Aarti Kinikar

Aarti Kinikar is a pediatrician whose work during the 2009 H1N1 outbreak in Pune showed how improvisation could save lives when conventional medical equipment ran short. Rather than treat a shortage of ventilators as a fixed limit on care, she adapted a low-cost breathing-support method for babies with flu, helping hundreds of children and making resourceful clinical judgment a central example in the book’s discussion of disaster preparedness.

Background and the H1N1 Crisis

In 2010, the narrator visited Pune, India, where the previous year’s H1N1 outbreak had overwhelmed local hospitals. Health officials, fearing further spread, restricted patients with flu symptoms to a small number of facilities. Those hospitals quickly filled, and Kinikar watched babies die because she did not have enough ventilators for them.

Kinikar had spent years treating children in a public hospital where expensive medical resources were often scarce. Her experience made her response more than an emergency workaround: she was accustomed to practicing under constraints and looking for what remained possible. She urged her students, “God has given you the brain, just use it,” and “Just keep on thinking.” The outbreak put that principle to an urgent test.

Improvising Bubble CPAP

Kinikar had previously used bubble CPAP, or continuous positive airway pressure, to help newborns with premature lungs breathe. Standard CPAP devices cost thousands of dollars, but her hospital staff assembled a homemade version from inexpensive plastic tubing and saline bottles already available there. The improvised equipment appeared to work well for premature babies, so Kinikar considered whether it could also support older infants with influenza.

She had no assurance that colleagues would endorse the technique; she worried that it lacked strong scientific backing. But, as she explained, the alternative was to do nothing and allow a baby to die, or to try the method and hope it worked. The choice was not between an established treatment and an equally established substitute. It was between acting under uncertainty and leaving a child without that possible support.

Releasing Ventilators for Other Children

When a baby with flu began improving on a ventilator, Kinikar decided to try moving him off the machine and onto the homemade bubble CPAP. His mother watched warily as the staff made the change, but the baby did well on the makeshift device. The ventilator could then be used to help another child.

Kinikar extended the approach over the weeks of the pandemic, using bubble CPAP to support the breathing of hundreds of children at her hospital. Colleagues credited her quick thinking with saving lives. The sequence matters: the improvised device did not merely offer another form of respiratory support; in the case described, it also freed a scarce ventilator for a second patient.

Significance in the Book

Kinikar’s example shifts the discussion of disaster medicine beyond the difficult task of deciding who receives scarce equipment. The book places her beside Frederick Burkle’s argument that emergency standards must remain responsive to changing conditions: rigid rationing can do harm when it is imposed even though scarcity may be easing, while supplies and needs may require reassessment as often as daily or hourly. Kinikar’s practice makes that adaptability concrete. She did not simply allocate a limited supply; she found a way to stretch what the hospital could provide.

The book also connects Kinikar’s style of thinking to the power crisis at Bellevue Hospital Center in New York. When generator fuel pumps failed there, volunteers passed fuel up thirteen flights of stairs so the generators could be fed manually. That improvisation kept backup power from failing while evacuation proceeded, preventing further emergency choices. The comparison does not make the situations identical: it shows how practical ingenuity can preserve options, whether by making a low-cost breathing device or by keeping a hospital’s power running.