#028 - Family Systems Care: An example from Hohoe, Ghana (ft. Christina Schuler, Jessica Honya-Tsiewu, and George Edward Ntow)
- Mickael Guigui
- May 9
- 27 min read
Hello friends 👋
In this episode, we explore a decade-long journey to transform newborn care in Ghana's Hohoe region, focusing on family systems of care, cross-cultural research collaborations, and innovative training approaches. In this episode we explore
• The healthcare landscape for small and sick newborns in Ghana's Volta region
• The concept and application of family systems care versus family-centered care
• Development and adaptation of practical tools like genograms and echo maps for local contexts
• Training healthcare providers in communication and relationship-building with families
• Case studies of integrating family involvement into neonatal care and outcomes
• The journey of collaborative research between colleagues
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Resources mentioned in episode:
Families' Perception of Cognitive and Emotional Support From Healthcare Professionals Across the Maternal and Newborn Care Continuum https://pubmed.ncbi.nlm.nih.gov/41546394/
Family systems care approaches and methodologies for maternal, newborn and child health in low- and middle-income countries: a scoping review https://pmc.ncbi.nlm.nih.gov/articles/PMC12529736/
Experiences of families and health professionals along the care continuum for low-birth weight neonates: A constructivist grounded theory study https://onlinelibrary.wiley.com/doi/full/10.1111/jan.15566
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Short Bios
Christina Schuler: Christina is a neonatal and paediatric nurse with a background in global health and nursing science. For the past 16 years, she has been involved in collaborative work in Ghana. Over the past decade, her focus has been on improving care for small and sick newborns and their families across the continuum of care.
Christina is currently completing her PhD in Global Health at the University of Geneva. As part of her doctoral research, she and her team have been implementing a family systems care programme within the maternal and neonatal care continuum in the Hohoe Municipality in Ghana. Alongside her academic work in both Ghana and Switzerland, Christina continues to practise part-time as a neonatal and paediatric nurse in Switzerland, bringing together clinical care, research, and global health.
Jessica Honya-Tsiewu: Jesssica Honya-Tsiewu is a dedicated Senior Midwifery Officer with the Ghana Health Service, bringing over 18 years of experience in maternal and neonatal health. She has played a pivotal role in advancing safe motherhood initiatives, in leading clinical teams. mentoring junior midwives and implementing evidence-based practices to improve safe delivery outcomes.
In her current role as the maternity In-charge of Adabraka Health Centre in the Hohoe Municipality, she oversees midwifery services, ensuring high standards of care in antenatal, intrapartum and postnatal settings. Jessica is a regional facilitator for Helping babies breath and Basic Emergency Obstetric and Newborn Care (BEmONC). She holds BSc in midwifery from University of Development Studies, Tamale and currently pursuing Mphil in Midwifery at the University of Ghana, Legon.
A passionate advocate for women’s health, Jessica Honya-Tsiewu continues to inspire colleagues and communities by championing compassionate, patient-centered care. Her vision is to empower women and families through safe, dignified, and equitable health services
George Edward Ntow: George Edward Ntow is a health researcher with several years of experience in public health research across West Africa. His work focuses on infectious diseases, health policy, and community-based interventions aimed at protecting marginalized populations in remote communities. George has experience in international research collaboration and stakeholder engagement through his involvement with the West Africa Network of Emerging Leaders on Health Policies and Systems (WANEL) on an International Development Research Centre (IDRC)-funded COVID-19 project. His research experience spans neurodiversity care (including autism and learning disabilities), maternal and child health, WASH initiatives, tuberculosis and HIV/AIDS prevention and control, and pandemic response. He is committed to advancing research that promotes health equity, social justice, and gender equality.
Contact
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The transcript of today's episode can be found below 👇
Mbozu Sipalo (00:02.429) In Ghana's Volta region, a team has spent nearly a decade exploring what happens when families become true partners in the care of small and sick newborns. Today, we're joined by three members of that team: Christina Schuler, a neonatal nurse and PhD candidate from Switzerland, and her colleagues from Ghana — Jessica Honyachew, a senior midwifery officer with the Ghana Health Service in Ho, and George Edward Nto, a health researcher at the Dodowa Health Research Center. Christina, Jessica and George, welcome to the Global Neonatal Podcast. We're so glad to have you with us. And hi, Shelly-Ann, how are you doing?
Shelly-Ann Dakarai (00:53.637) I am great, so excited to be part of another conversation. Welcome to the podcast, everyone.
Jessica Honya-Tsiewu (00:57.246) Thank you.
Mbozu Sipalo (01:01.139) Welcome, everyone. So to set the scene, we'll start with your work in Ho, and please do correct me if I'm butchering this name, but your team has been working in this region for nearly a decade. For our listeners who may not be familiar with this part of Ghana, can you paint a picture of what the healthcare landscape looks like there, particularly for newborns and their families? I'll give this question to either George or Jessica. George, would you like to respond? Or Jessica, would you like to respond to that question about the work that you do in your region and what your region is like?
Jessica Honya-Tsiewu (01:43.494) Okay, thank you for the question. The healthcare setting we have in the Volta region — for that matter, the Volta municipality — is one that comprises, from the tertiary level, which includes the teaching hospitals. Currently we have one, which is the Ho Teaching Hospital.
Then we come down to the secondary level, which comprises the municipal and district hospitals. These tend to receive a lot of cases from the referral facilities from the periphery — the primary care providers from the communities and the villages around the Volta North.
So looking at the Ho Regional Hospital, we happen to be the referral point for all the primary healthcare facilities. We see specialized cases as well, and we have the random maternal and child health services. We have the NICU, which is also there to receive babies that are sick and need special attention and care. We have the primary public health units in collaboration with the nutrition department that connects the communities with the secondary-level hospitals, which happen to be the Volta Regional Hospital. We also have the primary care facilities — the health centers, which are mostly run by physician assistants, midwives, and some professional nurses, depending on the staff or professionals that are available.
At that level, as well as the CHPS compound — the Community-Based Health Planning Services — they are mostly manned by community health nurses and some enrolled nurses. When it comes to the CHPS compounds, they attend to minor ailments, immunization services as part of the EPI programs, and home visits.
Jessica Honya-Tsiewu (04:01.116) Those home visits may occur after discharge — clients for whom they may do follow-ups, both babies and their mothers, to ensure they are fine, and if they've missed some of their scheduled care, to provide what they've missed. So those are the primary care providers. There is a link with the health center, which happens to be at the Brong Health Center, and the Volta Regional Hospital, and that communication is carried out using a teleconsultation medium. It's a center that has been established at the secondary-level hospital where we communicate all information pertaining to clients we are proceeding on referral, so they are in preparedness — they gather everything they need to receive a certain emergency before we even get to the referral facility. So basically, that is the health system we use here in the public sphere and the Volta region. Thank you.
Mbozu Sipalo (05:18.793) Thank you so much, Jessica, for giving us that snapshot of what it's like where you work. We also know that the Volta Regional Hospital serves around 200,000 people. What does the NICU or the newborn ward look like in practice — in terms of staffing, space, and any other day-to-day realities you encounter? Could you give us an idea of what your newborn ward looks like?
Jessica Honya-Tsiewu (05:48.814) Okay, thank you. Like any other health facility, the Volta Regional Hospital is not an exception when it comes to the staff attrition that almost all facilities within the Ghanaian context are facing. As we speak, we are far below the staffing norms, which results in some form of burnout among the staff, as well as referral challenges in terms of transport
Jessica Honya-Tsiewu (06:25.696) constraints, and some communication gaps. When referral is mentioned, some clients are a bit hesitant, so it's also an issue — a challenge that needs to be addressed, perhaps with awareness creation, more in-depth communication, to help clients understand the concept better. And that is the role the family systems care approach has come to play as far as this discussion is concerned.
Jessica Honya-Tsiewu (07:09.244) Thank you.
Christina Schuler (07:16.722) Maybe I can add — if we compare NICUs in Ghana, specifically in Ho, to NICUs in Western countries like Switzerland, there is a difference in terms of what they can provide. Gadgets, CPAP — something is not available — and medications are oftentimes not readily available, so families do have to go and source them themselves. So even though it's called a NICU, it has limited services available. There's also no specialized ambulance available to transfer babies to the teaching hospital, which is about an hour away. So there are some limitations in terms of small and sick newborn care.
Shelly-Ann Dakarai (08:21.19) Thanks for providing that overview — from the primary care setting, to the regional hospitals, to the teaching hospitals, and where you guys are based at the Volta Regional Hospital. Thank you for that detailed overview. I'd like to get into how the three of you came together. Christina, you're a Swiss nurse; George, you're a researcher; Jessica, you are a senior midwife. How did this team come together? Perhaps we can start with you, Christina, and then go to George and Jessica, and talk about how you each became involved in the project.
Christina Schuler (09:02.082) Yeah, thank you, Shelly-Ann. I call it my Ghana love story, in a way. So 16 years ago, I had the pleasure of visiting Ghana for the first time and worked as a nurse in two hospitals in a different region. I just fell in love with the country — the food, the people, the environment, the climate, all of it.
For a few years I visited privately, but then I had the chance to do a Master's in International Health. My supervisor — I met her in Germany, and she's Ghanaian — agreed to take me on as a student, and that's how I ended up in Ho. That was 10 years ago, and that's actually when I met George, and this beautiful journey began. We started working together, and I just continued staying in touch. I did my master's thesis, then a second one followed — it's been like a continuation. Ever since, we've worked on topics that moved from low birth weight infants, to the continuum of care, and then we transitioned to small and sick newborn care. And now my PhD project — which has actually ended — is what we are talking about today, the work we did in the past years. So that's how I first met
George, and then later Jessica. But I think the two of them are in the best position to tell us how we met and the beautiful journey we've had together so far.
Shelly-Ann Dakarai (11:16.679) Sure. George, do you want to tell us how you got involved?
George Edward Ntow (11:28.498) Yeah. So in Ghana, when you finish your first degree, there is a one-year opportunity to get into the practical realm where you learn from people in the field. After my bachelor's degree, the university kept me on to do what we call National Service. I had a chance to work with one of the lecturers there, and one day I had a call to come to the lecturer's office. When I got there, I saw a pleasant-looking white lady with the lecturer, and I was introduced to Christina. I was told about her research and what she intended to do — I believe by then she was doing her Master's in International Health. From that introduction, we became very close colleagues. The very first time we went out to a remote area to do data collection, I think that's when we really started getting to know each other. From then to now, it has been all research — engaging in different projects. We started from her master's through to another master's, then her PhD, and here we are today. So that, in short, is how I got involved with Christina. Over to you, Jessica.
Jessica Honya-Tsiewu (13:21.182) Okay, so after my BSc in midwifery, I was posted to the facility to head the maternity complex department. It was during one of those working periods when Madam Christina and her team paid a visit. At that time, they came for familiarization — they needed to get to know the facilities where they would be collecting their data, and she debriefed us on her mission. That was the first time I had contact with
Madam Christina and her team. After the introduction, they left and then came back for the data collection. We happened to be part of the participants because they wanted our perspective on the family systems care approach. After the data collection, as it happened, we were also selected to be part of the training, which was also part of the study, because there was a deficit when it came to the integration of family systems care into practice here in Ghana — and for that matter, in Ho. So we were invited for an eight-day training, which has been impactful. And looking further, I'm also pursuing my MPhil in midwifery at the University of Ghana, Legon, so I had some interest in research. It was quite interesting being part of this. Thank you.
Shelly-Ann Dakarai (15:39.249) Thanks for telling us how you all came together. I think this is a good segue to talk more specifically about the work itself, Christina, and why it was important for you to focus on family systems of care, which is distinct from family-centered care — I think you make that distinction. Can you tell us a little about why your work is centered around the family, and why family systems of care is a better term than family-centered care?
Christina Schuler (16:01.258) Yes, so we have to go back to our earlier work. We looked at how mothers care for low birth weight infants at home, and one of the findings was that they said they needed more education during the time they were in the NICU. That led us to the second research I did for my master's, which looked at the continuum of care — because we know
the gaps between the NICU and home care, and between the antenatal period and the NICU, and then at home, are really crucial. One finding from that continuum-of-care research was that families play a huge role — as we all know in healthcare generally — but particularly also for small and sick newborns in the Ho municipality. Mothers play an important role, of course, as any mother does for their baby, but families are also a very important part — whether it's the grandmother, a sister-in-law, or the husband. They have a huge role in decision making, support provision, and so on.
So we knew families play a role, but both healthcare professionals and families in that qualitative research told us that even though they know families are important, they don't know how to include them well in the care. Families feel left out, and healthcare providers don't know how to include them.
I had been trained in family systems care here in Switzerland, and we knew it had been practiced in Canada and in other countries in Europe. There was some research on the African continent, but more of a theoretical nature rather than a practical approach. We wanted to find out whether we could adapt it to the setting in Ho — and that's why the research we did for my PhD first looked at a context analysis. Even though the Ghanaian members of the team — my supervisor, George, and others — know the context really well, and over the years I've also learned a great deal, we wanted to specifically look at the health system. So we started with that. Then we also looked at the attitudes and skills
Christina Schuler (18:50.702) that healthcare providers have, and we looked at the family perspective on support, just to get baseline data. Then we examined the distinction you mentioned — that family-centered care is different from family systems care. To break it down: family systems care is really an extension. I see it more as a
tool that helps you actually put family-centered care into practice. Because family systems care — of course, there are many names for it: family-centered care, family systems care, family nursing — but we call it family systems care because it's not only nurses who can provide it; midwives and doctors can too. It's a way of interacting with families. You don't just send care toward the family, but you take a systemic approach, because family systems care is based on six foundations. One of them is systems theory.
Another is communication theory of change. So it has those elements, and it looks at how you interact. Family systems care is based on models developed in Canada — the Calgary Family Assessment and Intervention Models. One part is how to assess a family, and the other is how to plan your intervention with the family based on that assessment. One of my lecturers, where I did my master's, actually developed a tool that makes it more practical, so that you can plan your conversation and have a tangible approach.
Christina Schuler (21:10.624) And Jessica will tell us more later about how she uses it in practice. This is also what we focused on during the training — we taught 30 nurses, midwives, and educators how to practically plan conversations with families. You essentially look at the interaction and reciprocity
between families and healthcare providers. And not just the woman, but the whole family — because if someone is sick in a family, the illness doesn't only affect the person who is sick. If your mother is sick, you worry about her and it can have an impact on you.
Or if your baby is in the NICU, it can have a huge impact — stress, anxiety, and so on — on the parents. Healthcare providers can, with the family systems care approach, assess the family, identify where the problems are, and then together with them try to find solutions and provide emotional and cognitive support.
Family systems care looks at cognitive, emotional, and behavioral domains, and the interventions that are planned are based on those domains. It's a bit technical, but you can really break it down in practice to guide people through challenges. You can imagine that when a baby is sick, it's like a storm out at sea. When a healthcare provider can guide you, your ship can move into a bay, into calmer waters — you can calm down, regain strength, and start sailing again. This approach doesn't just look at challenges; it also looks at
Christina Schuler (23:37.304) the strengths and opportunities that families have. So it's a more strength-focused approach, not only focused on problems and challenges. This is essentially the difference — or rather the extension. We see it as an extension of family-centered care.
Shelly-Ann Dakarai (24:26.087) Thanks. So you gave us a good overview of family systems care as an extension, and you described how your work emerged from the recognition of a gap in the experience from the prenatal period, through the NICU, and then home — and how that translates into the care of the infant. I want to
go to Jessica now and ask: from your side of things, how does this look on a day-to-day basis — before the work you've been involved in with family systems care versus after? Can you tell us a bit about the journey through the training and what that looks like now?
Shelly-Ann Dakarai (26:28.007) Jessica, can you hear us?
Mbozu Sipalo (26:31.773) I think we can give her a couple of minutes to see if she'll rejoin.
Shelly-Ann Dakarai (26:52.003) If we don't see her in a couple of minutes, we could just move on to a George question and then circle back.
Shelly-Ann Dakarai (30:16.519) So George, since you are Ghanaian and part of this research, how was the journey from your end — looking at the pre and post of starting these changes and training staff? Did you find it was a relatively easy process in terms of people being on board with trying these new approaches to family systems care, or was there significant work involved in demonstrating why this could be beneficial?
Shelly-Ann Dakarai (31:15.461) Yes — so what I was asking was: this is your country, your culture, your region. I was curious about your thoughts on how people's perceptions changed when this was rolled out — prior to the training and after. Was it an easy sell, in a way, or was there a lot of work that had to go into explaining why this approach could be important and why it could be adapted to your setting?
Shelly-Ann Dakarai (34:09.559) No, this was great. You answered it well — essentially saying this is how we already live, that we are a family-integrated culture, and that healthcare is catching up with what we do on a daily basis. And now my last question before I hand back to Mbozu. Jessica, I was asking you about your experience
Jessica Honya-Tsiewu (34:33.17) Okay, thank you so much.
As mentioned earlier, initially it was what we called family care. The difference is that with the old approach, we didn't really involve all family members, and we didn't even have in-depth discussions with clients to ask who they considered to be family. So we sometimes didn't involve the people who mattered most to them
Shelly-Ann Dakarai (34:35.559) going through the training, and how was it for you on the ground, taking care of patients? Was it easy to get buy-in from other staff? How do you see the difference from before integrating family systems care to now, where this is commonplace in your unit?
Jessica Honya-Tsiewu (35:05.236) when it came to decision-making. And the follow-up home visits to reunite families with the siblings they had left prior to their hospital admission, and so on. But with family systems care, after the training, we have come to appreciate that it helps us to build better rapport with our clients and their relatives —
to understand their concerns, their expectations, and perhaps some previous experiences they may have had with healthcare providers and facilities. That informs how we can reframe or restructure our care to suit their expectations. So after the training —
let me say that prior to the training, we were quick to implement. We didn't really engage clients in depth, and we realized that most of the results we got were not sustainable. After the training, and through the effect of family systems care, we have come to appreciate how important it is
to involve the client — to find out who they see as family, who they see as their support system. For example, I once nursed a mother who was an antenatal client. At a point, her hemoglobin level
began to drop. So we took it upon ourselves, using the Bayer concept from the family systems care training, to build that rapport and find out what factors were really
Jessica Honya-Tsiewu (36:57.16) contributing to the low level — beyond what we might assume, such as not taking supplements or medications. And we found some really interesting issues. One of them was the fact that due to pregnancy-related aversions, she was unable to eat food that she had prepared herself. She prepared food for the family, but she couldn't partake in it herself. So there was a nutritional deficit. In the old approach, we would just advise her to eat her four food groups, take fruits, vegetables, and so on — but the person was dependent on a context that had its own challenges. When we engaged her in depth, she was able to tell us that her husband was quite supportive, but that the extended family did not understand her need to perhaps leave the house temporarily and go spend some time with her mother, who could support her in preparing meals she could comfortably eat. So that gave us in-depth knowledge about what was really happening and what possible solutions we might consider.
From there, we engaged the husband, and he understood perfectly what
the issue was. So after that, the arrangement was made and the woman went to spend time with her mother. She delivered, and with the mother's support, she was able to eat well. With the medications and supplements, her hemoglobin improved within a short time. You could see that psychologically and emotionally she had become stable — and that is the kind of outcome we had been hoping for. The whole family
was happy. That illustrates the importance of family systems care — engaging the client. After she delivered, the next decision was whether she would go back to
Jessica Honya-Tsiewu (39:01.3) her mother's place or back to her husband's house. And she said she had no issue now — she felt she could manage anything. She would be happy to go back to her husband's house, and everyone would be ready to welcome her. I think that helped a long way. In our subsequent follow-ups, we realized that the family as a whole was happy, and that is a good outcome for us. Thank you.
Mbozu Sipalo (39:52.319) Thank you, Jessica, for sharing that account. It's always good to hear case studies and examples from implementation research. That was a very helpful illustration of how you put family systems care into practice. Could you share a bit about
the tools that were developed through this framework? I know of tools like genograms and eco-maps. What did those actually look like in practice? Perhaps I'll give a guess and say George or Christina might be best placed to respond. Whoever wants to go first.
Christina Schuler (40:54.91) Yes, thank you. Maybe I'll start and then George can contribute, since we ran the training together. And I think you asked a very important question, because before we actually planned the training, I was also a bit skeptical — I always want to be sensitive about what you bring from one country to another. Because for me, Ghana is like my country. I don't just want to bring something that doesn't suit the culture or the setting. And I was so surprised during the training by how my colleagues responded.
What you mentioned — the genogram and eco-map — and I think for our listeners who may not be familiar with these, it's worth explaining. In the end, it was a co-creation. There are many books on the subject, but they're not really handy for practice. So we came up with a pocket guide, and inside the pocket guide, there are also genograms, because from any family you can draw a kind of family tree.
But family isn't just parents and siblings — it could be anyone. A neighbor, a friend. Some people even include their pets — maybe not so much in Ghana, but the point is that it's whoever is important. And that is also the definition of family: the family — or the individual — decides who family is for them.
The genogram and eco-map, when you draw them together with the family during a conversation — of course that's a longer conversation — allow you to ask about who exists in the family, what experiences they've had, maybe with a previous pregnancy, a previous delivery, or a previous child. You can ask because every person has an expertise in something.
Christina Schuler (43:33.39) So you can ask the family about their expertise and their expectations. Our colleagues learned how to ask questions along those lines: "What would you expect from us, the healthcare workers? What would help you — what can we do so that you can go through this process, even if it's challenging, knowing that you are not alone and that you are supported?" So the genogram and eco-map actually help to draw out the strengths and resources of families. That is what we did.
Then we had communication training so that participants could put it into practice. George can maybe tell us a bit more about that, since he was actually the one teaching the participants on the genogram and eco-map. What we know — and this is true not only in Ghana but in many settings — is that putting these tools into practice can still be a challenge, partly because healthcare recording systems are oriented toward medical data rather than family dynamics. But as we heard from Jessica, families sometimes don't take medications or follow through with interventions when the family is not involved. So we need to combine the medical with the more relational, because they go together. Family and medicine should go together — only then can we really achieve a solid foundation for the mother, and for the newborn.
But George, maybe you want to add something about the experience during the training and how it was to bring this new approach to the participants.
Mbozu Sipalo (48:32.277) Thank you, George, for giving us the heart of what these tools are about. Thank you for reminding us that it's about relationship and connection, and also about identifying the support systems the mother has — that was really nice to hear. I have a question about the communication training. Could you give us
a snapshot of what that looked like, and what the pre- and post-training experience felt like for you as the trainers? Because I know that one of the gaps in developing contexts is that — while there is a deeply Ubuntu, connected culture — there can also be ways of communicating in clinical settings that may not always be sensitive. I'm curious what approaches you used, and what you observed in the people you were training before and after the communication component.
Christina Schuler (49:52.622) So maybe I can start. Of course we had the research component, so every participant who wished to could fill in a questionnaire to assess their attitudes, skills, and knowledge around working with families. That was administered before the training, and then
after the training, then again at four months, and again at twelve months — just to see if there was a change. That was more the research aspect. For the communication training itself, we looked at the data we had collected beforehand, looked at the cases, and then — they were still fictional but grounded in reality — we created scenarios: one antenatal, one during delivery, one postnatal, one in the community, one in the hospital setting. We created case vignettes so that participants could read through them. And then we used the tool called Bayer — which Jessica mentioned — which guides how you can communicate. There's a specific way you introduce yourself to the family,
then you ask about the problem, then you ask questions about who belongs to the family — their experience, expertise, and expectations. That's what we trained them on. And then the participants gave feedback to each other — so it was also a peer-to-peer method.
Before creating the training, of course I was guided by my supervisors, but we also reviewed literature from the African context to see what methodologies have actually been shown to be suitable, and what African authors have recommended — so that we were using tools that fit the setting. That was one part. Then we also invited a family into the training so that I could do a live
Christina Schuler (52:08.724) interview, and my colleagues and participants could observe. A couple came with their child, so we had a live demonstration, and then participants could give feedback: What could I have done differently? What did they observe? What kinds of questions did I use? And then we had a second session a few months later where we recorded another family session — we invited another family, recorded it, and then discussed it during that session.
So those were some of the more practical tools we used. Of course we also needed the theory, but these communication training sessions were really about giving a feel for the work. And ideally, it would have been even better to use professional actors to play the role of families — but we didn't have the resources for that. Family systems care is also about how to ask questions. You can ask reflective questions, hypothetical questions: "What would happen if this and this were in place? How could you react the next time if this and this happened?" The goal is really to enable the family to use their own strengths and resources to navigate challenging times.
That's my perspective as one of the tutors. But Jessica, maybe you can share how it was for you as a training participant, because it's always two different sides.
Jessica Honya-Tsiewu (53:46.098) Thank you. I think you've elaborated on that very well. One thing I want to add: prior to the training, as mentioned, we were quick to intervene. Interventions were fast. We didn't really engage clients much. So that communication gap sometimes meant clients left feeling unsatisfied,
because we hadn't fully explored their problems or been able to help them on their own terms. The training has come to enlighten us. Good communication can actually solve about 70 to 80% of a client's problems if you are able to engage them properly. And that is where we as healthcare providers often fall short —
maybe due to time, or maybe due to a knowledge deficit. But after the training, we were able to make time for clients who really needed that support.
We were able to engage them. The Bayer concept focuses on rapport building, building relationships, and assessment — before even thinking about implementation. Once you are able to build that relationship, assess the situation, and engage the client, the more
Christina Schuler (55:10.062) I can also add — we wanted to evaluate the training and also see the outcomes from the family perspective. So what we did after the training is that the healthcare professionals we trained actually carried out these conversations and recorded themselves. We had eight families, and we followed them from the last trimester of pregnancy
through birth and then the first six weeks postnatal. They recorded different conversations with the mother and a support person of their choice. We are now in the middle of analyzing those conversations to see what changes over time, how the interactions evolved, and to evaluate whether the approach was actually being used.
We also did a pre- and post-assessment with both the families and the healthcare professionals. We looked at the families' prior experiences with the healthcare system, and then after six weeks — when the baby was six weeks old — we did a post-evaluation and asked what the experience had been like. Generally, they
had a good experience — mostly in the cognitive area. They felt they got more information and better education. In terms of emotional support, some still wished they had been asked about how they were feeling and had been supported more. Some also acknowledged that because they knew they were being recorded — or had recorded themselves — they wondered whether it would really continue like that in a real setting, outside the research context. But they said if healthcare professionals could continue communicating that way and could be that approachable, they
Christina Schuler (57:27.138) said they would really appreciate that friendliness and having more time to talk.
Shelly-Ann Dakarai (01:01:01.191) So as we're nearing the end and wrapping up, we always like to ask our guests for advice for someone who might be trying to do something in the vein of what we've talked about. But we have three very distinct guests, so I'm going to ask three separate questions — remember yours for when it's your turn. Christina, my question for you is: for someone who is a nurse in one part of the world and wants to do global health
Shelly-Ann Dakarai (01:01:31.175) and make a difference elsewhere, what advice would you give? For Jessica: for a nurse who's caring for babies and feels like we could do a better job including families in the care — where should she start to try to improve things? And for George: for someone passionate about research and about improving maternal and newborn health, how can they find mentorship or projects they're drawn toward? How can they get started? Let's begin with Christina, then Jessica, then George.
Christina Schuler (01:02:25.952) Thank you, Shelly-Ann. I think the advice I would give is that the passion has to come from deep within your heart, and you have to be willing to listen and to learn. Because I always say I have learned so much more than I could possibly ever bring somewhere. I wouldn't necessarily call it a selfish approach, but working with my colleagues in Ghana has brought me so much joy. I think the most important things are: really be patient, listen, and be ready to learn from others.
Long-term commitment and collaboration is the second thing I think should be in place to have a truly fruitful partnership.
Jessica Honya-Tsiewu (01:03:45.951) From my perspective as a healthcare provider, my advice to my colleagues and juniors is to appreciate that the client is our partner in health. For that reason, they may even have most of the answers we are seeking elsewhere — and those answers are with them. So it is far more appropriate, and more results-yielding, if we can engage them. Have the patience and the time to communicate properly with them. If you are able to explore all the avenues with the client — to understand her situation economically, psychologically, emotionally — all those things come into play, and you will find where the challenge lies. That gives you about 90% of the answers you are looking for.
Some clients come to us not because they don't know what to do, but because they just need guidance. We are there to guide them. We should not assume we are the all-knowing ones and that they know nothing. We are partners, and for that reason, we should collaborate and engage in shared decision-making when it comes to their health. Thank you.
George Edward Ntow (01:05:18.648) Thank you very much. Talking about research mentorship and how to get involved in research around maternal and child health — I would say it depends on where you find yourself. If you already work in a research institution, look at the research network you're part of. If you're a student,
or you work in a care setting — let me give an example. During this family systems care training, I deliberately spoke with some of the nurses outside the formal scope of the training and asked them: "What is the current issue challenging maternal and child health?" And I got some really interesting feedback — around the rise in congenital abnormalities, which is becoming increasingly prevalent in the region, and around the increase in hypoglycemia after delivery among women. So the data, the areas of interest, emerge simply by asking questions. By being observant, you can detect the critical areas that need
detailed research investigation. In terms of mentorship, there are many networks interested in working on maternal and child health and public health. You can sign up for some of those networks. You can also go to the websites of some great universities — there is so much work being done on maternal and child health, and it has become a global issue.
So I think finding mentorship is also about getting onto those websites, reading around, and you'll find a good mentor. The interest should come first — have an interest in the issues of maternal and child health, make sure you ask questions, try to be observant, and through the networks you have, engage with others. I believe you can identify the most pressing issues as far as maternal
George Edward Ntow (01:07:38.536) and child health are concerned.
Shelly-Ann Dakarai (01:07:59.889) Thank you all for those words of advice. What I'm hearing is that the three of you essentially said something similar about curiosity and asking questions — without having planned it. And I think that's a universal piece of advice for all our listeners: it all starts with curiosity, a genuine interest in knowing more. The more questions we ask, the more we can
Christina Schuler (01:08:25.272) Thank you.
Shelly-Ann Dakarai (01:08:28.667) find the answers, and it puts us down different paths. It all starts with being curious and being open to learning. Thank you.
All right, and I'm sure our listeners may want to collaborate or connect. What's the best place for people to reach you? We'll put it in the show notes, but how can people connect with you?
Christina Schuler (01:08:45.462) So for me, I have my LinkedIn profile, so I'm very happy to connect there. Yeah, great.
George Edward Ntow (01:09:04.744) Same for me. I also have my LinkedIn. I can share that for any form of connection.
Shelly-Ann Dakarai (01:09:10.875) We'll link your LinkedIn handle in the show notes.
Christina Schuler (01:10:02.424) Jessica will update her LinkedIn profile — so I think she's also reachable there. That's what we discussed earlier today.
Shelly-Ann Dakarai (01:10:26.711) Perfect. Well, thank you all so much for your time and for sharing the work you're doing — and for actually doing that work and making a difference right where you are. For our listeners, thank you for joining us on this episode of the Global Neonatal Podcast. We hope you found this conversation as inspiring as we did. If any of this resonated with you,
or if you know anyone who would benefit from hearing it, please feel free to share it wherever you're listening or watching. And if there's someone you think we should interview, please reach out — we are always happy to hear about folks doing amazing work to improve neonatal care around the globe. Until next time, please take care, keep making a difference, and let's go faster together for newborn care. Bye!
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