Siobhán Neville (Dublin) and Peter O'Reilly (Co. Kerry), both paediatricians, have just returned from volunteering for six months in Lindi, Tanzania. Based across several local hospitals and health centres, they helped to improve neonatal mortality rates by assessing practices and recommending changes to support both mothers and newborns. In this blog post, Siobhán discusses the challenges and successes encountered on her placement.
A lack of medical professionals
In Lindi, about 34 babies die per 1,000 live births, which is about 12 times higher than in Ireland. There are only three qualified medical doctors for Nyango hospital, only one of whom is a surgeon. There's limited soap or running water to wash and dry hands. Parents have to pay for prescriptions, and if they can't do that then nothing happens for their child. As a doctor, I am used to seeing patients pass away but definitely not to this degree. At home when a child dies, it's very upsetting and that’s always acknowledged. Here it's so commonplace, I don't think I will ever get to a point of acceptance.
Bringing mothers in to hospital
Many births happen outside of hospital. If there's an issue in hospital, we can assist to deliver the baby. That's not available in the communities so babies are severely compromised if there is a complication. The project here is trying to challenge that through a text message alerts, to remind them to attend antenatal visits or to go to hospital if there is an early warning sign of labour or bleeding. It also reminds them to check for their babies once they are born for signs of infection and so on. Most women have a mobile phone - it's such a simple solution.
However in the health centres where VSO hasn't had a chance to work, I see babies regularly dying from things that they wouldn't have at home. That is extremely frustrating. One of the first cases I saw here was a 24-hour-old baby with severe asphyxia. It's a condition that should be prevented rather than treated, usually done by a quick delivery with appropriate resuscitation at birth. It wasn't done as well as it could have been and the baby didn't survive.
There are good moments too. One baby was readmitted after being born premature with a low birth weight. On the basis of our advice, mum brought the baby back in because she had a high temperature and was very irritable. We saw signs of newborn meningitis that slowly got worse and the infection made her head swell. We were worried she would pass away, but after two and half weeks of antibiotics she showed signs of improvement. After the course of meds, mum was able to take her home and when we saw her for a review it was great to see the baby do really well.
Simple techniques making a big difference
There are other parts to this project that are providing important equipment, like V-scanners (a portable ultrasound machine). It will screen expectant mothers in hospitals, dispensaries and health centres to look for common danger signs. It's basic but important. There's also a newborn triage checklist, which is a legacy of previous VSO work. It's a straightforward list assessing the health of a newborn in three parts - at birth, 24 hours and 48 hours old. It's a traffic light system marking out things like temperature, breathing, skin colour and how the baby feeds. If anything is flagged red then the baby is admitted to the Neonatal Intensive Care Unit for a review. Every baby now gets seen at birth and before they go home. It's easy, simple and can be easily reproduced.
Every baby deserves a chance. They shouldn't be at a disadvantage from being born in Tanzania. Both here, or in Ireland, I see brothers and sisters looking forward to their new arrival and the faces of excited, devastated and anxious parents. I'm looking forward to reviewing a few babies we have discharged in the last few weeks. I want to hear that they are ok. It's the most rewarding part of the job.
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