WEBVTT 00:00:22.365 --> 00:00:26.005 My name is Dr. Moses deGraft-Johnson. 00:00:26.005 --> 00:00:28.363 The term “assistive technology” is defined 00:00:28.363 --> 00:00:31.563 by the World Health Organization (WHO) 00:00:31.563 --> 00:00:35.003 as an umbrella term that covers 00:00:35.003 --> 00:00:37.443 systems and services that are related to 00:00:37.443 --> 00:00:40.233 the delivery of assistive products and 00:00:40.233 --> 00:00:42.547 services, and the whole purpose 00:00:42.547 --> 00:00:44.757 of this is to aid an individual by giving 00:00:44.757 --> 00:00:46.877 them independence and promoting their 00:00:46.877 --> 00:00:50.347 overall well-being. 00:00:50.347 --> 00:00:53.447 Now, as my colleague here just showed us 00:00:53.447 --> 00:00:57.037 some very cool innovations, 00:00:57.037 --> 00:01:00.047 some of the innovations that we 00:01:00.047 --> 00:01:02.487 are very familiar with are the simplest 00:01:02.487 --> 00:01:04.857 things such as the hearing aids, 00:01:04.857 --> 00:01:07.027 wheelchairs, and the prosthesis. Even 00:01:07.027 --> 00:01:09.287 something as simple as pill organizers, 00:01:09.287 --> 00:01:11.647 because this is something even people 00:01:11.647 --> 00:01:14.667 without a true disability utilize, you 00:01:14.667 --> 00:01:19.597 know? My mother utilizes pill organizers. 00:01:19.597 --> 00:01:21.427 So we find that there are certain 00:01:21.427 --> 00:01:23.487 assistive technologies that even 00:01:23.487 --> 00:01:25.487 individuals who do not have a true 00:01:25.487 --> 00:01:29.487 disability also utilize in their daily 00:01:29.487 --> 00:01:32.117 lives. And we’re seeing more and more 00:01:32.117 --> 00:01:33.705 of that globally; more than 00:01:33.705 --> 00:01:35.475 one billion people need one or more 00:01:35.475 --> 00:01:39.475 assistive products. 00:01:40.020 --> 00:01:42.190 Now this is the part that I really want to 00:01:42.190 --> 00:01:48.630 get into, because this really talks about 00:01:48.630 --> 00:01:50.468 what I do for a living, 00:01:50.468 --> 00:01:52.928 and recently what we’ve seen is that the 00:01:52.928 --> 00:01:55.258 World Health Organization released some 00:01:55.258 --> 00:01:58.608 data, and what we see is a rise in 00:01:58.608 --> 00:02:01.428 non-communicable diseases that are 00:02:01.428 --> 00:02:06.058 causing persons with disability. 00:02:06.058 --> 00:02:09.328 And one of the most common ones that was 00:02:09.328 --> 00:02:12.518 mentioned was diabetes. But also, along 00:02:12.518 --> 00:02:15.908 with diabetes was hypertension and 00:02:15.908 --> 00:02:17.908 hyperlipidemia, also known simply 00:02:17.908 --> 00:02:22.028 as high cholesterol, obesity, and smoking. 00:02:22.033 --> 00:02:25.173 Now what’s interesting is that these five 00:02:25.173 --> 00:02:29.703 variables are also known in cardiovascular 00:02:29.703 --> 00:02:33.813 medicine as the five major risk factors 00:02:33.813 --> 00:02:36.469 for a major cardiovascular event 00:02:36.469 --> 00:02:41.029 They lead to something called atheromatous plaque. 00:02:41.029 --> 00:02:43.869 This is plaque formation of buildup in 00:02:43.869 --> 00:02:47.869 our blood vessels. This is an example of a 00:02:47.869 --> 00:02:51.229 normal coronary artery in the heart, 00:02:51.229 --> 00:02:55.229 and as we see, over time we get damages, 00:02:55.229 --> 00:02:58.089 buildups, and eventually we have lack of 00:02:58.089 --> 00:03:00.499 perfusion, or lack of blood flow. 00:03:00.499 --> 00:03:02.489 And that’s what eventually leads to heart 00:03:02.489 --> 00:03:04.709 attacks, strokes, and poor circulation, 00:03:04.709 --> 00:03:07.259 commonly known as “P-A-D.” 00:03:07.259 --> 00:03:09.459 Now, at the Heart and Vascular Institute, 00:03:09.459 --> 00:03:11.219 what we have done is we have an 00:03:11.219 --> 00:03:16.059 initiative called the "Save a Limb Initiative." 00:03:16.059 --> 00:03:19.459 One of the things that my goal was was to 00:03:19.459 --> 00:03:21.979 at least limit the amount of amputations 00:03:21.979 --> 00:03:25.964 that were occurring in that community. 00:03:26.016 --> 00:03:28.266 When we see patients who have these 00:03:28.266 --> 00:03:30.306 sorts of problems, the first thing we 00:03:30.306 --> 00:03:32.696 do after we’ve assessed them is called 00:03:32.696 --> 00:03:34.656 acute limb ischemia. We take them 00:03:34.656 --> 00:03:36.716 into the operating room and utilize a 00:03:36.716 --> 00:03:40.716 GE system called a C-ARM. 00:03:41.767 --> 00:03:44.177 What it does is it’s an X-ray that takes 00:03:44.177 --> 00:03:46.577 pictures of the legs from the bellybutton 00:03:46.577 --> 00:03:49.297 all the way down to the feet. 00:03:49.297 --> 00:03:52.837 We use contrast dye to inject into the 00:03:52.837 --> 00:03:56.693 patients so it will allow us to give us an 00:03:56.693 --> 00:03:59.153 image, sort of like this. 00:03:59.153 --> 00:04:00.913 So this first picture here… clearly you 00:04:00.913 --> 00:04:02.813 don’t need to be a doctor to see there’s a 00:04:02.813 --> 00:04:06.493 significant problem here. This is called 00:04:06.493 --> 00:04:08.473 This is called the superficial femoral 00:04:08.473 --> 00:04:10.593 artery. this is the big vessel that lies 00:04:10.593 --> 00:04:13.373 between your hip and your knee. 00:04:13.373 --> 00:04:15.813 It’s like a highway that’s not complete 00:04:15.813 --> 00:04:19.143 because there’s something missing here, 00:04:19.143 --> 00:04:20.643 right in the middle. 00:04:20.643 --> 00:04:22.747 So this individual has developed a 00:04:22.747 --> 00:04:25.351 blockage in that blood vessel that has 00:04:25.351 --> 00:04:27.961 definitely caused a total occlusion of 00:04:27.961 --> 00:04:30.471 blood flow flowing from this part, 00:04:30.471 --> 00:04:32.726 which is coming from the belly button area 00:04:32.726 --> 00:04:34.976 going down to the knee. 00:04:34.976 --> 00:04:37.296 So once we take that picture with that GE 00:04:37.296 --> 00:04:39.736 system, I’m able to see this and initial, 00:04:39.736 --> 00:04:43.896 and right here I’m able to, just like a 00:04:43.896 --> 00:04:47.896 plumber does, you know, you snake the pipes. 00:04:47.896 --> 00:04:51.286 So here you have a specific type of water 00:04:51.286 --> 00:04:54.876 system that I use to cross the artery. 00:04:54.876 --> 00:04:57.566 And once I cross the water system, on this 00:04:57.566 --> 00:05:01.876 side… I’m going to show you this picture 00:05:01.876 --> 00:05:03.967 here… I use a system called 00:05:03.967 --> 00:05:05.607 a jetstream atherectomy device. 00:05:05.607 --> 00:05:08.687 Now this system is a system that is made 00:05:08.687 --> 00:05:10.657 by a company called Boston Scientific. 00:05:10.657 --> 00:05:12.747 Boston Scientific is a medical device 00:05:12.747 --> 00:05:14.677 company based out of 00:05:14.677 --> 00:05:19.087 Maple Grove Minneapolis, in Minnesota. 00:05:19.087 --> 00:05:21.277 And what it is is that basically we use 00:05:21.277 --> 00:05:23.457 this device, it’s like a drilling system. 00:05:23.457 --> 00:05:27.457 Just like in the oil fields, they drill 00:05:27.457 --> 00:05:30.117 the ground. We use this system over that 00:05:30.117 --> 00:05:32.564 wire that I’ve put into the system and 00:05:32.564 --> 00:05:35.791 we’re able to go over the wire and clean 00:05:35.791 --> 00:05:39.770 out the plaques that have formed. 00:05:39.770 --> 00:05:41.940 Once that plaque is cleaned out, we use a 00:05:41.940 --> 00:05:44.630 balloon system to stretch out the 00:05:44.630 --> 00:05:46.690 blood vessels to really give it a wide 00:05:46.690 --> 00:05:50.690 opening, and sometimes once it stays open, 00:05:50.690 --> 00:05:52.940 if it stays open it’s fine but if it 00:05:52.940 --> 00:05:55.020 doesn’t stay open, it has a tendency 00:05:55.020 --> 00:05:57.410 to constrict again, and that’s when 00:05:57.410 --> 00:05:59.890 we have a tendency to put in a stent 00:05:59.890 --> 00:06:04.620 to keep it open. So in this picture right 00:06:04.620 --> 00:06:07.638 here, this diagram, you see that we were 00:06:07.638 --> 00:06:12.488 successful opening up this total occlusion 00:06:12.488 --> 00:06:14.668 here, and opening it up and restoring 00:06:14.668 --> 00:06:18.943 blood flow back to the limb. 00:06:22.987 --> 00:06:26.117 This is an actual photograph of one of my 00:06:26.117 --> 00:06:30.937 patients. Unfortunately, this was a 00:06:30.937 --> 00:06:33.140 gentleman that we were not able to save 00:06:33.140 --> 00:06:35.660 his leg. So this is six weeks 00:06:35.660 --> 00:06:38.730 after surgery after I amputated. 00:06:38.730 --> 00:06:40.860 This is called a BKA, a below the knee 00:06:40.860 --> 00:06:45.920 amputation. And I often say that if 00:06:45.920 --> 00:06:48.619 you’re not fortunate enough for me to save 00:06:48.619 --> 00:06:50.279 the limb, I’d rather you have a 00:06:50.279 --> 00:06:53.169 below the knee amputation versus 00:06:53.169 --> 00:06:56.709 above the knee amputation, because 00:06:56.709 --> 00:07:00.229 functionality-wise it’s better for the 00:07:00.229 --> 00:07:02.299 individual because we’re able to really 00:07:02.299 --> 00:07:04.429 fit him very well with a good prosthesis, 00:07:04.429 --> 00:07:06.519 that they can go back and handle it and 00:07:06.519 --> 00:07:08.929 walk as if nothing ever happened. 00:07:08.929 --> 00:07:11.488 But it becomes a huge challenge once you 00:07:11.488 --> 00:07:14.698 go above the knee. It’s very hard to fit 00:07:14.698 --> 00:07:17.138 someone for any good prosthesis, 00:07:17.138 --> 00:07:20.758 for them to bear weight. 00:07:20.758 --> 00:07:23.458 We call this the “stump line.” 00:07:23.458 --> 00:07:25.488 And we have a tendency to have a lot of 00:07:25.488 --> 00:07:27.158 breakdown on this stump line. 00:07:27.158 --> 00:07:29.468 So it just makes things a little bit 00:07:29.468 --> 00:07:31.436 difficult. So unfortunately, I was not 00:07:31.436 --> 00:07:34.096 able to save this man’s leg sine we had 00:07:34.096 --> 00:07:38.679 the surgery, and this is him and his wife 00:07:38.679 --> 00:07:41.669 after surgery. 00:07:41.669 --> 00:07:43.469 So this is the sort of assistive 00:07:43.469 --> 00:07:46.902 technology we’re used to seeing. 00:07:46.902 --> 00:07:49.262 And in the past, I have to admit, 00:07:49.262 --> 00:07:51.502 I have to be clear and be honest with you, 00:07:51.502 --> 00:07:53.342 I never really paid attention to a lot of 00:07:53.342 --> 00:07:55.122 this stuff until I met Chet Cooper. 00:07:55.122 --> 00:07:57.102 That’s when I started to really focus and 00:07:57.102 --> 00:07:58.432 pay attention to these things. 00:07:58.432 --> 00:08:00.592 They’re right in front of us, they’re 00:08:00.592 --> 00:08:02.752 right around us, but we’re so busy with 00:08:02.752 --> 00:08:04.772 our daily lives we don’t pay attention to 00:08:04.772 --> 00:08:07.482 things that are happening. 00:08:07.482 --> 00:08:10.224 But this is now a big problem and a part 00:08:10.224 --> 00:08:13.574 of my practice right now, of what I do. 00:08:13.574 --> 00:08:16.244 So once we have saved the limb, 00:08:16.244 --> 00:08:18.484 the question is then how do you prevent 00:08:18.484 --> 00:08:21.204 them from ending up like this gentleman. 00:08:21.204 --> 00:08:25.734 So we have a technology called the SPY. 00:08:25.734 --> 00:08:28.174 The SPY was developed by a company 00:08:28.174 --> 00:08:30.424 called Novadaq and then they sold it off 00:08:30.424 --> 00:08:31.964 to a company called Stryker. 00:08:31.964 --> 00:08:34.244 Stryker is a big medical device company 00:08:34.244 --> 00:08:36.144 that does a lot of spine surgery for 00:08:36.144 --> 00:08:38.234 people with back problems and this sort 00:08:38.234 --> 00:08:40.324 of thing. So it’s kind of shocking why 00:08:40.324 --> 00:08:42.434 they got into the vascular business. But 00:08:42.434 --> 00:08:45.894 anyway, with SPY technology, what it does 00:08:45.894 --> 00:08:48.594 is that it utilizes a fluorescent agent 00:08:48.594 --> 00:08:50.744 that we inject into the patient, so after 00:08:50.744 --> 00:08:54.744 the patient has had the revascularization procedure, 00:08:54.744 --> 00:08:56.724 they follow up at the office, we inject 00:08:56.724 --> 00:08:58.704 them with the fluorescent agent, 00:08:58.704 --> 00:09:00.814 and what it does is that we’re able to put 00:09:00.814 --> 00:09:02.914 this camera right on their feet, right 00:09:02.914 --> 00:09:08.384 overhead, and it gives us this thermal imaging. 00:09:08.384 --> 00:09:10.972 So when you see this right here, that’s 00:09:10.972 --> 00:09:14.472 good news. Actually the redder, the more 00:09:14.472 --> 00:09:17.537 red it is, the better it is. It means you 00:09:17.537 --> 00:09:18.977 have really good flow. 00:09:18.977 --> 00:09:21.087 And as the area gets a little bit blue, 00:09:21.087 --> 00:09:24.277 that means you have diminishing blood 00:09:24.277 --> 00:09:27.427 flow in that area. And when it gets to be 00:09:27.427 --> 00:09:31.292 like this, you know you have a serious 00:09:31.292 --> 00:09:37.932 problem. So this type of stuff is what 00:09:37.932 --> 00:09:40.442 we’ve been doing for people in Miami, 00:09:40.442 --> 00:09:43.682 for people in the Florida region. 00:09:43.682 --> 00:09:47.352 And so I started to take this type of 00:09:47.352 --> 00:09:50.382 practice back to Ghana. 00:09:50.382 --> 00:09:53.682 Ghana is very interesting to me, not only 00:09:53.682 --> 00:09:56.988 because I’m from Ghana, 00:09:56.988 --> 00:09:59.408 but I’ve been very impressed with the 00:09:59.408 --> 00:10:01.488 government of Ghana in terms of their 00:10:01.488 --> 00:10:05.218 initiatives, which is a little bit 00:10:05.218 --> 00:10:08.368 surprising to me because in those parts 00:10:08.368 --> 00:10:11.948 of the world there’s a stigma that is 00:10:11.948 --> 00:10:14.308 associated with individuals or persons 00:10:14.308 --> 00:10:16.128 with disability. 00:10:16.128 --> 00:10:18.248 Ghana is a small country in West Africa, 00:10:18.248 --> 00:10:20.548 the population is about 28 million. 00:10:20.548 --> 00:10:24.548 The GDP is about $130 billion. That puts 00:10:24.548 --> 00:10:27.478 them at number 12 out of 52 of African 00:10:27.478 --> 00:10:30.108 countries, and it’s actually the blueprint 00:10:30.108 --> 00:10:31.768 for African democracy. It’s a 00:10:31.768 --> 00:10:34.008 constitutional republic. 00:10:34.008 --> 00:10:39.098 And English is the official language of the country. 00:10:39.098 --> 00:10:41.788 About 15 percent of the Ghana population 00:10:41.788 --> 00:10:43.558 are persons with disability. 00:10:43.558 --> 00:10:47.418 In 2006, the country passed a disability 00:10:47.418 --> 00:10:50.708 law, and the purpose for this was to end 00:10:50.708 --> 00:10:54.568 discrimination against individuals with 00:10:54.568 --> 00:10:57.768 disability in the country. 00:10:57.768 --> 00:11:00.628 The country has been working very very 00:11:00.628 --> 00:11:03.421 hard to improve the living conditions 00:11:03.421 --> 00:11:05.401 of individuals that live there. 00:11:05.401 --> 00:11:09.064 My foundation, what we’ve done is that, 00:11:09.064 --> 00:11:12.504 we’re really focusing on, because 00:11:12.504 --> 00:11:15.074 disabilities, there are so many causes of 00:11:15.074 --> 00:11:19.524 disabilities, from congenital diseases to 00:11:19.524 --> 00:11:23.424 hereditary diseases and also acquired 00:11:23.424 --> 00:11:26.304 diseases. With the acquired diseases, 00:11:26.304 --> 00:11:27.774 my focus is really on the 00:11:27.774 --> 00:11:29.984 noncommunicable diseases, because it 00:11:29.984 --> 00:11:31.994 really falls in line with something we 00:11:31.994 --> 00:11:34.544 have knowledge on. So what I've done is 00:11:34.544 --> 00:11:36.694 that I’ve invested my own money into 00:11:36.694 --> 00:11:40.774 building a hospital. This is a rendering, 00:11:40.774 --> 00:11:44.774 a rendition, of the hospital, the deGraft Research Hospital, 00:11:44.774 --> 00:11:46.554 and the purpose of this hospital 00:11:46.554 --> 00:11:48.334 is to facilitate the work that we 00:11:48.334 --> 00:11:51.534 have done very successfully in Florida. 00:11:51.534 --> 00:11:54.834 This is more images, and this is the 00:11:54.834 --> 00:11:56.645 current progress of the hospital. 00:11:56.645 --> 00:11:58.685 So hopefully by the end of next year 00:11:58.685 --> 00:12:00.235 we will complete this project, 00:12:00.235 --> 00:12:02.575 and then we will be able to offer the same 00:12:02.575 --> 00:12:06.575 things we offer the people of Florida, 00:12:06.575 --> 00:12:10.575 in Ghana. Thank you.