I re­mem­ber the first time I walked in­to the “Prem Unit” at the Port-of-Spain Gen­er­al Hos­pi­tal, and a gen­er­al hos­pi­tal it cer­tain­ly was for chil­dren. There were a cou­ple of pae­di­a­tri­cians but no sub­spe­cial­ists. In 1977, there were no neona­tol­o­gists. It was not a neona­tal unit, it was a dump where ba­bies who were born too soon were sent to die un­der the care of two el­der­ly, over­worked pae­di­a­tri­cians who had not been al­lowed to take va­ca­tion for over 15 years, i.e. since In­de­pen­dence. The mor­tal­i­ty was 50%. In plain lan­guage, half the pre­ma­ture ba­bies sent there died. That was around 20 ba­bies a month.

Most of the work on the ba­bies was done by re­cent med­ical grad­u­ates who changed their ti­tle from ‘med­ical stu­dent’ to ‘in­tern’ from one evening to an­oth­er and were thrown in­to the dump to care for ba­bies weigh­ing three and four pounds with lit­tle im­mune de­fences, im­ma­ture lungs and poor­ly func­tion­ing di­ges­tive sys­tems. There were no nurs­es trained in tak­ing care of new­borns, far less pre­ma­ture ones.

In­cu­ba­tors were scarce so it was com­mon to see two prems in­side one in­cu­ba­tor. There was no x-ray equip­ment in­side the unit and sick ba­bies had to be car­ried quick­ly over to the x-ray de­part­ment to get an x-ray be­fore they turned blue from cold or pul­monary fail­ure. The lab de­mand­ed 5-10 mls of blood for any test in tiny ba­bies who had an av­er­age blood vol­ume of around 250 to 300 ml. Four blood tests bled them out, so we went with­out many tests.

Above all, there was no pol­i­cy. About any­thing. For ex­am­ple, it was com­mon to have doc­tors come to the Prem Unit af­ter mak­ing rounds on the Gas­tro Ward, a high­ly in­fec­tious area. Some did this with­out clean­ing their hands. Of­ten, this was be­cause there was no soap ei­ther on the Gas­tro Ward or in the Prem Unit. Ded­i­cat­ed doc­tors and nurs­es washed their hands in al­co­hol. The smarter ones went to the Prem Unit first.

This sit­u­a­tion per­sist­ed for the next ten years and mind you, this was the age of the oil boom when mon­ey was pour­ing in and out of T&T like salts. None of that mon­ey reached the prem units. I do not re­call any jour­nal­ist writ­ing any­thing about this. I do not re­call any politi­cians, op­po­si­tion or not, stand­ing up in Par­lia­ment and mak­ing a state­ment about this. And cer­tain­ly, no par­ents ever com­plained in pub­lic or in the courts about how the gov­ern­ment was man­ag­ing the prem units, ours and the one at San Fer­nan­do.

How times have changed. Ear­ly last year, sev­en ba­bies died dur­ing the course of one week at the PoS­GH NICU, there was an almighty out­cry about it in the me­dia and it was a top­ic of pub­lic con­ver­sa­tion for weeks and that was ex­cel­lent. Of course, no one both­ered to ask how we had been do­ing over the years. No one both­ered to ask why we were still us­ing the same dump, 22 years af­ter the “Re­view of Four Neona­tal Units in Trinidad” in 2003 by Dr Bar­bara John­son, PA­HO tem­po­rary ad­vi­sor, when the neona­tal mor­tal­i­ty rate was 26 per 1,000 live births. No one asked why we did not have more neona­tol­o­gists and trained neona­tol­ogy nurs­es, an­oth­er rec­om­men­da­tion of that re­view? Yet, our doc­tors and nurs­es had been able to de­crease the rate to sev­en in the in­ter­ven­ing years.

And no one asked how our mor­tal­i­ty stacked up in­ter­na­tion­al­ly, tak­ing in­to con­sid­er­a­tion that WHO con­sid­ers a neona­tal mor­tal­i­ty rate of un­der 12 per 1,000 live births to be ac­cept­able and ours have been run­ning at sev­en per 1,000 live births for the past five years and we com­pare favourably with oth­er Caribbean states who av­er­age ten to 11 deaths per 1,000 live ba­bies or South Africa, which is at 11 or In­dia, 20. We are sig­nif­i­cant­ly worse off than the Eu­ro­pean Union and Chi­na, who are at two per 1,000 live births.

Why aren’t we do­ing bet­ter? Well, read the above again. Since 2015, we have had one neona­tol­o­gist, Dr Mar­lon Tim­o­thy, in the Pub­lic Ser­vice. We now have two. A third to come pos­si­bly in Ju­ly and doc­tors and nurs­es are vol­un­tar­i­ly go­ing abroad to study neona­tol­ogy with­out as­sis­tance from the Min­istry of Health. Be­cause of Dr Tim­o­thy and build­ing on the shoul­ders of for­mer neona­tol­o­gists, we now have a Na­tion­al Neona­tal Com­mit­tee, a Na­tion­al Neona­tal Pol­i­cy, stan­dard­ised man­age­ment of the most com­mon neona­tal med­ical prob­lems and re­search start­ed on our lo­cal med­ical new­born ill­ness­es.

Deaths in new­born ba­bies are set to drop slow­ly in the next five to ten years. There will al­ways be the pos­si­bil­i­ty of a clus­ter of new­born deaths but the trend is clear. If we main­tain progress, it is up­ward.