Just to put everything in context, and to kind of give you a background to where I'm coming from, so that a lot of the things I'm going to say, and the things I'm going to do -- or things I'm going to tell you I've done -- you will understand exactly why and how I got motivated to be where I am. I graduated high school in Cleveland, Ohio, 1975. And just like my parents did when they finished studying abroad, we went back home. Finished university education, got a medical degree, 1986. And by the time I was an intern house officer, I could barely afford to maintain my mother's 13-year-old car -- and I was a paid doctor. This brings us to why a lot of us, who are professionals, are now, as they say, in diaspora. Now, are we going to make that a permanent thing, where we all get trained, and we leave, and we don't go back? Perhaps not, I should certainly hope not -- because that is not my vision.
Só para poñer as cousas en contexto, e que saiban vostedes a miña bagaxe e de onde veño, para que moitas das cousas que vou dicir, e as cousas que vou facer ou que vou dicir que fixen e que entendan exactamente as razóns e as motivacións para estar onde estou. Gradueime no instituto de Cleveland, Ohio, en 1975. E como xa fixeran os meus pais ao terminar de estudar fóra, volvín á casa. Rematei a universidade, gradueime en Medicina en 1986. E cando era médico residente, case non podía manter o coche de trece anos de miña nai, e era un doutor cun soldo. Isto lévanos a preguntarnos por que moitos de nós, profesionais, estamos agora, como din, na diáspora. Imos facer que isto sexa algo permanente, que nos formemos e marchemos para non volver? Pode que non, oxalá non porque esa non é a miña visión.
All right, for good measure, that's where Nigeria is on the African map, and just there is the Delta region that I'm sure everybody's heard of. People getting kidnapped, where the oil comes from, the oil that sometimes I think has driven us all crazy in Nigeria. But, critical poverty: this slide is from a presentation I gave not that long ago. Gapminder.org tells the story of the gap between Africa and the rest of the world in terms of health care. Very interesting.
Ben, para termos unha idea, aí está Nixeria en África, e xusto aí está a rexión do Delta da que seguro que oíron falar. Persoas secuestradas, o sitio de onde procede o petróleo, o petróleo que moitas veces parece que nos volveu a todos tolos en Nixeria. Pero hai pobreza extrema. Esta diapositiva é dunha presentación miña de hai pouco. Gapminder.com explica a historia da fenda entre África e o resto do mundo en atención sanitaria. É moi interesante.
How many people do you think are on that taxi? And believe it or not, that is a taxi in Nigeria. And the capital -- well, what used to be the capital of Nigeria -- Lagos, that's a taxi, and you have police on them. So, tell me, how many policemen do you think are on this taxi? And now? Three. So, when these kind of people -- and, believe me, it's not just the police that use these taxis in Lagos. We all do. I've been on one of these, and I didn't have a helmet, either. And it just reminds me of the thought of what happens when one of us on a taxi like this falls off, has an accident and needs a hospital.
Cantas persoas dirían vostedes que viaxan neste taxi? E, créano ou non, isto é un taxi en Nixeria. E na capital, na que era capital de Nixeria, Lagos, isto é un taxi, e a policía vai nel. Entón, digan, cantos policías pensan que van aí? E agora? Tres. Entón, cando esta xente --e créanme, non só é a policía a que utiliza estes taxis en Lagos. Faino todo o mundo, eu tamén, e tampouco levaba casco. E isto lémbrame o que pasa cando un de nós cae dun destes taxis, ten un accidente e precisa dun hospital.
Believe it or not, some of us do survive. Some of us do survive malaria; we do survive AIDS. And like I tell my family, and my wife reminds me every time, "You're risking your life, you know, every time you go to that country." And she's right. Every time you go there, you know that if you actually need critical care -- critical care of any sort -- if you have an accident -- of which there are many, there are accidents everywhere -- where do they go? Where do they go when they need help for this kind of stuff? I'm not saying instead of, I'm saying as well as, AIDS, TB, malaria, typhoid -- the list goes on. I'm saying, where do they go when they're like me? When I go back home -- and I do all kinds of things, I teach, I train -- but I catch one of these things, or I'm chronically ill with one of those, where do they go? What's the economic impact when one of them dies or becomes disabled?
Aínda que non o crean, algúns sobrevivimos. Algúns de nós sobrevivimos á malaria, á sida. E como lle digo á miña familia, e a miña esposa lémbramo cada pouco "Arriscas a túa vida, e sábelo, cada vez que visitas ese país." E ten razón. Cada vez que vas sabes que se precisas de coidados intensivos --coidados intensivos de calquera tipo-- se tes un accidente --e hai moitos, por todas partes-- onde van? Onde van se precisan axuda para todo isto? E non digo no canto de, digo ademais de. Sida, tuberculose, malaria, febre tifoide... a lista continúa. Estou a dicir, onde van se están coma min? Cando regreso á casa... e fago todas esas cousas, ensino, formo... pero contraio algunha destas enfermidades, ou son enfermo crónico, onde van? Cal é o impacto económico cando algún deles morre ou queda discapacitado?
I think it's quite significant. This is where they go. These are not old pictures and these are not from some downtrodden -- this is a major hospital. In fact, it's from a major teaching hospital in Nigeria. Now that is less than a year old, in an operating room. That's sterilizing equipment in Nigeria. You remember all that oil? Yes, I'm sorry if it upsets some of you, but I think you need to see this. That's the floor, OK? You can say some of this is education. You can say it's hygiene. I'm not pleading poverty. I'm saying we need more than just, you know, vaccination, malaria, AIDS, because I want to be treated in a proper hospital if something happens to me out there. In fact, when I start running around saying, "Hey, boys and girls, you're cardiologists in the U.S., can you come home with me and do a mission?" I want them to think, "Well there's some hope."
Penso que é bastante significativo. Aquí é onde van. Non son imaxes antigas nin de ningún antro. É un hospital importante. De feito, é o maior hospital universitario de Nixeria. Agora unha de hai menos dun ano. Unha sala de operacións. Este é un equipo de esterilización de Nixeria. Recordan todo aquel petróleo? Sinto se os afecta, pero creo que teñen que ver isto. Este é o chan, vale? Poden dicir que en parte é un problema de educación Poden dicir que é de hixiene. Non pretendo usar a pobreza como escusa. Digo que precisamos algo máis que, xa saben, vacinas, malaria, sida, porque quero ser tratado nun bo hospital se me pasa algo. De feito, cando ando dun lado para outro dicindo: "Rapaces, rapazas, sodes cardiólogos nos EE. UU., podedes vir comigo a unha misión?" Quero que pensen: "hai algunha esperanza".
Now, have a look at that. That's the anesthesiology machine. And that's my specialty, right? Anesthesiology and critical care -- look at that bag. It's been taped with tape that we even stopped using in the U.K. And believe me, these are current pictures. Now, if something like this, which has happened in the U.K., that's where they go. This is the intensive care unit in which I work.
Miren isto. É unha máquina de anestesia. É a miña especialidade, vale? Anestesioloxía e coidados intensivos. Fíxense nesa bolsa. Está arranxada cunha fita que xa nin utilizamos no Reino Unido. E créanme, son fotos recentes. Se algo coma isto pasara no Reino Unido aquí sería onde irían. Esta é a UCI na que traballo.
All right, this is a slide from a talk I gave about intensive care units in Nigeria, and jokingly we refer to it as "Expensive Scare." Because it's scary and it's expensive, but we need to have it, OK? So, these are the problems. There are no prizes for telling us what the problems are, are there? I think we all know. And several speakers before and speakers after me are going to tell us even more problems. These are a few of them. So, what did I do?
Ben, esta é unha diapositiva dunha conferencia que dei sobre as UCI en Nixeria e tiñamos a brincadeira de chamarlles "expensive scare" [medo caro]. Porque meten medo e son caras pero precisamos delas. Así que estes son os nosos problemas. Non hai premios por enumerar problemas, non? Todos sabemos facelo. Varios oradores anteriores e outros que virán a continuación exporán máis problemas. Estes son algúns deles. Así que, que fixen?
There we go -- we're going on a mission. We're going to do some open-heart surgery. I was the only Brit, on a team of about nine American cardiac surgeons, cardiac nurse, intensive care nurse. We all went out and did a mission and we've done three of them so far. Just so you know, I do believe in missions, I do believe in aid and I do believe in charity. They have their place, but where do they go for those things we talked about earlier? Because it's not everyone that's going to benefit from a mission. Health is wealth, in the words of Hans Rosling. You get wealthier faster if you are healthy first.
Imos alá, á nosa misión. Imos practicar unha operación a corazón aberto. Eu era o único "británico" nun equipo duns nove cirurxiáns cardíacos americanos, a enfermeira de cardioloxía e a de coidados intensivos. Levamos adiante a misión e xa levamos tres nestes momentos. Para que o saiban, eu si creo nas misións, creo na axuda e na caridade. Teñen a súa función. Pero, onde buscan esas cousas das que falamos antes? Porque non todo o mundo pode beneficiarse dunha misión. "A saúde é riqueza", dicía Hans Rosling. Faste rico máis rápido se tes saúde.
So, here we are, mission. Big trouble. Open-heart surgery in Nigeria -- big trouble. That's Mike, Mike comes out from Mississippi. Does he look like he's happy? It took us two days just to organize the place, but hey, you know, we worked on it. Does he look happy? Yes, that's the medical advice the committee chairman says, "Yes, I told you, you weren't going to be able to, you can't do this, I just know it." Look, that's the technician we had. So yes, you go on, all right?
E aquí estamos, na misión. Gran problema. Unha operación a corazón aberto en Nixeria. Gran problema. Este é Mike. É de Mississippi. Parece feliz? Levou dous días organizar este sitio. Pero, ei, esforzámonos. Parece feliz? Si, este é o consello que o presidente do comité deu "Díxenvolo, non iades poder, non podedes facelo, seino." Miren ao anestesista que tivemos. Entón si, de acordo, non?
(Laughter)
(Risas)
I got him to come with me -- anesthesia tech -- come with me from the U.K. Yes, let's just go work this thing out. See, that's one of the problems we have in Nigeria and in Africa generally. We get a lot of donated equipment. Equipment that's obsolete, equipment that doesn't quite work, or it works and you can't fix it. And there's nothing wrong with that, so long as we use it and we move on.
Logrei que fose comigo. Anestesista, vén comigo desde o Reino Unido. Fagamos que isto siga cara a adiante. Miren, este é un dos problemas que temos en Nixeria e en África en xeral. Moito do equipamento é doado. Está obsoleto, non funciona correctamente ou funciona pero non o podes amañar. E non hai nada malo nisto sempre que o utilicemos e vaia ben.
But we had problems with it. We had severe problems there. He had to get on the phone. This guy was always on the phone. So what we going to do now? It looks like all these Americans are here and yes, one Brit, and he's not going to do anything -- he thinks he's British actually, and he's actually Nigerian, I just thought about that. We eventually got it working, is the truth, but it was one of these. Even older than the one you saw.
Pero tivemos problemas. E moi serios. El tivo que chamar por teléfono. Estivo sempre co teléfono. E que imos facer agora? Todos estes americanos están aí, tamén un británico, e non vai facer nada? Cre que é británico e realmente é nixeriano. Acábame de acordar. Ao final conseguimos que funcionara pero era un destes. Máis antigo que este.
The reason I have this picture here, this X-ray, it's just to tell you where and how we were viewing X-rays. Do you figure where that is? It was on a window. I mean, what's an X-ray viewing box? Please. Well, nowadays everything's on PAX anyway. You look at your X-rays on a screen and you do stuff with them, you email them. But we were still using X-rays, but we didn't even have a viewing box! And we were doing open-heart surgery.
A razón de que estea esta imaxe aquí, esta radiografía, é para que vexan as condicións nas que estábamos. Danse conta? É unha ventá. Un negatoscopio? Por favor! Hoxe está todo no ordenador de todos os xeitos. Miras as radiografías nunha pantalla e traballas nelas, envíalas por correo-e... nós empregabámolas pero sen ter negatoscopio! E estabamos a practicar operacións a corazón aberto.
OK, I know it's not AIDS, I know it's not malaria, but we still need this stuff. Oh yeah, echo -- this was just to get the children ready and the adults ready. People still believe in Voodoo. Heart disease, VSD, hole in the heart, tetralogies. You still get people who believe in it and they came. At 67 percent oxygen saturation, the normal is about 97. Her condition, open-heart surgery that as she required, would have been treated when she was a child. We had to do these for adults. So, we did succeed and we still do. We've done three. We're planning another one in July in the north of the country. So, we certainly still do open-heart, but you can see the contrast between everything that was shipped in -- we ship everything, instruments. We had explosions because the kit was designed and installed by people who weren't used to it. The oxygen tanks didn't quite work right.
Seino, non é sida nin malaria pero necesitamos estas cousas. Si, ecógrafos. Isto é para o preparatorio de nenos e adultos. A xente aínda cre no vodú. Enfermidade cardíaca, defecto ventricular, un burato no corazón, tetraloxías. Aínda existe xente que cre no vodú e tamén veñen. A saturación de osíxeno ao 67%, o normal é sobre o 97%. Isto require cirurxía cardíaca e xa deberan operala de pequena. Nós temos que facelo de adultos. E fixémolo. Levamos xa tres e temos prevista outra operación para xullo no norte do país. A pesar de todo seguimos a operar a corazón aberto e poden ver o contraste entre todo o que enviamos enviamos todo, o instrumental. Houbo explosións porque a sala deseñouna e instalouna xente que non estaba familiarizada con isto. O osíxeno non funcionou demasiado ben.
But how many did we do the first one? 12. We did 12 open-heart surgical patients successfully. Here is our very first patient, out of intensive care, and just watch that chair, all right? This is what I mean about appropriate technology. That's what he was doing, propping up the bed because the bed simply didn't work. Have you seen one of those before? No? Yes? Doesn't matter, it worked. I'm sure you've all seen or heard this before: "We, the willing, have been doing so much with so little for so long --
Pero, cantas persoas operamos a primeira vez? Doce. Operamos do corazón a doce pacientes satisfactoriamente. O noso primeiro paciente, xa fóra da UCI. Observen a cadeira. Exacto. A isto me refiro cando falo da tecnoloxía apropiada. Isto facía, apuntalaba a cama porque non funcionaba. Viron algo así antes? Non? Si? Tanto ten, funcionou. Seguro que todos o viron antes: "nós, os voluntariosos, levamos tanto tempo facendo tanto con tan pouco
(Applause) -- we are now qualified to do anything with nothing."
(Aplausos) que xa podemos facer calquera cousa con nada.
(Applause)
(Aplausos)
Thank you. Sustainable Solutions -- this was my first company. This one's sole aim is to provide the very things that I think are missing. So, we put my hand in my pocket and say, "Guys, let's just buy stuff. Let's go set up a company that teaches people, educates them, gives them the tools they need to keep going."
Grazas Solucións sustentables. Esta foi a miña primeira empresa. O meu propósito é ofrecer as cousas que penso que faltan. Entón metemos a man no peto e dicimos: "Rapaces, vaiamos de compras. Imos facer unha compañía que ensine, que eduque a xente
And that's a perfect example of one. Usually when you buy a ventilator in a hospital, you buy a different one for children, you buy a different one for transport. This one will do everything, and it will do it at half the price and doesn't need compressed air. If you're in America and you don't know about this one, we do, because we make it our duty to find out what's appropriate technology for Africa -- what's appropriately priced, does the job, and we move on. Anesthesia machine: multi-parameter monitor, operating lights, suction. This little unit here -- remember your little 12-volt plug in the car, that charges your, whatever, Game Boy, telephone? That's exactly how the outlets are designed. Yes, it will take a solar panel. Yes a solar panel will charge it. But if you've got mains as well, it will charge the batteries in there. And guess what? We have a little pedal charger too, just in case. And guess what, if it all fails, if you can find a car that's still got a live battery and you stick it in, it will still work. Then you can customize it. Is it dental surgery you want? General surgery you want? Decide which instruments, stock it up with consumables.
que lles dea as ferramentas para saír adiante." E este é un exemplo perfecto disto. Cando se compra un respirador nun hospital normalmente compras outro diferente para nenos e outro transportable. O noso serve para todo, coa metade de prezo e sen aire comprimido. Se vostede está nos EE. UU. e non o coñece, nós si. Porque temos que atopar tecnoloxía apropiada para África. Apropiada nos prezos e que funcione. Seguimos. Máquina de anestesia, monitor multiparámetros, luces de operación, succión. Esta pequena unidade, recordan o pequeno enchufe de 12 V do seu coche, que carga calquera cousa? A Game Boy, o teléfono... Así están deseñados estes enchufes. Si, poden usar un panel solar. Un panel solar pode cargalos. E se hai rede eléctrica esta tamén pode cargalos. E adiviñan que? Temos tamén un pequeno cargador de pedal, por se acaso. E adiviñen, se todo isto falla, se podes atopar un coche coa batería cargada e o conectas a el tamén funcionará. Tamén é personalizable. Necesitas cirurxía dental? Cirurxía xeral?
And currently we're working on oxygen -- oxygen delivery on-site. The technology for oxygen delivery is not new. Oxygen concentrators are very old technology. What is new, and what we will have in a few months, I hope, is that ability to use this same renewable energy system to provide and produce oxygen on site. Zeolite -- it's not new -- zeolite removes nitrogen from air and nitrogen is 78 percent of air. If you take nitrogen out, what's left? Oxygen, pretty much. So that's not new. What we're doing is applying this technology to it.
Escolle o instrumental e almacénao cos consumibles. Agora mesmo estamos a traballar co osíxeno. Na dispoñibilidade in situ. Esta tecnoloxía non é nova. Hai concentradores de osíxeno desde hai moito tempo. O novo --e que agardo que o teñamos nuns meses-- é a capacidade de utilizar o mesmo sistema de enerxía para prover e producir osíxeno in situ. A ceolita non é nova. Elimina o nitróxeno do aire e o nitróxeno é o 78% do aire. Se quitas o nitróxeno, que queda? Osíxeno practicamente. Isto non é novo pero nós estamos utilizando esta tecnoloxía para facelo.
These are the basic features of my device, or our device. This is what makes it so special. Apart from the awards it's won, it's portable and it's certified. It's registered, the MHRA -- and the CE mark, for those who don't know, for Europe, is the equivalent of the FDA in the U.S. If you compare it with what's on the market, price-wise, size-wise, ease of use, complexity ...
Estas son as características básicas do meu dispositivo, do noso dispositivo. Isto é o que o fai tan especial. Á parte dos premios que leva gañados é portátil e está certificado. Está rexistrado. A MHRA e o selo CE, que para quen non o saiba é o equivalente en Europa da FDA nos EE. UU. Esta é a comparativa co que hai no mercado en prezo, tamaño, facilidade de uso, complexidade...
This picture was taken last year. These are members of my graduating class, 1986. It was in this gentleman's house in the Potomac, for those of you who are familiar with Maryland. There are too many of us outside and everybody, just to borrow a bit from Hans -- Hans Rosling, he's my guy -- if the size of the text represents what gets the most attention, it's the problems. But what we really need are African solutions that are appropriate for Africa -- looking at the culture, looking at the people, looking at how much money they've got. African people, because they will do it with a passion, I hope. And lots and lots of that little bit down there, sacrifice. You have to do it. Africans have to do it, in conjunction with everyone else.
Esta foto é do ano pasado. Son os membros da miña promoción, de 1986. Foi na casa deste cabaleiro en Potomac para os que lles sexa familiar Maryland. Moitos de nós estamos fóra e todos, colléndolle algo prestado a Hans. Hans Rosling, o meu heroe. Se o tamaño do texto representara ao que prestamos máis atención é aos problemas. Pero en África o que necesitamos son solucións e que sexan apropiadas para alí. Hai que ter en conta a cultura e a xente e os cartos que teñen. Á xente africana, porque o farán con paixón, agardo. E moito, moito deste anaquiño de aquí embaixo, "sacrificio". Vostedes teñen que facelo. Os africanos teñen que facelo, conxuntamente co resto.
Thank you.
Grazas.
(Applause)
(Aplausos)