Dialoasis, Design, and Determination

Heading into our big implementation week, I spent a lot of time thinking about dialysis, and what exactly we were setting out to accomplish. My motivation for joining the GMI program was driven by the desire to work to improve the lives of patients around the world. After spending a few weeks in Costa Rica observing in hospital settings and speaking with patients and doctors, I felt like I had a better understanding of why the current systems left many patients with Chronic Kidney Failure (CKD) feeling unsatisfied. For starters, Chronic Ambulatory Peritoneal Dialysis (CAPD) is a rigorous process – many patients require treatment up to 4 times a day, and the process takes a long time. Though this process could be done in the home, patients are mostly unable to do so due to inadequate infrastructure. For example, the environment for the procedure must be sterile, and many homes lack a suitable space for safe therapy. The process also requires a strict hand washing procedure, and the sinks in patient homes are inappropriate. This means that patients must be transported to the hospital daily, which is strenuous to the patient and drains hospital resources. Moreover, the patient’s quality of life declines significantly – they spend a huge portion of their lives in the hospital, and this impacts their ability to work and live autonomously. For me, the opportunity to see firsthand how dialysis treatment is affecting these patients’ lives made the project much more meaningful, and really got me excited to do my best work.

With our patient needs in mind, GMI has set out to devise a way to allow patients with CKD to perform their dialysis treatments in the comfort of their own homes. The team last year set the foundation by designing a small room, or cuartito, that could be set up in the patient’s home to allow them to do their dialysis treatments. Our goal for the past two weeks has been to refine this design, source materials locally, build a prototype, and get feedback from dialysis patients, doctors, and nurses.

In order to achieve this goal, we decided to divide up into three teams. Callie, Anna and Karlee focused on finding the materials we needed to form the cuartito, Chandler and Josh focused on devising a testing plan and interview guide, and Ryan, Tasha and I worked on designing and building the prototype. We had five days to put together all of these pieces so that we could get feedback at Hospital Liberia on Friday morning.

The design and building process was really exciting. We were collaborating with Invenio and using their machine shop, so they ordered the frame and panels that would make up the walls of the device. This allowed us to focus our design questions on the interior, specifically the sink. We felt the sink was one of the most important aspects of our design, so we devoted a lot of time and consideration into how we should construct it. We discussed design criteria for what we wanted the sink to accomplish. First and foremost, we wanted our sink to be effective at giving the user enough space to wash their hands up to their elbows. We also wanted it to be affordable, durable, easy to clean and not take up too much space in our cuartito.

We considered multiple options, including buying a readymade sink. In the end, we chose to design our own. This would allow us to test out our unique design ideas and get feedback, which would be valuable moving forward with the project. It also gave us greater flexibility in making the sink cohesive with the rest of the unit. We settled on a trough-style sink design, as can be seen in the image below. This design allows the user to have a lot of space inside of the sink, which is critical due to the nature of the hand washing process. It also allowed us to anchor the sink to the panels, eliminating the need for legs which take up valuable real estate in the cuartito and make it more difficult to navigate. Though it would be difficult to put this sink together in the short time frame we had, we believed it would be worthwhile in the long run.

Building the sink was very challenging, particularly because we were unfamiliar with the machines that Invenio had, and because of all of the moving parts to our project that had to be settled before we could commence building. By Wednesday afternoon, with the help of Dr. Richardson, we were able to devise a simple way to put together our sink, deciding to just cut and bend the sheet metal into place, and then seal off the edges to make it watertight. This plan seemed simple enough, but we definitely had our work cut out for us (pun intended). The cutting process took a very long time, and the bending process even longer. The bending machine we were using was pretty finicky, and Dr. Richardson, Tasha, Ryan and I exhausted quite a bit of energy trying to get it to cooperate. But after some blood (Dr. Richardson’s), sweat (all of ours) and tears (just kidding), we built a sink!

Other design questions that we considered were layout and the door. We wanted to maximize foot space in the cuartito so that the user could extend their legs during the procedure, or a caretaker could fit inside to help the patient. We also wanted to make the device modular, so that it could be rearranged to suit the patient’s preferences and the layout of their home. When selecting a door, we wanted something lightweight and closable so the patient would be able to keep out children and pets, and also sheer to allow a family member to check in on the patient during the procedure if need be.

After a few long nights this week, we finally were able to get the device assembled. We were pretty proud of how it looked! The prototype was functional and aesthetically pleasing, and we were excited to hear the hospital’s feedback. Our final hurdle on Thursday night was getting the device disassembled and loaded into the truck to transport to Liberia. A few hours of tetris later, we were ready to go!

On Friday morning, we arrived at Hospital Liberia and assembled our device as quickly as possible. It was a little stressful and we faced some unexpected difficulties in getting it up, but finally we had it all installed, got water running through the sink, and began bringing in patients and doctors. The feedback we got was very useful, and it was awesome to see that people were really excited about the project. This device has the potential to revolutionize the way dialysis is delivered in Costa Rica, and I am really excited to see where this project goes over the course of the next year!

The development of our prototype was really exciting, but this week was trying in a number of ways. Logistically, it was difficult for us to accomplish things at times because we all needed to be in different places at once, but we only have one car and only one Dr. Richardson to shuttle us from place to place. This meant that we had to be very flexible with our plans. For example, the design team spent a good portion of Tuesday morning working at a local McDonald’s taking advantage of the free wifi (though honestly I enjoyed this, mainly due to the McFlurries). Moreover, because our work was so intertwined, oftentimes some of our sub teams were left waiting for another part of the project to be completed before they could do their own work. This was a little frustrating at times, and definitely something that could be improved in the future by considering a different structure for dividing tasks.

This week was also our last in Guanacaste! On Friday, our last night at Earth, we met some students from the other Earth campus and hung out with them. It was really cool to hear firsthand about the Earth structure and how they apply the things they learn in the classroom to their work. On Saturday we drove back down to Santa Ana where we will be spending the remainder of the summer. On our way back, we took a detour at Monteverde where we did some zip lining, rappelling, and Tarzan swing-ing! It was an awesome way to decompress after a pretty stressful and taxing week, and the scenery was beautiful.

This week, we are back in the city and will be taking an industry course! Stay tuned for more adventures.

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