LDS Physicians Helping Babies Breathe

  By Howard Collett, LDS Philanthropies

  • 16 January 2014

Dr. Michael Visick presents a gift to Dr. Wirastari Marnoto at the Helping Babies Breathe graduation of the first class of midwives in Bandung, Indonesia. A total of 600 midwives will be trained during the next six months.  Photo by Howard Collett, LDS Philanthropies.

Article Highlights

  • Volunteers from the U.S. traveled to West Java, Indonesia, to train local physicians in newborn resuscitation.
  • Following the “train the trainer” model, Indonesian physicians plan to train 600 midwives within six months.
  • The training program is tailored for circumstances with limited resources because only 30 percent of births in West Java take place in a medical facility.

“LDS Charities helps by providing a professional team, equipment, and assistance so we can administer ongoing training. … As midwives gain a new level of skills, they can share that knowledge with others.” —Dr. Nani Dharmasetiawani, assistant director of training for Perinasia

It’s a much-needed approach to saving newborn babies—two volunteer physicians and a registered nurse journey from the United States to Bandung, Indonesia, to train 20 local physicians in newborn resuscitation. But what difference can they possibly make when an overwhelming 900,000 babies die each year because they can’t breathe at birth?

The difference comes when three trainers train 20 who in turn train 600 more.

“There are 21 million people in West Java,” said Dr. Reby Kusumajaya, a pediatrician from Cicalengka Hospital in Bandung. “Most baby care in Indonesia is done by midwives. Their confidence is low due to limited training and resources. Volunteers from LDS Charities help change that by introducing proper procedures and training with the instruments they provide.”

“Our trained volunteers work side by side with local physicians and nurses,” said Dean Walker, manager of neonatal resuscitation training for LDS Charities. “They in turn train local midwives to provide lifesaving skills. This program becomes their program.”

LDS Charities is a recognized innovator of the “train the trainer” approach to neonatal resuscitation training. In Indonesia, a portion of that training, called Helping Babies Breathe (HBB), is being introduced for the first time. While more advanced training focuses primarily on physicians in a hospital setting, HBB focuses on midwives in a clinic or rural setting. Each year, LDS Charities presents about 40 such training programs around the world.

Training midwives is not a new concept for the humanitarian effort of The Church of Jesus Christ of Latter-day Saints.

“Our first effort began more than 140 years ago,” said Sharon Eubank, director of LDS Charities and a former member of the Relief Society general board. “In 1873, Brigham Young and Eliza R. Snow recognized that too many babies born to pioneer Saints were dying. They determined to send several women to attend medical school in Philadelphia. Returning as doctors, they trained 500 local midwives. The result was a dramatic drop in death and suffering as they and those they trained put their medical knowledge to use” (see sidebar “Helping Then, Helping Now”).

Partners make it happen. In every humanitarian program in which it is involved, LDS Charities works with local partners who have demonstrated staying power. In Indonesia, that partner is Perinasia. An organization of neonatologists, obstetricians, and pediatricians, Perinasia has a 16-year history of effectively training medical professionals in Indonesia in neonatal resuscitation.

The Perinasia partnership with LDS Charities began in Jakarta in 1997 and has evolved into an effective and self-sustaining model. To date, Perinasia has trained more than 11,000 doctors and nurses. Perinasia and LDS Charities have recently added the HBB program to involve midwives.

“LDS Charities helps by providing a professional team, equipment, and assistance so we can administer ongoing training,” said Dr. Nani Dharmasetiawani, assistant director of training for Perinasia. “We can customize the training they offer to our program and conditions. As midwives gain a new level of skills, they can share that knowledge with others.”

“LDS Charities has projects all over the world in societies with conditions similar to West Java,” said Sister Eubank. “Government officials and professionals are seeking to get their infant mortality rate down. We know how to help. It’s in our experience as a charity. It’s part of our Church history. It’s in our DNA.”

Dr. Michael Visick of Logan, Utah, oversees an individual practical examination of skills learned by midwives. Photo by Howard Collett, LDS Philanthropies.

The Helping Babies Breathe curriculum is tailored for circumstances where resources are limited. That’s important because in West Java, it’s estimated that only 30 percent of births take place in a medical facility. And one in four newborns who die are not breathing at birth.

“I have seen three babies die that could have been helped with this training,” said N. Uli Istiqoma, a midwife in a Bandung healthcare center. “Now I have the confidence to help babies like those in the future. The emergency plan I learned will decrease the mortality rate. I also received good equipment that I can use to help my friends learn too.”

HBB was developed by the American Academy of Pediatrics with input from the World Health Organization and other partners including LDS Charities. It is supported with low-cost medical devices and curriculum from the Laerdal Foundation. The program emphasizes skilled attendance at birth, assessment of every baby, temperature support, stimulation to breathe, and assisted ventilation as needed, all within the “golden minute” after birth.

“HBB has produced exciting results for a program that’s only been out for three years,” said Dr. Michael Visick. Dr. Visick is an LDS Charities short-term specialist from Logan, Utah, who was assigned to the HBB project in Bandung. “Published results in Tanzania show that in three years HBB reduced the infant mortality rate by 47 percent. That’s huge. We’re hoping to see similar results in other countries.”

“I find nothing more gratifying than placing a new baby in a mother’s arms,” said Carolyn Leifer, a registered nurse from Highland, Utah. “I’ve learned from my volunteer experience that we are all children of our Heavenly Father. When we recognize that, we realize that culture does not matter—we’re more alike than we are different. No matter where you go, every mother loves her baby.”

Dr. Dennis Hughes, a retired obstetrician from Salt Lake City, Utah, was medical director for the HBB program in Bandung. Highly experienced, he has served as a specialist in neonatal resuscitation training for three years on four continents. He outlined how a training program gets approved.

“Once an Area Presidency determines a location, technical specialists such as my wife and I are assigned to a project,” said Dr. Hughes. “We contact the humanitarian missionaries and other officials in a country to learn what’s been done in the past. “Then we’ll visit government health officials and talk about benefits and requirements of the NRT or HBB program. We find out what is wanted and the specific location of greatest need.”

Dr. Reby Kusumajaya, a pediatrician from Cicalengka Hospital in Brandung, reviews possible scenarios and life-saving actions with Indonesian midwives. Photo by Howard Collett, LDS Philanthropies.

Once LDS Charities is connected with the ministry of health, the next step is to arrange the logistics of the training. “We want to identify and work with a champion,” said Dr. Hughes. “It may be a local physician or official who is passionate about NRT and who will make sure the results are realized.”

Finally, a detailed project plan is written and submitted to Church headquarters for approval. Then the training, follow-up, and evaluation are implemented.

Dr. Visick, Carolyn Leifer, and Dr. Hughes comprised the LDS Charities medical team in Bandung. Liz Visick and two humanitarian missionaries—Elder Lonnie and Sister Mary Lucherini from Preston, Idaho—oversaw administrative details. The doctors and nurse trained 16 Indonesian doctors and four midwives. In turn, the Indonesians trained 60 midwives in four days. Following this “train the trainer” model, 600 midwives in West Java will be trained in just six months.

HBB training began with a pretest to assess the current knowledge of each midwife. Demonstrations on specific techniques are followed by practical, hands-on experience with baby simulators. At the end of the training, both practical and written examinations were given. Finally, each participant received a certificate of completion.

“When we finished the training in Bandung, we told all 60 midwives that they were going to receive their own ventilator bag and mask, suction device, and stethoscope for their own deliveries,” said Dr. Visick. “Everyone cheered and clapped. These midwives are doing home deliveries and do not have their own equipment to resuscitate babies. They were very excited to hear that they would receive this equipment.”

The experience reminded Dr. Visick how he and his wife feel when they donate just $50 to the Church Humanitarian Fund, which finances LDS Charities.

“That contribution buys two kits and equips two midwives with everything they need to resuscitate babies,” he said. “They may not need it every month, but they’ll be ready when they do. Most have worked for 10 or 15 years and have never been able to help babies in respiratory distress. When they cheered at receiving equipment, inside we were cheering too. We were touched to know our little sacrifice will make a big difference in their lives.”

Last year, LDS Charities trained hundreds of doctors and nurses who, in turn, trained thousands more in 40 countries. A total of 28,000 were trained. If each person trained saved the lives of only two babies during their career, the number of lives saved and families blessed would exceed 50,000.

Funds for HBB training come from individual donations to the LDS Humanitarian Fund, through LDS Philanthropies, and from partner organizations in each country. None of the LDS Charities trainers or participants is paid for his or her involvement.

The program has a far-reaching impact in Indonesia. If each of the 600 midwives trained in the Bandung program saves only two babies in her entire career due to HBB training, the average cost is only $54 per baby. That’s a significant return on investment—both for the donor and for the family who celebrates a new life at home.

“This program has a special place in my heart,” said Liz Visick. “Our daughter needed assistance when she was born. Now we are training people to provide the kind of assistance she needed. My daughter is an incredible person and I have now had 18 years with her. Eighteen years from now, many mothers in West Java will feel the same joy I feel today.”

“Indonesia is not the only place to serve, and HBB is not the only way to serve,” said Dr. Visick. “But it’s one way that we can serve. It’s one way to use the skills Heavenly Father has given us—whether it be logistical skills, resuscitation skills, or language skills. It’s one way we can reach across the globe and make a difference. It’s a chance to lift burdens. It’s one way to stand in the stead of the Savior to help relieve the suffering of others.”

To donate to the NRT initiative at LDS Charities, please visit give.lds.org and click on the LDS Charities link on the left. Then select the Neonatal Resuscitation Training link. One hundred percent of contributions will help fund future NRT initiatives around the world without regard to race, religion, or ethnic origin.