S1E80 - Glia on 3D Printing Medical Devices
This week on Live Like the World is Dying, Inmn is joined by Carrie and Korin from the Glia project to talk about some of their projects and specifically to talk about why 3D-printed medical devices are really cool and how they help get medical devices to places where they are not otherwise easily accessible. They talk about Glia's work on 3D-printed tourniquets, stethoscopes, otoscopes, and dialysis machines. Also, please give them $5 million. You won't regret it.
Inmn can be found on Instagram @shadowtail.artificery.
This show is published by Strangers in A Tangled Wilderness. We can be found at www.tangledwilderness.org, or on Twitter @TangledWild and Instagram @Tangled_Wilderness. You can support the show on Patreon at www.patreon.com/strangersinatangledwilderness.
Glia on 3D Printing Medical Devices
Inmn 00:15 Hello, and welcome to live Like the World is Dying, your podcast for what feels like the end times. I'm your host Inmn Neruin. And this week we're going to be talking with Glia, a rad organization that designs 3D printed medical devices so that no matter where you are, you can access basic and quality medical devices. But first, this podcast is a proud member of the Channel Zero Network of anarchists podcasts. And here's a jingle from another show on the network. Doo doo doo doo doo. [Singing a simple melody]
Inmn 01:17 And we're back. Thanks so much, y'all, for coming on the podcast today. Would y'all like to introduce yourselves with your name, pronouns, nd what you what you're here to talk about or what your role is in Glia.
Carrie 01:45 Okay, I'll go first. My name is Carrie Wakem and she/her and my role at Glia is executive director. It sounds very flashy. It's not. We're all team players here at Glia.
Korin 02:00 My name is Korin, my pronouns are she and they. I'm a volunteer with the Glia project, particularly focused on the tourniquets, and specifically with regards to manufacturing instructions and quality control documentation.
Inmn 02:13 Cool. And would you want to kind of introduce what Glia is?
Carrie 02:20 Absolutely. So Glia is a medical device manufacturing company. We do lots of research and we build and research devices that are considered high quality, open source, and at cost. And that's sort of the stuff that we do.
Inmn 02:42 How did Glia come to get started? Also, does Glia stand for anything? Is it an acronym? Or is it just a fun word?
Carrie 02:50 Everybody asks that question about the acronym and how we became Glia or where the name came from and really there's no interesting story behind it. I think the original team on the Glia project just basically said, "What should we call this?" Somebody throw it the name Glia. And then it stuck as far as I know. But that was before my time. I can absolutely speak to a bit of the history of Glia and how it came to be. So, our founder Tarek Loubani is in emergency medicine physician in London, Ontario in Canada. And he works frequently in the Gaza Strip. And quite a few years ago he was there during the war and he was responding to a large amount of casualties. And he was in a room with a whole bunch of patients that needed to be seen. And when he looked around, he saw that there were only two stethoscopes being used in that room and one of them was around his own neck. And literally people had blood on their ears because they were putting their ear to the chest of patients to hear if there were heartbeats. And it occurred to him that some other places in the world don't have access to even basic medical tools like stethoscopes. And then after that trip, he was home and he was playing with one of his nephews and he was using the little toy plastic stethoscope doctor kit--I think Fisher Price used to make one when I was a kid. Anyway, that's who made one. I'm sure there's a lot of knock offs now. But, they have a little toy stethoscope. And he put it to his ears and he was listening and he was like, "This thing actually works. You can actually hear a heartbeat through this plastic toy." And he just had an interest in 3D printing at the time and he thought to himself, "I wonder if I could create a stethoscope using a 3d printer that would be more accessible, lower cost, and hopefully as high a quality as the Littmann cardiology iii, which is what our stethoscope now compares to. So Glia does have a 3D printed stethoscope today. It was our first product that was developed and it's based off of that experience of our founder.
Inmn 05:00 Cool. Is that is that...[incoherent starting and stopping and stuttering] That makes sense how that would prompt an organization like Glia. But it is...That's really grim that that is how these organizations start.
Carrie 05:15 Yeah. Unfortunately. Though, those are the stories that probably motivate people to do something about these scenarios, right? So, you see a problem and you want to solve it
Inmn 05:27 Is Glia, like, I guess....So from there, this person started 3D printing stethoscopes and then how did the larger structure of Glia kind of start from there? Was it like people just being like, "Oh, that's really cool. Could we also make this other thing?" or?
Carrie 05:43 Um, yeah, so a lot of what we've done...There's parts of it that's have been strategic and parts of our projects that have been organic. The first stethoscope, I believe, was developed in 2014. I didn't come into the project full time myself until 2017. So this is a little bit before my time. Stethoscopes were the thing that we were sort of working on, at the moment that I joined Glia myself. And we started with the stethoscope specifically because it's an iconic device, right? Like everybody recognizes it. So, there was some strategy into picking a device to get started on the topic of "How can an open source stethoscope really changed the world? How can that provide better access to quality health care?" It's a talking point and it still is to this day. From there, though, it was the experiences of the people that were working or associated with the project--collaborators, we've had a lot of collaborators, a lot of volunteers over the years--that sort of drove the direction of some of these projects. And the one that Korin mentioned at the beginning when she introduced herself was the tourniquet project. And that was actually originally developed by the engineers that were working for Glia back in 2017, a group there. And they saw a need for tourniquets in the Gaza Strip. They just couldn't access this type of device. And as we know in Gaza, there's constantly the threat of war. So, they needed to be able to come up with something that they could get access to. And so they designed this tourniquet--and we can probably get into that a little bit later--but that was something that organically happened from our remote office. Other projects like our otoscope. We have a 3d printed otoscope. This project was literally designed by a guy that was attending audiology school. So a gentleman that was in his early 20s had a fondness again for 3D printing and he was sitting in class going, "Why does an otoscope cost $400. I'm a student. I'm on a student budget. I can't access this general piece of equipment." And, and we're not talking about the Welch Allyn otoscopes that are attached in your doctor's office. We're talking about just you know, a plain handhold regular tool to look into somebody's ear. And so this guy, his name's Frankie Talarico, he actually sought us out and he was like, "I want to make this otoscope. And I want to just design it quickly on some software. And I want to make it open source so that anyone else can access that source code and copy it from anywhere else in the world." And he looked out to see who else was doing things like him. And it just so happened, we were in the same exact city, literally like a 10 minute drive from each other. And he reached out and he said, "I have this device that I've been working on. I want it perfected. You guys seem to be a little bit more ahead of of the game in terms of open source medical devices. How can we help each other?" And so he brought this idea, this concept, this design. We had it, you know, sort of perfected in a couple of different versions. And now what you see on our website is working a portable otoscope for...It's $100 for that device and we're hoping to improve our manufacturing process in the next year when we have people like Korin involved to help those processes get a little bit more efficient, we can lower the price even further. So its cost right now is 1/4 of what it does for the comparable gold standard model on the market.
Inmn 09:35 Wow. Yeah, that is...I mean, that's a significant difference. If someone downloaded it and printed it themselves, would it be cheaper for them to print it themselves then?
Carrie 09:49 Yeah, so yeah, in a sense it would be. So there's...So what Glia does is we take our designs that we make--all of our medical devices are located in our public repository on GitHub--and people can access those files and make them themselves. So there's no, you know, limit to what people can do with these things. They can redevelop them and make them better. That's what we really love is when people come into our feedback cycles and we see improvements for devices. That's one benefit of having it open source. But people certainly can take the device and make it. And in fact, if somebody copies what we're doing, that is a success to us. That's what we want to happen here, which is probably much different from many of the other medical device companies you think you might know. We measure our success based on how much it's replicated. And so somebody can take that device, they can make it on their printer. It really does cost cents to print with the plastic that we're using. There's a few electronic components and batteries. There's a lens that you need to source. So that might be you know...You could get that somewhere between $5 and $20 USD, to get a lens that goes into this. Not very expensive pieces. And then it's your time of putting it together. But I must say, the one caveat in all of this being, is that if you are building and replicating medical devices and using them on patients, you have to have proper compliance in your area. So Glia holds a Medical Device Establishment license, which is a Health Canada license that we have to make sure that all of our devices that are going out are safe to use on patients. And we would encourage anyone else to do the same thing if they were really making these things to use on patients, to sell to others to use on patients, etc.
Inmn 11:47 Yeah, I was gonna ask, not in like a skeptical way or anything, but like in a....How do the devices that y'all make compare to professional medical devices that are produced in factories? Which I mean, this is just...Yeah, it doesn't seem all that different, just a different means of manufacturing....
Carrie 12:10 Great question. I love this question. So what Glia is trying to do is to make our devices as close in functionality to the gold standard devices that you would see. So we don't compare ourselves to cheap plastic shit that's built elsewhere, or knock offs, or crap that you can find all over Amazon, you know. We want to make sure that we are building high quality devices. So we do real research backed by real institutions on that. And then we publish real papers in reputable journals about the research that we do. So, the idea here is to make something in a different way that lowers the cost, increases the access, but does not touch the standard of quality. So quality is number one for us. And then alongside quality is safety. So that's where the question of compliance sort of comes in. We encourage anyone that's producing medical devices to make sure they understand proper compliance in their area. And really in the world right now there are four main places to get compliance. One is Health Canada, which is where we...our home offices is in Canada. There's also the FDA. There is one--and I'm not sure of the exact name--but there's one for the European Union that qualifies. And then I believe there's one in Australia as well. So for the countries that don't have these types of governing bodies, where often these devices are needed most, they would follow compliance from one of those other countries that provide that service. And if they are then you could trust that you're being safe with what you're doing.
Inmn 14:03 Cool. Cool. Yeah. So in contrast, y'all are producing these medical devices for very little money, but it is without the sacrifice of quality and so it's...like, is that kind of...[starts over] Does that offer a good alternative to if people are like, "Oh, I need cheap medical supplies. I will go buy them on Amazon."
Carrie 14:33 Yeah, I wouldn't recommend doing that specifically, but it doesn't mean there aren't good quality medical devices on Amazon. Okay, so I can just say that for sure. The difference...So the point of this all is to make a sustainable business model where people get paid fair wages to build build high quality devices. And the point here is not to gouge people that need these devices to improve their health. What Glia is trying to do, and say, and change in the culture of the way our health system operates today is that nobody should be making money on the backs of people's health care. And so we should charge what it costs to produce these devices. That's what the customer should pay at the end, not that price plus investments--like paying off investors--paying off people so that they can have their Lamborghinis and their yachts and go out and do all these things, right? Like, this is not the place for that. If you want to make a designer t-shirt and sell that to someone and they want to pay, you know, $500 for a t-shirt, that's up to them. That's not something they need. But people need access to health care and there's a lot of inequity in our world today with accessing even these simple devices as I said in my very first example of how the company came to be. Like why is it in 20--I believe that happened in 2012--why was it in 2012 that stethoscopes weren't available in a place in this world? Like quality stethoscopes. And that just doesn't make any sense. And the three of us, we may have had enough privilege to be able to understand what a stethoscope was from the minute we could walk or talk--thanks to Fisher Price too--but also, you know, like it's not an issue for us to really get some simple tools, but that's not everywhere in the world.
Inmn 16:54 How then do devices make it from y'all to places like Gaza? Or anywhere where people who need to be able to access them? Yeah, how does that that flow path work?
Carrie 17:11 This can happen in a couple of different ways. Our preferred method is for people to adopt what we're doing and do it themselves. You know, this is...I was talking a little bit about the measurement of success for Glia and one of those things is getting people to replicate what we're doing. And so if they decide, "I need access to a particular device, anywhere in the world," it really, for our devices right now, the way they stand, it's mostly about having access to a quality desktop printer, and having the source code, having a little bit of expertise, proper compliance, and you've got the recipe to start building your own devices. So whether that be 100 devices or 100,000 devices, you can really do that based on this model. It is scalable. I mean, but it's not meant to be massively scalable, right? It's about keeping the decentralized manufacturing model alive and only filling the need in communities as they need things, not over producing. You know, like, we don't want to throw a whole bunch of crap into the landfill. That's not one of our objectives. Our objective is to fill the needs of the people who need what they need. Now Glia...That doesn't mean that Glia doesn't ship things. You know, like we will...Some people can't, or don't have interest, or don't want to, or it's not feasible. An example of that is sending tourniquets over to Ukraine for some response there. There are...We also had an initiative--we're working on it again this year--but a couple of years ago we sent out 200 stethoscopes to medical students graduating from their class. So fourth year medical students still did not have access in Kenya and Zambia to a simple stethoscope. So, we worked with a group over there called Myka Medic--or sorry, they're in the UK--and we collaborated with them to send these stethoscopes over. They weren't necessarily interested in that moment in starting their own lab, getting proper compliance, you know, getting all those tools. But getting that conversation started by sending over a couple of hundred units means that we can talk about those things in the future. Now we have these stethoscopes And now, when something happens to one of these stethoscopes, how do we repair it? Right? And that's what's beautiful about the model if you actually do, you know, invest in a $1,400 (Canadian) printer and teach somebody a little bit about what we're doing, give them the access to be able to build it themselves, and then they can go ahead and make more, repair what they have, you know? It just makes it just makes sense.
Korin 18:29 You mentioned a little bit about Gaza, specifically. Those are produced in Gaza. And the reason for that was because there was a dire need for them. And attempting to get medical supplies through that blockade is very difficult without paying exorbitant fees. They would cost...To get a CAT tourniquet here in the US cost about $30 and to get it into Gaza would be about $40 USD even if you're buying in massive bulk quantities.
Carrie 20:23 For a single tourniquet?
Korin 20:37 Yeah, about $40 each.
Inmn 20:52 Oh, my God,
Carrie 20:53 Yeah, that's, a lot of money in Gaza to pay for medical devices. And not only that, but there's another huge issue we can bring in, if it's time to do that, which is talking a little bit about donation culture and how a place like Gaza, especially, deals...I mean, I've learned a lot about this, especially in the last year, but the health system in Gaza right now is reliant on donations so much so that it's hard for them to steer out of any other path. And they can't even, you know, fathom the idea sometimes about being empowered to build their own stuff because they're so used to receiving basically other people's secondhand items. But what this does is it creates this dumping culture where devices will get dumped into an area because another place doesn't need it. So they'll say, "Oh, who wants this? We don't want to throw it away. So let's go put it somewhere where people can't have access." So there's a whole bunch of problems with that system, especially in Gaza. One of the things is they get a lot of stuff they don't need or don't want. They can't store it. They have inventory crisis constantly because of all of this dumping that happens of things they don't need or don't want. And then they become reliant on something. So for example, one of the ideas that Glia has down the pipeline is creating a dialysis machine. And we don't really want to reinvent dialysis. What we want to do is to take an existing type of dialysis machine and build an adapter to fit on that existing machine that will speak to any one of the disposables that may be used for the purpose of dialysis. So right now, those things are manufactured in a way that if XYZ company makes it, you have to get XYZ disposables to be compatible with that machine in order to use it. So, what's happening in Gaza is that there is literally a gymnasium full of dialysis machines that are unusable and another gymnasium full of disposables that are unusable because those two units are not compatible. So Glia's idea for a device--now this is going to be a $5 million project and you know, if any of your listeners have access to that type of cash, we would absolutely love to begin this project--but, you know, we want to build an adapter that will speak to those two pieces so that people can actually use the stuff that is donated to them, that is given to them, because it...And you can imagine, so now they have storage issues and they become reliant on these people that are feeding them the donations, right? So it's just there's so many problems with that. Now, if you look at what Glia is trying to do, we have an office in Gaza. We have an office with several printers running. We build our own turkeys locally there. So we build our own medical devices there. So they're already there, you know, and people can purchase or use what they need. They don't need to rely on somebody else's handouts to get them in there. And there's a lot more that we could do there as well. But it's difficult. It's difficult to even negotiate with those governing bodies that make those decisions in Gaza because they're so used to dealing with these donations and that's kind of the system they're relying on right now.
Inmn 24:33 Yeah. I cannot imagine being a medical practitioner in Gaza and being, "Well, we need dialysis machines," and having an entire gymnasium full of dialysis machines that you can't use that. Wow, I hope that y'all get to start that one soon.
Carrie 24:52 And like Korin was saying, it's extremely difficult to get things in. I worked on a project in 2016 I want to say--yes 2016-- where I moved 10 dialysis machines from Northern Ontario. So for your US listeners, Ontario is in central Canada and northern Ontario is somewhat remote. Okay. And this is going to fill all the stereotypes that people think of Canada right now what I'm going to say. Where I moved these, I work with a nephrologist and he wanted me to take--he did some work in Gaza--and he saw that there were some machines that were at this northern Ontario hospital that were compatible with some of the disposables that were already in Gaza. And they weren't being used by us. So he said, "Let's pay to get these 10 machines that are basically obsolete for Canadians." Okay, "Let's move them to Gaza." This project took me nearly 12 months to get these in. They had to come from this hospital via Ice River, onto a train, onto another train, onto a plane, and then perhaps a ship--I can't remember, it was a while ago--I don't know if we had it on a ship to get across. But then of course, it had to wait. To get this in through the blockade was terribly difficult. But we were able to get the Ministry of Health in Gaza on board and, you know, they let them in eventually. It also cost us $10,000 Canadian in shipping. So, what are we doing here, folks? This makes no sense. And all just because "Oh, somebody donated some disposables and they don't talk to any of the machines we have here. So let's dig out these ones out of the basement of northern Ontario and move those over." You know, it's just so frustrating because think about how far $10,000 would have gone in terms of buying any type of medical device if they had the market to do so in Gaza. It would be...It's just there's nothing that can can really be said about that. It's...
Inmn 27:15 Yeah, that is maddening. I know that...I mean, not to relate things back to things in the United States, but I remember when, you know, early, early COVID times, there was a serious lack of ventilators and all the car companies were going on strike to have the car company factories make ventilators instead. And I don't really know where I'm going with this, but just maybe for people in the United States to think about a comparable or semi-comparable situation of like absurdity that we have all these means of production and we're using them to make cars or we're using them to make stuff that people don't need instead of getting basic medical...having basic medical supplies be accessible to people who need basic medical supplies. I don't know, it just it hurts my brain a lot.
Korin 28:30 Not to, again, not to directly compare these two things because they are different, but even here in the US, you know, glucometers, the things that are used to measure your blood sugar, the the strip and I think the lancet and the unit itself, same kind of razor and blades model where one does not work with every other type of glucometer. So, it's exactly like manufacturers just love to do the whole razor and blades thing with people's health because at the end of the day, if it make some money, they will do it.
Inmn 29:07 Yeah, yeah. And that is the wild thing too when I think about it, is that all these medical industries, they exist to make people money not to necessarily get people medical supplies.
Carrie 29:23 Yeah, yeah. It's sadly true. And so...So I guess the question is then what can you do about that to change that culture? And to start thinking about this in a way that's more about sharing what you know versus holding it tight to your vest to serve yourself? How do you really serve other people with the information that you have? And so that's what Glia is really trying to do is just to show that there are...there's a different business model for this, folks. It doesn't mean that people need to be making no money or that it needs to be charitable. There's a system that could be in place where people just get paid to build stuff fairly. Maybe even just add a little bit to that so it's a nice cushy job, you know, like, give them extra vacation time, or give them just a couple of extra bonuses per year for just being great people. And you can do all of that and not gouge people at the end for all that that upfront R&D (Research and Development) that's done at the beginning. Because that's kind of, you know, fluffy, in and of itself, all of the R&D. We really don't need to redo R&D every time we do it if we just share the information we learned the last time we did it. Right? So why are we reinventing the wheel? Like really why did Glia have to come in and take a device like the stethoscope--that has seen no improvements since the 1970s in terms of its functionality, or design, or anything--and say we have to start from scratch and build this? Because, you know, like we took something that was off patent and looked at that design and replicated it. But why are we hiding behind patents here? You know, like it doesn't...it doesn't really make much sense when people need health care. Okay, I have an example. I will share a personal example. I talk about this sometimes when I give presentations. So, my personal experience isn't actually about medical devices, it's about pharmaceuticals. And I think the thing is, is that people in the US and Canada...There's a difference between the relation for a lay person in the US and in North America, especially, probably other places in the world, too, but I know here. I know our neighbors here. And everybody in North America has a relationship with pharmaceuticals, whereas not everybody in North America has a direct relationship with medical devices. Medical practitioners do. Medical administrators do or people that are making decisions on purchases, or people that are building these things. But not necessarily. Like my mother doesn't have any personal connection to a stethoscope, even though I'm sure her physician uses it on her every time she goes and sees her. But I think the thing about pharmaceuticals is that everybody's accessing this. So we all know about how much of an upcharge there is on certain medicines. And so for example, I have a sister who has a very serious heart condition, and she needs to take medicine in Canada that it costs $40,000 a year for her lung health. And without that she wouldn't be here. So because of where we live in the world, she's able to access that through a community, like through the Trillium program that's in Canada that supports people who, who can't afford it. And she can't, you know, she's on disability here in Canada because she can't work because of her condition. It's quite severe. And without this life saving medication. But $40,000 a year? How on earth would anyone without a health care system like we have in Canada be able to live? You would die. You would die, right? So what are we doing when we don't have working dialysis machines, you know, that are not talking to each other. People need dialysis or they die. A lot of people need dialysis. And so the thing is is that the technology exists, the manufacturing of these things can exist. This is not like brand new science. This is stuff that people can do now. We're not talking about building a dialysis machine on Mars. We're talking about just building it here on Earth. And then the problem here is that, you know, but this one has to be compatible with that one. Anyway. It's it's just a mess.
Inmn 34:18 I know that a big project that y'all have currently is tourniquets. And corn, I was wondering if you could tell us a little bit about that project.
Korin 34:28 Yeah, the Glia tourniquet, I believe, started in Gaza as well. And that was due to necessity. This happens very frequently, where Israel will start waging war on on the Gaza Strip and that causes a lot of casualties. And due to the blockade, it's very difficult to get like commercially manufactured tourniquets in and so the solution that came up--and this was before I joined the project--but the solution that happened there was to make this tourniquet that can be 3D printed and sewn together with locally available materials. And that's...It works. Yeah.
Inmn 35:10 That's awesome. And I know you're saying the price comparison of like If you wanted to buy one, it's like $30-40 bucks and then like to get it into Gaza, it would be a lot more?
Korin 35:24 Yeah, absolutely. I mean, getting it in there, from what I've heard from Tarek, it's about $40 US if you have a bulk order to get it into Gaza and the time that that would take is variable. Depends on a number of factors. Here in the United States, you can get them for about $30 give or take. Some models are more expensive, but that's about what you're looking for. The Glia tourniquet, I think we've run the numbers a little bit. Depending on where you source your materials, how you do it, in theory, you could manufacture it for about $7.50. But that is before any compliance or overhead. That's just materials and assuming you have the equipment ready to make it.
Inmn 35:24 Yeah, cool. I guess beyond the obvious of like putting the means into people's hands to produce their medical supplies, like why is tourniquets a big deal?
Korin 35:43 So just in general, what they're used for, I guess, for folks who don't know, it's basically a big strap that gets tightened around a limb and it occludes all blood flow to that. So in the event of like a massive hemorrhage, a massive amount of bleeding, these can save lives. These have been gaining popularity over the last, I want to say about 20 years, I think it's largely due to the forever wars, unfortunately. That's where a lot of trauma medicine winds up coming out of. And so there's been a huge resurgence of interest in them. And at this point, they are now very popular and they're very much used to stop massive hemorrhage. For non military applications, there's any number of them here in the US. We have to contend with a large number of mass shootings. So aside from mass shootings, there's a number of other situations where you might need a tourniquet. You can have accidents with cooking, accidents with knives, or power tools, lawnmowers, chainsaws, things of that nature, natural disasters, which are unfortunately becoming more common. Those are all situations where folks might need tourniquets,
Carrie 37:25 I would also add to that industrial accidents and a lot of back country activities. So things like your friends in the north doing a lot of snowmobiling, those types of people, a lot of those types of sports have been reaching out to us with interest in the tourniquet as well. So it's becoming an item that really should be in every first-aid kit. And one of Glia's goals in the next, let's say year to two years, is to start diving in a little bit more into the US market with these items and making sure they're in every public space. So for example, every school needs one of these tourniquets in the US. Every mall. But even in Canada, where we don't have as many mass shootings, these things are useful for all those other reasons. If you work in a facility--lots of people still work online, so you know, machines are doing stuff for us, but there's a lot of people doing factory work--tourniquets need to exist there.
Inmn 38:27 Yeah, yeah. I remember seeing this kind of shift. As you know, in 2020, when there was a lot of gun violence happening at large protests and stuff, and just like seeing people...everyone had tourniquets strapped to their belts and stuff, but I also remember talking to people who were like, "Oh, I'm maybe not going to go to the thing because I don't have a tourniquet and spending that much money on a tourniquet right now sounds overwhelming.
Carrie 39:08 That's so interesting. Yeah, so it's becoming way more commonplace I think, with tourniquets, and it's becoming something that your regular EMS isn't just carrying because the other big issue with tourniquets and why the hill is so steep for Glia is not just all of the R&D, and the manufacturing, and the governing body approval--which I think we might get into a bit--but you know, all the certifications and things that you might need for these types of devices, or what you would assume you may need, aside from all of those tricky things, the steepest hill for us is that lay people don't know how to apply tourniquets properly. So, unless you're a trained person in the use of tourniquets, then it's hard to just put a tourniquet in a public space and know how to use it. So, part of Glia's endeavor is never just to make a device and be like, "Oh, we made our device. That's it. Here you go." No, no, no, we have to do the full package. So likely, you know, we might seek out educational companies that are interested in open source as well and provide educational material to people so that you can become fluent in using a device like this.
Inmn 40:28 Cool. Korin, I know we were talking a little off-air about this, but you mentioned that--I guess maybe the right word is compliance--for civilian grade tourniquets doesn't really exist or something?
Korin 40:49 There is no standard for a tourniquet. So the way I actually got into the project was Tarek Loubani did an interview on It Could Happen Here, where he talked about 3D printed tourniquets. And I said, "Well, that's very interesting." And so I go, when I look through the GitHub and look through all the resources and couldn't find like, 'What standard does this meet? How is this being tested?" And after some further back and forth and discussion, it turns out, there isn't a standard for tourniquets. That does not exist. ASTM, which is a standards making body, is I think, working on one, but it's not released yet. And it's extremely new, if that ever does come out. There literally just is no standard that you can say, "Well, I've done this. And so therefore, it's a good tourniquet." Yeah. And, the way you kind of determine whether or not your tourniquet works is, I think, largely by comparison. And there is some testing that's done, but it's by comparison to what's being used currently. And does it work as well as that?
Carrie 41:56 Yeah, I was just gonna add to that again, like Glia doesn't just stop at like, "Oh, let's take a medical device and reproduce it or build it again." We have to do...we have to go to all the lengths to make sure that this thing can get out there and people can use it safely. So one of the things we needed to do was to partner with somebody that was willing to design a tester for the type of tourniquets that we were making. And that's been a massive project. And actually, it was designed by the Free Appropriate Sustainable Technology Research Group at Western University. And they just published the tester that they developed to test not only the Glia tourniquet, but any tourniquet that works in the way that the Glia tourniquet works. So now we can start developing some sort of standard because when you make a device like this and then you realize that the only thing that really gave it any clout was some panel that decided that these particular tourniquets were the one we were going to use and then because of mass production built a reputation, even though, you know, the CAT tourniquet, actually, in the field is only something like 55% effective when it's applied. And it's the most well known gold standard tourniquet out there today on the market that people trust the most. But you know, half the time you're going to put that on, it's going to fail. So you, Glia dives into, like, why does it fail? What is the test being done on that? Is it actually the education of the user? Does the user know how to apply the tourniquet? You know, we don't we don't just stop at, "Oh, here's the device now for the market. You can buy it. Do what you will with it," you know, like all those other checkboxes are applicable.
Inmn 43:47 Yeah. Yeah. Is like...I guess, because...Is the CAT VII, is that the tourniquet that like the military uses, or do they?
Korin 43:58 I think this is maybe a good time to explain what COTCCC is if that?
Korin 44:03 Yeah, okay, there is this panel called COTCC, Committee on Tactical Combat Casualty Care. It's a military panel. And I'm actually gonna quote from their website, it says, "The Committee on Tactical Combat Casualty Care is the pre hospital arm of the joint trauma system for the Department of Defense." So what it is, is it's about 40 something folks who are various types of medical professionals, or some doctors, surgeons, nurses, combat medics, special operations medics, things like that. And these folks, at some point, some years ago--I don't have the exact article here in front of me--they evaluated some number of tourniquets, and they said, "Okay, here's, based on what we've been using in combat, and based on our examination of them, we recommend the following tourniquets," and they had the Combat Application Tourniquet generations Six and Seven by North American Rescue, that's the CAT by NAR. There was also the SOF-T-Wide by TacMed Solutions. And there was a third one that's a pneumatic tourniquet that we don't need to talk about. And so for the longest time, just those two tourniquets were the only ones that this this panel said you should buy. Now, that makes plenty of sense. They're a military panel. They are interested in serving the military. They're interested in military procurement systems. So, they want to go to a company who can produce an enormous quantity of them and certify that they are good and will work and supply them in bulk. That's what they're interested in. They are not so much interested in civilian applications. That's not their concern because they serve the Department of Defense, right? So, that's their concern. That's why they had only those, like those three tourniquets because that's all they needed. Now, more recently, they released another journal article in which they--which when I say more recently, I mean, it's still several years ago at this point--where they expanded that list of recommended tourniquets substantially. But they don't evaluate every single tourniquet on the market. A lot of their recommendations are based on combat experience. So, if the tourniquet hasn't seen combat, they're not necessarily going to recommend it. And there's no other things like that. At the end of the day, they are still a military panel interested in making decisions for and about the military.
Inmn 44:03 Oh, yeah.
Inmn 46:37 Yeah, yeah. So Glia is kind of offering like a much better alternative for civilian use tourniquets than currently exists?
Korin 46:49 Yeah. And that's actually one of the design criteria in the Glia tourniquet was that it works better on children. From the experience of folks, medical professionals in Gaza, they found that the CAT tourniquet didn't necessarily work as well on people who had very small limbs. So young children in general. One of the design criteria that then came out of that was that it works better on children. So some of the design decisions on the Glia tourniquet, particularly the separation of the backplate and the clip, came as a result of wanting to make the tourniquet work better for children.
Inmn 47:29 Can I ask you all a kind of, I guess, maybe a little bit funny, like kind of a theoretical question?
Carrie 47:35 Course.
Inmn 47:36 Cool. Or just some things that are going through my head when I think about, like Glia's project and open source pharmaceuticals and open source medical equipment in general is that if we start seeing more parts of society, kind of like collapse or breakdown or like infrastructure breakdown more, is this open source medical equipment something that is going to be useful for people like in, I don't know, in 10 years--God, I hope it's more than 10 years--when the North American governments collapse and we're in some kind of hellish civil war and people are like, "Oh, medical...like the military has stuff. And that's it."
Carrie 48:27 Yeah, I mean, I think the nice thing about the model that Glia is developing is that it's really adaptable by many different types of scenarios. So it's as relevant for what you've just said, and what you're just talking about now, as it is for some refined medical school somewhere in the world where they just want to do some good, and they want to lower costs, and they want to build their own medical devices and send them out to all their students for the incoming class that year. You know, we can set a lab up here in London, Ontario at our medical school that exists here and have those students build their own medical devices and have proper--as long as they have proper compliance. I'm not going to stop saying that--as long as they have proper compliance, then they can build their own devices. And the thing that's beneficial about that is that then you get up-and-coming medical practitioners thinking about their medical devices in a different way than they currently do today. They can make...they can see that they can customize, make modifications, be innovative, have a say, so they do not get into vendor lock-in with any of the products that they purchase. So I think that's one applicable scenario. And then you can go to some war-torn country, someplace that's desolate, and all they need is solar energy--which by the way, our Gaza office completely powers all of their printers with solar energy--and you can use a solar power energy in the middle of the desert and if you just are able to tent in that unit and get proper humidity under control then you can start building your own medical devices wherever you need them. And I mean, we're talking about stethoscopes, tourniquets, otoscopes...Glia also has a pulse oximeter coming down the road. We have a portable electrocardiogram that's coming out very soon. It's just entering clinical trials this summer. So there's lots of different types of devices that could be in these scenarios that you may need, like in something that's somewhat remote. And so it doesn't matter how remote the community or how vast and vibrant the community is, these devices can be used anywhere, and the process is applicable in all of the communities. Like really we should be making all our devices like this everywhere. Like why are we transporting shit halfway across the world anymore? It makes no sense. It makes no sense.
Inmn 51:19 No, no, it truly does not.
Korin 51:20 You asked in the context of societal collapse and there's a lot of areas even today where we can see that, for example, the wildfire smoke that's blanketing areas of Canada and even in the US. And I know that Margaret Killjoy, along with Robert Evans over at It Could Happen Here talked a bit about this and building Corsi-Rosenthal boxes, which are basically air filters made out of box fans and furnace filters. And so those boxes are a very good example of devices medically--we can call them medical supplies--that people right now may want to come together and make. Those are also a particular kind of device that lends itself to this kind of ad hoc, in the moment, production, where if everyone doesn't stick around and everyone kind of breaks off and goes and does their own thing later, that's completely fine. There's some medical devices, which are a little bit more critical, that have to be approached with a little bit more intention. But there's a number of things all across the spectrum that you could do right now, to things that maybe you should only do in an emergency, to things that we should start building the infrastructure for now so that we can use that later.
Inmn 51:22 Yeah, yeah. And y'all have talked a lot about this, about compliance. And, I guess I'm just wondering, if you could explain for listeners, like what is involved in compliance? Like is it like testing it, the device, to make sure that it works? To make sure it works properly? Like, what goes on for compliance?
Carrie 53:01 So proper compliance. Yes, we've mentioned it a whole bunch of times. It's very important. What that looks like in Canada is four different class levels. And it depends on what types of devices you're manufacturing as to which type of class level you fall into. So currently, Glia is only manufacturing devices that fall into class one. It's a fairly simple license for class one and it's very similar with the FDA, their class, one license looks a lot alike. It's a little bit more expensive to get a class one license from the FDA than it is in Canada. It's actually about double the price. But if you're selling multiple devices, or you have some pool of money to draw on from to get this. Usually these licenses last for a year, so you have lots of time to set up a manufacturer, learn what you need to do. The process is fairly straightforward. You often tend to learn things in North America after the fact. So you know, we set up our license, we got our approval, Health Canada said, "We trust you," and then they came knocking on our door and said, "Hey, by the way, we have an audit for you." And that's very common, you know, and especially for people that are doing stuff in their home basement labs, which at the time, that's what we're doing. So, you know, the point being that it's fairly straightforward. The most important thing to remember about compliance is that it's for the patient's safety. And you have to make sure that if for some reason there's a problem with what you've created, that you can issue a recall. And so, you know, recalls aren't just, "Oh, somebody was poisoned because they ate this bad bag of kale." It's also with medical devices. If there's a problem in that manufacturing process, we may distinguish that there's an issue and we need to take back those devices and inspect them. And it's important that you have a process to do that as swiftly as possible. So you know, sometimes depending on how dangerous the situation could be, you may have to initiate a recall within 48 hours of discovering the problem, and trying to retrieve those devices very quickly. So, it's about knowing those processes really well and protecting the patients, they're health and safety and life.
Korin 55:28 And kind of going back to a little bit about what I said about there are some things where we might want to stand up the infrastructure now so we can use it later. If we're talking about a situation in which we think the government is going to break down or not function at all, some kind of collapse or a civil war or what have you, the FDA may not exist. And so in that case, if I'm making tourniquets, for example, then how do you know that these are actually well made and that they're going to work? And so having proper quality assurance processes in place is extremely important. And that's something you don't need a license to develop, I'm not recommending you go make these devices and distribute them without one. But when it comes to other things, you could do a trial run with Corsi-Rosenthal boxes and try and serialize every single one and send them out if you wanted. And that gives you some practice with with doing this because it is, as Carrie mentioned, extraordinarily important. You determine later, "Oh, oops, we sewed these tourniquets together with the wrong thread. Oh, we used the wrong plastic." I've seen these things happen in commercial environments, for not medical devices but for other things. That is absolutely critical that you have this relationship established with everybody that you might be giving these tourniquets to, or passing them along to, that you can contact them and they know you and you know them. And we're not just making a bunch of medical supplies, dumping them into a community and then disappearing and then hoping that no one gets hurt because that's just reckless.
Carrie 57:13 Yeah, absolutely. And the other thing is, is people shouldn't be afraid of proper compliance. You know, it's not something to run from. Like any system, and especially as large as some of these systems we're talking about in terms of where to obtain proper compliance from, they're all going to have their pros and cons. But at the end of the day, this really is about making sure that companies are doing things in a safe manner. What I see a lot is that there's a lot of engineers out there that want to engineer things, right. So they want to build stuff. People love building. People love designing. People love adding their little flair to whatever it is they're doing. They want to contribute in that way. And then when it comes time for the paperwork, they get super bored. And so that's why they don't pursue these things. But, I can tell you from experience, I came into this job, I knew nothing about compliance, and I am now probably the expert on compliance in our group. And I had to figure it all out just on my own while doing a whole bunch of other things for the project at the same time. So, it's not impossible to figure out these systems. But also in addition, remember, I spoke earlier about how Glia doesn't just put the device code out there and say, "Here's the device world do what you will with it." We do the whole package. So you may not find all of our compliance records on our GitHub right this minute, it may not be there today, but it is our intention to make those things public so that people don't have to have that uphill struggle and figuring out how to do these systems because that's part of the issue, right, is that these systems are made to be somewhat convoluted and difficult to discern. And if you have a bit of an example of somebody else that did this for a tourniquet, and you want to go out and build some other type of device and innovate that and then get the compliance so you're doing it, you can come to Glia and say, "Oh, how did they do it with this device? Oh, this is what they did. Here's the roadmap for doing that. Okay, now I just have to put in my company name, copy these systems exactly. And off we go. I'm doing everything safe," you know, and they're not going to give you a license unless they think you're doing it safe. So you have that back to follow on. But why do you have to start from square one even with compliance? It's not just about building and innovating the device, it's the whole entire system that comes along with getting those devices from materials to actually treating patients.
Inmn 59:50 Yeah, yeah. It's almost like y'all trying to build like a large community of people who are invested in each other's well being regardless of profit or something, which is really cool.
Carrie 1:00:05 Yeah. And in terms of the societal breakdown scenario too and having compliance not really exist in that moment in the way that we see it today, I mean, that's already happening in the world, right? Like a lot of really amazing places and countries don't have these governing systems. And they have to go and borrow the roadmaps for that type of compliance from somewhere else. But there's likely no one in their own countries even governing that. So then, so then what are they doing? Are they being safe? Are they not being safe? You know, so making these processes as clear and transparent and accessible as possible makes sense because at the end of the day, we want to save people not kill people, right? Like, that's the plan here. Yeah.
Inmn 1:00:57 Yeah. And I'm just going to retrospectively change the question that I asked, which is, yeah, what do we do when the compliance for these organizations don't exist or are not accessible? And I'm gonna pretend I asked y'all that and that we just got those lovely answers. Cool. Well, that about brings us to time. Is there anything else that y'all would like to say before we wrap things that we didn't talk about?
Carrie 1:01:32 Well, I'm pretty sure I want to mention a call to action. So often when we meet people and people come to Glia...So Glia., first of all, I probably didn't explain this earlier on, but Glia has a very small staff. But in my time, in the last six years of being in this position, I've seen about 300 volunteers from all over the world get involved in many different ways. And our volunteers are really what fuels our company and what pushes things forward. Korin is a perfect example of somebody who comes in and becomes quite dedicated to the work that we're doing. And often, when we're talking to volunteers or people that are interested in Glia, they want to know how they can get involved and what they can do. So if you don't mind then I'm just gonna share those points.
Inmn 1:02:30 Please. Plug. Plug the things.
Carrie 1:02:31 Yes, yes, we have to plug Glia. That's something I can't go through this whole interview without.
Inmn 1:02:39 Yeah, the end is always for plugs.
Carrie 1:02:41 That's right. So of course, visit our website at Glia.org You're gonna find out about all of the projects that we're working on, and it doesn't stop with device work. We do education in 3D printing, we do other things, we'll come and we'll do a seminar for you, we'll talk to people about any of the topics that we cover. Of course, this project cannot run without funding, which is always kind of the thing that hurts me the most to have to say, but cash is king. And if you are willing to make a donation, you can do that through our website at Glia.org
Inmn 1:03:20 Especially if you have $5 million to give them so that there can be dialysis machines.
Carrie 1:03:23 Yes, absolutely. If you have access to $5 million, I promise you, we will make it work and really Glia is the most frugal project I've ever seen, you know. People are really good at wasting lots of money. We are very good at having the lowest budgets possible and making the most happen. So I mean, please trust me, I will make all of your dollars go as far as I possibly can stretch them. We always do that. We want to see our work continue into the future.
Inmn 1:03:54 Cool. And are there ways for folks to get involved with? Like, I don't know, like, if they have, if there's listeners who are in places where people might have a hard time accessing medical supplies and they have 3D printers, is there other ways for those people to connect to y'all?
1:04:17 Yeah, we have a GitHub page. That's GliaX on GitHub. But all of that can be found through the website as well. So, glia.org, click on the products that you're interested in, and you will find the links to take you to all the information to get all of the roadmaps to be building these things yourself. And certainly if you cannot find those answers there, just reach out to us. We'll help you along the way for sure.
1:04:43 I also want to mention OpenSourceMedicalSupplies.org, all one word, all spelled out, opensourcemedicalsupplies.org. There's a number of plans and a lot of information about, as you would expect, open source medical supplies there. So that that may be helpful.
Carrie 1:05:00 Yeah, absolutely.
Inmn 1:05:03 Wonderful. Well, thanks you all so much for coming on today. And someone out there, please give them $5 million. Please.
Carrie 1:05:14 Thanks so much for having us. Thank you.
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