David Milestone

Jorge Odón, Mario Merialdi, David Milestone, Claudia Weill, Chiara Atik, and Sonia Epstein on car mechanics, birthing technology, the Odón device, and BUMP

From left: Sonia Shechet Epstein, Chiara Atik, Claudia Weill, Jorge Odón, Mario Merialdi, translator Rosa Rivera, and David Milestone

From left: Sonia Shechet Epstein, Chiara Atik, Claudia Weill, Jorge Odón, Mario Merialdi, translator Rosa Rivera, and David Milestone

An amazing thing happened during the last weekend run of BUMP, the new comedy by Chiara Atik that was this year’s EST/Sloan Mainstage Production. The idea for the play began when Chiara discovered the story of Jorge Odón, an Argentine garage mechanic who saw a YouTube video about a cork getting removed from a wine bottle – and that video inspired him to invent a revolutionary new device to help in the late stages of childbirth delivery. A fictionalized version of Odón’s story became, in Chiara’s hands, one of three storylines in BUMP. Odón still lives in Argentina but on Thursday, May 31, three days before the play was due to close, the EST office got a call that Jorge Odón himself was flying in to attend the Saturday matinee performance . . . and yes, he would be happy to participate in a talkback after the performance. Odón arrived with his wife and with Mario Merialdi, the former World Health Organization executive who was critical in helping Odón turn his idea into a product that has gone on to be clinically tested in Iowa, South Africa, and Argentina and may start going into use in 2020.

Joining Odón and Merialdi for this remarkable talkback on June 2 were the playwright Chiara Atik, the director Claudia Weill, translator Rosa Rivera, and David Milestone, the Acting Director of the USAID’s Center for Accelerating Innovation and Impact, an organization that also played a key role in funding the development of the Odón device. Sonia Shechet Epstein, Executive Editor of Sloan Science and Film at the Museum of the Moving Image, moderated the discussion.

A lively comedy about childbirth, BUMP explores women’s evolving understanding of and control over the birthing process through three stories: a young first-time mother giving birth in colonial New England with the help of an experienced and peppery midwife; five women sharing quips, gripes and observations on an online message board; and a grandfather-to-be getting inspired to invent a device that could revolutionize how infants in difficulty get delivered (this is the storyline inspired by the experiences of Jorge Odón).

Some of the highlights of the June 2 discussion follow: (Recap by Rich Kelley)

Sonia Shechet Epstein: Chiara, in BUMP there are characters who give birth in a range of ways. Why was it important for you to present that range?

Chiara Atik: The play is not trying to say that there is a correct or incorrect way to give birth. My hope was that by offering an assortment of examples of what giving birth is like, that the audience could take what it wants from the different experiences. The play ends with the colonial girl looking at her future. That’s where I wanted the focus to be.

What Jorge Odón thought after seeing BUMP

Sonia: Jorge, what is your reaction to seeing your invention dramatized? 

Jorge (translated by Mario Merialdi): The play is great and he is still surprised about his invention and how it has been interpreted. . . . This invention actually took him around the world to meet many important people. He met Princess Caroline in Monaco. He met Pope Francis. The device got on the front page of The New York Times. Seeing this play was really a surprise for him.

When he was seeing the play he could see and feel very much of what had happened in reality. He was spending hours on this device. His wife Marcella, who is here with him today. She actually did sew parts of it . . . He congratulates Chiara the playwright and all the actors who interpreted his story.

Sonia: And what do you have there?

Jorge (translated by Mario): [shows prototype for Odón device] This is a simulator of the uterus that he uses for demonstrations of the Odón device. The first prototype of the device is what he is showing here. He’s a car mechanic. He’s not a doctor. He needed to learn how the baby exists inside the uterus. This part was used the first time to insert the device. It was difficult for the doctor to use it and to position the device correctly. This is the inserter. The gauge indicates when the device has been inserted properly.

From left: Chiara Atik, Claudia Weill, Jorge Odón, Mario Merialdi

From left: Chiara Atik, Claudia Weill, Jorge Odón, Mario Merialdi

It’s been fourteen years since he had the original idea. This is the bag we use now. Now he is going to fill it with air. This is not hard to do. The device immediately deflates once the baby is removed. You have now seen in just a few minutes the evolution of the device over fourteen years. Imagine what happened in between. Jorge was actually very afraid of seeing blood. Because of his passion, he was able to attend 48 deliveries. In these 48 deliveries he was able to deploy the device. Without the help of his family, his friends, and everyone who believed in him, he would not have been able to develop the device. Without them it would not have been possible for a big company like Becton Dickinson to pick up his idea and take it to the next level. It first was his family that supported him, then it was CEMIC, the Center for Medical Education and Clinical Research in Buenos Aires; then it was me [Mario Merialdi] who was shown this device and fifteen weeks later Jorge and I were together in a hospital in Des Moines, Iowa, a very specialized advanced center testing the device. . . . I didn’t mention that I’m actually his friend.

How the Odón device went from an idea to a product

From left: Sonia Shechet Epstein, Chiara Atik, Claudia Weill, Jorge Odón, Mario Merialdi

From left: Sonia Shechet Epstein, Chiara Atik, Claudia Weill, Jorge Odón, Mario Merialdi

Sonia: Mario, you’ve been instrumental in the development of Jorge’s device. I’m curious about two things: first, what about the Odón device stood out for you when you first saw it and second, how aware were you of the need for innovation in obstetrics before the device?

Mario: Someone mentioned in the play that there had been no innovation in the instruments used for childbirth deliveries for centuries. There was definitely a gap there. I remember I was working at the time at the World Health Organization. I was leaving to go from Geneva to Buenos Aires for a meeting. I got a call in the evening from a colleague in Argentina telling me about a crazy doctor at a hospital working with an even crazier mechanic who had a new device for assisted vaginal delivery. I was very skeptical but at the same time I was intrigued because of the unmet need for new devices both in developed and developing countries. So I said I will be at this meeting and will be able to give him ten minutes. I met with Jorge who showed me the device. The moment I saw that this was something new in the field I was intrigued. The reason why it’s so appealing is that forceps and suction are all lifesaving procedures but they require professionals and they are not available everywhere in the world, especially in the area where most of the world lives. Seeing this device that is potentially easier to use and potentially safer was very, very promising and pushed me to invest and to develop a research plan.

How USAID innovates new medical solutions — and helped develop the Odón device

Sonia: Dave, I know that you and USAID also helped develop the device. What are some of the criteria you were using to decide which innovations to support?

From left: Jorge Odón, Mario Merialdi, Rosa Rivera, David Milestone

From left: Jorge Odón, Mario Merialdi, Rosa Rivera, David Milestone

David Milestone: I’m with the Global Health Bureau of the US Agency for International Development, the part of the State department that works on economic development and humanitarian assistance primarily in places with low resources. Think Sub-Saharan Africa, Southeast Asia. We’ve made a lot of progress in global health. For example, we cut child mortality in half in the last few decades. We still have a long way to go to reach what we call sustainable development goals that the United Nations targets around maternal newborn mortality. One of the things we recognize is that we need to start working and thinking in different ways if we’re going to have any chance of reaching those targets. Part of that is casting a wider net to different nontraditional problem solvers.

Over the last several years we’ve run programs called “Grand Challenges,” which are open innovation competitions around maternal and newborn health, like Saving Lives at Birth, and around the Ebola and Zika grand challenges to help us be better prepared for the next outbreak. [Note: The Odón device received funding in Round 5 of the Saving Lives at Birth challenge in 2015]. What we’ve found is that great ideas can come from anywhere, from Buenos Aires to just up the street at Columbia University where a group of students developed a type of colorized bleach to be used in decontamination settings during the Ebola outbreak in Liberia. It’s now being used in the current outbreak in the Democratic Republic of the Congo. What’s exciting about that is that was a group of students at Columbia. They now have a business, they’re making money and it’s sustainable. That was only three or four years ago, in 2014.

Traditionally, in global health it can take 30 to 40 years for a product to go from an idea in the garage to scale. This can really accelerate the progress. There’s a saying that vision without execution is hallucination. It takes a village to execute. Jorge delivered the vision. It took us as a government agency to take the risk and invest in this device and it took the World Health Organization to be supportive of it and to get it to scale. We look for products that are potentially game changers, that can leapfrog existing technology and address the leading killers of newborns and mothers.

Sonia: Were there any other innovations that you awarded that also address these needs?

David: Yes, over the course of the eight years that we have run the Saving Lives at Birth Grand Challenge we have awarded some 120 different awards to innovators. Some awards were as low as $250,000. Some as high as two million dollars in order to be catalytic. Yes, we’ve seen a whole host of ideas. About 15% of these will transition through development and get to scale. That doesn’t sound like a lot but when you’re looking for new approaches to reach what we call the last mile in real rural settings, it’s proven to be a pretty successful model. We’re going to be seeing more of it.

Claudia Weill on directing BUMP

From left: Sonia Shechet Epstein, Chiara Atik, Claudia Weill

From left: Sonia Shechet Epstein, Chiara Atik, Claudia Weill

Sonia: Claudia, one of my favorite storylines in the play is during colonial times when you see and feel the terror of giving birth without the aid of technology or community. What was it like directing that scene?

Claudia Weill: We were very lucky. We found an amazing group of actors who really brought the play to life. The two actors in that scene (Lucy DeVito and Jenny O’Hara) were fantastic in making it come to life. When Chiara writes “1690” she writes it almost as a contemporary scene. It’s not like “Ye ole . . .” It’s very hip and edgy. That made it very easy to direct and easy to connect it with the other material.

Sonia: Claudia, can you tell us about the creation of the set and the development of the prototype for the device?  

Claudia: I wasn’t so much involved in developing the prototype. We had wonderful prop people who were.  In terms of the set, we worked with this wonderful woman Kristen Robinson. Early on, we realized we had to create the world of the Internet and to bring it onstage in some alternate space. She came up with this wonderful idea of this window. Everything that happens in the window is somehow connected with the Internet, whether it’s a YouTube video or a chat room or whatever. I thought that was a marvelous visual concept, a visual metaphor for what Chiara is doing in the play. One of the things Chiara is writing about is that we are more intimate with our devices and with what’s happening on the Internet than we are with the person next to us in bed. It’s as if that person in the device is in the room. It’s not a remote thing. The set brings that home.

Why outsiders may be key to medical innovation

From left: Sonia Shechet Epstein, Chiara Atik, Claudia Weill, Jorge Odón, Mario Merialdi

From left: Sonia Shechet Epstein, Chiara Atik, Claudia Weill, Jorge Odón, Mario Merialdi

Sonia: Jorge, another question. How do you think your experience as a car mechanic helped you to think about the problem that your device solved?

Jorge (through Mario): He has several patents related to automotive mechanics. When he was having issues with mechanics in his garage, he used to go to bed with the problem and woke up with the solution. This time when he had the idea his wife was not pregnant. He thanks God for giving him this idea. He wants to congratulate the actor who portrayed him on stage. He has only one complaint. In the program he is not described as an Argentine mechanic but simply as a grandfather inventing the device.

Sonia: I have a question for any of the panelists. Forceps were invented in the seventeenth century. I’m surprised there haven’t been more innovations in this area. Do any of you have ideas on why that is?

Mario: There have been many attempts to improve the forceps and the vacuum extractor. There are at least one thousand different kinds of forceps. Obstetricians have typically tried to improve on what’s already existing. Being a car mechanic, Jorge looked at the problem from a different perspective. Speaking as an obstetrician, I know we often refer to labor and delivery as a biological process, but mostly it’s a mechanical process. The baby has to go down the birth canal and navigate different diameters, taking different positions as it is being pushed by the mother. It has always struck me that Jorge has a better understanding of the dynamics of delivery than a physician. He always says he’s a car mechanic. He’s not a doctor, so he doesn’t have any kind of biological background. This always brings to mind for me the saying that sometimes imagination is more important than knowledge. What you need sometimes is someone who takes a totally different view who has a lot of creative imagination. It’s great that there are now platforms available for innovation. Innovation can come from totally different backgrounds. This is my view. This is why there has not been so much innovation. We had to wait for Jorge.

David: I’d add that it’s very expensive to develop new medical technologies. For a good reason. We want to make sure that they’re safe. So they often require these randomized controlled trials which are very expensive. If you’re a medical device company like Becton Dickinson, you want to make sure that the devices you’re developing and testing will allow you to make more of those and make a profit. Often In these low resource settings . . . in northern Nigeria, for example, women often will give birth by themselves by tradition. These are completely different markets with different user needs than are available in more developed places. There is not necessarily an incentive for innovation in these low resource stings. Fortunately, Becton Dickinson is very progressive in moving into these emerging markets – the fastest growing markets in the world – Africa and Southeast Asia – so we’ll likely see more of this innovation coming sooner than later.

How the testing process for a new medical device works

Question from audience: The play makes a point of the difficulty of moving from testing a device on dummies to clinical trials on people. How does that process work? How are the first human testers chosen?

Jorge (through Mario): There is a process you have to go through in order to get a device approved. There is an ethics committee that has to approve it. In this case, there actually was a first woman to test the device that had never been used before in the world. Jorge was involved in approaching the women. Jorge is really grateful to the first woman. We have to remember that the women in Argentina were going to have a normal delivery. They would not actually need the device. They needed to start with women who were going to deliver anyway. So the first women who agreed to participate were doing it for science. When you do research of this kind there is a very detailed form the women have to read and discuss with their family. Reading the two or three pages describing all the possible risks could have been very scary. Despite that, the women decided to participate. Another requirement of the ethics committee was that the first test had to be conducted with women who had advanced education, a university degree.  They wanted a population of women who could not be interpreted as being disadvantaged or who might consent without properly understanding what they were consenting to.

What inspired  BUMP

From left: Sonia Shechet Epstein and Chiara Atik

From left: Sonia Shechet Epstein and Chiara Atik

Question from the audience: Chiara, what was it about Jorge’s story that made you want to write a play about him?

Chiara: I read this article and I just loved the idea of a man, a mechanic, someone not in the medical field, someone just completely out of it in this very female experience and I thought this was a funny juxtaposition. The idea of someone with a plastic uterus in his garage just seemed lovely.

The 2018 EST/Sloan Mainstage Production, BUMP by Chiara Atik began previews at the Ensemble Studio Theatre on May 9 and completed its run on June 3, 2018.

Read more about BUMP

Interview with Chiara Atik about BUMP: Chiara Atik on new mom message boards, ALT lines, science stories, and BUMP

Background on the science behind BUMP: Childbirth’s “Grinding Pirouette,” a Colonial Midwife, the Odón Device: Some Background to BUMP

May 26 talkback panel on BUMP: Rebecca Tannenbaum, Debra Pascali-Bonaro, Chiara Atik and Robin Marantz Henig on Midwives, Doulas, Colonial Home Births, Birthing Positions, Medical Devices, and BUMP

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Inventor Jorge Odón, Global Health Experts Mario Merialdi and David Milestone, and Director Claudia Weill join Playwright Chiara Atik and Editor Sonia Epstein to discuss Birthing Technology and BUMP

Clockwise from top left: Jorge Odón. Mario Merialdi, David Milestone, Sonia Shechet Epstein, Chiara Atik, Claudia Weill

Clockwise from top left: Jorge Odón. Mario Merialdi, David Milestone, Sonia Shechet Epstein, Chiara Atik, Claudia Weill

On June 2, following the 2:00 pm matinee performance of BUMP, the lively new comedy by Chiara Atik, audience members are encouraged to stay for an extensive discussion of many of the issues the play addresses, especially current birthing technology, devices for instrumental vaginal delivery  (IVD), the Odón device, and how medical devices get approved for clinical use. Joining playwright Chiara Atik  and director Claudia Weill will be Jorge Odón, the inventor of the Odón device, Mario Merialdi, Senior Director of Global Health at Becton Dickinson, and David Milestone, Acting Director for the Center for Accelerating Innovation and Impact, USAID, for a conversation moderated by Sonia Shechet Epstein, Executive Editor of Sloan Science & Film at the Museum of the Moving Image.

BUMP is the exuberant exploration of the evolution of women's understanding about and control over the childbirth process through the  stories of three separate quests for knowledge: a young expectant mother in colonial New England getting coached through her first pregnancy by a peppery midwife (inspired by the diary of Martha Ballard); a contemporary message board where new pregnant moms swap gripes, quips, and observations; and a grandfather/mechanic's invention of a device that could revolutionize how babies in distress could be safely delivered (the last inspired by the story of Argentine mechanic and inventor Jorge Odón). 

The World Premiere of BUMP is this year’s mainstage production of the EST/Sloan Project, EST's partnership with the Alfred P. Sloan Foundation to develop new plays "exploring the worlds of science and technology," an initiative now in its twentieth year.

About the Panelists

Jorge Odón

Jorge Odón

Jorge Odón is the inventor of the Odón device. For more than thirty years, he operated the El Rayel S.A. automobile alignment and wheel balancing service center in Lanús, Argentina. During that time he patented several products relating to car parts. In 2005, he had an idea for facilitating childbirths after seeing a YouTube video about how to pull a cork from an empty wine bottle. After developing several device prototypes, Odón’s big breakthrough came in 2008 when he presented his device to Dr. Mario Merialdi, then director of Reproductive Health at the World Health Organization. That meeting led to both traveling that December to the birth simulation center at Des Moines University in Iowa for a successful series of tests. The WHO then agreed to conduct a series of hospital-based tests of the device in three phases in Argentina and South Africa. In 2013, Becton Dickinson and Company (BD) licensed the development rights of the Odón device and developed a new prototype based on their pre-clinical studies. In March 2018, BD and WHO announced the results of the latest round of tests. The report concludes: “Delivery using the Odón device is therefore considered to be feasible.” BD will next pursue a randomized pivotal clinical trial before potential introduction in clinical practice.

Odón has won recognition for his invention that includes finalist in the First WHO Forum on Medical Devices in Thailand (October 2009); winner of one of the 19 awards in the international contest Saving Lives at Birth: A Grand Challenge for Development, in Washington (July 2011); recognition at world congresses and athenaeums in gynecology and obstetrics; first prize from INNOVAR 2011, and the gold medal from IMPI as best inventor of 2012.

Dr. Mario Merialdi

Dr. Mario Merialdi

Mario Merialdi, MPH, MD, is Senior Director of Global Health at Becton Dickinson (BD), with a special interest in Maternal and Newborn Health. Prior to joining BD, Dr. Merialdi served as the coordinator of Human Reproduction and as a Medical Officer in the Maternal and Perinatal Health Research Unit at the World Health Organization in Geneva, Switzerland. He worked in the design, implementation and coordination of large multinational epidemiological studies involving research institutions in developed and developing countries. Dr. Merialdi’s research interests have been focused on issues related to the reduction of maternal and newborn mortality worldwide. He is a strong supporter of the need to foster international research collaborations between researchers from developing and developed countries.

David Milestone

David Milestone

David Milestone is Acting Director of USAID Bureau for Global Health's Center for Accelerating Innovation and Impact (CII). CII applies business-minded approaches to the development, introduction and scale-up of health innovations. Since 2011, USAID, CII, and its partners have cultivated a pipeline of over 150 innovations and supported them on their path to deliver health impact—from improved maternal and newborn health to enhanced outbreak response for diseases like Ebola and Zika to strengthened health supply chains. David has also held various strategic marketing roles at Stryker, an $11B medical device company, where he led innovation and strategy initiatives in India.

Claudia Weill

Claudia Weill

Claudia Weill is a film, television, and theatre director. After graduating Harvard in 1969, she made 30 short films for Sesame Street (still on the air) and directed documentaries, notably This is the Home of Mrs. Levant Graham (Kennedy Journalism Award) and The Other Half of the Sky: A China Memoir, with Shirley MacLaine, released theatrically in 1975 (Academy Award Nomination). She produced and directed her first feature, Girlfriends, in 1979, which she sold to Warner Brothers after winning multiple awards at Cannes, Filmex, and Sundance. Next she directed It’s My Turn for Columbia Pictures, winning the Donatello (European Oscar) for Best New Director.

She directed mostly new plays at Williamstown, The O’Neill, Sundance, ACT, Empty Space and in New York at MTC, the Public and Circle Rep among others. In 1984, she was nominated for the Drama Desk Best Director Award for the premiere of Donald Margulies’ Found a Peanut, produced by Joe Papp at the Public Theatre. Moving to Los Angeles in 1985, she began working in television, directing episodic, cable movies and pilots. She is most well-known for multiple episodes of Thirtysomething (Humanitas and Emmy Awards), My So-Called Life, Chicago Hope (Reynolds Award), Once and Again, and TV movies, including Johnny Bull and Face of a Stranger (Gena Rowlands, Emmy Best Actress). Returning to theatre in the last few years, she directed the West Coast Premiere of Pulitzer Prize winner, Doubt, at the Pasadena Playhouse; Tape, Memory House, and End Days at the Vineyard Playhouse, Archy and Mehitabel at the Yard; Huck and Holden at the Black Dahlia; La Bella Famiglia at ACT; Twelfth Night, Act a Lady and Sweet Mercy at Antaeus; Melancholy Play and The Shore at the Pasadena Playhouse.

Chiara Atik

Chiara Atik

Chiara Atik is a graduate of the Obie Award-winning EST/Youngblood program, and a portion of BUMP had its origins as a short play written for Youngblood's monthly Sunday Brunch series, specifically its annual crossover with the EST/Sloan Project, the Youngblood Science Brunch. Her plays include I Gained Five PoundsWomen (a mashup of Louisa May Alcott’s Little Women and HBO’s Girls) and Five Times in One Night, which was first produced at EST. She is the author of numerous articles for Cosmopolitan Magazine, Glamour Magazine, Refinery29, and New York, as well as the book, Modern Dating: A Field Guide. Her screenplay, Fairy Godmother, was on the 2016 Blacklist. Helen Estabrook (Whiplash) and Cassidy Lange will produce for MGM, which won the rights in a bidding war. Television: NBC’s Superstore.

About the Moderator

Sonia Shechet Epstein

Sonia Shechet Epstein

Sonia Shechet Epstein works at the intersection of science and culture. As Executive Editor of the Museum of the Moving Image’s website Sloan Science & Film, she produces all of its content. At the Museum, she also curates the ongoing series “Science on Screen” which pairs rarely screened films with discussions between scientists and filmmakers. Since 2014, she has been a mentor at NEW INC—the New Museum of Contemporary Art’s incubator for practitioners in art and technology.

BUMP began previews at the Ensemble Studio Theatre on May 9 and runs through June 3. You can purchase tickets here.

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