Student Mini Grant: Project Alivio

Project Alivio Team

Project Alivio is a multidisciplinary global health project team that is a part of Michigan Health Engineered for All Lives (M-HEAL). Our goal is to reduce the incidence rate of pressure ulcers in San Juan de Dios hospital. What makes us unique as a project team is that our 19 students work as a co-design team with the Students Association of International Medical Research (SAIMER), a medical student organization from the Universidad de San Carlos in Guatemala City. As we design our solution, we are constantly receiving input from peers our age with more medical experience at our target location.

Pressure ulcers, or bedsores, form when a patient is exposed to pressure for a prolonged period of time. This pressure restricts proper blood flow to a certain area on the body, usually the coccyx, heels, back of head, or elbows, causing skin and tissue damage. To prevent pressure ulcers, nurses turn patients to offload the pressure exerted on the body. Pressure ulcers have high incidence rates in Guatemala City for many reasons, but the factor we are targeting is the understaffing of nurses.

Our team meets for several hours a week to design, build, discuss progress, and plan next steps. With the input of professors, physicians, and nurses from both universities, we hope to design a sustainable solution for our end-users. We also value offering our members a meaningful and educational project experience.

Project Alivio team members we were on our last needs assessment trip when we were still working at mobile clinics with a doctor.
We were on our last needs assessment trip when we were still working at mobile clinics with a doctor. At the meeting shown in this photo, we discussed our project and potential issues to try and develop a solution for. Soon after this photo was taken, we decided to pursue pressure ulcer prevention

This spring, from April 29th to May 10th, seven of our members will be traveling to Antigua, Guatemala. In past, we have made two trips to Guatemala to conduct a needs assessment, which is how we narrowed the need to pressure ulcer prevention. This will be the first trip that is focused on the design itself. We will bring some sketches and prototypes of different concepts to show to our stakeholders to receive feedback. Besides the project itself, the trip will be a great opportunity for some of our newer members to learn more about the global health scene and feel connected to this project.

Anticipated Results

In our meetings with physicians, nurses, and students, we anticipate that we will receive lots of diverse feedback on our designs. As these people are our end-users, their input is vital to the success of our socially-engaged design project. Another component of this is understanding the cultural context in which our prototypes will be implemented in. Although we can remotely ask for feedback from the members of our co-design team, we need to physically experience the context of our end-environment. There is no better way to understand how Guatemalan hospitals differ from hospitals in other countries.

A second result of this trip is that we will identify and fill the gaps in our knowledge of the nurses’ tasks and responsibilities during a normal workday. We need to get a better sense of the priority patient-turning, as well as understanding what else the nurses have on their plate. Though preventing pressure ulcers is the main goal for us, the nurses will have to perform other tasks for the patient. Being able to shadow a nurse in the Hospital Nacional de Antigua to see what they deal with on a day-to-day basis will inform us on how to best structure our solution so that it fits in with their demanding schedule.

In terms of the design project, these two results will contribute to our final goal of the trip: deciding on a single concept to pursue for further prototyping. This is the most measurable design goal of our initiative. As there are many factors that contribute to the high incidence of pressure ulcers in San Juan de Dios, we also have many potential solutions. It is not, however, in any of our stakeholders’ best interests for us to decide on the final solution, which is why we need their feedback.

The benefits of this trip don’t end there. We also get to meet and work with our co-design team in-person! Every week, the leads of each team video chat to discuss progress and plan the next steps. Besides our summer pen pal system, there is rarely a chance for the other members on the teams to meet each other. Each member of each team joined with the desire to work with a team of peers from the other country. Very rarely is there ever an opportunity to work on an impactful, extracurricular project with students internationally. By going to Guatemala and meeting the medical students and doctors in SAIMER that we are working with in person, we will be able to create friendships that will easily transcend any sort of “partnership” that may be in place already. Both sides will feel more comfortable reaching out to the other on a more regular basis, allowing for improved communication, and thus, stronger work together on the project at hand. No matter what happens, we hope to return from this trip with good friends in Guatemala.

Finally, the most measurable anticipated result in terms of our members involves the leadership skills they will develop while on this trip. Members who go will already be able to feel more ownership of the project, which can allow it so be sustained for years. We expect the members who attend this trip to be future leaders of our team, as they will have more knowledge of our project than the newer members who join next year. This is why we would like our trip to be accessible to any member on our team who wishes to go.

Next Steps

To summarize our anticipated results, the goal of our trip to Guatemala is to receive feedback on our project, decide on a concept to pursue for future prototyping, and foster future leadership for our team.

After we return from the trip, our next goal is to meet with the rest of our team over the summer to analyze the qualitative data we collect from our interviews. Both co-design teams will rank each concept based on the user requirements (i.e. reduction of nurse responsibility, duration of use, etc.), team interest, and overall feasibility. We will use this to determine which prototype to further pursue starting in the Fall 2018 semester.

Since we value the educational aspect of this project experience, reteaching skills to the new recruits will be one of our primary goals in the beginning of the upcoming semester. After the trip, these new recruits will be able to interact with members of SAIMER earlier on in their experience. Once ready, we will resume prototyping.

Depending on the concept we choose, the team will split into sub-teams to work on designing each component. Fall will be mostly focused on modeling these components, and fleshing out the small details in the design. In Winter 2019, we will began to build, which will be a new, but extremely valuable experience for many members on the project. If we can have our first prototype prepared by the end of Winter 2019, we can travel again to Guatemala to test the prototype and gather feedback. Throughout all of this, we will be seeking out the advice of many U-M resources, including the Center for Socially Engaged Design, and the U-M Libraries.

Fund Allocation

Our project is starting to prototype potential solutions to the pressure ulcer problem in San Juan de Dios Hospital. We are currently working on representing different mechanisms to prevent pressure ulcers by creating four different prototypes to take with us to Guatemala in our upcoming trip in May. These prototypes, while low-fidelity concepts, still require materials. The funds we have received from this grant will be directly used to purchase the necessary prototyping materials. Some of these materials include pressure sensors, foam, sheets, springs, and silicone patties.

Any remaining funds will be allocated towards travel compensation, because it is important to us that this trip be accessible to any of our members, regardless of background. Travel expenses include, plane tickets, transportation in Guatemala, and housing.

Library Mentor Support

Project Alivio has had the privilege to work with one of the head librarians of the University of Michigan’s Engineering Library, Leena Lalwani. We have had multiple meetings with Leena discussing our project’s direction to see how the library could best assist us. She has introduced us to multiple citation management programs to better organize our research and has connected us with other research opportunities the University of Michigan offers through our libraries. Our project has a great deal of conducted research that has not been organized, while also having to connect new research to the direction of our project. Leena and the staff at the Duderstadt Design Lab have provided Project Alivio with a tremendous amount of help. Even after receiving the grant, we would be honored to continue working with Leena to better understand everything the libraries have to offer as we began prototyping next year.