delanceyplace.com 11/8/10 - newborns
"Sometime in the late 1870s, a Parisian obstetrician named Stephane Tarnier took a day off from his work at Maternite de Paris, the lying-in hospital for the city's poor women, and paid a visit to the nearby Paris Zoo. Wandering past the elephants and reptiles and classical gardens of the zoo's home inside the Jardin des Plantes, Tarnier stumbled across an exhibit of chicken incubators.
Seeing the hatchlings totter about in the incubator's warm enclosure triggered an association in his head, and before long he had hired Odile Martin, the zoo's poultry raiser, to construct a device that would perform a similar function for human newborns. By modern standards, infant mortality was staggeringly high in the late nineteenth century, even in a city as sophisticated as Paris. One in five babies died before learning to crawl, and the odds were far worse for premature babies born with low birth weights. Tarnier knew that temperature regulation was critical for keeping these infants alive, and he knew that the French medical establishment had a deep-seated obsession with statistics. And so as soon as his newborn incubator had been installed at Maternite, the fragile infants warmed by hot water bottles below the wooden boxes, Tarnier embarked on a quick study of five hundred babies. The results shocked the Parisian medical establishment: while 66 percent of low-weight babies died within weeks of birth, only 38 percent died if they were housed in Tarnier's incubating box. You could effectively halve the mortality rate for premature babies simply by treating them like hatchlings in a zoo. ...
"Modern incubators, supplemented with high-oxygen therapy and other advances, became standard equipment in all American hospitals after the end of World War II, triggering a spectacular 75 percent decline in infant mortality rates between 1950 and 1998. ...
"In the developing world, however, the infant mortality story remains bleak. Whereas infant deaths are below ten per thousand births throughout Europe and the United States, over a hundred infants die per thousand in countries like Liberia and Ethiopia, many of them premature babies that would have survived with access to incubators. But modern incubators are complex, expensive things. A standard incubator in an American hospital might cost more than $40,000. But the expense is arguably the smaller hurdle to overcome. Complex equipment breaks, and when it breaks you need the technical expertise to fix it, and you need replacement parts. In the year that followed the 2004 Indian Ocean tsunami, the Indonesian city of Meulaboh received eight incubators from a range of international relief organizations. By late 2008, when an MIT professor named Timothy Prestero visited the hospital, all eight were out of order, the victims of power surges and tropical humidity, along with the hospital staff's inability to read the English repair manual. ...
"Prestero and his team decided to build an incubator out of parts that were already abundant in the developing world. The idea had originated with a Boston doctor named Jonathan Rosen, who had observed that even the smaller towns of the developing world seemed to be able to keep automobiles in working order. The towns might have lacked air conditioning and laptops and cable television, but they managed to keep their Toyota 4Runners on the road. So Rosen approached Prestero with an idea: What if you made an incubator out of automobile parts?
"Three years after Rosen suggested the idea, the team introduced a prototype device called the NeoNurture. From the outside, it looked like a streamlined modern incubator, but its guts were automotive. Sealed-beam headlights supplied the crucial warmth; dashboard fans provided filtered air circulation; door chimes sounded alarms. You could power the device via an adapted cigarette lighter, or a standard-issue motorcycle battery. Building the NeoNurture out of car parts was doubly efficient, because it tapped both the local supply of parts themselves and the local knowledge of automobile repair. These were both abundant resources in the developing world context, as Rosen liked to say. You didn't have to be a trained medical technician to fix the NeoNurture; you didn't even have to read the manual. You just needed to know how to replace a broken headlight."
Author: Steve Johnson
Title: Where Good Ideas Come From
Date: Copyright 2010 by Steven Johnson