Hello Friends 👋

In this episode of the Global Neonatal Podcast, hosts Mbozu and Shelly- Ann interview Dr. Gae Mundundu and Dr. Ritah Nazziwa, neonatal fellows in the African Paediatric Fellowship Program (APFP) at the University of Cape Town. During the conversation Dr. Mundundu and Dr Nazziwa  discuss neonatal services in their home countries of Zambia and Uganda, as well as their experiences as neonatal fellows. They highlight the challenges and opportunities in neonatal care in their respective countries, including the need for improved infrastructure and the importance of basic interventions. They also discuss the APFP which aims to empower African paediatricians and improve child health outcomes by providing specialized training and mentorship. Dr. Mundundu and Dr. Nazziwa also share about their day-to-day experiences as fellows, emphasizing the continuous learning process, the  practical application of knowledge and the diverse roles and responsibilities of a neonatology fellow.

Resources mentioned in episode:

The African Paediatric  Fellowship Program: https://health.uct.ac.za/apfp/our-model-0

Contact:   

Dr. Gae Mundundu LinkedIn

Email: gaemcn@gmail.com

Dr. Ritah Nazziwa

Email: ritahanazziwa@gmail.com

Episode Webpage Link:

Episode Webpage

Title: Training Tomorrow’s Leaders. Insights from Neonatal Fellows in the African Paediatric  Fellowship Program (ft Dr. Gae Mundundu and Dr. Ritah Nazziwa)

In this episode of the Global Neonatal Podcast, hosts Mbozu and Shelly- Ann interview Dr. Gaye Mundundu and Dr. Ritah Nazziwa, neonatal fellows in the African Paediatric Fellowship Program (APFP) at the University of Cape Town. During the conversation Dr. Mundundu and Dr Nazziwa  discuss neonatal services in their home countries of Zambia and Uganda, as well as their experiences as neonatal fellows. They highlight the challenges and opportunities in neonatal care in their respective countries, including the need for improved infrastructure and the importance of basic interventions. They also discuss the APFP which aims to empower African paediatricians and improve child health outcomes by providing specialized training and mentorship. Dr. Mundundu and Dr. Nazziwa also share about their day-to-day experiences as fellows, emphasizing the continuous learning process, the  practical application of knowledge and the diverse roles and responsibilities of a neonatology fellow.

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Dr Gae Mundundu

Dr Gae Mundundu is a Zambian Paediatrician, Neonatologist-in-training and budding

researcher. She is currently stationed at Mowbray Maternity Hospital, Cape Town

pursuing her Master of Philosophy in Neonatology under the University of Cape

Town. Her background of working in the Neonatal Unit of the University Teaching

Hospital in Zambia has allowed her to partake in both clinical work and development

of research opportunities and clinical protocols for the clinicians working with

neonates in Zambia. Her interest in research begun while pursuing her Master of

Medicine in Paediatric and Child Health from the University of Zambia when she

served as study physician.

Serving as National Coordinator for Neonatal Health has accorded her the chance to

be instrumental in health systems strengthening for the improvement of Neonatal

Care Services from community to national level through improvement of a women’s

health as she believes a healthy neonate can only be born of a healthy, informed

mother.

Dr. Ritah Nazziwa 

Dr. Ritah Nazewa is a Ugandan Paediatrician who is currently a neonatal fellow at the Mowbray Maternity Hospital in Cape Town South Africa. Dr. Nazziwa completed her specialty pediatric training in 2014 at the St. Francis Hospital, a  private not for profit tertiary care (missionary) hospital in Uganda. Following her training, Dr Nazziwa remained at St. Francis where her roles include Member of institutional research review ethics board, Academic coordinator for Mmed Paediatrics and child Health(Uganda Martyrs University) and Coordinator, Continuous Professional Development along with In service training of intern doctors. Dr. Nazziwa’s interests are in implementation research.

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

Mbozu Sipalo (00:01.887)

Hello everybody. Welcome to another episode of the Global Neonatal Podcast. Shelly Anne, how are you doing?

Shelly-Ann Dakarai (00:10.36)

Doing great, doing great. Just always happy to have another interview that we're getting to share. love meeting new people and learning about what they're doing.

Mbozu Sipalo (00:19.535)

Yeah, same here. So today we're excited to bring you another interview with more people in the field of neonatology doing amazing work. So joining us today are Dr. Gaye Mundundu and Dr. Rita Nazewa. How are you guys doing today?

Gae Mundundu (00:41.334)

I like to eat it. Doing very fine, thanks. Any day to discuss neonates is a good day.

Mbozu Sipalo (00:45.719)

Alright.

Right. Yes. So Gaye Mundundu is a pediatrician and neonatology fellow at the University of Cape Town. She is the national coordinator for neonatal services in Zambia, a global women's health fellow at Johns Hopkins University and a clinical trial physician. Nazewa is a neonatology fellow as well at the University of Cape Town, based at Mulberry Maternity Hospital.

She qualified as a pediatrician in 2014, works at St. Francis Hospital and has a keen interest in implementation research. She serves as the Institutional Research Review Ethics Board and is the academic coordinator for the M .Ed. Pediatrics and Child Health Program in Uganda. All right. So welcome ladies to the podcast. I will hand over to Shelley Anne to ask the first question.

Shelly-Ann Dakarai (01:49.27)

Yes, welcome to the podcast. Happy to have you guys here. Before we delve into the discussion about the African Pediatric Fellowship Program, where you guys are currently fellows at the University of Cape Town, can you tell us a little bit about your home countries, particularly the regions that you've worked in, and a little bit about the neonatal services in your home countries?

Gae Mundundu (01:52.214)

Thank you.

Gae Mundundu (02:13.662)

I'll let Rita go first.

Gae Mundundu (02:18.204)

as my senior.

Ritah (02:20.131)

Thank you, gay as my senior. Yes, back in Uganda, the neonatal field is, I would say, still a virgin area for growth. And many of the pediatricians are very enthusiastic about neonatology and...

why we have a special touch there. Much as the child mortality rate, the under five has been improving and steadily towards the sustainable development of goals. Unfortunately, the neonatal mortality rate has stagnated for long at about 27 per 1000 over the last decade. So there is a lot of concern to tackle

neonatal mortality. As a country, neonatal intensive care units are not widespread. There are about five hospitals that have

Neonatal Intensive Care Unit. And by that I mean units that are able to ventilate babies who have neonatal ventilators, who can do maybe some blood gas monitoring, like with a good equipment. Like I would say, touch -relevel neonatal unit. There just about five hospitals in the whole of my country. And of those five, only one is a public

The three are private hospitals and one, that's where I work, is a missionary hospital which is a private not -for -profit. So there is really a big need. But that said, improving neonatal mortality is just not about the equipment.

Ritah (04:11.639)

but also about the subtle things. Like we like saying with gay, the low -hanging fruits, going for infection control, breastfeeding, KMC, all those things can impact very, very greatly on neonatomotality. And that's why there's now a more, very many pediatricians are interested in neonatology, which makes me smile because by that we get equipped

And if you have the knowledge, then you're able to empower others and advocate. So that's where we are. And I'm happy to say that currently we have three neonatologists who are fully trained from South Africa here, Cape Town.

And I love South Africa training because it's a bit related to the African setting. They have some of the state of the art neonatal units, so the equipment is there that will be in the Western world, but then it's more practical, more hands -on, and more relatable to the African setting. So the three neonatologists have studied from here and two were funded by APFP.

And I'm the one who is upcoming. And the more you are, the more you can join hands and improve the new care in my country.

Shelly-Ann Dakarai (05:45.688)

Okay, what about you? you tell us a little bit about your country?

Gae Mundundu (05:50.496)

Sure, so a little bit about Zambia. It's a little bit difficult to summarize all the things that I want to tell you about Zambia. But if we're going to focus on the part of Zambia that drove me to coming here, it is mostly, it comes from wanting to...

paint a better picture of the neonatal care in the country, which at present could be much better. I mean, it's much better than it was before, but it has many places that it could go. as is the case with most low and middle income countries, a vast majority of deaths that are occurring in the under five population are occurring between the birth and the first birthday.

And even up to 44 % of these are occurring in the first 28 days of life. So this just means that the first month of life is so critical because it has such a huge impact on outcomes, not just in the under five population, but even going beyond that.

That I think is one of the driving factors behind the need for us to improve neonatal care in Zambia. our recent demographic health surveys between 2014 and 2018 showed an increase in the neonatal mortality. It went up from 24 % sorry, from 24 per 1000 live births before to 27.

And I mean, there's always been debates as to whether this is because we're reporting them data or if we actually have more babies dying. But either way, it's still an unacceptable number considering the global targets of having only 12. So.

Gae Mundundu (07:51.888)

Zambia is not in a terrible place in terms of neonatal care, but I feel like it could be in a much better place. And that basically is one of the major drivers behind me being here, as well as having... I also have a very big passion for teaching. So, but I'm guessing we're to get into that later. But basically about Zambia and how I got here, this is part of what drove me to...

come here to UCT and venture into the field of neonatology. And in terms of the availability of neonatal care, we have quite a number of tertiary level facilities if we combine public and private facilities. But under the public health facilities, very few of them are able to offer

even the basic standard of neonatal care. We have one tertiary level facility, which is where I'm stationed in the capital city. But other than that, there are very few other facilities in the country that are able to offer even just the basic neonatal care, let alone tertiary level care. So apart from UTH in the capital city, we have

one other step down facility called Levy Hospital, which is also able to offer some level of tertiary care. And then there are other facilities in other provinces as well that are specialized and can offer tertiary level care. But like I said, considering the population that is there to be served, we still have a very long way to

Gae Mundundu (09:39.936)

Thank you.

Shelly-Ann Dakarai (09:39.946)

And let me just, yeah, thanks so much for sharing that. And let me just clarify so I make sure that I'm clear. So what you're saying is where you are now, there is the one main hospital that is a tertiary facility or were you saying that was in Zambia?

Gae Mundundu (09:58.61)

in Zambia. So I was speaking about Zambia. Yes. Yeah.

Shelly-Ann Dakarai (10:00.0)

Okay, that's what I Okay, okay. Yeah. And then the acronyms that you, some of them have the same, what you call it, acronyms. So that's why I was like, that's why I got a little confused. Got it. So, that's okay. Got it. So one tertiary institution in Zambia is what you said. And so that was part of what prompted

Gae Mundundu (10:09.31)

Right, yes, yes. Thanks for that reminder. I need to always remember that I'm speaking beyond the boundaries of the country. Yeah.

Gae Mundundu (10:25.642)

that is able to offer tissue -enabled care to the neonates. And then we have step -down facilities.

Shelly-Ann Dakarai (10:37.344)

Okay, got it. So Rita, you briefly touched on this when you were talking a little bit about Uganda, but tell us why you chose to do neonatology. Gay did explain her reasons behind it. Can you tell us a little bit about what prompted you to go into neonatology?

Ritah (10:55.267)

So one of the reasons that I went into neonatology was inspiration from my patients, first of all. And by these, I would give that encouragement where we would see the babies and they're fine. And then the patients thank the team and they're like, we thank the neonatologists.

Dr. Victoria and Rita and I'm like, damn, I'm not yet in neonatology. And they're like, I'm the other pediatricians. I'm like, you're supposed to be in the other pediatricians. Well, that was already inspiring. And I would find myself subconsciously enjoying the neonatology, the neonets more. Like if I'm on call, I'll be, my mind is more focused on the neonets. I'm like, I'll start with the neoneto unit.

when I see the babies, I think the night will be fine. The babies are fine. If there are any other issues, we shall talk. The babies are fine. I think it's just, naturally I just love the neonates more. They make me more happy. So that's where my passion is. But also too, it's because, like I said earlier,

they still contribute the biggest to the under five mortality rates. And the fact that the neonatal mortality stagnated for long, like, you know, 10 years, like over a decade, it's just at the same value, not improving, yet the other mortality rates were improving. That to me was showing like, they can't talk and they are really voiceless and...

I think there was more focus on the older children. So neonettes are so innocent that I imagine they are easily forgotten. So that is one of the things that drove me. And also when my senior came back from Cape Town, she just made me realize these babies can survive. Because when I was studying, just see neonettes dying. And you feel like you can't do much.

Ritah (13:11.617)

It's like you've already sentenced them to death.

But when Victoria came back, she's one of the first neonatologist in Uganda, Natchiboka Victoria. She did a lot of things and we just saw the mortality rate. Infection control was improved. Actually, for those who have time, can go to the BMC. We published a paper there. She's the primary author where we looked at the impact of secondary.

and tertiary interventions on neonatal care. And when we compared what we used to do before we introduced some of these tertiary interventions and just improving on the already existing secondary interventions, basic things like CPAP, KMCY introduced, yes, some ventletas came into the unit. The neonatal mortality rate decreased from 8 .2 % before the improvement

it dropped to 5 .7 percent and the preterm case fatality rate improved from 16 .2 percent to 9 .2 percent so there was a lot of improvement but just seeing someone who came empowered with knowledge first of all and then empowering her team because we had to improve our hand washing those subtle things and then of course when the equipment came in that now

able to ventilate. We changed a lot of things, so seeing the impact that babies could survive by just having knowledge, having better skills encouraged me. was like, no, I can also be part of this team. She can't be alone. She needs a team to work with her. Yeah, so that pushed me to come and do neonatology. Yeah.

Shelly-Ann Dakarai (15:10.956)

Thanks so much for sharing. Gay, did you have anything else to add on that?

Gae Mundundu (15:18.77)

I mean a lot of what Rita has said resonates with me as well and I think an added thing for me is perhaps I like broken things. The neonate is such a fragile being.

but is also one patient that responds to the most minimal of interventions. Usually with adults, you need to come in guns blazing and throw everything that you have at them for them to actually show recovery. But with neonates, they need the most basic things. And I think the other thing for me that inspired me to do neonatology was

hearing all the changes that have occurred over the years in order for us to achieve very minimal things, right? But it's the simplest of interventions that have caused the biggest changes in survival of the neonates. And I wanted to be a part of the group of people that have improved that.

Even I think those are are speech I listened to on one of the newborn toolkit presentations where they were talking about this population, the smallest population, which has the biggest impact long term on outcomes and.

basically how we all turn out as adults is very dependent on how we are treated in those first 28 days. So I think for me, looking at this.

Gae Mundundu (16:59.954)

supposedly forgotten or abandoned field of medicine, which has such a big impact, is something that appealed to me. And that's why I said that maybe I like broken things, the things that need, the things that no one else seems to want to fix, things that I gravitate towards, and it has worked out perfectly for me. And I also had a very,

big influence from my mentor, Dr. Kapembwa, who incidentally was also trained under the APFP. And watching what she was able to achieve with very simple interventions for me was a big inspiration to enter the field of neonatology. So yeah, that's basically seeing a small population that responds to the most minimal of interventions with very big results is a big motivation for me.

You can change a lot by simply washing your hands.

Yes. Thanks.

Shelly-Ann Dakarai (18:00.161)

So true, so true.

Mbozu Sipalo (18:02.469)

Yeah, super inspiring to hear about your individual stories and to just.

I like how, you ended on the fellowship program, because that's where we're going to next. For our listeners who are not familiar with the program, can you share a brief background about the African Pediatric Fellowship Program and what made you choose this program? So I think we'll start with Rita.

Ritah (18:38.047)

So the EPFP, which is the African Pediatric Fellowship Program, is a program that was

It was started around 2007, 2008. And it started with just about five fellows that were sponsored. And with time, it's grown in that per year, there are almost 50 fellows that are sponsored. And it...

It funds -MED programs, but basically in pediatrics and -FILS, that is the fellows, and also diplomas in pediatrics. So it's basically about empowerment.

and its main focus is on improving child health in the whole of Africa. So they're looking, it looks at a child as its focus. And by empowering the different African pediatricians or doctors who are interested in being in pediatrics, then it creates a, I would say a...

a critical mass in particular fields.

Ritah (19:59.979)

and empowers them so that they can begin these specialties or subspecialties in their countries. So it focuses on specialties that are lacking in particular countries. I'll give an example. If Uganda has very few neonatologists, then it will open up for neonatologists to be trained. And then at the same time, it doesn't just stop at that. It empowers

the alumni into leadership with leadership skills and empowers them on how to mentor and grow the programs in their own countries.

Some of us who are benefiting from it, we must say that it doesn't just look at the academics part of you coming out as a unitologist, a pulmonologist. It has a great team that will look at you holistically. And that is something I really love about the APFP. It makes you feel like you have another home away from home.

starting from the coordinators, the people in that office, they just want you to live, they want you to live the program when you're happy and fully grown, like.

holistically grown, not only in the medical field, but in your other parts of life. So they will check on you and all that. Well, the funding comes from different sources. ELMA is one of them. And then there are also other organizations and even I think well -wishers. So it's accessible to.

Ritah (21:43.647)

any African and it also encourages growth of the particular institutions that get involved. For example, if I'm from St. Francis Hospital,

when I become an alumni or I'm even still in the program, I'm able to discuss with APFP to identify which other areas in my hospital which are lacking. For example, if we don't have critical care or any other field, they will help that institution to grow in all other areas. So that is the little I can talk about APFP. But well, what I can say, it's great and some of us are already seeing fruits

The first alumni in our institutions now we're up and other people are coming up and it's changed the hospitals. And at the end, it is the children that are surviving better and having a better quality of life. It's just not an organization. The end results is mobility and mortality of children of neonates at the end of the day. Yeah, thank you.

Mbozu Sipalo (22:59.909)

Thank you, Rita, for sharing that really thorough account of what the fellowship is all about. And I can see Gay has put something additional to add. So please, Gay, go

Gae Mundundu (23:14.165)

I was just going to say that that's a very comprehensive summary of what the APFP stands for and yeah I think all of us are completely honored, blessed and should emulate

exactly the tenets that the APFP tries to instill in all of us. mean, they deliver on what they say they stand for, which is to improve the outcomes of pediatric care in Africa. And I think when you look at the maps of how many people have been trained, what they've been able to achieve in their individual countries, how many people still continue to come here, how many more specialties have opened

it's a big beacon in the continent in terms of improvement of pediatric care. So yeah, very much honored. I only found out about the APFP through my mentor, Dr. Kapemba, because she was trained under the APFP. yeah, it instills that sort of mentorship in...

all the trainees in the sense that when you've been trained under the APFP and you have achieved your fellowship, you only want to see more people benefit from it. It's not something that you want to encounter and keep to yourself. You want to go out there and spread it and have more people benefit from it. And I think the goal in mind is to get the continent to a point where people no longer have to cross borders in order to attain

subspecialty or specialize in any field in pediatrics. And it will make each country self -reliant and you know medical tourism maybe doesn't have to be all about coming to one particular country and we can all achieve better outcomes with in -house programs that the fellows that have been trained under the APFPO eventually set up. it's definitely

Gae Mundundu (25:26.866)

I mean, whenever we speak about the outcomes of pediatrics in the continent and in particular for neonates, we cannot speak about what we've achieved without going back to what the APFP has enabled us to actually attain while we've been

Gae Mundundu (25:47.763)

That was my audition.

Mbozu Sipalo (25:51.291)

Thank you, thank you so much for shedding more light on what the fellowship is all about and just the importance of peer -to -peer learning. It sounds like there's been a lot of empowerment and learning in the spaces you're occupied through your mentors and through just other colleagues who are part of this fellowship. And it really is amazing how it's impactful and it's training African pediatricians.

to be neonatologist and to pay it forward to their own colleagues within the field. Just to again explore the fellowship life, what is it like to be a fellow and what does your day to day look like? I will start with Rita.

Ritah (26:44.985)

Well, the life of a fellow is interesting. Sometimes it feels like your day has 12 hours instead of 24. The fact is I will not sugarcoat. It's exciting, and it keeps you wanting to know more.

And sometimes it puts you in this situation where you say the more you know, the more you realize that you don't know. And I say it's beautiful. Like you come and you're challenged that, so this thing is reality. You put the textbook.

to reality because sometimes you read the books or the published work and some things look abstract. It looks alien. But the beauty with a fellowship is that you start seeing the practical part and you believe that what is published is actually really done because these things exist. And I talk about this as a fellow coming from a low -income country.

Sometimes some of the things we see published or in the textbook are so abstract. When they're talking about hyper -ecplexia, you're like, mm -mm. Which gene is that? Or we use CFM and AEG to look at the seizures? Really? Things are so abstract. So what makes a fellowship very interesting is that each day,

Each day mark my word, each day you're going to meet something new. It challenges you, but at the same time, it's exciting. The beginning is, I would say your GCS almost is not 15 out of 15, because you're going to see like 20 new things in one day. And you're like, how am I going to learn all this? That is how the first months are.

Ritah (28:59.661)

And then when you start knowing the system and believing that this is real, you start enjoying it and it's, you start enjoying everything and going back to read the evidence. And that is the other beautiful thing about fellowship. a fellow is that you're able to,

make decisions using evidence -based and you will put what has been published to practice and you stop making decisions out of your feelings that I feel like that I think so you start making decisions with evidence shows this and this and then it's amazing when you see the neonates improve

And then it also teaches you the teamwork and what it means to consult. it reminds, actually it kept reminding me of one of my seniors who used to say that a good doctor is one who knows when to consult because you can never know everything. So when you're a fellow, it puts you sometimes at that level that humbles you and you agree and say.

I don't know this, I should consult so that I learn it and I will practice it because I have understood why it's done like this. And the beauty is when you start doing these things and seeing the outcome, especially when a baby improves and you did the new things you have learned from A up to Z and you see the outcome, the follow

So that is basically what I can say about life as a fellow.

Gae Mundundu (31:01.734)

Yeah, I share a lot of sentiments with Rita and I would also say it's The life of the fellow is one that can almost make you start to feel like maybe a developing split personality disorder because There are many roles demanded of you. I mean you could you need to be a clinician You need to be a researcher. You need to be a clinical manager of a unit

You need to be a policymaker sometimes. You need to be an ethical specialist in certain instances. You need to be a mentor to other fellows. And then you also need to be ready to be mentored by fellows that may have come before you. So this, and this is all not separate from the human being that you are when you first wake up, which

There's you, the individual, there's me, gay, and then there's gay, mom, there's gay, the wife. So you still have to function in all these other roles despite what the fellowship is demanding of you. And in all of this, you have to keep the goal in mind, which is I want to improve neonatal outcomes. I want to see more mommies go home with their babies. So when your day first begins, you don't know which role.

that day will be demanded of you the most. So you have to set yourself in such a way that when you wake up, whatever is thrown at you, you must be ready to sink. I mean, sorry, to swim. Please not to sink. You must be ready to swim. So that day, it could be that you need to exercise more of your clinician power.

which means facing the patient that's in front of you and solving the problems of that patient. Or it could be that on that day, you need to be more of a clinical manager. You need to know what's happening in the different parts of the unit that you're working in and even in the other hospitals because the fellowship trains you not just to think for the patient in front of you or for the unit that you're working in or even the hospital you're working in. You are being trained to think on a

Gae Mundundu (33:18.004)

provincial and even national level. So it goes beyond the baby in front of you. So, and that's why I saying, you can almost start to think you're developing a split personality because you have to think as all these different people, depending on what the day is demanding of you that day. one of the most important things that the fellowship has taught me is what you mentioned earlier, like peer to peer learning.

landing in the fellowship and finding someone who has been through it. For example, when I first arrived at Morbem Maternity, Rita had been there maybe about a year and having that sort of experience of someone that's been there and then now for me being able to pass it on to the fellow that has recently joined us because we recently received a fellow from Ethiopia. So having that sort of seamless continuity from

previous fellow to yourself to another person, you learn from another person's experiences, assimilate them, then you have your own experiences and you then have to sieve and choose what you're going to pass on to the next person. So it's all about understanding the role that's demanded of you for that particular day, knowing what is required of you the most in that particular situation.

and then also being able to function as someone that can take the skill, use it, and then also be able to pass it on to the next person, all with the goal in mind of improving your NATO outcome. it's tough, but I think that if you are surrounded by the right sort of support and you have the goal in mind,

and you're doing what you actually want to be doing rather than something that sounded fancy because saying the word neonatologist sounded nice. You know, like your day -to -day life is going to help you know whether or not you're in the right place. But yeah, so it does demand a lot of you, but it also, you also reap a lot of benefits. Yeah, that would be my description of my experience with the fellowship.

Shelly-Ann Dakarai (35:34.156)

Thank you for that overview and that perspective. So you mentioned research. Can you tell us a little bit about how long the fellowship is and kind of what the requirements are? Of course you have that clinical side of it where you're willing to take care of babies, but you also mentioned research. Where does that kind of come in in the training? Gay, you can go ahead and start and then maybe Rita can add in.

Gae Mundundu (35:54.522)

Okay, sure. So coming into the fellowship, it's a two -year program and you have 18 months of a clinical attachment to a particular unit during which you will achieve your certificate in neonatology from the College of Medicine of South Africa. In that time and until the end of the 24 months,

because we're training under the university, you are then accorded a Master of Philosophy in Neonatology upon completion of your dissertation, completion and handing in of your dissertation. So, I mean, there is the option to go the shorter route and do the 18 -month program and get your certificate and then where you get your certificate in Neonatology.

But if you then go ahead and have your dissertation and submit it, then you'll be accorded the Master of Philosophy in Unitology under the University of Cape Town. So the research is not particularly limited in terms of topics and what you can explore.

For example, I'll give an example of, I mean, we are doing different sorts of research, Rita and myself, but essentially we're encouraged to explore new means of data collection. And I mean, it would be great if we could all do systematic reviews, but then there's also the time factor that you need to put in. Because apart from the research, there's still the big clinical component that you need to to complete. So essentially it's a two year program.

in which you get a certificate in neonatology from the College of Medicine of South Africa. And then if you go on to further submit your dissertation to the University of Cape Town, you'll be afforded a Master of Philosophy in neonatology, which is what we are both going for actually.

Gae Mundundu (38:03.687)

Maybe Rita you can add.

Shelly-Ann Dakarai (38:05.708)

Yes.

Shelly-Ann Dakarai (38:10.052)

Nothing else to add Rita to that. No, okay. So I guess I would ask then the follow up question is, would you mind sharing what you guys are working on research wise?

Gae Mundundu (38:23.221)

Sure, so my study

we're trying to profile extreme low birth weight babies, which are babies born below the weight of 1 ,000 grams. So in 2017, there was a document, it's called the Peri -Viability Document, which was instituted for the Western Cape province. And this document basically outlines the care of babies born less than 1 ,000 grams at different levels of care.

Previously, there was no standardized way of managing babies born less than 1000 grams. And depending on the clinician that's attending to you at the time that you're born.

And depending on where you are born, the outcomes were very diverse because some babies would get referred to the tertiary facilities, others wouldn't. So there's now a streamlined way of managing babies born less than 1000 grams based on the facility at which they are born with particular categories and guidance as to which babies should be referred to secondary level or tertiary level facilities and when.

So since the institution of this perivariability document in 2017, there hasn't been a proper profiling of the outcomes of the babies. So my research is going to compare the outcomes of babies born less than 1000 grams in the four years preceding the institution of the perivariability documents and comparing with an epoch of babies born in the four years after.

Gae Mundundu (40:05.238)

the peri -viability document was put in place. So I'm going to compare the outcomes of these babies, the ones before 2017 and those after 2017, and just see the impacts that the peri -viability document has had in terms of streamlining the care of babies born less than 1 ,000 grams. It's a topic that's dear to my heart because babies born less than 1 ,000 grams, I mean,

I've been segregating my patients from the time I went from attending to everybody, to those less than 16, to those less than five years old. And now I'm subspecializing in those less than 28 days, but I have a further interest in the tiniest ones that are born less than 1 ,000. So it's a topic that's very close to my heart and I'm looking forward to seeing the outcomes that I get.

Shelly-Ann Dakarai (41:01.964)

Rita, what about you?

Ritah (41:05.811)

My studies also in extreme low birth weight pre -times and what my rationale for my study is the fact that

Preterm babies are surviving better and better in all countries, whether high income or low middle income countries, their survival rate is better. And even when we come to the less than 1000 grounds, their survival is better. But what matters most is having a disability free life or disability free survival. Otherwise having lots of

surviving and their quality of life is so low I don't know it may not be worth it we can do better so and they are

Measures that have been, that are evidence -based showing that if we can try to follow them, then the outcome, the quality of life, the neurodevelopmental outcome is gonna be better in these babies. Because we as health workers, the health resource, the equipment, the time the family puts in for a preterm baby is a lot. And these

and fighters need the best we can do. So my study is basically assessing neuroprotective care practices for these babies and I'm doing it in Western Cape province just to see what measures health care workers are

Ritah (42:57.163)

offering these babies in terms of neuroprotective care practice. So it's basically a health case survey. I've already done it and I'm smiling at the results that are coming out. But.

Basically, it's got to be like, it's a gap assessment, just to see where we are as Western Cape province, and how much we should improve, where should we put the emphasis, because Western Cape as per se is doing better than other states, if I can put it like that, in terms of survival of extreme low birth weight. But it shouldn't just be about quantity.

To me it should be about quality. So that's why I did this study. you know, nowadays in unitology, especially the VON, the Vermouth Oxford Network, one of those quality improvement networks, the global one.

It says that all care is brain care. So whatever we do for a neonate, not just a preterm baby, should be looking at the brain. Is this baby going to have cerebral palsy, motor deficiencies, behavioral patterns like autism, ADHD? Is this baby going to have schooling problems when they start their school, language disabilities? So when we improve our neuroprotective care practices and

neuroprotective care bundles in hospitals and yet they've already shown evidence that when we do these things we improve their outcome. Why not? Let's go all the way if we've decided to save lives then we try to go all the way and also have better quality at the end of the day. Yeah so that's what I'm doing.

Shelly-Ann Dakarai (44:53.272)

Great work. Thank you so much for sharing what you guys are working on. So we talked a little bit about the fellowship and your reasons for going into fellowship, where you are in the fellowship. So I want to switch gears now and talk a little bit about what your plans are when you complete the fellowship. Do you have any plans moving forward that you can share with us about what you plan to do once you leave the fellowship? Maybe we can start with you, Rita, and then Gay after.

Ritah (45:19.609)

Okay, so when I finished the fellowship, firstly, planning to be a good teammate to my colleague so that her pressure of work reduces. Yeah, just planning to work with her. My other desire is to have a team of neonatologists working together and planning.

so that we are not, you know, antagonistic. I believe that if we are working together as a team, Jessica from the National Referral, my senior Victoria, and then we shall make better plans and better advocacy when we work together. Then lastly, where my passion is, I'll work on it long, short term and long term, is to have...

empowerment of the health care teams in the rural areas. That's where my passion is, having advocacy and going there to pass on skills, starting from the basics, basics that are killing most of our babies, infections. What I didn't say about my own hospital, and I'm not ashamed to say it because we're already working on it back home.

Much as our mortality rate improved and the preterm case fatality rate improved, the infection rate doubled.

with all those equipment coming in. So it was kind of antagonizing our efforts. But well and good overall, the mortality improved. So my desire is to empower the rural settings. And why I have a passion there.

Ritah (47:13.753)

Yes, the mortality rate is coming down. Currently, it's around 22 per 1 ,000 live births. But when we look at the rural areas, it's about 30 per 1 ,000 live births. And then when we look at the pediatricians, most of the specialists are in the urban area. They are in the capital.

And the biggest population, the highest mortality rate is down there in the rural areas. And yet our transport system and the referral system is still lacking. So when is an innocent neonate gonna reach Kampala where the pediatricians are concentrated, where the good hospitals are?

they're not gonna reach, they're gonna die on the way. If they haven't gotten good recess, even if they reach your hospital, what quality of baby are you getting at the end of the day? So for me, my passion is having a team of passionate pediatricians who are ready to a service, what you call giving back, like giving back to the community, where we can go and empower health workers in

grow a setting and train them to be like TOTs so that it's like a boomerang just trickling down like coming bottom up rather than just top down so that is what I really plan to do if I can have that I will feel like yes I did this fellowship for a reason because I feel even if I'm not working in my hospital

The babies will not die that much. But our praise is.

Ritah (49:10.773)

in those rural areas is needed. We've neglected them and I don't blame anyone because I don't blame also myself. It's because we want to survive. Salary, you have your child, you want them to go to a good school in the capital, there are more opportunities, yes. But at the end of that day, our critical mass, the neonates, the new generation, they are dying and they are coming out as vegetables, disabilities and all that.

So empowering and empowering the rural areas. That's it for me.

Shelly-Ann Dakarai (49:51.512)

Thanks for sharing that Rita. Gay, what about you? What are your plans?

Gae Mundundu (49:58.144)

Yeah, so I think my plans are very similar to Rita's. think all of us are inspired to...

go for what have been termed the low -hanging fruits. So you would rather have 10 KMC beds than one ventilator because the cost were essentially way on the one side. So low -hanging fruit for me also translates into things like, I think my most, my biggest priority is strengthening of primary care.

So one of the biggest problems that we have faced in terms of neonatal care back in Zambia is that our primary care in terms of newborn health or newborn care is not very strong and then this floods the higher level facilities and in particular the tertiary level hospital gets flooded by patients that ideally should be cared for in a primary health care setting.

So I think my biggest goal is to strengthen primary care. Like I think feeding into the idea that, I can't remember where I read this, but at least two thirds of small and sick newborns worldwide would benefit from improved primary healthcare and not necessarily tertiary care. So.

Some of my targets in terms of improving primary health care are improving information access for pregnant mothers and even women of childbearing age. Just so people understand the importance of recognizing danger signs, recognizing a very sick baby. So health information access for the public.

Gae Mundundu (51:53.8)

and then strengthening primary care in terms of empowering the people in the primary level facilities with life -saving skills, recognizing a baby in danger. And I say this with the background of actually already being a part of a team that's working to improve this. I mentioned Dr. Kapemba earlier, who happens to be my mentor. I think she has been very instrumental in changing the face of neonatal care in Zambia.

And she's behind a lot of the successes. And one of the first things that she did was to create a team of people that are as passionate as she is about neonatal care. And most of these people are actually at the primary level facilities. So one of the things that we're doing in terms of strengthening primary health care is even the launch of district health protocols. These are protocols that are different from the national ones, but are particularly

fashioned for district level facilities just to help people recognize a baby who's in danger and know how to stabilize a baby prior to transportation. Having mentioned transportation, I think that would probably be my next goal. Improved health access from the point of view of referral from one level of care to the other.

Also a low hanging fruit because a lot happens during the transfer of babies. People start off with a baby that has a heartbeat and arrive at the referral center with a baby that is gasping. So improved stabilization and transportation of babies. And then my other big goal is education and training in terms of

health professions, integrating certain components of neonatal care into school curriculums, both for medical students as well as nursing students. Because I think a lot of people encounter neonatal care when they're already in service. So I think it's something that needs to be made as a core component of curricula, both for medical schools as well as nursing schools.

Gae Mundundu (54:13.622)

So those would probably be my biggest goals. Improve primary health care, health information, access and public health, as well as education and training. And then of course, after that, we can go into other things that will benefit the most critical babies who usually only 1 % of the population. So yeah, those would be my biggest goals going back.

Mbozu Sipalo (54:40.956)

Thank you so, much for sharing your goals. It'll be amazing to see them be attained bit by bit and looking at the fact that previous fellows have done that. We're quite excited to see where your paths will lead you after you're done with your fellowships. So we're coming to an end of this amazing interview and just to wrap

our amazing talk. Any last words from you ladies on how you would like to encourage health professionals like yourselves, especially our female doctors as they venture on their career journeys? I will start with Rita.

Ritah (55:30.565)

I would like to encourage doctors, especially ladies, to not give up on career development. It's fulfilling because as a doctor,

the more you improve your skills and your knowledge, it's very fulfilling when you see it translating into better outcomes for your patients. And it also gives fulfillment to your families, like the children or these spouses. That said, it may not be as easy with responsibility when you're going into a career, but it takes

from the family and better communication. But what I can say is it's possible because most of us were in these programs. We have children. But yes, it's like the whole family is doing that fellowship at that time. My eight year old, I've always had a busy hand when I'm on call, as well as my friend Gay. We are busy bees. So one of those

my eight -year -old told me I had had a camp call so she was like my god Manny you deserve a present today you having a quiet night at work surprising we need to gift you so I was like my god my girls are now understanding what night duty means so when you're doing your career

your whole family is part of it. When I was doing my exams my six -year -old and eight -year -old whom I'm with here at Cape Town were all like rooting for me they're like finally mommy you're gonna do your exams and then you're gonna get a holiday so

Ritah (57:31.179)

It's amazing, but it's about communication and when your family sees that you love what you're doing, then they're going to support you. And it also comes with balancing your time. It's not easy when you're in it, but sometimes you have to.

make the sacrifices and also just make it intentional. If you have a family make it intentional to communicate with them whichever little time you get but that said it is very possible to be to have career development as a woman and

It's God given that we nurture. So even when we go into whatever practice we go to, we nurture it. It's at a different level of passion when women do things. So I encourage you fellow women, go for that. Go for what your passion is and you'll make it. You'll make it. Thank you.

Gae Mundundu (58:43.77)

My encouragement would be if there's something that you want to change, you have to be ready to make the sacrifice. And I think one of the first things I said in the beginning was that sometimes

the program can make you feel like you're developing a split personality disorder. So I think if you feel like it's something that you need to explore, then just prepare for a bit of split personality disorder, but understand that it's a part of the process. being passionate about something means nothing if you're not willing to lose a little bit of sleep over it. And if you're not willing to, you know,

make some sort of sacrifice. Like Rita has said, family is a big part of why we do what we do. And you need a supportive system around you. You need supportive mentors.

And you need to actually be interested in what you're doing first and foremost. So if there's something that drives you, if there's something that you want to change, if there's something that you like doing, even if it means that you like watching little babies sleep, but you feel like the field of neonatology will help you achieve that, you need to go for it. And I think that if a number of us wake up feeling that way every day,

then maybe, just maybe, a lot of our outcomes would change. And I mean neonatal outcomes, pediatric outcomes, whatever field that you're in. The outcomes would change if a lot of us feel passionate enough to, you know, take that big step. So, yeah. Just do it. Quoting Nike.

Shelly-Ann Dakarai (01:00:45.903)

So inspiring.

Gae Mundundu (01:00:48.33)

Thank you.

Mbozu Sipalo (01:00:51.223)

Thank you, thank you so much for this really interesting conversation, learning more about your individual journeys and what brought you two wonderful ladies together. And that was a beautiful way to wrap up this conversation about two African pediatrician neonatologists pursuing their dreams and very, very delighted to talk to you today.

I'm sure our listeners would love to know how they can connect with you and learn about how they can work with you and collaborate. So how best can they link with you? I'll start with Gay.

Gae Mundundu (01:01:31.766)

Okay, so I'm open to collaboration and you can reach me via email or via my LinkedIn profile. My email address is gaemcn at gmail .com.

or my full name, Gaymondundu, is for my LinkedIn account or my LinkedIn bio. So very open to collaboration and anything that's got to do with neonates, improving outcomes, research, and even clinical, anything clinically inclined as well. I'm very much interested.

Gae Mundundu (01:02:16.906)

Thank you.

Mbozu Sipalo (01:02:21.572)

and Rita.

Ritah (01:02:26.225)

My software is open to any collaboration and especially with the Neonet and implementation research. It excites me. My email, Rita, that is R -I -T -A -H -A for Apple, -A -Z -I -W -A at gmail .com. That's it.

And just a correction before I finish. I think in my introduction, it had been commented that I'm an academic coordinator of the field department in Uganda. No, it's not in Uganda. It's at Uganda Matters University. Thank you.

Mbozu Sipalo (01:03:14.359)

All right. Thank you so much for that correction. And thank you so much for joining us today once more. So we'll catch you next in our next episode of the Global Neonatal Podcast. Thank