Simple saves lives

By Emma Attwell

I’m at a technology conference, surrounded by extraordinary gadgets doing amazing things. Among the latest mobile phones, smart washing machines and eco-friendly fridges, there’s also a solar-powered internet classroom and, my favourite, a solar-powered mobile health clinic kitted out to test hearing, sight and blood. Driving through Africa in one of those was my childhood dream and I must say, it still appeals. But is that really what Africa needs most?

We live in one of just a few countries in the world with a rising under five mortality rate, 40% of these children die in the first month of life. Yet, saving these lives isn’t complicated. It doesn’t need a solar-powered mobile clinic. It doesn’t require expensive equipment or a radical increase in human resources.

All it requires is simple innovation and the knowledge to put it to use. For the tiniest babies to survive, only three things are really needed to save most: a small dose of surfactant, CPAP oxygen, and to be nursed skin-to-skin on her parent’s chest. That’s it. It’s not hard. It’s not rocket science.

So why isn’t it happening? My guess is that people just don’t know.

Vanessa Booysen heads up the Maternal and Child Health Unit in the Free State. It’s the province with South Africa’s worst neonatal mortality statistics and it’s her job to turn it around. It’s a daunting task. But she hasn’t gone all out for new technology or sweeping changes to human resources. She’s gone for the three things that can make the biggest impact in the shortest time. And she’s gone all out to make sure her people know how to use them. She’s doing that with PEP.

PEP stands for the Perinatal Education Programme. PEP started in the early 90s to address the continuous training of nurses, midwives and doctors in South Africa. It focuses on getting the basics right and has been proven to improve knowledge, skills and patient care.

With traditional methods of training, nurses leave their posts to attend training workshops at large, centralised teaching hospitals. It’s an expensive way to train: hiring venues, paying for transport and accommodation, the cost of facilitators, but it’s still popular.

PEP is different. PEP gives nurses a way to manage their own learning, to develop their knowledge and skills on the job and at their own pace. PEP encourages peer learning and skills transfer by creating communities of learning in the workplace, with everyone moving forward together. It doesn’t cost more than one book per participant.

It seems ridiculous that something so simple should work. It seems as ridiculous as the idea that laying a baby skin to skin on her mother’s chest could be better than an incubator. As humans, we want to do things. We think big problems need big solutions. Complicated, technology-laden approaches are appealing because they make us feel like we’re really doing something. And when we feel powerless, in the face of appalling child and infant mortality or any other pressing social problem, we want to get the big guns out. It makes us feel better, but it doesn’t necessarily get the job done.

It takes a certain kind of humility and courage to make the small change that will make a big difference. It means setting aside our own hubris, our own blind faith in technology, our own conviction that bigger is always better. It means looking for the tiniest step instead of the biggest leap, because that’s the snowflake that will become an avalanche.

Emma Attwell is publisher at Bettercare. She has a background in psychology and social work, and has been actively engaged with South African healthcare as a social worker, parent, patient and activist for over 10 years. She has worked in book publishing for many years as a writer, editor and publisher.