There is no shortage of ideas about how 3D printing is going to be a driver for change and development in low-income countries, but there hasn’t been a whole lot of discussion about how 3D printers solve problems in-country and that’s because 3D printers don’t solve problems at all: design does. A 3D printer has about as much design intuition and empathy as a toaster.
At LimbForge, we partner with experienced NGOs and rehabilitative care providers to arm them with the tools, technology, and training needed to produce low-cost, culturally appropriate prosthetics, ultimately expanding their capacity to provide care. But in order to do that, somebody has to design prosthetics that truly meet patient needs and that are sensitive to the cultural and social context of a given population. On Tuesday, the a LimbForge team will land in Haiti for a week of in-country design and iteration on low-cost 3D printed prosthetics. This in-country research and design process is critical to LimbForge’s ability to develop impactful design. Once a design has been refined, it can be loaded into LimbForge’s software platform and made available for rapid configuration and sizing.
In this first of three posts, we’ll discuss how the LimbForge prepares for in-country work, based on our experience working with patients and partners this past year, before the team heads to our partner clinic, Healing Hands for Haiti, in Port-au-Prince on June 6th.
Build the Dream Team
As with any endeavor, an effective team is key. At LimbForge, we’re bringing a diverse team of engineers, designers, and software developers to iterate on-site. Diversity in a team is critical: it gives the team more “empathic surface area”, more experiences to draw upon to relate to patients, and a greater ability to iterate quickly and efficiently while on-site. In particular we’ve found having that having team members of different ages, genders, and personalities critical to making patients feel comfortable enough to share their thoughts, ideas, and concerns with us. Be sure to bring somebody who is good at slapstick humor, nothing breaks the ice like good physical comedy.
Know the What You’re There to Do (and Not Do)
Every minute counts while you’re on-site. It’s a rare opportunity to have all of the design stakeholders in the same room, so it’s critical to know what is and isn’t a good use of your (and your collaborators’) time. Most importantly, know the constraints of where you will be working and always ask the question “is this something that we can only do here?” This question should be your constant companion when designing and prototyping on-site. Use this question to set clear goals about what you need to achieve while you are on-site.
Some things that can only be done on-site:
- Gathering patient feedback on designs. This is the most important thing that you’re there to do.
- Gathering clinician feedback on workflows and processes. Again, a 3D printer and a 3D printed prosthesis are only part of the solution: clinicians will be the ones that actually make devices every day and fit them with patients. Get their professional opinions about what will work and what won’t: their experience is a tremendous resource, their feedback can point you in valuable new directions.
- Observing existing workflows in the clinic. It’s critical to understand how your proposed solution will fit in with the other workflows and processes that a local partner maintains: they’re the experts, they know how to best deliver care.
Some things that should be done after a site visit:
- Elimination of fasteners, hardware, etc from designs. While extremely important for the final product, replacing steel with plastic is a time consuming and iterative process.
- Optimization of print settings. This is an iterative process that consumes both time and material. The majority of print settings development can be accomplished remotely and then tuned locally.
- Development of interfacing geometries. Another iterative process that can consume valuable print time and design time while on-site. Interfaces and couplings can be developed when there are fewer time constraints.
Know Who You’re Working With
Know who you’re going to be working with and what their circumstances are. If they’ve come a long ways or are spending a long time at the clinic, be very considerate of their time. If they’re staying at the clinic for more than an hour or two, offer to share a meal with them, or to send them home with something to eat, especially if they may not have eaten that day. Make sure that you have a couple sandwiches or snacks nearby. Be conscious of your “cultural footprint” and privileges, recognize that things you take for granted may have different weight in a different culture, and vice-versa. If working on prosthetics, as LimbForge is, consider reviewing and adopting the ISPO Code of Conduct, which provides valuable guidelines for working in low-resource areas.
Optimize Your Processes
Organize and optimize everything and constantly re-evaluate resource and time allocation. Start every day with a quick ten minute meeting to go over the day’s goals and priorities. Document on the fly, taking notes, photographs, and videos. After the working day at the clinic concludes, circle up for a more detailed discussion of what was learned from patients that day and how it will be rendered into actionable design decisions. As you start designing, make sure to get feedback early and often. Manage your print time and machine bandwidth. Prioritize printing when grid power is available to save generator fuel costs. Schedule jobs to print overnight off battery reserves and set alarms if a team member needs to wake up and kick off new prints.
One of the most valuable optimization techniques our team uses for on-site work is design modularization. Different parts of a device take different amounts of time to print. If you are iterating only on one part that interfaces with a second, larger part, create third, smaller module that interfaces between the iterating part and the larger part. This removes the need to re-print the larger part every time the iterating part changes.
On this trip, we are using this technique for the development of our new transhumeral arm’s elbow mechanism. Rather than print out entirely new upper arms and forearms when we make a change to the elbow mechanism, we can just print the new iteration of the elbow mechanism and two interfacing inserts for the upper arm and forearm (if needed). This will easily double if not triple the number of design-print cycles that we will be able to execute on this trip.
Part II: In Practice
In the next post in this series, the LimbForge team will share updates from Port-au-Prince and share how we work with patients and local partners. Have questions or ideas for the team while they’re on-site? Tweet us at @LimbForge3D or comment below!
