Erica Frenkel

Innovations in Anesthesia: How Gradian Health Systems is making surgery safer at the BoP

Think about this: Hospitals and other firms in low-income countries lose power, on average, 18 times per month.

Now think about this: More than 90 percent of the 5.8 million annual deaths from physical injury, much of which could be prevented with surgical treatment, occur in low-income countries. There are 32 percent more injury-related deaths in the world than malaria, tuberculosis and HIV/AIDS – combined.

These two stats combined just begin to touch on the many challenges that lead to a lack of emergency and essential surgery – key components of any primary health care system – in many parts of the world.

While there is a dire need for more data on this issue, we do know that more than 2 billion people lack access to adequate surgical services and receive just 4 percent of the 234 million surgical procedures performed each year. More recent estimates show that 56 million people across Africa are in need of surgical treatment today.

Infrastructure in Malawi, NextBillion Health CareWhen surgically treatable patients present at a hospital in these settings, it is not uncommon to see surgeons rely on sunlight or a headlamp to finish a case interrupted by a power cut. When compressed oxygen runs out, cases are routinely postponed or referred many kilometers away. These are critical problems themselves and are only further complicated because power and oxygen are required for any conventional anesthesia machine to function.

The machine through which a patient breathes (and tolerates the surgery) depends completely on reliable infrastructure that hospitals in low-income countries often can’t offer. Despite this reality, until now, the only options for these facilities to offer anesthesia (and the life-saving surgeries it affords) have been to purchase or receive donations of machines not designed for and ill-suited to their environment.

(Left: an example of the level of infrastructure inside many hospitals in low-resource settings.)

While in ideal situations these new or used anesthesia machines generally function when they arrive at the facility, their ability to facilitate safe surgeries is often short-lived once the machine has technical problems (and all machines, everywhere, eventually have technical problems). There are three reasons that this is particularly problematic in low-income countries:

1. Biomedical engineers are incredibly scarce and often concentrated in the capital cities (Uganda, for example, launched its first ever formal biomedical engineering program in 2011)

2. Hospitals often cannot afford the costly service contracts that conventional device companies offer

3. Donated machines are often so old that replacement parts are no longer manufactured, and are certainly not easy to procure in a low-income country.

Without working machines, (whether because of a lack of electricity, oxygen or repairs) surgeries that require general anesthesia cannot be safely performed and the outcome can be tragic. The absence of anesthesia capability contributes to high rates of maternal mortality, death from trauma and a greater burden from surgically treatable conditions.

At Gradian Health Systems, a social enterprise based in New York City, we are working to address this challenge through the development of the Universal Anesthesia Machine (UAM), and the training of anesthesia providers and biomedical technicians.

The UAM, NextBillion Health CareThe UAM, a CE-marked device, was developed to ensure a safer and more reliable form of anesthesia for hospitals with infrastructural challenges. The machine was first designed by Dr. Paul Fenton, who worked at Queen Elizabeth Central Hospital in Blantyre, Malawi, for 15 years, and saw first-hand that anesthesia machines were consistently breaking down and that power failures and oxygen stock-outs would prevent or interrupt life-threatening surgeries. After years of frustration he developed a reliable and rugged solution to deliver safer anesthesia.

One of his main concerns was to design a machine that functions seamlessly when there is a power failure. The UAM was designed to automatically convert to an external oxygen source or, failing that, use room air (“draw-over mode”), allowing the machine to continually deliver safe anesthesia. In other words, it works whether the power is on or off, whether the oxygen is in stock or not. Gradian’s hope is that through the UAM we can improve the delivery of anesthesia in low-resource settings around the world and, more broadly, encourage others to approach seemingly intractable problems from a new perspective and, in so doing, save a lot of lives.

(Right: the Universal Anesthesia Machine).

To read more about the work Gradian is doing, you can visit our website at and follow us on Twitter @GradianHealth.

Erica Frenkel is director of business strategy at Gradian Health Systems. She has managed programs in global health and economic development for nearly ten years. Check out her TEDx talk about the design of medical technology for low-resourced settings below.

Health Care
healthcare technology, public health