From Grand Rapids to Ghana: In developing-world healthcare market, low-tech is the new cutting edge

Local medical device startup Sisu Global Health plans to create a channel for needed technology to the developing world, while infusing Grand Rapids’ startup scene with a mentality for global impact.
A Grand Rapids-based medical device startup aims to create a pipeline for new products between West Michigan and the developing world — not just for its products, but for other companies and their needed devices as well, the startup’s founders say.

Sisu Global Health is a new startup partnership between two existing Michigan companies. Gillian Henker, chief technology officer of Sisu, is the founder and CEO of Design Innovations for Infants and Mothers Everywhere, Inc., while Sisu CEO Carolyn Yarina and chief marketing officer Katie Kirsch come from CentriCycle, a former nonprofit based out of Chassell in the Upper Peninsula.

The new startup will focus on completing development of DIIME’s Hemafuse technology, a blood autotransfusion device, and of CentriCycle’s flagship product, a manual modular blood centrifuge called (r)Evolve. Then the company plans to use these two products as a “pilot,” as they call it, for a model to export affordable medical technology to Ghana.

“We’re not just focusing on developing devices,” says CMO Katie Kirsch. “We’re focused on being a channel to have some sort of on-the-ground knowledge and distribution help, to get our devices into some different places — but also to help other companies, smaller and larger, to get into these spaces. So helping guide them through some of the more difficult channels, and using our two devices as a way to show how to do that, to prove it.”

The r(Evolve) Centrifuge, developed by CentriCycle, is a manual hand-crank blood centrifuge that can operate without electricity in rural areas, separating blood for quick and accurate diagnostic testing. It also has a modular component that allows the operator to hook up an electric motor and bypass the hand-crank if electricity is available.

Although the r(Evolve) isn’t the first or only manual centrifuge on the market, Yarina says she believes it’s the best design available, and the one with the most chance to make a real impact in its target markets.

“There’s some competition,” Yarina says, “but they’re missing a lot of those kind of... the timeliness, usability, indicators for letting people know when blood has separated. We’ve gotten feedback from the field that people will crank the device for two to three minutes, which is what our device is, but with other devices they’ll essentially get blood that’s not fully separated and they get inaccurate tests, so it’s not really serving its purpose.”

Meanwhile, the Hemafuse is Henker’s innovation at DIIME — a blood autotransfusion system, meaning that it takes blood from an internal hemorrhage and transfers it back to the patient. It’s an important technology for the developing world, Henker says, as donated blood in the developing world is an exceptionally rare commodity.

Autotransfusion is an absolute necessity there, and current lack of access to medical technology forces doctors there to perform “soup-ladle autotransfusion,” which is exactly what it sounds like. Doctors use a stainless steel soup ladle to extract blood from the patients and filter it through gauze before returning it to the patient — an old-fashioned medical practice documented in European medical papers during the 1800s.

Not only is soup-ladle blood transfusion an obvious sterility challenge, it’s also a labor-intensive process and actually quite difficult to perform. This makes it a problematic solution despite its low-tech resourcefulness, as rural areas frequently lack the medical staffing to perform the procedure properly. Still, there is a logic to the simplicity and portability of the process, which eventually informed Henker’s development of the Hemafuse more than she expected.

“Originally we thought it would be this electromechanical system,” she says, “something fairly similar to what we use in the U.S., but maybe pared down. But instead what we came up with after making the right cultural considerations is basically a giant syringe. It can be re-used and it’s about 13 inches long and you can carry it whenever you need to go. So our revised thinking really drove our design, where all of a sudden it’s purely manual, and honestly it can do the job just fine.”

Henker and Yarina have spent extensive time on the ground in Ghana, observing the problems that plague the current medical device pipeline to Ghana, where Yarina notes that over 90 percent of the medical devices are provided by donation. Yet within 5 years, 96 percent of them end up on what experts have called the developing world’s “medical device graveyard” — unable to withstand the rigorous conditions of local hospitals and rural travel, or simply not proving user-friendly and practical to medical professionals in the areas where they’re used.

“We’re trying not to do pared-down solutions of what’s here in the West,” Yarina says, “but culturally-appropriate designs in these areas that fit the different constraints there. They don’t have access to consumables, the way they sterilize things is often by bleach.”

“It’s not just a matter of making things cheaper and simplifying things,” Henker adds. “A lot of these people [in the developing world] are highly technically-trained, they’re educated doctors and things like that. Really, it’s more of a shift in thinking in terms of, ‘what do they need?’ What we think of in the Western world isn’t always appropriate.”

“And for myself as an engineer,” she continues, “it’s just a new challenge. If it were high-tech, that’s its own challenge, but we like low-tech and accepting the challenge of: ‘Yes, you can make this with 2000 parts, but what if you can only make it with 25 parts? What are you going to do then?’”

DIIME and CentriCycle shared common roots at the University of Michigan’s engineering program, where Yarina and Henker both attended and completed the same social venture practicum. The two became acquainted and kept in touch after graduation, but Yarina says they were just “different” as entrepreneurs.

Even though the two had similar goals to improve access to medical devices in the developing world, Henker gravitated toward operating a for-profit business and worked on that model with DIIME, while Yarina wanted to focus on the nonprofit side of things, and she established and ran CentriCycle as such.

The two companies also focused on different areas of the world. DIIME worked primarily in Ghana, where Henker had made connections from a long-standing U of M exchange program, while CentriCycle mainly targeted problems and challenges in India.

As recently as the past few years, the two say, they considered combining their efforts, but backed away when they started to look at the details. It wasn’t until recently, when CentriCycle began to explore the idea of incorporating for-profit aspects into its business model, that the idea for Sisu Global finally began to take on a tangible shape.

“We actually exchanged business plans a while back, then we read them and we were both like, ‘Nope, not gonna happen,’” Henker says. “So it’s been this going back and forth on it, and when they [recently] came back from India it made more sense in terms of where they were pivoting to and where DIIME was at. So we kind of converged at this very opportune moment — Katie and Carrie being on CentriCycle and sort of looking for a more technical side, and myself being a technical person and looking for more of that business development side.”

The three decided that Sisu would initially focus on Ghana as the most manageable location to develop and pilot their model, and they eventually settled on making Sisu a for-profit C corporation for a variety of reasons. While Yarina had experience running CentriCycle as a nonprofit, she had already begun to shift her vision toward a for-profit structure due to a host of domestic and international restrictions on nonprofit companies.

“The problem we ran into over in India is that we’re almost pushed up against a wall,” Yarina says. “In terms of being able to do that nonprofit model, there’s a lot stricter rules for nonprofits in other countries. So you can’t actually sell things as easily. And also in the U.S. there’s this one-third rule, one-third of your money has to come from public grants and donations. So that also restrained our ability to scale, because even with the for-profit [model], a lot of what we’re looking at is creating impact in a sustainable way.”

They also think the for-profit model can help them create long-lasting relationships with health care providers in the developing world, avoiding some of the pitfalls of the “donate-and-forget” device distribution model that has led to the sprawling proliferation of the “medical device graveyard.”

“Since we are for profit, we are selling devices,” Henker says. “So that’s where it comes into a little of a difference, in that we’re not just donating and letting that be the end of the customer relationship. Anything we put in there and implement, we want it to have that ongoing relationship, where they know if we deliver it, it’s going to be right for their needs.”

The name “Sisu” has a Finnish origin, and it came from Yarina’s upbringing in the U.P., where she grew up around a large Finnish population and heard the word in everyday conversation. Although the word is often considered to lack a perfect translation in any other language, it generally means “determination or perseverance against adversity.”

Yarina says she not only liked the word as a summation of the new company’s philosophy and target customers, but figured that it wouldn’t tie the company down to any one focus or image when used as a name.

The principals note that the new startup isn’t a merger, technically. The for-profit DIIME will morph completely into Sisu, also a for-profit company, while CentriCycle will stay around in some form to maintain some of its nonprofit ties with the university and other partnerships.

Henker and Yarina decided to base their new company in Grand Rapids for a variety of reasons — possibly including Kirsch’s “instigator” influence, they say.

“Yep, I did that,” Kirsch says. “I grew up south of Kalamazoo and my uncle lives in Holland. I talked to him a lot about what was going on in Grand Rapids, and when I was growing up it seemed like this kind of stuffy place that was not very innovative in the past. But since we’ve been gone, going to college and traveling and doing all these things over the past decade, coming back and just seeing how it’s changed and how the startup scene is getting very vibrant. It just seemed like the perfect fit right now.”

The three also considered the resources available in the Medical Mile, and the connections they could make in the local startup scene — they’re currently based out of the collaborative office space of GR Current at 234 Division Ave NE. And, they say, they also wanted to re-brand themselves from DIIME’s well-known image as a student organization in the Ann Arbor area.

In the coming months, Sisu Global Health will continue to look for investors, as they’ve “bootstrapped all they can,” according to Yarina, and need a larger infusion of cash to get their products validated and prove that their distribution channel can work. They will also finish developing the Hemafuse and r(Evolve) and prepare them for regulatory testing, and continue to look for manufacturing partners for their devices in the area. And the three principals will also make their fifth trip to Ghana in June, to meet with their customers and end users and further refine their ideas. Also, somewhere in all of that, they plan to carve out time to get a proper website up and running.

“It’s pretty fresh coming together, but we’re evolving quickly,” Henker says.

“A lot of people think California when they think of this kind of social innovation work,” Kirsch adds, “but we don’t see why it couldn’t be here. We talk to connections we have in California all the time, but we feel like all the resources we need are right here.”

Steven Thomas Kent is the editor at Roadbelly magazine and a high-tech, high-growth features writer at Rapid Growth Media. Stalk him on Twitter @steventkent or e-mail him at [email protected] for story tips and feedback.

Photography by Adam Bird

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