (including this one) often require fees for access to individual articles or large databases. Academia claims that publishing articles is complete outreach to the public…after you pay the fee. This hits the hardest in the international education community where students may not have access to these expensive databases.

While the academia can’t really claim public outreach with their restricted articles, fees to access reports are a part of the medical device field (see the cost of the CE Mark’s annually updated report) for both industry and research. These are built-in costs that companies plan into their budgets, but few individual (think about college students at Makarere in Uganda or the University of Ghana) plan or are able to purchase peer-reviewed research articles. These articles that keep companies and students on the cutting edge of their technology and market; creating barriers to this information inhibits everyone.

Our article in the International Journal for Gynecology Obstetrics is exciting, but some of that excitement is dulled. Many of our major stakeholders, doctors in the developing world, and those we hope to inspire, young people particularly women and minorities, may not have the chance to read the article. We hope that some of these barriers to information can be broken and we can continue to move away from “white tower” stereotype. 

American Association of Blood Banks' Annual Meeting

What do blood, Philadelphia and PEPFAR all have in common?  A quaint little event with thousands of experts in worldwide blood transfusion, that is.

 Gillian Henker, Sisu’s CTO, spent a busy Saturday exploring the American Association of Blood Banks’ Annual Meeting. She was able to make connections to a variety of big players in the medical blood space including our new advisors, Jim Reilly, head of the AABB’s Global Strategy and who partners with16 different African blood systems and PEPFAR, and Dr. Jon Waters, a leading expert in autologus blood transfusion from the University of Pittsburgh. 

The entire conference had a huge international influence from Kyrgyzstan to Uganda. Experts from Kyrgyzstan and other countries in central Asia also listed blood transfusion and banking issues that Sisu Global Health had seen in Ghana.

Gillian also made key connections with the African Society for Blood Transfusion including a Ghana coalition and Ugandan head, Dr. Isaac Kajja. Her favorite session was on trauma in developing countries with Dr. Amina Merchant of Vanderbilt University, Dr. Isaac Kajja an orthopedic surgeon of Makerere University, Dr. Kaushik Mukherjee of Vanderbilt University talking about the general state of trauma in developing countries as a major health learning. Trauma frequently involves blood transfusions and their effective treatment is often determined by the quality of blood systems. 

From right to left: Mark Popovsky, Chief Medical Officer of Haemonetics; Inna Jurkevich, Senior program officer of the American International Health Alliance; Jed Gorlin, the Medical Director of Memorial Blood Centers; and Charles Munk, the IT consultant for AABB. Photo credit to Pat from the Red Cross. 

From right to left: Mark Popovsky, Chief Medical Officer of Haemonetics; Inna Jurkevich, Senior program officer of the American International Health Alliance; Jed Gorlin, the Medical Director of Memorial Blood Centers; and Charles Munk, the IT consultant for AABB. Photo credit to Pat from the Red Cross. 

At the Exhibit Expo, John G. Rivera of Medtronic delivered an entire history of the blood transfusion and autotransfusion industry. Gillian also ran into Heamonetics’ Chief Medical Officer, Mark Papavsky. They were able to reconnect with after touring the Heamonetics factory years ago and discuss the Hemafuse’s current progress. 

The Annual Meeting was October 25th through the 28th. You can find more information on AABB, their Annual Meeting and their initiatives here.

Customers as Partners

This post was originally published on NextBillion: Development through Enterprise, written by Katherine Kirsch, Sisu's CMO.

“Human-centered design” is often thrown around as the next business trend for the American medical device market, but what does it mean to do human-centered design in a completely different cultural context?

Sure, it makes sense that the devices we interact with on a daily basis are built with some feedback from us concerning their use, but previous design thinking often was less intent on meeting customers’ actual needs than on increasing sales and the firm’s technical ability. Most do this by asking categorical questions: How much does it cost? How many features does the customer want? Few companies actually focus on their customers’ purpose for the product and the observations that could be vital to redesigning that device. Add to that an FDA regulation or other difficult governmental hurdle, and most design is created to speed the immediate business runway.

Human-centered design can make sense in the ever-changing U.S. market, but is even more important in developing markets, which require a variety of perspectives and empathetic views before companies can even dream of entering. In a different cultural context, such as Sub-Saharan Africa, the purpose of a product and how it’s received can be lost despite training or educational sessions. The exception is when end users are able to collaborate on the creation of the product or service. Their expert understanding of the purpose for the product cannot be matched and they will often help drive demand.

Human-centered design has helped open a previously ignored market: Africa. The burgeoning medical device market in developing countries has drawn the likes of Medtronic, Covidien and Becton Dickson, but is also a ripe place for startups with more flexible core strategies.

My company, Sisu Global Health, is seeking to take advantage of this trend of African growth and consumer need. We have a double bottom line approach – profits and social impact – in offering medical devices specifically tailored toward African hospitals and clinics. We are bringing in customers as actual partners of the designs, to help critique, test and analyze how our devices can better serve their needs – even at the sacrifice of some profit.

Our first device that demonstrates human-centric design is the Hemafuse. The Hemafuse is designed to transfuse blood – not from someone else’s voluntary donation but, in emergency cases, from the patients themselves when other blood isn’t available.

 

Related:  Ethnographic Design: The best ideas come from your users

 

Emergency doctors in Ghana and other parts of Sub-Saharan Africa frequently see traffic accidents and pregnancy complications that they are unable to treat because they cannot access needed (donated) blood. We hope to solve this problem by allowing doctors to reallocate internally hemorrhaging blood back into the patient. This prevents issues of transferring disease and rejecting donated blood – which are problems as much in the U.S. as in African hospitals.

Sisu learned of this issue after four years of independent trips to hospitals in Ghana. The team has traveled to the major hospitals in Kumasi, Tamale and Accra. Gillian Henker, our chief technical officer, observed the procedures of OBGYN and emergency doctors and has taken multiple prototypes of our devices for critique. Our partners at Komfo Anokye Teaching Hospital, Korle Bu Teaching Hospital and the Ministry of Health have been with us since the beginning of the company. They have as much stake in the Hemafuse as we do, and tell us they desperately want to see it brought to their surgical theaters.

Many medical device companies (and some aid agencies, for that matter) do not seek out the advice of the doctors using the devices. The fact that we do gives us immense advantages with our customers; we have loyal relationships that began with design, not the sale.

These relationships enable us to not only design a great product, but to effectively scale. Some of our major champions in the country are at teaching hospitals. These institutions train the next generation of doctors, meaning that if the Hemafuse becomes a standard piece of equipment in these hospitals, trained doctors will begin to demand it in other hospitals.

That initial demand is also the beginning of the procurement process for government and most private hospitals. We intend to let our human-centered process lend itself to scalability outside of Ghana as well, as we continue to seek out blood transfusion experts in each country to both advise and support our international scaling.

With the intent to scale internationally, we specifically chose to be a for-profit social enterprise based in Southwest Michigan – a medical device hub with deeply embedded philanthropic values. This choice came after more than a year of deliberations. But it can still pose a significant obstacle: How do we approach potential funders? We do not want donations. We want the funder’s investment to be a sustainable return that they can reinvest in ours or other initiatives. Returns on these investments will take a little longer, but will make a greater impact in the long run.

Human-centered development is at the very heart of Sisu Global Health’s design and business model. Not only do we view independent sales transactions as more than just the exchange of money, we firmly believe that by creating a product for sale, and not for donation, we give people a choice. Simply put, there is dignity in choosing to buy a product – one that helps ensure the continued use of the product for its intended purpose. A product that is intentionally bought requires a rational decision to weigh the costs and benefits of the purchase. This posture firmly fits within Sisu’s vision to utilize market-driven motivations compared to channels of charity.

Human-centered development puts those customers within reach who would otherwise never be a part of the design and business process.

Farewell to Dan Wall

Sisu Global Health could do very little without the generous support from its consultants. And so, Sisu was lucky enough to have Dan Wall work over the summer, supporting the financial side of the company. Last week, the Sisu team gave Dan a send-off as he moves onto a full-time position. Festivities included a footballing dinosaur cake; an important asset for any Sisu celebration. 

The famous Dinosaur cake- only the most valued consultants get one of these delicacies. 

The famous Dinosaur cake- only the most valued consultants get one of these delicacies. 

Dan performed significant financial research for the proformas, making Sisu a more marketable company to investors and potential partners. He also did some work to update a new and improved Bill of Materials template that can be updated as we move forward. He will be moving onto a position with Mead-Johnson in materials management as a Planning Assistant. 

Reflections on Ghana

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About a month ago, Chief Technology Officer, Gillian Henker, and Chief Marketing Officer, Katherine Kirsch, returned from another successful trip from Ghana. Both wanted to share their insights on the trip and what it means for Sisu Global Health:

Return to Ghana: Fifth Times the Charm

Gillian Henker, CTO

After mentioning that I have been to Ghana five times, many Ghanaians say to me “Ah, you must really like Ghana. Why do you keep coming back?” I first arrived in 2010 with 12 other students; most of whom had never set foot in Africa before. As young engineering students, we relied almost entirely on ties through our university name. Four years later, I still find myself saying I went to the University of Michigan and making those connections with anyone who has been to Ann Arbor.

After that first trip, I often traveled to Ghana by myself. Working in a team again, our Ghanaians contacts could see there was a new breath of life in the company. Conversations have evolved from hesitant technical inquiries to confident entrepreneurial investigations. Katie and I were able to bring together marketing and technical goals for our field visits. Every time I travel to Ghana I am continually inspired, particularly from the doctors, nurses, technicians, engineers and community health workers.

For the first time, I was inspired equally by other entrepreneurs (including heads of Vytrak, Rik Air and Persistent Energy Ghana) who I consider my peers. All of these people are the reason I go back.

From left to right: Katherine Kirsch, Sisu's CMO, Dr. James Akazili of Navrongo Health Research Center and past researcher at University of Michigan, his son, Eusebius Alowine Gavin Akazili, and Gillian Henker, Sisu's CTO

From left to right: Katherine Kirsch, Sisu's CMO, Dr. James Akazili of Navrongo Health Research Center and past researcher at University of Michigan, his son, Eusebius Alowine Gavin Akazili, and Gillian Henker, Sisu's CTO

Return to West Africa: Hello Ghana!

Katherine Kirsch, CMO

This was my first visit to Ghana- though not my first trip to West Africa. I was excited for the color of the fabrics, the constant sunshine and the heavy rhythm of the business week. Of course, we were lucky enough to have fairly consistent internet, but appointments and any real progress happens face-to-face. Relationships are the key to pushing progress in many domains and cultures, and Ghana is a strong reminder that nothing works better than making a personal effort. Email and websites are still not a large part of the culture and virtual communication can sometimes be much slower than a quick conversation.

One of the easiest entrances into the Ghanaian network was through our lovely host family, the Boahene’s. Gillian had stayed with them in past trips and they certainly offered a warm welcome this time. The family was incredibly hospitable, feeding us homemade local food each evening. They even had a connection to Grand Rapids. Their son and daughter-in-law live in the city after going to Calvin together. Having a home in Accra, the capital city, made traveling around the country to show off the devices to a variety of doctors and administrators.

Most of all, the trip demonstrated the excitement that surrounds our work. Helping to build relationships with the doctors, nurses and technicians only makes me more anxious to return. 

A vista from Cape Coast, Ghana

A vista from Cape Coast, Ghana

Saving Lives at Birth Nominees

The Sisu Global Health team at the Saving Lives at Birth Development XChange. In the foreground, the Hemafuse is pictured next to another autotransfusion tool in Sub-Saharan Africa: the stainless steel soup ladle. 

The Sisu Global Health team at the Saving Lives at Birth Development XChange. In the foreground, the Hemafuse is pictured next to another autotransfusion tool in Sub-Saharan Africa: the stainless steel soup ladle. 

With excitement and great appreciation to all our supporters, Sisu Global Health is proud to announce that it has been nominated for the Saving Lives at Birth: Grand Challenges for Development grant. Sisu Global Health was among the top 3% of applications from around the world; a prestigious group that included large companies such as Becton Dickinson; universities such as John Hopkins and the University of Cambridge; and large NGO's such as PATH. 

The award was announced after a three-day long event called the DevXChange which featured breakout sessions and focus groups from some of the most brilliant marketers, doctors and facilitators in the public health field. Additionally, Carolyn Yarina (Sisu's CEO) underwent the final interview for the $250,000 award by Dr. Sylvia DeGananes, a Ghanaian OBGYN from Tema General Hospital. Companies and participants came from all over the world. The entire event was made possible by USAID, the Gates Foundation, Grand Challenges Canada, the Norwegian Ministry of Foreign Affairs and UKAID.

The final day included a Marketplace event where the public could tour exhibits of nearly 100 finalists and previous award winners. During this event, we had the privilege to meet the head Administrator of USAID, Dr. Rajiv Shah, a fellow University of Michigan graduate (Go Blue!). The final day ended in a forum featuring Dr. Rajiv Shah; Paul Farmer, Co-Founder, Partners in Health; and Paul Polak, author and entrepreneur.

For more information on the Development XChange event, check out this press release

Gillian Henker (Sisu's CTO) with Dr. Sylvia DeGananes of Tema General Hospital. We met Dr. DeGananes on previous trips to Ghana and were happily surprised to meet her again in Washington D.C.

Gillian Henker (Sisu's CTO) with Dr. Sylvia DeGananes of Tema General Hospital. We met Dr. DeGananes on previous trips to Ghana and were happily surprised to meet her again in Washington D.C.

How You Can Help!

Sisu Global Health has some great news! We are finalists for Saving Lives at Birth: A Grand Challenge for Development. Saving Lives at Birth is an international grant competition for new, ground-breaking ideas to combat maternal and infant deaths. 

We are also seeking to win the People's Choice Award. To help us, please register and vote for us to promote our mission for greater healthcare access throughout the world. Thanks in advance!

The Development XChange is a 4 day event that will include informational sessions, finalist interviews and a marketplace event for 59 different innovators. The total grant is prized at $250, 000- our first large infusion of funds. Saving Lives at Birth is sponsored by USAID, the Gates Foundation, the Norwegian government and UKAID. 

Big Questions

Timothy Wolfer (behind camera) filming Gillian Henker; Dr. Peter Paul Bacheyie, Head of Blood Transfusions; Dr. David Kolbila, Head of OBGYN; and Dr. Asirifi Amoako Samuel, OBGYN consultant, at Tamale Teaching Hospital. 

Timothy Wolfer (behind camera) filming Gillian Henker; Dr. Peter Paul Bacheyie, Head of Blood Transfusions; Dr. David Kolbila, Head of OBGYN; and Dr. Asirifi Amoako Samuel, OBGYN consultant, at Tamale Teaching Hospital. 

Over the past few days, the Sisu team has had a small addition. Timothy Wolfer of Wolfer Productions is tailing us over the past week. The worldly documentarian from Grand Rapids is filming an episode for DePaul University's "Big Questions" television show. The show aims to bring the study of business ethics to some of the world's biggest issues including corporate social responsibility and social ventures. The show airs on Indiana area PBS stations and aims to expand to other Midwest stations soon. 

In the meantime, we continue to ask physicians, nurses, government officials and administrators for their input on our devices and most have been captured on camera. If you want to see the "Big Questions" episode or see more footage of our trip, keep tuned in to our News page. 

Knocking on Doors

On an average day, two oburonis (foreigners) can be seen strutting into various hospital halls. Marching in business clothes through the equatorial heat with a large plastic box under one arm, creased notebook in the other- we look quite curious. The patients that line the walls of many of these hospitals must think we are absolutely crazy; a sentiment that is often echoed in the hospital administrator’s face upon meeting us.

Our curious look is only matched by our approach. One of our main goals (see post “Accra Bound”) over the next six weeks is to collect extensive amounts of feedback from doctors, administrators, patients and other stakeholders in the Ghanaian healthcare system. Many of these stakeholders seem to never have been asked their advice on a piece of manufactured equipment, much less a medical device. There is often a significant hesitation when we first start to ask questions, as though many of these people have never been asked what would make a difference in this hospital, surgical theatre, laboratory, etc.

Most administrators and doctors immediately assume that the prototypes that we put before them are the finished product. This has caused several faulty, though not always negative, responses. Several doctors have asked to take the Hemafuse prototype directly into a surgery- which we quickly decline and firmly hold onto the 3D-printed model, of course. Conversely, there are always those who wish the prototype looked more polished which leads us to question the importance of packaging- even for a device that could save a life.

The forgotten nurses or technicians often offer the best feedback and so we do our best to seek out a variety of sources for our feedback. This approach is not entirely novel for many human researchers, however, few medical device creators actually take the time to evaluate feedback from such varied sources including in the US. Including such a wide range of stakeholders does take significant more work and time, but it also creates more opportunities for efficient implementation with sleek, simple designs. 

Gillian holding the latest prototype of the (r)Evolve. The prototype was made possible by Geek Group, a maker space in Grand Rapids. 

Gillian holding the latest prototype of the (r)Evolve. The prototype was made possible by Geek Group, a maker space in Grand Rapids. 


Where the Money Flows...

Looking over the past 2 ½ weeks in Accra, much of our work has been around the money. And when I mean the money, I mean the twisty-turny routes that both money and products take to arrive at their intended goals. Some of you may call this supply chain management, but in a culture where relationships rule supreme, that “chain” becomes very knotted.  

Lekma Hospital, a government-supported district hospital, performs many basic services. It also receives supplemented funds from the Chinese government (see flag) to manage one of the only CT scans in the country. 

Lekma Hospital, a government-supported district hospital, performs many basic services. It also receives supplemented funds from the Chinese government (see flag) to manage one of the only CT scans in the country. 

Ghana has a fairly well-established healthcare market with both public and private institutions. Each of these institutions, however, frequently receive money from both sectors. There is even a official category for funding specific hospitals called “quasi-government”(that’s an official term, folks). Additionally, many government hospitals and healthcare centers, particularly in rural areas, receive the bulk of their income from the government but maintain a certain amount of self-sustained revenue. This revenue comes from patients, who often have to pay for consumables like blood bags, medications and even gauze. But more often than not, other donors will support government hospitals by donating equipment or staff support. 

Though this support is gladly welcomed, it can be difficult to regulate when the government seeks to upgrade equipment across the multiple regions. Each hospital then has piecemeal services and no one hospital can maintain the same quality of care across all departments. When this equipment is donated, there's often issues of maintenance where the device breaks down within 2 years with nothing to replace it. 

Luckily, the Ministry of Health has recently received multiple financial backings from various US banks to raise the level of care at most hospitals. With a focus on capacity building and maintenance in regional, district and teaching hospitals, state-of-the-art x-ray, oxygen generation systems and surgical theatres (operating rooms) have made an appearance across the country.

Great news for more urban hospitals, however, many rural health centers have yet to receive basic point-of-care equipment.  These places have an opportunity to be stocked with sleek, new equipment that can free the centers from dependence on infrastructure. 

Ashesi University College

Gillian and I had the pleasure of visiting Ashesi University College last Tuesday, the 24th. Ashesi University is an institution built to bring an entrepreneurial focus to African students. There, we had a great conversation with university professors about their hands-on curriculum and how to further influence future entrepreneurs. We also discussed how our own educations and experiences that encouraged us to create a social venture. 

The institution has been around since 2001, but it's beautiful new campus (modeled after Swathmore College) was place in a rural area of Greater Accra. 

The institution has been around since 2001, but it's beautiful new campus (modeled after Swathmore College) was place in a rural area of Greater Accra. 

We were really impressed with the Ashesi approach and the diversity of thinking that they bring their students. Its faculty has a mix of Ghanaian, other African and American PhD’s (and those were only the few that we met) who want to re-invigorate how African college students learn about entrepreneurship. Though most of the students are Ghanaian, they offer huge support for international African students. The curriculum emphasizes how to use business to fix tangible issues throughout Ghana, from water sanitation to poverty alleviation.  Their view on social entrepreneurship is in line with our own and we hope to recruit a recent graduate to help with some market studies in the near future.

Currently, they have three major areas of study, business, informatics and computer science, but also give the students a broad liberal arts education with history, economics, math, and language study in the first two years. They are also in the midst of building an engineering school in the Fall of 2015. The engineering school will be fully equipped with a small Maker Space (a 3D printer and some lathe equipment) to encourage the creation of innovative products. 

From left to right, Gill Henker (Sisu Global Health), Dr. Stephen Armah (professor of Economics), Isaac (Dr. Armah's TA), Katie Kirsch (Sisu Global Health) and Jude (student of entrepreneurship)

From left to right, Gill Henker (Sisu Global Health), Dr. Stephen Armah (professor of Economics), Isaac (Dr. Armah's TA), Katie Kirsch (Sisu Global Health) and Jude (student of entrepreneurship)

The mission of Ashesi University College is to educate a new generation of ethical, entrepreneurial leaders in Africa; to cultivate within our students critical thinking skills, the concern for others and the courage it will take to transform a continent
— Ashesi University College's Mission