BioEd Online

Architects and a public health expert have unveiled a new solution to some of the world's ills: Doc-in-a-Box. The mass-produced medical clinics, housed in empty shipping containers, could help bring vital healthcare to needy communities.

Thousands of discarded shipping containers clog up ports around the globe because it is too expensive for companies to send them back. The tough, steel boxes are a standard size designed to travel on ships and trucks everywhere.

Former journalist turned global health advocate Laurie Garrett, a fellow at New York's Council on Foreign Relations, saw a recycling opportunity. Around two years ago she came up with the idea of converting the containers into mobile medical centres that could be mass-produced cheaply and transported around the world.

Installed in towns and villages the world over, Doc-in-a-Boxes could provide basic but pressing health services such as HIV, tuberculosis and malaria screening, doling out drugs and routine childhood vaccinations. This would free-up hospitals to focus on other care.

Ship shape

A group of architecture students at Rensselaer Polytechnic Institute in Troy, New York, latched onto Garrett's idea and decided to build a prototype. After six months' planning, blow-torching and welding, they unveiled their 2.4 metre wide, 2.6 metre high, 6.1 metre long effort on a New York City street corner on Wednesday.

The hope is that the containers could be fitted out in any country from inexpensive, scavenged materials. The shelves are built from broken down packing containers, the sink is a punctured washing-up bowl and the curtain made of sheets. There is a basic bed and seat.

The whole structure is pierced with ventilation panels and painted white to reflect heat; a small refrigerator and laptop computer are powered by solar panels. The team estimate that the whole thing could be fitted out for $4000 or less, including the cost of the container.

Containing disease

Garrett has ambitious plans for Doc-in-a-Box. Adopted widely, she thinks such a system could help eliminate some of the wastefulness from international health services, which are often delivered to developing countries via multiple different non-profit organisations with no central co-ordination. "We've got to change the way of doing this game," she says, outlining her grand scheme through the rumble of Manhattan traffic outside Doc-in-a-Box.

Garrett envisions a system in which public health services are more streamlined and efficient. The boxes could be manufactured in bulk by companies in developing countries, perhaps for a small profit. They would then be operated in towns and villages somewhat like a chain of restaurant franchises; each box is similar and offers the same health services, but is run by locals. A central organisation takes queries and co-ordinates the boxes.

One idea is that Doc-in-a-Box could be equipped with very simple and robust diagnostic technologies, when such things become available, that screen for multiple strains of bacteria or viruses with one saliva test. Because all the boxes are standardised, information from these tests could be fed into a central computer and used to track the spread of diseases such as avian influenza.

In addition, a supply of Doc-in-a-Boxes could be held in reserve to ship out to regions hit by tsunamis, hurricanes or other disasters.

Much of this remains a grand scheme, and Garrett says it would take buy-in by health ministers and aid organisations to get the idea off the ground. "Obviously a fundamental sea-change has to occur," she says. She hopes to ship the prototype box up to the International AIDS Conference in Toronto this August in order to give the idea more publicity.

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