This weekend in Mutengene, Cameroon, Grace was invited to help lay the foundation stone of the new Children’s Hospital. We are so incredibly proud of her and what she is doing for newborn babies in Cameroon.
Julia asked Sadias to reflect on what learning – and now teaching – the Neonatal Care Course had done for him as a clinician and for the care of newborn babies in Uganda.
Looking back to 2022, when we had our first Neonatal Care Course (NCC) in Uganda, care for the newborns has since never been the same in my work area, considering the fact that Uganda still faces a challenge of high neonatal mortality rate with birth asphyxia being the leading cause (50%).
Whereas the Neonatal Mortality Rate (NMR) in Uganda stands at 22/1000 live births, I should be proud to share that Kanungu district in Southwestern Uganda where Neonatal care course (NCC) was first introduced (through Bwindi Community hospital in partnership with NICHE International,) is now one of the districts with the lowest NMR at 9/1000 (2025). This improvement has been brought about partly by practical skills training acquired in NCC by NICHE.
As a clinician, NCC has improved my confidence in caring for the newborns, it has given that ability to stay calm and perform effective resuscitation when the baby cannot breath, understanding the delicate physiology of preterm infants and educating mothers and my fellow teammates about neonatal care. NCC has boosted my passion for paediatrics and has inspired me to further my studies and hopefully become a neonatologist some day.
Our NMR as a country is still very high compared to the SDG target of less than 12/1000 live births by 2030, and we are determined to bring it down. With such training like NCC, rolling out to the rest of the national, I strongly believe there will be a huge positive impact.
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.
*IVH intraventricular haemorrhage (bleeds into the brain which can have an effect on a premature baby’s neurodevelopment)
*OG orogastric tube, normally used for feeding babies but in resource poor areas can also be used as a line through a blood vessel in the umbilical cord stump to give intravenous fluids and antibiotics
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…
The training team is back at work in south Uganda. This is the second of 2 courses that NICHE International volunteers are facilitating. Two Ugandan trainers are working alongside the 2 life support instructors from the UK which greatly enhances the credibility of the project and strengthens it for the future. Kabale is a new venue and so the team will be trying to identify suitable clinicians to be trained as instructors themselves on a future visit. This all requires funding so if you are reading this and wanting to help out in some way – please do click on the “Donate now” button! All funds go to the courses; we have no overheads as a small charity run by the volunteer trustees. Instructors’ travel expenses, accommodation, insurance and malaria pills bill are paid by the charity but their time and expertise is given freely. It’s a humbling and totally inspiring set up.
The District Medical Officer has welcomed the NICHE International team to Kabale to carry out this training. The WHO Uganda update from April 2025 (The health of mothers and babies is the foundation of healthy families and communities | WHO | Regional Office for Africa) states that Uganda’s maternal mortality ratio (MMR) stands at 189 per 100,000 live births, with a one (1) in 66 lifetime risk of maternal death. In Kabale, maternal mortality is slightly less but still stands at a shocking 163 per 100,000. The neonatal mortality rate (NMR) nationally has decreased from 27 to 22 per 1,000 live births but remains above the SDG target of 12 per 1,000 live births. Teenage pregnancies contribute significantly to mortality, with one (1) in 4 girls aged 15-19 pregnant or already mothers, accounting for 20% of overall maternal deaths.
Facility data in Kabale show a significantly higher neonatal death rate of 33 per 1,000 live births. Over 70% of neonatal deaths occur within the first week of life, with a substantial proportion occurring on the day of birth. The leading direct causes here mirror those listed in the WHO document and include birth asphyxia (49%), complications of prematurity (14%), and neonatal sepsis (12%), indicating critical gaps in intrapartum care, immediate newborn care, and early postnatal monitoring.
The course covers all the topics known to decrease the risk of newborn babies’ risk of dying in that first week and so far has been well received by enthusiastic candidates! Significant learning, as fed back by them, has included: inflation breath techniques, how to be confident with intraosseous access and how useful an ABC approach is. The infection session and antibiotic use sparked much discussion about early and easier availability of broad spectrum antibiotics in some of the districts. Skin to skin was another highlight especially with the doctors who hadn’t appreciated all its benefits.
We talk about the use of Early Warning Scores to pick up early signs of sepsis which the clinicians in Kabale were not used to using. Elizabeth was able to explain how she has introduced this into the paediatric ward in Bwindi Community Hospital with good effect. The credibility of the Neonatal Care Course is hugely enhanced by having local instructors teaching on it. We are blessed to have such wonderful colleagues to learn with and from.
It was a non teaching day today and the team went with Sheila to lake Bunyonyi to see the local hospital and the women making crafts. The hospital on the island is a level 3 facility, with 25 births per month. They have a good pharmacy and lab with all the investigations needed. Low HIV, TB and malaria rates. They have a new incubator for the babies but not in use yet. They are aiming to develop a neonatal area. Some of the staff from there are excited to attend the training tomorrow.
Elizabeth got off the boat onto the island where the hospital was and unfortunately dropped her phone in the lake. 2 kind gentlemen, one wearing Jo’s swimming goggles chivalrously got into the murky oily water and after quite a long time found the phone. A donated bag of rice then helped to dry out the phone and give it time to get to the phone hospital back in Kabale – we are all hoping for a quick recovery!
“We continue to have too many newborns die during or shortly after birth, with most deaths occurring within the first week of life. The current neonatal mortality rate in Kabale (33/1,000) exceeding the national average (22/1,000).”
Kabale’s District Health Officer in August 2025
We were approached by the charity Edirisa UK (www.edirisa.org.uk) which makes free healthcare available at the Bwama Island Health Centre on Lake Bunyonyi. This includes maternity and newborn care, and we were asked to do the training to support staff from this and surrounding health centres. Edirisa UK has contributed funding for the project and Sheila Windridge, who founded the charity, has helped us enormously with the logistics of this trip, including with the difficulties the team has had getting there. It’s great to see the plans coming to fruition!
Jo from the UK and Sadias and Elizabeth from Uganda got the course off to a great start while Cath was still stuck in snowy Amsterdam:
“Fabulous candidates and a great team” Jo, NCC course director
Elizabeth and team were busy teaching the Neonatal Care Course (NCC) to the rest of the final year nursing students in May. The highly thought of nursing school (Uganda Nursing School Bwindi – Home) is co-located with Bwindi Community Hospital and newly qualified nurses from here will go and work across Uganda, hopefully sharing their neonatal skills and their new found confidence in resuscitation for the good of babies throughout the country.
“We are proud of our ambassadors going out to reduce Neonatal mortality” Elizabeth Ariho, nursing lead for paediatric services and course director for these two NCCs.
Well done team!
A few weeks ago, Grace asked for some funds (less than $1000) to help her roll out the Neonatal Care Course training in a remote area of Cameroon where one of her ex-colleagues was working in a government health centre.
Mbam is a village in a remote valley of the North-West Region of Cameroon. It is difficult to reach by road and does not have an internet signal. The population there has increased following civil unrest in the Region, as people have felt safer there, away from larger towns, and are also attracted by the fertile farming land of the valley.
Word reached Grace, NICHE International’s programme manager in Cameroon, that two pairs of twins had died on the day of their birth in the government health facility of Mbam. When she spoke to the nurse in charge, she discovered that there are 40-50 births / month in this health centre with a high neonatal mortality both there and in the community. There is no equipment for resuscitating babies and none of the staff had had training.
NICHE International agreed to support training there, and Grace gathered 3 trained Neonatal Care Course Instructors to go with her to Mbam, taking the necessary equipment. The journey was difficult, taking 36 hours including travel at night.
The staff at the clinic appreciated the training course greatly. They were left with a bag valve mask (vital for newborn resuscitation), and a baby manikin to practise the skills they had learnt. *
Grace plans to keep in touch with the health workers to encourage them to maintain their new skills.
*These items were funded by a grant from BMA Giving.
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