Thu, Dec 18, 2008 - Page 14 News List

Turning to auto parts to save newborns

Global health entrepreneurs have built a US$1,000 incubator out of discarded car parts for developing countries

By Madeline drexler  /  NY TIMES NEWS SERVICE , NEW YORK

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The heat source is a pair of headlights. A car door alarm signals emergencies. An auto air filter and fan provide climate control.

But this contraption has nothing to do with transportation. It is a sturdy, low-cost incubator, designed to keep vulnerable newborns warm during the first fragile days of life.

Unlike the notoriously high-maintenance incubators found in neonatal intensive care units in the US, it is easily repaired, because all of its operational parts come from cars.

And while incubators can cost US$40,000 or more, this one can be built for less than US$1,000.

The creators of the car parts incubator — a project being promoted by the Global Health Initiative at the Center for Integration of Medicine and Innovative Technology, or CIMIT, a nonprofit consortium of Boston teaching hospitals and engineering schools — say it could prevent millions of newborn deaths in the developing world.

The main causes of newborn death — infections, preterm birth and asphyxiation — are readily treatable with the right expertise and equipment, said Kristian Olson, principal investigator on the project. He called them the “low-hanging fruit” of global health interventions.

“It’s so frustrating to see these preventable deaths,” he said. “They won’t name babies in Aceh, Indonesia, until they’re two months old. It’s a cultural adaptation to expect a death.”

Mechanically, incubators are simple devices, providing a warm, clean, womblike environment in which a baby can mature (though state-of-the-art models may have accessories like built-in X-ray machines and rotating mattresses). Low birth weight and other problems make it especially difficult for newborns to regulate their body temperature, a condition that can lead to organ failure.

REPLACEMENT PARTS ... VIRTUALLY LIMITLESS

In the car parts incubator, infants born at 32 weeks’ gestation or longer can receive supplemental oxygen while their lungs gain strength, antibiotics if they have infections, and low-lit quiet in which to sleep if their mothers are away or are otherwise unable to hold them. In an emergency, the incubator’s bassinet can be removed and carried to another part of the building or even to another hospital.

In truth, experts say, the developing world doesn’t need more incubators. It needs incubators that work. Over the years, thousands have been donated from rich nations, only to end up in “incubator graveyards” — most broken, some never opened. According to a study from Duke University last year, 96 percent of foreign-donated medical equipment fails within five years of donation — mostly because of electrical problems, like voltage surges or brownouts or broken knobs, or because of training problems, like neglecting to send user manuals along with the devices.

To compensate for this philanthropic shortsightedness, medical staffs either crank up the temperature in “incubator rooms” to 37.8ºC or more, or swaddle babies in plastic to hold in body heat.

Such makeshift solutions led the Boston team to ask: How can we make an incubator for the developing world that will get fixed?

One person pondering that question in 2006 was Jonathan Rosen, then director of CIMIT’s technology implementation program. A proponent of sustainable biomedical technology, Rosen, now at the Boston University School of Management, uses the term “organic resourcing” to describe the principle of fashioning medical devices from whatever materials were locally abundant.

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