It's been more than a year since the deadliest ebola outbreak ever hit with full force in West Africa. And while the virus has retreated, the reckoning over the best approach to treat the inevitable next outbreak is only gaining speed.
Picture: AP Photo/Brynn Anderson.
The debates ranges from the delivery of US-made military hospitals to the way social outreach about prevention is spread in affected countries. And then there are the suits. The design of the suits nurses and doctors wear to treat patients is probably the biggest liability, as well as the most important line of defence for aid workers.
And over the last few months, it's been the subject of a number of projects at universities and design labs that hope to create a better one.
Every Idea Worth Pursuing
Renfrew Group, a London-based design studio, is among them. Renfrew's work ranges from power tools to motorcycles, but it also has a large group devoted to medical products -- that could mean working with scientists to design an artificial pancreas to building a better chair for giving blood.
It also includes products for infection control, as founder Bruce Renfrew told me. In 2008, the group designed an isolation room for the UK's National Health Service that would allow a patient to be isolated within a larger ward thanks to a temporary structure set up around their bed. Embedded filters, air movers, washing facilities, lighting systems, and ventilation would let the patient stay comfortably within the unit without needing the entire ward cleared.
During the crisis, an NGO reached out to Renfrew about designing an improved suit for health care workers. The project inspired the team to think about what patient isolation might look like in the future, and raised the idea of what Renfrew calls "reversing the whole thing." Rather than caregivers putting on a suit, what if a system focused on "protecting nurses and health care workers by putting the person in the protective suit"?
Renfrew's concept is, essentially, a body-sized version of the isolation chamber: A pressurised suit that contains all of the systems necessary to keep a patient comfortable and biologically isolated, from a HEPA filter to a faecal waste management system, as well as an intercom, a tube system for feeding the patients, and hatches that would allow healthcare workers to touch and treat the patient inside. The World Health Organisation is waiting to assess the first working prototype.
Still, it's far from an intuitive solution. Dozens of questions sprang to mind when I first saw the concept: How would you keep the suit clean? Ebola, a notoriously messy virus, would make it nearly impossible. And what about bed sores from the heavy-duty material? Wouldn't it be expensive to outfit each patient with all of the hardware necessary for the suit?
The group is keenly aware of the enormous technical challenges of the project -- as it develops working prototypes, it is working through these questions. Waste would be handled by existing faecal waste treatment systems that can be left in place for a month. All of the hardware, from the filters to the waste systems, are essentially modular -- the suit can be disposed of, and the systems can be re-used with another patient. Another big challenge is how to get products into and out of the suit -- for example, cleaning wipes or tissues. A one-way hatch could be used to get objects into the suit, while the finished wipes could be deposited into a valve-controlled waste hatch. The material, and the system to keep contaminants inside, is patent-pending.
So why, you might ask, do they want to reinvent the wheel? There is one major benefit to the patient suit -- and it's social and emotional. Patients in ebola wards are scared, isolated, and often unable to even see the faces of the suited nurses and doctors caring for them. Renfrew's design is focused on improving that experience. "It allows the patient to interact with others, to hug their family safely, for example," he says. "But it also means that they can do the stuff anyone else can do, like reading a newspaper."
It's far from the most realistic proposal floated in the wake of the ebola crisis. But it does a pretty good job of illustrating the massively complex design problem that has to be solved to control ebola.
From Artists to Wedding Gown Designers
Earlier this month, NPR interviewed an LA artist named Mary Beth Heffernan who is trying to help solve the same dilemma as Renfrew Group: How to make patients feel less isolated. As she explained to NPR's Nurith Aizenman, the personal protective equipment used by healthcare workers is nothing short of terrifying:
"They looked completely menacing," says Heffernan. "I mean they really made people look almost like storm troopers. I imagined what would it be like to be a patient? To not see a person's face for days on end?"
Heffernan's idea, which she describes as "almost stupidly simple," is actually brilliant in its simplicity: Just take a snapshot of the healthcare worker -- smiling -- and paste it to the front of their suit.
Some scientists even go so far to argue that full-on pressurised suits for healthcare workers might not be necessary at all. A recent PBS report on suit designs pointed out controversial editorial in The Lancet by three doctors from University of Valencia last summer argued that since the ebola virus is primarily transmitted through secretions -- blood, saliva, and faecal matter -- the expensive, heavy, and panic-inducing pressurised suits used in some wards are unnecessary for effective treatment. The piece spurred a huge amount of debate (and at least one clarification from the authors) in the medical community. It also showed how finding the right protocol to treat ebola -- and to treat patients with ebola -- is a hotly-debated topic within the medical community.
A black light illuminates traces of ultraviolet-responsive liquid that represents fluids which could transmit the Ebola at Madigan Army Medical Center Madigan, where training uses realistic patient simulators that speak through microphones and can express simulated bodily fluids. AP Photo/Elaine Thompson.
It's also being debated outside of it. Last fall, Johns Hopkins University invited hundreds of people from disparate fields -- including at least one wedding gown designer -- to participate in a "hackathon" to build a better suit for ebola caregivers. One of the suit designs that came out of the hackathon was ultimately chosen for funding by a separate design challenge hosted by the U.S. Agency for International Development, called Fighting Ebola: A Grand Challenge for Development.
The suit solved some of the most important problems with current personal protective equipment. To deal with the oppressive heat, it has a filter at the mouth and above the head to suck in fresh, dry air and control humidity. Rather than goggles, a wide clear face plate lets patients see their doctors' faces. Perhaps most importantly, removing or "doffing" the suit, which is arguably the most dangerous part of the process, has been completely overhauled. It's difficult to describe in words the new system -- it's a brilliant ergonomic feat -- so just watch:
Thanks to funding from USAID and a number of other organisations, the suit is now being developed and studied for possible manufacturing.
Supply and Demand
Renfrew says each of the group's suits would run at about $US1,500. That's compared to about $US80 for the suits currently worn in many ebola wards. While the need for a new suit is real, the budget for a better suit is not. And as Co.Design's Mark Wilson pointed out last fall, the companies capable of making a better suit have no financial incentive to do so -- with demand rising and declining quickly and unpredictably.
A Chinese worker manufactures protection suits that meet the standards for use by healthcare workers treating Ebola patients at a factory in eastern China's Shandong Province. AP Photo/Wayne Zhang.
On a more abstract level, the quest to build a better suit has thrown the role of design on the global stage into clear relief. Design is about human factors, understanding the needs and circumstances of the user -- including the supply chain issues. Earlier this month, The New York Times published an in-depth look at why the US's ebola treatment wards sat empty in Sierra Leone during the outbreak last summer, concluding that an unpredictable virus left the government unable to quickly adapt and local communities stepping in to take charge of preventative and educational efforts.
As the 12-month mark of the worst ebola outbreak in history passes, the medical community is only just getting started studying why efforts to contain the virus did or didn't work. Building a better suit is part of that. In some ways, it's the most important design challenge of the century -- and one that will take decades to resolve.