BY Abiose Adelaja- Adams
Imagine a warehouse full of 240,000 brown boxes/ cartons arranged in rows of ten. This time, the boxes are not full of some frozen fish or biscuits for sale; however, they are full of asphyxiated, ice-cold babies, graveyard bound. Tragically, 240,000 is the scary number of premature babies that die on the average yearly, in Nigeria.
It is no big news that the list of incubator donations across several teaching hospitals is lengthening. For instance, on the 13th of July, 2017, the Heineken Foundation donated eight incubators for preterm babies to the Lagos University Teaching Hospital, LUTH. In 2016, Sterling Bank donated two modern infant incubators to the University of Uyo Teaching Hospital in Akwa Ibom State. In same year, the Bill and Melinda Gates Foundation, through its Barnard Research project, donated eight units of infant incubators to the Murtala Specialist Hospital in Kano.
In 2014, the UBA Foundation did same for several teaching hospitals across the country. In 2011, Sapphire Crest Youth Foundation donated four brand new incubators also to LUTH.
“Despite all these donations, the numbers of incubators in the hospitals are never enough compared to the birth of preterm babies,” Dr. Zainab Imam, a Neonatologist at the Massey Street Children’s Hospital, Lagos, who spoke exclusively to CITY VOICE says. “In 2005-2006, we had 1,363 preterm births. And that is in one center.”
Dr Imam adds that there are about 19-20 of such babies referred to the hospital in a month.
At LUTH, the head of Neonatology, Professor Chinyere Ezeaka says over 400 preterm babies are referred to the unit every month. A preterm baby is one born alive but before 37 weeks of pregnancy are completed.
Since such babies are born too soon; they come with underdeveloped lungs, digestive and immune systems, and thin body fat that pre-dispose them to easy deaths or life-long disabilities. Estimates by the UN Inter-agency Group for Child Mortality shows that preterm births account for 31 per cent of newborn deaths, while deaths of newborns represent a quarter of the total number of deaths of children under-five.
According to UNICEF, Nigeria loses 2,300 children under five years every single day.
Tragedy for families
Beneath these statistics lie real agony for families. Mr and Mrs Peterson are one brave couple ready to share their experience.
Mrs Peterson, a 39-year-old Caterer, took in with a set of twins after been married for 10 years.
“Around 34 weeks of pregnancy, she started complaining of abdominal cramps. We started seeing some watery, bloody discharge, around 11:50pm,” says her husband, a teacher, who sat on the brown couch in their small parlour.
She was rushed to the hospital around our area on Iponri.
‘’I was surprised when I was told I was in labour,” she said. “Few hours later I was delivered of a set of twins. Male.”
Their joy was overflowing until they were referred to LUTH.
“We were told the babies were premature. The one I carried weighed 1.4kg while the one my husband carried, 1.6kg,” she said.
They needed an incubator, the doctor said with an urgency enough to convey imminent danger.
Troubled, she and her husband began looking for a taxi. In the meantime, the nurses wrapped the babies airtight.
“By the time we got a taxi, it was 4:30am. We arrived at LUTH 5am. While we rushed to the Emergency ward flashing the referral letter to the attendant, I noticed that the baby I carried had suddenly become icy. Distracted by the coldness, I became incoherent in explaining why I came. The letter said it all,” she said sniffing.
” When I noticed she was stammering and frightened I became the spokesperson and marched to the neonatal ward,” the husband said. “We were told the incubators were occupied. So we proceeded to a private hospital.’’
Mrs Peterson said: “All the while I wouldn’t accept the reality that the baby was still. Not after 10 years of prayer, fasting and numerous fertility tests. I sang for him, kept pinching him with the hope he would cry. But as we got into another taxi, I didn’t know when I broke into tears over my husband’s shoulders.
“When I heard her say, ‘he is dead, he is dead,’ I said it’s not possible in Jesus name. Let’s see the doctor to certify him,” the husband said. ‘’We got down from the cab and went back into the hospital. The doctor asked the nurse to bring an empty carton of indomie. My wife rolled on the floor, I held and patted her. Our only assurance was in God and that the second baby was still breathing. The first was wrapped and packed into the cartoon.”
When they got to the private hospital, they were asked to pay N60,000 deposit. They begged them with N20,000, but the clinic would not budge. There were parents of other babies willing to pay that amount.
Desperation, rage and despondency ensued. They left. A family member directed them to Massey Street Children’s Hospital. On getting there, they were given an incubator.
“For five days, I was beside him watching every day. I expressed my milk because he cannot suck. But one morning I came into the ward after bath and met the neonatal nurses head bowed, shoulder sagged. I asked them what happened looking at the incubator where my baby used to sleep, now empty. I initially thought they wanted to give him my expressed breast milk.
‘’One of the nurses looked at me and said he was dead. From whimpering to sobbing and suddenly an outburst of wail rent the air. I was quickly rushed out of the room lest I startle other babies.”
And that was it! A decade of anxiously waiting on the Lord, of visiting specialists, of enduring stigma from family and in laws, went up in the smoke of insufficient incubators for her two pre-term babies!
When there is no incubator
Looking through the Nigeria Health budget for 2016, there is no specific provision for such equipment as baby incubator. One may however assume it is lumped under the capital project to provide ‘Medical Equipment.’’
Under the budget for the LUTH, a sum of N82,200,000 was allocated for this purpose. At Ahmadu Bello University Teaching Hospital, Zaria, N43million was allocated for the same purpose. University of Benin Teaching Hospital allocated N141million, University of Calabar, Teaching Hospital- N22million, University of Abuja Teaching Hospital allocated the highest, with N229 million.
It is not however certain exactly from how much of these will go into purchase or maintenance of incubators. The going rate for an incubator at this time of reporting ranges from $1000-$5500. That is approximately N500,000 by the current dollar rate.
The Chief Medical Director of LUTH says the institution has the highest number of incubators in the country – 40. Dr. Imam of Massey Hospital says the hospital has about 10, while it owns another 10 at the Island Maternity Hospital, Lagos. As at 2013, UNIBEN teaching Hospital has 24. Only one was spotted at the General Hospital Ijede, Ikorodu.
In the wake of this insufficiency, which had been found to be a big contributory factor to neonatal deaths and child mortality on the whole, Dr. Imam says one of the ways to address the situation is through the kangaroo method of motherhood.
“This will help us give those babies who are more stable a chance to live. Survival depends on how preterm a baby is. In Nigeria, if the baby is below seven months, they have a survival rate of 25 per cent. That is one in every four. Sometimes all four brought in may even die – especially those ones who weigh 1kg and below. But if above seven months, they have a higher chance of survival. At Massey we don’t turn them back. It will be wickedness to do so. We use our discretion, something like co-bedding. We move the more stable preterm babies from the incubator to create rooms for the ones more at risk. And that’s why we are adopting the kangaroo mother method in which the babies can be put in a pouch next to the mothers’ skin.
A pouch is provided where the skin-to-skin contact between mother’s chest and baby’s front is enhanced continuous day and night. Experts say this direct warmth from the mother helps the babies to regulate their temperature. The baby can also latch onto the breast directly for those that can suck.
Prevention of preterm births
On prevention, Dr. Imam says; ” No woman gets pregnant and wants to give birth to preterm, but there are certain factors that contribute, while some is beyond the woman’s control.
“For instance, if a woman develops hypertension in pregnancy, we just have to keep monitoring such a woman to keep it controlled and that is why we encourage women to attend their antenal clinic regularly so the doctor can spot such dangers ahead.”
Other factors, as reported by the WHO, are teen pregnancy or if a woman is older than 35; domestic violence that results in premature labour, multiple pregnancy, use of illegal drugs, smoking and certain birth control methods.