After graduating, there were many reasons for Toronto-based industrial engineer Jessica Ching to take the safe route and seek employment with an established company. But none of them fit when she visualized the regret her 80-year-old self might experience if she didn’t try developing her HPV self testing idea; after all, HPV causes cervical cancer. Encouraged by a professor to further expand on her thesis, which focussed on a hand-held self-sampling device, Jess took the risk and embarked on a project that often felt like a plummeting roller coaster. Navigating the channels of medtech startup – including learning about requirements like clinical trials – led Jess to eventually launching Eve Medical and its Eve Kit platform as cofounder and CEO. She’s not only been inspired to make an impact in women’s health by giving women an alternative option to what can often be described as awkward or uncomfortable, but she’s also focussed on reaching under-tested populations, such as transgender individuals. Becoming an entrepreneur turned into a course on personal development for Jess, an introvert who had to combat her shyness due to the necessity of networking and pitching. She once considered it a win if she could complete even one short conversation at an event before ultimately spending the rest of the evening hiding in the washroom. However, powered by such a strong purpose, Jessica has forcibly learned to become the successful female entrepreneur she is today, and continues setting her sights on challenging public health care and redesigning medical experiences for women.
Our Product, Eve Kit
Unplugging and being creative
Sports has played an important role
Reaching each milestone in my business is incredibly rewarding
I enjoy having plants in my environment, and watching them grow over time
My mission is to empower women
Moments that matter most
My Sister, Jenny
I love enjoying a good meal, and cooking when I have time
Spending time with my silly, purring fur ball, Mochi
Tell me about your company.
Eve Medical is a healthcare company focused on improving women’s health. Our product is called Eve Kit, which gives women a way to screen themselves at home for the infections that cause cervical cancer, pelvic inflammatory disease and infertility. The problem we’re trying to solve is that about 1 in 3 Canadian women don’t screen for cervical cancer on a regular basis or they just don’t screen at all. Often the challenges they face can be pretty simple things; they don’t have time, they live too far from the clinic, they can’t take time off work or, sometimes, it’s a cultural issue – they’re just not comfortable, especially with male physicians. All of these little barriers prevent women from screening, and of course the people who don’t screen for the most part are the ones who develop cervical cancer, which is completely preventable. That’s why we developed this system – as a solution to help address that problem.
How does the Eve Kit device work?
You just go online (evekit.com) to order a kit and we send it to your home with a unique identity code. You collect a sample using a proprietary device that we developed – it’s a medical device that we designed to be very easy for women to use without supervision, and it collects high-quality samples for molecular testing. You then send the sample back in the pre-stamped box to our partner lab; they process the sample and upload the results to a secure, password-protected online portal. You can access your results there, and whether you’re positive or negative, we provide educational material. If your test is positive we also connect you with a licensed physician to answer any questions, discuss what to do, and recommend next steps for you.
What inspired you to start Eve Medical?
I’m actually an industrial designer by training, I went to university at OCAD – the design university in Toronto – and we had to do a thesis project in order to graduate. I was looking for a project and I’ve always been interested in design in health care because I think there’s a lot of opportunity to improve the health care experience. While sitting around having coffee one day I had a conversation with a group of girlfriends about the Pap test. I think someone brought up that they had to go get one and everyone was sort of moaning and groaning about how uncomfortable it was. I think if I had an ‘aha’ moment it was probably then. I mean, on one hand it’s kind of funny to joke about how awkward the Pap test is, but on the other hand it really is a problem if people aren’t going, and in this case some of my friends weren’t going because they felt uncomfortable. It just felt like such a shame that something that could be potentially lifesaving was being treated like a necessary evil. I was already interested in the space and so I wanted to figure out how to redesign that experience to make it positive. The idea was to feel good at the end of the day that you took care of your health with a preventative test – that’s where the initial impetus came from.
So you had the idea, then how did you run with it?
We started talking to lots of women and lots of health care practitioners and experts and doing our own research too. In doing this we came across some research that was around the idea of self-sampling – women collecting their own samples – for molecular diagnostic testing. This really sparked our interest because we were discovering that cervical cancer was caused by a virus – the Human Papilloma Virus (HPV) – so basically if you didn’t have a high-risk strain of the HPV virus then you wouldn’t develop cervical cancer. Then the other thing that’s really interesting is that the test for HPV is a molecular test, which means that it’s DNA based. It’s possible to actually collect and look for viral DNA, which is neat because it’s a much newer technology; it didn’t exist when the Pap test was invented.
And then how’d you approach the redesign of the traditional process?
We realized that in a lot of instances, normal swabs that doctors use to perform Paps were just being repurposed for the self-collection idea. Although a lot of women could technically collect their samples themselves using that method, and the research often showed that the samples were okay, a concern that was coming up in study after study is that women didn’t feel confident they were collecting a good enough sample. I mean, if you take a swab and instruct someone to insert it three inches and turn it five times, it’s very likely everyone is going to do this differently; there wasn’t a lot of consistency despite the very simple instructions. From our standpoint that’s actually a design problem, so we decided to try a redesign. We came up with criteria around what a perfect device would look, feel, and operate like, and from there developed a concept for a device that would work according to how women wanted to use it. At the same time, we were collecting criteria from the medical side, like where the sample needs to specifically come from, how much sample is required, and how to transport it, et cetera.
I understand you first pitched your idea to a class while in school at OCAD. How’d you go from there to developing and manufacturing the device?
Initially I had no intention of starting a company. It was actually a professor of mine who encouraged me – my thesis supervisor Diane Croteau, who’s kind of a design entrepreneur; she’s done lots of projects in the past and was actually involved in designing the CPR dummy. She came over after my presentation and asked, ‘Hey, have you ever thought about taking this a little bit further and not just leaving it as a your thesis project?’ And I said, ‘No, I never thought about it.’ She told me about all these grants and things available to apply for and suggested I maybe try because she thought it was a really great project and was something that could help women, which I think really stuck with me.
We incorporated the company in 2010 to go after one of the grants she told me about, and we ended up with a little bit of money. For the next few years however I still couldn’t commit full time; I was a new grad, I was working basically three jobs, and the economy wasn’t great at the time, so a lot of designers weren’t finding much work. A lot of people were freelancing, similar to what I was doing, in addition to working other jobs.
How did you step away from juggling a few jobs and find the opportunity to pursue your business full time?
The real problem with grants is they could be used for projects but you couldn’t actually pay yourself, which meant that we were never really focusing on the business 100% – it was always sort of a side project. Eventually, we applied for the Martin Walmsley Fellowship, which is also a grant, but they call it a fellowship because it’s more like a scholarship for entrepreneurs; you get some money you can use to pay yourself, and the intention is to allow new university grads a real opportunity to take an idea further. We won that in 2011 and that was really the reason we were able to quit everything else. I partnered with my co-founder, we split the money – which we didn’t actually get until 2012 – and then decided to go full time and see what would happen.
Once you went for it and focussed all your energy on your business, did everything unfold naturally?
Not quite. Part of the problem was that I had this concept and a prototype of the device but it really didn’t work; it wasn’t truly functional or manufacturable. I didn’t know how to do that part – there were all of these steps to take.
Can you lay out those steps?
It sounds silly now, but there were so many things I didn’t know. I didn’t know what a medical device actually was, in that I didn’t know what defines a medical device. I had to learn about how it’s actually a regulated product, learn about all these classifications and such, and so that actually ended up somewhat driving the development process. We had to change the device in order to meet regulations so we could commercialize it more easily. We hired a mechanical engineer to help make the product functional and manufacturable and went through the process of building a prototype tool. There wasn’t any way to really know whether it fully worked until we started the manufacturing stage. The next step, which I also wasn’t fully prepared for, was that we were required to do a bunch of clinical stuff to evaluate whether the device actually did exactly what we said it was going to do. In healthcare you can’t just sell a product; no one is going to believe you without some kind of data to back up your claims, and on top of that it you have to be approved by Health Canada. The first few years were really about establishing all the pieces we needed for this to even be a marketable product. So that’s what we did: we conducted the studies and eventually got the data. Research takes a really long time – that’s another fun thing I learned. But we got there! We were able to start selling the device and got it into a few pilots, but one of the pieces of feedback we were getting was that the device was only one piece of the solution instead of the full one.
In screening you have three main components: patients, which we had covered – patients collecting their samples – then the lab processing the samples, then the doctors overseeing the whole process. That’s how it works in health care. Our device wasn’t connecting to the other two pieces so we ended up deciding to build a delivery platform, which is Eve Kit, to enable us to directly deliver the whole process. Again this path involved development and clinical studies and then earlier this year we were able to fully launch the Eve Kit platform, and it’s now available to women across Canada.
Since the launch, how do you reach the public to grow your business?
We do a lot around education, starting with HPV. I don’t think HPV is very well understood by the public at this point. I think people know what it is but don’t always know – similar to me when I started – the difference between HPV and Pap tests and why they are both valuable. We found that women are really open to learning about it though; they want to learn and they really want to talk about it, so we focus a lot on education. A lot of the growth we see comes from teaching in person; it builds connections when we share the story behind why we started this in the first place and why it’s important they screen. I think the idea of collecting a sample by yourself and testing at home is a relatively new concept but I do think people are very intrigued by it – they just need to get more comfortable with it.
Given self-testing for this is a new concept, do you imagine the public will take a long time to get on board?
Who knows!? When the at-home pregnancy test first came out no one really understood why it was useful; the reaction was pretty much ‘Why don’t you just go to your doctor? It’s more reliable and then you don’t have to be alone.’ When it was developed a lot of doctors had concerns about people getting results without a doctor present – they thought women might freak out and jump off bridges or things like that. Today, it’s really hard to imagine anyone going to their doctor right away to take that first test. The self administered test has become embedded in our culture, it’s there, everybody knows about it, and it’s no big deal – you take a pregnancy test yourself first, then you decide on what to do from there. I don’t really see STI testing or HPV testing being that far removed from the pregnancy test; it involves being sexually active, which is a natural part of being human, and physical health, which is universal.
You actually have two different kits - can you tell me about them?
The HPV kit is available now and the STI (chlamydia and gonorrhea) one is still in development. We’re actually going through an evaluation study now and once it’s done it’ll be released to market.
What’s next for your company in terms of long-term goals?
The kit is offered now as a private test to women largely for convenience reasons or comfort or privacy – and those are a lot of the benefits our customers are looking for. But we know that moving forward there are going to be a lot of people who can’t afford our kit but still need screening. A lot of times the people who don’t screen are marginalized women, and so our long-term goal is to get our work integrated with the public health system in some way. We want to be able to offer these kits not on a private-pay basis but through community programs to reach women who might not otherwise be screening or be able to afford a private test.
How are you taking steps toward working with public health?
We have a bunch of pilot and demonstration projects we’re working on in a few different provinces to hopefully get us to that position in the future. In the meantime, we’ve set up our own community programs where people can support screening by purchasing kits at a discounted price – these are donated to Eve, and we facilitate providing them to communities that are generally under screened. Our first partnership, for example, has all of the kits donated going to trans men. Because they present as male they often face discrimination when seeking female-centric health care, and many of them can feel uncomfortable with the process. We know that the trans population tends to be significantly more under screened and that’s why we’ve decided to start by supporting this group in particular. The hope is to expand this type of program to other groups as well: refugees for example, or other vulnerable or marginalized populations. We’re trying to address gaps short-term with projects like this, but again our long-term goal is to have the kits available for everyone, any time. It’s a multi-stage approach.
Could you explain the value of your approach compared to the Pap test, which has traditionally worked for many women over the years?
We know that self-sampling is a very promising way to reach women who don’t screen – it’s very clear from the research. The value of offering this or having it available is that it increases participation in the demographics that are the hardest to reach. Two out of three women go to their doctor and are fine with that, and we think that that’s great! We want people to keep seeing their physicians, we want people to keep screening; we just also want there to be an alternative in case that’s something some women aren’t comfortable with. The group that doesn’t screen is high-risk, and we need to get them screening in order to make a difference in reducing cervical cancer rates. It’s one of the most preventable cancers, and in this day and age we really shouldn’t be seeing women getting cervical cancer or even dying from it. In Canada there are about 1,500 women who develop cervical cancer every year; 400 of them die. That averages out to about four women a day developing cervical cancer, and one woman a day dying. That for me is the driving force behind why this is important and why we need to offer this. The Pap test has been around for about 50 years and there’s no denying it’s one of the most successful health campaigns, but it has it’s limitations. Still having hundreds of people die every year tells us there’s more we can do, and we’ve come up with a different way to do it.
Do you think that many women feel they don’t need to be tested for cervical cancer?
I think that people often feel like it won’t happen to them. October 1st through 7th is HPV Prevention Week, which is a new campaign by the Federation of Medical Women of Canada. As part of that campaign, we’re publishing a story about a woman whose best friend died of cervical cancer. She got the diagnosis and she was sort of like: ‘Wait, what? Are you sure they said cancer? How did that even happen?’ You never think that it’s going to affect you, especially if you feel healthy – it’s not something that is top of mind. That’s where we feel that the education, and a lot of time the experience, can really make a difference, despite the screening being uncomfortable or inconvenient. We’re trying to eliminate some of the barriers so hopefully people are interested and engaged enough to at least take that first step.
How does you company approach educating the public?
We do it a couple different ways. On our website we have a health and information section that includes general information about HPV, cervical cancer and STIs. It’s split up into little modules that are very visual; users can click through the different sections and do a quiz at the end to test their knowledge. We also go to public events with giant poster boards that have big pictures of the female reproductive system on them. We approach people in a fun game sort of way – we offer them chocolate to take our quiz, which a lot of people seem to find funny. Guys in particular really want to demonstrate that they know how to label the parts, so we’ve found it’s a good way to engage people. We then use the opportunity to tell them a little about HPV and tell them what we do, and answer any questions they may have. Through social media we post facts and figures related to cervical cancer and STIs and we also have an anonymous question box, where people can drop questions and we have our two resident experts – registered nurses – answer the questions. We share the questions and answers on social media to reach a wider audience. We’re also starting to use a similar Q and A format for videos we’re creating and sharing.
I understand that you describe yourself as an accidental entrepreneur - could you elaborate?
I wasn’t one of those kids who started their first lemonade stand business when they were two and it’s been a string of businesses since – that was definitely not me as a child. I never really thought about starting my own company until my thesis supervisor started talking to me about it. I think ultimately at the end of the day when I was deciding between doing this or getting an established job – and a steady income and all the things that go along with it – I thought of what the 80-year-old version of me looking back would think. I think that person would regret not trying, because if I can have some kind of impact on women’s health in some way, it’s worth the try. I saw a direct path towards somehow making a difference and that’s why we decided to jump in, take the risk, and start the company. That’s why I think I’m sort of an accidental entrepreneur.
What has the entrepreneurial journey been like for you?
People talk about entrepreneurship being a roller coaster ride and I think that’s accurate. We were many times in a position where we could have definitely failed but there were also other times that we impressively accomplished something as a very small team that had no experience in business or health care. Finishing our first clinical trial was really exciting. My sister is a doctor and I’m a bit competitive, so it was sort of this race to see who could get published first. She was talking about how unfair it was that I was doing some of the same stuff as her but she had to go to med school. There were a lot of exciting times, like when we made our first sale – that was so exciting – or when we got our first investment money instead of just grant money. There are lots of highs and lots of scary lows but in general I think entrepreneurship is sort of life compressed. You learn so much, and I don’t think I would have been able to learn everything that I have over these past five years in probably ten years if I had gone a different route, and I mean that both professionally and personally. I think you learn a lot about yourself when you are ultimately responsible for everything that you’re doing; you really have to come to terms with a lot of things about yourself.
Would you say you had to face any hard truths during your learning process?
Yes, I did. I’m naturally a pretty introverted shy person and in the early days I had to go out to networking events, which was hard. Not just early days actually; I still have to go out and do that. Getting out there and talking to people was a really huge hurdle for me. I felt so uncomfortable being in those situations that just showing up to an event and maybe talking to one person before hiding in the bathroom for the rest of the evening was a win for me. I remember wondering at the time if I had social anxiety. I thought, ‘is there something wrong with me?’ I had the same feeling when it came to public speaking – it was really hard and really scary. I think I signed up for a social anxiety meetup group but then got too scared to go; I didn’t want to put myself through more networking things than I absolutely had to. I don’t know if it’s so much a hard truth about myself or if it was just something that really challenged me personally, because I eventually got over it mostly through the repetitive exposure of having to do it. I would spend hours on my presentations – basically just memorizing them – so when I got up there to present or pitch I was on autopilot and I couldn’t get tripped up by anyone commenting in the middle. I’d just start from wherever my brain left off and the practice made it come naturally. Getting over a lot of the fears and anxieties that I had by being forced into those situations has really accelerated my personal growth.
What’s been the most rewarding on your roller coaster ride?
The greatest rewards in a way have been getting over the challenges. I mean let’s fast forward – now I can do things I never thought I could or thought I was bad at; I’ve proven myself wrong. I think we all have an idea of our identity, our strengths and our weaknesses, and we tell ourselves things like ‘I just shouldn’t do this because it’s not really my thing.’ But then as an entrepreneur you’re forced to do it all, and at the end of the day, you maybe realize it’s more that you just didn’t have a lot of practice or a lot of exposure. Looking back at everything we’ve accomplished against the odds is rewarding in itself. It’s been many years of work, but we actually did it. We built this thing and we put it out into the world and people are using it, and that’s amazing.