Anaesthesia and Child Birth

Try for a moment to imagine: you're in the middle of an emergency C-section and the power goes out. Your surgeon has a headlamp and tools to continue. But the machine that has anesthetized you – through which you are breathing while unconscious – is completely dependent on electricity to run properly. Quite literally your breath relies on the electric functioning of the machine, and the hospital has just lost power. Unfortunately, this scenario quickly turns routine procedures in to unnecessary tragedies. And sadly it is not a rare occurrence - the World Bank estimates that hospitals in low-income countries lose power on average 18 times per month.

It is perhaps not surprising that we don’t often think about anesthesia when discussing maternal health around the world. However, as the scenario above illustrates, it is an integral component of emergency obstetric care. And today the conventional technology that exists to deliver anesthesia simply isn’t designed to function in a setting with unstable electricity and other infrastructure challenges. Nevertheless well-intentioned donors and traditional device companies continue to donate and sell these machines that can jeopardize the life of mother and baby at an already tenuous moment.

Gradian Health, a non-profit social enterprise based in New York City, has taken steps to address the challenge of delivering anesthesia in low-resource settings by developing the Universal Anaesthesia Machine (UAM). The UAM, which they sell at their manufacturing cost to government and non-profit hospitals, was originally developed by Dr. Paul Fenton, a British anesthesiologist who worked in Malawi for 15 years, experiencing firsthand the challenges of delivering anesthesia in the context of a poorly-resourced hospital. After years of frustration and tragic outcomes, he developed the UAM, a reliable and rugged solution to safely deliver anaesthesia in any setting.

In developing the UAM, which Gradian now markets, one of his main concerns was to design a machine that functions seamlessly during a power failure or if compressed oxygen, another standard and expensive requirement for anesthesia machines, runs out. His design integrated an electrically-driven oxygen concentrator that purifies room air (free and abundant everywhere) to 95% pure oxygen.  However if the electricity goes out, the machine still uses other external sources of oxygen (from a tank or pipeline), should they be available. If the hospital has no electricity and no other source of oxygen, the UAM automatically begins to draw in room air, which is 21% oxygen, to safely deliver anesthesia. 

These design features were combined with a structure created as a series of sub assemblies to facilitate service and maintenance of the machine and a straightforward user interface to ensure that anesthesia providers of all levels of training can easily learn how to use the UAM.

We are hopeful that this newest technology can contribute to making not only emergency obstetric care but all surgical care across the world safer.

For more information, visit www.gradianhealth.org and watch Gradian Health’s Erica Frenkel speak about the design of appropriate medical technology for the developing world on Ted.com.