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Good morning and welcome to the global surgery green zone.

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I just thought, I'll just put you into the picture of where we are and what we do in the global surgery group.

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So we formed the Oxford University Global Surgery Group, which is made up of four departments,

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which includes NDAs and dorms, reproductive medicine and anaesthetics.

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We've just have leads for each of these departments, and the leads basically just coordinate the activities.

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And if people are doing global work, then most welcome to talk to us and we would give you some platform to showcase your work.

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We meet every Thursday, Thursdays in the NDA seminar room and we have a business meeting from 7:30 to eight.

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And after that, we run seminars from eight to nine and everyone is welcome to the seminars.

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Noel, who coordinates the seminars, is here in front.

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If you have a topic, if you're doing some work and you'd like to discuss it, please get in touch with Noel and we'll put you on to the seminars.

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It's just not surgeons or medical people that that presented the seminars.

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We have the likes of Nigel, Chris, BBC reporters advocates, you know, the likes of equivalent of Bill Gates and people like that.

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Google would come on to the seminars. So please, you know you most welcome.

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The seminars are video linked for those that don't are not present.

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So a lot of them are videos streamed and exciting and a lot of discussion following the seminars.

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We run three Chumley meetings. Two of them are linked to the engineer round, which is this one of them?

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Is this and one we run independently, which is in Oslo House in the next one is on the 28th of March at six p.m. and we have

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speakers from ranging from students right up to advocates at the Oslo House meeting.

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You will get some kind of peace and drinks and Prozac for Jessica.

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Yeah, so please come, even if you just want the drink. We also link up with the International Journal Club, which is run by monthly.

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So nationally, again, this is all we just dreamed this of five universities that are linked to this and internationally as well.

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And we have a lot of input from Africa and Asia at these journal clubs.

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We have a lot of system students now interested and that do modules with us,

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but we also have a AFP's active students who are doing projects in different departments that are linked to this group.

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These are just a few examples of some of the research projects that we have,

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and you're most welcome to join us if you have an idea or you need some support or you have a global issue that you want to discuss.

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We'll be very happy to support you. And we've been running.

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We last year we ran credit betting short course equivalent to 20 cat points, hoping to link it to a masters.

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And this year we're running it from nine to the 13th of September.

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So if you wish please and apply sort of content, what I'm going to do is hand over to Newell and Sarah to introduce the main speakers for today.

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So thank you. Good morning, everyone, and thanks for coming. My name is Sarah Davidson.

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I'm currently one of the fellows for the Oxford Global Surgical Group, which I'm very excited to be with you today.

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I'm going to introduce Sarah Casely. She's been working in global health for around 10 years as a former journalist.

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She was the first employee of the Lightbox Foundation,

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which is an NGO which has been working to make surgery and anaesthesia safer in those or settings.

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And I think it's one of the things that global surgery that lots of people not involved

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a global surgery have actually heard of and a foundation that we're very fond of.

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And she's also the producer of the Checklist Effect, which is an award winning documentary about the state of surgery globally.

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This was directed by Lauren Anders Brown, and it's been translated into 12 languages, and it's been screened in more than 20 countries.

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And she's going to give you a few elements of that and discuss a few things about global surgery arrangement.

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Sarah, thank you very much. OK, thank you so much.

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I I never feel more like an English literature grad than when I'm addressing a roomful of surgeons.

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So thank you for having me. Thank you.

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And you know, we come from very different planets, but my very cheesy joke was always that yes,

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surgery has been around for a long time, but storytelling has been around for a lot longer.

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So actually, my profession is older than yours. And I've actually I left life books about six months ago,

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and I can't tell you actually how much I have missed this community and the familiar faces that are in the room now.

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Some of them very much directly responsible for the kind of global translation of the checklist effect.

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And it's an extraordinary I don't know so much about the surgical community.

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The global surgical community has my has my heart entirely, and I wanted to say just a few words about life books.

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I think many of you, I'm hoping, may have heard of it.

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I think you probably at least will have heard of Atul Gawande, who is the chairman and founder of the organisation,

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and we're celebrating the 10 year anniversary of the W.H.O. checklist this year, which life very much grew out of.

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And I'll work,

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and I think I will still be saying I'll that for many years to come is around three core elements of surgical safety so safe anaesthesia,

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infection reduction and teamwork. And that teamwork component is particularly relevant to and to this conversation today.

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I haven't timed my speech, so I'm going to try and talk for as long as I think I have.

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And then I'm going to show you two video clips from the film, and I'm very lucky to be hearing Shafi.

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We'll be talking later and then we'll hopefully have time for a few questions.

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And I'm slightly conscious that the approach I was going to take here may be a very different approach to innovation,

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and I think that's exactly what a grand round should be kind of two very different

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perspectives on a word that I suddenly realised I was hearing a lot less.

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In the six months since I've left a global surgery, I'm working right now in maternal child newborn health and spirit obviously

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could figure out the International Federation of Obstetrics and Gynaecology.

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I know there is a slightly contentious relationship with ARVs, and I knew that I'm not here to stick my nose in, but I did notice the.

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If all sorts of maybe armchair psychology, but the field has a a much is more of a sense of, I think,

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resourcing of awareness of what maternal health is globally, and I started to wonder whether that was connected to the slightly less.

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Less of an anxiety around needing innovations, because I think what it's also starting to recognise is a lot of the things

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that we see and the challenges that colleagues and low resource settings face,

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whether it's around access to an ongoing training, whether it's around access to resources,

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it's infrastructure are not very glamorous things, and they're certainly not things that are going to and to have very quick fixes.

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And so innovation, I think at Life Box was always aware that I struggled with a little bit because he felt a lot of pressure to use it.

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And in some ways we did have a piece of technology. We had this pulse oximeter, which was specially designed for challenging settings.

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So rather than kind of approach to to medical technology, which is to say, don't bring me the cheapest, don't bring me the most expensive,

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don't bring me the newest or the oldest, bring me one that will do exactly what it needs to do for an environment that cannot afford failure.

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So, yes, there is innovation there, but I think we kind of settled ourselves around the idea of being innovative implementers.

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And that's what I kind of like to focus my framing of the checklist effect and my framing of the surgical safety checklist around,

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which is to say that I think it is one of the greatest innovations in surgical history,

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and I say that not as a surgeon, I say that knowing there might be some very different opinions about it.

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But I think what I what I do get to speak to you as is probably to not as a surgeon,

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but as a patient and as a person who has talked to a lot of different surgical teams about the checklist

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in a lot of different countries about what it means to them and what opportunities it has brought them.

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And. And actually one of the the the revelations in making this film wasn't even in talking to patients or surgical teams,

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it was talking to other disciplines. I don't know if anyone in the room has read the checklist manifesto,

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which is the tools book about the development of the checklist and looks at how in different industries.

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This approach to structured and teamwork is not only an innovation is a given.

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And I was I was thinking about the I call in the two sets of of ideals that I relate to talking about the checklist.

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And I think I'm used to a lot of surgical team eyeballs which are kind of, you know,

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it's it's more paperwork or it's more or we were doing this before or a kind of a wariness that is and I think,

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entirely psychologically understandable. And then the other set of eyeballs from kind of patients lay people,

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the ones who get to sort of talk about surgery without ever having to smell cauterising, which was a real shock to me the first time I did.

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And those are the ideals of excuse me, the checklist is only 10 years old.

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This wasn't an established protocol as I lay with my body open in sensitised in an operating room.

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And I think that's that's the space between.

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That is what is really fascinating to me about the kind of the closed world of surgery, the still slightly, I think, closed world of global surgery.

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I think we all know very much the kind of the statistics, and this is not a talk about the need for access to safe surgery on a global scale.

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I think nobody can deny it. Nobody can, I think, fail to be shocked by the extent of that need.

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But it is a, I think, an opportunity to reflect on.

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What the checklist can be in that in that space and the two clips I'm going to show we made this film is, I say, a little bit about the film.

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I never intended to be a documentary producer. I didn't realise I was making one for quite a while into the process.

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But what we did know is that those surgical doors are very heavy and the world beyond

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is maybe one that we're very privileged not to know entirely what happens inside it,

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to go through it. And Bill Barry, who is one of the kind of, I think, the grandfathers of the checklist,

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extraordinary patient safety cardiac surgeon and he used to say surgery is this thing that would be illegal to do in any other context.

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You can't go to someone on the street and, you know, and slash him and not expect some consequences.

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But I think it's this incredible like wrestling of, you know, human fate out of the hands that would have it's been otherwise.

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And I think we're so lucky as we know to be in a country with a system that provides us with a foundation of safe surgical care.

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And the first clip that I will be showing is filmed in the UK at Alison Dunstable Hospital at Great Ormond Street Hospital.

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The by the checklist really was lifted up and implemented put in Philip and CEO at Dunstable,

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who really kind of pushed for its development and implementation.

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And the second life I'm going to show is from Uganda of where life works have worked very closely with the anaesthesia community in particular there.

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It's one of the first countries where we did any joint projects around and around anaesthesia, safety and the checklist.

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And I think what I want those two comparisons to be is absolutely nothing whatsoever.

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It's not salacious. It's not to say S&M is actually to say this.

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You know, surgery as is great, unifying a component of health care.

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And my favourite thing when I got to travel to other countries and surgical

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communities was watching healthcare professionals talk to each other on a level,

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on a language that was totally outside of context because it wasn't about.

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It wasn't about culture, it was about surgical culture, which actually has a lot of similarities,

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every operating room, every incision is pretty much the same concept.

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And so to watch it and see and I hope it will maybe demonstrate those two different perspectives one in making it showing the challenges

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with making the checklist stick in a culture where we actually we do have a lot of safety frameworks and we do have a lot of people ask me,

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do have a lot of.

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It's a very particular culture that the checklist was trying to break into, and then I think to look at the culture of our colleagues in Uganda,

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the challenges that they're facing and to see how the checklist has been adapted

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in very different ways that make it and that thing that you sort of laughed at.

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But I didn't mean for it to be a joke,

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but to make it a great innovation in surgical history because it is a tool that that is flexible, that is adaptable.

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If you want to think in innovation terms, I guess it's it's a a hackable tool that you can bring into your own space and

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you make it work for your patient flow and your surgical flow in your context.

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And I think they make really strong and powerful comparisons.

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And maybe the last thing I will say about the film and I hope we will have time for questions is always when I wish this wasn't a a one sided me.

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Just talking up this magical mountain.

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Here is why we made the film, which is that the sense that nobody really understands what happens inside an operating theatre.

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And I think that's part of Global Surgery's real communication struggle is it's a really frustrating.

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Of. Cause to make your own because you know how important it is and you will be that person standing in a pub shouting loudly about and, you know,

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hospitals where an amnesty at seventy thousand hospitals,

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where surgery is taking place without a pulse oximeter to monitor the patient under anaesthesia.

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And these staggering statistics that don't often reverberate well in noisy spaces.

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And I was staggered by how many people helped us make this film for free.

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It's a really high quality, award winning feature length production that we made for less than £10000,

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working with partners in seven different countries around the world.

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The director worked pro bono, pulled in favours from people who had had their lives changed by surgery and either themselves or people they loved.

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And what we hoped, I think this film was that it would take us outside of hospitals, often into hospitals, but often outside them.

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And and that it could it could be the best film about global surgery that ever left medical practise.

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And so I guess I've seen it about four hundred and fifty times.

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You can be the judge of these couple of clips, and if you would like to see the whole thing afterwards,

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I would be a million times glad to send you a link. So I'm just going to show the first clip now.

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The usual values of health care or autonomy. Leave me alone, let me make whatever decision I've made.

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I know what I'm doing. The values in the checklist are humility, discipline and teamwork.

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It's all about the communication that you make happen on behalf of the patient.

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You can embed that culture of looking at your system and seeking where it can be improved and you're in effect, a much bigger improvement in safety.

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Some staff were quite uninterested in this. Everybody having a say so we introduced the surgical safety checklist.

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But yeah, it was about six years ago,

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and in that time it has really opened up a culture that we were able to sort of raise concerns much more easily than maybe we previously were able to.

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I think one of the things about when you look at how the dynamics of the theatre war is that you have several different grades of staff,

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you have your consultant surgeons,

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you have you registrars, surgeons, you have anaesthetists as consultants, you have registrar anaesthetists, so you have junior doctors as well.

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You have a lot of trainee nurses. You have trainee ADP's qualified dedicated nurses and also you have your unqualified

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set of practitioners or health care system to work within within the environment.

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And it's always a thing that the consultant is the man in charge.

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And not so long ago, I once heard that the consultant was described as end to the emperor.

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And everybody felt that they were on the parapet about the full on.

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I think the culture within health care is for such a long time has been that people

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don't not question that people don't interact with the doctors on that level,

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and I don't know that was the case in lots of places, in lots of places around the world.

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And it definitely was like that in the UK and not so long ago.

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If I'm really honest, they're probably not thinking how to think I could manage to do that.

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So in my day to day work in the operating theatre, obviously take a lot of responsibility on board,

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and many people look to us as being in charge of what happens in the operating room, and the doctors would have banned all conversations.

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The nurses would have felt that were conversations and that there was never that conversation quite in the middle.

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And so the doctors with my very personal things about the patient and what happened prior to this and the nurses,

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we would know exactly what should we have seen in theatres. Yeah, it was like never.

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The twain was made at a personal level. If I'm concentrating, focussing on the case that I've got a hand, I've got a lot of pressure.

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Though the work being to go in different directions. Often I know what's happening, I know what I want to do.

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But remembering to communicate that with the team explained to test what the plan is explaining to my script and what we're going to be doing.

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It's really important to maintain that communication and all too often that does get overlooked in the pressured environment working.

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We've got to the point where surgery is now within the wider hospital system,

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a much more complex and potentially dangerous environment to be working in.

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And it's crucial in an awareness of that beyond just our own technical skill, which is always really important to consider.

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And I think the general public can sometimes see surgery as being routine, but they should never be never be undertaken as routine.

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These risks are always in the back of our mind when undertaking a case.

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The the main thing about any situation or any serious incidents is in 99.9 percent of circumstances where it's happening,

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someone in the room or someone in the area has no idea it's going to happen prior to it happening,

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but hasn't hasn't felt that they have the authority or even the courage to speak out.

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And it's very, very important that they do speak out because we could prevent so many accidents,

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so many serious instances when in surgery, just by saying the right thing at the right time.

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So we had only eight anaesthesiologists, and most of the work was done by the paramedics and the nurse and the cities.

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So from then up to now, we're probably going to something like 40 plus and definitely has given a very different picture.

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Things have changed. The scope of work has changed because defining the scope of surgery is determined by the capacity of the anaesthesia providers.

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So that has changed and things are fairly different.

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We're looking for a brighter future. If we go to dispense, things would be much better.

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Safe surgery right now is becoming a reality in this country.

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And for some of us who who are heavily involved in perioperative medicine,

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I should say it's a question of and it's very comforting to travel to hospitals out of Kampala and find good.

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And I see the machines being good, good drugs,

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good monitoring nurses who are educated about warning signs and efficient surgeons who are very keen to very keen to maintain patient safety.

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And we also have a patient population that is becoming more information.

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And, you know, and. Of course, you won the sergeant.

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You also have to be more careful because I've had colleagues who have, as they do, the spinal.

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You've had yourself kind of flowing back and getting into the eyes so that to be

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extra careful because CSF is like ten times more infectious than than the blood.

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And then there's preventing mother to child transmission.

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So usually those babies will actually get a zero. Soon after delivery, so in Asia, we have that syrup business is not doing.

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Once they've delivered the child, they've showed it to the mother.

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They'll go ahead and actually give the prophylactic dose of Arabs to the child and then they'll follow it up.

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So that's one of the, I think, 70 things.

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Anaesthesia for caesarean section is usually straightforward if you're vigilant and what sort of things can be prevented by looking at,

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mostly because it's something simple, like I know it has been vastly different things that happen.

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But if you're not vigilant, she passes on no matter there is.

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Or maybe it's my honour. Maybe I was able to monitor the patient. But here the big question is what do I tell the husband or their children?

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When the pot is off or when you get that power cut, it is disturbing in a way because most of the equipment uses power.

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There is a sound byte generated by someone who comes from whatever they are, which may be five kilometres.

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They are doing other things, so it may take time for you to get back to, you know, to follow up the lights.

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Well, we have to back up the puzzle to me because I know it has a battery.

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So I think having things with backup tape, machine learning and nano biotechnology or wearables or sensors,

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big data analytics and we are we've never had such riches together at the same point of humanity to change health and education.

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We're so fortunate. But it's going to really manifest itself in a way that we can't imagine.

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And next thing was, remember that it's not just about the technology is that our mindset,

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the new version of the industrial revolution four point I was at the World Government Summit in Dubai,

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speaking to world leaders only a few weeks ago, and the next concept now is what's called globalisation 4.0 is how do we use

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that technology to globalise things to make life more equitable going forward?

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So this new technology that's taking place as we speak? The first to his change of mindset.

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We are thinking about innovation, it's about exponential growth, which were exponential technologies and change.

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So the first thing to think about is not linear expression is exponential change.

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What I mean by that, if I said to the audience, let's take 30 linear steps together, I start walking up to the stairs.

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You know how far I'd get, probably to the end of the door, perhaps in the corridor just beyond, right?

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That's about 13 steps. We understand the expression.

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If I said, you know, let's take 30 exponential steps together the way that computers are powered, the way that life is changing so rapidly.

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How far do you think we'd get? To the car park.

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Beyond. We do go around the planet 26 times.

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That's the pace of change your mind has to adjust to.

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You can't sit here and think about linear expression anymore because you become obsolete before you know it.

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Life will go and pass you by fairly quickly. We've got to think about that as we move on.

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But exponential changing growth, of course, is enormous health care burden.

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If you look at the graphs of money going in, it's not surprising we can't afford health care.

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We all know this is not a secret. We spend a lot of GDP on health care,

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but we can't afford health care as it is because we have an ageing population and we have a bigger population expansion of global growth.

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What are we going to do now? In my visit to 35 countries or so visit governments, there's one commonality.

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No one's got any money, right? No one's got cash for health care.

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It's a surprise surprise. So you've got to think about the money that we have, how to recreate reimagined health care that's more affordable.

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It's more accessible. There must be ways to find solutions. You can't say, give me money.

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It's not going to happen. So the onus is on us to figure out what do we do to fund solutions of this health care?

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Of course, the global problem of shortage of health care professionals.

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In our case, surgeons with all health care professionals, but rather to be short by millions.

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What do we do to overcome that? I was training more doctors quickly.

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Of course we're not we need to challenge everything the new doctors of tomorrow need to be understanding innovation, entrepreneurship.

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The medical school curriculum, for example, hasn't changed for hundreds of years. It's still five years long, maybe six.

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Why is it five years while cutting trade offs in three years? What will it challenge the dog in the tradition of medical curriculum?

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What is it we do about adding a few Oscars, maybe ofappeals to kind of spice up the variety of the curriculum?

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But I'm an associate dean, the medical school.

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When I run the boxing programme at year medical students, all of them go through a process of unsettling innovation entrepreneurship.

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They get taught not by biochemists or clinicians. They get taught by venture capitalists.

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Amazon's code developers. You are your teams, great thinkers. The future technology thinking about how health care will change next 10 years.

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They go in groups of four or five with mentors on tech industry. Think of ideas or change the world.

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They go to a hackathon and then they get two dragons and pitch for crowdsource funding to make that work.

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So that's the thing we have to create.

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And I think Albrecht, because we need rapid think, but train a curriculum to design it for today's mentality so people are leaving medicine now.

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We know that huge shortage students are not upset that they don't want to do the work that we did before, and the workforce is changing appropriately.

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But what we need to do in Oxford is a child rapid as well.

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Otherwise, you lose that kind of clarity and will lose many numbers in the future.

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We never lost the commission. We all know that some you have a massive say in the commission that came out back in 2014,

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and we know there's a huge problem in surgery for the first time globally.

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We exercised the number crunching and found that there was a global problem with more people

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required to train with more operation needed and more funding required for health care.

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We know that sounds were part of Ashaiman clip of a video from BBC World.

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Billion people worldwide don't have access to safe and affordable surgery when they need it.

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That's two thirds of the world's population.

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New commission, published in The Lancet medical journal says that in low income and lower middle income countries,

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as many as 90 percent of people can't access basic surgical care.

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More than 300 million operations are performed worldwide each year.

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Just one in 20 occur in the poorest countries, where more than a third of the world's population lives.

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With me is the surgeon, Shafi Ahmed from the Royal College of Surgeons here in Britain,

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who has supported this commission of attention, naturally focussed on the situation in Nepal at the moment.

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And is Nepal one of those countries which doesn't have the sort of access to modern surgical techniques that this report is looking into?

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It is, indeed it's mainly parts of sub-Saharan Africa, parts of Asia and Southeast Asia,

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but it's not about having modern facilities having basic requirements. It's more important to sort of state in terms of the Lancet commission.

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So are we looking at than just poor funding, not enough doctors or just not being a priority of the various governments concerned?

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I think it's quite a complex process, number of things that have come out from the commission itself.

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One, of course, is the fact that we need to perform about 143 million more operations per year to satisfy the demand in these countries.

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There's a workforce play this be done with estimates there's a need for another million surgical surgical staff that

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trained to deliver these operations until they are those people being trained at the moment in significant numbers.

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No, they're not. So this gives a huge a resource implication for us to deliver some of the objectives of the

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commission and the ways of training people to think about how we in certain kinds of workforce,

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we planned national level and also from world wide point of view, you,

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I think you've recently we're doing operations using Google Glass is now presumably

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that is a way that you can you can show students the techniques that you employ.

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I mean, is that something which is being used internationally now? Yeah, I think that's really exciting.

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So I think the way we deliver education and training is going to be using modern technology.

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The work I did last year is showing how we can teach about 14000 people across 132 countries.

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A number of cities using a simple device is a way, perhaps, that we should be looking at in the future.

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It's not the only one, of course, but I think we should incorporate technology into the training programme.

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So going forward, my want to the pushes by education, of course, and how we reconfigure the current paradigm of inequality.

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I guess what we all agree on this from, of course,

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that the there's an education be a fundamental human right is for everybody to be free and accessible.

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But of course, that whole statement on that slide is a fallacy. The fallacy, of course, is that education depends on two things.

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It depends on resource how much money you have, where you born and where you live.

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But the geography is two things, and it's not fair. So we've overcome some of the boundaries, the hurdles,

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some of the geopolitical barriers that we create for ourselves to think about how to scale up education,

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how to access that knowledge on a global scale.

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My view is that our legacy as we live in our lives is legal, a living legacy of knowledge behind for future generations.

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That's who we are. So my question for you is if you want to share knowledge, do challenges one person or two people in the theatre.

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Well, we'd like to share that with millions of people and leave a real legacy of what you've learnt,

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the skills we have of many years are very valuable. We've got mixed picture.

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I mean, he's got this Harvard people teaching officers. What have been the centre point of attraction is what attracts us to become a surgeon.

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Of course,

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this important person in the middle of a lot of other people isn't great because imagine what people are learning from that audience is very little.

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It's not engaging at all. It's more of a show showmanship rather than teaching.

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If we fast forward, of course, you wonder what people in this operate theatre learning how they're hanging off various places.

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See the new Fandango operation that's been performed. It's ridiculous.

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We've kind of tissue surgery in this manner for many years.

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Medical students who pay hefty sums of money to go to an operating theatre for eight hours a day,

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sit in the back of the room completely dismissed by the operating theatre, right?

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You know that right? You do, right?

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What do they do there on their smartphones or social media on Instagram and occasionally get summoned to go to the theatre,

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to the operating table and get shown something and they go back again for another three or four hours?

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We thought this is a good way of teaching. It's ridiculous. It's a teaching by a process of osmosis and diffusion.

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We think we're learning we don't let anything, so we're going to challenge the paradigm. We haven't done that for a long time.

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This isn't my kind of concern because the thing is that we connect it to knowledge that has to be local.

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It can be remote and we're now putting drones in the sky or we're putting caves under the under the kind of the oceans and balloons,

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the cloud like Google or the so we can be more connected as we go on.

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5G is just coming out this year, which connected in further and more rapidly.

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We have assessments that we have this thirst and say we want to really connect people.

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And the global companies I work with are now say, Well, your Connexions, you guys figure, let's do with it.

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Let's get back to these basic human level. We can train people in a different way, human to human contact, and I want my many roles.

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The college is I run the international programme, which I've set up about four or five years ago.

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This is to work with governments and ministries of health ET to target training.

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We've brought in over the last four or five years they were turning to 50 surgeons for targeted training,

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one or two year programmes to go back to enrich their population.

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And we work from all those sectors. We have I've travelled a lot.

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As you can see, we've got 47 international stations on our partners across all countries.

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We mainly support the different countries as part of alignment with the college and across many, many zones, many continents.

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And we've now printed up to about 250. I think it's in 10 14 and we're expanding rapidly kind of offering for global health.

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As a college, we haven't had a proper policy now. We're getting that in terms of our own agenda.

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And of course, it supports the great stuff. It's Westie through and above, and we've shown really great, I think,

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vision in how we support in a kind of a measured way the controlled way so that we can support governments with what they require going forward.

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We've worked with many countries, including the Egyptians, both the civilian and the military population, by interviewing.

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We've done a lot of Egyptian trainings now in the U.K. we worked with a big association, says India, who now send the best trainees here again.

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Targeted training take back to rural parts of India.

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And of course, because next year, which is your countries in central South Africa and across the Middle East and other places,

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we're not really thinking about what's our measure of success in this whole programme, but it's expanding rapidly.

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Of course I am, and I work with a university there where we're now creating training programmes,

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both based surgical skills, lab skills training, the trainers, etc. Think about how we sustain a new kind of training method in a poor country that

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requires a lot of infrastructure about the 2014 when the how the last war in Gaza.

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I was asked by Medical Palestine, the Minister of Health,

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to go and visit West Bank and Gaza to do a kind of a just a mission to think about what

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does what we require in these places to sustain training and education for surgery.

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So I did two trips back in 2014, just after the war. In fact, I remember going into my first this is the entrance going into Gaza.

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It's a no man's land either side. If you touch things, you get outside, you get shot and vaporise immediately.

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That's about five hours waiting to get in with a sniper, pointing at me, thinking, This is ridiculous.

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This is the kind of world we live in. We create these artificial boundaries for ourselves.

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That nonsensical. So I did the whole trip.

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We actually wrote a whole plan of action, which with the Minister of Health and I said, Okay, this is what we need to do.

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I'm not worried about. I'm not going to firefight, but what we do then goes, is firefighting.

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I do specific things and you come away. It's not impactful. Impacts a few people is personally rewarding.

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It doesn't leave sustainability issue. So I said, that's the plan I've got for you.

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We're not going to do this. We've got to train everybody to become trainers. Tom, educationalists, we want them to be inspired.

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They can't get out of the country. So how do you bring that to them? They have to train the genius level that sufficient.

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We've trained for lieutenant, my general surgical skills, laparoscopic skills and you're three to five years into the programme.

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And then we think about training the consultants to make sure they have the skill sets required in the modern world.

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And of course, it requires very accreditation. So this the programme said fine.

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We're happy with your proposals. Here's hundred thousand pounds we want. It's implemented as soon as possible, which is not a big deal, right?

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Okay. Thanks for the money. Let's go do that. I went to the college.

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Of course I said, right. This is a big deal. This is my project.

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Our access to budget. This I want to pull our credibility so that we can do things long term.

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This is not a short term plan for me. So we have we got ourselves. Approval has come.

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We've done the two course for 25 surgeons.

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We've done three basic surgical skills, empowering the local faculty to run their own courses, both lab skills.

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And we've done lots of advanced operations. So building infrastructure and training education across all sectors.

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And our last visit for this three year programme is in about two months where we can walk

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away and say we produced something and then we'll think about what's the next level.

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We've got money for next projects about next sustainability programmes.

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So it's vast and it's all about firefighting and we should be working in silos.

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One thing I've noticed in Joe's they work in silos, they work in small areas.

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It's not good enough and the access hopefully will get all of them together in one room.

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So how do you go about working together rather than silo achieving these, the kind of course,

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of running based based on such perceived lack skills, etc., etc. But again, the infrastructure required is for a country like that.

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Of course, we had a lot of attention about what we're doing. I think it's first time there's the state of model of care in one of these countries.

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We mentioned earlier in the news report that my Google search job,

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an experimental technology about how to scale up education, how do you share that knowledge on a global level?

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So back in 2014, I was Google+, which a simple wearable device you can stream live on operation through your eyes.

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Students around the world watched their smartphone the text of message as a text message company glass in the corner.

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Johnson tracked that same time that day. I took 14000 people across the globe.

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In many countries, many continents hope platform learning.

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This is the image of the continent to attract to me fashionista who noticed that I'm sure about this kind of work.

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Much better views the back of the room on your smartphone. You'll all agree, of course.

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Peer to peer learning, sharing the resource around the world. People want to learn in that way.

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And actually, I meant to teach this man a live surgery to do a simple suturing to let him know who this is.

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You should know who is. You will have smart devices. John Sculley, the CEO of Apple.

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The guy who sacked Steve James, the film who's made Apple into the first trillion dollar company in the world.

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I told this man how to operate your man, his mobile phone company. He wants to do some work around global health.

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So I can teach you, is that right? Let's show me, and we did remotely. And actually,

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it wasn't bad for some Joe man to learn his first suture from me using a device because I was moving on the 3D printing device on a smartphone.

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The work people I work with in Japan make us think about his team hollow eyes and I bet

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augment your actual precision surgery put in seats are mirrors real time over the course?

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What's going on of much more precise going forward imagined in other settings?

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This might be very useful, but you have to go to who might be able to do the operation in real time for you.

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So well, these are coming in. They are moving rapidly on birds with touch controls, etc. I've worked many companies.

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One of them was AMA. But how we redesign that cut interface and this is me in the operating theatre.

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Now what I do with that, of course,

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as I'm teaching my medical students about a situation ten times people elsewhere around the world because being streamed,

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they can communicate on their smartphone at the same time again, share knowledge on much grander scale on a global scale.

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And the interactions there, of course, I can point to things that can add things on the screen and it comes my view and

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you can actually interact with people in a way that would have been done before.

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Look, a lot of virtual reality, which is the next step of evolution. If look at education as a whole, it's a continuum.

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We've come from this kind of stone tablets in the past to papyrus the Egyptians and the printing press and then online platforms for books.

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And they are just extensions.

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The new platforms for learning and very soon will all be encompassed and using these technologies for learning going forward.

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I think they are and they are to Gaza. How did you break the barriers of a place that you can't get to?

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Actually, it's technology, it's connexion. You can connect people free their minds.

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Refugees or people in conflict zones use technology to empower them.

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To allow them to share knowledge and to gain experience required was so hard to travel otherwise.

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So this is the kind of things we've been doing. So I was the world's first factuelles operation.

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I thought, how could I forget travelling using are being removed?

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What about bringing people to your practise in VR so they can actually access a smartphone

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which is free and app a Google Cardboard headset which cost $3 and then be transported?

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It's an operating theatre in the world. So we did that, but some of the time with special measures, we had no cash.

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We've just come out special measures. Actually, I made them pay for Google Cardboard headsets can imagine for everyone in the hospital.

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That's why we measure no money. I spent it all on the cardboard. I thought, Let's do this together.

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Let's get everyone in my practise together.

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And what we did, of course, with the world's first, the operation where people can just literally proper smartphone and be my friend theatre.

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And it was amazing. We had 55000 live viewers being trained, 240 two countries, four thousand cities engaged and then it kind of trended on Twitter.

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So we are told, has done less than 24 hours, and this is the kind of students advance.

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We're getting parents is off, and that's how we teach them currently in some parts of the curriculum.

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This visits to Campbell Rig allows emotion people around the world using low cost technology,

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a simple VR headset, actually immersive sounds and operators around the world to what America's students.

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If the wrong medical school right now, I'm just kidding, I'm just kidding. You got it, got to be one of those.

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I'm just kidding. Just kidding. But obviously it's about also bringing over into reality.

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I mean, I thought, that's the way you can empower people and overcome the barriers.

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So absolutely, they were inspired people from very parts of the world to Syrian refugees.

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They thought, This is great. We can actually connect with people going forward. My company are in many companies, tech companies.

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One of them is a VR company. It's the world's first VR learning platform, which you can download on the platform.

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And this is what looks like.

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And simulation, you have knowledge and to our knowledge of the nation going forward, we can practise cooperation in CGI animation,

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can forward social media very quickly, is actually quite powerful platform that Facebook has over 2.5 billion active users on a monthly basis.

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So its total population, the world using social media, I think actually, how do I use social media to interact with my audience?

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Well, I've done. Of course, I've taught on all this video, on Facebook, on Twitter.

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I have run the NHS account for a week or two on tweets 140 characters or less, the first operation on Twitter over the course of a day.

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A million people engaged Snapchat for young people. Of course, you might think slightly relevant for us.

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Batch is relevant because the 200 million users of Snapchat said five percent of teenagers, 17.

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Twenty five days of a medical student. So you think about the media they use and the operation that Snapchat was shared by 2.5

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million people and fifty six point two people on Twitter for the operation live in real time.

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So it's just using the platforms. We have a different way and understanding the end user not thinking about how we were taught, it's prehistoric.

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The other think about the modern world and Generation X and Z, right?

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Our future, although we keep going towards, obviously we think about robots, of course,

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with the plethora of robots coming in and the whole system around autonomous learning, around deep machine learning and AI, of course.

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And I would seeing three of robots coming into our programmes, Intuitive had the cut all of the stuff before coming in.

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I actually worked with Google on that verb robot, which is still a year away from release this connected robot to produce lots of hard data.

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And of course, robots can spawn in smaller, but they'll become the same thing,

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and they're becoming very precise when they can do, of course, with a surge of plastic surgery.

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Its mechanical device? That's OK. It gets to a certain point and takes away some of the allows.

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More precision patching is more smart about big data, about analysis becoming.

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So we have objective means assessing us the quality going forward.

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Of course, I remember a few years ago this is back in 2001. The operation Lindbergh is the first operation carried out from France to New York,

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doing a gallbladder operation using old fashioned technology, of course, wires and cables.

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This has moved on now only recently with 5G. We saw the first surgeon doing it kind of remotely from China, but also it autonomous vehicles.

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Of course, this is not autonomous. So at what point do we become more autonomous?

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What point do we get assistance in terms of surgery where we are going? Get this is Tesla driving around?

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This is what's going to happen next. Five years you have Thomas circles as important concepts,

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autonomous vehicles which tell us about the legal issues, litigation that the blame game, what it is.

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We'll learn a lot from that because medicine will change in terms of coming in radiology, dermatology,

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pathology, rule change with AI interfaces and be overtaken or augmented in the practise.

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They think we can't be replaced as surgeons think again. This is the world's first or trauma surgeon doing a Massachusetts together.

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We think we're super not so super anymore better than surgeons. Leslie, Great Prep. Already, I think it could augment our practise.

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Not replacing us is augmenting. We need to embrace that technology, make our lives easier.

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The job that we trained for last is less. Think about the big future where we're heading towards.

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We going to get to Mars. We're going to be at need plant species by 2025. So we'll think about that.

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But it's important being remote is important by pushing that drive to Mars.

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We think that remoteness the refugees for people in Gaza,

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because actually it's about being remote and all technologies that were driving food for Mars because I'm here today.

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I always want to have this impression, always be kind of be me.

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For one day my life, I wanted to so badly and actually, I'm trying my best so I can make it work.

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This me, of course. Practical photogrammetry holiday cameras produce the world's first virtual surge.

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That's me. But it's virtually the magic air interface that speaks like me.

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I can teach people on a global level. I am limited by time and space.

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This thing won't be limited, so you can imagine that. Shasta, you have a look at this.

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Yeah. Let me have a look at your shoulder. Oh, yeah.

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Come on, man, I need some advice. Come on. No problem. Thanks for calling me.

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That's my hologram being transported in real time,

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imagine someone in Africa who needs an operation who's in trouble and need some advice like a thing that you appear before him,

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give advice, points, things and you walk away. That's what it would be for as soon that democratises health care and global level.

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What about the operating theatre? And you want advice from people from different continents at the same time as avatars?

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Maybe that's what I did. Hi, everybody.

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I think.

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So the homeland itself, which allows us to reshape the way we connect people, we communicate with people closely to be used in teaching and training,

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and this whole lens on it feels a bit strange, but actually few minutes it becomes quite normal.

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You feel as though you're just discussing cases with people of the same room, for example, that we do in normal through practise.

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We can come in and actually look at this content in full 3D, and obviously when you're working in in this case, the medical field,

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having a full 3D understanding of a situation, for example, is really much more powerful in solidifying how you want to navigate it in your mind.

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So avatars, imagine that, so to speak, the last couple of slides.

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No work around innovation technology. This is why I feel like I'm going to be like a rock star now.

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This is my tool for this [INAUDIBLE].

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00:52:56,620 --> 00:53:02,140
So if you wanna come and see me speak on various parts of technology innovation rather than just surgery itself, please welcome.

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Come to these things, I think. Would you change your mind? So this is good, but I think you should think about other conferences was moving at pace.

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Let's come to tech medtech conferences, things that are going to change your mind,

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global leaders to think about change and really rich that I'd like to invite you all to one particular conference.

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I'm running in May. I run a number of countries around the world and its website and see if your friend may grab it,

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take a sphere and enjoy this kind of kind of, I guess, meeting the right people, the right frame of mind.

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We are here to create the future. These discussions must have trickle out to everyone and everywhere.

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Weber is the new. Is a city within the city. We all want to grow.

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We all want him to feel where it's going to happen.

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00:53:52,160 --> 00:54:01,650
The best thing about the weather is meeting the innovators, the policy makers, the entrepreneurs and those driving the future.

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If we come to where we are supported by the amazing organisation, we come for free and could be complicit for launching, this is a pretty big one.

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And there's more than a hundred countries here, they don't have to travel to their country,

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I can just come here to weather and then all the countries come to me. But rugby itself is just spectacular.

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It's a crazy mix of people, from politicians to innovators to engineers to healthcare professionals to finance the venture capitalists.

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Wonderful networking that happens here. Thank you very much.