By Magdalena Guillen
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Summoned by a scream, Dr. Tanie HoTan rushed toward the woman drenched in blood and amniotic fluid outside the Haitian hospital grounds. Improvising tools with the bare minimum they could find, HoTan and the medical team cut the umbilical cord and took hold of the newborn.
They had a single golden minute to resuscitate the breathless child.
The family physician rushed the baby, who was born curbside, through hospital doors to perform three simple steps that would save the child’s life: Drying, suctioning and positive pressure ventilation. Shirts were used as towels to dry the child, but they would have to forgo the suctioning; the minute was almost up and positive pressure ventilation had to be applied.
Limp and breathless, the baby’s nose and mouth were suddenly covered by HoTan with a plastic mask. Her steady ventilation from the bag to mask was fueling life into the newborn.
“It almost took two minutes for the baby to start responding and perk up,” says HoTan. “If the bag and mask equipment weren’t there, and if we weren’t there, the baby wouldn’t have made it.”
The bag and mask kit is the collateral material of Helping Babies Breathe, an evidence-based educational program initiated by the American Academy of Pediatrics. Its mission is to teach neonatal resuscitation techniques in resource-limited areas. Their goal is to have at least one person who is skilled in neonatal resuscitation at the birth of every baby.
From working in Haiti, HoTan carries her skills back to Vietnam, her native land. After 39 years, she returns with Project Vietnam to educate the Vietnamese on neonatal resuscitation methods.
“Part of me feels like I’m coming home,” says HoTan. “Part of me knows, part of the reason, [is why] I’ve had this training.”
HoTan, her husband Scott Hadden, and their team of three nurses, joined Project Vietnam, a non-profit organization that assembles medical missions in impoverished areas of Vietnam where medical aid is not readily available. She and her neonatal team are among the physicians leading Helping Babies Breathe, in collaboration with the organization. Together, they plan to educate Vietnamese nurses and medical students resuscitation methods –a skillset the team hopes that they too, will pass on.
Their collective goal is to help decrease the infant mortality rate in Third World countries.
According to the Journal of the American Academy of Pediatrics, high infant mortality rate is higher in Third World countries due to the lack of optimum equipment for resuscitation.
Both visions align perfectly, says HoTan about teaching resuscitation methods with Project Vietnam. The best thing, she says would be to compare this mission trip with one in a couple of years from now, and see the infant mortality rate go down.
“Babies are being born in homes where there is no [readily] available access to a hospital or neonatologist,” says Hadden, who is also a family physician.
The model is both simple and teachable, says HoTan, but they needed a team of nurses who will successfully teach the resuscitation process. Financially backed by their hospital, Santiam Memorial Hospital in Oregon, and Project Vietnam, they purchased 13 kits to leave in Vietnamese medical facilities.
At Santiam Memorial Hospital, HoTan recruited its department’s top nurses and asked them to join the mission. The qualifications: top of their department, have completed several missions, and could work calmly and effectively under extreme and stressful situations. Three nurses made the cut, including the head of all nursing, the head of neonatal care and an emergency room nurse who joined HoTan, Hadden and Project Vietnam.
“I’ve been a nurse for about 10 years and I’m very passionate about babies and making sure they’re well taken care of,” says Juanita Culver, emergency room R.N. “I work with Dr. HoTan and she was passionate about this program, so I chose to come along.”
Week one proved to be a challenge for HoTan and her team in the Vietnamese district of Cam Lam. She, her husband and their team of nurses helped Project Vietnam with the primary care team, practicing basic primary care. After seeing hundreds of malnourished patients, it was disheartening to be unable to provide long-term medical solutions. It was a challenge to know that these patients would be seen, treated with medicine for 30 days and return with the same illness after their dosage was complete.
“There is kind of a sense that we are just putting on some band-aids on people,” says HoTan.
By the second week of the mission trip in Hai Duong City and Hanoi, Vietnam, complications unknown to HoTan and her team arose in the teaching of Helping Babies Breathe. The program was cancelled and the team was faced with a challenge. Still using the kits purchased, they were able to teach the U.S Neonatal Resuscitation Program, NRP instead.
NRP requires more advanced steps than the simplistic approach of Helping Babies Breathe. Where HBB consists of the three primary steps: drying, suctioning and positive pressure ventilation; NRP additionally includes chest compression skills and intubation methods in advanced levels.
With a young team of eager Vietnamese professionals and students learning the resuscitation program, teamwork and collaboration is key.
With the goal that these professionals and students will pass this knowledge on to others, they will have created a durable program that can serve as a model in other Vietnamese communities and other third world countries where the infant mortality rate is high.
It means so much to just have even one baby live, says HoTan, it means having someone’s child live.
Returning to Vietnam jogs HoTan’s mind and memories. Her bits of Vietnamese are picking up again, and the food reminds her of her childhood.
Her eyes close as she searches for memories of her deceased mother.
Her strong spirited mother served as an anchor for HoTan’s success as a doctor. Her mother tolerated harsh situations and never complained — no matter the circumstances. Financial sacrifices, a dependence on welfare, raising five children and an imprisoned husband in a concentration camp were just some of the things she endured.
Most importantly, she always told her to dream big.
“She would have been so proud of me to do this,” says HoTan. “This is serving my country, it’s honoring my mom.”