Beena Kamath-Rayne, MD, MPH, FAAP, is a board-certified pediatrician and neonatologist with 20 years of clinical experience and expertise in clinical research, quality improvement, and medical education. Since 2019, she has served as vice president for Global Newborn and Child Health for the American Academy of Pediatrics.
While she was in Washington, D.C., attending the Pediatric Academic Societies (PAS) meeting, we had the opportunity to sit down with her to discuss the state of global pediatric health and some of the AAP initiatives designed to improve pediatric health no matter where a child lives.
Carol Vassar, producer/host
Guest: Beena Kamath-Rayne, MD, MPH, FAAP
Vice President for Global Newborn and Child Heath, American Academy of Pediatrics
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Carol Vassar, podcast host/producer (00:00):
Welcome to Well Beyond Medicine, the Nemours Children’s Health Podcast. Each week we’ll explore anything and everything related to the 80% of child health impacts that occur outside the doctor’s office.
I’m your host, Carol Vassar. And now that you’re here, let’s go.
MUSIC: Well Beyond Medicine! (00:21):
Carol Vassar, podcast host/producer (00:27):
Westmead Australia, Cape Town, South Africa, Cincinnati, Ohio, Washington DC. These are just a few of the destinations visited in the past months by Dr. Beena Kamath-Rayne, in her quest to improve children’s health across the planet.
Dr. Kamath-Rayne is a board-certified pediatrician and neonatologist with 20 years of clinical experience, as well as expertise in clinical research, quality improvement, and medical education. And since 2019, she has served as vice president for Global Newborn and Child Health for the American Academy of Pediatrics.
And it was while she was in Washington DC at the Pediatric Academic Societies meeting that we had the opportunity to sit down with her to discuss the state of global pediatric health, and some of the AAP initiatives designed to improve pediatric health, no matter where a child lives.
We started our conversation, though, by talking about an experience Dr. Kamath-Rayne had that has informed her entire career trajectory: living and working abroad as a general practitioner at a clinic in rural Ecuador.
Dr. Beena Kamath-Rayne, AAP (01:45):
I spent one year in rural Ecuador, and this year happened after my pediatrics residency. One of the things that happened, knowing that I had been accepted into fellowship already for neonatal-perinatal medicine, was I wanted to spend that year working in a community setting and really using what I had learned in pediatrics and being able to apply it in a setting where there wasn’t as easy access and availability for healthcare.
And one experience that I had that really impacted the rest of my career was that I started following a woman named Rosa, who was pregnant. The care of pregnant women and newborns is free in Ecuador. So we lived in a small town about 90 minutes from the closest hospital by bus. I had told her that when she was ready to deliver the baby, it was really important that she get to that hospital in case things went wrong.
There’s a lot of mistrust and also concern about the quality of care in hospital settings in various places around the world. And I think some people have the impression that when you go to the hospital, it’s where you go to die. It’s not where you go to get high-quality care. And so people actually sometimes avoid going to the hospital for that reason.
As her labor progressed, she actually waited until the last bus went through the village and passed through the village. And she was not on that bus. She had her friends come and knock on my door when she was further along in her labor and say that they needed me to come and help deliver the baby.
By the time that I walked to her house, her labor was so advanced that I didn’t think there was any way that I could get her back to the clinic. So we ended up delivering her baby in her house.
For me, that is probably one of the scariest formative experiences in my early career where knowing that I had a love of being in the NICU and I saw a lot of things that could go wrong in pregnancy and early newborn care; and worried that in this situation if something went wrong; what was I going to do to get her the help that she needed?
Luckily in this situation, she had a normal delivery. The baby cried right away after I started doing some simple measures like drying and stimulating the baby. I had brought a bag and mask, just in case the baby didn’t start breathing.
But this story had a positive outcome. This baby cried. And Rosa actually eventually named the baby Beena. But it reminded me that at that time, a majority of women delivered their babies in a home-based setting. That is also the time when both mothers and babies, in the 24 hours around delivery, are at the highest risk for mortality.
This story had a happy ending, but many do not. Then actually, the next year, I spent in Australia working in a NICU as what’s called a registrar, which is very similar to an upper-level resident or an early fellow.
It was in that year that The Lancet first published their Neonatal Survival Series. And it was really the first time that attention had been drawn on newborn mortality around the world. At that time, we were losing 4 million babies a year. So neonatal mortality is the death of a newborn before 28 days … 4 million babies worldwide every year.
You have to be outraged at that statistic and wonder, what are you going to do? What are you going to do to make this better? So that really changed the course of my career. That personal experience, and then also seeing that coupled with the actual data of what was happening around the world.
And I knew that then my career, in some form, was going to have to involve advocacy, research, education around that statistic of how many babies were dying in the first year and what we could do to improve it.
Carol Vassar, podcast host/producer (05:42):
Have we done anything? Has there been any improvement?
Dr. Beena Kamath-Rayne, AAP (05:46):
There has been. Right now, the statistic is 2.4 million newborn babies die every year. So there’s still more that we can do. What has changed that statistic, and we’re still learning more, is the pandemic. We don’t have the most recent data on where we stand because the 2.4 million is pre-pandemic data.
But I think as we start to see more of that data come out during and post-pandemic, we’re going to see that we’ve actually taken steps backward: similar to what we’ve seen with loss of immunization coverage, loss of facility-based delivery. Those are things that have gone backward during the pandemic. I think we’re probably going to also see that reflected in some of the data on neonatal mortality.
Carol Vassar, podcast host/producer (06:30):
And you’re doing a lot; you’re doing your part. You’re also overseeing training programs with AAP and providing technical assistance. Talk about that.
Dr. Beena Kamath-Rayne, AAP (06:41):
In my role at the academy, I oversee our clinical skills training program, things like the Neonatal Resuscitation Program. We have pediatric education for pre-hospital professionals. We also have some content on first aid for lay providers and parents, and child caregivers.
Then, in addition, there has been a program called Helping Babies Breathe that originated in 2010. That is basically a basic curriculum of neonatal resuscitation. It’s very pictorial and skills-based. And that program has taught over 1 million birth attendants around the world the critical skills to attend to a baby just after delivery: assess that baby, make sure they’re breathing, and then providing essential newborn care.
In my initial years at the academy, one of our big accomplishments has been collaborating with the World Health Organization to take that methodology of Helping Babies Breathe and incorporate that into their Essential Newborn Care Program, Second Edition. That program is actually going to be officially launched at an upcoming conference in Cape Town: the International Maternal Neonatal Child Health Conference.
Myself and our senior vice president of Global Child Health and Life Support, Dr. Janna Patterson, are actually leaving from PAS to head to South Africa to participate in that launch.
Carol Vassar, podcast host/producer (08:07):
Talk about how that program has improved newborns’ lives and saved newborns’ lives over the 13 years since it was first started.
Dr. Beena Kamath-Rayne, AAP (08:19):
Well, Helping Babies Breathe has a wide body of evidence that it has decreased rates of early neonatal mortality. We can’t actually provide information about neonatal mortality; because, in a lot of the settings where the program is implemented, babies go home. And then, often, they may sort of be lost to further record keeping. And there aren’t sophisticated enough data systems to really capture that metric of neonatal mortality. So often, they’re looking at early neonatal mortality or death before discharge from that initial hospitalization where they’re born.
So HBB implementation, Helping Babies Breathe implementation, has been shown to decrease early neonatal mortality and then also stillbirth rates. Stillbirths are babies that may be born still and have a heart rate, but they don’t exactly exhibit signs of movement or breathing.
And what may have been happening in the past was that these babies weren’t appropriately assessed for that heart rate. So they were just assumed to be stillbirths, and then not really given those initial steps of drying and stimulation.
And I think what HBB has done is said that every baby deserves a chance unless it’s a macerated stillbirth, meaning visible signs that they died earlier on in utero.
Sometimes babies die in the intrapartum period, during labor, and they don’t have that macerated appearance. HBB encourages birth attendants to start drying and stimulating those babies. And what they found that babies that had likely been misclassified as stillbirths were actually live-born babies that were just born still. And if somebody had dried and stimulated them, they started to cry and breathe. And so HBB also decreased rates of stillbirth.
Carol Vassar, podcast host/producer (10:07):
That’s fantastic. Talk about what you’re going to present in Cape Town.
Dr. Beena Kamath-Rayne, AAP (10:11):
Well, we have worked collaboratively with the World Health Organization in the formulation of their new Essential Newborn Care course. It’s the second edition. We had representatives on a technical working group that helped bring that content over to the WHO course, as well as update it and align it with current WHO guidelines.
So if you look at the new WHO Essential Newborn Care course, it looks very similar to HBB. It uses that pictorial action plan or algorithm for resuscitation. It continues to have an emphasis on skills-based practice, and particularly the critical life-saving skill of neonatal resuscitation is bag-mask ventilation: giving breaths to the baby if they don’t start breathing.
So we work with WHO on a panel, basically, to celebrate the launch of the face-to-face materials that most people are familiar with Helping Babies Breathe. So the facilitator flip chart, the action plan, et cetera.
Carol Vassar, podcast host/producer (11:13):
I’m going to ask you the big question. From your perspective, what is the state of child health, pediatric health, newborn health in the nation and in the world right now?
Dr. Beena Kamath-Rayne, AAP (11:25):
Well, I think the good thing is that pediatricians are people that use the health of children and newborns as their North Star. They’re also people that have a lot of grit and determination. And they will keep fighting for children, no matter what happens.
I think no one can deny that the pandemic put a lot of stress on our children, as well as ourselves as providers. And that we have backslid not only domestically but also globally in some of the metrics that we had previously seen only improving over time. So I think we are in a very critical juncture right now where we are going to have to recoup some of the areas in which we’ve gone backward.
I remain hopeful, and I think that’s one of the things about pediatricians: is that we’re always hopeful when it comes to children’s health. But there’s no denying that there’s still a lot of work to do.
Carol Vassar, podcast host/producer (12:22):
How do you envision making that recuperation?
Dr. Beena Kamath-Rayne, AAP (12:26):
Well, I think one of the things that we are hoping to do at this International Maternal Neonatal Child Health meeting, or IMNCH meeting in Cape Town, at least on a global level, is collaborate with our other stakeholder organizations like the WHO, like UNICEF.
But also one of the ways in which I think the AAP is really important is partnering with our sister professional associations. We do a lot of our work globally in collaboration with sister pediatric societies: in building their education and infrastructure and sort of leading from behind.
We want to make sure that whatever we do in global health is also sustainable and that we’re allowing them to tell us, “What are the gaps that we think are where we need your help?” Not to impose what we think they need to do.
They’re in country, they understand their circumstances, they understand what the priorities are, and they should tell us what those are. And then, we figure out ways to help them lead in repairing or improving those problems.
That is how we work now in global health. It’s almost like a decolonized view of global health moving forward. And it’s different from the way the academy has worked in the past. I hope people think that and see that it’s improved; and that we’re really trying to collaborate in a more equitable way with some of those partners.
I think people are excited to partner with the AAP because of the experience that we bring and also in this new way that we’re working.
Carol Vassar, podcast host/producer (14:04):
Let me ask you this. Health equity is a big term in healthcare in the United States right now, as well it should be. What is the scope of that worldwide? How are we bringing health equity principles to the world writ large?
Dr. Beena Kamath-Rayne, AAP (14:20):
Well, I hope people see the example in how the AAP is choosing to work globally. Also, I think the way in which we send our members out into the communities and to collaborate on projects, we are trying to take a more decolonized view and equitable view of how those relationships function, making sure that partnerships are bidirectional and collaborative.
We have a new curriculum at the AAP called GHEARD, which is Global Health Education for Equity, Anti-Racism and Decolonization. It’s basically a number of modules that cover the history of global health: which, as we know, sometimes was not always the most equitable, and covering things like local-global.
So even taking a walk in your own neighborhood and understanding some of the barriers that some of your patients in your own neighborhood may face in getting a bus to go to the clinic to access healthcare. Things like climate change. Things like self-reflecting on your own motivations to do global health work and examining your implicit biases.
This program is one that I’m really excited about. It involves small-group facilitation where you can really have those critical conversations and difficult conversations with other global health practitioners and start hopefully incorporating some of those principles in your practice of global health.
We need to get away from that small-term kind of mission-based work, which we know hasn’t had as much of a sustainable impact, and go more towards a decolonized view of global health: where there’s more bidirectional partnership and joining with longer-term sustainable projects that are driven by the people that are in the countries themselves.
Carol Vassar, podcast host/producer (16:06):
I want to pull on one of the details you just delineated, and that is climate change. Talk about how climate change and healthcare and healthcare equity all converge, in many ways, worldwide.
Dr. Beena Kamath-Rayne, AAP (16:22):
Climate change is actually something that people that are in the maternal-neonatal space are very concerned about. There are differences in how the effects of climate change will affect women and children specifically.
As someone who’s interested in newborn health, we know those disproportionate effects of climate change will also affect then how women’s health are as they enter into pregnancy: how they’re able to access facility-based care, how they are able to then care for their own children.
There are multiple sessions at this upcoming meeting about climate change and how we are going to engage the global community in caring about this issue. Also, then, making sure that we mitigate some of those impacts and inequities that will result from worsening climate change on women and children.
Carol Vassar, podcast host/producer (17:08):
Anything else we haven’t talked about that AAP is doing, that you’re doing in the global health space, that you want to share with our listeners?
Dr. Beena Kamath-Rayne, AAP (17:15):
Well, I’m only part of our global health team, and my focus is on newborn health. The AAP also does a lot with child and adolescent health.
My senior vice president, Dr. Janna Patterson, leads as well the other half of the team, which focuses a lot on vaccination coverage, vaccination hesitancy, early child development, tobacco cessation. They’re doing more in mental health as well.
There’s a lot that the AAP is doing in the global health space, and I’m excited to be here to let people know that there’s a lot of work going on at the academy in regard to global health.
Carol Vassar, podcast host/producer (17:53):
I want to pull on another detail there, and that’s tobacco cessation. We’ve seen a lot of that in the United States. What’s the status worldwide? It seems to me a lot of the tobacco companies are actually selling their product internationally, and that’s where there may be some concerns.
Dr. Beena Kamath-Rayne, AAP (18:10):
Absolutely. I think what we see in the United States is that tobacco companies know how to specifically market their products in a way that captures children and are intentionally geared towards children. Because if you get them addicted early, they continue to be users of that product, even when they become adults.
I think we see many of those same things globally. But then how you sometimes deal with the problems may incorporate a certain cultural context that may be a little bit different.
An example that I can build on for that is I know that the global team is looking at use of a suicide screener in several countries around the world. It really involves validating: are the things that we’re looking at towards evaluating that problem the same questions that we should be asking in a domestic setting?
For example, some of the words that we use to describe suicidal ideation or depression may be different in a different cultural context than what we would ask here in the United States.
So it’s also bringing that lens of some of those differences in our global work to ensure that we’re actually getting the information that we need to help improve the problems that we’re trying to solve.
MUSIC: Well Beyond Medicine! (19:22):
Carol Vassar, podcast host/producer (19:24):
Thanks for listening to our conversation on global children’s health with me, Carol Vassar, and our guest, Dr. Beena Kamath-Rayne, vice president for Global Newborn and Child Health for the American Academy of Pediatrics.
Let’s continue our conversation on global children’s health offline. Leave a voicemail at nemourswellbeyond.org. That’s nemourswellbeyond.org. You might even hear your voice on an upcoming episode of the Well Beyond Medicine Podcast.
While you’re there, check out our other episodes, subscribe to the podcast, and leave a review. Thanks to Che Parker, Cheryl Munn, and Susan Masucci for this week’s production assistance.
Join us next week as we take a look at a program aimed at increasing the diversity of the academic pediatric workforce: the New Century Scholars Resident Mentoring Program.
Until then, remember: together, we can change children’s health for good: Well Beyond Medicine.
MUSIC: Well Beyond Medicine!