As we continue our global journey (set sail in late February, 2016) within the Neonatal Womb (preterm birth) community we seek to see and understand who we are as a community, what our needs, strengths, and resources are and how we can contribute to the health and well-being of our global community. Every country we visit, article we review, organization we meet, video we watch, family we talk to broadens our perspective. We have learned that high income countries do not necessarily have low preterm birth rates, and countries with limited resources can create innovative solutions to serve our global needs. We understand that part of our healthcare provider community is professionally denied humane healthcare itself, and that globally the shortage of healthcare providers is critically high. The training of community health care workers is positively impacting the preterm birth community in many areas, and the potential for technology combined with community health care workers has the ability to bridge to a great extent the vast healthcare deficit we are experiencing. We know that resources to reduce preterm births and infant mortality exist, and that the process of working together as a Community is the key to supporting the health, well-being, and positive evolution of our Community as a whole.

MADAGASCAR

Madagascar is a biodiversity hotspot in which over 90% of its wildlife is found nowhere else on Earth. Madagascar’s diverse ecosystems and unique wildlife are threatened by the encroachment of the rapidly growing human population and other environmental threats.

 

                Community

The Republic of Madagascar, the fourth largest island in the world, is located off the east coast of sub-Saharan Africa. Eighty percent of the country’s population lives in rural settings with limited access to public health facilities. Malaria is a major cause of morbidity and mortality, and despite improvements in maternal, infant and child mortality, these mortality rates remain high. http://fieldnotes.jhpiego.org/?_ga=1.139497203.1749228238.1482733953  

27% of infant deaths in Madagascar are due to preterm birth complications (Healthy Newborn Network @http://www.healthynewbornnetwork.org/country/madagascar/)

Per Every Preemie Scale (http://reliefweb.int/sites/reliefweb.int/files/resources/Madagascar_0.pdf) In Madagascar, 118,000 babies are born too soon each year and 5,400 children under five die due to direct preterm complications.

Community Health Care Workers/Volunteers Worldwide provide crucial care as health care resource shortages remain at critically high levels. Madagascar will provide increased support of the General and Neonatal Womb community through expansion of an effective healthcare outreach program!

United States Mission to Madagascar

10/24/2016: “New health program will deliver improved Community Health Services for 6.1 million Malagasy.

Antananarivo –  6.1 million people, 23.3% of the total population of Madagascar (INSTAT, 2015), will benefit from a new 5-year, $30 million USD integrated community health program funded by the United States Agency for International Development (USAID).  The program is a collaboration between the Ministry of Public Health, USAID and JSI Research & Training Institute, Inc. (JSI).

The Community Capacity for Health (CCH) program, which will be known locally as Mahefa Miaraka, is a follow-on of a previous, highly successful 5-year program called MAHEFA, which helped over 3.5 million people access health care through community health volunteers, treated more than 620,000 children for serious illnesses and built over 86,000 latrines.  MAHEFA also trained and equipped 6,052 community health volunteers, who are an essential part of Madagascar’s health care system, providing underserved and remote communities with access to health services, education on healthy behaviors and delivering lifesaving medicines. The Mahefa Miaraka program builds on this success and will continue to promote the community health approach”.https://www.antananarivo.usembassy.gov/embassy_news/press-releases2/10/24/2016–new-health-program-will-deliver-improved-community-health-services-for-6.1-million-Malagasy

On our journey to Madagascar we have discovered a compelling organization that we intend to explore and reference, perhaps for a very long time! Premature Birth most often involves trauma, and trauma is an integral experience to all encountering global crisis and disasters. The Neonatal Womb represents a very large portion of out worldwide population, and the trauma experienced within our community is expanded in crisis, disaster, and within war zones. I was especially excited to see that information regarding the conflicts in countries such as Palestine and Syria appeared to be represented with at least some factual healthcare/related status and needs/humanitarian action information. We are very motivated to support the global health and well-being our preterm birth family in all socioeconomic, political/religious, demographic and geographic dimensions.

ReliefWeb (Informing Humanitarians Worldwide)-ReliefWeb is a leading humanitarian information source on global crises and disasters. It is a specialized digital service of the UN Office for the Coordination of Humanitarian Affairs (OCHA).

Relief Web notes Madagascar as a country in need of Humanitarian help. Food, nutrition, water, health, sanitation, hygiene, and livelihood are all factors that affect preterm birth and infant mortality in general and in Madagascar specifically. The website states “We provide reliable and timely information, enabling humanitarian workers to make informed decisions and to plan effective response. We collect and deliver key information, including the latest reports, maps and infographics and videos from trusted sources”.http://reliefweb.int/sites/reliefweb.int/files/resources/Madagascar%20Grand%20Sud%20Humanitarian%20Snapshot%20%28as%20of%20October%202016%29.pdf

INNOVATIONS

New development/recommendations regarding the timing of umbilical cord clamping following birth may increase preterm birth wellness/survival and developmental outcomes while reducing the need for invasive procedures. Please review this interesting information regarding umbilical cord clamping recommendations as provided by The American College of Obstetricians and Gynecologists:

Recommendations: The American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice makes the following recommendations regarding the timing of umbilical cord clamping after birth:

• In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes.
• Delayed umbilical cord clamping is associated with significant neonatal benefits in preterm infants, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage.
• Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30–60 seconds after birth.
• There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing delayed umbilical cord clamping. Consequently, obstetrician–gynecologists and other obstetric care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor and treat neonatal jaundice.
• Delayed umbilical cord clamping does not increase the risk of postpartum hemorrhage.
• http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Delayed-Umbilical-Cord-Clamping-After-Birth

JHPIEGO & The John Hopkins University

! Imagine you’re a mother who just gave birth to a 28-week-old baby. Per Jhpiego, if you live in a high-income country, there’s a 90 % chance your baby will survive and go home with you. If you live in a low-income country, there’s a 90 % chance your baby will die within the first few days of life. As Neonatal Womb Community partners, we know that preterm birth is a problem in every country, and even within a high-income country such as the USA preterm birth rates vary substantially (Oregon at 7.6 % preterm birth rate, Mississippi at 13%). However, preterm birth infants in the USA have a high rate of survival. Low-income countries in general are disproportionately affected because they have both higher rates of preterm birth and lower rates of survival.

Jhpiego is an international, non-profit health organization affiliated with The Johns Hopkins University. For 40 years and in over 155 countries, Jhpiego has worked to prevent the needless deaths of women and their families. The article Ending Preventable Preterm Birth through Integrated Maternal and Newborn Care dated October 16, 2015 authored by Lindsay Grenier and Stella Abwao shares information regarding the need to prepare skilled health workers through training, and addresses issues such as the availability of essential supplies and commodities, organization of and linkages between services and cultural practices and expectations that influence the survival of premature babies, and coordinating care for at risk pregnant women. Please enjoy:https://www.jhpiego.org/success-story/ending-preventable-preterm-birth-through-integrated-maternal-and-newborn-care/

Health Care Partners

The Wendt Center for Loss and Healing published a helpful article for Professionals addressing Vicarious Trauma. The Center states:

“Vicarious trauma often carries many of the same symptoms as first-hand trauma or post-traumatic stress disorder. These symptoms are usually grouped into three broad categories:

• Intrusions, such as flashbacks, nightmares, intrusive thoughts
• Avoidance of situations, people or places that bring on the intrusions
• Hyperarousal, including hypervigilance, sleeplessness, and increased startle response (“jumpiness”)

What you can do…

Monitor yourself. In order to stave off vicarious trauma, it is important to keep track of your levels of “burnout” or “compassion fatigue”. There are several professional assessments aimed at these areas, including the Professional Quality of Life Scale, which is available online free of charge. There are also many online self-assessments, which will give you a sense of whether you are adequately engaging in self-care”.

In addition, the recommendations for Professionals experiencing Vicarious Trauma include: Take care of yourself. Take time for yourself. Separate yourself. Limit yourself. Help yourself. Be honest with yourself. Empower yourself. Renew yourself.

Full access to this empowering article here:  http://www.wendtcenter.org/resources/for-professionals/

Kat and I have experienced PTSD personally and I have professionally worked for over 30 years with a population that includes a high percentage of people who have experienced significant trauma. I appreciate the recommendations presented in this article. One gift trauma has provided to me is a closer, more intimate relationship to the Universe (perhaps experienced as God for some). My concept of our Oneness is well represented in Dr. Larry Dossey’s book One Mind. Meditation (listening) and a commitment to positive self talk is valuable. The concept of reframing has helped me navigate the toughest journeys (a miracle is a change of perception). Reframing is not about denial (closing doors) and is about creating spaciousness in order to expand our options. The late Wayne Dyer stated “Peace is the result of retraining your mind to process life as it is rather than what you think it should be”. There is a significant alignment to freedom (and therefore wholeness) within Wayne’s statement.

Preemie Family Partners:

Do you long to feel more connected to your preemie baby? Bonding with a preemie infant can be challenging. The delayed ability to hold our baby when she/he is in a special care baby  or neonatal intensive care unit can be frustrating, disappointing and saddening. Massage may provide us with an alternative way to connect with and contribute to the infant’s well-being. When Kat was in the NICU a very gifted respiratory therapist empowered me with the ability to provide the appropriate massage and tapping of Kat’s little body (back, chest) in order to decrease the effects of her chronic lung disease. I continued that therapeutic practice daily for years. Most often premature and low-birth-weight babies respond well to gentle rubbing or stroking. Of course, the appropriate medical guidance from your healthcare team is required, so check in with your providers to determine what is medically supported for your infant. Per the article “Can I massage my prem baby “(Baby Centre) massage can also help your baby to develop. It may:

• Help your baby to gain weight, especially if you use oil to massage him.
• Help your baby to feed more readily. This may mean he can come home sooner.
• Help to stabilize your baby’s brain activity, breathing and heart rate.
• Reduce levels of stress hormones. Massage can help your baby to cope better with procedures that are necessary, but uncomfortable.
• Help your baby to sleep more easily.
• Please enjoy this helpful article: http://www.babycentre.co.uk/x1042912/can-i-massage-my-prem-baby#ixzz4UExq3vwh

WARRIORS!

We are born into fascinating times. The age of technology is expanding quickly, offering us diverse and unique landscapes to explore! Space is not the last frontier. Our frontiers are evolving before our eyes! Catch a wave with us on this exciting little (yet very BIG) adventure!

Vayu’s Drones Deliver Healthcare in Rural Madagascar (08/04/16)-