Hope Is A Verb - Tarek Loubani- 3D printing emergency healthcare

Episode Date: July 30, 2023

Meet Tarek Loubani, an emergency doctor who has created open-source, 3D printed medical supplies to solve critical shortages in war zones like Gaza and Ukraine.   In this conversation, Tarek shares his journey as a Palestinian refugee - the powerful moments that have shaped the trajectory of his life and inspired his mission to create high quality and open source medical hardware and make it accessible and affordable to those who need it most. Giving us a rare insight into the crisis zones we hear about in the news but rarely have access to on-the-ground stories, this episode is compelling, confronting and incredibly inspiring.    For more information:    Glia's website:https://glia.org Steth-of-hope:https://glia.org/blogs/news/the-steth-of-hope-campaign-with-make-a-medicGlia's Patreon, if you want to contribute in a durable way:https://www.patreon.com/gliaDonation to Glia:https://glia.org/collections/glia-donationsTo volunteer or reach out to Glia:https://glia.org/pages/contact This episode of Hope Is A Verb was hosted by Angus Hervey, cofounder of Future Crunch and Amy Davoren-Rose, creative director.  The soundtrack for this podcast is "Rain" composed and performed by ⁠El Rey Miel ⁠from their upcoming album "Sea the Sky." Audio Sweetening by Anthony Badolato- ⁠Ai3 Audio and Voice⁠. We would like to acknowledge that this podcast is recorded on the lands of the Gadigal, Wurundjeri and Woi Warring People. These conversations are inspired by our charity partners and our Humankind Project that celebrates the people who are stitching our world back together. You can contact us at: [e-mail] Transcripts will be available on our website soon. 

Hi, welcome to Hope is a Verb, a podcast from Future Crunch that explores what it takes to change the world through conversations with the people that are making it happen. I'm Amy. I'm Gus and these are the unknown heroes who are mending our planet, stitching together a better future and showing us the best of what it is to be human. And in fact the success of this project will be the transition of the stethoscope from being a glia stethoscope to being everybody's stethoscope. That's how you know when it replicates in the wild. It has replicated in the wild, by the way, which is such a huge sign of the success of

the model. But we didn't know that at the time. Technology is reshaping industries and healthcare is no exception. From operating theatres to laboratories, inside traditional bricks and mortar hospitals and out in the field. We're starting to see a wave of new tools that are giving us new ways to mend bodies and save lives. For Tarek Lubani, a doctor on the front lines of some of the most intense conflict zones in the world, technology is also solving an even bigger problem, access and affordability.

After working in a hospital in Gaza without critical medical supplies, Tarek teamed up with innovators to create a 3D printed stethoscope that was hundreds of times less expensive than its traditional counterpart, yet just as effective. And if that wasn't revolutionary enough, his organisation, Glia, made the invention open source, leveraging the power of collaboration and transparency to change tens of thousands of lives.

Tarek, welcome to the podcast. Thank you so much for inviting me. We'd love to know, is there a new story anywhere in the world that is giving you hope right now? Okay, it's a bit of a wonky story. But the story that's given me a lot of hope recently has been this deal that unfolded between the Saudis and the Iranians. And I know for almost everybody, it's quite distant, quite off to the side. But for me, having watched the Middle East for so long, and having seen how things go, the idea of a Saudi-Iranian peace was unthinkable six months ago. And to see it happen, to see the triumph in so many ways of

diplomacy over war, I know that it's a very realpolitik move. It's the smart move for them to make. But isn't it amazing that the smart move is peace and diplomacy? Isn't it amazing that these two competitors, enemies in the region, looked and said, yeah, let's make a deal. I love that framing, Tarek. And as you said, you've spent a lot of time in the Middle East. And we'd actually love to go right back to the beginning of your story because you have lived your life as a Palestinian refugee. You were born in Kuwait. Your family immigrated to Canada when you were nine years old. What memories stand out from your childhood? I lived my life not in Palestine, but in Kuwait, I lived my life not in Palestine, but in Kuwait, because as a Palestinian refugee in the diaspora, I wasn't allowed in.

The first time I was allowed into Palestine was when I became a Canadian citizen. In terms of my youth, it was a very happy youth. I understood acutely that I was a refugee, but ultimately I came up in a family with all the advantages. My parents loved us very much. They treated us very well. They made sure that we understood the priorities. You know, for Palestinian refugees in the 80s, it was education, education, education. And my parents drilled that into us. And I remember one really clear conversation I had with my father where I had gotten some not very bad mark. This is quite a typical immigrant story. Lots of my immigrant friends have had it.

My father was disappointed and upset, not angry, not any of these things. He just felt like I didn't get it. And I could tell that he was trying to convey something to me that I couldn't understand. I was probably eight and a half, nine at the time. And so he says, you know, this apartment we live in, that car we have outside, none of this stuff belongs to us. All of this stuff, it can go in a day. this stuff, it can go in a day. And he was trying so hard to convey how absolutely disposable all of that stuff was, not just in the sense of we could let it go, but in the sense of it could be taken away from us. And of course, what was my reaction? I was like, yeah, yeah, whatever, old man. It wasn't even a year later when the war happened. We lost our home. We literally had to melt down our beds, which were

metal framed, and turned them into a roof rack so that we could take our possessions and drive out so that we could escape. And of course, we didn't have the car. We didn't have the apartment, didn't have any of our possessions. We just had each of us one little backpack that we could carry with some clothes. And that was it. And of course, when I got to Canada, all I could really think is, damn it, that man was right. My father wasn't with us. He's also a doctor. And he wasn't allowed to leave until the war more or less wrapped up. This was the first Gulf War. Interesting kind of dichotomy that on the one hand, you're going through these incredibly traumatic, life-changing experiences.

And at the same time, this incredible sense of security and the instilling of really strong values from both of your parents. What role did your parents play in your decision to eventually study medicine? My mother's also a doctor. So a lot of people kind of assumed from an early age that we would be destined into medicine. And that was, I think, the last people who knew that I was going to go into medicine were my parents.

Because I had so many other interests. I wanted more than anything in the world to help people, but I just didn't see medicine as my way to do that. It was actually just that I was a terrible student in chemistry. That was my life trajectory. I was planning on doing a PhD, but my very, very insightful supervisor sat me down and was just like, listen, don't do this. This isn't for you. And that really left me directionless for some time. So after 9-11, I thought to myself, I have to be involved somehow. So I went to the West Bank. And back then it was shortly after what was called the fourth siege in which it had been more or less wiped to the ground. And I was part of a group of people who tried to introduce accountability by just being present and witnessing and writing up what we saw. And one day there was a bomb, a shelling of a market.

Of course, it was very loud. Dust was everywhere and couldn't really see anything. And everybody was yelling and screaming and I'm yelling and screaming and everybody's running and I'm running. And then as this dust starts to settle, I look around and I realized like, oh, everybody else ran away from the sound and I ran towards it. And here I was in front of these victims, these people who were injured, some of whom were children, and I had no idea what to do. And it was such a terrible experience naturally that all I could really think of is like something is broken inside me that

brought me to the sound instead of away from it. And when I got there, I didn't know what to do. And I never want that to happen again. I never want to feel that way again. So that's why I went into emergency medicine. That's why I go onto battlefields. That's why I put myself in these places it's something not everybody can do it is depending how you present it either a gift or a defect in Arabic there's this thing about what you should do in life you know you you have to pick something and it has to have these criteria one of them is that you have to have the desire to do it, which we all think about, right? The other one is that you have to have the opportunity to do it, which sometimes we think about.

In the West, we very much emphasize, what do you want to do? But in this sort of like Arabic saying, it's, well, what do you want to do? What are you able to do? And what do you have the opportunity to do? And here was something where I had the ability, I had the opportunity. And it was only once I really got into emergency medicine that I fell deeply and passionately in love. And I can't imagine my life without it.

Hearing you tell that story of running toward the sound, I mean, that is the ultimate answering of a call, if ever I've heard one. It really is. And so you studied medicine and then in 2011, you went to Gaza to start teaching emergency medicine at a hospital there. Can you tell us what that experience was like? Gaza was at this incredible crossroads in 2011. The Arabic Spring had just happened and a bunch of tunnels, about 1,800 tunnels had formed, which are actually the only way I was able to travel into Gaza for the first several years. Funny side effect of the blockade was that Gaza was forced to become independent. For example, by 2011, Gaza had been under blockade

for six years or so. And in that time, they developed the largest organic farm in the world because all of a sudden they had no fertilizers. And so they had to use what they had in order to make their own agriculture. But when I was coming in, it was clear that medicine and technology were somewhere down the line if somebody would just get engaged in them. And it's not for lack of very smart people there, but they had difficulties getting lots of the stuff from the West. However, I'm a person of Palestinian origin, but I speak in a way that Westerners understand. I speak with an accent that makes Westerners comfortable. I was able to translate between the Western medical system and their medical system. I mean, it's such an interesting place

to find yourself. You've ended up as this bridge in between these two very, very different places. You were in Gaza during an eight-day war. You were working in emergency departments under some really challenging circumstances. Can you talk us through the inciting incident that led to the creation of your first 3D-printed stethoscope? In November 2012, there was a war that kicked off that ended up ultimately killing about 200 people and wounding many, many more. And because of my very specialized skill set, I was the first doctor that patients would see. I served as the disaster triage doctor. I was 31. Really, a doctor of that age shouldn't have had so much experience in a place like that, that I was the senior or the ranking doctor in almost all cases. It's not right. It's not right. But that's the situation we were in. So I was there almost the

entire time. I was sleeping in the parking lot in a car that they had set aside for me. And I would come in, work until more or less I was ready to drop and then rinse and repeat. And there are not many things that you can and should do as an emergency doctor in those scenarios. Because realistically, when people are getting bombed, when people are getting shot, generally, the injuries are either survivable on their own or they're mortal. They will kill you no matter what anybody does. But of the injuries that are in between, there are a few that are more dangerous than a thing called a pneumothorax, when you have air in the wrong place. And that air is then creating pressure that stops you from taking your next breath. It is the most treatable of the super deadly emergencies, right? You literally put a

needle, it just drains the air, you're done. However, you just need to recognize the problem. But we didn't have stethoscopes. The only stethoscope in circulation was mine. I had a Littman, which is the gold standard. That's what I got when I got into medical school as a gift. And I was using this Littman and then passing it around. There were about 10 of us there. And the way people were listening to chest was literally listening. Put their ear to the patient's chest and listen. And so you'd know the doctors who had been doing this because their ears were generally full of blood, other people's blood. why of it? Why was this technology so expensive? Why was it unavailable? And at the end of the war, I had the luxury of going home because I have a Canadian passport. And one of the things that happens when you're in this situation, and this is true for me and it's true for almost everybody I've spoken to, is that you feel a good amount of self-loathing. Why did I get to be here?

I started resenting my life. And while I was feeling sorry for myself, I was at my brother's place and his son came over to me. He's like, oh, Amo, are you sick? He goes and he grabs a toy stethoscope. And so I picked up this toy stethoscope. I put it on my ears and I listened to my heart, listened to his heart. I'm like, oh my God. make this thing as cheaply manufacturable as possible could do this then what could i do with all of the technology of 2012 2013 almost at that point like what could i do and i'd been intrigued by 3d printing i just built myself a 3d printer and off we went just trying to target all of the abilities of the first world on this one thing until we got it done. And I mean, the stethoscope is as good as the Littman.

I did not want to give them anything less than what I would use on my patients in Canada. And in fact, I use my stethoscope every shift in Canada. I did not want it to be any lesser because they deserve the same. And of course, once the idea was there, Glia was born. The idea that like, why would we stop at a stethoscope? I read a brilliant quote from you, and you described yourself as that geeky friend in high school that was down in the basement yourself as that geeky friend in high school that was down in the basement tinkering with stuff. So you obviously already had that passion. What was that process like of developing that prototype?

Yeah, and more importantly, kind of getting it to scale. You know, it's all very well building one stethoscope, but what happens when you have to do 10 or 20? It took me about a year to build my first 3D printer because back then you couldn't buy them. And once that happened, I very quickly realized that I did not have the engineering chops for this. When you think about this problem, this problem has several parts.

And I won't just take us back to 2012, but actually the fulfillment of the project. So the obvious ones are the technical and the clinical, right? Like you have to make a thing and it has to be a thing that is usable in a clinical context. Once we got those stethoscopes into Palestinians' hands, they didn't know how to auscultate. Auscultation is the name of what you do to listen to somebody. They didn't know how to listen because they'd never had the equipment to do it. And so we realized that it's not just the device. It's also teaching them how to use it.

We had to construct courses and how to use a stethoscope and reintroduce it to a place that had lost it easily a decade, two decades, three decades ago. As for scaling, I mean, good question, Gus. I don't have the answer to that one yet. We're not really scaling all that well because the scaling kind of goes in a few different steps. The first thing is, like you said, making the prototype, making sure that it works. And then it's small batch manufacturing. As far as I'm concerned, all the way up to 10,000 or 20,000 units of small batch. And that's where we're at right now. And to really get into the 200,000, 500,000 unit place, which is where the stethoscope really impacts on the usage of doctors

all around the world, well, you need other people to pick it up. You need mass manufacturers to pick it up. And this is a problem I can't crack because the reality is that Chinese manufacturers are manufacturing terrible stethoscopes in quantity for more than it would cost to manufacture ours. Why don't they just manufacture ours? It's open source, et cetera, et cetera. It's a problem I haven't yet cracked. Problem I haven't yet cracked. But if we could control a little bit more of the market or have a little bit more market share, I suspect that they would bring their stethoscopes

down to almost parity. They would sell them for much, much, much less. And that would make them truly universally accessible. This is one of the reasons I love your story so much. And actually, I remember when we first heard about your story, this was one of the things that caught my attention. The decision to go open source, why? And also talk us through the impact that that's actually had.

That's a decision you made 10 years ago. What does that mean today? When we started with hardware, I had two perspectives. One, this is actually the superior way to develop. I do not want to be in the stethoscope development business the rest of my life. I need to hand that off. And in fact, the success of this project will be the transition of the stethoscope from being a glia stethoscope to being everybody's stethoscope. That's how you know when it replicates in the wild. It has replicated in the wild, by the way, which is

such a huge sign of the success of the model. But we didn't know that in the wild. It has replicated in the wild, by the way, which is such a huge sign of the success of the model. But we didn't know that at the time. But I did know that I didn't want to be making every adjustment myself, servicing every market myself. So for example, somebody messaged us and said, oh, you know, I use hearing aids and your stethoscope isn't really built for that. So I modified it. Thanks for the source code. Here's my modification. Or the ring on the stethoscope or the way that the earbuds, these were not our work. They were the work of other people who looked at our work and said, that's good, but I can make it better. And that phrase, but I can make it better,

but I can make it better. And that phrase, but I can make it better, that's where free software lives. That's where free software excels. And that's where I wanted free hardware to go as well. So we really didn't know. At the time, there was no such thing as open source medical devices on a professional scale. We didn't know that it was going to work. devices on a professional scale. We didn't know that it was going to work. But that's where I sort of leaned on the second thing. I did think it would be the most efficient, the most successful, but I knew even before I started that it was the most ethical. Okay, let's say I patented it. Somebody violates it to go build a cheap stethoscope in Uganda, for example, which is one of the locations where people in the wild started building stethoscopes. Am I going to sue them?

Like what kind of a human being would that make me? Who is Tarek Loubani if he goes and sues that person? And so, you know, a patent isn't just a patent. A patent is a bunch of other things. And the other things that that brings with it is that you have to go after people and tell them no. And I never wanted to say that. The only reason that I will say no to people is if I feel that they're modifying things to make them dangerous, to make them less safe, to make them less effective or less efficient. That's it. So often, by the time we hear a story like yours,

it's condensed into this really lovely 600 word press release. And it can tend to gloss over from beginning to end. But we know in the work that you've done, you face some really big challenges and frightening situations. You've been arrested, you've been shot, you've lost colleagues. Can you tell us a bit about those parts of the story that maybe we don't get access to all the time? Yeah, I mean, I think a lot of people forget that when you work in places like this, you're exposed to the same risks as the people who live in places like this. So the first time I went to jail was when I was 22. And that was an Israeli jail. And I remember when I came out, doing a little bit of work on the stats and realizing that I was in the minority for having lasted so long before I went to jail. Everybody around me didn't just know the experience. They

knew the jails I was talking about. When I told them which jail I was in, they were like, oh, do you know such and such a guard? Yeah, he was a real jerk. Or this guy was nice. Do you know such and such a guard? Yeah, he was a real jerk or this guy was nicer. You know, like Palestinians go to jail. And so I went to jail because I was working with Palestinians, you know, and it's the same thing as well when we talk about getting shot. Like, yeah, I got shot. The day I got shot, 1,700 people got shot. 1,700 people. It's such a mind-boggling number that for me to sort of look at myself as anything extraordinary, to me, it does not seem like there's anything special about that experience. The decision is to work with people who are experiencing real things. And once that decision is taken, then all of the consequences follow. What you realize is that you don't go on your own. You take everybody you know with you. Your family, your friends, your colleagues. I take four months a year off of my job. That's only possible because my colleagues make it possible. They are as responsible for my work as I am. You know, like I get to be here on podcasts talking about cool stuff. They don't. They are the rear guard who makes sure that everything is safe at home. is safe at home. And so I really look at it as such a collaborative effort to put me in a place with people who are us, who experience things that I'm subject to as well.

It reminds me of a story I once heard where someone said, whenever we tell the stories of change in the world, we always tell the stories of the people in the tribe who got and go on adventures, but we often forget the stories of the people who stayed at home and kept the fires burning. I want to talk a little bit about Glia and what you're doing now. You're going backwards and forwards between Gaza and Canada. We first heard about you in 2018. That's when Future Crunch discovered you and what you were doing. What have you been up to since then? Yeah, well, when Future Crunch reached out, we were at this point where we were making a lot of tourniquets because there was a series of weekly protests in which a lot of people were being shot.

And also we were trying to push forward the Stethoscope project. And so we took the money from Future Crunch, which was very generous and I guess donated by your readers and listeners and viewers and supporters, and really turned it into the two things we valued the most at that point in time. We taught doctors how to use them. The other piece was we made an awful lot of tourniquets and lots of developments on tourniquets. Everything, of course, stopped for the pandemic. And we shifted from, I'm going to put this in very loose air quotes, giving Gaza to taking from Gaza because Gaza had been working on a face shield for quite a while. It had a face shield ready for us. As soon as the pandemic hit, their engineers walked us through, had a mass manufacturer quality assurance check, all of the stuff we made, I think 60,000 or 70,000 face shields in the end. Yeah. Yeah. I know. And it would have been impossible if not for the Gazans. And I think, look, like solidarity should never be about expecting something back. At the same time, it was incredible for both of us, for us and for the people in Palestine and in Gaza, to have it such that the solidarity was flowing the other way as well. And so that period was of a lot of development related to PPE and so on.

And then the other big one that actually we used the last of the Future Crunch money for was tourniquets in Ukraine. I myself traveled to Ukraine and we imparted as much as we knew about tourniquets, their manufacture, etc., and helped guide a lot of people in terms of properly manufacturing tourniquets at scale. Wow. I didn't know this part of the story, the efforts in Ukraine. That's amazing. Thank you for sharing that. It should have come up a little bit sooner because we had a little bit left of the money that we had set aside to re-pick up the stethoscope work. And we just were throwing all of our resources at this problem. And so we're like,

okay, we'll just throw this Future Crunch money in there and then come back to it later. I don't think you fully realized how critical your intervention was. And it showed us that, especially the way in which Future Crunch looked at the world, it was just so incredible and something that I really needed in that exact moment in my life. And I loved sharing it with the Glia team at the time and ever since. So thank you as well. It's been a big 10 years for Glia. A big 10 years for Glia and it's spanned pandemics, crisis zones, war zones. We're really interested in what have you learned notching up almost a decade of this work?

I think the most important thing is we proved the model. We also started developing quality assurance and mass manufacturing techniques that didn't really exist before. What we learned, I think above all else, is that the problems that we face are trivial technologically and even trivial clinically. I think if I had it to do over again, I would pay so much more attention to the cultural aspects. For example, we had a prosthetics project in Gaza that failed because we were producing Iron Man looking hands and people wanted something that looked real. They would rather have had something that looked real and was non-functional to something that was functional and didn't look real.

We did not consider their needs or wants. We did not consider their desires or cultural background. All we thought about was what we thought was right. We also learned how to run an organization. Right? This's been amazing. I'm the least important part of Glia now, and that's great. What can our listeners do to support you? What do you need help with right now? The biggest project that I think we need some help with from an audience like yours, who would be committed and into things

that aren't necessarily sexy, is one called the Open Gaza Initiative. The Open Gaza Initiative is an attempt to make it so that the medical devices that are already there are repairable. So we're developing procurement policies. We're also training biomedical engineers and have repositories and manuals. So we're working, for example, with iFixit to get a bunch of manuals and parts and so on. This project is critically important, not just in Gaza, but everywhere. And it is terribly unsexy. It is infrastructure work. And so a very committed person who understands what we're doing should support Open Gaza Initiative.

At the same time, we're working right now on another project that should launch soon. You'll find it on our website or on our socials at glia underscore intl for international. And there, what you'll find is a campaign to make a bunch of stethoscopes as well with groups all over the world, but right now focusing on Zambia. That's called the Steth of Hope campaign and has been a really great one. It's the third year running. We're transitioning it so that they're not only getting and receiving stethoscopes, but rather manufacturing their own over the next couple of years. But I think, Gus, what I'd like to do is actually propose something a little bit more abstract, which is to think of this as a ladder. The first

thing that people should do is understand and appreciate that open source medical devices and open source in general is the way to go. And the next rung of the ladder is to try to engage with these projects. Use open source wherever you can. And then if they're willing to get involved in projects, we need engineers primarily. Of course, we need funding and people to help us with grant writing. And also we need scientists, people who are willing to do research studies in their locales.

So if they're willing to get engaged at that level, reach out info at glia.org. And then the last step, which is the hardest, is if they feel really committed and capable then to start their own project targeting their own needs. The Stethoscope project is actually a beautiful segue into our final question. What does the word hope mean to you? final question. What does the word hope mean to you? Oh boy. The way that I look at the world is such that hope doesn't really matter all that much. Because I have that particular view in which I'm hopeless, in which I don't believe that necessarily there's some kind of panacea waiting.

I haven't really examined the word hope all that much. I guess to me, hope would be the place in which I can sleep comfortably. It would be the feeling of the people around me having what I have. For me, really hope is freedom. And I think that there can't really be hope without some kind of freedom. This conversation is proof that if you have an idea that can change the world, the most effective way to scale it is to share it. Make it accessible to everyone. Adapt locally, evolve globally. Tarek's journey

may have started with a 3D printed stethoscope, but at the heart of his work beats a global revolution in healthcare. If you want to find out more about the GLEAR project, you can check out our show notes for links to donate, to get involved and follow the organisation's progress. We're proud to have supported GLEAR as one of our charity partners at Future Crunch and would like to thank our paying subscribers for making this possible.

We donate a third of our subscription fees to under-the-radar charities that are helping people on the planet. If you're interested in becoming a subscriber, you can find out more at futurecrunch.com. We would like to acknowledge that this podcast is recorded in Australia on the lands of the Gadigal, Wurundjeri and Woi Wurrung people. There are a lot of podcasts out there. It means a lot to us that you chose this one. There are a lot of podcasts out there.

It means a lot to us that you chose this one. If you enjoyed this episode and you'd like to support Hope as a Verb, please subscribe and leave a review. And if you want to reach out directly, send us an email at hope at futurecrunch.com.au. Thanks for listening.