 First of all, can I start by saying it's an absolute pleasure to be invited to speak today, especially as our wild card presentation. I'm very excited. I hope you are all too. So as a rumour professionals, I'm sure you're all very good and like to keep ahead of current affairs and I'm sure you've all seen these very exciting stories coming up in the news of how 3D printing is going to revolutionise medical care. So for example stories of 3D printers producing new structures of drug, 3D printers being able to provide bespoke, personalised implants for people, 3D printers being able to print organs. This is all very exciting, but it's a little way off in the future and what I want to speak to you about today is to give you a snapshot of what is currently happening in the medical sector in a humanitarian context with 3D printing. So because of the nature of this talk, a little bit of a wild card, I thought it would be helpful to provide you with a bit of background as to who I am, what I'm talking about and why on earth I'm talking about it. So I currently work for an organisation called Field Ready. I'm based in Nepal. Field Ready has a very optimistic view of how 3D printing and other digital manufacturing technologies can revolutionise the humanitarian sector in the future. I thought I'd explain what we mean by this with a bit of an example from a project I'm working on with UNICEF in Nepal. So on the left of the screen you can see a picture of the UNICEF shoreboard. This is a device that's used to measure the height of children and identify cases of malnourishment, a very important device. And I just thought I'd share with you the journey it takes to get to Nepal when and where it's needed. So it actually starts off in the USA where it's manufactured. It's then shipped to Copenhagen where UNICEF devices are stored in a big warehouse. There you can buy one for the nice sum of $82. It takes about a week to process the order. It then gets put on a ship which can take up to three months to get to Nepal. In the aftermath of the earthquake of course it was a little bit complicated getting from a ship into Nepal because of various restrictions such as the blockade, there was a bottleneck at the airport due to the amount of aid that was trying to get into the country and there were rapidly changing customs restrictions, changing basically every every few weeks in the government and by that time it's cost you another extra 15% and taking you several weeks to get there. After that it's got to go through several layers of local warehousing to get to where it's needed in the health post and again by the time it's got there you've potentially increased the cost by further 15% and in some cases because of the difficulty of transport in Nepal 120% and added another several weeks to the process and on top of that you lose 10% to damage. So by the end of that you've got two blanks of wood and a measuring tape which have cost you upwards of $100 and 10 to 32 weeks to get there. So if you already think we can do a little bit better than that and we're excited about new technologies such as 3D printing and helping us get there, the future we envision looks like this where the factory is essentially right next to the point of need so things can get there when and where they're needed exactly when you need them. So today I'd like to give you a snapshot of just 3D printing particularly 3D printing being used for humanitarian Nepal in the medical sector in particular. Because of the early stage nature of this field the way the research is presented is basically three case studies. Two are from field ready projects essentially the projects have happened through meeting workshops with medical professionals exploring what they would do given access to this technology and then actually manufacturing, installing and monitoring the parts and the third case study is observation of spontaneous activity which has happened between a professional in the medical sector in Nepal and a local makerspace in Kathmandu. So on to our first case study. So this is a picture from a hospital in the Neuakot district of Nepal. It was a hospital that was unfortunately destroyed during the earthquake it was knocked down and currently most of its operations are being run out of a series of tents. I'm not sure whether you recognise the unit in the picture but what it is is it's a box in which you take an electricity cable from outside an industrial electricity cable plug it in and then you can get electricity to all your electronic medical devices that you need to run in order to provide good care. So this is the original connector I'm not sure if you can see at the back from that unit. You might be able to see that it's perished and the connection has failed. What this meant for the hospital was that they basically they didn't have power in this tent. This unit was donated by an aid agency. There are none available on the local market and there certainly aren't any spare parts available on the local market and so the options for actually replacing the unit are very very limited. It's quite expensive and basically the hospital couldn't afford to import a new one from abroad. So what we did to resolve this problem I went there with my 3D printer and sat down measured up the part and muddled it on a computer and then printed out a fresh one which is the one you can see in the picture there and the result of this is that instead of having no electricity and unable to get the spare part the hospital was easily to able to obtain something that got it working. This part cost $12 off my 3D printer so not bad. To give you another example of this here is a picture of a baby incubator from another hospital. This hospital has five baby incubators. Three of them have been in a back room for over a year. Again it's another piece of donated equipment. This one is not even manufactured anymore. It's so old and what happened was the little clips holding the size on broke, they failed and the doctors were unable to safely use the equipment anymore. So again what we did we went in measured up the part and produce a new one. This was invaluable. There would have been no other way of getting these incubators back up and running. So on to case study number two. So this is a different example where I worked with, I've been working with an orthopedic surgeon who works in a hospital in Camaridou but he's also involved in lots of humanitarian projects around the country and I wanted to explore what he would do given access to this technology. So it's interesting getting his views on the matter because the way the places he wanted to go with 3D printing was much more to do with equity in care. So making sure that the same treatment is available for people with very little resource in very remote areas of Nepal as is possible in Camaridou. One of the problems he shared with me was in repairing people's broken risks and what you'd usually do is you'd take an orthotics device to support the risk for several weeks while it heals. He can only get one type of this device in Nepal, a metal bar basically wrapped in velcro and he finds that I mean if you compared all the sizes of your wrists in this room I'm sure you'd find quite a lot of variation and if we tried to attach the same wrist strap to all of you probably some of you would find it very comfortable, some of you would suffer quite a lot with it. So the project I've been working on with him is to take a mobile phone, scan somebody's hand by taking lots and lots of photographs and produce a device that fits exactly. So this one is my own so if I ever break my wrist I'm safe, I'm good. So there's a further example of what we've been doing. I'd like to change the tone of the conversation now so I've talked a little bit about the very positive things that can come out of having this kind of technology in the field and in both these scenarios the risks associated with the project was very low. Had we not completed them, had either of the parts failed there wouldn't have been any harm done. However in this latest project the risks are a little higher. So this third one is blank for a reason and the reason is that this project is still ongoing and the outcome for the patient has not been seen yet so I'm keeping it deliberately a little bit vague. Well the story behind this is an excellent surgeon working in oncology was treating a cancer patient and they had to have their ankle bone removed. He wanted to be able to replace this bone and what he did was he went along to a local makerspace with a 3D printer with a scan of the ankle bone and asked them to 3D print a plastic version of that bone. It's a common process, you can take this plastic model and use it as the basis for metal casting so he cast it in medical grade steel and then has subsequently implanted this in the patient. Now while I'm very excited about this project and the possibilities opens up for treating people with an excellent standard of care in the field, I'm also watching the outcome of this project quite nervously. There are quite a lot of places that this treatment could have gone very wrong. For example the material that they used in the 3D printer is absolutely not suitable to go anywhere near somebody's body if the process resulted in any plastic being left on that final part which with this material is quite likely that patient will now have very unsuitable plastic implanted inside his body for example. There are other concerns with the process which I won't go into now. So the conclusions from this for me is I think this is a very exciting space to watch and I'm very very excited about the possibilities this opens up for providing an excellent standard of care even in the most remote and resource starved locations. I'm particularly excited about the ability to provide spare parts and keep donated or expensive or complex medical equipment running. However I'm a little concerned about the risks and I think my I don't know call to action for today from you all is to think about perhaps creating a code of practice for medical professionals in the field. I think the value of this would be seen in that if medical professionals were you know comfortable and and happy with talking about and understanding the applications and limitations of this technology. First of all it would be great to see many more people identifying great opportunities to improve operations and improve the ability to access spare parts or basic medical equipment out in very remote locations. On the other side of this I think it's very important that with the rise of maker spaces the increase in access to this technology and the obvious desire amongst professionals to yield the benefits of this I think is very important that we're able to advise on this and make sure that things are done in a safe and low risk manner. So thank you very much for listening to me today. I hope you enjoyed it and open to questions.