Category: surgical design

Rethink Relief ’14

I just came back from Pader, Uganda, after the intense Rethink Relief workshop.

Pader belongs to the district of Gulu in Northern Uganda and it’s about 10 hours drive from Kampala through Lira. This region was devastated by a long war between the Lord Resistance Army and the government. This war harmed many Acholi communities, disrupted families and their homes. After several years living in displaced camps the Acholi people could go back but faced a difficult return and resettlement as coming back meant facing the devastation and the past fears.


Hall room at CCF House

View from the house

Our host, Caritas Gulu Archdiocese received all participants with a warm welcome and helped making this a great week! Rethink Relief brought together 16 nationalities and people with the most various backgrounds to focus on problems that communities face when returning from camps. We formed 5 teams, each with at least a design facilitator from the international organizers, an international participant, a local resident and a south sudanese refugee from Ayilo camp in the district of Adjumani, Northern Uganda. The teams were divided in the topics of agriculture, rainwater harvesting, cooking, preventive healthcare and lighting.

Amongst the many activities:
..we heard six speakers representing different perspectives who came to tell us about their experience with the war and peace process in Northern Uganda.

..we visited the Technology centre in Pader.

..we had fun activities to open our minds and use our hands.

..we worked in teams.

..and we had a final ceremony with presentations and dance!

Preventive Healthcare
I worked on the Preventive Healthcare team. We worked on a broad concept to support the healthcare of refugees during the future period of return to their communities. Within this broad idea we designed something specific for safeguarding healthcare records of a refugee household. We designed a packaging to be distributed to everyone at a camp containing for example hand sanitizer and mosquito repellent for babies. This package should be beautifully illustrated with “positive living”* messages and can be used to store the healthcare records of everyone in the household.

One of our considerations was to care for the HIV diagnosed patients. There is a tremendous stigma created around HIV. If you are diagnosed positive you will leave the healthcare facilities carrying a huge box containing some condoms, a tiny leaflet of “positive living” some water tablets and a white jerrycan. A white jerrycan will condemn you to be looked at and be segregated.

The package we designed should replace the need to carry this differentiated equipment home. It can be hung like a poster at home and can be transported when necessary. Everyone should have one.

* Positive living messages we though of include: how to make your own hand sanitizer, how often to feed your baby, how to wash hands and why to use a mosquito net

Thank you everyone!

Now there’s a good example of how to look at a problem systemically!

John Oliver gives a terrific overview of the evolution of Uganda’s laws on homosexuality and the build-up of public intolerance throughout the last century: from influences of british colonial days to hysterical american evangelicals to 21st truly unbelievable idiots.

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Relating Systems and Design

The organizers of the RSD symposium take their subject very literally!

This great conference in Oslo gathered a great diversity of participants and speakers in a truly self-organizing event. There were opportunities for very meaningful networking which made people feel interconnected and engaged. From “add the slides yourself” and “find the free coffee” to being rolled up in a wool hank and playing a Norwegian version of curling.

Keynotes included amongst other an inspiring talk by Ranulph Glanville on the similarities between cybernetics and design, and the circularity of conversations as key essence of design in path finding.
John Thackara gave a rather disruptive talk full of examples on how to ‘leave things better’ as opposed to ‘doing less harm’. In his talk there was a clear critic to growth models, urging a mentality shift to turn back to earth.
Michael Hensel was of all the most radical talk in my opinion. Taking an engaging example of the elephant, he lead us through the idea that the change humans impose in the word happens at a pace genetics cannot handle.
Finally, Hugh Dubberly gave a rich talk of perspective in systems thinking and design and proposed a comprehensive manifesto for the creation of a universal systems language for designers.

There was coffee, full rooms, a beautiful exhibition of Gigamaps and local jazzy music. AHO knows how to make the best of itself!
You can read the proceedings and announcement for RSD4 (!) at their website.

I presented with Jairo da Costa Jr. the results of the Product Service System course we organized. We summarized our advise for universities wanting to explore the value of this design approach using universities as platform multiple stakeholders.

Oslo was, as always, beautiful…

Photographs by Jairo da Costa Junior.

Appropriate Healthcare Technologies

15 Hatfields in London was the place to be on the 17-18 September! The Appropriate Healthcare Technologies for Low Resource Settings gathered an amazing quality of participants, of 16 nationalities! Here’s an idea of how in two days the definition of technology was revisited…

“The era of complex and expensive medical devices is over”

Gary Clifford had a strong presence representing the Centre for Affordable Healthcare Technologies and Emory University as co-author of about 7 publications, all related to the use of mobile phones as a central functional unit of low-cost medical devices. The solutions presented ranged from apps to sensitive hardware add-ons that facilitate maintenance of water pumps, training of practitioners or diagnostics. For Clifford there is a huge potential in this idea and you could see his passionate drive for interconnectivity and machine learning, data management, and crowd diagnostics.
Other presentations related to mobile phone applications were made by Biosense, David Clifton, Walter Carlen and Livia Bellina.

There is still a long way to go to bring these projects out of academia… The proposal of creating world-changing social businesses based on low-tech smart solutions and on the reliance on internet safety and virtual data management is a way of thinking – and living – many countries didn’t adopt yet. This “app landscape” suggests a dematerialized world about which social and political implications are not really yet discussed.

“Technology is not necessarily translatable”
Several contributions discussed the importance and challenges implied in training (mostly of local biomedical staff but also of users) from skill sets, to a library of resources, and a lively debate about whether training should be done in partnership-basis or in institutional-basis.
Besides the topics of mobile apps and training, new subjects gained force on the 2nd day and truly challenged the limited definition of technology as “product/service embodiment”. In fact, technology design and implementation are a complex process involving many unattended problems.

“54% out of 169 countries have actually no specifications to support medical device procurement”

Dr. Nakatani gave an insightful presentation about the newly published WHO Technical Specifications of Medical Devices for improved procurement. There was also mention to a future WHO nomenclature for medical devices about which Anna Worm, expressed concerns regarding the inconsistency of creating yet one more nomenclature system rather than working towards the harmonization of the already existing ones.

“Procurement driven by low-cost delivers medical devices with substandard performance and safety”
Jan Huys presented a hitherto-missing consideration about the often neglected aspects of certification. “If you follow standards, you get high-tech equipment”, an example of this is the process validation or repeatability which can only be assured when a device is fully automated. African countries are barely present in the CEN/ISO membership and so their needs are not really reflected.

“Is the effort of donations worthwhile?”
The early findings of a study that maps the donation process of organizations in Canada and Ghana were presented by Bill Gentles and showed how, even when the WHO donation process is properly followed, 30-50% of devices are not functioning after 1 year. This raised a rather provocative question whether the efforts and resources spent in donating used devices are worthwhile. More of these studies are important to effectively ground the evaluation of donations and acquisition of used but also new devices.
Someone actually questioned the process by asking with whom were the initial consultations made since “the higher in the hierarchy, the worse the decisions”. This reflects an important issue about the need for procurement (and prioritization) to be made in consultation with users and technicians and not only by high management employees. On this topic the Tropical Health & Education Trust – Partnerships for Global Health – presented a great exemplar on compiling a set of guidelines and great examples of medical device donation.

Low-cost devices, really?! Why not call them subsidized instead.
Robert Neighbour from Diamedica made a provocative presentation about the lack of consideration for what it takes to develop technology. With a strong business stance he raised questions that challenge the criteria of donors and awards granting support for academic projects of “redundant” low-tech devices. This contribution really highlights that much of the work done in this field is being wrongly evaluated by social rules rather than market rules.

This conference reflected well the multidisciplinarity inherent in global health issues. For biomedical engineers, as well as for mechanical or industrial designers, it is important to acknowledge that we often forget the market side of the development process, the one beyond the clinical trials, but also one that largely contributes to the sustainability of a business. Great conference!

Medical devices in context

I presented a paper entitled “Human factors perspective on the safety environment of nurse anaesthetist training in Haiti” at the Appropriate Healthcare Technologies conference in London.

Abstract: This study focuses on the safety of use of medical devices during a training program of nurse anaesthetists in Haiti. Our aim is to describe five observable near misses from the perspective of Human Factors and Ergonomics. The results reveal specific challenges related to the vulnerable learning environment of the nurse anaesthetists. In the discussion the authors elaborate on four ways in which systemic interdependencies of technology potentially contribute to safety threats: delay of procedure, attention diversion, introducing errors and worsening work conditions. Finally, this discussion proposes a System Design approach for innovation of appropriate medical devices.

I focused on the role of a systems perspective to describe the surgical work context in low-income countries. A systems perspective includes considerations for team and task dynamics, infrastructure, managerial and organizational aspects of work – and the respective handicaps that lead to incidents. This applies for both donors of medical devices and to practitioners but is also a new perspective for engineers designing medical devices.