By Deborah Ziff Soriano
From the time she began leading medical teams at a clinic in Haiti in 2006, UIC Clinical Associate Professor of Nursing and Pediatric Nurse Practitioner Susan Walsh DNP ’14, MS ’00, BSN ’80 has noticed a disturbing trend.
Newborns developed infections – sometimes fatal – from traditional umbilical cord practices. These practices involve covering the end of the cord with fabric ties and substances, such as grasses, ashes or even animal feces. Passed down from generation to generation as a method of protecting the baby, these actions instead introduce germs and cause infection.
Walsh set out to study the issue in partnership with Global Health Action, a nonprofit organization that has worked in Haiti since 1982. Together, they conducted a community campaign with pregnant women and lobbied the Haitian Ministry of Health. Health to obtain permission to bring in potentially life-saving drugs. in Haiti.
This years-long effort paid off in late 2021 when the Haitian government officially added 7.1% chlorhexidine digluconate – a topical antiseptic shown to reduce local infection of the cord stump – to the approved list of National Essential Medicines List on its website. Only drugs on this list can be legally brought into the country.
“It was really amazing that after all these years it was finally accepted,” says Walsh. “Now [chlorhexidine] can be brought in and aid organizations can start saving babies by implementing an information campaign and distribution process.
“Unfortunately, infants are dying of it”
In 2006, Walsh and her husband, Brian, began leading medical teams at Mountain Top Ministries in rural Gramothe, Haiti. As travel grew in popularity, Walsh formed the non-profit group Little by Little. She was there during and after the devastating 2010 earthquake and documented her experiences in a book, “Walking in Broken Shoes: A Nurse’s Account of Haiti and the Earthquake.”
Haiti is the poorest country in the Western Hemisphere, where the neonatal mortality rate is 25 per 1,000 live births, more than eight times the rate in the United States
Over the years, Walsh noticed infants coming to the clinic with bandages around their abdomens. The bindings were frequently stained and the umbilical cord areas were sometimes infected and needed to be treated with antibiotics.
Focus group participants explained that keeping a newborn’s cord covered with a cloth or other substance protects against evil spirits carried through the air, according to an article Walsh published in the journal Global Public Health.
“The problem is that the umbilical cord has to be open to the air to avoid infection,” she said. “If it’s in a warm, dark environment covered with a binder and other clothing, and especially if there’s a poultice that has the potential to be infested with germs, then unfortunately infants die of it. .”
Walsh joined the Chlorhexidine Task Force, an international collaboration designed to promote the use of the antiseptic to improve umbilical cord care. With the help of Global Health Action, which trains and supports traditional birth attendants, she led a community campaign to encourage pregnant women to use chlorhexidine. The study found that among 198 new mothers, 98% used chlorhexidine at least once after the campaign (Walsh received special permission to use the antiseptic in his study).
Walsh and Global Health Action presented these results to the Ministry of Health in hopes that the government would include chlorhexidine on its list of essential medicines, allowing it to be brought into the country and distributed. After several years of no movement from the government of Haiti, Walsh’s organization, Little by Little, provided a grant to Global Health Action in 2017 to increase its advocacy efforts for chlorhexidine, increase support in the country and formally request that the medicine be added to the national list of essential medicines. These efforts paid off in late 2021, when it was added to the ministry’s website.
Wendy Jolley-Kabi, president and CEO of Global Health Action, said Walsh’s vision and work was what first got her organization involved.
“Sue’s dedication to maternal and newborn health in Haiti has inspired us all and led to this incredible milestone,” she said. “During the years that we have worked on this initiative, Haiti has faced natural disasters, political unrest and economic challenges, but Sue has never lost sight of the goal: to save babies’ lives.
Walsh and Jolley-Kabi say there is still work to be done to get the antiseptic accepted and accessible on the ground in Haiti.
“Adding chlorhexidine to the national list does not automatically guarantee access to this lifesaving drug,” Jolley-Kabi said. “The next step is to promote the acceptance of chlorhexidine in the National Neonatal Operational Plan and to advocate for the local manufacture of the drug to ensure a stable supply chain.”
Walsh adds, “Cord care is still not where it needs to be. It will be a lot of work to accept this compared to traditional methods. However, we have seen a lot of changes in my clinic, and I think the word is spreading.
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