[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.81,0:00:02.27,Default,,0000,0000,0000,,I'm going to talk to you today
Dialogue: 0,0:00:02.29,0:00:05.78,Default,,0000,0000,0000,,about the design of medical technology\Nfor low-resource settings.
Dialogue: 0,0:00:05.80,0:00:08.15,Default,,0000,0000,0000,,I study health systems in these countries.
Dialogue: 0,0:00:08.18,0:00:10.09,Default,,0000,0000,0000,,And one of the major gaps in care,
Dialogue: 0,0:00:10.12,0:00:11.78,Default,,0000,0000,0000,,almost across the board,
Dialogue: 0,0:00:11.80,0:00:13.97,Default,,0000,0000,0000,,is access to safe surgery.
Dialogue: 0,0:00:13.99,0:00:16.65,Default,,0000,0000,0000,,Now one of the major\Nbottlenecks that we've found
Dialogue: 0,0:00:16.67,0:00:19.91,Default,,0000,0000,0000,,that's sort of preventing\Nboth the access in the first place,
Dialogue: 0,0:00:19.93,0:00:23.37,Default,,0000,0000,0000,,and the safety of those surgeries\Nthat do happen, is anesthesia.
Dialogue: 0,0:00:23.85,0:00:26.24,Default,,0000,0000,0000,,And actually, it's the model\Nthat we expect to work
Dialogue: 0,0:00:26.26,0:00:28.96,Default,,0000,0000,0000,,for delivering anesthesia\Nin these environments.
Dialogue: 0,0:00:29.62,0:00:33.47,Default,,0000,0000,0000,,Here, we have a scene that you would find\Nin any operating room across the US,
Dialogue: 0,0:00:33.50,0:00:34.97,Default,,0000,0000,0000,,or any other developed country.
Dialogue: 0,0:00:34.100,0:00:36.18,Default,,0000,0000,0000,,In the background there
Dialogue: 0,0:00:36.21,0:00:38.78,Default,,0000,0000,0000,,is a very sophisticated\Nanesthesia machine.
Dialogue: 0,0:00:38.80,0:00:42.65,Default,,0000,0000,0000,,And this machine is able\Nto enable surgery and save lives
Dialogue: 0,0:00:42.68,0:00:45.98,Default,,0000,0000,0000,,because it was designed\Nwith this environment in mind.
Dialogue: 0,0:00:46.33,0:00:49.26,Default,,0000,0000,0000,,In order to operate,\Nthis machine needs a number of things
Dialogue: 0,0:00:49.28,0:00:51.18,Default,,0000,0000,0000,,that this hospital has to offer.
Dialogue: 0,0:00:51.21,0:00:54.58,Default,,0000,0000,0000,,It needs an extremely\Nwell-trained anesthesiologist
Dialogue: 0,0:00:54.60,0:00:57.05,Default,,0000,0000,0000,,with years of training\Nwith complex machines
Dialogue: 0,0:00:57.08,0:00:59.50,Default,,0000,0000,0000,,to help her monitor the flows of the gas
Dialogue: 0,0:00:59.52,0:01:02.08,Default,,0000,0000,0000,,and keep her patients\Nsafe and anesthetized
Dialogue: 0,0:01:02.11,0:01:03.56,Default,,0000,0000,0000,,throughout the surgery.
Dialogue: 0,0:01:03.58,0:01:06.35,Default,,0000,0000,0000,,It's a delicate machine\Nrunning on computer algorithms,
Dialogue: 0,0:01:06.37,0:01:09.59,Default,,0000,0000,0000,,and it needs special care, TLC,\Nto keep it up and running,
Dialogue: 0,0:01:09.62,0:01:11.47,Default,,0000,0000,0000,,and it's going to break pretty easily.
Dialogue: 0,0:01:11.50,0:01:14.41,Default,,0000,0000,0000,,And when it does, it needs\Na team of biomedical engineers
Dialogue: 0,0:01:14.43,0:01:17.74,Default,,0000,0000,0000,,who understand its complexities,\Ncan fix it, can source the parts
Dialogue: 0,0:01:17.77,0:01:19.100,Default,,0000,0000,0000,,and keep it saving lives.
Dialogue: 0,0:01:20.69,0:01:22.22,Default,,0000,0000,0000,,It's a pretty expensive machine.
Dialogue: 0,0:01:22.25,0:01:24.89,Default,,0000,0000,0000,,It needs a hospital\Nwhose budget can allow it
Dialogue: 0,0:01:24.91,0:01:29.80,Default,,0000,0000,0000,,to support one machine\Ncosting upwards of 50 or $100,000.
Dialogue: 0,0:01:30.30,0:01:32.20,Default,,0000,0000,0000,,And perhaps most obviously,
Dialogue: 0,0:01:32.22,0:01:33.73,Default,,0000,0000,0000,,but also most importantly --
Dialogue: 0,0:01:33.76,0:01:36.59,Default,,0000,0000,0000,,and the path to concepts\Nthat we've heard about
Dialogue: 0,0:01:36.62,0:01:37.90,Default,,0000,0000,0000,,kind of illustrates this --
Dialogue: 0,0:01:37.93,0:01:43.07,Default,,0000,0000,0000,,it needs infrastructure that can supply\Nan uninterrupted source of electricity,
Dialogue: 0,0:01:43.10,0:01:46.11,Default,,0000,0000,0000,,of compressed oxygen,\Nand other medical supplies
Dialogue: 0,0:01:46.13,0:01:50.41,Default,,0000,0000,0000,,that are so critical\Nto the functioning of this machine.
Dialogue: 0,0:01:50.44,0:01:53.73,Default,,0000,0000,0000,,In other words, this machine\Nrequires a lot of stuff
Dialogue: 0,0:01:53.76,0:01:55.73,Default,,0000,0000,0000,,that this hospital cannot offer.
Dialogue: 0,0:01:56.33,0:01:59.35,Default,,0000,0000,0000,,This is the electrical supply\Nfor a hospital in rural Malawi.
Dialogue: 0,0:02:00.15,0:02:01.31,Default,,0000,0000,0000,,In this hospital,
Dialogue: 0,0:02:01.34,0:02:04.01,Default,,0000,0000,0000,,there is one person qualified\Nto deliver anesthesia,
Dialogue: 0,0:02:04.03,0:02:05.18,Default,,0000,0000,0000,,and she's qualified
Dialogue: 0,0:02:05.21,0:02:09.78,Default,,0000,0000,0000,,because she has 12, maybe 18 months\Nof training in anesthesia.
Dialogue: 0,0:02:09.81,0:02:12.06,Default,,0000,0000,0000,,In the hospital and in the entire region
Dialogue: 0,0:02:12.08,0:02:14.09,Default,,0000,0000,0000,,there's not a single biomedical engineer.
Dialogue: 0,0:02:14.11,0:02:15.68,Default,,0000,0000,0000,,So when this machine breaks,
Dialogue: 0,0:02:15.70,0:02:17.91,Default,,0000,0000,0000,,the machines that they have\Nto work with break,
Dialogue: 0,0:02:17.94,0:02:19.71,Default,,0000,0000,0000,,they've got to try and figure it out,
Dialogue: 0,0:02:19.73,0:02:22.02,Default,,0000,0000,0000,,but most of the time,\Nthat's the end of the road.
Dialogue: 0,0:02:22.05,0:02:24.26,Default,,0000,0000,0000,,Those machines go the proverbial junkyard.
Dialogue: 0,0:02:24.29,0:02:26.62,Default,,0000,0000,0000,,And the price tag\Nof the machine that I mentioned
Dialogue: 0,0:02:26.64,0:02:28.70,Default,,0000,0000,0000,,could represent maybe a quarter or a third
Dialogue: 0,0:02:28.72,0:02:31.54,Default,,0000,0000,0000,,of the annual operating budget\Nfor this hospital.
Dialogue: 0,0:02:32.58,0:02:35.96,Default,,0000,0000,0000,,And finally, I think you can see\Nthat infrastructure is not very strong.
Dialogue: 0,0:02:35.99,0:02:38.66,Default,,0000,0000,0000,,This hospital is connected\Nto a very weak power grid,
Dialogue: 0,0:02:38.69,0:02:40.47,Default,,0000,0000,0000,,one that goes down frequently.
Dialogue: 0,0:02:40.49,0:02:43.04,Default,,0000,0000,0000,,So it runs frequently,\Nthe entire hospital,
Dialogue: 0,0:02:43.06,0:02:44.48,Default,,0000,0000,0000,,just on a generator.
Dialogue: 0,0:02:44.51,0:02:46.66,Default,,0000,0000,0000,,And you can imagine,\Nthe generator breaks down
Dialogue: 0,0:02:46.69,0:02:48.00,Default,,0000,0000,0000,,or runs out of fuel.
Dialogue: 0,0:02:48.36,0:02:50.39,Default,,0000,0000,0000,,And the World Bank sees this
Dialogue: 0,0:02:50.41,0:02:53.94,Default,,0000,0000,0000,,and estimates that a hospital\Nin this setting in a low-income country
Dialogue: 0,0:02:53.97,0:02:57.04,Default,,0000,0000,0000,,can expect up to\N18 power outages per month.
Dialogue: 0,0:02:58.66,0:03:01.85,Default,,0000,0000,0000,,Similarly, compressed oxygen\Nand other medical supplies
Dialogue: 0,0:03:01.88,0:03:03.06,Default,,0000,0000,0000,,are really a luxury,
Dialogue: 0,0:03:03.08,0:03:06.36,Default,,0000,0000,0000,,and can often be out of stock\Nfor months or even a year.
Dialogue: 0,0:03:06.39,0:03:09.55,Default,,0000,0000,0000,,So it seems crazy, but the model\Nthat we have right now
Dialogue: 0,0:03:09.58,0:03:11.78,Default,,0000,0000,0000,,is taking those machines\Nthat were designed
Dialogue: 0,0:03:11.80,0:03:14.09,Default,,0000,0000,0000,,for that first environment\Nthat I showed you
Dialogue: 0,0:03:14.11,0:03:17.98,Default,,0000,0000,0000,,and donating or selling them\Nto hospitals in this environment.
Dialogue: 0,0:03:18.86,0:03:20.44,Default,,0000,0000,0000,,It's not just inappropriate,
Dialogue: 0,0:03:20.46,0:03:22.100,Default,,0000,0000,0000,,it becomes really unsafe.
Dialogue: 0,0:03:23.52,0:03:25.44,Default,,0000,0000,0000,,One of our partners at Johns Hopkins
Dialogue: 0,0:03:25.46,0:03:29.64,Default,,0000,0000,0000,,was observing surgeries in Sierra Leone\Nabout a year ago.
Dialogue: 0,0:03:30.22,0:03:33.56,Default,,0000,0000,0000,,And the first surgery of the day\Nhappened to be an obstetrical case.
Dialogue: 0,0:03:33.58,0:03:36.56,Default,,0000,0000,0000,,A woman came in,\Nshe needed an emergency C-section
Dialogue: 0,0:03:36.59,0:03:39.32,Default,,0000,0000,0000,,to save her life and the life of her baby.
Dialogue: 0,0:03:39.80,0:03:41.76,Default,,0000,0000,0000,,And everything began pretty auspiciously.
Dialogue: 0,0:03:41.78,0:03:44.04,Default,,0000,0000,0000,,The surgeon was on call and scrubbed in.
Dialogue: 0,0:03:44.06,0:03:45.35,Default,,0000,0000,0000,,The nurse was there.
Dialogue: 0,0:03:45.37,0:03:48.23,Default,,0000,0000,0000,,She was able to anesthetize her quickly,\Nand it was important
Dialogue: 0,0:03:48.26,0:03:50.59,Default,,0000,0000,0000,,because of the emergency\Nnature of the situation.
Dialogue: 0,0:03:50.62,0:03:52.33,Default,,0000,0000,0000,,And everything began well
Dialogue: 0,0:03:52.36,0:03:54.43,Default,,0000,0000,0000,,until the power went out.
Dialogue: 0,0:03:55.77,0:03:57.60,Default,,0000,0000,0000,,And now in the middle of this surgery,
Dialogue: 0,0:03:57.62,0:04:00.69,Default,,0000,0000,0000,,the surgeon is racing\Nagainst the clock to finish his case,
Dialogue: 0,0:04:00.71,0:04:03.07,Default,,0000,0000,0000,,which he can do -- he's got a headlamp.
Dialogue: 0,0:04:03.09,0:04:07.15,Default,,0000,0000,0000,,But the nurse is literally running\Naround a darkened operating theater
Dialogue: 0,0:04:07.18,0:04:10.13,Default,,0000,0000,0000,,trying to find anything\Nshe can use to anesthetize her patient,
Dialogue: 0,0:04:10.15,0:04:11.84,Default,,0000,0000,0000,,to keep her patient asleep.
Dialogue: 0,0:04:11.87,0:04:14.75,Default,,0000,0000,0000,,Because her machine doesn't work\Nwhen there's no power.
Dialogue: 0,0:04:15.44,0:04:18.49,Default,,0000,0000,0000,,This routine surgery that many of you\Nhave probably experienced,
Dialogue: 0,0:04:18.52,0:04:22.99,Default,,0000,0000,0000,,and others are probably the product of,\Nhas now become a tragedy.
Dialogue: 0,0:04:23.66,0:04:26.39,Default,,0000,0000,0000,,And what's so frustrating\Nis this is not a singular event;
Dialogue: 0,0:04:26.42,0:04:28.91,Default,,0000,0000,0000,,this happens across the developing world.
Dialogue: 0,0:04:28.94,0:04:31.89,Default,,0000,0000,0000,,35 million surgeries\Nare attempted every year
Dialogue: 0,0:04:31.92,0:04:33.51,Default,,0000,0000,0000,,without safe anesthesia.
Dialogue: 0,0:04:34.21,0:04:37.12,Default,,0000,0000,0000,,My colleague, Dr. Paul Fenton,\Nwas living this reality.
Dialogue: 0,0:04:37.15,0:04:38.98,Default,,0000,0000,0000,,He was the chief of anesthesiology
Dialogue: 0,0:04:39.00,0:04:41.50,Default,,0000,0000,0000,,in a hospital in Malawi,\Na teaching hospital.
Dialogue: 0,0:04:42.03,0:04:43.52,Default,,0000,0000,0000,,He went to work every day
Dialogue: 0,0:04:43.55,0:04:45.51,Default,,0000,0000,0000,,in an operating theater like this one,
Dialogue: 0,0:04:45.54,0:04:48.68,Default,,0000,0000,0000,,trying to deliver anesthesia\Nand teach others how to do so
Dialogue: 0,0:04:48.70,0:04:49.98,Default,,0000,0000,0000,,using that same equipment
Dialogue: 0,0:04:50.00,0:04:54.31,Default,,0000,0000,0000,,that became so unreliable,\Nand frankly unsafe, in his hospital.
Dialogue: 0,0:04:55.04,0:04:56.82,Default,,0000,0000,0000,,And after umpteen surgeries
Dialogue: 0,0:04:56.84,0:04:59.41,Default,,0000,0000,0000,,and, you can imagine,\Nreally unspeakable tragedy,
Dialogue: 0,0:04:59.44,0:05:01.78,Default,,0000,0000,0000,,he just said, "That's it.\NI'm done. That's enough.
Dialogue: 0,0:05:01.80,0:05:03.87,Default,,0000,0000,0000,,There has to be something better."
Dialogue: 0,0:05:04.23,0:05:05.78,Default,,0000,0000,0000,,He took a walk down the hall
Dialogue: 0,0:05:05.80,0:05:09.23,Default,,0000,0000,0000,,to where they threw all those machines\Nthat had just crapped out on them,
Dialogue: 0,0:05:09.26,0:05:10.93,Default,,0000,0000,0000,,I think that's the scientific term,
Dialogue: 0,0:05:10.96,0:05:12.30,Default,,0000,0000,0000,,and he started tinkering.
Dialogue: 0,0:05:12.32,0:05:14.68,Default,,0000,0000,0000,,He took one part from here\Nand another from there,
Dialogue: 0,0:05:14.70,0:05:17.28,Default,,0000,0000,0000,,and he tried to come up\Nwith a machine that would work
Dialogue: 0,0:05:17.30,0:05:18.93,Default,,0000,0000,0000,,in the reality that he was facing.
Dialogue: 0,0:05:18.96,0:05:20.17,Default,,0000,0000,0000,,And what he came up with:
Dialogue: 0,0:05:20.20,0:05:21.52,Default,,0000,0000,0000,,was this guy.
Dialogue: 0,0:05:21.54,0:05:25.08,Default,,0000,0000,0000,,The prototype for the Universal\NAnesthesia Machine --
Dialogue: 0,0:05:25.10,0:05:28.40,Default,,0000,0000,0000,,a machine that would work\Nand anesthetize his patients
Dialogue: 0,0:05:28.42,0:05:31.100,Default,,0000,0000,0000,,no matter the circumstances\Nthat his hospital had to offer.
Dialogue: 0,0:05:32.52,0:05:34.00,Default,,0000,0000,0000,,Here it is, back at home
Dialogue: 0,0:05:34.02,0:05:37.45,Default,,0000,0000,0000,,at that same hospital, developed\Na little further, 12 years later,
Dialogue: 0,0:05:37.48,0:05:40.66,Default,,0000,0000,0000,,working on patients\Nfrom pediatrics to geriatrics.
Dialogue: 0,0:05:41.14,0:05:43.91,Default,,0000,0000,0000,,Let me show you a little bit\Nabout how this machine works.
Dialogue: 0,0:05:43.93,0:05:45.81,Default,,0000,0000,0000,,Voila!
Dialogue: 0,0:05:46.45,0:05:47.66,Default,,0000,0000,0000,,Here she is.
Dialogue: 0,0:05:47.68,0:05:48.93,Default,,0000,0000,0000,,When you have electricity,
Dialogue: 0,0:05:48.95,0:05:51.97,Default,,0000,0000,0000,,everything in this machine\Nbegins in the base.
Dialogue: 0,0:05:51.99,0:05:54.59,Default,,0000,0000,0000,,There's a built-in\Noxygen concentrator down there.
Dialogue: 0,0:05:54.61,0:05:57.74,Default,,0000,0000,0000,,Now you've heard me mention\Noxygen a few times at this point.
Dialogue: 0,0:05:57.77,0:06:01.56,Default,,0000,0000,0000,,Essentially, to deliver anesthesia,\Nyou want as pure oxygen as possible,
Dialogue: 0,0:06:01.58,0:06:05.00,Default,,0000,0000,0000,,because eventually you're going\Nto dilute it, essentially, with the gas.
Dialogue: 0,0:06:05.03,0:06:07.46,Default,,0000,0000,0000,,And the mixture that the patient inhales
Dialogue: 0,0:06:07.49,0:06:09.80,Default,,0000,0000,0000,,needs to be at least\Na certain percentage oxygen
Dialogue: 0,0:06:09.82,0:06:11.51,Default,,0000,0000,0000,,or else it can become dangerous.
Dialogue: 0,0:06:11.53,0:06:13.45,Default,,0000,0000,0000,,But so in here when there's electricity,
Dialogue: 0,0:06:13.47,0:06:16.35,Default,,0000,0000,0000,,the oxygen concentrator takes in room air.
Dialogue: 0,0:06:16.37,0:06:19.65,Default,,0000,0000,0000,,Now we know room air is gloriously free,
Dialogue: 0,0:06:19.68,0:06:20.98,Default,,0000,0000,0000,,it is abundant,
Dialogue: 0,0:06:21.00,0:06:22.100,Default,,0000,0000,0000,,and it's already 21 percent oxygen.
Dialogue: 0,0:06:23.44,0:06:27.11,Default,,0000,0000,0000,,So all this concentrator does\Nis take that room air in, filter it
Dialogue: 0,0:06:27.14,0:06:30.96,Default,,0000,0000,0000,,and send 95 percent pure oxygen\Nup and across here,
Dialogue: 0,0:06:30.98,0:06:33.19,Default,,0000,0000,0000,,where it mixes with the anesthetic agent.
Dialogue: 0,0:06:33.74,0:06:37.37,Default,,0000,0000,0000,,Now before that mixture\Nhits the patient's lungs,
Dialogue: 0,0:06:37.39,0:06:39.60,Default,,0000,0000,0000,,it's going to pass by here --\Nyou can't see it,
Dialogue: 0,0:06:39.63,0:06:41.41,Default,,0000,0000,0000,,but there's an oxygen sensor here --
Dialogue: 0,0:06:41.44,0:06:45.64,Default,,0000,0000,0000,,that's going to read out on this screen\Nthe percentage of oxygen being delivered.
Dialogue: 0,0:06:46.28,0:06:48.26,Default,,0000,0000,0000,,Now if you don't have power,
Dialogue: 0,0:06:48.28,0:06:51.89,Default,,0000,0000,0000,,or, God forbid, the power cuts out\Nin the middle of a surgery,
Dialogue: 0,0:06:51.91,0:06:54.26,Default,,0000,0000,0000,,this machine transitions automatically,
Dialogue: 0,0:06:54.28,0:06:56.03,Default,,0000,0000,0000,,without even having to touch it,
Dialogue: 0,0:06:56.05,0:06:58.38,Default,,0000,0000,0000,,to drawing in room air from this inlet.
Dialogue: 0,0:06:58.80,0:07:00.14,Default,,0000,0000,0000,,Everything else is the same.
Dialogue: 0,0:07:00.16,0:07:01.76,Default,,0000,0000,0000,,The only difference is that now
Dialogue: 0,0:07:01.78,0:07:04.100,Default,,0000,0000,0000,,you're only working\Nwith 21 percent oxygen.
Dialogue: 0,0:07:05.41,0:07:08.23,Default,,0000,0000,0000,,Now that used to be\Na dangerous guessing game,
Dialogue: 0,0:07:08.25,0:07:10.64,Default,,0000,0000,0000,,because you only knew\Nif you gave too little oxygen
Dialogue: 0,0:07:10.66,0:07:12.04,Default,,0000,0000,0000,,once something bad happened.
Dialogue: 0,0:07:12.06,0:07:14.77,Default,,0000,0000,0000,,But we've put a long-life\Nbattery backup on here.
Dialogue: 0,0:07:14.80,0:07:16.99,Default,,0000,0000,0000,,This is the only part\Nthat's battery backed up.
Dialogue: 0,0:07:17.02,0:07:20.42,Default,,0000,0000,0000,,But this gives control to the provider,\Nwhether there's power or not,
Dialogue: 0,0:07:20.44,0:07:22.04,Default,,0000,0000,0000,,because they can adjust the flows
Dialogue: 0,0:07:22.06,0:07:26.03,Default,,0000,0000,0000,,based on the percentage of oxygen\Nthey see that they're giving the patient.
Dialogue: 0,0:07:26.05,0:07:29.40,Default,,0000,0000,0000,,In both cases,\Nwhether you have power or not,
Dialogue: 0,0:07:29.42,0:07:31.46,Default,,0000,0000,0000,,sometimes the patient\Nneeds help breathing.
Dialogue: 0,0:07:31.49,0:07:34.69,Default,,0000,0000,0000,,It's just a reality of anesthesia,\Nthe lungs can be paralyzed.
Dialogue: 0,0:07:34.71,0:07:36.80,Default,,0000,0000,0000,,And so we've just added\Nthis manual bellows.
Dialogue: 0,0:07:36.82,0:07:39.81,Default,,0000,0000,0000,,We've seen surgeries\Nfor three or four hours
Dialogue: 0,0:07:39.84,0:07:41.69,Default,,0000,0000,0000,,to ventilate the patient on this.
Dialogue: 0,0:07:42.42,0:07:45.41,Default,,0000,0000,0000,,So it's a straightforward machine.
Dialogue: 0,0:07:45.44,0:07:48.34,Default,,0000,0000,0000,,I shudder to say simple;\Nit's straightforward.
Dialogue: 0,0:07:48.94,0:07:50.84,Default,,0000,0000,0000,,And it's by design.
Dialogue: 0,0:07:50.86,0:07:56.06,Default,,0000,0000,0000,,You do not need to be a highly trained,\Nspecialized anesthesiologist
Dialogue: 0,0:07:56.08,0:07:57.26,Default,,0000,0000,0000,,to use this machine,
Dialogue: 0,0:07:57.28,0:08:00.03,Default,,0000,0000,0000,,which is good because,\Nin these rural district hospitals,
Dialogue: 0,0:08:00.06,0:08:02.65,Default,,0000,0000,0000,,you're not going to get\Nthat level of training.
Dialogue: 0,0:08:02.68,0:08:05.80,Default,,0000,0000,0000,,It's also designed for the environment\Nthat it will be used in.
Dialogue: 0,0:08:05.83,0:08:07.60,Default,,0000,0000,0000,,This is an incredibly rugged machine.
Dialogue: 0,0:08:07.63,0:08:11.08,Default,,0000,0000,0000,,It has to stand up to the heat\Nand the wear and tear
Dialogue: 0,0:08:11.11,0:08:14.22,Default,,0000,0000,0000,,that happens in hospitals\Nin these rural districts.
Dialogue: 0,0:08:14.25,0:08:16.64,Default,,0000,0000,0000,,And so it's not going\Nto break very easily,
Dialogue: 0,0:08:16.67,0:08:19.94,Default,,0000,0000,0000,,but if it does, virtually\Nevery piece in this machine
Dialogue: 0,0:08:19.97,0:08:21.98,Default,,0000,0000,0000,,can be swapped out and replaced
Dialogue: 0,0:08:22.00,0:08:23.99,Default,,0000,0000,0000,,with a hex wrench and a screwdriver.
Dialogue: 0,0:08:25.75,0:08:28.01,Default,,0000,0000,0000,,And finally, it's affordable.
Dialogue: 0,0:08:28.03,0:08:31.69,Default,,0000,0000,0000,,This machine comes in\Nat an eighth of the cost
Dialogue: 0,0:08:31.71,0:08:34.79,Default,,0000,0000,0000,,of the conventional machine\Nthat I showed you earlier.
Dialogue: 0,0:08:34.81,0:08:39.30,Default,,0000,0000,0000,,So in other words, what we have here\Nis a machine that can enable surgery
Dialogue: 0,0:08:39.32,0:08:40.50,Default,,0000,0000,0000,,and save lives,
Dialogue: 0,0:08:40.52,0:08:43.51,Default,,0000,0000,0000,,because it was designed\Nfor its environment,
Dialogue: 0,0:08:43.54,0:08:45.95,Default,,0000,0000,0000,,just like the first machine I showed you.
Dialogue: 0,0:08:45.98,0:08:47.98,Default,,0000,0000,0000,,But we're not content to stop there.
Dialogue: 0,0:08:48.00,0:08:49.18,Default,,0000,0000,0000,,Is it working?
Dialogue: 0,0:08:49.20,0:08:51.79,Default,,0000,0000,0000,,Is this the design\Nthat's going to work in place?
Dialogue: 0,0:08:51.81,0:08:53.58,Default,,0000,0000,0000,,Well, we've seen good results so far.
Dialogue: 0,0:08:53.60,0:08:56.99,Default,,0000,0000,0000,,This is in 13 hospitals in four countries,
Dialogue: 0,0:08:57.01,0:09:00.94,Default,,0000,0000,0000,,and since 2010, we've done\Nwell over 2,000 surgeries
Dialogue: 0,0:09:00.97,0:09:03.20,Default,,0000,0000,0000,,with no clinically adverse events.
Dialogue: 0,0:09:03.54,0:09:04.71,Default,,0000,0000,0000,,So we're thrilled.
Dialogue: 0,0:09:04.73,0:09:09.15,Default,,0000,0000,0000,,This really seems like\Na cost-effective, scalable solution
Dialogue: 0,0:09:09.18,0:09:11.21,Default,,0000,0000,0000,,to a problem that's really pervasive.
Dialogue: 0,0:09:11.70,0:09:13.30,Default,,0000,0000,0000,,But we still want to be sure
Dialogue: 0,0:09:13.32,0:09:15.74,Default,,0000,0000,0000,,that this is the most effective\Nand safe device
Dialogue: 0,0:09:15.76,0:09:17.82,Default,,0000,0000,0000,,that we can be putting into hospitals.
Dialogue: 0,0:09:17.84,0:09:20.37,Default,,0000,0000,0000,,So to do that, we've launched\Na number of partnerships
Dialogue: 0,0:09:20.39,0:09:21.88,Default,,0000,0000,0000,,with NGOs and universities,
Dialogue: 0,0:09:21.90,0:09:24.55,Default,,0000,0000,0000,,to gather data on the user interface,
Dialogue: 0,0:09:24.58,0:09:26.77,Default,,0000,0000,0000,,on the types of surgeries\Nit's appropriate for,
Dialogue: 0,0:09:26.79,0:09:29.18,Default,,0000,0000,0000,,and ways we can enhance the device itself.
Dialogue: 0,0:09:29.20,0:09:31.86,Default,,0000,0000,0000,,One of those partnerships\Nis with Johns Hopkins
Dialogue: 0,0:09:31.88,0:09:33.25,Default,,0000,0000,0000,,just here in Baltimore.
Dialogue: 0,0:09:33.28,0:09:37.56,Default,,0000,0000,0000,,They have a really cool anesthesia\Nsimulation lab out in Baltimore.
Dialogue: 0,0:09:37.58,0:09:39.46,Default,,0000,0000,0000,,So we're taking this machine
Dialogue: 0,0:09:39.48,0:09:43.06,Default,,0000,0000,0000,,and recreating some\Nof the operating theater crises
Dialogue: 0,0:09:43.08,0:09:44.59,Default,,0000,0000,0000,,that this machine might face
Dialogue: 0,0:09:44.61,0:09:46.98,Default,,0000,0000,0000,,in one of the hospitals\Nthat it's intended for,
Dialogue: 0,0:09:47.00,0:09:49.12,Default,,0000,0000,0000,,and in a contained, safe environment,
Dialogue: 0,0:09:49.15,0:09:50.86,Default,,0000,0000,0000,,evaluating its effectiveness.
Dialogue: 0,0:09:51.35,0:09:54.98,Default,,0000,0000,0000,,We're then able to compare\Nthe results from that study
Dialogue: 0,0:09:55.00,0:09:56.42,Default,,0000,0000,0000,,with real-world experience,
Dialogue: 0,0:09:56.45,0:09:58.64,Default,,0000,0000,0000,,because we're putting\Ntwo of these in hospitals
Dialogue: 0,0:09:58.67,0:10:00.82,Default,,0000,0000,0000,,that Johns Hopkins\Nworks with in Sierra Leone,
Dialogue: 0,0:10:00.84,0:10:03.96,Default,,0000,0000,0000,,including the hospital\Nwhere that emergency C-section happened.
Dialogue: 0,0:10:05.38,0:10:08.51,Default,,0000,0000,0000,,So I've talked a lot about anesthesia,\Nand I tend to do that.
Dialogue: 0,0:10:08.54,0:10:12.63,Default,,0000,0000,0000,,I think it is incredibly fascinating\Nand an important component of health.
Dialogue: 0,0:10:12.65,0:10:15.28,Default,,0000,0000,0000,,And it really seems peripheral,\Nwe never think about it,
Dialogue: 0,0:10:15.31,0:10:17.51,Default,,0000,0000,0000,,until we don't have access to it,
Dialogue: 0,0:10:17.54,0:10:19.50,Default,,0000,0000,0000,,and then it becomes a gatekeeper.
Dialogue: 0,0:10:19.52,0:10:21.49,Default,,0000,0000,0000,,Who gets surgery and who doesn't?
Dialogue: 0,0:10:21.82,0:10:24.55,Default,,0000,0000,0000,,Who gets safe surgery and who doesn't?
Dialogue: 0,0:10:25.22,0:10:27.68,Default,,0000,0000,0000,,But you know,\Nit's just one of so many ways
Dialogue: 0,0:10:27.70,0:10:30.81,Default,,0000,0000,0000,,that design, appropriate design,
Dialogue: 0,0:10:30.83,0:10:32.81,Default,,0000,0000,0000,,can have an impact on health outcomes.
Dialogue: 0,0:10:33.32,0:10:35.44,Default,,0000,0000,0000,,If more people\Nin the health-delivery space
Dialogue: 0,0:10:35.46,0:10:39.03,Default,,0000,0000,0000,,really working on some of these\Nchallenges in low-income countries
Dialogue: 0,0:10:39.05,0:10:42.71,Default,,0000,0000,0000,,could start their design process,\Ntheir solution search,
Dialogue: 0,0:10:42.73,0:10:44.67,Default,,0000,0000,0000,,from outside of that proverbial box
Dialogue: 0,0:10:44.69,0:10:46.63,Default,,0000,0000,0000,,and inside of the hospital --
Dialogue: 0,0:10:46.66,0:10:48.49,Default,,0000,0000,0000,,In other words, if we could design
Dialogue: 0,0:10:48.51,0:10:51.70,Default,,0000,0000,0000,,for the environment that exists\Nin so many parts of the world,
Dialogue: 0,0:10:51.72,0:10:54.13,Default,,0000,0000,0000,,rather than the one\Nthat we wished existed --
Dialogue: 0,0:10:54.16,0:10:56.32,Default,,0000,0000,0000,,we might just save a lot of lives.
Dialogue: 0,0:10:56.79,0:10:58.26,Default,,0000,0000,0000,,Thank you very much.
Dialogue: 0,0:10:58.28,0:11:02.71,Default,,0000,0000,0000,,(Applause)