A leading Israeli expert in neonatology is eager to export his country’s success in saving babies in distress.
Dr. Michael “Miki” Karplus was Israel’s sole delegate to last week’s summit in Toronto, “Saving Every Woman, Every Child Within Arm’s Reach,” convened by Prime Minister Stephen Harper to address maternal, newborn and child health.
The three-day conference, which drew dozens of doctors, scientists and experts from around the world, addressed three key objectives, according to a statement: delivering results for mothers and children, doing more together globally, and undertaking “real action” for women’s and children’s health.
Real action is something Karplus understands; it turns out Israel is a leader in the field of neonatology, a pediatric subspecialty devoted to the health and well-being of newborns.
Over the past few years, through two “mother and baby” units it established in the African nation of Ghana, Israel has learned how to treat troubled newborns cheaply and without expensive medical intervention that is unavailable anyway.
The idea is to involve mothers much more centrally, Karplus told The CJN in an interview before the conference’s start. While the notion has taken hold, he’s eager to take tangible results to other places.
“The whole idea is to expand,” said Karplus, who headed the department of neonatology at Ben-Gurion University’s Soroka Medical Center for nearly 30 years.
“We would like to come to international agencies and say, ‘look, we have this model and we would like to propose that we take it to an area and set up a number of them. Then we can study [infant] mortality when we compare an area that has a unit with an area that does not.’ ”
The units in Ghana, established by Mashav, Israel’s Agency for International Development Cooperation, with guidance from the Soroka Medical Center, do not rely on expensive respirators, ventilators or incubators.
“The high mortality in babies in the developing world…is due to infections and complications from being born small,” Karplus explained. “Many of these complications could be dealt with [using] limited resources so that mortality can be reduced with simple means.”
Among the best known methods is so-called “kangaroo mother care,” in which the mother, through skin to skin contact, warms her baby. That replaces incubators, which are expensive and when they break down in developing countries, there’s no one to fix them, Karplus pointed out.
Underweight babies, meantime, also need warmth, as well as feeding and a clean environment. Great care is taken to allow only the mother to handle her newborn. “Infection will be minimal because no one else is handling the baby. The big danger is cross-infection.”
Decades ago, Karplus came to the view that newborns with problems could be saved through basic, inexpensive interventions that did not require a doctor. He and his team developed a training course for nurses and medical assistants based on simple, affordable methods.
In Ghana, the Israelis focused on newborns’ most common problems and found that treatments, in most cases, did not require doctors. “There are very few doctors in Africa,” Karplus pointed out. “You cannot set up such units in rural areas of Africa if you expect doctors to work there. So the approach is really to work with the staff who are available. With these very simple means, you can reduce mortality tremendously.
“If the condition of the baby deteriorates, we are helpless,” he went on. “But the number of babies we will lose because of the lack of respirators is very small. We are going to save, with simple means, the majority of the babies who are now dying.”
With just two centres in Ghana, both in the southern town of Kumasi, it’s impossible to tell whether Israel’s efforts have made a dent in the country’s infant mortality rate, which in 2012 stood at 49 per 1,000 live births (Canada’s rate is five, Israel’s is three).
That’s why this year, Israel will evaluate its units, both from a health and cost-effectiveness standpoint.
As a pioneer in the field, Israel was represented at the Toronto conference to share its experience in Africa and propose that its model spread elsewhere, Karplus noted.
“We started very early, 20 years ago, before there was an international trend [and] nobody was interested in this kind of approach,” said Karplus. “Nowadays, it is the internationally accepted way of doing things.”
Asked whether Israel is known for its work in the field, Karplus replied, “not enough. There are so many countries with very high neo-natal mortality that would gain so much if these units could be set up.”