Neonatal nurse Janine Evans recently returned from working in Jahun General Hospital, Nigeria, supervising care in the newborn unit. She shares her tips for ways of working in a “low-resource” setting like Nigeria or South Sudan.
Janine’s top 5 tips for neonatal nursing in MSF projects:
- Low-resource doesn’t mean low quality
- Simple things can really make a difference
- Clinical assessment skills are vital
- The fundamentals of care for babies don’t change
- Be prepared! Draw on all available resources before departing
1. Low-resource doesn’t mean low quality
A baby is monitored and kept warm after an emergency delivery in the operating theatre, Jahun General Hospital. © Matthew Smeal / MSF
Of course the work still has to be high quality and done well. You need to stick to infection control and medication safety, just as in a high-resource setting. But there is a lot that can be achieved with low resources. Which leads to my second point...
2. Simple things can really make a difference
A four-day-old baby recovering in Aweil hospital in South Sudan. © Jean-Christophe Nougaret / MSF
You don’t need the latest high technology gadget or fancy expensive program to improve care and ensure good outcomes. It might be simple bedside training, but lots can be achieved by reminding, and refocusing on, what’s important. Especially because it’s easy for staff to be overwhelmed when the caseload is high, and you never know how many people are completely new on the team.
For example, newborn care starts in the delivery room, so we trained all the midwives and nurses to stick to the priorities there. This focused on following existing protocols well to start resuscitation within a minute, in the correct manner. Then we looked at the existing resuscitation area. As a team we brainstormed how to make it more accessible and functional, and added an equipment checklist to go with it. The result? An improved resuscitation approach for the babies that needed that help in the first moments of life.
3. Clinical assessment skills are vital
MSF medical staff discuss recovery and treatment for four day old baby Mou in the Aweil Hospital in South Sudan. © Jean-Christophe Nougaret / MSF
In high-resource settings we have monitors, tests and X-rays—we can gather a lot of information from a lot of sources. In an MSF project you rely much more on your own clinical assessment skills to inform your plans and decisions. For example, babies can often have neonatal sepsis (severe infection) and need antibiotic treatment. At home we use blood tests like bacterial cultures to guide treatment, but in Jahun we use clinical examination. The good news is you are not completely alone: you have MSF’s excellent guidelines to follow, and the national staff around you—they know a lot about diseases that you don’t normally see. Then you also have medical advisors you can call on remotely.
4. The fundamentals of care for babies don’t change
Skin-to-skin, or kangaroo mother care, is a low-tech way to keep babies warm and help their survival. © Martina Bacigalupo / VU / MSF
There is a motto for neonates: keep the baby “warm, sweet and pink”. Warm is for normal temperature; sweet is for normal blood sugar; and pink is for well-oxygenated. In an MSF project, the principles are the same but how you do it is different. For example, if you don’t have radiant warmers or incubators, you can substitute with the mother’s own warmth via intermittent skin-to-skin care.
5. Be prepared!
Draw on all available resources before departing. Read situational reports. Download the guidelines to know the protocols. Google the projects to see photos of the set-up. Get the statistics: know how many babies are coming through, what the common diagnoses are, and what the mortality rate is—as it is obviously much higher than our home contexts.
Would you like to join our team? As a neonatal nurse working for Médecins Sans Frontières your training and supervisory skills will be utilised to the full. You’ll be working very closely with national staff who have experience in low-resource settings if not specifically in neonatal care. Our Newborn Units range from higher capacity to more basic units with minimal possible intervention, in contexts such as Afghanistan, Pakistan, Jordan, and South Sudan.