Fighting for their first breath

Health workers trained through a Rotary project resuscitate infants struggling for air

By Etelka Lehoczky

As a midwife who works at health facilities all over the Western Rural District of Sierra Leone, Banneh Daramy sometimes has to assert herself. Her confidence and skill can make the difference between life and death.

“I went to one facility and the people on duty did not even recognize that I was a midwife,” she recalls. “They’d just done a delivery, and the baby was not crying. So they concentrated on the mom, and the baby was left alone. Immediately, I entered. I knew how to resuscitate the baby.”

As the mother screamed in panic, Daramy grabbed a self-inflating resuscitator and fitted it over the baby’s face.

“I used it to ventilate the baby. And within one minute, the baby started crying,” she says. “The mom had been crying and shouting, ‘Oh God, please save my baby! Please save my baby!’ And then she was so happy. That’s why, whenever I see a delivery, I stay until the end to see that the baby is safe.”

It didn’t take expensive equipment to save that baby’s life. A self-inflating resuscitator sells for about US$11. Daramy’s knowledge of neonatal resuscitation — and her quick thinking — made all the difference. She learned many of her skills through Helping Babies Breathe, a training program created by the American Academy of Pediatrics that she took part in through a Rotary global grant project.

Trainees in the Helping Babies Breathe program hold newborn simulator dolls called NeoNatalies at the Lungi Government Hospital in Sierra Leone.

Birth asphyxia, or the failure to breathe at birth, kills an estimated 900,000 infants globally each year. Although it accounts for less than 0.1% of newborn deaths in industrialized countries, it’s the leading cause of neonatal mortality in low- and middle-income countries, like Sierra Leone. Many newborns who aren’t breathing can be saved if health care workers begin resuscitation immediately, so it’s crucial for providers to learn how to respond as quickly as Daramy did.

Since 2022, Rotary members in Sierra Leone and North America have collaborated to offer the Helping Babies Breathe protocol to more than 650 nurses, midwives, and other health workers from all over Sierra Leone. The program was funded through a global grant co-sponsored by the Rotary Clubs of Palm Harbor, Florida, USA, and Freetown, Sierra Leone.

Charlotte Israel, 2023-24 president of the Rotary Club of Palm Harbor, initiated the project partly because of a personal tragedy.

“In 2020, my daughter passed away,” she says. “I went in to wake her up to go to work, and she was lying on her bed. I called [emergency services] and they told me to try giving her CPR. But I had never done CPR. That has always been on my mind: Maybe, if I had the training, I could have helped my daughter.”

On the Freetown side, the project was coordinated by club member Sylvia Bailor and her sister-in-law, 2023-24 club president Sybil Bailor. Sybil was committed to the project in part because of her own experience. She once had a difficult delivery, during which her baby struggled to breathe.

“When my second child was being born, it was quite a long process, and she got distressed in my birth canal,” Sybil. “Her oxygen level was below 90%, so they gave me [a medication] to make the contractions come quicker. This is one of the reasons why this particular project is very special to me.”

Like CPR programs, Helping Babies Breathe teaches non-doctors how to provide lifesaving care. Rotary’s association with the program goes back several years. The American Academy of Pediatrics relied on help from Rotary members when it created training materials for the program in 2010.

“Rotarians have been champions of the program from the very start, [including] serving as editors on the various curricula,” says Beena Kamath-Rayne, a neonatologist and the vice president of global newborn and child health for the American Academy of Pediatrics. “We have a very much valued partnership with them as we continue to spread Helping Babies Breathe around the world.”

One of the great things about Helping Babies Breathe, Israel notes, is that its training materials can be downloaded for free.

“We provided wall charts. We provided brochures. And if I gave you a brochure, you could actually learn that entire course yourself to be able to do that technique,” she says.

But Israel wanted the trainees in Sierra Leone to be able to practice on dolls that are specially designed for the program. The NeoNatalie newborn simulator’s chest rises only when the trainee uses the correct resuscitation technique. The trainee can also check for a pulse in the doll’s attached umbilical cord, and a trainer can use squeeze bulbs to make the doll breathe spontaneously or cry.

Israel and Bailor’s clubs used The Rotary Foundation grant to purchase 160 NeoNatalies and other supplies. The trainees practiced with self-inflating resuscitation devices and used plastic bottles (known as “penguins” because of their shape) to learn to suction fluid from infants’ noses and mouths.

Graduates display their certificates after completing the Helping Babies Breathe training program that was sponsored by Rotary clubs.

The project’s sponsors overcame some unexpected costs, including higher shipping fees and the need to provide transportation and lodging for nurses and midwives from rural areas. Israel was able to raise a bit more money from clubs to meet some of these needs and received a donation of free lodging.

Because of this, the clubs were able to make another significant investment in the health of babies in Sierra Leone. The grant also provided five oxygen concentrators and a solar power system to the King Harman Maternity and Child Hospital in Freetown. In addition, Israel distributed baby hats, blankets, and clothing at the hospitals where the training was conducted.

To ensure sustainability, the project trained people who could then teach other health workers and lead courses for them to refresh their skills. The clubs partnered with Sierra Leone’s health ministry and the nongovernmental organization Health Care Sierra Leone USA to make sure training would continue. Members of Health Care Sierra Leone USA had been providing training before the Rotary grant-funded project, and they continue to monitor the program.

“We train the participants with the goal that when they go back to their various localities, they will be able to train others,” says Sulaiman Sannoh, a neonatologist and member of Health Care Sierra Leone USA. “Over the years, people who’ve attended our training sessions have sent us pictures of themselves training their colleagues.”

Learn more about Rotary’s focus on maternal and child health.

Fighting for their first breath

Health workers trained through a Rotary project resuscitate infants struggling for air

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