Ethiopia’s St. Paul’s Hospital Millennium Medical College Graduates First Cohort of OB/GYN Residents
PEPFAR-funded partnership supports specialization in women’s reproductive health, improves access to PMTCT and other critical services
In 2015, Ethiopia recorded 353 maternal deaths per 100,000 live births, down from 676 in 2011 and 1,250 in 1990. While it’s clear that the country has made great strides in reducing maternal mortality, it is still one of six nations that have collectively contributed to more than 50 percent of all maternal deaths worldwide.
A key reason for this is a longstanding and severe shortage of trained health workers. Physicians are in particularly short supply, with the World Bank reporting just one doctor per every 42,706 people. For people in need of specialized care, the situation is dire.
That’s why the July 2016 graduation of the first seven highly qualified specialists from St. Paul’s Hospital Millennium Medical College’s (SPHMMC) OB/GYN Residency Program is cause for celebration.
“Despite having medical schools operating in Ethiopia for more than 50 years, the number of OB/GYNs is surprisingly low,” explains Dr. Ferid Abbas Abubeker, Chief Resident of St. Paul’s first cohort in the OB/GYN Residency Program.
Dr. Abdulfetah Abdulkadir can attest to that fact. “In the summer of 2007 when I arrived at St. Paul, I was the only OB/GYN specialist employed by the Ministry of Health,” he says, noting that there were also four OB/GYN faculty and residents at Addis Ababa University who supported both the clinical and academic activity conducted in the hospital’s nascent OB/GYN Department.
As chair of the Department in 2010, Dr. Abdulfetah recognized the need to establish an OB/GYN Residency Program to help meet not only the needs of the hospital in Addis Ababa, but also of the country as a whole. With support from the Ministry of Health, St. Paul began collaborating with the University of Michigan to develop a 4-year, competency-based curriculum and, in July 2012, they launched the OB/GYN Residency Program.
“Being one of the largest referral centers in Ethiopia, St. Paul is the ideal place fora residency program,” Dr. Ferid says. “The number andvariety of cases here is more than enough for residents to acquire the necessary knowledge and skills expected of a competent OB/GYN.”
According to Dr. Ferid, formal attachments to related specialties such as surgery, neonatal intensive care, radiology, and anesthesia ensure that residents are well-prepared for multitasking.“This is a critical quality in anation with few trained humanresources for health,” he stresses.
“One of the most important ways of decreasing maternal mortality is having skilled personnel present during labor and delivery. The goalof this residency program is to reduce Ethiopia’s staggeringly high rates of maternal mortality and morbidity, but it is impossible for a single institution to accomplish this. The least we can do to start is to eradicate maternal mortality in our own hospital,” Dr. Ferid stresses.
The US President’s Emergency Plan for AIDS Relief (PEPFAR) and the US Centers for Disease Control and Prevention (CDC) in Ethiopia began supporting St. Paul’s efforts in 2013 through a twinning partnership managed by the American International Health Alliance (AIHA).
In addition to targeted training to improve care for pregnant women living with HIV and help prevent mother-to-child transmission of the virus— both critical factors for achieving an AIDS-free generation— residents and other medical staff at St Paul were trained in screening and treatment techniques for gynecological cancers, including cervical cancer, which is one of the most common cancers found in women living with HIV.
AIHA also organized week-long clinical attachments at Martin Luther Hospital, Krankenhaus St. Elisabeth, and St. Barbara Hospital in Germany so the residents could observe advanced OB/GYN and surgical procedures not currently offered in Ethiopia. These attachments gave the doctors an opportunity to acquire hands-on practical skills across a broad range of critical areas.
According to Dr. Abdulfetah, since the OB/GYN Residency Program was launched, St. Paul has undergone a dramatic change in both the quality and quantity of services they provide. “In our Labor Ward, the number of annual delivers has increased from 3,000 in 2012 to 8,500 currently. The number of patients seen in our Outpatient Department has gone from 16,601 to 22,310. We’ve increased the number of women receiving antenatal care by 32 percent and quadrupled the provision of family planning services,” he explains proudly.
These improvements are not limited to St Paul Hospital; they are being replicated at affiliate hospitals where the residents have been placed on rotations. Worabe Hospital has seen an increase of deliveries from 742 to 998 during the five months following resident placement, while deliveries at Yekatit Hospital rose from 1,246 to 2,316 annually after residents were assigned, Dr. Abdulfetah reports.
These results clearly demonstrate that US Government support to improve services to women living with HIV is having a significant impact on the quality and scope of OB/GYN services available to all women in Ethiopia.
“This Residency Program and the benefits of the reproductive health services it provides are not limited to Addis Ababa but have spread to the country at large. This kind of expansion of service should be encouraged and supported by concerned stakeholders,” Dr. Abdulfetah says, concluding, “I believe that all of these achievements have been realized because of the hardworking efforts, sacrifice, and commitment of our residents, who are pioneers of the OB/GYN specialty in Ethiopia.”