Lucky unlucky, the march for Kisumu preterms with no neonatal-ICU

The party commemorating the World Prematurity Day, began with a march from Kisumu Medical Training Center (KMTC) through Kondele to Jaramogi Oginga Odinga Hospital to raise awareness about the condition, but also symbolically showing the journey of preterm mothers.

Once the baby comes early, he has a long way to maturity, a long and patient march full of challenges we can all contribute to help alleviate.

A preterm baby is any child born before attaining full-term pregnancy, which is anything less than 37 weeks.  Preterm babies account for 16 percent of all babies lost under the age of 5, that is twenty-two per 1000 live births.

It is estimated 15 million babies (one in ten) born prematurely worldwide every year.

Read Also: Kenya’s top export tea boils over bumper harvest

World Prematurity Day is commemorated worldwide to raise awareness of the challenges faced by women and babies who experience preterm births. It celebrates the lives of preterm infants and the fortitude of mothers because this condition is a leading cause of death among children under five.

Show of support

In Kisumu, the event was marked by Harvard in collaboration with Nest 360, Discourse CBC, USAID Boresha Jamii , Vayu, Wanderhouse systems, Prisma, Palm Pharmaceuticals, Aghakhan and Gertrude’s, adorned in purple in a public meeting at Jaramogi Hospital locally known as Russia.

It is at this event that I had the appreciation of what it means to have a preterm child after Jane Akinyi offered to share her story that had happened just a few months at this very location.

She held her baby, wrapped in the soft babyish silk that could give a heat rash in this Kisumu heat, and stood up to give her speech still holding onto it.

You could tell the trauma of wanting to leave the hospital with her child still assailed her, and Dr Shikari Rosemary, a doula who had done her presentation on lactation for preterm mothers just a few minutes back, read the room quickly and offered to take the child and stay just within sight of her mother.

Normal pregnancy

Finally, she could speak. For Akinyi, what seemed to be a normal pregnancy turned into a preterm birth that she could not have prepared for.

She says she religiously attended all her clinic visits since finding out she was expecting her first child. All had been well, and everything was normal, until her 31st week, on 20th August when her water broke at 2am.

Being a first-time mom, and since she was not yet due nor in any pain, she did not think much of it, assuming it would pass.

However, the water kept flowing for hours, pushing her to rush to Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) for checkup the following morning.

Upon arrival, the hospital had Jane do a scan that confirmed she had lost a lot of amniotic fluid and had to deliver the child immediately. She was told that a normal delivery would endanger the life of the infant and was scheduled for a c-section. Her first birth would be premature, a shocking reality for the young mother.

Premature births are quite a common occurrence in Kenya, with 12 percent out of all babies born annually being premature.

For JOOTRH in 2023 alone, they had 1200 newborn babies pass through their newborn unit, and out of this, a staggering 40 percent were premature.

No incubators

What she did not know was that her baby was facing the first life and death test given that for preterm babies, initial care between the first 72 hours is the most crucial, and determines not only the baby’s survival but the quality of the rest of their life after discharge.

With hours gone and the risks heightened, if the baby would need specialized care, Ms Akinyi preterm child faced great danger as the hospital, JOOTRH, lacks a neonatal intensive care unit (NICU) even though it is a level 6A Hospital and is the largest public Hospital in the region.

In a region with a poverty rate of 38 percent, for most moms, JOOTRH is their first most affordable choice. It follows that JOOTRH, hosts the largest number of infants per facility hosting over 1000 babies each year public newborn unit. 

Any newborn born requiring these services has to be transferred to Eldoret’s Moi Teaching and Referral Hospital or the Kenyatta National Hospital in Nairobi.

It is no wonder Kisumu is struggling to bring down infant mortality to down from the 40 deaths per 1,000 live births, according to the 2022 Kenya Demographic and Health Survey (KDHS), which is lower than the national average of 32 deaths per 1,000 live births.

Other than the NICU services, the hospital also urgently needs vents, oxygen, trained personnel, medical air and suction, and Incubators, which will make a difference in caring for premature and newborn infants. 

We need equipment

Dr Kuta Elizabeth from Aga khan hospital who is also Pediatrician and lecturer at Maseno university called on the Ministry to help equip the Hospital to set up NICU.

“Premature babies should be in incubators with access to medical interventions to provide them with quality care” she said. 

Dr Maureen Muchela, the Head of Department at JOOTRH pediatric department, newborn unit, said that the hospitals infrastructure and medication have improved over the last two years to help care for the newborn and premature babies.

They have been able to train more nurses, and with the help of Vayu and nest 360 , they have moved from only three to fifteen CPUP machines which are vital in the respiratory care of premature babies. They assist in reducing the Oxygen percentage from 100 percent to less than 30 percent.

“It is everyone’s responsibility to care for these newborns and we need to support them whenever we can. We try to improve as much as possible to keep up with WHO recommendations” she said.

For Jane and her newborn baby, the care they needed was available at JOOTRH. The C-section was successful, and her baby was 2100 grams, which is above the recommended discharge rate of 1800 grams for premature babies.

A Journey of Complications

Unfortunately for her, however, major complications came up in the first few hours of breastfeeding that meant emergency procedures that would keep them in the hospital for another two months.

Her baby was not passing stool and would vomit everything after breastfeeding. After further examination, they discovered that she had a condition that blocks food from entering the small intestine, and the only way to correct it was through surgery.

Jane was devastated that her premature 3-day-old baby had to go through that. She wishes there was another way, and sometimes felt hopeless and spent a lot of time in tears. The surgery was successful, and now she had to see a nutritionist who recommended a special meal that would help the baby regain its strength.

The meal cost the young family Kes6000 weekly, an amount that to them, was too expensive. They rallied their families who helped raise the funds that would save their young baby’s life.

Unfortunately, the baby was sick again and was scheduled for a second surgery and a blood transfusion. Jane was devastated and it hurt her to see her innocent baby struggling for her life. Prayer would carry her through, and she shared her experience with other moms in the newborn Unit who consoled her.

From them, she had a shared experience that gave her advice that might save her baby from a second surgery. She shared with the doctors and nurses who agreed to try and luckily it worked.

Her baby would be okay. A few weeks later, she was moved to nursery, and with plenty of Kangaroo treatment, the baby gained some weight and was ready to be discharged.

Jane turned to face the other moms seated on the front row of the gathering, recognizing some by name. She knew she was an inspiration to their own journeys a hope of light at the end of the tunnel despite the long and arduous journey ahead.

Smiling warmly at them, she told them to be patient; it will pass, and just like her, they too will soon get to carry their babies home.

She said she understood the frustration, and the powerlessness, but with patience and immeasurable hope, along with the great help and equipment available at JOOTRH, they too would overcome.

Milking men

The young moms also got a chance to learn some lactation tips that are unique to them. Preterm babies may need time to learn to suckle, and they may require different feeding methods than babies born at full term including a feeding tube, Intravenous (IV) line, and will need sucking practice before they can latch. Over and above that, just like their contemporaries they also face the challenges of breastfeeding.

Dr Shikari from Mama Toto gave a hilarious demonstration where she had four men drink soda from baby bottles to see who would finish first.

It took them more than 5 minutes and they left sweating, acknowledging that it was a difficult task. She used this to explain to the girls and other moms like me present that feeding takes time.  That it is important to be patient with your baby, and yourself.

She taught of the harmful effects of pacifiers and bottles that should be discouraged where possible. Other than the sanitary concerns, they can affect the dental structure of some children, and cause others to prefer bottle feeding to mothers’ breasts.

She also gave tips on how to express milk that was very useful to the moms, especially those who may not be able to directly feed their premature infants.

Kangaroo care

Kangaroo mother care is also encouraged which has numerous benefits including bonding, comfort, breathing, good bacteria from mom, thrive better, improved brain function, and reduced risk of cerebral palsy.

A lot of psychosocial support is needed for moms who go through this. Even after they leave the hospital, they will need support when it comes to caring for the newborn. 

The future of our nation lies here. It is crucial that it is given the most attention. One of the health care officials there told us, they have even seen some doctors and nurses get into their pockets to try to save the lives of babies in various public hospitals across the country.

Yet our own government which has not paid enough attention to the healthcare systems, especially at this core aspect, then goes ahead to frustrate them, even denying them pay for more than three months of labor.