When Justinian Jackson started working as a midwife in a clinic in Buzilasoga, Tanzania, pregnant women who came from different parts of the rural region to have their babies were told to bring their own candles or lamp oil to avoid being in the dark after the delivery. To bring the baby into the world, Jackson relied on ambient light from the window, kerosene lamps, or the glow of his cell phone to light the exam room.
“It was so difficult to work,” he told TakePart. “Even though there is not good infrastructure [in the town] and no proper transport, pregnant women were traveling 25 miles, often on motorcycles, to go to the big hospital to have their babies.”
The clinic in Buzilasoga is not an anomaly.
In developing countries, hospitals and health clinics are often off the grid or experience frequent power outages or rolling blackouts, forcing health care workers to treat patients in the dark or operate without power to run essential equipment.
“Reliable light has to be a first-line intervention,” says Amy Livingston, executive director of Global Health Foundation, a Denver-based nonprofit working to fund international health systems. “We can’t make any other investments in health care infrastructure unless clinics have light.”
In 2015, Global Health Foundation provided funding to install 58 Solar Suitcases, solar electric units packed into compact cases, to clinics in Tanzania, and it is on track to install 91 more in the African country by the end of the year. The Suitcases, made by California nonprofit We Care Solar, are one of the tools Tanzanians have to reduce maternal mortality. Worldwide, 830 women die every day because of preventable complications of pregnancy and childbirth; 99 percent of those deaths are of women in developing countries like Tanzania, according to the World Health Organization. Although rates of maternal mortality dropped 44 percent between 1990 and 2015, women—especially those in poor, rural areas—are still at risk. As part of the United Nations’ Sustainable Development Agenda, the goal is to reduce maternal deaths to 70 per 100,000 live births by 2030; Solar Suitcases are part of the solution.
With each installation, Livingston hears more stories about the effect of the innovation: One doctor missed a postpartum hemorrhage because he couldn’t see it. The patient survived. Another doctor told her, “Before, we were scared to work in the dark. Now we will be fearless.”
“The things we take for granted here make such a big difference there,” she says.
As cofounder and executive director of We Care Solar, Dr. Laura Stachel is not surprised that Solar Suitcases are having a powerful impact.
The California obstetrician and gynecologist witnessed the challenges facing rural health clinics while she was studying maternal mortality in Nigeria in 2008. When Stachel returned to the United States, she told her husband, Hal Aronson, a solar educator, about doctors doing procedures with cell phones in their mouths or waiting until morning to suture vaginal tears in women who delivered their babies at night.
“A lack of electricity was affecting their ability to provide care,” she recalls.
Stachel and Aronson designed a solar electric system that fit into a suitcase, which she took to Nigeria on a return trip several months later. The clinic staff were so enamored with the idea, they begged her to leave the unit behind.
“They were saying to me, ‘This can help us save lives right now,’ ” Stachel says.
That single unit led to the creation of We Care Solar, a nonprofit organization that manufactures and distributes Solar Suitcases to developing countries that lack access to a conventional power grid. Since 2010, We Care Solar has placed 1,800 Solar Suitcases in 27 countries.
Although Solar Suitcases could be used to power lifesaving equipment and improve care in all areas of hospitals and clinics, We Care Solar focuses on providing the portable devices, which now include a cell phone charger and a fetal Doppler, to maternity wards.
“There are a lot of potential applications for [Solar Suitcases], but in an effort to be very focused and effect change in a very specific way, we decided to put all of our attention on maternal outcomes,” says Kristi Raube, executive director of the Institute for Business and Social Impact at the Haas School of Business at University of California, Berkeley, and a member of the We Care Solar board of directors.
In Buzilasoga, Solar Suitcases have improved hygiene, safety, and maternal outcomes. Before the solar units were installed, Jackson delivered up to five babies per month in the clinic, and the experiences were less than ideal. If a mother had a tear during the birth, a relative had to come into the room to hold a cell phone or kerosene lantern so Jackson had both hands free for stitches.
“Even with someone holding the torch, there was still not enough light to see all of the tissues,” he says. “No one wanted to come here for deliveries. Now, with the light, we deliver 15 to 20 babies per month, and mothers know they can come here and deliver safely.”
Navigating the Need
Solar Suitcases have succeeded because the products make sense for the environment: It’s not hand-me-down equipment that was purchased—and discarded—by clinics in the developing world. The units are small, easy to install, inexpensive to maintain, and rugged enough to stand up to the challenges of the hardscrabble landscape.
“Some of these clinics are literally littered with equipment that well-meaning people send from overseas that isn’t built for those environments, and there are no strategies to keep it running, so it’s a good thing for a week or a month but not an effective long-term solution,” Raube says.
We Care Solar provides infrastructure to the clinics—it trains local technicians to install, maintain, and fix the units. To increase the odds that the equipment will be maintained, the nonprofit ensured that parts like lithium batteries and phone chargers could be sourced in the countries where the units are installed.
Just because the solution is simple doesn’t mean deploying it has been easy.
Cost is a significant barrier. Because clinics in developing countries lack the funds to cover the $3,000 price tag for each Solar Suitcase, the units are paid for through grants, individual donations, and funding through organizations like Global Health Foundation and the World Health Organization. One significant grant came from the United Nations Department of Economic and Social Affairs, which gave We Care Solar $1 million in 2015.
Once funding is confirmed, the Solar Suitcases, which are manufactured in the U.S., need to be delivered and installed. Stachel used to pack up each unit, taking them with her on the airplane and delivering them to clinics around the world. As demand grew, personal deliveries became impractical, and the nonprofit needed to start shipping Solar Suitcases. That meant figuring out customs requirements for dozens of countries.
“We had Suitcases stuck in ports around the world,” Raube recalls.
With the shipping problem conquered, We Care Solar faces new challenges.
Solar Suitcases are in high demand outside under-resourced hospitals and clinics. The units were requested in Haiti after the 2010 earthquake and in 2014 following Typhoon Haiyan in the Philippines; even outdoor companies want to sell Solar Suitcases for camping.
“A lot of nonprofits are donor dependent, but we have a product, and that creates some interesting opportunities,” Raube says. “One of the conversations we’ve had is whether it would make sense to sell a bunch of Solar Suitcases commercially to make money to fund our operations or whether to start lending libraries to deploy [Suitcases] for medical lighting after natural disasters.”
While the organization grapples with these decisions, it maintains an ironclad commitment to installing Suitcases in off-the-grid clinics to improve maternal outcomes and ensure that women don’t have to deliver their babies in the dark.
The innovation appears to be working: Health care workers like Jackson tell stories of women eager to deliver at local clinics equipped with Suitcases instead of traveling many miles to access lighted clinics, and more women are choosing to deliver their babies at hospitals instead of at home.
“Once you turn on the lights, women know there is someone there to help them,” Livingston says.