Winchester woman's work saves babies in Sierra Leone

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WINCHESTER — The volunteer work of a Winchester woman has greatly improved the chances of survivability for babies born in impoverished Sierra Leone.

Carolyn Kruger, who holds a master's degree in nursing, has spent the past five years working with Project HOPE to establish something the African country has never had before: A neonatal nursing program to train healthcare workers and give them the skills they need to lower Sierra Leone's alarmingly high infant mortality rate.

"Sierra Leone had a history of civil war and was an epicenter for Ebola in Africa," Kruger wrote in a recent blog post explaining the country's need for neonatal care. "This history depleted the human resources that were assigned to hospital care of mothers, children and newborns. Many healthcare workers were not up to date on their skills, equipment and supplies were scarce, and the remaining nurses and doctors were often not paid for their services — but they were committed to improving newborn care."

In 2014 — nearly a decade after the country's latest civil war had ended but at the very beginning of a two-year outbreak of the deadly flesh-eating Ebola virus — the infant mortality rate in Sierra Leone was 94 deaths for every 1,000 live births, according to Macrotrends LLC. For comparison, the 2014 infant mortality rate in the United States was just six deaths for every 1,000 live births.

During a recent interview with The Winchester Star, Kruger said Sierra Leone's government officials were happy to receive assistance from Project HOPE, a nonprofit, international humanitarian organization that had been based in Clarke County for 40 years before consolidating its operations in 2019 in Washington, D.C.

Kruger served as Project HOPE's director of nursing in the 1980s and '90s, and she returned as a full-time volunteer consultant in 2016. When the organization agreed in 2018 to help Sierra Leone improve its infant mortality rate, Kruger was the one called upon to head up the project.

"My background is mostly in nursing education," she said. "What we did was work in the communities first to help families and committed healthcare workers learn about newborn care and how to observe for any danger signs. That brought the awareness to their primary care areas in their districts. The primary care nurses and midwives and doctors did not have a lot of knowledge about how to care for small babies or a new baby that needed resuscitation, so we did a lot of training there."

Project HOPE also established Kangaroo Mother Care units at Ola During Children's Hospital and Bo District Hospital, both in Freetown, Sierra Leone. Kruger said these eight-bed units help mothers care for small and premature babies by placing them skin-to-skin and wrapping them together, similar to a kangaroo carrying a joey in her pouch.

As word spread about Project HOPE's work, Kruger said the organization started getting requests for assistance from other hospitals and universities in the African nation. Sierra Leone's Ministry of Health and Sanitation, as well as the University of Sierra Leone, also asked Project HOPE to develop more advanced educational and clinical programs to improve neonatal care.

"At that time on the continent of Africa, there were only two other neonatal nursing programs at the baccalaureate or master's level," Kruger said. "They were very committed [in Sierra Leone] to developing a two-year baccalaureate program."

With Project HOPE's guidance, the College of Medicine and Health Science at the University of Sierra Leone in 2020 began offering a bachelor's degree in neonatal nursing and pediatrics.

"Over the next two years, our volunteer neonatal nurse educators began developing curricula and training faculty, much of it done virtually during the COVID-19 pandemic," Kruger wrote in her blog post. "When travel restrictions were lifted, multidisciplinary teams of Project HOPE volunteers made trips to Ola During Children's Hospital in Freetown to focus on implementing the advanced curricula and training faculty to teach the new content to future students."

The inaugural group of 30 students recently completed studies and earned their degrees in neonatal nursing and pediatrics. It was such a positive experience that the University of Sierra Leone's School of Nursing asked for Project HOPE's assistance in developing a master's degree program in advanced neonatal care. Kruger said the first students were admitted into the program in May.

The hope now, Kruger said, is that nursing students who have received their degrees will pass along their knowledge as more people enroll in the programs, and more people in Sierra Leone become familiar with the best ways to ensure a baby's health.

"What we're doing is gradually, block by block, preparing the capacity of the country to train their own neonatal experts and sustain that through an accredited university program," she said.

Kruger said a lot of work went into improving Sierra Leone's neonatal care over the past four-plus years, and she spent a lot of time traveling and conducting virtual training sessions online, but the fruits of Project HOPE's labors are already becoming evident.

Today, the infant mortality rate in the African country has decreased from 2014's level of 94 deaths per 1,000 live births to a much-improved 70 deaths per 1,000 live births. Even better, the United Nations is now projecting that by the year 2100, assuming the country remains stable and its neonatal training initiatives continue to grow, Sierra Leone's infant mortality rate will be down to 20 deaths per every 1,000 live births.

To learn more about Project HOPE and its international humanitarian efforts, and to learn more about the work of Kruger and the nonprofit organization in Sierra Leone, visit projecthope.org.

— Contact Brian Brehm at [email protected]

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