Too many newborns die because they are born too early, too small or too sick to breathe properly on their own. Simple medical devices can assist newborn breathing until an infant can breathe on his or her own. However, these devices are often out of reach for small clinics and hospitals.
ThePumani bubbleCPAP was designed to meet this need for Malawi and is now widely available through Maternova. We had a few questions about post-research phases of the Pumani bubbleCPAP which we posed to Jocelyn Brown, inventor of the Pumani bubbleCPAP, and Molly McCabe, Director of Product Management.
Here is the brief interview:
Do tell us where the 'densest' concentration of Pumani CPAPs is in in the globe and how many infants are being treated per month (or day or week or year)?
Pumani is used in more than 35 countries around the world. Pumani was developed in partnership with the Rice 360 Institute for Global Health, Queen Elizabeth Central Hospital in Malawi and the Malawi Ministry of Health. Pumani is now a part of the NEST 360 bundle and its biggest area use continues to be Malawi, followed by the other NEST countries of Tanzania, Kenya and Nigeria
In 2020, Pumani was recognized by the Global Innovation Exchange for impacting the lives of over a million babies.
We understand that there are specific champions of the Pumani bubbleCPAP in Malawi who maintain the training and transfer of knowledge about the device-- can you tell us how that came to be?
As described above, the partners in Malawi first proposed the idea to develop a low-cost, robust CPAP for Queen Elizabeth Central Hospital (QECH) to Rice 360, and these partners provided ongoing feedback during the Pumani design and development. The clinical study was also conducted at QECH. Since the clinical study, partners at the Malawi Ministry of Health, who have already conducted countrywide training on oxygen therapy and management of newborn respiratory conditions, became the champions of the national CPAP training in Malawi, and worked closely with the Rice 360 and QECH staff to conduct the Pumani training and distribution. (JB)
In 2019 Rice 360 and 3rd Stone Design partnered with a number of other international organizations on the NEST 360 program which aims to reduce the neonatal mortality in sub Saharan Africa by 50%. Through this program we have been able to further expand the distribution and training of the Pumani bubbleCPAP in Malawi.
When you are introducing the bubble CPAP to a nurse, midwife or physician who has never used such a device before, how long does it take for him/her to become proficient in treating an infant?
For the Malawi training, and training conducted in other countries, the Pumani training agenda is typically 1.5-2 days. This may vary, depending on the skill level of the trainees, the time available for training, and the number of trainees. But this training program covers more than just the Pumani bubbleCPAP assembly and use – it includes diagnosing newborn respiratory conditions and respiratory distress, identifying patients for CPAP therapy, what CPAP therapy is and why it’s beneficial, and how to monitor and wean patients on CPAP.
It probably takes some time following the training for a clinician to feel comfortable treating a patient with the Pumani. In Malawi, NEST 360 has set up a clinician mentoring program, so that new users can be mentored and supported by users who have been using the Pumani for years and are more comfortable.
What are the most common questions that your team gets in the training sessions for the Pumani?
The most common questions are usually related to the use of the Pumani – how to increase or decrease therapy, how to adjust the flow settings, how to maintain and repair the Pumani if any issue arises, etc. Our goal with the user manual and training materials is to make sure the assembly, use, and maintenance of the Pumani are as simple and understandable as possible, but there’s only so much information that can be conveyed via print or video. The application of the Pumani to the patient is still most easily conveyed via actual use by clinicians.
What is the optimal training scenario (and continuing education) for the bubble CPAP?
The optimal initial training scenario for the Pumani is a training prepared and conducted by local clinicians. As much as possible, we aim to support local users in their initial training – whether that’s providing training materials, training videos, explaining how other training has been organized and run, etc. In certain cases, we can offer in-person training provided by 3rd Stone Design staff, but even then, much of the training is led by a clinician familiar with bCPAP, and we provide the training on the Pumani assembly and use.
For continuing training, it is also optimal if local clinicians can provide this training and ensure that current users and new users are comfortable and familiar with the Pumani.
Maternova is working to accelerate awareness and uptake of the Pumani bubbleCPAP and will work with partners to ensure long-standing support and continuing education on this low-cost, rugged device.
Now as a next step, we ask what could be done to lower the costs of the implementation of the E-MOTIVE bundle? The most obvious answer is to consider displacing the tens of thousands of disposable plastic drapes with a purpose-built reusable device.
Fortunately one of the obstetricians involved in the E-MOTIVE study, Dr. Justus Hofmeyr, had been innovating around this very issue, designing a tray with wells that could fit under a woman’s buttocks, collect and accurately measure the. blood. This tray, theMaternaWellTraywas conceived as a device that could be sterilized and reused, and is manufactured in South Africa by Umoya.