Professor Tony Ryan:

I thank the joint committee for giving me an opportunity to address it today. I am a paediatrician who specialises in newborn medicine. For ten years, with my colleagues in Cork, including Dr. Sami Ahmed, who is from Sudan, we have made approximately ten visits to Sudan to teach newborn resuscitation at Ombdurman Maternity Hospital, the largest maternity hospital in Sudan. We realised, however, that approximately 80% of deliveries in Sudan take place outside of hospitals - primarily in villages - and most deaths occur in the newborn period around the time of delivery. As a result, we decided to introduce the Helping Babies Breathe programme, a new initiative from the American Academy of Pediatrics.

I will describe how babies are born in Sudan and the changes that arose as a result of the new programme. Selma is 16 years old and is having her first baby in a village of 100 houses. Her midwife, Fatima, receives a call on her mobile phone informing her that Selma is about to deliver. All of the midwives have mobile phones. Fatima puts on her white sari. She has a bucket of water which was boiled the previous night and an aluminium box containing equipment that has also been boiled. She walks across the village and knows which house to enter because everyone in the village is gathered around it. A birth is a festival in the village. She enters the house to find Selma, her mother and the father's mother. The midwife will sit on a stool, while the two other women will be on either side of Selma. The midwife, who does not have gloves or a local anaesthetic, will wash her hands, make a large episiotomy and deliver the baby. If the baby cries, there is a good chance it will live. If it does not cry, she will hand it to a grandmother before delivering the placenta. The grandmothers know the baby will die because it did not cry and the people outside will turn away from the house. They will say, "Selma is young and will have another baby next year."

The next year, Fatima may come to Helping Babies Breathe, where we will teach her how to use the equipment, which I have brought with me. Fatima must concentrate on giving the first minute of life to the baby and helping it breathe in the first minute. If Selma becomes pregnant again the following year and the midwife returns to the village, she will have a plan. She will wash her hands and prepare her bag and mask for delivery. She will also prepare a clean area in the room in case the baby needs help. When the baby is born she will place it on Selma's tummy and dry it vigorously to stimulate it. If the baby is still not breathing, she will cut the cord, bring it to the clean area and keep it warm. She will then suction out the baby's mouth, place the mask around its head and squeeze the mask, repeating the words "Breathe, two, three." She will then change the position of the mask, repeating the same words. The baby should begin to move and cry. If it starts to breathe within the first minute, it will survive, and Fatima will bring it to her mum.

Helping Babies Breathe is based on a very simple concept that if a baby breathes within the first minute of birth, it will have a chance of survival. We will change practices through this programme. Last year, Irish Aid provided funding to enable us to purchase 1,000 bag masks and suction balls at a cost of approximately €25 per training.