Fieldset
A neonatal experience in Gambela, Ethiopia

Just one month ago, Harriet began her first posting with Médecins Sans Frontières / Doctors Without Borders (MSF). She is working at a busy hospital in Ethiopia, where she is working to ensure that very young babies have the best possible start in life. She blogs about her own first 28 days…

Worldwide, almost half of the deaths in children aged under five years old occur in the first 28 days of life, when babies are considered ‘neonatal’. 

Despite great progress since 1990, Ethiopia has one of the highest neonatal mortality rates in sub-Saharan Africa. I’ve recently arrived at the MSF hospital in Gambela, in the west of the country. 

For newborns, the care needed is very specialised, but that doesn't necessarily mean it requires high levels of technology

The hospital is finding itself overwhelmed. It was built for a capacity of 100,000 people,and is now serving a population of 800,000 – half of whom are refugees from neighbouring South Sudan.

And this is where MSF comes in. We are providing infrastructure, equipment, training and support to the regional hospital in efforts to reduce deaths and improve health in the area. The youngest are most affected by lack of access to quality health care. 

For newborns, the care needed is very specialised, but that doesn't necessarily mean it requires high levels of technology. 

Specialist care

Many babies’ lives can be saved by providing high quality care for the most common newborn issues: supporting nutrition in low birth weight babies, treating infections, managing unstable blood sugars and temperatures. Other vital steps include preventing infectious diseases through vaccines, good infection control measures, and preventative treatment to babies born to mothers with HIV/Hepatitis etc. 

I'm surrounded by people who demand the best of me, but also encourage me to give just that

And this is where I come in. My role is to manage the neonatal unit, which includes (but with MSF is never limited to): supporting and developing the nurses to provide care in accordance with MSF and national guidelines, HR and rostering for staff, and managing the medical drugs and supplies we use.

The babies may have been preparing for life for nine months, (or in the case of some of our patients, many weeks less). For me, my journey has taken a little longer. 

Arrival

Working for MSF has been my goal for 15 years, ever since I found out about them. I shaped my career towards this goal: learning about global health and tropical diseases, developing my teaching and manging skills as well as clinical ones, gaining work experience in resource limited settings, and learning French. The last skill hasn't been so useful here yet...

Despite all the preparation, new beginnings can still be an overwhelming experience. I expected a steep learning curve, though perhaps I didn't quite anticipate finding myself on the first day inside the operating theatre, ready to assist with resuscitating a baby. 

The mother needed to have an emergency cesearean section due to the babies' heart rate being too high – a sign of the baby being in distress. 

I felt my pre-assignment reading and preparing evaporate somewhat, as I looked around the operating theatre to locate the equipment I might need, and learn who all the staff around me were. 

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Harriet Zych at the MSF hospital in Gambela
 

Time was running out and the surgeons were working fast. Just a few minutes after they started, the baby was out.

The room fell quiet. They brought the baby’s limp body to the resuscitation table. The midwife worked quickly, drying and stimulating the baby to encourage her to breathe. At last she took her first breaths. Her colour began to pink-up. Relief. 

I smiled to the mother and give her a thumbs up, wondering how universal this gesture really is. She gives me a tired but happy smile back. I take it the message got across. 

This little one was too healthy to need admitting to our department; she and the mother would stay in maternity for monitoring. So, it was time for me to change out of my scrubs and get back to the ward round. Back in to the MSF jacket that had given me such a thrill to put on for the first time that morning, which already felt like days ago.

The beginning

But what determines how well one copes in the neonatal period? Largely it’s the people and skills around you. 

For the babies - the nurses encourage the mothers to breastfeed, and promote kangaroo-mother-care: keeping babies skin-to-skin with the mothers or caregivers, which gives much better outcomes in several ways, especially in terms of infections and weight gain. 

As for me, I'm surrounded by people who demand the best of me, but also encourage me to give just that. The collaboration with both the local and international staff is one that I feel privileged to be a part of. The exchange of ideas and experiences is one of the highlights of working for MSF, and is definitely one of the strengths of the organisation. 

Adapting and learning

The passing of time is interesting here. Each day seems so long as so many different things happen, in such a short space of time, and I have to adapt, reprioritise, and react to changing situations.

I have learned the main structure of how the organisation works in collaboration with other departments and the regional hospital. Learned more about neonatal care in these environments. Learned greetings and numbers in Amharic (next month, medical words!) 

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MSF Land Cruisers parked by the base in Gambela
MSF Land Cruisers parked by the base in Gambela

I was also thrilled with my second attempt at making baby hats using tubed bandages and string... Admittedly the first too small and the hats fell off, the second with a bit too much fabric flapping at the top: the twins looked a little more like gnomes than babies.

Yet, already a month has flown. Of course, we are also running on two calendars – the Ethiopian calendar runs a few years behind the rest of the world –  and the new year arrived on September 11th, as we greeted 2011. Reading through patient files, I have to constantly convert from one calendar to the other. The new day also starts at 6am, but the AM and PM stays the same as the Gregorian calendar. Have I confused you yet?

We score babies in the first few minutes after birth to see how well they are adapting to their new, extra-uterine environment. At the end of my own neonatal period, my first 28 days of life as an MSFer, I wonder how quickly I have adapted to this extra-ordinary life.