Ebola In 3-D: A Video Game To Guide Health Care Workers Through A Ward

Here's a demo of the Ebola training video game. (Note: Only click once on the play button to run the video; ignore the pop-up dialogue boxes.) The player walks through several treatment zones of the facility, based on the newly opened, U.S.-built treatment center in Monrovia, Liberia. The zones and walkways, marked off with orange barriers, separate low-risk cases from confirmed Ebola patients. Along the way, you'll see protective equipment that's not worn properly by workers and healthcare workers sitting on beds (see below to find out why that's a bad idea). The foggy streaks on the screen are meant to replicate a health worker's steamed-up face mask.

Credit: Shift Labs

Could you walk through an Ebola treatment center in Liberia without catching the virus?

Soon you may be able to find out from the comfort of your living room. Shift Labs, a Seattle-based tech outfit, has developed a prototype for a video game that could be used to train health workers on duty in West Africa.

The startup creates health devices for the developing world. That's why the IMAI-IMCI Alliance, a global network of clinicians that creates health care training programs for the World Health Organization, got in touch in mid-September.

"The alliance had just finished the curriculum for a WHO training surge and asked if it'd be possible to build a 3-D simulation," says Beth Kolko, CEO of Shift Labs. No funds were available for game development, and Kolko didn't have enough in-house staff, so she decided to hack the problem.

She invited 40 video game developers, digital designers and clinicians for a hackathon over Halloween weekend at Seattle's Living Computer Museum.

"In the weeks before the hackathon, Beth asked me to build a digital environment based on the U.S. Department of Defense plans for the new Ebola treatment unit in Monrovia," says artist Mark Selander, who works as industrial designer for Nordstrom and knows Kolko from Seattle's tech sphere.

Selander created a library of 3-D models — people, latrines, tents — so the attendees had a head start when they arrived on Friday night. The next morning one person suited up in personal protective equipment (PPE), so the developers could program how arms and legs move while wrapped up in a suit.

The alliance provided the blueprints and flew in two health care workers as consultants, Kate Hurley and George Risi. They're employees of St. Patrick Hospital in Montana, one of the U.S. sites equipped to treat Ebola patients, and they'd both worked in Sierra Leone in mid-August.

Even with the practice drills at her home base, Hurley, a clinical nurse manager, was surprised by her West African experiences, which helped inform the video game.

"Most health care workers go into a place like Kenema, Sierra Leone, with an understanding of how to monitor and treat Ebola. But they've never done it while wearing a suit of plastic in 90-degree heat and 90 percent humidity," she says. "Before I left [for Sierra Leone], I didn't realize that I couldn't wear my reading glasses under the face shield because of the fogging."

The video game developers programmed such unexpected obstacles into the game. The video gets a little misty, mimicking the waves of sweat that cause the face mask to steam up. A simple instinct such as kneeling to treat a child is labeled a misstep in the game because the floor of a ward can be easily contaminated with a patient's vomit and diarrhea, even with buckets to collect the waste.

That's just one test of a game player's knowledge of Ebola.

While walking through the ward, players are confronted with various real-life scenarios that could prove dangerous. For example:

Everyone works in pairs in a treatment center: Did your buddy suit up correctly in PPE and use the right tools to take blood (and then dispose of the tools in the right order)?

Should a health care worker sit on a bed? (Answer: No, because viral particles on a contaminated mattress can cling to the PPE and potentially infect the wearer when the suit is removed.)

Did you clean your outer pair of gloves before taking them off and wash your inner gloves with a chlorine solution before putting on a new set of outer gloves?

A big taboo is touching your hands to your face. One team at the hackathon added a feature that works with Microsoft Kinect, the motion-detecting game platform, says Choong Ng, who helped recruit developers to the event. An alarm sounds if a player reaches for his or her face in real life to help wean them off the "bad" habit.

The game also helps doctors and nurses learn the layout of the Ebola facility where they'll be working. Health workers must move through the different areas in a precise loop. If they move from a tent with suspected cases to an area with confirmed patients, they're not supposed to turn back to the previous ward. Doing so could potentially expose uninfected patients to the virus.

The next step is a fundraiser to develop the game into a Web-based program that can be used at training centers in West Africa, as well as by doctors and nurses abroad who are preparing for the trip to Ebola-stricken areas.

"If [the game] turns out well," says IMAI-IMCI Alliance chair Dr. Sandy Gove, "it'll give people a realistic sense of how to navigate an Ebola treatment unit."