Shining a light on maternal mortality

An obstetrician-gynecologist by training, Laura Stachel became interested in maternal mortality when she began attending the School of Public Health at the University of California, Berkeley. Through a school project, Stachel ventured to northern Nigeria in 2008 to learn why so many women there were dying during childbirth.

What she found were substantial infrastructure problems, including a lack of supplies, equipment, training and supervision. "And there was another factor that seemed huge to me," Stachel recalled. "They didn't have reliable electricity."

Even at large state hospitals, electricity was rationed. Doctors were lucky to get 12 hours of electricity in a day. Without electricity, hospitals couldn't power refrigerators to store blood for transfusions or ensure that cell phones could be charged. And there was no guarantee that doctors would have light to deliver babies and perform Cesarean sections.

The Nigerian hospital performed about 150 deliveries each month and could see as many as seven or eight deaths in the same time frame, Stachel said. "Electricity was playing a pretty big role in some of the delays that were affecting maternal health outcomes," she said. "It felt like there was very little I would be able to offer clinically if we didn't take care of some basics first. We really needed to be able to ensure that there was a reliable electricity system."

Determined to find a solution, Stachel launched WE CARE Solar. Here's more of our recent conversation:

How did you start WE CARE Solar?

My husband, Hal Aronson, is a solar educator. When I was writing to him from Africa, he said, Maybe we can get a solar electric system for the hospital. When I came back to Berkeley, there was a competition to provide a technology for a social good. My husband and I pulled together a team to see if we could get some money for this solar electric system. We didn't win the top prize, but we got enough attention to secure funds for this project. Our initial project was to help one hospital and provide a fairly hefty amount of solar power. We also brought in a walkie-talkie system that was charged by the solar power. We named our group WE CARE, which stands for Women's Emergency Communication and Reliable Electricity.

Before that installation happened, I wanted to show my Nigerian colleagues what we'd been working on. I asked my husband to put together a small unit -- small enough to fit in my suitcase -- to show what solar electricity was all about. I showed them this demonstration kit -- and they loved it. It was enough to power walkie-talkies and power batteries for headlamps. They wanted to keep it. I left it there while we were getting ready for the larger installation. They used it for six months. When we came back to do the big installation, people in the hospital had already talked to their colleagues at other clinics in Nigeria about the solar suitcase. [The other clinics had] the same problems. It occurred to me that we could have enough power in that little suitcase to provide quite a bit of good for these clinics. We ended up creating more suitcase-sized systems. We literally adapted a carry-on piece of luggage to have all the equipment it needed.

Do you primarily do the suitcases now, or are you doing more big installations at hospitals?

We're not primarily doing big hospitals anymore. We decided to focus on smaller systems because it didn't seem like there were other groups working on that. The solar suitcase can be expanded. It started with a fairly limited amount of electricity, using either a 40-watt panel or an 80-watt panel. But it has the capacity to be expanded to accommodate a 300-watt panel. My guess is that over time we'll have different sized solar suitcase-like systems. We started getting requests for these suitcases from all over the world, so we feel like there's a need for these. We've tried to have a focus on the solar suitcases and other types of accessories. The solar suitcases come with solar-powered flashlights, solar-powered lanterns, headlamps.

We're going to do a study with the World Health Organization starting in Liberia. We'll be equipping 18 clinics with these systems and we'll be comparing clinical outcomes to 18 clinics that don't have solar suitcases. What we found in that first hospital [in Nigeria] was that the maternal mortality rate in the hospital decreased substantially and the capacity to admit more patient increased. The hospital that had as many as seven or eight deaths a month now only has one or zero. They're also seeing more patients every month. It seemed like that larger installation made a big difference. What we want to see now is if a solar suitcase can also have an impact on lowering maternal and neonatal deaths.

How many suitcases have gone out so far?

Around 50 [suitcases] in about 11 different countries.

What's been the biggest challenge so far?

We started as a cottage industry and as we've had increasing demand, we've needed to develop an organizational structure. There's a lot that needs to be done to build the capacity of an organization. We need to formalize processes that were, up until now, very informal. Most of the people in the organization have been volunteering. But as we grow and become sustainable, we need to create a budget and hire people. To me, what's been challenging is growing an organization and learning how to scale something up so it can work in different countries and develop supply chains. As we want to supply larger organizations with these, we need to come up with other mechanisms for transport. All of these things become more complicated as we grow.

Other than the WHO study, what else is planned for the organization?

We were funded by the Blum Center for Developing Economies to create a second iteration of the solar suitcase. We've tried to get feedback from people who have been using the solar suitcase around the world and pull that together to try to make a better piece of equipment -- something we think will be more robust, more cost effective and suit the needs of clinicians better than the original. We'll be doing field trials in Nigeria in the coming year.

Photo: Laura Stachel, at right, at a clinic in northern Nigeria the day they received a solar suitcase

This post was originally published on Smartplanet.com