#330 - 🌍 Empowering Neonatal Nurses Globally (ft, Dr. Karen Walker and Edith Gicheha)

Hello friends 👋

In this episode, Shelly-Ann interviews Professor Karen Walker and Edith Gicheha about the importance of specialized training in neonatal nursing, the challenges faced in low and middle-income contexts, and the role of COIN (Council of International Neonatal Nurses) in advocating for improved neonatal care globally. They discuss the significance of continuous education, the establishment of the Community of Nursing Practice, and the impact of NEST 360 in providing essential solutions and training for neonatal care. The conversation highlights inspiring stories of nurses making a difference in their communities and the importance of collaboration in improving neonatal health outcomes. 

Link to episode on youtube: https://youtu.be/qaY7g3tR-h8

Resources mentioned in episode:

https://nest360.org/

https://www.coinnurses.org/

https://www.conpcommunityofpractice.org/

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Short Bios :

Karen Walker PhD,MN, BAPPSC, RGN, RSCN, MACN

Clinical Professor Karen Walker is a Neonatal Clinical Nurse Consultant and a Clinical Professor, Faculty of Medicine and Health at the University of Sydney. As a clinical neonatal nurse, with extensive experience in clinical research and policy, she was awarded her PhD through the University of Sydney in 2011, investigating neonatal outcomes following early major infant surgery. She now has more than 130 publications.

Karen is the current President of the Council of International Neonatal Nurses, the global organisation representing neonatal nurses on the international arena and the past president of the Australian College of Neonatal Nurses and serves on multiple global committees representing neonatal nurses.

Karen is passionate about improving health outcomes across the lifespan, ensuring equitable access to universal health care and education, as well as supporting and advocating for neonatal nurses and the specialization of neonatal nursing. Karen is committed to supporting the nursing workforce and recently became an advisor in setting up the first undergraduate nursing degree program in remote Western Province in Papua New Guinea

Contact: president@coinnurses.org

Edith Gicheha

Edith Gicheha is a neonatal nurse from Nairobi, Kenya currently working with Newborn Essential Solutions and Technologies (NEST360) as the clinical training director. In this role she supports countries in Africa (currently Kenya, Malawi, Nigeria, Tanzania & Ethiopia) to catalyze change through developing and sustaining a vibrant continuous learning ecosystem to improve the quality of care given to small and sick newborns. She works with countries to develop, refine and implement training & mentorship programs for all clinical staff (nurses, clinical officers, medical officers, pediatricians, neonatologists) in the secondary level (WHO Level 2) newborn units. These programs ensure staff are proficient in translating evidence-based knowledge into actual every day best practices as well integrating country specific guidelines with use of essential affordable robust devices. 

As a master trainer, she also enjoys mentoring clinical mentors and teachers to teach using refined methods like simulation teaching, 4 stage skills teaching, group discussions and reflective assessment - all taught in the Generic Instructor Course (GIC). 

Edith has 6 years’ experience in hands-on maternal and newborn care as a midwife and another 6 years teaching and supervising over 150 neonatal nursing students at the Kenyatta National Hospital (KNH) – School of Nursing. As lead author and co-author, she has published a couple of papers on maternal and newborn health as well as presented in numerous conferences. 

Edith is passionate, practical and a real newborn care champion and advocate.

Contact: @edithwathira

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

Shelly-Ann Dakarai (00:01.807)

Hello friends, welcome to another episode of the Global Neonatal Podcast. I am flying solo today. Bozu's not with me today, but I'm very excited to bring you yet another interview on the podcast. Today we have two guests joining us from COINT, and I'll provide brief introductions to them and then have more of their detailed bio in our episode show notes. So first we have Professor Karen Walker who is a neonatal nurse consultant and also serves as the clinical professor at the University of Sydney. As a clinical neonatal nurse with extensive experience in clinical research and policy, she was awarded her PhD through the University of Sydney in 2011. Dr. Walker is the current president of the Council of International Neonatal Nurses, a global organization representing neonatal nurses on the international arena, and the past president of the Australian College of Neonatal Nurses and serves on multiple global committees representing neonatal nurses.

Edith Geshia is a neonatal nurse from Nairobi, Kenya, who is currently working with newborn essential solutions and technologies, NEST 360, as the clinical training director. In this role, she supports countries in Africa to catalyze change through developing and sustaining a vibrant continuous learning ecosystem to improve the quality of care given to sick and small newborns.

She also works with countries to develop, refine, and implement training and mentorship programs for all clinical staff, which include nurses, clinical officers, and medical officers, pediatricians, and neonatologists. These programs ensure staff are proficient in translating evidence-based knowledge into actual everyday best practices, as well as integrating country-specific guidelines with the use of essential, affordable, robust devices. Karen Edith, welcome to the podcast.

Karen Walker (01:57.08)

Thank you.

Shelly-Ann Dakarai (02:03.909)

Awesome, great. All right, so I just want to jump right in and start our discussion and learn a little bit more about COIN. Karen, we'll start with you. You have been an advocate for neonatal nurses and for specialization in neonatal nursing. Why do you think that it's so important that nurses who are caring for neonates have specialty training in neonatal nursing?

Edith Gicheha (02:04.312)

Thank you. Thank you. Yes, thank you.

Karen Walker (02:32.269)

Thank you so much and what a pleasure to be here. Now I've been a neonatal nurse for many decades and I believe that all nurses and any healthcare workers who care for the small and sick newborn have specialised training because nursing these babies who are often very premature, critically ill or have complex medical or surgical needs, they require highly specialised care and that differs from care that is required for more healthy babies.

The neonatal population are the most vulnerable in our society. They have immature organ systems and different physiological responses. So again, different to healthy normal babies and also children and adults. so specialized training equips nurses to understand and manage these. Our neonatal nurses need advanced training and education to develop the required skills to provide quality, family-centered care.

But it's not just about knowledge, it's about developing clinical judgment, technical skills, and the emotional intelligence needed to safely care for these smallest and sickest, vulnerable babies. And this is what specialized training will give them. And it ensures that the care provided is evidence-based, developmentally appropriate, and it's delivered with the precision required to enable these babies to survive and thrive. So I think it's very, very important.

Shelly-Ann Dakarai (03:56.303)

Yes. You know, it's folks who don't take care of neonates, particularly sick neonates, often don't realize the complexities that we deal with and they think, they just take care of babies. And so it's so important, you're right, about making sure that all the persons involved in that care do understand the physiology. And we also have to think in the developmental aspect of our developing brains and the many different aspects, the families and the trauma of the NICU. And so it's great that

COIN is working to ensure that nurses everywhere have that specialized training that they need to take care of these babies. Edith, for you, you worked for six years in the clinical world before moving on to do your other positions. Tell us a little bit about what that was like for you working in that low and middle income context and how important it is for nurses to have that kind of specialized knowledge and expertise when caring for

Edith Gicheha (04:45.22)

Yes.

Shelly-Ann Dakarai (04:57.012)

sick babies.

Edith Gicheha (04:59.778)

Yeah, it's very thank you for having me in this discussion. think it's a very useful discussion and we do hope that we get more neonatal nurses into our units. So as a neonatal nurse working in Africa, one thing I know is that all of us are very passionate.

about the babies that we taking care of. And many of us, whether you are specialized or you just have the neonatal skills, usually we want to see the baby going home with the mother.

and the baby going home, not just because they're alive, but also the quality of the care we give them is so good that we maintain even their neurodevelopment and they don't have any, quote unquote, complications that will affect their quality of life. So at least the intention of every neonatal nurse in Africa is that. We, however, work in a very hostile environment.

And when I say hostile, I mean, we have many of our babies dying because of preventable reasons. Not because me as a nurse, don't know what to do. It's because I'm not able to do what I know what to do. So for example, I may have too many babies at the same time. So we have a very high workload.

Like for example, you can find that one nurse can have one nurse for 35 babies. That's a lot. So even if I'm an expert.

Edith Gicheha (06:44.164)

I do not get the quality time that I need to take care of each baby the best way I know how to. So if we want more, this would make life so much easier. So workload is a big one, staff shortage. And so we still have those very high ratios, but they have seen some that go even up to 50. So nurses end up task shifting to people who are less qualified than us so that we can get at least the bare minimum.

We also have difficulties with technologies, devices, consumables, accessories. Getting those on a consistent basis is a big challenge. And that's one of the things that we as Nes360 are trying to help to address. And you find that we have very many good-willing, good-hearted people.

who would want to support us. But when they donate things to us, we are not able to have consistent supply of what is needed to use that. So we have all those challenges. Data systems are a problem. We don't have robust systems.

and countries have to come up with their own way to collect data. And I'm glad that this is also something that most countries are working on and improving. So the intention of political care is there, but the health system needs a lot of improvement. And one thing, and we have papers which have been written, which are coming out to show.

Shelly-Ann Dakarai (08:10.425)

Mm-hmm.

Edith Gicheha (08:22.188)

that many times me as the nurse, I miss giving care. Not because I don't know, but because I don't have what it takes to do to give that care which is needed. So we need our governments to get serious. We need as many people to be advocates. Like Karen has really made a lot of noise. Coyne has been doing such amazing work and we need such advocates to continue so that we can improve the system in Africa.

Shelly-Ann Dakarai (08:30.725)

you

Edith Gicheha (08:52.696)

Yes.

Shelly-Ann Dakarai (08:53.733)

Thanks for sharing your expertise and that gives us a good segue, Karen, to talk a little bit about COIN and what is COIN and what does the organization do to empower nurses globally?

Edith Gicheha (08:59.918)

Thank

Karen Walker (09:07.606)

Thank you. So COIN, the Council of International Neonatal Nurses, is a global organization. It was founded in 2005 by Professor Carol Kenner, who still remains the CEO of COIN and is very much involved. what we're trying to do in COIN is to advocate for improved neonatal care by uniting neonatal nurses worldwide. And it's working with different organizations. We don't think we should work alone.

and we work with many, many organisations around the world because together we're much stronger. One organisation can do a lot, but if we all combine and work together, we can do so much more. COIN is a non-profit, non-governmental organisation and we represent neonatal nurses from all around the world. We know that there's great inequality in, as Edith was just saying, the number of nurses that look after a baby, very different to high-income countries. And we know that there's...

such tragedy in the world with the trauma that's happening in countries with wars. And we're working with all organizations around the world to try and advocate for nurses, for neonatal nurses, and to allow them to deliver high quality care and for babies to survive wherever they're born. And to do this, we work in advocacy and policy at the highest level with the World Health Organization and UNICEF and colleagues like that.

but we also work on the ground with our colleagues who are hands-on clinicians because they're the ones that are actually providing the care. So we work to develop education and training through our community of neonatal nursing practice. We work to bring nurses together, like our conferences. And we've had, and we work closely with Edith and Ness360 and the team. And we work with others in Africa to, where we know that there's some of the highest mortality and morbidity in some countries. And we're holding a conference in Lusaka.

in August, which will be our third African conference. And Edith and I have been, think, at all of them. So Coins of Voice for neonatal nurses. We want to be at the table with anything that's to do with neonatal nursing and neonates and have the global health dialogues where we can advocate for policies worldwide. And we want to help develop the workforce. We know that there's workforce challenges across the world. And we want to work with countries in helping to

Karen Walker (11:33.24)

Look at strategies to support that as well. So COIN is busy. We work in research, we work in policy, we work in advocacy and we work in just trying to bring nurses around the world together.

Shelly-Ann Dakarai (11:38.213)

Mm-hmm.

Edith Gicheha (11:47.586)

Thank

Shelly-Ann Dakarai (11:48.037)

So tell me a little bit about the advocacy and policy or have there been any changes that have been made from like on a systemic level that coin has kind of helped bring about in maybe some, know, a particular country or maybe globally.

Karen Walker (12:04.866)

Yeah, I think that's really a really important one. What we've advocated a lot for is advocacy around education and the recognition of coin of not of coin, the recognition of neonatal nursing as a speciality because it's not recognized in many countries. And this has been quite successful where you'll see that there are neonatal nurse courses and education happening in different countries around the world. I think Kenya, where Edith is, has got a very nice, strong neonatal program.

that they started and that's testament to the neonatal nurses of Kenya and obviously the government who've actually invested in it. If we look at other countries like India, they're investing very much in care of the small and sick newborn. So with the advocacy work, we work very closely with the World Health Organization. We've been developing a new course that will be coming out, the small and sick newborns, which is very much going to be in addition to the helping babies breathe course and COIN's been involved in working with that.

But we've also been involved in advocacy documents such as the Human Resources for Health Strategies for Low and Middle Income Countries. And it's writing these documents but also working with countries to implement.

Shelly-Ann Dakarai (13:18.981)

Great. And you touched on, you said advocacy, in addition to policy and then also education. And so I know that there are a lot of educational resources that COIN produces and they're all free. And I know even in the Caribbean where I'm from, our nurses have tapped into that and have been using that training. And so I'd like to...

shift gears and kind of talk about that. think it's called the, is it the, I have it written here, sorry, I can't bring it up. You will tell me about that. Community of Nursing Practice, there you go, it's back, it came back to me. Community of Nursing Practice. Can you tell us a little bit more about how that came to be and what that really is and how folks can tap into that?

Karen Walker (14:00.254)

That's right. Yeah.

Karen Walker (14:10.892)

Yeah, absolutely. So the policy document, the Human Resources for Health Strategies for Low and Middle Income Countries that we were very much involved writing with the WHO talked about education and training and how important it was, but how hard it is to access it in many regions of the world. So we wrote a grant and were very successful in getting funded by the Bill and Linda Gates Foundation. And we started a community of neonatal nursing practice. So this is a website.

which has resources on it. And you can join the community of neonatal nursing practice. It's absolutely free. And to join it, it's just so that's again, so that we can collect data and help people access the courses. There's different courses on it. There's a neonatal orientation program, a preceptor program, and advanced neonatal care. And there's also lots of other resources with webinars as well. And throughout the time with the community of neonatal nursing practice,

When it started up, we started hosting webinars from different countries and regions around the world. When we wrote the grant, we focused on four countries, which was Ghana, Nigeria, Kenya and Zambia. And reasons for that was our colleagues that are there that we got to work with to get the community practice happening, but also areas of high need. However, the countries now that actually we see it.

working and coming through the community of practice now number over 160 countries and people take the courses from high-income countries. Certainly we have amazing colleagues from Barbados that take it and all over the world people are doing the course which again is free and it doesn't give them a degree or something like that but it provides them with education and there's lots of other resources that we keep putting up onto the community of practice as well.

Shelly-Ann Dakarai (15:38.949)

It's great.

Karen Walker (16:01.934)

So that's very much been driven by Dr. Sue Proulage, who is our director, who works with us and she's helped drive that, which is fantastic.

Shelly-Ann Dakarai (16:12.581)

Right. Edith, I kind of want to ask you maybe a somewhat controversial question in terms of, you you mentioned that sometimes, you know, in the low and middle income context, sometimes it's not that I don't know what to do, it's just that I don't have the resources available to me to help with that or the staffing numbers that would support it. And COIN is at the forefront helping with that advocacy work. But I guess I want to ask

Edith Gicheha (16:19.116)

Okay.

Edith Gicheha (16:35.172)

Yes.

Shelly-Ann Dakarai (16:42.245)

Why do you think or do you think it's still important to continue education efforts regardless of the equipment that you might have available to you?

Edith Gicheha (16:55.748)

Yes, absolutely. I think that the community of Nyonyto practice that coin runs is very important because

is that we are constantly churning out in and out nurses. So we constantly need to not only refresh ourselves, but we always have new people who are coming into the system that need to be taught. So education should actually be continuous. And that is needed, that is necessary, that should be there.

Now in terms of specialized training, I think what from my experience with NETS360 and with all our five countries, my experience has been anybody who has undergone the longer specialized training, they are not easily moved around. So they remain in your NATO care longer than other general nurses.

So it is important that we need to have a critical mass of nurses who have specialized in taking care of the pediatric patient. Then that means then we keep them in the newborn unit so they are not easily moved around. But also we need to also check why are we moving nurses around because that should not be there. We should not be doing it unless somebody wants to move.

Shelly-Ann Dakarai (18:14.979)

Mm-hmm.

Edith Gicheha (18:29.636)

I find it very counterintuitive for us to do that. then it really, in fact, there are many papers that have been written that shows it actually affects the outcome of babies. The other thing is when a nurse is specially trained, she's able to be a voice. So she's able to know that, we need CPAPs and we need this kind of CPAPs.

Shelly-Ann Dakarai (18:52.485)

Mm-hmm.

Edith Gicheha (18:59.976)

We need ventilators. We need this kind of ventilators. So when she has the knowledge, then she's a better leader. She's a better mentor. She's a better advocate. She's a better voice. And so we, I am for this because I have trained in the school where I used to teach. We trained over 115 unit nurses and now they're almost 300 and they're making a difference everywhere they are.

So I feel like this is so important and these are the change agents we need in the system so that they can ignite fire in different places and hopefully we will see the system changing. Yes.

Shelly-Ann Dakarai (19:45.797)

Thanks. Thanks for putting that all into perspective where education is definitely necessary. And you really listed all those different areas between advocacy, giving nurses a voice, and then that stability of the workforce. Because this is not an uncommon theme. feel like everybody we talk to, and it's globally, nurses get moved around a lot.

Edith Gicheha (19:53.058)

Yes.

Edith Gicheha (19:58.391)

Thank you.

Edith Gicheha (20:03.972)

See you there.

Shelly-Ann Dakarai (20:11.237)

depending on where needs are and so you don't have that stable workforce and you're always having new people and things like that. So thanks for that perspective. I know we're gonna talk mostly about coin and neonatal nursing, but I think it's a good point to kind of talk a little bit about NEST 360 and some of the work that you're doing, Edith, that kind of helps with that bridge between education and then now the training of the staff in equipment and how to use them and things like that. And also having this

Edith Gicheha (20:12.228)

Mm.

Edith Gicheha (20:23.128)

Yes.

Edith Gicheha (20:39.468)

Thank

Shelly-Ann Dakarai (20:40.997)

based on a list of supplies that are tailored for the resource constrained context.

Edith Gicheha (20:49.516)

Yeah, so I feel like I always like to say what nest is newborn essential solutions and technologies. So there are two things about.

Edith Gicheha (21:06.914)

What I'd like to say is one of my mentors like to say that we use devices as an excuse to get into the unit. But once you get into the unit, you try and solve so many problems which are in the unit, which help to improve the system. So as NETS360, we provide hands-on competency-based trainings for clinicians. And here we are talking about the doctors is interprofessional.

We have doctors, nurses, neonatologists, clinical officers, and biomets. Because biomets are important to maintain our devices. We provide the level two WHO essential devices. We provide them as a donation for a period of time. And then we expect the government or the facility to continue supplying the accessories, the consumables.

And so we provide them for a season as we help them to put their house in order. We also have to improve data systems. If a hospital or a country doesn't have a proper data collection system.

then we also have to do that. And we do that all the way from health facility assessments to continuous care. are constantly monitoring about 53 variables. So we have a very robust system and implementation tracker, which we are able to see that now people are using it to make decisions about requisitions, mentorship, education needs. And so that information is becoming.

quite useful. So usually we are all about those three things, the technologies, the hands-on training and competency and data systems. And then overall we catalyze the government to be able to sustain this even when we are not there. For education, we go a bit deeper. We develop materials just like coin, and we have lots of materials on how to use all the devices.

Edith Gicheha (23:23.944)

We have job aids in different languages. We have materials for moms. We have materials for new staff. And we are currently developing online courses so people can use them to refresh their skills and also for the new staff. So we have traditional systems as well as continuous education systems. And our vision really is to make sure that we create a continuous learning insight.

at the newborn unit. We also have something called generic instructor course. Anybody who does this course is never the same because they learn to see things differently. We teach you how to teach others. So we show you.

Then you show others. So the generic instructor course teaches you adult learning principles. It teaches you how to teach skills, how to use scenarios, how to run a group discussion like you're doing so well. I've given you so many marks. You're running this discussion really well. And also how to take assessment.

Shelly-Ann Dakarai (24:27.685)

Thank you.

Edith Gicheha (24:34.21)

Yeah, so we teach people how to do that so that when they come up, they're able to be advocates. They can speak. They can break down problems and find solutions. So that's the education bit that we are doing in NEST 360. Yes.

Shelly-Ann Dakarai (24:51.685)

And so how would someone connect with Ness360? Is this just specifically for African countries or does a government reach out to folks there or how does that system start?

Edith Gicheha (25:07.84)

So we are currently in five countries in Malawi, Nigeria, Tanzania, Ethiopia and Kenya. These five countries together provide almost half of where most of the babies are dying. And so we are working with governments.

We wish we could be in every country in Africa, but the issue is the resource constraint. But we're in these five countries. And in these five countries, the only country we are at scale is Malawi. In the other countries, we are still working not at scale, but our model is available for people to use and they can go to our website.

And they can reach us on either just go to www.nest360.com. You will find us there. You can also find us on Facebook, on LinkedIn, same at nest360. You will find all the information you need. And if you write an email asking for requests, asking for support, somebody will get in touch with you and we'll discuss if we are able to meet your need or if we are able to advise you.

on what to do. Yes.

Shelly-Ann Dakarai (26:21.989)

Great, thank you. And you know, from a side note, a couple years ago, I just kind of came across Nest 360 and when we were trying to procure some supplies for a hospital in the Eastern Caribbean. so using that list of technology that's based for low and middle income context, we were able to get some supplies and use your training materials to give to the nurses. So it's definitely reached.

Edith Gicheha (26:47.171)

Peace.

Shelly-Ann Dakarai (26:50.637)

outside, but I just wanted folks to kind of know how to get to it and who it's for in case they wanted some extra support. And so it's great having the two of you and Edith, you're still, you're part of COIN, but having that COIN, neonatal nursing advocacy, education, as well as the supplies that you need and the training and how to train others is a beautiful partnership.

Edith Gicheha (27:14.756)

Yes, thank you.

Shelly-Ann Dakarai (27:16.421)

So I was wondering, since we talked a little bit about, you know, coin and what it's doing, I know we talked a little bit about some of the policy statements and some of the advocacy work, but Karen, are there any other stories that you could think of that where coin has made an impact, whether it be from some small change, whether it's, you know, advocating and have for

other organizations to be bubbled up underneath Coin or any other stories that you can kind of share to let our listeners know a little bit about some more of the impact Coin has been able to help.

Karen Walker (27:57.41)

Thank you. Yeah, look, I think one of the most satisfying things we have done in COIN since I took over my presidency is looking at the number of neonatal nurse organizations that have actually come together and started their own organizations. And great examples of that are from Africa, because in 2018, we held our first conference in Africa in Rwanda. And at that conference, we launched the Rwandan Neonatal Nurses Association.

And this is where the strength in countries where they come together. The next year, at the invitation of some amazing nurses from Kenya, we went to Kenya in 2019 to hold a Kenyan conference and we launched the Kenyan Neonatal Nurses Association, which was absolutely fantastic. We were supposed to in 2020 then go to Zambia, but the pandemic hindered that.

So we're now going to Zambia this year, but last year when we went to Kenya, we rebranded and shared the rebranding of the Society of Neonatal Nurses of Kenya, which is fantastic. But we also went to Zambia to launch the Community of Neonatal Nursing Practice and launched the Zambian Neonatal Nurses Organization. So this is something that's really important from an advocacy perspective, we can do it different levels, but from a country organization.

then the organizations of neonatal nurses coming together actually add strength to it as well. I was in Geneva just a couple of weeks ago at some WHO pre-world health assembly meetings and I met the ministers of health from Malawi, the ministers of health from Kenya. And it was great to actually share with them stories of some amazing neonatal nurses that are working in their countries that they probably might not know about, but hopefully they will now.

Another example is a nurse from Kenya who through mentorship with COIN is now sitting on the International Stillbirth Association Board, first neonatal nurse to be on the board of this organization. And she came through as COIN, as one of the members of the Kenyan Neonatal Nurses and COIN and is now doing this. And for me, this is one of our key roles and COIN is to actually support our colleagues in different countries to actually achieve.

Karen Walker (30:15.406)

Let me tell you about one more and he just happens to be Kenyan. Patrick Two, I first met in 2019 as a young nurse who'd just qualified. And over the last, what we now in six years, he's gone from starting as a neonatal nurse. I joined virtually to watch him graduate as a neonatal nurse during the pandemic. And he came onto the COIN board as the youngest director ever.

Shelly-Ann Dakarai (30:17.914)

Please go right ahead.

Karen Walker (30:43.8)

because generally getting onto global boards you need to be fairly experienced. it was clear that he is very strong neonatal nurse and he's now started a neonatal nurse organization. The African neonatal nurses of course which Edith is part of, bringing together the leaders of countries in Africa. This is what Klein actually tries to do is to try to support people in countries to do amazing things within their own countries.

And I think that's one of our key roles in COIN and it's a great story. When we first started the community of practice, our colleagues said, we'd love a network to talk to each other. So we started a WhatsApp group and within 24 hours we had a thousand members. It was huge and it's still going strong. And we have neonatal nurses midwives, but we also have neonatologists.

Shelly-Ann Dakarai (31:27.023)

Wow.

Karen Walker (31:35.374)

in part of the group as well, which is fantastic. Because I think I said earlier about working together with organizations, we work very closely with NEST 360 and we don't compete, we share resources and we've got a memorandum of understanding, great support with Joylawn and the whole team of NEST 360. But we also work with the African Neonatology Association with Dr. Alex Stevenson. And this is where if we can all band together to work together.

Shelly-Ann Dakarai (31:46.841)

Mm-hmm.

Karen Walker (32:02.338)

then we can make a difference. But it's the stories you see of the people that I see in coin, the people that in different countries who are just doing amazing things. And these are the stories we need to tell.

Shelly-Ann Dakarai (32:12.451)

Yes, yes, yes. Such inspiring stories. Thank you for sharing all of those. And you talked about that nurse who went and had training in Indian nursing and then now is on the board. And that is another good segue into, I wanted to ask a little bit about your careers. You both have been at the bedside taking care of babies and have...

moved on to doing various things. And so I'm interested in hearing a little bit more as to, first of all, why the babies, why did you start? What about the babies caught you? And then talk a little bit more about those different steps you made and how your careers unfolded. Because I'm sure there are some nurses listening who may not have even considered other things than being at the bedside. But they have an inkling that they want to do more and make

you know, create an impact with helping with neonatal care. So maybe Edith, we'll start with you and then Karen, you could tell us about your career.

Edith Gicheha (33:17.996)

Yeah, that's a very good question. And when you asked it, I'm thinking about where it all started. It started during my internship when I did my bachelor's in the University of Nairobi.

And the most place I've, the place that I found the most joy, I was not even tired to work around the clock. Cause you know, when you're an intern, you just work. Yeah. So the place that I found the most joy and I could work 24 hours without getting tired was the labor ward and the newborn unit. I just loved it. And I think that's where it all began. So when I started my career,

Shelly-Ann Dakarai (33:48.805)

you

Edith Gicheha (34:05.732)

For some reason, I think there are people who had observed me as I was working there and they sent me back to the labor ward to work with the moms and the babies. And so one thing actually led to another and then my heart has always been for moms and babies. I don't know whether it's because of my mother, because my mom always loved babies.

and she would bring all the babies in the compound, in the whole village, to our home. I don't know.

Shelly-Ann Dakarai (34:40.91)

you

Edith Gicheha (34:43.106)

moms and babies. And maybe that's where it comes from. I don't know. But this is work that I would do with even without pay. And I would do it on the clock without getting tired, because I love it. So for those who are listening and probably are thinking what should I do, they need to search themselves and genuinely ask, where do I find most joy? And that's where you should go. Because I feel when you go there, then

other opportunities present themselves because that's what happened. I found opportunities. I found great teachers, great mentors, people who held my hand and walked with me. And one thing led to another. And I kept discovering who I am. That's where I discovered that I'm a teacher and I'm able to very easily break down complex things to simple things without even

struggling. So one thing led to another and I worked there and I used to teach even as I was doing midwifery work. I would teach my colleagues all the time and then I was asked to go to the school. They took me to the school and I continued teaching there even in class I continued to teach. So it's just who are you? Find out what you really like to do.

Shelly-Ann Dakarai (35:53.541)

the

Edith Gicheha (36:08.012)

and you'll discover that you have an arsenal of skills if you're able to identify that. So my career has been driven by good intention, my own interest, things that fulfill me. I've had amazing teachers, I've been so fortunate. The likes of Carol and Karen in coin, opening doors which I never used to think would exist.

So I think I've been very grateful for that journey. Yes, that's what I'd say.

Shelly-Ann Dakarai (36:46.083)

Thank you. Karen, what about you? Tell us a little bit about how your career unfolded.

Karen Walker (36:52.59)

I'm just loving listening to Edith. I love listening to Edith's passion. just makes me so happy, Edith. So I started, gosh, you can tell that I'm very old. So I started nursing in Great Ormond Street in London a very long time ago, and that was pediatrics and general nursing. So hospital-based training. And I love the excitement of the emergency of ICU. So I drifted into neonatal and pediatric ICU.

Shelly-Ann Dakarai (36:59.427)

Yeah.

Karen Walker (37:19.896)

very exciting. I moved out to Australia and then by then we'd moved very much into degrees and general training in hospital based had changed and wasn't happening as much. So I did a degree, I did my masters and eventually went into my PhD. And I worked in retrieval. I've worked in lots of aspects of neonatal nursing. worked in retrieval for 10 years. I worked in data collection and auditing because I think

And Edith touched on the importance of data and I love data. It is so important. So I actually collected data while my children were young for the big neonatal data set in Australia. And then I moved into research and a PhD and I got very interested in the outcomes of what happened in our neonatal unit. I sort of moved from what's happening now, very exciting working in an ICU to thinking, okay, what's happening to all our babies after they leave ICU?

Shelly-Ann Dakarai (37:51.129)

Mm-hmm.

Karen Walker (38:16.952)

what's happening in the future, what are we doing in ICU that we could change to make things better in the future for the babies. So my PhD focused on neurodevelopmental outcomes following major cardiac and non-cardiac surgery. And I very much looked at the outcomes of neonatal intensive care. So moving to the actual ICU to the outcomes provided me with a whole load of more information and an interest. And so lots of research for many years. sort of...

drifted in and out of the Australian College of Neonatal Nurses, which is the Australian Neonatal Nurse Organisation. And because my children were young, I was doing a PhD, I was involved and then I wasn't. And then a colleague asked me, would I be chair of the New South Wales branch? And I'm very, very bad at saying no. So I said, of course I will. Of course I will. You can't find anybody, of course I'll do that. So I became chair of the New South Wales branch of the Australian College of Neonatal Nurses, but then became

of course, the president, because I just drifted into it as well, no idea. And one of my colleagues was then the president of COIN. And she said, would you join COIN as vice president? We're really short of people and I think you'd be great. And of course I said, yes. then years later, I ended up president of COIN and I've been president there for five years now. And it's been an absolute privilege to be president. But from my own career perspective, because I became president of

Shelly-Ann Dakarai (39:27.407)

Good.

Karen Walker (39:41.486)

and it was all during the pandemic as well. I was thinking that I really needed to get back to neonates. I drifted into research. I'd worked in global health with the George Institute. And so I took a job going back to hands-on clinical. So that when I spoke about neonatal nursing, then I actually could speak from my own experience. When I spoke about the impact of the PPE,

Edith Gicheha (40:00.068)

Mm.

Karen Walker (40:07.544)

during COVID and we saw the face, the theses and things like that with all the masks and things, then I could actually talk from experience because I had those marks and things as well. So I felt that I was very connected and could speak for neonatal nursing. And so I've been there for a few years now, very different going back to hands-on clinical, but I've also kept my research and I worked as a clinical professor with the University of Sydney. So I keep my research, keep my education.

Shelly-Ann Dakarai (40:10.949)

Mm-hmm.

Shelly-Ann Dakarai (40:17.049)

Mm-hmm. Mm-hmm.

Karen Walker (40:36.194)

hands on clinical and recently now I have taken up a role helping set up a school of nursing in very remote Papua New Guinea. And I find we talked a little bit, I needed to mention the shortage of nurses. are nurses so short of nurses and we're talking Africa which has great shortage but Papua New Guinea five nurses per 10,000 of population. It's so low. So I felt I got asked would I be interested in helping.

Shelly-Ann Dakarai (40:50.169)

Mm-hmm.

Karen Walker (41:03.5)

And I think that's another avenue, not quite neonatal nurse, saying although when I got there, I went to the local district hospital and there was a tiny little baby. And I got to help with some resources and tapes and things that I had there. So I think for me, the journey is just so much fun. It's hard to say no. And I'm trying really hard in that, but I'm very bad at it because...

Shelly-Ann Dakarai (41:24.293)

Great. Yeah.

Karen Walker (41:28.832)

I think when you're a nurse, you just want to help people. You want to do as much good as you can. And as part of COIN, I feel I can do an awful lot of good with advocating for nurses and neonatal nurses and same and to to work with all the colleagues that we have across Africa, but across the world. And that's where we can make a difference. So exciting, a career pathway that's fun.

Shelly-Ann Dakarai (41:48.911)

Mm-hmm.

Shelly-Ann Dakarai (41:52.293)

Great, yes.

Karen Walker (41:55.286)

I've flown in helicopters. I've done lots of things, but it's all been great fun.

Shelly-Ann Dakarai (41:55.629)

Right. Right. And, you know, the theme I'm hearing, and I feel like it's a theme that we hear from all guests, it's, you know, looking back, it may look to folks that there was a path that you knew you were going to do this, and then this would lead to that, and the other, but it's all been opportunities presenting themselves. you know, when you...

Edith Gicheha (41:58.148)

Thank

That's it.

Shelly-Ann Dakarai (42:23.813)

And then you say yes, and then that opens other doors and things like that. So I think for those that they're in the beginning of their career that are worried about, how will I know? Will I get it right? This is what I want to do, but I'm not sure how to get there, you know? It's like you stay ready and then the opportunities come and you just kind of walk in whether or not you're quite ready or sometimes you still feel like an imposter, but you walk in and you learn and you get better and you move on from there.

Edith Gicheha (42:41.262)

Yes.

Edith Gicheha (42:47.524)

you

Karen Walker (42:52.574)

Absolutely. I was on a panel with Carol and some other leaders of organizations and we called ourselves the accidental leaders because none of us actually plan to be a leader of any national or global organization. It just seems to happen. And I think for anybody that's listening, just enjoy it. I really want to advocate for being part of neonatal organizations or national organizations.

Edith Gicheha (43:00.972)

You

Shelly-Ann Dakarai (43:05.198)

Right.

Edith Gicheha (43:06.788)

Yeah.

Karen Walker (43:19.052)

because you never know where it's going to lead you. Every time I sit in meetings with ministers and things, I think, wow, what am I doing here? Real imposter syndrome. And I'll say something, that's a good idea. And I go, wow, was it? So I think it's absolutely fascinating, but it's great fun.

Shelly-Ann Dakarai (43:28.389)

You

Shelly-Ann Dakarai (43:37.317)

Mm-hmm.

Edith Gicheha (43:37.636)

It's absolutely, you know how I got into Nes360. Somebody saw the advert. I had not seen it and somebody read it and they said, Edith, this is you. You must apply. And I'm like, what? So I read it and I applied and the rest is history. But the opportunities as we, you have to enjoy it. Then the opportunity will come. It will come to you.

Yes. Say yes! Just say yes.

Karen Walker (44:07.522)

Just say yes.

Shelly-Ann Dakarai (44:08.896)

Just say yes. That might be the title of the episode. Just say yes.

Edith Gicheha (44:16.148)

Yes. Yes. yes. I'm lazy. Yes.

Karen Walker (44:18.956)

You get to meet so many wonderful people as you do it. mean, Edith and I have met and it's great. This is so much fun. And I will meet again in Lusaka in August, which will be, yeah, International Neonatal Nurses Day is the 15th of August. So we arranged a conference around that on the 14th, 15th and the 20th anniversary of COIN. So very much lots to celebrate.

Shelly-Ann Dakarai (44:25.294)

Right.

Edith Gicheha (44:30.187)

in August, yes.

Edith Gicheha (44:41.444)

Wow!

Shelly-Ann Dakarai (44:41.625)

Wow.

Karen Walker (44:44.622)

And we're delighted that Dr. Queen Dooby from the WHO is coming, Dr. Alex Stevenson from ANA, and some colleagues, I think, from UNICEF and Kiesi. And of course, NEST 360 have got a big group coming, which is fantastic. So it's really, really great that we all work together. And this is what the conferences do. They're hard to run, especially in this day of age when everybody's struggling for funding. But bringing people together is so important.

Shelly-Ann Dakarai (44:45.061)

Great.

Edith Gicheha (44:57.836)

Yes. Yeah.

Shelly-Ann Dakarai (45:15.151)

Yeah, and you mentioned funding. I looked at your website and your courses are all free and you talked about how that was funded and the conference fee is very, very, very affordable. And so, not in any way, this is not in any way to talk about political or anything like that in the, I just am curious, because I know there are other folks who are in nonprofits that, I'm just curious as to how you guys able to fund these initiatives to.

Edith Gicheha (45:15.907)

Hmm.

Shelly-Ann Dakarai (45:43.897)

be able to provide the resources to people who need them most but may not be able to afford them.

Karen Walker (45:50.06)

Yes, such a good question. This is why I've got lots of grey hair. Well, the Community of Practice was funded through the grant from the Gates Foundation, which has now stopped now. And yes, we are definitely looking at how we fund that. We used to have educators that we employed and now we don't anymore. So the Community of Practice, while it's up and running, is still... We're very much a volunteer organisation. The only person in coin that now is at whose page is our wonderful webmaster. And we could not do without him.

Shelly-Ann Dakarai (45:53.721)

Mm-hmm.

Shelly-Ann Dakarai (46:20.058)

Mm-hmm.

Karen Walker (46:20.09)

Our membership to coin is incredibly low because it has to be. So it's only a dollar for low income countries and two dollars for high income countries. And it is a struggle. The conference in, we try and get small grants. So we are very, very fortunate to work with Casey Foundation who've supported the translation of our website into French. So we're currently translating our community and we look for small grants from different places as well.

Yeah, the conference in Los Acre, we had to make it very, very reasonable for people to come because we asked our colleagues what would be a reasonable price for the two-day conference for them to come. And you can see on the website, it's about $10 for the two-day. So it has to be like that for people to come. So we look for sources of funding. And sometimes we have on the website that if our colleagues

are coming from a high income country and they want to pay for somebody for a income, a low income, middle income country to come, they can do that too. And we got a donation of $250 from the Australian College of Neonatal Nurses in memory of one of their members. And that would provide admission to the conference for 250, 25 nurses. So that's sort of ways we're doing it. But we also work with colleagues to look for funding opportunities. just recently I was with

Shelly-Ann Dakarai (47:37.593)

Mm-hmm.

Karen Walker (47:46.158)

colleagues from JEPIGO. And again, everybody is struggling for funding across the globe now. So what's really interesting is that we are all going to try and work more closer together to when you go for grants instead of us going for grants and maybe JEPIGO and maybe Nest 360, then we actually all go for them together and get smaller amounts. So I think we now need to talk about how we work even closer together to source the funding because the funding is challenging for all of us to get to, but it's important.

Shelly-Ann Dakarai (47:58.085)

Mm-hmm.

Shelly-Ann Dakarai (48:10.521)

Mm-hmm.

Edith Gicheha (48:10.852)

Thank

Shelly-Ann Dakarai (48:16.197)

Right. Thank you for your honesty and sharing. And like I said, know, we are here to share stories and just kind of share how others, how folks are doing what they're doing because it may give somebody an idea or spark collaborations to, as know, as Ness 360 always says, to get the, together we go faster.

Karen Walker (48:39.022)

together. Absolutely, we all say that. And I was talking with a colleague in UNICEF just recently and they're possibly going to support our conference as well. So it's little small pockets of money that people would actually donate because again coming together will make us go faster too.

Edith Gicheha (48:39.606)

Absolutely. Yes.

Edith Gicheha (48:58.424)

Yes. You know, can I say something about coming together?

Shelly-Ann Dakarai (48:58.703)

Yeah, yes, absolutely.

Yes!

Edith Gicheha (49:05.444)

Yeah, I feel like that's so, so, important because we are so interconnected and everything we're doing affects each other. What Karen and her team are doing affects what NEST 360 is doing, what JapaGo is doing for the newborn, it affects us. What CHAI is doing, it affects us. So we must work together. What nurses are doing, it affects the neonatologists and doctors. It affects the barmaids. We must work together. We don't have a choice.

Shelly-Ann Dakarai (49:34.072)

Mm-hmm.

Edith Gicheha (49:35.468)

anybody who comes in and tries to do something different, I don't think we should break that interconnectedness because that is what makes us better. And that is what will help us to move faster to achieve the goal that we all want to achieve.

Karen Walker (49:53.624)

think one of your other questions, Shelley, was around working with the medical staff. And I think that is so incredibly important. And this is why we're advocating at the highest level to work with the neonatologist. And I work in a neonatal unit. It's a team. And I think it's making sure that everybody is valued in the team. No one is better. One of my colleagues who's a neonatologist says, well, I can't run the neonatal unit if I don't have nurses.

Shelly-Ann Dakarai (49:58.885)

Mm-hmm.

Shelly-Ann Dakarai (50:09.711)

Mm-hmm.

Yes.

Edith Gicheha (50:19.308)

Mmm.

Shelly-Ann Dakarai (50:19.618)

Absolutely.

Karen Walker (50:20.024)

when nurses are absolutely essential. And this is what, and I want every nurse to think that you are just as important as we are all equally important in neonatal unit to take, to look after your babies. And probably the most important people are the parents. And we, it should be very much partners with our care.

Shelly-Ann Dakarai (50:24.687)

Mm-hmm.

Edith Gicheha (50:26.573)

Hmm.

Edith Gicheha (50:34.212)

Absolutely.

Shelly-Ann Dakarai (50:34.657)

Mm-hmm. Yep. Yep.

Mm-hmm, yeah, that is absolutely true. Absolutely true. And, you know, we're getting to the end of our time, and so I do want to talk about, you you brought that up about working with the medical team, and, you know, that brings us to talking about the hierarchical structure of medicine. You know, it's changing in some places, but the reality is everywhere. There's still that hierarchy.

Edith Gicheha (50:39.364)

Yes.

Edith Gicheha (50:44.824)

So true.

Shelly-Ann Dakarai (51:06.699)

of doctors versus nurses, and even within the doctors, the different ranks, and even in the nurses, the different ranks and things like that. And so to wrap up, I wonder if you both could potentially give some words of advice to a nurse who might be taking care of babies, they want to see improvements, they just don't know where to start, or they don't feel like they might be taken seriously. Is there something, what can they do to start? What words of advice would you give to that nurse?

Edith Gicheha (51:39.352)

Well, then if I could start. What advice, the advice I would give to this nurse is number one.

be the best you can be. Know everything you need to know about the newborn and be able to assess, be able to diagnose, be able to know what is the best way forward so that you can have a constructive discussion with a doctor who is taking care of this baby. If we are mediocre, if we do not

focus on the right things. If we are distracted, if we don't feel like we are value.

Edith Gicheha (52:27.128)

Be the best you can be. Then have a proper, constructive, scientific discussion about this baby with a doctor, with a pediatrician, with whoever else is on the team. That way, your life is going to be easier.

But if you don't, you are not at your best. You cannot be able to speak up because you're going to be feeling that you're lower than them. This identity of we are lower than the doctors. I feel like it is a self-imposed prison because we don't have to be in that prison. All you have to do is be the best you can be and then

Be the person to say, doctor, this medicine that we're giving this baby or this plan that we have with this baby, I don't feel it is the right way. I feel that we should do one, two, three, four. If you're updated, you're informed, you know the newest therapies that should be done for this baby. Why wouldn't anyone listen to you? They would. But if yourself, you're not competent, yourself, you're not confident, you will not be able to convince anybody else what is needed.

for this baby. So I feel like my advice to them would be be the best that you can be. Put effort in yourself. Then speak up. Don't hold up. Don't hold back. Speak up. If you see something is not going right, speak up and let us not use the hierarchy because the hierarchy is needed for order. But it should not be oppressive. But we need to be able to be competent.

then speak up, speak your mind, explain why do you think A is better than B? Why do you think we should go this way instead of this other way? That way you will help yourself, you will be happier to do the work and your baby is going to get the best. And this is all for the baby, it's not for anybody else. So that would be my advice.

Shelly-Ann Dakarai (54:37.901)

Thank you.

Edith Gicheha (54:38.116)

Thank you.

Karen Walker (54:40.946)

Great advice from Edith. I love it. It's all about education and having the confidence in your own abilities and then you value yourself. I think we all want to be valued in our workplace and everybody wants to be to provide the best care. So we actually all have the same common goal. It's all about communication. I think many things in the world come down to communication or lack of.

But if you have a nurse who is confident in her abilities, who values her knowledge, and who has also taken the time to actually be educated in the care of the small and sick newborns, so her voice is actually equal to, then I think that's really important, what Edith has just said. I think that the value of nurses, you cannot underestimate it. I was at the ICN conference in Helsinki last week.

So I'm very jet lagged. And we talked about the power of nurses there. And there are more nurses in the world than any other health care provider. We are a very, very strong organization. There's about 29 million nurses. We're the strongest health care organization in the world. And so you have to think that we have such a strong voice and we need to use it. And that's part of coming back to what Id is saying is to value yourself.

A colleague of mine talked about a nurse and this takes us back into being moved away from the neonatal intensive care unit. And they moved her just because they moved her out of the room. And he collected data, back to Edith's data, on the mortality rate within the neonatal unit over six months and the mortality rate went up because she was the educator, she was the experienced nurse. And he showed the data, power of data.

to the administrators and said, I need the nurse back. And of course he did. But you could see there how much he valued the nurse as well. And her value was absolutely clear. And it's saying that all of us are valued and what we actually manage to achieve in our workplace. So having the confidence to, I think from my perspective, I feel like everybody's equal. You might be the Minister of Health.

Karen Walker (57:01.538)

but you can have a really good conversation with them about global health issues because of the background and knowledge that you actually have. So the one thing I guess I leave everybody with is I was at a conference and I met this lovely, lovely nurse and I said, who are you? What do you do? And she goes, I'm just a nurse. Absolutely not. And in the neonatal world, just a nurse. Neonatal nurses hold the lives of babies in their hands.

How many places can you go to work and if you do something wrong you can impact their, you can actually kill somebody or you can impact their morbidity. Neonatal nurses hold the tiniest babies and the future of society in their hands. So never ever adjust a nurse.

Shelly-Ann Dakarai (57:42.969)

Mm-hmm.

Edith Gicheha (57:46.02)

Absolutely.

Karen Walker (57:49.518)

So maybe I'll leave you with that. Never just a nurse.

Shelly-Ann Dakarai (57:52.933)

Yeah, we're just a nurse. Thank you. I love that. I love that. Yes. Edith and Karen, thank you so much for joining us today. We know the time difference. is not early for you guys. And so we appreciate you taking the time to join us on the podcast. And I know our guests, our listeners, sorry, will be inspired and empowered to take action.

Edith Gicheha (57:53.346)

Never just at once. Yes, I love that.

Karen Walker (57:57.678)

Yeah.

Shelly-Ann Dakarai (58:21.879)

and I'm sure they're gonna wanna check out Nest 360 resources as well as Coin resources. So as we wrap up, can you let us know the best way for folks to connect with you? And we'll put those in the show notes for them.

Edith Gicheha (58:26.882)

Yes.

Karen Walker (58:37.358)

For me, the best way to connect is through COIN, President at COIN Nurses. If you go on to our website, which is www.coin.org. So it's very easy to find us and you'll find the resources for the Community of Practice. You'll find our website for Lusaka and you'll find our website for our next conference, which will be in Darwin in Australia in August 2026.

So connect, all our emails are on the website. Very, very happy for people to reach out and connect. So president at coinnurses.org.

Shelly-Ann Dakarai (59:13.893)

Great.

Edith Gicheha (59:14.532)

Great, thank you. Yeah, so I am at Edith Wadira on Instagram, at Edith Gishaha on Facebook. I can connect there with me. Yes, yeah.

Shelly-Ann Dakarai (59:24.377)

Okay.

Shelly-Ann Dakarai (59:30.381)

Okay, we'll put that in the show notes.

Perfect, sounds great. Well, thank you again for your time. And to our listeners, we will talk to you again next month when we bring you another episode of the Global Neonatal Podcast. And if this has been inspiring to you, please share it with someone who you know could benefit from this so that we can all go faster together and improve neonatal care around the world. Thank you so much. Bye.