The document discusses a project called WE CARE (Women's Emergency Communication and Reliable Electricity) that implemented solar energy solutions to improve emergency obstetric care in hospitals in West Africa. Phase I provided LED headlamps, walkie-talkies, and a solar charging station which improved communication, reduced delays, and increased lighting. Phase II installed a permanent solar photovoltaic system providing power to the maternity ward, delivery room, and operating room. This led to increased capacity and no patients turned away. Challenges included ensuring quality products and gaining government support, but outcomes were positive with staff feedback praising the "fantastic" and "great improvement" in care.

1. 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 Sustainability University of California, Berkeley

2. Maternal Mortality

3. Maternal Mortality http://www.worldmapper.org/display.php?selected=258

5. Infection

6. Unsafe Abortion

7. Eclampsia

8. Obstructed LaborAMDD, Columbia; www.pphprevention.org

9. Federal Republic of Nigeria

11. Early Marriage

12. High Illiteracy

13. Low contraceptive use

19. The Three Delays Home Transport Hospital

20. The Three Delays Home Transport Hospital Recognition Decision

21. The Three Delays Home Transport Hospital Recognition Decision Availability Cost Distance

22. The Three Delays Home Transport Hospital Facility Supplies Staffing Cost Recognition Decision Availability Cost Distance

23. Municipal Hospital, Zaria

24. Lack of Running Water

25. Lack of Sanitation

26. Pharmacy Stock Outs

27. Medical Records

28. Operating Theatre

29. Labor and Delivery

30. Labor and Delivery

31. Life-Threatening Delays

32. Lack of Blood Bank

33. Inadequate Lighting

34. Emergency Obstetric Care - Challenges Electricity Light Communication Water Facility Supplies Staff Medication Equipment Surgical supplies Staff shortages Deficient Training Lack of Protocols

35. Emergency Obstetric Care – Intervention Electricity Light Communication Water Facility Supplies Staff Medication Equipment Surgical supplies Staff shortages Deficient Training Lack of Protocols

36. WE CAREWomen’s Emergency Communication and Reliable Electricity Solar Electricity to… ….provide reliable lighting ….enable mobile communication ….power blood bank refrigerator and surgical equipment

37. Design Principles Autonomous power Durable, Robust Reliable Simple to Use Easy to Maintain Affordable Scaleable

38. Operating Room Design

39. “Solar Suitcase”

40. Demonstration to Hospital Staff

41. Phase I Solar Suitcase charging station for: LED Headlamps for maternity & surgical staff Walkie-Talkies (short range) for physicians, midwives, and operating room staff

42. Impact of LED light Medical Documentation Before After

43. Impact of LED lightNursing Care Before After

44. Impact of LED lightsSurgical Care Before After

45. Testing Two-way Radios

46. Phase I Outcomes Improved Communication Immediate Contact Reduced Delays Patient Status Updates Less Referrals Out

47. Phase I Outcomes Improved Communication Immediate Contact Reduced Delays Patient Status Updates Less Referrals Out BUT…. Inadequate Range Battery runs out during shift

48. Phase I Outcomes Improved Lighting Increased Visibility Increased Ease of Procedures Increased Safety

49. Phase I Outcomes Improved Lighting Increased Visibility Increased Ease of Procedures Increased Safety But…MORE Desired

50. 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

51. LED Headlamps

52. PV Installation

53. Labor and Delivery Ward

54. Maternity Ward

55. Maternity Ward

56. Operating Room

57. Operating Room

58. Solar Powered Suctioning using DC to AC Inverter

59. Long-distance two-way radiosand solar powered charging

60. Solar Powered Blood Bank Refrigerator

61. 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

62. Nigerian Support Ministry of Health, 2008 Governor of Kaduna, 2009

63. Impact No patients turned away from L&D Increased capacity to deliveries Immediate assembly of surgical team Clinician feedback: “Fantastic!” “Great Improvement!”

64. Challenges Fixed budget Vetting solar electric companies in Nigeria Obtaining government buy in Ensuring Quality Products and Service When to delegate

65. 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

66. Next Steps Assessing health facility needs throughout Kaduna and other states Optimizing“solar suitcase” prototypes Scaling this intervention to other facilities

68. Blum Center for Developing Economies

71. Maternal Mortality http://www.worldmapper.org/display.php?selected=258

72. Formal Commissioning

74. 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

75. 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