PHILADELPHIA — One of the most overlooked and underfunded necessities in global healthcare is access to safe and effective anesthesia. Anesthesia and basic surgery are essential health services and one third of the world population either do not have access to essential surgical procedures or are subjected to improper and unsafe anesthesia. The incidences of injuries necessitating surgery and non-communicable diseases requiring anesthesia are rapidly on the rise. There are tremendous disparities in access to safe anesthesia globally, and the burden is most egregiously placed on the poorest of those seeking medical care.
Gradian Health Systems emerged to address this specific health crisis by developing the world’s first Universal Anesthesia Machine (UAM) to deliver anesthesia safely and in an economically just manner. The genesis of this technological advancement in global health began with Dr. Paul Fenton, a British anaesthetist based out of Malawi. Dr Fenton was motivated by the horror of witnessing the failure and breakdown of donated and outdated machines that would frequently interrupt or cancel surgeries and put many lives at risk. Even when the anesthesia machines worked, doctors still faced the hurdles of electrical shortages and shortages of compressed medical gases – occurrences common in hospitals and clinics in the developing world.
Dr. Fenton dreamed of a machine that could function in any environment and would adhere to international standards effectively. He wanted to develop a machine that would be reliable in any setting and would operate with or without electricity and compressed gas. He conceived of a model that would have integrated safety features that would allow the device to run on a battery pack for up to 10 hours during power outages and that would automatically monitor and disable gas flow if a dangerous hypoxic mixture was detected.
Dr. Fenton introduced his design in 2009 while working in Nepal. The UAM has been proven to be safe and effective with over 23,000 successful cases performed in Malawi and another 2,000 patients in the UK and Nepal. Dr. Fenton entered into an arrangement with The Nick Simons Foundation in 2010 to establish a commercial entity to develop and deliver the machines globally in conjunction with training and service support to users.
With over two billion people lacking adequate surgical care and safe anesthesia, the UAM stands to be a model of medical advancement to help close the gap in equitable and accessible health care. This technological breakthrough is timely, given that anesthesia and basic surgical procedures for the global poor may emerge as the new global health crisis. The World Health Organization (WHO) included “strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage” as a goal in May of 2014 but has yet to implement an effective strategy to address this issue.
The developing world faces a critical health concern in guaranteeing safe and effective surgical procedures. Some of this is caused by the equipment itself. The majority of the medical equipment in the developing world is broken with estimates of at least 38 percent and upwards of 96 percent according to some claims. The World Health Organization Guidelines states that 70 percent of medical equipment in sub-Saharan Africa is not useable or working. In 2010, Dr. Margaret Chan, the Director-General of WHO, stated that 70 percent of the more complex donated medical devices are inoperable when they reach their final destination. Additionally, WHO reports that, “only 10 to 30 percent of donated equipment ever becomes operational.”
In these developing countries, the three main causes of inadequate and failing equipment are lack of either training, infrastructure or health technology management. Developing countries face systemic deficiencies including lack of spare parts, lack of access to technicians, administrators and donors making decisions without technical advice and a lack of training and basic knowledge of maintenance and difficulties in capacity building.
The Gradian Health Services business model has been a thoughtful approach to addressing some of the specific failures global health has been unable to fully address. They have done this with innovative technology that specifically focuses on the needs of those most poor and without effective healthcare services. By using technology to circumvent the limitations and gaps facing developing nations they have delivered on a product that can be used in areas with inadequate facilities, technicians and infrastructure.
There is little cohesive focus or funding to support safe and effective anesthesia. Major donors to global healthcare providers have been unwilling to address and fund safe surgery and anesthesia as part of global health initiatives due to common misconceptions and a lack of coordinated and sustainable strategies. The global poor have accounted for only three percent of major operations and anesthesia related mortality, which is three times higher in developing nations, is intrinsically linked to the level of development in countries and the number of trained anestheticphysicians.
Gradian Health Systems has taken into account the larger picture facing healthcare providers and has included not only proven quality, durability and targeting common parts failures, it has also integrated considerations for training and parts services into its hybrid business model.
The UAM is rugged, easily maintained, and has eliminated common mechanical valve problems with the unique Fenton valve. The company provides local training and internet and phone support to technicians to ensure a knowledgeable base of administrators and users. They also provide spare parts delivered by both regional service providers and courier shipment to maintain optimal device usability.
By offering not only a top of the line machine, but also service and parts, Gradian Health Systems has emerged as an innovative example of needed approaches in delivering appropriate and essential healthcare services to anyone, anywhere regardless of wealth or privilege.
– Nina Verfaillie
Sources: Gradian Health, IFMSA, MIT, Global Health Journal
Photo: Edna Hospital