Hello Friends 👋

This episode of the Global Neonatal Podcast features reflections from the Tiny Feet Big Steps Conference, highlighting the growth and impact of neonatal care initiatives in Africa. Dr. Steven Swanson and Dr. Margaret Nakakeeto share insights on the importance of networking, quality improvement, and the future of neonatology in the region. The conversation emphasizes collaboration, the need for real-time translation in training, and the significance of engaging with healthcare systems and government for better newborn care.

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Resources mentioned in episode:

Link to playlist from Tiny Feet Big Steps conference https://youtube.com/playlist?list=PL-94lDL-ozLatIqf_yQVHjubePerN7NGg&si=fgFOBLpWVP2w5Yy4

Institute of Child Health Africa (ICHA) https://www.tanzanianchildren.com

Tiny Feet Big Steps Conference https://tinyfeetbigsteps.com

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Bios: 

Dr. Stephen Swanson

Dr. Stephen Swanson is a pediatrician and infectious disease physician. He is the Director of the Neonatal Intensive Care Unit at the Arusha Lutheran Hospital in Arusha Tanzania. He is also an Associate Professor, Division of Global Pediatrics at the University of Minnesota Medical School and a Founder, Institute for Child Healthcare Africa (USA, Tanzania) and the Tiny Feet Big Steps Conference.

Dr. Margaret Nakakeeto

Dr. Margaret Nakakeeto is a retired Consultant Neonatal Pediatrician from Uganda who has had an extensive history of working to build sustainable responsive systems for newborn survival.  She has been involved in various research projects on newborn health issues especially premature babies from disadvantaged and other vulnerable communities, children and women, and has published her work in international scholarly journals. Her professional interests include lecturing, leadership, and management in medical educational institutions

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The transcript of today's episode can be found below 👇

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This episode of the Incubator is proudly sponsored by Kiesi. Providing innovative neonatology solutions for more than 35 years, Kiesi is committed to supporting the neonatology community and the NICU families you serve. To learn more, visit www.nicuconnections.com slash incubator.

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Welcome to the Global Neonatal Podcast on the Incubator Network.

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monthly podcast highlighting the remarkable work being done around the world to enhance neonatal care.

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I am Dr. Shelly Ndekari. And I am Dr. Mbozu Sipalo. Thank you for joining us. Hello, everyone. Welcome back to another episode of the Global Neonatal Podcast. We are so excited to bring you today's episode. Mbozu, how are you doing today? I'm good. How are you doing? Still really excited from Tanzania. great. I'm doing good, but a little jealous.

that I didn't get to make this conference. Mbosu was at the Tiny Feet Big Steps Conference in Arusha, Tanzania, and was able to talk to a lot of amazing folks doing great work in the field of neonatology and trying to improve care of neonates everywhere. And so we are very excited to highlight just two of those conversations that Mbosu had with two guests, but we are going to link below.

all the conversations that Mbozu was able to have. So please check that out. Like I said, the link will be below in the description box to all of the videos and conversations from that conference. But Mbozu, tell us a little bit about the conference, what it was like and about the two talks that we're gonna focus on here. Yeah, happy to. So it was the fourth annual Tiny Feet Big Steps Conference. Firstly, I was just amazed at the fact that

they host this annually because that's insane. And it's always in Arusha, Tanzania. Arusha is beautiful, beautiful weather, beautiful people. The conference itself had representatives from about 17 countries and not just African countries. There were a few from Haiti and Mongolia. And also it was just a nice positive environment. More so

as we talk about these very sad things that, yeah, the outcomes in African countries and other LMICs for neonates hasn't been favorable, but then it was just great to speak about it in such a positive way. And also in a way that is very contextual to the African continent. Really excited to be profiling these two amazing speakers for this month's edition of the Global Neonatal Podcast.

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So we have, of course, the founder himself and his name is Dr. Steven Swanson. I think a few of our listeners will find that name familiar because we profiled him earlier this year. He is the founder of Tiny Feet Big Steps and also the founder of the Institute for Child Healthcare Africa. And really excited to have him speak about the conference in a reflective way after the six very exciting days.

And also we'll be having Dr. Margaret Nakaketo, who was another really, really amazing lady that we spoke with. So she is a consultant, retired consultant, neonatal pediatrician from Uganda. And they call her the matriarch of all things neonatal from Uganda. Yeah. So really, really wonderful people to speak with, with a wealth of experience in neonatal health in Africa. And I'm glad that

listeners will be able to hear from them. Great. So without much further ado, we will get into those conversations. Hello, everyone. Today is the last day of the Tiny Feed Big Steps Conference. I was with the host of the Global Neonatal Podcast. And we're here with Steve, finally, to just have a chat about the conference and see the deep reflections from how everything went. Hi, Steve. Hi, I'm busy. Hi.

I'm good. How are you feeling? Well, I think I'm losing my voice. I'd say deprived. But I'm really good about how the last 60s went. Amazing. Firstly, congratulations to the whole team, to you on just executing this conference. It's been quite an event, very energizing, very packed, but also very light and positive. So big congratulations to you and the A-

LMC team. Yes. So to take us back to just the heart of the conference, where did the idea come from? In 2019, when our NICU was growing dramatically quickly, and we had already spent about five years writing protocols, we had done a lot of workshops throughout Tanzanian hospitals. In fact, that particular year, we led 12 workshops at large government hospitals.

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that were each two to three days long. We began to think about, wouldn't it be great if we could bring everybody to a rucha and gather everyone here? And so we planned to do the first Tiny Feet Big Steps Neonatology Conference, which was a name that actually one of my nurses came up with. I don't take credit for it. And we planned it and we were all ready to launch it and then COVID hit. And so the world shut down, speakers that were traveling to Tanzavia

We're stranded in airports and we postponed it to 2021. In 2021, when we did the conference, it was three days long and have five countries represented. Each year it has grown with more attendees and more countries represented. So that this year we were somewhere around 230 attendees from 17 African countries, if I remember correctly, and then several non-African countries like Haiti.

Mongolia and Pakistan. The idea for the conference really came out of a desire to share what we had learned and those mistakes that we had made that could be avoided with other hospitals, primarily African hospitals. Though over time I've begun to welcome more and more non-African countries because I think it doesn't really matter where you are in the world. We're all having the same challenges of

in a low cost, low tech, evidence based way, how do I maximize my NICU to be able to both survive and thrive little babies? That's brilliant. And yeah, just a nice way to give us a background of the heart of the conference. So how do you think it's changed over the four years of its existence? Over the four years, we've noticed A, that we've

been able to draw more and more African-based speakers and trainers, doctors and nurses. It seemed that there's a growing pool of talent within Africa. we're less reliant on going outside to high income countries to bring in speakers. Though frankly, as the conference has raised in profile, I receive it for more requests from individuals in Australia, United States, Europe who would like to come and participate.

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But we have more and a larger African talent pool over the last four years. And that's also a credit to the African Neonatal Association and all the things that they've done to develop. I also noticed that the level of knowledge and where people are coming in and starting from has risen. In 2021, when we led our first conference, some of it was very basic. were teaching people very basic resuscitation, HVB.

basics of warming a baby, positioning a baby. This year, people come in with higher knowledge. I think that's also because we're attracting more countries. We also have a lot more international individuals. This year, over half of the participants were non-Tanzanian, coming from academic hospitals, mission hospitals, residency and fellowship programs.

So we've grown both in size and outreach to other countries and the talent pool has deepened both with instructors and the attendees. Okay, great to see how it's grown. There's been like a scale up of the conference. Adding on to that, what do you think you've learned? Like the key, maybe the key three things you've learned over the years as the conference has developed? Well, I've learned that in order for us to really do this,

It takes a huge team. had 50 nurses and doctors and psychologists and ultrasonographers who came to participate in teaching, both in lectures and in workshops. We could never have done a conference of 90 unique lectures and workshops without this team of 50 individuals who flew in most of a month at their own expense, taking their own vacation time to be part of something that is

is wonderful and growing. I've learned that we need that team. I've learned that we need sponsors and donors more than ever to support the conference. Our conference costs were fixed. We were only able to charge somewhere around 25 to 30 % of what it cost us per attendee to the actual person coming and learning. And so that gap between what we collected, but what it cost us was made up by sponsors.

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exhibitors, donors, and that is important. We've learned the value of networking. When people came to the conference the first years, the immediate response was thank you for all of the knowledge, for the foundational skills, for the protocols you're sharing. But this year, one of the most common things we hear back is thank you for the opportunity to network, to connect with other hospitals in Africa and instructors from around the world.

That networking is so important because it allows people to go back to their hospital, have a resource or a person they can reach out to with clinical questions, and not feel alone in the work that they're doing. Yeah. I got that a lot in the conversations I was having myself that this was a brilliant way to connect with both peers at your level and a lot of the senior, senior people in neonatology. So yeah, it is a brilliant space for that.

Considering you do have a big group of people, I can imagine you receive some feedback, both good and bad. How do you think the conference can improve going forward? Well, we, from the very beginning, we wanted to value nurses. And therefore we made the conference in its educational format, in the lectures and in the workshops, as much nurse-friendly as doctor-friendly.

And therefore that meant that we were going to create special workshops and lectures for the nurses, those for the doctors. But what I think we can improve on is finding a way to bring those workshops together to engage both of them at the same time. So workshops around resuscitation are all certain NICU based procedures where nurses are just as much there. Workshops that maybe the doctors need to be involved with to understand better what the nurses are doing, undulating procedures in the NICU.

and vice versa, bringing the nurses in for some of those physician workshops. It's hard with a group that big to individualize their training and also bring them together. It's something I think we're struggling with, but it's something we need to do better is bringing the nurses and doctors into shared workshops where they learn, particularly the doctors, to listen to the value and the ideas that the nurses bring at various times.

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especially with resuscitation. Yeah, I completely agree with you on that. The value of communicating well between a doctor and a nurse and a NICU, because it's such a small space and you do need to communicate well. So that's a very good note to take, something to take note of. The next question I have is, I do understand that the idea behind this conference is that people should go back to their homes and basically promote

the learnings from this conference. But what's your thought on taking the conference to other places in Africa? I understand that you've been in Tanzania the past four years. Do you have plans of rooting in other places as well? Yes. So the NGO that is now serving as the sponsor and the umbrella organization for Tiny Feet Big Steps Neonatology conferences is a new NGO that was

created in the United States and registered in Tanzania called the Institute for Child Health Care Africa, or as the 10 students like to call it, ICHA. And I think that part of our vision in starting Institute for Child Health Care Africa was A, to make it about training, hence the word Institute, to make it African-focused, hence the word Africa, but actually to go beyond Tanzania. And I'm already looking at how we can do

shorter versions of his conference in places like Uganda, areas of East Africa, and then it's in my heart to bring it out into West Africa. And I'd especially like us to be able to start to reach out to the Francophone or the French-speaking African nations. I feel that that's an area that we've missed it on. We need to find ways to do real-time translation of the lectures and the workshops to get our printed materials in.

translated into French and to actually expand this opportunity, this teaching into the Francophone countries of Africa. Mm-hmm. I love that, like, bringing in Africa and also breaking the language barrier. I met this Maasai translator here who was helping a neonatal expert from Cameroon, and that was one of my most favorite interactions from this conference, because it was just such a beautiful reflection of cross-cultural

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barriers, know, and breaking those barriers. So I do appreciate that insight that we do need to get into the other non-English speaking African countries as well. So you touched on ICHR and I'd love to hear your thoughts on where you think ICHR is going as the conference grows as well. So originally when we started Tiny Feet Big Steps, we were under a relatively small Lutheran hospital in Arusha that I had been working at for

about 10 years to develop the NICU and from which we wrote protocols and we adapted them into a book. I'll bend over for a moment and show you. are the two books are actually identical. One is a physician or nurse copy that they could put in their coat pocket or in their bag. And this is the book that we keep in the unit. And it's about 400 pages long and it covers a wide range of topics and also drug doses.

And more recently, Echa has taken over the writing and publishing and dissemination of this book. And the reason for that was that we realized that since we're growing, we've trained over the last four years, probably over 300 hospitals and well over 600 doctors and nurses. We need to upscale that. We need to find ways to

and we need to find ways to reach out into new countries and lead new workshops. And so Institute for Child Health Care will be the umbrella for that. But furthermore, I've been thinking a lot about how the lessons learned in Tanzania can serve as a canal that feeds a thousand farms, rather than just keep it to ourselves, nurturing one farm or one NICU.

use this as an opportunity to spread it across Africa. Through partnership with other organizations that are doing education as well, Incubator is one of them, and using the book Conferences Under the Umbrella at Vicha. And then we would like to go one step further. We would actually like to build a team of African neonatologists and nurses and educators and biomedical engineers and

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through each go and spend two, three months in various hospitals in their NICUs across the continent, helping them think through and implement high impact, low cost interventions to help their NICU. And so each could be, in other words, a training institute that sends teams to work and then we draw teams in for conferences to add on to that.

As I think about that, it's important to me that we bring people together for the networking, for the teaching, for the workshops and conferences, but then we follow up and we go to their location as educators and collaborators and always with the heart of, what can we also learn from you? Because this is not a unidirectional relationship with every NICU and with every doctor we work with, we come back with new ideas.

And new ways to strengthen the training in neonatology. I really love that reflection and just connecting Africa. And it really does need to be connected more to go faster together. My last question, just on a light note, could you tell us any happy reflection from this conference? Like one of your top, top, top moments of, this conference happened before we close. I've had a lot of...

shaking my hand, hugging me, thanking me for the books. We gave a large book to every hospital in, well there were 120 hospitals, we gave a large man to every hospital. And when I announced today that we were going to do that as a final gift, the audience applauded. Because I know that a lot of doctors and nurses may have enough money to buy a small book for themselves, but they don't have the $40.

to buy a book for their hospital, especially if it's an unreimbursed expense. So that was a really happy moment. I particularly love those workshops that are addressing four key areas that I call sort of four pillars or the four legs of a chair on which a NICU has to be built. And those workshops were around thermal regulation, helping babies breathe and being the lungs for a sick baby.

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through bubble CPAP and non-invasive means of respiratory support until that baby's able to independently breathe on their own. Helping babies to grow through good nutrition and feeding protocols and what we do to keep babies from getting infected. So infection prevention and control. So thermal regulation, respiratory support, nutrition and growth and infection prevention control.

All of those workshops were so well received. And I'll add one last really highlight. We do a skit every year with our foreign and African instructors where they are in a NICU and they're just making every mistake you can make around infection control. And the audience is just laughing as the doctors and nurses do one stupid thing after another, breaking infection prevention and control rules.

And then the audience raises their hand and they point out every mistake that typically the foreign doctor made. And it's a light moment, but it's a teaching moment. And that's always a highlight for me to see the audience's response. It's a lot of swaps to humor, but it's effective. I love that. On that note, this was a lovely chat and I'm glad I've gotten to chat with you in person because we met online months ago when you were talking about this conference.

Congratulations once more. And yeah, hope to see all the dreams and aspirations that you talked about through this conference coming to fruition. Well, it comes through people like you that's probably enjoying us in this journey. What was that saying that I think someone said, you want to go fast, go alone. But if you want to go far, go together. And so this is a together project and not one person or one

organization can take credit for it. Yeah. Thank you so much, Dr. Swanson. wow. So inspiring. It's always so great to hear from Dr. Swanson. I leave inspired, you know, the possibilities, the optimism, just so great to hear, I mean, the conference and what the work that he's doing. Yeah. Like, I'm so glad I managed to grab him post-

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conference because he's naturally a very, very busy person. But yeah, it was good to get a reflective approach to the week that was very, very jam packed, but also very informative for many. And happy to now shift to another incredible woman in the near NATO space in Africa, Dr. Margaret Nakaketo. And I hope more will be inspired from this lovely conversation we had together.

All right. Let's take a listen. Hello. This is day six of the Tiny Feet Big Steps conference. And I'm Dr. Sipalo, your host for the Global Neonatal Podcast. Today is the last day of the conference and we have yet another incredible person with us to get to speak with and just learn more about. Hello there. Hello. How are you doing today? I'm fine. How are you? Good. Can I please get your name and your background? well.

a doctor, Margaret Nakaketo Kijambu, and I'm a Ugandan. I am a neonatologist. I'm retired, but not tired. And so I work a lot with the Ministry of Health and Global Health. And I took on this task of implementing newborn care services in the country. So I helped the Ministry of Health with that. wow. I love that. Retired, but not tired. And there are so many researchers.

I realized that first I was really involved in research, but there was so much evidence out there, but this evidence was not really in action. And so I said, but I can take that evidence, which is being talked about evidence-based, evidence-based, and then put it in action. And that is really what I do, trying to establish, I call it a responsive and sustainable system for newborn care in that country. Responsive.

Responsive and sustainable. So it responds to the gaps and then I have to make sure that when it responds, it is sustained. So that is why, and the QI is about that. So if you want to do quality improvement, you have to come up with small. And I believe why I like this conference, tiny feet, big steps. those tiny feet, those small things we do, the tiny little things we do, they can make a big, I remember

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Last year, think the theme of the World Prematurity Day, that small actions, big impact. liked that theme so much that washing hands only, can reduce the infection rates even by 70%. So, and sustaining it is usually the problem. So, I really want the quality improvements we have put in place to be

They can say, I always tell people quality is not talked about. Quality is visible. So if you really have a quality improvement program or whatever, people should come and as soon as they like come in, see it. They see there's a system there for quality. So that is what I, and my job, maybe I can serve as an influencer. I've learned some words.

As an advocate for newborn, as a champion for newborn, as a mother of a newborn, grandmother, I have so many names back home there. Matriarch. Yes, Matriarch, which is that. So I feel that we have to help the young generation. I tell people I'm 65, but we are still working with the young people and the young people we have to really

help them to realize that they can do it. You know, most people, they may have the skills, they may have the passion, they may have everything, but they feel they don't know how to take the first step. So we, as the people who have gone through it, who have reached to that stage of saying that you can change things, we have to help them as they take the small steps. We are behind them saying, take another one, take another one.

You can do it. If you have done, take the next one, take the next one. And then sometimes I'm amazed. They take those first ones with care, with care. Then sometimes they run after that and they leave me and then I say, wow, okay, ready to go. And then you get another one and you take, you take, And then one other thing I've seen that after that, because the...

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in this conference, they asked me to talk about the regional. Because as you saw, most people are talking about my NICU, my NICU, my NICU. And actually, I started with my NICU. And then I said, but this NICU is in the national, it is this capital city. How many babies really come from here? And yet every time they say the babies are born out there. So if the babies are born out there, who will reach out to them? So that's why we thought that as you saw, capacity building. But as I said,

that you need some kind of power, you need some kind of authority, people to believe that in you. And that's why I work with the Ministry of Health, because this is the top most. Like today when we are saying that, they are the boss. So if you think that you are going to bring your things and you are not following their policies, you are not following their why, you do not communicate with your boss what you are going to do. And really I've found even local government is worse, because at the top,

because they are policy and what it is easy to make the policy. But I can say local government now they implement us, the district office, the assistant district, and most people even they don't know the hierarchy or the infrastructure or how local government works. So you take the initiative to know what does the local government act say? What are the policies in your ministry? Because WHO can give guidelines on what.

But what does your ministry say? What does the country say? So when we sit in these meetings, for me, for one, I really to say, what is the essential drug list like? So if the essential drug list is there, are your drugs there for your newborns? And if they are not there, so you raise your hand, the list you are putting it up, but this is not there. Are the ND tubes the right sizes? No, they are not there. And then, as I said, sometimes people

up in the country because newborn I used to use the word that was in limbo. was nobody was talking about babies. Every time you talk about reproductive health, the first person is the mother. But that mother I always used to say she wants a baby. We are reproducing and she wants a lively, healthy, a white baby. But we don't think when we are planning that how do we plan for this mother to get a healthy baby. So,

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In short, think the message is clear that you have to have the right, and I always say have the right communication at the right time, use the right words and why at that particular time. And then you have to watch the roadmap. What is trending? You know, some people, you can bring something really out of the box, see what is trending and also...

You walk with the train. Run with the train. Don't bring something and then everyone will say, what is this one talking about? So always be on the ground. You may have been thinking, I've been thinking about this thing I said since I was a resident, but I had to wait for the opportunity moment. I had to wait for everything. As I said, that whenever you want change and you see you are not in the...

The timing is wrong. The critical event, which I was talking about, something erupts all of a sudden. I remember when I was still the boss of the neonatal unit at the national level. You want the babies' washbasins to clean them. They want this. And it's not happening. Then I got an outbreak of tetanus. I used it.

I went to the administration, I said tetanus. The international says this, NICU is supposed to be closed, what, what, no. And then they said, but you can't close the unit, said. So they were like dragging. I wrote to all the health facilities around and I said, don't bring babies here, we have had an outbreak of tetanus. And then I did what? And because it was the national, now the director stood up, said, what do we do? So.

then I give my plan. What does the national guidelines say when you get whatever? And so we implemented so many things and the things appeared like I don't know how. So critical events. Be ready. Listen, watch out, read the news, what it's saying, what is trending. Basically, that is the way. And as I said, when you...

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The boss, everybody's a boss in there, whatever. So when you go there, now don't go there as if now you are the other boss. Go there and humble yourself and say what you want to say. Appreciate that they are doing something, but don't come and think that you are going to tell them what to do. They've been doing something. I used to, when I was still now junior, and then my director would say,

Margaret, why are babies dying? Why are babies dying? I said, why shouldn't they die? Then she said, why are you asking that? I said, you tell me that you gave me this, you gave me this, you gave me this, you gave me this, and the babies are dying. said, what? She said, yes, I've given you so many lists all the time, so that's why the babies are dying. So you know, it is like she's to cheat him back, but in a very casual manner. Not to say what, she says, okay, what do we do?

Then okay, now we are talking. Okay? So now we are talking, then you list down the things and why, and then we start and then we say, because you already have a plan, it is already there. So don't go there and then you don't have a plan. So you say, if we do this, if we do this, if we, then it says, okay, you're going to be in charge. Like I remember we used to have babies dying, no oxygen, every time midnight the oxygen goes.

because the central oxygen was not enough. They were using cylinders and distributing the whole hospital into a big hospital. So one time in the morning, there was a baby who almost died. He had severe asphyxia. And it had been long in the ward and was a precious baby to this family. why? So the baby, they called the director that night. So in the morning, I said, I've been telling about this oxygen.

So I have nothing to do. But I said, I heard there was a plan some years back before it came that they are going to build an oxygen plant here in the world. What happened in that plan? Which hospital was that? It was Mulago, the National Hospital. So he said, OK. So when digging out the plan was there, I think it was 30 million or something. And then he said, I put you in charge. And then I said, how long? I said, two weeks.

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Then he said, put you in charge to see that the work goes on. And within two weeks, we had the whole thing constructed and we had an oxygen tank. think the oxygen was coming from Nairobi. This big, huge task. the oxygen thing was just critical. I told the parent, know, critical event.

Yes, and there was good in the night by this parent, know, the affluent, the some government official, no? So it is just that you opportunities, you say, action-oriented and acting at the right time, the critical time. Yes, at critical time so that you who is so vulnerable and what you get that opportunity. I really appreciated that point from your panel discussion talk today about just

the approach to the government. So one of the things I took home was that you have to be very humble. Yes. What other things do you think health care workers should have in mind when they want to approach the government? Yeah. And then, like I was saying, we become humble when you are mature and what. But the young doctors, because of course the other one sees them, they become vulnerable and you become like naive. So you go there like you are seeking help.

Well, I am here, maybe a student or I'm an intern. I'm just new. what I do? you will take care, you will become now a mentor. Yes. But if you go there, you see now you are here, there are no things to use. There's no this, this, this. So you become vulnerable. You become humble. You become naive as if the whole system. I want to know how do I go about this? When I want this, where do I go? Then I say, okay.

sit down here and then you talk to him and what and then you if automatically you become his mentor, her mentor, because every time she has a problem she will come to you. Every time she has a problem she'll come because even me when I was starting with the neonatal unit, then director, I went there I said, the thing says this and this, how do I go about it? This renovation they had put the special care unit, the neonatal care unit was not a priority.

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So when I went I said, I see they renovating the whole hospital, but our unit nothing is happening. I said, wanted this, I wanted that one. Then he called the contractor and then he said, I want you to work with her. She has some issue. the contractor was like, did you tell me this? We worked well and when he put everything in order, then he calls me, are you satisfied with this? Are you what?

Yes. People want to know, but you have to really show yourself, but the way you even approach it and what be vulnerable, be... Go there to learn. Yes, go there to learn. What am I supposed to do in this situation? You know, and people don't know, as one of the panelists said, you have to know who is responsible for what.

Don't go to the director when you are supposed to go to the administrator, to the HR. No way are those. So people don't care, especially in the medical profession, people don't care to know who is who in the animal kingdom. Very important to know your boss, know the infrastructure. I love that. And then they say things have failed. Things don't fail. You have to have the system, the skills, the who, the...

And also another thing I've encountered in my practice, sometimes why I said that find the characters, find the work, you will find even that up there, them themselves are not their enemies or their work, they are not working together. And it's not a problem to start solving it or arguing about it. So when you know that the two don't work together, see each them separately and tell them they are whatever they are concerned with.

I always say people remain professional. Just be professional. Don't enter into wars which don't concern you. The office politics doesn't Yes, yes. Before you go and you tell this one, because you know he's one. Why? And for example, when we have big days like our wild prematurity day, then we go in that district, then you find these people are saying, security, you bring money for what to give them, whatever. But for me, I say,

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Who is in charge of security in the district? The resident district commissioner, the RADC. I go to the RADC, sir, we are here. We are going to have an occasion here. It's a national occasion. We are going to be, we shall need security. you need security. He will not, he knows you know that he's in charge of security. Then he will deploy his men. You will not put in a penny because that is his job.

But if you don't know, then you start saying, now in the budget, we have to put security, we have to have two policemen, have to have this, we have have this. So for me, I make those occasions very cheap. I go to the, the cow, I always have to meet the chief administrative officer of that district. This is the person in charge of the budget. And we say we want this, we want that. But what is he saying?

How are they perceiving? I went to one of them and said, no doctor, they shouldn't tell you lies. The DHOs are the ones who give us whatever. And when you go to the DHO, says, you see the cow, the cow. You go to the cow, says, whatever he gives us. say, okay. And you are with the DHO there. So will he tell you lies? No. From then you will say, cow said you are the one. Can you now put there this one? Don't you think we need it here? So that's the way we've been operating and then get success. And then another thing I tell people.

Let the boss take the credit. Not you as come thinking that you are going to be the credit. Let the boss take the credit. If the boss wants to praise you, let him be the one, but not you to go there and you are shining. So for me, that the way I've gone about that is whatever I take the step, whatever I go back and I tell him, now we did this, what, if you get time, please go there and visit the neonatal unit. Please do what?

please help me to tell you girls and what. And some of them even have given me, like there's one DHO, he said, can we make newborn now, when we are sending stuff, he called it affirmative action for newborn, that when they are sending the nurses to the hospital, they send them with the letter saying you are going to work in the new NATO unit. Because when they just send them, the priority of the hospital is different.

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They would just put them in the way. So I've got nurses and why. And even when I go to the district hospital and we are going to train, we say we have to have special nurses. Can you select them? And we train them and we also give them some administrative work and why. And so they are in there. They always know the good nurse, the one who is passionate and what. I said that one will head our unit and then we take them on and then we train them.

And every time we are in the training, we are saying, see, here you have, you start thinking of how you are going to do this, how you are going to create the system. So from the word go, she's whatever. And all of them, as you saw them in the chart, if you were there, I still have them five years. I've never lost any of them. Yeah, because of that, because they selected them, the administration gave them to us and what, and if they now, the districts are a bit difficult, I go to the head there and they send them direct.

I work with the ADHD. And when they come, the letter is saying, who? So many gems of wisdom. I've just been a sponge taking everything you've said. Thank you so much for everything you're sharing. I think before you wrap up, I'd just love to know, as you've been in the neonatal space for such a long time, what are your hopes for newborn health in Africa? Okay, health in Africa. First of all,

I'm happy because even when I was working training, now we have all in Africa countries that started those new and it'll fellowship programs, are very good. And now back home, I'm also pressurizing for short courses for nurses and that and mid-wide. And that's why I'm bringing them to such meetings. And because what I believe nurses, that division, keep on posting.

changing them every six months, every one year. So I said the only solution is for them to get a certificate or a diploma in newborn, then they will not take you anywhere. So I'm creating that type of whatever that in Africa, if we want our nurses and what to remain with us as in your network, get papers, get papers and they are your network nurses to say in your network this. So when you go to the hospital and you present, they will not work. And another thing which you

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I was going to start before I left, I retired. I wanted a neonatal division in every way because most of the hospitals, the universities, I don't know about some South African ones, but most of the universities in Africa, we have only pediatrics. And then neonatal is there in bed in three months. I used to tell people that, for example, when I was a medical student, we rotated in the neonatal unit.

or neonatology for two weeks. Of course, we are students. You can walk there, you see the lecturers. There are nobody, there's no attention. So you go away without really knowing anything. you know, the question is, this is not an exam for neonatology. This is the next time in pediatric. So neonatology, a few questions, if you fail them, it's not a big deal. And it's not a responsibility. Then when I came to my postgraduate, that's when I said, that's when I started seeing things. I said, what is the problem?

but also postgraduate, you are there for three months. So in six years, let's say seven, three years and six years, five and one, you have only like three months. If you do internship in pediatrics, you also go there for two weeks, okay? Because you are rotating in all these pediatrics, so you are in social pediatrics, you are in the world, you are everywhere. So you only go there.

for maybe two months. So it is ridiculous. So how do you explain? So I realized that most of the medical officer when they graduate after those six years internship and what they fear. Neonatology. Neonatology. Because not to work because they don't want to work there but they don't know. Because I have an example. I took some medical officers and I put them and I trained them and I did them and some were managers. And after doing that they have made changes.

And so many of them have even become managers because now they started thinking, right? They started feeling, they were confident that I know what I'm doing and they are really... So I believe that if this neonatology is first looking at it at the discipline when it's on in Africa. And I'm glad now there's the African Neonatology Association. There are so many neonatology associations in different countries and we're breaking away from pediatrics.

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So we should break, I'm not saying that we are not pediatricians, but if we really want also to really push, we should break away. I always use the term, we never cut the cord. Because we are either in the maternal, we are moving with the mother everywhere, The baby is, as you cut the cord, the baby's hours. It's no longer obstetric. So give us a space to take care of our babies. Okay. So when, so in also pediatrics.

I always say, you know, pediatricians, UPS, those associations in pediatrics, they want, they are all so concentrated in pediatrics. Neuronetology is just a small Just a by the way thing. A by the way thing. So let's break away and come and do Neuronetology. That's a brilliant way to end this conversation. Thank you so, much. Thank you. Wow.

Another inspiring conversation. I'm so in awe of the work that's being done around the globe to help our tiniest, most vulnerable patients. So inspiring. Truly inspiring and was so happy to be part of the Tiny Feet Big Steps Conference and to be able to speak with so many interesting, inspiring people working in neonatal health. And yeah, glad to profile Dr. Steve Swanson and Dr. Margaret Nakaketo in this month's

Global Near NATO podcast episode. Please do look at the show notes to get the rest of the interviews from the Tiny Feet Big Steps conference and do share with your networks so we get more people to know about the incredible work that's going on in Africa. yeah, hoping that similar organizations are able to do similar conferences and share with their wider networks. Yeah, definitely.

So with that, we will say see you next time on the next episode of the Global Neonatal Podcast. Bye.

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to our email address, nikupodcast.gmail.com or by visiting our website, www.the-incubator.org. You can also message the show on Instagram or ex, formerly known as Twitter, at Nikupodcast. Thanks again for listening and see you next time. This podcast is intended to be purely for entertainment and informational purposes and should not be construed as medical advice. If you have any medical concerns,

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