A Good Week

Life in Harar has been pretty good since we got back from our holidays. I feel like I’ve had a really productive week which is great, as so often it takes forever to get anything done here and it can be really frustrating. So what have I achieved....? Pretty simple stuff really but it still feels good. The internet has been reliable enough to get in email contact with all the other volunteers and start planning a set of guidelines that can be used in neonatal units across the country, my neonatal admissions book, which is a record of all the admissions to the neonatal unit, their diagnoses and outcomes was received with great enthusiasm by my colleagues, and we had a visit from the director of VSO Ireland and a gaelic football player called Pat Spillane, who are about to do a VSO recruitment drive in Ireland and wanted to come and meet some volunteers and hear about their experiences. They seemed genuinely interested and impressed with what we are trying to do and it’s always so lovely to get a nice bit of positive feedback.

One of the things I’ve been mulling over a bit recently is what I can do to try and keep the babies warm. It seems ridiculous that this should be a problem in tropical Africa, where the average daily temperature is somewhere in the high 20’s, but it is. The problem is that all babies, and particularly those that are born prematurely or with low birth weight have real difficulty in maintaining their body temperature. The mechanisms which keep them warm are immature and they have less fat stores to burn to produce heat so they become hypothermic very easily. There is lots of evidence that in most cases getting cold is detrimental to both immediate chances of survival and long term developmental outcomes, so hypothermia is a real problem. The thing that frustrates me about it that the solutions are not particularly high tech. Yes a lovely heated humidified incubator would be great but these things often break or require maintenance and the support services are simply not in place to make that kind of equipment sustainable. We do actually have an incubator but as soon as you turn it on it just alarms and says it requires a qualified technician to service it, so it doesn’t get used much. The simple things we need to do are keep the babies dry, keep them skin to skin with their mother, and keep a hat on their head but this is easier said than done. There are no nappies of of any variety here, and babies are wrapped in whatever light cotton shawl the mother has spare when she arrives in hospital. They pass urine, the shawl gets wet, they get cold. The hospital doesn’t have nappies, or blankets or hats – we just use what the parents bring which is often not a lot. We have one radiant heater on the floor in the neonatal unit and we cram as many cots next to it as we can. So what is the solution? I have a few things in mind. I have been finding out about some simple incubators suitable for resource poor settings, that aren’t heated but protect infants from drafts. I am hoping that my neonatal unit admission book will help me prove what a common problem this is and we will be able persuade the powers that be to get some of these made locally. Secondly I will keep insisting infants are placed skin to skin as much as possible. Finally, I wondered if anyone reading this knows anyone who knits? And if so, whether they would like to produce some hats for my neonatal unit? We need as many as possible, in a variety of sizes with a circumference of between 28cm and about 38cm.... so can anyone help? If you think you might be able to, please comment on the post and I will email you. Oh and any suggestions for the nappy problem would be greatly received  Jo x