TEDWomen 2013
Krista Donaldson: The $80 prosthetic knee that's changing lives
克里丝塔· 唐纳森: 改变人一生的80美元假膝
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近几年来，科学技术在不可思议地进步着，但是，大多数情况下，它似乎只能使少部分富足的人群受益。工程师克里丝塔· 唐纳森为我们介绍了“移动假膝”，一种为膝上截肢者设计的假肢，而这些截肢者中的很多人每天的生活费不足四美元。这种产品不但拥有一流的品质，也比市面上的其他假肢要便宜得多。
Krista Donaldson - Engineer
Krista Donaldson is the CEO of D-Rev, a non-profit product development company improving the health and incomes of people around the world. Full bio
Krista Donaldson is the CEO of D-Rev, a non-profit product development company improving the health and incomes of people around the world. Full bio
Double-click the English transcript below to play the video.
00:12
Nine years ago, I worked
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九年前，我在伊拉克
00:14
for the U.S. government in Iraq,
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为美国政府工作，
00:16
helping rebuild the electricity infrastructure.
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帮助重建电力基础设施。
00:19
And I was there, and I worked in that job
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在那里，我致力于那项工作
00:22
because I believe that technology
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因为我相信技术
00:24
can improve people's lives.
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能够提高人们的生活质量。
00:27
One afternoon, I had tea with a storekeeper
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一天下午，我在巴格达的拉希德宾馆
00:29
at the Al Rasheed Hotel in Baghdad,
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与一位仓管员喝茶，
00:32
and he said to me, "You Americans,
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他对我说：“你们这些美国人，
00:35
you can put a man on the moon,
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可以把人送上月球，
00:36
but when I get home tonight,
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但是当我今晚回家的时候，
00:38
I won't be able to turn on my lights."
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我甚至连电灯都无法点亮。”
00:41
At the time, the U.S. government had spent
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那个时候，美国政府
00:42
more than two billion dollars
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已经在电力重建上
00:45
on electricity reconstruction.
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花费了超过二十亿美元。
00:47
How do you ensure technology reaches users?
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你怎么才能确保技术真正触及用户？
00:50
How do you put it in their hands
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你怎么才能把它交到用户手里
00:52
so that it is useful?
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来使它真正有用？
00:55
So those are the questions that my colleagues and I
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这些就是我和我的同事
00:58
at D-Rev ask ourselves.
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在D-Rev（非盈利组织名）问自己的问题。
01:00
And D-Rev is short for Design Revolution.
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D-Rev就是“设计革新”（‘Design Revolution’）的缩写。
01:03
And I took over the organization four years ago
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我在四年前接管了这家组织
01:05
and really focused it on developing products
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并且专注于开发
01:08
that actually reach users,
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真正能触及用户的产品。
01:10
and not just any users,
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并且，不仅仅是任何用户，
01:11
but customers who live on
less than four dollars a day.
less than four dollars a day.
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甚至也包括那些每天的生活费不足四美元的顾客。
01:16
One of the key areas we've been working on recently
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我们最近正在致力的其中一个关键领域
01:17
is medical devices, and while it may not be obvious
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就是医疗设施，虽然它与伊拉克的电网
01:20
that medical devices have something in common
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之间的共同点
01:22
with Iraq's electricity grid then,
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似乎并不明显，
01:25
there are some commonalities.
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但共同点确实存在。
01:27
Despite the advanced technology,
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尽管今天的技术已经十分发达，
01:29
it's not reaching the people who need it most.
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它却并没有触及到真正需要它的那些人。
01:32
So I'm going to tell you about one of
the projects we've been working on,
the projects we've been working on,
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所以我要告诉你们一个我们正在进行的项目，
01:35
the ReMotion Knee, and it's a prosthetic knee
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“移动假膝”（the ReMotion Knee），
它是一种为了膝上截肢者
它是一种为了膝上截肢者
01:38
for above-knee amputees.
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而设计的假膝。
01:40
And this project started when
the Jaipur Foot Organization,
the Jaipur Foot Organization,
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这个项目是在世界上最大的
01:43
the largest fitter of prosthetic limbs in the world,
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假肢装配商——斋浦尔足组织
01:46
came to the Bay Area and they said,
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来到海湾地区的时候开始的。他们说：
01:47
"We need a better knee."
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“我们需要更优质的假膝。”
01:50
Chances are, if you're living on
less than four dollars a day,
less than four dollars a day,
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然而很有可能的是，如果你一天的生活费不足四美元，
01:53
and you're an amputee,
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而且你还是一位膝上截肢者，
01:55
you've lost your limb in a vehicle accident.
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在一场车祸中丢掉了下肢。
01:57
Most people think it's land mines,
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许多人都认为是地雷惹的祸，
01:59
but it's a vehicle accident.
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但事实上却是一场车祸。
02:00
You're walking by the side of the road
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你正在路边上走着
02:02
and you're hit by a truck,
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然后被一辆卡车撞到，
02:04
or you're trying to to jump on a moving train,
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或者你想尝试跳到一节行进的火车上，
02:05
you're late for work, and your pant leg gets caught.
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你上班迟到了，裤腿却被攫住了。
02:09
And the reality is that if
you don't have much money,
you don't have much money,
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事实就是，如果你没有足够的钱，
02:13
like this young named Kamal right here,
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就像这儿的这位名叫卡马尔的年轻人，
02:15
the option you really have
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你真正唯一的选择
02:17
is a bamboo staff to get around.
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就是找一根竹棒来支撑身体走动。
02:19
And how big a problem is this?
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这是个有多普遍的问题？
02:22
There's over three million amputees every year
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每年有超过三百万膝上截肢者
02:25
who need a new or replacement knee.
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需要一副新的或者替代的假膝。
02:28
And what are their options?
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他们有什么选择呢？
02:30
This is a high-end. This is
what we'd call a "smart knee."
what we'd call a "smart knee."
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这是一类很高端的东西。我们称它为“智能假膝”。
02:32
It's got a microprocessor inside.
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它的内部装有微型处理器。
02:34
It can pretty much do anything,
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它几乎可以做任何事，
02:37
but it's 20,000 dollars,
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但是它要花费两万美元，
02:38
and to give you a sense of who wears this,
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那是什么人装配得起它呢？
02:40
veterans, American veterans coming
back from Afghanistan or Iraq
back from Afghanistan or Iraq
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他们通常是老兵，从阿富汗或伊拉克归来的美国老兵
02:44
would be fit with something like this.
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一般都会装配这样的东西。
02:46
This is a low-end titanium knee.
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这是一种低端的钛制假膝。
02:49
It's a polycentric knee, and all that that means
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它是一种多中心的假膝，也就是
02:51
is the mechanism, is a four-bar mechanism,
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一种机械，一种四杆机械，
02:53
that mimics a natural human knee.
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用来模仿人类本来的膝盖。
02:56
But at 1,400 dollars, it's still too expensive
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但是一千四百美元的价格，它对于像卡马尔一样的人
02:58
for people like Kamal.
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还是太贵了。
03:01
And lastly, here you see a low-end knee.
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最后，这还有一种低端的假膝。
03:03
This is a knee that's been designed specifically
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这是一种特别为贫困人群
03:05
for poor people.
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设计的产品。
03:07
And while you have affordability,
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虽然你拥有购买它的能力，
03:09
you've lost on functionality.
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但是在功能性上就缺失了不少。
03:10
The mechanism here is a single axis,
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它的机制是一个单一的轴，
03:13
and a single axis is like a door hinge.
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这根单一的轴就像门枢一样。
03:15
So you can think about how unstable that would be.
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这样你们就能够想象它有多不稳定。
03:18
And this is the type of mechanism
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而且这就是斋浦尔足组织
03:20
that the Jaipur Foot Organization was using
when they were looking for a better knee,
when they were looking for a better knee,
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在寻找更好的假膝时正在使用的机械，
03:23
and I just wanted to give you a sense
of what a leg system looks like,
of what a leg system looks like,
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我想让大家知道一下整个腿部系统是如何工作的，
03:26
because I'm showing you all these knees
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因为我仅仅是在把这些假膝展示给你们看，
03:27
and I imagine it's hard to think
how it all fits together.
how it all fits together.
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仅凭这些你们可能很难想象它们是如何与腿部结合在一起。
03:29
So at the top you have a socket,
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在顶部有一个插孔，
03:32
and this fits over someone's residual limb,
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以便安装在人的残肢上，
03:33
and everyone's residual limb is a little bit different.
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但是每个人的残肢都不太一样。
03:36
And then you have the knee,
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然后是膝盖，
03:37
and here I've got a single axis on the knee
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在膝盖的这里有一根单一的轴
03:39
so you can see how it rotates,
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这样你们就能看见它如何旋转，
03:41
and then a pylon, and then a foot.
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然后是小腿，最后是脚。
03:45
And we've been able to develop a knee,
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我们现在已经有能力去开发一种
03:47
a polycentric knee, so that type of knee
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多中心的假膝，这样它就能够模仿
03:49
that acts like a human knee, mimics human gait,
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人类原本的膝盖，模仿人类原来的步态，
03:52
for 80 dollars retail.
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并且以80美元的价格零售。
03:55
(Applause)
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（掌声）
03:58
But the key is, you can have this great invention,
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关键是，我们有了这种伟大的发明，
04:01
you can have this great design, but how do you get it
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有了这种伟大的设计，但是怎么才能
04:03
to the people who most need it?
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把它交给最需要它的那些人？
04:05
How do you ensure it gets to them
and it improves their lives?
and it improves their lives?
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怎样才能确保产品触及他们并且真正提高生活质量？
04:08
So at D-Rev, we've done some other projects,
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在D-Rev，我们也完成了其他的一些项目，
04:11
and we looked at three things that we really believe
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而且，我们认为有三样东西可以真正确保
04:13
gets technologies to customers, to users,
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技术触及顾客，触及用户，
04:17
to people who need it.
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触及那些真正需要它的人。
04:19
And the first thing is that the product
needs to be world class.
needs to be world class.
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第一，就是产品必须是一流的。
04:21
It needs to perform on par
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它必须要与市面上最好的产品
04:23
or better than the best products on the market.
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势均力敌，甚至要超过它们。
04:26
Regardless of your income level,
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无论你的收入水平高还是低，
04:28
you want the most beautiful,
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你想拥有的都是
04:30
the best product that there is.
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现有的最精美最优良的产品。
04:32
I'm going to show you a video now
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我现在要为你们播放一段
04:36
of a man named Ash. You can see him walking.
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一位名为阿什的男士的视频。你们可以看见他走路。
04:37
He's wearing the same knee system here
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他正装配着一副和这儿这副一样的
04:39
with a single axis knee.
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单轴假膝。
04:41
And he's doing a 10-meter walk test.
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他正在完成一个十米的行走测试。
04:43
And you'll notice that he's struggling
with stability as he's walking.
with stability as he's walking.
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你们可以注意到，他走路的同时正与假肢的稳定性苦斗。
04:47
And something that's not obvious, that you can't see,
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还有一些不明显的、你们注意不到的东西，
04:49
is that it's psychologically draining
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就是走路和防止自己摔倒时
04:52
to walk and to be preventing yourself from falling.
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带来的心理负担。
04:56
Now this is a video of Kamal.
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这是一段卡马尔的视频。
04:58
You remember Kamal earlier,
holding the bamboo staff.
holding the bamboo staff.
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你们记得我刚才说过的用竹竿走路的卡马尔。
05:00
He's wearing one of the earlier versions of our knee,
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他正装配着一副我们生产的假肢的初期版本，
05:03
and he's doing that same 10-meter walk test.
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他在完成和刚才那个一模一样的十米行走测试。
05:06
And you can see his stability is much better.
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你们可以看得到，稳定性好了许多。
05:11
So world class isn't just about
technical performance.
technical performance.
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因此，产品的一流不仅仅在于技术性能上，
05:14
It's also about human performance.
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也在于对人体机能的帮助上。
05:18
And most medical devices, we've learned,
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我们在深入研究时了解到
05:20
as we've dug in, are really designed for Westerners,
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大部分医疗设备，都是为西方人设计的，
05:22
for wealthier economies.
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是为富足的经济体设计的。
05:24
But the reality is our users, our customers,
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然而事实却是，我们的用户与顾客
05:27
they do different things. They sit cross-legged more.
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所做的是不同的工作。他们更多的是盘腿坐着。
05:30
We see that they squat. They kneel in prayer.
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我们看见他们下蹲，他们跪下来祷告。
05:33
And we designed our knee to have
the greatest range of motion
the greatest range of motion
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我们设计自己的假膝，以便使它在市场上所有假膝中
05:35
of almost any other knee on the market.
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拥有最大的运动幅度。
05:39
So the second thing we learned, and this leads
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所以，我们所学到的第二样东西，这就切入我说的第二点，
05:41
into my second point, which is that we believe
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就是我们坚信
05:43
that products need to be
designed to be user-centric.
designed to be user-centric.
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产品应该以用户为中心。
05:46
And at D-Rev, we go one step further and we say
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而且，在D-Rev，我们还更进一步地认为
05:49
you need to be user-obsessed.
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用户至上。
05:51
So it's not just the end user
that you're thinking about,
that you're thinking about,
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所以不应该只考虑产品的最终用户，
05:53
but everyone who interacts with the product,
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更要考虑每一个与产品打交道的人，
05:55
so, for example, the prosthetist who fits the knee,
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比如说，安装这种假膝的修复专家，
05:58
but also the context in which the knee is being fit.
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还有这种假膝会被用户们使用的环境。
06:01
What is the local market like?
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本地市场如何呢？
06:03
How do all these components get to the clinic?
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这些零件怎样进入到那些诊所里去呢？
06:05
Do they all get there on time? The supply chain.
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它们能够按时到达那里吗？供应链的问题。
06:07
Everything that goes into ensuring
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这所有的一切都是为了确保
06:09
that this product gets to the end user,
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这种产品能够触及最终用户，
06:11
and it goes in as part of the system, and it's used.
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确保它成为体系的一部分，并且被使用。
06:15
So I wanted to show you some of the iterations
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因此我想要展示给你们一些我们
06:17
we did between the first version, the Jaipur Knee,
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对最初版本，也就是斋浦尔假膝做的一些改变的尝试。
06:22
so this is it right here.
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就是这个。
06:24
(Clicking)
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（咔哒声）
06:25
Notice anything about it?
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注意到什么了吗？
06:28
It clicks.
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它在咔哒作响。
06:30
We'd seen that users had actually modified it.
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我们看到用户们其实改变了这一点。
06:33
So do you see that black strip right there?
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你们能看到那个黑色的带子吗？
06:37
That's a homemade noise dampener.
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那是一个自制的噪音缓冲器。
06:40
We also saw that our users had modified it
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我们也看到了我们的用户以其他方式
06:42
in other ways.
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来改变这一点。
06:43
You can see there that that particular amputee,
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你们可以看到这位膝上截肢者，
06:45
he had wrapped bandages around the knee.
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他在假膝周围缠上了绷带。
06:47
He'd made a cosmesis.
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他把它美化了。
06:49
And if you look at the knee,
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如果你看看这个假膝，
06:51
it's got those pointy edges, right?
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就会发现它有尖锐的边缘，对吗？
06:55
So if you're wearing it under pants or a skirt
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所以如果你在长裤、裙子或者印度纱丽底下
06:57
or a sari, it's really obvious
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装配它，真的是非常容易
06:59
that you're wearing a prosthetic limb,
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就能看出来你装配了假肢。
07:01
and in societies where there's social
stigma around being disabled,
stigma around being disabled,
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在对残疾人有歧视的社会里，
07:05
people are particularly acute about this.
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人们就对这一点尤其敏感。
07:08
So I'm going to show you some
of the modifications we did.
of the modifications we did.
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因此，我要展示给你们一些我们所做的改变。
07:10
We did a lot of iterations, not just
around this, but some other things.
around this, but some other things.
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我们做了许多尝试，
不仅围绕这一点，还有其他的东西。
不仅围绕这一点，还有其他的东西。
07:13
But here we have the version three,
the ReMotion Knee,
the ReMotion Knee,
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我们有了第三个版本，“移动假膝”，
07:16
but if you look in here, you can see
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如果看一下这里，你就会发现
07:17
the noise dampener. It's quieter.
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噪音缓冲器。它变得更安静了。
07:22
The other thing we did is that
we smoothed the profile.
we smoothed the profile.
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我们所做的另一件事就是使轮廓变得平滑。
07:26
We made it thinner.
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我们使它更薄。
07:27
And something that's not obvious is that we
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还有可能不是那么容易看出来的就是
07:29
designed it for mass production.
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我们是为了大规模生产而做的设计。
07:32
And this goes into my last point.
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这就涉及到了我要说的最后一点。
07:34
We really, truly believe that if a product
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我们真诚地相信如果一个产品
07:36
is going to reach users at the scale that it's needed,
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要能够触及到所有需要它的用户，
07:38
it needs to be market-driven,
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它就得面向市场，
07:40
and market-driven means that products are sold.
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意思就是要被售卖出去。
07:43
They're not donated. They're not heavily subsidized.
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它们不应被捐赠出去，亦无需得到大量的资助。
07:46
Our product needs to be designed to offer value
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我们的产品设计的宗旨是为最终用户
07:48
to the end user.
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提供价值。
07:50
It also has to be designed to be very affordable.
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同样，它也必须经济实惠。
07:52
But a product that is valued by a customer
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但是被顾客赋予价值的产品
07:54
is used by a customer,
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同时也是为顾客所用的，
07:56
and use is what creates impact.
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而使用才能产生影响。
07:58
And we believe that as designers,
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而且，我们相信，作为设计者，
08:00
it holds us accountable to our customers.
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我们需要对顾客负责。
08:03
And with centralized manufacturing,
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通过集中生产，
08:06
you can control the quality control,
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我们就可以控制产品质量，
08:08
and you can hit that $80 price point
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你们能够看出
08:09
with profit margins built in.
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就连八十美元中都含有利润。
08:12
And now, those profit margins are critical,
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谈到这里，利润是很重要的，
08:14
because if you want to scale, if you want to reach
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因为如果你想要得到最大收益，或者想要
08:16
all the people in the world who possibly need a knee,
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触及到世界上每一个可能需要一副假膝的人，
08:18
it needs to be economically sustainable.
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它必须是能持续获益的。
08:21
So I want to give you a sense of where we are at.
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现在我想让大家知道我们现在到哪个阶段了。
08:24
We have fit over 5,000 amputees,
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我们已为超过五千位膝上截肢者安装了假肢，
08:27
and one of the big indicators
we're looking at, of course,
we're looking at, of course,
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当然，我们所重视的一个重要指标
08:30
is, does it improve lives?
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就是，它能够提高人们的生活质量吗？
08:31
Well, the standard is, is someone
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嗯，标准就是，是否半年以后
08:33
still wearing their knee six months later?
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人们还在装配着他们的假膝呢？
08:36
The industry average is about 65 percent.
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行业平均值是65%。
08:38
Ours is 79 percent,
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我们的是79%，
08:41
and we're hoping to get that higher.
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而且我们希望能使它变得更高。
08:44
Right now, our knees are worn in 12 countries.
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目前，我们的产品遍及十二个国家。
08:47
This is where we want to get, though,
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然而，这是我们想在三年后
08:48
in the next three years.
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到达的地方。
08:50
We'll double the impact in 2015,
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我们将在2015年使这种影响力加倍，
08:52
and we'll double it each of
the following years after that.
the following years after that.
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并且在这之后的每一年都再次加倍。
08:55
But then we hit a new challenge,
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但是，之后我们遇上了一个新挑战，
08:57
and that's the number of skilled prosthetists
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就是能够安装假膝的
08:59
who are able to fit knees.
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熟练的修复专家的人数。
09:02
So I want to end with a story of Prinima.
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所以，我想以普蕾妮玛的一个故事来结尾。
09:05
Prinima was 18 years old
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普蕾妮玛在一场车祸中
09:07
when she was in a car accident
where she lost her leg,
where she lost her leg,
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失去一条腿的时候才十八岁，
09:10
and she traveled 12 hours by train
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她乘火车辗转了12个小时
09:13
to come to the clinic to be fit with a knee,
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到诊所去安装一副假体膝盖，
09:15
and while all of the amputees who wear our knees
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虽然所有装配了我们产品的截肢者们
09:18
affect us as the designers,
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都在深远地影响着我们这些设计者，
09:20
she's particularly meaningful to me
as an engineer and as a woman,
as an engineer and as a woman,
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可我作为一个工程师以及一位女性，
她对我来说却尤其有意义，
她对我来说却尤其有意义，
09:24
because she was in school,
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因为她还在上学，
09:26
she had just started school to study engineering.
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她那时才刚刚入学开始学习工程学。
09:29
And she said, "Well, now that I can walk again,
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她说：“嗯，现在我又能走路了，
09:31
I can go back and complete my studies."
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我可以回去完成我的学业了。”
09:33
And to me she represents the next generation
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对我来说，她象征着
09:36
of engineers solving problems
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那些要去解决问题、确保有意义的技术真正
09:39
and ensuring meaningful technologies
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触及它们的用户的
09:42
reach their users.
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下一代工程师。
09:44
So thank you.
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谢谢你们。
09:46
(Applause)
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(掌声)
ABOUT THE SPEAKER
Krista Donaldson - EngineerKrista Donaldson is the CEO of D-Rev, a non-profit product development company improving the health and incomes of people around the world.
Why you should listen
Prosthetic limbs are expensive and complex, and they must be fit to each individual -- yet having a replacement for a lost limb can mean the difference between working and not, having a social life and not. So, Krista Donaldson and her team at the nonprofit design firm, D-Rev, are attacking the problem on several fronts, from re-engineering the moving parts, to exploring way-new materials that replace expensive titanium, to forming deep local partnerships for distribution and maintenance around the world.
It's the kind of work that D-Rev does; with a mission "to improve the health and incomes of people living on less than $4 per day," their motto is "Design for the other 90%." Taking a truly user-centered approach that could be summarized as "Listen before you build."
As Donaldson wrote in a paper for the WEF: "The world is confounded by difficult problems in healthcare that are ripe for innovative solutions. The information most needed for these solutions ... is readily available -- from the users. They need to be asked: How can we solve X? What is your experience with Y? Instead of focusing on asking people in developing countries to change their behavior, those of us who work in healthcare should sit up and listen to what they have to say."
Krista Donaldson | Speaker | TED.com