On a cool, rainy day in Kenya’s central rift-valley, approximately 60 nurses and midwives are in learning mode as they work in pairs practicing steps to keep newborn babies alive. Eyes are glued to life-like dolls called “Neonatalies,” swaddled in sky-blue paper, with skin that depresses when touched and necks that abruptly waddle backwards if not supported.
Globally more than three million babies die every year within the first weeks of life due to preventable infections, premature birth and breathing problems before or after delivery (‘asphyxia’). In East Africa, there is an urgent need for skilled birth attendants who can monitor labor, identify distress in the mother or fetus, and ensure that the newborns breathe within the first minute of delivery.
In 2010, USAID, with the Laerdal Foundation, the Regional Center for the Quality of Health Care and the East, Central Southern Africa Health Region, initiated a three-year project to reduce newborn deaths across 10 East African countries, under a global USAID-supported Helping Babies Breathe initiative. Health providers are learning about newborn resuscitation and infection control; upgrades are being made to regional newborn care training curricula and service delivery; and asphyxia management is improving across the region.
USAID is rapidly reaching its goal of training 400 “Master Trainers” in newborn care practices. Every trainer should in turn train other health providers. Over time, and with on-going advocacy work at senior Health Ministry levels, a ‘cascade’ effect will increase the ability of nurses and midwives to save newborn lives.
During a two-day training these professionals learn simple, inexpensive steps that can mean life or death for a newborn. One participant enthusiastically demonstrates 11 steps to proper hand washing, candidly saying that many health providers wash their hands before delivering a baby as if they were merely ‘going to lunch.’
Teams learn to resuscitate a baby by placing it on a clean, dry space, securing the head, and covering the baby’s chin, mouth and nose with a miniature plastic mask. Air is rhythmically expressed into the baby’s lungs from a plastic sack to a count of ‘one two three.’ Magically, the mannequin springs to life as the small chest begins to move as if taking breaths of air. Suddenly, a trainer from across the room notices an uncovered baby and scolds, “But look at your baby! She is getting cold!”
Teams prepare the mother and baby for the initiation of breastfeeding within 30 minutes of birth. The mother’s milk provides immediate sustenance and is rich in immunity-providing vitamins and nutrients.
A Pediatrician leading the training insists that regional Ministries of Health must make newborn health a priority, decrying the 40,000 babies under 28 days old who lose their lives every year in Kenya alone. But he also admits to certain challenges, saying, “There’s a big gap between knowing and doing.”
Practices improve and change over time. We no longer should hold a baby who stops breathing upside down, and drugs are usually not the answer. The practices taught in our program will greatly improve newborn care in the region and will save lives. --Dr. Wamuyu Maina, RCQHC