Med School Professor Assists Vietnamese Babies

Four years ago on a medical mission, Steven A. Ringer, an assistant professor of pediatrics at Harvard Medical School, came to the startling realization that babies were dying because Vietnamese hospitals lacked a basic technology.

Ringer, who makes semiannual trips to Vietnam with a California-based nonprofit called Project Vietnam, says that he and other American doctors were immediately struck by the dearth of respiratory assistance equipment in the country’s neonatal units.

“When we got there, we could see that one of the significant problems is they don’t have much in the way of machines or resources to do respiratory support,” Ringer says. “Needless to say, you can imagine, it was a bit stunning because I knew, if they were in the U.S., how easy it would be” to save the babies’ lives, he adds.

The Vietnamese hospitals lacked a basic device called Continuous Positive Airway Pressure (CPAP), which can provide lifesaving respiratory support for newborns, especially those born prematurely. Ringer says this simple technology consists of a tube that is inserted in the baby’s nose and used to supply pressurized air to help an infant breathe and keep his or her lungs from collapsing.

But while using the technology is simple, Ringer says that convincing Vietnamese doctors to adopt CPAP required Project Vietnam to overcome some obstacles.

After redesigning CPAP in 2002, Project Vietnam was able to introduce the technology in Hanoi.

“We were able to decrease the mortality rate for premature babies in the first 24 hours from 35 percent to 10 percent” during trials at the National Hospital of Pediatrics in Hanoi, says Ringer.

BUILDING NEW LIFE

After realizing the gravity of the situation in Vietnam during his mission in 2000, Ringer and his colleagues tried to convince local doctors to implement CPAP in their home country. The Project Vietnam contingent was able to garner some curiosity about CPAP through exhibitions using crude prototypes of the equipment.

“We got some interest but some resistance” to the idea after demonstrating its use with the rudimentary machines, Ringer says.

But while many of the Vietnamese doctors were interested, says Ringer, they also wondered how they would repair CPAP machines if they malfunctioned and how they would afford replacement parts from the United States or other developed countries if the need arose.

“They were resistant to investing in a machine that they wouldn’t be able to fix if it broke,” Ringer said.

Ringer then realized that in order to convince Vietnamese hospitals to start using CPAP, he and his colleagues would need to create a form of the technology that could be developed, assembled and maintained within Vietnam.

A fellow member of Project Vietnam stepped up to the task of carrying out this challenge.

“We had an engineer who was part of our group, who agreed to actually live [in Vietnam],” Ringer says.

The engineer, Kirk Evans, developed the machine on site using parts available in Vietnam, while members of Project Vietnam and American neonatologists worked with him on a long-distance basis. In 2002, Evans created a version of CPAP that could be produced and maintained from within Vietnam. The new version costs only $400 to $500 in Vietnam, while CPAP usually costs $6,000 or more in the industrialized world, according to Ringer.

Once the new CPAP was developed, Ringer, Evans and other members of Project Vietnam had to convince local doctors that the technology actually worked and would be affordable.

After two years, there are about 100 machines in operation, which have treated over 2,000 infants. These machines save two to three babies a day, estimates Evans.

Evans, who still lives in Vietnam, commends Ringer’s commitment to the cause.

“The thing that makes him stand out over so many other visiting doctors here in Vietnam, is his long term commitment,” Evans writes in an e-mail. “He continues to come back, and each time his understanding and advice is more appropriate and focused.”

Ringer says CPAP has now received approval from Vietnam’s Ministry of Health, and Project Vietnam is currently in the process of spreading the technology throughout the country—a procedure made easier by increased interest from officials at other hospitals who have heard of the dramatic results of the trials in Hanoi.

“I think we’ll probably face different issues…in less sophisticated hospitals,” Ringer says, noting that some Vietnamese hospitals probably do not have the right oxygen hookups that can be connected to the CPAP equipment and that doctors will have to learn how to use the technology.

But Quynh Kieu, the chairperson of Project Vietnam, says that the low cost and relative simplicity of the technology will play a key role in its spread to rural areas.

Kieu says that the Ministry of Health’s endorsement of CPAP is important because the ministry is the only source of medical resources and direction in the country. The Vietnamese government has adopted newborn care as a priority and hopes to have a newborn unit in each of its provinces by 2010.

Like Evans, Kieu says that she has been impressed with Ringer’s commitment.

“He has fulfilled beyond my expectations his promise of being, for the long term, involved with [Project Vietnam’s] neonatal program and leading it,” she says.

Once CPAP becomes widespread throughout Vietnam, Ringer and Evans hope to bring it to other developing countries as well.

“I expect I will have a long term working relationship with [Ringer] to save babies, hopefully all over the world,” Evans writes.

—Staff writer Matthew S. Lebowitz can be reached at mslebow@fas.harvard.edu.