Aid workers put their lives on the line to treat patients with Ebola. Can robots help make their jobs a little easier and allow more people to survive the disease? Bill Smart, professor of robotics at Oregon State University, is exploring how robots may be most useful during disease outbreaks.
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OWEN PERRY: Remember the Ebola scare that dominated the news just a few years ago?
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UNIDENTIFIED REPORTER #2: "totally out of control."
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WILL LYMAN: A catastrophe is unfolding - the world's deadliest outbreak of Ebola.
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KELLY COBIELLA: Highly infectious, quick to kill, with no vaccine and no cure.
PERRY: It was terrifying. It devastated countries like Guinea, Liberia, and Sierra Leone. The 2014 epidemic was the most widespread in history, with 28,000 cases and at least 11,000 deaths.
And during that outbreak, for the first time, there were cases of Ebola in Europe and North America, mainly aid workers who were infected by the disease while working with patients in Africa.
It may not be in the news as much now, but Ebola is still out there. Even as we record this, there’s an outbreak in the Democratic Republic of Congo. Though, aid organizations are applying lessons they’ve learned to help make sure this outbreak and future ones aren’t as bad.
Here at Oregon State, one researcher thinks he can help...with robots.
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NARRATOR: From the College of Engineering at Oregon State University, this is “Engineering Out Loud.”
PERRY: I’m your host, Owen Perry. This season on “Engineering Out Loud” we’re sharing stories of how our researchers are helping us stay healthy and safe, from here in Oregon to halfway around the world in West Africa.
BILL SMART: My name is Bill Smart, I’m on the faculty here at OSU in the robotics program in the College of Engineering. Most of what I spend my time doing is looking at how robots and people work together, collaborate together on tasks.
PERRY: One of those tasks is how robots might be used during an outbreak to treat patients with the Ebola.
Bill has partnered with Medecins Sans Frontieres. That’s Doctors Without Borders for those of you who don’t speak French. For this story, you’ll mostly just hear them referred to as MSF. They are an aid organization that brings medical humanitarian assistance to victims of conflict, natural disaster, or, in this case, disease epidemics.
The group has been on the frontline combating almost every reported Ebola outbreak. They set up isolation units and provide care to the infected, raise community awareness about the disease, conduct safe burials, and support existing health structures.
They’re always on the lookout for new approaches to contain and treat the disease. Bill reached out the them to see if robots might be useful.
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SMART: If you have Ebola, I can be completely safe from catching it if I'm three feet away from you. To catch Ebola from someone, I have to get some of their infected bodily fluids — blood or something — inside my body and that's relatively hard to do under most conditions.
PERRY: But for those working directly with patients, that risk of infection rises significantly. They must wear protective gear, including full body plastic coveralls, several layers of gloves, face protection, and goggles.
SMART: Typically Ebola thrives in places that are very hot and very humid, maybe 100 degrees of heat on 100 percent humidity. It takes about an hour to put the gear on. It takes about an hour to take the gear off. And in those conditions you get about 40, maybe 50 minutes of useful work and then you heat stroke.
PERRY: There is no cure for Ebola, but, despite its high mortality rates, people do survive it.
SMART: It's like the flu you just keep people hydrated, you make sure they eat, they make sure they take care of their personal needs and they, they kind of ride it out, and if you give them supportive care, then Ebola is survivable, and the less care you give less of the supportive care you give, the greater your chances of dying from the disease.
PERRY: So those 40 to 50 minutes workers spend with patients are precious.
SMART: One of the problems in the last big outbreak is that the healthcare workers just didn't have enough time to work with the patients to do all the things they needed to do to keep them alive in the long-term.
PERRY: In a traditional hospital model, you have doctors, nurses, housekeeping staff, and catering staff – all types of people in very specialized positions. But Ebola outbreaks tend to happen in remote villages without hospitals. A single health care worker’s job can include treating and feeding patients, checking vitals, taking samples, mopping up vomit or other fluids, just to name a few tasks. And they do it all while wrapped in plastic in sweltering heat.
This is where Bill thinks robots may have a role to play. But maybe not in the way you’re thinking.
SMART: When you think about robots in these, these healthcare situations, you think about maybe the da Vinci surgical robot and these very high tech interventions to these very high tech things, but we're really looking at is much simpler applications of robots not to do the medical care, but to free up people to do the medical care.
One of our thoughts was we could take robots, we can take automation, we could apply automated planning, artificial intelligence, all these techniques and see if we could make the healthcare workers jobs a little bit more efficient or a little bit easier. Can you take a robot and do some of the simpler stuff?
PERRY: Imagine a robotic table that can move about the tent delivering food and medication to patients or equipment to workers.
SMART: You assemble it, and you put it in the corner, and you give it a map of the tent, and then when it comes time, when it's lunchtime, you come in, and maybe you hit a big red button on top of the table and it goes to each of the beds in turn.
If I can take away 10 minutes of fetching and carrying, then you can spend those 10 minutes with a patient and then you can make the patient outcomes better.
PERRY: Another idea is a floor scrubbing robot -- something like a Roomba -- that rushes over to clean spilled blood. Or one with more advanced programming that actually keeps track of people’s movements and identifies when they might be unknowingly spreading contamination around the room.
SMART: So a lot of what we've been focused on is really identifying working with people from MSF who've been in the field and dealt with Ebola and trying to understand what they do, what their pressures are on, where they think they could use some help because one of the things we're really sensitive to is coming up with a solution and saying this is the way we should do it, giving it to them, and they just don't use it because it's nonsense.
PERRY: And where you’re dealing with Ebola, there’s no room for nonsense.
SMART: Where Ebola breaks out, it's very under resourced. There's not a lot of infrastructure in place. There isn't often reliable electricity. There isn't reliable satellite internet, there's none of the stuff we take for granted in more resourced environments like the US.
MSF/Doctors Without Borders has a lot of engineers on staff, but they are engineers for water and sanitation, for building construction, for logistics. They don't have any roboticists because they don't use robots. And so you have to make whatever technology you ship with them, really, really robust. Right? You have to take it out of the box, turn it on, and it has to work. And so making it simple really helps with that.
PERRY: But being simple is not enough. These robots also need to be tough enough to survive the heat and humidity as well as being dipped into a 50-gallon drum of disinfectant. Or they have to be built cheap enough that you don’t mind incinerating them when you’re done.
SMART: As an engineer, that's a really interesting set of constraints to work in because you know, when we use robots in the lab, if it doesn't do its job, if it breaks, if you need to go and do something with it to get out of a corner, it's not that big of a deal. But really in the field when you're talking about these literally life or death situations, then it really changes the equation, really changes the balance of what you want to try.
Anything that we do with them can't have any potential for reducing the quality of care. At the very worst it has to not impact them.
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PERRY: That’s right, even robots have to follow the Hippocratic oath, do no harm.
Having robots work near people raises another question. How will robots be received in communities that aren’t used to advanced technology.
Even without robots, people in these small villages are suspicious of healthcare workers. MSF has found that people avoid care because of rumors that the workers are killing people not helping them.
That's why it is critical to understand the local culture. To do this, MSF relies on ethnographers who can help identify and minimize the friction between the locals and these strange looking foreigners.
SMART: They integrate as well as they can, but there's still these people dressed like space aliens come in and a lot of our people die. And I think robots make that worse because now the people dress like space aliens are bringing robots. Your family member goes into a tent with a robot and they die.
PERRY: Bill is looking at ways to introduce these new technologies to help gain the trust of the local people.
SMART: Maybe you buy some radio controlled cars and you take them to the village and you give them to the kids and then the kids drive the cars around it because kids love radio controlled cars. And then you can have a conversation with the grownups of that's sort of on the lines of, well, we have robots in that clinic, but they're just like radio controlled cars, right? And you can start to build a relationship and you can start to explain what's going on with this technology they've never seen before in terms that they can really get their head around.
PERRY: Approaches like that may be helpful gaining acceptance in a community, but for an individual patient, a robot may still be pretty scary.
SMART: If you've never seen any technology before, and then all of a sudden this robot is coming over and forcing a drink in your face, that's going to be terrifying. And so that will make your health outcomes worse, and if rumors of that get out, fewer people might come in and the outbreak might not be treated as effectively.
PERRY: But Bill has a plan to address that too.
In his lab here in Corvallis, Bill is trying to understand how people might react to robots in these outbreak scenarios. He sets up simulations, complete with plastic tents, cots, and, of course, robots.
SMART: We bring people in and we briefed them about the, the context, sort of like, pretend you're in this Ebola treatment unit, pretend you're feeling sick, and you get them to maybe lie on one of these cots. And we have robots do things around them. And then we measure their physiological responses. We measure their heart rate, how much they're sweating other signs basically to show how calm they are, how agitated they're being around the robot.
PERRY: One thing they’ve found is that people tend to be more relaxed when they can see a person is controlling the robot.
SMART: So, that's kind of important because then when you're building these systems and you're putting them in treatment units in the field, then you want to make sure that there's a window in that treatment unit that's looking through onto the operator of the robot because that'll make people feel calmer and over the long term that that'll improve their medical outcomes.
If we could do just a little bit better we could save a significant number of lives.
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SMART: For a roboticist, it's a really interesting project because a lot of it really isn't about the technology of the robots. It's about that larger question of how these robots fit into an existing set of social structures.
PERRY: For Bill, big questions about robots’ place in society are nothing new. And he’s in good company here at Oregon State, where questions like this gave rise to the Collaborative Robotics and Intelligent Systems Institute – or CoRIS – where faculty study the theory, design, development, and deployment of robots and intelligent systems, both in the physical and virtual world.
SMART: When we were putting CoRIS together, we really wanted to focus not just on the technology involved but also on how that technology fits in society.
The idea there is we wanted to make the academics, the research and policy, which is sort of shorthand for how things fit in society, equal because no one of them can exist without the other two. And I think we're one of the few places in the country that that's thinking about this in the strong terms. So all, I think all of the faculty and robotics are really interested not just in building the robot but in understanding how it fits into these bigger structures. And that makes us kind of unusual, I think.
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PERRY: Bill calls it unusual. I call it something special, and I find it reassuring that there are people thinking about these things in a holistic way.
Thanks for listening. This episode was produced and hosted by me, Owen Perry. Audio editing was by Molly Aton. Our intro music is “The Ether Bunny” by Eyes Closed Audio. You can find them on SoundCloud and we used their song with permission of a Creative Commons attribution license. Other music and sound effects in this episode were also used with appropriate licenses.
For more episodes and bonus content, visit engineeringoutloud.oregonstate.edu. Also, search for “Engineering Out Loud” on your favorite podcast app, and do us a solid, please subscribe.
SMART: What else do I want to say? It's all about talking and sending emails to people. That's what it's about. That's engineering…being good with Gmail.
