Putting the interests and rights of the child first in Kazakstan
How patronage nurses are managing their work during the COVID-19 pandemic
The first twenty-eight days of a newborn's life is the most important period in a baby's life. According to both UNICEF and WHO, providing adequate feeding and care during this period is critical to a child's chances of survival and a healthy life.
Young parents with no experience of raising young children may not know how to take care of the child properly. The role of the patronage nurse is to show parents how to express milk and breastfeed, bathe and cradle the baby.
When conducting patronage, medical workers also pay attention to the childcare in the family and take measures to identify and prevent possible diseases.
Mandatory patronage of a newborn is specified in the Order of the Minister of Healthcare of the Republic of Kazakhstan dated 29 December 2017.
Kaltayeva Saule is 49 years old. She works as a chief nurse at the Zhanuya polyclinic in Taraz and oversees the work of the patronage nurses.
In 2020, the daily life of nurses changed dramatically after the introduction of a state of emergency in Kazakhstan. And during the quarantine, they had to conduct remote counselling instead of scheduled patronage visits.
"Remote counselling should only be done if the family with the child is in self-isolation or in quarantine," Saule says. “In other cases, patronage of pregnant women and young children (i.e. up to the age of five) is now carried out exclusively offline."
At the same time, patronage nurses must comply with the sanitary standards. They must thoroughly wash their hands with soap and water before and after the patient's appointment and change their mask accordingly. During home visits, nurses also carry hand sanitizer with them to clean their hands as needed - to protect the health of the children, their families and themselves.
However, the risk of COVID-19 infection for nurses remains, as their work schedule has not changed, and they are in daily contact with parents and newborns.
The only way they can avoid contact with infected patients is by making a preliminary call before a scheduled patronage visit.
“Since we provide outpatient care [medical care provided to patients in the clinic and when calling a doctor at home], we continue to work during the day," says Saule. “We call the family and conduct an epidemiological survey: ‘Are there any family members with an infectious disease?’ and ‘Have family members been in contact with infectious patients and those with coronavirus infection?’”
If the family confirms contact with a COVID-19 patient, the nurse contacts the district doctor to find out the date of a possible contact or infection, then reschedules the visit for 14 days later or conducts an examination via video link.
“The nurse also asks the parents about how they take care of the baby, how they feed, whether the baby has all the essentials,” Saule says. “We are also looking at the family environment to make sure that the child is safe and not in any danger.”
In Saule’s practice, there have been cases where the parents neglected the child or left them in the care of other family members. In some families, parents and/or grandparents have alcohol addiction, which is also very dangerous for the newborn.
“In one of the recent cases, a mother left a child with cerebral palsy with a grandmother who had an alcohol addiction,” says Saule. “The grandmother was constantly drunk and did not take care of the baby. Every day, he was lying in a pile of blankets, dirty and hungry."
In such cases, patronage nurses contact the police and social workers. Fortunately, this story ended well. Social workers found the child's father, who took the baby with him. He now takes care of him and regularly sends photos and video reports on the baby’s condition to social services.
"If a nurse sees signs of violence or cruelty towards a child, she immediately contacts social workers who talk to the parents, help the mother and, if possible, eliminate the cause of the danger or the trigger of violence,"
In addition, a woman may be suffering from a toxic home environment, which affects the health and well-being of both the mother and the child.
According to Saule, patronage nurses always closely monitor the mother's physical and mental health condition, including detecting the early signs of postpartum depression.
Each nurse has a list of questions for the mother by which she determines her emotional state. In case of depression, psychologists visit the mother to help her cope with this condition.
“Often postpartum depression is experienced by women with an unwanted child, or when the child’s father leaves her alone,” says Saule. “That is why it is so important for nurses to establish a trusting relationship with the mother, to be friends with her, so that they can see the alarm bells in time and help her and the baby."
According to Saule, the best interests, rights and well-being of the child will always be the number-one priority for patronage nurses.
Cooperation with the European Union allowed UNICEF to support the healthcare system of Kazakhstan during the COVID-19 pandemic by equipping it with the medicines and diagnostic devices necessary to effectively combat the coronavirus.
Funded by the European Union Humanitarian Aid. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union. European Union cannot be held responsible for them.
The people in the photographs are not related to the described cases from the practice of patronage nurses.