How a Yeovil doctor is helping to save babies’ lives in Afghanistan

Over the last couple of years, Afghanistan has become one of the most difficult countries to reach from the western world, and this means the people who live there are unable to regularly access the latest healthcare technology.

During the years of Taliban exile in Afghanistan, teams from UNICEF, and other non-governmental organisations, were very active in the country, along with the more rural areas of neighbouring Pakistan too.

But when the Taliban retook power in Afghanistan in the summer of 2021, many western charities and organisations also pulled out of the country, as the world waited to see what would happen next.

Despite the ruling government, there are still thousands of babies born every day in Afghanistan, and access to decent healthcare is particularly problematic in the more remote and poorer areas of the country.

Afghanistan has one of the higher neonatal mortality rates in the world, and it was with this in mind that Dr Michael Fernando, a consultant paediatrician and our associate medical director at Yeovil Hospital, decided he wanted to try to find a way to help Afghans to give their babies the best possible start to life.

Michael had previously led a programme through Rotary International, in the Sindh Province in Pakistan, to train the trainers in remote and rural areas on how to resuscitate babies at birth.

“It all started five years ago, when I attended a ‘Helping Babies Breathe’ course in London where professionals came from around the world to learn how to train trainers in resource limited settings,” says Michael.

“I met a doctor from Pakistan, which at the time had the highest neonatal mortality rate in the world, who asked me to introduce him to Rotary to help spread this training further."

After running two ‘Master Trainer’ courses in Pakistan, the American Academy of Pediatrics asked Michael to be a technical expert to work with UNICEF in Pakistan, as part of a year-long programme to run ‘telementoring’ in neonatal units there.

This was part of a wider multinational project that went on to become a global quality improvement programme in neonatal care.

Two years ago, Michael was asked by the Rotary International President’s Special Representative to Afghanistan, Katerina Kotsali-Papadimitriou, to run the ‘Helping Babies Breathe’ programme in Afghanistan, along with Rotary clubs in Afghanistan – led by Rameen Javid from Rotary Kabul City.

Michael continues: “Data suggest that the number of babies who die per 1,000 births in Afghanistan has been reducing in recent years, down from 40 in 2019, to 35 in 2024, but this is still way too high, as it’s about 1 in 30 births.

“When a baby is born, there’s very little that needs to be done in the vast majority of cases, apart from babies needing to be dried, kept warm and given back to mum. Some need to be stimulated to breathe; a smaller number need air to be pushed into their lungs. Fewer than 1 in 100 need more advanced treatment such as chest compressions and medication, like adrenaline.

“There’s a golden minute of life where a baby’s life can be saved, by ensuring that the baby breathes.

“That first minute is the most important part we teach in our training sessions, and we deliberately kept things simple, such as teaching people how to position the head – that can be lifesaving in itself.

“For much of the past two years, running this project has seemed impossible to achieve, given the major changes in Afghanistan over the last few years, especially with some of the new laws making it difficult for men to train women out there, and vice versa.

“I have to be honest, at one stage I had pretty much given up, as all the odds were stacked against us, especially as early on in the planning period, it was announced that secondary school for girls would not be allowed in Afghanistan.

“People looking after babies at birth in Afghanistan are almost all female; there were some exemptions for access to education, such as for doctors and midwives.

“I was encouraged by words of advice from Dr Merry Kane, our deputy chief medical officer, and Dr Lucy Knight, our medical director for neighbourhoods, community services and mental health, who urged me not to give up. I took real heart from this advice and tried to push it through.”

Michael and the team in Rotary Afghanistan have managed to work past every single obstacle they faced, and successfully ran the course earlier this year, which he said was an incredible feeling.

“We set out on our trip to the capital city, Kabul, but still had a number of obstacles to overcome,” he continues.

“It was difficult to get people to go, and also tough to get a visa – in the end we were told, a week and a half before planned departure, that we’d get that on arrival. All trainers self-funded their travel and came from differing parts of the world.

“We arrived at the airport, which was pretty modern, and we were hosted in the Intercontinental Hotel, which has a chequered history, and is now owned and run by the Afghan government.

“We were hosted very well and were provided with a lot of government security, both at the hotel and during our sessions. We had about a 50/50 split of women and men at the training and we worked sensitively through this while being able to run effective sessions.

“I was the course director and led the team who trained doctors and midwives at a teaching hospital in Kabul, to train other people on how to resuscitate babies in remote settings with limited resources.

“We brought some training equipment from back home and our partners at the Rotary Club of Karachi took some out too; the teaching facilities at the hospital were very good.

“The training itself is quite realistic as we can mimic the baby's heartbeat and listen in using a stethoscope, or we can feel the umbilical cord. We can also use it to simulate breathing, so although the equipment is low cost, it’s really effective as a training aid.

“Despite some differences in the country, everyone was highly motivated to reach that important principal aim of reducing the death rate of babies.

“The feedback we had from people we trained in Afghanistan was fabulous, and they were really happy. Not only that, but they’ve already started putting their learning into practice, which is great news.

“If the teams in Afghanistan do take forward what they learned and train people in remote areas, it will literally save so many babies’ lives, and I truly hope this happens.”

Katerina Kotsali, Rotary International (RI) President Representative to Afghanistan, adds: “Afghanistan, along with Pakistan, are the two-remaining endemic-to-polio countries and Rotary International is a pioneer in the fight against polio.

“As RI President Representative to Afghanistan, I encourage the implementation of any project alleviating the severe humanitarian crisis in the country.

“The "Help the Babies Breathe’’ project not only contributes to improving maternal health and decreasing neo-natal mortality, but also elevates the role of Afghan women, and opens opportunities for the accomplishment of more projects in Afghanistan.

“Heartfelt congratulations to the volunteer doctors and team, with Michael Fernando ahead, for creating hope in a country that desperately needs humanitarian aid.”