by Montita Sowapark, MA Medical Anthropology
Once upon a time the term “hacking” might have conjured images of hoodie-sporting software savants operating out of a hidden back room conducting dubious-if-not-outright-illegal online activities. Nowadays, hacking is more likely to be associated with commercial hackathons and the sleek venues, corporate sponsorships, and high production value characteristic of these events. Originally conceived as competitions for computer programmers, hackathons are now held for a variety of product types and interest areas. Participants sign up for 1- to 3- day events during which they collaborate in small teams to make as much progress on an idea as possible, and at the end of the event present their results for judging. Take any technological, scientific, or social issue that occupies enough of the public imaginary, and there is likely a hackathon for that specific issue, from fintech to sustainability to breast pumps. While hackathons retain a connotation of novelty and ‘disruption’ for some, they have also become rather quotidian.
The same could be said of hacker culture’s more materially-grounded sibling, maker ‘culture,’ which combines the self-reliant spirit of D.I.Y culture with the tools of desktop 3D printing, laser cutting, and other fabrication methods. I use ‘culture’ lightly because there is no one cohesive maker identity or maker culture, and while many companies that cater to makers promote a certain MacGyverish subjectivity and sense of community, people of all dispositions tinker with things at home to fulfill practical and aesthetic goals. In response to the widespread shortages of various medical supplies due to the COVID-19 pandemic, makers, crafters, and DIYers have organized platforms to develop, share, produce, and distribute supplies to hospitals and others in need. The largest forum of such initiatives, the Open Source COVID 19 Medical Supplies group on Facebook, estimates that over 5 million units of medical supplies, particularly face shields and cloth masks, have been produced by associated makers since the start of the pandemic. For some, this represents a futuristic vision of cyberpunk post-human assemblages, in which medical devices can be made at-home, circumventing profit gauging corporations and cumbersome insurance bureaucracies. For others, these responses are more illustrative of neoliberal dystopia in which civilians put bandages on bones broken by government ineptitude and corruption.
It is hard to argue against well-meaning people dedicating time, labor, and, often, material costs out of their own pocket, to make supplies that are in great need. However, as much as the openness and fluidity of open-source initiatives allows for rapid iteration of ideas, they also entail uneven levels of device testing and variable production conditions. Face shields might seem like a straightforward and non-risky device to produce, but a too flimsy or too shallow design renders them useless. Luckily, critiques of poor designs and debunking of spurious claims are likely to come from other makers and DIYers themselves. While they have received celebratory media exposure, 3D printed masks seem to be at the intersection of a lot of hype with little follow-through. The first canary in the coal mine I saw to completely rebuke 3D-printed face masks was Naomi Wu, self-described as “China’s #1 Tech and DIY Youtuber.” Wu has a large following in the DIY and maker community and is known for her tech review and creative project videos. Wu has pointed out that 3D-printed face masks are unlikely to maintain a tight seal around the face and thus would work at-best like a cough shield. Even if one could form a tight seal, there is the subsequent risk of CO2 buildup because a much smaller surface area of 3D printed masks are permeable to airflow compared to N95 masks. One of the most well-known open-source face mask models, the Montana mask, developed by a physician and dentist in Billings, Montana, “recommend[s] using surgical masks or N95 masks, and cut into 2½ inch squares” as filter material, which, assuming anybody has spare surgical masks or N95s lying around, is a big gamble to take with potentially little to no payoff. Beyond issues of material sourcing and fabrication methods, the questions of what can be made and what should be made are embedded in a landscape of perceived risks and rewards. The inherently politicized and value-laden choices involved in answering these questions are being made increasingly visible.
With every turn of the clock in the time of corona, we confront the fact that the certainties we lived with yesterday have become ghosts, while new, unpredicted challenges have taken their place. Despite the warnings from the CDC in mid-March that the U.S. would run out of ventilators and have to resort to rationing, these predictions have not transpired. This could be due to a looping effect – the prediction of shortages sounded the right alarms that ended up preventing ventilator shortages. In contrast, there may be a real shortage in the U.S. for ICU dialysis machines as more and more COVID-19 patients develop acute kidney injury during the course of illness, with reports of rationing dialysis care already taking place in immigrant and working-class communities in New York. Still, many highly visible and well-resourced groups are working on designing low-cost open-source ventilators, presumably for use in resource-poor healthcare settings. One such project at MIT, for example, explains their rationale by speaking of greater needs “in the emerging markets.” This status quo – conventional operational standards for countries in the Global North and unfortunate-but-inevitable crisis standards of care in the Global South – flies in the face of ideals of health equity and healthcare as a human right, but is treated as a fact of life. Furthermore, a recent review of open-source ventilator projects concluded that they were “either at the very early stages of design (sometimes without even a prototype) and were essentially only basically tested (if at all)” (Pearce 2020). A skeptic might regard this as the normal course for 90% of similar open-source low-cost medical device projects. Why is it that they continue to inspire such adulation.
No aspect of the medical device design process is immune from questions of potential patient/customer pool and profit margins, and the altruistic low-cost open-source projects are enacted with a place of perpetual crisis in mind. Moreover, perpetual crisis is often assumed to be somewhere else, over there, a not-yet-developed, emerging place, rather in our own backyard. One the one hand, it is dishonest to deny the material difference between countries that have thousands of ventilators and countries that have four. But it is also dishonest to promote and fundraise, again and again, for unfeasible projects under the guise of concern and with the assumption that such places will gladly accept whatever half-baked contraption is thrown their way. The other side of this exceptionalism presumes that “medical rationing is not something Americans are accustomed to” which is untenable; patients are denied potentially beneficial care all the time, especially those who are uninsured or underinsured. However, moral indignation at the idea of rationing medical care in the United States emerges when rationing becomes a perceived possibility for those normally shielded from the reality of U.S. healthcare inequity.
Gui Cavalcanti co-created the Open Source COVID 19 Medical Supplies Facebook group initially to crowd source designs for an open-source ventilator. Once it became clear this wasn’t a viable project, he has changed gears to focus on other supply shortages. In an article titled “The Futuristic Solution the Internet is Crowdsourcing to Cure Coronavirus” Gui characterizes his approach as “trying to get the literal apocalyptic backstop in place.” Futuristic crowdsourced cures are a long cry from apocalyptic backstops. Most makers are aware that DIY medical supplies are not going to save the world, and PPE shortages are but one issue in the panoply of obstacles to address. Making vetted supplies for well-defined needs is a way to keep busy or to contribute to one’s community, but investing too much in the potential for “hacking” the pandemic, or for that matter “hacking” cancer or “hacking” global warming, might make one, well, a hack.