“You never want to lose a baby”: Gathering with purpose at D-Rev’s first newborn symposium
Above: Participants gathered in Kigali, Rwanda in March 2019 for newborn health symposium presented by D-Rev, the Rwanda Ministry of Health, and the Rwanda Pediatric Association.
One thing about neonatologists, they are very passionate about their babies. You never want to lose a baby. You would do anything to save that baby… and sometimes babies are very sick, and we have very few neonatal intensive care units. And even the spaces sometimes are not enough. So sometimes as a neonatologist or as a doctor or as a nurse, you are asking yourself, “Which baby is going to go in the ventilator? Which baby is going to go on the CPAP?” Because the CPAPs are not enough. “Which baby is going to go under phototherapy?” Those are some of the challenges that we face.”
-Dr. Victoria Nakibuuka, Neonatologist at Nsambya Hospital in Uganda and symposium panel moderator
It is 2019, and hospitals around the world still do not have the equipment they need to care for newborns, their most vulnerable and precious patients. So at the end of last month, D-Rev, the Rwandan Ministry of Health, and the Rwandan Pediatric Association gathered over 100 doctors, nurses, government health officials, innovators, journalists, and development professionals from across East Africa for a symposium, Newborn Health: Spotlighting Innovations in Design Solutions, in Kigali, Rwanda to talk about the challenges they face and discuss potential solutions.
Representing Rwanda, Kenya, Uganda, Tanzania, and Zambia, the panelists and participants voiced concerns that varied and reflected different health landscapes. But there were also common themes. Among the challenges mentioned most frequently:
Prematurity rates across East Africa are astonishingly high. Almost 50% of babies born in Rwanda in 2018 were born premature. Rates in Kenya are similarly high at 30%. Compare that to prematurity rates in the US and Europe of 10% and 9%, respectively.1 Clinicians who treat newborns are also facing high rates of birth asphyxia, congenital malformations, neonatal sepsis, neonatal jaundice, and sickle cell anemia.
Health workers are working under tremendous burdens and constraints. There is high turnover, especially among nurses, and few specialists. For instance, at one hospital that D-Rev visited in East Africa recently, Krista Donaldson learned that there would sometimes be only one nurse on duty to treat up to 48 patients. This strain on staff negatively impacts skill and capacity to care for all patients, staff morale, and institutional learning.
Much of the equipment that hospitals have access to is still inappropriate, unreliable, and costly. Progress has been made in preventing donations of broken or unwanted equipment into Sub-Saharan African countries, increasing the quality of donations. Most governments and hospitals would rather choose their own equipment, however, and many governments and hospitals still struggle to procure enough devices and consumables (i.e., necessary accessories like breathing tubes attached to CPAP devices) to treat all their patients.
Newborns are only just recently getting the global attention they deserve. The Millennium Development Goals (2000-15) included a target of reducing under-5 child mortality, but the Sustainable Development Goals (2015-30), now put special attention on newborn health, by calling for an end to preventable neonatal (and under-5) deaths, and a reduction in neonatal mortality rates to 12 per 1,000 live births. Meanwhile, we heard relief and enthusiasm from symposium participants that neonatology, as a practice, was getting more attention—and hopefully, more support in the form of expertise, training, space, equipments, and services.
Health systems are complicated, and determinants of health of are multifaceted. But that doesn’t mean that there are not some actionable solutions. These were among the solutions that seemed to resonate and energize participants most:
Support research, especially on what works to improve care and outcomes. While we seek to understand the underlying causes and drivers of prematurity, for instance (e.g., through the excellent discovery research being done by the UCSF Preterm Birth Initiative), we must develop and test evidence-based solutions that give doctors and nurses the confidence they need to care for their patients. D-Rev was grateful to Child Relief International (CRI), who provided funding for a study that showed that providing 46 hospitals across Rwanda with 106 Brilliance phototherapy devices significantly improved the quality of care actually provided to newborn patients in those hospitals. This is the kind of research that governments and hospital administrators can rely on in making smart, transformative health policy and procurement decisions.
Be willing to innovate. We heard inspiring and successful examples of innovation addressing old problems in new ways, including; lifesaving blood deliveries via drone by Zipline in Rwanda; educating parents on pregnancy and child development through mobile app Totohealth in Kenya; and providing interactive, personal reproductive health information through chat tool Lily Health, also in Kenya.
Support clinicians through training and development of evidence-based protocols and guidelines. Whether through the heartbreaking stories of under-trained staff in hospitals making avoidable mistakes, or the dearth of neonatologists in hospitals throughout East Africa, we understood that there is a hunger for more training, and now. Fortunately, we learned how successful Project ECHO tele-clinics can be in connecting specialists with primary health care providers spread across great distances. And we learned that the Kenya Pediatric Association will soon be releasing one of the first comprehensive guidelines on neonatal care in East Africa.
Once you know what works, scale it. For years, Gradian Health Systems has been singularly focused on delivering its universal anesthesia machines (UAM) to hospitals in low-resource settings. Their dedication, results, and insistence on quality and training have earned them deep credibility and respect—and health systems are taking notice: their devices are now in use in 24 countries around the world, and the Tanzanian government recently selected Gradian’s UAM as its anesthesia machine of choice for hundreds of upcoming health facility upgrades.
Before and after the symposium in Rwanda, D-Rev had teams of D-Rev engineering and impact staff visiting over a dozen hospitals across Rwanda, Kenya, and Uganda. We were meeting with doctors and nurses to better understand their priorities and constraints. In every hospital we visited, the concerns voiced by participants at our symposium were echoed. But for every issue that health care providers faced, doctors and nurses had twice as many ideas on how to address them. The need is there, surely, but so is the creativity and a desire for solutions. Those busy offering care to the smallest and newest humans on the planet just need those of us with the skills and vision to collaborate with them on solutions to listen to what they are telling us—and to act.
Much gratitude to Child Relief International (CRI) and New Opportunities Foundation for their sponsorship of the symposium.
1Rwanda rate: “In Rwanda in 2018, out of 320,000 babies born, 49% of them were premature babies.” – Dr. Agaba Faustine, University Teaching Hospital of Kigali (CHUK), Rwanda. Kenya rate: Kenya Pediatric Association. US rates: CDC. Europe rates: https://www.who.int/reproductivehealth/global-estimates-preterm-birth/en/.