Table 2 Description of NG tube feeding of a premature baby, First 24hrs in Kijani – room A

Among the three other mothers whom nurse Mwajuma had shown where to place their babies was Hellen. Hellen is a first time mother and she was told to place her baby in an incubator that already contained another premature baby. For the first one hour, she mostly just stares at what is happening around her. Next to her are other mothers including the mother of the baby that is in the incubator with her baby, all of whom are busy either expressing milk or feeding. Nurse Mwajuma is still attending to the baby in the radiant warmer and Hellen appears to have no idea what is expected of her or what she is to do. She keenly observes what the other mothers are doing and strikes up a conversation with the mother of the baby who shares the incubator with her baby. Her neighbour had been there for a couple of weeks. Under each incubator are drawers and her neighbour informs her that she can keep her babies diapers and feeding cups in the drawer. After checking, Hellen realises that her baby needs a diaper change and goes down to the postnatal ward to bring some diapers, she had brought with her essential baby items such as clothes and diapers which she had left in the postnatal ward. Upon her return, she turns to one of the mothers next to her and asks how it is done, she asks how to open the incubator and how to change the diaper. Having been there for some days now, her neighbour knows how to open and close the incubator and Hellen observes and learns from her neighbour. She is instructed by the mothers next to her on how to go about diaper change and how to close the incubator when done.

Mwajuma passes by and tells her to express milk and feed the baby. “She doesn’t have this pipe”, she informs Mwajuma who then tells her and asks her to wait a bit. As nurse Mwajuma goes away, Hellen turns to the mother next to her and asks, “Where do I get the cup and how do I know how much I am to feed?” she asks her neighbour. “The nurse will fix for you this pipe and tell you how much to feed”, she is told. She sits and waits for Mwajuma to get to her baby. When the nurse gets to her, she stands behind the nurse wanting to observe what the nurse was doing. However, immediately she notices the NG tube being inserted in her baby’s nose, she moves back and looks the other way, with both hands on her cheek. She can’t bring herself to observe the procedure. One of the mothers next to her smiles and asks her what was wrong to which she responds that she can’t watch that pipe being fixed, she imagines that the baby is feeling pain.

After fixing the NG tube, the nurse provides her with feeding syringes and tells her “do you have a cup, get a cup and express milk, then measure 5 mls and then feed the baby, I will get you the syringe, so you measure and then pour into this pipe”. She is handed the syringes which she places on the drawer on her baby’s incubator and proceeds to get a cup. She is advised by the mother she is sharing the incubator with to go and buy a cup downstairs by the gate. Hellen leaves the NBU and after a few minutes she walks back in with a cup, sits back on the chair and begins expressing. Having seen what the other mothers were doing, she follows suit and does what she saw the other mothers do. Unsure of what to do next after expressing, she turns to her neighbour and asks how to measure.  “Put what you have expressed into this syringe, you see this lines and numbers here, pointing to the marks on the syringe, so this is one..two,…five, so you put until here and then you open here and pour the milk inside the pipe”. After feeding her baby she is shown where to wash her cup and she then keeps her feeding cup and syringes on her drawer.