The universal anesthesia machine
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0:00 - 0:02I'm going to talk to you today
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0:02 - 0:05about the design of medical technology for low resource settings.
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0:05 - 0:07I study health systems in these countries.
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0:07 - 0:09And one of the major gaps in care,
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0:09 - 0:11almost across the board,
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0:11 - 0:13is access to safe surgery.
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0:13 - 0:16Now one of the major bottlenecks that we've found
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0:16 - 0:19that's sort of preventing both the access in the first place
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0:19 - 0:21and the safety of those surgeries that do happen
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0:21 - 0:23is anesthesia.
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0:23 - 0:25And actually, it's the model that we expect to work
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0:25 - 0:27for delivering anesthesia
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0:27 - 0:29in these environments.
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0:29 - 0:31Here we have a scene that you would find
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0:31 - 0:34in any operating room across the U.S. or any other developed country.
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0:34 - 0:36In the background there
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0:36 - 0:38is a very sophisticated anesthesia machine.
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0:38 - 0:40And this machine is able
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0:40 - 0:42to enable surgery and save lives
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0:42 - 0:44because it was designed
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0:44 - 0:46with this environment in mind.
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0:46 - 0:49In order to operate, this machine needs a number of things
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0:49 - 0:51that this hospital has to offer.
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0:51 - 0:54It needs an extremely well-trained anesthesiologist
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0:54 - 0:56with years of training with complex machines
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0:56 - 0:59to help her monitor the flows of the gas
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0:59 - 1:01and keep her patients safe and anesthetized
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1:01 - 1:03throughout the surgery.
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1:03 - 1:06It's a delicate machine running on computer algorithms,
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1:06 - 1:09and it needs special care, TLC, to keep it up and running,
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1:09 - 1:11and it's going to break pretty easily.
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1:11 - 1:14And when it does, it needs a team of biomedical engineers
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1:14 - 1:16who understand its complexities,
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1:16 - 1:18can fix it, can source the parts
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1:18 - 1:20and keep it saving lives.
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1:20 - 1:22It's a pretty expensive machine.
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1:22 - 1:24It needs a hospital
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1:24 - 1:26whose budget can allow it to support one machine
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1:26 - 1:29costing upwards of 50 or $100,000.
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1:29 - 1:31And perhaps most obviously,
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1:31 - 1:33and perhaps most importantly --
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1:33 - 1:35and the path to concepts that we've heard about
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1:35 - 1:37kind of illustrate this --
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1:37 - 1:39it needs infrastructure
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1:39 - 1:41that can supply an uninterrupted source
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1:41 - 1:44of electricity, of compressed oxygen
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1:44 - 1:46and other medical supplies
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1:46 - 1:48that are so critical to the functioning
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1:48 - 1:50of this machine.
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1:50 - 1:53In other words, this machine requires a lot of stuff
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1:53 - 1:55that this hospital cannot offer.
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1:55 - 1:57This is the electrical supply
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1:57 - 1:59for a hospital in rural Malawi.
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1:59 - 2:01In this hospital,
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2:01 - 2:03there is one person qualified to deliver anesthesia,
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2:03 - 2:05and she's qualified
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2:05 - 2:07because she has 12, maybe 18 months
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2:07 - 2:09of training in anesthesia.
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2:09 - 2:11In the hospital and in the entire region
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2:11 - 2:13there's not a single biomedical engineer.
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2:13 - 2:15So when this machine breaks,
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2:15 - 2:17the machines they have to work with break,
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2:17 - 2:20they've got to try and figure it out, but most of the time, that's the end of the road.
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2:20 - 2:23Those machines go the proverbial junkyard.
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2:23 - 2:26And the price tag of the machine that I mentioned
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2:26 - 2:28could represent maybe a quarter or a third
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2:28 - 2:30of the annual operating budget
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2:30 - 2:32for this hospital.
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2:32 - 2:35And finally, I think you can see that infrastructure is not very strong.
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2:35 - 2:38This hospital is connected to a very weak power grid,
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2:38 - 2:40one that goes down frequently.
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2:40 - 2:42So it runs frequently, the entire hospital,
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2:42 - 2:44just on a generator.
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2:44 - 2:46And you can imagine, the generator breaks down
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2:46 - 2:48or runs out of fuel.
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2:48 - 2:50And the World Bank sees this
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2:50 - 2:53and estimates that a hospital in this setting in a low-income country
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2:53 - 2:56can expect up to 18 power outages
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2:56 - 2:58per month.
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2:58 - 3:00Similarly compressed oxygen and other medical supplies
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3:00 - 3:02are really a luxury
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3:02 - 3:04and can often be out of stock
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3:04 - 3:06for months or even a year.
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3:06 - 3:09So it seems crazy, but the model that we have right now
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3:09 - 3:11is taking those machines
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3:11 - 3:13that were designed for that first environment that I showed you
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3:13 - 3:15and donating or selling them
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3:15 - 3:18to hospitals in this environment.
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3:18 - 3:20It's not just inappropriate,
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3:20 - 3:23it becomes really unsafe.
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3:23 - 3:25One of our partners at Johns Hopkins
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3:25 - 3:28was observing surgeries in Sierra Leone
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3:28 - 3:30about a year ago.
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3:30 - 3:33And the first surgery of the day happened to be an obstetrical case.
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3:33 - 3:36A woman came in, she needed an emergency C-section
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3:36 - 3:39to save her life and the life of her baby.
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3:39 - 3:41And everything began pretty auspiciously.
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3:41 - 3:43The surgeon was on call and scrubbed in.
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3:43 - 3:45The nurse was there.
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3:45 - 3:47She was able to anesthetize her quickly,
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3:47 - 3:50and it was important because of the emergency nature of the situation.
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3:50 - 3:52And everything began well
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3:52 - 3:55until the power went out.
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3:55 - 3:57And now in the middle of this surgery,
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3:57 - 4:00the surgeon is racing against the clock to finish his case,
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4:00 - 4:02which he can do -- he's got a headlamp.
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4:02 - 4:04But the nurse is literally
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4:04 - 4:07running around a darkened operating theater
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4:07 - 4:09trying to find anything she can use to anesthetize her patient,
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4:09 - 4:11to keep her patient asleep.
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4:11 - 4:14Because her machine doesn't work when there's no power.
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4:15 - 4:18And now this routine surgery that many of you have probably experienced,
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4:18 - 4:20and others are probably the product of,
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4:20 - 4:23has now become a tragedy.
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4:23 - 4:26And what's so frustrating is this is not a singular event;
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4:26 - 4:28this happens across the developing world.
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4:28 - 4:3135 million surgeries are attempted every year
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4:31 - 4:33without safe anesthesia.
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4:33 - 4:35My colleague, Dr. Paul Fenton,
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4:35 - 4:37was living this reality.
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4:37 - 4:39He was the chief of anesthesiology
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4:39 - 4:41in a hospital in Malawi, a teaching hospital.
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4:41 - 4:43He went to work every day
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4:43 - 4:45in an operating theater like this one,
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4:45 - 4:48trying to deliver anesthesia and teach others how to do so
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4:48 - 4:50using that same equipment
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4:50 - 4:52that became so unreliable, and frankly unsafe,
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4:52 - 4:54in his hospital.
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4:54 - 4:56And after umpteen surgeries
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4:56 - 4:59and, you can imagine, really unspeakable tragedy,
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4:59 - 5:01he just said, "That's it. I'm done. That's enough.
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5:01 - 5:03There has to be something better."
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5:03 - 5:05So he took a walk down the hall
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5:05 - 5:07to where they threw all those machines that had just crapped out on them --
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5:07 - 5:09I think that's the scientific term --
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5:09 - 5:11and he just started tinkering.
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5:11 - 5:13He took one part from here and another from there,
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5:13 - 5:15and he tried to come up with a machine
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5:15 - 5:18that would work in the reality that he was facing.
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5:18 - 5:21And what he came up with was this guy,
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5:21 - 5:24the prototype for the Universal Anesthesia Machine --
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5:24 - 5:26a machine that would work
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5:26 - 5:28and anesthetize his patients
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5:28 - 5:32no matter the circumstances that his hospital had to offer.
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5:32 - 5:34Here it is back at home
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5:34 - 5:37at that same hospital, developed a little further, 12 years later,
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5:37 - 5:40working on patients from pediatrics to geriatrics.
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5:40 - 5:43Now let me show you a little bit about how this machine works.
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5:43 - 5:45Voila!
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5:45 - 5:47Here she is.
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5:47 - 5:49When you have electricity,
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5:49 - 5:51everything in this machine begins in the base.
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5:51 - 5:54There's a built-in oxygen concentrator down there.
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5:54 - 5:57Now you've heard me mention oxygen a few times at this point.
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5:57 - 5:59Essentially, to deliver anesthesia,
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5:59 - 6:01you want as pure oxygen as possible,
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6:01 - 6:03because eventually you're going to dilute it essentially
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6:03 - 6:05with the gas.
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6:05 - 6:07And the mixture that the patient inhales
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6:07 - 6:09needs to be at least a certain percentage oxygen
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6:09 - 6:11or else it can become dangerous.
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6:11 - 6:13But so in here when there's electricity,
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6:13 - 6:16the oxygen concentrator takes in room air.
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6:16 - 6:19Now we know room air is gloriously free,
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6:19 - 6:21it is abundant,
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6:21 - 6:23and it's already 21 percent oxygen.
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6:23 - 6:26So all this concentrator does is take that room air in, filter it
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6:26 - 6:28and send 95 percent pure oxygen
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6:28 - 6:30up and across here
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6:30 - 6:33where it mixes with the anesthetic agent.
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6:33 - 6:35Now before that mixture
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6:35 - 6:37hits the patient's lungs,
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6:37 - 6:39it's going to pass by here --
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6:39 - 6:41you can't see it, but there's an oxygen sensor here --
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6:41 - 6:43that's going to read out on this screen
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6:43 - 6:46the percentage of oxygen being delivered.
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6:46 - 6:48Now if you don't have power,
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6:48 - 6:51or, God forbid, the power cuts out in the middle of surgery,
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6:51 - 6:53this machine transitions automatically,
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6:53 - 6:55without even having to touch it,
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6:55 - 6:58to drawing in room air from this inlet.
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6:58 - 7:00Everything else is the same.
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7:00 - 7:02The only difference is that now
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7:02 - 7:05you're only working with 21 percent oxygen.
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7:05 - 7:08Now that used to be a dangerous guessing game,
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7:08 - 7:11because you only knew if you had given too little oxygen once something bad happened.
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7:11 - 7:14But we've put a long-life battery backup on here.
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7:14 - 7:16This is the only part that's battery backed up.
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7:16 - 7:18But this gives control to the provider,
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7:18 - 7:20whether there's power or not,
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7:20 - 7:22because they can adjust the flow
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7:22 - 7:25based on the percentage of oxygen they see that they're giving their patient.
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7:25 - 7:27In both cases,
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7:27 - 7:29whether you have power or not,
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7:29 - 7:31sometimes the patient needs help breathing.
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7:31 - 7:34It's just a reality of anesthesia. The lungs can be paralyzed.
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7:34 - 7:36And so we've just added this manual bellows.
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7:36 - 7:39We've seen surgeries for three or four hours
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7:39 - 7:42to ventilate the patient on this.
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7:42 - 7:45So it's a straightforward machine.
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7:45 - 7:47I shudder to say simple;
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7:47 - 7:49it's straightforward.
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7:49 - 7:51And it's by design.
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7:51 - 7:53And you do not need to be
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7:53 - 7:56a highly trained, specialized anesthesiologist to use this machine,
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7:56 - 7:59which is good because, in these rural district hospitals,
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7:59 - 8:02you're not going to get that level of training.
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8:02 - 8:05It's also designed for the environment that it will be used in.
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8:05 - 8:07This is an incredibly rugged machine.
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8:07 - 8:09It has to stand up
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8:09 - 8:11to the heat and the wear and tear that happens
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8:11 - 8:14in hospitals in these rural districts.
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8:14 - 8:16And so it's not going to break very easily,
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8:16 - 8:19but if it does, virtually every piece in this machine
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8:19 - 8:22can be swapped out and replaced
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8:22 - 8:25with a hex wrench and a screwdriver.
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8:25 - 8:27And finally, it's affordable.
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8:27 - 8:29This machine comes in
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8:29 - 8:31at an eighth of the cost
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8:31 - 8:34of the conventional machine that I showed you earlier.
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8:34 - 8:37So in other words, what we have here
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8:37 - 8:40is a machine that can enable surgery and save lives
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8:40 - 8:43because it was designed for its environment,
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8:43 - 8:45just like the first machine I showed you.
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8:45 - 8:47But we're not content to stop there.
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8:47 - 8:49Is it working?
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8:49 - 8:51Is this the design that's going to work in place?
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8:51 - 8:53Well we've seen good results so far.
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8:53 - 8:56This is in 13 hospitals in four countries,
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8:56 - 8:58and since 2010,
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8:58 - 9:00we've done well over 2,000 surgeries
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9:00 - 9:02with no clinically adverse events.
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9:02 - 9:04So we're thrilled.
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9:04 - 9:08This really seems like a cost-effective, scalable solution
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9:08 - 9:11to a problem that's really pervasive.
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9:11 - 9:13But we still want to be sure
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9:13 - 9:15that this is the most effective and safe device
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9:15 - 9:17that we can be putting into hospitals.
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9:17 - 9:19So to do that we've launched a number of partnerships
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9:19 - 9:21with NGOs and universities
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9:21 - 9:24to gather data on the user interface,
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9:24 - 9:26on the types of surgeries it's appropriate for
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9:26 - 9:28and ways we can enhance the device itself.
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9:28 - 9:30One of those partnerships
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9:30 - 9:33is with Johns Hopkins just here in Baltimore.
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9:33 - 9:37They have a really cool anesthesia simulation lab out in Baltimore.
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9:37 - 9:39So we're taking this machine
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9:39 - 9:42and recreating some of the operating theater crises
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9:42 - 9:44that this machine might face
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9:44 - 9:46in one of the hospitals that it's intended for,
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9:46 - 9:49and in a contained, safe environment,
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9:49 - 9:51evaluating its effectiveness.
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9:51 - 9:54We're then able to compare the results from that study
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9:54 - 9:56with real world experience,
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9:56 - 9:58because we're putting two of these in hospitals
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9:58 - 10:00that Johns Hopkins works with in Sierra Leone,
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10:00 - 10:03including the hospital where that emergency C-section happened.
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10:05 - 10:08So I've talked a lot about anesthesia, and I tend to do that.
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10:08 - 10:10I think it is incredibly fascinating
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10:10 - 10:12and an important component of health.
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10:12 - 10:15And it really seems peripheral, we never think about it,
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10:15 - 10:17until we don't have access to it,
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10:17 - 10:19and then it becomes a gatekeeper.
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10:19 - 10:21Who gets surgery and who doesn't?
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10:21 - 10:24Who gets safe surgery and who doesn't?
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10:24 - 10:27But you know, it's just one of so many ways
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10:27 - 10:30that design, appropriate design,
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10:30 - 10:33can have an impact on health outcomes.
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10:33 - 10:35If more people in the health delivery space
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10:35 - 10:38really working on some of these challenges in low-income countries
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10:38 - 10:40could start their design process,
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10:40 - 10:42their solution search,
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10:42 - 10:44from outside of that proverbial box
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10:44 - 10:46and inside of the hospital --
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10:46 - 10:48in other words, if we could design
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10:48 - 10:51for the environment that exists in so many parts of the world,
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10:51 - 10:53rather than the one that we wished existed --
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10:53 - 10:56we might just save a lot of lives.
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10:56 - 10:58Thank you very much.
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10:58 - 11:02(Applause)
- Title:
- The universal anesthesia machine
- Speaker:
- Erica Frenkel
- Description:
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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.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 11:03
Krystian Aparta commented on English subtitles for The universal anesthesia machine | ||
Krystian Aparta edited English subtitles for The universal anesthesia machine | ||
TED edited English subtitles for The universal anesthesia machine | ||
TED added a translation |
Krystian Aparta
The English transcript was updated on 11/9/2016.