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The Kangaroo Project in Bogota, Colombia

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My name is Sandra Milena. Maria-Paula. And this is the father? And how many weeks is she? She was born 6 months ago now. At how many weeks was she born? She was born at 29 weeks. How much did she weigh? 1260 grams Now she's 6000 grams. It is incredible! We gave her oxygen for more than 3 months. How much time did she spend in the incubator? 42 days. And in the Kangaroo Program? Almost 6 months now. Tell us a little about the program and its challenges... At first it's hard because you have to keep the baby in the kangaroo position, for about a month. You need the support of your whole family so that the baby survives. You can't just leave her anywhere, because she'll lose heat and weight. You need help from your husband, family, because you can't just leave her anywhere. She always has to be in the Kangaroo Position. Who helped you with the Kangaroo position? My husband, and my mother. Did you receive lots of support from the people here? Yes very much, especially with complicated things like the oxygen, from all the nurses and doctors And anything we didn't know, any question, the pediatricians are experts, right? How about things like feeding? In the Kangaroo Program, one touchy subject is breastfeeding. You need their help on breastfeeding and giving milk to the baby. Anyhing else you'd like to add? Just that it's a wonderful program, they've helped us from the start until the baby is older, they relieved so many of our difficulties. And I just want to thank everyone for their help and collaboration. For me the hardest part was the beginning... I thought I wouldn't be able to do it. I found that I had the most difficulty with, and fear of, the oxygen system. It's very complicated. But then... I had help from the workers here, a lot of support. How do you sleep when you're wearing the baby? At first, well, we didn't really sleep because we were so nervous. Later, we got used to wearing the baby with the sling here, normally. Also my husband helped a lot, we would take turns wearing the baby. 24 hours we had to have the baby here, skin-to-skin. He'd come home at 6 and wear the baby until 10, for example. So I got a chance to relax. With the sling it became easier, just to know that the baby is safe here. Yes, now she's doing great. I'm replacing the psychologist, Marta Cristo, for her vacations. The psychology workers here have a lot of work. We support the mothers in a psychosocial manner when they arrive. Because often they don't respond to the situation in the same way. Everything the Kangaroo Project implies is very, very demanding on the mother, the father... all the attention is on the baby. And the mother can find herself a bit overwhelmed, and the father too. In essence, we try to try to identify it, we do workshops every week for the arriving mothers to try and give them this kind of moral group support. They learn from each other's experiences and when necessary, we give them individual attention and support. Sometimes it can be only a mother, or only a father, it's a case-by-case basis. We identify cases that lack help and support, and we try and give them more attention because to be with the baby on you for 24 hours, feeding it, without anyone else helping you, it's very difficult. We identify what we call 'maternity deficiencies' sometimes if the mother is exhausted or for whatever reason she doesn't take sufficient care of her baby then we have to give her more attention to help her so that the baby has everything it needs and to avoid any risk due to lack of attention. Also, we have group discussions regularly on different topics, like how to treat a preterm baby, all the special needs, special attention, all the psychological aspect that's different than what the pediatricians can give, crying episodes, stimulation, then with the mobile, with the toys, what stimulation we can give them depending on the age, about the teeth for example, for each age, meetings when they are very small, and meetings when they are a little bigger. We don't do them in here, but out in the common room for everyone present, it depends on how many people are here, the ages, the themes, for example how to prepare a bed, how to go outside, all those implications and what to expect as the child is growing. What we do in here are some tests called "The Griffith Tests" of psychomotor development and the "Beig" behavior test, then we watch them when they reach 6 months (compensated age), we look at how they are development in different areas, we try and identify any problems, for example premature babies often have posture problems such as hipotonia or hypertonia, then we immediately administer a recommendation and file a report in the child's dossier, check if they're regular, we can send them to physical or complete therapy, depending on what's necessary, or if they seem fine we just give them some stimulation exercises that they can do and continue at home during their first year; we do this at 6 months, and if necessary we have a follow-up at 7 1/2 months and 1 year. So at one year, like the child you just saw in here, will move on to the next test to make sure everything is ok, then we give them their 'diploma' that they've earned, to show they passed this stage, we report on their motor skills, behavior, we give the parents advice, and answer any of their questions and try to resolve their doubts. This is the diploma for girls - the one for boys is blue. My name is Martha Ranos. At what week was your baby born? At 36 weeks. Now I'm at 37, 38 weeks. 10 days were spent in the incubator. How much time in the Kangaroo Project? This is my second visit. I enjoy it because they give a good level of support, I've only just started but I look around me and see that the babies are ok, big babies of 6 or 7 months, big, chubby, and very healthy. I think that things will evolve very nicely for us here. Did you receive a lot of support from the workers here? From the moment the baby was born, still in the incubator, they were very attentive with how to wear the baby, how to care for it, they gave us all the information about how the process works. They told us to come here once the baby is released from the incubator, to the Kangaroo program and they're very attentive to the babies. It's excellent. 37 weeks and a half (gestation). When was she born? How much did she weigh? Around 1500 grams at one point. Today, 2020 grams. How much time did she spend in the incubator? 13 days. And in the Kangaroo Program? So far, 20 days. What do you think about the program? Oh it's great. Did you receive a lot of help from the people here? Yes, very much so. I'm the child's aunt. I'm sort of the 'substitute mother'. I wear her too. And so does the uncle. If you ask them, 'What's it like?'. they'll tell you 'that's not important', It's like the pain of childbirth. Of course there's pain, but well, we make kids, right? So what I want to emphasize is that yes, of course, they go through a difficult time that's not easily forgotten for the benefit of what comes after. The Kangaroo Program is similar; it's lots of work, but they keep their baby with them. They're not separated. The greatest anxiety is feeling powerless. But now they have the baby with them, carrying them, staying with them. Otherwise, they feel separated from the baby. But with the Kangaroo, they have the total responsibility. That's one point. Another is that sometimes, well, people criticize the collective structure. It's special here, isn't it? "There are lots of people". Maybe it's a bit busy today, but we're opening more departments to make it a little less crowded. But it will still be collective. And the reason it's collective is because when you have a tiny baby, you are very anxious and nervous about its future, every day. But here, not only are you not alone, but you also have a neighbor with a fat baby, who was once as tiny as yours. You watch the people talking amongst themselves, and then you realize what you're working for. Like hearing "my baby too was 2500grams", and you see how big it is now. And you se eother babies smaller than yours too. And that gives them hope and energy. They trade tips and tricks to sleep better, how to position the bed a certain way, they help each other, interact, this is very important. Some parents come every day, from the very start no less, while the baby 'grows' like it was supposed to inside its mother. Then, they come every week, until the moment when the baby was supposed to be 'born'. You saw how easy it is for the parents? You ask them 'when was your baby supposed to be born?', they answer 'in 15 days, today,etc.' It's an easy notion for the parents. One was 'born' today! So the exam is different each time, if you examine one now you won't recognize it the next visit, it's not longer a Kangaroo, it's 'born'! And for them that's a different stage. So it's easy for the parents to understand. Seeing so many people consult the doctors too, so many other besides them, at first, the parents didn't feel comfortable. Because they want an 'individual, private' consultation. But that's not a problem either. The doctors know how to do the consultation, if they need an hour with a baby, no problem. The other keep working, and they can take their time with this one baby. Because we're 4, so the other just keep working. And of course, if more privacy is needed, for example for a breastfeeding issue, we go to the breastfeeding room and they can work with the mother. If it's a psychological support issue, we always have a psychologist here who can meet with the parents in privacy. But usually the parents love seeing the doctors working because they can hear everything. They listen to the advice given to others. And they pay attention, the doctors can easily talk to the whole crowd, and say 'listen up everyone', and explain everything at once. This lets parents learn a lot information quickly. The other things is that we have group meetings, normally in the morning, Wednesday and Friday, on planning, diversificaiton, everything. Then, those who come every day to listen end up learning much more. And the parents enjoy it. They appreciate being here. So, the Kangaroo Method should be used everywhere. Of course here in Colombia, we have incubators. But the cost of a low-birth-weight child is very large. We get the benefit of saving babies, keeping the incubators free for the less healthy babies. It helps manage the resources. Also, the baby goes straight to the family, and gives hope to the parents, and brings the baby to the family, where they should be. It conditions them into better parents. That's worth much more than all the other benefits. The parents become the best-trained to care for their baby. And it's in Canada where studies have shown that there is more child-abuse with premature children, because the children are separated for a long time, so when they come home they are like strangers. Integration becomes much more difficult then. There is usually someseparation. In some countries they are working to eliminate that. In Sweden, there's almost no separation. In Uppsala, a 500 gram child is not separated. There's a bed next to the incubator, and they are always together. The parents participate the whole time. But whether in Canada, Europe, or the U.S., there's usually a separation, short, but still a separation. You can consider the Kangaroo Method as the treatment for this separation. The sooner you do it, the better. I didn't discover the method, it's a Colombian method. A pediatrician from the National University of Colombia systemized it. Who was the director of the department of pediatrics in the Mother-Child Institute, a hospital which almost disappeared now. They had 30 000 births a year. That's enormous. They had incubators but never enough, 2 or 3 babies in each. There were many infections, mother abandoning their babies. It served a poor population of the city. So this pediatrician read about Kangaroo physiology, found the heat link for skin-to-sking contact, and decided to start using the kangaroo method. But nothing was officialized, or systemized. No one had statistics on deaths, all we knew was that the rate of abandoned babies dropped, breastfeeding increased, and there were fewer infections. And fewer deaths. Here we lived the first impacts of the Kangaroo method. And so I started with this team here, in 1989, to study the method... to see if we should use it or not.

Video Details

Duration: 24 minutes and 11 seconds
Country: Colombia
Language: Spanish (Spain)
License: Public Domain
Producer: Steven Mansour
Director: Steven Mansour
Views: 1,591
Posted by: stevenmansour on May 19, 2008

The Mother-Child Network visits Dr. Nathalie Charpak at the Programa Canguro, San Ignacio Hospital in Bogota, Colombia.

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