For all the technologies that Rice 360 has built over the years, one of the most dramatic and impactful projects has been the bCPAP machine. In just one week at Queens, I’ve been able to see how important the bCPAP is for patient care in the Pediatrics Ward and the Chatinkha Nursery. Additionally, one of our main jobs last week was to enter data from the bCPAP clinical trial from hospitals in Malawian districts as far away as Mzuzu and Rumphi, a task that showcased the reach and impact this simple technology is having not only at QECH, but also across the country.
Though previous interns have written extensively about various aspects of the machine, I thought I would take this opportunity to lay out an overview of how the device was developed, how it evolved, and how it continues to spread to new areas and new patients.
What is the bCPAP?
The Bubble Continuous Positive Air Pressure machine is a device that helps neonates with respiratory distress breathe properly through the use of bubbling water. The device is an innovative redesign of an existing medical technology that costs $6000 in US hospitals. Made with aquarium pumps, a water bottle, and sheet metal casing, the bCPAP only costs $800. (1) It is astounding to see the impact this technology has had in Queen Elizabeth Central Hospital as nurses and doctors have embraced the bCPAP and are starting to use it as a new standard of care for their sickest patients.
What was the timeline?
Working in the bCPAP store room last week gave me the opportunity to look at the various design iterations of the machine and at the cyclical nature of the design process itself. Though it now has prettier packaging and a cooler name (Pumani means “breath” in Chichewa), the essentials of the bCPAP haven’t changed much over the years. 3rd Stone Design, with feedback from Rice 360 staff at QECH, continues to make important changes and improvements to allow for wider acceptance and use of the device. With the help of several grants, the device spread from QECH to district hospitals across Malawi and is now making the transition to Zambia, Tanzania, and South Africa.
Implementation and Acceptance
The bCPAP is now used in hospitals around the country, but it was by no means accepted immediately. The machine was designed with affordability in mind and 3rd Stone Design made sure it would be available in adequate quantities. However, there were still several barriers to adoption, as with all new healthcare interventions brought to a community. At first, some bCPAPs weren’t used because nurses felt they lacked adequate training and were not comfortable with it. However, with better training procedures, nurses are beginning to accept and use the devices. At QECH, I was introduced to Nurse Florence (Chatinkha Nursery) and Nurse Chrissie (Paediatric Ward), two CPAP nurses who are prime examples of well-trained, proactive healthcare workers. These two are the bCPAP’s most ardent supporters at Queens, regularly encouraging health workers to use bCPAPs on patients and traveling to district hospitals to provide CPAP mentorship.
Another major problem in the implementation of the device was accounting for hypothermia in neonates. Especially in the winter months, data collected from the bCPAP clinical trial showed lower survival rates since babies were hypothermic and unable to get the warmth and care they needed. This led to another innovation by a team at Rice: the CPAP heating sleeve. Designed by Sarah, Renata, and their teammates, the heating sleeve is a cloth cover for bCPAP tubing that uses resistance wires to keep air warm as it flows to the infant. We’re hoping to get useful feedback on this addition to the bCPAP system by talking to people like Nurse Florence and Nurse Chrissie, who are highly familiar with and highly invested in the CPAP project.
What’s the impact?
The main criteria for success in the bCPAP trial are the survival rates and the cost-effectiveness of the device. In its initial pilot trial at Queens, the bCPAP showed stunning results. Infants put on CPAP had a 71% survival rate as compared to a 44% survival rate for infants given the standard-of-care oxygen treatment. Specifically, the bCPAP was good for treating Respiratory Distress Syndrome (RDS) and Sepsis. (2) In a follow-up cost-effectiveness study on the same data, the bCPAP was found to have an incremental cost-effectiveness ratio of $4.20 per life year saved, making it an extremely effective investment in neonatal care. (3)
Numbers aside, a more visible indicator of success is the integration of the bCPAP into the clinical practices of nurses and doctors at Queens. A quick walk through Chatinkha Nursery brings you in contact with numerous infants breathing steadily with the help of Pumani bCPAPs under the watchful eye of a trained CPAP nurse. Additionally, Karen and I often go to the morning handover meetings in the Paeds Ward where doctors debrief on the status of their patients during the previous night. The most striking moment for me was when an attending physician interrupted a debrief on an infant with RDS to ask, “Why wasn’t this baby put on CPAP sooner?” The fact that this technology is now such a crucial part of clinical decisions at QECH is both telling and encouraging. Hospitals like Queens need access to low-cost technologies like the CPAP, but more importantly, the technologies have to be accepted on all levels–by healthcare workers, doctors, and families–in order to make a meaningful difference.