Prompt:
While trying to develop a low-cost syringe for the developing world context, you (the designer) hit a cross-roads. Constructing the syringe to auto-disable after a single use, an important safety feature, significantly adds to the cost of the design – making it potentially unaffordable for some hospitals and clinics. However, if you don’t add the safety feature, you are enabling the potential for the spread of disease. How do you as a designer proceed?
Glossary:
I will refer the syringe indicated above as the smart syringe, which prevents the plunger being pulled back after an injection or retract the needle so it cannot be used again.
STEP 1: Facts
- The syringe is designed for the developing world context.
- The syringe needs to be low-cost.
- Adding the safety feature to the syringe increases its cost, making it potentially not affordable for some hospitals and clinics.
- Reusing syringes cause more than two million people being infected with diseases each year (Source: WHO, 2015).
- Ethical issues: The designer must decide whether he/she wants to add the auto-disable feature to the syringe that might make it unaffordable for some hospitals and clinics or completely removes the safety feature but facing the risks of spreading dangerous diseases to thousands or millions of people. If the designer cannot keep both the cost low and the safety feature, an innovation solution might be desired to determine the best course of action.
STEP 2: Stakeholders
- Designers
- Hospitals and clinics (administrators)
- Manufacturers/companies that produce the syringe
- Patients
- Doctors and nurses
STEP 3: Motivations
- Designers
- Design a low-cost smart syringe
- Ensure the design meets the need of the patients and minimize the loss for patients if any potential errors might happen to the syringe
- Complete the task assigned by the companies, possibly helpful for promotions if getting good results
- Hospitals and clinics (administrators)
- Treat patients well
- Keep the supply cost low
- Syringe manufacturers
- Making profits
- Keep good reputation
- Patients
- Accessible to excellent and affordable healthcare service
- Do not want to get treated with used syringe and get infected with dangerous diseases like HIV
- Doctors and nurses
- Keep patients away from harm
- Save people
- Keep good reputation
STEP 4: Solutions
Solution 1: Double barreled syringe
Potential solution: Revamp the syringe technology, making it possible to inject highly concentrated biological drug formulations using 7x reduction in force that is required for commercial syringes.
Ethical principle: consequence-based thinking, the designers want to promote more accessibility to healthcare for patients in developing countries. This approach will not only change the syringe technology, but also promote self-administration of drug formulations.
Pros: MIT researchers have recently developed a low-cost, simple, yet efficient technology to inject powerful drug formulations that are too viscous to be injected using conventional medical syringes. In their system, the viscous fluid to be injected is surrounded by a thin coating layer of lubricant. This system of double barreled syringe makes the injection of high-concentration drug formulations feasible by reducing the required injection force by 7 times what is required with a conventional syringe. This technology allows subcutaneous injection of any of the more than 100 drugs that would be otherwise too viscous to be injected. This will help provide high-concentration vaccines and biologic therapies to people residing in developing countries who could not travel to hospitals and clinics from their houses.
Cons: The materials to produce this syringe needs to be very specific to ensure the wettability, an important feature for the design of the double barreled syringe. If the syringe model is more wetting toward the viscous aqueous payload, this might result in a huge loss in the core annular low, making the double barreled syringe less effective than it could have been. In addition, some costs and time also need to be invested on educating and training doctors and nurses with the new technology. New regulations and legislation for the new device might also increase the cost for the manufacturers and prevent the syringe from being accessible to the healthcare and clinics. If we want to promote self-administration of biological drugs at home, training and education programs might also be required to make sure the patients know exactly how to deliver the safe injections and disposals of the syringe.
Solution 2: Wireless syringe
Potential solution: Design a low cost smart syringe but integrate it with Internet of Things (IoTs). This can be used for telemedicine purpose in the rural areas for the low- and middle- income countries.
Ethical principle: consequence-based thinking, the designers want to increase the accessibility of the smart syringe to more patients, particular for those in rural areas.
Pros: This technology makes use of the advancement of wireless technologies and IoTs that can enable the medical devices (syringes) to be accessible and precisely controlled over a long distance. While the cost of the smart syringe might be a slightly more expensive than the conventional syringe without the added safety feature, the “wireless” syringe might allow doctors and nurses to provide better health care to rural area. The ability to treat more patients might also help offset the additional cost of making the smart syringe with the wireless features
Cons: The cost might still increase, and the marginal profits might only return in the long-term. The proposed framework of the technology might also not work well where Wi-Fi or Internet is still inaccessible.
Solution 3: Syringe community prevention program
Potential solution: skipped the safety feature of the syringe, making it more affordable for patients in developing countries; at the same time, using the money saving by not adding the safety feature to invest on syringe community prevention program, facilitating safe disposal of used needles and syringe, education on safe injection practices, wound care, overdose protection, testing for infections, etc.
Ethical principle: community-based thinking, designers want to improve the accessibility of the syringes to more patients by removing the safety feature and thereby reducing the cost of the syringe. More investments in education and training for doctors and nurses might be require ensuring the safe practice of biological drugs injection using syringes.
Pros: This design is the least expensive one among the three solutions proposed, making sure the syringes can be widely distributed to hospitals and clinics.
Cons: This design still leads to many potential risks and might serve more harms than goods to the community. Human can make errors, and no matter how good we educate and train people, there might be always rooms for mistakes, which might result in more than thousands or millions getting infected with the diseases.
STEP 5: Additional assistance
I have looked up research journals from IEEE and Advanced Health Materials to aid in my decision making process. Discussion with my fellows is also helpful to explore this topic at different perspectives.
STEP 6: Best course of action
I would choose solution 1 because it has the highest impact on improving access of patients to healthcare. Although solution 1 and solution 2 both aim to achieve such tasks, I personally feel that the double barreled syringe in solution 1 might do a better job. The proposed “wireless” smart syringes have many more risk factors, including the compatibility of the telecommunication system with the patients and the availability of internet access might hinder the wide distribution of the technology. Solution 3 is also good in its own way, but education and training might take a long time to encourage good practices of safe disposal of used needles.
In the context of the COVID-19 pandemic, not many patients will be comfortable/able going out to medical settings to get treated. So, being able to stay home and self-administer medication to treat diseases really makes a difference to patients, not only in low- and middle-income countries but also in developed countries like the United States. Among the possible solutions, solution 1 offers the best pathway to promote self-administration of drugs and vaccines in a fast, simple, and efficient manner. This can help increase accessibility to healthcare for people in developing countries.
However, it should be noted that if patients don’t need to come to the medical setting to get treated, there might be hidden costs in the training to educate people how to self-administer the drugs and the hidden risks in misuse and over-dosing. In addition, there are associated risks of selling and distributing the high-concentration drug formulations to the public, which might require a stricter and more costly regulation.
STEP 7: Implications
If you read through here, thank you, I know it’s a long text, but you might realize that I am really passionate about technology-driven solutions that can deliver IMPACT, IMPACT, and IMPACT. I am really looking forward to the world where patients can be treated completely wireless, and high-quality healthcare is available for everyone. The impact of novel technology, if implemented in the right way, is tremendous on the lives of people. On the other hand, one simple missing part of the design, such as the safety feature, can easily spread the disease and cost millions of lives.
The coconut team, as we investigated the coconut processing to find better solutions for increased income of copra framers, hope to deliver meaningful solutions that can help not one farmer, ten farmers, but thousands or millions of farmers in the long term. During the process, we need to make sure that practice making ethical decisions so that our solution will not cause more harms than goods. For example, if we decide to design and market a hand-held machine that allows the farmers to process and make their own virgin coconut oil at home for additional income, will it create extra opportunities for farmers or disrupt the workforce flow (e.g., brokers, sellers, transporters)? Will this process be more eco-friendly or unsustainable to the coconut farm, considering that the process of making virgin coconut oil at home might not be as energy-efficient as that at the manufacturing setting? The field-trip in the future will be a tremendous aid to help answer these ethical questions for our venture.