Baby, It's Cold Outside

Students devise an incubator for poor nations: it costs next to nothing and needs no juice.

January/February 2009

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Baby, It's Cold Outside

Courtesy Embrace

In developing nations, where at least 20 million low-birth-weight babies are born every year, incubators are important lifesaving devices. The problem? They typically cost a cool $20,000, plus you need to plug them in. Two years ago, a team of Stanford students from the Entrepreneurial Design for Extreme Affordability class figured out how to take electricity out of the equation while whittling that price tag down to a mere $25; their nonprofit organization called Embrace is poised to take the idea worldwide.

Embrace CEO Jane Chen, MBA ’08, points out that 40 percent of deaths under age 5 occur during the critical first 28 days of life. Hypothermia, a common complication among low-birth-weight babies, is a significant cause of these deaths. Babies who survive may still have lifelong problems, “because during the first month when their organs should be growing, their bodies are devoted to keeping them warm,” says Rahul Panicker, PhD ’08, who is Embrace’s CTO. Health problems associated with low birth weight can include lowered IQ, early onset of diabetes, and liver disease.

An inexpensive incubator was on the “wish list” of international challenges posed to the class. Grad student Linus Liang was chosen as his team’s envoy to Nepal to assess the need in a developing nation. He saw that while urban hospitals had the standard metal-and-glass behemoths, mostly donated by hospitals in richer nations, conditions were much worse in the countryside, where 80 percent of Nepal’s population lives. Liang recalls a rural doctor’s office: “There were bullet holes in the wall, and they had a box made out of plywood with a light bulb—that was their incubator,” he says. Worse, the bulb had been burnt out for 10 years. Rural women who could not afford transportation to city hospitals sometimes resorted to wrapping hot water bottles around infants—a scalding risk—or even placing babies in ovens.

When Liang returned to Stanford, the Embrace team decided that instead of building a cheaper version of a box with a plug, they’d seek a concept that would work in rural areas without electricity, where most women give birth at home. “Technology should not be the starting point—real need should be the starting point,” Panicker says.

Embrace created a “sleeping bag” designed with a removable heating element. It’s a little like the hand-warmers used by campers. The team used phase-change material (PCM), a waxy substance that, as it cools from melted liquid to solid, maintains the desired temperature of 37 degrees Celsius (98.6 F) for four hours. The PCM is enclosed in a plastic pouch. To reheat it, mothers place the pouch beneath a metal flask filled with hot water, often a readily available energy source. “It’s a very simple concept,” Panicker says. “It essentially uses high school physics, and there are few ways it can fail.”

The concept’s simplicity extends to all its parts. To ensure that it can be repaired locally, the bag fastens with buttons, rather than zippers or Velcro. The Embrace team chose a waterproof vinyl material for the interior and a nylon exterior, both easily washable. Course instructor Jim Patell, a management professor at the Business School, says that to ease logistics and distribution costs, all class projects must be small enough to carry by backpack or bicycle. Colleen Patell, ’85, his wife, stitched many of the prototypes, and, as a mother, offered advice on how to create a snug fit for a newborn.

Making the design mom-friendly was important: Embrace hopes to encourage “kangaroo care,” the World Health Organization-endorsed practice of keeping the baby in skin-to-skin contact with the mother, sharing heat and facilitating breast-feeding and bonding. But in agrarian cultures where mothers need to return to field work soon after giving birth, holding a baby isn’t always practical. The Embrace bag operates in two modes: straps and a fold-open front let the mother carry the baby against her chest, but she also can lay the warm baby down while she works.

Headed into its sixth year, Entrepreneurial Design for Extreme Affordability draws together students from many disciplines—medicine, design, engineering, business—with the goal of creating products for impoverished areas that cost only 1 percent of their price in the developed world. Patell says it teaches deep empathy for the consumer, the ability to quickly rework prototypes, and what he calls a “laser-sharp focus on the essential needs of the user,” as well as flexible thinking. Patell points out that Embrace wouldn’t exist if Liang had been so wrapped up in talking to hospital staff about traditional incubators that he never visited the countryside.

The Embrace team has entered competitions, including those for the Piramal Prize and the NU Venture Challenge (they were semifinalists for both) and the American Express Members Project (they placed 11th among 1,190 proposals). The nonprofit organization ( has raised $150,000 in such competitions and from foundations.

Last fall Chen went to India—where 40 percent of the world’s low-birth-weight babies are born—to do further research on the design. “We have the technology, we have a product, there’s a huge need for the product,” Chen says. Embrace hopes to work with neonatal care organizations, and believes that 15 million children can benefit from its innovation within 10 years. Quoting Stanford professor and pediatrician Paul Wise, she adds, “We believe that the death of a child is a tragedy, but the death of a child from a preventable cause is an injustice.”

KARA PLATONI is a freelance journalist in Oakland.


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