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#176 - 🌎 Global Neonatal Pod - 🇿🇲 Pioneering Neonatology in Zambia with (Dr. Kunda Mutesu Kapembwa)





🥳 Welcome to the first episode of the Global Neonatal Podcast.


In this inspiring conversation, Dr. Kunda Mutesu-Kapembwa. shares her incredible journey from her neonatal training in South Africa back to her home country, Zambia. Despite facing initial skepticism and challenges, she became the first neonatologist in Zambia's public sector in 2015. Driven by a passion to make a difference, she implemented low-cost interventions, reducing neonatal mortality at one institution from 35% to 15%. Discussing her role as a force for change, she highlights the importance of celebrating small victories and emphasizes the significance of self-care in combating burnout. Dr Mutesu-Kapembwa.  also delves into her involvement in developing national guidelines, both for neonatal care and resuscitation, tailored to Zambia's unique healthcare landscape. Additionally, she explores the creation of postgraduate training programs for medical officers and nurses, addressing the shortage of neonatal healthcare staff. As she ventures into new initiatives, Dr. Mutesu-Kapembwa.  continues to be a beacon of inspiration for physicians striving to make a positive impact in challenging environments.


Happy listening 🎧


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Short Bio: Dr. Kunda Mutesu-Kapembwa is a Paediatrician and Neonatologist working in Zambia. She holds a Bachelor of Medicine and Surgery, a Master in Paediatrics and Child Health, a Certificate and Master of Philosophy in Neonatology. Her career is dedicated to nursing and doctors’ education and to the health of neonates and their families. She Co-founded Newborn Support Zambia, a not for profit Non-Governmental Organization to help improve the care of neonates in Zambia.


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Links 



 

Bridging the gap in Neonatal Resuscitation in Zambia: https://www.frontiersin.org/articles/10.3389/fped.2022.1038231/full



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



Daphna 00:00

This episode of the Incubator is proudly sponsored by KAC. Providing innovative neonatology solutions for more than 35 years, KAC is committed to supporting the neonatology community and the NICU families you serve. To learn more, visit wwwnicuconnectionscom.

 

Shelly-Ann Williams Dakarai 00:22

Welcome to the Global Neonatal Podcast on the Incubator Network, a monthly podcast highlighting the remarkable work being done around the world to enhance neonatal care. I am your host, dr Shelley Endikari. Thank you for joining us. Hello everyone, welcome back to the Global Neonatal Podcast Today. I have been co-hosting with me and we are so honored to have Dr Kunda Mutesu Kapwemba with us today on the podcast. I'll give her a brief introduction. Dr Kunda Mutesu Kapwemba is a pediatrician and neonatologist working in Zambia. She holds a Bachelor of Medicine and Surgery, a Master in Pediatrics and Child Health, a certificate and a Master of Philosophy in Neonatology. Her career is dedicated to nursing and doctor's education and to the health of neonates and their families. She co-founded Newborn Support Zambia, a not-for-profit, non-governmental organization to help improve the care of neonates in Zambia. Kunda, welcome to the podcast. We're honored to have you here today as our first guest.

 

Kunda Mutesu-Kapembwa 01:44

Thank you so much, Shalyan. Thank you, Ben Kunda, can you?

 

Shelly-Ann Williams Dakarai 01:47

tell us a little bit about yourself and about the decision to become a pediatrician. What led you to that decision? And then, after being a pediatrician for a few years, you then decided to go on and do neonatal training and become a neonatologist. Can you walk us through what made you want to be a pediatrician and then what made you want to move, continue on and become a neonatologist.

 

Kunda Mutesu-Kapembwa 02:07

Okay, thank you very much, shalyan. So when I was training as a doctor and I finished and did my internship, I went through different departments and realized that the children were just very close to my heart and so I knew then that I was the pediatrician. And when I became a pediatrician I realized that the guts that I had in looking after newborn were so big and nobody was answering my question. So I thought I should just become a neonatologist to answer these questions of newborn care, especially that at that time babies were really dying and sometimes you wouldn't even know the reason why a baby would have died. So I became a neonatologist to save this more baby's life. Oh, at least try. Right.

 

Ben 03:07

Can I ask you a follow-up question on that? I think the motivation to pursue this career is eloquent and quite nice, but I think for a lot of us in neonatology, and especially in global health, we don't always achieve this goal. So were you reaching a point where this wish to save baby's lives actually transitioned to frustration of not being able sometimes to achieve the goal that you needed to achieve?

 

Kunda Mutesu-Kapembwa 03:34

Yes. So it immediately became clear that you may wish for something that you don't realize. Our heart it would be to get them. And when I went to train in Cape Town, everything was available. You know, equipment and investigative capacity and just certain other important drug were there. That when I went back home to Zambia I realized that we may not reduce mortality of newborn just like that. So it required some innovation but also some patience. But then quickly you also realize that neonates may not need high-tech often.

04:20

So it's really understanding the basics. You know the keeping warm dry. Stimulate the baby, keep the baby warm, give them breast milk and give them antibiotics. And if they're in respiratory distress we may not have the standard equipment to actually improve their breathing. But then we learned to make you know like improvise. You put a bottle and you put some water there and you generate a pressure that helps you open baby's lungs. Of course it's not ideal, but you did better than putting Nezopron oxygen Subsequently. We started fighting for this thing and yeah, well, there was a lot more improvement than alien baited.

 

Ben 05:14

I understood. And so how was that transition? Because I feel like for us it's terrifying to imagine ourselves being placed in a position where the tools that we take for granted are no longer available and now, suddenly, I have to, like, devise my own CPAP machine, my own bubble CPAP. Is that something that you and I'm assuming that's something you had to learn quite quickly, because when a baby's sick like you got to, it's got to happen very soon. How is that transition for you from being a physician to being a mechanical engineer?

 

Kunda Mutesu-Kapembwa 05:43

Oh, it's quite serious because you don't know. Even when you make a bottle bubble, CPAP bottle, you really don't know how much pressure you're getting. You don't know how much pressure you're generating for this thing. And so you play with it and you realize that if there's initial settings that you can put on a normal CPAP, these are not your initial settings on a makeshift bubble CPAP. So if you're supposed to start with six centimeters of water, you know that if you have a big baby, you probably should put 10 centimeters of water for you to see any effect. So it's quite challenging. Actually it's quite challenging, and initially I didn't even believe these things would work, but actually do. Yeah.

 

Ben 06:33

What was the transition like for you? Going from South Africa with a lot of means and a lot of things available to you. And, right, you transitioned from South Africa to Zambia directly. Right, there was no other countries along that path. You went back to Zambia, is that correct?

 

Kunda Mutesu-Kapembwa 06:50

Yeah, I think it's really the decisions to go back, the decisions to go back and change the landscape. But also, I think, when you're a certain age, you just don't think that you can migrate to anywhere. So the transition is hard, but then it has to be done and you get a casual shock. You're going back to your own country, but you get a casual shock and I think a couple of times I told my husband we needed to go back, we needed to go back to Cape Town and we needed to go back to South Africa to wake in an environment which would give us job satisfaction. But then there were other things that made me feel that being back home was much better. You know issues of xenophobia here and I think around the time that I completed my training in 2015, there were some clashing with foreigners and the South Africans. I think for me that was really one of the drivers. Every time I remembered, I thought, okay, maybe we should just try and get back at home. So the transition was.

 

Ben 08:08

I want to maybe get your perspective from the Zambian folks, because how many new Neutologists are there in Zambia altogether?

 

Kunda Mutesu-Kapembwa 08:17

One. I've been the only Neutologist in the public sector since 2015.

 

Ben 08:23

So they must have been very excited to see you arrive from South Africa then.

 

Kunda Mutesu-Kapembwa 08:26

Not really, you know, like Not really. I just received a lot of backlash and, in order to extend to where people said, oh, congratulations, I'll call in for your assignment, but we don't need your services. Wow. I know, I know.

 

Ben 08:51

I would have expected the opposite. I would have expected, finally, we're going to have somebody proficient in newborn critical care and we're going to be able to save all these babies that we've not been able to save. So I'm surprised to hear that.

 

Kunda Mutesu-Kapembwa 09:02

Yeah, it took some time before people actually even knew the difference that a Neutologist can make. So for me, I think that some of it could have been ignorant we had never seen a Neutologist and we didn't think they would add anything to the way we looked after newborn. So I think some of it could have been like that and they needed maybe for someone to prove that oh, there's actually a difference that this one person can make.

 

Ben 09:33

I know you have that answer. Can you give us one example of a story or of a case where you were involved and you could see that they're like? Oh, we see the difference a Neutologist can make.

 

Kunda Mutesu-Kapembwa 09:46

So when I arrived in Zandia, I think people didn't know who a Neutologist is and what they can add. And so when I was coming to Cape Town, I'd been in a small town called Livingston and when I got back I went back to Livingston and, as far as the world was concerned, well, I was a pediatrician and I was a Neutologist, but that's it. So at one point one of the companies that the distributors are factoring needed a Neutologist to teach people how to give a fact, and so it meant that I needed to be traveling from Livingston to to Losaka and I was doing it like for a week, a month, for six months. So during this time a baby was born from from the wife of a dignitary, and this baby had terrible TTN and you know like the baby was even having a voluntary movement. So this was a 4.2 kilo baby, was a macrosomic baby, really behaved like an infant of a diabetic mom, despite the fact that really the mom wasn't a proven diabetic. So, because of the people attitude there, like, I didn't really feel welcome. So when it was time to knock off, a knock off. And then this baby got very ill and actually the father was the minister and he was called back to go and you know like sort of went to the bite is baby because the baby was feeding. You know like they said the baby was feeding. So the head of the institution called me and said but you're the only Neutologist we have. So I went back and I found that this baby was really sick and you know all these involuntary movements, and so I just I looked through all the results and the only consistent thing was the hypocalcemia. And so I said, ok, we'll get blood so that we do the formal calcium, but let's give calcium look on it Even as we do that. Right? So we gave calcium look on it and then the baby started looking pink.

 

11:52

By the time the father was coming again to see the baby. It's the first time you were seeing the baby's face. The baby didn't have all the masks but now, just at the bit of nasal prong oxygen. And then he came and stood and said talk, what do you do? And I said, oh, this and that. Then he said, no, I'm not a layman, tell me what you did. I said, ok, I thought the baby had hypocalcemia. This is our influence of diabetic moms actually in behave. I know she's not an infant of a diabetic mom, but she's macrosalamic. So she had signs of hypocalcemia and we gave calcium and the baby just recovered. I think that was the first time anybody even saw what difference, because the father was a doctor and he knew that this is a baby that that would have died.

 

Ben 12:38

Wow, yeah, super impressive. How has your relationship with your local government and institutions in your local, in your country, evolved after that? Like you took a significant role in trying to be a force for change in your home country. How did that begin? What did that look like?

 

Kunda Mutesu-Kapembwa 13:01

The dignitary was the minister of health and from then on he just said oh OK, so is it possible for her to move and take up a position of national coordinator for neonatal services.

 

 

13:17

It was a brand new position to create. So from then on I think I could say I was in and people were now able to see the significant and I took advantage of that position oh, I would say took advantage of that position because it made me enter those that otherwise I wouldn't have managed to enter. So with that position I was able to influence the nursing council for us to start the nursing training. So we have two nursing training programs, we have a diploma in neonatal nursing and we also have a masters in neonatal nursing with the investor of Dandy. And then we were able to even create the same diploma for MOs medical officers that I was talking about. We were able to make nice little documents, curriculum and things like that. And I think now that sort of put me in a different position and it sort of made people listen and even when I left the position I had, you know, I would have already done some of the things that were very important.

 

Shelly-Ann Williams Dakarai 14:24

Can you tell us a little bit more about that postgraduate diploma for the medical officers? What was that training like for them? Was it you know? How long was it? What type of training was that?

 

Kunda Mutesu-Kapembwa 14:36

So during the time that I became national coordinator for neonatal services, they created a college, zambia College of Medicine and Threatery, which was supposed to be running some training program, and under that we call it ZACOM. Zacom allowed people like me to create a curriculum that could teach people you know certain things. So it was a one year program, it was skill based and it was for medical officers who had just finished their internship but wanted to spend some time in the neonatal unit. So they would do the one year and after that others have gone on to do their MM in pediatrics and then, like Gay, who was already a pediatrician, had just graduated, has been, you know like, has used it as a stepping stone to doing neonatal and she was telling me how it had prepared her for an environment like this one where she came, she knew how to intubate, she could catheterize and baleico code, she could ventilate and things like that, so she wasn't thought so lost. So how it helped is that we have now medical officers that are now like running the neonatal unit. There's a consultant pediatrician and I was there before I actually left UTH, but it's a different landscape because these postgraduate diploma doctors actually know their stuff like they have. They are very hands on and they're able to teach Even postgraduates who come to rotate. On the neonatal unit they teach medical students and like, just generally, there was a critical mass that was created to look after newborn.

 

Shelly-Ann Williams Dakarai 16:26

Wow, that's pretty impressive. I can see how that is bridging the gap between providing neonatal providers in places where there aren't that many neonatologists. So I feel like that's a model that probably could be used many other places of implementing that sort of intense training for medical officers in a specific area to help bridge that gap.

 

Kunda Mutesu-Kapembwa 16:52

Yeah, and I'm actually I've just been freely sharing the curriculum because I got the idea from the base of Keptown, because they have another African Pediatric Fellowship Program. They developed a diploma like that but it didn't work Somehow it didn't. It didn't fit. So I said, okay, let's use it for Zambia, let's modify it and see whether it works. And it did work. So Malawi has asked for the curriculum and I'm giving it to one of my colleagues. So, like you know, like it just creates a critical mark and it it's still bad. So they know the first thing about living your life.

 

Shelly-Ann Williams Dakarai 17:29

Yeah, yeah, right, want to switch gears a little bit and talk a little bit about the National Neonatal Guidelines that you helped develop. Once you came back and the need was seen that a neonatologist really could improve the care of neonates, how did that process come about? Can you tell us a little bit about those guidelines and how you were able to get uptake, you know, in the community hospitals and things like that?

 

Kunda Mutesu-Kapembwa 17:57

I think even before I finished my training I realized that one of the gaps we had was that the protocol that we had clinical protocol that we had were very outdated and I had learned a lot of new things and realized that we needed to update the guidelines. So when I came back I started, you know like, working on the guideline until somebody from what's saving mother giving, like you know, even actually injected some funding that now I was able to interview to integrate other pediatricians to come and sit down, make a protocol and and put those guidelines and have them printed. It was a nice process because it felt all inclusive and, you know like, you get by in, you know to make them and you, you see that people actually use the guideline. It's a guideline we've had for the past five years. I think it means revision, but I think it was one of those things that that changed how people took care of neonates.

 

Ben 19:03

I have a question about that, as we're designing guidelines. I think it's very, it's a very challenging process and I am wondering how do you manage designing a guideline based on the latest evidence and based on the resources you have available? Because you could look at the evidence and say, well, this is what the evidence says we should be doing, but you could say also, well, I don't have that, that device, I don't have this tool, and so what was the process of designing these protocols, taking into account both the evidence and the resources that were available at your disposal?

 

Kunda Mutesu-Kapembwa 19:36

Some guidelines that we actually adapted them from Cape Town and we just removed some of the high tech things like high frequency of slatter ventilation. We could mention it there, but because we know that we don't have it in Zangaya, we've put it as something that somebody can use. So we want to go into details of putting what the map is, what the frequency is, because you know like we want to really use them. So we'll end up, you know, like just putting the basic ventilation and the basic ventilator setting so you just bring them down to a level where you know that people use them, but again, not to dilute the extent that people don't know outside the scope of what they have. So if it's mentioned somebody will remember, but we don't go into details of how it's used when we don't have it.

20:30

And I noticed also that for certain things that we have, we sort of even went into details of how to manage certain things that would not be detailed when you look at the Cape Town guideline. So that's how we went about it. But again we've noticed that those guidelines are still a bit detailed and they are for the Anato IC. So we are actually now currently making guidelines for district hospitals that look after new than those now are more basic. So we've been working at them and you know, like those ones I think will be more widely mentioned, you mentioned the guidelines that you're developing for the community hospitals.

 

Shelly-Ann Williams Dakarai 21:24

What is the system of care like? There Are most of the babies outborn and then referred into the main NICU that you're talking about.

 

Kunda Mutesu-Kapembwa 21:34

So those guidelines are supposed to be used at every delivery point and a lot of deliveries are actually happening in district hospitals and the district hospitals may not have ventilators but they can have CPAP. So, and in the guidelines they're actually putting at which point they have to refer which, what type of baby they should refer. If you know, like, let's say, they've put a baby on CPAP and they find that they've adjusted the settings and clearly this baby is failing on CPAP, they should already be having a discussion regarding referral to an institution that can provide more than CPAP. So, yes, some babies may be outborn even as they are going to the district facilities. But the referral system is going to allow to tease out those babies that may go to the, may go to the district hospital or may actually just go to the Teshmerin institution where they big will be held.

22:36

We've been encouraging in neutral transfers. This is not, you know like, in other places it's so obvious, but in our setting it's not that obvious. So now we're just emphasizing that if you have a high risk mom, why not send them to deliver? And, you know like, refer this baby in neutral and there's a little referral based on the mother's condition and not on the baby's condition. So we are trying to say that both lives have to be there. So if it's just a baby, they still should go to a facility where the both mom and baby can actually be get help.

 

Shelly-Ann Williams Dakarai 23:11

I know we mentioned earlier that you came back as the only neonatologist. Are you still the only neonatologist in Zambia?

 

Kunda Mutesu-Kapembwa 23:21

In the public sector. I was the only other person who's come to do neonatologist this gay that came to see me. Otherwise I think they are neonatologists in the private sector. I know of two hospitals that have got, I think, one private hospital that has a neonatologist and the other one has got a medical officer who's got a bias towards neonatology. But they would always consult and they would always want to to bring the babies the public host to where I was. But I left the public base one year, six months ago. I moved to the copper belt for family reason, but maybe I also got tired. I got bent out, yeah.

 

Ben 24:07

That's an interesting point. I mean what?

24:09

do you think is going to be the recipe for people like you to actually have the stamina necessary to remain in the public sector? Because it does feel like listening to your story that you get back home and you're really stressed by the demands of the units, by the demands of the state, the guidelines. I think it's not surprising to hear that it was tiring after some time. How do we make sure that for people like you, who are returning home, who are trying to make a difference, that we don't bring them out too quickly and lose precious years of continuity that we could have gotten from them?

 

Kunda Mutesu-Kapembwa 24:44

This is why I told you that this consultancy I'm doing with Elma is interesting, because that's exactly the question that we are trying to answer the issue of impact and retention of the African Pediatric Fellowship Program. Alumni is really at the core of this. I realize that I'm not the only one who's had to go through this period of wanting to carry everybody on your shoulders. I think the issue I was saying to African Pediatric Fellowship Program is that when they pick people they have to be strategic, because you can't have one neonatologist trained in seven years. They will be bent out. Really, the issue is train more people so that the work is shared. That would be great. But also, if you're working in the public sector, the renumeration should make them.

25:37

My husband moved and I followed him. Then there was an opening for a pediatrician and I jumped at it because in the government I get $1,000 and when I moved to this place I get $5,000. You realize that, yes, I have served, but then am I getting the return the way they should be? Really, the idea is, if you are more of you, you could even be in the public sector and do private practice which supplement your income, but of course you'd be very tired. Just being the only one. Renumeration not so great, makes people move.

 

Ben 26:22

And that aspect of Alma's philanthropies was actually featured on. There's a CNN Inside Africa segment that aired in 2017, I think that was really good. So, yeah, we'll post some of that stuff on our episode show notes.

 

Kunda Mutesu-Kapembwa 26:41

Okay, that's great.

 

 

Shelly-Ann Williams Dakarai 26:44

So before we touch a little bit on what you're currently doing now, I did want to talk about the Zambian Neonatal Resuscitation Guidelines. I saw a paper that you guys recently published where you came up with your own guidelines for a resuscitation.

 Can you speak to why you thought that was important and what those guidelines entail?

 

Kunda Mutesu-Kapembwa 27:08

In the Zambian scenario, anybody who came with their own research guidelines and their own algorithm just came in and started teaching People came with helping babies bring. The people from the NHS, from the UK, would come with their own algorithm. The Americans would come with their own algorithm. But if you look at this guideline, this algorithm, if you look at helping babies bring, they talk about bugging the baby until he'll parry. If, let's say, the chest is not moving, they just talk about repositioning and continue bugging. So if the baby is not really receiving adequate ventilation, the chest won't rise unless the baby will die. So helping babies breathe is really for a low, very low resource setting. But you probably don't even have an Orofarranger airway to push the tongue away from the airway. And then you realize that our setting has got it's low resource, but not too low resource depending on where you are. So, let's say, in an institution like an investment hospital where you even have a unit or unit, you know that this baby has a tongue so you can just use helping babies breathe in a place like that. And if you look at maybe like the NRP from the USA, yes, you are starting with basically substitution, but it's advanced resuscitation and you talk about intubation, you talk about all these things and including the UK algorithm. So when you put them together, we put them together because we realized that we had something to learn from each of those algorithms. So we had been using the UK algorithm for a long time and why we liked it was because when assessing it was talking about color, tone, breathing, heart rate and it's not really focusing on whether you have a pulse oximeter or not, and then it doesn't really focus on intubation. So we picked that because, even though we know that color may not mean a lot, if you're looking at a dark skin baby, it still was using color. So we could relate, especially if you don't have pulse oximetry and things like that.

29:36

So in our algorithm we got ideas from helping babies bit and we've got ideas from the UK algorithm. And in our algorithm we don't focus much on intubation. We focus on things that somebody can do, like in session of an Orofaryngeal airway or doing a Jothra to push the tongue out of the way, and then, if somebody is killed enough, they could actually intubate. So it's slightly above helping babies breathe and it still prepares somebody to be able to do advanced unit or resuscitation.

30:15

And in our algorithm we've actually put the stages at which a referral can actually be done, like you do certain things and we say, okay, at this point you can refer, at this point you can talk to the parent, and those are things that are not really in the helping baby breathe and may not really be in the UK algorithm. So we wanted an algorithm that we can use at all stages, be it in a very low, low resource area or in an average, or an average meaning, if you can't intubate, put an Orofaryngeal airway and then you can never use it at a point where you can act to make the baby. So we've made a handbook and, of course, we got all the permission from the Immature, the Muc, the Resuscitation Council to use some of the things, and they were very, very generous because they even gave us some of the new guidelines of 2021 and we've included them in our book.

 

Shelly-Ann Williams Dakarai 31:23

Right, and I think a lot of what you talked about highlights the challenge of the middle. Sometimes you're in a situation where you have some equipment, and that's the challenge. I'm originally from the Eastern Caribbean and so that's kind of where we find ourselves a lot of times right in that middle, and so I was very intrigued by the guidelines, because it really does put both of those types of algorithms together to help those countries in the middle who have some access to some equipment.

 

Kunda Mutesu-Kapembwa 32:02

One of the things we did when I was a national coordinator for the UNEDO SEVICE, apart from the long term trainings, we had a short term training which orient stuff that work on the UNEDO ICU. So it's a five day training program. So in the first two days we actually do Neonatal Resuscitation and now those are the algorithm we use Like. On the third day we teach how to make a zip up, how to make and use zip up, how to make your zip up, and then we teach them a few things fluid management and things like that. So that group of people of national trainers about feeding them, are the ones that are down to make that algorithm and it's now they are part of newborn support. So it's a mix of people and with different ideas. Their pediatricness is pediatrician and midwives and we search together so that everybody could actually have buy in and see that that's an algorithm. They cannot.

 

 

Shelly-Ann Williams Dakarai 33:07

So before I took you back to talking about the national resuscitation algorithm, we were talking about the fact that you've left the public system and are doing some other work now that you're very excited about. Can you share a little bit about your non-profit and some of the work that you're doing with the African alumni who fellowship trained?

 

Kunda Mutesu-Kapembwa 33:28

So I work now in a private hospital and I work as a pediatrician, but I've been doing more Neonatal Wake for the hospital and I still do Neonatal Wake for the province and involved in the discussion of Perinatal death weekly and I've been teaching using that same short course and so I'm very much involved with the Neonatal. But because I had left it was funny after I had left the public vector, then Elma said oh, we've been wanting to work with you for a long time. Now that you're not very busy, is it possible for you to do this consultancy where we try and do this thing, looking at the impact and retention of the alumni? And so it's just a one year consultant and I have three deliverables. The first deliverable is to look at the alumni of different sub-species to see what their impact and issue of retention are in their own country. Then I'm also doing a landscape for Neonatal nesting because I'm very much interested in training Neonatal nurses.

34:41

So trying to see which countries are actually doing training Neonatal nurses and seeing what gaps they are and identifying investment areas for Elma. And then I'm supposed to make the strategic plan newborn strategic plan for Zambia in terms of training the pediatric health care at, more specifically Neonatal health care and the way it works. So it's interesting work. Tomorrow we are having a meeting with the APFD working group and presenting the findings of the engagement with the APFD alumni that have been doing for the past few months Sounds like pretty exciting work and very impactful work as well, so I can sense the excitement in your voice about it.

 

Shelly-Ann Williams Dakarai 35:31

You also mentioned that you co-founded a nonprofit. Can you tell us a little bit about that and the work that you're doing and why this started in the first place?

 

Kunda Mutesu-Kapembwa 35:41

So when I just got back from training, I wanted to give back but I didn't know how to because you know like somehow to do something on a large scale. Yes, you do need to be in the government system, but it wasn't working like that. So we made this, not for profit, to adjust that. Teaching people it was actually meant supposed to be teaching people, disseminating information about Neonatal, and one of the other things was to try and do before equipment for different hostages so that we could create Neonatal units. So we started in 2016 and it's worked well so far, and we developed the same training program and we've been writing grants for equipping of new and later units. So the first unit that we equipped with the livings and the first host that I was working in. So we wrote a grant to livings on Rotary Club and they wrote to their partner and they were able to buy some good equipment that we put in the livings on the unit.

36:56

And then, when I moved to the University of hospital, we started doing more or we would have a rest generally, fund raise, especially on World Pematurity Day, and buy certainly two small pieces of equipment that were not in the ICU where it worked, like phototherapy machines, you know, transkitcheners, bilirubinometers, and lately we recently bought Mannequins because we only had one set of Mannequins, so now we've bought a second set of Mannequins to help us as we teach our course and so use new born, support Zambia. That's when we've been able to make all these, some of these documents that we've made, and really trying to ensure that people get to hear about neonet. We have a presentation every Thursday at 7pm and we teach. Everybody who's willing to listen mostly is a neonet on essence that actually joined, so we'll teach different topic, somebody will pick a different topic and teach and I think we are creating awareness and we're trying to just correct how people manage newborn and really emphasizing on the low cost interventions that I Right yeah, and you quickly said that you talked about the low cost interventions.

 

Shelly-Ann Williams Dakarai 38:22

What interventions are you talking about? Because I knew that when you first came back and worked in one of those units, you implemented a few changes that reduced the need for mortality, and I remember it, you wrote there were low cost interventions. So could you just quickly tell us what you mean by low cost interventions?

 

Kunda Mutesu-Kapembwa 38:38

Yes, I think, low cost interventions, those interventions that don't need big investment. So, for example, hand washing, you know, and somebody just has to make sure that they stop in the unit and make sure that people are washing their hands. So I think I used to be a pain in people's because I would insist on can you wash your hands, even when, when dignitaries and whoever would come to the unit and I'll talk okay, wait, we have some alcohol hand wrap, can you please wash your hand here? And so just hand washing. Actually you could tell the sepsis levels won't actually reduce.

39:17

And then let's talk about KMC. You know, kangaroo mother care it wasn't a thing in Zambia. So now we started creating KMC units and we started teaching people how to do intermittent KMC, how to do continuous KMC, including things like. I remember that when we were training, if a baby came in the Pacific, all we did was give them boluses of fluid. You know what I mean. So now people learned that, look, you don't need to do all these boluses. In fact you have to restrict fluids. So give fluid the way they should be given. We encouraged breastfeeding and as well as even just expressing breast milk or preterm babies and giving them Previously you would have a baby on IV fluids for like 48 to 72 hours because mom doesn't have milk and we're just waiting for it to naturally come. So now, expressing milk from day one made people realize that at the end of day two you still have some drops of milk and the energy is that the expression the more likely that by the time day three is coming, the mom has adequate milk.

40:28

And then even just making the CPAP you know like making them the CPAP and putting babies on CPAP, those for me were low cost interventions that actually meant a different. So in Livingstone, I think at the time that I was there, mortality was at 35%. By the time we had implemented all that we had implemented, we were like at 15%. When I went to UTH it was the same thing. I think the issue is I think another local's intervention is leadership, and leadership which people realize that you are not just talking but you're actually doing it, and I think that's more useful. And the issue of buying in and not imposing. You're going to do this but you say, can we try this? You know we did this and we did. People used to do this in Cape Town and it worked wonderfully. Can we try it, and I realized that that kind of thing made people want to do what you were asking them.

 

Shelly-Ann Williams Dakarai 41:32

Yes, thank you so much for going over those with us. So we're getting close to the end of our time together, so just wanted to, you know, ask if there's someone out there, a physician, who, like you, is toiling and trying to make a difference where they are. I know we talked a little bit about how to prevent burnout, but in terms of speaking to that individual in that position, do you have any words of advice? Or in terms of how to tackle making changes? How to, you know, look at your career, do you have anything for somebody who might be just starting out where you were when you just came back?

 

Kunda Mutesu-Kapembwa 42:11

I think my advice would be to start with the low hanging and to realize that you can't change the world in a day. So I think, celebrating the small game, like if we make a protocol, that again, if you serve the baby's life who otherwise would have died first, again, I think just taking one step at a time and getting buy in from people and you know like even just one disciple at a time makes a difference. But also realizing when you're tired, when you have to rest, because burnout is actually very real, and I think self love and just cutting yourself some slack is very, very important and you eventually get to where you have to be, but one day at a time.

 

Ben 43:09

These are great words to part on Shelly Ann.

 

Shelly-Ann Williams Dakarai 43:13

I don't think there's any more that we can add to that. We are so honored to have had you as our first guest on this Global Health series and we appreciate your time and all the words of encouragement that you have given in your life is truly an inspiration.

 

Ben 43:29

Thank you, kanda. Thank you so much. Thank you for listening to the Incubator. If you liked this episode, please leave us a five star review on Apple Podcast or the Apple Podcast website. You can find other episodes of the Incubator and new shows from the Incubator Network on Apple Podcast, spotify, google Podcast or the podcast app of your choice. We would love to hear from you, so feel free to send us questions, comments or suggestions to our email address, nicoopodcastcom, or by visiting our website, wwwthe-incubatororg. You can also message the show on Instagram or ex, formerly known as Twitter, at NICU podcast. Thanks again for listening and see you next time. This podcast is intended to be purely for entertainment and informational purposes and should not be construed as medical advice. If you have any medical concerns, please see your primary care practitioner. Thank you.

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