Kangaroo Care: Ingenuity, Simplicity, Survival
At the Mother and Child Institute in Bogota, the oldest maternity hospital in Colombia and one of the poorest, nearly everything was in short supply, including doctors, nurses and medicines. Incubators were so scarce that as many as three newborns had to be crowded into one, increasing the risk of infection and death among fragile premature infants.
Tina Rosenberg, in her New York Times column Fixes, describes how Dr. Edgar Rey, chief of pediatrics came up with a way to save babies that avoided a time consuming and politically fraught fight for funds for more equipment and staff. His idea was to strap newborn infants, wearing only diaper and head covering, to their mothers’ bare chests so that the baby has skin to skin contact and the mother’s breathing and heartbeat helps stabilize the infant’s heart and respiration. Everything but the baby’s head is under the mother’s shirt. The baby stays warm, can nurse at will, is secure, and remains in an upright position to help avoid reflex and apnea. Dr. Rey first had mothers act as human incubators in 1978. Rosenberg reports that the practice, now called kangaroo care, is used in some form in U.S hospitals and around the world. The diffusion did not happen accidentally. .
The Colombian physician and nurse advocates formed an organization, Fundacion Canguro, to help support use of this ancient life-saving practice in modern hospitals, Rosenberg explains in a separate column. Much of the financing for teaching kangaroo care today comes from the U.S. Agency for International Development, The Bill & Melinda Gates Foundation and Save the Children.
Innovators trying to save babies have historically taken inspiration from different cultures and fields. Steven Johnson, in his book Where Good Ideas Come From, tells how French obstetrician Stephane Tarnier saw baby chicks hatching in a heated enclosure at the Paris Zoo in the 1870s and thought about the two thirds of low weight babies who died within weeks of their birth. He had similar warm boxes built for babies, and infant survival at his hospital soared. Within a few years, incubators were required in Parisian maternity hospitals. Bizarre exhibits of Incubators with live babies were shown in Europe and one called a baby hatchery in New York’s Coney Island lasted well into the twentieth century and the use of incubators in hospitals spread.
Modern incubators are expensive technological wonders that offer many protections for fragile preemies. Their complexity daunted medical practitioners in the developing world and sparked ingenuity at the same time. Johnson tells what MIT Professor Timothy Prospero did in 2008 when he visited an Indonesian hospital in an area still recovering from the Indian Ocean Tsunami four years earlier. Eight incubators donated by international aid groups were out of order because of power surges and tropical humidity. Prospero realized much complex equipment donated to developing world institutions is useless when it breaks because spare parts and trained maintenance technicians aren’t available. Prospero had founded an organization called Design that Matters. He and his team realized that local people might not know how to repair high tech medical devices, but they knew a great deal keeping old cars running. So after many iterations they arrived at an incubator design that looked sleek and modern on the outside, but its insides were automotive. Special sealed headlights provided the warmth, for example, and it could be powered by an adapted cigarette lighter. Hospital employees and helpful neighbors were quite adept at keeping it in fine functioning condition.