Design a special clinical thermometer for Africa: this is one of the projects being carried out at the Leiden-Delft-Erasmus Centre for Frugal Innovation in Africa. Medical anthropologist Ria Reis and industrial designer Jan Carel Diehl tell the story of how their ‘frugal thermometer’ came about.
The term ‘frugal innovation’ suddenly appeared five years ago, and refers to the development of simplified versions of products and services, primarily for developing countries, adapted to local circumstances and at a low cost –intriguing wonders of clever simplicity.
The Leiden-Delft-Erasmus Centre for Frugal Innovation in Africa studies the conditions under which frugal innovation can succeed and contribute to sustainable, inclusive development. A number of existing or newly set up projects in the field will serve as experiments to help find the answers. Such projects have a dual objective: to develop working, marketable innovations, but also to provide input for frugal innovation research. One of these projects is the 'frugal thermometer' – a clinical thermometer specially developed for Africa.
How it started: fever in Africa
Ria Reis is Professor of Medical Anthropology at Leiden University Medical Center (LUMC) and Africa is one of her regions of research. While studying the attitudes of people and children to fever, she found that ‘the concept of fever just crumbles to dust in Africa.In the Netherlands, fever is a sign that you are ill and is something that you can measure. However, you cannot simply transfer this idea to a different cultural setting. In Africa, there are other dimensions to “fever”. For example, there is a great deal of overlap between fever and malaria. It is made even more complicated by the fact that the idea of “hot-cold” has completely different connotations in traditional African medicine. Menstrual blood, for example, is classified as “hot”. Hot and cold are a kind of yin and yang that need to be kept in balance. If they get out of balance, you are ill. This means that a child that is hot is not necessarily considered to be ill.’
Furthermore, there is a clear case for developing a special thermometer for Africa: very often they are simply not available and, where they are available, Western thermometers are too fragile or complex. This most basic piece of medical diagnostic kit is therefore missing in the ‘doctor’s bag’ of volunteers in village health teams. The back of the hand against the forehead is used to decide: go to hospital, take malaria medicine, or do nothing. The result of this is both under- and over-diagnosis, says Reis. Children are not taken to hospital when they should be, they make the long trip too late, or go for nothing, plus people take malaria pills or antibiotics when they are not needed, leading to medicine resistance.
Then suddenly, in early 2013, the idea for a special thermometer was born. ‘I think that I just said it once’, says Reis. ‘And right away I knew it: it had to be a tool that could be used right at the lowest level of the health pyramid.’
And then came ‘the click’ as they both call it: in the brand new Centre for Frugal Innovation in Africa, Reis met Jan Carel Diehl of the Faculty of Industrial Design Engineering at TU Delft. Diehl is specialised in designing for and with emerging markets. They brainstormed together: what was the best way to develop the idea? What should the thermometer be able to do and show, where do you measure the temperature, what will it look like, and how do you charge it? Niels Chavannes of the LUMC also joined the team. Chavannes is a pulmonary disease specialist and currently a Professor of Primary Care Medicine. He has built up a good healthcare network in Uganda, where serious disorders that are not accompanied by fever, such as COPD, often go undiagnosed or are wrongly treated.
Design in Uganda: prototype 1
The first law of frugal innovation is: design together with local stakeholders. So a team of four Industrial Design Master’s students travelled to Uganda in 2014. They carried out participative research for four weeks, interviewing local stakeholders about the ideal clinical thermometer and sitting with them at the drawing board. They interviewed men and women, people working in healthcare and people who did not, from every layer of the population. They came up with an idea on the spot and made some mock-ups. This resulted in a prototype: a kind of stamp for reading the temperature on the forehead. It not only displayed the temperature, but it showed green for ‘no fever’ and red with a warning for ‘fever’.
This is what the process looked like:
Design in the studio: prototype 2
The prototype and all the information gathered was taken back to the Netherlands and, in 2015, a different team of students went into the design studio for ‘advanced embodiment design’. And then it all changed again. ‘That is what is so great about design’, says Diehl, ‘There is never one straightforward answer.’ One big difference: it was no longer a stamp. Diehl: ‘They thought that a stamp breaks the contact between the doctor and the patient and that is not what you want, you want interaction. So now you approach the forehead from the side, just as you do with the back of your hand. The thermometer is also different on each side: friendly on the side facing the patient and professional/medical on the side facing the doctor. The original battery has also gone. Now you generate your own energy.
And what now? In the summer of 2015, Ana Laura Santos, post-doc in industrial design, will present all the new ideas to stakeholders both in Europe and Africa. New, working prototypes are also being made to support the presentations and for testing in practice in Uganda. A real cliffhanger.
The researchers are also continuing their work on the theory. Reis: ‘If we really want to help people, we need a thermometer with different cut-off points. A number doesn’t say so much, as the danger zone for babies is different for that for older children or adults.’
Meanwhile, ideas are changing about the target group. ‘We are developing the thermometer for healthcare in Africa’, says Reis. ‘But more and more often I think “where could it have even more impact”? In fact, it is needed in areas where there is absolutely nothing, such as conflict or disaster areas. People often say to us “why don’t you just develop an app?”. But after an earthquake like the one in Nepal, nothing works any more.’
The urgency is clear, so when will the thermometer find its way into the doctor’s bag? Diehl: ‘That depends on who we decide to join forces with. With local healthcare organisations? With an international medical organisation? If we decide on the last, it could be available within a couple of years. This is the next step. The thermometer will also be included as a case study in an NWO project that recently received funding at the Centre for Frugal Innovation on new business models for socially-responsible innovation. This is where the Rotterdam School of Management at Erasmus University will get involved.’
The researchers are aware that this is not a normal design process. ‘In fact, the idea in itself is more complex than our thermometer’, says Diehl. Reis: ‘First we thought, we are going to make a product that will be used. This is still what we think, but the thermometer has become more than that. It is also a tool that makes you think about the function and impact of such a measuring device in frugal circumstances, where you do not have the luxury of choosing between simple or high-tech, with user instructions in 21 languages.’
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