🔒 Red tape is preventing local company from churning out ventilators – Iain Ambler

The search for ventilators that have become such a scarce commodity during the coronavirus pandemic, as they are critically important for patients who land in intensive care units with breathing problems, has been described as ‘a hunt for a dodo’. Anaesthetists in South Africa have recently been informed that their ventilators may be needed when Covid-19 reaches a peak so there is clearly a shortage in South Africa as well. It has prompted a mechatronic company, Clifford Welding who have made ventilators in the past but stopped production because they refused to pay bribes to corrupt officials, to improve their initial design and software, and come up with an updated version of their original product. But despite help from ANC officials and the Industrial Development Corporation; they have run into red tape with delays at Customs at OR Tambo Airport and say there does not seem to be a rush from state departments to order units. The Managing Director of Clifford Welding, Iain Ambler told Alec Hogg they have had interest from overseas, but not much locally. – Linda van Tilburg

During the Easter weekend I had a conversation with Iain Ambler – who is the co-owner of a company called Clifford Engineering – and it was a fascinating interview. It went pretty viral. Many people were interested in it – not least – because to get a respirator nowadays, it’s like – in the Business for South Africa press conference that I attended a couple of weeks ago – Stavros Nicolaou from Aspen said it was like trying to hunt a dodo – they are so rare. And with Iain’s company – with Clifford Engineering – they actually produced one (many of them are still in use) but they stopped producing them in 2003 because of corruption. Of course, with what’s happening now – Iain’s dusting off the blueprints, he said he was prepared to give those blueprints to anybody else, they would like to start producing them again. I thought it would be a good idea to bring him on to the show today and you guys can also ping a few questions at him just to find out how things have developed. Iain, I hope you can hear us now. Can you just bring us up to date with what the response has been to the interview that we had?

Sure, Alec. The response was remarkable actually; we’ve had an incredible amount of assistance and goodwill, we’ve had assistance from companies like Rapid 3D (who have printed 3D printed parts for us overnight and in incredibly short time frames), other companies we work with around here – Cosmos Engineering – have made parts for us and refused to let us invoice for them. They’ve literally made them for nothing. It’s been an incredibly collaborative effort and it’s been very gratifying to see – it kind of restores your faith in human nature. What was interesting – our biggest delay (believe it or not) ended up being the parts stuck in customs in Johannesburg at OR Tambo and we lost a whole week on that – which was a tragedy. But it was impressive to see how people helped us. We had ANC politicians rolling up their sleeves to help us. We had Nigel Ward (the Vice President of Toyota South Africa) assisting us himself and he really got stuff out of customs for us in record time together with a company he uses for all their own clearing. So, it’s been extremely humbling actually and gratifying to see how everyone has rolled up their sleeves to assist us and we got our updated ventilator model running on Saturday afternoon and it’s working beautifully. If the line is clear – you may hear it breathing behind me in the background, but it’s running very nicely. We are incredibly happy that it’s up and running – we thought we would be late. We could have been done a week earlier if it wasn’t for the customs delays, but the bottom line is it’s up and running, working, and doing what it’s supposed to do. We’re very pleased with it.

Now the critical part about that is whether the machine will actually work on sick people. I did pose (again at that press conference – I actually asked one of Gigi’s questions and one of your questions) and the question there was – there was a lot of interest in the respirator but it was also made that it has to be technically correct – you can’t just put any bellows into someone’s lungs and expect that they’re going to be able to be respirated. Just take us through the, not the technicals of it, but the development of it which makes you confident that this is a solution. Oh and we can hear it in the background by the way.

Okay, good. Obviously it’s a machine that is connected to a human being – you’ve got to use the best possible components. We don’t just use normal pneumatic valves or pressure transducers or anything like that. We buy medical rated components – so they are completely clean, there’s no pneumatic grease inside them or anything like that, their air has to be completely filtered and cleaned, the solenoid valves that we use (you need to make sure that they cannot create) – there’s no possibility of a spark because oxygen is highly combustible and it can explode pure oxygen.So, we obviously take care of all of those details, but if we hadn’t built these things before and supplied them to hospitals and worked with various doctors, hospitals and anaesthetists – we wouldn’t have a chance to do this as quickly as we are. But the fact of the matter is we did this for many years – that gave us a big headstart. We know what components to use, we know how to do the control, we have not changed the design – it’s the same proven design. All we did was update the components and, particularly, the electronic components so that there are present day components that you can buy off the shelf. 

Last we spoke, you were having problems actually getting through to the right people at the Department of Trade and Industry and the IDC – any progress there?

Yes. The IDC has been very helpful and we appreciate that. There’s a lot of people there rolling up their sleeves and working extremely hard and I really do respect that. We had the CEO of the IDC call us personally and send us an e-mail or two and a number of his staff assisting us. So, we appreciate that very much. The IDC (and I’m talking unofficially here) – it looks like they will move forward with a simpler design than ours. It’s basically what we call a CPAP ventilator – CPAP standing for continuous positive airway pressure. Without going into too much detail – ours will do the same function but ours has additional functions which enable it to be used as an ICU ventilator – an intensive care unit ventilator. So ,it will do the simple functions but it will do a lot more. But – and this is where the big but comes in – it’s not a complicated device. Most ICU ventilators are not simple to use – not at all. Our one we developed 20 odd years ago was specifically developed to be a full ICU ventilator which is built for African conditions and made to be very simple to use – and it really is very simple to use. So, it will cover the CPAP functions – that’s the absolute minimum – but it will cover a lot more than that. Now, in my opinion, I understand why the IDC appears to be concentrating on a much simpler CPAP type unit. It does reduce the complexity and I think they’re sort of trying to follow the 80/20 principle where they’re covering the 80-70% need rather than the 100% need. But I do believe that there is a definite requirement for slightly more detailed ventilators – and I use the word detailed as opposed to complicated. Ours can be used not just as a constant pressure device (or CPAP device) but as an active breathing device that will assist the patient with each intake of breath and it will be automatically timed – it is automatically timed – to work with his breathing. In other words, his breathing triggers the assistance that the machine provides – it doesn’t just force him to take a certain number of breaths per minute (which could actually do more harm than good in a Covid-19 patient).

A mechanical ventilator sits by a bed at the Aga Khan University Hospital in Nairobi, Kenya, on Thursday, April 9, 2020. Kenyan President Uhuru Kenyatta banned all road, rail and air travel in and out of the capital, Nairobi, and three other regions at the coast that are the epicenter of the Covid-19 outbreak in the nation. Photographer: Patrick Meinhardt/Bloomberg

So what’s next Iain – how many of these ventilators are you going to be able to produce for the country?

You asked me that in our last interview and I said it’s a chicken and egg question – and it really is. We understand that if there’s an enormous demand we can’t possibly produce enough at the moment. We’re not being asked to produce any directly for South Africa at all – in fact, most of the interest (we’ve had enormous interest) – most of it from being from outside our borders, strangely enough. But how many we can produce really depends on how many we get orders for. We’re a company that works with a large number of subcontractors and suppliers that we’ve been using for many years and we will continue to use those. We’ve been talking with many local companies who have contacted us to assist with making additional components where we can’t keep up with our own supply chain. We’ve had people like Nigel Ward phoning up and saying that he’s completely ready to assist us with whatever we need to ramp this thing up and go into serious production volumes. Toyota understands that kind of thing better than we do and we would certainly take full advantage of a kind offer like that. 

But Iain – here we have people saying that respirators are rarer than dodos and you’re saying you’d like to make them… where’s the gap? Where’s the disconnect?

The disconnect is that we haven’t had anyone yet (from the South African government or Department of Trade and Industry or IDC or anyone like that) say, ‘we want you to make 500 of these or 5000 of these’ (or anything like that). That really is the disconnect. They are going through a process and we are waiting to hear what comes of it. We made the decision three weeks ago that we weren’t going to wait for any more response or come back. We’ve still heard nothing official – so I’m glad we didn’t wait. We decided to go ahead and (in the last three weeks) we’ve used that time to make our first working unit and it’s working really nicely. But the bottom line is we’ve done that off our own backs. We made that decision on our own and we got on with it on our own and we haven’t had any financial assistance thus far – which is a pity. But, as I said last time – we’re seeing this project we’re engaged in as a double edged sword. There’s the altruistic side of it – where we obviously want to do the right thing for our country and our people and build ventilators (there’s a desperate need for them). And the other side of it is from a more typical business decision – we need to keep our company moving and we need to be able to pay our employees so they can put food on the table and we are chasing all available options right now. Would we prefer to make them for South Africa rather than overseas? Yes, we would.

If you got an order today from the state for 500 – how long would it take you to produce them?

If we got an order today for 500, I think we could make them easily within a month, if – and this is the big if – we need a hotline or a speed dial number to someone in government or in SARS or the IDC (or whatever) who can get us things through customs – we cannot sit waiting for things to clear in customs for a week. Our most critical components were items that hit customs on Tuesday (the week before last) and we only got them out on Tuesday last week after the Easter weekend. I understand that it was particularly problematic during the lockdown and the Easter weekend – but those are the things that kill us If we can have assistance with that kind of thing, it will make an enormous difference to how fast we can make these things.

We’ve seen that in many areas – mountains have been moved by government in this Covid-19 crisis. You would think that if respirators are such a desperately required piece of equipment (they’re looking all over the world to try and source them) – you’ve got a homegrown solution that can produce hundreds within a month… 

That they’d open it up. In fact, I hope Iain’s still listening because I heard a fascinating interview this morning with Phillips – their results came out which were very good (and they were talking about respirators and there’s a lot of sophistication as well, I would assume, that they’re at the top end, because they were talking about the complications of the software which obviously monitors the way you’re breathing and so on). And the CEO was talking about how they’re working three shifts a day, 24 hours a day, seven days a week – to get what he called ‘precision diagnostic equipment’ through to the users. The question I want to ask Iain is, ‘What does a respirator cost (of his making)? What are we talking about in terms of cost and also how do they compare to someone like Philips?’, and I’m not questioning the quality – just simply trying to gauge where we are in the global market.

The cost is a difficult one to answer because it depends on how much sophistication you want in the unit. If you want a really simple CPAP only unit that’s a big difference in price. Ours will do that and it will also do all the ICU functionality but my opinion is we should build these things all the same – with all of their functionality, because our unit is particularly simple. In terms of pricing, we have not got that 100 percent battened down yet, because we are still looking at the cost of some of the components and transport etcetera. And also, we have used slightly more expensive components in the thing. For example; the PLC (the programmable logic controller) is a Siemens unit. It’s made in Germany, it comes from Germany – but they’re incredibly reliable and that’s what we put our software into. There are cheaper ways of doing it – but that unit is completely reliable, it’s completely proven, there’s hundreds of them available off the shelf. And you could argue that it’s an overkill for what it is doing, but under the current circumstances – where delivery is critical – it’s a no brainer to use an item like this. So the cost of ours compared with the Philips ICU ventilator; it’s enormously cheaper. In rough numbers, depending on the spec of the machine, it’s going to be somewhere around 8000 dollars or something like that.

GG (Alcock), from your perspective – do you have any thoughts for Iain?

My feeling is that – to a large extent (and this is my frustration with government around the informal sector among other things) the ability to move is just so slow, hence the lack of orders – and I think this is the tragedy; that when you have got an epidemic like we have now, you need agility and speed of movement and in some ways – drop a lot of the bureaucratic barriers and, tragically, this is not happening.

It’s interesting that in certain areas it is happening. There are certain things that have been going through very rapidly but in a case like this, as you’ve mentioned, not so easy. I guess, Iain, you’ve got to start moving mountains yourself somehow? 

Yes. And we’re doing that. We’re moving ahead as best we can and we have a number of other interested parties who we’re talking to – which is not quite the way we expected it to go – but obviously, we’re a business. We’ve got to make business decisions for the best of ourselves and our employees and their families. But just to highlight – to pick up on something GG Alcock said there. He mentioned small companies’ speed and agility and I want to pick up on that. I said the same thing in my interview to you two weeks ago – that I thought there’s an irony here that a company like ours gets overlooked because we are small, but in a situation like this – we’ve shown that in three weeks we’ve built a working ventilator. We’ve got the drawings done, it’s all modelled, it’s completely done, we’ve got a complete bill of materials – and it is working. It is physically running, it’s operating, it’s pumping mechanical lungs up and down. And tomorrow we’ll test it further with the doctors. So, in three weeks we’ve done that. And in fact, we could have done it in two weeks – because we lost a full seven days with the most critical components sitting in customs. That’s where I think that if you use a small agile company and you put them together with the might of the DTI and IDC and those guys assist us with the logistics (like getting stuff through customs and all the rest of it and assisting with buying power et cetera) – it’s amazing what can be achieved. I’m not pretending that our business is particularly unique or it’s a one in a million or anything like that. We were very fortunate, in that we have made these things before. So let’s take advantage of that. To me it makes perfect sense and, as I said many times, we are completely happy to work as collaboratively as possible. We really are.

Iain Ambler from the Pietermaritzburg company Clifford Engineering.

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