As a paediatrician and head of the Department of Paediatrics at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi, my focus is improving care for newborns and children in our hospital and supporting the referring districts. My colleagues and I remain committed to caring for small and sick newborns during the COVID-19 pandemic despite the additional challenges it presents.
In March 2020, global healthcare partners in Malawi began responding to COVID-19 by recalling their staffs and doctors to their home countries. These were huge shifts in staffing—losing eight doctors (more than half our staff) at once in any healthcare facility is a significant undertaking with enormous challenges. The shift largely affected HIV and emergency care efforts, with minor disruptions to neonatal wards. Then nursing staff and junior workers became scarce due to restrictions and difficulties traveling. This situation was worsened by protests on lack of adequate Personal Protective Equipment (PPE) and a demand of better medical risk allowance.
What stood out for the newborn intensive care unit (NICU) at KCH—and has made it more successful than other departments in weathering the current staffing challenges—is the importance our department had placed prior to COVID-19 on establishing a team of local healthcare workers.
Being part of the Newborn Essential Solutions & Technologies (NEST360°) program—which focuses on local sustainability, capacity-building, and training of local staff and professionals in its approach to improve care for small and sick newborns—means that we experienced less disruption to our NICU staffing. Of course, we still experience some staffing shortages. In the period when junior staff were unable to make it to the unit, our senior team members and the matrons jumped in to cover the workload. Our efforts over the years to build sustainability has put us on a better footing during this crisis.
Changes in the NICU for infection prevention & control
We see positive changes in our facilities as our staff continues to focus on our main purpose: to improve care for small and sick newborns.
Measures for infection prevention have taken on new importance during the pandemic. We are seeing success in health education on handwashing and hygiene and facilities improvements to support water and sanitation needs.
COVID-19 distancing measures have led to a new urgency in meeting our needs for more space for the NICUs. Where we normally have over 100 neonates in one ward, we have been able to get more hospital space for the NICU, allowing more space per patient.
To reduce infection risks, a hospital-wide policy is in place to limit the number of people in the wards. While such policies were in place before COVID-19, the COVID-19 response made these efforts more successful. Having fewer people in the hospital helps us control infections and provides more space for the healthcare workers and the neonates within the ward.
Training, protocols & guidelines for COVID treatment in the newborn
Practical approaches to improving care for small and sick newborns within the framework of a COVID-19 response include training, updating protocols, and establishing guidelines for COVID-19 care within our NICUs.
KCH launched a special team to develop a plan and materials to train our staff locally on the hospital’s guidelines for COVID-19 and the associated new procedures for the NICU.
Because COVID presents like pneumonias, we offer refresher training to staff on the best practices for infection prevention and breathing support informed by COVID-19 experiences in NICUs around the world. These training sessions do not teach any new skills but give confidence to our staff and medical professionals in their paediatric protocols.
We reevaluate all our protocols to weigh patient outcomes and safety risks for healthcare workers. We are identifying best practices before a pandemic surge, so staff know how to proceed and remain safe on their job.
Continuing to Develop Our Response
Total hospital admissions declined with the arrival of COVID. However, we are seeing more complicated paediatric cases. The assumption is that people stay home and delay seeking treatment until they can no longer manage. With more complicated cases, we rely on staffing, training, and equipment, including breathing assistance received through our NEST360° partnership.
We believe that the decline in admissions is temporary, as people have developed a significant amount of trust in our hospital based NICU care. I believe that the trust remains, and people will return to our hospital for newborn and maternal care once COVID-19 is under control. I am proud of our staff and medical professionals for developing this trust by improving care for small and sick newborns—their skills and professionalism will help see us through.
About the author :
Msandeni Chiume Kayuni is the Paediatrician & Head of the Department of Paediatrics at Kamuzu Central Hospital in Lilongwe, Malawi
Competing interest: The author declares no competing interest.