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Herald: Our next speaker is Tarek Loubani.

He is an emergency physician,

working in the Gaza Strip and in Canada

and he is developing medical hardware devices.

And he is going to tell us about the 
Palestinian use of free hardware and software.

So enjoy and give a warm welcome to Tarek.

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Tarek: ... (missing Audio)

Thank you to CCC for inviting me 
to give this talk

and to you for being here tonight.

I want to start with just some very basic information
here about myself.

If we can get the video feed up.

OK, so there we go.

If you want to get a hold of me, you can find me,
find this project on github,

you can find our team on openmed at freenode,

or you can always get a hold of me by e-mail,

hopefully one of the easiest e-mails
you'll ever have to remember.

And I'll bring that information up at the end.

I want to start then with a story:

This is another story, because you heard so many
about refugees.

But this story is a personal one,

because it is my story as a refugee.

And about the time, that my father reminded me
of who I was.

He put this card in front of me, 
when I was 8 years old.

This card was literally the only thing,

that atested to my existence as a human being 
for the first 12 years of my life.

It says: The director general affirms that
Tarek Loubani is a palestinian.

And as proof, I have given him 
this identity card.

Not a lot to work, not a lot to own,
not a lot to do anything. That was it.

And so I sat in front of my father,

I just got, I think it was a C
on some meaningless subject

as an 8 year old. Who cares?

But he cared. He put that paper in front of me
and he said:

Son, this paper, it doesn't prove 
that you're somebody,

it proves, that you're nobody,

that you're nothing.

And there we were, living in Kuwait with 
a nice appartment that we had rented

A and a car outfront. And he said:

all of these things didn't belong to us and
could be taken in a moment.

He had only one caveat to this nihilism.
He said:

There is only one thing you have, one thing
that the wolfs can never take away from you.

One thing, that you can never be dispossessed of.

And that's what you know, 
that's the information in your head.

That's what's up in here.

And so was thesapokalyptic warning would 
result in me and my family minus my father

because he was trapped in Kuwait at the time
driving through this:

The highway of death 
as it would later be called.

With my mother crying tears for weeks
while she got us out,

her 4 children until we finally made our way 
through, I think it was 4 or 5 different countries

and into Canada.

Mine is a microcosmic lesson of the lesson,
that all Palestinian were given.

Because all Palestinian have been dispossessed
at some point or will be.

What do you think the parents of these 
children will tell them

about who they are and what they possess?

What do you think is the meaning of their homes
and physical possessions?

What is it that they own or that they have?

Their parents will tell them, 
what my parents told me:

You have nothing and you are nothing.
Only what's in here.

And so, if they are in their predatory drones
then we must be the prey.

And that means, that we'll always live in the 
third world a different life

from the life the people live in the developed 
world.

You have to be on one of the two sides of
that predator drone of that advanced missle,

of that technology, that litigation of 
treaty.

And we had seen the light of the first world
from that those refugees camps.

We saw it. And what we wanted was not
the Playstation 4s and the iPhones

though yes, of course. Great stuff.

What we wanted was the CT scanners

and the hospitals that were outfitted so that
you could feel like you cold go in them

and come a whole human being still 
just like you went in.

That is the wealth that we wanted. That is the
wealth that we saw and that is the wealth

that they protected.

Both metaphorically and literally

through all manner of instruments of 
neoliberalism and colonialism.

They do it

because to them everything, everything 
they see, everything in the world around them

is fish.

They can't see the world any other way.

And so they think, that if you catch a fish
I can't have that same fish.

And they don't realise, that we live in a 
different world, where not everything is fish.

Where there is information
and that information can go anywhere,

and be anything and it can help everybody
at the same time.

It's not a new concept.

It's a concept that was almost perfected
by Magritte, 85 years ago

represented here:

That is not a pipe.

It is the information to make a pipe.

That is not an STL. Or that is not a
reproduction, that is an STL.

Let's put some economic terms on this,
because the people, who we are working against,

the people who promote the anti commons
they put language on this stuff.

This is the main language.

We can divide it into two main axes:
excludable and rivalrous.

All items more or less fall into these categories.

And so fish falls into this category. It is a 
non-excludable, largely commodity

that is rivalrous. Indeed

it is very hard to keep people from 
catching fish out in the harbour.

But if one person catches one fish, then
the next person can not.

Where society wants us to be by and large is right here:

Products that are non-rivalrous but excludable.

Think for example of an mp3. An mp3 should be this:
public good, it is not excludable,

you can't keep people from it.
It is non-rivalrous.

You give somebody an mp3, you haven't 
taken away an mp3 from anybody else.

And yet, what is desired, is for everything
to be here:

A club good.

You need a membership.

Be that the country you live in or
the amount of money that you make.

It is excludable.
Because they have excluded you.

Not because of any inaid or inherant reason.

How can we turn things from club goods
into public goods or

another question: how have they turned things
from public goods into club goods?

Well, here two men who've led the charge:

Birch Bayh and Bob Dole.

They came up with this legislation, that
ended up, basically making it so, that

one thing that was available, non-excludable 
and non-rivalrous, that is

all of the information coming out of universities
and these sorts of charities and other little groups

could now be patented. Patenting is the 
main weapon here.

That's how you turn things from usable by
everybody, available to everybody

to usable by a few and available to few.

Their policy was absolutely a success.

Here you see the patents, starting from 1963
all the way to 2014. Total patents granted.

1980 is highlighted in blue. Everything before
that is basically since the time of a man

named Vannevar Bush,
who kind of floated the main idea,

that information should kind of be out for folks.

And as you can see, it's relatively stable.

More or less minor deviations
more or less the same.

But from 1980 to 2014 it virtually looks exponential.

So closer with the numbers.

1980 66 thousend patents, in 2014 326033.

And so these weapons, they've resulted in 
us not being able to take things from

simple idea to something we can use,
but instead we are loaded,

we have to walk through these landmines.

Now, this is a story that you all already know.

Because it doesn't matter what country 
you live in.

I'm guessing that everybody here lives in
first world.

These are issues, that innovators in the first world
must content with.

But by and large these are issues that stop
people in the first world from becoming rich.

In the third world these are issues,
that can mean the difference between

life and death.

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Here is an example from the late 90s
early 2000s.

Profiteering pharmaceutical companies versus
South Africa.

South Africa was in the middle of a 
absolutely terrible crisis,

which arguable they have not exited
with HIV AIDS

and pharmaceutical companies using
the weapon of patents

were saying: ehm, sorry, we can not give you
this medication at the rate you can affort,

we can not give this medication to everybody,
because what protects our profits?

Now, most people aren't that crass most of the
time, there are not saying what protects our profits,

because that's bad public relations.

But they say: Oh, what about our research and
development funds etc etc.

Of course mostly done on the public dime.

But in the end every once in a while, we happen to
see, one of the type, who pops up, who speaks

a little bit more from the heart, as we have seen
recently.

What my father told me initially, was what I've been
taught for all the years of my life.

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What he told me is that either
you are one of the predators

or one of the prey.

It is an absolutely irrefutable truth.

It's a natural order.

It is absolut. God gave us this.

You have to be on one side or the other.

You just have to accept it.

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And so if you're born the caribou, 
you have to own that existence,

and just accept it.

Well, just before I got on my plane here.
I was at work as a doctor.

When I went to my shift, I did not go there,

so that I would allow the natural order 
to take its course.

I did not wake up today, so that the natural
order would take its course.

Fuck the natural order.

And fuck the world's who are behind it.

I don't want it.

People in Palestine don't want it.

My patience don't want it.

None of us want it.

So, why do we accept it?

If we look at the world around us

what we're seeing then, is this thing, that 
we want to just throw off that natural order.

But the terms of our insurgency have to be

careful.

You can't as the caribou look at the wolf and say:

ehm, well, I don't really care, you know, 
fuck you and fuck your natural order

and I am not participating.

You have to be careful,

because they are potent, they are dangerous.

In this particular case the main danger
to us in the third world and developing nations

is treaties.

These laws are applied on us by treaty and 
you can't just opt out.

The Palestinian economic system is shut down
by FIAT

Medication can't arrive by FIAT.

All of these things happen, because we are too
weak.

And so, how do you respond?

What is the tool of resistance?

We eluded to it earlier.

My father even told it to me as a child.

Knowledge

and the Commons

That is where a better future comes from.

And that is where our examples live.

So let's think about the free software movement.
Let's look at some examples.

Some of you are German. 
Munich is one such example.

Munich has shifted allmost all of their city
digital infrastructure into free and open source.

They even have their own Linux distribution.

That's pretty amazing actually.

There are other examples, that are some minor
cities here and there.

There are some state wide examples.

For example, such as Kerala in India.

The chief minister basically like the prime, the 
highest person within Kerala at the time said:

We believe that free and open-source software
is an essential component in our drive to

democratise information technology and bring
its benefits to all sections of society.

In additon to Kerala, Tamil Nadu has done 
something similar, also in India.

And then there are some partial ministry level
efforts, that have been happening,

for example Italy, in their ministry of, I think it is, 
defense or interior, you know, had decided

just a small move to go from Microsoft Office
to Libre Office.

Apperently small moves, but really
meaningful to the people around us.

We'll look at this from places like
Palestine, like the Gaza Strip, where I work,

and we think, why can't we do that?

Why can't we participate in these commons?

What is it, that we can do to contribute?

At the national level, there are a couple of very
potent examples.

The two main examples, that I ran into, 
were Equador and Brazil.

Equador, if you guys were at the talk yesterday
is a very interesting and nuanced place.

So there are some authoritarian tendencies.

Bethany Horne, who I believe is in our 
audiency here, I won't point her out,

is one person, who's been visited by the 
authoritarianism of the group.

But notwithstanding, they are doing some very 
good things and one of those very good things

is free software at the national level.
That's actually quite incredible.

Directed from the presidency.

Brazil very similar. Brazil started their move
almost the same time, maybe a little bit before.

So, Palestine looks quite ripe. For exactly the 
same thing we've been seen,

has a few characteristics:

These are the literacy levels of 
a few different countries.

United States and Germany,
basically 1% who are illiterate.

Brazil and Equador 90.4 and 91.6

Palestine 95.3. That's the Westbank and the
Gaza Strip. My best guess, if you would include

the diaspora that number would go significantly up.

Because the diaspora tends to be well educated.

That means that this lesson 
that my father gave me is a lesson that

clearly Palestinians have been receiving for
years if not decades.

They're intelligent people, they're well educated.

They're living under occupation and they want to
see a change.

So, we've started all of the same things 
that you would expect.

We started of course replacing all of our servers 
with Apache based

if any of them were ever on Windows.

We've started of course using backends for 
our contact management systems, like

Joomla and Drupal.

Of course, we started doing those things.

In terms of the infrastructure that's more or less
the step where we are.

We are at infrastructural components rather
then desktops.

We have a very nascent EMR, 
that will be coming up hopefully soon.

And we expect that this EMR will leverage at the
best of what we have and what we see.

However there is something else that's interessing
a response to the necessity we have in Palestine.

We learned that lesson from people, decorating
their shoes, submerging their computers

from Novenas and homemade 
chicken CT scanners.

And what we started doing is making our 
own hardware as well.

I believe that the Gaza Strip is the first place
that is trying a national level strategy for

open source hardware and is pushing it hard.

We saw 3D printers, we saw how they worked.
We wanted our own and we got them.

Leftmost is the very first 3D printer ever
made in Gaza.

In the middle and the next one are their children.
Made entirely in Gaza.

Some of the electronics have to come in,
all of the motors are salvaged from garbage.

We expect that within a year, we'll be able to
make everything domestically.

That's our hope and that's our dream and
I think we can get there.

Of course my own work has been to make 
medical devices.

That's where I've been leveraging them.

This is a stethoscope, a very early version.

This is the final version as of 3 weeks ago
approved by Health Canada.

This is a first world medical device, 
that is available for pennies.

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2 Dollars and 50 Cents to replace 
a 300 Dollar stethoscope.

It's not that people have 300 Dollar stethoscope
running around, I said they had nothing.

Now they have something.

It's been with the help of Kliment, who you will
recognise from around here and

Jenn who you will recognise from here

and some engineers, who I can't really show,
because I fear for their safety.

Our Palestinians, the heros, 
the real heros of this work.

And as you can see here from a frequency-audio
response curve, it's as good as anything out there.

We're working next on a pulse oximeter with the
help of really talented engineer Hanan Anis

from University of Ottawa. And that should be 
ready by the middle of next year.

Surgical tools will be forthcoming, because
right now in Gaza we're washing everything

with salt water.

And prostetics are coming, we hope.
Lots of issues there, but not technical.

We have this origin story for the commons, as 
so the commons was something from the past.

That was there and then now it's gone.

But that origin story, I think, is a myth.

And when we recognise, that the commons
are actually an evolution of where we are

rather than somewhere that we were before,
we trying to reclaim.

Then I think the next step is trying to
figure out, how to get back there.

At that's what we are trying to do in Palestine.
How do we get back there?

The biggest way is to break down those borders
and blockades and share information.

And so, I want to invite you, all of you
to come with me to Gaza

In May for the first international Free and 
Open Source Health Conference.

Where we will discuss these ideas
and where we will try to move forward

the commons. If the anti commons
is generally funded by

military industrial complex, as we see within
Silicon Valley and so on,

then maybe this commons can be funded
by the ever green spending

that we always have in health care.

Health care is one of the biggest spends
in the Gaza Strip.

And if we direct it in the right places we can also 
use it to develop our national sovereignty.

Join me, in whatever where you can.

And let's make it more sovereign
better place.

For Gaza and for everywhere else.

Thank you.

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Herald: Thank you for the talk.
And we have about 5 min for questions.

So please if you have any questions line up 
in front of one of the microphones.

Please!

Question: I would like to know, how did you 
distribute your open source instruments.

Is it also possible for other countries that have
the same problems as in Palestinian areas

to get those?

Tarek: Yes, absolutely. One thing we don't do
is give medical devices.

Anybody who's interested, and there have been
few ministry to ministry contacts on this,

is basically encouraged to start up their own
fundamentally fab lab.

So, what we do is, we go into a country, talk to their
engineers, engineering departments and so on,

and we try to get them up and running, 
so that they're manufacturing their own stuff.

This means anybody who's tried to start an open
source project or free and open source project

will know that the more contributors the better.

You don't want consumers.

You want people, who are participating.

And so anybody who wants to... it's under an open
source licence. The open hardware licence.

And actually it's also cross licenced to GPLv3.

Please take it. It would be my privilege to see it 
in the news everywhere else. It really would be.

Everybody who's working on it, wants to see that.

Herald: OK, thank you very much again and see
you at the next talk, enjoy the rest of the conference.

Oh, wait we have a question from the internet
it seems.

Question: What would be the solution to Palestine?

Tarek: I don't think you need to worry about the
occupation. I think that's the question.

Don't worry about the occupation.

The occupation is a little bit like a marathon.

You have to keep working, we see the end though.

The Palestinian will take care of their own freedom.

You don't need to worry about that one.

All you need to do as much as possible,
is try to not participate within the occupation.

Now, I travel through Israel and nobody, who 
travels through Israel is allowed to endorse

the boycott divestment and sanctions campaign,
because that would be illegal and would mean

I could not travel through Israel.

However some people consider it to be a
nonviolent way of participating against

the occupation.

Now, what we do need to do is figure out
what happens the day after occupation

that's what worries me. For example there is
a Coca Cola bottling company being built

in the Gaza Strip. Why? It's going to use more
water than the entire Gaza Strip has available to it.

More concrete than in all of the construction
projects. Why?

Because they are looking for the day after
occupation.

And what I don't want is for Palestine to turn
into South Africa.

Beautiful dreams, excellent vision and you 
loose the war the day after the occupation ends.

That's why we have to encourage
these democratic institutions.

That's why we have to participate in these, I guess
essentually like chaos based

anarchist based collectives, that are going to move
forward the democratic process there

and everywhere else.

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Herald: So we have time for one final question.
The microphone at the right please.

Question: The big one. Can you say something 
about the interface between open medical devices

and regulation? So in Europe most of the stuff is
public or a lot of it is public, so you have two layers

of regulation: one is what devices you're authorised
to use and operating on the human body.

The other one is how you're authorised
to buy the stuff,

so procurement regulation is very, very rigid
in some European countries

in term of medical devices. Most of the stuff
would be illegal.

Tarek: It was very important for us, the project
wasn't, you know, people have made stethoscopes

and actually a lot of people told me this. They
said, your's isn't the first 3D printed stethoscope.

I made one, we made one, whatever it is.

And it is true, we are not nearly the first
3D printed stethoscope.

We are the first validated and now Health Canada
approved 3D printed stethoscope.

I think that these regulations are actually
a good thing, because the population is

an incredibly vulnerable population 
on the other side.

We see a lots of experiments being run on poor,
disenfranchised people.

It happens in the first world.
Think Tuskegee and

similar things are happening today.

It happens in the third world,
think Nestle and such projects.

So I think the regulations are a good thing.

The FDA, you know, probably not. It's very 
expensive, very hard to get through.

But it's not taxing to get through
reasonable regulatory bodies, like Health Canada.

I myself don't object. What I see in the Gaza Strip
is people there want to know

that they're not receiving garbage. So they're
asking for these regulatory approvals.

The Gaza Strip will not use expired medical
devices, that people, you know well-wishers and

some hospital in the first world that decided
I like rather throw this away in the Gaza Strip

than throw this away in the garbage.
No we don't want that.

There is a dignity as well that has to be provided.
And that dignity comes with the same standards

being met in the third world as in the first world

Herald: OK, thank you very much. Unfortunately
we are out of time, but I hope you enjoy the

rest of the congress and see you at the next talk.

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