Bringing care and hope to children in their first moments

Midwives in North Maluku are learning how to prevent newborn deaths caused by serious bacterial infections.

Wahyu Handoyo, Yuliana Hasim and Adinda Silitonga
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North Halmahera District Health Office/2020/Billie Bitjoli
24 February 2021

In December 2018, Mita and her husband Yorhen adopted a baby boy named Stefano who was born on New Year’s Eve in a hospital in Tobelo, North Maluku. Stefano was born by cesarean section and had several health issues, including bowlegs and yellowish skin. After five days at the hospital, Mita decided to bring her son home to her village.  

But during his first night, Stefano came down with a fever. He refused food and had mucus in his throat, bluish skin and foaming around his mouth. In a panic, Mita called the village midwife, who then called Meri, the midwife at the village where Stefano was born. 

When Meri arrived later that night, she immediately checked the baby’s vital signs. His body temperature was 40°C and she noticed that he had difficulty breathing. Based on his symptoms, Meri believed that Stefano had a possible serious bacterial infection (PSBI).  

In Indonesia, 1 out of 67 babies die within the first 28 days of life (DHS, 2017)1. Serious bacterial infections such as pneumonia, sepsis and meningitis are responsible for about 600,000 newborn deaths every year.2  Sepsis is a major cause of neonatal mortality and accounts for 13 per cent of newborn deaths (DHS, 2017). Many sick infants with these conditions only have non-specific signs, making it difficult to recognize that they have an infection.  

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Timely referral to a health facility is critical to treat PSBI, but many young infants face challenges accessing these facilities, which leads to deteriorating conditions and even death. When referral is not accepted or possible, treatment through primary health care, including antibiotic injections, may save lives.  

UNICEF is working with health workers in North Maluku to support early identification and prompt treatment of young infants. Meri is among dozens of midwives who participated in a Bill and Melinda Gate Foundation (BMGF) and UNICEF-supported programme to strengthen care of young infants, particularly those with PSBI.

“Before, I was not confident when handling sick young infants, especially when I needed to give them an antibiotic,” she explained. “But after completing the training and receiving mentoring, I feel more comfortable and confident with my new skills.” 

Aware that the consequences of not immediately treating PSBI in infants could be fatal, Meri convinced Mita and Yorhen that referral to a hospital was necessary for Stefano’s survival. The family, who previously refused this, agreed to bring Stefano to a district hospital. On the way there, Mita prayed fervently for her son to hold on. 

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IMCI Maluku 1

“I was so scared and worried about Stefano,” said Mita. “I was afraid of losing him as I saw his body turning blue.”  

When they arrived, the health workers were ready, having already been informed in advance of the situation by Meri. After quick observation and referral, they were able to provide timely and proper medical treatment for Stefano.  

For the next 13 days, Mita and Yorhen waited in the hospital for any updates on their son. On the 14th day, their prayers were answered, and they were overjoyed when the doctor told them that Stefano had fully recovered and could leave the hospital.  

Not long after they left, Mita and Yorhen brought Stefano to the posyandu (community health post) to see Meri. She smiled with delight as she saw Stefano healthy, and his parents filled with pride. 

“No words can describe how I feel when I see my patients recover,” said Meri. “It’s just priceless.”