In the US, postpartum hemorrhage is rarely deadly. Most women here deliver in hospitals, where blood transfusions and other life-saving interventions are readily available. Yet in the remote regions of Nepal, where nearly 80 percent of women deliver at home, often without a skilled midwife or other attendant, pregnancy complications like postpartum hemorrhage make giving birth a risky proposition.
Telluride residents and world-wandering physicians Nancy Kerr and Mark Hauswald are working to change that, with their invention of an innovative yet deceptively simple device that could save women’s lives in even the most isolated corners of the planet.
The Circumferential Abdominal Pelvic Pressure device, CAPP, utilizes three mountain bike inner tubes that are wrapped around a patient’s torso and legs with sheets and inflated with a bike pump to apply direct pressure to slow the flow of blood into the uterus. With its easy-to-construct design and straightforward operation, the device has such potential to play a significant role in women’s health in the developing world that it was one of 89 applications recently selected, from a field of 2,500, for a $100,000 grant from the Bill and Melinda Gates Foundation.
“This has major utility in low-income parts of the world, where there may not be many alternatives,” Hauswald says of the CAPP device, on which he and Kerr have been working for the last three years.
Conceptually, the device works along the lines of Military Anti-Shock Trousers (MAST), delivering direct pressure over a large area of the body to help slow internal bleeding therein, staving off hypovolemic shock and subsequent death.
The perils of postpartum hemorrhage in the third world is important to the husband-and-wife medical team (she’s an OB-GYN, he’s an E.R. doctor), who both have degrees in tropical medicine.
They met while working on the Navajo Reservation nearly three decades ago, after which Kerr started a private practice in Albuquerque and Hauswald worked as associate dean of the University of New Mexico Medical School (they have now retired from those posts).
When not working in Albuquerque, the two traveled on medical missions to the planet's furthest reaches – Africa, Southeast Asia and, most recently, Haiti, where they were deployed as members of New Mexico’s Disaster Medical Assistance Team to provide medical care to victims of the January 2010 earthquake.
They make an annual trip to Nepal, which is where they will now concentrate their efforts in exploring the effectiveness of the CAPP device.
Working in far-flung clinics and hospitals lacking even the most basic tools and supplies that are found in any American hospital has given the duo insight into issues facing third-world health care, which is how their concept for this effective yet low-tech device evolved.
There is another device designed specifically for use in cases of postpartum hemorrhage, which has been studied in low-income parts of Africa, but using non-inflatable neoprene cuffs, it is costly to make and difficult to clean.
“I thought, couldn’t we make something that was easier to use and less expensive to make?” Kerr remembers.
Hauswald, meanwhile, participated in MAST research early in his career, and while working on the Navajo Reservation saved one woman’s life by applying the MAST apparatus to slow her postpartum hemorrhage.
“So it was always in the back of my mind that something like this would be useful,” Hauswald says.
They discovered they didn’t need much beyond a few bike tires, a couple of sheets and an average bike pump to create a device that would mimic the results of the neoprene device – manufactured at a much lower cost and utilizing instruments that can be found almost anywhere.
The CAPP device has been put through a number of preliminary tests, passing those tests with flying colors. Last year Kerr and Hauswald, with the support of the University of New Mexico (the entity through which they applied for the grant), conducted a study of the device, using ultrasound machines to measure the amount of blood flowing into the uterus while it was affixed to a patient. They found that the CAPP device reduced the flow of blood by two-thirds, whereas the neoprene device reduced blood flow by only one-third.
Now, they’re hoping to get more positive feedback that the device really works. The Gates Foundation grant will enable the couple to take three separate trips to Nepal, beginning in August. The objective of the first trip is to train 60 health care providers, 40 midwives and 20 hospital staffmembers in the use of the device. They will then interview the providers and nurses in two subsequent trips, to gather feedback on the CAPP device’s efficacy in the field.
They introduced the CAPP device to a limited number of physicians and midwives in a trip to Nepal last November. During that trip they met with a midwife who hiked for a day, then took an hours-long bus ride to attend the gathering, in hopes of learning more about this new, potentially lifesaving device.
She later told Kerr and Hauswald that a 22-year-old patient had died from postpartum hemorrhage the week before. “Maybe, with this device, I could have saved her,” she had explained.
“It was really the midwives in Kathmandu that convinced us to go for it – that this really was valuable,” Hauswald says of the duo’s newfound mission to gather more research about their invention.
Following their travels to Nepal, in which they’ll be joined by research partner Dave Wachter of the University of New Mexico Global Health Program, Kerr and Hauswald hope to have evidence that the device performs in real situations. Their next step will be to start applying for grants to study the CAPP device in a larger-scale clinical trial.
Although thrilled about the $100,000 grant from the Gates Foundation, that's just enough to plant initial seeds. The doctors are optimistic, however, that their CAPP device could effect global change.
“There needs to be across-the-board acceptance of it as a viable method,” Kerr explains, underscoring the massive effort (and financial resources) it will take for the CAPP device to become an accepted instrument for midwives and physicians working in low-resource areas around the world. “It won’t replace other things, like pitocin or uterine massage… but where those are either not available, or don’t work, this could offer another option.
“It’s just one more thing midwives can have in their kit – all it is is a bike pump, a few inner tubes and some sheets – and since it’s highly portable, and doesn’t require electricity, it could really serve a purpose when other interventions are either not available or have been exhausted.”