Chris Yip  0:01  
Welcome to Tell Me More: Coffee with Chris Yip, the official podcast of the Faculty of Applied Science and Engineering at the University of Toronto.

Each month, I sit down with someone from our vibrant global community to talk about what places them at the heart of designing bold solutions for a better world. You'll meet students, professors, and alumni who are making a difference across a range of fields, including some where you may not expect to find them. My guest today is alumnus Marissa Wu, whose fascinating career lies at the intersection between healthcare technology and entrepreneurship. And Marisa is the founder of two startups, Onyx Motion and Rhythm, and she has acted as a mentor to other founders through our entrepreneurship hatchery. And today, she is joining us from London, UK where she serves as manager for essential medicines for the Clinton Health Access Initiative. Marissa, welcome to the podcast.

Marissa Wu  0:59  
Thank you. Thank you for the lovely introduction.

Chris Yip  1:03  
It's great to connect. It's been a while I think. I'm gonna go into it at some point, talk about when I taught you, but we got to start from the very, very beginning. So where did you grow up? And when did you realize engineering was for you?

Marissa Wu  1:16  
Yeah, so I grew up in Waterloo, Ontario, not too far away from U of T, which, as you know, is a center for engineering with RIM and University of Waterloo and whatnot. And to answer the question of how I got into engineering, the honest truth is I did not choose engineering.

Chris Yip  1:36  
I've heard this before (laughing).

Marissa Wu  1:39  
It is a common story. But um, I was 16 years old when I went to university, and I had no idea how to make a decision like that. So I went with what my parents told me to do. You know, I think it's interesting that my parents were...they are both Chinese and they came over in the 70s to Canada, which was pretty much as early as you could come over after the Cultural Revolution. (Chris: Right.) And, you know, they brought over not what is current Chinese culture, but they brought over the Chinese culture of the 70s. So by the time I was 16, they were still in that mindset. And they had this thought of, you know, coming from a background where your career changes on a whim, and whose cousin, you know, can determine your entire life path. What they really wanted, for me, was to be judged objectively (Chris: right), you know, they hope that I could be judged by the value that I brought and not by some of those other things and they thought engineering is where I would have the best chance to do that. So yeah, when I was in engineering, I really struggled with my identity and with appreciating it, but I think it's changed a lot since then.

So it developed over the course of the program you think? Or was it over time since then?

I would say definitely since then. I spent most of my time in engineering rebelling against being an engineer. But no, there's there's a good turnaround here. Um, but yeah, so my career, as you mentioned has led me through many twists and turns, and I think, exposed me to a lot of non-engineers. And I think it's by working with non-engineers that I was able to kind of see what engineers do bring to the table. You know, one of the things I love about engineers is just this dogged pursual of trying to find the truth as objectively as possible, even if that's a very complicated answer. And so now if I really vibe with someone at work, I call them an honorary engineer.

Chris Yip  3:40  
Nice. Well done. So I guess then maybe the question is, how did you choose U of T? I mean, you did actually start off by saying, you grew up in Waterloo, and the center of RIM and Blackberry and all that sort of stuff and then you chose U of T.

Marissa Wu  3:52  
Yeah. So I'll give you my answer and then I'll give you my dad's answer. No, so my answer was, I have a sister who's nine years older than me and she went to the University of Waterloo for engineering. And when she went, she was told to post her class schedule on the fringe. And if she wasn't at home, in between classes, you get a phone call from my parents asking her where she was. 

Chris Yip  4:19  
I see.

Marissa Wu  4:20  
I thought that is not going to happen to me (laughing). But yeah, I mean, my dad, in his infinite wisdom. You know, I think he knew that I had reservations about engineering, he could see that and what he suggested was that U of T might be the best fit for me because it would offer me the opportunity to get exposed to excellence in a variety of disciplines and see how people were achieving what they wanted to in maybe a multidisciplinary way. And I think he thought that if I had any chance of making use of my engineering degree, it might be in that kind of environment.

Chris Yip  4:59  
Oh nice. So was that the impetus? I know you went through engineering science but was that the impetus to go into Eng Sci or...?

Marissa Wu  5:06  
Yeah, and here was definitely my first pick. I think at the start, it was, yeah, it was the hardest program. So like, let's open as many doors as we can. I was really interested in the biomedical engineering option from the beginning. That was one thing I never wavered on. So I've just, I've just always really loved the subject. I think it's just amazing that it's super chaotic, super complex but then, when things work, you know, it's just that much more magical. Yeah, I think engineering science, I have a funny story, actually, that I think encapsulates what I love about that program. So I remember late one night, we're in the Eng Sci common room, and there's an exam the next morning, and it's like, I don't know, 3am, or something. And one of my classmates just becomes convinced that hair is not really dead, you know, and he's like, I don't think it's dead. Like, I can feel it, you know, and he has short hair, like you're, so obviously, you can feel it. And there's just this whole, I just remember this, like cluster of classmates around him and they're just, they're just trying to prove to him that hair is not dead. But at no point does anyone just like pull up Wikipedia and say, you know, Wikipedia said it. So you're wrong. You know, like, nobody was just like, I want to be right, I just want to tell you the right answer. Everyone was like, how do I prove this to you, you know, and they were so excited about it and they just got where that curiosity came from. And so, you know, I feel like Eng Sci is really encapsulated by that, that curiosity and that kind of relentless nerdiness.

Chris Yip  6:38  
I just think I mean, I think that's what's nice about engineering now. And I think we're gonna get into this a little more. So maybe the opportunity to interface with other people from other disciplines, or people that have a diverse set of interests? Like what we've seen is the interest, right? From students like yourself who said, "You know, I really want to pursue biomed, or I want to pursue these other areas," and we start introducing more minors and options and stuff so that you start to get these communities that build and link people. So you get used to this idea of working with or from outside your discipline, actually it's quite exciting about being at university in general, just mixing it up. So talking about mixing it up, I said in the intro the sort of startups and things like that. Give me some background on some of the stuff you did while you were in undergrad and sort of that entrepreneurial sector.

Marissa Wu  7:23  
So I think the entrepreneurial interest really started when one of my friends in Eng Sci caught the startup fever. I mean, it worked out for us. But no, it was so exciting at the time, I think it was when Silicon Valley was undergoing like a renaissance of, you know, venture capital and startups and Uber had made it big, and everybody wanted to make the next Uber and he actually went down to California to just try and make a go of it. And he, as old fashioned as the sounds, wrote me letters back, transmitted over email, but they were really letters just describing how what it was like, you know, and then I started to kind of dig into what was going around and the university around me with the Hatchery and then UTEST and Next 36. And it started to become clear to me that this was another way to approach my career that I hadn't thought of that might give me the opportunity and levels of responsibility that no one else was ready to offer me at that time.

Chris Yip  8:29  
So the first one was, was this Onyx Motion, right?

Marissa Wu  8:32  
Sure. So Onyx Motion was building digital coaching applications for smartwatches. And how it came about that was just thinking about what's going to be the killer app for wearables a good example for mobiles, Uber, right? You wouldn't really want to do Uber on a laptop, it only started to make sense (Chris: right.) with mobile phones. And with watches, you know, you don't want to watch a video on your watch so what is something that you can only do with your watch? Well, it's with you all the time, especially you know, when you play sports, and it can tell you about the nature of your movement, not just you know, how far you've moved. And so we actually started by trying to build a smartwatch. And then Android and Apple Watch beat us to it (laughing). So we did the smart thing and we pivoted to building software for Android and Apple Watch. And we ended up building partnerships with an NBA team, the Orlando Magic, raising money, managing a team, you know, again, all these things at 22 that you wouldn't get offered that in the workforce but we took it on.

Chris Yip  9:37  
Cool. And so I think this was a coaching app, right? For how they shoot or...

Marissa Wu  9:41  
Yeah, exactly. So our first use case was with basketball. So the idea was that you would have it on while you shot a free throw. And it would tell you, you know, but your speed, your release time and what the arc looked like maybe compared to professional athletes, and just tried to give you real time feedback the way a good coach would.

Chris Yip  10:00  
I think this is a great application, right? I mean, to identify that as an opportunity, when you're, when you're that young, I think it's cool to get that sort of level of engagement is so terrific. And then you went, and then you've got Rhythm, right? Or you've also... did it spin into Rhythm or Rhythm came out as another one?

Marissa Wu  10:02  
It sort of spun into Rhythm. So at some point, we decided to close the kind of main part of the business, we sold some of that algorithms and then I had built all of these skills, you know, in team management, in brand building and so I applied that basically to other startups for a time to help them.

Chris Yip  10:35  
And how big is that? That, to me seems like a great, very fulfilling sort of thing where you, you take your experience and feed it back. And did you have a mentor when you rolled out Onyx?

Marissa Wu  10:47  
Yes, I had tons of mentors actually. I had one that was originally assigned by the University of Toronto to an incubator UTEST. I had one that was a, also U of T alumni, Karl Martin, who was the founder of Nymi. He was definitely one of my core mentors. And then a few kind of in and out through the experience of going through the Next 36, and other kind of entrepreneurial communities, so I definitely would not even have known, you know, how to overcome some of the first tough challenges without them. I needed like a North Star to try and navigate this incredible minefield of uncertainty, which is entrepreneurship. So yeah, I think more than ever, I really needed those mentors. And I think it's something that, that's a habit now that I've built, and then I've continued to cultivate in my life, is to just always, always find a mentor for what you're doing.

Chris Yip  11:48  
Your LinkedIn profile talks about healthcare, and that technology exists to put us well ahead of where we are, but are slow to adopt any, what are your thoughts on that?

Marissa Wu  12:00  
Oh, my gosh, the million dollar question. 

Chris Yip  12:03  
Million? Billion dollar question.

Marissa Wu  12:05  
Yeah, billions. Yeah, I mean, so first of all, you know, this is where I want to say that there are so many people trying to figure this out. And so I can only give my best guess, and I definitely don't speak on behalf of my employer, or any organization I work with here. But yeah, I mean, you know, first of all that problem and what it looks like, I want to speak a little bit to that. When I was in Sierra Leone, when I first arrived, which was in 2018, I saw how the majority of banking transactions, the day to day banking transactions were being done over SMS over mobile phone, you know, and that's arguably ahead of, you know, what we're even doing in the West, depending on how you look at it. And then in the healthcare centers, they were recording their data on paper, you know, which was then getting rained on and trudged over by motorbikes on its way to being recorded in a computer. And my roommate at the time, he was leaving every other week to go install mobile solar power stations in these tiny villages. And I was going off to the same villages and asking them, you know, where was the bookshelf that they kept their condoms on? You know, so it was just a completely different world. And, of course, we can see that in Canada as well, right? You know, you have your, your pizza arrives in 30 minutes or less, but your emergency room wait is hours. (Chris: Days.) So, you know, first of all, just kind of setting the stage of whatever you say about why it exists, that feels wrong, and it feels unfair, you know, considering what's at stake. In terms of why I think, you know, there's a couple of things that I've seen worked on to some success. You know, one is kind of a asymmetry with information. So what I mean by that is, you know, I'm working on oxygen right now and industrial oxygen is basically a solved problem everywhere in the world, you know, if you need it for steel, or manufacturing, or mining or whatever, it's there, and it's pretty cheap. And then in the same countries in the same context, these health facilities are getting gouged for the same oxygen. (Chris: Right.) And just to clarify industrial medical oxygen, essentially the same thing, at the molecular level, the same thing. There are some more quality assurances that need to go into medical oxygen, but, you know, at a fundamental level is the same thing. And why is that the case? I mean, sometimes the healthcare administrators or the hospital, they just don't know, we know, they don't know how much they're supposed to be paying for it. They don't know that they are getting gouged. They don't know that they are paying more because they're ordering too sporadically. You know, if they just got a little bit more organized, they could probably negotiate the price down. And you know, the suppliers are not going to tell them. (Chris: Right, right.) So that's, that's kind of one type of problem. And then the other type of problem, which is one that I'm you know, personally really, really passionate and a little upset about...just the the risk taking, you know, and I know this is very much talked about, but human health care, nobody wants to be responsible for risking human lives. And nobody wants to be reckless. And that's not wrong. Obviously, you know, when human rights lives are at stake, you have to be careful. But I think that the other side of that coin is, what about the opportunity to save more lives? What opportunities are we missing out on every time we make the safe decision? And I think that even asking that question is so uncomfortable in every room full of, you know, public health or healthcare workers and I've ever been in, like, you just can't even ask, what if we did this? You know, and I think that's got to be a huge part of the problem.

Chris Yip  15:51  
Tell us about the Clinton Health Access Initiative, where you are right now. What's it all about? And, of course, your role now as manager of Essential Medicines.

Marissa Wu  16:02  
So Clinton Health Access, we affectionately call ourselves CHAI, Clinton Health Access Initiative. Yeah, I think the best way to describe what we do is actually just the founding story, which is a cool one. So Clinton Health Access was started by Bill Clinton and his chief health policy adviser, Ira Magaziner. And it started when Bill Clinton and Nelson Mandela were attending the same conference, International Conference on AIDS in Barcelona, and they made speeches on getting more international resources directed at the HIV crisis at the time. And as they were stepping off stage, apparently, Nelson Mandela said to Bill Clinton, that you really have to do something about the cost of ARVs in Africa, because it's killing us. And according to Bill Clinton, you don't say no to Nelson Mandela, which I can imagine. So yeah, they got to work on it and basically, through a combination of working with suppliers and understanding what drove their bottom line and how they could make this work for them. And then working with the governments in Sub Saharan Africa, and in countries where it was hitting the most vulnerable populations and putting that demand together and organizing that supply chain. They were able to bring the cost of treatments down from $10,000 per person per year, down to $60 per person per year. (Chris: Wow.) Yeah. I mean, basically, from the moon, to reality. And I think that just that's the reason I joined, you know, I think that combination of ambition, and being willing to work with all of the different players, you know, not not just your traditional NGO stakeholders, has just been incredible. And we've been able to apply it across other disease areas, you know, he's talking about oxygen. Yeah. And we're now in 30 countries, which is crazy to think about. So Essential Medicines, we work across like 28 of those countries, which is insane. I don't know what manager means but Essential Medicines means that we work on the leading causes of death for children under five and at the moment in developing countries, that's mostly pneumonia and diarrhea. So that's actually how we got into the oxygen work is through our pneumonia expertise.

Chris Yip  18:20  
We started the conversation you tell me, you mentioned your work in Sierra Leone and identifying that that disparity between your roommate who was focused on sort of building micro nets for cellular charging, and then what you were seeing in terms of medical, was that also tied to an assignment through CHAI was your work in Sierra Leone?

Marissa Wu  18:36  
Yeah, so Essential Medicines is my current team. So my first role at CHAI was with the Sierra Leone country team. I was the program manager for family planning, working on increasing the coverage of methods that were less familiar or less available so those are the the kind of long acting methods like IUDs and implants.

Chris Yip  19:00  
From your context, right? If we talk about healthcare, and I think in the broader context of healthcare, it's really broad, it's everything from electronic patient record stuff, all the way down to what? You know, medicines and reducing costs and down to drug delivery, but impossible, obviously, not to talk about COVID and how has that pandemic affected the impact of work you do, or maybe more broadly, the context of pandemics impact the work of CHAI?

Marissa Wu  19:27  
I mean, in so many ways. You know, I can kind of talk about it from two perspectives, my country team experience and my global team experience. So COVID hit when I was working on the Sierra Leone country team, and I made the difficult decision to leave the country at that time, not knowing what healthcare infrastructure would be available during a global pandemic. And so I was actually working for the team from Australia and it was, oh my gosh, almost impossible. I mean, it was incredible to see how fast people learn how to use Zoom, you know, situations where people were not even using calendar invites before and then we're now jumping on to that, which is great. But, you know, the reality is there's so much of public health work that is about understanding the politics. What I like about CHAI is that, you know, we strive to be acutely aware of the politics, but then use data to kind of drive a more objective decision. But you know, step one, be aware, and that's very hard to do remotely, you know, it's hard to just have casual conversations and understand where people are coming from and what baggage they might have about your organization and, you know, the most important thing, which is showing up their office and rolling up your sleeves and saying, I'm here to help. (Chris: Right.) You know, that's, that's just hard to do remotely. So that was actually one of the reasons why I transitioned to our global team. And our global team also had a very interesting experience with COVID, where, you know, we were working in pneumonia before on the central medicines team, and we had honed in on oxygen therapy and diagnosing hypoxemia as one of the kind of key problems with pneumonia. And we're starting to work on that in a small way. And very much trying to convince donors that this was an issue, and that the lack of oxygen infrastructure was a problem in these countries. And then COVID hit and all of a sudden, we didn't have to convince anyone anymore. We were panicking. And so our team was engaged in a big way and kind of pivoted from the pneumonia, diarrhea mission to address, you know, how do we take the money that is funneling into addressing COVID at the moment, but how do we help think about how it can be implemented in a sustainable way, so that those gains are lasting, instead of temporary?

Chris Yip  21:58  
Within CHAI, do you see other programs which are which are being affected by the pivot to COVID? Are you starting to see sort of, you know, okay, COVID, it's now become kind of, it's there, we know how to manage it, we've come up with sort of vaccines and strategies, the biggest issue now is access to these these vaccines and therapies to kind of reduce the burden on the healthcare system. So now we can read, we can sort of retask ourselves and start to look back at some of the things we were focused on before?

Marissa Wu  22:27  
Yeah, I think that transition is starting to happen. And, you know, it's, in some ways, it's a concern for our team, because as much as we, you know, we don't want other disease areas to be neglected, we also don't want to stop before the work is finished. It's kind of interesting, some of the donors are acting across these disease areas, you know, so they have a kind of a unique position to look at this, one of the biggest ones being Global Fund. You know, the Global Fund looks at TB, malaria, labs, and they were one of the big actors that pivoted to allocate money towards oxygen, and really put a mandate, I think, on countries to say, "Well, you've got to look at all of these together now, because we're gonna give you this pot of funding, and we need you to tell us how you want to split that up." So they're keeping oxygen in the mix for the long term, because they can see, I think, the same thing that as much as they need to make sure that the gains they've made in the other disease areas are not lost, they also need to make sure that that what was done in oxygen is sustained.

Chris Yip  23:42  
Okay, so here's, here's the big question. Where do you think are the biggest opportunities at this intersection? Tech and healthcare? Let's give a five or even a 10 year or 20 year window, what do you think?

Marissa Wu  23:53  
Yeah, so I have kind of a shorter term response and a longer term response. So in the short term, you know, as we were talking about earlier, the gap between technology and implementation, there is a lot of technology that is already where it needs to be or way past where it needs to be and it's about implementation. And I think data is one of those areas. Information about our healthcare services being delivered, how well are they being delivered? Do you have the supplies you need to deliver them? And of course, I'm kind of speaking more from the perspective of developing countries because that's where I work. A lot of times the data is being collected. But I think the huge opportunity is using that data to respond to the system and to proactively manage the system. But, you know, one thing that's my pet peeve as an engineer, I think, is when people sort of view technology as like a blunt instrument. If I make a website people will come sort of mentalit. Since, you know, I think there's been many times when there's the perception that if I give someone $10,000, they can build something to fix the problem. And there isn't the perception of, okay, once, let's say they can build something, you know, then what? Right? Who's maintaining it, who's adapting it as the system changes? Who's making sure that it's solving the problem that it set out to solve? So I think in the short term, that's where a lot of the low hanging fruit lies. We have the data, we have very simple systems that can take care of this. Let's, let's use it, you know, and let's recognize that data is really so much more about people than numbers. And then my longer term answer, first of all, I have to say, I was discussing this podcast with my partner, and he told me to say robots, and he was really disappointed that wasn't my response. I think, you know, I think engineers are naturally really excited about cutting edge technology and I'm sure it will be disappointing to not talk about that. I'm one of those people who just, I think when you look at history, you can see that things take so much longer to develop than you think and as much as there are really exciting advancements in robotics, and you know, the field of research for cancer, there have been some really exciting developments lately, I think I'm a little bit skeptical in terms of what that timeline is gonna look like, although, you know, hope for the best. But my answer is actually, so I'm sort of getting to this age now, which I'm sure you will find funny because I graduated in 2013 but I'm getting to this age now where my friends think it's interesting to say, like "Kids these days", you know, like all kids these days, like they're terrible. Some of my friends are starting to manage people for the first time and they're like, "Oh, gosh, like, Gen Z, they're lazy, they're entitled", you know, whatever. But I actually got on Tik Tok recently. Yeah, so I've learned things from my my spy work on TikTok and I think what I've learned is that the next generation of students and young people is actually incredible, you know, like, really proactive. I think they're not waiting to get involved in the issues of their time, you know, like climate change. I think that they don't concede to norms that we take for granted. You know, like, I think dress codes at work is the simple one. And I think, I hope what we will see in healthcare is that mindset take hold as more of these young people join the workforce. And so I hope that we see is, you know, instead of saying how can we avoid the most risk, these members of the workforce will be asking how can we assess risk in a smart way? And instead of taking for granted that in healthcare, there's a certain pace that things move. You know, I hope that they can be asking the questions of why does it have to be that way?

Chris Yip  28:05  
Yeah, no, I think you're right. There's always a youthful enthusiasm, which drives stuff really fast, right? And we see this at school now. It's about other questions about like, why is this policy put in this way? Like, we should be adapted this way. And I think the other thing you said, which was interesting is that, especially in the context of the pandemic, right, you're seeing rapid adoption of technologies that were being rolled out. Kind of really classic on slow paid timelines, like the mRNAs, right? It was like, they've been in development for 20 years, they've been tested on different things, they just never got rolled out on a massive scale. They just did. And look it worked.

Marissa Wu  28:38  
Actually that's, that's interesting that you bring that up in terms of what's been rolled out lately, because I've had some engineer friends who were working on some of these solutions that were rolled out for the pandemic in developed countries. And, you know, consistently they were saying, like, you won't believe what is happening on like an Excel spreadsheet. You know, like, a lot of times it was this is getting cobbled together. But you know, from the outside of someone who was living in the UK, for example, where vaccinations got rolled out to me, it felt smooth, and it felt it made sense and it was easy. And so yeah, I think that's the other side of it is that there is so much that we can do that we wouldn't think we would be able to with very simple tools. Maybe it's supposed to look messy.

Chris Yip  29:26  
This has been great, Marissa. Thanks so much for taking the time. This has been awesome to catch up and hear what you've been up to with CHAI and and just the impact you're having. This is just, it's terrific.

Marissa Wu  29:39  
Yeah, thank you so much for the opportunity. I was very excited when you reach out and it's nice to get to think about these questions with someone and reconnect on school and what that was like.

Chris Yip  29:53  
Thanks again for listening to Coffee with Chris Yip. If you want to catch up on past episodes or make sure that you don't miss the next one. Please Subscribe. We're on Apple Podcasts, Spotify and more. Just look for Coffee with Chris Yip. You can also check out @uoftengineering on Twitter, Facebook, Instagram and LinkedIn for more stories about how our community is building a better world. And finally, if you'd be inspired to join us, we'd love to welcome you. Whether you're thinking of taking a degree or working with us on our research project, you can find us online at engineering.utoronto.ca or you can visit our beautiful campus in Toronto, Ontario, Canada. I hope I can join you for coffee soon.