I looked at her soberly, taking in the significance of what she had just [...]]]> We were in Malawi for three days when I asked a hospital midwife to tell me the word for pregnancy in Chichewa, the local language. “Pakati,” she told me. “What does that translate to?” I asked.  “Between life and death.”

I looked at her soberly, taking in the significance of what she had just told me. In Malawi, as in so many parts of the developing world, pregnancy is indeed fraught with peril. In 2010, the WHO reported the Maternal Mortality Ratio (MMR) for Malawi was 470. That means that for every 100,000 live births, about 470 women will lose their lives.  And my Malawi colleagues on this trip suggested the risk in rural areas is significantly higher.  In fact, a young woman in Malawi faces a 1 in 36 lifetime risk of dying from pregnancy-related complications.[1]

When I was a practicing obstetrician in California, a big part of my job was to provide preventive care, identify and treat pregnancy complications as they arose, and ensure a joyful outcome for mother and baby.  My pregnant patients had a lot of questions – about natural childbirth, the use of pain medication, the chances of needing a c/section, and so on – but never about the odds of survival. We all assumed that childbirth was an event to be celebrated, rather than one to be feared.

In Malawi, a healthy outcome is far from certain. For a rural woman, access to a decent health center is a significant challenge, often necessitating hours of travel by foot. Women in Malawi are encouraged to have at least four prenatal visits, compared to a minimum of eight visits for routine care in the United States. But at best, prenatal care identifies only a fraction of the complications that can occur in childbirth. The greatest threats to life: hemorrhage (excessive bleeding); obstructed labor (inability of the baby to fit through the birth canal); eclampsia (high blood pressure leading to convulsions); and sepsis (disseminated infection)– usually manifest close to the time of delivery. These conditions may not be preventable, but they are certainly treatable with proper medical and/or surgical care.  They need not result in death. But appropriate treatment does require skilled clinicians capable of providing immediate emergency care.

The global Safe Motherhood movement now recognizes that emergency obstetric care – critical care that addresses the major complications of pregnancy – is an essential part of the package of health services that must be provided to every pregnant woman.  In Malawi, community health workers and village leaders are called upon to encourage pregnant women to deliver in a health center. The law now forbids home births. This means that women must be able to reach functional health centers: facilities stocked with clean equipment, medical supplies, trained health providers, and something that is often overlooked – light.

On this trip to Malawi, we travel for hours to reach each clinic. As our four-wheel drive carefully maneuvers muddy dirt roads with deep trenches of water, I ask myself if I would choose to make the trip by foot if I were in labor. Would I be willing to leave the security of my home to arrive at a clinic shrouded in darkness? In Malawi, clinics lacking electricity expect women to bring their own candles and matches as part of their birthing kit.  For a woman living in poverty, even the price of a candle can be a deterrent to obtaining skilled care.

So many women make a calculated risk. They stay home. They make the same choice their mothers made, and try and deliver by traditional means. They take their chances. And, in places like Malawi, where skilled health care is far and clinics are often in darkness, many of them are unable to obtain the care they need when problems arise. And pregnancy tragically does become a period of time “between life and death.”

I visited one health center in the middle of the night. Without my flashlight, I would not have been able to see my hand in front of my face. I look at the midwife in this health center with awe, imagining the courage it must take to come to work each night. I think about the thousands of babies I have delivered in the United States, and wonder how I could have functioned without the entire hospital infrastructure in place.

On this evening, the midwife shows me the only light available. She pulls her cell phone out of her pocket and shines a dim blue light in my direction. The battery is low, she explains. She shows me how she carefully sets the phone on a counter and points it in the direction of the delivery table six feet away. I can barely see the table. “How do you repair a laceration with this light?”  “I don’t,” she apologizes, “I must wait for morning.”

I pull out the bright yellow suitcase that is the reason for my visit. When I open it and turn on the lights, the room becomes visible again. And now Fanny has a wide smile on her face. She immediately realizes that she will no longer rely on cell phones or candles at night. That her cell phone can always be charged. That the fetal Doppler we include with the Solar Suitcase will make it easier for her to hear the fetal heart beat. “By the grace of God, you have come,” she tells me.

[1] That compares to a lifetime risk of dying in the U.S. of 1 in 2,400. In Britain the risk is 1 in 4800. (http://data.worldbank.org/indicator/SH.MMR.RISK, accessed 3/1/2013)

On January 21st, 2013 (Martin Luther King Jr. Day) We Care Solar launched We Share Solar in collaboration with The Tech Museum of Innovation in San Jose and through the support of Applied Materials. Held in the newly opened TechLab of The Tech Museum, twelve We Share Solar teachers gathered with forty [...]]]>

On January 21st, 2013 (Martin Luther King Jr. Day) We Care Solar launched We Share Solar in collaboration with The Tech Museum of Innovation in San Jose and through the support of Applied Materials. Held in the newly opened TechLab of The Tech Museum, twelve We Share Solar teachers gathered with forty students from the local Girl Scouts, Third Street Community Center and teams from the museum’s program called The Tech Challenge. Together they built ten We Share Solar Suitcases, five of which are destined for the developing world.

Hal Aronson, Neal Aronson and Gigi Goldman mentor students building Solar Suitcases at the TechLab

Hal Aronson and Laura Stachel opened the workshop by teaching the students about energy poverty, sustainable development and how circuits and the flow of electricity works through diagram drawings.  The students were then divided into teams of four; each table was assigned an instructor.  They opened their beautiful blue suitcases filled with the components of a We Share Solar Suitcase and identified each of the parts.  Together the teams completely assembled the Solar Suitcases, commissioned their systems, and took them to the sunny museum rooftop. They held their solar panels up to the sky, watched their batteries fill with solar energy, and monitored the current coming in and out of the Solar Suitcase using the system’s charge controller.  Then they performed the ultimate test. The students turned on efficient LED lights and…much to their delight…charged their own cell phones!

At the end of the workshop, the students received t-shirts commemorating the special day.

Before departing, the group reflected on their day and wrote notes to their counterparts in Uganda and Sierra Leone who live in orphanages and attend schools that have no light.  The We Share Solar Suitcases will be going overseas to provide light to youth who live in energy poverty.  In cooperation with Pennies for Posho, some suitcases will be installed in a girls’ dormitory at New Hope Orphanage in Bugiri, Uganda, providing a safer environment where the girls can study and play once the sun sets. Schools For Salone will provide We Share Solar Suitcases to schools in Sierra Leone, illuminating the library of the Children in Crisis Primary School in Upper Allentown.  This will be the first light for a school with over 470 students. The Solar Suitcase will enable students to study at night and teachers to hold evening workshops and community meetings.

All in all…it was a wonderful day! Hal Aronson, Program Director of We Share Solar and Co-Founder of We Care Solar, explained that “We Share Solar serves youth twice…first as an educational experience for American youth and second as a renewable power and lighting system for youth in parts of the world that lack electricity.”

In October 2012, 14 women arrived in Berkeley, California to take part in  a very unique workshop. Some arrived from Colorado, New Jersey, Massachusetts, Oregon, and Washington; others flew in from Kenya, Uganda, Nigeria, and Mexico. Their objective? To learn to be installers and trainers in We Care Solar’s international programs.

The program was conceived by We Care Solar co-founders, Laura Stachel and Hal Aronson, and Solar Energy International’s Laurie Guevera-Stone more than a year ago.The three imagined the power of an educational program that could train a cadre of women to teach female health providers how to use and maintain solar electricity systems, and who could lead PV installations in health facilities populated by women patients. With support from the Putnam Foundation and the Clif Bar Family Foundation, this dream became a reality.  And instructors Carol Weis, Hal Aronson, and Laura Stachel worked for weeks to prepare a comprehensive course.

The women ambassadors were selected from a large pool of applicants and included electricians, PV installers, a doctor, a geologist, two business women, and engineers. All the women were required to take 12 weeks of SEI’s Introductory PV courses before coming to the 6-day intensive in Berkeley. The workshop included hands-on instruction in wiring, installation, roof mounting; exercises in how to size solar electric systems and trouble shoot existing solar electric systems;  and classes on Safe Motherhood and Maternal Health Care including common pregnancy complications and treatments. Some of the time, the students attended classes held at UC Berkeley. On other occasions, they were drilling rooftops at a training center built by Aronson and volunteers in his Berkeley backyard. Most evenings included scrumptious meals and additional evening activities. One very special feature of the program was that almost all the participants were hosted by Berkeley residents, who opened their homes and hearts to this talented group. At the end of the course, two public health providers headed for Nepal  visited the class how to use and deploy Solar Suitcases in upcoming maternal health projects, giving the Solar Ambassadors their first chance to their try out their teaching skills.

It was an enriching experience for all the ambassadors, most of whom had never been in an all women’s PV class, or a workshop that combined teaching pedagogy, technology, and women’s health. In addition to the excellent training, there was a sense of cooperation and support that was unparalleled, and many women reported that the week was transformative.

We Care Solar has an opportunity to transform Ugandan maternal health care under a new award entitled Saving Lives at Birth: A Grand Challenge for Development. We Care Solar partnered with African Medical Research Foundation (AMREF) Uganda and the White Ribbon Alliance to create an integrative solution for maternal health care in [...]]]>

We Care Solar has an opportunity to transform Ugandan maternal health care under a new award entitled Saving Lives at Birth: A Grand Challenge for Development. We Care Solar partnered with African Medical Research Foundation (AMREF) Uganda and the White Ribbon Alliance to create an integrative solution for maternal health care in Southwest Uganda, and was selected as one of three recipients of a “transition-to-scale” grant.

Winners were announced in Seattle at the 2012 Development XChange event. The We Care Solar partnership project also won the Peer Choice Award, voted by the innovators themselves.

The international Saving Lives at Birth competition drew more than 500 entries from nearly 60 countries and is a collaboration among five organizations: the US Agency for International Development (USAID), the Bill & Melinda Gates Foundation, Grand Challenges Canada, the Government of Norway, and the Department for International Development (DFID) in the United Kingdom. The World Bank is an affiliate partner.

Solar Suitcase As a Power Hub

The We Care Solar, AMREF Uganda, and White Ribbon Alliance project, entitled Saving mothers and babies with reliable solar power, will bring Solar Suitcases to 200 health centers in Southwest Uganda. The suitcase will serve as a hub to power light for medical care at night, a fetal Doppler to detect fetal well-being, phone charging to enhance patient referrals, and a computer for data management and continuing education.

The Saving Lives at Birth Grand Challenge set out to find innovations that could have a dramatic impact on reducing maternal mortality. “We are accustomed to advances in computers and cell phones that leapfrog existing solutions,” stated Saving Lives at Birth on its website. “The Saving Lives at Birth Challenge is about nurturing that same energy and innovation to the challenge of protecting mothers and newborns in the poorest places on earth during their most vulnerable hours.”

Leapfrogging Conventional Approaches

In particular, the challenge asked for innovations addressing three main domains: (1) technology; (2) service delivery; and (3) ‘demand side’ innovation….”

The Saving mothers and babies with reliable solar power project meets all three aspects of the challenge. It includes a technological innovation – the Solar Suitcase integrated platform – to enable better service delivery, as well as community based education and advocacy to increase demand for skilled care.

In addition to funding, the Saving Lives at Birth grant winners will receive “support and networking assistance from each of the [funding] partners, engage with other innovators, and participate in high-level meetings including the Gates Foundation’s annual Grand Challenges in Global Health meeting,” according to the Grand Challenges in Global Health website.

The intent of the transition-to-scale funds, the funders state, is “to develop, refine, and rigorously test the impact of integrated solutions that have previously measured promising health outcomes in a controlled or limited setting and have the potential to credibly scale to improve the lives of millions of pregnant women and newborns in multiple countries.”

At the 2012 Development XChange event, We Care Solar Co-Founder Laura Stachel presented the proposal to technical reviewers and met with other finalists during two days of workshops. We Care Solar’s Ilinisa Hendrickson and Carol Weis (pictured in the photo, from left to right) were on hand to demonstrate the suitcase and to receive the award.

Emphasizing the “especially heavy toll” energy poverty takes on [...]]]> “As we know, a pregnant woman can go into labor at any time,” UN Secretary-General Ban Ki-moon said at the Rio+20 UN Conference on Sustainable Development. “Her survival should not depend on daylight. That is why new initiatives like the solar suitcase are so valuable.”

Emphasizing the “especially heavy toll” energy poverty takes on women, the Secretary-General spoke of the We Care Solar Suitcase and of Dr. Jacques Sebisaho, who received a Solar Suitcase in December 2011 for his clinic in the Democratic Republic of the Congo.

“Women face especially grave risks when they have to rely on a clinic that has no electricity,” Mr. Ban said at the June 21 side event on “Energy, Gender and Economic Growth.” “More than a quarter of a million health facilities in our world are dark at night.”

He added, “One Congolese doctor told us that in his village, the first night he received the solar suitcase he was able to save two women who were giving birth.”

The Secretary-General concluded, “We cannot have the future we want without full equality for women. Today, I call on everyone to help put the ‘power’ in our drive to empower women. Then they can help light our world.”

In a celebration of her 100th day in office, Malawi President Joyce Banda received a We Care Solar Suitcase on July 19, 2012, the first of more than a dozen portable solar electric systems headed to Malawi clinics that serve mothers and babies. (In photo, President Banda tested the suitcase. From left are [...]]]>

In a celebration of her 100th day in office, Malawi President Joyce Banda received a We Care Solar Suitcase on July 19, 2012, the first of more than a dozen portable solar electric systems headed to Malawi clinics that serve mothers and babies. (In photo, President Banda tested the suitcase. From left are President of the Whitaker Group consulting firm Rosa Whitaker, U.S. Ambassador Jeanine Jackson, President. Banda, USAID Chief Economist Dr. Steve Radelet, and USAID/Malawi Mission Director Doug Arbuckle. Photo Credit: M’baso Photographics.)

Mrs. Banda, the first female president of the Republic of Malawi, has made women’s health a focus of her administration through the launch of a Presidential Initiative for Maternal Health and Safe Motherhood.

In a letter to President Banda,  We Care Solar co-founder Dr. Laura Stachel wrote, “We are honored to provide these Solar Suitcases to the President of the Republic of Malawi and to the people of Malawi. We are delighted to provide sustainable energy to health clinics to support President Banda’s work in reducing maternal mortality.”

Pregnant Women Required to Bring Candles

With one of the highest rates of maternal mortality in the world, Malawi has a low rate of reliable electricity at health clinics. Some health clinics have no electricity at all and pregnant women are routinely required to bring their own candles when entering a clinic to give birth. The We Care Solar Suitcase will provide a complete electrical system designed for medical use that includes lightweight solar panels, high-efficiency medical lights, fetal monitors, and cell phone charging stations. Each installation will include staff training programs and follow-up.

Doctors and midwives who currently perform emergency deliveries and obstetric procedures by candlelight or in the dark will now have adequate lighting and the ability to communicate.

A generous donor to We Care Solar made the gift of the Solar Suitcases to Malawi possible. Fundraising is underway to support the donation of additional Solar Suitcases to Malawi.

According to the World Health Organization, for every 100,000 live births, 460 mothers in Malawi die as a result of pregnancy and childbirth-related causes. Many countries, including Malawi, are working to show progress toward the 2015 Millennium Development Goal of a 75 percent reduction in maternal mortality rate, even if they will not meet the goal by the deadline.

A Personal Connection for President Banda

President Joyce Banda, Photo from Center for Strategic and International Studies

During a visit to the US in June, President Banda noted at an Aspen Institute roundtable on maternal health that she could have died in childbirth herself, had she not received a blood transfusion for postpartum hemorrhaging in time to save her life, according to a report from the Washington-based Center for Strategic and International Studies.

President Banda recounted visiting a clinic where a woman who had given birth at night lost her child because there was no electricity, and it was too dark for health workers to see that the umbilical cord was wrapped around her newborn’s neck.

The We Care Solar Suitcases are slated for use in Malawi clinics that have no access or very limited access to electricity and in which there are at least 20 deliveries per month.

Globally, more than 200,000 clinics in developing countries lack reliable electricity, crippling their ability to provide emergency care to mothers and newborns, to respond to epidemics, and to provide other critical services.

“Chance favors the connected mind,” is Steven Johnson’s short answer to the question posed by his book, “Where Good Ideas Come From.”

Leading minds in global health and sustainable energy connected [...]]]> David Bank wrote this article about the UN Foundation Powering Healthcare workshop; it was originally posted on  Impact IQ on May 7,  2012.

“Chance favors the connected mind,” is Steven Johnson’s short answer to the question posed by his book, “Where Good Ideas Come From.”

Leading minds in global health and sustainable energy connected last week at “Powering Health Care in the Developing World” in Washington, D.C. The UN Foundation and the World Health Organization brought together more than two dozen organizations, including the U.S. State Department, the US Agency for International Development and the United Nations Development Program. Sure enough, the workshop brimmed with good ideas for electrifying the approximately 300,000 health facilities in the developing world that don’t have access to reliable power.

The United Nations has proclaimed 2012 the Year of Sustainable Energy for All, and a series of high-level convenings will peak next month at “Rio + 20″ — the 20th anniversary of the 1992 Rio conference that effectively set off the sustainability movement. In the lead-up to Rio+20, global players large and small are making commitments to Sustainable Energy for All at the UN Foundation’s website.

The Powering Health Care workshop made a start at putting health facility electrification on the Rio+20 agenda. More than a dozen presentations made clear the tremendous opportunity to enable lighting, communications, medical devices and tele-medicine at frontline health facilities in resource-starved parts of the world. The convergence of improving technology and falling prices for sustainable energy, new low-power LED lighting and medical devices, ubiquitous mobile phones, almost insatiable demand for power and the increasing urgency to meet the 2015 “Millennium Development Goals” is generating a groundswell of activity.

I had the privilege of being a participant-observer at the workshop. One of my hats was as a board member of We Care Solar, the social venture that produces and distributes the award-winning “Solar Suitcase” as an immediate, interim solution for powering health facilities, specifically as a way to reduce deaths in childbirth among both mothers and newborns.  My other hat was as a journalist now chronicling (at Impact IQ) just such new opportunities to tackle major social challenges with innovative approaches and new financial models.

Dr. Laura Stachel, the ob-gyn who co-founded We Care Solar, graphically described the debilitating effects of energy poverty on health delivery, particularly the life-and-death situations in which women with complications in labor arrive at clinics and hospitals without even light to see by.

To illustrate the transformative effect of even modest lighting solutions, she  introduced Dr. Jacques Sebisaho from the Democratic Republic of Congo, who said patients, including the sick and women in labor, generally come in only when their work day is done, that is, when it’s getting dark. “We have lost so many women, so many children, so many people have died, because we didn’t have light,” Dr. Sebisaho said. Two weeks after he returned with a Solar Suitcase, cholera broke out in his village. With light, they were able to monitor patients through the night. “For the first time in this island’s history, nobody died from cholera,” he said. “95 percent of the survival was due to the fact that we had light.”

In my presentation, I tried to synthesize some of the takeaways from the workshop. I’ll just summarize here and return to some of these themes in continuing coverage.

MAKE CONNECTIONS. Many health professionals remain unaware of the new possibilities in sustainable energy, and many energy practitioners don’t fully appreciate the strategic value of focusing on health care facilities as an anchor for the provision of electricity.

UNLOCK VALUE. New technologies, new financing methods or simply new approaches make possible better outcomes at lower costs. Poor people already pay high costs for low-quality energy — as much as $38 billion a year, according to Richenda van Leeuwen, who heads the UN Foundation’s Energy Access initiative. Even problems such as the theft of panels and light bulbs reported by Walt Vernon, head of M+LNB Engineering, who as installed solar in hospitals and health facilities in Haiti and elsewhere, are really evidence of high demand, the key to a growing market.

TRACK THE INEVITABLE. Global megatrends — a growing middle class in emerging and ‘frontier’ markets, the shift in spending power by women driving investments in health and education — mean that more and more people are becoming willing to pay for that unlocked value.

DRIVE THE AGENDA. Dr. Carlos Dora of the WHO laid out the goal: “Put health care energy needs in the spotlight.” The energy needs of health facilities is not nearly on the agenda now, said Elaine Fletcher, a communications officer with WHO. The UN’s Every Woman, Every Child initiative has gathered 217 commitments around health childbirth, including in some cases significant country-level increases in health funding. But the word ‘electricity’ appears only once (Rwanda has committed to 100% electrification of its health clinics).

IT’S GETTING BETTER.  The presumption that problems are getting worse is not warranted — many things are getting better and could get markedly so with additional investment and innovation. Many developing countries are not on track to meet MDG5, to reduce maternal mortality by 75 percent between 1990 and 2015, but even in maternal mortality, success in some places has been stunning, with reductions of 5 percent or more each year, and global reduction on the order of 40 percent or more since 1990. Only a few dozen laggards are holding back even more dramatic progress. And other MDGs, such as the provision of clean drinking water, have been met even ahead of the deadline.

FOCUS ON SOLUTIONS.  One person’s problem is another’s opportunity. Rick LaRue of Solar Electric Light Fund mentioned Trojan Battery’s efforts to develop the market for off-grid energy storage devices. Others described low-power medical devices such as digital X-rays and super-cheap refrigerators. Jim Meszaros of the PR giant Weber Shandwick, who is handling the Sustainable Energy for All campaign, noted that nobody would have believed a plan to deploy more than five billion mobile phones in a decade, but we’re well past that now.

SCALE UP.  The world is awash in capital, and it’s increasingly flowing to ‘frontier markets’ in the developing world and to products and services that show falling prices and increasing demand. That confounds the prevailing assumption in the world of global health and economic development is that there’s a chronic shortage of money. Vijay Modi of Columbia University’s Earth Institute reported that with comparative energy sources costing the equivalent of $3 per kilowatt/hour, and $30,000 per mile to extend the electricity grid, that provision of off-grid sustainable energy is becoming increasingly attractive to local entrepreneurs.

TELL STORIES. Credible data and investable deals can go a long way toward putting Powering Health on the global agenda. But compelling stories of success, such as Dr. Sebisaho’s, can harness people’s passion for progress.