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How big is the problem?

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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

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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.

I think i’ve been here before…

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12 seater plane Entebbe to Kihihi airstrip in south western Uganda
Julia, 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.

Uganda – step 1

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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.

World prematurity day

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Dr Alison Earley

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, Liberia
Kola and team of nurses and neonatal technicians in their Neonatal Nursery

bag-valve-mask questionnaire

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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.

Teaching again after the pandemic

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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.

Scenario teaching – unexpected preterm baby delivery

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

Neonatal resuscitation training in Liberia – also june 2021!

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Not to be outdone, Kola has been busy in Liberia with neonatal resuscitation training at the same time as the Cameroonian course was running. WhatsApp was alive with photos coming in for a couple of days – heartening stuff to our NICHE team still unable to leave the UK to train more instructors.

Neonatal technicians in Liberia lecturing on Newborn Life Support during a resuscitation training session, June 2021

It’s official! skin to skin care saves lives

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https://www.nejm.org/doi/full/10.1056/NEJMoa2026486 takes you to the full text of this 2021 publication from WHO comparing survival data of low birth weight infants nursed skin to skin from birth with a cohort who only received a couple of hours a day of skin to skin care. The trial had to be cut short because the babies in the control group (couple of hours a day) had a significantly higher risk of dying than the babies in the intervention group (around 17 hours a day skin to skin).

Keeping babies warm workshop, Neonatal Care Course, Mutengene, Cameroon. June 2021

Grace gathered 9 of the trained instructors in Cameroon this month for a Neonatal Care Course which trained 36 more healthcare workers in the care of the newborn baby in the first 28 days of life. Quite a feat in a country battling with Covid and political unrest. Immensely rewarding for NICHE volunteers and trustees to see the programme up and running without much direction from us. Julia did try to “drop in” to some of the sessions via zoom on day 2 but the internet connection was so bad that, in the end, she gave up and let the Cameroonian faculty get on with it themselves. There’s only so much one can do remotely.

Today is International women’s day

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Dr Alison Earley

It’s a day for dressing up in much of the world, a day to celebrate the work women do to make the world go round, a day of empowerment. The picture here is of Cameroonian women on International Women’s Day in 2018, learning how to resuscitate babies dressed in their International Women’s Day material that they make into powerfully beautiful dresses every year. We should make more of it in the UK really.

There are many achievements to celebrate on International Women’s Day, but we mustn’t forget that in resource poor areas of the world, maternal mortality (death related to pregnancy and childbirth) is still 5 – 10 times higher than in richer countries.

Many mothers still give birth in unclean or unsafe places, and without skilled help or adequate facilities.   This has a direct result on the survival of their babies; two of the leading causes of neonatal mortality are infection and intra-partum related events.

Education for healthcare workers and sustainable improvements in maternal and newborn care are the key to improving this situation.   NICHE International has a mission to improve the care of newborn babies, by the training we give and by supporting nurses, doctors and midwives to maintain their skills and improve the care they give to mothers and babies.

Training (predominantly female) nurses and midwives to be instructors on the Neonatal Care Course (NCC) empowers them to “Choose to Challenge” and make changes to their own healthcare systems from the bottom up.