{"id":8893,"date":"2017-08-03T11:18:07","date_gmt":"2017-08-03T10:18:07","guid":{"rendered":"https:\/\/blog.blueventures.org\/?p=8893"},"modified":"2017-08-03T11:18:07","modified_gmt":"2017-08-03T10:18:07","slug":"helping-babies-breathe-one-year","status":"publish","type":"post","link":"https:\/\/blog.blueventures.org\/en\/helping-babies-breathe-one-year\/","title":{"rendered":"Helping Babies Breathe: one year on"},"content":{"rendered":"

\u201c<\/span>Poussez<\/span><\/i>, Madame Balbine!\u201d <\/span><\/p><\/blockquote>\n

And so, the baby was born. The only noise, however, was the background cacophony of chickens, goats, and Malagasy music hits floating over the breeze. The sound of a baby crying was deafeningly absent. I looked around. The midwife was calm. All was under her control: \u201cDon\u2019t worry, Madame Balbine\u201d. She dried the baby, changed the wet towel for a dry one, and then rubbed the baby\u2019s back several times. She quickly evaluated the baby \u2013 still no crying. She placed the baby down, next to the mother, and started helping the baby to breathe using a specialised bag-valve-mask device. After a few breaths, the piercing cry of a newborn broke the air. The midwife smiled, and handed a healthy, albeit slightly disgruntled, plastic baby over to mum. As she explained about skin-to-skin contact and breastfeeding, I ticked off the final points on my mark sheet.<\/span><\/p>\n

<\/a>
Safidy staff member Balbine helping the Chef CSB from Ambatomilo with the simulation.<\/div><\/div><\/div>
<\/a>
Revising the HBB action plan in Ambatomilo.<\/div><\/div><\/div><\/div><\/div>\n

They\u2019ve delivered over 200 babies since last August, and almost 15% of these babies needed ventilation.<\/span><\/p>\n

We\u2019re back in Velondriake, the Locally Managed Marine Area in southwest Madagascar that is supported by Blue Ventures. This time, we\u2019re catching up with all of the <\/span>Chefs CSB<\/span><\/i> \u2013 the nurses or midwives who manage the public health centres (<\/span>Centres de Sant\u00e9 de Base<\/span><\/i>) in the area. They all successfully completed the <\/span>Helping Babies Breathe course in August 2016<\/span><\/a> with Dr Alison Leaf and myself. This course provides lots of hands-on simulation training on evaluating a newborn baby, with a focus on the first minute of life. Babies who are not breathing must receive help within the \u201cgolden minute\u201d, in the form of ventilation with a bag-valve-mask. This is usually all that is needed to initiate the baby to breathe by itself. Between the one private midwife and five Chef CSBs, they\u2019ve delivered over 200 babies since last August, and almost 15% of these babies needed ventilation.<\/span><\/p>\n

\"CSB

CSB in Belavenoke, north of Andavadoaka in the southwest.<\/p><\/div>\n

Neonatal resuscitation has become a new activity for the <\/span>Safidy community health programme<\/span><\/a> (<\/span>Safidy<\/span><\/i> means \u201cthe freedom to choose\u201d in Malagasy), which is an integral part of <\/span>Blue Ventures\u2019 holistic approach to conservation<\/span><\/a>, combining community-based\u00a0reproductive and other health services with locally-led marine resource management initiatives. Historically, Safidy has worked closely with Community Health Workers (CHWs) who provide basic healthcare services to rural communities. Now Safidy is also focusing on improving training and coverage of neonatal resuscitation in public health centres – not only to contribute to strengthening the government health system, but also to encourage CHW referrals for pregnant women to give birth in health facilities rather than their homes.<\/span><\/p>\n

\"A

A midwife in Andavadoaka provides ventilation during a HBB simulation.<\/p><\/div>\n

As a result, a well-weathered black Nissan 4×4 became home for the week. Together, the Safidy team and I overcame the sand tracks, rocky coastal roads, and spiny forest to visit the remote health centres, one by one. The most turquoise sea that you\u2019ll ever see lined the route to Belavenoke. Lush green mangroves awaited us in Befandefa. Bulbous baobab trees, overflowing at the waist and meagre at their zenith, speckled the landscape as we bounced along the sandy roads. The blue and white signs announcing the presence of a <\/span>Centre de Sant\u00e9 de Base, Niveau I<\/span><\/i> (public health centre) quickly became familiar. We were invited into a small clinic room, with promotional posters of mosquito nets and condoms. A large blue fridge hummed in the background, protecting its precious cargo of polio and tuberculosis vaccinations. We were shown around: a lone delivery bed stood proud, in the centre of an otherwise bare <\/span>salle d\u2019accouchement <\/span><\/i>(delivery room). <\/span><\/p>\n

\"The

The entrance to the maternity ward. Many of the rural health centres only have a small room in the health centre, which is used for deliveries as well as postnatal care.<\/p><\/div>\n

The nurses and midwives work here alone, each responsible for the health of those in their village, and neighbouring villages. By visiting them in their place of work, the centre did not have to close for the day. Indeed, we were interrupted as patients arrived and the <\/span>Chef CSB<\/span><\/i> rushed off to manage a fever; a bleeding umbilical cord; a follow up from the previous week. The <\/span>Chef<\/span><\/i>s reflected that they had used the skills we had taught them previously, but, with low numbers of deliveries each month, they were worried they might get out of practice.<\/span><\/p>\n

What are Safidy project coordinators for if not to act out the role of expectant mothers during the refresher training? Both \u201cMadame\u201d Nicholas and \u201cMadame\u201d Njaka did a sterling job of encapsulating the essence of being heavily pregnant. Madame Balbine also gave several Oscar-worthy performances, but, with two X chromosomes, the role may have been a bit easier for her! We spent an enjoyable few hours \u2013 and I promise the <\/span>Chefs CSB<\/span><\/i> enjoyed it too \u2013 revising the actions to be taken at birth, until it had been committed to muscle memory. A short test later, with skills renewed and confidence improved, we said a loud and hearty <\/span>veloma<\/span><\/i> (goodbye) and it was on to the next CSB.<\/span><\/p>\n

<\/a>
Discussing the Action Plan with the Chef CSB from Tsiandamba and revising the steps to take when a baby is not breathing at birth.<\/div><\/div>
<\/a>
Meeting with the Chef CSB of Befandefa to discuss deliveries from the past three months.<\/div><\/div><\/div>
<\/a>
The Chef CSB from Andavadoaka practicing ventilation techniques during a simulation.<\/div><\/div><\/div><\/div>
<\/a>
More practice! Using the flipchart to help the Chef CSB in Ambatomilo practice one of the action plan scenarios. <\/div><\/div><\/div>
<\/a>
Skills renewed and confidence improved.<\/div><\/div><\/div><\/div><\/div>\n

It\u2019s been a busy week, as you might imagine! We leave, happy in the knowledge that babies delivered by these nurses and midwives will be given the support they need. I have so much respect for everyone we\u2019ve worked with this week, doing alone what we do as a team in the UK. I would like to thank them all for being so inviting, and for their continued enthusiasm. <\/span>Misaotra bevata, amanarake koa!<\/span><\/i> (Thank you, and until next time!) <\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Volunteer medic Emily Clark returns to Velondriake to help improve the training and coverage of neonatal resuscitation in public health centres.<\/p>\n","protected":false},"author":112,"featured_media":8907,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[345,622,43,478],"tags":[625,507,506,483,488,641],"class_list":["post-8893","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-community-health","category-madagascar","category-velondriake-madagascar","category-volunteer-stories","tag-community-health","tag-maternal-health","tag-reproductive-health","tag-sharing-learning","tag-training","tag-volunteer-medic"],"yoast_head":"\nHelping Babies Breathe: one year on - Blue Ventures - Beyond Conservation blog<\/title>\n<meta name=\"description\" content=\"Volunteer medic Emily Clark returns to Velondriake to help improve the training and coverage of neonatal resuscitation in public health centres.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blog.blueventures.org\/en\/helping-babies-breathe-one-year\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Helping Babies Breathe: one year on - 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