Médecins Sans Frontières (MSF) work in some of the most difficult conditions in the world, bringing vital medical care to the victims of conflicts and natural disasters. As first-responders to global emergencies they need to be able to set up a medical camp anywhere in the world in less than 72 hours. However, emergency-response tents are not ideal places to treat patients – they are difficult to keep clean, difficult to use equipment in, and have poor working conditions for medics. Our design team from TU Delft were asked to see whether a better solution for disaster-zone shelter could be found.
After research with MSF, the problem was redefined. Rather than trying to make a more robust shelter – which would slow down their critical deployment speed – quality of care in the existing fast-deploy tents could be greatly improved by designing some low-cost, easily transportable furnitures which could be added to any structure and adapted as the circumstances of the disaster change. Two exemplary products, a modular storage system and a combined sterile space and seating unit, were designed and prototyped.
Research: Getting to Know MSF, Product Concept: Turning Shelter Inside Out, User studies: Research from Afar, Problem Analysis & Design Requirements, Creating a Design, Product Detailing, Prototyping & User Tests, Final Designs,
MSF: Essential care in difficult conditions
Getting to know MSF
We started off with a co-creation workshop with over 30 MSF staff – both field medics and staff involved in planning, supply chain and purchasing. We asked them to create a timeline of the medical camp, from the first planning to the end of the disaster, and to identify and brainstorm some solutions to problems of shelter.
This gave us an insight into not only the problems they faced, but also the culture of MSF. Staff work in constantly shifting situations, so any product designed for them must be flexible, allowing for customization and improvisation. Products must be intuitive and have immediate impact, since any minute a medic spends away from a patient is a minute wasted. Quick deployment is key, but a camp intended to last only a month can end up staying for years if a conflict or disaster drags on.
Turning Shelter Inside-Out
Early in our design work we realised a problem: any shelter that could create conditions comparable to a ‘’real’’ hospital would be too bulky and expensive to meet MSF’s need to deploy within 72-hrs. Instead, we proposed turning the idea of shelter ‘’inside out’’ – instead of improving the shelter itself to meet medical needs, products could be created to bring a high quality of care within any shelter, however basic. In addition, we found that in fact MSF in practice did not only use tents, but often set up medical care in whatever local buildings it could access. This strengthened the case for a flexible, product-based solution. We focused on three key problems to solve, which had been identified during the co-co-creation session: hygiene, drug & equipment storage, and a comfortable working environment for medics.
Researching From Afar
To turn our idea into a design we needed to learn in detail about how the medics worked – their daily journeys, and the ways they physically interacted with equipment and patients. The places where MSF work are dangerous and travel is restricted, and internet connections poor, so we had to do this without actually going to the field, or even being able to observe it on a live web connection.
To get around this we developed an iterative way of working. We first analysed videos taken in the field, and then explored the observations we made in a phone interview with staff. We then went back to video analysis using new insights from the interviews, and repeated the process, iterating models of problems and behaviour as we went.
From this analysis, we found that hygiene, storage and medic comfort were all at their most difficult during bed-to-bed care, when the medics were doing their ward rounds. Patients are often treated while lying on or close to the ground, so medics kneel or squat, potentially hurting themselves or compromising hygiene, and have no sterile surface on which to place equipment.
‘Nursing trolleys’, normally used to transport medicines to patients on a ward round, are difficult to transport to the field and hard to use on uneven tent floors, so bringing patients medicine can be time consuming. Storage of medicine and equipment in tents also quickly becomes chaotic – some medicines are stolen and others attract vermin.
(for privacy, MSF stock photos have been used in pictures below)
In order to consolidate the many different problems and requirements we found, we defined our design requirements in terms of three levels – the direct interaction of the medical and the patient, the environment of the tent or other structure, and the systems of logistics and culture in the organisation in general.
Creating a Design
Our team brainstormed various concepts to deal with these issues, and identified the most promising as a combined seating/storage solution for tent medics, which would give them a place to sit while treating patients while also allowing them to transport tools. Some early initial concepts for this are shown below:
In the design process we realised that it would not be possible to make a ‘one size fits all’ product, since many of the requirements of the product were directly in conflict with one another. To take this into account, we created ‘’design tradeoffs’’, and mapped potential solutions on to them for evaluation.
Because of the heavy involvement of medical equipment in the design, we made a ‘’tool map’’ for each common procedure, showing which tools were required at different points in the process, and used this to figure out tool storage, work surface and disposal requirements. We used the tool maps as the basis for storyboards showing how these tools would be accessed and used in practice.
Prototyping & Final Concepts
We developed our ideas with basic ‘’looks like’’ and ‘’feels like’’ prototypes, and tested these with retired MSF staff in the Netherlands, and sent videos of them being used to staff in the field for analysis.
Mobile Ward Kit
This kit is a ‘’mini-clinic” which a medic can carry with them from bed-to-bed. It gives them a place where they can sit or kneel to comfortably to make eye contact with the patient, a sterile surface to work on, a place to safely store medicines, a box to dispose of waste and a light to see what they are doing.
This small kit can be deployed on the first day of a disaster and can improve hygiene and working conditions without affecting set-up time.
Modular Nursing Unit
Drugs and equipment are already sent to the field in standard shipping containers – the Modular Nursing Kit modifies these so they can be turned immediately into a clinic storage facility and workspace.
This project was performed with Anand Khandelwal, Romi Buquet, Arie de Kam and Boris Boom.