Pierre Moreau, clinical coordinator of the project, presents the evolutions and perspectives of the 3D program developed by The MSF Foundation in Jordan and Haiti.
After Reuters a month ago, it was the turn of the AFP to meet our teams in Gaza a few days ago. The journalists from the press agency were able to visit the hospital, meet patients from the 3D program and discover the technological innovations implemented by the Foundation thanks to the support of our partner Rodin4D. This AFP report was picked up by many media, with a story on TV5MONDE but also in La Marseillaise, L'Est Républicain or L'Orient-Le Jour.
As the project continues to develop in the field, the international news agency Reuters visited the MSF teams in Gaza. This was a good opportunity to present the progress of the 3D activities on site and to highlight once again the exceptional work of the physiotherapists and physiotherapists of Médecins Sans Frontières (MSF) France, who are making it possible for this project to continue. The telemedicine support provided by our team continues to play a key role in the development of this innovative practice.
Discover the 5 steps in the manufacture of a compression mask, from diagnosis to patient follow-up. This process is made possible by telemedicine and access to 3D technology.
Watch the presentation video of the 3D program in Gaza, with the interview of Abed El Hamid Qaradaya, MSF Physiotherapy Activity Manager in Gaza.
In Gaza, after sending the necessary equipment on site, and training field teams in the use of 3D technology, the project has now been operational for three months, and makes it possible to cope with an exceptional influx of patients. 10 of them are now equipped and followed by MSF staff, and 5 new patients will be in the coming weeks.
A terrible accidental explosion took place in early March in Gaza, killing many and injuring around 60, including around 30 burned in the face.
It is in this context that Rodin4D, a partner of the Foundation for its 3D program, agreed to provide a free 3D scanner, the M4D Scan, and a latest generation computer to intervene with patients as quickly as possible. After several weeks of transit, made difficult by restrictions linked to the Covid-19 pandemic, the equipment arrived in Gaza and the teams there were able to be trained remotely in the use of the scanner.
Tests are underway for the 3D printing of the molds used in the manufacture of the masks, which may benefit our patients in the coming weeks.
To combat Coronavirus, the 3D program in Amman in Jordan has set up remote monitoring of patients, sending them videos of exercises to be performed via a Whatsapp group. Individual sessions are also set up via Skype for people who have specific needs. We have also been able to continue to print compression masks for facial burns patients, despite the temporary closure of our usual partner, by developing a new partnership with the Tecklab in Amman.
At Drouillard Hospital in Haiti, the MSF Foundation uses 3D technology to make compression masks for patients with severe facial burns. Élise Tauveron, our physiotherapist, explains to you the benefits provided to patients by this innovation.
Élise is a physiotherapist assigned to the MSF Foundation’s 3D program.
Up to the 20th of January 2020, she conducted a mission of one and a half months in Port-au-Prince (Haiti) to train the physiotherapy team in the use of 3D technology to make equipment for patients with facial burns.
Samar, our 3D supervisor in Amman (Jordan), gives a review of our patients: in addition to those already in the care pathway, 24 others are on the waiting list.
We are therefore currently expanding the structure to meet an ever-growing need.
See Noor, aged 7, at Amman Hospital (Jordan) trying on for the first time his facial compression mask manufactured using 3D technology.
We followed Hanan, aged 4, equipped with a 3D printed prosthetic.
At the end of January, the project team went to the “Arab Health Exhibition and Congress” in Dubai and then a few days later to the "Rodin4D Users Days" in Bordeaux attended by international prosthetics specialists.
Participation in conferences and our public speaking in general facilitate sharing of experience.
The Economist reports on our 3D prosthetics printing project in Amman (Jordan)
A solution to equip a larger number of patients with prosthetics
Since 2016, the Fondation Médecins Sans Frontières has been betting on 3D technology to try to overcome the problem of access to prostheses in our intervention contexts. This is a major challenge for amputees to regain their physical integrity and autonomy. The project team in Amman, Jordan, has proven since June 2017 that 3D printing of prostheses is a tool adapted to the field, more personalized and adapted to the needs of patients and less expensive than the traditional method of manufacturing prostheses.
The project has also expanded to design facial compression masks for burn patients, in Amman since 2018 but also in Haiti in 2019 and in 2020 in Gaza, also using 3D technology. Facial burns can lead, months after the accident, to very serious after-effects if they are not treated with compressive masks and a thorough follow-up of the patient. The method of making these masks assisted by 3D technology is less painful, more comfortable for the patient than the traditional technique and allows for expert-assisted treatment at a distance, thus increasing access.
These two facets of the project are possible thanks to the use of scanners that allow the digitization of data that can be sent to experts in specialized centers so that they can share their knowledge and know-how. This digitization makes it possible to overcome the main barrier to access to care: the involvement of personnel trained in these very specific tasks. Tele-expertise is therefore taking a leading role in the Foundation's 3D projects.
The six key steps in the design of 3D prosthetics:
° 1 An individualised clinical assessment is made is made to determine the patient’s needs and expectations.
° 2 The scanner is used to make a 3D image of the surface of the stump.
° 3 Modelling software is used to design the socket* and the prosthetic.
° 4 3D printing is carried out by superimposing layers of plastic or other material.
° 5 Tests are carried out to check the fitting of the prosthetic and make any modifications required.
° 6 A follow-up and evaluation of the effectiveness of the prosthesis and its benefits is carried out for several months.
* Socket: interface between the patient’s stump and the prosthetic.
The six key steps in the design of facial compression masks:
° 1 An individualized clinical assessment is performed to determine the patient's needs and expectations.
° 2 The scanner is used to make a 3D image of the patient's face.
° 3 The digitized file is sent to a center specialized in the treatment of burns in France at the Léon Bérard Hospital in Hyères or to our teams to be reworked and thus shape the mold of the compression mask.
° 4 The file is sent back to the field. The mold is printed in a center equipped with a 3D printer to cast a plaster on which the glycolized polyester sheet (PETG) will be applied, which will constitute the final mask.
5 Tests are performed to verify the fit of the orthosis and make modifications.
6 Follow-up and evaluation of the mask's effectiveness and the patient's progress are then performed over several months.
// Pierre Moreau
Pierre studied physiotherapy and has a Master of rehabilitation engineering. He has worked for MSF since 2015. After a first mission in Ukraine and a second in Haiti, he joined the 3D-printed prosthetics project in November 2016. He arrived in Amman in February 2017.
// Safa Herfat
Holding a Ph.D. in biomedical engineering, Safa is an Assistant Professor in the department of Orthopaedic Surgery at University of California. He works in the program of reconstructive surgery in Amman in Jordan and he is the technical coordinator of the 3D prosthetics project.
// Samar Ismail
Supervisor of the 3D project in Amman
To guarantee the continuity and development of the project in Jordan, a 3D supervisor position has been created in Amman. Samar Ismail, a physiotherapist, is now in charge of implementing this project and ensuring its sustainability. She organises the work of the team in collaboration with the patients.
// Elise Tauveron
// Hatim Mas’adeh
P&O Clinician Consultant
// Esra’a Alkhatib
// Rawan Ar’ar
// Zuheir Hijazi
It was therefore quite natural for the manufacturing of face masks for facial burns victims to be launched there.
In addition to 3D-printed upper limb prosthetics, the Foundation uses the same technology to launch the manufacturing of compression masks for facial burns victims.
Why 3D-printed masks? The conventional mask-making method consists in applying strips of plaster on the patient’s face. This step, which is cumbersome, uncomfortable and sometimes traumatising for the patient, is thus avoided thanks to 3D scanning and rapid printing of the transparent mask.
Ten children and seven adults thus regained mobility and therefore an improved social life.
In close collaboration with patients, it endeavours in particular to compare “conventional” sockets and sockets which it prints in 3D at the Irbid FabLab.
In our project, the operator first makes a “3D scan” of the patient’s morphology which is subsequently processed on computer, and then the prosthetic or the face mask is printed in 3D to fit the patient optimally.
A passive prosthesis is a fixed prosthesis adapted to unilateral patients, who still have a functional hand that they can use to carry out all or most of the activities of daily living.