Decreasing infant mortality in Guyana
More than a decade ago, Narendra Singh, MBBS, FRCPC, visited the city of Georgetown, Guyana, where he was born, purely for nostalgic reasons. The trip was the catalyst for a long-term mission to reduce neonatal mortality across the country.
“I had the opportunity during my travels to tour the pediatric ward and neonatal intensive care unit at Georgetown Public Hospital,” said Dr. Singh, who was chief of staff at Humber River Regional Hospital in Toronto at the time. “I was struck by the dedication of the doctors and nurses — despite the very limited recourses relative to what we have in Canada — and by the high infant mortality, which at the time was 30 deaths per 1,000 births in Guyana.”
Working with local health professionals
Dr. Singh asked local health care providers, the Ministry of Health, Georgetown Hospital and the University of Guyana how he could support them in lowering the mortality rate. With only two pediatricians serving Guyana at the time, they asked him and Andrea Hunter, MD, FRCPC, to help develop a pediatric postgraduate residency program.
Over 10 years, the program — a partnership between Toronto-based charity Giving Health To Kids, the University of Guyana, McMaster University and the Georgetown Public Hospital — has trained 22 local pediatricians with an average of three-to-five trained every year. The program has also expanded to include a neonatal nursing training program, which has graduated 70 NICU nurses.
The result so far? Infant mortality has dropped on average by more than a third across Guyana: from 30 to 19 deaths per thousand births.
Opportunity lies beneath the surface
But that statistic tells only part of the story.
“When we dig deeper, we find that infant mortality has dropped to six per 1,000 in Georgetown,” said Dr. Singh, who now serves as president of Giving Health To Kids. The challenge is to expand the program’s urban success toward the seven regional hospitals scattered across Guyana’s largely inaccessible geography. Mortality rates in what is known as Guyana’s hinterland (a forested area outside the densely populated coastal plain) still hover at 28 deaths per 1,000 births.
International Development, Aid and Collaboration (IDAC) funding from the Royal College will facilitate travel of local and foreign medical teams to teach neonatal care at each of the country’s regional hospitals, as well as fund the launch of Guyana’s telehealth program.
“The vision is similar to what we have in Toronto where physicians call Sick Kids hospital for advice on complex cases,” said Dr. Singh. “We want telehealth to support physicians stuck in remote areas of Guyana with very sick babies.”
Creating sustainable outcomes
Dr. Singh aims to lower infant mortality by 35 per cent in each of Guyana’s seven regional hospitals in three years. In addition, he is looking to create a sustainable postgraduate training program where local physician educators can train the next generation of pediatricians.
Dr. Singh has worked closely with Royal College Fellows Dr. Hunter, April Kam, MD, FRCPC, and Shirley Sit, MD, FRCPC, to bring these improvements to Guyana.