Improving Perinatal Care in Barbados & the Eastern Caribbean
Regional Conference

On February 7-8, 2019,  World Pediatric Project, in partnership with Rotary International & the Pan American Health Organization/World Health Organization, hosted the first ever regional conference on advanced neonatal care in the Eastern Caribbean.  This milestone event brought together clinicians and administrators from 7 Eastern Caribbean island nations, leading perinatal health specialists from North America, South America and Europe, and key inter-governmental health agencies from the region, with the shared goal of working towards a cooperative and innovative approach to enhancing neonatal care in the Caribbean. 
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Dr. Pablo Duran, Regional Advisor in Perinatal Health, PAHO /WHO CLAP delivers keynote address - Regional Situation of Perinatal Health and Regional Plan of Action
Objectives included:
  • To present and assess individual and shared challenges in neonatal care in the Eastern Caribbean region through analysis of health outcome data and sharing of personal clinician experiences.
  • To share tools and resources available to standardize data collection, facilitate perinatal case audits and streamline regional reporting.
  • To explore opportunities to develop a framework for regional coordination of neonatal care, including standardization of care protocols, sharing sub-specialist expertise and coordinated supply and medication procurement and distribution. 
  • To present high-impact interventions and assessments for use in small neonatal units. 

Day 1: Assessment of Perinatal Health in the Region & Strategies for Regional Coordination

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Above, event moderator Dr. Clyde Cave, Consultant Neonatologist at Queen Elizabeth Hospital in Barbados.
Day 1 focused on national and regional assessments of perinatal health and presentation of tools and mechanisms for regional coordination. Representatives from each of the attending island nations gave presentations outlining their national perinatal health indicators, available neonatal resources, and key challenges and opportunities facing their hospital units. Many common challenges emerged - variable or insufficient access to key medications, lack of specialty services for referral, and inadequate nurse to patient ratios.  Shared goals across the region included improvements in respiratory management, improved access to advanced imaging and analysis, and supporting and retaining trained neonatal nurses.  A review of regional statistics in aggregate further underscored the commonalities across all islands.

Data collection remains an important, strategic focal area for the region. The relatively small patient volume in each site offers unique opportunity for deeper, qualitative analysis and audits of adverse events. Representatives from PAHO/WHO demonstrated advanced data collection and case audit tools available for the region - Perinatal Information System (SIPS) and Making Every Baby Count system. Country experiences with both tools were shared. 
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Moderator Dr. Darlene Omeir Taylor, PAHO/WHO, facilitated group session on monitoring and evaluation of perinatal health outcomes.
Panel speakers from international NGOs and regional health agencies shared examples of regional programs and collaboration models, and lessons learned for regional neonatal efforts in the Easter Caribbean moving forward. Regional frameworks offer the opportunity for cost-effective resource sharing and standardizing goals and reporting. Dr. Carlene Radix, Head of Health for the Organization of Eastern Caribbean States, presented an overview of the newly established Eastern Caribbean Maternal and Neonatal Alliance, which may serve as a mechanism for some of the regionalization strategies discussed.
It was fabulous to have all of our colleagues from the region in one place. Whilst we have met each other at various times, I think it was a great idea for us to come together at the same time to discuss shared concerns unique to our region, and to explore creative ways of partnering to overcome them. I am grateful to have participated.

Dr. Gillian Birchwood, neonatologist, Barbados

Day 2: Exploration of Clinical Interventions Within a Regional Framework

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Dr. Colleen Claassen, Saint Louis University, presents CPAP therapy for treating respiratory distress in neonates
Clinical interventions appropriate for implementation across a regional model were presented on Day 2. These low-resource, high-impact interventions target key drivers of neonatal death in the region. The interventions presented also have the capacity for uniform implementation in units across the region. Presentations were given by clinical faculty from Saint Louis University and technical experts from PAHO/WHO, as well as frontline clinicians from the region who gave personal testimonials with the interventions and therapies presented. Topics included:
  • Respiratory management in neonates 
  • Routine newborn screenings  
  • Cardiac screening and stabilization 
  • Treating hypoxic ischemic encephalopathy (HIE) 
  • Neonatal nutrition 
The conference highlighted the strong and weak points of perinatal care in our region, and showed how we can collaborate to achieve best practices. Listening to countries’ experiences gave us an idea of who we are and where we need to be.  The topics will definitely assist us in creating protocols to improve perinatal care in our NICU.

Dr. Tyhiesia Donald, pediatrician, Grenada

Next Steps for Promoting Regional Coordination

This unique and groundbreaking event generated great momentum and excitement in the regional neonatal community and laid the groundwork for strong regional collaboration moving forward.  Program champions emerged and innovative strategies were discussed. Identified next steps include:
  • Forming unified regional goals and targets in specific clinical areas
  • Developing mechanism for pooled procurement of high-need medications and supplies
  • Continued attachment trainings for regional nurses at Queen Elizabeth Hospital in Barbados 
  • Planned in-person and virtual regional gatherings for further skills training in identified priority areas and to promote continued regional fellowship (Summer 2019)
The conference was timely and fruitful. It generated comradery and gave the opportunity to identify with the other participants, the struggles and challenges in their country. I was able to see that we all have similarities and if we work together much can be achieved.

Sister Magdalene Georgia Joseph, nurse, Dominica