Repurposing materials for other uses is not new concept. In India they even have a word for it. ‘Jugaad’ is Hindu for ‘frugal innovation’ – the art of repurposing existing materials for new solutions. In developing solutions for the current Ebola outbreak the concept of Jugaad is especially important: innovating using what already exists increases the speed with which any solution can be implemented.
The event was a ‘hackathon,’ hosted by the Renegade Times at the Oxford Launchpad home of the Skoll Centre for Social Entrepreneurship. Hackathons are a common event in technology circles – programmers spend a weekend non-stop coding to solve specific problems and present their solution to a large audience at the end. Now hackathons are entering healthcare and the methodology and solutions have expanded beyond technology.
Friday night started with talks from medical and infectious disease experts, and conference calls from health workers in West Africa. Small groups formed ideas quickly, brainstorming potential problems and coming up with a range of ideas for solutions. We then chose our teams around the ideas we most supported and got started.
My team focused on Sierra Leone as one of our members had direct experience on which we could draw. Infection control and the lack of protective equipment were identified as a significant problem. The strain on health clinics currently means communities are at high risk of having to care for the sick at home. Increasing the supply of PPE (personal protective equipment) to local communities was not going to be possible in a weekend. How could we help people protect themselves using just the materials they had around them?
One of our team mentioned the case of a girl who had cared for her family at home, protecting herself using plastic bags as gloves. We also found the CDC’s (Centres for Disease Control and Prevention) 60-page document on managing Ebola in the African healthcare setting, in which they recommend using plastic bags if no gloves are available.
We aimed to keep our design as simple as possible, using as few materials as we could: a clear plastic bottle, string, a knife, a rice bag and some plastic bags. We based our design on the CDC’s advice on donning and removing PPE, and my local NHS Trust’s protocol for infection control for viral hemorrhagic fevers.
I had been through Ebola infection control training at my hospital and understood enough of the basic principles to design a rough prototype. As with all health solutions, the final model will have to go through much more rigorous design and screening processes.
At the final presentation one of my team modelled the prototype. The hands and feet were covered in plastic bags (two bags for hands), with larger plastic bags for the suit. We designed the shirt of the suit by cutting holes in the top and sides of a bin bag, then cutting straight up the back, leaving 3cm intact just before the hole for the head. This means you can pull the bag forward, ripping the small piece of plastic remaining at the top and remove it safely like a surgical gown. The mask was made from a rice bag, a local material that is waterproof but also breathable. We closed the base of the mask with a cloth, and used half of a large water bottle as a visor.
There have been others working on similar concepts, but because of the danger of providing advice that if followed poorly could lead to infection, no one has yet developed it fully. The first challenge is to validate the design from an infection control perspective. The second and much greater challenge is to design the information sheet: this requires strong graphic design and communication skills and extensive user testing with local communities. This week I’m connecting with various aid organisations to determine the current opinion on homemade PPE, and looking for a designer to bring on board.
*Since publication further research I’ve conducted has indicated that recommending to use less-than-best-practice PPE, while pragmatic for those that don’t have an alternative, could present significant repercussions if Ebola was contracted while using the ‘home-made’ equipment.