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.
Konuyu bir baglam icinde ele almak icin ve size benim nereden geldigim hakkinda biraz bilgi vereyim Soyleyecegim bir cok sey ve yapacagim seyler veya yaptigimi soyleyecegim seyler bununla ilgili Neden ve nasil burada olmaya motive oldugumu anlayacaksiniz Cleveland'da 1975 yilinda liseden mezun oldum. Ve anne-babamin yurtdisi tahsini bitirdiginde yaptigini yapip yurda geri dondum 1986'da universite egitimimi tamamlayip tip derecesi aldim cerrahi uzmanligimi yaparken maddi gucum anca annemin 13 yillik arabasini kullanmama yetiyordu ve maasli bir doktordum iste bu yuzden biz profesyoneller simdi diaspora dedikleri seyin bir parcasiyiz Simdi bunu kalici hale getirecegiz yani biz egitim alip, ayrilip bir daha geri donmeyecek miyiz? Belki degil, umut ederim ki degil Cunku, bu benim vizyonum degil
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.
Pekala, Afrika haritasi uzerinde Nijerya'nin yaklasik nerede olduguna bakalim iste orada herkezin duydugundan emin oldugum Delta bolgesi insanlarin kacirildigi ve petrolun geldigi yer o petrol ki bazen Nijerya'daki herkezi cildirttigini dusunuyorum fakat, ciddi fakirlik, su yansi benim verdigim bir sunumdan uzun zaman once degil. Gapminder.org aradaki farki anlatiyor Afrika'da ve dunyanin geri kalani arasindaki saglik hizmetinin cok ilginc
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.
Su takside kac kisi var sizce? ister inanin ister inanmayin, bu Nijerya'da bir taksi Baskentte, yani bir zamanlarin Nijerya baskenti Lagos bu bir taksi ve icinde polisler var simdi, soyleyin bana sizce bu takside kac polis var? ve simdi? Uc. Yani, bu insanlar ve inanin bana sadece polisler degil Lagos'ta taksileri kullaniyolar, hepimiz kullaniyoruz. ben de bunlarin bir tanesinin icindeydim ve ben de kask kullanmiyordum ve bu bana su dusunceyi hatirlatiyor: eger birimiz takside bir kaza gecirir ve hasteneye gitmesi gerekirse
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?
ister inanin ister inanmayin, bazilarimiz hayatta kaliyor. bazilarimiz sitmaya ve AIDS'e ragmen hayatta kaliyor ve aileme de soyledigim, ve karimin bana surekli hatirlattigi su sen o ulkeye her gittiginde hayatini tehlikeye attigini biliyorsun ve karim hakli. oraya her gittiginizde biliyorsunuz ki gercekten yogun bakima ihtiyaciniz olursa herhangi bir cesit yogun bakim - eger bir kaza gecirirseniz ki, kazalar her yerde cokca olur kazayi gecirenler nereye gider? soyle sorunlar icin bir yardima ihtiyac duyduklarinda nereye giderler? bunlarin yerine demiyorum bunlar icin de AIDS, tuberkuloz, sitma, tifo liste uzayip gidiyor sunu soyluyorum, benim gibi insanlar nereye gidiyorlar? Ulkeme geri dondugumde, ben cok cesitli isler yapiyorum ders veriyorum, egitiyorum fakat su hastaliklarin birine yakalanirsam veya su kronik hastaliklardan birini tasiyorsam, nereye gidebilirim? hastalardan biri olur yada sakat kalirsa ekonomik etki ne olur?
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."
bence cok onemli. Hastalar nereye giderler? Bunlar eski resimler ya da cok fakir ve ezilmislerin resimleri degil bu buyuk bir hastane. Aslinda, bu Nijerya'daki buyuk akademik hastanelerden biri 1 yildan kisa bir sure once, bir ameliyathane Bu Nijeryada bir sterilizasyon makinasi bu yagi hatirladiniz mi? Evet, bu resimlerle bazilarinizin keyfinizi kacirdiysam kusura bakmayin Bence, bunu gormelisiniz. Bu zemin. Tamam mi? Sunu soyleyebiliriniz bu konu egitimle de ilgili Hijyen diyebilirsiniz. Ben fakirligi savunmuyorum Dedigim su, bizim asidan sitma, AIDS'ten korunmamizdan fazlasina ihtiyacimiz var. Ben tedavi edilmek istiyorum uygun bir hastanede eger basima orada birsey gelirse Aslinda, kosusturmaya ve etrafimdakilere beyler ve hanimlar siz ABD'de kardiyoloji uzmanisiniz demeye basladigimda benimle ulkeme gelip onemli bir hizmet verir misiniz? diye sordugumda onlarin "bir umut var" diye dusunmelerini istiyorum
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.
Simdi suna bakin. Bu bir anestezi makinasi Bu benim uzmanligim, degil mi? Anestezi ve yogun bakim. Su torbaya bakin bizim birlesik krallik'ta artik kullanmadigimiz bir bantla bantlanmis, ve inanin bana, bunlar guncel resimler Simdi, bunun gibi birsey birlesik krallik'ta olmus iste hastalarin oldugu yer. Burasi benim calistigim yogun bakim bolumu
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?
Pekiyi, bu benim onceki konuslarimdan bir yansi Nijerya'daki yogun bakim bolumlari hakkinda ve alayli bir sekilde biz buna "pahali panik" deriz Cunku, korkunc ve pahali ama bizim ona ihtiyacimiz var. Ve, bunlar problemler. Problemin ne oldugunu soyleyene bir odul vermiyorlar, degil mi? Sanirim hepimiz bu problemleri biliyoruz, benden onceki konusmacilar ve benden sonrakiler bunlari ve hatta fazlasini soyleyecekler Bunlar sadece bazilari. Peki ben ne yaptim?
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.
Iste, onemli bir hizmet vermeye gidiyoruz Acik kalp ameliyati yapacagiz. Ben tek Britanyaliydim Takimdaki diger dokuz kisi Amerikali kardiyoloji cerrahlari, kardiyoloji hemsiresi ve yogun bakim hemsiresiydi Onemli bir hizmet icin yola ciktik ve simdiye kadar uc acik kalp ameliyati yaptik Ben boyle hizmetlere inaniyorum, insani yardima inaniyorum ve yardimseverlige inaniyorum. Yeri geldiginde cok onemli. Hastalar boyle seyler icin nereye gidecekler Cunku herkes onemli hizmetten faydalanamiyacak Hans Rosling'in soyledigi gibi saglik zenginliktir Eger baslangicta saglikliysaniz daha cabuk zenginlesirsiniz
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?
Iste, hizmet, buyuk bir sorun Nijeryada acik kalp ameliyati - buyuk sorun Bu Mike, Mike Mississippi'den geliyor Mutlu biri gibi mi gorunuyor Iki gunumuzu aldi bu yeri duzenlemek, iste Bildiginiz gibi, calistik. Mutlu gozukuyor mu? Evet, komite baskanin verdigi tibbi tavsiye Evet, size dedigim gibi beceremiyeceksiniz yapamazsiniz, biliyorum 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. 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.
Onu ben getirdim. Anestezi teknisyeni, Birlesik Kralliktan geldi Evet, hadi su isi bir halledelim Goruyorsunuz, bu bizim Nijeryada ve de genel olarak Afrika'daki problemlerimizden biri Biz bir cok bagis alet-makina aliriz Bazi makilar cok eskimis, bazi makinalar calismiyor veya calisiyor ama ayarlanamiyor. Bunda garip birsey yok kullanabildigimiz kadar kullanip, isimize bakiyoruz
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.
fakat sorunlarimiz oluyor. Ciddi sorunlar Bu adam telefonla konusmak zorunda idi. O surekli telefon basindaydi Peki, simdi ne yapacagiz Bu Amerikalilar burada ve evet, bir Britanyali, hic birsey yapmiyor, O kendini aslinda Britanyali saniyor, aslinda Nijaryali Bunun hakkinda dusundum Gercek su ki, sonucta isi basardik bunlardan sadece biri. Gorduklerinizden bile eski
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.
Bu resmi buraya koymamin nedeni, bu X-rey filmi nerede ve nasil X-rey filmlerine baktigimizi gostermek Bunun neresi oldugunu anladiniz mi? Pencere Yani, X-rey filmi tetkik kutusu nedir? Lutfen... Neyse, bugunlerde hersey Görüntü Arşivleme ve İletişim Sistemlerinde zaten Siz X-rey filmlerine ekranda bakip uzerlerinde calisiyorsunuz email atiyorsunuz. Fakat biz hala eski X-rey filmleri kullaniyoruz fakat bizim uygun bir tetkik kutumuz bile yok ve biz acik kalp ameliyati yapiyorduk.
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.
Tamam, biliyorum AIDS degil, biliyorum sitma da degil fakat bizim hala buna ihtiyacimiz var. Ah evet yanki bu sadece cocuklari ve yetiskinleri hazirlamak icin Insanlar hala vuduya inaniyor - kalp hastaligi VSD, delik kalp, dortleme Hala bunlara inanan insanlarla karsilasacaksiniz, size geleceklerdir %67 oksijen derisiminde, normali yaklasik 97 Onun sartlarinda, acik kalp ameliyati gerekliligi cocuklukta ortadan kaldirilabilirdi Bunlari yetiskinler icin yapmak zorunda kaldik. Ve basardik ve hala basariyoruz Simdiye kadar 3 tane yaptik. Temmuz'da bir tane daha yapmak istiyoruz Ulkenin kuzeyinde. Yani kesinlikle acik kalp ameliyati yapmaya devam ediyoruz, fakat, su zitligi gorebilirsiniz nakil edilen herseyle biz herseyi, aletleri sevk ederiz - patlamalar gorduk cunku takimlar ehil olmayan kisiler tarafindan tasarlandi ve kuruldu Oksijen tupleri dogru durust calismadi
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 --
fakat, ilkini kac kere yaptik? 12. 12 acik kalp ameliyat hastasini basariyla tedavi ettik Iste ilk hastamiz. Yogun bakimda. ve dikkat edin su koltuga, tamam mi? Bu benim uygun teknoloji dedigim sey Yaptigi sey su, yatagi destekliyor cunku yatak calismiyor Bunlardan hic daha once gormus muydunuz? Hayir? Evet? Farketmez. Oldu. Eminim bunu daha once gordunuz ya da duydunuz. Biz, bir istekle, uzun zamandir cok kucuk imkanlarla buyuk isler basariyoruz
(Applause) -- we are now qualified to do anything with nothing."
Alkislar... Biz hic yardim almadan herseyi yapma yetkinligimiz var
(Applause)
Alkislar...
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."
Tesekkur ederim. Surdurebilir cozumler - bu benim ilk ekibim. bunun tek amaci en cok ihtiyac duyulanlari saglamaktir. Boylece, elimizi cebimize attik ve dedik ki, Hey, hadi birseyler satin alalim Egitim ve ogretim veren bir ekip kuralim onlara calisabilmleri icin aletleri saglayan bir ekip
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.
Ve bu mukemmel bir ornek Genelde, biz bir hastaneye solunum cihazi aldigimiz zaman cocuklar icin ozel bir cihaz aliriz Hasta nakilleri icin ozel bir cihaz. Bu her durumda kullanilabilir, hem de maliyeti yari yariya ve sikistirilmis hava olmadan kullanilabilir Eger siz Amerika'da yasiyorsaniz, bunu bilmezsiniz. Biz biliyoruz cunku bir cikis yolu bulmayi gorev edindik Afrika'ya uygun teknoloji nedir? Neyin fiyati uygun? Ne is gorur ve devam edelim. Anestezi makinasi, coklu parametreli monitor, isletme isiklari, emme Bu kucuk unite -- arabanizdaki kucuk 12-volt bujiyi hatirlayin arabanizi dolduran, ner neyse - Game Boy, telefon? Prizler de tam olarak boyle tasarlaniyor Evet, gunes paneli is gorebilir. Evet, bir gunes paneli doldurur Fakat, eger ana boru kurarsaniz, oradaki pilleri de doldurabilirsiniz ve tahmin edebilir misiniz? bir kucuk pedal doldurucumuz da var gerekirse ve tahmin edin, eger butun bunlar basarisiz olursa eger calisan bir pili olan araba bulabilirseniz takin ve calisiyor. Sonra ihtiyaclariniza uygun degisiklikler yapabilirsiniz. istediginiz bir dis ameliyati mi? Genel cerrahi mi istersiniz? Aletlere karar verin, sarf malzemeleriyle doldurun.
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.
Su siralar oksijen uzerinde calisiyoruz. Oksijen sevkiyati. Oksijen sevkiyati teknolojileri yeni degil Oksijen yogunlastiricilar cok eski teknoloji. Yeni olan ve birkac ay icinde sahip olacagimiz, umarim, bu ayni yenilenebilir enerji sistemini kullanabilme yeterliligi gerekli yerde oksijeni uretebilmek icin. Zeolite - yeni degil - Zeolite havadaki nitrojeni ayristiriyor ve nitrojen havanin %78'i eger nitrojeni cikarirsaniz, geriye ne kalir? Oksijen Yeni degil. Bizim yaptigimiz teknolojiyi uygulamak.
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 ...
Bunlar cihazimin ya da cihazimizin temek ozellikleri Bunu ozel kilan sey. Kazandigi oduller disinda tasinabilir ve serifikali, kayitli MHRA ve CE isareti, bilmeyenler icin birlesik devletlerdeki FDA'in Avrupa'daki karsiligi Eger bunu piyasadakilerle karsilastirirsaniz fiyat olarak, buyukluk olarak ve kullanim kolayligi ve karmasiklik olarak
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.
Bu resim gecen sene cekildi Bunlat benim mezuniyetimde sinif arkadaslarim, 1986 Bu su beyfendinin Potomac'taki evindeydi Maryland'i bilenler icin soyledim Cogumuz disaridayiz ve herkes, Hans'tan aldigim kucuk birsey - Hans Rosling, adamim Eger harf buyuklugu en cok neyin dikkat cektigini gosteriyorsa Burada problem var. Bizim Afrikali cozumlere intiyacimiz var. Afrikaya uygun - kulture bakin insanlara bakin, ne kadar paralari olduguna bakin Afrikalilar, bunu bir tutkuyla yapacaklar, umut ediyorum, ve kucuk bir seyden cokca lazim: fedakarlik Bunu yapmak zorundasiniz. Afrikalalilar bunu yapmak zorunda digerlerinin yardimiyla.
Thank you.
Tesekkur ederim
(Applause)
Alkislar