The universal anesthesia machine | Erica Frenkel | TEDxMidAtlantic
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0:01 - 0:02I'm going to talk to you today
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0:02 - 0:06about the design of medical technology
for low-resource settings. -
0:06 - 0:08I study health systems in these countries.
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0:08 - 0:10And one of the major gaps in care,
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0:10 - 0:12almost across the board,
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0:12 - 0:14is access to safe surgery.
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0:14 - 0:17Now one of the major
bottlenecks that we've found -
0:17 - 0:20that's sort of preventing
both the access in the first place, -
0:20 - 0:23and the safety of those surgeries
that do happen, is anesthesia. -
0:24 - 0:26And actually, it's the model
that we expect to work -
0:26 - 0:29for delivering anesthesia
in these environments. -
0:30 - 0:33Here, we have a scene that you would find
in any operating room across the US, -
0:33 - 0:35or any other developed country.
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0:35 - 0:36In the background there
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0:36 - 0:39is a very sophisticated
anesthesia machine. -
0:39 - 0:43And this machine is able
to enable surgery and save lives -
0:43 - 0:46because it was designed
with this environment in mind. -
0:46 - 0:49In order to operate,
this machine needs a number of things -
0:49 - 0:51that this hospital has to offer.
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0:51 - 0:55It needs an extremely
well-trained anesthesiologist -
0:55 - 0:57with years of training
with complex machines -
0:57 - 0:59to help her monitor the flows of the gas
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1:00 - 1:02and keep her patients
safe and anesthetized -
1:02 - 1:04throughout the surgery.
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1:04 - 1:06It's a delicate machine
running on computer algorithms, -
1:06 - 1:10and it needs special care, TLC,
to keep it up and running, -
1:10 - 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 -
1:14 - 1:18who understand its complexities,
can fix it, can source the parts -
1:18 - 1:20and keep it saving lives.
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1:21 - 1:22It's a pretty expensive machine.
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1:22 - 1:25It needs a hospital
whose budget can allow it -
1:25 - 1:30to support one machine
costing upwards of 50 or $100,000. -
1:30 - 1:32And perhaps most obviously,
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1:32 - 1:34but also most importantly --
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1:34 - 1:37and the path to concepts
that we've heard about -
1:37 - 1:38kind of illustrates this --
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1:38 - 1:43it needs infrastructure that can supply
an uninterrupted source of electricity, -
1:43 - 1:46of compressed oxygen,
and other medical supplies -
1:46 - 1:50that are so critical
to the functioning of this machine. -
1:50 - 1:54In other words, this machine
requires a lot of stuff -
1:54 - 1:56that this hospital cannot offer.
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1:56 - 1:59This is the electrical supply
for a hospital in rural Malawi. -
2:00 - 2:01In this hospital,
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2:01 - 2:04there is one person qualified
to deliver anesthesia, -
2:04 - 2:05and she's qualified
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2:05 - 2:10because she has 12, maybe 18 months
of training in anesthesia. -
2:10 - 2:12In the hospital and in the entire region
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2:12 - 2:14there's not a single biomedical engineer.
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2:14 - 2:16So when this machine breaks,
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2:16 - 2:18the machines that they have
to work with break, -
2:18 - 2:20they've got to try and figure it out,
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2:20 - 2:22but most of the time,
that's the end of the road. -
2:22 - 2:24Those machines go the proverbial junkyard.
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2:24 - 2:27And the price tag
of the machine that I mentioned -
2:27 - 2:29could represent maybe a quarter or a third
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2:29 - 2:32of the annual operating budget
for this hospital. -
2:33 - 2:36And finally, I think you can see
that infrastructure is not very strong. -
2:36 - 2:39This hospital is connected
to a very weak power grid, -
2:39 - 2:40one that goes down frequently.
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2:40 - 2:43So it runs frequently,
the entire hospital, -
2:43 - 2:44just on a generator.
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2:45 - 2:47And you can imagine,
the generator breaks down -
2:47 - 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 - 2:54and estimates that a hospital
in this setting in a low-income country -
2:54 - 2:57can expect up to
18 power outages per month. -
2:59 - 3:02Similarly, compressed oxygen
and other medical supplies -
3:02 - 3:03are really a luxury,
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3:03 - 3:06and can often be out of stock
for months or even a year. -
3:06 - 3:10So it seems crazy, but the model
that we have right now -
3:10 - 3:12is taking those machines
that were designed -
3:12 - 3:14for that first environment
that I showed you -
3:14 - 3:18and donating or selling them
to hospitals in this environment. -
3:19 - 3:20It's not just inappropriate,
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3:20 - 3:23it becomes really unsafe.
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3:24 - 3:25One of our partners at Johns Hopkins
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3:25 - 3:30was observing surgeries in Sierra Leone
about a year ago. -
3:30 - 3:34And the first surgery of the day
happened to be an obstetrical case. -
3:34 - 3:37A woman came in,
she needed an emergency C-section -
3:37 - 3:39to save her life and the life of her baby.
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3:40 - 3:42And everything began pretty auspiciously.
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3:42 - 3:44The surgeon was on call and scrubbed in.
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3:44 - 3:45The nurse was there.
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3:45 - 3:48She was able to anesthetize her quickly,
and it was important -
3:48 - 3:51because of the emergency
nature of the situation. -
3:51 - 3:52And everything began well
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3:52 - 3:54until the power went out.
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3:56 - 3:58And now in the middle of this surgery,
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3:58 - 4:01the surgeon is racing
against the clock to finish his case, -
4:01 - 4:03which he can do -- he's got a headlamp.
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4:03 - 4:07But the nurse is literally running
around a darkened operating theater -
4:07 - 4:10trying to find anything
she can use to anesthetize her patient, -
4:10 - 4:12to keep her patient asleep.
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4:12 - 4:15Because her machine doesn't work
when there's no power. -
4:15 - 4:18This routine surgery that many of you
have probably experienced, -
4:19 - 4:23and others are probably the product of,
has now become a tragedy. -
4:24 - 4:26And what's so frustrating
is this is not a singular event; -
4:26 - 4:29this happens across the developing world.
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4:29 - 4:3235 million surgeries
are attempted every year -
4:32 - 4:34without safe anesthesia.
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4:34 - 4:37My colleague, Dr. Paul Fenton,
was living this reality. -
4:37 - 4:39He was the chief of anesthesiology
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4:39 - 4:42in a hospital in Malawi,
a teaching hospital. -
4:42 - 4:44He went to work every day
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4:44 - 4:46in an operating theater like this one,
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4:46 - 4:49trying to deliver anesthesia
and teach others how to do so -
4:49 - 4:50using that same equipment
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4:50 - 4:54that became so unreliable,
and frankly unsafe, in his hospital. -
4:55 - 4:57And after umpteen surgeries
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4:57 - 4:59and, you can imagine,
really unspeakable tragedy, -
4:59 - 5:02he just said, "That's it.
I'm done. That's enough. -
5:02 - 5:04There has to be something better."
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5:04 - 5:06He took a walk down the hall
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5:06 - 5:09to where they threw all those machines
that had just crapped out on them, -
5:09 - 5:11I think that's the scientific term,
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5:11 - 5:12and he started tinkering.
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5:12 - 5:15He took one part from here
and another from there, -
5:15 - 5:17and he tried to come up
with a machine that would work -
5:17 - 5:19in the reality that he was facing.
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5:19 - 5:20And what he came up with:
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5:20 - 5:22was this guy.
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5:22 - 5:25The prototype for the Universal
Anesthesia Machine -- -
5:25 - 5:28a machine that would work
and anesthetize his patients -
5:28 - 5:32no matter the circumstances
that his hospital had to offer. -
5:33 - 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, -
5:37 - 5:41working on patients
from pediatrics to geriatrics. -
5:41 - 5:44Let me show you a little bit
about how this machine works. -
5:44 - 5:46Voila!
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5:46 - 5:48Here she is.
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5:48 - 5:49When you have electricity,
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5:49 - 5:52everything in this machine
begins in the base. -
5:52 - 5:55There's a built-in
oxygen concentrator down there. -
5:55 - 5:58Now you've heard me mention
oxygen a few times at this point. -
5:58 - 6:02Essentially, to deliver anesthesia,
you want as pure oxygen as possible, -
6:02 - 6:05because eventually you're going
to dilute it, essentially, with the gas. -
6:05 - 6:07And the mixture that the patient inhales
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6:07 - 6:10needs to be at least
a certain percentage oxygen -
6:10 - 6:12or else it can become dangerous.
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6:12 - 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 - 6:20Now we know room air is gloriously free,
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6:20 - 6:21it is abundant,
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6:21 - 6:23and it's already 21 percent oxygen.
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6:23 - 6:27So all this concentrator does
is take that room air in, filter it -
6:27 - 6:31and send 95 percent pure oxygen
up and across here, -
6:31 - 6:33where it mixes with the anesthetic agent.
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6:34 - 6:37Now before that mixture
hits the patient's lungs, -
6:37 - 6:40it's going to pass by here --
you can't see it, -
6:40 - 6:41but there's an oxygen sensor here --
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6:41 - 6:46that's going to read out on this screen
the percentage of oxygen being delivered. -
6:46 - 6:48Now if you don't have power,
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6:48 - 6:52or, God forbid, the power cuts out
in the middle of a surgery, -
6:52 - 6:54this machine transitions automatically,
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6:54 - 6:56without even having to touch it,
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6:56 - 6:58to drawing in room air from this inlet.
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6:59 - 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. -
7:05 - 7:08Now that used to be
a dangerous guessing game, -
7:08 - 7:11because you only knew
if you gave too little oxygen -
7:11 - 7:12once something bad happened.
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7:12 - 7:15But we've put a long-life
battery backup on here. -
7:15 - 7:17This is the only part
that's battery backed up. -
7:17 - 7:20But this gives control to the provider,
whether there's power or not, -
7:20 - 7:22because they can adjust the flows
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7:22 - 7:26based on the percentage of oxygen
they see that they're giving the patient. -
7:26 - 7:29In both cases,
whether you have power or not, -
7:29 - 7:31sometimes the patient
needs help breathing. -
7:31 - 7:35It's just a reality of anesthesia,
the lungs can be paralyzed. -
7:35 - 7:37And so we've just added
this manual bellows. -
7:37 - 7:40We've seen surgeries
for three or four hours -
7:40 - 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 - 7:48I shudder to say simple;
it's straightforward. -
7:49 - 7:51And it's by design.
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7:51 - 7:56You do not need to be a highly trained,
specialized anesthesiologist -
7:56 - 7:57to use this machine,
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7:57 - 8:00which is good because,
in these rural district hospitals, -
8:00 - 8:03you're not going to get
that level of training. -
8:03 - 8:06It's also designed for the environment
that it will be used in. -
8:06 - 8:08This is an incredibly rugged machine.
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8:08 - 8:11It has to stand up to the heat
and the wear and tear -
8:11 - 8:14that happens in hospitals
in these rural districts. -
8:14 - 8:17And so it's not going
to break very easily, -
8:17 - 8:20but if it does, virtually
every piece in this machine -
8:20 - 8:22can be swapped out and replaced
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8:22 - 8:24with a hex wrench and a screwdriver.
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8:26 - 8:28And finally, it's affordable.
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8:28 - 8:32This machine comes in
at an eighth of the cost -
8:32 - 8:35of the conventional machine
that I showed you earlier. -
8:35 - 8:39So in other words, what we have here
is a machine that can enable surgery -
8:39 - 8:40and save lives,
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8:41 - 8:44because it was designed
for its environment, -
8:44 - 8:46just like the first machine I showed you.
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8:46 - 8:48But we're not content to stop there.
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8:48 - 8:49Is it working?
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8:49 - 8:52Is this the design
that's going to work in place? -
8:52 - 8:54Well, we've seen good results so far.
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8:54 - 8:57This is in 13 hospitals in four countries,
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8:57 - 9:01and since 2010, we've done
well over 2,000 surgeries -
9:01 - 9:03with no clinically adverse events.
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9:04 - 9:05So we're thrilled.
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9:05 - 9:09This really seems like
a cost-effective, scalable solution -
9:09 - 9:11to a problem that's really pervasive.
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9:12 - 9:13But we still want to be sure
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9:13 - 9:16that this is the most effective
and safe device -
9:16 - 9:18that we can be putting into hospitals.
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9:18 - 9:20So to do that, we've launched
a number of partnerships -
9:20 - 9:22with NGOs and universities,
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9:22 - 9:25to gather data on the user interface,
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9:25 - 9:27on the types of surgeries
it's appropriate for, -
9:27 - 9:29and ways we can enhance the device itself.
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9:29 - 9:32One of those partnerships
is with Johns Hopkins -
9:32 - 9:33just here in Baltimore.
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9:33 - 9:38They have a really cool anesthesia
simulation lab out in Baltimore. -
9:38 - 9:39So we're taking this machine
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9:39 - 9:43and recreating some
of the operating theater crises -
9:43 - 9:45that this machine might face
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9:45 - 9:47in one of the hospitals
that it's intended for, -
9:47 - 9:49and in a contained, safe environment,
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9:49 - 9:51evaluating its effectiveness.
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9:51 - 9:55We're then able to compare
the results from that study -
9:55 - 9:56with real-world experience,
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9:56 - 9:59because we're putting
two of these in hospitals -
9:59 - 10:01that Johns Hopkins
works with in Sierra Leone, -
10:01 - 10:04including the hospital
where that emergency C-section happened. -
10:05 - 10:09So I've talked a lot about anesthesia,
and I tend to do that. -
10:09 - 10:13I think it is incredibly fascinating
and an important component of health. -
10:13 - 10:15And it really seems peripheral,
we never think about it, -
10:15 - 10:18until we don't have access to it,
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10:18 - 10:19and then it becomes a gatekeeper.
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10:20 - 10:21Who gets surgery and who doesn't?
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10:22 - 10:25Who gets safe surgery and who doesn't?
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10:25 - 10:28But you know,
it's just one of so many ways -
10:28 - 10:31that design, appropriate design,
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10:31 - 10:33can have an impact on health outcomes.
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10:33 - 10:35If more people
in the health-delivery space -
10:35 - 10:39really working on some of these
challenges in low-income countries -
10:39 - 10:43could start their design process,
their solution search, -
10:43 - 10:45from outside of that proverbial box
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10:45 - 10:47and inside of the hospital --
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10:47 - 10:48In other words, if we could design
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10:49 - 10:52for the environment that exists
in so many parts of the world, -
10:52 - 10:54rather than the one
that we wished existed -- -
10:54 - 10:56we might just save a lot of lives.
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10:57 - 10:58Thank you very much.
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10:58 - 11:03(Applause)
- Title:
- The universal anesthesia machine | Erica Frenkel | TEDxMidAtlantic
- Description:
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Erica Frenkel helps lead UAM Global, a social enterprise enabling safe surgery through innovative anesthesia technology. She has been a Peace Corps volunteer, managed the Global Media AIDS Initiative for the Kaiser Family Foundation and helped shape public health initiatives as a consultant for the Clinton Foundation, the Liberian Ministry of Health, Merck Vaccines, and the Wellcome Trust.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDxTalks
- Duration:
- 11:34
TED Translators admin edited English subtitles for TEDxMidAtlantic 2011 - Erica Frenkel - Demonstrating the Universal Anesthesia Machine | ||
Ivana Korom edited English subtitles for TEDxMidAtlantic 2011 - Erica Frenkel - Demonstrating the Universal Anesthesia Machine | ||
Ivana Korom edited English subtitles for TEDxMidAtlantic 2011 - Erica Frenkel - Demonstrating the Universal Anesthesia Machine |