Breathe easy, repeat

How good design could save a million babies a year

The winter 2017 issue of Rice Magazine features a story about how simple, smart health technologies improve the lives of newborns and mothers in Malawi. Rice News excerpts the feature here.

A Malawian mother checks on her baby at Zomba District Hospital’s neonatal ward. (Photo by Brandon Martin)

The boy was minutes old and near death. His breath came in shallow, rapid gasps. His mother, Mary Nankwenya, knew something was terribly wrong. When her labor had begun several weeks too early, she’d rushed to the nearest hospital in Zomba, a small city in southern Malawi, and given birth at midnight. But before she could even hold her baby, he was whisked away to the neonatal ward for treatment.

A few hours later, at the dawn of an unseasonably warm June morning, Nankwenya’s son was breathing normally. He shared the nursery with 20 other babies, so many that Nankwenya had to wait in the hallway and watch her son through glass. An air hose ran from his nose to a shoebox-sized breathing machine nearby. Malawian babies often aren’t named until they are about a month old, and thanks to the continuous positive airway pressure machine, or CPAP (pronounced SEE-pap), Nankwenya’s child was about three times more likely to reach his naming date.

Other mothers in the hallway had told Nankwenya that the machine had saved their children. “Some are being discharged today,” she said through an interpreter. “They have recovered. All through that CPAP machine.”

Zomba’s neonatal CPAP was invented 9,000 miles away, in Houston, by Rice undergraduates. It has a Malawian name, Pumani, which means “breathe easy,” and it’s saving babies today in more than 20 countries in sub-Saharan Africa, the Caribbean and Southeast Asia.

Pumani’s story is one of hope, perseverance and innovation in action. It’s the middle chapter of an epic 20-year quest to save the lives of a million babies every year. The protagonists are two Rice professors — Maria Oden and Rebecca Richards-Kortum — who’ve grown so close that their staff often call them by one name, “MORRK” (their initials), and their quest began a decade ago in a different neonatal ward in Blantyre, Malawi, a bustling city of 1 million.

HOW CAN WE HELP?

Bioengineer Richards-Kortum can vividly recall the emotions she felt when she first saw the crowded, two-room ward at Blantyre’s Queen Elizabeth Central Hospital in 2006.

From Left, Malawi College of Medicine Professor Josephine Langtonwith Maria Oden and Rebecca Richards-Kortum stand in the expanded neonatal ward at Queen Elizabeth Central Hospital. (Photo by Brandon Martin)

“That visit changed my entire life,” she said. “There were 60 babies being cared for there with very minimal equipment. As a mom, it is incredibly difficult to walk into that and to see babies who are literally struggling to take every breath.”

Each bassinet held three or four babies, and there was no room for all the mothers. She had to step over a dozen moms who sat on the floor breastfeeding, but scores more packed the hallway outside, awaiting their turn. She learned that almost one in five Malawian babies — about twice the U.S. rate — are born premature. These preemies are prone to respiratory distress and a host of other problems; three-quarters of all newborn deaths occur in the first week of life.

As a mother of six, Richards-Kortum felt for both the mothers and the doctors and nurses at Queen’s. The engineer in her noted the lack of technology: Devices U.S. hospitals use to save premature babies — incubators, ventilators, monitors — were missing.

“When I walked out, I didn’t yet know how we could be helpful, but shortly after that we went to the hospital’s biomedical engineering department, and I saw that there were rooms and shelves full of broken equipment,” she said. “There were 83 broken oxygen concentrators, and if any one of those had been working, it would have been in use in the neonatal unit.

“When I saw those two things — the great need for equipment in the hands of these dedicated medical professionals right next to this equipment graveyard — I thought, that’s how we can help. We can develop the kind of equipment that is affordable, that is rugged and robust, that is easy for nurses and physicians to use, and that can be the difference between life and death for tiny babies.”

This story is featured in the winter 2017 issue of Rice Magazine. To read the rest of the story and watch videos, visit http://magazine.rice.edu/2017/01/breathe-easy-repeat.