Training health professionals in neonatal resuscitation continues to help save newborn lives in Perú. We share the success story of one nurse and HBI's journey to support health professionals like her:
It was November 2019 when Lic. Catherine Tejada Aguirre was in Pasco, holding a newborn in her arms. The baby was in a poor state, with an Apgar score* of only 4 out of 10. Baby Luz* had a limp body with a bluish appearance, a low pulse rate, and barely any response to simulation. Her situation is similar to 10% of babies born in homes and health centers across the country.
While progress has been made and neonatal mortality rate in Perú has fallen from 16 deaths per 1,000 live births (2000) to only 6 (2019), the rate in rural and underserved regions still lag behind. In these areas — home to almost half the country’s entire population — around 75% of women give birth at home alone or in small clinics with only a single healthcare professional because they do not have the same access to health services as those in urban areas.
Working with local organizations, communities, and government units since 2014, we at Health Bridges International have learned that the country’s healthcare system has yet to standardize training for medical professionals in neonatal resuscitation. Healthcare professionals in Perú need support to consistently develop crucial skills in neonatal care.
The three other medical professionals in the room attempted resuscitation efforts for Baby Luz. They went through several attempts but Baby Luz showed no signs of improvement. The services of a certified neonatal resuscitation specialist was needed.
To provide medical and health professionals critical support, we sought to create and replicate a neonatal resuscitation training and teaching model. Co-developed with the Perúvian College of Midwives, the HBI Neonatal Resuscitation Train-the-Trainer Program (HBI NRTP) is an official certification program that trains midwives to provide contextualized training to colleagues in their own communities. The program creates a powerful multiplier effect: since 2014 with over 130 trainers trained in 246 regions, more than 20,600 participants have received neonatal resuscitation training and an estimated 5,200 babies per year have been saved. We support our partner’s leadership in ensuring that this certification becomes part of future licensure requirements for all midwives in Perú.
Without hesitation, Lic. Catherine, a neonatal resuscitation trainer, stepped up to help resuscitate Baby Luz. She led her colleagues through the steps in providing warmth, clearing the airway, drying, and stimulating Baby Luz. With her assistance, Baby Luz’s condition improved. They applied positive pressure ventilation and Baby Luz spontaneously started to breathe. Within an hour, Baby Luz was well and breastfeeding. “What I learned in this [NRTP] course gave me a solid understanding to perform resuscitation and to be able to save lives,” says Lic. Catherine.
Topics in NRTP include the foundations of neonatal resuscitation, including initial steps of newborn, post-resuscitation, and end-of-life care, as well as ethics. Participants are trained to facilitate positive-pressure ventilation, alternative airways, and chest compressions for newborns. Amid COVID-19, we worked with our partners in shifting to distance learning: creating web-based resources, virtual training, online communities, and even upcoming tele-simulations so participants safely complete the program. With NRTP, healthcare workers equip themselves to multiply their lifesaving skills and care for mothers and newborns. Lic. Francisco León, who works as a midwife in a health post in Chachapoyas, said of his neonatal resuscitation-trained nurse technicians: “[They] are more than my right hand. I am part of them and they are part of me!”
Today, we continue to support trainers and fortify each newly established regional NRTP program. We work with the Perúvian government, state hospitals, and other health facilities in adopting and conducting the Neonatal Resuscitation Train-the-Trainer Program across the country. Together, we work toward a future where all newborn babies will be given a chance at life.
1 - The Apgar score is a 10-point scoring system doctors and nurses use to assess newborns one minute and five minutes after they are born. The higher the score, the better the baby is doing after birth. A score of 7, 8, or 9 is normal and means the newborn is in good health.
2 - Not the baby’s real name
Being back with our team and visiting with the staff and boys at the Casa Girasoles - this whole experience is a huge gift. Today we took the boys for a 4 hour hike. It was hard. They did awesome.
This afternoon we continued our discussion with the program directors. We've been meeting in a sort of "re-set" manner and talking about our work, changes that may be coming in child-welfare in Perú, and how we can continue to support one another in this work.
Check out a few photos from our hike and activities at the Casa Girasoles. Thanks for all the ongoing support.
I am back in Lima. I arrived late last night.
In all my years of travel in the many trips I've taken to-and-from Perú, the excitement and energy I feel when I arrive are the same. I am giddy. Perhaps even more so - given the months of uncertainty and travel restrictions in the face of the pandemic.
We have a busy trip planned. We will be traveling to the Casa Girasoles in Urubamba and Ica - and make a brief visit to Arequipa for a day of meetings.
This trip is one of the most essential trips I have made in a long time. Not only is it a chance to truly reconnect with our staff and spend time with the children in the homes, but this is also a trip that continues to reset our mission and vision.
Over the past year, we've spent a lot of time and numerous discussions with our staff talking about the new focus of HBI. We've crafted a new vision for our work that emphasizes women and children. We've even intentionally narrowed the scope of our programs and projects to focus on child welfare and empowerment, programs that will address the root causes of risk, opportunity, and health gaps for vulnerable children in Perú.
Over the next two weeks, we will meet with staff and talk about how our new focus can galvanize our organization. We are living in an inspiring time. Thanks for your ongoing support and generosity. Stay tuned to the blog for stories, photos, and updates.
Who said this work is supposed to be easy? There is nothing easy about working with communities, local change agents, and on-the-ground providers to build the pathways to the futures they desire . . . and deserve. There is nothing easy - but it is so vital.
This work, walking alongside local leaders - it's hard. The "success" stories are far fewer than the challenges. NGOs have a way of making it seem like everything always works out. Visit a website, and you are dazzled by the numbers - thousands of lives impacted, thousands of hours invested, and hundreds of thousands of dollars provided. Every story seems to end with a happy outcome. Many websites don't disclose the challenging outcomes that contrast to the pretty picture-perfect results of our work.
Global health and social justice advocacy are complex, relationship-driven, slow-and-steady wins the race work. This is hard work.
A few weeks back, a couple of HBI staff were visiting a remote mountain community. They met a young woman. For purposes of this post, I will call her Gabriela. Gabriela is only 18 years old. Shy and self-conscious, she was in the market, and one staff noticed her swollen belly. Inquiring, they asked if the young lady was pregnant. Much to their surprise, she started crying and told them a story that involved visiting a hospital in a large city a few hours drive away. She told them of the doctor telling her she had a "tumor" and needing surgery. Unsure what this all meant, she returned to her town. She continued, however, to feel more and more worn-down and weakened. Her abdomen was getting larger and larger.
When our staff met Gabriela, they knew something was wrong. They quickly gathered her contact information and told her they would be back in contact very soon. Hours of phone calls, numerous messages back-and-forth, a thorough review of her medical records - and our team was sure of one thing, Gabriela needed help . . . and soon.
We could get Gabriela seen through a partnership with a very well-respected hospital in Cusco (NB: run by Catholic nuns - many of whom are also physicians). The physician who did her intake knew their small hospital could not help; and suggested we get Gabriela transferred to a large public hospital with an oncology team.
I wish I could say this was a story that ended with a happy outcome. It does not. The struggle to get Gabriela seen by oncology was convoluted. When she was finally seen - with an HBI staff person present - the physician explained to her that nothing could be done. There is no curative treatment. Her cancer has disseminated to her entire abdomen and spine.
We are now working with Gabriela and her family to get her compassionate palliative care. Gabriela's is a story of struggle and an all too often reality of our work. There is nothing easy about an 18-year-old young woman living in extreme poverty with terminal cancer. Nothing easy. This is our work. To build bridges . . . even if the outcome is not what we all want or hope.
This is not supposed to be easy! It's life and it's complex. That is what makes it all the more important.
It has been over a month since the new presidential administration took office in Perú; and the response to the COVID pandemic by the government remains strong.
More and more age-groups are eligible for vaccination and larger geographic segments of the population are receiving their first doses. Projections by the Ministry of Health indicate all eligible citizens will receive their first dose by the end of 2021. This is great news. However, a number of questions remain - will the current vaccine formulations confer immune coverage in response to the rapidly changing variants (NB: Perú is predominately administering the Sinopharm BBIBP-CorV vaccine formulation - which study data indicates has a <51% efficacy rate)? Will a booster vaccine be required to match the evolving viral complexity? And if such, how will Perú secure the millions of additional doses needed to "immune boost" thousands of rural and underserved communities?
In addition, a third wave of cases is expected to hit before the end of 2021 (NB: modeling predictions forecast a mid-December peak to the third wave). How well prepared is Perú for this inevitable impact on the healthcare system? On their fragile economy?
At present, things are looking up for Perú as case loads continue to decrease and more and more eligible individuals receive their inoculations. The future - however - remains a bit uncertain; and as the U.S. and E.U. wrestle with the ethics of booster immunizations, much of the developing and middle-income world struggle to find a clear path to a new normal way of living in the age of COVID.
Add to this complex picture, climate disruptions, natural disasters like the horrible impact and devastations in Haiti, unending political and military conflicts, and a widening divide between "have" and "have not" citizens of our terrestrial globe - and it is really hard to know where we "go from here?"
I think the focus is making a difference for the communities we serve. Our focus as an organization is to continue to create pathways of health, hope, home and purpose for the women, children, and healthcare professionals we are called to serve. We will keep build bridges - one person at a time.
The HBI Blog is a rotating journal from our staff. Our Blog is a series of messages from the field, insights from our work, and lessons in service.