KORD - Comprehensive developmental care programme for preterm infants. Episode 97

Ewa Helwich
This was a programme that we have known the need for for a very long time, many years back. Ladies and gentlemen, it is important to remember that this is a preterm baby, a preterm baby is unequal. It is a huge range in fetal age from 23 weeks, because that is more or less the limit of the possibility of saving a child's life. We were light years behind the countries of the European Union precisely in the 1990s, at the beginning of this century, and in a short space of time we managed to make up for a great deal of these delays.

Monika Rachtan
Was this death of President Kennedy's child just such a seed?

Ewa Helwich
Exactly right. Exactly. You read that correctly, because that is what happened. It actually started in the States, but Europe also moved very quickly. Well, it cannot be that we do not give full opportunity to children who are born prematurely. They should have the opportunity to catch up with their peers, right?

Monika Rachtan
Hi Monika Rachtan. I would like to welcome you very warmly to the next episode of the programme First Patient. Every year, about 25,000 premature babies are born in Poland. Some of these babies need very specialised and very comprehensive care. And it is precisely this care that I will be talking about today with my guest, Professor Ewa. Welcome, Professor Ewa.

Ewa Helwich
Hello, ladies and gentlemen, welcome to the editor.

Monika Rachtan
You are a neonatologist and national consultant in neonatology. Professor, have you been able to count how many premature babies you have delivered in your entire career?

Ewa Helwich
No, it is uncountable. No, I have not dealt with such counting. Nevertheless, the neonatologist always thinks mainly of those children who are most at risk, so he thinks mainly of those who are born prematurely and those who are born with developmental defects, because these are children who need special care, not just the kind dedicated to children who are born on time, weigh about three or more kilos and scream from the first moment after birth. Also, indeed, these children who are born prematurely have always been some. They have always been treated specially by me and by all neonatologists in fact.

Monika Rachtan
And why did you choose this specialisation? Because I think that for a young girl who is starting her adventure in medicine, contact with such a tiny baby. I'm already thinking about one that's even born on time. It is something difficult and something demanding. And contact with a premature baby, I'm sorry, Professor, I would be afraid to take such a demanding child.

Ewa Helwich
That's true, but I started with paediatrics That's the specialisation I started after I graduated, after I got my diploma. I did my specialisation in paediatrics, but at the time that this was taking place, just in the world, neonatology started to emerge as this science that is aimed at children who are born much prematurely and who need to be kept alive, to be applied after they are born. Intensive care methods. And it might be interesting to recall where all this came from. In the 1980s, actually, at the end of the 1970s, the President of the United States was John Kennedy. His second child was born considerably prematurely was born weighing, if I remember correctly, about two kilograms. At the moment, such children are not a problem, but this child died because the intensive care already known for adults, that is to say intensive therapy, that is to say that type of therapy which assists breathing if there is a lack of it, which monitors heart function and therefore enables doctors to intervene appropriately, was then, at that time, possible for adults, for children, and especially for children as tiny as those born prematurely.

Ewa Helwich
This was not possible at all.

Monika Rachtan
And was this death of President Kennedy's child just such a seed?

Ewa Helwich
Exactly right. Exactly. You read that correctly, because that is what happened. It really started in the States, but Europe also moved very quickly and it was in the 1980s and 1990s that the speciality of neonatology was established.

Monika Rachtan
That is, the professor was in fact the founder of this neonatology in Poland.

Ewa Helwich
On the whole, yes. All in all, yes. Which was extremely interesting, because it involved developing a range from scratch of both the therapy itself and the application. We had to learn how to use this special intensive care equipment. And here these possibilities, this ability to apply it, we obtained from the anaesthetists, because they only dealt with.

Monika Rachtan
Now how do you transfer that to such a little baby, to such a small body, that it's at all like imagining the procedure on an adult. I'm terrified if I had to do that. And on the other hand we have a two-kilogram baby, or an even smaller one, for that matter.

Ewa Helwich
Here, without medical technology, we would have done nothing. It was the medical technicians who developed just minimised all these Instruments to. They have adapted all these tubes, all these punctures, all these needles, all these catheters to the needs of a small child. So there you go. And then in Poland, the Polish Mother's Centre in Łódź started to work. That was the centre that, for the first time, where actually paediatricians were learning from anaesthetists these possibilities of intensive care, the use of these procedures, these tools. Well, and my boss at the time sent me to the United States to also get these skills that we wanted to transplant to Poland.

Monika Rachtan
If you found our conversation interesting and are looking for more valuable content, subscribe to us on YouTube and Spotify. Monika Rachtan I invite you! And that's where that first premature baby came into the hands of the professor.

Ewa Helwich
Well? I had already dealt with premature babies in Poland, only that I was then quite helpless if they didn't want to breathe on their own.

Monika Rachtan
Well, that is it. I wanted to ask, was that the first one who was successfully helped? Was it the first premature baby there in the States that you yourself, Professor, just said? Yes, I succeeded.

Ewa Helwich
In the States. It is the Polish doctor who does not work on the basis that he could touch the patient can look without permission to work is not possible.

Monika Rachtan
The professor came back with just that knowledge.

Ewa Helwich
But there, I had already received phantom training, which was already a lot. And it was this phantom training that we later introduced in Poland, and which we still carry out today. To pass the specialisation exam, you need to know a number of things. This is what you show to the exam board on the phantoms.

Monika Rachtan
And then after you came back to Poland, what was it like, Professor? Well, because, as I say, in the end, there had to be this first child who had to be taken in hand and a decision had to be made. Ok. We are trying to save his life. We're trying to make it so that he can breathe.

Ewa Helwich
It started very, very properly. It ran very dynamically. It really did. At the moment, I can hardly remember those first children you ask about, because it immediately began to grow exponentially. And it has to be said that it was done with great enthusiasm. This very first programme of care for children who were born so prematurely. Introducing these procedures to Poland and introducing the possibility of doing them in a hospital that was not adapted to this. It was very interesting, difficult, but we had a lot of help from the Ministry of Health at that time. I have to say that at that stage I remember it very well.

Monika Rachtan
As I think to myself, we have 25,000 of these births a year in Poland. The professor told me earlier. Is it between 5TP3T and 7% of all the babies that are born in our country are babies born prematurely, and those babies that require this most professional care are 1% of births. Did I remember that correctly?

Ewa Helwich
A little over 1% births. Because, ladies and gentlemen, it is important to remember that this is a premature baby. A preterm baby is unequal to a preterm baby. It's a huge range of fetal age from 23 weeks, because that's more or less the limit of the possibility of saving the baby's life, to 37. So here we have babies who are extremely immature, very difficult to keep alive and need very good supervision of their development. Well, and babies who are born on the borderline of prematurity, that is, those late preterm babies around 35 36 weeks, who need little time to catch up with their peers born on time. So those babies who are born before the end of 32 weeks over 23 and before the end of 32 weeks. That is, we have a range of birth weights from 500 to say 1500 1600. This is the group that is the most difficult to get them safely through the period of adaptation to independent living after birth, to get them safely through the period of adaptation to independent living after birth, to get that baby to already be breathing on their own, to be able to manage the coordination of sucking and swallowing on their own, and so be able to be nourished like any adult. Any adult newborn. This takes time, this requires supervision and this also requires special measures.

Ewa Helwich
This cannot be done without preparation.

Monika Rachtan
I will ask you in a moment what this looks like today. How do you look after children today, both those who are born extremely early and those who are born in a slightly better position, when they no longer require so much care. But I think back to the times you are talking about, the 1980s, the 1990s, when I find it hard to imagine what a hospital looked like back then. But I live in Wrocław, and we have these clinics which are no longer functioning, but when you go there, you can imagine what the hospital looked like in the 1980s/90s. And that's a bit of a vision, very frightening and discouraging for me. On the other hand, it was then that the Great Orchestra of Christmas Charity (Wielka Orkiestra Świątecznej Pomocy) started to operate, Jurek Owsiak appeared with his enthusiasm, with his desire to do good things. And do you remember what it was like when the first hearts and equipment from Jurek started to appear in your wards, which were probably already called neonatology wards?

Ewa Helwich
Well, that is invaluable help. It was for years that this help lasted, but there, at the beginning, this help was most needed. And indeed, these incubators, these ventilators, cardiac monitors, all these infusion pumps, what Jurek Owsiak bought from specialised companies and gave to us. This was a huge help and thanks to this it was possible to save these children. We always remember it with great fondness, because that is how it was and that is how it continues to be.

Monika Rachtan
This year I had the opportunity to be on the staff of the Great Orchestra of Christmas Charity, and I have been analysing so much, because I happen to be a 92-year-old, so let's say I started out in life just like the Great Orchestra of Christmas Charity. And so I think that over these 33 years we have managed to do so many wonderful things. And so I closed my eyes for a moment and thought about what a paediatric ward would look like today Or just a neonatology ward. If there was no Jurek Owsiak, that it would be empty.

Ewa Helwich
Yes, and we would not have achieved such medical indicators, such indicators in terms of perinatal mortality, infant mortality and child mortality, as are currently comparable with European countries. We were light years behind the countries of the European Union in the 1990s, at the beginning of this century, and in a short space of time we were able to make up for a great deal of these delays precisely thanks to the creation of a special three-tier care programme, and thanks to the selection of hospitals which were to care for those children who were most ill at birth, thanks to the help of the Great Orchestra when it came to equipping them. And finally, however, thanks to the Ministry's interest in providing these. To provide us with the capacity to finance these procedures.

Monika Rachtan
Well, yes, well, because the fact that there is equipment is one thing, but the fact that there has to be money so that these procedures can be performed is the other issue and.

Ewa Helwich
Probably the most important are the specialists for sure, and it was during this time that the speciality of neonatology was established, one that was separate from paediatrics. And also a separate anaesthesiology.

Monika Rachtan
And what do medical students say today when they decide just to study neonatology?

Ewa Helwich
It is with regret that I have to say that we would like more students to choose this specialisation. It is specific because it is very dependent, at least in this first period, on the hospital, on the intensive care unit. Such a child, if you take him in, you cannot help him, because he requires too many specific and highly specialised devices, both to sustain his life and later to assess his development. Also, these are all hospital specialities. And besides, this is a speciality that requires very high manual skills. Imagine a vein or an artery that is not much wider than a thread, and you have to use a thin needle to pierce it in order to administer the nutrients that the child needs in order to grow, while its digestive tract is not yet mature enough for it to eat the entire portion. In the same way, after all, we administer medication. All that makes it possible for such a very immature organism to survive, which is in an artificial world, outside its mother's organism? So very premature.

Monika Rachtan
I think it is one thing to have manual skills, it is another to have the will to help, but I also think that there has to be great empathy and consideration, because it is such a huge responsibility. And it's in general a fight not only for the life of this child, but de facto use the whole family, because when a tragedy happens, then.

Ewa Helwich
It affects the whole, the whole family, of course. Yes, it is true that the mental burden is enormous. And you have to remember that, unfortunately, it is not always the case that you succeed. You can have very good conditions, you can have a lot of experience and you don't manage to save such a child, or you don't manage to make him. So that this child does not have some complication that is important for his further life. We always try our best to prepare for it, to apply ourselves to it and to manage it as well as possible. But successes are not 100 per cent and you also have to swallow that and move on.

Monika Rachtan
And do you remember your first situations, when it was very difficult, when you failed? And what were the feelings, emotions and how did you cope?

Ewa Helwich
I have to say that what I remember most is a child who was born on my doctor's duty, one of my first duties after finishing my diploma, back then, when there were no intensive care methods in Warsaw, in one hospital on Litewska Street, there were such possibilities for older children. And I remember a child who didn't want to breathe on his own and whom I ventilated for half a night, while the nurse working behind me called the hospital, asking about the possibility of transporting this child and applying intensive care to him, the doctor replied Well, but, doctor, surely this child has had a stroke and there's nothing to fight for. Such were the beginnings. But every year we knew more, we knew already. Then ultrasonography developed. You could look through the fontanel and see the whole brain and tell the doctor no, there is no stroke there. We have to give this child a chance and.

Monika Rachtan
Fight.

Ewa Helwich
About life. Yes, yes, yes. Indeed, it was hugely interesting that before my eyes, all these methods that were so, that seem obvious at the moment, right, are possible in any hospital, and before that they were implemented by us and they only decide what kind of diagnostics we use, whether we extend it, whether we think it's enough already. What treatment do we use? What treatment do we use? What do we tell the parents about the future of this child?

Monika Rachtan
I think it is also. When the professor said strong psyche, I think this question about the future is one difficult situation for the doctor, because it's always the doctor who communicates this difficult diagnosis, but on the other hand it's also a difficult situation when you have to tell the parents that unfortunately it didn't work out this time. And I think this is also very aggravating.

Ewa Helwich
Absolutely yes. But it has to be learned. Well, yes, such are the demands of life in general and of this specific field of life, which is what medicine is. In neonatology.

Monika Rachtan
When you talk, Professor, about all these procedures that have been refined and improved over the years, we have reached a point in Poland where we have a special programme dedicated to these youngest children who are born prematurely. It is a programme that has been created by experts, which is multispecialised and which covers our entire country. There are highly specialised centres that take care of such children. Well, Professor, can you tell us about this programme?

Ewa Helwich
Well, yes. This was a programme that we knew needed to be introduced for a very long time, many years back. The neonatology community stressed the need for these prematurely born children to receive this specific, multi-specialist care not only in the hospital where the child is born, but also after discharge for the first years of their life, and, on the other hand, we already had examples from EU countries, from the old EU countries, that such programmes had already been introduced, so it was as if we were not the only ones who thought that this was very much needed for our patients.

Monika Rachtan
Professor, I mean, I understand that until there was a code, it was often the case that parents were discharged from hospital with a child who was already independent and could go home safely, but then they were given hundreds of referrals to various specialists and had to cope on their own, look for appointments, choose the best doctors. They probably often ended up with ones who said they had no experience with a premature baby. And it was a kind of panto mail. Will I be able to find a good specialist to guide my child? And you decided that this couldn't be the case and that this child had to leave with such a guarantee that he or she would go to the right ones.

Ewa Helwich
You have summed it up perfectly. Indeed. Yes, yes, yes. That is how we reasoned and that is how we saw the matter, that this is where enormous help is needed. Ladies and gentlemen, it is important to point out that it must not be the case that we do not give full opportunity to children who are born prematurely. They should have the opportunity to catch up with their peers, because that is what social justice demands. Also true.

Monika Rachtan
Exactly.

Ewa Helwich
And so, well, this plan had to be defined. And, ladies and gentlemen, we have worked very hard over the past years. Finally, in 2003 2023, in May, a decree was issued by the Minister of Health stating that a Comprehensive Developmental Care Programme for children born prematurely, or cards for short, was being set up. Over the next many months, we selected the units that agreed to lead this programme.

Monika Rachtan
What were the eligibility criteria to be one of the centres that runs the court.

Ewa Helwich
Firstly, you had to want to. Secondly, you have to be at the third referral level of the hospital. Well, and we wanted it to be centres spread evenly across Poland, so that it wasn't that there was everything. Yes. This is a pilot programme so that we can select the best elements from it and possibly add what was missing there. And then, after these three years of the programme and the fourth year for analysis, there is a plan to extend this to the whole of Poland. Then it will probably be in 20 some, 23 26 units in Poland, so that parents will have the best possible access, the shortest and shortest possible journey to such a care centre. Well, because you have to remember that this is a three-year care after discharge from the unit where the child. They have been treated and supervised until their maturity is such that they can be discharged into the care of their parents.

Monika Rachtan
Professor, a lot of people who are not in the medical field, just our audiences, wonder why pilots are done. People don't understand it. Why we have to try it first. Can we explain it? Why a pilot and not already a hard programme? Well, because it's just like the professor said, you have to collect these experiences. If someone has never done something, we can observe others abroad. But every premature baby is different. It looks a bit different in every country. And that's why you decided to do the pilot and observation first.

Ewa Helwich
Yes, exactly like that. Because we were concerned that, firstly, we might encounter obstacles that we had not anticipated, and absolutely experience has confirmed that. Secondly, we chose the tools for the programme really all over the world, but they have to be tested in the Polish conditions, because these tools for the survey, for the surveillance, resulting in a certain diagnosis.

Monika Rachtan
That's right.

Ewa Helwich
What does the child need? Is there a neurological abnormality that needs to be corrected? They require very well-defined tools. Here you cannot base the whole, the whole care of such a demanding child on one person, because he or she will not be competent to both determine his or her motor development and neurological development, as well as to follow his or her emotions, the development of these emotions, as well as to follow all the acquisitions of all the Competence to also determine whether there is any hearing loss, whether the eyesight is working properly, whether everything is fine from the cardiological side. This is not possible for one specialist, preferably even the most talented, best educated one. It has to be a team of people who work according to a certain algorithm. And this programme is just such an extended algorithm, which envisages in the first, second, third year of a child's life. What specialist visits must take place? What tools need to be used in order to identify needs for the next year? Possibly confidently determine the needs for the next year?

Monika Rachtan
When I think back after my daughter was born, how many doctor's appointments there are when the child is healthy and when everything is fine And it really is difficult and shocking for parents, Because here suddenly an ultrasound of the hips, here you have to go maybe to a speech therapist, but I'm talking about a healthy child. But when I think of the parents of premature babies, who are exhausted because, for example, they've spent the last three months practically the whole time in hospital with this child, there comes this wonderful moment when they can go home and suddenly the doctor dumps such a pile of referrals in front of them and says Well, now you're consulting. It must have been horrible for those parents.

Ewa Helwich
To be enormously difficult and enormously stressful. I for one hope that those children who are in the care of Chord, or rather the parents of those children, already have the kind of guide that we give them.

Monika Rachtan
And how many children do you now have in the programme?

Ewa Helwich
Well almost two hundred.

Monika Rachtan
And as you can see right now, 2023 is thankfully already a year and a half away. Even a little more than that. Do you already see such results from your work? Can you already speak of success.

Ewa Helwich
These are just the first cats over the hump. As they say. That is to say, at the stage we are at now, we assess that the programme has been well structured, that one thing follows from the other and everything is connected. The programme is based on the fact that when a child is born, his organs are immature, his brain is immature. He is thus malleable. Consequently, it is possible to provoke certain pathways with these external measures, which will develop in the correct direction. In a situation where a child encounters certain developmental difficulties in this first period of life. That, too, is sort of the theoretical basis of it all. And we know that each sensory organ, each area of the brain, is responsible for something different and oversees something different. And we need to keep an eye on this in order to give the child a helping hand in the form of, for example, a physiotherapist, who will guide their rehabilitation when we see any deficiencies in motor development. The same when it comes to mental development. Generally speaking, the programme is aimed at the proper development of children born prematurely.

Ewa Helwich
This, of course, is the pinnacle of what we want and we have many tools for this and we would like, above all, to select a group of specialists to monitor this development, but also to work very closely with the parents And the programme stipulates that parents fill in a developmental questionnaire prior to a planned medical appointment from the age of six months, in which they mark what they see in their child. What then? At the time of the medical appointment, all this is discussed. Parents say what concerns them and this also strengthens parental competence a lot, because the parent can see. Yes, I saw it well. The doctor confirmed that it is indeed very good, and here you have to help a little bit and so on. And finally, the third element is we will try to have a good contact, a good cooperation between the programme, that is the programme run by neonatologists and paediatricians who take over the care of the children. Very many neonatologists are also paediatricians, they have a double specialisation, which is very conducive to the programme. But. Nevertheless, every child in Poland or is under the care of its primary care doctor, where it undergoes further examinations, where it is vaccinated, where health balances are performed.

Ewa Helwich
Well, and with this group of doctors we need to have a good relationship, because when a child becomes ill, he or she goes to a primary care doctor, who needs to know that this is a special risk patient and needs to know what has been diagnosed in this highly specialised team.

Monika Rachtan
And what specialties does it cover. Because you have already told the professor about neonatology.

Ewa Helwich
The neonatologist is this main coordinator. Very close. So very close. He collaborates with a neurologist, one who is familiar with babies born prematurely. And it's the neurologists who do the Precla test, the Heine method. These are the tests that are validated in the world and that are known to show certain things.

Monika Rachtan
That is, those tools that the professor mentioned.

Ewa Helwich
In addition to this, we have a psychological check-up at certain times in the child's life. Again, the psychologist performs certain tests to find out whether the child's mental development is normal, whether it is not heading towards some kind of anxiety, some kind of hyperactivity, whether the child is likely to develop properly, whether it will be able to go to a proper, correct, normal school, or whether it needs some help. Then we have physiotherapists who, when some developmental deficiencies are identified, help to correct these deficiencies. Then, of course, there are ophthalmologists, ENT specialists, neurologists and speech therapists when difficulties are observed in the coordination of sucking, swallowing or when there is a change from a liquid to a more solid diet. Also, it is a whole army of people, in addition to depending. Because every child is different, this may be required. A cardiologist may be required a surgeon very many specialists and the availability to them must be guaranteed.

Monika Rachtan
That is exactly what I wanted to ask about these appointments, because we also know that in Poland, the queue chases the queue and it is often difficult to get to a doctor even with a child. Here, if we have a court, is it so that the neonatologist sees the need for the child to be consulted ophthalmologically and presses some magic button. And this consultation is very quick.

Ewa Helwich
So yes, the programme stipulates a minimum number of visits for each child in the first year of life, i.e. 5 visits, with 6 practically still taking place in the ward, because this is when the classification takes place and then there are baseline examinations already carried out in the cord and then after a month, after three months, after 6, after 10 and after 12 there are specific, concrete visits and with specific specialists, so that in the 12th month of life, after a year, the whole team of these specialists assess whether the effect is 100%. The child is developing normally and does not require any support, or whether this physiotherapist should continue to work with the child. In the second year of life there are already 4 such visits and the third year of life. There are 3 such visits. At the same time, if the child requires some specific further medical assistance after the age of 3 years. Then we know how to intentionally transfer the child to the care of a specialist. However, you asked about time limits. This is very difficult, because in order for the programme to run smoothly in the way it has been defined, these visits must take place at certain times.

Ewa Helwich
That it can't be, if it's supposed to be in the third month of life, it can't be until the fourth month. Well, but it can be in the third month + + 10 days. So here a certain amount of potential for shifting the adjustment exists, but not very much. Therefore, the programme needs specialists to plan these visits and such specialists. We have such help in coordinating all these studies. It is a difficult programme, it is undoubtedly indicative of that already. We know what the unmet needs are, including this health service that we have at the moment.

Monika Rachtan
What are these needs?

Ewa Helwich
Well, for example, there are not enough neurologists who know about such a young child. There are not enough ophthalmologists who know about the same child. But in those centres where this programme started, that's why it started. Yes, it did not start as soon as the minister's decree appeared, but we had been preparing for the programme for many months and we had to have time to contract these specialists.

Monika Rachtan
Put together a team.

Ewa Helwich
Assemble a team and therefore. Well, colleagues from other centres. I am in constant contact with colleagues, I hear a lot of complaints from them about how difficult it is. Well, but we know why we are doing it.

Monika Rachtan
Because here this mission and this higher good, well it is very, very important. And I think that such a programme, which is really very unique compared to other programmes that are operating in Poland.

Ewa Helwich
There is no doubt about it, it is uniquely needed and i. And the effect of this programme, this pilot, will be to point out what gaps we have, what needs we have, what we need to pay attention to.

Monika Rachtan
That is, we are definitely doing such a review.

Ewa Helwich
Without this, it is difficult to plan, isn't it? Without this, it is difficult to apply to the National Health Fund for some funding, for a valuation of a procedure. If we don't know in what number of cases our patients will have to be treated. And yes, this already gives us a concrete answer. So, this is a programme on many different levels, which should bring new elements, but, above all, it should be for each of our separate children, separate patients, a guide in their development, in achieving the best possible result of this development.

Monika Rachtan
It seems to me that this programme can also serve as a kind of instruction for other programmes on how to do things in a rational way, so that all programmes are first revised, then we sit down again, discuss what works and what doesn't work, and then we implement certain solutions in the finished programme. Because it's not always like that in Poland, it doesn't always work out.

Ewa Helwich
It seems to be, as you will specify, that this is the most rational way of getting something new and something very deliberate rather than accidental.

Monika Rachtan
We were talking about a situation when it was difficult and I asked about a premature baby that you remembered at the time. And do you have a story, Professor, that there is a special premature baby that you want to think about so warmly, That's the one that comes to mind.

Ewa Helwich
Yes, it is. Ania. Ania, who is now an adult and has children of her own. Ania, on the other hand, was born into a family where her parents spent 19 years trying to have a child.

Monika Rachtan
Gosh, that's very long, Very long.

Ewa Helwich
Finally, Anna was born. It was a long time ago. Ania was born with a weight of 300 kilos, so by today's standards this is quite a good weight. However, by those standards, those first steps of our intensive care, it was very difficult to bring her out, and we managed to do it. Ania She finished, she turned out to be a very capable person. She graduated from the Jagiellonian University in Krakow, and there she is. She's a specialist in her field, she's a happy wife and mother. So I continue to hear from her. I was invited to her wedding.

Monika Rachtan
Wow!

Ewa Helwich
Yes, yes, it is indeed such a story that lasts a long time and is such a very positive story, where both sides see the results of what they have been working on for these many years.

Monika Rachtan
Well, that's what it was. There was this saying to myself that what I was doing made sense. It's very.

Ewa Helwich
Relevant.

Monika Rachtan
Very important. I am just wondering what it is like now, when the professor sits down in her chair in the evening and thinks to herself, how many children in Poland has she saved? Well, maybe not always with her own hands, but by introducing all these changes, by introducing all these solutions. But you have made neonatology in Poland world-class. And how does it feel?

Ewa Helwich
You know what? I rarely sit down and think about it. Really rarely. it takes a special occasion to go back and say well, so much has changed. I have to say that it has been such a busy time and it has changed so dynamically that I don't feel that it has been, well, 50 years, 50 years, because this June I will be celebrating 50 years as a doctor.

Monika Rachtan
That's a congratulations to you Professor, It's a really big deal.

Ewa Helwich
Yes, yes, it is indeed. But I do not feel the weight of those years. I am surprised how quickly they have passed. But it is thanks to these patients, who have always been more demanding patients, thanks to the times in which I came to develop this medicine. So very conducive to this field. And I think thanks to these challenges that we see all the time. Neonatologists are such a specific group who see the need for certain actions, who are very empathetic, who have all these abilities that they have. As a result, this is a group that, just as I was not bored, is not bored now. Times are completely different, doctors are different, but we still manage to find those who are very dynamic and willing to do this. This is not all about financial results. I would definitely say that fewer things are converted into financial effects and more into satisfaction. When the three-year-old visits us in hospital, can you see him in the clinic? You can see those curious eyes wandering all over everything, the way he runs, the way he does.

Ewa Helwich
He tries to pull off everything that interests him. It is that moment of such deep satisfaction that he has succeeded.

Monika Rachtan
A unique speciality, because unfortunately it has been accepted that medicine is not always about this higher good, Just what the professor said, it seems to me that such a, well yes, spoiled speciality, maybe also by not having this opportunity.

Ewa Helwich
Working in the office, yes?

Monika Rachtan
Well, but the professor is now a national consultant.

Ewa Helwich
To make herself a consultant, national.

Monika Rachtan
Consultant.

Ewa Helwich
And I prefer national consultant. Somehow it sounds more Polish to me.

Monika Rachtan
Well, then, Professor, because I wonder if a person who has worked in a hospital for 50 years, who is a national consultant, who has probably dozens of students under her care, does she still happen to go into the room where these little incubators are and help her staff with their work, or do you rather leave that place to other doctors?

Ewa Helwich
I have to say that it's only from the holidays at the moment. I don't work at the clinic on a day-to-day basis anymore. It is my task to provide consultation and organisation. The point is to be able to translate the experience I have gained into specific programmes. On the other hand, there are times when I have an issue to deal with and I come into the department. I'm always welcomed and it's always a pleasure to look at these children and ask: what's this? And what do you do in this case? And what problems do you have? Well that is also important to see the whole speciality, isn't it? So I am less in one hospital at the moment and more in these many, many different places in Poland. After all, I have a whole team of provincial specialists who work with me in national supervision, and we are the ones who summarise every year what new things have happened. Those things which are going wrong, possibly, and we discuss all this to determine what the plan of action is for the next year. Also here I have. It's not individual work, it's the work of experts from all over the country.

Monika Rachtan
It is amazing to be able to talk to a person who has done so much for children in Poland. Thank you very much, Professor, for your work on behalf of myself, but also on behalf of our viewers and all the children who, thanks to you, could safely and securely enter this world as adult premature babies. Because it is amazing the work you do. My dear friends, my guest, but above all your guest, was Professor Ewa Helwich, who is the founder of Polish neonatology. It was a great pleasure, Professor.

Ewa Helwich
Thank you very much for your very kind words, undeservedly so, because, as I said, it is always a team of people who develop new methods. And also, as I said, it happened so quickly that I hardly noticed it.

Monika Rachtan
Dear friends, today I showed you that by doing things that are really special and really great for this world, you can remain a great and humble doctor. You often write me things in the comments, so I think this kind of testimony is also very important. Thank you very much for your attention. This was the programme First Patient. My name is Monika Rachtan and I invite you to follow me on my social media.