July 8, 2022 • 43 mins
James catches up with Tarek Loubani, an emergency medicine doctor who has volunteered in Gaza, Egypt, and Ukraine. We talk about Glia, an open source medical device company that arose from his experience working in resource poor medical settings.
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Speaker 1 (00:05):
All right podcast it could happen here. It's a podcast
about the terrible things that are happening all around the
world and the wonderful people who are trying to fix them.
What it is today is a podcast with Trek Lubani
of Glia. And what really inspired me about the story
and maybe want to share it with you, is that
(00:28):
it came out of a really dark place. Terek was
on the ground in Gaza treating gunshot wound victims, and
a lot of gunshot wound victims, like I remember reading
his field testing of the device and just being appalled
by the number of people who have been shot, a
lots of them children, and some of the reporting he
(00:49):
was doing right like, oh, I had this this tornique
and we were reusing them and they don't work very
well on the pediatric application because kids shouldn't be shot, right.
But instead of getting down, he was able to make
a solution. And I think that's really important, and I
really like that even through like this dark and terrible
stuff that we've all had to experience and he experienced
(01:11):
in Gaza, he was able to see a positive solution
away to look after people, to move forward in this case,
to prevent death and preserve life. And I think it's
easy to focus on the dark stuff. There's enough of
it happening, but I think it's important to focus on
the great people who are doing great things to protect
and care for other people as well. So that's a
(01:32):
little bit of what we got today, and I hope
you enjoy it. So I'm here with Tarak Lubani. He's
from Glia. There, a company came across from I was
writing about three D printed tornic case. Would you like
to introduce yourself to us a little bit about Glear
and what you do there. Thank you so much for
having me. My name is terrickle Banny. As you had mentioned,
I'm an emergency physician. I work in Canada in a
(01:56):
city in Canada called London, and I also work in
the Gaza strip as an emergency physician as well. Glia
was really an answer to a problem, the problem being
that when I see patients in Gaza, they don't get
the same quality of service that I can give to
my nations. To that. Of course, that's multi factorial, but
(02:16):
a big part of that has to do with the
way in which we as uh that the medical profession
have medical devices that we don't release, that we don't
give access to other people to use. And so Glia's
purpose was to take the most medical devices that doctors
use and to make sure that they were accessible and
(02:38):
available to doctors all over the world. Okay, yeah, yeah,
that's that's very cool. And you make a number of devices, right,
Like I know that I first called to you about
the torn ca, but you make also a stethoscope, is
that right? The stethoscope is the calling card of medicine.
And so it was the first project that we started
(02:58):
working on to start the theory. I mean, we started
with the theory that hey, we can probably make a
device that's just as good as a three D device,
but the costs let's say three dollars or even thirty dollars,
And that was the stuff scope. We tested it, we
published the results, we proved it was as good as
the Gold standards, the Litman Cardiology three at the time,
(03:21):
and often using it both in our own practices also
making it available other people to make for theirs. Okay, yeah,
And so that's what's really interesting about your company as
opposed to other companies, right, you're not necessarily like manufacturing
and distributing. You are providing the designs that allow other
(03:42):
people to make them, right, and so can you talk
about some of their Like, uh, I know that you
use three D printing, and I want to talk about that.
But also like I remember seeing that the tubing and
the cessoscope comes from the a Coca Cola machine, right
for some of those considerations. Yeah, absolutely, the purposes to
make these device is available to other people for the
(04:04):
lowest cost possible, but also like actually be available. It's
no good if you can make it for twenty cents,
but the part that required are nowhere. So that's why
we went with a basket of items that are more
or less earsily available and we made the stuffoscopes out
of that. For example, you can probably get the very
(04:24):
specific kind of earpieces that most stuffoscopes have, but they
are naturally going to be less available and less abundant
than if you were to use regular earbuds the contact phones.
There are way more headphones out there than there are stuffoscopes. Therefore,
those parts are more available, even if, of course there
they are less expensive. But even if they were slightly
(04:46):
more expensive, it would be worth it. What we really
take away is the monopoly and the profit motive, and
so by doing that, or rather, let's say the ex
orbitant profit that medical device companies are making, and by
doing that, we're really able to realize the promise of patents.
(05:09):
All of the devices that we make were patented at
one point. The promise of patents is that when the
patent is over, you'll get a cheap device, but that
promise is not realized. The stethoscope is a three hundred
year old device basically, and the fact that it is
not available at the highest quality except for three kind
of nuts. So that's why we started there, and of
(05:30):
course moved on to more and more complicated devices, much
more complicated even than the tourniquet. By now, okay, yeah,
can you I remember reading because you have you you
kept a blog. I remember on like medium where you
talked about testing the tourniquet when when you were in Gaza,
and it just a like, you know, if you read
(05:52):
medical literature then it did. This was just the shocking
I remember being absolutely shocked by the number of casualties
you ring unting encountering, and then also like you were saying,
like the the lack of available tools. So perhaps you
could explain like a little bit of what you saw
there and then how these tournicates have been able to
(06:15):
help you address that like massive disparity and access to care.
The turniket project really started in Gaza because we noticed
that after one of the wars, the war in two
thousand fourteen, that we had a particularly high casualty rate,
of course, but of that there were many deaths that
we would classify as preventable. That's where we felt that
(06:39):
had turnikets been available, those patients likely wouldn't have died. Um.
When we started working on it, of course, we knew
at some point there'd be another war. It is it
is very common in Gaza for there to be attacked
by the Israelis. We didn't anticipate for it to happen
so fast and for it to happen in a way
where the turnicket was so necessary. That, of course, was
(07:01):
what what's called the Great March of Return, where Palestinians
protested on mass and one of the Israeli responses was
to shoot live fire at the protesters, often targeting About
eight percent of the hits were targeting the arms and
the likes, which is where turnickets are the most effective.
So the high number really is owing to the way
(07:24):
in which the Israeli has decided to deal with this
protests and the fact that it was a protest rather
than a specific war. And that meant also that we
could predict with the relative degree of accuracy where the
injuries would be, which meant that it was even more
important to have the right equipment of the right training.
It was part of an overall strategy. So of course
(07:45):
it's not like turnikets were the thing that saved lives.
Tourniquets were part of a campaign to train paramedics and
to train doctors and how to stop bleeding in these
kinds of injuries, and they were one of the most
important tools in that campaign, but only part that campaign. Yeah,
of course, of course you need other tools and obviously
their education and you can't just slap it on and
(08:06):
then the person's fine, right, Obviously there's a lot of
care afterwards which is important to And can you maybe
talk us through You talked about like the promise of patents, right,
and I think this is important in exactly what we're
talking about in tornic its because it's a little different
to like medic medicines, right, it's a little different with
medical devices. So there are existing torn kits on the
(08:30):
market right and I think the sort of market leading
one is the CAT. Can you explain, like why at
those not getting to people who need them desperately in
these areas The problem with the turnickets that are available
right now, it kind of falls into a few different categories.
North American Rescue the makers of CAT have two key
(08:52):
patents on the Cat, and as far as we can tell,
just based on the posture of the company, if anybody
else were to make exact Cat replicas, they will be suited.
The people who are willing to then make exact Cat
replicas tend to be people who are unaccountable and largely
(09:13):
have not much to lose, and so that's why we
saw a glut initially, for example, with the Ukraine campaign
of tourniquets that that were relatively low quality. And so
you can't just make the device. You also have to
know that the device will work, because you don't want
to discover that when you put it on armor alike
(09:34):
and then it fails. Gaza is an acid test of
all of these things, because not only our devices generally
not available or expensive, it's kind of at the bottom
of any purchase list, for example, but also in Gaza,
there's a complete international blockade Israeli led, of course, but
(09:56):
there are other countries that are that are contributory, and
that blockade means that equipment can't get in so long
as the Israelis deem it to be of military value. Um.
This is where things like dual use devices and so
on come into play. The tourniquet is a medical device.
It is it can only be a medical device. There
(10:17):
is no second use, and so it should be exempt. However,
even if the Palestinians could afford fifty U S dollars
per units, which should be the cost to get one in,
the Israelis won't let them in. So de facto, even
though they shouldn't be banned, they are de facto banned,
and that means that not only can we depend on
(10:39):
cheap Chinese retailers. Let's say to give us replica turniquets,
we actually have to manufacture them ourselves. When we open
sourced our designs, it was with an eye to two things.
One making it available so that the replica makers can
make higher quality replicas. They're already making replicas, we may
(11:00):
as well give them a legal replica rather than a
patent break busting replica. Not that I think there's anything
wrong with that in these cases where there's emergencies, but
just the same Glia's tourniquet doesn't break any patents. And
at the same time, in addition to giving them the
ability to make high quality turnikets, we can also make
(11:20):
high quality turnikets locally and domestically. Because of course, national liberation,
as it were in the medical device space can't come
if you can't make your own devices. We discovered that
during COVID. The Palestines have known that for decades now,
and we're kind of rediscovering it in Ukraine where there
just aren't enough turnickts and so they are forced to
(11:44):
improvise or except tourniquets that they don't want to accept,
right Yeah, Like I think I think COVID was this
great example that we can't continue to rely on the
sort of winds of global capital to provide things that
we need to survive. I think you're manufacturing is fascinating
because you're using essentially commonly available materials in the three
(12:06):
D printeries that right, Yeah, that's correct. I mean we're
not against using other things they just have to be
very simple. For example, are electronics use PCBs. You can't
three D print electronic circuits just yet, so we use PCBs.
But when we design our PCBs, there are a couple
of ways to design it. You can design an eight
layer board that can only be manufactured in one or
(12:27):
two places in the world, or you can design a
board that's three times the size but can be manufactured
anywhere in the world. And when you're talking about credit
card sized devices, if it's notebook size instead of credit
card size, it doesn't really matter that much. For example,
the example i'm thinking of here as an electric cardiogram,
(12:47):
where we took a device that had failed um in
the sort of market that they the maker's open source
and they had intended it to be a fitness device,
and then it didn't work. A company went bankrupt, and
so they open sourced it. So we looked at their
schematics all of the problems that they had already solved.
We said, okay, the problem we're going to solve is
(13:09):
to make it so that this can be manufactured in
a high school electronics lab. And we were able to
achieve that it was bigger, it was twice as big,
But who cares? The old one was half the size
of a credit card? You know who cares? You make
it a little bit bigger. But at the same time, um,
you make it much more accessible, twice as big, twenty
(13:29):
times more accessible. I know some of your staff like
your tony cats. It's really um. There's not much or
any really of a performance trade off from what you've seen, right. Indeed,
they might be better for some pediatric applications if I
(13:51):
remember correctly that that's right. So when you think of
the way in which corporate devices are made, they are
made to the specifications of particular buyers. And the buyers
are the people who have the money. Who's the buyer
for tourniquets? When you think about who needs tourniquets consistently,
who do you who has money to give you turnickets?
Who should you market too? There's only one sane answer,
(14:14):
and that is First world militaries, especially occupation militaries or
militaries that are engaged in UH ground level warfare, who
are expected to take small arms or i e. D s.
And so there are not many children who you have
to sell to in that particular market. There aren't many
small women or even women at all they have to
(14:34):
sell to in that market. So I don't think that
North American rescues engineers would have any trouble making sure
that their turnickets worked amazingly well for children. But why
why would they spend one to million dollars doing that
work and research when that's not their audience and that's
not their buyer. For us, the normal person, the civilian
(14:59):
is uh in quotation marks bire. They're not the ones buying,
but they're the ones who are the main consumer, and
so they're the ones who we target. In Gaza specifically
of the population is under the age of fourteen. You'd
have to be crazy to go out there and put
a tourniquet out that only works on big, burly men.
So that's that's why we were we were driven to
(15:22):
do that. And as for the performance traight offs, yeah,
you're right. The the what we learned about spec sheets
on lots of these devices is that they're made up.
There isn't really a great way to know how well
elterni it works. Unfortunately, there isn't a really great way
to know how well stuffoscope works. And so some of
(15:42):
the first work we did was actually designing some tests
so that we can say, okay, well here's how you
prove that the stuffoscope works as well as that stuffoscope,
or here's how you prove that you know this works
as well as that. And those testing protocols we made
them open source and easily available too. For example, if
you want to test the stethoscope, you can do that
(16:03):
with a pair of headphones, a microphone, and the Hello
Kitty balloon. That's how we did it originally. Could we
have spent ten dollars making that test right, Yeah, we
could have, but that wouldn't have helped us in terms
of helping other people make stutoscopes wherever they are. Yeah,
that's very cool. And then by open sourcing that test,
(16:23):
you allow for other people who have ideas or sort
of models for their own improvements or different designs, that
they can then use that test right and continue to
improve and share their improvements with others. I do not
want to work on stethoscopes anymore. I want to people
to take it up. And it doesn't mean that I won't,
of course I will. But my favorite thing is when
(16:44):
somebody sends a message and says, hey, I like what
you've done. Here's how I think it could be better.
I love those messages. I love them. And you know what,
nine out of ton of those ideas don't work out.
They don't pan out. But like our stethoscope, since two
thousands seventeen, all of the improvements have been from other
(17:05):
people because we haven't had the time and money to
work on it. But we have been open minded, have
incorporated lots of design changes that other people in the
community have suggested. That's a good thing. It's good for everybody. Yeah,
I think it does an excellent job at getting it.
They like their fundamental conceit of our Dragon device development model, right,
(17:25):
which is that which isn't true actually that there's massive
R and D costs and those R and D costs
have to be recouped by charging a massive amount for
a period of time and making access to that medicinal
device a privilege, not right, and then eventually the costs
will come down they often don't, and then everyone will
have active to this thing. And it's like, it's been
my experience that it doesn't work that way. But what
(17:47):
you've shown is an alternative right that people want to
help and that that they don't that there's not a
need for this like price gouging to facilitate the improvement
in this technology. Is that fair? We're not taking a
really altruistic model here. People are generally improving the stethoscope
for their own uses, so there is a self interested
(18:08):
aspect if you want to present it that way. What
we realized is that actually the most useful way to
develop a device is to make it as good as
possible and release it and then have other people who
want to improve it have a capacity to share back
to you. So as much as I I believe in
(18:29):
altruism and I do think every time that I've seen
people collaborate, I've seen a tremendous amount of it, this
more resembles the open source software model, where which is
actually the world I came from. I came from the
free software model, where yes, you do things just for
the fun of it, but also very large corporations are involved.
(18:50):
For example, some of the stuffoscope's improvements happened because the
lab needed to use it for some experiments on animals,
and so they made modifications and they fed them back amazing,
that's fantastic, And but that that was totally self interested,
that they knew that it would cost them significantly less
to build on our work, and it would cost them
nothing to share back their their contributions. So it's you know,
(19:16):
we're not going out there trying to to prove that
everybody is good at heart, even though I do actually
think that's fundamentally true. What what we're doing is showing
through this model the devices can advance with relatively little
upfront costs and with the contribution of many, many members. Yeah, yeah,
(19:39):
that's a review phrase. It really well. I think that
people have this self interest which also serves out of
people's interests, and and it's like, yeah, I've seen it
in all kinds of open source communities, like we've reported
before on three D printed guns, which is obviously it's
kind of a different end of the spectrum. But it's
fascinating to see this global exchange. And I'm sure you
(20:01):
have people. You've mentioned that there are people in MYANMA
who are who are printing your tournic case. Right. We
were amazed when people from my and mar had reached
out and said that we've senior tourniquet and we want
to implement it. We have situation that's very similar to Gaza.
We thought that's exactly what we want. What they did
(20:22):
was two things. One they took our instructions and they
used them, but then they also fed back to us
how those instructions were incomplete, how they could be better,
and some design changes that made their lives better. Again
amazing by them using it, by them taking, they also gave.
(20:46):
And that's the sort of relationship, the kind of solidarity
that we've seen. Whatever other people have used our devices,
we've noticed that they take, and it's it's not a problem.
If people in me and had just taken and not
given anything back, that's fine too, because it doesn't take
anything away from us to share. This is this is
(21:07):
a kind of sharing where the more you share, the
more there's potential for benefit, but there's never a loss.
You never lose by sharing in that sense. We're not
also trying to present it as though we need people
to share for us to feel that this model works.
We don't. But we're already making it anyway. We're already
using it anyway. We're sharing, and some people help out
(21:29):
by contributing black and some people don't. It's it seems
to me to be the most effective way to develop
devices for low costs and make sure that they get
out to where they need to be. Yeah, because they
can century and people who need them can find them.
As you found out, right like people across the world.
Do you have a sense of where else they're being used?
(21:50):
The turnickets right now are being used in Gaza, in
Ukraine and in me and mar if they're being used
in other places. Were not really aware of it, but
people aren't compelled to make us aware of it. Um
and and all three of those locations have moved forward
the project tremendously. For example, for Ukraine, Uh, the Ukrainian
(22:14):
support people weren't really able to contribute so much their
own ability to construct and make, but they were able
to contribute really important research, financial and testing capabilities. And
so of course a project like this costs money. They're like, hey, look,
you know, we don't have farms print farms, but we
(22:34):
do have some cash that we want to put into it.
And we were able to use that money very very effectively,
more effectively than if they would have bought the pieces.
Two then create the capacity for them to go and
make their own turn accounts. Okay, so yeah, let's talk
about that. That's fascinating and uh, and we could maybe
contrasted to a sort of another model, right like if um,
(22:58):
because you you understand you're able to go to Ukraine
and help them set up as opposed to Yeah, it
would have taken months, I imagine to do that with
I don't know how they make the cats, but they
like they molded or something. But with with a non
sort of with a non open source, non printed model,
like to set up a tournicate factory in Ukraine or
(23:19):
Poland would take months, right, yes, absolutely, but you're not
going to There's two reasons why North American Rescue I'll
just call them now from here on out, won't do that.
One of them is that that conflict at some point
will end. It's very expensive to set up production lines.
And the other thing is the more tourniquets you put
(23:40):
into the market, the cheaper tourniquets get, you know, supply
and demand. Like we learned that one pretty well from capitalism.
And so they have an inherent disincentive, whether they recognize
it or not, whether it's conscious or not. North American
Rescue and all these companies have an inherent disincentive in
flooding the market with tourniquets, whereas we do not for us.
(24:01):
It's the opposite. The more people we lose pretty much
Glia loses about ten to twenty dollars per tourniquet that
we manufacture, we have no incentive to keep doing it,
and we want other people to do it because we
want as many tourniquets to be provided as possible. What
we do then is we heavily subsidize the tourniquets using
(24:23):
our own internal funds and and fundraising that that we
do with the goal of getting them out there so
that deaths can be prevented. And so we want other
people producing. When I go there, every tourniquet somebody else
makes instead of me is less headache for me, is
less pain for me, and is less financial loss for
me and for Glea. Of course, so our incentives are different.
(24:48):
They want a shortage consciously or not, and we want
an abundance. We want everybody to have tourniquet in their pocket.
Now that's that's our goal. Yeah, Can you talk a
(25:09):
little bit about your experiences in Ukraine? You with that
pretty recently, right, Ukraine is a very very complicated subject
when it comes to tourniquets, because the tourniquet wasn't at
this h I'm gonna mind my words very carefully. I'm
not Ukrainian, I'm not a Ukrainian doctor, and my experience
(25:31):
there is very limited. I am in solidarity with the
medical community in Ukraine, and part of being in solidarity
with a medical community is recognizing that even when there
are weaknesses, it is not my place to insert myself
into their processes. And so the way that the Ukrainians
(25:54):
have approached tourniquets is at the outset to ban all
three the printed tourniquets, and two basically make it so
that only what they considered to be high quality tourniqts,
mainly the CAT and another another one or two models
were available in there. This unfortunately created a tremendous shortage,
(26:18):
and the other thing that functionally happened was a disconnect
between the policy makers within the medical community and the
people on the ground. The people on the ground, of course,
are doing whatever they can to provide care wherever they can,
and the policy makers are a little bit more disconnected
from that and so have different considerations. The shortage then
(26:42):
creates this um difficulty. You know, there are of course
three D printed tourniquets aren't accepted officially in Ukraine, but
there are an abundance of three D printed tourniquets in
Ukraine because the people on the ground are accepting them
um and what we see is a kind of grassroots
(27:03):
experimentation with how it is that we can prevent deaths.
The other difficulty is that tourniquets are a tool, and
in bad hands, this tool isn't going to work, even
if it's a great tool. And so one of the
things that I realized, and I think everybody at this point,
(27:23):
I'm not saying anything that's new or unknown to the community,
we all realize that without appropriate training and how to
use a tourniquet, they're not going to work um. And
so even high quality tourniquets out there in the field
are failing because they're being used improperly and it's causing
unnecessary deaths. So I don't know how deep you want
(27:45):
to get into that experience in Ukraine, but I think
what we can say is that it's important to be
in solidarity with that community, and as such, we're providing
them all of the experience that we have and all
of the capability that we have to produce tourniquets that
the Ukrainians themselves, both officially and on the in the
(28:08):
front lines, are able to use and feel are actually
safe for their patients. Yeah. Yeah, that's a difficult situation.
I think. Obviously a lot of what's happening in Ukraine
has been necessarily like like rushed, and it's somewhat perhaps
chaoticism it's the wrong word, but it took a while
for people to fully sort of understand that the necessities
(28:32):
of the scale and the scale of the conflict, or
perhaps understand this is still the wrong word. But yeah,
to come up with the most of the way to
do the least harm. I guess that's such a great
way of to frame it. And I think even from
your experience as you see that very often in these
situations that's the name of the game. It's not even
doing what you know is best, but rather figuring out
(28:52):
what the least horst scenario is. Yeah, yeah, so often,
I think, and it's very easy I think Tom to
look backseat drive feeds things right from from positions of
safety and sort of a plenty, you know, to say, oh,
what should then they should do that, which I think
you did very well to explain that the first and
(29:14):
most important thing is to be instolidarity with the people
there and to hopefully allow their experience to guide us
in how we can best help them to to prevent
death prevent harm. And so, can you talk about what
you were able to do there, what sort of interventions
could you make to hopefully help prevent more dying. The
(29:35):
main thing that that we did in terms of so
I kind of was there in with two hats on.
One of them was the trying to get manufacturing hat,
and the other one was as an emergency doctor. Because remember,
fundamentally what brought me to medical devices in the first
place was that I was an emergency doctor having problems
actually caring for my patients. As a tourniquet manufacturer basically
(30:02):
was about engaging with other people who are making and
using tourniquets to understand some of the roadblocks and problems.
One of the biggest ones is that there isn't a
great way to test units of tournikets. So traditionally tourniquets
are tested by design. Uh Nar says, here's our design
and here's how we tested it, and then we accept
(30:22):
that this particular company will make this particular device to
this particular standard. But in the Ukraine, especially with the
presence of replicas and three D two tourniquets, there became
a new problem, how do you test each unit rather
than a specific line, and working on that, I don't
know how into the leads you want me to get,
(30:43):
but working on that is still a problem that is unsolved,
but has been one of the biggest issues that we've
been dealing with on the emergency medicine side. Of course,
when I provide direct care to patients, I was in
a hospital on one of the communities, on the front line,
on one of the fronts, and so providing direct care
(31:04):
became important. And working with the doctors, many of whom
didn't really experience that much have that much experience with
trauma patients, so working with them to share our experiences
from GAZA in low resource trauma medicine, and also to
gain from them their experiences because of course their scenarios
(31:25):
and situations are different. It's more artillery based rather than
small arms fire or um sort of bombing based, so
they're there are different scenarios. I had a lot to
learn from them. I did, and UM I tried to
contribute some of our experiences as well. The training I
think is probably the number one problem right now, but
that's my personal opinion. Is one doctor who is there
(31:48):
for a limited period of time so that that individual
unit tests that you're you're working towards is um because
I know in theory, at least a CAT it's a
single youth device, right and so in theory, if you
if you just slapped it on something that could mess
your pressure, and Titan did that. Devices and being used
and shouldn't be used again to provide care. Is that
(32:10):
the bottom that you're running up against, or is it
sort of making a way to test things it's replicable
and cheap and accessible. Reusability was the number one problem
that we tried to tackle in Gaza because we couldn't
print tourniquets as fast as they're being used, and so
we re used them up to ten times. And when
I was in the hospital, I walked by this I
(32:34):
V pole with a bunch of turniquets hanging from it,
and I instantly recognized what I was looking at. That
was a tourniquet rewashed station in which tourniquets that came
off of patients who were being rewashed, dried, and then
sent back out into the field, whatever you think the
standards are for tourniquet. When there's this level of of shortage,
(32:56):
that's what's going to happen. That's what happened in Gaza,
and that's why happened in the Ukraine. That's what I
saw in my own eyes. Of course, we don't need
to stretch that far anymore to recognize us. What were
people doing with the ninety five masks two years ago
in my hospital. We were holding them, storing them, watching them,
reusing them. So this is something that we see whenever
(33:17):
there's a shortage, and it makes the unit testing that
much more important because if you could take an already
used tourniquet and assure that it will succeed the next
time it's being used, that is so valuable, so valuable,
and it cuts down every tourniquet you can reuse as
a tourniquet. You don't have to import, you don't have
to buy, you don't have to package, you don't have
to ship over all of these lines. Yeah, yeah, of course,
(33:41):
and I think it's probably we should probably address like
the the ways in which they can fail because I think, uh,
look it just people in the United to State if
in an extremely like resource Ridge setting right, we'll probably
have knowingly or unknowingly acquired to want to get on
Amazon or somewhere else eBay that that might not be
(34:04):
a real one, and so I want it's real, but
we might not be a reliable one. Can you explain
like like how they fail and what the consequences of
that failure. Ah, there are two kinds of failures when
we talk about turniquets. One of them is what we
would call a technical failure, and the other one is
a clinical failure. A technical failure is the easiest one
(34:28):
for most people to spot. The tourniquet literally breaks in
your hand. And that said, you hear a crack, you
see something crack, you see a break, things fall apart
the end. And so one of the things that we
we want is to minimize these by over engineering. So,
(34:49):
for example, the first Glia tourniquet was engineered to spec
you're supposed to be able to turn it three times,
and so we made it so you can turn it
three times. And then what I realized is that even I,
who is like super well trained, I would be in
the field running while my eyes were full of tear gas,
while people are shooting and I didn't. I'd forget did
(35:11):
I turn it two times? Three times? So we over
we started over engineering the tourniquets. At a certain point.
Of course, every TURNIKID is going to break. You turn
it enough times, every turniquet is going to break. But
that's not necessarily going to be the case if you
have even a moderate amount of training. I'm going to
turn it for five times, but I'm not going to
turn it twenty times. So the technical failures are one
(35:36):
kind of failure. The other one is clinical failure. Now
here's something that I wonder if you knew about thirty
tourniquets from the gold Standard Company fail They fail on application,
and that number goes up to if you were to
check sixty seconds after application. So what does this tell us?
(35:59):
What this tells us is clinical failure is actually the
important marker here because we know turniquets break, and we
know turniquets fail in general, especially turnickets that have been
in some g i's pocket in Afghanistan for six months.
Those ones that their failure rate can go even higher.
And so what we train people to do is to
(36:21):
recognize clinical success. Put on a tourniquet, did the blood stop? No?
Put on a second turniquet, did the blood stop? No,
try a third one if you have them, obviously, and
so the routine training involves applying a second tourniquet. And
one of the like happiest moments for me, I mean,
(36:43):
this is obviously bitter sweet, but it was when I
saw a patient who was brought in by a medic
who I had I had been in the training four
and he had applied to turniquets to a guy who
certainly would have died had he had he not had
the tourniquet up flights on and I was exaguinating so
much injury so severe that he needed a couple of
(37:05):
turnickets to really get it under control. So it's it's
where we have to recognize that there is no magic tool.
This is part of an overall program. There's no three
D printer that's going to train people just going to
make you stuff. Then you have to do the rest
of it, right Yeah. Yeah, So I think if we, uh,
(37:27):
we should look maybe at the fact that like I
live in the United States and you're in Canada, and
I think there were like three mass shootings yesterday, right
that the that the threat of violence is certainly added
high for recent times in for a why a modiverse
range of people. Right, There's always been violence in this country.
(37:50):
There's always been violence against certain groups of people disproportion
in this country. But people are probably more concerned with
treating constria wounds and they would have been years ago.
And so if someone was looking to make one of
your devices, how can they do that? And they show
or do their best to ensure that they are doing
(38:11):
so in a way which gives them the best chance
of success. At the moment, I would say to the
individual maker, don't do it, not for a life threatening situation.
If individual individual makers want to make turnikets, then they're
going to have to be proficient at three big things.
One of them is plastics three D printing, ensuring that
the quality of the plastic is good. The other one
(38:34):
is sewing, that is to say, assembling sold stuff. And
the third one is is quality assurance, because even done perfectly,
a certain number of tourniquets aren't going to make it.
And that quality assurance is both at the moment of
manufacture and then over time, because of course all devices
(38:55):
deteriorate over time, but tourniquets have such an import role
that you have to check them periodically to make sure
everything is okay. So I would say to the individual maker,
don't or if you do, do it as an exercise
rather than as an actual tool. If somebody is in
an emergency situation, there's nothing they can do except to
(39:18):
do it, then be in touch with us. So, for example,
there are makers in in countries that have been in
touch and have said, okay, look, I have to do
this because the situation here is bad. We support them
as best as we can. We try to send people
out to them, or we try to have them ship
units to us. We try to get them up and going.
(39:39):
Glia is not a medical device manufacturer. GLIA is a
access to medicines and access to medical devices company, and
part of that is making sure that people who are
making medical devices are doing them to the highest possible quality.
So if you are forced to make them, be in
(39:59):
touch with us, we will help in any way that
we can. However, there's another category of people, and that
is manufacturers who already know how to make medical devices.
To those people, we say, take our stuff, please use
it please. It is there for the taking, and it
(40:21):
is high quality, it works really well, and if it's
missing something, tell us we'll make it better for you
and for us. Yeah, that's great. I think that's really
excellent advice and perhaps a good note for us to
finish on. Where can people find you if they want
to get in touch, if they if they want to
look at some of the devices like making a stethoscope,
I imagine could be like a fun project and put
(40:43):
a lot less potential risk there. So where can they
find that stuff? Absolutely, the stethoscope is such a fun project.
It's fun because any everybody has a heart in general,
and um you can listen to your family and friends
and loved ones that It's one of my favorite things
when I'm in practice and I listen for sometimes patient
(41:04):
will be there with their son or daughter or child,
and I'll tell the kid, you want to listen to
mommy's heart, your daddy's heart. It's one of the best things.
So the stethoscope is a great, fun, low risk project.
Please go ahead and do it. Make it. You can
find our stuff anywhere you can find printiple stuff. It's
on thingy versuss on principles, it's basically everywhere or through
(41:27):
our GETH hub or on the GLIA site. So that's
CLIA dot org and if people want to participate, they're
very welcome to We always want, need and love help,
and of course it's a community. You can never have
too many friends, so we're always looking for more friends
and love to see more people. We have a matter
(41:50):
most obviously, it's not just our devices that are open source.
We try to make our tire stack open source so
people can join and chat with us and you know,
hang out with people who are doing really, really cool
and super impressive stuff. At this point, I love to
recognize the fact that I'm one of the least productive,
least impressive people at clear Really the work that's happening
(42:12):
is amazing, and it's led by lots of smart, dedicated,
visionary people. Yeah, that's great to hear that. It's really
cool that you can we can work with people as well,
So hopefully people do get in touch. I'm sure there'll
be someone who's interested in what you're doing but has
something to contribute in some fashion. Yeah, thank you so
much for giving us some of your evening. Is there
anything else you'd like to say before we finish up.
(42:33):
I think the most important thing to say is that
there's this mystique that people develop you alluded to it earlier.
There's a mystique people develop around medical devices. Medical devices
are solutions to problems, and they were made by people
like me who don't know what the hell they're doing sometimes,
and so let's not you know, aggrandize or like separate
(42:56):
ourselves from the people who are doing this work. Yes
we have to be just, Yes we have to be vigorous,
but at the same time we can all contribute to
be a part of this very cool And can people
find you personally anyway? Do you have social media that
that people could follow. Yeah, if people look at my name,
Terry Labanni, I'm on all the all the socials, as
is Glia as well, So you can contact me or
(43:17):
Glia and participate in in anything that you want. And
like I said, we we always welcome friends. Great, wonderful,
Thanks so much man, Thank you so much. That was
such a pleasure. It could happen here as a production
of cool Zone Media. For more podcasts from cool Zone Media,
(43:38):
visit our website cool zone media dot com, or check
us out on the I Heart Radio app, Apple Podcasts,
or wherever you listen to podcasts. You can find sources
for it could happen here, updated monthly at cool Zone
media dot com, slash sources, Thanks for listening.
All right podcast it could happen here. It's a podcast
about the terrible things that are happening all around the
world and the wonderful people who are trying to fix them.
What it is today is a podcast with Trek Lubani
of Glia. And what really inspired me about the story
and maybe want to share it with you, is that
(00:28):
it came out of a really dark place. Terek was
on the ground in Gaza treating gunshot wound victims, and
a lot of gunshot wound victims, like I remember reading
his field testing of the device and just being appalled
by the number of people who have been shot, a
lots of them children, and some of the reporting he
(00:49):
was doing right like, oh, I had this this tornique
and we were reusing them and they don't work very
well on the pediatric application because kids shouldn't be shot, right.
But instead of getting down, he was able to make
a solution. And I think that's really important, and I
really like that even through like this dark and terrible
stuff that we've all had to experience and he experienced
(01:11):
in Gaza, he was able to see a positive solution
away to look after people, to move forward in this case,
to prevent death and preserve life. And I think it's
easy to focus on the dark stuff. There's enough of
it happening, but I think it's important to focus on
the great people who are doing great things to protect
and care for other people as well. So that's a
(01:32):
little bit of what we got today, and I hope
you enjoy it. So I'm here with Tarak Lubani. He's
from Glia. There, a company came across from I was
writing about three D printed tornic case. Would you like
to introduce yourself to us a little bit about Glear
and what you do there. Thank you so much for
having me. My name is terrickle Banny. As you had mentioned,
I'm an emergency physician. I work in Canada in a
(01:56):
city in Canada called London, and I also work in
the Gaza strip as an emergency physician as well. Glia
was really an answer to a problem, the problem being
that when I see patients in Gaza, they don't get
the same quality of service that I can give to
my nations. To that. Of course, that's multi factorial, but
(02:16):
a big part of that has to do with the
way in which we as uh that the medical profession
have medical devices that we don't release, that we don't
give access to other people to use. And so Glia's
purpose was to take the most medical devices that doctors
use and to make sure that they were accessible and
(02:38):
available to doctors all over the world. Okay, yeah, yeah,
that's that's very cool. And you make a number of devices, right,
Like I know that I first called to you about
the torn ca, but you make also a stethoscope, is
that right? The stethoscope is the calling card of medicine.
And so it was the first project that we started
(02:58):
working on to start the theory. I mean, we started
with the theory that hey, we can probably make a
device that's just as good as a three D device,
but the costs let's say three dollars or even thirty dollars,
And that was the stuff scope. We tested it, we
published the results, we proved it was as good as
the Gold standards, the Litman Cardiology three at the time,
(03:21):
and often using it both in our own practices also
making it available other people to make for theirs. Okay, yeah,
And so that's what's really interesting about your company as
opposed to other companies, right, you're not necessarily like manufacturing
and distributing. You are providing the designs that allow other
(03:42):
people to make them, right, and so can you talk
about some of their Like, uh, I know that you
use three D printing, and I want to talk about that.
But also like I remember seeing that the tubing and
the cessoscope comes from the a Coca Cola machine, right
for some of those considerations. Yeah, absolutely, the purposes to
make these device is available to other people for the
(04:04):
lowest cost possible, but also like actually be available. It's
no good if you can make it for twenty cents,
but the part that required are nowhere. So that's why
we went with a basket of items that are more
or less earsily available and we made the stuffoscopes out
of that. For example, you can probably get the very
(04:24):
specific kind of earpieces that most stuffoscopes have, but they
are naturally going to be less available and less abundant
than if you were to use regular earbuds the contact phones.
There are way more headphones out there than there are stuffoscopes. Therefore,
those parts are more available, even if, of course there
they are less expensive. But even if they were slightly
(04:46):
more expensive, it would be worth it. What we really
take away is the monopoly and the profit motive, and
so by doing that, or rather, let's say the ex
orbitant profit that medical device companies are making, and by
doing that, we're really able to realize the promise of patents.
(05:09):
All of the devices that we make were patented at
one point. The promise of patents is that when the
patent is over, you'll get a cheap device, but that
promise is not realized. The stethoscope is a three hundred
year old device basically, and the fact that it is
not available at the highest quality except for three kind
of nuts. So that's why we started there, and of
(05:30):
course moved on to more and more complicated devices, much
more complicated even than the tourniquet. By now, okay, yeah,
can you I remember reading because you have you you
kept a blog. I remember on like medium where you
talked about testing the tourniquet when when you were in Gaza,
and it just a like, you know, if you read
(05:52):
medical literature then it did. This was just the shocking
I remember being absolutely shocked by the number of casualties
you ring unting encountering, and then also like you were saying,
like the the lack of available tools. So perhaps you
could explain like a little bit of what you saw
there and then how these tournicates have been able to
(06:15):
help you address that like massive disparity and access to care.
The turniket project really started in Gaza because we noticed
that after one of the wars, the war in two
thousand fourteen, that we had a particularly high casualty rate,
of course, but of that there were many deaths that
we would classify as preventable. That's where we felt that
(06:39):
had turnikets been available, those patients likely wouldn't have died. Um.
When we started working on it, of course, we knew
at some point there'd be another war. It is it
is very common in Gaza for there to be attacked
by the Israelis. We didn't anticipate for it to happen
so fast and for it to happen in a way
where the turnicket was so necessary. That, of course, was
(07:01):
what what's called the Great March of Return, where Palestinians
protested on mass and one of the Israeli responses was
to shoot live fire at the protesters, often targeting About
eight percent of the hits were targeting the arms and
the likes, which is where turnickets are the most effective.
So the high number really is owing to the way
(07:24):
in which the Israeli has decided to deal with this
protests and the fact that it was a protest rather
than a specific war. And that meant also that we
could predict with the relative degree of accuracy where the
injuries would be, which meant that it was even more
important to have the right equipment of the right training.
It was part of an overall strategy. So of course
(07:45):
it's not like turnikets were the thing that saved lives.
Tourniquets were part of a campaign to train paramedics and
to train doctors and how to stop bleeding in these
kinds of injuries, and they were one of the most
important tools in that campaign, but only part that campaign. Yeah,
of course, of course you need other tools and obviously
their education and you can't just slap it on and
(08:06):
then the person's fine, right, Obviously there's a lot of
care afterwards which is important to And can you maybe
talk us through You talked about like the promise of patents, right,
and I think this is important in exactly what we're
talking about in tornic its because it's a little different
to like medic medicines, right, it's a little different with
medical devices. So there are existing torn kits on the
(08:30):
market right and I think the sort of market leading
one is the CAT. Can you explain, like why at
those not getting to people who need them desperately in
these areas The problem with the turnickets that are available
right now, it kind of falls into a few different categories.
North American Rescue the makers of CAT have two key
(08:52):
patents on the Cat, and as far as we can tell,
just based on the posture of the company, if anybody
else were to make exact Cat replicas, they will be suited.
The people who are willing to then make exact Cat
replicas tend to be people who are unaccountable and largely
(09:13):
have not much to lose, and so that's why we
saw a glut initially, for example, with the Ukraine campaign
of tourniquets that that were relatively low quality. And so
you can't just make the device. You also have to
know that the device will work, because you don't want
to discover that when you put it on armor alike
(09:34):
and then it fails. Gaza is an acid test of
all of these things, because not only our devices generally
not available or expensive, it's kind of at the bottom
of any purchase list, for example, but also in Gaza,
there's a complete international blockade Israeli led, of course, but
(09:56):
there are other countries that are that are contributory, and
that blockade means that equipment can't get in so long
as the Israelis deem it to be of military value. Um.
This is where things like dual use devices and so
on come into play. The tourniquet is a medical device.
It is it can only be a medical device. There
(10:17):
is no second use, and so it should be exempt. However,
even if the Palestinians could afford fifty U S dollars
per units, which should be the cost to get one in,
the Israelis won't let them in. So de facto, even
though they shouldn't be banned, they are de facto banned,
and that means that not only can we depend on
(10:39):
cheap Chinese retailers. Let's say to give us replica turniquets,
we actually have to manufacture them ourselves. When we open
sourced our designs, it was with an eye to two things.
One making it available so that the replica makers can
make higher quality replicas. They're already making replicas, we may
(11:00):
as well give them a legal replica rather than a
patent break busting replica. Not that I think there's anything
wrong with that in these cases where there's emergencies, but
just the same Glia's tourniquet doesn't break any patents. And
at the same time, in addition to giving them the
ability to make high quality turnikets, we can also make
(11:20):
high quality turnikets locally and domestically. Because of course, national liberation,
as it were in the medical device space can't come
if you can't make your own devices. We discovered that
during COVID. The Palestines have known that for decades now,
and we're kind of rediscovering it in Ukraine where there
just aren't enough turnickts and so they are forced to
(11:44):
improvise or except tourniquets that they don't want to accept,
right Yeah, Like I think I think COVID was this
great example that we can't continue to rely on the
sort of winds of global capital to provide things that
we need to survive. I think you're manufacturing is fascinating
because you're using essentially commonly available materials in the three
(12:06):
D printeries that right, Yeah, that's correct. I mean we're
not against using other things they just have to be
very simple. For example, are electronics use PCBs. You can't
three D print electronic circuits just yet, so we use PCBs.
But when we design our PCBs, there are a couple
of ways to design it. You can design an eight
layer board that can only be manufactured in one or
(12:27):
two places in the world, or you can design a
board that's three times the size but can be manufactured
anywhere in the world. And when you're talking about credit
card sized devices, if it's notebook size instead of credit
card size, it doesn't really matter that much. For example,
the example i'm thinking of here as an electric cardiogram,
(12:47):
where we took a device that had failed um in
the sort of market that they the maker's open source
and they had intended it to be a fitness device,
and then it didn't work. A company went bankrupt, and
so they open sourced it. So we looked at their
schematics all of the problems that they had already solved.
We said, okay, the problem we're going to solve is
(13:09):
to make it so that this can be manufactured in
a high school electronics lab. And we were able to
achieve that it was bigger, it was twice as big,
But who cares? The old one was half the size
of a credit card? You know who cares? You make
it a little bit bigger. But at the same time, um,
you make it much more accessible, twice as big, twenty
(13:29):
times more accessible. I know some of your staff like
your tony cats. It's really um. There's not much or
any really of a performance trade off from what you've seen, right. Indeed,
they might be better for some pediatric applications if I
(13:51):
remember correctly that that's right. So when you think of
the way in which corporate devices are made, they are
made to the specifications of particular buyers. And the buyers
are the people who have the money. Who's the buyer
for tourniquets? When you think about who needs tourniquets consistently,
who do you who has money to give you turnickets?
Who should you market too? There's only one sane answer,
(14:14):
and that is First world militaries, especially occupation militaries or
militaries that are engaged in UH ground level warfare, who
are expected to take small arms or i e. D s.
And so there are not many children who you have
to sell to in that particular market. There aren't many
small women or even women at all they have to
(14:34):
sell to in that market. So I don't think that
North American rescues engineers would have any trouble making sure
that their turnickets worked amazingly well for children. But why
why would they spend one to million dollars doing that
work and research when that's not their audience and that's
not their buyer. For us, the normal person, the civilian
(14:59):
is uh in quotation marks bire. They're not the ones buying,
but they're the ones who are the main consumer, and
so they're the ones who we target. In Gaza specifically
of the population is under the age of fourteen. You'd
have to be crazy to go out there and put
a tourniquet out that only works on big, burly men.
So that's that's why we were we were driven to
(15:22):
do that. And as for the performance traight offs, yeah,
you're right. The the what we learned about spec sheets
on lots of these devices is that they're made up.
There isn't really a great way to know how well
elterni it works. Unfortunately, there isn't a really great way
to know how well stuffoscope works. And so some of
(15:42):
the first work we did was actually designing some tests
so that we can say, okay, well here's how you
prove that the stuffoscope works as well as that stuffoscope,
or here's how you prove that you know this works
as well as that. And those testing protocols we made
them open source and easily available too. For example, if
you want to test the stethoscope, you can do that
(16:03):
with a pair of headphones, a microphone, and the Hello
Kitty balloon. That's how we did it originally. Could we
have spent ten dollars making that test right, Yeah, we
could have, but that wouldn't have helped us in terms
of helping other people make stutoscopes wherever they are. Yeah,
that's very cool. And then by open sourcing that test,
(16:23):
you allow for other people who have ideas or sort
of models for their own improvements or different designs, that
they can then use that test right and continue to
improve and share their improvements with others. I do not
want to work on stethoscopes anymore. I want to people
to take it up. And it doesn't mean that I won't,
of course I will. But my favorite thing is when
(16:44):
somebody sends a message and says, hey, I like what
you've done. Here's how I think it could be better.
I love those messages. I love them. And you know what,
nine out of ton of those ideas don't work out.
They don't pan out. But like our stethoscope, since two
thousands seventeen, all of the improvements have been from other
(17:05):
people because we haven't had the time and money to
work on it. But we have been open minded, have
incorporated lots of design changes that other people in the
community have suggested. That's a good thing. It's good for everybody. Yeah,
I think it does an excellent job at getting it.
They like their fundamental conceit of our Dragon device development model, right,
(17:25):
which is that which isn't true actually that there's massive
R and D costs and those R and D costs
have to be recouped by charging a massive amount for
a period of time and making access to that medicinal
device a privilege, not right, and then eventually the costs
will come down they often don't, and then everyone will
have active to this thing. And it's like, it's been
my experience that it doesn't work that way. But what
(17:47):
you've shown is an alternative right that people want to
help and that that they don't that there's not a
need for this like price gouging to facilitate the improvement
in this technology. Is that fair? We're not taking a
really altruistic model here. People are generally improving the stethoscope
for their own uses, so there is a self interested
(18:08):
aspect if you want to present it that way. What
we realized is that actually the most useful way to
develop a device is to make it as good as
possible and release it and then have other people who
want to improve it have a capacity to share back
to you. So as much as I I believe in
(18:29):
altruism and I do think every time that I've seen
people collaborate, I've seen a tremendous amount of it, this
more resembles the open source software model, where which is
actually the world I came from. I came from the
free software model, where yes, you do things just for
the fun of it, but also very large corporations are involved.
(18:50):
For example, some of the stuffoscope's improvements happened because the
lab needed to use it for some experiments on animals,
and so they made modifications and they fed them back amazing,
that's fantastic, And but that that was totally self interested,
that they knew that it would cost them significantly less
to build on our work, and it would cost them
nothing to share back their their contributions. So it's you know,
(19:16):
we're not going out there trying to to prove that
everybody is good at heart, even though I do actually
think that's fundamentally true. What what we're doing is showing
through this model the devices can advance with relatively little
upfront costs and with the contribution of many, many members. Yeah, yeah,
(19:39):
that's a review phrase. It really well. I think that
people have this self interest which also serves out of
people's interests, and and it's like, yeah, I've seen it
in all kinds of open source communities, like we've reported
before on three D printed guns, which is obviously it's
kind of a different end of the spectrum. But it's
fascinating to see this global exchange. And I'm sure you
(20:01):
have people. You've mentioned that there are people in MYANMA
who are who are printing your tournic case. Right. We
were amazed when people from my and mar had reached
out and said that we've senior tourniquet and we want
to implement it. We have situation that's very similar to Gaza.
We thought that's exactly what we want. What they did
(20:22):
was two things. One they took our instructions and they
used them, but then they also fed back to us
how those instructions were incomplete, how they could be better,
and some design changes that made their lives better. Again
amazing by them using it, by them taking, they also gave.
(20:46):
And that's the sort of relationship, the kind of solidarity
that we've seen. Whatever other people have used our devices,
we've noticed that they take, and it's it's not a problem.
If people in me and had just taken and not
given anything back, that's fine too, because it doesn't take
anything away from us to share. This is this is
(21:07):
a kind of sharing where the more you share, the
more there's potential for benefit, but there's never a loss.
You never lose by sharing in that sense. We're not
also trying to present it as though we need people
to share for us to feel that this model works.
We don't. But we're already making it anyway. We're already
using it anyway. We're sharing, and some people help out
(21:29):
by contributing black and some people don't. It's it seems
to me to be the most effective way to develop
devices for low costs and make sure that they get
out to where they need to be. Yeah, because they
can century and people who need them can find them.
As you found out, right like people across the world.
Do you have a sense of where else they're being used?
(21:50):
The turnickets right now are being used in Gaza, in
Ukraine and in me and mar if they're being used
in other places. Were not really aware of it, but
people aren't compelled to make us aware of it. Um
and and all three of those locations have moved forward
the project tremendously. For example, for Ukraine, Uh, the Ukrainian
(22:14):
support people weren't really able to contribute so much their
own ability to construct and make, but they were able
to contribute really important research, financial and testing capabilities. And
so of course a project like this costs money. They're like, hey, look,
you know, we don't have farms print farms, but we
(22:34):
do have some cash that we want to put into it.
And we were able to use that money very very effectively,
more effectively than if they would have bought the pieces.
Two then create the capacity for them to go and
make their own turn accounts. Okay, so yeah, let's talk
about that. That's fascinating and uh, and we could maybe
contrasted to a sort of another model, right like if um,
(22:58):
because you you understand you're able to go to Ukraine
and help them set up as opposed to Yeah, it
would have taken months, I imagine to do that with
I don't know how they make the cats, but they
like they molded or something. But with with a non
sort of with a non open source, non printed model,
like to set up a tournicate factory in Ukraine or
(23:19):
Poland would take months, right, yes, absolutely, but you're not
going to There's two reasons why North American Rescue I'll
just call them now from here on out, won't do that.
One of them is that that conflict at some point
will end. It's very expensive to set up production lines.
And the other thing is the more tourniquets you put
(23:40):
into the market, the cheaper tourniquets get, you know, supply
and demand. Like we learned that one pretty well from capitalism.
And so they have an inherent disincentive, whether they recognize
it or not, whether it's conscious or not. North American
Rescue and all these companies have an inherent disincentive in
flooding the market with tourniquets, whereas we do not for us.
(24:01):
It's the opposite. The more people we lose pretty much
Glia loses about ten to twenty dollars per tourniquet that
we manufacture, we have no incentive to keep doing it,
and we want other people to do it because we
want as many tourniquets to be provided as possible. What
we do then is we heavily subsidize the tourniquets using
(24:23):
our own internal funds and and fundraising that that we
do with the goal of getting them out there so
that deaths can be prevented. And so we want other
people producing. When I go there, every tourniquet somebody else
makes instead of me is less headache for me, is
less pain for me, and is less financial loss for
me and for Glea. Of course, so our incentives are different.
(24:48):
They want a shortage consciously or not, and we want
an abundance. We want everybody to have tourniquet in their pocket.
Now that's that's our goal. Yeah, Can you talk a
(25:09):
little bit about your experiences in Ukraine? You with that
pretty recently, right, Ukraine is a very very complicated subject
when it comes to tourniquets, because the tourniquet wasn't at
this h I'm gonna mind my words very carefully. I'm
not Ukrainian, I'm not a Ukrainian doctor, and my experience
(25:31):
there is very limited. I am in solidarity with the
medical community in Ukraine, and part of being in solidarity
with a medical community is recognizing that even when there
are weaknesses, it is not my place to insert myself
into their processes. And so the way that the Ukrainians
(25:54):
have approached tourniquets is at the outset to ban all
three the printed tourniquets, and two basically make it so
that only what they considered to be high quality tourniqts,
mainly the CAT and another another one or two models
were available in there. This unfortunately created a tremendous shortage,
(26:18):
and the other thing that functionally happened was a disconnect
between the policy makers within the medical community and the
people on the ground. The people on the ground, of course,
are doing whatever they can to provide care wherever they can,
and the policy makers are a little bit more disconnected
from that and so have different considerations. The shortage then
(26:42):
creates this um difficulty. You know, there are of course
three D printed tourniquets aren't accepted officially in Ukraine, but
there are an abundance of three D printed tourniquets in
Ukraine because the people on the ground are accepting them
um and what we see is a kind of grassroots
(27:03):
experimentation with how it is that we can prevent deaths.
The other difficulty is that tourniquets are a tool, and
in bad hands, this tool isn't going to work, even
if it's a great tool. And so one of the
things that I realized, and I think everybody at this point,
(27:23):
I'm not saying anything that's new or unknown to the community,
we all realize that without appropriate training and how to
use a tourniquet, they're not going to work um. And
so even high quality tourniquets out there in the field
are failing because they're being used improperly and it's causing
unnecessary deaths. So I don't know how deep you want
(27:45):
to get into that experience in Ukraine, but I think
what we can say is that it's important to be
in solidarity with that community, and as such, we're providing
them all of the experience that we have and all
of the capability that we have to produce tourniquets that
the Ukrainians themselves, both officially and on the in the
(28:08):
front lines, are able to use and feel are actually
safe for their patients. Yeah. Yeah, that's a difficult situation.
I think. Obviously a lot of what's happening in Ukraine
has been necessarily like like rushed, and it's somewhat perhaps
chaoticism it's the wrong word, but it took a while
for people to fully sort of understand that the necessities
(28:32):
of the scale and the scale of the conflict, or
perhaps understand this is still the wrong word. But yeah,
to come up with the most of the way to
do the least harm. I guess that's such a great
way of to frame it. And I think even from
your experience as you see that very often in these
situations that's the name of the game. It's not even
doing what you know is best, but rather figuring out
(28:52):
what the least horst scenario is. Yeah, yeah, so often,
I think, and it's very easy I think Tom to
look backseat drive feeds things right from from positions of
safety and sort of a plenty, you know, to say, oh,
what should then they should do that, which I think
you did very well to explain that the first and
(29:14):
most important thing is to be instolidarity with the people
there and to hopefully allow their experience to guide us
in how we can best help them to to prevent
death prevent harm. And so, can you talk about what
you were able to do there, what sort of interventions
could you make to hopefully help prevent more dying. The
(29:35):
main thing that that we did in terms of so
I kind of was there in with two hats on.
One of them was the trying to get manufacturing hat,
and the other one was as an emergency doctor. Because remember,
fundamentally what brought me to medical devices in the first
place was that I was an emergency doctor having problems
actually caring for my patients. As a tourniquet manufacturer basically
(30:02):
was about engaging with other people who are making and
using tourniquets to understand some of the roadblocks and problems.
One of the biggest ones is that there isn't a
great way to test units of tournikets. So traditionally tourniquets
are tested by design. Uh Nar says, here's our design
and here's how we tested it, and then we accept
(30:22):
that this particular company will make this particular device to
this particular standard. But in the Ukraine, especially with the
presence of replicas and three D two tourniquets, there became
a new problem, how do you test each unit rather
than a specific line, and working on that, I don't
know how into the leads you want me to get,
(30:43):
but working on that is still a problem that is unsolved,
but has been one of the biggest issues that we've
been dealing with on the emergency medicine side. Of course,
when I provide direct care to patients, I was in
a hospital on one of the communities, on the front line,
on one of the fronts, and so providing direct care
(31:04):
became important. And working with the doctors, many of whom
didn't really experience that much have that much experience with
trauma patients, so working with them to share our experiences
from GAZA in low resource trauma medicine, and also to
gain from them their experiences because of course their scenarios
(31:25):
and situations are different. It's more artillery based rather than
small arms fire or um sort of bombing based, so
they're there are different scenarios. I had a lot to
learn from them. I did, and UM I tried to
contribute some of our experiences as well. The training I
think is probably the number one problem right now, but
that's my personal opinion. Is one doctor who is there
(31:48):
for a limited period of time so that that individual
unit tests that you're you're working towards is um because
I know in theory, at least a CAT it's a
single youth device, right and so in theory, if you
if you just slapped it on something that could mess
your pressure, and Titan did that. Devices and being used
and shouldn't be used again to provide care. Is that
(32:10):
the bottom that you're running up against, or is it
sort of making a way to test things it's replicable
and cheap and accessible. Reusability was the number one problem
that we tried to tackle in Gaza because we couldn't
print tourniquets as fast as they're being used, and so
we re used them up to ten times. And when
I was in the hospital, I walked by this I
(32:34):
V pole with a bunch of turniquets hanging from it,
and I instantly recognized what I was looking at. That
was a tourniquet rewashed station in which tourniquets that came
off of patients who were being rewashed, dried, and then
sent back out into the field, whatever you think the
standards are for tourniquet. When there's this level of of shortage,
(32:56):
that's what's going to happen. That's what happened in Gaza,
and that's why happened in the Ukraine. That's what I
saw in my own eyes. Of course, we don't need
to stretch that far anymore to recognize us. What were
people doing with the ninety five masks two years ago
in my hospital. We were holding them, storing them, watching them,
reusing them. So this is something that we see whenever
(33:17):
there's a shortage, and it makes the unit testing that
much more important because if you could take an already
used tourniquet and assure that it will succeed the next
time it's being used, that is so valuable, so valuable,
and it cuts down every tourniquet you can reuse as
a tourniquet. You don't have to import, you don't have
to buy, you don't have to package, you don't have
to ship over all of these lines. Yeah, yeah, of course,
(33:41):
and I think it's probably we should probably address like
the the ways in which they can fail because I think, uh,
look it just people in the United to State if
in an extremely like resource Ridge setting right, we'll probably
have knowingly or unknowingly acquired to want to get on
Amazon or somewhere else eBay that that might not be
(34:04):
a real one, and so I want it's real, but
we might not be a reliable one. Can you explain
like like how they fail and what the consequences of
that failure. Ah, there are two kinds of failures when
we talk about turniquets. One of them is what we
would call a technical failure, and the other one is
a clinical failure. A technical failure is the easiest one
(34:28):
for most people to spot. The tourniquet literally breaks in
your hand. And that said, you hear a crack, you
see something crack, you see a break, things fall apart
the end. And so one of the things that we
we want is to minimize these by over engineering. So,
(34:49):
for example, the first Glia tourniquet was engineered to spec
you're supposed to be able to turn it three times,
and so we made it so you can turn it
three times. And then what I realized is that even I,
who is like super well trained, I would be in
the field running while my eyes were full of tear gas,
while people are shooting and I didn't. I'd forget did
(35:11):
I turn it two times? Three times? So we over
we started over engineering the tourniquets. At a certain point.
Of course, every TURNIKID is going to break. You turn
it enough times, every turniquet is going to break. But
that's not necessarily going to be the case if you
have even a moderate amount of training. I'm going to
turn it for five times, but I'm not going to
turn it twenty times. So the technical failures are one
(35:36):
kind of failure. The other one is clinical failure. Now
here's something that I wonder if you knew about thirty
tourniquets from the gold Standard Company fail They fail on application,
and that number goes up to if you were to
check sixty seconds after application. So what does this tell us?
(35:59):
What this tells us is clinical failure is actually the
important marker here because we know turniquets break, and we
know turniquets fail in general, especially turnickets that have been
in some g i's pocket in Afghanistan for six months.
Those ones that their failure rate can go even higher.
And so what we train people to do is to
(36:21):
recognize clinical success. Put on a tourniquet, did the blood stop? No?
Put on a second turniquet, did the blood stop? No,
try a third one if you have them, obviously, and
so the routine training involves applying a second tourniquet. And
one of the like happiest moments for me, I mean,
(36:43):
this is obviously bitter sweet, but it was when I
saw a patient who was brought in by a medic
who I had I had been in the training four
and he had applied to turniquets to a guy who
certainly would have died had he had he not had
the tourniquet up flights on and I was exaguinating so
much injury so severe that he needed a couple of
(37:05):
turnickets to really get it under control. So it's it's
where we have to recognize that there is no magic tool.
This is part of an overall program. There's no three
D printer that's going to train people just going to
make you stuff. Then you have to do the rest
of it, right Yeah. Yeah, So I think if we, uh,
(37:27):
we should look maybe at the fact that like I
live in the United States and you're in Canada, and
I think there were like three mass shootings yesterday, right
that the that the threat of violence is certainly added
high for recent times in for a why a modiverse
range of people. Right, There's always been violence in this country.
(37:50):
There's always been violence against certain groups of people disproportion
in this country. But people are probably more concerned with
treating constria wounds and they would have been years ago.
And so if someone was looking to make one of
your devices, how can they do that? And they show
or do their best to ensure that they are doing
(38:11):
so in a way which gives them the best chance
of success. At the moment, I would say to the
individual maker, don't do it, not for a life threatening situation.
If individual individual makers want to make turnikets, then they're
going to have to be proficient at three big things.
One of them is plastics three D printing, ensuring that
the quality of the plastic is good. The other one
(38:34):
is sewing, that is to say, assembling sold stuff. And
the third one is is quality assurance, because even done perfectly,
a certain number of tourniquets aren't going to make it.
And that quality assurance is both at the moment of
manufacture and then over time, because of course all devices
(38:55):
deteriorate over time, but tourniquets have such an import role
that you have to check them periodically to make sure
everything is okay. So I would say to the individual maker,
don't or if you do, do it as an exercise
rather than as an actual tool. If somebody is in
an emergency situation, there's nothing they can do except to
(39:18):
do it, then be in touch with us. So, for example,
there are makers in in countries that have been in
touch and have said, okay, look, I have to do
this because the situation here is bad. We support them
as best as we can. We try to send people
out to them, or we try to have them ship
units to us. We try to get them up and going.
(39:39):
Glia is not a medical device manufacturer. GLIA is a
access to medicines and access to medical devices company, and
part of that is making sure that people who are
making medical devices are doing them to the highest possible quality.
So if you are forced to make them, be in
(39:59):
touch with us, we will help in any way that
we can. However, there's another category of people, and that
is manufacturers who already know how to make medical devices.
To those people, we say, take our stuff, please use
it please. It is there for the taking, and it
(40:21):
is high quality, it works really well, and if it's
missing something, tell us we'll make it better for you
and for us. Yeah, that's great. I think that's really
excellent advice and perhaps a good note for us to
finish on. Where can people find you if they want
to get in touch, if they if they want to
look at some of the devices like making a stethoscope,
I imagine could be like a fun project and put
(40:43):
a lot less potential risk there. So where can they
find that stuff? Absolutely, the stethoscope is such a fun project.
It's fun because any everybody has a heart in general,
and um you can listen to your family and friends
and loved ones that It's one of my favorite things
when I'm in practice and I listen for sometimes patient
(41:04):
will be there with their son or daughter or child,
and I'll tell the kid, you want to listen to
mommy's heart, your daddy's heart. It's one of the best things.
So the stethoscope is a great, fun, low risk project.
Please go ahead and do it. Make it. You can
find our stuff anywhere you can find printiple stuff. It's
on thingy versuss on principles, it's basically everywhere or through
(41:27):
our GETH hub or on the GLIA site. So that's
CLIA dot org and if people want to participate, they're
very welcome to We always want, need and love help,
and of course it's a community. You can never have
too many friends, so we're always looking for more friends
and love to see more people. We have a matter
(41:50):
most obviously, it's not just our devices that are open source.
We try to make our tire stack open source so
people can join and chat with us and you know,
hang out with people who are doing really, really cool
and super impressive stuff. At this point, I love to
recognize the fact that I'm one of the least productive,
least impressive people at clear Really the work that's happening
(42:12):
is amazing, and it's led by lots of smart, dedicated,
visionary people. Yeah, that's great to hear that. It's really
cool that you can we can work with people as well,
So hopefully people do get in touch. I'm sure there'll
be someone who's interested in what you're doing but has
something to contribute in some fashion. Yeah, thank you so
much for giving us some of your evening. Is there
anything else you'd like to say before we finish up.
(42:33):
I think the most important thing to say is that
there's this mystique that people develop you alluded to it earlier.
There's a mystique people develop around medical devices. Medical devices
are solutions to problems, and they were made by people
like me who don't know what the hell they're doing sometimes,
and so let's not you know, aggrandize or like separate
(42:56):
ourselves from the people who are doing this work. Yes
we have to be just, Yes we have to be vigorous,
but at the same time we can all contribute to
be a part of this very cool And can people
find you personally anyway? Do you have social media that
that people could follow. Yeah, if people look at my name,
Terry Labanni, I'm on all the all the socials, as
is Glia as well, So you can contact me or
(43:17):
Glia and participate in in anything that you want. And
like I said, we we always welcome friends. Great, wonderful,
Thanks so much man, Thank you so much. That was
such a pleasure. It could happen here as a production
of cool Zone Media. For more podcasts from cool Zone Media,
(43:38):
visit our website cool zone media dot com, or check
us out on the I Heart Radio app, Apple Podcasts,
or wherever you listen to podcasts. You can find sources
for it could happen here, updated monthly at cool Zone
media dot com, slash sources, Thanks for listening.
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