Flute from his femur – researcher’s personal journey with healthcare tech, AI

27 February 2023 | Story Helen Swingler, Ralph Borland. Voice Cwenga Koyana. Read time >10 min.
HUMA’s Dr Ralph Borland tests the bone flute, a 3D-printed replica of his thighbone. The flute was exhibited recently at Brutal Curation, Side Street Studios, in Woodstock, as part of his art-research project, Future Hospitals: 4IR and Ethics of Care in Africa. <b>Photo</b> Robyn Walker.
HUMA’s Dr Ralph Borland tests the bone flute, a 3D-printed replica of his thighbone. The flute was exhibited recently at Brutal Curation, Side Street Studios, in Woodstock, as part of his art-research project, Future Hospitals: 4IR and Ethics of Care in Africa. Photo Robyn Walker.

Sweet and clear, the ethereal sound of a flute greets visitors to artist-researcher Dr Ralph Borland’s exhibition at Brutal Curation, Side Street Studios, in Woodstock. But the instrument yields a surprise: it’s been crafted from a human femur bone, a to-scale 3D replica of Dr Borland’s own thighbone.

The exhibition, AIAIA – Aesthetic Interventions in Artificial Intelligence in Africa, caps Dr Borland’s two-year collaboration with a surgeon at Tygerberg Hospital, and a parallel personal journey that intricately weaves together his art and his research – and his lived reality.

His project investigates emerging technologies in healthcare through collaboration. Borland is a Carnegie Corporation of New York-funded junior research fellow, and his work is one of seven strategic projects under the umbrella of HUMA’s Future Hospitals: 4IR and Ethics of Care in Africa initiative, which reflects critically on the role of artificial intelligence (AI) and other technologies of the Fourth Industrial Revolution in the future of hospitals in Africa.

Borland’s work focuses especially on the “potential for positive human–machine collaboration, amid the negative impacts of new technologies on human experience – automation’s threat to human skills, for example”.

He asks, “What choices can we make to use technology appropriately to enhance human skills and experience?”

Dr Ralph Borland
Dr Ralph Borland collaborated with musician Alessandro Gigli to ensure the correct placement of the air holes along the replica bone shaft. Photo Robyn Walker.

Bone instruments in history

Orthopaedic surgery is one of the specialisations benefiting from innovations in biomedical engineering, with 3D printing offering new, cost-effective approaches. At Tygerberg Hospital, orthopaedic surgeon Rudolph Venter works in his 3D orthopaedic laboratory to develop low-cost methods for 3D-printing patients’ bones so surgeons can practise complex procedures. Dr Venter’s work presented a unique opportunity for Borland to explore an existing idea for an artwork using a replica of his own femur.

Borland has a history of repurposing his own body parts and functions for artwork. For example, his art-design piece Suited for Subversion (2002), in the permanent collection of the New York Museum of Modern Art, is a suit made for protestors that amplifies the wearer’s heartbeat and makes it audible outside the body.

His current project emerged from a concept, first framed 10 years before, for using his bones as material for an artwork. This developed into a proposal for a bone flute made from his femur, tapping into a long history of musical instruments made of animal and human bone.

“The artwork plays on the history of the bone flute as an iconic musical object, as well as emerging technologies in healthcare,” he explained.

Borland also ties the work to the symbolism of the Danse Macabre, a popular motif in Western European art, poetry, literature and drama, in which the dead, represented by skeletons, dance with the living. It was a reminder of the universality of death, particularly after the Black Death and other epidemics that swept Europe in the mid-14th century.

Musical instruments made of bone have also been found at Neanderthal sites, the earliest dating back 53 000 years.

bone flute
Image of an early bone flute. Musical instruments made of bone have been found at Neanderthal sites, the earliest dating back 53 000 years. Photo Supplied.

But in the 21st century, artificial intelligence (AI) and digital technologies for making bones and body parts have introduced new conundrums for ethicists and for medical science, as Borland discovered when he proposed using a replica of his own femur.

“The exhibition explores some of the concerns around these technologies: the impact of automation on human experience, access to technology for patients, AI as a form of divinity and the possibilities of human–machine collaboration,” Borland wrote in the preamble to the exhibition.

Unique collaboration

After Borland’s femur was 3D-printed by CranioTech, he, Gigli and Venter came together in Venter’s orthopaedic laboratory to carve holes into the creation, using the same tools and processes Venter uses for his surgical simulations that utilise 3D prints.

Dr Ralph Borland worked closely with musician Alessandro Gigli and Dr Rudolf Venter of the Division of Orthopaedic Surgery at Stellenbosch University, based at Tygerberg Hospital, to 3D-print and create the bone flute. Video Supplied.

To recreate Borland’s thighbone, Venter and medical technologist Bernard Swart used MRI images obtained following a hip injury that Borland sustained in 2021 while running. Once the bone had been digitally printed, Gigli advised on the precise places the embouchure (place for the mouth) and other holes should be drilled, and tested the instrument for pitch and sound.

Up close and personal

But there is a parallel story here. Borland wasn’t to know how intimately he would get to know Cape Town’s hospitals – not as a researcher, but as a patient, when his leg and hip were scanned in those processes. These opportunities allowed him to collect data both for his personal health and for his art and research.

However, in the hospitals he was confronted by the real environments with which his art-research project engages. A series of images he took show the long, cavernous corridors, empty spaces, regimented rows of empty chairs and the artificial lighting of an ageing public hospital and the new, high-tech orthopaedic laboratory within it.

The 3D-printed bone flute. Photo Robyn Walker.

Further into his fellowship, things took a more serious turn. Based on a family history of cancer – his grandfather died of colon cancer at 48, the same age Borland is now – he booked a colonoscopy, and his surgeon immediately found a tumour. Biopsies and CT scans followed, and then an operation.

To determine his genetic risk for a recurrence of cancer, his age and cancer staging were fed into an online algorithmic tool, and he was presented with the option of chemotherapy to improve his chances of that not happening.

Similarly, Borland and his partner, expecting a baby, were offered newly available genetic screening tests. However, this screening carries its own risks of further invasive testing, and brings its own new ethical quandaries for care, he said.

These strands of personal experience became woven into the material of the exhibition. One of the exhibits is a timeline of the two-year research project, divided into “Research and Art” and “Personal”.

“Part of my intention with this exhibition is to acknowledge and work with the subjective aspect of research, framing the researcher not as an absent, objective voice, but as an active participant in their work.”

Who is coding, and for whom?

“As an artist and researcher who has worked with technology for the past 20 to 30 years, I am both excited by and critical of the role of emerging technologies. I’m excited about its creative potential, and critical of its commercially led intrusion into our work practices and everyday lives.”

What Bone Flute does is to concretise the idea of human–machine collaboration, the leitmotif of his exhibition, said Borland.

“It links ancient human creative practices with new technologies. It is a bone animated by the breath – I thank my friend, the artist Gerhard Marx, for observing this – an object with life in it, activated by the human. This should be the guiding principle for the development of technology, the centring of the human. This is the central idea of what is now being called the 5th Industrial Revolution.”

He added: “Looking back over the past two years, I feel as though I’m following threads through the labyrinth, with the strands of my own personal fate woven into my art and research,” he wrote in a text piece in his exhibition. “The labyrinth became one of the motifs to my experience – along with the bone flute, the most ancient musical instrument the world has found.”

Next, Borland plans to turn Bone Flute into an automation, creating a self-playing, automatic instrument, using the shape of a snake (a boomslang, specifically) wound around the length of the flute.

It seemed a natural choice, given the emblems and symbols he’d already explored.

“The snake is a symbol for medicine, combining toxicity with the potential for renewal, as it sheds its skin and emerges anew.”

This programme is funded by the Carnegie Corporation of New York and the Wenner-Gren Foundation.

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