The Caribbean nation is taking important steps to protect the health of its babies.
Dr. Marlon Timothy spends sleepless nights in the Neonatal Unit of Trinidad and Tobago's Port of Spain General Hospital (POSGH). Despite being sleep deprived, he looks enthusiast, not exhausted; he knows that his and his team's task of decreasing child mortality is crucial for his country.
In his multiple roles as Head of Department, Neonatal Intensive Care Unit at Port of Spain General Hospital; Head of Department of Paediatrics (Ag.) at Sangre Grande Hospital; Associate Lecturer at the University of the West Indies; and Chair of the National Neonatal Committee, this young neonatalogist is also the only neonatologist in the public sector.
Making sure every baby counts in Trinidad and Tobago
More than 3,000 babies were born at the main public hospital in the capital city of Port of Spain in 2017. This hospital mainy serves patients from low income and education households, ethnically composed of Trinidadians of African and Indian decent. However, in recent years, the hospital has seen an increase of migrant patients, particularly from neighboring Venezuela, which is 30 minutes away by boat.
Dr. Timothy and his staff maintain that "the first month of life is the most vulnerable time for a child's survival and health. Figures show that newborn deaths account for the majority of under-five deaths," which is why Dr. Timothy is interested in best practices to avoid preventable deaths, knowing the exact causes of mortality and developing a surveillance system to improve neonatal health.
According to 2017 PAHO data, out of every 1,000 babies born in Trinidad and Tobago, 10 died, compared with the United States' rate of 3.9 per 1,000 births and Chile's of 5.1 per 1,000 births. According to Dr. Timothy´s estimates, the rate was reduced by 1.9 per year and he expects to maintain this trend.
To improve neonatal health Dr. Timothy emphasizes the importance of clean, accessible, functional health care facilities, well trained health care workers, life-saving drugs and equipment, and dignity, respect and accountability.
In addition to this, it is also crucial to obtain accurate, measurable and comparable data that allow health care workers to learn the precise health reality of all newborns. That's why in January 2017, POSGH participated in a pilot program for the Perinatal Information System (SIP), a medical history form and electronic platform created by PAHO/CLAP to guide the clinical care and management of every pregnant woman and her baby.
The Perinatal Information System (SIP)
While SIP was piloted just over the last year, collecting both retrospective and prospective data, Dr. Timothy recognizes its potential: "It is a tool that creates connectivity among pediatricians and nurses. It also allows networking; if I am at home and need to verify admissions, I can do it with this information and coordinate with others - for instance, the radiology team. The SIP is powerful because it is such a comprehensive system".
Hospital staff members have already been trained and Dr. Timothy is anxiously awaiting the implementation of SIP NEO Plus to support his goal of further reducing neonatal mortality. The SIP Pilot has already produced and analyzed 8,000 records, including approximately 30 basic indicators for high-risk pregnancies and HIV, as well as a report on Perinatal Mortality of Very Low Birth Weight Babies 2016-2017.
Dr. Sally Ishmael, Head of Department, Medical Chief of Staff at POSGH also thinks SIP provides "an opportunity to obtain statistics in an easy way, at just the touch of your finger. Besides, it allows us to validate local protocols without dependence on international protocols".
Government commits to SIP Plus
Health care providers like Dr. Timothy and Dr. Ishmael were happy to learn of their government's commitment to fully implement SIP Plus given the successful piloting of the system since January 2017.
The Honourable Terrence Deyalsingh, Minister of Health, Trinidad and Tobago, made this committment publicly at the closing ceremony of the Caribbean Meeting on Neonatal Health and SIP Plus held in Trinidad and Tobago, 3-5 July 2018. He stated that "We will mandate the Perinatal Information System to be implemented, not only in the public sector, but also in the private sector. With this evidence-based tool we will have a clear roadmap on the way forward to reach our SDG goals for maternal and child health, and to maintain it."
More than 60 professionals specialized in neonatal health from 15 Caribbean countries attended this meeting hosted by PAHO/CLAP, which was held to address newborn screening, surveillance of birth defects, auditing and analysis of fetal and neonatal mortality and establishing a Caribbean SIP Network.
