A hearty thanks to our friend and colleague from Huambo, Jordan Yarborough. She endured rough roads south to reach Kalukembe last week. And then put on a great course for nurses and students, our 3rd annual resuscitation of the newborn. Over 60 students participated, including nurses from the district’s government health posts. It was especially sweet to have nurses from these government positions participate so that we might have opportunities for closer collegial relationships with them. With so much lack of cooperation in Angola’s health care sector, it was a big bonus for me to hear that one of the government nurses came back another day to repeat the course because, as she said, she didn’t remember all of it the first time.
In case you didn’t know, Angola is ranked worst in the world for neonatal mortality and children under-5 mortality. A course like this that Jordan did is immensely helpful. I remember when we first arrived, the first thing nurses seemed to do when a baby came out limp from a C-section or vaginal delivery was to draw up (too much) epinephrine and stick it in the baby, flick the chest and watch. Now, there is an improved culture of drying and stimulating the baby, moving to positive pressure breaths and chest compressions before drawing up (still too much) epinephrine.
To give a picture of the challenges to better outcomes for women and babies, I’ll lay out a typical story of a woman who might get transferred to our hospital. Most women might get one or no prenatal visits during pregnancy. And even if they go for prenatal visits, they often do not get good counsel about laboring at or near a health facility. So, a woman might labor at home or go to a ‘clinic’ by a ‘nurse’ in the village who likely would not do any monitoring during labor and give several injections of oxytocin. If these measures did not produce, then the family might take the woman to another health post often by motorcycle; this post in turn might refer to a health center where the woman may or may not be checked for progress of her labor. If discovered that the woman has uterine rupture, she would be transferred to our site. But if not, she might have another step in the delay of care and be sent to the government hospital across town (another motorcycle ride) where no materials are available for a cesarean delivery. Then, after further delay, a transfer would be arranged to our hospital. After perhaps 2-3 days of labor this way, it’s no surprise then to see sad outcomes: neonatal death or sepsis; birth injury to the mother leading to vesicovaginal fistulae later on; uterine rupture; uterine necrosis; postpartum hemorrhage; you name it and it’s probably happened.
Enter this course. It’s one act of good, beating back the forces of darkness!