A wild idea saves prem babies
Low-tech care is what the doctor ordered
ETRONELLA Malele thought her baby looked too small to survive. Born nine weeks early, little Thuto was barely bigger than a cellphone pouch.
“When I first saw him, I couldn’t believe this was my child,” Malele recalls. “I got such a shock. I was so scared and just prayed he would be okay.”
Now just over three weeks old, he is. Still tiny, the newborn’s weight has climbed from 1kg to a steady 1.3kg. And no one is prouder than Malele, who gazes adoringly at her son as he sips from a cup of her expressed breast milk.
Every three hours, he drinks just a few teaspoons, but takes more and more every day. “I’m used to his size now and he is growing so well,” says Malele, a cashier in Centurion.
She is sitting on her hospital bed in the kangaroo mother care (KMC) unit, at the Kalafong Hospital, with its crumbling façade, in Atteridgeville on the outskirts of Pretoria.
Like many of the new mothers here, Malele had not heard of the programme. Now she credits it with saving her baby’s life. “This place is wonderful,” she smiles.
In the past 15 years, the low-tech programme has saved more than 5 000 premature babies at Kalafong – many of them high-risk babies weighing under 1.5kg like Thuto. Fewer than 50 have died. The unit is the brainchild of Dr Elise van Rooyen, who introduced KMC at Kalafong in 1999. Back then, she says, few people had heard of it.
Today, most state hospitals have some form of kangaroo mother care for premature and low birth weight babies – those under 2.5kg.
Van Rooyen’s model has been replicated in other countries on the continent and abroad – she and her team regularly head teaching sessions with other hospitals.
Like the colourful mural at the unit’s entrance, of a kangaroo carrying her baby in her pouch, mothers in Ward 4 carry their babies skin-onskin, held gently to their chests. Unlike an incubator, the mother’s skin serves as a life-giving biological membrane.
“Our KMC programme saves babies’ lives,” says Van Rooyen, who is softly spoken but firm.
“You do find there are very small premature babies who will not survive if you don’t have a hi-tech unit, but many premature babies don’t need a hi-tech environment. They just need warmth and regular feeding. And that’s where kangaroo care makes such a huge difference.
“It’s a way of care for the babies where the mother becomes involved with the babies again. Often premature babies are removed from the parents… who are not allowed to be involved.”
Studies have shown stress levels are “sky-high” for premature babies confined to incubators.
“When they place the baby in the KMC position, within 30 minutes the stress levels drop up to 40 percent.”
Now not a single baby can be heard crying in the unit.
“You wouldn’t think you were in a ward with so many babies,” smiles the unit’s manager, Nancy Jiyani. “They don’t cry because they are not stressed,” she says while carrying a two-week old baby held to her chest in a wrap known as a Thari sling. Van Rooyen designed the sling specifically for the babies in the ward. She sells them for R10 to buy material to make more.
The mother of the baby Jiyani is cradling had a convulsion and then a stroke, and is a patient in another ward.
On Monday, Van Rooyen and her team will mark World Prematurity Day. Globally, one million babies born prematurely do not survive. In
PSouth Africa, one in 10 babies is born too early – but for these “little miracles”, the odds are no longer stacked against them.
But KMC, so vital in saving babies’ lives has not been embraced by the private sector.
“In private hospitals, you have to convince them to do it. I can’t understand why. They do it intermittently, but don’t have a unit like this,” Van Rooyen says.
In her unit, the mothers are “lodgers” from the start, sleeping with their 25 babies. For those whose babies are in neonatal intensive care, classes are held in the mornings about the KMC programme.
“The mother then learns how to take care of her baby, so that when she goes home, she knows the baby. She knows the cues, how to breastfeed. I think many premature babies die at home… because the mothers don’t know what to do with them.
“You have to wake the baby for feeding. With a full-term baby, you wait for the baby to cry for the feed. You can’t do that with a premature baby. He will keep on sleeping the whole day and he won’t get food. Then they lose a lot of weight.”
Mothers have their own hall for meals and a lounge, and don’t leave the ward until their babies are discharged. Some stay longer than others, like Daphne Mudau, who has been here for more than 100 days.
In July, her oxygen dependent baby, Rendani, was born at 28 weeks, weighing just 950g. Now he weighs 3.4kg. “The longest I’ve had a baby here was for 156 days,” smiles Van Rooyen. “The baby started eating porridge here in the ward.”
The unit runs a clinic twice a week to make sure those who are discharged gain weight – if they don’t, they are re-admitted.
“We’ve got security guards now because some of the mothers refuse to admit their children again and try to run away with them. We always stop them.”
Van Rooyen gestures towards a teenage mother from Spruit, an informal settlement nearby. Just 14, she has been pregnant twice. The first pregnancy ended in a miscarriage. The child stares at her tiny baby boy, sleeping in a cot. She has a Grade 3 education.
“The baby’s grandmother has an income of R300. They live in a shack. We don’t know what will happen to the baby, but we are speaking to social services. Whenever there are these cases, we have family conferences to find out what is going on. Our babies come first. We will not let them go home to a situation where there is no one to care for them.
“But if these babies are going back to a squatter camp, if they’re breast-fed and cared for like this, they survive. They come back for follow-ups and they do well.”
Breast milk is key to the survival of premature babies – mothers in the ward express their milk by hand. Bottle-feeding is outlawed.
“We don’t have milk in Kalafong Hospital,” boasts Jiyani.
“Our mothers produce all the milk our babies need.”
If mothers are ill, milk handlers visit their wards to collect their milk.
Van Rooyen emphasises: “The mothers breast-feed or feed by cup or syringe.”
She is proud that unit’s freezer is stacked with breast milk donated- from the mothers. The levels of nosocomial sepsis and necrotising enterocolitis, which occur when part of the babies’ guts rot because of for mula consumption, has dropped among neonates because of this donated milk.
Bottle-feeding is dangerous for premature babies.
“You find their oxygenation levels fall in poor hygiene settings. If you cannot clean the teat properly, these babies get candida thrush. If you live in a squatter camp, you don’t have running water, or electricity. You have to have a paraffin stove for boiling. It’s a lot of expense.
“It’s so much safer for a mother to have a cup that she can just wash with soap and water and it’s clean. Formula kills these babies.”
Van Rooyen worries about the capacity of her unit – and her staff.
“We are fuller than we’ve ever been. We have mothers from all over Africa here. As soon as you discharge one baby, you get another. Sometimes we don’t have space.
“We are always under stress and always full. You don’t see so many babies in a private hospital. We don’t have a lot of staff.
“But if we didn’t have the moth- ers, we wouldn’t be able to cope. The quality of care has improved since the mothers (began staying) here.
“They help their babies. They change, clean, feed their babies and give them their medicine.
“Our nurses very seldom touch the babies and that’s also a way to limit infection. In this set-up, the mother does nearly everything with the baby and it’s so much safer.”
Van Rooyen is 58, and her staff worry what will become of the unit when she retires.
“You can feel it when she is not here,” says Jiyane. “She cares so much about each and every baby. Other doctors just discharge, but she makes sure a baby is ready to leave.
“I’m not going anywhere yet,” Van Rooyen tells her, smiling.
Like Van Rooyen, her dreams for her unit are modest – a revamp.
“This unit is exactly as it was 40 years ago,” she says, indicating the broken floor tiles.
“When I got a little money, we bought the chairs and made a kitchen for our mothers.
“But look how clean it is – you can see the reflections of the mothers on the floor,” Van Rooyen says proudly.