Building Women’s Health Bridges in Guyana

"I'm going to squeeze you like a lime!" says the freshly minted medical student who has returned to her native Guyana to become a general medical officer at Georgetown Public Hospital in Georgetown.

After years of studying medicine in Cuba –nearly 2,000 miles away from her home on the northeast coast of South America --the medical student has returned to be trained in a variety of departments before selecting a specialty. She is eager to learn, to work and to take care of the people in her home country, but her intentions are lost on the throng of patients needing care from a handful of trained physicians.

When patients far outweigh providers, training and education swiftly go by the board. Drawing blood, running to the lab and making quick health decisions becomes more important than medicine’s dearly held tradition of teaching. So when University Hospitals MacDonald Women’s Hospital physicians joined morning rounds one day in January, the young doctor and her colleagues enthusiastically squeezed in as much case-based learning as they could.

Cleveland, Ohio, and Georgetown, Guyana, have little in common. One is in the Northern Hemisphere, the other, in the Southern. One is inland and has four seasons, the other is on the coast and has two seasons: rainy and dry. Unlike Cleveland, Guyana also suffers from an acute shortage of OB/GYN specialists, which is reflected in the statistics: a maternal mortality ratio of 470 deaths per 100,000 live births, and an infant mortality ratio of 45 deaths per 1,000 live births.

But the cities are connected by bonds formed several years ago between obstetrician/gynecologists Margaret Larkins-Pettigrew, MD, and Tia Melton, MD, from University Hospitals (UH) and physicians at Georgetown Public Hospital (GPH). Now, UH and GPH are creating a joint residency program to educate bright, motivated general physicians to meet the need for highly trained physicians in Guyana.

Drs. Larkins-Pettigrew and Melton began the Women, Neonates, Diversity, Outreach, Opportunities and Research program (known as WONDOOR and pronounced "one door") at UH MacDonald Women's Hospital in May 2012 to train their OB/GYN residents in global health. The program, which has eight resident trainees, is actively involved in coursework and experiential training in global health, and is leading the initiative in Guyana.

“A large part of the WONDOOR program is educating our residents to be better global health providers, recognizing that many problems encountered by women in resource-poor countries also are faced by women in our own backyards,” Dr. Larkins-Pettigrew said. “All women should have the same access to quality healthcare, regardless of which door they enter.”

UH will send attending physicians to Guyana for one week each month to instruct the residents. Each attending will teach a themed module and train physicians about his or her medical specialty or interest. For example, Chenits Pettigrew, PhD, and Martin Wieczorek, MD, lectured on humanism, professionalism, cultural competency and TeamSTEPPS (an internationally recognized approach to enhance team effort, promoting patient-centered medicine and patient safety) during the May trip. Dr. Pettigrew is an assistant dean for Student Affairs and Director of Diversity Programs at the University of Pittsburgh’s school of medicine. Dr. Wieczorek is an OB/GYN who directs obstetrical education at UH MacDonald Women’s Hospital and is an assistant professor at Case Western Reserve School of Medicine.

WONDOOR is a sustainable education program aimed at decreasing the "brain drain" phenomenon that drains Georgetown of its best and brightest physicians, who establish practices elsewhere. “We face this same challenge here in Cleveland,” Dr. Larkins-Pettigrew said. “Funding sustainable education programs enables qualified faculty to provide academic excellence and support to residents, midwives, medical students and nursing staff in the form of experiential training. It’s not an opportunity cloaked in medical tourism.”

The Guyanese trainees will graduate as full-fledged Obstetrics and Gynecology consultants after training for four years, completing all modules and passing qualification exams. In exchange, they will keep a promise to serve their country for four more years.

Simultaneously, residents from UH MacDonald Women’s Hospital will travel to Guyana to gain global health experience and expand their skills as practitioners by meeting their host country’s medical challenges. Malaria, HIV and other infectious diseases, for example, are encountered more often in Guyana than in Northeast Ohio.

All of the residents will collaborate on research projects and public health interventions. Eventually, the Guyanese consultants will teach their country’s medical students, and UH will continue to support and partner with Georgetown Public Hospital so it can stand on its own to lead the way in women's healthcare.

Building the capacity of physicians in Guyana will elevate the health and well-being of the entire country. As women receive priority and a high-standard of care, they may be better able to serve their families and communities –a philosophy in which UH takes pride. “Our residents, students, faculty and staff benefit by becoming better global health providers focused on humanism, and therefore better human beings,” Larkins-Pettigrew said.

A Glimpse of Guyana

To better understand and visualize the important work being donein Guyana, we invite you to browse our photo gallery.