The MGH Center for Global Health

Some 99 percent of all of the over three million deaths in the first month after birth — in the first 28 days of life, known as the neonatal period — occur in the world’s poorest countries, primarily in south-central Asia and sub-Saharan Africa. Most of those deaths happen, however, in the first week of life and are usually attributable to premature births, infections and asphyxia; the bulk of those babies had low birthweights. Because of these alarming figures, the United Nations put forth as one of its eight Millennium Develop-ment Goals to dramatically reduce mortality in children under five.

Many existing child survival programs have focused on and improved outcomes in pneumonia, diarrhea, malaria and vaccine-preventable conditions, but few have targeted neonatal mortality. Keeping newborn babies alive is the singular mission of Massachusetts General Hospital’s

Kristian Olson, MD, MPH, DTMH, a pediatrician and internist whose outside-the-box technological, research and educational initiatives have made him one of the world’s leaders in reducing neonatal deaths. He does this work in the context of his position as the program leader at the Global Health Initiative (GHI) at the Center for Integration of Medicine and Innovative Technology (CIMIT), which is affiliated with MGH.

His focus to date is on two key projects: helping babies take their first breaths — since 23 percent of neonatal deaths are a result of asphyxia — and sustaining low birthweight babies with incubators, which provide a warm, hygienic environ-ment in which to grow.

Mass General’s Kristian Olson, MD, MPH, DTMH, is pioneering efforts to reduce neonatal mortality in the developing world, where nearly four million babies die each year in the first month of life.

Keeping Babies Alive

The MGH Center for Global Health integrates research, education and front-line medical care to prevent avoidable deaths and alleviate the pain and mental anguish resulting from diseases, natural disasters, war and human rights violations throughout the world.

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Its initiatives span dozens of countries in the developing world over many medical specialties. With its base at Mass General, an epicenter of medical research and health education, the center is able to leverage the hospital’s vast resources and talent in a variety of ways to advance its agenda.

The center needs a major infusion of philanthropic investment in order to fund its programs in care, research and medical training. We hope to partner with donors eager in advancing health in the developing world, while at the same time advancing the overall body of knowledge about a spectrum of disease and health challenges.

Breathing easy

“What makes so many of these infant deaths so tragic is that many of those who die immediately after birth and are declared stillborn actually just needed help taking their first breaths,” says Dr. Olson. “Those kinds of deaths are easily preventable in the developed world because we have simple technology and training to enable these babies to breathe.” In addition to the more than three million newborn deaths, there are an additional three million deaths annually attributed to stillborn. Many of these stillborns may be misclassified and could potentially be saved, says Dr. Olson. At well-equipped hospitals, clinicians use a resuscitation device called a bag valve mask that mechanically stimulates breathing until the infant’s lungs can do the job unaided.

Several years ago, Dr. Olson developed a curriculum to treat birth asphyxia in rural areas in Aceh, Indonesia, the site of the 2004 tsunami. Within three years, he created a training network of 70 instructors and more than 500 midwives all of whom were using his curriculum to learn the methods themselves and then disseminate the training to other mid-wives throughout the region. As a result, 83 percent of those midwives can competently and confidently resuscitate a baby, as compared to 33 percent in a control group that were not trained.

He is currently seeking philanthropic support for implement-ing the program in Ethiopia, Africa’s second-most populous country with 80 million people and which has the highest neonatal mortality rates in the world. “Such a program would not only help save thousands of babies’ lives every year in Ethiopia, but would also help provide an example of how this important new program could actually be implemented on a massive scale,” says Dr. Olson.

‘First Days’ incubator

Dr. Olson’s neonatal incubator, which has been the subject of press articles and evening news shows, is an attempt to address the fact that millions of neonatal deaths worldwide could be prevented each year if clinics simply had suitable incubators for at-risk newborns. Indeed, about three-quarters of the 18 million low birthweight babies born every year die because of a lack of incubators, especially in rural areas of the developing world that lack reliable electricity to power them.

Many incubators donated by companies and aid agencies “end up in equipment ‘graveyards’ within a few years because of the lack of replacement parts or maintenance personnel, or they end up unused because of lack of local training,” he says.

He realized that the most common and reliable supply of sturdy mechanical equipment in Indonesia, where he has done field work for years, and similar resource-poor countries was car parts. So in partnership with his CIMIT colleagues and a non-profit called Design that Matters whose mission is to create health and education products in developing countries, he designed an incubator solely out of car parts. Clinics and hospital could then easily find replacement parts at minimal cost and getting them in a timely matter, precluding the need to order expensive parts from manufacturers abroad and wait for them to arrive. They can also be repaired by local handymen.

The first prototype was built using a Toyota 4Runner. The cost of the incubator is a mere $1,000, or three percent of today’s top-of-the-line incubators. It is designed so that it isn’t affected by local conditions like temperature extremes and power supply fluctuations. The incubator quickly received widespread attention.

“ What makes so many of these infant deaths so tragic is that many of those who die immediately after birth and are declared stillborn actually just needed help taking their first breaths. Those kinds of deaths are easily preventable in the developed world because we have simple technology and training to enable these babies to breathe.” — Kristian Olson, MD, MPH, DTMH