I totally agree with Prof Nisha Keshary Bhatta; but I feel that equally important is the realization of the importance of quality of care and motivation to implement whatever activities are feasible even in the presence of these challenges. Once the habit is inculcated, the processes can be, hopefully, adapted based on the availability of resources; getting better as the situation improves.
We have been using digital technology (Zoom and What’s App) to facilitate QI activities in some facilities in Ghana (primarily district hospitals) working within the available resources with no extra funding. While, of
course, there a number of challenges, some changes have taken place. An example was getting babies discharged very early, as it conventionally happens in many facilities in low and middle- income countries, to come back in a timely manner when jaundice was detected. This was achievedprimarily through interactive health education, both in the antenatal clinics and in the postnatal wards. In the interactive health education,
while showing a video on the topic, the midwife is physically present and encourages the mothers to simultaneously look for the signs highlighted in the video so that she gets to practice; and even has a few “return” demonstrations. We feel commencing counseling in the antenatal clinics is important as jaundice is mainly a problem in the early newborn period and since some mothers are discharged by 6-7 hours of the delivery, hearing all these messages for the first time following the exhausting process of birthing may not be the best option. Babies are being brought in earlier with lower levels of bilirubin and needless exchange transfusions have decreased.
While attempts were also made through community health workers to contact discharged mothers through phone calls due to the COVID pandemic, the interactive health education was more useful as not all the health workers followed the instructions appropriately due to delays in reimbursement of money for phone calls. Another expected challenge is the continuation of these activities when external facilitation activities need to be discontinued; but that is a story for another day!
Indira
Indira Narayanan MBBS, MD., FIAP, FNAMS.
Consultant, Global Maternal and Newborn Health and Nutrition,
Adjunct Professor,Pediatrics/Neonatology
Georgetown University Medical Center,
Washington, DC
*Email- *inarayanan6@gmail.com
- in83@georgetown.edu
Indira Narayanan is currently Adjunct Professor, Pediatrics/Neonatology at the Georgetown University Medical Center, Washington DC, USA and Independent Consultant, Global Maternal and Newborn Health. Professional interests: Maternal and Newborn Health, research, improving newborn care with emphasis on compassionate/respectful quality of care, health policies, program implementation, capacity building, social and behavior change communication. Her research includes the seminal randomized controlled studies on proving for the first time in world literature the clinical implications of the anti-infective properties of raw and heated human milk in neonatal units carried out during her work of 20 years in India.
inarayanan6 ATgmail.com
