 So, I'm very happy to dine. We have two speakers here, Zeb and Dagi, and they are somehow, I think they'll explain it later, connected to KADUS, and they are building medical apparatus. Let's say it like that. And the name of the talk is Raymobo, Robust and Reparable Vital Sign Monitoring for Mobile Hospital Boxes. Medical devices for all, and please give them a big applause. Thanks. Yes, good evening. I'm really happy, sorry that I'm in German, but you already know, it's the third day and a lot of red nests in my head. I'm very happy to be able to do the talk today, because we already talked about the project last year in the talk Hacking Humanitarian Disasters. And then it's a bit like a kind of beginning success story, that we can say, what happened after a year from a project, from a specific project actually became. Full of Kachiname Remobo, you can notice it, that's why it's actually a research project, you really need such a project name for the contracts. And I'm trying a little bit, first of all, the setting around why we took this topic at all. A trivial fact is that the humanitarian situation is getting worse and worse worldwide. Of course, one thing is the climate change, which some people don't believe, which leads to much more flow movement and migration worldwide, and that won't get better. That's one thing. But the other thing is that armed conflicts have become less and less. There are no more wars in the mass that create a global catastrophe, like the first and second world wars, but there are almost a lot of armed conflicts on the world that are mainly led by very asynchronous. Asynchronous means that there are often conflicts between war parties, where on the one side, for example, there is a state power, on the other side, but a group that doesn't understand the state power, which then, for example, doesn't accept human rights and gender convention at all. All of this leads to the fact that we have more conflicts all over the world and more needy people who need help. Traditionally, this is how the humanitarian aid was carried out after the Second World War by state structures or by the big international NGOs. You all know the International Committee of the Red Cross, the MSF, and probably all of us are in touch. They also have the problem that in a few years, in fact, things are happening that shouldn't actually happen. In the war, medical facilities are also the target of military acts. A very well-known example that all of you know from the media from the last years is Syria. You can also talk about Afghanistan, you can talk about Mali, you name it. There are a lot of different examples where different sides, as you said, are protected by health care from humanitarian reasons. That leads to the fact that in the countries that already have difficulties in getting medical supplies, the equipment is destroyed. We are not a big international humanitarian organization and only exist since 2014. We have been founded in the same way as many small aid organizations. The reason is that we said that we need organizations that can act faster, less bureaucratically, than the big organizations that may also sound a bit more critical, more flexible to react to situations. And above all, we look at the fact that this was our approach, that we want to take the local needs with a focus. We didn't want the classic thing, we come from a rich country, to a particularly affected country, provide a short aid with the equipment that we bring with us, go away from the situation as it was before. The idea was that we wanted to have more connection and more empowerment for local structures. That's how we actually implemented it. For example, last year in Iraq, in Mosul, we did a direct frontline response. Where other NGOs don't go or don't go anymore. We have been in Syria since 2014 again and again. We also try to stay there and continue to work. If the media interest doesn't look at this conflict anymore. Syria, for example, now the media and consumers have looked at it. There you really don't get a large number of articles in the newspaper. This thing has also been bombarded again. This is the first time a highlight in the newspapers. But that goes from the report of the city council stone down. Of course, that brings some problems with itself. On the one hand, as small organizations we don't have access to a huge logistical structure like the large organization has. On the other hand, if we don't get the media interest, we have less financial capacity. That means that we have to come out with extremely little means and try to provide help. This Remobo project actually took place as a result of one of our biggest projects so far, the Mobile Hospital for North Syrians. We were in North Syria and trained paramedics for a local health organization. And then we saw what was actually needed. It is not enough to improve this pre-clinical care through education. What we actually need is a mobile unit with which we can bring the medical care much closer to where things are currently happening. I think that in Syria a very extreme mobile or dynamic frontline, the so-called IAS, has constantly shifted. Our idea was to be able to follow the mobile clinic on the LKW basis in order to be able to help the injured civilians and civilians on the spot. The hospital is now available. It has also been handed over to my local health organization, after which we were first in Mosul and then in Syria. But what we saw was exactly this question after the outbreak of the hospital. And that is a bit what I always find in such projects. You can now take different approaches. We could say that we want to be cheap. Then we, as a small organization, will only have the opportunity to spend the necessary devices here, for example, from the hospital. The devices might have been written off in the hospital. And the maintenance and the security and technical control and all the things the German law prescribes will be uninteresting for the hospital. So they move the devices away. Maybe they still have something against donation. And that's how the industrial actions will be a bit to export from medical devices. We didn't want to go for different reasons. First of all, it's an ethical question. Why do we go into a place where the situation is much worse than with us and actually offer a worse medicine because we take devices that are no longer up-to-date? That was one story. The second story was also old devices. Here they actually have a very, very big need for trust. When problems arise, software problems, hardware problems, you really need a technician or a technician from the company, from the manufacturer's company. Otherwise, the device is used for 2-3 months and then that's it. The other option is to buy new devices. The problem is, on the one hand, they're expensive. That's an example device for virtual parameters, parameter monitoring. It doesn't do much. It can measure blood pressure. It can write an EKG. It can control blood pressure. It can measure oxygen saturation in blood. You need that in a medical institution to be able to monitor and see the critical patient. What will change? Is it getting worse? Is it getting better? Do I have to intervene again? The problem, as I said, is the price. Even such a device costs over 1,000 euros. Although it doesn't do anything yet. There is no defibrillator, for example. For our relationship here, it is so cheap with a price range between 1,000 and 2,000 euros that if something goes wrong, it will just be thrown away and replaced. If I want to set up a hospital with 20 places and have to pay 2,000 euros for each, I'm already at 40,000 euros. That's a lot of wood from a small health organization. The second thing is that almost everyone, I learned the term proprietary connectors. Every manufacturer has its own cable connections. That means I can't give it to any hospital. They still have some cables from before and it automatically fits together. That means that if the oxygen sensor breaks the cable, the device can actually be thrown away. That was the case with this mobile hospital. We made a mix concept back then because we couldn't do anything about it. We bought a few devices, a few devices that were still in a very good condition and were a bit unhappy with it. And then we went to the fantastic professor Dr. Dagmar Kräftig and said, what can you do with it? And at this point, do you accept it? Yes, that was loud. Actually, there is one more thing for you. There are robust devices that could also be used in Syria. These are devices that are used by large state health organizations or military organizations. They are robust, but they are also not repairable. And they are of course extremely expensive. So the device costs 40,000. So you can see that it is quite difficult for a small NGO. And then we said, man, that's actually stupid. It has to be possible to have medical devices to build the design criteria that you have in such a mobile hospital. Because the one thing is, they have to be robust. The standard medical devices here are of course built for the hospital here, nice and stationary, well-tempered. Of course, that is not the case in Syria. Or you have temperatures over 50 degrees, a lot of dust. If I drive this with a mobile hospital through the area, there are quite a lot of dusts on the street. So these are just criteria or claims to robustness that the devices here do not have. And above all, we specifically said, if the thing drives around in Syria and it breaks, then I can't call the service technician. He probably won't buy a spare device for me. That means it has to be possible to repair, especially for people who don't have a training as a medical technician and also with tools that I have and tools. And of course, it should be also financially available. Our claim is that we have a device that everyone can rebuild, a small NGO. That doesn't have to be Syria. Another example is Kyrgyzstan. It's a relatively raw infrastructure. They also get a lot of medical devices and they stand there unrepairable, broken and in the best case, they don't do any harm. In the worst case, it's a device that can cause damage to wrong operations. That means here we have the claim to build devices that can be repaired and where people really know what they're doing with it. We have the Vital Parameter Monitoring as a starting point for the following reason. Sebastian has done that especially for the first supply. It's ideal for a mobile hospital. In the meantime, we are in our hospitals with an incredible flow of technology, design, everything confronted with everything possible. But the Vital Parameter Monitoring is a very basic medical device. And above all, it's also something that is really not a rocket technology. These are very old methods to measure these biosignals. The EKG, I brought here the Wikidpedia Bild of a commercial system from 1911. The EKG is older than 100 years old. That has the advantage. These are of course established technologies. They also don't have such a beautiful age. There are no patents on it. That means it's possible and it's also done. Above all, this is also a good template for other medical products, because the structure is always the same. I have some sensors. It can be imaging. In our case, these are the classic biosignals, EKG, blood pressure, oxygen saturation and temperature. And then I have an analog digital converter. Then it lands in my IT system and there are the signals and also a little bit of evaluation. If some limit values are exceeded, there may be a signal. That's always the same thing. That means it's a good template to see how well it works with our approach. We then wrote a project contract with a team from Beutoch School, where I am a medical technician. I myself am at the HTW Berlin in Informatik. The card is an NGO and also an engineer. In the meantime, there are other people who have helped. Of course, it's nothing that we do alone. These are the various expertise that we have brought together. Of course, the first thing was to examine how it looks from these standard devices. Our SEP has done various stress tests. We have such a climate chamber at the HTW, where you can adjust the temperature up to, I think, 70 degrees. They did that. We then put in boiling water to bring up the humidity. But they actually put it quite well. We let it run all the time and it worked quite well. At least we did not test it for three weeks now. We did not get that much time. We only got a week of measuring time in the climate chamber. What the devices can do less well is actually the dust. We built it ourselves. There is dust proof, which I did not know before. It has a certain size of corn. We then took it with an old vacuum cleaner and glued it to it. And then our device was really clean with the dust. They cannot do that well because they have all ventilation slots on the back. That is what we have to consider with the design. The next question was of course about the hardware. I do not have the claim but as an example this is the layout of the vacuum cleaner so the pulse oximeter and here we have the claim that everything is open source. Everyone can rebuild and also that it is sustainable. With EKG and pulse oximeter there are the medical physicists who know the methods. There was no big difficulties. There are also some things that are in the textbook but are not usually implemented. Temperature is very simple. There is a standard sensor. We have always looked where there are components that are so far spread that they are either cheap that you can send them as a spare part or you can get them everywhere to build components that are also standard components. That is what you unfortunately missed. We actually had at our booth such small soldering kits. I hope that we can repeat that in Berlin in the next one. Let's do a soldering session. On the left you can see the result. That is the EKG unit. There are parts on it and next to it is the soldering plan. The whole thing is a bit more difficult with blood pressure. I have a mechanical pump I take it everyone has already measured blood pressure. You know, you have the manschette here. That is of course inconvenient. When I have a pump inside I have a mechanical part inside. It is always sensitive and I have to pull the air. There is also something where we try to reduce that. There are new ways how to measure the blood pressure over the pulse transit duration. I don't have to pump that. That is only qualitatively possible. What is possible to check for the use. Will the blood pressure change in an inexpensive way? Maybe that is enough. That is our prototype that you see here. You see the different colors. We have built it modular because it is nice if one part is broken then it would be nice if you could use the other one. It is not robust it is repairable but robust is not in that form. That was just the prototype to show that it works that I can assemble it on the other side we deal with the IT system we don't use the original WestBerry Pi but it is not our original but our original is to take standard components and that is the WestBerry Pi that is really suitable for prototypes you can send a second one with less current and then we thought about the display and we tried to build the system so that each mobile device can use as a display for the system. If it is broken then you can do nothing and Paul sitting there actually thought out solutions on the WestBerry Pi you can download it there is an image you can use that via Bluetooth you connect via Bluetooth and you can connect with the web browser and then our application is only small only Java script so I don't have to communicate with the server and the Java script application the web app communicates directly with the service that delivers the data and shows it the difficult part was to prepare the many different signals on one side and the other to make it dynamic mobile devices and to remove it from the Bluetooth that means the system has to be able to deliver the data regardless of how many devices I connected for all devices that is a really nice solution here the front end is still in development that doesn't look like the vital parameter that you just saw but you can already see the direction is correct we are still developing it overall we also had the request that everyone should be able to rebuild and should be able to finance the hardware for the signals under 100 euros with material 12 euros the EKG module as an example the others we don't have yet in this small form and the WESP costs about 35 euros if I take a typical WESP or WESP display costs 70 euros I am also at about 100 euros and of course I need the mobile end devices overall I think does anyone know the healthy pie there it costs 300 euros 300 that is in the right size we are really satisfied with repair I think we are also on a good path that you have these different modules and you can solder everything here is always the question I just send WESP it doesn't make sense to build a WESPerry Pie I just send a second WESP that is a bit of a distraction how modular do I do what I send with as a second spare but at least with the sensors we already have the claim that it is basically unsoldable the WESP image is a SD card you can also send a second one if you don't have internet and can't download it and the Javascript front end we didn't have any problems with it we got it on every mobile end device to run and with that in the end how does it go on with the project what I didn't say how does it look like with the robustness I told you before it is actually that we didn't test so much we are of course happy about people who rebuild our system and maybe even throw it down the project is still running until April next year that means we will do it on a free-willed basis and of course we are happy if we can win more free-willed who support us until they all go you can't do it yourself because you can't really test if you find your system great and miss free the talks at the stand where we built it we got a lot of feedback and of course we are happy that you have a solution we hope that we can go into the discussion there is another solution I already mentioned different things that you might like what you can do and of course we are happy about further development and great ideas and with that we will have an interesting discussion with you what you might like what you have for questions thank you I just noticed that from our point of view from the cardus side that such a component that also has a high political component because if you really think that this technology is so old and so easy for us as cardus we don't really need this device to be used the drive is almost over we could buy this device but why does it have to be that these devices are so expensive and there are a lot of these devices that were used for the first time professors for medical physics said that people come to the university and learn how to build the devices the technology is like no rocket technology then they go to the companies and learn how to make the devices so that they are not repairable and that is a point that we can talk about the ethical component why can this actually be so artificial that it is difficult to bring this device to the field and no matter where the project leads I think it is very wonderful for us to be able to show that it is possible to have such an argument to prove it politically that it doesn't have to be that devices that can do such things have to cost 40,000, 50,000, 60,000 that would be my question you have all smartphones for whom was the repairability of the device one, two, three I would say 10-20% of course you are right but it shows everywhere that what used to be very understandable that you can build your computer when something is broken that is a luxury and we live here in the world where it is not so bad I can buy a new smartphone if I want but in other regions that is not possible and I think that because of medical care I think that is true it is also an ethical question whether you really want to leave this market absolutely applause one of the most interesting projects that I have seen here in the context you probably have a donation address do you want to blend it here if we are here kardus.org come by we are still here we are in hall 2 I told you the whole thing is built up we are also at the start we are looking forward really it is so typical totally new and still totally new and the crazy thing is if you had the devices from the 50s 60s they would probably even be enough in quality that is also something if you look at the medical technology the requirements the limits for the accuracy they are always higher they have nothing really to do with it what you need in such a use to determine the health condition of a person but they really have more to do with it which manufacturers achieve these limits these criteria and which ones fly out of the market ok we already have a few questions you will get to it first the number 1 please your question thank you for the question I had a question do you have the demand for medical products to be fulfilled the question is if you let the repair of non-experts is this demand do you automatically fly out or can you make it theoretically so that the criteria is fulfilled although it was not repaired by experts it is a very good question we actually talked about it and thought about how we would do it because there is not only the medical products there is also the medical products and that means that medical devices can only be repaired by certified professionals where you just have to say that is of course for the use of this device here on site we have decided at least in the first step we want to check that because we find it interesting to see how far I can implement it but it is a very, very important very, very expensive process with a lot of stocks that you have to do there and we will not do that until April and it is not our actually not our demand because the idea is really that NGOs in the whole world can rebuild that cannot fall under the German medical product law we already have a demand that this device is very expensive but we will not do a certification you are on the one hand right when I say before that we want to export the medical product and now we are holding on to the German law it is a bit contradictory but I think it is possible to show what is actually possible and then I would be able to show it or to build more pressure if it is actually possible to allow equipment in crisis areas on the other hand as Carlos said this certification here in Germany if we really want to bring a product here on the market that is not the point then of course you have to see which structures and countries are responsible because the German MPG is not one-on-one applicable to all other countries and there you can of course develop exciting things if you have the opportunity that in other countries we will have to take steps MPG, QM and so on and so on everything is a bit of a sense but there is always a component in this artificial market and that is what I think we want to work on with this project ok, thank you microphone 2 and then with the signal ring hi, I was a bit surprised with the cost setting the display was integrated because it was a great idea with the smartphone they are usually available and that increases the cost to double the display is as I said a component that can break and then a second question was the Pi Zero of the hardware requirements simply not sufficient because that would have given a factor of 10 then I can create the whole thing for 20 dollars exactly, actually the first implementation was done with the Pi Zero right Paul? that's enough we have built the big one for the big prototypes we are not sure that's enough, we have to see with the display we have thought for a long time there is a problem we have built a system where everyone can connect with the device without identification but I have to be able to operate the device and we are not sure if we can have a special bluetooth connection for someone who just authorizes and maybe a bit more authenticated can operate the device because we don't want to connect 20 people with the device via bluetooth and everyone has to press a button and talk to the device that's why we first said the the display on the smartphone that's really only read only and we have on the device we still have a display that you can control the device but that's not the end I think in the direction of whether you have a device that I have what then we have to think about what the right one has to control the system that's the reason why we have a display or no more okay, let's not do it let's start with the colleague on the 1 2, thank you my question is in the direction of repairability how realistic is it that you get repaired in developing countries because there are many things but it's not that you just got a chip that's broken the one question the other question is also from the training is it realistic or is it not better to build as cheap as possible and then build in mass so should I do you want to start? yes exactly, I can start that's what I meant how modular do I do that my platform is pretty well solved you don't have to solder there is a good guide on the internet if the speaker is broken that you use a new module that's why we have built this modular one it's not like that it's not like there is nothing in these countries smartphones are widely spread and if it's a special chip I said you would pack a spare part with maybe even a whole module if you say it's hard to build together that's why it says help needed that's something that you have to try out in the community what's going to be repaired what's not going to be repaired what's not understandable the Slava who sits there makes videos explains videos with which it should go but it has to be tested if it doesn't work you would say we will send a second device if there is space or we will see how the supply chain will work I would say we are a member of global innovation gathering it's a network of over 50 maker spaces that are almost all in the global south I can say we often have a very wrong picture that means that there are not many resources that are available if people are repair artists then it's not like in the rich industrial nation but the people the resources are really scarce and that's a point when it comes to soldering do things together there is the I'm not at all worried that it's actually doable if you deploy in this construction site yes, from the shit I heard the internet the question is there we will try again the internet is the question if you have already heard of the GLIA project that has already developed open autoscopes, tourniquets and stethoscopes please name the project GLIA G-L-I-A they have endoscopes and spectroscopes did I get it right? stethoscopes otoscopes and tourniquets I don't know it personally but you have to say there is also a parameter monitor in the area we wrote the project three years ago two years ago it really did a great job that's why it says compare there is also a lot and we have a claim that it really is ours we have developed it it has to be no, that's not at all if other people have thought about something great and have built something solid which fully supports our claims or you can expand it much easier then we are totally grateful for such insights and tips but it's good to know because the endoscope was the next project we planned which is great to know that there are already people on it very good, again the address remover.f4.htb-berlin.de because everything just goes away we have a question the first one first of all, thank you for the exciting presentation I have two questions about what you planned for the next project what systems are there or medical devices that you might still want to build cost-effective and repairable and the second question about the device you have developed how did you create it with the housing to create the robustness as I said the prototype was just a plexiglass so you can see what's inside do you still need help or what is your idea for it exactly the SEPT is working very intensively with the audience and I think they already have ideas but we are really happy with the help we already had different ideas about how to do it maybe you can tell us about the project because it was an important requirement that the device is robust but as I said, we are always happy about the device we don't have it yet it's because we are currently with the prototype which is still relatively large and uncomfortable I don't know Slava, do you still have information about it you already had thoughts about yes, we are happy with the help about the project that is the professional component that develops between KARDOS and HTW is connected to the research project KARDOS has a crisis response maker space in Berlin but we are doing the big things we are building new patient treatment places we have developed a civil material air drop project in order to quickly deploy it with small machines where the big ones don't start working so quickly actually I don't understand anything I have no idea I would say it would be a dream to build a diagnostic at ULTRA but if you try to bring a diagnostic into the field then you start at 70.000 that would be a dream but we have to look again to find a university or a high school that works with us that is a friendship component but the professional component is connected to the research project the plan was to do several projects as an organization that we work in the field that we have to play both roles we have to look what we can contribute to make the project successful and for a field-based end and at the same time we are working in Syria to go into it and that is very difficult if we had known each other I don't think the research project would have been so easy in the evening hours we had to say that Ingebeckers von der Beut were actively involved because they said they have a cooperation with Kegisien we have the same problem with the equipment around them they are not repairable ULTRA would be a bit of a dream as the next challenge because it already exists in the field Dröntgen is difficult with ULTRA but you have to be really careful and that is what Ingebeckers just said Kegisien is standing there old CTS, old Röntgengräte people don't know how to deal with it and you also have a huge responsibility I think that is a bit of a challenge but ULTRA maybe there are also optical processes optical coherence tomography they are all non-invasive but I think that is you have to see what is there there was the idea to build an operational lamp that is as much energy saving even solar power is a ventilation for to have an OP table there was also a work group that dealt with it I think there are many different things but if you look at it you can find ways to finance it as a purely community project it is very difficult to implement sounds like someone who needs the whole thing ok, we still have a question I think we will finish after that so the last question, thank you it is a pretty cool topic very briefly the question about the complexity of the software when I have my modules etc. what does it look like with the diagnosis? does the user recognize that the blue module is broken I can switch it off so you have thought about something like that yes, we have we haven't developed it yet but we have to find a way to find out if it is broken and even if you build a new sensor you have to calibrate it but we have already thought about it but we haven't implemented it yet so there is still potential how do you do that you look at it is the impedance right and then the diagnosis of the broken device to find out if it is broken it is not broken or at least I get a signal and the doctor has to know or the user, wait a minute that can't be absolutely where we assume that the device is used by medical professionals or at least learned professionals they can already distinguish that can't be a pulse curve that looks like a oxygen set or at a temperature but that is clear especially if it is a bit out of date it fits that is an important point yes, okay thank you very much call again support, support applaud, donate kardus.org thank you both Dagi, Sepp and here is about 22 hours 10 of the next talk review for all functional applications Thank you