The document provides background information on Catrina Graffin's project called "Chew", which aims to create an iPad app to educate and support children with Tracheo-Oesophageal Fistula (TOF) and Oesophageal Artesia (OA). The app would focus on topics like eating, playing, medicine, and hospitals. It would make information engaging for children and ease anxieties. Currently, most information is text-based and aimed at adults. The goal is to develop the first app specifically for children with TOF/OA to help them socialize and learn about managing their condition.

1. MDes Business Document
Catrina Graffin B00341429
Background/History
The title of this project is Chew. Its aim is to raise awareness about a condition called
Tracheo Oesophageal Fistula (TOF) and Oesophageal Artesia (OA). TOF/OA is a condition
where a child is born unable to swallow. This project will focus on the specific areas that may
become of a concern once the child is of school age and aware that they are different from
others. Its purpose is to educate and emotionally assist the children in social situations
where the need for support becomes apparent.
TOF and OA are rare congenital conditions of the Oesophagus (food pipe) and/or trachea
(airway). With TOF the bottom of the oesophagus is joined to the windpipe, and with OA the
oesophagus ends in a blind pouch, unconnected to the stomach. The only way to correct this
problem is with surgery that is required normally within days of birth. Some children undergo
additional surgical interventions throughout their lives and many may have difficulties
swallowing, digesting food, reflux and respiratory problems. As the child gets older it is these
symptoms along with ongoing surgery and other health problems can add a great deal of
anxiety to both the child and parent.
I want to help breakdown the stigma of the medical condition and fill in the missing gaps with
a product that can familiarise children and carers with appropriate and useful information.
This project will concentrate on the main general aspects of the condition, which is often
difficult to explain.
My Goal
What prompted this project was my son who was born with TOF/OA, he is now 6 and is
attending Primary School. Leaving the security of the home and entering the school world
has been a daunting time for both my son and I. He realised that he was different from other
children in his class as he was the only one who had help at snack and meal times. His
meals have to be carefully planned and prepared in advanced and supervision is needed
whilst eating. In these situations, he is usually reluctant to eat, as he’s all too aware of the
potential possibility of choking events and the attention this can attract. He requires extra
time to eat food in a safe manner and is often the last person to complete the meal. Cold
weather greatly affects his respiratory systems causing chest infections and of course the
dreaded TOF cough. This can lead to him missing out on valuable school time. Every day he
takes a regular list of medication and frequently asks questions about all the hospital
appointments. He indulges in information about his condition and strives to inform all his
class mates about it.

2. At present there is nothing available for the children to view, almost all information is textual
and targeted at parents and/or medical professionals. I would like to change this and create
a product designed for specifically for children that would be not only appealing but
educational. Based on my son’s needs and feedback I received from other TOF/OA parents I
have refined this project and pinpointed the areas of need and importance to the child,
parent and carer. I aim to create an iPad App to be informative, interactive and fun. The
main topics of focus are Eat, Play, Medicine and Hospital. Eat will include all the issues
surrounding food, safe and non-safe foods, the possibility of choking episodes, and of
course the panic and anxiety of school and social events. Play will highlight difficulties
around the winter months with respiratory issues, the TOF cough, and the best way to help
with this. Medicine will feature the general types of that are commonly used, what they do,
how they help, and with a little reminder of when and how to take them. Hospital will involve
meeting the care team the app may introduce a surgeon, an anaesthetist and a doctor.
Based on the child’s selection the app will break down their roles and the importance what
they do so that the child not only becomes familiar with these roles but has a basic
understanding of how they help. The aim of this module of the app is to build a trust between
the child and care staff they encounter during their frequent check-ups and help ease any
anxieties. The children will interact and have fun with this app, whilst learning at the same
time, there may be a quiz at the end to test their knowledge on what was displayed. It will be
designed based specifically on TOF/OA and will help the child to identify, learn and grow
with it.
My Passion
Raising awareness for this condition has been my passion since the birth of my son and as
he has grown the areas I wish to highlight have changed. When he was first diagnosed with
TOF/OA, I only received a few internet print offs at the hospital which came from the TOFS
(Tracheo Oesophageal Fistula Support) Charity. At first these were quite alarming and
raised concern as it was so difficult to comprehend what the condition was. So whilst
completing a Multimedia Computing & Design Degree I took advantage of open topic
projects and used them as opportunities to do further research. I designed a website aimed
at new parents who have encountered the condition for the first time. My goal was to assist
these parents by providing all the important information, links and support available on one
site rather than having them search through the several to find what was relevant to them. It
was visually appealing and easy to navigate and more importantly it cut out all the middle
men and was from a parent’s perspective not a medical one.
As my son has gotten older it is not so much educating others and assisting new parents
that are my concern, but now to assist the child through all the areas of their life where their
different needs are apparent. It can be difficult to explain the reasons behind hospital visits
and also answer all the questions that follow. The information that is currently available is not
appropriate for a child to look at or read, and it does not touch on the emotional effects of
living with this condition every day.

3. Guest Speaker: Trisha Deery
Throughout the entrepreneur class guest speakers came and gave talks on about how they
grew their idea into a business. The speaker that stood out for me was local children’s
illustrator and author Trisha Deery, publisher of ‘Miss Rosie Red’. She told us about her
journey which was a particularly great insight to the world of children’s illustration to a novice
such as myself. I found her talk inspiring, educational and it gave me alot to think about.
Trisha showed her own illustrations and sketches and talked us through the process how to
develop a book and how it developed into an app. Trisha is now currently taking her
character Rosie and developing it even further in animation form, which gave me great
insight in to how far a great idea can be taken. Trisha’s’ influence has always been children,
she enjoys how they perceive the world and everything around them, how they speak at
times, being direct and to the point and with such innocence. She demonstrated how she
thought like a child when designing and tried to get into their frame of mind, seeing things
from their perspective and making drawings childlike.
This directly ties into the first title of my project ‘Through a child’s eyes’ and is the same
process I have been trying to put into motion when drawing and designing my app. Trisha
was very open about the progression of her project, from the creation of her character until
the present, signing publishing rights to Dog Ears and all the problems she endured. How
she stood by her principles, against opposition and still has her role to play. For example she
still has full control over her character design and final say on alterations. Trisha’s characters
are her own hand drawings they are a distinctive aspect of her work and children respond
well to them. These are techniques I have tried to put into practice when designing the
character in the likeness of my son by keeping the sketchy hand drawn feel. The discussion
was useful in many ways and made me realise that I may have to come to terms to the fact
that in order to get this app out there I may have to give up a percentage of it or even
change my designs.
Target Market
With one child in every 3,500 born with TOF/OA my target market will be children of school
age and carers. Based on information gained from questionnaires filled out from the parents,
88% own an iPad or a tablet. 100% say they download apps for their children. 87% would
use a visual product aimed for the younger children with TOF/OA. With this in mind and 11
support groups both nationally and internationally I want to make the app accessible to all,
as families are global and in contact via the charities support groups. I will seek validation
from medical professionals who have encountered children with this condition and aim to
receive constructive feedback to help improve with the development of this application. I
have been in contact with the UK support group TOFS who have supported the
questionnaires and will be updating them on future development of the project.
Whilst there are many other medical and health apps out there like respiratory and feeding
apps none of these focuses specifically on TOF/OA alone.

4. Funding
There are several funding bodies available that I could apply for. I am considering contacting
C-TRIC Clinical Translational Research and Innovation Centre who are based in Altnagelvin
Hospital. C-TRIC is Northern Ireland’s healthcare innovation hub which was developed to
bring together academics, industry and clinicians to develop solutions to areas of unmet
clinical need. Last year a fellow graduate from M.S.c in Design and Communications
Siobhan Kirrkamm came up with the idea of a healthy eating app. She secured support
through the Creative Industries Innovation Fund (CIIF) run by the Arts Council of Northern
Ireland to develop further her 3square concept app. Siobhan then secured further support
through C-TRIC’s Bio-entrepreneur programme to explore how she might further develop her
product range within a healthcare context.
The bio-entrepreneur programme is a new initiative set up by C-TRIC which is designed to
support entrepreneurs, innovators and start-ups to develop their innovations for better
healthcare whether they are software related, medical devices, diagnostics or therapies. The
programme has now closed but I may still contact them with this project as it could identify
an area of unmet clinical need.
Last month I attended a talk with Jennifer Cooke and Fergus Beagley about the 25K Awards,
this is a competition in Northern Ireland which is open to Masters and PHD students as well
as staff and researchers at the University of Ulster. This would be a good venture and a
possibility for funding. This could be a great opportunity to have a chat with them and see
the suitability and potential viability of the app. Two aspects I found interesting was they are
looking for a project that will make a difference and can be sold internationally, I believe that
this project has the potential and that Chew meets the criteria outlined. The closing date is
22nd
April 2013. I like the fact that as a Masters student I would own the Intellectual Property
(IP) rights giving me some say in my product and I would love the University to get involved
in development and funding. As this project is all about awareness of TOF/OA, I would like
as much help with the aid of others to make this a success and get this app out there into the
market place.
While researching the support groups I came across a post from AFAO (Association
francaise de l’atresie de l’oesophage) the French support group for Oesophageal Artesia
and Trachea Oesophageal Fistula. They recently launched a call for applications for all
research on Oesophageal Artesia. The winning project will receive €15,000 and will be
selected by its originality and relevance to the research they prefer. My project could
certainly be of interest to them and touches on an area of their preferred research. Closing
date is 20th
May 2013.
To date my years of research have still not proven to find anything for the children on the
market, and the potential to be the first out there with an illustrative and informative app
concerning this medical condition is exciting.

5. Bibliography
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