This past August, the Department of Obstetrics, Gynecology and Reproductive Scienceat the Icahn School of Medicine sent a team of maternal-fetal medicine specialists and gynecologic surgeons to Letsholathebe II Memorial Hospital in Maun, Botswana to establish a new global health site.
Being nominated as part of this team was truly an honor. I’ve been an active member of our department’s Global Women’s Health Program for the past four years, primarily working as an obstetrician in a remote area of Guatemala. However, this was my first experience in actually working to establish a new site.
In preparing for the trip, I found that nearly 75% of women come in for 4 or more prenatal visits and 95% of women deliver with skilled birth attendants. Despite this good access to care, the lifetime risk of maternal mortality was calculated to be 1:220 for the women of Botswana in 2010. World Health Organization (WHO) data from that same year for Botswana showed that greater than one third of these maternal deaths were attributed to hemorrhage, with an additional 20% being attributed to hypertensive disorders.
With this in mind, we set out with the intention of improving the local hospital’s delivery of women’s health care. From past experiences, I was cognizant that our notions about what would benefit the community and what was truly needed by the hospital could be very different things. To accurately identify the true needs of the hospital and community, we spent a large component of our efforts fostering relationships with the local officials and physicians by working alongside them in clinics, on the wards and in the operating rooms. In doing this, we were able to establish trust and mutual goals to better serve the women of Botswana on future visits.
As an American physician, it is often very tempting to want to practice medicine abroad in the same fashion that we do at home. However, this is neither always feasible nor beneficial. It takes working closely with local officials, physicians and patients to understand the cultural context and expectations of the community you hope to serve. It is often not until you are actually working in your new environment that you can fully appreciate the barriers to providing good health care, and can make the necessary paradigm shifts in your practice to overcome these barriers in a low resource setting.
I feel we accomplished this on our first trip to Botswana. It is my hope that the site will be sustainable for many years to come. We plan to send teams back 2-3 times annually to continue to train local health care providers, educate patients and also to provide direct patient care.
Noel Strong, MD
Assistant Professor of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai