REDUCING INFANT MORTALITY

This past week we have been hosting Dr. Michael and Sister Liz Visick. They are short-term specialists (STS) for our church as part of it's Neonatal Resuscitation Training (NRT) projects.

Over the past 11 months that we have been in Indonesia we have been trying to expand our relationship with a group called Perinasia on behalf of our church.  Perinasia is a group of highly qualified doctors that have committed themselves to saving babies lives through the teaching of NRT.  They have done this for a number of years.  The relationship with our church started approximately 17 years ago when our mission president Dr. George Groberg came to Indonesia to teach NRT as a STS and teamed together with Perinasia.  Since that time over 10,000 medical personnel in Indonesia have been trained. 

Our goal since we have been here has been to develop a project with Perinasia that would be able to continue on throughout the years.  We would also like to be able to use our church's humanitarian funds in a way that we felt would be useful.  I (Eileen), with my background in neonatal nursing and labor & delivery nursing,  have a keen interest in the area of NRT. 

After several months of planning we were able to have a project wherein we took Dr. Visick to an area in West Java called Bandung.  West Java has a higher than normal (Indonesian average) newborn infant mortality rate, currently over 3/100.  Statistically, world-wide, one in 10 babies born need some assistance breathing after birth and only 1/100 babies born need extensive resuscitation.    

Perinasia arranged for us to visit three healthcare facilities in the area.  First we visited a referral hospital called Rumah Sakit  Hasan Hadikan. This is a hospital that gets referred all the babies with complications from other smaller hospitals and puskesmas’ (clinics) in the area.  We were especially impressed with two of the neonatologists Dr. Dadang and Dr. Tetty who took us on a tour there. They obviously had a passion for their work despite their limited resources.  They only had 5 respirators where they needed 10. There was a set of conjoined twins in their NICU that would eventually be separated.  Their ER was full.  One baby in the ER was admitted with severe asphyxia and was being manually bagged by a nurse until he/she could be transferred to another hospital due to the lack of an available respirator.  The care that was being given looked excellent, and the neonatologists were very knowledgeable.

The next place we went to was called Rumah Sakit Cicalengka, a smaller hospital outside of Bandung.  It admits babies which have complications following home births, at the puskesmas and expectant mothers with complications.  Again I was impressed with the care that was being given.  The E.R. physician, Dr Lukeman,  told us about the need for more resuscitation equipment.    In the NICU there were no respirators.  Two babies were there that had been asphyxiated at birth and then referred to this hospital. Unfortunately, at this point although there is no way to know for sure, there is a high likelihood that these babies will be handicapped due to the asphyxiation. The pediatricians here had the knowledge of how to care for the babies and did their best, but were also without adequate equipment.

The third place we went was a puskesmas.  Women who don’t deliver at hospitals either deliver at home or a local clinic called a puskesmas.  Officially there are 8 puskesmas that feed into Rumah Sakit Ciralengka.  However, about twice that number refer clients there.  We visited the nicest puskesmas.  It was extremely hot in the delivery room.  There were about 15 midwife students that I enjoyed visiting with.  All of them had seen about 10 deliveries in the year they had been in school.  This particular puskesmas was the only one that had any kind of resuscitation equipment -  a suction bulb and one bag & mask (cost about $20).  There was still no oxygen in the delivery area. 

On Saturday and Sunday we attended Perinasia’s teaching of NRT to doctors and nurses.    They were teaching very advanced skills promoted by the American Academy of Pediatrics.  The challenge that we could see is that many of the people in this area do not have the equipment to offer the “advanced” skills that NRT requires. 

Sunday morning we attended church in Bandung.  Afterwards we attended a meeting we had requested with Perinasia doctors. As we visited with them we offered a plan.  We proposed that our church, in association with Perinasia, would bring in equipment and teachers to teach trainers, who would then teach additional students a program called helping babies breathe. (HBB)  This program only requires a stethoscope, suction, and a bag & mask for delivering breaths to the baby.  We would present this program to the midwives, pediatric doctors and nurses of the area that do not have access to the training or equipment that the more advanced hospitals might have.  Each trained midwife would have with her the donated equipment so that even with a home birth she could have the ability to resuscitate a baby during the first critical minute after a baby is born.

The Perinasia physicians supported the idea and seemed excited about its implimentation. Instead of building more wings onto the hospital, or adding more equipment, perhaps we could reduce their need by addressing the cause of the problem…birth asphyxia. 

The project is currently being written up to bring to our supervisors for approval.  Unfortunantly for us, the first training session will be after our return home.  Oh, how I wish we could be a part of it.  I love patient care and miss nursing.  We are glad however that it is happening and hope that by having this program infant mortality will go down in Indonesia.

DR TRI OPENING ONE OF 4 RESUSCITATION BABIES GIFTED TO PERINASIA
PRESIDENT GROBERG AND DR. VISICK LOOKING ON

PREEMIE UNDER THE LIGHTS

EILEEN AND HER WANNA BE GRANDBABY

BABY BEING MANUALLY VENTILATED IN EMERGENCY ROOM

DR. RETNO AND DR. REBY FROM RUMAH SAKIT CICALENGKA WITH EILEEN

RUSSELL AT RUMAH SAKIT CICALENGKA IN NURSERY

RUSSELL LOVES THOSE BABIES

SARI, EILEEN AND DR. RETNO IN NURSERY

LOCAL PUSKESMAS WITH SUCTION AND BAG AND MASK

EILEEN WITH MIDWIFE STUDENTS

DRS DISCUSSING RESUSCITATION TECHNIQUES

DR TETTY TEACHING BASIC RESUSCITATION TECHNIQUES

RUSSELL EXPLAINING HIS THOUGHTS TO SARI AND DR. VISICK

MEETING WITH PERINASIA TO DISCUSS PROJECT