Dr. Josephine

Dr. Josephine, a physician from Ghana who attended the 2024 Tiny Feet Big Steps Conference, shares how she is applying what she learned through the training to strengthen care in her home NICU.

By Dr. Josephine at Komfo Anokye, Teaching Hospital in Ghana

100 Days After Tiny Feet, Big Steps: Transforming Newborn Care in My Facility: It has been over 100 days since I attended the Tiny Feet, Big Steps Conference in Tanzania, and I am deeply grateful for the knowledge, skills, and connections I gained. The experience has had a profound impact on both my practice and my facility, and I would like to take a moment to express my appreciation and highlight the changes that have taken place since then.

Empowered by Knowledge and Skills 

The topics covered at the conference were incredibly valuable to me as a neonatology resident. I gained essential skills, including the administration of surfactant using the Laryngeal Mask Airway (LMA)/Supraglottic Airway. I was fortunate to receive a few LMAs to bring back, and after training my fellow residents at Komfo Anokye Teaching Hospital (KATH) in Kumasi, this technique has now been adopted as our standard method for surfactant delivery. Exceptions are made only for extremely small preterms, for whom I continue to use the LISA method with a tiny endotracheal tube.

Beyond my hospital, I have also trained doctors at district hospitals that refer preterm babies to KATH. Many of these hospitals already had CPAP and surfactant available but had not been using them optimally. Now, they have started administering surfactant via the LMA method before referring preterms to KATH, improving their initial care and stabilizing them better before transfer.

Structural and Clinical Changes in My Facility

Inspired by the conference, my hospital has restructured doctor shifts in the NICU to enhance newborn care. A dedicated resident doctor is now assigned solely to preterms in the NICU. Their role includes daily monitoring, infection prevention and control (IPC), staff training, and the implementation of best practices from the Every Breath Counts initiative, which was shared at the conference. This change has significantly improved the continuity and quality of preterm care in our unit.

We have also begun feed fortification for a select group of preterm babies. While our facility strictly adheres to the national policy of exclusive breast milk for preterms, three babies who were failing to thrive despite best efforts were counseled and started on feed fortification. Their progress has been promising, and we continue to monitor outcomes.

Advancing POCUS in My Practice

The Point-of-Care Ultrasound (POCUS) training I received at the conference has been invaluable. It has enhanced my ability to quickly diagnose and manage critical conditions, particularly in newborns with difficult IV access, cardiac concerns, and IVC assessments. The skill has also proved beneficial beyond neonatology, improving my clinical decision-making during my rotations in the Pediatric Emergency Unit and PICU.

Resources That Keep Giving

The Every Breath Counts pocketbook has become my trusted guide in the NICU, helping me and my colleagues with quick, evidence-based clinical decisions. I was fortunate to receive an extra copy, which I donated to a sister teaching hospital in Accra for their NICU. They have found it extremely useful and extend their heartfelt gratitude.

I am deeply grateful to the organizers, speakers, and mentors who made this conference possible. The knowledge gained has empowered me, transformed my hospital, and even impacted other facilities in Ghana. These past 100 days have truly been a journey of growth, and I look forward to continuing this journey of improving newborn care. Asante Sana!

Dr. Josephine, Komfo Anokye Teaching Hospital, Ghana