#309 - 🌍 World Pediatrics: A Mission to Save Children's Lives

Hello friends 👋

In this conversation, the guests from World Pediatrics discuss their mission to improve pediatric healthcare, particularly focusing on neonatal care. They highlight the significant global issues of infant mortality and the need for advanced healthcare access in underserved communities. The discussion covers the organization's history, the shift towards neonatal care, funding challenges, and the importance of building sustainable partnerships with local governments and communities. 

They also explore innovative strategies for capacity building and the adaptability of their programs in different settings. This conversation delves into the challenges and strategies of pediatric care in the Eastern Caribbean, focusing on the OECS. The speakers discuss the importance of regional cooperation, capacity building initiatives, and the need for community-centric approaches to healthcare. They highlight the significance of data sharing, training, and sustainable practices in improving neonatal care across the islands. 

The discussion also emphasizes the role of organizations like World Pediatrics in facilitating these efforts and the importance of connecting with healthcare professionals to enhance pediatric health outcomes.

Contact: Contact - World Pediatrics

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Short Bios

Vafa Akhavan: Vafa Akhavan serves as the President & CEO of World Pediatrics, a global non-profit based in the US focused on pediatric health in underserved communities.  He also serves on the Board of Directors at Children Believe, a global non-profit based in Canada covering children’s education in the global south.  Vafa’s career covers 8 industries in 15 countries as both management consultant and operating executive.  His experience spans across the spectrum from startup to conglomerate working with such notable brands as McGraw Hill, J.D. Power, T-Mobile, Virgin Australia, Telecom Italia, LAX International Airport, AT&T, Citi and Hertz Car Rental.  Vafa was selected in 2023 as one of the top 10 most influential Canadian Professionals by Beyond! Magazine.

Dr. Robert Fleming: Dr. Robert Fleming is a Neonatologist at SSM Health Cardinal Glennon Children’s Hospital. He is certified by the American Board of Pediatrics in Neonatal-Perinatal Medicine. He is also an Associate Professor of Pediatrics at Saint Louis University School of Medicine. He has special interests in iron homeostasis, iron metabolism, and acute phase response. He treats premature infants with a variety of medical issues. Dr. Fleming is a member of the American Academy of Pediatrics. He serves as an Assistant Editor for the American Journal of Hematology. In 2012, he started the neonatal program with World Pediatrics in St. Vincent & the Grenadines. 

Harper Lorencki: Harper Lorencki is the Director of Neonatal Capacity Building with World Pediatrics. She holds 12 years of experience with the organization, first as a social worker before moving on to dedicate seven of those years to direct international healthcare development in the Eastern Caribbean. She has worked to design and implement multilateral partnerships and systems that help families in lower resourced settings access tertiary pediatric care. She now oversees the Global Neonatal Program, which facilitates capacity strengthening in newborn care in more than 10 countries in the Caribbean and Latin America, and trains more than 1,000 medical professionals every year. She studied at the Universidad de Guadalajara in Guadalajara, Mexico and holds dual degrees from Virginia Commonwealth University. 

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

Mbozu Sipalo (00:09.726)

doing well. How are you doing, Chelyan?

Shelly-Ann Dakarai (00:12.111)

I'm good. I was always excited when we have guests that we interview, excited to learn a lot about what their organization does. So very happy to be here.

Mbozu Sipalo (00:21.47)

Same. We're really, really happy to have World Pediatrics with us today.

Shelly-Ann Dakarai (00:22.983)

Perf.

Shelly-Ann Dakarai (00:27.205)

Yes. So we are excited to bring you another interview today. Like we said, today we are joined by three guests from World Pediatrics, a global nonprofit based in the U.S. whose mission is to heal more children in less time by transforming access to advanced pediatric healthcare. Today we have Vafa Akhavan, Dr. Robert Fleming and Harper Lorenke. I'll provide some brief introductions here, but we'll put more complete bios on the episode webpage.

Vafa Akhavan serves as the president and CEO of World Pediatrics, a global nonprofit based in the US, like we said, focused on pediatric health in underserved communities. His experience spans across the spectrum from startup to conglomerate, working from notable brands such as McGraw-Hill, JD Power, T-Mobile, Virgin Australia, Telecom, Italia, LAX International Airport, AT &T to name a few.

Vafa Akhavan (01:23.128)

Thank you.

Shelly-Ann Dakarai (01:24.401)

Dr. Robert Fleming is a neonatologist at SSM Health Cardinal Glenel Children's Hospital, and he also serves as Associate Professor of Pediatrics at St. Louis University School of Medicine. His interests are in ion metabolism and homeostasis, and he serves as an Assistant Editor for the American Journal of Hematology. And in 2012, he started the neonatal program with World Pediatrics in St. Vincent and the Grenadines.

Robert Fleming (01:49.396)

and happy to be here.

Shelly-Ann Dakarai (01:52.101)

And third guest is Harper Lorenke. She's the director of neonatal capacity building with World Pediatrics. She has worked to design and implement multilateral partnerships and systems that help families in lower resource settings access tertiary pediatric care. She now oversees the global neonatal program, which facilitates capacity strengthening in newborn care in more than 10 countries in the Caribbean and Latin America and trains more than a thousand medical professionals each year.

Dr. Fleming and Harper. Welcome to the podcast.

Harper (02:25.046)

Thank you. Thanks so much for having us.

Vafa Akhavan (02:26.008)

Thank you, pleasure to be here.

Robert Fleming (02:26.77)

Thanks.

Shelly-Ann Dakarai (02:28.903)

Perfect. So Fafa, maybe we can start with you. Can you tell us a little bit about Woo Pediatrics? Maybe a little bit about the history and about what the organization does and some of its reach and impact.

Vafa Akhavan (02:42.26)

Sure, I'd be happy to. World Pediatrics is on the verge of celebrating its 25th year anniversary, founded in Richmond, Virginia and St. Louis, Missouri. It has spent the last 25 years focused in two primary areas. One, as you said at the introduction around pediatric health, notably pediatric surgery.

And the second one and one that we are talking a lot about today is neonatal care, specifically infant mortality. Both of those are significant global issues, right? I mean, you have about 450 million children under the age of five around the world that don't have access to surgical care. There are five times more children that pass away because of that.

as compared to HIV AIDS, malaria and TB combined. So it's a pretty significant space that requires help and support and to be addressed. With neonatal infant mortality, obviously that's also a very large significant area. There are about 2.3 million babies that pass away in the first 28 days of life. That's significant in a number of ways because

that it translates to roughly about 170 million years of life that's lost every year spread over 71 years. And if you look at it just from an economic perspective alone, the top 30 countries in infant mortality in terms of the number of deaths per thousand that they have translates to about $130 billion of economic impact over a 68 year period.

So these are two significant areas that World Pediatrics is very much involved in and has been looking to expand and grow. Last year alone, we worked with children in 27 countries. We provided about 1,100 surgeries, the significant majority in region, I must add. We only brought back, I think, about 70 of those to the United States. The rest were all in region.

Vafa Akhavan (05:04.172)

We sent over 90 teams into countries to provide surgical support and care. That's part of our deliver care where we go in country because children are suffering today. We need to care for them today. And then we focus a lot also on empowerment and transformation of care. So, you know, we...

trained as close to, you about over 2,000 health professionals with close to 4,000 hours of training, a lot of capacity building. And in transforming care, we work with hospitals, we work with ministries of health to work around improving the quality of care and capacity at the hospital in terms of policy and policy decisions at the government level.

And that's, you we're very much focused on those three venues or three modes of care as we call them.

Mbozu Sipalo (06:06.558)

Thank you, Vafa, for sharing that global perspective on world pediatrics and your shift to neonatal. And that's because there is a need and the numbers don't lie. So thank you so much for sharing that insight. So to dig deeper on the neonatal aspect, can you and Dr. Robert Fleming tell us about how the neonatal program started and what prompted the shift from pediatric surgical care

to neonatal, other than the numbers, is there another story you can share behind that shift?

Vafa Akhavan (06:43.886)

Right. Well, if you don't mind, I'll leave that to Dr. Fleming and Harper, who are much more experts in that space than I am. So please, Dr. Fleming, go ahead.

Robert Fleming (06:53.962)

Yes, well, let me build off of a couple of things that Vafa brought up. It's not so much a shift from surgery to neonates. The two really interface with each other. There are many infants that are born that may have a surgical problem, a fixable surgical problem, but the preoperative and postoperative management require advancements in newborn care.

not necessarily the kind of very sophisticated advancements that you would see in a unit in much of the more developed world that takes care of extremely premature babies. But many of these babies do require some additional help, some respiratory care, help with nutrition, ongoing treatment for managing sedation and pain.

These kinds of things that all interface with the mission for pediatric surgery. So these two really sort of interface in a very complimentary way. And it also provides an opportunity to ensure that we're doing more than simply going into a country and doing a surgical service and then leaving. This allows us to incorporate the capacity building that is really

so very important for making a sustainable long-term difference in these settings. Harper, do you want to speak any more along those lines?

Harper (08:31.532)

Sure, maybe I could just provide some clarity around the model of, or add some detail to the model of world pediatrics, speaking to what Dr. Fleming just said. So we do return year after year in all of the countries in which we work, especially those in which we are doing surgery or have neonatal capacity building programs. The areas in which we've been embedded the longest are the Caribbean and Latin America. Specifically, we have our surgical hub and St. Vincent.

We employ World Pediatrics representatives in all of the East Caribbean islands and all of the Latin American countries where we work and do the majority of our surgical and capacity building training at this time. It's the same people who go back year after year. So they are continually getting to know the patients, their families, their colleagues and country with whom they work.

And on the surgical side, they're doing capacity building as well. We recently, we worked very heavily with the general pediatric surgeon who's the only one in the small Eastern Caribbean islands. Dr. Jasmine Ellis is her name and St. Vincent, she's actually our medical director. And she's been training with us for the past 10 years or more in order to do laparoscopic surgery in the islands. So that is just one way in which in addition to the neonatal component and

building up NICUs and working on their small and sick newborn care, we complement the pediatric surgical component with that as well.

Robert Fleming (10:04.698)

Yes, and the question came up, how did this all start and how did we end up specifically in this setting? There were directed funds specifically to improve the outcome of newborns in the Caribbean island of St. Vincent, St. Vincent in the Grenadines. That generous donation really got things spearheaded and provided the kind of

seed money that's needed to have some initial successes and then to build off of those. And we're very, very grateful for that donor for bringing this about. that was sort of the main basis for the NIDUS of newborn care there. It has expanded quite a bit from that initial start in St. Vincent and includes a number of the East Caribbean island nations.

that all share some common issues with advancing the care that they can provide there, many of which are simply a matter of being physically isolated and having populations that make it more challenging to maintain the kinds of equipment, supplies, economies of scale.

subspecialty expertise on each one of the settings. And it was sort of a natural process by which that grew and expanded from there.

Shelly-Ann Dakarai (11:52.295)

Thank you. So it seems like the opportunity somewhat presenting itself in that, well, pediatrics already had a footprint as it were in that region and there was a need, but also funds that came around that time to kind of expand into that. We were going to ask this a little bit later, but it's kind of brought up now in terms of funding because everything costs money.

In some places it's insurance based, in other places it's, you you have NGOs that are helping and governments that have, you know, universal healthcare. There are many different ways to fund healthcare. And in this situation, you guys are an NGO helping in other countries. And, you know, as clinicians, you know that you want to make a change, you know what's needed. You may not necessarily have the funds, particularly if you're working from, you know, this setting where you're trying to help.

another community elsewhere. So maybe Vafa, maybe I can ask you as our resident business person among us, a couple of us clinicians, how do we kind of leverage those, you know, that private partnerships or networks that are out there, folks who want to be involved, but they just don't know the issues or how to do so. How can we as clinicians kind of leverage that or maybe tell the stories in a way that...

show the importance of it.

Vafa Akhavan (13:21.142)

Yeah, great question. Obviously, you know, we're we're in the health sector and I often use a health related symbol to talk about the financing, you know, because the finances are really the lifeblood of the organization, right? Without the finances.

there's not much we can do. The more funds are available, the more we can do to serve the children and help with infant mortality. And the less we have, the less we get to do. And it's been particularly interesting what's happened recently in the context of the new US administration and USAID essentially going away and the funding being

cut and so on and so forth. That's created a lot of obviously concern in the international aid community and a rethinking of how we go about being funded. Ultimately, it is about being community driven. That's one of our five core values is to be centered in community. It's most important for the community to tell us.

how we can best serve that community as opposed to us going in and saying, this is what you need to do and how you need to do it. And that journey of collaboration, that journey of accompaniment together is the best way of doing that. And I think in like ways, we want to bring in the sources of funding.

is to really understand the impact. All of the work that's being done is important. Vaccinations are important. Food is important. Food security is important. And what the Rockefeller Foundation is doing in that space is amazing. It's a question of prioritization, and it's a question of where do we invest to have the greatest impact and what partners we bring together. So we, like others, now we were...

Vafa Akhavan (15:24.534)

ready to go to USAID for some funding. That's going to be a lot harder now. So we'll be approaching some of the other foundations and some of the other potential donors that are picking up the slack, so to speak. You may have heard in the media that Jeff Bezos' parents have committed $500 million matching funds to UNICEF for the global food program for children.

So there's lots of philanthropic interests out there. There's lots of folks with organizations with means that are interested to fill the gap. It's going to be difficult to fill a $30 billion gap that USAID left. But that's why we're here, right? We're here to do the best possible. We've partnered with, you know, professionals like Dr. Fleming. We have incredible staff like Harper.

You know, we have a unity of purpose to save more lives and to help more children. So we'll find ways, new approaches. One of the things we're doing that's quite unique, I think, and should be of interest to your audience is because it's a growing trend in the nonprofit sector, which is how can we diversify our revenue streams? How can we diversify the ways in which funds are coming to us? So

That's where those that have more of a commercial background.

can bring some innovative thinking and we're trying new things. We have incredible data in our organization and we're looking at how we can leverage that data maybe to generate additional revenue for ourselves. We're working more closely with hospitals and international surgery because they do a lot of international surgeries and we're really good at international work, the back-end operations. And so we're looking at potential opportunities and partnerships there. So that's another way that we're trying to be creative

Vafa Akhavan (17:24.13)

and innovative and people should realize that innovation is not a function of sector or industry. It applies in every sector and in every industry. So I hope that helped answer your question.

Shelly-Ann Dakarai (17:38.361)

It did. Thank you. Thank you.

Robert Fleming (17:38.965)

Yeah. And if I may, let me expand a little bit on on some of those comments. I'm very enthusiastic about working with World Pediatric Project for a number of reasons, one of which is they do develop true partnerships and work very closely with ministries of health. This isn't a matter of coming, swooping in and doing something and leaving.

This is a matter of a longer term commitment and really getting to know the setting, to know the people in that setting and to learn from them what are the ways that if only, I always ask them, if only this, know, what would make things better? And for this particular part of the world,

We're not talking about a place where there's a complete lack of infrastructure or an inability to bring to bear some more sophisticated resources. A lot of it is just a matter of the pragmatics of that setting. And this is a setting where I think we're on a, excuse me for going into my scientific mind here, but a steep part,

of the return for effort curve. where a modicum of effort can get a substantial return. And we've been able to see that and witness that in some of the things that we put in place. And that's also made it very rewarding. So one of the first things that we did after an initial visit with myself and

a neonatal nurse is trying to get a better sense of their day-to-day work. What is it like at the bedside? And that nurse was so enthusiastic about this work that she decided to spend many months down there, think eight or nine months, something like that, in that setting at the bedside.

Vafa Akhavan (19:53.678)

It's back.

Robert Fleming (20:03.86)

shoulder to shoulder and seeing how things operate and work. And that really provided a great opportunity for us to understand that setting and where we can most be beneficial. She was asked at one time, what did she find most compelling about that experience? And it was...

seeing a baby and looking at it and saying, if this baby were only born in United States, its chances would be so much greater. Its ability to thrive would be so much greater, even if it were to survive in that setting nonetheless. And how unfair it is to have where you happen to be born.

to determine your chances in life and getting off to a good start in life. And I think that's what this is really about is trying to give these babies every opportunity to have as good a start as humanly possible in the setting that they're in, in the same way we do for the children in our own settings.

Shelly-Ann Dakarai (21:26.075)

Yes, that's true. Like you said, Vafa, 2.3 million babies die every year in that first 28 days of life. And unfortunately, the majority of them are in low and middle income settings. And like Dr. Fleming said, where you are born, just that alone changes your risk for dying or living. we certainly are so appreciative of organizations that

believe in the mission and can bring support where it's needed. So you mentioned about the importance of partnering with the governments and having this long-term ability. How has that process looked in terms of, know you said you want to make sure that governments are, you're partnering with governments and countries and not swooping in, helping and leaving. How has that process looked like as you've

settled in St. Vincent and also taken on the other islands. Was that a somewhat easy, easy, easy process with partnering? Did other governments reach out to you and that's how you got started in other islands? Talk to us a little bit about that process. And that could be Dr. Fleming or Harper, whoever can best speak to that.

Robert Fleming (22:43.286)

Harper, I'll let you feel that one. I only want the easy questions.

Harper (22:50.828)

Thank you, Dr. Filming. Well, and certainly you can add to this because you've had plenty of meetings with the St. Vincent Ministry of Health as SVI. But I guess just to give one concrete example that came up recently as we were thinking about what is the next phase of this program going to look like? All right, we've been embedded in St. Vincent for the past 12 years, more than that.

We've really built up a lot of special care for small and sick newborns here. We've equipped the NICU. We've kind of done some training of nurses and specialty training of junior doctors and things like that. But now where do we want to go in the future? And so we approached the Ministry of Health, went back to them again with kind of this question to say, you know, how can we really dig in further and make this a more sustainable project?

Well, not project, but endeavor together. And the suggestion came from the permit secretary that we should engage with the St. Vincent Community College where nurses are trained. And public private partnerships are something that's our bread and butter. That's really what we've been doing in pediatric surgery and to a certain extent in the neonatal space as well, maybe just to a lesser extent until now. So.

you know, that was something that we were definitely willing to wrap our arms around. We had prior experience as well with facilitating clinical attachments at Queen Elizabeth Hospital in Barbados, which I know you've talked to some of our colleagues over there, Dr. Jillian Birchwood and Dr. Clyde Cave, who's also the director of our neonatal network down in the Eastern Caribbean. And so we got together with Queen Elizabeth Hospital and

the Ministry of Health and St. Vincent Community College and kind of started to say, okay, how can we really fill this gap that we're now seeing post COVID, which is another part that's playing into this, in nursing expertise within the NICUs in the region, because so much turnover happened during that time. And of course we know that happened worldwide, but it was a trend that we saw happen in all of the islands as well with a lot of migration from the area, a lot of

Harper (25:06.592)

nurses just deciding not to be in healthcare anymore. And so we saw all of these nurses that we had trained over the past decade. We were down to only one, you know, and so we had a lot of fresh young faces in the NICU. But, you know, without a lot of training and knowing how to approach these babies. So...

We also brought together, we found a resource through COIN, the Council of International and Neonatal Nurses, that they had been funded by the Bill and Melinda Gates Foundation to, because this is a worldwide issue, to really come up with a free resource for nurses to access some of the specialty education that you really need to work in a NICU. So we leveraged that tool and put it together with the clinical attachment.

in Barbados. So using the online course is kind of perceptorship to the clinical attachment and then moving, we're now moving from clinical attachment to the third phase, which will be when the nurses return from Barbados, which they just did a couple of weeks ago to work with our world pediatrics teams and some of the expertise there to really solidify that knowledge and put into practice what they've learned.

So that's just one example of kind of a tri-way partnership, maybe even more than that, counting the community of nursing practice from COIN and innovative ways that we're trying to bring together all of these different components that already exist and find the talent to meld all of these things that we can improve care in a way that also is financially feasible in today's environment.

So I think that that's one program that, you know, it's not finished yet. It's not been certified yet, but we expect that that will happen in the next few months. And we're really excited to see if it's a replicable model elsewhere.

Robert Fleming (27:10.782)

And if I may, let me expand a little bit on one aspect of that. And that also ties into one of the attractions I have for working with World Pediatrics is that it's very adaptable. We initially were bringing physicians or nurses to our own setting here in the US in St. Louis.

and spending time here learning from some of the things that we did and the way we did things. And that was successful in many ways, but it also became clear that probably the best way of improving the care in an incremental and successful way involves having the trainees

have an experience in a Caribbean island nation like Barbados that is a bit more sophisticated and does have a much higher capacity for taking care of sick newborn infants than many of the other islands in the region. And I really appreciate that sort of sense of adaptability. We always have to learn from what things have worked very well and what things have worked.

you know, not as well. we're always, you know, watching our feed and making sure that we're taking appropriate steps. So I really appreciate that aspect of it as well.

Vafa Akhavan (28:44.974)

Thank you.

Mbozu Sipalo (28:56.596)

I appreciate the adaptability angle that you've talked about, Dr. Fleming, and also that peer-to-peer learning as a small island nation learns from Barbados, which is basically, it's a bigger island, but similar landscape in a way. So that was a good example. Back to the question Shelley Anne sort of mentioned.

I think this would be to Harper. You gave an example of a community of nurses partnership locally in that country, but curious how what pediatrics has reached other island nations considering there's quite a specific landscape in the Eastern Caribbean with they're close together, but also not too close at the same time.

thoughts around your strategy around bringing them together and how it's worked so far.

Harper (30:02.322)

Yeah, thanks for that question. I think that's good to also help us set some context maybe for the audience and those that aren't as familiar with this very small area of the world. So the Organization of Eastern Caribbean States, also known as the OECS, comprises of, think there are up to 12 islands now and some of the ones that people recognize we've already mentioned so much, but beautiful St. Vincent and the Grenadines, St. Lucia, Antigua, St. Kitts, all of these places that persons mostly from the U.S. would know from going on cruises.

down there, but all of these islands comprise of an island chain. They are all independent nations, mostly gain their independence, you know, throughout the 60s, 70s and 80s. They are a small population, so ranging from I think the smallest being 60,000 persons up to Barbados is the biggest, which is about 270,000, I believe, but the majority fall somewhere between 100,000 and 150,000.

people and that their birth rates like globally we just saw and I'll kind of get to talking about the perinatal health conference in a moment, but are going down so a couple of years ago one of these islands would have seen a birth rate around maybe 1,100 per year now we're down to about eight hundred seven hundred eight hundred a year and so what that means when you're working in

a NICU setting is that you're only maybe encountering some of the real issues that premature babies have or small and sick newborns have a couple of times a year. Maybe you're only using your, the need to use your ventilator only comes up a couple of times a year. So how do you maintain that expertise to really be able to tackle some of these issues?

Vafa Akhavan (31:43.15)

you

Harper (31:52.8)

So similar to what happens with pediatric surgery in a place like that is you're going to have to create an economy of scale of knowledge in some way and be able to share it across different independent island nations. And so I think that's what World Pediatrics has been good at doing is bringing these different island nations together. And one of the ways that we started to do that, not only virtually and through email newsletters and WhatsApp groups and things like that, but

In 2019, we worked with PAHO to do the first perinatal health conference for the region. And we just replicated that again in February, 2025. And that was the first one we were able to do since the pandemic really disrupted so much in that area. And that we've really seen as just a great way to come together and allow the, we dedicate the entire first day to data.

All of the islands present on their perinatal health statistics. It allows them all to see once again that they're in similar situations. It allows them to hear from the successes of others. And we did see a lot of growth between 2019 and 2025, even with all of the setbacks in human resources and things like that. We saw a lot of islands had implemented hearing screening, which was one of their goals back in 2019.

So allowing them to work, to learn from each other, to network together so they feel more comfortable picking up the phone and calling, okay, I heard that you guys are doing really great at Bubble CPAP and how can we get better at doing that in this setting? So that's been a big way for us, but otherwise just as an organization, again, serving as that glue to see how we can continue to connect regionally and work together to approach some of the

intergovernmental organizations in the region to, for example, keep in stock essential medications. And that's still a big problem that we're working through. I'm not going to say we have all the solutions, but certainly just by continuing to push on it and bring people together to talk about these things, we see progress being made. Dr. Fleming, do you want to add anything to that?

Robert Fleming (34:10.918)

Yeah, no, I think that the regional conference, both of them that we've held have been really great successes. And I think the answer to many of the issues in the region is going to involve a cooperative venture between the different island nations. And it isn't like this is a unique concept or anything and there have been

attempts to and some successes at pooling some of the activities and

medication availability, that kind of thing in the past. But I think ultimately for this to succeed, it needs not just a top down, but also a sort of a bottom up approach as well, where the people on the ground are saying, you know, we can't get, let's say something as simple as caffeine to treat apnea of prematurity. And here in the US, we...

be the last thing we'd ever imagine that that would be an issue. if you hear about it maybe once in, you'd go, well, that's kind of strange in your setting. I don't understand that. But it's a reason why kind of issue. And when you bring people together who are actually on the ground needing certain things and insane to themselves, if only I had, and there's a common thread to that,

then it helps bring additional sort of energy to bear, some pressure to bear on systems to bring that about. And I think that has worked out very nicely for the conferences. Don't you think too, Harper? Yeah.

Harper (36:05.824)

Yeah, I think it has. And to speak to the future strategy, I mean, I do think that it will be working towards formalizing the network and, you know, not having us at the center of it, but obviously for sustainability. And our goal is always to work ourselves out of this job. So how can we really hand it over and have it be community run and community led as we've as we've talked about, you know, and it is it is right now as well with Dr. Clyde Cave at the helm kind of leading it and

us as more advisors on it, but I think that the formalization of it is the next step that's gonna be needed to really, again, ensure that sustainability and move forward with some sustainability in terms of procurement and supply needs, which supply chain is another huge issue and things like that.

Robert Fleming (36:59.478)

Harper, you used the word glue, sort of holding this together. And I think that that is a role that is very important whenever you try to build a cooperative among various interests. Because there's always this concern of, you know, are we really making it the best that it can be for all of us?

or some losing out more than they're gaining back, and how do we trust each other around these things? And I think to sort of have an independent outside viewpoint to sort of provide an additional perspective on the process, I think it helps.

make it actually stick. And I think that's an important role altogether. So I see us increasingly working ourselves out of a job in terms of many of the direct kinds of things, but still sort of taking on that role as a trusted outside viewpoint and voice.

Harper (38:19.508)

Yeah, absolutely.

Shelly-Ann Dakarai (38:20.925)

Right. Yep. You know, and something I, tend to say, which is a little bit of kind of like what we're talking about, you know, if you look at many of the children's hospitals over here, they have someone's name on it. Um, there is always some benefactor or some organization or something that provides either that seed money for it to start or anything like that. And so sometimes, like you said, like maybe still being part of the glue.

even if that were to have to continue may not necessarily be a sign of failure that there was not, you know, a team to take over, but it's more of a, like Dr. Fleming said, like a change in the relationship of what, what, what will pediatrics is role is. yeah, it's some, as we talk about sustainability, sometimes I think, in the region and outside, sometimes we, I sometimes feel like we give, we're, we are asking more than is possible.

in some situations because that's just the landscape in which we live everywhere, you know, and the pediatric side of things, the insurance never covers everything, you know, even on this side of the world. So we definitely appreciate organizations such as World Pediatrics to kind of help fill in those holes or spaces, I would rather say, until organizations and countries can take over more of it and those organizations kind of changing their role.

Vafa Akhavan (39:20.608)

Thank

Harper (39:33.736)

Sure,

Vafa Akhavan (39:34.99)

you

Shelly-Ann Dakarai (39:49.445)

maybe not necessarily leaving or, you very complicated, know, philosophical and political topics.

Vafa Akhavan (39:55.03)

Yeah, this is a really, really interesting issue we're discussing because it goes to the question of scalability and what does scalability mean, right? Because in a large part of the world, scalability is about doing the same thing the same way in everywhere, right? But if you're rooted in community, your definition of scalability has to change.

Because what may be good in the Caribbean or what may work in the Caribbean may not be the same as Latin America, may not be the same as parts of Africa, that may not be the same as South Asia. Even within the Caribbean, you know, it may be different in Barbados as it is in, you know, St. Vincent and the Grenadines, et cetera. So, you know, our role in being that catalyst, if you want to call it, some have described us as a switchboard operator.

Shelly-Ann Dakarai (40:28.807)

Yes.

Vafa Akhavan (40:46.53)

you know, trying to fix this Rubik's Cube, et cetera. It's really, really important to A, first and foremost, focus on what's in the interest of the children, what's in the interest of the babies. That must be the driver. And at the center of our five core values, at the center, it's kids first, babies first.

And so it may look a little different. We may be more involved in one part of the region because that's what's required to serve the children and the babies. In another place, it may be that we're less. In another place, maybe we start by being involved heavily and then slowly move out. So it really impacts that definition of scalability because that's a large part of global funding goes towards scalability.

right, is I can deliver 5,000 vaccines per day. Important, please continue doing it, don't stop. From a different perspective in different areas of global health, it may need a different approach, right? And I think what we have a responsibility is those that are looking to serve the children and really our own future, because they are 30 % of the population, but 100 % of the future.

is to be able to make those adjustments, to be resilient, to be able to pivot, to be able to change based on what the needs are. But the need of the children and the babies has to be the driving force.

Robert Fleming (42:25.876)

Yeah, yeah. And let me also emphasize that.

The people that we work with in each of these island nations have all been just wonderful, very dedicated.

Sorry.

Harper (42:47.295)

Vafa, you might need to mute.

Robert Fleming (42:50.676)

wanting to do as well as possible for the baby in front of them.

Vafa Akhavan (42:55.854)

than people in front of

Robert Fleming (42:57.462)

And very often it's simply a matter of some practicalities of that particular setting. And that's where an outside influence can really catalyze something that might not otherwise occur, even though the drive and the energy and the commitment is all there. It requires something additional from the...

from the outside to make it happen.

Shelly-Ann Dakarai (43:30.225)

Yeah. And I mean, could speak to, so some of our listeners may know I'm actually from St. Vincent and the Grenadines. So I've worked, you know, I have seen World Pediatrics through the years from all of the name changes. And I was an intern in the local hospital and one of the interns that helped with one of the surgical missions back in 2008 or nine. And so World Pediatrics is still, you know, coming to the island, still helping with improvements and that.

has looked differently, like you said, like different, you know, and it's been interesting to see how it grew in the region and other islands, you know, getting, being added to the whole pediatrics family. So I can speak firsthand of seeing that long standing commitment to a region. And, you know, a lot of times from a smoke in that Caribbean region, you guys talked a lot about the differences, how something in one place might be different than the others. And in the global health landscape, sometimes the Eastern Caribbean can get

sometimes forgotten about because we have better, some social economics better in quotation marks in some areas and others. So we may not be, and I sit his tongue in cheek, poor enough to get some of the, the aid from other things, but may actually need it too. So it's that I think it's important because we in, on this podcast, we talk to clinicians, other people from other organizations. We try to keep it very broad and wide and just, you know, just

happy to have another organization on just to share something different, you know, because different places need different approaches and that private to public partnership is definitely helpful in some situations. And like you said, VAFA scalability looks different depending on where you are, what you're talking about, because a surgical mission could potentially be a short-term thing depending on what you're fixing, but a neonatal mission...

babies stay in the hospital for months at a time. And so it's a different approach that might be needed. And so just happy to have an organization on to kind of talk about your approach and your impact in one of the regions of the world.

Vafa Akhavan (45:38.456)

Beautifully said, right? In a lot of organizations, you can scale the supply chain. You can scale execution. I think in many ways, we are scaling an approach to solving the issues at hand. And I think that's kind of the shift that we have made and are explaining to people that we're scaling the approach.

to address a particular issue, the approach to the intervention, as opposed to the intervention itself.

Does that make sense?

Shelly-Ann Dakarai (46:14.661)

It does. It ties the discussion up into a really good bow. Yes, I agree. Yes. Thank you for putting that into context. And so as you brought that up, could you give us maybe some details? Because I know we talked a lot about building knee-kneel capacity and we kind of sprinkled in some nurse training and physician training, but I don't know if all of that might have come through.

Harper (46:20.106)

you.

Shelly-Ann Dakarai (46:38.941)

So in terms of what you've done to build needed capacity in the region, can you speak to some specific initiatives? It sounds like we do some provider education, there's nursing education, there's maybe some support with supplies. Can you tell us a little bit about what those initiatives have looked like, what that approach kind of has looked like?

Harper (47:00.748)

Sure, that sounds like maybe it's one for me and Dr. Fleming. Well, I get us started out maybe on a broader sense. So the cycle that we go through, you know, looks like approaching the Ministry of Health, you know, getting and the hospital administrations where the NICUs are housed, because sometimes in the Caribbean, there's a separation between the two. The hospital authority could be different from the Ministry of Health, although of course they interface together.

Robert Fleming (47:01.238)

Yeah.

Robert Fleming (47:04.916)

Yeah, go ahead.

Harper (47:28.648)

So approaching them both, you know, seeing what the priorities are, speaking with the clinicians as well, that are in the unit, running the unit, seeing what their priorities are, conducting a needs assessment, ourselves to see if those, we're seeing is what, you know, matches, up with that. And then coming up with what, okay, what is the solution going to be in this setting or what, what is the need that we're going to address here? And that's as we've just spoken to going to be different.

in different settings. So for example, in Dominica, what we decided to focus on there is neonatal asphyxia. And one of the ways to address that, that's evidence back approach by the WHO is what's now called essential newborn care. used to be called helping babies breathe. And the helping babies breathe program is still around and exists. The essential newborn care is the updated version.

And so we partnered with one of our volunteers, our long-time volunteers, such as Dr. Fleming, Dr. Colleen Clawson, who's also from St. Louis University Medical Center, and was one of the first trained in this new updated helping babies breathe. And we went through and trained the entire country on how to resuscitate a newborn using the WHO approach. So that meant not only working at the hospital level, which we did, but

also working at the primary health level and anywhere where an emergency birth could occur. And so that was a process that took close to two years. We did utilize a train the trainer model. So it started out with engaging clinicians themselves working in all of these centers to become trainers to then help us roll out training to the frontline workers.

So that is that's one way, know that we approached and at the same time we also were still doing training in the hospital with the NICU nurses at that time and will continue to do so because It's a dual approach right? So you're going to primary health and Trying to make sure that the baby is resuscitated in the best way possible the quickest possible And then when arriving to the NICU that there's a skilled nurse by the bedside when that baby does arrive

Harper (49:47.148)

In St. Lucia, the approach has been one of the many approaches that we've taken is kind of focusing on neonatal transport, which is an issue across the world and in the US and everywhere. You know, how do you get a very, very sick baby from point A to point B? And there are two major hospitals that care for babies in the country of St. Lucia. And to get to the one that's the higher level NICU, you have to traverse through two hours of mountainous region.

And I mean, literally the physician is holding on to the incubator to keep it from going back and forth. So how do you do that? What does that look like? How many personnel do you need? What kind of handover information do you need? And just forming kind of a task force to work together on that. So those are a couple of examples. Dr. Fleming, do you want to add anything to that?

Robert Fleming (50:37.27)

Yes, I think, you know, that speaks very nicely to dealing with whatever particular issue and whatever particular setting. St. Vincent, for example, the vast majority of deliveries occur in a single setting, and we have had some outreach to other places where there will be occasional deliveries to ensure the training there, but that hasn't been

as much of a focus in the past in St. Vincent just because of the differences in where babies are born. One of the ways that we have, I think, made a substantial impact in that setting had to do with a systems issue. And that was the nurses not staying within a

particular area of expertise that is in the newborn ICU. And they would migrate to other settings instead. And that had some simply to do with the process needed to continue on and work a way up through the nursing hierarchy and getting your years of experience. So that was sort of a systems issue that we dealt with.

another aspect of it had to do with a particular supply. That supply was something that was not particularly expensive, a transcutaneous bilirubin meter, a way of simply putting a device against the skin and getting a reading of what the bilirubin is. And that helped bring down the number of babies that were requiring exchange transfusions to avoid brain damage from getting very high bilirubin levels.

Another piece of equipment that we put in place was some initial CPAP machines. And that was an example of a particular piece of equipment. Very often in these settings, particular, sometimes very large and sophisticated pieces of equipment get donated and thereafter the setting is left with

Robert Fleming (53:01.162)

finding their own way of ensuring that people are adequately trained, that there is someone who is able to service that piece of equipment, some sort of budget to have the ongoing supplies be provided for that piece of equipment, for the appropriate sterilization and that kind of thing. so for other aspects, we've been trying to ensure that we provide that.

And then we don't fall into a trap of simply saying, here's a big shiny, you know, new ventilator or some other extremely sophisticated transport isolate. If that isn't really where the need is, and it's not going to be something that really is the best use of people's time and resources, not just the resources of

world pediatrics, but the time resources of the people there. so it very much is context dependent in terms of what the best solution is for what particular issue we're looking at.

Mbozu Sipalo (54:19.348)

Thank you. Thank you everyone for sharing your insights and telling us about World Pediatrics and everything that you're doing. I think you're the first organization we're speaking to on the show. So this is also good for the Global Neonatal Podcast as the first organization working in neonatocare that we've profiled. So thank you very much for making the time to share the World Pediatric Vision with our audience.

Looks like we are wrapping up now and we'd just like to ask two questions that we usually ask our guests, how people can connect with you and what pediatrics centric, how people can volunteer with the organization. So Harper, maybe you could respond to that.

Harper (55:09.014)

Sure, sure. Well, thank you so much. And it's an honor to be the first organization on the podcast. We're really excited about that. So we would love it as persons are listening, if they'd like to reach out to us, you can find our website at worldpediatrics.org. You can find our contact information there. Certainly those who are working within neonatology, feel free to reach out to me directly. We'd love to hear from you because we're always recruiting for this program and looking to leverage that expertise.

to areas that need it and this is program that's growing for sure. Then that's kind of part of the model is to pair settings that are in need with some of that expertise that maybe people are willing to volunteer. So certainly reach out to us. We would love to hear from you.

We do mainly work with medical volunteers anywhere within that are working anywhere within the unitology. So, unitologists, NNPs, respiratory therapists, anyone with that kind of expertise. And there's just an application process and then we kind of call on you as needed.

Harper (56:20.054)

Did I miss anything,

Shelly-Ann Dakarai (56:20.285)

Great.

Vafa Akhavan (56:22.338)

That was great. Thank you for the opportunity and letting people know about the importance and the significance of the babies that come into this world. Thank you.

Shelly-Ann Dakarai (56:38.577)

was our honor and pleasure and thank you so much for your time and to our listeners, we'll see you next month with another episode of the Global Neonatal Podcast. Bye.

Vafa Akhavan (56:47.95)

specific to the Global DNA Needle podcast.

Harper (56:51.734)

Thanks so much. Bye.

Vafa Akhavan (56:52.68)

Thanks so much.