Dr Sam Wamani's sister-in-law bled to death in his arms, a victim of obstetric complications. happened 10 years ago, says the 33-year-old resident of Leba, in western Uganda. My brother came to my door at 1 am. I had just graduated from medical school in Kampala, and he thought I could help. I said we had to get her to the health unit. She could not walk, they wheeled her on a bicycle. But at the clinic, they were told that the health worker had left because there was no electricity. By this time she was in agony, Wamani says. He tried to stop the bleeding, to no avail: both mother and baby died on the roadside in the dark. Obstetric complications are the leading cause of maternal death in sub-Saharan Africa, accounting for roughly half of deaths globally due to pregnancy and childbirth. Lack of antenatal care, the dearth of skilled birth attendants and the limited availability of emergency obstetric procedures are among the most commonly-cited reasons for this situation. Yet access to electricity- essential to many medical interventions including night-time emergency response--is rarely an issue to which health policymakers pay attention. [ILLUSTRATION OMITTED] Electricity should be a priority for public health, says Dr Maria Neira, director of the Department of Public Health, Environmental and Social Determinants of Health at the World Health Organization (WHO) in Geneva. and its partners are now working to foster awareness of this neglected need. According to a WHO study published in Global health: science and practice in August last year, about one in four health facilities in 11 countries in sub-Saharan Africa has no access to electricity and most facilities that do have access have an unreliable supply. The study reviewed national surveys of health facilities in the 11 countries, which included six of the continent's 10 most populous: Ethiopia, Ghana, Kenya, Nigeria, Uganda and the United Republic of Tanzania. It covers over 4000 clinics and hospitals. Diesel generators have traditionally powered off-grid facilities and also served as back-up power sources in grid-connected hospitals and clinics. But these facilities struggle with both high fuel costs and unreliable fuel delivery. In the six sub-Saharan countries that we reviewed with data on generator functionality, fewer than 30% of these generators were actually operational, said Dr Carlos Dora, who leads the WHO team that did the analysis. Without power, health facilities cannot run equipment such as vaccine refrigerators or use many of the most basic, lifesaving medical devices. They cannot pump or heat water. They cannot even put on the lights. As doctors, we have been trained to think about human resources, drugs and equipment--not electricity, says Dora. The problem is not limited to rural areas, notes Dr Laura Stachel, an obstetrician and gynaecologist at the University of California, Berkeley, United States of America (USA). She recalls doing her doctoral research in 2008 in a Nigerian hospital, where electricity was available only 12 hours out of 24. Night-time deliveries were taking place in near-darkness. The results were often tragic. When the lights went out during one Caesarean section, she recalls, people didn't even react. They were used to it. We couldn't use the suction machine, or do cautery (burning procedure) to stop the bleeding. Luckily, I had a flashlight with batteries, which they used to finish the surgery. The experience left Stachel with a strong desire to do something. Her husband, Hal Aronson, is a power specialist, so it just seemed logical to me to start thinking in those terms. Aronson designed a solar suitcase, a portable kit containing a small photovoltaic (PV) panel, battery charger and outlets for energy-efficient LED (light-emitting diode) lights. Stachel took it back to the hospital in the Nigerian city of Zaria. …
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Nov 7, 2014
K E Gilland + 1
Open Access