KU nursing faculty and students help Uganda birth attendants deliver more healthy babies

August 22, 2012

By Cori Ast

KU nursing student Lauren Courtney
KU School of Nursing student Lauren Courtney shows Ugandan nursing students the Helping Babies Breathe kit.

No roads. No electricity. No gloves.

This is the landscape of the northern Ugandan countryside, where 16 nursing students and faculty traveled in June to train health workers in a special childbirth technique called Helping Babies Breathe.

A technique to save lives

Helping Babies Breathe is a relatively new program, developed by the American Pediatric Association and endorsed by the World Health Organization (WHO), which provides traditional birth attendants the skills to deal with still births and neonatal deaths in low-resourced countries, such as Uganda. Martha Baird, Ph.D., RN, assistant professor in the University of Kansas School of Nursing, led the trip, which also included colleagues from Research College of Nursing and Johnson County Community College. Before the team left Kansas, they received formal training in Helping Babies Breathe during an intensive retreat in May.

For Ugandan women, childbirth often occurs at home with the presence of traditional birth attendants. These attendants, who have little or no formal training, help deliver the bulk of Uganda's 1.5 million babies each year.

"A lot of Ugandan women use traditional birth attendants. They believe it is a better way to have babies, but the infant mortality rate is sky high," explains Baird. "Helping Babies Breathe is an easy technique that can help save lives."

According to UNICEF, the infant mortality rate in Uganda is 63 out of every 1,000 live births. In the United States, the infant mortality rate is 7 for every 1,000 live births. Helping Babies Breathe takes advantage of the child's first 60 seconds of life, something known as "the golden minute."

KU School of Nursing undergraduate student Andrew Kastner says it is crucial to make sure the baby can breathe within that first minute. "It can not only lower the chance of child mortality, but also reduces the risk of brain damage."

Each nursing student had a Helping Babies Breathe kit that contained one rubber baby that simulates typical baby responses, including crying and breathing, as well as supplies needed for childbirth, including aspirators, baby blankets and hats. The students used these babies to train traditional birth attendants and nursing faculty at St. Mary's Hospital Lacor (pronounced la-cho) in Gulu. Also known as Lacor Hospital, the walled compound has received international attention for its role as a safe haven from the Lord's Resistance Army (LRA). During the 26-year civil war, which ended in 2006, Lacor Hospital would open its gates to women and children each night for a safe place to sleep, thereby preventing them from being killed or kidnapped at night by the LRA.

Today, Lacor Hospital is the primary health provider in northern Uganda, with 482 beds and a staff of nearly 600 who serve approximately 300,000 patients each year. Lacor Hospital also prepares 250 students for a variety of health careers, including nurses, doctors, lab assistants and AIDS educators.

"The practice [of health care at Lacor Hospital] is basically the same, as far as what is being taught," Kastner says. The biggest exception, he says, is in the technology because of limited resources. "For example, only the operating rooms are air-conditioned while the wards are cooled by barred, open windows."

Despite a robust medical practice at Lacor Hospital, the region is still very low-resourced. On a previous trip, Baird and her colleagues asked health workers outside the hospital about their needs.

"Kerosene and gloves topped the list," Baird recalls. She says that these needs demonstrate the extreme lack of resources in parts of northern Uganda. "These women (traditional birth attendants) were delivering babies at night in the dark, from HIV positive or Hepatitis B positive mothers, with their bare hands."

Culturally sensitive change

In addition to improving health care through enhancing delivery techniques, Baird believes an enhanced understanding of cultural norms in northern Uganda will help health professionals derive culturally sensitive strategies that will improve mother and child health.

Graduate student Cara Smith agrees. "Culture does play a huge role in health care. It's important, if we are going to have these partnerships, not to just come in and say, 'This is how it needs to be done. This is how you guys should be doing things.' We should be able to help facilitate change in a way that is culturally sensitive."

Smith, who is pursuing her master of science in nursing at KU, is studying Ugandan perceptions of childbirth and neonatal death under the instruction of Baird. During the trip, they conducted dozens of interviews and focus groups on the subject with Ugandan nurses and health professions students.

"Health care in northern Uganda is very spiritual, where many individuals will go to traditional healers to have a spell removed or be given herbal remedies, remedies that may actually negatively affect health," explains Baird.  "We also found out that a lot of people in rural areas of northern Uganda don't want to go to hospitals, because they believe hospitals are where you go to die."

Despite these beliefs, Smith says the Ugandan Ministry of Health is leading an initiative to encourage more women to give birth at health centers to improve infant and maternal health.

"It's hard to change the cultural views of babies being born at home. But slowly and surely, I think they are getting more births at the hospital," says Smith, who believes the initiative derives much of its power from being driven and owned by the Ugandan government and people.

Smith says the applicability of Helping Babies Breathe in any setting helped support this initiative. "Building these international partnerships is really important for the people of Uganda and for us."

Last modified: Sep 20, 2012