Saving newborns: revolutionary changes in the conservative field of medicine
By Olga Grebennikova, Media Liaison Office, UNICEF Kyrgyzstan
“Don’t touch me with dirty hands”, reads a poster in the intensive care department for newborns in the City Perinatal Centre of Bishkek city. If infants who needed intensive medical care from the first minutes of life could talk they would say the same: come to me with clean hands, make sure I’m kept warm, don’t disturb me with noise, and make sure my mum and dad visit me often and that my incubator is always monitored by a nurse.
Everything is simple, and at the same time complicated. It’s simple because that is basically how infants were cared for in long-gone pre-Soviet times. It’s complicated because the medical system still suffers too much from the influence of the “Soviet inheritance” with its fundamentally different principles of infant care.
Maya Mergenbaeva, the Head of the intensive care department in the City Perinatal Centre, says that in the past medics did not pay attention to the temperature in the ward. “On the contrary,” she says, “we always believed that the ward should be cool. What is more, infants in intensive care were subjected by doctors to an excessive number of procedures.”
As the doctors themselves say today, the children were “overfed with medicine”. Artificial lungs were used that were not infant-friendly and could easily traumatise the larynx. The system of feeding and drug therapy was also short and difficult to use.
Revolutionary changes began to be step-by-step introduced to the Centre from 2006 when, with the support of UNICEF, doctors began to receive training to improve the quality of medical care. Participants themselves stated that the most difficult part was to overcome psychological barriers and stereotypes. Medicine is an extremely conservative field always based on proved evidences so any innovation is more likely to be rejected that accepted. And if a doctor has been taught for seven years at university and during internships, and then constantly in practice, that the intensive care department should be keep sterile and that children should not be approached by “non-sterile parents”, or that only a doctor and nobody else can give medicine, then accepting new approaches is very difficult.
Unfortunately, statistics still are not optimistic. Out of 7882 children born in the Centre in 2009, 1400, or almost 18 per cent, were admitted to the intensive care ward. There are many reasons why almost a fifth of the infants needed intensive care. These include economic instability in the country that lead to extremely unwelcome levels of stress for pregnant women, a range of possible complications caused by anaemia and shortages of other important microelements, women approaching doctors at late stages of pregnancy and the quality of healthcare services provided.
This is the reason why UNICEF, in close partnership with the Ministry of Health has invited top international specialists to the country in order to share with Kyrgyz practitioners evidence of the effectiveness of approaches and practices for intensive care of children, patient management, and ensuring “quality life in the future”. The last of these is no less important than the first two because, for instance, if infants’ weak throats are traumatized by artificial lungs they can lose their voices, or a brain hemorrhage can lead to disability. Use of devices such as nasal cannulas, Ambu bags, and easy-to-use systems for introducing nutrients and medicines prevent such trauma.
Training carried out in the middle of 2009 for “doctor-nurse” teams have had particularly positive effects on Kyrgyz healthcare workers, because almost all of the lessons helped the extremely overloaded personnel to divide responsibilities and at the same time work more effectively as a team.
As a result of all the innovations, the intensive care department is quiet and warm, and very clean but not smelling of chlorine because it is washed with soap. Nurses are on duty next to the infants’ cots– there are five of them for twelve children, which is also a revolutionary innovation. Empty cots and resuscitation devices are constantly in a state of preparedness – when there are difficult births in the department, a signal is quickly sent and staff on call to save infants’ lives. But, most remarkably, there is almost unlimited access to the children in the ward. Both mum and dad can regularly see their children, but of course with clean washed hands.