#029 - Scaling Newborn Care in Ghana: Telemedicine, Caffeine, and the Power of Collaboration

Hello friends 👋

In this episode, Mbozu and Shelly-Ann sit down with Dr. Naana Wireko Brobby, a neonatologist leading national efforts to strengthen newborn care in Ghana. She shares a grounded view of daily life at Komfo Anokye Teaching Hospital, where high patient volumes, resource constraints, and continuous teaching shape clinical work.

The conversation traces her journey into neonatology, then moves into system-level change: building a national retinopathy of prematurity (ROP) telemedicine program, introducing caffeine citrate for apnea of prematurity, and advancing kangaroo mother care (KMC). Throughout, she highlights practical lessons on leadership, collaboration, and starting before conditions are perfect. 

Link to episode on youtube: https://youtu.be/WthRpIDH03Q

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Short Bio:

Dr. Naana Ayiwa Wireko Brobby is a neonatologist and senior lecturer at Kwame Nkrumah University of Science and Technology in Kumasi, Ghana. She leads neonatal fellowship training nationally, chaired the rollout of caffeine citrate for apnea of prematurity, and spearheads Ghana’s telemedicine-based ROP screening program. Her work focuses on improving outcomes for preterm infants through scalable, system-level interventions.

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

Mbozu Sipalo (00:01) Hello everyone. Welcome to yet another episode of the Global Neonatal Podcast. Today we're joined by an amazing Ghanaian force of nature, Dr. Nana Reku Brobi, a neonatologist and senior lecturer at Kwame Nkrumah University of Science and Technology in Kumasi, Ghana. She leads neonatal medicine fellowship training nationally, chaired Ghana's rollout of caffeine citrate for apnea of prematurity, and is the Ghana lead on a national telemedicine-based screening program for retinopathy of prematurity through Zero Blind Babies. Dr. Nana, welcome to the Global Neonatal Podcast. We're so glad to have you join us. Shelly-Ann, how are you doing today?

Shelly-Ann Dakarai (00:51) I'm great, very excited as always for this conversation. It's been a long time coming with schedules and things, so just super excited.

Mbozu Sipalo (00:59) Yeah, and Dr. Nana, how are you? So happy you're here today.

Naana WB (01:04) Doing great. Thank you, Grace. I'm happy to be here finally.

Mbozu Sipalo (01:10) Yes. So let's jump right in. We love to learn about where our amazing guests are from. Please take us to the mother-baby unit at Komfo Anokye Teaching Hospital. What does a typical day or week look like for you? And what kind of babies do you care for?

Naana WB (01:32) Komfo Anokye Teaching Hospital is the second biggest teaching hospital in Ghana. It's located in the central portion of the country, but much closer to the southern part. The Ashanti region is one of 16 regions in the country and has a population of about 5.5 million people. It used to be the most populous region in Ghana, but the last census in 2021 saw it overtaken by the capital city.

The teaching hospital is located in the capital city of this region, and we get referrals from 10 out of the 16 regions. It's a 1,200-bed capacity hospital. This is where my neonatal unit is. It's under the directorate of pediatrics and child health, and the neonatal unit itself is a 130-bed capacity — quite big. Because we're in the southern part of the country and there are pediatric surgeons here that you won't find elsewhere apart from the northern part and the capital city, most of the pediatric surgical cases end up with us.

We get quite a number of babies. Our monthly admissions are usually between 250 and 300, and about 40–45% of those are premature infants. On a typical day — where do I even begin? It can start with anything at all. It can start with fathers who are agitated because they want their babies to go home. But typically it starts with morning rounds. The three seniors on the unit try to do ward rounds together with the fellows in training. We make a schedule — you do rounds wherever you're assigned for the week.

So for example, if I'm assigned to the preterm unit, I'll start with the acute care preterm ward, then ensure that the babies on the stable ward have been taken care of, and those on the KMC ward as well. Amidst all that, you're expected to be teaching — we have residents, fellows in training, and medical students, not to forget the nurses. So you spend a lot of time talking, training, and teaching.

There's also a lot of counseling, because most times you need to update the parents and relatives on what is happening and why you cannot discharge their baby, because half the time they're worried about the hospital bills. Unfortunately, even though nationally a recent policy is such that the mother's National Health Insurance covers the baby, the parents still do pay some money at the end of the hospital stay. So if a baby is staying for a long period of time, they start getting agitated because they're worried about how to offset those bills.

It could vary depending on whether the medical students are in session or not, and whether there's a need for some routine training for the nurses. You could be called to the labor ward or theater. It's exciting — it's different every day.

Mbozu Sipalo (05:46) Great. Thank you for giving us a snapshot of Komfo Anokye. I'm glad to have experienced it for myself a month or so ago — Kumasi is truly beautiful. The next question we love to ask our guests is about your background. Could you take us back to the young girl, Dr. Nana, who was getting into medicine — who that person was, and what brought you specifically to caring for newborn babies?

Naana WB (06:29) How far back do you want to go? Let me start from medical school. The preclinical years were tough for everybody — that's when you're trying to find your footing, wondering why you're doing analytical chemistry and thinking, what has this got to do with wanting to be a doctor?

But then you come to the clinical years, and that's when you're exposed to something as close to practice as possible. We tend to do pediatrics and obstetrics in the fifth year of medical school. One of my favorite lecturers was Prof. Plangereau. I don't know if you met her when you came to Ghana, but she had this way of transporting you mentally to the ward even in the classroom. When she talked about a baby with neonatal jaundice, you could just picture the baby. At the time we didn't have PowerPoints — they had those plastic sheets you'd place on a projector and it would show on the wall.

Shelly-Ann Dakarai (07:54) Overhead projector?

Naana WB (07:59) Yes! Overhead projector. She used to make hers so colorful and appealing, and you could actually hear the passion when she talked about newborns. Somehow, that was when my interest was piqued in newborn care.

Fortunately, when I was starting my housemanship, I was placed on the neonatal unit for my first two months. It was almost like God was trying to tell me something. I won't lie — there's a lot of work. Even at that time we were cramped in a space meant for about 50 babies, but we usually had between 80 and 100. As a houseman, you are the foot soldier — you do everything, and there were only two of us.

So I told myself: if, after being thrown in at the deep end like this, I still want to do newborn care, then maybe it's for me. And in spite of all that, I still enjoyed it.

She was my boss at the time, and I've been lucky where mentors are concerned. She was great — something very calm and reassuring about her. Even when a baby was dying and you were panicky, she had a way of calming you down. There were a few others along the way who encouraged me as well.

During housemanship you rotate through all the specialties — pulmonology, hematology, oncology, everything. I went through all of that, and then came back to newborn care. I just couldn't stay away. Fortunately, in 2015 I was offered a fellowship by APFP (African Pediatric Fellowship Program) in Cape Town, and that, as they say, was the beginning of everything.

It's been a great journey. Even in Cape Town, I was blessed with a good mentor — Prof. Tood — and he took me under his wing. The advantage of training in South Africa is that the settings are similar, the cases are quite similar, but in terms of equipment and infrastructure you're exposed to a lot more. You come back more confident, and it pushes you because you think: they've managed to do this there — why can't we do the same here?

When I was coming back in the last quarter of 2017, one of the things at the top of my list was ROP (Retinopathy of Prematurity) screening. I was very scared that we were pushing out blind babies into the world. We were saving quite a number of premature infants, but we weren't screening them. And the problem is — you go through all this trouble to save a 700-gram baby. It's an emotional journey, a traumatic one for both the health professional and the parents. They stay in the hospital for three, four months, and then you have no idea what's going to happen to their vision. You can't really tell until maybe the mother comes back later and says her baby is running into things while crawling — and by then it's too late.

We didn't have a lot of monitors either. We did have some from the iKMC trial where WHO donated monitors, but even then we had fewer than 15 monitors for a unit with at least 40% premature admissions. So ROP was one of the first things on my list.

And that too was a journey, because across all of Ghana there are only 150 ophthalmologists, and only seven of them are retinal specialists. Of the seven, only one is in my hospital. As of 2018, he had gone for training, so it was a lot of back and forth — the ophthalmology team told me to wait for the retinal specialist to come back.

He finally got back, and the following day he came to look for me on the neonatal unit. I've always been grateful for that, because if he wasn't committed there's no way we could have worked together. The main problem was that there was no way he could have done it alone. If we were going to screen on a weekly basis, he was already going to the theater, running the diabetic retinopathy clinic, and training his nurses. Committing to weekly screenings was tough.

So he suggested we reach out to some colleagues he had met during his training — some from Harvard, some from Stanford — and see what we could come up with. That is what led to the telemedicine approach. The agreement was: let's get a retinal camera, train some community health workers, and set up a PACS (Picture Archiving and Communication System), custom-made for ROP.

The community health workers were trained by both local ophthalmologists and partners from Harvard and Stanford. I also guided them on handling newborns — babies should always be on the monitor, these are the target oxygen ranges, these are normal heart rates — and there's always a nurse as part of the team as well.

They take the pictures, upload them to the PACS system, and the ophthalmologists read and diagnose the images. Within a few hours, we get a response. The screening days are set up so that if we get a result requiring treatment, the baby can be sent to the theater within 24 hours.

We started at my teaching hospital in August 2024, so this coming August will be two years. We've since managed to get two more cameras — one for the Northern Region teaching hospital and one for the Greater Accra Regional Hospital. So now there are three sites for the telemedicine-based ROP screening, and we're hoping to add one more for the teaching hospital in the central region. We're also thinking about a mobile ROP setup — a van with a camera and a photographer that moves from NICU to NICU on a schedule.

As of two days ago, we had screened almost 3,000 babies — 2,900 something — and about 80 of them have been treated. Because it's being done in collaboration with the NGO Zero Blind Babies and a local NGO, the anti-VEGF injections for treatment have been free so far. We're now looking to engage the government to have it covered by the National Health Insurance so the injections remain free sustainably.

Ethiopia is already involved — one of our community health workers went to train their community health workers in taking retinal images, and they now cover an additional five NICUs with the mobile system. Our next stop is Tanzania — Martha's hospital. We're hoping to get them on the telemedicine ROP as well.

Shelly-Ann Dakarai (19:02) That does sound exciting. You laid out where you started and where things are now, and I'm sure there were many steps in between. You mentioned the ophthalmologist came back, reached out to his colleagues, and then the NGOs got involved. How did they come in? And are they also paying for the community health workers, or are those workers paid through the healthcare system?

Naana WB (19:36) For now, the NGOs came in with the external partners. Zero Blind Babies was formed, and we also have Africa Eye Imaging Center. Africa Eye Imaging Center was formed around 2023, in anticipation — they had already managed to set up the diabetic retinopathy clinic. Because of the success with that clinic, it paved the way for the ROP screening program. When we were writing to get permission and support from the hospital, we could point to the diabetic retinopathy clinic and say: we followed the same path there, and it's doing very well — this one will follow the same trajectory.

For now, it's the NGOs paying the community health workers, not the hospital. And the mothers are not paying anything for the screening at this stage — everything is being handled by the NGO. That's why we're hoping to get the National Health Insurance involved to cut down some of the costs. Otherwise, it wouldn't be sustainable.

Shelly-Ann Dakarai (21:28) So the power of collaboration.

Naana WB (21:30) Absolutely. But I also have to mention that the ophthalmologists need to be committed. In the hospital, your local ophthalmologists need to be totally on board because it's ongoing — almost every week. We're now screening between 40 and 80 babies per week, and for approximately every 160 babies screened, at least one needs treatment.

The ophthalmologist has to be on standby — as soon as the diagnosis comes in, the baby is immediately rushed to the hospital. It all comes down to partnership and collaboration. From the beginning it can be challenging. You sometimes ask yourself why you're even bothering. But you go back to the drawing board, and one way or another there are always solutions. You take it one day at a time, and eventually everything works out.

Shelly-Ann Dakarai (22:47) Is it the local ophthalmologist doing all the reading, or is there a schedule where his colleagues also review the images?

Naana WB (22:56) The custom-made PACS system is set up so that a select number of ophthalmologists can access it — those at Harvard, those at Stanford, and the local ophthalmologist. Just the partners involved.

Shelly-Ann Dakarai (23:36) And do you have blended oxygen at the teaching hospital?

Naana WB (23:45) We do have some blended oxygen now, and the situation is definitely much better than it was three or four years ago. About three years ago, on the acute care preterm ward — which takes between 18 and 22 babies — it could be so bad that you'd have just three monitors on the ward. Every morning you'd decide who's the sickest, place one monitor on that baby, and use the remaining two to check vitals on everyone else — one nurse checking saturations every hour for the most critical babies, another checking every three hours for the more stable ones.

Now, out of the 18 to 20 babies on the preterm ward, I can honestly say that at least 15 would be on continuous monitoring on any given day. Things have improved significantly.

The ROP program also helped, because after the first 100 or 200 babies were screened, we wrote a paper, and we had NGOs, partners, and even individuals reach out. They donated about 20 portable monitors and 40 CPAP devices with blended oxygen. The number of babies placed on unblended oxygen has definitely gone down.

We still do have a few babies on what we call improvised CPAP. We're trying to move away from that. But one of our biggest challenges remains weaning of oxygen. Health professionals tend to like it when a baby is saturating at 100% on supplemental oxygen — and no matter how many times I say it, the message that a baby on supplemental oxygen should not saturate at 100% doesn't seem to register.

So now what I do is quote the ROP figures. I tell the nurses: for every 160 babies, one needs treatment. And sometimes I show them a picture of Stevie Wonder and tell them that Stevie Wonder was not born blind — it was poor oxygen management that caused his blindness. I'd like to think I'm making a dent.

Shelly-Ann Dakarai (27:48) Yeah. You highlighted challenges that exist in so many parts of the world. Where I'm from as well, there's no infrastructure for blended oxygen in many places — oxygen tanks are seen as life-giving, and it's very hard to change that mindset around oxygen potentially being harmful. When CPAP machines came out that allowed blended oxygen by drawing air from the atmosphere, that was huge — that's how CPAP was introduced in the NICU where I'm originally from. Challenges similar in many parts of the world, but glad things are improving with new devices and the ability to do blended oxygen.

Before I hand back to Mbozu, one last question about ROP: there are a lot of moving parts and partners in this project, and it's clearly making a huge impact. How much of what you do — navigating stakeholders, managing all of that — did you learn in medical school, fellowship, or residency? And how much did you learn on the ground?

Naana WB (29:21) Shelly-Ann, we were not taught any of this in medical school. I always complain to my colleagues that certain things should be in the curriculum — maybe even a business class, how to engage potential donors, management skills, leadership skills. Unfortunately, none of that was there. You learn on the job.

But I've also come to realize that even the things we are taught in medical school, some of them are forgotten by the time you're working. And some of what you learn on the job you end up becoming even more skilled at, because you make mistakes and learn from them.

I also believe strongly in mentorship — it keeps coming back to that. There's no harm in asking for help. The fastest way to move forward is through people who have already charted that path. You find someone who's done it before and ask: what would you recommend? What challenges did you encounter? There's no shame in saying I've never done this before.

I used to be very quiet — come to work, do what I had to do, go home. But certain projects force you to come out of your shell, because there's only so much you can do on your own. Even with ChatGPT or Gemini, it's still theory. You need someone who's done it before, because they'll point out things you never would have thought of by yourself.

It's always good to work with a good team. We all have our strengths and our flaws. Some people bring ideas; some bring those ideas to fruition; some are good with interpersonal relationships and glue the team together. Without such people, the team might not work.

There's no harm in asking. You must appreciate everybody's strengths. No matter how small or minor you think someone's contribution is, in the end it helps make the project better. No, we weren't taught these things in medical school — but you end up learning. You find someone more knowledgeable, and even if the person doesn't want to be bothered, you find a way to get some of that knowledge and those skills from them.

Mbozu Sipalo (32:55) I have a question piggybacking off Shelly-Ann's, linked to the sharing of knowledge and where you are now and where you're going. You touched on the telemedicine ROP program and upscaling in other contexts — you mentioned Tanzania, and we know you presented this work recently at the International Maternal Newborn Health Conference. I'm curious about how you're going to support other countries to start this screening, especially as we see more in-hospital births and a growing need to follow up preemie babies who previously didn't have a chance to survive.

What are the non-negotiable principles you share with colleagues looking to start ROP screening? And beyond Tanzania, are you thinking about supporting other countries — Zambia, for instance?

Naana WB (34:14) Before I came for the IMNHC conference, I reached out to the Stanford and Harvard teams, Zero Blind Babies, and our local ophthalmologists. I told them I was going to present at a newborn conference and would likely get people asking whether it could be set up in their country — was it okay to give out their contacts? And they were like, yes — ZBB is ready to help.

The goal is to ensure no baby goes home blind. Zero Blind Babies is prepared to help — if it means writing a grant or approaching partners to secure at least the first camera, they are willing to do that.

The most important thing is having a good team on the ground. You need a neonatologist who is ready to do the groundwork, because there's a lot of running around. It's a multidisciplinary team, but everything will revolve around you even though the ophthalmologists are doing the main clinical work. You need to coordinate everything well.

Sometimes the team will send you a report saying: we've screened this baby and it doesn't look like ROP, but there seem to be some lesions in the eyes. You're then responsible for following up that baby with a pediatric ophthalmologist. Sometimes you'll get a call saying: this baby's mother needs to come in immediately and be prepared for surgery. You need to coordinate that fast.

So you need a committed neonatologist and a committed ophthalmology team. And the golden rule: once you start screening, you don't screen if you're not ready to treat the diseases you find. Make sure your pharmacist is ready and on standby. Get a good team on the ground that is ready and willing to do the work — and then Zero Blind Babies will step in with the other partners.

Shelly-Ann Dakarai (37:16) I had a question from earlier when you were describing your typical day. You mentioned "the three seniors." How many neonatologists do you have at the teaching hospital? And when you say seniors, do you mean neonatologists plus senior fellows, since you also mentioned having fellows and residents?

Naana WB (37:41) We have three neonatologists. The neonatology fellowship was started two years ago with the Ghana College of Physicians and Surgeons. There are currently three accredited hospitals, and you can choose where you want to do your training. We've put together the curriculum — technically it's two years, but you're expected to do one year of general pediatrics before starting the neonatology fellowship.

Before that, if you wanted to specialize in neonatology, you had to go outside the country — which is what led me to Cape Town with APFP. But now we have it set up here. The West Africa College of Physicians and Surgeons has also started a subspecialty in neonatology.

With the Ghana College, we currently have three fellows with us. With the West Africa College, we have one additional fellow. They also do external rotations because it's important to be exposed to what's happening outside — we have a memorandum of understanding with Cape Town and APFP, Nebraska, and a third institution. They go for three to six months, rotate there, get that exposure, and then come back to sit their exams. The first exam for the neonatology fellowship will actually be held this October.

Shelly-Ann Dakarai (39:37) What was it like starting that fellowship from essentially the ground up?

Naana WB (39:46) A lot of work. Putting together a curriculum is intense, because by the time you've finished, you want to be assured that these fellows are truly ready to go back to their facilities and lead their neonatal units.

There are challenges too, because the training facilities need to be well-equipped to provide everything in the curriculum. But as with all new things, as you go along you identify the gaps and work on them. I believe that in a year or two, we'll have filled most of those gaps and it will be running better. Right now we're in the early stages — not quite toddler phase. We're still in the first six months of exclusive breastfeeding.

Shelly-Ann Dakarai (41:03) That's a great analogy.

Mbozu Sipalo (41:18) I'd love to explore one other topic — your national leadership on apnea of prematurity and caffeine. You chaired the introduction of caffeine citrate under the Ghana Health Service, which led to national health guidelines and SOPs. Could you walk us through that process of introducing caffeine to Ghana and where things stand now?

Naana WB (42:05) In 2024, CHAI (Clinton Health Access Initiative) — an NGO that has done a lot of work in this space, including with Kenya on caffeine citrate — partnered with the Ghana Health Service and the Ministry of Health. There were concerns that some facilities across the country were not having access to caffeine citrate, and some were still using aminophylline.

As you know, respiratory distress syndrome and apnea of prematurity are top causes of neonatal death. For the past two to three years, prematurity and its complications have been the leading cause of death in the country — partly because we're seeing a lot of assisted reproductive techniques, lots of multiple births from IVF, and many of those babies come prematurely.

CHAI decided to address respiratory distress and apnea of prematurity, but to do that properly they needed national guidelines — because we didn't have guidelines or SOPs for the management of apnea of prematurity in the country. A technical working group was formed with the Ghana Health Service, Ministry of Health, and CHAI. We met a series of times and put together the national guidelines on apnea of prematurity. That was completed in January 2025.

CHAI then donated 40,000 ampules of caffeine citrate to hit the ground running. The next step was to get apnea of prematurity included in the standard treatment guidelines, because that's the first step toward getting caffeine citrate on the essential and emergency drug list — and it's only once a drug is on that list that it can be considered for coverage by the National Health Insurance.

It's been a long process, but in the meantime, trainings have been done for health workers on the protocol — how to manage apnea of prematurity and the use of caffeine citrate instead of aminophylline. About 8 to 10 regions have been trained so far, covering at least 500 health workers, using a trainer-of-trainers model. Representatives from each region are trained and then go back to train their own teams.

The data systems were also strengthened — once trained, facilities enter data on every premature baby who receives caffeine: gestational age, birth weight, outcome, length of stay, and so on. It's generating a lot of reliable data.

What we're waiting and hoping for now is that caffeine citrate will be covered by the National Health Insurance, so there's easy nationwide access and parents don't have to pay for it. It was actually an exciting journey. Some of the data showed that for every three hospitals, one was still using aminophylline. And about two out of three were not doing blended oxygen. We're hoping that with continued government support and partners like CHAI, things will keep improving.

Mbozu Sipalo (47:48) Just a follow-up, Dr. Nana — has there been any pre- and post-caffeine analysis done yet?

Naana WB (48:06) Not yet. They're working on that — I know the pre and post analysis is being done, but I don't have the figures yet.

Mbozu Sipalo (48:16) Great to hear it's been introduced and that things are improving. I think we're almost wrapping up, but we should explore kangaroo mother care before we do. We know you were involved in the WHO Immediate Kangaroo Mother Care Study Group, and KMC is a big topic right now. We'll also be celebrating World KMC Day in about a month, and possibly releasing this episode around that time. What are your thoughts on KMC in Ghana, how has it been received, and what does the future of implementation look like post-study?

Naana WB (49:20) Before we started the study, there was one major concern. As part of the methods, the requirement was that ideally for the intervention, the baby should be placed in skin-to-skin within two hours of birth. If the mother had had a caesarean section and wasn't in a position to do it, a surrogate would. The concern was whether mothers would be comfortable with someone else holding their baby skin-to-skin — looking at it from a cultural and traditional angle.

But what we learned was that it wasn't an issue at all. It was actually quite pleasantly surprising. The mothers didn't have a problem, and the potential surrogates didn't either.

In fact, we had one mother who had come from the northern part of the country to marry — she had no family close by. When we asked if there was anyone, she said no, but suggested we call her pastor's wife. We called her, and she came — and then made a full roster for the women in her church. Those who worked during the day would come at night for a kind of skin-to-skin night shift. The response was genuinely positive.

The bigger challenges were mostly infrastructural. You'd wish the father could also do skin-to-skin, but when the mother is in the neonatal unit alongside other mothers, there's only so much time a father can be present. And if the mother is going to be there 24/7, you need to think about washrooms, bathrooms, feeding — and most NICUs aren't built with that in mind. But one way or another, you find a way.

There's also the matter of collaborating with obstetricians — something that's a bit silent in the neonatal space but important. No matter what we do, we're supposed to be joined at the hip with them. Our babies are in their care before birth. If we collaborate better with them, it helps with clinical interventions — antenatal steroids, delayed cord clamping, magnesium sulfate — and with emergency communication: knowing ahead of time that there's a possible 28-weeker coming so we can be on standby.

Once we're doing KMC and the mother is in the NICU, the obstetricians also need to come do their rounds on her there. If they're not in sync with the neonatologist, that can be tough — it's an everyday issue, and they're used to seeing mothers on their own territory.

Having said all that, KMC is a wonderful concept. It's essentially an extension of the in-utero environment for a preterm baby. I've literally seen mothers become more and more confident once they start. Things they used to call me for immediately — they now handle themselves. And they start using our terminology: "The saturation dropped to 88 but went straight back up." It builds confidence, reduces excessive handling, which in turn reduces infection risk. It helps with weight gain and breastfeeding. It's a beautiful thing.

In Ghana, our biggest issue is infrastructure. But the staff have bought in. Sometimes I'm doing rounds and don't mention KMC because I assume it's routine — and the nurse will say, "And KMC?" right to my face. So one day at a time, but I think we'll get there.

I always say: it doesn't have to be 24 hours a day. Even six to eight hours makes a difference. The most important thing is that the mother understands the concept. Most times when you pass by, she'll call out: "Can you help me put my baby in KMC?" Because she's bought in and understands it. And I think it starts from there — you educate well, you advocate for it, and eventually they do it by themselves.

Shelly-Ann Dakarai (57:20) Thanks. One quick follow-up before we close: you mentioned a KMC unit at the top of the episode. Can you describe what that unit looks like and which babies are cared for there, for listeners who might not be familiar?

Naana WB (57:39) The KMC unit is like an adult ward — a large hall. Ours is an 11-bed capacity unit. You have adult beds, and the mothers are there with their babies 24/7. Unlike the acute care unit where you have radiant warmers and incubators and babies are the focus, here it's adult beds with mothers present. We do have a few radiant warmers or incubators for when a mother needs to use the washroom, but most of the time mothers now place the baby on the bed even while eating — unless the baby is having an episode, in which case they'll step out briefly and come back.

You come to the ward and you see mothers in all kinds of states — some lying on their beds, and we've managed to provide a television. They like watching telenovelas and African movies. In the middle of the night, the baby is right there, and we have nurses running shifts monitoring vitals.

So how it flows: when a premature baby is admitted, it goes to the acute care ward first — that's where you have the CPAPs, monitors, phototherapies, everything. Once the baby is off respiratory support, we move to the stable ward, which takes between 20 and 24 babies.

Because the KMC ward is small — only 11 beds — we tend to be selective. We prioritize the extremely premature babies there, because they need to gain weight and will be staying longer. They also benefit most from having their mother present continuously, with her own bed, washroom access — everything in one place.

From the stable ward, babies go to the KMC ward before they can go home. On the KMC ward there's daily education: newborn danger signs, feeding, what to do if the baby vomits, why to do KMC, immunization — all the things they need to know. One day covers jaundice, another covers feeding, why you shouldn't give formula if you have breast milk, and so on. By the time they're going home, they know most of what they need to. And even after discharge, they're expected to come for at least twice-weekly weight monitoring until they're discharged from the KMC clinic.

Shelly-Ann Dakarai (01:01:29) Thank you for that detailed picture of your KMC unit, Dr. Nana. It was a pleasure having you on the podcast. We learned a great deal about all the work you're doing, and as always it's been an inspiring conversation. When you hear about what somebody is doing in one place, you think: I could do that too.

You do a lot — clinical work, leading multiple initiatives. One of the things we love to ask at the end is: what advice would you give to someone who is starting out and trying to make a change? Someone who wants to make an impact but might be navigating a lot of different responsibilities?

Naana WB (01:02:38) The first thing I would say is: don't wait for things to be perfect before you start. Someone's been sending me quotes lately, and one stuck with me: you always regret not doing something when you were younger — but today is the youngest you will be. So whatever you want to do, start.

If you have an idea and you're passionate about it, start with small steps. Which brings me back to seeking the help of those who have done it before, or mentors who can give you advice — not necessarily someone who's done it specifically, but someone who can say: if you go this way, you might encounter these challenges. Look at the system before you proceed.

Start small. Even if it means just jotting something down. Find a good team. Small, consistent steps are usually better than one big inconsistent move.

When it comes to newborn care specifically, stick to the basics. Get your core skills right: resuscitation, infection prevention and control, hand hygiene, breastfeeding, KMC, thermal protection. These things may seem simple, but they are foundational — whatever baby you encounter, these principles run through everything.

Shelly-Ann Dakarai (01:05:05) How can people connect with you if they want to collaborate or ask a few more questions?

Naana WB (01:05:13) Email would be best.

Shelly-Ann Dakarai (01:05:16) Sounds good. We'll put a contact form in the show notes for those who'd like to reach out.

Thank you again, Dr. Nana, for being on the podcast, for taking the time, and for inspiring everyone listening. For our listeners — if this resonated with you, please share it with someone who might benefit from hearing about Dr. Nana's work and who might need a little inspiration. If there's someone you'd like us to interview, reach out to us on LinkedIn or by email at globalneopodcast@gmail.com. Until next time — take care, keep making a difference, and let's go faster together for newborn care.

Naana WB (01:06:20) Thank you so much.

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