While British, I spent much of my childhood living outside of the UK, including in Africa and Asia, where the differences and vast inequities in the world were both strikingly obvious and very unsettling to me as a young child.
For example, on a snowy day in Turkey, I remember seeing children roughly my age hunting through the city landfill trying to find things to sell to make a little money to live on. Even at eight years old, seeing this – especially in contrast to the lifestyle I’d always known – had a significant impact on me and I promised myself that one day I would try and do something to help those who were less fortunate than I. This commitment shaped my life.
When I relocated to the United States, at first I found myself on a more corporate path, working in investment banking, management consulting and technology startups. I enjoyed working in a business setting and being surrounded by smart, ambitious people. I learned a lot and was very enthusiastic about my work; however, there was always a part of me that felt that the corporate work wasn’t enough.
Around the age of 40 I started thinking more purposefully about how to use my skills to make a meaningful difference. It was difficult at first. I lacked the training for the more obvious pathway of making a positive impact, such as being a doctor or an educator.
But as often happens when you open yourself up to possibilities, the chance to make a difference practically landed in my lap. Whilst working at The University of Iowa, a colleague shared a video with me showing the devastating consequences of untreated clubfoot.
It was heart-breaking to learn that one out of every 600 babies are born with the condition: nearly 200,000 newborns a year. It was also heart-breaking that the simple, non-invasive, and inexpensive treatment routinely provided in developed healthcare systems such as the UK and US, is largely unavailable to children in low- and middle-income countries.
I was instantly drawn to the possibility of making a difference in the lives of children around the world. I joined a small group of parents and surgeons hoping to start an organisation to address the long-overlooked issue of untreated clubfoot. Things took off from there and my entrepreneurial experience was a huge help in moving ambition into action.
When I founded MiracleFeet, I had just finished working with two highly successful internet startups. It was thrilling at the time because I was working with small businesses that were leveraging everything the internet had to offer in the mid-1990s. Amazon had just been founded; it was the era of the first internet corporations, and I was a part of it.
I was able to leverage my strategic and high-tech skills but shift my focus from financial impact to social impact. I needed to recruit the right people and partners, research existing systems and funding mechanisms, and most importantly collaborate with industry specialists who could fill in our gaps in technical expertise.
The first leap of any entrepreneur’s journey is to find funding. It was crucial to be able to pitch and sell an idea to investors using language they understood and related to. Little did I know how often I would draw on my corporate and hi-tech experience when meeting with individuals and groups to share the MiracleFeet story. Now, we’ve raised over $42 million to help support children all over the world.
Of course, with any venture, people want a good return on investment. In philanthropy this is measured in terms of social or human impact. MiracleFeet treats young children at an average cost of $500 per child. This investment not only allows a child to walk and run, but also unleashes lifelong potential. This return on philanthropic investment is tremendously appealing to many donors.
More broadly, my experience as a business entrepreneur made me more comfortable taking risks and being brave enough to develop something from scratch. Being in an environment where I saw other entrepreneurs succeed and fail energised me – it was a great thrill, and I took away some of the ability to tolerate a certain level of risk in exchange for the possibility of success.
The design challenge
As technology and internet access evolved during the early days of MiracleFeet, my next task was to figure out how to integrate and leverage technology to improve our processes and services.
Clubfoot has a very low-tech solution: the Ponseti method, which is an affordable, non-surgical- treatment, involving the child wearing a series of casts for 4-6 weeks to gently reposition the feet, followed by a simple procedure to release the Achilles tendon. Lastly, infants wear a foot abduction brace to prevent relapse. The method is well tested and endorsed by leading health agencies and provides full mobility in 95% of cases.
The doctors had already figured out the medical aspects of clubfoot treatment. MiracleFeet’s job was and still is to implement that treatment across the world. To achieve this, we worked with extraordinary experts to roll-out and scale access to treatment efficiently without compromising the quality of the care. This is when design came into play.
When we first started, braces in the US cost between $350-1,600 each. This price point wasn’t realistic for families in low- and middle-income countries. We tried using locally made braces, but quality and inventory control were hugely challenging as we expanded to multiple countries and continents.
So we partnered with Stanford University and HU-USP in Brazil to design an affordable, but easy-to-use and mass-producible brace. We partnered with Clarks Shoes to design comfortable but low-cost shoes and a cutting-edge US plastic company who manufacture the injection-moulded plastic components. The award-winning brace we developed costs $20 – a fraction of the cost of US or UK braces – and is in use in 20 countries around the world.
During the early years of MiracleFeet, when we only had a few clinics, we could visit them in person to keep updated with patients and their progress, and to ensure we were meeting the high standards we set for ourselves.
But as the organisation grew, this became increasingly difficult. We needed a streamlined data collection tool to support and track patient progress across our growing global network of clinics and providers. Designing the tool was a long and involved process, but thanks to a fortuitous Google.org grant, we were able to develop a mobile data collection app, CAST, which allowed us to transform how we gather and use real-time data worldwide and helped us amplify our focus on treatment precision and programme quality. This technology was made available by Dimagi, a tech firm specialising in creating systems for low-resource environments.
As the technology reflects patient treatment in real time, we don’t need to visit each clinic to know the status of each child’s care; we can simply check on our phones. This has allowed us to scale quickly while not sacrificing quality.
If something is flagged in CAST, the centralised team can work with the local teams to find a solution. The in-country providers know what solutions will work best in their area and use this knowledge along with the information shared on the platform to drive decision-making – resulting in a much more streamlined way of working.
Not only does it help with internal monitoring and reporting, but also the data we can mine from the programme is a fantastic way to demonstrate transparency with external stakeholders. It’s important to show investors what we’ve been doing with their money, and who we’ve been helping.
During the pandemic, this technology and data were especially useful. It allowed work to continue without the need for the central team to visit the clinics in person, as all processes were fed through the app. Because everything could be done online, the team didn’t skip a beat.
We were able to use CAST data to identify how long a child had been in a cast, allowing the caretakers to respond and advise without the child or parent needing to come into the hospitals or clinics.
Currently, we are working on a brace sensor that can detect if a brace is being worn properly, and how often. Data from the sensor feeds back to the digital system and providers can counsel parents on the importance of correct use.
This is still in the preliminary stages of development, but we see a lot of potential for a technology like this in helping prevent relapse.