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