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.

“Apart from getting money, are we not also blessed?” [Kola on the “noble” profession of nursing]

Kola’s turns of phrase when he’s lecturing have been delighting Jo and I all day.  The title of this and the previous posts are good examples of the fervour with which he plays his role as MCAI’s on the ground neonatal trainer.  And he is not alone.  Gertrude, Agnes and Christina are equally dedicated to their patients and their unit, totally committed to the patients they look after.  And totally engaged in their roles today as instructor candidates on the Newborn Care Course.

Gertrude doing Stage 2 of the 4-stage procedure in how to tie a kalafong wrap for the baby to be skin-to-skin with its mother.
Christina overseeing resuscitation skills training.
Agnes (gesticulating with her hands) running an animated discussion workshop on pain in babies and how to manage the baby who won’t live long.

Kalafong wraps

 

 

 

 

 

 

 

 

Kim and Julia have been busy in London (and Alison in Amersham) making these baby slings for mothers of preterm babies in Liberia.  They will be used on the training courses in November and then left in country for use on the neonatal unit.  Skin to skin mother care develops the bond between mother and baby as well as helping to prevent infection and keeping the baby warm.  You can read more about the advantages of skin to skin care at https://www.nicheinternational.org.uk/2018/11/13/skin-to-skin-mother-and-father-care/.

We call them kalafongs on the Newborn Care Course but they are not actually called kalafong wraps – even in Kalafong hospital in South Africa which is where the pattern for these (very cheap and easy to make) skin to skin wraps is from, see https://www.up.ac.za/media/shared/Legacy/sitefiles/file/45/1335/877/thariinstructionsnewkmcwrappatternmay2011.pdf.

Skin to skin mother (and father) care

Keeping babies warm is one of the 4 themes identified by WHO as factors which contribute to bringing down neonatal mortality rates.  The mean temperature in Liberia is 27° C (81° F ), with temperatures rarely exceeding 36° C (97° F ) or falling below 20° C (68° F ).  But our learners today were telling me about the traditional birth attendants’ habit of holding the baby upside down and slapping its feet as soon as it is born and then washing it in cold water straight away.  Mind you, I am not sure it is that long ago that babies in my own country were treated like this.

Putting the baby skin-to-skin with its mother as soon as he or she is born is the best way to maintain his/her temperature and has many other advantages as well.  Take a look at this list from a South African site, www.kangaroomothercare.com:

Benefits of skin-to-skin contact for babies

  • Better brain development
  • Better emotional development
  • Less stress
  • Less crying
  • Less brain bleeds
  • More settled sleep
  • Babies are more alert when they are awake
  • Babies feel less pain from injections
  • The heart rate stabilizes
  • The oxygen saturation is more stable
  • Fewer apnoea attacks
  • Better breathing
  • The temperature is most stable on the mother
  • Breastfeeding starts more easily
  • More breast milk is produced
  • Gestation-specific milk is produced.
  • Faster weight gain
  • Baby can usually go home earlier
  • Enables colonisation of the baby’s skin with the mother’s friendly bacteria, thus providing protection against infection (UNICEF Baby Friendly Initiative information)

Benefits of skin-to-skin contact for parents

  • Parents become central to the caring team
  • Better bonding and interaction with their child
  • Emotional healing
  • Less guilt
  • Parents are calmer
  • Parents are empowered and more confident
  • Parents are able to learn their baby’s unique cues for hunger
  • Parents and baby get more sleep
  • Parents (especially mothers), are less depressed
  • Cope better in NICU
  • See baby as less “abnormal”
We have a long way to go with this in the UK.  On the course we teach that babies should be skin-to-skin with a parent for most of the day when on the neonatal unit.  All treatments except phototherapy can be carried out with the baby in this position.  Have a think about your own neonatal unit; do you have parents present all day with their baby tucked into their shirt?  If not, why not?
Learning how to tie a kalafong in the S2SMC practical session.