Pediatrician dedicates career to reducing neonatal deaths worldwide
Dr. Nalini Singhal is the recipient of the 2022 Royal College Teasdale-Corti Humanitarian Award
It takes a village to raise a child, as the saying goes, and it takes a properly trained team to safely care for a neonate. That belief is the driving force behind the career of Nalini Singhal, MD, FRCPC, professor of Pediatrics at the University of Calgary’s Cumming School of Medicine — a career that has given countless newborns the chance to live longer, healthier lives.
In recognition of her decades of work on newborn survival globally, Dr. Singhal is the 2022 recipient of the Royal College Teasdale-Corti Humanitarian Award. The award honours doctors who make truly exceptional sacrifices, often while exposing themselves to personal risk. Recipients bring hope and health services to people who lack access to widespread health care.
A teachable approach: Helping Babies Breathe
Dr. Singhal helped develop Helping Babies Breathe (HBB) with colleagues in the American Academy of Pediatrics. HBB is an educational program for resuscitating newborns that has been implemented in over 90 countries and has saved multiple newborns from birth asphyxia, one of the major contributors to newborn deaths. Launched in 2010, HBB has saved many infants in the last 12 years. Dr. Singhal has also trained local physicians and nurses to teach the program in their own countries.
“Dr. Singhal has been an international world pioneer in developing and implementing programs to reduce the mortality rate of newborns around the world,” writes nominator Jean-Francois Lemay, MD, FRCPC, a developmental pediatrician at the Cumming School of Medicine. “Summarizing a quote she said a few years ago, ‘Neonatal deaths around the world have not changed significantly for quite a while, even though childhood deaths have dropped. We know that it is likely due to babies not being resuscitated properly, so we set out to come up with a simple, feasible project with a teachable approach.’ This sentence shows the flexibility and common-sense approach of Dr. Singhal.”
Within its first two years, HBB was used to train 100,000 care providers. “During this time, more than 82,000 bag and mask devices, 93,000 suction bulbs and 23,000 neonatal simulators were distributed, and 10 countries developed national plans for HBB training and service delivery,” writes Jon Meddings, MD, FRCPC, dean at the Cumming School of Medicine, in his letter of support.
New programs and broad implementation
After launching HBB, Dr. Singhal worked to develop complementary programs, including Essential Care of Every Baby.
“Where Helping Babies Breathe addresses birth asphyxia, Essential Care of Every Baby includes examination, prevention of infection and administration of vitamin K to prevent deaths due to newborn bleeding, [as well as] immunization, breastfeeding and discharge planning with a pictorial pamphlet for parents to recognize danger signs and seek help,” writes Dr. Meddings.
Over time, the success of these programs led the World Health Organization (WHO) to adapt the programs and implement them under the WHO logo, with Dr. Singhal’s involvement.
Later, Dr. Singhal implemented the Kangaroo Mother Care program — a method of care of small and preterm infants emphasizing skin-to-skin contact, usually with the mother — in Tanzania, Uganda, Ethiopia, Bangladesh and other countries.
“Implementing programs also requires the same thoughtfulness and use of evidence-based approaches that designing the initial programs had,” writes Dr. Meddings. “To this end, Nalini helped implement the Healthy Child Uganda [program] in the community in multiple districts. The work started with a small $75,000 grant and eventually a $3.4 million grant was received from Global Affairs Canada to implement a comprehensive program for maternal, newborn and child care in the community, [in] health care centres and [at] referral hospitals.”
Uptake of these programs has been substantial throughout the world and Dr. Singhal prioritized widely sharing her research and experiences. “The statistics associated with her peer review publications are impressive with 6,074 citations,” notes Dr. Meddings. “Where possible, she has opted for open access journals so that the very people who she worked with internationally can access the publications but also so that others in international communities have access to the work.”
An altruistic mission
Dr. Singhal’s dedication and resilience in her mission is impressive. “She has worked well after most of us would have retired, travelling to remote areas in Africa and Asia where health care is limited and risk to personal safety requires continual assessment,” writes University of Alberta pediatrician Khalid Aziz, MD, FRCPC.
“Nalini is an ’on the ground’ worker,” writes Jenn Brenner, MD, FRCPC, professor of Pediatrics at the Cumming School of Medicine, in her letter of support. “She has travelled far and wide, including to many difficult to reach communities, bettering her understanding of barriers faced in different settings in order to develop new adaptations and ensure ‘no newborn is missed’…She always takes time to listen, watch, and hear ideas from health providers, motivating clinicians in low-resource and remote settings through her passion, care and time, always following up, as promised.”
Colleagues also praise Dr. Singhal’s humility and generosity. “She doesn’t demand or want recognition,” writes Shoo K. Lee, MD, FRCPC, professor emeritus at the University of Toronto. “She is eager to help people who are disadvantaged and can’t help themselves.
“It is rare to work with someone who is so generous of their time and asks for so little.”