MacArthur Newsletter: Winter 2007
Population and Reproductive Health

Low Tech; High Impact
Using the Anti-Shock Garment to Save Lives 

By the time the 29 year-old woman arrived at the emergency room of the University College Hospital in Ibadan, Nigeria, she was unconscious. She had no blood pressure or pulse. Five days earlier, she had given birth, and now she was dying from profuse post-partum bleeding. The family members who accompanied her began the rituals of mourning. "They were crying, falling to the floor, tearing at their garments," recalls emergency obstetrician Dr. Oladosu Ojengbede.

But Ojengbede and his staff had been trained in the use of the anti-shock garment (also known as Life Wrap). Originally developed for battlefield use, the device has the potential to save lives and protect hundreds of thousands of women from the effects of post-partum hemorrhage.

Made of lightweight neoprene, the garment resembles the bottom part of a wetsuit. It can be manufactured inexpensively and is reusable up to 100 times. When the suit's five Velcro closures are tightened around the patient's body, the compression stops blood from flowing to the lower extremities and forces it back to the heart, lungs, and brain to counteract the shock.

The results are immediate and dramatic. A few minutes after the suit was applied to Ojengbede's patient, she began to revive. Summoned to her bedside, her relatives watched in amazement as the woman raised her hand and asked where she was.

"You can imagine their sheer joy," says Ojengbede. "The relatives nicknamed her 'Ayorunbo' for 'the person who has gone to heaven and returned.'"

Ojengbede has seen or heard many similar stories since the anti-shock garment was introduced in Nigeria as part of a MacArthur-funded study carried out by the Women's Global Health Imperative at the University of California-San Francisco and the University of Ibadan. Pilot studies took place in Egypt, where the garment was used to keep women alive in busy urban hospitals while they waited up to 36 hours for a blood transfusion. Early results indicated that those treated with the garment lost half as much blood as those treated using standard methods, and the use of the garment saved more lives.

In Nigeria, the study is focusing not only on hospital use but also on rural health care stations, where the suit is being tested as a first aid tool until women can be transported to better-equipped treatment facilities.

The garment's success is having a ripple effect, Ojengbede says. "Once word gets back to a village that a woman has survived, more families are willing to seek treatment for obstetrical hemorrhaging."

Because the early results proved so promising, MacArthur has invested $400,000 to expand the study in Egypt in an effort to yield statistically significant evidence of the suit's effectiveness. If the study provides scientific proof that the garment works, MacArthur has plans to support scaled up use of the suit to the point where government agencies can incorporate it into standard health care. "We believe the anti-shock garment holds great potential to save tens of thousands of lives each year," says Jonathan Fanton, President of the MacArthur Foundation. "It could be a very simple solution to a seemingly intractable problem."

Rigorous studies like those underwritten by MacArthur are critical to convincing the medical establishment and gaining the imprimatur of global health organizations, says Suellen Miller, a professor of public health at the University of California-San Francisco who directs Women's Global Health Imperative's Safe Motherhood Programs and coordinates the anti-shock garment study. "Once it's deemed an essential device, donor agencies such as UNICEF and USAID will be willing to pay for it," Miller explains.

More than 500,000 maternal deaths occur worldwide annually, mostly in developing countries. Of these deaths, 30 percent - the largest single percentage - are due to obstetrical hemorrhaging. "For years, health care workers have had to stand by helplessly and watch these women die of something that's almost entirely preventable," says Ojengbede. "Now, there's hope."