Global Health Volunteers: Educating for Change

Laura A. Stokowski, RN, MS

Disclosures

January 21, 2015

In This Article

Maureen Ries, MD: Tanzania

Maureen Ries recently returned from northwestern Tanzania, where she spent a year teaching groups of 10-12 medical students (assistant medical officer students and clinical officer students) during their 6-week obstetrics-gynecology (ob-gyn) rotation at a district hospital in northern Tanzania. Maureen also worked with the medical school faculty, helping to develop the medical school curricula and organizing conferences. She invited nurses to participate in her educational trainings because she realized stronger healthcare delivery comes from an interdisciplinary approach. Nurses play a huge role in delivering babies and taking care of pregnant women in Tanzania, and she felt they should be included in ob-gyn trainings.

Figure 3. Maureen Ries, MD, with colleagues in Tanzania. Courtesy of Seed Global Health.

Obstetric care in Tanzania differs from care in the United States. It has been estimated that the country has only about 60 practicing ob-gyns, none of whom were at Maureen's hospital. "At my hospital, 90% of the care is provided by midlevel practitioners (assistant medical officers and clinical officers). An obstetrician is called in only for very critical complications," explained Maureen.

Furthermore, prenatal care is limited. Some women might go to a community clinic dispensary once during their pregnancy, but many do not receive any prenatal care. Even if they do have a prenatal visit, the care that they receive is contingent upon supplies. For example, pregnant women may not receive malaria prophylaxis or be screened for HIV tests if clinics are out of stock. "The barriers to adequate prenatal care extend beyond merely a lack of provider or patient education but include challenges within the healthcare infrastructure and the availability of resources," said Maureen.

Because providers may not be able to rely on having a complete patient history, Maureen taught her medical students how to do an intake interview starting from scratch. She explained that these training moments are "a great opportunity to teach preventive medicine and community health concepts. Students heard me tell the patient that next time, she needs to get prenatal care for these reasons. She needs to tell her sisters and the people in her village that she must get care. When I modeled that advice, the students learned and copied it."

Maureen also thought creatively about how she could train her students because the teaching resources that she may have had in the United States were not available to her in Tanzania. For example, when she taught suturing techniques to her trainees, they practiced on goat feet and cow hearts. To practice C-sections, students used a cat carrier to simulate an abdomen. Recognizing that infant mortality is high in Tanzania, Maureen taught her trainees the Helping Babies Breathe curriculum, an educational program designed to teach basic newborn resuscitation skills to providers in low-resource countries.

By the end of her service, Maureen began to see the impact of her efforts. Her 40 students all passed their ob-gyn exams. She also saw signs of improved clinical care delivery from the medical providers at the hospital whom she had taught how to perform hysterectomies and to manage uterine rupture. "Early in the year, I was called in often to help with surgery. Gradually, I was called less and less often, so that by the end of the year, I was rarely called in because the hospital was calling the doctors I had taught." She views this as a reflection of the sustainability that the GHSP program strives to engender. "I left with the hopeful feeling that they were better off than when I came," she said.

Become a GHSP Volunteer

Matthew, Kelly, and Maureen were in the first wave of GHSP volunteers in Malawi, Tanzania, and Uganda. Their work continues as new volunteers have taken over and are continuing the collaboration with professional health educators at local partner training institutions.

In its inaugural year (2013-2014), there were 30 GHSP volunteers; this year, there are 42 doctors and nurses currently serving in the field. The program plans to continue expanding to send more volunteer educators in the years to come.

Apply to be a GHSP volunteer! Physician educator position descriptions and requirements can be found here, and nursing educator position descriptions and requirements can be found here. To apply, click here. Visit seedglobalhealth.org or or peacecorps.gov/globalhealth or contact info@seedglobalhealth.org for more information.

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