Hello friendsĀ š
In this episode of the Global Neonatal Podcast, Dr. Om Krishna Pathak shares his journey into neonatology, his experiences at Bharatpur Hospital in Nepal, and the various initiatives he has implemented to improve neonatal care. He discusses the challenges faced in developing a NICU, the importance of empowering nursing staff, and the significance of quality improvement projects. Dr. Pathak also highlights the role of mentorship in his career, the implementation of POCUS in neonatal care, and the ongoing efforts to train more healthcare providers in Nepal.
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Short Bio: A dedicated neonatologist and NICU in-charge at Bharatpur Hospital in Nepal. Dr. Pathak also serves as theĀ program coordinator for the Fellowship in Neonatology and an academic deputy coordinator. Heās published extensively, contributed to multiple guidelines and book chapters, and is deeply passionate about advancing neonatal care. Dr. Pathakās interests include quality improvement and POCUS in neonatology.
Contact: Ā dr.pathakomk@gmail.com
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IntroductionĀ
Hello Everyone, welcome to another episode of the Global Neonatal Podcast.
Today, weāre honored to welcome Dr. Om Krishna Pathak, a dedicated neonatologist and NICU in-charge at Bharatpur Hospital in Nepal. Dr. Pathak also serves as theĀ program coordinator for the Fellowship in Neonatology and an academic deputy coordinator. Heās published extensively, contributed to multiple guidelines and book chapters, and is deeply passionate about advancing neonatal care. Dr. Pathakās interests include quality improvement and POCUS in neonatology. Weāre thrilled to have him share his expertise and insights with us today. Dr. PathakĀ welcome to the podcast.Ā
QuestionsĀ
Ā What led you to pursue a career in neonatology? Mbozu
Before we get to far into our discussion, can you tell us a little bit about Nepal and about the about the region where you work Shelly-Ann
Can you tell us about your unit and about the care you are able to provide? Shelly-Ann
You did your medical school training and pediatric residency training in Nepal then went on to do your fellowship training in India. Can you tell us about what it was like returning to Nepal after training. Mbozu
Can you speak to some of the wins that you have been apart of as it related to neonatal care in your region/country OR can you talk about some of the big jumps your unit was able to make as it relates to improving neonatal care Mbozu
Can you tell us a little bit about the Quality Improvement Initiatives that you have been a part of
Can you share a bit about the neonatal fellowship program?
Your interests include POCUS. What is the role of POCUS in Neonatology, particularly in the LMIC context
You are currently in the Global Clinical Scholars Research Training Program at Harvard. What prompted the decision to purse this sort of training?Ā
In your opinion, how important is it for research to be done locall/in LMICs
Do you have any words of advice for a provider looking to improve neonatal care in their institution/Country?
How can people connect with you
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The transcript of today's episode can be found below š
Mbozu Sipalo (00:01.942)
Hello everyone, welcome to another episode of the Global Neonatal Podcast. We're so happy to be here again in 2025 and exploring more amazing change makers in neonatal health all over hybrid contexts globally. Hi, Shelly Anne, how are you doing?
Om Krishna Pathak (00:14.798)
Hi, Mbozu. Hi, Sally. Good morning and good afternoon and good evening all over the world. Namaste from Nepal. I'm good.
Shelly-Ann Dakarai (00:20.216)
I'm good excited for a conversation today. How about you?
Mbozu Sipalo (00:24.574)
Yes, me too. I'm really, good. Happy January and Om, how are you doing?
Shelly-Ann Dakarai (00:36.908)
Yes.
Mbozu Sipalo (00:39.03)
Namaste. Great. So today we're honored to welcome Dr. Om Krishna Pathak, a dedicated neonatologist and NICU in charge at Bharatpur Hospital in Nepal. Dr. Pathak also serves as the program coordinator for the fellowship in neonatology and an academic deputy coordinator.
Shelly-Ann Dakarai (00:42.52)
Namaste.
Mbozu Sipalo (01:04.778)
He's published extensively, contributed to multiple guidelines and book chapters, and is deeply passionate about advancing neonatal care. Dr. Om's interests include quality improvement and focus in neonatology. We're thrilled to have him here to share his expertise and insights with us today. Om, welcome to the podcast.
Om Krishna Pathak (01:26.978)
Thank you, Mbuzu, and it's my pleasure and honor to be a part of the team. Thank you.
Mbozu Sipalo (01:32.672)
Thank you so, much. So firstly, this is a question we love to ask all our neonatal specialists when they join the show. What led you to do neonatology?
Om Krishna Pathak (01:44.526)
His long story actually in Nepal after you do graduation in the scholarship and the government scholarship You have to solve to the rural areas for at least two years So I went to a certain place that they didn't see even a doctor before me I went to such a remote areas in Nepal and while serving in the remote areas I got to see many people with a lot of problem with maternal and child health, especially the child health and neonatal health so that was
So after doing the MD pediatrics, I choose to join critical care service that includes both an ENL and periodic critical care in India. So that training saved me in a good critical care specialist and an ENL and I came back to the Nepal and I started doing the government service once again. And there was a lot of demand for the ENL care quality, new one care.
So we had to do, I had to do a lot of things to improve the quality care. That was the turning point. My MDP tradics and the fellowship was the turning point along with my background, the rural posting of Nepal.
Shelly-Ann Dakarai (03:01.548)
Thank you for sharing that. It's always nice to hear how everyone ends up in neonatology. And like you said, it's something about the critical care and the babies that gets us every time. Before we get into talking about all the initiatives that you've been a part of, and I'm looking forward to that discussion, can you let folks know a little bit about Nepal, for those who may not know about it, a little bit about your country, and then specifically maybe the region that you're working at?
Om Krishna Pathak (03:11.906)
Yeah.
Om Krishna Pathak (03:30.348)
Okay, Nepal is a very beautiful country, is located in South East Asia. It's a small country, but people with a big heart. And we would like to welcome the Arab and foreigners and everyone in our country with a smile in our face. You might have heard about the Mount Everest and Buddha was born in Nepal. Mount Everest is located in Nepal. There are so many other beautiful places and people you can see in Nepal, even in the small country.
with around 30 million people living in the country. You can see a wide range of from mountains to Tarai region in the same city or nearby. So it is a small country, but with a beautiful country located in Southeast Asia, close bordering China and India. In this country, we have got seven provinces and I work in Bharatpur Hospital that is located in province three. It is
somewhat four to five hours distance or in plain 15 to 20 minutes from the capital city Kathmandu. So Bharatpur Hospital is one of the tertiary hospital referral center 600 bedded. We have got around 12,000 deliveries per year and the number of admission in Niku is around 1000 per year. So it is a really pretty big center for the maternal newborn and other multi-specialty care.
Shelly-Ann Dakarai (04:59.89)
and you brought up the NICU, well, you gave us a good description and kind of breakdown of kind of Nepal and the region and then the hospital that you work up. So thank you for that. Can you tell us a little bit about your unit and what kind of care you're able to provide in your unit?
Om Krishna Pathak (05:11.31)
Mm-hmm.
Om Krishna Pathak (05:17.166)
Yeah, after my medical post-graduation training in 2015, I landed up in Bharatpur Hospital in its government hospital. And that time we didn't have NICU. So we struggled to start off NICU from the six bed unit. But there is a lot of deliveries in our unit, in our hospital. It was around 15,000 before. Now the delivery is around 11,000 to 12,000 per year.
Obviously that six bed will not be suffice for the our babies. So we had to increase from six to eight unit then to 12 unit. Now we have got 20 weighted NICU. We have what isolation NICU as well. Other than the NICU we have got a Kangaro mother care unit separately. A total approximately 40 bedded dedicated for the neonatal patient and the pediatric unit we have got a different separate 50 60 weighted pediatric unit. And in that
Nico have got fellow one fellow and recently we have got another DM resident as well joining at the training center for our unit and we have got house officer they are on duty all the time and usually the bed is full around the 20 minute all the time and but luckily we are trying to manage this unit for our patient and we also get outpatient
as well from other hospital referred from the other hospital. This being a tertiary care center, there are a lot of referrals from all over the regions to this hospital.
Mbozu Sipalo (06:56.918)
sounds like a really busy place to work and you must be, yeah. Could you please tell us about your medical training background? And you mentioned that you did your pediatric training in Nepal and then went to do your fellowship training in India. What was it like returning to Nepal after the training and what were the biggest lessons for you returning back home?
Om Krishna Pathak (07:00.674)
Yeah, a lot of busy.
Om Krishna Pathak (07:25.506)
Yeah, yeah, after the 12th class, we used to have a lot of entrance examination and a lot of the experience for the medical graduation. They appeared in exam, thousands of them, and only a few hundreds will get the chances for a scholarship to study the medical graduation. And I was one of the lucky chap among those thousands of people. So I studied medical graduation in the
one of the reputed medical college, Manipal College of Medical Sciences, Pokhara. It was one of the Manipal group led by the Indian team. So I did my graduation under medical, under government scholarship from Nepal only. And after that, I had already told I had to serve to the remote areas for a few years. So I went to the remote areas of Nepal for two to three years. During that time, I got to see the how people
and their life, we can make some change in their life being a doctor. And that keeps me motivated all the time. You have to keep me stimulating all the time to do better in my field. And after that, we have to fight for our scholarship and training, which I did from National Academic Medical Sciences Kathmandu. And the training used in the Kandichindl Hospital, it is the
one of the largest children's hospital in Nepal located in Kathmandu. So after that, I came back to what a poor hospital to work as a consultant, but I decided that we need our unit started in NICU six. We started from the sixth bed. And as I was interested in the critical care of NICU and the critical care, I was looking for my training. And one of my mentors suggested to try for that.
Shelly-Ann Dakarai (09:15.832)
Thank
Om Krishna Pathak (09:19.648)
in India, which was the Bharati Vidyapit University Hospital that is located in Pune. And I did 18 months of training as a fellowship, dual fellowship in Neonatology and Periodic Critical Care. There I got trained not only in Neonatology, I got trained in the Periodic Critical Care as well. I got trained in the research activities to some extent. I was trained for the academics.
Shelly-Ann Dakarai (09:34.092)
Mm-hmm.
Om Krishna Pathak (09:48.586)
And I was also trained for the mentoring as well. And Pocus was one of the core training I was given during my fellowship training. So after the fellowship, I returned back to the same hospital. I started leading the NICU and since then I'm leading the NICU. And since last two years, we have started the post MD medical fellowship as well. One year clinical fellowship in the Nienertloge. So this was my journey.
Shelly-Ann Dakarai (10:15.032)
Hmm.
Om Krishna Pathak (10:17.07)
in last nine years or so after medical post-graduate training.
Shelly-Ann Dakarai (10:25.72)
I see. So you started the unit while as a consultant pediatrician, then went on to do neonatal training and then came back and continued to build that unit. How did your training help you in terms of making progress? Was it a situation where now that you came back with the neonatal training, you were able to get a little bit more resources than before? Like how did that help? And the reason I ask is because I know we've had somebody else on our podcast who
Om Krishna Pathak (10:35.246)
Exactly.
Shelly-Ann Dakarai (10:55.51)
went into training and then had a difficult time trying to use her neonatology background to help and to keep improving. So I'm just curious as to what that transition was like having started the unit and now coming back as a neonatologist, was that fuel to the flame and things were able to move a little bit faster or did it...
Om Krishna Pathak (11:03.978)
Okay.
Shelly-Ann Dakarai (11:22.978)
Did it still seem like there were a lot of obstacles that you needed to get over?
Om Krishna Pathak (11:27.492)
Yeah, yeah, yeah, yeah, you were right on the both aspect. is fuel and the flame as well because it's it increased my passion in the neonatology more. So I could see there are so many things we have to do in our unit to make it a quality service. Starting from the nursing training to the training of the house officer, acquiring new equipments.
And starting each and every new things in a unit is not that easy. It is really time consuming and a little difficult. But once you are into it, will definitely make a change. One interesting thing is the government and issue in the government hospital is free of cost. See, of course, but the quality care is not that cheap. OK, so the money government provides free of cost to the hospital to some extent is fine. But
that is not adequate to acquire new equipments to have adequate staff and so many other things. So in that case, our hospital management has supported us in such a way that we could acquire so many new equipments and have a fairly, not the standard one, but the fairly good amount of good number of medical staffs, health workers as well, which is lacking in usually in the low resource countries. So in that way, we are lucky to have a good supportive unit.
both from the hospital and from the government as well. So it's a bit like both, right? It's challenging as well, but the every challenges without challenge, cannot get over it. You can't move forward. You cannot upgrade as well. So it was, I found it as a challenging and equally interesting as well and motivating as well.
Shelly-Ann Dakarai (13:13.484)
Mm-hmm.
Om Krishna Pathak (13:14.67)
So if I can give you an example, like in last one and a half year, in talking about the resources, we were able to require two baby log high frequency ventilator, a cooling machine as well. Okay, pretty hypothetical cooling as well. And we were able to start newborn checking for each and every delivered baby in the hospital by a team of doctor.
It is not available in most of the part of the government in the country. It is one of the first unit to start a complete newborn check for all the new ones by a medical doctor. And we have conceptualized, had started neonatal nursing program in our unit. So if you see that the number of doctors are very less in the country, right? So we had to utilize as many number of health workers for the neonatal care.
So in most of the countries, what will happen is there will be someone to deliver the baby, but no one will be there to look after the baby. So since we could not have doctors all the time, had arranged neonatal nurses so that I'll train them in the NICU about the normal newborn care, newborn resuscitation, and so many other care about the newborn. So it was an initiative taken by our team, and it was very useful as well. So there are so many things.
Our hospital management has also supported us and that has the fuel that has increased our quality service scale of the newborn in our unit.
Shelly-Ann Dakarai (14:51.436)
So you mention... Sorry, go ahead and boozoo.
Mbozu Sipalo (14:56.19)
Alright, I just wanted to ask about the neonatal nurses bit, because that's really, really... we have the same question. Well, you can add on. I bet we might not be in the same wavelength, so you can like, you know, twist mine around. Just a question on the neonatal nurses bit, like as a medical doctor coming in, what has been the strategy you used in...
Shelly-Ann Dakarai (15:00.513)
Is this gonna ask it?
Om Krishna Pathak (15:02.968)
God.
Mbozu Sipalo (15:23.008)
promoting them and empowering them and teaching them? Do you have a master's program or is it a clinical program? Like how have you been working with the nurses to capacity build in your NICU?
Om Krishna Pathak (15:37.208)
So you see what I was interested was there has to be someone to take care of the baby all the time in the delivery unit. There has to be someone who is good at research taking the newborn. Okay. So the concept is so simple and clear, but having human resources all the time that to a doctor is not that easy and it is challenging. So this is in our own effort. We have started acquiring, getting new nurses and
It's not the master training, but with them, we post them in the NICU for certain duration, 15 days to one month will assess their ability to assess the newborn and do the new research situation. And by rotation, we used to put them to keep them in the labor room on duty so that and on the regular basis, I used to supervise their practice. And if needed in a day to day or in a few days time, I used to train them about the lab.
something that they are lacking in their knowledge or in their skill increase. So in that way, we have started the Indian nurses, but there is no definite clear-cut master's program role.
Mbozu Sipalo (16:51.112)
Okay, just to also add on to my question, linked to the nurses, I know there's an issue in developing contexts or globally where nurses are rotated around rather than kept in these specialized units, they tend to jump units and it doesn't really help those specialized units because they're being pulled away. So what has been your strategy or thoughts around that? Because it is like a big issue.
Om Krishna Pathak (17:04.91)
Mmm.
Shelly-Ann Dakarai (17:06.601)
you
Mbozu Sipalo (17:21.016)
everywhere.
Shelly-Ann Dakarai (17:22.922)
Mm-hmm.
Om Krishna Pathak (17:22.968)
Yeah, yeah, yeah. Most that was was accidentally picked up point, right? We are always struggling with keeping the same nurses to the same unit. We have two challenges. One is internal. One is external challenge. The internal challenge is the management wants to rotate the new nurses, any nurses to the different units based on their priorities. But since we don't have super specialty nursing unit like like cardiology nurse, any nurse or
Shelly-Ann Dakarai (17:28.194)
Mm-hmm.
Om Krishna Pathak (17:51.37)
anesthetic nurses, we don't have that much provision, but whatever nurse we get, we train them for a few months, three to six months time. That is something like an induction period. So after that, they become slightly expert in the same unit. So I always struggle with the management that I don't want to change large number of nurses at the same time. If you want to change, keep it to the minimum so that my unit will not get affected. As we all know that having a
same nurse, good quality nurses over the many months and years significantly differs the patient outcome. So that was one of the major internal challenges. Another external challenge is as all the low resource countries facing all over the about it is about the shifting of the human resource to the high income countries, be it Australia, UK or America, which we cannot do anything for that. So that was one of the major challenges.
is for their career development and so many are opting to the abroad job and education. It is very challenging to keep the same nursing staff over the same unit. if you have got a good number of nurses over a year, you have got a very lucky unit, I must say that.
Shelly-Ann Dakarai (19:10.304)
Yeah, that seems to be similar, like you said, across the low and middle income context in terms of keeping that stability of that nursing staff. And like you said, for their own career development, even if they do stay in country, there's no incentive to stay because the mechanisms for which they career development and career advancement and increased responsibility doesn't follow those lines.
Om Krishna Pathak (19:21.164)
Yeah, yeah.
Om Krishna Pathak (19:28.471)
Exactly.
Shelly-Ann Dakarai (19:39.906)
Very challenging. So you talked about when you came back, some of the big areas that you focused on was nursing staff and then house offices and then equipment. It seems like that's kind of the process that we've heard from other folks as well. It's that human resource area first, starting nurses and then physicians before kind of doing that.
Om Krishna Pathak (19:55.118)
Yeah, it's.
Shelly-Ann Dakarai (20:09.494)
the equipment. Am I correct in my thinking of how, of the approach that you took or was it a multi-pronged approach in terms of hitting all the areas multiple ways?
Om Krishna Pathak (20:20.974)
Yeah, it's a multi-prong approach actually. You cannot just have only equipment first or human resource first because getting equipment and human resource might take many weeks, months, or sometimes even years also. So you have to keep on doing it so that one by one you will get a multiple response, be in a human resource or be in the equipment part. So I think we have to go with a multi-prong approach for the same.
Shelly-Ann Dakarai (20:47.02)
So can you give us some stories about some of the specific quality improvement initiatives that your unit has undertaken to make improvements? I know you talked about having dedicated staff at every delivery and then also the nursing training part and then the physician training part and then getting equipment and things like that. But can you tell us a little bit about maybe some of the other projects or maybe stories within those spheres about some quality improvement projects that your unit was able to do?
Om Krishna Pathak (21:15.284)
Yeah, yeah, definitely. So as a patient safety and governance program, we have started some quality improvement projects. I just already mentioned a few things like a new one checked for all the new ones to detect not only congenital heart disease, critical congenital heart disease, but other critical conditions of the new one. We have started that recently around the month back for the
all the deliveries, 10,000 deliveries that are going to our hospital. And as I already told that the newborn, every newborn should be, should be attended by at least by someone who is training resuscitation. That is another quality improvement project. And recently we have started infant and family centered development care. We have trained all the nursing staffs and house officer and we have involved the patient and we have trained all of them.
to find that to know to recognize the patient cues and address them accurately correctly. So implementing infant and family family development care and monitoring that through the checklist. We have developed checklist also so that it's everybody knows what to do and we'll be doing currently and now also we are doing the audit on infant and family center development care. That checklist we are doing that audit at present.
We have also done before about the prescription writing audit quality improvement audit. So we have heard that the medication is a huge issues in any ICU all over the country, all over the world. So to minimize that, we have studied how a good prescription should look like. So for that, had done prescription writing quality improvement project.
Simulated there are so many other quality improvement issues like pain management in the newborn in NICU and a checklist for the blood transfusion and the had also done the Occident Delivery quality improvement already in the Occident Delivery devices also. So you see because in even in the Occident Delivery, Occident is one of the most commonly used drug in NICU. So if you don't give it properly, not only it has advantages, has disadvantages as well. So to check that
Om Krishna Pathak (23:25.23)
I had done quality improvement audit on the choice of oxygen delivery device in NICU. So there are so many quality audit projects that had happened that is going on also and we may be doing further quality audit projects based on the patient's requirement and for the patient's safety and governance.
Mbozu Sipalo (23:48.278)
It sounds like you have your hands in many pots, which is really interesting. I'd love to unpack the pain management one, because I think that's something that is oftentimes overlooked in hybrid and context. Could you please share a bit more about your quality improvement on that topic?
Om Krishna Pathak (24:07.982)
So it's like it is one of the part of infant and family centered development care. We should know the cues of the patient pain and we should address that adequately. So we had done one research in our unit. We had tested about the pain response of the mother's milk. We just soak the gout piece in the baby's mouth one and another arm will just soak the dextrose in the baby's mouth. So in both
showed a significant reduction in the patient newborn's pain score. So previously, some years back, we used to do a break without just ignoring the patient's newborn's pain. So those poor babies, cannot do anything other than crying and showing some cues. But we are there to hear their voice, to pick up their cues, because the parents have given the babies to us
complete believing, complete that they will take care of this. Health work will take care of the baby, my baby to the fullest, just like the parents. So for that pain control also, we have to be responsible to give as minimum as pain. One is cluster of care. Second is if there is no use of doing intervention, let's not do it. Sometimes even less is more, not only always more, it was something less is more and
to find the patient cues and many men and the managing the pain is so so important. So we had done that research and followed by the quality improvement project. And since then we have now started using if mother colostrum is available, we'll use that. If that is not available, then we'll go for the textose for the pain management for the minor pain. And obviously we have got other medication for the severe pain.
Mbozu Sipalo (26:01.226)
That sounds really interesting. Just out of curiosity, is that research published? Is it like open access?
Om Krishna Pathak (26:07.968)
it is it's on the process of publishing.
Mbozu Sipalo (26:12.348)
All right. Okay, great. I will follow up on that because it sounds quite impactful. And packing again more on the quality improvement initiatives that you've covered. think Shaili Ann touched on this earlier and you did as well. Your neonatal fellowship program. Could you tell us a bit more about how that's going, how it started and yeah, the progress in that fellowship program?
Om Krishna Pathak (26:37.624)
Yeah, two years like in a two years back as our unit is too big and we have all the resources from the human resource from the equipment from the patient and whatever is necessary for the academic position. had planned and decided the clinical fellowship of one year duration. So in that one year, the fellow will have a traditional duty. You will have a labor room posting as well. He'll have a new insect as well.
along with the level three and level two NICU and the follow up units as well, clinic as well. So you will be having academic rounds, regular presentation and optional one research project also you'll conduct one optional research project. Research is optional for this one year clinical fellowship because we are more focusing on the clinical aspect of knowledge and skill acquiring. it's since last one and half year it's going really well.
is going really well and we'll continue to produce the fellows which is required to decrease the neonatal mortality in Nepal. So quality neonatal care is required in all over the country and across all the hospitals. The neonatal care units should be providing the quality care to decrease the neonatal mortality. One thing I must emphasize at present is
Initially in Nepal there are lot of hilly regions and mountain regions so institutional delivery was a very limited number. But currently as there are lot of development going on the number of institutional delivery is 85 to 90 percent that is really good number. Institutional delivery. But if you see in 2000 in last five years the neonatal mortality rate is 21 per 1000 live birth in 2000 from 2016.
So there is no significant decrease in the neonatal mortality. And if you see, the most of the mortality is within 24 hours of birth. That means our hospital newborn quality services should be improved. So that is the reason we should be targeting to decrease the hours. STG goal by 2030 is to decrease neonatal mortality to 12 per thousand live birth. It is a long way to go, but increasing, improving the quality newborn care service in hospital is one of
Shelly-Ann Dakarai (29:03.276)
So is this the first fellowship program in Nepal or is there one at the Children's Hospital in the capital?
Om Krishna Pathak (29:13.21)
yeah, it's not the first one but it's one of among the first few ones. Maybe probably, maybe third one in the country, maybe.
Shelly-Ann Dakarai (29:26.072)
Okay, I see, thanks. So you had mentioned your research project with the, looking at the difference between dextrose versus breast milk and that you are in the process of writing that up for publication. So that brings me to asking you about your global clinical scholars program training. So you're currently pursuing this training. It's a program through Harvard. Can you tell us a little bit about what prompted you to
to do this sort of clinical research training and why you think it's important to do local in-country experiments slash studies.
Om Krishna Pathak (30:05.294)
So as I believe that a doctor should be a multi-pronged, he should be a good clinician, he should be a good academician, he should be a good manager, and he should be a good researcher as well. So in my setup, I'm leading the NICU, I'm managing it till now, I'm doing the academics and clinical part as well to a large number of patients. But the clinical...
academic and the managerial aspect is well covered in my unit. But the research part, I was not happy that I should be learning more research and to gain more knowledge about the research part, I had applied in the Harvard Medical School, GCSRT program last year and have selected and I've enrolled in the program in last few months now. It's really interesting and very, really useful until now.
Hopefully by the end of one year it's gonna change my knowledge and research to a significant way that contribute to decreasing the mortality again, decreasing the mortality in my country. I hopefully that will be useful to reduce to do the quality research to decrease the mortality and reduce the morbidity of the new one care.
Shelly-Ann Dakarai (31:27.434)
And you are also interested in neonatal POCUS and you mentioned that this was started based on your fellowship and where you did your fellowship. So tell us a little bit about how you've been able to implement this in your unit and the role you think that POCUS has not only in the high income space but also in the low and middle income context.
unit.
Om Krishna Pathak (31:58.114)
Yeah, about the focus, I can go out and I will text with it. I love talking about the focus and all right. Yeah, it is a new stethoscope, not only in the high-end countries, but even in the low-end countries as well. It gives you so many other things that only the clinical examiners cannot give. I just want to give you one example only. the newborn I have in my unit has got apnea. OK, so if the baby has apnea in my unit,
What I do is I just see his brain, his or her brain, either there's IVH or not, there is hydrocephalus or not. I just look into heart, is there PD or not? How is the contractility? I just look into the lung. Is there any fluid or is there any lung collapse or pneumonia developed or not? So there are so many things. Even for the sepsis, I look for the cardiac output, is high cardiac output or not? And
I have not practiced the NEC part yet, but there are people who practice either there is NEC or not. So there are so many things you can do loud to find the cause of one of the conditions. I just gave an example. There are so many conditions. There is so many conditions that require the use of focus into day to day life. It's just like a new stethoscope in new era, not only for the high income countries. And I was one of the lucky to have a point of view on the sound.
with all the props in my unit since the beginning and my knowledge of learning Pocos in India. was also involved in contributing the two book chapters in the Long Altar Sound and Cranial Altar Sound during my fellowship as well. So I can utilize that part during my practice in my unit at present. I'm also doing one research project using the Pocos.
like utilizing the point of care ultrasound for the long recruitment in the new and at large. Yes. As, as, as we can see that surfactant is very costly in our country. costs around 20 to 25,000 for the smaller babies. And if it's a baby's weight is higher, it can go up to 45, 40, 40,000 as well. So everybody does not afford surfactant government in the product providing surfactant free of cost. And that I utilize my focus to see how the lung are recruited or not.
Om Krishna Pathak (34:19.532)
by using the POCUS, I can try to treat the PEEP so that it will be useful for the patient to have an optimal PEEP. This is one of the research I'm doing at present. So I believe that POCUS can change so many aspects of the newborn care in an ICU. And there are so many units in the world. They have just replaced the chest X-ray by the point of care ultrasound. And in my unit also, if I do an X-ray,
The X-ray technician coming to the unit doing the X-ray and getting the report it takes, it might take a few hours time, but I can do it without much radiation, without much hassle, the point of catalyzer immediately. In our unit, we don't have a periodic cardiology in the hospital. We have to rely on the adult cardiologists. They are also in a few number. So, as a neonatal focus,
someone who does a neonatal focus, I can utilize that knowledge also for the screening of the major anomalies, major heart defects or functional anomalies in the children. Obviously, if there is something major, I have to consult with the cardiologist as well. But for my patient management, it's helping me a lot and it's giving a lot better outcome compared to the without focus.
Om Krishna Pathak (35:40.556)
That is the reason I recently I went into the new corner India as well as the faculty have to focus in the conference as well recently.
Mbozu Sipalo (35:40.939)
Just.
Shelly-Ann Dakarai (35:49.656)
I can sense the passion about the topic. Thank you for sharing those stories and describing what the role could be for this, like you said, it's the new stethoscope.
Om Krishna Pathak (35:52.76)
Yeah.
Om Krishna Pathak (36:04.238)
Mmm.
Mbozu Sipalo (36:08.16)
Just out of curiosity, do you have any local focus training trainings in Nepal?
Om Krishna Pathak (36:18.438)
not yet. It's emerging still. It's emerging and there are not many people utilizing the Pocus as frequently in their unit. But I must say that the new people who are doing the training in Nepal or outside Nepal, they are getting trained about the Pocus. And I'm sure that they utilize Pocus more than I do at present. So in a few years time, can see that many units will be there who will be utilizing Pocus.
Mbozu Sipalo (36:50.112)
Thanks. Now, I think it's really important for people like you to really like promote the intervention and saying, and I love how you touched on the big neonatal burdens like sepsis can be explored to focus and all the other big issues, the cardiology issues. So that was really insightful to listen to.
Om Krishna Pathak (37:08.622)
Mmm.
Mbozu Sipalo (37:14.92)
So yeah, just to touch on the many things you've been doing and just research in general, how do you think neonatal specialists can get more into research in LMIC context? Because you've touched on so many things, which must be quite a lot. So I'm just wondering how you do what you do and how you think others could also get involved and
be similar change makers within your NATO space.
Om Krishna Pathak (37:46.894)
I must say it's really challenging doing the research in the unit is really challenging, but to have a better understanding of so many disease conditions, so many outcomes and must be focusing some part of that into the research. And to begin with, I think we should be collaborating with someone who knows how to do research properly. And subsequently we can go build our own team and to have a good quality of research. But it's really challenging, especially in the no LMI second phase.
Mbozu Sipalo (38:20.736)
And just to touch on the point you made, I think that's mentorship, right? Like even at your level, you do have people that you look to for inspiration and for guidance and stuff like that. Do you mind giving us an example of how mentorship has helped you as a neonatologist in Nepal?
Om Krishna Pathak (38:41.14)
Yeah, actually, mentorship is very, very important to shape you in a way the way you are. back that day in the training, I got so many good mentors. cannot take all the names at present here, but I don't want to miss one of the names like in during my fellowship period. I have got a very good critical care specialist, both in PISU and to further NSU. have got Dr. Pradeep Suryabansi. I think he had a
He had appeared in the photographs as well. He was one of my mentors and he had trained the renaudology, the focus and he had motivated and inspired me in so many other ways to be the person I am at present now. just copying the same thing, just trying to be the way how a good mentor should be. I'm also trying to push the new guns, new medical team.
to do a good research and it feels so good that after passing to your unit from your unit, if they choose to become a neonatalogist or PD-Addison, I think that is one of my success.
Shelly-Ann Dakarai (39:59.286)
Yes. It's a team effort and you can't do this work alone. you know, especially in, in contexts as similar as to where you work, as Mpuzu was saying, there's so many hats you have to wear, whereas in some of the units, there's one person that does this, some person who's the go-to for that. And so, so important to have that kind of mentorship and folks to lean on when I'm sure it gets hard and...
Om Krishna Pathak (40:15.938)
Exactly.
Shelly-Ann Dakarai (40:27.448)
You need some words of encouragement.
Om Krishna Pathak (40:31.899)
Definitely.
Shelly-Ann Dakarai (40:34.562)
So with that, I wonder if you have any words of encouragement for a provider who is working to improve care and may not have the resources, whether that be human versus equipment, to make a difference and just kind of about to throw their hands up and just say, I'm not sure what else to do. Do you have any words of encouragement or advice for that provider?
Om Krishna Pathak (40:55.566)
It's not that easy. I know everybody. know that having a good quality care and the practicing NICU and critical care is not that easy. We all know that. But just believe yourself, believe yourself, believe your team and just make your team good. If one door is closed, there has to be another that will open. But don't give up.
never ever give up because it is not the one day process. It's long, long. You need a long time investment to have a good quality service. So if I already said if there is one door is closed, there has to be another that that will open. But don't stop knocking the door. I must say that.
Shelly-Ann Dakarai (41:48.76)
won't stop knocking on the door. Thank you. Truly inspirational.
Before we wrap up, is there anything else that we didn't touch on that you might want to share? Either about the unit or anything else before we end our time together?
Om Krishna Pathak (42:09.39)
Yeah, other than that, other than this in my hospital, I'm also doing a few things. I have been a secretary of Nepal pediatric society, the chapter and the secretary of the back, my deep province of the country. I am basically involved in the protocol making up so many new one and the pediatric critical care stuffs like comprehensive newborn care, sick newborn care and the pediatric essential critical care training and so many other things. So I
Let's take them as a team to all of the countries along with the AF of government of Nepal and Nepal periodic society to train more health worker, more pediatrician, more house official and nursing staff so that they have a good knowledge and skills about the re-enactment. Our team Nepal periodic society in collaboration with the Royal College of Pediatrician and Child Health UK.
They also build a Nepal standard for neonatalogy and pediatric emergency critical care service in some of the hospitals in Nepal. I was one of the part of that. So I feel that getting knowledge and disseminating is never ending process. Each and every day, I don't know how much others will learn from me, but I'll definitely learning from them and from the babies each and every day. And the curve of learning is never flat. It's always increasing. So what I believe is
Keep on learning yourself and keep on teaching others so that you'll have a very good team. And once you have a good team, your pressure over the head, having a large unit, 20-meter unit in your head will definitely decrease. With a good team, together, your pressure of managing the unit with a good quality service will definitely decrease over the years.
Shelly-Ann Dakarai (44:01.26)
Thank you. So we have to build our team and we have to keep knocking on doors.
Om Krishna Pathak (44:06.923)
Exactly.
Shelly-Ann Dakarai (44:09.1)
great words to work by, you know. Thank you.
So thank you again for coming on to the podcast and we appreciate your sharing your stories and giving those words of advice and encouragement. And I'm sure there are a lot of folks who are gonna wanna connect with you, maybe to even collaborate with you. How can people connect with you? What's the best way?
Om Krishna Pathak (44:37.634)
Thank you, Shelly-Ann and Mbozu for getting me in this podcast so that we can share each other's experience and the issues of the neonatal care in the low and middle income countries. Yeah, I'm ready to open the connection through my email or the LinkedIn we will be provided along with this podcast. Let's feel free to have a connection with each other and share ideas for the quality of neon care from all over the world.
Shelly-Ann Dakarai (45:11.084)
Great, we'll put those in the show notes. Om, thank you again. We appreciate your time. And to the rest of our listeners, we will see you again next month with another episode where we share stories of folks doing work around the world. Thanks.
Om Krishna Pathak (45:30.606)
Thank you, Skyri. Thank you, Ambedu. Thank you and Namaste from Nepal.
Mbozu Sipalo (45:34.806)
Namaste.
Shelly-Ann Dakarai (45:35.169)
Namaste.
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