Innovation blog: IV fluids for Land Cruisers - the problem

Our teams work in conflict zones, epidemics, and places where no other health care is available. This means thinking differently to solve problems that simply don't exist in conventional medical settings. In the first instalment of their blog, nurse Josie and logistician Anup write about an innovative new project that could save vital time in an emergency...

The nurse's perspective

I joined MSF after working in the National Health Service (NHS) in the UK. I was used to following systems and those systems only changing after years of pleading and trying to convince the powers-to-be that there was a better option.

So, when on my first MSF assignment, I started highlighting certain nursing issues to my boss, the medical team leader, and was asked what I thought would be best to do, I was kind of open mouthed!

Josie at at work in South Sudan

Josie at work in South Sudan. Photo: Brendan Bannon / MSF.

My team and I could make certain changes ourselves or with just the permission from my medical team leader! It was so liberating! To be able to see a problem in the morning, discuss it with the nursing team, find a solution and have it implemented by the afternoon was so satisfying.

However, this satisfaction slowly starts to wear off the more MSF assignments you do, as you find yourself changing the same things, or re-inventing wheel time and time again, or just getting into the habit of thinking certain things you are just expected to. This is what happened with IV fluid holders for Land Cruisers. 

The background

In our projects, MSF uses Land Cruisers – 4x4 cars that drive well on a variety of terrains. They are multipurpose, which means one Land Cruiser can go from being packed with medical supplies, to loaded with sand and wood, to being used for a mobile clinic or to transfer patients, several times in a day.

When you’re working in a project there is not necessarily one Land Cruiser that is what we would call an 'ambulance' and therefore when transferring patients, you set the car up as you need it, when you need it.

An MSF land cruiser drives through the mud in DRC

An MSF Land Cruiser drives through the mud in DRC. Photo: Natacha Buhler / MSF

This often meant arriving to the car with a patient on IV fluids and realising there was nowhere to hang the fluids. Our emergency patients often need IV fluids to help rehydrate them or to replace the fluid they are losing. These patients include those suffering from severe diarrhoea or cholera, patients with gunshot wounds and women haemorrhaging after giving birth.

Being able to deliver IV fluids to these patients while transferring them enables us to keep their condition stable until we can get them to a hospital where they can receive the necessary treatment. Not having an IV fluid holder in the car leaves us with a few options.

1.You could ask the caretaker of the patient to hold it.

2. If you were lucky the car had hand rails and then you could use a latex glove, bandage or a piece of string to tie it up.

3. If you didn’t have the hand rails you needed to get a little more inventive and would maybe have to give the technical logistician a call to come help.

Although this whole process of finding how to hang the IV fluids inside the Land Cruisers generally only takes a maximum of five minutes, when you multiply those five minutes for every nurse and technical logistician every time there is a patient with IV fluids needing to be transferred, you start to realise you are losing a lot of time. And that’s before you start involving anyone else in trying to find a more permanent solution. 

The technical logistician's perspective

As a field logistician in MSF, I’ve always felt like I’m a service provider, the ‘go to person’ for all the departments when something needs fixing or doing.

It's not just Land Cruisers we work with...  Photo: Anup Ravi 

Requests come by every day and majority of the time the issue needs to be sorted immediately. Very quickly I realised I didn’t necessarily have to do it myself to get the job done. I have a logistics team of national staff and we work together to meet the needs of the medical team.

There are many requests which are considered as emergencies in the field, but some of these would have never even be a point of concern back at home, because such things were already in place.

I remember times when nurses asked me to make an IV fluids holder for inside the Land Cruiser. The first time it happened I didn’t know what IV fluids or a holder for them was supposed to look like, but there was not time to find out as a solution was needed now! And I had the patient and medic watching and waiting for me to produce something, and I knew the patient was unwell and they needed to get moving. It was tense.

I ran off to get a piece of string and tied the IV fluids to a corner inside the Land Cruiser. I used to wonder: there’s got to be a simpler solution to this. This did not have to be a ‘quick fix’ and surely, I did not have to deal with this frustration on a regular basis.

There are various reasons why these ad hoc solutions don’t work in the long term. One of the main issues is that they can’t be cleaned very easily, which means there is a risk of spreading infections. Since the Land Cruisers are usually a multipurpose car (used for cargo and passengers) the IV fluid holders can be subjected to dust, wear and tear, unnecessary human contact, etc.

On top of the risk of infection, with all the temporary solutions we come up with, the medics sometimes complain that the IV fluid bags are constantly moving about with the motion of the car, making it more difficult for them to monitor whether the fluids are running at the right rate or if they are still running at all. Therefore, these 'quick fixes' never last long.

This is how the project  to design IV fluid holders for Land Cruisers came about. 

The mission

So having both spent a lot of time in the field, we now find ourselves on a completely different type of mission, a product design mission, with three weeks to design an IV fluid holder for Land Cruisers. And yes, we said three weeks!

Our initial thought was how we are going to focus on only one thing for three weeks? In our heads, we’d already come up with several solutions and that had taken us about 10 minutes. Luckily, we had Fearsome to explain and guide us through how product design actually works, and we realised that really, we need three weeks.

The team

1.       Myself, Josie, a nurse with MSF since 2010

2.       Anup, a logistician with experience as a supply and technical logistician with MSF since 2013

3.       Nils, a product design engineer with Fearsome, a product design engineering company

The project site

For the next three weeks we’re based at the Fearsome offices in Glasgow. It’s an old building that used to be a whisky distillery. Unfortunately there’s no whisky left kicking around, but we do have a large work space surrounded by whiteboards and access to all their product-making toys, including a workshop and 3D printer. 

Nils told us to feel free to write, draw and stick up whatever ideas and information we gathered. As you can see we did as we were told!

Our base for the next three weeks! Photo: Fearsome / MSF

Getting into the product design mind frame

The first things we learnt were:

1.       To stop calling it an IV fluid ‘hook’, as this just makes you think of a hook! Think about what this product actually has to do, it has to be able to hold IV fluids upright in a Land Cruiser, so it could be anything that can do that. 

2.       Stop thinking of solutions! This one was initially a bit of a shock, because, (a) we thought that was the whole point of the project and (b) that’s what we’ve spent the past five years doing when in the field with MSF.

As Anup put it, this was going to be an interesting three weeks! We'll be forcing ourselves to take baby steps, instead of the usual Usain Bolt sprint towards a solution that happens when we're working in the field.


Anup hard at work. Photo: Fearsome / MSF

Want to know what happened next? Check out Josie and Anup's next blog, as they start the first intensive week in their search for a solution

You can read this post in Arabic here.