Tools for clinical examination have not fundamentally evolved since the invention of the stethoscope by René Laennec in the nineteenth century. However, three decades ago, the medical community started to consider repurposing ultrasound scanners to improve physical examinations. A broad community of healthcare professionals trained in the new clinical examination paradigm could not be created due to the very high price of portable ultrasound scanners available on the market. In this paper, we study an Open-Source Hardware (OSH) community that aims to improve diagnosis in hospitals and medically underserved areas worldwide. They are designing an echo-stethoscope – a portable ultrasound scanner – that would be affordable in low and middle-income countries. The variety of expertise pooled to achieve this objective puts this knowledge common (KC) at the crossroads of open-source software (OSS), OSH, and medical communities. Unlike typical KC outcomes, an ultrasound probe is a physical object. Development and innovation in the physical world bring social dilemmas that the community has to overcome, restrictions in terms of openness, and in this case, unintended privatization. Our study uses the governing knowledge common framework (GKCF), a modified institutional analysis and development framework, to untangle the interactions between resources, participants, and governance structures. Our research describes why and how the creation of a physical object subject to industry regulation influences the evolution and governance of the KC. We provide evidence that temporary privatization of the KC can be used as a way to protect and sustain a common during the industrialization phase. We also demonstrate how a portfolio of projects is an effective and resilient way to help the common survive this privatization step.
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