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5. Global Health in Tanzania: A Journey of Fistula Surgery and Empowerment
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In this episode, join Dr. Rachel Pope and her colleagues, Dr. Anne Sammarco and Dr. Maria Shaker, as they reflect on their recent trip to Tanzania. Dr. Pope shares the personal connection she has with the country, dating back to her early career when she worked on a research project about obstetric fistulas. Fast forward nearly two decades, and she returns with her colleagues to assist with fistula surgeries, childbirth injuries, obstetrics, and women's health care.
Key Takeaways:
- The Early Days in Tanzania: Dr. Pope recounts her initial time in Tanzania working with Utu Mwanamke (Women’s Dignity Project) and conducting a study on the social reintegration of women who underwent obstetric fistula surgeries.
- CCBRT Hospital: Now a much larger charity hospital, Dr. Pope reflects on how much the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) hospital has grown, offering services for vulnerable populations and providing high-quality care in a resource-limited setting.
- A Team of Experts: Dr. Pope, alongside Dr. Sammarco and Dr. Shaker, shares their unique collaboration during the trip, combining their skills in obstetrics, gynecology, and urogynecology to provide critical care and training at CCBRT.
- Cultural Exchange: The episode highlights the importance of exchanging knowledge with local medical professionals, offering education to Tanzanian medical students and residents while learning valuable insights from their practices.
- Global Health Impact: The trio discusses the complexities of global health, including how resources and cultural factors shape patient care. They stress the importance of capacity building and sustainable healthcare practices that extend beyond short-term missions.
The episode also covers the broader themes of women’s healthcare advocacy, access to surgery, and the need for global solidarity in providing equitable health services to underserved populations.
Resources Mentioned:
- CCBRT – Comprehensive Community Based Rehabilitation in Tanzania
- Roe Green Foundation – Support for global health initiatives
- What is Obstetric Fistula?
If you’re passionate about global health, women’s empowerment, or the importance of providing sustainable medical care, this episode will inspire you to consider the ways we can all make a positive impact.
A huge thank you to the Roe Green Foundation for sponsoring this impactful journey, CCBRT for hosting the team, and all the medical professionals involved for their dedication to women's health globally.
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Transcript
Introduction to Tanzania and Fistula Surgery
00:00:00
Speaker
Tanzania is a country very close to my heart. It was one of the first places i had lived abroad for an extended period of time. I was there in 2006 and 2007 working for a local NGO called Utumonamke, or Women's Dignity Project, run by dr Maggie Bangzer. This was an incredible opportunity for me as a young, recent grad from college doing my master's in public health. I was doing a research project on women who had had obstetric fistulas.
00:00:32
Speaker
can tell you all about that and you can listen to another episode. And I wanted to find out after they had their surgeries to repair the fistulas, what happened to them. because they were so socially ostracized from their communities. They might've been living alone. They might've been divorced by their husbands. And I wanted to find out after they got their surgeries, did they get back together with their families, with their spouses, or did they start life over
Return to Tanzania and Planning the Trip
00:00:57
Speaker
again? And so that was my research project back then.
00:01:00
Speaker
I fell in love with the country. I loved learning Swahili. I visited this amazing tiny hospital at the time called CCBRT, It's a German-run charity hospital because there was a fistula surgeon there. So I got a little bit of exposure to the hospital at that time.
00:01:18
Speaker
Over the years, as I continued my degree and ended up becoming a fistula surgeon myself, I always stayed in touch with the surgeons from CCBRT as it continued to expand. CCBRT is now a massive hospital with multiple different departments. It's a rehabilitation hospital, but they also have labor and delivery now. And it's still a charity hospital focusing on disabled and vulnerable populations.
00:01:45
Speaker
And it has grown tremendously. But it was almost 20 years later that i went back to Tanzania for the first time again. And this time i was so fortunate to bring my two best friends, Dr. Anne Samarco and Dr. Maria Shaker. So, so excited to tell you more about our trip together.
00:02:04
Speaker
Listen in. You want to ask me questions? Yeah. Rachel, you instigated the whole trip. What was your purpose in going to Tanzania? So for real, honestly, i I really wanted to do fistula surgery.
00:02:19
Speaker
i feel like that I'm trying to stay connected to the obstetric fistula world as much as possible, despite living in a place where there are very rarely obstetric fistulas.
00:02:31
Speaker
And I do some virtual work. I'm on the... Figo fistula committee, and I stay involved with our International Society of Fistula Surgeons. And I'm in touch with a lot of my friends and colleagues that way. But I but like doing the work, the actual surgeries and the actual teaching and training and being with the patients is something that I really miss.
00:02:53
Speaker
And so I was planning to do something after vera was going to be one and I'd be ready to leave her at home, ah even though I still wasn't really ready to leave her. That was my thought.
00:03:03
Speaker
And I didn't want to go alone. It's so much better to go on these trips with other physicians or trainees or, you know, medical students and... Colleagues, yeah. And I think I typically bring a fellow or a resident.
00:03:19
Speaker
And this time when I was talking to my colleague, Dr. Majenge, Dr. Peter Majenge in Tanzania, he told me that they had opened up a labor and delivery ward in and the last couple of years. And if I was going to bring anyone, could I bring someone who could help with obstetrics?
00:03:35
Speaker
sorry, but the first person who comes to mind with OB is Maria Shaker. and Yes. Then, you know, Maria and Ann, the three of us have a chat going all the time because I have to talk to you guys every day.
00:03:49
Speaker
And I feel like I was talking to Maria about going. I'm like, Ann, you should come with us. Not only can you do fistula surgeries, you can also help with any other GYN and specifically Eurogyne prolapse cases. And then especially the cases that I wouldn't be doing, you would be able to do.
Medical Careers and Global Health Training
00:04:07
Speaker
Perfect compliment for the three of us to go together. a great, it was a great trip. It was a great team. Yeah, I know. We're a good team. Isn't that funny? Like we never get to work together.
00:04:20
Speaker
know that for the past 15 years. i know. We're the very first labor and delivery team together, all three of us. 2011. Oh my gosh. Yes, with Deb Prince.
00:04:31
Speaker
She was the only one missing. That's true. Okay, so to give people a little bit of background, Anne and I were interns together during our residency for OBGYN. We became fast friends.
00:04:43
Speaker
I still remember Anne sitting in the lawn at Wade Oval talking to you about music and New Orleans because we were just moving from New Orleans. trying to figure out how we were going to get through intern year going to Cedar Point. We actually didn't like roller coasters as much as we used to. And Maria was a year ahead of us and became not only a good friend, but also a mentor because she could show us the ropes and introduce us to Mac House and help us find ways of surviving.
00:05:14
Speaker
So that's just a little bit of background. i guess we're all OBGYN trained Mac House at University Hospitals Cleveland Medical Center and then have gone into three different paths. So Maria, tell us about your path so that kind of gosh everybody's background and why we made such a good team together.
00:05:30
Speaker
So just to go off your story a little bit is you guys were the first year that we had two interns. So I was like tasked with this. I have to teach two interns how to be interns on labor and delivery. That's right.
00:05:46
Speaker
I forgot all about that. ah gosh. So I don't know. I didn't want to do anything fellowship-wise after residency. But I knew I wanted to stay in academic medicine. I loved Mac House. I felt like that was my home. And my family's in Cleveland, so it was just the natural course was to stay there.
00:06:05
Speaker
And thankfully, they gave me a job. And so I stayed on as an academic generalist. We all three of us, you know, we were in the global health track. We were fortunate enough to have that experience.
00:06:16
Speaker
Wednesday nights, every Wednesday night, I feel like we, you know, when you're ready to go home for after a grueling day. we went upstairs instead of going home and talked about global health totally agree and one hour it was like two hours yeah like they would order pizza or something and drinks and we'd all sit and like talk about global health articles or whatever they'd have a speaker come in yeah was it every Wednesday night maybe not every Wednesday it might have been like once or twice a month but it was over the course of like
00:06:51
Speaker
three years of the entire residency. We had to apply in our first year to be in the track. Yeah. You'd be in good standing. So it's good. and as know let's see We're only going to take one resident per class, but like Rachel and petitioned to see if we could both be in it.
00:07:06
Speaker
Do you remember that? I forgot about that too See, we were always doing together. way in But Maria, you have gained ah additional expertise. I mean, I think maybe you can explain like, what is a generalist? Because even i find a lot of people are really confused about the different types of OBGYNs.
00:07:26
Speaker
And I feel like instead of doing less and less, like are becoming more and more specialized, you actually do more and more. And like, you get really good at doing everything. Yeah. i Maybe some people would argue ah that, you know, you can be good at a lot of different things, but I didn't really want to give up anything that I had learned, you know.
00:07:44
Speaker
so to become a general OBGYN, you go through four years of residency and you graduate and you're able to do a lot of things in obstetrics, a lot of things in gynecology. And then, you know, that's kind of where patients start with us. We do primary care.
00:07:59
Speaker
we do prenatal care. We do deliveries. We take care of patients after delivery. And then, you know, if anybody develops any sort of gynecologic issue, whether it's abnormal bleeding or they want to talk about family planning and the reproductive life plan, or they develop like abnormalities with pap tests, we can take care of all those things. But then if somebody needs a little bit more subspecialized care, then I refer on like, I am so thankful that I have Dr. Samarco for anything like stress urinary incontinence, those sorts of things. And then I have, you know, a general OBGYN can do sexual medicine and menopause care. But, you know, then there are people who like, the really, that's their niche. And so i can refer on to you or for any gender care, Rachel Pope.
00:08:48
Speaker
And then like, if somebody develops GYN cancer, they go to a GYN oncologist, or if they have infertility issues that I can't help them with, and they go to the endocrinologist. So But I do have a little sub-specialized expertise in complex family planning. I sat for the boards and passed. And so that's kind of my claim to fame yeah this moment in time, along with my general OBGYN knowledge. Thanks for explaining that. And then, Anne, you're a urogynecologist. Can you explain to people what that is and then how you became that?
00:09:19
Speaker
Sure. So urogynecologist, you can get to urogynecology either through OBGYN or through urology. So you complete one of those two residencies and then you do do an additional fellowship.
00:09:30
Speaker
And the main things we treat are urinary incontinence, bowel incontinence. So, you know, having accidents on the way to bathroom either with urine or stool, and then pelvic organ prolapse, which is like when the vagina can kind of sag or fall outside of the body.
00:09:46
Speaker
And then a lot of other pelvic floor dysfunction. So a lot of times we'll treat pelvic pain, pain with intercourse. and things like that. So pretty much anything, like the way I'll explain it to patients or people who haven't heard of your gynecology before is like the aftermath of childbirth because a lot of public disorders develop after having kids, but they also occur in people who've never been pregnant before, whether, you know, that's just the way you were born or things like,
00:10:10
Speaker
sort of devolved over time or slowly developed. You know there's a lot of people who end up with a pelvic floor disorder. And I kind of think not the greatest job of marketing what we do, because every day I hear someone come in and say, you know, like, oh, man, I wish I knew that this could have been treated 10 years ago, 20 years ago, you know, so. trying to get the word out there that we exist. Yes, I know. but Continue you getting the word out. you Look for a urogynecologist if you have any of those issues that you heard Anne just mentioned.
00:10:37
Speaker
There's a lot of people now. There's a lot of people across the country, so you should be able to find someone. Absolutely. Pretty much any major city will have urogynecology specialists. I feel like the cool thing about our trip, and I don't know really where to start, but I'm so glad that first of all, you both said yes, and we decided we were able to go.
00:10:55
Speaker
what was really cool is that, you know, this wasn't the first time that you had traveled abroad. And I think that made things really good for going to visit a hospital that I had never worked at before or been at before, because I wasn't quite sure sort of what expectations to have or to even or to tell you guys to have. And so I think I'd love to hear about the background that you have, the trips that you've done your experience, especially in sub-Saharan Africa, which then also kind of made you to taking the risk of going on this trip, whoever wants to start.
00:11:27
Speaker
Anne, you go first. All right. I have always sort of been interested in global health. Even before I went to med school, went, did like a global health outreach trip, and I went in the role of an interpreter. and So we went to the Dominican Republic, I was a finishish interpreter And then I always knew I
Impact of Pandemic and Rediscovering Passion
00:11:43
Speaker
wanted to kind of keep it in my sights.
00:11:45
Speaker
So in medical school, I had a couple opportunities. One was to go to Nicaragua for a week and assist with like a, basically a primary care clinic. And then in my fourth year at Tulane Medical School, they allowed us to do a one month rotation in Bogota, Colombia.
00:12:01
Speaker
that was really cool too. I did two weeks of primary care and two weeks of OBGYN. And then... I was lucky enough to match at University Hospitals Case Western for my residency. And we had this great global health track, that certificate program. And then they had also opened a sister residency in Georgetown, Guyana. And that gave us the opportunity to travel there during residency. And I think all of us went down to Guyana at different times, but I don't think any of us were there together. Yeah. And none of us went together. know.
00:12:31
Speaker
Kind of funny. They wouldn't let two of us leave. Yeah, yeah. We could have more than one resident gone from the hospital. One of us, right? So, you know, just learning how to work in very different environments. You know, Guyana is completely different from Colombia, which is completely different from rural Nicaragua and rural Dominican Republic where I was.
00:12:48
Speaker
And then during my fellowship, I had another opportunity. ah Michigan has a longstanding relationship with a hospital in Accra, Ghana. And so I got to spend a month at Corlebu Teaching Hospital in Ghana, learning from, they had one of the only urogynecology fellowships in West Africa at the time. i'm not sure if there are more now.
00:13:10
Speaker
And so I got to work with their faculty and their fellows and got to learn a lot about fistula surgery and fistula care from them and did a lot of outreach, you know, to various different areas in Ghana during my month there. So that was really eye-opening and really helpful in terms of like,
00:13:26
Speaker
building my surgical skill, getting me like, I guess, familiar with what obstetrical fistula was because, you know, we don't see a lot of that in the United States. I guess if anyone's ah an avid listener to your podcast, Dr. Pope, they already know what it it is, but it's, yeah, it's what happens when you don't have access to safe cesarean section. So, you know, if You have a small mom, a small pelvis and a large baby, and there just physically isn't room for the baby to fit.
00:13:53
Speaker
Then you can get a lot of trauma to the tissue between the baby and in the sides of the pelvis, and it can damage the bladder and the urethra and the vagina and the rectum and cause holes to form between all those organs, which is really a devastating complication for everyone involved. Fortunately, in U S most people have access to cesarean section.
00:14:11
Speaker
And that doesn't happen quite as often here, but in rural areas where it takes, you know, hours or days sometimes to get to a place where they can have a C-section, it's much more of an issue. Then I became a resident in Rush and did some more work. We did outreach trips. They have an outstanding global health program to Dominican Republic as well.
00:14:32
Speaker
And then the pandemic hit and it was hard to to leave, you know, and think ah global health in general has been challenging in the last five or so years. So, you know, know you had just had a baby and you go a lot, but it was hard for you to get away. And think for a lot of us, we all had kind of kids in that time, plus the pandemic.
00:14:51
Speaker
So when but the phone rang for this trip, I think we were all ready to get back into it. I guess my thoughts in general, like having worked mostly in the U.S., but, you know, in several different global health settings, like it really is important to be flexible.
00:15:04
Speaker
The number one thing is to maintain safety and to give the patients the best level of care you possibly can and the same level of care you could in the U.S. And, you know, you're working with less in terms of resources. So, you know, I think that's helped me to be resourceful in the U.S. as well as when you're traveling, because you're always thinking about, okay, what if I can't get this? What if, you know, how do I adapt? How do I be nimble? Yeah.
00:15:30
Speaker
And I think that goes kind of back to what you're saying about like, oh, you know, I'd never been to this hospital before. I didn't know what to expect. You know, it's not always going to be like walking into your home operating room or walking into your labor and delivery ward where you have all the things you're used to having but it doesn't mean that you can't provide good care and safe care for people.
00:15:47
Speaker
Yeah. I mean, not every surgeon has that attitude. And so I think it's amazing. The fact that you've sought out and you've had those experiences has set you up for the ability to do that again and again in different settings.
00:16:00
Speaker
But also I think people can respond to those lack of resources in very different ways. And so it speaks volumes to who you are is that, you know, you can go with the flow and figure it out while keeping the patient safety first and foremost and That was cool. It's cool to know that, you know, I've got friends and colleagues who can do that. And, you know, especially because when we travel abroad, there are so many cultural differences. And so I'm always like, I don't want to offend anybody. And I know with the two of you, like, there would be no problems.
00:16:31
Speaker
But Maria, you tell tell us about your past experiences and why, like how you got into global health and why you're passionate about it. You know, thinking back many, many years ago, I think it was actually Dr. Kate Conway. Shout out to her. She is awesome. She's one of my best friends from childhood. She went to Wright State and graduated, you know, a few years ahead of me from medical school.
00:16:54
Speaker
And she's the one who really introduced this whole concept of global health to me. I was like, oh what are you talking about? And state had this awesome, it was well-established global health program called the Global Health Initiative. And I got really involved with that early on as a medical student. I went to Guatemala right after my first year.
00:17:12
Speaker
and it was just like a language immersion program. It was through the University of Nebraska, actually, their medical school. And we did Spanish school all week in Antigua. And then we would go out and learn about the culture of the different regions of the country on the weekends.
00:17:26
Speaker
So that was really fun. It wasn't clinical, except towards the end, we went and did a little like health education for little kids, which was, you know, a great introductory experience. And then my last year, i went to Swaziland. It's now known as Eswatini. It's a small country within the borders of South Africa.
00:17:44
Speaker
And that was a very different experience from what we just had in Tanzania. It was a little bit more rural where we worked at the hospital, so many less resources. and they kind of threw us in there. at times I felt a little uncomfortable, but it was also like a great experience. And I love global health because there's so many opportunities for the exchange of education. It's not about us from our ivory towers in the United States to go there and bestow our knowledge and expertise upon them because there's so much to
Challenges and Fulfillment in Global Health Work
00:18:17
Speaker
learn.
00:18:17
Speaker
Just like, you know, Ann said, you know, working in really low resources, like I came back from this trip and I was like, oh, and as of late, I'm really into sustainability and trying to reduce waste in the operating room and on labor and delivery. And it's just like, wow, ah we could do so much more and how we're affecting, you know, our environment and all that.
00:18:39
Speaker
And, you know, keeping my skills sharp, too. Like I was thrown into like an ectopic pregnancy and I was not in my comfort zone of laparoscopy. I had to do it um through an incision in the a big incision in the abdomen. And I was like, oh, gosh, am I going to make sure that like, am I going to achieve he was like, you know, blood loss control and all that. So it really did great. The patient did great. Everyone did well. Yes. And there was great education to be had by all in the operating room. But, you know, global health for me is really invigorating. i love learning about other cultures and what else is going on out in the world and how women are being cared for or not being cared for and what we can do differently to really uplift them and make sure that they are being respected. I really saw that in Tanzania, which was, you know, really heartwarming and, you know, everyone cared and they were into quality issues at this hospital. And I just, you know, that all those things warmed my heart and You know, I had been on hiatus from global health for a while and I'm ready to jump back in So I'm excited. Thanks for giving me the opportunity, getting me to go again. Oh my gosh, I'm so excited that you came. All right, I'm just gonna get a little bit political for a minute because honestly, I think like what you just said about you know, doing something for women and traveling around and seeing what's happening in the world, regardless of where we were to go. i think we could have gone almost anywhere. But it's so important for me right now in the political climate of the US where I feel like women
00:20:06
Speaker
are being repressed even more and oppressed even more. And the research and medical information for women is like just going out the window and they're trying to do it very quietly or sneakily in a lot of ways. We see it in our day-to-day life and our research and our clinical work.
00:20:24
Speaker
I feel like I needed to do something for women outside of my day-to-day job. I don't know if you guys felt the same, but I just felt like, gosh, I got to get out into the world and do something for women. it was pretty partly with like USAID just being wiped off the face of this earth. All of these things that the US s was doing to help people in other countries, I felt like part of me wanting to go right now was to go do something for women with my own two hands, even though it was very brief opportunity. But I felt like I needed that for my soul.
00:20:53
Speaker
I don't know if you guys felt the same. It's just such an incredible experience, even just being outside your comfort zone and everything is hard in different ways. wherever you are, know, like it's never just a breeze, especially when it comes to women's health.
00:21:08
Speaker
I do feel we are able to do that every day. i find my job fulfilling and I'm not saying you don't feel fulfilled and stuff, but it is. Yeah. Yeah. Yeah. yeah not yeah what you're signing In terms of like, when you like see patients who wouldn't have the opportunity to have their surgery or it would take so much longer because there's a backlog or whatever, and you see the impact that care that you're providing.
00:21:29
Speaker
will have on their life, especially when it comes to like fistula or obstetric, you know, stincter tears, or like even the ectopic pregnancies and stuff. The hospital we went to is like super well established. It had amazing resources.
00:21:42
Speaker
But I think us being there really offloaded some of the volumes so that the people who are there boots on the ground full time every day could catch up on some of the other things that they're doing and not have such like a backlog.
00:21:54
Speaker
And so it felt really good in that respect, you know, like I felt like we were helping colleagues. I felt like we were helping patients. And the cool thing about this specific scenario is that we had local Tanzanian like medical students and residents who were there working with us too. And we all had opportunity to teach Maria on labor and delivery. For us in the operating room, they would scrub with us and we'd give a talk on like obstetric anal sphincter injuries and things like that. So it That part I thought was really cool. And, you know, those are all aspects of our lives every day at home, but it's cool to be in a different setting and like have different perspectives on all of it.
00:22:31
Speaker
Yeah, I agree. I almost felt like we were being ambassadors, you know, like ah so much turmoil here We're not making friends politically, like between our country and our allies or maintaining our allyship and, you know, going there. And i feel like maybe patients were skeptical of us because we were strangers, you know, the outsiders, but like just breaking a smile and trying to
Motivations and Sustainability in Global Health
00:22:57
Speaker
communicate with them. Like I love seeing other people smile back. You know, they're like, oh, I don't know about this person. And then like you smile at them and then they smile. It's just beautiful. um
00:23:06
Speaker
And I had a really good experience with the medical students there. I think they thought I was from Mars or whatever. because I was like, all right, what are we going to learn? Let's, you know, do something. Because they were like off in another room by themselves. And we just had a great time. And actually, they still email me, which is... Oh, I love that.
00:23:24
Speaker
and we We've developed a nice relationship. So I tried to affect a little bit of change. You know, I think they have a lot of the hierarchy there. And they're scared to sometimes answer questions because they don't want to be wrong, you know, and we have a lot of that too here. and I said, when you guys are the educators, you can start to make some changes happen.
00:23:45
Speaker
definitely. No, it's it's cultural, right? For those of you who are listening who are not in medicine, like it is very hierarchical. And in some settings, it's more like you're going to learn by watching me. rather than interacting. And sometimes the medical students are lowest on the totem pole. So it was really nice to to see you like kind of give them that attention and give them that sort of special feeling, which was great.
00:24:07
Speaker
And I was kind of thinking about it, like, I feel like in our day to day jobs, all three of us, we do serve women. And so what makes us want to go travel abroad abroad? and do that for other women? You know, like why? Trying to figure out if I could answer that. And I thought, okay, well, let me ask you guys. For me, it's some of what Rachel said at the beginning. So we do see fistulas in the United States, but they're not usually from obstetrics.
00:24:32
Speaker
And so I think that's really important, but also, you know, We're citizens of the world, you know, like I think it is really important to share knowledge and share our skill sets. And like we do have a different perspective that we can share.
00:24:45
Speaker
and that's not to suggest that it's like unilateral. I learned way more victor from that week than I can imagine that I passed on. But I would say, you know, for me, I think the things that keep me interested in global health are one, being able to provide care for people who are in need, like help colleagues. Two, you know, we learn, we see complicated cases that we may not see on our day-to day to day.
00:25:08
Speaker
and number three, like it helps create sustainability if it's done in the right way. You know, so like whenever i think about whether or not I want to take on a global health experience, like I want to think about whether or not we're just providing a service versus whether we're quote unquote, capacity building. So like passing on knowledge and sustainability for a program, like boots on the ground so that we're not dropping in, doing a bunch of work and leaving and, you know, nobody's following up on those patients or anything like that.
00:25:37
Speaker
That's not the ideal setting. I was very comfortable in this setting where they had such a great health system. They have four fantastic OBGYNs that are there. Like before I did any case, I was like, okay, so like if this person has trouble urinating, what's the steps? and they're like, oh yeah, we would do XYZ. And I was like, okay, that's what I would do at home. So cool.
00:25:55
Speaker
You know, like I feel comfortable doing that. I think capacity building includes like working with those residents, those medical students. And even, you know, we were working with new attending who just started there, who was learning fistula surgery. And like he scrubbed almost every case doing those.
00:26:14
Speaker
And so that, I mean, to me, that is one of the most important reasons to Yeah, absolutely. Maria, how about you? No, I totally agree with Anne said about everything. i mean, global health, yeah, we serve women every day and ah hopefully I'm providing them. Like I always strive for excellence in the care I deliver, but going out and getting those experience, I think really refines my skills and reminds me to meet people where they're at. Interestingly, we went to a lecture by a priest in Guatemala and And he was talking a lot about like walking in solidarity with people and how we can apply that. i mean, he didn't mention medicine, but it's so applicable in the medical realm. You know, it's, again, not all about like being paternalistic, but like figuring out where people are coming from. and what is shaping their experience and how my recommendations change or modify those recommendations based on what a patient is able to achieve or what they're ready for.
00:27:11
Speaker
So I don't know, I think global health really helps me better refine those skills. And i always think like, you know, we we used to say and people, a lot of people say maybe in the global health world, like global health is local health, like What we learned, whether we're in Cleveland, Ohio, or we're in Dar es Lom, Tanzania, like you can like apply all those things in every situation that you're in, really.
Trip Highlights and Financial Constraints
00:27:34
Speaker
That's true. What was your favorite thing? Like, what was the highlight of the trip for you all? I mean, I loved spending time with you guys. I think that was so, so fun. Yeah. There's so much time in travel when you're waiting for a flight, kind of at your layover. And then at the end of the long day, kind of reflecting on how the day played out. There's so much of that sort of liminal space. And i love getting to spend that time with you both and catch up with you as you know, as adults after 15 years of friendship, but also, you know, the operating together and,
00:28:12
Speaker
I think one day i just tell the story that we were operating on a really challenging case. Ann and and i were doing together with one of the local surgeons and it was getting to be pretty bloody because of the nature of this part of the case. And there was a C-section happening next door. So the nurses were needed there. And so we didn't have a scrub nurse for a while. And so I was like, you know, kind of turning to the side like,
00:28:38
Speaker
assisting myself to get the suture and get everything together, which I have done before many times when working in sub-Saharan Africa. But with the bleeding, you know, you don't want to move your eyes. Like you want to be operating and you want someone to hand you something and you keep going to keep your focus and to move quickly. Probably by the third time that I complained, I'll let I was like, can you just call my friend, Dr. Maria?
00:29:00
Speaker
And went and got Maria from labor and delivery and she's scrubbed and she said, I've always wanted to be a scrub nurse. And she's scrubbed in and like assisted Ann and I was like handing us everything and getting the suture ready. And it was so nice that you were humble enough to do that, first of all, and just to kind of jump in for the three of us to be working together was such a pleasure for me.
00:29:25
Speaker
I love to be part of the action and however I can help, I'm in it to win it. I love providing exposure. I'm the queen of visualization, as I like to say.
00:29:35
Speaker
important You can't operate well if you cannot see. I would say getting to operate with you, Rachel, in you know that experience with Maria also is ah highlight for sure, because you know in the US, there's almost 20%.
00:29:50
Speaker
no chances for us as attendings to operate together anymore. You know, like we did as residents and things like that, but you know, unless we have a combined case or something like that and you learn things from each other, you know, like I think we're all very thoughtful surgeons and we kind of adapt and we kind of change things a little bit to make it better for the next time as we move along. And so like, if I operated with you like five, 10 years ago, it's probably not going to be the same experience. right And like, I love picking up new little tips and tricks and like,
00:30:18
Speaker
thinking through things in a different way. And I always learn something, you know, so I think that's really amazing. It's just not an opportunity. We get a lot of here. My other favorite memory was, you know, so we gave that talk on obstetric anal stincter injury and like chronic fourth degrees.
00:30:34
Speaker
And I think it was really well received. People like had a lot of questions, which we love when people ask questions because then they were listening and like internalizing and, you know, crunching through information. And then the very next day we had the exact case that demonstrated, you know, the principles of the repair that we'd gone through the day before. So like, that was like total kismet, you know, like, kicked that like So they're like, okay, here's a step. Here's a video. Let's walk through it. And then the next day is like, and this is real life. This is exactly what we do in this scenario. And it was very cool for me. That was so good. And it was like a master's class. Seriously. You have the expertise. You gave the talk. And then you did the procedure with them. It was wonderful. It was like, it was really great. It wasn't planned that way. It was just like, wow. I was impressed. Okay.
00:31:18
Speaker
It was really cool. What were the highlights for you? I hate picking favorites. I can't pick my favorite food. The days went by so fast. I really love the fact that I was hungry at lunchtime, but like it was so busy that we were just, we pushed through to the end and then it was time to go home and eat. And I was like, all right, I'm ready for a good meal.
00:31:37
Speaker
I really loved connecting with the medical students. You know, developing a relationship with them was really fun for me. I loved connecting with Dr. Brenda, who has a leadership role at the hospital, and just hearing about the quality initiatives she has already enacted or is trying to implement. And it was really inspiring for me and what she's able to do and how she's always thinking, you know, and what she can do to make things better for women there at the hospital and for like educational purposes, too. I mean, she's really committed to educating her general practitioners as well as like the people who are OBGYN residents.
00:32:13
Speaker
I just loved it all. I can't pick a favorite. I'm sorry. loved coming back the next day to hear what happened to the patients that we rounded on. And, you know, everyone had a great outcome during the week. So I was very thankful for that.
00:32:26
Speaker
Then the thank you to CCBRT for allowing us to crash. The key thing about global health is that it it costs money. And that's kind of why there's a need in the first place.
00:32:37
Speaker
Right. You know, A lot of the care that we're providing, like obstetrical fistula a disease of poverty, like in, you know, access to good healthcare and things like that, safe healthcare.
00:32:48
Speaker
And, you know, if these people had the money to get themselves to where they needed for care, they wouldn't be having some of the things we were treating. And so, you know, a lot of times it costs the health system, the local health system money to take care of these patients. It costs the local surgeons time and money to take care of this patient. So like, it's a,
00:33:08
Speaker
challenging problem, especially obstetrical fistula in particular, because there just isn't. Those patients don't have money to pay for their services. Right. Yeah. it It's not, they're not the patient population that's going to keep the hospital lights on, you know, the facts of the matter are like, you know you have to have some kind of income to be able to like provide care for everybody.
00:33:31
Speaker
You know, we traveled there on the generosity of people who donate money. for global health, we donated our own time to do it. yeah And so I think that is a really important key aspect to touch on is that, you know, like we can only do this because of the generosity of others. And, you know, we're we're donating our time and expertise and we're doing our very best to help the people on the ground who also donate their time and resources and knowledge. We're all kind of coming together to help these people who otherwise wouldn't have very many other treatment
Gratitude and Future Plans
00:34:01
Speaker
options. Yeah, that's so true.
00:34:03
Speaker
Like we are very thankful to ro Green and the grant that... yeah provided. And it's just amazing that you come together to do stuff like this. Well, the cool thing about Ro Green, who sponsors the travel medicine and global health program that I'm a fellow in at UH and that sponsored our trip, is that she considers herself a global citizen, like you said earlier, Maria. And I think that is really the underlying theme of the whole thing. Like if you consider yourself a global citizen and then you're a global physician, you're going to want to help women everywhere.
00:34:39
Speaker
and anywhere. And she's not a physician. She's coming at this from a very different set of experiences, but she has traveled the world and she loves travel and she loves culture. And she's come to see the need of people and of women around the world.
00:34:54
Speaker
And so I think if you can see outside of your own town, city, backyard, and you see what's happening around the world, then you can't help but want to be involved in the ways that your work would be influenced. And for us, that's OBGYN in some way or some form. So I love everything that you guys talked about. We've got to start planning our next trip. I can't wait to do this again with you both.
00:35:18
Speaker
And a huge thank you to Ro Green and to the program at UH for the sponsorship of the trip. A huge thanks to CCBRT for hosting us and making it all possible. To Dr. Majinge and Dr. Brenda as well, who hosted us.
00:35:32
Speaker
And then to, of course, our coworkers who may have picked up some of our slack in order for us and our families.
00:35:41
Speaker
Who picked up some slack to allow us to be out for the time that we were. Thanks, everybody. And yeah, go ahead, Maria. Oh my gosh, I know you're trying to wrap up. But while we were like saying all this out loud, and I know we know this, but the fact that it takes money to care for women elsewhere in the world. you know This is a big topic in medicine right now, or maybe amongst OBGYNs like ourselves, and how women's health is not as well reimbursed from insurance companies in the United States. And was it Dr. Fitzgerald who wrote a great article? And was it published in in one of our journals? And just how different women's health is reimbursed, women physicians, you know those who provide care for women, and how different it is. just in the United States. And like, you know, we're over-resourced and, you know, we all know that, but, you know, just calling that to light too. That's such a good point. And, you know, know dr Fitzgerald and I went to high school together ah we're both from Squirrel Hill and we took our MCAT together, which was so fun. So I love following her and seeing what she's doing. And and her world is very different from mine. And yet like the values are the same. It's really about like valuing women's health, right? And whether that's money, time, resources, it's about,
00:36:55
Speaker
needing to put that into perspective and keep that value there because women are worth it and we wouldn't be here without them. All right. Well, thank you guys so much for your time. It's so good to talk to you and let's get planning for our next trip.
00:37:08
Speaker
All right. I'm on board.