Exploring our preterm birth community in Mali where the preterm birth rate is one of the highest in the World has been unsettling. The health care provider shortage in Mali is severe. The country remains in political turmoil and according to Daily Mail.com in an article dated 2 March 2018 “Across the country an estimated 4.1 million people are in need of humanitarian assistance.” In this environment, general health care and security issues for the population as a whole are needed in order to provide a basis for caring for the preterm birth community. The need for safe drinking water remains a crisis Mali faces.
Preterm birth rate (births <37 weeks per 100 live births) – 12
Leading causes of neonatal deaths in Mali (2015) – 29% Preterm birth complications
Mali, officially the Republic of Mali (French: République du Mali), is a landlocked country in West Africa, a region geologically identified with the West African Craton. Mali is the eighth-largest country in Africa, with an area of just over 1,240,000 square kilometres (480,000 sq. mi). The population of Mali is 18 million. Its capital is Bamako. Mali consists of eight regions and its borders on the north reach deep into the middle of the Sahara Desert, while the country’s southern part, where the majority of inhabitants live, features the Niger and Senegal rivers. The country’s economy centers on agriculture and fishing. Some of Mali’s prominent natural resources include gold, being the third largest producer of gold in the African continent, and salt. About half the population lives below the international poverty line of $1.25 (U.S.) a day.
Mali faces numerous health challenges related to poverty, malnutrition, and inadequate hygiene and sanitation. Mali’s health and development indicators rank among the worst in the world. Life expectancy at birth is estimated to be 53.06 years in 2012. In 2000, 62–65 percent of the population was estimated to have access to safe drinking water and only 69 percent to sanitation services of some kind.
Born On Time
We have mentioned Born on Time in prior blogs. Several organizations provide humanitarian assistance in Mali. Our challenge is to identify sources that we can research and recommend with some reliability. Born on Time work in Mali is ongoing and focused, and their efforts may profoundly affect our Mali preterm birth community.
Born On Time is a Public-Private Partnership to Prevent Preterm Birth. This bold new initiative brings together expertise and resources from World Vision Canada, Plan Canada, Save the Children, the Government of Canada and Johnson & Johnson. Working closely with local governments and stakeholders, the partners are working to improve newborn survival, with a focus on preventing preterm birth in high-burden areas of Bangladesh, Ethiopia and Mali over five years (2015-20).
Save the Children’s participation in Born On Time will focus on Mali: In Mali men, as the primary decision makers, generally do not see maternal and newborn health and nutrition as their priority and women’s and girl’s voice are often excluded from community-level health services, which can mean decisions around healthcare do not reflect a focus on maternal and child health and needs. As such women are often hindered in their ability to seek healthcare for themselves and their children, and are limited in their ability to adopt preventive health measures such as family planning. Other important factors contributing to the high prevalence of preterm births in Mali include child, early, and forced marriage (CEFM) – in Mali, 55% of women aged 20 – 24 were married by 18 – and the high prevalence of violence against women and girls in the country.
Save the Children will work to conduct capacity-building activities on the gender equality dimensions of MNH to support the delivery of quality, gender-responsive reproductive health services. We will seek to empower girls and women by engaging them in health centre management boards and community health action groups in Mali, encouraging them to play a role as decision-makers in the community and at home. We will work to increase women’s and girls’ access to information and knowledge through a wide range of actions, such as the provision of information on healthy behaviors and care seeking through community awareness sessions. We will also engage the community, including traditional and religious leaders, older female decision-makers and especially men, as active partners of change through awareness-raising and social and behaviour change communication activities.
You can give a single gift, become a monthly donor, provide emergency relief, host an event and much more. Join us today in changing children’s lives!
Donate/participate in Mali heath here: https://www.savethechildren.ca/what-you-can-do/donate/
PREEMIE FAMILY PARTNERS
Kat: My life was deeply enriched when I witnessed the overwhelming changes that adoptable NICU babies experienced on special occasions when a preemie baby and an adoptive family were united. I have no doubt that lives are saved and/or transformed through the love and attention, touch and emotional connection of a family and infant.
Adoptive Families: February 26, 2018
Adopting a Premature Infant-
If you’re adopting a premature baby, our expert has all of the information you need to understand development, hospital stay, and feeding to better care for your little one. by Dana E. Johnson, M.D., Ph.D. and Judith K. Eckerle, M.D.
In the United States, 8 to 10 percent of infants are born prematurely, and the figure is likely higher in adoptees, due to the prevalence of factors that lead to prematurity, such as lack of prenatal care and poor nutrition. Adoptive parents whose child was born prematurely, or at a low birth weight (LBW), are justifiably concerned about the medical conditions the child may face immediately after delivery, and medical and/or developmental problems in the future. While they appear tiny and fragile, preemies are surprisingly resilient. Most overcome their initial medical problems and enter their adoptive families with few lingering concerns.
Very low birth weight (VLBW) or very preterm infants have the highest risk of adverse outcomes. An analysis of multiple outcome studies, published in Pediatrics, in 2009, concluded that these children were at risk for moderate to severe deficits in academic achievement (math, reading, and spelling), and at a higher risk for attention problems, internalizing behavior problems (depression, anxiety), as well as deficits in executive function. Additional problems can include cerebral palsy or persistent lung problems, such as asthma, as well as hearing or vision loss.
For late preterm infants, which make up the majority of premature births (75 percent), outcomes are usually quite good. However, work published in Child’s Nervous System, in 2010, has identified a slightly increased risk over full-term infants for many of the long-term issues that affect very low birth weight/very preterm infants.
Some correction for prematurity is commonly used up to 24 months, to determine adjusted growth and development. Thus, the younger the baby, the more difficult it is to predict outcome. If a child is making good progress in developmental milestones during the first 12-24 months, growth is normal and hearing and vision unimpaired, we can be fairly optimistic that outcome will be favorable. However, we must often wait until school age to detect more subtle problems in learning, cognition, attention, and behavior. Preemies will be monitored through life for growth (shorter stature as an adult), subtle abnormalities in lung function, and a possibly higher risk of chronic diseases, such as hypertension.
Parenting a Preemie-
The environment in which a preemie develops is enormously important. Studies have found that parent education, child rearing by two parents (regardless of marital status), and stability in geographic residence and family composition over a 10-year-period positively impact school outcome in preemies. The Minnesota International Adoption Project surveyed more than 1,800 families whose children had been living with them for an average of seven years. When asked how the child’s medical and/or behavioral problems affected the family, parents of low birth weight infants were no more likely than parents of other children to report they were struggling to adjust.
While there are risks of ongoing medical, developmental, and behavioral problems, particularly for the smallest preemies, most of them experience normal growth and development during infancy and childhood. If a family sets appropriate expectations, knows their own abilities and the resources available, seeks appropriate consultation, and is cognizant of a premature child’s potential challenges, they can experience all the joys of parenting.
Spirituality, Health and Medicine
Kat’s Survival as a micro-preemie was supported, enabled, empowered by a gifted Neonatal Womb Community of Healers from Western, Eastern, and globally indigenous (originating or occurring naturally in a particular place) backgrounds. I cannot express the anguish I felt as the mother of a child on the brink of death, moment to moment, hour to hour, day to day, week to week for the first year of Kathryn’s life. I am endlessly grateful for the guidance that led me to all of the healers that kept my daughter alive and created a foundation for her health. This Mali blog was a tough one for me, but there are healers in Mali, and a complex and challenging foundation to approach. We human beings are a tenacious species….
Our (Kathy) Story Continues –Writing for Wellness:
The label on the isolette said “Baby B, Kathryn”. My intention was to call the infant by her middle name, Keeley, but by the end of her 4 month stay, the NICU that saved her had formalized her name; Kathryn. Who is this tiny brown being covered in hair fighting to survive, I wondered? Standing in the NICU for the first time, the resounding question for me was “what do I do now, and how can I breathe without screaming”?
Every NICU family arrives with its own particular luggage and life that is left behind, forever transformed by the evolving NICU journey. NICU families have deeply held stories to tell. We too traveled from an origin that was both unique and complex. Our NICU story will focus on the NICU journey itself in order to attempt to connect with the NICU community, which we call The Neonatal Womb, through aspects that may reflect the collective experience.
On March 19, 1991, the day the twins were born, the NICU’s only available information for NICU families was a pamphlet for families whose child had died and while this was useful for entering the dark, it provided no direction towards the light. There were no books, publications, resources or technology available to guide the NICU family journey. My experience was one of navigation without compass or illuminated pathways.
Kathryn’s brain bleeds and declining weight (from 1 lb. 8 oz. to 1 lb. 3 oz.) culminated in a lifesaving heart surgery at a mere 3 and ½ weeks of age. The surgery, performed without anesthesia (due to medical standards at that time) was provided by a pioneer in cardiac surgery, and supported by a staff that trusted the renown and very brave surgeon. My spiritual self kept the rest of me present at a time when so much of me wanted to disconnect. My older twins, Seth and Ciara, played quietly in the designated family waiting room while we waited; me not knowing if I wanted the wait to end. Eventually, a staff member came to inform me Kathryn had survived the surgery, but her condition was critical. I never met the surgeon, a very private person I am told, whom I deeply love and appreciate. Over time I learned about her dynamic and impressive accomplishments and esteemed career.
During her NICU stay we visited Kathryn multiple times daily. The steroids she was given provided her with chubby cheeks in two localities. Over time the precious and anticipated “peanut” shaped head formed giving her a cartoonish appearance. Kathryn recognized the music I had played to her when she and Cruz resided within the confines of my womb. We watched her ears form, her eyes open, and were terrorized and yet proud of her ability to remove her intubation equipment, setting off all kinds of frightening alarms, forcing the World to acknowledge that she was a force to be reckoned with. Two months after Kathryn was born she experienced her first bath. The nurse placed Kathryn in a very small metal bowl and Kathryn, a Pisces, clearly expressed her love of water. Following this immersion, a milestone occurred, and I held Kathryn in my arms for the very first time, a fragile yet tender encounter.
One particular member of our NICU staff did advance my desire to participate in the healing and well-being of my child. A respiratory therapist, a preemie himself, born in Africa, who clearly had healing capacities beyond his job title taught me under his supervision and guidance to massage and “tap” Kathryn’s spine in order to support her very weak respiratory functioning. We both understood the healing potential touch bestows, and I provided this treatment to Kathryn for several years following her hospitalization. This healer empowered me, a gift I desperately desired at that time when I felt I had so little to offer.
During our NICU journey, NICU staff was fully and appropriately immersed in providing care to the premature infants and clearly the medical focus was directed toward the neonate patient. Families were unattended for the most part, not seen as participant team members and not provided with resources to empower their abilities to positively participate in and support the NICU and their journey. On our NICU journey we were allowed to observe the Neonatal Womb, but in general were not educated to appropriately and powerfully engage. Moms that choose to provide breast milk for the neonate (requiring consistent and arduous pumping several times daily) did have a visceral opportunity to contribute to their child’s health and survival, while other family members were left with little if any ability to meaningfully contribute, engage, empower their roles within the Neonatal Womb. The impact on the NICU fathers/other parent was often devastating especially given the general action-oriented nature of men in their roles as protector/provider. In this regard the NICU journey, even now, can devastate a family unit.
Two months after Kathryn was born, our insurance carrier required a transfer to an alternative Medical Center that was not as well certified as our prior provider. In order to ensure Kathryn was not put through unadvised medical procedures that had already been performed by the initial NICU provider, I was guided at times to intervene, educate and monitor the staff. The drop off in care was clearly evident, and but for a knowledgeable traveling NICU Nurse the staff was clearly less qualified to provide quality care and treatment. When Kathryn left the NICU following an additional two month stay (4 months total) she wore a white 18-inch doll dress with a matching bonnet. Only a few hours prior to discharge were Kathryn’s oxygen ensuring nasal prongs removed. Our family was not prepared by staff to confidently care for the still tiny infant weighing barely 4 pounds. Kathryn terrified us for months as we took turns watching her chest move up and down, ensuring her breath and vitality.
NICU babies are fragile in many ways. Underdeveloped and compromised immune systems, complicated by the use of steroids to support the development of the infant’s lungs and physical growth, and numerous other medical conditions, render exposure to people in general, well dangerous! In the NICU and following discharge exposure to people outside of the caregivers and immediate family may be significantly restricted, sometimes for many months. The separation and limited exposure available to children and other family members limits bonding opportunities with NICU infant. Technology, now expanded, offers current NICU travelers enhanced opportunity to build connection with family members in a safe, progressive, interactive fashion. The issue of limiting infant exposure becomes especially difficult once the baby leaves the NICU and goes home. Well-meaning family members want to see, touch, connect with the infant and may not understand the danger to the infant created through exposure to airborne and contact pathogens. Lack of resources to educate family/friends, who are also a part of the Neonatal Womb, and conflicting emotions of the parents/caretakers as they care for the infant may create stress, separation and conflict within the extended family unit. While the NICU parents/caregivers seek to protect the NICU infant, family members may feel rejected, useless, and denied the roles they imagined for themselves in the premature infant’s life. Currently, the availability of technology has the potential to educate, include, and connect the extended family throughout the NICU journey while supporting the infant’s health and reducing stress for family members.
When Kathryn was about five months old a group of family members arrived unannounced at the house to meet the surviving twin. Although asked not to visit and provided with the associated medical recommendations and precautions they pushed through the door into the room where Kathryn abided in her little red crib. My heart sunk knowing the meeting was a dangerous one. Feeling angry and powerless to protect her in that moment I was aware of the visiting family members determination to stake a claim in Kathryn’s life, and their total dismissal of the precautions related to Kathryn’s well-being. The situation was difficult, and Kathryn ended up in the ER shortly following the family exposure, critically ill, unable to breath. The ER visit was one of many that occurred following graduation from the NICU unit.
Long before Kathryn’s birth I had observed through my professional career the harmful and sometimes deadly effects of long term steroid use. Reaching her first birthday, Kathryn remained under treatment for her chronic lung disease and I perceived myself as slowly killing her as I blew the steroid towards her face three times daily. ER visits for treatment related to Kathryn’s chronic lung disease were frequent and profoundly disturbing. The Universe answered my constant prayers for guidance at 5:30 AM one morning when the local news program ran a one-time only report citing research confirming the dangers of long term steroid use. I did not hear the report ever broadcasted publicly again, but once was enough to confirm the “Truth” I had long acknowledged deeply within.
In 1992 the late renown Sylvia Browne was a locally known psychic residing in the Federal Way area south of Seattle, WA. Guided to seek alternative healing for my daughter, I met with Sylvia Browne who listened to my needs and referred me to a well-known horse healer who lived in Oklahoma. The healer, who preferred to work with horses, not humans, agreed to provide distance healing to Kathryn via surrogate (Kathryn was too ill to travel). Within a week of the healing session, Kathryn was successfully weaned from steroids completely, and she has not since been to an ER, emergency walk-in or general medical clinic for medical treatment for her lungs.
To be continued…
HEALTH CARE PARTNERS
Premature birth associated with increased risk of heart disease in mothers-January 24, 2018- Source: Keele University – Summary: A study has found the risk of death in later life due to coronary heart disease doubles in women who give birth prematurely.
A study led by researchers at Keele University has found the risk of death in later life due to coronary heart disease doubles in women who give birth prematurely.
Researchers from Keele University’s Research Institute for Primary Care and Health Sciences, together with colleagues at the University Hospital of North Midlands Trust (UHNM), the University of Arizona, and the University of Leicester, analyzed 21 studies and over five million women, with the findings published in the Journal of the American Heart Association.
Premature birth (delivery before 37 gestational weeks) affects 10% of all pregnancies, and is linked to poor health in premature babies. However, the study found that there are also long-term implications for the mother’s health. The study shows women who give birth before 37 weeks are 1.4 — 1.6 times more likely to experience cardiovascular disease, stroke, and coronary heart disease than mothers who give birth at full term (39 weeks), and also have double the risk of death caused by coronary heart disease.
The study promotes the importance of cardiovascular risk assessments in women who give birth prematurely, in order to identify high-risk individuals. These individuals can be targeted to reduce the risk of future cardiovascular events by encouraging a healthy lifestyle and behavioural changes, and prescribing drug therapies which will help reduce their risks.
Lead author Dr. Pensee Wu, Keele University lecturer and Honorary Consultant Obstetrician at the University Hospital of North Midlands NHS Trust, commented: “Doctors need to be aware that women who have had premature births are at higher risk of cardiovascular disease, and should be considering obstetric history during a woman’s cardiovascular risk assessment.
“I hope this work will raise awareness amongst hospitals and primary care doctors of the lifestyle advice that they can give women who have had a preterm birth in the past. With funding from the National Institute for Health Research (NIHR) we are conducting further research to understand the causes of increased cardiovascular risk in women who have premature births.”
Mamas Mamas, senior author of the study and Professor of Cardiology at Keele University, added: “Obstetricians and cardiologists need to work closer together in treating these patients identified as high risk, with the development of shared treatment pathways that cross medical specialties and target interventions to this high-risk group.”
Dr. Wu has also been awarded a NIHR fellowship to examine pregnancy complications and long-term cardiovascular outcomes.
Eye On Traditional Medicine In Mali
Posted by THE BODY TEMPLE INSTITUTE on January 27, 2014 at 7:30pm
- Traditional Medicine Men Being Certified By The Government
- Pregnant women in Mali are dependent on medicine men and women, also called traditional practitioners (TPs) of folk medicine. Researchers are now collaborating with these healers to help improve their practice.
- Approximately 75 percent of the population of West African countries rely on traditional plant medicines when they fall ill.
- Healers, or TPs, play a key role in the primary health system of Mali’s 14 million inhabitants, including caring for women who are pregnant, giving birth or lactating.
- Mali has only one doctor per 20,000 inhabitants. The risk of women dying during pregnancy or during the delivery of an infant is 100 times higher than in Norway.
- What happens when TPs and healers have responsibility for treating pregnant women?
- Master’s degree students at the University of Oslo (UiO) and the Norwegian Institute of Public Health have joined the University of Bamako in interviewing 72 TPs or “medicine men” [although 64 percent of these healers were women] in Mali.
· Treating 13 pregnancies per month
- The researchers calculated that each TP or healer treated an average of 13 pregnant women per month. The ages of the TPs interviewed ranged from 34 to 90.
- “Our study indicates that healers and TPs play an important part in the health care of pregnant women in Mali,” says Pharmacology Professor Hedvig Nordeng of UiO.
- The researchers found that TPs in Mali know quite a bit about pregnancies and deliveries. They treat common maladies associated with pregnancy as well as diseases such as malaria.
· Nausea and births
- Many of the pregnant women who seek help from PTs have problems with morning sickness ― nausea. The TPs generally agree on which plants should be used to treat nausea and dermatitis among pregnant women, Nordeng says.
- The researchers also observed that pregnant women with malaria were generally treated with fever-reducing plant medicines.
- They catalogued more than 40 different medical plants that were used, and also found that traditional practitioners in Mali know very little about the mental problems that can plague pregnant women.
- “We asked the healers specifically if they knew of any treatment for depression in connection with a pregnancy or birth,” says Nordeng.
- This was a difficult subject. Most of the healers did not know about any medicinal plants that could be used for these kinds of ailments.
- The researchers attribute this to the fact that it is taboo to talk about depression in many African cultures. The professor in pharmacology thinks mental health ought to get more attention in Mali.
· Safer use of plants
- Many TPs use the plant Cola cordifolia in difficult deliveries, because it is believed to help ease the birth.
- “The healers often take special precautions when treating pregnant women. They said they refrain from using the strongest parts of certain plants. They also avoided the use of plant parts that taste bitter, because they thought this could lead to uterus contractions and a spontaneous abortion.”
- Nordeng says that pharmacological studies have documented that many bitter plants contain high concentrations of alkaloids. Thus, there is scientific support for avoiding these compounds during pregnancy.
- Now the researchers want to interview women in Mali about their attitudes and habits regarding plant medicines and pregnancies. The researchers hope to contribute to the safe use of medicinal plants during the birthing process, or afterwards, when women are breastfeeding.
· The healers have main responsibility
- Professor Berit Smestad Paulsen of UiO’s Department of Pharmaceutical Chemistry was the first to initiate contact with Mali’s health officials and has played a key role in the project.
- Paulsen says healers definitely have the main responsibility for health in countries like Mali.
- “This is simply because there are no doctors available for most people.”
- “The Mali authorities have created an official quality control system for healers, and are the first country in Africa to do so. Healers cannot be issued a certificate without demonstrating their ability to heal a certain number of people.”
- Paulsen thinks this system could serve as a model for other African countries. She has received an EU research grant to continue collaboration with Mali health officials and will initiate similar projects in Uganda and South Africa.
· Cheaper medicines
- The National Institute of Public Health in Mali has opened a department of traditional medicine. One of the major priorities of the authorities is to bolster knowledge of folk medicine.
- They want to ensure the public gets the best traditional medicines available.
- “Traditional medicines are also cheaper than Western medicines,” Paulsen points out.
- She has worked with her colleagues in Norway and Mali on laboratory studies to determine the chemical effects of the plants that are used.
- Researchers and other partners from Mali will use this information to develop local medicinal products, which will then be made available in the country’s pharmacies.
- Four students from Mali have earned their doctorates in pharmacology at the University of Oslo. They are now involved in the study of traditional medicinal plants in their home country.
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Reducing Invasive Procedures in Preterm Infants
Neil Finer, MD, discusses reducing invasive procedures and finding alternatives with surfactants in preterm infants.
Simple innovations that are transforming neonatal care in Africa.
The only neonatal doctor in Zambia’s public sector empowers future pediatric healthcare workers to make a difference in Africa‘s healthcare industry.
Mali is a land-locked country, surrounded by countries that touch the ocean. The rain that falls upon our pre-term birth community brothers and sisters in Mali slaps the Elliot Bay seawall in Seattle. Days and hours of researching surfing in Mali (the Niger River does cross through Mali) we finally stumbled upon a true gem in the documentary below, a West Africa Surf trip, including travel through Mali. The 29 minute, 12 second film overwhelmed us with beauty, fragility, strength, diversity, heart and humility that we share throughout our human experiences. This blog challenged us to find that Ray of hope and inspiration required to transform the hopelessness we sometimes feel when we feel disempowered. The film, through great music, vivid and spectacular videography, touching humanity will touch your soul. We could not take our eyes away from this gift! Enjoy the adventure …..
West Africa Surf Trip | I’M AFRICAN
XTreme Video (29.12) – Published on Aug 23, 2017
“I’m Moroccan and Africa is my continent, a continent where happiness is epidemic. I travelled 8 countries in 5 months with a mission, bringing clean water to peoples in need, and a dream crossing a continent with local transport”.
Filed by Ismail Benlamlih – Dji by Mark Leonard
Additional footage by Mehdi Boutaleb
Music by Ballaké Sissoko and Toumani Diabaté