In the Open Healthware sphere many organizations and groups are started due to a deep desire to help. The inequalities in healthcare worldwide are impossible to ignore, especially for those who take on the Hippocratic oath such as Doctor Tarek Loubani, founder of Glia.
Loubani is a Palestinian-Canadian who frequently returns to Palestine to do on-the-ground work and medical care where he experienced the access disparity for stethoscopes in 2012. This led to the creation of Glia and their inaugural project, a 3D printed stethoscope that is designed to be manufactured in low resource settings and easily assembled.
3D printing has a complicated history with open source, we had the tools and knowledge for how it could work as early as 1980 but because of a group patenting the process and locking it down to manufacturing and research industries the rest of the world didn’t get access until 2005. With the patent expired there has been massive developments in the process to the point where it’s not about toys and knick knacks but effective tools for all types of industries. “There is the false assumption that 3D printed medical devices are toys, that they are not real. They're not something that is worth spending money on. That can be a really big obstacle to overcome with people. But that just comes with time,” said Jen Wilson, Glia’s Director of Manufacturing and Design. “Because our stethoscope is peer reviewed, if you make it this way, you are not making a toy. You're making something that's legitimate.”
This stethoscope, tested in the field starting in 2014 when their first prototype was finalized, began Glia’s process for how they approach designing devices on a whole. By 2017 the stethoscope became a flagship product and in 2018 a peer-reviewed paper showed that it performed at the same level of commercially available stethoscope that retail at 130-150$.
“Glia isn't just producing a thing, but really creating an ecosystem, this closed loop way of looking at open source medical hardware. We provide a replicable model for other organizations who may be wanting to do the same thing,” Wilson explained. “We have little incubator organizations who are trying to make their own compliant open source manufacturing in their respective areas.”
By working to create a device and then following the creation with peer-reviewed documentation they are able to not only have an accessible tool but confirm the validity of its use, creating more access across the field. They are able to follow the required safety and quality systems while releasing everything open.
“We radically open source all of our products,” Wilson said. “Because we've chosen that as our model, including the fact that every device either has a peer reviewed publication attached to it, or is currently undergoing a peer reviewed publication.”
It makes it harder for the industry to deny the reality that these devices are compliant with local authorities and regulations, and effective tools because there is such thorough documentation and clear publication that shows their success. Glia is a huge proponent of open source in all situations, including the workplace where they utilize open source software throughout their workflow.
“[Loubani] insists that everybody in the company use open source software for everything that we do for the business,” Wilson said. “Every time proprietary software is being used they eventually put up a paywall so large or do not end up improving the product enough to be able to take it further into what is needed as things change in technology, whereas open source can be improved all the time.”
This is something that the open source world is all too familiar with, especially in proprietary software and hardware. In the medical field users frequently lose access to devices and programs because a business closes, but with open source the access remains long after a business is gone.
Within the work Glia does they have had a large pivot since October 7th, 2023 and have since been taking on brokering medical bringing in medical practitioners, and other medical delegates, from around the world that want to volunteer in Gaza.
“We have a really long waiting list of people. So they're being vetted and there's a lot of things to take into consideration as to who goes and when they can go and that kind of thing. But we've been doing that consistently since December of 2023,” Wilson said.
Loubani’s Palestinian roots play a huge role in the organization, many of the devices they make are created to meet a need seen in Gaza and to help get more medical care to the people who are being affected by the Israeli campaign. One of their projects, the tourniquet, was deployed during the Great March of Return, tested under live fire, and has had consistent use in Gaza’s hospitals including field testing under live fire. The device was publicized for use in Ukraine in 2022 with an open-source injection mold model to increase access as well as being developed to print on solar powered 3D printers.
There’s no way to peer review the tourniquet beyond an upcoming clinical trial, there are no industry standards for a tourniquet but Glia is committed to keeping the process open. They will only publish findings in open source journals, enabling widespread access.
This practice reinforces their radical commitment to open source, and their belief that everyone should have access to the information.
Glia works hard to make sure their work is open in as many ways as possible, especially for those who are in the most dire need due to blockades such as the one that the people of Gaza are experiencing. They’ve even turned down sales to maintain their values in open source, especially when people have misunderstood the uses of their devices.
“It's important for people to know about this work that it's not impossible to be steadfast in your values and to have boundaries around that. We have actually let go of some large sales due to the fact that they do not align with our anti-capitalist open source values,” Wilson said. “We have not worked with people that are not open source. We have declined sales where they were thinking that the stethoscope was disposable. It's not disposable, so we're not going to sell you a million devices because you're just going to throw them away.”
The work Glia is doing is a testament to what can be accomplished when companies and organizations engage with open source fully. They are able to work around major disruptions in supply chains, create solutions to significant medical access disparity and find ways to bring those who need the most into the fold to empower them with the ability to make these devices themselves. The freedom to share that comes with Open Healthware helps eliminate the barriers that we’ve created in convoluted healthcare systems across the globe.
