Do you ever wonder what keeps environmentalists and humanitarians going? It is stories like the story of Laura Stachel & We Care Solar, and organization that provides light to medical facilities without electricity.
Zachary Shahan, Director & Chief Editor of CleanTechnica, earlier this year had the opportunity to interview Laura E. Stachel, M.D., M.P.H., who together with her husband Hal Aronson, Ph.D., co-founded We Care Solar to improve maternal health outcomes in regions without reliable electricity. We Care Solar had nearly won a Zayed Future Energy Prize award and Solar Sister Founder Katherine Lucey, BNEF Founder Michael Liebreich, and Zachary were enjoying dinner and CleanTechnica interviews after the awards ceremony.
Laura starts by explaining, “We Care Solar is bringing small, compact, very rugged solar electric systems to maternal health facilities in the developing world. I am an obstetrician-gynecologist. I got very concerned several years ago when I realized that women were dying in childbirth around the world at extremely high rates. Half a million women were dying every year from complications of pregnancy and childbirth. That is the same as two 747s filled with pregnant women crashing to the ground every single day.
“In my own profession as an obstetrician, I always thought that birth was a happy event. It was one of the fields of medicine that I was most attracted to because I loved the joy that came about with both pregnancy and childbirth. So to realize that women around the world were fearing childbirth because they knew it was so risky was something that very upset me. I started studying public health.”
As a graduate student in public health, Laura went to northern Nigeria to learn more about the causes of maternal mortality in 2008.
“I was sent to study maternal mortality in Nigeria. Nigeria accounts for 2% of the world population, but 11% of maternal deaths were coming from that country alone when I first went in 2008.
“I spent time just observing care in a large national, a state hospital. And, every day, I would spend 10 to 12 hours watching nurses and doctors as they cared for patients. I had realized that they weren’t going to have all the equipment and all the technology that we had in our American hospitals, but what hadn’t occurred to me before I went there was that they wouldn’t have electricity — for at least 12 hours of every day.
“So, what does it mean not to have electricity when you are in a hospital? It means that you might be doing deliveries at night by candlelight or by kerosene lantern. It might be that midwives have to cancel procedures or doctors are trying to do C-sections when the lights go out. Or they can’t even do a C-section at all because the entire operating room is in darkness. It means that they can’t store blood in a blood bank. So if someone comes in bleeding, hemorrhaging from a complication in pregnancy, they can’t get an immediate blood transfusion.”
Childbirth can appear to be healthy, but in seconds, a life-threatening crisis to the mother and child may arise. Interventions to keep the mother and child alive become necessary, immediately. One cannot delay responding to the need for skilled support and risk losing a mother or infant. Without lights for the birth and electricity for the birth attendants, the surgeon, physician, or midwife nighttime can become deadly.
Laura continues, “If you are a baby being born and you need to be resuscitated, there is no equipment relying on electricity that can be used. Or there if you need to use diagnostic equipment, it can’t be used. And I was in this hospital with nurses and doctors that were actually quite skilled. But they were crippled because that could not use a lot of their skills when the electricity was down.
“I happened to be married to someone who’s a solar educator, and I began writing letters home to him, my husband Hal Aronson, explaining different scenes that I was seeing in the hospital and how upsetting it was. And he suggested that when I came back home from Nigeria, he could design a solar electric system that would help the hospital.
“So, I came back to the states. At that time, I was a public health student at UC Berkeley. I actually entered a competition that was supporting technology for a social good. We designed the solar electric system targeting the parts of the hospital most likely to be affecting pregnancy outcomes: the maternity ward, the laboratory, the labor and delivery room, and also the operating theater.
“And we didn’t win the prize that we wanted to from that competition. We came in as an honorable mention, but someone who was one of the judges at the competition called me that night and said, ‘I think you should have won. How much money do you need for your project?’ And within three weeks he had gotten us money from the Blum Center for Developing Economies at UC Berkeley. And we were able to do this project.
“So we did bring in a solar electric system”
Zach notes, “That’s what you call judge revenge!”
Laura continues, “So, we did bring in a solar electric system and the hospital was transformed. Women could get care throughout the night. They were able to store blood because we brought a blood bank refrigerator there.”
Blood loss is rapid, and life-threatening in some deliveries. Immediate control of bleeding and blood transfusions can be critical for survival.
Laura continues that after that, “with solar electricity, surgeries could be conducted day or night. And over the next year, the maternal deaths at the hospital went down by 70%. And they were no longer turning away women at night.
“At that point, we didn’t have an organization. We just had done one project, and I thought we were done. But many people began coming to me saying, ‘Why are you only helping the big hospital? We’re also in the dark.’
“One of the things that my husband had done at the beginning of our first project was he created a small demonstration kit that I can pack inside my suitcase to show doctors and nurses what we were thinking about for the larger solar electric installation. And when we began getting requests from outside clinics, we began to wonder: Could we repurpose that demonstration kit into an actual solar electric kit that could be used in hospitals? And that’s called the Solar Suitcase. Each time I’d go back to Nigeria, I would pack one or two solar suitcases in my luggage and bring them to clinics there.”
Zach laughs, “You might have used the word smuggle.”
“Well, actually, it had to be small enough to fit inside my regular suitcase because I thought someone’s going to stop me for having batteries and wires. We had walkie-talkies, a solar panel. I said if anybody were to find us — find me — I’m going to go to jail with this. But that was in the earlier days before TSA was quite as invasive as they are right now.”
Laura continues, “We helped several health centers. And then, Nicholas Kristof wrote about us in the New York Times. Soon, we got requests from around the world. And we realized that the problem I was identifying in Northern Nigeria …”
Zach interjects, “Do you know how Nicholas Kristof picked up the story? Did you have a connection feed the story?”
She says, “So, what happened was I went to a global health conference and he was the keynote speaker. And I went to him afterward and said, ‘You know, you really inspired me.’ I talked about a story I’d read that he had written about him personally giving blood for someone who was hemorrhaging in a hospital and I told him how much his stories affected me … and then I gave him just a piece of paper describing our project, and then by the next day, he had written a blog about us. I didn’t realize that, but I started getting donations and requests to our little organization.”
Zach chimed in, “He’s wonderful, he’s really a great one.”
She continued, “He’s helped us a number of times.”
“Because there was another time: He had a competition called Half the Sky, where he was looking for stories of women development organizations. He was going to give copies of his book Half the Sky to authors of the top 3 stories. Out of something like 700 entries, we were number 523, but we were one of the groups selected. And the interesting thing about that was there was no money involved. But at the time, I had been applying repeatedly for grants from the MacArthur Foundation. And after we won Nicolas Kristof’s competition, we got a call from the MacArthur Foundation saying ‘Hey, congratulations for winning that. Would you resubmit an application again?’ And that was the winning application that gave us the money to start manufacturing solar suitcases and doing this in scale.”
“And this was when?” Zach inquires.
She continues, “That was about 2010. We had been doing a few of these by hand. We used to make these in our backyard with sort of an assembly line of neighbors and friends that help us put these together, these solar electric kits.
“And we did a lot of rapid prototyping. So one of the things that was interesting at the time was that we would look at what were the points of failure of existing solar electric systems and what things failed in our own handmade solar electric systems. And by having many prototypes in the field, we were able to start isolating which things needed to be improved and which things were working well. And it really affected the design process.”
Zach remarks that he was surprised to find out that they created their own lights.
Laura explains the issues: “Well, the light creation happened just a couple of years ago. We actually had worked with a company that was doing lights for bus stations. And we thought that is a pretty rugged type of light — it has to be in the elements for a while and they put them also in submarines. But it turned out when we used them in Nigeria, when the systems would be very high voltage — the lights were designed for 12 volts, but because the sun is so strong sometimes, the systems would go up to 14 volts, and that actually overpowered those lights. And some of the LED lights burned out. And so we realized that there wasn’t a good — this is very technical now, there’s no heat sink. And we needed to find a way to dissipate some of the heat. We redesigned the lights so they would be able to work with 12 volt systems even when the voltage went up to 14 volts without getting overheated.”
Zach jokingly invites more technical notes: “We’re called CleanTechnica, we like the tech stuff too. You highlighted that the light is a certain quality that is ideal for surgery.”
Laura continues: “We really wanted a light that was going to be good enough to do C-sections with. And we started working with people at Lawrence Berkeley National Laboratory that were light experts to help us think about how to assess the lights. And then we would test them in the field and I wanted to make sure that nurses and doctors could do things like start IVs, deal with hemorrhaging, and deal with doing surgeries, and so the lights are excellent. And many of the surgeons who work with us tell us they’re the best lights they work with, so they prefer it to the lights in the hospital.”
Zach points out that they also made sure they weren’t so breakable, they were sturdy, leading Laura to confirm that as true. And that led to filling another need for such reliable, rugged solar electricity — people began to ask for solar suitcases after natural disasters. The amount of design put it into that rugged, durable quality led to more success stories of solar suitcases after natural disasters, such as ones Nepal, the Philippines, Haiti, and Puerto Rico suffered — only to mention a few, but there were more and other natural disasters, such as earthquakes, typhoons, etc.
Zach continues his interview with an appreciation of how the company has focused so effectively on technology. At this time, he acknowledges that We Care Solar is producing 1,000 Solar Suitcases a year and asks about exponential growth moving forward.
“We would love to exponentially increase scale but one of the things that we’re doing is we are not just dropping off technology. We are actually training people, training people to use things well, training people to install them well, training people to maintain them. And we’re doing this in some of the most difficult places of the world to reach. So, for example, we might be doing a program where the roads got washed out during the rainy season. And so we can’t do anything for several months while we wait for them to be repaired. And so it has really limited the extent to which we can just start dispersing these.
“One of the things we did initially was we were fairly opportunistic and if someone wanted 10 solar suitcases in one country and 20 in another, we would try and respond to that.
“Now we are trying to do deeper penetration in fewer countries. It is a better way to create supply chains. it is a better way to have a workforce that can help with both installation and maintenance.
“And most recently we started an initiative that’s called ‘Light Every Birth.’ And that’s a countrywide initiative to basically ensure that every government health facility has reliable lighting and essential electricity for childbirth both for mothers and for newborns. And so we’ve first got Liberia to sign on with us. And we’ve already equipped more than 300 health facilities in Liberia. And next we are going to be doing Uganda, and we are also looking at other countries in West and East Africa to join this initiative.”
Zach asked Laura if they are involved in partnering with other large organizations: “One of the things that we’re doing is that we are piggybacking onto existing maternal health programs where there may be a group where, like, UNICEF or UNFPA or Pathfinder that are working on trying to empower health workers or maybe bringing in the appropriate equipment. But they have not tackled the electricity part of the equation.”
Zach asks, “Or they just don’t have as good of a product?”
Laura continues, “Electricity using clean energy just hasn’t been one of the central parts of most maternal child health programs. We are trying to change that. … We are trying to create the two silos of energy and health and say …”
Zach comments, “They are just delivering and expecting that there’s going to be…”
And Laura jumps in again, “It’s not their core area of expertise.”
Laura explains more. We Care Solar is focused also on strengthening weaker parts of existing support systems. “So, we’re basically filling in an area that seems to have fallen through the cracks. Yet it is so vitally important to try and save the lives of mothers and newborns. If you save the life of a mother, it is much more likely that her child will survive the first year of life. It’s more likely that her children will be able to attend school and have better nutrition. She can be a much more productive person in the community.”
Zach expresses that Laura’s humanitarian work and her stories are giving him chills. “It’s just a hard thing to think about someone losing their mother at childbirth. … There is a tendency to shut off when you hear something so sad. To shut off and not think, ‘What’s the scale of the problem, how can we help?'”
Zach asked Laura to revisit her initial inspiration.
She said as that graduate student at UC Berkeley, when she was invited to Nigeria to work on a project to study hospital emergency obstetric care, she experienced the power outages and witnessed health workers using candles and the kerosene lamps as the electricity was out — but there was one particular experience, one image she could not shake. It was observing a woman in a coma from pre-eclampsia on a table with no one able to help.
She explains, “Eclampsia is where you have high blood pressure because your blood vessels constrict. That increases the blood pressure. It shuts down blood flow to the brain, to the lungs, to the kidneys, to the liver. Her kidneys had shut down. She was in a coma. Every time she took a breath, her lungs were rattling. And in my hospital, in the United States, she would have been in an intensive care unit.”
Laura explains, “Here, she was on a metal table with no monitors in complete darkness. And I sat in the corner of the room thinking, ‘She is going to die tonight. And I feel totally helpless.’ Here I am a physician, studying public health; I had no idea that women could be trying to fight for their lives in utter darkness. And I said, ‘These women are dying in silence.’ And I asked myself, ‘Why am I here watching this right now?'”
Zach said it’s horrible, and Laura responds, “Yea, I did, I called it a chamber of horrors. So why am I here? Maybe I can be a voice for these women who are dying in silence.”
By some miracle, the woman actually survived. Laura acknowledges that experience changed her life forever. Laura may have felt helpless that night, but it seems she is a doer as well as a healer.
She says, “Now our organizations have worked in 20 countries.”
Laura has collected stories from midwives, from around the world. Among her birth stories are stories of how a mother’s birth experiences and life changed — stories of birth before and after the addition of the solar lights.
We Care Solar believes it is vitally important to save the life of the mother, and then you also save the child. The World Health Organizations, WHO, worked with We Care Solar in Liberia and had seen first-hand the difference in maternal health that light and power can make. “This is sunshine saving lives.”
Another story shines a light on the broader need of all health issues in crises — and the impact of the solar suitcases and solar lights.
Laura trained a doctor on Skype from We Care Solar in California (to use the solar suitcase). Dr. Jacques Sebisaho was flying from New York City to his clinic in DR Congo, after being trained on its use by Skype. He was to call her for more instruction as soon as he returned to his home. She never got the call from him that she expected a few days later. She felt the suitcase may have been confiscated. Weeks went by.
She got his call five weeks later. He said, “I’m so sorry that I didn’t call right away. That night I got to my clinic and I used the solar suitcase to deliver a woman with twins and that was great. But the next day there was an outbreak of cholera. For the next 30 days, I took care of 122 fathers, mothers, and children.”
He said, “In the past, I used to lose half my patients to cholera.” He said, ‘”80 percent of the deaths happened at night.”
He said, “I used the solar suitcase and for the first time in the history of our island, no one died. We are witnessing what light in our communities means when the night means death to those in need of care after the sun goes down.”
Now they have light for the clinic at night, not darkness. Before, in a cholera epidemic, he lost half of the community. But with the Solar Suitcases in the latest epidemic, he lost no one. I had to write this again.
As of September 2018, We Care Solar has deployed 3,400 Solar Suitcases in health centers in Africa and Asia, lighting up deliveries for more than 1.7 million mothers and their newborns.
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