design of the next generation mobile health clinic … · design of the next generation mobile...

DESIGN OF THE NEXT GENERATIONMOBILE HEALTH CLINIC FOR THEWESTERN CAPE OF SOUTH AFRICA

FINAL REPORT

August 1, 2013

Hendrik Bosman1

Barend de Villiers1

Erick Froede2

Bryan Lewis2

1 University of Stellenbosch, South Africa2 The Pennsylvania State University, USA

i

Contents

Contents

Contents ii

List of Figures vi

List of Tables x

List of Abbreviations xii

Acknowledgments xiv

1 Introduction 11.1 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.2 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.3 Motivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

1.3.1 Current Mobile Clinic Deficiencies . . . . . . . . . . . . . . . . 31.3.2 Patient Transportation . . . . . . . . . . . . . . . . . . . . . . . 41.3.3 Health Problems In South Africa . . . . . . . . . . . . . . . . . 4

1.4 Project Scope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51.4.1 Constraints . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51.4.2 Boundaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61.4.3 New MC Specifications . . . . . . . . . . . . . . . . . . . . . . 6

1.5 Stakeholders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2 Project Organization 92.1 Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92.2 Competencies and Responsibilities . . . . . . . . . . . . . . . . . . . . 112.3 Communication Plan and Software . . . . . . . . . . . . . . . . . . . . 122.4 Activities and Work Breakdown Structure . . . . . . . . . . . . . . . . 13

2.4.1 Planning Phase . . . . . . . . . . . . . . . . . . . . . . . . . . 152.4.2 Vehicle Selection Phase . . . . . . . . . . . . . . . . . . . . . . 152.4.3 Modular Design Phase . . . . . . . . . . . . . . . . . . . . . . 162.4.4 Modular Design Phase, Part II . . . . . . . . . . . . . . . . . . 182.4.5 Final Design Phase . . . . . . . . . . . . . . . . . . . . . . . . 18

2.5 Deliverables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

3 State of the Art 213.1 Mobile Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213.2 Large Mobile Clinics . . . . . . . . . . . . . . . . . . . . . . . . . . . 233.3 Small Mobile Clinics . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

ii

Contents

3.4 Benchmark Mobile Clinic by Advanced Vehicle Engineering cc. . . . . 26

4 User Requirements 294.1 User Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294.2 Distinctions between User and Client . . . . . . . . . . . . . . . . . . . 314.3 Needs/Desires Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . 314.4 User Preference Survey . . . . . . . . . . . . . . . . . . . . . . . . . . 33

4.4.1 Summary of Survey Results . . . . . . . . . . . . . . . . . . . 344.5 Anthropometric Analysis . . . . . . . . . . . . . . . . . . . . . . . . . 34

4.5.1 Develop an Anthropometric Model of the User Population . . . 354.5.2 Key Anthropometric Measures of the Virtual Population . . . . 36

5 Equipment Requirements and Selection 415.1 Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415.2 Auxiliary Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

5.2.1 Electrical Supply . . . . . . . . . . . . . . . . . . . . . . . . . 455.2.2 Lighting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 475.2.3 Refrigeration . . . . . . . . . . . . . . . . . . . . . . . . . . . 485.2.4 Heating Ventilation and Air Conditioning (HVAC) . . . . . . . 485.2.5 Sanitation and Ablution . . . . . . . . . . . . . . . . . . . . . . 505.2.6 Examination Bed . . . . . . . . . . . . . . . . . . . . . . . . . 525.2.7 Emergency Communication . . . . . . . . . . . . . . . . . . . 53

5.3 Optional/Future Considerations . . . . . . . . . . . . . . . . . . . . . . 53

6 Vehicle Evaluation and Selection 546.1 Drivers Licence Requirements and Re-Registration . . . . . . . . . . . 546.2 Evaluation Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . 576.3 Evaluation Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 596.4 Important Vehicle Options for the Crafter 35 . . . . . . . . . . . . . . . 61

7 Modular Unit Development 657.1 Concept Development . . . . . . . . . . . . . . . . . . . . . . . . . . . 657.2 Modular Unit Design . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

7.2.1 Determining the Optimal Unit Length . . . . . . . . . . . . . . 677.2.2 Realization of Modular Interfaces . . . . . . . . . . . . . . . . 687.2.3 Implementing the Modular Units in the Clinical Layout . . . . . 69

7.3 Final Modular Units . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

8 Clinic Area Layout Development 738.1 Design Feedback and Improvements . . . . . . . . . . . . . . . . . . . 838.2 Final Layout Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

iii

Contents

8.2.1 Design Specification . . . . . . . . . . . . . . . . . . . . . . . 918.2.2 Summary of MC Production Cost . . . . . . . . . . . . . . . . 91

9 Conclusion 929.1 Future Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

References 96

Appendices 100

A Summary of Healthcare Policy, Standards, and Reviews 101

B Detailed Gantt Chart 102

C Details of Benchmark MC by Advanced Vehicle Engineering cc. 104

D User Preference Survey 106D.1 The Complete Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . 107D.2 Application for Survey Approval by the Penn State Internal Review Board115D.3 Survey Approval Letter by the Penn State Internal Review Board . . . . 123D.4 Survey Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

E Results and Method for Anthropometric Analysis 144E.1 Description of Anthropometric Measures . . . . . . . . . . . . . . . . . 144E.2 Distribution of the Anthropometric Measures . . . . . . . . . . . . . . 147E.3 R Code for Determining the Anthropometric Measures of the South

African Nurse Population . . . . . . . . . . . . . . . . . . . . . . . . . 149

F Meetings Conducted by Representatives of Team MRC 155F.1 Vehicle Funding and Selection, GMT and DoH . . . . . . . . . . . . . 155F.2 Stakeholder Meeting I, Update and Feedback . . . . . . . . . . . . . . 155F.3 MRC and Philips Meeting . . . . . . . . . . . . . . . . . . . . . . . . . 156F.4 Stakeholder Meeting II, Stakeholder Update and Feedback . . . . . . . 156F.5 Discussion on Modern Mobile Health Vehicle, DoH Business Develop-

ment Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

G Functional Analysis 159

H Details of Considered Auxiliary Equipment 162H.1 Electricity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162H.2 Lighting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165H.3 Refrigeration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168H.4 Heating Ventilation and Air Conditioning (HVAC) . . . . . . . . . . . . 170

iv

Contents

H.5 Lavatory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175H.6 Water Storage and Disposal . . . . . . . . . . . . . . . . . . . . . . . . 178H.7 Examination Bed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181H.8 Emergency Communication . . . . . . . . . . . . . . . . . . . . . . . . 182

I Description of Available Light Commercial Vehicles 183I.1 Vehicle Venders and General Specification . . . . . . . . . . . . . . . . 183I.2 Detailed Specifications: VW Crafter . . . . . . . . . . . . . . . . . . . 186I.3 Description of Roads in the Western Cape of South Africa . . . . . . . . 187

J Details of Vehicle Comparison using the Analytical Hierarchical Process 189J.1 Original AHP Relation Matrices . . . . . . . . . . . . . . . . . . . . . 189J.2 Refined/Updated AHP Relation Matrices . . . . . . . . . . . . . . . . . 192

K E-Mail Correspondence Regarding Process for Re-Registration of Vehi-cle License Class 195K.1 Alta Swanepoel and Associates, Rode Traffic Legal Consultants . . . . 195K.2 Theo Becher and Dewald Horn, Government Vehicle Inspection . . . . 197K.3 Coretha Matthee, Legislation and Permits . . . . . . . . . . . . . . . . 198

L Matlab Code for Determining the Optimal Modular Unit Size 201

M Concept Development 202M.1 Modular Unit Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . 202M.2 Fixture Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211M.3 Feasibility and Concept Filtering . . . . . . . . . . . . . . . . . . . . . 217

N Clinic Layout, by Charlotte Stemmet, CNP 222

O Specifications for the Design of a New Mobile Clinic for the Western Cape 224

v

List of Figures1.1 Current MC servicing the Cape Winelands region. . . . . . . . . . . . 11.2 Interior view of the current MC servicing the Overburg area. . . . . . 22.1 Diagram of work breakdown structure and work packages. . . . . . . 142.2 Planning phase detailed work packages and activity list. . . . . . . . . 152.3 Vehicle selection phase detailed work packages and activity list. . . . 162.4 Modular design phase detailed work packages and activity list. . . . . 172.5 Modular design phase detailed work packages and activity list. . . . . 182.6 Modular design phase detailed work packages and activity list. . . . . 193.1 Mobile hospital. Produced by Mirae Systems and Technology Inc. . . 223.2 Single unit mobile surgical hospital constructed from a standard tractor-

trailer container. Produced by Mobile Clinics International. . . . . . . 223.3 Converted large recreational vehicle for a woman’s health clinic and

maternity care facility. Produced by Mobile Clinics International. . . . 233.4 Converted bus that conducts educational outreach and provides med-

ical services for community events in Iowa, USA. Provided by TheUniversity of Des Moines. . . . . . . . . . . . . . . . . . . . . . . . . 24

3.5 Portable shipping container equipped as a mobile AIDS and TB testinglaboratory. Produced by TFD. . . . . . . . . . . . . . . . . . . . . . . 24

3.6 Converted panel van. Produced by Medifit. . . . . . . . . . . . . . . . 253.7 Mobile clinic produced by Advanced Vehicle Engineering from a con-

verted panel van. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264.1 The product design process as outlined by the Hasso Plattner Insti-

tute Design Thinking method. The elements of the process related tounderstanding the user and the product are highlighted. . . . . . . . . 29

4.2 PreziTM presentation representing the average work day of a field nurse. 304.3 Sample question for the survey given to the CPNs working in the mobile

clinics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334.4 Representations of several standard anthropometric measures used in

the analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374.5 Representations of the remaining standard anthropometric measures

used in the analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . 385.1 Honda EU2000i 2000 Watt light weight mobile generator. . . . . . . . 455.2 Standard USB power outlet include in a 110 volt AC outlet. . . . . . . 465.3 LED Strip lights for on board lighting. . . . . . . . . . . . . . . . . . 475.4 LED position adjustable spot light. . . . . . . . . . . . . . . . . . . . 475.5 Portable thermoelectric cooler, medical quality. . . . . . . . . . . . . 485.6 Roof mount HVAC unit with both heating and cooling modules. . . . 495.7 Schematic of the ablution system for a recreational vehicle. . . . . . . 505.8 Simple chemical toilet with included waste capture tank. . . . . . . . 51

vi

List of Figures

5.9 Meditek-Hemco M96 universal examination couch. . . . . . . . . . . 526.1 Volume of the example clinical area. Toyota Quantum, current MC. . . 556.2 Volume of the example clinical area. VW Crafter 50, Class C1 vehicle. 556.3 A partition with an aluminum sliding door is available to provide fast

access from the cab to the load compartment. A folding front passengerseat can be ordered as an option. . . . . . . . . . . . . . . . . . . . . 62

6.4 The passenger compartment can also be air-conditioned. The vents arein the headlining and the second evaporator is fitted on the roof. . . . . 62

6.5 Skylights integrated in the roof provide more light in the load compart-ment. Natural light coming through the roof makes working inside thevehicle easier. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

6.6 The anti-slip aluminum floor has grid rails and an integrated ramp forwheelchairs. The ramp has a damper and two handles so that it caneasily be folded and unfolded by one person. . . . . . . . . . . . . . . 64

7.1 Modular unit cross section and preliminary major dimensions for thestandard, seated, and standing configurations. . . . . . . . . . . . . . 67

7.2 Extruded aluminum bar from the Bosch-Rexroth high performancealuminum system of components. Bars of this type were used to createthe interfacing members of the modular units and customizable pieces. 68

7.3 Aluminum modular frame design (front and back supports shown).Front support uses parts from Bosch-Rexroth high performance alu-minum system, and the back support is made from welded aluminumchannels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

7.4 Implementation of various drawer concepts to utilize the modular unitstorage compartment. Both the long and short standard drawer lengthsare shown. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

7.5 Implementation of storage compartments in the modular units. Fromleft to right: filing cabinet, coolers, chemical toilet, water tanks. . . . . 71

7.6 Implementation of worktops on the modular units. From left to right:file rack, wash basin, work desk with JIT storage, plain work desk. . . 72

7.7 Implementation of the patient examination bed as the worktop forthee modular units. The head and foot sections of the patient bed canincline in order to place the patient in different positions as required fortreatment or diagnosis. Also shown is the use of two standard drawsdepths with representative organizers and containers inside. . . . . . . 72

8.1 C. Stemmet’s concept model, the Nurses’ Vision. (3D Model) . . . . . 748.2 MC clinic layout: Team Concept Layout #1. (Overhead Sketch) . . . . 758.3 MC clinic layout: Team Concept Layout #1. (3D Model) . . . . . . . 768.4 MC clinic layout: Team Concept Layout #2. (Overhead Sketch) . . . . 778.5 MC clinic layout: Team Concept Layout #2. (3D Model) . . . . . . . 78

vii

List of Figures

8.6 MC clinic layout: Team Concept Layout #3. (Overhead Sketch) . . . . 798.7 MC clinic layout: Team Concept Layout #3. (3D Model) . . . . . . . 808.8 MC clinic layout: Team Concept Layout #4. (Overhead Sketch) . . . . 818.9 MC clinic layout: Team Concept Layout #4. (3D Model) . . . . . . . 828.10 Detailed view of the wall mounted storage bin in the Overburg area

MC. A similar bin was found in most MCs in the Western Cape. . . . 848.11 Isometric view of the final MC layout with representative vehicle side-

walls shown with transparency. The roof mounted air-conditioningunit, ventilation fans, and spaces occupied by the wheel arches are alsorepresented. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

8.12 Closer view of the staff nurse, or administarative, working area, withwriting desk, medication coolers, and patient file storage. . . . . . . . 88

8.13 Closer view of the CNP working area, with wash basin, chemical toilet,filing racks, and working desks. . . . . . . . . . . . . . . . . . . . . 88

8.14 The patient examination bed with head or foot section raised. The stor-age compartments under the bed are filled with various sized drawersfor medical storage. . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

8.15 Final layout (overhead view) of the MC clinical area. The name andlocation of each modular unit is shown, as well as the third seat, wallstorage bins, and roof mounted HVAC system. . . . . . . . . . . . . . 90

B.1 Detailed project Gantt chart . . . . . . . . . . . . . . . . . . . . . . . 103E.1 Representations of several standard anthropometric measures used in

the analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145E.2 Representations of the remaining standard anthropometric measures

used in the analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . 146E.3 Density plots of anthropometric results for the entire simulated population.148G.1 Functional architecture, transparent box . . . . . . . . . . . . . . . . 160G.2 Physical architecture, transparent box . . . . . . . . . . . . . . . . . . 161H.1 Standard USB power outlet include in a 110 volt AC outlet. . . . . . 163H.2 5000 Watt mobile generator by Bundu. This generator was used in the

mobile AIDS laboratory shown in Figure 3.5. . . . . . . . . . . . . . 164H.3 Honda EU2000i 2000 Watt light weight mobile generator. . . . . . . . 165H.4 LED Light fixtures for (a) overhead lamps and (b) and under cabinet

lamps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166H.5 LED Strip lights for on board lighting. . . . . . . . . . . . . . . . . . 167H.6 LED position adjustable spot light. . . . . . . . . . . . . . . . . . . . 167H.7 In-cupboard LED lighting. . . . . . . . . . . . . . . . . . . . . . . . 168H.8 Small refrigerator unit. . . . . . . . . . . . . . . . . . . . . . . . . . 169H.9 Portable thermoelectric cooler, medical quality. . . . . . . . . . . . . 170H.10 Roof mount HVAC unit with both heating and cooling modules. . . . 171

viii

List of Figures

H.11 Aftermarket minibus auxiliary roof air conditioning unit. . . . . . . . 172H.12 TurboKOOLTMroof mount evaporative air cooler . . . . . . . . . . . . 173H.13 Awning on a converted panel van. . . . . . . . . . . . . . . . . . . . . 175H.14 Fixed toilet for recreational or mobile vehicle. . . . . . . . . . . . . . 176H.15 Simple chemical toilet with included waist capture tank. . . . . . . . . 177H.16 Self contained portable hand washing basin. . . . . . . . . . . . . . . 179H.17 Schematic of the water system for a recreational vehicle. . . . . . . . 180H.18 Meditek-Hemco M96 universal examination couch. . . . . . . . . . . 181I.1 Example the corrugated gravel roads the MCs must travel on. . . . . . 188I.2 Important vehicle angles when operating in rough roads. . . . . . . . . 188M.1 Pull out worktop concept. . . . . . . . . . . . . . . . . . . . . . . . . 203M.2 JIT storage space concept. . . . . . . . . . . . . . . . . . . . . . . . . 204M.3 Removable storage concept. . . . . . . . . . . . . . . . . . . . . . . . 205M.4 Self locking drawer concept. . . . . . . . . . . . . . . . . . . . . . . 206M.5 Overhead bin storage concept, similar to those used in airplanes. . . . 207M.6 Cupboard concept with garage door style opening. . . . . . . . . . . . 209M.7 Ladder & drawer storage concept. . . . . . . . . . . . . . . . . . . . 210M.8 Rotating corner storage area concept. . . . . . . . . . . . . . . . . . . 211M.9 Self-lubricating parallel rails concept. . . . . . . . . . . . . . . . . . 212M.10 Magnets and Velcro concept. . . . . . . . . . . . . . . . . . . . . . . 213M.11 Wall fixed parallel rail concept. . . . . . . . . . . . . . . . . . . . . . 214M.12 Pin and damping floor mount combination concept. . . . . . . . . . . 215M.13 Transverse-parallel rail type system concept. . . . . . . . . . . . . . . 216M.14 Various design evaluation methodologies. . . . . . . . . . . . . . . . 217M.15 Unified Product Architecture Design Methodology. . . . . . . . . . . 220M.16 Excerpt from the House of Quality that was generated to describe

the relations between the engineering characteristics and customerspecified attributes for the MC redesign. . . . . . . . . . . . . . . . . 221

N.1 Original clinic layout drawing by C. Stemmet, CPN (English translation)223

ix

List of Tables2.1 Breakdown of the subject knowledge required to complete the MC

redesign. Indicated are the team members that have previous experienceor competency is each of these areas. . . . . . . . . . . . . . . . . . . 11

2.2 Detailed breakdown of which team members had primary and sec-ondary responsibility for each subject area (L = Lead, A = Alternate).Responsibilities were assigned based on the respective level of compe-tency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

4.1 Identified needs and desires for the next generation MC, listed in rela-tive order of importance. This list of needs and desires is a result of asurvey performed by C. Stemmet, CNP, to evaluate the effectiveness ofMC healthcare treatments and working conditions . . . . . . . . . . . 32

4.2 The relationship between the key dimensional characteristics and thecorresponding anthropometric measure capable of being extracted fromthe VPS are shown. The recommended design constraint for eachcharacteristic is also shown that will satisfy 95% of the population. . . 40

5.1 Preliminary list of the medical equipment to be included in the new MC. 425.2 List of the auxiliary equipment to be included in the new MC. The

product details, a local supplier, and estimated cost are also shown. . . 446.1 Outline of procedure for changing the MC vehicle classification. . . . 566.2 A example of the adjustment of the vehicle payload in order to not

exceed a final tare mass of 3500 kg. The adjusted payload would thenbe used in the vehicle evaluation criteria. . . . . . . . . . . . . . . . . 57

6.3 Details of the updated weighting factors for each category and sub-category as developed by the AHP method. The original and revisedweights are both shown for comparison. . . . . . . . . . . . . . . . . 58

6.4 Summary of the weighted comparison of 18 candidate vehicles. Thescores were obtained using the original AHP generated weightingfactors from Table 6.3. . . . . . . . . . . . . . . . . . . . . . . . . . 59

6.5 Summary results for the evaluation of the top seven candidate vehi-cles. The evaluation was performed using the revised category andsubcategory weights shown in Table 6.3. . . . . . . . . . . . . . . . . 60

6.6 A list of the most interesting factory options for the VW Crafter series.Also indicated is the reletive importance of each of the presented options. 61

7.1 Optimal modular unit lengths between 0.3m and 1.5m, with incrementsof 0.01m, for all three wheelbase versions of the VW Crafter. Note, theside door is located on the passenger side of the vehicle. . . . . . . . . 68

8.1 Revisit of the originally identified needs and desires for the next gen-eration MC (Table 4.1). The items that were improved, completed, orsatisfied with the new design are indicated. . . . . . . . . . . . . . . . 86

x

List of Tables

8.2 Summary of final production cost as perfided by AVE. Quote recievedon 12 Sep. 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

E.1 Key anthropometric values obtained from analyzing the MC-ANSURdatabase. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

I.1 List of candidate LCVs for conversion into the new MC and the manu-facturers specification websites. All vehicles are available from localsuppliers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184

I.2 Vehicle specifications taken from the LCV websits above. For ratingpower steering, a Boolean scale has been used (yes=1). For climatecontrol, serviceability, durability, and cost, they were rated from 0 to 1in effectiveness when compared to the other vehicles. . . . . . . . . . 185

J.1 AHP Relational Matrix for the three general vehicle criteria. . . . . . 189J.2 AHP Relational Matrix for the comfort subcategories. . . . . . . . . . 189J.3 AHP Relational Matrix for the drivability subcategories. . . . . . . . . 190J.4 AHP Relational Matrix for the miscellaneous subcategories. . . . . . . 190J.5 The relative subcategory score for each vehicle is presented using the

best-in-class method. The composite category evaluation obtained bymultiplying the subcategory score with the respective AHP weightsshown in Table 6.3 is also shown. . . . . . . . . . . . . . . . . . . . . 191

J.6 Updated AHP Relational Matrix for the three general vehicle criteria. . 192J.7 Updated AHP Relational Matrix for the comfort subcategories. . . . . 192J.8 Updated AHP Relational Matrix for the drivability subcategories. . . . 193J.9 AHP Relational Matrix for the miscellaneous subcategories. (Note:

*Represents estimated category) . . . . . . . . . . . . . . . . . . . . 193J.10 The relative subcategory score for each vehicle is presented using the

best-in-class method with minimum value pinning correction. Thecomposite category evaluation obtained by multiplying the subcategoryscore with the respective AHP weights shown in Table 6.3 is also shown.194

xi

List of Abbreviations


A/C Air Conditioning

ABS Antilock Break System

AC Alternating Current

AD Axiomatic Design

ADC American Diagnostic Company

AFSA Aluminum Federation of SouthAfrica

AHP Analytical Hierarchical Process

AIDS Acquired Immune DeficiencySyndrome

AVE Advanced Vehicle Engineeringcc.

CAD Computer Aided Design

CNP Clinical Nurse Practitioner

CoC Certificate of Compliance

COTS Commercial Off-The-Shelf

CWD Cape Winelands District

DC Direct Current

DDPs Design Dependent Parameters

DoH Department of Health

DP Design Parameter

DSM Integration Analysis of ProductDecompositions

EDL Electronic Differential Lock

FEA Finite Element Analysis

FMEA Failure Mode and Effect Analy-sis

FPD Fractal Product Design

FR Functional Requirement

GCM Gross Combined Mass

GET Global Engineering Teams

GMT Government Motor Transport

GVM Gross Vehicle Mass

HIV Human Immunodeficiency Virus

HoQ House of Quality

HR High Roof

HVAC Heating Ventilation and Air Con-ditioning

IRB Internal Review Board

LCV Light Commercial Vehicle

LoA Letter of Authority

LWB Long Wheelbase

MC Mobile Clinic

MC-ANSUR U.S. Marine Corps An-thropometric Survey

MDG Millennium Development Goals

MFD Modular Function Deployment

MIB Manufacturer Importer Builder

MIM Module Identification Matrix

MPD Modular Product Development

MPM Modeling the Product Modularity

MRC Medical Research Council

MWB Medium Wheelbase

NaTIS National Traffic InformationSystem

NRCS National Regulator for Compul-sory Specifications

PGWC Provincial Government WesternCape

xii


PHC Primary Health Care

PMTCT Mother-To-Child Transmis-sion Baby Follow-Up

QFD Quality Function Deployment

RMSS RSA Military Standards Steer-ing Committee

RSA Republic of South Africa

SHR Super High Roof

SN Staff Nurse

TB Tuberculosis

TCS Traction Control System

TFD Thermo-Fluid Design Inc.

TPMs Technical Performance Measures

UHF Ultra High Frequency

UN United Nations

USB Universal Serial Bus

VHF Very High Frequency

VPS Virtual Population Simulation

xiii

Acknowledgments

AcknowledgmentsThe authors would like to express sincere appreciation to the many individuals that havegraciously given their support to this project. Without their assistance and guidance, thiskey improvement to rural health care in the Western Cape of South Africa would not bepossible.

The authors would like to acknowledge Dr. Frans Krige, M.D., from StellenboschUniversity, for his medical insight, Charlotte Stemmet, CNP., for insight into the workingsof the mobile clinics. Alta Swanepoel, from Alta Swanepoel and Associates, for herlegal assistance in the re-registration of the new mobile clinic, Coretha Matthee, fromTransport and Public Works, for her revision of the legislation and permits toward there-registration of the mobile clinic, and Jeff Banks, from AVE, and Grant Haimler, fromTFD, for their input regarding the manufacturability of the new mobile clinic design.

In addition, special thanks must be given to Dr. Richard Devon, from the PennsylvaniaState University, for design insight, Kevin Lewis, P.E., from C.L.H. Architects andEngineers, for advice on electrical systems, Robert Swope, from the Pennsylvania StateUniversity, for content recommendations, Dr. Gopal Nadadur, from the PennsylvaniaState University, for advice on methodology, Charlotte de Vries, from the PennsylvaniaState University, for providing R code, and Coen Calitz, formerly from StellenboschUniversity, for his input toward ergonomics.

Particularly, the authors would like to acknowledge the GET advisors for this project,Dr. Cornie Scheffer, from the University of Stellenbosch, and Dr. Matthew Parkinson,from the Pennsylvania State University. Both have provided invaluable assistance, insight,and direction throughout the course of this project.

xiv

1. Introduction

1. IntroductionOver 10 percent of the population of the Western Cape province of South Africa live inremote rural areas supporting the South African agricultural industry[23]. The primaryform of health care for these individuals is through mobile health clinics (MC) staffedby clinical nurse practitioners (CNP) [19]. These MCs are light transport vehicles, orpanel vans, that are converted in to health clinics. The Western Cape Medical ResearchCouncil (MRC) and Department of Health (DoH) have launched an initiative with theUniversity of Stellenbosch and Global Engineering Teams (GET) to improve the qualityof rural health care in the Western Cape through the design of a new mobile clinic for theWestern Cape.

1.1. BackgroundThe current MC fleet for the Western Cape consists of 85 units of varying make and age.Over the past five years, a third of these vehicles have been replaced with new models[25],as shown in Figures 1.1 and 1.2. However, the current MC design makes it impossibleto provide all the necessary clinical services as well as meet many standard health carerequirements[35]. It also does not satisfy several occupational health requirements forthe professional staff[24]. The Medical Research Council proposes the development of anew set of specifications for MC design and manufacturing, as well as the design of thenext generation MC to meet the new specifications[25].

Figure 1.1: Current MC servicing the Cape Winelands region. (image taken by H. Bosman)

1

1. Introduction

Figure 1.2: Interior view of the current MC servicing the Overburg area. (image taken by H.Bosman)

2

1. Introduction

1.2. ObjectivesThe objective of this project was to improve the rural healthcare in the Western Capeby designing the next generation of mobile health clinics. The new MC design shouldaddress major deficiencies in both the patient care, as well as the working conditions ofthe MC staff. If the new design specifications are acceptable to the MRC, the new MCwill be constructed as a pilot vehicle with funds from the Rotary Club. The pilot vehiclewill then be field tested by the MRC and DoH to evaluate the design and identify furtherimprovements.

History clearly shows that both technology and medical practice will change overtime. As such, particular attention will be given to developing a level of expandability, ormodularity, in the MC design and specifications. This modularity will ensure future MCneeds can be satisfied without a complete MC redesign.

1.3. MotivationThe MRC and DoH have identified three major issues that motivate both the continuationof the mobile health system, as well as the current project to improve the future MCdesign. These issues are:

1. Current Mobile Clinic Deficiencies

2. Patient Transportation

3. Health Problems In South Africa

For further details, refer to Appendix A.

1.3.1. Current Mobile Clinic Deficiencies

Klopper and Stemmet[23] recently performed an audit of the current MC fleet in theWestern Cape. Their findings identified various problems that must be addressed inorder to provide the patients with the best possible health care and the MC nurses with asuitable working environment. The main problems are:

• The temperature within the MC can achieve 45◦C in the summer and 10◦C in thewinter.

• No refrigerated space for storage of vaccines and temperature sensitive medica-tions.

• The space available within the MC is not enough for proper movement of eitherMC personnel or patients.

3

1. Introduction

• The layout of storage spaces and equipment are not ergonomically suited for properhandling.

• The retrofitted vehicles are not structurally rigid enough to withstand stressescaused by driving on underdeveloped roads.

• Equipment and storage spaces break and malfunction due to driving on underde-veloped roads.

• Dust enters the MC causing discomfort and creating an unhygienic environment towork in.

• Cellular phone reception is poor in rural areas and MC do not have an adequatemeans of communication (UHF or VHF radios).

• MCs are technologically outdated and poorly serviced.

1.3.2. Patient Transportation

Medical treatment is available to South African residents through a government healthcare system, which operate public health clinics in most cities and villages. However, dueto the isolated locations of farms in the Western Cape, medical support for farm workersis limited[29]. For farm workers to receive care at an urban they face the followingchallenges:

• Farm workers do not have their own modes of transport.

• Owners of the farms are not always available/willing to provide transport.

• Roads leading to the farms are underdeveloped and difficult to drive on.

• Attending the clinic would require taking several hours leave from work.

Therefore, a need exists for a distributed health care system. In South Africa, andmany other countries, the use of mobile clinics has been a beneficial solution to thesechallenges.

1.3.3. Health Problems In South Africa

According to the South African Health Review[38] the main causes of premature deathin the Western Cape are:

• Human Immunodeficiency Virus (HIV)

• Tuberculosis (TB)

4

1. Introduction

• Homicide

According to this review, health problem are the leading causes of death. Thoughthese health problems are not unique to South Africa, they particularly challenges dueto their frequency and severity. However, the use of mobile clinics has been found toimprove their treatment.

Both HIV and TB are chronic illnesses which require regular treatment in order tobe manageable. For normal cases one or two treatment are required every month. Dueto the transportation problem, many patients diagnosed with these conditions can notreceive the necessary frequency of medical attention without the MC service. As such,MC staff are authorized to prescribe medication, administer vaccines, provide personalhealth counseling, and perform the complete range of diagnose and treatment for thesechronic illnesses, as well as other conditions[36, 6].

Preventing the transmission of these diseases from mothers to their infants is also amajor concern. As such the DoH performs Prevention of Mother-to-Child Transmission(PMTCT) follow-ups: This involves testing newborn babies and children under the ageof five for any diseases, especially HIV. Should a child be tested positive for any illness,the follow-up procedure entails a formal diagnoses of the child two to three months aftertesting, at which point treatment begins. However, it has been found that some childrendie within the two month waiting period[14]. The use of the MC system for PMTCTfollow-ups would reduce the waiting period and help prevention infant mortality in linewith the United Nations Millennium Development Goals[34].

Finally, though improved healthcare does not directly lead to a reduced homicide rate,healthy living does affect the likelihood of a violent lifestyle. As such MC staff alsoprovide general health education and counciling to promote a healthy lifestyle.

1.4. Project ScopeDue to the number of MC deficiencies described above, it is essential to clearly definethe scope of the project to ensure its focus is centered on the most important items of thenew MC design. As such, project constraints and boundaries are listed below.

1.4.1. Constraints

In discussion with the project stake holders (Section 1.5), various constraints for the newMC design have been identified. The following list of constraints was updated throughthe course of the project as a better understanding was gained, by both the GET teamand the stakeholders, of the needs of the new MC design.

• The selected vehicle must be operable with a standard Class B drivers license.

• The vehicle must be able to service rural communities that are accessible only bypoor roads.

5

1. Introduction

• The available MC services must include:

– Treatment of chronic conditions, primarily HIV, TB, diabetes, hypertension,and asthma

– Preventative care, such as family planning, education, nutrition, and immu-nization

– Women’s health and maternity care

– Pediatric care

– Treatment of acute conditions (This is not a primary function of the MC)

• The new design must provide improved working conditions for the MC staff

• Final cost of new MC not to exceed R500,000 to R600,000

1.4.2. Boundaries

It is important here to distinguish constraints from boundaries. The constraints definewhat capabilities the new MC must have and the boundaries define the extent of theproject scope, or items that are outside the scope. Through the course of the project,various aspects of the MC were identified that merit improvement which were not knownat the project onset. Where possible, these items were addressed in the final designspecifications. However, the following items could not be included:

• Healthcare quality standards

• Biohazard and waste management protocols

For each of these items, the current policy, regulation, or law was found to be insuffi-cient. However, these items are not related to the engineering or the design of the MC,and were beyond the scope of the project.

1.4.3. New MC Specifications

The primary deliverable for this project will be a list of specification for the next genera-tion MC. The new specifications list will summarize the recommendations of the GETteam findings, and serve as a guide for drafting future government MC procurementdocuments. The new MC specifications will include the following elements:

• Details of the Light Commercial Vehicle (LCV) that will be converted into an MC

– Make and model of the vehicle

– Manufacturers Gross Vehicle Mass (GVM) and tare mass

– Engine type

6

1. Introduction

– Maximum payload

– Overall dimensions of the clinical area

• Specification of necessary medical equipment

• Selection of all auxiliary equipment

– Power supply

– Lighting

– Heating ventilation and air conditioning

– Refrigerated medication storage

– Sanitation systems

• Detail of clinical work space

– 2D and 3D drawing of the layout

– Design of all units used within the clinical area

– Means of fastening modular units to one another and to the load bay

– Materials used for all units and structures

• Relevant safety equipment

– Placement of fire extinguishers

– Placement of first aid kits

• Estimated budget for producing the new MC, including the cost for the vehicle,conversion, and all necessary equipment

1.5. StakeholdersThis project is a joint venture with local government, academia, and community organi-zations. As such, it is important to identify the role of each stakeholder to ensure that thegoals and needs of each group were satisfied. Below is a list of the main stakeholdersand their roles in the project.

Medical Research Council (MRC):

• Funding for procurement of a vehicle as serve as platform for MC

• Approval and implementation of the new MC design

Rotary Club of Western Cape:

7

1. Introduction

• Funding for vehicle conversion of an improved MC

Government Department of Health:

• Update of current MC specification

• Funding for the vehicle procurement

• Transportation

• Licensing and vehicle standards

Nursing Staff:

• CNP - Primary source of information and suggested improvements to the MC

• SN, Assistant nurses, Counselors - Availability of trained supplementary staff

Stellenbosch University Department of Nursing:

• Use of new MC for research projects for nursing students and MRC

Rural and Agricultural Communities:

• Require improved healthcare services

• Define the required healthcare services to be provided by the MC

8

2. Project Organization

2. Project OrganizationThe key aspects of the project organization, such as deliverable and deadlines, wereoutlined by the GET program. The various roles that each team member filled wereassigned by the team based on the the previous experience of each team member. Thework breakdown for the project was developed using a “fast-forward” technique.

2.1. Members

Erick FroedeProject [email protected]

First year graduate student in mechanical engineering at ThePennsylvania State University, with a thesis focus on mechani-cal design. Eric A. Walker fellow with the Penn State AppliedResearch Laboratory. Two years of work experience, of whichone year was international.

Skills: Project management, Solidworks modeling, FEA, an-thropometry/human factors design, and engineering design.

Hendrik [email protected]

First year graduate student in mechanical engineering at theUniversity of Stellenbosch with thesis focus on material sci-ence.

Skills: Strength of materials, materials science, FEA, CADmodeling. Experience in the casting, manufacture, and materi-als testing industries.

9

mailto:[email protected]



Bryan [email protected]

Second year PhD student in mechanical engineering at ThePennsylvania State University, with a thesis focus on computa-tional analysis of hydro-turbines. National Defense Sciencesand Engineering Graduate Fellow, funded by the Departmentof Defense High Performance and Modernization Program.

Skills: Unsteady computational fluid dynamics and analysis,heat transfer, and thermodynamics. Experience in commonmedical nursing practices.

Barend de [email protected]

First year graduate student in mechanical engineering at theUniversity of Stellenbosch with thesis focus on turbomachin-ery.

Skills: Experience in the fields of fluid dynamics, computa-tional fluid dynamics (CFD), and heat transfer.Further fields of interest include computer aided design (CAD)and vibration and noise modeling.

10




2.2. Competencies and ResponsibilitiesTable 2.1 details the skills and engineering competencies necessary to complete theproject. From the information in Table 2.1 it is clear that at least one member of the teamhad some previous experience in each important aspect of the project.

Table 2.1: Breakdown of the subject knowledge required to complete the MC redesign.Indicated are the team members that have previous experience or competency iseach of these areas.

Team Member

Subject Knowledge Area E. Froede B. Lewis H. Bosman B. de Villers

Fluid Mechanics � �Heat Transfer � �Vibration/Noise Analysis �Nursing Practices �Strength of Materials � �Anthropometry �Project Management � �Technical Writing � � � �

Based on their various competencies, responsibilities for each major aspect of theproject were assigned to members of the team (Table 2.2). Two people were assigned toeach area, listed as lead and alternate. This was done to ensure all phases of the projectcould be completed, even if unexpected circumstances arose causing a team member tobe unable to complete the tasks.

11


Table 2.2: Detailed breakdown of which team members had primary and secondary respon-sibility for each subject area (L = Lead, A = Alternate). Responsibilities wereassigned based on the respective level of competency.

Team Member

Subject Knowledge Area E. Froede B. Lewis H. Bosman B. de Villers

Fluid Mechanics L AHeat Transfer L AVibration/Noise Analysis A LNursing Practices L AStrength of Materials A LAnthropometry L AProject Management L ATechnical Writing A L

2.3. Communication Plan and SoftwareWeekly meetings were scheduled for Thursdays (14:00 US, 20:00 SA). As team memberswere located in both South Africa and the United States, the meeting was conductedthrough video conferencing. Meeting guidelines and agendas were established andsupplemented with various modes of information sharing including: Gmail, GoogleDocs, and Google Calendar. Dropbox and Google Drive were used for file sharing.Barend was appointed as the group’s scribe and was responsible for posting meetingagendas and minutes. Bryan was appointed as the group’s scheduler and was responsiblefor keeping track of project progress and upcoming deadlines. Hendrik was appointed asthe group’s ambassador and acted as liaison for the relevant parties in South Africa. Asthe team leader, Erick managed the work and progress of the team and made executivedecisions when necessary.

In the weeks leading up to Milestone 2, it became necessary to begin holding teammeetings on Tuesdays (14:00 US, 20:00 SA) as well as Thursdays. These meetingsfocused on special topics such as brainstorming sessions, design discussions, and anyother relevant tasks for that week. Holding meetings twice a week proved more effectivein maintaining group focus and progress through the project.

Following is a description of software required to communicate and facilitate the newMC design:

• Computer aided design(CAD): Google SketchUp and Solid Works

• Programming: R and MATLAB

12


2.4. Activities and Work Breakdown StructureAs part of the project planning, a “fast-forward” technique was used where the requiredactivities of the project were planned in reverse order. In this exercise, the final designof the MC and the necessary deliverables were visualized, and then each step requiredto reach them was planned. As a result, the following list of activities were compiled.(Initials are given for the responsible individuals)

• Interview nursing staff and circulate questionnaire (HB)

• Physically examining the current MC (BdV, HB)

• Benchmark available MC’s from commercial suppliers (BL)

• Research necessary medical equipment and compile a critical list of essentialequipment (BL, HB)

• Create a cost breakdown for all equipment and manufacturing (HB)

• Evaluate what equipment will be included using a Needs-Benefit matrix (BL)

• Research and rank available vehicle models (All)

• Select vehicle based on necessary payload and licensing regulations (BdV, HB)

• Interview vehicle modification companies and obtain estimated quotes (BdV)

• Produce a CAD model of clinical space inside selected vehicle (EF, HB)

• Create CAD models of necessary onboard equipment (EF, HB, BdV)

• Generate concepts for clinical workspace layout (EF, HB)

• Research modular design methodologies (HB, EF)

• Develop a suitable modular unit frame design (HB, BdV)

• Evaluate ergonomic layout of clinical space using R and feedback (EF)

• Iterate on layout design to find optimal solution (EF, HB, BdV)

• Finalize design and new MC specification (All)

The layout of these activities have been divided into five major project phases: projectplanning, vehicle selection, equipment selection, design and analysis, and project fi-nalization. The key elements or activities for each phase are listed in Figure 2.1. Thedeliverables for each phase are also shown as the final element in each phase. Thefour listed reports and final presentation also correspond to milestone deliverables. Thedetailed Gantt charts for the project are not shown here, but are contained in Appendix B.

13

2.ProjectO

rganization

Mobile HealthClinic Project

ModularDesign Phase

Vehicle SelectionPhase

Modular DesignPhase, Part II

PlanningPhase

Vehicle SelectionReview

LiteratureReview

Customer Requirementsand Constraints

Ergonomic Workspace Analysis

AuxiliaryEquipment Review

Vehicle SelectionReport

Final DesignPhase

Benchmarking

Project ScopeDocument

State of the Art

ProblemDefinition

CostEstimation

Plan WorkBreakdown

Essential MedicalEquipment List

AnthropometricPreparation

FunctionalAnalysis

ConceptScreening

Equipment CostEstimation

Modular DesignReport

Final Design forPrototype Production

CustomerFeedback New MC

Specifications

WorkspaceDesign/Anaysis Final Design

Report

Design Revisions GET Webpage

SummaryFinal

Presentation

ModularUnit Design

AnthropometricAnalysis

Clinic LayoutDesign

Modular Unit Design

Production CostEstimation

Modular DesignReport, Part II

Finalize VehicleSelection

Poster for D-‐CON Festival

Figure 2.1: Diagram of work breakdown structure and work packages.

14


2.4.1. Planning Phase

Details of the planning phase are shown in Figure 2.2. This phase began at the kick-off meeting in South Africa, which included meetings with the key stakeholders and apersonal visit to an operating MC. The planning phase was completed with the submissionof the project scope document.

PlanningPhase

LiteratureReview

Customer Requirementsand Constraints

Project ScopeDocument

ProblemDefinition

Plan WorkBreakdown

Desire/NeedAnalysis

Meet with Nurses

Physically Examine

User ProfileCreation

Apply DesignThinking

Sub Packagesw/ Activity Breakdown

Update Gantt Chart and

Work Package Deadlines

Main WBSTree

Create and CirculateQuestionnaire to

Nurses

Reevaluate and Refine Project Tasks

and Objectives

Meet with Sponsorto Clarify Objectives

Summarize MC Documents by C.

Stemmet and Dr. Krige

Investigate Existing MC in South Africa

and Abroad

Develop Understanding ofLocal Health Trends

and Diseases

Gain Understanding of Clinical Standards for

Summarize

Healthcare in South

Examine Legislation Regarding VehicleLicensing and Usage

Figure 2.2: Planning phase detailed work packages and activity list.

2.4.2. Vehicle Selection Phase

Details of the vehicle selection phase are shown in Figure 2.3. The key aspect of thisphase was to identify a list of the four best vehicles for use as an MC in the WesternCape. This list of vehicles was then presented in the Vehicle Selection Report to theMRC and other government officials. Following the completion of the project, the MRCand government procurement office will make the final decision regarding which vehicleto purchase.

15


Vehicle SelectionPhase

Vehicle SelectionReview

Vehicle SelectionReport

Benchmarking

State of the Art

CostEstimation

InitialEstimation

Meet withGov. Officials

ContactVendorsResearch Commercially

Available Products(Medifit, AVE)

Visit MCManufacturers

Research Benchmarking

Methods

Develop Criteria forEvaluating New MC

Design

Determine Why aParticular Typeof MC is Used

Identify Services Rendered by MCs

Lit. Review of MCsAround the World

Classify MCSizes and Vehicles

Gather VehicleInformation

Research AHPSelection Method

Research Light CommercialVehicles in SA

Implement AHPon Vehicle Dataset

List Evaluation Criteria and breakinto Categories

Create List of TopSeven Vehicles

Develop Various Weighting Matricies

Create Dataset ofPossible Vehicles

Present Top Selections to Gov. Officials

Figure 2.3: Vehicle selection phase detailed work packages and activity list.

2.4.3. Modular Design Phase

Details of the modular design phase are shown in Figure 2.4. The key aspects of thisphase were to develop a functional breakdown of the MC, and then identify conceptsthat will satisfy the various functions in the MC. For commercial off-the-shelf (COTS)equipment items, basic market research was conducted to identify the best availableitems. All other concepts were generated by the GET team. Special attention was givento including modularity in the concepts to allow for adaptation for future needs.

16


Modular DesignPhase

ConceptsScreening

Modular UnitDesign

Refrigeration

Perform AHP Analysis of Design Variables

Assemble Final Candidates Into a Draft Layout

Component Screening:Eliminate Impracticality

Develop AHP Weightings of Design Variables

Develop CAD Models for Each Component

Develop Pro/Con List for Each Component

Gather Equipment List With Pictures and Dimensions

Brainstorm How toAddress Issues

Gather Anthropometric Data for SA Females

Use R to Process RawAnthropometric Data

AnthropometricPreperation

Create AssembliesFrom Components

Clinic LayoutDesign

AuxiliaryEquipment Review

FunctionalAnalysis

Find Optimal Unit Length

Determine CurrentDeficiencies

Develop Multiple Layouts Ideas

Create CADAssemblies

Electrical Supply Sources

Climate Control

Lighting

Water Storage and Disposal

LavatorySystems

Transparent Box:Block Diagrams

Draw SystemBoundaries

Breakdown the Key Sub-‐Function

Find Appropriate Components

Black Box Model(Inputs & Output)

Figure 2.4: Modular design phase detailed work packages and activity list.

17


2.4.4. Modular Design Phase, Part II

Details of the modular design phase are shown in Figure 2.5. Due to delays in receivingfeedback from User Preference Survey (Section 4.4), the Final Design Phase was pushedto Milestone 4, and Milestone 3 was dedicated to further developing the modular unitdesign, compiling the list of essential medical equipment, and generating an anthropo-metric model of the nurses working in the MCs. This model was used to determine keydesign parameters, such as the workspace heights and depths.

Modular DesignPhase, Part II

AnthropometricAnalysis

Use R to ProduceVirtual Production

Data

Develop Models and Code in R

Size EquipmentLayout from R Results

Modular Unit Design

Equipment CostEstimation

Essential MedicalEquipment List

Determine theAppropriate Level of Modularity

Brainstorm Designs

Develop PrototypeDesign

Integrate PrototypeInto Vehicle Layout

Estimate Initial Cost

Contact Local Vendors

Meet with GovernmentOfficials

Generate ConsolidatedEquipment List

Verify ConsolidatedList With MC Staff

Extract Relevant Information from Lists

Obtain EquipmentList(s) from MC Staff

Modular DesignReport, Part II

CustomerFeedback

WorkspaceDesign/Anaysis

Design Revisions

Obtain ProductionQuote from MIB

Generate UserSurvey

Obtain Penn StateIRB Approval

Distribute UserSurvey

Generate VariousWorkspace Options

Evaluate OptionsFrom Survey

Results

Update WorkspaceDesign


2.4.5. Final Design Phase

Details of the final design phase are shown in Figure 2.6. As this phase marked theconclusion of the project, several elements of the previous phases were concluded during

18


this time but were not shown in the work breakdown structure.

Final DesignPhase

Finalize VehicleSelection

Obtain Approval from Stakeholders

Finalize Legalities of Re-‐Registration

Update the Design with Final Vehicle

Final Design forPrototype Production

Production CostEstimation

Ergonomic Workspace Analysis

Develop DesignRevisions

Process SurveyData

Implement Revision and Finalize Design

Create 2D and 3DDesign Models

Quote for Final Modular

Unit Design

Quotes for FinalEquipment List

Quote from MIB for Conversion

Explore Crafter 35Manufacture Options

Update VirtualPopulation Model

Adapt/Update Design

for Feasibility

Use Population Model to Find

Design Parameters

Produce Final Design Images

New MCSpecifications

Final DesignReport

GET WebpageSummary

FinalPresentation

Poster for D-‐CON Festival


2.5. DeliverablesThe various planned deliverables for each milestone are listed below:

Milestone 0 : 5 AprilProject Scope DocumentThis document will include: brief definition and exploration of the project problemstatement and solution outline.

Milestone 1: 14 MayPlatform Selection ReportThis document will include: problem definition and scope, literature review, benchmark-ing, state of the art, work breakdown structure, customer requirements and constraints,

19


medical equipment and vehicle selection review, cost estimation, and platform selection.

Milestone 2: 18 JuneModular Design ReportThis document will include: auxiliary equipment list, basic anthropometric analysis,needs/benefit analysis, modular design concept, modular unit designs, and feasible initialdesign configurations.

Milestone 3: 6 AugustModular Design Report, Part IIThis document will include: essential medical equipment list and final auxiliary equip-ment list with available local vendors and estimated costs, final modular frame designwith cost estimate, and workspace anthropometric analysis.

Milestone 4: 20 SeptemberFinal Design ReportNew Mobile Clinic SpecificationFinal PresentationSummary page for GET WebpageProject poster for the dCon FestivalThis document will include: final vehicle selection, ergonomic workspace design, finaldesign for prototype production, and production cost analysis.

20

3. State of the Art

3. State of the ArtThe main purpose of a mobile health service is to improve access to health care[31]. Assuch, mobile health services have been implemented around the globe in both rural andurban areas. The Dominican Republic sustains an extensive program for mobile pediatriccare[8]. The remote rural areas of Saudi Arabia are predominately served by MCs[3].Due to the HIV epidemic, many effected regions are using mobile testing facilities, suchas in rural areas of Malawi[29]. Also, China operates a fleet of 1004 mobile clinics[44]to serve their vast underdeveloped regions. An example of an urban MC application wasseen by providing health care to veterans in the aftermath of Hurricane Katrina[27].

Due to the wide variety of health care needs, MCs are produced in many sizes. MCsare designed for services ranging from basic clinical care and dentistry to open heartsurgery. In evaluating MC options from around the world it was determined that threemajor classes of MCs exist: mobile hospitals, large mobile clinics, and small mobileclinics.

3.1. Mobile HospitalsThe mobile hospitals are similar in size to the traditional military field hospital. As shownin Figure 3.1, mobile hospitals normally consist of multiple tractor-trailers and enoughpersonnel to staff a small hospital. The mobile hospitals will contain an emergencyroom, operating rooms, maternity units, laboratories, clinical exam rooms, educationalclassrooms, and administrative offices. They also supply their own electricity and filteredwater systems.

The multi-unit mobile hospitals have become common in regions of the world wherethere is no established medical infrastructure. It is more cost effective to purchase onehospital that can be moved to various needed locations than to build a small hospitalin every area. Also, the staff to operate a small hospital is not available in most ofthese areas. The main disadvantage of the multi-unit mobile hospitals is the difficultyof transporting the hospital. It requires significant time and personnel to relocate thehospital. In particular, much of the sensitive examination and analysis equipment mustbe calibrated every time the hospital is moved.

For areas with a smaller patient demand, mobile hospitals can be contained in onelarge unit (Figure 3.2). These units are much more mobile, and can serve a more widelydispersed geographic area, but sill contain all the necessary laboratory and surgicalfacilities.

21

3. State of the Art

Figure 3.1: Mobile hospital. Produced by Mirae Systems and Technology Inc. (image fromhttp://www.medifit.co.za)

Figure 3.2: Single unit mobile surgical hospital constructed from a standard tractor-trailercontainer. Produced by Mobile Clinics International. (image from http://www.mobileclinicsinternational.com)

22

http://www.medifit.co.za

http://www.mobileclinicsinternational.com


3. State of the Art

3.2. Large Mobile ClinicsLarge mobile clinics are single units, and are normally designed for specialty care(i.e., laboratory, dentistry, woman’s health, education). Large mobile clinics are oftenconverted recreational vehicles (Figure 3.3), busses (Figure 3.4), off-road trailers, orportable containers (Figure 3.5). It is common to have multiple exam rooms or counselingareas, climate control, water, electricity, and a bathroom. The key advantage of the largeMC over the full mobile hospital is the versatility in providing effective specialty care.The available working space, water supply, and electrical power facilitate providingthe complete range of services given in a clinical office. Due to these factors, a simpleinternet search for mobile clinics will indicate that this class of MC is the most commonworldwide.

Figure 3.3: Converted large recreational vehicle for a woman’s health clinic and maternitycare facility. Produced by Mobile Clinics International. (image from http://www.mobileclinicsinternational.com)

As shown in Figure 3.4, large MCs are not unique to rural or underdeveloped areas.Many MCs of this class serve metropolitan areas where population density results in overutilization of existing medical facilities. Real-estate costs also inhibit the establishmentof more fixed clinics. Large MC’s are often used to respond to natural disasters, as seenin the aftermath of Hurricane Katrina[27]. It is also common to utilize large MCs formedical staff at sporting events and public gatherings.

The mobile laboratory unit shown in Figure 3.5 is of particular interest, because it iscurrently being deployed in the Western Cape as an AIDS and TB testing center[26].This unit was produced by TFD, a potential MIB for the new mobile clinic.

23



3. State of the Art

Figure 3.4: Converted bus that conducts educational outreach and provides medical servicesfor community events in Iowa, USA. Provided by The University of Des Moines.(image from http://www.dmu.edu/community/mobileclinic)

Figure 3.5: Portable shipping container equipped as a mobile AIDS and TB testing labo-ratory. Produced by TFD. (image from http://www.tfdesign.co.za/index.php?id=39&entryId=125&catId=3)

24

http://www.dmu.edu/community/mobileclinic

http://www.tfdesign.co.za/index.php?id=39&entryId=125&catId=3

http://www.tfdesign.co.za/index.php?id=39&entryId=125&catId=3

3. State of the Art

3.3. Small Mobile ClinicsSmall mobile clinics are normally converted panel vans or pickup trucks. This is the classof MC being developed in this project. They are intended for routine medical care suchas prenatal visits, immunizations, and general pediatrics, and do not offer all the servicesavailable at a traditional clinic. Small MCs are most commonly utilized in rural areaswhere transportation is limited and a visit to the nearest clinic would take a completeday. Though they can not receive all the treatment available at a clinic, patients find theaccessibility of basic health care the main advantage of small MCs.

Various designs of small MC’s are available through commercial suppliers. Theavailable models include many of the necessary improvements over the current MC beingused in the Western Cape. These improvements include climate control, working spacefor multiple staff, increased storage space, bathrooms, reliable water supply with a washbasin, and portable electricity supply. Figure 3.6 shows the current small MC producedby Medifit which is being used in various other regions of South Africa. More details ofthe State-of-the-Art for small MC’s, in relation to this project, are given in the followingsection (Section 3.4).

Figure 3.6: Converted panel van. Produced by Medifit. (image from http://www.medifit.co.za)

25



3. State of the Art

3.4. Benchmark Mobile Clinic by Advanced Vehicle Engineering cc.Advanced Vehicle Engineering cc. (AVE) recently delivered 50 new MCs to the FreeState of South Africa. These MCs were built using a VW Crafter 50 (Figures 3.7). TheCrafter 50 is a larger vehicle than is currently used for the MCs in the Western Cape,which provides an expanded clinical area. The AVE clinic has been found to be the bestavailable MC and therefore was selected as the benchmark MC for this project.

Figure 3.7: Mobile clinic produced by Advanced Vehicle Engineering from a convertedpanel van. The numbers in the figure correspond to item descriptions in theproduct brochure in Appendix C. (image from [5])

The product brochure for the AVE clinic is available in Appendix C, which includesdetailed images of the MC interior and the novel equipment that was included in thedesign. The AVE clinic was presented to the MRC as a possible option for the new MCin the Western Cape. From the list of required improvements to the current MC used inthe Western Cape (Table 4.1), the AVE clinic satisfied the following needs:

• Air conditioning and heating in the driver’s cab and clinical area

• Good sealing on doors and windows to prevent dust entering while driving

• Stainless steel washbasin with ample water supply

26

3. State of the Art

• Onboard lavatory, which also included a closing door for privacy

• Ample overhead lighting

• Multiple storage locations and sizes

• Acute care (First-Aid) kit

• Improved patient privacy

• Improved sanitation and ablutions

The AVE clinic also included several design ideas that were of interest to the MRCand MC nursing staff, including:

• Separate work area for administrative/counseling work and patient examination,which allowed

– Improved patient privacy

– Location for preventative care and healthcare education

– Working space for a specialist or third MC staff member

• Onboard electrical generator

• Electrical outlets throughout the clinic

• Side awning for shaded patient waiting area and group healthcare education

However, the AVE clinic did not address a number of necessary items, which were:

• Refrigerated storage for critical medication, vaccines, and blood samples

• Emergency communication equipment

• Seating for third staff member during travel

• Access from the cab to the clinic

• Increased range of medical services

• Anthropometric (human factors) considerations of the users

Essentially, the AVE clinic is based on the traditional South African MC designwith an improvement in the included auxiliary equipment. This understanding of thecurrent State-of-the-Art provides a clear direction for this project in producing the nextgeneration of mobile clinics. In particular, the GET team has identified several areas forimprovement that will be addressed in the new MC design.

27

3. State of the Art

• Design for Future Needs

– Allow the MC to be rearranged, adapted, and changed to fit unknown futureMC needs

– Provide methods for including new technology

• Design for the User

– Design for the anthropometrics of the South African population

– Ensure a positive user perception by provideing an open environment (avoidclaustrophobia)

– Place priority on patient and nurse comfort

– Include direct participation of the MRC and MC staff in the design process

• Improved Medical Treatment

– Provide a clinical bed that will facilitate all necessary patient positions (i.e.,lithotomy and trendelenburg)

– Include space in the MC for a third MC staff member or traveling specialist

It is almost certain that the future will bring changes to medical practice and procedures,and this new MC design will not only accommodate these changes, but encourage them.By including these features in the new design, the next generation of mobile clinics forthe Western Cape will be a significant enhancement to rural health care in South Africa.

28

4. User Requirements

4. User RequirementsIn order to improve the design of the new mobile clinic, it is important to completelyunderstand the users and their needs. Various methods were used to gain this under-standing including photographing the interior of several MCs, traveling in an MC toobserve the nurses and patients at several farms, and gathering nurses opinions on designchanges through a user preference survey. An anthropometrics model of the nurse andpatient population was also created in order to properly design the MC clinical area toaccommodate the heights and weights of the various users.

4.1. User ProfileWhen approaching a design it is critical to hear the voice of the users and acknowledgetheir unique perspective. It is typically the case that those seeking to develop a solutionlive a much different life than those they are attempting to serve, lending the creationof a user profile particular significance. In the case of mobile clinics, both nurses andpatients must be considered. A design thinking technique (Figure 4.1) was applied tounderstand the needs and perspectives of the users.

Figure 4.1: The product design process as outlined by the Hasso Plattner Institute DesignThinking method. The elements of the process related to understanding the userand the product are highlighted. (Image from [22])

To this end, a presentation representing the average working day of a field nurse wascreated, taking into account feedback and first hand observations made during two site vis-its. If using AdobeTM Acrobat Reader version 10, or later, the presentation can be vieweddirectly in Figure 4.2. The presentation is also available to download at http://dl.dropbox.com/u/4362508/Team_MRC_Mobile_Clinic_User_Profile.zip.

29

http://dl.dropbox.com/u/4362508/Team_MRC_Mobile_Clinic_User_Profile.zip

http://dl.dropbox.com/u/4362508/Team_MRC_Mobile_Clinic_User_Profile.zip

4.U

serRequirem

ents

Figure 4.2: PreziTM presentation representing the average work day of a field nurse.

30


4.2. Distinctions between User and ClientThere are two main groups of people who interface with the MC: the MC staff and thepatients being treated. A detailed description of each group is given below. For the caseof this design, the MC staff members are defined as the users and the patients are definedas the clients. As such, the majority of design input and evaluation will be from the users.However, special consideration will be given to the possible improvements in health carethe new MC will provide the clients.

User: Mobile Clinic StaffWho: Clinical Nurse Practitioner (CNP) and Staff Nurse (SN).What: Provide healthcare to rural areas, specifically farm workers and their families.Where: Various routes throughout all rural farm areas in the Western Cape.When: Monday to Thursday, and some Fridays (6am - 6pm).Why: Nurses are obliged to provide their healthcare services to rural communities.How: Mobile clinics provide a means to deliver these healthcare services to rural areas.

Clients: PatientsWho: Farming communities situated in rural and agricultural areas within the WesternCape.What: Harsh working conditions and lifestyle of communities require proper healthcare.Where: Within the Western Cape of South Africa.When: Visits from the MC every two weeks.Why: Lack of transport in rural communities denies them access to urban clinics.How: Localized farming community visits the MC when it renders its services on thefarm.

4.3. Needs/Desires AnalysisDue to the number of possible improvements that could be made to the next generationMC, it is essential to differentiate between needs and desires. Focusing on the needsfirst will help to alleviate distractions by non-essential items. A break down of the needsand desires is shown in Table 4.1, in relative order of importance. The list of needs anddesires, as well as the designations, were provided by the DoH and MC nurses.

31


Table 4.1: Identified needs and desires for the next generation MC, listed in relative order ofimportance. This list of needs and desires is a result of a survey performed byC. Stemmet, CNP, to evaluate the effectiveness of MC healthcare treatments andworking conditions [40].

Area for Improvement Need Desire

Internal Climate Control �Ample Work Space and Storage �Improved Ventilation and Containment �Power Steering �Cooled Storage for Medication �Increased Range of Medical Services �Improved Sanitation and Ablutions �Robust Internal Clinic Design �Self Sustained Electrical Supply �Provision for a Third Staff Member �Improved Patient Privacy �Emergency Communication Equipment �Emergency First Aid Box �Access from Cab to Clinic �Vibrational Damping of Clinic Structures �Improved Means of Medical Documentation �Improved Capabilities for Preventative Care �Improved Capabilities for Healthcare Education �Improved Off-Road Capabilities �External Shading �Safety from Environment and Elements �

32


4.4. User Preference SurveyIn order to validate the needs and desires from Table 4.1 a user preference survey(Appendix D.1) was administered to nurses who work in an MC on a daily basis. Thesurvey questions focused on gaining an understanding of the user needs and desires byasking them to indicate their satisfaction with the current MC equipment, how muchtime they spend each day performing certain tasks, and their likes and dislikes of the MCclinical area layout. A sample of the questionnaire can be seen in Figure 4.3. The finalMC design was developed by integrating what the CNPs indicated as valuable, poorlyplaced, or unnecessary.

Figure 4.3: Sample question for the survey given to the CPNs working in the mobile clinics.The complete survey can be found in Appendix D.1.

According to United States regulation, all institutions receiving federal funding mustreceive approval by an Internal Review Board (IRB) in order to perform research involv-ing human subjects. Gathering information on the desires and preferences of MC nursesfalls within the category of human subject research. As such, an application for IRBapproval for this portion of the project was submitted to the Penn State Office of ResearchProtection (Appendix D.2). An official letter of approval was received (Appendix D.3),and stipulated that only the aggregate data gathered in the study could be released forpublic use.

The survey was developed and administered using the online Qualtrics survey softwareoffered through a Penn State license. Distribution of the online survey was to be organizedby Ms. Liebenberg, Deputy Director for Comprehensive Health Services in the CapeWinelands Health District. There were concerns that many of the CNPs would havedifficulty completing an online survey due to the lack of computer experience. Therefore,administration staff was provided to the CNPs to aid the nurses in completing the survey.Also, an instructional video was created to introduce each question of the survey and

33


demonstrate how to properly complete it. The instructional video can be viewed athttp://www.youtube.com/watch?v=v48IMDe6wAY.

The survey also featured the conceptual layouts that were developed through theproject. These layout concepts, outlined in Section 8, were evaluated by the CNPs.Discussion of the survey responses to the layout concepts is also given in Section 8.

4.4.1. Summary of Survey Results

After several weeks of circulation, the results of the survey were collected. Uponexamination, it was found that only ten nurses completed the survey. As there are 85MCs currently in operation in the Western Cape, a larger number of survey responseswere expected. However, further distribution and ecouragment by Ms. Liebenbergyielded no additional results. Ten completed surveys, while not a statistically largesample, nonetheless provided valuable insight, as 88% of the completed surveys werefrom CNPs. Additionally, half of the CNPs that completed the survey have been workingon an MC for more than ten years.

The responses indicated a general attitude of indifference to the existing design atbest, and at worst dissatisfaction across several categories. For example, question fourasked the nurses to rate ten key aspects of the current MC; nine out of the ten werelisted at less than 50% satisfaction. This extended to the specific components in questionseven, of which all ten presented fell within a neutral or dislike category. When shownin a different manner, as was the case in question nine in the form of a heat map image,all components again fell into the same neutral or dislike categories as before. Theseproblems resulted in serious inefficiencies, and 47.25% of the nurses’ time was spent onavoidable activities outside of treating patients, such as organizing files, searching formedication, and cleaning dust and dirt.

From the survey results a sufficient understanding of the user population was obtainedto properly evaluate the various design decisions. It was also concluded that the needsand desires of the user population had been properly identified in Table 4.1. A discussionof the survey results for the various proposed clinic layouts is given in Section 8. Also,the complete survey results can be seen in Appendix D.4.

4.5. Anthropometric AnalysisThe purpose for performing an anthropometric analysis was to adapt the MC clinicalworkspace to the variation in human characteristics of our user population. By usinganthropometric data to guide the development of the clinical area, a design was achivedthat would accomidate the human characteristics of 95 percent of the user population.This process, known as Design for Human Variability, can serve as a tool to make thefuture mobile clinic truly a next generation development effort. In order to produce ahuman variable design, a virtual user population was created based on statistical human

34

http://www.youtube.com/watch?v=v48IMDe6wAY


measures. Key design features, such as table height and depth, were then extracted inorder to fit 95 percent of the user population.

4.5.1. Develop an Anthropometric Model of the User Population

Currently, no anthropometric data exists for the nurses that staff the MC, so withoutperforming a detailed measurment survey it was necessary to identify sources thatcan provide statistically significant data for the South African population. One suchresource is the RSA Military Standards Steering Committee (RMSS), which compileddata on 4,903 military-affiliated individuals for use by the RSA Defence Family[11]. TheRMSS data was intended for use in determining ergonomic design criteria for systems,subsystems, equipment and facilities in the RSA. While this is a useful data set, it iscomposed of individuals that are generally larger, younger, and stronger than those foundin the general population as a result of preferential selection in military recruitment.

Another option for obtaining the anthropometric data is outlined in Use of Knee Heightas a Surrogate Measure of Height in Older South Africans[30]. This study evaluateda civilian population consisting of 2,271 individuals, collecting data for knee height,stature, and BMI. Also, while over half of the samples were from an age group 60 yearsof age or older, adults with a mean age of 39 were included and accounted for 1,033individuals in total. Furthermore, it should be noted that both these studies consistedof very different distributions of race and gender. The military source features a largerfemale sample and is weighted towards black individuals, whereas the civilian sourcehas a smaller female sample weighted towards colored individuals.

Taking the aforementioned details into account, there are two paths which could bepursued. By using the RSA data, the step of applying population dimensions to thedesign can take place immediately. However, this military population is far removed fromthe demographics of our nurses, and would result in a design that is sub-optimal. Rather,the value of a true civilian sample cannot be underestimated, and that is the course thatshould be pursued. The cost of this stance is the lack of anthropometric measures thatare available, which are essentially limited to stature and BMI from the aforementionedstudy by Marais et al. In order to address this issue, a method by which the necessarydata can be extrapolated must be developed.

The problem of developing new human measures from limited information is not a newone, and a survey of literature provides several tools which can be useful in this regard.The most traditional and straightforward of these are proportionality constants, famouslydeveloped by Drillis and Contini[10]. These constants represent a series of ratio valueswhich relate stature to the size of other segments of the body. These are used widely andhave a long history of application, yet there are a number of key drawbacks that limittheir accuracy. In The Validity of Anthropometric Predictions Derived from ProportionalMultipliers of Stature[17], Ganon and Moroney highlight the limited sample populationused to derive these ratios as well as the ambiguity from which anthropometric landmarks

35


they are actually measured. A related, yet improved, method is found in the form ofso-called boundary ratios which are applied in much the same manner but are consideredbetter suited for design analyses[16].

While the previous methodologies would provide the required measurements, theylack the rigor and robust results that would derive from having a population of indi-viduals to consider. However, Nadadur and Parkinson[33, 32] provide an alternativemethod using a Virtual Population Simulation (VPS). The VPS uses a linear regressionmodel with residual variance to extrapolate anthropometric measures to new populations.The regression model produces a linear correlation between predictors and the desiredanthropometry. A simple statistical analysis is then used to correct the residual varianceto more closely model real world data. This method has been found to more accuratelycapture the extremes of a population, when compared to the methods listed previously.Further detail on how this can be implemented, as well as graphical representations ofthe difference between these two models, can be found in [32].

To develop the regression equation for the VPS, the U.S. Marine Corps Anthropo-metric Survey (MC-ANSUR) was used[43], as this survey contained the necessaryanthropometric measures to produce the regression equation. While this again presentsthe challenge of introducing a population unlike those of the MC nurses, the final systemof relationships was found to be valid by comparing the generated stature and BMI valuesto those in Marais et al.[30]. For the current analysis, data from MC-ANSUR was usedfor a completely female population, with a racial distribution of 60% white and 40%black, as recommended by stakeholders in the 20 Aug. progress review. In this case,black and colored nurses are treated as a single category due to lack of anthropometricdata distinguishing the two races. Additionally, several assumptions are made, including:

• The analysis does not take into account the underlying race/age distribution of thestature or BMI data within ANSUR. Rather, all that is certain is that it’s purelyfemale. However, the data from Use of Knee Height as a Surrogate Measure ofHeight in Older South Africans[30] came from an adult group (mean age of 39)with 7.4% black, 59.2% colored, and 33.4% white.

• A virtual population base of 1000 individuals is statistically significant.

• This analysis is not multivariate (i.e., anthropometric measures are independent inthe design).

• All generated measures correlate strongly with stature and/or BMI.

4.5.2. Key Anthropometric Measures of the Virtual Population

When a nurse interacts with the mobile clinic, there are key anthropometric measuresthat play critical roles in determining the relationship between the individual and their

36


surroundings. The following standard anthropometric measures were extracted from theVPS, which are depicted in Figures 4.4 and 4.5: Elbow-Rest Height, Sitting Eye Height,Forearm-Forearm Breadth, Standing Overhead Reach, Sitting Overhead Reach, Wrist toWall Length, Trochanterion Height, and Sitting Hip Breadth. A description of how thevarious measurements are gathered is given in Appendix E.1.

(a) Elbow-Rest Height (48) and EyeHeight, Sitting (49)

(b) Forearm-ForearmBreadth (53)

(c) Hip Breadth, Sitting(66)

(d) OverheadReach,Standing(83)

Figure 4.4: Representations of several standard anthropometric measures used in theanalysis. (images from http://mreed.umtri.umich.edu/mreed/downloads/anthro/ansur/Gordon_1989.pdf)

Table 4.2 shows the relationship between these key dimensional characteristics andthe corresponding anthropometric measure. Also shown is the recommended designconstraint for each characteristic that will satisfy 95% of the population. The complete

37

http://mreed.umtri.umich.edu/mreed/downloads/anthro/ansur/Gordon_1989.pdf



(a) Overhead Reach, Sitting(85)

(b) Trochanterion Height(107)

(c) Wrist to Wall Length (131)

Figure 4.5: Representations of the remaining standard anthropometric measures used inthe analysis. (images from http://mreed.umtri.umich.edu/mreed/downloads/anthro/ansur/Gordon_1989.pdf)

38




statistical distribution for each measure can be seen in Appendix E.2. Also, theseanthropometric measures can be reproduced by executing the computer code listed inAppendix E.3.

39

4.U

serRequirem

ents

Table 4.2: The relationship between the key dimensional characteristics and the corresponding anthropometric measure capable ofbeing extracted from the VPS are shown. The recommended design constraint for each characteristic is also shown thatwill satisfy 95% of the population.

Anthropometric Measure Related Action Environmental Geometry Recommendation

Elbow Rest Height Working at a table whilesitting

Sitting Worktop Height Worktop height should not exceed209 mm

Eye Height, Sitting Examining something onthe table while sitting

Visual Work Area The visual work area placed nocloser than 160 mm to the user*

Forearm-Forearm Breadth Reaching along a table Worktop Depth The work area width should not ex-ceed 279 mm

Overhead Reach, Standing Reaching an overheadstorage bin while standing

Overhead Storage Height Storage to be reached while standingshould not be higher than 2130 mm

Overhead Reach, Sitting Reaching an overheadstorage bin while sitting

Overhead Storage Height Storage to be reached while seatedshould not be higher than 1341 mm

Wrist to Wall Length Reaching across a table Worktop Depth The worktop should not be deeperthan 616 mm

Trochanterion Height Working at a table whilestanding

Standing Worktop Height The standing worktop height shouldnot be greater than 882 mm

Hip Breadth, Sitting Fitting on a seat Seat Width The seat should not be narrower than245 mm

* This was computed using a visual cone 75 degrees below the horizontal meridian.

40

5. Equipment Requirements and Selection

5. Equipment Requirements and SelectionThe equipment available on the MC, both medical and auxiliary, greatly determinesthe effectiveness of patient care, the range of services that can be offered from the MC,and the quality of the working conditions for the MC staff. In order to understand themedical procedures conducted on the MCs, and their respective equipment requirements,a standardized equipment list was compiled by C. Stemmet, as assigned in the June 6meeting with the Department of Health and SUN Medical Faculty (Appendix F.2). Thisequipment list was used to identify improvements to the medical and auxiliary equipmentonboard the MC.

A functional analysis was also performed to identify the relationship between theequipment items and their function in the MC. By analyzing the system from the perspec-tive of functions rather than equipment items, it can be ensured that equipment (medicalor auxiliary) is not being included unnecessarily. For the MC system being analyzed, nosignificant change in equipment was recommended from the functional analysis. Thecomplete functional analysis results are presented in Appendix G.

5.1. Medical EquipmentFrom the compiled equipment list mentioned above, quality medical products wereidentified for the MC. The list of desired medical equipment is shown in Table 5.1, alongwith a possible supplier and corresponding product cost. This medical equipment list wasdistributed to medical personnel at the Department of Health and SUN for feedback onAug 6. The final selection of specific medical products is beyond the scope of this project,and has been deferred to the corresponding healthcare officials. The preliminary listpresented here was sufficient to produce a cost estimate for the project budget and ensurethat adequate space would be available in the MC to store and operate the equipment.

41


Table 5.1: Preliminary list of the medical equipment to be included in the new MC.

Name Quantity Product Supplier Cost (R)

Blood Pressure Meter 1 Portable Desk Baumanometer Model Non LatexAdult Calibrated V-lok - Model 0320NL

Baumanometer 4,685.00

Blood Pressure Meter 1 Cuff And Inflation Bag Adult, Calibrated Bau-manometer V-lok - Model 1880

Baumanometer 1,200.00

Stethoscope 1 Littmann 2201 Classic II S.E. Stethoscope,Black, 28 inch

3M RSA 1,724.00

Thermometer 1 Suretemp Plus 690 Electronic Thermometer Welch Allyn 3,667.00Thermometer 1 ADTEMP V Fast Read Digital Thermometer ADC 326.00Ear-Nose-Throat Set 2 Welch Allyn Otoscope/opthalomscope Diagnos-

tic Set MOD 95001Welch Allyn 7,308.00

Hemoglobino Meter 1 STAT-SITE M Hemoglobin Meter, STANBIO STANBIO 2,693.00Hemoglucose Meter 1 Diabetes Monitoring Care Kit, CompactPlus ACCU-CHEK 692.00Laryngoscope 1 Portable Standard Laryngoscope Set with ”C”

Handle for Adults, Welch AllynWelch Allyn 4,516.00

Doppler Fetal Monitor 1 Ultrasound Pocket Doppler 2 MHz Probe Grafco 4,429.00Fetoscope 1 Riester Pinard Fetal (Embryo) Stethoscope in

Lightweight AluminumRiester Pinard 622.00

Peak Expiratory FlowRate Meter

1 asmaPLAN+ Peak Flow Meter asmaPLAN+ 432.00

Scale 1 Medway 3 in 1 with height rod Masskot Scale 3,078.00Vaginal Speculum 2 Small - Stainless Steel Graves Speculum Graham-Field 562.00Vaginal Speculum 8 Medium - Stainless Steel Graves Speculum Graham-Field 3,232.00Vaginal Speculum 4 Large - Stainless Steel Graves Speculum Graham-Field 1,352.00Ambu Bag 1 Child - Ambu Spur II Disposable Resuscitator Ambu Spur 1,302.00Ambu Bag 1 Adult - Ambu Spur II Disposable Resuscitator Ambu Spur 1,302.00Tuning Fork 1 ADC Aluminum Alloy Tuning Fork , 512 CPS ADC 298.00Patella Hammer 1 Prestige Taylor Percussion Hammer with

Stealth Gray HeadADC 305.00

Bandages Scissors 1 ADC 320V Medicut Shears, Purple ADC 302.00Simple Scissors 1 ADC 323N Listerette Scissor 5 1/5, Navy ADC 240.00Blunt Point Forceps 1 Kelly Forceps, Straight, 5” ADC 269.00Emesis Basin 2 Larg Emesis Basin, 10” x 4” x 2 1/8”, 26 oz.

CapacityGraham Field 1,772.00

Snellen Card 1 Grafco Snellen Plastic Eye Chart, Non-Reflective Matte, Green and Red Color Bar

Graham-Field 476.00

Monofilament 1 10 gram Model # 12-1391 Baseline 1,143.00Trauma Kit 1 Standard Trauma First Aid Kit Medique 8,454.00Nurse Diagnostics Kit 1 American Diagnostic Corporation 116-647BKQ

Nurse Combo-One, Black, AdultADC 693.00

Total 57,074.00

42


5.2. Auxiliary EquipmentAuxiliary equipment, though not directly used in patient treatment, significantly effectsthe medical services offered from the MC, as well as the working conditions for the MCstaff. The main challenge in selecting the auxiliary equipment is balancing the needand subsequent benefit of including the equipment with the available space in the MC.As such, multiple equipment options were identified for each major component andevaluated based on effectiveness in satisfying the customer needs as well as the availablespace in the MC. A detailed description of all considered equipment options, and thereevaluations, is presented in Appendix H. The selected auxiliary equipment was sourcedfrom local distributors, and a cost estimate and supplier for each item are shown in Table5.2.

For several items, such as the electrical generator, patient examination bed, andablution system, it was not possible to include the preferred option in the final design.The reasons for these decisions are given below, along with a description of the mostimportant, or unique, equipment items. Also, it will be shown in Section 7 that theauxiliary equipment items were integrated into modular units that form part of themodular storage system.

43


Table 5.2: List of the auxiliary equipment to be included in the new MC. The product details,a local supplier, and estimated cost are also shown.

Name Quantity Product Supplier Cost (R)

Ambient Lighting 12 12V-15mm SpacingLED Strip NaturalWhite

LED Lighting SA 3,374.64

Examination Light 1 Aven 26525 Sirus Halo-gen Task Light, 20 1/2”Arm

Aven Sirus Halo-gen

2,068.00

Refrigerator 2 PTC 7L ThermoelectricCooler (5-50)◦C

Healthcare Tech-nologies

7,500.00

HVAC 1 Telair 7300H Roof AirConditioner

Parasol 20,383.00

Fan 2 Fan-Tastic Vent1100WH 12V Fan

Endless Breeze 3,470.00

Awning 1 Fiamma 3M F35Awming

Alu-Cab CapeTown

11,027.50

Toilet 1 Bi-Pot 39, Fiamma Fiamma 1,199.95Wash Basin 1 Under Mount Sink

(UM440), NeumannNeumann 800.51

Water Tap 1 Elbow Action PillartapLong Arm, (503-21B),Cobra

Cobra 912.13

Submersible Pump 1 12 VDC SubmersiblePump

AVE 232.13

Office Chair 2 Perch Walter ChromeExam Stool with BasicBackrest

Perch Walter 9,452.00

Emergency Radio 1 Kenwood TK-7102long range radio

HRO-SA Com-mercial Radio

350.00

Fire Extinguisher 1 1.5 kg DCP Fire Extin-guisher

Peninsula SafesDirect

130.00

Total 71,904.02

44


5.2.1. Electrical Supply

Virtually all modern medical equipment requires some electrical power source. Assuch, the selection of the electrical supply is a key factor in the choice of all otherequipment. It was determined that the 12 volt DC vehicle battery was the ideal choicefor powering the most commonly used electrical components (i.e., refrigerator, lighting,and basic medical diagnostic equipment). A backup battery should also be included toprovide more capacity and a longer operating time to the MC when parked. It was alsorecommended by AVE to include a simple battery monitor. If the total batter capacitydrops below a given threshold, an alarm sounds in the cabin to instruct the staff to startthe vehicle engine and recharge the batteries.

In order to provide electricity to the equipment items with greater power requirements,particularly the heating ventilation and air-conditioning (HVAC) system, a standard 220volt AC connection was required. It was found that the two most advantageous optionswere to either include a small generator that was just large enough to supply the HVACsystem (Figure 5.1), or to utilize the vehicle engine and alternator to produce AC power.

Figure 5.1: Honda EU2000i 2000 Watt light weight mobile generator. (image fromhttp://powerequipment.honda.com/generators/models/eu2000i)

Though the generator originally appeared to be the preferred option, in discussionwith the MRC and MC medical staff, it was unclear if nurses would be comfortablestarting, operating, and refueling the generator. To use the generator, the MC would needto carry gasoline fuel, as the vehicle uses a diesel engine. The generator would also takeup valuable floor space in the MC and require periodic maintenance, which likely wouldnot be completed as often as necessary.

45

http://powerequipment.honda.com/generators/models/eu2000i



Due to these factors, it was decided that the best option was to idle the vehicle enginewhen parked to supply power to the HVAC system. This would only need to be doneduring the few months of the year when either heating or air-conditioning is needed.Compared to the user difficultly and cost of purchasing, operating, and maintening thegenerator, the additional fuel and wear on the vehicle engine was found to be the lessexpensive.

A 220 volt AC electrical hookup should also be installed on the outside of the vehicle.When the MC is parked for the night, power for the refrigerators and other systems onthe MC could be provided by a standard outlet at the clinic or garage. Efforts could alsobe made in the future for farm owners to provide an electrical hookup for the MC.

Finally, other GET projects have focused on developing modern medical diagnostictools using smartphones and tablet computers, such as the iPhoneTM, AndroidTM, andiPadTM. The use of these devices will require a suitable power supply, as their internalbatteries may not hold a charge for a complete working day. With a 12 volt DC powersystem, universal serial bus (USB) power outlets can be mounted in several areas ofthe vehicle. An example of a USB outlet, integrated into a 110 volt AC outlet is shownin Figure 5.2. This image is for conceptual reference, as South Africa uses a 220 voltelectrical system rather than the 110 volt outlet depicted. Also, the USB outlet does notrequire an AC electrical system, and should be powered on the vehicle battery only.

Figure 5.2: Standard USB power outlet include in a 110 volt AC outlet. (imagefrom http://rcaaudiovideo.com/power/chargingstations/?sku=WP2UWR)

46

http://rcaaudiovideo.com/power/chargingstations/?sku=WP2UWR



5.2.2. Lighting

The absence of windows in the panel vans used for the MCs do not allow natural lightto enter the clinic, so artificial lighting is necessary. High intensity LED light fixturesprovide an efficient ratio of luminescence (light intensity output) to power consumption.They can be powered by either a 12 Volt DC or a 220 Volt AC system, are rated to operatefor thousands of hours before diods must be replaced, and are less expensive than lightswith a similar luminesnence.

The use of LED strip lights (Figure 5.3) would also require less space in the clinicand provide indirect lighting to the working environment. The use of indirect lightinghas been found to produce a mental perception of openness, which is important for thenurses who spend every work day in the small enclosed space of the MC.

Figure 5.3: LED Strip lights for on board lighting. (images from http://www.ledlighting.co.za/uploads/LED%20Strips.pdf)

For certain procedures, an examination light in necessary. The examination light mustbe position-adjustable for the various procedures and patients. A example of this type oflight is shown in Figure 5.4.

Figure 5.4: LED position adjustable spot light. (images from http://www.lightingwarehouse.co.za/prod-in-wall.html)

47

http://www.ledlighting.co.za/uploads/LED%20Strips.pdf


http://www.lightingwarehouse.co.za/prod-in-wall.html



5.2.3. Refrigeration

To properly store sensitive medications, vaccines, and blood samples, a refrigeratedspace is needed. A small cooler with ice is currently used. However, the ice does notmaintain the correct temperature, especially during the hottest days of the summer. Thishas resulted in damaged vaccines and blood samples.

Recent advances in thermoelectric technology have widely expanded the use ofportable thermoelectric cooling/heating containers for both recreational purposes andtransporting temperature sensitive medical products. Medical quality coolers (Figure 5.5),though marginally more expensive than recreational models, include variable temperaturesettings (5oC to 50oC), accurate temperature control (± 3oC), and recorded history of theinternal temperature.

Figure 5.5: Portable thermoelectric cooler, medical quality. (image from http://www.evermed.it/english/english/english/english/ptc.html)

The variable temperature setting is a key feature, as two coolers are needed ( Table5.2). One will be used for storing medication and vaccines. The other will be used forblood samples, which require a different storage temperature.

5.2.4. Heating Ventilation and Air Conditioning (HVAC)

From the project onset, it was stated that the new MC must contain a method of internalclimate control. Controlling the air temperature inside the MC will allow the nurses towork more effectively. Portable HVAC units, minibus roof air-conditioners, evaporativecoolers, and various methods of natural cooling were all evaluated. The only reliable

48

http://www.evermed.it/english/english/english/english/ptc.html



option for controlling the climate in the MC was to install a roof-mounted heat pump,which is a combined heating and air-conditioning unit. For several of the LCVs consid-ered for the base vehicle, including the Mercedes Sprinter and VW Crafter, a unit of thistype is available as a optional addition from the manufacturer. For vehicles that do nothave this option, an aftermarket unit (Figure 5.6) can be installed by the MIB during thevehicle conversion process.

Figure 5.6: Roof mount HVAC unit with both heating and cooling modules. (imagefrom http://www.support-telecogroup.com/telecogroup/telair/en/products/air-conditioners/SILENT-7300H.asp)

Also, due to the fact that the engine must be running in order to operate the HVACsystem for any extended period of time, it was recommended that the MC staff be trainedon effective operation of this system in order to maintain the clinic at a comfortabletemperature. A few items to consider are:

1. Park in the shade

2. Keep the doors closed

3. Condition the clinic

Frist, during the summer months, the MC should be parked in the shade, wheneverpossible, to decrease the solar radiative heat load on the MC. However, during the wintermonths, the MC should be parked in full sun to take advantage of the additional solarheating. Second, the door to the clinic should be closed as much as possible. This willincrease the effectivness of the HVAC system in controling the internal temperature.Third, when either heating or air-conditioning is needed, the HVAC unit for the clinicalarea should be operating at full capacity during travel in between farms. In this way, thenurses can “condition” the cabin before arrival. This will allow for some time at eachstop before the HVAC system and engine must be started.

49

http://www.support-telecogroup.com/telecogroup/telair/en/products/air-conditioners/SILENT-7300H.asp




Though not directly related to the internal climate control, an awning could be addedto the side of the vehicle to create a shaded location. This idea was demonstrated inthe benchmark vehicle by Advanced Vehicle Engineering cc. (Figure 3.7). The awningwould not provide significant shade to the MC, but would provide a shaded location forpatients to wait. The shaded space could also be used by the nurses to provide groupeducational or counseling courses.

5.2.5. Sanitation and Ablution

It is often difficult for nurses to find an available lavatory during the day. Also, whenurine samples are needed from patients, and facilities are not available at the farm, theyare forced to utilize nearby foliage for privacy. The lack of a lavatory onboard the MChas been considered by the DoH as a violation of human dignity for both the nursesand patients. The centralized ablution systems commonly found in recreational vehicles(Figure 5.7) would be ideal for providing private lavatory facilities, as well as amplewater supply for washing hands and cleaning instruments. However, the size of the MCvehicles will not allow for these systems.

Figure 5.7: Schematic of the ablution system for a recreational vehicle. (image from http://www.rvpartsoutlet.com/images/graphics/3360.jpg)

50

http://www.rvpartsoutlet.com/images/graphics/3360.jpg



As such, it was found that a self-contained wash basin, similar to those in the currentMCs, and a portable flushable chemical toilet (Figure 5.8) should be installed as theablution system. However, the wash basin must be supplied with a larger water reservoir(at least 25 liters) and a more reliable water pump. In a portable chemical toilet, some-times called a porta-potty, the human waste is captured in a small tank below the toiletand held in a neutralizing/deodorizing chemical. The portable chemical toilet can beintegrated into a floor level compartment, and concealed from view in order to preservethe ambiance of the clinic. The chemical toilet would only be exposed during use. At theend of the day, the unit can be removed, the waste disposed of, and the chemical tankrefilled. Also, the chemical toilet does not require any additional water supply or wastedisposal, which greatly simplifies the integration of this unit in the MC. However, onedraw back of the chemical toilet is the limited waste volume. This will require that thelavatory be designated mainly for staff use.

Figure 5.8: Simple chemical toilet with included waste capture tank. (image from http://www.outdoorwarehouse.co.za/fiamma-bio-potti-20l.html)

51

http://www.outdoorwarehouse.co.za/fiamma-bio-potti-20l.html




5.2.6. Examination Bed

The current examination beds on board the MCs are typically custom made by the MIBfrom high density foam covered with wear resistant vinyl. The current beds allow thepatient to be placed only in a supine (face up) or a prone (face down) position. Also,the nurse can only access the patient from one side. However, the medical examinationsperformed aboard the MC require patient positions other than supine or prone, suchas the lithotomy, Trendelenburg, and Fowler’s position. Also, to properly utilize thesepatient positions, the nurse must be able to access the patient from multiple angles andlocations. The fixed bed design does not allow for this flexibility.

The universal examination couch (Figure 5.9) allows the patient to be placed in variouspositions, including a sitting position and with their feet elevated in stirrups for pelvicexaminations. The couch can also be easily repositioned in the MC to provide the nursewith multiple access locations to the patient. However, including the examination couchrequired sacrificing the complete space under the bed. It was not possible to fit the neededstorage into the vehicle without using this space. Also, in order to gain full advantage ofthe examination couch, there must be room to reposition the unit, which was not possible.Therefore, an examination bed will be supplied by the MIB with some of the desirablefeatures of the universal examination couch, most important being the adjustable backrest and foot stirrups.

Figure 5.9: Meditek-Hemco M96 universal examination couch. (image fromhttp://www.meditek.co.za/beds-cots-a-couches/obstetric-a-gynae)

52

http://www.meditek.co.za/beds-cots-a-couches/obstetric-a-gynae



5.2.7. Emergency Communication

The MCs are required to travel long distances on poor roads. If any malfunction of thevehicle should occur, the nurses would be stranded, with no way of receiving assistance.Also, occasionally the nurses will be asked to treat a patient that is in need of emergencycare, even though the MCs are not equipped for this function. In both cases the nursesneed some method of emergency communication.

Currently, each MC CNP is given a monthly credit for their personal cell phone for usein these situations. However, the credit is given as a reimbursement and the maximumreimbursable amount only allows for a few phone calls a month. Also, in many of therural areas the cell phone coverage is highly intermittent and unreliable. Ironically, theseare the areas where emergency communication is more needed.

Due to the unreliable cell phone coverage, the best option was to use a long dis-tance radio. The radio would connect to the emergency network already in place forcommunication between ambulances, and provincial fire and police departments.

5.3. Optional/Future ConsiderationsOne of the purposes of this GET project was to add innovation to the next generation ofMCs. One method for doing this is by expanding the available services offered from theMCs. The MC services may be expanded by including additional medical equipment orallowing other medical specialists to travel with and work from the MC.

The expansion of the medical equipment available for use on the MC could be benefi-cial to primary healthcare service delivery. By equipping the nursing staff sufficiently,the utilization of their training would be maximized. This would also expand the rangeof the MC’s available services.

The envisioned increase in seating capacity as discussed in Table 4.1 would allow fora third healthcare worker such as a dietician, occupational therapist, counselor etc. Theexpertise of a specialist would be a great benefit to the rural population.

53

6. Vehicle Evaluation and Selection

6. Vehicle Evaluation and SelectionThe goal in the vehicle selection process was to identify a vehicle that would increasethe clinical floor space, the roof height, and maximum payload compared to the currentMC vehicles. These characteristics are essential in order to satisfy the needs of the users.Other aspects of the vehicle (i.e., reliability, safety, and cost) are also important, butthe driving factor is that the additional equipment and needed working space cannot becontained in the current MC vehicle.

The vehicle selection was identified as a critical constraint at the inception of theproject. Funding for vehicle purchase was provided by the Western Cape Department ofHealth (DoH) and procurement was to be done through the Western Cape GovernmentMotor Transport (GMT). Originally, the funds from the DoH were only available untilthe end of June 2012. However, after an initial evaluation of the vehicle candidates itwas evident that further investigation was required, and a funding extension was grantedby the DoH until the end of October 2012.

Based on the current State-of-the-Art (Section 3) and the desires of the MRC, it wasdecided to only consider Light Commercial Vehicles (LCV) for use as the base vehiclefor the new MC. From 11 manufacturers, 18 vehicles, or combinations of vehicle options,were identified as candidates for MC conversion. A list of the vehicles and manufacturers,as well as the general vehicle specifications are shown in Appendix I.1. The majority ofthe candidate LCVs were available from local suppliers and listed on the GMT tenderlist. However, the Nissan NV400 and the Ford Transit panel van recently announced thatthese vehicle lines would be available in South Africa in the next year. As both vehicleshave received superior reviews in the European market, they were also considered. Albeit,currently acquiring these vehicles in South Africa may be difficult.

One particular challenge in selecting a vehicle for the new MC that was not directlyconsidered in the vehicle evaluation are the road conditions in rural South Africa. Ona daily basis, MCs are required to travel on corrugated, or washboard, roads. Theincreased vibration from traveling on corrugated roads leads to premature equipmentfailure and deterioration of rubber dust seals around the doors and windows. Also, duringthe rainy season, dirt roads are often damaged. For some remote areas, the damage issignificant enough that off-road vehicles are required for travel. The MRC is currentlyinvestigating the design of a mobile clinic built from an off-road vehicle. These off-roadMCs would service the areas that are inaccessible with an LCV. More information onthe road conditions in South Africa and the need for an off-road MC is presented inAppendix I.3.

6.1. Drivers Licence Requirements and Re-RegistrationIn order to provide the maximum improvement in the new MC, a substantial increase inclinical space is required. As such, many of the candidate vehicles were selected due to

54


their increased loadbay area and height. Figures 6.1 and 6.2 show a comparison of theincrease in clinical space available to the new MC by using a larger vehicle. However,these larger vehicles require the driver to hold a class C1 license, due to the gross vehiclemass (GVM) being greater that 3500kg.

Figure 6.1: Volume of the example clinical area. Toyota Quantum, current MC.

Figure 6.2: Volume of the example clinical area. VW Crafter 50, Class C1 vehicle.

At a meeting with the Provincial Government Western Cape (PGWC) on 08 June(Appendix F.1), the primary concern from the GMT was the class C1 drivers licenserequirement. Though the class C1 licensed vehicles present significant possibilities forimproving the MC, requiring the nurse to obtain a class C1 license would be difficult.

55


After substantial debates on the issue, the PGWC mandated that the drivers licenserequirement for mobile clinics be restricted to a standard class B license. Due to thisrequirement, it was necessary to either restrict the vehicle selection to class B licensedvehicles, or identify some means of re-registering the vehicles into a lower license class.

To address the re-registration issue, legal counsel was obtained from Alta Swanepoeland Associates (AS&A), Road Traffic Legal Consultants (Appendix K.1). Over the lastseveral years SA&S has been involved in the re-registration of class C1 vehicles foruse as recreational vehicles (i.e., motor homes or campers). The counsel from SA&Sindicated that the South African Road Traffic Act provided the possibility for a classC1 vehicle to be re-registered as a class B vehicle if the vehicle no longer fit one of thestandard vehicle descriptions, and the tare mass (actual loaded weight) of the vehicle wasbelow 3500 kg. For many of the considered C1 class vehicles, the GMV (vehicle weightand maximum payload) specified by the manufacture only marginally exceed 3500kg. As such, these vehicles are primary candidates for re-registration. The subsequentre-registration process is outlined in Table 6.1.

Table 6.1: Outline of procedure for changing the MC vehicle classification.

Action Authority Documentation Impact on Project Cost (R)

Procure Vehi-cle

Vehicle Man-ufacture

Certificate of Regis-tration

Goods vehicle is obtainedand registered

350,000

MC Retrofit MIB CoC Modifications are made 150,000Modify Seat-ing Capacity

NRCS NaTIS number Increase in the number ofpassengers aboard the MC

1,500

Homologation NRCS LoA Modifications are ap-proved

4,325

Re-registration

Departmentof Transport

RoadworthinessCertificate, Certifi-cate of Registration

Vehicle license require-ment based on tare massnot GVM, thus the ClassB license will suffice forMC

165

Total Cost: 505,000

The legal counsel given by AS&A was thought to be sufficient on a national level.However, discussions with the PGWC indicated that the process must be approved by thelocal government (Appendix K.2). Three parties were contacted from the Department ofTransport and Public Works to obtain the necessary approval:

1. Ms. Johnson (Administrative Officer: Motor Vehicle Administration)

2. Ms. Swart (Administrative Officer: Drivers Licence Administration)

56


3. Ms. Matthee (Assistant Manager: Legislation and Permits)

The matter has been reviewed by Ms. Matthee (Appendix K.3). Her feedback showsthe PGWC will support the re-registration process. She also has agreed to add a mobileclinic description to the National Traffic Information System (NaTIS) to aid in there-registration of the MC. Therefore, the class C1 vehicles listed previously were stillconsidered, with the requirement that the final tare mass of the MC not exceed 3500 kg.

Due to the 3500 kg tare mass limit, the effective payload of the candidate LCVs wereadjusted. As defined in the vehicle specifications, the GVM is the sum of the originaltare mass (weight of the empty vehicle) and the maximum allowable payload. During theMC conversion, the vehicle tare mass will increased due to the extra weight of the MCinterior, equipment, and supplies. In order to maintain the final tare mass under 3500kg, the maximum payload given in the vehicle specifications were reduced (AppendixI.1). An example of this adjustment is shown in Table 6.2. The adjusted payload wasthen used in the vehicle evaluation process.

Table 6.2: A example of the adjustment of the vehicle payload in order to not exceed a finaltare mass of 3500 kg. The adjusted payload would then be used in the vehicleevaluation criteria.

Vehicle Specification Mass (kg)

GVM 5000Tare Mass 2500Payload 2500

Adjusted Payload 1000

6.2. Evaluation ProcessIn order to make a quantitative comparison of the candidate vehicle, a weighting systemwas implemented. The Analytical Hierarchy Process (AHP), developed by Satty[37], wasused to generate the comparative weights. The weights represent the relative importanceof a particular vehicle characteristic in relation to all other characteristics. To simplify theAHP application, the vehicle characteristics were divided into two categories: operationalcomfort and road performance (drivability). The comfort category evaluated the vehiclebased on climate control, loadbay area, loadbay height, and loadbay volume. Thedrivability category evaluated the vehicle based on the unladen mass of the vehicle,power steering, engine power, and engine torque. Important characteristics, such asthe serviceability, durability, and vehicle cost, were placed in their own miscellaneouscategory.

57


Due to the large variation in the specifications for the candidate vehicles, the AHPweights may not demonstrate sufficient resolution when comparing the upper tier ofvehicles. This is due to the fact that the AHP method utilizes the value of the vehiclespecification relative to the maximum and minimum as an input to the weighting factor.Therefore, to ensure sufficient resolution in the comparison, a preliminary evaluationwas performed using the complete list of vehicles. Then a secondary evaluation wasperformed using only the seven highest scoring vehicles from the preliminary evaluation.A list of both sets of AHP generated weighting factors are presented in Table (Table 6.3).More information on implementing the AHP method, particularly the relational matricesused to generate the weights, is presented in Appendix J.

Table 6.3: Details of the updated weighting factors for each category and sub-category asdeveloped by the AHP method. The original and revised weights are both shownfor comparison.

Comfort Weight (%) Drivability Weight (%)

Subcategory Org. Rev. Subcategory Org. Rev.

Climate Control 8.654 5.114 Unladen Mass 5.325 9.740Loadbay Area 11.538 6.818 Power Steering 7.100 1.948Loadbay Height 17.308 10.227 Engine Power 5.325 3.247Loadbay Volume 8.654 5.114 Engine Torque 5.325 3.247

TOTAL 46.134 27.273 TOTAL 23.077 18.182

Miscellaneous Weight (%)

Subcategory Org. Rev.

Payload 5.769 10.227Serviceability 5.769 13.637Durability* 11.538 10.227Cost 7.692 20.455

TOTAL 30.769 54.545

* Identifies categories with no quantitative evaluation data.

In order to apply the AHP generated weights in a vehicle comparison, the vehiclespecifications must also be scored or ranked. A best-in-class approach was used to scoreeach specification according to its percentage of the minimum and maximum value forthat specification. Due to the large variations in the vehicle specifications, it was difficultto resolve the differences between vehicles with similar specifications.

To correct this problem, in addition to the revised AHP weights, a slight adjustment

58


was made to the scoring method by introducing minimum value pinning. This involvesadjusting the zero score for a certain category to a prescribed value greater than theminimum value. In this way, the secondary evaluation also limited the favorable scoresto vehicles that contained applicable values for a given characteristic. The respectivescores for each evaluation category are given in Tables J.5 and J.10 (Appendix J).

6.3. Evaluation ResultsThe summary results of the preliminary evaluation are shown in Table 6.4. As anticipated,the preliminary evaluation does not show significant variation in the vehicle scores, exceptfor the lowest scoring vehicles. As stated earlier, the seven highest scoring vehicles wereselected for a secondary evaluation. The summary results of the secondary evaluationare shown in Table 6.5.

Table 6.4: Summary of the weighted comparison of 18 candidate vehicles. The scores wereobtained using the original AHP generated weighting factors from Table 6.3.

Subcategory Score

Vehicle Comfort Drivability Misc. Total

Nissan NV400 PV L3H3 3.5t RWD 30.18 14.97 23.77 68.92Mercedes Sprinter 519CDI PV LWB HR 33.43 19.99 14.15 67.57VW Crafter 50 2.0 TDI PV LWB SHR 36.60 11.65 17.20 65.45VW Crafter 35 2.0 TDI PV MWB SHR 27.37 13.42 21.84 62.63Toyota Quantum 2.5 D-4D PV LWB HR + Pop-Up Roof 25.96 12.27 23.78 62.01Ford Transit PV LWB HR 350 RWD 22.59 15.25 22.68 60.52Mercedes Sprinter 319CDI PV SWB HR 21.24 20.95 17.83 60.02Iveco Power Daily Van 42.12 V 32.97 10.64 15.57 59.19Toyota Quantum 2.5 D-4D PV LWB HR 17.04 12.27 29.23 58.54Toyota Sesfikile 25.72 11.67 20.29 57.67Iveco Midi bus 16 seater A42.12 35.24 9.61 11.22 56.07Peugeot Boxer 28.04 14.49 13.02 55.55Opel Movano panel van MWB high roof 3500 21.68 13.70 19.23 54.62Fiat Ducato Panel Van 33 high roof 22.89 14.69 14.90 52.48Hyundai H1 Panel van 2.43 18.80 22.98 44.21VW Transporter Panel-van 6.76 12.41 19.22 38.38VW Transporter Crew bus LWB 10.11 11.77 15.91 37.79Renault Traffic 10.01 12.99 8.59 31.59

From the secondary evaluation, the two highest ranking vehicles were the VW Crafter35 and the Nissan NV400. As imported to South Africa, both of these vehicles requirea class C1 license to operate. This demonstrates the need for limiting the tare massof the vehicle to 3500 kg and allowing the vehicle to be re-registered under a class Blicense. The load bay in both vehicles is approximately 30 percent larger than the most

59


Table 6.5: Summary results for the evaluation of the top seven candidate vehicles. Theevaluation was performed using the revised category and subcategory weightsshown in Table 6.3.

Subcategory Score

Vehicle Comfort Drivability Misc. Total

VW Crafter 35 2.0 TDI PV MWB SHR 14.22 11.38 41.88 67.48Nissan NV400 PV L3H3 3.5t RWD 18.08 9.74 39.52 67.35Toyota Quantum 2.5 LWB + Pop-Up Roof 12.16 11.86 41.63 65.66VW Crafter 50 2.0 TDI PV LWB SHR 27.27 4.66 27.61 59.54Ford Transit PV LWB HR 350 RWD 7.31 10.78 33.24 51.33Mercedes Sprinter 319CDI PV MWB HR 17.77 12.08 13.75 43.60Mercedes Sprinter 519CDI PV LWB HR 17.77 8.44 10.11 36.31

recently purchased MCs in the Western Cape, which utilized a Toyota Quantum as thebase vehicle. Also, the roof of the load bay is 40 cm taller than the standard ToyotaQuantum. An additional pop-up roof has been added to the Quantums in the past, butthe dust seals for the pop-up have quickly deteriorated due to the vibration of travelingon corrugated roads. This allows dirt to enter the clinic and compromise the sanitationof the environment. As the high-roof options for the VW Crafter and Nissan NV400are standard from the manufacture, no dust seals are needed. Therefore, not only do thelarger Class C1 vehicles provide additional space for the clinic, but they also mitigatesome of the other design challenges.

As mentioned earlier, the Nissan NV400 and Ford Transit will become available inSouth Africa in the next two years. For the past decade, the Ford Transit has been oneof the highest ranked panel vans in terms of safety and performance, as well as sales.Both these vehicles scored highly compared with the other 18 LCVs. As such, it isrecommended that GMT work with the suppliers to have these vehicles placed on thegovernment tender list when they become available. Either of these vehicles may be agood choice for future medical and government projects.

As a result of this analysis, and discussions with the PGWC, it is the recommendationof the GET team that the VW Crafter 35 2.0 TDI PV MWB SHR should be used asthe base vehicle for the new MC. In addition to the increased clinical space and higherroof, the VW Crafter series also provides a large variety of additional equipment andperformance options that will be beneficial to the new MC design. These are describedin the following section. Also, it may be important to note that the VW Crafter 35 MWBSHR was recently selected for the new PGWC ambulance fleet.

60


6.4. Important Vehicle Options for the Crafter 35The latest product catalogue for the VW Crafter series is available at http://www.volkswagen-commercial-vehicles.com/en/models/crafter_delivery_van/information_material.html. As for any vehicle, there are a completearray of optional additions to the VW Crafter series. The factory options that are ofgreatest interest to the new MC design are listed in Table 6.6. Also listed is an indicationof the relative importance of including each of the options. Several of the items listedhave been explained or discussed previously, and the importance of the inclusion isknown. One example being the door connecting the driving cab to the loadbay (Figure6.3). However, a few of the optional features required further analysis. The optionalfeatures are not essential to the project, but should be considered depending on theavailable budget and final project cost.

Table 6.6: A list of the most interesting factory options for the VW Crafter series. Alsoindicated is the reletive importance of each of the presented options.

Relative Importance

Option Required Optional

Super High Roof �Sliding Door with Intermediate Latch �Cabin Partition with Sliding Door �Antilock Break System (ABS) �Traction Control System (TCS) �Electronic Differential Lock (EDL) �Loadbay Air-Conditioning �Loadbay Heating �Aluminum Grid Floor with Wheelchair Ramp �

The first item that must be analyzed is the optional loadbay/passenger air-conditioningsystems (Figure 6.4). The unit available with the VW Crafter includes roof distributorvents that help in evenly distributing the cold air though the rear compartment of thevehicle.

The rear compartment heating unit, though purchased separately from the air-conditioningunit, has several advantages over the heat pump HVAC system presented in Section 5.2.4.The Crafter heating unit was not designed to quickly heat the the passenger area, butrather it maintains the vehicle at a comfortable temperature for extended periods of time– without the engine running. The target market for this design was hotel and airportshuttles. These vehicles are often parked for several hours at a time in between uses.With the Crafter system, the vehicle can be continuously heated without idling the engine.Applying this technology to the new MC will result in a major fuel cost saving during

61

http://www.volkswagen-commercial-vehicles.com/en/models/crafter_delivery_van/information_material.html




Figure 6.3: A partition with an aluminum sliding door is available to provide fast accessfrom the cab to the load compartment. A folding front passenger seat can beordered as an option. (image from VW Crafter catalog)

Figure 6.4: The passenger compartment can also be air-conditioned. The vents are in theheadlining and the second evaporator is fitted on the roof. However, the heatingmodule for the rear compartment must be purchased separately. (image fromVW Crafter catalog)

62


the winter months, while still maintaining the vehicle at a comfortable temperature.One concern that has been considered in the current LCV is the lack of natural light in

the clinc. Side windows can be added but must be heavily tinted or translucent in oder topreserve the privacy of the patients. Having a glass roof in the loadbay area (Figure 6.5)would provide more than enough light, not compromise privacy, and result in increasedsolar heating. The solar heating is desirable during the winter, but uncomfortable duringthe summer. Also, having a glass roof would make working in the MC difficult at middaydue to the brightness in the clinic. Therefore, to include this option, a screen or coversystem must also be added to the roof to block the light when not wanted.

Figure 6.5: Skylights integrated in the roof provide more light in the load compartment.Natural light coming through the roof makes working inside the vehicle easier.(image from VW Crafter catalog)

The Crafter manufacturers also offer several options to improve the safety and userfriendliness of the vehicle. A Traction Control System (TCS) and Electronic DifferentialLock (EDL) would improve the vehicle handling when driving on poor roads.

Finally, a wheelchair ramp is available for the rear door (Figure 6.6). The MCs rarelysee a patient in a wheel chair, but this may become more prevalent in the future. However,it is obvious that the ramp supplied by VW is not ideal for an MC. The ramp wouldneed to be expended at every stop in order for the nurse to use the rear section of theclinic. Also, depending on the clinic design, the rear door may not be accessible. Aramp mounted under the side door of the vehicle would be more beneficial, but the lowclearance of the van makes such a placement difficult. This will be considered in futuredesigns if it becomes necessary to accommodate wheelchair access to the MC. A largervehicle with an increased road clearance will likely be needed.

63


Figure 6.6: The anti-slip aluminum floor has grid rails and an integrated ramp forwheelchairs. The ramp has a damper and two handles so that it can easilybe folded and unfolded by one person. (image from VW Crafter catalog)

64

7. Modular Unit Development

7. Modular Unit DevelopmentMajor shortcomings of the current clinical layout have been identified. One aspect ofthe current design that contributes to these shortcomings is the use of a fixed design(i.e., unmodifiable). Not only are the fixed cabinets cumbersome, but they restrictcustomization of the clinical space to fit the needs of the various nurses, and they aredifficult to maintain. After investigating various design methods, it was determined thata modular design approach would be ideal for the new MC. By applying this designapproach, the medical equipment, auxiliary equipment, and necessary storage wereintegrated into modular units. The units are capable of being interchanged, or attached, inany location in the clinical area. In this way, the nurses are able to customize the locationof equipment in the clinic to better satisfy their current needs. Also, the modular designenables the new MC to be easily adapted and modified as new technology becomesavailable. The new MC will not only improve the current rural health care in the WesternCape, but encourage continual improvement in the future.

7.1. Concept DevelopmentOne of the major steps in any design process is concept development. The goal of thisphase of the process was to generate as many product ideas as possible that could servesome purpose or satisfy some need of the design. Due to the international nature of thisproject, the Delphi method[28] was used for concept generation. In this method, conceptswere generated individually by team members, because face-to-face communicationwas not always possible. The concepts were then presented to the team for review anddiscussion, allowing the individual group members to combine ideas and thus better theirown concepts.

The range of concepts and concept categories are too extensive to be included here,but are presented in Appendix M. The main advantageous and disadvantageous of eachconcept are also listed. After selecting the most useful or unique concepts, they wereevaluated by the project stakeholders. Following this evaluation the final concepts werechosen for implementation into the new MC design as modular units.

7.2. Modular Unit DesignIn the development of the modular units there were many trade-offs to be considered.The first challenge encountered in the design was to establish an acceptable level ofmodularity. The level of modularity describes the extent of interchangeability betweenunits and components of the units. External modularity refers to the interchangeability ofmodular units (i.e., the location of the modules can be interchanged). Internal modularityrefers to the interchangeability of components within a modular unit, or even betweencomponents of different modular units.

65


Appendix M.3 outlines the modular design method that was applied. This designapproach uses five phases: decomposition, identify functions, integration, realization,and evaluation. The physical parts of the current MC design were identified during thedecomposition phase, and included: cabinet frame, storage, and worktops. Though thefunctions of the resulting physical parts may appear self-explanatory, in reality eachphysical part fulfilled multiple functions. For example, several forms/sizes of storagespaces were required (i.e., shallow drawers, deep drawers, shelves for small items, shelvesfor large items). Also, worktop surfaces were needed for writing, washing hands, andexamining the patient.

While integrating these various functions to form a conceptual modular unit, it becameapparent that all the functions could not be integrated into one standard modular unit.As such, a complete internal modularity was not possible. However, a limited form ofinternal modularity could be applied without sacrificing the advantages of the modulardesign. With a limited internal modularity, each modular unit would have the followingstandard characteristics:

• External Dimensions

• External Structure or Frame

• Method of Attachment to Vehicle and Other Units

For units that contained drawers for storage, the drawer sizes (widths and depth) wouldalso be standardized.

The first steps to realizing the design of the modular units were to create a cross-sectional layout of the unit in their common configurations and assign preliminary majordimensions. As nurses perform tasks while both sitting and standing, standard configura-tions for both of these cases were outlined. The module cross section and preliminarymajor dimensions are given in Figure 7.1 for the standard, seated, and standing config-urations. The final unit height and depth were determined by anthropometric analysis(Section 4.5). The unit length was determined by a simple optimization method describedbelow.

66


Frame fixed base

Frame modular front

Storage module

Seated worktop module

Standing worktop module

Frame fixed base

Frame modular front

Storage module

Frame fixed base

Frame modular front

Vehicle load bay floor

~150

mm

~600

mm

~750

mm

~900

mm

W

W

W

Figure 7.1: Modular unit cross section and preliminary major dimensions for the standard,seated, and standing configurations.

7.2.1. Determining the Optimal Unit Length

In order to determine the length of the modular units, an iterative Matlab program wasdeveloped to determine the optimal unit length for a given load bay length. The programinputs takes into account restrictions of the rear and side doors, where the side dooris considered to be on the passenger side of the vehicle. Only discrete unit lengthsare considered with increment sizes that are both reasonable for implementation andmanufacturing. The program then tests various permutations of each unit length to ensurethat the cumulative length of the units utilize the maximum load bay length and do notinterfere with the access to the side door. If these conditions are sufficiently met, theprogram prints the unit length, number of units per side, cumulative unit lengths per side,and “%Use” per side, where the “%Use” is a parameter that describes to what extent thegiven load bay lengths have been utilized.

The program code, given in Appendix L, was set up to identify feasible modular unitlengths between 0.3m and 1.5m, with increments of 0.01m, for a generic LCV load bay.The program tests each discrete unit length and identifies the length with the maximumuse of the load bay. For the results presented in Table 7.1, all three wheelbase versionsof the VW Crafter series were analyzed. A subsequent objective function was addedto the evaluation to determine a unit length with maximum load bay use for all threevehicles. This would allow the units to be interchangeable between a fleet of VW Crafter35 and VW Crafter 50 vehicles. From this analysis, the optimal modular unit length was

67


found to be 520mm for the VW Crafter and Mercedes Sprinter series. As the VW andMercedes LCVs utilize the same chassis design, these units are also interchangeable withthe Mercedes Sprinter series.

Table 7.1: Optimal modular unit lengths between 0.3m and 1.5m, with increments of 0.01m,for all three wheelbase versions of the VW Crafter. Note, the side door is locatedon the passenger side of the vehicle.

Driver Side Passenger Side

Wheelbase Unit Length (mm) No. Units %Use No. Units %Use

Crafter 35, MWB 520 6 0.967 3 0.810Crafter 50, LWB 520 8 0.977 5 0.878

Crafter 50, XLWB 520 9 0.983 6 0.902

7.2.2. Realization of Modular Interfaces

One of the final aspects of developing the modular units was to establish a method ofinterfacing, or attaching, the various units. The scope of this modular system does notwarrant a customized interfacing design, thus a COTS solution was identified. The Bosch-Rexroth high performance aluminum system of components (Figure 7.2), supplied locallyby Tectra Automation, is a German-made aluminum profile system. For over 30 years,Bosch-Rexroth has established itself as the market leader in the supply of components forrapid assembly and easy reconfiguration. This makes it ideal to providing interfacing ofthe various units, in addition to fixing the units to the load bay floor.

Figure 7.2: Extruded aluminum bar from the Bosch-Rexroth high performance aluminumsystem of components. Bars of this type were used to create the interfacingmembers of the modular units and customizable pieces.

68


7.2.3. Implementing the Modular Units in the Clinical Layout

Conceptually the modular unit consists of three parts: a frame, a storage compartment,and a worktop. The frame forms the external supports for the unit, the storage com-partment occupies the internal volume of the frame, and the worktop comprises the topsurface of the modular unit. The final concepts selected from the concept developmentphase were integrated in the storage compartments and worktops of the units.

The frame design was developed through various design iterations. Originally, themodular unit frame was designed to be self contained (i.e., could support itself and onlyconnected on the sides to other units). However, this design created two sets of framesupports between each unit. Due to the limited space in the MC, this was considereda significant loss. Therefore, the frame was redesigned with the final version beingcomposed of two parts: a welded aluminum back support and a front support built fromcomponents from the Bosch-Rexroth aluminum profile system (Figure 7.3).

Figure 7.3: Aluminum modular frame design (front and back supports shown). Front supportuses parts from Bosch-Rexroth high performance aluminum system, and theback support is made from welded aluminum channels.

The welded back section spanned the entire load bay length and provided a fixed framefor the various units to mount to. The customizable front section was attached to thewelded frame but maintained the freedom to be altered and arranged to preserve the

69


modular characteristics. The front section of each modular unit was then developed toattach to the welded frame. Each unit was required to have a uniform width and depth sothe units could be interchanged as needed.

After superimposing the frame design in a model of the vehicle load bay, it becameapparent that special consideration was required in the region of the wheel arches. Twooptions were available, either cut the lower support of the welded frame and install aspecial unit in that location, or else move the lower support of the frame forward to notintersect with the wheel arch. Moving the lower support forward would also requiremodifying the unit front ends to accommodate the change in location of the rear support.As was shown in Figure 7.3, the latter option was chosen. This decision was primarilymade in order to preserve the modularity of the clinic design.

In order to effectively utilize the space around the wheel arches and the large gapbetween the back of the frame and vehicle wall, two standard drawer lengths weredeveloped. The long drawers extended past the frame and filled the gap between theframe and the wall. Extending runners were used to allow the long drawer to fully extendwhen opened. The sort drawers only extended to the back of the frame and would beinstalled at floor level at the wheel arch locations.

7.3. Final Modular UnitsThe necessary medical equipment, auxiliary equipment, and storage space were incorpo-rated into the modular units to create the various storage and worktop modules. Here, thevarious units are presented individually. The integration of these modular units into theMC clinical layout will be shown in Section 8.

Storage Compartments: (Figures 7.4 and 7.5)

• Drawers

• Filing Cabinet

• Coolers

• Chemical Toilet

• Water Tanks (Fresh and Waste)

Worktops: (Figures 7.6 and 7.7)

• File Rack

• Wash Basin

• Work Desk with JIT Storage

• Patient Examination Bed

70


Figure 7.4: Implementation of various drawer concepts to utilize the modular unit storagecompartment. Both the long and short standard drawer lengths are shown.

Figure 7.5: Implementation of storage compartments in the modular units. From left toright: filing cabinet, coolers, chemical toilet, water tanks.

71


Figure 7.6: Implementation of worktops on the modular units. From left to right: file rack,wash basin, work desk with JIT storage, plain work desk.

Figure 7.7: Implementation of the patient examination bed as the worktop for thee modularunits. The head and foot sections of the patient bed can incline in order to placethe patient in different positions as required for treatment or diagnosis. Alsoshown is the use of two standard draws depths with representative organizersand containers inside.

72

8. Clinic Area Layout Development

8. Clinic Area Layout DevelopmentAnother aspect of the MC design to consider is the arrangement of the workspace, whichplays a critical role in both the patient and nurse experience. For the patient, a welldesigned cabin provides for greater comfort, treatment quality, and treatment efficacy.As for the nurse, comfort is also provided along with occupational satisfaction andefficiency; the following layouts have been completed with these viewpoints in mind.Additionally, medical professional interviews and documents gained during the GETkickoff conference were heavily influential during this stage.

Note: The following figures contain embedded 3-D models. The models can be rotatedto better view the interior of the clinic layout. AdobeTM Acrobat Reader 9, or later, isrequired for this functionality. Also, empty spaces in the models indicate drawers orcabinets.

The Nurses’ VisionInitially, our team was provided with a conceptual sketch (Appendix N) for an improvedcabin from Charlotte Stemmet, CNP, a practicing MC nurse. This translated compositeserved as an interesting insight into the “voice of the customer” and starting point forfuture developments. By converting this to a CAD model (Figure 8.1), even more detailcan be seen.

This design, while appearing quite straightforward, has two distinct features whencompared to the current MC: there is much more organized storage and a third seat isprovided. Currently, the majority of storage within the MC is in the form of temporaryboxes which are typically spread throughout the vehicle. Here, there are purpose-builtdrawers and cabinets that provide a permanent, logical, and centrally located solution.Also, the importance of the third seat cannot be underestimated, as the need for spaceto carry an additional professional is pressing. For example, a mental health counselorwould be considered beneficial in many circumstances.

73

8.C

linicA

reaLayoutD

evelopment

Figure 8.1: C. Stemmet’s concept model, the Nurses’ Vision. (3D Model)

74


Layout #1In this concept (Figures 8.2 and 8.3), there are a number of key aspects, such as adedicated desk to complete paperwork, a dark area to perform enhanced eye examinations,JIT storage system, fold out chair, and an integrated chemical toilet for enhanced humandignity. It is important to realize that this and all subsequent drawings/models do notrepresent the floor plan for any particular vehicle, but rather serve as a representativecollection of ideas.

Patient Bed & Filing System

Dark Room Sitting Area

Overhead Storage

Chemical Toilet

AC Unit (roof)

Sink & Water Tank

Desk

Storage & Sharps/Trash Bin

Third Seat (Fold Out)

Storage & Baby Scale

Handrails

Figure 8.2: MC clinic layout: Team Concept Layout #1. (Overhead Sketch)

75

8.C

linicA

reaLayoutD

evelopment

Figure 8.3: MC clinic layout: Team Concept Layout #1. (3D Model)

76


Layout #2Many of the same features from the previous layout have been included in this layout(Figures 8.4 and 8.5), with the notable addition of a corner storage system to maximizespace usage. Also, since the patient is mainly on the bed for the duration of their visit,in every design a conscious decision was made to make that area the focal point of allsurrounding modules. For example, the third seat, sink and primary storage locations aredirectly across or under the bed, minimizing the effort required to utilize these primaryfeatures.

Desk & Storage


Overhead Storage

Third Seat (Fold Out)Handrails

Corner Storage

Baby Scale & StorageSharps/Trash Bin

Gen Set & Water

Sink & Storage

Patient Seat

AC Unit (roof)

Seat

Chemical Toilet


77

8.C

linicA

reaLayoutD

evelopment


78


Layout #3In this arrangement (Figures 8.6 and 8.7), there is the addition of a designated coolerfor medications, curtain for patient privacy and enhanced examinations, and modularworkstation for use by a third seat professional. It should be made clear that in everycase the components of a floor plan are represented as independent modules that resideon an as yet unmodeled mounting systems.

Curtain

Seat


Cooler Desk

StorageThird Seat

AC Unit

(roof)

Modular Workstation

Sink & Sharps/Trash Bin


79

8.C

linicA

reaLayoutD

evelopment


80


Layout #4The motivation for this layout concept (Figures 8.8 and 8.9) was to provide two separateworking areas for the nurses. The area near the entrance was dedicated to administrativeand counseling duties. The space was designed for the staff nurse, with a writing deskand chair, small filing cabinet, space for the patient to sit, and overhead storage forrecords and supplies. The patient chair would also conceal a small toilet. The rear areaof the clinic (divided by a curtain) was designed for the CNP. A reclining chair wassubstituted for the patient bed, as few examinations require the patient to be lying down.The goal of the design was to keep everything the CNP needed close at hand, while stillproviding an open environment for the patient and nurse.

Curtain

StorageThird Seat

AC Unit (roof)

Patient Reclining Chair

Seat

Seat

Desk

Cooler

Wall Rail

Overhead Bin

Overhead Bin

StorageHandrails

Slide-‐Out Entrance RampSink and Sharps/Trash Bin

Modular Workstation


81

8.C

linicA

reaLayoutD

evelopment


82


8.1. Design Feedback and ImprovementsThe four initial layout designs were distributed to MC nurses for feedback in the userpreference survey (Section 4.4). From the survey results, it was determined that Layout 4(Figures 8.8 and 8.9) was the preferred layout concept. Therefore the fundamental designand concepts from Layout 4 were used to develop the layout of the clinical area in thenew MC. A summary of the survey analysis is given below.

• Question 12 asked the users to rank the layouts in order of preference. To dothis, they were asked to use a drag-and-drop feature to place the layout names intheir desired order. However, it appears approximately 50% of the nurses wereunsure how to answer the question, and the responses were submitted in theirdefault positions. By analyzing only the responses that did change from the defaultorder, all but one of the nurses placed Layout 4 in the top position, with the singleremaining top vote being for Layout 2.

• Question 13 asked the users to write in what they liked about their favorite layout.71% of the users addressed Layout 4, citing the concept of a two room patient/officesplit and additional privacy from the curtain as good additions.

• Question 18 requested that users indicate what components included in the layoutsthey preferred. Five of the components from Layout 4 received an above averagepreference, which was more than any other layout. The following concepts fromboth Layout 4 and the other layouts received a positive response: slide-out entranceramp, privacy curtain, entrance hand rails, a chair for both nurses, and the writingdesk.

The fundamental idea behind the design of Layout 4 was to provide the nurses withtwo separate working spaces. In this way both the staff nurse and CNP would be able toproperly administer to patients simultaneously. Providing the staff nurse with a writingdesk and filling cabinet was a necessary improvement, as they currently work out of thepassenger seat of the vehicle cab.

Each of the preferred concepts were incorporated into the final layout except theslide-out entrance ramp. The slide-out entrance ramp, though beneficial, could not beincluded due inadequate clearance between the vehicle and the ground. This option wasdiscussed in Section 6.4, and should be considered when selecting the vehicle for futuremobile clinics.

The survey also asked the users to identify aspects of the current MC design thatthey were happy with. However, this question did not receive many positive statements.Nevertheless, it was considered unlikely that every aspect of the current design beunfavorable. Therefore, photographs of the interior of several MCs, with different designs,were analyzed for elements that appeared to be well utilized. From the photographs, it

83


was found that a narrow bin was attached along the wall of most of the MCs. This bincan be seen in an image of the MC currently servicing the Overburg area (Figure 8.10).

Figure 8.10: Detailed view of the wall mounted storage bin in the Overburg area MC. Asimilar bin was found in most MCs in the Western Cape.

From analyzing the photographs, it appeared that the majority of the regularly usedmedical equipment (i.e., stethoscope, thermometer, pressure cuff) was kept in this bin foreasy access. In discussion with MC staff, that was again found to be the case. As such, asimilar narrow storage bin was included to the new MC design.

The final question in the survey asked the user to provide any further ideas for waysthey thought the MC could be improved. Most of the listed ideas were a repeat of whathad already been stated in the survey. However, a number of user indicated that theability to access the the clinic from the vehicle cab was essential. Also, the availabilityof an additional seat for a third staff member was of interest. These ideas were alsoreflected in the original desire/needs analysis (Table 4.1).

Also, when the initial layouts were developed, it was assumed that a larger vehiclewould be used for the MC. However, after a detailed vehicle analysis and selection(Sections 6), the chosen vehicle was slightly smaller than anticipated. Therefore, somemodifications to the proposed Layout 4 were necessary due to space constraints in thevehicle.

84


8.2. Final Layout DesignThe final layout was compiled after incorporating the feedback from the user survey andother sources described above. Had time permitted, a second and third round of userdesign feedback exercises would have been performed on the design presented below.However, it would require at least a month circulate another survey, with little certaintythat the survey would provide more than a handful of nurses responses. Given the allottedtime for the project, this was not possible. As such, the following design is the team’sbest recommendation for the new MC.

At the project inception, a list of deficiencies in the current MC were drafted by thestakeholders. The deficiencies and other desired improvements were categorized intoneeds and desires. To verify that the new MC design satisfies all the needs and currentdeficiencies, the needs-desires analysis table is presented again, indicating which itemshave been accomplished in the new design (Table 8.1). All the required improvementswere accomplished, as well as the majority of the desired improvements.

The final design is shown in Figures 8.15 through 8.14. A 3-D animation of the MCcan also be viewed at http://tinyurl.com/9q87jze. Particular attention shouldbe given to the incorporation of the required equipment into the modular units, as well asthe various depths and heights of the drawers. The changes in dimensions were not onlyto accommodate different sized objects in the storage containers, but to more effectivelyutilize the space surrounding the wheel arches.

85

http://tinyurl.com/9q87jze


Table 8.1: Revisit of the originally identified needs and desires for the next generation MC(Table 4.1). The items that were improved, completed, or satisfied with the newdesign are indicated.

Area for Improvement Need Desire Accomplished

Internal Climate Control � �Ample Work Space and Storage � �Improved Ventilation and Containment � �Power Steering � �Cooled Storage for Medication � �Increased Range of Medical Services � �Improved Sanitation and Ablutions � �Robust Internal Clinic Design � �Self Sustained Electrical Supply � �Provision for a Third Staff Member � �Improved Patient Privacy � �Emergency Communication Equipment � �Emergency First Aid Box � �Access from Cab to Clinic � �Vibrational Damping of Clinic Structures � �Improved Means of Medical Documentation �Improved Capabilities for Preventative Care � �Improved Capabilities for Healthcare Education � �Improved Off-Road Capabilities �External Shading � �Safety from Environment and Elements �

86


Figure 8.11: Isometric view of the final MC layout with representative vehicle sidewallsshown with transparency. The roof mounted air-conditioning unit, ventilationfans, and spaces occupied by the wheel arches are also represented.

87


Figure 8.12: Closer view of the staff nurse, or administarative, working area, with writingdesk, medication coolers, and patient file storage.

Figure 8.13: Closer view of the CNP working area, with wash basin, chemical toilet, filingracks, and working desks.

88


Figure 8.14: The patient examination bed with head or foot section raised. The storagecompartments under the bed are filled with various sized drawers for medicalstorage.

89


Figure 8.15: Final layout (overhead view) of the MC clinical area. The name and locationof each modular unit is shown, as well as the third seat, wall storage bins, androof mounted HVAC system.

90


8.2.1. Design Specification

As outlined in Section 1.4.3, the primary deliverable for the project was a new set ofdesign specifications for MCs in the Western Cape. The new specifications documentsummarizes the recommendations of the GET team findings, and will serve as a guidefor drafting future government MC procurement documents. The new MC specificationdocument can be found in Appendix O.

8.2.2. Summary of MC Production Cost

The specification document was delivered to AVE to receive an initial cost estimate forperforming the conversion. A summary of the final cost breakdown is given in Table8.2. The complete details of the quote are shown in the new MC specification document(Appendix O).

Table 8.2: Summary of final production cost as perfided by AVE. Quote recieved on 12 Sep.2012.

Item Cost (R)

Vehicle and Options 350,693Auxiliary Equipment 99,338Medical Equipment 57,837Modular Units 122,248Vehicle Preparation 16,580Systems Installation 28,440

Total Cost: 675,136

91

9. Conclusion

9. ConclusionOver 10 percent of the population of the Western Cape lives in remote, rural areas wherethe primary form of healthcare is provided through the use of MCs. MCs are panel vansor Light Commercial Vehicles (LCVs) in which the load bay is converted into a smallclinical area. Due to the fact that current MCs do not adhere to the requirements ofprimary healthcare, the MRC has launched an initiative to design a new generation ofMCs.

This project consists of four international students from various fields of expertise inmechanical engineering. By making use of adequate electronic communication, theyhave set out to achieve the goal of designing a new generation MC. The group membersare fully aware of the constraints inherent in the project scope and have accordinglybroken down the stages of the project into manageable steps by means of a WBS in orderto achieve the final goal.

Through interviews, consistent stakeholder involvement, and a comprehensive userpreference survey the most critical aspects and requirements of the MC design wereidentified and hence appropriately addressed. To ensure a comfortable working envi-ronment the clinical area had to be of such a design as to allow for proper movementof the nursing staff. As a result, a thorough anthropometric analysis was performed,aiding in the design of the modular frame that would house all of the storage modules,worktops, and other equipment required by the nursing staff. One initial requirementfrom the project sponsor (Dr. Krige) was that a degree of innovation be inherent in theMC design. As such, extensive benchmarking was done in order to identify current stateof the art MCs as well as the requirements that these MCs adhere to, fail to adhere to, orthat can be improved upon. By including and/or improving the identified requirements itis certain that the new generation MC will adhere to the requirements of the stakeholdersand nursing staff alike.

To further improve upon the comfort of the working environment and daily routineof the nursing staff, the best LCV had to be selected from a pool of potential models.Intuition alone would not suffice in selecting the best LCV and hence a proven andtrustworthy methodology had to be used, namely, the AHP process. Emphasis wasplaced upon the comfort, drivability, and other primary aspects; details of the updatedweighting factors for each category and sub-category as developed by the AHP methodcan found in Table 6.3. The original and revised weights are both shown for comparisonand the resulting score is available for each of the vehicles. After the AHP process wascompleted and the results thoroughly evaluated, it was found that the VW Crafter 35 2.0TDI, MWB, SHR was the best candidate to convert into an MC. It was clear, however,that the chosen vehicle is a Class C1 type vehicle but through legal counsel has beenfound to be re-registerable as a Class B license vehicle. This has many advantages,especially with regards to the space available for a clinical area. The details of theseadvantages are presented and discussed in Section 6.1.

92

9. Conclusion

The equipment available on current MCs does not fulfill the requirements of thenursing staff in that it does not provide the most comfortable working environmentnor does it ensure the most adequate patient care. The team has accordingly identifiedmedical and auxiliary equipment (Section 5) and within each category selected the typeof equipment best suited to fulfill the aforementioned requirements. This was done byidentifying the advantages and disadvantages of each type of equipment and selectingthe most favorable product. During meetings with stakeholders it was clear that the teamidentified and placed emphasis on the most important aspects of the MC design and thatthe selected equipment will fulfill the shortcomings inherent in the MCs.

One of the primary deficiencies of the current MC is the lack of climate control inthe clinic. As such, heat pump HVAC systems were identified to both heat and cool theclinic. The VW Crafter 35 also provides an optional passenger/load bay A/C unit withheating module. As determined in a simple Cost/Benefit analysis (Section 6.4), this isthe preferred method of controlling the air temperature in the clinic. A great need alsoexists for cooling compartments for medication, blood samples, and vaccines. As suchthe team decided to employ thermoelectric coolers that are both 220V AC and 12V DCoperable, both having the same cooling volume of 7 liters.

In order to provide workspace for two nurses, a privacy curtain will separate theexamination bed from the rest of the MC. The examination bed will allow either thehead or the feet to be elevated. This allows the nurses greater access to the patientsduring diagnosis and/or treatment. Furthermore, it was imperative to provide the nursingstaff with ablution facilities that would allow for dignified use. Since the MC is of amodular design the toilet can not be fixed permanently and hence a portable, yet flushable,chemical toilet was identified. This further reduces conversion cost and simplifies theMC design. To ensure hygienic diagnosis of patients, a wash basin with a reliable andsufficient water source will form part of the ablution facilities.

A great shortcoming in current MCs is the inability to modify the clinical area to bestsuit the nursing staff. To address this problem a modular frame design was envisionedthat would allow the nursing staff to customize the clinical area layout. In this way,the nursing staff rearrange the layout to best suit their needs. Other advantages of themodule design include the ability for the clinic to be easily modified to suit healthcarerequirements set out by other provinces within South Africa. Also, as new healthcaretechnology arise they can be easily incorporated into the MC. Lastly, should any of themodular units be damaged, the individual units can be replaced, with minimal changeson the rest of the system.

Considering the load bay dimensions of the VW Crafter 35, a MATLAB code wascreated to optimized the width of the modular units to best utilize the space within theCrafter 35 load bay. In order to easily assemble and disassemble the modular frame,the frame was designed using standardized industrial extruded aluminum parts. Thealuminum frame also contributes to minimizing the total weight of the MC.

93

9. Conclusion

As mentioned, a comprehensive survey was envisioned in order to gather constructivecriticism from the nursing staff. This survey provided the nurses with clinical area layoutsas developed by the group members as well as C. Stemmet. The nurses could then rankthe layouts to their preference. Only ten out of 164 MC nurses completed the survey.From this minimal response it was determined that Layout 4 (Figures 8.8 and 8.9) wasthe preferred layout. Therefore, the team decided to use this layout as a baseline forincluding all other improvements to the final layout.

Finalizing the project entailed providing a more detailed design. One important re-quirement of achieving this goal was to create a specification sheet for the next generationMC. This specification sheet (Appendix O) represents all design aspects as mentioned inSection 1.4.3. Amongst these aspects are the final assembly of the clinical area whichincludes the aluminum frame, all the storage modules and worktops as well as all theoutsourced equipment. Upon investigation of this final design the team strongly believesthat the MC to be built by the MIB will satisfy the requirements of the next generationMC and improve rural health in South Africa.

9.1. Future WorkThroughout the course of this project every effort was made to address the needs ex-pressed by a wide variety of stakeholders. From the MRC, nurses, government, andmany more, requests for improvements were considered and eventually developed, ascan be seen throughout this report. However, due to the limited nature of both time andscope, not everything was included. Additionally, the MC described here is intended as aresearch platform, and should undergo further refinements and changes in the future.

Therefore, it is our recommendation that followup efforts be directed in four key areas:

• Government integration of the MC as a unique vehicle platform.– There was a great amount of effort put into the acceptance of a larger vehicle

as a proper C1 designation, and currently this issue has reached the limits ofour team’s influence.

– As a result, the government should finalize the addition of the MC descriptionto the NaTIS and consult with AS&A.

• Development and implementation of cutting edge technologies within the MC.– Ultimately, the purpose of a modular MC is to allow for adaptation and

deployment of future technologies. It is important that investments be madein these technologies, so quality of care improves consistently in the comingyears.

– To deploy such tools, the modular units will have to be adapted and redesignedas needed. As a result, efforts should be made to keep this idea contemporaryand meaningful.

94

9. Conclusion

• Procurement of desirable vehicles for the SA market.

– In the vehicle section of this report, there are alternative options presented forvehicles that have advantageous characteristics but are currently not availablefor purchase. If these, or even as yet unannounced platforms, are broughtinto the country the potential performance of the MC improves across everycategory.

– Additionally, once these vehicles are imported, efforts should be made toplace them on government procurement lists for simple and possibly dis-counted purchase. Also, this will allow for enhanced after sales service andsupport.

• Pursuit of an anthropometric study specifically targeting MC nurses

– To compute several important dimensions of the modular units, a combinationof an American military study and limited-scope SA medical paper were used.These were the best available at the time, and while these were combined insuch a way that the results are scientifically sound and reasonably accurate, itis possible to do better.

– By conducting a survey of the nurses, accurate and powerful data can be col-lected and the modular units subsequently refined. Even small improvementsin the realm of anthropometrics pay significant dividends in terms of nursecomfort and occupational satisfaction.

• Iterate through the latest design

– While the design produced in this report is the result of extensive thoughtand effort, it has not undergone another round of user review and input. Thisshould be conducted in order to produce an outcome that builds upon andfurther refines the ideas that have been developed previously.

– Prototyping is an integral part of any design process, and due to the project’sconstraints this step was not conducted outside of 3D CAD models. However,there is significant value to creating a representative environment (i.e, usingfoam cutouts) and bringing users into this space to observe their impressions.

95

REFERENCES

References[1] Constitution of The Republic of South Africa, NO. 108, 1996.

[2] Y. Akao and G. H. Mazur. The leading edge in qfd: Past, present and future.International Journal of Quality & Reliability Management, 20(1):20–35, 2003.

[3] B. Aljasir and M. S. Alghamdi. Patient satisfaction with mobile clinic servicesin a remote rural area of saudi arabia. Eastern Mediterranean Health Journal,16(12):1085–1090, 2010.

[4] B. S. Blanchard and W. J. Fabrycky. Systems Engineering and Analysis. PrenticeHall, 5th edition, 2011.

[5] Advanced Vehicle Engineering cc. Large mobile clinic. Avalible upon request:[email protected], May 2012.

[6] The South African Pharmacy Council. Good pharmacy practice in south africa, forthedition. Availible: www.saop.co.za/documents/SA%20Pharmacy%20Standards.pdf, 2010.

[7] N. Cross. Engineering Design Methods, Strategies for Product Design. Wiley, 4thedition, 2008.

[8] H. L. Crouse, C. G. Macias, A. T. Cruz, K. A. Wilson, and S. B. Torrey. Utilizationof a mobile medical van for delivering paediatric care in the bateys of the dominicanrepublic. International Journal of Emergency Medicine, 3(4):227–232, 1210.

[9] South Africa Department of Health, Western Cape Provance. Specifications for amobile clinic, April 2008.

[10] R. Drillis and R. Contini. Body segment parameters. Technical report, Office ofVocational Rehabilitation Engineering and Science, New York, 1966.

[11] L. Mac Duff, J.P. Venter, D.C. Meyer, and J.D. Pelser. Ergonomic design: Anthro-pometry and environment. 4th ed. Vol. 1, Republic of South Africa. RSA MilitaryStandards Steering Committee (RMSS), 2004.

[12] K. Edwards. Design for X — Concurrent Engineering Imperatives. Chapman &Hall, 1996.

[13] Ø Eggen. Modular product development: A review of modularization objectivesas well as techniques for identifying modular product architectures, presented in aunified model. Technical report, Norwegian University of Science and Technology,Department of Product Design.

96


www.saop.co.za/documents/SA%20Pharmacy%20Standards.pdf

www.saop.co.za/documents/SA%20Pharmacy%20Standards.pdf

REFERENCES

[14] R. English. Annual Health Status Report: Boland/Overberg Region 2007-2008. Available: www.westerncape.gov.za/text/2009/12/boland_overberg_region.pdf, 2008.

[15] Andris Freivalds. Niebel’s Methods, Standards, and Work Design. McGraw Hill,12th edition, 2009.

[16] R. C. Fromuth. Predicting anthropometric segment lengths. Technical report,Bachelors Thesis, The Pennsylvania State University, 2009.

[17] A. Gannon and W. Moroney. The validity of anthropometric predictions derivedfrom proportionality multipliers of stature. In Human Factors and ErgonomicsSociety, 1998.

[18] Geneva: International Labour Office. Ergonomic Checkpoints: Practical and Easy-to-implement Solutions for Improving Safety, Health and Working Conditions,1996.

[19] C. Guasasco, L. J. Heuer, and C. Lausch. Providing health care and education tomigrant farm workers in nurse-managed care centres. Pictorial, 23(4):166–171,2002.

[20] W. Heath and R. Robinson. Supplementary report 610. Technical report, Transportand Road Research Laboratory, 1980.

[21] T. Holmqvist and M. L. Persson. Analysis and improvement of product modular-ization methods: Their ability to deal with complex products. Systems Engineeing,6(3), 2003.

[22] K. Holzle. Introduction to the HPI D-School, 2012.

[23] C. Klopper and C. Stemmet. Report on mobile clinic audit: Bossieveld. e-mail toC. Stemmet 30 March. Available e-mail: [email protected], 2012.

[24] F. Krige. Ukwanda rural clinical school: The need for improved mobile clinics forthe district health services. e-mail to C. Stemmet [Online]. 12 March. Availablee-mail: [email protected], 2010.

[25] F. Krige. Minutes: Meeting to discuss redesign of mobile clinics - 17 november2011. e-mail to C. Stemmet [online]. 1 March. Available e-mail: [email protected], 2011.

[26] F. Krige. GET project kickoff meeting in Stanford, SA. April 2012.

97

www.westerncape.gov.za/text/2009/12/boland_overberg_region.pdf

www.westerncape.gov.za/text/2009/12/boland_overberg_region.pdf

mailto:[email protected].



REFERENCES

[27] C. R. Lafuente, V. Eichaker, V. E. Chee, and E. Capital. Post-katrina provision ofhealth care to veterans in a mobile clinic: Providers’ perspectives. Journal of theAmerican Academy of Nurse Practitioners, 19(8):383–391, 2007.

[28] C. Lin, J. Hong, M. Hwang, and Y. Lin. A study of the applicability of idea genera-tion techniques. Available: http://portales.puj.edu.co/jaguilar/A_STUDY_OF_THE_APPLICABILITY_OF_IDEA_GENERATION_TECHNI.pdf.

[29] T. G. Lindgren, K. Deutsch, E. Schell, A. Bvumbwe, K. B. Hart, J. Laviwa, andS. H. Rankin. Using mobile clinics to deliver hiv testing and other basic healthservices in rural malawi. The international electronic journal of rural and remotehealth research, education, practice and policy, 11(1682):1–8, 2011.

[30] D. Marais, M. L. Marais, and D. Labadarios. Use of knee height as a surrogatemeasure of height in older south africans. South African Journal of ClinicalNutrition, 20(1):39–44, 2007.

[31] G. McNeal. Umdnj school of nursing mobile healthcare project: A component ofthe new jersey children’s health project. The ABNF Journal, 19(4):121–126, 2008.

[32] G. Nadadur and M. Parkinson. Extrapolation of anthopometric measures to newpopulations. SAE International Journal of Passenger Cars - Electrinic Systems,2008.

[33] G. Nadadur and M. Parkinson. Consideration of demographics and variance inregression approaches to estimating body dimensions for spatial analysis of design.Journal of Mechanical Design, 132, 2010.

[34] United Nations. The millennium development goals report 2010, June 2010.

[35] Western Cape Government: Department of Health. Greenpaper on the future ofhealth care in the western cape towards 2020. A draft framework for dialogue,November 2011. Cape Town: Western Cape Government., 2011.

[36] Republic of South Africa: National Department of Health. Nursing act 33 of 2005,section 56 (6). Pretoria: Government Printer, 2006.

[37] T. L. Saaty. Decision making with the analytic hierarchy process. InternationalJournal of Services Sciences, 1(1):83–98, 2008.

[38] N. Schaay and D. Sanders. South African Health Review 2008. Durban: HealthSystems Trust, 2008.

98

http://portales.puj.edu.co/jaguilar/A_STUDY_OF_THE_APPLICABILITY_OF_IDEA_GENERATION_TECHNI.pdf



REFERENCES

[39] D. H. Stamatis. Failure mode and effect analysis: Fmea from theory to execution.Technometrics, 38(1), 1996.

[40] C. Stemmet. An investigation to assess whether the newly designed mobile cliniccomply with phc requirements in the western cape. Literature review for persute ofMaters of Nursing, April 2012.

[41] N. Taberlet, S. W. Morris, , and J. N. McElwaine. Washboard road: The dynamics ofgranular ripples formed by rolling wheels. Available: http://www.physics.utoronto.ca/˜nonlin/preprints/TMM07.pdf, 2007.

[42] T. P. Tomiyama, Y. Jin, D. Lutters, Ch. Kind, and F. Kimura. Design methodologies:Industrial and educational applications. CIRP Annals - Manufacturing Technology,58(2):543–565, 2009.

[43] USA. US Marine Corps. NSRDEC. U.S. Marine Corps Anthropometric Survey(MC-ANSUR). Natick, MA: JSAS Publication Office, 2010.

[44] Watts. Wheeling and healing. Lancet, 364(9441):1205–1206, 2004.

99

http://www.physics.utoronto.ca/~nonlin/preprints/TMM07.pdf

http://www.physics.utoronto.ca/~nonlin/preprints/TMM07.pdf

Appendices

100

A. Summary of Healthcare Policy, Standards, and Reviews

A. Summary of Healthcare Policy, Standards, andReviews

The improvement of service delivery in the PHC (primary health care) system hasbeen addressed in the 2020 vision for the healthcare in South Africa[35]. The CSP(Comprehensive Services Plan) has previously developed a range of medical servicesthroughout the country and devised strategies to deliver these services as discussed in the2020 Future of Health Care[35]. The concept of CBS (Community Based Services) areintroduced to aid in the improvement of patient-centred care and quality service. The useof MCs to deliver the CBS to rural communities is pivotal, as promoted by Stemmet[40].

A thorough review of the healthcare infrastructure in SA[38] shows various short-comings in the Western Cape healthcare system which is largely due to understaffingand financial limitations of both healthcare system and the patients which they serve.Parts of the CSP and the 2020 healthcare reform[35] include the development of healthtechnologies that includes a care pathway approach to service delivery that is initiated byCBS. The services delivered by the MCs are crucial to rural communities to maintaintreatment of chronic diseases, pre- and postnatal care, treatment of STIs, immunization,nutrition and family planning. This furthers the aims of the 2020 healthcare reform byproviding a healthcare pathway to rural communities.

There are many hurdles to overcome before an improved MC design can be developedand implemented. The current MC design has been described as impeding the quality ofservice delivered by the MC which does not provide an adequate clinical environment[40],the main issues include: the upkeep of hygienic standards, exposed work environment,lack of adequate work and storage space. The current governmental standards andspecifications set for MCs do not fully describe the necessary requirements to producefunctional and feasible MC and thus the mobile clinic specification[9] requires revisionand amendment.

Finally, with regards to broader policies, there are both national and internationalinfluences in decision making. The constitution of South Africa[1] mandates nationwideaccess to health care services, including reproductive health care, to all citizens andmakes special mention of the provision of basic nutrition, basic health care services andsocial services to children. This strengthens the argument for the continuation, improve-ment and expansion of the MC services. The UNs MDGs (Millennium DevelopmentGoals)[34] stipulate many efforts that are promoted by the operation of MCs, including:the empowerment of women, reduction in child mortality, improvement of maternalhealth, combating HIV/AIDS and other diseases.

101

B. Detailed Gantt Chart

B. Detailed Gantt ChartAs this is a dynamic project, the Gantt chart (Figure B.1 will be updated and expandedas work progresses. As the image may be difficult to read, the current Gantt chartin Microsoft ProjectTM format can be downloaded from https://docs.google.com/file/d/0B7krzp4eXlWhS3JwcVZwTVAxcEU

102

https://docs.google.com/file/d/0B7krzp4eXlWhS3JwcVZwTVAxcEU

https://docs.google.com/file/d/0B7krzp4eXlWhS3JwcVZwTVAxcEU

B.

Detailed

GanttC

hart

Figure B.1: Detailed project Gantt chart

103

� �

��

��

��

�� !�� !�"�� !�� #�� !�$��$�� #��#��!��#�� !

��!

��

��

��

��

��

�� #��"��%&''!

��

�

�

�

C. Details of Benchmark MC by Advanced Vehicle Engineering cc.

C. Details of Benchmark MC by Advanced VehicleEngineering cc.

104

� �

(��

��(�� #�� !��)� �� !�� #� �� !��*��#�� !��) �� ! ��+��

�� #�� #��,!!��$�� #�� #��!"��)� ��$�� $�� $�� !�#�� #�� #��!�� #��#�� #�� !

�

�

�

�

$

��

!

�$�� -��!

�� $��

� ��#��!�� .��/��-��,� ��

�� 0��1�#��!�!2��'34�554�3&4&

"

�#

%�&��&�'�� (��

��(��

C. Details of Benchmark MC by Advanced Vehicle Engineering cc.

105

D. User Preference Survey


106

Yes

No

IRB Disclaimer

A research study by the Global Engineering Teams (GET) 2012 at Penn State University & StellenboschUniversity

Principal Investigator:Erick FroedeMasters Student, Mechanical Engineering127 Reber BuildingUniversity Park, PA 16802+1 (973) 975 2953; [email protected]

Other Investigators:Bryan LewisMasters Student, Mechanical Engineering127 Reber BuildingUniversity Park, PA 16802+1 (801) 643 3036; [email protected]

1. Research objective: To study user preference of both the current mobile clinic and a potential next generationredesign.

2. Data-collection procedure: Participation in this study will involve a brief online survey. You will be asked toprovide your current opinion on the mobile clinic design. Next, you will be presented with alternative designs andwill be asked to evaluate them based on your experience and personal preference.

3. Research impact: This study will help to better understand the current problems, as well as help guide the designdecisions for a next generation of mobile clinic. This knowledge will allow the government and other concernedentities (e.g. GET 2012) to more appropriately pursue a new mobile clinic.

4. Duration: This survey will take approximately 30 minutes to complete.

5. Statement of confidentiality: All data collected in this study are strictly confidential. You will not be asked toprovide anyinformation whatsoever that could be used to identify you as an individual. If you choose to complete thequestionnaire online,your individual responses will be kept confidential to the degree permitted by the technology used. No guaranteescanbe made regarding the interception of data sent via the Internet by any third parties.

6. Right to ask questions: Please contact Erick Froede or Bryan Lewis with questions, comments, or concernsabout this research.

7. Voluntary participation: Your decision to participate in this study is completely voluntary. You have the right tostop yourparticipation at any time, even after the start of the survey. You can choose to not answer any questions that youdo notwant to answer.

You must be 18 years of age or older to take part in this study.

If you consent to participate in this research study and to the terms above, please click “next” below.

By completing this survey, it is implied that you agree to participate in this research study.

(Note - If you do not agree with the information in this consent form, please exit the survey)

Please print this form to keep for your records. Thank you.

Introduction

This survey will consist of two parts, starting with a section related to the current mobile clinic and anotheraddressing potential future improvements. Before beginning, we would like to gather some basic informationbelow.

Are you a clinical nurse practitioner?

Qualtrics Survey Software https://pennstate.qualtrics.com/ControlPanel/PopUp.php?PopType=Surve...

1 of 8 7/11/2012 11:03 AM


D.1. The Complete Survey

107

One year or less

Between one and five years

Between five and ten years

More than ten

How many years of experience do you have working on a mobile clinic?

Current Mobile Clinic

Please enter the make, model, and year of your current mobile clinic (for example: Mercedes, Sprinter, 2001)

Note: All following questions should be completed in reference to this vehicle.

Please rate your current satisfaction with the various aspects of your mobile clinic, ranging from completedissatisfaction (0) to complete satisfaction (100). This selection can be made by left clicking and dragging thesliders.

Off road capability

Floor space

Head space

Storage space

Internal temperature

Vehicle durability

Equipment durability

Access to technologyand/or modern design

features

Nurse comfort

Patient comfort

0 10 20 30 40 50 60 70 80 90 100


2 of 8 7/11/2012 11:03 AM


108

Please rank the following aspects for improvement, from most important (top position) to the least important(bottom position). This can be accomplished by left clicking, dragging, and dropping the categories.

Please briefly list and describe the primary problems you have encountered with your mobile clinic.

The following list comprises several components of the mobile clinic. Please select your level of satisfactionassociated with that component.

Satisfaction Level Very

Satisfied Satisfied Neutral Unsatisfied CompletelyUnacceptable

Patientbed

Patientrecordstorage

Overheadstorage

Chilledmedicinechest

Scale(adult)

Scale(child)

Wastedisposal

Washbasin

Personalstoragespace

Chairs Fan Small itemstorage(medicineboxes,foodproducts,etc)

Lighting(Overhead,patientlamp)

Off road capability

Floor space

Head space

Storage space

Internal temperature

Vehicle durability

Equipment durability

Access to technology and/or modern design features

Nurse comfort

Patient comfort


3 of 8 7/11/2012 11:03 AM


109

What percentage of your time do you spend on the following activities?

Note: Values can be approximate, but all items must total up to 100%

The following is an image of a representative mobile clinic. Using your previous experience, please click ONCEon any regions/objects which you would consider well designed and TWICE on those which you would considerpoorly designed.

Cleaning dust and dirt

Organizing files

Treating patients

Searching for medication

Making minor equipment repairs

Unable to work due to major equipment repairs

Total


4 of 8 7/11/2012 11:03 AM


110

If you clicked on a region in the picture above, either positive or negative, please provide a brief description ofwhy.

Please enter any further comments or concerns related your mobile clinic that were not covered previously.

Next Generation Mobile Clinic

In this section, several conceptual images from a next generation mobile clinic will be presented. These arepreliminary and will change over time.


5 of 8 7/11/2012 11:03 AM


111

Consider the following four layout concepts. Based on your own experience and intuition, please rank them fromthe most important (top position) to the least important (bottom position). This can be accomplished by leftclicking, dragging, and dropping the images.

Note: Blue regions indicate padding and therefore a place where a person can sit. Additionally, the term "modularworkstation" refers to a unit which can support the third seat passenger and/or specific route needs; for example,a family planning councilor.

Layout 1:

Layout 2:

Layout 3:

Layout 4:


6 of 8 7/11/2012 11:03 AM


112

Consider your most preferred layout: what did you like the most? Were there any bad aspects?

Consider your least preferred layout: what did you dislike the most? Were there any good aspects?

The following is an image of the first layout. Using your previous experience, please click ONCE on the name ofany objects which you would consider well placed and/or needed & TWICE on those which you would considerpoorly placed and/or unnecessary in the MC.

The following is an image of the second layout. Using your previous experience, please click ONCE on the nameof any objects which you would consider well placed and/or needed & TWICE on those which you would considerpoorly placed and/or unnecessary in the MC.


7 of 8 7/11/2012 11:03 AM


113

The following is an image of the third layout. Using your previous experience, please click ONCE on the name ofany objects which you would consider well placed and/or needed & TWICE on those which you would considerpoorly placed and/or unnecessary in the MC.

The following is an image of the fourth layout. Using your previous experience, please click ONCE on the name ofany objects which you would consider well placed and/or needed & TWICE on those which you would considerpoorly placed and/or unnecessary in the MC.

Please enter any further comments or concerns related to future improvements that were not covered previously.

Thanks & Reminder

Special Note: The GET 2012 team aims to create the best solution possible for you, the user, and would welcomeany thoughts or feedback. Please email the principal investigator, Erick Froede, at [email protected] at any time.

Copyright: The Pennsylvania State University & Stellenbosch University, 2012


8 of 8 7/11/2012 11:03 AM


114

IRB# 40415 Submitted June 28, 2012 10:14:39 AM 1

Institutional Review Board (IRB) The Office for Research Protections

The 330 Building, Suite 205 University Park, PA 16802 | 814-865-1775 | [email protected]

Submitted by: Bryan Lewis Date Submitted: June 28, 2012 10:14:39 AM IRB#: 40415 PI: Erick W Froede Review Type: Exemption Protocol Subclass: Social Science Approval Expiration: -pending- Class Project: Yes

Study Title 1>Study Title

Design of the Next Generation Mobile Health Clinic for the Western Cape of South Africa

2>Type of eSubmission New

Home Department for Study 3>Department where research is being conducted or if a student study, the department overseeing this research

study. School of Engineering Design, Technology and Professional Programs

Review Level 4>What level of review do you expect this research to need? NOTE: The final determination of the review level

will be determined by the IRB Administrative Office. Choose from one of the following: Exemption

5>Exempt Review Categories:

Choose one or more of the following categories that apply to your research. You may choose more than one category but your research must meet one of the following categories to be considered for exempt review.

Information about the review categories can also be found in the Code of Federal Regulations Title 45 Part 46 Subpart A Section 101: http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.html#46.101. Information that is bolded below is additional clarification provided by Penn State, as allowed by federal law.

[X] Category 2: Research involving the use of educational tests (cognitive, diagnostic, aptitude, achievement), survey procedures, interview procedures, or observations of public behavior unless:


D.2. Application for Survey Approval by the Penn State InternalReview Board

115


Basic Information: Association with Other Studies 6>Is this research study associated with other IRB-approved studies, e.g., this study is an extension study

of an ongoing study or this study will use data or tissue from another ongoing study? No

7>Where will this research study take place? Choose all that apply. [X] University Park

[X] Other Site(s)

8>Specify the building, and room at University Park where this research study will take place. If not yet

known, indicate as such. Participants will be able to complete the study at any location where they have access to a computer with Internet access.

You have indicated that the research study location will include an outside laboratory or other non-PSU

site(s).

9>List each site and provide contact information [name & address] for each site. Participants will be able to complete the study at any location where they have access to a computer with Internet access. Since each contacted person will be individually asked to decide whether or not they would like to participate in the survey, no letter of agreement/permission from an individual in a decision making position is attached in response to Question 10.

10>Do any of these sites have an IRB? No

If you answer "No" to the above question, provide a letter of agreement/permission from an individual in a decision making position indicating their willingness to participate in the research study.

11>Does this research study involve any of the following centers? [X] None of these centers are involved in this study

12>Describe the facilities available to conduct the research for the duration of the study.

This study will only use an internet based surveys. All data will be collected online and stored on a secure server, hosted by Qualtrics.com.

13>Is this study being conducted as part of a class requirement? For additional information regarding

the difference between a research study and a class requirement, see IRB Policy I – “Student Class Assignments/Projects” located at http://www.research.psu.edu/policies/research-protections/irb/irb-policy-1. Yes


116


You have indicated that the study is being conducted as part of a class assignment.

14>Provide the following information: Instructor’s Name: Matthew Parkinson

Course Title and Number: EDSGN 597 Global Engineering Teams

Semester course is being offered: Fall 2012

Semester the project is due: Fall 2012

Personnel 15>Personnel List PSU User ID Name Department Affiliation Role in this

study Added

ewf5012 Froede, Erick W Mechanical and Nuclear Engineering Principal Investigator

108964 06/28/2012

bjl5176 Lewis, Bryan John

Mechanical and Nuclear Engineering Co-Investigator 108964 06/28/2012

mbp11 Parkinson, Matthew B

School of Engineering Design, Technology and Professional Programs

Advisor 108964 06/28/2012

Froede, Erick W (Principal Investigator)

PSU User ID: ewf5012 Phone: 1 973 347 6755 Email: [email protected] Alt: Email Notifications: Yes Pager: PSU Person Type: Graduate Student Fax: Dept: Mechanical and Nuclear Engineering Address 1: 5 ANDREA COURT Address 2: Mail Stop: City, State, Zip: BUDD LAKE, PA 07828 Procedures: Primary surveys developer, analyze survey data. Experience: Previous graduate course analyzing survey data for design iterations.


117


Lewis, Bryan John (Co-Investigator)

PSU User ID: bjl5176 Phone: 1 801 643 3036 Email: [email protected] Alt: Email Notifications: No Pager: PSU Person Type: Graduate Student Fax: Dept: Mechanical and Nuclear Engineering Address 1: 338A REBER Address 2: Mail Stop: City, State, Zip: University Park, PA 16802 Procedures: Analyze survey data Experience: 2 years experience in computational science. Moderate experience in statistical analysis

Parkinson, Matthew B , PhD (Advisor)

PSU User ID: mbp11 Phone: 814 863 9079 Email: [email protected] Alt: Email Notifications: Yes Pager: PSU Person Type: Faculty Fax: Dept: School of Engineering Design, Technology and Professional Programs Address 1: 213K Hammond Building Address 2: Mail Stop: City, State, Zip: University Park, PA 16802 Procedures: Oversee and verify analysis of survey data Experience: 10+ years of design drivin data analysis

Funding Source 16>Is this research study funded? Funding could include the sponsor providing drugs or devices for the

study. No

NOTE: If the study is funded or funding is pending, submit a copy of the grant proposal or statement of work for review.

17>Does this research study involve prospectively providing treatment or therapy to participants?

No

Conflict of Interest 18>Do any of the investigator(s), key personnel, and/or their spouses or dependent children have a

financial or business interest(s) as defined by PSU Policy RA20, “Individual Conflict of Interest,” associated with this research? NOTE: There is no de minimus in human participant research studies (i.e., all amount must be reported). No


118


Exemption Prescreening Questions (Prisoners) 19>Does this research study involve prisoners?

No

20>Does this research study involve the use of deception?

No

21>Does this research study involve any FDA regulated drug, biologic or medical device?

No

22>Does this research study involve the use of protected health information covered under the Health

Insurance Portability & Accountability Act (HIPAA)? No

23>Does this study involve any foreseeable risks and/or discomforts (i.e., physical, psychological, social,

legal or other) to participants? No

24>Will information collected from participants during the research study be recorded in such a manner

that participants can be identified directly or indirectly through identifiers linked to the participants? No

Exemption Questions: Objectives 25>Summarize the research study’s key objectives, aims or goals.

The purpose of this project is to provide a new set of specifications for the design of a modern mobile clinic for the Western Cape Province of South Africa. A new set of specifications will be given to the South African Medical Research Council together with the detailed design of a new mobile clinic. An internet surveys will be administered to gather user preference information from the nurses currently working in the mobile clinics. The survey questions will focus on the benefits and drawbacks for various workspace layouts and designs for the new mobile health clinic.

26>Provide the background information and rationale for performing the research study.

The Medical Research Council of the Western Cape Province of South Africa has launched an initiative with the University of Stellenbosch and Penn State University to improve the quality of rural health care in the Western Cape. Over 10 percent of the population of the Western Cape live in remote rural areas supporting the South African agricultural industry. The primary form of health care for these individuals is mobile health clinics staffed by clinical nurse practitioners. However, the current clinic design makes it impossible to provide all the necessary clinical services as well as meet many standard health care requirements. It also does not satisfy several occupational health requirement for the professional staff. The Medical Research Council proposes the development of a new set of specifications for mobile clinic design and manufacturing.

27>Summarize the research study’s procedures by providing a step-by-step process of what each group

of participants will be asked to do after informed consent has been obtained.


119


All potential participants are currently working as Clinical Nurse Practitioners in mobile clinics in South Africa. Potential participants will be sent an email through their management chain informing them about the study and inviting them to participate in the survey; a link to the survey will be provided in the recruitment email. Should the participants acquiesce to participate and click the link, they will be directed to the online survey. After reading a brief overview of the survey, participants will indicate their consent to participate in the study by clicking 'Next' on the first page of the survey. Participants will subsequently be asked questions regarding their satisfaction with equipment item in the mobile clinic (i.e., patient bed, sink, overhead storage), and how often they use each piece of equipment. They will also be asked to identify the amount of time in a working day they spend doing various clinical tasks (ie. cleaning, organizing files, treating patients, searching for medication). The participants will then be presented with images of future equipment designs. They will be asked to identify which new designs they prefer, and why. Finally they will be shown an image of a current mobile clinic, and asked to identify which items/areas of the clinic they approve of, and which areas they think should be improved.

28>List the data collection measures/instruments that will be used in this study. Upload all instruments,

measures, interview questions, and/or focus group topics/questions for review. Data collection instruments are a required element of the review process. Data will be collected using the Qulatrics online survey system.

29>Provide the age range of the research participants. Check all that apply. [X] 26 - 40 years

[X] 41 - 65 years

30>Provide a brief description of the participant population.

All participants will be Clinical Nurse Practitioners (CNP) who currently work with mobile clinics in the Western Cape province of South Africa. Each CNP has completed a bachelors degree in nursing, as well as a professional training program. CNPs are licensed to prescribe and distribute prescription medication, provide medical counseling, treat chronic illnesses, and perform basic clinical assessments and examinations. Approximately 40 CNP nurses will be contacted for participation in the survey.

31>Does this research exclude any particular gender, ethnic or racial group, and/or a person based on

sexual identity? No

32>Describe the steps that will be used to identify and/or contact prospective participants. If applicable,

explain how you have access to lists or records of potential participants. During this process, participants must be informed of the following information: • The researcher identifies him/herself as a Penn State researcher; and • The study is being conducted for research purposes. Survey will be provided to the South African Medical Research Council, who will select participants, as well as distribute and administer the survey. The Medical Research Council is a South African organization commissioned by the government to work with academia and government medical groups to improve the quality of health care in South Africa.


120


There is a potential that some survey participants will not be fluent in English. As such, the South African Medical Research Council has agreed to provide interpreters to aid participants in understanding and answering the survey questions.

PLEASE NOTE: Submission of recruitment materials is not required for review, but may be requested on a case-by-case basis.

33>Explain how permission to take part in this research study will be obtained from potential

participants (and parents, if minors are participants). During the consent process, participants must be informed of the following basic ethical principles of human participant research: • The researcher identifies him/herself as a Penn State researcher; • The study is being conducted for research; • A description of the procedures that the participant will undergo as part of the study; • The individual’s participation is voluntary; • They may end their participation at any time; and • Participants may choose not to answer specific questions.

PLEASE NOTE: Submission of consent/assent forms is not required for review, but may be requested on a case-by-case basis.

Implied consent will be obtained as a part of completing the survey. The first page of the survey will constitute the implied consent material, and will explain the study and indicate to participants that clicking 'continue' will constitute implied consent to participate in the study. It will be recommended that participants print the page for their records prior to continuing to the survey document.

34>Will any type of recordings (e.g., audio, video, digital or photographs) be made during the conduct of

this research study? No

PLEASE NOTE: If audio or video recordings with audio are made, Pennsylvania state law requires agreement from all parties.

35>Is compensation being offered (e.g., money, extra/course credit, gift certificates, etc.)?

No

36>Are student records (e.g., coursework, grades, test scores, etc.) being collected as part of this research

study? No

37>Please check the "I Agree" box below to confirm that all data (and recordings if applicable) are

stored securely (e.g., locked cabinet, password protected computer, etc.) and accessible only to the research personnel listed on this application.

[X] I agree

38>Please describe how data confidentiality (including recordings/photographs, if applicable) will be

maintained AND how data will be reported when writing the results (use of code numbers,


121


pseudonyms, without names attached, etc.). All data is to be stored in a confidential manner (even if identifiers are not connected to the responses), in locked locations, on password protected computers. During data collection, data will be stored on an encrypted server owned and maintained by Qualtrics.com. Confidentiality will be maintained to the degree permitted by the software. The data will only be accessible to the principal investigator and members of the research team. No identifying information will be collected to enable the data to be traced back to individual participants. All data will be aggregated prior to conducting analyses. Data will be reported anonymously, and no individual-identifying information will be gathered.

Document Upload DATA COLLECTION INSTRUMENTS

Document 1001 Received 06/28/2012 10:11:51 - Survey


122

Date: June 29, 2012

From: The Office for Research Protections FWA#: FWA00001534Stephanie L. Krout, Compliance Coordinator

To: Erick W. Froede

Re: Determination of Exemption

IRB Protocol ID: 40415Follow up Date: June 28, 2017Title of Protocol: Design of the Next Generation Mobile Health Clinic for the Western Cape of

South Africa

The Office for Research Protections (ORP) has received and reviewed the above referenced eSubmissionapplication. It has been determined that your research is exempt from IRB initial and ongoing review, ascurrently described in the application. You may begin your research. The category within the federalregulations under which your research is exempt is:

45 CFR 46.101(b)(2) Research involving the use of educational tests (cognitive, diagnostic, aptitude,achievement), survey procedures, interview procedures or observation of public behavior, unless: (i)information obtained is recorded in such a manner that human subjects can be identified, directly orthrough identifiers linked to the subjects; and (ii) any disclosure of the human subjects' responsesoutside the research could reasonably place the subjects at risk of criminal or civil liability or bedamaging to the subjects' financial standing, employability, or reputation.

COMMENTS: Please review the following link to determine if there are any local IRB/ethics committeesthat will need to review/approve this protocol or if local approval is needed from any governmentofficials, community officials, etc. (International compilation of human research standards:http://www.hhs.gov/ohrp/international/intlcompilation/intlcompilation.html). Our office needs tomake sure that any local customs or norms are taken into account. Please also review our guideline forinternational research located at: http://www.research.psu.edu/policies/research protections/irb/irbguideline 2.

Given that the IRB is not involved in the initial and ongoing review of this research, it is theinvestigator�’s responsibility to review IRB Policy III �“Exempt Review Process and Determination�”which outlines:

What it means to be exempt and how determinations are made What changes to the research protocol are and are not required to be reported to the ORP Ongoing actions post exemption determination including addressing problems and complaints,

reporting closed research to the ORP and research audits What occurs at the time of follow up

Vice President for ResearchOffice for Research Protections

The Pennsylvania State UniversityThe 330 Building, Suite 205

Phone : (814) 865-1775 Fax: (814) 863-8699 Email : [email protected] Web : www.research.psu.edu/orp


D.3. Survey Approval Letter by the Penn State Internal ReviewBoard

123

Please do not hesitate to contact the Office for Research Protections (ORP) if you have any questions orconcerns. Thank you for your continued efforts in protecting human participants in research.

This correspondence should be maintained with your research records.


124


D.4. Survey Results

125


126


127


128


129


130


131


132


133


134


135


136


137


138


139


140


141


142


143

E. Results and Method for Anthropometric Analysis


E.1. Description of Anthropometric MeasuresThe measures produced by the code were gathered using precise subject positions and an-thropometric landmarks. For a full description of these is contained in the following list,as well as how the measurements are taken. The numbers reference the callouts in Fig-ure E.1 and E.2. Note: The following descriptions are from http://mreed.umtri.umich.edu/mreed/downloads/anthro/ansur/ADAS-Dimension_Definitions.pdf.

• Elbow-Rest Height (#48) - The vertical distance between a sitting surface theolecranon landmark on the bottom of the flexed right elbow is measured withan anthropometer. The subject sits erect looking straight ahead. The shouldersand upper arms are relaxed and the forearms and hands are extended forwardhorizontally with the palms facing each other.

• Eye Height, sitting (#49) - The vertical distance between a sitting surface and theectocanthus landmark on the outer corner of the right eye.

• Forearm-Forearm Breadth (#53) - The maximum horizontal distance across theupper body between the outsides of the forearms is measured with a beam caliper.The subject sits erect looking straight ahead. The shoulders and upper arms arerelaxed and the forearms and hands are extended forward horizontally with thepalms facing each other.

• Overhead Reach (#83) - The vertical distance between a standing surface and thetip of the right middle finger when the arm is extended overhead. Subject standsfacing a wall-mounted scale with both arms extended overhead parallel to eachother. The toes are 20 cm from the wall and the feet are about 10 cm apart. Thepalms of the hands rest on the wall.

• Overhead Reach, Sitting (#85) - The height of the tip of the middle finger abovethe sitting surface measured with the subject sitting erect, right side against a wall,left hand in lap, and the right arm and hand extended upward with the palm againstthe wall.

• Wrist to Wall Length (#131) - The horizontal distance between a back wall andthe stylion landmark on the right wrist of the outstretched arm. Measured on awall scale. Subject stands erect in a corner looking straight ahead with the feettogether and the heels 20 cm from the back wall. The buttocks and shoulders areagainst the wall. The right arm and hand with the palm down are stretched forwardhorizontally against a scale on the side wall. The thumb continues the horizontal

144

http://mreed.umtri.umich.edu/mreed/downloads/anthro/ansur/ADAS-Dimension_Definitions.pdf




(a) Elbow-Rest Height (48) and Eye Height, Sitting (49)

(b) Forearm-Forearm Breadth(53)

(c) Overhead Reach,Standing (83)

Figure E.1: Representations of several standard anthropometric measures used in theanalysis. (images from http://mreed.umtri.umich.edu/mreed/downloads/anthro/ansur/Gordon_1989.pdf)

145




(a) Overhead Reach, Sitting(85)

(b) Wrist to Wall Length (131)

(c) Trochanterion Height (107) (d) Hip Breadth, Sitting (66)

Figure E.2: Representations of the remaining standard anthropometric measures used in theanalysis. (images from http://mreed.umtri.umich.edu/mreed/downloads/anthro/ansur/Gordon_1989.pdf)

146




line of the arm and the index finger curves around to touch the pad at the end ofthe thumb. The subjects right shoulder is held against the rear wall.

• Trochanterion Height (#107) - The vertical distance between a standing surfaceand the trochanterion landmark on the upper side of the right thigh. Measured withan anthropometer. The subject stands erect looking straight ahead. The heels aretogether with the weight distributed equally on both feet.

• Hip Breadth, Sitting (#66) - The distance between the lateral points of the hips orthighs (whichever are broader) is measured with a beam caliper. The subject sitserect with the feet and knees together.

E.2. Distribution of the Anthropometric MeasuresThe overall distributions of the anthropometric measures can be seen in Figure E.3, whichis a compilation of density plots for the entire simulated population. The first and secondvertical lines on each graph represent the 2.5% and 97.5% cutoff, respectively. Thesevalues ensure that we encompass 95% of the population overall, which is a typical bestpractice in ergonomics. A summary of the mean, standard deviation, and 97.5 and 2.5percentials is also shown in Table E.1.

Table E.1: Key anthropometric values obtained from analyzing the MC-ANSUR database.The VPS found in Appendix E.3 was used to produce these results.

Statistical Values (mm)

Anthropometric Measure Mean 97.5 Percentile 2.5 Percentile Std. Dev.

Elbow Rest Height 209.4 252.0 165.9 21.56Eye Height Sitting 765.5 830.9 700.0 32.95Forearm to Forearm Breadth 279.2 323.8 233.3 22.30Standing Overhead Reach 2130 2315 1948 96.03Sitting Overhead Reach 1341 1462 1223 60.60Wrist Length to Wall 616.8 680.2 550.2 32.54Trochanterion Height 882.6 970.3 795.5 45.71Hip Breadth 245.1 283.7 205.3 20.49

147

E.R

esultsand

Method

forAnthropom

etricA

nalysis

Figure E.3: Density plots of anthropometric results for the entire simulated population.

148


E.3. R Code for Determining the Anthropometric Measures of theSouth African Nurse Population

1 ##Getting raw stature data2 #Enter stature and bmi information3 mean_stature <-1690 #Stature mean (in millimeters)4 std_stature <-70 #Stature standard deviation (in millimeters)56 n <-1000 #How many people you want in your virtual population78 mean_bmi <-27.06 #BMI mean9 std_bmi <-6.99 #BMI standard deviation

1011 stat <- rnorm(n, mean_stature, std_stature)12 bmi <- rnorm(n, mean_bmi, std_bmi)13 bmi_corrected <- log(bmi)14 weight <-bmi_corrected*(stat/1000)ˆ215 #Double check that this results in statistics similar for the data for stature, bmi,

and weight. You could also create a linear model for weight to stature, andcalculate BMI after.

1617 ##Creating Linear Models1819 ##Black Model2021 #Model22 ANSURfemale <- read.table("ANSURwomen.csv", header=TRUE, sep=",")23 femaleData <- na.omit( cbind( ANSURfemale[,100], ( ANSURfemale[,124] / 9.81 ) / ( (

ANSURfemale[,100] / 1000)ˆ2 ), ANSURfemale[,49],ANSURfemale[,50], ANSURfemale[,54], ANSURfemale[,84], ANSURfemale[,86], ANSURfemale[,131], ANSURfemale[,108],ANSURfemale[,67], ANSURfemale[,156])) #Select the numbers for measures of interest, here the data are stature, BMI, elbow rest height, eye height sitting, forearmto forearm breadth, overhead reach, overhead sitting reach, wrist length to wall,trochanterion height, hip breadth and race.

2425 #Elbow rest height26 elbowrestheight_black.lm <-lm(femaleData[femaleData[,11]==2,3]˜femaleData[femaleData

[,11]==2,1]+femaleData[femaleData[,11]==2,2]) #the linear model of elbow restheight for black females using stature (mm) and bmi as predictors

27 elbowrestheight <- elbowrestheight_black.lm$coefficients[1] + elbowrestheight_black.lm$coefficients[2]*stat +elbowrestheight_black.lm$coefficients[3]*bmi_corrected +rnorm(n, mean=0, sd=summary(elbowrestheight_black.lm)$sigma) #create new elbowrest height using the predicted stature and weight

2829 #Eye height sitting30 eyeheightsitting_black.lm <-lm(femaleData[femaleData[,11]==2,4]˜femaleData[femaleData

[,11]==2,1]+femaleData[femaleData[,11]==2,2]) #the linear model of eye heightsitting for black females using stature (mm) and bmi as predictors

31 eyeheightsitting <- eyeheightsitting_black.lm$coefficients[1] + eyeheightsitting_black.lm$coefficients[2]*stat +eyeheightsitting_black.lm$coefficients[3]*bmi_corrected+ rnorm(n, mean=0, sd=summary(eyeheightsitting_black.lm)$sigma) #create new eyeheight sitting using the predicted stature and weight

3233 #Forearm to forearm breadth34 forearmtoforearmbreadth_black.lm <-lm(femaleData[femaleData[,11]==2,5]˜femaleData[

femaleData[,11]==2,1]+femaleData[femaleData[,11]==2,2]) #the linear model offorearm to forearm breadth for black females using stature (mm) and bmi aspredictors

35 forearmtoforearmbreadth <- forearmtoforearmbreadth_black.lm$coefficients[1] +forearmtoforearmbreadth_black.lm$coefficients[2]*stat +forearmtoforearmbreadth_

149


black.lm$coefficients[3]*bmi_corrected + rnorm(n, mean=0, sd=summary(forearmtoforearmbreadth_black.lm)$sigma) #create new hipbreadth using thepredicted stature and weight

3637 #Overhead reach38 overheadreach_black.lm <-lm(femaleData[femaleData[,11]==2,6]˜femaleData[femaleData

[,11]==2,1]+femaleData[femaleData[,11]==2,2]) #the linear model of overhead reachfor black females using stature (mm) and bmi as predictors

39 overheadreach <- overheadreach_black.lm$coefficients[1] + overheadreach_black.lm$coefficients[2]*stat +overheadreach_black.lm$coefficients[3]*bmi_corrected + rnorm(n, mean=0, sd=summary(overheadreach_black.lm)$sigma) #create new overhead reachusing the predicted stature and weight

4041 #Overhead sitting reach42 overheadsittingreach_black.lm <-lm(femaleData[femaleData[,11]==2,7]˜femaleData[

femaleData[,11]==2,1]+femaleData[femaleData[,11]==2,2]) #the linear model ofoverhead sitting reach for black females using stature (mm) and bmi as predictors

43 overheadsittingreach <- overheadsittingreach_black.lm$coefficients[1] +overheadsittingreach_black.lm$coefficients[2]*stat +overheadsittingreach_black.lm$coefficients[3]*bmi_corrected + rnorm(n, mean=0, sd=summary(overheadsittingreach_black.lm)$sigma) #create new overhead sitting reach using the predicted statureand weight

4445 #Wrist length to wall46 wristlengthtowall_black.lm <-lm(femaleData[femaleData[,11]==2,8]˜femaleData[femaleData

[,11]==2,1]+femaleData[femaleData[,11]==2,2]) #the linear model of wrist length towall for black females using stature (mm) and bmi as predictors

47 wristlengthtowall <- wristlengthtowall_black.lm$coefficients[1] + wristlengthtowall_black.lm$coefficients[2]*stat +wristlengthtowall_black.lm$coefficients[3]*bmi_corrected + rnorm(n, mean=0, sd=summary(wristlengthtowall_black.lm)$sigma) #createnew wrist length to wall using the predicted stature and weight

4849 #Trochanterion height50 trochanterionheight_black.lm <-lm(femaleData[femaleData[,11]==2,9]˜femaleData[

femaleData[,11]==2,1]+femaleData[femaleData[,11]==2,2]) #the linear model oftrochantarion height for black females using stature (mm) and bmi as predictors

51 trochanterionheight <- trochanterionheight_black.lm$coefficients[1] +trochanterionheight_black.lm$coefficients[2]*stat +trochanterionheight_black.lm$coefficients[3]*bmi_corrected + rnorm(n, mean=0, sd=summary(trochanterionheight_black.lm)$sigma) #create new trochanterion height using the predicted stature andweight

5253 #Hip breadth sitting54 hipbreadthsitting_black.lm <-lm(femaleData[femaleData[,11]==2,10]˜femaleData[femaleData

[,11]==2,1]+femaleData[femaleData[,11]==2,2]) #the linear model of sitting hipbreadth for black females using stature (mm) and bmi as predictors

55 hipbreadthsitting <- hipbreadthsitting_black.lm$coefficients[1] + hipbreadthsitting_black.lm$coefficients[2]*stat +hipbreadthsitting_black.lm$coefficients[3]*bmi_corrected + rnorm(n, mean=0, sd=summary(hipbreadthsitting_black.lm)$sigma) #createnew hip breadth using the predicted stature and weight

5657 ##Tabulation58 virtualpop_black <- cbind(stat, bmi_corrected, weight, elbowrestheight,

eyeheightsitting, forearmtoforearmbreadth, overheadreach, overheadsittingreach,wristlengthtowall, trochanterionheight, hipbreadthsitting)

59 write.table(virtualpop_black, file="virtualpop_black.csv", sep=",")6061 ##White Model6263 #Model64 ANSURfemale <- read.table("ANSURwomen.csv", header=TRUE, sep=",")

150


65 femaleData <- na.omit( cbind( ANSURfemale[,100], ( ANSURfemale[,124] / 9.81 ) / ( (ANSURfemale[,100] / 1000)ˆ2 ), ANSURfemale[,49], ANSURfemale[,50], ANSURfemale[,54], ANSURfemale[,84], ANSURfemale[,86], ANSURfemale[,131], ANSURfemale[,108],ANSURfemale[,67], ANSURfemale[,156])) #Select the numbers for measures of interest, here the data are stature, BMI, elbow rest height, eye height sitting, forearmto forearm breadth, overhead reach, overhead sitting reach, wrist length to wall,trochantarion height, hip breadth and race.

6667 #Elbow rest height68 elbowrestheight_white.lm <-lm(femaleData[femaleData[,11]==1,3]˜femaleData[femaleData

[,11]==1,1]+femaleData[femaleData[,11]==1,2]) #the linear model of elbow restheight for white females using stature (mm) and bmi as predictors

69 elbowrestheight <- elbowrestheight_white.lm$coefficients[1] + elbowrestheight_white.lm$coefficients[2]*stat +elbowrestheight_white.lm$coefficients[3]*bmi_corrected +rnorm(n, mean=0, sd=summary(elbowrestheight_white.lm)$sigma) #create new elbowrest height using the predicted stature and weight

7071 #Eye height sitting72 eyeheightsitting_white.lm <-lm(femaleData[femaleData[,11]==1,4]˜femaleData[femaleData

[,11]==1,1]+femaleData[femaleData[,11]==1,2]) #the linear model of eye heightsitting for white females using stature (mm) and bmi as predictors

73 eyeheightsitting <- eyeheightsitting_white.lm$coefficients[1] + eyeheightsitting_white.lm$coefficients[2]*stat +eyeheightsitting_white.lm$coefficients[3]*bmi_corrected+ rnorm(n, mean=0, sd=summary(eyeheightsitting_white.lm)$sigma) #create new eyeheight sitting using the predicted stature and weight

7475 #Forearm to forearm breadth76 forearmtoforearmbreadth_white.lm <-lm(femaleData[femaleData[,11]==1,5]˜femaleData[

femaleData[,11]==1,1]+femaleData[femaleData[,11]==1,2]) #the linear model offorearm to forearm breadth for white females using stature (mm) and bmi aspredictors

77 forearmtoforearmbreadth <- forearmtoforearmbreadth_white.lm$coefficients[1] +forearmtoforearmbreadth_white.lm$coefficients[2]*stat +forearmtoforearmbreadth_white.lm$coefficients[3]*bmi_corrected + rnorm(n, mean=0, sd=summary(forearmtoforearmbreadth_white.lm)$sigma) #create new hipbreadth using thepredicted stature and weight

7879 #Overhead reach80 overheadreach_white.lm <-lm(femaleData[femaleData[,11]==1,6]˜femaleData[femaleData

[,11]==1,1]+femaleData[femaleData[,11]==1,2]) #the linear model of overhead reachfor white females using stature (mm) and bmi as predictors

81 overheadreach <- overheadreach_white.lm$coefficients[1] + overheadreach_white.lm$coefficients[2]*stat +overheadreach_white.lm$coefficients[3]*bmi_corrected + rnorm(n, mean=0, sd=summary(overheadreach_white.lm)$sigma) #create new overhead reachusing the predicted stature and weight

8283 #Overhead sitting reach84 overheadsittingreach_white.lm <-lm(femaleData[femaleData[,11]==1,7]˜femaleData[

femaleData[,11]==1,1]+femaleData[femaleData[,11]==1,2]) #the linear model ofoverhead sitting reach for white females using stature (mm) and bmi as predictors

85 overheadsittingreach <- overheadsittingreach_white.lm$coefficients[1] +overheadsittingreach_white.lm$coefficients[2]*stat +overheadsittingreach_white.lm$coefficients[3]*bmi_corrected + rnorm(n, mean=0, sd=summary(overheadsittingreach_white.lm)$sigma) #create new overhead sitting reach using the predicted statureand weight

8687 #Wrist length to wall88 wristlengthtowall_white.lm <-lm(femaleData[femaleData[,11]==1,8]˜femaleData[femaleData

[,11]==1,1]+femaleData[femaleData[,11]==1,2]) #the linear model of wrist length towall for white females using stature (mm) and bmi as predictors

89 wristlengthtowall <- wristlengthtowall_white.lm$coefficients[1] + wristlengthtowall_white.lm$coefficients[2]*stat +wristlengthtowall_white.lm$coefficients[3]*bmi_

151


corrected + rnorm(n, mean=0, sd=summary(wristlengthtowall_white.lm)$sigma) #createnew wrist length to wall using the predicted stature and weight

9091 #Trochanterion height92 trochanterionheight_white.lm <-lm(femaleData[femaleData[,11]==1,9]˜femaleData[

femaleData[,11]==1,1]+femaleData[femaleData[,11]==1,2]) #the linear model oftrochantarion height for white females using stature (mm) and bmi as predictors

93 trochanterionheight <- trochanterionheight_white.lm$coefficients[1] +trochanterionheight_white.lm$coefficients[2]*stat +trochanterionheight_white.lm$coefficients[3]*bmi_corrected + rnorm(n, mean=0, sd=summary(trochanterionheight_white.lm)$sigma) #create new trochanterion height using the predicted stature andweight

9495 #Hip breadth sitting96 hipbreadthsitting_white.lm <-lm(femaleData[femaleData[,11]==1,10]˜femaleData[femaleData

[,11]==1,1]+femaleData[femaleData[,11]==1,2]) #the linear model of sitting hipbreadth for white females using stature (mm) and bmi as predictors

97 hipbreadthsitting <- hipbreadthsitting_white.lm$coefficients[1] + hipbreadthsitting_white.lm$coefficients[2]*stat +hipbreadthsitting_white.lm$coefficients[3]*bmi_corrected + rnorm(n, mean=0, sd=summary(hipbreadthsitting_white.lm)$sigma) #createnew hip breadth using the predicted stature and weight

9899 ##Tabulation

100 virtualpop_white <- cbind(stat, bmi_corrected, weight, elbowrestheight,eyeheightsitting, forearmtoforearmbreadth, overheadreach, overheadsittingreach,wristlengthtowall, trochanterionheight, hipbreadthsitting)

101 write.table(virtualpop_white, file="virtualpop_white.csv", sep=",")102103 ##Create combined population with 40% black, 60% white split104105 #Black106 virtualpop_black_subset<-virtualpop_black[sample(1:1000, size = 400),]107 write.table(virtualpop_black_subset,file="virtualpop_black_subset.csv", sep=",")108109 #White110 virtualpop_white_subset<-virtualpop_white[sample(1:1000, size = 600),]111 write.table(virtualpop_white_subset,file="virtualpop_white_subset.csv", sep=",")112113 #Merge114 virtualpop_combined <- merge(virtualpop_black_subset, virtualpop_white_subset, all.x=

TRUE, all.y=TRUE, by=c("stat", "bmi_corrected", "weight", "elbowrestheight", "eyeheightsitting", "forearmtoforearmbreadth", "overheadreach", "overheadsittingreach", "wristlengthtowall", "trochanterionheight", "hipbreadthsitting"))

115 write.table(virtualpop_combined,file="virtualpop_combined.csv", sep=",")116117 ##Plotting118119 vp <- read.table("virtualpop_combined.csv",header=TRUE,sep=",")120 par(mfrow=c(3,3))121122 upperpercent <- c(0.975)123 lowerpercent <- c(0.025)#These two quantiles span 95% accommodation124125 #Elbow rest height126 densityelbowrestheight <- density(vp$elbowrestheight)127 plot(densityelbowrestheight, main="Density Plot of Elbow Rest Height", xlab="Elbow Rest

Height (mm)")128 abline(v=quantile(elbowrestheight, upperpercent))129 abline(v=quantile(elbowrestheight, lowerpercent))130131 #Eye height sitting

152


132 densityeyeheightsitting<- density(vp$eyeheightsitting)133 plot(densityeyeheightsitting, main="Density Plot of Eye Height Sitting", xlab="Eye

Height Sitting (mm)")134 abline(v=quantile(eyeheightsitting, upperpercent))135 abline(v=quantile(eyeheightsitting, lowerpercent))136137 #Forearm to forearm breadth138 densityforearmtoforearmbreadth<- density(vp$forearmtoforearmbreadth)139 plot(densityforearmtoforearmbreadth, main="Density Plot of Forearm to Forearm Breadth",

xlab="Forearm to Forearm Breadth (mm)")140 abline(v=quantile(forearmtoforearmbreadth, upperpercent))141 abline(v=quantile(forearmtoforearmbreadth, lowerpercent))142143 #Overhead reach144 densityoverheadreach<- density(vp$overheadreach)145 plot(densityoverheadreach, main="Density Plot of Overhead Reach", xlab="Overhead Reach

(mm)")146 abline(v=quantile(overheadreach, upperpercent))147 abline(v=quantile(overheadreach, lowerpercent))148149 #Overhead sitting reach150 densityoverheadsittingreach<- density(vp$overheadsittingreach)151 plot(densityoverheadsittingreach, main="Density Plot of Overhead Sitting Reach", xlab="

Overhead Sitting Reach (mm)")152 abline(v=quantile(overheadsittingreach, upperpercent))153 abline(v=quantile(overheadsittingreach, lowerpercent))154155 #Wrist length to wall156 densitywristlengthtowall<- density(vp$wristlengthtowall)157 plot(densitywristlengthtowall, main="Density Plot of Wrist Length to Wall", xlab="

Wrist Length to Wall (mm)")158 abline(v=quantile(wristlengthtowall, upperpercent))159 abline(v=quantile(wristlengthtowall, lowerpercent))160161 #Trochanterion height162 densitytrochanterionheight<- density(vp$trochanterionheight)163 plot(densitytrochanterionheight, main="Density Plot of Trochanterion Height", xlab="

Trochanterion Height (mm)")164 abline(v=quantile(trochanterionheight, upperpercent))165 abline(v=quantile(trochanterionheight, lowerpercent))166167 #Hip Breadth Sitting168 densityhipbreadthsitting<- density(vp$hipbreadthsitting)169 plot(densityhipbreadthsitting, main="Density Plot of Hip Breadth Sitting", xlab="Hip

Breadth Sitting (mm)")170 abline(v=quantile(hipbreadthsitting, upperpercent))171 abline(v=quantile(hipbreadthsitting, lowerpercent))172173 ##Data output174175 #Elbow rest height176 mean(elbowrestheight)177 sd(elbowrestheight)178 quantile(elbowrestheight, upperpercent)179 quantile(elbowrestheight, lowerpercent)180181 #Eye height sitting182 mean(eyeheightsitting)183 sd(eyeheightsitting)184 quantile(eyeheightsitting, upperpercent)185 quantile(eyeheightsitting, lowerpercent)186

153


187 #Forearm to forearm breadth188 mean(forearmtoforearmbreadth)189 sd(forearmtoforearmbreadth)190 quantile(forearmtoforearmbreadth, upperpercent)191 quantile(forearmtoforearmbreadth, lowerpercent)192193 #Overhead reach194 mean(overheadreach)195 sd(overheadreach)196 quantile(overheadreach, upperpercent)197 quantile(overheadreach, lowerpercent)198199 #Overhead sitting reach200 mean(overheadsittingreach)201 sd(overheadsittingreach)202 quantile(overheadsittingreach, upperpercent)203 quantile(overheadsittingreach, lowerpercent)204205 #Wrist length to wall206 mean(wristlengthtowall)207 sd(wristlengthtowall)208 quantile(wristlengthtowall, upperpercent)209 quantile(wristlengthtowall, lowerpercent)210211 #Trochanterion height212 mean(trochanterionheight)213 sd(trochanterionheight)214 quantile(trochanterionheight, upperpercent)215 quantile(trochanterionheight, lowerpercent)216217 #Hip Breadth Sitting218 mean(hipbreadthsitting)219 sd(hipbreadthsitting)220 quantile(hipbreadthsitting, upperpercent)221 quantile(hipbreadthsitting, lowerpercent)

154

F. Meetings Conducted by Representatives of Team MRC

F. Meetings Conducted by Representatives of TeamMRC

The following meetings were conducted with various groups, and are listed in chronolog-ical order.

F.1. Vehicle Funding and Selection, GMT and DoHDate: 2012/06/08Location: Cape Town

Attendance Register:J Koegelenberg GMT

Riaan Fourie GMTJohann Jooste DoHHandri Liebenberg DoHPiet Smal DoHHendrik Bosman GETBarend de Villiers GET

Summary: Team MRC presented their work toward the vehicle selection and theAHP used. The team delivered a shortlist of vehicles made their recommendationstoward the procurement of a LCV to serve as a base vehicle for the prototype. The GMTcritiqued the shortlist presented due suggested because of servicing and drivers licensingrequirements. GMT promoted the use of the Toyota Quantum as a base vehicle despitethe fact that it had not been shortlisted.

Post Meeting: The vehicle selection was reviewed and the short list was revised. Thelicensing issues were investigated and a feasible means of re-registering the LCVs wasidentified and explored. The deadline for the provision of funding from the DoH wasextended from 06/2012 to 10/2012.

F.2. Stakeholder Meeting I, Update and FeedbackDate: 2012/06/12Location: Worcester

Attendance Register:Prof Marina Clark SUN

Dr. FK Krige SUNDanine Kitshoff SUNHamilton Pharaoh SUNDr Stefanus Snyman SUN

155


Gwinn Lourens SUNCoen Calitz SUNDr Peter Vurgarellis RotaryTienie Smith Private SectorSam Clark Private SectorHandri Liebenberg DoHCharlotte Stemmet DoHHandri Liebenberg DoHPiet Smal DoHLiona Botha DoHProf Cornie Scheffer GETHendrik Bosman GETBarend de Villiers GET

Summary: Team MRC discussed the scope of the MC project and their work to date.The various stakeholders made their arguments toward the improvements for the new MCdesign. Future plans, developments and collaborations were also discussed and arranged.

F.3. MRC and Philips MeetingDate: 2012/08/16Location: Parow

Attendance Register:Prof Tony Bunn MRC

Milandri Giovanni MRCDr Riaan van Tonder PhilipsRefiloe Moutlwatse PhillipsHendrik Bosman GETBarend de Villiers GET

Summary: Team MRC presented the scope of the MC project and their work to date.Representatives from Phillips shared their plans toward establishing mother and childhealth program in SA. The representatives from the MRC made mention of possibledevelopment of mobile mother and child health services. Electronic information systemsand software packages toward bettering connectivity and documentation, were discussedalso.

F.4. Stakeholder Meeting II, Stakeholder Update and FeedbackDate: 2012/08/20 Location: Stellenbosch

Attendance Register:

156


Prof Tony Bunn MRCMilandri Giovanni MRCDr E Stellenberg SUNDr FK Krige SUNHamilton Pharaoh SUNGwinn Lourens SUNCoen Calitz SUNDr Peter Vurgarellis RotaryKeith Pellengelly Private SectorCharlotte Stemmet DoHPiet Smal DoHProf Cornie Scheffer GETHendrik Bosman GETBarend de Villiers GET

Summary: Team MRC presented their work to date and various topics were discussed.The progress made toward the vehicle selection and re-registration was acknowledged.The equipment selection was discussed in detail, revisions from the DoH was organized.The use of a generator and aftermarket heat pump was criticized. Detailed costing wasrequested for funding from Rotary.

Post Meeting: The DoH gave backing toward attempting a vehicle re-registration andthus the Crafter 35 was selected. The DoH gave feedback on the equipment selectionafter which the generator and heat pump HVAC system was scrapped in favor of the newvehicle option: rear-compartment cooling/heating, available for the Crafter series.

F.5. Discussion on Modern Mobile Health Vehicle, DoH BusinessDevelopment Unit

Date: 2012/09/05 Location: Cape TownAttendance Register:Michael Manning DoH

Mandi Bell DoHJoan du Plessis DoHMilandri Giovanni MRCHendrik Bosman GET

Summary: The DoH Business development unit is planning on developing a large(code C) modern mobile health vehicle to render various healthcare services, especiallypromoting preventative healthcare, to schools and other areas with high patient densities.The developments of Team MRC’s MC project was discussed and recommendations

157


were made toward a course of action for the DoH regarding their project. The publicprivate healthcare forum (PPHF), 2012/10/04 was discussed, the DoH suggested.

158

G. Functional Analysis

G. Functional AnalysisBefore selecting the available MC equipment, it is important to analyze the MC operationbased on it’s functional characteristics. The functional analysis method is a logicalprocess for breaking down the overall function of the MC into a system of functions andsubsequent subsystems and subfunctions. After identifying the correct functions andsystems, the systems can be designed.

Cross[7] describes the functional analysis method using two block diagrams: the blackbox model and the transparent box model. The black box model gives an understandingof the inputs and output crossing the system boundary, where the transparent box modeldevelops the functional elements required to execute the system objectives. The procedureis as follows:

1. Black box: inputs and outputs block diagram

2. Breakdown into essential sub-functions

3. Transparent box: Develop a block diagram

4. Draw system boundaries

5. Find appropriate components for sub-functions

In summary, this produced a functional architecture (Figure G.1) and a physicalarchitecture (Figure G.2), as outlined in [4]. The functional architecture captures theabove mentioned steps 1-4 and the physical architecture embodies step 5.

159


Legend

Sanitation

CNP + SN Transport or Treatment

Transport

CNP+SN

SN Documentation

Internal Storage

Predefined Process

Documentation

Process

Decision

Attain Medical History

Update Documetation Examination

Diagnosis

Treatment

PatientMedical

Documentation

CNP

No medical History

Presciption

CounselingCNP

Clinical SuppliesMedical Supplies

Water SupplyFresh Water Waste Water

Patient Records

Fuel Fuel Supply

Medical Waste

Was

te W

ater

Med

ical

Was

teRecord Archive

Treated PatientPatient

CNP

RefferalPatient Records

Dispensing

Preperation

Mobile Clinic

Vehicle Cab

Clinical Area

External Storage

SN

Figure G.1: Functional architecture, transparent box

160


Hot

Dry

Air

PrimaryBattery

SecondaryBattery

Alternator

Evaporative Cooler

Water Supply Tank Waste Water Tank

Inlet Valve

Tap

Sink

Submersible Pump

Outlet Valve

Three WayValve

FluidCapacitor

Alternative: Generator

Alternative: AC uinit

Shaft Work

Cool Air

Fresh Water

Lighting, Outlets etc

Effluent

Legend

LED Lighting

Power Outlet

Ground

Switch

Wiring

Plumbing

Power

Light

Figure G.2: Physical architecture, transparent box

161

H. Details of Considered Auxiliary Equipment

H. Details of Considered Auxiliary EquipmentAuxiliary equipment forms an integral part of the effectiveness of patient care, theservices that can be offered from the MC, as well as the working conditions for theMC staff. The main challenge in selecting the correct equipment is balancing the needand subsequent benefit of including the equipment with the available space in the MC.As such, multiple equipment options were identified for each major component andevaluated based on effectiveness in satisfying the customer needs as well as the availablespace in the MC.

H.1. ElectricityVirtually all modern medical equipment requires some electrical power source. Anelectrical supply is also needed to power the other auxiliary equipment needed for theMC. As such, the choice of electrical systems is a key factor in the choice of all otherMC medical and auxiliary systems.

12 Volt DC SystemThe most basic electrical solution is to utilize the standard 12 volt DC battery andalternator system used to power the vehicle. Expanding the the current vehicle electricalsystem to support the additional MC equipment would require very little effort. However,due to the increased power draw to support the MC auxiliary equipment, a second batterymay need to be included.

Advantages:

• Inexpensive to purchase and install the necessary parts

• Small physical size and weight

• Fewer safety precautions are necessary

Disadvantages:

• Limits the MC to only use low power equipment

Other GET projects have focused on developing modern medical diagnostic toolsusing smartphones and tablet computers, such as the iPhoneTM, AndroidTM, and iPadTM.The continued use of these devices will require a suitable power supply, as the batteriesmay not hold a charge for a complete working day. With a 12 volt DC power system,universal serial bus (USB) power outlets can be mounted in several areas of the vehicle.An example of a USB outlet, integrated into a 110 volt AC outlet is shown in Figure H.1.This image is for conceptual reference, as South Africa uses a 220 volt electrical system

162


rather than the 110 volt outlet depicted. Please note that the USB outlet does not requirean AC electrical system, and can be powered on the 12 volt DC system only.

Figure H.1: Standard USB power outlet include in a 110 volt AC outlet. (imagefrom http://rcaaudiovideo.com/power/chargingstations/?sku=WP2UWR)

220 Volt AC SystemA standard 220 volt, 50 Hertz, AC electrical system could be provided by including aportable generator (Figure H.2). Including a generator would allow the MC to providemore of the services available in standard clinics, and provide sufficient power to run asmall heating and air conditioning system. The limiting factors for including a generatoris the necessary space and weight it would occupy in the MC.

Advantages:

• Allow the MC to include conventional electrical equipment for:

– Advanced medical treatment (ie. x-Ray, ultrasound, laboratory testing)

– Standard office computers

– Conventional heating and air conditioning systems

• Allow medical specialists (ie. dentist and optometrists) to work out of the MC

163




Disadvantages:

• Occupy significant space and weight in the MC

• High capital and operational cost

• Noise output during operation

Figure H.2: 5000 Watt mobile generator by Bundu. This generator was used in the mo-bile AIDS laboratory shown in Figure 3.5. (image from http://www.bundupower.co.za/bp5s.php)

Including the generator shown Figure H.2 would be difficult, as the MC design isconstrained by both available space and weight. However, the benefits of inclusionof a generator merit some compromise. Another option would be to attach the mostused electrical components (i.e., refrigerator, lighting, computers, and basic medicaldiagnostic equipment) to the dual battery-powered 12 volt DC system and included asmall generator to supply sufficient power to run an air conditioning or heating system.In this way, the generator would only operate for short periods of time during the fewmonths of the year when either heating or cooling is needed. A generator of this size isavailable from Honda, and was used in the benchmark MC by AVE shown in Appendix

164

http://www.bundupower.co.za/bp5s.php

http://www.bundupower.co.za/bp5s.php


C. As shown in Figure H.3, the Honda EU2000i is very compact, and can be stored inany location in the MC.

Figure H.3: Honda EU2000i 2000 Watt light weight mobile generator. (image fromhttp://powerequipment.honda.com/generators/models/eu2000i)

H.2. LightingThe absence of windows in the panel vans used for the MCs do not allow natural lightto enter the clinic. Therefore, artificial lighting is necessary. The most advantageouslighting option is to use high intensity LED light fixtures. They provide the most efficientratio of luminescence (light intensity output) to power consumption. Examples of LEDlight fixtures are shown in Figure H.4.

Advantages:

• Virtually no heat generation

• Low electrical power requirements

• Function with both AC and DC currents

• Small physical size

165




Disadvantages:

• LED lights lack the warm appearance of incandescent lights

• Lower luminescence than incandescent or fluorescent lights

(a) (b)

Figure H.4: LED Light fixtures for (a) overhead lamps and (b) and under cab-inet lamps. (images from http://www.lightingdirect.com/led-under-cabinet-lights/c27832)

In the final design phase, it will be essential to specify lighting configurations thatwill satisfy industrial standards for workspace lighting. General practice guidelines forworkspace lighting are given by Freivalds[15]. However, government standards andrequirements will need to be identified and satisfied.

The team has subsequently decided to make use of LED strip lights as shown inFigure H.5. This saves on space and allows the lights to be hidden from sight while stillmaintaining adequate luminescence in the working environment. The LED strip lightalso allows for ease of assembly and can be powered by the 12V DC battery supply.

It has also been decided that as opposed to using disc type LED lights as shown inFigure H.4 (b) for under cabinet lighting the strip type LED lights will be used. Thisallows for a more consistent type of LED lighting system within the clinical area. asmentioned these strip type LED lights provide proper luminescence and thus can be usedwhen the nursing staff have to do administrative work.

It is also important to provide the nursing staff with lighting they can use for examina-tion of patients. This type of light must be position adjustable (Figure H.6) so that thenursing staff can view any area as required. It has also been decided that these lights beLED type lights in order to save on power and provide proper luminescence.

166

http://www.lightingdirect.com/led-under-cabinet-lights/c27832

http://www.lightingdirect.com/led-under-cabinet-lights/c27832


Figure H.5: LED Strip lights for on board lighting. (images from http://www.ledlighting.co.za/uploads/LED%20Strips.pdf)

The team is considering incorporating in cupboard LED lighting that, when a draweror door of a storage area is opened, lights up and allows the nurses to better see whatequipment or medication is in the storage area. An example of such an LED light isshown in figure H.7.

Though the decision as to whether or not using in-cupboard lighting is still pendingthe team is satisfied with the lighting that will currently be installed in the clinical area.The quality, power requirements and luminescence provided by the chosen LED lightsseem adequate.

Figure H.6: LED position adjustable spot light. (images from http://www.lightingwarehouse.co.za/prod-in-wall.html)

167






Figure H.7: In-cupboard LED lighting. (images from http://www.roco.co.za/Documents/7B.pdf)

H.3. RefrigerationIt is necessary for the new MC to contain a refrigerated space for storage of temperaturesensitive medications, vaccines and blood samples. A small cooler with ice is currentlyused, but this does not maintain the correct temperature during the hottest days of thesummer. Currently, only a small refrigerated space is required. However, future needsshould be considered when selecting the size of refrigerator.

Small refrigerator (220 volt AC)If an AC generator is included in the MC design, a small refrigerator could be included(Figure H.8). Small refrigerators are commonly used in hotel rooms, small apartments,and offices. If future MC needs require increased refrigerated space, these types of unitswould be ideal.

Advantages:

• Large refrigerated space

168

http://www.roco.co.za/Documents/7B.pdf

http://www.roco.co.za/Documents/7B.pdf


• Guaranteed to maintain the necessary temperature range

Disadvantages:

• AC generator required

Figure H.8: Small refrigerator unit. (image from http://www.danby.com/en/US/our_products/refrigeration/dar0488bl)

Portable Thermoelectric Cooler (12 volt DC)Recent advances in thermoelectric technology have widely expanded the use of portablethermoelectric cooling containers for both recreational purposes and transporting tem-perature sensitive medical products. One example of a medical quality thermoelectriccooler is shown in Figure H.9. Medical quality coolers, though more expensive thanrecreational models, include variable temperature settings, accurate temperature control,recorded history of internal temperature, and other features needed when storing sensitivematerials.

Advantages:

• Operates without a generator

• Accurate temperature control (±2o C)

• Data log of internal temperature

169

http://www.danby.com/en/US/our_products/refrigeration/dar0488bl

http://www.danby.com/en/US/our_products/refrigeration/dar0488bl


• Possible to cool or heat the storage volume

Disadvantages:

• Only maintains a maximum of 25o C below the ambient temperature

• Smaller cooling space than a refrigerator

Figure H.9: Portable thermoelectric cooler, medical quality. (image from http://www.evermed.it/english/english/english/english/ptc.html)

H.4. Heating Ventilation and Air Conditioning (HVAC)From the project onset, it was stated that the new MC should contain a method of internalclimate control. Controlling the air temperature inside the MC will improve the patientcare and allow the nurses to work more effectively. To achieve this, either an HVACsystem must be included or a method for reducing the heat load of the vehicle must beimplemented.

Standard HVAC (220 volt AC)If an AC generator is included in the MC design, this will allow for a complete HVACunit to be included. Many roof mount HVAC units have been designed for recreationalvehicles, and include modules for both heating and cooling. This type of system would

170




eliminate the discomforts of the MC climate in both the winter and the summer months.An example of a roof mount HVAC unit is shown in Figure H.10.Advantages:

• Satisfies both heating and cooling requirements

• Roof mount design does not require any additional space in the MC

Disadvantages:

• Requires a generator

• Increased cost

Figure H.10: Roof mount HVAC unit with both heating and cooling modules. (imagefrom http://www.support-telecogroup.com/telecogroup/telair/en/products/air-conditioners/SILENT-7300H.asp)

Minibus Auxiliary Roof Air Conditioner (12 volt DC)Auxiliary roof mount air conditioning units are commonly included in minibuses designedto transport more than 10 passengers. Many of the panel vans being considered for theMC have this secondary air conditioning unit as an available option from the manufacturer.Aftermarket units are also available, as shown in Figure H.11.

The main limiting factor in using a minibus auxiliary air conditioning units is themaximum length of operation when the vehicle engine is not running. These unitscommonly required between 50 and 80 Amps of current, depending on the coolingcapacity. A 70 amp-hour battery is currently used in the platform vehicle. Therefore,the air conditioner may only be running continuously for approximately one hour for

171





the larger air conditioners. The smaller units will operate for longer periods of time, butat a lower cooling capacity. Also, a separate heating unit would need to be included toprovide proper patient comfort during the winter months.

Advantages:

• No generator required

• Provides sufficient cooling for the clinical space


Disadvantages:

• Limited operation time due to high power draw

• Less cooling capacity than the HVAC unit

• No heating capability, may be possible with alteration

Figure H.11: Aftermarket minibus auxiliary roof air conditioning unit. (im-age from http://www.waeco.com/en/4516_2251.php?hirID=514&sprID=2&artOrigID=32097)

Evaporative Cooler (12 volt DC)Evaporative coolers, or swamp coolers, operate using a psychrometrics process, ratherthan the refrigeration process used in air conditioners. The effective air temperature isreduced by increasing the relative humidity of the cooled air. When compared with airconditioners, evaporative coolers are inexpensive and require very little power. A unitcapable of cooling the clinical space in the MC (Figure H.12) could operate for more

172

http://www.waeco.com/en/4516_2251.php?hirID=514&sprID=2&artOrigID=32097

http://www.waeco.com/en/4516_2251.php?hirID=514&sprID=2&artOrigID=32097


than 10 hours on the 70 amp-hour vehicle battery. However, a pressurized water supplyis needed for the evaporative cooler. The available water supply options will be discussedin Section H.6.

Advantages:

• Low power requirements

• Extended operating time

• Low cost and weight

• Provides sufficient cooling for the clinical space, if humidity is below 50%


Disadvantages:

• Increased relative humidity inside the MC

• Inefficient operation if humidity exceeds 50%

• Pressurised water supply required for operation

Figure H.12: TurboKOOLTMroof mount evaporative air cooler. (image from http://www.turbokool.com/cooler.html)

When considering the use of evaporative cooling, particular emphasis must be given tothe effectiveness of a psychrometrics process given the local environment. The relativehumidity and wet bulb temperatures determine the efficiency of this process. For theWestern Cape region, the summer months correspond to the lowest relative humidity andwet bulb temperatures through the year. Using the fact that household evaporative coolers

173

http://www.turbokool.com/cooler.html

http://www.turbokool.com/cooler.html


are available for purchase in Cape Town from multiple suppliers, it can be assumedthat evaporative cooling is a viable option. However, the increase in sanitation risksand the corrosion of electrical systems are major deterrents for the use of this type ofcooling. Due to these risks, an evaporative cooler should only be considered if a suitableair conditioning system can not be installed.

Natural CoolingAn alternative method for controlling the air temperature inside the MC is to use naturalcooling. The dominant heat source for the MC is radiative energy from the sun. Assuch, it is possible to reduce the air temperature inside the vehicle by reflecting theradiative energy. This is most effectively achieved by parking the MC in a shadedlocation. Reflective paint, particularly on the roof of the MC, would be an alternativewhen natural shade is not available. However, the change in heat load would not besubstantial, and a thermal insulative barrier would need to be added to the inside walls ofthe MC to prevent heat transfer from the outer vehicle surface. Finally, an awning couldbe added to the side of the vehicle to create a shaded location. This idea was included inthe benchmark vehicle by Advanced Vehicle Engineering cc. (Figure H.13). The awningwould not provide significant shade to the MC, but would provide a shaded location forpatients to wait. The shaded space could also be used by the nurses to provide groupeducational or counseling courses.

Advantages:

• No operational cost

• Provides a sheltered location for the patients

• Provides extra space for the nurses to work

Disadvantages:

• Time required to set up and take down the awning at every stop

• Manual awnings may cause extra physical strain for the nurses

Recommendation: Whenever possible, the MC should be parked in the shade.

174


Figure H.13: Awning on a converted panel van. (Repeat of Figure 3.7)

H.5. LavatoryAblution is a mandatory requirement for the new MC. It is often difficult for nurses tofind an available lavatory during the day. Also, when urine samples are needed frompatients, and facilities are not available at the farm, they are forced to utilize nearbyfoliage for privacy. However, in order to reduce the water and waste volumes, the lavatorywill be designated mainly for staff use. The lack of a lavatory onboard the MC has beenconsidered a violation of human dignity for both the nurses and patients.

Standard ToiletStandard toilets are available for recreational vehicles that utilize water or sanitationliquid as the flushing liquid (Figure H.14). The human waste is collected in a capturetank, as discussed in Section H.6. Some systems also include liquid recycling system inorder to reduce the amount of flushing liquid.

Advantages:

• More comfortable for the person using the toilet

• Ensures better hygiene in the clinical area

175


Disadvantages:

• Requires significant space in the clinical area

• Must include water supply and waste capture methods

Figure H.14: Fixed toilet for recreational or mobile vehicle. (image from http://www.campingworld.com/category/rv-toilets-accessories/128)

Chemical ToiletA more simple option is to use a portable chemical toilet, sometimes called a porta-potty. The human waste is captured in a small tank below the toilet and held in aneutralizing/deodorizing chemical (Figure H.15). At the end of the day, the unit can beremoved, the waist disposed of, and the chemical tank refilled.

Advantages:

• Smaller size

• No need for extra water supply or waste capture

Disadvantages:

• Removing this type of toilet for cleansing can be difficult

In discussion with Absolute Ablutions, a local company specializing in military grademobile toilets/showers, similar conclusions were drawn. The feasibility of a onboard

176

http://www.campingworld.com/category/rv-toilets-accessories/128




Figure H.15: Simple chemical toilet with included waist capture tank. (image from http://www.outdoorwarehouse.co.za/fiamma-bio-potti-20l.html)

177





recirculatory system was discussed and found to be minimal. This was mainly due to thespace restrictions within a MC with a LCV platform. Their recommendation was either achemical toilet onboard the MC, or having the MC pull a trailer unit with a recirculatingtoilet.

After much consideration the team decided to use a chemical toilet as apposed to afixed toilet. The motivation being that the chemical toilet can in fact be removed formaintenance and waste disposal and does not take up as much space as a fixed toilet.Furthermore, because the chemical toilet does not require any further water supply orwaste disposal facilities on board the MC, the design and the conversion process will besimplified.

H.6. Water Storage and DisposalTo satisfy basic sanitation needs, sufficient water must be available for the nurses towash their hands after every patient and clean any equipment used during treatment. Asmentioned in Sections H.5 and H.4, some auxiliary equipment possibilities also require awater supply or storage of waste water. Care must be taken to ensure the choice of watersystems does not hinder the choice of other auxiliary systems.

Portable Wash BasinThe MCs currently in use utilize a self contained hand washing unit. Small reservoirs forclean water and wastewater are located in the cabinet below the wash basin. However,these reservoirs are not sufficient to supply the MC for a complete day. Similar optionsare available (Figure H.16) that mitigate this insufficiency.

Advantages:

• Self contained unit (no external connections are required)

• Does not require much physical space in the MC

• Possible to use with the evaporative cooler (Section H.4)

• Functions with both 12 volt DC and 220 volt AC systems

Disadvantages:

• Eliminates the possibility of a standard toilet (Section H.5)

• Amount of available water is limited by the size of the unit

Central Water System

178


Figure H.16: Self contained portable hand washing basin. (image from http://cartablesolutions.com/portablehandwashsinks.html)

As shown in Figure H.17, the central water system found in mobile homes and recre-ational vehicles are significantly more complex than the portable wash basin. Significantspace and weight in the MC are required for such a system. In the end, the use of acentralized water system was found to be not feasible due to volume constraints in theMC vehicle. As such, the self-contained portable wash basin is the most advantageousoption.

Advantages:

• Adequate water for ample hand sanitation

• A conventional toilet may be included in the MC

• Compatible with all other auxiliary equipment

Disadvantages:

• Large physical size and weight

• Complex installation

179

http://cartablesolutions.com/portablehandwashsinks.html

http://cartablesolutions.com/portablehandwashsinks.html


Figure H.17: Schematic of the water system for a recreational vehicle. (image from http://www.rvpartsoutlet.com/images/graphics/3360.jpg)

180




H.7. Examination BedThe current examination beds aboard the MCs are typically, custom made by the MIBfrom high density foam covered with wear resistant vinyl. The bed is built into thevehicle wall and forms a flat surface for the patient to lay on. The current beds allow thepatient to be placed only in a supine or prone position, and the nurse can only access thepatient from one side. However, the medical examinations performed aboard the MCrequire patient positions other than supine or prone, such as the lithotomy, Trendelenburg,and Fowler’s position. Also, to properly utilize these patient positions, the nurse must beable to access the patient from multiple angles and locations. The fixed bed design doesnot allow for this flexibility. As such, alternatives to the fixed frame design are beingconsidered. After researching various options, a suitable product and local supplier wereidentified (Figure H.18).

The universal examination couch allows the patient to be placed in various positions,including a sitting position. The couch can also be easily repositioned in the MC toprovide the nurse with multiple access locations to the patient. These capabilities will bea great benefit to the nurses and patients, and will allow greater utilization of the MCclinical space.

Figure H.18: Meditek-Hemco M96 universal examination couch. (image fromhttp://www.meditek.co.za/beds-cots-a-couches/obstetric-a-gynae)

Due to the limited space available in the MC, it was not possible to integrate theuniversal examination couch into the new MC. Though the examination couch had many

181




superior features, including it required sacrificing the complete space under the bed.It was not possible to fit the needed storage space into the vehicle without using thespace under bed. Therefore, an examination bed will be supplied by the MIB with someof the desirable features of the universal examination couch, most important being theadjustable back rest and foot syrups.

H.8. Emergency CommunicationThe MCs are required to travel long distances on poor roads. If the any malfunctionof the vehicle should occur, the nurses would be stranded, with no way of receivingassistance. Also, occasionally the nurses will be asked to treat a patient that is in need ofemergency care, even though the The MCs are not equipped for this function. In bothcases the nurses need some method of emergence communication.

Currently, each MC CNP is given a monthly credit for their personal cell phone for usein these situations. However, the credit is given as a reimbursement and the maximumreimbursable amount only allows for a few phone calls a month. Also, in many of therural areas the cell phone coverage is highly intermittent and unreliable. Ironically, theseare the areas where emergency communication is more needed.

Due to the unreliable cell phone coverage, the best option was to use a long dis-tance radio. The radio would connect to the emergency network already in place forcommunication between ambulances, and provincial fire and police departments.

182

I. Description of Available Light Commercial Vehicles


I.1. Vehicle Venders and General SpecificationThe list of candidate vehicles is given in Table I.1, along with the manufactuer websitewhere the vehicle specifications can be obtained. A summary of the important vehiclespecifications is show in Table I.2, for each of the 18 candidate vehicle. As the Crafter35 was cosen as the final candidate vehicle, the specification sheet is also included inSection I.2.

183


Table I.1: List of candidate LCVs for conversion into the new MC and the manufacturersspecification websites. All vehicles are available from local suppliers.

Vehicle Name Specification Website

Fiat Ducato Panel Van 33 highroof

http://www.fiatcommercial.com.au/cms/media/newDucato_brochure.pdf

Ford Transit PV LWB HR 350RWD

http://www.ford.com/trucks/transitconnect/specifications

Hyundai H1 Panel Van http://commercial.hyundai.co.za/index.cfm?event=H1

Iveco Power Daily Van 42.12 V http://www.iveco.co.za/assets/Brochures/Power-Daily.pdf

Iveco Mini Bus 16 Seater A42.12 http://www.iveco.co.za/assets/Brochures/Power-Daily.pdf

Mercedes Sprinter 319CDI PVSWB HR

http://www.mercedes-benzsa.co.za/mercedes-benz/eMB/Downloads/Vans/Sprinter_Brochure.pdf

Mercedes Sprinter 519CDI PVLWB HR


Nissan NV400 PV L3H33.5tRWD

http://www.nissan.co.uk/GB/en/vehicles/lcv/nv400.html

Opel Movano panel van MWBhigh roof 3500

http://www.findvauxhall.co.uk/NEW_brochures/NEW_vauxhallvans_vivaro_movano_specifications.pdf

Peugeot Boxer http://www.peugeot.co.uk/Resources/Content/brochures/technical/peugeot-boxer-prices-and-specifications.pdf

Renault Traffic http://www.renault.com.au/cars/traficvan/specifications.html

Toyota Sesfikile http://www.toyota.co.za/VehicleSpecification.aspx?VehicleModelID=61

Toyota Quantum 2.5 D-4D PVLWB HR

http://www.toyota.co.za/VehicleRange.aspx?vehicleRangeId=10

Toyota Quantum 2.5 D-4D PVLWB HR + Pop-Up Roof


VW Crafter 35 2.0 TDI PV MWBSHR

http://www.vwcommercial.co.za/assets/models/crafter/brochure.pdf

VW Crafter 50 2.0 TDI PV LWBSHR


VW Transporter Panel Van http://www.vwcommercial.co.za/models/transporter/specifications

VW Transporter Crew Bus LWB http://www.vwcommercial.co.za/models/transporter/specifications

184





http://commercial.hyundai.co.za/index.cfm?event=H1

http://commercial.hyundai.co.za/index.cfm?event=H1

http://www.iveco.co.za/assets/Brochures/Power-Daily.pdf















http://www.peugeot.co.uk/Resources/Content/brochures/technical/peugeot-boxer-prices-and-specifications.pdf



http://www.renault.com.au/cars/traficvan/specifications.html

http://www.renault.com.au/cars/traficvan/specifications.html

http://www.toyota.co.za/VehicleSpecification.aspx?VehicleModelID=61

http://www.toyota.co.za/VehicleSpecification.aspx?VehicleModelID=61









http://www.vwcommercial.co.za/models/transporter/specifications




I.D

escriptionofA

vailableLightC

omm

ercialVehicles

Table I.2: Vehicle specifications taken from the LCV websits above. For rating power steering, a Boolean scale has been used (yes=1). For climate control,serviceability, durability, and cost, they were rated from 0 to 1 in effectiveness when compared to the other vehicles.

Category FiatDucatoPanelVan33highroof

FordTran-sit PVLWBHR350RWD

HyundaiH1Panelvan

IvecoPowerDailyVan42.12V

IvecoMidibus 16seaterA42.12

MercedesSprinter319CDIPVSWBHR

MercedesSprinter519CDIPVLWBHR

NissanNV400PVL3H33.5tRWD

OpelMovanopanelvanMWBhighroof3500

PeugeotBoxer

RenaultTraf-fic

ToyotaSes-fikile

ToyotaQuan-tum2.5D-4DPVLWBHR

ToyotaQuan-tum +Pop-UpRoof

VWCrafter35 2.0TDIPVMWBSHR

VWCrafter50 2.0TDIPVLWBSHR

VWTrans-porterPanelVan

VWTrans-porterCrewBusLWB

Unlaiden Mass 1,925 2,078 2,049 2,530 3,070 2,255 2,500 2,148 1,879 1,975 1,713 1,998 1,845 1,845 1,940 2,392 1,738 1,901Payload 1,375 1,422 1,180 1,670 1,210 1,245 2,500 1,352 1,621 1,575 1,187 1,152 1,355 1,355 1,565 2,533 987 824Effective Payload 1,375 1,422 1,180 970 430 1,245 1,000 1,352 1,621 1,525 1,187 1,152 1,355 1,355 1,560 1,108 987 824Climate Control 0.80 0.80 0.80 1.00 1.00 0.80 0.80 0.80 0.80 0.80 1.00 1.00 0.80 0.80 0.80 0.80 0.80 1.00Power Steering 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1Roof Height (mm) 1,932 1,885 1,350 1,900 1,940 1,940 1,940 2,048 1,912 1,932 1,285 1,635 1,635 2,035 2,140 2,140 1,410 1,394Floor Area (m2) 5.83 5.99 3.85 6.51 6.58 5.50 8.10 6.59 5.67 6.93 3.89 6.00 6.00 6.00 5.81 7.65 4.66 3.38Volume (m3) 11.27 11.30 5.19 12.36 12.76 10.50 15.50 14.20 10.84 13.39 5.00 9.82 9.80 12.20 12.44 16.38 6.57 4.72Torque (Nm) 320 350 392 269 285 440 440 350 290 320 270 260 260 260 300 300 250 250Power (kW ) 88 92 120 85 93 140 140 92 84 88 74 75 75 75 80 80 75 75Serviceability* 0.00 1.00 1.00 0.00 0.00 0.50 0.50 1.00 0.50 0.00 0.00 1.00 1.00 1.00 0.50 0.50 0.50 0.50Durability* 0.25 0.85 0.75 1.00 0.75 0.75 0.75 0.75 0.50 0.25 0.00 0.75 1.00 0.75 0.75 0.75 0.75 0.75Cost* 1.00 0.50 0.75 0.50 0.50 0.50 0.25 0.75 0.75 0.75 0.75 0.50 1.00 0.75 0.75 0.50 0.75 0.50


185


I.2. Detailed Specifications: VW Crafter

186


I.3. Description of Roads in the Western Cape of South AfricaSpecial care must be taken during the selection of the MC vehicle and the design ofthe clinical area to account for the underdeveloped roads an MC is required to drive on.Traveling on underdeveloped gravel roads present two main challenges: corrugated roadsand rough roads. Understanding these challenges will effect the selection of the MCvehicle as well as the selection materials used when constructing the clinical area.

On a daily basis, MCs are required to travel on corrugated roads. Corrugated, orwashboard, roads are identified by a ripple effect on road surfaces (Figure I.1). Thisripple effect is believed to be caused by vehicles traveling over the road as well aswind and water erosion. Corrugated roads severely hamper traveling and transportation,especially in developing countries[20]. Therefore care has to be taken when selecting thematerials that will be used to construct the clinical area of the MC. The materials usedto construct the clinical area of the MC must be durable enough such that all the unitswithin the MC do not break apart. Ideally these materials must have some dampeningproperties in order to absorb the vibrations caused by these corrugated roads. This willallow fewer vibrations to be induced on the equipment used in the MC, thus increasingequipment life[41].

It is also important to ensure that the dust proofing of the MC be done properly. It hasbeen found that the vibrations cause chafing of the rubber seals on doors used to keepdust out of the clinical area. When the rubber seals fail dirt will enter the clinical areainhibiting a hygienic work area for the nursing staff.

During the rainy months of the year, roads can become rough due to washout. A fewMC routs also contain mountainous or rocky areas which require the MC to operate onrough roads more frequently. When operating on rough roads, three vehicle propertiesmust be considered: approach angle, departure angle, and break-over angle (Figure I.2).These properties are commonly referred to as the vehicle angles.

The type of vehicles considered for the development of the MC do not, by design, haveproper vehicle angles for extreme off-road operation. However, previous MC vehicles,which are of the same vehicle type, have reliably operated with the current MC routs.Alternative MC designs, using an off-road vehicle, are currently being considered bythe MRC to service the few areas that are inaccessible with a panel van. However, thecurrent work focuses only on the MC design needed to serve the greater rural population.For this larger population, the MRC has determined that a panel van is the most logicalvehicle, and is the only vehicle type considered in this work.

187


Figure I.1: Example the corrugated gravel roads the MCs must travel on. (Image fromhttp://www.ritas-outback-guide.com/OutbackDriving.html)

Figure I.2: Important vehicle angles when operating in rough roads. (Image from http://adventure.howstuffworks.com/outdoor-activities/off-roading/off-roading1.htm)

188

http://www.ritas-outback-guide.com/OutbackDriving.html

http://www.ritas-outback-guide.com/OutbackDriving.html

http://adventure.howstuffworks.com/outdoor-activities/off-roading/off-roading1.htm



J. Details of Vehicle Comparison using the Analytical Hierarchical Process

J. Details of Vehicle Comparison using the AnalyticalHierarchical Process

The Analytical Hierarchical Process (AHP)[37] is a method for developing the weight-ing factors for by use of an Relational Matrix. Each element under consideration isindividually ranked in importance compared to every other element. These ranking areorganized in a matrix, as show in Table J.1. The final weighting factor is simply the rowsum divided by the matrix sum.

J.1. Original AHP Relation MatricesThe Relational Matrix for the general vehicle criteria is given in Table J.1. The RelationalMatrices for the comfort, drivability, and miscellaneous subcategories are given in TablesJ.2, J.3, J.4, respectively.

Table J.1: AHP Relational Matrix for the three general vehicle criteria.Categories Comfort Drivability Misc. Wight of TotalComfort 1 2 1.5 46.154Drivability 0.5 1 1.75 23.077Misc. 0.66667 1.33333 1 30.769

Total 100

Table J.2: AHP Relational Matrix for the comfort subcategories.Categories Climate

ControlLoadbayFloorArea

LoadbayVolume

LoadbayHeight

Wight of Total

Climate Control 1 0.75 1 0.5 8.654Loadbay Floor Area 1.3333 1 1.333 0.6667 11.538Loadbay Volume 1 0.75 1 0.5 17.308Loadbay Height 2 1.5 2 1 17.308

Total 46.154

Using the obtained AHP weighting factors, the list of 18 candidate vehicles werescored. The results are listed in Table J.5.

189


Table J.3: AHP Relational Matrix for the drivability subcategories.Categories Unladen

MassPowerSteering

EnginePower

EngineTorque

Wight of Total

Unladen Mass 1 0.75 1 1 5.325Power Steering 1.3333 1 1.3333 1.3333 7.101Engine Power 1 0.75 1 1 5.325Engine Torque 1 0.75 1 1 5.325

Total 23.077

Table J.4: AHP Relational Matrix for the miscellaneous subcategories.Categories Payload Serviceability* Durability* Cost* Wight of TotalPayload 1 1 0.5 0.75 5.769Serviceability* 1 1 0.5 0.75 5.769Durability* 2 2 1 1.5 11.538Cost* 1.3333 1.3333 0.6667 1 7.692

Total 30.769

190

J.D

etailsofVehicle

Com

parisonusing

theA

nalyticalHierarchicalProcess

Table J.5: The relative subcategory score for each vehicle is presented using the best-in-class method. The composite category evaluation obtained by multiplyingthe subcategory score with the respective AHP weights shown in Table 6.3 is also shown.

Category FiatDucatoPanelVan33highroof

FordTran-sit PVLWBHR350RWD

HyundaiH1Panelvan

IvecoPowerDailyVan42.12V

IvecoMidibus 16seaterA42.12


MercedesSprinter519CDIPVLWBHR


OpelMovanopanelvanMWBhighroof3500

PeugeotBoxer

RenaultTraf-fic

ToyotaSes-fikile

ToyotaQuan-tum2.5D-4DPVLWBHR

ToyotaQuan-tum +Pop-UpRoof

VWCrafter35 2.0TDIPVMWBSHR

VWCrafter50 2.0TDIPVLWBSHR

VWTrans-porterPanelVan

VWTrans-porterCrewBusLWB

COMFORTClimate Control 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 0 0 1Roof Height 0.751 0.697 0.075 0.714 0.761 0.761 0.761 0.886 0.728 0.751 0.000 0.407 0.407 0.871 0.993 0.993 0.145 0.127Floor Area 0.520 0.552 0.098 0.662 0.678 0.449 1.000 0.680 0.485 0.752 0.108 0.555 0.555 0.555 0.515 0.905 0.270 0.000Volume 0.562 0.564 0.041 0.656 0.690 0.496 0.925 0.813 0.525 0.743 0.024 0.437 0.436 0.641 0.662 1.000 0.159 0.000

Comfort Total 22.894 22.590 2.429 32.973 35.236 21.242 33.433 30.178 21.683 28.038 10.007 25.716 17.039 25.958 27.369 36.601 6.759 10.115

DRIVABILITYUnlaiden Mass 0.844 0.731 0.752 0.398 0.000 0.601 0.420 0.679 0.878 0.807 1.000 0.790 0.903 0.903 0.833 0.500 0.982 0.861Power Steering 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Torque 0.368 0.526 0.747 0.100 0.184 1.000 1.000 0.526 0.211 0.368 0.105 0.053 0.053 0.053 0.263 0.263 0.000 0.000Power 0.212 0.273 0.697 0.167 0.288 1.000 1.000 0.273 0.152 0.212 0.000 0.015 0.015 0.015 0.091 0.091 0.015 0.015

Drivability Total 14.686 15.249 18.799 10.640 9.615 20.950 19.988 14.974 13.703 14.489 12.987 11.669 12.269 12.269 13.421 11.647 12.409 11.769

MISC.Effective Payload 0.749 0.787 0.595 0.428 0.000 0.646 0.452 0.731 0.944 0.868 0.600 0.573 0.734 0.734 0.896 0.538 0.442 0.312Serviceability* 0.000 1.000 1.000 0.000 0.000 0.500 0.500 1.000 0.500 0.000 0.000 1.000 1.000 1.000 0.500 0.500 0.500 0.500Durability* 0.250 0.850 0.750 0.500 0.750 0.750 0.750 0.750 0.500 0.250 0.000 0.750 1.000 0.750 0.750 0.750 0.750 0.750Cost* 1.000 0.333 0.667 0.333 0.333 0.333 0.000 0.667 0.667 0.667 0.667 0.333 1.000 0.667 0.667 0.333 0.667 0.333

Misc. Total 14.900 22.680 22.983 15.573 11.218 17.831 14.146 23.770 19.231 13.023 8.592 20.290 29.232 23.783 21.837 17.204 19.215 15.905

Grand Total: 52.481 60.518 44.211 59.186 56.069 60.023 67.568 68.922 54.616 55.550 31.586 57.674 58.540 62.010 62.626 65.453 38.383 37.789


191


J.2. Refined/Updated AHP Relation MatricesThe weights from the AHP method are dependent on the value of the vehicle specificationrelative to the maximum and minimum for all considered vehicles. Therefore, the seventop scoring vehicles from Table J.5 were selected for a more refined evaluation. TheAHP method was again applied to create the updated Relational Matrices for generalvehicle, comfort, drivability, and miscellaneous subcategories, which are shown in TablesJ.6, J.7, J.8, J.9, respectively. The results of the evaluation are then shown in Table J.10.

Table J.6: Updated AHP Relational Matrix for the three general vehicle criteria.

Categories Comfort Drivability Misc. Wight of TotalComfort 1 1.5 0.5 27.273Drivability 0.6667 1 0.3333 18.182Misc. 2 3 1 54.545

Total 100

Table J.7: Updated AHP Relational Matrix for the comfort subcategories.

Categories ClimateControl

LoadbayFloorArea

LoadbayVolume

LoadbayHeight

Wight of Total

Climate Control 1 0.75 1 0.5 5.114Loadbay Floor Area 1.3333 1 1.3333 0.6667 6.818Loadbay Volume 1 0.75 1 0.5 5.114Loadbay Height 2 1.5 2 1 10.227

Total 27.273

192


Table J.8: Updated AHP Relational Matrix for the drivability subcategories.

Categories UnladenMass

PowerSteering

EnginePower

EngineTorque

Wight of Total

Unladen Mass 1 5 3 3 9.740Power Steering 0.2 1 0.6 0.6 1.948Engine Power 0.3333 1.6667 1 01 3.247Engine Torque 0.3333 1.6667 1 1 3.247

Total 18.182

Table J.9: AHP Relational Matrix for the miscellaneous subcategories. (Note: *Representsestimated category)

Categories Payload Serviceability Durability* Cost Wight of TotalPayload 1 0.75 1 0.5 10.227Servicability 1.3333 1 1.3333 0.6667 13.636Durability* 1 0.75 1 0.5 10.227Cost 2 1.5 2 1 20.454

Total 54.545

193


Table J.10: The relative subcategory score for each vehicle is presented using the best-in-class method with minimum value pinning correction. The composite categoryevaluation obtained by multiplying the subcategory score with the respectiveAHP weights shown in Table 6.3 is also shown.

Category FordTransitPVLWBHR 350RWD

HyundaiH1Panelvan



ToyotaQuan-tum 2.5D-4DPVLWBHR +Pop-UpRoof

VWCrafter35 2.0TDI PVMWBSHR

VWCrafter50 2.0TDI PVLWBSHR

COMFORTClimate Control 1.00 1.00 1.00 1.00 1.00 1.00 1.00Roof Height 0.25 0.41 0.41 0.73 0.69 1.00 1.00Floor Area 0.10 0.86 0.86 0.42 0.10 0.00 1.00Volume 0.00 0.53 0.53 0.57 0.18 0.22 1.00

Comfort Total 7.31 17.77 17.77 18.08 12.16 14.22 27.27

DRIVABILITYUnlaiden Mass 0.64 0.37 0.00 0.54 1.00 0.85 0.16Power Steering 1.00 1.00 1.00 1.00 1.00 1.00 1.00Torque 0.53 1.00 1.00 0.53 0.05 0.26 0.26Power 0.26 1.00 1.00 0.26 0.00 0.08 0.08

Drivability Total 10.78 12.08 8.44 9.74 11.86 11.38 4.66

MISC.Effective Payload 0.86 0.67 0.42 0.78 0.79 1.00 0.53Servicability 0.00 0.00 0.00 0.50 1.00 0.50 0.50Durability* 1.00 0.57 0.57 0.86 0.29 0.43 0.43Cost 0.70 0.05 0.00 0.78 0.83 1.00 0.54

Misc. Total 33.24 13.75 10.11 39.52 41.63 41.88 27.61

Grand Total 51.33 43.60 36.31 67.35 65.66 67.48 59.54


194

K. E-Mail Correspondence Regarding Process for Re-Registration of Vehicle License Class

K. E-Mail Correspondence Regarding Process forRe-Registration of Vehicle License Class

K.1. Alta Swanepoel and Associates, Rode Traffic LegalConsultants

Hendr ik Bosman5 :02 PM (2 h o u r s ago )

t o J j o o s t e , j k o e g e l e , hpsmal , Cornie , Er i ck , Bryan , Barend , f k k r i g e , M,c h a r l o t t e , h l i e b e n b , Mr J o o s t e , Mr Koeglenberg , Mr Smal ,

Conce rn ing t h e v e h i c l e s e l e c t i o n p r o c e s s o f t h e ongoing mobi l e c l i n i cp r o j e c t and t h e prob lems wi t h GVM and d r i v e r s l i c e n c e i s s u e s : I haver e c e i v e d an e m a i l ( s e e below ) from A l t a Swanepoel and A s s o c i a t e s , RoadT r a f f i c Lega l C o n s u l t a n t s , showing t h a t t h e re−r e g i s t r a t i o n o f a t h eNi s s an I n t e r s t a r i n t o t h e c l a s s −B l i c e n c e i s p o s s i b l e a s long as t h ef i n a l ( i e . a f t e r t h e r e t r o f i t t i n g ) t a r e mass o f t h e v e h i c l e i s below3500 kg . I t was found t h a t t h e I n t e r s t a r ’ s GVM i s 3510 kg , n o t 5000 kg asp r e v i o u s l y b e l i e v e d . Th i s i n f o r m a t i o n and a d e s c r i p t i o n o f t h er e t r o f i t t i n g and re−r e g i s t r a t i o n p r o c e d u r e w i l l be summarized i n t h em i l e s t o n e 2 r e p o r t , which w i l l be a v a i l a b l e on Monday t h e 18 t h o fJune . I s t i l l b e l i e v e t h a t t h e i m p l e m e n t a t i o n o f such a v e h i c l e i n t h ee n v i s i o n e d mobi le c l i n i c p r o t o t y p e w i l l be o f g r e a t b e n e f i t t o t h eq u a l i t y o f h e a l t h c a r e i n t h e r u r a l Western Cape and t h e workingc o n d i t i o n s o f t h e n u r s i n g s t a f f .

P l e a s e f e e l f r e e t o c o n t a c t me wi th any q u e s t i o n s o r comments .

Regards ,Hendr ik Bosman

−−HL Bosman ( S t e l l e n b o s c h U n i v e r s i t y : MEng R e s e a r c h − Ti−PM)h e n d r i k 5bosman@gmail . com ; 15422542\@sun . ac . za082 850 8722

−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−H a l l o Hendr ik

Our t e l e p h o n e c o n v e r s a t i o n o f y e s t e r d a y r e f e r s .

Any motor v e h i c l e t h a t d e s i g n e d as a bus , minibus , goods v e h i c l e o rt r a c t o r must have a v e h i c l e i n f o r m a t i o n p l a t e r e f l e c t i n g t h e GVM and av a r i o u s o t h e r mass r e l a t e d i n f o . The v e h i c l e t h a t you w i l l use t or e c o n s t r u c t i n t o a c l i n i c would be c l a s s i f i e d as a goods v e h i c l e . Once youhave c o n v e r t e d t h e v e h i c l e you would need t o t a k e i t f o r a l e t t e r o fa u t h o r i t y . The NRCS i s s u e s t h e l e t t e r once t h e y a r e s a t i s f i e d t h e v e h i c l es t i l l c o m p l i e s wi th t h e l e g i s l a t i o n .

You would t h e n r e q u i r e a r o a d w o r t h y c e r t i f i c a t e t o g e t t h e v e h i c l e back ont h e sys tem wi th a d e s c r i p t i o n t h a t must no l o n g e r i n d i c a t e goods v e h i c l e .I am n o t s u r e i f t h e y have a mobi le c l i n i c c l a s s i f i c a t i o n b u t I t h i n kt h e r e i s a mobi l e o f f i c e c l a s s i f i c a t i o n .

The v e h i c l e w i l l t h e n n o t r e q u i r e an o p e r a t o r card , a n n u a l r o a d w o r t h yc e r t i f i c a t e and t h e d r i v e r on ly r e q u i r e s a code B l i c e n c e p r o v i d e d t h et a r e i s l e s s t h a n 3 500 kg . The d r i v e r a l s o does n o t need a P r o f e s s i o n a l

195


D r i v i n g P e r m i t (PRDP) .

The r e l e v a n t r e g u l a t i o n s a r e Reg 99 , 115 , 138 , 142 and 2 6 5 . As i t i s n o t amotor home or goods v e h i c l e i t w i l l n o t r e q u i r e c o n t o u r mark ings e i t h e rb u t i t i s much s a f e r t o f i t i t .

RegardsA l t a

A l t a Swanepoel and A s s o c i a t e s1266 S t a r k e y avenueWaverleyP r e t o r i a0186www. a l t a s w a n e p o e l . co . zaaltaswanepoel@mweb . co . zaTe l : 012 0332 2186 / 9Fax : 086 672 0469

−−−−−O r i g i n a l Message−−−−−From : A l t a Swanepoel [ m a i l t o : al taswanepoel@mweb . co . za ]Sen t : 15 June 2012 08 :01 AMTo : ’ A l t a Swanepoel ’S u b j e c t : FW: Mobile c l i n i c r e d e s i g n p r o j e c t

On Thu , Jun 14 , 2012 a t 3 :22 PM, Hendr ik Bosman <h e n d r i k 5bosman@gmail . com>wro te :> Dear A l t a Swanepoel ,>> I c o n t a c t you t h r o u g h a r e f e r r a l from Mike P h e i f f e r a t Maui / J u r g e n s> Motor−homes , i n your c a p a c i t y as a l aw y e r r e g a r d i n g l i c e n c i n g> i s s u e s wi th a p r o j e c t i n v o l v i n g mobi l e c l i n i c s i n t h e Western Cape .> I u n d e r s t a n d you have had s u c c e s s i n t h e l e g a l m a t t e r s p e r t a i n i n g> t o t h e re−r e g i s t r a t i o n o f a c l a s s C v e h i c l e i n t o a c l a s s B motor−home .>> I am i n v o l v e d wi th a p r o j e c t s p e a r h e a d e d by t h e Medica l R e s e a r c h> C o u n c i l t h a t a ims t o r e d e s i g n a mobi l e c l i n i c f o r t h e Western Cape> Gov . We have i d e n t i f i e d a s u i t a b l e v e h i c l e : N i s san I n t e r s t a r (LWB)> p a n e l van as t h e pr ime p l a t f o r m v e h i c l e , b u t t h e v e h i c l e ’ s GVM> t o t a l s a t 3510 kg which p u t s i t i n a c l a s s C d r i v e r l i c e n c e . For i t> t o be s u i t a b l e f o r s e r v i c e as a mobi le c l i n i c , t h e t a r e mass ,> number o f p a s s e n g e r s need t o be i n c r e a s e d and t h e GVM r e d u c e d t o> below 3500 kg so t h a t a c l a s s B l i c e n c e would s u f f i c e . I must> produce d o c u m e n t a t i o n t o show t h i s i s f e a s i b l e b e f o r e t h e v e h i c l e> can be p rocu red , what would you s u g g e s t i o n s be i n t h i s r e g a r d ?>> During our phone c a l l you g r a c i o u s l y a g r e e d t o draw up a s i g n e d> document showing t h e f e a s i b i l i t y o f such a p r o c e d u r e . Th i s would be> a boon t o t h e improvement o f h e a l t h c a r e i n t h e Western Cape , I> a p p r e c i a t e your t r o u b l e g r e a t l y .>> Regards ,> Hendr ik Bosman>> PS .> I u n d e r s t a n d J e f f from Advanced V e h i c l e E n g i n e e r i n g , a MIB i n t h e> Western Cape would a l s o l i k e t o c o n t a c t you i n t h e f u t u r e .> Thus he has been CCed .>> −−> HL Bosman ( S t e l l e n b o s c h U n i v e r s i t y : MEng R e s e a r c h − Ti−PM)> h e n d r i k 5bosman@gmail . com ; 15422542@sun . ac . za

196


> 082 850 8722

K.2. Theo Becher and Dewald Horn, Government VehicleInspection

Mr Becker , Mr Horn ,

I am i n v o l v e d wi th a p r o j e c t s p e a r h e a d e d by t h e Medica l R e s e a r c hC o u n c i l t h a t a ims t o r e d e s i g n a mobi l e c l i n i c f o r t h e Western CapeGov . We have i d e n t i f i e d a s u i t a b l e v e h i c l e : N i s s an I n t e r s t a r (LWB)p a n e l van as t h e pr ime p l a t f o r m v e h i c l e , b u t t h e v e h i c l e ’ s GVM t o t a l sa t 3510 kg which p u t s i t i n a c l a s s C d r i v e r l i c e n c e . For i t t o bes u i t a b l e f o r s e r v i c e as a mobi le c l i n i c , t h e t a r e mass , number o fp a s s e n g e r s need t o be i n c r e a s e d and t h e GVM r e d u c e d t o below 3500 kgso t h a t a c l a s s B l i c e n c e would s u f f i c e . I must p roduce d o c u m e n t a t i o nt o show t h i s i s f e a s i b l e b e f o r e t h e v e h i c l e can be p rocu red , whatwould you s u g g e s t i o n s be i n t h i s r e g a r d ?

I have spoken t o Mr Horn and he i s i n t h e p r o c e s s o f drawing up as i g n e d document t o show t h a t t h e number o f p a s s e n g e r s can be i n c r e a s epend ing t h e MIB’ s c e r t i f i c a t e o f c o m p l i a n c e .

I u n d e r s t a n d Mr Becker i s i n v o l v e d wi th t h e MIBs and I would l i k e t od i s c u s s t h e m a t t e r w i th him toward f i n d i n g s o u r c e s o f t h ed o c u m e n t a t i o n t h a t I r e q u i r e .

I am c o n t a c t i n g N i s s an SA t o g e t t h e i r i n p u t a s w e l l on t h erecommendat ion o f Mr Horn .

Regards ,Hendr ik

Dewald Horn HORND@nrcs . o rg . zaJun 13 (3 days ago )−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−t o me , Theo , hpsmalGood Morning Mr Bosman

The s e a t i n g c a p a c i t y can be changed i f t h e m o d i f i c a t i o n was doneby a r e g i s t e r e d MIB t h a t has o b t a i n e d a NaTIS no from o u r s e l v e sf o r t h i s p a r t i c u l a r v e h i c l e . The GVM can a l s o be a l t e r e d b u t on lyt h e o r i g i n a l m a n u f a c t u r e r can g i v e t h a t p e r m i s s i o n .

Regards

Dewald HornI n s p e c t o r

NRCS Cape Town14B Rai lway RoadMontagu Gardens

TEL : 021 526 3400FAX : 086 676 4275

−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−Mr . Bosman hi ,

197


RE : Mobile C l i n i c

As a MIB i n s p e c t o r , I am most o f t h e t ime o u t busy wi th i n s p e c t i o n s ;t h e r e f o r e I c o u l d n o t y e t r e s p o n d t o you r e g a r d i n g t h i s m a t t e r .

I f t h e m o d i f i c a t i o n i s go ing t o be done by a r e g i s t e r e d B u i l d e r t h e ni t might be t h a t t h e B u i l d e r w i l l have t o a p p l y f o r h o m o l o g a t i o n f o rt h e m o d i f i c a t i o n . Advanced V e h i c l e E n g i n e e r i n g i n Montague Gardens i sa r e g i s t e r e d B u i l d e r who has done s i m i l a r m o d i f i c a t i o n s on v e h i c l e sb e f o r e . The Homologat ion c o s t w i l l be R 4325 .00 t o c o n v e r t t h e N i s sa np a n e l van . You can a l s o a p p l y f o r a l e t t e r o f a u t h o r i t y f o r t h em o d i f i c a t i o n . Mr . Horn w i l l be a b l e t o g i v e you more i n f o r m a t i o n ont h e l e t t e r o f a u t h o r i t y .

RegardsTheo

S e n i o r I n s p e c t o rAutomot ive MIBNRCS Cape Town

K.3. Coretha Matthee, Legislation and Permits

<T r a n s l a t e d v i a Google T r a n s l a t e ( A f r i k a a n s t o E n g l i s h ) + e d i t e d by hand>

Good Morning Mr . Bosman ,

I r e g r e t t h a t an answer t o your que ry now on ly be p r o v i d e d due t o v a r i o u s a s p e c t s andr e l e v a n t p l a y e r s i n t h e m a t t e r had i n p u t s t o comment .

V e h i c l e : Let ’ s s t a r t w i th t h e v e h i c l e , a s i t i s a goods v e h i c l e a s p roduced by t h em a n u f a c t u r e r and so t h e NRCS homologa ted t o t h a t v e h i c l e c l a s s . I f t h e o r i g i n a ls p e c i f i c a t i o n s a r e a l t e r e d by any m o d i f i c a t i o n , i t must be approved by t h em a n u f a c t u r e r c o n d u c t e d by a r e g i s t e r e d ” m a n u f a c t u r e r−i m p o r t e r−b u i l d e r ” (MIB) .A f t e r t h e c o n v e r s i o n / changes made , t h e NRCS a g a i n i n s p e c t t h e v e h i c l e and t h ec o n v e r s i o n approved under t h e p r o v i s i o n s o f t h e N a t i o n a l Road T r a f f i c Act andR e g u l a t i o n s .

D r i v e r s L i c e n c e r e q u i r e m e n t s : In t h i s c a s e t h e d r i v i n g l i c e n s e o f t h e goods v e h i c l ed e t e r m i n e d by t h e GVM of t h e v e h i c l e (3500+ kg ) b e c a u s e i t i s homologa ted and t h eN a t i o n a l T r a f f i c I n f o r m a t i o n System ( eNaTIS ) as a goods v e h i c l e . The code C1 orh i g h e r d r i v e r ’ s l i c e n s e i s r e q u i r e d f o r such v e h i c l e . In t h e c a s e o f a p a s s e n g e rv e h i c l e ( a d i f f e r e n t v e h i c l e ) w i th a t a r e we igh t ove r 3500+ kg s h a l l a l s o a p p l y .For a p a s s e n g e r o r goods v e h i c l e wi th a t a r e o r GVM 3 500 kg under t h e Code Bd r i v e r ’ s l i c e n s e s t i l l a p p l i e s .

G e n e r a l : You ment ioned t h a t i f t h e v e h i c l e i s changed t o a GVM / t a r e unde r 3500 kg t ohave t h e d e s c r i p t i o n o f e NaTIS p o s s i b l e t o a ” mobi le home” may be amended . Thep r o v i s i o n s o f t h e d e f i n i t i o n i n r e g u l a t i o n 1 of t h e N a t i o n a l Road T r a f f i cR e g u l a t i o n s f o r mobi l e home / motorhome ’ must be k e p t i n mind . I q u o t e t o you t h eE n g l i s h v e r s i o n as f o l l o w s −

” Motor home” means an e n c l o s e d motor v e h i c l e Which i s s o l e l y d e s i g n e d or Adapted t ol i v e i n and Which i s s e l f −P r o p e l l e d .

In mind , t h e mobi le c l i n i c does n o t have a ’ mobi l e home ’ can be d e f i n e d . The Depar tment( T r a n s p o r t a t i o n and P u b l i c Works , PGWC) i s o f t h e o p i n i o n t h a t t h e d e s c r i p t i o n o f

198


” mobi l e c l i n i c ” t o be added eNaTIS and i s i n t h e p r o c e s s t o m o t i v a t e t h i s changet o t h e L e g i s l a t u r e .

There a r e c e r t a i n r e q u i r e m e n t s o f t h e u s e r ( and c l i n i c s t a f f ) i n mind , namely t h a t −

t h e v e h i c l e used a t a l l t i m e s t o be a b l e t o i n h o s p i t a b l e a r e a s on e a r t h andmounta in r o a d s can be e a s i l y h a n d l e d ;

i t must be d u s t p r o o f ;boxes f o r m e d i c a t i o n and f i l e s o f t e r t r a v e l uncovered , b u t t h e y r e q u i r e

p r o p e r c o n t a i n m e n t ;t h a t a i r c o n d i t i o n i n g be f i t t e d t o t h e MC f o r summer t ime t o keep m e d i c a t i o n

and s t a f f c o o l ;t h a t where n e c e s s a r y t h e v e h i c l e s a t l e a s t 2X4 i s s u f f i c i e n t t o g i v e

t r a c t i o n on t h e mounta in r o a d s and d i r t r o a d s ( h e r e i n a f t e r a l s o t h e VW Kombi o rs i m i l a r v e h i c l e t h a t i s a l s o c o n s i d e r e d wi th an a d j u s t a b l e r o o f ) ;

You a r e t h e r e f o r e a d v i s e d , i n c o n s u l t a t i o n wi th t h e c u r r e n t p r o v i d e r o f t h e s e v e h i c l e s ,t h e Government Garage t o c o o p e r a t e c l o s e l y f o r any p r o p o s e d p r o j e c t i n t h i s

r e g a r d b e c a u s e t h e y have f i r s t h a n d knowledge a b o u t t h e needs o f t h e Depar tmen t o fH e a l t h .

I t r u s t t h a t t h e above i n f o r m a t i o n may be of a s s i s t a n c e .

Regards ,

C o r e t h a Mat theeA s s i s t a n t Manager , L e g i s l a t i o n and P e r m i t sT r a n s p o r t a t i o n and P u b l i c WorksWESTERN CAPE GOVERNMENT

−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−

G o e i e m r e Mnr Bosman

D i t s p y t my d a t ‘ n an twoord op u n a v r a a g nou e e r s v e r s k a f word omdat v e r s k e i e a s p e k t een r o l s p e l e r s i n d i e saak i n s e t t e moes l e w e r .

V o e r t u i g : Kom ons b e g i n by d i e v o e r t u i g , N i s san I n t e r s t a r , wat a s ‘ n g o e d e r e v o e r t u i gd eu r d i e v e r v a a r d i g e r v e r v a a r d i g i s en so deu r d i e NRCS homologeer was . Sou d i eo o r s p r o n k l i k e s p e s i f i k a s i e s s o d a n i g gewysig word deu r e n i g e m o d i f i s e r i n g moet d i tmet d i e g o e d k e u r i n g van d i e v e r v a a r d i g e r gedoen word deu r ‘ n g e r e g i s t r e e r d e bouer /m o d i f i s e e r d e r . Nadat d i e ombouing / w y s i g i n g s gedoen i s , moet d i e NRCS weer d i ev o e r t u i g i n s p e k t e e r en d i e ombouing goedkeur v o l g e n s d i e b e p a l i n g s van d i eN a s i o n a l e P a d v e r k e e r s w e t en − r e g u l a s i e s .

B e s t u u r s l i s e n s i e : In h i e r d i e g e v a l word d i e b e s t u u r s l i s e n s i e van d i e N i s sa n I n t e r s t a rb e p a a l v o l g e n s d i e GVM/BVM van d i e v o e r t u i g (3510 kg ) want d i t i s gehomologeer enop d i e N a s i o n a l e V e r k e e r s i n l i g t i n g s t e l s e l ( eNaVIS ) as ‘ n g o e d e r e v o e r t u i g . Diekode C1 of g r o t e r b e s t u u r s l i s e n s i e word benod ig om s o d a n i g e v o e r t u i g t e b e s t u u r .In d i e g e v a l van ‘ n p a s s i e r s d r a e n d e v o e r t u i g ( a n d e r motor v o e r t u i g ) met ‘ n t a r r abo 3 500 kg s a l d i e s e l f d e g e l d . Vi r ‘ n p a s s a s i e r s o f g o e d e r e v o e r t u i g met ‘ n t a r r a

o f GVM onder 3 500 kg kan d i e kode B b e s t u u r s l i s e n s i e nog g e l d .

Algemeen : U h e t gemeld d a t i n d i e n d i e m o t o r v o e r t u i g v e r a n d e r word om ‘ n BVM/ t a r r a onde r3 500 kg t e h d i e besk rywing op e NaVIS m o o n t l i k na ‘ n m o b i e l e h u i s gewysig

kan word . Die b e p a l i n g s van d i e woordomskrywing i n r e g u l a s i e 1 van d i e N a s i o n a l eP a d v e r k e e r s r e g u l a s i e s v i r mob ie l e h u i s / motor h o m e moet e g t e r i n g e d a g t e gehouword . Ek kwotee r v i r u d i e E n g e l s e weergawe as vo lg

motor h o m e means an e n c l o s e d motor v e h i c l e which i s d e s i g n e d or a d a p t e d s o l e l y t ol i v e i n and which i s s e l f −p r o p e l l e d .

199


G e d a g t i g h i e r a a n s a l d i e mob ie l e k l i n i e k dus n i e as ‘ n m o b i e l e h u i s omskryf kan wordn i e . H i e r d i e Depar t emen t i s e g t e r van mening d a t d i e besk rywing van m o b i e l e

k l i n i e k t o t d i e eNaVIS t o e g e v o e g moet word en i s i n p r o s e s om d i t so aan d i eWetgewer t e m o t i v e e r .

Daar i s s e k e r e b e h o e f t e s van d i e g e b r u i k e r ( k l i n i e k s u s t e r en p e r s o n e e l ) wat i n g e d a g t egehou moet word , naaml ik d a t

d i e v o e r t u i g wat g e b r u i k word t e a l l e t y e i n s t a a t moet wees om i nonhe rbe rgsame a r e a s op grond en b e r g p a a i e gemak l ik h a n t e e r kan word ;

d a t d i t s t o f d i g moet wees ;d a t d i e k a s s i e s v i r m e d i k a s i e en l e r s n i e gedu rekde d i e r e i s oopgaan nie ,

maar d e e g l i k e s l o t t e h e t ;d a t d i t met l u g r e l i n g t o e g e r u s i s om d i e m e d i k a s i e en p e r s o n e e l i n s o m e r t y e

t e k o e l t e hou ;d a t waar nod ig d i e v o e r t u i e t e n m i n s t e 2X4 i s om vo ldoende t r a k s i e t e gee op

d i e b e r g p a a i e en g r o n d p a a i e ( h i e r i n kan ook d i e VW Kombi o f s o o r t g e l y k e v o e r t u i goorweeg word wat ook ‘ n v e r s t e l b a r e dak h e t ) ;

U word dus a a n g e r a a i om , i n o o r l e g p l e g i n g met d i e h u i d i g e d i e n s v e r s k a f f e r van h i e r d i ev o e r t u i e , naaml ik d i e S t a a t s g a r a g e nou saam t e werk v i r e n i g e beoogde p r o j e k i nh i e r d i e ve rband a a n g e s i e n h u l l e e e r s t e h a n d s e k e n n i s h e t oor d i e b e h o e f t e ( s ) vand i e Dept van Gesondheid .

Ek v e r t r o u d a t bogenoemde i n l i g t i n g t o t hu lp kan wees .

V r i e n d e i i k

C o r e t h a Mat theeA s s i s t e n t B e s t u u r d e r : Wetgewing en P e r m i t t eVervoer en Openbare WerkeWES−KAAPSE REGERING

Adres : D o r p s t r a a t 9 , Kaaps tad 8001 ; Posbus 2603 , Kaaps tad 8000Tel : +27 21 483 2076Faks : +27 21 483 2357E−mai l : c o r e t h a . matthee@pgwc . gov . zaWebs i te : www. w e s t e r n c a p e . gov . za

200

L. Matlab Code for Determining the Optimal Modular Unit Size

L. Matlab Code for Determining the Optimal ModularUnit Size

1 % optimize unit lengths2 clear; clf; clc; % clear all3 maxunits=12; % set max unit bound4 minl=0.3; maxl=1.5; % set unit length bounds5 minloadbl=2.6; maxloadbl=3.7; % set loadbay lenght bounds

[2.615,3.714]6 inc=0.01; % set increment length variable7 x=minl:inc:maxl; % bound the length variable8 irt=length(x); % itteration count9 sol=[maxl,maxunits,0,maxloadbl,minloadbl]; % initialize the

solution matrix10 use=[0 0]; % initialize the %use matrix11 for j=1:irt % outside loop12 for k=1:4 % vary difference opposing unit numbers13 for i=3:maxunits % loop to consider the variation in

units14 if x(j)*i<maxloadbl & x(j)*i>(maxloadbl-0.05) %

maximum length15 if (x(j)*(i-k))<minloadbl & (x(j)*(i-k))>(

minloadbl-0.2) % minimum length16 plot(x(j),i,’ko’); hold on;17 sol=[sol;x(j),i,i-k,x(j)*i,x(j)*(i-k)];18 use=[use; x(j)*i/maxloadbl, x(j)*(i-k)/

minloadbl];19 end20 end21 end22 end23 end24 grid on; xlabel(’unit length (m)’), ylabel(’max number of

units’);25 disp(’unit_length max_units min_units max_L min_L %

use_max %use_min ’)26 printsoluse=[sol,use]; % append the solution and %use matrices27 disp(printsoluse); % print the sol and use matrices28 disp(’end’);

201

M. Concept Development

M. Concept DevelopmentDue to the international nature of this project only one type of method could have beenimplemented in order to come up with the concepts that are discussed below. Thismethod is known as the Delphi method. It involves individual and stress-free thinkingof the group members because face-to-face communication is not always possible[28].Additionally, the group meetings are subject to time constraints and as such a morecommon technique such as brainstorming was more difficult to apply.

The only instance were brainstorming was implemented was when the group membersintroduced individually generated concepts during the meetings. The group in its entiretycould then discuss these concepts, allowing the individual group members to combineideas and thus better their own concepts.

It should also be mentioned, however, that before any concept development took placethe TRIZ method was implemented to some degree. The TRIZ method was developedby a Russian engineer and scientist, Genrich Altshuller and it involves the discretizationof problems that need to be addressed. The identified problems were divided into twocategories, namely physical and technical[28].

The modular design concepts are of a physical as well as technical nature, whereas thelayout concepts are completely physical. Furthermore, the fixture concepts are a hybridas well.

As an initial concept design stage it was thought best that each group member coulddevelop concepts of modular units and any designs surrounding these units for usewithin the MC. These concepts involved the physical design of the units, the means offixing them to the MC as well as one another, and proposed layouts of the clinical area.These different designs are categorized as Modular Unit Concepts, Fixture/modularityConcepts and Layout Concepts respectively. The details of which, including advantagesand disadvantages, are discussed in the following section.

M.1. Modular Unit Concepts

Pull-Out Counter TopThe idea behind this concept was to increase the area of a worktop that would be used bythe nurses for any administrative work such as documentation, writing prescriptions etc.This type of design is similar to that of a pull-out tray on which a computer keyboardwould be placed (Figure M.1).

Advantages:

• Provides larger surface area for doing administrative work.

• Does not impede on space in clinical area when not in use.

202


Figure M.1: Pull out worktop concept.

Disadvantages:

• Prone to failure when large loads are placed on working surface.

• Dust or other particles may affect the movement of the counter top.

JIT (Just In Time) Storage SystemThe ease of access to certain equipment used regularly by the nurses is important. Thisdesign makes use of storage volumes that are not sealed by means of a door or cover.The storage volumes are angled such that when the MC is in motion the equipment orany other bodies within the storage space does not fall out and when a nurse requiresanything within the storage space it can be accessed very easily (Figure M.2).

Advantages:

• Provides easy access to any equipment or medication that needs to be used often.

• Allows for quick and easy restocking, as well as a visual indicator of when thatrestocking needs to take place.

203


Figure M.2: JIT storage space concept.

• Should the storage compartments be manufactured from foam it can be used as aconvenient, removable storage system.

Disadvantages:

• Though designed to keep equipment and medication safe a risk exists that theequipment and medication might fall out while the MC is traveling.

Removable & Transportable Storage CabinetA means of restocking with ease is desirable, and therefore a light storage unit that canbe removed and carried by nurses was considered. The storage system also incorporatesthe JIT storage method highlighted in the aforementioned concept. This further increasesthe ease of restocking and access to any equipment or medication required by the nursingstaff. (Figure M.3).

Advantages:

• Allows for easy restocking since the supplies need not be brought to the MC.Instead the storage compartment can be brought to the inventory where suppliesare kept are restocking can be done quickly and effectively.

204


Figure M.3: Removable storage concept.

• Provides a higher degree of modularity to MC staff and thus allow the nurses tointerchange components as they see fit.

Disadvantages:

• Though designed to be light the added supplies might make it difficult for somenurses to carry this storage design around.

• Should the nursing staff forget to secure/fasten this transportable storage system inits determined position it might move about while the vehicle is in motion. Thiscould cause equipment kept in this storage system to move about and get damaged.

Self Locking DrawerIt is imperative that all of the modular units be secured such that, when the MC istravelling from one post to another no structure breaks apart or allows any equipment ormedicines to fall out of place. A self locking drawer is a simple design that ensures thatthe drawer itself does not open when not in use. The self locking drawer makes use of asimple edge that locks into a mating groove and as a result inhibits translation (FigureM.4)

205


Figure M.4: Self locking drawer concept.

Advantages:

• The design is very simple.

• Ensures that supplies/equipment kept in this type drawer do not fall out duringtransportation since the drawer cannot open by itself.

Disadvantages:

• Should the drawer be filled with too much equipment/supplies it might be difficultfor the nursing staff to open or close the drawer since it needs to be lifted out ofthe female part when in use.

206


Overhead Bin StorageIn order to utilize all of the space within the clinical area storage mounted to the upperhalf of the load-bay area should be incorporated. It is important, however, to ensure thatusing these type of storage areas be easy since the nurses will have to make a greaterphysical effort than usual; in comparison, using hip height storage areas are more natural.A bin storage system similar to that used in airplanes was considered as a promising andconvenient option for the nurses (Figure M.5).

Figure M.5: Overhead bin storage concept, similar to those used in airplanes.

Advantages:

• Provides a means of increasing the amount of storage space within the clinicalarea.

207


• The design allows for easy access to supplies kept in the storage compartments.

• As opposed to what is currently used in the MCs, this storage system ensures thatthe supplies are kept in a secure compartment while the vehicle is in motion.

Disadvantages:

• The design might have to be overly large in order to house all the supplies.

• These storage compartments may hinder movement in the vertical direction closeto the wall of the clinical area, causing a reduction in workspace for the nurses.

Garage Door CupboardDue to the limited amount of space within the MC a door system that, when open, doesnot impede the amount of space within the clinical area would be preferred. This doordesign is similar to that of a garage door that articulates and slides in rails when openingor closing (Figure M.6).

Advantages:

• The opening and closing of this storage concept does not impede the clinical spacein which the nurses work.

• Since the door door will be made of a lightweight material such as plastic littleeffort is required when opening the storage compartment.

Disadvantages:

• Should any dust or other particles reside in the rails it may become difficult to openthe door.

• This type of storage system will not be as durable as a typical drawer or cabinet.

Ladder & Drawer StorageSome nurses will be shorter than others and correspondingly a concept was consideredthat would allow them access to higher storage areas but at the same time not reduce theamount of storage space within the clinical area. This consists of a system where thedrawers can be used as steps. The lower drawers are pulled outward as usual and thusthe nurse can step upwards onto these drawers. This gives rise to a step climbing actionproviding the nurse access to storage spaces that are normally too high to reach (FigureM.7).

Advantages:

208


Figure M.6: Cupboard concept with garage door style opening.

• Allows nurses of a shorter height to reach supplies kept in higher drawers.

• A greater portion of the load bay area can be converted into a storage area.

Disadvantages:

• It would be difficult to design the drawers strong enough in order to hold the weightof a nurse.

• A risk exists that when the nurse stands on a drawer the drawer might move causingthe nurse to injure herself.

• Standing on the drawers may cause dirt to enter the storage compartment andtherefore affect the hygiene of some medical supplies.

209


Figure M.7: Ladder & drawer storage concept.

Rotating Corner Storage AreaIt was realized that the corners within the load-bay area would be problematic due tothe difficulty of accessing any equipment that would be stored there. Namely, no simpledrawer or cupboard unit can be placed in the corner of the load bay-area. A simplesolution was realized that makes use of a turning table that would allow any storedequipment to be rotated and brought into reachable distance (Figure M.8).

Advantages:

• Allows ease of access to supplies or equipment kept within the corner volumespace of the clinical area.

• Provides a means of utilizing the space in the corner of the load bay area for

210


Figure M.8: Rotating corner storage area concept.

storage.

Disadvantages:

• The design might have to be too intricate in order to guarantee rigid operation ofthis storage system.

• The rotation or vibration of the storage area might cause supplies or equipment tofall from the surface.

M.2. Fixture ConceptsDue to the modular nature of the MC design it is important to allow for ease of assemblingas well as disassembling the units within the clinical area. The reason for this, as wasmentioned, is so that the nurses can interchange units as they see fit. Another reasonbeing that should one of the modular units fail, replacement of that unit can occur easilyand quickly.

Self-Lubricating Parallel RailsSelf-lubricating rails used in the design of extendable booms could be adopted to allowfor ease of sliding of the units into and out of the clinical area (Figure M.9).

Advantages:

211


Figure M.9: Self-lubricating parallel rails concept.

• Assembly as well as replacement/maintenance of the modular units can be doneeasily and quickly.

• If designed correctly this system can also be rigid enough in order to guaranteethat the modular units do not move when the MC is in motion.

• The self-lubricating material is tough and guarantees long term use.

Disadvantages:

• It might prove difficult to provide ease of movement due to the friction caused byparts that are not constructed of this self-lubricating material within the railingsystem.

• The price and availability of a proper self-lubricating material is not yet known.

Magnets & Velcro fixturesCertain units within the clinical area require cleaning from time to time such as thepatient diagnosis bed as well as patient sitting area. Velcro would ensure proper fasteningof the padded covers when in use, while allowing the nursing staff to remove themwith ease as needed. Additionally, the use of magnets to fix units to one another makesremoving of individual units very easy for whatever reason. (Figure M.10).

Advantages:

212


Figure M.10: Magnets and Velcro concept.

• Allows for rigid inter-modular attachment when it is required that units be fixed toone another.

• Removal of modular units requires no tools and minimal physical effort.

Disadvantages:

• It might prove difficult to clean Velcro after a certain amount of time. Dirty Velcrohas a lower adhesive capability.

• The amount of required permanent magnets might be too expensive.

Wall Fixed Parallel RailAs was mentioned as much as possible of the space in the load bay area of the chosenpanel-van must be converted into a clinical area. Therefore a system must be devisedthat allows for modular units to be attached to the wall of the load-bay area. To facilitatethis, a parallel rail system was considered which makes use of rubber wheels. The rubberwheels allow the units to transverse in a direction parallel to the length of the MC. Theunits will be fastened to the rubber wheels by a bolt system (Figure M.11).

Advantages:

213


Figure M.11: Wall fixed parallel rail concept.

• This system allows wall storage units to be modular as well as replaceable orinterchangeable for whatever reason.

• The rubber wheels dampen vibration and thereby protect sensitive equipment.Disadvantages:

Disadvantages:

• It would prove difficult to ensure the structural rigidity of the modular units,especially when the MC is traveling.

• Fastening the railing system to the wall of the load bay area might compromise thestructural integrity of the chosen panel van and should it be strengthened, undueweight may have to be added. Any structural strengthening has the probability ofreducing the availability of space within the load bay area.

Pin and damping floor mount combinationDue to the bumpy nature of the roads on which the MCs will travel some dampeningwould be required in order to ensure that the units within the clinical area do not sufferdamage. Nevertheless, care must be taken to ensure that the units remain modular for easeof assembly and replacement. This concept incorporates pins that allow for attachment

214


of the modular units to the floor. These pins will then be able to slide within rails that runthe length of the clinical area. Although the modular units are fastened to the pins somevertical translation is allowed such that any vibration caused by the corrugated roads isabsorbed by a dampening material placed between the modular unit and a shoulder onthe pin (Figure M.12).

Figure M.12: Pin and damping floor mount combination concept.

Advantages:

• This system ensures that the clinical area remains modular and that units can beremoved individually if required.

• The dampening material inherent in the design absorbs the vibration from roadson which these MCs will have to travel.

Disadvantages:

• Selecting the correct tolerance for the railing system may prove to be difficult. Ifthe tolerance is large enough in order to provide ease of assembly the modular unitsmight shake about the clinical area, rendering the damping material pointless. Ifthe tolerance is small in order to eliminate the aforementioned problem, assemblyis hindered.

215


Transverse-Parallel Rail SystemIn addition to assembling the modules along rails running the length of the cabin, it ispossible to do so in a transverse direction as well. In order to do so, the modules wouldhave to be carried the length of the vehicle, however, and would complicate modification.Therefore, a hybrid parallel-transverse solution was considered (Figure M.13).

Figure M.13: Transverse-parallel rail type system concept.

Advantages:

• This system allows modular units to be removed or assembled individually shouldreplacement or maintenance be done.

• Modules can be adjusted not only in terms of placement along the cabin length,but also depth as well.

Disadvantages:

• The design might inhibit secure fastening of the modular units to the load bay floorarea.

216


M.3. Feasibility and Concept FilteringOnce a pool of concepts were developed, it was necessary to determine which of thesewere valuable and should be carried through as final design candidates. While it is possi-ble to qualitatively assess an idea based on engineering judgement, literature providesformalized methodologies that make this process more effective and efficient. A overviewentitled Analysis and Improvement of Product Modularization Methods: Their Abilityto Deal with Complex Products by Homqvist and Persson[21] explores best practicesin this field, specifically in the context of product modularization. There are six salientmethods considered (Figure M.14), which while being drawn from different disciplinesand applications, all address design feasibility.

Figure M.14: Various design evaluation methodologies explored by Homqvist andPersson[21].

217


The first to be considered is Fractal Product Design (FPD), which develops individualmodules known as fractals and their associated standardized interfaces. Then, thesefractals are evaluated and optimized according to traditional redesign methods such asDesign for X and Failure Mode and Effect Analysis (FMEA); for more on these topics,see Edwards[12] and Stamatis[39].

On the other hand, Modular Product Development (MPD) consists of six defined stepswhich span the entire product design process, beginning with defining the purpose ofthe product and ending with preparing production documents. Modeling the ProductModularity (MPM) takes a different perspective by leveraging matrix representationsof product interactions and their suitability; specifically, the latter aspect addresses thereasoning behind including individual product components in a particular module. In asimilar manner, Modular Function Deployment (MFD) uses a matrix-based evaluation inthe form of the Module Identification Matrix (MIM), implementing many of the sameprinciples of MPM. However, the MIM is preceded by a Quality Functional Deployment(QFD) to determine customer requirements and a Pugh Decision matrix, or equivalent,to evaluate technical merit of a particular design. These are established tools and areexplored by Akao[2], Tomiyama[42], and many others.

Next, Integration Analysis of Product Decompositions (DSM) consists of three stepsculminating in a matrix-based clustering of chunks, representing distinct product modules.These chunks consist of scored elements, the creation of which are supported by priorproduct decomposition and evaluation of interactions. Lastly, Axiomatic Design (AD)may not explicitly represent a modularization method, but it is based on the principleof functional independence, embodied in two key axioms. Specifically, these are theindependence axiom and the information axiom. The former states at a particular designparameter (DP) and functional requirement (FR) should be directly related, meaning theadjustment of one DP should only affect a single FR. As for the latter, a design shouldbe functionally uncoupled and contain as little information as possible to be consideredideal.

Despite the respective advantages and disadvantages of these methods, the authorsemphasized three key steps which are nearly universal in the application:

• The Decomposition Phase: identify functions and physical parts

• The Integration Phase: create independent modules

• The Evaluation Phase: consider aspects of product realization

If these are earnestly applied, modularity can indeed be achieved and a product has ahigh probability of benefiting as a result.

Taking this into consideration, along with the large number of ideas present in literature,of all those considered by the team MFD seemed the most promising as a result of itsrobust approach. To further understand the process involved in MFD, Modular Product

218


Development by Eggen[13]was leveraged, which includes a detailed procedure consistingof seven steps (Figure M.15).

As dictated by MFD and Eggen’s methodology, a Quality Function Deployment (QFD)method was employed. The QFD method allows a designer to improve a product byidentifying the engineering characteristics required to satisfy the customer specifiedattributes. One concise means of applying the QFD method would be to create a QFDinteraction matrix to illustrate the relationships between the specified attributes andengineering characteristics. The House of Quality (HoQ) would be an example of such ainteraction matrix.

Blanchard and Fabrycky[4] describes the QFD method as relating the TechnicalPerformance Measures (TPMs) to the Design Dependant Parameters (DDPs), or putmore colloquially relating the whats to the hows.

The QFD method as described by Cross[7] has been reduced to the following:

1. Identify customer requirements

2. Determine relative importance of attributes

3. Draw a matrix of product attributes against engineering characteristics

4. Identify relevant interactions

5. Set target figures

An excerpt from the HoQ is shown in Figure M.16 The complete table is too large toinclude in the report, but is available for download at http://dl.dropbox.com/u/4362508/HOQ_V1.xlsx. The Needs/Desires analysis (Table 4.1) was used topartially complete the customer attributes and additions made from suggestions duringthe meetings conducted on 06/08 and 06/12 (Appendix F.1 and F.2). The HoQ describesthe relations between the engineering characteristics and customer specified attributesfor the MC redesign as well as the interaction between the engineering requirements anddesign targets.

219

http://dl.dropbox.com/u/4362508/HOQ_V1.xlsx

http://dl.dropbox.com/u/4362508/HOQ_V1.xlsx


Figure M.15: Unified Product Architecture Design Methodology.

220


Figure M.16: Excerpt from the House of Quality that was generated to describe the relationsbetween the engineering characteristics and customer specified attributes forthe MC redesign.

221

N. Clinic Layout, by Charlotte Stemmet, CNP

N. Clinic Layout, by Charlotte Stemmet, CNP

222

N.

Clinic

Layout,byC

harlotteStem

met,C

NP

Figure N.1: Original clinic layout drawing by C. Stemmet, CPN (English translation)

223

Stellenbosch University Pennsylvania State University Private Bag X1 127 Reber Building MATIELAND 7602, WC SA. University Park, PA USA 16802 __________________________________________________________________

Specification for a panel van converted into a mobile clinic.

Base Vehicle: VW Crafter 35. Super high roof Medium Wheel Base (MWB).

Engine: 2 cm3 in line 4 cylinder turbo diesel (80 kW - 300 Nm).

Tare Mass (kg): 1940

Gross Vehicle Mass as per manufacturer (GVM) (kg): 3505 Approach, Break-over and Departure angles respectively: 22.5 , 19.3 , 13.7 .

Load bay (clinical area) dimension (mm): L: 3713 W: 1764 H: 2146

NOTE: Any details of designs not portrayed/provided in this specification sheet will be left to the expertise of the MC building company (MIB) to design.

1. Description of conversion:

The use of a panel van/light commercial vehicle (LCV) typically used to transport small amount of goods will be used to convert into a mobile clinic (MC). The volume used for loading goods will be converted into a clinical area. This vehicle will then be classified/re-registered as a MC. The MC will mostly be used in the Western Cape (WC) of South Africa (SA) but will serve as a platform such that the clinical area can be altered to adhere to requirements throughout the rest of SA. This entails all structures in the clinical area to be of a modular/interchangeable design such that a layout, preferred by the nursing staff working on the MC, can be created. The interchangeable units include all the storage compartments and other structures such as the work tops, patient bed, ablution facilities etc. The modular units are designed such that they can be interchanged/removed individually. Though the manufacturers GVM requires the vehicle to be of a Class C1 license the final Tare Mass of the vehicle (after the conversion has been done) will not be more than 3500 kg. The vehicle can then be re-registered as a Class EB license vehicle. The clinical area should include the following areas/structures:

Patient bed for diagnosis and care. Area for administrative work.

O. Specifications for the Design of a New Mobile Clinic for the Western Cape

O. Specifications for the Design of a New Mobile Clinicfor the Western Cape

224

Storage compartments for medicines as well as medical equipment. Cold storage areas for blood sample and vaccines. Storage compartments for any file based information (paperwork). Ablution facilities which include:

o A toilet area. o Wash basin to ensure hygiene of the nursing staff. o Storage area of all cleansing materials/solution for hygiene. o Fresh water storage. o Waste water storage.

Waste storage area for all disposable equipment that the nursing staff will use. This includes sharps, empty medicines, swabs, bandages etc.

Storage compartments for quick removal and placement of equipment.

Due to the underdeveloped dirt roads on which the MC will travel it is required to ensure that all the units within the clinical area are rigidly built and fastened. Dampening will also be incorporated such that the vibrations caused by dirt roads are not absorbed by the medical equipment. The dampening will be done according to MIB standards. The dirt roads will also kick up dust when the MC is traveling and hence the MC must be dust proof. The use of proper rubber sealants at all entrances and windows are again, as per MIB standards, required. To provide a comfortable working environment, windows will also be inserted where necessary.

2. Clinical Area Layout: (refer to figure 1)

a) The dimensions of the sitting- and standing height modular units and worktops will be manufactured according to anthropometric data as can be viewed in table 1 (Refer to figure 11 as reference).

3. Storage compartment Materials and Specs:

a) All the modular units have an integrated frame permanently fastened to the load bay area and is manufactured from aluminium grade 6063 with 4043 (were required as per MIB standards) filler welding (refer to figure 3).

b) Aluminium extrusions (grade 6063) as depicted in figure 4 will be used to construct the rest of the modular unit as it will fasten to the integrated frame.

c) The worktop surface material must be durable, light weight and of a white colour. Typically PST or HDPE and permanently fastened to the aluminium modular frame. The surface must be gloss free to inhibit glare caused by ambient lighting.

d) Polyurethane shall be used for dampening between the floor and storage area according to MIB standards.

e) Two storage compartments shall be provided for bottled medicines as can be seen in figure 5.

f) Two storage compartments shall be provided for pill packages as can be seen in figure 6.


225

g) Two storage compartments shall be provided for small medical equipment as per figure 7.

h) One larger storage compartment shall be provided for larger medical equipment similar to that of the pill packages storage unit (figure 6).

i) Three different sized drawers shall be manufactured according to MIB standards and must adhere to the required storage compartments mentioned in 3. e.) to h.) above (Refer to figures 5 through 9).

j) A permanent and partitioned slit type storage compartment shall be manufactured according to MIB standards (Refer to figure 1).

4. Floor Material and specs:

a) The floor must be manufactured from a metallic, rust resistant material (as originally build in on the chosen LCV) and lined with a waterproof, easy cleansing PVC material of at least 2 mm thick.

b) It must allow for sufficient grip even when wet such that the nursing staff do not slip and as a result get injured.

c) It must be of a light (preferably light grey) colour to allow for good contrast between the floor and any equipment.

5. Misc. Material and specs:

a) All padded areas (including the patient bed and seating area) shall be manufactured from shock/weight bearing industrial type sponge of at elast 75 mm thick and covered with a blue, waterproof, good quality PVC.

b) Aluminium piping shall provide handles at the entrance of the vehicle to provide ease of entering the mobile clinic according to MIB standards.

c) A head-bump protective pad shall be installed according to MIB standards on the inside of the MC at the top of the main clinical area entrance.

d) Drawer rails shall be outsourced by the MIB and rigidly constructed into the frame design.

e) Any hinges for swinging doors shall be outsourced by the MIB. f) Locks for drawers shall be outsourced by the MIB and of such a quality as

to keep any drawer closed while the vehicle is in transit as well as to ensure ease of opening any drawer at all times i.e. even when dirty.

g) Piping for water shall be done according to MIB specs.

6. Means of Adhesion/Fastening:

The following will be fastened to one another according to MIB standards and by means of Bosch Rexroth products unless otherwise required by the MIB or stated hereunder.

a) The patient bed to the aluminium frame underneath as per MIB standards. b) The 3rd seat (figure 1; as design according to MIB standards) to the

adjacent aluminium frame. c) The modular aluminium frame extrusions to one another. d) The modular work tops to the aluminium frame underneath.


226

e) The integrated frame to the modular. f) To adjoin the integrated frame to the MC floor dampening will be used.

7. Power Supply equipment and specs:

a) The MC will have one source of power namely the standard vehicle battery.

b) The battery will be as per the battery or similar. c) 12V (similar to that of a vehicle cigarette lighter port) as well as 220V

power points will be incorporated (according to MIB standards) within the clinical area as depicted in figure 1.

d) There will be a minimal of 3 power points of the above mentioned in the clinical area.

e) The power points will be 300mm above the worktop surfaces. f) Wiring will be done according to MIB specs and safety standards. g) A battery level sensor will be provided according to MIB standards to alert

the MC staff if the vehicle battery is nearing power depletion. h) When more power is required if for instance the battery power is nearly

depleted, the engine will be required to idle and hence the vehicle alternator will recharge the batteries.

8. Medical equipment:

(a) Refer to table 2 for the preliminary list of medical equipment required by the nurses on board the MC.

9. Auxiliary equipment and specs:

a) A stainless steel wash basin as typically used by the MIB will be provided. b) A fresh water container of no less than 25 litres shall be placed in the

clinical area and as close as possible to the wash basin (preferably underneath).

c) A waste water container, also of no less than 25 liters, shall be placed near the fresh water container.

d) A flushable chemical toilet (similar to camping toilets) shall provide toilet facilities for the nursing staff. The waste reservoir of which will be no less than 15 litres and removable.

e) Adequate storage space shall be provided for hand wash solution and drying towels.

f) A drying towel reel shall be fitted to the modular worktop of the wash basin. If the aforementioned is not required drying towels should be available close to the wash basin

g) Either a 12 V DC submersible pump or foot pump shall provide the flowing power for the wash basin (as preferred by the MIB). If a submersible pump is used one extra submersible pump shall also be available within the hand wash storage space should the first one fail.

h) The clinical area will have a patient bed of no less than 1560 mm long and 600 mm wide.


227

i) Two coolers will be on board the MC of which both are temperature adjustable. The coolers must be able to be powered by 12V DC or 220 V AC. Each cooler must have a cooling volume of no less than 7 litres. Both coolers will be placed in one storage volume that has cushioning so as to absorb vibrations.

j) A partitioned patient bed, that would allow the head, feat or both of the patients to be positioned at an incline, shall be built as per MIB standards (figure 10).

10. Safety equipment:

a) The mobile clinic shall have two standard ASBS approved fire extinguishers on board at all times subject to regular maintenance.

b) One fire extinguisher shall be in the cabin area in an easy reachable location.

c) The second fire extinguisher shall be in the clinical area and no less than 700 mm from the main/side entrance.

d) A standard mobile medi-kit shall be available in the clinical area that will house provisions for emergency medical treatment not found in the remaining clinical area.

11. Lighting: (As per MIB standards)

a) The clinical area shall contain light emitting diode (LED) lights of the following type:

i. 12V DC LED lighting that will provide ambient luminescence (of SABS standards) for the entire clinical area. Hidden and of a longitudinal type.

ii. 12V DC LED spotlights that is position adjustable for patient diagnosis and administrative work.

12. Doors:

a) The side door shall be used as the main entrance and exit point for the patients and nursing staff alike and shall be no less than 1000 mm wide when open and as high as possible:

b) A rear door must be available and be no less than 1500 wide and as high as possible. The rear door shall provide access to maintain the generator, fresh water supply, ablution facilities etc.

c) A walkthrough shall be provided that allows access from the vehicles cab to the clinical area that will be at least 1600 mm high and 500 mm wide. This is an optional extra for the chosen vehicle.

d) All of the doors must be lined with UV resistant dust proof rubber so as to ensure a hygienic clinical environment.

e) A partition in the form of a curtain, outsourced by the MIB, that can divide the clinical area into two areas as depicted in figure 1 will be included.


228

13. Windows:

a) Windows as is optionally extra from the vehicle manufacturer shall provide natural lighting for the clinical area.

b) All windows shall be lined with UV resistant dust proof rubber so as to ensure a hygienic clinical environment.

14. Seating:

a) The cabin seats shall be as provided by the chosen vehicle for conversion. b) The third seat shall be of similar dimensions to that of the chosen vehicle

and with a roadworthy seatbelt. The standards of which must adhere to that of the MIB.

c) The patient bed shall provide patient seating.

15. Optional Extras:

The following are options that can be bought with the chosen vehicle.

a) Mandatory options (will be included in the MC as described in this here Specification Sheet):

i. Super High Roof. ii. Cab to clinic partition (includes sliding door). iii. A/C for the load bay/passenger area. iv. ABS (if not standard on the selected vehicle). v. Windows as for a passenger defined LCV.

b) Other options (can be included as per user preference and within budget limits).

i. Intermediate latch for sliding door/main clinical entrance. ii. Traction control system (TCS). iii. Electronic Differential Lock (EDL). iv. Aluminium grid floor with wheelchair ramp.

16. MC budget

The entire cost of the MC as discussed in this specification sheet is divided into the following sections (refer to table 2):

a) Vehicle including the options as discussed in 15 above. b) Auxiliary equipment. c) Medical equipment (as given in table 3). d) Modular units (as given in table 4). e) Vehicle preparation (as per table 5). f) Systems installation (as per table 6)

The grand total being R 675 136. NOTE: This grand total is subject to change as the specification of a MC changes in the future.


229

Reference figures.

3265

1750

100

250

Desk Desk

JIT Storage JIT Storage

Seated Worktop

Standing worktop:

Documentation Storage

Chemical Toilet

Standing worktop: Wash

basin and misc. waste

unit

Patient Bed

3rd s

eat

Patient Bed Patient Bed

MC Entrance

1300

220V/12V power supply port.

220V/12V power supply port.

220V/12V power supply

port.

Wall slit storage.

Wall slit storage.

500

Acc

ess

from

cab

to

clin

ic

Cur

tain

Figure 1: Clinical layout.

Figure 2: Aluminium frame design.


230

Figure 3: Integrated frame aluminium extrusion. As per Bosch Rexroth products unless otherwise required by the MIB.

Figure 4: Modular frame aluminium extrusion. As per Bosch Rexroth products unless otherwise required by the MIB.


231

Figure 5: Storage for bottled medicine. Half-‐size drawer.

Figure 6: Storage for pill packages and larger medical equipment. Half-‐size drawer.


232

Figure 7: Storage for small medical equipment. Quarter-‐size drawer.

Figure 8: Coolers for blood and vaccines. Full-‐size drawer.


233

Figure 9: Documentation storage: Full-‐size drawer.

Figure 10: Patient bed with head piece in inclined position.


234

Figure 11: Anthropometric reference (images from http://mreed.umtri.umich.edu/

mreed/downloads/anthro/ansur/Gordon_1989.pdf).

Reference data.

Table 1: Worktop dimensions as per anthropometrics.

Worktop dimension Reference Length (mm) Standing worktop height. #107 figure 10 882

Sitting worktop height. #48 figure 10 209

Worktop depth. #131 figure 10 616

Worktop width. As per figure 1. 520

Table 2: Final cost of MC.

Cost source

Vehicle + various options

Aux equipment

Medical equipment

Modular units

Vehicle preparation

Systems installation

Grand total

Cost total R 350 693 R 99 338 R 57 837 R 122 248 R 16 580 R 28 440 R 675 136


235

Table 3: Preliminary list of medical equipment to be included in the new MC.

Name Quantity Product Supplier Cost Sub-total

Blood pressure meter 1.

Portable Desk Baumanometer Model Non Latex Adult Calibrated V-lok - Model 0320NL Baumanometer R 4 685.00 R 4 685.00

Blood pressure meter 1.

Cuff And Inflation Bag Adult, Calibrated Baumanometer V-lok - Model 1880 Baumanometer R 1 200.00 R 1 200.00

Stethoscope 1. Littmann 2201 Classic II S.E. Stethoscope, Black, 28 inch 3M RSA R 1 724.00 R 1 724.00

Thermometer 1. Suretemp Plus 690 Electronic Thermometer Welch Allyn R 3 667.00 R 3 667.00

Thermometer 1. ADTEMP V Fast Read Digital Thermometer ADC R 326.00 R 326.00

Ear-nose-throat set 2.

Welch Allyn Otoscope/opthalomscope Diagnostic Set MOD 95001 Welch Allyn R 3 654.00 R 7 308.00

Hemoglobino Meter 1.

STAT-SITE M Hemoglobin Meter, STANBIO STANBIO R 2 693.00 R 2 693.00

Hemoglucose meter 1.

Diabetes Monitoring Care Kit, CompactPlus ACCU-CHEK R 692.00 R 692.00

Laryngoscope 1. Portable Standard Laryngoscope Set with "C" Handle for Adults, Welch Allyn Welch Allyn R 4 516.00 R 4 516.00

Doppler fetal monitor 1. Ultrasound Pocket Doppler 2 MHz Probe Grafco R 4 429.00 R 4 429.00

Fetoscope 1. Riester Pinard Fetal (Embryo) Stethoscope in Lightweight Aluminum Riester Pinard R 622.00 R 622.00

Peak Expiratory 1. asmaPLAN+ Peak Flow Meter asmaPLAN+ R 432.00 R 432.00 Flow Rate Meter Scale 1. Medway 3 in 1 with height rod Masskot Scale

R 2 700.00 (excl. VAT)

R 3 819.00 (incl. VAT)

Vaginal Speculums 2.

Small - Stainless Steel Graves Vaginal Speculum Graham-Field R 281.00 R 562.00


Medium - Stainless Steel Graves Vaginal Speculum Graham-Field R 404.00 R 3 232.00


Large - Stainless Steel Graves Vaginal Speculum Graham-Field R 338.00 R 1 352.00

Ambu Bags 1. Adult - Ambu spur II Disposable Resuscitator Ambu Spur R 1 302.00 R 1 302.00

Ambu Bags 1. Child - Ambu spur II Disposable Resuscitator Ambu Spur R 1 324.00 R 1 324.00

Tuning Fork 1. ADC Aluminum Alloy Tuning Fork , 512 CPS ADC R 298.00 R 298.00

Patella Hammer 1. Prestige Taylor Percussion Hammer with Stealth Gray Head ADC R 305.00 R 305.00

Bandages Scissors 1. ADC 320V Medicut Shears, Purple ADC R 302.00 R 302.00 Simple Scissors 1. ADC 323N Listerette Scissor 5 1/5, Navy ADC R 240.00 R 240.00

Blunt Point Forceps 1. Kelly Forceps, Straight, 5" ADC R 269.00 R 269.00

Emesis Basin 2. Emesis Basin, Large, 10" x 4 " x 2 1/8". Capacity: 26 oz. Graham Field R 886.00 R 1 772.00

Snellen Card 1.

Grafco Snellen Plastic Eye Chart, Non-Reflective Matte, Green and Red Color Bar Graham-Field R 476.00 R 476.00

Monofilament 1. 10 gram Model # 12-1391 Baseline R 1 143.00 R 1 143.00 Trauma kit 1 Standard Trauma First Aid Kit Medique R 8 454.00 R 8 454.00

Nurse diagnostics kit 1

American Diagnostic Corporation 116-647BKQ Nurse Combo-One, Black, Adult ADC R 693.00 R 693.00

Total: R 57 837.00


236

Table 2: Cost for modular frames (M = Material cost, L = Labour cost)

Frame: Welded back end M R 3 100 L R 6 900

Frame: modular front end M R 16 248 L R 3 000

Frame: cladding M R 8 210 L R 9 200

Storage M R 3 870 L R 11 500

Storage: heavy duty M R 2 570 L R 6 500

Storage: equipment integration M R 9 500 L R 11 900

Worktop: desk with storage M R 1 710 L R 1 380

Worktop: standing M R 17 200 L R 1 150

Worktop: standing, sink M R 210 L R 1 840

Worktop: standing, documentation rack M R 5 800 L R 460

R 122 248

Table 3: Cost for vehicle preparation (M = Material cost, L = Labour cost).

Interior cladding M R 7 820 L R 4 140

Frame mounting preperation

M R 2 500 L R 2 120

R 16 580

Table 4: Cost for systems installation (M = Material cost, L = Labour cost).

Module installation

M R 220 L R 920

Plumbing and wiring: Fluid ports

M R 3 100 L R 6 900

Plumbing and wiring: Charging system

M R 17 300

L -

R 28 440


237