 This is a podcast of the Nuffield Department of Medicine. Today we speak with Dr Jacob McKnight about neonatal nursing in Kenya. Morning Jacob. Morning. Can you tell us about nursing care for sick babies in Kenya? Yes. The first thing to mention before I really begin is that I'm a small part of a big team in Nairobi and while I'm helping organise, the people doing the hard work are out there probably doing night shifts last night in fact. But yeah, what I can tell you about neonatal nursing in Nairobi is that these nurses are extremely busy. They have very busy working lives but also personal lives. So in the hospital we see very big ratios of nurse to patients, something like one nurse to perhaps 45 sick babies on the work shifts and then again some lack of resources, some kind of lack of appreciation as well. And then of course these nurses have their own personal lives. They have families and sometimes they need other jobs to pay the rent. So they're very busy and very stressed as a result of this particular situation. So they're the most immediate things but then there are other things as well about management styles and about the way that the wards themselves run and then some more cultural issues as well about how these tiny very sick children are seen. What are the ethnographic challenges? The ethnographic challenges are quite significant. The first of them is that there's a period of scandal in nursing in Nairobi in particular at the moment the National Press have covered some significant scandals and some of the hospitals we're working in. In addition there are strikes and legal cases and all these kinds of things. So nurses are very reticent to talk and then in addition we are in these extremely busy wards and we're studying why these nurses are so busy. We don't want to take them out and take their time. So just getting the work done can be quite difficult. Can you tell us a bit more about your team's research? Sure, yeah we are finding as I said some very interesting stuff are in the just immense pressure that these nurses are under but within that they still turn up for work. So what do they do on the shift? How do they get through it? They put in significant effort to cope with these extremely stressful environments and this very emotional job and that's something that we see anchoring the shift in both ends and some certain tasks that they they they elevate within their job to give them some kind of a reprieve. But this is all quite it's ongoing research and so these are all very early findings but yeah it's a very peculiar and interesting field because of the stress that's on these nurses. Which are the most important lines of research that have developed in the last five to ten years? Well I think what I'm most proud of with this project and the reason I'm involved really is that we have given ourselves a chance to learn about an environment before we jump in with any particular intervention. So here this is a very particular situation and as I've mentioned the the nurse is very stressed there's lots of political context economic context to their working lives and by conducting ethnography we have a chance to learn about all of that before we devise a strategy to go in and help. So I'm part of a larger team which will draw together various strands of evidence to try and design something that fits based on the best evidence rather than just something that we thought of or something that we took from the international literature just dropped into a new context. Why is this research so important and why should it be funded? For that last reason in particular it's quite novel in the field and I think the larger field of public health could could do a bit more of that but in particular with newborns we've missed in sub-Saharan Africa quite a few of the millennium development goals and some of the other targets that have been set and it's been identified that these the first two days of a child's life are particularly vulnerable and for children that are born in hospitals their survival rates in these hospitals can be quite poor. So this is an area that if we get it right we could have a really large effect which yeah is what we're aiming for. Finally how does this research fit within translational medicine in the department? Within translational medicine well yeah some of the things that I mentioned about how this project is different are also part of the kind of larger trend of translational medicine. I understand that term in meaning that you need to be more careful about how you bring new ideas new treatments etc etc to the field and here obviously we're spending a lot of time in the field before bringing through an intervention so I think this is very much an example of that albeit in health system strengthening rather than in drug development and such which is where I think that phrase is often used. Thanks very much Jacob. Thank you.