Research Project Provides Essential Neonatal Resuscitation Education for Resource-Limited Environments

For the last year, Kathryn Taylor (Ohio State B.S. ’12; Harvard M.D. ’17) has been training Shoulder to Shoulder’s physicians, nurses, and local midwives how to save babies’ lives. Based at our Santa Lucia clinic, Kathryn has trained and evaluated our staff for basic neonatal resuscitation techniques as part of a study of Helping Babies Breathe, a joint program of the WHO, Save the Children, and the American Academy of Pediatrics. She teaches a curriculum designed for developing countries in limited resource environments.
Approximately 23% of neonatal deaths worldwide are due to asphyxiation. Helping Babies Breathe was developed on the premise that all babies deserve simple neonatal care, regardless of resources. It focuses on improving outcomes in the neonatal period and reducing birth asphyxia. Each year, an estimated 10 million babies require breathing assistance. However, only one to two percent of babies require advanced care. In hospital-based settings in the rural departments of Honduras, including Intibucá, the neonatal death rate is 46.9 deaths per 1000 live births. In the United States, there are four deaths per 1000 live births.
The course is taught at a fifth grade reading level, and focuses more on facilitation than traditional education – utilizing interaction and practice in pairs. Training partners learn to have a plan and materials in place at the time of delivery, to recognize whether a baby is breathing, and operating under time and pressure constraints in order to have a baby breathing in under a minute.
Kathryn has attended and filmed 78 births at the Santa Lucia clinic. She meets with the labor and delivery team following each birth and leads a debriefing. They review the video and find ways to improve.  Kathryn will be spending her final month implementing the program at the main regional hospital in La Esperanza prior to beginning medical school in the fall. Srirama Josyula (Ohio State B.S. ’13; Ohio State M.D. ’18) will continue with the program in Santa Lucia and La Esperanza.

National Vaccination Campaign

Between April 22 and May 3, we vaccinated every scheduled child, elderly adult, and high risk individual for measles, rubella, diphtheria, pertussis (whooping cough), polio, pneumonia, rotavirus, hepatitis B, and Vitamin A.
We are still compiling the final numbers for Concepción (pop: 10,758) and San Marcos de la Sierra (pop: 9,085). Here are our stats for the municipalities of Santa Lucia (pop: 5,527), San Antonio (pop: 5,606), and Magdalena (pop: 4,815):
• Vitamin A supplements – children four and under: 420
• Tetanus – 11 year olds: 327; other groups: 80
• Diphtheria, pertussis, tetanus, hepatitis B, influenza – under 12 months: 41
• Diphtheria, pertussis, tetanus boosters – 18 months: 11; four year olds: 33
• Measles, mumps, rubella – 12-23 month olds: 16
• Rotavirus – 28
• Pneumococcal – under 12 months: 41
• Polio – under 12 months: 52
• Tuberculosis  –  under 12 months: 18
Pneumococcal vaccines were also provided for high-risk patients, including elderly, asthmatic, diabetic, hypertensives and patients with chronic pneumonia.
• High-risk aged 2-59: 625 scheduled, 637 reached (102%)
• Elderly aged 60 and over: 260 scheduled, 298 reached (115%)
Overall, it was a very successful campaign, part of the national vaccination campaign. These vaccinations help prevent the spread of disease and ensure the continued health of our community members.
For more photos from the vaccination campaign, check our Facebook page.

A Word on Brigades

In November 2012, the U.S. State Department issued a travel warning for parts of Honduras, including the states where Tegucigalpa and San Pedro Sula are located. Intibucá was not named in the travel warning.
On February 19, 2013, U.S. Ambassador to Honduras Lisa Kubiske tweeted: “Proud to meet the Public Health Brigade from my alma mater Brandeis. Look forward to seeing more volunteer groups soon.” How should we react when the State Department issues a travel warning, but the Ambassador encourages brigades to come to Honduras?
Honduras is certainly not without its problems. For generations, there have been problems with political instability, corruption, and violence. Over the last two decades, the country has seen a rise in drug and human trafficking. For the most part, Intibucá has avoided much of the violence associated with Tegucigalpa, San Pedro Sula, and the North Coast. Intibucá has problems, but currently they are largely limited to alcohol, ongoing family or business disputes, and domestic violence.
The safety of brigades visiting Shoulder to Shoulder remains our number one concern. As a result of the travel warning, we decided to temporarily suspend certain brigades, including less established brigades and certain undergraduate programs.
Brigades associated with Shoulder to Shoulder are subject to rigorous safety checks, including undergoing safety training and passing a test prior to visiting Honduras. When the brigades are away from our service areas, they stay in secure hotels and are supervised by both US- and Honduras-based brigade coordinators.
In our 23-year history, we have never had a violent incident involving a brigade member. Still, we remain vigilant with our brigade members. The brigades sleep securely in one of our two CMI clinics or one of our three affiliate clinics. Fieldwork is performed under the supervision of our Honduran doctors and nurses or American brigade leaders.
We recognize that brigades play a central role in the education of both US and Honduran practitioners, and have formed the basis for many a practitioner’s desire to volunteer, contribute, or practice in needy areas worldwide. Brigade alumni remain our most vocal advocates.
Honduras, the United States, and Shoulder to Shoulder remain committed to fostering individual development in a safe environment. For more information regarding our brigades, please e-mail Scott Reinstein at scott@shouldertoshoulder.org.