THAILAND: Neonatal care for refugees by refugees

Just as staff at the maternity clinic in the Mae La refugee camp began learning about special care for newborns, a baby was born six weeks premature, weighing 1.3kg.

The medics and nurses - all ethnic Karen refugees from Myanmar - were anxious about treating the tiny boy. Resigned to his fate, the family decided to take him home for his last hours or days. The staff agreed.

Then Claudia Turner, a British research paediatrician working in the camp, convinced them to let the clinic staff help the baby live. After a month-and-a-half in the special care baby unit (SCBU), he went home, healthy.

"The staff suddenly realized they could do it. It boosted confidence. That feels like a pivotal moment for us here," Turner said in the office at the cluster of bamboo and thatch huts housing the Shoklo Malaria Research Unit (SMRU) maternity clinic. "Babies do die, but not all babies have to die, and we do our best."

Turner has been training Karen refugee medics and nurses in neonatal care since 2007, when she set up the clinic's SCBU in Mae La, the largest camp, housing 45,000 of the estimated 145,000 refugees living in nine camps along the Thai-Burmese border.

"Forty percent of neonatal deaths happen within the first 24 hours after delivery," said Hervé Isambert, senior regional health coordinator with the UN Refugee Agency (UNHCR) in Bangkok. "This can be prevented by providing appropriate care within the first hours of life."

The care can be as simple as cleaning the baby, providing skin to skin contact to prevent hypothermia and encouraging the mother to breastfeed within the first hour if possible, he said.

While UNHCR does not provide healthcare in the camps, NGOs working in maternal care mostly refer severe neonatal cases to nearby hospitals, but the SMRU unit in Mae La is staffed with 10 medics and 15 nurses trained to deal with difficult cases.

Neonatal deaths - within the first 28 days of life - have been halved in two years in Mae La. According to data, this is a model camp in terms of maternal health.

"Before that, there was no specific care or training for staff to look after very small babies," Turner said, noting that to reduce infant mortality, a key focus must be on newborns.

"These are quite complicated cases. They [the medics] are operating on a level equivalent to doctor in the UK. It amazes me what they do," Turner said. "They're running it... they do all the work."

Of the 10 million children who die each year globally, four millionsuccumb in the first 28 days mostly to prematurity, infections and birth complication-related asphyxia. The first week is the hardest: three million die in those first seven days.

SMRU handles about 1,500 births each year. The neonatal unit cared for 279 babies in 2010.

In 2007-2008, the early years of SCBU, the neonatal mortality rate was 26 per 1,000 live births, according to SMRU statistics. By 2009-2010, that figure had dropped to 12 per 1,000 live births.

According to the UN Children's Fund, neonatal mortality nationwide in Myanmar in 2009 was 33 deaths per 1,000; in Thailand, it was eight per 1,000.

Caring for newborns in western countries is expensive - costing upwards of US$1,000 a day, and for premature babies in a refugee camp many believed it would be too difficult and too expensive. But a month of SMRU care totals about $165. Other NGOs afford local hospital bills through health programming grants and negotiating costs.

"People don't believe it is possible - that's what I hope to disprove. I've disproved it here, but I haven't proved that it can be used in any setting," Turner said. "Even without spending all that money, you can make an impact."

Waves of ethnic Karen refugees and labour migrants have poured into Thailand since the 1980s. Many came to escape fighting between the Burmese government and ethnic minority groups, while others are in Thailand because of greater economic opportunities.