April 14, 2015
Navya Nair, MD, MPH, PGY4, recently participated in Emory's Global Health Residency Scholars Program. This international elective offers senior residents a four-week rotation in Ethiopia, where they participate in clinical and educational activities.
Dr. Nair's reflections on her experience:
Navya Nair, MD, MPH, PGY4 and Ira Horowitz, MD, SM, John D. Thompson Professor and Chairman, operate in Ethiopia.
Addis Ababa literally translated from Amharic means “new flower.” Similar to the city’s namesake, my global health experience in Addis Ababa was like seeing a new flower starting to unfold. While obstetrics & gynecology in Ethiopia has been practiced for centuries, the structured health care system and large-scale training of obstetrician/gynecologists is just gaining momentum. There is a huge push to improve the care that is provided to women in Ethiopia; however, lack of access to care, limited resources, and lack of preventive services remain significant challenges.
The World Bank estimates that only 1 in 10 births in Ethiopia have a skilled birth attendant present. Compared with the United States, this statistic is mindboggling and brings to mind the long list of potential complications that women face in the peripartum period, including obstructed labor, intrauterine fetal demise, postpartum hemorrhage, and infant and maternal mortality -- just to name a few. Not surprisingly, the risk of maternal and infant mortality is high in Ethiopia, and in order to change this, a structured referral system has been put in place for the care of laboring patients. For those patients who have been able to access antenatal care, delivery occurs at community health centers, where there may be a midwife or other skilled birth attendant present. If there are any complications of labor, they get referred to a tertiary referral hospital, where there are physicians and operating room capabilities.
One striking difference between Ethiopia and the United States is the lack of cervical cancer screening. The infrastructure necessary to perform pap smears is complex and expensive, and accordingly, there are essentially no screening pap smears in Ethiopia! As expected, the rates of cervical cancer are significantly higher and during my time there, I saw many patients with this preventable disease. The Ethiopian ministry of health has made cancer prevention a health priority and there is a current effort being made to implement a system for cervical cancer screening and prevention. I was lucky enough to directly work with one of the physicians who has taken on the responsibility of creating this system.
Many aspects of practicing medicine that we consider routine in the United States are not straightforward in Ethiopia. For example, getting blood work involved the nurse drawing blood, then a family member taking the blood to an outside laboratory and then bringing the results back for the physician to review. The Ethiopian physicians – residents and faculty – have learned to practice medicine in these settings and in the process are extremely skilled clinicians.
During my time in Addis Ababa, I had the opportunity to broaden my horizons and put my practice of medicine into a global context. While I learned about the numerous challenges that physicians face in Ethiopia, I was extremely impressed with their ability to triage, use resources effectively, and practice evidence-based medicine without the luxury of the extensive resources that we are afforded in the United States. I learned a lot from my experience in Ethiopia and will use what I have learned in my future practice.
|Dr. Nair with Emory Dermatology residents|