Nasal Decongestion in South Africa - Stanford Universitywz402qb2020/Merck Winter... · 2 1...

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Nasal Decongestion in South Africa Mechanical Engineering 310 Winter Document 2015

Team Merck

Danny Concha, Sri Sibi, and Jade Fernandez

Mechanical Engineering Design Group

416 Escondido Mall

Stanford University

Stanford, CA 94305-2203

http://me310.stanford.edu

March 3, 2015

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1 Executive Summary

Our design challenge is to create a better solution for nasal decongestion for the

middle class in South Africa. The Stanford University team of Mechanical Engineers is

partnered with a University of St. Gallen team of Master’s of Business Innovation

students to address this task. Our corporate sponsor, Merck, has approached our team of

seven with this goal of reinventing and redesigning the current solution for nasal

decongestion. Merck would ultimately like to penetrate the African market and they

believe that South Africa will set the trends for the rest of Africa because they are the

most Western-leaning country. The middle class is the selected user group because

Merck similarly believes that this rapidly expanding demographic will set the trends for

other classes.

During our travels to South Africa to perform crucial need finding, we discovered

that pharmacies play a crucial role in overall healthcare as they are very accessible and

often overtake the role of a typical clinic. We also spent time with our user group and

found that they are not very different from us. Middle class South Africans are extremely

Western leaning and use many Western products. For decongestion, most people in South

Africa use a small, single-dosage topical product called “Zam-buk” that is made up of

mainly Eucalyptus oils and is very discreet. Most people keep it in their pockets and use

it for decongestion, as well as lip balm. We also discovered that South Africans do not

use nasal sprays, as inserting something in their nose seems very foreign and

unappealing. From these findings, we determined that our product needed to be small,

discreet, Western-leaning, and trendy, while still effectively decongesting the user, but

preferably not through their nose.

Although a possible solution would be to simply package nasal sprays in smaller

doses, we as a team of engineers desired to build something truly innovative for this

project, and something that would truly mitigate South Africans’ hesitations with nasal

sprays. Thus, we decided on developing a promotional tool for Merck that would

dispense small, single-dosage oral decongestant medication. One of our Stanford

teammates traveled to St. Gallen in Switzerland to meet with the Swiss team and

converge on one solid direction which led us down this final design path. This idea was

then presented to our corporate liaison at the Merck headquarters in Germany, where the

idea was well received and validated by Merck scientists and executives. Upon returning

to Stanford, we began building our first prototype of what would later become the

“Merck Box.”

The Merck Box is a tool that mixes chemical and natural remedies to treat

decongestion, and dispenses the mixtures in small single-dose containers. The mechanical

movements of the machine during the mixing process are made very transparent to the

user, in order to inspire confidence in the components used in their medicine. The

physical construction of the machine is meant to be very alluring and attractive, in the

hopes of drawing customers into the pharmacies. Our proposed design solution benefits

all of the stakeholders involved with this project. Merck would pay pharmacies to have

these boxes installed and in return, they would reap the benefit of branding their name,

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allowing them to later distribute additional decongestant products in South Africa. The

pharmacies would reap the rewards of having returning customers to use the box for

additional doses if needed, while pharmacists could direct their attention to customers

with a more dire need for personal medical attention. Most importantly, the user would

have the convenience of buying medication only when truly needed, and in a form they

truly desire. They would have the ability to customize their medicine with natural

remedies of their choosing and could purchase single doses for approximately 20 cents.

Our current prototype is very funky, but functional. We wanted to test not only

functionality, but also user experience. From our user testing, we discovered some key

insights and suggestions that will certainly appear in the next iteration of our prototype

and are identified in this report. Although rough, our prototype completed the essential

functions of rotating and collecting medicine, allowing our test users to experience the

process of obtaining medicine. Going forward, we look to design a final prototype and

begin manufacturing it. This final construction will entail reaching conclusions about the

specific mechanisms to actuate the different systems in our prototype as well as the

overall form and assembly of the device. Because a promotional tool similar to the one

defined has not been used by Merck, the St. Gallen team will be working on the overall

logistics regarding pricing, marketing and distribution of this product. By the end of the

year, at EXPE, our team will display a fully functional and highly captivating Merck Box

(Fig. 1.1) which successfully combines natural remedies with Western medicine.

Through our research we are confident that this solution will help South Africans

embrace Western medicine in a customized and affordable form, and most importantly, it

will help them to breathe more freely.

Figure 1.1 CAD Model of Potential Box Design

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Table of Contents

1 Executive Summary ...................................................................................................... 2

2 Glossary ........................................................................................................................ 9

3 Context ....................................................................................................................... 12

3.1 Need Statement .................................................................................................... 12

3.2 Problem Statement ............................................................................................... 12

3.3 Corporate partner: Merck KGaA/ Partner School: University of St. Gallen ....... 13

3.3.1 Corporate Liaison .......................................................................................... 13

3.3.2 ME 310 Coach ............................................................................................... 14

3.4 The Design Team ................................................................................................. 14

3.4.1 Stanford Teaching Team ............................................................................... 18

4 Design Requirements .................................................................................................. 20

4.1 Functional Requirements ..................................................................................... 20

4.1.1 Functional Constraints ................................................................................... 21

4.1.2 Assumptions .................................................................................................. 22

4.2 Physical Requirements ......................................................................................... 22

4.3 Business Requirements ........................................................................................ 23

5 Design Development .................................................................................................. 24

5.1 Fall Quarter Technology Benchmarking ............................................................. 24

5.2 Fall Quarter Need Finding ................................................................................... 26

5.3 Fall Quarter Critical Experience Prototype ......................................................... 28

5.4 Persona Development .......................................................................................... 30

5.5 Need finding in South Africa ............................................................................... 32

4.5.1. Reurbanization and Repurposing of Things .................................................... 33

4.5.2. Western Leaning Trends .................................................................................. 35

4.5.3. Pharmacies in South Africa ............................................................................. 36

4.5.4. Meeting with the St. Gallen Team ................................................................... 39

5.6 Critical Function Prototype .................................................................................. 41

4.6.1. Prototype Goals and Rationale ........................................................................ 41

4.6.2. What We Hoped to Learn ................................................................................ 42

4.6.3. Prototype Description ...................................................................................... 42

4.6.4. Functional Prototype Results and Insights....................................................... 43

4.6.5. Overall CFP Conclusions ................................................................................. 44

5.7 Dark Horse Prototype .......................................................................................... 45

4.7.1. Dark Horse Prototype Version 1 ...................................................................... 45

4.7.1.1. Prototype Goal and Rationale ....................................................................... 45

4.7.1.2. Prototype Description ................................................................................... 45

4.7.1.3. Prototype Testing .......................................................................................... 47

4.7.2. Dark Horse Prototype Version 2 ...................................................................... 47




4.7.3. Dark Horse Version 3 ...................................................................................... 51


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4.7.3.4. Testing Results .............................................................................................. 54

4.7.4. Dark Horse Conclusions .................................................................................. 55

5.8 Funky Prototype................................................................................................... 56

4.8.1. Prototype Goal and Rationale .......................................................................... 56

4.8.2. Prototype Description ...................................................................................... 56

4.8.3. Prototype Testing ............................................................................................. 58

5.9 Exploration and Realignment .............................................................................. 59

4.9.1. Findings from St. Gallen .................................................................................. 59

4.9.2. Findings from the Merck Visit ......................................................................... 63

5.10 Functional Prototype 1 ...................................................................................... 65

4.10.1. Prototype Goal and Rationale ........................................................................ 65

4.10.1.1. Prototype Description ................................................................................. 65

4.10.1.2. Prototype Testing ........................................................................................ 66

4.10.2. Functional Prototype 2 ................................................................................... 66

4.10.2.1. Prototype Goal and Rationale ..................................................................... 67

4.10.2.2. Prototype Description ................................................................................. 67

4.10.2.3. Prototype Testing ........................................................................................ 69

4.10.2.4. Testing Results ........................................................................................... 70

4.10.3. Functional Prototype Conclusions ................................................................. 71

6 Design Vision ............................................................................................................. 72

7 Project Planning and Management ............................................................................. 75

7.1 Deliverables and Milestones ................................................................................ 75

7.2 Project Timeline ................................................................................................... 76

8 Distributed Time Management ................................................................................... 76

9 Report on St. Gallen ................................................................................................... 78

10 Project Budget .......................................................................................................... 83

11 Reflections and Goals .............................................................................................. 86

Danny Concha ........................................................................................................... 86

Jade Fernandez .......................................................................................................... 87

Sri Sibi ...................................................................................................................... 87

Philipp Elbel.............................................................................................................. 88

Jasmine Bissig ........................................................................................................... 89

Carolyn Ragaz ........................................................................................................... 90

Rouven Gruenig ........................................................................................................ 90

12 References ................................................................................................................ 92

Bibliography ................................................................................................................. 92

Image Sources ............................................................................................................... 97

13 Appendix A: Fall Brainstorming .............................................................................. 99

14 Appendix B: Fall Benchmarking ........................................................................... 102

15 Appendix C: Fall Need Finding ............................................................................. 114

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16 Appendix D: Fall Persona Development ................................................................ 121

17 Appendix E: Fall Critical Experience Prototype .................................................... 122

18 Appendix F: Fall SGM Handouts .......................................................................... 128

19 Appendix G: Quotes from Need finding and Benchmarking Interviews ............... 134

20 Appendix H: Winter SGM Handouts ..................................................................... 134

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List of Figures FIGURE 1.1 CAD MODEL OF POTENTIAL BOX DESIGN ................................................................................................................ 3 FIGURE 3.1: MERCK KGAA LOGO .................................................................................................................................................. 13 FIGURE 3.2: UNIVERSITY OF ST. GALLEN LOGO .......................................................................................................................... 13 FIGURE 4.1: SCREEN DISPLAY ALLOWING MAXIMUM NUMBER OF DOSES ............................................................................... 22 FIGURE 5.1: ORGANIZATIONAL CHART OF BENCHMARKING .................................................................................................... 24 FIGURE 5.2: ORGANIZATIONAL CHART OF NEED FINDING ....................................................................................................... 26 FIGURE 5.3: MIDDLE CLASS SOUTH AFRICAN WOMAN, AYANDA ............................................................................................. 28 FIGURE 5.4: MABONENG PRECINCT .............................................................................................................................................. 32 FIGURE 5.5: BHEKI, A LOCAL SOUTH AFRICAN ............................................................................................................................ 33 FIGURE 5.6: REPURPOSED TIRE AS A LIGHTING FIXTURE ........................................................................................................... 34 FIGURE 5.7: OSTRICH EGG SHELLS REPURPOSED AS A LIGHT FIXTURE .................................................................................... 34 FIGURE 5.8: VAN REPURPOSED AS MOVEABLE SPACE ON WHEELS........................................................................................... 35 FIGURE 5.9: BHEKI USING A MAC LAPTOP ................................................................................................................................... 36 FIGURE 5.10: ONE OF THE MANY PHARMACIES IN SOUTH AFRICA .......................................................................................... 37 FIGURE 5.11: INSIDE THE PHARMACY........................................................................................................................................... 37 FIGURE 5.12: NATURAL REMEDY WALL ....................................................................................................................................... 38 FIGURE 5.13: SOME OF THE NASAL SPRAYS CARRIED AT THAT PHARMACY............................................................................ 38 FIGURE 5.14: PACK OF ZAM-BUK.................................................................................................................................................. 39 FIGURE 5.15: POWDER DELIVERY CARTRIDGE ............................................................................................................................ 42 FIGURE 5.16: TWO BLADDERS AND TUBING USED FOR CFP #2 .............................................................................................. 43 FIGURE 5.17: THERMISTOR ............................................................................................................................................................ 46 FIGURE 5.18: DARK HORSE PROTOTYPE 1 SETUP ..................................................................................................................... 46 FIGURE 5.19: THE ANATOMY OF A BITALINO BOARD ............................................................................................................... 48 FIGURE 5.20: ILLUSTRATION OF THE OPEN SIGNALS INTERFACE ........................................................................................... 49 FIGURE 5.21: A.) STRAP USED TO ATTACH THE BITALINO B.) BITALINO WITH ECG AND EMG ........................................ 47 FIGURE 5.22: FORCE SENSITIVE RESISTOR USED TO TRACK RESPIRATION ............................................................................. 52 FIGURE 5.23: TEAM TESTING FORCE SENSITIVE RESISTOR FOR RESPIRATION....................................................................... 50 FIGURE 5.24: WEBPAGES USED TO SHOW USERS' BIOMETRIC "RESULTS" AFTER WIZARD OF OZ TESTS ......................... 53 FIGURE 5.25: FUNKY PROTOTYPE HOUSING AND FUNKY PROTOTYPE ASSEMBLED WITH STETHOSCOPE ......................... 55 FIGURE 5.26: FUNKY PROTOTYPE SYSTEM FLOWCHART AND ADVANTAGE OF SYSTEM IMPLEMENTATION ..................... 56 FIGURE 5.27: ST. GALLEN'S MERCK BOX DURING USER TESTING ............................................................................................ 57 FIGURE 5.28: EXAMPLES OF SMALL PACKAGING FREQUENTLY USED BY VICKS AND OTHER COMPANIES TO MARKET

DECONGESTION ...................................................................................................................................................................... 59 FIGURE 5.29: CHART BREAKING DOWN CRITICAL COMPONENTS OF OUR DESIGN ............................................................... 60 FIGURE 5.30: FIRST CONCEPT SKETCH OF THE MODIFIED MERCK BOX .................................................................................. 61 FIGURE 5.31: QUICK SKETCH OF FUNCTIONAL PROTOTYPE DESIGN ........................................................................................ 63 FIGURE 5.32: IMAGE AND SKETCH OF ASSEMBLY USED FOR FINAL FUNCTIONAL (YET EXTREMELY FUNKY) PROTOTYPE

.................................................................................................................................................................................................. 67 FIGURE 5.34: MOTOR WITH HORN CONFIGURATION USED FOR OUR FUNCTIONAL PROTOTYPE ......................................... 68 FIGURE 5.33: PNEUMATIC VALVES USED FOR FUNCTIONAL PROTOTYPE ................................................................................ 66 FIGURE 6.1: THE MERCK BOX ........................................................................................................................................................ 72 FIGURE 6.2: FRONT AND REAR VIEW OF PROTOTYPE WITH FEATURES LABELED .................................................................. 72 FIGURE 6.3: FINAL MEDICINE CARTRIDGE WITH BARCODE ...................................................................................................... 74 FIGURE 9.1: IN HOME INTERVIEWS CONDUCTED BY ST. GALLEN PARTNERS IN AFRICA ...................................................... 79 FIGURE 9.2: THE HOT COLD SHOT PROTOTYPE ........................................................................................................................... 80 FIGURE 9.3: PRETTY-HEALTHY STICK ........................................................................................................................................... 80 FIGURE 9.4: WRISTLET ................................................................................................................................................................... 81 FIGURE 9.5: RING-THING ............................................................................................................................................................... 81 FIGURE 9.6: PATCH .......................................................................................................................................................................... 82 FIGURE 13.1: OUR TEAM'S DESIGN DEVELOPMENT PROCESS ................................................................................................... 97 FIGURE 13.2: UNDERSTANDING FEARS OF WESTERN TECHNOLOGY AND MEDICINE ........................................................... 98 FIGURE 13.3: IMPORTANT CONSIDERATIONS OF INHALERS ...................................................................................................... 99

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FIGURE 14.1: ORGANIZATIONAL CHART OF BENCHMARKING ............................................................................................... 102 FIGURE 14.2: EXAMPLE OF WET, ACTIVE INHALER ................................................................................................................. 101 FIGURE 14.3: COMPARISON OF WET AND DRY INHALERS ....................................................................................................... 101 FIGURE 14.4: PROS AND CONS OF NASAL SPRAYS .................................................................................................................. 102 FIGURE 14.5: ILLUSTRATION OF THE INTRUSIVE NATURE OF A RESPIRATOR ..................................................................... 105 FIGURE 14.6: ILLUSTRATION OF THE INTRUSIVE NATURE OF SAL CANNULA ...................................................................... 103 FIGURE 14.7: A VIEW INSIDE A MODERN E-CIGARETTE .......................................................................................................... 104 FIGURE 14.8: A VIEW INSIDE A NICOTINE PLUG INHALER ...................................................................................................... 105 FIGURE 14.9: A STANDARD NEBULIZER .................................................................................................................................... 105 FIGURE 14.10: OCCURIS INHALER ENGINE ............................................................................................................................... 106 FIGURE 14.11: DESCRIPTION OF HOW A METERED-DOSE INHALER FUNCTIONS ................................................................ 109 FIGURE 14.12: SCHEMATIC OF RESPIMAT INHALER ............................................................................................................... 108 FIGURE 14.13: A.) NETI POT B.) VICKS PORTABLE STEAM INHALER C.) GASMASK D.) NEBULIZER E.) FULL-FACE MASK

STEAM INHALER .................................................................................................................................................................. 111 FIGURE 15.1: ORGANIZATIONAL CHART OF NEEDFINDING ................................................................................................... 115 FIGURE 15.2: JADE SKYPING TRUDY MEEHAN ......................................................................................................................... 115 FIGURE 15.3: DANIEL SKYPING JEAN FOURIE .......................................................................................................................... 115 FIGURE 15.4: ADVANTAGES OF DESIGNING FOR SOUTH AFRICAN MINERS ......................................................................... 117 FIGURE 15.5: DESIGN CONSIDERATIONS FOR THE MIDDLE CLASS INHALER ....................................................................... 118 FIGURE 16.1: MIDDLE CLASS SOUTH AFRICAN WOMAN, AYANDA ....................................................................................... 119 FIGURE 17.1: INHALER DESIGN SELECTION ............................................................................................................................. 121 FIGURE 17.2: INTERVIEW RANKING PREFERENCES ................................................................................................................. 122 FIGURE 17.3: INTERVIEWEE "MOST DISLIKED" INHALERS ..................................................................................................... 123

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2 Glossary Active inhaler: Inhaler that propels the medicine into the user’s mouth.

Arduino: Single board microcontroller frequently used for prototyping

Asthma: a respiratory condition marked by spasms in the bronchi of the lungs, causing

difficulty breathing.

Benchmarking: The process of discovering information on existing products/systems

and their relevance to our project.

Bitalino: A biometric tool that includes a micro-controller-equipped board with

additional pre-attached biometric units including an EMG, EDA, ECG and

accelerometer.

Breath Actuated Mechanism (BAM): Mechanism which is used to deliver medication

into the user and is triggered and actuated by the user’s breath.

Cannula tube: tube that can be inserted into the body for the delivery or removal of fluid

or for the gathering of data.

Chronic Obstructive Pulmonary Disease (COPD): Chronic obstructive pulmonary

disease (COPD) is one of the most common lung diseases. It makes it difficult to breathe.

There are two main forms of COPD: Chronic bronchitis, which involves a long-term

cough with mucus; Emphysema, which involves destruction of the lungs over time.

Critical Experience Prototype (CEP): A prototype used to observe an important

experience that the user of a device will undergo. This prototype helps gain insight on

how to best design the product based off of the user experience.

Critical Function Prototype (CFP): A prototype used to observe an important function

that a device must include in order to operate properly.

Decongestion: Relief applied to the nostrils which helps a user breathe more easily,

usually combating a swelling of the inner nose experienced from a cold

Dry inhaler: Inhaler that disperses medicine in the form of a powder.

e-cigarette: electronic cigarette which usually uses a heated coil to atomize liquid

nicotine.

Force Sensitive Resistor: A resistor which fluctuates in resistivity based on deformation

of the resistive element

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KGaA: Kommanditgesellschaft auf Aktien – abbreviated KGaA – is a German corporate

designation standing for 'partnership limited by shares', a form of corporate organization

roughly equivalent to a master limited partnership.

Living Standards Measure: a scale that has been developed in order to classify the

South African population. It uses a variety of factors such as appliances in the home,

number of vehicles owned, types of jobs, and much more to classify the living standards

of different South African people

Nasivin: Nasal spray created by Merck for treating congestion from the common cold

Respirator: Personal air filtration device worn around the mouth, usually in the form of a

mask.

Nebulizer: a device for producing a fine spray of liquid, used for example for inhaling a

medicine drug.

Need finding: the process of investigating the potential users of a device and

understanding what needs these users need addressed by the device’s function.

Neti Pot: container which is filled with saline water and is used to rinse your nasal

cavity.

Obstructiveness: the degree to which a device covers a significant portion of a user’s

face.

Passive inhaler: Inhaler that requires user’s inhalation to intake medicine.

Pseudoephedrine: Medicine used to treat stuffy nose and conditions in the sinuses

usually caused by a cold. It is used in common Western medicines including NyQuil.

Pugh Matrix: tool for weighing the relative strength of various objects versus a baseline

object as defined by various categories.

Silicosis: lung fibrosis caused by the inhalation of dust containing silica. Silicosis is

currently incurable.

Throat/mouth deposition: residual medication that is left on the user’s mouth and throat

upon inhalation of a medication.

Traditional Healer: a figure in South African culture who employs non-Western

techniques to cure physically, emotionally and spiritually sick people by means of herbs,

rituals and other natural remedies.

Thermistor: Electrical resistor whose resistance is altered by temperature

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Tuberculosis: an infectious bacterial disease characterized by the growth of nodules

(tubercles) in the tissues, especially the lungs.

Unnaturalness: how “strange” it feels to use the device, first hand (as used from our

team’s benchmarking process).

Urban regeneration: Land redevelopment in areas of moderate to high density urban

land use

Wet inhaler: Inhaler that disperses medicine in the form of a gas.

Westernized: Aspiring to invoke elements of culture from America or Europe. For the

purposes of this report, this most frequently refers to medicines created by American or

European companies which use synthetically created active chemicals.

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3 Context

3.1 Need Statement

Merck KGaA is the oldest operating pharmaceutical and chemical company in the

world, being founded in 1668 in Darmstadt, Germany. Merck has established a positive

public image through their innovative and diverse products. They maintain an active role

in developing modern technology and life science discoveries in order to better their

products for the well-being of millions of lives. Merck aims to continuously improve the

quality of their products and develop a customer relationship with the brand in order to

continue to grow and develop their business. With these goals in mind, Merck has asked

our team to introduce a new product into the market to help people breathe easier by

redesigning a solution for nasal decongestion for the South African market.

South Africa is the ideal location to introduce this new product because South

Africa tends to set the trends for the rest of the African nations. They are, historically, the

most Western leaning country and they have a desire to become more like their Western

counterparts. Merck has decided that in order to enter the African market, they first must

penetrate a more targeted customer base and that is the black middle class in South

Africa. Currently, the black middle class is in a transitional phase. They are entering a

new role in society and are growing more technologically sophisticated. Aspiring to have

products of the West, the black middle class is embracing a new mindset of ambition,

health, and success. With this in mind, we are intending to design an affordable, yet

Westernized product that will emphasize health, well-being, and success.

We have selected a promotional tool for Merck as our product that we will be

designing and ideally implementing in pharmacies throughout South Africa. Our

intention is to make Merck a household name in South Africa in hopes that more of their

products will be familiar to people and trusted by them. This promotional tool would

essentially be a box that dispenses mixed medicines in single doses so that customers can

buy them on a need-basis.

3.2 Problem Statement

Our team’s goal is to create a tool that dispenses affordable medication that

customers are attracted to and trust. In order for Merck to be a successful brand name in

South Africa, they must first create trust between their product and the customer. Our

hope is that this box will not only bridge the gap, but also open other opportunities for

other Merck products to get into South African households.

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3.3 Corporate partner: Merck KGaA/ Partner School:

University of St. Gallen

The corporate partner for this project is Merck KGaA, based in Germany.

Merck’s headquarters are located in Darmstadt, Germany and is the oldest operational

pharmaceutical and chemical company. They are expected to close in on $1 billion by the

end of 2014 in sales. Our partner school is the University of St. Gallen in Switzerland.

We are working with Philipp Elbel, Rouven Grunig, Carolyn Ragaz, and Jasmine Bissig,

who are all Master’s in Business and Innovation students.

Figure 3.1: Merck KGaA Logo

Figure 3.2: University of St. Gallen Logo

3.3.1 Corporate Liaison

Luc Van-Der-Heyden

Head of Innovation Management

Merck, Darmstadt, Germany

Contact: [email protected]

mailto:[email protected]

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3.3.2 ME 310 Coach

3.4 The Design Team

The design team consists of three members from the Mechanical Engineering

Department at Stanford University and four members from the program of Master’s of

Business and Innovation at St. Gallen University, a prestigious business school in

Switzerland. We have great advantages because of our diverse educations, personal

interests, and cultural backgrounds and thinking styles. This design challenge was

developed with the help of Merck and coordinated through the ME 310 class. ME 310:

Project-Based Engineering Design, Innovation, and Development teaches us how to work

with international, as well as corporate teams in order to innovate and design an inspiring

solution for the design challenge.

Annika Matta

ME 310 Coach


Daniel Concha

Status: 1st Year ME Graduate Student


Skills: Rapid prototyping, SolidWorks modeling, Medical

Device Development

I was born in Cali, Colombia but moved to the United States

at the age of one. I grew up partially in Boca Raton, Florida

but now live in Sammamish, Washington. I completed my

undergraduate studies in Mechanical Engineering at Duke

University in Durham, North Carolina earning a Bachelor's

Degree. I am greatly interested in design, particularly within

the medical device field and on my free time I enjoy playing

guitar and recording my own songs.


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Jade Fernandez

Status: 1st Year ME Graduate Student


Skills: Microsoft Office, iWork Suite, Adobe Creative

Suite, iMovie, SolidWorks, Autodesk Fusion 360,

CNC machine, 3D printer, general machining.

I was born and raised in Honolulu, Hawaii. I completed

my undergraduate degree at Stanford University in

Product Design Engineering. I am heavily interested in

design and manufacturing and hope to continue to study

my interests in depth while completing my Master’s

degree in Mechanical Engineering at Stanford University.

I enjoy playing soccer, going to the beach, and practicing

my crafts in studio art.

Srinath Sibi

Status : 2nd year ME graduate student

Contact : [email protected]

Skills :CAD, Human Factors Experiment

Design, Finite Element Modeling,

Mechatronics, General Machining

I was born and raised in Chennai, India. I

completed my undergraduate at Indian Institute

of Technology Madras in Engineering Design

and Automotive Design. I am very interested in

Automotive Design and Human Factors for

drivers. I enjoy movies, good food and my

research.


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Philipp Elbel

Status: 1st Year Business Innovation Master Student


Skills: web-programing (php/mysql), STATA, Microsoft

Office

I come from Zug, Switzerland. After my military service as

Electronic Warfare Officer, I completed my Bachelor's degree

in Business Administration at University of St. Gallen (HSG)

including an exchange semester in Sweden. After a gap year

for internships I've started the Master's in Business Innovation

at HSG due to my strong interest in innovation regarding

business models and technology, and am accepted for

the CEMS Master's in International Management. I like

running, road cycling, hiking and hold a private pilot license

for single-engine aircrafts.

Rouven Grunig

Status: 2nd Year Master in Business Innovation student


Skills: Microsoft Office, Java Programming (Eclipse),

Languages: English, German, French, Italian

I was born and raised in Switzerland. I completed my

undergraduate degree at Zurich University of Applied

Sciences in Business Administration with a Major in General

Management. I am highly interested in business models,

technology and innovations and thus hope to continue to study

my interests whilst completing my Master's degree in

Business Innovation at the University of St. Gallen. I like

playing tennis, going for a run and travelling through the

world.



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Carolyn Ragaz

Status: 1st year Business Innovation Graduate Student


Skills: Microsoft Office, Google Sites, speaks German,

English and French

I was born in Virginia, USA and I grew up in Lucerne,

Switzerland. I completed my Bachelor's degree in Business

Administration at the University of St. Gallen. During my

studies I spent a semester in the US and I worked at two

multinational companies in Germany and Ireland for 10

months. I'm interested in working on innovative projects

within an international setting and learning from different

cultures. I hope to pursue my interests in completing my

Master's in Business Innovation at the University of St. Gallen

and with a second exchange semester in Asia. I enjoy hiking

and skiing in the Alps and traveling to different countries.

Jasmin Bissig

Status: 2nd Year MOK (Master in Management, Organization and

Cultural Studies) Student


Skills: Microsoft Word, Excel, Powerpoint, Adobe Photoshop,

Illustrator and InDesign

After finishing my Bachelors degree in communication studies

(University of Lucerne) I am now working on my Masters degree

in Management, Organization and Cultural Studies. When not

studying I like to spend time outdoors, meet friends and

sometimes read a books.



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3.4.1 Stanford Teaching Team

Mark Cutkosky

Status: Stanford Professor


Larry Leifer



George Toye



Katie Zhou

Status: ME 310 Teaching Assistant


Shiquan Wang



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Andrew Hudak



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4 Design Requirements The Merck Box is a promotional tool that is meant to establish familiarity and trust

among the users in South Africa. The competition for nasal decongestants, especially low

cost ones is quite high. The Merck box would create a foothold for Merck using one of its

main products ‘Nasivin.’ After benchmarking, we have identified a number of features

that we would need to incorporate in the final prototype.

4.1 Functional Requirements

Requirements Metric Rationale

1. Device should

provide a way to

combine natural and

pharmacological

remedies.

Device should be able to

provide at least 3 to 4

natural remedies that can be

mixed with the active

ingredient

The combination of natural

remedies and allopathic

medicine is very popular in

South African culture. The

combination offers more

benefits than either

ingredient alone.

2. Enable users to

obtain multiple

doses at a time.

Dispense at least 3 doses

consequently, with each of a

different combination of

medicines.

Since the number of doses

required is 3 to 4 a day, the

user should be able to pick

all of them up at a time

instead of picking them up

multiple times a day if they

desire to

3. The device should

display all relevant

and medicinal

information about

the remedy that is

currently being

added.

1. Information about

possible side effects

and any allergy that

can be induced by

the remedy needs to

be displayed so that

the user is aware of

the side effects.

2. We also wish to

display any and all

information that we

can obtain about the

positive aspects of

the remedies from

published medical

studies and doctors’

opinion.

We believe that the trust

levels of the patient in the

medicine will be better

when they see and

understand its actions

better. We want them to

better understand the

healing process that they

are likely to undergo. This

way, over time, trust is

developed in the brand

name ‘Nasivin.’


be refilled easily

The device should have

refillable canister slots that

We need to establish an

easy procedure for Merck

21

with little chance of

contamination.

allow for easy removal of an

empty cartridge and

placement of a new cartridge

in under 5 minutes without

breaking a seal of

contamination.

so that there is a

continuous service

provided after sale of the

device itself.


ensure that the user

gets a sealed

container of

medicine in the end.

Delivered cartridge should

be heat sealed and spill

proof such that vigorous

shaking cannot cause

spilling

The medicine dose might

not be for immediate

consumption, thus it may

need to be transported.

6. We need to ensure

that there is no

transfer of infection

from one user to the

next.

We need to establish touch-

less control so that no

contact is needed between

the user and the device.

Contact between the user

and device surface is an

easy way of transferring

germs between two users.

We wanted to ensure that

the users sanitize their

hands before they use the

machine. However,

touchless or gesture control

would be the best method

as it eliminates all chances

of disease transference

through touch.

7. Device needs to be

able to communicate

effectively to user.

Device needs to

communicate in all 11 South

African National Languages.

Though the users in the

city are fairly conversant in

English, other languages

such as Zulu and Afrikaans

are fairly common and are

the only language spoken

in some areas.

8. Device needs to be

alluring to the user.

User needs to find the device

interesting. The metric to

measure this would be user

feedback.

In order to get ahead of the

competition, we need the

machine to capture the

user’s attention and ensure

that user returns again.

4.1.1 Functional Constraints

Limited number of Doses:

Since the drug is prone to abuse, we want to limit the number of doses that

a person can buy from the Merck Box. Shown below is the screen display that

allows for the patient to select the number of doses.

22

Figure 4.1: Screen display allowing maximum number of doses

4.1.2 Assumptions

The user has an understanding of his/her illness. They need to understand the

effect of the medicine on their illness.

4.2 Physical Requirements The physical requirements of the device are listed below in the column. Physical

requirements are described for the key components such as the claw and the outlet

manifold used to dispense the fluid.

Requirement Metric Rationale

1. Robotic arm has to

provide enough range

to pick up the

cartridge and place it

beneath all

independent channels

and then at the pick-

up window.

Robotic arm should be able

to rotate a complete 360

degrees on the horizontal

plane with a 1 degree of

freedom claw that grips the

cartridge (cylindrical with

approximately 1 inch in

diameter and 1 inch tall)

Device needs to accurately

place the cartridge for

liquid infusion.

2. Independent channels

need to be able to

deposit liquid in

small quantities.

Independent channels need

to be able deposit liquid

quantities from 2 to 20 ml.

The device needs to be able

to mix the active ingredient

and the herbal remedies in

small concentrated

quantities.

3. Weight and load

requirements on the

end of the arm.

The robotic arm has to be

able to bear a load of 30-40

gms at the end of the arm.

The arm needs to be able to

bear the weight to

appropriately place the

cartridge beneath all the

outlets.

4. System should be

aesthetically

appeasing and

alluring.

At-least 80% of the users

should react positively to

the device.

A pleasing system

will encourage

adoption and use

5. Parts of the system

(medicine canisters)

need to be replaced

Takes no more than 5

minutes for the technician

or a pharmacist with

Post-installation service

needs to be established for

smooth operation and easy

23

when empty easily. minimal training to replace

canister while still ensuring

sterility easily.

availability with as little

technically trained manual

input as possible.

6. Filled cartridges need

to be sealed before

they are dispensed

The filled cartridge with 30

ml of liquid medicine

should be hermetically

sealed in under a minute.

At times the medicine may

not be consumed at the

pharmacy.

4.3 Business Requirements The price of the medical dose would be about 20 cents (2 Rand). Our St. Gallen

partners will be working to appropriately price the individual doses. We will also be

working to establish a post-installation service and supply system so that Merck can

establish a system in South Africa.

24

5 Design Development

The winter quarter was a time of vast exploration in terms of design development for

our team. These design developments were born out of a process involving many

prototypes. Our team first developed a critical function prototype, followed by dark horse

prototypes, a funk-tional prototype, and lastly our converged functional prototypes.

During this time, the approach to our project vastly changed, as explained in the

subsequent sections. The fall quarter was when principal brainstorming, benchmarking,

and need finding were conducted as well as a CEP study. These processes are laid out in

full in the Appendix, and are only briefly summarized in this section before proceeding

into new material from the winter quarter.

5.1 Fall Quarter Technology Benchmarking

Figure 5.1: Organizational Chart of Benchmarking

As a brief reminder of our benchmarking process from the fall quarter, the three

main components are illustrated in Fig. 5.1. There were many important insights that

were gained from conducting benchmarking through these three different routes. During

the fall, at the early stages of our design process, our work was centered around inhalers

used to administer medication through the mouth to the lungs. Our team chose to

investigate asthma inhalers in particular as our research indicated a huge prevalence of

asthma in South Africa. Our bench marking included understanding the two basic

classifications of inhalers—dry and wet inhalers. Dry inhalers disperse medicine in the

form of a powder and are frequently referred to as “passive” devices as they rely on the

user’s inhalation to intake the medicine. Wet inhalers on the other hand disperse medicine

stored as an aerosol which can be released by pressing a trigger which propels the

25

medicine into the user’s mouth. Due to this function they are often referred to as “active”

inhalers.

Through interviews with doctors from the Stanford Hospital Pulmonary Care

division, we learned that while each inhaler form has its advantages and disadvantages,

both designs are fairly simple. The cost of these devices (on average about $60) comes

mostly from the medicine itself, which is sold as a package with the actual inhaler. Our

team also observed alternative inhalation devices but through some analysis it was

decided that a regular pocket inhaler provided the best solution for our target user when

considering categories such as obstructiveness, unnaturalness, portability, ease of use and

cost. The doctors who we spoke to also informed us that lung diseases are highly varied

in places like South Africa. Silicosis for example, is a commonly contracted lung disease

for miners due to inhalation of excessive silica. This disease, like others in South Africa,

cannot be treated as it is incurable. Thus development of an inhaler for such a purpose

would be impractical. Diseases like this instead require an early diagnostic tool for

detection in its early stages. We learned that for some diseases, such as tuberculosis, it is

actually advised to cough to clear the lungs. In cases such as this, suppressing a cough by

inhaled medication could actually be very dangerous to our user.

One benchmarked inhaler was particularly attractive to us at the time called the

Occoris Inhaler Engine. As a very unique option, this inhaler offers a breath-actuated

delivery system of powder medicine. It operates as a one-time-use inhaler and is

manufactured for only twenty cents, thus making it particularly attractive for targeting

relatively-poor demographics such as our target users in South Africa. Using our bench

marking results we identified the following unmet needs moving forward:

Continuously-operating inhalers/breathing apparatuses

Familial pocket inhalers with sterilizable or interchangeable mouthpieces

Integration of inhalers to mobile phone texting service for managing treatment

Inhalers for severely affected miners using central nebulizer and personal masks

Rechargeable inhalers--use of tablets or liquid medicine

Extremely cheap inhalers

Redesign of the pocket inhaler form for portability and concealibility

26

5.2 Fall Quarter Need Finding

Figure 5.2: Organizational Chart of Need Finding

During the fall quarter, our need finding process consisted of online research and

interviews of South Africans (mostly over skype) as illustrated in Fig. 5.2. We discovered

many troublesome signs regarding the state of healthcare in South Africa as a whole. The

physician density is about 0.76 physicians/1000 people with an average of 13,718 people

per clinic which exceeds the World Health Organization’s guidelines of 10,000 people

per clinic. This is disheartening to begin with, but what is even more saddening is that

since approximately 73% of general practitioners work in the private health sector, there

is only about one practicing doctor for every 4,219 people. Understanding the role of

traditional medicine in South Africa was a particularly difficult task due to a lack of

statistical data, however one rough figure computed that there are about 200,000 healers

compared to 25,000 western doctors.

Through our research and interviews we learned that South African perceptions of

Western culture are actually very different than what we expected and than what was

originally presented by Merck. When given our project prompt, our corporate liaison had

described how middle class South Africans were tied to their tribal roots and therefore

not usually interested in embracing Western culture. We learned this was not the case, but

rather that our target users were constantly looking to embrace Western culture as a way

of establishing their status in a new and quickly fluctuating South African middle class.

While part of this status involves physical items including cars and televisions, it is also

built around one’s health. In a country with such serious health problems, promoting an

image of good health is a way of demonstrating one’s high status. We also subsequently

learned that middle class South Africans frequently do refrain from using many Western

medicines, not because of the chemicals necessarily, but more because of economic

constraints. They live on tight budgets and prefer to spend their money on technology or

other flashy items which serve as status symbols. This is especially the case for

medicines for illnesses which pass naturally such as the common cold. While it is true

that many people do opt to use natural remedies for treating conditions such as a stuffy

nose, this decision is prompted by the fact that it is not a dire medical emergency, but

27

rather one that can be treated using natural remedies which are readily available within

villages for extremely low prices.

Through interviews and online research our team learned that most South

Africans opt to visit healthcare clinics when truly sick. Even the population of South

Africans who continue to go to traditional healers frequently visit clinics for serious

medical concerns. Unfortunately, getting treated at a clinic can be a huge hassle, as

patients frequently wait more than six hours to see a doctor, and clinics are located far

away from many villages. Because of this inconvenience, pharmacies have gained great

importance. Pharmacies are very accessible, and provide a wide range of medicines

produced from American and European pharmaceutical companies and African natural

remedies alike. Pharmacists have acquired new roles as pseudo-doctors, as sick people

usually opt to seek medical device from them directly rather than wait in line at a clinic.

Using these findings at the end of the fall quarter it was decided that a successful inhaler,

if implemented for the South African middle class demographic, should include the

following traits:

Emphasize health and symbolize ambition

Emphasize cheap/resusable/sharable solutions

Very easy to use

Remove stigma of sickness/weakness

Westernized design which draws positive attention if seen in use

28

5.3 Fall Quarter Critical Experience Prototype

Through our need finding and benchmarking processes last quarter, our team

discovered an apparent stigma associated with using an inhaler. As many people

indicated to us, inhalers continue to be looked down upon for reasons that they make the

user look unhealthy, and they are usually associated with weakness or being “nerdy.” Our

team wished to examine this broad stigma. If we wished to implement an inhaler which

would be accepted by the South African middle class, it would seem logical to first

approach the design challenge by designing an inhaler that mitigated the effect of this

stigma. In order to test this, nine different inhaler prototypes were constructed of either

wood or plastic and with different form factors. These prototypes are described as the

following:

E-cigarette design (pocket inhaler)

“High-tech” disk design (pocket inhaler)

Rectangular block design (pocket inhaler)

Abstract “jewel” design #1 (pocket inhaler)


Wrist design (wearable inhaler)

Diamond design (wearable inhaler)

Large pendant design (wearable inhaler)

Small pendant design (wearable inhaler)

By having users hold and manipulate the different inhalers (as if to simulate their use)

and by having them rank their favorite and least favorite designs, we gathered many

meaningful insights as shown below:

Most people who do not use an inhaler (a majority of our interviewees) believe that

there is not a stigma against inhalers and people who use them

Most people who do use inhalers believe there is a stigma against inhalers, as it

makes the user look unhealthy and it is disruptive to social interaction

Unanimously, people would opt not to use a typical inhaler at a large social gathering

such as a party

● Small inhalers are preferable, especially ones that can be hidden behind clothing

● Wearables are preferred because of convenience, but only if inhaler use is very

frequent

● The most liked design was the small pendant necklace wearable inhaler, with the least

favorite being the e-cigarette shape as it was highly polarizing amongst interviewees

● If a pocket inhaler were to be pursued, people generally like something that does not

look the slightest bit like a typical metered dose inhaler, but is instead sleek and easy

to hold (such as 2)

● Necklaces are preferred over wrist wearables because they can be concealed (such as

9)

29

○ Necklaces must be small (a reason why various people disliked option 8) and

“stylish,” to look fashionable like jewelry.

In addition to this study, our team also conducted a long-term study in which we

asked four people to “use” four of our inhalers for an entire day (including in very public

places) and to report back any findings. We learned that the pocket inhalers received the

most unwanted attention, whereas the wearables (especially the necklace) could be used

fairly discretely. For example, our tester using the necklace inhaler commented that

bringing her inhaler to her mouth did not draw much attention in public areas, probably

due to the fact that some people naturally chew on their jewelry already.

The overall results from our critical experience prototype revealed that there is an

evident conscious and subconscious stigma associated with inhalers. While some people

claimed that they see no issues with using an inhaler publicly, everyone unanimously

agreed that they would not want to use them in a public setting themselves. This presents

a huge problem, especially for people with chronic lung conditions that require an inhaler

at times which are not socially “ideal.” In these situations, it seems that users tended to

prefer an inhaler which could be used incredibly easily, quickly, discreetly, and then

concealed again after use. At this stage in our design development, it was decided that if

we were to implement an inhaler with a new form, the most effective design would need

to incorporate these traits, likely as a necklace or other wearable. If a pocket inhaler were

to be pursued, it seemed that people would prefer a form factor which does not resemble

a traditional inhaler at all, as a way of disassociating from that underlying stigma.

30

5.4 Persona Development

Developing a persona is critical to our project, as it allows us to fully identify a

potential user. It forces us to understand how this user lives, and the typical experiences

they undergo each day. By thinking on this personal level, it allows us to develop a

product which is well suited for their particular needs, and therefore integrates more

naturally into their life. This persona serves as a good indicator of how we can expect (at

least roughly) the rest of our target users to act and accept our product.

Since the end of the fall quarter, the basis of our project has changed quite a bit

(as explained in subsequent sections) causing us to alter our persona. As was clarified by

Merck during the winter quarter, our new persona is still in the South African middle

class, but of a slightly lower economic status than before. This person likely chooses not

to purchase Western medicine due to economic constraints, and commonly uses

traditional remedies due to their accessibility and extremely low cost.

Our persona is a 30 year old female from Johannesburg named Ayanda. Ayanda

grew up in Johannesburg, and was a young child during the time when apartheid ended

and integration began. She watched her father struggle to earn enough money to support

her, her mother and her two little sisters. Her father had a hard time integrating into his

new job as a teller at a department store, as he often got confused on how to use the cash

register. When Ayanda was old enough to work around the age of 12, she dropped out of

school and started working at a very small business that her friend’s mom owned. Here

Ayanda assisted in painting wooden beads and assembling them into beautiful bracelets

and necklaces. While the pay was minimal, it was enough to make a difference and help

support her family’s lifestyle. This became especially important once her father became

very sick around the time Ayanda turned 17.

Figure 5.3: Middle class South African woman,

Ayanda

31

Since then Ayanda has continued painting beads, and eventually took over the small

business at the age of 24. At this time, Ayanda had been caring for her sick father for

many years, and now had a daughter of her own to take care of as well. Despite the fact

she loves her job and is an incredibly talented artist, her daily work barely brings in

enough money to allow her and her family to live comfortably. With the huge

responsibility of having a daughter, Ayanda always wants to ensure her child’s well-

being.

During Ayanda’s adolescence, the South African culture began to become much more

westernized, and this process exposed her to the benefits of Western medicines as they

were promoted on city billboards and pamphlets distributed throughout the city. Because

Ayanda does not own a car, she relies heavily on the city buses as her form of

transportation. Once when her daughter became ill, Ayanda was forced to take a bus for

one hour and then wait at a clinic for seven more before her daughter could be seen by a

doctor. Hoping to avoid experiencing this ever again, she has relied on natural remedies

to treat her daughter more efficiently ever since. However, she has noticed that many

times the natural remedies are not as effective as she would hope and the recovery

process takes much longer than expected.

Ayanda would love to use Western medicine to help her daughter recover more

quickly when sick, however the containers for medicine are very large and the cost of the

medicine at the pharmacy much too high with respect to her daily earnings. Because she

has never used this Western medicine before, she would also feel much more comfortable

if the medicine could be mixed with some traditional African remedies too. Ayanda truly

believes in the power of Western medicine, but would greatly prefer if she could better

understand or at least see the components that are being used in it. Ayanda seeks a cost-

effective method to ensure her daughter’s good health--one that is convenient,

trustworthy and does not require her to spend all her earnings on excess medication that

she does not immediately need, yet still effectively relieves her daughter through the

power of Western medicine.

32

5.5 Need finding in South Africa

Over winter break, Jade and Sri ventured to Johannesburg, South Africa and Cape

Town, South Africa to perform need finding amongst the black middle class. They spent

four days in Johannesburg and five days in Cape Town to find key insights about the

defined user group. Their itinerary consisted of pharmacy visits, home visits, and meeting

up with the St. Gallen team while in Cape Town.

They began their journey in a placed called the Maboneng Precinct, meaning “place

of light” near Johannesburg. Maboneng is a particularly interesting place to be right now

because it is currently undergoing urban regeneration. Urban regeneration is defined as

land redevelopment in areas of moderate to high density urban land use. It was here that

they met the owner of their hostel, Curiocity, in the Maboneng Precinct.

Figure 5.4: Maboneng Precinct

Bheki Dube, also known as the neighborhood host, is a 22 year old man, who was

born below the poverty line. He was a very humble and kind host and one would have

never guessed that he was as successful as he was. A few years back, Bheki started

making money by giving city tours. He spent most his time gathering his friends and

training them on how to give a tour. He also was and still is involved with the Maboneng

Reurbanization. This included implementing 24/7 police surveillance in the streets and

the encouragement for the black middle class to start their own business. And, that is

exactly what Bheki did. His generation, as well as the area he lived in, was setting trends

for many other similar neighborhoods. Since Merck was looking for the trendsetters of

Africa, Sri and Jade determined Maboneng would be a great place to start need finding.

33

Figure 5.5: Bheki, a local South African

5.5.1. Reurbanization and Repurposing of Things

One year ago, Bheki started a backpackers hostel in Maboneng and became the

first black man to own a business there. Since then, there have been numerous new

ventures to do the same. Bheki has been featured in New York Times and is owning a

very successful business now. Bheki is not only redefining his role in society, but also

impacting a community through the regeneration of what it means to be a thriving and

young business in a place that is constantly in flux. On the streets, one could clearly see

examples of repurposing of not only roles of people, but also of objects.

34

Figure 5.6: Repurposed tire as a lighting fixture

Figure 5.7: Ostrich egg shells repurposed as a light fixture

35

Figure 5.8: Van repurposed as moveable space on wheels

Not only were roles being repurposed, objects, and spaces were also a large theme

of trends and change. At the current time in our design process, these findings truly fit the

role of our wearable device that we aimed to create. We wanted to repurpose a necklace

as a means for someone to carry their medicine with them. This seemed to fit their

structure of products and roles

5.5.2. Western Leaning Trends

A huge trend Jade and Sri saw all around South Africa was a heavy adoption of

Western customs and products. Bheki had an iPhone and used a Mac computer (Fig. 5.9).

36

Figure 5.9: Bheki using a Mac laptop

He was very Western and this was a theme throughout many people we met in

South Africa. After a few days, Jade and Sri soon realized how Western ideology and

products were very popular amongst the people in that community. In order to make a

product successful in South Africa, they determined that the product must be highly

Westernized and trendy to the upcoming generation.

5.5.3. Pharmacies in South Africa

Sri and Jade spent a lot of time understanding the cultural differences, as well as

the product usage differences in South Africa. In Cape Town, they visited a series of

pharmacies that were very local to the communities. During their time there, they

interviewed a variety of people who preferred both natural and clinical remedies. Another

thing they noticed was how frequent pharmacies were in the city. In fact, there was a

pharmacy on every 3 or 4 blocks.

37

Figure 5.10: One of the many pharmacies in South Africa

The pharmacy was divided very clearly into two different divisions - one area for

natural remedies and one area for chemical remedies. Chemical remedies were separated

by sickness behind the counter. They had nasal sprays, including Merck’s Nasivin

product marketed in South Africa under the name Iliadin. Natural remedies were also

organized, but in the open space and one did not require the assistance of a pharmacist to

obtain their medication.

Figure 5.11: Inside the pharmacy

38

Figure 5.12: Natural remedy wall

Figure 5.13: Some of the nasal sprays carried at that pharmacy

After speaking with several pharmacists, it seemed that people did not like buying

nasal sprays because of the mere fact that it needed to be placed into the nostril. People

39

seemed to prefer rubs and natural remedies. The most common product bought for

decongestion was a rub called “Zam-Buk,” which was mainly made up of Eucalyptus oil.

Many people preferred this remedy because the packaging was small, discreet, and could

be carried around in one’s pocket with ease.

Figure 5.14: Pack of Zam-Buk

5.5.4. Meeting with the St. Gallen Team

Half way through their trip, Sri and Jade met up with the St. Gallen team in Cape

Town, where they exchanged findings and insights. They converged on insights gathered

from the trip and they were able to come up with a list and charts to better organize their

ideas. Here are some of the key insights that the teams found during their stay in South

Africa.

Treatment of colds Inhaling of e.g. Vick is popular

The differences between colds, flus, sinus and hay fever is not understood

Irritated skin is often treated with Vicks, Zam-Buck or Vaseline

Sniff products are only used by old ladies

Drops are cheaper, easier to use and more widely known than nasal sprays

It is popular to drink medicine

Pills are not very popular

The process of nasal sprays is perceived as alien and is also not widely known

Home-made and natural remedies Home-made remedies are mostly inhaled or orally ingested

People are used to mixing their own (natural) remedies

The belief in natural remedies is inherited from older family generations

Aloe is one of the most well-known and popular natural ingredients

40

Traditional medicine (healers) There is not necessary a contradiction between Western and traditional medicine /

healers. Many people embrace both

Traditional healers and their treatments focus more on psychological issues

Not everybody believes in traditional healing

Influential people Typically, mothers decide on and buy medicine for their whole family

Doctors, pharmacists, nurses are the most trusted people when it comes to medical

treatments

Word-of-mouth (e.g. within family, minibuses) has a great influence on the

publicity of medical treatments

Black middle class Everyone owns a television and uses it constantly.

The traditional family model is rarely seen (fathers often don’t live with their

children)

Pap is the most popular food and is eaten on a daily basis by many people

People highly believe in god

Many people dream of having their own business

Adults want their children to have a good education

People want to improve their living conditions especially housing

There is a certain awareness of what is healthy

It is hard to get a higher education

Cars, housing and education are status symbols

Society Separation and mistrust among black, colored and white people are still common,

especially in older generations

Business is done in more informal ways (markets, street, neighbors)

Some products are sold as single items or small packages instead of full/big

packages (e.g. cigarettes, MedLemon)

The leader of an African society cares for his people but usually gets something in

return. This is often seen as corruption to outsiders

Medical aid The possession of medical aid depends on employment as it is partly financed by

employers

People who have medical aid tend to use Western medicine often

41

5.6 Critical Function Prototype

At the end of the fall quarter and after speaking more with Merck, the project

direction was altered as it was clarified that Merck desired a nasal decongestant as

opposed to a traditional inhaler for respiratory conditions. The turn in this direction was

driven by Merck and was motivated by the fact that their flagship product called Nasivin

is a nasal spray which is inserted into the nostrils and delivers a fine mist of decongestant

medication. Their ultimate goal was to successfully sell such a product in South Africa.

The medicine can be taken every 12 hours and relieves the nose in 30 seconds allowing

the user to then breathe freely. With this new direction, our team decided it would be best

to investigate two different critical function prototypes, with the hope of gathering a

broader spectrum of learning. Regardless of this change in our project path, our previous

need finding and benchmarking exercises remained highly valuable, as many of the

insights attained could be carried over into developing a decongestant device. The need

finding conducted in South Africa by our team also proved to be critical in the

proceeding developments as well.

5.6.1. Prototype Goals and Rationale

Goal 1: Investigate whether medication could be delivered to the nose in the form of a

cartridge filled with powder

Rationale: Going off of our previous findings on inhalers, our team discovered that powder

medicine was a very common alternative to “spray” delivery mechanisms. It was also found

that these powder “passive” inhalers were actually quite basic in terms of internal

mechanisms, and thus posed the potential for a very cheap adaptation for nasal spray

medicine. Lastly, some light benchmarking on nasal sprays identified that many nasal spray

critics dislike the “drippy” feeling experienced when using a nasal spray. Thus there seems to

be a motivation for delivering nasal medicine in a dry powder form.

Goal 2: Investigate the ease of dispersing two different liquids through a simple spray nozzle

at the same time in order to simulate a DIY (do it yourself) spray medicine with which users

could combine Nasivin and their personal natural remedy.

Rationale: As indicated through previous need finding, it was found that many South

Africans opt to use natural remedies as a first line of defense against non-severe sickness.

With this in mind, we wanted to observe how difficult it would be to simply disperse both

Nasivin and a second natural remedy (in liquid form) through a spray nozzle at the same

time.

42

5.6.2. What We Hoped to Learn

CFP #1:

Is it easy to prepare a cartridge that holds powder?

What is the best way to disperse the medicinal powder?

How does the medicine disperse?

Are the results repeatable?

CFP #2:

Can a simple spray nozzle be used to mix two different liquids?

How much pressure needs to be applied to produce a sprayed mixture of the liquids?

Are there limitations to how much liquid can flow or what types of liquids could be mixed?

5.6.3. Prototype Description

CFP #1:

A multilayered rubber mesh cartridge was constructed and filled with silk wool. This

wool was coated with a brown colored powder to act as the “medicine.” This wool

was sandwiched in between the different rubber mesh layers and sealed to a

cardboard frame as shown in Fig. 5.15.

An air intake tube was attached on one side of the cartridge frame and air gaps were

sealed with hot glue.

A CO2 canister was used to provide a flow of air through the cartridge at a high

enough pressure to release the medicine

Figure 5.15: Powder delivery cartridge

CFP #2:

Two flexible bladders were filled with separate liquids (Fig. 5.16)

Two clear plastic flexible tubes were attached to these bladders and joined at a T-

junction

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The output of the T-junction was fed to a basic spray nozzle from which the

combined liquid would be sprayed when simultaneously squeezing both of the

bladders

Figure 5.16: Two bladders and tubing used for CFP #2

5.6.4. Functional Prototype Results and Insights

CFP #1:

After setting up the cartridge prototype and running various tests using the device, some

important insights were made. First off, we found that it was fairly difficult to “refill” the

same cartridge with powder for more than one trial due to the compactness of the steel wool

between the rubber mesh layers. As we were originally concerned about the powder falling

out of the cartridge too easily, we found that surprisingly the cartridge held the powder fairly

well. Even when turning the cartridge upside down, the powder did not easily fall out without

tapping the top of the cardboard frame. It seems that our multilayered rubber mesh

construction was effective in holding the powder. Regarding the actual dispersion of the

powder, we found that the first burst of air produced a very full and large plume of powder as

desired. However, the results were not repeatable. Subsequent puffs produced much smaller

plumes as the cartridge could not be properly refilled. Lastly, although the CO2 canister

produced an effective plume as desired, our team realized that such a strong burst of air

would not be reasonable for insertion into the nose. Such a high pressure would surely be

dangerous. Without other pressure-producing mechanisms at hand, our team attempted to

blow on the cartridge to disperse the powder but despite our best efforts we were

unsuccessful in releasing the medicine.

CFP #2:

After setting up the bladder t-junction, initial tests were successful. While simultaneously

compressing the bladders, we found that the water flowed through both of the tubes and

successfully sprayed out in the form of a fine mist. Our struggles began when we attempted to

44

use two different colored liquids to understand how well-mixed the spray truly was through

the color pattern. By adding only a slight bit of different colored paints into the two water

bladders, the liquid no longer flowed through the nozzle, despite extreme compression of the

bladders. This revealed a very important point that we had not considered: viscosity. As soon

as the mixed liquids become only slightly viscous, they could no longer spray through the

nozzle. This was a critical finding and something that we had overlooked, as natural remedies

which would likely be used in South Africa would have varying viscosities, likely higher than

water.

5.6.5. Overall CFP Conclusions

CFP #1:

A powder-based nasal decongestant delivery mechanism seems plausible, but

only on the condition that the powder medicine is packed in such a way that it can be

easily dispersed by low enough pressures to insert into the nose. Considering such a

system would be used by a person with a potentially clogged nose, one cannot rely purely

on their inhalation to intake the medicine, but rather a safe level of air pressure must be

used. Balancing the ease of powder dispersion from the cartridge with the cartridge’s

ability to retain the medicine even when shaken poses a difficult issue, as improving one

factor seems to worsen the other. Lastly, as reloading such a cartridge with powdered

medicine was so difficult, a solution of this form would likely need to consist of single-

use cartridges.

CFP #2:

Mixing two liquids through a basic spray nozzle seems very feasible but only if

the liquids have very low viscosities. Considering the wide range of possible home

remedies, this places a severe limitation on this application. It does not seem reasonable

to utilize a spray nozzle such as this for a Do-It-Yourself application, as the wide

viscosity range of the remedies would undoubtedly lead to clogging and displeased users.

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5.7 Dark Horse Prototype

For the Dark Horse prototype phase, our team changed our path many times. These

changes were prompted by the insights we gained from each prototype each week, as

well as new insights regarding the Nasivin product that Merck was hoping to market.

Each iteration is depicted below and illustrates our desire to push the boundaries of the

design space and approach our project prompt from a new and creative path.

5.7.1. Dark Horse Prototype Version 1

At this stage in our design process, our team perceived our user to be an upper

middle class South African. Because the South African middle class is so difficult to

describe with its vast size and its constant state of flux, we attempted many times to get a

more specific description of our target user group from Merck. However, after Merck

failed to respond to our questions, our team moved forward designing for the upper

middle class with the thought that such a target group would have the disposable income

necessary to invest in nasal decongestants. As colds and congestion naturally pass over

several days, it seemed to our team that low income individuals in South Africa would

not likely want to invest in a medicine to treat these conditions. Our Dark Horse Version

1 prototype was therefore targeted at the upper middle class.

5.7.1.1. Prototype Goal and Rationale

Goal: For this prototype we wanted to analyze the feasibility of creating an automated

delivery system for nasal medicine by using a control system and feedback

Rationale: Our past work demonstrated that the South African user appreciates a simple

product. With this in mind, the ultimate simplicity seems to imply automatic medicine

delivery, where no human-machine interaction is necessary. A perfect time to utilize such

a machine is while sleeping—a time when congestion is often most severe, yet people are

ultimately unable to address the issue as they are busy attempting to fall asleep.

5.7.1.2. Prototype Description

Through some brief research we learned that thermistors (Fig. 5.17) and ultrasound have

both been used to detect and quantify human breath. Thermistors were particularly

attractive to us as they presented a very cheap way to detect human breath by analyzing

the temperature changes in inhalation and exhalation by adjusting their resistive

properties accordingly.

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Figure 5.17: Thermistor

Figure 5.18: Dark Horse Prototype 1 Setup

47

As illustrated in Fig. 5.18, our setup consisted of a CO2 canister and dispenser as well as a

linear actuator, an Arduino, some flexible rubber tubing, a nebulizer filled with nasal

decongestant medicine, and a face mask fitted with a thermistor. The system was to

function as follows:

1. While the user wears the mask, the thermistor adjusts its resistivity in accordance

to air flow temperature (inhalation vs. exhalation). This is monitored by a

controller. If the temperature difference is not significant enough, the nose is

thought to be “congested.”

2. If “congestion” is detected, the linear actuator moves, triggering the CO2 canister

which pressurizes the Nasivin medicine held in the nebulizer.

3. The pressurized Nasivin creates a puff of medicinal mist into the mask, which

theoretically decongests the nose.

4. The entire system is controlled by means of an Arduino Mega

5.7.1.3. Prototype Testing

Prototype testing for this iteration was meant to test the accuracy of such a

thermistor-based system. We aimed to analyze various subjects to test the sensitivity of

the system and learn how to best tune the controller for different breathing tendencies.

However as this was our first design iteration, no testing was actually preformed.

5.7.2. Dark Horse Prototype Version 2

For our second Dark Horse Prototype, we decided to move away from an

automated nasal spray system. The reason for this change is that after reconsidering such

a solution, we remembered that Nasivin can only be used safely every 12 hours. It

therefore doesn’t seem logical to invest in an automated system. One dose is more than

enough for an entire night’s worth of sleep and could simply be taken before going to

bed. For our second prototype, we wanted to completely drop the nasal spray delivery

system, and instead focus on creating a wearable tool to analyze a user’s heart rate,

respiration patterns and hopefully detect congestion. This change was driven by a desire

to widen our design space significantly, as our team felt very constrained by a design

space limited to administering one specific nasal spray medicine.


Goal: Develop a system capable of acquiring and storing data regarding respiration

and a user’s general health.

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Rationale: Through our research we found that South Africans typically shy away

from nasal sprays because they are unwilling to pay to treat a condition which naturally

passes over time (congestion). In order to address the bigger picture we wanted to think

of an overall health monitor with a particular emphasis on respiratory patterns. By

making respiratory patterns more transparent to users, we hoped that people could better

track their conditions during sickness (such as a cold) to see whether they are getting

better or worse. We felt transparency was an effective way for South Africans to further

embrace Western medicine.


Through some brief benchmarking of existing biometric systems, we quickly discovered

the Bitalino (Fig. 5.19)

Figure 5.19: The Anatomy of a Bitalino Board

The Bitalino proved to be a perfect tool for our intended uses as it is a micro-controller-

equipped board with additional pre-attached biometric units including an EMG, EDA,

ECG and accelerometer. Using the board’s Bluetooth capabilities it was possible to

stream biometric data directly to an open source software called Open Signals (Fig. 5.20).

49

Figure 5.20: Illustration of the Open Signals Interface

As we ultimately wanted to bring this Bitalino board close enough to the user to

allow the biomedical sensors to be placed in the correct anatomical positions, we decided

to create a strap to hold the Bitalino against the user’s chest (Fig. 5.21).

Figure 5.21: a.) Strap used to attach the Bitalino b.) Bitalino with ECG and

EMG

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Our team ultimately decided to use only three of the biometric tools on the Bitalino:

the accelerometer, the EMG, and the ECG. The accelerometer was left on the Bitalino

board such that inhalation and exhalation would move the board and therefore lead to

different readings on the accelerometer to track respiration. The ECG electrodes were

attached at the sternum and used to detect heart rate. The EMG electrodes were placed on

the nostrils (with a ground electrode placed on the forehead). These electrodes were used

to sense “sniffles” or extraneous movements of the nostrils which could indicate a

congested nose. The overall function of the device was intended to be as follows:

1. The user wears a chest strap containing the Bitalino board. This device is worn

under the shirt. Two more sensors are worn on the outside of each nostril and the

sternum with one additional sensor placed on the forehead.

2. The user would download the appropriate app onto their smartphone, but for the

sake of this prototype, Open Signals is used for data collection.

3. Through the sensors, (ECG, accelerometer, EMG) heart rate, breathing rate and

muscle activity data are gathered.

4. This information is delivered by means of Bluetooth to the user’s cellphone app

(Open Signals), through which the user is notified of their current breathing

patterns and health trends


At this stage in the prototype development, no user tests were completed due to a lack of

time. However, the testing protocol for the final prototype for the following week was

established and is indicated below. The system would be tested on 4-5 people, having

them wear all of the sensors while data was recorded and stored. The test plan was

defined as follows:

1. Sit user in chair and mount sensors in correct positions, without telling them the

purpose of each one.

2. Begin data acquisition, and show the subject the data while it is gathering.

3. Have the subject simulate normal breathing, deep breaths, congestion (using

cotton balls to clog airways), and sniffles, to make sure the system picks

everything up as expected.

4. During this process, encourage the subject to guess at what the sensors are

detecting, and “nudge” them in the right direction to encourage spontaneous

conversation about the setup.

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5. Ask the user to comment on their experience, including whether or not they find

the data useful or interesting after revealing to them the purpose of the sensors

and the goal.

The ultimate goal of performing these user tests was to understand 1) if people actually

find value in the data provided to them and 2) if it is possible to derive symptoms of

“congestion” from the data collected.

5.7.3. Dark Horse Version 3

For our third prototype, our team decided to further pursue and develop our

concept from the previous week. The focus of this iteration was to figure out an effective

way to test our system on users. Originally, we had planned to write a Matlab code to

extract the streamed data from the Bitalino, and also provide some analysis to draw

conclusions about the user’s breathing and overall state of health during different tests.

This analysis would then be presented to the user in the form of a website or app. After

careful consideration, our team decided that we didn’t have sufficient time to create this

overall system. Luckily, through some research we discovered many publicly available

Matlab scripts online which could be used to filter our biometric data and derive heart

rate, breathing rate and muscle activation (EMG readings). With the newfound

knowledge that drawing these conclusions from our data was indeed possible, we decided

that rather than spending our time tinkering with the code we would implement a Wizard

of Oz technique to get at the true question we wished to answer—do people care for this

data? Instead during this time our team worked on improving the respiratory tracking

system. Through testing within our team we found that the accelerometer was not always

capable of detecting relaxed breathing due to subtle movement of the chest. The design

changes used to correct for this issue and the new testing method are presented below.


Goal: Continue developing a system capable of acquiring data regarding respiration and a

user’s general health. With data acquisition proven to be possible, implement a Wizard of

Oz test to address users’ true interests in such biometric data.

Rationale: The reasoning for this prototype iteration was the same presented for the

previous prototype iteration (see 5.7.2).


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As previously mentioned, our team sought an alternative method to track respiration. We

opted to utilize a long force sensitive resistor (Fig. 5.22) as it could be easily mounted on

the strap we had already created to wrap around the user’s chest.

Figure 5.22: Force sensitive resistor used to track respiration

The concept behind this method was that the resistor would be attached to the

elastic strap placed around the user’s chest. When inhaling or exhaling, the resistor would

deform, therefore altering its resistance and allowing us to detect the different voltages as

respiratory patterns. An amplification circuit was used to amply the derived signal from

the resistor to usable levels as shown in Fig. 5.23.

As previously mentioned, this prototype and its subsequent testing relied heavily

on a Wizard of Oz technique. In order to convince the tested subjects that we were indeed

streaming their personal biometric data to a website, our team created the website itself

with the following pages:

Figure 5.23: Team testing force sensitive resistor for respiration

53

Figure 5.24: Webpages used to show users' biometric "results" after Wizard of Oz tests


In order to prove to the users that our device was capable of tracking respiratory

and other biometric data, we proposed a protocol of four one-minute long “exercises”

which were intended to alter the readings from the different sensors. We chose to make

54

respiration the focus of our testing and data display, as this most closely aligned with

Merck’s goals for decongestion. The “results” for each test illustrated in the website were

derived beforehand by having our team measure breaths while doing the tests ourselves.

Although in reality the numbers always stayed the same, since we tested subjects one at a

time, after their tests we were able to trick them into believing that their data had

“compiled” and that the displayed numbers represented their personal data. In order to

have the subjects believe our study, before beginning the tests each subject was hooked

up to all of the sensors and their true real-time biosignals were shown to them on the

laptop including heart rate, respiration and nostril movement.

As previously mentioned, four one-minute tests were run per subject with

instruction from one of our team members while another team member “compiled the

data.”

1) The first test consisted of a simple minute of relaxed breathing. This test was intended

to display “normal” results to the user as indicated by a regular breathing pattern and

heart rate.

2) The second test consisted of “shallow breathing” where the user was asked to take

breaths that were less deep. This test was intended to simulate breaths of low amplitude,

thus recreating an effect experienced when congested as less air is capable of passing

through the nostrils.

3) For the third test, the users were asked to breathe normally but to “sniffle” every

fifteen seconds. This test was intended to demonstrate to our user the effectiveness of our

system in tracking nostril movement and the ability of our “software” to indicate that

these sniffles may be due to a runny nose.

4) The final test consisted of having the user actively lift a moderately-heavy weight (a

bowling pin was used) for one minute while breathing normally. This test was intended to

display an increased breath rate coupled with increased heart rate which would prompt

the software to ask the user whether they were exercising.

Our team decided to keep the data display as minimalistic as possible, displaying

very basic information in an incredibly simple manner. The focus was left on respiration

data, in the hopes of learning about people’s interest in respiratory monitoring in general.

After completing the testing protocol, users were asked to quickly identify whether they

found value in the data, whether they would be interested in using such a system and who

they feel would most likely use a system such as this.

5.7.3.4. Testing Results

After completing our study, we reached several key insights. First, we learned that

our Wizard of Oz testing process was incredibly successful as no one questioned the

validity of the data presented to them. However, regarding the data itself, while many

55

people found the system to be “cool,” they didn’t find the data to be that practical. Users

identified that rather than posing questions back to the user, it would be nice if the

software was capable of analyzing the respiratory data and giving suggestions to the user

on how to potentially improve their breathing. However, even with these improvements,

many subjects commented on how they don’t see this as a practical tool because

breathing is a subconscious action. After we related the device to biometric systems such

as Fitbit which track daily fitness, our subjects mentioned that people tend to like

products such as these because they pose a “challenge.”

By indicating to a user how many miles they walk in a day, these biometric tools

inherently challenge the user to walk a little further each day. This is something which

does not seem to have the same effect with a subconscious action such as breathing.

Several subjects indicated to us that while they would not use the device, they could

potentially see applications for people with chronic respiratory conditions, for whom

constant monitoring is important. Likewise, regarding the general form factor, it was

unanimously agreed that the placement of the sensors all along the body and particularly

along the face was undesirable. Subjects suggested incorporating such a system into a

more concealable device that has less of a “medical” appearance if it is to be marketed as

a consumer product.

5.7.4. Dark Horse Conclusions

From the Dark Horse prototyping phase, our team was able to draw very useful

conclusions. As a whole we found that biometric tracking itself is not a difficult task, nor

is filtering/analyzing this data. What we did learn however, is that users do not want

direct data, but rather a corresponding diagnosis or suggestion. Considering our lack of

medical knowledge, this desire for a diagnostic capability posed quite the challenge

moving forward. It was also identified that if we were to pursue this path, subsequent

design iterations would need to minimize the overall size of the device. With the goal of

making the device easier to conceal and more appealing, it would likely need to be

created as one piece, without wired electrodes that extend to other regions of the body.

Such a constraint would imply that careful consideration would need to be taken to

ensure that the location of this central piece was such that all of the desired biometric data

(respiration, pulse, and nostril movement) could be attained from its position.

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5.8 Funky Prototype

For our Funky Prototype, our team decided to continue with the diagnostic tool

development idea. This stage of prototyping included improving the system based off of

previous user testing and developing a justification for why such a system could be

beneficial to our target users (upper middle class South Africans).

5.8.1. Prototype Goal and Rationale

Goal: Modify the previous biometric tracking prototype into a more compact and

appealing form. Also seek a justification for how the device would be used in the South

African context, to validate the need for such a solution.

Rationale: As noted during our previous user testing, people found our dark horse

prototype to be burdensome and intimidating. Also, while such a device would not likely

be used by the average person, it would be best utilized for special circumstances. As

pointed out by the teaching team at our previous discussion, it was important to identify

the correct way to justify moving forward with this idea.

5.8.2. Prototype Description

Our funky prototype was meant to serve as a rough prediction of what we hoped to

develop for our functional prototype. The concept was taken from our previous prototype

using biometric data tracking, but with added functionality. The funky prototype was

intended to track a user’s breathing (with increased accuracy), heart rate, congestion, and

temperature as well. This additional temperature sensor was included in the hopes of

being able to make more meaningful diagnoses (including symptoms such as a fever) and

provide users with more valuable suggestions from their biometric data. In order to

consolidate all of the components into one central housing unit (as advised during our

previous user testing) a small casing was created that could mount onto our respiratory

tracking flex sensor strap. Our new system included the respiratory tracking amplification

circuit and the EMG and ECGs from the Bitalino all compiled onto one board as shown

in Fig. 5.25. This new system also incorporated a new stethoscope attachment. Although

not functional at this stage in development, the hope was that this stethoscope attachment

would allow us to obtain more detailed respiratory information (such as weezing), in turn

allowing us to present users with more meaningful data. The final additional piece of

hardware for this prototype was a flash drive which was meant to simulate the device’s

data storing capability, as well as an added functionality where the device could be

connected to a user’s computer to then download the collected data.

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The second part of this prototype included developing an overall application for the

device in order to justify its importance to the user. From Sri and Jade’s trip to South

Africa, they learned that South Africans can wait an excess of six hours before being able

to speak to a doctor in health clinics due to a lack of available doctors and an excess of

patients. Our desire was therefore to create a device that would expedite the doctor-visit

process in order to treat more people while still preserving a high quality of patient

treatment. This device would likely be integrated into a greater system used to improve

overall health care in South Africa defined as follows:

When a patient first visits the doctor (a clinic), the doctor loans this device to the

patient if they feel the patient should return for check-ups. This would most likely

be best suited for chronic conditions which require monitoring or frequent doctor

visits.

Every day the patient wears the device for an amount of time predetermined by the

doctor (about 5 minutes per day) and the data is stored internally on the device

At the end of each day, the patient plugs the device into their computer

Their data is downloaded onto a greater hospital database where the doctor is able

to then track the patient’s health. A computer software tool is used where the doctor

inputs any illnesses the doctor suspects the patient might have, and each morning

the software scans the patient’s data to track specific symptoms related to these

illnesses.

If abnormalities are detected that require immediate medical attention, the patient is

called and asked to return for a check-up

Figure 5.25: Funky Prototype housing and funky prototype assembled with stethoscope

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If everything is deemed “clear” for a substantial amount of time (as determined by

the clinician), the patient returns the device to the hospital either in person, or

through a mail delivery option.

Through this system, the hope is that people with chronic medical conditions would only

need to go to the doctor when truly necessary. This would cause them to be much happier

by avoiding the hassle of traveling all the way to the clinic and having to wait a very long

time. Also, doctors could then treat more people, which would decrease overall patient

wait time. It is also suggested that Merck could use such a system to their advantage. By

analyzing the collected data from patients (while preserving patient confidentiality), it

would be possible to track sickness trends around the world and implement their products

accordingly. The flowchart of the overall system and increased efficiency implemented

by our device is shown in Fig. 5.26.

5.8.3. Prototype Testing

For this stage of prototyping no testing was completed due to a lack of time, but

instead this time was used as preparation for the functional prototype which was meant to

expand on the funky prototype.

Figure 5.26: Funky Prototype system flowchart and advantage of system

implementation

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5.9 Exploration and Realignment

Following the funky prototype, the Stanford team had a design vision of creating

a biometric tracking and diagnostic tool as shown above. With this in mind, Danny

travelled to Switzerland to meet with the St. Gallen team. The purpose of this visit was to

converge on the best solution for the remainder of our project, and ideally one that would

truly address the user’s needs. As part of this trip, Danny and the St. Gallen also travelled

to Darmstadt, Germany to meet with our corporate liaison and other Merck executives at

the Merck headquarters. During the time of Danny’s visit, he participated in intense

brainstorming sessions with the St. Gallen team to attempt to converge on an idea. The

insights were relayed back to the Stanford team as email briefs at the end of each night.

The following insights are broken into the findings at St. Gallen and at the Merck

headquarters in Darmstadt, Germany.

5.9.1. Findings from St. Gallen

Upon Danny’s arrival in Switzerland, Stanford’s biometric tracking system was

presented to the St. Gallen team. In response, they presented their most recent idea of the

“Merck Box” (Fig. 5.27). The concept behind the box was to give users the opportunity

to receive more personalized suggestions regarding which nasal decongestant medicine

they should take by using interactive menus. Due to their lack of access to sophisticated

prototyping materials, St. Gallen’s design was not mechanically complex but rather

implemented a Wizard of Oz technique to invoke user responses. Using a survey they

created online, a series of questions were displayed on a touchscreen which a user could

Figure 5.27: St. Gallen's Merck Box during user testing

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manipulate. The survey asked the user to rank their sick symptoms (congestion, head

ache, fever, etc.) and in turn would provide the user with a bottle of the most suitable

medicine, also allowing them to add additional natural remedies. Through user testing,

the St. Gallen team found that test users were generally receptive of the idea and

appreciated the customizable nature of the medicine and the fact that the medicine was

specifically selected for their symptoms.

Through combined brainstorming with Danny and St. Gallen, the team identified

key components of the project. First off, the St. Gallen team informed Danny that Merck

had recently asked them to target their prototypes for LSM (Living Standards Measure) 6

South Africans. The Living Standards measure scale is one that has been developed in

order to classify the South African population. It uses a variety of factors such as

appliances in the home, number of vehicles owned, types of jobs, and much more to

classify the living standards of different South African people. As the Stanford team was

previously designing for upper middle class South Africans (around LSM 8 or 9), this

decision effectively changed our user to a less prosperous group of South Africans. We

were informed that Merck made the decision to target this population because they had

found their nasal spray products to be quite unsuccessful amongst upper middle class

South Africans. These people understood the uses of nasal sprays, and opted to not use

them simply because of a dislike of the chemical product itself. In the hopes of targeting

a new (and much larger) demographic, they decided to instead market to LSM 6 South

Africans. Families classified under LSM 6 have a monthly household income of

approximately 6398 South African rand or $520 per month. Designing for this subclass of

the South African middle class makes quite the difference as now cost of the device poses

a much bigger concern than we previously expected. These people cannot afford to spend

their money purchasing large containers of medicine which can be very expensive and

hold more doses than they need.

By brainstorming with St. Gallen and recounting the experience of travelling to

South Africa, the importance of the pharmacy was brought up. Because access to clinics

is very limited, most people frequently go straight to pharmacies when they are sick.

These pharmacies are abundant and easily accessible to most people. It was also brought

up that people in South Africa simply do not like the concept of putting devices inside of

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their noses. Medicine is almost exclusively taken in the form of a liquid whenever

possible. Most commonly, people opt to put natural remedies in hot water to make teas

that they can drink. Lastly, and very importantly, the St. Gallen team identified that

during their trip to South Africa they noticed that Vicks was a fairly successful Western

product in South Africa, and that their products were usually packaged in very small

containers which seem better suited for someone on a tight budget (Fig. 5.28).

Through careful evaluation, it was decided that Stanford’s proposed biometric

system was perhaps a decent idea, but that it strayed too far from Merck’s desires in that

it did not directly incorporate Nasivin or any form of decongestant. Considering the

above “critical components” it was decided that St. Gallen’s Merck Box actually

presented a viable design path, if modified in some ways. As it had been identified that

our target South African demographic is very fond of (or at least accustomed to) natural

remedies and would likely appreciate the opportunity to blend them with western

medicines if possible, the Merck Box seemed like a good way to implement this into an

automated system.

In order to address the issue of affordability, it was decided that the Merck Box

should disperse single doses of medicine rather than containers with an excessive amount

of medicine. This would allow users to pay for only the doses they really need, costing

them only several cents. This pay-as-you-go system would likely be appreciated by the

LSM 6 South Africans who live on fairly tight budgets. In order to address decongestant

efficacy, we also deemed it critical that this machine contain some degree of medicinal

chemical products such as Merck’s Nasivin. Not only would these products treat

Figure 5.28: Examples of small packaging frequently used by Vicks and other companies to

market decongestion

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congestion more effectively than natural remedies alone, but it would allow Merck to

distribute their flagship product. In order to address user comfort, it was decided that the

doses of medicine should be distributed in liquid form as need finding in Africa had

demonstrated that liquid medicine was highly desirable. Also, users would be given the

option of combining active chemical products (Nasivin) with natural remedies, in turn

increasing their comfort with drinking the medicine. Lastly, to satisfy user comfort, it was

noted that the machine should be incredibly easy to use, with minimal menus and steps in

order to not frustrate and confuse customers. To inspire more confidence in the machine

and medicine dispersed, transparency of the mixing process was deemed critical. To

address the issue of transparency, it was decided that rather than having pre-combined

chemical-natural-remedy mixtures, the machine should combine the materials in front of

the user. The process should be visible through a glass screen such that the user can

clearly identify when different components are being poured into the decongestant dose.

This would inspire more trust and confidence that the materials being used to make the

mixture are truly what they claim to be.

When coming up with these ideas, we realized that implementing this box in

locations in South Africa would pose concerns regarding theft, especially if it were to be

filled with money used to pay for the doses. It was therefore decided that payment would

not occur at the machine itself. Instead, such a device should be placed inside of a

pharmacy, and upon ordering one “dose,” a barcode labeling mechanism would label

each container. This container could then be taken to the teller and paid for as you would

with any item at the pharmacy. This also inspired the thought of incorporating a barcode

scanner on the machine as well. If a user wanted to return to the pharmacy for a second

dose of a mixture they had previously ordered, they could simply scan this barcode from

their old container, and the box could rapidly mix the solution. We decided implementing

this scanner could be another factor that could contribute to user comfort using the

machine. With all these requirements established (Fig. 5.29), a very quick sketch of the

box was created (Fig. 5.30) and the concept was presented to Merck at their headquarters

in Germany.

Figure 5.29: Chart breaking down Critical Components of our Design

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5.9.2. Findings from the Merck Visit

After converging on the Merck Box idea with the St. Gallen team, Danny and the

St. Gallen team travelled to Darmstadt, Germany to the Merck headquarters. Here, they

met with their corporate liaison as well as one of Merck’s top medical scientists. To begin

the visit, Danny presented the Stanford team’s cumulative work since the start of the

project, including the need finding and benchmarking phases as well as the prototyping

phases. The St. Gallen team did the same with their work. It was after these individual

presentations that the joint Merck Box idea was presented. It was received very well by

the Merck employees. Our corporate liaison identified one immediate concern which was

the cost the device and whether pharmacists would be willing to pay such a great amount

of money to implement the device in their pharmacy. Through some joint brainstorming

with our liaison, we came up with the best way to market such a device. It was agreed

that it would serve primarily as a promotional tool. Merck would pay the pharmacy to

install the device in the hopes that it would make Merck’s name more known to

customers. The pharmacy would profit as well as they would likely get increased

numbers of customers who would either be drawn to the technologically advanced

machine, or who would return for additional doses.

Figure 5.30: First concept sketch of the modified Merck Box

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Because this Merck Box relied heavily on the fact that the Nasivin medicine could

be ingested orally, it was critical to address whether this was truly a possibility. By

asking the Merck medical scientist, we learned that Nasivin itself cannot be taken orally

and can actually be fairly dangerous if ingested through the mouth. However, the same

decongestant effect could be created through an orally-ingested medicine. Instead of

using Oxymetazoline this medicine would have a different active ingredient known as

Pseudophedrine which is less concentrated (and in turn less effective at providing

decongestion) but is safe to drink. As our liaison revealed, the fact that the medicine is

less concentrated is not necessarily a bad thing, as this makes it easier to obtain

regulatory approval for new medicinal products using this ingredient. One potential issue

foreseen with this design was abiding by laws regarding medicine distribution. In its

current state, Nasivin and other decongestants must be purchased at pharmacies from

behind the counter.

By law, the pharmacist is required to present the medicine to you along with a

brief instruction regarding how to properly use the medicine and a short pamphlet stating

the proper uses as well. It was unclear how the Merck Box would play into this greater

system. Despite the different active ingredient it was unknown whether such a box would

be legally allowed to be placed in front of the counter in a pharmacy. If so, there would

likely be certain policies that would need to be obeyed, such a printing a detailed receipt

of how to use the medicine or simulating the instruction usually given by the pharmacist.

A secondary concern was with obtaining medical approval for the different combinations

of medicines. While the Merck staff really liked the concept of customizable mixtures,

they mentioned that obtaining medical approval for such a wide range of possible

mixtures would become a huge obstacle. It was instead advised that we keep the possible

combinations as minimal as possible. For example, only four natural remedies could be

used, and only one could be mixed with the active ingredient at a time. This would imply

a total of only four combinations, which Merck could more easily get approved.

The last concern posed by Merck was very different and regarded the state of

sanitation. Merck’s brand name is highly regarded around the world for the unwavering

success of their products. For medicinal products in particular, the high quality of the

medicine is regulated by Merck’s facilities which personally mix all medicinal

components and package the product before distributing it to the customer in a sealed

container. As this Merck Box would now do the mixing itself, it would be incredibly

crucial that mixtures were very accurately mixed every time. Likewise, there would need

to be a system implemented to ensure that that each dosage provided to a customer was

sanitary. This would imply that the inside of the box would need to be completely

sanitary but also that the different liquids being poured would have no way of

contaminating each other or the system as a whole. If the box did not consistently

perform at this high standard, it would pose a huge liability for Merck.

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5.10 Functional Prototype 1

After Danny returned from his trip to Switzerland with two weeks left in the

functional prototype design cycle, our Stanford team decided to move forward with

developing a rough prototype of the Merck Box. Due to our slightly late start on this

prototype after the “redirecting” phase during Danny’s travels, it was decided to only

focus on developing the main function of the Merck Box—a mechanism which could

automatically fill a small container with predetermined volumes of various liquids.

5.10.1. Prototype Goal and Rationale

Goal: Begin construction of a device which combines multiple liquids in a transparent

and visible way into single doses.

Rationale: This combination of liquids is the most critical component of the overall

Merck Box design. Building and understanding this component of the system would

likely reveal many unforeseen issues which should be addressed before incorporating

additional system components such as the scanner, barcode labeler, etc.


At this stage in the design process, our team was in the very principal stages of

building the “Merck Box.” After reassessing the function of the machine, we decided that

rather than having a receptacle move in a linear path to collect the dripping liquids, it

would be easier to use a rotating arm. By positioning the dispensing nozzles in a circular

pattern, one single central servo motor could be used to rotate an arm holding the

receptacle. The general concept is illustrated below as the arm allows one to “catch” the

falling liquids (Fig. 5.31). At this stage, our team was building simply the outer frame.

Figure 5.31: Quick sketch of functional prototype design

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At this stage in our design process, the functions of the device were laid out as

follows:

A touch screen allows users to choose to have “Nasivin” (with Pseudophedrine) at

different dilutions, and to add one of 3-5 natural remedies. As currently sold, three

different forms of Nasivin are available—for adults, children and infants. The

chemicals are exactly the same with the exception that the children and infant

solutions have a smaller concentration of the active ingredient. This dilution could

be simulated while having only one stock container of Nasivin by filling the

dosage container with more or less of the natural remedy depending on the user’s

selection of Nasivin dilution. One nozzle is used for Nasivin, while each natural

remedy (such as aloe vera, menthol, ginger, etc.) receives its own dedicated

nozzle as well.

A motor turns a rotating arm which holds the receptacle at one end and catches

the falling liquids. The opening and closing of the nozzles is either mechanically

activated (such as by physically turning a ball valve with a motor) or electrically

activated (such as by using a liquid solenoid valve). The overall control of all of

the device would be managed by an Arduino Mega.

A transparent window allows the user to view the mixing (while the touch screen

indicates what is pouring at different times)

All the ingredients are stored and dispersed in liquid form and can be orally ingested

The medicine is delivered to the pick-up window where a barcode is added for scan at

the Pharmacy register

The large supply containers of Nasivin and the natural remedies would be stored

behind/under the machine and pumped into the nozzles rather than relying solely on

gravity to push more liquid into the nozzles after each dosage. Gravity dependent

processes would be difficult to deal with, as every poured dosage would change the

amount of stored liquid in the larger containers. This would alter the pressure and thus

the amount of time the nozzle would need to drain to obtain the same volume of liquid

as before in the receptacle.

A barcode reader could possibly be included if its inclusion is deemed critical


Because our team was still in the beginning stages of our functional prototype,

prototype testing was not possible at this time. Rather, our efforts were dedicated to

completing more of the prototype in order to ensure that by the following week a working

device could be tested for user feedback.

5.10.2. Functional Prototype 2

This last stage of prototyping for this quarter was aimed at building off of the

previous week in order to develop a functioning device which would be user tested in

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order to gauge interest in the overall system. To reiterate, the goal of this prototype was

simply to create an automatic system which could fill a single-dose container with

different liquids.


Goal: Complete construction of a device which combines multiple liquids in a

transparent and visible way into single doses.

Rationale: This combination of liquids is the most critical component of the overall

Merck Box design. Building and understanding this component of the system would

likely reveal many unforeseen issues which should be addressed before incorporating

additional system components such as the scanner, barcode labeler, etc.


Figure 5.32: Image and sketch of assembly used for final functional (yet extremely

funky) prototype

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The final functional prototype was assembled as pictured in Fig. 5.32. Due to time

constraints, our team ended up using many supplies that were readily available to us,

including four pneumatic ball valves as pictured in Fig. 5.33.

These four valves were mounted through the surface of one of two central support

platforms which had holes drilled at the appropriate positions to accommodate about two

inches of tubing. This tubing was pushed through the drilled holes and into four liquid

holders (for which plastic cups were used). These cups were meant to act as the reserve

store of liquids. For the sake of this prototype, gravity would be used to drain the nozzles,

as there was not sufficient time to purchase and install the appropriate pumps as

previously suggested. On the lower part of the pneumatic valves, approximately one inch

of plastic tubing with a wire strand inside was added. The tubing served as a way to

obtain a more accurate flow of liquid, and the wire allowed one to manipulate and mold

the tube for added accuracy. Four support rods were used to constrain the two central

platforms. At the height corresponding to the valve levers, these rods were fitted with a

servo motor with a horn as shown in Fig. 5.34.

Figure 5.34: Motor with horn configuration used for our functional prototype

Figure 5.33: Pneumatic valves used for functional prototype

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The motor horns were attached to the valve levers by means of two screws. The

axes of the motors and the valves were aligned such that turning the motor caused the

valve to open and close as well. Slightly lower on these same rods, IR sensors were

positioned at the height of the rotating receptacle. On the lower central support platform,

the motor was mounted vertically in the middle of the platform with its axis pointing

upwards. A plastic arm was attached to its horn such that rotation of the motor would

cause the arm to spin as well. At the end of this arm, the receptacle was attached for

which a small plastic cup about 0.75 inches high and 0.75 inches in diameter was used.

The cup was permanently fixed at the end of the arm for the purpose of this prototype. On

the outside surface of this cup, LED light strips were added. The entire system was

controlled by an Adruino Mega positioned under the device. The Arduino was

programmed such that it would direct the central motor to begin turning. When the

spinning cup reached one of the four support rods, the LED strips’ lights were sensed by

the corresponding IR sensor. This then directed the arm to stop spinning for a

predetermined amount of time, while that support rod’s motor spun too, causing the valve

to open for a certain time, and liquid to drain into the cup. This process was repeated at

each of the four rods before the cup returned to its start point.


With our prototype complete and functioning, the user testing consisted of a

simple process. We wanted to encourage spontaneous dialogue regarding the function of

our device. We assembled four groups of about five people each. Each group was tested

one at a time. Without any prior explanation of the use of the device, the system was set

in motion, as the rotating arm caused the spinning receptacle to be filled with liquid from

each cup. During this demonstration, our team posed very broad questions like “what do

you think?” to encourage the audience to spontaneously comment on their thoughts of the

system and what it may be used for. After this initial demonstration, the function of the

device was explained, and our team followed up with more specific questions, asking the

group to comment on the overall form factor, novelty, lighting (use of LEDs as the

triggering mechanisms), movement and purpose. We also inquired about whether our

viewers would trust this machine to make them medicine and what could be done to

make them trust it more. Lastly, we inquired about the volume of liquid produced per

serving. Although each serving would still contain sufficient active ingredient for only

one dosage, this could be diluted to various volumes. We desired to learn what overall

volume was most desirable.

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5.10.2.4. Testing Results

From these user tests, many valuable insights were gained. These insights are listed

below.

Diluted solutions are more desirable/meaningful. There is a fear that with

too small a volume, you may have residual medicine which stays at the

bottom of the container when attempting to drink it

Larger diluted solutions may also make the drink taste better, in turn

allowing the user to forget they are taking medicine

Transparency is extremely crucial for any medicine-mixing machine. Our

users find it vital to witness the liquid-pouring process.

To further increase transparency, it was suggested that the large storage

containers be visible, such that when some of this liquid is used for a

dosage, the volume in the large container can be seen to decrease slightly.

Regarding the overall form factor, test subjects did not have a preference

of linear vs. circular motion as long as both methods allowed for complete

transparency.

The LED strips used for sensor triggering were very well received. People

thought that the lights were very alluring and gave the machine a “high-

tech” look.

It was brought up that South African buyers may need to purchase more

than one dose at a time. For convenience, it would be nice if multiple

doses could be purchased in such a way that the containers were

connected. We were encouraged to possibly implement a packaging

system similar to that used for condoms, where individual condoms are

connected at perforated sections on a larger strip.

Overall, the first functional “Merck Box” prototype was well received. People

found the concept to be innovative, and the product itself to be very intriguing and a

creative way to deliver cheap and personalized medicine. Functionally, the device

completed the desired task. Using a mechanically-actuated release of the pneumatic

values with a motor was perhaps not the best option in terms of accurate volumes of

liquid. Moving forward, something such as water solenoid valve may provide a better

solution. Likewise, while the flexible plastic tubing was an effective way to pour the

liquids into the receptacle, during our small group meeting it was proposed by the

teaching team that perhaps syringes could be an alternative. The smaller flow cross-

sectional area allows for greater control in terms of accuracy, and allows one to

pressurize the flow of the liquid such that a stream is achieved instead of drops of water.

One last yet critical point made by the teaching team during our small group meeting was

the point of sanitization for users interacting with the machine. Considering most or all of

the users using the machine would be sick, it would be very important to ensure sanitary

conditions such that one customer could not contaminate following customers. For this

purpose, George Toye suggested that it may be ideal to use very basic motion tracking for

users to navigate the medicine menus, such that they never need to come in contact with

the machine or a touch screen.

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5.10.3. Functional Prototype Conclusions

After Danny’s very important visit to St. Gallen and Merck and the team’s critical

functional prototyping phase, we were finally able to converge on an idea with much

potential. The Merck Box concept is one which satisfies all parties involved in this

project, and most importantly addresses our South African user’s needs. This project

presents the Stanford team with enough technical components, that it will require vast

amounts of designing and true engineering. At the same time, the St. Gallen team has the

opportunity to investigate the best business and marketing plan for such a product in the

South African context. The Merck box serves as a great tool for Merck as well. While the

device does not produce Nasivin in its usual nasal spray form, it delivers a personalized

oral decongestant medicine which is better suited for South Africans. It also establishes

Merck’s brand name in South Africa, therefore allowing them to later penetrate the

market with additional pharmaceutical products. Lastly, for the reasons previously

discussed, the South African user benefits highly from such a device and is able to obtain

the decongestant relief they desire at a price they can afford.

Moving forward, there are still some important questions which must be answered

before proceeding with the final fabrication of such a device. One vital question is the

quantity of medicine associated with one “dose” of this medicine. Our team has contacted

Merck and our corporate liaison seeking an answer to this question, but based off of poor

communications in the past, it is possible that this question will not get answered in the

near future. If this is indeed the case, we have been advised to move forward using other

products with the same active ingredient (Pseudophedrine) as a reference. These products

(such as NyQuil and Tylenol Cold and Sinus) are readily available in American

pharmacies and can give us a sense for how big our single “doses” will likely be. Moving

into the next quarter, it is also crucial that our team reaches a conclusion regarding which

of our device’s functions are truly critical, and which functions are simply nice to have.

Although the device would be used as a promotional tool, it is desirable to decrease the

overall complexity of the machine in any way possible. For example, it has been

discussed whether the barcode scanner/application functionalities are truly important, or

whether these components could be bypassed in some way. Likewise, it may be possible

to implement an alternative to motion tracking that still allows the users to operate the

machine while keeping it sanitary. Lastly, moving forward the teaching team has urged

our team to consider what functions we will realistically design for, and which ones can

be left for future development after completion of the project. This of course depends

heavily on the decisions made regarding the critical functions of the device. However as

one example, our liaison has reiterated that sanitation inside the device is extremely

important. While our team will do our best to seal the device in order to achieve a germ-

free environment, it is not realistic to expect that we will create a medical-grade sanitary

environment. By sealing it to the best of our abilities, it can be demonstrated that a

perfect seal could potentially be achieved by Merck if desired, and thus that the concept

is viable.

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6 Design Vision

After the iteration cycles we went through during the dark horse and the

‘Funky’ phase, we reached the idea of a medicine mixer or a dispenser. Shown below is a

model that embodies all the features that we wish to incorporate in our final design.

However, it is not a CAD model for a final prototype and is subject to future alterations

as previously mentioned.

Figure 6.1: The Merck Box

Shown above is the device that enables users to mix herbal/natural remedies with

a pharmacologically active ingredient. The device itself would be placed inside a

pharmacy. Customers would be able to approach it and get a dose of medicine with an

infusion of their most trusted natural remedy and then pay for it at a cashier.

Figure 6.2: Front and rear view of prototype with features labeled

=

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The functions of each feature are explained below:

1. Display Screen: The device will contain a display screen that shows the user

the operations that occur inside the Merck box on real time. It will also be

used to display the properties of the ingredient being added, its benefits and

possible adverse reactions that users might have if they are allergic to a

component of the ingredient.

2. Camera: Touchless control would be an important part of our design. In order

to prevent any infection from spreading from one user to the other, we want to

make sure that device can be operated without touching it. To this end, the

camera would be used for gesture control.

3. Cartridge Dispenser: The cartridges used to fill the medicine are stacked in

an array and loaded into the dispenser. The cartridges are then dispensed one

at a time as per requirement. Cartridges will be uploaded when empty by the

pharmacist or the service technician from Merck.

4. Mechanical Claw: The mechanical claw is a 1 degree of freedom gripper that

is used to pick up the cartridge from the dispenser and place it under one of 5

outlets. The medicine is filled in calculated quantities into the cartridge and is

then placed in the pick-up window.

5. Independent Channels: Each remedy has its own independent dispensing

manifold that is capable of dispensing controlled quantities. The independent

channels ensure that there is no cross-contamination between the ingredients.

6. Pick-up Window: After the cartridge is filled with medicine, it is sealed and

stamped with a bar-code that can be scanned at the checkout counter of the

pharmacy. The medicine is retrieved from this pick-up window.

7. Canister Bay: Each medicinal remedy is stored in canisters in bays on the

rear of the machine. They can be switched out for new canisters by either the

pharmacist or the Merck support technician.

The medicine once delivered will be enclosed in the cartridge and stamped

with a bar code so that it’s easy to pay. The final medicine cartridge looks as

shown below.

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Figure 6.3: Final Medicine cartridge with barcode

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7 Project Planning and Management

After many prototypes, we have currently fixed the direction we want to pursue

for the final product. The general functionalities of the final prototype are identified and

the final detailed design is the next step in our direction. Our St. Gallen partners are

planning a trip to Johannesburg to field test the idea of the Merck box. This will also help

us to finalize the detailed design of the final product. We also hope to start building the

final prototype shortly thereafter and aim to finish by the end of the third week of May.

7.1 Deliverables and Milestones

Deliverable/Milestone Duration Description 1. ‘Part X’ is finished. 31st March to 16th

April

We plan to finish the most crucial

part of the device; the robotic arm to

pick up and place cartridges under

each independent channel. Once the

cartridge is filled, the arm needs to

place the cartridge at the pick-up

window. We also need to design and

ensure a sealing mechanism that

safely traps all the medicine inside

the cartridge.

2. Spring Hunting Plan 31st March to 2nd

April

Formulate a plan to manufacture and

build the prototype for the spring

quarter. 3. Manufacturing Plans 7th April to 23rd

April

Plan for manufacturing for the rest of

the quarter. We also want to come up

with a list of items that we will be

outsourcing and a possible

manufacturers so that the outsourcing

is complete by 30th March.

4. Outsource

Manufacturing. By 30th April All parts of the final product that

need to be outsourced 5. Revision using St.

Gallen’s Input from the

South Africa trip.

15th April to 23rd

April

Final Revision of design with inputs

from the St. Gallen trip to the

Johannesburg. 6. Develop all inner

functions and

capabilities.

By 30th April This is a crucial deadline before

which we will attempt to complete in

entirety all of the prototype’s inner

function and parts.

7. Penultimate focus on

function and system

integration.

21st April to 7th

May

Plan and finish final design revisions

for EXPE ready model.

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8. Penultimate Focus on

testing 5th May to 21st

May

Test key features and functions and

ensure that they work without fail.

We also hope to integrate parts from

the vendors that we outsourced to. 9. EXPE brochure and

Poster 19th May to 26th

May

Develop the poster and brochure in

conjunction with St. Gallen. Also

work towards developing the video as

a part of the presentation.

7.2 Project Timeline

The list of activities are better indicated by the Gantt chart below.

Activity March April

May June

Week 1

Week 2

Week 3

Week 4

Week 1

Week 2

Week 3

Week 4

Week 1

Week 2

Week 3

Week 4

Week 1

Spring Break

‘Part X’ is

finished.

Spring Hunting Plan

Manufacturing

Plans

Outsource Manufacturing

Revision using

St. Gallen’s Input from the

South Africa

trip.

Develop all

inner

functions and

capabilities.

Penultimate

focus on

function and

system

integration.

Penultimate

Focus on testing

EXPE

brochure and Poster

EXPE

8 Distributed Time Management

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Currently Merck has no system in place to provide after-market services to products

installed in the field. Our St. Gallen partners will be working on developing a service that

provides a sustainable service to the installations. They will also conduct a second field

test in Johannesburg with the idea of the Merck box and investigate potential costs for the

resultant product that strikes a balance between spending capability of our users and the

profits for Merck. We will also be discussing responsibilities for the parts of the

presentation with our St. Gallen partners.

The Stanford team will be primarily involved in manufacturing and developing

the product. Some aspects of the manufacturing such as deciding the herbal remedies and

the dispensing system for the herbal remedies will be decided in conjunction with the St.

Gallen team as they would have access to the herbal markets during their trip.

Combining any two forms of medicines is inherently dangerous and might

involve some serious risk. We will be looking into the legal procedures that are to be

adhered too determine if the drug can be used in South Africa. In this regard, we will be

working closely with the technicians at Merck and the St.Gallen team to determine the

best possible combination of drugs that don’t pose any ill effects for the user.

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9 Report on St. Gallen

Our St. Gallen partners began this quarter by visiting Johannesburg and Cape

Town after Jade and Sri had left. They interviewed families during their home visits

arranged by our sponsors and they came to many conclusions, the most salient of which

are listed below.

1. The difference between many illnesses is not clearly understood. They seek or

take the same remedy for similar symptoms. Also, alleviation of symptoms

takes precedence over treatment of illness.

2. Medical care is broadly classified into two categories; private and public. In

general, private healthcare is not affordable to the middle and lower classes.

Public healthcare though inexpensive is less frequently available due to

crowding at hospitals and insufficient resources.

3. People often buy things in singles. Cigarettes are the most popular example.

People don’t buy entire cartons, instead they buy two to three at increased

prices. This reflects their routine spending habits that are day to day.

4. Belief and trust in natural remedies are inherited and passed down within

families. Parents pass it down from generation to generation.

5. Mixing natural and pharmacological remedies is very popular and desired.

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Figure 9.1: In home interviews conducted by St. Gallen partners in Africa

We incorporated our findings in South Africa along with St. Gallen’s findings to

come up with our current design vision.

For their dark horse prototype and Functional prototype phases they designed

multiple low-resolution design solutions. A variant of one of these ideas lead to our

current design vision (a.k.a. the Merck Box). Some of the ideas listed below are shown

with pictures below.

1. Hot Cold Shot: The hot cold shot is a flavored decongesting liquid that comes in a can

with a chemical heating mechanism. Once the loop is pulled the heating begins

and after a few minutes, the drink is ready to be consumed.

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Figure 9.2: The hot cold shot prototype

2. Pretty-healthy stick: The Pretty-healthy stick has two sides. One is filled with pharmacological

remedies and the other side contains a cosmetic concealer that covers up cold

sores.

Figure 9.3: Pretty-healthy stick

3. Wristlet:

This prototype is a two-in-one solution for active people and serves the

critical function wearability. In addition to the heat-absorbing function, the

wristlet also has an integrated medicine solution which helps to breathe more

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freely when doing sports. Whenever relief is needed, one can simply breathe in

the chemical solution of Nasivin.

Figure 9.4: Wristlet

4. Ring-Thing: The Ring Thing has an additional feature to its core function which is an

integrated medicine solution. You can wear it all day and then open a cap tp sniff

in the chemical solution. This two-in-one solution is ideal for the business woman

or mom on the go.

Figure 9.5: Ring-Thing

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5. Patch: The patch is dosed with natural, essential peppermint oils. These oils help

to de-congest the nose and breathe more freely. The patch would incorporate no

chemical ingredient and also has the added benefit of simplistic usage.

Figure 9.6: Patch

The St. Gallen team came up with many more ideas. All of them are attached in

the appendix of this document.

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10 Project Budget

Figure 10.1: Merck Team Fall Expenses

84

Figure 10.2: Merck Team Winter Expenses

85

Figure 10.3: Merck Team Travel Expenses

86

11 Reflections and Goals

Danny Concha

Working on our project for this past quarter led to some very important insights

and forward progress after several bumps along the way. For the first part of the quarter,

our Stanford team felt fairly disjointed from our Swiss teammates. The reason for this

disconnect was that the St. Gallen team felt very inclined to create a final product which

addressed specifically Merck’s interests. Because of strained communication between

Merck and our team, we were unclear as to what exactly Merck was expecting, but our

understanding was that they wanted us to redesign their Nasivin nasal spray to attract

more South African customers. Our Stanford team was more interested in pursuing a

solution which truly satisfied the user’s needs. For quite some time our Stanford team

struggled on converging on ideas with our St. Gallen teammates as they often pursued

ideas that did not invoke enough complexity for our final project or were simply out of

our scope. As some examples, a “mixology kit” was proposed, which a user would

purchase with a variety of natural remedies that they could then mix at home. However

such a solution implies simply placing several different ingredients into a box. It was also

proposed to simply change the Nasivin nasal spray to a simple ointment which could be

applied to one’s skin, or a piece of chewing gum. While these might be feasible solutions,

they were not solutions that we could actually create as mechanical engineers. Getting

this idea across proved to be very difficult.

Considering these struggles, I believe the trip to St. Gallen was incredibly crucial

in our design progress. Sitting down with my St. Gallen teammates made it much easier

to communicate the advantages and disadvantages of different ideas. Through intensive

brainstorming sessions we were finally able to reach viable conclusions about our

direction moving forward. This direction would present a good compromise as it would

(most importantly) satisfy our user, satisfy our corporate sponsor, and satisfy our design

team by requiring a high degree of innovation and design. I found that speaking to Merck

staff in person in Darmstadt was very helpful as well. They addressed many looming

questions which confirmed that our design direction was feasible. Our corporate liaison

insists on still keeping the “design space open” and would probably keep this space

“open” indefinitely if he could. Our team has learned to move forward with the idea we

agreed upon with our St. Gallen teammates, essentially ignoring our liaison’s wishes to

not converge yet. While we don’t mean this out of disrespect for our liaison, our team has

already been unnecessarily delayed by our liaison’s lack of communication and

decisiveness regarding the vision for the project. While it has been a rocky road, I believe

these struggles have been a good growing experience for our team moving forward, as

they have forced us to be independent and make important decisions to continue our

progress during times of unclear expectations. Moving forward, our team will continue

taking ownership for our project, and will assert ourselves to our liaison in the hopes of

demonstrating the importance of converging at this stage in our project. More importantly

however, at this time it feels as though the Stanford and St. Gallen teams are more

87

connected, which will prove critical for developing a refined and functional product for

EXPE.

Jade Fernandez

Needing in South Africa truly made the project much more real and interesting.

Actually interacting with our user group was a great way to not only better understand the

market, but people themselves. I learned not only about my life, but also huge needs in

South Africa. I am really happy I was able to do needfinding in South Africa as it was a

huge part of this experience. The people we met along the way were perhaps the most

interesting people I have ever met in my life. Many people, especially the younger

generation are very much in flux. They are in a transitional period in their lives there and

I found it very relevant for me. I was not only intrigued by the people, but also the culture

that vastly influenced and is influencing our design. From there, we were able to truly

start brainstorming for the final project.

After Danny’s visit to the Merck headquarters, it seemed that the purpose of this

project drastically changed, but I am still very excited about the direction of the project.

Having the purpose of the project now be promotional means that we have less

constraints as engineers. This will allow us to build something really cool and interesting.

I look forward to the final outcome of this project. In the end, I am very happy with the

direction we chose. It seemed that both St. Gallen and our team could finally converge to

one solid idea. Hopefully, we will be able to divide the tasks in an equal way and have a

really awesome project to show at EXPE

Overall, I have been learning a lot of life skills from this class. Traveling played a

large role in that. It is very different to travel to a far away place to do work. I also found

it very difficult to just approach people and start talking about nasal sprays. I think there

is a balance that one must find in order to have these meaningful conversations both

about life and projects and I worked very hard on trying to achieve that while in South

Africa. I am also finding out the difficulties of working with a corporate team. However,

these problems are helping me grow and preparing me for real-world problems that

realistically could be the constraints I work in the future with.

Sri Sibi

I like: I like the fact we built multiple prototypes. We explored the design space

that was defined initially to us. But when we found that we were too constrained by it, we

expanded into a realm where we would have more freedom though we were exploring a

space that we were unfamiliar with. The vast varieties of prototypes that we built helped

us glean helpful information into the user opinion of nasal sprays and medicinal remedy.

We had to switch our design paths according to design feedback. Though this was taxing,

we were able to reach a design solution that everyone agreed on and felt good about. I

also like the fact that the St. Gallen team for the Merck box idea. They developed several

idea of which the Merck box was just one.

88

I wish: Though the final prototype we converged on was liked all members of the

team and our sponsor, we realized that this would not be the most ideal solution. The

more we explored the problem space, the more we realized that we would possibly find a

better solution through the application of chemical engineering to existing products. It

would help Merck to thoroughly explore this area. Currently, we are building a device

that can dispense a single kind of remedy. However, I would like to ensure that there is

modularity in the device so that when Merck establishes their brand in South Africa and

needs to widen their product range, they can use the same device with only minor

modifications.

Philipp Elbel

In the dark horse phase, we had the possibility to travel to South Africa to meet

our target group, representatives of the South African middle class, the first time. We

conducted several interviews in the townships of Johannesburg. We started our

conversations with questions regarding the general environment and living conditions,

before we moved to more medicine-specific aspects. We could confirm Merck’s

observation that nasal sprays are not widely used within our target group due to

unaffordability and doubts about its proper application and effectiveness.

During the in-home visits we found that many people use natural remedies and

that only very few switch to chemical medicine when the cold gets more serious. As

distribution is one issue of the business model we found potentials of decentralized

distribution, e.g. in small “container” shops were products are sold in single and small

units to make them more affordable. Inhaling and drinking solutions containing natural

ingredients like Ginger or Aloe are quite popular. Benchmarks to beat are Vicks and

Zam-Buk – two ointments based on synthesized natural ingredients, either to put on the

skin directly or to inhale with steam. Both products are very popular and can be bought

almost everywhere.

The trip was very inspiring and a unique opportunity to get to know potential customers

in all their facets, as going to South Africa is only possible twice during the project.

However, we should had tested more of our prototypes, even if the needfinding was not

completely finished that time. The next travel to South Africa is exclusively there for test

and finalizing the functional / X-ish finished prototypes.

Back home we started to combine your insights and tried to address them with our

prototypes: must-have-features from the critical function phase and innovative elements

from the dark horse phase. We came up with the Merck Box, a mixing machine of a

single dose medical liquid including either just chemical or natural ingredients, or a

mixture of both of it.

However, especially during our short prototype testing in India – another potential

market for our product – and a challenging feedback by our liaison, the St. Gallen part of

the team got some constraints, which we have to further look at and conduct testing in

South Africa. We try to address these constraints on a business model level as best as

possible. However, as not all aspects can be solved this way, the St. Gallen part of the

team has started to build another functional prototype. It bases on the same insights as the

89

Merck Box but solves certain issues, leaves out unspecified critical functions and reacts –

as suggested by the Design Thinking approach – on negative feedback that we already

got and which is further expected in South Africa. We hope that this prototype can then

potentially be produced in the Merck Box.

Stanford’s and St. Gallen’s diverse understanding and teaching of the Design

Thinking approach and the distance (location/time) between our project teams made

collaboration difficult. It was great to have Danny in St. Gallen for collective prototyping.

Jasmine Bissig

Time flies in our Design Thinking project and we move really fast towards the

end in the Design cycle.

All the St. Gallen team agreed, that the visit in South Africa was the most

important milestone in our project. We had read a lot about the country, its culture and

our target group. But to actually be there and experience how they life in their daily

environment was priceless. Everybody was more than willing to answer our questions

and showing us around in their houses. Next to the planed interviews we had a lot of luck

on our side and met some of the most interesting people by accident. So for example the

traditional healer, which involved us immediately in an ancestor ceremony. An

experience that none of us will ever forget.

But we benefited not only with regard to contents from our visit in South Africa.

Also was it highly beneficial for our work as a team. We literally spend twenty-four-

seven together and only stopped to think about our project when we slept. It was very

tiring sometimes to sit together and work late hours while discussing and interpreting all

the multifaceted learnings from the long day. Nevertheless was this the best exercise for

a team to grow together and to develop a shared working style.

Coming back from South Africa we soon had to build our first funky prototype

and from then on, time was very short. Soon we found ourselves in the phase where we

(especially our Stanford team members) had to go from diverging into extreme

converging. For me this step was to fast. It felt like we skipped a big part of the

converging phase and went from diverging directly into “one-solution-only”. Which was

not how I understood the DT-circle.

Regarding our global teamwork we probably all learned about its difficulties.

Sometimes it is even hard to make your point within the local team that speaks in your

first language and is physically present all the time. Considering that, it’s obvious how

hard it can be to really understand each other via skype. But I think we really did well. I

only whish that we had more time together as whole team. Also, it would make things

easier, if the teams in both universities had the same assignments and deadlines.

90

Carolyn Ragaz

When I signed up for ME310 through the University of St.Gallen, I was expecting

to participate in an exciting project and get a glimpse of the real working life due to the

collaboration with a corporate partner. I was especially interested in the human-centered

Design Thinking approach. Since I was focusing on marketing and sales during my

bachelor's degree in business administration, I was expecting to talk to a lot of different

stakeholders to get a broader understanding about their needs and interests when it came

to our challenge. Also, I liked the idea of the practical approach with prototyping. I was

expecting to learn a lot since building something myself rather than writing a concept is

new to me as a business student.

After having worked on this project for the past 6 months, I see my learning

process in terms of time and project management as well as working in a

multidisciplinary, global team which I believe will help me in my career in an

international company after my studies. I was lucky enough to be part of a project for the

South African market which was a big added value to get to know a new country and its

culture which is very different to Switzerland. Through talking to a lot of consumers and

a helpful feedback session on the winter presentations in St.Gallen, I believe we have

understood the consumer’s needs accordingly and came up with two suitable prototypes

so far.

However, I’m interested in testing our current prototypes the “Merck Box” and

the “Ginger Star” during our second South Africa visit to be sure that we truly fulfill

people’s needs in our target market. I’m also looking forward to EXPE in June and I

wonder how we still might change and improve our prototypes based on the findings we

get from testing our current prototypes in South Africa.

Rouven Gruenig

Before starting the design thinking course I had numerous expectations since I

heard much about it from former students which were all excited and strongly

recommended me to take the course. Now having completed more than half of the course

I must admit that this enthusiasm has fully caught me. Not only do I appreciate the

creative, human-centric approach on tackling such an innovation challenge but also the

experience we gained from the collaboration in an international team and with a

multinational company such as Merck.

So far the work on this project was an inspiring journey to me. One of the

highlights was definitely the needfinding we conducted in South Africa. In fact, I would

have never expected this trip to be that insightful. I realized that simply meeting and

interviewing consumers in their usual environment seems to be a very effective way to

find their true needs. During this trip we also talked to further stakeholders such as

pharmacists, traditional healers or shop owners which led us to additional insights.

Insights we would have never gained by conducting a conventional desk research.

91

Therefore, I claim this human-centric needfinding phase truly facilitated our approach on

this challenge since it helped us to better understand the South African society.

Back home we started to combine our insights and we defined several critical

functions. Adding some innovative dark horse elements brought us to several funky

prototypes. One example was the Merck Box which basically considers all of the defined

critical functions and since it is a medicine mixing machine it also has a great innovation

potential. After Danny’s visit in St. Gallen we were all sure that the Merck Box was the

right direction.

However, having travelled to India - for Merck a comparable emerging market -

we found that users do have real concerns regarding this machine. Following the

principles of design thinking we took these concerns serious. In addition, inputs from our

liaison Merck gave us the impression that our steps towards the Merck Box have gone

too fast. Smaller and simpler prototypes were needed in order to address the true needs of

consumers.

Accordingly, the St. Gallen team started to look for a new direction and came up

with a simpler prototype called GingerStar. We believe that the GingerStar is sufficient to

satisfy both the needs of the South African Middle Class and the expectations of Merck.

However, since we are one team we strongly want to unite the two approaches of St.

Gallen and Stanford. In fact, we are currently working on a business model which enables

us to combine the GingerStar prototype with the Merck Box.

Despite working on two different prototypes, which most certainly results from the

different views on the design thinking process, I am confident that we can develop a

solution that includes both the work of Stanford and St. Gallen and I look forward to

tackle these most important final steps.

92

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http://en.wikipedia.org/wiki/Urban_renewal

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97

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soft-0-025-aerozol-do-nosa-z-glicerolem-dla-dzieci-od-1-do-6lat-220dawek-10ml.jpg









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diskus.jpg

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glicerolem-dla-dzieci-od-1-do-6lat-220dawek-10ml.jpg

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st_expandable/item_expandable_2/media/image.-630536188.image.png

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Respirator.jpg











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98

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dpr=1.1#imgdii=_&imgrc=eQnM2ifX2kdJQM%253A%3ByCaUDubfOSyC2M%3Bhttp

%253A%252F%252F41.media.tumblr.com%252Fc784b4ca7f72987a7b6963adff87f23d

%252Ftumblr_n6pv2rrHTm1qbvfcto2_500.jpg%3Bhttp%253A%252F%252Ftheincident

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&source=lnms&tbm=isch&sa=X&ei=eNf5VITrCtCboQTd2IHQCw&ved=0CAgQ_AUo

Aw#imgrc=_J6j21UMxcPOiM%253A%3BAa0RM0NJm7bJYM%3Bhttp%253A%252F

%252Fr-

ec.bstatic.com%252Fimages%252Fhotel%252Fmax300%252F283%252F28306417.jpg

%3Bhttp%253A%252F%252Fwww.booking.com%252Fhotel%252Fza%252Fcuriocity-

backpackers-johannesburg.html%3B300%3B200

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https://www.google.com/search?q=bheki+maboneng&espv=2&biw=1034&bih=566&source=lnms&tbm=isch&sa=X&ei=gNX5VJ_xDpPgoATsqYBY&ved=0CAYQ_AUoAQ&dpr=1.1#imgdii=_&imgrc=eQnM2ifX2kdJQM%253A%3ByCaUDubfOSyC2M%3Bhttp%253A%252F%252F41.media.tumblr.com%252Fc784b4ca7f72987a7b6963adff87f23d%252Ftumblr_n6pv2rrHTm1qbvfcto2_500.jpg%3Bhttp%253A%252F%252Ftheincidentaltourist.com%252Fpost%252F87929330217%252Fjohannesbur







https://www.google.com/search?q=curiocity+backpackers&espv=2&biw=1204&bih=566&source=lnms&tbm=isch&sa=X&ei=eNf5VITrCtCboQTd2IHQCw&ved=0CAgQ_AUoAw#imgrc=_J6j21UMxcPOiM%253A%3BAa0RM0NJm7bJYM%3Bhttp%253A%252F%252Fr-ec.bstatic.com%252Fimages%252Fhotel%252Fmax300%252F283%252F28306417.jpg%3Bhttp%253A%252F%252Fwww.booking.com%252Fhotel%252Fza%252Fcuriocity-backpackers-johannesburg.html%3B300%3B200







99

13 Appendix A: Fall Brainstorming

Our project presented a very unique set of challenges from the get-go considering

that it required us to not only get a grasp on the design space and our potential users and

their needs, but also a completely unfamiliar culture. Tackling this immense task of

understanding the lifestyle of a middle class person in South Africa proved to be tough,

but we were able to draw important conclusions through benchmarking, need finding,

persona development, and a critical experience prototype. Our design development can

be seen in Fig. 13.1.

Figure 13.1: Our team's design development process

100

Figure 13.2: Understanding fears of Western technology and medicine

101

Our team’s approach to the brainstorming phase of our project changed drastically

throughout the Fall quarter. Merck originally presented the project as a way of

introducing inhalers to a culture that shies away from Western technology. With this

mindset, our team was forced to initially think about why South Africans might shy away

from Western technology (and especially Western medicine). Our team reached some of

the conclusions shown in Fig. 13.2.

After speaking with multiple South African interviewees, we learned that our findings

contradicted those of Merck. The middle class South African demographic is one which

does not oppose Western culture. Instead, they embrace it, and desire Western products

as a way of establishing their status within society. These findings are better explained in

our need finding section, and forced our team to change our brainstorming approach. The

thought was that since our research points to the South African middle class as a

Western-leaning demographic, it makes sense to understand inhalers from our point of

view (a Western view). Fig. 13.3 shows our first brainstorming map demonstrating the

important considerations when designing an inhaler.

Figure 13.3: Important considerations of inhalers

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14 Appendix B: Fall Benchmarking

Technology Benchmarking

Figure 14.1: Organizational Chart of Benchmarking

Online Research

The first step to our design development was to explore the design space and

conduct some benchmarking. In order to diversify our approach to this step, we

conducted our design space exploration and benchmarking by researching existing

products online, conducting interviews, and dissecting existing inhalers and other

relevant technologies (Fig 14.1). In order to gather some fundamental knowledge about

inhaler types, functions and advantages/disadvantages, we first conducted some online

research.

Basic Pocket Inhalers

Through this research we learned that inhalers are most commonly used for

treatment of Asthma and Chronic Obstructive Pulmonary Disease (COPD). We also

learned that inhalers are typically categorized by the form of the medicine they dispense

(wet vs. dry inhalers) as well as the method in which the medicine is delivered to the user

(active vs. passive inhalers). Wet inhalers refer to a medicine which is stored as an

aerosol such as most Albuterol inhalers which exist today (Fig. 14.2). These wet inhalers

are referred to as “active” or “metered” because upon pressing a trigger, the aerosol

medicine is released into the user’s mouth. The alternative dry inhalers use dry powders

and are passive because there is no medicine delivery mechanism. Instead the user uses

the force of their inhalation to intake the medicine. One of the most common dry inhalers

103

on the market today is called Advair (Fig. 14.3). We found very distinct advantages and

disadvantages with each type of inhaler, as illustrated in Fig. 14.4.

Alternative Inhalation Devices

Figure 14.2: Example of wet, active inhaler Figure 14.3: Example of dry, passive inhaler

Figure 14.3: Comparison of wet and dry inhalers

104

In addition to researching inhalers specifically, our team conducted online

research investigating other inhalation devices or potential methods of delivering

medicine. Topics of focus included nasal sprays, nebulizers, respirators, e-cigarettes,

humidifiers, and even cannula tubes. Considering that Merck currently makes a nasal

spray product called Nasivin, we conducted much research on nasal sprays. Our research

however very quickly pointed us away from nasal sprays, for the many unwanted side-

effects illustrated in the chart below (Fig. 14.5) and the fact that administering respiratory

medicine through one’s nose is very inefficient. After speaking with several doctors (see

Need Finding section), they informed us that respiratory conditions are best treated

through the mouth directly. While nasal sprays are effective at decongesting a nose (as

experienced during a common cold), our team was more interested in designing for more

prevalent South African respiratory problems such as asthma or COPD. As demonstrated

in the Need Finding section, we found there was a greater need for treatment of these

conditions within our South African context.

Figure 14.4: Pros and Cons of Nasal Sprays

105

After researching respirators (Fig. 14.6) and understanding their functions, we

quickly learned that they are a very effective filtration tool in which air is fed through a

filter which absorbs undesirable toxins. However, when considering the acceptance of

these products into a South African culture which historically shies away from Western

medicine, options such as regulators and cannula tubes (Fig. 14.7) were not further

pursued as they were very intrusive and unnatural. As can be seen in the images below,

these options cover sections of the user’s face, and project the notion of “unhealthiness”

in a very public way—something we learned is looked down upon amongst South

Africans due to their history with disease.

Figure 14.5: Illustration of the intrusive nature of a respirator

Figure 14.6: Illustration of the intrusive nature of sal cannula

106

One alternative benchmark which proved to be fairly promising was the concept

of an e-cigarette. E-cigarettes are extremely compact, sell for as little as $3, and deliver a

liquid nicotine (which we can analogously think of as medicine) to the user’s lungs

through a simple atomization process with a heated coil. The interesting thing about these

e-cigarettes and other nicotine inhalers, is that there are various patents on very distinct

nicotine delivery methods, all of which are very basic. Two notable designs are the

modern electric atomization cigarettes (Fig. 14.8), and a different system which passes air

through a porous nicotine infused plug (Fig. 14.9). This concept was particularly

appealing to us until our CEP during which we found that a cigarette-shaped inhaler was

actually very polarizing with users (see CEP section). While the cigarette shape was

abandoned, the unique nicotine delivery methods were not, as the porous plug idea was

incorporated into our current design vision as a medicine delivery method.

Figure 14.7: A view inside a modern e-cigarette

107

In addition to e-cigarettes, the concept of a nebulizer proved to be promising but

limited by its difficulty of operation and lack of portability. Although it is much bulkier

than an inhaler, a nebulizer functions in a similar way, delivering a very fine mist of

medicine

Figure 14.9: A standard nebulizer

Figure 14.8: A view inside a nicotine plug inhaler

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(but over a treatment of about 5-10 minutes). However the devices are very large,

complex to use and require electricity. The sheer size, technical complexity and high cost

(starting around $60) made the nebulizer a poor choice for our target South African

demographic as we later explain that our users have very little excess income that they

would like to use on medical devices.

Perhaps some of the most important findings from our online research were the

facts that there does exist the potential to make extremely cheap and portable inhalers

(which we found to be a vital consideration when designing for Africa) and that there are

many unique mechanisms used to deliver medicine through inhalers. One of our biggest

findings was an inhaler by the name of Occoris (Fig.14.11). The inhaler is called an

inhaler “engine” as it is an active device which propels the powder medicine into the

user’s mouth using a unique and undisclosed breath actuation mechanism (BAM). Thus,

this is a unique example of an active inhaler that uses dry powder! Through testing, the

throat/mouth deposition has been found to be only about 20% vs the usual 40-70% for

typical active inhalers, meaning that users experience much more relief per dosage. The

most remarkable thing about this single-use inhaler, is that it is made of extremely cheap

materials (with a cost of manufacturing of about 20 cents). This finding served as an

important indicator to us that it was indeed possible to create an extremely cheap and

effective inhaler.

Figure 14.10: Occuris inhaler engine

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In addition to the Occoris inhaler engine, our online research showed that inhalers use

various methods to administer the medicine to the user, some of which are complex

electrically-controlled mechanisms, and others which are very basic and clever

mechanical mechanisms. The basic metered active inhaler functions in a way shown in

Fig.14.12, where the drug particles are mixed with a propellant that is stored as a

liquefied compressed gas that is gaseous at atmospheric pressure (allowing for the

gaseous spray of medicine into the user’s mouth) but a liquid when compressed.

Figure 14.11: Description of how a metered-dose inhaler functions

110

One example of an especially clever design for an active inhaler is the Respimat

(Fig. 14.13) which utilizes the mechanical force of a compressed spring (which is twisted

each time to load the spring) to load the proper dosage into a capillary tube which is then

released by a trigger.

The plethora of these medicine delivery methods presented many options for the

delivery method in our device. The fact that so many of these methods are basic in nature

and use mechanical components implies that they could also be highly cost efficient

(compared to electrical alternatives).

Figure 14.12: Schematic of Respimat inhaler

111

Home Remedies

In order to approach the problem of respiratory troubles from a very different and

more traditional vantage point, we also researched some “home remedies” typically used

to treat a cough or a cold. We learned that the treatments are extremely varied in form

(and often inconsistent). For example, steeping some thyme to make a tea is very

common as the leaves have compounds which relax the cough-causing muscles. Rather

than drinking a tea, some people opt to consume a gooey gel made of boiled flax, honey

and lemon to sooth the throat. Others rely on aromatherapy or vaporized eucalyptus oils

to clear the nostrils and respiratory tract and some even insist (believe it or not) that

sucking a lemon is the best way to restrain a cough. It is clear that when it comes to a

cough or cold, there are very many supposed remedies with unique forms and

applications. However, none of these options present a practical and portable method to

address a chronic respiratory condition such as asthma quickly and easily.

Interviews

In the hopes of learning more about existing products related to our project, we

interviewed four people with very different backgrounds. The significant findings

(related to benchmarking) from these interviews are outlined through the following

points:

Interviewee Name and relation to South

Africa/Background

Significant Benchmarking Findings from Interview

Margaret Irving-South African native connected

to one of our team members through Stanford

research group

Public healthcare is very poorly

run/organized, but pharmacies are stocked

with many westernized drugs

There are certain cure-all medications at the

pharmacy (think Tylenol in the US)

Everyone in South Africa has a cell phone,

rich or poor

o It is free to receive text messages

Stanford firefighters and paramedics-Familiarity

with respiratory devices. No relation to South

Africa

Safety is emphasized with respiratory

devices

o Oxygen tanks used when entering

dangerous environments

o Respirators can be plugged into tank

of other firefighter when running low

on personal oxygen

o Many signals (both audible and

visual) on equipment used to indicate

low oxygen or dangerous respiratory

situations

112

Dr. Van Wert and Dr. Ruoss-Stanford Hospital

Pulmonary Care division. No relation to South

Africa.

The design of an inhaler has not been

radically altered for many years

The basic wet aerosol inhaler and dry

powder disk inhalers have become the

staple—they accomplish their goals

Dry powder inhalers are especially simple

and could make for a cheap design

Suggest that we consider the economic

constraints of our demographic and which

inhalers are cheaper to make/sell

Modern inhalers are sold with the medicine

included—you cannot simply refill an

inhaler

There are no inhalers which use atomization

of a liquid medicine (like e-cigarettes)

There are no portable “pocket” inhalers

which are continuously operating

It is important to consider the form of the

medicine including how it holds up in the

environment/climate we will work in

It is important to consider if certain forms of

medicine can be more easily transported to

Africa—transport can become a big cost

HIV, Tuberculosis and other transferable

diseases makes sharing inhalers very

dangerous in South Africa.

Coughing in general is not always bad. For

certain diseases like Tuberculosis, it is

encouraged to clear the lungs of fluid

Many South African miners inhale excessive

silica and acquire Silicosis which is not

curable, but detectable through x-rays

After speaking with Dr. Van Wert and Dr. Ruoss and for the sake of our research, we

conducted a quick search on the prices of different inhalation therapy devices and found

113

that an Albuterol (wet active) inhaler costs approximately $30-60, while a nebulizer can

cost upwards of about $60.

Purchase and Dissection of Existing products

In order to investigate and learn more about existing products, our team purchased

a variety of products online. Luckily we already had a basic active metered Albuterol

inhaler on hand from one of our team members. Using this as a baseline, we investigated

a Neti Pot for nostril cleansing, a full-face steam inhaler, a gas mask, a nebulizer cable

and a Vicks portable inhaler (Fig. 14.14).

After playing with these devices, learning how they worked and observing their

advantages and disadvantages, we found that they were all very basic in the way they

a) b) c)

d) e)

Figure 14.13: a.) Neti Pot b.) Vicks Portable Steam Inhaler c.) Gasmask d.) Nebulizer e.) Full-face

mask steam inhaler

114

functioned but that they were all obstructive, unnatural, or unappealing in their individual

ways. We believe it is critical to consider these unappealing factors and the implications

they may have on our particular South African demographic (as confirmed through our

need finding). These immediate concerns are voiced in the following Pugh matrix. As we

were not able to obtain a full nebulizer, the corresponding values are computed for the

nebulizer system as a whole. The terms obstructiveness and unnaturalness are used as

described in the Glossary.

Criteria Active

Metered

Inhaler

(Baseline)

Neti

Pot

Vicks

Portable

Steam

Inhaler

Gasmask Nebulizer Full-face

steam

inhaler

Obstructiveness 0 0 -1 -3 0 -2

Unnaturalness 0 -2 2 -3 1 2

Portability 0 0 -2 -2 -3 -3

Ease of use 0 -1 1 2 -2 -2

Cost 0 1 -1 -2 -3 -2

Total: 0 -2 -1 -8 -7 -7

As revealed in this matrix, we found that the active metered inhaler perhaps

serves as the best solution for these categories which we designated. Based off of our

initial understanding of the South African demographic, and the results of this matrix,

this suggested to us that we should think about moving forward with a modification of

the existing portable pocket inhaler form.

Unmet Needs/Opportunities and Interests Moving Forward

From our benchmarking our team became interested in several important concepts

which could be further pursued and are listed below:

Continuously-operating inhalers/breathing apparatuses

Familial pocket inhalers with sterilizable or interchangeable mouthpieces

Integration of inhalers to mobile phone texting service for managing treatment

Inhalers for severely affected miners using central nebulizer and personal masks

Rechargeable inhalers--use of tablets or liquid medicine

Extremely cheap inhalers

Redesign of the pocket inhaler form for portability and concealibility

15 Appendix C: Fall Need Finding

In order to best understand the South African culture (and particularly the middle

class) and due to a lack of South African contacts in our close proximity, we conducted

our need finding through both online research and interviews (mostly through Skype).

115

Figure 15.1: Organizational Chart of Needfinding

Online Research

Through our online research, we gained a lot of insights regarding the South

African culture as a whole, which we learned is very diverse and fairly fragmented. There

are eleven official languages in South Africa, with a population of approximately 52

million people. The population can be broken into the following categories:

Population group Number % of total

African 41,000,938 79.2

White 4,586,838 8.9

Coloured* 4,615,401 8.9

Indian/Asian 1,286,930 2.5

Other 289,454 0.5

Total 51,770,560 100

We learned that the majority of the population lives within or very near to the three main

cities of Durban, Cape Town or Johannesburg, and that the majority of the population is

between the ages of 25-54 years old (38.2%). We discovered many troublesome signs

regarding the state of healthcare in South Africa. The physician density is about 0.76

physicians/1000 people with an average of 13,718 people per clinic which exceeds the

World Health Organization’s guidelines of 10,000 people per clinic. This is disheartening

to begin with, but what is even more saddening is that since approximately 73% of

general practitioners work in the private health sector, there is only about one practicing

doctor for every 4,219 people. Perhaps another staggering statistic is that South Africa

has reported the fifth highest asthma case fatality rate (18.5 people per every 1000

116

asthmatics die). Understanding the role of traditional medicine in South Africa was a

particularly difficult task due to a lack of statistical data, however one rough figure

computed that there are about 200,000 healers compared to 25,000 western doctors. We

learned more details regarding the role of traditional medicine through our interviews.

4.3.2 Interviews

Our interviews were conducted with the following interviewees:

Name Title Relation to S.

Africa

Medium for

interview

Margaret Irving PhD Sociology Born in South

Africa

Skype

Stephen Reid PhD Statistics Born and raised in

South Africa

In Person

Mike Blum President of

Materials and

Technology Inc.

Born in South

Africa

In Person

Trudy Meehan Director of Bing

Overseas Studies in

Cape Town

Works in South

Africa

Skype

Sean MacDonald Palo Alto Fire

Fighter

None. Asthmatic In Person

Jean Fourie Microsoft Employee Born in South

Africa

Skype

Below we list some of the most significant findings from our interviews. Note that

important quotes from our interviewees regarding each category listed below can be

found in the Appendix.

Racial Divisions and the Role of Race in Society

● Before 1994, segregation effectively separated the different economic classes,

with white South Africans occupying almost all of the middle and high class

while also holding most of the jobs which drove the economy.

● With the end of segregation, many of these jobs become available to people in

previously lower classes (traditionally black South Africans)—since this time, the

“middle class” has been in flux and is still growing today.

● For these same reasons, the middle class has become hard to define

● These newcomers to the “middle class” largely aspire to embrace Western ideals,

culture, and technology (and they are often willing to spend nearly all the money

they have to do this) as they attempt to speed their assimilation into their new

societal roles.

● These middle class newcomers are often not sufficiently educated and

technologically savvy for the jobs they hold.

117

Healthcare

● Private healthcare/insurance is largely

reserved for the upper class (almost

exclusively white South Africans), but

offers excellent treatment

● The public healthcare system is very

poorly managed and even corrupt. There

are insufficient doctors/facilities to treat

everyone, and people must wait very

long to receive treatment if they are

lucky enough to even get a hospital bed

● These public health clinics are mostly

located by the larger cities and are very

inaccessible to anyone who lives in rural

areas

● Many people opt to visit traditional healers simply because they are more readily

available (no long wait necessary) and are cheaper than Western medicine. Many

people use both traditional medicine and public healthcare, turning to traditional

medicine when they can’t receive treatment quick enough from a clinic

● Traditional healers play a more prominent role in rural areas--here health is

thought to be a function of your relationship with the community and ancestors

● Nowadays, to bypass the delays in a clinic, most people rely on the pharmacist for

medical advice

Technology as a Whole and the Perception of Inhalers

● Technology is embraced in South Africa,

especially cell phones which almost

everyone has (some are even solar

powered!). Everyone is free to receive

text messages.

● Functional, “intuitive,” easy to use

products are highly valued (such as ones

that don’t require extensive user

manuals). Communicating complex

information is further complicated by the

11 national languages.

● Even in Western countries, inhalers have

a stigma for unhealthiness

● Many people, even in Westernized countries would rather choose a healthier

option than inhaling chemicals to treat respiratory conditions

Figure 15.2: Jade skyping Trudy

Meehan

Figure 15.3: Daniel skyping Jean Fourie

118

● The image of “appearing healthy” is especially critical in South Africa, where

disease is so rampant. It is important to present oneself as healthy, and therefore

(supposedly) of a higher class

Our Biggest Takeaways

After synthesizing the knowledge gained from our interviews, we found that our

findings contradicted the ideas proposed by Merck in their project abstract. Contrary to

what was originally stated, most of the South African middle class does not shy away

from Western medicine. In fact, most people attend both a public healthcare facility and a

traditional healer in parallel, opting for traditional healing when constrained by time and

money. Although they do embrace this Western lifestyle and often purchase expensive

things, these people live on very tight budgets, barely scraping by to live this way. The

fluctuating middle class strives to use sleek-looking Western products to establish their

status, thus it seems logical to create a product that invokes this look while still being

very economical and promoting the image of strength and good health.

One interview with Mike Blum was particularly insightful as he encouraged us to

target the mining industry, as South African miners have some of the highest rates of

occupational lung disease in the world. Mike informed us that miners are almost

unanimously men, who leave their families (almost as a rite of passage) to go work the

mines and send money back home. They live on very little money themselves, and often

acquire lung diseases such as silicosis. Historically, mining companies have opted to pay

off the families of workers diagnosed with silicosis or other mining-induced diseases if

they can prove the cause of death through an autopsy. Mike saw this as a great field to

make a big impact and together we formulated the following chart to outline the

advantages to designing for South African miners (Fig. 15.4).

119

We entertained the idea of designing our inhalers for these miners, as there were

evident advantages to doing so. We even proposed our first persona as a South African

miner. However, after some reconsideration, we (at least temporarily) turned away from

the miners for the reason that these miners are considered part of the working class, not

the middle class (the particular demographic which Merck asked us to target). We also

decided that designing for the middle class would allow us to potentially have a much

broader influence, seeing as the middle class is in such flux and continues to grow. With

the established mindset of designing for this group, and from the information in our

interviews the important design considerations were laid out as follows (Fig. 15.5):

Figure 15.4: Advantages of Designing for South African miners

120

Figure 15.5: Design considerations for the Middle class inhaler

121

16 Appendix D: Fall Persona Development

Developing a persona is critical to our project, as it allows us to fully identify a

potential user. It forces us to understand how this user lives, and the typical experiences

they undergo each day. By thinking on this personal level, it allows us to develop a

product which is well suited for their particular needs, and therefore integrates more

naturally into their life. This persona serves as a good indicator of how we can expect (at

least roughly) the rest of our target users to act and accept our product. Based off of our

need finding, we decided to create a persona who is young and aspires to become more

westernized in order to cement her social and economic status.

Our persona is a 30 year old female from Johannesburg named Ayanda. Ayanda

grew up in Johannesburg, and was a young child during the time when apartheid ended

and integration began. She watched her father struggle to earn enough money to support

her, her mother and her two little sisters. Her father had a hard time integrating into his

new job as a teller at a department store, as he often got confused on how to use the cash

register. Ayanda acquired a better education than her parents, going to school until the

10th grade, after which she began working at a small restaurant to support her now-sick

father. During her adolescence, she (along with all of her friends) became captivated by

Western culture. They often listened to popular music from America and she loved to

watch American action films. Shortly after obtaining her restaurant job, she and her

sisters were making sufficient money to support the family, while also being able to

indulge in new things. She soon began buying Western clothes, technology, and even

jewelry to fit in with her friends (who were also doing the same) and the white South

Africans she would see around town.

Figure 16.1: Middle class South African woman, Ayanda

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Having now worked at the restaurant for a long time, Ayanda has acquired a

passion for cooking and wants to open her own high-end restaurant in order to keep

making sufficient money to support her growing lavish lifestyle. It is important to note

that while Ayanda does live this lavish lifestyle, she lives on a very tight budget,

sometimes on the brink of going into debt, just to establish her upper status.

Unfortunately, Ayanda has always suffered from moderate asthma. She spends much of

her time coughing, and frequently gets strange looks from strangers who see her as sick

and unhealthy like her father. She really wants to end this coughing, because she needs to

uphold her image of success in order to attract the clientele she is looking for. However,

she does not want to use an inhaler as they are too obvious, bulky, and would invoke the

same concerns from strangers. Ayanda is looking for a sleek, discreet and effective

solution which she can use about five times per day to help her halt her coughing and

succeed as a businesswoman.

17 Appendix E: Fall Critical Experience Prototype

After conducting our need finding and learning very interestingly that most

people within the South African middle class tend to embrace Western culture, we

decided to plan our CEP accordingly. Our team figured that since these South African

people are Western-leaning, we wanted to learn what influences Western people to

hesitate using an inhaler. It is no secret that people who use inhalers (including one of our

team members) don’t always feel completely comfortable using them in public, and we

wanted to understand why. In particular, we wanted to understand the effect of shape

factor and inhaler placement on a user’s comfort using an inhaler. Our team decided to

conduct a CEP rather than an CFP, as we deemed it very important to first understand the

psychological implications of using an inhaler—a very important consideration for our

project. A CEP is important as a method of understanding a vital experiential component

of our project, and what a user should experience if our product is designed effectively.

Our Goal: We aim to analyze human perceptions of inhalers and detect any patterns in their

rankings of different inhaler forms.

Why?: Our need finding showed that the South African middle class is very Western-leaning,

and therefore may have the same psychological reservations about using inhalers as people in

our close vicinity.

What We Hoped to Learn

Is there a preferred inhaler shape amongst the interviewees?

Is there a preferred inhaler size amongst the interviewees?

Do interviewees prefer wearables or pocket inhalers? Why?

Does material construction affect perception?

Any additional insights regarding inhaler uses and stigmas against inhaler users.

Experience Description

In order to best address the questions listed above, our study consisted of a basic interview

process with 16 interviewees. The interview was structured as follows:

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1. After showing the interviewees a typical metered active inhaler, they were asked whether

there is a stigma associated with these inhalers and people who use them.

2. Interviewees were asked if they would use an inhaler like this in a social setting like a

party.

3. Users were asked to rank their three favorite inhaler designs from Fig. 17.1

4. Users were asked to state their least favorite inhaler design.

5. Elaboration on any of these points was encouraged

Figure ???: Typical metered dose inhaleri

Figure 17.1: Inhaler Design Selection

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Inhaler Design Selection

E-cigarette design (pocket inhaler)

“High-tech” disk design (pocket inhaler)

Rectangular block design (pocket inhaler)



Wrist design (wearable inhaler)

Diamond design (wearable inhaler)

Large pendant design (wearable inhaler)

Small pendant design (wearable inhaler)

Study Results

The different inhalers illustrated in Fig. 17.1 were machined from either wood or 3D

printed out of plastic. The intent was to create a variety of unique shapes and forms, from

distinct materials to allow interviewees to compare the inhalers. The inhalers were also

modified with air channels, such that the interviewees could actually breathe through the

device to simulate inhalation. Results from our study were quantified in the following

way: for the question in which participants were asked to rank the different inhalers in

terms of preference, their first rank was awarded three points, their second rank was

awarded two points and their third rank was awarded one point (Fig. 17.2). For the

question in which the participants were asked to state which inhaler they most disliked,

their vote was counted as one point (Fig. 17.3). The results are shown below.

Figure 17.2: Interview ranking preferences

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CEP Insights

The following are insights gained from the first portion of questioning during each

interview:

Most people who do not use an inhaler (a majority of our interviewees) believe that

there is not a stigma against inhalers and people who use them

Most people who do use inhalers believe there is a stigma against inhalers, as it

makes the user look unhealthy and it is disruptive

Unanimously, people would opt not to use a typical inhaler at a large social gathering

such as a party

Many interviewees mentioned the role of inhalers during their childhood or their

friends’ childhood, and “fitting in” during these childhood years

Many interviewees mentioned how inhaler users in movies and TV shows are

portrayed as weak or nerdy

Our Conclusion

Although most people claim that there is no stigma against inhalers, they are forced

into a contradiction by saying that they themselves wouldn’t use them in a social context.

This tells us that there is a conscious, as well as unconscious stigma against inhalers. From

our interviewees, it seems much of this perception stems from one’s childhood when it is not

Figure 17.3: Interviewee "most disliked" inhalers

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“cool” to have to pull out an inhaler during recess and from pop culture which paints inhaler

users as inferior.

The following are insights gained from the form of our prototypes:

● Small inhalers are preferable

● Many people commented on the fact that a watch/inhaler is too noticeable, as you

move your hands around throughout the day.

● Various people commented on the fact that they wouldn’t want to occupy even more

space on their wrist (in addition to watches, smart bands, etc.)

● The e-cigarette design was very polarizing. The overall size was desirable, but many

people disliked the association with smoking

● Wearables are only preferred if inhaler use is very frequent. They were usually

preferred by women over men

● If a pocket inhaler is pursued, people generally like something that does not look the

slightest bit like a typical metered dose inhaler, but is instead sleek and easy to hold

(such as 2)

● Necklaces are good because they can be concealed (such as 9)

○ Necklaces must be small (a reason why various people disliked option 8) and

“stylish,” to look fashionable like jewelry.

Our Conclusion

Through the preferences, we found that people generally all seemed to appreciate

discreet inhalers. Whether for pocket use, purse use, or as a wearable, the overall

conclusion is that smaller is better. Regarding the overall form, people generally tried to

stray as far as possible from a typical inhaler shape (we believe, as a way of dissociating

from the typical perception of an inhaler). We were surprised to find that most people did

not want inhalers on their wrist, as we figured it was natural to cover one’s mouth while

coughing, and thus bringing your wrist close to your face seemed practical. Instead,

people wanted an even less noticeable solution that can be tucked away when not in use,

and discreetly used when needed. No one commented on the different materials of the

inhalers, although the top results were made of plastic, leading us to believe people prefer

a sleek modern finish over a traditional wooden finish.

Long-Term Study

As a way of gathering more varied data, our team also gave four of our highest

ranking inhaler prototypes to four people to test for an entire day. They were encouraged

to “use” them at regular intervals (about every hour) in both private and social settings,

and to report back any important findings. From this, our team learned that the pocket

inhalers seemed to get the most “funny looks” and questions from friends, despite their

abstract shapes (as people simply wanted to know what they were). The e-cigarette

design remained well camouflaged and did not lead to any questions, although perhaps

some strange looks when “smoking” indoors. The necklace design (9) was found to

attract very little attention. The user mentioned she thought it was because people tend to

naturally chew on their necklaces and jewelry.

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Overall CEP Conclusions

Overall, the results from our study point to a discreet necklace design or

alternative concealable wearable as a good route for our project. This design should be

sleek, look very little like a traditional inhaler, and be very quick and easy to use, such

that it does not inhibit social interactions. It is also crucial that this device be very

inexpensive, as our need finding demonstrated that middle class South Africans still live

on tight budgets. Keeping our persona in mind, such a device would be great, as it would

not lead people to think of her as “unhealthy.” Rather, they would probably not see the

device at all (tucked under her shirt) and if they do, they would see it as a new Western

technology. The idea is to make the inhaler “cool,” by hiding it, simplifying it, and

completely changing its shape. It is believed that such a wearable (if basic enough), could

also be given to children, in the hopes of remedying the root of the stigma at a young age.

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18 Appendix F: Fall SGM Handouts

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19 Appendix G: Quotes from Need finding and

Benchmarking Interviews

“The black middle class in South Africa is fast growing and quickly expanding”-Stephen

Reid

“Market [the inhaler] as a way to become better, stronger, more Westernized, and people

will want it”-Stephen Reid

“The black middle class often aspires to what the white middle and upper class have”-

Mike Blum

Valuable Quotes Regarding Healthcare

“The quality of care is very poor in the local health clinics…sometimes people have to

bring their own blankets and sheets”-Mike Blum

“In rural areas, it is easier for people to visit the traditional healer than local health

clinics”-Margaret Irving

“Given the average household income, to many, medicine is simply not affordable”-

Margaret Irving

“People in South Africa have really come to rely a lot on the pharmacist behind the

counter to serve as their main source of medical advice”-Jean Fourie

Valuable Quotes Regarding Technology and the Perception of Inhalers

“Everyone in South Africa has a phone. They may not have food, or a house, but they

have a phone”-Margaret Irving

“People often use their phones for banking. It’s a system that’s been in use for a long

time, even before apps like Venmo existed”-Stephen Reid

“I’d rather do an open water swim than inhale chemicals. I’m tired of putting crap into

my body, I guess I’m just stubborn”-Sean MacDonald.

“Things like inhalers or devices which require instructions are very difficult to package in

South Africa—you need to account for the 11 languages which increases the complexity

of getting an idea across.”-Jean Fourie

20 Appendix H: Winter SGM Handouts

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21 Appendix I: St. Gallen Prototypes

Figure 21.1: E-inhaler Figure 21.2: E-inhaler

Figure 21.3: Smoke Sticks Figure 21.4: Hot Aroma Stone

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Figure 21.5: Refillable Nasal Sprays Figure 21.6: Decongestant Pillow

Figure 21.6: Decongestant Air

Freshener

Figure 21.6: Suction Nose Spray

Figure 21.7: Face Warming Mask Figure 21.8: Decongestant Piercing

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Figure 21.9: Decongesting Gum Figure 21.10: GingerStar attached

decongestant saches

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