We are back in Dar at our hotel, and we are behind on our blogging! So here is a recap of the week:
The hands of the HBB program Monday – Helping Babies Breathe (HBB)
Megan and I went to a training for HBB, a program aimed at reducing neonatal mortality caused by birth asphyxia. HBB teaches nurses, midwives, and doctors a simple and effective algorithm for providing care to newborns that includes drying, stimulating, and then resuscitating if needed. Eric and David were sick, taking cipro (they’re healthy now). The program is engaging and hands on. The resuscitation training begins like this:
“Imagine a baby is born, it isn’t breathing.” The trainers instruct everyone to stand up hold their breath while a timer counts down from 1 minute. As people have to breathe, they sit down. After the minute has elapsed, no one is left standing (most of the time). Then is the question, can we expect a baby to sustain many minutes without oxygen if we cannot hold our breath for 60 seconds? Regardless of the science behind the empathetic exercise, it served its purpose. During the training, the caregivers were quick. They rushed against the clock. At one of the tables, every person in a group of six was able to reach their goal within one minute (not easily, and it was always a rush).
Observing and interacting with the caregivers and trainers was a perfect experience for us because anything that we develop will have to be implemented. A quality training program is one way of doing that.
Megan and I went to a training for HBB, a program aimed at reducing neonatal mortality caused by birth asphyxia. HBB teaches nurses, midwives, and doctors a simple and effective algorithm for providing care to newborns that includes drying, stimulating, and then resuscitating if needed. Eric and David were sick, taking cipro (they’re healthy now). The program is engaging and hands on. The resuscitation training begins like this:
“Imagine a baby is born, it isn’t breathing.” The trainers instruct everyone to stand up hold their breath while a timer counts down from 1 minute. As people have to breathe, they sit down. After the minute has elapsed, no one is left standing (most of the time). Then is the question, can we expect a baby to sustain many minutes without oxygen if we cannot hold our breath for 60 seconds? Regardless of the science behind the empathetic exercise, it served its purpose. During the training, the caregivers were quick. They rushed against the clock. At one of the tables, every person in a group of six was able to reach their goal within one minute (not easily, and it was always a rush).
Observing and interacting with the caregivers and trainers was a perfect experience for us because anything that we develop will have to be implemented. A quality training program is one way of doing that.
Tuesday – The labor, delivery, post-natal, and neonatal wards at a district hospital
On Tuesday Megan and I were at a large hospital within Dar es Salaam. It is amazing to see the nurses and midwives work with limited resources in high intensity settings. There are usually two nurses in the delivery ward, and at any one time there is five to fifteen expecting mothers. One of the nurses can be called away to a c-section at any time, leaving only one nurse to handle the ward. To give you a bit of perspective, there was maybe one nurse for every one or two patients in L&D in Baltimore. These are the environments we have to consider.
Also today, Eric went to the HBB training…
On Tuesday Megan and I were at a large hospital within Dar es Salaam. It is amazing to see the nurses and midwives work with limited resources in high intensity settings. There are usually two nurses in the delivery ward, and at any one time there is five to fifteen expecting mothers. One of the nurses can be called away to a c-section at any time, leaving only one nurse to handle the ward. To give you a bit of perspective, there was maybe one nurse for every one or two patients in L&D in Baltimore. These are the environments we have to consider.
Also today, Eric went to the HBB training…
Today I met a clinical officer named Richard, a friendly and proud Tanzanian. Richard told me about growing up in a small rural town in the center of Tanzania and his training to become a clinical officer at a nearby training facility.
After three years of training, Richard moved to Dar es Salaam to work in a Labor and Delivery Ward at a Dispensary clinic. Unfortunately however, Richard’s Labor ward hasn't delivered any babies since he arrived 18 months ago. The ward ran out of medical supplies and has redirected all deliveries to other facilities nearby. It can’t resume delivering mothers until the government supplies resources. Richard expects the ward to be resupplied by the government in about 1 year. Until then, the ward will offer antenatal care, family planning, and serve the local community the best it can with its limited resources. Also, Richard took this opportunity to attend the Helping Babies Breathe training, where I met him today.
Despite the language barrier and Richard’s speech impediment, he was eager to talk with me for over an hour after the HBB training. Richard told me about the Tanzanian medical and education system. And he showed me how much Tanzanians can care to make a difference even with limited resources.
After three years of training, Richard moved to Dar es Salaam to work in a Labor and Delivery Ward at a Dispensary clinic. Unfortunately however, Richard’s Labor ward hasn't delivered any babies since he arrived 18 months ago. The ward ran out of medical supplies and has redirected all deliveries to other facilities nearby. It can’t resume delivering mothers until the government supplies resources. Richard expects the ward to be resupplied by the government in about 1 year. Until then, the ward will offer antenatal care, family planning, and serve the local community the best it can with its limited resources. Also, Richard took this opportunity to attend the Helping Babies Breathe training, where I met him today.
Despite the language barrier and Richard’s speech impediment, he was eager to talk with me for over an hour after the HBB training. Richard told me about the Tanzanian medical and education system. And he showed me how much Tanzanians can care to make a difference even with limited resources.
Wednesday - An honest day's work
We went to a different hospital on Wednesday. It had a tremendous impact on all of us. Some of it was good, but other elements made our efforts seem futile. There are nurses working hard to learn and provide better and better care, but there are also stagnate areas within the facility. Simple processes are not followed. Why is that?
We were able to have some long and honest conversations with a few doctors and nurses, which helped clarify some questions that hadn’t been addressed directly. In these conversations we can get down to how things are really done in the hospital; they stop spouting off protocol and tell us how it really is. It helped us to better understand the root causes of some of difficulties we have seen in the hospital setting. We need to understand this system legitimately to design for it. Today was a great success in this way, but it also showed us a system that has many varying challenges that we need to address.
We went to a different hospital on Wednesday. It had a tremendous impact on all of us. Some of it was good, but other elements made our efforts seem futile. There are nurses working hard to learn and provide better and better care, but there are also stagnate areas within the facility. Simple processes are not followed. Why is that?
We were able to have some long and honest conversations with a few doctors and nurses, which helped clarify some questions that hadn’t been addressed directly. In these conversations we can get down to how things are really done in the hospital; they stop spouting off protocol and tell us how it really is. It helped us to better understand the root causes of some of difficulties we have seen in the hospital setting. We need to understand this system legitimately to design for it. Today was a great success in this way, but it also showed us a system that has many varying challenges that we need to address.
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