While in Tibet, Anne CC Lee, MD, MPH, received a call that a baby had been born barely breathing after his mother spent more than 24 hours in labor. She ran to the remote Himalayan village, with So Drogha, a local Tibetan doctor, abandoning motorcycles that could no longer travel the poor roads leading up to the house where mother and baby waited.
“My heart was beating so fast,” said Lee, a physician-researcher in the BWH Department of Pediatric Newborn Medicine’s Clinical and Translational Research Program, recounting the memory from 10 years ago as if it were yesterday. The baby was big, with no obvious birth defects; the pregnancy had been uncomplicated. Lee believed that if his mother had had access to a skilled birth attendant to monitor the delivery, or if the baby had received a few breaths to help him start breathing, he could have been completely healthy. Instead, the baby died.
As a result of such heartbreaking experiences in the field, Lee, who has worked in rural health clinics in Tibet, India, Africa and China, became determined to find a way to improve birth outcomes in underserved communities.
“It is the saddest thing in the world to hold a baby who has died,” said Lee. “But what is even worse and more unjust is when it could have been prevented.”
Making Changes
Lee soon diverged from her training as a primary care pediatrician and entered the field of epidemiology and public health. Her mission: to investigate the reasons underlying newborn deaths in low-income countries, understand the health systems in which they occur and develop tools to prevent them. She has devoted much of her career to understanding the risks of childbirth and measuring newborn morbidity and mortality in the world’s poorest communities.
Her research findings were included in the Every Newborn action plan, a World Health Organization and UNICEF initiative to guide the design of national policies to prevent newborn deaths worldwide.
Lee also travels frequently to Bangladesh, where she works in the Projahnmo (Project to Advance the Health of Newborns and Mothers) study site. In this rural northeastern district, almost 90 percent of mothers have no prenatal care and give birth at home, and the rates of newborn mortality and stillbirth are very high. The Projahnmo group was established in 2001 by Abdullah Baqui at Johns Hopkins University and has trained community health workers to provide essential prenatal and newborn care to all mothers in the area.
“Most babies only need a few essential things to get the right start, so it’s about teaching mothers how to breastfeed early and adequately, keep the baby warm and recognize signs of illness in order to seek health care early,” said Lee.
Simple Tools
In training community health workers, Lee has also worked on creating simple tools to help them assess immaturity and illness. She recently participated in a challenge called “Saving Lives at Birth,” launched by USAID, the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada and the Department for International Development.
“We proposed a simple plastic ruler that can be used to screen for prematurity and jaundice in the home setting,” said Lee. “The health worker measures the baby’s foot length as part of the screening. Having a small foot in the ‘red’ zone of the ruler indicates that the baby is high-risk and should be sent to a hospital and visited more frequently at home by the community health worker.”
On the other side of the ruler is a color strip with varying shades of yellow to identify jaundice, a discoloration of the skin and eyes. The health care worker presses the strip against the newborn’s nose and selects the color on the strip that best matches the baby’s skin to determine the severity of jaundice.
Lee and her team at BWH, Rachel Whelan and Karima Ladhani, plan on developing and testing the tools and algorithms at BWH and in Bangladesh next year. If they are accurate, the next step is to study whether their use will help improve health outcomes in different settings.
“Newborns cannot advocate for themselves,” said Lee. “Almost all newborn deaths occur in low-income countries. As health care providers, we need to bring attention to these places in the world, where simple interventions have the potential to save many lives. We need to give these babies and mothers a voice because every newborn needs to count, no matter where and to whom they are born.”