Sharing our knowledge and expertise worldwide: Meet Dr. David Rakotsoane, Johannesburg, South Africa

Meet Dr. David Rakotsoane, Clinical Fellow, Neonatology, one of four South African fellows currently training at SickKids supported through the SickKids International/ Nelson Mandela Children’s Hospital Initiative. David is about to complete his year of subspecialty training at SickKids, in neonatology with rotations in cardiac critical care. He will be the second fellow to complete their training under this partnership.

David shared his story with us and what the opportunity to learn at SickKids has meant to him. David also describes the impact his experience at SickKids will have upon his return to Johannesburg in contributing to improving the health care of children in South Africa.

Please tell us about your background and professional role back in South Africa?

I trained in South Africa as a neonatologist. Prior to starting my fellowship here in Toronto, I was working in the neonatal intensive care unit (NICU) at the Nelson Mandela Children’s Hospital (NMCH) in Johannesburg. Upon completion of my fellowship training here at the end of this month, I will be returning to my position as a neonatologist at NMCH.

Explain to us a little more about neonatal intensive care and the current situation in South Africa.

NMCH forms part of a network of hospitals in Gauteng province providing tertiary/quaternary level care to children across South Africa. What is unique about the NICU at NMCH is that it is not primarily attached to a perinatal centre and gets referrals from various surrounding hospitals. We aim to provide world-class care focusing on neonates requiring surgical intervention, including but not limited to neurosurgical, general and cardiovascular surgeries.

What learnings will you take away from this fellowship experience at SickKids?

My experience and what I had hoped to gain from this fellowship at SickKids includes not only the clinical management aspects in looking after complex patients but also systems which are in place at SickKids in dealing with the overall day-to-day care. Something which I have already learned and think would be valuable in South Africa is the Caring Safely initiative, which aims to reduce medical errors.

The establishment of a similar patient safety focused initiative in a new hospital like NMCH, where the culture and practice habits of the hospital are taking shape, could be very impactful to establishing a culture focused on improving safety of both patients and staff. The fellows/trainees expected to come through the system would also benefit from this training that teaches behaviours to prevent errors from occurring, and to use tools to ensure we’re all speaking the same language of safety. There is a saying we jokingly say, “You haven’t done something until you have done it the SickKids way” -- basically meaning being more aware/conscious of what you are doing in order to minimize adverse risks to patients.

I do think overall it has made me reflect on things which we do “automatically,” to think through a decision broadly and assess what possible pitfalls there might be in caring for a patient and pre-empt and address them first. My involvement in quality improvement/safety teaching at SickKids has really been of tremendous benefit and this will surely translate to my management practice at NMCH.

Besides my time in the NICU, I have been fortunate to rotate through the Cardiac Critical Care Unit (CCCU), which is a very different paediatric intensive care unit to the one I have trained at in South Africa. I believe lessons learned in this rotation have been valuable for my own growth/knowledge as a doctor and, more importantly, will allow me to better manage patients who require cardiac surgery once I get back home.

A somewhat unexpected outcome from my experience here is an appreciation for curriculum development and adult-based learning. The knowledge I acquired from my mentors here at SickKids with respect to education will be leveraged to support the establishment of training programs at NMCH in order to build capacity of staff and trainees.

What impact do you expect this to have upon your return to South Africa?

With the experience and knowledge acquired throughout this fellowship, I hope to transfer and share what I have learned here to NMCH and broadly to all the nurses and doctors who will rotate through the hospital. I am optimistic that we will be able to make meaningful change to our patient care through this partnership.

I would like to confer a special thank you to the donor and SickKids International for this generous gift enabling me to come to SickKids for the fellowship. I would also like to take this opportunity to thank the staff and program directors both in NICU and CCCU for all the lessons learned and their tremendous support over the past year. They are truly changing the world.

For an overview of SickKids International's current projects, visit SKI's Projects page. To learn how you can get involved in these exciting projects, contact Lutfi Haj-Assaad, Executive Director, SickKids International.