#374 - 🌍 Uganda’s Model for Collaborative Neonatal Care with Dr. Ruth Grace Babirye Kakoba

Hello friends 👋

In this episode, Dr. Ruth Grace Babirye Kakoba discusses the transformative efforts in newborn care in Uganda, emphasizing the importance of collaboration among healthcare professionals. She shares insights on the National Surfactant Administration Protocol and her personal journey in maternal and newborn health, highlighting the significance of mentorship and self-care for future leaders in healthcare.

Link to episode on youtube: https://youtu.be/LCJHVyP1Iq4

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Short Bio: Dr. Ruth Grace Babirye Kakoba is an Obstetrician and Gynecologist and Technical Advisor for Maternal and Newborn Health with Doctors with Africa CUAMM, seconded to Uganda’s Ministry of Health. She also worked with the National Newborn Secretariat, leading efforts to strengthen regional networks of care, improve clinical mentorship, and align national newborn initiatives.

Dr. Babirye Kakoba’s work also includes introducing the first National Surfactant administration protocol in Uganda and helping to establish regional newborn networks, fostering collaboration among facilities and clinicians across Uganda.

A passionate advocate for maternal and newborn health, Dr. Ruth Grace is part of a new generation of Ugandan physicians combining clinical expertise, systems thinking, and compassionate leadership to transform care for mothers and babies.

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

Shelly (00:02.914)

Across Uganda, a quiet transformation is unfolding. One led not by technology alone, but by people who connect, coordinate, and care. Today we're joined by Dr. Ruth Grace Babirekoba, a Ugandan obstetrician gynecologist who's been instrumental in creating regional newborn networks of care and leading Uganda's first national surfactant administration protocol. Today we'll explore how collaboration drives change and how a young physician's leadership

is shaping the future of newborn care in Uganda. Dr. Ruth Grace, thank you for joining us on the podcast today. We're so excited to have you here.

Dr Ruth Grace B. Kakoba (00:42.369)

Thank you very much for having me. I'm also glad to be here at the Globoneo Podcast. Thank you for having me, Shirley-Anne and Bozard Grace.

Mbozu Sipalo (00:53.302)

I love that introduction, Sheleanne, and great to have you here, Dr. Ruth Grace. Just to explore that beautiful story that Sheleanne has started, you've played a central role in establishing regional newborn networks and leading Uganda's first national surfactant protocol. When you reflect on these achievements, what do they represent to you personally?

Dr Ruth Grace B. Kakoba (01:24.425)

Okay, so first of all, I am I am glad to be here and I wanted to share that these are the efforts of a team and not for one person. And this team is made up of amazing pediatricians, neonatologists, gynaecologists, and also neonator nurses and midwives. So it's a whole team. And maybe to start off with, I'll go from the side of many people want to know why is an obstetrician doing this work a newborn.

I know it's the biggest question, but when you think about it, having a newborn is really from the period from zero to 28 days, but we always leave out the baby who's growing inside the mom. So before the baby comes out, there is a living human that the pediatricians love a lot, but is also making their way through the nine to 10 months of pregnancy so that they can come out live and healthy and able to survive and thrive.

So being an obstetrician, you have to look at the angle from one, point when, one, when are you planning to have the baby? I mean, planning to have a baby that is healthy, and then you see the baby through the pregnancy, not just the mom. That's a thing that most times I think, in my view, my profession, that most of us forget that there's a baby that's growing in there. And also parents as well tend to just see a bump and say, yes, there's a baby coming through.

And most times they don't really think about what's happening within my uterus, how are my baby's movements, how is my baby doing today and all that impacts the health of the baby either leading to a stillbirth which most times ignored or leading to an early neonatal death. So being an obstetrician leading a newborn care was through the vision of the department of reproductive and child health at the ministry led by the commissioner.

and commissioner did give a direction that it is important to look at things from a 360 approach. When we are talking about bath asphyxia, how do we also engage the teams before the baby comes out? We always have gaps in monitoring of the baby. When the mother is admitted into the labor ward, you will find the mother very happy and then everyone comes and checks, okay, how is your blood pressure today? How are you doing today? Are you okay? Did you eat?

Dr Ruth Grace B. Kakoba (03:46.231)

But then the question is, how is your baby today as well? That needs to also come out. So before that baby comes out, there's a lot we can do. And also looking at beyond just the newborn resuscitation and us exploring other areas really in neonatal health and also perinatal health. That is why that is. And along this journey, there's been a lot of tests. Guys, I talk a lot, so feel free to interrupt me at any point. So, okay.

So along this journey, there's been a lot of interactions made, of course, with friends and also the pediatricians. And Uganda, along its MPDSR story, created what you call the local maternity and newborn systems. So in the past five years, the maternal systems have been strong, having regional obstetricians run care or guide care to the lower level facilities through a hub and spoke model. So we said, how about...

having newborn clinical support networks of care within this local maternity and neutral systems. And that's how we came up with the newborn coordinators within the local maternity newborn systems. So these are held at a house at the regional referral hospitals. And within the central part of Uganda, they are housed at the national referral hospitals. Our health system is in a way that you have a specialized hospital, a national hospital.

And then you have a lower level facilities that follow, are regional referral, general hospital, and then the health centers. So it's more of a primary health care approach if you look at it. And majority of our mothers give birth at the lower level facility. That is health center threes, that is an in health center four. That's the first interface a woman has for an emergency obstetric, cesarean section or blood transfusion.

That's the first international woman will have that with. So that means that if a baby is going to be moved up to care at the higher level, which is most often far, you will have a delay. But how then do you support these other facilities lower to be able to take care of this newborn before they even come out, before they are even born? So the newborn coordinators who are the local maternity newborn coordinators are doing a good job in championing this.

Dr Ruth Grace B. Kakoba (06:07.265)

How do they start up newborn conversations within their region to different healthcare workers? Most times a healthcare worker is torn apart. I've resuscitated a baby, the baby is convulsing, I've given diazepam. I'm now on my second dose, I do not know what else to give. Then someone will promptly come through and say, okay, I think you should try this. Give this to this baby, do this investigation, this should support. And amazingly, we've been able to do this through WhatsApp. So COVID showed us a lot of things that you can learn from.

So majority of this work is done on WhatsApp and phone call. So if you're stuck with a baby, you say, okay, so hi, I'm now called a neonet. So they say, hi, neonet, so what's happening? I have this case, this and that. And then because I am not technical in pediatrics, I'll quickly call up the pediatricians in some regions or even just link them up straight and say, please, this facility needs your help. And that way they're able to get the care that they need.

And it's starting off, we want to see that we get all the regions involved. There's been of course, like any other starting points, there's been a little bit of slowness, not all the regions are covered. As we've had some pediatricians go back to school to study, which is good. So in that absentia, we now having to think through how else do we improve our network? In the view of the less human resource we have for the newborn, could we also have say,

have medical officers who run the newborn units. Most times if you look at the newborn space, will see that newborns are left for midwives. I don't know if you guys noticed that. They're left for midwives a lot. And I think it's a perception that yes, okay, the midwives still deliver as a baby, and they should be able to continue with the baby. But I will gladly say that I think nurses do a better job because if you have a midwife focused on the mother,

And then you have a dance focused on the baby, you're able to make things work. In other hospitals, they've been dynamic. I'll give an example of the Mbali newborn system, clinical support network led by Dr. Kathy Vagoine. She's done a good job. She's actually involved clinical officers in the care of the newborns. the clinical officers, so clinical officers are like a sub title below medical doctor.

Dr Ruth Grace B. Kakoba (08:27.881)

And they're now able to do ultrasound scans for babies, you're able to do a cranioscan, you're able to do a lung scan. So how do we harness the efforts of the other healthcare professionals within the system? And through those conversations, I think we'll definitely improve where you have in the absence of a pediatrician within the region, you're able now to get, okay, where is the clinical officer? Where is the medical officer to come through? Where is the head of nursing here to come through? And I think that will definitely move strides.

a long survival of newborns in the country.

Mbozu Sipalo (09:06.254)

Thank you, Ruth, for taking us through the landscape of the newborn network and giving us a really good example of how it's working in that scenario with the clinical offices. As an obstetrician, like you've said, you've had...

I think like a duality of clinical experience from being in the front end on the mother side and having this technical eye on the baby side. So are there more people like you in Uganda? Or is it a thing where the neonate of the neonate obstetrician is only Ruth? I'm just curious about that.

Dr Ruth Grace B. Kakoba (09:55.098)

I think there are more champions in Uganda. There very many champions in Uganda. I am glad to be just one of them. And I think the biggest champion, I'll be honest with you, I think it is the commissioner, the one who leads all of us, who is also the chair of the Newborn Working Group. He's amazing. If someone thinks through ways in a global space like that, then it's just amazing. Things work.

There are very many, of course the maternal teams now interestingly the maternal teams when you opened up the newborn coordinators the maternal teams also now are like yes the babies the babies the babies so we are we are having really a reverberation of newborn energy to sort of like champion this and it should really stick I will share with you that we did lead the first and I think I shared with you Grace when we were in in Tigali

that we didn't have the very first celebration of a baby's first cry. And how did this come up? We were thinking, okay, we can't celebrate bath asphyxia. It's sad. It just is we have failed that baby. We have failed that mother. And we have failed that family. But how can we celebrate a baby's first cry? And what does the community know about bath asphyxia? They just know the baby delayed to cry. In my language, you'll say,

cover, which means the baby delayed to cry. So we say, let's celebrate the baby's first crime with a community knowledge saying your baby should cry within the first minute of life. And interestingly, most times we say, okay, yes, the birth has fixed here is because, you know, the mother delayed within the community, the mother delayed to come to a facility. And throughout this month, as in June, we discovered that

It's actually our delay and the data is not deceiving us. Delays one and two have really been solved much of the time and now we are having delay three at the facilities. Healthcare workers holding on to clients, holding on to mothers. Mothers being delayed within long queues and I think it's not the only case in Uganda, it should be elsewhere.

Dr Ruth Grace B. Kakoba (12:11.701)

You're in a long queue, a mother is referred on time and then she spends about three days or four days in a referral facility without being attended to and then we lose her and then we lose the baby as well. throughout that entire month we were saying, please parents listen to the baby's first cry. Did your baby cry? If your baby did not cry, ask the doctor, ask the midwife, ask the nurse, what is going to happen to my baby?

Because most times we also, you realize that the most newborn deaths, the late newborn deaths after seven days occur within the community. A majority of these births, of these babies that actually die within the communities are birth asphyxia related babies. So I will say that during this month, we got both the obstetrician teams, the midwifery teams, the neonatologist, the pediatricians, stroke neonatologists, all of them came together to just give one lecture.

talk to the people of Uganda within the different regions and say, okay, let's have the babies cry so that we can reduce birth asphyxia rates in our country, which is the largest cause of death among our newborns. Contributes about 57 % of all our newborn deaths.

Shelly (13:25.966)

Wow. I really like that celebrating the newborn cry and using that as a bridge to help advocate, to have parents self-advocate as well as remind the providers that that is a sign of physiologic stability in a way. And I think you brought up a very important point that we hear through talking to people on this podcast, which we're so honored to be able to do that.

and what Dr. Joylan talks about in terms of we have now seen that shift globally from you need to have care with a specialized birth attendant, we need to have, be able to get to a hospital if you need to. And now we're in that category of now it's us and the quality improvement and how can we really provide safe care for these patients that are trusting us that we've.

over years that you need to come here because it's safer here. And we're learning that sometimes it's not. And so that's that shift that we are seeing globally, which brings me to one of the things I was excited to learn more about is that National Sofactive Administration Program because that's in that intensive care layer now that the baby's born, the baby's early and needs specialized care. So I would love to kind of switch gears and talk a little bit about that.

specifically, how did that initiative begin and what inspired it and maybe any learnings that you have learned by implementing a national program of this scale.

Dr Ruth Grace B. Kakoba (15:05.751)

I'll be happy to share that is one of the many programs really that have been championed in our country. One, why surfactants? And I'm glad you mentioned the intensive care level. That's true. Currently in our country, we are finalizing the guidelines for setting up and operationalization of newborn care units. And in Uganda, we've defined our newborn care levels of care to be four.

And that is level one, level two, level two is split into two. We have a two A and a two B, and then a level three and a level four. And for our general referral hospitals, we really want an in-intensive care unit there. That is our level three. Having every region, that is where now our pediatricians are, and also some of our in-initial logists, be able to carry that mantle on. And we want all our national referral hospitals to be at least specialized.

NINETO intensive care units. There's only one misnomer that one Ritunorio-Farrow hospital which we're going to be launching this November during World Pimertory Day is not actually just an NINETO ICU. It's going to be a specialized NINETO ICU with pediatric surgery. It's going to be amazing. And you guys are welcome, by the way, to attend. So yeah, make time.

So when we said, as we are writing these guidelines, what else do we need to do to make sure that this product is available for babies? In Uganda's, prematurity complications are the second leading cause of newborn deaths. And we're seeing about 200,000 babies are born in Uganda. Pretend these babies are not born within the central area. majority of them are actually referred to national referral hospitals for suffocating administration and also for

for care. So we say, okay, how do we get the regional teams involved to come through and support that these other petitions to understand how do we give surfactant, which protocols do we even need to give surfactant? So along the way with the support of BLESS, I don't know if you've heard about BLESS, but it produces surfactant and it was also introducing the surfactant within the country. We said, why not? We are welcome to this idea. So we're able to discuss with the marketing team.

Dr Ruth Grace B. Kakoba (17:28.223)

led by Joanne, I forget the other name, it's very hard, but she's Canadian. But yeah, so they came through and they were able to support a training of the pediatricians. But before the training, we did go through a development of the protocols. So we did both the insure protocols and also the minimum invasive method. So those two protocols are available for pediatricians to use. And we say that yes,

After having these protocols developed, then the pediatricians within the regions can now reactivate to see how do we have mechanical ventilation also available at their facilities. Now, has this come with challenges? The answer is yes. The first big challenge is one, how do we buy surfactants within our generic fire hospitals? Along the way, it's an interesting by the way journey, it's a very interesting journey newborn.

we are, and I think globally it's the same thing. We're moving away from the point where the newborn was managed with a baby. When I was a medical student, the newborn was always managed where the mother is. So the mother is here and the baby is just on the side. And if they say they have subsist, they will give the antibiotics just on the bedside. Now we are, and now we are recognizing that a newborn baby can be a patient, is an actual patient.

And whenever I'm talking to my newborn teams, I tell them, look at a newborn baby as a patient who enters the hospital. If you go through the outpatient department, which is our clinics, our newborn follow-up clinic, a baby can be sick or a baby can be stable. If the baby is stable, you'll give health counseling or give vaccination as needed. If the baby is unstable, you will admit the patient. So why do you admit this patient? That is why newborn care units now make sense.

And when you're admitting to the newborn care unit, just like any other patients, the baby may deteriorate. Now if they deteriorate, usually in our hospitals, we have a high dependency unit. So you're like, okay, so where is the high dependency unit within your newborn care unit? It should be there. Then after that, you're like, okay, but what if the high dependency unit is not enough for this patient who's doing badly? Where do you end up? You end up in an ICU. And after that, you step up into the unit or ICU. And then after that, you realize that

Dr Ruth Grace B. Kakoba (19:47.785)

Okay, just like any other patients, you may be there and then you have a condition that requires a specialist to attend to you beyond nurse or neonatologist. Someone else to attend to, could be a cardiac surgery, it could be, I don't know, a kidney surgery, it could be a tumor or cancer. So how do we now also have a specialized neonatal intensive care unit? And that is how the levels of newborn are. Now, at our Unary Faro hospitals, we realized that yes, we have a space for newborn care. Newborns are being taken care of.

But not all our January pharaoh hospitals are offering surfactants and also ventilating babies. So we've tried to visit a few and had interactions and say, okay, why is the challenge? Why is the challenge? And then we realized that there's actually a gap between the commodities that are requested for by the facilities and versus what is delivered. So in the newborn care units, the pediatrician is going to ask for surfactants, is going to ask for caffeine,

is going to ask for sephotaxin, my second line antibiotic. But then when it comes to the team that is going to procure, they will say, what is this? This is very expensive for us. And then they'll put it down. And that is, I just think that my teams are angry people. And I think it's okay to be angry sometimes, angry for the newborn. you have to, you know, it's not a fist fight, of course, not going to fight, but politically and diplomatically.

paves the way for the newborn and say, please, we need this drug. It's important. It is well. And indeed, that's how the National Referral Hospital got in. Now, what are the glitches that we are facing? One, the surfactant is expensive. I don't know if one day God will wake up and just say, surfactant, let's just half the prices. It will be amazing for all our babies. And I hope pharmaceutical companies can understand that. It's very expensive therapy. is needed.

Shelly (21:16.272)

Mm-hmm.

Dr Ruth Grace B. Kakoba (21:41.367)

for a good number of days, maybe one or two, but those two days are really pricey and out of pocket most times for the clients. Now our government hospitals are able to procure this. How do we now get it onto the lists? Now through how to solve those challenges, we've interacted with pharmacists, we've interacted with these different medical team coordinators to say, please, we request kindly include this drug, even if they are two vials, please.

Let's start with that and then you can be able to save the babies. So that's how we've seen that yes, most of the time, pediatricians now are able to give us surfactant, but the ability of the commodity is the problem. And then of course, like I mentioned, the fallout and other pediatricians having to go back to school. So you leave a gap in care. Now, when some of my nurses who actually know how to use the minimally invasive method try, then they find resistance from the hospital teams. Those have been some of the challenges that people have shared with us.

where one of the nurses was actually asked, are you an anesthesiologist to give surfactant? So such questions. And that way it delays care. It delays care. But I think with time we are going to get there. If to me the win will be if we start one by one, I think we now have, think, two general pharoahospitals that are able to give surfactant care and even receive the babies within the delivery room.

For me, that is amazing. If we start one by one, we'll be able to cover all the 17 regions that we have in Uganda. So we solve, because the issues of one hospital may not be the same as the other hospital. You may find one hospital has a budget, but you find it's the staff that are not trained. Then you may find that one hospital has a staff that is trained, and you may find you don't have a budget. So we solve things slowly by slowly, but I think we'll definitely get there.

How we move on to ensuring that the fact that is available in ordinary parahospitals, my view is that, of course, we are trying to see how do we get more funding so that we go and now train all teams. So beyond just training just the pediatricians alone, which we did nationally because now there are trainers of trainers, how do we support them to now gather the other healthcare workers to come and support them and train? Yeah.

Shelly (24:00.88)

Wow, that is indeed a challenging process I can see to get where it needs to be because you have surfactant issues and then training issues and things like that, but well worth the fight, I'm sure. When you said minimally invasive, are you talking about using an LMA or is it the thin catheter? Do you know, perchance, what minimally invasive?

Dr Ruth Grace B. Kakoba (24:24.595)

Yeah, we, the thin catheter, yes, but we did have discussions and then you can still use a small NG tube, I think size five. I don't know. Yeah, you can still use an NG tube to do that. But the BLESS team, I think has some BLESS catheters and they were in discussion to see how do they have them procured together with the surfactant. So I hope that they get success through the pharmacy team of the Ministry of Health, that those can be procured together.

Shelly (24:32.954)

Mm-hmm. Yeah. Yeah.

Dr Ruth Grace B. Kakoba (24:52.373)

But in the meantime, the teams will be able to use the NJTUB to administer. And then, of course, for the insure method, then they will have to intubate. Those are available within the facilities.

Shelly (25:04.654)

And just to clarify, the Blue Steam is this pharmaceutical company that does surfactoids. It's an NGO. Okay. Okay. Got it. Okay. Okay. Thanks. Thanks for clarifying that.

Dr Ruth Grace B. Kakoba (25:10.357)

Yes. No, it is a pharmaceutical company. Yes. Now we have more pharmaceutical companies willing to come through and support, which is good.

It's everyone's business.

Shelly (25:23.076)

So we, yeah, yes. I mean, it's gonna take, it takes multiple stakeholders to be able to get, to get something like that off the ground. So we, we, we continue to be hopeful that over time the process will get smoother and every baby will be able to get surfactants should they need it. And so we kind of jumped in and, and, kind of talked about all the national stuff that you've done so far, cause we wanted to make sure that we, our listeners understand

the person that we're speaking to. We were very excited to hear about all the things that you're doing, but I want to take it back a little bit and kind of learn a little bit more about you and kind of what prompted this. I know you clearly have an interest in a newborn space, but I'm curious as to where the journey began for you in maternal and newborn health. Was there a moment early in your life or training that prompted your decision to become an obstetrician?

Dr Ruth Grace B. Kakoba (26:24.039)

Interesting. Now, I'll be honest with you, the very first time I didn't even see, I had a woman give birth, I ran out of the labor ward. It was too much. It was too too much. It's, no, it was a lot. I still think it's a lot. Don't judge me. I still think it's a lot. And I don't think there is a...

Shelly (26:38.406)

You

Dr Ruth Grace B. Kakoba (26:49.697)

there is any award for women going through pain during labor and I hope more women really do that. They can have painless labor. It's just important. It's just too much. Anyway, so how did we end up here? So three weeks into the first rotation in obstetrics, I did not, I had not examined the mother, had not touched the mother, but I had to go through the rotation, which means I had to actually participate in the care.

of a mother. I'm like, okay, so what do I do? So I went to the midwife and I said, can I help you prepare to receive the baby? Because the other process was a little bit too much. I'm like, can I help you to at least prepare to receive the baby? And then she said, it's okay, no problem. So the next one week had me preparing cotton, preparing gloves.

And then after one week, I'm like, can I help you receive the baby? So she would deliver the baby. And then she gives me the baby. That's a male midwife. I was in Barra University in Southwestern Uganda. So the male midwife also gave me the baby. And then I received the baby. And then I, you know, keep the baby warm, remove warts, dress up the baby. It was cute. That was the cute part. Aha. Then one day. So now I'm left with about two weeks to leave the rotation.

one day I was doing the process as usual and then I'm saying okay it's okay I am waiting for you guys to give me the baby so I'm there with my gloves and then the woman comes in turns out she was actually a friend of my mom um she's like it was a she was a gravity defy which mentioned that this was her fifth pregnancy so they don't delay in labor so she comes and she's like the baby is here I'm like where

She's like, Musa, which means doctor. The baby's head is coming out. I started screaming. Second, far as the one in labor, I was like, Oh my God, the baby's here. And then, so the midwife, I just stepped out to go and get a drink and then everyone comes running into the labor ward and they're looking at me. I'm wearing a surgical gloves. You can't deliver them. I'm like, the baby's here. They're like, yeah, you're dressed up. I'm like, what? Everything was just a turn. I turned up like, what?

Shelly (28:56.314)

You

Dr Ruth Grace B. Kakoba (29:10.891)

You can deliver the baby. And the woman, like the baby kept on coming. And I'm like, okay. So I grab the head. I'm like, okay, what do I do? They're like, okay, the shoulder, first shoulder down. I'm like, what? How? Then he's like, just tilt the baby down. I'm like, okay. Just know, I think I made more noise than the mother. The baby comes out and I'm shaking. I am like, okay. The midwife comes in, I give the mother the baby. And I'm like, whoo, whoo, whoo.

Shelly (29:30.702)

you

Dr Ruth Grace B. Kakoba (29:37.779)

Yeah, and everyone clapped for me and said congratulations on your first bath. I give bath notes to the mother that way.

Shelly (29:42.822)

you

Dr Ruth Grace B. Kakoba (29:46.039)

So fast forward, we go through obstetrics and next week I was very comfortable with at least even delivering a baby and that is how my journey in obstetrics started. If I told you that I would ever imagine myself in obstetrics, I would be wrong because I've really been a public health and global health advocate. That's one I will not be shy about.

So here comes the COVID times, internship that gets done. Internship, interestingly, I did pediatrics for five months. Everyone thought I was going to do pediatrics because of my personality. I am a jolly person, I am just happy. And then I always go to the wards with colored rubber bands in my head and then have time to sing with the patients. And then the sad part is crying for the patients. That's too much. I feel like...

It's a lot, it's a lot. five months down, I'm like, okay, so this may be the side where I go. But in my head I'm like, do I do a master's of public health? Do I do a clinical masters? Which clinical masters were still torn apart between obstetrics and pediatrics? So internship gets done. My first job was a public health job.

It was really in the camp. was amazing. And then after six months, I said, okay, I have to get into school. So the only reason I did not do neonatology is because it had to take me five more years to do neonatology and I'm a lazy person. So I chose to go the hard way, which is do obstetrics for three hours and solve the problem of who makes the baby. Yeah. And that is it.

So if you solve the problems of women, if you solve the problems peripatia, that's probably before they get pregnant, during pregnancy, more likely to have a healthy baby. So I hope that paves the way. And somehow I find myself into this journey of championing maternal and newborn health, which I am very proud of because I've been doing that for the past five years. It's been amazing. When you talk about medicine beyond the four walls of a clinic, that's what makes sense to me.

Shelly (31:38.608)

Mm-hmm.

Shelly (32:01.936)

Mm-hmm.

Dr Ruth Grace B. Kakoba (32:02.817)

when you enter the hospital and ask, why don't I have a cannula today? Why don't I have a cannula for the newborn? Why am I having only big cannulas? Why does the mother have to go out and buy a medication that's available in our stores? Because for us, healthcare in Uganda is actually largely free. You enter into a hospital, in a public hospital, you will receive care as needed.

So you shouldn't be able to go and buy things just because someone did not order for the drug, just because someone forgot to take a stock count of what is available, someone forgot to place in an order timely from the national stores. So really, to me, that's what makes sense. And I believe that voices need to be heard, especially in our field. If you look at many people who are in the advocacy space, will see people within the social world. And I appreciate those people.

because of the people that made me an advocate. I was mentored very well. I've always been a peer educator for girls at campus and also for young people, for adolescents. I've always been that. And it's the people that mentored me. But I always ask myself, where are we medicine into this space? Why are we quiet? Why are we in our hospitals locked up? And then you see a mother carrying a baby coming in with a baby who is really sick, malnourished.

with a cardiac disease that was diagnosed early but the mother is not coming to hospital and you want to ask why, why aren't you coming to hospital? So before we become too judgmental, the actual question is that maybe there is something that we should have solved earlier. There's something that maybe that this person is dealing with socially that impacts their health. And when you look at health in that way, with social determinants of health also impacting health, you're able to solve most of the issues of...

of the mothers and children in Uganda. Yeah. So that's how I am here now.

Mbozu Sipalo (34:03.278)

Thank you for giving us that very interesting, very humorous account of what got you into the obstetric space and also to the newborn babies, which is a great linkage. I sort of have a question linked to interacting with

healthcare workers like yourself. So considering you're now outside of the clinical space, but leading the neonatal space and your obstetrician sort of being the newborn coordinator, if I'm not mistaken in Uganda, how do the healthcare workers perceive you? Because oftentimes there's this outsider sort of perspective when you're trying to

bring up new initiatives and bring in healthcare workers who are still on the ground. So have you been able to move through that as a clinician who's now in the public health space?

Dr Ruth Grace B. Kakoba (35:10.995)

Okay. Thank you for that question. I get that a lot. So many people ask me, do I miss clinical care? The answer is I'm doing clinical care a different way. So yeah, there's a lot of perception that when you are a clinician or you have a Masters of Medicine in a clinical area, you should really be in hospital.

My parents also ask me that a lot. So you're not the first ones to ask me and I always say one what is your passion and I know that very many young ladies out there Today we are celebrating girls, by the way in Uganda. There's a brave girls festival. So and I hope they get to see this podcast that

We are all women and we're women in medicine. We're women moving strides. You do not have to do something that you don't feel passion for. So if I am an obstetrician, I did obstetrics so that I can be able to help people out of the hospital. And I hope this makes sense for more people as we come out. I'm here with Dr. Shelley Anne. She's an urologist, but if she was too clinical, she wouldn't be here today. She wouldn't have given me her time at 6 a.m.

And I think that is the movers of the world. can't just say, we can't just be coy and then cover ourselves up in the books and say, okay, yes, I'm going to do how many surgeries, I'm going to see how many patients and change the world. Even if you see those many patients and you're not an advocate for them, you cannot change the world. And so that is how we solve things. If you are a clinician, very good. Now have someone else to support you and move the angle of advocacy.

And indeed, our teams also have done the same thing. Some of them will tell me, Dr. Rosemary, I'm not good at the things that you do. I am like, it is very OK. So how do I support you? I have given you my midwife. I think she'll be able to represent me. And I'm like, thank you so much. I have given you my nurse. I think she'll be able to be the one to represent me in this meeting. She'll be the one to be able to talk about the things that we need. And that is how we are going to create the change, harnessing onto each other's efforts.

Dr Ruth Grace B. Kakoba (37:17.963)

So I am happy being a clinician that goes out. And do I sometimes, of course, end up in two clinical care? answer is yes. So most times by mandate, the Ministry of Health is supposed to provide support supervision to facilities. Now in our department, our support supervision is not becoming bossy and saying, hey, why didn't you do this correctly? Why didn't you do this work? No. You head in and understand and work with the teams.

So most times if you put me on your support supervision team, I will be the annoying person who just does not get out of the facility. We will move with the teams and see, okay. And when, by the way, when you have the obstetrics part included, it makes mentorship for newborn easy because you're able to see where is this newborn sepsis coming from? Where is this asphyxia coming from? If you get into the labor ward and you realize, okay, there's only one.

one bed for delivery and other mothers are pushing from the floor. There is no resuscitation kit for the newborn. There is no resuscitation kit within the theater. Then you're able to say, okay, let's solve things from this angle. And then we continue through to the newborn care units. So most times, yes, you will find me in hospital. when you find me, yes, I am a clinician, a very good one. You will find me reviewing the mother, you find me reviewing the baby, you find me counseling clients.

mentoring the young doctors, my other colleagues as well, and say, no, this is what we should have done here. This is what we should do here. And yes, sometimes you also find me in surgery. So sometimes, yes, I actually end up going into theater and serving some some more babies and just making sure you work with the teens. And I also borrow these words from the commissioner who says that you cannot work with people when you are sort of bossy. make your healthcare workers your friends, And when you're friends with them, that's when you're able to get more details from them to get to share. Because they're all human beings at the end of the day. If I am unwell, and most times when you share with them, somebody is going to tell you, Dr. Ruth, I'm really fine. But you know, my challenge is I don't have a fridge within my neonatal unit. So I don't understand how I'm supposed to keep my drugs okay. And then you're like, so you need a fridge, let's solve that immediately, we get the fridge in. And then so when you get to understand what healthcare workers go through, and also share with them at more, not so personal, but close to a personal level, you have at least to support them, you're able to support them through understanding how the

supposed to go ahead and request for things. Some of them do not even know we have commodities like I was talking about like as a fact and cafe inside trade, you know that we have them in the stores. So you're like, no, this is actually available. You can request for this. You can do that. And you can only get there without shouting at someone. so yeah, it does it does come out that way. So yes, just to answer again is that if you find me

In my official suit, I'll be the official suit. If you find me in my clinical attire, I will really be clinical. If you find me in my personal space, I will be Ruth Grace unapologetically. And yeah, you have to at the end of the day, be yourself and have fun. cannot, you cannot fake it. You cannot fake it. You have to be real with yourself and ensure that you're okay.

And that's if you, I feel like if you also take care of yourself and you're happier being you, being Shirley and being Bozzie Grace, you're happier to say, okay, now I think I'm feeling comfortable now. How best can I also move others? How best can I work with others? Yeah.

Mbozu Sipalo (43:24.148)

everything that you shared, every little detail and thank you for giving us really important nugget wisdom that we tend to forget but also good to remind ourselves that when we're leading we need to lead from the back and lead from that friendship, like working together perspective. Still exploring leadership.

and you've used this word already, mentorship. You clearly stand on the shoulder of giants. You've given us this name, commissioner. It would be nice to explore what that means for you, like who that person is in your working space. But also just curious around mentorship and how mentorship has influenced you as Dr. Ruth.

Grace Kakoba and how you continue to be a mentor and a mentee as well. You've already sort of touched on this, but would be great to hear a perspective on mentorship specifically and how the greats, the neonatal champions and obstetrician champions have influenced your story.

Dr Ruth Grace B. Kakoba (44:37.971)

Okay, thank you. That's easy. So when it comes to mentors, I've had many along the way. I've really had many. can't mention and conclude all of them. But I will say it's right from my secondary school or high school, depending on where you come from, or college.

Yeah, I've had very many people who have supported me through not only just the career journey, but then also social life and all that. My main mentors, of course, through the world of safe motherhood, advocating for mothers and newborns have been the commissioner who is Dr. Richard Mugahe. Now the commissioner is the head of the Department of Reproductive and Child Health. And that is where Newborn Health is housed. So he's been really a great mentor. We also have the Reproductive Health Consultant important within our department. Dr. Daniel Morokorados have been amazing. And of course, along this journey, many have supported really. cannot just mention all of them. But I want maybe to make a shout out to the professor during my postgraduate training who had a meeting with me. We had a mentor-mentor meeting and then I shared with him, I think I'm starting to live much love maternal fetal medicine more. Because it made sense again, mothers and babies I love. And then he sat me down and say, Ruth, Ruth, Ruth, I know this is something that you're starting to love.

I know you are also good at this, but you have come from a programming world. I do not want you to do something because it looks good now and because you think you like it now. At the end of the day, you'll strengthen somewhere else. So please, after you're done with this, I know you're a very good clinician. I want you to explore the other part of advocacy that you would have done. And I am glad we had that conversation because right now maybe I would be having to do a fellowship of maternal fetal medicine.

I don't know if I would be happy. have no idea, but I am really glad. So I want to thank all the mentors that have really shaped my world. It's not one person. Of course, the parents are there. It's not one person. It's not two. But all I can say is that it's important to always have the person that you go to. And along the way, those people will change, and that's fine. Now, how do you also move up and support the other people? Now.

If I have been supported like this, shown the way, do I also support other people? answer is yes. And that is why you will find that in our Department of Reproductive and Child Health, we are really welcome to people who come through and volunteer. People have met along the course of my leadership. I also meet some of my senior colleagues who ask me and they call and say, Dr. Ruth, so we know this, this and that. How are we able to do it? And then you're able to guide accordingly. It really humbles you.

We've met, of course, many of our seniors, many of our teachers, many of our, I know, you know, all the big people in medicine in our country and you're like, okay, I'm really humbled to be the one to guide this person. It's really a humbling feeling. So you do not get to eat because you feel like, my God, I'm too above this person. No, that's not how it works. You really, for me, it is really, I'm humbled. I'm just humbled and just, I feel privileged to be able to serve.

Dr Ruth Grace B. Kakoba (52:34.665)

to serve the mothers and the babies of this nation and to work with a team that's really diverse. And there would be no national newborn secretariat without the efforts of the pediatricians, neonatologists, neonatal nurses, and midwives. It is not there without them. They are the ones who make the work. Even if we are holding campaigns, they're the ones who come through and push them. Even if we had organizing meetings, if they would not attend, they would not be there.

With all the funding, can have all the funding, can have all the partners here and there, but if you don't have the actual person down who is going to deliver this information to the, deliver this service to the newborn, you are not going to do anything. So those, I really appreciate that team. And I think it's really a tremendous team. And I always say that right now is the best time to be born in Uganda. I always tell my my mother's that, and I always tell the babies who are born, I'm like, hey little one, welcome to the world.

You are glad, you should be happy you are born at this time. And it's amazing, it's amazing. And when you see some advancements in the world of maternal fetal medicine, you feel good for the babies who may not have had a chance. You know, I'll go a little bit into that, that we've always had policies, especially about pregnancy laws, how do you terminate a pregnancy, based on congenital anomalies. And now we are seeing exit procedures, are intrauterine procedures being done.

to save the lives of these babies before they even delivered. We are learning more and more about this. So it's amazing that we can now even do a surgery for the baby before the baby is delivered. can now cancel mums. it's amazing. That's what I can say. It is amazing. Still for the mothers who have lost babies, we're trying to see and remove. And we say, how do we support mothers go through the process? Because the nine-month journey, even if it's a three-month journey or one month,

is a pregnancy to that mother. us clinicians, it's mainly, okay, yeah, it's just an abortion. It's okay. The baby just came out. No, it is a baby for that mother. How do we support them through these journeys? And that is why I'm really big on stillbirth and say, please the stillbirth and asphyxia, asphyxia should always be a reminder that we failed the mother and this baby was an ear miss. This baby was an ear miss. So any baby that had asphyxia that really was preventable, it really should trigger all our

Dr Ruth Grace B. Kakoba (55:00.285)

You know, our thoughts and say, OK, know this. And I'm really glad that the team that I work with is also as passionate is as is amazing. It's really amazing. Yeah. And the newborn secretariat as well. I would not be what I am without them. The people that helped me move the things they they help me mobilize. They help me coordinate. They help me guide. It's been amazing. Of course, shout out to Dr. Dewell-Gracias. He's he's the is the best companion.

So me and him are the neonates. We are the neonates when you come to Ministry of Health, please. Which you're welcome to do so. You're welcome to join us in there. Yeah.

Shelly (55:28.507)

Mm-hmm.

Shelly (55:40.984)

And with that, I would like to ask what words of advice, if you were to be a mentor to someone who's listening, what words of advice would you give to someone, a young Ruth Grace who wants to make a difference and just doesn't know where to start or is getting a little bit overwhelmed by all the things that need to happen?

Dr Ruth Grace B. Kakoba (55:47.351)

Yeah.

Thank you. It's a beautiful question. A young growth grace out there, I will say do not be hard on yourself. It takes time. There's a lot of internet out there and everyone is showing you how everything is superb in their life. Everything is okay. You are a young doctor. You have just finished school or you're even just a student who is between the path of career. Do what you love.

Do what you love. If you do what you love, you'll find your way in there. You'll find your way and you'll make money in there. Do not do a career thinking there's a lot of money. That's why I'm doing the career. No. Love first before the career. When you love what you do, you're able to make money with it.

And also do not forget to take care of yourself. Self care is very important. You do not need to break down or lose your life because you have not given yourself that time. So please always take care of yourself. Make sure that you also help others. Help others because others also helped you. And that is it. Yeah. Thank you.

Shelly (57:14.182)

Beautiful. Thanks, Dr. Ruth Grace, for such an inspiring, sometimes hilarious, just an amazing conversation. We were honored that you could join us. We know how busy you are, and it was certainly our pleasure. How can folks connect with you? Because I know they're going to be like, I would love to connect with this Dr. Ruth Grace, learn a little bit more. How can folks connect with you?

Dr Ruth Grace B. Kakoba (57:16.423)

Thanks Dr. Rupers for such an inspiring, sometimes hilarious, just an amazing conversation. We're honored with that. Join us.

Dr Ruth Grace B. Kakoba (57:40.056)

So that's very easy. I'm a TikTok doctor so they can find me on my TikTok at Dr Ruth Grace. They can also connect with me through my Instagram at Dr Ruth Grace. So it doesn't change Ruth Grace, Ruth Grace, they'll be able to get up to me and then they can also reach out to me with my email. My email is very easy. Maybe you can just display it later but it's RuthGraceKB at gmail.com and I'll be very

Shelly (57:46.414)

You

Shelly (57:54.683)

Okay.

Shelly (58:04.56)

Yes.

Dr Ruth Grace B. Kakoba (58:05.561)

glad to have more of these conversations, if it's also sharing with the young people. It's amazing also with other fellow professionals who are stuck somewhere and how do we move these newborn conversations. I'll be definitely very happy to do this over and over again.

Shelly (58:08.102)

put in the show notes.

Shelly (58:29.158)

So, well again, thank you so much for your time and thank you to our listeners for listening to another episode of the Global Neonatal Podcast. If this was inspiring to you, please share it with someone who you know would love to hear it. And till next time, let's go faster together for newborn care.