Erica Frenkel: The universal anesthesia machine

翻译人员: Chunxiang Qian 校对人员: Stephanie Zhou

今天我要谈的

I'm going to talk to you today

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

是关于在低能源供给下的医疗技术设计

我在这些国家学习医疗系统

I study health systems in these countries.

一个重大的医疗缺口

And one of the major gaps in care,

在很多国家都存在的

almost across the board,

是安全手术通道

is access to safe surgery.

我们发现的一个影响手术进行

Now one of the major bottlenecks that we've found

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

和手术安全

的重要医疗瓶颈

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

就是麻醉

事实上，这个方案正是我

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

为手术能在如此环境下顺利进行

for delivering anesthesia in these environments.

而致力开发的麻醉方式

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

这个场景是一个

在美国和其他发达国家的手术室里常见的景象

or any other developed country.

背景是

In the background there

is a very sophisticated anesthesia machine.

一台非常精密的麻醉器

这个机器能让

And this machine is able to enable surgery and save lives

手术顺利进行并挽救生命

because it was designed with this environment in mind.

因为它是按照此要求

设计出来的

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

要操作这台机器

that this hospital has to offer.

医院需要具备一系列条件

It needs an extremely well-trained anesthesiologist

需要一个接受过良好训练的麻醉师

with years of training with complex machines

有数年操作复杂机械的经历

来监控气体进出

to help her monitor the flows of the gas

and keep her patients safe and anesthetized

保证病人的安全和

手术中的麻醉状态

throughout the surgery.

It's a delicate machine running on computer algorithms,

这台精巧的机器会进行精密运算

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

需要特别护理，TLC，以保证其正常运行

and it's going to break pretty easily.

而且它很容易出故障

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

出故障的时候，需要一队能解决复杂问题的

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

生物医学工程师的小组

来修理，替换零件

and keep it saving lives.

让其继续挽救生命

It's a pretty expensive machine.

这是台很昂贵的机器

It needs a hospital whose budget can allow it

医院需要有

五万到十万美元的预算

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

来购置和维持运营一台机器

也许最明显的就是

And perhaps most obviously,

或者说最重要的－

but also most importantly --

我们所知的那些概念

and the path to concepts that we've heard about

也说明了这个问题－

kind of illustrates this --

这个机器需要

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

能提供不间断电源

不间断供氧

of compressed oxygen, and other medical supplies

还有其他医疗设备的基础设施

that are so critical to the functioning of this machine.

这些都对这个机器的运转

至关重要

In other words, this machine requires a lot of stuff

也就是说，这台机器需要的许多东西

是这个医院所不能提供的

that this hospital cannot offer.

这是马拉威一个乡下医院的

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

供电情况

这个医院里

In this hospital,

there is one person qualified to deliver anesthesia,

有一个人有实施麻醉的资质

她具备资质的原因是

and she's qualified

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

她接受过12或许18个月的

麻醉训练

在这个医院和这整个区域

In the hospital and in the entire region

没有一个生物医学工程师

there's not a single biomedical engineer.

所以机器一旦出故障

So when this machine breaks,

the machines that they have to work with break,

就得带着故障运行

他们得自己试着修理，但大多时候，故障就意味着没戏了

they've got to try and figure it out,

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

这些机器就进了垃圾堆

Those machines go the proverbial junkyard.

而我提到过这台机器的价钱

And the price tag of the machine that I mentioned

could represent maybe a quarter or a third

这可能是这个医院

of the annual operating budget for this hospital.

一年预算的四分之一

或三分之一

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

最后我想你们了解了它的基础设施不佳

这家医院接入的电网非常弱

This hospital is connected to a very weak power grid,

one that goes down frequently.

经常停电

So it runs frequently, the entire hospital,

这整个医院常常就是靠

一台发电机运作

just on a generator.

And you can imagine, the generator breaks down

可以想象 发电机若是出了故障

or runs out of fuel.

或者燃料耗尽会如何

And the World Bank sees this

世界银行借此估计

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

在一个低收入国家的此类条件下的医院

每个月大约有高达

can expect up to 18 power outages per month.

18次断电

Similarly, compressed oxygen and other medical supplies

同样，压缩氧气和其他医疗设备

可以算是奢侈品了

are really a luxury,

常常数月甚至一年

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

都没有任何储备

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

这个看上去挺疯狂，但我们现在做的事

is taking those machines that were designed

就是把针对我最开始展示给你们的环境

设计出来的机器

for that first environment that I showed you

捐赠或出售给

and donating or selling them to hospitals in this environment.

只有这样条件医院

这不仅是不合适的

It's not just inappropriate,

it becomes really unsafe.

而且不安全

One of our partners at Johns Hopkins

我们一位在約翰·霍普金斯大学的合作者

was observing surgeries in Sierra Leone about a year ago.

一年前在塞拉利昂观察了

那里的手术

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

第一例手术正好是产科手术

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

一个妇女需要进行紧急剖腹产

to save her life and the life of her baby.

来挽救她的孩子和自己的生命

开始一切顺利

And everything began pretty auspiciously.

外科医生准备好了动手

The surgeon was on call and scrubbed in.

护士也在

The nurse was there.

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

能马上实施麻醉

因为是紧急情况所以这一切很重要

because of the emergency nature of the situation.

And everything began well

一切都很顺利

until the power went out.

后来停电了

在手术进行过程中

And now in the middle of this surgery,

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

外科医生正和争分夺秒完成手术

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

他能做到，有个头灯

但是护士就得

But the nurse is literally running around a darkened operating theater

在黑漆漆的的手术室里四处搜寻

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

能麻醉她的病人的东西

让病人处于睡眠中

to keep her patient asleep.

因为没有电机器就不能运转

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

This routine surgery that many of you have probably experienced,

这样一个诸位都可能经历过

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

或者由此出生寻常手术

演变成了悲剧

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

更让人难过的是这并不是个案

this happens across the developing world.

在整个发展中的世界都是这样

每年有三千五百万例手术

35 million surgeries are attempted every year

是在没有安全麻醉的情况下实施

without safe anesthesia.

我的同事，鲍尔･芬东医生

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

就处在这样的情况下

He was the chief of anesthesiology

他是马拉威一家医院的

in a hospital in Malawi, a teaching hospital.

首席麻醉师，那是个教学医院

他每天就得

He went to work every day

in an operating theater like this one,

去这样的医院上班

trying to deliver anesthesia and teach others how to do so

在医院里教导别人怎样实施麻醉

using that same equipment

怎么使用这个器材

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

十分不可靠

不安全的设备

在无数手术之后

And after umpteen surgeries

你可以想象，无数悲剧之后

and, you can imagine, really unspeakable tragedy,

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

他说：“我不干了，我受够了

我得做点有用的东西。”

There has to be something better."

他去了一趟

He took a walk down the hall

堆着扔掉的那些他抱怨过的机器的房间

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

我想这就这些机器的名称

I think that's the scientific term,

他开始修补

and he started tinkering.

他从每个上面取一些

He took one part from here and another from there,

然后作出一个机器

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

能在他所处的环境里实用的

in the reality that he was facing.

他就得到了这个东西

And what he came up with:

was this guy.

The prototype for the Universal Anesthesia Machine --

这就是万能麻醉器的原型

这个机器能在

a machine that would work and anesthetize his patients

任何条件下

no matter the circumstances that his hospital had to offer.

工作，麻醉病人

Here it is, back at home

这还是在那家医院

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

12年后 有了改进

working on patients from pediatrics to geriatrics.

适用于各个年龄的病人

现在我来解释一下它的运作原理

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

哇！

Voila!

这就是了

Here she is.

When you have electricity,

有电力供给时

everything in this machine begins in the base.

一切是从基座开始工作

下面有一个内置的氧气集中器

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

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

你已经听我提到过几次氧气了

基本上，要实施麻醉

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

就得尽可能地使用纯氧

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

因为你最终会用气体

来稀释

And the mixture that the patient inhales

最后患者吸入的混合气体

needs to be at least a certain percentage oxygen

必须有一定比例的氧气

不然就会很危险

or else it can become dangerous.

But so in here when there's electricity,

但是当有电的时候

the oxygen concentrator takes in room air.

氧气集中器就采入室内空气

Now we know room air is gloriously free,

室内空气反正是免费的

it is abundant,

而起取之不尽

and it's already 21 percent oxygen.

并且含有21％的氧气

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

集中器采入室内空气，过滤

输入95％的纯氧

and send 95 percent pure oxygen up and across here,

经过这里

混合麻醉成分

where it mixes with the anesthetic agent.

在混合气体

Now before that mixture hits the patient's lungs,

进入病人肺部之前

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

会先经过这里

but there's an oxygen sensor here --

你看不到，这是个氧气传感器－

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

能读出氧气含量

显示在屏幕上

Now if you don't have power,

没有电的时候

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

或者上帝不帮忙，手术中间断电了

这个机器不需要人工操作

this machine transitions automatically,

就能自动切换模式

without even having to touch it,

开始从这个口采入室内空气

to drawing in room air from this inlet.

其他的都是一样的

Everything else is the same.

The only difference is that now

唯一的区别是

you're only working with 21 percent oxygen.

你用的只是21％氧气

Now that used to be a dangerous guessing game,

这曾是个比较危险拼运气的手术部分

because you only knew if you gave too little oxygen

因为通常是出事了你才知道供氧不足

once something bad happened.

但我们有一个超常寿命的电池

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

这是唯一一部分依靠电池的

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

但这能让麻醉师能

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

应对无论有电没电的情况

because they can adjust the flows

因为他们能按照屏幕上读取的

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

氧气比例来调节气流

不论

In both cases, whether you have power or not,

是否有电

sometimes the patient needs help breathing.

有时候病人需要协助呼吸

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

这是麻醉的现实情况 肺部有可能麻痹

And so we've just added this manual bellows.

所以我们加入了手动风箱

我们见过三到四小时的手术

We've seen surgeries for three or four hours

用这个来保持病人呼吸

to ventilate the patient on this.

So it's a straightforward machine.

所以这是个操作简明的机器

I shudder to say simple; it's straightforward.

我不想说它简单

而是操作简明

And it's by design.

从设计层面上

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

而且你不必是一名

经过优秀训练的，具备专门技能的麻醉医师才能来操作

to use this machine,

这一点很重要，因为位于乡下的医院

which is good because, in these rural district hospitals,

不可能具备这个训练水平人员

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

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

而且它也是按其使用环境来设计的

这是个不可思议地很粗糙的机器

This is an incredibly rugged machine.

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

它能承受

在乡下医院里

that happens in hospitals in these rural districts.

会出现的过热和磨损

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

也不容易出故障

but if it does, virtually every piece in this machine

但是如果出了故障，几乎每一个零件

都可以用个六角扳手和螺丝刀

can be swapped out and replaced

with a hex wrench and a screwdriver.

卸下来换个新的

最后，它价钱不贵

And finally, it's affordable.

这个机器只有

This machine comes in at an eighth of the cost

之前展示的那个传统机器的

of the conventional machine that I showed you earlier.

八分之一的价格

也就是说，这个机器

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

能保证手术进行挽救生命

and save lives,

because it was designed for its environment,

因为它贴合环境实际的设计

just like the first machine I showed you.

用途就和我一开始展示的机器一样

但是我们并不于此止步

But we're not content to stop there.

这个机器能用吗？

Is it working?

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

这个设计能管用吗？

目前为止结果还是很好的

Well, we've seen good results so far.

This is in 13 hospitals in four countries,

这个装备已经在4个国家13个医院应用

从2010起

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

我们已经用它做了超过两千例手术

没有一起医疗事故

with no clinically adverse events.

我们乐坏了

So we're thrilled.

This really seems like a cost-effective, scalable solution

这似乎是个经济又可推广的方案

来应对目前广泛存在的问题

to a problem that's really pervasive.

But we still want to be sure

但是我们仍需要确定这是

that this is the most effective and safe device

最有效和安全的设备

能在医院里使用

that we can be putting into hospitals.

所以我们为此和一些非政府组织及大学

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

合作

with NGOs and universities,

来收集使用者方面的资料

to gather data on the user interface,

on the types of surgeries it's appropriate for,

机器适宜操作的手术

以及增强设备的数据

and ways we can enhance the device itself.

我们的其中一个合作者

One of those partnerships is with Johns Hopkins

来自约翰･霍普金斯大学，正好也在巴尔的摩

just here in Baltimore.

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

他们在巴尔的摩有一个非常棒的麻醉实验室

So we're taking this machine

我们带着机器

and recreating some of the operating theater crises

在一个受控的安全环境下

重现机器

that this machine might face

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

在其原本设计环境下

可能遇到的紧急情况

and in a contained, safe environment,

evaluating its effectiveness.

来评估其有效性

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

这样我们就能把研究结果

和实际经验进行比较

with real-world experience,

because we're putting two of these in hospitals

因为我们把两台机器投放到

that Johns Hopkins works with in Sierra Leone,

约翰･霍普金斯大学在塞拉利昂的合作医院

包括紧急剖腹产的那家

including the hospital where that emergency C-section happened.

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

我谈了很多关于麻醉的内容，我总是这么做

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

我认为麻醉是医疗中

非常重要的一部分也是非常有意思的

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

麻醉看上去是次要的，我们几乎想不到它

until we don't have access to it,

只要我们需要而得不到的时候

and then it becomes a gatekeeper.

那时候麻醉就变成守门人了

Who gets surgery and who doesn't?

能不能有手术机会？

能不能施行安全的手术？

Who gets safe surgery and who doesn't?

你知道 这只是无数设计中的一个

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

that design, appropriate design,

无数合适的设计中的一个

会对医疗结果产生影响

can have an impact on health outcomes.

If more people in the health-delivery space

如果更多工作在医疗现场的人

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

能面对低收入国家的这些挑战

开始设计

could start their design process, their solution search,

寻找方案

from outside of that proverbial box

跳出惯性思维

and inside of the hospital --

面对实际状况

In other words, if we could design

也就是说，如果我们

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

能够按照世界各地不同的环境

rather than the one that we wished existed --

而不是我们希望的理想环境来设计的话

我们可以拯救很多生命

we might just save a lot of lives.

非常感谢

Thank you very much.

(Applause)

（掌声）