Misrak Tadesse, MD
Misrak Tadesse, MD
Neonat/Perinatology · Frederick, MD

WAGI-SPHMC neonatal care improvement project

July 21st
Addis Ababa, Ethiopia

Project Description

Our project has been working with St. Paul hospital pediatrics and OBGYN department in Addis Abab, Ethiopia for the last three years. We have been providing nursing education, pediatric resident education, Neonatal fellowship curriculum development, upgrade of services in both the labor ward and the neonatal ICU, training the first neonatal advance life support team in the country and with the second one completing in July 2018, NICU design in a new building. We are in the process of introducing a locally assembled and sustainable infant incubator and have just been awarded a small grant to pilot a locally assemblies and sustainable phototherapy light for treatment of neonatal jaundice.
We are in the process of assisting the hospital to develop a respiratory therapy school (none exists in the country) as well as a NICU nursing clinical preceptorship program.
Our organization send volunteers to St. Paul hospital through out the year and in the last three years, on average someone from our group is on the ground about 6 -7 months of the year.

Population Served

St. Paul hospital is a regional public referral center with over 5,000,000 underserved population. It has ~12,000 high risk births annually. It has a neonatal unit that not only provides medical care to the ones born at St. Paul but also referred from other facilities. The neonatal unit admits over 4000 neonates per year. In addition to being one of the largest hospitals in the country, it is also a trainibg facility for physicians and nurses.
Our organization has been involved in multiple aspects of training, quality improvement, service upgrade and direct patient care for neonates at St. Paul Hospital.
St. Paul being designed as one of two centers of excellence in the country, any education and improvement gained at St. Paul will have the chance for desimination to other facilities in the country.

Expected Impact

As noted above, we provide an ongoing presence at St. Paul hospital and we are involved improving care for the neonate and it’s mother.
We collaborate with our partners at St. Paul hospital, we make sure all changes proposed are something our local partners have identified. We do hands on training with continued mentor ship and work on system and process changes that are sustainable.

Trip Photos & Recap

I arrived in Addis Ababa on the morning of July 22 after about thirteen hours of flight. A familiar face, the driver from the hotel where we stay was waiting for me and it was a beautiful day that felt more like a fall morning than the rainy season it was supposed to be. Diving through the streets of Addis on a Sunday morning before the city woke up was a treat.

After I checked in at the Embilta hotel and had breakfast, I made some phone calls to plan my first day. The Wax and Gold team members that had just left Addis 48 hours prior had left me a to do list which made my work that much easier. My assignment was to complete testing the second group of Neonatal Advanced Life Support (NALS) providers, work with the biomedical engineering department on a locally assembled incubator, continue working with our local partners from St. Paul Hospital Millennium Medical College (SPHMMC) on the design of the new neonatal ICU (NICU), continue mentoring the NALS nurses in the delivery room, continue working on a locally assembled phototherapy light for treatment of jaundice in the newborn, and teaching rounds with the pediatric residents in the neonatal ICU.
I have been volunteering in Ethiopia for over ten years now and our organization has been specifically working at St. Paul hospital since 2015. We spend 6-7 months on the ground at SPHMMC. The beauty of working with the same local partner over a period of time is the collegiality and the personal relationships formed over time and being able to see improvement and change. At the same time, work in Ethiopia is never dull or predictable. What I have learned through the years is the need to be flexible and adjust plans. This trip was no different.

On Monday morning, after attending morning report, I walked to the NICU to greet people and deliver donated blankets, equipment, and books. I was asked if I could take part in a meeting regarding upgrading the current NICU nurses’ skills. To my surprise and happiness, the NICU nurses had met with the pediatrician, nurse educator, and the nurse manager and made a list of topics that they felt they needed to be trained on to be able to provide better care for their patients. There was a sense of urgency to begin this process immediately. Although this was not part of my plan, it was a welcomed surprise. Our organization’s mission is capacity building through education, training, and empowering neonatal health care providers so that they can identify the gap in care they have within their system and identify ways they can improve the care for neonates. Finding out what the gaps are and asking for training on relevant topics is exactly what we have been encouraging them to do. I spent the following three full days with ten of the 40 NICU nurses training them on neonatal resuscitation as well as certifying them in the S.T.A.B.L.E. course. I divided the team into four groups to make sure that I was able to spend adequate time with each nurse. The next team coming will train the remaining 3 groups.

I also had the pleasure of meeting and working with a young biomedical engineer that had just graduated from school and who has invented a targeted oxygen delivery device (TODD) that is specifically designed for neonates. I spent some time with him exploring ways of locally building neonatal Continuous Positive Airway Pressure (CPAP) machine.

As an aside, I got involved in facilitating an opportunity for pediatric oncology fellowship training for one of the pediatricians from St. Paul Hospital. There are only two formally trained pediatric oncologists in Ethiopia.

Having two high school students from the US that shadowed me for a few days learning about health care outside of the US was one of the highlights of this trip.

As usual, the nurses in the neonatal ICU and the delivery room never cease to amaze me. Despite what we would consider to be unacceptable work environment and work condition, they come to work every day ready to do better than they were able to do the day before. They are kind and happy group of people that have the outmost concern for each other, their patients and their patients’ families. They are interested in improving their skills and very grateful for any knowledge one is willing to share.

The Neonatal Advanced Life support team has been providing care in the delivery room for about 15 months. As a result, St. Paul Hospital has made significant strides towards decreasing the number of babies that die in the delivery room and ones that require admission to the neonatal ICU.

This was a wonderful trip and I was able to accomplish what I set out to do and more. As I sit down to prepare my hand off for the next team representing the wax and gold organization and travel to Ethiopia in October of 2018, I am looking forward to my return trip in the spring of 2019.

I would like to thank the Doximity Foundation for sponsoring my trip.