Seyi Oyesola: Health care off the grid

Dr. Seyi Oyesola Nijerya'da bir hastaneyi geziyor

Çeviri: Mustafa Ozkaynak Gözden geçirme: Sancak Gülgen

Just to put everything in context,

Konuyu bir baglam icinde ele almak icin

and to kind of give you a background to where I'm coming from,

ve size benim nereden geldigim hakkinda biraz bilgi vereyim

so that a lot of the things I'm going to say,

Soyleyecegim bir cok sey

and the things I'm going to do --

ve yapacagim seyler

or things I'm going to tell you I've done --

veya yaptigimi soyleyecegim seyler bununla ilgili

you will understand exactly why and how I got motivated to be where I am.

Neden ve nasil burada olmaya motive oldugumu anlayacaksiniz

I graduated high school in Cleveland, Ohio, 1975.

Cleveland'da 1975 yilinda liseden mezun oldum.

And just like my parents did when they finished studying abroad, we went back home.

Ve anne-babamin yurtdisi tahsini bitirdiginde yaptigini yapip yurda geri dondum

Finished university education, got a medical degree, 1986.

1986'da universite egitimimi tamamlayip tip derecesi aldim

And by the time I was an intern house officer,

cerrahi uzmanligimi yaparken

I could barely afford to maintain my mother's 13-year-old car --

maddi gucum anca annemin 13 yillik arabasini kullanmama yetiyordu

and I was a paid doctor.

ve maasli bir doktordum

This brings us to why a lot of us, who are professionals,

iste bu yuzden biz profesyoneller

are now, as they say, in diaspora.

simdi diaspora dedikleri seyin bir parcasiyiz

Now, are we going to make that a permanent thing,

Simdi bunu kalici hale getirecegiz

where we all get trained, and we leave, and we don't go back?

yani biz egitim alip, ayrilip bir daha geri donmeyecek miyiz?

Perhaps not, I should certainly hope not --

Belki degil, umut ederim ki degil

because that is not my vision.

Cunku, bu benim vizyonum degil

All right, for good measure, that's where Nigeria is on the African map,

Pekala, Afrika haritasi uzerinde Nijerya'nin yaklasik nerede olduguna bakalim

and just there is the Delta region that I'm sure everybody's heard of.

iste orada herkezin duydugundan emin oldugum Delta bolgesi

People getting kidnapped, where the oil comes from,

insanlarin kacirildigi ve petrolun geldigi yer

the oil that sometimes I think has driven us all crazy in Nigeria.

o petrol ki bazen Nijerya'daki herkezi cildirttigini dusunuyorum

But, critical poverty: this slide is from a presentation I gave

fakat, ciddi fakirlik, su yansi benim verdigim bir sunumdan

not that long ago. Gapminder.org tells the story of the gap

uzun zaman once degil. Gapminder.org aradaki farki anlatiyor

between Africa and the rest of the world in terms of health care.

Afrika'da ve dunyanin geri kalani arasindaki saglik hizmetinin

Very interesting.

cok ilginc

How many people do you think are on that taxi?

Su takside kac kisi var sizce?

And believe it or not, that is a taxi in Nigeria.

ister inanin ister inanmayin, bu Nijerya'da bir taksi

And the capital -- well, what used to be the capital of Nigeria -- Lagos,

Baskentte, yani bir zamanlarin Nijerya baskenti Lagos

that's a taxi, and you have police on them.

bu bir taksi ve icinde polisler var

So, tell me, how many policemen do you think are on this taxi? And now? Three.

simdi, soyleyin bana sizce bu takside kac polis var? ve simdi? Uc.

So, when these kind of people -- and, believe me, it's not just the police

Yani, bu insanlar ve inanin bana sadece polisler degil

that use these taxis in Lagos. We all do. I've been on one of these,

Lagos'ta taksileri kullaniyolar, hepimiz kullaniyoruz. ben de bunlarin bir tanesinin icindeydim

and I didn't have a helmet, either.

ve ben de kask kullanmiyordum

And it just reminds me of the thought of what happens when one of us

ve bu bana su dusunceyi hatirlatiyor: eger birimiz

on a taxi like this falls off, has an accident and needs a hospital.

takside bir kaza gecirir ve hasteneye gitmesi gerekirse

Believe it or not, some of us do survive.

ister inanin ister inanmayin, bazilarimiz hayatta kaliyor.

Some of us do survive malaria; we do survive AIDS.

bazilarimiz sitmaya ve AIDS'e ragmen hayatta kaliyor

And like I tell my family, and my wife reminds me every time,

ve aileme de soyledigim, ve karimin bana surekli hatirlattigi su

"You're risking your life, you know, every time you go to that country."

sen o ulkeye her gittiginde hayatini tehlikeye attigini biliyorsun

And she's right. Every time you go there,

ve karim hakli. oraya her gittiginizde

you know that if you actually need critical care --

biliyorsunuz ki gercekten yogun bakima ihtiyaciniz olursa

critical care of any sort -- if you have an accident --

herhangi bir cesit yogun bakim - eger bir kaza gecirirseniz

of which there are many, there are accidents everywhere --

ki, kazalar her yerde cokca olur

where do they go?

kazayi gecirenler nereye gider?

Where do they go when they need help for this kind of stuff?

soyle sorunlar icin bir yardima ihtiyac duyduklarinda nereye giderler?

I'm not saying instead of, I'm saying as well as,

bunlarin yerine demiyorum bunlar icin de

AIDS, TB, malaria, typhoid -- the list goes on.

AIDS, tuberkuloz, sitma, tifo liste uzayip gidiyor

I'm saying, where do they go when they're like me?

sunu soyluyorum, benim gibi insanlar nereye gidiyorlar?

When I go back home -- and I do all kinds of things,

Ulkeme geri dondugumde, ben cok cesitli isler yapiyorum

I teach, I train -- but I catch one of these things,

ders veriyorum, egitiyorum fakat su hastaliklarin birine yakalanirsam

or I'm chronically ill with one of those, where do they go?

veya su kronik hastaliklardan birini tasiyorsam, nereye gidebilirim?

What's the economic impact when one of them dies or becomes disabled?

hastalardan biri olur yada sakat kalirsa ekonomik etki ne olur?

I think it's quite significant. This is where they go.

bence cok onemli. Hastalar nereye giderler?

These are not old pictures and these are not from some downtrodden --

Bunlar eski resimler ya da cok fakir ve ezilmislerin resimleri degil

this is a major hospital. In fact, it's from a major teaching hospital in Nigeria.

bu buyuk bir hastane. Aslinda, bu Nijerya'daki buyuk akademik hastanelerden biri

Now that is less than a year old, in an operating room.

1 yildan kisa bir sure once, bir ameliyathane

That's sterilizing equipment in Nigeria.

Bu Nijeryada bir sterilizasyon makinasi

You remember all that oil?

bu yagi hatirladiniz mi?

Yes, I'm sorry if it upsets some of you, but

Evet, bu resimlerle bazilarinizin keyfinizi kacirdiysam kusura bakmayin

I think you need to see this. That's the floor, OK?

Bence, bunu gormelisiniz. Bu zemin. Tamam mi?

You can say some of this is education.

Sunu soyleyebiliriniz bu konu egitimle de ilgili

You can say it's hygiene. I'm not pleading poverty.

Hijyen diyebilirsiniz. Ben fakirligi savunmuyorum

I'm saying we need more than just, you know, vaccination,

Dedigim su, bizim asidan

malaria, AIDS, because I want to be treated

sitma, AIDS'ten korunmamizdan fazlasina ihtiyacimiz var. Ben tedavi edilmek istiyorum

in a proper hospital if something happens to me out there.

uygun bir hastanede eger basima orada birsey gelirse

In fact, when I start running around saying,

Aslinda, kosusturmaya ve etrafimdakilere

"Hey, boys and girls, you're cardiologists in the U.S.,

beyler ve hanimlar siz ABD'de kardiyoloji uzmanisiniz demeye basladigimda

can you come home with me and do a mission?"

benimle ulkeme gelip onemli bir hizmet verir misiniz? diye sordugumda

I want them to think, "Well there's some hope."

onlarin "bir umut var" diye dusunmelerini istiyorum

Now, have a look at that. That's the anesthesiology machine.

Simdi suna bakin. Bu bir anestezi makinasi

And that's my specialty, right?

Bu benim uzmanligim, degil mi?

Anesthesiology and critical care -- look at that bag.

Anestezi ve yogun bakim. Su torbaya bakin

It's been taped with tape that we even stopped using in the U.K.

bizim birlesik krallik'ta artik kullanmadigimiz bir bantla bantlanmis,

And believe me, these are current pictures.

ve inanin bana, bunlar guncel resimler

Now, if something like this, which has happened in the U.K.,

Simdi, bunun gibi birsey birlesik krallik'ta olmus

that's where they go. This is the intensive care unit in which I work.

iste hastalarin oldugu yer. Burasi benim calistigim yogun bakim bolumu

All right, this is a slide from a talk I gave

Pekiyi, bu benim onceki konuslarimdan bir yansi

about intensive care units in Nigeria,

Nijerya'daki yogun bakim bolumlari hakkinda

and jokingly we refer to it as "Expensive Scare."

ve alayli bir sekilde biz buna "pahali panik" deriz

Because it's scary and it's expensive, but we need to have it, OK?

Cunku, korkunc ve pahali ama bizim ona ihtiyacimiz var.

So, these are the problems.

Ve, bunlar problemler.

There are no prizes for telling us what the problems are, are there?

Problemin ne oldugunu soyleyene bir odul vermiyorlar, degil mi?

I think we all know. And several speakers before

Sanirim hepimiz bu problemleri biliyoruz, benden onceki konusmacilar

and speakers after me are going to tell us even more problems.

ve benden sonrakiler bunlari ve hatta fazlasini soyleyecekler

These are a few of them. So, what did I do?

Bunlar sadece bazilari. Peki ben ne yaptim?

There we go -- we're going on a mission.

Iste, onemli bir hizmet vermeye gidiyoruz

We're going to do some open-heart surgery. I was the only Brit,

Acik kalp ameliyati yapacagiz. Ben tek Britanyaliydim

on a team of about nine American cardiac surgeons,

Takimdaki diger dokuz kisi Amerikali kardiyoloji cerrahlari,

cardiac nurse, intensive care nurse.

kardiyoloji hemsiresi ve yogun bakim hemsiresiydi

We all went out and did a mission and we've done three of them so far.

Onemli bir hizmet icin yola ciktik ve simdiye kadar uc acik kalp ameliyati yaptik

Just so you know, I do believe in missions, I do believe in aid

Ben boyle hizmetlere inaniyorum, insani yardima inaniyorum

and I do believe in charity. They have their place,

ve yardimseverlige inaniyorum. Yeri geldiginde cok onemli.

but where do they go for those things we talked about earlier?

Hastalar boyle seyler icin nereye gidecekler

Because it's not everyone that's going to benefit from a mission.

Cunku herkes onemli hizmetten faydalanamiyacak

Health is wealth, in the words of Hans Rosling.

Hans Rosling'in soyledigi gibi saglik zenginliktir

You get wealthier faster if you are healthy first.

Eger baslangicta saglikliysaniz daha cabuk zenginlesirsiniz

So, here we are, mission. Big trouble.

Iste, hizmet, buyuk bir sorun

Open-heart surgery in Nigeria -- big trouble.

Nijeryada acik kalp ameliyati - buyuk sorun

That's Mike, Mike comes out from Mississippi.

Bu Mike, Mike Mississippi'den geliyor

Does he look like he's happy?

Mutlu biri gibi mi gorunuyor

It took us two days just to organize the place, but hey,

Iki gunumuzu aldi bu yeri duzenlemek, iste

you know, we worked on it. Does he look happy?

Bildiginiz gibi, calistik. Mutlu gozukuyor mu?

Yes, that's the medical advice the committee chairman says,

Evet, komite baskanin verdigi tibbi tavsiye

"Yes, I told you, you weren't going to be able to,

Evet, size dedigim gibi beceremiyeceksiniz

you can't do this, I just know it."

yapamazsiniz, biliyorum

Look, that's the technician we had. So yes, you go on, all right?

bakin, bu bizim teknisyenimiz. Evet, devam et, tamam mi?

(Laughter)

Gulusmeler

I got him to come with me -- anesthesia tech -- come with me from the U.K.

Onu ben getirdim. Anestezi teknisyeni, Birlesik Kralliktan geldi

Yes, let's just go work this thing out.

Evet, hadi su isi bir halledelim

See, that's one of the problems we have in Nigeria and in Africa generally.

Goruyorsunuz, bu bizim Nijeryada ve de genel olarak Afrika'daki problemlerimizden biri

We get a lot of donated equipment.

Biz bir cok bagis alet-makina aliriz

Equipment that's obsolete, equipment that doesn't quite work,

Bazi makilar cok eskimis, bazi makinalar calismiyor

or it works and you can't fix it. And there's nothing wrong with that,

veya calisiyor ama ayarlanamiyor. Bunda garip birsey yok

so long as we use it and we move on.

kullanabildigimiz kadar kullanip, isimize bakiyoruz

But we had problems with it. We had severe problems there.

fakat sorunlarimiz oluyor. Ciddi sorunlar

He had to get on the phone. This guy was always on the phone.

Bu adam telefonla konusmak zorunda idi. O surekli telefon basindaydi

So what we going to do now?

Peki, simdi ne yapacagiz

It looks like all these Americans are here and

Bu Amerikalilar burada ve

yes, one Brit, and he's not going to do anything --

evet, bir Britanyali, hic birsey yapmiyor,

he thinks he's British actually, and he's actually Nigerian,

O kendini aslinda Britanyali saniyor, aslinda Nijaryali

I just thought about that.

Bunun hakkinda dusundum

We eventually got it working, is the truth,

Gercek su ki, sonucta isi basardik

but it was one of these. Even older than the one you saw.

bunlardan sadece biri. Gorduklerinizden bile eski

The reason I have this picture here, this X-ray,

Bu resmi buraya koymamin nedeni, bu X-rey filmi

it's just to tell you where and how we were viewing X-rays.

nerede ve nasil X-rey filmlerine baktigimizi gostermek

Do you figure where that is? It was on a window.

Bunun neresi oldugunu anladiniz mi? Pencere

I mean, what's an X-ray viewing box? Please.

Yani, X-rey filmi tetkik kutusu nedir? Lutfen...

Well, nowadays everything's on PAX anyway.

Neyse, bugunlerde hersey Görüntü Arşivleme ve İletişim Sistemlerinde zaten

You look at your X-rays on a screen and you do stuff with them,

Siz X-rey filmlerine ekranda bakip uzerlerinde calisiyorsunuz

you email them. But we were still using X-rays,

email atiyorsunuz. Fakat biz hala eski X-rey filmleri kullaniyoruz

but we didn't even have a viewing box!

fakat bizim uygun bir tetkik kutumuz bile yok

And we were doing open-heart surgery.

ve biz acik kalp ameliyati yapiyorduk.

OK, I know it's not AIDS, I know it's not malaria,

Tamam, biliyorum AIDS degil, biliyorum sitma da degil

but we still need this stuff. Oh yeah, echo --

fakat bizim hala buna ihtiyacimiz var. Ah evet yanki

this was just to get the children ready and the adults ready.

bu sadece cocuklari ve yetiskinleri hazirlamak icin

People still believe in Voodoo. Heart disease,

Insanlar hala vuduya inaniyor - kalp hastaligi

VSD, hole in the heart, tetralogies.

VSD, delik kalp, dortleme

You still get people who believe in it and they came.

Hala bunlara inanan insanlarla karsilasacaksiniz, size geleceklerdir

At 67 percent oxygen saturation, the normal is about 97.

%67 oksijen derisiminde, normali yaklasik 97

Her condition, open-heart surgery that as she required,

Onun sartlarinda, acik kalp ameliyati gerekliligi

would have been treated when she was a child.

cocuklukta ortadan kaldirilabilirdi

We had to do these for adults. So, we did succeed and we still do.

Bunlari yetiskinler icin yapmak zorunda kaldik. Ve basardik ve hala basariyoruz

We've done three. We're planning another one in July

Simdiye kadar 3 tane yaptik. Temmuz'da bir tane daha yapmak istiyoruz

in the north of the country. So, we certainly still do open-heart,

Ulkenin kuzeyinde. Yani kesinlikle acik kalp ameliyati yapmaya devam ediyoruz,

but you can see the contrast between everything that was shipped in --

fakat, su zitligi gorebilirsiniz nakil edilen herseyle

we ship everything, instruments. We had explosions

biz herseyi, aletleri sevk ederiz - patlamalar gorduk

because the kit was designed and installed by people who weren't used to it.

cunku takimlar ehil olmayan kisiler tarafindan tasarlandi ve kuruldu

The oxygen tanks didn't quite work right.

Oksijen tupleri dogru durust calismadi

But how many did we do the first one? 12.

fakat, ilkini kac kere yaptik? 12.

We did 12 open-heart surgical patients successfully.

12 acik kalp ameliyat hastasini basariyla tedavi ettik

Here is our very first patient, out of intensive care,

Iste ilk hastamiz. Yogun bakimda.

and just watch that chair, all right?

ve dikkat edin su koltuga, tamam mi?

This is what I mean about appropriate technology.

Bu benim uygun teknoloji dedigim sey

That's what he was doing, propping up the bed because the bed simply didn't work.

Yaptigi sey su, yatagi destekliyor cunku yatak calismiyor

Have you seen one of those before?

Bunlardan hic daha once gormus muydunuz?

No? Yes? Doesn't matter, it worked.

Hayir? Evet? Farketmez. Oldu.

I'm sure you've all seen or heard this before:

Eminim bunu daha once gordunuz ya da duydunuz.

"We, the willing, have been doing so much with so little for so long --

Biz, bir istekle, uzun zamandir cok kucuk imkanlarla buyuk isler basariyoruz

(Applause)

Alkislar...

-- we are now qualified to do anything with nothing."

Biz hic yardim almadan herseyi yapma yetkinligimiz var

(Applause)

Alkislar...

Thank you. Sustainable Solutions -- this was my first company.

Tesekkur ederim. Surdurebilir cozumler - bu benim ilk ekibim.

This one's sole aim is to provide the very things that I think are missing.

bunun tek amaci en cok ihtiyac duyulanlari saglamaktir.

So, we put my hand in my pocket and say, "Guys, let's just buy stuff.

Boylece, elimizi cebimize attik ve dedik ki, Hey, hadi birseyler satin alalim

Let's go set up a company that teaches people, educates them,

Egitim ve ogretim veren bir ekip kuralim

gives them the tools they need to keep going."

onlara calisabilmleri icin aletleri saglayan bir ekip

And that's a perfect example of one.

Ve bu mukemmel bir ornek

Usually when you buy a ventilator in a hospital,

Genelde, biz bir hastaneye solunum cihazi aldigimiz zaman

you buy a different one for children,

cocuklar icin ozel bir cihaz aliriz

you buy a different one for transport. This one will do everything,

Hasta nakilleri icin ozel bir cihaz. Bu her durumda kullanilabilir,

and it will do it at half the price and doesn't need compressed air.

hem de maliyeti yari yariya ve sikistirilmis hava olmadan kullanilabilir

If you're in America and you don't know about this one, we do,

Eger siz Amerika'da yasiyorsaniz, bunu bilmezsiniz. Biz biliyoruz

because we make it our duty to find out

cunku bir cikis yolu bulmayi gorev edindik

what's appropriate technology for Africa -- what's appropriately priced,

Afrika'ya uygun teknoloji nedir? Neyin fiyati uygun?

does the job, and we move on. Anesthesia machine:

Ne is gorur ve devam edelim. Anestezi makinasi,

multi-parameter monitor, operating lights, suction.

coklu parametreli monitor, isletme isiklari, emme

This little unit here -- remember your little 12-volt plug in the car,

Bu kucuk unite -- arabanizdaki kucuk 12-volt bujiyi hatirlayin

that charges your, whatever, Game Boy, telephone?

arabanizi dolduran, ner neyse - Game Boy, telefon?

That's exactly how the outlets are designed.

Prizler de tam olarak boyle tasarlaniyor

Yes, it will take a solar panel. Yes a solar panel will charge it.

Evet, gunes paneli is gorebilir. Evet, bir gunes paneli doldurur

But if you've got mains as well, it will charge the batteries in there.

Fakat, eger ana boru kurarsaniz, oradaki pilleri de doldurabilirsiniz

And guess what? We have a little pedal charger too, just in case.

ve tahmin edebilir misiniz? bir kucuk pedal doldurucumuz da var gerekirse

And guess what, if it all fails,

ve tahmin edin, eger butun bunlar basarisiz olursa

if you can find a car that's still got a live battery

eger calisan bir pili olan araba bulabilirseniz

and you stick it in, it will still work. Then you can customize it.

takin ve calisiyor. Sonra ihtiyaclariniza uygun degisiklikler yapabilirsiniz.

Is it dental surgery you want? General surgery you want?

istediginiz bir dis ameliyati mi? Genel cerrahi mi istersiniz?

Decide which instruments, stock it up with consumables.

Aletlere karar verin, sarf malzemeleriyle doldurun.

And currently we're working on oxygen -- oxygen delivery on-site.

Su siralar oksijen uzerinde calisiyoruz. Oksijen sevkiyati.

The technology for oxygen delivery is not new.

Oksijen sevkiyati teknolojileri yeni degil

Oxygen concentrators are very old technology. What is new,

Oksijen yogunlastiricilar cok eski teknoloji. Yeni olan

and what we will have in a few months, I hope,

ve birkac ay icinde sahip olacagimiz, umarim,

is that ability to use this same renewable energy system

bu ayni yenilenebilir enerji sistemini kullanabilme yeterliligi

to provide and produce oxygen on site. Zeolite -- it's not new --

gerekli yerde oksijeni uretebilmek icin. Zeolite - yeni degil -

zeolite removes nitrogen from air and nitrogen is 78 percent of air.

Zeolite havadaki nitrojeni ayristiriyor ve nitrojen havanin %78'i

If you take nitrogen out, what's left? Oxygen, pretty much.

eger nitrojeni cikarirsaniz, geriye ne kalir? Oksijen

So that's not new. What we're doing is applying this technology to it.

Yeni degil. Bizim yaptigimiz teknolojiyi uygulamak.

These are the basic features of my device, or our device.

Bunlar cihazimin ya da cihazimizin temek ozellikleri

This is what makes it so special.

Bunu ozel kilan sey.

Apart from the awards it's won,

Kazandigi oduller disinda

it's portable and it's certified. It's registered, the MHRA --

tasinabilir ve serifikali, kayitli MHRA

and the CE mark, for those who don't know, for Europe, is the equivalent

ve CE isareti, bilmeyenler icin birlesik devletlerdeki

of the FDA in the U.S.

FDA'in Avrupa'daki karsiligi

If you compare it with what's on the market, price-wise,

Eger bunu piyasadakilerle karsilastirirsaniz fiyat olarak,

size-wise, ease of use, complexity ...

buyukluk olarak ve kullanim kolayligi ve karmasiklik olarak

This picture was taken last year.

Bu resim gecen sene cekildi

These are members of my graduating class, 1986.

Bunlat benim mezuniyetimde sinif arkadaslarim, 1986

It was in this gentleman's house in the Potomac,

Bu su beyfendinin Potomac'taki evindeydi

for those of you who are familiar with Maryland.

Maryland'i bilenler icin soyledim

There are too many of us outside and everybody,

Cogumuz disaridayiz ve herkes,

just to borrow a bit from Hans -- Hans Rosling, he's my guy --

Hans'tan aldigim kucuk birsey - Hans Rosling, adamim

if the size of the text represents what gets the most attention,

Eger harf buyuklugu en cok neyin dikkat cektigini gosteriyorsa

it's the problems. But what we really need are African solutions

Burada problem var. Bizim Afrikali cozumlere intiyacimiz var.

that are appropriate for Africa -- looking at the culture,

Afrikaya uygun - kulture bakin

looking at the people, looking at how much money they've got.

insanlara bakin, ne kadar paralari olduguna bakin

African people, because they will do it with a passion, I hope.

Afrikalilar, bunu bir tutkuyla yapacaklar, umut ediyorum,

And lots and lots of that little bit down there, sacrifice.

ve kucuk bir seyden cokca lazim: fedakarlik

You have to do it. Africans have to do it,

Bunu yapmak zorundasiniz. Afrikalalilar bunu yapmak zorunda

in conjunction with everyone else.

digerlerinin yardimiyla.

Thank you.

Tesekkur ederim

(Applause)

Alkislar