IMA - Distributed Manufacturing trials

[Jessicang]

From October to November this year, the cohort of 9 makerspaces will be testing local distributed manufacturing by making a total count of 1,125 products.

125 items will be produced in each makerspace:

• 100 simple devices - cost $2 USD per item
• 20 simple products - cost $10 USD per item
• 5 complicated products - cost $80 USD per item

To not boil the ocean and have some focus, all items will be health care related and donated to local health clinics near the makerspaces.

This thread is to discuss this activity.

[Jessicang]

First question: What should be made?

This Thursday, May 11th, we will present the same question to the cohort. On July 13th, for our 3rd monthly check-in, we will have a work session to discuss which items will be locally manufactured in Ghana, Kenya and South Africa.

What would you like to see made?

[schutton]

Here is the link to the video we reviewed during today’s checkin meeting, providing an overview of how the Prakash Lab’s Foldoscope helps combat Malaria:

How Manu Prakash's Foldscope is Helping to Fight Malaria

[Jessicang]

More ideas on health care related hardware we can find in open source, also shared during the last Monthly Checkin Meetings:

• Menstrual plant pad by Prakash Lab: https://twitter.com/PrakashLab/status/1651516294150361089?s=20
• Catalogue of hardware resources from Hubiqituous project: Learning Centre
• Open Know-How: https://search.openknowhow.org/
• EnAccess for energy access software and hardware open resources : https://enaccess.org/

[unibrow]

The Open Flexure microscope might fit as a complex project: The OpenFlexure project

[BarbaraSchack]

@julianstirling : Open Flexure mentioned above!
And there’s a video shared by Sarah a couple of messages higher. Have you heard of this tiny open microscope: the Foldoscope?

[BarbaraSchack]

@julianstirling : Open Flexure mentioned above!
And there’s a video shared by Sarah a couple of messages higher. Have you heard of this tiny open microscope: the Foldoscope?

[Jessicang]

Thanks for sharing and happy to see you on the Forum

[julianstirling]

@BarbaraSchack

@julianstirling : Open Flexure mentioned above!
And there’s a video shared by Sarah a couple of messages higher. Have you heard of this tiny open microscope: the Foldoscope?

Hi @BarbaraSchack,

My thoughts on microscopes

I have played with a foldscope. The licenses is such that you cannot make your own locally. They may be able to be assembled locally. Foldscope’s can be bought here:

Store Home

The project is an interesting one for me, I think we have in general with OpenFlexure tried to be very careful not to over-promise on our capability. For the WHO malaria diagnosis you need to be able to reliably count malarial parasites across multiple fields of view of the microscope. Foldscope have always been one of those projects that in my mind has promised and promoted far more than it is actually capable of delivering. It is incredible for the size and simplicity, but when you think about the medical uses they are promising it has significant distortion and aberrations. I see it as an educational microscope, with perhaps some use for larger parasites where qualitative rather than quantitive metrics are needed.

I have to say I feel significant damage is done by this form of over-promising from academic groups. They regularly claim use for malaria diagnosis, and make these sort of videos.

These are fold scope red-blood images. I see no way you could reliably count parasites living in these cells.

For comparison an OpenFlexure image:

Notice the clarity of the central sections of the image, yet the images still blur to the edges. To combat this we use an automated stage to take multiple images that overlap and stitch them together to make one large high quality composite image using the centre of 100 different images:

The resulting composite image is about 170 megapixels, and is then used for analysis. Is this good enough for malaria diagnosis? The answer is we think so, but testing is ongoing.

My thoughts on the trials

I think that making some items in a distributed way and distributing them is locally is a great idea. However, I would be very hesitant about producing for clinics unless you know there is a need, and you have expertise and procedures in place to check the items quality and compliance, and that you are making items which do not count as medical or in-vitro diagnostic devices without having license to do so. One way around this is finding clinical partners for testing whether devices are fit for purpose, but there are significant ethical and safety considerations before doing that.

If we are simply testing manufacturing repeatability, I would opt for non-medical uses and distribution.

[BarbaraSchack]

Thanks a lot for the detailed thoughts above!

@julianstirling

I would be very hesitant about producing for clinics unless you know there is a need, and you have expertise and procedures in place to check the items quality and compliance, and that you are making items which do not count as medical or in-vitro diagnostic devices without having license to do so.

@julianstirling

If we are simply testing manufacturing repeatability, I would opt for non-medical uses and distribution.

That’s definitely several elements that we will need to take into account to make choices (recapping your points below)

• need
• expertise and procedures in place to check the items quality and compliance
• items that don’t need a license that the manufacturers don’t have

Some of the thoughts around the ethical questions for testing “fit for purpose” could be to have a different purpose: making materials for health partners that are not medical materials. Could be around lighting for example, or quality of the space for visitors and patients, rather than medical care itself.

[Felix]

I need to agree with this 100%, we did work during and after with Red Cross Memorial Children’s hospital in Cape Town making PPE and later some nebulisers for Asthma, and it is a fine line to walk

@julianstirling

I think that making some items in a distributed way and distributing them is locally is a great idea. However, I would be very hesitant about producing for clinics unless you know there is a need, and you have expertise and procedures in place to check the items quality and compliance, and that you are making items which do not count as medical or in-vitro diagnostic devices without having license to do so. One way around this is finding clinical partners for testing whether devices are fit for purpose, but there are significant ethical and safety considerations before doing that.

If we are simply testing manufacturing repeatability, I would opt for non-medical uses and distribution.

[Felix]

I attended the City of Cape Town Urban Waste Management conference and one exhibitor exhibited this product, a washable sanitary pad.

Washable Sanitary Pads

" Menstrual plant pad by Prakash Lab: https://twitter.com/PrakashLab/status/1651516294150361089?s=20"

Maybe the brief should say “Healthcare” rather than “Medical” as in diagnostic or treatment solutions?

[Jessicang]

It is indeed health-care related. A washable sanitary pad is a very good example of what could be produced.

[schutton]

I agree that focusing on using healthcare as opposed to medical (which connotes diagnostic purposes) is an important distinction that provides a bit more flexibility for distribution. That being said, the more pressing issue, as I see it, is the “fit for purpose” part of this thread.

Discussing here at length what we all think may be a good product fit is interesting in the ideation phase for generating ideas. It will ultimately depend on what what the localized needs of the healthcare facilities are, and that is a question that needs to be asked of the partner organizations. This may require an additional survey tool to gather that information - though, that is something for discussion perhaps, during the next checkin meeting on June 8 @Jessicang.

[max_w]

This is a very interesting thread providing great insights into the factors that need to be considered in selecting each of the three items. Another set of dimensions to add to the “assessment matrix” (I’m using that phrase figuratively for now) for selection is the capabilities of the maker spaces. The items need to be ones that all nine spaces have the capability to produce in terms of processes, machines, tools, materials, and skills.

@schutton can speak more to this, but unavailability of suitably skilled makers might be mitigated by provision of training in some cases, but would need to be verified.

Perhaps unavailability of materials is less critical if the required materials can be shipped to any marker spaces that don’t have them locally, although again that would need to be verified (eg cost and logistics).

However, if any maker space doesn’t have the process/machines/tools needed for making any of the items then that might mean excluding it from selection.

[Jessicang]

I agree that it is something we should discuss with the whole cohort on our next monthly check-in meeting, June 8th. It is important to start talking to the nearby healthcare facilities to understand their needs and inform them on the donations.

[Kwakueffa]

This is true. We could do a quick survey at one or two clinics to see what theirs needs are, then we filter the needs with the concerns raised up here, to fish out what is appropriate to be made.

The point about the distinction between “healthcare” and “medical” equipments indeed brings about the flexibility of what can be made.

Whatever itemor product being developed may not neccessarily help a diesease to be detected or battled, but as long as it fits in a healthcare setting, I think it qualifies too.

[Felix]

products for disability might be another space to look at, this is a local company that produces a range of products maybe some inspiration or ideas. https://shonaquipse.org.za/all-products-page/

[AlexKimber]

Jumping onto this thread with my own comments, for what it’s worth haha. So far, I agree with the jist of this thread - the distinction between medical and healthcare is not only flexible and avoids overselling highly regulated and specialised equipment, but also aids the central purpose of the exercise to test distributed production. It seems fair that in the assesment matrix we include the goals of the testing of distributed manufacturing, such as a range of materials, machines and distributed infrastructure applied across the product categories.

If it helps expanding the range of candidate products, it seems to me a clinic might also need less medicalised products, like toys for children, building maintenance (spare door knobs, I don’t know) and signage - which might improve the healthcare experience, patient turnover and staff workflows.

Regarding assistive designs, say grab handles or mobility devices, even if they’re less regulated than medical devices there are still detailed ergonomic considerations that apply to disabled, elderly, expectant mothers, children etc. Here’s a reference I’ve used before for inclusive design, which would detail the kind of requirements for a product for disability (https://www.routledge.com/Extra-Ordinary-Ergonomics-How-to-Accommodate-Small-and-Big-Persons-The/Kroemer/p/book/9780367392321) (Happy to scan in my copy and share pdfs haha). Not exactly sure how exactly this point applies here, except as a selection criteria for appropriately considered designs, ie. if you have a product intended for use by pregnant people, has the appropriate anthropometric data been used in the tolerancing?

But, if you need to delimit the range of products right down to a handful of ideas, rather than widen the selection pool and making the job harder, then a quick phone call to a clinic bluntly asking ‘what do you need6’ could work wonders.

Relating to my recent research on materials (shameless plug: Scoping Document for Materials and Components - Draft Available for Comments) , it seems to me that setting out as a selection critereon material availability from the outset would be hard - you’d end up in a quagmire of local suppliers, varying vernacular etc. etc. Instead, this is a golden opportunity to use as a product selection critereon a highly detailed material specification, then ask the makerspaces to report on the materials actually used and any substitutions made, as a kind of pseudo inspection certificate. This way, an outcome of the trials could be an intuative sense of material availability, after the fact.

Hope any of this helps Really interesting discussion here, hope the trials go well. Best of luck to the makerspaces and clinics

[schutton]

I like this idea of an ‘assessment matrix’ @max_w ; you are suggesting a simple criteria grid for product selection. If we clearly define parameters for what we mean by “simple item/simple product/complex product(s)” and provide definitions for each additional category (Machinery/Tools/Materials/Skills), an assessment matrix for each product/item type could look something like this:

Each “X” or " " representing group consensus on whether the parameters for each defined category have been met by the suggested item (Option 1/2/3/4…).

Is that along the lines of what you had in mind?