#351 - 🌍 Improving Neonatal Care in Bamenda Cameroon (Ft Dr. Kate Kan)

Hello friends 👋

In this episode, Mbozu and Shelly-Ann are joined by Dr Kate Kan, Consultant Pediatrician and the director of the Neonatal Unit at theRegional hospital in Bamenda Cameroon. During the discussion, Dr Kan describes her journey from aspiring pediatrician to her current role as the head of the Neonatal Unit at her institution. She describes some of the challenges as well as  the progress that is being made to improve neonatal care in her region. 

Dr. Kan also highlights the impact of mentorship in her journey and shares her views on how  mentorship not only guides individual careers but also enhances neonatal care in resource-limited settings.

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Short Bio: Dr. Kate Kan is a Paediatrician who trained at the University of Calabar and proceeded to do her residency at the University of Uyo teaching Hospital all in Nigeria that earned her the prestigious award as a Fellow of the West African College of Physicians in the Faculty of Paediatrician. 

Dr Kate currently serves as a Consultant Pediatrician and the head of the Neonatal Unit at the Regional Hospital in Bamenda Cameroon. Dr. Kan also serves as senior lecturer of Paediatrics, Faculty of Health sciences and The University of Bamenda in Cameroon. 

Contact:  linkedin.com/in/kate-kan-33a766115

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

Mbozu 

Hello everyone and welcome to another episode of the Global Neonatal Podcast. We're excited to bring you another interview today with an amazing neonatal champion working in the African continent. But before we introduce our guest, how are you doing Shealyan?

Shelly-Ann

I'm good, I'm good. Excited as usual for another interview. The last couple episodes we've been solo, so it's nice to do one together again.

Mbozu

Yes, I'm super excited to be sharing ideas with you and figuring out who shares the best questions between us.

Shelly-Ann 

I know right. I don't know. It's not a competition. We make, each other iron sharpens.

Mbozu 

Thank you. Yes, definitely. So I will introduce our guest, Dr. Can Kate Muffle. She is a pediatrician who trained at the University of Kalaba and proceeded to do her residency at the University of Uyo Teaching Hospital in Nigeria and then earned her prestigious award as a fellow of the West African College of Physicians in the Faculty of Pediatrics, and she currently at the regional hospital as the head of the immunology unit and also serves as senior lecturer of pediatrics, faculty of health sciences, the university of Bamenda. Dr. Katie, thank you for joining us today and how are you doing?

Dr Kate Kan

Fine, thank you. It's an honor to be with you this morning.

Mbozu

Yes, and we're so glad to be able to hear more about Cameroon. Today we're touring Cameroon, learning more about what the neonatal care there is like through the eyes of Dr. Katie. And just to start us off our chat today, could you tell us a bit about Cameroon and a bit about the region where you work?

Dr Kate Kan

Cameroon is a small country, not very small though. It has a population of about 20 million. It's located in central Africa and probably the biggest in central Africa. Cameroon is made up of 10 regions. And in these regions, you have diverse cultures and the two main languages in the country are English and French. And the English speaking region is a minority in the country. And unfortunately, those two English speaking regions have some social political instability. Our government, it's doing its best to make healthcare available and accessible in every district such that it's accessible to the nearest home. When it comes up to newborn scaling in Cameroon, the Cameroon government is committed to ensuring that no newborn dies from a preventable cause of death. And there's a lot of mobilization being done by the federal minister, through the federal ministry of public health with a program in maternal and child health that ⁓ envisages the basic components of newborn care. We have packages like the essential newborn care. We also have programs for the kangaroo mother care. We also have a vaccination schedule being updated and we recently incorporated the malaria vaccine into our calendar. We have grown through the expanded program or immunization and We are at the level of administering a second dose of MMR, which was instituted two years ago, and most recently the human papilloma virus. So in as much as it's not easy because of a lack of manpower, particularly in the two English speaking zones, there is actually a disproportion in pediatricians in the suburbs. this sub-urban areas compared to the urban areas where majority of the health personnel, particularly the pediatricians, who really want to stay. Like in the Northwest region, we are just three pediatricians. One of them is a professor, and my other colleague is a pediatric endocrinologist. In the Southwest region, they are... I think for pediatricians in different subdivisions, one in Mutengene, one in Limbe, one in Buye and I think one in Kumbha, as opposed to other regions where you could have over 30 pediatricians. So that's a little about an overview about Cameroon and healthcare as pertains to neonatology.

Shelly-Ann

Thanks for that overview of Cameroon and the different regions, the fact that there are two main languages and some of the challenges you face in your region. Since you mentioned that you started talking about the newborn care packages and the improvement that's being made. And so I want to kind of talk a little bit about the NICU that you work at. I know from our discussions earlier that you came back from training to head up neonatal unit. So tell us a little bit about what that experience was like coming straight from training and then kind of being charged to lead this neonatal unit and talk about where it's come from since that time.

Dr Kate Kan

Thank you, Shirley-Ann. When I compare the newborn units from where I came from and where I am now, it was really challenging to marry the previous from the former. But notwithstanding, there was already an existing newborn unit set up by the hospital and the previous pediatrician. And one thing I noted about the unit was overcrowding. There was really no separation between the preterms and ⁓ the sick newborns and the units. I also met a situation where the unit managed those beyond the neonatal period. You had babies two months, three months who were readmitted into the unit. And that was really challenging. They had to be admitted because the unit is kind of a NICU the needed oxygen, the needed immediate care. So they had to be placed with the smaller babies, which probably increased the risk of infection. Now as pertains to the human resources, the unit is headed by a pediatrician with interest in neonatology, has two to three medical officers at any point in time and 10 nurses with some supernumerary staff. With regards to the equipment in the facility, through the donations of the Federal Ministry of Health and United Nations emergency, Children Emergency Fund UNICEF, we've been able to grow in terms of acquiring incubators. Currently there are eight incubators in the unit, four functional and four non-functional. We also have about four working phototherapy units. We have two resourceters, modern and two ancient resourceters. We also have two oxygen cylinders and we have quite a number of oxygen concentrators. Unfortunately, they keep getting bad. And for the capacity of our newborn units, we have a capacity of maximum 30, but occasionally we stretch it to up to 48 when the burden is much and the children really have nowhere to go to. The unit is divided into four cubicles. Recently we added another cubicle. The first cubicle serves as a NICU and in that NICU you have preterms and very sick babies. Most of the preterm are nursed in incubators. When we are out of incubators, we keep them in the resuscitory to keep them warm. And then their mothers are close to them to ensure that the babies are kept in the kangaroo method. The other part of the neonatal unit is made up of six newborns and those babies that we have weaned out of the incubator. And we have about 10 baby cots. in that unit and that enables the transition from incubator into the courts and on the opposite side, the candaru beds, which permits the mothers to have some bonding with their children during that period. The other aspect of the NICU is made up of 10 beds and those 10 beds are, those 10 beds have courts beside them. It basically, The babies are nice to their mothers on the bed, which encourages breastfeeding. And this other part is meant for sick babies, inborn or outborn, probably referred. We probably have managed for neonatal sepsis, neonatal jaundice, the stable sick babies with cerebral dysphysia, respiratory distress, a transition to that part of the world. Then we have this other part of the world made up of four beds, which is basically for those bigger babies who were discharged from the unit and returned from some community acquired infection. And then we have a nursing station in the NICU and then the other station meant for counseling. So then we also have a consultation room just beside the units where we follow up the preterm and the low-budget babies and babies who have been discharged from the unit. Then besides the neonatal unit, about a one meter walk, we have a mother lodge where mothers take time to rest ⁓ when they are not actively taking care of their babies to prevent overcrowding in the units. Well, most recently, do not have that glass that separates caregivers from their mothers. It's really congested, but most recently we've been able to work with the administrator, with our administration. And we now have clothes which prevents overcrowding. If you're mother on admission, you have a baby, you'll be recognized by that linen that was manufactured by the hospital. And we have seen that that has significantly reduced overcrowding and it has also reduced the number of hospital-acquired infection. in our setting. To facilitate the work in NICU, it's going to be difficult for the pediatrician to always be there because there's only one pediatrician that has to serve the entire region. Yet this pediatrician also has to attend to other sick children and also has to attend to referral cases for pediatric consults. And to facilitate what they are certain guidelines on management of common urinary illnesses ⁓ that the medical officers use in the management of patients and the pediatrician comes in when there are difficult cases, comes in for ward rounds once or twice a week, depending on the burden of the work. And that has significantly helped in caring for these newborns in... in the resource limited country like ours, particularly in the north west and in south west regions.

Mbozu 

Thank you so much, Dr. Katie, for giving us an overview of your NICU and for giving us a tour of the different sections of your NICU. Considering you're the pediatrician leading this neonatal unit, just curious to hear about your personal story. Could you tell us why you got into pediatrics and what inspired you to become a neonatal pediatrician?

Dr Kate Kan 

Thank you very much, Shelly Anne and Dr. Bozu. ⁓ Well, becoming a pediatrician for me was out of passion because of how I saw those children recover after admission, after they presented in very critical conditions. I would also have wanted to become a gynecologist because it was much easier. It was like mathematics. And ⁓ for pediatrics, I had a little scare. What was my scare? The children were little too fragile for my liking. And I was like, would I be able to handle those tiny babies, particularly those in the NICU, the 700 grams? And during my housemanship, When I had the opportunity to examine these babies, touch them, I was now convinced that indeed pediatrics was where I wanted to settle. My passion for pediatrics after becoming a general pediatrician was to become a pediatric neurologist, which I will still become. And on your natology ranks among the next if I did not become a pediatric nephrologist. And therefore, finding myself heading in your natal units was nothing surprising that I could not handle. And therefore, my interest in your natalogy was breached four years ago when I started working at the regional hospital in Bamenda. And from that period, I've acquired a lot of skills. two conferences, two webinars that has also updated my knowledge on current guidelines on newborn care. And I would say that the love and the passion for wherever I find myself in the field of pediatrics is second to none because I give in my best and I ensure that as a team player, I involve and I carry everyone such that together, we all achieve a common goal to reduce neonatal mortality and to improve outcome from neonatal morbidities.

Mbozu 

Thank you, Dr. Katie, for sharing a bit about your background and why you're the pediatrician you are today and bringing it back to the big why of what we do, what we do, which is saving newborn lives. You touched on this at beginning of our chat, where you shared that the pediatricians on the English speaking side of Cameroon are not as many as the pediatricians on the French speaking side of Cameroon. And we just would like to explore that a bit and get your opinion on how neonatal care interventions are upscaled ⁓ considering the bilingual context of Cameroon and also how you go through those challenges and ⁓ make progress despite those disparities in the the human resource. Do you mind just sharing a bit on that as a pediatrician who is based on the English speaking side of Cameroon?

Dr Kate Kan 

The last Cameroon pediatric society congress we attended, there was an overview of the map of pediatricians across the country. And in a country of about 120 something pediatricians, we only had seven pediatricians in the North and the Southwest region. And why the disproportionality in the distribution? It's simple, the North West and the South West regions are suburban areas with less motivation in terms of people not having ability to involve in other practices alongside the social-political instability in those areas. Hence the scare of people to endanger themselves to be in this region. But notwithstanding, I am originally from the Northwest region, Anisa is from the Southwest region, and if we do not come to save our own children, no one is going to. And it's only but easy for you to see that EY Child Advocates and then you just have to make up your mind that as long as you're there for the common good, God will protect you. One of the reasons I left Nigeria back to Cameroon was to be a missionary to the Cameroonian child. Coming from where, in my faculty where I trained, there were over 40 pediatricians. And they're coming to marry it to having to be an only ⁓ one of three pediatricians in an entire region. It's quite demanding, but one thing I know is that God keeps giving me strength. Although I work in the regional hospital, I receive consults from the little health centers from the district hospitals when the medical officers are in distress. The other areas of the country where everything is apparently okay, you have a mixture of English and French speaking pediatricians who are also bilingual who render services to those in need of their services. And these places already have guidelines, policies, and of course the expertise of specialists in these different facilities. And... ⁓ This together with the backing of the Cameroon Pediatric Association guides and incorporates so that our practices are in conformity, irrespective of where you are practicing. Now we also have this belief that people think that if you can have some English-speaking people who are ill and they prefer to come to the northwest region or the southwest region because they believe that. Because they emanate from this region and when they come, their own people would speak and they would understand what they being managed for. And when they get to those other regions, yes, the doctor speaks French, but he understands English, but there is a problem of communication. This may be certain barriers in practice, but in terms of guidelines, There is unisomity irrespective of the level of the health facility, whether it's a primary health center or a secondary health center or a tertiary health facility. There are certain guidelines to guide even the cases where there is no pediatrician. ⁓ despite our difficulties, there are guidelines that aid in the practice of pediatrics, even in the sub-Oxfordans, no pediatrician. and the pediatricians, we guide them to ensure that we have a good outcome and when it is beyond their needs, then they have to refer to the facilities where they have access to pediatricians.

Shelly-Ann

Thanks for giving us that context and you went out the Kermmer and Pediatric Association. I know you just came back from the A &E conference, which is the African Neonatal Association Conference. What are your thoughts on the importance of networking in, especially working in the low and middle income context? Because sometimes We focus on education and supplies and sometimes not realizing the importance of networking and having a support system that you can potentially ask questions of and learn from others who are in similar situations. So I'm curious to hear your thought having been to the first ANA conference ⁓ and being involved in the Cameroonian Pediatric Association, your thoughts on these networking and slash professional associations and their role for the practicing provider.

Dr Kate Kan

the power of belonging and the power of networking. And that is what made me join the Cameroon Pediatric Association. And through the Cameroon Pediatric Association, I've been able to understand a lot about the practice of pediatrics in Cameroon. And it's not surprising that when you get to associate with other people, you get to understand more, you get to understand how things are done. and the justification for some of those things. Through the Cameroon Pediatric Association, there has also been collaboration for perinatal networks across the country. And the aim of the perinatal network is all the facilities in a particular region are linked to each other, such that if there is a problem in one facility, and there is an answer in another facility, it's going to be easy. And so this note, being present at the first African Unitality Association physical meeting that took place at Kigali, personally to me, it was a great opportunity to interact with other African nations and to see where to see how ⁓ close we were in our practices and to also see that we experienced almost the same problem. And it's actually a motivation that you're not there alone. And if others in those difficulties can go through, then we too can go through two collaborations. Now, one thing I learned from the Anna Congress was the involvement of a lot of stakeholders in their health facilities, which has made it possible for the many advances in neonatology to take them to where they are. I'll give an example of the caffeine citrate. The caffeine citrate was a major issue in most countries. Of course, it was an issue even for me in my undergraduate days. And according to Cameroon, at the time I came to Cameroon, the right transitioning from amino filling to caffeine citrates. And I remember one of the days a patient could not afford caffeine citrate and I wanted to do amino filling. And my nurse said, don't change, don't change. And I was like, why? She said she noticed that since they started placing the preterms of caffeine C-trade, their morbidity and mortality from respiratory distress significantly reduced. That was because at some point caffeine C-trade was able to get into the country. But yet, if we are able to collaborate with Anna, we are able to have some funding. with some hospitals being a site, I think that surfactants could also get into our context. And that would significantly ⁓ also improve outcome as pertains to prematureity, prolonged oxygen use, retinopathy, and a lot more. So what I see is that Anna Congress made me understand that a lot has been done and unfortunately Cameroon is a country that was just nested out of a lot that was being done in West Africa, East Africa and very little emphasis was put probably because we are not part of West Africa and we had to make ourselves visible to represent our country for the passion that we have to improve newborn care. And I believe that if we can get our home association to collaborate with Anna, they would have the power to bring in some of these projects like the Ness 360 into the country that may be an initial start point that would go a long way to improve what is being done. I must say that most of what we have in the country has been planned out through the efforts of WHO and UNICEF in collaboration with the Federal Ministry of Health. So I believe that the networking is good. I believe that the collaboration is good. with innovations, every country wants to grow in the health system. And I really believe that the Cameroon Perinatal Association and the Cameroon Pediatric Associations would be good bodies for anath to collaborate with so that we could share. our strengths, could share our weaknesses and we could build up together to fill in the gap.

Mbozu

Thank you so much for that really interesting reflection on the first ever African Neonatal Association Conference and the importance of leveraging new connections through established connections such as that association. And it is a very good idea and a very good suggestion to build or strengthen connections between national pediatric and neonatal associations and the African Neonatal Association. I know that the African Indian Association does have a memorandum of understanding with NEST 360. So perhaps that could be something explored with the Cameroonian pediatric association and just having conversations with the association on how to strengthen links with Cameroon and other Francophone and Portuguese speaking African countries. So really appreciate you sharing that. reflection. So we've touched on so many interesting things and I really do appreciate you sharing your personal career story and also your reflections as a pediatrician in Cameroon. ⁓ One thing that we're big on and I think you're big on as well is mentorship, considering that you would like to get into pediatric nephrology, but at the moment you are in neonatal space. How important has mentorship been for you as a consultant now working in the neonatal space and also leveraging new connections as you go along?

Dr Kate Kan

In fairly mentorship, I'd say that mentorship plays a great role in career. Looking back at myself a month ago, just reflecting, I found that I was a replica and a reflection of the woman who saw me at the beginning of my residency days when I did not know exactly what it took, all I knew was, naive and immature as I was, I wanted to become a pediatrician. Yet, I did not do the things that was going to make me become a pediatrician. But because I met someone I told I wanted to be like you, she held me by my hands and she put me through every skill until I became a pediatrician. And I would say that I remember the days you had to go for membership exams, the first time I went and I failed. Not because I wasn't equipped with what it took to make the exam, but I had a lot of distraction. had a lot of, I felt that I was too young. I felt I had time. But I remember you telling me, if you go and fail this exam, don't come back. So I quite won't. And that's like, that really put me on my feet. Apart from, you know, just becoming a pediatrician, she also taught me how to become a manager. She also taught me how to become a leader. She also taught me the role of personal development, the role of multitasking apart from medicine. And through that, I've been able to, you know, have other avenues to generate funds at some point to or some children who really don't have. And she plays a significant role in my life when it comes to self-investment. She's the first person who taught me that you could attend conferences even when you're not sponsored. And I'll tell you that her role in this has also increased. My network. Myself and Niza became ⁓ members of ANA when we attended the pediatric association, the pediatric association of Nigeria Congress, where we got to learn about ANA. And it is through that that we beg the office, we are pediatricians, we work in the Neurology unit, would we be added to the group? Initially, I was added because I trained in Nigeria and Niza did not. but with her next involvement, she was added. Also, I have also had another mentor in Brazil who has put me through the paths. I didn't have an opportunity to go through a formal training, but through the mentorship of Professor Nizet in Brazil, we were able to successfully manage renal patients in a in Bamenda here where there is no other pediatric nephrology. So I summarize the cases with her and she puts me through, Katie, have you done this? Have you done that? And all the patients I manage with her through her mentorship, even at a distance, significantly improves the outcome of my patients. It is through her mentorship to me that I am on my way to acquiring a fellowship in pediatric nephrology. at the University of Cape Town in South Africa. I remember going to some scouting program over the internet. The response I was given was that, beautiful, we see your CV. We see that you're well grounded in nephrology. We think that you would make a better fit for a scholarship in pediatric nephrology rather than in neotology. But one thing I've told myself is, All I need is a mentor in unitology and I would have a fellowship in the two, nephrology and unitology. It's only a matter of time. And Green, I have benefited from mentors. And now as a teacher, as a leader, as a consultant, I have also played a role in mentoring my students, my GPs who I work with. as I talk up with you, two of a student I trained and a GP who has worked with me is being mentored. And we are on the path of looking for a way for him to go into residency in pediatrics. I would say that he He never initially thought he wanted to become a pediatrician, but I called him one day say, you're doing so good in pediatrics. Love for children is there, the passion is there. No, no, no, no. I don't want to see you be a GP. When you become a specialist, it's like there are neither, the distance is clear. And as a teacher, I am a role model to some of my students and I'll say some of them love pediatrics because of me. So the role of mentorship in career, in teaching, cannot be underestimated. It's like a motivator, it's like a push, it's like a drive and it helps in achieving and attaining success, either to the mentee or to the mentor. Because a mentor is proud, I have trained you, my child has grown to become like me. And the mentee is like, ⁓ thank God for my mentor, if not for her. I would not have been motivated to get to this level.

Shelly-Ann

I love that. Definitely a two-way street ⁓ mentor-mentee relationship. ⁓ So we are getting close to the end of our time together and we appreciate you taking the time out of your busy schedule. And so one of the things we always like to ask as we're winding up is, do you have any words of advice for someone, whether it's a medical officer, a pediatrician, working in an area that's trying to improve neonatal care? any words of advice that they can kind of cling to on those days where it seems really hard or they feel like they're not making progress so they don't have what they need, what words of advice or encouragement would you give to that person?

Dr Kate Kan

My word of advice goes to two sets of people. So those who are currently working in the Li'l Atta unit, first of all, to be passionate about what they do. Once you're passionate, you love what you do and you're going to go out of your way to try to create a solution to that problem. Like I often tell people, I was trained in the tropics and I can practice pediatrics, even in the bush. So whenever there is a will, there is a way. And the second thing is anytime there is an ability to get a little knowledge to improve upon yourself in capacity building, do not hesitate whether it was being sponsored by you or it has been funded by someone because whatever knowledge we acquired, can never be taken away from you. And that knowledge would go a long way to help a thousand generations to come. And for those who are not yet working in an unitology unit, to avail themselves to acquire all the necessary knowledge they need right now to equip themselves for the battle ahead of them. In summary, the passion you put in what you get is a reflection of the love you have for that thing. And once you're determined, you say this child will not die, the effort you put may actually prevent a death. As compared to when a child comes out of here, you say, it's okay. So compassion, love, dedication, sacrifice are all that are needed to improve neonatal care in Africa despite our limited resources.

Mbozu

Thank you so much, Dr. Katie, for ending on such an inspiring note. I'm sure our listeners would be curious how they can reach you. So how would you prefer to be reached and would happily add that to our show notes? Is it LinkedIn or via email?

Dr Kate Kan

They can get to me by email, by WhatsApp, or in LinkedIn.

Mbozu 

Okay, we'll definitely add that to our show notes. So thank you for that. Thank you for joining us on this episode of the Global Neonatal Podcast. We hope you found this conversation as inspiring as we did. If any of this resonated with you, share this episode with someone else who you think would find this valuable. If there's someone you think we should have on the podcast, please don't hesitate to reach out. We'd love to hear your suggestions. Until next time, take care, and keep making a difference and let's go faster together for newborn care.