Dili: Amelia Da Cruz, a 48-year-old midwife, now feels significantly more confident in caring for sick newborns. She recently completed the World Health Organization’s Essential Newborn Care Course training at Hospital Nacional Guido Valadares (HNGV). The training covered essential aspects of newborn care, such as immediate care at birth, resuscitation, breastfeeding, keeping the baby warm, preventing infections, and identifying/responding to warning signs, and aimed at equipping healthcare workers like Amelia with the necessary skills and knowledge to offer optimal care during the critical early days of a baby's life.
“Previously, I had to seek help from others to assemble an ambu bag,” said Amelia. “But now, I can assemble it myself and administer it in case of an emergency”. The Bag Valve Mask (BVM), commonly known as ambu bag, is used to provide respiratory support to patients.
Amelia also emphasized her recent knowledge of the correct measurements for the suction tube and the appropriate pressure when a newborn is aspirating. “On average, we handle 8-10 deliveries in an eight-hour shift, encountering emergency scenarios among sick newborns almost every second day,” said Amelia, adding that nothing impacts her more than losing a baby under her care.
Timor-Leste's Neonatal Mortality Rate (NMR), which looks at infant deaths in the first 28 days, is 22 per 1000 live births, while the Under Five Mortality Rate is 41 per 1000 live births, as per 2016 data. Despite advancements in maternal and child health over the years, concentrated efforts to protect the well-being of pregnant women and newborns are critical for the country.
Recognizing this, WHO partnered with the Ministry of Health and HNGV to introduce the new and updated Essential Newborn Care Course in October 2023. The sessions were led by international experts from WHO and other independent experts who trained doctors, nurses, and midwives in various aspects of essential care, including classifying the baby, recording weight and temperature, umbilical cord care, and skin-to-skin contact.
During the training, the experts identified six master trainers, to conduct further training sessions. In December 2023, under the supervision of an international expert, this first batch of Timorese master trainers rolled out the course to staff from maternity and emergency departments at HNGV.
There were many nuances that we were not paying close attention to while handling sick babies,” said Luisa Marcal da Jesus (46), a midwife and one of the master trainers. “For example, when we administered ventilation through bagging, we rarely paid attention to counting the seconds, checking the position of the mask, or understanding the pulse and rhythm. We would just do it randomly,” Luisa said.
She cited an example of a 5-day-old baby who started aspirating and was breathless. A group of healthcare workers who had undergone the first ENCC training in October quickly came together to ensure that the suction to extract the mucus was done accurately as taught to them. “We were taught that the depth of the suction tube should be no more than one centimeter in the nose or three centimeters in the mouth,” said Luisa, adding that the team successfully stabilized the baby.
Timor-Leste continues to grapple with a low institutional delivery rate and poor antenatal care follow-ups, contributing to poor maternal and child health outcomes. Nearly half of the childbirths take place at home, posing a substantial risk to the mother and child due to a lack of access to skilled care in case of complications such as post-partum hemorrhage, eclampsia, sepsis, among others. The country’s Minister of Health Dr. Élia A.A. dos Reis Amaral has prioritized strengthening maternal and newborn care, providing the necessary momentum and focus to these programs.
“Access to skilled care during institutional deliveries is also a crucial need,” said Dr. Arvind Mathur, WHO Representative to Timor-Leste. “The rollout of WHO’s updated ENCC training modules is aimed at enhancing the skills of healthcare workers across the country so that sick newborns are identified, and accurate interventions are made within the golden hour.”