TEDxMidAtlantic
Erica Frenkel: The universal anesthesia machine
愛瑞卡‧芬科：泛用型麻醉機
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如果你正在手術中，電力卻中斷了──沒有燈、沒有氧氣，麻醉氣體也不流動了。全球的醫院常常發生這種情況，讓例行程序變成悲劇。愛瑞卡‧芬科展示解決方法之一：泛用型麻醉機
Erica Frenkel - Medical technologist
At Gradian Health Systems, Erica Frenkel works to bring safe anesthesia to hospitals all over the world. Full bio
At Gradian Health Systems, Erica Frenkel works to bring safe anesthesia to hospitals all over the world. Full bio
Double-click the English transcript below to play the video.
00:15
I'm going to talk to you today
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我今天要與各位分享
00:17
about the design of medical technology for low resource settings.
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資源貧乏環境中的醫療技術設計
00:20
I study health systems in these countries.
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在我進行健康照護體系研究的國家
00:22
And one of the major gaps in care,
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都有一個嚴重的不足之處
00:24
almost across the board,
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幾乎所有的國家
00:26
is access to safe surgery.
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都無法取得安全的手術
00:28
Now one of the major bottlenecks that we've found
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我們遇到的重大瓶頸之一
00:31
that's sort of preventing both the access in the first place
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讓病患一開始就沒有取得手術的機會
00:34
and the safety of those surgeries that do happen
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或是即使有手術也不安全
00:36
is anesthesia.
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就是麻醉
00:38
And actually, it's the model that we expect to work
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事實上 這是我們期待的工作模式
00:40
for delivering anesthesia
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提供麻醉的方式
00:42
in these environments.
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在這種環境中
00:44
Here we have a scene that you would find
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像這樣的場景
00:46
in any operating room across the U.S. or any other developed country.
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在美國或任何其他已開發國家的手術房都很常見
00:49
In the background there
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照片的背景
00:51
is a very sophisticated anesthesia machine.
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是一台非常複雜的麻醉機
00:53
And this machine is able
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這台機器
00:55
to enable surgery and save lives
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讓手術得以進行 拯救生命
00:57
because it was designed
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因為在設計時
00:59
with this environment in mind.
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已經把環境納入考量
01:01
In order to operate, this machine needs a number of things
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這台機器要運作 需要幾個條件
01:04
that this hospital has to offer.
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醫院必須滿足這些條件
01:06
It needs an extremely well-trained anesthesiologist
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這台機器需由訓練精良的麻醉師操作
01:09
with years of training with complex machines
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麻醉師對於複雜機器需有多年經驗
01:11
to help her monitor the flows of the gas
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才得以監控氣體的流動
01:14
and keep her patients safe and anesthetized
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確保病患安全無虞 維持在麻醉狀態
01:16
throughout the surgery.
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直到手術結束
01:18
It's a delicate machine running on computer algorithms,
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這台精密的機器 仰賴電腦運算
01:21
and it needs special care, TLC, to keep it up and running,
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還有特別照顧 小心謹慎地使用 才能維持運作順暢
01:24
and it's going to break pretty easily.
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它很容易故障
01:26
And when it does, it needs a team of biomedical engineers
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故障時 要由一整團的生物醫學工程師
01:29
who understand its complexities,
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了解這台機器複雜之處的專家
01:31
can fix it, can source the parts
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才能進行修復 替換零件
01:33
and keep it saving lives.
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讓它繼續拯救生命
01:35
It's a pretty expensive machine.
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這台機器價格不斐
01:37
It needs a hospital
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醫院
01:39
whose budget can allow it to support one machine
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必須有充足的預算 才能維持一台機器
01:41
costing upwards of 50 or $100,000.
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成本高達五至十萬美金
01:44
And perhaps most obviously,
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也許最明顯
01:46
and perhaps most importantly --
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也最重要的
01:48
and the path to concepts that we've heard about
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是我們聽過的一種思考方式
01:50
kind of illustrate this --
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描述類似這樣的觀念
01:52
it needs infrastructure
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就是基礎建設
01:54
that can supply an uninterrupted source
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必須能夠不間斷地供應資源
01:56
of electricity, of compressed oxygen
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包括電力 壓縮氧氣
01:59
and other medical supplies
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和其他醫療輔助
02:01
that are so critical to the functioning
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這些都是機器正常運作
02:03
of this machine.
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不可或缺的
02:05
In other words, this machine requires a lot of stuff
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換句話說 這台機器需要的許多東西
02:08
that this hospital cannot offer.
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這家醫院都不能提供
02:10
This is the electrical supply
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這是供電系統
02:12
for a hospital in rural Malawi.
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地點是馬拉威郊區一處醫院
02:14
In this hospital,
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在這所醫院裡
02:16
there is one person qualified to deliver anesthesia,
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有一個人 有資格進行麻醉
02:18
and she's qualified
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她之所以合格
02:20
because she has 12, maybe 18 months
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是因為她花了12個月 或是18個月
02:22
of training in anesthesia.
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接受麻醉訓練
02:24
In the hospital and in the entire region
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在這所醫院 以及整個地區中
02:26
there's not a single biomedical engineer.
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完全沒有生物醫學工程師
02:28
So when this machine breaks,
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所以當機器故障
02:30
the machines they have to work with break,
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他們還是得想辦法繼續使用
02:32
they've got to try and figure it out, but most of the time, that's the end of the road.
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必須試著解決故障問題 但大多數時候都束手無策
02:35
Those machines go the proverbial junkyard.
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這些機器就被扔進垃圾堆
02:38
And the price tag of the machine that I mentioned
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另外我剛剛提到 這台機器的價錢
02:41
could represent maybe a quarter or a third
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可能就占掉這所醫院
02:43
of the annual operating budget
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年度營運預算的
02:45
for this hospital.
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1/4或1/3
02:47
And finally, I think you can see that infrastructure is not very strong.
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最後 我想各位看得出這裡的基礎建設並不牢固
02:50
This hospital is connected to a very weak power grid,
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這所醫院連結的電力網路非常不穩定
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one that goes down frequently.
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常常斷電
02:55
So it runs frequently, the entire hospital,
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所以整家醫院
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just on a generator.
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常常只靠一個發電機
02:59
And you can imagine, the generator breaks down
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各位可以想像 發電機會故障
03:01
or runs out of fuel.
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或是燃料不足
03:03
And the World Bank sees this
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世界銀行注意到這種情況
03:05
and estimates that a hospital in this setting in a low-income country
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並估計在低收入國家環境中的醫院
03:08
can expect up to 18 power outages
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一個月可能發生
03:11
per month.
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多達18次跳電
03:13
Similarly compressed oxygen and other medical supplies
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同樣的 壓縮氧氣和其他醫療輔助
03:15
are really a luxury
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都是奢侈品
03:17
and can often be out of stock
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都可能常常供應不足
03:19
for months or even a year.
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長達數月或一年的時間
03:21
So it seems crazy, but the model that we have right now
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所以雖然看起來很瘋狂 但我們現有的模式
03:24
is taking those machines
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就是把這些機器
03:26
that were designed for that first environment that I showed you
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這些專為第一張照片裡那種環境設計的機器
03:28
and donating or selling them
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捐獻或賣給
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to hospitals in this environment.
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這種環境中的醫院
03:33
It's not just inappropriate,
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這不僅不合適
03:35
it becomes really unsafe.
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還可能很不安全
03:38
One of our partners at Johns Hopkins
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我們在約翰‧霍普金斯的一位同事
03:40
was observing surgeries in Sierra Leone
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在獅子山共和國觀察手術
03:43
about a year ago.
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時間大概是去年
03:45
And the first surgery of the day happened to be an obstetrical case.
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當天的第一場手術是難產手術
03:48
A woman came in, she needed an emergency C-section
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一位婦女被推進手術室 她需要緊急剖腹生產
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to save her life and the life of her baby.
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才能救自己和寶寶的命
03:54
And everything began pretty auspiciously.
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一開始都還蠻順利的
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The surgeon was on call and scrubbed in.
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醫生待命 準備就緒
03:58
The nurse was there.
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護士也在場
04:00
She was able to anesthetize her quickly,
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她很快地麻醉病患
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and it was important because of the emergency nature of the situation.
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這點很重要 因為情況十分緊急
04:05
And everything began well
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一切都很順利
04:07
until the power went out.
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直到電力突然中斷
04:10
And now in the middle of this surgery,
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手術才進行到一半
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the surgeon is racing against the clock to finish his case,
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醫生正努力加快速度要把手術完成
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which he can do -- he's got a headlamp.
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他做得到 因為他有頭燈
04:17
But the nurse is literally
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但是那位護士
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running around a darkened operating theater
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就在黑暗的手術室裡團團轉
04:22
trying to find anything she can use to anesthetize her patient,
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試著要找能用來麻醉病患的任何東西
04:24
to keep her patient asleep.
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讓病患維持睡眠狀態
04:26
Because her machine doesn't work when there's no power.
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因為她的機器沒有電就無法運作
04:30
And now this routine surgery that many of you have probably experienced,
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在座許多人可能都經歷過這項例行性手術
04:33
and others are probably the product of,
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其他人可能經由這項手術而誕生
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has now become a tragedy.
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但現在成了一場悲劇
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And what's so frustrating is this is not a singular event;
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讓人氣餒的是 這不是單一事件
04:41
this happens across the developing world.
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這種事情在開發中國家屢見不鮮
04:43
35 million surgeries are attempted every year
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每年要動的3500萬次手術
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without safe anesthesia.
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都沒有安全的麻醉
04:48
My colleague, Dr. Paul Fenton,
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我的同事 保羅‧芬頓博士
04:50
was living this reality.
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就身臨其境
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He was the chief of anesthesiology
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他是麻醉部門的主任
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in a hospital in Malawi, a teaching hospital.
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服務於馬拉威一所醫院 教學醫院
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He went to work every day
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他每天去上班
04:58
in an operating theater like this one,
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就在這種手術室裡工作
05:00
trying to deliver anesthesia and teach others how to do so
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他試著進行麻醉 也教導其他人
05:03
using that same equipment
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如何使用這種設備
05:05
that became so unreliable, and frankly unsafe,
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這種在他的醫院中變得不再可靠
05:07
in his hospital.
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又不安全的設備
05:09
And after umpteen surgeries
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在無數次手術之後
05:11
and, you can imagine, really unspeakable tragedy,
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還有 各位應該可以想像 難以言喻的悲劇之後
05:14
he just said, "That's it. I'm done. That's enough.
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他終於說：「夠了 我受夠了 到此為止
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There has to be something better."
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一定有更好的辦法」
05:18
So he took a walk down the hall
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因此他走到大廳
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to where they threw all those machines that had just crapped out on them --
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他們把所有壞掉的麻醉機都堆在那裡─
05:22
I think that's the scientific term --
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─我想那是個科學專有名詞
05:24
and he just started tinkering.
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然後他開始七拼八湊
05:26
He took one part from here and another from there,
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從這裡抓一個零件 那裡抓一個零件
05:28
and he tried to come up with a machine
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試著組裝成一台機器
05:30
that would work in the reality that he was facing.
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能夠在他所面對的現實環境中運作的機器
05:33
And what he came up with was this guy,
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結果他組裝出來的是就這個玩意兒
05:36
the prototype for the Universal Anesthesia Machine --
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通用麻醉機的原型
05:39
a machine that would work
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這台機器能夠運作
05:41
and anesthetize his patients
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讓他麻醉病患
05:43
no matter the circumstances that his hospital had to offer.
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不論他所工作的醫院提供的環境如何
05:47
Here it is back at home
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這張照片是它回到家
05:49
at that same hospital, developed a little further, 12 years later,
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12年後它略為改善 回到同一所醫院
05:52
working on patients from pediatrics to geriatrics.
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從小兒科服務到老人醫學
05:55
Now let me show you a little bit about how this machine works.
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現在讓各位多看一點這台機器如何運作
05:58
Voila!
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鏘鏘！
06:00
Here she is.
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就是它
06:02
When you have electricity,
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當有電力時
06:04
everything in this machine begins in the base.
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一切都從機器的底部開始運作
06:06
There's a built-in oxygen concentrator down there.
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這裡有內建的氧氣壓縮機
06:09
Now you've heard me mention oxygen a few times at this point.
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各位剛剛已經聽到我提起氧氣好幾次
06:12
Essentially, to deliver anesthesia,
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基本上 要進行麻醉
06:14
you want as pure oxygen as possible,
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純氧要越多越好
06:16
because eventually you're going to dilute it essentially
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因為最後這些純氧會被稀釋
06:18
with the gas.
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會跟空氣混合
06:20
And the mixture that the patient inhales
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病患吸入的混合氣體
06:22
needs to be at least a certain percentage oxygen
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必須至少有一定比例的氧氣
06:24
or else it can become dangerous.
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不然會很危險
06:26
But so in here when there's electricity,
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因此 有電力的時候
06:28
the oxygen concentrator takes in room air.
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氧氣壓縮機會吸取室內空氣
06:31
Now we know room air is gloriously free,
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我們都知道 室內空氣不花一毛錢
06:34
it is abundant,
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又源源不絕
06:36
and it's already 21 percent oxygen.
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而且氧氣含量達21%
06:38
So all this concentrator does is take that room air in, filter it
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因此壓縮機吸取 過濾室內空氣
06:41
and send 95 percent pure oxygen
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然後送出濃度達95%的純氧
06:43
up and across here
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上面送達這裡
06:45
where it mixes with the anesthetic agent.
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就是混合麻醉劑的地方
06:48
Now before that mixture
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混合氣體
06:50
hits the patient's lungs,
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到達病患肺部之前
06:52
it's going to pass by here --
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會先通過這裡
06:54
you can't see it, but there's an oxygen sensor here --
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各位看不到 不過這裡有一個氧氣感應器
06:56
that's going to read out on this screen
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會把資訊送到這個螢幕
06:58
the percentage of oxygen being delivered.
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可以看到送出氣體中氧氣所占的百分比
07:01
Now if you don't have power,
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但是如果你沒有電源
07:03
or, God forbid, the power cuts out in the middle of surgery,
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或是天公不長眼 電力在手術時中斷
07:06
this machine transitions automatically,
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這台機器會自動切換
07:08
without even having to touch it,
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連碰都不用碰
07:10
to drawing in room air from this inlet.
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換成從這個開口吸取室內空氣
07:13
Everything else is the same.
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其他都一樣
07:15
The only difference is that now
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唯一的差別是
07:17
you're only working with 21 percent oxygen.
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你現在只有氧氣濃度21%的氣體
07:20
Now that used to be a dangerous guessing game,
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在以前 這會是個危險的猜謎遊戲
07:23
because you only knew if you had given too little oxygen once something bad happened.
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因為只有情況惡化時 你才會知道氧氣供應不足
07:26
But we've put a long-life battery backup on here.
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但我們這裡放了一顆長效備用電池
07:29
This is the only part that's battery backed up.
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這是唯一有備用電池的部分
07:31
But this gives control to the provider,
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麻醉師可以藉此掌控情況
07:33
whether there's power or not,
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不管有沒有電
07:35
because they can adjust the flow
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他們都可以調整氣體流動
07:37
based on the percentage of oxygen they see that they're giving their patient.
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按照所看到的氧氣濃度 調整病患吸入的份量
07:40
In both cases,
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在這兩種情況中
07:42
whether you have power or not,
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不論有電或沒電
07:44
sometimes the patient needs help breathing.
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病患有時就是需要幫助才能呼吸
07:46
It's just a reality of anesthesia. The lungs can be paralyzed.
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麻醉的實情就是如此 肺部可能會癱瘓
07:49
And so we've just added this manual bellows.
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所以增加了這個手動的鼓風扇
07:51
We've seen surgeries for three or four hours
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我們遇過3或4小時的手術
07:54
to ventilate the patient on this.
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就靠這個讓病人換氧
07:57
So it's a straightforward machine.
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因此這是一台直截了當的機器
08:00
I shudder to say simple;
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我不想說它簡單
08:02
it's straightforward.
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它非常直接
08:04
And it's by design.
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但是是精心設計的成果
08:06
And you do not need to be
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你不需要
08:08
a highly trained, specialized anesthesiologist to use this machine,
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受過嚴格 專門的麻醉師訓練才能使用這台機器
08:11
which is good because, in these rural district hospitals,
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這是優點 因為在這些農村醫院
08:14
you're not going to get that level of training.
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你也得不到那種程度的訓練
08:17
It's also designed for the environment that it will be used in.
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它是為了所服務的環境而設計的
08:20
This is an incredibly rugged machine.
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也是一台非常耐操的機器
08:22
It has to stand up
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能夠耐得住
08:24
to the heat and the wear and tear that happens
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高溫 耗損 磨蝕
08:26
in hospitals in these rural districts.
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這些在農村醫院發生的情況
08:29
And so it's not going to break very easily,
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所以它不會輕易故障
08:31
but if it does, virtually every piece in this machine
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但如果故障了 機器裡的每一個零件
08:34
can be swapped out and replaced
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都可以拆下來換新
08:37
with a hex wrench and a screwdriver.
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只要有六角扳手和螺絲起子就做得到
08:40
And finally, it's affordable.
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最後 它的價格合理
08:42
This machine comes in
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這台機器的成本
08:44
at an eighth of the cost
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是剛剛讓各位看到的
08:46
of the conventional machine that I showed you earlier.
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傳統型機器的1/8
08:49
So in other words, what we have here
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因此換句話說 我們現有的
08:52
is a machine that can enable surgery and save lives
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是一台讓手術得以進行 能拯救生命的機器
08:55
because it was designed for its environment,
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因為它是因應環境而設計的
08:58
just like the first machine I showed you.
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就像我讓各位看到的第一台機器
09:00
But we're not content to stop there.
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但是我們並不就此滿足
09:02
Is it working?
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它有效嗎？
09:04
Is this the design that's going to work in place?
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這種設計是最適當的嗎？
09:06
Well we've seen good results so far.
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目前我們看到的結果都不錯
09:08
This is in 13 hospitals in four countries,
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這是分佈在四個國家的13所醫院
09:11
and since 2010,
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從2010年起
09:13
we've done well over 2,000 surgeries
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我們已經進行超過2000次手術
09:15
with no clinically adverse events.
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都沒有臨床上的不良反應
09:17
So we're thrilled.
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讓人十分振奮
09:19
This really seems like a cost-effective, scalable solution
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它確實像是個具成本效益 可擴展規模的方法
09:23
to a problem that's really pervasive.
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可以解決這個普遍的問題
09:26
But we still want to be sure
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但我們仍然想確定
09:28
that this is the most effective and safe device
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它是最有效 最安全的設備
09:30
that we can be putting into hospitals.
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完全適合放在醫院裡
09:32
So to do that we've launched a number of partnerships
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因此我們發起了幾個合作計畫
09:34
with NGOs and universities
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跟非政府組織和大學合作
09:36
to gather data on the user interface,
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從使用者介面取得資料
09:39
on the types of surgeries it's appropriate for
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得知這台機器適於哪一種手術
09:41
and ways we can enhance the device itself.
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以及如何強化機器的方法
09:43
One of those partnerships
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這些合作計畫之一
09:45
is with Johns Hopkins just here in Baltimore.
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就是跟巴爾的摩這裡的約翰‧霍普金斯大學合作
09:48
They have a really cool anesthesia simulation lab out in Baltimore.
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他們在巴爾的摩這裡有一間很酷的麻醉模擬實驗室
09:52
So we're taking this machine
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所以我們拿了這台機器
09:54
and recreating some of the operating theater crises
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又重建了一些手術室裡的危機
09:57
that this machine might face
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這台機器可能
09:59
in one of the hospitals that it's intended for,
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在未來服務的醫院裡會遇到這些危機
10:01
and in a contained, safe environment,
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我們在受控制 安全的環境中
10:04
evaluating its effectiveness.
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評估它的效能
10:06
We're then able to compare the results from that study
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然後就可以把這項研究的結果
10:09
with real world experience,
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跟真實世界的經驗做比較
10:11
because we're putting two of these in hospitals
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我們放了兩台機器
10:13
that Johns Hopkins works with in Sierra Leone,
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到約翰‧霍普金斯大學在獅子山共和國的合作醫院中
10:15
including the hospital where that emergency C-section happened.
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包括發生緊急剖腹生產手術的醫院
10:20
So I've talked a lot about anesthesia, and I tend to do that.
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我對麻醉做了許多說明 我常常會這樣
10:23
I think it is incredibly fascinating
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我認為它非常引人入勝
10:25
and an important component of health.
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也是健康非常重要的要素之一
10:27
And it really seems peripheral, we never think about it,
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這個議題似乎處於邊陲 沒有人會想到
10:30
until we don't have access to it,
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直到沒得用了我們才會注意
10:32
and then it becomes a gatekeeper.
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然後它成了守門人
10:34
Who gets surgery and who doesn't?
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誰能接受手術 誰不能？
10:36
Who gets safe surgery and who doesn't?
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誰能接受安全的手術 誰不能？
10:39
But you know, it's just one of so many ways
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但其實 這只是說明
10:42
that design, appropriate design,
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設計 合宜的設計
10:45
can have an impact on health outcomes.
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可以對健康結果造成影響的諸多例子之一
10:48
If more people in the health delivery space
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如果醫療服務傳遞領域有更多人
10:50
really working on some of these challenges in low-income countries
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確實努力解決低收入國家的這些挑戰
10:53
could start their design process,
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開啟設計的過程
10:55
their solution search,
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尋找解決之道
10:57
from outside of that proverbial box
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不墨守成規
10:59
and inside of the hospital --
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而是設身處地為醫院著想
11:01
in other words, if we could design
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也就是說 如果我們能夠
11:03
for the environment that exists in so many parts of the world,
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替存在於世上許多地方的環境設計
11:06
rather than the one that we wished existed --
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而不是替我們希望存在的環境設計
11:08
we might just save a lot of lives.
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也許就能拯救無數的生命
11:11
Thank you very much.
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感謝各位
11:13
(Applause)
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(掌聲)
ABOUT THE SPEAKER
Erica Frenkel - Medical technologistAt Gradian Health Systems, Erica Frenkel works to bring safe anesthesia to hospitals all over the world.
Why you should listen
Erica Frenkel helps lead Gradian Health Systems, a social enterprise enabling safe surgery through innovative anesthesia technology. She has been a Peace Corps volunteer, managed the Global Media AIDS Initiative for the Kaiser Family Foundation and helped shape public health initiatives as a consultant for the Clinton Foundation, the Liberian Ministry of Health, Merck Vaccines, and the Wellcome Trust.
Erica Frenkel | Speaker | TED.com