There’s more to language than the words that we say. Our learners are still wearing masks most of the time and gauging the mood of the lecture theatre is occasionally challenging. I was wondering why people were looking at me like I was crazy – it was the eyebrows. When Ugandans raise their eyebrows (at least in this part of Uganda) they mean “yes, definitely” (or “you can take it to the bank” as one of the Americans staying in the guest house with us put it). I saw it as an expression of doubt or enquiry so I was repeating the questions and getting more and more eye brow waggling. The manager of the guesthouse has a degree in applied linguistics but does not have a technical term for this.
Here I am, learning how to read people’s eyebrow talk
All 15 candidates passed the first course and we have identified 7 potential instructors who we will train later in the year (all being well with the fundraising). The standard was high overall and we were very impressed in particular with the learners’ level of engagement with the scenario / simulation training this afternoon. There is a sim lab in the nursing school here and it showed in the way everyone got involved. Well done everyone!
We are going through the feedback forms at the moment but here is a flavour. We collect information on confidence levels before and after a skill or topic is taught. An increase in confidence has been shown to correlate with an increase in competence because confidence empowers people to “give something a go”. If you lack confidence in resuscitating a baby, you might stand by and not even try when faced with a baby born with no respiratory effort. Whereas, if you think you might be able to achieve something, and at least position the baby’s airway so that when he/she gasps, air goes into the lungs, the likelihood of a positive outcome is infinitely increased.
A reassuring increase in confidence in 3 fundamental areas of neonatal care for this learnerWe received lots of positive free text feedback comments. And the common request to extend the length of the course.
Grace overseeing neonatal life support trainingKirstie lecturing on skin to skin mothercareTwins in skin to skin mother care on the neonatal unitJarlath running a breastfeeding workshop with our hastily knitted breast from yesterday as visual aid
Timings have been a bit of a challenge today: Devotions over ran, half our learners had to do a ward round before the teaching could start and Julia and Grace were called for clinical duties in the neonatal unit at lunch time as the paediatrician is away and a new 1kg baby was admitted. Jarlath and Kirstie did sterling work keeping the show on the road and we came in at 5.45pm with only one lecture left out and everyone still smiling.
NICHE International was set up to train local health professionals to teach the Neonatal Care Course (NCC). We follow the model used by life support organisations all over the world – clinicians do the course themselves, some are recommended as instructors, they train as instructors, form their own faculty with a bit of support initially from senior instructors, start training their peers and eventually begin to train their own instructors. The NCC sits under the umbrella of the Advanced Life Support Group (ALSG) in the UK.
The overall aim of the Neonatal Care Course is to reduce neonatal mortality rates (death of a baby in the first month of life).
The statistics above taken from https://www.healthynewbornnetwork.org/hnn-content/uploads/Uganda-CD2030.pdf, show that the neonatal mortality rate in Uganda reduced from 35 per 1000 live births in 2000 to 21 in 2016. 35% of the under-5s deaths though are in the neonatal period. The NCC can help bring down the numbers of deaths caused by complications of preterm births, sepsis and pneumonia. Together, these 3 causes make up half of the deaths in the first 28 days of life. We think that’s something worth working for.
Bwindi community hospital with the Impenetrable National Park as a backdrop
Bwindi Community Hospital cares for more than 120,000 people living in the South Western corner of Uganda. It was set up by American missionaries in 2003, starting as a clinic under a tree and expanding over the years to a thriving, award winning community hospital with 135 beds, a Nursing School with 400 students and Uganda College of Health Sciences Bwindi. Quite a bit of research goes on here, human and the other primates who inhabit the forest.
Grace, Kirstie and Jarlath admiring the banana plantation on the path between the hospital and nursing school
Tomorrow we start the course. We have 16 students for the Neonatal Care Course and are excited to get going. We’ve spent today setting up the room, finding spare tables, oxygen concentrator, remote control for the slides etc. Jarlath left his knitted breast in Ireland which we normally use for the breastfeeding workshop but the guesthouse manager’s daughter came up trumps and crocheted one for us last night with her last bits of yarn. So we’re all set.
12 seater plane Entebbe to Kihihi airstrip in south western UgandaJulia, Grace and Kirstie looking fairly relaxed en route to Kihihi
This was the 12 seater plane that brought us to Kihihi yesterday, the nearest airstrip to Bwindi Community Hospital. We were the only ones on it with our 2 pilots, and we are very grateful that we were allowed to bring the extra teaching equipment with us. The photos are reminiscent of Liberia in 2019.
Storm Eunice over the UK threatened our departure plans and Grace had fun and games with her visa from Cameroon but we all arrived safely and in good spirits.
It is just great to be out doing this again after 2 years grounded in our individual home countries. Flying over the the world’s largest and driest sand desert—the ‘Rub’al-Khali’— in Saudi Arabia, Yemen and Oman I felt like my world had opened up again. We are so very privileged to be able to volunteer like this, to be accepted into other people’s lives, to teach and to learn.
We are delighted and very excited that we are at last going abroad again – tomorrow!
I (and the family cat) have been packing up 4 teaching sets and trying to keep the weight down as our internal flights from Entebbe to Kihihi allow rather less baggage than we normally take with us.
Julia (and Chocco) packing up teaching equipment for NICHE’s first trip to Uganda
We are going to Bwindi Community Hospital to teach the first two Neonatal Care Courses and to recruit some keen would-be instructors.
We have a multinational team instructing this time around – Jarlath joining us from Ireland, Kirstie and Julia from the UK and Grace from Cameroon.
We are grateful to the charity Child Health Matters and to the Souter Trust for funding a large part of this trip.
The statistics on premature birth remain of great concern: 12% of babies are born too soon in the poorest countries, compared with 9% in higher income countries. One million babies die each year from complications of premature birth, and prematurity remains a leading cause of mortality globally.
Education for health care workers, enabling them to provide better care for pregnant women and new born babies, is vital if this situation is to improve.
Kola sent these pictures from Liberia this morning – a celebration of their babies born too early! Most of the nurses in these pictures have done the Neonatal Care Course with NICHE trainers.
Celebrating World Prematurity Day at CB Dumbar, LiberiaKola and team of nurses and neonatal technicians in their Neonatal Nursery
Gathering the evidence for the work we do, both for funders and to inform our direction of travel as an organisation, is not at all easy! Alison has been working with Grace in Cameroon to collect information from health clinics about their use of bag-valve-masks which NICHE International provided them with a few months ago.
3 out of the 5 units who had the questionnaire responded which doesn’t give us statistically robust information but does give us a fascinating insight into the obstetric services at these centres, the numbers of deliveries, trained staff and how many babies were born in a bad enough condition to worry the newly trained personnel.
preliminary results from the BVM questionnaire
There are a couple of things to learn from here:
1.) The very positive free text comments at the bottom that all units feel that having the bag-valve-mask over the last 8 weeks has potentially saved lives.
2.) The disappointing comment from Bafoussam that people have been reluctant to use the BVM because they can’t attach it to the oxygen supply is a reminder of the need for on-going training and refresher courses. Babies born at 32 weeks gestation and above should be resuscitated in air. The new 2021 guidelines suggest that babies between 28 and 32 weeks can be resuscitated in air to 30% oxygen. Only the very small ones, most of which do not survive in resource poor areas of the world, should be resuscitated in 30% oxygen from the outset. It is recommended to increase to 100% oxygen in any situation if the baby requires cardiac compressions.
We are looking to return to Cameroon at the end of April 2022 to train more instructors and begin training some of the Cameroonian instructors to be instructor trainers themselves. Well done to Grace and team for keeping the Neonatal Care Course training going throughout the Covid pandemic and thanks to the Cameroon Baptist Convention for continuing to fund the programme.
It is great to be back teaching face-to-face again, albeit still only in the UK. UK NICHE instructors have to teach on a certain number of life support courses per year to maintain their instructor status. Julia was teaching the UK Resuscitation council Newborn Life Support (NLS) course this week in her home hospital in London.
There are some differences when stabilising a preterm delivery at birth. The 2021 guidelines suggest that babies born under 32 weeks gestation should be put into a plastic bag at birth and placed under a radiant heater to stop them getting cold and dehydrated. Just their heads should be dried.
In most other respects, and if there is no radiant heater available, they should be stabilised the same way one would stabilise a term baby. Here the learners are demonstrating the 2-handed BVM technique with Julia checking that the chest is actually rising!
2-person technique of bag-valve-mask use at a simulated preterm delivery
