We caught up with Nathan Macabuag, Founder at Koalaa prosthetics as part of ‘Product | People | Potential’. Koalaa looks after people with limb differences across the world providing enabling soft prosthetics and holistic support.
Nate: Hi, I’m Nate Macabuag, founder of Koalaa. In a nutshell, we look after people with limb differences across the world. We provide enabling soft prosthetics and holistic support but what’s different about the way we do things is that we’re entirely user focused.
We will speak to a potential user and figure out what they want to do. Which is kind of fun, as everyone is unique and there are all sorts of different things people want to do. For example, they may want a tool that helps them in the gym, to ride a bike, go surfing, play a guitar, or to pursue a passion for baking or DIY.
From there, we will see what device they need and learn more about the important reasons behind that, and then produce something that will essentially stay with them for life.
The concept behind our soft prosthetics is also unique. The design of artificial limbs has barely changed since World War II. They tend to be plastic and really heavy. Almost no one has a bionic limb and they are also crazy expensive – a basic arm typically costing upwards of £10,000. (I actually carry one around with me which is worth £25,000!).
In contrast, our soft prosthetics are essentially designed like clothing, so made from material with a range of tool attachments that can be swapped in and out, depending on what the user would like to do. Rather than having a rigid casing, they are super comfy, light and really easy to fit for anyone, no matter where in the world they are, or what age they might be.
Our virtual clinic model meant that even during the pandemic, when everyone had to stay home, we could get our prosthetics out to people who needed them. They can just be put in the post and sent to people, with just a few measurements needed.
Having been founded in 2020, we’ve now reached the stage where we want to grow internationally and to figure out a global solution to supporting people with limb loss and limb difference because every country in the world is impacted by it. Our mission being to make prosthetics that are comfortable and affordable for everyone.
Nate: To be honest, starting a company was the last thing on my mind! I studied mechanical engineering at Imperial College London and in my third year began working as part of a team to solve a real-world problem. I love making stuff, so things became very exciting at this point!
We saw a bionic limb on TV, which was just like something Iron Man might have made and (being Marvel fans!) that inspired us to want to make an Iron Man suit of our own.
Really early on, we met a guy called Alex Lewis, who is a designer, world traveller and a dad. Literally the coolest dude I’ve ever met. But he’s also a quadruple amputee, meaning he’s lost both of his legs and both of his arms. He was wearing prosthetics, but not those bionic limbs we had been imagining. They were simple prosthetics with hooks on the end. I asked him what he thought about them: ‘Oh, I hate them’ was the response. So, I asked what he would like from a prosthetic limb.
He described something very different to what we were expecting and had imagined was needed. He wasn’t after high-tech prosthetic limbs and advanced mechatronics, or anything like that. He was asking for something that was really, really comfy to wear all the time. Also, he wanted it to be very simple to use – thinking of it as a tool that would be there for him to use when he needed it. Affordability was a big thing too, so he wouldn’t have had to fundraise or beg the doctors to get one for him and he could change it himself if he wanted a different one.
Those were very simple problems. And we did it – we made a really bad prototype and for whatever reason, he loved it!
We’re engineers, not clinicians. We only knew how to make a prosthetic limb that made sense to us. What this whole experience really hit home was that working closely with end users and listening to their needs, ideas and feedback, was the most important thing we could do – and always will be.
Nate: I think the hardest part was actually getting started, as launching a business is a massive step and a steep learning curve. You hope it will be the start of something that will grow and be long term, so you want to get those early stages right. It can be really scary.
My top tip is to just take your time. I felt a lot of pressure to rush because I wanted to get going and wanted other people to join. But that’s a big mistake. Equally, if someone is trying to hurry you then that should be a red flag too. Try to get to know someone and only when you feel really comfortable, think about bringing them on board.
The other tip I have is around teamwork. I once heard this said and it’s stayed with me ever since: ‘When you’re building a team, especially in the early stages, you can do one of two things. You can either optimise the team for control, or you can optimise it for growth’.
Either option is fine, as long as everyone is on the same page. If you’re optimising for control, you’re saying ‘You’re going to be COO, you’re going to be the CTO, etc.’ This will always be about roles. In which case, at some point your company might grow to a point where you’re not the best person to do that role, but you’re going to stay there, because this is who you wanted to be. And that’s totally fine.
Or you can optimise for growth, which is the opposite. It’s saying ‘I am going to be the CTO for now, but at some point, it might grow beyond what I am capable of doing. I can then step aside and bring another person in.
Again, it’s important to make sure everyone’s on the same page and to have discussions upfront, so problems don’t arise down the line.
Nate: In our industry, which is limb loss and limb difference, customer opinion really matters. There’s no point in me guessing what a person with a limb difference needs. You need to ask what they want.
It actually took us a long time to learn that lesson. We spent a year making a prototype and then gave it to Alex. The stuff we spent ages on, he said he didn’t need. The bits that we spent almost no time on, he said was genius! In his words – ‘So simple, I love it’.
That was when I knew that my assumptions were not important. Individual users are the only people who know what they want and what works for them. So now, when starting with new product designs, we strive to make it in the simplest way, as quickly as possible, and then give it to someone that’s going to use it, for their feedback. It’s an endless cycle and works with the business plan as well.
We initially had the idea that we would sell everything directly to consumers but it quickly became apparent that we needed to try something different. So, we asked end users want they want and how they want us to interact with them and have grown our service from there. For example, our ‘Limb Buddies’ have personal experience of limb difference and are there for users at every stage of the journey, offering advice, support and inspiration.
Nate: At a technical level, we are trying to make things that fit to the human body. Traditionally, the way prosthetics are made is that every prosthetic is 100% bespoke. You have a highly skilled clinician, who essentially moulds and crafts the limb to fit the body. And so it fits perfectly at that moment in time.
We (as engineers) didn’t know how to do that; it was too skilled. Also, that presented a massive barrier for scaling the business, as there are around 65million people worldwide who would benefit from access to a prosthetic limb. If you do one at a time, how are you ever going to do that?
We were trying to make prosthetics limbs that would fit people securely and well. However, we needed to find a way to do it with something that was essentially generic, not bespoke. Every prosthetist we spoke to was like: ‘That’s physically impossible, everyone is different’.
I knew they were right – they were the professionals after all – but I just couldn’t stop thinking about shoes!
You and I have completely different feet, but still, we can buy shoes at the same shop. The answer was that shoes are made of fabric, so made flexible but with rigid parts in all the right areas. But replicating that idea with our prosthetics and getting to a design that worked was really difficult.
How do you make something that fit someone securely and feels like part of them, without ever meeting them? And how do we mass produce them in the UK? That was another huge technical challenge – the biggest, in fact, when it came to our product. But we learnt from other industries and figured it out.
The idea of making something personalised, yet which can be mass produced, is fun but quite tricky. From a customer point of view, the way we treat them is that every single person is an individual. ‘We are talking just about you today – what do you need? Let’s figure it out’. But behind the scenes, there are (within the prosthesis) different modules that can be clipped together. In the right combination, they make the perfect device for each user. We also have different services. Some people need a specific kind of support, some people need training in the sports etc.
So, from the users’ point of view, it is bespoke. Everyone wants to be treated individually. But from the business side you need to figure out the efficiency and how to do stuff.
Nate: You get the most when you don’t ask for things. Rather than asking for money, I ask for advice. I ask investors if they know anyone they think I should talk to. It’s a win-win.
Building relationships is more important than people’s money because obviously the investors are going to stay with you. You want to get people that want to be there as a part of your team.
I was told really early on that ‘you want smart money’. As while it may be possible to get money, especially being in London in the big city, it’s better to have less money and to work with investors who are there to genuinely help you achieve your goals. Their experience will help you succeed.
Lastly, we are a full profit company but everything we do is socially minded. I have been asked how we make an investor understand that this isn’t all about the money, it’s about the people. But actually, if they don’t get that, they are not the right investor for us.
As a start-up, you need to find and align with people who understand what you’re aiming to achieve, especially early on. Later, it’s more about commercialising and is much more transactional, however, the same rules still apply.