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.
Numai pentru a pune lucrurile intr-un context, si pentru a va da o idee despre locurile de unde provin, astfel incat dupa multe dintre lucrurile pe care le voi spune si le voi face -- sau lucruri despre care va voi povesti ca le-am realizat -- veti intelege exact de ce si in ce fel am fost motivat sa ajung unde sunt astazi. Am absolvit liceul in Cleveland, Ohio, in 1975. Si la fel cum au facut si parintii mei cand si-au terminat studiile in strainatate, ne-am intors acasa. Am terminat facultatea, mi-am luat diploma in medicina in 1986. Iar in vremea rezidentiatului, abia imi puteam permite sa intretin masina veche de 13 ani a mamei mele, si eram un medic cu salariu. Acest lucru ne aduce la intrebarea de ce multi dintre noi, cei care suntem profesionisti suntem in prezent, cum se spune, diaspora. Deci, vom face din asta ceva permanent, in care suntem cu totii pregatiti si apoi plecam, si nu ne mai intoarcem? Poate nu, cel putin eu asa sper -- deoarece nu aceasta este viziunea mea.
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.
In regula, pentru siguranta, aici este Nigeria pe harta Africii, iar acolo este regiunea deltei de care sunt sigur ca ati auzit cu totii. Oameni rapiti, locul de unde provine petrolul, petrol care ma face sa cred uneori ca ne-a adus pe toti in pragul nebuniei in Nigeria. Dar, saracia extrema, aceasta poza este de la o prezentare pe care am sustinut-o nu cu mult timp in urma. Gapminder.org spune povestea prapastiei dintre Africa si restul lumii, in ceea ce priveste serviciile medicale. Foarte interesant.
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.
Cati oameni credeti ca sunt pe acel taxi? Si fie ca va vine sa credeti sau nu, acela este un taxi in Nigeria. Si capitala -- acea era pe vremuri capitala Nigeriei, Lagos, acela este un taxi pe care se pot vedea politisti. Deci spuneti-mi, cati politisti credeti ca sunt pe acel taxi? Si acum? Trei. Deci, cand acesti oameni -- si credeti-ma, nu sunt numai politistii cei care folosesc aceste taxiuri in Lagos, cu totii le folosim, si eu am urcat pe unul si nici nu aveam casca. Si asta imi reaminteste de ce se intampla cand unul dintre noi cade de pe un astfel de taxi, are un accident si necesita spitalizare.
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?
Fie ca va vine sau nu sa credeti, unii dintre noi chiar supravietuiesc. Unii dintre noi supravietuiesc malariei, supravietuiesc SIDA. Si asa cum spun si familiei mele, iar sotia mea imi reaminteste de fiecare data, iti risti viata, stiti, de fiecare data cand mergi in acea tara -- si are dreptate. De fiecare data cand mergi acolo, stii ca daca chiar ai nevoie de asistenta medicala de urgenta -- de orice fel -- daca ai un accident, astfel de cazuri sunt multe, sunt accidente pretutindeni, unde se pot duce? Unde merg cand au nevoie de ajutor pentru astfel de lucruri? Nu spun in loc de, spun in plus. SIDA, tuberculoza, malarie, febra tifoida -- lista poate continua. Ma intreb, unde pot merge cand sunt ca mine? Cand ma intorc acasa -- si fac tot felul de lucruri, predau, tin traininguri, dar contactez o astfel de boala, sau sunt bolnav cronic cu o astfel de boala, cui ma adresez? Care este impactul economic al unei persoane care moare sau ramane infirm?
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."
Cred ca este semnificativ. Aici merg aceste persoane. Acestea nu sunt poze vechi si nu sunt dintr-un spital de mana a doua -- acesta este un spital important. De fapt, pozele sunt dintr-un important spital universitar din Nigeria. Aceasta poza nu e mai veche de un an, intr-o sala de operatii. Asa se sterilizeaza instrumentarul in Nigeria. Va amintiti tot acel petrol? Da, imi pare rau daca acest lucru este suparator pentru unii dintre voi, dar cred ca trebuie sa vedeti aceste imagini. Aceea este podeaua, da? Puteti spune ca o parte din asta este educatie. Puteti spune ca e igiena. Nu pledez saracie. Spun ca avem nevoie de ceva mai mult decat numai, stiti, vaccinare, malarie, SIDA, pentru ca vreau sa fiu tratat intr-un spital corespunzator daca patesc ceva acolo. De fapt, cand incep sa spun in stanga si-n dreapta, "Hei, oameni buni, sunteti cardiologi in Statele Unite, va puteti intoarce acasa cu mine intr-o misiune umanitara?" Mi-ar placea sa gandeasca, "Ei bine, exista speranta."
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.
Acum, uitati-va la asta. Este un aparat pentru punerea sub anestezie. Iar asta este specializarea mea, nu? Anestezie si medicina de urgenta -- uitati-va la acea punga. A fost lipita cu banda adeziva de care am incetat sa mai folosim in Marea Britanie. Si credeti-ma, acestea sunt poze recente. Deci, daca s-ar intampla asa ceva, cum s-a intamplat in Marea Britanie, aici vin. Aceasta este unitatea de terapie intensiva in care lucrez.
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?
In regula, acesta este o poza de la o prezentare pe care am tinut-o despre unitatile de terapie intensiva din Nigeria, si in gluma facem referire la ele ca "Sperieturi Scumpe" (joc de cuvinte). Pentru ca este infricosator si presupun costuri mari, dar trebuie sa le avem. Deci, acestea sunt problemele. Dar nu exista nici un premiu pentru identificarea problemelor, nu-i asa? Cred ca stim cu totii, si cativa vorbitori inaintea mea si cativa de dupa mine va vor infatisa si mai multe probleme. Acestea sunt doar cateva dintre ele. Deci, ce am facut?
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.
Iata, mergem intr-o misiune umanitara. Mergem sa facem operatii pe cord deschis, eram singurul britanic, intr-o echipa de noua chirurgi cardiologi americani, asistente de cardiologie si asistente de terapie intensiva. Am mers cu totii intr-o misiune umanitara, am fost in trei pana acum. Pentru informatia dumneavoastra, cred in misiuni umanitare, cred in ajutor si cred in caritate. Toate au locul lor, dar unde se pot duce oamenii pentru rezolvarea acelor probleme medicale despre care am discutat mai devreme? Pentru ca nu toata lumea va putea beneficia de ajutor prin aceste misiuni. Sanatatea este bogatie, citandu-l pe Hans Rosling. Ajungi mai instarit, mai repede, daca esti intai de toate, sanatos.
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?
Deci, iata-ne, misiune umanitara. Mari probleme. Operatie pe cord deschis in Nigeria -- mari probleme. Acela este Mike, Mike este din Mississippi. Arata ca si cand ar fi fericit? Ne-au trebuit doua zile numai pentru a aranja locul, dar hei. Stiti, am muncit acolo. Arata fericit? Da, acela este sfatul medical pe care ni l-a dat seful comisiei, "Da, v-am spus, nu veti reusi, nu puteti face face asta, o stiu pur si simplu." Uitati, acela este tehnicianul pe care l-am avut cu noi. Deci da, continuati, in regula?
(Laughter)
(Rasete)
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.
L-am convins sa vina cu mine. Tehnician anestezist, vino cu mine din Marea Britanie. Da, hai sa rezolvam aceasta problema. Vedeti, aceasta este una dintre problemele pe care le avem in Nigeria si in Africa in general. Primim multe echipamente din donatii. Echipamente invechite, echipamente care nu prea mai functioneaza, sau fuctioneaza si nu le poti repara. Si nu este nimic in neregula cu asta, atata vreme cat le folosim si mergem mai departe.
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.
Dar am avut probleme cu ele. Am avut probleme grave acolo. Trebuia sa stea la telefon. Tipul asta era tot timpul la telefon. Deci ce vom face de acum inainte? Se pare ca toti acesti americani care sunt aici si da, un britanic, si nu va face nimic, el crede ca este de fapt britanic, dar, in fapt, este nigerian, tocmai mi-a venit aceasta idee. In cele din urma am reusit sa-l facem sa mearga, acesta este adevarul, dar era unul dintre acestea. Chiar mai vechi decat cel pe care l-ati vazut.
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.
Motivul pentru care am aici aceasta fotografie, aceasta radiografie, este pentru a va impartasi unde si in ce conditii examinam aceste radiografii. Va dati seama unde este? Este pe un geam. Vreau sa spun, ce este un panou pentru examinat radiografii? Va rog. Oricum, in zilele noastre totul e pe PAX. Vezi radiografiile pe un ecran si faci fel de fel de lucruri cu ele, le poti trimite chiar si prin email. Cu toate ca inca foloseam radiografiile, nu avem un panou pentru a le analiza! Si faceam operatii pe cord deschis.
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.
Ok, stiu ca nu e SIDA, stiu ca nu e malarie, dar tot ne sunt necesare aceste lucruri. Ah, da, ecograf -- era pentru a pregati copiii si adultii. Oamenii inca cred in Voodoo -- boli de inima, VSD, o perforatie pe cord, tetralogii. Inca gasesti oameni care cred in aceste lucruri si cu toate acestea au venit. La o saturatie cu oxigen de 67%, fata de rata normala de aproximativ 97%. Starea ei, operatia pe cord deschis de care avea nevoie, ar fi fost tratata cand era copil. A trebuit sa facem asta pentru adulti. Si am reusit si inca reusim. Am facut trei. Avem in plan inca una in iulie in nordul tarii. Deci cu siguranta inca realizam aceste operatii, dar puteti observa contrastul dintre tot ceea ce a fost adus -- ne aducem tot ce avem nevoie, instrumente -- s-au produs si explozii, pentru ca echipamentul a fost proiectat si instalat de oameni care nu erau obisnuiti cu el. Rezervoarele de oxigen n-au functionat chiar cum ar fi trebuit.
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 --
Cate am facut prima data? 12. Am vindecat 12 oameni cu operatii pe cord deschis, cu succes. Acesta este primul nostru pacient, iesit de la terapie intensiva, si priviti acel scaun, in regula. La asta ma refer cand spun tehnologie corespunzatoare. Asta facea: proptea patul pentru ca acesta pur si simplu nu functiona. Ati mai vazut asa ceva pana acum? Nu? Da? Nu conteaza, a functionat. Sunt convins ca ati mai vazut sau ati mai auzit cu totii asta pana acum. Noi, cei care am avut vointa, am facut atat de multe, cu atat de putine, pentru atat de mult timp --
(Applause) -- we are now qualified to do anything with nothing."
(Aplauze) -- incat acum suntem in masura sa facem orice, cu nimic.
(Applause)
(Aplauze)
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."
Multumesc. "Solutii sustenabile" -- aceasta este prima mea companie, al carei singur scop este sa ofere exact acel lucru care cred ca ne lipseste. Asa ca bag mana in buzunar si zic, "Baieti, hai sa cumparam ce ne trebuie." Sa infiintam o companie care educa lumea, ii pregateste, le da uneltele de care au nevoie pentru a continua.
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.
Iar acesta este un exemplu perfect de un astfel de lucru. De obicei, cand cumperi un ventilator intr-un spital, cumperi unul diferit pentru copii, cumperi altul pentru transport. Acesta va indeplini toate functiile, si va face asta la jumatate de pret si nu are nevoie de aer comprimat. Daca esti in America si nu ai aflat despre asta, noi stim, pentru ca facem din asta datoria noastra sa aflam care este tehnologia potrivita pentru Africa -- care este pretul corespunzator, rezolva problema si trecem mai departe. Aparatul pentru anestezie, monitor cu mai multi parametri, lumini pentru operatie, aspiratie. Acest aparat de aici -- va amintiti micuta priza de 12 volti din masina, de unde va incarcati, ma rog -- Game Boy, telefonul? Exact asa sunt proiectate si aceste prize. Da, este nevoie de un panou solar. Da un panou solar este suficient pentru a-l incarca. Iar daca avem si retea electrica, va incarca bateriile inauntru. Si ghiciti ce? Avem si o mica pedala pentru incarcare, pentru orice eventualitate. Si ghiciti ce, daca totul esueaza, daca puteti gasi o masina care are o baterie ce functioneaza il conectezi la ea si inca merge. Apoi il poti adapta pentru nevoile tale. Vrei o operatie de stomatologie? Sau ai o operatie de chirurgie generala? Decide de ce instrumente ai nevoie, fa-ti stocuri de consumabile.
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.
Si in momentul de fata lucram cu oxigen. Oxigen livrat la fata locului. Tehnologia pentru livrarea oxigenului nu este noua. Tehnologia concentratoarelor de oxigen nu este noua. Ceea ce este insa nou, si ce vom avea in cateva luni, sper, este capacitatea de a folosi acelasi sistem de energie regenerabila pentru a produce si furniza oxigen la fata locului. Zeolitul -- nu este nou -- zeolitul inlatura azotul din aer, iar azotul reprezinta 78% din aer. Daca scoti azotul, ce ramane? Oxigen, in mare parte. Deci asta nu e ceva nou. Ceea ce facem noi este sa aplicam aceasta tehnologie.
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 ...
Acestea sunt elementele de baza ale dispozitivului meu, dispozitivului nostru. Acest lucru il face atat de special. In afara de premiile pe care le-a castigat, este portabil si este certificat; este inregistrat, MHRA -- si marcajul CE, pentru cei care nu stiu este echivalentul european al FDA-ului in Statele Unite. Daca il compari cu alte produse similare de pe piata, in ce priveste pretul, dimensiunile, usurinta de folosire, complexitatea.
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.
Aceasta fotografie a fost facuta anul trecut. Acestia sunt colegii mei, promotia 1986. Era in casa acestui domn in Potomac, pentru aceia dintre voi care cunosc statul Maryland. Prea multi dintre noi sunt in strainatate si cu totii, ca sa il citez pe Hans -- Hans Rosling, preferatul meu -- daca marimea textului este cea care atrage cea mai multa atentie, exista o problema. Dar ceea ce ne trebuie cu adevarat sunt solutii africane, care sunt potrivite pentru Africa -- luand in considerare cultura, oamenii, si cat de putini bani au. Africanii, pentru ca vor pune suflet in ceea ce fac, sper, vor sacrifica cu totii cate putin din ceea ce au. Trebuie sa faceti asta. Africanii trebuie sa faca asta, laolalta cu toti ceilalti.
Thank you.
Va multumesc.
(Applause)
(Aplauze)