Irene Nabusoba
10 March 2008
Kampala — A healthy, beautiful, bouncing baby. This is what every mom longs for. But for Hawa, the story was quite different. She had to depend on the incubator, a special facility where babies born before their due date are kept to give them enough warth.
Hawa's baby, Tabitha Tika, was born at 24 weeks. She weighed only 1.2kgs.
A standard pregnancy lasts 40 weeks (though at 36 weeks, the baby if fully developed) and a normal baby weighs at least 2.5kg.
"I did not think she would survive," says Hawa. "She was so tiny. Her father abandoned us saying they do not have a history of producing such kids in their clan."
Hawa gave birth in a tiny room at her home in Naguru, a Kampala suburb. Her neighbours rushed her to Mulago Hospital with her baby after the husband vanished.
"I had no relative here. I come from Arua. I stayed in the prematures' ward for three months. We were discharged when Tika was three months old, the time she was supposed to have been born. She weighed about 3.7kg," says the 35-year-old who lost her first child at six years, when she was pregnant, leading to a premature birth because of shock.
Now, at six years, Tika has so much to look up to.
Comfortably sitting on her mother's lap, she shyly stretches her hand to greet Dr Margaret Nakakeeto, the woman who, through a simple cost-effective intervention known as Kangaroo Mother Care (KMC), helped her to live.
KMC is the care given to premature infants. The mother carries the baby skin-to-skin, the same way mother kangaroos carry their babies in a pouch.
Pioneered as a home care system for premature infants in Bogota, Colombia, KMC is an alternative method to inadequate and insufficient incubator care for premature babies.
A mother holds her infant skin-to-skin between her breasts, ties a cloth around it and the baby pops the head above the chest like a baby kangaroo. It has proven to be a powerful method in promoting the health and well being of infants born preterm because of the effective thermal (temperature) control, breastfeeding and bonding between the mother and the newborn.
Small babies can be discharged early as the mothers can express the milk and feed them manually while keeping them warm with the warmth from the bodies.
"I started the Kangaroo project in an attempt to reduce premature deaths here. It was heartbreaking. Infants were dying, especially after being discharged from hospital," Nakakeeto says. "I realised they were okay in the hospital but back home, the mothers could not cope. I wanted continuous care."
Well, doctors are supposed to mend and save lives. But few go an extra mile to make a difference in the people's lives.
However, when the Ministry of Health appointed Nakakeeto, a consultant paediatrician/neonatalogist, head of the neonatal/special care unit at Mulago Hospital in 2000, her immediate task was to find an alternative way to save newborns who were dying mostly because of low temperatures.
The numbers of the infants were too many for the health and social systems; there was inadequate supervision and monitoring. She also realised about 60% of mothers were giving birth at home under unskilled care. Besides, some were being discharged early, with poor postnatal attendance and consequent high neonatal mortality (death of a baby within 28 days after birth).
Nakakeeto sent the unit's head nurse to Bogota for training in KMC and on her return, the nurse passed on the knowledge acquired in Bogota to other nurses and made a plan on how to implement KMC.
"We were admitting 70 babies, though we had the capacity of only 20 babies. I had about nine nurses yet such infants need close observation. I wanted to introduce KMC here so I could save as many babies as possible, using the meagre resources," Nakakeeto says.
With no special funding for such a programme that required a lot of training for the staff, Nakakeeto embarked on the implementation.
"I approached the hospital administration for extra beds and managed to secure eight adult beds. I turned the space for admission and a room next to the unit into a KMC area.
"Everybody was involved, from the cleaner to the consultant. We started by recruiting the bigger premature babies. I removed them from the incubators and left them with their mothers. I knew the administration would not buy the idea so I dared on my own, with the support of my team. The results were amazing.
"The babies were surviving. Previously, I had to keep them until they reached 2.5kgs. This meant that the mothers would stay in the hospital for months, but I started discharging them after few weeks.
"Some would cry and plead to stay. They were not sure how they would handle the infants on their own but I realised that involving the mothers themselves would make a big difference. With training, counselling and involvement of their partners it was not long before I got the mothers to accept.
"Amazingly, I did not register any deaths," Nakakeeto says. "I emphasised 20 hours of Kangaroo care."
To keep them busy, Nakakeeto taught the mothers how to make kangaroo bags, which they sold to their colleagues cheaply to make an income.
This, they did with their babies tucked in their chest. With the natural warmth, love and bonding, the infants grew very fast and in three months, she had tremendously cut the admissions by half. This also meant decreased costs of running an incubator, which consumes a lot of electricity.
Well, some babies still needed the incubators and warmers because their mothers could not take them home when their respiratory system was not well developed. But this meant that many would access the facilities because of the room created with the KMC.
Nakakeeto has now started Kangaroo Care clinics at health centres, immunisation outreach clinics and in hospitals countrywide, training the mothers, midwives and the nurses how to save premature babies at no cost.
She is also trying to influence the ministry policy to scale up the programme by integrating it into district health plans so that KMC clinics are in all hospitals and Health Centre IVs. She is designing community programmes in KMC care and massively training community healthcare providers to maintain skills in neonatal health care to cut down the overload in the stretched facilities.
Nakakeeto's pride lies in the fact that mothers have embraced the idea, something that has driven her to set up her own centre at Kyengera on Masaka Road. At Kampala Mother Baby Medical Centre she devotes her energies to saving newborns.
Born to Cyprian Bwanika and Veneranda Nalubega Bwanika of Masaka, Nakakeeto studied in Mt. St. Mary's Namagunga. She then joined Makerere University where she graduated with a bachelor's degree in medicine and surgery.
She developed a passion for children while doing her internship, after witnessing the stress that mothers of premature infants go through.
"Some would even get scared of their own babies. Admission at the ward was such a nightmare, with babies being declared dead every minute because of limited facilities like incubators and warmers," she says.
She later decided to do a post-graduate diploma in paediatrics and an master's degree in neonatology.
A wife and mother of four girls, Nakakeeto does not believe in failure.
"I never see problems; I look out for the opportunities. I strive for optimum utility in our world of scarcity. Once you work as a team, everything is possible," she says.
Indeed, Nakakeeto's education and motivation of mothers in the care of preterm infants makes sense in a poor country like Uganda.
The country's child mortality-ratio (the number of children who die before their fifth birthday) is 136 per 1,000 births. Of these, 76 die before one year, with 40% these dying in the first 28 days after birth. Premature births is the biggest cause of these deaths.
Yet prematures are still being stigmatised, with people regarding them as a curse.
Many mothers have made it a routine to bring their children to pay respect to Nakakeeto.
Nakakeeto can barely remember all of them because so many have and still pass through her hands.
But while many end at the 'thank you', Hawa Tika, who lays bricks back home in Arua is passing on the baton, teaching fellow mothers informally about KMC.
"Traditionally, we would light fire and hold the kids around or tuck them into bed and put a sigiri under the bed but they often died. (This practice is dangerous because of the poisonous gas, carbon monoxide, from the charcoal). Helping my friends is the only way I can show how thankful I am to Nakakeeto for saving my baby," Hawa says.
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