vimeo.com/.../277682681

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My name is Dr. Moses deGraft-Johnson.

The term "assistive technology" is defined
by the World Health Organization

in an umbrella term
that covers systems and services

that are related to the delivery
of assistive products and services,

and the whole purpose of this
is to aid an individual

by giving them independence
and promoting their overall well-being.

Now, as my colleague here just showed us
some very cool innovations,

some of the innovations
that we are very familiar wit

are the simplest things,

such as the hearing aids,
wheelchairs, [outer] prosthesis.

Even something as simple
as pill organizers,

because this is something

even people without
a true disability utilize,

My mother utilizes pill organizers.

So we find that there are certain
assistive technologies

that even individuals
who do not have a true disability

also utilize in their daily lives.

We’re seeing more and more
of that globally.

More than one billion people
need one or more assistive products.

Now this is the part
that I really want to get into

because this really talks about
what I do for a living.

Recently, what we’ve seen

is that the World Health Organization
released some data

and what we see in this data
is a rise in non-communicable diseases

that are causing persons with disability.

One of the most common ones
that was mentioned was diabetes.

But also, along with diabetes
was hypertension and hyperlipidemia,

also known simply as high cholesterol,
obesity, and smoking.

What's interesting
is that these five variables

are also known in cardiovascular medicine
as the five major risk factors

for a major cardiovascular event.

They lead to something
called atheromatous plaque.

This is plaque formation
of buildup in our blood vessels.

This is an example
of a normal coronary artery in the heart,

and as we see, over time,
we get damages, buildups,

and eventually we have lack of perfusion,
or lack of blood flow.

That’s what eventually leads
to heart attacks, strokes,

and poor circulation,

commonly known as PAD.

At the Heart and Vascular Institute,

what we have done
is we have an initiative

called the "Save a Limb Initiative."

One of my goals

was to at least limit
the amount of amputations

that were occurring in that community.

When we see patients
who have these sorts of problems

the first thing we do
after we’ve assessed them

is called acute limb ischemia.

We take them into the operating room
and utilize a GE system

called a C-Arm.

It's an X-ray
that takes pictures of the legs,

from the bellybutton
all the way down to the feet.

We use contrast dye
to inject into the patients,

so it will give us an image, like this.

This first picture here--

Clearly, you don’t need to be a doctor

to see there’s
a significant problem here.

This is called
the superficial femoral artery

This is the big vessel that lies
between your hip and your knee.

It’s like a highway that’s not complete

because there’s something missing here,

right in the middle.

This individual has developed
a blockage in that blood vesse

that has definitely caused
a total occlusion of blood flow

flowing from this part,

which is coming
from the belly button area,

going down to the knee.

Once we take that picture
with that GE system,

I'm able to see this in initial,

and right here I'm able to,

just like a plumber does,

you snake the pipes.

So here you have
a specific type of wire system

that I use to cross the artery.

Once I cross the wire system,

on this side...

I’m going to show you this picture here.

...I use a system called
the Jetstream Atherectomy Device.

This system is made by a company
called Boston Scientific.

Boston Scientific
is a medical device company

based out of Maple Grove,
Minneapolis, in Minnesota.

Basically we use this device.
It’s like a drilling system.

Just like in the oil fields,
they drill the ground.

We use this system over that wire
that I’ve put into the system

and we’re able to go over the wire

and clean out the plaques that form.

Once that plaque is cleaned out,

we use a balloon system
to stretch out the blood vessels

to really give it a wide opening,

and sometimes once it stays open...

Once it stays open, it’s fine,

but if it doesn’t stay open,
it has a tendency to constrict again,

and that’s when we have
a tendency to put in a stent

to keep it open.

In this picture right here, this diagram,

you see that we were successful
opening up this total occlusion here,

and opening it up and restoring
blood flow back to the limb.

This is an actual photograph
of one of my patients.

Unfortunately, this is a gentleman
that we were not able to save his leg.

This is six weeks after surgery,
after I amputated.

This is called a BKA,
a below-knee amputation.

I often say that
if you’re not fortunate enough

for me to save the limb,

I’d rather you have
a below-the-knee amputation

versus above-the-knee amputation,

because functionality-wise,
it’s better for the individual

because we’re able
to really fit him very well

with a good prosthesis,

that they can go back and handle it
and walk as if nothing ever happened.

But it becomes a huge challenge
once you go above the knee.

It’s very hard to fit someone
for any good prosthesis,

for them to bear weight.

We call this the "stump line."

We have a tendency to have
a lot of breakdown on this stump line.

So it just makes things
a little bit difficult.

So, unfortunately, I was not able
to save this man’s leg

since we had the surgery,

and this is him
and his wife after surgery.

This is the sort of assistive technology
we’re used to seeing.

In the past, I have to admit,

I have to be clear and honest with you,

I never really paid attention
to a lot of this stuff

until I met Chet Cooper.

That’s when I started to really focus
and pay attention to these things.

They’re right in front of us,
they’re right around us

but we’re so busy with our daily lives,

we don’t pay attention
to things that are happening.

But this is now a big problem and a part

of my practice right now, of what I do.

So once we have saved the limb,

the question is then how do you prevent

them from ending up like this gentleman.

So we have a technology called the SPY.

The SPY was developed by a company

called Novadaq and then they sold it off

to a company called Stryker.

Stryker is a big medical device company

that does a lot of spine surgery for

people with back problems and this sort

of thing. So it’s kind of shocking why

they got into the vascular business. But

anyway, with SPY technology, what it does

is that it utilizes a fluorescent agent

that we inject into the patient, so after

the patient has had the
revascularization procedure,

they follow up at the office, we inject

them with the fluorescent agent,

and what it does is that we’re able to put

this camera right on their feet, right

overhead, and it gives us
this thermal imaging.

So when you see this right here, that’s

good news. Actually the redder, the more

red it is, the better it is. It means you

have really good flow.

And as the area gets a little bit blue,

that means you have diminishing blood

flow in that area. And when it gets to be

like this, you know you have a serious

problem. So this type of stuff is what

we’ve been doing for people in Miami,

for people in the Florida region.

And so I started to take this type of

practice back to Ghana.

Ghana is very interesting to me, not only

because I’m from Ghana,

but I’ve been very impressed with the

government of Ghana in terms of their

initiatives, which is a little bit

surprising to me because in those parts

of the world there’s a stigma that is

associated with individuals or persons

with disability.

Ghana is a small country in West Africa,

the population is about 28 million.

The GDP is about $130 billion. That puts

them at number 12 out of 52 of African

countries, and it’s actually the blueprint

for African democracy. It’s a

constitutional republic.

And English is the official language
of the country.

About 15 percent of the Ghana population

are persons with disability.

In 2006, the country passed a disability

law, and the purpose for this was to end

discrimination against individuals with

disability in the country.

The country has been working very very

hard to improve the living conditions

of individuals that live there.

My foundation, what we’ve done is that,

we’re really focusing on, because

disabilities, there are so many causes of

disabilities, from congenital diseases to

hereditary diseases and also acquired

diseases. With the acquired diseases,

my focus is really on the

noncommunicable diseases, because it

really falls in line with something we

have knowledge on.

So what I've done

is that I’ve invested my own money
into building a hospital.

This is a rendering,
a rendition, of the hospital,

the deGraft Research Hospital,

and the purpose of this hospital
is to facilitate the work

that we have done
very successfully in Florida.

This is more images,

and this is the current progress
of the hospital.

So, hopefully, by the end of next year,

we will complete this project,

and then we will be able to offer

the same things we offer
the people of Florida in Ghana.

Thank you.