Breathing new life into newborn and pediatric care
In southern Nepal, support for improved access to and use of oxygen through a UNICEF initiative, generously funded by USAID, is strengthening healthworkers’ abilities to save precious young lives
Dhanusha, Nepal: Pinki Sah remembers how terrified Pujan Mahara and husband Indeshwor had been when they arrived at the Janakpur Zonal Hospital in Dhanusha District in southern Nepal on the afternoon of 26 June 2021, holding their newborn baby in their arms.
Pujan had given birth to the little boy just that morning at a health facility in the couple’s home village in Mirchaiya in nearby Siraha District. But it soon became clear that there were problems: the baby was underweight, at just 1,600 grams, he wasn’t crying normally, and more worryingly, was having trouble breathing. The facility had subsequently referred them to the better-equipped Janakpur Hospital for treatment.
And so, following a harrowing two-hour ambulance ride through roads largely emptied by the pandemic-induced lockdown, the couple had finally arrived in Pinki’s unit.
“They were visibly exhausted, but more than that, they were scared,” she says. “It’s a parent’s worst fear to see your child suffering and feel helpless to do anything.”
Pinki and her team at the NICU soon took over. With the child’s oxygen saturation levels found to be severely low, he was quickly placed in a radiant warmer bed and administered a steady supply through a concentrator. This continued on and off for about a week, with the NICU staff regularly monitoring oxygen levels and adjusting the supply as required.
This was an area in which the hospital had recently seen considerable improvements thanks to efforts under a UNICEF initiative – generously funded by USAID – that was aimed at strengthening quality of newborn and pediatric care through improved access to, supply of and skills in using oxygen infrastructure and infection control measures. Janakpur Hospital and Narayani Hospital in Parsa District were the two hospitals in Nepal where the initiative was rolled out between February and June 2021. Both high-volume health facilities, the hospitals also comprise the only referral hospitals for neonatal intensive care and pediatric care services for all eight districts in Province 2.
Through the initiative, UNICEF supplied a variety of oxygen equipment to the neonatal and pediatric wards in both hospitals, including concentrators, oximeters, oxygen analyzers ad CPAP machines. At Janakpur Hospital, the oxygen piping system was additionally renovated, ensuring that all beds in the pediatric ward were connected to the central oxygen distribution system.
Relevant health staff like Pinki were then provided training on using these equipment, as well as managing neonatal and childhood illnesses, diagnosing and managing of hypoxemia, and proper handwashing and equipment cleaning, among other areas. A total of 45 healthworkers from the NICU, pediatric units and pediatric emergency units of both hospitals were trained. Further to this, a follow-up training and onsite coaching mentoring was also recently conducted.
“We didn’t know very much about proper management of oxygen, especially the use of equipment like concentrators, before the training,” Pinki says. Given the huge surge in demand of oxygen supplies at the peak of the second wave of COVID-19 across the country and the possibility of more and more children being infected, she says it was something she and her fellow healthworkers were very eager to build their skills on.
“It's been very useful for us, not just in handling our regular cases, but also to be more prepared in the context of the pandemic,” she adds.
Thanks to the efforts of Pinki and her team, on 5 July, nine days after he had been admitted, Pujan and Indeshwor’s baby boy had recovered well and was ready to be discharged. To help the young couple continue to support his improvement at home, the team also counselled them on Kangaroo Mother Care (KMC) or Mayako Angalo (“a loving embrace”) in Nepali. This comprises a technique which involves maintaining prolonged skin-to-skin contact with a newborn to keep them warm and help boost weight gain, particularly crucial for preterm and underweight babies.
For Pinki, who has been working in her present capacity for over a year, it was rewarding to see the little boy’s condition improve under their care.
“In these times when there is so much bad news around us, it’s a good feeling to be able to continue to provide these important services to families and save children’s lives,” she says.
