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Government Affairs & Health Policy: The Malawi Journal of ACOG’s First Global Health Scholar


Dr. Bridget Kelly in a relaxed Malawian moment.

“I walked into the room of my first patient, who was in active labor, to see a foot at the vaginal introitus,” wrote Bridget Kelly, MD, a third-year resident at Baylor College of Medicine in Houston, in her journal. “With the help of a midwife, I delivered my first footling breech without complications.”

So began Dr. Kelly’s first 24-hour call in the labor and delivery section of Kamuzu Central Hospital in Lilongwe, the capital of Malawi. The pace never slackened. “As I was leaving to take the baby to the warmer, I was called back—there was another baby surprise—also breech!” she wrote. “I performed a total breech extraction of the second twin. Both babies did well, as did Mom—without any anesthesia!”

In Malawi at Kumuzu Central Hospital: Dr. Bridget Kelly, GHS, BCM; Dr. Susan Raine, Mentor, Vice Chair Global Health Initiatives, BCM; Dr. Lameck Chinula, Jr. Faculty, Kamuzu Central Hospital; and Dr. Vineeta Gupta, Techical Director, ACOG, Global Women’s Health.

As ACOG’s inaugural Global Health Scholar, funded by Johnson & Johnson, Dr. Kelly spent January 2015 in a one-month elective in Malawi, providing general obstetrics and gynecologic care. The Global Health Scholar Program is an opportunity for well-supervised residents and Fellows to work in ACOG’s low-resource target countries alongside established university faculty with whom ACOG partners.

The most difficult situation happened during Dr. Kelly’s third week. “I met a 16-year-old woman who was septic. She had delivered five days prior via cesarean delivery. She was transferred to the tertiary care hospital where I was working for postoperative fevers and peritonitis. She underwent an exploratory laparotomy, and the uterus appeared healthy. Though a washout was performed and she was continued on antibiotics, her sepsis worsened, as did her peritonitis. As we brought her into her third surgery in less than a week, just before she went to sleep, I asked her if her baby was alive. She shook her head no. The surgery began. Her abdomen was a disaster. There was dehiscence of the hysterotomy. The lower uterus was necrotic. When I touched it, pieces of uterine tissue just crumbled away. Her uterus didn’t seem salvageable. We needed to perform a hysterectomy in an attempt to save her life. We did it. It was difficult and not straightforward, but overall the procedure went well. That same night two young women died of sepsis—one was 19 and the other was 23.”

Dr. Bridget Kelly with supervising faculty and on-site mentor, Dr. Joe Sclafani, BCM.

Dr. Kelly worked with patients who were generally the sickest of the sick. She dealt with a variety of complications, many caused by the time it takes to be transferred by litter, cart, bicycle, or even walking to the tertiary referral center. The public health challenges in Malawi are large: The country has the highest rate of cervical cancer in the world, sepsis is the leading cause of maternal mortality in Malawi, and postpartum hemorrhage is the cause of many of the pregnancy-related complications and deaths that Dr. Kelly witnessed. While her experiences were often rewarding, invigorating, and enjoyable, she hopes that more Malawian women will soon have access to quality care.

When she returned to the United States at the end of January, Dr. Kelly visited ACOG, met with ACOG Executive Vice President and CEO Hal C. Lawrence, MD, and gave a presentation to ACOG staff who are also working with marginalized populations. Her experience has opened the door for future opportunities to help build institutional and human resource capacity through educational exchanges in low-resource countries. This first round of the ACOG’s Global Health Scholar Program was made possible with funding from Johnson & Johnson as well as a successful partnership between Baylor College of Medicine’s Global Health Initiatives and ACOG’s Office of Global Women’s Health. It is only through pooling resources and teamwork that this program has had its initial success.

Dr. Kelly with ACOG CEO and Executive Vice President Hal C. Lawrence, MD, and ACOG's Jan Chapin, Senior Director, Women’s Issues

As envisioned by Johnson & Johnson and ACOG, the Global Health Scholar Program is bidirectional: At the end of February, Lameck Chinula, MD, a Malawian junior faculty member from Kamuzu Central Hospital will travel to the United States. Baylor College of Medicine will host Dr. Chinula as he focuses his clinical observations on cervical cancer and attends ACOG’s leadership course to help contribute to his leadership position in the Malawian Ob-Gyn Society. Dr. Chinula will debrief at ACOG in late March, when he will present on his experience with U.S. cervical cancer patients. (Learn more about his experiences in a future edition of ACOG Rounds.)

To learn more about our Global Health Scholar Program, as well as opportunities for sponsoring a Global Health Scholar, contact Senior Director Jan Chapin, RN, MPH, in the Office of Global Women’s Health at Jchapin@acog.org

 

 

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