Jane Chen is racing against the clock, again. She knows well how every minute that passes is crucial for a new life that emerges prematurely into the world in the most vulnerable of circumstances — in the midst of war, in the aftermath of a natural disaster or in a remote village far away from a medical center.
Acutely aware of the deepening crisis between Israel and Gaza, Chen is mobilizing her team at Embrace Global, a nonprofit she co-founded to help save babies' lives, in a way that's become second nature to her.
Embrace, based in San Francisco, California, makes low-cost portable baby incubators that don't require a stable electricity supply.
The Embrace incubator resembles a sleeping bag, but for a baby. It's a three-part system consisting of an infant sleeping bag, a removable and reusable pouch filled with a wax-like phase-change material which maintains a constant temperature of 98 degrees F for up to eight hours at a stretch when heated, and a heater to reheat the pouch when it cools.
Chen said the pouch requires just a 30-minute charge to be fully ready for reuse. "This is really ideal for settings that have intermittent access to electricity, which is a lot of places where we work in the world," she said.
According to the UN Population Fund (UNFPA), an estimated 50,000 pregnant women currently reside in Gaza, 5,500 of whom are due to give birth in the coming month.
The stats are startling to Chen, who is bracing for a swell of need there. She's learned how access to incubators becomes critical in conflict areas through the organization's efforts to donate 3,000 Embrace incubators with the help of UNICEF to doctors and hospitals in Ukraine where a war with Russia rages on. The nonprofit also sent the devices to Turkey and Syria after devastating earthquakes there earlier this year.
Medical experts point to elevated stress as a potentially serious factor that could trigger preterm deliveries in these situations.
"There's been plenty of data that show stress not only causes preterm birth but also low-birth-weight," said Dr. Veronica Gillispie-Bell, an obstetrician-gynecologist and associate professor with Ochsner Health in New Orleans, Louisiana
In general, babies born preterm or before 37 weeks, have difficulty maintaining their body temperature, said Bell. "Specifically, if we are speaking of disasters.... in my own experience of being here during [Hurricane] Katrina, in those very stressful situations, we have seen an uptick during those times in preterm birth and low birth weight," she said.
Because preterm and low-birth-weight babies don't have as much body fat, it's harder for them to maintain their body temperature, which for a healthy baby is between 96.8 and 99.5 degrees F, she said. "The lower it is below that, the more oxygen and energy they need to stay warm. So they would have use even more energy."
In both cases of preterm and low-birth-weight infants, quick and constant access to an incubator is vital.
From Ukraine to Gaza
In Ukraine, Chen said doctors have indicated that preterm births are on the rise across the country at the same time that intermittent power outages have made the use of conventional incubators very challenging. Several doctors and nurses, she said, also must consistently take babies and mothers to basement shelters as bombings continue.
Dr. Halyna Masiura, a general practitioner, is experiencing this first hand at the Berezivka Primary Healthcare Center in the Odesa region of Ukraine.
"Half of the babies being born in this area need more care," Masiura told CNN. "They are being born early and with low birth weight. When air raids happen, we all have to go into shelters." Masiura said her staff members have been relying on donated Embrace incubators for babies born with a birth weight of 2 kg (4 lbs) and up.
In the Palestinian exclave of Gaza, Israel has instructed more than half of the more than 2 million residents in the north to evacuate to the southern region ahead of an anticipated ground operation in Gaza by the Israel Defense Forces (IDF) in response to Hamas' deadly October 7 attack on Israel.
That attack killed more than 1,400 people.
In Gaza, where half of the overall population are children, access to medical aid, food, water, fuel, electricity and other normal daily necessities of life have evaporated in recent days amid sustained Israeli bombardment.
Over the weekend, after days of a complete siege of the exclave by Israel, the first trucks reported to be carrying medicine and medical supplies, food and water entered Gaza on Saturday.
For Chen, the most pressing problem is to figure out how to get the incubators to where they are most needed on the ground there. "As we did for Ukraine, we're looking for partnerships with organizations that can get into the region effectively and also for funding," she said. As a nonprofit, Chen said donations are sought through GoFundMe and a mix of individual donors, foundations and corporate donations.
Her team is working on a partnership with a humanitarian relief organization to respond in Gaza. "We're also reaching out to organizations in Israel to assess the need for our incubators there," she added.
A couple of hundred incubators are ready to immediately be sent to Israel and Gaza. Said Chen, "Depending on the need, we would go into production for more. But the big question is, can we get into those areas? We don't want to ship products and then have them sit there."
From a classroom idea to real-world solution
Linus Liang, along with Chen, was among the original team of graduate students at Stanford University who, as part of a class assignment in 2007, were given a challenge to develop a low-cost infant incubator for use in developing countries.
Liang, a software engineer who had already created and sold two gaming companies by then, was intrigued. "This class deliberately brought together people from different disciplines -- law, business, medical school, engineers -- to collaborate to solve world problems," he said.
"Our challenge was that about 20 million premature and low-birth-weight babies are born globally every year," he said. "Many of them don't survive, or if they do, they live with terrible health conditions."
The reasons why came down to factors such as a shortage of expensive conventional incubators or families living far away from medical centers to access quickly for their newborns.
The team formed their company in 2008 and then took a few years to engineer and produce the solution, with Liang and Chen both moving to India for a few years to get it off the ground and market test it there. Chen said the incubators, made in India, underwent rigorous testing and are CE certified, a regulatory standard that a device must meet to be approved for use in the European market and in Asia and Africa.
"We chose that route instead of seeking FDA approval because the need really is outside of the US," said Liang. The cost per incubator is about $500, including cost of the product, training, distribution, shipping, implementation, monitoring and evaluation, said Chen. That compares to as much as $30,000 or more per conventional incubators, she said.
Chen estimates some 15,000 babies benefited from Embrace incubators in 2022.
Not just wars
Dr. Leah Seaman has been using Embrace incubators for three years in Zambia. Seaman is a doctor working in pediatrics for the last 12 years, including six years focusing on neonatal care at the Kapiri Mposhi District Hospital in the Central Province of Zambia.
Seaman has also been busy setting up a new specialized neonatal ward in the rural district hospital. "When I first came to Zambia, we had one old incubator that would draw a lot of power," she said. "We often struggle with power cuts here, so even the voltage can be too low for the incubator to function well. Having enough space to set up conventional incubator was an issue as well."
So she reached out to Chen in late 2020 after researching solutions that would work for the specific conditions in Zambia.
"In Zambia, 13% of births are premature, and that's not even including low-birth-weight babies born at term," she said. "We needed an effective solution."
Embrace Global donated 15 incubators to the hospital. The new neonatal ward, set to open this month, is built around the Embrace incubator stations with Kangaroo mother care, or skin to skin contact between mother and baby.
"Last year we had 800 babies through the ward and maybe half of them used the Embrace incubator," said Seaman. "This year we've had over 800 already. We haven't asked for any conventional incubators because from 1 kg (2.2 lbs) and above, the Embrace incubator does the work."
Because of their heavy use, Seaman said the main challenge with the incubators is making sure that the heating pad is kept warm and reheated in a timely manner. "We've built a mattress station where we will be teaching the new mothers how to do that," she said.
"Why do we keep babies warm? It's not just a nice thing. It literally does save lives," Seaman said.