Simon Rowley, one of the country's leading paediatricians and neonatologists, has spent the last 30 years caring for the youngest and most vulnerable at Starship hospital and in private practice.
Photo: supplied
He’s cared for tiny pre-term babies, infants who've been neglected and abused or older children with development delays, and been involved with stressed-out parents and whanau.
He was “always the kid that looked after the other kids” when his farming parents were visiting other families, he says, but it wasn’t until some years into his medical career he found he liked paediatrics, then “happily” fell into a neonatal job.
Dr Rowley has written Mind That Child: A Medical Memoir about his life and career.
Photo: Tim Bish / Unsplash
Over his career, Rowley has seen huge breakthroughs in the care of pre-term babies, such as assisted ventilation, which have transformed the chances of survival youngest ones.
He recalls his sadness at the death of a “beautiful little Māori boy” born at about 32 weeks, at a time when they didn’t know to deal with immature lungs - these days the infant would have the same chance as a full-term baby
Babies as young as 23 weeks and weighing 500 grams can pull through.
But Rowley is conscious that there are limits to what a baby can and should be put through - and says practitioners think deeply about this as science and research changes what's possible.
“At 23 weeks we’re not so sure that outcomes are so good that we would insist on resuscitating and reviving a baby at that gestation, so we often use that as the cut off point for having a discussion with the parents.”
Damage to the tiny babies’ bodies or brains give some clue to whether they’ll have neurological or other difficulties later in life, but the doctors can’t really predict the outcome, he says.
“When you look at some of our former pre-term babies as adults who’ve got significant disabilities, when you ask them the question, they’re all glad they’re alive.”
“It’s absolutely wonderful” when he gets to see former patients as adults. One, a ’25 weeker’ and 620 grams at birth, came back to the unit with her own baby to see Rowley and a nurse who’d spent hours looking after her.
“We all just felt a tear coming to our eyes because it was so moving and so rewarding that she’d come back to tell us thank you for everything and the life she’s having.”
Neonatal nurses are extraordinarily skilful and should be paid a lot more than they are, he says.
In his decades caring for young lives, he's firmly of the view that the effects of poverty and social deprivation can easily overwhelm the work of the doctor.
“In New Zealand we still have a lot of third world infectious diseases.”
Social conditions have a huge impact on our health, he says.
“If you’re poor, it makes it much harder to just do all the nice normal things you do with your child and keep them healthy”.
Rowley is a trustee of and presenter for the Brainwave Trust, an organisation with a vision to help ensure every New Zealand child gets the best start in life, which raises awareness of new findings in brain research.
“One of the things we now know is we wire up our brain, and we keep that wiring, according to experiences in those first two or three years.”
This “sculpting of the brain” is dependent on lots of love, nurturing and positive experiences.
And early experience affects health over our whole lifetime; Rowley cites US research indicating that if a child has several adverse experiences such as family violence or abuse, they have a higher risk of dying early from cardiovascular or respiratory diseases.
“I don’t think we realised … that we’re setting our lifetime health outcomes quite early in life.”
We need to identify and support parents who are in trouble – but more than that, we need to look at our society, he says.
“For a long time New Zealand has been a macho society.
“We’ve somehow developed this way of saying men shouldn’t be too tender and soft with their babies … we’ve got to get over that.”
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