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Entry into Indonesia – Providing Innovative Solutions to Quality Care

Being in a completely new country, it’s easy to forget that sometimes even simple, routine tasks aren’t done in the same way as they are back home. I learned that lesson quickly and -- admittedly by mistake – during my first trip grocery shopping in Jakarta. After buying produce, I did what we always do at home --went directly to the register to check out. I didn’t realize that here each piece of produce needs to be carefully weighed, and then has a label placed on it with the weight and cost before you ever make your way up to the check-out register. Lesson learned. But what I didn’t realize at that time was that that small scale could be instrumental in saving a newborn baby’s life.  
 

In Indonesia, it has been estimated that 66,000 newborns die every year1-- with the first week of life being the most dangerous2. Nearly one-third of newborn deaths occur within the first 24 hours after birth, with more than three-quarters occurring in the first week of life2. Newborns die from three main causes – complications from being born premature or low birth weight, asphyxia and infection3.
 

The statistics are startling – there’s no question about that. But what has hit home for me even more than the numbers is a genuine passion to make a difference that’s evident in each member of the U.S. Agency for International Development (USAID)-funded Expanding Maternal and Newborn Survival (EMAS) project team.  Often making that difference here comes in innovative forms of providing quality care – in this case it’s the use of a produce scale.  What does a produce scale have to do with newborn babies? That’s what I thought initially too. Premature or low birth weight is a key cause of newborn deaths in Indonesia. While out in the field Dr. Wilson Wang (EMAS Senior Technical Advisor from Save the Children) realized that in some low resource facilities there was a huge discrepancy in the daily weight measurements of premature babies due to faulty scales. Infants were often undernourished based on inaccurate readings and lack of formal feeding support systems –a potentially deadly mistake. A new scale would cost the facility no less than $800, but he came up with a $40 solution – pieces of a produce scale that together provided a much more accurate reading. The new scales along with a simple feeding tool keeps track of daily weights and tells staff the right volume of milk to give to babies based on these weights.  This has resulted in fewer calculation errors, better medical documentation, more regular feeding and weight gain.
 

That same passion was evident in the physicians I met in a recent visit to EMAS partner Budi Kemuliaan – Jakarta’s top rated maternal and neonatal hospital. Through a meeting with Dr. Lilik (EMAS Senior Clinical Governance Advisor) and Dr. Irma (EMAS Clinical Advisor) and after a tour of the facility – I quickly learned that quality care was directly tied to the hospital staff and their passion to provide the best care they could to their patients. Their passion was evident not only in their words but their innovative solutions – including a cabinet with a light bulb and thermometer that keeps IV solutions at the right temperature for immediate insertion into the body or a syringe box made from a cardboard box. A simple but critical reminder in the developing world -- that the word quality is not always synonymous with being complicated or costly.
 

Needless to say, I left inspired and energized about my own project—developing a communications strategy to incentivize high performing facilities and raise public awareness of the issues. Whether it’s the communications team digging for the right stories to share, the monitoring team tracking progress, or the physicians in the field mentoring other facilities – I’ve noticed that one thing remains the same – there’s an addictive passion in everyone here to do their part in reducing the number of maternal and neonatal deaths in Indonesia. And just sometimes – that comes in the form of a produce scale.
 

To read more about EMAS click here.




1United Nations Children’s Fund. Levels and Trends in Child Mortality: Report 2012. New York: UNICEF; 2012.

2Titaley, C, Dibley, M, Agho, K, Roberts, C and Hall, J. Determinants of neonatal mortality in Indonesia. BMCPublic Health 2008, 8, 232.

3UNICEF Statistics and Monitoring Section. Maternal, Newborn & Child Survival: Indonesia. 2012.  Retrieved on April 9, 2014, from http://www.childinfo.org/files/maternal/DI%20Profile%20-%20Indonesia.pdf