Final Verdicts
I am very excited that I will be leaving one unit of the bili-lights and the incubator at RFM. I am so glad that the devices are in great hands. The road wasn’t smooth; there was hesitation from a few pediatricians during the pivotal meeting. I understand their concern at the lack of a license; there is no safety net for them to fall back on if something happens. At the same time, I am extremely grateful for the understanding and backing of the SMO, Dr.Bichung and the head of pediatrics, Dr. Getahun, for acknowledging that the risks are minimal. Dr. Getahun even shared my private suspicion that the bili-lights might be safer and more efficient than what they are currently using, as I have checked both the wavelength and the intensity of the lights. Dr.Bichung, a medical researcher himself, empathized with the new technologies and their plight. Fear will always be associated with them, but for any technology to be successful, an institution has to pilot it. It is a balance of understanding the facts, acknowledging the risks and finally, trust. I am honored for the last one.
I had the opportunity to personally drop the bili-lights off at the neonatal ward with Dr.Getahun. It was the perfect chance for a demonstration and training session with the nurses. Although the device is not difficult to use, it is essential that it would be used correctly—to have the baby’s eyes covered at all times, to check the intensity of the light. I think most accidents happen as results of misconceptions or misunderstandings. The nurses’ excitement made me giddy with excitement as well. They liked that the device was portable and can be propped right on top of the incubator. It saves them the trouble of moving the baby from an incubator to an open bed underneath the florescent light; they must then carefully monitor the temperature of the room, which is more troublesome and costly than setting a temperature for an incubator. The concentrated area of irradiation was also a plus for them. The fluorescent lamp was too much a diffused source of light; I already saw cases where babies’ eye covers had slipped off and no one, not even the mothers, noticed. I did stress that the eyes must be covered at all times under the bili-lights, but the fact that the device mainly irradiates the baby’s truck and lower limb regions does minimize the risk of eye exposure. They were especially excited about the bili-meter; they passed it around and tested it on the fluorescent lamps. We found that the because the babies were placed so far underneath the lamps, the irradiance was low—at about two to five µW/cm2/nm—compared the standard of 15 µW/cm2/nm for mild cases of jaundice. Before I left, they were already discussing ways they could change. Like a mother, I watched with anticipation and wistfulness as the bili-lights got settled, with instructions written on the box on how to use it and the evaluation sheets placed next it for the nurses to fill when it is in use. The people at RFM are so friendly and open; I really hope we can continue to work with them in the future.
As for the incubator, I have to give thanks and gratitude for the workers and owners—the Irwins– of Woodmaster. As foreigners in Swaziland, Elizabeth and I really had no idea where to buy all the materials—wood, drills, screws; even if we did, we had limited forms of transportation for shipment and limited time to build the incubator. When I contacted Mr.Irwin at Woodmaster, he jumped into the project with enthusiasm. It is heart-warming to meet people who can see the potential of this project and is willing to lend a hand to achieve it. A big hand in this case. Woodmaster single-handedly build the incubator for us, ordering and assembling the wood, glass and wiring. Free of charge. I wished I had my camera with me when I saw the finished product; it was sturdy, beautiful, professional and much better than anything Z and I probably would have built. Mr. Irwin is definitely interested in collaborating with us on the project once it reaches the mass production phase and I do hope our paths will cross again.
In my previous entries, I had talked about MGH. Unfortunately, I was not able to convince them to pilot the bili-lights and the incubator. As it is right under the government’s nose, the hospital cannot accept any technology that does not have a stamp of approval from recognized agencies. I jumped all the hoops I could, but sometimes the effort just doesn’t equal the result. I meet with the doctors who directed me the SMO who lead me to the Biomedical Department where I individually meet with heads. I was to learn that at the very least, the devices needed to go through the South African Bureau of Standards. I appreciate the time everyone at MGH had taken to listen to me. They liked the projects, but as THE referral hospital in the country, they have much to lose from a new technology.
Leaving on a positive note, I was extremely glad and excited to have caught the deputy director, Dr. Mohammed Mahdi, of EGPAF in Swaziland three days before I leave. The foundation has a huge reach across Africa and a big reputation, at least in Swaziland. It funds about 70% of the equipment in maternity wards here as a part of their PMTCT sector. The meeting was wonderful. As a pediatrician himself, Dr. Mahdi understands the need for the cost-effective alternative technologies and is very interested in their potential. The foundation would be a powerful partner and I really can’t wait to see what the future will unfold.