March 6, 2017 |

How to survive birth in one of the world’s hardest places

Doctors were losing three out of five newborns in an intensive care unit. But within weeks, that changed.
Dr. Albert Nyembo, director of Sendwe Hospital neonatal unit, admires a newborn baby.
Nearly 100,000 newborns die each year in the Democratic Republic of the Congo (DRC). This little girl survived thanks to Dr. Albert Nyembo and his training in newborn resuscitation. Photo: PATH/Georgina Goodwin.

Everyone gets one golden minute. If we don’t take our first breath in the 60 seconds after we’re born, all bets are off.

But if the right person is paying attention—someone trained in exactly what to do and when—then the game of life tips back in our favor.

Until a little over a year ago, no one at the largest hospital in the second largest city in the Democratic Republic of the Congo (DRC) had received that life-or-death training. Nearly 300 babies died at Sendwe General Hospital in 2015.

But after one intensive 14-day training and some follow-up supervision, newborn deaths dropped by 40 percent. That’s the power of focusing on the systems that save lives.

Mothers and babies in the Sendwe Hospital NICU nursing room.
The neonatal intensive care unit (NICU) at Sendwe Hospital is packed and so is the nursing room next door. Mothers nurse their babies together every two hours. Their body heat helps keep the room warm. Photo: PATH/Georgina Goodwin.

Four to a bed

Twenty-two babies are squirming and crying in Sendwe Hospital’s neonatal intensive care unit (NICU). They’re packed together in cribs and incubators, most of which no longer work. Snuggling together, the babies keep each other warm.

The staff talk quietly, the babies’ cries just normal background noise. Dr. Albert Nyembo, who directs Sendwe Hospital’s NICU, is leaning over a little boy who was born that morning, seven weeks early.

The hospital sees many preterm babies like this one, born to mothers who are young, malnourished, unhealthy, poor. In this case, “so poor, his mother had only a dirty rag to dress him in,” Dr. Nyembo says sadly.

Infant mortality rate (per 1,000 live births)

A graph showing the DRC's infant mortality rate (per 1,000 live births).
Globally, newborn deaths have been cut by more than half since 1990, but progress has been slower in the DRC. The country has one of the highest infant mortality rates in the world. (Estimates from the UN Inter-agency Group for Child Mortality Estimation.) Graph: Dave Simpson.

Babies in the DRC are born into some of the world’s most challenging circumstances. Poverty, violence, and disease are common—but strong health systems, drugs, and medical supplies are not.

Despite the frequency of complications in pregnancy and childbirth, few providers are trained in emergency obstetric and neonatal care. Only 3 percent of health facilities provide these services. Facilities lack essential equipment like blood pressure monitors and suction devices used for newborn resuscitation. Many delivery rooms don’t even have mattresses.

Training for the golden minute

In this environment, our team in the DRC stays focused on this statistic: 80 percent of newborn deaths could be prevented with proven and affordable interventions. One of these is training in newborn resuscitation.

Five health providers bend over a long table and practice resuscitating newborns with NeoNatalie resuscitation dolls. A seated woman watches.
Health providers practice resuscitating newborns in distress using NeoNatalie, an infant model that can simulate breathing, an umbilical pulse, and heart sounds. Sixty health providers from 20 facilities have received the training. Photo: PATH/Marie-Louise Mbo.

PATH collaborated with the Ministry of Health on a hands-on training in newborn resuscitation developed for underresourced facilities like Sendwe. Sendwe Hospital delivers dozens of babies each day, many of whom struggle to breathe.

But before Dr. Nyembo and four others on his team received the training, they lost three out of five babies that came to the NICU. It was devastating for the team and worse for parents.

Infant in the Sendwe Hospital NICU nursing room.
More than 25,000 newborns have received newborn care services with PATH support. Without these services, many of these babies could have died or suffered severe complications. Photo: PATH/Georgina Goodwin.

Together, the five doctors and nurses learned to identify danger signs during the first 60 seconds after birth and the steps to take in each critical moment that follows. Because people learn better by doing, they practiced on a realistic model of a newborn called NeoNatalie.

PATH also provided the NICU with the essential supplies and medicines it needed. Another 19 facilities in the DRC have received similar training, supervision, and supplies.

“Before the training, we didn’t work according to the norms,” says Dr. Nyembo. “Now we know what to do.”

Dr. Pierre Kitha Bitingo Lusambia (right) and Dr. Albert Nyembo, director of Sendwe Hospital neonatal unit care for a newborn.
Dr. Albert Nyembo (left) talks Pierre Kitha through the process of intubating a premature infant. Photo: PATH/Georgina Goodwin.

Babies survive

The preemie that Dr. Nyembo is currently attending to struggled to breathe during his golden minute, but thanks to Sendwe’s now well-trained team, he survived.

But Dr. Nyembo is concerned that the infant still has fluid in his lungs, so he’s showing Pierre Kitha, a new trainee, how to clear out the boy’s airways. Dr. Nyembo first practiced this technique—sliding a tube through the nose—on NeoNatalie. Now he’s passing the skills on.

Babies sleeping at the Sendwe Hospital NICU.
The government budget for the DRC—a country two-thirds the size of Western Europe—is little more than the budget of the city of Seattle. But small investments can have a big impact for babies like these. Photo: PATH/Georgina Goodwin.

When they’re done with the procedure, Dr. Nyembo and Pierre carefully dress the boy in a little green gown provided by the hospital. “Don’t forget his other sock,” the attentive doctor reminds Pierre.

While Pierre tucks the baby alongside three other preemies, Dr. Nyembo picks up a little girl—just 30 minutes old and a mere four pounds. He smiles and coos at her, clearly in his element.

“We have rescued many, many babies. An average of ten a day!” he says. “We are very happy.”

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