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#141 - 👩‍⚕️ Dr. Anne Hansen MD MPH


Anne Hansen Incubator Podcast

Hello Friends 👋

We have the pleasure of bringing you this week our chat with Dr. Anne Hansen, medical director of the NICU at Boston Children's. She is an amazing physician that has excelled in her medical director role and has led impressive global health initiatives.

Enjoy!

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If you'd like to contact Dr. Hansen she can be reached via email at: anne.hansen@childrens.harvard.edu


Bio: Dr. Anne Hansen received her MD from Harvard Medical School and then went to Boston Children’s Hospital for her pediatric internship and residency. She stayed in Boston for her fellowship in Newborn Medicine at the combined program between Children’s, Beth Israel, and Brigham and Women’s Hospitals. She obtained her M.P.H. with a concentration in Clinical Effectiveness from Harvard School of Public Health. She joined the Harvard Medical School faculty in 1996 and is currently an Associate Professor of Pediatrics.

Dr. Anne Hansen has been the Medical Director of the Neonatal Intensive Care Unit at Boston Children’s Hospital since 2003. She has authored dozens of clinical guidelines, and is a chair or member of multiple unit based and hospital wide committees. She is a Fellow in the American Academy of Pediatrics. An acclaimed teacher, she is the recipient of the Merton Bernfield mentoring award, the Harvard Medical School Humanism Award, and the Tutor of the Year Award at Harvard Medical School. Dr. Hansen has published over 35 peer reviewed articles, 53 chapters and 8 books.

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

[00:00:00] BEN: Hello everybody. Welcome back to the incubator podcast. It is Sunday. We have a very special interview for you guys today. Daphna, how are you?

[00:01:09] DAPHNA: I'm doing great. We're nearing the end of the summer, sadly, but

[00:01:14] BEN: Is it already?

[00:01:15] DAPHNA: it is, it's getting to be that. There we go, we have a little bit of time. Maybe, what, when did your daughter go back to school? September?

[00:01:22] BEN: No. End of August

[00:01:23] DAPHNA: Huh. Back to the grind, as they say.

[00:01:27] BEN: It's unbelievable because I'm sure other listeners are going through the same thing. We. We have a lot of things planned out for the year and then something so those things come up and we say and when we have to figure out what time we'll do these projects we say as far as possible in the future so that we so that we can take care of what we need to take care of right now and then this was To me still etched in my mind from this, talk that we gave on june 20th I think the group at envision reached out to us way back when and we said oh june 20th And [00:02:00] it felt like years ahead and for oh, we'll have so much time.

[00:02:03] BEN: Not only has it came and surprised us like oh shoot That's next week and then it went and now i'm dealing with the same things for the things. We said september was going to

[00:02:13] DAPHNA: so far away, yeah. I

[00:02:17] BEN: But we are managing to juggle everything. So we are happy about that. We finally, thank you for your patience. Everybody finally are having our Delphi talks released on YouTube. And so

[00:02:34] DAPHNA: I'm more excited than I should be about

[00:02:35] BEN: this is very exciting. I've been, we, the reason they took a bit of while to come out is because we maybe were.

[00:02:43] BEN: Perfectionists about them. And so thank

[00:02:45] DAPHNA: Yeah, I'll say this because you're the tech guy, right? I'm just in the back. I'm in, I'm just watching this unfold. They're really good. That's why we're excited. And I had no role in the tech of this.[00:03:00]

[00:03:00] BEN: I would love to take more credit, but I was more of an editor than anything else. And the team Mark Parsons team is the videographer that we worked with. And so from the recording all the way to the end of the editing, they done a phenomenal job. And if you are interested in these talks, we designed them in a way that.

[00:03:20] BEN: Would make them enticing to watch. So they're like 10 to 20 minutes, no more. And they're very pleasant to watch because they're so short. They're on a variety of topics and they're extremely well produced. So they're in 4k. You're not going to feel like you're getting on a zoom call. I feel like too often we put out content on video and it's a transcription of a zoom call and god knows I dread my zoom calls as they are already So we really wanted to not have it look like a zoom call because that was an option They gave us not mark parsons, but like some of other people they said that we could but no so they're very pleasant to watch and i'm thinking if you are a training program and [00:04:00] Like when I was a chief fellow you're struggling with what are we going to put together for noon conference this day?

[00:04:05] DAPHNA: idea.

[00:04:05] BEN: You can put this up. It's 20 minutes and these are experts in the field and they're great lectures. So God knows I've been there when the speaker for noon conference bails on you and you're like, are we cancelling noon conference? Are we putting something you could literally just put this up and there'll be two videos released every week.

[00:04:24] DAPHNA: If you weren't at the Delphi Conference or you haven't been following the Delphi Conference, okay, the speakers were really good. The lineup was really good. We've got some big names. We've got some rising stars. We have some people that are outside of neonatology that I think made great They were able to lace what they do into what we do really beautifully.

[00:04:46] DAPHNA: And so

[00:04:47] BEN: It was

[00:04:47] DAPHNA: it's a

[00:04:48] BEN: really insightful to have people from the PICU world show us exactly some of the things they're doing, which apply a thousand percent to our field of medicine as well. And as we are releasing the videos [00:05:00] we are planning for Delphi 2024. So stay tuned for dates and registration and so on.

[00:05:05] BEN: And again, the video is really a product of the conference, but the opportunities that people had There to pitch some of their research ideas, some of their tech ideas, and the opportunities that people had to connect with these speakers and plan collaborations is really another facet of the conference that may not show readily on these YouTube videos, but was definitely there.

[00:05:28] BEN: We're hoping that we're changing the game a little bit in what you get out of a conference and also how you can access the content from the conference by making this free of access on YouTube. Yeah, I think that's the update for this week. We are very excited today to welcome back on the podcast, Dr.

[00:05:47] BEN: Anne Henson. If you guys are avid listeners of the podcast, you know that Dr. Henson was on the show for a tech Tuesday episode where she spoke to us about the dream warmer which is [00:06:00] basically. I'm gonna I'm gonna not do this justice, but it's basically an electricity free form of incubator that allows babies in low resource environments to maintain normal temperature all the while not compromising on mother kangaroo care

[00:06:19] BEN: we are very happy to bring her back to talk a little bit about her, the other side of her career, which is her actual career as a neonatologist. And we're very happy to have her back on for those of you who are not familiar with who she is.

[00:06:31] BEN: She's been the medical director of the NICU at Boston children's. Since 2003, she's authored dozens of clinical guidelines. She is a chair of, or member of multiple unit based and hospital wide committees. She's a fellow of the American Academy of Pediatrics. She's an acclaimed teacher. She is the recipient of the Merton Burfield Mentoring Award, the Harvard Medical School Humanism Award, and the Tutor of the Year Award at Harvard Med School.

[00:06:58] BEN: Dr. Hansen has [00:07:00] published over 35. Peer reviewed articles, 53 chapters, eight books. She is a star in our field and an inspiration to all of us. So without further ado, please join us in welcoming to the show, Dr. Anne Hanson.

[00:07:13] BEN: Dr. Anne Hanson, welcome back to the incubator podcast.

[00:07:18] ANNE: Thank you so much. Of course, I'm excited to have a second round.

[00:07:22] BEN: We're excited to have you back. Obviously I have to let the audience know this was always planned because, and it was quite hard to do the tech Tuesday with you first, because obviously we have all these questions that we had to keep bottled up for today. But no, thank you. Thank you for accepting our invitation and for coming on the podcast.

[00:07:40] BEN: I wanted to start this conversation really with your background and you have an impressive track record. You've done your training at Harvard. You are the medical director of the NICU at Boston children's. I wanted to maybe start where we start with a lot of our guests.

[00:07:55] BEN: What is the inception story of your career in neonatology? What drove you to [00:08:00] wanting to take care of critically ill babies?

[00:08:02] ANNE: Ah, that's an easy one. I actually majored in anthropology as an undergraduate and always wanted to do medical anthropology. And then that was where I was really exposed to a wide range of medical problems. Living in the United States, I had never really seen that many medical problems. And so I was actually really struck by the need not to do medical anthropology, but to do medicine outside of the United States.

[00:08:25] ANNE: And so I went to medical school really to be able to do global health work. But then I fell in love with neonatology, which At the time, I thought it was a terrible choice for global health work because it seemed like the most high tech, most rich country luxurious use of resources, but I figured that I would just do what I love and hope that things worked out in the end.

[00:08:48] ANNE: And in fact, it has been a wonderful subspecialty to be able to provide global health work when we can

[00:08:53] BEN: yeah how come not OB because I think having, I personally have an interest in global health as well. And when you do [00:09:00] go abroad and especially in low income countries you feel like the impact is probably more. It's probably easier to achieve on the OB side by providing better maternal care and reducing the risk of preterm birth and complications rather than, like you said, trying to go the technological side of the nicu.

[00:09:17] BEN: Was that ever a consideration to try to do obstetrics instead to try to maybe take care of both the mothers and indirectly than the fetus and the

[00:09:23] ANNE: I think we need both. I think the world is realizing that maternal and neonatal health are key to improve global health. But we, for me, I knew I wanted to do pediatrics. I always loved that. That was my first passion. I was just surprised at the pull that neonatology had for me. And when I think back on that which I was actually doing in preparation for this interview, because I know you've asked other people the same question.

[00:09:49] ANNE: It's interesting for me to think back on what really drew me to neonatology. And there were really several factors. I remember the day that I decided I wanted to be a neonatologist.[00:10:00] I was. still thinking I wanted to do general pediatrics and I was having a rotation in the Boston Children's Hospital NICU.

[00:10:07] ANNE: And we had just admitted my first patient with meconium aspiration pulmonary hypertension. And so somebody was explaining to me all of the in depth, both pathophysiology and then the solutions to be able to increase pulmonary blood flow and decrease systemic blood flow and nitric oxide and oxygen.

[00:10:29] ANNE: bicarb and the whole thing. And I just was so intrigued by all of that. And then I realized that I needed to go to my primary care clinic, which we had as a continuity clinic throughout our whole residency. So I, we set up our high oxygen nitric oxide, our pressers, the bicarb drip, the whole thing.

[00:10:47] ANNE: And I ran over to my continuity clinic where I had a patient who had asthma. And I was having this long conversation with his mother who had all these cats and this child with asthma. And I was trying to explain to her that [00:11:00] really she couldn't have all these cats when her child was so allergic to the cats and it was giving the child so much and of an exacerbation of asthma.

[00:11:08] ANNE: And at one point she looked at me and she looked at the clock and she looked at her little parking ticket. For the Children's hospital parking garage. And she said, if this is actually all you're gonna tell me, I would rather leave because I wanna save money on the parking. And it was just this moment where my value to her was so clearly, so low.

[00:11:28] ANNE: Children's hospital parking is expensive, but the idea that I was, Worth less than her just getting her car out of that parking garage was a very clarifying moment for me. And I thought, she's right. This is fair. I don't have a lot to offer here. This is not a very, big sell to have her get rid of all her cats.

[00:11:44] ANNE: And so then I went running back to the NICU and this patient. I ran in, checked on the patient who was doing so, so much better with all the interventions that we had made. And also the extended family had all gathered together. And I was asked if I would go in and do a family meeting and explain what was going on [00:12:00] to this family.

[00:12:01] ANNE: So I walked into the room and there was the mother, the father, grandparents on both sides, siblings, aunts, uncles. They were there with clipboards, pencils, papers, questions, staring at me. And I just saw it. I am in the middle of the most important moment for this family and also I have something so effective to offer them.

[00:12:25] ANNE: And as I explained, they were very interested in all the details, all of what we were doing and really like the whole pulmonary circulation, the systemic circulation, the medications, why they worked, how they worked, the pre and post ductal O2 sat monitors. We were all just so gripped by the whole story and I just thought.

[00:12:43] DAPHNA: to social

[00:12:45] ANNE: do this. This is just made for me. And so I just said, I'm going to do this for now. And we'll circle back to the global health work later. And in fact, I really feel like ultimately, neonatology is a kind of primary care [00:13:00] specialty. Once you get rid of some of the, fancy bells and whistles.

[00:13:03] DAPHNA: a little bit of

[00:13:04] ANNE: It really is about nutrition, antibiotics, growth, warmth, that's we've discussed in the past. So it's ended up being a good choice for me.

[00:13:12] BEN: It's funny how these polarizing cases either shun you away. You're like, there was this baby so sick. I couldn't, I knew it this way. I would never do this or it just creates that spark. And then it's all love

[00:13:24] ANNE: yes. Yeah.

[00:13:27] DAPHNA: I actually had a, did you have more questions about

[00:13:32] BEN: Yeah. I do have we'll get back to this in a little bit but you are the medical director. of the NICU at Boston children and you train there. And I wanted to, since we're talking about the inception story of Dr. Hansen I think where everybody that I've spoke to who considers staying on in their institution where they trained, there is this concern of are they always going to [00:14:00] see you?

[00:14:00] BEN: As a trainee or as they always going to see you as the fellow and will that impede your growth as a professional, right? There's nothing, I'm not talking about anything malignant. I want to be clear, but that idea that this is an institution that has seen you grown. And so you will always be in that box.

[00:14:16] BEN: And you are the example that you can be at one institution and thrive. And so I'm wondering if you have any advice for people who are. struggling with making the decision of staying on in their institution of training and balancing that with, am I going to be able to grow there and have a career, or am I just going to be the fellow?

[00:14:35] ANNE: that's interesting. I actually never considered that. I think that people are so we have so many trainees here. Obviously, we're a huge training institution and I think everybody is used to seeing people go from. I literally was a medical student and then an intern and then a resident and then a fellow and then an attending and then the associate director and then the director.

[00:14:54] ANNE: And I think people are very used to seeing trainees rise and shine. [00:15:00] So yeah, that's not really been an issue here. I did obviously think about leaving Children's Hospital and going other places. Now I'm going to just brag about Children's Hospital for a second and say, it is a very hard institution to leave because we have a breadth and depth of services that we can offer here that is just very difficult to match.

[00:15:22] ANNE: And I am spoiled in knowing that when I say to a family, this is everything that can be offered, that really is. true. And I don't need to refer people to a place like Children's Hospital when I reach the limits of what an institution can offer. And actually, not to keep flipping back into global health, but that's a huge piece of why I am so interested in global health.

[00:15:48] ANNE: Because, if we have a family where, for example, there isn't more to offer and there's not There's, their child has a really life limiting condition. I [00:16:00] know when I say to them, there's not more that we can offer, that, that is correct. That there's, it's not that if they were One transport right away, that something could be different.

[00:16:10] ANNE: And that is what's always so heartbreaking when I'm with families who have a baby who is not going to make it in a global health setting that from a completely preventable condition. I know that I could never look at that family and say, there's nothing more that can be offered. And so it's always that tension of the complete satisfaction of bringing every possible resource to bear in the Children's Hospital NICU and the absolute flip side of that in many of the global health settings.

[00:16:36] ANNE: But Children's Hospital is just a very difficult place to to leave, having been here for so long. It's just, you get used to just this knowing if this can ever be, this problem can ever be addressed, it's going to happen here. And so that's difficult. And then I just will say from a social standpoint, to be at a place for so long actually has wonderful advantages because I have [00:17:00] known people here for decades and decades.

[00:17:02] ANNE: And I love that. And if I left, I would be starting with friendships that were. Just much less mature.

[00:17:09] BEN: Your answer reminds me of this very very this silly quote, those motivational things that you see when you scroll Instagram that said like the grass isn't always greener on the other side, it's greener where you water it and it feels like exactly what you're describing.

[00:17:23] BEN: I think if you're describing an institution that does water its plants and allows them to grow. And then, yeah, like you said, then the pasture is not always greener on the other side than when you take good care of your little backyard.

[00:17:33] ANNE: my pasture feels very green.

[00:17:36] DAPHNA: Oh, what a lovely thing. I have a related question. We talk a lot about the dynamics of our neonatal community and your career so far has really spanned a shift in neonatology, for example, where it was mostly men in the profession, but over [00:18:00] time and you've shared, some of your.

[00:18:02] DAPHNA: mentors. We're seeing a lot more female neonatologists in positions of leadership and authority. It's especially complicated at really big institutions. like yours, major academic centers. What was that like for you during this really paradigm shift and, other what are your recommendations for people who are still trying to

[00:18:24] ANNE: Yeah, let me think about that. I think in pediatrics, and especially in newborn medicine, there really have always been very high representation of women. I think that's also true in OB GYN. The whole scene at a birthing hospital or at a pediatric hospital, I actually feel like there have been a lot of women mentors and a lot of expectation that women would be able to rise into leadership positions.

[00:18:52] ANNE: I'm sure I'm discounting some implicit bias, but I've I [00:19:00] feel like I've been supported and that's really not been a big block for me. Yeah.

[00:19:07] DAPHNA: That's great. That's great. You also, though have taken a a journey into the engineering world, right? And the entrepreneurship, development and I wonder what that's like. Not just as a female physician, but as a physician in general trying to break into, to those worlds where sometimes they don't want our input at all, or it can be really foreign

[00:19:34] ANNE: So those have all been relationships that I've sought out. So I have handpicked the people that I've worked with and they have all been so impressive and so helpful and so amazing and those relationships have been I think mutually beneficial. So I've brought to my engineering colleagues really important clinical problems with global impact and then they've brought to me their engineering mind and knowledge and neither one of us could have gotten where we [00:20:00] got without each other.

[00:20:01] ANNE: And so that's just been a, so mutually beneficial that it's been an easy working relationship.

[00:20:10] BEN: I wanted to ask you a little bit about your current status as medical director of the NICU at Boston Children's. And I feel like, especially in academic institutions, the chair of the division sometimes gets a lot of the glory and we forget about the medical directors. For people, can you briefly, obviously, because maybe a lot of our listeners are familiar with this, but what is the role of a medical director?

[00:20:32] ANNE: I'm sure that varies from place to place, so I will describe my role, but other people may, who are medical directors, may listen to this and say, wow, that doesn't sound anything like their role. I really feel like my role is to ensure that the overall quality of the medicine that we provide Is excellent and current based on best evidence and. That it's [00:21:00] applied equitably to all patients and families, and also that the morale of my faculty is as high as it possibly can be. That includes a lot of reviewing current literature and making sure that all of our guidelines and protocols are as up to date as they possibly can be. It includes, whether I like it or not, a lot of issues related to scheduling and making sure everybody has the vacation they care the most about off and the ones they don't care about are willing to work.

[00:21:36] ANNE: It includes ensuring as we grow as a unit that we continue to have, to, size our faculty and the schedules that we make. We have a safety briefing that we do every day where we look backwards 24 hours and forward 24 hours and look at all of the safety concerns. And then I consider it my job to think about. What those are and from [00:22:00] a systems level, how to ensure that those are addressed in a way that something that might have been a near miss would not happen or some or an error that occurs won't recur.

[00:22:11] ANNE: So a huge amount of attention towards safety and then also just trying to create an environment where people understand that they can come forward with concerns and that will never be something held against them. So all of that, the whole culture of safety and excellence and just ensuring that I know that every family that comes into that NICU is going to get the best care that they possibly can, regardless of who they are, what their condition is, whether they have a surgical problem, a medical problem, anything, and that we are constantly working behind the scenes to, to bring the best evidence to bear

[00:22:46] BEN: that's great. And I'm curious to ask you more questions about that because you've been medical director since 2003. So you've been doing this for now 20

[00:22:56] ANNE: too long.

[00:22:56] BEN: And regardless you're still doing it. [00:23:00] And I think that's a huge testament to how important the work you're doing is.

[00:23:04] BEN: And also the fact that you're getting the satisfaction probably in return, because otherwise it definitely would not have lasted this long. What I'm interested in is that you mentioned a lot of administrative tasks that you are dealing with as a medical director and as physicians, medical students, residents, we get zero training.

[00:23:19] BEN: In any of this how do you, is this something that, you're have to, you're going to have to face as you're rising through the ranks and you're didn't prepare yourself or is it something that hits you in the face as you get into position?

[00:23:30] ANNE: I would say both. I started out as the associate director. And so I had the mentorship of the current director and then, a lot of the skills that are required in this are things that I have always loved to do. A lot of it is navigating some disagreements, de escalating conflicts really respecting everybody's opinion, listening carefully, realizing that if there's a conflict, there's always two perspectives of what's going on and trying to hear both of those and understand, how to [00:24:00] mitigate.

[00:24:00] ANNE: And as I said, de escalation is just a huge a huge piece of it. Also, I would say my one thing I've tried to do is, if there is a problem, create a really lasting solution. And, one example that comes to mind is that when I first started this back. Not, in the early 2000s, the relationship between the medical and surgical providers was a little bit contentious.

[00:24:21] ANNE: And we had some disagreements about how to manage patients. And so when I went to go try to read about what is the actual medical management of all these surgical patients, there must be some thing that we can just all refer to. I realized there's actually Very little written about that. And so one of the things that I did that was so fun and I think has been really helpful for all of us was started this manual of neonatal surgical intensive care and paired a neonatologist with a surgeon to write each of the chapters.

[00:24:50] ANNE: And through that, we were able to just agree upon. What is going to be our practice for every aspect of the medical management of these patients, not what happens in the [00:25:00] operating room. There's whole textbooks about that, but preoperatively and postoperatively, how, what do we consider the systematic standardized way that we take care of these babies?

[00:25:09] ANNE: And we're now just putting together the fourth edition of that manual. And so the advantages of that kind of approach is not only do we go ahead and put on paper what we're going to agree to do, but also by working together. The neonatology and surgery co authors have really been able to, again, see things from the other person's perspective and understand and have a working relationship.

[00:25:33] ANNE: And I feel like that kind of solution is just so much better than battling it out at the bedside and saying, okay we are going to agree to disagree and we hope this never comes up again.

[00:25:41] BEN: Creating meaningful collaboration. And so that's interesting what you're bringing up because you're bringing up a subject like a neonatal surgical management, where sometimes there's a lack of evidence. But as we've seen on the podcast, the evidence in neonatology comes fast at us every month. And Boston children [00:26:00] is a NICU that, that functions very well.

[00:26:02] BEN: And so as a medical director how, what is your advice or what is your approach to juggling the incoming new evidence and implementing that into practice? Because I feel like for many institutions, protocols come out of, as you mentioned, sometimes a near miss event, they said, Oh, like we had a near miss.

[00:26:20] BEN: We should really have a protocol for this. That's outlined something. But sometimes you can be proactive and say there's new evidence that's coming out. And you're looking at your rates of whatever complication you're looking at, Hey, we're not doing too bad and the team is working well, but there's this new evidence that's coming out.

[00:26:33] BEN: How do you juggle all these elements and decide what you're wanting to implement in the unit? What are you going to wait for more evidence? What is your approach on from that standpoint?

[00:26:43] ANNE: Somebody once said, and I remember who this is, but I'm actually not going to share it. Somebody said to me, you never want to be the first or the last person to implement a new practice, and then you have to decide, okay, that seems like good advice, but how close do you want to be to first or how close do you want to be to last?

[00:26:59] ANNE: [00:27:00] And I think when there's evidence, we want to be. Not first, but close to first. For example, when the whole area of therapeutic hypothermia was coming out and, everybody could look on the horizon and say, this is going to be standard of care. That was something where we thought, we just want to be very close to first on that.

[00:27:16] ANNE: So we, pulled together all of our multidisciplinary colleagues in neurology and neuroimaging and ourselves, our neonatal nursing colleagues, and we had a protocol ready to roll and shared with all of our referring institutions. So that the day that the AAP published that this is now standard of care, we were ready to roll.

[00:27:36] ANNE: So that's an example of when I feel comfortable saying, we really want to hit the ground running on this and be first. And there's other situations where I feel like it's really hard to know the safety and we would rather be somewhere more in the middle of the pack on purpose. Maybe an example of that would be the use of Presidex, actually, for patients with therapeutic hypothermia, where Presidex was a [00:28:00] relatively new agent, and I felt like when you have a patient who already has a high risk of having a kind of neurologic deficit, to bring that new therapy to this high risk population, I don't think there's gonna be a huge amount of evidence that we're ever gonna be able to read some randomized controlled trial of Presidex versus Narcotic for long term output outcome of babies with H.

[00:28:26] ANNE: I. E. But I felt like I wanted to have other institutions that might be willing to use this earlier and see how they found it before we were willing to go ahead and. write it into our protocols, but now actually we're just redoing our entire pain and sedation protocols and we're adding it in there because we've seen lots of other places do it and it really does seem like it's safe and it should be neuroprotective and benzodiazepines we're learning more and more really not good for the developing brain.

[00:28:53] ANNE: Purposefully coming in in the middle. Yeah, and we try never to be last.

[00:28:57] BEN: That makes sense. One. [00:29:00] One last question about this specifically, as physicians, we're often tasked to write these protocols. And it's sometimes very easy to do a physician to physician process where it's like, Oh, I'm writing this protocol for my colleagues. And we can, and it's a very easy mistake to omit all the other providers that are working in the NICU.

[00:29:17] BEN: How do you make sure that when you are thinking about implementation, you are involving I don't like the word stakeholders, but in this case, that's what I mean. All the stakeholders so that the process is is relatively wholesome.

[00:29:30] ANNE: There, I will say that in our NICU we have a extremely strong nursing partnership with everything that we do. And the nurses, again, I'm going to brag for just a moment, but now I'm not bragging about what I do. I'm bragging about our nursing colleagues. They are so supportive. amazing and they are so highly trained and they have so much experience and our clinical nurse specialists are just absolutely the backbone of everything that we do.

[00:29:56] ANNE: And so it would honestly be unheard of [00:30:00] to, to write a protocol without having it be truly multidisciplinary. I should say, our pharmacists, our nutritionists, everybody is just amazing. And so if we are going to be writing a protocol, it usually comes out of some committee that already has multidisciplinary representation.

[00:30:13] ANNE: And we, it would just be unthinkable to sit down and write a protocol based on our small faculty of neonatology MD staff.

[00:30:23] BEN: That's awesome.

[00:30:25] DAPHNA: Yeah, I think that's a great lesson that you just, you keep sharing and I think it speaks to probably the way that you lead that, medicine is so much about relationships and communication for it, it to work right. And so I have a related question. Like you said, you've been overseeing the changes over decades.

[00:30:46] DAPHNA: And I know, for example, in our own unit, Ben and I, our unit sometimes, I want to roll something out new and Ben wants to roll out something new at the same time. And we've got another doc who wants to roll something out new at the same time. [00:31:00] And. Like both of you have mentioned, it takes the whole unit to really do this right.

[00:31:05] DAPHNA: So your resources can't be working on all different things all at the same time. Do you have any recommendations about how should units prioritize or do the kind of ranking of which projects to roll out first,

[00:31:19] ANNE: are all such fun questions. So first of all, we have a couple of committees so that everybody knows what's coming down the pike. We have a steering committee. We have a quality improvement committee. So it's not a surprise that somebody would say, Oh, we have six new projects that we want to launch them all on.

[00:31:34] ANNE: day after Labor Day. So through those committees, we organize ourselves, and we also do try to pair project launches that are related to each other. For example, we're just about to have a brand new set of guidelines for red blood cell and platelet transfusions. So we'll just launch those at the same time.

[00:31:51] ANNE: Then we're going to take a pause, and then we're going to Actually launched this new pain and sedation guideline that I just spoke about. So I think we try to [00:32:00] give ourselves some time to adapt to a new protocol or procedure or approach. And then I think after a month or so, we're ready to bring in something else new.

[00:32:10] ANNE: We do have a lot of data that we collect to be sure that we're not forgetting the old. Projects for the new again, our clinical nurse specialists are amazing in all of the educational materials that they provide for the whole unit, but especially for our nurses. But we do try to keep pushing forward because there's a lot of new information out there and we never want to get behind.

[00:32:34] ANNE: Yeah.

[00:32:35] DAPHNA: Absolutely. That's

[00:32:37] BEN: So besides the, your role as medical director, I think [00:33:00] what's most impressive about you, Dr. Henson is the fact that you're able to do so many other things. And specifically we spoke already about global health on our tech Tuesday episode for. For people who haven't checked that out, we recommend you listen to that to that episode that aired a few weeks ago.

[00:33:15] BEN: What have you learned from your experience in global health? What are some of the lessons that you take away from these experiences?

[00:33:24] ANNE: That I bring back here to the United States. Yeah I'll tell you, one of them is definitely what you just asked about, which is about the multidisciplinary nature of training, because it was actually when I was there, when I first started doing global health work in Rwanda, it was through Partners in Health and The reason I keep bragging about our clinical nurse specialist is that I borrowed her for three months and we went along with my family to live in this very rural village with this rural hospital in Rwanda for an entire summer.

[00:33:54] ANNE: And one of the things that we realized right away was that they did not have a good collaboration between their nursing and their [00:34:00] medical staff. And so the I think one of the biggest things we offered was rounding together. Teaching together writing protocols that included both medical and nursing aspects of neonatal care and even writing a kind of combined order set daily progress note that was. force it or a force function for doctors and nurses to work well together. And we really insisted on having all of our trainings and all of our practices and all of our educational modules be collaborative with nurses and doctors working together. And that was something that was really new for them.

[00:34:41] ANNE: And that has strengthened my sense of the degree to which neonatology really is a team sport. And so I, it's not something that I only learned in Rwanda, but that's definitely been strengthened by my global health work.

[00:34:54] BEN: So interesting. That's so interesting. And I'm impressed by how obviously you've been able to [00:35:00] leverage that experience to, to help with the issue of neonatal hypothermia. As we spoke about on the tech Tuesday episode, I'm going to stop referring to that episode. People should just go and listen.

[00:35:10] BEN: But you mentioned to us that you were also able then to collaborate. Because of your interest in global health, because of your experiences in global health, you've been able to collaborate with the Vermont Oxford Network and you're about to, and I'm not exactly sure at the time of this release, whether the article may already be in press and published, but you are in the process of publishing a paper looking at rates of hypothermia.

[00:35:32] BEN: Can you tell us a little bit more about, about that

[00:35:34] ANNE: Yes. So , my work has been expanding through Partners in Health. I'm now in a lot more countries than Rwanda, and we can speak about that in a second, but I was actually really interested in looking at a large database, like the Vermont Oxford Network, and looking at admission hypothermia rates across not just hundreds of patients, but, hundreds of thousands of patients.

[00:35:55] ANNE: And we approached the Vermont Oxford Network and asked if they had ever looked at their admission hypothermia [00:36:00] rates across income levels of hospitals. And they had not done that yet. And they were very excited to share their data and collaborate with us to examine how rates of admission hypothermia varied by the income level of the country in which their hospital was Existed.

[00:36:19] ANNE: And then also to look at variables related to hypothermia and mortality rates and associations and things like that. And so there's a whole lot of literature about rates of hypothermia, but they tend to be, generally out of one hospital or one region, or at least one country. And there's actually.

[00:36:35] ANNE: Very little that looks at a global perspective. We would love to have been able to include hospitals in low income settings, but at the time there was actually only one hospital or one country. Very little data there. So that didn't quite work. We'd love to redo this when they have a better, bigger representation of low income settings, but at this point it was just middle versus high income, but still it was very [00:37:00] interesting and hopefully, definitive in terms of the sample size to answer some of these questions about what are these rates and what, what is the effect on mortality and when you're one degree warmer.

[00:37:11] ANNE: Thank you. Thank you. Thank you. What does that do in terms of decreasing your risk of mortality? And to answer that with these enormous sample sizes was fascinating for us and evidently for,

[00:37:21] BEN: The last time I reviewed data on this, I think the number was 10% of more. I think a change in one degree led to probably a change in mortality that is close to 10%, which was when I read it was mind boggling. And I'm wondering, is that something that you guys were you, is this, does that based on your work, does that still hold

[00:37:40] ANNE: actually that is on the nose exactly what we found. Well done. Yes, every one degree increase in admission temperature 9 or 10% increase in the relative risk of death.

[00:37:54] BEN: that's baffling. It's still

[00:37:56] ANNE: but it was amazing to see that actually holds true with these just [00:38:00] enormous sample sizes. Yeah, we had over 200, 000 patients all in, so it was a really enormous sample size.

[00:38:06] BEN: Yeah it's rare when you do tune up the sample size and then it scales up pretty nicely it rarely do you see that. Sometimes you just lose, you lose your signal along the way. And kudos for getting that getting that done. Yeah.

[00:38:18] DAPHNA: I just think it speaks to just how important, I mean that homeostasis. is, right? Nothing else works if you don't at least have the correct ambient temperature. I wanted to ask a little bit about more, more about global health. I feel like neonatologists are very good at specializing, right?

[00:38:39] DAPHNA: We pick something we're interested in, or I'm into global health or I'm not into global health. But I wonder, especially when we think about here in the United States, like you mentioned, we have all the tech and we are really pushing the limits of viability and we are pouring, literally pouring, resources into every single baby [00:39:00] that is delivered which is great that we have that opportunity.

[00:39:04] DAPHNA: But when we think about neonatal mortality on a kind of a global scale and how many babies That if they had the luxury of living somewhere else it really is the difference between life or death. Shouldn't all neonatologists care about global health, is my question.

[00:39:21] DAPHNA: And what impact should that have on our, our research and our research goals as a global

[00:39:26] ANNE: That is music to my ears. I just say yes. Yes is my first answer. I think it's just really interesting as the words equity and justice keep being pushed forward across all of medicine and across all of everything that the whole world is looking at. Now we are having this increasing understanding that we need to provide equitable medical care, education, labor conditions.

[00:39:51] ANNE: You name it. I feel like every paper I read now is about medical Ensuring equity. So I think we all understand that equity and justice are [00:40:00] crucial. And yet Sometimes the equity still has some boundaries around it where it's equity within the United States or equity within a hospital or within a NICU and 90, over 99% of newborns who die.

[00:40:18] ANNE: Die in low and middle income countries more than 99%. So if we're saying that we're interested in equity and justice, we have to get out of the United States and rich countries. We have to get into low and middle income countries. And, I understand global health is not right for everyone, but it's right for me.

[00:40:41] ANNE: And I just can't see how we can make the claim that, of course, every life is of equal value. No one can possibly argue with that. And yet. Essentially, all of the deaths that are happening, especially preventable deaths, are happening outside of rich countries. [00:41:00] And I just don't think the world is going to stand for this.

[00:41:02] ANNE: It's just so unfair. So I think we, everybody can, everyone's doing important work and everyone is saving babies lives and all of it's important. But I really feel like the smallest amount of additional resources that can be brought to some of these poorest settings makes, you Such an enormous.

[00:41:23] ANNE: Difference. It's just impossible not to be compelled by that.

[00:41:28] DAPHNA: Yeah, I think especially as you call it, the preventable deaths, things that we know how to treat and we know what to do and we just can't get the resources to those settings. So what is the future of global health in neonatology look like? How can people get engaged and start making a

[00:41:47] ANNE: Boy, I wish I knew the answer to that question. I would say a couple of things. One of them is I think it's really important if people are interested in doing this and making a long term commitment to it. The what is not helpful is the brief trip to [00:42:00] somewhere or to Make a couple of suggestions and get out of there because it has to be a long term commitment that includes something that makes the work sustainable.

[00:42:10] ANNE: I did a lot of things where I would go to a conference somewhere and then give a bunch of lectures and then leave, and I don't think that is all that useful. In fact, I sometimes feel like that just makes things worse because I think most of the providers know what they're supposed to do with the problem is that they don't have the resources to carry out the knowledge that you're giving them.

[00:42:26] ANNE: And so I think, being sure that the work is in collaboration with the folks who are in the country who ideally are, include the Ministry of Health or whatever would be the appropriate organization that would make the work sustainable and durable making sure that the the, Medicine that you're assisting with is addressing issues that are important to the people who you're working with, and not saying, I am incredibly interested in, problem X, and so I'm going to come here and address problem X with [00:43:00] you, when that might, they might be interested in problem Y, so starting out by understanding for the people who you'll be working with, what are their highest levels of concerns, and then working with them on those problems, and building them.

[00:43:15] ANNE: Capacity in the location where you are, rather than building dependency on yourself as the solution. Everything that I've done has been based on some of those pillars. For example, in Rwanda. When we first got there, as I mentioned with my clinical nurse specialist, we realized there really weren't any protocols for how to take care of these babies.

[00:43:38] ANNE: And so we started with a very basic protocol that would be what we would do in a level two nursery. And then every day we would go down to the wards and take care of babies. See what they had compared to what we thought would be a rough idea of what they needed to take care of a patient.

[00:43:57] ANNE: And we did it kind of body system by body [00:44:00] system. The first week we did nutrition and we taught these protocols and then we went down to the ward and saw, okay, what are they doing for fluids and nutrition and what do they actually have? And then we would adapt the protocols based on what they had.

[00:44:12] ANNE: So for example, we wanted our, D10 with two and one of two of sodium, one of K and they don't have that fluid, but they have. Okay. Thank you. bags of D50 and bags of LR and bags of, I can't remember exactly what. And so then we would just sit down in the afternoon and take all of these solutions and figure out how do you combine what ratio of what IV fluid to come out with something that's close to the IV fluids that we would be using.

[00:44:36] ANNE: And then we changed the protocols to add in those recipes and then taught again in the next morning and then went down to do rounds and then adapted and finished off. the fluid and electrolyte whole body system in a week, then we moved to respiratory, then we moved to infectious disease and on we went.

[00:44:52] ANNE: So by the time that we were done, we had a protocol that was every body system that really worked for the doctors and nurses and the [00:45:00] supplies that hospital had, which actually across Rwanda is very standardized because the ministry of health supports hospitals in a very equitable fashion across all sites.

[00:45:08] ANNE: And then that ended up. After some editing and adapting, presenting to be adopted as their national protocols for newborn medicine, and they're used across the whole country. So that's the kind of sustainability that's helpful. Then, now I, we've done a second and a third edition and now, I'm out there doing it and they've got their protocols and they're everywhere and that.

[00:45:33] ANNE: Is that, offers a kind of sustainability and longevity to the work and helps the folks who are there to go ahead and take care of their own patients rather than relying on a kind of telemedicine program or something where they continue to be reliant on a external source for their to help them.

[00:45:52] BEN: Capacity over dependency. I really like that.

[00:45:54] DAPHNA: Yeah, I think those lessons are important even here in the [00:46:00] States in the, about if you're not there, will this project continue, in making sure about the longevity. I have one more question about your global health work and then surely we must move on to all of the other topics we have listed, but I imagine, like you said, coming from an institution like yours and then working in Rwanda, I can imagine there's a degree of this moral distress where you say I know what to do and we just can't do it.

[00:46:27] DAPHNA: And I wonder, taking some of those lessons for us here in the city. States, we feel that sometimes in our own hospital systems I know what the right thing is for my patient and there are all these barriers and obstacles and that's really leading to a lot of the moral distress that, causes this burnout in, in physicians.

[00:46:46] DAPHNA: So what are the lessons that we can take to help navigate some of those feelings as we meet these obstacles

[00:46:54] ANNE: when I'm here in the United States, I, my, I feel like my moral distress is very low because I realize how much [00:47:00] we actually are able to offer these families and how incredibly luxurious our medical system is.

[00:47:06] ANNE: And I think there's things that we take for granted. For example we have the luxury of specialization here in the United States where we can become superheroes because we.

[00:47:18] ANNE: Train in pediatrics, and then we train in neonatology, and then we can actually work and stay in a NICU environment for the rest of our careers. Whereas in a lot of the global health settings, people are general practitioners, and if they can specialize in pediatrics, that's amazing, but the opportunity to do a neonatology fellowship is extremely rare.

[00:47:39] ANNE: And the opportunity to just work, whether a doctor or a nurse in a site where you have. that level of experience that you can continue to accrue over your lifetime and bring back to your patients, that is such a luxury. And when I go up to our NICU, I, all of the doctors and all of the nurses have this sub specialized, not [00:48:00] only formal training, but years, lifetimes of experience.

[00:48:04] ANNE: And so we of course can get really good at what we do if we can work in such a limited patient population. That luxury is missed by us. I don't think people realize how rare and critical that is to the care that we're able to provide.

[00:48:18] BEN: Yeah, that's so true. And to that, I think that's a great segue to something that we were talking about affair. And I know this is a project that is in its inception. And we're going to be thankful for whatever details you can give us, but tell us more about this project involving both, collaboration and mentorship for.

[00:48:36] BEN: For neonatology providers that you're working on that's that looks like is going to be taking place on a global scale. Can you tell us a little bit more about that?

[00:48:45] ANNE: As I have mentioned, my work with Partners in Health started in the single country of Rwanda. But Partners in Health has expanded and they're now in many countries, but eight of those countries they have on the ground, maternal and neonatal health care. And so I was interested in bringing the work that we [00:49:00] had done to Rwanda.

[00:49:00] ANNE: I'm always looking to scale scale, because, as we've We, there's a lot of families and babies out there who could really benefit from a lot of help. And it doesn't make sense to bring something to one site and then leave it there. Partners in Health approached me and I approached them about developing a consortium where we could bring the work that we had all done in Rwanda to all of these other sites.

[00:49:22] ANNE: We ended up naming it 10 for 2030. It the, Thank you. The TAN is the eight sites plus Boston Children's Hospital and Partners in Health. And the 2030 is to achieve the sustainable development goals for newborns, which is 12 or fewer deaths per thousand live births by 2030. And we've brought together this group of Partners in Health associated sites across these eight countries.

[00:49:46] ANNE: And we're, you it's a. Long story, what we're doing, but basically we're trying to make sure that every site has the essential medications, essential medical devices, essential education and data platform to [00:50:00] achieve these 2030 sustainable development goals and then using a Q. I. approach to look across this dashboard and see, where are the places that.

[00:50:09] ANNE: we need to improve and then doing some PDSA cycles to try to drive various different problems down as low as they can and then keep moving along. And so across that consortium, those in country providers are looking for Mentorship, sometimes about a broad question about like how to do QI research, sometimes about a more narrow question about, for example, a detail about how to write a new nutrition guideline or how to write an appropriate infectious disease guideline.

[00:50:38] ANNE: And we, through my work with the. perinatal part of the global health group within the AAP, we were thinking, as I think it was you, Daphna, who asked, how do people be able to participate in global health? Not everybody can do the amount of time commitment that I have had the luxury of being able to provide, but [00:51:00] they really would love to be able to do something.

[00:51:01] ANNE: And they, and everyone has so much to offer. And we're starting with a pilot project where we'll be matching. We hope two fully trained neonatologists and one trainee with one of the sites in Partners in Health to be able to provide this mentorship and then if that is successful, then we would expand the program to be able to offer on a volunteer basis, pediatricians, neonatologists from across the United States representing their own institutions Matched with providers and sites across at this point, the P.

[00:51:36] ANNE: I. H. eight countries. And we would really leave the details of that to those two teams. What it is that the in country partners were looking for and what it was that the. United States based neonatologist or pediatrician could offer, but we will be matching people by experience, by language, by expertise and asking for, a minimum commitment of a year.[00:52:00]

[00:52:00] ANNE: And really just a couple of hours a week and all virtual, unless there was some reason to. Go into the country, which would be, by the mutual agreement of both sides. But this seems like something that's feasible. That would be really rewarding. That would be very valuable. I would think to both partners.

[00:52:16] ANNE: So we're hoping this will be successful.

[00:52:18] BEN: We're going to leave,

[00:52:20] DAPHNA: Yeah, that sounds very

[00:52:22] BEN: to leave your email in the show notes. And if anybody is interested in making that commitment, then they can definitely

[00:52:27] ANNE: Yes, I'll send you an intake form if you send me an email.

[00:52:31] DAPHNA: Yeah, I think that's what keeps people maybe from engaging with global health is feeling like it's too big The commitment is too big, but it seems like this is a potentially a very good

[00:52:45] BEN: and the fear of the unknown also, Oh, I'm going to go over there. What am I going to find? Am I going to be up to the task? I think this is a great way to prime yourself as well, to just get a sense of what the need is. Yeah. We're coming to the end of the interview [00:53:00] and you clearly Dr.

[00:53:01] BEN: Hanson you have come across in this interview as somebody who is so dedicated, such dedicated to your patients, to excellence So I want to give people a bit of a glimpse as to the full gamut of who Dr. Hanson is. What do you do for fun?

[00:53:16] ANNE: Anybody who knows me we'll know that I'm a big exercise fan. So most of my fun is related to getting outside, walking, running. I have a everybody in this hospital knows that I love walking up all the stairs in the hospital. Our Nikki was on the 11th floor, so I make people who want to come see that Nikki walk up those 11 flights of stairs if they want to come with me.

[00:53:37] ANNE: So everything related to physical activity I love. I have a wonderful husband and three now grown children, so that was all my fun for, and still is. Friends, family Baking?

[00:53:51] BEN: How important is it for you to make the time to have these experiences, whether it is good, like you said, going outside. Cause I [00:54:00] think these are not with your role. As a neonatologist, as a director as an entrepreneur to go outside for a hike takes time and time is very, for someone like you, time is very valuable.

[00:54:10] BEN: How important it is for you to block off sometimes all the intrusion from other. Areas to make sure that, that time is protected.

[00:54:18] ANNE: Yes. Okay. I have two answers to that. The first one is, I just make the time. It is always, everyone has time to go take a hike. That's just, doesn't take that much time. And I think you can work it into your day, work it into your week. As I said, that's why I take the stairs because it doesn't take any longer than the elevator and then I feel amazing when I get up there.

[00:54:35] ANNE: So I think it can just be worked into everybody's daily practice, but I really do believe that we were all made to be outside and no matter what the weather. get out there. It's always worth it. You'll always feel better after you come back in. And then the other thing is that for the global health piece, what I've done is I've actually worked my family into all of that work.

[00:54:53] ANNE: So when we go, we often go as a family. When I went for the three months, I brought everyone. And that has [00:55:00] spawned a lot of global health interest in my children and also definitely in my husband, and so I don't think these activities have to be siloed. This is my work and this is my family.

[00:55:09] ANNE: This is, I think they can all be braided together and they complement each other.

[00:55:14] BEN: What was your family's response to a summer in Rwanda? Was it always something that they were excited about? They were excited before, during and after, or was it something where they were excited before and maybe not so much when they were there or the opposite, not so much before.

[00:55:27] BEN: And then they got excited there. What was the response?

[00:55:29] ANNE: That's fine. There were five of us, so I think we all had different responses before and during and after. But there was definitely challenging. I said to everybody ahead of time. There is going to be guaranteed sometime at least once. When we're all going to look at each other and say, this was a terrible idea.

[00:55:46] ANNE: And that definitely happened, but we also had such amazing times together. And our children, I'm sure you've heard all these stories. They played soccer with all of the other kids. We brought every [00:56:00] possible activity to do. The children all worked in a HIV. Clinic and they also taught in the local schools.

[00:56:06] ANNE: We brought beads and electric piano and paints and you name it. We brought a duffel bag full of activities to share books, everything. We left all of that there. They had a ball. Yeah,

[00:56:21] BEN: And they probably were. Probably positively changed from this experience. I think as a kid, these kinds of experiences are worth, they're invaluable. What am I

[00:56:32] ANNE: but my, my, my last memory was all of us arriving at the airport in Atlanta. Amsterdam flying home, and we had to be purifying our water for three straight months. And so we saw this water fountain where you could just drink water, and all five of us were just staring at this water fountain in total awe, on our [00:57:00] knees, just, how can this be that you could just press a button and have potable water?

[00:57:04] ANNE: And I still think about that. So I think that, it's, takes many of the things that we just take for granted every day and make us realize how much effort went into having that be available for us and how lucky we are to have it.

[00:57:16] DAPHNA: I love those lessons of the relativity and seeing, the luxuries that we really do have and the term, what did you say? Braiding together your work and your family life and that they enhance. I was hoping just before we leave that for people who did listen to our first interview with you about the DreamWarmer, the reusable low cost non electric mattress, that maybe you can give us an update on the progress since it's been a few months.

[00:57:45] ANNE: So as with everything to do with a dream warmer, it always has its positive and its negative progress going forward. So I'll start with a negative so I can end with a positive.

[00:57:57] BEN: Okay.

[00:57:57] ANNE: so I said in [00:58:00] that podcast that it was going to be available for purchase final. beautiful manufacturer product in March.

[00:58:07] ANNE: And then what happened was I received the completely available warmer that I described to you on my doorstep in March, and I realized that I didn't like the final design of the lid. We had made a timer that we put in the lid so that somebody who didn't have a Watch or a clock could just pull it. Push the timer to 30 minutes.

[00:58:27] ANNE: And when it dinged off, they were ready to roll. And it made the ergonomics of opening the lid a little bit difficult. And now you'll see the perfectionist side of me. I said, stop everything. I don't like this lid. And I want this to be absolutely zero barrier to use. So you need to redesign the lid. So we've redesigned the lid and now it's perfect.

[00:58:48] ANNE: And now it will be available. 2, 000 of them in two weeks from today. So we've had a little pause, but it's now perfect. So

[00:58:58] BEN: So mid July[00:59:00]

[00:59:00] ANNE: yes, mid July, that's fair, mid July, yes. But then I've had amazing progress in just getting the word out. So I was able to attend a conference in South Africa, in Cape Town, the International Maternal Neonatal Health Conference.

[00:59:19] ANNE: And I was able to present at their technical marketplace and I met people from absolutely every corner of the world. And it was so well received this warmer. So I have a pile of business cards and I'm making my way through them and everybody really understood the need to Supplement and compliment KMC with something for mothers who were doing the best that they could.

[00:59:47] BEN: That's the best feeling when you see the response from the people you think might have a

[00:59:52] ANNE: Yes, it was so exciting. It went on for two and a half hours and it was just a very heady experience to have people just running [01:00:00] over and looking and these big crowds of people all wanting to see how it worked. And then from there I was actually able to go up to Lesotho, which is a little country, a kingdom.

[01:00:10] ANNE: It's surrounded by South Africa and present. That's where one of these Partners in Health sites is and also to their Minister of Health. So that also went extremely well, and I've even had a couple of contacts from the podcast that I did, and from our website, so I think that we are really poised to have global scale, and now I just need to I'm looking for as many partners as I can who are interested.

[01:00:34] ANNE: Many people have approached me but the more the better, and I'm looking for people who can just help get the word out that. We can't be apathetic about neonatal hypothermia, and we need to provide not only something like the Dream Warmer for what we call a thermal wrap, according to the new Every Newborn Action Plan 2, which is what you're supposed to offer if you optimize thermal environment and you still have a baby who's cold, but also [01:01:00] all of the education about why hypothermia is important and how to provide optimal KMC, yeah, we are making great progress. This is going to be a big year for us.

[01:01:09] BEN: That's awesome.

[01:01:11] DAPHNA: Amazing. Amazing. Thank you

[01:01:13] BEN: I wanted to finish by. Saying something on your behalf, because I think people are listening to the podcast and they're not seeing that since even the previous episode that we recorded together, you have constantly a smile on your face, even when you describe climbing up the 11 flights of stairs at Boston children.

[01:01:31] BEN: And I think what I'm gathering also from this interview on top of the many pearls you've given us is that you seem to. Always try to find the happiness in whatever you're doing and I don't know if that's true But at least that's something that comes across that tell me if i'm wrong

[01:01:47] ANNE: I like that. I think that's fair. I'll take it. Thank you.

[01:01:52] BEN: Dr. Hanson, thank you so much for making the time to be with us this morning This was a fascinating conversation. Congratulations on everything you've accomplished You are [01:02:00] a model for all of us and we will as we've said, during the episode we will leave Your email in the episode show notes if anybody wants to reach out to you to Talk to you about the dream warmer about hypothermia about this global mentorship project.

[01:02:15] BEN: You've mentioned They'll be able to get in touch with you. Thank you. Once again for everything that you do and for coming on the show

[01:02:21] ANNE: Thank you so much. Thank you both.

[01:02:23] BEN: Thank you

[01:02:25] DAPHNA: Bye.

[01:02:27] [01:03:00]

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