**5. Modelling Recycled Incubators**

Recycled Incubator Technique (RIT) speaks of the successful application that most Nigerian tertiary hospitals have used to re-equip their Special Care Baby Units (SCBU) using their formally condemned or obsolete incubators. Many of these old systems were abandoned in the stores or used as ordinary cages (cots) in the Special Care Baby Units.

In the recycling technique that was designed in this study, the casings of the obsolete system were re-used but the functional assemblies of the power unit were completely reengineered with customized generic digital components. RIT incubators currently make up 80% to 100% of the functional incubators in many Nigerian tertiary hospitals at the time of this report. These included University of Benin Teaching Hospital (UBTH) Benin-City, Lagos University Teachning Hospital (LUTH) Lagos, Jos University Teachnig Hospital (JUTH) Jos, Ebonyi State University Teaching Hospital (EBSUTH) Abakaliki, Aminu Kano Teachnig Hospital (AKTH) Kano, Federal Medical Centres (FMCs) at Nguru, Gombe, Owerri, EbuteMetta and Abeokuta. Others were University of Nigeria Teaching Hospital (UNTH) Enugu, University of Calabar Teaching Hospital (UCTH) Calabar, University of Ilorin Teaching Hospital (UITH) Ilorin and University of Abuja Teaching Hospital (UATH) Gwagwalada. An RIT system comparatively saves up to 75% of the cost of procuring and maintaining a modern state-of-the-art incubator whilst being functionally akin to these (Amadi et al, 2007). RIT has presently made it possible for some

Neonatal Thermoneutrality in a Tropical Climate 521

Unfortunately, many of these that were taken away from some of the hospitals by prospective repairers were returned without success as the spare parts were no longer available. Some repairers lost or did not even bother to return the removed power-units after their unsuccessful attempts. In RIT, the casing of the power module was normally reused. However, when these could not be traced to where they were sent to or by whoever removed them, a new simplified casing was designed and locally produced. In some cases, the high aesthetic finishing of the incubator was not altered by this major reconstruction. The Airshields model C100 systems at the Ebonyi State University Teaching Hospital (EBSUTH) Abakaliki and one of the C200 models at University of Benin Teaching Hospital (UBTH) were examples of incubators that were recycled with re-engineered power module

Fig. 4. Recycled incubators, originally carcasses of (A) Airshields model C200 (B) ISIS

**<sup>A</sup> <sup>B</sup>**

Designing and developing a new assembly of an operating system to power the incubator was the most challenging step in the RIT procedure. The chain of electronic and digital communications that powered the intelligence system was generally achieved by interconnectivity of distinct units of circuitry. These were called assemblies and were generic constructs by different companies but selected and arranged by design in RIT systems (Figure 5). All used circuitry could be sourced for internationally through the internet. Specifications of input requirements and expected outputs of such units of assemblies enabled effective integration of these to achieve the ultimate incubator output during the design stage. Ability to design a functional system with this method required a good understanding of how the incubator worked and the different functions of the assemblies that powered it. A good knowledge of human anatomy and neonatal physiology were essentially applied to relate to the outputs of these assemblies to ensure the clinical suitability of the resulting system. These different assemblies or components were then purchased from their individual companies or marketers, appropriately reconfigured to design specifications and mounted in the power module casing. The various outputs, signals and actuations specified in the design were compatible with the applied transduction elements in the incubator; else design adjustments or matching transducers

casings (Figure 4).

Mediprema system

**5.5 Operating system** 

were sought for and applied.

of these hospitals to currently maintain up to 25 functional incubators whereas they could not simultaneously own up to 3 or none at all in the recent past. This has therefore been described by a Nigerian healthcare organisation as a significant contribution to national development in the Nigerian healthcare system (Committee of Chief Executives of Federal Tertiary Health Institution [CCEFTHI], 2007).

### **5.1 Original concept**

The initial hypothesis proposed that the application of generic assemblies in the rebuilding of the functional mechanisms and electronics of an incubator would drastically reduce the unit cost of incubation in low income countries. To verify and implement this, modern manufacturing techniques based on standard generic assemblies was exploited in a careful design of interfaces for the linking of the generic assemblies. Using the internet market, individual mechanical, electrical and electronic assemblies that could apply to design the functional mechanism of an incubator were cost-competitively selected. These were assembled by design to yield desired outputs necessary for effective maintenance of the unique standard conditions required in an incubator's micro-environment.

#### **5.2 Casing and trolley**

System functionality was the primary focus of the RIT, however the overall peripheral finishing must be appealing necessitating a careful investigation of the abilities of selfemployed local artesans. It was discovered that individual fabricators, welders and car painters around major cities in Nigeria were good enough in their arts such that with very close supervision these could do excellent jobs. Therefore the best of these artisans were identified and separately guided to renovate the old incubator casings and to finish these with the best possible standards.

#### **5.3 Canopy and plastic components**

There were identified artisans that worked on Perspex materials in the small and big cities. Some of these demonstrated good skills in the methods they used in their jobs. Various plastic components of different models of incubator amongst the carcasses were re-designed to be produced as spares for the replacement of the originals; the new designs being such as would be easy to fit into the crafting techniques of the local artesans. Most of the new designs therefore resulted in different shapes from those of the original incubator manufacturers. The changes in the RIT designs for these plastics/Perspex parts were necessary in order to simplify their production as required to ensure good finishing by a closely supervised artisan. The incubator hoods were assessed. Old age and handling could make some of these to become opaque after technical cleaning and must not be reused if not completely clear and transparent. Effort was hence made to reproduce the discarded hoods with locally available Perspex materials by applying simple procedures of working and reshaping of the materials.

#### **5.4 Power unit modules**

This is a detachable unit that houses the operational control elements in most incubator designs. A repairer intending to fix a broken-down incubator would normally detach and take this unit away in attempt to diagnose the source of a wrong system signal.

of these hospitals to currently maintain up to 25 functional incubators whereas they could not simultaneously own up to 3 or none at all in the recent past. This has therefore been described by a Nigerian healthcare organisation as a significant contribution to national development in the Nigerian healthcare system (Committee of Chief Executives of Federal

The initial hypothesis proposed that the application of generic assemblies in the rebuilding of the functional mechanisms and electronics of an incubator would drastically reduce the unit cost of incubation in low income countries. To verify and implement this, modern manufacturing techniques based on standard generic assemblies was exploited in a careful design of interfaces for the linking of the generic assemblies. Using the internet market, individual mechanical, electrical and electronic assemblies that could apply to design the functional mechanism of an incubator were cost-competitively selected. These were assembled by design to yield desired outputs necessary for effective maintenance of the

System functionality was the primary focus of the RIT, however the overall peripheral finishing must be appealing necessitating a careful investigation of the abilities of selfemployed local artesans. It was discovered that individual fabricators, welders and car painters around major cities in Nigeria were good enough in their arts such that with very close supervision these could do excellent jobs. Therefore the best of these artisans were identified and separately guided to renovate the old incubator casings and to finish these

There were identified artisans that worked on Perspex materials in the small and big cities. Some of these demonstrated good skills in the methods they used in their jobs. Various plastic components of different models of incubator amongst the carcasses were re-designed to be produced as spares for the replacement of the originals; the new designs being such as would be easy to fit into the crafting techniques of the local artesans. Most of the new designs therefore resulted in different shapes from those of the original incubator manufacturers. The changes in the RIT designs for these plastics/Perspex parts were necessary in order to simplify their production as required to ensure good finishing by a closely supervised artisan. The incubator hoods were assessed. Old age and handling could make some of these to become opaque after technical cleaning and must not be reused if not completely clear and transparent. Effort was hence made to reproduce the discarded hoods with locally available Perspex materials by applying simple procedures of working and

This is a detachable unit that houses the operational control elements in most incubator designs. A repairer intending to fix a broken-down incubator would normally detach and take this unit away in attempt to diagnose the source of a wrong system signal.

unique standard conditions required in an incubator's micro-environment.

Tertiary Health Institution [CCEFTHI], 2007).

**5.1 Original concept** 

**5.2 Casing and trolley** 

with the best possible standards.

reshaping of the materials.

**5.4 Power unit modules** 

**5.3 Canopy and plastic components** 

Unfortunately, many of these that were taken away from some of the hospitals by prospective repairers were returned without success as the spare parts were no longer available. Some repairers lost or did not even bother to return the removed power-units after their unsuccessful attempts. In RIT, the casing of the power module was normally reused. However, when these could not be traced to where they were sent to or by whoever removed them, a new simplified casing was designed and locally produced. In some cases, the high aesthetic finishing of the incubator was not altered by this major reconstruction. The Airshields model C100 systems at the Ebonyi State University Teaching Hospital (EBSUTH) Abakaliki and one of the C200 models at University of Benin Teaching Hospital (UBTH) were examples of incubators that were recycled with re-engineered power module casings (Figure 4).

Fig. 4. Recycled incubators, originally carcasses of (A) Airshields model C200 (B) ISIS Mediprema system

#### **5.5 Operating system**

Designing and developing a new assembly of an operating system to power the incubator was the most challenging step in the RIT procedure. The chain of electronic and digital communications that powered the intelligence system was generally achieved by interconnectivity of distinct units of circuitry. These were called assemblies and were generic constructs by different companies but selected and arranged by design in RIT systems (Figure 5). All used circuitry could be sourced for internationally through the internet. Specifications of input requirements and expected outputs of such units of assemblies enabled effective integration of these to achieve the ultimate incubator output during the design stage. Ability to design a functional system with this method required a good understanding of how the incubator worked and the different functions of the assemblies that powered it. A good knowledge of human anatomy and neonatal physiology were essentially applied to relate to the outputs of these assemblies to ensure the clinical suitability of the resulting system. These different assemblies or components were then purchased from their individual companies or marketers, appropriately reconfigured to design specifications and mounted in the power module casing. The various outputs, signals and actuations specified in the design were compatible with the applied transduction elements in the incubator; else design adjustments or matching transducers were sought for and applied.

Neonatal Thermoneutrality in a Tropical Climate 523

using the available meagre funding. This would hence create the platform to properly study thermoneutral application in a tropical busy centre. In order to keep the project focused and on course, some of the collaborating hospitals Managements were advised to adopt a 'slow but steady batch-by-batch' recycling approach. This approach allowed a hospital to put a time frame vision for the completion of the recycling of all available carcasses of incubators. The Lagos University Teaching Hospital, for example, had no functional incubators at the start of the project. Ten incubators were initially recycled; there after the Hospital Management recycled 5 more each year to achieve a fleet of 25 functional incubators in three years. This boosted patient flow and staff enthusiasm for work thereby enabling better

The good dedication of most of the collaborators soon led to the successful recycling of all available old incubators in most of the participating hospitals. However, the drive to provide adequate number for the SCBUs meant that some of the hospitals had to take another step of procuring more incubators from the market. The confidence already reposed on RIT made it possible for the Hospitals Managements to use available funds to purchase affordable systems they could easily re-power with RIT component when these failed. This hence secured a sustainable fleet of functional incubators required for the study in each of the participating Centres. The Centres were also encouraged and assisted to add one or more transport incubators in the fleet. This helped to reduce the distress some of the neonates suffered during intra-hospital transports using inappropriate and

The high neonatal admission delivery in these hospitals coupled with high influx of referrals resulted in extensive demands on the incubators. Many of these functioned continuously for weeks and months without break except when they were to be cleaned for another waiting baby. There was then need to initiate another supportive programme to guarantee sustainability of the functional status of the incubators and freedom from frequent unexpected system failures. This was ensured by the introduction, in each Centre, of a routine maintenance culture. By this the Hospital Managements allowed all the RIT systems to undergo professional functionality auditing and thorough system servicing by qualified RIT in-country technicians once in every 6 months. Some employees of the hospital's engineering department were deployed to be trained to assist in the technical upkeep of the recycled systems. This programme ensured the replacement of any damaged or damaging

It was discovered that generations of medical students and staff had come and passed on from the Units without ever practicing with a really functional incubator. This created generations of staff who knew no better than how to crudely improvise cages to do the work of an incubator. This hence meant an absolute lack of the fundamental knowledge of how to operate and nurse babies in proper incubators. There was initial 'general' staff training on how to operate the newly recycled systems. This basically familiarised the systems to the nurses, clinical staff and the engineering technicians, demonstrating the various assemblies of the machine and how it worked. The course was basic enough to introduce the system with the assumption that the attending staffs were already trained in various aspects of

investigations of the objects of this study in the Centre (Amadi et al., 2010).

**6.1 Incubator routine maintenance and functionality auditing** 

part of the incubator before this could lead to the system being run to a stop.

**7. Paediatrics incubation technique course** 

crude techniques.

Fig. 5. RIT Assembly Block Diagram (Amadi et al, 2007)
