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1、www.XiYuS锡育软件Im going to talk to you today about the design of medicaltechnology for low resource settings.今天我要谈的 是关于在低能源供给下的医疗技术设计00:15I study health systems in these countries.我在这些国家学习医疗系统00:20And one of the major gaps in care,almost across the board,is access to safe surgery.一个重大的医疗缺口 在很多国家都存在的 是
2、安全手术通道00:22Now one of the major bottlenecks that weve found thatssort of preventing both the access in the first place and thesafety of those surgeries that do happen is anesthesia.我们发现的一个影响手术进行 和手术安全 的重要医疗瓶颈 就是麻醉00:28And actually,its the model that we expect to work fordelivering anesthesia in thes
3、e environments.事实上,这个方案正是我 为手术能在如此环境下顺利进行 而致力开发的麻醉方式00:38Here we have a scene that you would find in any operatingroom across the U.S.or any other developed country.这个场景是一个 在美国和其他发达国家的手术室里常见的景象00:44In the background there is a very sophisticated anesthesiamachine.背景是 一台非常精密的麻醉器00:49And this machine
4、is able to enable surgery and save livesbecause it was designed with this environment in mind.这个机器能让 手术顺利进行并挽救生命 因为它是按照此要求 设计出来的00:53gaps:n.差异,缺口;缝隙(gap的复数形式)/v.裂开;使豁裂(gap的第三人称单数形式)bottlenecks:n.包装瓶颈(bottleneck的复数)in the first place:首先;起初 surgeries:n.外科手术(surgery复数)anesthesia:n.麻醉;麻木(等于anaesthesia)s
5、ophisticated:adj.复杂的；精致的；久经世故的；富有经验的/v.使变得世故；使迷惑；篡改(sophisticate的过去分词形式)In order to operate,this machine needs a number of thingsthat this hospital has to offer.要操作这台机器 医院需要具备一系列条件01:01It needs an extremely well-trained anesthesiologist withyears of training with complex machines to help her monitor
6、the flows of the gas and keep her patients safe andanesthetized throughout the surgery.需要一个接受过良好训练的麻醉师 有数年操作复杂机械的经历 来监控气体进出 保证病人的安全和手术中的麻醉状态01:06Its a delicate machine running on computer algorithms,andit needs special care,TLC,to keep it up and running,and itsgoing to break pretty easily.这台精巧的机器会进行
7、精密运算 需要特别护理,TLC,以保证其正常运行 而且它很容易出故障01:18And when it does,it needs a team of biomedical engineerswho understand its complexities,can fix it,can source theparts and keep it saving lives.出故障的时候,需要一队能解决复杂问题的 生物医学工程师的小组 来修理,替换零件 让其继续挽救生命01:26Its a pretty expensive machine.这是台很昂贵的机器01:35It needs a hospital
8、 whose budget can allow it to support onemachine costing upwards of 50 or$100,000.医院需要有 五万到十万美元的预算 来购置和维持运营一台机器01:37And perhaps most obviously,and perhaps most importantly-and the path to concepts that weve heard about kind ofillustrate this-it needs infrastructure that can supply anuninterrupted so
9、urce of electricity,of compressed oxygenand other medical supplies that are so critical to thefunctioning of this machine.也许最明显的就是 或者说最重要的 我们所知的那些概念 也说明了这个问题 这个机器需要 能提供不间断电源 不间断供氧 还有其他医疗设备的基础设施 这些都对这个机器的运转 至关重要01:44well-trained:adj.训练有素的;良好训练 anesthesiologist:n.麻醉学者(医师)anesthetized:vt.使麻醉(anaestheti
10、ze);使麻痹 biomedical:adj.生物医学的 complexities:n.复杂性(complexity的复数);错综复杂的事物 upwards:adv.向上;在上部;向上游 concepts:n.概念,观念;思想(concept复数形式)uninterrupted:adj.不间断的;连续的 compressed:adj.被压缩的;扁平的 functioning:n.运行,运作;计功能;机能;起酌(function的动名词)/v.运行,起作用(function的现在分词形式)In other words,this machine requires a lot of stuff th
11、at thishospital cannot offer.也就是说,这台机器需要的许多东西 是这个医院所不能提供的02:05This is the electrical supply for a hospital in rural Malawi.这是马拉威一个乡下医院的 供电情况02:10In this hospital,there is one person qualified to deliveranesthesia,and shes qualified because she has 12,maybe 18months of training in anesthesia.这个医院里 有一
12、个人有实施麻醉的资质 她具备资质的原因是 她接受过12或许18个月的 麻醉训练02:14In the hospital and in the entire region theres not a singlebiomedical engineer.在这个医院和这整个区域 没有一个生物医学工程师02:24So when this machine breaks,the machines they have towork with break,theyve got to try and figure it out,but most所以机器一旦出故障 就得带着故障运行 他们得自己试着修理,但大多时候,
13、故障就意味着没戏了02:28TED演讲者：Erica Frenkel|艾丽卡?弗兰凯尔演讲标题：Erica Frenkel:The universal anesthesia machine|万能麻醉器内容概要：At Gradian Health Systems,Erica Frenkel works to bring safe anesthesia to hospitalsall over the world.如果手术中停电了怎么办?没有灯，没有氧气麻醉也停止供给。全世界的手术室里经常有这样的事，把日常程序弄成了悲剧。艾丽卡?弗兰凯尔展示了一个解决方案:万能麻醉器work with break
14、,theyve got to try and figure it out,but mostof the time,thats the end of the road.02:28Those machines go the proverbial junkyard.这些机器就进了垃圾堆02:35And the price tag of the machine that I mentioned couldrepresent maybe a quarter or a third of the annual operatingbudget for this hospital.而我提到过这台机器的价钱 这可
15、能是这个医院 一年预算的四分之一 或三分之一02:38And finally,I think you can see that infrastructure is not verystrong.最后我想你们了解了它的基础设施不佳02:47This hospital is connected to a very weak power grid,onethat goes down frequently.这家医院接入的电网非常弱 经常停电02:50proverbial:adj.谚语的;众所周知的;谚语式的 junkyard:n.废品旧货栈;废物堆积场;旧汽车丢弃的地方 frequently:adv.
16、频繁地,经常地;时常,屡次So it runs frequently,the entire hospital,just on a generator.这整个医院常常就是靠 一台发电机运作02:55And you can imagine,the generator breaks down or runs outof fuel.可以想象 发电机若是出了故障 或者燃料耗尽会如何02:59And the World Bank sees this and estimates that a hospitalin this setting in a low-income country can expect
17、 up to 18power outages per month.世界银行借此估计 在一个低收入国家的此类条件下的医院 每个月大约有高达 18次断电03:03Similarly compressed oxygen and other medical supplies arereally a luxury and can often be out of stock for months oreven a year.同样,压缩氧气和其他医疗设备 可以算是奢侈品了常常数月甚至一年 都没有任何储备03:13So it seems crazy,but the model that we have rig
18、ht now istaking those machines that were designed for that firstenvironment that I showed you and donating or selling themto hospitals in this environment.这个看上去挺疯狂,但我们现在做的事 就是把针对我最开始展示给你们的环境 设计出来的机器 捐赠或出售给 只有这样条件医院03:21Its not just inappropriate,it becomes really unsafe.这不仅是不合适的 而且不安全03:33One of our
19、 partners at Johns Hopkins was observingsurgeries in Sierra Leone about a year ago.我们一位在約翰霍普金斯大学的合作者 一年前在塞拉利昂观察了 那里的手术03:38estimates:n.估计;预算(estimate的复数);概数/v.评价(estimate的三单形式);估量 outages:n.储运损耗;中断供应;运行中断out of stock:adv.已脱销 donating:捐赠/捐献 inappropriate:adj.不适当的;不相称的 unsafe:adj.不安全的;危险的;不安稳的 observi
20、ng:adj.观察的;注意的;观察力敏锐的/v.观察;遵守(observe的ing形式)Leone:n.利昂(塞拉利昂货币单位)And the first surgery of the day happened to be anobstetrical case.第一例手术正好是产科手术03:45A woman came in,she needed an emergency C-section tosave her life and the life of her baby.一个妇女需要进行紧急剖腹产 来挽救她的孩子和自己的生命03:48And everything began pretty a
21、uspiciously.开始一切顺利03:54The surgeon was on call and scrubbed in.外科医生准备好了动手03:56The nurse was there.护士也在03:58She was able to anesthetize her quickly,and it was importantbecause of the emergency nature of the situation.能马上实施麻醉 因为是紧急情况所以这一切很重要04:00And everything began well until the power went out.一切都很顺
22、利 后来停电了04:05And now in the middle of this surgery,the surgeon is racingagainst the clock to finish his case,which he can do-hesgot a headlamp.在手术进行过程中 外科医生正和争分夺秒完成手术 他能做到,有个头灯04:10But the nurse is literally running around a darkenedoperating theater trying to find anything she can use toanesthetize
23、her patient,to keep her patient asleep.但是护士就得 在黑漆漆的的手术室里四处搜寻 能麻醉她的病人的东西 让病人处于睡眠中04:17Because her machine doesnt work when theres no power.因为没有电机器就不能运转04:26obstetrical:adj.产科的;助产的 C-section:n.剖腹产 anesthetize:vt.使麻醉(anaesthetize);使麻痹 headlamp:n.照明灯;桅灯;车前灯 darkened:adj.变黑的,没有灯光的And now this routine sur
24、gery that many of you haveprobably experienced,and others are probably the productof,has now become a tragedy.这样一个诸位都可能经历过 或者由此出生寻常手术 演变成了悲剧04:30And whats so frustrating is this is not a singular event;thishappens across the developing world.更让人难过的是这并不是个案 在整个发展中的世界都是这样04:3835 million surgeries are a
25、ttempted every year without safeanesthesia.每年有三千五百万例手术 是在没有安全麻醉的情况下实施04:43My colleague,Dr.Paul Fenton,was living this reality.我的同事,鲍尔?芬东医生 就处在这样的情况下04:48He was the chief of anesthesiology in a hospital in Malawi,ateaching hospital.他是马拉威一家医院的 首席麻醉师,那是个教学医院04:52He went to work every day in an operatin
26、g theater like thisone,trying to deliver anesthesia and teach others how to do他每天就得 去这样的医院上班 在医院里教导别人怎样实施麻醉 怎么使用这个器材 十分不可靠 不安全的设备04:56one,trying to deliver anesthesia and teach others how to doso using that same equipment that became so unreliable,and frankly unsafe,in his hospital.全的设备04:56And afte
27、r umpteen surgeries and,you can imagine,reallyunspeakable tragedy,he just said,Thats it.Im done.Thatsenough.在无数手术之后 你可以想象,无数悲剧之后 他说:“我不干了,我受够了05:09There has to be something better.我得做点有用的东西。”05:16frustrating:adj.令人沮丧的/v.使沮丧(frustrate的ing形式)singular:adj.单数的；单一的；非凡的；异常的/n.单数anesthesiology:n.麻醉学 unreli
28、able:adj.不可靠的;靠不住的 umpteen:adj.无数的;很多的 unspeakable:adj.无法形容的;不能以言语表达的;坏透了的www.XiYuS锡育软件So he took a walk down the hall to where they threw all thosemachines that had just crapped out on them-他去了一趟 堆着扔掉的那些他抱怨过的机器的房间05:18I think thats the scientific term-and he just startedtinkering.我想这就这些机器的名称 他开始修补0
29、5:22He took one part from here and another from there,and hetried to come up with a machine that would work in thereality that he was facing.他从每个上面取一些 然后作出一个机器 能在他所处的环境里实用的05:26And what he came up with was this guy,the prototype forthe Universal Anesthesia Machine-a machine that wouldwork and anesth
30、etize his patients no matter thecircumstances that his hospital had to offer.他就得到了这个东西 这就是万能麻醉器的原型 这个机器能在 任何条件下 工作,麻醉病人05:33Here it is back at home at that same hospital,developed alittle further,12 years later,working on patients frompediatrics to geriatrics.这还是在那家医院 12年后 有了改进 适用于各个年龄的病人05:47Now le
31、t me show you a little bit about how this machineworks.现在我来解释一下它的运作原理05:55Voila!哇！05:58Here she is.这就是了06:00crapped:n.废话;废物;屎;拉屎/vi.掷骰子;拉屎 tinkering:n.铸补,熔补/v.做焊锅匠,笨拙的修补(tinker的现在分词形式)partfrom:向告别 come up with:提出;想出;赶上 pediatrics:n.小儿科 geriatrics:n.老年病学;老年病人 Voila:int.(法)瞧;可不是When you have electrici
32、ty,everything in this machine beginsin the base.有电力供给时 一切是从基座开始工作06:02Theres a built-in oxygen concentrator down there.下面有一个内置的氧气集中器06:06Now youve heard me mention oxygen a few times at thispoint.你已经听我提到过几次氧气了06:09Essentially,to deliver anesthesia,you want as pure oxygen aspossible,because eventuall
33、y youre going to dilute itessentially with the gas.基本上,要实施麻醉 就得尽可能地使用纯氧 因为你最终会用气体 来稀释06:12And the mixture that the patient inhales needs to be at leasta certain percentage oxygen or else it can becomedangerous.最后患者吸入的混合气体 必须有一定比例的氧气不然就会很危险06:20But so in here when theres electricity,the oxygenconcent
34、rator takes in room air.但是当有电的时候 氧气集中器就采入室内空气06:26Now we know room air is gloriously free,it is abundant,andits already 21 percent oxygen.室内空气反正是免费的 而起取之不尽 并且含有21的氧气06:31So all this concentrator does is take that room air in,filter itand send 95 percent pure oxygen up and across here whereit mixes w
35、ith the anesthetic agent.集中器采入室内空气,过滤 输入95的纯氧 经过这里 混合麻醉成分06:38built-in:adj.嵌入的;固定的/n.内置 dilute:adj.稀释的;淡的/vt.稀释;冲淡;削弱/vi.变稀薄;变淡 inhales:vt.吸入;猛吃猛喝/vi.吸气 or else:否则;要不然 gloriously:adv.光荣地;辉煌地;壮观地,壮丽地 mixes:n.混淆;调拌料(mix的复数)/v.混合(mix的第三人称单数)anesthetic:adj.麻醉的;感觉缺失的/n.麻醉剂,麻药Now before that mixture hits
36、the patients lungs,its going topass by here-you cant see it,but theres an oxygen sensorhere-thats going to read out on this screen the percentageof oxygen being delivered.在混合气体 进入病人肺部之前 会先经过这里 你看不到,这是个氧气传感器 能读出氧气含量 显示在屏幕上06:48Now if you dont have power,or,God forbid,the power cutsout in the middle o
37、f surgery,this machine transitionsautomatically,without even having to touch it,to drawing inroom air from this inlet.没有电的时候 或者上帝不帮忙,手术中间断电了 这个机器不需要人工操作 就能自动切换模式 开始从这个口采入室内空气07:01Everything else is the same.其他的都是一样的07:13The only difference is that now youre only working with 21percent oxygen.唯一的区别是
38、你用的只是21氧气07:15percent oxygen.Now that used to be a dangerous guessing game,becauseyou only knew if you had given too little oxygen oncesomething bad happened.这曾是个比较危险拼运气的手术部分 因为通常是出事了你才知道供氧不足07:20But weve put a long-life battery backup on here.但我们有一个超常寿命的电池07:26This is the only part thats battery ba
39、cked up.这是唯一一部分依靠电池的07:29But this gives control to the provider,whether theres poweror not,because they can adjust the flow based on thepercentage of oxygen they see that theyre giving theirpatient.但这能让麻醉师能 应对无论有电没电的情况 因为他们能按照屏幕上读取的 氧气比例来调节气流07:31pass by:经过;走过;逝去 sensor:n.传感器 transitions:n.过渡,转变(tra
40、nsition的复数形式);转场效果;转换滤镜automatically:adv.自动地;机械地;无意识地/adj.不经思索的 inlet:n.入口,进口;插入物 long-life:adj.经过延长保质期处理的(牛奶等)provider:n.供应者;养家者In both cases,whether you have power or not,sometimes thepatient needs help breathing.不论 是否有电 有时候病人需要协助呼吸07:40Its just a reality of anesthesia.The lungs can be paralyzed.这
41、是麻醉的现实情况 肺部有可能麻痹07:46And so weve just added this manual bellows.所以我们加入了手动风箱07:49Weve seen surgeries for three or four hours to ventilate thepatient on this.我们见过三到四小时的手术 用这个来保持病人呼吸07:51So its a straightforward machine.所以这是个操作简明的机器07:57I shudder to say simple;its straightforward.我不想说它简单 而是操作简明08:00And
42、 its by design.从设计层面上08:04And you do not need to be a highly trained,specializedanesthesiologist to use this machine,which is good because,in these rural district hospitals,youre not going to get thatlevel of training.而且你不必是一名 经过优秀训练的,具备专门技能的麻醉医师才能来操作 这一点很重要,因为位于乡下的医院 不可能具备这个训练水平人员08:06Its also desi
43、gned for the environment that it will be used in.而且它也是按其使用环境来设计的08:17This is an incredibly rugged machine.这是个不可思议地很粗糙的机器08:20paralyzed:adj.瘫痪的;麻痹的/v.使麻痹;使无力;使失去勇气(paralyze的过去分词)bellows:n.波纹管;风箱;皮老虎 ventilate:vt.使通风;给装通风设备;宣布 straightforward:adj.简单的；坦率的；明确的；径直的/adv.直截了当地；坦率地shudder:n.发抖;战栗;震动/vi.发抖;战
44、栗 specialized:adj.专业的;专门的/v.专攻(specialize的过去分词);使专门化;详细说明rugged:adj.崎岖的;坚固的;高低不平的;粗糙的It has to stand up to the heat and the wear and tear thathappens in hospitals in these rural districts.它能承受 在乡下医院里 会出现的过热和磨损08:22And so its not going to break very easily,but if it does,virtually every piece in this
45、 machine can be swapped out andreplaced with a hex wrench and a screwdriver.也不容易出故障 但是如果出了故障,几乎每一个零件 都可以用个六角扳手和螺丝刀 卸下来换个新的08:29And finally,its affordable.最后,它价钱不贵08:40This machine comes in at an eighth of the cost of theconventional machine that I showed you earlier.这个机器只有 之前展示的那个传统机器的 八分之一的价格08:42S
46、o in other words,what we have here is a machine that canenable surgery and save lives because it was designed for itsenvironment,just like the first machine I showed you.也就是说,这个机器 能保证手术进行挽救生命 因为它贴合环境实际的设计 用途就和我一开始展示的机器一样08:49But were not content to stop there.但是我们并不于此止步09:00Is it working?这个机器能用吗？09:
47、02Is this the design thats going to work in place?这个设计能管用吗？09:04Well weve seen good results so far.目前为止结果还是很好的09:06This is in 13 hospitals in four countries,and since 2010,wevedone well over 2,000 surgeries with no clinically adverseevents.这个装备已经在4个国家13个医院应用 从2010起我们已经用它做了超过两千例手术 没有一起医疗事故09:08distri
48、cts:n.地理区域;地域(district的复数形式)/v.把划分为区(district的第三人称单数形式)hex:n.十六进制;妖法;巫婆/vi.施魔法/vt.施魔法于 wrench:n.扳手，扳钳；扭伤；痛苦；歪曲；猛扭/vt.扭伤；猛扭；曲解；折磨/vi.扭伤；猛扭；猛绞/screwdriver:n.螺丝刀 affordable:adj.负担得起的 clinically:adv.临床地;门诊部地;不偏不倚;通过临床诊断 adverse:adj.不利的；相反的；敌对的(名词adverseness，副词adversely)So were thrilled.我们乐坏了09:17This re
49、ally seems like a cost-effective,scalable solution to aproblem thats really pervasive.这似乎是个经济又可推广的方案 来应对目前广泛存在的问题09:19But we still want to be sure that this is the most effective andsafe device that we can be putting into hospitals.但是我们仍需要确定这是 最有效和安全的设备 能在医院里使用09:26So to do that weve launched a numb
50、er of partnerships withNGOs and universities to gather data on the user interface,on the types of surgeries its appropriate for and ways we canenhance the device itself.所以我们为此和一些非政府组织及大学 合作 来收集使用者方面的资料 机器适宜操作的手术 以及增强设备的数据09:32One of those partnerships is with Johns Hopkins just here inBaltimore.我们的其