By Audette Exel, Founder and Chair, the Adara Group
Eva leaned forward, eyes flashing with anger as she told me the story. “The babies came early and were not moving. There was no power and it was dark. I didn’t have any equipment. The other nurse had no neonatal training. She put the babies on the bench and said wearily, ‘They are dead.’
‘No! Not yet are they dead!’ I said. I gave her my phone and told her, ‘Turn on the flashlight!’ And in that light, I did a gentle, gentle tiny resuscitation with two fingers. And as the twins gasped for breath, I knew my work was worth it. One baby at a time.”
I sat silently, in awe, wondering where this amazing midwife in rural Uganda found her passion, her commitment to the poor and her determination to go on in such trying conditions. I also found myself furious at the injustice. That millions of babies die for want of the most basic health care every year. And that, despite her iron will and passion, she did not have access to the most basic resources to do her job. Nor do her colleagues have access to the training they need to save more lives.
I am lucky enough to know at first hand how smart investments in healthcare can create huge change for communities. Just a few kilometres away from where Eva sat fighting for tiny lives is a hospital that has very different outcomes for babies born too soon. Although it began life as a humble bush clinic, Kiwoko Hospital is now considered a model for what is possible for neonatal care in low-resource settings. Adara has worked hand in hand with Kiwoko Hospital for the past 18 years. Over that time we have developed deep expertise in the development and delivery of holistic newborn health programmes. The results have been astounding. The smallest babies (those weighing less than 1kg) in Kiwoko Hospital’s neonatal intensive care unit now have almost twice the chance of survival that we saw a decade ago.
These are our tiniest clients, and we stand shoulder to shoulder with the incredible team at Kiwoko fighting for each and every one of them.
Our work with Kiwoko means we now have nearly two decades of mistakes as well as successes under our belt. With our strategy of staying for the long haul and building service delivery expertise, we at Adara are now ready to take what we have learnt and grow this work to save newborn lives – not only in Uganda but around the developing world.
We have bold plans and big dreams for this scale up work over the next decade, and many are coming to help us. We have formed a coalition of passionate newborn health experts in Uganda to help us drive this agenda to save as many newborn lives as possible. After much consultation and discussion, the Adara Global Health team is now putting together the vision and strategic plan for this exciting new work, which will be underpinned by collaboration and partnership at every level.
We have had the honour of partnering with Kiwoko Hospital as it builds toward a standard of excellence that is a beacon of hope and inspiration to others in the developing world. First and foremost, we will continue our need partnership to support Kiwoko to maintain service delivery at the highest standards. Service excellence underpins all our work and is at the heart of all we do.
Our scale up programme will build on the excellence and the lived experience of newborn health work at Kiwoko. It will have four main focus areas:
- Training and capacity building: Adara will form training teams to work across the country delivering tailored programmes, based on hospital or clinic needs. We plan to begin this work in the hospital and community where the amazing Eva is based.
- Resources: We will work to make sure all clinicians have the resources they need to do their job. These could include educational resources such as training manuals on the essentials of newborn care, or the supplies and equipment critical to delivering lifesaving interventions that the clinics or hospitals should request from the Ministry of Health. We will work in partnership with communities, other non-profits and government agencies to help improve the availability of resources. Adara is writing the training curriculum for Level 1 and Level 2 training in Newborn Health, and developing toolkits for appropriate staffing, minimal equipment and supply lists.
- Policy and curriculum development: In collaboration with the National Newborn Steering Committee, Makarere University and other newborn health leaders in Uganda, we will work to support and influence policy on newborn health, sharing our learnings. We hope to work with a number of leading training institutions in the country to include holistic neonatal training in the curriculum for all those who are critical at a birth, including nurses and other clinicians.
- Access to oxygen: With our long-term partners the University of Washington, Seattle Children’s Hospital and PATH, we are excited to build and roll out the Safe Newborn bCPAP Project. This programme is seeking, through its simple technology, to address the lack of access in low-resource settings to safe and affordable treatment for respiratory distress syndrome – the most common cause of disease and death for babies born before 34 weeks’ gestation. A million babies a year die of respiratory distress in the first 24 hours of life. Those babies need the support that new technology and training can bring. After feasibility testing of our bCPAP device, we will be working with our partners to bring the device to global scale. Adara will be the expert implementers on this project.
There is still much to do. We are incredibly proud of our work in newborn health, which is possible because of the support of so many, and the brilliant local clinicians who have had access to the training, resources, facilities and support systems they need for saving lives. Our dream is that all clinicians in developing world settings have the same opportunity, and we will be playing a small role in making that happen.
After all, if a Ugandan midwife can save babies against all odds with a flashlight and her bare hands, the least we can do is give her what she needs to do her job.
On World Prematurity Day, we at Adara salute all the unsung heroes working in newborn health in incredibly difficult circumstances. One baby at a time.