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From the FieldThe following are narratives from NRP instructors/advocates in the field. Their work is a testament to the Neonatal Resuscitation Program. We hope you enjoy their tales. Dian Ruder, RN, BS, MA ZIMBABWE I was excited to read in the November (2007) newsletter about the NRP Global
Implementation Task Force. I would like to report my experience in
teaching NRP in Zimbabwe, Africa this October. I am a NICU RN and NRP
instructor at Lucile Packard Children's Hospital in Palo Alto, CA. My husband and I went for three weeks,
during which he taught music to children in orphanages and programs for
street children. I went alone to Karanda Mission Hospital, in the rural
north, which has become a referral center for the country due to severe
nursing and doctor shortages around the country. The hospital situation
in Zimbabwe is under crisis, given the current economic woes there.
This hospital has a high-risk program, where mothers come to live in a
compound outside the hospital grounds for a few weeks before their
anticipated delivery, so they don't have to walk for miles to get to
the hospital when in labor.
Karanda's nursing school program has had NRP taught once before, and they were interested in having it taught again. In eight teaching days, we covered lessons 1 through 6 of the NRP textbook, and aspects of 7, 8 and 9. Each day involved practicing skills with dolls I brought and equipment that they will use. Sequentially, we added skills each day, with daily testing and successful megacodes performed on the last days. Fifteen nurse-midwife and nursing students participated, and additional regular staff came after work several days to review recent NRP changes and to practice skills. I left them with teaching materials for future classes, and the instructors excitedly planned to share them with a nearby hospital. I was also able to leave other equipment which had been donated for the hospital's use. I hope this small beginning will help advance NRP in the country for the good of the babies born there. Lloyd Jensen, MD, FAAP Elizabeth Disu, MD NIGERIA
These course were held in conjunction with the Pediatric Association of Nigeria national Conference in Lagos, Nigeria. We had representatives from 60 different organizations that attended the training. Among those organizations were 20 Federal Medical Centers and 15 University Teaching Hospitals in Nigeria. LDS Charities donated 24 sets of SBA teaching sets and 24 set of standard NRP teaching equipment. The course was supported by the Ministry of Health (Dr Grange is the Minister of Health in Nigeria - former International Pediatric Association president) and the Pediatric Association of Nigeria.
ARMENIA In March of 2006, we team-taught two NRP courses in Goris, Armenia, with four physicians who had been trained the previous week in Yerevan. On Tuesday morning we were setting up the breakout tables and preparing for the course when Dr. Astghik Gabrielyan, a neonatologist at Goris Hospital and one of our team teachers, rushed in to us exclaiming "I saved a baby, I saved a baby!" She went on to explain that about an hour before she was to be at our meeting she had delivered a baby girl who was not breathing... "The child was depressed as the result of difficult delivery. It was the 3rd pregnancy and the second child. The baby was born without cries, breathing, muscle tone and was cyanotic, with no meconium. She was immediately put under the heat, positioned properly, suctioned (mouth, then nose), dried and stimulated. Wet blanket was removed and changed, the baby was repositioned. After additional stimulation the baby still didn't breathe, heart rate was less than 50, still blue and no muscle tone. Positive pressure ventilation was done with Ambu. The baby still didn’t breathe. The 2nd resuscitator performed chest compressions; after 30 seconds the baby started breathing, the ventilation was continued without chest massage. Very soon the baby took several breaths, after which spontaneous breathing was restored. The baby started moving. Ventilation was stopped. After the evaluation – adequate heart rhythm, skin still remained blue, breathing spontaneous. The doctors provided oxygen. Now the baby is doing fine. I would like to share my happiness with all those who would know about this case and express my gratitude to all the doctors who came to Armenia and taught this wonderful course. Thanks to the new principles mentioned in the algorithm we were able to resuscitate the depressed newborn in a couple of minutes. We are honestly grateful for this project and will start using our knowledge immediately. When we were following the algorithm we were sure of the positive results. We strongly believe that this project will save many, many babies of Armenia and again want to thank those who developed, organized and implemented this project in our country." We were thrilled to hear Astghik’s experience and George asked her to stand and tell her story to the participants in our class – they were all so proud of her; I saw her several times during the day obviously retelling exactly the steps she had taken to save this baby girl. Before this session began Astghik was nervous and insecure about participating as a teacher; suddenly she was smiling and animated – it gave her the confidence she needed and her confidence spilled over to the rest of the doctors who were participating. When our day was finished we went to visit the mother and baby and Astghik dictated her story to Anna Babakhanyan, who then translated this story into English for us. This was wonderful in every way; a baby was saved first of all, but Astghik was a real inspiration to all the other doctors who participated. We know that she and all those who taught with us that day as well as the participants in the course will be inspired to continue teaching all those who work with them to deliver babies. |
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