Interview with Patty Kelly, program leader in neonatal care
In addition to our ongoing newborn care work in Vietnam and Rwanda, we have added two delegations for HBB Trainings of Trainers in Tanzania to the 2017 calendar. Both delegations (May 6-13 and Oct 14-21) will be led by our lead master trainer, Patty Kelly, who has selected the partner hospital in Mwanza where she has taught before. We have interviewed Patty on this exciting development. Her insights offer more context as well as a professional view of why this program is so important for Tanzania.
Patty, what obstacles do women face in Tanzanian health care facilities when giving birth?
There are many obstacles that women face. Here are some that come to mind:
- Many have to deliver at home because there is no transportation, or the distance is too far, and/or there is no money to pay for transport or the clinic.
- While the birth rate is declining among middle-income, educated women in cities, many women still have multiple pregnancies. There are various reasons why this occurs, but primary causes are : Women have no say in the number of children or with whom they have children. This is decided by men. Women face sexual assault daily, especially in conflict zones. It can happen when they are walking for water, or a neighbor man or relative pays a “visit”.
- When a woman gives birth to 8 children, 1 is likely to die before the first birthday, 2 are likely to die before age 5; 1 or 2 will die from malaria before they are teens and 1 may die from trauma before their 18th birthday. You have to have enough children to help you on your farm and help you when you are old. It is the old adage of “an heir and a spare.”
- Women may not have a reliable means of birth control. Again, money and distance play a part. Tanzania is good at giving anti-retrovirals for HIV, good about sending health care workers to distribute TB medications, and are making strides at offering Family Planning Clinics and providing birth control. But we must remember this is not accepted in some religions and cultures within the country.
- Many women are still just girls when they deliver their first baby. Their bone/pelvic structure is not yet adequate to have an easy birth. They then have prolonged and obstructed labors, causing greater problems such as stillbirth, infection that can result in death, excessive bleeding that can result in death, and fistula. Also, many adult African women have very narrow hips and pelvises thereby facing the same problems.
- Women do not receive pain medication during labor.
- Because of malaria and other tropical disease complications, it is not uncommon for women to hemmorrhage to death following the delivery. When a mother goes missing this way, the family falls apart. We integrate Helping Mothers Survive with HBB so both mother and baby receive the necessary medical interventions in the first minute following birth.
- I have not witnessed this myself, but there can be a high incidence of “abuse” against the laboring woman. They might be told, in an unpleasant manner, to be quiet, or even be slapped. Their needs are not considered. Labor wards can be full to the max, with laboring women having to squat and deliver on the floor.
- Electricity is an issue, even in the big cities. Without power, handling a delivery and emergency is very difficult.
- Cleaning and disinfection of equipment depends on electricity (in most cases), clean water, the right solutions and the knowledge to do it properly. This is another challenge we have to overcome in our classes, teaching the methods and alternatives of what is basically infection control.
What tools can HBB training provide in order to improve newborn care in Tanzania?
It is important to note that most babies breathe at birth and need no intervention. Only about 10% need help to breathe and roughly 1% of those will need advanced, more intensive care. HBB is for that 10%, and teaches us that we have only 60 seconds, “The Golden Minute” to help the baby inflate its lungs and be able to breathe. We also teach recognition of a baby not breathing well and how to manage those problems.
In our newly revised edition of HBB, we strive to integrate Helping Mothers Survive so both mother and baby do well. Both need attention in the first minute of birth, sometimes emergently so. We teach how to manage both and to have a clear emergency plan in case of problems.
Why is this GEI HBB training program ideal to make a positive impact on newborn care in Tanzania?
There has been a national effort in Tanzania for healthcare providers to learn HBB and they have done a reasonably good job of it. However, I have found that there isn’t enough follow-up and follow-through. The providers need practice, constructive critique, the necessary tools and people to encourage and help them. HBB classes can’t be a one-off. The work must continue, with solid ways of collecting and reporting data. A mentor, like myself, has to be available to them, or the work is in danger of stopping. But once these midwives, doctors and nurses see results in their numbers, they will and do make the effort. HBB encourages them, gives them the tools, the knowledge and the encouragement to make the difference. But we need initially to be present at least every 6 months to do this.
It is important to note that the HBB program is a Train the Trainer model. We train local providers to take over from us, to teach each other, to manage their skills and equipment so every baby survives, because we believe every baby deserves to grow up to be a productive adult.
For more information on our newborn care programs in Tanzania, Vietnam and Rwanda as well as an HBB curriculum update, please follow the links below:
- Newborn Care program page for HBB delegations to Tanzania, Vietnam and Rwanda
- Helping Babies Breathe (HBB) curriculum update