#032 - Learning From Each Other: SALSA, Quality Improvement, and Global Health (ft Dr. Scott Guthrie)

Hello friends 👋

In this episode, Shelly-Ann sits down with Dr. Scott Guthrie to discuss his global health work, SALSA, and quality improvement. He shares how working alongside neonatal teams in different settings has shaped his approach to improving care, including what he has brought back to his own practice in Tennessee. From introducing SALSA in Azerbaijan to adapting lessons from a delayed cord clamping project in Ethiopia, Scott describes how learning moves in both directions between higher- and lower-resource settings. We also discuss the practical work of implementing change, training teams, and approaching global partnerships with humility and respect for local expertise.

Link to episode on youtube: https://youtu.be/_riLsbA00JU

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Short Bio: Dr. Scott Guthrie is the System Director for Neonatal Quality, Research, and Outreach at Erlanger Health System and Professor of Clinical Pediatrics (Neonatology) at the University of Tennessee Health Science Center College of Medicine in Chattanooga. He also directs the Small Baby Unit. Dr. Guthrie earned his Doctor of Medicine from East Tennessee State University and completed a Certificate in Medical Education from the University of Cincinnati. He completed his Pediatric Residency with the University of Tennessee and his Neonatal-Perinatal Medicine Fellowship at Vanderbilt University. He has a deep commitment to improving outcomes for premature and critically ill infants around the world. Recent clinical research interests have included: use of the supraglottic airway to deliver surfactant (SALSA), aerosolized surfactant, and probiotics for the prevention of NEC. He has served as a Fulbright Specialist with the US State Department and has shared his expertise internationally to strengthen and improve neonatal care across 5 continents.

Connect with Dr. Scott Guthrie: drsgu3@gmail.com

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Resources:

Article: SALSA a viable option for Middle Income and Low Income Countries https://pubmed.ncbi.nlm.nih.gov/35372140/

Article: Implementation of Surfactant Administration through Laryngeal or Supraglottic Airways (SALSA): A Jordanian NICU’s Journey to Improve Surfactant Administration https://pubmed.ncbi.nlm.nih.gov/36010038/

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

Shelly-Ann Dakarai (00:01.273)Welcome back, everyone, to another episode of the Global Neonatal Podcast. We’re so glad you’re joining us today. I’m flying solo today, as you can see. Mbozu isn’t with me, but I’m still very excited to be here and to have our guest in the studio. Today we have with us Dr. Scott Guthrie. He’s a neonatal intensive care specialist and the system director for neonatal quality, research, and outreach at Erlanger Health System. He’s also Professor of Clinical Pediatrics (Neonatology) at the University of Tennessee Health Science Center College of Medicine in Chattanooga, Tennessee. He has served as a Fulbright Specialist with the US State Department, sharing his expertise across five continents. One of his recent interests is SALSA (Surfactant Administration through Laryngeal or Supraglottic Airways): using a supraglottic airway device to deliver surfactant. He’s passionate about his work and deeply committed to improving outcomes for preterm and critically ill infants worldwide through research and quality improvement. Dr. Scott Guthrie, welcome to the podcast. We’re so glad you’re joining us today.

Scott Guthrie, MD (01:09.678)Thank you so much for the invitation. It’s been great meeting some of you; Mbozu and I met in Tanzania a couple of years ago. So it’s a wonderful opportunity to sit down and chat.

Shelly-Ann Dakarai (01:22.465)Awesome. And it’s been a while coming, because it took us quite a while to line up everyone’s schedules, so I’m just so glad it’s happening today.

We like to start at the beginning, with your origin story, as we call it. Before we get into SALSA and all the global health work you’ve done, and before all five continents, there was a young Scott who, from our research, liked kids and science. So I’m curious: what got you interested in pediatrics, and later neonatology?

Scott Guthrie, MD (01:58.881)You’ve done your homework, then. Yes, the kids and science thing. I obviously love kids; my wife will tell you I’m still a big kid at heart. In college, I was a philosophy and biology major, two very different areas. But philosophy asks what a life is worth, and biology asks how life actually starts.

My very first rotation in medical school was actually in the NICU (neonatal intensive care unit). My wife says I came home one day and said, “Man, I absolutely love this. This is fantastic, this is so cool.” I did everything else in medical school, and honestly, I liked everything I did, but I ultimately settled on pediatrics. Then my very first rotation in residency was also the NICU, and I was scared to death as a resident. That was back before work-hour restrictions, so it was 120-hour weeks in the NICU. A lot of work, and I didn’t quite understand the medicine. Fortunately, I did the rotation again at the end of my first year, and I thought, I absolutely love this. This is what I want to do.

What it did for me was combine three things. First, the philosophical and ethical questions we deal with, specifically in neonatology: how do you talk to a family facing end-of-life issues at the beginning of life, and how do you do that compassionately? Second, I’ve always been a tech nerd, so all the technology and tools in the NICU that we use to get better outcomes really appealed to me. And third, I’ve always been an adrenaline junkie, so the procedures, and walking into a delivery room not knowing what to expect. All three of those really appealed to me. I ultimately settled on neonatology and never looked back. I tell residents and medical students that I’d do this again in a heartbeat. No regrets at all. I’ve absolutely loved my time in the field.

Shelly-Ann Dakarai (04:33.059)It’s such a multifaceted field, and people outside it don’t quite understand all the nuances of what draws us to it. We’ve been one of the more tech-forward pediatric specialties, so it’s not surprising that the tech side brought you joy and was part of the inspiration.

So you liked kids, you liked science, you became a neonatologist, and then you’ve had this long career in global health. How did global health find you? Was it while you were a student, or once you became an attending?

Scott Guthrie, MD (05:28.142)If you want the true origin story, it started when I was a little kid. My dad was a dentist, and he would always go with mission organizations to do dental work. I thought that was the neatest thing. I was six or seven, saying, “Dad, take me,” and he’d say, “No, absolutely not. You’re too young.”

Then the college I went to was a Christian college, so there was a lot of emphasis on service and taking opportunities to serve others. And of course, the greatest philosopher said, “To whom much is given, much will be required.” I’ve always taken that to heart. As a premed student, between my junior and senior years of college, I had an opportunity to live in the Dominican Republic and work at a medical clinic in Santo Domingo. I spent the summer living with a Dominican family. I didn’t speak any Spanish, and they didn’t speak any English, so I learned Spanish. Yo hablo español ahora. I’d get home from the clinic and take the kids around the neighborhood, and they’d laugh at me as I tried to say words in Spanish. Every morning I’d wake up and navigate Santo Domingo by motorcycle, bus, and foot to make it to the clinic, then work there during the day. That was my first exposure to global health.

As a resident, a fellow, and even an early attending, I was more involved in the classic model: going in with a clinic or hospital and doing a medical campaign. But the further I got from training, the more difficult I found that, with all the technical wizardry of the NICU. I was getting distant from seeing the 90-year-old and treating hypertension, yet when I did that work, I had to manage it. And I realized that a lot of times you’re just putting a Band-Aid on a problem when you do work like that. How can we do more sustainable work? How can I use the knowledge I’ve gained in the NICU to educate people in the setting they’re in, and make it translatable to different settings and countries?

All of this was sort of accidental. One of my mentors at Vanderbilt said, “Hey, do you want to go to Jordan and speak at a conference?” And I said, “Sure.” I figured it would be a one-off. Then I got an email from a doctor who was a medical consultant in a country called Azerbaijan.

Shelly-Ann Dakarai (08:59.025)Please, yes, explain.

Scott Guthrie, MD (09:17.23)Most people, when I say that country, ask, “Where?” It’s a Central Asian country, one of the former Soviet republics. Literally a third of the country is on the European plate and two-thirds is in Asia, so it’s a bridge between East and West, with a lot of oil wealth. They were looking to improve their infant mortality rates. A US physician who worked with the US Embassy there also consulted for the Azerbaijan Ministry of Health, and they told him, “Get us an academic neonatologist who can come work with us on this.” An email went out, and I just happened to respond to this random, anonymous email. One thing led to another. I went to Azerbaijan for a week, that turned into a Fulbright grant, and I went back on two more Fulbright trips, working with Azerbaijan Medical University and the Ministry of Health. It was a lot of fun.

On the first trip, we did a lot of simulation work. Near the end of that trip, and this is a fun story, one of the Ministry of Health officials took me to her office and said, “We’ve determined you’re not a CIA spy. You know a lot about taking care of babies.”

Shelly-Ann Dakarai (10:31.734)Oh my goodness.

Scott Guthrie, MD (10:38.264)She said, “We have a problem, and we need you to help us with it.” She showed me a refrigerator holding the surfactant for the entire country. She said, “We’ve made a huge investment in this, because we know this is what we need to improve our outcomes. Every quarter, I send surfactant out to our regional hospitals that care for babies, and it’s not being used, because people don’t know how to intubate to give it. Come back next year and fix this problem for us.” So I thought, well, one, I’ve got an invitation back. This is great. And two, how am I going to teach people laryngoscopy and intubation to give surfactant? That leads to the rest of the story, which I know we’ll get into in a bit.

Shelly-Ann Dakarai (11:17.521)Big problem.

Scott Guthrie, MD (11:35.105)So that’s the origin story of the global health work. Really, one thing has led to another. I’ve always had a problem telling people no. When I’d get emails or requests to come to this country or that country, I’d say, “Sure, let’s go. I’ve got a passport. Let’s see what we can do.” It’s been quite an enjoyable experience.

Shelly-Ann Dakarai (11:57.445)Interesting. Would you travel with your family, or were these trips mostly by yourself?

Scott Guthrie, MD (12:08.276)Both. If I had the opportunity to bring my family, I would. One daughter went with me to Jordan and then to Nicaragua, and another daughter went to Honduras. My wife has gone with me to Jordan and Tanzania. And one daughter is actually a NICU nurse now, so she’ll be going with me to Tanzania in the spring to help teach. We’ll have a father-daughter teaching team.

Shelly-Ann Dakarai (12:38.054)That’s amazing. I want to get into SALSA now, because we’re at that point in the story. But you mentioned Tanzania and all these other places, so as a sidebar: was it that each opportunity made more people aware of you, and more emails came, and you ended up in different countries? Or were some of these part of your work as a Fulbright Specialist?

Scott Guthrie, MD (13:12.764)The Fulbright Specialist work was just Azerbaijan. But one thing would lead to another, and somebody would reach out to me, especially as the SALSA story began to grow and people realized how the technique could improve care for babies in places where laryngoscopy and intubation are difficult.

Shelly-Ann Dakarai (13:37.777)What year were you first tasked with figuring out how to teach people to give surfactant?

Scott Guthrie, MD (13:46.223)That discussion was in 2017, and I went back in 2018 to implement SALSA in Azerbaijan.

Shelly-Ann Dakarai (14:00.155)So why did you choose SALSA rather than teaching laryngoscopy? On our side of the world, and I say “our” in quotation marks because I’m originally from the Caribbean, it seems somewhat new. It’s not really new, but it seems to be talked about more now. But that was 2017 and 2018. So I’m curious what made you think differently, rather than teaching everyone the way we currently do it here, with INSURE (intubate, surfactant, extubate).

Scott Guthrie, MD (14:32.46)Good question. If you go back to the origins of SALSA, the first case reports came out around 2004 or 2005. What coincided with this request from Azerbaijan was that one of the major SALSA papers was published in early 2018, work by Kari Roberts. I had gotten back and was trying to figure out whether to teach laryngoscopy and intubation, plus equipment maintenance, or whether there was something else. I looked at the thin catheter methods as well, but you still have to do laryngoscopy and you still have to be quite skilled. Then I stumbled upon Kari Roberts’ paper, and it made a lot of sense.

Shortly after it came out, I happened to be at the Pediatric Academic Societies meeting, talking about this with somebody, and they said, “You need to meet Kari Roberts.” Then they looked up and said, “There she is, right there. Hold on a second.” Kari and I just hit it off. I learned the technique from her and got all the information. We reached out to industry for donations, and this is where the family gets involved again: as the boxes came in, I sat down with my kids, and they opened all the boxes and made the SALSA kits for Azerbaijan. We had translated the protocol into Azerbaijani, so every kit had everything you needed.

Going back to your question about why SALSA: it’s the ease of the procedure. You can think of it almost as a blind intubation. You put the device in, and it really can’t go anywhere else. It sits above the vocal cords, and if you have good devices with a good seal, the surfactant goes where it’s supposed to go. I taught it in Azerbaijan, and within about 48 hours of teaching it at one of the hospitals, I got a WhatsApp message from one of the doctors, with a video of her doing it. She said, “You’re right, this is very easy.”

That’s been a really interesting part of this. As I teach and travel, I’ve collected videos from all over the world of people doing the procedure literally 24 to 48 hours after learning it in simulation. That’s something you typically can’t do with laryngoscopy and intubation. I still remember my first time trying to intubate, and my second and third times, and they didn’t go too well. But this is something you can teach in simulation one time, and people can implement it immediately: get the airway within seconds, complete the surfactant procedure within a couple of minutes, and have the device out.

Shelly-Ann Dakarai (17:52.357)I was home on maternity leave, and I think something about SALSA came across YouTube. Then I saw Dr. Roberts’ paper and thought, oh my goodness. I reached out to her, she sent me her SALSA outline, and I forwarded it to an organization I volunteer with. I said, “This is how we can give surfactant in places where there might not be neonatologists, laryngoscopes, and all the things that go into it.” Within a couple of months, they were able to get supplies for the airways, and that’s how they give surfactant now.

It’s amazing to go from not being able to give it to being able to give it. And because it can be used, it becomes a flywheel: the administration is willing to keep sourcing it, because it’s no longer expiring on the shelf. It’s been amazing to see that unfold. And I know your unit locally is also doing it. It’s interesting how de-intensifying care is helping us in global health settings, and it’s also giving us more evidence to bring back and say, “We can do this.”

Scott Guthrie, MD (19:23.49)Yes, and that’s been the fun part of this story. It’s been nearly a decade since we began implementing this globally, and the reverse is really happening: what we’ve learned and implemented in low- and middle-income country settings is coming back to the United States, and even the Europeans are starting to pick up on it and do studies on SALSA. It’s amazing to see how what’s done in a low- and middle-income setting can affect what we do in a high-resource setting and actually improve care for babies.

You mentioned my own hospital. This has been a fun test of implementation, because I changed jobs in December of last year and moved, as you mentioned, to Erlanger in Chattanooga, with the University of Tennessee. It was a good test of whether I knew what I was talking about with quality improvement and implementation. We had designed a whole implementation package of lessons learned: if you’re going to do this, here’s how. Within about six weeks, in early February of this year, we started implementing SALSA. As of this morning, we’ve done 82 SALSA cases, and SALSA now accounts for nearly 80% of our first-time surfactant administrations in non-intubated babies outside the delivery room.

Shelly-Ann Dakarai (21:13.99)Amazing.

Scott Guthrie, MD (21:16.438)One of my partners said the other day, “We seem to be ventilating a lot fewer babies than we used to. I wonder if it’s because we’re treating babies with surfactant sooner and not letting them get sicker.” I think there’s a lot of validity to that. We’re pulling some retrospective data to see if it’s true. But that’s the impact of an easy technique, whose implementation we really perfected in low- and middle-income settings, now having an effect in a high-resource setting.

Shelly-Ann Dakarai (21:51.289)We’re implementing it in our Level II unit as well. I was able to bring that feedback, to say the organization I volunteer with has used it in other places, and there’s now data from both settings on how good it is.

You mentioned this new role as a test of quality improvement, which is a good segue to a couple of questions about QI (quality improvement). Sometimes I feel like we sit in different camps, the research folks and the QI folks. But you sit in the middle, as a director of both research and quality improvement. I’m curious how you see these two not as opposite ends of the spectrum, but as working together. And as you said, implementation is where a lot of things fall apart. How does quality improvement give us a lens for implementing change?

Scott Guthrie, MD (22:57.222)Great question. It’s really difficult to take a randomized controlled trial protocol and drop it into your setting. We love that data; it’s what tells us that a change we make will be effective. But it’s really impractical to take a 100-page research protocol and drop it directly into your setting. The quality improvement work is what will change what we do, and the implementation work is what changes practice. There’s pretty good documentation that it typically takes 17 years from when a study shows something works to when physicians do it regularly in practice. That’s a really long time. That’s me having to die off and a new doctor replacing me with new ideas.

So the question is: how do we get people to do the right thing, at the right time, in the right place, with something appropriate for their setting? How do we get the same thing done at 2 a.m. as at 2 p.m.? And how do we get the best thing to the bedside for the baby? That’s where implementation and quality improvement work sit: looking at processes, people, equipment, and setting, and figuring out what works in that setting and what might be broken. Being able to do that locally is certainly important.

I’d encourage anybody who wants to do global health work to make sure they can do this well locally before attempting it somewhere else. You’re looking at systems and how they work, and you can’t necessarily import what worked at your place into another place without testing it and making changes.

The other fun thing I’ve gotten to do with quality improvement is work that started globally and came back locally, through TIPQC, the Tennessee Initiative for Perinatal Quality Care. I got to be its medical director for a few years; the medical director role rotates. During COVID, none of us global health people could go anywhere. Danielle Ehret put together a group with Carl Bose of people who did global health work, and we said, “Let’s see if we can make this Zoom thing work and still do some global health work.” We partnered with the Ethiopian Pediatric Society on delayed cord clamping at eight hospitals the society was involved with. Over the course of a year, we did a great delayed cord clamping project that was published last year in Pediatrics.

At the same time, working with TIPQC, I thought, if they can do this in Ethiopia, we can do it in Tennessee. I knew what was going on at the different hospitals. We all know delayed cord clamping is better science, but getting people to change, getting our obstetric friends to change, and getting us neonatologists not to grab the baby immediately and to give the physiology a chance to work, is a difficult thing to reprogram. So we took what was done in Ethiopia and adapted it for Tennessee. We made it work not only in the big Level III and IV hospitals, but also in our Level I and II hospitals and birthing facilities. The project engaged nearly half of all birthing hospitals in Tennessee, including all the Level III and IV ones. It ended up affecting about 67,000 births, I believe, and finished with a delayed cord clamping rate somewhere around 80 to 87% across the state. So again, it’s something we learned in a low- and middle-income setting that came back, through quality improvement and implementation work, to benefit our state.

Shelly-Ann Dakarai (28:01.481)We’ve been talking about globalization and the internet and how we’re all connected for decades, but it’s really true that we can learn so much from each other. It used to be someone from a higher-income place coming in, teaching, and leaving. It’s no longer a one-way street. We’re definitely learning from each other, and having open spaces where everybody can share only makes things better, because you can hear something and tailor it to your context, whether it’s similar or completely different.

With your work in so many countries, and leading teams in your day job, how do you approach education? How do you share new knowledge without seeming like the most knowledgeable person in the room? How do you create an environment of sharing, collaborating, and facilitating? Because that can be hard to do.

Scott Guthrie, MD (29:23.178)I believe global health takes a lot of humility. A lot of times people come into it thinking, and I did this earlier in my career, that they know everything, have all the answers, and can fix the problems by taking a protocol that worked in their hospital and dropping it into a hospital in Azerbaijan or Jordan. That is 100% not how global health should be done. And just giving straight lectures rarely moves the dial.

In the work we do in Africa now, with the Institute for Child Healthcare Africa and the Tiny Feet, Big Steps conference, we do have some didactic lectures, but we keep them really short, a 20-minute summary of what you need to know. What we’ve found really effective is simulation time: small breakout groups and workshops with a lot of engagement with the facilitators. Our job is to engage them, learn about the settings they work in, ask questions to figure out their needs, and then adapt the training in that simulation workshop to that group or team.

We really work on building teams. One of the great things about the Tiny Feet, Big Steps conference is that every physician who comes from a hospital is required to bring two of their nurses. We make sure we focus on that team approach, because I think that’s where the difference is made. We all know the nurses run the NICU; we’re just there to share some ideas. So in the end, I think that’s where the humility comes in: strengthening the teams we’re trying to help lead change effectively.

Teaching people the basics of quality improvement is really where you can begin to implement change. During the week of the conference, we ask people to choose two or three things they think would work in their setting. It could be something as simple as delayed cord clamping, because we teach about that. It could be figuring out how to keep CPAP (continuous positive airway pressure) working all the time with the seal in place, sorting out nursing ratios, or stopping antibiotics at an appropriate time. Or maybe you’ve got CPAP working well and you have access to surfactant, so let’s step it up a level and implement SALSA at your hospital. I hope that answers your question.

Shelly-Ann Dakarai (32:38.841)It definitely does, thank you. Earlier you talked about data in quality improvement, and knowing whether what you’re doing is actually improving things. How do you talk about the importance of data in settings where people are so busy just doing the day-to-day work? How do you think about balancing the fact that we need data to know we’re doing things better, and not inadvertently making them worse, with what look like much more immediate needs, like the patient right in front of us?

Scott Guthrie, MD (33:25.88)I like how you put “making things worse,” because that’s the gist of quality improvement: doing the work, making the right thing the easy thing, and checking that you didn’t break something along the way. In most of the high-resource settings we work in, you have to have the ability and a method to collect data when you implement something, because people will ask questions. With our SALSA work: Is this actually working? Are we having problems? Is it as good as INSURE? If you don’t have data to answer those questions when they come up, the project won’t be effective, and you’ll lose steam. But if you can show your team, “Look at what’s actually happening; we’re doing better than last year, before we made this change,” you’ll keep building trust in the changes you’re implementing.

Low- and middle-income settings are a little harder, because nursing and physician staffing ratios and lack of resources can make things difficult. We’re trying to help with that too, through the Institute for Child Healthcare Africa and our conference. I’m really excited about this, so I’m going to mention it first on your podcast.

Shelly-Ann Dakarai (34:56.262)You got the scoop here first.

Scott Guthrie, MD (35:18.112)Right now we have a beta version. We’ve taken our paper manual on how to provide NICU care in low- and middle-income settings, a book called Every Breath Counts. At the Tiny Feet, Big Steps conference, we try to get it into everybody’s hands, so at least every hospital has a copy. But we figured that if we could move away from paper and put it in an app on people’s phones, it would be much more accessible. So we’ve got the app up and working.

Shelly-Ann Dakarai (35:41.147)That’s awesome.

Scott Guthrie, MD (35:41.197)I’m hoping to launch it for the very first time in a couple of weeks, when I’m in Kenya, and it’ll be fascinating to see how quickly it spreads. We’re also trying to build in occasional push questions about the quality improvement work people are doing. Very simple things, but they’ll give us an idea of where people are, the settings they’re working in, and the changes they’re seeing. We see this year after year at the conference, with the same hospitals coming back and telling us what they’re doing. But if we can begin to measure it, and help people measure it, through a little tool on their phone, that could be incredibly powerful. So stay tuned; we’ll see if it works.

Shelly-Ann Dakarai (36:32.601)I’m very excited. I think it will be an important tool. Like you said, the hallmark of implementation and quality is doing the right thing at the right time and making the right choice the easy choice. So thinking about the easiest way to access information is huge. That’s pretty amazing.

Scott Guthrie, MD (36:59.798)Everybody has a phone now. They’ve all got fancy phones.

Shelly-Ann Dakarai (37:07.107)They do. As we wrap up, I have two last reflective questions. If you think back to little Scott, who liked science and kids, what words of advice would you give him, looking at how your life and work have evolved?

Scott Guthrie, MD (37:30.968)I think the same thing I started with: to whom much is given, much is required. We have been given a lot, just by our place in life and the jobs we’re in. So look for opportunities to help others, reach out, and give back knowledge. I think that’s the most effective and important thing. I can go into a hospital, take care of a baby, and save that baby’s life for a few days. But if I leave and the team is unprepared to take over, it didn’t mean anything. If I teach somebody to work more effectively in their environment and give them basic tools to improve care, that will last a lifetime.

That’s been one of the most joyous things about this journey: seeing the smiles on people’s faces when it all clicks and they know they’ve got something to take back and change in their hospital. And then waking up in the morning to a WhatsApp message from somebody in Nigeria. This happened about two months ago. I was flying back from a conference I’d spoken at, I had Wi-Fi on the plane, and I got a message from a doctor in Nigeria with a video of him doing SALSA. It just said, “Does this look right?” And I said, “That’s awesome. Yes, it looks very good. Great job.” Seeing things like that makes it all worthwhile.

Shelly-Ann Dakarai (39:20.507)That’s awesome. Humility, and to whom much is given, much is required. Would that be your advice to a young neonatologist or neonatal fellow who knows they want to do global health but isn’t from the culture or country they’ll be working in? What advice would you give them, in addition to humility?

Scott Guthrie, MD (39:46.955)Working cross-culturally, humility is number one. I’m a good old boy from Alabama, living in Tennessee, so you have to have that deep sense of humility and cultural respect. I’ve always made a habit of reading a book about the history and culture of a country before I go, so I understand the people, their history, and their culture. You want to respect that. Then just listen, ask questions, and try to learn.

The other advice I’d give a younger neonatologist interested in global health is this: until you’ve shown you can do it locally, be even more humble, cautious, and careful before trying to do it globally. It’s not about taking your protocol and what worked at your place and imposing it on another setting. It’s about learning the intricacies of another system, how it works, how that setting functions, and even the culture of the place, which you have to figure out to make your work effective.

Even more important, find people to partner with in those countries. In the work I’ve been involved with in Jordan, for instance, there’s an incredible young neonatologist who’s on fire to make this work, and we’ve kept partnering on projects over the years. Find people like that who can help you achieve your goals, because they’re also deeply invested in caring for babies and making a difference in their country.

Shelly-Ann Dakarai (41:57.297)Great advice for the younger generation coming up. Thank you so much for your time and for sharing your experience and stories with us. I’m sure listeners may have questions about SALSA, or you never know, you might get another email saying, “Hey, come help us over here.”

Scott Guthrie, MD (42:18.124)I’ve got a passport.

Shelly-Ann Dakarai (42:20.000)That’s right. What’s the best way for people to connect with you?

Scott Guthrie, MD (42:25.592)Let me give you my personal professional email account. It’s DR, as in doctor, then S-G-U and the number 3: drsgu3@gmail.com.

Shelly-Ann Dakarai (42:45.245)We’ll definitely put that in our show notes. Thank you so much for your stories and for being with us, and I’m sure some of our listeners will reach out to you. And to everyone listening, thank you for being with us. We hope to talk to you again next month, when we bring you another interview, so that we can go further together in improving newborn care globally.

Scott Guthrie, MD (42:59.47)Thank you for the invitation. I appreciate it.