Helping Children Survive to 5 in Bolivia

Bolivia comes in at number 75 out of 125 countries, ranked according to the overall health and well-being of mothers and children, in this year’s Mothers’ Index in Save the Children's 2006 State of the World's Mothers report.

Why is this country ranked below so many others? Bertha Pooley, the national advisor for Save the Children's newborn health program in Bolivia sheds light on the issue of health care for mothers and newborns below:

Beyond the ranking, what is the situation really like for mothers and newborns in Bolivia?

Bertha Pooley: The newborn death rate is three times higher in the poorest municipalities than in the highest. There is national health care, but the [newborn] population has been neglected because we are just discovering that one of the most important stages of life is the first 28 days.

Before, we were focusing on preventing illness in children over 2 years old, but then we began to discover that 70 percent die before they are 7 days old. Why were these babies dying? They had infections or diarrhea. They lacked vaccinations. They had respiration problems or they were born prematurely.

And the mothers?

Pooley: The relationship between the mothers and babies is very important. The respiratory problems of babies are usually directly related to what happens during labor. Low birthweight is directly affected by the mother’s pregnancy. If we want healthy babies, we have to have healthy mothers.

After the birth, is it true that umbilical cords are sometimes cut by using broken pieces of clay pots and babies are fed tea or urine, instead of breast milk, in their first few days of life.

Pooley: This is very common in Andean culture. The problem with pottery is that sometimes it can infect the cord, so we recommend that they use a new razor blade instead. If they prefer to use a traditional clay pot, we recommend they boil it first, for at least 20 minutes. Some cultures put drops of urine in the newborn’s mouth to cleanse it. It is a mix of religious and cultural customs.

They also delay the feeding of the baby because the first milk - it is called colostrum - is yellowish and many think it is impure. We had to explain to them that this milk was the most important because it’s like a vaccine for the baby. Before, they waited one or two days to breastfeed and would give babies chamomile tea in bottles.

How has this presented challenges to teaching safer care for newborns?

Pooley: We haven’t been teaching. We have been establishing communication with the mothers in the communities to exchange ideas. It is important to have this type of communication because they are going to teach us some things, too.

What is the main message you are trying to get through to mothers and midwives who come to your sessions?

Pooley: It has to do with several very basic things: warm and wrap the baby after delivery, early breastfeeding and delaying the baby’s first bath for 48 hours (because one of the problems that newborns have is they can develop hypothermia). You have to remember La Paz is 14,000 feet above sea level and it gets cold.

For instance, with small or premature babies a method like kangaroo care, where a mother can position the baby to have skin-to-skin contact with her, transmits a warmth between the bodies that can prevent hypothermia. If they have a low temperature, then this method can raise it and the beat of the mother’s heart can give the baby a rhythm for the beat of his or her own heart.

We are not saying that we are going to replace incubators, but it is important to have kangaroo care as an alternative for rural areas.The important message here is that we can save babies with low-tech, accessible methods that we can afford.

It’s amazing that something as simple as a mother’s warmth can save a baby’s life.

Pooley: I think everything is amazing! A baby’s life is amazing; to work with the Bolivian government is amazing; to see that things can get done with little money is amazing. Sometimes it is invisible things that make a difference. This message of saving newborn lives guarantees not only life, but a quality of life for this new generation.

Addressing high rates of newborn and child mortality around the world remains one of the most urgent health issues of our time. Every year, over 9 million children under age 5 die. Incredibly, almost two-thirds of these deaths are caused by easily preventable and treatable illnesses.

The majority of these deaths occur among children living in marginalized and remote areas that lack access to trained health professionals or well-equipped health facilities.

Save the Children is committed to supporting the Bolivian Ministry of Health in delivering proven, existing life-saving health and nutrition interventions to families living in hard-to-reach, remote communities. This important effort requires Save the Children to raise $1.8 million to help implement a five year comprehensive health and nutrition program to children under age 5, women and adolescents. We are pleased to share this overview of our program and invite you to consider pooling resources with the gifts of others to support this project.

BACKGROUND Bolivia suffers from serious health inequities, especially for rural, indigenous children living in small communities ranging from the high Andes to the steamy and flood-prone lowlands of the Amazon. Distance and remoteness contribute to the challenge of providing adequate health services. Approximately half of the rural population lives at least a one hour walk away from the nearest health post and some must walk over ten hours to reach the nearest facility― which may or may not have adequate staff and supplies. Cultural and linguistic differences may also prevent effective treatment.

Save the Children is committed to assisting the Bolivian government in providing effective health care to the youngest and most vulnerable. Our Community Case Management (CCM) strategy reaches children at the village level with early and appropriate treatment for common, yet serious, childhood illnesses. Its simple and cost-effective interventions involve carefully-selected community members who are trained to assess, classify and treat children with signs of infection; the local Ministry of Health which is strengthened to support, supply and supervise community-based workers; and families who are trained to recognize and seek care for signs that indicate serious disease.

PROJECT IMPLEMENTATION In order to attain the long-term objective of reducing illness and preventing maternal and child mortality in Bolivia, Save the Children has prioritized the following strategies: -Promote evidence-based models and strategies -Strengthen health systems -Promote healthy practices at community level -Advocate for improved funding and policies

Measures of Success: At the end of the pilot program, we expect to have: -Established agreements with local authorities to expand methodologies -Adapted methodologies to local contexts -Trained community health promoters (volunteers) -Trained local health workers in support of community health promoters -Supported mid-level Ministry of Health workers in supervision of the above mentioned processes -Supported central level Ministry of Health workers with print material, editing and mainstreaming activities. -Developed Communication strategies with multi-media health messaging campaign -Signed agreements with national, departmental, municipal and community authorities -Developed advocacy strategy for Community Case Management

In the communities covered by this program, children under five (at least 8,000), women of reproductive age (at least 12,000) and adolescents 10-19 years (8,000) will directly benefit each year from improved access and quality of services. The program impact will be further expanded by reaching the following indirect beneficiaries: 10.000 older children; 100 health staff; 400 teachers, and 200 community leaders.