The following post is part of our series, Technology and Innovation for Maternal and Newborn Health. Join the global conversation as we explore the potential for delivering innovative technologies to save the lives of newborns around the world.
My first daughter, Eva, was born three months early, at 920 grams. She seemed unbelievably tiny to us, smaller than the Burrito Especial you can order for lunch in our native San Francisco.
Being groovy parents, my wife and I were planning a home birth with quiet music, a midwife, and perhaps some non-allergenic incense smoking gently on the mantle. It was not to be, but we did get to do something equally wonderful.
After our daughter’s sudden birth, three months early, our midwife told us about Kangaroo Care, which we had never heard of before. So my wife and I spent 10 hours a day in the hospital, holding our precious baby five hours a day each. It was a special time, and I believe that she did better as a result, and is now a successful college student. But it was the access to technology and knowledgeable staff, as well as our commitment to Kangaroo mother and father care what saved her life. Eva was on the neonatal intensive care unit, with endless machines and all the great doctors and nurses you could want. Our daughter would have died soon after birth in the absence of at least basic technology and skilled staff. And what was true for us in San Francisco 18 years ago is true now in the poorest countries in the world.
Tragically, this is still the reality for far too many of the millions of premature babies born every year, with nearly all of these deaths taking place in the poor countries of Asia and Africa. Many preterm survivors suffer avoidable life-long morbidities due to lung damage, severe jaundice and other pathologies of prematurity, because of lack of evidence based care and essential technology.
Success in reducing the leading causes of child mortality has been fantastic over the past 10 or 15 years; deaths from diarrhea, malaria, pneumonia and infectious diseases are dropping at last, in some cases rapidly. For babies, however, the progress has not been as good. Neonatal mortality has remained stubbornly high, and now makes up the largest cause of child mortality in most countries, both middle-income and low-income and is the majority in high income countries.
This should come as no surprise to anyone paying attention to the data, or to what Dr. Joy Lawn has been saying and writing for years. However, in my opinion, what is not fully understood or acknowledged is what I came to learn through painful personal experience two decades ago. If we want to make real progress in reducing child mortality we have to focus on neonatal mortality, and if we want to save more babies we have to deal with the fact that a critical part of the solution is the necessary technology in the hands of skilled nurses and frontline workers. Saving more newborn lives now will require the development of facility-based neonatal intensive care technologies that can be delivered to millions of families around the world.
This does not mean that every town in rural India and Africa has to have a Neonatal Intensive Care Unit (NICU) stuffed full of modern pieces of equipment that each cost more than a new car. But it does mean that every family should have access to a facility that offers the basics – good infection control, injection antibiotics, resuscitation, a KMC unit, phototherapy, and bubble CPAP for treating respiratory distress.
Thanks to the work of many innovators, businesses and non-profit organizations, we now have the ability to provide even small towns with a basic NICU. My own organization, the East Meets West Foundation, has created over 260 NICUs in five countries in Asia, and we are just getting started. However, this equipment cannot be the same as that used in the San Francisco hospital where my daughter Eva was born, and most hospitals in low-income countries lack the resources to purchase and maintain modern NICU medical equipment.
What we do need – and is now available – is equipment that is affordable, extremely durable, with no or very few consumable parts, specifically engineered for hot, humid climates and that functions well in places with fluctuating electricity and with poor capacity to do basic maintenance. This can now be done, at a very reasonable cost. In fact, in most cases, East Meets West can set up a complete NICU, including three years of intensive after-delivery support, for under $50,000.
Mom feeds baby while he get phototherapy from new EMW Firefly high-intensity bililight (Vietnam)
Most medical equipment delivered or sold to low-resource medical clinics in the developing world is either never used, or breaks down very quickly. There needs to be a comprehensive solution provided that addresses issues of staff capacity, long-term viability, robust after-sales service, and so on. The moment the equipment arrives at the hospital or clinic is the moment the intensive work starts, not finishes.