PHASE 2:

This hospital's infant profile is mostly that of extremely vulnerable infants due to an increasing number of mothers giving birth here being HIV-positive and suffering from Tuberculosis. These circumstances place particularly high demands on the availability of donor breastmilk to feed new-born babies and it is primarily in this area that the Healing Kids funding was utilized. Due to the installation of a Fuchs Human Breastmilk Bank at the hospital, increased numbers of orphan new-born infants can now be catered for. Also, the care-giving facilities and infrastructure were improved through renovation of the hospital's Kangaroo Mother Unit and alterations to the Mother Lodger Unit.

At this beneficiary hospital, the Healing Kids grant mostly focused on upgrading of facilities. The Kangaroo Mother Unit at the Rahima Moosa Mother & Child Hospital has been upgraded and the newly improved conditions for neonates and their mothers directly translate into improved mortality and morbidity rates at the hospital. In addition thereto, the Neonatal High Care Nursery has also been renovated and additional equipment, including oxygen saturation monitors and oxygen blenders, have been installed.

In the Labour Ward, a new ultrasound machine was acquired and installed. Nursing staff benefited from attending a national neonatal conference, specialized training in neonatal neuro-developmental care, as well as specialized neonatal resuscitation training.

The Steve Biko Academic Hospital utilized their Healing Kids grant to impact their neonatal mortality rates through the installation of a Human Breastmilk Bank and the establishment of a brand new Kangaroo Mother Care Unit. The Milk Bank is reported to already have facilitated a significant decrease in Nosocomial Infections in the Newborn Intensive Care Unit of the hospital.

The new Kangaroo Mother Care Unit is being established at the Tshwane District Hospital, which is located on the same premises as the Academic Hospital. This new unit will assist with the severe overcrowding of infant patients at the hospital.

Pelonomi Hospital's infant profile is mostly that of vulnerable, HIV-exposed infants. The hospital frequently admits very ill babies from all over the Northern Cape in addition to all the sick newborns from the smaller Free State towns surrounding the hospital. Due to its large catchment area, the neonatal mortality rates for their smaller babies are relatively high.

The hospital's Fuchs NMR Reduction Plan involved the acquisition of life-saving intensive care equipment, the establishment of a satellite Donor Breastmilk Bank, improving KMC facilities and conducting specialized newborn resuscitation training for intensive care staff. They have purchased two "cosy cots" with build-in ventilation facilities and an oxygen saturation monitor during 2008. These were placed in the Caesarean Section Theatre and in the Intensive Care Unit, resulting in all babies being born by caesarean section, now being effectively resuscitated when required, while babies who otherwise would have been denied access to intensive care services, can also now be ventilated. In addition, medical staff attended formal resuscitation training as part of the Healing Kids grant.

Given its academic and tertiary level hospital status, Universitas Intensive Care Unit babies are often critically ill and tend to have a longer than average stay in hospital. The Universitas project team aimed to reduce the neonatal mortality rates and average length of intensive care stay through a strategy that targets the incidence of Necrotising Enter Colitis (NEC) - one of the killer infections for small infants. If not fatal, this condition prolongs intensive care bed occupancy and often bottlenecks the Intensive Care Unit, consequently denying another critically ill baby access to an intensive care bed.

The Healing Kids grant was applied to establish a Human Breastmilk Bank (these banks have proven to greatly reduce the incidence of NEC), upgrade their Kangaroo Mother Care facilities, purchasing of additional ventilation equipment and for specialized staff training.

The Kimberley Hospital Complex focused on two main aspects in order to reduce their neonatal mortality rates. Firstly, the Intensive Care Unit staff received training on neuro-developmental supportive care for new-borns and secondly, a Fuchs Breastmilk Bank was installed. The training was conducted during 2008 and has already improved the quality of service delivery in the unit. Their Kangaroo Mother Care Unit was also upgraded during 2009 and ventilation equipment was purchased and installed in the Neonatal Intensive Care Unit.

The hospital reported significant cost savings and improved neonatal outcomes following the amendment to their nutrition facilities as follows: No more formula feeds are used for low-birth weight babies in the first fourteen days of life; and a decreased incidence of Nosocomial Infections.

The hospital's Intensive Care Unit ventilation capacity has been further expanded through the acquisition of additional equipment for the unit.

The Western Cape has the highest percentage of low birth weight infants in the country. Doctors here report a distinctive positive correlation between prematurity, HIV-exposure, coupled with Tuberculosis and substance abuse in their patient profile at Tygerberg Hospital. Their Healing Kids grant was utilized to significantly expand the infrastructure and care-giving facilities in the Neonatal Section of the hospital. This involved the upgrade of a vacant ward in order to cope with the ever increasing number of small babies who remain in hospital after birth.

Renovations to the Kangaroo Mother Care Ward started during June 2008 and were completed in record time by October 2008. The new ward has facilities for thirty neonatal beds and for twenty Kangaroo Mother Care mothers. An official opening ceremony was conducted during October 2008 and the ward is named after the Carl & Emily Fuchs Foundation. In addition thereto, a regional Human Breastmilk Bank has been installed in the Cape Peninsula.

Worcester Hospital caters for the entire Boland Overberg Region (Worcester plus nine other towns in the district). A new Paediatric Facility is being build which should be completed during 2010. Their Healing Kids grant was mostly used to purchase phototherapy lamps and to install SIPAP machines. These machines increase their capacity to care for the smallest of new-borns, specifically those weighing less than 1000g at birth. The new equipment facilitates shorter hospital stay periods for many infants, also resulting in further cost savings for the unit. The Worcester Kangaroo Mother Care facilities are now being upgraded as part of the completion of the new Paediatric Facility.

This Port Elizabeth-based hospital employed a holistic strategy in applying the grant from the Fuchs Foundation to decrease their neonatal mortality rates. Their approach focussed on staff training for both nursing and medical personnel. It also involved improving the quality of care rendered in the delivery room, improved transport to the neonatal wards and various management systems in these wards. Here the project elements included expanded Kangaroo Mother Care, ventilation equipment (CPAP), promoting exclusive breastfeeding and baby-friendly principles, as well as involving mothers in the care of their babies.

As a result of their Healing Kids intervention, the following areas of care were impacted most positively: training on resuscitation of new-borns, improved transport of ill neonatal patients, improved quality of monitoring of sick new-borns, and improved care in Kangaroo Mother Care.

The Greys Hospital Complex (a Pietermaritzburg-based hospital) and five "feeding" hospitals benefited from the Healing Kids-funded programme in KwaZulu-Natal. These included Edendale, Ladysmith, Christ the King, Madadeni and Newcastle Hospitals. During the project, new bilirubinometers, infusion pumps and syringe pumps were acquired for the Neonatal Intensive Care Units. In addition thereto, Kangaroo Mother Care pouches were produced for the units and the equipment was deployed in all six hospitals.

Specialized neonatal intensive care training and the adoption of neurodevelopmental care have resulted in shorter periods of hospital stay, leading to more cost-effective use of resources and a greater turnover of babies through the various hospital nurseries. Greys Hospital has reported a 2% decrease in early neonatal deaths (extreme low birth weight category) during the course of the project. Major benefits were also derived for their Neonatal Experiential Learning Site by the complimentary implementation of the Fuchs-funded programme.

KwaZulu-Natal as a province caters for the largest paediatric population in South Africa. An aggressive Neonatal Mortality Reduction Plan was funded by the Healing Kids grant at this Durban-based hospital. The programme revolved around three major interventions:

Firstly, an outreach programme for "flash-heating" of HIV-infected mothers' own breastmilk enjoyed huge success. Individual mothers were initially trained, who then in turn trained others in the community. Secondly, Kangaroo Mother Care programmes were promoted at the hospital. One of the existing Obstetric Wards was renovated to accommodate these Kangaroo Mother Care practices.

Also a Human Breastmilk Bank was installed. A separate room has been renovated and fully equipped with freezers, pasteurizer and a new breastmilk analyser.

The Witbank Hospital reported significant progress with an average decrease of thirty-four deaths per 1000 live births during the course of the project. Key components of their Mortality Reduction Plan involved amendments to the hospital's nutrition policy and facilities through the installation of a Fuchs-funded Human Breastmilk Bank. Extensive training in neurodevelopmental care was introduced to the Neonatal Intensive Care Unit. The project team also involved the Obstetrics Department in a programme aimed at improved quality of care for new-borns, specifically aimed at a reduction of Intra-partum Asphyxia.

Three cardio-technograph machines, pulse oxymeters and additional neonatal resuscitation equipment were purchased, which increased their capacity to substantively improve the hospital's rendering of specialized neonatal care. The hospital has now become a benchmark for others in the Mpumalanga Province and is extensively involved with the training of lower-level hospitals with a view to improving the quality of their infant patient care.

The Walter Sisulu Paediatric Cardiac Centre for Africa is an autonomous, philanthropic non-profit organization based at Sunninghill Hospital. It also is the largest paediatric cardiac unit on the African continent, not only providing lifesaving heart surgery to local children, but also training surgeons into Africa in order to provide their much needed services. As part of a grant agreement and funding partnership between the Centre and the Foundation, our grants are being used to perform life-saving cardio-thoracic surgery, specifically on underprivileged South African children.

Surgikids was initiated at Chris Hani Baragwanath and Johannesburg General Hospitals by Professor Peter Beale, Head of Paediatric Surgery at the University of the Witwatersrand. Their aim is to meet the ever-increasing demands of delivering state-of the- art surgical services to disadvantaged children in Gauteng. As part of the Healing Kids project, Surgikids received funding which has assisted the unit with acquiring surgical instrumentation for the Baragwanath Paediatric Theatres, where neonates often wait up to seven days to have a birth defect surgically corrected. Such surgical instruments are not a luxury - it literally could mean the difference between life and death of a child patient.