Putting Infants and Families First in Nepal District Hospital

Published on July 2, 2024

By Dr. Sajal Twanabasu, Dhading District Hospital, Nepal; Dr. Neena Khadka and Daniel Sweeney, MOMENTUM Country and Global Leadership

Patali Maya Chepang, a 35-year-old mother from Nepal, delivered her first-born baby at 33 weeks when her water broke unexpectedly.

Her daughter, weighing just 2.6 pounds, was referred to the Special Newborn Care Unit (SNCU) at Dhading District Hospital in Nepal’s Bagmati province by her local health facility.

Patali poses for a photo with her baby. Photo Credit: Dr. Sajal Twanabasu

Patali and her baby were admitted to the hospital and received care immediately. Much to Patali’s surprise, she was able to stay with the baby inside the SNCU, breastfeed, and provide skin-to-skin care for her little one.

“When the nurses in the hospital told me that my baby needs to be admitted to the SNCU, I thought I will only be allowed to peek at my baby through doors. But it is quite the opposite here,” said Patali. “I was allowed to touch my daughter, feed her, and feel her. It felt magical when I held my mouse-sized baby onto my skin.”

Patali benefitted from recent infant- and family-centered care changes made in Dhading Hospital’s SNCU thanks to Dr. Sajal Twanabasu, a pediatrician who was posted at the hospital. In August 2023, Dr. Sajal was one of 27 health professionals in Nepal who attended a training led by the Ministry of Health’s Family Welfare Division and supported by MOMENTUM Country and Global Leadership to pilot the Infant and Family-Centered Developmental Care (IFCDC) Hospital to Home (H2H) modules. Considered a highly innovative and effective method that emphasizes empowering families to better care for small and sick newborns, IFCDC-H2H puts newborns and families at the center of the care team and ensures infants are not separated from their families.

The training Dr. Sajal received demystified IFCDC and inspired him to advocate for and implement these practices in Dhading Hospital’s SNCU. This model of care has created a partnership with parents.  It allows parents to be involved in caregiving for their babies, with roles in their baby’s care. Parents feel valued and useful as they engage in caring for their small and sick babies in the SNCU.  Health workers in turn feel supported by parents and have more time to focus on specialized medical tasks, leading to overall reduction in stress.

“The workshop was a thought-provoking one,” said Dr. Sajal. “I became a firm advocate of developmentally supportive, infant and family-centered care.” Through Dr. Sajal’s effective advocacy, many elements of IFCDC were integrated into the hospital’s SNCU.

Health workers in Dhading Hospital’s SNCU now start their day by orienting parents, teaching them about proper handwashing, handling and feeding their small or sick babies, recognizing and responding to baby cues, and identifying danger signs. Guardians can now stay inside the SNCU all the time, providing routine care for their newborns independently, under the close supervision of health workers. Information regarding IFCDC is now displayed at Dhading Hospital in the Nepali language.

“Initially, there was hesitation in adopting this new concept,” says Dr. Sajal. “One of the health professionals stated that a concept like this could only be implemented in Western countries.” Some health professionals were skeptical about IFCDC, fearing it could lead to sepsis outbreaks or lower service standards. However, as the practice became more common, acceptance grew, and positive outcomes were observed. Two nurses on the unit even shared their experience implementing IFCDC during their continuous nursing education course. Dr. Sajal is now studying the impact of these changes on the duration of hospital stays for preterm babies.

A health worker posts information on IFCSDC in Dhading Hospital. Photo Credit: Dr. Sajal Twanabasu

Despite challenges such as overcrowding in the SNCU, the hospital continues to manage and overcome these issues. Later in 2024, MOMENTUM plans to release the full IFCDC-H2H modules for public access to benefit more families globally.

“We believe in small steps at a time, and we will definitely reach the destination one day,” says Dr. Sajal.

“It really is a loving hug,” says Patali. “Initially, I doubted that my baby would survive, but now I am confident she will make it. I am very happy.”

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