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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

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is anesthesia.

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And actually, it's the model that we expect to work

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for delivering anesthesia

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in these environments.

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Here we have a scene that you would find

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in any operating room across the U.S. 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

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to enable surgery and save lives

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because it was designed

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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,

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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

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whose budget can allow it to support one machine

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costing upwards of 50 or $100,000.

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And perhaps most obviously,

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and perhaps most importantly --

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and the path to concepts that we've heard about

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kind of illustrate this --

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it needs infrastructure

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that can supply an uninterrupted source

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of electricity, of compressed oxygen

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and other medical supplies

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that are so critical to the functioning

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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

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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

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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 they have to work with break,

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they've got to try and figure it out, 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

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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

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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

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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

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that were designed for that first environment that I showed you

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and donating or selling them

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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

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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,

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and it was important 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

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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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And now this routine surgery that many of you have probably experienced,

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and others are probably the product of,

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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,

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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,

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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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So 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 just 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

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that would work in the reality that he was facing.

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And what he came up with was this guy,

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the prototype for the Universal Anesthesia Machine --

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a machine that would work

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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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Now 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,

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you want as pure oxygen as possible,

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because eventually you're going to dilute it essentially

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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

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up and across here

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where it mixes with the anesthetic agent.

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Now before that mixture

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hits the patient's lungs,

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it's going to pass by here --

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you can't see it, but there's an oxygen sensor here --

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that's going to read out on this screen

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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 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 had given too little oxygen 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,

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whether there's power or not,

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because they can adjust the flow

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based on the percentage of oxygen they see that they're giving their patient.

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In both cases,

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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;

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it's straightforward.

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And it's by design.

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And you do not need to be

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a highly trained, specialized anesthesiologist 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

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to the heat and the wear and tear that happens

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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

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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

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is a machine that can enable surgery 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,

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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

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is with Johns Hopkins 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.

0:10:05.000,0:10:08.000
So I've talked a lot about anesthesia, and I tend to do that.

0:10:08.000,0:10:10.000
I think it is incredibly fascinating

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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

0:10:38.000,0:10:40.000
could start their design process,

0:10:40.000,0:10:42.000
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

0:10:48.000,0:10:51.000
for the environment that exists in so many parts of the world,

0:10:51.000,0:10:53.000
rather than the one that we wished existed --

0:10:53.000,0:10:56.000
we might just save a lot of lives.

0:10:56.000,0:10:58.000
Thank you very much.

0:10:58.000,0:11:02.000
(Applause)