Helping Babies Breathe Training in Zanzibar, Tanzania

Gina Wilson - May 2015

​Hi my name is Gina Wilson. I am a nurse practitioner and currently a student in the Doctor of Nursing Practice (DNP) program at Duke University. The focus of my DNP quality improvement project is implementation of Helping Babies Breathe for mid​​​wives in Zanzibar, Tanzania. I am completing this project in the North District of Unguja, on the main island of Zanzibar, Tanzania.

The inspiration for this project came last year as I was completing a portion of my final clinical residency to be a Family Nurse Practitioner. I had traveled to Moshi, Tanzania for a month to work in one outpatient location with severalavailable clinics. One of the many opportunities I had there was helping deliver babies in the maternity clinic. I was really enjoying my time until a delivery went terribly wrong. The mother was hemorrhaging while the baby was blue and unable to breathe. There were so many interventions that I wanted to do in that moment, but there were few supplies to be found. We were able to complete some interventions for the mother and sweet baby, but those were minimal. Watching this mother and baby suffer was such a scary and helpless feeling. I kept replaying the situation over in my head and wondering what I could have done differently.

When I returned home several weeks later, I spent time reviewing the available evidence about the reality of childbirth in sub-Saharan Africa. Zanzibar, like most of sub-Saharan Africa, has a very high neonatal mortality rate (29 deaths per 1,000 live births). I knew I wanted to focus my doctoral work in this area, so I approached one of my professors to talk about it. She encouraged me to continue reviewing the evidence to find why neonates are dying and what programs are being implemented to help reduce this. That is when I found the Helping Babies Breathe program and the rest is history! The first step I took to pursue implementation was to establish connections with a local non-profit in Zanzibar. I knew of an American based non-profit that did some medical work on the island. They were able to connect me the appropriate people within the Zanzibar Ministry of Health to gain approval. This was an adventure of emails, meetings and discussions. Thankfully I received approval and after a great deal of collaboration we planned our initial steps for implementation.

My contacts at the Ministry of Health assisted me in identifying 6 nurse-midwives who would serve as master trainers. The main requirement for these individuals was the ability to speak both Swahili and English. The initial training for the 6 master trainers lasted three days. During the training we utilized demonstration, return demonstration, and situational simulation. Everyone helped each other and promoted an environment of positive collaboration and teamwork. Each master trainer received the following supplies: upright bag-mask resuscitator, penguin suction device, solar light, HBB learner handbook in Swahili, laminated HBB action plan in Swahili, pen, notebook, and a bag to hold all the supplies. At the end of this training the master trainers practiced how they would train other midwives. It was neat to watch the master trainers encourage each other as they discussed and practiced how they would conduct trainings. Pre and post testing was also completed utilizing the Knowledge Questionnaire and OSCEs.

The next round of training was led by the six master trainers. The six master trainers conducted the training in Swahili and trained an additional 15 midwives in the rural North B district. This training also took place over three days and all midwives at this training received the same supplies as stated above. Training was conducted in a similar format utilizing demonstration, situational simulation, collaboration, and team work. Pre and post data was collected in this training too. It was incredible to watch the midwives learn from each other!

After spending two months in Zanzibar, Tanzania facilitating and leading training efforts, I headed back to the United States.

Three months after implementation I returned for follow up testing and to continue with additional trainings. During my absence the master trainers completed 62 observations of live births. The purpose of the observations was to see whether or not HBB was coming to life in their clinics and communities. It was found that out of the 62 observations recorded over a 3 month time period, 12 babies were not breathing at birth and received the proper intervention which allowed them to survive the Golden Minute. During this trip, we also had the first 21 trained midwives come together for a focus group discussion and a second post measurement to evaluate their retention of HBB knowledge and skills. We also had a celebration to congratulate the midwives on their success. The celebration featured framed certificates, cake, soda, t-shirts, and HBB pencils! This was so much fun!

During my time in Zanzibar, two of the master trainers also conducted another training for 3 additional districts on the island. Eleven new midwives were trained in Swahili utilizing the same methods stated above. All received the same supplies stated above and data was collected pre to post. Again, it was amazing to watch these midwives in action. After completing the training, I had a chance to meet with the Ministry of Health to share results and discuss our plans moving forward. The Ministry of Health is very happy with our progress thus far and wants to continue training midwives. The Ministry of Health has agreed to continue helping coordinate trainings, providing the training location and assisting with the transportation of supplies to the island. They have been a great partner in this project! Our goal is to train and provide supplies to all the midwives on Unguja (Main Island) and Pemba (another major island that is part of Zanzibar) by the end of 2017.

This work is so close to my heart. The midwives are incredible; so intelligent and dedicated to caring for those around them. They inspire me. It is a blessing to my soul to know that simply sharing knowledge and supplies with midwives is breathing hope into communities all the way on the other side of the world! I am so incredibly thankful for this.