for the U.S. government in Iraq,

九年前

helping rebuild the electricity infrastructure.

我在伊拉克為美國政府工作

And I was there, and I worked in that job

幫助重建電力基礎設施

because I believe that technology

我會在那裡做這樣的工作

can improve people's lives.

是因為我相信

One afternoon, I had tea with a storekeeper

科技可以使人的生活更好

at the Al Rasheed Hotel in Baghdad,

有天下午我跟一個倉庫管理員

and he said to me, "You Americans,

在巴格達拉希德飯店裡喝茶時

you can put a man on the moon,

他這麼跟我說：你們美國人啊

but when I get home tonight,

你們有本事把一個人送上月球

I won't be able to turn on my lights."

但是我今天晚上回到家

At the time, the U.S. government had spent

卻連燈都打不開

more than two billion dollars

當時美國政府總共投入

on electricity reconstruction.

超過了二十億的美金

How do you ensure technology reaches users?

在這些電力設備的重整規劃上

How do you put it in their hands

我們如何能確保消費者 真的有因為科技而受益

so that it is useful?

又或者你如何能確定

So those are the questions that my colleagues and I

你做的正是人們需要的

at D-Rev ask ourselves.

這些是我和同事們

And D-Rev is short for Design Revolution.

在D-Rev所在思考的

And I took over the organization four years ago

D-Rev是非營利組織「科技革新」 (Design Revolution)的簡稱

and really focused it on developing products

我四年前開始接管這個機構

that actually reach users,

專注於研發產品

and not just any users,

讓真正有需求的人可以使用

but customers who live on less than four dollars a day.

並非給每個人使用

One of the key areas we've been working on recently

而是給一天不到四塊美金過活的人使用

is medical devices, and while it may not be obvious

我們最近專攻的領域是

that medical devices have something in common

醫療器材，或許這兩者中間看起來

with Iraq's electricity grid then,

就是醫療器材跟當時在伊拉克所蓋的電路設備

there are some commonalities.

好像沒有太大的關連

Despite the advanced technology,

但其實是有共通點的

it's not reaching the people who need it most.

即使有先進的技術

So I'm going to tell you about one of the projects we've been working on,

真正需要的人卻無法受惠

the ReMotion Knee, and it's a prosthetic knee

所以我要跟大家分享我們的一個研究計畫

for above-knee amputees.

「活動膝蓋」，這是人工膝蓋的一種

And this project started when the Jaipur Foot Organization,

專為膝上截肢者所設計

the largest fitter of prosthetic limbs in the world,

這個計畫始於世界最大的義肢製造組織

came to the Bay Area and they said,

也就是齋浦爾足機構（Jaipur Foot Organization）

"We need a better knee."

來灣區拜訪我們說

Chances are, if you're living on less than four dollars a day,

我們需要有更好的人工膝蓋

and you're an amputee,

如果你一天生活費不到四塊美金

you've lost your limb in a vehicle accident.

在一場車禍中失去你的腿

Most people think it's land mines,

腳又剛好截肢的話

but it's a vehicle accident.

大家都以為你是因為誤踩地雷

You're walking by the side of the road

但其實是因為一場車禍

and you're hit by a truck,

你在路旁走著走著

or you're trying to to jump on a moving train,

就被一台卡車給撞到了

you're late for work, and your pant leg gets caught.

又或者你是因為試著要跳上行駛中的火車

And the reality is that if you don't have much money,

因為上班已經遲到，卻很不巧褲管被夾到

like this young named Kamal right here,

而如果現實情況是你並沒有錢

the option you really have

就好像這位名叫卡莫（Kamal）的年輕人

is a bamboo staff to get around.

你真正能選擇的

And how big a problem is this?

就是拄著一根竹竿走

There's over three million amputees every year

這個問題究竟有多嚴重？

who need a new or replacement knee.

每年有超過三百萬人必須面臨截肢

And what are their options?

他們都需要一個新的或可替代的膝蓋

This is a high-end. This is what we'd call a "smart knee."

他們有哪些選擇呢?

It's got a microprocessor inside.

這個相當高級，我們稱之為 「智慧膝蓋」

It can pretty much do anything,

裡面裝了一個微處理器

but it's 20,000 dollars,

幾乎可以做任何動作

and to give you a sense of who wears this,

但是要價兩萬美金

veterans, American veterans coming back from Afghanistan or Iraq

讓大家有個概念 這類產品都是什麼樣的人在用

would be fit with something like this.

退役軍人，特別是從阿富汗 或伊拉克回來的美國退役軍人

This is a low-end titanium knee.

他們就能穿得起這樣的義肢

It's a polycentric knee, and all that that means

這款是比較低階的鈦金屬人工膝蓋

is the mechanism, is a four-bar mechanism,

這是一種多軸心膝關節，意味著

that mimics a natural human knee.

裡面的構造是四連桿的結構

But at 1,400 dollars, it's still too expensive

是照著原本的膝蓋結構來設計

for people like Kamal.

但一組要1,400美金，還是太貴了

And lastly, here you see a low-end knee.

特別是對像卡莫這樣的人來說

This is a knee that's been designed specifically

最後，這是另一款低階的人工膝蓋

for poor people.

是專門為經濟拮据的人而設計

And while you have affordability,

是專門為經濟拮据的人而設計

you've lost on functionality.

雖然價格低廉

The mechanism here is a single axis,

但功能也就被犧牲了

and a single axis is like a door hinge.

這個構造是單軸的結構

So you can think about how unstable that would be.

單軸就跟門軸是一樣的

And this is the type of mechanism

你可以想像這有多麼不牢靠

that the Jaipur Foot Organization was using when they were looking for a better knee,

而這種人工膝蓋也就是

and I just wanted to give you a sense of what a leg system looks like,

齋浦爾足機構找到另一個 更好替代方案前所使用的

because I'm showing you all these knees

這裡我想先讓大家看看一副完整的義肢長怎樣

and I imagine it's hard to think how it all fits together.

因為我剛剛呈現給大家的都只是膝關節

So at the top you have a socket,

大概很難看得出來是怎麼穿戴的

and this fits over someone's residual limb,

你們可以看到頂部有一個凹槽

and everyone's residual limb is a little bit different.

這個會包覆住截肢後的殘肢

And then you have the knee,

但每個人的殘肢都些許的不同

and here I've got a single axis on the knee

再來是人工膝關節的部份

so you can see how it rotates,

這裡有個單軸的膝關節

and then a pylon, and then a foot.

大家可以看到它是怎麼轉動

And we've been able to develop a knee,

然後是小腿跟足部

a polycentric knee, so that type of knee

我們目前已研發出

that acts like a human knee, mimics human gait,

多軸心的膝蓋，就是能夠正常活動

for 80 dollars retail.

就好像真的膝蓋，可以跟正常人一樣走路

(Applause)

但只要80塊美金就可以買到

But the key is, you can have this great invention,

(掌聲)

you can have this great design, but how do you get it

重點是，擁有偉大的發明

to the people who most need it?

跟絕佳的設計，但是要怎麼樣才能確保

How do you ensure it gets to them and it improves their lives?

那些真正需要這項產品的人可以用得到呢？

So at D-Rev, we've done some other projects,

你怎麼確定他們真的用得到 而且確實對他們生活有幫助呢？

and we looked at three things that we really believe

針對這點在D-Rev我們還有進行別的計畫

gets technologies to customers, to users,

我們相信透過下列三點可以

to people who need it.

使得這些新科技或技術

And the first thing is that the product needs to be world class.

讓真正有需求的顧客或使用者使用

It needs to perform on par

首先就是產品必須要有世界級的水準

or better than the best products on the market.

必須在水準之上

Regardless of your income level,

或比市面上最好的產品更好

you want the most beautiful,

不管你的收入有多少

the best product that there is.

人總是會渴望買到最美

I'm going to show you a video now

或者是最好的產品

of a man named Ash. You can see him walking.

我現在要播放一段影片

He's wearing the same knee system here

影片裡的男子叫艾許(Ash) 大家可以看他怎麼走路

with a single axis knee.

他所穿戴的就是跟這組義肢一樣

And he's doing a 10-meter walk test.

是單軸結構的膝關節

And you'll notice that he's struggling with stability as he's walking.

他在進行一項十公尺的步行測驗

And something that's not obvious, that you can't see,

可以注意到他走路時會有不平穩的問題

is that it's psychologically draining

並且另外一個大家可能不會注意到的問題

to walk and to be preventing yourself from falling.

如果走路必須隨時提防跌倒

Now this is a video of Kamal.

就會讓人心力交瘁

You remember Kamal earlier, holding the bamboo staff.

現在影片上出現的是卡莫

He's wearing one of the earlier versions of our knee,

還記得先前我們提到拿拄著竹竿的卡莫

and he's doing that same 10-meter walk test.

他所穿的是我們前幾代出產的人工膝關節

And you can see his stability is much better.

做一樣的十公尺步行測試

So world class isn't just about technical performance.

可以注意到他走路的穩定性提高很多

It's also about human performance.

世界級指的不僅是技術層面

And most medical devices, we've learned,

也是要適合全世界的人穿戴

as we've dug in, are really designed for Westerners,

我們發現大部份的醫療器材

for wealthier economies.

當我們越深入研究，就發現大都是為西方人

But the reality is our users, our customers,

或是經濟較富裕的國家而設計

they do different things. They sit cross-legged more.

但是事實上我們的客群或使用者

We see that they squat. They kneel in prayer.

他們的生活習慣是不一樣的，他們比較常盤腿坐

And we designed our knee to have the greatest range of motion

我們發現他們會蹲著或跪著禱告

of almost any other knee on the market.

而我們所設計的膝關節 跟市面上其他產品比起來

So the second thing we learned, and this leads

能做最多的動作

into my second point, which is that we believe

所以我們學到的第二件事

that products need to be designed to be user-centric.

也是我接下來要說的第二點

And at D-Rev, we go one step further and we say

我們相信產品必須針對使用者的需求設計

you need to be user-obsessed.

在D-Rev我們甚至更進一步表示

So it's not just the end user that you're thinking about,

我們設計的原則是使用者至上

but everyone who interacts with the product,

所以這裡講到的不光是使用產品本身的人

so, for example, the prosthetist who fits the knee,

也包含要把其他會跟 這個產品相關的人考量進去

but also the context in which the knee is being fit.

比方說，為患者穿戴義肢的矯具師

What is the local market like?

患者會在什麼樣的情況下穿戴義肢？

How do all these components get to the clinic?

當地的義肢行情是怎樣？

Do they all get there on time? The supply chain.

這些組件會怎麼被運送到診所裡？

Everything that goes into ensuring

是否能夠都準時送到呢？這就關係到生產線

that this product gets to the end user,

每一個環節都是為了確保

and it goes in as part of the system, and it's used.

末端使用者能夠真正拿到

So I wanted to show you some of the iterations

一副完整的義肢，並且知道如何穿戴

we did between the first version, the Jaipur Knee,

接下來想讓大家看一下過去

so this is it right here.

我們最早所研發出來的 齋浦爾膝關節(Jaipur Knee)

(Clicking)

就是我手上的這個

Notice anything about it?

(咯喀聲)

It clicks.

有注意到些什麼嗎

We'd seen that users had actually modified it.

它會發出咯喀聲

So do you see that black strip right there?

我們真的有客人自己改良它

That's a homemade noise dampener.

有看到畫面上黑色那塊嗎？

We also saw that our users had modified it

那是自製的消音器

in other ways.

還有其他客戶用不同的方式

You can see there that that particular amputee,

還有其他客戶用不同的方式

he had wrapped bandages around the knee.

大家看到這位截肢患者

He'd made a cosmesis.

他用繃帶纏裹自己的膝蓋

And if you look at the knee,

嘗試美化它

it's got those pointy edges, right?

如果你靠近一點看

So if you're wearing it under pants or a skirt

有些地方會凸凸的，對吧

or a sari, it's really obvious

這樣穿褲子、裙子

that you're wearing a prosthetic limb,

或印度傳統紗麗的時候，別人一看

and in societies where there's social stigma around being disabled,

就會知道你裝了義肢

people are particularly acute about this.

而若社會風氣是歧視殘障人士時

So I'm going to show you some of the modifications we did.

人們總是對這點特別敏銳

We did a lot of iterations, not just around this, but some other things.

接下來是我們所作的修正

But here we have the version three, the ReMotion Knee,

我們做了許多嘗試 除了剛講到的還有調整其他部份

but if you look in here, you can see

這是第三版：移動膝蓋(ReMotion Knee)

the noise dampener. It's quieter.

如果往裡面看，就會看到

The other thing we did is that we smoothed the profile.

消音器，比剛剛的聲音還要小

We made it thinner.

另外一點是我們把表面做得更平滑

And something that's not obvious is that we

厚度也變得也更薄

designed it for mass production.

可能不是那麼容易看出來的是

And this goes into my last point.

這是專門為了大量生產而做的設計

We really, truly believe that if a product

而這也是我分享的最後一點

is going to reach users at the scale that it's needed,

我們真的相信如果一個產品

it needs to be market-driven,

要能廣泛到所有需求者都可以用得到

and market-driven means that products are sold.

那它必須得是市場導向的產品

They're not donated. They're not heavily subsidized.

市場導向表示產品要能賣得出去

Our product needs to be designed to offer value

而並非透過捐贈方式，也無需申請大量補助

to the end user.

除了產品的設計必須是對消費者有益

It also has to be designed to be very affordable.

除了產品的設計必須是對消費者有益

But a product that is valued by a customer

也要讓價格平易近人

is used by a customer,

但是一個對消費者有益的產品

and use is what creates impact.

跟一個被消費者使用的產品

And we believe that as designers,

只有被使用了才能真正帶來影響

it holds us accountable to our customers.

我們相信身為設計師

And with centralized manufacturing,

對於顧客負有相當的責任

you can control the quality control,

而透過中央統一生產

and you can hit that $80 price point

品管就可以有保障

with profit margins built in.

雖然價位在美金八十塊

And now, those profit margins are critical,

卻也仍是有利潤

because if you want to scale, if you want to reach

講到這裡，利潤是相當關鍵的

all the people in the world who possibly need a knee,

因為如果你希望達到最大的效益

it needs to be economically sustainable.

或希望世界上每個 需要膝關節的人都可以擁有

So I want to give you a sense of where we are at.

那勢必要是能持續獲益的

We have fit over 5,000 amputees,

也再跟大家分享我們的一些心得

and one of the big indicators we're looking at, of course,

目前有超過五千名 截肢患者使用了我們的產品

is, does it improve lives?

而我們所關注的一項最重要的指標

Well, the standard is, is someone

當然就是：是否真的有助於改善生活？

still wearing their knee six months later?

衡量的標準是

The industry average is about 65 percent.

這個人是否六個月後 還是穿戴這副人工膝關節

Ours is 79 percent,

一般業界平均值是 65%

and we're hoping to get that higher.

而我們的產品則達 79%

Right now, our knees are worn in 12 countries.

我們仍在嘗試能提升這個數據

This is where we want to get, though,

目前有我們的膝關節使用者遍及 12 個國家

in the next three years.

這是我們接下來三年要努力的目標

We'll double the impact in 2015,

這是我們接下來三年要努力的目標

and we'll double it each of the following years after that.

希望可以在 2015 年有雙倍成長

But then we hit a new challenge,

並在那之後每年雙倍成長

and that's the number of skilled prosthetists

但之後又會面臨另一個新的挑戰

who are able to fit knees.

就是是否有足夠協助 穿戴膝關節的優秀矯具師

So I want to end with a story of Pournima.

就是是否有足夠協助 穿戴膝關節的優秀矯具師

Pournima was 18 years old

最後，我想跟大家分享普利尼瑪(Prinima)的故事

when she was in a car accident where she lost her leg,

普利尼瑪當時十八歲

and she traveled 12 hours by train

她在一場車禍裡失去了一條腿

to come to the clinic to be fit with a knee,

她搭了十二個小時的火車

and while all of the amputees who wear our knees

來到診所裡試穿人工膝關節

affect us as the designers,

而當這些截肢患者穿戴上我們的膝關節時

she's particularly meaningful to me as an engineer and as a woman,

是我們身為設計者最感動的時刻

because she was in school,

她身為一位工程師又是女性 對我而言意義非凡

she had just started school to study engineering.

因為她當時還在念書

And she said, "Well, now that I can walk again,

剛開始準備研讀工程學

I can go back and complete my studies."

她說，我現在又可以走路了

And to me she represents the next generation

就也可以回到學校繼續就學了

of engineers solving problems

她就好像是代表了下一個世代

and ensuring meaningful technologies

即將興起的工程師 不光解決現有問題

reach their users.

還會確保這些意義非凡的科技

So thank you.

落實於有需求的人

(Applause)

謝謝大家