#025 - Leadership in Action: Establishing Neonatal Services in a Regional Hospital

Hello friends 👋

Dr. Naiza Ngowo Monono, the sole pediatrician at Limbe Regional Hospital in Cameroon for nearly a decade, shares how she reduced neonatal mortality to 16 per 1,000—well below the national average. Key interventions included implementing hygiene protocols, training staff on danger sign recognition and neonatal resuscitation, task-shifting responsibilities to nurses and general practitioners, scaling Kangaroo Mother Care, and partnering with UNICEF to train referral hospitals for earlier identification and transfer. Dr. Ngowo Monono emphasizes starting with available resources, building team capacity through mentorship, and maintaining discipline in planning. She advocates for multidisciplinary post-discharge follow-up and improved respiratory care as next priorities for advancing newborn outcomes.

Link to episode on youtube: https://youtu.be/Fu2ZOb2abBA

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Short Bio:  Dr. Naiza Ngowo Monono is a trained dynamic, hardworking Paediatrician from the Faculty of Medicine and Biomedical Science, University of Yaounde 1. She has obtained other postgraduate training courses with NICHE (International Newborn, Infant and Child Health Education) as a Newborn Care Course Instructor, International Program on Preterm Nutrition (IPPN) with the European Foundation for the care of newborn infants (EFCNI) and a master’s degree in public health from the PGIMER (Postgraduate Institute of Medical Education and research), Chiandigarh- India. 

She has been practicing as the lone paediatrician of the Limbe regional hospital for the past 9years, where at the beginning of this journey, she identified major public health deficits so, goals were set with the aim of improving health care services to the community, strengthening the health care system of the hospital and reduce neonatal mortality to achieve the third sustainable development goal (SDG) relating to the reduction of under-five mortality by 2030. In this challenging environment in 2016, determined to do things right with the purpose of reducing neonatal mortality, it unconsciously brought out intervention skills of advocacy, team building in simplicity and humility, coaching, networking, monitoring, and evaluating the implemented standard operating procedures (SOP) that were set in place. Her dedication and passion to serve her community earned her the position of a Clinical tutor and mentor in the region and a regional supervisor of hospitals and community postnatal care and implementation of Kangouroo Mother Care in collaboration with UNICEF since 2022. This good intention to foster positive change in the community, the health care system of the  hospital and improve on the National data has trained staff, built, equipped the neonatology service, and reduced neonatal mortality to 16% in the year 2022 in the Limbe Regional hospital, compared to the National data which revealed a neonatal mortality rate of 26.3% in the same year and the neonatology unit was inaugurated by the Minister of Public health in 2023.

Irrespective of all the styles of leadership, a good leader will apply the right style of leadership were applicable and will not impose a particular style of leadership all the time. ‘When it is obvious that the goals cannot be achieved, don’t adjust the goals, adjust the action steps.

She was also recruited as an assistant Lecturer in the faculty of Health Sciences, University of Buea (FHS-UB) where she has been teaching and practicing in the Limbe Regional Hospital. Presently she is a Lecturer and the coordinator of the department of Internal Medicine and Paediatrics FHS-UB. The neonatology service now serves as one of the principal sites of newborn care and research in the region, with a survival rate of preterm babies of 69.2%.

‘The man who moves the mountain begins by carrying small stones.

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

Shelly-Ann Dakarai (00:02) Welcome back to another episode of the Global Neonatal Podcast. Happy New Year. We are glad that you are with us again listening in. We are so excited to be joined by Dr. Naiza Ngowo Monono, a pediatrician in Cameroon who for nearly a decade has been the only pediatrician at Limbe Regional Hospital. Along with her clinical work, she's led efforts to improve neonatal outcomes, advance kangaroo mother care, and mentor teams across her region.

In this conversation, we hope to explore what it takes to strengthen newborn care within complex health systems and the leadership and collaboration that make meaningful change possible. Dr. Naiza, welcome to the podcast. Mbozu and I are so happy that you are here with us today.

Dr. Naiza Ngowo Monono (00:49) It's a pleasure to be with you. Thank you very much for having me.

Shelly-Ann Dakarai (00:56) To start us off, can you tell us a little bit about Cameroon and specifically the region where you work? What should people understand about the healthcare system, the population, and neonatal care in your setting?

Dr. Naiza Ngowo Monono (03:56) Cameroon is a country in Africa like many other countries, and what is particular about Cameroon is that we are bilingual. We have French-speaking Cameroon and English-speaking Cameroon. We are divided into 10 regions, basically three ethnic groups where we have the Muslims in the north, the grassroots around the west, and the center and the east where you find the Sawa and the Bantus. So it's a diverse, multicultural country with a lot of nice people. We are very welcoming and we have a lot of nice dishes that once you come, I'll make you try some.

Mbozu Sipalo (04:58) I love that. I love the food bit. I'm always up for different foods and I know West African food is different. It hits different. So I would definitely take you up on that offer, Naiza. Thank you for giving us that background of Cameroon, beautiful Cameroon, its diversity in people and culture. We know that you are a pediatrician at Limbe Hospital. Could you please give us a background of what that hospital is like and your work there?

Dr. Naiza Ngowo Monono (05:35) The Limbe Regional Hospital is actually one of the main hospitals in the region. For us who categorize it as a third-level hospital, it's not the top-ranking hospital in Cameroon. But in the region, which is a semi-urban region, it's one of the main hospitals because there are just two big hospitals: the Buea Regional Hospital and the Limbe Regional Hospital. The Limbe Regional Hospital receives all referrals from health centers and smaller districts. They refer to the hospital in the region because that's where you find the specialists and a team that does multidisciplinary care.

If we can't handle you, then we send you to the level five hospitals, which are found in the economic capital and the national capital. But with respect to the region, it's the main hospital for referral where you find academicians and students. So it's a blend of clinical and academics.

In the regional hospital, I work as the pediatrician. I offer care to children from the first day of life to 15 years of age. We basically have neonatology, where we cater for the preterms and term newborns, and then we have pediatrics, divided into subspecialties where you have nutrition, nephrology, hematology and other areas. It's multi-tasking at the same time. I have to cover basically all the units with the general practitioners who are under me.

Mbozu Sipalo (07:49) I have a question that's personal to your career for all young listeners, the young medics wanting to get into pediatrics or considering getting into pediatrics. Could you give us a background on your personal story, why you got into pediatrics, and if you were to speak to your younger self, what reflections you'd share?

Dr. Naiza Ngowo Monono (08:22) Falling in love with pediatrics came very early as a student while in med school. I realized I would care for the babies. I spent more time in the pediatric unit, especially in your final year when they send you out to district hospitals to offer care.

Every mentor in the hospital told me, "You have to do pediatrics," because from morning till night, I'd be in the pediatric ward. I wouldn't see myself going to the maternity or the surgical ward. They noticed I was in love with pediatrics and I was very skilled, though I wasn't yet a pediatrician. When my mentor made my report, he specified that I shouldn't miss my career. I was supposed to do pediatrics.

When I got my first posting, I was posted to a pediatric center that made it even better. The First Lady of Cameroon has a pediatric center for children in the national capital. I was posted there, so I continued my career with children. It was like God had planted it. As a GP, I worked all my life with children. I had wonderful mentors and teachers, and they opened the door for me. They said, "Young woman, you need to go out specializing in pediatrics. You're so comfortable with it and you're doing well with it." So I got into the specialization.

You're not the wealthiest of doctors as a pediatrician because you don't do big surgeries. You don't earn so much money, but you're happy as a pediatrician. Why I'm saying so is because you put a smile on a baby's face. They are innocent. They are loving people. They don't bear grudges and they can be good friends for life. So I feel fulfilled. I don't think I would have chosen another specialty apart from pediatrics because I feel fulfilled in doing what I'm doing.

Shelly-Ann Dakarai (10:39) Yes, pediatrics is where it's at. For those who are not pediatricians, we love our jobs and we are so grateful to be taking care of the next generation. You talked a little bit about going to residency and becoming a pediatrician. Then you came home and had to be the only pediatrician for the first nine years at Limbe Hospital. Can you talk to us a little bit about what your training was like and what that transition was like coming back and now being in charge of pediatrics at your regional hospital?

Dr. Naiza Ngowo Monono (11:25) Shelly, the residency was tough. It wasn't child's play. You had teachers who were hard, but I'm very grateful they were because they were preparing you for challenges in life. You had to work day and night for four years before thinking of going in for a subspecialty. It wasn't that difficult anymore because I was versed with the French language. Most of our studies are done in French. Most of our universities are French-inclined. So with respect to the language, it wasn't that difficult. But what was difficult was meeting the demands of your teachers, what they wanted you to acquire, the skills and the capacities you're supposed to build before they could give you the certificate.

We sailed through it as a team. I had a working team as a student, friends, classmates. We worked together as a team, helping each other when you were weak and identifying your strengths so that you could excel in those areas. Finally, we got through it and I was sent back to work in my region of origin, mostly because my husband works there. If you had asked me to choose, I wouldn't come back to this region. But here we are, and I found myself the only pediatrician in the Limbe Regional Hospital.

The beginning was challenging because people thought I was young to be the pediatrician of the hospital in my early 30s. When I would explain with facts, medical facts, they thought I was blabbering till something happened to the baby. Then they said, "She was right." So in a few months, they got to know that she's good at what she's doing. They didn't argue anymore and came together so that we could work as a team. I got the confidence of my nurses, my administrators, and then they gave me full charge. I could now build my own team with confidence and plan work in the service.

What I used as my strength was task shifting. I began to empower my nurses because I wasn't going to be there 24/7. I had to pick up the ones who had the zeal and liked what they do and empower them. If I wasn't there, I would teach you danger signs to know when a child is dehydrated, to identify severe anemia, and I would tell you what to do in emergency. Some of them had notebooks so that when I'm not there, on the phone I will guide you and the baby will be saved.

I had to ask the administration to give me general practitioners who were interested in pediatrics. Not all general practitioners want to work with those tiny babies and have babies crying around them. I had to pick up the ones who loved pediatrics. Thanks be to God, a lot of them have gone back to residency. With them, it was easier to do a lot of task shifting and we could manage all the services smoothly.

Sometimes dealing with administration is not that easy. They don't understand you as a clinician. Your needs might not be what they need. So you have to come to a compromise for them to see your needs and that the need is going to benefit both the community and strengthen the health system.

When I first came, there was no neonatology service. It was just a room that had been adapted like a nursery with cots and there was no hygienic procedure or anything like that. Over the years, with evidence that neonatal mortality was reducing, they saw the need for a neonatology service. Thanks be to God, in 2023, the service was officially inaugurated by the Minister of Public Health. Now we have a beautiful neonatology service where we take our babies and train students. It's been a challenging journey, but it's been a fulfilling journey for me.

Shelly-Ann Dakarai (16:10) I want to camp here for a little bit. You said that the unit officially opened in 2023, but prior to that, you were already able to cut your neonatal mortality to even less than what it is nationally. It dropped to 16 per 1,000 live births, which is well below the national average. I'm curious if you can walk us through in a little detail the different approaches that you took, because it seems like a short time. It's a huge undertaking to be able to start a neonatal unit from the ground up and to already be seeing such improvements even before your unit is officially dubbed a neonatal unit. That's why I wanted to camp here and learn a little bit more about the specific steps that you undertook leading the team and getting neonatal care improved in that hospital.

Dr. Naiza Ngowo Monono (17:29) Apart from teamwork, where I trained the staff, we did a lot of partnership. We already had a nursery where the babies were kept in little cots. Working in the nursery, we had to improve hygiene first of all, the don'ts and the do's. We began by working on ourselves, knowing what we should do, what we should not do. Helping the general practitioners identify danger signs in a newborn was very essential so that the baby doesn't come when it's late or with very severe complications. We can pick them up early enough and begin appropriate treatment. That was one of the strategies.

In terms of partnership, we partnered with the government through UNICEF. UNICEF came in as a funder to carry out training programs because we realized that most bad cases came from the districts and the health centers around the regional hospital. It didn't come from the hospital itself. We had this program to train the healthcare workers in those health districts and health centers to quickly understand the sick baby and not refer late.

That was a very powerful partnership we had with UNICEF when we trained the other local health workers to be able to refer us the babies on time. It got to a point where the unit was small. We couldn't take in all the babies at the same time because they came from everywhere around. Sometimes we had to push into some other space to cater for these babies. I think that was one of the main strengths that helped us to reduce neonatal mortality—identifying the danger signs and treating them on time.

Secondly, we also had training on neonatal resuscitation, which helped us to cut down on neonatal asphyxia, which is another leading cause for neonatal mortality. We also had to strengthen them and train them on how to monitor the pregnant woman in labor, identify the warning signs early so that we get a healthy baby and healthy mother. Training the staff on identifying danger signs and neonatal resuscitation was a good strengthener to the system to reduce neonatal mortality in the region.

When I began, we were at the bottom, second to last in the entire country when it comes to neonatal mortality. But after a few years, the regional delegate had to congratulate us because we had moved about three steps higher. We were doing a great job and it's reflecting on the national statistics.

Shelly-Ann Dakarai (21:07) Thank you for going over those details. That was a huge undertaking and it seems like hygiene, danger signs, partnerships, training, resuscitation, then making sure that the referral hospitals were equipped and had education so they knew to send babies earlier and were better able to take care of the babies as well. While we're talking about leadership and the changes that you were able to help spearhead in that unit, there are a couple of quotes that I know you ascribe to. I wonder if you could tell us a little bit about them. One of them is, "When it's obvious the goals cannot be achieved, don't adjust the goals, adjust the action steps." I would love to hear a little bit about how that mindset played out in practice as you were building this NICU from the ground up.

Dr. Naiza Ngowo Monono (22:13) Thank you very much. You always set goals to achieve. Sometimes it's really difficult to achieve your goals. You might have some challenges that are really difficult to crack. You will not go back and change your goals because you have to meet those goals. Maybe the plan you were using to attain your goal was not what your bosses wanted, especially when it comes to working with administration. They won't give you everything smoothly. Maybe you have to buy their idea and then try to fit yourself into their idea. So there are many ways in experience to struggle to make your goal come to reality.

For example, each time I would go for a meeting, I would tell the director, "I'm in a kitchen, I'm not in a neonatology service." And he would smile. I'd say, "You call that place a kitchen?" I'd say, "Yes, because if I have to tell you what a neonatology service is, then you will know I'm in a kitchen." Those were technical ways I kept lobbying to make him see reason that we are not of standard, yet we have so much to do and we should do it in good standard. We're strengthening the healthcare system and it's going to benefit the hospital. That's just one of the techniques I used to lobby my administration with some technical words.

When it comes to staff, some might think because they are much older than you, they shouldn't take instructions to attain an objective. So I humble myself. I know you're quite older than me in age, so I'm not going to pull along with you because I'm your boss. I will call you names like, "You are the aunt of all these babies here. You should be very careful. You are an auntie to all these babies, so you must reflect your auntie name."

I start flattering you like that, that you should build up yourself, forget about me, your younger boss, but be like an aunt, like the sister to the mother of the baby, so that we attain our objective by treating them and sending them home safe. In attaining the objectives, there are many ways you have to cut through your challenges when you come to human relationships. You just have to think of something and say, "How do I go through this challenge?" and struggle to go through it. Those are little techniques I use to keep everybody in place. Don't look at me, but look at what you have to do to get a good outcome.

Mbozu Sipalo (25:30) Thank you for giving us those really insightful action steps on managing relationships. In the same space of managing people and relationships, could you tell us about the staff ratios at your hospital and what has changed through the life course of your leadership there? Also, how has your role evolved in the shifting of the staff and the hospital support in the neonatal ward?

Dr. Naiza Ngowo Monono (26:10) With respect to the staff, I always, first of all, make it to be like a family. We are a family. We are not colleagues. We should be more like family with an objective we have to attain. The staff has gained more interest and knowledge in neonatology because they have been part of these trainings and I begin to see that a lot of them feel fulfilled.

The staff strength is not that strong. The least I will have is two nurses on a shift and sometimes if one person is off duty for a health reason or social reason, you find one staff on duty for almost 20 babies, yet they don't complain. They know how to manage it. It's a difficult situation in Africa. She will give you a phone call if she needs advice. If I'm not available, she'll call the GP or she calls the ward charge to give her assistance. Since there are many pediatric wards apart from the neonatology, if she needs help, she can call the other nurse in the other department to assist her quickly before she goes back to her department.

We build ourselves as a family, standing by each other, strengthening each other. Though we know that the staff strength is quite small and we have a lot of other challenges to face, I always make sure they keep educating themselves, gaining knowledge and being the best of what they should be, irrespective of every other challenge around. Your blessings don't only come because you walk into a hospital. They can come because a parent smiled at you just because of the way you took care of the baby. I always encourage them to keep calm and continue doing their job in the best manner they can.

Mbozu Sipalo (28:31) My second question is how has your role evolved as the neonatal ward has been capacity-built? It sounds like you have been doing some capacity building. Have there been more pediatricians come to your ward or more neonatologists or neonatal pediatricians? What does that look like?

Dr. Naiza Ngowo Monono (28:57) This year in 2025, we have a second pediatrician. She visits from the economic capital twice a week. She's not a neonatologist, but she's a full pediatrician and she comes and gives her input. For now, all my mentees are still in residency, so I keep my fingers crossed and I'm waiting for them to come in full-time and join the team fully. But for now we have one visiting pediatrician. Yes, you're right. We do a lot of capacity building with the nurses since we know we are weak in staff strength. We really capacitate our nurses to take full charge when we are absent because the least I will do is help you over a phone call if other duties have beckoned me.

Shelly-Ann Dakarai (30:07) You talked about the staff ratios and sometimes having one nurse, sometimes two for 20 babies. I would guess that the parents are very involved in helping with some of the care of the babies. I wanted to use that as a jump-off point to ask a little bit about Kangaroo Mother Care and what that looks like in your region. I know you've been instrumental in scaling up KMC, not only in your region, but also across the country. I'd love to hear a little bit about what that implementation looked like. How did that start and how were you able to grow that at the Limbe Regional Hospital?

Dr. Naiza Ngowo Monono (30:54) Thank you for the question. We are going to talk about family-centered care. I always tell parents, "We are under an umbrella and below this umbrella, you are there as a parent, I'm there as a doctor and we have a baby in our hands. We are going to do it together so that the rain doesn't beat this baby." It's a saying I use to build the confidence of the parents that I'm not going to do it alone. I have to do it with you.

Kangaroo Mother Care has been very welcomed in the region. It all began with partnership with UNICEF where we trained the staff for them to understand what it was without just pushing it on them. Then we put it into practice. We use it as a means of safe transportation where the preterms have to be transferred from the health centers to the regional hospital. We use it as a means of comfortably treating and living in the hospital because we have kangaroo space, we have kangaroo chairs there where the mothers can lie down comfortably and carry out another activity. We have seen its benefits in reducing infection in babies, strengthening breastfeeding, and helping the babies grow better and faster.

It's been very welcomed and each mother with a small or preterm baby leaves the hospital with their kangaroo wrap. When you're coming for follow-up, you must carry that baby in the kangaroo mother care position and walk into the unit and we are happy for you. We examine your baby and you go back with the baby in the kangaroo mother care position so that we also educate the community that it's a simple strategy that is used to cater for our small and sick babies.

Shelly-Ann Dakarai (33:18) For an institution that might be wanting to institute KMC, where would you tell them to start?

Dr. Naiza Ngowo Monono (33:29) I always tell them after we've done the training and you have the kangaroo wrap, start with the baby who needs kangaroo mother care. You know the principles, you know how to position the baby. There should be an indication and you know the principles—hygiene must be top. So any baby with the right indication should be put on kangaroo mother care. There is no specific day you should start or specific rules that should govern you to start. So long as the baby needs that care and the baby is right in front of you, follow the principles and start.

Shelly-Ann Dakarai (34:11) Just do it, just start.

Dr. Naiza Ngowo Monono (34:14) Yes, you need to start from somewhere.

Shelly-Ann Dakarai (34:22) I want to talk a little bit about mentorship because you mentioned having mentors that spoke into you and said, "You have to go and do pediatrics. This is where your heart is at." Now you are a mentor to trainees and you are also mentoring the outlying hospitals where you're helping with education. What are some principles or what's your perspective on what it takes to be a good mentor?

Dr. Naiza Ngowo Monono (34:58) To be a good mentor, I believe you need to be patient. You should always keep calm because you are looking into the future of somebody, not only professionally—you might even be involved in their social life as a mentor. I believe one of the principles is always keep a cool head and be patient.

You can also meet very difficult mentees, the stubborn ones who don't want to follow up. You won't push, you won't force. You go gradually and you can meet the gentle ones who see in line with you and know it's for their best. You are guiding them and not pushing them to become what they don't want to become. My main principle is being very patient and always put on a smiling face because as an adult, we have diverse issues. It's not just professional. She might be going through some social difficulties in her own marriage or in her own family line. You need to help her cross that bridge and bring her back to her profession smoothly and let her continue her way in the right track. I always try to be patient and keep a cool head. If not, your own head will bubble.

Mbozu Sipalo (36:37) I appreciate you adding in the personal aspect of mentorship. I think that's something that most people deliberately don't talk about, or it's an assumption that it's addressed or it's not addressed oftentimes because there's that gray area of should this be strictly professional or should this have some personal balance. I'm just curious, how do you have that balance and also ensure that you have boundaries as you're navigating both of those very important aspects of mentorship?

Dr. Naiza Ngowo Monono (37:22) If I should work with my mentees, I don't go straight to the professional. I won't begin by, "Where were we? How far have you gone?" No, it's always a very calm environment. I will ask you, "What's been up with you? How has life been treating you?" Because I'm very conscious of the fact that if you are not okay mentally, you won't do what you were supposed to do. It's going to weigh on you and it's going to work on you.

We always begin our discussions like, "What's up? What's new? Are you okay? Is everything in shape?" Then we get a light mood and she could open up as a mother, a big sister. I will see that she's carrying a burden that might even weigh on her professional life. From there, we try to close that gap and bring you back to your professional life. Though it's there, it's always going to be there. There's no human being without issues, but you need to stay focused and attain your dream and your goals. I might propose one or two simple techniques or solutions to help you through some challenges, but I always remind you to come back to your goal, your profession, your dream and what's right ahead of you. That's how I go about it.

Shelly-Ann Dakarai (39:00) You talked about giving some advice, maybe some strategies, some tools. I wonder how you do it in your personal life in terms of how do you balance—which again, we could argue, is there such thing as balance or is it work-life integration? We won't get into the terms, but how have you been able to merge all aspects of who you are? A pediatrician who loves babies and likes being at the bedside, but also needing to be the administrator in a way of helping to set up units and create programs to train other hospitals, and then your hobbies and then your personal life. I know you're a mother, a lot of things, a lot of roles, a lot of people who need you. How have you been able to integrate all of those? Maybe share one or two of the things that might have helped you that you've shared with your mentees to help them along their journey as well.

Dr. Naiza Ngowo Monono (40:06) Planning and discipline. I always tell my patients that I can't be a good pediatrician and be a bad mother. My patients know. They know I plan. The week is planned. I have days in the hospital. You find me there. I'm in the hospital on that day. It's my hospital day, morning till evening. I'm with my babies, I'm with the parents. I have days where I teach as a lecturer. You won't find me in the hospital. After a certain hour of the day, I'm no longer a teacher nor the pediatrician. I become the mother, the housewife.

Everything is planning. You must plan and discipline yourself that it's time for this. I've got to do it now. I'm not going to procrastinate. You try to plan, discipline yourself so that everything moves in harmony and you don't lag in one area of your life. During the weekends, it's difficult to find me in the hospital, except I am really needed. Then I'll rush to the hospital. But weekend is family time. It's consecrated for family because the week is a busy week. You run from morning till nightfall. We try to plan with respect to the little time in front of you, how to fit in each agenda and discipline yourself to respect your agenda so that you don't lag in any area of integrating all your busy schedules. That is my secret.

Shelly-Ann Dakarai (41:58) That's a great one. Thank you. It's interesting you say planning, because especially in the neonatal world, we are very specific about the CCs. We deal in very small numbers and we're a detail-oriented specialty because we're dealing with small babies. Sometimes I find myself, I could do it there, but then other parts of my life, I don't bring that same planning and level of detail to it. So that's interesting that you said planning, because you're right. It's so true.

Shelly-Ann Dakarai (42:44) Your training has taken you all over, some of which was in India. Could you tell us a little bit about your time there and how all the different exposures to different cultures and different ways of doing things has impacted the way you lead now in your current role?

Dr. Naiza Ngowo Monono (43:14) In India, I went for a leadership and management course. There, I saw the difference between being a leader and a manager. The leadership style is the best, where you bring people to understand your vision. You are not imposing that they buy your vision, and you move along with them to attain this dream. It was really a defining moment for me to understand what it means to be a leader.

There in India, I noticed something. They are very honest people. They train their children to be very honest. And they are very humble. You know what they do—namaste, namaste. Even the teachers were so humble, you felt so comfortable being with them or having very insightful discussions with them. It wasn't typically the teacher-student relationship. It was more like a friend who was your teacher. If I took back home something, I took back honesty and humility, irrespective of the knowledge I acquired. I learned that being humble and honest are two powerful things any human being should have, irrespective of your caps on your head, professor X and the rest. Just keeping it humble and honest was very important.

Mbozu Sipalo (45:19) Leading with that humility aspect, there's a quote that you also added to your bio that says, "The man who moves a mountain begins by carrying small stones." Could you also expand on that a bit, hopefully linking with your different experiences as well? I think right after that, we'll start wrapping up this really insightful chat.

Dr. Naiza Ngowo Monono (45:52) You could build a mountain from small stones so long as you have the energy to keep carrying the small stones to build your mountain. Like some people will say, Rome wasn't built in a day. It took years for it to be built. Only two drops will fill the container someday. You don't need heavy downpour at a particular time. But if you're consistent and persistent with those drops, someday that container will get full.

What I mean by that is that I never began where I am today. It all began small. It was a very humble beginning. Not really knowing where I was going, but all the burden I carried was the babies need to be okay. If I identify a need, I will start small. Okay, I'm in the kitchen. I need to go to a neonatology space. My nurses are not versed with caring for newborn babies. Let me start. I'll have the nurse on duty come and do rounds with me. "Do this, don't do that. Make sure it's done like this."

You start from one person knowing she will tell the next person. Before you know, the whole team is aware that this is how it should be done and it shouldn't be done like that, even before we have a general meeting. I never ignore the small pieces in the puzzle because if they are not there, that puzzle won't be okay. It all begins small. One day you will see the mountain.

Shelly-Ann Dakarai (47:53) Sometimes it's so easy if you don't see all the pieces. It's easy to give up. You don't even want to start because you don't feel like you have all the things at your disposal. But this is such a great reminder that there are all these pieces that fit into a puzzle. Start with one and just keep building from there. Thank you for that picture that helps to inspire us to keep going, even when it just seems so small. They do add up over time.

Shelly-Ann Dakarai (48:22) What do you think is next for Limbe Regional Hospital as it relates to neonatal care? Where do you see it going in the next five years? What are your hopes for your unit?

Dr. Naiza Ngowo Monono (48:39) My hopes for the newborn in the nearest future, I don't know how fast that will be. After the ANA Conference, my dream, which I had been carrying, was to improve respiratory care in the newborn in my setting, because we are not yet versed and very advanced with respiratory care in the newborn.

I've been visiting conferences in Nigeria where I've been receiving trainings to use the ViO and to interpret. But I was privileged to meet the team of ViO who have enrolled me with another team in Cameroon. Some training is going to begin. I don't know when it will begin, but sometime in the future to really empower us with respiratory care. I'm praying that the training should come forth fast so that we can institute proper respiratory care for the newborn in Cameroon. That is my first dream in the nearest future.

Secondly, I need to build a strong follow-up plan, post-discharge plan for the babies. It has to be multidisciplinary. It's not just going to be the pediatrician checking on the babies, especially the preterm who might suffer from some neurodevelopmental deficiencies or retinopathy of prematurity. I'm trusting and hoping that a grant will give us funders to build this multidisciplinary team where we'll involve the ophthalmologists, a neuropediatrician and build a strong follow-up, post-discharge follow-up at least for 12 months for the preterm babies to quickly pick up the deficits and orient them to care on time so that in the nearest future they don't become humans with poor quality of life. For now, I have these two dreams in mind and I'm praying to get the right direction to make them a reality in the nearest future so that more babies can be saved one day at a time.

Mbozu Sipalo (51:12) I just want to reflect on what you've shared, because I've picked up South-to-South or rather, African country to African country learning. You said that you visited Nigeria and I know the African Unity Association—we met there and that's why we're having this conversation. We met in Kigali. It was a very insightful conference linking African practitioners together. Thoughts on that on your end? What other South-to-South, or should I say African country to African country learnings have helped you in the last six months to one year? Just curious around how you're connecting with other practitioners in the African space.

Dr. Naiza Ngowo Monono (52:05) I can say in the last one year or two years, it's been mostly connecting with the brothers from Nigeria. It's when I came to Kigali that I got to connect with a lot more other people, like people from Rwanda, people from Uganda, and a lot more. The ANA Conference was the perfect piece in the perfect whole to build relationships and to strengthen the African neonatology team.

Shelly-Ann Dakarai (52:56) It's that connectedness that keeps us all feeling competent in our roles sometimes. Knowing that you have the supplies you need, you have the knowledge that you need, but also knowing that you have someone to call should you need help, somebody who's further along on the journey to help give you the learnings that they've had is so important. That's why it's so important to have networks—professional, personal, all those things to keep us well-rounded and to keep us moving in the right direction. Because sometimes the days can be hard when you don't get to see the effects of what you've been working on. It seems like it's slow. Having those connections can keep you motivated to keep going.

With that, I'd like to ask, do you have any words of advice for a physician, let's say maybe a young Naiza who's just starting out? What words of advice would you give to her knowing what you know now back then?

Dr. Naiza Ngowo Monono (54:10) I would just tell her, be yourself. Don't be someone else, first and foremost. Go after your dream, irrespective of your challenges, and make sure whatever you do, it's self-fulfilling to you. Don't do it because you were asked to do it, but do it because that is what you feel you should do. At the end of doing it, you feel complete, you feel happy, and you feel like someone else should do it because you were happy doing it.

Shelly-Ann Dakarai (54:56) Thank you for those words to young Naiza and to our young colleagues who are just starting out listening. Naiza, it was a pleasure having you with us today. Thank you for sharing your work, your journey, and the perspective you bring to newborn care. These conversations help remind us that improving outcomes is not just about the interventions, it's about the leadership, the collaborations, and the people who stay committed to strengthening the system over time.

I'm sure that our conversation today has inspired a lot of folks. There might be some people listening who, on hearing what your dreams are for your unit, may be able to offer collaboration or support. How best can someone connect to you should they want to learn more about your work or even maybe collaborate?

Dr. Naiza Ngowo Monono (55:57) With the advancement of technology, I have a mobile number, it's on WhatsApp, and I have a Gmail account. You can always drop a mail, and from there we'll pick it up, get to know each other, and see how we can fit it to each other's agenda and strengthen the neonatal team.

Shelly-Ann Dakarai (56:25) Great, thank you. We'll definitely put that in our show notes. As I said, Naiza, thank you so much for being here on the podcast with us. We appreciate all your time and all that we've learned from you.

Mbozu Sipalo (56:39) Yeah, thank you for being our first guest in 2026. That is so exciting. And the fact that we met at the African Neonatal Association and the conversation has continued. Just want to say thank you for making the time to chat with us.

Dr. Naiza Ngowo Monono (56:56) Thank you too for having me. It's been a wonderful time talking to you ladies. I also learned from you. I can see you're very determined in doing the best and the very best for the newborns across Africa. I'm wishing you all a lovely new year. May all your dreams come true and may you grow better in every aspect of your life.

Shelly-Ann Dakarai (57:25) Thank you. And to our listeners, thank you for joining us on this episode of the Global Neonatal Podcast. We hope that you found this conversation as inspiring as we did. If any of this resonated with you, please share this episode with someone else who you think would find it valuable. If there's somebody that you would like us to interview, please send us a quick email at GNPodcasts@gmail.com. We would love to hear your suggestions. Until next time, take care, keep making a difference, and let's go faster together for newborn care.