Improving newborn care in Uzbekistan: A German-Uzbek partnership sparks learning and change
A multi-disciplinary team from Dresden is working with Uzbek neonatologists, surgeons and nurses to integrate new diagnostic and treatment technologies – and to strengthen the overall approach to care for premature and sick babies.
In recent decades Uzbekistan has made significant progress in reducing preventable deaths among newborns. The country has a neonatal mortality rate of between 4 and 5 deaths per 1,000 live births – well under the 2030 target set out in the Sustainable Development Goals – and a well-organised and centralised system of perinatal care.
Despite these achievements, much remains to be done to reduce deaths even further – and to ensure that small and sick babies not only survive, but also thrive. Access to new diagnostic and treatment technologies, including minimally invasive surgery for congenital anomalies, is one priority. Another is optimising care for premature infants, starting right in the delivery room, to minimise health problems which can emerge as they grow and develop.
A three-way partnership between the Republican Perinatal Center in Tashkent, Uzbekistan’s Center for the Development of Professional Qualifications of Medical Workers, and the Center for Feto-Neonatal Health at the Universitätsklinikum Carl Gustav Carus in Dresden is tackling this agenda in a very practical way. Since mid-2022, neonatologists, neonatal surgeons and neonatal nurses from Uzbekistan have had the opportunity to learn new techniques and approaches to caring for small and sick infants directly from their German counterparts. And through participation in study tours to Dresden, workshops and master classes in Tashkent, and an international study on delivery room management, they have also had the chance to reflect on their current practice and to introduce small, but important changes which benefit the newborns in their care.
‘This partnership has brought a lot of new knowledge and practical changes into our daily work,’ says Dr Nodira Kasimova, the Deputy Director of the Republican Perinatal Center, Uzbekistan’s leading tertiary care hospital for small and sick newborns. ‘The cooperation with Dresden is helping us not only see the problems, but also the ways to solve them.’
The genesis of a dynamic partnership
The Tashkent-Dresden partnership is supported by the German Federal Ministry for Economic Cooperation and Development (BMZ) and facilitated by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), which implements a project on the effective use of advanced medical technology in Uzbekistan on behalf of BMZ.
Cornelia Becker, who leads the project, helped to establish the connection with Dresden in response to a request from the Republican Perinatal Center for support to expand its capacities to perform neonatal surgery. Searching for the right partner for this highly specialised topic, she turned to members of the working group on children’s health at the Global Health Hub Germany. They, in turn, directed her to Professor Mario Rüdiger, the director of the Center for Feto-Neonatal Health in Dresden, the first such institution of its kind in Germany.
Professor Rüdiger was immediately intrigued by the chance to be part of a structured effort, backed by Uzbekistan’s Ministry of Health, which aimed to improve the health of pregnant women and newborns. He also welcomed the chance to combine medical technology, provided by German development cooperation, with a collaborative programme of teaching and training for doctors, surgeons and other health professionals.
After a series of initial consultations, Professor Rüdiger visited Uzbekistan, including the perinatal centers in Tashkent and Fergana, to develop a firsthand impression of neonatal care in the country and to discuss promising areas for collaboration with the partner institutions. In November 2022, a delegation of neonatologists, neonatal surgeons and representatives of Uzbekistan’s Ministry of Health paid a first visit to Dresden and a formal agreement was signed.
‘After these visits, the cooperation really took off,’ says Aliya Zhalmagambetova, the responsible technical advisor with GIZ. ‘People now knew one another personally, they’d been in each other’s operating theaters, and they understood the level of experience on each side.’
Workshops and master classes introduce new methods into clinical and surgical practice
During the first year of the collaboration, specialists from Dresden delivered seven workshops and master classes to colleagues in Tashkent. The sessions were filmed and livestreamed to all 14 regional branches of the Republican Perinatal Center, allowing more than 500 neonatologists, neonatal surgeons and neonatal nurses across the country to benefit from the lectures and demonstrations.
Workshops for neonatologists focused on neonatal resuscitation and support for transition, and on the use of ultrasonography to diagnose congenital anomalies of the heart or damage in the brain. Professor Rüdiger introduced participants to an alternative method for placing umbilical catheters (‘side-entry’), which proved highly popular, and also provided an overview of therapeutic hypothermia, a special treatment for babies with hypoxia which is not yet widely used in Uzbekistan. The team from Dresden also brought mannekins to Uzbekistan to support further teaching on resuscitation.
Neonatal surgeons from Dresden conducted two master classes in Tashkent, during which they performed two dozen endoscopic procedures to correct congenital malformations, together with their Uzbek counterparts. The surgeries were broadcast live to surgeons across the country, and then debriefed afterwards.
The surgical master classes were received with great interest, not least because some of the procedures were being performed in Uzbekistan for the first time. However, according to Professor Mario Rüdiger, ‘the most important part is that the surgeons explained how to care for the baby afterwards.’ They emphasised the importance of making rounds, checking on patients, and engaging with parents who are often frightened by the seeming fragility of their tiny babies.
Sophisticated devices can help doctors to accomplish amazing things, he noted, but only when they are embedded in a package of care: ‘If you only put the focus on how to do the operation and then you go, the results won’t change very much.’
Different specialists must work together to deliver effective neonatal care
The importance of a holistic package of care was not lost on the Uzbek neonatalogists who visited Dresden. ‘I was deeply impressed by the work of the neonatal nurses,’ says Dr Umida Nasirova, the Chief Neonatologist of Uzbekistan and the Deputy Director of the Center for the Development of Professional Qualifications of Medical Workers. She and the other members of the delegation were struck by the precision with which the German nurses handle premature babies and how they engage the babies’ parents from a very early stage, in close cooperation with psychologists and physiotherapists.
Watching the nurses work, they also identified a number of simple changes – from the placement of feeding tubes to the way premature babies are positioned in their beds – which they could easily introduce to help the babies’ development and well-being. ‘We saw in Dresden that they have possibilities we don’t currently have because of the equipment at their disposal,’ says Dr Kasimova, the Deputy Director of the Republican Perinatal Center. ‘But we also realised that there are a lot of things that are in our hands to change.’
With this idea in mind, they invited nurses from Dresden to come to Tashkent to conduct an interactive workshop on basic newborn care. Through demonstrations with mannekins and pre-recorded videos, the German nurses presented the essential elements of their approach. More than 80 nurses from across Uzbekistan took part; feedback was uniformly positive. ‘This was the first time that our nurses ever attended a training event at such a high professional level,’ said Dr Umida Nasirova. ‘There was a lot of interaction and time to ask questions. We need to expand this kind of training.’
Far-reaching effects in a short time – and a strong desire to keep going
The Tashkent-Dresden partnership is noteworthy for the dense web of ties which has sprung up between the three institutions as more and more health professionals from different specialties have become involved in teaching, learning and sharing. Trust, mutual respect and openness have characterised the engagement from the very start.
There is a strong desire on both sides to continue the collaboration beyond the end of the current project in March 2024. The Uzbek partner institutions would like to widen the lens and to consider maternal and child health more broadly, including a focus on diagnostic screenings and the detection of congenital abnormalities among pregnant women. This would be an important contribution to the further development of Uzbekistan’s health system and the government’s commitment to building a ‘social state.’ Given the enthusiastic backing of key partners and neonatal experts in the country, the sky is the limit when it comes to this very special collaboration.