Expanding our Maternal, Newborn and Child Health work to Nepal

Since 1998, we have specialised in delivering high-quality healthcare to women, newborns and children at health facilities in the community and at home. This work in Maternal, Newborn and Child Health (MNCH) has primarily exhibited in Uganda.

As we celebrate our 25-year anniversary, we are also expanding our reach. We are doing this by sharing our knowledge and taking this expertise to health posts and birthing centres in Humla – our remotest site, high on the Nepali border with Tibet.

In April, members of our MNCH team from Seattle visited Humla to provide specialised newborn training for nurses, midwives and female community health volunteers. The trip also provided the opportunity for our team to gain a greater understanding of the context, so they can identify ways to adapt our teachings to this remote area.

Heidi, Adara’s Senior Clinical Advisor, and Molly, Adara’s Clinical Programme Manager, are both experts in neonatal care units and providing care for small and sick newborns. While they understand that the needs and challenges in Humla are different to Uganda , they believe that the foundations and lessons from our programmes can be transferred and implemented in Nepal.

“Our work in Maternal, Newborn and Child Health has only previously been in Uganda. It is very exciting that we can start to share this knowledge and expertise with our Nepal team. It is thrilling to see this crossover of Adara’s programmes and transfer the knowledge from our learnings in Uganda.”

Heidi Nakamura, Senior Clinical Advisor

This journey began with a flight to Simikot in Humla which requires clear weather and an 18-seat plane. In Simikot, the team began a three-day intensive training for staff from Adara-supported birthing centres in Humla. Some of the nurses and midwives had walked up to three days to reach the training. Designed to be a small class, the Adara team provided training to 10 attendees in Helping Babies Breath and Essential Care of Every Babies – courses that focus on immediate and follow-up care of a newborn.

According to Heidi, the purpose of this work was all about saving lives. “Upskilling and equipping birthing centre staff with the knowledge and tools they need will help to ensure that every mother has the opportunity for a safe delivery, in a well-equipped facility with a skilled birth attendant by their side,” Heidi said. “This is something we have refined after 25 years work in Uganda.”

The training, while intense, was extremely practical; something that the attendees expressed was a strength as previous trainings had been theory based only. The small class size allowed for critical hands-on practical training and one-on-one instruction.

Both Molly and Heidi reflected that it was the practical performances where they saw the most improvement. While attendees could grasp the concepts, they lacked the ability and resources to put that knowledge into practice. They were extremely impressed with the attendees’ attitudes towards the training, and it was wonderful to watch them grow in confidence.

“It was so great to see how interested and engaged the midwives and nurses were during the training. They are all passionate about providing the best care possible to their mothers and babies, often under very challenging circumstances,” said Heidi.

“The nurses’ energy, compassion, dedication and ingenuity in caring for mothers and babies is exceptional,” agreed Molly.

Adapted from our Hospital to Home training for community health workers in Uganda, the team also ran a training session for female community health volunteers (FCHVs) in Chauganfaya. The training focused on supporting a mother and child and assessing a baby for danger signs. The eight FCHVs also benefitted from a specialised training in breastfeeding techniques and lactation support from Molly who is a Board Certified Lactation Consultant.

Following the training, the team hiked to the various birthing centres to see the staff in their own environments. This allowed staff to reinforce what had been taught at the training and run through practice scenarios. The impact of the training was evident with all the staff being proficient and able to provide guidance to their colleagues. This visit was extremely fruitful as it enabled the team to see firsthand the birthing centres and their staff in action. We plan to commence regular visits by local Adara staff to check in and provide support.

One nurse from Muchu birthing centre reflected, “I feel the training was very effective, relevant and useful. Theory along with practical was so effective and helped us to upgrade our knowledge.

“In the future, I can confidently deliver a newborn baby safely, arrange all necessary materials needed during the delivery, and teach breast feeding techniques to a new mother.”

Nurse from Muchu Birthing Centre

Another positive outcome of the trip was watching Adara staff feel empowered to take on more of the mentoring and training roles. While some said they initially felt nervous to lead, by the end of the trip they were confidently leading the mentoring sessions.

“It was inspiring to see their confidence grow and watch how they adapted and enriched the materials for the context,” said Molly.

Throughout each of their visits, the team were generously welcomed by the local communities with katas (silk scarves), ceremonies, rich conversations, dances and even horseback rides! At each village, there was an outpouring of gratitude and appreciation for Adara’s work in Humla and it was a wonderful opportunity to celebrate how much has been achieved in the past 25 years.

There is still more to be done and the team were often reminded of the challenges of working and living in a remote place like Humla. However, Adara is excited for what the next 25 years may bring.

We look forward to seeing our teams in Nepal and Uganda continue to exchange knowledge and share insights from their programmes with the goal of reducing preventable maternal and newborn deaths.

“With continued mentoring and support, I am confident that mothers and babies born in Humla will receive the expert care they need, not only in those first crucial moments of a baby’s life, but beyond,” shared Heidi.

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Child in Nepal