We desire to save more pre-term birthed child

Wednesday 25 July 2018

Ms. Mai is a young doctor working for a provincial level hospital, Nghia Lo General Hospital located in Nghia Lo Town (Yen Bai Province) as a Deputy Director of Paediatrics Department and person in-charge of Neonatal Intensive Care Unit. Not only is she responsible for day-to-day operation of the unit, but she also provides direct care for newborn babies. “She is a very dedicated doctor,” parents of newborn babies told me when learning that I was going to interview her, and I observed the same when I came to her unit. She ran room to room to check on each newborn baby and guide their parents on how to take care of them. I saw that she was holding and soothing a preterm newborn at 30 weeks. She focused a lot on four preterm newborn babies who were receiving intensive care in her unit.

Photo: Doctor Mai is holding a preterm baby at 30 weeks. Her mother is on the right side and smiling.

“Preterm birth is very common among ethnic minorities here. You can see that almost all preterm newborns who received intensive care in my unit are ethnic minorities. They are born preterm at around 30 weeks,” Mai said. Ethnic minority women, according to her, are taught about care and regular check during pregnancy, but practicing these behaviours is a real challenge. “Ethnic minorities are living up in the mountains and the roads from there down to the health stations and hospitals are extremely rough. It is not safe at all for pregnant women to travel through such a kind of road by motorbike or walking. It takes hours to go down the mountains”.

Ethnic minority women also have to do hard work in the field during pregnancy because of their difficult living situation. They have to support their families. “Consequently, delivering birth at the field is quite common among ethnic minority women. It is a big threat to the lives of newborn babies. Many ethnic minority newborns were brought to my unit with serious infections,” Mai said.

To meet the demand of local communities, Mai’s unit was established three years ago. At that time, Mai was a doctor of Intensive Care Department and mobilized to work for Neonatal Intensive Care Unit. Unfortunately, she was not trained to do the job.

Mai said: “In the past, cases of preterm birth at around 30 weeks were directly transferred to national hospitals. My unit could not take care of them because we did not have capacity. It was also families of pregnant women who requested us to transfer babies to higher level hospitals as they know we could not. Time to travel from my unit to higher level hospital was a big challenge for mothers and preterm newborns especially.”

Since 2013, Save the Children has implemented several projects to improve the situation in Mai’s unit. Currently, GSK is providing generous support to strengthen the capacity of units like Mai’s and provide equipment to improve the quality of service delivery. Specifically, Mai and her colleagues were sent to the Vietnam National Hospital of Paediatrics to join an intensive on-the-job training. They were able to learn by doing under instruction by the hospital’s senior paediatricians, and certificates of completion were only granted to those who demonstrated that they can deal with a real case on their own.

Mai remarked that she joined the first training in 2013 and the second one in 2017. And, the result is that her unit is now capable of dealing with cases of preterm birth. My observation at her unit on that day substantiated what Mai said, as four cases of preterm birth (around 30 weeks) were being cared for directly by her and colleagues. “My colleagues and I keep regular contact with doctors and experts of the Vietnam National Hospital of Paediatrics to get technical support directly through visits or phone calls. I appreciate a lot and it helps us so much.”

Doctor Phan Thanh Ton, Deputy Director of Nghia Lo General Hospital, also referred to 4 cases of preterm birth at around 30 weeks as a proof for improvement in the capacity of Mai’s unit. “Ethnic minority families let her unit to treat and take care of newborns who were born preterm. This means that they already believe in Mai’s and her colleagues’ capacity since previously they were always requesting to transfer their children to a higher level hospital. Now, only extremely serious cases will be transferred. For me, this is the biggest success of the project”.

The GSK project will also provide Mai’s unit with two additional 5 – parameter monitors and an electric syringe. “The more equipment my unit has, the more patients my unit can serve,” Mai said. “My unit used to be equipped with only one monitor so our ability to monitor multiple newborns. With the two monitors provided, we can check and track critical parameters of three sick newborn at the same time for accurate and intensive care. I consider this an important improvement in the service delivery of the unit.”

Last but not least, Ms. Hoa, a doctor of the Vietnam National Hospital of Paediatrics, shared with me: “I was there when the ethnic minority boy was brought to Mai's unit. I was happy to see that they could really save the life of the boy as their way of treatment was appropriate. We only provided them with additional advices. This proved an improvement in their capacity and the training we provided to them yield good fruits.”

It is a miracle

That is Mai’s remark about a serious case of a H’Mong ethnic minority boy that she treated 4 months ago. “When he was brought to my unit, his body turned blue. He showed very little response. He had an infection and had not eaten anything since he was born (around 34 hours). He was born preterm at around 31-week gestation,” Mai said.

Mr. Ho – the boys’ father– said that his wife, who is just 20 years-old, saw symptoms of labour after her dinner. It was dark and they lived up in the mountain. There is no skilled midwife living nearby so his wife delivered with support from her mother-in-law.

However, after being born, the boy did not respond and start feeding. He was left hungry until the the next morning, and it took more than three hours to bring the boy to Mai’s unit. I personally experienced how extremely rough the road was when I visited the boy’s house. It was really an adventurous trekking up to the peak of a mountain with an abyss on the left and a high cliff on the right.

At that time, no one believed that the boy could recover. However, with support from a senior doctor and newborn nurse from the Vietnam National Hospital of Paediatrics, Mai and her colleagues did everything they could do at that time. Miraculously, the boy overcame a difficult situation and recovered. When admitted, his weight was only 1,500 grams.  When discharged, his weight was 2,300 grams.

At the time when I paid a visit to his house, they boy was 4 -months old. He weighs 4 kilograms and is developing very well, according to the doctor who accompanied me to check the health of the boy.

Photo: Ho’s son and wife. The boy is 4-month old.