Erica Frenkel: The universal anesthesia machine

Prevodilac: Mile Živković Lektor: Dejan Vicai

I'm going to talk to you today

Danas ću vam pričati

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

o dizajnu tehnologije u medicini za okruženja sa manjkom resursa.

I study health systems in these countries.

U ovim zemljama proučavam sisteme zdravstva.

And one of the major gaps in care,

Jedna od velikih rupa u zdravstvu,

almost across the board,

skoro svuda,

is access to safe surgery.

je pristup bezbednim operacijama.

Now one of the major bottlenecks that we've found

Jedno od većih uskih grla koje smo pronašli

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

i koje na neki način isprva onemogućava pristup

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

i bezbednost operacija koje se dešavaju

je anestezija.

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

Zapravo to je model za koji očekujemo da funkcioniše

for delivering anesthesia in these environments.

kod davanja anestezije

u ovim okruženjima.

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

Ovde imamo prizor koji biste videli

u bilo kojoj operacionoj sali u SAD ili nekoj drugoj razvijenoj zemlji.

or any other developed country.

In the background there

U pozadini se nalazi

is a very sophisticated anesthesia machine.

veoma sofisticirana naprava za anesteziju.

And this machine is able to enable surgery and save lives

Ova naprava može

da omogući operacije i spasi živote

because it was designed with this environment in mind.

jer je smišljena

za ovo okruženje.

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

Kako bi radila, ovoj napravi je potreban određen broj stvari

that this hospital has to offer.

koje ova bolnica može da ponudi.

It needs an extremely well-trained anesthesiologist

Potreban joj je veoma obučen anesteziolog

with years of training with complex machines

sa godinama iskustva sa kompleksnim napravama

to help her monitor the flows of the gas

da pomogne sa praćenjem protoka gasa

and keep her patients safe and anesthetized

i da pacijente drži bezbednim i pod anestezijom

throughout the surgery.

kroz tok operacije.

It's a delicate machine running on computer algorithms,

To je prefinjena naprava koju pokreću kompjuterski algoritmi

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

i potrebna joj je posebna nega kako bi funkcionisala,

and it's going to break pretty easily.

i lako će se kvariti.

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

A kada se pokvari, potreban je tim biomedicinskih inženjera

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

koji razumeju njene pojedinosti,

koji mogu da je poprave, pronađu delove

and keep it saving lives.

i omoguće joj da nastavi da spašava živote.

It's a pretty expensive machine.

To je prilično skupa naprava.

It needs a hospital whose budget can allow it

Potrebna joj je bolnica

čiji budžet može da dozvoli jednu napravu

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

koja košta od 50 do 100 000 dolara.

And perhaps most obviously,

Ono što je možda najočiglednije

but also most importantly --

i možda najbitnije -

and the path to concepts that we've heard about

i put do koncepata o kojima smo slušali

kind of illustrates this --

na neki način ovo ilustruje -

potrebna joj je infrastruktura

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

koja može da doprema neprekidan izvor

struje, kompresovanog kiseonika

of compressed oxygen, and other medical supplies

i drugih medicinskih zaliha

that are so critical to the functioning of this machine.

koje su toliko bitne za funkcionisanje ove naprave.

In other words, this machine requires a lot of stuff

Drugim rečima, ovoj napravi je potrebno puno toga

that this hospital cannot offer.

što ova bolnica ne može da ponudi.

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

Ovo je snabdevanje strujom

za bolnicu u zabačenom delu Malavija.

In this hospital,

U ovoj bolnici

there is one person qualified to deliver anesthesia,

postoji jedna osoba kvalifikovana za davanje anestezije

and she's qualified

i kvalifikovana je

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

jer ima 12, možda 18 meseci

obuke za anesteziju.

In the hospital and in the entire region

U bolnici i u celom okrugu

there's not a single biomedical engineer.

nema nijednog biomedicinskog inženjera.

So when this machine breaks,

Kada se ova naprava pokvari -

the machines that they have to work with break,

naprave sa kojima rade se kvare -

moraju da pokušaju da to reše, ali to je većinom kraj priče.

they've got to try and figure it out,

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

Ove naprave idu na poslovičnu deponiju.

Those machines go the proverbial junkyard.

And the price tag of the machine that I mentioned

A cena naprave koju sam spomenula

could represent maybe a quarter or a third

mogla bi da predstavlja četvrtinu ili trećinu

of the annual operating budget for this hospital.

godišnjeg budžeta za operacije

za ovu bolnicu.

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

Konačno, mislim da možete videti da infrastruktura nije veoma jaka.

This hospital is connected to a very weak power grid,

Bolnica je povezana na veoma slabu energetsku mrežu

one that goes down frequently.

koja često nije u funkciji.

So it runs frequently, the entire hospital,

Tako da cela bolnica veoma često

just on a generator.

radi samo na generatoru.

And you can imagine, the generator breaks down

Kao što možete zamisliti, generator se kvari

or runs out of fuel.

i nestane mu goriva.

And the World Bank sees this

I Svetska banka vidi ovo

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

i procenjuje da bolnica u ovom okruženju, u zemlji sa malim primanjima,

can expect up to 18 power outages per month.

može da ima i do 18 nestanaka struje

svakog meseca.

Similarly, compressed oxygen and other medical supplies

Slično tome, zalihe kompresovanog kiseonika i druge

are really a luxury,

su zaista luksuz i često ih nema

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

mesecima ili čak godinu dana.

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

Možda izgleda ludo, ali model koji imamo sada

is taking those machines that were designed

uzima te naprave

koje su smišljene za prvo okruženje koje sam vam pokazala

for that first environment that I showed you

and donating or selling them to hospitals in this environment.

i onda ih donira ili prodaje

bolnicama u ovom okruženju.

It's not just inappropriate,

To nije samo neodgovarajuće

it becomes really unsafe.

nego i veoma opasno.

One of our partners at Johns Hopkins

Jedan od naših partnera iz Džons Hopkinsa

was observing surgeries in Sierra Leone about a year ago.

je posmatrao operacije u Sijera Leoneu

pre oko godinu dana.

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

Prva operacija tog dana je bila akušerski slučaj.

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

Došla je žena kojoj je hitno bio potreban carski rez

to save her life and the life of her baby.

kako bi se spasio život nje i njenog deteta.

And everything began pretty auspiciously.

Sve je počelo prilično uspešno.

The surgeon was on call and scrubbed in.

Pozvan je hirurg i dezinfikovao je ruke.

The nurse was there.

Medicinska sestra je bila tu.

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

Brzo joj je dala anesteziju

i to je bilo bitno zbog hitnosti situacije.

because of the emergency nature of the situation.

And everything began well

Sve je počelo dobro

until the power went out.

dok nije nestalo struje.

And now in the middle of this surgery,

I sada, usred operacije

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

hirurg se bori s vremenom da završi sa operacijom,

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

što može da uradi - ima naglavnu lampu.

But the nurse is literally running around a darkened operating theater

Ali medicinska sestra bukvalno

trči po zamračenoj operacionoj sali

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

i pokušava da pronađe bilo šta da pacijentu da anesteziju,

to keep her patient asleep.

kako bi pacijent ostao u snu.

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

Jer njena naprava ne radi kada nema struje.

This routine surgery that many of you have probably experienced,

I sada ova rutinska operacija koju je verovatno mnogo vas iskusilo

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

i čiji su drugi ljudi proizvod,

postaje tragedija.

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

Ono što je frustrirajuće je to što ovo nije pojedinačan događaj,

this happens across the developing world.

ovo se dešava širom dela sveta u razvoju.

35 million surgeries are attempted every year

35 miliona operacija se započinje svake godine

without safe anesthesia.

bez bezbedne anestezije.

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

Moj kolega, dr Pol Fenton,

je živeo u ovoj stvarnosti.

He was the chief of anesthesiology

On je bio šef anesteziologije

in a hospital in Malawi, a teaching hospital.

u pripravničkoj bolnici u Malaviju.

He went to work every day

Svakog dana išao je na posao

in an operating theater like this one,

u operacionoj sali poput ove,

trying to deliver anesthesia and teach others how to do so

pokušavajući da da anesteziju i nauči druge kako da to urade

using that same equipment

koristeći istu opremu

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

koja je postala toliko nepouzdana, i iskreno opasna,

u ovoj bolnici.

And after umpteen surgeries

I nakon bezbroj operacija

and, you can imagine, really unspeakable tragedy,

i kao što možete zamisliti, neopisive tragedije,

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

samo je rekao: "To je to. Gotov sam. Bilo je dosta.

There has to be something better."

Mora da postoji nešto bolje."

He took a walk down the hall

Prošetao je hodnikom

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

do mesta gde bacaju sve te mašine koje crknu -

mislim da je to naučni izraz -

I think that's the scientific term,

i počeo je da čačka po njima.

and he started tinkering.

He took one part from here and another from there,

Uzeo je jedan deo odavde, jedan odande,

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

i pokušao da smisli napravu

koja bi radila u situacijama sa kojima se suočavao.

in the reality that he was facing.

Smislio je ovo,

And what he came up with:

was this guy.

The prototype for the Universal Anesthesia Machine --

prototip Univerzalne naprave za anesteziju,

a machine that would work and anesthetize his patients

naprave koja bi radila

i pružala pacijentima anesteziju

no matter the circumstances that his hospital had to offer.

bez obzira na okolnosti u bolnici.

Here it is, back at home

Evo je kod kuće

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

u istoj toj bolnici, u daljem stepenu razvoja, 12 godina kasnije,

working on patients from pediatrics to geriatrics.

u radu sa pacijentima, od pedijatrije do gerijatrije.

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

Dozvolite da vam pokažem kako radi ova naprava.

Voila!

Opa!

Here she is.

Evo je.

When you have electricity,

Kada imate struju,

everything in this machine begins in the base.

sve u ovoj napravi počinje u osnovi.

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

Postoji ugrađeni koncentrator kiseonika dole.

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

Dosad ste čuli već nekoliko puta da pominjem kiseonik.

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

U principu, da biste dali anesteziju,

želite najčistiji mogući kiseonik,

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

jer ćete u nekom trenutku da ga razblažite gasom.

And the mixture that the patient inhales

Mešavina koju udiše pacijent

needs to be at least a certain percentage oxygen

mora da bude najmanje određeni procenat kiseonika

or else it can become dangerous.

ili može postati opasna.

But so in here when there's electricity,

Ali kada ovde imate struju,

the oxygen concentrator takes in room air.

koncentrator kiseonika uzima vazduh iz prostorije.

Now we know room air is gloriously free,

Znamo da je ovaj vazduh veličanstveno besplatan,

it is abundant,

ima ga puno,

and it's already 21 percent oxygen.

i već se sastoji od 21% kiseonika.

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

Sve što ovaj koncentrator radi je da uzima taj vazduh, filtrira ga,

and send 95 percent pure oxygen up and across here,

i šalje čist kiseonik od 95%

gore i preko ovoga

where it mixes with the anesthetic agent.

gde ga meša sa anestetičkim agensom.

Now before that mixture hits the patient's lungs,

Pre nego što ta mešavina

dopre do pluća pacijenta,

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

proći će ovuda -

but there's an oxygen sensor here --

ne možete to videti, ali tu je senzor kiseonika -

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

to će se očitati na ovom ekranu,

procenat kiseonika koji se doprema.

Now if you don't have power,

Ako nemate struje,

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

ili ne daj bože struja nestane u sred operacije,

this machine transitions automatically,

ova naprava se automatski prebacuje,

without even having to touch it,

bez ijednog dodira,

to drawing in room air from this inlet.

na korišćenje vazduha iz prostorije kroz ovaj ulaz.

Everything else is the same.

Sve ostalo je isto.

The only difference is that now

Jedina razlika je to što sada

you're only working with 21 percent oxygen.

radite samo sa kiseonikom od 21%.

Now that used to be a dangerous guessing game,

To je bila opasna igra pogađanja,

because you only knew if you gave too little oxygen

jer ste mogli da znate da ste dali premalo kiseonika

once something bad happened.

jedino kada se desi nešto loše.

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

Ali smo ovde stavili dugotrajnu rezervnu bateriju.

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

To je jedini deo koji ima rezervnu bateriju.

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

Ali ovo snabdevaču daje kontrolu,

bez obzira da li ima ili nema struje,

because they can adjust the flows

jer može da podesi tok

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

na osnovu procenta kiseonika koji vidi da daje svom pacijentu.

In both cases, whether you have power or not,

U oba slučaja,

bez obzira da li imate struje ili ne,

sometimes the patient needs help breathing.

ponekad je pacijentu potrebna pomoć oko disanja.

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

To je stvarnost anestezije - pluća mogu biti paralizovana.

And so we've just added this manual bellows.

I upravo smo dodali ove ručne mehove.

We've seen surgeries for three or four hours

Viđali smo operacije od 3 ili 4 sata

to ventilate the patient on this.

gde su pacijentima davali vazduh preko ovoga.

So it's a straightforward machine.

Tako da je to jednostavna naprava.

I shudder to say simple; it's straightforward.

Stresem se na reč "prosta" -

jednostavna je.

And it's by design.

I to je po dizajnu.

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

I ne morate biti

visoko obučen, stručan anesteziolog da biste je koristili,

to use this machine,

što je dobro jer se u ovim bolnicama u ruralnim krajevima

which is good because, in these rural district hospitals,

ne može videti taj nivo obuke.

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

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

Takođe je dizajnirana za okruženje u kom će se koristiti.

Ovo je neverovatno izdržljiva naprava.

This is an incredibly rugged machine.

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

Mora da se odupre

vrelini i habanju koje se dešavaju

that happens in hospitals in these rural districts.

u bolnicama u ovim ruralnim krajevima.

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

Tako da se neće lako pokvariti,

but if it does, virtually every piece in this machine

ali ako se to desi, bukvalno svaki delić ove naprave

can be swapped out and replaced

može da se izvadi i zameni

with a hex wrench and a screwdriver.

sa običnim ključem i šrafcigerom.

And finally, it's affordable.

I konačno, jeftina je.

This machine comes in at an eighth of the cost

Ova naprava košta

osminu sume

of the conventional machine that I showed you earlier.

klasičnih naprava koje sam vam ranije pokazala.

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

Drugim rečima, ovo što imamo ovde

je naprava koja može omogućiti operacije i spašavati živote

and save lives,

because it was designed for its environment,

jer je smišljena za svoje okruženje,

just like the first machine I showed you.

baš kao prva mašina koju sam vam pokazala.

But we're not content to stop there.

Ali nećemo se ovde zaustaviti.

Is it working?

Da li radi?

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

Da li je ovo dizajn koji će raditi na svom mestu?

Well, we've seen good results so far.

Do sada smo videli dobre rezultate.

This is in 13 hospitals in four countries,

Nalazi se u 13 bolnica u 4 zemlje,

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

i od 2010,

izvršili smo preko 2000 operacija

with no clinically adverse events.

bez klinički štetnih događaja.

So we're thrilled.

Tako da smo uzbuđeni.

This really seems like a cost-effective, scalable solution

Ovo zaista izgleda kao jeftino, skalabilno rešenje

to a problem that's really pervasive.

za problem koji je stvarno sveprisutan.

But we still want to be sure

Ali opet želimo da se postaramo

that this is the most effective and safe device

da je ovo najefektivnija i najbezbednija naprava

that we can be putting into hospitals.

koja se može staviti u bolnice.

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

Zbog toga smoi pokrenuli nekoliko partnerstava

with NGOs and universities,

za NVO i univerzitetima

to gather data on the user interface,

da bismo skupili podatke o korisničkom interfejsu,

on the types of surgeries it's appropriate for,

o tipovima operacija za koje je pogodna

i o načinima na koje možemo unaprediti samu napravu.

and ways we can enhance the device itself.

One of those partnerships is with Johns Hopkins

Jedno od tih partnerstava

je sa Džons Hopkinsom odavde iz Baltimora.

just here in Baltimore.

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

U Baltimoru imaju sjajnu laboratoriju za simulaciju anestezije.

So we're taking this machine

Uzimamo ovu napravu

and recreating some of the operating theater crises

i simuliramo neke od kriza u operacionoj sali

that this machine might face

sa kojim se može susresti ta naprava

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

u nekoj od bolnica za koju je namenjena,

and in a contained, safe environment,

i u zatvorenom, bezbednom okruženju,

evaluating its effectiveness.

procenjujemo njenu efektivnost.

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

Onda možemo uporediti rezultate iz tog istražiivanja

with real-world experience,

sa stvarnim iskustvom

because we're putting two of these in hospitals

jer stavljamo dve naprave u bolnice

that Johns Hopkins works with in Sierra Leone,

sa kojima Džons Hopkins radi u Sijera Leoneu,

uključujući i onu gde se desio onaj hitni carski rez.

including the hospital where that emergency C-section happened.

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

Puno sam pričala o anesteziji, imam običaj da radim to.

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

Mislim da je neverovatno očaravajuća

i bitna komponenta zdravlja.

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

I zaista se čini nebitnom, nikada ne razmišljamo o njoj

until we don't have access to it,

sve dok ne možemo da je dobijemo.

and then it becomes a gatekeeper.

i onda postane faktor odluke.

Who gets surgery and who doesn't?

Ko će se operisati, a ko ne?

Who gets safe surgery and who doesn't?

Ko će se bezbedno operisati, a ko ne?

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

Ali znate, to je samo jedan od mnogih načina

that design, appropriate design,

kako dizajn, odgovarajući dizajn,

can have an impact on health outcomes.

može da ima uticaj na ishode u zdravstvu.

If more people in the health-delivery space

Kada bi više ljudi iz sektora zdravstva

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

zaista radilo na nekim od ovih izazova u zemljama sa malim primanjima

could start their design process, their solution search,

i započelo proces dizajniranja,

njihova potraga za rešenjem,

from outside of that proverbial box

van te poslovične zatvorene kutije

and inside of the hospital --

i unutar bolnice -

In other words, if we could design

drugim rečima, kada bismo dizajnirali

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

za okruženje koje postoji u toliko delova sveta,

rather than the one that we wished existed --

umesto za ono za koje želimo da postoji -

we might just save a lot of lives.

možda bismo spasili puno života.

Thank you very much.

Puno vam hvala.

(Applause)

(Aplauz)