[Music] this is chemi I meant chemi in Nigeria
this is chemi I meant chemi in Nigeria
this is chemi I meant chemi in Nigeria last year when she was admitted to
last year when she was admitted to
last year when she was admitted to hospital with pneumonia a common line
hospital with pneumonia a common line
hospital with pneumonia a common line infection chemi needed a particular
infection chemi needed a particular
infection chemi needed a particular simple medical therapy Kemah needed
simple medical therapy Kemah needed
simple medical therapy Kemah needed oxygen the same oxygen that we breathe
oxygen the same oxygen that we breathe
oxygen the same oxygen that we breathe in the air around us the same oxygen
in the air around us the same oxygen
in the air around us the same oxygen that many of you will have inhaled if
that many of you will have inhaled if
that many of you will have inhaled if you’ve ever been a patient in hospital
you’ve ever been a patient in hospital
you’ve ever been a patient in hospital oxygen is an amazing medical therapy and
oxygen is an amazing medical therapy and
oxygen is an amazing medical therapy and we’ve been using it to save lives for
we’ve been using it to save lives for
we’ve been using it to save lives for over 100 years a little bit of oxygen
over 100 years a little bit of oxygen
over 100 years a little bit of oxygen for a sick child like Kimmy is almost
for a sick child like Kimmy is almost
for a sick child like Kimmy is almost miraculous however there are thousands
miraculous however there are thousands
miraculous however there are thousands of children around the world who need
of children around the world who need
of children around the world who need oxygen right now but who won’t get it
oxygen right now but who won’t get it
oxygen right now but who won’t get it children with pneumonia like Kimmy
children with pneumonia like Kimmy
children with pneumonia like Kimmy others with meningitis malaria babies
others with meningitis malaria babies
others with meningitis malaria babies born prematurely this simple life-saving
born prematurely this simple life-saving
born prematurely this simple life-saving therapy simply doesn’t reach them so how
therapy simply doesn’t reach them so how
therapy simply doesn’t reach them so how do we get simple life-saving therapies
do we get simple life-saving therapies
do we get simple life-saving therapies like oxygen to the children who need
like oxygen to the children who need
like oxygen to the children who need them well first we need to stop
them well first we need to stop
them well first we need to stop pretending they’re simple this is a
pretending they’re simple this is a
pretending they’re simple this is a Children’s Hospital just down the road
Children’s Hospital just down the road
Children’s Hospital just down the road at first glance providing oxygen here
at first glance providing oxygen here
at first glance providing oxygen here might look simple oxygen comes from the
might look simple oxygen comes from the
might look simple oxygen comes from the wall nurses give it to patients however
wall nurses give it to patients however
wall nurses give it to patients however when we look behind the scenes we see a
when we look behind the scenes we see a
when we look behind the scenes we see a different picture nurses will tell you
different picture nurses will tell you
different picture nurses will tell you how they’re trained to give oxygen
how they’re trained to give oxygen
how they’re trained to give oxygen safely how they follow guidelines so
safely how they follow guidelines so
safely how they follow guidelines so that every child who needs oxygen gets
that every child who needs oxygen gets
that every child who needs oxygen gets it Engineers will tell you that there’s
it Engineers will tell you that there’s
it Engineers will tell you that there’s a three story high tank sitting out the
a three story high tank sitting out the
a three story high tank sitting out the front of the hospital that contains
front of the hospital that contains
front of the hospital that contains 30,000 leases of liquid oxygen they’ll
30,000 leases of liquid oxygen they’ll
30,000 leases of liquid oxygen they’ll tell you there’s 20 kilometres of piping
tell you there’s 20 kilometres of piping
tell you there’s 20 kilometres of piping taking that oxygen to every single room
taking that oxygen to every single room
taking that oxygen to every single room in the
in the
in the in the hospital they’ll tell you about
in the hospital they’ll tell you about
in the hospital they’ll tell you about quality control maintenance and backup
quality control maintenance and backup
quality control maintenance and backup systems that ensure we never run out of
systems that ensure we never run out of
systems that ensure we never run out of oxygen this is a hospital in Nigeria a
oxygen this is a hospital in Nigeria a
oxygen this is a hospital in Nigeria a couple of years ago I asked the director
couple of years ago I asked the director
couple of years ago I asked the director here about oxygen and he said ah doctor
here about oxygen and he said ah doctor
here about oxygen and he said ah doctor Hamish oxygen is my biggest headache
Hamish oxygen is my biggest headache
Hamish oxygen is my biggest headache oxygen supply was always running out
oxygen supply was always running out
oxygen supply was always running out doctors were having to choose which
doctors were having to choose which
doctors were having to choose which child would get oxygen which child would
child would get oxygen which child would
child would get oxygen which child would miss out and technicians had piles of
miss out and technicians had piles of
miss out and technicians had piles of broken equipment they couldn’t fix
broken equipment they couldn’t fix
broken equipment they couldn’t fix providing oxygen to children is complex
providing oxygen to children is complex
providing oxygen to children is complex there’s technical complexity
there’s technical complexity
there’s technical complexity administrative complexity and then
administrative complexity and then
administrative complexity and then there’s the enormous complexity of human
there’s the enormous complexity of human
there’s the enormous complexity of human behavior how do you get fallible humans
behavior how do you get fallible humans
behavior how do you get fallible humans like you and I to give oxygen to the
like you and I to give oxygen to the
like you and I to give oxygen to the right child at the right time every time
right child at the right time every time
right child at the right time every time complexity doesn’t mean that we throw it
complexity doesn’t mean that we throw it
complexity doesn’t mean that we throw it in the too hard basket but it does mean
in the too hard basket but it does mean
in the too hard basket but it does mean we need to understand how complex
we need to understand how complex
we need to understand how complex interventions actually work in messy
interventions actually work in messy
interventions actually work in messy real-life situations
real-life situations
real-life situations I’ll give you an example in Nigeria part
I’ll give you an example in Nigeria part
I’ll give you an example in Nigeria part of our plan was to use oxygen
of our plan was to use oxygen
of our plan was to use oxygen concentrators concentrators are amazing
concentrators concentrators are amazing
concentrators concentrators are amazing little machines that drawing air take
little machines that drawing air take
little machines that drawing air take out the nitrogen and give a continuous
out the nitrogen and give a continuous
out the nitrogen and give a continuous supply of medical grade oxygen we know
supply of medical grade oxygen we know
supply of medical grade oxygen we know from experience that concentrators can
from experience that concentrators can
from experience that concentrators can work well for many years with minimal
work well for many years with minimal
work well for many years with minimal repair or maintenance needs
repair or maintenance needs
repair or maintenance needs concentrators are a great alternative to
concentrators are a great alternative to
concentrators are a great alternative to traditional oxygen cylinders which run
traditional oxygen cylinders which run
traditional oxygen cylinders which run out after a few days and are notoriously
out after a few days and are notoriously
out after a few days and are notoriously unreliable and expensive however when we
unreliable and expensive however when we
unreliable and expensive however when we first proposed concentrators in Nigeria
first proposed concentrators in Nigeria
first proposed concentrators in Nigeria doctors from one Hospital told me that
doctors from one Hospital told me that
doctors from one Hospital told me that in their experience concentrators didn’t
in their experience concentrators didn’t
in their experience concentrators didn’t really seem to work that well so we went
really seem to work that well so we went
really seem to work that well so we went around and we tested every concentrator
around and we tested every concentrator
around and we tested every concentrator on their wards every concentrator they
on their wards every concentrator they
on their wards every concentrator they were using for patients and we found
were using for patients and we found
were using for patients and we found they were absolutely right most of their
they were absolutely right most of their
they were absolutely right most of their concentrators were not even giving
concentrators were not even giving
concentrators were not even giving oxygen they were just blowing out air
oxygen they were just blowing out air
oxygen they were just blowing out air imagine that you think you’re giving
imagine that you think you’re giving
imagine that you think you’re giving life-saving oxygen therapy to a
life-saving oxygen therapy to a
life-saving oxygen therapy to a patience and it’s just plain air so he
patience and it’s just plain air so he
patience and it’s just plain air so he sat down to try and work out what was
sat down to try and work out what was
sat down to try and work out what was going on and we found that their
going on and we found that their
going on and we found that their concentrators were not suitable for use
concentrators were not suitable for use
concentrators were not suitable for use in hot humid dusty Nigerian conditions
in hot humid dusty Nigerian conditions
in hot humid dusty Nigerian conditions many of them were poor quality many were
many of them were poor quality many were
many of them were poor quality many were donated secondhand from abroad many were
donated secondhand from abroad many were
donated secondhand from abroad many were dead-on-arrival concentrators were
dead-on-arrival concentrators were
dead-on-arrival concentrators were flogged until they died with no routine
flogged until they died with no routine
flogged until they died with no routine maintenance and no way of doing repairs
maintenance and no way of doing repairs
maintenance and no way of doing repairs or even getting spare parts by
or even getting spare parts by
or even getting spare parts by understanding how concentrators were
understanding how concentrators were
understanding how concentrators were actually used in this particular
actually used in this particular
actually used in this particular environment we were able to work
environment we were able to work
environment we were able to work together to improve the system
we selected simple concentrators that
we selected simple concentrators that work well in hot humid conditions we
work well in hot humid conditions we
work well in hot humid conditions we installed reliable solar power we built
installed reliable solar power we built
installed reliable solar power we built teams of nurses technicians and doctors
teams of nurses technicians and doctors
teams of nurses technicians and doctors who could look after concentrators and
who could look after concentrators and
who could look after concentrators and access help for repairs and we worked
access help for repairs and we worked
access help for repairs and we worked with nurses to make sure that oxygen
with nurses to make sure that oxygen
with nurses to make sure that oxygen therapy was integrated seamlessly into
therapy was integrated seamlessly into
therapy was integrated seamlessly into their existing bedside routines and that
their existing bedside routines and that
their existing bedside routines and that they weren’t overloaded with more work
they weren’t overloaded with more work
they weren’t overloaded with more work simple solutions that came from
simple solutions that came from
simple solutions that came from understanding and wrestling with the
understanding and wrestling with the
understanding and wrestling with the complex we learned similar lessons when
complex we learned similar lessons when
complex we learned similar lessons when we looked at how oxygen was being used
we looked at how oxygen was being used
we looked at how oxygen was being used for patients for example we’d heard that
for patients for example we’d heard that
for patients for example we’d heard that some nurses were turning children’s
some nurses were turning children’s
some nurses were turning children’s oxygen off over night when they thought
oxygen off over night when they thought
oxygen off over night when they thought no one was watching shocking right well
no one was watching shocking right well
no one was watching shocking right well it turns out that many nurses and
it turns out that many nurses and
it turns out that many nurses and patients were actually scared of oxygen
patients were actually scared of oxygen
patients were actually scared of oxygen you see it’s generally the sickest
you see it’s generally the sickest
you see it’s generally the sickest patients that need oxygen and sometimes
patients that need oxygen and sometimes
patients that need oxygen and sometimes these sick patients die not because of
these sick patients die not because of
these sick patients die not because of the oxygen but because they’re very very
the oxygen but because they’re very very
the oxygen but because they’re very very sick
sick
sick so these nurses had seen some children
so these nurses had seen some children
so these nurses had seen some children who died while they’re on oxygen so they
who died while they’re on oxygen so they
who died while they’re on oxygen so they associated oxygen with death
associated oxygen with death
associated oxygen with death they weren’t stopping children’s oxygen
they weren’t stopping children’s oxygen
they weren’t stopping children’s oxygen to be nasty but because they were under
to be nasty but because they were under
to be nasty but because they were under the misconception that oxygen was
the misconception that oxygen was
the misconception that oxygen was causing harm by understanding
causing harm by understanding
causing harm by understanding people perceived oxygen and how nurses
people perceived oxygen and how nurses
people perceived oxygen and how nurses actually used it we were able to find
actually used it we were able to find
actually used it we were able to find ways to help nurses use oxygen well and
ways to help nurses use oxygen well and
ways to help nurses use oxygen well and confidently part of this involved
confidently part of this involved
confidently part of this involved oximeters oximeters are machines which
oximeters oximeters are machines which
oximeters oximeters are machines which enable nurses to be able to measure the
enable nurses to be able to measure the
enable nurses to be able to measure the blood oxygen level of a child this means
blood oxygen level of a child this means
blood oxygen level of a child this means they can tell who needs oxygen and they
they can tell who needs oxygen and they
they can tell who needs oxygen and they can immediately see the beneficial
can immediately see the beneficial
can immediately see the beneficial effect when they put someone on oxygen
effect when they put someone on oxygen
effect when they put someone on oxygen and they can even share this with
and they can even share this with
and they can even share this with families by making the effort to
families by making the effort to
families by making the effort to understand the complexity of how nurses
understand the complexity of how nurses
understand the complexity of how nurses were using oxygen we were able to come
were using oxygen we were able to come
were using oxygen we were able to come up with effective locally appropriate
up with effective locally appropriate
up with effective locally appropriate solutions now chemi got oxygen when she
solutions now chemi got oxygen when she
solutions now chemi got oxygen when she needed it and it helped save her life
needed it and it helped save her life
needed it and it helped save her life kami got oxygen because we work together
kami got oxygen because we work together
kami got oxygen because we work together to understand how an oxygen system would
to understand how an oxygen system would
to understand how an oxygen system would work in the local context and then we
work in the local context and then we
work in the local context and then we built on what people were already doing
built on what people were already doing
built on what people were already doing well but this is not just a story about
well but this is not just a story about
well but this is not just a story about oxygen this is about how we get basic
oxygen this is about how we get basic
oxygen this is about how we get basic life-saving therapies to the people who
life-saving therapies to the people who
life-saving therapies to the people who need them not just in the easy to reach
need them not just in the easy to reach
need them not just in the easy to reach places but especially the difficult ones
places but especially the difficult ones
places but especially the difficult ones basic rehydration for children with
basic rehydration for children with
basic rehydration for children with diarrhoea basic resuscitation for
diarrhoea basic resuscitation for
diarrhoea basic resuscitation for newborn babies basic prevention of
newborn babies basic prevention of
newborn babies basic prevention of malaria using bed nets basic health
malaria using bed nets basic health
malaria using bed nets basic health interventions that we know save lives
interventions that we know save lives
interventions that we know save lives and this involves all of us healthcare
and this involves all of us healthcare
and this involves all of us healthcare workers technicians managers researchers
workers technicians managers researchers
workers technicians managers researchers educators so let’s stop pretending the
educators so let’s stop pretending the
educators so let’s stop pretending the basic health therapies are simple every
basic health therapies are simple every
basic health therapies are simple every health intervention is complex to do in
health intervention is complex to do in
health intervention is complex to do in messy real world environments and let’s
messy real world environments and let’s
messy real world environments and let’s embrace that mess and try to understand
embrace that mess and try to understand
embrace that mess and try to understand how the complex interventions actually
how the complex interventions actually
how the complex interventions actually work on the ground and let’s start with
work on the ground and let’s start with
work on the ground and let’s start with what’s working let’s build on people’s
what’s working let’s build on people’s
what’s working let’s build on people’s insights and strengths that’s where
insights and strengths that’s where
insights and strengths that’s where change starts
”
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