Stories from the Field

Global Health TV Feature
Watch the Global Health Council video, "Saksham Shivgarh: A Community Empowerment and Essential Newborn Care Program in Rural India." The video highlights the work of Hopkins faculty in Uttar Pradesh, India, to fight neonatal mortality through community-based interventions. It also features Dr. Vishwajeet Kumar from the Center, as well as Dr. Robert Black, chair of the Department of International Health where the Center is based.  

Stories from Community Health Workers (CHW) as part of the JHSPH/Saksham collaboration in Shivgarh, Uttar Pradesh, India

Preterm Baby Saved at Home

Delivered almost three months premature, Sakshi weighed only two pounds when she was born. But her family could not afford to keep her incubated in a hospital, and she was taken home wrapped in a warm cloth. With her health rapidly deteriorating, Sakshi’s life was saved by a home visit from a community health worker (CHW) with wise advice.

Before Sakshi was born, when her mother was taken to the hospital in a critical condition, doctors suggested that the baby was dead and should be surgically removed in order to save the mother.

But the mother-in-law insisted that the baby was alive, and the second round of ultrasound confirmed this. Because the mother’s condition was critical, the doctors proceeded with the operation and Sakshi was born. Since the newborn was so young and not fully developed, the doctors suggested that she should be kept in the incubator, which was not available there.

Sakshi was moved to another hospital. In the second hospital, incubator charges were up to 6,000 rupees per day. This was too expensive for the family to pay so Sakshi was taken home wrapped in a warm cloth.

At home Sakshi was first bathed in lukewarm water, wrapped in a cotton cloth and given honey water to drink. Later she was given cow’s milk through a wet cotton ball. Soon after, the baby’s condition began to deteriorate.

The JHSPH/Saksham office received news of the baby’s return to the village, and the CHW in charge of the area went to make a home visit. The health worker first recorded Sakshi’s body temperature as 36.20 degrees Celsius (97.0 degrees Fahrenheit) and then discussed the condition of the baby with her family members, warning them of the risk of hypothermia.

He asked the mother to try immediately to begin breastfeeding, and he monitored the baby’s temperature every hour. The mother was advised to keep Sakshi in the skin-to-skin contact position as preferred in community-based kangaroo mother care (KMC) for longer durations. On an average the baby was kept for 15 hours daily in this position. The baby was not bathed, but massaged with mustard oil and warmly clothed. The room temperature was kept warm with firewood. Very few people were allowed inside the saur (delivery room). Because the baby was very young, the mother tried feeding her expressed milk using a dropper. In the end, these measures proved to be heroic: using these techniques the community health worker succeeded in saving Sakshi’s life.   

Skin-to-Skin Care Revived Baby

Within 24 hours of delivery, the newborn’s mother was unconscious, and the baby lay shivering with cold. This is what the community health worker (CHW) found upon a routine visit to the home of the newborn baby.

The traditional birth attendant had arrived for the delivery, and after cutting the cord she bathed and wrapped the hypothermic baby in a thin cloth. No arrangements had been made to keep the saur (delivery room) warm, and the baby was extremely cold. The CHW saw the condition and asked the neighbors and other relatives to light a fire and make the bay’s and mother’s room warm. Then she asked them to cover the baby in warm clothes. 

But still, the baby shivered and he began to turn blue.  The CHW asked the new mother’s sister-in-law to administer skin to skin care to the baby—but the sister-in-law said that if the baby was suffering from jamoga (evil eye) the evil spirit would pass on to her as well. For this reason, she refused to cooperate. No one in the village was willing to touch the baby.  This left the CHW with two options: either watch the baby die in front of her or give kangaroo mother care (skin to skin care) to the baby herself.

She chose the second option, although she was apprehensive because she was unmarried and concerned about what people would say. She was in someone else’s house and was not comfortable taking off her clothes to give skin to skin care. She was scared about what her parent’s reaction would be if they found out. But the baby’s condition continued to deteriorate, and she was left with no other option. She held the baby in the proper position for skin to skin care, and after some time the baby showed signs of recovering. His color returned to pinkish, he felt warm, and his body temperature increased. This episode helped to convince the community about the benefits of kangaroo mother care, and they acknowledged their gratitude to the CHW who was determined to save the baby’s life.

New Mother Praises Skin to Skin Care

“I initially doubted that holding the baby against my bare chest would help in milk expression, but because the community health worker said so, I decided to give it a try. We have six children, and with the first four babies, I could express milk only after four to five days, and the babies often fell sick. With my next two babies, I gave kangaroo mother care (skin to skin care), and within four hours of the delivery, I could express milk. So much so, that if I did not feed my babies within three hours, my saree would get wet! These two babies don’t fall sick and we haven’t had to take them to the doctor.”

Thermospot Helped Baby to Live

Within 24 hours of delivery, Meera’s baby was weak, low in birth weight, and cold to the touch. But help was on the way for Meera, an Anganwadi worker in Narayanpur village, and her baby. When the community health worker (CHW) made a visit within those first 24 hoursand found that the baby to be hypothermic, she contacted the JHSPH/Saksham office and a team went to meet the family members of the newborn baby.

The team tested the baby with a thermospot, the results of which were black, indicating that the baby was hypothermic. The temperature of the baby was 32 degrees Celsius (90 degrees Fahrenheit). The team members present asked the other family members to immediately arrange to light a smokeless fire in the saur(delivery room) and cover the baby in warm clothes. They also asked the mother to give skin to skin care to the baby and initiate breastfeeding.

After one hour of skin to skin care, the temperature of the baby increased to 33 degrees Celsius (91.4 degrees Fahrenheit). The mother and the sister-in-law were asked to take special care to ensure that the baby should under no circumstance be exposed. To help the baby gain weight, the mother was advised to begin breastfeeding as soon as possible. When the team of data collectors reached the home, they found that the baby’s temperature was 33.9 degrees Celsius (93 degrees Fahrenheit) and the baby weighed 1.7 kilograms (3.7 pounds). After four days of special monitoring of the temperature using thermospot, the family members were able to understand when the baby had to be kept warm. On the fourth day, the temperature of the baby had gone up to 36.7 degrees Celsius (98 degrees Fahrenheit).

Meera feels that in villages, where awareness level is so low, the practice of skin to skin care and the use of thermospot will prove beneficial to the community. The thermospot will also help mothers monitor the temperature of the baby even if they are unable to read a thermometer. And today, Meera, as an Anganwadi worker and a JHSPH/Saksham volunteer, spreads awareness on essential newborn care in her community.