“But Doctor we can’t afford a Kangaroo…”

MDGS copied from Born too soon report

If you are wondering what all the fuss is about and why the RCPCH has decided to send us out here, it is partly because of the famous United Nations Millennium development goals (MDGS).  I first heard about these goals whilst I was listening to a clever man speak at the University college of Ife, Nigeria summer of 2013. A week before I heard this speech I had my interview with the RCPCH Global links and was given an offer to come out here just before my flight to Nigeria. When I heard the speech I knew I had made the right decision, it was one of those moments when everything becomes clear.  The UN has 8 MDGS, it is a blueprint made by all the countries of the world to meet the needs of the poorest and improve standards of living globally.  MDG4 aims to reduce childhood mortality, the largest of which is neonatal death in developing countries.  A staggering 40% of under 5 deaths are neonates, Neonates are babies less than 28 days old, some are born too soon (premature), born too small (Low birth weight), stillborn or born in poor condition and unwell.

In low-income settings the mainstay of management of neonates involves good antenatal care, maternal education, good resuscitation at birth, WARMTH for low birth weight and premature babies as well as early recognition of infections. A warm baby is less likely to get unwell, more likely to gain weight and grow because they use less of their energy to keep warm. And how does the WHO suggest we achieve warmth in low-income settings?  By doing Kangaroo Mother Care (KMC).

 This quote best describes why KMC is appropriate: “Incubators, where available, are often insufficient to meet local needs or are not adequately cleaned. Purchase of the equipment and spare parts, maintenance and repairs are difficult and costly; the power supply is intermittent, so the equipment does not work properly. Under such circumstances good care of preterm and low birth weight babies is difficult: hypothermia (low temperature) and infections are frequent, aggravating the poor outcomes. Frequently and often unnecessarily, incubators separate babies from their mothers, depriving them of the necessary contact.”

Adapted from WHO pocket book, a mum doing KMC

KMC was first noted in Kangaroos who keep their babies warm by putting them in a pouch in front.  Once a baby is stable, i.e. no longer needing respiratory support, they can start KMC from as little as 30 minutes a day to 24 hours stretches. The baby is naked apart from a nappy, a hat and socks on for warmth, they are then put skin to skin on the mum’s skin (clean skin) in front of her chest and a cloth is wrapped round the baby. That way the baby can nuzzle in and be fed, mum sees the baby constantly and can report any concerns. This is done on the unit and after discharge. 

Last week we had a set of twins born in very good conditions with low birth weight of less than 2kg, they were both cold and ideal for KMC. Both I and one of the local paediatricians sat and explained to mum and dad that it would be beneficial for them to learn KMC and keep the baby warm before we discharge them. My colleague spent over 20 minutes explaining KMC to both parents and at the end asked if they were happy to learn, at which point the dad replied… “but doctor I cannot afford a Kangaroo”. I could not stop laughing! It just made my day, needless to say we started the explanation again and they agreed to stay and learn.

The twins, eyes blurred out for confidentiality 

My colleague Sarah and I are knitting hats for the babies to wear during their KMC, our first guinea pigs are these 2 twins born prematurely. They both weighed less than 1 kilogram at birth and are now 4 weeks old and going strong thanks to KMC, homemade CPAP (only respiratory support we have) and antibiotics!