When Dr Daynia Ballot is on call she’s responsible for about 100 babies. In the neonatal unit, some of the new-borns are on ventilators and many are sick. In the paediatric intensive care unit, others are fighting for their lives.
As a doctor working in an academic hospital, Ballot’s responsibility is to treat these babies, to try and save them, and to council their parents.
As a researcher in the Department of Paediatrics within the Wits School of Clinical Medicine, she wants to make sure her interventions work in the long-run. “It’s all very well treating them, but what happens to them when they grow older?” she asks.
Ballot is currently enrolling some of her new-born patients at the Charlotte Maxeke Johannesburg Academic Hospital in a study that will follow their development for the next two years.
The babies include those born prematurely, ICU survivors, near-term babies and those that suffered perinatal asphyxia (oxygen deprivation that could cause brain damage). Babies born at the hospital without any complications will make up the control group.
“We are a totally public hospital, so most of our patients have middle-to-lower socio-economic status,” says Ballot. This plays a role because her study will take into account factors like maternal education levels and employment status, whether or not the family receives a child support grant, and the child’s nutrition.
But the main aim of the study is to assess survival and brain development. Ballot will look at the children’s cognitive, motor and language skills, compared with those of an age-corrected, “normal” population (the control group). The outcomes will help neonatologists at South African public hospitals assess whether or not their approach to medical care is effective.
Ballot says such long-term studies have been performed in countries such as America, but that it is important for developing countries to find solutions to their own unique problems.
For example, until recently, premature babies were not offered ventilation to support their breathing. It was felt that the babies would have a high chance of being handicapped, and that they would have to stay on ventilation for too long. In fact, says Ballot, we now know their outcome is not nearly as bad as it used to be.
“If we’re serious about decreasing child mortality, neonatal care must be a priority. Our focus has to be on the tiny prematures.” She says neonatal deaths make up about 40% of child fatalities.
Research plays an important part in bringing this figure down, but finding time for it in between clinical duties is a tough balancing act, says Ballot. There can be other challenges too, such as obtaining funding for specific studies, or finding innovative ways around a lack of adequate hospital facilities.
One innovation that Ballot is particularly proud of is a new neonatal database that will allow her and her colleagues to improve both the service to patients and the unit’s research capabilities: the data will be used to conduct clinical audits and for the research projects of trainee specialists. Ballot also hopes it will allow her team to link up with an international network of neonatal researchers.
“I think research is absolutely essential to practicing excellent medicine, and I think we still can practice excellent medicine, even with all the challenges of the public health sector.”
Disclaimer: This article was written for original publication in Wits Leader.