Contributors: Emily Kalenik, WG’19, and Andrea Rivera, WG’19
To learn more about Emily and Andrea, click here.
Wharton Global Health Volunteers (WGHV) supported the 100 Person Village Initiative led by Dr. Osayame Ekhaguere during the 2017-2018 academic year. The 100 Person Village Initiative aims to improve the effectiveness of neonatal care across Nigeria.
Nigeria currently experiences an infant mortality rate of 71 deaths per 1,000 live births, which is 10 times greater than the infant mortality of the United States. The initiative is first focusing on improving care in the neonatal intensive care unit of Lagos University Teaching Hospital (LUTH) through new processes, equipment, and training. The WGHV project was focused on identifying the most cost-effective initiatives and documenting these in a pitch to potential donors. We focused on respiratory distress, nutrition, and infection control, as these areas are the three main drivers of neonatal mortality.
To achieve our goal, we took three steps.
- We researched the current U.S. standard of care at the Hospital of the University of Pennsylvania (HUP). We interviewed and shadowed experts at HUP to understand their processes, equipment, and training. While we recognized the Nigerian resources would be vastly different, this gave us a baseline of knowledge with which to work.
- We went to Lagos and documented the current state of care at LUTH. We took inventory of their equipment and interviewed their personnel to understand how they operated. We also sought their ideas on what would be most helpful for them and tested ideas we had to improve care with them.
- Finally, we identified discrete initiatives based on this information, understood how they would affect neonatal outcomes, and identified how much they would cost.
A surprising learning from this experience was that LUTH’s biggest need was not a suite of upgraded equipment. In fact, we saw that LUTH possessed some expensive respiratory equipment that had been donated. However, this equipment was never used because the medical personnel did not receive the proper training. Additionally, the one-time-use parts were often too expensive for families to afford. We learned that when we recommended new equipment, we needed to ensure it had the lowest run cost over time, and we needed to emphasize proper training.
Another takeaway from this experience is how resourceful the medical personnel at LUTH are in their efforts to save lives. Their ingenuity ranged from developing a sustainable version of respiratory equipment that was less cost-prohibitive for families to individually fundraise to help families who could not afford to buy medicines for their children. Families in Nigeria do not have insurance, so they must pay for most medical materials upfront. While families can often scrape together the money needed from friends and family, this can delay care. As part of our recommendations, we proposed setting up a revolving fund to ensure that patients can access the materials they need when they need it, and also to subsidize families if needed.
Dr. Ekhaguere will continue to champion the project through the next phases, which include to fundraise and develop an implementation plan for these initiatives. It was truly a rewarding experience to learn from both LUTH and HUP personnel, and we hope our work will ultimately help reduce neonatal mortality at LUTH and across Nigeria.
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