Medical aid is a good story. We’ve all seen articles about well-meaning groups donating X-ray machines and incubators to needy clinics in the developing world. What we don’t see are those same devices when they fail as little as six months later — or even dead on arrival — because they weren’t designed to operate in these environments.

About 90% of medical technology that reaches poor countries is hand-me-down equipment designed for first-world facilities. Expecting it to keep working is like expecting a used Rolls-Royce to survive the Paris-Dakar Rally. And after it malfunctions, it’s usually junked.

In response, some designers have felt that we need to send over cheaper versions of the high-end equipment, the equivalent of economy cars. But what these clinics really need are Land Rovers — devices designed to be rugged, accessible, and easily repairable in the field.

Fortunately, increasing numbers of professionals in the medical equipment industry are becoming interested in applying this different design philosophy to devices aimed at developing countries. My lab at MIT, Innovations in International Health (IIH), is taking this approach even further, by getting everyday makers around the world to design and maintain their own medical technology.

MacGyver Health Care
In developed countries, we rarely think of modifying medical devices. Isn’t that the job of a professional? But in most of the developing world, doctors, nurses, and health care workers tinker with failing medical technology every day to fix it or make it work better.

Using the Drug Delivery MEDIKit in Nicaragua.

It’s tragic that Daniela wasn’t proud of her innovation. But in the IIH lab at MIT, we’re developing MEDIKits (Medical Education Design and Invention Kits), construction sets designed to encourage invention among doctors and nurses in the field.

MEDIKits: Designed for Hacking
Our MEDIKits currently come in five flavors: Drug Delivery, Lateral-Flow Diagnostics, Lab-on-Chip, Vital Signs, and Agricultural Prosthetics. The kits started as boxes of parts assembled to familiarize MIT students with medical devices, and evolved to include linear components that you can assemble like Lego bricks into a final device. Through the process, we developed a modular design language to help users see the underlying logic to connecting the parts, and added physical stops to keep some components within safe ranges of operation.

Nothing beats field experimentation to understand whether a kit works. In our case, we would run across the river to the Boston hospitals and share the kits with colleagues, and then fly to Nicaragua, open the box, and see what people would do with them. Each kit provided us with insights into the design of an invention space — which ultimately is what you want.

The Drug Delivery kit.

We designed the limits of our early kits carefully, but when users began to snap on, extend, and test their creations, something emerged that we did not anticipate: they hacked our kits. It starts with someone asking permission to simply cut a piece of tubing and bypass our carefully designed coupling. Or taking a part they find in one kit and using it for another, for example, adding diagnostic tubing into a mechanism to disable syringes for safety. As users take ownership of a kit, you as the kit designer become less involved in training people how to use it.

So for the kit to be successful, you have to Design for Hack. And while it’s impossible to predict every type of device a kit can produce, you can start with a core set, add degrees of freedom to that core, and then anticipate and design areas in which those degrees will be hacked.

An Agricultural Prosthetics kit in use.

The Agricultural Prosthetic MEDIKit uses a universal gripper made from PVC, bicycle inner tubes, and a soda bottle to attach most farm tools onto the arm or forearm of an amputee farmer. Each part of the kit follows the same three principles: core device, modifier device, and consumables.

Since the price of all three is so small, users have no problem in modifying the core components to make them work better. One person did away with the MIT-designed inner tube, and simply cut a notch in the PVC joints to let the excess tubing out of the way, creating a sling to carry the whole thing. And instead of using the shorter parts provided, they quickly attached long pieces such as broomsticks and telescoping fruit pickers.

Languages of Design
If you’ve ever tried to explain over the phone something like how to replace a headlamp in a foreign car, you know how frustrating it is to lack a language of design. “The little plastic knob with screws … yes I understand there are four knobs, try the first one….”

We realized that many of the components we included in the kit might be foreign to their users: English-language labels, injection-molded parts, tiny inhaler mechanisms, reagent combinations. To avoid confusion, we created a Language of Design, a way of color-coding each component in a logical manner so that people can identify its function immediately, and share their designs simply by describing the sequence of coded parts, and not the often-intricate mechanisms themselves.

The PuzzleDx kit design for Lateral-Flow Diagnostics.

So we color-coded different puzzle pieces according to the reagent paper contained within and cut slots in the pieces to connect the sample collection and reagent papers when the puzzle pieces were joined. By sharing the types of color combinations and the order in which they’re connected (which can be as easy as snapping a picture on a cellphone), users can easily re-create experiments without having to publish a formal protocol.

By using Languages of Design, you encourage communication across your user communities, facilitate understanding, crowdsource patterns of inventive behavior, and allow recognition of those patterns. If the Flickr MEDIKit group is getting filled with pictures of prototype combinations with the Yellow, Green, and Blue reagent blocks, it may mean that manufacturing engineers should really start looking at mass-producing glucose, ketones, and human chorionic gonadotropin combinations.

When was the last time your pregnancy test did that?

Toys: Local and Globally Available Materials
A toy helicopter has a rack and pinion mechanism. A toy Ferris wheel turned on its side is an excellent centrifuge. A scrapbooking vinyl cutter is a pretty good CNC machine for making microfluidic channels. Makers have made repurposing materials a competitive sport, and health hacks are no exception. While many of the parts in our kits come prepackaged, we’ve also seen our users find and invent locally available replacements and accessories from toys.

Now, when we go into a toy store, we see a mechanism paradise. Toys make up an amazing supply chain of cheap plastic and electronic mechanisms with fairly good tolerances for most medical applications. Early on, our team was intrigued by what we call the glucometer and the Gameboy paradox. Both of these devices have equally complex electronics and comparable retail price points, but dramatically unequal distribution. I can find a handheld game console almost anywhere around the globe, even in very small towns in the developing world, but in Estelí, Nicaragua, 16 different clinics had to share a single glucometer.

Lab-on-Chip microfluidics module on Lego base.

Trickle-Up Innovation
Places like Nicaragua have some of the poorest areas on the continent. But what about Nebraska? What about healthcare at home? For years, health technology has been shielded from tinkering and DIY invention because of the perceived barriers to entry: you’re not a doctor, you’re not a biomedical engineer, you require professional supervision. Health equipment has to be safe and rigorously tested, first and foremost.

All true, but along the way, that message got blurred with professional requirements that are not answering our need to make healthcare affordable. Try to buy a simple pillbox that lets you know when grandma took her pills: some are several hundred dollars. Makers build bird feeders that have the same functionality for a fraction of the cost. A surgical sterilizer costs $1,000–$8,000. But Anna Young got the same functionality by hacking a $30 pressure cooker and adding some DIY solar technology. A $30,000 incubator? Dr. Kris Olson made an incubator out of car parts for about $1,000.

Medical invention kits have the potential to lower many of these barriers and put health hacking back into the hands of users and of patients — the people who have the most to gain from affordable and elegant innovations. As the developing world gets a head start on DIY medical technologies, we’ll see many of those user-generated inventions make their way back to richer countries.

An Invitation
As skyrocketing healthcare costs converge with the democratization of making, many more people will hack health. Whether it’s putting RFID stickers on pill bottles to help patients take their pills on time, or hacking bike pumps and scrapbook cutters, health is filled with fantastic challenges. You can make a difference whether or not you work in healthcare.

Medical devices are very tangible things. One of the reasons I got into the field is because I knew I could create things that you can hold in your hand, give to someone else, and make a positive difference. If you’re a maker thinking about hacking health, or someone in healthcare thinking about creating something tangible, I invite you to try it. Start with a kit or a toy, and you’ll find a community that is eager to embrace your creations. We might even hack them, and we might even heal someone.

-Jose Gomez-Marquez

Their first product was the Tactile Metronome Kit. “After selling our first batch of kits, and even making a profit, we decided to turn our business experiment into an actual business in the spring of 2009,” Wolf says.

Their next kit, the Video Game Shield, turns an ordinary Arduino into a video game machine. As an open source project, users can create and share their own games for the shield.

Since then, W&L have come out with a line of innovative kits and plan to do some work with Android and Arduino in the future, as well as add features to their Blinky kits. Stay tuned!

—John Baichtal

Daniel had a magician-like patter for each item he showed me: the cylindrical Edison phonograph, the mutoscope, and the hidden camera inside a silver pocketwatch that was used by boxing reporters to take forbidden ringside photos. These inventions were the predecessors of devices and toys we use today, and Daniel wants the current generation to see that inventions don’t come out of the blue.

On a table in his living room sat open a large red Erector Set, a construction toy I remember getting in the 1960s. Daniel’s set was older and well worn. The manual said the Erector Set was “Developed at the Gilbert Hall of Science.” I realized how little I knew about this toy from my childhood.

A 1950 Erector Set: “The World’s Greatest Toy.”

Located in midtown Manhattan, the Gilbert Hall of Science was a multi-story museum created in 1941 by the Erector Set’s inventor, A.C. Gilbert, to showcase educational toys. Gilbert was born in Salem, Ore., and went East to get a Yale medical degree that he never used. He said he was interested in three things: “athletics, sleight-of-hand, and scientific experiments” and those interests would define him. He won the pole vault in the 1908 Olympics, having invented the box that catches the pole on the ground (before then, it had a spike at the end).

Gilbert’s first business was making Mysto Magic kits. It was barely profitable, but while making train trips from New Haven, Conn., to New York, he was inspired by the steel-girder construction of bridges and skyscrapers to create a new kind of educational toy. He produced the first Erector Set in 1913, the year the classic The Boy Mechanic books debuted from Popular Mechanics. It was an immediate success, the right product at the right time.

Each Erector Set box was filled with steel girders, wheels, pulleys, and in larger sets, a battery-powered motor that brought the models to life. Different sets, numbered from 0 to 8, provided the parts for making specific models such as a train bridge or Ferris wheel. In the 1920s, the #8 Erector Set cost $70 and weighed a staggering 150 pounds; it included all the parts for building a 5-foot zeppelin.

Gilbert saw the Erector Set as an ideal toy for the ideal boy, which he defined as competitive, clever, and curious, like himself. His biographer Bruce Watson argues that Gilbert didn’t just invent educational toys, he transformed the popular image of the American boy from problem child to problem solver, from delinquent to constructive contributor.

Perhaps the first to create advertising that spoke directly to young people, Gilbert’s ads opened with his characteristic “Hello Boys.” His slogans for the Erector Set included “Young Boy’s Paradise,” “1000 Toys in 1,” and “The World’s Greatest Toy.”

Gilbert believed children will educate themselves if you give them the right tools — an idea shared more recently by technologists like Seymour Papert of MIT. In an age when most learning was rote memorization, Gilbert saw the importance of creative play and exploration. He made learning fun.

From 1913 to 1966, 30 million Erector Sets were sold. The toy’s popularity spanned the technological era from the Model T and electrification to the age of aerospace, and it evolved to keep pace with these developments. It reflected the can-do spirit of the American Century, a society that was rapidly gaining new abilities to solve problems and do ambitious projects thanks to science and technology. The Erector Set was an invitation for any boy to participate in that future.

Erector’s decline followed Gilbert’s death in 1961, and the A.C. Gilbert company went bankrupt in 1967. The brand was bought by Meccano, an English company whose comparable construction kits grew in parallel to Erector. Lego became the educational construction toy for the video game generation, and today, Gilbert’s image of the American boy seems almost corny, like a Normal Rockwell painting. Still, we recognize him in ourselves and in our kids.

What will be the Erector Set of the 21st century? What construction systems will reflect the methods and personalities of a more diverse group of builders that includes girls and a more global perspective?

Maybe we’re already seeing key components in Arduino, MakerBot, and Kinect, all of which represent new ideas about how to build things and interact with them. Perhaps a new generation will build custom construction sets, as does architect Marc Fornes, designing and cutting pieces to order. I see Maker Faire and MAKE as successors to the Gilbert Hall of Science, inviting kids to build a future for themselves.

-Dale Dougherty

Construction Sets for the American Century

The Erector Set, Tinkertoys, and Lincoln Logs were all introduced in the 1910s, creating a triad of constructions sets that would become dominant toys for many American generations.  Meccano, an English-made construction set of metal parts, was developed around 1901 and was introduced into America in 1903 (Meccano owns the Erector product line today).   LEGO from Denmark was developed around 1949, initiating a wave of sets made from plastic components that came to dominate the latter half of the 20^th Century.

Sources:  Gilbert Project at the Eli Whitney Museum, GirdersandGears.com, The Man Who Changed How Boys and Toys Were Made by Bruce Watson.

This kit spares you that error. The pre-bent crank and laser-cut parts fit precisely; you only need scissors, glue, and a few evenings. Instructions are well illustrated, and online there’s a build video and a teacher’s guide. The delicate ’thopter weighs ¼oz, has a 16″ wingspan, and flies about 1 minute on 200 turns of the rubber band. At press time BirdKit.com was upgrading the kit, so yours may fly that much better.

The finished project is fun to use: you lift it a half-inch above the table and drop it to “roll” the die. A piezoelectric buzzer senses the impact and triggers the circuit to generate a random number and illuminate the LEDs. Everyone I show it to smiles at the way it works.

The kit comes with all electronic components, PCB, hardware, and a 2B pencil. It works with any pencil (the softer, the better), and is ridiculously fun for all ages. Reviewer Sue from Boston writes: “I have never soldered anything until this kit. It took about an hour to put together, going slow. Once I finished and tested it out, the shrill sound it produces made my cat hiss at me and run out of the room. I’d recommend this to any beginners out there.”

Reviewer Barry from Emeryville, Calif., writes: “I built a Drawdio and showed it around my physics class (which happens to be studying electrical circuits) and got a great response. One of my guys even started brainstorming a musical instrument, something really big and loud based on the resistance of a long copper pipe. Good times!”

Reviewer Thomas O’Brien from San Antonio writes: “The instruction booklet is very well written and goes step by step with clear explanations. My grandson Ben, 5, helped put components in the holes of the circuit board, then I soldered them, and he clipped the wires. He likes working with the magnifier to see what’s going on, while I solder. I showed him how to insert batteries correctly (look for the plus sign). The kit went together without a hitch and worked the first time. Grandma, look what we made! Thanks for a nice, well-designed kit — an easy one that a youngster can help build.”

Reviewer Tyler Bennett of Cary, N.C., writes: “This kit was a lot of fun for me as well as my 11- and 12-year-old grandkids. The kids put the kit together (with me looking over their shoulders) in around two hours and then we all enjoyed running it around on the floor.”