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					            CITRIS WHITE PAPER COMPETITION



          “Where There Is No Light”

Bringing Reliable Power and Mobile Communication to
  West Africa to Improve Emergency Obstetric Care




          Kofan Gayan Municipal Hospital Delivery Ward at Night




                    Laura E. Stachel, M.D., M.P.H.
                       Christian Casillas, M.S.
                          Melissa Ho, M.Sc.
                         Hal Aronson, Ph.D.
                        Andrew Sproul, B.A.
                                        April 11, 2008



TABLE OF CONTENTS

                                                                        Page Number

  I.     ABSTRACT                                                         2

  II.    BIOGRAPHIES                                                      3

  III.   PROBLEM STATEMENT                                                5

  IV.    TECHNOLOGIC SOLUTION                                             6

  V.     EVALUATION                                                       9

  VI.    ACTION PLAN                                                     10

  VII.   CONCLUSION                                                      10

  VIII. BUDGET                                                           11

  IX.    REFERENCES                                                      12

  X.     APPENDICES


         A.   Photographs of Nigerian Hospital                            14
         B.   Form for calculating electricity load at hospitals          16
         C.   Photovoltaic and Communication Equipment List and Costs     17
         D.   Sample Price Estimate from Nigerian Solar Dealer            19
         E.   Photographs of Equipment for project                        22
         F.   List of Nigerian Solar Dealers                              23




                                                                                      1
                 Improving Emergency Obstetric Care in West Africa:
Using Photovoltaic Systems to Enhance Surgical Lighting and Hospital Communication
CITRIS Team: Laura E. Stachel, M.D.1, Christian Casillas, M.S.2, Melissa Ho, M.Sc.3, Hal R. Aronson,
Ph.D.4, Andrew Sproul5

Faculty Advisors:     Dan Kammen, Ph.D. (Energy Resources Group)
                      Malcolm Potts, M.B., Ph.D, (School of Public Health)
Nigerian
Collaborators:        Dr. Oldapu Shittu6, Director, Population and Reproductive Health Partnership, Zaria
                      Dr. Muazu, Hospital Director, Kofar Gayan Municipal Hospital, Zaria
1
  DrPH candidate, School of Public Health, lestachel@yahoo.com
2
  MS/PhD candidate, Energy Resources Group, cecasillas@berkeley.edu
3
  PhD candidate, School of Information, mho@ischool.berkeley.edu
4
  Co-Director, Solar School House, hal.aronson@gmail.com
5
  Director of Product Management, Adax Inc., andrewsproul@comcast.net

Abstract
The University of California, Berkeley has long standing commitments to improving maternal health and to
developing innovative technologies to address social problems. This proposal uses renewable energy
technology to improve obstetric care in a country with one of the highest maternal mortality rates in the world.

Maternal mortality worldwide accounts for more than 530,000 deaths a year; 99 percent of these occur in
underdeveloped countries (UNFPA, 2005). Maternal mortality rates in Nigeria are among the highest in the
world, with a ratio of 1100 maternal deaths occurring for every 100,000 live births (UNICEF, 2005a). Rural
women in Northern Nigeria, most of whom do not receive prenatal care and deliver at home, are estimated to
have maternal mortality ratios three fold higher than national ratios (Wall, 1998). Major causes of maternal
death include obstetric hemorrhage, obstructive labor, eclampsia, and sepsis. These emergencies cannot
always be predicted, nor are they always preventable. Women facing obstetric emergencies require access to
prompt, appropriate and reliable medical care.

Sporadic supply electricity impairs the operation of surgical wards, delivery wards, essential hospital
equipment, and hospital communications; this compromises the ability of Nigerian health workers to provide
safe, appropriate and timely medical care. Labor and delivery nurses cannot quickly notify on-call physicians
of emergencies. Midwives and physicians often make treatment decisions without the benefit of necessary
diagnostic tests or equipment. Obstetric procedures and emergency surgeries are conducted under grossly
suboptimal conditions, and can have tragic consequences.

We propose a “proof of concept” project to demonstrate the impact that reliable power and communications
will have on addressing these problems. We will design and install a photovoltaic energy system retrofit to
power lighting, medical equipment and communication equipment in a major municipal hospital in Northern
Nigeria. The proposed system will power (1) overhead surgical lighting in areas of critical need such as the
operating room and labor and delivery, (2) mobile telecommunications between hospital staff and on-call
physicians, and (3) existing on-site medical equipment that is currently underutilized. The designed system
will be robust, durable, and nearly maintenance-free, with the goal of being easily installed in existing
hospitals and clinics, all of which have unreliable/problematic power systems. It is anticipated that improved
surgical lighting, enhanced usage of existing medical equipment, and the establishment of a sustainable
telecommunication system will reduce delays and complications in providing emergency obstetric care.
                                                                                                             2
Biographies

Student Team Members

Laura Stachel is a second year DrPH student in the School of Public Health. She is a board-certified
obstetrician-gynecologist with fourteen years of clinical experience, and holds a B.A. in Psychology with
highest honors from Oberlin College, an M.D. from UCSF and an M.P.H in Maternal and Child Health from
UCB. Her dissertation focus is on reducing maternal mortality in Northern Nigeria. Since arriving at the
School of Public Health, Laura conducted several community based projects in developing countries
including (1) a nutritional assessment of pregnant and postpartum mothers in the Western Guatemalan
highlands, (2) an assessment of the effects of fluoride varnish and dental hygiene on the incidence of dental
caries in El Salvadorean children, and currently (3) an assessment of the availability and adequacy of
emergency obstetric care in Northern Nigeria. In March 2008, Laura spent two weeks in Northern Nigeria
investigating the feasibility of this project.

Christian Casillas is a second year MS/Ph.D. student in the Energy and Resources Group. He holds a B.A.
in environmental engineering from Harvard and a M.S. in applied math from Johns Hopkins. He spent
several years doing oceanic and atmospheric research at the Johns Hopkins Applied Physics Laboratory in
Maryland before joining the US Peace Corps to teach math and science in rural Namibia, where he became
interested in renewable energy. He has worked as an engineer designing off-grid solar systems in New
Mexico, and has served as a technical advisor since 2006 for blueEnergy, an NGO in Nicaragua that builds
and installs wind and solar systems for rural villages. Christian’s current research is related to the analysis of
small wind systems appropriate for integration into diesel micro-grids in developing countries.

Melissa Ho is a PhD student in the University of California, Berkeley School of Information, and holds a
BA in Computer Science from Cornell University, and an MSc in Data Communications, Networks and
Distributed Systems from University College London. Since 2004, she has been actively conducting
research (ethnographic fieldwork and systems design and deployment) with the Technology and
Infrastructure for Emerging Regions (TIER) research group, an inter-disciplinary project funded by Intel and
the National Science Foundation (NSF) and led by Prof. Eric Brewer in the EECS department. As part of
this group, she has participated in numerous deployments including the setup of long distance wireless
communications networks for hospitals and universities in Africa and India. Her project in Ghana is an open
source tele-medicine application enabling doctor-to-doctor consultation between rural doctors and urban
specialistsus.tierstore.net). In Uganda, she is working on the use of mobile devices for information
management in the Uganda Output Based Aid health project. Her research focuses on healthcare and
telecommunications infrastructure in Africa, and is funded by the Blum Center for Developing Economies
and CITRIS (BBB'07).




                                                                                                                 3
Industry and Community Team Members:

Hal Aronson, Ph.D. obtained his PhD in environmental sociology from UCSC with a focus on
environmental justice. He has been teaching renewable energy in the Bay Area and in other parts of
California for ten years. In his current position as co-director of Solar Schoolhouse, Hal leads professional
development workshops, creates project-based learning, designs stand alone solar electric systems and
creates curriculum for students in the 4th to 12th grades. Hal installed the first legal residential solar electric
system in Santa Cruz County (in 1983) learning to make do with what was then available. He also created
California Youth Energy Services, a service learning program for adolescents that now employs one hundred
youth a year as energy-efficient retrofitters.

Andrew (Drew) Sproul is currently Director of Product Management at Adax, Inc., a company that has
provided signaling solutions to telecommunications equipment for over 25 years. Drew earned his BA in
Human Services from Western Washington University in Bellingham, WA in 1976, working with teenage
status offenders before devoting a decade to community organizing in Seattle and the Bay Area. Since 1988,
Drew has been in the field of telecommunications, focusing on infrastructure products. In addition to
working on this project, Drew volunteers for kiwanja.net (www.kiwanja.net), a non-profit foundation that
donates software and computer equipment to NGOs in health, economics, environmentalism and democratic
initiatives. Mr. Sproul’s participation was sought not for his technologic expertise but also for his business
acumen.

Nigerian Collaborating Institution:

The Population and Reproductive Health Partnership (PRHP) is an NIH-funded collaboration between
the UCB Bixby Program and Ahmadu Bello University (ABU). The purpose of this 5-year partnership is to
enhance the capacity of key departments at ABU, Zaria, Nigeria to conduct community based research
leading to innovative solutions to maternal mortality and morbidity. The PRHP carried out a baseline
demographic and reproductive health survey and exploratory ethnographic fieldwork in three communities in
Northern Nigeria. This fieldwork has emphasized the importance of reducing delays and improving the
quality of emergency obstetric care in local hospitals and health centers. The PRHP invited Dr. Stachel to
come to Northern Nigeria in March to collaborate with them on their work on improving emergency
obstetric care.




Note: The above authors consent to public, online dissemination of this white paper.




                                                                                                                  4
PROBLEM STATEMENT
Delays in Obtaining Emergency Obstetric Care
Maternal mortality worldwide accounts for more than 530,000 deaths a year. Ninety-nine percent of maternal
deaths in underdeveloped countries; over half occur in Africa alone (UNFPA, 2005). Maternal mortality
rates in Nigeria are among the highest in the world, with a ratio of 1100 maternal deaths occurring for every
100,000 live births (UNICEF, 2005a). This ratio is 100-fold higher than that in the United States (UNICEF,
2005b). Despite efforts to reduce maternal mortality subsequent to the 1987 Safe Motherhood Conference,
limited progress has been made in this field (Maine and Rosenfield, 1999).

The great majority of maternal deaths are from easily treatable conditions that include obstetric hemorrhage,
obstructive labor, eclampsia, and sepsis. These emergencies cannot always be predicted, nor are they always
preventable. Women facing obstetric emergencies require access to prompt, appropriate and reliable medical
care. As Judith Fortney (2001) states, “Maternal mortality is perhaps unique among public health problems,
in that its reduction depends upon treatment rather than the prevention of illness.”

The vast majority of Northern Nigerian women deliver at home, with minimal supervision from unskilled
attendants (Galadanci, Ejembi, Iliyasu, Alagh, & Umar, 2007). When complications arise, families must try
and obtain emergency care. After the difficult and costly decision is made by an impoverished family to
bring a laboring woman to the hospital, the family must locate a facility that has the capacity to provide
appropriate emergency care for obstetric complications.

A series of verbal autopsies conducted in three Northern Nigerian communities by the PRHP has revealed
that rural families often travel to several hospitals before finding appropriate care (D. Perlman, personal
communication, March 13, 2008). Hospitals may be ill equipped to care for critically ill obstetric patients.
Lack of electricity at night, and the inability to contact appropriately trained personnel often cause a heatlh
care facility to turn away patients in need.

The Nigerian Energy Sector and Hospital Care
Nigeria has an abundance of petroleum-based energy resources and is the fifth largest supplier of oil to the
U.S. Sadly, the revenue generated from this natural resource has to date, had limited impact on rural
populations. (EIA, 2007) In fact, rural populations in Northern Nigeria are among the poorest in the world.
Only 40% of Nigerians have access to electricity. (EIA, 2007.) Those with access to electricity face frequent
power outages. Virtually all state institutions, including hospitals, are without reliable electricity due to a
combination of energy blackouts and difficulties affording fuel to supply privately owned generators
(Sambo, 2005).

Hospitals Suffer from Lack of Reliable Electricity
Northern Nigerian hospitals often lack a consistent, reliable, affordable energy system with which to provide
clinical services. Because or the intermittent availability of electricity, operating rooms often function
without overhead light or suction machines, autoclaves are unable to sterilize instruments, diagnostic
equipment (such as an ultrasound and laboratory machines) lay dormant, and delivery rooms rely on
kerosene lamps for nighttime illumination (Stachel, field research in progress).

Inefficient communication is another problem in these settings. There are no landlines for phones within
many hospitals. Individual staff members may have cell phones, but network coverage is inconsistent and
unpredictable. When emergencies arise, nurses rely on available staff members to physically track down on-
call physicians. This results in miscommunication and tragic delays in emergency care.




                                                                                                                  5
Experience in One Northern Nigerian Hospital
Dr. Stachel spent nine days observing emergency obstetric care in Kofan Gayan Municipal Hospital in
Northern Nigeria in March 2008. Though the Nigerian state of Kaduna recently authorized “free obstetric
care,” the municipal hospital was ill equipped to provide adequate emergency services. Included among the
many observed deficiencies: there was no reliable source of electricity, the back-up generator depended on
fuel which was often too costly to be purchased, there was no phone or intercom system, and there was no
running water. Photographs are presented in Appendix A.

Labor and delivery nurses could not quickly notify on-call physicians of emergencies. Midwives and
physicians could not consistently utilize machinery that relies on electricity to perform diagnostic tests.
Daytime surgeries and deliveries were conducted using ambient lighting from the windows. At night time,
surgeries were performed by flashlight or critically ill patient were referred to other institutions resulting in
additional delays. Delivery rooms utilized kerosene lamps for nighttime illumination. A fully functional
ultrasound machine went underutilized because the electricity source for its use was unreliable. The
laboratory could not store blood products because there was no consistent source electricity for a blood bank
refrigerator. These constraints occurred despite the fact that this hospital is the major municipal hospital in
the city of Zaria.

The absence of reliable electricity and hospital communication systems resulted in substandard clinical
practices as the following observed vignette illustrates.

A young pregnant woman arrived in severe pain at labor and delivery after prolonged labor at home. A
quick assessment by the nurses led to the presumed diagnosis of uterine rupture and a fetal demise.
Clinically, the patient appeared to be hemorrhaging internally, and was going into shock. The only course of
action that would save her life was an emergency surgery to repair her ruptured uterus. The nursing staff
sent a staff member to look for the on-call physician. An attempt was made to find a suitable family member
to donate fresh blood, as no blood was banked in the hospital. The first unit of collected blood was found to
be the wrong blood type; this resulted in additional delays. After two hours passed which included several
unsuccessful attempts to locate the physician in the hospital, the U.S. researcher drove to the doctor’s home.
The doctor was unaware that a critically ill patient was waiting in labor and delivery. With the doctor’s
attention, the obstetric patient was prepped for emergency surgery. However, due to a lack of electricity, the
emergency surgery she needed was conducted in an operating room without overhead lighting or suction.
The absence of surgical lighting and suction compromised the ability to visualize the uterine laceration that
needed repair. Thankfully, this patient survived. However, without the unusual outside intervention that
occurred, she probably would not have survived.



PROPOSAL FOR A TECHNOLOGIC SOLUTION
Photovoltaic Energy to Power Lighting and Communication Equipment in Hospitals
Solar power provides an appealing alternative for electricity needs in Northern Nigeria. Solar energy is a
renewable resource that requires no fuel, is non-polluting, and is well suited to the sun-rich Nigerian climate
(Sambo, 2005). Solar electric (photovoltaic) modules are warrantied for 20 years and have a life expectancy
in excess of 40 years. They are designed to withstand the punishment of extreme environments.

We plan to create a solar electric system that integrates solar charging, battery power storage and efficient
electrical lighting to fit hospital needs. This system will provide essential lighting for medical and surgical
procedures, and a charging station for a mobile communication system to improve hospital communication.
The system will be tested in a particular municipal hospital in Northern Nigeria, but will be designed to be
reproducible for other medical facilities that have unreliable sources of electricity.
                                                                                                                  6
For this “proof of concept” pilot project, information will be gathered on electricity loads required by the
operating room, labor and delivery room, and laboratory of the hospital under study (Appendix B). We will
then come up with a “menu” of solar energy systems that can meet different levels of energy need,
depending on available resources. The systems will be designed as packages that are simple to deliver,
assemble, and maintain.

       1) Lighting: The lighting system will be based on installing a parallel DC light system in prioritized
       rooms, such as the operating, labor, and delivery rooms, where high quality light is essential for
       adequate medical treatment. Using DC lighting eliminates the possibility for inverter failure and
       improves overall system efficiency by removing inverter conversion losses. The DC lighting will be
       installed in parallel with the existing AC lighting system in the hospital. The system will utilize high
       efficiency lighting: compact fluorescent for general room lighting and an LED spotlight for focused
       operating lighting. Our aim is to have highly efficient lighting that will continue to operate even when
       minimal power is available.

       2) Communication Equipment: A DC battery charger will be installed in the operating room and
       delivery room to enable the facility to always have a supply of charged batteries for the walkie-
       talkies.

       3) Parallel AC Capacity: Small loads that require AC electricity (such as suctioning equipment) will
       be powered by small inverters plugged into DC outlets. These will be installed in the operating room
       as well as the labor and delivery room.

       4) Power for Larger AC Load: Power for larger AC loads such as refrigeration and laboratory
       equipment will be determined once we gather more information on the power demands of these
       items.

A simple well-designed solar electric system is well suited to this area because it requires little or no
maintenance. While solar modules last decades, and inverters should last over 10 years, batteries will require
more frequent attention. Depending on battery type, the system is predicted to run for 5-7 years before
requiring a replacement battery. The type of batteries that will be selected for this system will depend on
budget, local availability, and size of battery required. We aim to design a system that will be robust,
because it is understood that maintenance may be lacking in these facilities. We will explore the advisability
of linking this system to the existing electric grid for auxiliary charging.


Proof of Concept: Kofan Gayan Municipal Hospital System Design
The municipal hospital in Kofan Gayan is located in the state of Kaduna which lies at a latitude
approximately 10 degrees north of the equator. This means the sun will be overhead much of the year; and
makes it an ideal location for a photovoltaic system.

The hospital itself has several units housed in separate buildings. Units include Outpatient Services, Inpatient
care (Gyn, Maternity, Pediatrics, Adult Male), an Operating Theatre (consisting of three active operating
rooms, a recovery room, and offices), Maternity and Delivery (consisting of a four bed labor and delivery
area, a sixteen bed maternity ward, and a three bed eclampsia ward), and the Laboratory (which provides
selected blood tests and prepares blood collection for fresh blood donations). The Operating Room is several
hundred feet from the Maternity and Delivery Ward.



                                                                                                               7
(1) Operating Room.
      a. The operating room will have its own stand-alone solar electric system (Figure 1). It will be a
          300 Watt PV system with 1.4 KW-Hrs of battery storage This will power four 15 Watt DC
          fluorescent lights in the operating room and one 10 Watt LED spotlight for the operating
          room table.
      b. Equipment that requires AC power (such as suction) will be powered by mini-inverters run
          off of the solar electric system.
      c. The communications equipment will have a dedicated outlet for battery charging. The
          batteries will be used for charging communications equipment.




           Figure 1. Stand-Alone DC Photovoltaic System
           Photographs of specific equipment are included in Appendix E.

(2) Labor & Delivery Wards
       a. The labor and delivery room, which is adjacent to the maternity ward in a building that is at
          significant distance from the operating room, will have a separate stand alone solar electric
          system. It will be 200 Watt PV system with 1.4 KW-Hrs of battery storage. This will power
          four 15 Watt DC fluorescent lights in the maternity ward and two 15 Watt DC fluorescent
          lights in labor and delivery for ambient lighting, as well as an LED spotlight for deliveries and
          procedures.
       b. Equipment that requires AC power will be powered by mini-inverters run off of the solar
          system. This includes the ultrasound machine.

(3) Mobile Communication System
      a. This proposal offers a simple solution to the problem of faulty, unreliable, or non-existent
          communications systems within hospital compounds as well as shorter distances beyond;
          walkie-talkies. Commercially available walkie-talkies, at about $50 each will be distributed
          to on-duty hospital staff (see Appendix C and D). This would include nurses most closely
          involved with the patients, on-call doctors (who reside within 1 mile of the hospital), and
          administrators or other hospital staff who hold the keys to locked operating rooms. With a
          reliable range of 2 miles and optimal ranges up to 25 miles, staff members can be reached at
          all times. Rechargeable batteries will keep on-going maintenance costs low and security
          features can be used to ensure privacy and safety. The specific model chosen for the proof of
          concept project also features a hands-free speaker phone option that could be used to (1)
          enable physicians to talk to patients to improve early diagnosis and (2) talk staff through
          unfamiliar procedures while help is on the way.


                                                                                                         8
Local Capacity
We will investigate the availability of local photovoltaic (PV) equipment and installers in Nigeria and
determine the quality of their service and equipment. We would like to work with local installers to increase
development of regional capacity in Northern Nigeria and to utilize local knowledge and experience. We
have made contact with three companies that work in Nigeria (Appendix F), and estimates of the cost of a
sample PV system that would power lighting in the operating room and delivery room (using American
supplies) are included in Appendix C. An estimate of equipment and installation costs provided by two
Nigerian suppliers is included in Appendix D. Estimates from all three companies will be obtained, and
along with PRHP we will make a final choice based on a comparison of equipment cost and quality, as well
as the reputation of the supplier and installer.

EVALUATION
Interviews will be conducted before and after the PV/communication system installation with hospital
personnel to evaluate the interface between the medical staff and the power/communication system.

Pre-Intervention: Using a combination of open-ended and directed questions, PHRP staff will document
electricity and rapid communication needs of doctors, nurses and additional hospital staff. We will document
the frequency and severity of unmet need for operating and delivery room lighting, specific medical
equipment, laboratory testing, and emergency communication.

Log of System Functioning: We will ask the operating room manager and the delivery room charge nurse to
record the solar system battery charge at the beginning and end of each day, and to record the weather
conditions that day. We will review this log after several weeks of data collection to assess the adequacy of
the system in meeting the electricity demands of the O.R. and L&D under a variety of weather conditions.

Post-Intervention: Six weeks after the installation of new solar equipment, communication equipment and
training of hospital personnel, interviews will be conducted to assess the functionality of the
PV/communication system and its adequacy in meeting clinical needs. We will inquire about the ease of use
of the system and difficulties that hospital staff may have encountered. We will assess whether hospital staff
members have had to adapt clinical activities due to reduced battery storage during rainy days, or whether
the system provides ample power in spite of weather fluctuations. We will also investigate whether hospital
staff members have utilized the solar energy system to meet additional electricity needs. (For example,
charging lap top computers may be an attractive use.)

We will investigate whether the communication equipment has reduced delays in providing emergent care to
obstetric patients, and whether the system is being used in other departments of the hospital. We will see
which members of the hospital staff have found the walkie-talkies to be of most use, and will inquire about
problems encountered with use of the equipment.

Based on this evaluation, we will modify the PV/communication equipment at the pilot hospital within out
budgetary constraints. We will also use this information to guide the design and development of
PV/communication systems that could be replicated in additional hospitals.




                                                                                                                9
ACTION PLAN
We plan to install this system at the Kofan Gayan Municipal Hospital this coming summer. We have made
contact with the hospital director, the director of the Ob/Gyn department, the laboratory director, and our
collaborators at PRHP, all of whom are eager for the project to proceed. We have requested information on
specific load requirements of hospital equipment at Kofan Gayan Municipal Hospital in order to design an
appropriate system. We also plan to provide practical solar energy education to the facilities manager so that
he will be able to understand the system and provide the minimal maintenance necessary to ensure its long-
term functioning.

In Berkeley: We will collect additional information from the pilot hospital on electricity load and room
specifications to enable a final design for the solar energy system. We will test out sample solar energy
systems and communication devices in Berkeley to ensure that the system we create will have maximum
utility in Africa. For example, Dr. Stachel will test several energy-efficient LED spotlights to decide which
ones hold the most promise for surgery and obstetric procedures. We will collect and compare prices and
quality of equipment from several solar energy companies that serve Nigeria, and will facilitate plans for
installation at the hospital. We aim for a system with maximum efficiency and minimal cost. We will finalize
the pre- and post-installation questionnaire. All of our time and much of the equipment will be donated for
this phase of the project.

In Northern Nigeria: At least one member of our team and one member of the PRHP will provide on-site
supervision for the installation process and will train hospital staff to utilize the equipment effectively.
While the American members of our team will volunteer our time in Nigeria, we will require travel expenses
for one team member. Another team member will participate in the evaluation process (along with a PRHP
member) using travel funds from a separate research project. The bulk of the award will be used to purchase
equipment for the hospital PV installation and communications equipment. The capacity of the PV system
will be enhanced to include electricity for laboratory equipment at Kofan Gayan Municipal Hospital if our
award exceeds the amount listed in our budget.

CONCLUSION
Reducing maternal mortality by three quarters between 1990 and 2015 is one of the Millennium
Development Goals. Most countries in Africa and South Asia are far from achieving this goal. Women know
that childbirth is dangerous but they often avoid going to a clinic or hospital when one is accessible because
the quality of care is so poor, and they are aware of the almost total lack of functioning equipment. Efforts to
reduce maternal mortality will fail if childbearing women cannot obtain prompt, competent medical
treatment when they face life-threatening complications.

Aside from clean water, electricity is the single most important service any medical facility needs (and even
clean water often involves an electric pump.) This project utilizes the promise of solar energy to provide a
low-cost system for improving hospital personnel communication and a robust photovoltaic energy system to
provide electricity for hospital diagnostic equipment and surgical lighting. It is anticipated that together,
these interventions will substantially improve outcomes for the critically ill mothers who require emergency
care.

The CITRIS award will allow us to field test the functionality of a solar energy/communication system under
day-to-day hospital conditions in West Africa. The evaluation of this pilot project will be used to guide the
development and implementation of this concept, maximizing system efficiency and function while
minimizing costs. Ideally, our aim is to design a system that can be replicated in many hospitals facing
similar conditions.


                                                                                                             10
BUDGET

(See Appendix C for specific breakdown):

Item                                   Units      Cost per Unit   Total Cost
Materials for PV/Communications                                   $   250
Testing in Berkeley
Motorola Walkie Talkies                6          $50             $ 300
Photovoltaic System for O.R.           1          $3700- $5200    $ 4,450
Photovoltaic System for Delivery and   1          $2600 - $3100   $ 2,900
Maternity Ward
Storage Cabinet for Battery Bank       2          $400            $    800
Travel and Per Diem Costs              1 person   $3000           $ 3,000
TOTAL                                                             $ 11,700




                                                                               11
REFERENCES

EIA (Energy Information Administration). 2007. Country Analysis Briefs: Nigeria: Electricity.
Accessed March 31, 2008 at http://www.eia.doe.gov/cabs/Nigeria/Electricity.html

Fortney J. (2001). Emergency obstetric care: the keystone in the arch of safe motherhood. International
Journal of Gynecology & Obstetrics 74:95-97.

Galadanci, HS, Ejembi, CL, Iliyasu, Z, Alagh, B, and U.S. Umar. (2007). Maternal health in Northern
Nigeria – a far cry from ideal. BJOG 114:448-452.

Maine, D and A. Rosenfeld. (1999). The Safe Motherhood Initiative: why has it stalled? Am J Public Health
89(4):480-2.

Sambo, A. S. (2005). Renewable energy for rural development: the Nigerian perspective. ISESCO Science
and Technology Vision 1:12-22.

UNFPA. (2005). Maternal Mortality Figures Show Limited Progress in Making Motherhood Safer.
Accessed April 6, 2008 at http://www.unfpa.org/mothers/statistics.htm.

UNICEF (2005a). At A Glance: Nigeria Statistics. Accessed April 2, 2008 at
http://www.unicef.org/infobycountry/nigeria_statistics.html

UNICEF (2005b). At A Glance: USA Statistics. Accessed April 2, 2008 at
http://www.unicef.org/infobycountry/usa_statistics.html

Wall, L. (1998). Dead mothers and injured wives: the social context of maternal morbidity and mortality
among the Hausa of Northern Nigeria. Studies in Family Planning 29(4):341-359.




                                                                                                          12
APPENDIX A. Photographs of Conditions in Kofan Gayan Municipal Hospital in Kaduna State,
Northern Nigeria




Operating Ward Building at Kofan Gayan
One story structure facilitates solar panel installation.




Operating Room at Kofan Gayan.
Lack of electricity resulted in inability to utilize surgical lighting (visible in photo and not functioning), and
failure to utilize suction during surgery. (Suction improves visibility and safety during surgical procedures,
and prevents blood from spilling onto the operating room floor.)




                                                                                                                 13
Figure 4. Labor and Delivery Room at Kofan Gayan.
Three delivery beds are shown in the right of the picture.
There is no overhead lights and no focused lighting for deliveries.
The air conditioner doesn’t operate due to lack of electricity.




Figure 4. Physician at Kofan Gayan Municipal Hospital trying to assess
fetal viability by Pinard Stethoscope rather than by using an ultrasound machine,
which was available in the hospital but could not be used due to lack of electricity.




                                                                                        14
APPENDIX B: Form to Assess Electricity Load with Existing Hospital Equipment

Medical Equipment    Voltages       Amperes         Hours of     Hours of
                                                    Daytime Need Nighttime
                                                                 Need
Operating Room Equipment
Operating Room
lights
Operating Room
Suction
Recovery Room
Lights
Operating room
Autoclave
Maternity and Delivery
Maternity Ward
Lighting
Maternity Ward
Ambient Lighting
Delivery Room
Procedure Light
Suction Machine
Newborn Incubator
Ultrasound Machine
Autoclave
Laboratory
Domestic
Refrigerator
Blood Bank
Refrigerator
Autoclave
Electrophoresis
Machine
Ceiling Fan
Warm Bath
Machine to Distill
Water




                                                                               15
APPENDIX C: PV and Communication Equipment and Estimated Costs

Projected Equipment for Operating Room (300 watt system, American pricing)

   Equipment                   Quantity        Cost per Item    Total Cost
   Solar electric              2                         $750       $1500
   photovoltaic panels:
   150 watt, 12 volt
   Deep cycle maintenance      1                         400          400
   free batteries
   12 volt, 108 AH or
   (Concord)
   Charge controller           1                         300          300
   60 Amp
   (Morningstar Tristar with
   Display)
   Load center:                1                        ?350          350
   Midnight Solar
   Wire:                                                 200          200
   various sizes
   Miscellaneous parts                                                200
   Compact fluorescent         6                          20          120
   bulbs:
   12 volt DC
   Mini-inverters (can be      2                         300          600
   plugged into the DC
   system to power AC
   loads) 300 watt
   High Intensity LED task     1                         200          200
   lighting
   DC light fixtures           4                          25          100
   DC receptacles              4                          25          100
   Conduit                                                            250
   System steel enclosure                                             800
   Trimetric Battery Monitor   1                         200          200
   Total Cost                                                       $5120




Labor and Delivery Room Projected Equipment Costs
   Equipment                   Quantity        Cost per Item    Total Cost
   Solar electric              1               $400                   $400
   photovoltaic panel
   80 watt, 12 volt
   Deep cycle maintenance      1               400                    400
   free batteries
   12 volt, 80 ah or
   2 X 6V 40 AH
   Charge controller:          1               250                    250
   45 Amp with display
   Morningstar Tristar
   Load center:                1               200                    200
   Midnight Solar

                                                                             16
   Equipment                      Quantity            Cost per Item         Total Cost
   Wire:                                              100                          100
   various sizes
   Miscellaneous parts                                                              200
   12 volt DC compact             6                   200                           200
   fluorescent bulbs
   Procedure light                                                                  200
   12 volt
   DC light fixtures              4                   25                            100
   DC receptacles                 6                   25                            150
   Conduit                                                                          100
   Mini-inverters (can be         1                   150                           150
   plugged into the DC
   system to power AC
   loads) 200 watt
   System steel enclosure                                                          400
   Trimetric Battery Monitor      1                   200                          200
   Total Cost                                                                    $3050

Maternity Ward Addendum
To add ambient lighting to Maternity Ward, we could run lighting off of the Labor and Delivery (L&D) solar
system. To do this we would assume a system need of three 20 watt DC compact fluorescents for 5 hours,
requiring an additional 300 watt hrs of power. This would necessitate doubling the size of the L&D solar
power system. To add 60 watts of solar panels, 60 amp hrs of battery, and enlarge the charge controller to a
minimum of 30 amps, plus wiring and fixtures, would total $1200 of additional costs.



COMMUNICATION SYSTEM EQUIPMENT
This would be powered off of batteries charged by the solar energy system in the O.R. or L&D.

Equipment              Quantity                Cost per Unit           Total Cost
Motorola Walkie        6                       $50                     $300
Talkie
Battery Charger        2                       $30                     $ 60


EQUIPMENT FOR TESTING SYSTEM DESIGN IN THE U.S.

Equipment              Quantity                Cost per Unit           Total Cost
10 Watt LED            1                       99                      $100
Floodlight
Walkie-Talkie          1–2                     50                          100
Rechargeable sealed    1                       Will be loaned by Hal   -
battery                                        Aronson
Solar Panels                                   Will be loaned          -
Charge Controller                              Will be loaned          -
DC Receptacles         2                       20                        40
Total Cost                                                             $250

We will test functionality of the LED light for surgical procedures, ease of system use, functionality of
mobile telecommunications system, ease of charging, and adequacy of power and illumination.
                                                                                                            17
APPENDIX D: Sample Equipment and Labor Costs from a Nigerian Solar Company




                                                                             18
19
20
APPENDIX E. Pictorial Presentation of Equipment for Solar Electric Hospital Project

Stand Alone System Designed to provide for DC ambient and focused lighting and to power small AC
loads using plug in sine wave inverters.

Note: Solar Electric System Components not to scale. Brands of components pictured may or may not be the
                                    actual ones used in the system


Solar Array




                                                           Combiner Box




                                                                                  Charger Control




Energy
Monitor


                                                                                Mini-sine wave inverter


              Load Center




                                                 Battery AGM




                                                                                                     21
Mobile Communication Equipment (Walkie-Talkies)

Motorola TALKABOUT SX800R Two Way Radios
The Motorola SX800R is a high powered, feature packed two way radio that is perfect for the extreme
outdoors. With 2 full watts of power, the SX800R is capable of delivering up to 16 miles of range (under
optimal conditions). The Motorola SX800R supports the iVOX hands free feature, which makes the SX800
acts as a speaker phone, allowing you to use your hands for other activities. Support for NOAA weather
channels is also provided, allowing you to access continuous local and regional weather broadcasting.

The SX800R radios support all 22 FRS and GMRS channels with an amazing 121 interference eliminator
(privacy) codes per channel. This model also offers a channel scan feature, your choice of 10 normal call
tone alerts, and a backlit display.

This value pack includes two Motorola SX800 two way radios, one dual-pocket desktop charger, and NiMH
rechargeable batteries for each radio, and two belt clips.




                                                                                                            22
APPENDIX F: Solar Energy Companies that currently do Installations in Nigeria




   Green Energy LLC through GESOLAR, a Middle East supplier of solar products. From their website: We provide
   reliable and cost effective solar solutions for road, airport, marine, industrial (oil and gas, telecommunication),
   commercial, government, military, rural development, residential and customised applications. We offer
   products that are proven to work under rugged weather environments and meet the highest industry standards.

   •   Address: Ground Floor, Office # 9 -12, Dubai Creek Tower, Deira, Dubai, United Arab Emirates. Offices in
       Afghanistan, Algeria, Angola, Burundi, Brazil, Congo, Djibouti, Eritrea, Ethiopia, Gambia, Ghana, India, Iraq,
       Kenya, Malawi, Mozambique, Nepal, Niger, Nigeria, Oman, Pakistan, Peru, Philippines, Puerto Rico, Saudi
       Arabia, Senegal, South Africa, Sudan, Tanzania, Uganda, USA, United Kingdom, Yemen, Zimbabwe 120599
   •   Telephone: 9714 2282 456 / +97150 4376527
   •   FAX: 9714 2215 234

   Solar Power International Ltd
Wholesale, Retailing, Import and Export of Solar Renewable Energy Products for a Large to Small scale levels.
Large Grid-Connected Sytems for Large Business Enterprises Off-Grid Solar Home Kit Water Pumping System
Telecommunication System Gate or Fence Chargers Street LED Lighting System In UK, Africa and Asia

   •   Address: 235, Ikorodu Road, , lupeju, POBox 965 Marina Nigeria Lagos
   •   Telephone: +009. 07930846550/ +4400234. 80231252
   •   Web Site: http://www.solarpowerinternational.co.uk




            African Energy

African Energy is a specialized distributor of solar electric and power back-up equipment focusing exclusively on
the African market. We sell only to Africa, and concentrate primarily on serving the needs of renewable energy
companies based there. Because of our specific focus, we receive exceptional pricing from the manufacturers we
represent, and we understand the challenges of doing business in Africa. Door to door shipment, 24-hour service,
flexible payment arrangements, and the continent's best prices. We carry Trace/Xantrex, Outback, Photowatt, GE
Energy, Morningstar, Steca, Suntech, Southwest Wind, Surrette, Deka, Sundanzer and other fine brands.

   •   Address: 237 S. Miller Lane, P.O. Box 664, Saint David, Arizona USA, Tunisia, Morocco, Senegal, Gambia,
       Guinea (Conakry), Mali, Burkina Faso, Ghana, Nigeria, Cameroon, Chad, Congo (DRC), Angola, Namibia,
       Zimbabwe, Zambia, Malawi, Rwanda, Tanzania, Kenya, Uganda, Ethiopia, Algeria, Sierra Leone, Liberia,
       Niger, Gabon, Madagascar, Mozambique, Burundi, Djibouti, Somalia 85630
   •   Telephone: 1-520-720-9475
   •   FAX: 1-520-720-9527
   •   Web Site: http://www.africanenergy.com
   •   E-mail: Send Email to African Energy




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