Transcript of a talk given by Marc Koska at DLD10 about the transmission of disease through unsafe injections - and the solution to this problem that he invented:
Steffi: Marc Koska, Marc has a special thing; he is devoted to the humanitarian cause for 20 years. He invented of an AD syringe called K1 - physically prevents re-use, but you tell it better.
Marc: Thank you Steffi. Well I’d really like to thank Steffi and her team for the warm welcome and secondly just to fulfill a promise, to mention Gabriella from HP because I did say that I would do that.
I promise, I make you one promise also before I start that this will be the lowest tech presentation that you see today. Everything else has just been in another level compared to where I operate. So here we go.
My subject is the re-use of syringes. The re-use of syringes kills 1.3 million people by transmitting viruses from one patient to another. It actually results in also 23 million cases of Hepatitis B and you can imagine the cost of treating that on a global scale, and that’s a cumulative number; 23 million cases every single year. Syringes on average are used around 4 times in the developing world and it's just unacceptable, so I decided to do something about it. In fact it kills more people than malaria, which currently kills about 1 million a year.
These three children that I met in an orphanage in Delhi sadly all had HIV and two of them have passed away now. They had HIV because they went and got an injection from a doctor that their parents had taken them to and were supervising. But what was the saddest thing is that all three of these were actually orphaned straight afterwards. Their parents gave them away once they became HIV positive, which is a double tragedy.
Re-use is a problem and this scum bag doctor here in India admitted to me that he had actually re-used this syringe 25 times in one day. This footage here shows you some undercover film that we took in a hospital (again in India) where 40 medicines were delivered; you can see them on the tray in the top corner, and 40 medicines were delivered with two syringes only, to the whole floor of that hospital. And in a minute, you’ll see a nurse return (here she comes) back to the tray, which is their station and drop back the syringe, ready to be used on this next patient. And this is happening on an hourly, minute-by-minute basis across India.
These needles are wet and they're ready to be used again. They are not wet in Europe, they are only wet in the developing world because they’ve been washed downstairs and then bought back up. Patients are often given the choice to pick a needle.
Outside hospitals, we find baths created actually to wash the syringes on a wholesale basis. This is the number of barrels and plungers that were in that bath. If you look closely you can see what’s inside them. This lady was burnt in a dowry burning in Pakistan, and when I talked to her, I asked her why she was back because all her burns were all healed, but still with bad disfigurement. She said she was in the hospital to be treated for Hepatitis B. I asked her where she had contracted it, and ironically (she didn’t see the irony), she contracted it in that very room that we were standing in, taking that photograph. Ten years earlier, being treated for the burns and it was something that has just plagued her life.
This syringe maybe is the world record holder. The ink has come off the barrel and that means that it must have been used over a 100 times. There’s recycling and this is a 6 year-old girl, early in the morning in Islamabad, leaving (in Erdu this says health centre), leaving a health centre with a bag from yesterday's work; there’s blood bags, there’s scalpels, there’s syringes and needles in there, and she’s taking them off to be recycled.
There’s a growing market for plastic. Not necessarily for re-use, but also for washing and recycling back into the market. And while they’re doing this, these kids, they bash into each other and they prick themselves. And I took this photograph and I was so utterly ashamed when one boy poked the other boy with a needle and his hand started bleeding and I felt absolutely devastated that I had caused that by being the white man taking the photograph. He said “no, no don’t worry, it happens 5 times a day.” (which it did).
In China, wholesale recycling again and then re-sorting to be sold and actually, just quickly back to Pakistan - this is the boy’s father who was showing me a syringe, and while he was digging it out of the pile of rubbish on the floor he pricked the end of his finger. And very interestingly, he whipped out a box of matches, lit one match and burnt the bead of blood that was on the end of his finger, and assured me that that was absolutely safe now and there was no way that he could be infected with HIV. So you can see the misinformation coming into this scene.
And then there’s misuse. Kids are sold syringes, sadly used syringes, on toy stalls in school, and they use them for water pistols. But what you don’t see is that afterwards, because it’s hot, they use these water pistols to squirt into their mouth and they drink the water, and afterwards you can see that the one that’s closest to you is blood stained, there’s all sorts of rubbish in the other one. So it’s just a bizarre, terrible act that is being perpetrated.
Anyway I followed this route through and we got in a car with the toy seller in it. He took us to where he bought his syringes wholesale, and we found these kids turning these syringes over in the sun to dry them, so that they could be ready for sale as toys. They were unprotected; they had to actually remove all the needles before they prepared them. And here you can see them in the display - there’s tanks and cap pistols and all sort or normal plastic toys and then some bunches of syringes.
So the solution is that we need a safer product. Well I came across this problem 25 years ago. I was a young guy. I was actually looking for a problem like this. It was something that had fascinated me for a long time, the intervention in large diseases, and then when I read a newspaper article which said that one day syringes would be a major cause, I knew instantly that that was what I wanted to do.
So I researched the problem including the new innovations that were out there. But I researched the problem from A to Z. I looked at how plastic was refined, how it was molded into syringes, how they were stored, how they were marketed, how they were distributed. And then what happened to them during and after use, and who regulated these. So I studied this for two and a half years and then was able to come up with the design, which I’m just about to show you.
An informed public, obviously that’s what we need, so that they can back off. Funnily enough there’s no way in the areas that I work if I ask a child if they would re-use, or they would use the toothbrush of their neighbour, they jump back in horror. “No way!”, “That’s disgusting!” And yet they’re subject to the medical abuse. And I think that (this is where I spend most of my time), we need to fight for human rights on this subject. It’s not right that a doctor can trick their patient in this way.
The product, it’s very difficult to show you on screen, is a valve that’s molded into the plunger, and then it breaks afterwards, and I think, if I hold this up here, here we go. This is one of my syringes and it works in exactly the same way as a normal syringe. So you do all the complex or simple procedures and you give the injection. Then after use, if someone wants to re-use this, (either accidently or on purpose) and they try and re-use it, it locks and breaks. And this valve is molded into the plunger during the manufacturing process. It’s very, very easy to make this modification; it’s very cheap and my vision is that every single syringe factory in the world should make this, or something like it and then we can end this situation.
Just a personal photograph. This was the first syringe I ever saw used of my design in Cambodia in 2001 and if you remember, I started the journey 25 years ago in 1984 and it took me 17 and a half years to actually sell the first product, which I sold to UNICEF. And then this was part of a UNICEF program, which I was able to witness, and I cried. It was a lovely moment.
They’re made on existing machinery as I mentioned, not that this is going to make, unless your in injection molding, this is a typical nest for making barrels and that’s exactly the same one that we use so we don’t make any major changes. Our product comes out at about 5 cents, depends on different territories, different volumes but that’s the average price, and that’s actually the average price for a normal syringe. So we aim to match the price exactly. You can’t really make a product like this any cheaper. If we could, we would, I promise you.
But just to put it into perspective, it’s one tenth the price of a soft drink. And believe you me, Coca Cola are in Tanzania, they’re in Cambodia, they’re in India for the indigenous population. They’re not there for the tourist trade. So everyone can afford Coca Cola, therefore everyone can afford a safe injection, it’s just they don’t know they have to.
I wanted to, sort of, take you into one particular area that I focused on last year. I was donated a lot of money from a European donor who allowed me to run a dream. And the dream was to go and run a programme in India. The minister there had always refused to see me. And over the last four years, he had point blank just not answered any communication. And yet during that time they had published the study that 62% of all injections given in India were unsafe. So I had to find a new way of, sort of, tackling that and what better than the largest democratic population in the world. What I was able to do was do 11 trips to India doing research and I was able to talk to lots and lots and lots of public, school children and come up with a message that they all agreed was the reduction of the problem and therefore that they could understand it and everyone could understand it - that was simply that a syringe should come in a sealed packet, and you should see it opened in front of you, after use, it should be broken, (it doesn’t have to be one of mine) - you can snap the plunger on any product. And that thirdly, it had to go into a safety box.
Now obviously, you can’t enforce safety boxes in every country, but it’s the goal. We were very kindly joined in our program by this lady, Kiran Bedi. She’s probably the most well known lady in India. Her voice is very well known, as well as her face and she joined us on this campaign and it resulted in a large scale, 5-day blitz across India. We were able to hold 14 press conferences, we were in 240 newspapers, we bought the media with the money that was donated to 10,500 radio announcements and 5,000 TV announcements and this was, maybe, the largest public health campaign in the world, because in 5 days, we were able to inform 700 million people.
Now the key was, that during this newspaper expose, I got most of the newspapers to run the headline “Minister refuses to meet Syringe Guru”, which of course went straight back to head office and he got really annoyed. A couple of weeks later, I was able to return to Delhi, on my own, privately I went to see him and he gave in and passed a law, which came into effect in April 2009. And now with the adoption of that law, it’s growing daily, we’ve got about 40% now of all public hospitals and clinics across India are using auto disable syringes.
And my final bête noire is the UN. I’m not very well received there, and maybe I just move too fast, or actually do something which hasn’t been researched and written about, so they’re not really my greatest supporters. But never the less, I am now working on UN resolutions in the African union, in the east central and southern African countries, and hopefully one day, in the next couple of years, I would like to have a global resolution for the safety, to protect these people under the banner. Not my banner, or my product, but under the banner that we have developed, which we’ve proposed to the industry - called LifeSaver.
So every syringe gets stamped with this in one colour, and then everyone who uses it knows that it is a quality assurance symbol. 50% of injections are unsafe in the world, as I mentioned. One dollar spent now on safe injections results in a $200 treatment cost, (which is new data) which is just coming out of Tanzania, which is very exciting. Because if we can base this on economy, I think we can move it forward very, very fast.
And just to wrap up, since that 2001, since that first syringe that we sold in Cambodia, we have been able to sell 1.8 billion K1 syringes and that has resulted in about 9 million lives saved - so you can imagine we are very proud.
This is the insanity ladies and gentlemen, and this is what we are trying to stop and I think it comes from safer product, better information and then once we’ve done our job, perhaps the governments will do theirs.
Thank you very much.