In times of COVID-19, distributed design had quickly become our reality out of necessity. Fab Labs and maker spaces started distributing machines, companies started collaborating, and designers worldwide opened their processes to rapidly design, and many individuals wanted to help and innovate health and wellbeing equipment in response to the crisis on a global scale. For one, distributed design and digital fabrication can help overcome supply problems in a crisis. For effectively supporting the fight against COVID-19, you need to know, however, where your help really has an impact on medical needs.
Quick Response with Local Production
Paulien Melis, programme developer at Amsterdam-based research institute Waag, works at MakeHealth Lab — a programme where they invite people with healthcare questions, healthcare professionals, makers and designers to co-design and co-develop personalised healthcare solutions. Current markets are only serving a certain amount of people, but some have special needs as the materials don’t fit. That’s where the capacity of makers and designers comes in. By matching them with people with needs and the know-how to use it, MakeHealth Lab facilitates medical innovation on a local scale.
When COVID-19 hit Europe, MakeHealth Lab focused on the production of medical face shields. According to Paulien, it’s critical that medical expertise is involved. “You absolutely need to make sure that it is validated and full proof. Otherwise, you create a fake sense of security and maybe even do more damage by spreading the disease instead of preventing it.” While MakeHealth wanted to push co-designed and co-produced solutions on a European and even global scale via networks like www.carebles.org, it was hard gathering insights from health care professionals in these times. “They were all needed for acute care and medical support related to the virus”, Paulien adds. “It’s amazing to see how fast the maker community responded— bringing their design capabilities, skillset, and power to the table. But designers are no health professionals— validation with research institutes, universities, or healthcare workers is crucial to see if the design is progressing in the best possible way.”
Finding your Network
Not every maker or designer has a network like that. Where do you find people that can help you validate your design? “There are organisations like TNO (Dutch Organisations for Applied Scientific Research) that can help you, but sometimes it’s also the healthcare professionals that reach out because they see a need”, Paulien says. “For example, my dentist is producing and developing a mouth mask together with a social lab for sustainist design.” There are several ways for collaborating and finding each other, the advice is to take the effort to find that match, and make that search an integral part of your design process.
One of the things Waag did was setting up a shop with laser cutted transparent face shields that can be disinfected. They used files are from a validated design from Belgium-based Makers against Corona, where it’s used in hospitals. That’s the power of distributed design: instead of producing in Belgium and shipping it to the Netherlands, local production facilities can reach out to local organisations that facilitate elderly care, home care, or other people that need personal safety measures. “Looking at a larger perspective”, adds Paulien, “you are also preventing becoming dependent on factories in say China, risking waiting for a shipment that needs to be returned cause it doesn’t fit local validations.” Distributed design offers short lines and more possibilities in the production and accessibility of equipment.
Pieter van Boheemen, hacker, engineer, and researcher at Rathenau Institute is one of the makers working together with Waag. Pieter started working on PPE based on a snorkeling mask (Snorkel Mask 4 Life, 2020). The mask itself is available at a well known French sporting goods retailer. Adding a 3D-printed connector and a P3 filter, it should protect you from catching the virus. Pieter’s sister, who is a doctor working at a hospital and indicated supplies were soon running low, was his motivation to start the project. She showed him a picture of a colleague wearing a similar mask and asked her brother to make her one too. Pieter found online communities with researchers, makers, and designers from Chile, Italy, Croatia, the United States, and many more countries working on designs together. In the Netherlands, he connected with many local makers through a Whatsapp group.” Basically, I reached out to everybody that I know that has some connection to personal protection”, says Pieter. “That’s how I also found someone that could validate what we were actually doing, so he started testing the models in a properly certified setting and the results have been what we were hoping for.”
Catering Local Needs
Pieter is using 3D prints for the connectors, which are sufficient for prototypes and single-use. For sterilisable (and therefore reusable) connectors, it is better to produce the connectors by injection molding. The design for the connector is open-source and published on Thingiverse. He published two different files, one for the connection to the mask (from Decathlon) and one for the connection to the filter (RD40). That’s also one of the beauties of distributed design; it makes customisation on a large scale possible.
It’s also what Erik Cederberg, lead engineer at Stockholm based 3DVerkstan and co-founder of Makers of Sweden figured out. Erik and his team designed a quick to print and easy to assemble protective visor, consisting of a frame for holding standard sized plastic sheets. The plastic shield can be made out of any semi-stiff plastic sheet between 0.1 and 1mm, including overhead film, cover sheets for binding machines, etc, as long as it is available in a suitable format. Soon, architecture firms, design studios and maker labs across the world were using their 3D-printers and laser cutters to make thousands of copies of his clinically tested #3DVFaceshield, which are being delivered to hospitals for distribution to frontline medical staff amid shortages of the safety devices. Due to the difference in standards for hole punchers (the ones you get in an office supply store), Erik’s open-source design is available in three versions: for Sweden, Europe, and North-America.
“We felt the need to come up with a design that was effective, fast to print, and can be manufactured in large quantities. We expected it would take a few more weeks before the medical supply industry would be able to start up the process of local production.
To meet short term demand, distributed design and manufacturing would be really useful so we started designing quite iteratively with the help of professionals working at one of the larger hospitals in Stockholm.”
Within 72 hours and many prototypes, they came up with publishable files. Official governmental validation in Sweden costs about eight thousand euros and takes three weeks, so they decided to do an internal validation with five different hospitals instead. After positive results, each local healthcare region independently (Sweden has a decentralised healthcare system where the 21 regions themselves establish principles and guidelines and set the political agenda for health and medical care) decided to take the responsibility for distribution and provided local hospitals with the face shields. By mid-April— as far as Erik can oversee— Swedish volunteers already printed at least 70,000 copies of the design. worldwide numbers are hard to track.
The most impressive story though came from Ghana, where a local surgeon reached out to Erik with the message asking him to send one visor so he could ask a local plastic factory to copy the design. Erik remotely connected him with a local one-man factory he found online who’s building 3D-printers for the West African market. Together, they were able to set up a print farm for the hospital. “What made a huge difference is when lots of maker groups and even companies started pivoting towards injection molding with this design. There are at least seven factories that I know of that are doing that now. Two of them are located in India and they can produce 70,000 copies a day that way.”
Erik wanted to design something that could be made with locally available materials. “Where can we find transparent plastic in large quantities that people can get easily? Office supply stores! Sheets, overhead film, rapport covers, basically everything that is A4 shaped and transparent enough”, says Erik. “The next question is: how do you fasten that on a 3D-printed part? You could use a laser cutter for that but we felt we needed a more common tool.” Hole punchers are something that every household, office, or hospital has available. However, because the dimensions of hole punchers differ worldwide (for example, Sweden has a four-hole national standard that is almost exclusively used), multiple designs were needed. “I have definitely learned way more about hole punchers than I knew before”, Erik answers with a smile. To test the design for the North-American market, he called in a favour from an American friend for help. “In the US, Canada, and in a part of Mexico and the Philippines, a three-hole standard is widely used. The first test showed three holes are not strong enough to hold the sheet, so we designed a frame with six holders which means you have to punch the sheet twice.” In the design, Erik took into account that it is suitable for different head sizes by giving an option to add a rubber band for optimal security.