We are launching a new Series - interviews with interesting people within the big world-wide neonatal community. Our goal is to publish one interview per month.
First out is Mats Blennow, Stockholm, Sweden, senior consultant neonatologist at the Karolinska University Hospital and professor in neonatal neurosciences at the Karolinska Institutet. Furthermore, he was also a president for the European Society for Neonatology (2008-2014).
Mats Blennow took a break from the level-3 NICU life in Stockholm to do something extraordinary...
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Where are you working now?
I am working in Irbid, a city in the north of Jordan approximately 25 km from the Syrian border. I work here in a project run by Medecins sans Frontieres (MSF- Doctors without Borders).
This is, for MSF, a unique setting as Jordan, a middle-income country, is considered safe and developed. This in contrast to the usual MSF projects dealing with situations in war, natural and man-made disasters.
The MSF rationale for this project is that the Syrian refugees here do not have free access to the Jordanian health care. In my project we provide maternal and neonatal health care for the approximately 130,000 syrian refugees living in the Irbid Governate. We run a highly efficient maternity unit, annually providing antenatal, maternity and neonatal care for 3,500 pregnant women and their offspring. The project is housed in a private hospital, where MSF rents 2 floors.
I work as a pediatric/neonatal expat in the small neonatal unit. Recently, in matter of fact this week, we have expanded the unit from 10 to 16 cots/incubators. I would describe this as a level 2 unit, for example we do not provide ventilator care or long-term TPN. Our admission criteria include babies from 32 weeks gestation. Very preterm infants are referred to other local private or Ministry of Health facilities, and then MSF covers the costs of care also there.
Why did you choose to go on this mission to Jordania?
Since many years I have wanted to broaden my views on paediatrics and neonatology to other settings than working in a tertiary NICU in a high-income country, preferably by working for some NGO. The reputation of MSF is highly respected by everyone. For example, in a survey in Sweden, more than 50% of the responders expressed high confidence in the work MSF provide in more than 70 countries. The MSF charter stating the organisation is to provide medical help irrespective of race, religion, creed, or political convictions and doing this observing neutrality, impartiality and independence is to me fundamental.
The fact that my current mission is in Jordan is primarily not from my own choosing. Signing up to work for MSF, I had full confidence that the organisation would send me on an important mission.
What is it like to work there? What are the largest similarities and differences compared to the NICU you normally work at in Sweden?
The work has many similarities, but also differences, to the work I usually do in Stockholm. The national staff is well educated with very good theoretical and practical knowledge. Nurses and doctors work together, although the emphasis on teamwork is not as strong as in Europe.
The organisation of health care is not as developed as back home, and a lot of attention needs to be given to organise for referrals to tertiary units, to follow-up clinics and for more advanced tests and examinations. For example, when I first arrived here we did not have access to blood cultures. Due to this, many infants with only risk factors for early onset infections were given full courses of antibiotics despite no clinical signs of infection. Consequently, this resulted in prolonged stays in the neonatal unit and mother-child separations as many families live far from Irbid and have several children at home needing attention.
Another difference is the access to respiratory support. My primary task was to start CPAP care in the project, which was successfully started after 2 weeks. Before that, infants with any respiratory distress were given nasal cannula oxygen with FiO2 of 1.0 and rather high flow rates.
Perhaps the biggest difference however was the nursing care of the infants. I was lucky to be able to recruit a neonatal nurse expat, and together we worked hard to implement as many elements of developmental care as possible, including reducing ambient noise, covering incubators, nesting and supporting the infants position, and clustering of blood sampling. We also managed to expand the area of the neonatal unit with 2 additional rooms allowing mothers to remain with their babies 24/7 in the unit.
What expertise have you brought to Jordania and what experience can you bring back to Stockholm?
Medically, my most important contribution has been to update the protocols on non-invasive ventilator care. This includes implementing nCPAP treatment, but also t-piece ventilation for resuscitation, guidelines for treatment of apneas, use of fractionised oxygen and emergency surfactant treatment before referral of very preterm infants with RDS unintentionally delivered at the MSF hospital.
I have also trained the staff after updating many other protocols, such as those for infants at risk of septicaemia and the use of a Neonatal Early Warning Signs (NEWS) protocol in the maternity.
To bring back home is the knowledge of good care being given also in this resource limited setting, problem solving in an environment that doesn´t have all the expertise available just around the corner. The basic principle to always have a humanitarian approach to everything we do in medicine.
Working with the dedicated MSF-expats from all over the globe is extremely rewarding. In my project we had expats from France, Scandinavia, Canada, Liberia, Sudan, Lebanon and Australia. Personally, I think I will after my mission come out as a better and more humble person J.
What is your advice to those wanting to go on a similar mission?
Take a good course preparing for NGO work. It was invaluable for me to take an 8-week course in Humanitarian Health Assistance and 1 week of Preparation Primary Departure (PPD) before leaving. There is also an abundance of information to be found on the webpages of UNHCR, WHO, MSF and other NGOs. There it is possible to, once the destination is decided, to get detailed information about the country, project and security issues.
Most important is to keep an open mind to new cultures and experiences, to have a great respect for the knowledge and integrity of everyone you meet; patients, locals and colleagues.
ISH - the hospital where the delivery unit and NICU is located.
The NICU environment at ISH
The first infant recieving nCPAP in the MSF NICU.
Umm Qais - a popular area to visit in norther Jordan - an old town with a history going back >2000 years. From this site it is possible to view (from the left): Israel, Lake Genesaret/Tiberia, Palestine (in the valley), the southern parts of the Golan mountains, and distantly Lebanon and Syria.
Edited by Stefan Johansson