Preemies and Programming
Implementation of Technology in the Neonatal Intensive Care Unit to Promote Positive Health Outcomes
by Maggie Wick
A Legacy of Inequality
Friendly houses line the suburbs situated just beyond the grounds of the University of Cape Town. Walking through the winding streets, it’s impossible to miss the blooming flowers and branches of fruit trees hanging low with pomegranates and lemons. These days - in contrast to Minnesotan winters - can only be characterized by sunshine, warmth, and beauty. Yet (for reasons apart from the weather, the oceans, the mountains, and the endearing accents) I can’t help but contemplate the juxtaposition of Macalester’s cozy neighborhood with these Cape Town suburbs. Maybe this is because of the cold, tall, metal fences - often accentuated with barbed wire - surrounding the friendly houses, each and every one. See, the beauty that so often defines Cape Town is masked only by the inequality that plagues the city, and the country of South Africa as a whole. In 2018, the World Bank deemed South Africa the world’s most unequal society, with the top 10% owning 70% of the nation’s assets (Baker, 2019). While multifaceted, the root of the inequality lies in the legacy of apartheid, a system of segregation that, while dismantled 26 years ago, continues to manifest in unemployment, poor education programs, a collapsing public health system, and the lack of affordable housing. In Cape Town, 60% of the population - nearly all black - live in townships and informal settlements, a stark contrast to the gentrified coastlines boasting stately mansions owned by wealthy whites (Ibid, 2019).
My Work
I spent six months living and studying in Cape Town. During this time I was a frequent visitor in the neonatal intensive care unit (NICU) at Groote Schuur Hospital (GSH). GSH is a government-funded teaching hospital that provides tertiary level neonatal intensive care, obstetric, and antenatal services primarily to those living in informal housing settlements on the periphery of the city where most face overcrowding, unemployment, and poverty. It was here, in the NICU where I worked as a research assistant in collaboration with researchers in the computer science department of the University of Cape Town (it should be noted - the implications of this research, namely of a white, American, undergraduate student working within this space were an important consideration as I conducted this research); our research focused on the utilization of technological intervention to support mothers of preterm infants.
Our Purpose
New parents with infants in the NICU face days, weeks, sometimes months of uncertainty as their child fights for their life. For low-income mothers, like most at GSH, uncertainty is compounded by the disparities leading to inequitable health outcomes. For these parents, feelings of powerlessness, despair, and exclusion are not uncommon. In addition, mothers often feel unprepared to care for their new baby, unsure of how to transition out of the NICU and into their homes. As such, education, in addition to significant emotional support, is necessary in preparing parents to care for their new infants. Yet, for NICU staff, a focus on the infant’s wellbeing often takes precedence over tending to these parents, leaving limited opportunity for provision of necessary support. This is where our research was focused - on providing the support and education that was otherwise lacking.
The Role of Technology
Information and Communication Technologies (ICTs), including mobile phone apps and the use of Short Messaging Services (SMS), have been used to assist, support, and empower parents with premature infants (Doron et al., 2013). Many such interventions have been designed and successfully implemented -- apps like “My Preemie”, “My NICU Baby”, and “PreeMe+You”. However, little work has been done to designing such technologies in a developing world context. In cases of preterm birth, stark inequalities exist in survival rates between low-income and high-income countries, and half of the babies born at or below 32 weeks die largely due to a lack of access to cost-effective care (World Health Organization [WHO], 2018). ICTs offer the potential to bridge these gaps. The application of ICTs toward social, economic, and political development, referred to as Information and Communication Technologies for Development (ICT4D) in fields such as medicine, can often mean the difference between life and death. ICTs harnesses the potential to provide efficient modes of accessing, communicating, and storing information, thus playing a crucial role for health outcomes. Thus, our focus was on the development and application of ICTs to enhance communication between mothers and NICU staff, foster support, and promote increased maternal and neonatal health outcomes.
Bridging the Gap
While my lack of knowledge in computer science rendered me a less than ideal candidate for technology development, my public health background added a critical perspective to the development process. My research consisted of hours spent talking with mothers, attempting to gain a deeper understanding of the issues they were facing, their concerns, how they dealt with the challenges that come with being a parent of a premature infant. The resources they had, the resources they wish they had, etc. I talked with nurses and doctors, asking similar questions and attempting to gauge where and how our work could be of the greatest benefit. I worked to compile these viewpoints to help ensure that the technology to be developed would be something that parents could access and would want to access. While my limited time in Cape Town meant I was unable to see an end result, I was able to gain an incredibly valuable perspective regarding the implications of inequity on health outcomes. While the technology is still in the works, a bigger picture emerges: our health and wellbeing is manifested in the environments in which we live, grow, work, and play. Nowhere has this been more clear than in the NICU at GSH. For many infants, discharge looked like a life of poverty. Health conditions aside, a lack of support, resources, and opportunity paints a picture of poorer outcomes across the board. Helping new mothers is one small step that we can take to ensure proper care and support, however, the research should not - can not - stop there.
Maggie Wick
Hi and welcome to my page! My name is Maggie Wick, I'm a senior at Macalester College studying Neuroscience and Community and Global Health. I came to Macalester from rural Eyota, Minnesota where I grew up surrounded by cows and corn. I'm so grateful to have had the opportunity to live in St. Paul, and, while at Macalester, have spent lots of time exploring the Twin Cities. Outside of the classroom, I've enjoyed finding time to volunteer and work at the Minnesota Department of Health. I'm also lucky to have been able to continue my hockey career with the renowned Macalester Club Hockey team and to have spent a semester abroad in Cape Town - where I was able to work on this research project.
Sources
Baker, Aryn. “What South Africa Can Teach Us as Worldwide Inequality Grows.” Time, Time, 2 May 2019, time.com/longform/south-africa-unequal-country/.
Mburu, Christine W., et al. “Co-Designing with Mothers and Neonatal Unit Staff.” Proceedings of the Second African Conference for Human Computer Interaction on Thriving Communities - AfriCHI 18, 2018, doi:10.1145/3283458.3283487.
Wanjiru Mburu, Christine Wanjiru Mburu, et al. “Using Experience-Based Co-Design Approach to Improve Communication between Mothers of Preterm Infants and NICU Staff.” 2018.