Nurse Joyce Bright Baidoo cleans and dresses the umbilical cord on a tiny newborn boy with the firm but gentle hands of someone who has done this countless times.
He is just a couple of days old, still too young in Ghanaian culture to even have a name. But the swaddled newborn is not thriving as he should.
As his teenaged mother looks on worriedly, medical staff at the Korle Bu teaching hospital in Accra are running a gamut of diagnostic tests.
But even before a diagnosis, he is already getting oxygen, an early intervention that could well save his life and which has come to him via an innovative program harnessing expertise from Toronto's Hospital for Sick Children.
It was front-line nurses who determined his oxygen level was low, Bright Baidoo says.
"Because of the knowledge they have or we have, they will do something to stop the disease from progressing."
In Canada, that kind of nurse-initiated early treatment would probably be standard.
But it has not been common in most treatment centres or hospitals in Ghana. Pediatric nurses tend to wait for doctor's orders before treating their tiny patients.
Dr. Isaac Odame, a Ghanian-born, world-renowned sickle cell disease specialist at the Hospital for Sick Children in Toronto, believed that was at least part of why Ghana's child mortality rate, while improved, has failed to reach the United Nations' Millennium Development Goals.
In 2013, 78 Ghanaian children died per 1,000 live births. The goal of reaching just 40 deaths per 1,000 live births this year is quite obviously out of reach.
So when Odame heard the Canadian International Development Agency was seeking proposals for maternal and child health programs to fund, he believed a nurse-focused initiative could have the best chance of actually saving children.
"I've come to be assured that if we can deliver this skill in pediatric nursing, it's going to be one of the features that make a dent in under-five mortality in Ghana."
That confidence comes as a result of the success of a $2.5-million, four-year pilot project involving Sick Kids and the Canadian International Development Agency.
Anecdotally, it has already made a dent in that under-five mortality.
There are stories of nurses using new skills to hydrate and stabilize babies and children who would have otherwise died.
The "Scaling-Up Pediatric Nursing Care in Ghana" initiative is the first time Sick Kids and CIDA have formed a partnership. In its first phase, more than 200 practising nurses were taught specialized pediatric nursing skills geared towards holistic family care.
As well as the clinical and classroom training, the initiative is working with the Ghana College of Nurses and Midwives to improve standards and access to specialized training for generations to come.
Leticia Amengor has 25 years experience in nursing. But she calls herself a different nurse since taking the Sick Kids-Ghana pediatric nurse training program a year ago.
"It has broadened my knowledge and it has empowered me to do more than I was ever doing before," she says, adding that it's now routine for her to diagnose and administer treatment for low oxygen, dehydration and low blood sugar.
'It has broadened my knowledge and it has empowered me' - Pediatric nurse Leticia Amengor
Amengor says pediatricians have come to count on the specialized skills of the graduates.
"There are some things I can even prompt the doctors on."
The Sick Kids-Ghana initiative is moving into its second five-year phase now, with a new $9.6-million grant from Foreign Affairs, Trade and Development Canada.
It has ambitious goals of putting 1,500 nurses, midwives and health-care workers through specialized courses, all the while building an educational infrastructure so that the standard of front-line pediatric health care will be raised forever.
Nursing project manager Stephanie de Young says no small part of that is the leadership component of the course.
"They're really developing a skill set to not only care for patients and their families, but also to think about how they can influence their unit or their ward, to make changes in positive ways and to influence the practice of their colleagues."
In the second phase, the program will be looking at ways of tracking real mortality outcomes among the 6.7 million children expected to benefit from the enhanced training, rather than relying solely on anecdotes from nursing staff.
Odame is confident the newly trained nurses are saving lives,
"It's not by accident that I, a Ghanaian-born physician, find myself working at Sick Kids, a world-recognized and world-renowned institution, with this opportunity to give something back to Ghana."