Erica Frenkel: The universal anesthesia machine

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Danas ću vam pričati

I'm going to talk to you today

about the design of medical technology for low-resource settings.

o konstruiranju medicinske tehnologije za okolnosti u kojima se teško snaći.

Proučavam zdravstvene sustave u ovim zemljama.

I study health systems in these countries.

I jedan od najvećih propusta u zaštiti,

And one of the major gaps in care,

gotovo duž cijele zemlje

almost across the board,

je pristup sigurnoj operaciji.

is access to safe surgery.

Jedna od najvećih prepreka na koju smo naišli,

Now one of the major bottlenecks that we've found

that's sort of preventing both the access in the first place,

a koja na neki način na prvom mjestu sprječava dostupnost,

a onda i sigurnost tih operacija,

and the safety of those surgeries that do happen, is anesthesia.

je anestezija.

I zapravo, to je model za koji očekujemo

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

da će funkcionirati pri dostavljanju anestezije

for delivering anesthesia in these environments.

u takvim uvjetima.

Here, we have a scene that you would find in any operating room across the US,

Ovdje imamo prizor koji ćete zateći

u bilo kojoj operacijskoj sali diljem SAD-a ili u bilo kojoj drugoj razvijenoj zemlji.

or any other developed country.

U pozadini

In the background there

is a very sophisticated anesthesia machine.

je sofisticirani stroj za anesteziju.

I ovaj je stroj sposoban

And this machine is able to enable surgery and save lives

omogućiti operaciju i spasiti živote

because it was designed with this environment in mind.

zato što je napravljen

s ovim uvjetima u vidu.

In order to operate, this machine needs a number of things

Da bi radio, taj stroj treba niz stvari

that this hospital has to offer.

koje ova bolnica treba moći ponuditi.

It needs an extremely well-trained anesthesiologist

Treba krajnje dobrog anesteziologa

with years of training with complex machines

s godinama vježbe sa složenim strojevima,

da mu pomogne nadzirati tok plina

to help her monitor the flows of the gas

and keep her patients safe and anesthetized

i održati pacijente sigurnima i uspavanima

tijekom operacije.

throughout the surgery.

It's a delicate machine running on computer algorithms,

To je osjetljiv stroj koji radi uz pomoć kompjuterskih algoritama,

and it needs special care, TLC, to keep it up and running,

i treba posebnu brigu da bi ispravno radio,

and it's going to break pretty easily.

i vrlo će se lako pokvariti.

And when it does, it needs a team of biomedical engineers

A kada se pokvari, treba tim inženjera biomedicine

who understand its complexities, can fix it, can source the parts

koji razumiju njegovu složenost,

mogu ga popraviti, mogu pronaći dijelove

and keep it saving lives.

i omogućiti mu da nastavi spašavati živote.

It's a pretty expensive machine.

To je prilično skup stroj.

It needs a hospital whose budget can allow it

Treba bolnicu

čiji budžet može dopustiti uzdržavanje jednog stroja

to support one machine costing upwards of 50 or $100,000.

koji stoji od 50 do 100.000 dolara.

I možda najočitije

And perhaps most obviously,

i možda najvažnije --

but also most importantly --

i put do koncepata o kojima smo čuli

and the path to concepts that we've heard about

donekle prikazuje to --

kind of illustrates this --

treba infrastrukturu

it needs infrastructure that can supply an uninterrupted source of electricity,

koja može priskrbiti neprekinuti izvor

struje, komprimiranog kisika

of compressed oxygen, and other medical supplies

i ostalih medicinskih potrepština

that are so critical to the functioning of this machine.

koje su toliko bitne za rad

tog stroja.

In other words, this machine requires a lot of stuff

Drugim riječima, taj stroj zahtjeva puno stvari

koje ova bolnica ne može ponuditi.

that this hospital cannot offer.

Ovo je izvor struje

This is the electrical supply for a hospital in rural Malawi.

za bolnicu u ruralnom Malawiju.

U ovoj je bolnici

In this hospital,

there is one person qualified to deliver anesthesia,

jedna osoba kvalificirana za obavljanje anestezije,

i kvalificirana je

and she's qualified

because she has 12, maybe 18 months of training in anesthesia.

jer ima 12, možda 18 mjeseci

prakse u anesteziji.

U bolnici i u cijeloj regiji

In the hospital and in the entire region

nema niti jednog inžinjera biomedicine.

there's not a single biomedical engineer.

Stoga kad se ovaj stroj pokvari,

So when this machine breaks,

the machines that they have to work with break,

kada se stroj s kojim moraju raditi pokvari,

moraju pokušati shvatiti kako ga popraviti, ali većinu vremena, to je kraj puta.

they've got to try and figure it out,

but most of the time, that's the end of the road.

Ti strojevi idu na poznata smetlišta.

Those machines go the proverbial junkyard.

I cijena stroja koji sam spomenula

And the price tag of the machine that I mentioned

could represent maybe a quarter or a third

može predstavljati možda četvrtinu ili trećinu

of the annual operating budget for this hospital.

godišnjeg operacijskog budžeta

za ovu bolnicu.

And finally, I think you can see that infrastructure is not very strong.

I konačno, mislim da možete vidjeti da infrastruktura nije vrlo jaka.

Ova je bolnica povezana s vrlo slabim izvorom struje,

This hospital is connected to a very weak power grid,

one that goes down frequently.

koji redovito zakaže.

So it runs frequently, the entire hospital,

Stoga cijela bolnica često radi

samo na generatoru.

just on a generator.

And you can imagine, the generator breaks down

I možete zamisliti, generator se pokvari

or runs out of fuel.

ili ostane bez goriva.

And the World Bank sees this

I Svjetska banka to vidi

and estimates that a hospital in this setting in a low-income country

i procijeni da bolnica u takvim okolnostima u zemlji s niskim prihodom

može očekivati do 18 nestanaka struje

can expect up to 18 power outages per month.

u jednom mjesecu.

Similarly, compressed oxygen and other medical supplies

Slično, komprimirani kisik i ostale medicinske potrepštine

zapravo su luksuz

are really a luxury,

i često mogu nedostajati

and can often be out of stock for months or even a year.

mjesecima ili čak godinu dana.

So it seems crazy, but the model that we have right now

Čini se ludo, ali model koji trenutačno imamo,

is taking those machines that were designed

uzima strojeve

koji su dizajnirani za onu prvu okolinu koju sam vam pokazala

for that first environment that I showed you

i donira ih ili prodaje

and donating or selling them to hospitals in this environment.

bolnicama s ovakvim uvjetima.

Nije samo neprikladno,

It's not just inappropriate,

it becomes really unsafe.

nego postaje i stvarno nesigurno.

One of our partners at Johns Hopkins

Jedan od naših partnera u John Hopkinsu

was observing surgeries in Sierra Leone about a year ago.

promatrao je operaciju u Sierra Leoneu

prije godinu dana.

And the first surgery of the day happened to be an obstetrical case.

I prva operacija tog dana bio je porod.

A woman came in, she needed an emergency C-section

Žena je došla, trebala je hitan carski rez

to save her life and the life of her baby.

da spasi svoj i djetetov život.

I sve je počelo prilično obećavajuće.

And everything began pretty auspiciously.

Kirurg je pozvan i pojavio se.

The surgeon was on call and scrubbed in.

Sestra je bila tamo.

The nurse was there.

She was able to anesthetize her quickly, and it was important

Uspjela ju je brzo anestezirati

i to je bilo važno zbog hitnosti situacije.

because of the emergency nature of the situation.

And everything began well

I sve je krenulo dobro

until the power went out.

dok nije nestalo struje.

I sada, usred ove operacije,

And now in the middle of this surgery,

the surgeon is racing against the clock to finish his case,

kirurg se bori s vremenom da završi slučaj,

which he can do -- he's got a headlamp.

što uspijeva -- ima lampu na glavi.

Ali sestra doslovno

But the nurse is literally running around a darkened operating theater

trči okolo po mračnoj operacijskoj sali

trying to find anything she can use to anesthetize her patient,

pokušavajući naći bilo što što će moći upotrijebiti da anestezira svoju pacijenticu,

da ju održi uspavanom.

to keep her patient asleep.

Jer njezin stroj ne radi kada nema struje.

Because her machine doesn't work when there's no power.

This routine surgery that many of you have probably experienced,

I sada je ta rutinska operacija koju su mnogi od vas vjerojatno iskusili,

and others are probably the product of, has now become a tragedy.

a ostali su vjerojatno njezin produkt,

postala tragedija.

And what's so frustrating is this is not a singular event;

I ono što je toliko frustrirajuće jest što to nije izdvojeni slučaj;

this happens across the developing world.

to se događa diljem zemalja u razvoju.

35 milijuna operacija se pokušava izvesti svake godine

35 million surgeries are attempted every year

bez sigurne anestezije.

without safe anesthesia.

Moj kolega, dr. Paul Fenton

My colleague, Dr. Paul Fenton, was living this reality.

živio je tu stvarnost.

He was the chief of anesthesiology

Bio je glavni anesteziolog

in a hospital in Malawi, a teaching hospital.

u bolnici u Malawiju, obrazovnoj bolnici.

Išao je na posao svaki dan

He went to work every day

in an operating theater like this one,

u operacijsku salu poput ove,

trying to deliver anesthesia and teach others how to do so

pokušavajući anestezirati i poučavati druge kako to učiniti

using that same equipment

pomoću te iste opreme

that became so unreliable, and frankly unsafe, in his hospital.

koja je postala toliko nepouzdana i potpuno nesigurna

u njegovoj bolnici.

I nakon bezbroj operacija

And after umpteen surgeries

i , možete zamisliti, neopisive tragedije,

and, you can imagine, really unspeakable tragedy,

he just said, "That's it. I'm done. That's enough.

samo je rekao: „To je to. Gotov sam. Dosta je.

Mora postojati nešto bolje.“

There has to be something better."

Prošetao je niz hodnik

He took a walk down the hall

do mjesta gdje bacaju sve te strojeve koji su jednostavno otišli u klinac --

to where they threw all those machines that had just crapped out on them,

mislim da je to znanstveni izraz --

I think that's the scientific term,

i jednostavno je počeo sastavljati.

and he started tinkering.

Uzeo je jedan dio odavde i drugi odande

He took one part from here and another from there,

i pokušao je sastaviti stroj

and he tried to come up with a machine that would work

koji će raditi u okolnostima s kojima se on susretao.

in the reality that he was facing.

I ono što je smislio bio je ovaj frajer,

And what he came up with:

was this guy.

The prototype for the Universal Anesthesia Machine --

prototip univerzalnog stroja za anesteziju --

stroj koji će raditi

a machine that would work and anesthetize his patients

i anestezirati njegove pacijente

no matter the circumstances that his hospital had to offer.

bez obzira na okolnosti koje njegova bolnica može ponuditi.

Here it is, back at home

Ovdje je ponovno kod kuće

at that same hospital, developed a little further, 12 years later,

u toj istoj bolnici, malo razvijeniji, 12 godina kasnije,

working on patients from pediatrics to geriatrics.

radeći na pacijentima od pedijatrije do gerijatrije.

Sada mi dopustite da vam pokažem malo kako ovaj stroj radi.

Let me show you a little bit about how this machine works.

Voila!

Voila!

Evo ga.

Here she is.

When you have electricity,

Kada imate struje,

everything in this machine begins in the base.

sve u ovom stroju počinje u bazi.

Tu je ugrađeni koncentrator kisika ovdje dolje.

There's a built-in oxygen concentrator down there.

Now you've heard me mention oxygen a few times at this point.

Dakle, čuli ste me da spominjem kisik nekoliko puta ovdje.

U suštini, da biste ostvarili anesteziju,

Essentially, to deliver anesthesia, you want as pure oxygen as possible,

želite što je moguće čistiji kisik,

because eventually you're going to dilute it, essentially, with the gas.

jer ćete ga u konačnici zapravo razrijediti

s plinom.

And the mixture that the patient inhales

I smjesa koju pacijent udiše

needs to be at least a certain percentage oxygen

mora biti barem određeni postotak kisika

ili može postati opasna.

or else it can become dangerous.

But so in here when there's electricity,

Dakle, kada ovdje ima struje,

the oxygen concentrator takes in room air.

koncentrator kisika uvlači sobni zrak.

Now we know room air is gloriously free,

Znamo da je sobni zrak veličanstveno besplatan,

it is abundant,

ima ga u obilju,

and it's already 21 percent oxygen.

i već sadrži 21 posto kisika.

So all this concentrator does is take that room air in, filter it

Dakle, sve što ovaj koncentrator radi jest da uvlači taj sobni zrak, filtrira ga

i šalje 95 posto čistog kisika

and send 95 percent pure oxygen up and across here,

gore i ovdje preko

gdje se miješa s anestetskim sredstvom.

where it mixes with the anesthetic agent.

Prije nego ta mješavina

Now before that mixture hits the patient's lungs,

dosegne pacijentova pluća,

it's going to pass by here -- you can't see it,

proći će ovdje --

but there's an oxygen sensor here --

ne možete to vidjeti, ali ovdje je senzor kisika --

that's going to read out on this screen the percentage of oxygen being delivered.

koji će očitati na ovaj zaslon

postotak kisika koji se dostavlja.

Now if you don't have power,

Sada, ako nemate struje,

or, God forbid, the power cuts out in the middle of a surgery,

ili, ne daj Bože, struje nestane usred operacije,

ovaj se stroj automatski prebacuje,

this machine transitions automatically,

bez da ga čak morate dotaknuti,

without even having to touch it,

na uvlačenje sobnog zraka iz ovog odjeljka.

to drawing in room air from this inlet.

Sve ostalo je isto.

Everything else is the same.

The only difference is that now

Jedina razlika je što sada

you're only working with 21 percent oxygen.

radite s 21 postotnim kisikom.

Now that used to be a dangerous guessing game,

To je prije bila opasna igra pogađanja,

because you only knew if you gave too little oxygen

jer ste mogli znati da ste dali premalo kisika jedino kad bi se nešto loše dogodilo.

once something bad happened.

Ali stavili smo dugoročnu baterijsku nadopunu ovdje.

But we've put a long-life battery backup on here.

To je jedini dio koji podupire baterija.

This is the only part that's battery backed up.

Ali to daje kontrolu opskrbljivaču,

But this gives control to the provider, whether there's power or not,

neovisno o tome ima li struje ili ne,

because they can adjust the flows

jer mogu namjestiti tok

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

temeljeno na postotku kisika koji vide da daju svom pacijentu.

U oba slučaja,

In both cases, whether you have power or not,

imali vi struje ili ne,

sometimes the patient needs help breathing.

nekada pacijent treba pomoć pri disanju.

It's just a reality of anesthesia, the lungs can be paralyzed.

To je jednostavno stvarnost anestezije. Pluća mogu biti paralizirana.

And so we've just added this manual bellows.

Stoga smo samo dodali ovaj priručni mijeh.

Vidjeli smo operacije od tri ili četiri sata

We've seen surgeries for three or four hours

u kojima ventiliraju pacijenta s time.

to ventilate the patient on this.

So it's a straightforward machine.

Dakle to je neposredan stroj.

I shudder to say simple; it's straightforward.

Drhtim da kažem jednostavno:

neposredan je.

And it's by design.

I takav je po dizajnu.

You do not need to be a highly trained, specialized anesthesiologist

I nemorate biti

visoko obrazovani, specijalizirani anesteziolog da koristite taj stroj,

to use this machine,

što je dobro jer, u ovim ruralnim bolnicama,

which is good because, in these rural district hospitals,

nećete dobiti tu razinu obrazovanja.

you're not going to get that level of training.

It's also designed for the environment that it will be used in.

Također je dizajniran za okolinu u kojoj će biti korišten.

To je nevjerojatno moćan stroj.

This is an incredibly rugged machine.

It has to stand up to the heat and the wear and tear

Mora podnijeti

vrućinu i sito i rešeto koje se događa

that happens in hospitals in these rural districts.

u bolnicama u ovim ruralnim okružjima.

And so it's not going to break very easily,

Stoga se neće pokvariti tako lako,

but if it does, virtually every piece in this machine

ali ako se pokvari, praktički svaki dio u ovom stroju

može biti izvađen i zamijenjen

can be swapped out and replaced

with a hex wrench and a screwdriver.

uz pomoć inbus-ključa ili odvijača.

I napokon, pristupačne je cijene.

And finally, it's affordable.

Ovaj stroj košta

This machine comes in at an eighth of the cost

osminu cijene

of the conventional machine that I showed you earlier.

uobičajnog stroja koji sam vam pokazala ranije.

Dakle drugim riječima, ono što imamo ovdje

So in other words, what we have here is a machine that can enable surgery

je stroj koji može omogućiti operaciju i spasiti živote

and save lives,

because it was designed for its environment,

jer je dizajniran za svoj okoliš,

just like the first machine I showed you.

baš kao i prvi stroj koji sam vam pokazala.

Ali neće nas zadovoljiti ako ovdje stanemo.

But we're not content to stop there.

Radi li?

Is it working?

Is this the design that's going to work in place?

Je li ovo oblik koji će raditi kako treba?

Pa dosad smo vidjeli dobre rezultate.

Well, we've seen good results so far.

This is in 13 hospitals in four countries,

Ovo je u 13 bolnica u 4 zemlje,

i od 2010. godine,

and since 2010, we've done well over 2,000 surgeries

napravili smo više od 2.000 operacija

bez klinički štetnih situacija.

with no clinically adverse events.

Stoga smo uzbuđeni.

So we're thrilled.

This really seems like a cost-effective, scalable solution

Čini se stvarno isplativim, podesivo rješenje

za vrlo raširen problem.

to a problem that's really pervasive.

But we still want to be sure

Ali još uvijek želimo biti sigurni

that this is the most effective and safe device

da je to najdjelotvorniji i najsigurniji stroj

koji možemo staviti u bolnice.

that we can be putting into hospitals.

Stoga da bismo to napravili pokrenuli smo nekoliko partnerstva

So to do that, we've launched a number of partnerships

s nevladinim organizacijama i sveučilištima

with NGOs and universities,

da skupimo podatke na korisničkom sučelju,

to gather data on the user interface,

on the types of surgeries it's appropriate for,

o tipovima operacija za koje je prikladan

i načinima na koje možemo poboljšati sam uređaj.

and ways we can enhance the device itself.

Jedno od tih partnerstva je

One of those partnerships is with Johns Hopkins

s Johnom Hopkinsom upravo ovdje u Baltimoru.

just here in Baltimore.

They have a really cool anesthesia simulation lab out in Baltimore.

Imaju stvarno super simulacijski laboratorij za anesteziju u Baltimoru.

So we're taking this machine

Stoga smo uzeli ovaj stroj

and recreating some of the operating theater crises

i ponovno stvaramo neke od kriza u operacijskoj sali

s kojima se stroj može susresti

that this machine might face

in one of the hospitals that it's intended for,

u nekoj od bolnica za koju je namijenjen,

i u kontroliranom, sigurnom okolišu,

and in a contained, safe environment,

evaluating its effectiveness.

procjenjujemo njegovu djelotvornost.

We're then able to compare the results from that study

Onda možemo usporediti rezultate te studije

s iskustvom stvarnog svijeta,

with real-world experience,

because we're putting two of these in hospitals

jer stavljamo dva ovakva u bolnice

that Johns Hopkins works with in Sierra Leone,

s kojima John Hopkins radi u Sierra Leoneu,

uključujući i bolnicu u kojoj se onaj hitni carski rez dogodio.

including the hospital where that emergency C-section happened.

So I've talked a lot about anesthesia, and I tend to do that.

Dakle, pričala sam puno o anesteziji, i često to činim.

I think it is incredibly fascinating and an important component of health.

Mislim da je to nevjerojatno fascinantan

i važan dio zdravlja.

And it really seems peripheral, we never think about it,

I zapravo se čini perifernom, nikada ne razmišljamo o njoj,

until we don't have access to it,

dok joj nemamo pristup,

and then it becomes a gatekeeper.

a onda postane najvažnija.

Who gets surgery and who doesn't?

Tko dobije operaciju, a tko ne?

Tko dobije sigurnu operaciju, a tko ne?

Who gets safe surgery and who doesn't?

Ali znate, to je samo jedan od toliko mnogo načina

But you know, it's just one of so many ways

that design, appropriate design,

u kojima dizajn, prikladan dizajn,

može imati utisak na zdravstene rezultate.

can have an impact on health outcomes.

If more people in the health-delivery space

Kada bi više ljudi u sferi zdravstvene njege,

really working on some of these challenges in low-income countries

koji rade na nekom od ovih izazova u zemljama s niskim prihodima,

počelo vlastiti proces stvaranja,

could start their design process, their solution search,

njihova potraga za rješenjem,

from outside of that proverbial box

izvan one opće poznate kutije

and inside of the hospital --

i unutar bolnice --

In other words, if we could design

drugim riječima, kada bismo mogli dizajnirati

for the environment that exists in so many parts of the world,

za uvjete koji postoje u mnogim dijelovima svijeta,

rather than the one that we wished existed --

radije nego za one za koje bismo htjeli da postoje --

mogli bismo spasiti mnogo života.

we might just save a lot of lives.

Hvala vam lijepa.

Thank you very much.

(Applause)

(Pljesak)