DESIGNING A TRAINING TOOL FOR ASSEMBLING A BUBBLE CPAP
volunteering programme ICRC & Philips Foundation
Year 2019
THE SITUATION AND THE ICRC’S APPROACH
Prolonged conflicts continued to have severe consequences for people in Afghanistan.
In the south, where the fighting remained especially intense and the geographical terrain is difficult, people had limited access to basic health care. Children were put at further risk of contracting life-threatening diseases such as pneumonia, owing partly to the cold weather, chronic malnutrition and lack of access to clean water, sanitation and adequate living conditions.
According to the Afghanistan Health Survey 2018, pneumonia remained to be one of the leading causes of child mortality in the country.
The challenge
Medical interventions in MRH are not high tech - what is available is emergency stabilization, x-ray, labs, blood bank, operating theatre (with regional, GA and spinal anaesthetics), airway support is limited to ambubag, and oxygen mask/cannula. IV fluids, antibiotics and basic BP support medication, monitors are available for temp, BP, 3 lead ECG and SpO2, confidence in the machines is low - even though ICRC has spent many hours on training and appropriate use.
There is no mechanical ventilation or CPAP. Tank Oxygen is available but no compressors for air. ICRC aims to support the hospital to a level that can be sustained by the MoPH if ICRC is no longer the main source of support.
Children suffering from pneumonia have difficulty breathing. They rely on airway support to keep their lungs open and to help them rest and recover from the illness. However, commonly available solutions to provide airway support are expensive and too complicated to implement in the Mirwais Hospital.
DESIGNING A TRAINING TOOL FOR ASSEMBLING A BUBBLE CPAP
After discussing various options and taking into account the local context and capacities, we decided to pursue a simple yet sustainable solution for providing children with airway support.
With advice from the clinical paediatric team at the hospital, we focused on developing a training tool to guide hospital staff on the proper set up and use of improvised Bubble Continuous Positive Airway Pressure (CPAP) for newborn infants and children suffering from severe breathing complications.
The improvised Bubble CPAP would make use of air instead of high-flow oxygen; with a simple design and technology and made from basic materials already available at the hospital, it would be easy to use, low cost and appropriate for young children.
“From a paediatrician’s perspective, paediatric airway support in the Mirwais Hospital is far from optimal. With this very good CPAP learning tool developed by the Philips Foundation Volunteers, newborns and infants admitted to Mirwais Hospital with breathing complications stand to benefit so much from a properly set up CPAP, an essential component of their treatment.”
– an ICRC health delegate working in the Mirwais Hospital
To promote self-learning, the training tool in English and Pashto is printed and displayed in the paedriatric ward; clinical trainers will use it when instructing staff in setting up the Bubble CPAP. The tool was tested by the ICRC and delivered to the Mirwais Hospital.
Project team: Lloyd Spencer - Product Designer, Pittsburg, Pascal de Graaf - Project manager, Eindhoven, Amir Abdolahi - Research scientist, Andover, Aline Mittag - Healthcare Transformation Services, Hamburg
Special thanks to Fred Oola, Gail Corbett and Rudina Turhani from ICRC, YuJin Lee for the artwork, Marjolijn Heslinga, EdouardnGebski, Alissa Millenson, Victor de Boer, Bart de Vries, Benjamin Loppnow, Helle Ullerup.