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Summary Report from Visit to Lira University, Uganda: November 2016

Peter McEwan, consultant neonatologist.

Report on visit to Lira, Uganda, November 2016

Notes on neonatal unit experience:

Personnel:

  • Christine (Chris) Newsome, VSO Volunteer, Paediatric Nurse, chris.newsome@hotmail.com
  • Lead Neonatal Practitioner on hospital staff: Caroline
  • Lead nurse in neonatal unit: ………………

Cots:

5-6 spaces in (only) room, additional space available in room opposite for fridge, mums to sleep, (1 or 2 max.) and some space around in corridor etc (not much privacy) for breastfeeding babies

Technology:

No IV giving sets or infusion pumps

IV access: Cannula bought by parents, put in by nurse

Bolus IV fluids for administration of fluid to baby who is nil by mouth

Naso-gastric tubes: unknown to me whether these bought by parents and brought in or hospital supplies, also unknown if any means of storage of a feed to be given later, (I assume NG food is being expressed in time to be given to baby.)

Respiratory support: 2 oxygen concentrators, “bubble” CPAP (Continuous Positive Airways Pressure) being given by using equipment manufactured using corrugated tubing with the oxygen concentrator at one end, standard “nasal specs” oxygen delivery tubing to the baby and a bottle (discarded IV fluid container) for delivery of set pressure

Humidifier: this is being used for bubble CPAP circuit and is standard Fischer/Paykell device, but isn’t being applied to a source of heat, therefore not sure how much humidity this provides.

Thermal care: one overhead heating device (this is a resuscitaire) which does perfectly well, but there was no sensor for provision of servo-control temperature control therefore need to take babies temperature and adjust the heater appropriately. Also one incubator. Haven’t seen this turned on, so unsure whether the heater works, (also not sure whether is designed to provide humidity – not sure whether this is relevant as smallest baby likely to survive should do so without added humidity).

Babies:

Mostly inborn (transferred from labour ward), also few transferred in from home

Mums:

Some (one or two) given sleeping space in room opposite neonatal nursery, not much room for chairs for breast feeding mums. Lots of room in adjacent room to nursery for staff

Activity (while at Lira Referral Hospital) led by me:

Bedside teaching for nursing students. Occasionally attended by (very) junior medical staff

Lots of discussions with Caroline

Taking (brief/impromptu) resuscitation training sessions (both in neonatal unit and labour ward)

Main themes I think could be developed in future by team member from Poole:

  1. Moving baby from labour ward to NICU (earlier better)
  2. More emphasis towards nursing observations (not much “ownership” of observations chart by particular staff member – tends to be sporadic filling in of chart)
  3. Make resuscitation more of an emphasis with staff trained in resuscitation able to go from NICU to labour ward for emergencies(especially as caesarean section deliveries happening in room just up some stiars)

Ideas for things to take with the group in future:

  1. Glucometers and test strips
  2. Paediatric bag/valve/masks (I would discourage the use of very small (250ml) bag devices – but if that’s all you’ve got….)
  3. IV fluid infusion kit: tubing, cannulas, things to fix IV in place. This would represent more of a commitment to providing “consumables”, and also a technology that nurses aren’t used to dealing with. Given the level of intervention (respiratory support) which is available for the sicker baby in general, this would seem to be an appropriate – although staff wouldn’t necessarily be agreeable with its use.

Teaching provided while in the Lira Teaching Hospital:

  1. Neonatal emergencies
  2. Neonatal resuscitation
  3. Developmental assessment
  4. Congenital abnormalities



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