The universal anesthesia machine | Erica Frenkel | TEDxMidAtlantic
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0:05 - 0:07I'm going to talk to that guy,
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0:07 - 0:10I need one of those bottles
for my appartment in Park Slope. -
0:10 - 0:12Thanks for having me.
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0:12 - 0:13I'm going to talk to you today
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0:13 - 0:16about the design of medical technology
for low-resource settings. -
0:16 - 0:19Some of the countries
that Arun just highlighted -
0:19 - 0:20that were dark in that map.
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0:21 - 0:23I study health systems in these countries.
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0:23 - 0:25And one of the major gaps in care,
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0:25 - 0:26almost across the board,
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0:26 - 0:29is access to safe surgery.
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0:29 - 0:31Now one of the major
bottlenecks that we've found -
0:31 - 0:35that's sort of preventing
both the access in the first place, -
0:35 - 0:38and the safety of those surgeries
that do happen, is anesthesia. -
0:39 - 0:41And actually, it's the model
that we expect to work -
0:41 - 0:44for delivering anesthesia
in these environments. -
0:44 - 0:48Here, we have a scene that you would find
in any operating room across the US, -
0:49 - 0:50or any other developed country.
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0:50 - 0:51In the background there
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0:52 - 0:54is a very sophisticated
anesthesia machine. -
0:54 - 0:58And this machine is able
to enable surgery and save lives -
0:58 - 1:02because it was designed
with this environment in mind. -
1:02 - 1:05In order to operate,
this machine needs a number of things -
1:05 - 1:07that this hospital has to offer.
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1:07 - 1:10It needs an extremely
well-trained anesthesiologist -
1:10 - 1:12with years of training
with complex machines -
1:12 - 1:15to help her monitor the flows of the gas
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1:15 - 1:17and keep her patients
safe and anesthetized -
1:18 - 1:19throughout the surgery.
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1:19 - 1:22It's a delicate machine
running on computer algorithms, -
1:22 - 1:26and it needs special care, TLC,
to keep it up and running, -
1:26 - 1:28and it's going to break pretty easily.
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1:28 - 1:31And when it does, it needs
a team of biomedical engineers -
1:31 - 1:34who understand its complexities,
can fix it, can source the parts -
1:34 - 1:36and keep it saving lives.
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1:37 - 1:39It's a pretty expensive machine.
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1:39 - 1:41It needs a hospital
whose budget can allow it -
1:41 - 1:46to support one machine
costing upwards of 50 or $100,000. -
1:47 - 1:49And perhaps most obviously,
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1:49 - 1:50but also most importantly --
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1:50 - 1:53and the path to concepts
that we've heard about -
1:53 - 1:54kind of illustrates this --
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1:54 - 2:00it needs infrastructure that can supply
an uninterrupted source of electricity, -
2:00 - 2:03of compressed oxygen,
and other medical supplies -
2:03 - 2:07that are so critical
to the functioning of this machine. -
2:07 - 2:11In other words, this machine
requires a lot of stuff -
2:11 - 2:13that this hospital cannot offer.
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2:13 - 2:16This is the electrical supply
for a hospital in rural Malawi. -
2:17 - 2:18In this hospital,
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2:18 - 2:21there is one person qualified
to deliver anesthesia, -
2:21 - 2:22and she's qualified
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2:22 - 2:27because she has 12, maybe 18 months
of training in anesthesia. -
2:27 - 2:29In the hospital and in the entire region
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2:29 - 2:31there's not a single biomedical engineer.
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2:31 - 2:33So when this machine breaks,
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2:33 - 2:35the machines that they have
to work with break, -
2:35 - 2:37they've got to try and figure it out,
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2:37 - 2:39but most of the time,
that's the end of the road. -
2:39 - 2:41Those machines go the proverbial junkyard.
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2:42 - 2:45And the price tag
of the machine that I mentioned -
2:45 - 2:47could represent maybe a quarter or a third
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2:47 - 2:50of the annual operating budget
for this hospital. -
2:51 - 2:54And finally, I think you can see
that infrastructure is not very strong. -
2:54 - 2:57This hospital is connected
to a very weak power grid, -
2:57 - 2:59one that goes down frequently.
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2:59 - 3:01So it runs frequently,
the entire hospital, -
3:01 - 3:03just on a generator.
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3:03 - 3:05And you can imagine,
the generator breaks down -
3:05 - 3:06or runs out of fuel.
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3:07 - 3:09And the World Bank sees this
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3:09 - 3:12and estimates that a hospital
in this setting in a low-income country -
3:12 - 3:15can expect up to
18 power outages per month. -
3:17 - 3:20Similarly, compressed oxygen
and other medical supplies -
3:20 - 3:21are really a luxury,
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3:21 - 3:25and can often be out of stock
for months or even a year. -
3:25 - 3:28So it seems crazy, but the model
that we have right now -
3:28 - 3:30is taking those machines
that were designed -
3:30 - 3:32for that first environment
that I showed you -
3:33 - 3:36and donating or selling them
to hospitals in this environment. -
3:37 - 3:39It's not just inappropriate,
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3:39 - 3:41it becomes really unsafe.
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3:42 - 3:44One of our partners at Johns Hopkins
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3:44 - 3:49was observing surgeries in Sierra Leone
about a year ago. -
3:49 - 3:53And the first surgery of the day
happened to be an obstetrical case. -
3:53 - 3:56A woman came in,
she needed an emergency C-section -
3:56 - 3:58to save her life and the life of her baby.
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3:59 - 4:01And everything began pretty auspiciously.
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4:01 - 4:03The surgeon was on call and scrubbed in.
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4:03 - 4:04The nurse was there.
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4:04 - 4:07She was able to anesthetize her quickly,
and it was important -
4:07 - 4:10because of the emergency
nature of the situation. -
4:10 - 4:11And everything began well
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4:14 - 4:16until the power went out.
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4:17 - 4:19And now in the middle of this surgery,
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4:19 - 4:22the surgeon is racing
against the clock to finish his case, -
4:22 - 4:24which he can do -- he's got a headlamp.
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4:24 - 4:28But the nurse is literally running
around a darkened operating theater -
4:28 - 4:31trying to find anything
she can use to anesthetize her patient, -
4:31 - 4:33to keep her patient asleep.
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4:33 - 4:36Because her machine doesn't work
when there's no power. -
4:37 - 4:40This routine surgery that many of you
have probably experienced, -
4:40 - 4:45and others are probably the product of,
has now become a tragedy. -
4:46 - 4:49And what's so frustrating
is this is not a singular event; -
4:49 - 4:51this happens across the developing world.
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4:51 - 4:5435 million surgeries
are attempted every year -
4:54 - 4:56without safe anesthesia.
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4:57 - 5:00My colleague, Dr. Paul Fenton,
was living this reality. -
5:00 - 5:01He was the chief of anesthesiology
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5:02 - 5:04in a hospital in Malawi,
a teaching hospital. -
5:05 - 5:06He went to work every day
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5:06 - 5:08in an operating theater like this one,
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5:08 - 5:11trying to deliver anesthesia
and teach others how to do so -
5:11 - 5:12using that same equipment
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5:12 - 5:17that became so unreliable,
and frankly unsafe, in his hospital. -
5:18 - 5:19And after umpteen surgeries
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5:19 - 5:22and, you can imagine,
really unspeakable tragedy, -
5:22 - 5:24he just said, "That's it.
I'm done. That's enough. -
5:24 - 5:26There has to be something better."
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5:27 - 5:28He took a walk down the hall
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5:28 - 5:32to where they threw all those machines
that had just crapped out on them, -
5:32 - 5:33I think that's the scientific term,
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5:33 - 5:35and he started tinkering.
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5:35 - 5:37He took one part from here
and another from there, -
5:37 - 5:40and he tried to come up
with a machine that would work -
5:40 - 5:41in the reality that he was facing.
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5:42 - 5:43And what he came up with:
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5:43 - 5:45was this guy.
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5:45 - 5:48The prototype for the Universal
Anesthesia Machine -- -
5:48 - 5:52a machine that would work
and anesthetize his patients -
5:52 - 5:55no matter the circumstances
that his hospital had to offer. -
5:56 - 5:57Here it is, back at home
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5:57 - 6:01at that same hospital, developed
a little further, 12 years later, -
6:01 - 6:04working on patients
from pediatrics to geriatrics. -
6:04 - 6:07Let me show you a little bit
about how this machine works. -
6:07 - 6:09Voila!
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6:10 - 6:11Here she is.
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6:11 - 6:13When you have electricity,
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6:13 - 6:16everything in this machine
begins in the base. -
6:16 - 6:18There's a built-in
oxygen concentrator down there. -
6:18 - 6:21Now you've heard me mention
oxygen a few times at this point. -
6:21 - 6:25Essentially, to deliver anesthesia,
you want as pure oxygen as possible, -
6:25 - 6:29because eventually you're going
to dilute it, essentially, with the gas. -
6:29 - 6:31And the mixture that the patient inhales
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6:31 - 6:33needs to be at least
a certain percentage oxygen -
6:33 - 6:35or else it can become dangerous.
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6:35 - 6:37But so in here when there's electricity,
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6:37 - 6:40the oxygen concentrator takes in room air.
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6:40 - 6:43Now we know room air is gloriously free,
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6:43 - 6:45it is abundant,
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6:45 - 6:47and it's already 21 percent oxygen.
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6:47 - 6:51So all this concentrator does
is take that room air in, filter it -
6:51 - 6:54and send 95 percent pure oxygen
up and across here, -
6:54 - 6:57where it mixes with the anesthetic agent.
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6:57 - 7:01Now before that mixture
hits the patient's lungs, -
7:01 - 7:03it's going to pass by here --
you can't see it, -
7:03 - 7:05but there's an oxygen sensor here --
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7:05 - 7:09that's going to read out on this screen
the percentage of oxygen being delivered. -
7:10 - 7:12Now if you don't have power,
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7:12 - 7:15or, God forbid, the power cuts out
in the middle of a surgery, -
7:15 - 7:18this machine transitions automatically,
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7:18 - 7:20without even having to touch it,
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7:20 - 7:22to drawing in room air from this inlet.
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7:22 - 7:24Everything else is the same.
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7:24 - 7:25The only difference is that now
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7:25 - 7:28you're only working
with 21 percent oxygen. -
7:29 - 7:32Now that used to be
a dangerous guessing game, -
7:32 - 7:34because you only knew
if you gave too little oxygen -
7:34 - 7:36once something bad happened.
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7:36 - 7:38But we've put a long-life
battery backup on here. -
7:38 - 7:40This is the only part
that's battery backed up. -
7:41 - 7:44But this gives control to the provider,
whether there's power or not, -
7:44 - 7:46because they can adjust the flows
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7:46 - 7:50based on the percentage of oxygen
they see that they're giving the patient. -
7:50 - 7:53In both cases,
whether you have power or not, -
7:53 - 7:55sometimes the patient
needs help breathing. -
7:55 - 7:58It's just a reality of anesthesia,
the lungs can be paralyzed. -
7:58 - 8:00And so we've just added
this manual bellows. -
8:00 - 8:03We've seen surgeries
for three or four hours -
8:03 - 8:05to ventilate the patient on this.
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8:06 - 8:09So it's a straightforward machine.
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8:09 - 8:12I shudder to say simple;
it's straightforward. -
8:12 - 8:14And it's by design.
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8:14 - 8:20You do not need to be a highly trained,
specialized anesthesiologist -
8:20 - 8:21to use this machine,
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8:21 - 8:24which is good because,
in these rural district hospitals, -
8:24 - 8:26you're not going to get
that level of training. -
8:27 - 8:30It's also designed for the environment
that it will be used in. -
8:30 - 8:32This is an incredibly rugged machine.
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8:32 - 8:35It has to stand up to the heat
and the wear and tear -
8:35 - 8:38that happens in hospitals
in these rural districts. -
8:38 - 8:41And so it's not going
to break very easily, -
8:41 - 8:44but if it does, virtually
every piece in this machine -
8:44 - 8:46can be swapped out and replaced
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8:46 - 8:48with a hex wrench and a screwdriver.
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8:50 - 8:52And finally, it's affordable.
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8:52 - 8:56This machine comes in
at an eighth of the cost -
8:56 - 8:59of the conventional machine
that I showed you earlier. -
8:59 - 9:03So in other words, what we have here
is a machine that can enable surgery -
9:03 - 9:04and save lives,
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9:04 - 9:07because it was designed
for its environment, -
9:07 - 9:10just like the first machine I showed you.
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9:10 - 9:12But we're not content to stop there.
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9:12 - 9:13Is it working?
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9:13 - 9:16Is this the design
that's going to work in place? -
9:16 - 9:17Well, we've seen good results so far.
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9:18 - 9:21This is in 13 hospitals in four countries,
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9:21 - 9:25and since 2010, we've done
well over 2,000 surgeries -
9:25 - 9:27with no clinically adverse events.
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9:27 - 9:29So we're thrilled.
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9:29 - 9:33This really seems like
a cost-effective, scalable solution -
9:33 - 9:35to a problem that's really pervasive.
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9:36 - 9:37But we still want to be sure
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9:37 - 9:40that this is the most effective
and safe device -
9:40 - 9:42that we can be putting into hospitals.
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9:42 - 9:44So to do that, we've launched
a number of partnerships -
9:44 - 9:46with NGOs and universities,
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9:46 - 9:48to gather data on the user interface,
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9:48 - 9:51on the types of surgeries
it's appropriate for, -
9:51 - 9:53and ways we can enhance the device itself.
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9:54 - 9:56One of those partnerships
is with Johns Hopkins -
9:56 - 9:58just here in Baltimore.
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9:58 - 10:02They have a really cool anesthesia
simulation lab out in Baltimore. -
10:02 - 10:04So we're taking this machine
-
10:04 - 10:08and recreating some
of the operating theater crises -
10:08 - 10:10that this machine might face
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10:10 - 10:12in one of the hospitals
that it's intended for, -
10:12 - 10:14and in a contained, safe environment,
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10:14 - 10:16evaluating its effectiveness.
-
10:17 - 10:20We're then able to compare
the results from that study -
10:20 - 10:22with real-world experience,
-
10:22 - 10:24because we're putting
two of these in hospitals -
10:24 - 10:26that Johns Hopkins
works with in Sierra Leone, -
10:26 - 10:29including the hospital
where that emergency C-section happened. -
10:31 - 10:34So I've talked a lot about anesthesia,
and I tend to do that. -
10:34 - 10:38I think it is incredibly fascinating
and an important component of health. -
10:38 - 10:40And it really seems peripheral,
we never think about it, -
10:41 - 10:43as he said when he was introducing me,
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10:43 - 10:45until we don't have access to it,
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10:46 - 10:48and then it becomes a gatekeeper.
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10:48 - 10:50Who gets surgery and who doesn't?
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10:50 - 10:53Who gets safe surgery and who doesn't?
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10:53 - 10:56But you know,
it's just one of so many ways -
10:56 - 10:59that design, appropriate design,
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10:59 - 11:01can have an impact on health outcomes.
-
11:02 - 11:04If more people
in the health-delivery space -
11:04 - 11:07really working on some of these
challenges in low-income countries -
11:07 - 11:11could start their design process,
their solution search, -
11:11 - 11:13from outside of that proverbial box
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11:13 - 11:15and inside of the hospital --
-
11:15 - 11:17In other words, if we could design
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11:17 - 11:20for the environment that exists
in so many parts of the world, -
11:20 - 11:23rather than the one
that we wished existed -- -
11:24 - 11:27we might just save a lot of lives.
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11:27 - 11:28Thank you very much.
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11:28 - 11:33(Applause)
- Title:
- The universal anesthesia machine | Erica Frenkel | TEDxMidAtlantic
- 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.
- 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 |