Real lives

Real lives


No child should die for a lack of medical equipment

© UNICEF/Geo-2010/Amurvelashvili
A baby in the intensive therapy unit of the Neonatology National Medical Centre at the Tbilisi’s Gudushauri National Medical Center

By Sarah Marcus for UNICEF Georgia

February 2010

In the intensive therapy unit of the Neonatology National Medical Centre at Tbilisi’s Gudushauri National Medical Center, eight tiny babies are squeezed in pairs into four incubators. Most of them are lying quietly, watched over by a careful medical team, but in one incubator a baby stretches and kicks its small legs and arms, fighting for life in difficult conditions, occasionally brushing against the other baby as it flails about.

The babies in these incubators are lucky to have reached the Gudushauri Center, yet even there their luck may run out, for the Center does not have enough resuscitation units or incubators to accomodate the number of seriously ill newborn babies who arrive at its doors.

In Georgia, too many newborns die unnecessarily and in 2008 the Committee on the Rights of the Child expressed grave concern over the country’s relatively high neonatal mortality rates.

The latest estimates from inter-agency group  on Under- 5 Mortality Rate and Infant Mortality Rate are 30 and 27 respectively per thousand live births.

Visiting the Gudushauri Neonatal Centre, the bald fact that in Georgia 58 per cent
of deaths under the age of five occur in the first four weeks of a baby’s life really hits home. In addition to the clear lack of sufficient equipment, Dr Gela Metskhvarishvili, the head of the Neonatology Centre of the Clinic, tells heartrending stories of the babies that his staff could not save, in many cases because they simply did not have an incubator or resuscitation unit available.

‘There are many more emergency cases than we can accept,’ said Dr Metskhvarishvili, whose centre deals with 150-200 complicated pregnancies and emergency resuscitations per month.

‘We have only 10 resuscitation units and only 6 of those actually work. We need at least 15 working resuscitation units, because they also need to have rest periods – at the moment all our units work 24 hours a day,’ he explained.

© © UNICEF/Geo-2010/Amurvelashvili
babies are squeezed in pairs into incubators because of lack of resuscitation units or incubators to accomodate the number of seriously ill newborn babies

Furthermore, sometimes there is no incubator available in the intensive therapy unit for a successfully resuscitated baby, meaning it has to stay in the resuscitation unit, meaning another baby clinging to life by a thread will be turned away from that unit.)

At the moment, Dr Metskhvarishvili said, they need to move four babies from the resuscitation to the intensive therapy unit but they cannot. The unit has 14 beds but only 4 incubators. The centre needs a minimum of ten more incubators for the intensive therapy unit, the doctor said, pointing to one Soviet-era incubator still in use.

The centre, opened in 2003, has already achieved a heartening degree of success: in its early days the mortality rate in the centre was at 30 per cent; now it is down to 12-13 per cent.

‘But this is not low enough,’ said the doctor, ‘In Israel it is three per cent.’

But there is not much more progress they can make at the centre without more equipment – in order to be complete, each bed should have an incubator, a resuscitation unit, a monitor and a drip.

Staff skills too are a cause for concern. Although Dr Metskhvarishvili said that the doctors have adequate skills and have experience working abroad, even some of them could benefit from additional training, while neonatal nurses urgently need training to update their skills.

Both equipment and skills levels were noted in a general preliminary assessment for the aims and objectives of the project to overhaul perinatal care in Georgia made by visiting staff from the Chaim Sheba Medical Centre in Israel. The Sheba Centre played a crucial role in the impressive reduction of neonatal mortality in that country, where infant mortality dropped from 16 in 1980 to 4 in 2005.

The Sheba centre in partnership with the Ministry of Health of Georgia and UNICEF stands ready to assist the country in aiming to achieve a similarly impressive reduction.

Such a reduction would not only be impressive but is imperative, so that more babies do not suffer the fate of Demetre.

Demetre and his twin Davit were delivered by emergency Caesarean section at the Gudushauri National Medical Center Centre. They were born alive but critically underweight and in need of resuscitation and help breathing – but the Centre did not have enough respiratory units available.

The two babies were placed in one incubator and one had oxygen administered manually until a respiratory unit was found available at a hospital in Gori, a city about one hour’s drive from Tbilisi. Demetre was taken there until a respiratory unit became available at another hospital in Tbilisi. Demetre was then sent back to Tbilisi, but his heart could not stand the strain and he died on the way back.

All that was needed to save Demetre was more respiratory units at the Gudushauri Centre, where despite complications, staff had delivered him and his twin safely.

At the centre, and others like it in Georgia, more equipment and training will save more children like Demetre. Complicated pregnancies have and will always occur everywhere around the world and there will always be a small number of newborns which it is impossible to save.

But in Georgia in 2010, newborns are dying because of insufficient equipment and this need not happen. If Dr Metskhvarishvili gets his wish of more equipment, he and his staff will stand a high chance of saving many more babies’ lives.




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