Good morning and welcome to the global surgery green zone.
I just thought, I'll just put you into the picture of where we are and what we do in the global surgery group.
So we formed the Oxford University Global Surgery Group, which is made up of four departments,
which includes NDAs and dorms, reproductive medicine and anaesthetics.
We've just have leads for each of these departments, and the leads basically just coordinate the activities.
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.
We meet every Thursday, Thursdays in the NDA seminar room and we have a business meeting from 7:30 to eight.
And after that, we run seminars from eight to nine and everyone is welcome to the seminars.
Noel, who coordinates the seminars, is here in front.
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.
It's just not surgeons or medical people that that presented the seminars.
We have the likes of Nigel, Chris, BBC reporters advocates, you know, the likes of equivalent of Bill Gates and people like that.
Google would come on to the seminars. So please, you know you most welcome.
The seminars are video linked for those that don't are not present.
So a lot of them are videos streamed and exciting and a lot of discussion following the seminars.
We run three Chumley meetings. Two of them are linked to the engineer round, which is this one of them?
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
speakers from ranging from students right up to advocates at the Oslo House meeting.
You will get some kind of peace and drinks and Prozac for Jessica.
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.
So nationally, again, this is all we just dreamed this of five universities that are linked to this and internationally as well.
And we have a lot of input from Africa and Asia at these journal clubs.
We have a lot of system students now interested and that do modules with us,
but we also have a AFP's active students who are doing projects in different departments that are linked to this group.
These are just a few examples of some of the research projects that we have,
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.
We'll be very happy to support you. And we've been running.
We last year we ran credit betting short course equivalent to 20 cat points, hoping to link it to a masters.
And this year we're running it from nine to the 13th of September.
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.
So thank you. Good morning, everyone, and thanks for coming. My name is Sarah Davidson.
I'm currently one of the fellows for the Oxford Global Surgical Group, which I'm very excited to be with you today.
I'm going to introduce Sarah Casely. She's been working in global health for around 10 years as a former journalist.
She was the first employee of the Lightbox Foundation,
which is an NGO which has been working to make surgery and anaesthesia safer in those or settings.
And I think it's one of the things that global surgery that lots of people not involved
a global surgery have actually heard of and a foundation that we're very fond of.
And she's also the producer of the Checklist Effect, which is an award winning documentary about the state of surgery globally.
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.
And she's going to give you a few elements of that and discuss a few things about global surgery arrangement.
Sarah, thank you very much. OK, thank you so much.
I I never feel more like an English literature grad than when I'm addressing a roomful of surgeons.
So thank you for having me. Thank you.
And you know, we come from very different planets, but my very cheesy joke was always that yes,
surgery has been around for a long time, but storytelling has been around for a lot longer.
So actually, my profession is older than yours. And I've actually I left life books about six months ago,
and I can't tell you actually how much I have missed this community and the familiar faces that are in the room now.
Some of them very much directly responsible for the kind of global translation of the checklist effect.
And it's an extraordinary I don't know so much about the surgical community.
The global surgical community has my has my heart entirely, and I wanted to say just a few words about life books.
I think many of you, I'm hoping, may have heard of it.
I think you probably at least will have heard of Atul Gawande, who is the chairman and founder of the organisation,
and we're celebrating the 10 year anniversary of the W.H.O. checklist this year, which life very much grew out of.
And I'll work,
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,
infection reduction and teamwork. And that teamwork component is particularly relevant to and to this conversation today.
I haven't timed my speech, so I'm going to try and talk for as long as I think I have.
And then I'm going to show you two video clips from the film, and I'm very lucky to be hearing Shafi.
We'll be talking later and then we'll hopefully have time for a few questions.
And I'm slightly conscious that the approach I was going to take here may be a very different approach to innovation,
and I think that's exactly what a grand round should be kind of two very different
perspectives on a word that I suddenly realised I was hearing a lot less.
In the six months since I've left a global surgery, I'm working right now in maternal child newborn health and spirit obviously
could figure out the International Federation of Obstetrics and Gynaecology.
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.
If all sorts of maybe armchair psychology, but the field has a a much is more of a sense of, I think,
resourcing of awareness of what maternal health is globally, and I started to wonder whether that was connected to the slightly less.
Less of an anxiety around needing innovations, because I think what it's also starting to recognise is a lot of the things
that we see and the challenges that colleagues and low resource settings face,
whether it's around access to an ongoing training, whether it's around access to resources,
it's infrastructure are not very glamorous things, and they're certainly not things that are going to and to have very quick fixes.
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.
And in some ways we did have a piece of technology. We had this pulse oximeter, which was specially designed for challenging settings.
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,
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.
So, yes, there is innovation there, but I think we kind of settled ourselves around the idea of being innovative implementers.
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,
which is to say that I think it is one of the greatest innovations in surgical history,
and I say that not as a surgeon, I say that knowing there might be some very different opinions about it.
But I think what I what I do get to speak to you as is probably to not as a surgeon,
but as a patient and as a person who has talked to a lot of different surgical teams about the checklist
in a lot of different countries about what it means to them and what opportunities it has brought them.
And. And actually one of the the the revelations in making this film wasn't even in talking to patients or surgical teams,
it was talking to other disciplines. I don't know if anyone in the room has read the checklist manifesto,
which is the tools book about the development of the checklist and looks at how in different industries.
This approach to structured and teamwork is not only an innovation is a given.
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.
And I think I'm used to a lot of surgical team eyeballs which are kind of, you know,
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,
entirely psychologically understandable. And then the other set of eyeballs from kind of patients lay people,
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.
And those are the ideals of excuse me, the checklist is only 10 years old.
This wasn't an established protocol as I lay with my body open in sensitised in an operating room.
And I think that's that's the space between.
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.
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.
I think nobody can deny it. Nobody can, I think, fail to be shocked by the extent of that need.
But it is a, I think, an opportunity to reflect on.
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.
I never intended to be a documentary producer. I didn't realise I was making one for quite a while into the process.
But what we did know is that those surgical doors are very heavy and the world beyond
is maybe one that we're very privileged not to know entirely what happens inside it,
to go through it. And Bill Barry, who is one of the kind of, I think, the grandfathers of the checklist,
extraordinary patient safety cardiac surgeon and he used to say surgery is this thing that would be illegal to do in any other context.
You can't go to someone on the street and, you know, and slash him and not expect some consequences.
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.
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.
And the first clip that I will be showing is filmed in the UK at Alison Dunstable Hospital at Great Ormond Street Hospital.
The by the checklist really was lifted up and implemented put in Philip and CEO at Dunstable,
who really kind of pushed for its development and implementation.
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.
It's one of the first countries where we did any joint projects around and around anaesthesia, safety and the checklist.
And I think what I want those two comparisons to be is absolutely nothing whatsoever.
It's not salacious. It's not to say S&M is actually to say this.
You know, surgery as is great, unifying a component of health care.
And my favourite thing when I got to travel to other countries and surgical
communities was watching healthcare professionals talk to each other on a level,
on a language that was totally outside of context because it wasn't about.
It wasn't about culture, it was about surgical culture, which actually has a lot of similarities,
every operating room, every incision is pretty much the same concept.
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
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,
do have a lot of.
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,
the challenges that they're facing and to see how the checklist has been adapted
in very different ways that make it and that thing that you sort of laughed at.
But I didn't mean for it to be a joke,
but to make it a great innovation in surgical history because it is a tool that that is flexible, that is adaptable.
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
you make it work for your patient flow and your surgical flow in your context.
And I think they make really strong and powerful comparisons.
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.
Just talking up this magical mountain.
Here is why we made the film, which is that the sense that nobody really understands what happens inside an operating theatre.
And I think that's part of Global Surgery's real communication struggle is it's a really frustrating.
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,
hospitals where an amnesty at seventy thousand hospitals,
where surgery is taking place without a pulse oximeter to monitor the patient under anaesthesia.
And these staggering statistics that don't often reverberate well in noisy spaces.
And I was staggered by how many people helped us make this film for free.
It's a really high quality, award winning feature length production that we made for less than £10000,
working with partners in seven different countries around the world.
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.
And what we hoped, I think this film was that it would take us outside of hospitals, often into hospitals, but often outside them.
And and that it could it could be the best film about global surgery that ever left medical practise.
And so I guess I've seen it about four hundred and fifty times.
You can be the judge of these couple of clips, and if you would like to see the whole thing afterwards,
I would be a million times glad to send you a link. So I'm just going to show the first clip now.
The usual values of health care or autonomy. Leave me alone, let me make whatever decision I've made.
I know what I'm doing. The values in the checklist are humility, discipline and teamwork.
It's all about the communication that you make happen on behalf of the patient.
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.
Some staff were quite uninterested in this. Everybody having a say so we introduced the surgical safety checklist.
But yeah, it was about six years ago,
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.
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,
you have your consultant surgeons,
you have you registrars, surgeons, you have anaesthetists as consultants, you have registrar anaesthetists, so you have junior doctors as well.
You have a lot of trainee nurses. You have trainee ADP's qualified dedicated nurses and also you have your unqualified
set of practitioners or health care system to work within within the environment.
And it's always a thing that the consultant is the man in charge.
And not so long ago, I once heard that the consultant was described as end to the emperor.
And everybody felt that they were on the parapet about the full on.
I think the culture within health care is for such a long time has been that people
don't not question that people don't interact with the doctors on that level,
and I don't know that was the case in lots of places, in lots of places around the world.
And it definitely was like that in the UK and not so long ago.
If I'm really honest, they're probably not thinking how to think I could manage to do that.
So in my day to day work in the operating theatre, obviously take a lot of responsibility on board,
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.
The nurses would have felt that were conversations and that there was never that conversation quite in the middle.
And so the doctors with my very personal things about the patient and what happened prior to this and the nurses,
we would know exactly what should we have seen in theatres. Yeah, it was like never.
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.
Though the work being to go in different directions. Often I know what's happening, I know what I want to do.
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.
It's really important to maintain that communication and all too often that does get overlooked in the pressured environment working.
We've got to the point where surgery is now within the wider hospital system,
a much more complex and potentially dangerous environment to be working in.
And it's crucial in an awareness of that beyond just our own technical skill, which is always really important to consider.
And I think the general public can sometimes see surgery as being routine, but they should never be never be undertaken as routine.
These risks are always in the back of our mind when undertaking a case.
The the main thing about any situation or any serious incidents is in 99.9 percent of circumstances where it's happening,
someone in the room or someone in the area has no idea it's going to happen prior to it happening,
but hasn't hasn't felt that they have the authority or even the courage to speak out.
And it's very, very important that they do speak out because we could prevent so many accidents,
so many serious instances when in surgery, just by saying the right thing at the right time.
So we had only eight anaesthesiologists, and most of the work was done by the paramedics and the nurse and the cities.
So from then up to now, we're probably going to something like 40 plus and definitely has given a very different picture.
Things have changed. The scope of work has changed because defining the scope of surgery is determined by the capacity of the anaesthesia providers.
So that has changed and things are fairly different.
We're looking for a brighter future. If we go to dispense, things would be much better.
Safe surgery right now is becoming a reality in this country.
And for some of us who who are heavily involved in perioperative medicine,
I should say it's a question of and it's very comforting to travel to hospitals out of Kampala and find good.
And I see the machines being good, good drugs,
good monitoring nurses who are educated about warning signs and efficient surgeons who are very keen to very keen to maintain patient safety.
And we also have a patient population that is becoming more information.
And, you know, and. Of course, you won the sergeant.
You also have to be more careful because I've had colleagues who have, as they do, the spinal.
You've had yourself kind of flowing back and getting into the eyes so that to be
extra careful because CSF is like ten times more infectious than than the blood.
And then there's preventing mother to child transmission.
So usually those babies will actually get a zero. Soon after delivery, so in Asia, we have that syrup business is not doing.
Once they've delivered the child, they've showed it to the mother.
They'll go ahead and actually give the prophylactic dose of Arabs to the child and then they'll follow it up.
So that's one of the, I think, 70 things.
Anaesthesia for caesarean section is usually straightforward if you're vigilant and what sort of things can be prevented by looking at,
mostly because it's something simple, like I know it has been vastly different things that happen.
But if you're not vigilant, she passes on no matter there is.
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?
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.
There is a sound byte generated by someone who comes from whatever they are, which may be five kilometres.
They are doing other things, so it may take time for you to get back to, you know, to follow up the lights.
Well, we have to back up the puzzle to me because I know it has a battery.
So I think having things with backup tape, machine learning and nano biotechnology or wearables or sensors,
big data analytics and we are we've never had such riches together at the same point of humanity to change health and education.
We're so fortunate. But it's going to really manifest itself in a way that we can't imagine.
And next thing was, remember that it's not just about the technology is that our mindset,
the new version of the industrial revolution four point I was at the World Government Summit in Dubai,
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
that technology to globalise things to make life more equitable going forward?
So this new technology that's taking place as we speak? The first to his change of mindset.
We are thinking about innovation, it's about exponential growth, which were exponential technologies and change.
So the first thing to think about is not linear expression is exponential change.
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.
You know how far I'd get, probably to the end of the door, perhaps in the corridor just beyond, right?
That's about 13 steps. We understand the expression.
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.
How far do you think we'd get? To the car park.
Beyond. We do go around the planet 26 times.
That's the pace of change your mind has to adjust to.
You can't sit here and think about linear expression anymore because you become obsolete before you know it.
Life will go and pass you by fairly quickly. We've got to think about that as we move on.
But exponential changing growth, of course, is enormous health care burden.
If you look at the graphs of money going in, it's not surprising we can't afford health care.
We all know this is not a secret. We spend a lot of GDP on health care,
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.
What are we going to do now? In my visit to 35 countries or so visit governments, there's one commonality.
No one's got any money, right? No one's got cash for health care.
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.
It's more accessible. There must be ways to find solutions. You can't say, give me money.
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?
Of course, the global problem of shortage of health care professionals.
In our case, surgeons with all health care professionals, but rather to be short by millions.
What do we do to overcome that? I was training more doctors quickly.
Of course we're not we need to challenge everything the new doctors of tomorrow need to be understanding innovation, entrepreneurship.
The medical school curriculum, for example, hasn't changed for hundreds of years. It's still five years long, maybe six.
Why is it five years while cutting trade offs in three years? What will it challenge the dog in the tradition of medical curriculum?
What is it we do about adding a few Oscars, maybe ofappeals to kind of spice up the variety of the curriculum?
But I'm an associate dean, the medical school.
When I run the boxing programme at year medical students, all of them go through a process of unsettling innovation entrepreneurship.
They get taught not by biochemists or clinicians. They get taught by venture capitalists.
Amazon's code developers. You are your teams, great thinkers. The future technology thinking about how health care will change next 10 years.
They go in groups of four or five with mentors on tech industry. Think of ideas or change the world.
They go to a hackathon and then they get two dragons and pitch for crowdsource funding to make that work.
So that's the thing we have to create.
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.
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.
But what we need to do in Oxford is a child rapid as well.
Otherwise, you lose that kind of clarity and will lose many numbers in the future.
We never lost the commission. We all know that some you have a massive say in the commission that came out back in 2014,
and we know there's a huge problem in surgery for the first time globally.
We exercised the number crunching and found that there was a global problem with more people
required to train with more operation needed and more funding required for health care.
We know that sounds were part of Ashaiman clip of a video from BBC World.
Billion people worldwide don't have access to safe and affordable surgery when they need it.
That's two thirds of the world's population.
New commission, published in The Lancet medical journal says that in low income and lower middle income countries,
as many as 90 percent of people can't access basic surgical care.
More than 300 million operations are performed worldwide each year.
Just one in 20 occur in the poorest countries, where more than a third of the world's population lives.
With me is the surgeon, Shafi Ahmed from the Royal College of Surgeons here in Britain,
who has supported this commission of attention, naturally focussed on the situation in Nepal at the moment.
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?
It is, indeed it's mainly parts of sub-Saharan Africa, parts of Asia and Southeast Asia,
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.
So are we looking at than just poor funding, not enough doctors or just not being a priority of the various governments concerned?
I think it's quite a complex process, number of things that have come out from the commission itself.
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.
There's a workforce play this be done with estimates there's a need for another million surgical surgical staff that
trained to deliver these operations until they are those people being trained at the moment in significant numbers.
No, they're not. So this gives a huge a resource implication for us to deliver some of the objectives of the
commission and the ways of training people to think about how we in certain kinds of workforce,
we planned national level and also from world wide point of view, you,
I think you've recently we're doing operations using Google Glass is now presumably
that is a way that you can you can show students the techniques that you employ.
I mean, is that something which is being used internationally now? Yeah, I think that's really exciting.
So I think the way we deliver education and training is going to be using modern technology.
The work I did last year is showing how we can teach about 14000 people across 132 countries.
A number of cities using a simple device is a way, perhaps, that we should be looking at in the future.
It's not the only one, of course, but I think we should incorporate technology into the training programme.
So going forward, my want to the pushes by education, of course, and how we reconfigure the current paradigm of inequality.
I guess what we all agree on this from, of course,
that the there's an education be a fundamental human right is for everybody to be free and accessible.
But of course, that whole statement on that slide is a fallacy. The fallacy, of course, is that education depends on two things.
It depends on resource how much money you have, where you born and where you live.
But the geography is two things, and it's not fair. So we've overcome some of the boundaries, the hurdles,
some of the geopolitical barriers that we create for ourselves to think about how to scale up education,
how to access that knowledge on a global scale.
My view is that our legacy as we live in our lives is legal, a living legacy of knowledge behind for future generations.
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.
Well, we'd like to share that with millions of people and leave a real legacy of what you've learnt,
the skills we have of many years are very valuable. We've got mixed picture.
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.
Of course,
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.
It's not engaging at all. It's more of a show showmanship rather than teaching.
If we fast forward, of course, you wonder what people in this operate theatre learning how they're hanging off various places.
See the new Fandango operation that's been performed. It's ridiculous.
We've kind of tissue surgery in this manner for many years.
Medical students who pay hefty sums of money to go to an operating theatre for eight hours a day,
sit in the back of the room completely dismissed by the operating theatre, right?
You know that right? You do, right?
What do they do there on their smartphones or social media on Instagram and occasionally get summoned to go to the theatre,
to the operating table and get shown something and they go back again for another three or four hours?
We thought this is a good way of teaching. It's ridiculous. It's a teaching by a process of osmosis and diffusion.
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.
This isn't my kind of concern because the thing is that we connect it to knowledge that has to be local.
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,
the cloud like Google or the so we can be more connected as we go on.
5G is just coming out this year, which connected in further and more rapidly.
We have assessments that we have this thirst and say we want to really connect people.
And the global companies I work with are now say, Well, your Connexions, you guys figure, let's do with it.
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.
The college is I run the international programme, which I've set up about four or five years ago.
This is to work with governments and ministries of health ET to target training.
We've brought in over the last four or five years they were turning to 50 surgeons for targeted training,
one or two year programmes to go back to enrich their population.
And we work from all those sectors. We have I've travelled a lot.
As you can see, we've got 47 international stations on our partners across all countries.
We mainly support the different countries as part of alignment with the college and across many, many zones, many continents.
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.
As a college, we haven't had a proper policy now. We're getting that in terms of our own agenda.
And of course, it supports the great stuff. It's Westie through and above, and we've shown really great, I think,
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.
We've worked with many countries, including the Egyptians, both the civilian and the military population, by interviewing.
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.
Targeted training take back to rural parts of India.
And of course, because next year, which is your countries in central South Africa and across the Middle East and other places,
we're not really thinking about what's our measure of success in this whole programme, but it's expanding rapidly.
Of course I am, and I work with a university there where we're now creating training programmes,
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
requires a lot of infrastructure about the 2014 when the how the last war in Gaza.
I was asked by Medical Palestine, the Minister of Health,
to go and visit West Bank and Gaza to do a kind of a just a mission to think about what
does what we require in these places to sustain training and education for surgery.
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.
It's a no man's land either side. If you touch things, you get outside, you get shot and vaporise immediately.
That's about five hours waiting to get in with a sniper, pointing at me, thinking, This is ridiculous.
This is the kind of world we live in. We create these artificial boundaries for ourselves.
That nonsensical. So I did the whole trip.
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.
I'm not worried about. I'm not going to firefight, but what we do then goes, is firefighting.
I do specific things and you come away. It's not impactful. Impacts a few people is personally rewarding.
It doesn't leave sustainability issue. So I said, that's the plan I've got for you.
We're not going to do this. We've got to train everybody to become trainers. Tom, educationalists, we want them to be inspired.
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.
We've trained for lieutenant, my general surgical skills, laparoscopic skills and you're three to five years into the programme.
And then we think about training the consultants to make sure they have the skill sets required in the modern world.
And of course, it requires very accreditation. So this the programme said fine.
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?
Okay. Thanks for the money. Let's go do that. I went to the college.
Of course I said, right. This is a big deal. This is my project.
Our access to budget. This I want to pull our credibility so that we can do things long term.
This is not a short term plan for me. So we have we got ourselves. Approval has come.
We've done the two course for 25 surgeons.
We've done three basic surgical skills, empowering the local faculty to run their own courses, both lab skills.
And we've done lots of advanced operations. So building infrastructure and training education across all sectors.
And our last visit for this three year programme is in about two months where we can walk
away and say we produced something and then we'll think about what's the next level.
We've got money for next projects about next sustainability programmes.
So it's vast and it's all about firefighting and we should be working in silos.
One thing I've noticed in Joe's they work in silos, they work in small areas.
It's not good enough and the access hopefully will get all of them together in one room.
So how do you go about working together rather than silo achieving these, the kind of course,
of running based based on such perceived lack skills, etc., etc. But again, the infrastructure required is for a country like that.
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.
We mentioned earlier in the news report that my Google search job,
an experimental technology about how to scale up education, how do you share that knowledge on a global level?
So back in 2014, I was Google+, which a simple wearable device you can stream live on operation through your eyes.
Students around the world watched their smartphone the text of message as a text message company glass in the corner.
Johnson tracked that same time that day. I took 14000 people across the globe.
In many countries, many continents hope platform learning.
This is the image of the continent to attract to me fashionista who noticed that I'm sure about this kind of work.
Much better views the back of the room on your smartphone. You'll all agree, of course.
Peer to peer learning, sharing the resource around the world. People want to learn in that way.
And actually, I meant to teach this man a live surgery to do a simple suturing to let him know who this is.
You should know who is. You will have smart devices. John Sculley, the CEO of Apple.
The guy who sacked Steve James, the film who's made Apple into the first trillion dollar company in the world.
I told this man how to operate your man, his mobile phone company. He wants to do some work around global health.
So I can teach you, is that right? Let's show me, and we did remotely. And actually,
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.
The work people I work with in Japan make us think about his team hollow eyes and I bet
augment your actual precision surgery put in seats are mirrors real time over the course?
What's going on of much more precise going forward imagined in other settings?
This might be very useful, but you have to go to who might be able to do the operation in real time for you.
So well, these are coming in. They are moving rapidly on birds with touch controls, etc. I've worked many companies.
One of them was AMA. But how we redesign that cut interface and this is me in the operating theatre.
Now what I do with that, of course,
as I'm teaching my medical students about a situation ten times people elsewhere around the world because being streamed,
they can communicate on their smartphone at the same time again, share knowledge on much grander scale on a global scale.
And the interactions there, of course, I can point to things that can add things on the screen and it comes my view and
you can actually interact with people in a way that would have been done before.
Look, a lot of virtual reality, which is the next step of evolution. If look at education as a whole, it's a continuum.
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.
And they are just extensions.
The new platforms for learning and very soon will all be encompassed and using these technologies for learning going forward.
I think they are and they are to Gaza. How did you break the barriers of a place that you can't get to?
Actually, it's technology, it's connexion. You can connect people free their minds.
Refugees or people in conflict zones use technology to empower them.
To allow them to share knowledge and to gain experience required was so hard to travel otherwise.
So this is the kind of things we've been doing. So I was the world's first factuelles operation.
I thought, how could I forget travelling using are being removed?
What about bringing people to your practise in VR so they can actually access a smartphone
which is free and app a Google Cardboard headset which cost $3 and then be transported?
It's an operating theatre in the world. So we did that, but some of the time with special measures, we had no cash.
We've just come out special measures. Actually, I made them pay for Google Cardboard headsets can imagine for everyone in the hospital.
That's why we measure no money. I spent it all on the cardboard. I thought, Let's do this together.
Let's get everyone in my practise together.
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.
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.
So we are told, has done less than 24 hours, and this is the kind of students advance.
We're getting parents is off, and that's how we teach them currently in some parts of the curriculum.
This visits to Campbell Rig allows emotion people around the world using low cost technology,
a simple VR headset, actually immersive sounds and operators around the world to what America's students.
If the wrong medical school right now, I'm just kidding, I'm just kidding. You got it, got to be one of those.
I'm just kidding. Just kidding. But obviously it's about also bringing over into reality.
I mean, I thought, that's the way you can empower people and overcome the barriers.
So absolutely, they were inspired people from very parts of the world to Syrian refugees.
They thought, This is great. We can actually connect with people going forward. My company are in many companies, tech companies.
One of them is a VR company. It's the world's first VR learning platform, which you can download on the platform.
And this is what looks like.
And simulation, you have knowledge and to our knowledge of the nation going forward, we can practise cooperation in CGI animation,
can forward social media very quickly, is actually quite powerful platform that Facebook has over 2.5 billion active users on a monthly basis.
So its total population, the world using social media, I think actually, how do I use social media to interact with my audience?
Well, I've done. Of course, I've taught on all this video, on Facebook, on Twitter.
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.
A million people engaged Snapchat for young people. Of course, you might think slightly relevant for us.
Batch is relevant because the 200 million users of Snapchat said five percent of teenagers, 17.
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
million people and fifty six point two people on Twitter for the operation live in real time.
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.
The other think about the modern world and Generation X and Z, right?
Our future, although we keep going towards, obviously we think about robots, of course,
with the plethora of robots coming in and the whole system around autonomous learning, around deep machine learning and AI, of course.
And I would seeing three of robots coming into our programmes, Intuitive had the cut all of the stuff before coming in.
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.
And of course, robots can spawn in smaller, but they'll become the same thing,
and they're becoming very precise when they can do, of course, with a surge of plastic surgery.
Its mechanical device? That's OK. It gets to a certain point and takes away some of the allows.
More precision patching is more smart about big data, about analysis becoming.
So we have objective means assessing us the quality going forward.
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,
doing a gallbladder operation using old fashioned technology, of course, wires and cables.
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.
Of course, this is not autonomous. So at what point do we become more autonomous?
What point do we get assistance in terms of surgery where we are going? Get this is Tesla driving around?
This is what's going to happen next. Five years you have Thomas circles as important concepts,
autonomous vehicles which tell us about the legal issues, litigation that the blame game, what it is.
We'll learn a lot from that because medicine will change in terms of coming in radiology, dermatology,
pathology, rule change with AI interfaces and be overtaken or augmented in the practise.
They think we can't be replaced as surgeons think again. This is the world's first or trauma surgeon doing a Massachusetts together.
We think we're super not so super anymore better than surgeons. Leslie, Great Prep. Already, I think it could augment our practise.
Not replacing us is augmenting. We need to embrace that technology, make our lives easier.
The job that we trained for last is less. Think about the big future where we're heading towards.
We going to get to Mars. We're going to be at need plant species by 2025. So we'll think about that.
But it's important being remote is important by pushing that drive to Mars.
We think that remoteness the refugees for people in Gaza,
because actually it's about being remote and all technologies that were driving food for Mars because I'm here today.
I always want to have this impression, always be kind of be me.
For one day my life, I wanted to so badly and actually, I'm trying my best so I can make it work.
This me, of course. Practical photogrammetry holiday cameras produce the world's first virtual surge.
That's me. But it's virtually the magic air interface that speaks like me.
I can teach people on a global level. I am limited by time and space.
This thing won't be limited, so you can imagine that. Shasta, you have a look at this.
Yeah. Let me have a look at your shoulder. Oh, yeah.
Come on, man, I need some advice. Come on. No problem. Thanks for calling me.
That's my hologram being transported in real time,
imagine someone in Africa who needs an operation who's in trouble and need some advice like a thing that you appear before him,
give advice, points, things and you walk away. That's what it would be for as soon that democratises health care and global level.
What about the operating theatre? And you want advice from people from different continents at the same time as avatars?
Maybe that's what I did. Hi, everybody.
I think.
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,
and this whole lens on it feels a bit strange, but actually few minutes it becomes quite normal.
You feel as though you're just discussing cases with people of the same room, for example, that we do in normal through practise.
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,
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.
So avatars, imagine that, so to speak, the last couple of slides.
No work around innovation technology. This is why I feel like I'm going to be like a rock star now.
This is my tool for this [INAUDIBLE].
So if you wanna come and see me speak on various parts of technology innovation rather than just surgery itself, please welcome.
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.
Let's come to tech medtech conferences, things that are going to change your mind,
global leaders to think about change and really rich that I'd like to invite you all to one particular conference.
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,
take a sphere and enjoy this kind of kind of, I guess, meeting the right people, the right frame of mind.
We are here to create the future. These discussions must have trickle out to everyone and everywhere.
Weber is the new. Is a city within the city. We all want to grow.
We all want him to feel where it's going to happen.
The best thing about the weather is meeting the innovators, the policy makers, the entrepreneurs and those driving the future.
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.
And there's more than a hundred countries here, they don't have to travel to their country,
I can just come here to weather and then all the countries come to me. But rugby itself is just spectacular.
It's a crazy mix of people, from politicians to innovators to engineers to healthcare professionals to finance the venture capitalists.
Wonderful networking that happens here. Thank you very much.