Breastfeeding workshop

The Neonatal Care Course (NCC) is an educationally robust product.  We teach about the four main areas that the World Health Organisation identifies as contributing maximally to neonatal mortality rates: resuscitation at birth, early breast-feeding, keeping babies warm and early recognition and management of sepsis.  https://www.who.int/maternal_child_adolescent/topics/newborn/enap_consultation/en/).  Our feedback forms show increased confidence of learners in all 4 of these areas. Increased clinical confidence correlates with increased performance over time.

Here is Grace, a one time NCC learner and now in-country NICHE champion and convener of their own independent NCCs, delivering a workshop on breastfeeding to local midwives.  This is what empowerment of local health professionals does.  This is our legacy and we are proud of it and very grateful to all who donate time, money and expertise to our charity.

Cameroon Instructor Development Days

We have been busy putting together suitable programmes for our on-going development and support of the local instructors in both Cameroon and Liberia.  We have been asked by Grace and her team in Cameroon to return there once a year for the next 3 years to take them from Step 8 of the “10-steps to sustainability” plan to Step 10 (where they can train their own instructors).  We are actively fundraising for this project at the moment if anyone wants to help out – https://www.nicheinternational.org.uk/ways-to-donate/.

We have begun to put together a tentative programme for a 2-day instructor development course, termed CIDD, which will be delivered in-country to ensure instructors are up to date in both the content and delivery of their provider course, the Neonatal Care Course (NCC), and to furnish them with the skills needed to keep themselves developing professionally after 2023.

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Independent Neonatal Care Course

Midwives in Bamenda this week (North West region of Cameroon) learning how to tie a “Kalafong” wrap for skin-to-skin mother care as part of their 2 day Neonatal Care Course.  22 learners with 100% pass rate in a town which is at the centre of the current sociopolitical unrest in Cameroon and to which UK instructors are no longer allowed to travel.  Hats off to Grace and her team for running their first independent course and thanks to our partners, the Cameroon Baptist Convention Health Services, for their support and encouragement.

United Nations Convention on the Rights of the Child

The rights of children across the world are enshrined in the United Nations Convention on the Rights of the Child, or UNCRC, signed by all UN members except the USA.  The Convention has 54 articles that cover all aspects of a child’s life and set out the civil, political, economic, social and cultural rights that all children everywhere are entitled to. It also explains how adults and governments must work together to make sure all children can enjoy all their rights.

Every child has rights, whatever their ethnicity, gender, religion, language, abilities or any other status.

You can read more about it at https://www.unicef.org.uk/what-we-do/un-convention-child-rights/.

The UN rights of the child are often violated when families are in situations of conflict.  In particular articles 19 (protection from violence, abuse and neglect) and article 38 (war and armed conflicts) from the UN Convention, are relevant in this regard.

Over the last 2 years, while NICHE has been working in Cameroon, West Africa, we have seen how civil unrest there has affected patients, and indeed, hear firsthand from health professionals who continue to try to care for them.

A young doctor who attended one of our Newborn Care training courses earlier this year in Cameroon, has recently written about the direct effects on children’s health that she has witnessed.

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Over the past three years, the English-speaking North West and South West Regions of Cameroon have been affected by civil unrest.  Since the crisis started in October 2016 following a strike action by teacher and lawyer unions, it has escalated to an armed conflict. There has been heavy military deployment to the regions and violent attacks by the opposing forces in urban and rural areas, leading to disruption of activities in communities, displacement from homes, and loss of property and lives. Education, business and healthcare are some of the most directly hit activities in the different communities affected by the conflict. Its adverse effects are numerous, including difficulty in providing and accessing proper health care facilities, causing diseases, which had been under control, to regain grounds, become virulent and lead to increasing levels of disability and death.

Working in the Pediatric Unit of the Bamenda Regional Hospital over the past months, we have witnessed this centre, which is the only very accessible reference centre of the North West Region, struggle to manage the current challenges despite the continuing conflict. We have seen a rise in the severity of epidemic diseases like Malaria and Dysenteric illnesses, seen by the 198 cases of malaria treated from January to August 2019 as to the 168 treated in the same duration in 2018. In 2018 alone, 119 cases of meningitis were managed in our health facility.  Added to these, are diseases which are now poorly managed due to lack of health facilities and personnel in the surrounding villages, notably Tuberculosis, HIV/AIDS, Sickle cell Disease, Pneumonia, and  Severe Malnutrition.

Children are the most affected, with two out of every five inhabitants of our Region being under the age of 15 years old. As the conflict continues, access to hospitals and other health centres from surrounding villages remains very difficult for these populations notably the children. By the time they successfully arrive at facilities like ours, it is either too late and they expire, or they end up disabled.

The lack of adequate health infrastructure and personnel especially in the periphery of Bamenda and surrounding villages has also adversely affected vaccination coverage for children in these areas. We are therefore exposed to a high risk that vaccine-preventable diseases may resurface, with catastrophic effects on the children. We have unfortunately had cases of children as old as 1 year who haven’t received any vaccines since they were born in the bushes to displaced mothers.

On a final note, we have been witnessing an alarming rise in cases of sexual abuse on children. The numbers are on the rise, thereby increasing the risk of sexually transmitted disease infections as well as additional psychological trauma, which would both have disastrous consequences.

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The current crisis in Cameroon is complicated.  Good resources to look at if you want to know the timeline of the conflict are:

https://africanarguments.org/2019/08/13/cameroon-crisis-three-deepening-divides/ and

https://www.bbc.co.uk/news/av/world-africa-44459488/cameroon-crisis-explained which has links to up to date information like the recent release of the opposition leader from prison and the current peace plan.

Community fundraising in the UK

Because too many babies die in low income countries in their first month of life

Seb and Julia at the NICHE table during a recent community event in north London.  Lots of people showed an interest in the charity, and in the handmade brass items from Cameroon.  The artists first make the model out of beeswax, then cover it in clay, allow the wax to melt leaving a clay mould and then fill a second container with old keys, bits of car engine etc., put more clay around the whole thing and put in a homemade kiln.  As the man who made my Nativity set said, you have to wait till the flames from the kiln are giving off white smoke, then you know the metal is melting and filling the moulds.  When the little clay parcels come out of the fire, they are allowed to cool and then the clay is broken off, leaving a brass model in place of the original wax one.  If you’re interested in seeing how scrap metal is recycled to make brass ornaments in West Africa, there’s a fascinating Ghanaian video on You Tube at https://www.youtube.com/watch?v=REutkpo3ors.

NICHE Oreo cup cakes courtesy of Seb and Julia’s daughter, video showing the Asante wax casting process (see Youtube link in the post)

 

Example of West African cast brass ornament

Di Pikin no don die 

This is what we are aiming for!

It was noticeable that when Cameroonian candidates were role-playing a scenario, for example giving the baby to the mother after a successful resuscitation, they would speak to her in Pidgin English (sometimes called Kamtok in Cameroon).

One of the candidates used the sentence above.  It means ‘the baby hasn’t died’.

It is a reminder that neonatal mortality in Cameroon is still 10 times that in the UK, and that the aim of teaching the Newborn Care Course is to reduce it.

 

 

 

 

 

 

48 of the 49 candidates who took part successfully completed the course in April 2019.  That’s 48 more skilled birth attendants and nearly 20 trained or partially trained instructors (not all those who did the GIC last year managed to get to these courses to do their supervised teaching) who will continue to cascade the learning.  That’s good news for many thousands of babies in Cameroon in the years to come.

Traffic light comprehension

 

 

With some French and some English speakers (and some hard to understand UK accents) we wanted to be sure that learners could hear and understand everything they were being taught.   Jarlath initiated his ‘traffic light system’, whereby everyone was given a piece of paper with a red light drawn on it.  They were asked to hold up the red light if they couldn’t hear or understand what was being said.  It works well with learners who are too polite to say they don’t follow.

 

 

We are very lucky to have such senior instructors involved with NICHE.  Their breadth of experience is humbling for those of us still hanging on their coat tails, they can adapt their teaching style to any situation, they are supremely patient with the learners and they never, ever, pass up an opportunity to pass on skills and knowledge – even if the only flat space available is a windowsill a few floors up (thank goodness it’s only a manikin).

The Newborn Care Course has reached a variety of health workers

On the NCCs at the end of April in Cameroon, altogether we had candidates from 6 of Cameroon’s 10 Regions. Participants came from a variety of work places, some small local health centres, some bigger hospitals. There were nurses, midwives, doctors and a paediatric surgeon taking part. There were English and French speakers. The workshops and small group teaching gave participants the chance to share their experiences, and discuss specific problems that they face at work.  This is important in a health environment where doctors and midwives and nurses do not usually share training experiences.

Paediatric surgeon, George, practises resuscitating a baby
Midwife, Julia, studies her course manual. Julia did particularly well on the course and is responsible for training other midwives in her health facility in Douala. NICHE left one of the manikins donated by the BMA with her so that she can continue to cascade what she learnt to others.

Civil unrest affects healthcare in Cameroon

Jarlath at breakfast with Grace, Ernestine and Margaret, instructors from Bamenda

Because of the civil unrest in Cameroon, some participants from the North West and South West Regions, which are the worst affected by violence, had difficulty travelling.  There are weekly ‘ghost towns and ‘lock downs’ in these regions, when no shops or schools are open and there is no public transport.

Nurses and doctors are forced to sleep on the floor in the hospital at these times. Pregnant women have difficulty reaching hospitals and health centres.  Three instructors from Bamenda NW Region, where we ran the first course in 2014, managed to get to Yaounde to teach.

The baby who won’t live long

Cameroonian doctors and nurses were entirely responsible for the teaching on the course on this occasion. They rose to the challenge; time keeping being the only aspect which needs a bit of work still.  Stella, one of the younger teachers, gave an inspirational talk on ‘The baby who won’t live long’, which is one of the most challenging lectures on the course.

Hard for us to teach too, as many of the babies who fall into this category in Cameroon such as those with spina bifida or congenital heart disease, can be offered so much more in the UK.  The reality is that the Cameroonian instructors do have a better idea of how to make these babies comfortable and also have more experience of having to do this than the UK instructors.  It is yet another area where the UK instructors learn from our Cameroonian counterparts.

Stella teaching on the baby who won’t live long