Melihat is a portable 2D black&white Ultrasound system for early risk detection, triage & pregnancy management. U/S is applied via probe projecting sound waves into the body, waves reflect to probe, relay to device calculating distance from probe to organ & time of echoes at millionths/sec. The distance & intensity of the echoes then form a 2D image. The U/S kit must be dust & shock proof & provide storage to carry related accessories. The design must allow for system to be easily packed/unpacked, cleaned; enable quick start, intuitive image acquisition & manage tele-com of fetal images for real-time diagnosis

With Indonesia’s population of 240m, medical systems overstretched & travel distances too long, access to ultrasound technology & quality care in low-resource settings is poor w/obstetric risks (15% of pregnancies) going undetected. Infant mortality is 5 times higher than Europe & US. Travel within the 6k inhabited islands makes getting to hospitals difficult, meaning many women miss crucial check-ups & potential to detect complications early. As Indonesia transitions to universal healthcare, providing physicians in remote areas is too expensive, consequently, only midwives can be afforded. During an exam, the main issue is detecting position of the fetus, i.e. breech pregnancies are a risk to handle. Worst cases are bleeding before & after delivery- and when mother is taken to hospital it’s often too late. Ensuring safe transport of the device is key, because midwifes typically walk, ride, or are given a ride on scooters between clinics and home visits. Because blackouts & voltage spikes can occur unexpectedly, a source of supplemental power would ensure the exam will not be disrupted. There is also no reliable way to send images to physicians for “real-time” diagnosis and/or consults. Current offerings are bulky, heavy, provide no means to pack the device or efficiently store accessories, resulting in long setup & pack up time. Additionally, portable Ultrasound systems are way over featured, are difficult to learn/perform a basic antenatal exam. Cost is another significant barrier; though some subsidies are provided, current “feature-creeped” devices are unaffordable, let alone service & support programs

An Antenatal exam is a highly sensory experience between midwife and the mother – its critical the device/technology will not disrupt this relationship. Traditionally midwives use a Pinard horn, the most widely used device in the world for listening to the fetus - Melihat in Indonesian means “to see”. We wanted to offer ultrasound as a technology to compliment this tradition, and because ultrasound uses sound, it also engages the sense of sight, providing a more comprehensive, and accurate exam/diagnosis of the maternal health of mother and her fetus. The average age of an Indonesian midwife is 30-60yrs. They are educated via a 3yr midwifery diploma, and most have a minimum of 10yr experience, earn at least $900mon. On a typical day they will see 20-30 patients or make 3 deliveries a day. They practice through local clinics /maternity huts, making house calls by foot, scooter or car & driver. Because the midwife community in Indonesia is 130,000+, the tablet can provide a social learning “platforum” for midwives to share & leverage collective knowledge. It can be removed from the charging cradle to more easily share images or GUI workflow protocols during training sessions, and each tablet is RFID tagged to its cradle/kit ensuring initial registration is tracked and corresponds to each owner/midwife. Especially because this is a device designed to improve quality and delivery of healthcare, the ongoing issue of “e-waste” and exposure to harmful materials, responsibility and accountability must be addressed where possible through the product lifecycle

Observational Research was conducted in the field with Indonesian midwives, and resulting material, i.e. qualitative and quantitative data, video, were referenced as well as YouTube, to gain a broader perspective into other midwifery cultures and potential markets. 1:1 scale mock-ups were developed to test proof-of-principle, and functional usability.

Other sources referenced, were The International Association of Midwives and Indonesian Midwives Association (IMA), Jakarta Pusat, Indonesia. By partnering with the IMA, a device manufacturer could sponsor/donate U/S kits for education and training, essentially developing real-time feedback loops towards improvements in early development. Giving prospective midwives; as users a level of ownership in design and development could provide a loyal brand following, thus incentivizing students towards future purchase of a device when they become professionals?

As a point of inspiration, we often purchase products from our local Plowshare Gifts store. Plowshare is a nonprofit distributor of handmade products from trade/craft guilds and co-ops throughout the world. Insights were gained interviewing the owners regarding sourcing, suppliers and distribution through organizations such as Fair Trade and Ten Thousand Villages.Materials can be sourced locally, & manufacture/assembly provided through coops investing in local communities.

At end of life enclosure can be repurposed as a personal tote and tablet(s) can be donated to schools. Remaining components are recovered via a take back program

Enclosure Assembly Materials:
Center Shell
- Outer Skin /Native Indonesian design on outdoor grade textile, 8watt thin film flexible Solar PV panel, Mid-layer/Recycled thin mil rubber sheet, Substrate/Recycled 3 gauge aluminum sheet

Sides
- 10mm solid laminated Bamboo board stock Handle-Recycled 3 gauge Aluminum bar stock, solid laminated Bamboo Internal Components
- Tablet dock/PCB connector housing & Battery/Solar PV connector housing are additive manufactured by laser sintering reclaimed aluminum powder, stainless hex fasteners, aluminum rivets

Specs & Manuf
- Computer: Standard 10”tablet Dock&BatteryCase-3D print
- Clamshell: Rolled aluminum, miniCNC, reclaimed rubber midlayer vulcanized to substrate w/heat stamp logo, local source textile out layer adhesive back midlayer transfer
- Top&Bottom: alum shells , w/rubber midlayer as top living hinge
- Sides: Local source/produced solid laminate board CNC router edges, countersink/ through holes, zeroVOC protective finish
- Handle: Roll formed alum flat stock drilled, countersink through holes, Solid laminate Bamboo, drilled counterbore/sink holes & inserts, CNC routered shape, bandsaw, zeroVOC protective finish

Melihat provides Midwives access to affordable Ultrasound technology that is portable, easy to setup, use & pack. Tablet/dock, probe & charger cords, gel, wipes are packaged as a fully integrated system. Between visits, the thin film Solar PV panel trickle charges battery lasting 3-4hrs. When needed, the wall plug adaptor is for direct or supplemental power. The standard 10”tablet utilizes familiar H/W & S/W platform where approx. 90% of users are accustomed & touch UI/display allows easy disinfection & cleanability. The training & use of device empowers midwives & compliments a strong, well established tradition of experience & skill. Upon arrival, the carry shawl is removed & laid by the mother & kit presented as if it were a gift.

Unintimidatingly it is opened like a purse, tablet/dock pivot up to reveal quick access to probe & charger while launching a friendly start-up screen. Once probe is connected, gel & wipe packs removed, top cover is folded back within kit’s footprint & dock/display nested at an optimal viewing angle. 16oz bottle of gel, the probe & skin coupler, messy & used in excess, is repackaged in individual biodegradable “pc’s” to reduce waste & weight. During exam midwives can remain engaged with the mother using the image as a point of interaction. Images can be sent to physicians for real-time diagnosis or early id of complications. With access to ultrasound technology & training it will be an essential conduit for comprehensive antenatal care contributing significant value to midwives practice & livelihood