 Good morning. Good afternoon. Good evening, everyone. Welcome to the latest in Engineering for Change, or E4C's 2014 webinar series. Today's webinar was developed in collaboration with Meg Worf, the co-founder of Matronova. My name is Jennifer Barragan, and I will be moderating today's webinar. I am a consultant in medical device management and innovation, and I have been working for the last eight years in global public health, focusing on improving access to medical devices in low resource settings. I currently serve as an E4C Solutions Library Program Advisor and as a reviewer for the Consortium for Affordable Technology Innovation Award. I'd like to take a moment now to tell you a bit about today's webinar, Innovations in Global Maternal Health. Childbirth presents a significant danger to a large portion of the world. To bring this into perspective, according to WHO, one woman dies every 60 seconds as a result of complications due to pregnancy or childbirth, leaving one million children without a mother. Worldwide, each year approximately 287,000 women die of maternal death, and for every woman that dies, 20 suffer injury, infection, or disease, approximately 10 million women each year. Though progress is being made towards the United Nations Millennium Development Goal No. 5 to reduce by three-quarters between 1990 and 2015 the maternal mortality rate, simple and low-cost life-saving technology is not yet bitterly accessible in limited resource settings. Fortunately, there is a big focus today on getting these technologies to those who need it the most. That's why E4C invited today's presenter, Meg Worth, to discuss more about what the organization she co-founded is doing in this regard. Thank you, Meg, for joining us today. I'd also like to take this moment to recognize the coordinators of the E4C webinar series, Yaniranda of ASME, Holly Snyder-Brown, Jackie Holliday, and Steve Welch of IEEE to work on developing and delivering the webinar series. Anyone has questions about the series or would like to make a recommendation for future topics and speakers, we invite you to contact E4C via the email address visible on the slide, webinars at engineeringforchange.org. In case you are not already familiar with engineering for change, I would like to give you a little background on who we are. E4C is a global community that represents nearly 100,000 individuals, including technically-minded members and social media followers such as engineers, technologists, representatives from NGOs, and social scientists who work together to solve critical humanitarian challenges faced by underserved communities around the world today, whether in water, energy, health, agriculture, sanitation, or other areas. We invite you to join E4C by becoming a member. Here, E4C membership provides cost-free access to a growing inventory of seal-tested solutions and related information from all the members of our coalition, including professional societies like ASME, IEEE, ASCE, SWE, and ASHRAE, academic supporters like MIT's D-Labs, international development agencies like USAID, EWBUSA, and practical action. Membership also provides access to a passionate, engaged community working to make people's lives better all over the world. Registration is easy and it's free. Check out the website, engineeringforchange.org, to learn more and sign up. The webinar you are participating in today is one installment of the Engineering for Change webinar series. This free, publicly available series of online seminars showcases the best practices in thinking of leaders in the field who bring innovative technology and solutions to bear on global humanitarian and development challenges. Information on upcoming installments in the series, as well as archived videos of past presentations, can be found on the E4C webinars webpage, engineeringforchange-webinars.org. If you're following E4C on Twitter, I'd also like to invite you to join the conversation with hashtag E4C webinars. E4C's next webinar will be at the end of May on the topic of agricultural devices, so stay tuned to the E4C webinars page for updates on the presenters and registration details. If you're already an E4C member, you will be receiving an invitation to the webinar soon. So just a few housekeeping items before we get started. First, let's see where everyone is from. If you could please, in the chat window, which is located at the bottom right of your screen, type in where you're calling in from. Any technical questions or administrative problems should go into this chat window. Feel free to send a private chat to Holly or Jackie if you're having any issues. You can also use the chat window to type any remarks you might have. And during the webinar, please use the Q&A window which is located right below the chat to type in your questions for the presenter. If you're listening to the audio broadcast and you encounter any trouble, try hitting stop and then start. If that doesn't work, you can use the call-in number for the teleconference. You may also want to try opening WebEx up in a different browser. Following the webinar to request a Certificate of Completion showing one professional development hour for this session, please follow the instructions on the top of the E4C Webinar's webpage. Okay, so I see a few people have entered where they're coming in from. I see many from the U.S., Hawaii, Boston, Georgia, New Jersey, Singapore, some international, Colorado, Switzerland. I'm also in Switzerland. That's great. Welcome. Canada, very good. So let's get started. Well, I would like to kick off today's webinar with a very brief background on medical devices and innovation. In honor of World Immunization Week, I've put in this particular image. I hope you can see it on my computer. It's not appearing well, but if you can, you will see a child receiving a vaccination. And that's something that would not be possible without a syringe, one of thousands of medical devices that exist in our world today. Fortunately, not all medical devices are as scary as a syringe is to a child, and they are a key component to providing critical quality healthcare. As with trained medical professionals, without them, medical diagnosis, treatment, and care would be impossible. They save lives every minute of every day. So what exactly is a medical device? Well, according to WHO, it is an article instrument apparatus or machine that is used in the prevention, diagnosis, or treatment of illness or disease, or for detecting, measuring, restoring, correcting, or modifying the structure or function of the body for some health purpose. Devices range from stethoscopes and eyeglasses to the most complex magnetic resonance imaging machines, and include devices used in childbirth such as delivery forceps, syringes for injection of critical medications, and other surgical instruments. Unfortunately, critical medical devices in limited resource settings are often not available. They may be completely inappropriate for the setting, are sometimes found sitting in a brand new box unopened, or are entirely broken and taking up space in critical patient areas. Improper procurements, poor donation practices, and lack of maintenance contribute to these issues. Light of the difficulties in repairing such a complex system, innovative devices that are simple to use, require little maintenance, are practical, easy to transport, and low cost are being developed at an incredible pace. WHO's annual Compendium of Innovative Health Technologies, academic networks and programs such as the Consortium of Affordable Medical Technology, and C2A award programs like Grand Challenges Canada and Saving Lives at Birth, plus the addition of numerous academic courses on innovation and low resource settings, highlight just how rapidly this field has grown in the last few years. The issue is in getting the best of these devices through the development phase successfully into the commercial market and into the healthcare systems of those in developing countries with the greatest need for them. Many useful tools already exist, but they are not reaching target populations. The reason for this is complex and one that every woman, every child is trying to address through their United Nations Commission on Life Saving Commodities. The commission has issued 10 recommendations that implementing partners are currently addressing. These include shaping markets, improving quality of products and strengthening regulatory systems, along with improving awareness and utilization of the 13 commodities they identified as the most critical. Furthermore, WHO, UNICEF, and UNFPA are getting ready to release an interagency list of essential interventions on reproductive maternal newborn and child care. Ministries of Health will look to this for guidance, but the next step of how and what to purchase is critical. And this is why I'm very excited to introduce our speaker today. Matronova is filling a critical gap, and I am personally very excited not only about what they are doing for maternal health, but also for the example they are setting for medical devices globally. So I'm honored to introduce our presenter. Meg Wurth is the co-founder of Matronova. She has worked on women's health throughout her career, from Appalachia to Borneo. Meg's expertise is in maternal health technology and innovation. She is co-author of the UN Millennium Project's final report on child and maternal health. I'll now turn it over to Meg. Good day, everybody. I am so happy to be presenting today and welcome everybody from Singapore to the U.S. and everywhere in between. I am going to go through a presentation to tell you about Matronova and the lessons that we've learned along the way in developing what is a social enterprise focused on maternal and newborn health. The first slide is really focusing on feedback from customers, and to us this is an absolutely critical component of what we do and what is the end game for every entrepreneur, inventor, and engineer out there working in this field. And this is what we want to hear. We want to hear from the folks using the product, not in its pilot stage, but in its full realization of commercialization. This is a note from Haiti Village Health. Thank you for your inspired commitment to practical technologies. Though it was sent to us, we really view it as a thank you to everyone working in this field. And really very much in the spirit of getting products out and accelerating the time that it takes to get a product from conception out to widespread uptake. And I think that's the work that is being done across the globe. It is a place where Matronova is stepping in to, again, accelerate progress. I want to go through the three leading causes of maternal, both maternal death, but also maternal morbidity, meaning ill health or consequences that detract from women's health. Many of you will already know that hemorrhage or excessive bleeding is a leading cause of death for women. Usually this happens in the postpartum period or after a woman gives birth. There is a certain amount of blood, but when it becomes excessive or if a woman is anemic to start, she can bleed to death very quickly. And in fact, it's very important to know that in the absence of any treatment, a woman can lose blood at such a rate that she will expire in just two hours from the onset of a massive postpartum hemorrhage. Now, aside from being a very grim and sobering issue from a medical perspective, I want to mention that there are many ways to think about reducing hemorrhage and addressing this issue. A lot of folks look right at the moment that the hemorrhage is occurring, so there are some interesting very, very low-tech products and ideas and solutions out there ranging from the Quayum blood mat in Bangladesh that alerts folks to how much blood has been lost to graduated drapes that again alert people to loss of blood. But if you think generally about the issue, there's a lot of work to be done in terms of thinking about biomedical design and devices in early warning signs, in new devices that could alert people more rapidly to problems, mobile devices, devices that could go home with a mother so she starts bleeding later, you can still address the issue. What I really want to do in this presentation is focus on the fact that maternal health is not a niche issue, that there are many antecedents to maternal ill health or problems during childbirth that really can be addressed by bright minds from around the world and that there is so much more that needs to be done and could be done. And I'll tell you a bit about our solutions for doing this. The next slide looks at Eclampsia, which is a profound hypertensive disorder which is usually manifest in a woman having seizures and eventually women dying, this is in many countries, what happens during childbirth and can accelerate very rapidly. Again, it is an emergency situation. So the question is, again, an engineering, a biomedical research, biomedical design point of view, what are the early markers of preeclampsia? What can you find in the urine? What can you do to address the fact that women may have eclantic seizures after they go home? We want to stress the need for innovative ideas that go beyond the moment of birth to predicting and following up on these issues. And I will talk a bit more later about a technology that starts to get at some of those questions. Similarly, women and their providers, the traditional birth attendants and community health workers, don't always know that this is a severe danger sign of pregnancy. And so if you are interested in mobile health or early detection and warning signs, information, education, communication, all of those innovations and solutions have a role to play in preventing what is either the leading or the second most common cause of maternal death and morbidity. And this is a really interesting frontier of research in both the industrialized countries as well as the developing world. This is an issue that is really a frontier and deserves quite a bit more information and research. And finally, I just want to mention, and again, these are in large, bold colors to drive home these three leading causes. Many of them are very interlinked and interrelated, postpartum hemorrhage and infection, linked to one another. In some cases, a woman has been enduring an infection for years, potentially if it's a sexually transmitted infection, or for the months during pregnancy. What are the innovative technologies, rapid diagnostics, simple methods to research sepsis and infection ahead of time? And one that I will point out, certainly HIV and syphilis are two very prevalent infections that have profound consequences for the newborn and for the outcome of the pregnancy. So again, to review hemorrhage or excessive bleeding, eclampsia and preeclampsia and sepsis infection are what many call in the public health space the approximate or immediate causes of death. But many of them have antecedents in the woman's life and in her pregnancy. And I really want to drive those home for those of you who are more on the research side of things. So let's just get to Modernova and why we would create such an entity. And really what Modernova is is an online e-commerce platform where what we do is research hundreds of innovations and solutions in maternal and newborn health. We started that way in order to let everyone know what the state of the art of innovation was. What we found was that there were a lot of incubator research projects and new ideas coming out. There were many of them, but we noticed that certain groups were not talking with other groups and some seemed unaware that products were further along in the commercialization pipeline than others. What we did with Modernova starting in 2009 was we put all of the products up in an open source library and sort of an interesting thing happened as we built our social media presence. And I would love it if everyone followed us on Twitter at Modernova and sent us ideas and information because that's really a lot of the currency of how we built our social enterprise and our company. What we found was that people were really interested theoretically in the innovations and the technologies, but they wanted something much more immediate. And what they wanted was access to the products. And we saw this as a very exciting market opportunity. At first we looked around to see who else could possibly, you know, who we could refer them to. And we didn't find an obvious answer. And so being entrepreneurial, we decided that we would try our best to fill this missing link. And what we wanted to do was meet the demands of the customers. They were saying, where is this product and how can I buy it and how can I get it now? Very, very practical questions. They also asked things like, who else has tried it? What's the literature on it? What were the findings of the pilot studies? And so from those initial forays and these explorations, we created what was at first just 10 products online that you could purchase. And now we have expanded what we are offering to include 40 products all in the maternal and newborn health space. The idea for doing that is fairly simple. I mean, it's an online catalog. We also send out a paper catalog. The reason we do it is because we know that in general the people providing frontline care are midwives, nurses, and doctors. They are in private franchise clinics. They're in stand-alone clinics. They are part of large humanitarian organizations and they're part of government-funded groups. But what they're doing is usually providing assistance at childbirth at the point of care, needing the latest products, not having time to research the most appropriate and newest technologies. And so what Modernova set up to do is to push out information and pull in information all in one place. The same frontline provider who uses one product to look at or treat eclampsia will inevitably, in her next birth or the next week, encounter one of the other issues. And so it makes sense to us to market similar products together, to put in one place life-saving technologies, to market them to the same end users, and to send them out in customizable bundles based on need. Our typical customer, well, it's hard to say. It's not terribly typical. But what we started doing was selling to experimental innovative nonprofit groups. A lot of them were online, looking at social media and researching products. We began with these innovative nonprofits. We then targeted the larger humanitarian groups, including places like the International Rescue Committee, who are in dozens and dozens of countries providing frontline care. And now we have moved on to direct, we have moved on including those other two classes of customer to ministries of health. So we do do our search engine capabilities. We are able to attract folks who are in the Ministry of Health Office looking for technologies or looking for new solutions. And we are just in 2013 to 14, we've started selling directly to ministries of health. So to look at this slide quickly, I do want to mention that we are a hybrid business model. And Modernova began with the social enterprise, which is the e-commerce platform that I described. And then in 2013, in the summer, we added Modernova Research, which is a nonprofit entity. And Emily Taylor is online. She is leading Modernova Research. The two pieces are really two separate organizations that work together fairly seamlessly. We're in the Modernova Research arm. We uncover innovative new products, ideas, and solutions. And in some cases, we consult or help those groups to move more quickly by finding them pilot sites and end users and perhaps stepping in to help with the rebranding and marketing of the product. In other cases, we really just pick up the product once it has reached a certain stage and we help to market it in countries where it may not have much of a presence. I think one of the reasons we started Modernova is that we felt as though the process could be accelerated. The process means the point from which a great idea is validated in a pilot study to the time at which it is commercialized and widely available in the countries where it is needed the most. And that is really our sweet spot and the approach that we are taking. If we market, sell, and distribute complementary reproductive health products, we believe we can spread information more quickly. In the business world, it would be called customer awareness, where we're making people aware of the very existence of these products. And more in the non-profit world, we are spreading information more quickly. And we're really poised at a balance between these two worlds and trying to prove out a model that will allow folks to move much more quickly. We've talked about the statistics. This actually is a photograph of a woman suffering from preeclampsia. We felt when we were founded that there is a lot of pointing to the negative statistics of maternal health. And indeed, they're very sobering. What we wanted to start to point to was the amazing number of solutions that are out there. And though we all know there's a human resource shortage globally and that it's most acute in the countries that are the worst off in terms of their health outcomes, there are still 14 million nurses and midwives who need rapid access to life-saving innovations. Jennifer, in her terrific introduction, mentioned all of the very inspiring new sources for innovations in maternal health. And these are coming out of universities and labs and non-profits. There are indeed hundreds of innovations. When we started, we had a core of about 20 in 2009. And we're now at almost over 300 innovations in maternal and newborn health. I mean, what I really want to emphasize to all of you again is this idea that maternal health is not a niche issue. That water plays, of course, a tremendous role in women's health and girls' health. And a subset of those women and girls will become mothers, will go through pregnancy. And so water and transport and things like sterilization of medical equipment are all things that will profoundly affect maternal health and should be thought of as such. In this picture, we sort of show a range of all of the products that we cover. And the range is from the simple fetoscope up in the upper left-hand corner, which is used across the world, to the lower left, which is the hemoglobin color scale. WHO approved technology to detect anemia using a colorimetric scale. In the middle is a rapid diagnostic using wicking paper. On the right is the Kiwi device for obstructed labor. And then we also heard Jennifer mention the importance of vaccination. And here in this UNIJECT technology, you can see how a medical device that can automatically disable can radically change both dosing as well as infection prevention in the process of vaccination for women. And then the tetanus toxoid vaccination is absolutely key and in most countries is part of antinatal care. So, you know, the one category that folks should think about is really how do you improve on existing technologies. There's a group in Uganda looking at, you know, hooking up that simple fetoscope, that funnel-shaped object that you see in the upper left of your screen, hooking that up to a mobile device. And how could that use this well-known technology and enhance it? Similarly, there are groups who have figured out how to create a solar-powered blood pressure cuff, blood pressure for the hypertensive diseases of pregnancy and for diagnosing preeclampsia and other issues, absolutely key to antinatal care and beyond. Similarly, a group of researchers found that you may need slightly different technology to think about measuring blood pressure in pregnant women, another very interesting area of research. So, for each of these technologies, there are very interesting tweaks and modifications and enhancements that could be made for different settings, but there's also completely out-of-the-box thinking. The embrace incubator is featured here. What if you were able to take the incubator out of the tertiary care setting and into the community? Lots of rapid diagnostics and labs on a ship can radically change the ability to detect very early signs of complications in women, in pregnant women, and are really, to us, some of the most exciting and promising technologies to allow us out into the field. Where are they coming from? We have a couple universities named here. We have gone well beyond the U.S.-based universities to virtually every corner of the globe, and sometimes that takes more digging. One of the disconnects that we've noticed is that a lot of the big contests that you think about for appropriate technologies in health are based in the U.S., and thus will source a lot from the U.S. But to us, the most exciting technologies are coming out of the settings where they are most needed. So, in the center, in the photos, you see what is a fetal heart rate monitor. This was developed in Uganda by a midwifery group providing very high quality of care. Again, like so many of the technologies that we feature and that we love and promote, this is a very interesting little permutation of that fetoscope. You can see it has some symbol signs and reminders in different languages on it. What they've done is say, use this fetoscope. We have a 15-second timer and we have a color-coded counting bead. This can be used to detect fetal heart rate and determine whether or not there's a complication going on as the mother gets closer to childbirth. Modern Nova's role here has nothing to do with the development of the technology, but what we've seen is an indigenously developed, tested technology that is incredibly exciting, extremely low-cost, developed by midwives in Uganda, and where we step in is to help to market this technology to let others know about it in the catalog, to push it out to ministries of health and elsewhere, and to get it into use in other settings. The group in Uganda could do this, but they are focused on providing care locally and expanding their model locally. They are focused on clinical care. This is a terrific example of how we source the ideal technologies. We also have innovations coming out of the Philippines, multiple places in India, Pakistan, Nigeria, and Uruguay. Very, very exciting range, and I think if I were to project forward, what we'd love to see is more and more rapid sharing of technologies developed for the base of the pyramid in the base of the pyramid countries. The final device that you see on the right I will discuss at some length, and that's the non-neumatic anti-shock garment. The other thing to just note is a lot of us work in the nonprofit sector, and that certainly is where my background is from, but if you really take a step back and look at the international market for medical devices just in obstetric neonatal commodities, we by our calculations find that it's a $15 billion market even in the poorest countries of the world. So this is where all of you who are entrepreneurs and innovators, this is where you want to be headed in order to reach scale, and I think that's quite important. This is another depiction on this slide of where modern over works. We see ourselves as a wheel connecting two groups. The tops, gear, entrepreneurs, innovators, nonprofits, large organizations and small, need a fast track to commercialize medical innovations for the rest of the world. How do 200 different groups go about getting products out into the market to be used by the same end user? On the other side with the cross, you see our customers or the end users, procurement agencies, humanitarian groups, private health care groups, are all interested in the latest products, but don't know what to trust or where to look for them. What we want to solve on a single platform is that we want to become a trusted place for researching and purchasing maternal and newborn health innovations. What that means is that we don't want to just take any product that comes along. What we are doing on our nonprofit side with modern over research is that we are testing products with trusted partners in the field and giving them really a stamp of approval so that it's known, is this a cool idea? Did it win a contest? That's great, but how well does it work over time? Did it break after a year? Is the company still around that you could even get a replacement or ask for customer service? Really very, very practical questions. Other questions would be, well, how does it stack up when run head to head with its competitor? These are pieces of information that we really think are missing right now. Design that matters has said, and we're big fans of their work, they sort of said don't design to win a contest, design for sustainability. We want to be able to provide a description of quality and ruggedness and customer feedback over time by having a platform where these products can be rated, actually. So this is our vision, it is a big vision, but as a startup that's how you generate your power and your staying power. We want to make access to global health technologies as easy as click and ship, and we know certainly from experience all of the regulatory hurdles and barriers that make that difficult. You want to remove a lot of those and put those in place, but make it seem as easy as click and ship. So we have product sales, and then we have our own proprietary products and a collaboration platform, which gets at the question of groups who are all using the same product together. How can they collaborate and write papers or undertake studies or inform ministries of health in tandem so that these are not happening country by country, pilot by pilot. This again is our Holy Grail, which is a photo of newly trained midwives. The newly trained midwife is in the pink suit in the scrubs in Haiti using a product that Modernova helped get there. It's not our product, but we're able to get it to end users who had never heard about it before and to accelerate that process of commercialization that we described. This is another kind of view of our goal, which is combining content, commerce, and collaboration with a trusted source in the middle. I think there are lots of groups and terrific groups that review technologies and look at them, but to get back to the piece that I mentioned at the very beginning, you can't always access the technology, and groups spend a lot of time trying to figure out how to actually purchase it, so we're hoping to fill that gap. Briefly, this technology is the non-neumatic anti-shock garment. It's an incredible medical device because it's completely non-invasive, and what it does is actually buy time. The compression suit wraps around a woman, shunts blood back to her core. There's a hard foam ball in the middle of the device that presses on the uterus. This changes the odds that I mentioned earlier. A woman who is hemorrhaging has about two hours using this suit. You can buy her, depending on her situation, a lot more time to get to a facility, to get blood, to get treatment. The next technology that I want to mention is one that we're partnered with. Biosense came out of India, and this is a really amazing smartphone-enabled device, although it can be done on a very basic Android-type phone. What it does is it takes your analysis with a dipstick test into a mini lab that costs about one-tenth of what a benchtop analyzer would cost. Using this really neat little white room, it stabilizes and standardizes the light using the camera of the smartphone to analyze up to 14 parameters simultaneously, whether you're in dipstick. We are working on this technology, if we believe in Zimbabwe and Tanzania, to test midwives' ability to use your analysis and really to look at issues like eclampsia and predicting eclampsia and pre-eclampsia earlier in pregnancy. This is a bit about Modernova's momentum. We have shipped product to 30 countries. We have 170 countries engaged online. We have 40 products. We will be moving to at least 60 products by the end of the year. Our goal is an unlimited number of products. Again, it's a trusted set of interventions that are symbiotic and synergistic and work together, ideally for our end customers in the lowest resource settings of the world. Our goal is 6 million lives by 2016. And I'd like to really thank everybody for being part of this seminar. I hope you have questions. I hope you have ideas. Imagine that there are innovations out there from all the corners of the world where you work that we haven't covered well and we'd love to hear about them. So thanks again to the organizers for this incredible opportunity. And again, our main currency is ideas and we welcome your ideas. Thanks so much. So I think we can go to questions. All right. Thank you, Meg. That was wonderful. I'd like to open up the floor for questions and answers. So if you all could take a look down at the bottom right hand part of your screen and where it says Q&A, if you could please enter your questions so that Meg can take some time and answer them. And let me take a look and see if anything has popped up. I believe you answered one of these already, Meg. The other one that's up there right now is how long does the math distinguish between amniotic fluid, urine, et cetera from blood when determining hemorrhage alerts? Right. So that's a good question. And this is an interesting technology where we have not actually been very successful in getting – we're in touch with the entrepreneur. And folks that work with them, but getting it out of Bangladesh and elsewhere has not become a reality. So I know these are all issues that they're working on and sort of counting in amniotic fluid and urine from blood is one of the main issues. So we don't have a great answer to that question, but it is absolutely critical. And I do know with the variation on that theme that we do have, which is a graduated under-products drape, it's called. It's basically something that comes down in a funnel with graduated milliliter markings. And users are instructed to sweep away the amniotic fluid or urine and to put the drape on after birth. So it's not a perfect system, but it has been shown certainly that in study after study, it's shown that providers, whether they're OBGYNs or village midwives, tend to underestimate blood loss. And so having some sort of quantification of blood loss to alert people, even if it's somewhat imperfect, is very, very important. But I would say there's no perfect solution to that yet. Okay. There was another question that came in. I keep losing it because it's sliding on me. Are you seeing particular countries beyond the U.S. leading the way in terms of maternal health technology innovation? Yes. That's a great question. Certainly India, and that includes anemia detection and things like all kinds of rapid tests. There's a lot in Brazil, a lot going on in Brazil. We have a whole subset of products that were developed in Uruguay, all specific to maternal and newborn health, and grew out of PAHO, WHO, Pan-American Health Organization, sister organization. So those are a few of the countries. There's a lot of experimentation in places like Nepal and Pakistan, and a lot happening in Uganda and Nigeria. So those are just places we have happened to have partnerships and contacts. But we know that some of the most interesting work is not happening here, actually. And that shouldn't be surprising. I think we are very committed to breaking through language barriers and marketing products as rapidly as possible. And marketing ideas and solutions that maybe they don't have IP behind them. Perhaps they have no revenue associated with them, but they're still just as critical. Okay, Meg, I don't see other questions, so I'm going to ask a few if you don't mind. I'm interested to know if you include devices that are not considered innovative. Because from my experience, I see that sometimes initiatives need to know what's just out there, and there are technologies that exist already that would be effective for what they need, but they just don't have a resource and they don't know how to compare all the different technologies. And to go along with that, how do you compare technologies? Do you give them an ability to say, well, this one is better than that one for the same function? That's a really great question, and certainly something that we found as we delved more and more into this. And that was we were really enamored of innovations and cool ideas, and we still are. But as we talk to more and more end users and customers, we did find that, you know, if something, an innovation, if it was invented 15 years ago, you know, at a certain point, you don't care if the person can't access it, it would be innovative to them. So we have definitely stepped in to things that, you know, are now so standard in some places they wouldn't be called innovative. An example would be the Muac tape for Child Health, which I think was pioneered by Médecin Frontierre. But a lot of groups have trouble accessing just a simple tape to measure the mid-upper arms circumference. So when we hear from customers again and again that it's hard to access the product, we do, and it's something that is critical to maternal health outcomes. We do step in, and we're increasingly adding those kinds of products to our site. Similarly, you know, your basic set of stainless steel instruments that any OBGYN should have, we are looking now at supplying, you know, sets of those from a very low cost but still well-regulated and trusted source or plastic versions of that for people that need in an emergency and don't even have the ability to sterilize. So it's a great question, and I would say over our evolution we have become equally interested in core products that are not well supplied. And that comes about because you can imagine if they're coming to us for their hemoglobinometer and their other anti-natal care, well, then it might be just as easy with one transaction to order their more sort of core non-innovative supplies. And that's how our business model is evolving. Great. And just to follow up to that, do you have a place where they can compare technologies? So you showed us the fetoscope of these, but there's also a fetoscope, you know, regular one. So is there a way to compare what one does and what the other one doesn't and vice versa? Right. We're working towards that. So we would like to have more of a, almost a consumer report function where you can compare how things work, like what requires the least training, what is the most specific and sensitive. And we're not really quite there yet, but what we do find ourselves with almost every order, we're sort of advising the group as well. So they'll say, okay, this is for OBGYNs, what would you suggest? And usually it's what we say is not what we personally would suggest, but our other customer in Columbia uses this, and they have found it effective. So it's that at this point in time, that's where we are, but you are pointing to quite a critical need, which is rapid feedback on what's most appropriate for where you are. Someone asked if we ship to point of use. Yes. So a lot of our business is drop shipping, where, you know, we just happen to be in the U.S., but we will, you know, ship from the manufacturer or the inventor or the nonprofit that created the technology to the end user. Okay, I have that. Sorry. I have a number of very good questions coming in. In your database, you have technologies being implemented, dormant, and in development. How do you support these innovations to move further the product development path until it becomes a commercialized product? Right. We choose a subset of products based on a few things. One is how checking with our customers, partners, and advisors where we think the greatest need and demand will be. Then checking with the entrepreneur, if they're sort of on their own journey or trajectory, they sometimes don't necessarily want input from someone else or they have another alternative, then it's not a good fit. But if we have discussions and then it looks as though we can move forward, we step in as partners, basically, to help move the product forward. So for an example, we did that with something called the thermospot. That's a newborn health technology, although we actually think it could be a maternal health technology as well. It's a stick-on thermometer to measure core body temperature and address hypothermia, something that happens to women when they go into shock from postpartum hemorrhage and other complications. The beauty of that technology is that it's not numbers or literacy-based. It's a color-based warning sign that your core body temperature is too low. So we've been working with that entrepreneur and manufacturer to rebrand that product and to market it much more widely. And through that process, we actually helped to get the product into large-scale pilots in Pakistan and Kenya. It had already been tested in India. So that's one example. Okay. I think we have time for about one more question. How do you select your innovation? What are your mechanisms for distribution in the countries where you deploy the technologies or who distributes them? Those are great questions. Each one is probably a half-hour discussion. We select them really based on the assured criteria, which we could send the link out to if those that don't know it. But was it designed for low-resource settings? How rugged is it? How sensitive and specific it is? Will it be able to clear regulatory hurdles, either usually a CE marking? Has it been tested elsewhere? A list of about 10 screens that we do for the product. And then the mechanism for in-country is quite a range. When we're working, say, if we're sending to the UN or the international humanitarian groups, we work just directly with their procurement arms. But in country, we are usually working with an import agent, a distributor, and it's a partner distribution agreement, country by country, or region by region. Right now, we're working on one for a group of a trading block in Central Africa. Okay. We have one more minute, so I can read out one more question. What capabilities are you investigating to support consultation on site during pre-delivery, delivery situations, communication links, monitoring, et cetera? Right. It sounds like it's a mobile health question. And one thing we found is that the mobile health sector is incredibly robust, even having the M Health Alliance. And so while we started looking at a lot of those technologies, we're, I would say, not investing a lot of time and energy there, except for maybe cherry picking a little bit of the best solutions and spreading the word on the great work that others are doing. An exception to that would be that UCheck biosense device that I mentioned, because they allow, what we're really interested in is technologies that have some hardware component, but also link to M Health or to sending information by mobile phone or to the cloud. And so that UCheck device is one example of that. There's also a really interesting technology called M Water where they are allowing with a simple water testing device to measure E. coli, and then they push information on that to the cloud so that there's a crowdsourced open source map of the quality of water at different service points. And that's in Tanzania right now. So I would say in general, we track that space, but we're not quite as engaged as we are in the actual hardware slash medical devices. Okay, thank you Meg. I think that's all we unfortunately have time for. It's 6-0-1. So thank you, Meg. Thank you to all the attendees. So much, everybody. Thanks everyone for participating in today's webinar on the screen. Right now you're going to see the PDH code and email address should you wish to earn a professional development hour. If you have any questions about the webinar series, feel free to email the webinar team. And finally, don't forget to become an E4C member to never miss a webinar announcement. 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