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The universal anesthesia machine

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    I'm going to talk to you today
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    about the design of medical technology
    for low-resource settings.
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    I study health systems in these countries.
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    And one of the major gaps in care,
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    almost across the board,
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    is access to safe surgery.
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    Now one of the major
    bottlenecks that we've found
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    that's sort of preventing
    both the access in the first place,
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    and the safety of those surgeries
    that do happen, is anesthesia.
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    And actually, it's the model
    that we expect to work
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    for delivering anesthesia
    in these environments.
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    Here, we have a scene that you would find
    in any operating room across the US,
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    or any other developed country.
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    In the background there
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    is a very sophisticated
    anesthesia machine.
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    And this machine is able
    to enable surgery and save lives
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    because it was designed
    with this environment in mind.
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    In order to operate,
    this machine needs a number of things
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    that this hospital has to offer.
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    It needs an extremely
    well-trained anesthesiologist
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    with years of training
    with complex machines
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    to help her monitor the flows of the gas
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    and keep her patients
    safe and anesthetized
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    throughout the surgery.
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    It's a delicate machine
    running on computer algorithms,
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    and it needs special care, TLC,
    to keep it up and running,
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    and it's going to break pretty easily.
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    And when it does, it needs
    a team of biomedical engineers
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    who understand its complexities,
    can fix it, can source the parts
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    and keep it saving lives.
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    It's a pretty expensive machine.
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    It needs a hospital
    whose budget can allow it
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    to support one machine
    costing upwards of 50 or $100,000.
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    And perhaps most obviously,
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    but also most importantly --
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    and the path to concepts
    that we've heard about
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    kind of illustrates this --
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    it needs infrastructure that can supply
    an uninterrupted source of electricity,
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    of compressed oxygen,
    and other medical supplies
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    that are so critical
    to the functioning of this machine.
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    In other words, this machine
    requires a lot of stuff
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    that this hospital cannot offer.
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    This is the electrical supply
    for a hospital in rural Malawi.
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    In this hospital,
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    there is one person qualified
    to deliver anesthesia,
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    and she's qualified
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    because she has 12, maybe 18 months
    of training in anesthesia.
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    In the hospital and in the entire region
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    there's not a single biomedical engineer.
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    So when this machine breaks,
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    the machines that they have
    to work with break,
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    they've got to try and figure it out,
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    but most of the time,
    that's the end of the road.
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    Those machines go the proverbial junkyard.
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    And the price tag
    of the machine that I mentioned
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    could represent maybe a quarter or a third
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    of the annual operating budget
    for this hospital.
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    And finally, I think you can see
    that infrastructure is not very strong.
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    This hospital is connected
    to a very weak power grid,
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    one that goes down frequently.
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    So it runs frequently,
    the entire hospital,
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    just on a generator.
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    And you can imagine,
    the generator breaks down
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    or runs out of fuel.
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    And the World Bank sees this
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    and estimates that a hospital
    in this setting in a low-income country
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    can expect up to
    18 power outages per month.
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    Similarly, compressed oxygen
    and other medical supplies
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    are really a luxury,
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    and can often be out of stock
    for months or even a year.
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    So it seems crazy, but the model
    that we have right now
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    is taking those machines
    that were designed
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    for that first environment
    that I showed you
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    and donating or selling them
    to hospitals in this environment.
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    It's not just inappropriate,
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    it becomes really unsafe.
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    One of our partners at Johns Hopkins
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    was observing surgeries in Sierra Leone
    about a year ago.
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    And the first surgery of the day
    happened to be an obstetrical case.
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    A woman came in,
    she needed an emergency C-section
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    to save her life and the life of her baby.
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    And everything began pretty auspiciously.
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    The surgeon was on call and scrubbed in.
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    The nurse was there.
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    She was able to anesthetize her quickly,
    and it was important
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    because of the emergency
    nature of the situation.
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    And everything began well
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    until the power went out.
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    And now in the middle of this surgery,
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    the surgeon is racing
    against the clock to finish his case,
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    which he can do -- he's got a headlamp.
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    But the nurse is literally running
    around a darkened operating theater
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    trying to find anything
    she can use to anesthetize her patient,
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    to keep her patient asleep.
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    Because her machine doesn't work
    when there's no power.
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    This routine surgery that many of you
    have probably experienced,
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    and others are probably the product of,
    has now become a tragedy.
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    And what's so frustrating
    is this is not a singular event;
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    this happens across the developing world.
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    35 million surgeries
    are attempted every year
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    without safe anesthesia.
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    My colleague, Dr. Paul Fenton,
    was living this reality.
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    He was the chief of anesthesiology
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    in a hospital in Malawi,
    a teaching hospital.
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    He went to work every day
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    in an operating theater like this one,
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    trying to deliver anesthesia
    and teach others how to do so
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    using that same equipment
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    that became so unreliable,
    and frankly unsafe, in his hospital.
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    And after umpteen surgeries
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    and, you can imagine,
    really unspeakable tragedy,
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    he just said, "That's it.
    I'm done. That's enough.
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    There has to be something better."
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    He took a walk down the hall
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    to where they threw all those machines
    that had just crapped out on them,
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    I think that's the scientific term,
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    and he started tinkering.
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    He took one part from here
    and another from there,
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    and he tried to come up
    with a machine that would work
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    in the reality that he was facing.
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    And what he came up with:
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    was this guy.
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    The prototype for the Universal
    Anesthesia Machine --
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    a machine that would work
    and anesthetize his patients
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    no matter the circumstances
    that his hospital had to offer.
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    Here it is, back at home
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    at that same hospital, developed
    a little further, 12 years later,
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    working on patients
    from pediatrics to geriatrics.
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    Let me show you a little bit
    about how this machine works.
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    Voila!
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    Here she is.
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    When you have electricity,
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    everything in this machine
    begins in the base.
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    There's a built-in
    oxygen concentrator down there.
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    Now you've heard me mention
    oxygen a few times at this point.
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    Essentially, to deliver anesthesia,
    you want as pure oxygen as possible,
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    because eventually you're going
    to dilute it, essentially, with the gas.
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    And the mixture that the patient inhales
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    needs to be at least
    a certain percentage oxygen
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    or else it can become dangerous.
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    But so in here when there's electricity,
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    the oxygen concentrator takes in room air.
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    Now we know room air is gloriously free,
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    it is abundant,
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    and it's already 21 percent oxygen.
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    So all this concentrator does
    is take that room air in, filter it
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    and send 95 percent pure oxygen
    up and across here,
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    where it mixes with the anesthetic agent.
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    Now before that mixture
    hits the patient's lungs,
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    it's going to pass by here --
    you can't see it,
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    but there's an oxygen sensor here --
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    that's going to read out on this screen
    the percentage of oxygen being delivered.
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    Now if you don't have power,
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    or, God forbid, the power cuts out
    in the middle of a surgery,
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    this machine transitions automatically,
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    without even having to touch it,
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    to drawing in room air from this inlet.
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    Everything else is the same.
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    The only difference is that now
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    you're only working
    with 21 percent oxygen.
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    Now that used to be
    a dangerous guessing game,
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    because you only knew
    if you gave too little oxygen
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    once something bad happened.
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    But we've put a long-life
    battery backup on here.
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    This is the only part
    that's battery backed up.
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    But this gives control to the provider,
    whether there's power or not,
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    because they can adjust the flows
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    based on the percentage of oxygen
    they see that they're giving the patient.
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    In both cases,
    whether you have power or not,
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    sometimes the patient
    needs help breathing.
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    It's just a reality of anesthesia,
    the lungs can be paralyzed.
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    And so we've just added
    this manual bellows.
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    We've seen surgeries
    for three or four hours
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    to ventilate the patient on this.
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    So it's a straightforward machine.
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    I shudder to say simple;
    it's straightforward.
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    And it's by design.
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    You do not need to be a highly trained,
    specialized anesthesiologist
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    to use this machine,
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    which is good because,
    in these rural district hospitals,
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    you're not going to get
    that level of training.
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    It's also designed for the environment
    that it will be used in.
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    This is an incredibly rugged machine.
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    It has to stand up to the heat
    and the wear and tear
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    that happens in hospitals
    in these rural districts.
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    And so it's not going
    to break very easily,
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    but if it does, virtually
    every piece in this machine
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    can be swapped out and replaced
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    with a hex wrench and a screwdriver.
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    And finally, it's affordable.
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    This machine comes in
    at an eighth of the cost
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    of the conventional machine
    that I showed you earlier.
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    So in other words, what we have here
    is a machine that can enable surgery
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    and save lives,
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    because it was designed
    for its environment,
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    just like the first machine I showed you.
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    But we're not content to stop there.
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    Is it working?
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    Is this the design
    that's going to work in place?
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    Well, we've seen good results so far.
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    This is in 13 hospitals in four countries,
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    and since 2010, we've done
    well over 2,000 surgeries
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    with no clinically adverse events.
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    So we're thrilled.
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    This really seems like
    a cost-effective, scalable solution
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    to a problem that's really pervasive.
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    But we still want to be sure
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    that this is the most effective
    and safe device
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    that we can be putting into hospitals.
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    So to do that, we've launched
    a number of partnerships
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    with NGOs and universities,
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    to gather data on the user interface,
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    on the types of surgeries
    it's appropriate for,
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    and ways we can enhance the device itself.
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    One of those partnerships
    is with Johns Hopkins
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    just here in Baltimore.
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    They have a really cool anesthesia
    simulation lab out in Baltimore.
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    So we're taking this machine
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    and recreating some
    of the operating theater crises
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    that this machine might face
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    in one of the hospitals
    that it's intended for,
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    and in a contained, safe environment,
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    evaluating its effectiveness.
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    We're then able to compare
    the results from that study
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    with real-world experience,
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    because we're putting
    two of these in hospitals
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    that Johns Hopkins
    works with in Sierra Leone,
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    including the hospital
    where that emergency C-section happened.
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    So I've talked a lot about anesthesia,
    and I tend to do that.
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    I think it is incredibly fascinating
    and an important component of health.
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    And it really seems peripheral,
    we never think about it,
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    until we don't have access to it,
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    and then it becomes a gatekeeper.
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    Who gets surgery and who doesn't?
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    Who gets safe surgery and who doesn't?
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    But you know,
    it's just one of so many ways
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    that design, appropriate design,
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    can have an impact on health outcomes.
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    If more people
    in the health-delivery space
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    really working on some of these
    challenges in low-income countries
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    could start their design process,
    their solution search,
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    from outside of that proverbial box
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    and inside of the hospital --
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    In other words, if we could design
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    for the environment that exists
    in so many parts of the world,
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    rather than the one
    that we wished existed --
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    we might just save a lot of lives.
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    Thank you very much.
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    (Applause)
Title:
The universal anesthesia machine
Speaker:
Erica Frenkel
Description:

What if you're in surgery and the power goes out? No lights, no oxygen -- and your anesthesia stops flowing. It happens constantly in hospitals throughout the world, turning routine procedures into tragedies. Erica Frenkel demos one solution: the universal anesthesia machine.

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Video Language:
English
Team:
TED
Project:
TEDTalks
Duration:
11:03
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