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TEDGlobal 2009

Marc Koska: 1.3m reasons to re-invent the syringe

July 24, 2009

Reuse of syringes, all too common in under-funded clinics, kills 1.3 million each year. Marc Koska clues us in to this devastating global problem with facts, photos and hidden-camera footage. He shares his solution: a low-cost syringe that can't be used twice.

Marc Koska - Inventor
Marc Koska wants to improve health care in the developing world by re-designing dangerous medical tools -- and offering education to practitioners in under-funded clinics. Full bio

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Double-click the English subtitles below to play the video.
Twenty-five-and-a-quarter years ago I read
00:18
a newspaper article which said
00:20
that one day syringes would be
00:22
one of the major causes of the spread of AIDS,
00:25
the transmission of AIDS.
00:27
I thought this was unacceptable. So I decided to do something about it.
00:29
Sadly, it's come true. Malaria, as we all know,
00:33
kills approximately one million people a year.
00:36
The reuse of syringes now exceeds that
00:39
and kills 1.3 million people a year.
00:41
This young girl and her friend
00:46
that I met in an orphanage in Delhi
00:48
were HIV positive from a syringe.
00:50
And what was so sad about this particular story
00:55
was that once their parents had found out --
00:58
and don't forget, their parents took them to the doctor --
01:01
the parents threw them out on the street.
01:05
And hence they ended up in an orphanage.
01:07
And it comes from situations like this where
01:10
you have either skilled or unskilled practitioners,
01:12
blindly giving an injection to someone.
01:15
And the injection is so valuable,
01:18
that the people basically trust
01:21
the doctor, being second to God, which I've heard many times,
01:23
to do the right thing. But in fact they're not.
01:26
And you can understand, obviously, the transmission problem
01:29
between people in high-virus areas.
01:31
This video we took undercover,
01:35
which shows you, over a half an hour period,
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a tray of medicines of 42 vials,
01:39
which are being delivered with only 2 syringes in a public hospital in India.
01:43
And over the course of half an hour, not one syringe
01:48
was filmed being unwrapped.
01:50
They started with two and they ended with two.
01:52
And you'll see, just now, a nurse coming back to the tray,
01:55
which is their sort of modular station,
01:58
and dropping the syringe she's just used
02:01
back in the tray for it to be picked up and used again.
02:04
So you can imagine the scale of this problem.
02:07
And in fact in India alone, 62 percent
02:10
of all injections given
02:12
are unsafe.
02:14
These kids in Pakistan don't go to school.
02:16
They are lucky. They already have a job.
02:18
And that job is that they go around and pick up syringes
02:20
from the back of hospitals,
02:22
wash them, and in the course of this,
02:24
obviously picking them up they injure themselves.
02:26
And then they repackage them and sell them out on markets
02:29
for literally more money
02:32
than a sterile syringe in the first place, which is quite bizarre.
02:34
In an interesting photo, their father, while we were talking to him,
02:37
picked up a syringe and pricked his finger --
02:40
I don't know whether you can see the drop of blood on the end --
02:42
and immediately whipped out a box of matches,
02:45
lit one, and burned the blood off the end of his finger,
02:48
giving me full assurance
02:51
that that was the way that you stopped the transmission of HIV.
02:53
In China, recycling is a major issue.
02:57
And they are collected en mass -- you can see the scale of it here --
03:01
and sorted out, by hand, back into the right sizes,
03:04
and then put back out on the street.
03:08
So recycling and reuse
03:10
are the major issues here.
03:13
But there was one interesting anecdote that I found in Indonesia.
03:15
In all schools in Indonesia,
03:18
there is usually a toy seller in the playground.
03:20
The toy seller, in this case,
03:22
had syringes, which they usually do,
03:24
next door to the diggers, which is obviously
03:26
what you would expect.
03:28
And they use them, in the breaks, for water pistols.
03:30
They squirt them at each other, which is lovely and innocent.
03:32
And they are having great fun.
03:34
But they also drink from them
03:36
while they're in their breaks, because it's hot.
03:38
And they squirt the water into their mouths.
03:40
And these are used with traces of blood visible.
03:43
So we need a better product. And we need better information.
03:48
And I think, if I can just borrow this camera,
03:50
I was going to show you my invention,
03:55
which I came up with.
03:57
So, it's a normal-looking syringe.
04:00
You load it up in the normal way. This is made
04:02
on existing equipment in 14 factories that we license.
04:04
You give the injection and then put it down.
04:08
If someone then tries to reuse it,
04:11
it locks and breaks afterwards.
04:13
It's very, very simple. Thank you.
04:15
(Applause)
04:17
And it costs the same as a normal syringe.
04:20
And in comparison, a Coca-Cola
04:22
is 10 times the price.
04:24
And that will stop reusing a syringe 20 or 30 times.
04:26
And I have an information charity
04:29
which has done huge scale amount of work in India.
04:31
And we're very proud of giving information to people,
04:35
so that little kids like this don't do stupid things.
04:38
Thank you very much.
04:40
(Applause)
04:42

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Marc Koska - Inventor
Marc Koska wants to improve health care in the developing world by re-designing dangerous medical tools -- and offering education to practitioners in under-funded clinics.

Why you should listen

In 1984, Marc Koska read an article that predicted HIV would spread widely through unsafe injections. He writes, "Appalled at the prospect of such an avoidable catastrophe, I decided there and then to try and do something about it." The prediction, sadly, turned out to be true: syringe reuse now accounts for 1.3 million deaths -- more than malaria. In the next years, Koska undertook the study of public health to find out what could be done. He determined that the design of syringes was the critical issue.

Today, Koska's solution to the problem, the K1 syringe -- it locks down after a single injection, preventing reuse -- is in use by millions. But he hasn't stopped there: In 2005, he founded a nonprofit, SafePoint, which aims to educate people in the developing world about the dangers of reusing any instruments that come into contact with blood.

The original video is available on TED.com
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