After extensive analysis of the state of neonatal care in Haiti, and based upon the literature on neonatal survival, Ohio State created a neonatal care training program that consists of both continuing education programs in newborn resuscitation, e.g., Helping Babies Breathe® and the Neonatal Resuscitation Program™, taught by certified instructors, and a combined didactic and experiential course in specialized newborn care nursing. The latter is a two to six-week course involving lectures, clinical skills training and mentorship in delivery units (L&D units and ORs) and in specialized newborn care units (SNCU). Our action plan was ambitious — develop curriculum to build in-country capacity and create a clinical site that offers a neonatal nurse training program. To enable the latter, and provide newborn care where none exists, the Ohio State Grief Neonatal Survival Program is improving and or building SNCUs at select hospitals beginning with L’Hôpital Sainte-Thérèse de Hinche.
The Central Plateau Department is one of 10 administrative areas of Haiti, with Hinche serving as the capital city of the Department. The population of Hinche is estimated to be 122,300, but the immediate catchment area is approximately 250,000 people from the arrondissement of Hinche, which includes Hinche, Maissade, Thomonde, Cerca and Carvajal, as well as neighboring communities in Thomassique and Cerca la Source. In its role as the Department-level referral hospital for the Plateau, it serves over 700,000 people. L’Hôpital Sainte-Thérèse, built in the 1930s by U.S. Marines, is currently run by the Haitian Ministry of Health and Partners In Health. L’Hôpital Sainte-Thérèse is approximately a three-hour drive from Port-au-Prince and a one-and-a-half-hour drive from Hôpital Universitaire de Mirebalais, built and operated by Partners in Health and the Haitian Ministry of Health. Given the geographic centrality of Hinche, the existing connection with Partners In Health, the support and collaboration of the hospital leadership, and the evident need for education and clinical training around newborn survival, the decision was made to establish the new Ohio State Grief Neonatal Survival Program in Hinche at L’Hôpital Sainte-Thérèse.
The program trained and hired nine full-time Ohio State-trained Haitian nurses to staff the Specialized Newborn Care Unit (SNCU) at L’Hôpital Sainte-Thérèse de Hinche. News of the work and successes in the newborn care unit spread throughout the region as evidenced by the story of a pregnant woman at a hospital in Port-Au-Prince. She was told that her baby’s chance of survival was slim to none and there was nothing they could do at the largest hospital in this capital city of more than 3 million people. Having heard of a place in Hinche “that saved babies when no one else could,” she made the three-hour trip to the St. Therese SNCU, where she delivered her baby and, although premature, he survived.
The goal of this program has always been to build capacity through training and mentorship. All involved know that a trained workforce pays dividends far into the future. We want to ensure that even after the Ohio State Grief in-country mentorship and collaboration ends, the care will continue. Seeing the difference that this new level of care makes in just this one small unit for newborns is inspiring. And, as the father of one of the SNCU patients said to the nurses, when you save the baby you don’t save one life — you save a whole family.
Expanded Nurse Training
A major initiative this year was the expansion of the six-week neonatal nursing course to a six-month certification program. In addition to the Helping Babies Breathe® and Neonatal Resuscitation Program®, Ohio State and PIH developed and are co-directed a six-month neonatal nursing certification course approved by the Haitian Ministry of Health. The course consisted of didactic teaching, side-by-side clinical mentoring, and instruction on how to serve as a mentor, which the nurses take back to their home institutions. After the selection process was completed, 27 participants representing seven cities in Haiti graduated from the inaugural course. Thus the course not only expands the participants knowledge on newborn care but through train-the trainer education it spreads that knowledge far and wide thus truly increasing healthcare capacity in the country.
Specialized Newborn Care Unit One-Year Anniversary
May 30, 2015 was a special day for the Ohio State Grief Neonatal Survival Program. It was the day that doctors, nurses, administrators and parents of former patients, celebrated the one-year anniversary of the Specialized Newborn Care Unit in L’Hôpital Sainte-Thérèse de Hinche and its success in educating and equipping neonatal nurses to save lives. The unit, made possible through the Greif Charitable Trust gift, offers the type of high-quality care that is scarce in so many developing countries and certainly in Haiti.
A little over a year ago, the Specialized Newborn Care Unit had yet to admit its first baby, fast forward one year and treatment has been provided to more than 250 patients with that number increasing every day. Ohio State-trained nurses attended over 750 deliveries this past year bringing their expertise to the delivery room and utilizing their training beyond the SNCU. In what now feels like such a short period of time, infants who prior to the opening of the SNCU would likely have died, are now surviving and thriving.
During the celebration of the unit, Dr. Prince, chief medical officer of St. Therese, gratefully acknowledged the impact that the unit has had on health outcomes. The neonatal nurse team is keenly aware of the difference that the training and education have made both in the treatment they provide and in the way they view their roles as professionals. Apart from the clinical improvements, the impact on families cannot be overstated. Time and time again they thank the nurses and Ohio State Greif for making this level of care available. They know all too well how fragile the line is between access to high-quality medical care and death. As one mother stated, “I delivered three babies previous to this one. Each baby died because they were born premature and I was told nothing could be done to save them. Now look! This was my fourth pregnancy and I stand before you today holding my baby in my arms because of your amazing work!”
In one year’s time the Ohio State Grief Neonatal Survival Program has saved hundreds of lives and has proven that side-by-side clinical mentoring combined with classroom learning delivered over months, not days, is a powerful and effective way of increasing newborn outcomes and yet it is only the beginning. Increasing neonatal nursing capacity, enlarging the newborn care unit and expanding training throughout the healthcare continuum will all help meet the needs of these tiniest patients.