Where There Is No LightUsing Solar Energy to Improve Emergency Obstetric
Care in West Africa
Laura Stachel, MD MPH
Bixby Center for Population, Health and SustainabilityUniversity of California, Berkeley
Maternal Mortality
Maternal Mortality
http://www.worldmapper.org/display.php?selected=258
Causes of Maternal Mortality, 2000
AMDD, Columbia; www.pphprevention.org
• Hemorrhage• Infection• Unsafe Abortion• Eclampsia• Obstructed Labor
Federal Republic of Nigeria
Why Nigeria?
11% of the world maternal mortality
>1100 deaths per 100,000 live births
Lifetime risk of dying as high as 1 in 13• Poverty• Early Marriage• High Illiteracy• Low contraceptive use• High Fertility
The Three Delays
Home Transport Hospital
The Three Delays
Home Transport Hospital
RecognitionDecision
The Three Delays
Home Transport Hospital
RecognitionDecision
AvailabilityCostDistance
The Three Delays
Home Transport Hospital
RecognitionDecision
AvailabilityCostDistance
Facility SuppliesStaffingCost
Municipal Hospital, Zaria
Lack of Running Water
Lack of Sanitation
Pharmacy Stock Outs
Medical Records
Operating Theatre
Labor and Delivery
Labor and Delivery
Life-Threatening Delays
Lack of Blood Bank
Inadequate Lighting
Emergency Obstetric Care - Challenges
Facility
Supplies
Staff
Electricity
Light
Communication
Water
Medication
Equipment
Surgical supplies
Staff shortages
Deficient Training
Lack of Protocols
Emergency Obstetric Care – Intervention
Facility
Supplies
Staff
Electricity
Light
Communication
Water
Medication
Equipment
Surgical supplies
Staff shortages
Deficient Training
Lack of Protocols
WE CAREWomen’s Emergency Communication and Reliable Electricity
Solar Electricity to…
….provide reliable lighting….enable mobile communication….power blood bank refrigerator and surgical equipment
Design Principles
Autonomous power Durable, Robust Reliable Simple to Use Easy to Maintain Affordable Scaleable
Operating Room Design
“Solar Suitcase”
Demonstration to Hospital Staff
Phase I
Solar Suitcase charging station for: LED Headlamps for maternity & surgical staff
Walkie-Talkies (short range) for physicians,
midwives, and operating room staff
Impact of LED light Medical Documentation
Before After
Impact of LED lightNursing Care
Before After
Impact of LED lightsSurgical Care
Before After
Testing Two-way Radios
Phase I Outcomes
Improved Communication Immediate Contact Reduced Delays Patient Status Updates Less Referrals Out
Phase I Outcomes Improved
Communication Immediate Contact Reduced Delays Patient Status Updates Less Referrals Out
BUT…. Inadequate Range Battery runs out during shift
Phase I Outcomes
Improved Lighting Increased Visibility Increased Ease of
Procedures Increased Safety
Phase I Outcomes
Improved Lighting Increased Visibility Increased Ease of
Procedures Increased Safety
But…MORE Desired
Phase II
LED headlamps for all night duty staff
Installation of permanent PV system in
maternity ward, delivery room, and OR
Long-range walkie-talkies for all
emergency staff
LED Headlamps
PV Installation
Labor and Delivery Ward
Maternity Ward
Maternity Ward
Operating Room
Operating Room
Solar Powered Suctioning using DC to AC Inverter
Long-distance two-way radiosand solar powered charging
Solar Powered Blood Bank Refrigerator
WE CARE Accomplishments….
Solar electric system in hospital in
maternity, delivery, & operating theatre
Solar powered blood bank refrigerator
LED headlamps for all night duty staff
Walkie Talkies for Emergency Obstetric
Staff
Nigerian Support
MINISTRY OF HEALTH, 2008
GOVERNOR OF KADUNA, 2009
Impact
No patients turned away from L&D Increased capacity to deliveries Immediate assembly of surgical team Clinician feedback:
“Fantastic!” “Great Improvement!”
Challenges
Fixed budget Vetting solar electric companies in
Nigeria Obtaining government buy in Ensuring Quality Products and Service When to delegate
Lessons Learned
Let the user drive the product Field testing is important Design to be “idiot proof” Create redundancy in system Interdisciplinary collaboration Be Patient ….and persistent
Next Steps
Assessing health facility needs throughout Kaduna and other states
Optimizing “solar suitcase” prototypes Scaling this intervention to other facilities
Special Thanks to Our Funders…
Big Ideas @ Berkeley Blum Center for Developing Economies Bixby Program in Population, Health and
Sustainability
Maternal Mortality
http://www.worldmapper.org/display.php?selected=258
Formal Commissioning
Phase I Outcomes Improved Communication
Immediate Contact Reduced Delays Patient Status Updates Less Referrals Out
Improved Lighting Increased Visibility Increased Ease of Procedures Increased Safety
Phase II Evaluation
Lighting Adequacy Survey Pre and Post LED headlamps
Communication Survey Who’s needed by whom? How was this person contacted? Time to locate and bring to facility
Obstetric patient triage and outcome Observation/Interviews