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Feedback forms were received from 51 learners in all. 4 were nurses, 47 were medical officers (mainly doctors with an MBBS degree). Many of the medical officers had been qualified for over 10 years, one or two had been doctors for over 10 years but had only been caring for babies for the past 1 or 2 years. All 4 nurses are regularly working with birth attendants and attending deliveries. They were research nurses employed by CEL to support the birth attendants. They were not confident in resuscitation skills before the course but learnt quickly with the keenness of people who know they really need the skills. The increase in confidence levels is shown in the diagrams below. Confidence in all areas increased by the end of the course but there were more people scoring 3 out of 4 in all areas pre-course than we usually have, perhaps because of the overall higher level of training of these learners.

Free text feedback comments were all positive from the enjoyment of the course point of view and the perceived usefulness of the skills taught. Most of them had not been taught before using simulation techniques and this aspect of the course was much appreciated.

Interestingly, confidence in supporting a mother to breastfeed was quite high before the course but the questions on breastfeeding in the MCQ exam scored the lowest overall. This mismatch might be worth looking into – is breastfeeding generally thought of as a good thing but people are not so sure of how to help the mother with the practicalities of feeding?

A UNICEF report from 2024 states: breastfeeding is one of the most critical behaviours for child survival and growth. The NFHS-5 (2019-21) shows very low rates of early initiation of breastfeeding (EIBF) within an hour of birth for Uttar Pradesh at 24 per cent. 

Key Breastfeeding Data (NFHS-5, 2019-21):

• Early Initiation (Within 1 Hour): Approximately 24% of infants.
• Exclusive Breastfeeding (0-6 Months): 41.5%.
• Prelacteal Feeding: Roughly 21% of infants receive prelacteal feeds (e.g., ghutti, honey)
• Colostrum Feeding: While many initiate feeding within 24 hours, about 15.4% of babies still do not receive colostrum. 

Factors Affecting Rates:

Healthcare Practices: Lack of training for staff in some facilities hinders immediate, “skin-to-skin” contact.

C-Section Deliveries: A major factor causing delays in early initiation.

Social and Cultural Beliefs: Rituals such as delaying feeding until after a bath or discarding colostrum remain prevalent.

It’s a complicated simulation with some challenging moments – as in real life. By the end of the afternoon, the medical officers we were teaching were so much better at running this simulated situation which is more familiar to them in Varanasi unfortunately than we see in the UK. Questions like “when do we stop resuscitating if the heart rate is still not audible and we’ve given 2 rounds of adrenaline?” and “what do we do when the baby is still fitting after glucose and 3 anticonvulsants?” led to long reflective discussions with – I hope – some sort of therapeutic tinge to them. These medical officers are called to the baby when all is not well at delivery, and often they are too late to help the baby. It was uncomfortable for some of them to think about cases they had been involved in. By the end of the course a few of them had some good ideas about how to better support and train the birth attendants and the importance of multidisciplinary team working in an emergency.

Our learners on both courses have been medical officers, mainly medical graduates with some homeopathy graduates and those from an Ayurvedic background (Ayurvedic Medicine: In Depth | NCCIH). We have had over 30 learners on each course with a wonderful sense of engagement with particularly the simulation aspect of it.

The densely populated Uttar Pradesh (UP) state in India is the size of France and has a massive population of over 240 million. Still, it’s toll of around 170,000 newborn deaths each year (around 28 deaths per 1000 live births) is quite shocking. 40% of neonatal deaths occur during delivery or within the first 24 hours after birth. The Community Empowerment Lab believes that 70% of these could be prevented with simple interventions without the need for intensive clinical care and they have done a huge amount of work on trying to prevent neonatal deaths.

The leading causes of newborn deaths include premature birth (35%), neonatal infections (33%), birth asphyxia (20%) and congenital malformations (9%).  [https://www.drishtiias.com/state-pcs-current-affairs/child-mortality-rate-in-uttar-pradesh]

One of these simple interventions is Skin-to-skin care, also called Kangaroo Mother Care (KMC). CEL’s research on the state’s KMC programme has shown fantastic results:

We went to the neonatal unit of the hospital we are teaching in to see KMC in action:

A few photos from day 1 of our 2 courses in Varanasi where we are teaching in collaboration with the Community Empowerment Lab, a not-for-profit community entrenched global health research and innovation organisation based in Lucknow.

31 medical officers from across Varanasi have turned up for a 24 person course. Teaching groups of up to 8 is challenging but we’re loving the enthusiasm.

In the excitement of packing, last minute changes to the teaching programme (and content) and a near miss with one of our visas, Ajinkya’s message this morning reminds us all of just why we volunteer with NICHE International:

Post written by Dr Ajinkya Kale, neonatologist working with the Community Empowerment Lab (CEL), our collaborating partners for a forthcoming project in Uttar Pradesh where neonatal mortality is still more than 30 per 1,000 live births.

Oh yes—that’s me holding a 28-weeker, now 32 weeks corrected.
A happy, healthy little girl—IVH-free*, antibiotic-free.
It may look like a simple moment, but where I worked, this is nothing short of a quiet miracle. A true achievement for that setup.

Visiting this village every month gives me a stark, humbling reality check—of where half the world truly stands when it comes to resources, funding, and even access to evidence-based knowledge.
So much of what we consider routine in big cities feels almost indulgent here. Money, systems, affordability, safety nets. In places like the NHS, people don’t even think about paying. Care simply exists.

But in Derwan, reality is different.

Here, warmers are shared—two babies under one light—so both can receive phototherapy.
OG* tubes replace umbilical catheters because there is no money.
Feeds are advanced faster than guidelines would allow, not by choice, but by necessity.
Doctors, nurses, and families pray—not quietly, not occasionally—but constantly—that the baby will tolerate feeds, because there’s no money for cannulas, long lines, IV fluids, or second chances.

I consider myself a moderately religious Hindu. I visit temples often.
Yet I have never heard prayers as raw, as desperate, or as united as the ones I hear within these hospital walls.
Here, there are no divisions—no barriers of caste, class, or role. Just parents, doctors, nurses, and babies, all bound by a single shared hope:

A healthy, neurologically intact baby.

It feels surreal every single time.

And somehow, standing here, holding that tiny life, I feel certain—
I am in the right place, in the right mindset, and in the right tone for what lies ahead.

See you very soon.

It was a chilly start to course 2 but after good interactive lectures and an ice breaker musical session, jumpers and coats were off and we had great all round participation in the workshops. The keeping babies warm and pain management sessions were really enjoyed with participants sharing work experiences and engaging well with their learning going forwards.
A visit to the neonatal ward at the hospital with Dr Gilbert (District Medical Officer) concluded the training day. The team then had a nice supper at Baharama guest house whilst celebrating the return of Elizabeth’s phone from the repair shop – it works!

The trainers will be making their way to their respective homes tomorrow, Bwindi, Kampala, and 2 to the UK – Storm Goretti allowing. It seems that Schipol’s efficiency is still a bit hampered by snow…