After I finished my Pediatrics Residency at University of Colorado, I decided to take time off before doing a Neonatal-Perinatal Fellowship to challenge myself by working in a low-resource setting. I found myself in rural Ecuador: I flew from Denver to Quito, boarded a small domestic flight from Quito to Loja, where I was met by a driver who expertly avoided every pot hole on the four hour journey on unpaved roads to La Clinica Nuestra Senora de Guadalupe. Despite my love for ventilators, procedures, and complicated physiology that made me want to be a neonatologist, my time working in rural Ecuador made me recognize that being a neonatologist also means being concerned about newborns that do not have access to these same technologies. In fact, I learned that the majority of newborns that die around the world do so in low-resource settings, where often they die at home without coming to the attention of a medical provider.
In Ecuador, despite the care of pregnant women and children < 5 years being free in the hospitals, I was still asked to attend the delivery of a patient in her home, even after seeing her antenatally and giving her the warning signs for which she should go to the hospital. Instead, her family purposefully waited until the last bus for the local hospital, located 1.5 hours away, had gone, and then came to fetch me when Rosa’s contractions were about 3 minutes apart. I walked ten minutes from the clinic to her home, where she lay writhing on the bed, on a piece of plastic, her two other children asleep nearby. There was no electricity, and her husband was waiting outside the house for me. I recognized in that instant that if there were complications with her delivery, I was almost 2 hours away from being near more advanced medical care for Rosa or her baby. It was a frightening amount of responsibility.
Luckily, this story has a happy ending—Rosa delivered a healthy baby girl two hours later, and when I visited the baby the next day, she was breastfeeding and doing well. When Rosa named her five months later, she did me the honor of giving the baby my name, and I have seen my little namesake on three subsequent visits to Ecuador since I ended my time there. But, the memory of that delivery and the possibilities of all that could have gone wrong that night have stayed with me and made me want to do more than just travel to different locales and treat patients. I wanted to do something sustainable in global health, to leave a lasting impression.
When I returned to University of Colorado for my fellowship, I knew that global health would play a strong role in my future career. Given that one of my mentors was Susan Niermeyer, the Editor in Chief of the Helping Babies Breathe® (HBB) curriculum, I had a natural entry point to get involved. Helping Babies Breathe is a neonatal resuscitation program which is pictorial, skills-based and designed for use in resource limited settings. HBB utilizes a low-cost simulator (NeoNatalie®) , paired learning and an emphasis on continued practice for sustainability. A public-private partnership of professional organizations, the Global Developmental Alliance (GDA), facilitated planning in 51 countries with over 94,000 skilled birth attendants trained to date. The emphasis is on initiating the simple steps of resuscitation (drying, stimulation, suctioning, and bag-mask ventilation) to get all babies to breathe within the Golden Minute®. Understanding newborn physiology in the delivery room is an important part of neonatology, and being able to treat babies with the simplest measures, even while being evidenced-based, has made me a better neonatologist when I am teaching residents about resuscitation, or practicing resuscitation myself, even with the additional gadgets and supports that we have in our delivery rooms in the United States. Being involved with HBB has allowed me to take a valuable skill around the world that will hopefully be sustained in the individuals that I teach, and improve neonatal care and outcomes around the world.
For young trainees and faculty that want to get involved in global health, Helping Babies Breathe is an excellent vehicle to do something sustainable and fun. More than that, given the sobering statistics worldwide about early newborn mortality, and particularly birth asphyxia related mortality, countries/ministries of health are urgently asking for help to support programs for neonatal resuscitation around the world. It’s an ideal opportunity to partner in an official capacity with local and even national leaders to improve newborn care.
I would encourage any young clinician who wants to get involved to use the resources on the HBB website (www.helpingbabiesbreathe.org to understand the training methodology, to contact experienced HBB Master Trainers for countries of interest to you to determine individual countries’ needs, and lastly to become trained as a Master Trainer yourself. Look at the Implementation Guide (on the HBB website) to think through ways to align your teaching with national and local needs and make it sustainable. In the future, there will also be resources that may guide you in formulating research projects that can produce important information that we still do not know about resuscitation in low-resource settings. Every time that I have taught HBB, I get chills at seeing the students come to understand the purpose of simulation and how to successfully make NeoNatalie® breathe by the Golden Minute. It is truly rewarding to hope that they will take these skills and teach someone else or help a baby breathe in a moment of need.