“Everyone, make sure you are here on time tomorrow, we are visiting Amana Hospital and have an appointment at 10 am”
When Julia announced we were going to visit Amana Hospital, our excitement was palpable. I immediately went from sleepily designing and CADing an interlocking puzzle-like organizational system for the low-fidelity prototyping table to typing up questions for feedback and needs-finding interviews. It had been a long week of engineering design workshops and small projects around the studio, and I thought we were well primed to sink our teeth into something more substantial and challenging. I could not wait to gain first-hand experience at finding problems and developing solutions.
During our visit to Amana Hospital, we had the chance to tour and observe their surgical theatres. Dr. Marie, who had kindly agreed to be our tour guide, took us into an OB/GYN surgical theatre that was not in use anymore. According to Dr. Marie, almost every medical device around the theatre did not work. The pulse oximeters, suction pumps, and blood pressure monitors were all malfunctioning. Even the surgical beds were unstable and missing some features. They shook so much that performing CPR on them was dangerous. As they had no vertical movement, the surgeon had to operate standing on a stool. Dr. Marie told us about a time that a surgeon fell off the stool and injured himself during surgery.
I was shocked. This was my first time in a surgical theatre, and I kept looking around, trying to take in as much as possible. Wearing an oversized hospital gown, gloves and hairnet, I tried to scribble observations and draw diagrams into my tiny notebook. Our team spread around the surgical theater, looking at different devices, translating signs on the walls, asking questions. We knew Amana was counting on us to fix their devices, and we were focusing on absorbing as much as we could from our surroundings.
We left Amana excited but slightly intimidated, with a vaguely defined task looming ahead. We were buzzing with new ideas and opportunities for the future. I was struck by how many medical devices were donated – fancy, sophisticated, branded equipment, from big, established medical device companies- most in disrepair, lining the sides of the operation theater. It broke my heart to think that these crucial devices sometimes were the difference between life and death in a surgical setting.
From Amana, we brought back a malfunctioning suction pump, caked with an unidentifiable dark maroon substance (we later identified this substance to be blood). We had decided to begin our relationship with Amana by troubleshooting and trying to fix this pump. It sat in the corner of our design studio. The six of us studied it from afar- where to begin? We decided to start by addressing the obvious biohazard. A trip to the supermarket and a pharmacy equipped us with cleaning supplies and medical grade gloves. We wheeled the suction pump into the men’s bathroom and cleaned the outside with all the disinfectant we could find.
Once the outside was clean enough, we decided to tackle the inside. On the trip back from Amana to the design studio, we had noticed some mysterious sloshing noises coming from the inside of the pump. We very hesitantly opened the back panel of the pump, to see the inside covered in much more of the same dark-maroon substance. There was solidified, crystallized blood caking the inside as well. By now, it was the end of the day and we decided to go back home, take a break and come back refreshed and better equipped with more PPE.
The next morning, Julia decided to split us into teams so that we could effectively finish our tasks before the next Amana visit. Joel, Sadick and I were assigned the suction pump. Before opening the pump and beginning to clean the inside, we decided to plug it in, turn it on, and see if it would work. Much to our surprise, the pump began whirring, and the pressure gauge showed -0.9 bar as expected of a well-functioning pump. The only problem that we noticed was that the pump made a lot of noise, but we realized that this could be easily solved by cleaning out the tubing system inside the pump. We then decided to open the pump and clean the insides. Dressed in makeshift garbage-bag gowns, we took out all the tubing, labeled it, and cleaned it well. Once we put the pump back together, it worked like it was brand new. We tested it on some water using a straw and some play-doh to replace a missing pipe. Not only did it suck all the water, it also regulated the pressure well.
Once we were done with our maintenance of the pump, our team sat down to reflect on our observations. We deduced that the solidified blood inside the pump was due to the backflow of body fluids into the pump once the canister overflowed. On further examination, we noticed that the protective valve on the canister lid was missing. It now made sense that the suction apparatus had stopped working due to the presence of fluid inside the pump, and as this fluid solidified, the suction capacity of the pump returned to normal. We realized that this problem could be avoided by training users on how to safely use the suction pump. In addition, we decided to develop a technical solution that would prevent backflow as well as alert users once the fluid began to overflow. On our next visit to Amana, we were happy to take back a fully functional suction pump and a list of recommendations, which we presented to a panel of doctors and nurses. Our audience was astonished to see the clean suction pump and were receptive to our recommendations.
Taking apart that suction pump and putting it back together taught me a lot about how medical devices function. After looking into the suction pump, I realized that the technology behind it is quite straightforward and easy to understand. It reminded me why I first fell in love with engineering – I am so fascinated by finding simple, elegant solutions to big problems. After studying the backflow problem, I realized that along with innovating new medical devices, it is important to make existing solutions easy to use and intuitive for settings like Amana Hospital, where they are used heavily, often in a rush.
An important part of our internship and experience here is to gain a thorough understanding of the social and technical context of our innovations. Before I visited Amana, I thought this was limited to hospital visits, observations, and talks with doctors, nurses and health professionals. Now, I have altered that definition. I realize that active participation- opening, troubleshooting and using existing medical devices is incredibly essential while creating new devices. Without literally getting my hands dirty and having the experience of taking apart and reassembling the suction pump, I would have never fully appreciated the elegance of the solution, the challenges to the design in a low resource setting and the importance of incorporating human factors into technical designs. I’m sure that this learning will help me during this internship and beyond, as I learn more about appropriate designs for global health challenges.