Infant mortality in Ghana and other African countries is 10 times the rate in developed countries like Israel. But to save premature babies, hospitals don’t necessarily have to have the most advanced and expensive incubators, respirators and other equipment. Teaching mothers to be “kangaroos” – holding their infants close to their skin, breastfeeding them and taking care of them almost around the clock –can be enough to help them the survive and thrive.
In 2006, the Agency for International Development Cooperation (MASHAV) in Israel’s Ministry for Foreign Affairs decided to focus on helping Ghana cut its high infant-mortality rate. It asked Prof. Michaek (Miki) Karplus, a leading neonatologist who headed the neonatal unit at Beersheba’s Soroka University Medical Center for three decades, to take on the project.
Since then, a delegation of Soroka doctors and nurses has flown once a year to the city of Kumasi in Ghana to guide and promote the special approach that Karplus developed in Soroka. In addition, throughout the year, video conferences and consultations are held via the Internet.
The medical facilities in Kumasi has no incubators for premature babies. Instead, mothers were taught how to take care of their babies using the “kangaroo method.’ After giving birth, she stays with the baby and takes care of all his needs as he clings to her breast almost 24/7 and nurses. The local teams were trained on subjects such as resuscitation, body heat control, infection management and prevention and treatment of jaundice.
Thanks to the experience that Karplus accumulated in India and Africa, he developed his approach based on the use of simple and effective technologies to take care of premature infants and full-term neonates, making it possible to significantly reduce death and illness of infants in poor countries. The approach is in line with World Health Organization recommendations.
During Soroka’s decade of guidance at the South and Suntreso Hospitals in Kumasi, doctors trained by Karplus’s teams have each treated 1,500 infants annually. The units cover a catchment area of five million Ghana residents, but its facilities are much too small to deal with all the babies who need medical care.
Karplus is working to have his model adopted throughout Africa for reducing the death rate among small babies. “We would like to come to international agencies and say: ‘We have a model and would like to propose that we take it to an area and set up a number of them. Then we can study infant mortality when we compare an area that has a unit with an area that does not.’ ” The project is now being assessed from the aspects of health and cost effectiveness.
The high death rate in babies born in the developing world results from infections and complications from being born at a low birthweight, said Karplus. But many of these can be minimized with simple measures that don’t even need the presence of physicians, who are very scarce.
That’s why this year, Israel will evaluate its units, both from a health and cost-efficiency aspect. The project is also being watched carefully by Ghana’s health minister Dr. Kwaku Agyemang-Manu and Israel’s ambassador to Ghana Shani Cooper, who said MASHAV has decided to supply the two Kumasi units with medical equipment including radiant warmers, phototherapy machines and infusion pumps.
Designed to serve a maximum of 50 babies at a time, the neonatal intensive care units in Kumasi often had five times that many receiving care. A crib or incubator meant for a single infant might be shared by five newborns. Sick babies shared space with preemies or moderately ill newborns who simply needed to be fed, kept warm and allowed to grow. As a result, the death rate among infants in the unit approached 50%.
Dr. Agneta (Agi) Golan, director of Soroka’s newborn and premature baby department, said: “We get tremendous satisfaction from the development of this project over a decade. We have accumulated much experience over the years. Our approach is tailored, developed and advanced according to local needs, where finding creative solutions is the name of the game. On every mission trip, I feel great making small steps. Project learning is completely reciprocal and empowering both personally and professionally. The professional challenge is great and the experience of another cultural meeting brings excitement every time,” she added.
Dr. Eylon Shani, a senior physician in the neonatal and premature ward in Soroka, added: “My participation in the project and being part of the delegation to Ghana always excites me and gives me immense pleasure, mainly because of the cooperation with the local staff. Each time you manage to overcome the gap between existing knowledge and capabilities and show that despite the shortage, much can be done. We have been successful in recruiting the cooperation of Kumasi hospitals and our Foreign Affairs Ministry and embassy, which have allocated resources and assisted in a very significant project for the project’s success.”