Flexistrap; the best fit for all

The pandemics like COVID-19 have increased the demand for Personal Protective Equipment to protect the medical workers from the direct contact with the patients. However, these PPE are only available in unisex sizes designed for particular men’s figures, which causes a problem of ill-fitted PPE for many women. For PPE coverall, the smallest size available is larger than the average female heights in many countries. Furthermore, globally 70% of the healthcare workforce are women and PPE hinders movement and carries the risk of injury. Therefore, Flexistrap can be worn on top of PPE like a belt for women to have a better fitting length and waist of PPE. As access to PPE is lacking during pandemics globally, this cost-effective and easily assembled Flexistrap is the solution for many women who cannot find their size with the available PPE without waiting for the unlikely production of various PPE designs for women.

Women make up 70% of the health workforce globally. For example, 73% of the medical workers at hospitals in Shanghai are female. Especially in the times of COVID-19, the healthcare workers who are in direct contact with the patients need to wear personal protective equipment (PPE). However, healthcare workers face a problem of not finding the PPE that fits them properly. Furthermore, majority of PPE are designed for male body and a survey by TUC in 2016 shows that 41% of women found PPE trousers unsuitable and only 10% found it good. 

In China, the smallest PPE body length of 165cm, although Chinese female’s average height is 158cm. In fact, many countries’ smallest PPE sizes are larger compared to the average heights of female. According to some female NHS workers, inappropriate fit of the PPE restricts the work, reduces the efficiency of their work, and puts the healthcare workers in risk of being infected despite the use of PPE. Some may not find their size and need to be absent at work. Not only is the availability of PPE limited, the fitting PPE are much less available for the majority of healthcare workers in direct contact with patients.

Flexistrap allows women to fit into oversized unisex coverall PPE gown, allowing them to work comfortably in different postures and improve the efficiency of work. Flexistrap is assembled with an elastic band and adjustable strap, functioning like a belt that can be worn on top of the coverall PPE gown around the waist and between the legs. It can be put on and taken off with two buckles. 

By this simple assembly, anyone can build-up Flexistrap with simple materials. Therefore, we suggest to hire women who have become unemployed due to the pandemic to lessen their financial burden as well as empower women. Unemployed women in nearby communities can be recruited online, materials delivered to their home, and then the assembled Flexistraps distributed to the hospitals in need. Piece rate payment can be applied, and this allows to help both communities of women. There are significant increase in the unemployment rate for female in many countries including G7 due to the recession by coronavirus. Especially for the U.S., according to the Bureau of Labor Statistics, the unemployment rate rose sharply to 15.5% for adult women in April, from 3.1% in February, before the COVID-19 outbreak started in the U.S..

This solution is specifically made for frontline women healthcare workers who may be in contact with potential viruses. The unisex PPE designs are not only too big to fit for women, but they are not considerate of the differences in the distribution of body figure for women. Due to the inappropriate or uncomfortable fit of PPE, it increases the risk of their injury and health. 

Introduction of Flexistrap takes account of the ergonomic needs of women while wearing a PPE and thus prevents women having poor posture which then prevents an increased risk of musculoskeletal disorders. Helping frontline women health care workers find comfort in their job allows them to deliver the best service to their patients and also prevents direct contact with the potential viruses as it reduces the workers to readjust the PPE. These small impacts are not only beneficial for the healthcare workers, but also help to sustain the workforce of the health care area, thus increasing the efficiency of fighting against infectious disease.

To work safely and efficiently against emerging COVID-19, the medical workers need to be protected well. The pandemic is urgent, therefore, a prompt response and practicality are necessary. Our solution should also be cost-effective and does not require special assembling lines or design. Oversized unisex PPE has hampered female medical workers from working efficiently. To fix such issue, introducing Flexistrap, an adjustable and easy to assemble strap, can be worn on top of PPE coverall. Flexistrap may function as a temporary solution, but it can also be used in middle sizes for different body shapes in the future.

1.     Flexistrap can provide perfectly individualized size of medical gowns for every healthcare workers (without expensive customization) which the original size system of medical gowns could not provide. The previous size system has been problematic because it was limited to fixed sizes from S to XL that covers unisex, and was not female-friendly.    

2.     Gender equality is established, and this will improve the overall working condition for healthcare workers. This is because 70% of the health and social sector are female workers worldwide. unisex-friendly PPE production would protect more healthcare workers completely from airborne diseases. 

3.     Flexistrap improves the working efficiency. This is because  

1) Healthcare workers would be able to adjust the size of the medical gowns by one touch 

 2) Flexistrap is separated from the gowns and resolve the lack of certain size of medical gown. 

4.     Most of the companies that produce PPE, such as 3M and DuPont, already make safety belts for construction workers and other safety goods. This would provide the assembly lines for Flexistrap. By building partnerships with these companies, and providing the design and ideas, we would be able to secure business model easily, and therefore, would be economically sustainable.  

5.   The data in terms of how many people of certain gender would request for a certain size of PPE in certain countries can be used for major developments and adjustments in the healthcare workers’ working conditions which will help the fight against the pandemic.

In the ideation process, we utilized fine craftsmanship and trial and error to design the optimum Flexistrap. To produce Flexistrap in large amounts, we intend to hire women who were unemployed during the pandemics of COVID-19. This allows women to have opportunity of staying at home and earn external income. In order to train women volunteers remotely to make these straps, we will develop online courses to teach them how to make it. To design the optimum Flexistrap, we aspire to use Al and big data to design the optimum Flexistrap for designated countries’ workers.

Most of the PPE coveralls have an ample crotch which reduces the risk of breaking the clothing while squatting or other postures that require stretches around the crotch. Therefore, shorter or skinnier healthcare workers who wear the PPE can fit and fix the position of PPE coverall around the waist with the Flexistrap while having enough space for stretch at different positions. Flexistrap has the same logic as elastic bands around the ankles or the wrists of PPE, but it is better as it can be adjusted according to individuals' sizes with the length adjustment and buckle attachments. The endurance of Flexistrap is strong, as it is the same technology used in the safety harness, which holds the entire human body. 

In addition, how the wearers of PPE coverall often rate the comfort of PPE is how easily they can move or stay in different postures. Such as bending over, lifting arms, squatting, and walking. These factors are shown by an academic paper by Johns Hopkins University School of Medicine. Flexistrap does not hinder these postures, and rather facilitate as it can prevent from having the PPE coverall misaligned around their body at the waist. 

A lot of reports depicted by the media have reported frontline health workers are experiencing.

Flexistrap allows frontline women healthcare workers to move around with more ease. Helping frontline women health care workers find comfort in their job allows them to deliver the best service to their patients. 

To achieve that, firstly, for the production line, we will source from companies which make straps and buckles. Next we will network with hospitals and respective labs which use PPE in Kunshan, China. We will also work with women empowerment organizations to recruit women to make Flexistrap in Kunshan. The profit for the 1st 21 Flexistrap will be for the woman. We will develop videos which teach women who became our independent contractors how to make this.

Then, we will collect feedback from hospital's health care workers. They should be experiencing higher comfortability in body movement and overall improvement of mood. Each hospital is eligible for free Flexistraps in the first month as free trials, and they can decide whether to continue for the next 6 months.

10% of the piece-rate wages that each worker gained will be used to help these individual contractors to develop their marketable skills as investment. Moreover, when we have sufficient steady stream of profit, we would use it to develop other PPEs for women healthcare workers such as tailor making the perfect mask and even the correct goggles.

The short term outcome of our project is that unemployed women could have an alternative income. Moreover, healthcare workers will experience higher job satisfaction and patients will be receiving better service. In the long run, our service or "training benefits" could offer unemployed women to develop designing skills. With their improvement in technical and designing skills, they could help to design other PPE products. With this constant cycle, women healthcare worker’s health and comfortability are taken care of. This will largely increase the job efficiently and encourage more women to take roles in healthcare.

Once we have gained a solid ground in Kunshan, we will expand our influence to other parts of China depending on the need.

This solution is a new business model or process that is being proposed, therefore, it is currently not serving for people. However, in the next one year, it is going to serve the neighborhood of Duke Kunshan University, the county of Kunshan. Kunshan has 3 main People’s hospitals that are associated with the government, and is the most popular hospitals around Kunshan. 

From the estimation of who are qualified to be at the frontline in these hospitals and using the estimation of 70% of them to be female (according to WHO), it would serve 913 frontline healthcare workers. If we include other hospitals in Kunshan, it would serve more than 1000 people. In five years, we hope to extend to Suzhou city and Shanghai. 

While the population of Kunshan is 1.645 million, the entire Suzhou city has 10.72 million and Shanghai has the population of 24.28 million people. As these two cities are both metropolitan compared to Kunshan, the number of healthcare workers will increase according to the population size. As the number of Flexistraps that are crafted increases, the income it creates for the women who need to work at home and need the external income will get support from this business as well. If each person dedicates 6 hours each day for 5 days, then 5 Flexistraps can be made per hour by hand, and 8 Flexistraps with a sewing machine (on average 7/hour). Therefore, with 5 people working, it can support the main hospitals at Kunshan.

Within the next five years, while getting feedbacks on the Flexistraps from the hospitals that purchase Flexistraps in Kunshan and nearby cities, we hope to have a similar business replicated to operate in the nearby countries or countries that are in need of the Flexistraps. There are chances that COVID-19 may become a seasonal outbreak until the vaccinations are created, and there are many other possible outbreaks that frontline healthcare workers need to avoid to get in contact with. 

Worldwide, 70% of the healthcare workers are women, and many Asian countries, and many other countries that have the population from ethnicity that have the traits of shorter or skinnier body shapes are in need of Flexistraps. Meanwhile, we aim to raise the awareness of the needs in different sizes and designs of PPE within the healthcare industry, and promote for more female-friendly designs in the industry. In addition to Flexistraps, we hope to come up with other items that allow adjustable and comfortable use for other parts of personal protective equipment such as goggles, masks, gloves, and shoes.

1. The most challenging barrier we would have to face is the current market system of the production and supply of PPE. As PPE is one of the most basic need for healthcare workers, the market is already involving most of the hospitals and medical institutions with the mass production and speedy supply system adapted.    

2. As China is the main country where we will be operating in next few years, it is noticeable that we might potentially not be able to have access to data freely in China due to its political, legal features. As foreigners, to what extent would we be able to achieve data is unknown.

1. This challenge is mostly due to the sudden peak in the demand that the companies were not prepared for. The speed in production and distribution can be increased by the financial support, such as expanding the factories and investing in technology of production. Also, providing subsidies to the hospitals to afford a larger quantity of PPE can be helpful for them to afford the PPE and increase the capacity of patients who are in need of care. 

2. As Flexistrap provides a great solution for many healthcare workers at the hospitals, we could have a contract of how the information that we receive from the hospitals would only be used for the purpose of improving the Flexistraps and will be kept confidential. This would establish a mutual benefits between the hospitals and us (the solvers). 

Currently, 4 people are working as a team. We are all undergraduate students at Duke Kunshan University, and we hope to involve some supervisors and more students who are interested to join our team in the future.

We are all rising female sophomore students at Duke Kunshan University, located in Suzhou, China. We are also the members of Youth Leaders of Global Health Club, where we work on different projects that collaborate with the local hospitals teaching English, working on community service, and participating in conferences. We are working towards the goal of helping the communities. 

We have a diverse background, all coming from different countries: China, Japan, South Korea, and Malaysia. Therefore, we have a potential of working in English, Chinese, Japanese, Korean and Malay in the future. We all experienced the COVID-19 pandemics in the early-stage in China and in our home countries in the later pandemics, so we are well aware of the different situations of COVID-19. We found time outside of work to have meetings online and worked on this solution remotely. We had advice from a Global Health Master Student from Duke University, and some of us have experience in working at pharmaceutical industry, cultivated leadership skills, and are enthusiastic students.

We have also worked on different projects collaborating with the local hospitals back in Kunshan, therefore, we are ready to deliver this solution with a tight corporation around our community. We have 3 years of university time left, which will allow us to expand this project in long-term with different locations while recruit the underclassmen to continue our project based in our university.

Manufacturers:

PPE manufacturers such as Baymro (in China) and 3M (in the U.S. and internationally) could be providing the materials for Flexistraps since they readily have materials for the straps (from other products they produce). Alternatively, any other companies that produce straps and buckles can be the source of Flexistraps. They provide the basic material including the elastic band, belts, and buckles. Considering the cost, time, and effort of producing more sizes for PPE and re-designing them for women, Flexistraps will be a better option for them to take action during the pandemics. We hope to buy the material in whole sale, cheaper than retail price. 

Unemployed women:

Unemployed women are hired as independent contractors by us, who assemble the Flexistraps together at home. They will receive the material, assemble them, and drop them off at designated stations. They will receive piece rate payment (as well as satisfying the minimum wages requirements and local laws). The simple procedures and requiring minimal material should bring a good quality control, and tutorial videos on assembling Flexistraps will be provided. To encourage them to try-out this work, the profit made from first 21 Flexistraps they assemble are directly going towards to their wages. By assembling more than 999 Flexistraps, they are eligible for "training benefits". 

Hospitals:

Hospitals order and receive Flexistraps through delivery by having the contracts with us monthly. To encourage them to try out the Flexistraps, they can sign up for the free trial in their first month.

1. The price of Flexistrap will be set according to each country/district, but in 2020 we are planning for $3/Flexistrap in Kunshan area. Since it is going to be a start-up business, we hope to have the opening balance of around $10,000 from the MIT Challenge. From this, we will be able to start purchasing to start running the business and sustain us until we receive the inflows from sales of Flexistraps.
2. The 10% of total wage per person will be collected by us, going towards the "investment bank" where we will be using this money to provide the workers some assistance on obtaining or improving techniques and skills from professionals virtually. The independent contractors who assembled more than 999 Flexistraps will be eligible for getting the support from the investment bank. 
3. We also hope to receive inflows from brand partnerships as we build up the reputation of Flexistraps and get more hospitals to buy them. For instance, by forming a partnership, we can receive advertisement revenue by embedding logos of a partner to the Flexistraps. The potential partnerships are pharmaceutical companies and the manufacturers themselves.
4. Receiving grants from the local government is possible if the public hospitals are satisfied with the Flexistraps and would like to receive financial support from the government. 

With partnerships and mentorship possibilities that SOLVE provides, our idea and concern will be able to reach a larger community, have a larger impact and eventually help more frontline medical workers to protect people from outbreaks like COVID-19. 

Firstly, if our solution is selected, we would like to make more prototypes and invite frontline female medical workers starting locally - in Kunshan area - to experiment the function of Flexistrap in a real clinical situation. Preferably, we will be able to obtain quantitative information on how much Flexistrap improves medical workers’ mobility. These data will then be used to analyze the flaws in our current prototype, and we will adjust the design accordingly before scaling up. We also would like to receive suggestions from manufacturer and bioengineering specialists who can be reached through MIT platform regarding environmental impacts of our products and social responsibilities. We would like to have further discussion with them about some technical issues such as the endurance of PPE if Flexistrap is used.

Secondly, the funding from Solve will be extremely helpful to start purchasing materials, start running the business and be financially sustained until inflows from the sales of Flexistrap come in. (Please refer to the “what is your path to financial sustainability?")

• Product/service distribution

We hope to have a partnership with companies like Baymro (in China), 3M, DuPont and other possible PPE manufacturing companies for Flexistrap production and distribution of the material from the factories to the individual contractors. 

We also hope to have an assistance in using digital designing tools or getting a software that allows us to save our designs digitally and precisely to facilitate the communication of designs among different stakeholders. 

• Marketing, media, and exposure

We would like to create some revenue from sponsorship, such as having companies' logos on Flexistraps for their advertisement. Therefore, we would like to have a partnership with some pharmaceutical companies and technology companies who may be interested in advertising within the healthcare industry. By having sponsorship, we hope to have Flexistraps recognized to a bigger audience. 

• Baymro (in China), 3M, DuPont and other possible PPE manufacturing companies

For the purposes mentioned before.

• MIT faculty

Especially the faculty from MIT Integrated Design & Management (IDM) for mentorship. Before starting to produce Flexistraps, we want them to be environmentally responsible, so would like to discuss on the appropriate disposing of Flexistraps after they are used. 

• Pharmaceutical companies and technology companies 

For sponsorships purposes, such as Johnson & Johnson, Pfizer, Amgen, Eli Lilly, Astellas Pharma, Otsuka, and Sino Biopharmaceutical. 

The project of Flexistraps started by hearing the voices of the heroes who work in the frontline of the healthcare, who put their health and safety at risk to treat the patients for all of us. A great portion of these workers are female, and the PPE are not designed to support these workers even though they are supposed to be wearing PPE to protect themselves. It is important to recognize this issue and take the action immediately to facilitate their work efficiency and improve their working environment.

In order to have the impact to a greater number of women (and not limited to women but anyone who cannot find their sizes in PPE due to the limited number of PPE), having sufficient financial support like from The Elevate Prize for Health Security can advance our solution from Suzhou, China to across the country and countries in a shorter period of time. 

Our solution is specifically serving frontline women healthcare workers with a simple but innovative design for optimizing PPE of every size. The invisible gender discrimination against female is omnipresent. The design does not have to be technically complicated to accommodate the uncomfortable fit of PPE, and it would assist their long hours of working. The more cost-effective, the more likely it can help and empower more women in different countries. By empowering them with this solution, it would bring beneficial impact on the workforce of the healthcare industry, increasing the efficiency of fighting against the infectious diseases.

As aforementioned in our solution, oversized PPE has been hampering female medical workers’ movement. Given the great proportion of female workers in the medical field, it is a huge problem. Flexistrap can decrease the risk of their injury, reduces fatigue due to working in oversized PPE for a long time and improve the overall quality of healthcare working conditions for women. During pandemics like COVID-19, every workforce in the medical team is essential.    

The Innovation for Women Prize will be used to first, collect the quantitative data to improve the design of the Flexistraps, and help us to expand our business in the future. Optimizing the efficiency of working, not only the individual experience of female medical workers can be improved, but also an overall increase in the workforce is expected to be achieved.