By Pierre M. Barker, MD, Senior Vice President, Institute for Healthcare Improvement (IHI)
Malawi – It’s amazing what a patient “walk-through” can teach you. Last week, I went to a district hospital in central Malawi, the prototype site for a 10-hospital quality improvement (QI) Collaborative to dramatically cut the death rate for preterm infants.
IHI recently was awarded a grant from the Bill and Melinda Gates Foundation to support our Malawian partner, MaiKhanda, and the Ministry of Health to tackle this problem. Newborn death rates are about eight times higher here than in the US. About half of these deaths occur in small or preterm infants.
The walk-through took me to the Kangaroo Mother Care Unit — a newly painted, well-fitted sanctuary for mothers and their newborn preterm infants. Inspired by marsupials, researchers in Colombia showed that death rates in preterm infants could be cut by 30 percent if a baby was swaddled 24 hours a day between its mother’s breasts. With only two neonatal intensive care units and few incubators in Malawi, this is a simple, no-cost life saver.
Before and after a life-saving intervention with Kangaroo Mother Care
At first the room looked empty — not a good sign since the six-bed room should have been full, based on the hospital’s rate of prematurity. On second look, we saw a mother sitting on the floor between beds, cradling a blanketed bundle. Inside was a scrawny, 1000g, cold and dehydrated one-week-old infant, transferred from an outlying clinic the previous day. My sense was that he had less than a 50/50 chance of survival.
But it could – and will– be so different. At my next visit in six months, the room will be full because nurses, inspired by new systems knowledge — and the empowerment that comes from well-tested local ideas — will avidly nurture warm preterm babies nestled between their mothers’ breasts, regularly nourished by feeding cups. And it will be unthinkable to look across an empty Kangaroo Mother Care Unit and see a mother on the floor cradling a preterm infant in her arms.