Speaker 1: All right podcast it could happen here. It's a podcast
Speaker 1: about the terrible things that are happening all around the
Speaker 1: world and the wonderful people who are trying to fix them.
Speaker 1: What it is today is a podcast with Trek Lubani
Speaker 1: of Glia. And what really inspired me about the story
Speaker 1: and maybe want to share it with you, is that
Speaker 1: it came out of a really dark place. Terek was
Speaker 1: on the ground in Gaza treating gunshot wound victims, and
Speaker 1: a lot of gunshot wound victims, like I remember reading
Speaker 1: his field testing of the device and just being appalled
Speaker 1: by the number of people who have been shot, a
Speaker 1: lots of them children, and some of the reporting he
Speaker 1: was doing right like, oh, I had this this tornique
Speaker 1: and we were reusing them and they don't work very
Speaker 1: well on the pediatric application because kids shouldn't be shot, right.
Speaker 1: But instead of getting down, he was able to make
Speaker 1: a solution. And I think that's really important, and I
Speaker 1: really like that even through like this dark and terrible
Speaker 1: stuff that we've all had to experience and he experienced
Speaker 1: in Gaza, he was able to see a positive solution
Speaker 1: away to look after people, to move forward in this case,
Speaker 1: to prevent death and preserve life. And I think it's
Speaker 1: easy to focus on the dark stuff. There's enough of
Speaker 1: it happening, but I think it's important to focus on
Speaker 1: the great people who are doing great things to protect
Speaker 1: and care for other people as well. So that's a
Speaker 1: little bit of what we got today, and I hope
Speaker 1: you enjoy it. So I'm here with Tarak Lubani. He's
Speaker 1: from Glia. There, a company came across from I was
Speaker 1: writing about three D printed tornic case. Would you like
Speaker 1: to introduce yourself to us a little bit about Glear
Speaker 1: and what you do there. Thank you so much for
Speaker 1: having me. My name is terrickle Banny. As you had mentioned,
Speaker 1: I'm an emergency physician. I work in Canada in a
Speaker 1: city in Canada called London, and I also work in
Speaker 1: the Gaza strip as an emergency physician as well. Glia
Speaker 1: was really an answer to a problem, the problem being
Speaker 1: that when I see patients in Gaza, they don't get
Speaker 1: the same quality of service that I can give to
Speaker 1: my nations. To that. Of course, that's multi factorial, but
Speaker 1: a big part of that has to do with the
Speaker 1: way in which we as uh that the medical profession
Speaker 1: have medical devices that we don't release, that we don't
Speaker 1: give access to other people to use. And so Glia's
Speaker 1: purpose was to take the most medical devices that doctors
Speaker 1: use and to make sure that they were accessible and
Speaker 1: available to doctors all over the world. Okay, yeah, yeah,
Speaker 1: that's that's very cool. And you make a number of devices, right,
Speaker 1: Like I know that I first called to you about
Speaker 1: the torn ca, but you make also a stethoscope, is
Speaker 1: that right? The stethoscope is the calling card of medicine.
Speaker 1: And so it was the first project that we started
Speaker 1: working on to start the theory. I mean, we started
Speaker 1: with the theory that hey, we can probably make a
Speaker 1: device that's just as good as a three D device,
Speaker 1: but the costs let's say three dollars or even thirty dollars,
Speaker 1: And that was the stuff scope. We tested it, we
Speaker 1: published the results, we proved it was as good as
Speaker 1: the Gold standards, the Litman Cardiology three at the time,
Speaker 1: and often using it both in our own practices also
Speaker 1: making it available other people to make for theirs. Okay, yeah,
Speaker 1: And so that's what's really interesting about your company as
Speaker 1: opposed to other companies, right, you're not necessarily like manufacturing
Speaker 1: and distributing. You are providing the designs that allow other
Speaker 1: people to make them, right, and so can you talk
Speaker 1: about some of their Like, uh, I know that you
Speaker 1: use three D printing, and I want to talk about that.
Speaker 1: But also like I remember seeing that the tubing and
Speaker 1: the cessoscope comes from the a Coca Cola machine, right
Speaker 1: for some of those considerations. Yeah, absolutely, the purposes to
Speaker 1: make these device is available to other people for the
Speaker 1: lowest cost possible, but also like actually be available. It's
Speaker 1: no good if you can make it for twenty cents,
Speaker 1: but the part that required are nowhere. So that's why
Speaker 1: we went with a basket of items that are more
Speaker 1: or less earsily available and we made the stuffoscopes out
Speaker 1: of that. For example, you can probably get the very
Speaker 1: specific kind of earpieces that most stuffoscopes have, but they
Speaker 1: are naturally going to be less available and less abundant
Speaker 1: than if you were to use regular earbuds the contact phones.
Speaker 1: There are way more headphones out there than there are stuffoscopes. Therefore,
Speaker 1: those parts are more available, even if, of course there
Speaker 1: they are less expensive. But even if they were slightly
Speaker 1: more expensive, it would be worth it. What we really
Speaker 1: take away is the monopoly and the profit motive, and
Speaker 1: so by doing that, or rather, let's say the ex
Speaker 1: orbitant profit that medical device companies are making, and by
Speaker 1: doing that, we're really able to realize the promise of patents.
Speaker 1: All of the devices that we make were patented at
Speaker 1: one point. The promise of patents is that when the
Speaker 1: patent is over, you'll get a cheap device, but that
Speaker 1: promise is not realized. The stethoscope is a three hundred
Speaker 1: year old device basically, and the fact that it is
Speaker 1: not available at the highest quality except for three kind
Speaker 1: of nuts. So that's why we started there, and of
Speaker 1: course moved on to more and more complicated devices, much
Speaker 1: more complicated even than the tourniquet. By now, okay, yeah,
Speaker 1: can you I remember reading because you have you you
Speaker 1: kept a blog. I remember on like medium where you
Speaker 1: talked about testing the tourniquet when when you were in Gaza,
Speaker 1: and it just a like, you know, if you read
Speaker 1: medical literature then it did. This was just the shocking
Speaker 1: I remember being absolutely shocked by the number of casualties
Speaker 1: you ring unting encountering, and then also like you were saying,
Speaker 1: like the the lack of available tools. So perhaps you
Speaker 1: could explain like a little bit of what you saw
Speaker 1: there and then how these tournicates have been able to
Speaker 1: help you address that like massive disparity and access to care.
Speaker 1: The turniket project really started in Gaza because we noticed
Speaker 1: that after one of the wars, the war in two
Speaker 1: thousand fourteen, that we had a particularly high casualty rate,
Speaker 1: of course, but of that there were many deaths that
Speaker 1: we would classify as preventable. That's where we felt that
Speaker 1: had turnikets been available, those patients likely wouldn't have died. Um.
Speaker 1: When we started working on it, of course, we knew
Speaker 1: at some point there'd be another war. It is it
Speaker 1: is very common in Gaza for there to be attacked
Speaker 1: by the Israelis. We didn't anticipate for it to happen
Speaker 1: so fast and for it to happen in a way
Speaker 1: where the turnicket was so necessary. That, of course, was
Speaker 1: what what's called the Great March of Return, where Palestinians
Speaker 1: protested on mass and one of the Israeli responses was
Speaker 1: to shoot live fire at the protesters, often targeting About
Speaker 1: eight percent of the hits were targeting the arms and
Speaker 1: the likes, which is where turnickets are the most effective.
Speaker 1: So the high number really is owing to the way
Speaker 1: in which the Israeli has decided to deal with this
Speaker 1: protests and the fact that it was a protest rather
Speaker 1: than a specific war. And that meant also that we
Speaker 1: could predict with the relative degree of accuracy where the
Speaker 1: injuries would be, which meant that it was even more
Speaker 1: important to have the right equipment of the right training.
Speaker 1: It was part of an overall strategy. So of course
Speaker 1: it's not like turnikets were the thing that saved lives.
Speaker 1: Tourniquets were part of a campaign to train paramedics and
Speaker 1: to train doctors and how to stop bleeding in these
Speaker 1: kinds of injuries, and they were one of the most
Speaker 1: important tools in that campaign, but only part that campaign. Yeah,
Speaker 1: of course, of course you need other tools and obviously
Speaker 1: their education and you can't just slap it on and
Speaker 1: then the person's fine, right, Obviously there's a lot of
Speaker 1: care afterwards which is important to And can you maybe
Speaker 1: talk us through You talked about like the promise of patents, right,
Speaker 1: and I think this is important in exactly what we're
Speaker 1: talking about in tornic its because it's a little different
Speaker 1: to like medic medicines, right, it's a little different with
Speaker 1: medical devices. So there are existing torn kits on the
Speaker 1: market right and I think the sort of market leading
Speaker 1: one is the CAT. Can you explain, like why at
Speaker 1: those not getting to people who need them desperately in
Speaker 1: these areas The problem with the turnickets that are available
Speaker 1: right now, it kind of falls into a few different categories.
Speaker 1: North American Rescue the makers of CAT have two key
Speaker 1: patents on the Cat, and as far as we can tell,
Speaker 1: just based on the posture of the company, if anybody
Speaker 1: else were to make exact Cat replicas, they will be suited.
Speaker 1: The people who are willing to then make exact Cat
Speaker 1: replicas tend to be people who are unaccountable and largely
Speaker 1: have not much to lose, and so that's why we
Speaker 1: saw a glut initially, for example, with the Ukraine campaign
Speaker 1: of tourniquets that that were relatively low quality. And so
Speaker 1: you can't just make the device. You also have to
Speaker 1: know that the device will work, because you don't want
Speaker 1: to discover that when you put it on armor alike
Speaker 1: and then it fails. Gaza is an acid test of
Speaker 1: all of these things, because not only our devices generally
Speaker 1: not available or expensive, it's kind of at the bottom
Speaker 1: of any purchase list, for example, but also in Gaza,
Speaker 1: there's a complete international blockade Israeli led, of course, but
Speaker 1: there are other countries that are that are contributory, and
Speaker 1: that blockade means that equipment can't get in so long
Speaker 1: as the Israelis deem it to be of military value. Um.
Speaker 1: This is where things like dual use devices and so
Speaker 1: on come into play. The tourniquet is a medical device.
Speaker 1: It is it can only be a medical device. There
Speaker 1: is no second use, and so it should be exempt. However,
Speaker 1: even if the Palestinians could afford fifty U S dollars
Speaker 1: per units, which should be the cost to get one in,
Speaker 1: the Israelis won't let them in. So de facto, even
Speaker 1: though they shouldn't be banned, they are de facto banned,
Speaker 1: and that means that not only can we depend on
Speaker 1: cheap Chinese retailers. Let's say to give us replica turniquets,
Speaker 1: we actually have to manufacture them ourselves. When we open
Speaker 1: sourced our designs, it was with an eye to two things.
Speaker 1: One making it available so that the replica makers can
Speaker 1: make higher quality replicas. They're already making replicas, we may
Speaker 1: as well give them a legal replica rather than a
Speaker 1: patent break busting replica. Not that I think there's anything
Speaker 1: wrong with that in these cases where there's emergencies, but
Speaker 1: just the same Glia's tourniquet doesn't break any patents. And
Speaker 1: at the same time, in addition to giving them the
Speaker 1: ability to make high quality turnikets, we can also make
Speaker 1: high quality turnikets locally and domestically. Because of course, national liberation,
Speaker 1: as it were in the medical device space can't come
Speaker 1: if you can't make your own devices. We discovered that
Speaker 1: during COVID. The Palestines have known that for decades now,
Speaker 1: and we're kind of rediscovering it in Ukraine where there
Speaker 1: just aren't enough turnickts and so they are forced to
Speaker 1: improvise or except tourniquets that they don't want to accept,
Speaker 1: right Yeah, Like I think I think COVID was this
Speaker 1: great example that we can't continue to rely on the
Speaker 1: sort of winds of global capital to provide things that
Speaker 1: we need to survive. I think you're manufacturing is fascinating
Speaker 1: because you're using essentially commonly available materials in the three
Speaker 1: D printeries that right, Yeah, that's correct. I mean we're
Speaker 1: not against using other things they just have to be
Speaker 1: very simple. For example, are electronics use PCBs. You can't
Speaker 1: three D print electronic circuits just yet, so we use PCBs.
Speaker 1: But when we design our PCBs, there are a couple
Speaker 1: of ways to design it. You can design an eight
Speaker 1: layer board that can only be manufactured in one or
Speaker 1: two places in the world, or you can design a
Speaker 1: board that's three times the size but can be manufactured
Speaker 1: anywhere in the world. And when you're talking about credit
Speaker 1: card sized devices, if it's notebook size instead of credit
Speaker 1: card size, it doesn't really matter that much. For example,
Speaker 1: the example i'm thinking of here as an electric cardiogram,
Speaker 1: where we took a device that had failed um in
Speaker 1: the sort of market that they the maker's open source
Speaker 1: and they had intended it to be a fitness device,
Speaker 1: and then it didn't work. A company went bankrupt, and
Speaker 1: so they open sourced it. So we looked at their
Speaker 1: schematics all of the problems that they had already solved.
Speaker 1: We said, okay, the problem we're going to solve is
Speaker 1: to make it so that this can be manufactured in
Speaker 1: a high school electronics lab. And we were able to
Speaker 1: achieve that it was bigger, it was twice as big,
Speaker 1: But who cares? The old one was half the size
Speaker 1: of a credit card? You know who cares? You make
Speaker 1: it a little bit bigger. But at the same time, um,
Speaker 1: you make it much more accessible, twice as big, twenty
Speaker 1: times more accessible. I know some of your staff like
Speaker 1: your tony cats. It's really um. There's not much or
Speaker 1: any really of a performance trade off from what you've seen, right. Indeed,
Speaker 1: they might be better for some pediatric applications if I
Speaker 1: remember correctly that that's right. So when you think of
Speaker 1: the way in which corporate devices are made, they are
Speaker 1: made to the specifications of particular buyers. And the buyers
Speaker 1: are the people who have the money. Who's the buyer
Speaker 1: for tourniquets? When you think about who needs tourniquets consistently,
Speaker 1: who do you who has money to give you turnickets?
Speaker 1: Who should you market too? There's only one sane answer,
Speaker 1: and that is First world militaries, especially occupation militaries or
Speaker 1: militaries that are engaged in UH ground level warfare, who
Speaker 1: are expected to take small arms or i e. D s.
Speaker 1: And so there are not many children who you have
Speaker 1: to sell to in that particular market. There aren't many
Speaker 1: small women or even women at all they have to
Speaker 1: sell to in that market. So I don't think that
Speaker 1: North American rescues engineers would have any trouble making sure
Speaker 1: that their turnickets worked amazingly well for children. But why
Speaker 1: why would they spend one to million dollars doing that
Speaker 1: work and research when that's not their audience and that's
Speaker 1: not their buyer. For us, the normal person, the civilian
Speaker 1: is uh in quotation marks bire. They're not the ones buying,
Speaker 1: but they're the ones who are the main consumer, and
Speaker 1: so they're the ones who we target. In Gaza specifically
Speaker 1: of the population is under the age of fourteen. You'd
Speaker 1: have to be crazy to go out there and put
Speaker 1: a tourniquet out that only works on big, burly men.
Speaker 1: So that's that's why we were we were driven to
Speaker 1: do that. And as for the performance traight offs, yeah,
Speaker 1: you're right. The the what we learned about spec sheets
Speaker 1: on lots of these devices is that they're made up.
Speaker 1: There isn't really a great way to know how well
Speaker 1: elterni it works. Unfortunately, there isn't a really great way
Speaker 1: to know how well stuffoscope works. And so some of
Speaker 1: the first work we did was actually designing some tests
Speaker 1: so that we can say, okay, well here's how you
Speaker 1: prove that the stuffoscope works as well as that stuffoscope,
Speaker 1: or here's how you prove that you know this works
Speaker 1: as well as that. And those testing protocols we made
Speaker 1: them open source and easily available too. For example, if
Speaker 1: you want to test the stethoscope, you can do that
Speaker 1: with a pair of headphones, a microphone, and the Hello
Speaker 1: Kitty balloon. That's how we did it originally. Could we
Speaker 1: have spent ten dollars making that test right, Yeah, we
Speaker 1: could have, but that wouldn't have helped us in terms
Speaker 1: of helping other people make stutoscopes wherever they are. Yeah,
Speaker 1: that's very cool. And then by open sourcing that test,
Speaker 1: you allow for other people who have ideas or sort
Speaker 1: of models for their own improvements or different designs, that
Speaker 1: they can then use that test right and continue to
Speaker 1: improve and share their improvements with others. I do not
Speaker 1: want to work on stethoscopes anymore. I want to people
Speaker 1: to take it up. And it doesn't mean that I won't,
Speaker 1: of course I will. But my favorite thing is when
Speaker 1: somebody sends a message and says, hey, I like what
Speaker 1: you've done. Here's how I think it could be better.
Speaker 1: I love those messages. I love them. And you know what,
Speaker 1: nine out of ton of those ideas don't work out.
Speaker 1: They don't pan out. But like our stethoscope, since two
Speaker 1: thousands seventeen, all of the improvements have been from other
Speaker 1: people because we haven't had the time and money to
Speaker 1: work on it. But we have been open minded, have
Speaker 1: incorporated lots of design changes that other people in the
Speaker 1: community have suggested. That's a good thing. It's good for everybody. Yeah,
Speaker 1: I think it does an excellent job at getting it.
Speaker 1: They like their fundamental conceit of our Dragon device development model, right,
Speaker 1: which is that which isn't true actually that there's massive
Speaker 1: R and D costs and those R and D costs
Speaker 1: have to be recouped by charging a massive amount for
Speaker 1: a period of time and making access to that medicinal
Speaker 1: device a privilege, not right, and then eventually the costs
Speaker 1: will come down they often don't, and then everyone will
Speaker 1: have active to this thing. And it's like, it's been
Speaker 1: my experience that it doesn't work that way. But what
Speaker 1: you've shown is an alternative right that people want to
Speaker 1: help and that that they don't that there's not a
Speaker 1: need for this like price gouging to facilitate the improvement
Speaker 1: in this technology. Is that fair? We're not taking a
Speaker 1: really altruistic model here. People are generally improving the stethoscope
Speaker 1: for their own uses, so there is a self interested
Speaker 1: aspect if you want to present it that way. What
Speaker 1: we realized is that actually the most useful way to
Speaker 1: develop a device is to make it as good as
Speaker 1: possible and release it and then have other people who
Speaker 1: want to improve it have a capacity to share back
Speaker 1: to you. So as much as I I believe in
Speaker 1: altruism and I do think every time that I've seen
Speaker 1: people collaborate, I've seen a tremendous amount of it, this
Speaker 1: more resembles the open source software model, where which is
Speaker 1: actually the world I came from. I came from the
Speaker 1: free software model, where yes, you do things just for
Speaker 1: the fun of it, but also very large corporations are involved.
Speaker 1: For example, some of the stuffoscope's improvements happened because the
Speaker 1: lab needed to use it for some experiments on animals,
Speaker 1: and so they made modifications and they fed them back amazing,
Speaker 1: that's fantastic, And but that that was totally self interested,
Speaker 1: that they knew that it would cost them significantly less
Speaker 1: to build on our work, and it would cost them
Speaker 1: nothing to share back their their contributions. So it's you know,
Speaker 1: we're not going out there trying to to prove that
Speaker 1: everybody is good at heart, even though I do actually
Speaker 1: think that's fundamentally true. What what we're doing is showing
Speaker 1: through this model the devices can advance with relatively little
Speaker 1: upfront costs and with the contribution of many, many members. Yeah, yeah,
Speaker 1: that's a review phrase. It really well. I think that
Speaker 1: people have this self interest which also serves out of
Speaker 1: people's interests, and and it's like, yeah, I've seen it
Speaker 1: in all kinds of open source communities, like we've reported
Speaker 1: before on three D printed guns, which is obviously it's
Speaker 1: kind of a different end of the spectrum. But it's
Speaker 1: fascinating to see this global exchange. And I'm sure you
Speaker 1: have people. You've mentioned that there are people in MYANMA
Speaker 1: who are who are printing your tournic case. Right. We
Speaker 1: were amazed when people from my and mar had reached
Speaker 1: out and said that we've senior tourniquet and we want
Speaker 1: to implement it. We have situation that's very similar to Gaza.
Speaker 1: We thought that's exactly what we want. What they did
Speaker 1: was two things. One they took our instructions and they
Speaker 1: used them, but then they also fed back to us
Speaker 1: how those instructions were incomplete, how they could be better,
Speaker 1: and some design changes that made their lives better. Again
Speaker 1: amazing by them using it, by them taking, they also gave.
Speaker 1: And that's the sort of relationship, the kind of solidarity
Speaker 1: that we've seen. Whatever other people have used our devices,
Speaker 1: we've noticed that they take, and it's it's not a problem.
Speaker 1: If people in me and had just taken and not
Speaker 1: given anything back, that's fine too, because it doesn't take
Speaker 1: anything away from us to share. This is this is
Speaker 1: a kind of sharing where the more you share, the
Speaker 1: more there's potential for benefit, but there's never a loss.
Speaker 1: You never lose by sharing in that sense. We're not
Speaker 1: also trying to present it as though we need people
Speaker 1: to share for us to feel that this model works.
Speaker 1: We don't. But we're already making it anyway. We're already
Speaker 1: using it anyway. We're sharing, and some people help out
Speaker 1: by contributing black and some people don't. It's it seems
Speaker 1: to me to be the most effective way to develop
Speaker 1: devices for low costs and make sure that they get
Speaker 1: out to where they need to be. Yeah, because they
Speaker 1: can century and people who need them can find them.
Speaker 1: As you found out, right like people across the world.
Speaker 1: Do you have a sense of where else they're being used?
Speaker 1: The turnickets right now are being used in Gaza, in
Speaker 1: Ukraine and in me and mar if they're being used
Speaker 1: in other places. Were not really aware of it, but
Speaker 1: people aren't compelled to make us aware of it. Um
Speaker 1: and and all three of those locations have moved forward
Speaker 1: the project tremendously. For example, for Ukraine, Uh, the Ukrainian
Speaker 1: support people weren't really able to contribute so much their
Speaker 1: own ability to construct and make, but they were able
Speaker 1: to contribute really important research, financial and testing capabilities. And
Speaker 1: so of course a project like this costs money. They're like, hey, look,
Speaker 1: you know, we don't have farms print farms, but we
Speaker 1: do have some cash that we want to put into it.
Speaker 1: And we were able to use that money very very effectively,
Speaker 1: more effectively than if they would have bought the pieces.
Speaker 1: Two then create the capacity for them to go and
Speaker 1: make their own turn accounts. Okay, so yeah, let's talk
Speaker 1: about that. That's fascinating and uh, and we could maybe
Speaker 1: contrasted to a sort of another model, right like if um,
Speaker 1: because you you understand you're able to go to Ukraine
Speaker 1: and help them set up as opposed to Yeah, it
Speaker 1: would have taken months, I imagine to do that with
Speaker 1: I don't know how they make the cats, but they
Speaker 1: like they molded or something. But with with a non
Speaker 1: sort of with a non open source, non printed model,
Speaker 1: like to set up a tournicate factory in Ukraine or
Speaker 1: Poland would take months, right, yes, absolutely, but you're not
Speaker 1: going to There's two reasons why North American Rescue I'll
Speaker 1: just call them now from here on out, won't do that.
Speaker 1: One of them is that that conflict at some point
Speaker 1: will end. It's very expensive to set up production lines.
Speaker 1: And the other thing is the more tourniquets you put
Speaker 1: into the market, the cheaper tourniquets get, you know, supply
Speaker 1: and demand. Like we learned that one pretty well from capitalism.
Speaker 1: And so they have an inherent disincentive, whether they recognize
Speaker 1: it or not, whether it's conscious or not. North American
Speaker 1: Rescue and all these companies have an inherent disincentive in
Speaker 1: flooding the market with tourniquets, whereas we do not for us.
Speaker 1: It's the opposite. The more people we lose pretty much
Speaker 1: Glia loses about ten to twenty dollars per tourniquet that
Speaker 1: we manufacture, we have no incentive to keep doing it,
Speaker 1: and we want other people to do it because we
Speaker 1: want as many tourniquets to be provided as possible. What
Speaker 1: we do then is we heavily subsidize the tourniquets using
Speaker 1: our own internal funds and and fundraising that that we
Speaker 1: do with the goal of getting them out there so
Speaker 1: that deaths can be prevented. And so we want other
Speaker 1: people producing. When I go there, every tourniquet somebody else
Speaker 1: makes instead of me is less headache for me, is
Speaker 1: less pain for me, and is less financial loss for
Speaker 1: me and for Glea. Of course, so our incentives are different.
Speaker 1: They want a shortage consciously or not, and we want
Speaker 1: an abundance. We want everybody to have tourniquet in their pocket.
Speaker 1: Now that's that's our goal. Yeah, Can you talk a
Speaker 1: little bit about your experiences in Ukraine? You with that
Speaker 1: pretty recently, right, Ukraine is a very very complicated subject
Speaker 1: when it comes to tourniquets, because the tourniquet wasn't at
Speaker 1: this h I'm gonna mind my words very carefully. I'm
Speaker 1: not Ukrainian, I'm not a Ukrainian doctor, and my experience
Speaker 1: there is very limited. I am in solidarity with the
Speaker 1: medical community in Ukraine, and part of being in solidarity
Speaker 1: with a medical community is recognizing that even when there
Speaker 1: are weaknesses, it is not my place to insert myself
Speaker 1: into their processes. And so the way that the Ukrainians
Speaker 1: have approached tourniquets is at the outset to ban all
Speaker 1: three the printed tourniquets, and two basically make it so
Speaker 1: that only what they considered to be high quality tourniqts,
Speaker 1: mainly the CAT and another another one or two models
Speaker 1: were available in there. This unfortunately created a tremendous shortage,
Speaker 1: and the other thing that functionally happened was a disconnect
Speaker 1: between the policy makers within the medical community and the
Speaker 1: people on the ground. The people on the ground, of course,
Speaker 1: are doing whatever they can to provide care wherever they can,
Speaker 1: and the policy makers are a little bit more disconnected
Speaker 1: from that and so have different considerations. The shortage then
Speaker 1: creates this um difficulty. You know, there are of course
Speaker 1: three D printed tourniquets aren't accepted officially in Ukraine, but
Speaker 1: there are an abundance of three D printed tourniquets in
Speaker 1: Ukraine because the people on the ground are accepting them
Speaker 1: um and what we see is a kind of grassroots
Speaker 1: experimentation with how it is that we can prevent deaths.
Speaker 1: The other difficulty is that tourniquets are a tool, and
Speaker 1: in bad hands, this tool isn't going to work, even
Speaker 1: if it's a great tool. And so one of the
Speaker 1: things that I realized, and I think everybody at this point,
Speaker 1: I'm not saying anything that's new or unknown to the community,
Speaker 1: we all realize that without appropriate training and how to
Speaker 1: use a tourniquet, they're not going to work um. And
Speaker 1: so even high quality tourniquets out there in the field
Speaker 1: are failing because they're being used improperly and it's causing
Speaker 1: unnecessary deaths. So I don't know how deep you want
Speaker 1: to get into that experience in Ukraine, but I think
Speaker 1: what we can say is that it's important to be
Speaker 1: in solidarity with that community, and as such, we're providing
Speaker 1: them all of the experience that we have and all
Speaker 1: of the capability that we have to produce tourniquets that
Speaker 1: the Ukrainians themselves, both officially and on the in the
Speaker 1: front lines, are able to use and feel are actually
Speaker 1: safe for their patients. Yeah. Yeah, that's a difficult situation.
Speaker 1: I think. Obviously a lot of what's happening in Ukraine
Speaker 1: has been necessarily like like rushed, and it's somewhat perhaps
Speaker 1: chaoticism it's the wrong word, but it took a while
Speaker 1: for people to fully sort of understand that the necessities
Speaker 1: of the scale and the scale of the conflict, or
Speaker 1: perhaps understand this is still the wrong word. But yeah,
Speaker 1: to come up with the most of the way to
Speaker 1: do the least harm. I guess that's such a great
Speaker 1: way of to frame it. And I think even from
Speaker 1: your experience as you see that very often in these
Speaker 1: situations that's the name of the game. It's not even
Speaker 1: doing what you know is best, but rather figuring out
Speaker 1: what the least horst scenario is. Yeah, yeah, so often,
Speaker 1: I think, and it's very easy I think Tom to
Speaker 1: look backseat drive feeds things right from from positions of
Speaker 1: safety and sort of a plenty, you know, to say, oh,
Speaker 1: what should then they should do that, which I think
Speaker 1: you did very well to explain that the first and
Speaker 1: most important thing is to be instolidarity with the people
Speaker 1: there and to hopefully allow their experience to guide us
Speaker 1: in how we can best help them to to prevent
Speaker 1: death prevent harm. And so, can you talk about what
Speaker 1: you were able to do there, what sort of interventions
Speaker 1: could you make to hopefully help prevent more dying. The
Speaker 1: main thing that that we did in terms of so
Speaker 1: I kind of was there in with two hats on.
Speaker 1: One of them was the trying to get manufacturing hat,
Speaker 1: and the other one was as an emergency doctor. Because remember,
Speaker 1: fundamentally what brought me to medical devices in the first
Speaker 1: place was that I was an emergency doctor having problems
Speaker 1: actually caring for my patients. As a tourniquet manufacturer basically
Speaker 1: was about engaging with other people who are making and
Speaker 1: using tourniquets to understand some of the roadblocks and problems.
Speaker 1: One of the biggest ones is that there isn't a
Speaker 1: great way to test units of tournikets. So traditionally tourniquets
Speaker 1: are tested by design. Uh Nar says, here's our design
Speaker 1: and here's how we tested it, and then we accept
Speaker 1: that this particular company will make this particular device to
Speaker 1: this particular standard. But in the Ukraine, especially with the
Speaker 1: presence of replicas and three D two tourniquets, there became
Speaker 1: a new problem, how do you test each unit rather
Speaker 1: than a specific line, and working on that, I don't
Speaker 1: know how into the leads you want me to get,
Speaker 1: but working on that is still a problem that is unsolved,
Speaker 1: but has been one of the biggest issues that we've
Speaker 1: been dealing with on the emergency medicine side. Of course,
Speaker 1: when I provide direct care to patients, I was in
Speaker 1: a hospital on one of the communities, on the front line,
Speaker 1: on one of the fronts, and so providing direct care
Speaker 1: became important. And working with the doctors, many of whom
Speaker 1: didn't really experience that much have that much experience with
Speaker 1: trauma patients, so working with them to share our experiences
Speaker 1: from GAZA in low resource trauma medicine, and also to
Speaker 1: gain from them their experiences because of course their scenarios
Speaker 1: and situations are different. It's more artillery based rather than
Speaker 1: small arms fire or um sort of bombing based, so
Speaker 1: they're there are different scenarios. I had a lot to
Speaker 1: learn from them. I did, and UM I tried to
Speaker 1: contribute some of our experiences as well. The training I
Speaker 1: think is probably the number one problem right now, but
Speaker 1: that's my personal opinion. Is one doctor who is there
Speaker 1: for a limited period of time so that that individual
Speaker 1: unit tests that you're you're working towards is um because
Speaker 1: I know in theory, at least a CAT it's a
Speaker 1: single youth device, right and so in theory, if you
Speaker 1: if you just slapped it on something that could mess
Speaker 1: your pressure, and Titan did that. Devices and being used
Speaker 1: and shouldn't be used again to provide care. Is that
Speaker 1: the bottom that you're running up against, or is it
Speaker 1: sort of making a way to test things it's replicable
Speaker 1: and cheap and accessible. Reusability was the number one problem
Speaker 1: that we tried to tackle in Gaza because we couldn't
Speaker 1: print tourniquets as fast as they're being used, and so
Speaker 1: we re used them up to ten times. And when
Speaker 1: I was in the hospital, I walked by this I
Speaker 1: V pole with a bunch of turniquets hanging from it,
Speaker 1: and I instantly recognized what I was looking at. That
Speaker 1: was a tourniquet rewashed station in which tourniquets that came
Speaker 1: off of patients who were being rewashed, dried, and then
Speaker 1: sent back out into the field, whatever you think the
Speaker 1: standards are for tourniquet. When there's this level of of shortage,
Speaker 1: that's what's going to happen. That's what happened in Gaza,
Speaker 1: and that's why happened in the Ukraine. That's what I
Speaker 1: saw in my own eyes. Of course, we don't need
Speaker 1: to stretch that far anymore to recognize us. What were
Speaker 1: people doing with the ninety five masks two years ago
Speaker 1: in my hospital. We were holding them, storing them, watching them,
Speaker 1: reusing them. So this is something that we see whenever
Speaker 1: there's a shortage, and it makes the unit testing that
Speaker 1: much more important because if you could take an already
Speaker 1: used tourniquet and assure that it will succeed the next
Speaker 1: time it's being used, that is so valuable, so valuable,
Speaker 1: and it cuts down every tourniquet you can reuse as
Speaker 1: a tourniquet. You don't have to import, you don't have
Speaker 1: to buy, you don't have to package, you don't have
Speaker 1: to ship over all of these lines. Yeah, yeah, of course,
Speaker 1: and I think it's probably we should probably address like
Speaker 1: the the ways in which they can fail because I think, uh,
Speaker 1: look it just people in the United to State if
Speaker 1: in an extremely like resource Ridge setting right, we'll probably
Speaker 1: have knowingly or unknowingly acquired to want to get on
Speaker 1: Amazon or somewhere else eBay that that might not be
Speaker 1: a real one, and so I want it's real, but
Speaker 1: we might not be a reliable one. Can you explain
Speaker 1: like like how they fail and what the consequences of
Speaker 1: that failure. Ah, there are two kinds of failures when
Speaker 1: we talk about turniquets. One of them is what we
Speaker 1: would call a technical failure, and the other one is
Speaker 1: a clinical failure. A technical failure is the easiest one
Speaker 1: for most people to spot. The tourniquet literally breaks in
Speaker 1: your hand. And that said, you hear a crack, you
Speaker 1: see something crack, you see a break, things fall apart
Speaker 1: the end. And so one of the things that we
Speaker 1: we want is to minimize these by over engineering. So,
Speaker 1: for example, the first Glia tourniquet was engineered to spec
Speaker 1: you're supposed to be able to turn it three times,
Speaker 1: and so we made it so you can turn it
Speaker 1: three times. And then what I realized is that even I,
Speaker 1: who is like super well trained, I would be in
Speaker 1: the field running while my eyes were full of tear gas,
Speaker 1: while people are shooting and I didn't. I'd forget did
Speaker 1: I turn it two times? Three times? So we over
Speaker 1: we started over engineering the tourniquets. At a certain point.
Speaker 1: Of course, every TURNIKID is going to break. You turn
Speaker 1: it enough times, every turniquet is going to break. But
Speaker 1: that's not necessarily going to be the case if you
Speaker 1: have even a moderate amount of training. I'm going to
Speaker 1: turn it for five times, but I'm not going to
Speaker 1: turn it twenty times. So the technical failures are one
Speaker 1: kind of failure. The other one is clinical failure. Now
Speaker 1: here's something that I wonder if you knew about thirty
Speaker 1: tourniquets from the gold Standard Company fail They fail on application,
Speaker 1: and that number goes up to if you were to
Speaker 1: check sixty seconds after application. So what does this tell us?
Speaker 1: What this tells us is clinical failure is actually the
Speaker 1: important marker here because we know turniquets break, and we
Speaker 1: know turniquets fail in general, especially turnickets that have been
Speaker 1: in some g i's pocket in Afghanistan for six months.
Speaker 1: Those ones that their failure rate can go even higher.
Speaker 1: And so what we train people to do is to
Speaker 1: recognize clinical success. Put on a tourniquet, did the blood stop? No?
Speaker 1: Put on a second turniquet, did the blood stop? No,
Speaker 1: try a third one if you have them, obviously, and
Speaker 1: so the routine training involves applying a second tourniquet. And
Speaker 1: one of the like happiest moments for me, I mean,
Speaker 1: this is obviously bitter sweet, but it was when I
Speaker 1: saw a patient who was brought in by a medic
Speaker 1: who I had I had been in the training four
Speaker 1: and he had applied to turniquets to a guy who
Speaker 1: certainly would have died had he had he not had
Speaker 1: the tourniquet up flights on and I was exaguinating so
Speaker 1: much injury so severe that he needed a couple of
Speaker 1: turnickets to really get it under control. So it's it's
Speaker 1: where we have to recognize that there is no magic tool.
Speaker 1: This is part of an overall program. There's no three
Speaker 1: D printer that's going to train people just going to
Speaker 1: make you stuff. Then you have to do the rest
Speaker 1: of it, right Yeah. Yeah, So I think if we, uh,
Speaker 1: we should look maybe at the fact that like I
Speaker 1: live in the United States and you're in Canada, and
Speaker 1: I think there were like three mass shootings yesterday, right
Speaker 1: that the that the threat of violence is certainly added
Speaker 1: high for recent times in for a why a modiverse
Speaker 1: range of people. Right, There's always been violence in this country.
Speaker 1: There's always been violence against certain groups of people disproportion
Speaker 1: in this country. But people are probably more concerned with
Speaker 1: treating constria wounds and they would have been years ago.
Speaker 1: And so if someone was looking to make one of
Speaker 1: your devices, how can they do that? And they show
Speaker 1: or do their best to ensure that they are doing
Speaker 1: so in a way which gives them the best chance
Speaker 1: of success. At the moment, I would say to the
Speaker 1: individual maker, don't do it, not for a life threatening situation.
Speaker 1: If individual individual makers want to make turnikets, then they're
Speaker 1: going to have to be proficient at three big things.
Speaker 1: One of them is plastics three D printing, ensuring that
Speaker 1: the quality of the plastic is good. The other one
Speaker 1: is sewing, that is to say, assembling sold stuff. And
Speaker 1: the third one is is quality assurance, because even done perfectly,
Speaker 1: a certain number of tourniquets aren't going to make it.
Speaker 1: And that quality assurance is both at the moment of
Speaker 1: manufacture and then over time, because of course all devices
Speaker 1: deteriorate over time, but tourniquets have such an import role
Speaker 1: that you have to check them periodically to make sure
Speaker 1: everything is okay. So I would say to the individual maker,
Speaker 1: don't or if you do, do it as an exercise
Speaker 1: rather than as an actual tool. If somebody is in
Speaker 1: an emergency situation, there's nothing they can do except to
Speaker 1: do it, then be in touch with us. So, for example,
Speaker 1: there are makers in in countries that have been in
Speaker 1: touch and have said, okay, look, I have to do
Speaker 1: this because the situation here is bad. We support them
Speaker 1: as best as we can. We try to send people
Speaker 1: out to them, or we try to have them ship
Speaker 1: units to us. We try to get them up and going.
Speaker 1: Glia is not a medical device manufacturer. GLIA is a
Speaker 1: access to medicines and access to medical devices company, and
Speaker 1: part of that is making sure that people who are
Speaker 1: making medical devices are doing them to the highest possible quality.
Speaker 1: So if you are forced to make them, be in
Speaker 1: touch with us, we will help in any way that
Speaker 1: we can. However, there's another category of people, and that
Speaker 1: is manufacturers who already know how to make medical devices.
Speaker 1: To those people, we say, take our stuff, please use
Speaker 1: it please. It is there for the taking, and it
Speaker 1: is high quality, it works really well, and if it's
Speaker 1: missing something, tell us we'll make it better for you
Speaker 1: and for us. Yeah, that's great. I think that's really
Speaker 1: excellent advice and perhaps a good note for us to
Speaker 1: finish on. Where can people find you if they want
Speaker 1: to get in touch, if they if they want to
Speaker 1: look at some of the devices like making a stethoscope,
Speaker 1: I imagine could be like a fun project and put
Speaker 1: a lot less potential risk there. So where can they
Speaker 1: find that stuff? Absolutely, the stethoscope is such a fun project.
Speaker 1: It's fun because any everybody has a heart in general,
Speaker 1: and um you can listen to your family and friends
Speaker 1: and loved ones that It's one of my favorite things
Speaker 1: when I'm in practice and I listen for sometimes patient
Speaker 1: will be there with their son or daughter or child,
Speaker 1: and I'll tell the kid, you want to listen to
Speaker 1: mommy's heart, your daddy's heart. It's one of the best things.
Speaker 1: So the stethoscope is a great, fun, low risk project.
Speaker 1: Please go ahead and do it. Make it. You can
Speaker 1: find our stuff anywhere you can find printiple stuff. It's
Speaker 1: on thingy versuss on principles, it's basically everywhere or through
Speaker 1: our GETH hub or on the GLIA site. So that's
Speaker 1: CLIA dot org and if people want to participate, they're
Speaker 1: very welcome to We always want, need and love help,
Speaker 1: and of course it's a community. You can never have
Speaker 1: too many friends, so we're always looking for more friends
Speaker 1: and love to see more people. We have a matter
Speaker 1: most obviously, it's not just our devices that are open source.
Speaker 1: We try to make our tire stack open source so
Speaker 1: people can join and chat with us and you know,
Speaker 1: hang out with people who are doing really, really cool
Speaker 1: and super impressive stuff. At this point, I love to
Speaker 1: recognize the fact that I'm one of the least productive,
Speaker 1: least impressive people at clear Really the work that's happening
Speaker 1: is amazing, and it's led by lots of smart, dedicated,
Speaker 1: visionary people. Yeah, that's great to hear that. It's really
Speaker 1: cool that you can we can work with people as well,
Speaker 1: So hopefully people do get in touch. I'm sure there'll
Speaker 1: be someone who's interested in what you're doing but has
Speaker 1: something to contribute in some fashion. Yeah, thank you so
Speaker 1: much for giving us some of your evening. Is there
Speaker 1: anything else you'd like to say before we finish up.
Speaker 1: I think the most important thing to say is that
Speaker 1: there's this mystique that people develop you alluded to it earlier.
Speaker 1: There's a mystique people develop around medical devices. Medical devices
Speaker 1: are solutions to problems, and they were made by people
Speaker 1: like me who don't know what the hell they're doing sometimes,
Speaker 1: and so let's not you know, aggrandize or like separate
Speaker 1: ourselves from the people who are doing this work. Yes
Speaker 1: we have to be just, Yes we have to be vigorous,
Speaker 1: but at the same time we can all contribute to
Speaker 1: be a part of this very cool And can people
Speaker 1: find you personally anyway? Do you have social media that
Speaker 1: that people could follow. Yeah, if people look at my name,
Speaker 1: Terry Labanni, I'm on all the all the socials, as
Speaker 1: is Glia as well, So you can contact me or
Speaker 1: Glia and participate in in anything that you want. And
Speaker 1: like I said, we we always welcome friends. Great, wonderful,
Speaker 1: Thanks so much man, Thank you so much. That was
Speaker 1: such a pleasure. It could happen here as a production
Speaker 1: of cool Zone Media. For more podcasts from cool Zone Media,
Speaker 1: visit our website cool zone media dot com, or check
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Speaker 1: or wherever you listen to podcasts. You can find sources
Speaker 1: for it could happen here, updated monthly at cool Zone
Speaker 1: media dot com, slash sources, Thanks for listening.