Improving neonatal care in Democratic Republic of the Congo
Since 2013, Karen Platonos, lactation consultant, and Annie Aloysius, clinical speech and language therapist in neonatology at Queen Charlotte’s & Chelsea Hospital, have spent many of their holidays travelling to Rwanda and Democratic Republic of the Congo (DRC) with Kathy Mellor of BirthLink UK to help improve neonatal and maternal health. Along with Dr Tom Lissauer, Professor Alison Holmes and the infection control team at the Imperial College School of Public Health, they’ve worked with hospital teams in both countries to help make a variety of sustainable improvements. Here, Karen and Annie share their experience, and explain how the integrated family-delivered neonatal care programme developed at our hospitals is helping new parents in central Africa.
Annie: Travelling in Democratic Republic of Congo (DRC) is chaos. Many of the roads aren’t paved so when it rains – and it really pours – they turn to rivers of red mud. Houses and market stalls are set up flush against the road so you’re driving right through people’s lives. But everywhere we went, people were so kind and eager to improve their practice.
Karen: The hospitals we visited have far fewer options for intervention than we do in the UK. They don’t have ventilators, they don’t have many cots and they tend to have one or two nurses for a unit of 15 to 20 babies. That’s why getting the basics right is so important.
Annie: Both Rwanda and DRC struggle to support breastfeeding for the smallest, sickest babies, and so many babies have died of starvation there. Lots of formula companies donate formula, equipment and supplies to low-resource hospitals, which has led to an assumption that formula must be best for babies. But many people – especially in DRC – don’t have reliable access to clean water, which makes it impossible to make up formula safely. We’ve seen formula kill babies. The prevalence of formula has devalued breast milk, but breast milk saves lives – and it’s free!
Karen: We’ve also seen babies suffer and die of hypothermia in DRC, even though the average temperature is over 24 degrees. After delivery, the babies aren’t dried and put skin-to-skin with their mums. They’re either put skin-to-skin wet and then get hypothermic, or they’re put somewhere else wrapped in a wet towel. They effectively die of hypothermia in a country where it isn’t cold.
Annie Aloysius"We’ve worked with staff over the years to encourage parents to spend more time doing skin-to-skin and just bonding with their babies"
Upskilling pressured staff
Annie: In DRC, we primarily work with Heal Africa Hospital in Goma, and Panzi Hospital in Bukavu, which was set up by Nobel Peace Prize winner Dr Denis Mukwege.
Karen: There’s often an expectation that we’ll bring money or equipment, and sometimes we do – we’ve brought a washing machine to one hospital, as well as reusable nappies, breast pumps and steam sterilisers. But it’s really about the initial care given to babies after delivery. Early skin-to-skin and keeping mum and baby together make a big difference.
Annie: We’ve set up a programme that works, with the goal being to support lactation and breastfeeding in low-resource settings. We use bite-size teaching programmes – 30 to 60-minute sessions developed within our neonatal service at the Trust to quickly train our teams in essential skills and topics. We try to use very little language and rely more on visuals. My mum’s knitting group crochets ‘woolly boobs’ for us – knitted models of breasts we use as teaching props. We go with two bags full of these woolly boobs – we get some strange looks from airport security staff!
Seeing steady improvements
Karen: Over several years, we’ve worked to train hospital staff to improve hygiene and cleanliness, to support breastfeeding more effectively and to apply elements of the integrated family-delivered neonatal care programme developed at our hospitals back in the UK. The programme supports families to care for their preterm babies through feeding, cleaning, skin-to-skin contact and breastfeeding – low-cost interventions that can make a big difference.
Annie: On this trip, both Panzi and Heal Africa hospitals had homemade alcohol hand gel at every bedside as a result of our previous work with them. Heal Africa also has this wonderful cleaner now who takes such pride in his work. He keeps the neonatal unit absolutely spotless – it’s a big improvement from our last few trips.
We’ve worked with staff over the years to encourage parents to spend more time doing skin-to-skin and just bonding with their babies. On our latest visit, we were overjoyed to see mums and dads both spending so much time with their babies. At Panzi Hospital in particular, there’s a lot of suspicion around men because of the prevalence of male violence against women in DRC. So to see a dad playing a hands-on role with his child is just wonderful.
We worry about being perceived as parachuting in with our ideas. We don’t want the staff to feel like we’re just going to tell them what to do and then leave. But they’re really taking our ideas on board and finding that they are making a difference for their patients.
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