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so carry on our theme of sustainability and policy and advocacy. We have Tim Beacon, who is the chief executive officer of Med Aid International. You may have seen their stand just over there. Um, they specialize in providing the right equipment and healthcare support for low and middle income countries. Um, Tim himself has a really interesting story. He's traveled the world, which I'm sure he's going to tell you about. He's had several rolls, including an O. D P assistant training coordinator, lecturer for universities, and okay, Special Forces courses. And he's a trustee for the UK racist Christian Center. He's smoking regularly at universities and BBC radio, so we're really fortunate to have him here today to speak about how we can achieve sustainable surgical solutions in low middle income countries. So let's welcome Tim. Yeah, thanks very much. What a what A privilege to be here. Having seen this started, I think 2015 great to see such sort of collective enthusiam, enthusiasm and passion just here, but also obviously overseas online. So let's crack straight on in. Um, I always think we're going to give a talk on what we do. Uh, whether to start with what we do or a bit about me. You just heard a tiny bit. But I just tell you briefly about me, Um so it can sort of give you my background in terms of how created the organization I have and also our mindset, because this is all about providing sustainable healthcare solutions on the front line where the medical staff are doing their work on a daily basis. Um, so, as you heard, I was well, I traveled the world doing a whole bunch of adventure stuff, then trained as an O. D. P. I was training coordinator and various other things. Um, that was ages ago. I started. It's been around for over 20 years. Um, and that was taken in Member are with my good friend Godfrey so long ago. That was before getting a bit sad now before led operating lights were working and that we set that up crying about 14, 15 years ago. Still going strong today. I've got a background in adventure training as well. About 2025 years, I ran an adventure training company that the team building and leadership courses for healthcare staff in the main Um and they went to a high level accredited by the Royal College. Is there an I T on TV and various things gave me some really good experiences. Um, and one of them helped influence nicotine. A fracture management in the UK Um, as a civilian, I've never been in the military, but somehow I ended up teaching on the Special Forces medical course. Um, so this was before the books written about them. So I was put through the SF medical training, which has been incredibly useful because we do a lot of disaster relief work, which includes things like Syria and indeed, more laterally. Ukraine. Uh, about 13 years, I worked in medical devices in orthopedic trauma, mainly, uh, so that gave me a really good understanding of how companies and industry works. And as you'll see in a minute, that's a really important aspect to the work I do. I'm also really interested in youth development. Are in a church camp every year for teenagers. Um, I've done loads of sort of youth club work and all sorts of stuff and travel. And so I did the Post graduate diploma in travel health at Glasgow University um ended up writing a book called The Gap of a Handbook, of which the principal reason for doing it was to put my wife on the cover so I can say I'm married to a cover girl. Um, anyway, so that's kind of my background. And it's a great background for doing what we do, which is essentially, um, to provide a the right equipment for low to middle income countries or low resource environments. Okay, And we do that through proper healthcare support, advice, consultancy, logistics, procurement, um, all the way through so that the equipment gets to the end user and it's appropriate for the environment in which it's going to and one of our big missions as part of that program. We're a social enterprise and is to make your budget, or whoever our partner is for this project to go as far as it can. So we utilize gifts and kind donations, and so on. No one funds us, so we have to make money. But for instance, we just finished with a really big project, really small projects. We just finished $2 million project in Ghana for a Canadian charity, and we probably supply them an extra million dollars worth of equipment on top of what they actually had. So actually, they're about the value. It's about whether it has a clinical use, and recycling is really good if you do it properly. But we all know about the problem of rubbish donations. But what that means is you can. This is a project done with mercy ships. This is in Madagascar. That's what we started with. And then that's what we finished with. And that was taken about six years ago. I think now completely sustainable solution Manual operating Table led lights with Battery Backup, one of the great diabetic anesthetic machines completely designed for this environment. Know consumables or anything like that, a sustainable solution does what it says on the tin and really enhance his clinical care. I think they came to about 80,000 lbs in operating theater. They probably had about 100 and 50,000 lbs worth per per one. But what's actually much more important is it just does what it should do through all of that. We developed kind of training system, if you like. Um, as you heard, I I I'm an educator. Um I really believe in the value of education, as we all do. So we created a biomedical engineering training course. We all know that stuff needs to be fixed. Did that with mercy ships. Very effective. But clearly a residential course training 10 people or whatever is not very cost effective. So I put the whole thing online. It was holistic. That includes Train, the trainer First aid, all designed for L. M. I. C. S in the sort of blue bags. You've got these details on the course. They get a professional toolkit with it text books and so on, and that has been monumentally successful. And indeed, in your blue bags. There's a report on the 1st 50 students, complete with evaluations a little bit more on that later, because it's a great opportunity. Um, and that ensures that there's two things about that. A. It means you can. They can fix equipment. It's already there. They can support our equipment that we send. But the fact of the matter is, if you send the right equipment, ladies and gentlemen, there's hardly any maintenance needed anyway. And that's the key thing. You send something that's 10 years old and it's electric. You're going to have a bad day in terms of maintenance. So and this is really interesting because, like cetera, who's teaching there for me in Madagascar, through relationships, he went off and did some more training for me when no one could travel. And so it's about empowering them to make a difference themselves. And again, The key thing about this is relationships with these people. Now here's an interesting thing I say relationships because we've got so many biomedical engineer that done our online training course now and we're talking about Internet in the previous lecture we've actually had people do are online course, which includes videos like in the middle of the D. R. C with no issue. And it seems to me that Africa and indeed India has got better Internet than we have here. But the fact is, through these relationships and through the knowledge they gained and we did A we sent out an email, a questionnaire to all our engineers and as a result, got immense amount of data back on the standards of operating rooms in L. M. I. C. S. And there's a copy of that report in the blue bags that are floating around staggering amount of depressing data, but it proves what we already know. And, for instance, 90% of all operating tables in the l. M I C environment are not fit for purpose. We also found that when we're, uh, looking at what the biomedical engineer is, found the most useful units in the program that by far and away it was the operating room related training that they found the most useful. But it's still a big spread of all the other stuff, including First Aid and Train the trainer, and this was taken recently. This was one was done in northern Ghana. Um, and that's, you know, it looks really nice, doesn't it? And it's actually really easy to do. That's our own designed operating table, a perfect fit for purpose. One of Robert's diabetic anesthetic machines, you know, suction with reusable jars, not the ones that the disposal insects, you know, the the operating table manual, not electric. None of this is is high tech. It's very, very sustainable, and I think one of my messages in order this is to demystify if you like the the equipping of health care facilities and in particular surgical facilities in MRC environments because it is not complicated to do. We've got loads of partners and I love it. We work with, You know, small church is right up to save the Children's of this world and everyone doing everything from disaster relief. We were in Nepal after the earthquake. We equipped the UK Disaster Relief Hospital and so on. Now, at this point, you're probably thinking time. But why are you showing a picture of a car crash in America? So you hit a crash barrier and landed the right way up. And that's because if we look at that picture like that, we see, yeah, So what landed the right way up? Everyone's happy. If we step back from that picture, we see that he's on the edge of the 300 ft drop, and my point about this is when you're doing frontline health care provision of equipment, I guess it applies to everything you need to look at the big picture, and that's something that we really push. So, for instance, we've got a large load going to northern Uganda includes a lot of orthopedic stuff so they can really develop the orthopedic service in this hospital. And I said to them, Well, how big is your autoclave? Because this stuff we're sending is quite big. Turned out it was small. And so we sorted out a large autoclave that was appropriate and could do what it needed to do. But big picture thinking has to be done when you're doing this. So you work out. What are the issues? Have they got the resources to do what they want to do? And everything's got to be adjusted for the environment? This was in the middle of the day. It was sort of on the eastern DRC, about 300 k n. And we shipped into Antibi for a great charity called some Eliquis Trust. Um and so this was kind of small operating room package it got there, you know, in the first four days they did 11 C sections, so those ladies would have not ever had any treatment had that operating room not been there. So either they all would have died. All they would have been women would have become incontinent or whatever. Um, so it's not hard to do these things and from leaving our offices in Bedford. I think it was about 14 days for it to get there, and that included the flight to antibody. That's the journey that it had to undertake. And the doctor from the hospital came to the border to get to meet it. My point being that when you're doing this sort of work, you can get stuff to those places. Just have to work through what the challenges are going to be and then figure it out and work out the solution, which is kind of what we do. And again sticking with the kind of the recycling theme. And it's really rewarding when you do this. Um, bizarrely, just when Cove it was kicking off, there's a change of contract in the N. H. S. And we basically offered about 3000 oxygen concentrator is when the world had none. Um, they were actually about 1500 of them were on their way to landfill, to the point where the cables have been cut off right next to the concentrator. So we've got a large team in, uh, we completely stripped them down, changed the filters, checked all the outputs, did a lot of been about 10% of them, um, and then ship them all over the world. Obviously, they're saving lives, not just for covert, but other things. Uh, we actually saved The charity is concerned about 2 million lbs. We charge 200 lbs of concentrated because they obviously took work to do it for those concentrators listed about 1200 lbs. And they were as good as new. And that was the wfs A and again talking about planning. So we sent generators with those. Sometimes we would send pulse oximeter generators to power them If there's a power outage, So whole solutions thinking. And then you can see just with some of my team and some of my volunteers. That's one shipment heading off to the airport, and it's quite staggering that I think it was about 1500 actually on their way to landfill, and we intercepted them. Got into our office is probably got about 1200 working again. But the interesting thing is, ladies and gentlemen, we've now got a large stock of them and people don't want them because covitz gone off the sort of media radar and the fact that people are dying from pneumonia and all the rest of it, but it doesn't take people's boxes. It's really interesting and quite sad. Another thing that we noticed again. It's a you've really got to strip this stuff back to basics is about sterilization in L. M I. C s which no one gives them. Well, we all know there's lots of stuff that doesn't get a lot of air time in terms of L. M I. C. Stuff and we're going to talk about in a sec. So I was running a primary trauma care course. Um, in Uganda. Uh, and I I did a little questionnaire. There's about I can't remember. I think about 10 hospitals represented there, and I did a a questionnaire about their sterilization. Bottom line is, none of them were actually sterilizing. And I've been in loads of sites where I've seen people kind of wash instruments under a tap from showing up one patient and then go off and set up another patient and stuff really, really big issue. We created this echo clave device, which uses it's very heavily insulated. Frame. Use is hardly any word. Two boxes, two shoe boxes of wood, and you can, uh, It's a really effective means of sterilizing, you know, when you've got no electricity. If you can play the video and this will explain more about it, it's the BBC news clip. It'll take about five seconds for the sound to kick in. It's called an echo clave, and frankly, it isn't much to look at, but in a disaster zone or in rural areas in the developing world, it's inventor Tim Beacon believes it could be brilliant. The Echo clave sterilizes surgical instruments. And in Africa, where Tim's medical charity does most of its work, sterilization isn't always a priority in these In these environments, Um, instruments and other surgical items are not sterilized between patients. On a good day, you may get them put in boiling water. Otherwise they might just be washed under attack. In this country, all our big hospitals, like here at the Norfolk and Norwich, have multi million pounds sterile services departments, robots, computers, all the latest kit in Africa. It's different, of course, and Tim Beacon believes the Echo clave can supply a low tech solution. It doesn't use electricity. Just would the instruments go into a pressure cooker? The fire heats it up and steam does the rest. Other doctors and healthcare personnel who work regularly in these environments regard it as a potential to be a global game changer because not only will you be sterilizing instruments, but it's about promoting good practice. Tim's charity, based near Bedford, provides a variety of medical solutions to the developing world. It refurbishes pre owned equipment, for instance, the Echo clave cells for just short of 4000 lbs, but frustratingly it hasn't yet had the impact it might. Sterilization is not is not a subject that that is trendy form of a better phrase. Obviously, malaria is HIV, and they're quite rightly they get a lot of attention. But the whole area of surgery, in fact, in the developing world is not really considered, and yet it is a massive, massive need. The Echo clave takes about 20 minutes to do its job. It's simple and effective, but not trendy. Perhaps sterilization isn't trendy, but Tim Beacon says his invention will save lives. Might Liggins, BBC Look East Bedford. Interestingly enough, where we have got that out there and in use, infection rates are absolutely plummeted. I took it once a comic relief site. They thought I was nuts when I took it there until I picked up a little bit of wood that was lying around. And 40 minutes later, they're sterile instruments. Um, so there's a whole bunch of stuff we could talk about that time precludes that one hospital where it's in use. And I only designed it for rural clinics have actually have their electricity bill through using it, and they grow their own fuel. Anyway, I've only got four minutes now. I suspect so. I've got to move on. Um, it's really important we send the right kit in this report. We talked. We put in benchmark standards. What we believe is there. This is on a reconnaissance to Northern Ethiopia, Uganda for a project with Rotary and this the hospitals. Not surprisingly, they had a totally inappropriate anesthetic machine sitting in the corner because it's not going to do any one any good in the environment in which there at, um so And in fact, this is from the data from this operating report, which said the proportion of safety close circuit anesthetic machines unsafe one was 90%. Anyway, when I designed this project, we completed the whole orthopedic units, sterilization, everything. I didn't tell them that they were going to get an l M I c appropriate anesthetic machine because I knew they would want to push one, so I just didn't tell them. Um, got there. These are the anesthetist. They thought they had died and gone to heaven because suddenly, when someone was thinking the way they needed to think and all the resources to match it with their, um interesting, if you can just see, like, the oxygen outlets behind, they were never going to work. They don't work. But now they've got a complete, sustainable anesthetic service. This is the O. R. That we equipped. Just after we left the Tigre, fighting kicked off, and in eight months, they did 4000 major trauma cases. The other thing is, before we got there with this, this resource had one part time orthopedic doctor. They've now got four because they can do their job. So people come because they can do their job and work. Not nearly there. Two minutes. Great too. And this is it's always good to have a case. History, isn't it? And also to demonstrate a point this is in Uganda. This lab fell off the back of a pickup. We went over him. As you can see, he's got a dead tibia. Came to us from Saint elsewhere. They have those everywhere, Uh, three weeks down the line. So complete mess. And in fact, there's quite a bit of damage to the back of his leg. Um, first of all, we gave this letter Spinal anesthetic. The drugs were fine. Good anesthetist. CSF came out, but it didn't work. So we had to use the in this case, an HMO vaporizer or anesthetic machine. The point being, sometimes people say to me, I'll do everything under local doesn't work you need. If you're going to do surgery, you need to have some sort of capability. I've cut the 30 stuff out. I haven't got time. We saved his leg, but he had a short leg. But we then referred him to call through hospital in, um, TB and through limb lengthening took him out to length. So it just goes to show what can be done in these places. And interestingly enough, all the stuff that we used on that was actually pre owned status quo. How many of you have heard of the rock band status quo? Yeah, a few of your good three calls and all that good band. Um, but I like to challenge the status quo, and I think we need to do that. So we've all seen the W H O surgical checklist. I actually have quite a few problems with that and then your bad thing that there is a sort of a brochure that says about our list and why I've designed it the way I have bearing in mind. I'm an O D. P. So it's worth looking at because actually, there are some significant discussion points. Actually, when you do look at it and again, one of the things that we've decided we do, we we created an operating room package that's easy to implement, can be customized and can go straight in to use. The real frustration for us is that it's not been taken up more, and we'll come to that in a second. Those details of that in your package and my final reflections. I am just about to finish in one minute because it says time, Um, my reflections, I'm ugly enough and old enough to have been around a while now. I've been doing this job a long time and so on, and my affections are and I deal with some really big charities and all sorts of people, and it's an amazing privilege. But my reflections are Remember the patient, actually, because sometimes I sit in meetings and think that you're forgetting about the patient. Um, these all have successful operation. The lady on the top left is official patient, um, and defined as it says here defining short and long term plans. It doesn't have to be war and peace. You should be able to do it on the back of an envelope. People tend to over think the problem and delivering sustainable surgical solutions in an l. M I. C. Environment is not complicated. Involve the recipient of the equipment decisions, allocate money to equipment, not just research. Okay, great doing the research. They got to have good kit in order to save lives. And I see such terrible situations where that's not the case. You got to trust people and people have got to work together between charities and suppliers. That's putting together a fissure set. We do a lot of physical work. The lady that is coordinating it for a great charity called Figo said that we achieved in 50 minutes what took w h 03 years. So, you know, make decisions, get things happening and go for it. You know, don't over think the problem. Thank you very much. Thank you so much time for that. Really incredible talk. The work that Medicaid is doing is really incredible. I think some of the key points we need to think about is what it is just said. We need to remember the patient, um frontline health care provision of equipment. You need to make sure you look at the bigger picture. And I think that's something that I'm going to take in. As I continue through my career, I'm going to hand over to. So he was going to introduce our last