GRADUATES IN
T H E NEWS
Helping Tiny Babies Live -
Doctor Leads Turkey's
Neonatal Care Field I
N
o two days are the same for Pınar Boncuk Dayanıklı, RC 83 who heads the
neonatal care unit at Istanbul's A m e r i c a n Hospital, one of the few specialized
centers in Turkey to offer premature babies a chance of survival.
After graduating from Robert College, Dayanıklı attended medical school at
Istanbul University and became a doctor. Wanting to gain more hands-on experience,
P I N A R B O N C U K
she then went to the Massachusetts General Hospital in Boston, one of Harvard University's teaching hospitals, where she completed
a three year residency in pediatrics. "During my years there, I did many rotations in different subspecialties of pediatric care and
realized that I loved attending births, taking care of sick babies, doing certain procedures and working with a constant stream of
adrenaline in my blood. I wanted to do intensive care, take care of really sick patients and work hard to try and heal."
"I realized that what I wanted to do, also had to be something doable in Turkey. P e r h a p s something relatively new, something I
could make a difference in," she adds. Dayanıklı became a newborn intensive care specialist, known as a neonatologist. She
completed a fellowship at the University of California in San Francisco and then returned to Turkey. "In a few months time, I was
involved in starting up a brand new unit, educating nurses, attending births (a novel concept then) and slowly building up a reputation
taking care of 5 0 0 gram babies, or twins and triplets and sometimes quadruplets."
Neonatology is a field that has been developing since the 1970s with the advent of new drugs and therapies. It is
a relatively new but growing field in Turkey. "In neonatology, I believe that every patient is a success story if that
baby is going home with her parents. Success should mean a well healed child with no major morbidities, full
medical and social adaptation to life," says Dayanıklı. As the degree of prematurity increases, the chances of
survival and chances of a problem-free life begin to decrease. Current recommendations are such that resuscitative
efforts for a less than 24 week baby (5.5 months) are considered futile. The survival rate of a 24-weeker would be
5 0 % in well developed countries and the chances of leading a life with no major morbidity would be somewhere
around the same rate.
Dayanıklı is a treasure trove of miracle stories. " O n e day we received a call from a father who had a newborn
son born at 22 weeks at another institution. Given the statistics for survival, the newborn baby was rightfully placed
aside; given some comfort measures, but no resuscitative help. This father believed deep in his heart that his son
would make it and he wanted to have the baby transferred to our unit if there was any hope. Reluctantly, we
admitted this 4 0 0 gram infant (fetus is a better term) to our unit. He had fused eyes (expectedly), gelatinous skin
and looked like a true 22 week fetus. Amazingly, he had no lung or heart problems. He was fed without difficulty,
had none of the premature baby problems we are so used to dealing with. He left our hospital on the 9 5 t h day, weighing 2 , 3 0 0 g r a m s ,
with no seeing or hearing deficiencies. He has been visiting us on his birthdays and is now 4 years old."
In Dayanıklı's unit, survival is close to 9 0 % . The unit's success rate in dealing with prematurity-related issues such as chronic lung
problems, bleeding in the brain, eye problems that could lead to blindness, hearing problems and neurological problems compares
well -if not better- with other leading countries.
In Turkey, one of the biggest challenges of newborn intensive care is that it is expensive. " L a c k of centralized health care makes it
very difficult for patients to have access to good care in Turkey," says Dayanıklı. "University and state hospitals are very crowded due
to high d e m a n d ; consequently quality of care suffers because of inadequate personnel or equipment. Private institutions
unfortunately can only serve out-of -pocket payers and maybe a very small percentage of privately insured." On a personal level, as a
pediatrician, Dayanıklı says that even after many years in practice it is still hard to have to inform parents that their baby not might
survive. In dealing with premature babies, Dayanıklı and her team sometimes have to make decisions regarding life or death. An
extremely premature baby who has serious bleeding in the brain decreases her chances of living a normal life to 10-15%. Carrying on
with major resuscitative efforts at that point might mean a blind infant who cannot walk or lead a normal life. P a r e n t s need to be
notified of such risks and a consensus needs to be reached regarding how aggressive one needs to be in treatment.
Families go through very difficult times while their babies are in the unit. In addition to the physical care of the infant, Dayanıklı
and her team need to be able to offer emotional support for the families. But the rewards of her job are immense, she says. "Luckily,
most newborns get better fast and most premature babies get better with meticulous good care. I can say, without hesitation, that I
got what I asked for. I am both happy and proud to be a member of a team of doctors and nurses taking care of these tiny babies."
FROM OUR
MAILBAG
Istanbul, 14.7.2006
I was v e r y m o v e d by the pages dedicated in my n a m e
under the meaningful headline " T h a n k You Feyyaz
B e r k e r " in the S p r i n g / S u m m e r 2 0 0 6 issue of the RC
Q u a r t e r l y m a g a z i n e . Firstly, I would like to thank
e v e r y o n e who c o n t r i b u t e d to this article.
All of the positive d e v e l o p m e n t s made hand in hand
with my fellow Robert College graduates to our
s c h o o l and the Hisar Eğitim Vakfı (Hisar Education
Foundation) make me i m m e n s e l y proud and happy.
But the principal motivation behind my decision to
retire now is my desire to see you y o u n g people take
over our roles, and watch your innovation and
s u c c e s s e s along this path.
I would like to thank o n c e again all those friends w h o
s u p p o r t e d me unflaggingly during my time in this
valuable position and the Robert College Family, w h o
appreciated and valued our efforts.
A f f e c t i o n a t e l y yours,
Feyyaz Berker RC Eng 46
R C Trustee from 1986 t o 2 0 0 6
30