WEBVTT - 3D Printing Tourniquets for Gaza 0:00:05.040 --> 0:00:08.760 All right podcast it could happen here. It's a podcast 0:00:08.800 --> 0:00:11.239 about the terrible things that are happening all around the 0:00:11.280 --> 0:00:15.680 world and the wonderful people who are trying to fix them. 0:00:16.120 --> 0:00:20.639 What it is today is a podcast with Trek Lubani 0:00:20.920 --> 0:00:24.239 of Glia. And what really inspired me about the story 0:00:24.280 --> 0:00:27.760 and maybe want to share it with you, is that 0:00:28.120 --> 0:00:31.400 it came out of a really dark place. Terek was 0:00:31.800 --> 0:00:35.479 on the ground in Gaza treating gunshot wound victims, and 0:00:35.560 --> 0:00:39.080 a lot of gunshot wound victims, like I remember reading 0:00:39.520 --> 0:00:43.360 his field testing of the device and just being appalled 0:00:43.720 --> 0:00:45.640 by the number of people who have been shot, a 0:00:45.680 --> 0:00:49.360 lots of them children, and some of the reporting he 0:00:49.400 --> 0:00:51.960 was doing right like, oh, I had this this tornique 0:00:52.000 --> 0:00:54.639 and we were reusing them and they don't work very 0:00:54.640 --> 0:00:58.840 well on the pediatric application because kids shouldn't be shot, right. 0:00:59.080 --> 0:01:02.800 But instead of getting down, he was able to make 0:01:02.840 --> 0:01:04.800 a solution. And I think that's really important, and I 0:01:04.840 --> 0:01:08.440 really like that even through like this dark and terrible 0:01:08.440 --> 0:01:11.720 stuff that we've all had to experience and he experienced 0:01:11.720 --> 0:01:15.039 in Gaza, he was able to see a positive solution 0:01:15.160 --> 0:01:17.600 away to look after people, to move forward in this case, 0:01:17.640 --> 0:01:21.560 to prevent death and preserve life. And I think it's 0:01:21.560 --> 0:01:23.600 easy to focus on the dark stuff. There's enough of 0:01:23.600 --> 0:01:26.880 it happening, but I think it's important to focus on 0:01:27.040 --> 0:01:30.360 the great people who are doing great things to protect 0:01:30.400 --> 0:01:32.520 and care for other people as well. So that's a 0:01:32.520 --> 0:01:34.119 little bit of what we got today, and I hope 0:01:34.120 --> 0:01:38.200 you enjoy it. So I'm here with Tarak Lubani. He's 0:01:38.200 --> 0:01:40.640 from Glia. There, a company came across from I was 0:01:40.640 --> 0:01:44.840 writing about three D printed tornic case. Would you like 0:01:44.880 --> 0:01:46.600 to introduce yourself to us a little bit about Glear 0:01:46.640 --> 0:01:49.120 and what you do there. Thank you so much for 0:01:49.320 --> 0:01:52.120 having me. My name is terrickle Banny. As you had mentioned, 0:01:52.240 --> 0:01:56.000 I'm an emergency physician. I work in Canada in a 0:01:56.080 --> 0:01:58.640 city in Canada called London, and I also work in 0:01:58.840 --> 0:02:02.840 the Gaza strip as an emergency physician as well. Glia 0:02:03.000 --> 0:02:06.680 was really an answer to a problem, the problem being 0:02:06.920 --> 0:02:10.160 that when I see patients in Gaza, they don't get 0:02:10.320 --> 0:02:12.600 the same quality of service that I can give to 0:02:12.720 --> 0:02:16.640 my nations. To that. Of course, that's multi factorial, but 0:02:16.680 --> 0:02:19.520 a big part of that has to do with the 0:02:19.600 --> 0:02:24.040 way in which we as uh that the medical profession 0:02:24.680 --> 0:02:28.040 have medical devices that we don't release, that we don't 0:02:28.080 --> 0:02:31.919 give access to other people to use. And so Glia's 0:02:31.960 --> 0:02:35.240 purpose was to take the most medical devices that doctors 0:02:35.360 --> 0:02:38.560 use and to make sure that they were accessible and 0:02:38.600 --> 0:02:42.760 available to doctors all over the world. Okay, yeah, yeah, 0:02:42.800 --> 0:02:46.240 that's that's very cool. And you make a number of devices, right, 0:02:46.280 --> 0:02:48.840 Like I know that I first called to you about 0:02:48.840 --> 0:02:52.000 the torn ca, but you make also a stethoscope, is 0:02:52.000 --> 0:02:56.360 that right? The stethoscope is the calling card of medicine. 0:02:56.400 --> 0:02:58.680 And so it was the first project that we started 0:02:58.720 --> 0:03:01.920 working on to start the theory. I mean, we started 0:03:01.919 --> 0:03:04.880 with the theory that hey, we can probably make a 0:03:04.880 --> 0:03:08.240 device that's just as good as a three D device, 0:03:08.600 --> 0:03:12.680 but the costs let's say three dollars or even thirty dollars, 0:03:12.800 --> 0:03:15.040 And that was the stuff scope. We tested it, we 0:03:15.160 --> 0:03:18.280 published the results, we proved it was as good as 0:03:18.320 --> 0:03:20.920 the Gold standards, the Litman Cardiology three at the time, 0:03:21.560 --> 0:03:25.680 and often using it both in our own practices also 0:03:25.760 --> 0:03:30.000 making it available other people to make for theirs. Okay, yeah, 0:03:30.040 --> 0:03:32.320 And so that's what's really interesting about your company as 0:03:32.360 --> 0:03:36.240 opposed to other companies, right, you're not necessarily like manufacturing 0:03:36.280 --> 0:03:42.160 and distributing. You are providing the designs that allow other 0:03:42.200 --> 0:03:44.000 people to make them, right, and so can you talk 0:03:44.040 --> 0:03:47.240 about some of their Like, uh, I know that you 0:03:47.320 --> 0:03:49.120 use three D printing, and I want to talk about that. 0:03:49.160 --> 0:03:51.440 But also like I remember seeing that the tubing and 0:03:51.480 --> 0:03:55.120 the cessoscope comes from the a Coca Cola machine, right 0:03:55.280 --> 0:03:58.720 for some of those considerations. Yeah, absolutely, the purposes to 0:03:58.800 --> 0:04:04.080 make these device is available to other people for the 0:04:04.120 --> 0:04:07.400 lowest cost possible, but also like actually be available. It's 0:04:07.440 --> 0:04:10.240 no good if you can make it for twenty cents, 0:04:10.320 --> 0:04:13.720 but the part that required are nowhere. So that's why 0:04:13.960 --> 0:04:17.719 we went with a basket of items that are more 0:04:17.800 --> 0:04:20.840 or less earsily available and we made the stuffoscopes out 0:04:20.839 --> 0:04:24.719 of that. For example, you can probably get the very 0:04:24.720 --> 0:04:29.320 specific kind of earpieces that most stuffoscopes have, but they 0:04:29.360 --> 0:04:32.320 are naturally going to be less available and less abundant 0:04:32.480 --> 0:04:36.080 than if you were to use regular earbuds the contact phones. 0:04:36.440 --> 0:04:40.120 There are way more headphones out there than there are stuffoscopes. Therefore, 0:04:40.160 --> 0:04:43.800 those parts are more available, even if, of course there 0:04:43.800 --> 0:04:46.120 they are less expensive. But even if they were slightly 0:04:46.160 --> 0:04:49.760 more expensive, it would be worth it. What we really 0:04:49.960 --> 0:04:55.960 take away is the monopoly and the profit motive, and 0:04:56.360 --> 0:04:59.839 so by doing that, or rather, let's say the ex 0:05:00.080 --> 0:05:03.800 orbitant profit that medical device companies are making, and by 0:05:03.839 --> 0:05:09.080 doing that, we're really able to realize the promise of patents. 0:05:09.120 --> 0:05:11.440 All of the devices that we make were patented at 0:05:11.440 --> 0:05:14.680 one point. The promise of patents is that when the 0:05:14.720 --> 0:05:17.560 patent is over, you'll get a cheap device, but that 0:05:17.680 --> 0:05:20.520 promise is not realized. The stethoscope is a three hundred 0:05:20.640 --> 0:05:23.600 year old device basically, and the fact that it is 0:05:23.880 --> 0:05:27.840 not available at the highest quality except for three kind 0:05:27.880 --> 0:05:30.160 of nuts. So that's why we started there, and of 0:05:30.160 --> 0:05:33.360 course moved on to more and more complicated devices, much 0:05:33.440 --> 0:05:37.240 more complicated even than the tourniquet. By now, okay, yeah, 0:05:37.480 --> 0:05:41.200 can you I remember reading because you have you you 0:05:41.279 --> 0:05:43.479 kept a blog. I remember on like medium where you 0:05:43.480 --> 0:05:47.679 talked about testing the tourniquet when when you were in Gaza, 0:05:47.839 --> 0:05:52.000 and it just a like, you know, if you read 0:05:52.120 --> 0:05:55.200 medical literature then it did. This was just the shocking 0:05:55.240 --> 0:05:58.400 I remember being absolutely shocked by the number of casualties 0:05:59.360 --> 0:06:02.400 you ring unting encountering, and then also like you were saying, 0:06:02.440 --> 0:06:07.320 like the the lack of available tools. So perhaps you 0:06:07.360 --> 0:06:11.159 could explain like a little bit of what you saw 0:06:11.279 --> 0:06:15.480 there and then how these tournicates have been able to 0:06:15.880 --> 0:06:19.000 help you address that like massive disparity and access to care. 0:06:19.720 --> 0:06:24.440 The turniket project really started in Gaza because we noticed 0:06:24.520 --> 0:06:27.120 that after one of the wars, the war in two 0:06:27.120 --> 0:06:31.640 thousand fourteen, that we had a particularly high casualty rate, 0:06:31.680 --> 0:06:35.120 of course, but of that there were many deaths that 0:06:35.160 --> 0:06:39.480 we would classify as preventable. That's where we felt that 0:06:39.800 --> 0:06:45.240 had turnikets been available, those patients likely wouldn't have died. Um. 0:06:45.320 --> 0:06:47.159 When we started working on it, of course, we knew 0:06:47.160 --> 0:06:49.400 at some point there'd be another war. It is it 0:06:49.520 --> 0:06:52.240 is very common in Gaza for there to be attacked 0:06:52.240 --> 0:06:55.119 by the Israelis. We didn't anticipate for it to happen 0:06:55.279 --> 0:06:58.080 so fast and for it to happen in a way 0:06:58.080 --> 0:07:01.720 where the turnicket was so necessary. That, of course, was 0:07:01.800 --> 0:07:05.640 what what's called the Great March of Return, where Palestinians 0:07:05.680 --> 0:07:09.960 protested on mass and one of the Israeli responses was 0:07:10.320 --> 0:07:14.120 to shoot live fire at the protesters, often targeting About 0:07:14.120 --> 0:07:16.800 eight percent of the hits were targeting the arms and 0:07:16.840 --> 0:07:19.680 the likes, which is where turnickets are the most effective. 0:07:20.440 --> 0:07:23.920 So the high number really is owing to the way 0:07:24.000 --> 0:07:25.840 in which the Israeli has decided to deal with this 0:07:25.960 --> 0:07:28.440 protests and the fact that it was a protest rather 0:07:28.520 --> 0:07:32.200 than a specific war. And that meant also that we 0:07:32.280 --> 0:07:35.000 could predict with the relative degree of accuracy where the 0:07:35.040 --> 0:07:39.160 injuries would be, which meant that it was even more 0:07:39.200 --> 0:07:41.720 important to have the right equipment of the right training. 0:07:42.440 --> 0:07:45.400 It was part of an overall strategy. So of course 0:07:45.480 --> 0:07:48.280 it's not like turnikets were the thing that saved lives. 0:07:48.520 --> 0:07:52.040 Tourniquets were part of a campaign to train paramedics and 0:07:52.120 --> 0:07:54.560 to train doctors and how to stop bleeding in these 0:07:54.640 --> 0:07:57.480 kinds of injuries, and they were one of the most 0:07:57.520 --> 0:08:01.559 important tools in that campaign, but only part that campaign. Yeah, 0:08:01.680 --> 0:08:03.800 of course, of course you need other tools and obviously 0:08:03.840 --> 0:08:06.200 their education and you can't just slap it on and 0:08:06.240 --> 0:08:07.920 then the person's fine, right, Obviously there's a lot of 0:08:07.920 --> 0:08:12.040 care afterwards which is important to And can you maybe 0:08:12.080 --> 0:08:15.440 talk us through You talked about like the promise of patents, right, 0:08:15.480 --> 0:08:17.920 and I think this is important in exactly what we're 0:08:17.920 --> 0:08:20.840 talking about in tornic its because it's a little different 0:08:21.000 --> 0:08:25.520 to like medic medicines, right, it's a little different with 0:08:25.520 --> 0:08:30.280 medical devices. So there are existing torn kits on the 0:08:30.320 --> 0:08:33.400 market right and I think the sort of market leading 0:08:33.400 --> 0:08:38.360 one is the CAT. Can you explain, like why at 0:08:38.400 --> 0:08:41.760 those not getting to people who need them desperately in 0:08:41.760 --> 0:08:45.960 these areas The problem with the turnickets that are available 0:08:46.040 --> 0:08:49.599 right now, it kind of falls into a few different categories. 0:08:49.840 --> 0:08:52.600 North American Rescue the makers of CAT have two key 0:08:52.640 --> 0:08:57.720 patents on the Cat, and as far as we can tell, 0:08:58.240 --> 0:09:00.880 just based on the posture of the company, if anybody 0:09:00.920 --> 0:09:04.560 else were to make exact Cat replicas, they will be suited. 0:09:06.360 --> 0:09:09.360 The people who are willing to then make exact Cat 0:09:09.400 --> 0:09:13.600 replicas tend to be people who are unaccountable and largely 0:09:13.679 --> 0:09:16.480 have not much to lose, and so that's why we 0:09:16.559 --> 0:09:21.120 saw a glut initially, for example, with the Ukraine campaign 0:09:21.720 --> 0:09:27.079 of tourniquets that that were relatively low quality. And so 0:09:27.160 --> 0:09:29.440 you can't just make the device. You also have to 0:09:29.559 --> 0:09:32.360 know that the device will work, because you don't want 0:09:32.400 --> 0:09:34.800 to discover that when you put it on armor alike 0:09:34.920 --> 0:09:38.880 and then it fails. Gaza is an acid test of 0:09:38.920 --> 0:09:43.400 all of these things, because not only our devices generally 0:09:43.960 --> 0:09:47.280 not available or expensive, it's kind of at the bottom 0:09:47.320 --> 0:09:51.600 of any purchase list, for example, but also in Gaza, 0:09:51.640 --> 0:09:55.800 there's a complete international blockade Israeli led, of course, but 0:09:56.040 --> 0:09:59.560 there are other countries that are that are contributory, and 0:10:00.040 --> 0:10:04.040 that blockade means that equipment can't get in so long 0:10:04.080 --> 0:10:08.040 as the Israelis deem it to be of military value. Um. 0:10:08.080 --> 0:10:10.679 This is where things like dual use devices and so 0:10:10.720 --> 0:10:15.000 on come into play. The tourniquet is a medical device. 0:10:15.040 --> 0:10:17.400 It is it can only be a medical device. There 0:10:17.480 --> 0:10:21.840 is no second use, and so it should be exempt. However, 0:10:23.000 --> 0:10:26.559 even if the Palestinians could afford fifty U S dollars 0:10:26.600 --> 0:10:28.760 per units, which should be the cost to get one in, 0:10:30.120 --> 0:10:32.360 the Israelis won't let them in. So de facto, even 0:10:32.360 --> 0:10:34.720 though they shouldn't be banned, they are de facto banned, 0:10:35.440 --> 0:10:38.640 and that means that not only can we depend on 0:10:39.320 --> 0:10:44.559 cheap Chinese retailers. Let's say to give us replica turniquets, 0:10:44.600 --> 0:10:48.040 we actually have to manufacture them ourselves. When we open 0:10:48.080 --> 0:10:52.560 sourced our designs, it was with an eye to two things. 0:10:52.679 --> 0:10:55.800 One making it available so that the replica makers can 0:10:55.840 --> 0:10:59.920 make higher quality replicas. They're already making replicas, we may 0:11:00.000 --> 0:11:02.400 as well give them a legal replica rather than a 0:11:02.440 --> 0:11:05.520 patent break busting replica. Not that I think there's anything 0:11:05.520 --> 0:11:08.720 wrong with that in these cases where there's emergencies, but 0:11:09.840 --> 0:11:14.800 just the same Glia's tourniquet doesn't break any patents. And 0:11:14.960 --> 0:11:17.880 at the same time, in addition to giving them the 0:11:17.880 --> 0:11:20.600 ability to make high quality turnikets, we can also make 0:11:20.679 --> 0:11:26.400 high quality turnikets locally and domestically. Because of course, national liberation, 0:11:27.080 --> 0:11:29.680 as it were in the medical device space can't come 0:11:29.760 --> 0:11:32.280 if you can't make your own devices. We discovered that 0:11:32.400 --> 0:11:36.000 during COVID. The Palestines have known that for decades now, 0:11:36.480 --> 0:11:39.800 and we're kind of rediscovering it in Ukraine where there 0:11:39.840 --> 0:11:43.640 just aren't enough turnickts and so they are forced to 0:11:44.360 --> 0:11:47.640 improvise or except tourniquets that they don't want to accept, 0:11:48.080 --> 0:11:51.120 right Yeah, Like I think I think COVID was this 0:11:51.200 --> 0:11:54.040 great example that we can't continue to rely on the 0:11:54.080 --> 0:11:56.560 sort of winds of global capital to provide things that 0:11:56.600 --> 0:12:00.840 we need to survive. I think you're manufacturing is fascinating 0:12:02.000 --> 0:12:06.520 because you're using essentially commonly available materials in the three 0:12:06.600 --> 0:12:09.240 D printeries that right, Yeah, that's correct. I mean we're 0:12:09.240 --> 0:12:11.520 not against using other things they just have to be 0:12:11.640 --> 0:12:14.920 very simple. For example, are electronics use PCBs. You can't 0:12:15.000 --> 0:12:19.679 three D print electronic circuits just yet, so we use PCBs. 0:12:19.720 --> 0:12:22.600 But when we design our PCBs, there are a couple 0:12:22.640 --> 0:12:24.440 of ways to design it. You can design an eight 0:12:24.520 --> 0:12:27.320 layer board that can only be manufactured in one or 0:12:27.320 --> 0:12:30.400 two places in the world, or you can design a 0:12:30.440 --> 0:12:34.040 board that's three times the size but can be manufactured 0:12:34.120 --> 0:12:36.760 anywhere in the world. And when you're talking about credit 0:12:36.800 --> 0:12:40.199 card sized devices, if it's notebook size instead of credit 0:12:40.200 --> 0:12:44.080 card size, it doesn't really matter that much. For example, 0:12:44.400 --> 0:12:47.480 the example i'm thinking of here as an electric cardiogram, 0:12:47.480 --> 0:12:51.280 where we took a device that had failed um in 0:12:51.520 --> 0:12:55.360 the sort of market that they the maker's open source 0:12:56.040 --> 0:12:58.520 and they had intended it to be a fitness device, 0:12:59.080 --> 0:13:01.120 and then it didn't work. A company went bankrupt, and 0:13:01.120 --> 0:13:03.800 so they open sourced it. So we looked at their 0:13:03.920 --> 0:13:06.679 schematics all of the problems that they had already solved. 0:13:07.080 --> 0:13:09.360 We said, okay, the problem we're going to solve is 0:13:09.400 --> 0:13:11.520 to make it so that this can be manufactured in 0:13:11.760 --> 0:13:15.000 a high school electronics lab. And we were able to 0:13:15.000 --> 0:13:18.160 achieve that it was bigger, it was twice as big, 0:13:18.840 --> 0:13:21.000 But who cares? The old one was half the size 0:13:21.000 --> 0:13:23.400 of a credit card? You know who cares? You make 0:13:23.440 --> 0:13:26.240 it a little bit bigger. But at the same time, um, 0:13:26.280 --> 0:13:29.600 you make it much more accessible, twice as big, twenty 0:13:29.600 --> 0:13:41.120 times more accessible. I know some of your staff like 0:13:41.160 --> 0:13:44.440 your tony cats. It's really um. There's not much or 0:13:44.480 --> 0:13:48.360 any really of a performance trade off from what you've seen, right. Indeed, 0:13:48.360 --> 0:13:51.839 they might be better for some pediatric applications if I 0:13:51.880 --> 0:13:55.640 remember correctly that that's right. So when you think of 0:13:55.840 --> 0:13:58.439 the way in which corporate devices are made, they are 0:13:58.520 --> 0:14:03.000 made to the specifications of particular buyers. And the buyers 0:14:03.120 --> 0:14:05.120 are the people who have the money. Who's the buyer 0:14:05.160 --> 0:14:09.000 for tourniquets? When you think about who needs tourniquets consistently, 0:14:09.040 --> 0:14:11.240 who do you who has money to give you turnickets? 0:14:11.280 --> 0:14:14.480 Who should you market too? There's only one sane answer, 0:14:14.520 --> 0:14:18.560 and that is First world militaries, especially occupation militaries or 0:14:18.600 --> 0:14:22.920 militaries that are engaged in UH ground level warfare, who 0:14:22.920 --> 0:14:25.280 are expected to take small arms or i e. D s. 0:14:26.080 --> 0:14:29.440 And so there are not many children who you have 0:14:29.520 --> 0:14:32.280 to sell to in that particular market. There aren't many 0:14:32.360 --> 0:14:34.680 small women or even women at all they have to 0:14:34.680 --> 0:14:37.720 sell to in that market. So I don't think that 0:14:37.760 --> 0:14:41.680 North American rescues engineers would have any trouble making sure 0:14:41.720 --> 0:14:45.840 that their turnickets worked amazingly well for children. But why 0:14:45.880 --> 0:14:50.560 why would they spend one to million dollars doing that 0:14:50.760 --> 0:14:54.440 work and research when that's not their audience and that's 0:14:54.480 --> 0:14:59.320 not their buyer. For us, the normal person, the civilian 0:14:59.560 --> 0:15:03.120 is uh in quotation marks bire. They're not the ones buying, 0:15:03.120 --> 0:15:06.160 but they're the ones who are the main consumer, and 0:15:06.240 --> 0:15:09.760 so they're the ones who we target. In Gaza specifically 0:15:11.000 --> 0:15:13.720 of the population is under the age of fourteen. You'd 0:15:13.720 --> 0:15:16.000 have to be crazy to go out there and put 0:15:16.000 --> 0:15:18.520 a tourniquet out that only works on big, burly men. 0:15:19.400 --> 0:15:22.440 So that's that's why we were we were driven to 0:15:22.440 --> 0:15:25.360 do that. And as for the performance traight offs, yeah, 0:15:25.400 --> 0:15:28.720 you're right. The the what we learned about spec sheets 0:15:28.760 --> 0:15:31.920 on lots of these devices is that they're made up. 0:15:32.600 --> 0:15:35.440 There isn't really a great way to know how well 0:15:35.440 --> 0:15:38.760 elterni it works. Unfortunately, there isn't a really great way 0:15:38.800 --> 0:15:42.840 to know how well stuffoscope works. And so some of 0:15:42.880 --> 0:15:45.840 the first work we did was actually designing some tests 0:15:46.280 --> 0:15:48.200 so that we can say, okay, well here's how you 0:15:48.280 --> 0:15:50.960 prove that the stuffoscope works as well as that stuffoscope, 0:15:51.440 --> 0:15:54.080 or here's how you prove that you know this works 0:15:54.120 --> 0:15:57.400 as well as that. And those testing protocols we made 0:15:57.480 --> 0:16:01.160 them open source and easily available too. For example, if 0:16:01.160 --> 0:16:02.960 you want to test the stethoscope, you can do that 0:16:03.040 --> 0:16:06.400 with a pair of headphones, a microphone, and the Hello 0:16:06.480 --> 0:16:09.320 Kitty balloon. That's how we did it originally. Could we 0:16:09.440 --> 0:16:13.160 have spent ten dollars making that test right, Yeah, we 0:16:13.160 --> 0:16:16.640 could have, but that wouldn't have helped us in terms 0:16:16.680 --> 0:16:20.440 of helping other people make stutoscopes wherever they are. Yeah, 0:16:20.560 --> 0:16:23.720 that's very cool. And then by open sourcing that test, 0:16:23.800 --> 0:16:26.880 you allow for other people who have ideas or sort 0:16:26.880 --> 0:16:29.760 of models for their own improvements or different designs, that 0:16:29.880 --> 0:16:32.320 they can then use that test right and continue to 0:16:32.360 --> 0:16:35.440 improve and share their improvements with others. I do not 0:16:35.560 --> 0:16:38.880 want to work on stethoscopes anymore. I want to people 0:16:38.960 --> 0:16:41.120 to take it up. And it doesn't mean that I won't, 0:16:41.200 --> 0:16:44.920 of course I will. But my favorite thing is when 0:16:44.960 --> 0:16:47.920 somebody sends a message and says, hey, I like what 0:16:48.040 --> 0:16:50.560 you've done. Here's how I think it could be better. 0:16:50.920 --> 0:16:54.040 I love those messages. I love them. And you know what, 0:16:54.240 --> 0:16:57.280 nine out of ton of those ideas don't work out. 0:16:57.320 --> 0:17:02.880 They don't pan out. But like our stethoscope, since two 0:17:02.880 --> 0:17:05.480 thousands seventeen, all of the improvements have been from other 0:17:05.520 --> 0:17:07.960 people because we haven't had the time and money to 0:17:08.000 --> 0:17:10.600 work on it. But we have been open minded, have 0:17:10.720 --> 0:17:13.760 incorporated lots of design changes that other people in the 0:17:13.800 --> 0:17:18.159 community have suggested. That's a good thing. It's good for everybody. Yeah, 0:17:18.359 --> 0:17:20.199 I think it does an excellent job at getting it. 0:17:20.280 --> 0:17:25.520 They like their fundamental conceit of our Dragon device development model, right, 0:17:25.560 --> 0:17:30.119 which is that which isn't true actually that there's massive 0:17:30.240 --> 0:17:31.880 R and D costs and those R and D costs 0:17:31.920 --> 0:17:34.280 have to be recouped by charging a massive amount for 0:17:34.320 --> 0:17:37.160 a period of time and making access to that medicinal 0:17:37.240 --> 0:17:40.679 device a privilege, not right, and then eventually the costs 0:17:40.680 --> 0:17:42.760 will come down they often don't, and then everyone will 0:17:42.800 --> 0:17:45.119 have active to this thing. And it's like, it's been 0:17:45.160 --> 0:17:47.119 my experience that it doesn't work that way. But what 0:17:47.160 --> 0:17:49.280 you've shown is an alternative right that people want to 0:17:49.320 --> 0:17:52.399 help and that that they don't that there's not a 0:17:52.440 --> 0:17:56.040 need for this like price gouging to facilitate the improvement 0:17:56.040 --> 0:17:59.560 in this technology. Is that fair? We're not taking a 0:18:00.000 --> 0:18:04.600 really altruistic model here. People are generally improving the stethoscope 0:18:04.600 --> 0:18:08.160 for their own uses, so there is a self interested 0:18:08.240 --> 0:18:10.640 aspect if you want to present it that way. What 0:18:10.720 --> 0:18:16.560 we realized is that actually the most useful way to 0:18:16.640 --> 0:18:18.760 develop a device is to make it as good as 0:18:18.800 --> 0:18:21.800 possible and release it and then have other people who 0:18:21.880 --> 0:18:24.480 want to improve it have a capacity to share back 0:18:24.520 --> 0:18:29.159 to you. So as much as I I believe in 0:18:29.200 --> 0:18:31.800 altruism and I do think every time that I've seen 0:18:32.359 --> 0:18:35.720 people collaborate, I've seen a tremendous amount of it, this 0:18:36.359 --> 0:18:40.720 more resembles the open source software model, where which is 0:18:40.760 --> 0:18:42.760 actually the world I came from. I came from the 0:18:42.800 --> 0:18:47.399 free software model, where yes, you do things just for 0:18:47.480 --> 0:18:50.760 the fun of it, but also very large corporations are involved. 0:18:50.800 --> 0:18:53.800 For example, some of the stuffoscope's improvements happened because the 0:18:53.920 --> 0:18:57.480 lab needed to use it for some experiments on animals, 0:18:57.880 --> 0:19:01.160 and so they made modifications and they fed them back amazing, 0:19:01.800 --> 0:19:05.680 that's fantastic, And but that that was totally self interested, 0:19:05.760 --> 0:19:08.080 that they knew that it would cost them significantly less 0:19:08.119 --> 0:19:10.399 to build on our work, and it would cost them 0:19:10.440 --> 0:19:16.439 nothing to share back their their contributions. So it's you know, 0:19:16.480 --> 0:19:19.880 we're not going out there trying to to prove that 0:19:19.960 --> 0:19:23.160 everybody is good at heart, even though I do actually 0:19:23.160 --> 0:19:28.400 think that's fundamentally true. What what we're doing is showing 0:19:28.560 --> 0:19:32.960 through this model the devices can advance with relatively little 0:19:33.040 --> 0:19:39.120 upfront costs and with the contribution of many, many members. Yeah, yeah, 0:19:39.119 --> 0:19:41.040 that's a review phrase. It really well. I think that 0:19:41.119 --> 0:19:43.560 people have this self interest which also serves out of 0:19:43.600 --> 0:19:47.879 people's interests, and and it's like, yeah, I've seen it 0:19:47.880 --> 0:19:50.920 in all kinds of open source communities, like we've reported 0:19:50.960 --> 0:19:54.040 before on three D printed guns, which is obviously it's 0:19:54.080 --> 0:19:57.440 kind of a different end of the spectrum. But it's 0:19:57.480 --> 0:20:01.080 fascinating to see this global exchange. And I'm sure you 0:20:01.080 --> 0:20:03.760 have people. You've mentioned that there are people in MYANMA 0:20:03.760 --> 0:20:07.480 who are who are printing your tournic case. Right. We 0:20:07.480 --> 0:20:11.399 were amazed when people from my and mar had reached 0:20:11.400 --> 0:20:15.200 out and said that we've senior tourniquet and we want 0:20:15.240 --> 0:20:18.120 to implement it. We have situation that's very similar to Gaza. 0:20:18.720 --> 0:20:22.320 We thought that's exactly what we want. What they did 0:20:22.520 --> 0:20:26.840 was two things. One they took our instructions and they 0:20:27.000 --> 0:20:30.440 used them, but then they also fed back to us 0:20:30.480 --> 0:20:33.560 how those instructions were incomplete, how they could be better, 0:20:34.080 --> 0:20:37.399 and some design changes that made their lives better. Again 0:20:37.960 --> 0:20:45.560 amazing by them using it, by them taking, they also gave. 0:20:46.440 --> 0:20:50.320 And that's the sort of relationship, the kind of solidarity 0:20:50.359 --> 0:20:54.440 that we've seen. Whatever other people have used our devices, 0:20:55.040 --> 0:20:58.399 we've noticed that they take, and it's it's not a problem. 0:20:58.440 --> 0:21:01.320 If people in me and had just taken and not 0:21:01.400 --> 0:21:04.320 given anything back, that's fine too, because it doesn't take 0:21:04.320 --> 0:21:07.480 anything away from us to share. This is this is 0:21:07.760 --> 0:21:10.919 a kind of sharing where the more you share, the 0:21:10.960 --> 0:21:13.840 more there's potential for benefit, but there's never a loss. 0:21:14.240 --> 0:21:17.280 You never lose by sharing in that sense. We're not 0:21:17.960 --> 0:21:21.840 also trying to present it as though we need people 0:21:21.880 --> 0:21:23.879 to share for us to feel that this model works. 0:21:23.920 --> 0:21:27.119 We don't. But we're already making it anyway. We're already 0:21:27.200 --> 0:21:29.560 using it anyway. We're sharing, and some people help out 0:21:29.680 --> 0:21:33.199 by contributing black and some people don't. It's it seems 0:21:33.240 --> 0:21:36.080 to me to be the most effective way to develop 0:21:36.119 --> 0:21:38.920 devices for low costs and make sure that they get 0:21:38.920 --> 0:21:41.720 out to where they need to be. Yeah, because they 0:21:41.720 --> 0:21:44.760 can century and people who need them can find them. 0:21:44.760 --> 0:21:47.320 As you found out, right like people across the world. 0:21:47.520 --> 0:21:49.919 Do you have a sense of where else they're being used? 0:21:50.400 --> 0:21:53.280 The turnickets right now are being used in Gaza, in 0:21:53.480 --> 0:21:56.880 Ukraine and in me and mar if they're being used 0:21:56.880 --> 0:21:59.080 in other places. Were not really aware of it, but 0:21:59.119 --> 0:22:02.840 people aren't compelled to make us aware of it. Um 0:22:02.880 --> 0:22:07.840 and and all three of those locations have moved forward 0:22:07.840 --> 0:22:13.960 the project tremendously. For example, for Ukraine, Uh, the Ukrainian 0:22:14.080 --> 0:22:18.600 support people weren't really able to contribute so much their 0:22:18.640 --> 0:22:21.280 own ability to construct and make, but they were able 0:22:21.320 --> 0:22:27.080 to contribute really important research, financial and testing capabilities. And 0:22:27.160 --> 0:22:31.520 so of course a project like this costs money. They're like, hey, look, 0:22:31.520 --> 0:22:34.719 you know, we don't have farms print farms, but we 0:22:34.760 --> 0:22:36.879 do have some cash that we want to put into it. 0:22:37.080 --> 0:22:40.440 And we were able to use that money very very effectively, 0:22:40.480 --> 0:22:42.480 more effectively than if they would have bought the pieces. 0:22:43.000 --> 0:22:46.159 Two then create the capacity for them to go and 0:22:46.200 --> 0:22:49.560 make their own turn accounts. Okay, so yeah, let's talk 0:22:49.600 --> 0:22:52.520 about that. That's fascinating and uh, and we could maybe 0:22:52.600 --> 0:22:58.200 contrasted to a sort of another model, right like if um, 0:22:58.440 --> 0:23:00.840 because you you understand you're able to go to Ukraine 0:23:00.880 --> 0:23:05.080 and help them set up as opposed to Yeah, it 0:23:05.080 --> 0:23:07.320 would have taken months, I imagine to do that with 0:23:08.640 --> 0:23:10.840 I don't know how they make the cats, but they 0:23:10.960 --> 0:23:14.320 like they molded or something. But with with a non 0:23:14.359 --> 0:23:17.520 sort of with a non open source, non printed model, 0:23:17.520 --> 0:23:19.760 like to set up a tournicate factory in Ukraine or 0:23:19.800 --> 0:23:22.760