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Summary

This on-demand teaching session is part of a Global Frugal Innovation Skills course with a focus on helping medical professionals devise resourceful solutions that can meet needs in low-resource settings. The session is enriched with case studies depicting excellence in frugal innovation. It features two knowledgeable guest speakers who discuss their experiences in implementing frugal solutions in healthcare settings globally. The session also introduces Gie Singh from Life Box, a global non-profit organization dedicated to making surgery and anaesthesia safer. Funded by the Global Surgery Foundation and supported by the Royal College of Surgeons of Edinburgh, the course proves essential for medical practitioners looking for low-cost, effective solutions to tackle a lack of surgical innovation and increasing healthcare costs. The session is expected to appeal to medical professionals interested in developing foundational skills in innovation for efficient healthcare delivery.
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Description

Join us for the 6th Module in the Global Frugal Innovation Skills Course - Frugal Innovation Case Studies. Here you will learn from experts and experienced clinician-innovators on how they addressed a problem with frugal innovation principles.

Learning objectives:

o  Learn from key exemplars of frugal innovation for global surgery

o  Recognise the key qualities of a frugal innovation

Learning objectives

1. Understand the concept of frugal innovation and how it can be applied in medical settings, specifically in low resource environments. 2. Gain insight into real-world examples of frugal innovation in healthcare and learn from the experiences of professionals in the field. 3. Discuss and analyze case studies of successful application of frugal innovation across the globe. 4. Understand the processes involved in the frugal design to bring solutions from the concept stage to reality in healthcare settings. 5. Explore the challenges involved in adopting innovations in healthcare and discuss possible solutions to overcome them.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.

OK, thanks very much everyone for joining us live for the next module of this Global Frugal Innovation Skills course. Uh Welcome for those that are joining us now. And I hope that if you are watching this and um catch up that you're enjoying it at your convenience. Um We've got an excellent session today and really we wanna focus on um case studies for excellence in the frugal innovation um to try and help you get inspired by the different types of frugal solutions that you may be able to come up with to um me needs in low resource settings. And we've got two amazing speakers who are going to talk through their experience of making uh frugal innovation a reality in, in uh in health across the globe. But before we just go on to that, I just need to very quickly, I'd like to quite, very quickly, just go through a quick introduction just in case. Er this is the first time that you're, you're seeing it. Um This is largely brought to you by Gas O the Global um er surgery Anesthesia and obstetric Collaboration. And please do follow us on Twitter and connect to us on our website to stay up to date. Um It's a uh a huge course that's been supported by funding from the Global Surgery Foundation from the Royal College of Surgeons of Edinburgh. And it's also supported by a range of organizations that are listed here. And we've got um AAA speaker from Life Box today. So, um thank you so much for these institutes for supporting us. Um as we know that there's a, a huge lack of uh surgical um innovation across the world and AAA wide, a wide uh a large amount of innovations actually never make it to widespread adoption, which is bad for patients and healthcare systems. And it's a huge contributor to the rising cost of healthcare. So how can we make frugal low cost effective solutions for healthcare systems across the globe? Um And there's a big barrier in terms of the innovation skills that are required to make these solutions a reality and also a lack of indisciplined collaboration. This was really the driving and need behind this course was to provide participants with those skills and also a network to connect with people from different disciplines across the world. This is the overview of the um modules we are now on module six. So we're coming towards the end actually. So if you haven't gone through the rest of the modules, they should all be available on metal on the gas. So organizations page. So please do go through them. Each one's normally not longer than an hour. Um And they give you all the core foundational skills that you need. And it's really exciting that early in 2024 and the New Year, we'll be going on to modules seven and eight, which is really where we'll be getting you guys to hack solutions to unmet needs and apply for funding to actually bring your renovations to life. So, um, do, do keep an eye on uh on your mailing lists for that. Um As I said, beyond this course, we hope to provide funding for you guys. So I hope that this is this, this session in particular is gonna give you some inspiration about what your innovations might look like. So I'm gonna stop presenting. Now. I'm gonna hand over to um Gie Singh from Life Box to uh formally introduce herself and also the organization that she works for and go through her case studies if possible. Thank you so much, Gie for your time. Thanks will. Um Hi, everyone. Um I have the technology training and innovation at Lightbox and uh for those of who you don't know. Life. Fox is a global health nonprofit. We focus on making surgery and anesthesia safer. Uh We work in over 100 and 16 countries. Uh We have trained more than 12,000 healthcare providers and uh make surgery safer for over 1 80 million patients. So, Lightbox was formed when the wh O surgical safety checklist uh was developed. Um And uh so pulse oximeter is the only um device on this checklist. And Lightbox was formed to distribute uh pulse oximeters to settings where it is not available. And this is the approach uh which we follow. Uh So our, our e end goal is safe for end to end surgical patient journey. Uh And this is achieved uh through partnerships uh trainings and tools. The three pillars that we focus on are anesthesia safety, surgical team work and uh surgical safety. So on improving anesthesia uh safety. Uh you know, this device that you see on the right is the lightbox mitra pulse oximeter. It addresses a major gap in anesthesia safety. Um and this device uh is low cost uh it it's used in very hot conditions and uh it's easy to use. We've distributed over 34,000 pulse oximeters across 100 plus countries and trained over 8000 surgical team members on on the use of this device. The next um device that we've been working on and this is more recent, we actually launched the Mitra Lightbox Capnograph on World Anesthesia day earlier this year. And uh again, you know, like capnographs are available in in high income settings. But the idea was to develop an affordable, high quality one for low resource settings. And the team worked on the specifications um for the device. We did a lot of engineering testing, usability testing of uh a number of devices after which we finalized the one that you see on the right, and there was also an education package to go with the device. Um And uh we've already started distributing these devices and conducting training workshops um to be, you know, like did uh a big one in Uganda in September uh with over 100 providers and very soon uh we'll do one in Benin and then the Philippines the other. Um And I'm not sure if you see the complete slide. Uh but uh it's not just about device innovations, it's uh about process of innovations and as well. So, clean cut is a program to reduce surgical site infections. It follows, you know, these very simple six steps um hand washing, um and others. Uh And again, you know, this program has been conducted in quite a few countries and we've seen uh surgical site infection reduction um in patients. So finally, I'll uh go a little deep into uh you know, this uh frugal innovation that the team has been working on for a while. So, uh in low middle-income countries, uh you know, we have observed that almost 48% of the surgeons experience frequent power outages, 80% of the surgeons working in low resource settings. Um you know, even said that inadequate lighting presented risks to patient safety. And this was a study done, uh you know, uh to assess the impact of surgical lighting on intraoperative safety in low resource settings. On the right, uh You see a surgical team using a phone flashlight to conduct surgeries. And I'm pretty sure if you know some of you uh practice in low resource settings, you might have experienced uh this challenge. So, uh on the solution, uh we identified that developing a durable, affordable, high quality headlight uh would close this unmet need and improve surgical safety. And uh the way we went about it was that the team got together to write a very detailed target product profile that talked about uh the specifications of, of this device. And we used a Human Centered approach where we took feedback from a lot of surgeons in terms of what the right brightness of, of this light should be, what should be the focus diameter. Uh and also, you know, on, on the comfort uh because surgeons wearing it, uh you know, on their head during uh the entire duration of the surgery, it should not impact uh their work. And again, uh you know, there are headlights out there uh in the market, you know, on one end you have the headlights that are used for adventure, you know, sports, hiking, et cetera, um which are as low as $30. And on the other hand, there are headlights by global tech companies which are like upwards of $800. And uh we wanted to come up with a headlight that would meet the specifications in the target product profile, but at the same time, be more affordable. So we issued a call to manufacturers. Um and, and we got a lot of uh interest and after shortlisting a few devices based on their specifications, we conducted an engineering testing to make sure that those devices performed um as for, you know, what, what they uh were marketed for. And finally, we did a usability assessment of these shortlisted devices. Uh surgeons used these devices uh in surgeries and, and gave us feedback. And uh after that, we finalized, you know, one headlight that you see on, on the right and we've already started distributing it. Um We did uh conduct a survey with over 100 surgeons who had received this headlight uh to see what the impact was. And 98% of the surgeons said that this headlight added value to the surgical practice. And again, you know, it increased the accuracy and discrimination of anatomic structures, uh provided better depth and uh even led to the continuation of surgery when there were power cuts. Um and sometimes, you know, it, it takes a while before the generators kick in. But at the same time, you know, we also received a lot of recommendations for improvement on on this device. So um the next step is, you know, we want to make this device better in terms of performance and comfort. And we pull together a small team that that will work um on customization of, of the headlight. But at the same time, we do not want uh you know, to wait until the idle product is out there. Uh You know, uh we, we are continuing distribution of this headlight. Um And at the same time, we're also doing a formal study to evaluate the impact of these headlights uh in three countries, Ethiopia, Malai, uh and Ivory Coast. So, yeah, this was, you know, one case study that I wanted to share with all of you. Uh you know, that's uh still going on. Um Thank you so much and uh we'll uh back to you back to you. Thank you much for that. Um Amazing talk talking about all the different, you know, genuinely inspiring innovations that Live Box um has done and how the different design processes that you guys have developed matches with the training that I think is really important, as you said, I think that really pulled through. So, um so thank you. We'll, we'll um just do a quick reminder for anyone who's, who is watching live. If you do want to post any questions, you need to write them out in the chat box. Um rather than speak them yourselves. I'll then try and put them to the speakers at the end. Um For AQ and A II have, I've been making a, a list of questions that I have go that I want to try and um pick your brains on if possible, we'll see if anyone else does as well just so that I don't hog hog it for too long. Um, and next, it's great to, er, have Doctor Gan, um, present as well on his experience and some of his case studies, um we're gonna do a bit of a double act in terms of sharing our screens. So do bear with us if there's any technical glitches. Um, so Doctor Anna, if you wanna start um your er slideshow, now I've got it open on my side as well. Ok. Thank you will for the introduction. Even though you didn't ask me to do, I think I should introduce myself before. Ok. I'm uh in the urologist and the laparoscopic surgeon by training and I've been working for the last four decades in the rural and remote areas. And right now I am right now in the Delta University working on uh some of the approval innovation that will cover in a little later. So I'll rush through the slide because uh initially I thought there was one hour is a long time and now it's come to a fairly short time. So I'm not going to bore you with all statistics, you can read about it later. My journey with the frugal innovation started uh way back when I was a medical student, we, I visited the area, the d districts and which has a population of about uh 300,000 people and not a single li doctor in that area, the only missionaries uh who used to work there and they came to our medical college to share about the needs uh in their place. So the usual uh tendency to say that uh what can one doctor uh some medical surgeon do to cover the medical needs of about 300,000 people living in the area from one end to the other. And it takes about 300 kilometers to travel. But then I realized that there are people who are already working in that area as the missionaries. So I thought we can uh train them to take care of the little bit of the medical need because we went and did a survey. We found the infant mortality is 500 which means half the Children uh don't survive beyond a year. And the entire hamlets about 10 to 15 houses which live together used to disappear because of cholera. So all that we need to do is a very simple uh solutions. But then how do you convince uh mission organization uh other people that it is possible to do. So what we did was we trained the our pray group leaders in uh South India. One of them is engineer and the other one is a pharmacist. We chose about 2025 over the counter medicines and uh taught them how to use it uh effectively for simple things. If you have fever, you go paracetamol. If you have diarrhea, give uh oral rehal solution and uh so on. And we kept good statistics of that. We found that 82% of the patients are quite happy with the treatment they received from the pharmacist and the engineer who had a little bit of uh training only. And then we uh after finishing the studies, I went to this place to sort of do the start the medical work for the organization. Now we can you play this uh slide, the the video and the slide fight and stop sharing. OK. This is I think probably the voice says, not the right, not the right one second. Yeah, that's ok. I can go to the the basic infrastructure, you can play the next two videos also before we switch over this one. Yes. And the next one, the association of rural surgeons of India, it's a group of brilliant surgeons who work among the rural areas, serving the poor and the much in the last three decades ago, they separated from the surgeons of India to concentrate on the rural surgical work. There were many innovations that are made by the rural surgeons to serve the poor and the marginalized. And one of them, they use a mosquito net for tension free hernia repair is listed as one of the six famous and effective low cost innovations for surgery by the World Health Organization. The World Health Organization also included the gas in circulation, laparoscopic surgical equipment. As part of the wh O compendium of innovative medical devices or the social setting. The benefits of minimally invasive surgery are not available to 80% of the world's population costs incurred by the need for general anesthesia, insufflation of CO2 and specialized instruments make traditional laparoscopic surgery too expensive. The the is involved in empowering the neural surgeons by the equipment and human resource sharing system. Yes. Helping the leg surgeons get involved and serve the rural patients. They also started the surgery research and training center in a remote area in by training them and helping them to share equipment and human resources. One of the major setback that these places had was that there was no anesthesiologist to help them. Surgeries under general anesthesia was very expensive and most of the patients are not able to afford it. Thanks to the impact and success of the model in empowering the rural surgeons. Many who are interested in global surgeries have pitched in to help. Ok. Do you want to go back to your PDF? Yeah. Yeah. Okie Dokey. Thanks for sharing the video as well. No worries if you notice uh the place that uh was shown in the video, can I share my if you just click on present now, share a video. There we go present now CP DFI think and you can see them. Yeah. Thank you. So if he had the seen the video, especially the, the places where you saw a place called uh LA and Pradesh where we had to travel for about 17 hours by from the nearest place where you can get a tea or coffee from a shop. And uh after that walk for 10 minutes to reach the place, there are about 3 to 4000 people who are living there. There are no electricity, no surfing there, no running water and uh very difficult to have anything to do in those uh those places. And uh I mean uh doctor who is just sharing about the need for power supply. So there, if you have a generator there, you need to carry the generator and walk up for 10 minutes and also the petrol or diesel or kerosene or whatever you use for the generator. And interestingly in that this, during that camp, during your visit, we found uh two or three patients who had uh who are in acute renal failure due to stones. So we need to, to do a procedure called double J stenting to bypass the stone and put a tube from the kidney to the bladder. And we were able to do that in that place. I'll tell you a little later how we were able to do it. So you might be wondering uh in uh I started uh telling you that I was interested in the rural area and the tribes where 300,000 people had no doctors. So my initial interest was to train the people who have gone there as missionaries and uh provide the basic health care to those people. And then you might wonder why he became a surgeon and a urologist after that. So there we devised excellent uh program. In fact, uh um medical college, Christian Medical College in we had a very famous uh community health and development uh program which was uh world r know program and uh had a great impact in South India. So we got their help and they wrote an excellent uh program to help. We do simple things because people are dying of cholera. All we needed was to provide the oral rehab solution. And then uh immunization and the solutions are very simple and the the result could be very dramatic. But unfortunately, what happened was nobody was willing to listen to us until the time there was a patient who needed the surgery because he had ulcer perforation. And prior to that, uh everybody who had ad in that area died. So this is the first sentence to a nearby mission hospital and uh did the surgical, I mean, did surgery on that patient and he survived. And when he came back alive, it made a lot of difference to the local population. And they started the believing what we said and they started implementing the various uh things we had done. So then I thought it was better to become a surgeon rather than uh just be a community health uh expert to take care of the needs of the poor and the margin even in such a remote area. Then I started working in the mission hospital because uh I found that it is uh very difficult and expensive for mission organizations to support medical work. On the other hand, it is easier to work in the established mission hospital. So I started working in a mission hospital. And then, then I realized that uh in the remote areas, especially people who belong to different tribal groups, they don't like traveling from one area to the other. So then we started doing, uh so I mean, taking in the entire surgical team to those uh tribal areas and doing the surgeries there. When you go there, we don't have established uh in hospital or the for doing the surgery. So then we used to started using the houses or uh any building that we could find. Then we realized that is also not adequate because uh we had a generator which is giving us a power supply. And then we can only either use either the light or the suction. You can use both simultaneously because the generator could not take the load of uh both working together. So then we started doing surgeries and open it. I done hysterectomies the of and uh a lot of surgeries in uh open air because the sunlight is excellent, uh, so light and uh we could use uh whatever little electricity we had we can use for suction and other machineries. So then we started doing what we call the diagnostic and surgical camps. In the, we found that uh 3% of the patients did not know that they had really curable condition, they just have the pain. But unless you do ultrasound or something, you won't know whether the pain is because of the kidney stone or a gallstone or whatever would be the cause. So then we started taking all the diagnostic uh in the facility that we had at the hospital to the rural. Hi doctor, can you hear us uh hand for outpatient work like uh going and getting an ultrasound done or something like that? They won't travel more than five kilometers. And uh in the northeast India where we are working at that time for the entire state, ultrasound is available only in one place and people had to travel for about seven or eight hours to reach that uh capital where the ultrasound uh facility is available. So then we decided to taking all the material that we had diagnostic material and we made the, once you made the diagnosis and we asked the patients to come to the hospital for surgical work and some of the minor surgeries then uh we started doing it at the remote areas. But then there is uh again, uh doctor go pointed out electricity is a big problem even though we carry two generators for still, there are times when uh we didn't have a part. So we had to complete. Uh And now we are unlike earlier, when you could do operate candy to later with laparoscopic surgeries or endoscopic urology, we can't do that. So in this picture, you can see as using a torch lade for doing a scoping. And uh also we were able to do a complete appendicectomy using it to osculate and the ordinary cell phone camera that we have. And, uh, another problem in rural areas is the affordability. It's very difficult for patients because, uh, a lot of surveys show that up to 40 some of the African countries, 70 to 80% of the people go below the poverty line if they had to spend a lot of money for surgical work. So then we liaise with the local grocery shop in those uh rural areas. And, uh, what happens is that, uh, when, when we know there is a diagnostic cancer, you know, somebody needs surgery, we leave the contact with the local grocery shop guy. So they have means of communications and, uh, again, uh for bringing medicines and giving it to them whatever they need from the nearby towns and so on. And also when they needed surgery, they were able to advance the money and uh, send the patient to the hospital for surgery and later on, they'll collect, uh, from them in installments. So it is a good tie up that we had with those local grocery stores. And another interesting way they found financing was that the local churches used to contribute a piglet to the patients who need the elective surgery. So they used to wear the pig and when the pig uh grows up, they used to sell it and come with the money to our hospital for elective surgical work. And uh I mean, as you probably briefly mentioned in the video earlier, most of the surgical places in rural areas, 70 to 87 do not have facilities for general anesthesia. Spinal anesthesia is uh available in all the data and even the anesthesiologists are not available. The local doctors are trained, the anesthesiologist can give the spinal anesthesia. So whatever surgery that is possible, actually, we would like to do them under the spinal anesthesia and all the laparoscopic surgeries. Uh and uh with the, with the invasive surgery and the even the me facilities that could be used efficiently because of a quick turnover. We were stuck because of the need for spinal anesthesia. And that is the time we started the, using the gasless laparoscopic surgeries. I think there is a, well, can you show the video about, uh, laparoscopic surgeries? Yeah, I think, I think 17. Yeah. 17. Yeah. And the same problem was there with the renal stones. So doing uh, renal surgery required general. Yeah. So we device methods of doing a real zone surgery and the spinal, if you're ready you can play the coming home. Yeah. The gastro laparoscopic surgeries or Gilson shot was developed to meet the needs of the patients in rural and remote areas. It makes laparoscopic surgeries possible under spinal anesthesia at a very low cost. Ok. Is there one more video after that? Um, yes, I think there's one on, uh, which slide? This one? No, no, no. Before that there was one on, uh, la cystoscope. Um, ok. But it's not different then. There was, uh, I can't see it. Ok. Then fine. I think, I think maybe it's not added. Ok. Yeah, I'll let you if you just re your PDF again. Ok. I'll. Ok. Yeah. Yeah. So you saw about the gastro laparoscopic surgeries that we developed uh, little bit uh earlier because we needed to do on the spinal anesthesia. Similarly, what we did was for kidney stones, we developed a method of uh removing them using the ureteroscope, which is originally meant for removing only the stones in the lower part of the ureter. So this procedure involves uh prior DJ stenting, putting a tube from the kidney to the bladder, which helps the ureter dilate about two or three times the usual size, which allows the ureteroscope to go all the way up to the kidney. And uh, we need, of course to manipulate the operating table in such a way the ureter straighten straightens out and we're able to reach the stone and break it to the li class and remove it. But then the problem was that uh many of these places we used to go only once or twice a month, I mean once in two months. So then we needed to train the local surgeons to do the put in the distance, which again is difficult because uh the investment necessary for doing a conventional cystoscopy is very high. You need the cystoscope, you need the telescope, you need the camera, you need the monitor and so on and all that is very expensive. And beyond the reach of most of the doctors, the surgeons were working in rural areas and that is the time we came up with a laptop cystoscope, there's a scope which has a camera, the small endoscopic camera, the tip and we can uh get the power supply, light, everything from the laptop computer and could be used uh as a low cost. Uh the thing for putting in a DJ stent or stent removal and so on. So that when we go there, be able to use the rescope to break the renal stones and uh save the patient's time. And because of gilts, uh the gastro laparoscopy surgeries is possible in the spinal anesthesia. This also made us uh take a lot of uh laparoscopic surgeries to the rural area. Although it has a big advantage about uh because the medicines used for spinal disease is much less expensive in terms of Indian rupees, it will cost you a couple of 100s of rupees for the medicine that you use for anesthesia during your spinal. On the other hand, if you use general anesthesia, it's about 10 to 20 times uh more expensive. But otherwise, uh if you look at the gastro laparoscopy equipment, it only replaces the encephal, which it is necessary for C two. So this still means that you need a very high investment for uh starting uh laparoscopic surgeries in uh rural areas, especially in areas like Africa. And that is the reason why I'm here right now in the Netherlands and Delta New York City because uh as you know, the cell phone has a very good uh camera. It also has a light which is uh pretty powerful for even uh taking very good uh pictures. So along with the engineering students from Delta University, now we have made a prototype for doing uh laparoscopic surgeries using a a cell phone camera. And interestingly, the specifications of the camera that you're using is exactly the specification which uh 25,000 on the Striker camera has the latest version. So now we have uh pictures which are as good as the latest Striker camera with the camera from the cell phone. And with the very minimal investment like uh less than 1000 lbs, anybody can start doing laparoscopic surgery on this uh equipment is made ready. So I think we don't have too much time. So I'll just quickly run through the, let's do the slides. So uh if you look at frugal innovations, these are all uh low cost adaptations which necessitate our business there only because of the needs that we find in rural areas. So instead of giving up on uh saying that it is not possible once you keep uh at it and uh start looking at uh what to do, we'll come up with a lot of solutions. So like if you look at this picture, it's an endo loop which is used for surgery which is made from ordinary proline suture. And uh pushes that we have for putting in a digest stent. It's a very ab absolutely low cost. Uh It's cost 1.1000 of the commercially available uh equipment. And the same thing about uh vacuum therapy unit, we have uh this uh engineering students from uh the engineering college in South India made it well. Uh the commercial uh once uh almost ₹1.2 million these are available for 20 ₹30,000 you can actually make the, buy the components for a few 1000 make it available at a fraction of the commercially available equipment cost. And also we can use the commercially available ones like the ureteroscope. I don't know whether they see that this is actually a tube, not the ureter. So you can, when in infertility, you can use the hydro circulation to remove the blocks in the fallopian tubes. And this again is a uterus which you can use conventional pe to the tumors and so on. And I think, uh, you know, we rush through all these things and the latest thing that we are doing now is, uh, we are working with a group called The Rooms of virtual reality and medicine and surgery. And, uh, you can, here what happens is that we use a 360 camera and the VR headset, what it does is uh gives the opportunity for the surgeon in a remote rural area to be virtually present in the operating room and the best possible place because uh the camera is uh next to the surgeon and you can hear what the surgeon is saying. You can turn your head and look around wherever you want. We have the pictures from the monitor, pictures from a close up camera which is about the light or even a powerpoint explaining the procedure. Everything is available at the same time for learning. So this gives the best opportunity to learn. And also there is not artificially created uh environment because there's nobody, I mean with the camera going around, looking at the faces of the surgeon and the clicking. What is uh what they think is important because it's a continuous uh recording. And uh the surgeons are not uh bothered by the small 360 camera which is standing next to them. So it gives the real operating room atmosphere and finally, the same thing, see what happens when you are training is that uh initially we learned by observing or looking at how others are doing the surgeries. And then finally, you have a hands on experience as a senior surgeon helps you to do learn the surgical skills. And finally, when you reach the final year, you do surgeries on their own. And the senior surgeon is, the consultant is available only for guidance from outside. So the first and last steps can be through the virtual reality so that the training programs can be much shorter. So this is exciting possibility. And also, as I mentioned earlier right now, we are working with the Delta University on uh working on a laptop laparoscope with the clarity, which is as good as any of the commercially alive. I mean available scopes. I think that leaves around 10 minutes for talks, further questions and answers. Thank you. Thank you so much, doctor. Sorry that the time was short. You've got such a breadth of experience um ever. But thank you for touching on those kind of key uh key innovations that you've been been involved with uh leading there. Um Yes, correct. We do have, you know, 5, 10 minutes for questions. If people do have any, I can see a couple in there. And I've also got some but I think we'll if you do have any, please post, otherwise we'll just go to the top one. in the chat box and this is from Lionel. Um, Jock. Um, I think it was, er, originally addressed to Gori but I think it would be good to get people both, both, uh, both your answers on this. So, gory, if you can start. So the question is, um, how did you choose the countries for distribution? Essentially how, I guess, you know, h as an innovator, h how should people find different countries, different partners to distribute their innovations to? Yeah, thanks for that question. Um So again, you know, like I was talking about Lightbox and how we do not just focus on one part of the problem, but you know, more, look at end to end. And Lightbox also works on program implementations in a lot of countries across Africa, uh Latin America and Asia. So, you know, the way we started is we just went back to where we are doing programs. So for example, at sites where we are doing clean cut, you know, even like uh having uh adequate lighting, help them uh in, in, in their outcome. So we, we have started with our program countries. But what we're also looking to do is um you know, anyone who either um who wants a headlight can contact us. We also, you know, attend conferences um and hopefully, you know, we're also looking to tie up with local distributors uh so that we can uh get these headlines in countries that are currently not available. Ok, great. Thanks very much er for that. Doctor Gnara. What's your kind of take on? How do you choose um different countries and partners to try and disseminate your innovation? See the, I mean, I don't know whether I'll just quickly see if we can go to the last slide in the Yeah, so free and no, with the last, the last leg. Ok. So this is a slide I got uh added this morning because somebody from uh Kenya, I had gone there in uh I think uh last year in June or July, there was a group of about uh 2025 surgeons from Kenya who would come there for a two day workshop and we did only three surgeries and the people are wondering why only three, why, why couldn't show more? Hm. But ii they had said I only set up the device for gastro device and made the local surgeons do the surgery. Yeah. So appendicectomy. It took almost 2, 2.5 hours for them to do. Ok. But then you see the result now within a year, they already done 50 surgeries in Kenya. And if you look at the full picture, they have done it in about four or five centers. Mm So these people are very, very eager to learn. Mm So the people who are eager to learn, even if you go on when they tell a little bit a decent train they take off on their own. Yeah. And same thing with the, I don't know whether, I mean, II asked few people to come and then finally decided there was not much time neural surgeon called doctor who he used to work with us. Uh, and I used to go to his hospital to help him learn the gasless laparoscopic cholecystectomies. Hm. He had done about three or four before COVID. Then during COVID, we are not able to travel. So we were able to guide him through Zoom and he was able to do 83 cholecystectomies because uh he, his center was the only place where surgeries were doing. Yeah. So both need and the interest are the two criteria that we choose for sharing or teaching innovative methods or Google innovation if that answers your question. Yeah. Yeah. Yeah. No, great. Thank you guys. Both as a really interesting question, talks to this need around. How do you, yeah, disseminate your innovations um globally to maximize the impact. And I think there's a big piece around training um and also, you know, choosing the right contexts as well and really understanding the local and met needs, I think are kind of really important. Take home messages from, from what you from what you were saying. Anyway, so thank you both. Um There, there's another question also from Lionel. Um They say er so teamwork, how does life box implement it? So I guess this, this kind of questions around. Yeah, how do you work with different members in the team, you know, working remote and the challenges of team working in a global context, I think. Yeah. Uh again, great question because at like Fox, we are a globally distributed team. Um you know, like I'm sure in India, uh we also have uh some team members in the US and everything in between. So and again, you know, when it comes to device development, uh that can get uh you know, become challenging. Um So, you know, with this new headlight uh custom development piece that we are, you know, planning to kick start soon, we are looking to, you know, pull together a team that's uh geographically close just so that, you know, we can get like one piece of device like, you know, once the electricity, uh uh you know, the led boards and other things are done, they can pass it on to the other person. Um So yes, it does get difficult when you're working on an active physical product. Uh But, but, you know, like the other pieces in terms of working on training programs. Um I think we've pretty much mastered that and slightly related to this is uh you know, Lightbox also conducts a program called COR um which is on teamwork and communication, but for uh surgeons, anesthesia providers, nurses in, in the operating room, because, you know, there, again, the teamwork is very important and we try to, you know, learn from that uh as well. Oh, great. Well, thank you very much. That was a great, great answer. Um II am gonna be um a little bit selfish and also ask a question or two if that's ok. Uh I'd like to hear both of your answers, but so I might take it in turns and go stop garage first. I think the thing, the thing I kind of want to talk about just as we come towards an end is around the kind of um design methods and design principles that you think participants of this course should take away when they're thinking about how they're going to innovate and hack their own solutions. So what kind of um what kind of considerations do you think they should be focusing on to make a frugal product or a frugal innovation? Er Doctor Gan? See the first thing uh which I feel is that for a engineer or something? Hm. Unless they actually come to the operating room and find out what is happening, it's very difficult for them to decide. Yeah. On the other hand, uh if there is a medical person, you should also know what the engineers are capable of. Yeah, exactly. You just, you just tell them that, OK, you do this and they say no, it can't be done. Mhm. So you need a balance of both engineering and medical knowledge to know how to decide on how to do. Yeah. So there are things with the final adjustment. Like even the gastro laparoscopic surgery. Hm. Unfortunately, what happened was when you were working on the second generation device. Raise the device. Yes, people are in, you can, the, the surgeons were in India. Yeah. And there's a COVID time. Yeah. So the, I mean, finally what one of the aspect which all looked was the spiral shape of the ring. Mhm. In pictures. You don't appreciate the spiral shape so much. So they made the ring flat. Yes. So what it resulted was, in fact one of the ho hospital we had gone for demonstrating the thing and he had to convert almost 90% of the surgeries because we couldn't do it uh laparoscopically and they don't, they didn't have facilities for conventional laparoscopic. Mm. But then, uh, but then that the engineer thought was uh easy with the simpler design and the most study and so on. Hm. But then he doesn not lift a wall like, uh do however gas lifts in the office space. Yeah. So you need to have both practical and the, the theoretical wisdom to go about the same process. Yes. And that is why I think uh India, we have one as soon as any prototype is made, we can actually test it. Yeah. Yeah. No, I love it. Thank you. That's, that's really interesting. I mean, just on the, the first bit that you said around getting engineers in theater, er, and hospitals and then as a, as a clinician, as a clinical professional, getting into the engineering lab, I mean, I try and go to the engineering lab most weeks, um and try and get engineers into theater as much as possible. So, yeah, I agree with that. Um Go away. I don't know if you had anything else. You'd, you'd wanna, you'd wanna impart any sort of top tips to people in terms of the design process to um yeah, create a frugal innovation. Yeah. And again, you know, like this was a learning we had during the headlight development where we were so focused on getting the performance specs, right? Like, you know, brightness and other things, what we lost track was comfort, which is also very difficult to, you know, define, like, how do you define some things come or not right in your CPP. Um And that again, you know, we only learned when we went back to the users and got feedback. So, yeah, as Doctor Gard said, you know, involving uh users from the start, maybe, you know, we would have learned this earlier. Um The other is also making tradeoffs. Um And, you know, this is a tricky one. And again, you know, like there's cost, there's performance comfort, portability. How do you prioritize uh you know your, your requirements? And again, if you reach that stage where you have to let uh you know, some things go, uh how, how do you make those decisions. Ok, great. Thank you very much. Both I think we're coming um towards the end now that I think we've covered all the questions that were asked and those are kind of my top ones that I wanted to ask. So I guess all that's left for me to say is thank you very much both for giving up your time today and sharing your expertise with um with me, I've learnt a lot and also with the participants. Um guys, if any of you um know people that couldn't make it live, this is available for free on catch up on playback forever, please do check out the other modules as well and um follow gas sock and stay tuned for um announcements about when the hackathon will be. Um And yeah, for your chance to design your own innovation and hopefully win some funding to make it a um reality. I've just got a new message. Um We should promote uh oh OK. Fine. See, as someone has taken the time to write one quick question, Doctor Gi will ask you if that's ok. I know you've posted your email address but um you, they, they've asked around the gas laparoscopy training. We are trying to develop a training program using the virtual reality videos so that the 1st 10, the last stages are covered virtually. And uh we also have prepared a curriculum which is uh approved by the Martin Luther University in Northeast India. So we have a university activated training program for gasless laparoscopic surgeries in soon. I mean, they start training in Africa and other places in rural India. Great. Thank you very much. So, yeah, Doctor G has very kindly popped his email address, er, in the chat. So please do, please do, uh, reach out, I'm sure. Um, yeah, I'm sure there's lots of exciting things that we can do together. Um, guys, once again. Thank you so much. I'm gonna stop. Um I'm gonna stop broadcasting now. Um I think if I can discuss like that if I press more.

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