 so now say some things all right i'm gonna count and that way we could estimate our delay too okay start counting this is thrilling to all of our internet fans one two three four six seven eight nine 10 11 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 it's half minute delay one two three four five 36 37 38 29 40 41 42 43 44 45 46 47 48 45 i freaking love pinball it is flipping cool i have played pins from all these manufacturers and i was kind of having a cathartic sad moment because as i was looking at these companies i'm like that one went under in 1990 but that's okay because capcom came along in 1994 adding to the rich pinball legacy except they died in 96 this one also died in 96 99 yeah it's sad so godly actually went to columbia pictures and then coca-cola and has this rich history of people like there's really cool intellectual property here and it's awesome and not enough people are playing again so one's left right fortunately that one's still in business and they do make awesome games and the future is a little bit brighter jersey jack was founded in 2011 and they also have and part of that is because of excitement from things like the pinball museum that's in alameda that you should check out we really don't want this to happen the pinball it's bad enough that we do this as like sort of companies going under business but fortunately science is coming to the rescue so what happens when you take cutting-edge lithography techniques add in sweet micro motors perhaps some pumps electrodes anyone anyone know what that gives us micro pinball no no they give us scientific papers i i guess it also gives us pinball so this is the world's smallest pinball a human hair is actually larger than the channels here's a quick video slow down a little bit more so you can see it actually it's fed up quite a bit so you can see it there's something and with that i would like to introduce you to uh michael very who are going to talk about early pinball art thanks rick so hi everybody i'm michael schiessons ladies are terry and we're from the Pacific pinball museum how many people have been there we're gonna get that library fast we're gonna check it out it is amazing so we're gonna talk about the art of pinball and how it kind of how it started and um it we're not going to go into the uh anything past the 40s probably so i hope you're not looking to see uh bud roger just a little brief thing the library's i mean the museum was founded about 11 years ago and became a non-profit mainly because nobody else is tackling you know preserving pinball we thought that was pretty sick almost lost it when you showed that one picture it was pretty hard at one point in the 1940s 50s and 60s there were no fewer than 18 different pinball manufacturers building pinball machines they were coming out with a different title on average about every month and a half they make about eight or ten a year uh as rick said there's really one major manufacturer left today stern electronics jersey jack is a recent entry in the field they're gonna produce maybe maybe two or three titles a year uh if we're lucky so it's really important and our entire mission actually is to preserve and promote pinball so to make sure it doesn't disappear because it's very much in danger doing just that yeah and uh our main our main thing is that we're into the art of pinballs our main um thrust we consider it well my wife came up with a great concept of it it's it's working class art it's it was art that was developed for to attract people common day everybody to go up to a pinball machine and put some money we're just gonna talk real briefly about the history of it uh pinball came from France it was basically a pool table played with a cue stick that was put on an angle so the idea was that you couldn't get a direct shot at the target um they brought it over to america uh and an american developed a spring-loaded plunger and got the patent on it and also got a patent on putting bells on a play field it was called parlor bagatelle and it had no artwork the second thing that happened was in the 30s at the birth of the depression a a game called wiffle board came out again had no artwork but it took uh it it just created this whole thing and pinball really took off in the 30s strangely enough when nobody had any money uh and they would dump a lot of money into these things so i i it got so hairy that uh that's why the mafia got involved that's why mary leguardia had a bigger war against pinball that's why the picture of the guys smashing the pinball machines so we lost a lot of this stuff uh to the police force as you can see there's there's no flippers to control the ball obviously flippers didn't come in until 1947 so it's purely a game of chance it's total gambling these games would sit on countertops in a in a bar in a drugstore yeah the um the first artwork to come along was uh this was another neat thing about pinball pinball i guess the lawyers weren't as adept back then they would borrow stuff from popular culture in this case the first pinball machine to actually have art on it is this bali hu machine and he got the the pattern off of a popular magazine called bali hu and that's where he got the name also and and that it's just basically it's a board with some nails in it and that is what started the whole bali empire bali casino bali fitness it was all started because uh one manufacturer couldn't keep up with this guy's demand so he said screw it i'll make my own and that's what happened this gentleman that founded bali was ray maloney who was actually a godly distributor of pinball so godly was the main competitor of bali he couldn't get enough of these things to distribute his own so he said i'm just gonna build my own company called bali so it's looking like 50 000 units very very popular yeah um so uh they immediately started looking for ways to make it more attractive and they came up with a process of silk screening artwork onto wood um and in this case we're using an example of a back glass which really didn't come along until later but it's uh i'm sure all of you are familiar with you know soap screen t-shirts uh with with the playfields they would uh sometimes do four or five colors and they're all separate screens and they really were only two artists in the very beginning um that started doing this process you want to talk about Wayne? The gentleman here is Wayne Nions he's 93 years old he designed every godly game from 1948 up until the mid 60s and he lives at mountain home mark and saw and one of the things we do at our museum is we have a pioneers in pinball film series we actually interviewed him for about seven hours uh on summer in mountain home markets that's a lot of stories to tell obviously. He's pretty amazing he's he's one of the he's an engineer that just uh he kind of blows your mind because he you probably have one of the funnest jobs in the world because it's one thing that we don't talk about too much but there's a whole other art besides the graphic art is the art of engineering because when you build a pinball machine you basically got to make it hard enough so that people don't win all the time but if you make it too easy you don't want to play it either so you got to you got to make that thin line where it's just you know you almost get it and you have to come back and put another nickel in it and and try it again and this guy was the master he uh he made what's called the golden form the golden age of pinball and all his designs and they're all before computers just using relays and uh and switches and it's amazing what these guys did it so now now we get into they're actually producing uh real artwork on on pinball machines and in this case uh we like to show that the world's fair because uh this all most of the machines at this point are made in chicago um and this particular one has sold more pinball machines than any pinball machine ever 75 000 yeah over 75 000 machines and it was a jigsaw puzzle that when you put a diamond into it it would uh flip all the pieces sideways when the balls would land in the corresponding puzzle pieces and one of the pieces puzzle would flip over yeah when the balls land in the area they they flip the the pieces over the sooner you complete the puzzle the fewer number of balls you would win skill points it's not gambling these are skill points you can cash in your skill points for a drink or actually cash that it marches on the floor yeah that that's kind of funny people always went well how is this gambling well it's gambling because you really don't have a chance um it's does anybody know what a queen coon's machine is uh our galton board uh sir france has galled and invented this board um strangely enough it's a bag of towel but it's pyramid shaped pins and you drop the ball in the top and it bounces through and he's got all these little slots down at the bottom well he was trying to actually he was a Darwinist and he was trying to disprove uh god subsistence and then he used this little thing to prove the fact that this curve called the bell curve is a natural curve and that's what happens when you when you do enough sampling you'll always get this curve he correlated that to uh people's lifetimes uh whether they believe in a deity or not and you found out they all form the same curve so that was his proof it's pretty interesting totally all of a subject and I apologize uh so uh they were making a quite a bit of money and at this point there are over 600 people 600 manufacturers making pinball in america it was it was off the hook it was more profitable in the motion picture industry yeah i've made more money for from the 50s of the 70s uh than the motion picture industry um so the first artist that we've found is George Molanton and he um he did the one on the left called stampede I think Roy Parker did the wall street and strangely enough I love it wall street I think came out 34 35 that's the thing that caused this whole depression and they make a pinball machine you know I love it because uh everybody's hurt and and the reason that they would go to pinball is because uh if it would give you that chance to escape you know things were pretty miserable talk to my mom it was pretty bad so after they developed the uh the play field they decided that they needed something more because the play field was was uh lying fairly flat and you couldn't really see it they wanted something to attract people they also needed a way to score to keep track of score so uh Balli and Tom Grant from advertising posters came up with this a scheme to actually silk screen on on glass and they developed this whole technique and they made this is one of the earliest uh back glasses and uh it was purely used for scoring got to realize the target audience for pinball is it males uh 18 through 35 generally so a lot of the back glasses on today's modern games and even the older games usually featured women scantily clad in various different activities whether it was uh sports themes or baseball or cars anything the common man with a nickel or a diamond in his pocket could relate to and again the whole theme was all about fantasy and escaping and gambling so this this machine is kind of our pride and joy um this was confiscated by the Oakland police in 1936 and it was supposed to be destroyed that's what they would do they just round them all up and throw them into the bay or burn them and smash them but you got to understand this this was the first game to actually add up your score for you and it just used those little bumpers those little spring things when the ball would hit it it would it would increase your score so back then this must have been like a you know a mac or a you know ipod or you know and i imagine if i was an oakland cop i wouldn't want to throw that away so what did they do they brought him over to my where i live alameda and they gave him to the alameda cops as gifts and that's where this one lived for 80 years until the gentleman passed away and his twin brother who was also a cop came by the museum was the lucky juji back then and i couldn't believe it and it got me into these really old games and so this one's at the museum and it's an incredible shape and it's art deco the artwork on it's got all these rosettes it's just an amazing machine um then it then uh pinball started to you know in order to attract you had to use popular themes so this is a world's fair treasure island and this is what pinball did to it you gotta have the grill in there with the rocket roll rocket's optional but it's pretty amazing though when you think about it and if you look down in the corner the right hand corner there's a bus and that's part of the bay bridge so i think they really they literally snapped a picture of it while they were going over the bay bridge that was the shot they got of it um and that's that ended up on the back so uh just as an aside note our friend ed castle he did a he took that one part of the grill on the rocket and made a separate painting of it he's the one who did the um he does a lot of murals uh we do these giant murals at the museum that started up like with dan faunce who did the you know giraffes under the freeway so he's he's one of our board members ed castle painted the uh oakland public library you know that beautiful mandala mural that's been up there for around 20 years or so so it's funny how things come around so here's uh here's the two artists uh i'll talk about george melendon larry will talk about roi parter these are the uh the two artists that we're doing the majority of the art um and they had completely different styles that after you look at this stuff for hours upon hours you get to know it pretty pretty readily but basically um melendon came kind of from fashion design or something he he had a an ease of being able to draw stuff very fluid and everything whereas parker was a little stiff but he put a lot of little jokes in boy parker basically is a norman rock well of pinball uh artistry as it were a lot of double entendres and a lot of detail in his work but you'll notice if you look at enough of his back glasses to show women he never shows a woman's hand because he wasn't a very good hand hand hand whereas melendon the women in his pinball machines look like they just literally stepped out of the pages of vogue magazine they were usually dressed in very flowing robes and gowns but not as much detail as parker um this these are some of george melendon's pieces um you gotta look at this stuff along quite a bit but um i can see this stuff immediately um park uh sorry george melendon uh started out in 1935 and started working for a a company called advertising posters and there was another company called uh reproduction graphics reproduction graphics and that's where roi parker worked um and these are some of roi parker's examples you can you can see the difference in the in the women they're a little uh i think he skipped the anatomy class that's but it's amazing uh most of the people when they talk about pinball art they they're talking about roi parker because he was incredibly prolific and he's on all the machines that godly made godly only used roi parker um this is a a game called metro and it's also by roi parker and this was 1940 right before we went into uh world war two we ended the war in 42 so when that happened they stopped making pinball machines um so this is one of the last ones to come out the reason we like to show this one is if you look at the the the back glass it's the city of the future and you guys would go no it's not that's pedaluma but it's 1940 we didn't have freeways um we still don't have the flying rocket cars i'm pissed off about that but you know this this city is is like totally futuristic especially for back then uh after this that what they do is they actually take the machines uh shape the glass uh to clear the ink off the glass uh sometimes they do the play field and they re-ink them with uh wartime things let's see um not this one this one they were always taking popular things like boxing and things like that sports to get people interested um showboat i don't know how many how many showboats are there three there's three different ones dot the big two and uh yeah they they seem to crank this one out quite a bit just because showboat was so popular but here's one of the ones that that was re uh redone into uh into the uh yeah they're pretty offensive but this it was wartime and um this is what the people wanted you know they these were really popular games back then so rather than build a brand new machine they just take the old artwork screen off put new artwork on the back glass and on the play field for a lot and there's a new pinball machine um and they they had a bunch of very offensive artwork on these things and eventually we're going to do a show when we get when we get enough uh credo behind us because we we think it's interesting i think people should see this stuff but uh i was i was amazed um they couldn't reuse any copper any any of that stuff strangely enough though the pinball industry actually lent uh a lot of technology into the war effort and came up with a lot of stuff they were somewhat cutting edge um not necessarily um inventing it although they did invent a lot but they drove the industry the whole relay and switch industry i'm sure got it you know from what i've been able to ascertain huge boosts from the pinball industry um again world war two they just kept the themes up and uh and they would anything that had to do with the wartime effort was really popular tail good that's one of my favorites because that guy looks like he means business and they did a really nice job on on their wings i mean uh you know it's kind of rare to see that kind of detail um and i don't feel anybody's uh you had a nerd night on the hornet so there's the hornet and uh they did a that actually is not the hornet but it looks very similar uh it might be the original hornet which was lost in the war though um and and then uh towards the end of the war they does that's uh anybody know who that is vettie davis yeah and at the us oh actually this stage or again he was the first game that got me made after the war yeah still no flippers yes still no flippers um so what uh we just want to talk a little bit about what our museum does um there's a gentleman up north uh and sabassapal that's been collecting pinballs since 1952 so they were only at that point 32 30 years old at that point and you know why who knows but he he just was fascinated by him he was an auto shop uh teacher and analy high up there and he started collecting him and he has amassed an incredible amount of really early pinball that nobody else this this most of the stuff they got destroyed because these were all gambling games um then he got up into the 40s and he just kept collecting and collecting these are machines that literally there's there's there's only one example of him and he's got it he's uh he's pledged all his machines to us because we're the only ones that are really concerned about preserving it um i sent several letters to the smithsoni and trying to find out what they were going to do and they basically said we're not gonna we have three machines and they're pretty good ones but but they only have three machines and they did not wind up this is the american heritage museum and i thought oh god this is horrible when i went there i looked all over for him and i found a miss pacman video game that's what they have to represent this whole history so uh so our goal is to find a place to distort or to display it richard richard is actually on record his uh all his wife was in the room at the time and he said when she was there he has about 750 of these things but i think if truth be told it's more of a factor of twice that please so we uh we recently got an offer from john russo we used to be one of your you see the city attorney i think for oakland we got him in alameda now he's the city manager and guess what he likes yes he loves pinball he even had a setup pinball at city hall that was pretty amazing because you go into city hall and i'd set up like five pinball machines and i'm going there every day and take pictures and i was surprised to see i set up this he definitely wanted fireball because i was his favorite and i thought well okay sure i come in there i'm taking pictures he didn't see me he comes back from lunch and um they've been only allowed to turn him on for one hour during the lunch hour and this little kid is up there playing fireball and as soon as he's about ready to punch off another game russo went up there and hip-checked him because you've had enough kids let me know so they made an incredible offer of a 30 year lease at a dollar a year on the carnage and they they've already put like four million into it um doing a retrofit and so what we're what we need the money for is the ADA electrical you know everything to basically uh do an adaptive reuse in a museum and we're kind of blown away that the city of alameda you know everybody seems to be getting behind this and we're just now starting our fundraiser so yeah what we're really trying to do is be the smithsonian of pinball as it were we want to if you walked into the smithsonia what would you expect to see for pinball you want an oral history section uh the games from every different era from the early 20s all the way up to the modern solid state games restoration classroom restaurant coffee shop basically a one-way ticket not round trip one a one-way ticket to pinball nirvana basically that's the state that's the state that we're trying to create and no one else is doing this and as i said as we said earlier these things are really in danger of just disappearing and going away the half-life based on a pinball machine it's about 10 years in other words every 10 years the number of surviving examples of each title that's cut in half so if we don't do it really no one else is going to yeah um it's it's funny the europeans um and strange enough russians have been buying up all our machines and if you look at what happened to jukeboxes you won't see any jukeboxes they're very very hard to get this because they're all in europe they bought them they bought and so they they kind of you know i don't blame them i always thought that was kind of neat you know when they when you go to look for jukeboxes it's pretty hard to come by so we don't want this to happen to pinball we think it's an important part of american culture and we hope you guys feel that way also will support us in our in our effort don't let it be game over for pinball i don't know if we have time rick for for any questions anybody got any questions well actually it's it came from the poster industry oh the question was uh was silk sweet printing developed specifically for pinball wood and glass uh no it was being used for um theater posters uh it was advertising posters it was done on paper um and the technique of doing it on glass was developed for pinball i believe but not not the silk screening process itself and one thing that we didn't mention was um you know there were two companies and one of them burned down um these these were in chicago so in i think in the 30s uh what was it reproduction graphics burned down so they rebuilt it remotely opened and within not too much longer it burned down again because i guess he didn't burn it right the first time and it kind of led you to you know to wonder there there was definitely to have a mafia influence in all of this so it's kind of funny roi parker had to come work under george millett which must have chapped his hide because uh george millett became the head of uh he was an art director of advertising posters what they did after that was in the late 70s some um one of the artists said hey why don't we just do four color process on this stuff instead of silk screening which is called spot color where you you have one screen for one color um and as far as i'm concerned it kind of ruined pinball art because now we're basically doing illustrations they're taking a photo of it they're splitting it up into cyan and jenna yellow and black and and doing a four color process it really took kind of the soul and a lot of the a lot of the artists said well i don't want to do that i want to do the spot color and it ended up with um doug watson who's actually out here he's teaching at expressions for a while i think now he's teaching up north and he he was not fond of that process um and he ended up doing a 13 screen one called barra pedicora which was just kind of like a cross between a beautiful woman i think it's brook shields and um uh alien she had all this stuff coming out of her head it was pretty amazing yeah when did when did flippers become status quo flippers are invented in 1947 they had these things called pitch and bat baseball games where the ball was pitched and one of the engineers at godly was screwing around and um accidentally hooked up the bat to a button so that you could um and it and it you know he realized that wow you know you could put that on the play field and then you could knock the ball back up you know the first game with flippers was by godly it's called the Humpty Dumpty in 1947 and prior to the invention of the flipper you really didn't have control of where the ball was going so it really was basically a game of chance he had a ball that was an inch and 16th in diameter rolling down a plane that's angle at about six or seven degrees and no control over the ball unless you nudge it just right and get it to bounce where you want it but that was about it so it really wasn't a game of skill until the flipper was invented and on a lot of the back classes after that the manufacturers made sure to say a game of skill yeah skills yeah you know a really amazing thing about the flipper was godly been you know engineered godly been invented they could have patented they could have put everybody else out of business at that point there was chicago coin valley williams um a few others yeah united keeney all these guys would have been out of business because it just changed everything overnight um but godly didn't patent it they and and when you find out it's you realize wow it was a different time back then the reason he didn't patent it is he said these all the other you know manufacturers these are my friends they'd be out of business and you know why you know besides if we do that we won't have any competition why we wouldn't you know have any reason to make better products so i it's pretty amazing yes so so we had time before flippers what do you think a game from the 80s is very engaging i definitely sit there and put quarters into it and play it for a long time you just sit there and watch the thing what was the environment we were at a farm we'd be here with the money on the table yeah people like betting as the ball was coming down i yeah so so the question is uh what was the fun before flippers well i i didn't understand it myself until i got that belly bumper and a bottle of james's and it took me half a bottle until i got the and set the high score on that thing and it kind of cured me of james's but but i still have a high score but no it was it's really amazing when you've got money writing on something it makes it a lot more interesting and the thing is is that you can have skill with this and another another interesting thing is even after flippers were invented belly was really into the gambling aspect of it and they didn't want to give that up i'm sure and they're the ones that are really connected with the mafia so after flippers were invented they went they went the other way they said yeah we don't you don't like those flippers we're going to make this thing we're going game called bingo and it was a you might have seen it they're all they're always in bars there's still some over in the city at starlight donuts silver crest silver crest and apparently in chinatown there's a shop that still repairs these things and get them out there what it is it's strictly gambling you put a nickel in and you can put in more nickels or maybe they have separate quarters now to get your your payoff better and it pays off in credits and the credits the credit number goes that's three digits so you can go up to 999 those essentially be games but who's going to play a thousand games it's it's real obvious anything with that many credits you're supposed to trade them into the bartender and he buys them back from you so that's how it worked and they kept making the bingos they're still making them in brussels in the playfield basically had 25 holes in it and the object was to shoot the ball try to get the numbers corresponding to bingo cards on the on the back class and as mike said if you could get five numbers in a row you win three other credits yeah even three numbers in a row like five or ten credits the more coins you would put in you think the bigger your payouts would and as soon as you had a lot of credits on there the cops walked in there was a button underneath the front of the cabinet that the operator could press and all of a sudden the replays go down to zero the cops go oh there's no gambling here what are you talking about this is for amusement only yeah and they they did try to outlaw them and they they gave up they actually gave up and they said okay you can play bingo but we're just you know limit you're the one game and we're going to have a trick so you can only put so many quarters and that that game's called triple play and you'll see them on craigslist all the time because it was in the bay area so the question was once flippers were introduced to that and the mafia interest in pinball yeah see pinball didn't even after flippers are invented pinball was still illegal in new york chicago and la at delete until 1976 and the and it took one gentleman roger sharp he went in front of the city council and showed him that he could beat the pinball machine and that's in barbo lifted it's still illegal to play pinball in atlantic city new jersey on sundays um and and pinball horrors pinball horrors are still illegal in alameda and that's one reason that you know well it's a long story but i found out the hard way that they're still illegal yeah oh yeah that's a good question thanks uh he asked about the relationship between the slot machine and pinball so slot machines were pretty much invented by uh edward fey here in san francisco and his son charles fey developed them even further and that led uh his son charles fey developed a lot of things for pinball one of the things that that they talk about was his influence on the back glass because um i guess that that came out of some of the slot machine we're giving these glasses done so they were using it for scoring um you know the correlation is slot machines were pretty heavy duty gambling pinball was gambling light you know because it didn't it didn't look like a one-armed bandit it looked like a game of skill it looked like something that anybody could do and you looked like you really had a chance to win um just on that note one machine that i got from a gentleman in berkeley he got it from his uncle and it was made by harry williams a stanford graduate well harry williams invented most of the stuff for pinball the tilt mechanism of bumpers a lot of the mechanisms a brilliant engineer the first machine he built introduced electricity to the game it was called contact it was in a hotel down in los angeles and it put this guy through college the money that he made on that one machine that's how much money was going i think that's thanks to both uh michael and larry for that awesome talk they're going to be over in theater two for the next 15 minutes or so we're going to take a break so replenish your drink go talk to anna about a library card except all you already have them so talk to her about what's happening during national library week instead and we'll be back soon with uh news on fusion is awesome right powers the sun and shit that's that's awesome um fusion also could potentially be a practical reliable energy source right i mean how else are we gonna fuel our time traveling delurians right the mr fusion okay well our next speaker uh is going to talk to us about the about a very big effort to make fusion a reliable practical energy source it may not look like the mr fusion too soon but we'll get there eventually um but the reality is the tabletop fusion is not actually a matter of science fiction that's a thing that exists thanks to a guy named farnsworth okay now that guy um but it is his ancestor that's canon uh phylo t farnsworth known as the inventor of television um which is close enough to true um he absolutely invented the first electric television system um and there's a stamp bearing his likeness and he also invented this thing uh called a fuser um which is a small device that performs does it sound not on any other hood would you check a small device that performs nuclear fusion and this is the um let's see this is the patent design for the farnsworth fuser um we're going to check okay good we have sound we're good um so these are contemporary versions based on farnsworth's design um which also was modified so it could be called the farnsworth hersh fusion device people just call them farnsworth fuses for short um but they performed fusion uh it's really cool they're relatively small they can be built at home uh hobbyists and amateurs build them although some also exist in various laboratories around the country in the world and some are used for commercial purposes and um also um for medicine if anybody knows about nuclear medicine please give a talk because i'd really like to know more about that um if you're interested in creating fusion at home this actually creates a fusion reaction um no it's not going to be um reaching break even where the output of energy is anywhere equal to the input of energy but still it's really cool you're doing exactly what the sun does so people call it a star in a jar um there's like a whole forum there's like a whole online community devoted to performing fusion at home i'm not shilling for these people i just thought this was really cool that this is somebody's hobby um so you can always go to fuser dot net and learn how to build your own uh farnsworth fuser uh to talk about more practical uh and large-scale fusion we have rob kolesinski okay well thanks very much for the uh introduction and uh i must say that i really enjoyed the previous talk on pinball and there's actually some similarities between pinball and fusion they both involve collisions so between little particles and so as a result and maybe this isn't so much of a stretch to transition to this topic from the previous one but um i'll be discussing the eater project which is a large magnetic fusion experiment under construction in southern france it's a big international effort which would for the first time achieve break even in a thermonuclear plasma and uh let's see my name is rob kolesinski i'm a staff member at sandia national laboratories um so i should stress that i myself uh have not directly worked on either however i did read about it on the bar bride on the way over here in preparation for this presentation so as a result hopefully this will lay any concerns you have about my expertise in this area but but actually our group does do a bit of you know quite a bit of work related to fusion energy and this eater project which i've described here eater stands for international thermonuclear experimental reactor um and uh because the word thermonuclear has you know sounds like a doomsday device or something like that they uh eventually found out that eater in latin stands for the way so now they've changed it to the way but as though you couldn't look it up somewhere online and figure out what it really meant but eater is depicted here in this diagram and just to provide some sense of scale the little 1.5 meter high human being shown here in relation to the actual device itself it really illustrates the scale that we have to go to really generate fusion energy uh once completed it'll generate about 400 megawatts of fusion power for about 50 megawatts of input power so that'll be uh you know in terms of the break even ratio it exceeded by a factor of five or so and so this will demonstrate this technology and hopefully lead us on the path toward fusion energy so fusion itself is a large international effort as i mentioned there are a total of seven different countries who are involved excuse me seven different nation organizations that are involved with developing this technology and you can see they're highlighted here in the in this graphic the actual site for the device as i mentioned previously will be in cataract france where it will be constructed and the assembly of this is expected to be completed in 2019 and the estimated cost will be about 15 billion dollars or so or 15 billion euro and uh to put in perspective this is on scale some of the largest scientific projects that have been undertaken in in our history i mean the national ignition facility across the street from sandia Lawrence livermore is about three billion or so the large hadron collider i think was about eight billion and then the international space station it's about 55 billion so i mean it's in terms of monetary costs it's very large as you can imagine there's quite a bit of effort that goes into um getting all these different countries to work together to develop this and as a result of me you can only imagine some of the uh various difficulties that would be involved with uh getting all these countries to work together and there are various opinions about how this will all eventually work out but you can only imagine the various difficulties that would be involved with that and so as a result it's as much as social experiment as it is a you know scientific one and so why even pursue this technology well for first of all uh you know fusion itself is an environmentally benign technology in that it it doesn't you know contribute cea to the atmosphere so the only uh byproducts of the reaction would be a helium ash from the plasma reaction so certainly that's an attractive aspect of it and it also doesn't have the less favorable aspects of fission in that you can get a meltdown or there's all this radioactive material which uh lasts hundreds of thousands of years or so fusion does generate some radioactive material in its operation but the half life of those materials is so short that it decays within uh you know the decades or so so it's doesn't create the long-term hazard that fission creates and the deuterium and lithium uh generate are provided nearly inexhaustible supply of fuel for the reactor itself and so I mean just to put it into perspective the lithium in a laptop battery and the amount of deuterium that's contained in that bath water would generate about 200,000 kilowatt hours of energy which is equivalent to about 40 tons of coal and so it's really an incredible amount of energy that's contained in just a tiny amount of material and so uh now I would not recommend dropping the lithium in the bath uh if you haven't happened to have them nearby each other so in order to generate these fusion reactor reactions well what's done is uh you generate a plasma and so this is essentially creating the same thing you know trying to reproduce the processes that occur in the core of the sun uh you know the reason for using a plasma is if you try to use some other type of device like a solid state uh you know hydride or something like that the collisions that you would need to generate the fusion reactions it wouldn't be efficient enough the incident particles would simply lose all their energy before they could generate the fusion reactions so a plasma itself I mean it's sometimes referred to as the fourth state of matter but it's basically a quasi-neutral gas that exhibits a collective behavior so an ionized gas but um you know the behavior of the gas is not uh you know based on just the fluid mechanics of the the gas itself you can act upon it with electric and magnetic fields to control how it works and I think probably most people are familiar with many of these different applications I won't go into them in any significant detail but uh the fusion science has really advanced the plasma science and a lot of those previous applications that I showed here so the the two input products to the fusion reaction are deuterium and tritium and so deuterium and tritium are both isotopes of hydrogen each containing a different number of neutrons uh you know so standard what people refer to as hydrogen is just a proton and electron deuterium uh contains one neutron tritium two neutrons and uh these are the fuel source for the fusion reaction deuterium is readily available it's in about one in every six thousand hydrogen atoms occurring naturally is a deuterium atom tritium is not naturally occurring it's a radioactive substance with a very short half-life so there's not any that occurs naturally but you can generate it through uh splitting apart lithium and so this creates a a fuel cycle that's useful for fusion reactions so the deuterium and tritium are put into a plasma form and then they collide with each other so the plasma is heated up to uh so the ions have an energy of about 50 kv or so and then that corresponds to you know something like a hundred million degrees uh for the plasma temperature and then the deuterium and tritium will collide with each other and then they'll form a uh basically a neutron and an alpha particle or a helium for core and what's interesting about it is we take the mass of the deuterium and tritium prior to the reaction and then these products the neutron and the helium four even though it contains all the same basic particles these are actually have slightly less mass than the deuterium and the tritium and so that mass is converted to energy that's released so the neutron itself would have about 14 meb of energy this is mega electron volts or millions of electron volts so electron volts about 1.6 times 10 to the 19 joules you know so it's a very small energy on a human scale but when applied to a single particle it's quite a bit of energy and and this is really where the energy from the fusion reactions comes from the neutrons heat up the walls of the vessel and are used to you know power esteem turbine now in addition the helium also do conservation momentum will have about 3.5 meb of energy imparted to it and so the helium has an important role in that it helps heat up the plasma after the reaction and then eventually what's going to happen is the neutron is going to collide with the lithium atom and this completes the fusion fuel cycle in this case and as a result what happens is the tritium atom that comes out of the products of this and ends up being fed back into the reaction and as a result what this does then is creates the fuel which then can be re-injected into the reactor and as a result of this then you can complete the fuel cycle and then have more fuel for the reaction so just a little bit of history of fusion itself a lot of the initial work occurred at Princeton and then at Harwell in the UK and then also in the USSR and it was started all you know shortly after the post-war era and between these three different excuse me you know between these three different areas of fusion research it was all conducted in secret because it was thought to have some sort of weapons application but then shortly afterward it was declassified when there was discovered not to be any possible weapons application and then of course the funding for this work plummeted as a result of that. You might notice in this picture this is Khrushchev visiting the UK laboratory and he looks much more approachable here in his nice lab coat than he did later when he was at the UN banging his shoe on the table saying that he would bury us. So there's two basic confinement schemes for magnetic fusion well you know these are the probably the most prominent man-made types of man-made ways to confine plasmas there's inertial confinement which is used at the national ignition facility across the street from CND at Lawrence Livermore and this is basically where they take you know 192 lasers or so and impart this huge amount of energy onto a deuterium tritium pellet shown here inside this device called Holrum and this basically vaporizes the outside of this pellet and compresses it down to densities that are about 30 times what it was previously and so this is a very interesting technique for generating fusion reactions and it's also a great way to study the properties of matter at very high densities on the other hand what I'll be describing is magnetic confinement and so this is kind of more this is what Eater's based off of its tokamak design where you generate a plasma and then use the magnetic fields to confine the plasma itself and so here you have a much lower density than this inertial confinement concept but the pulses from this plasma are much longer so here this is kind of nanosecond time scales and this is on the order of you know the pulses that they get have a magnetic confinement device are on the order of many seconds and then the case of Eater on the order of many minutes so it's a quasi steady state type of device so the actual you know way that the plasma is confined if you have a current flowing through a plasma and then it generates a magnetic field which creates this what's known as this inward force is j cross b force so it's kind of a pinching type of way to increase the density of the plasma itself and so basically it compresses the gas contained in the plasma to a much higher density and as a result increases the number of collisions and increases the number of fusion reactions that occur so the two most common types of this device are the tokamak and the stellarator and the tokamak is what the Eater project that I mentioned previously is based off of and the stellarator itself is also an interesting concept they both to the tokamak consist of these you know toroidal field coils which help to compress the plasma and counteract the plasma pressure and then these additional coils help stabilize the plasma that kind of twists around this this doughnut shaped loop as it goes around and the stellarator more or less accommodates that twisting by you know designing the vacuum chamber and the magnets to accommodate that twisting motion so that the the tokamaks was the first to really show good performance so it's much more advanced at this point than the stellarator but the stellarator has a lot of attractive advantages it doesn't have quite the same instabilities that the tokamak has and it may provide more optimization later down the road and so one question is that often comes up is how close are we to actually getting something that can achieve break even basically the ratio of fusion input power fusion output to fusion input power and so a figure of merit that's commonly used in the fusion community is the triple product it's not important that I go into all the details of this right now but basically you know in this plot I'll be plotting this triple product as a function of the the plasma temperature and you know essentially I think a thing that resonates a little bit better with most people is this energy multiplication factor of the heel so the power you get out over the input heating and so I've outlined these you know benchmarks here q of about 0.1 or 10 percent output over input and then this would correspond to break even here and then when you get to a point known as ignition this is a point where the you have enough heating from the alpha particles to counteract any losses from the plasma so the first tokamak to really show good performance was constructed by the USSR in the 1970s and as you can see that didn't have particularly good performance but as time went on in the 80s and then the 90s as they figured out how to confine the plasmas better and how to heat them properly the performance improved to the point where they started actually getting an appreciable amount of power out versus input and then the latest set of data from these tokamaks from around the world have really almost achieved this break even criteria and in fact you know this is the jet tokamak located in England they've achieved their record q is about 65 percent output powered input power and this is for deuterium tritium reactions now they can simulate you really need the deuterium and tritium to generate the fusion neutrons to generate power however you can simulate it with deuterium deuterium this is not such a advantageous reaction but what it enables you to do basically is you know without dealing with all the radioactive constraints of using tritium you can just use deuterium and they've actually exceeded what would have been the equivalent break even criteria for for fusion and the same thing occurred here in japan also they achieved about q of 1.2 so had they used tritium in these revactions presumably they would have have reached the break even metric that I've mentioned and so I mean in terms just of illustrating the progress that's been made over this time I mean it's useful to kind of plot as a function of date and then this is the triple product that I mentioned previously and if you compare it with you know kind of the typical Moore's law number of transistors per chip it's actually compares very favorably with that I would say it's comparable at least and so you know it this basically illustrates that I mean there's been tremendous progress in generating higher fusion yields except you know they just haven't reached that milestone of break even quite yet but that's what eater is designed to do and so the question is then well how do we progress progress from these other tokamaks to what eater can do and how do we know it will actually work and and so what's used is these empirical scaling laws basically we can take all the data from all the other tokamaks and come up with some model to cause all this data to collapse onto a single line and then the and then we can extrapolate to eater and as you can see it's not a tremendous extrapolation over the existing database of information that we have already so in comparison of the largest existing tokamak to what eater is capable of doing it assuming the size of eater you can see it's a increase of about a factor of four in terms of total total volume of the the instrument itself and so in terms of an actual design of a fusion power plant you can see in this schematic the basic design it would essentially heat up the wall of the plasma itself and then heat up the steam generator which would then feed into a heat exchanger and then into a turbine and then this turbine then would put power onto the grid so essentially that's what's depicted here in this diagram and so one of the key things that needs to be done in order to trans transition to this is you know develop some of the technologies that are required to you know get eater working and that would be useful for a practical power plant so one of these things is the superconducting magnet coils that are included in eater and so this is you know quite a bit of super good you know quite a bit of technology development but also I mean what's remarkable about this is the superconducting magnets are cooled down to about you know for kelvin or so with liquid helium and so inside the tokamak itself you've got a plasma up at hundreds of millions degrees so you have this tremendous gradient between basically as cold as you can get to as hot as you can get inside the tokamak itself also all the internal panels of the tokamak will be disassembled and removed by remote handling so it's all going to be done by robotics and that has to be done due to the tritium hazards inside the reactor itself and then they're going to develop techniques for heating the plasma up before they you know start up the fusion reaction itself and so the you know just to provide some of the insights the technology development issues that are associated with this the tokamak itself is aligned with these tiles and the question that arises I mean a lot of the greatest heat flux that's going to be exerted and this is basically an image of what the plasma looks like inside the tokamak the the the the largest heat flux is going to be in these you know regions near the top and bottom of the tokamak known as the diverter and it's basically a little secondary chamber that they channel some of the plasma impurities to and as a result these tiles get extremely hot and you know you have to come up with ways to prevent them from just being destroyed by exposure to the tokamak plasma itself and so this is the diverter region that I mentioned to you previously and this is an area that we are looking into here at CND also understanding these various effects and so the one way that we do that is use a linear plasma device that can create a well-colomated plasma column and then expose these metals to you know just huge currents about ampers square centimeters so and so this basically simulates a lot of the conditions that are encountered in these tokamak devices and then we study some you know rather bizarre effects that occur at the surfaces basically one thing that's rather interesting is it generates this tiny tendrils of fuzz nanoscale fuzz that can vaporize when you have a instability in the plasma itself and and cause contamination of the core plasma and then there's also an issue of tritium trapping in the walls of the tokamak and so this is a focused ion beam cross section showing you know it can create these really high pressure bubbles inside the materials and create a really you know trapping environment for the tritium that creates a safety hazard so that's something else that we've been looking at as well so finally just to mention you know eater is happening the schedule as I mentioned is about seven-year construction phase to be completed in 2019 and then there's going to be a 21-year operational phase with the first DT shot in 2027 so that's one of the first shots that could I exceed this break even criteria would occur and then a six-year disassembly phase and so if you're interested in further details in these various topics you're welcome to visit these various websites and so this concludes my presentation and I appreciate your attention and I'd be glad to answer any questions you may have I should mention that the speakers here and their night are generously compensated for their efforts with a picture of beer which has impaired my intellectual ability as a result I will do my best to answer any questions thank you very much so the question was I mentioned these currents that are going through the plasma and the question was whether these were eddy currents but actually no it's actually a continuous I mean it's more or less that you know it circles around the you know circumference of the tokamak and it but it it's actually a non-usual path it kind of spirals around you know twists around as it goes around the the tokamak diameter itself so it's a yeah I wouldn't say it's eddy currents so much but it's either the other magnetic fields are more or less to you know at least the counteract the plasma pressure kind of confine it more toward the center the donut shape more than anything yes I'm not just sure I swirl effect generators I'm not familiar with this like can you elaborate or yeah yeah I mean uh yeah I mean I suppose I mean it's not something that really consider me it might be something that could be more just that plasma physics kind of thing and uh you know directly related to you know generating fusion neutrons but I mean it's an interesting concept for sure yeah yes please yeah that's a good question so I mean certainly oh I'm sorry yeah what were the top things that would uh they're standing in the way of making this work I mean certainly the I mean the design of this device has been agonized over for quite a long time and getting the different countries to you know they the way they've set it up it means too expensive for any one of them construct and said oh physics person yeah okay yeah yeah well from that perspective I mean I guess just the you know the engineering constraints of you know due to just the immense size the tolerances you know dumping so much power into the the surfaces of the tokamak and then just the immense amount of power that's being dumped into it the tolerances on those the tiles are very tight and you know fractions of a millimeter so misalignment will cause melting and things like that so I mean that certainly the materials on the inside are known to be a significant impediment to getting something like this running um I think they'll probably be a period where they just need to experiment around with the plasma physics to really understand how to operate a device like this also and so that's probably the other thing but you know all in all I think certainly mitigation of the plasma and stabilities is a key issue as well and something that has to be addressed yeah sure sure is there one in the balcony no no no we don't have any plans for doing that at this time maybe some other time right right yeah I think the biggest uh I mean this oh sorry yeah I'll repeat the question I mean what are the safety issues with the tokamak um I would say the the largest uh so in comparison the fission the the risk of having a meltdown is not possible with this type of technology and so some sort of runaway reaction where the thing overheats and releases a bunch of radioactive material would not be an issue here because I mean as you can see they have enough trouble just keeping it going in the first place so um so I mean and it's you know it's you know certainly self-limiting I mean you take away the fuel source and then the reaction just dies away so I mean in terms of a safety issue um probably the biggest concern would be some sort of release of tritium um from the reactor but uh all in all that's you know the it would just disperse in the air and and it's you know very short half-life and the those that you would get from direct inhalation is very small and so um you know in comparison to a fission reactor that wouldn't be all that you know the the potential for a serious harm and be all that bad so I mean I think some sort of you know leak where the you know the tritium gas would escape would probably be the most major issue that you can encounter with this yeah so like so so so like how how how like what are these tokamaks like they they create and they use these they use fusions you create um to create energy versus if the reactor uses um uses uses um fission fission splitting with carbon nuclear atoms to create to create energy you try to see a steam a steam turbine or a boiler like so are so are there like any like end-of-life issues that involve any things like because I know I know like you only need like terium and helium as as the efforts to operate a a fusion reactor but like what about like do you mention like the tiles or like any any like any of like the uh any other materials used in building the reactor or if there are any like any like end-of-life concerns or no yeah that's a good question so the question is that are there any end-of-life concerns for the the tokamaks and uh so the probably the most significant one would be a neutron damage to the tiles and this radiation damage is probably the most I would say a significant end-of-life issue in that you know eventually what would happen is the neutrons would create vacancies and damage to the structures around the the tokamak itself and they would lose their mechanical properties and so after some period of time they'd have to either replace the tiles or decommission the the device itself and uh but uh I mean I would say that's the main end-of-life issue but you know I mean at least some of these have been operating for a very long period of time too but it's not like a big reactor like it's developed in the decade that's like it has spent a lot of time all the way off the site due to some of this sort of environmental potential in a billion years no no no any uh you know activated material from the tiles on the reactor itself would uh decay to a safe level within several decades or so but it wouldn't be anything and it's severe is what we even not milling it hundreds of thousands of years yeah okay thanks again to Rob he'll be over in theater two answering questions uh this is your last chance to go over and talk to mana and say hi and figure out what the open public library is doing during national library week she's right there people in theater two can of course come over she's right by the door to theater one and we'll be back in about 10 minutes but shabani's talk on global surgery welcome back welcome back I don't know if you were told but tomorrow's April Fool's Day in homage to that there's been many awesome April Fool's Day pranks for instance I'm sure that you followed the BBC's report of the spaghetti harvest uh apparently this uh this 1957 report which they have repeated at least three times since each time they they repeat it they get requests for seeds they uh get people call them asking them to connect them to the botanist who came up with this brilliant idea they're like I really want to grow my own spaghetti don't get me wrong the media is really good at pranks but I think I think science does it better uh the media and science teamed up in 1976 so this is British astronomer Sir Patrick Moore and he convinced uh he convinced people that on April 1st that I wanted to get the precise time right 947 a.m. uh Jupiter and Pluto were in conjunction with one another so if everyone jumped they would be able to jump higher because of the extracurricular from the combination of the largest planet and at that time Pluto is still a planet the smallest planet it's utter bullshit uh that being said they got many reports from collars extremely surprised at how high they could jump turns out that Sir Patrick Moore is rather corpulent individual he probably can't jump that high in the first place there's there's other there's other incidents that are labeled pranks that verge on pseudoscience charlatanism outright fraud uh Bart in San Francisco has this great series on great assholes in science history this person is not part of that because I don't think he was really a scientist first of all Argentina is beautiful they picked this site on the Isla Humil in 1949 to construct the first fusion facility that would break even so he convinced the argentinian president you know probably was more concerned with Evita at the time to give him a blank check so Ronald Rittenberg took no grad students no uh no real argentinian staff scientific staff at least on this project he had other former nazi scientists on the project um and they built this this impressive facility which was going to be the first site for fusion cost 250 million euros into this money so it's a similar effort as here except from the tiny country of argentina which was relatively well off at the time on february 16th 1951 they claimed that they had great even fusion they had multiple geiger counters showing that they had radiation for some reason and they had many sensors that were going off uh and this later shown that they were going off because huge magnetic fields that were generating there so uh our poor scientist ends up in an argentinian prison and fusion research is set back well sort of this is linus spitzer who rob alluded to earlier he was an astrophysicist astrophysicist on the us hydrogen bomb project he received a phone call from his father telling him that the news from argentina and spitzer pondered for days while skiing and aspen how he could potentially make fusion himself he wondered if he could contain a plasma in a magnetic field and eventually he presented his newly formed uh theory to the us atomic energy commission saying that he could basically build a magnetic bottle within which the fire of the sun could be harvested so that eventually led to this uh according to many fusion sectors so there's a negative usefulness even out of some breaks we should think yours completely uh i'd like to move on to another much more serious topic non-apropyls topic with shavani's talk on global surgery hi everybody hope everyone's having a good time have some refill of drinks and food um so my name is shavani as rick said and i'm here because i started an organization a couple years ago called samahope and at samahope we basically crowdfund for doctors who are performing medical treatments for women and children in really poor parts of the world and what we're really trying to solve for is trying to help build funding and awareness around this problem that's often unknown around global surgery and so i'll spend most of the time today talking a little bit about what global surgery is the impact of it and hopefully you'll come away learning a little bit more about this the topic so if you'll indulge me i'll just start by showing you a short video of one of the doctors that we fund so you can get a sense of uh the work we do and sort of the inspiration behind what keeps us motivated i'm also the director of access the african community center for sustainability which is placed at naka sekio hospital the major challenge with yoga is that we have very few health workers for me like and they follow this we are only three for the 36 million yoga men's if you take it to the level of a medical officer it's usually one thousand people so inevitably most of the medical centers don't have a single doctor and as anywhere in the world most doctors want to stay in the main centers so very few doctors find time to go to the yoga areas so i was fortunate enough that after my graduation i went and worked at the district hospital at this district hospital i saw the first hand of people who come very few doctors very few resources so this touched my heart into this organization called access that tries to help these patients here at access we do minor surgeries so we do things like working on abscesses banias minor injuries providing these teachers we work with the lower health centers we do communities with trained community workers who've been able to provide surgeries most of the surgeries are not that expensive sometimes you need ten dollars to get the equipment like a knife that is going to do the graft of a child sometimes you need 60 dollars to be able to do a city scan sometimes you are going to need ten dollars to buy medicine so little things can make very big difference in these people's lives because they come from a background that has nothing so for one in this clinic actually this is like my data i don't get any money from access so here i don't show studies for money i do them for the community so we like to think of the doctors that support as heroes and we try to tell their untold um heroic stories but for the purpose of today i really want to focus on telling you a little bit more about the global surgery challenge and the problems that we have on a broader scale so this is dr paul farmer he comes out of harvard and is really well known for work he's done in Haiti and he started partners in health if for those of you who might be familiar with the work he's done and he calls surgery the neglected stepchild of global health and there's a lot of reasons why he's right so just shed some light on that let's go through some of the statistics so two billion people have no access to basic surgical care today and the bottom third of our world's population received only three and a half percent of all the surgeries performed globally that's pretty staggering when you think about it you know and more people die each year than due to the inability to access surgical care then um the same from hiv aids tb and malaria combined and you know we don't really talk about this you don't really hear about this i didn't know about this until i really got into the space and we'll get into some of the reasons why but it's definitely the problem is there what's the impact of this problem so in the global health space we measure the global burden of disease through this metric called dollies the disability adjusted life year and essentially what that means is it's a year of lost healthy a year of um basically lost healthy life so how can you think about that as it relates to different medical conditions or um or uh suffering that exists related to health conditions and surgical disease is among the top 15 causes of disability and actually accounts for 15 percent of total dollies lost worldwide that's a significant percentage um yet it can be really cost effective so obstructive emergency obstructive care for example can cost less than 11 dollars to be able to prevent a dolly so that's a year of giving back someone a year of their life for less than 11 dollars to put it in scale so let's think about the funding gap i said that you know why don't we know more about this it's because in the global health space traditionally we hear a lot more about um diseases that are communicable like hiv aids tb malaria and a lot of effort and energy has been put towards these these areas which is great and as a result we've had over in 2012 20 billion dollars spent uh in support of these programs to try to eradicate these diseases however no global funding organization actually exists around the global surgery space so hence you don't care about it you do it doesn't get a lot of attention and the funding sources don't exist in this space um there's a couple reasons why it's a little bit more complicated there's been very few efforts to coordinate the bigger players in the space around global surgery that's starting to change which is great but that's sort of why we exist so a small nonprofit can try to direct funds towards a space that doesn't get traditional funding from these big global health sources through the power of the crowd through the power of the masses by accumulating small donations and pulling them together to really have big impact to give you an example and bring it back down to an actual patient story so here's Fatmata she comes from Sierra Leone she comes from pretty rural areas in Sierra Leone where the maternal mortality rate is something like the second highest in the world it's one in 14 women die due to pregnancy related complications she lives on less than two dollars a day and at 19 she had a pretty difficult labor and as a result of four-day labor without any anesthetics or birth attendant she had an obstructed labor that led to a condition called fistula how many people have heard of or know of obstetric fistula okay so there's a handful of people in the room for those of you who don't know what it is essentially it's a hole in the vaginal cavity that develops and essentially it leads to almost always you lose the baby you're becoming fertile and as a result you also become permanently incontinent so now women who suffer from this they can't work and often there's this emotional and psychological turmoil because their families may not understand why this is happening and sometimes they'll kick these women out of the homes and so now their support structure is also taken away from them but this is treatable we can actually just sew up these holes through reconstructive surgery and this is something we don't hear about here in the U.S. even though it might have been doing labor because it's taking care of immediately yet there are about and I'll talk about it again later but there are about two to three million women suffering from fistula today and they don't have to be so to tell you a little bit more about the different types of surgery areas here are some of the essential surgeries so I mentioned that they're starting to become more consortiums and groups that are coming together to try to drive awareness about global surgery a couple of these organizations are saying well how can we focus on what are some of the more essential interventions in this space so the ones here are inclusive in that list so birth injuries I mentioned are really around the maternal health bucket so that's the official repair surgeries that's even just having a safe birth having access to a birth attendant or someone who can say okay there's a high risk for c-section and then direct someone towards c-section services there's a birth defects and that's really all around pediatric surgeries so congenital deformities congenital heart conditions many of you may have heard of smile train cleft palate cleft lip club foot and and the likes of those the third bucket is burns and so these are severe burns when we're talking about burns they're they're not the burns that you and I get by you know maybe touching the top of an oven and they lead to not only deformity but disability and a rapid sort of progression towards morbidity and mortality but if you can actually treat it close to when the injury is sustained you can prevent that cycle from happening and occurring then there's blindness from cataract which many of you are probably familiar with and river blindness which can be reversed through again simple surgeries and the final bucket that I'll talk a little bit more about is trauma so just think about like road accidents broken bones broken limbs emergency wound repair or care those are the types of things that would fall under trauma so here's just real quick to dive into the birth injuries bucket just to give you a sense in uh Uganda this is the an example of a maternity ward and to give you the sense of some of the impact here so every day around 800 women die from pregnancy and childbirth I feel like I'm the doom person here today telling you all these really uh you know sort of sad statistics but there are silver linings around effort that's being done towards this which we'll talk about a little bit later but um you know around 99 of these occur in developing countries and so that's a really high percentage um and for every woman who dies about 30 more actually have additional complications that can result into a disability infection and the likes I mentioned that two to three women today two to three million women today are suffering from obstetric fistula and um you know about 74 percent of maternal deaths could be averted if they had access to care and so that's these are all things that we can solve with the knowledge that we have today and it's just about allocating the resources in the right place the next one was around the birth defects so here's an example of a child who has a cleft palate and cleft lip and um what happens with cleft palate and cleft lip is it's not only the the deformity but it causes then speech issues with speech and prevents often the child from going to school and um about one in 700 babies are born with a cleft palate and cleft lip globally uh the surgeries that fall under this bucket can actually avert around four point six four and a half dollies so it's about four and a half years of life to be given back on average by giving this kind of care uh clubfoot is another where essentially the feet are the joints and the ligaments are uh the deformity exists at birth in a way that it's kind of like pigeon toad in inwardly so it becomes difficult to walk and it can cause a lot of pain over the lifetime of the child and often these children again don't make it into school but it can be corrected if treated through both um surgical and non-surgical treatments and then congenital heart conditions which I mentioned uh there are about eight to 24 million children who are who are actually born with these congenital defects and many of them can be treated within the first year of life which would reverse the the deaths of these children which would reverse the the pain and suffering that they might have in the shortened lifespan uh here's a photo of Bishal and and Bishanti so to talk a little bit about Burns Bishal is a two-year-old from the rural hills of Nepal he you know lives in a place where it gets very cold in the winter months and one of those winter days he actually was so cold that he crawled into the fire that the family used for heating purposes and as a result he suffered from massive burns on his face and his neck and now Bishanti is the sole caretaker for Bishal and his siblings she works at this brick factory here and she knew that without treatment Bishal would be basically living a shortened lifespan not able to go to school again and she did not want that future for her child so she actually sought out treatment from one of the doctors that we support luckily um on Salma hope and is now been able to get care for Bishal and he's on his way to recovery but these are stories that happen every day in in places like rural Nepal for example and I was really shocked to learn that actually more women are severely burned each year than are diagnosed with HIV or TB combined and um when I learned that stat I thought again why are we not talking about this why don't people more people know about this we need to build more awareness around these conditions um and you know burns are among the leading cause of dali's loss in these low and middle income countries and what happens is is when you have a burn the skin starts to contract and so imagine if you have a burn which often happens because women are cooking over open flames they don't have access to the grid or they may not have a reliable heating source so there's kerosene lamps so imagine if you have a burn on your hand um the skin starts to contract and it starts to close up and the longer you wait to treat it the more the the click starts to close and the less you're able to have functional use but if you can treat it close to when uh the burn occurred you can bring the movement back and be able to prevent the not only the deformity but the disability and then eventually the impact of the burn over time so again something that we can treat and prevent from people being able to not get to work or get to school uh blindness which we mentioned so here's a photo of a woman in uh rural bedroth um in india who has a really severe cataract in her left eye and so out of that eye she's completely blind and so again with blindness it comes back down to empowering individual people happily make sure that people aren't suffering from conditions that prevent them from living productive lives or being able to earn an income um and get back to work and for her you know it's it's again she was lucky to be able to find a doctor who was doing these surgeries in her community or in a nearby community for free there are about 180 million people globally who are visually disabled and 45 million of those are completely blind a big percentage of those can be reversed because of the cataract surgeries and another treatments that are now being developed to treat these conditions and here's um trauma the the fifth bucket that i mentioned so here you'll see in uganda a child who has a broken broken bone being treated in in a hospital um i actually think this might even be access for dr robert orcs who from the video that i mentioned earlier um trauma you know here really there are about 5 million deaths a year related to trauma trauma is a big bucket uh road accidents are one of the leading killers globally just in general and trauma is a way to think about how can we basically treat broken bones broken limbs you're not going to be able to get everybody who suffers from those road accidents but there is emergency medicine if there are ways to get people to care you can prevent a lot of those deaths from happening and i think what's interesting here is that's just an economic cost of those road traffic crashes that i mentioned uh are significant so in 2000 that's a long time ago but it was over 500 billion dollars so there's not only impact on individuals and the empowerment that we can give them but economically there's a whole other story to to what we're losing out on if we're not able to treat these people so i don't know if you guys saw but i think maybe it was recently there was this 20 year old here in the us who posted a bill for um a medical bill that he received he had appendicitis and his he's on his father's insurance luckily the whole thing cost around 55 thousand dollars but because of insurance he was charged the mere number of 11 thousand dollars as a 20 year old um and he posted this and it went pretty viral online and i think what was interesting is there's a line item here on the bottom for the recovery room in which he spent about two hours and it cost him seven and a half thousand dollars so uh the cost of healthcare here is you know as we know can be very very high but to put it in perspective i just thought it would be interesting to do a comparison so for some of the interventions we mentioned um you know this a c-section here on adridge in the u.s. costs anywhere just sub of 30 thousand dollars globally to give you a sample it can be anywhere under 300 dollars to be able to perform this lifesaving intervention uh official repair surgery doesn't happen here as i mentioned it because we have access to care and because things are taking care of right away and here it can be anywhere from a 200 to 500 total all in surgical costs the cataract surgery in the us averages around three thousand dollars per eye um you can do that for less or just a little bit over a hundred bucks in a country like nipal and in many other countries as well uh pediatric cardiac surgery these are tend to be the most expensive even globally because they're the most complicated so whereas it might be anywhere from depending on what the surgery is 12 000 to uh over 350 thousand dollars here uh you can still be able to on a relative scale do it at a much lower costs um and often you know the range of the tens or 20s of thousands of dollars uh globally uh you know i think the what we see on salma hope is we try to arrange our funding around surgical treatments that range from 50 dollars to a thousand dollars and these are fully loaded costs so these costs are things that include transportation and outreach for the patients to bring them into the clinics that we partner with so that they know hey there's actually treatment for me or there's places where i can go to get care because many of them don't even know that they have access to care it includes things like making sure that patients who arrive to the clinics who may be malnourished and not be able to receive the best care from the treatment are given the time and space to stay at the hospital or at the clinic be given food vitamins such that they can get their strength back up so they can benefit from the surgical treatment to the post-recare the recovery period medicines often the treatment cost itself is only about 30 percent of the total fully loaded costs and it's still typically under a thousand dollars across those five buckets that we just walked through so um you can see you know there's actually a lot of hope because we have a lot of amazing doctors like dr robert who are trying to reach these populations and with the growing momentum that is now building with the likes of salma hope and lots of other organizations dr paul farmer partners in the health there's now more attention being spent on global surgery and hopefully within the next year or two the world health organization will start to recognize global surgery as a big area of focus and more funding will go towards this space so thank you very much um all hope is not lost please uh uh let me just open it up for questions and thank you for having me yes please what is river blindness yeah what is uh the question was what is river blindness um so it's actually growing in number as i understand it and um in more like swamp areas i don't know all the details of this but in more swampy areas it can be a bacteria that gets transmitted into um the eyes that then can get transmitted within a community um and cause blindness it is it's tradable and operable yeah yes sorry yeah uh it's a really good question uh this is where it gets pretty complicated because if you look at operating rooms here versus what you'll find in the field i mean the field these rooms are it's they're just like empty you know rooms with a table and an ivy and the biggest thing is you need the anesthesia so at a minimal you need the anesthesia um and you need the actual surgical instruments and the hygiene basically the the protocols that can enable you to to make sure that the environment is in a clean way so there might need to be a big tub for the surgeons to wash their their hands or make sure that the the surgical instruments can be sterilized those tend to be the biggest minimum requirements but upon which operations can still happen um now anesthesia is still pretty expensive but there are great organizations like um there's an organization called out of new york um for getting gradient health and they have come up with a really low cost anesthesia machine especially designed for really low resource settings and they're just trying to get them in all the operating rooms they can in really rural environments so we're seeing more innovation to enable uh technology and and supplies that are meant for these scenarios instead of just taking donated equipment which may then need to be many like basically the maintenance is not possible or doesn't work in these environments um which is not the preferable model yes uh what's the most common lifesaving surgery the one that would save most people is reformed over and over again that's a really good question what's the most common or most impactful i guess lifesaving surgery um you know i think the the maternal health bucket would probably be the one if you take the aggregate of c-sections having a safe birth having a birth attendant and official repair would probably be the most impactful um but that's also a big bucket that i put a lot of things under um so from a scale perspective that's probably big but the numbers are big across across the five areas that i i mentioned do you have a question yeah i was wondering if i was wondering if many of the uninsured adults are from california for example they need to go to mexico to be prepared or like brazil for a good job has that put any pressure or raised prices impacted sort of medical care in those countries yeah that's a that's an interesting question so the question was um people who may be uninsured here or seeking cheaper treatment um in other countries like mexico or brazil is that impacting the uh the supply or the the the cost of the accessibility of surgeries for the local population um and essentially i would say no because the the organizations that are catering to the people who can't afford care are really in these really rural areas and they really only serve people who are living in you know in poverty um the places that these individuals may be going to are we tend to still serve a higher income population in those countries and so um they may be affecting prices for the higher income population in those countries but not necessarily um limiting access to the lower income um more poor population that we're trying to help uh deliver treatments to work yeah last one yes please um so what's the split in terms of how many how many organizations exist who are serving the yeah okay so you're saying so um you know what are these organizations focused on and what's a split um at a high level but i think to answer your question and let me know if i am is essentially the there are um i would say hundreds of thousands of organizations that are trying to reach the parts of the poor patients in rural areas and um there's a mix of those who are saying whatever the needs are uh we will service them um from like a critical care perspective and then there's probably about and that's probably makes up like 60 percent of them and then there's probably about 40 percent of them that say well we have this doctor or these resources that are dedicated to only burns or reconstructive surgery around burns or club pallet club flip because that's what they specialize in or that might be what the demand is the highest in but i will say that it tends to be based on what the demand of the community is that is driving what the organizations are are trying to do it does that answer your question okay um thank you so i'd like to thank shavani as well as all of the rest of our speakers i thought tonight's lineup was awesome but i did want to do a little bit more pluggy there's lots of awesome events happening in april arm barrier particularly here in the east bay put this slide up for like five seconds so you could take a photo or whatnot and you can ask me about it afterwards that is pretty awesome our next show is also awesome we're talking about race in comic books we're talking about uh making in schools and this making in schools actually comes from a suggestion in the near night east bay facebook group that we cover education in some way people are worried about what we are teaching our kids and how and we have the food science talk so awesome month you should get tickets as soon as possible i believe that shavani will be out in the lobby answering questions immediately after this and if that's everything see you next month