International Women’s Day #BeBoldForChange
Since 1992, when we first got our start implementing partnership programs in countries across the former Soviet Union, AIHA has been fortunate to work with thousands of women who were bold leaders for change in their respective nations. Some of them were already leaders in their field when we started working with their institutions, while others grew into the role through what they learned from their partners, from us, and from each other.
When AIHA launched the HIV/AIDS Twinning Center Program in late 2004, we took our partnership model to another part of the world, applying the peer-to-peer, institution-based methodology to strengthen health systems and develop human resources for health in sub-Saharan Africa.
On International Women’s Day, AIHA is proud to shine a spotlight on just a few of the many, many women who have contributed to the success of our health systems strengthening initiatives around the globe.
In paying tribute to this handful of bold women, we mean to pay tribute to all of the amazing women whose dedication and hard work has contributed to the success of our capacity building programs for the past 25 years.
Each one of them is a champion for their patients, their clients, their professions, and their countries. They serve as both an inspiration and a call to action as we work to achieve our vision of a world with access to quality healthcare for everyone, everywhere!
Dr. Meseret Ansa Giweta says that she’s always felt it was a privilege to be among the first OB/GYN residency class at St. Paul Millennium Medical College in Addis Ababa, Ethiopia.After all, she says, Ethiopia’s national fertility rate is 4.6 children per woman. Maternal mortality is very high, too, with four women dying for every 1,000 births. “There is no question that the country needs OB/GYN specialists,” she admits.
Looking back, Dr. Meseret credits her feminist attitude for her decision to become an OB/GYN well before she entered medical school. “I simply thought that a female doctor would understand female patients better than a male doctor,” she admits. “The most tangible reason, though, was that during my internship there were so many women coming from remote areas with grave obstetric complications just because there were no skilled OB/GYN professionals within a reasonable distance,” she continues.
“I saw firsthand that most of these women were treated successfully and discharged after they got appropriate care by the senior OB/GYNs. That made me believe that this is a specialty where one can make difference, even when patients are on the verge of death,” Dr. Meseret recounts. “So I joined St. Paul’s Hospital and worked there in the OB/GYN as a general practitioner for about a year before she joined the first cohort of the new OB/GYN Residency Program established with technical support from St. Paul’s partners at the University of Michigan School of Medicine.
Since completing her OB/GYN residency in July 2016, Dr. Meseret has been working at Adama Hospital, which serves a catchment area that encompasses five regions — Afar, Amhara, Dire Dawa, Oromia, and Somali — and is home to more than 6 million people.
There are just five OB/GYNs and residents.
She says there is a saying that sums up her experience there over the last seven months: ‘I am not telling you it’s going to be easy. I am telling you it is going to be worth it.’
“I am not sure of the source of this saying, but it definitely applies,” she says with a laugh.
One of the biggest challenges is that the majority of patients are from remote rural areas. Often, they come in late and with complications such as post-partum or obstetric hemorrhage, according to Dr. Meseret.
“These conditions require more advanced care, including blood transfusion and surgical intervention,” she explains, noting that the most difficult part about her work is that the families of OB/GYN patients are not ready to accept bad news. “It is so difficult to handle whenever there is a loss. Even we OB/GYNS are not ready to accept that,” she says.
On the other hand, being an OB/GYN also means she can be there for someone in need. “I feel like I am really making a difference,” she explains. “I get to be part of one of the happiest moments a family can have — when an innocent, beautiful newborn joins this world.”
Dr. Meseret says that the future of OB/GYN in Ethiopia is bright and promising with young, dedicated, and outgoing doctors joining the field. “Like my residency class, they are committed to teaching other generations,” she says, noting that multiple areas of sub-specialty training is becoming more and more standard. “I’m looking forward to training in infertility and reproductive endocrinology myself, so I can be part of these positive changes.”
Four years of residency training was a challenge, she admits. “The sleep deprivation, exhaustion, disappointments, and even miracle outcomes — it all made me a stronger person than I was before,” she says. “It was more than just acquiring knowledge and skills needed to become an OB/GYN professional. The experience made me bold to face challenges even in other aspects of life. Being the only woman on this dedicated crew strengthened my belief that to accomplish your dream, it’s all about being ready to face the challenges, not about your gender.”
Looking back to 2010 when AIHA established a twinning partnership linking University of the Witwatersrand (Wits) in South Africa with Emory University in Atlanta, Dr. Dana Sayre-Stanhope says: “The Wits folks weren’t entirely sure what value they would get from a partnership with Emory and we weren’t sure what we had to offer, if anything,” she admits. “The value of this twinning is that it has always been and remains, first and foremost, a partnership. I have learned so much from my Wits colleagues and it has continued to inform my work in the States,” Dr. Sayre-Stanhope says. “I guess the reason I continue is because I do seem to have something to offer, but also because I draw so much from these relationships. I LOVE the twinning model.”
Sayre-Stanhope holds a doctor of education degree and is one of the four original founders of the International Academy of Physician Associate Educators (IAPAE). Over the course of her career, she has founded two graduate physician assistant programs and directed two others. In addition, she directed post-graduate programs as department chair and division chief. She has been
She has been a consultant to a number of developing physician assistant programs both in the United States and internationally. Although she retired from Emory, she continues her work with the Wits partnership supporting their Clinical Associates program.
“When I first visited Wits in 2010, there were students enrolled who, frankly, were pretty confused about what a ClinA was. Spots for them after graduation were anticipated, but not assured. Although there were some practice regulations in place, they weren’t very realistic and most important, the people who were going to be working with this new cadre — the doctors and nurses — weren’t sure what they could or should do,” Dr. Sayre-Stanhope recalls, noting that starting a new profession in a country is a massive undertaking given the confluence of education, regulation, and public acceptance. She had experienced some of these challenges in the United States and could offer some perspective.
“Now, there are ClinA graduates using their skills to care for the citizens of South Africa — that’s huge!” she says. “The work the partnership did in starting PACASA [the Professional Association of Clinical Associates in South Africa] has, I think, had a profound effect on the awareness of the medical community and the Department of Health relative to the ClinAs,” Dr. Sayre-Stanhope continues.
“I keep returning because now the faculties are working on educational evaluation components of their programs that will help them offer the most educationally sound programs. Clinicians aren’t trained as educators and developing the skills and abilities one needs to accurately evaluate the success of your educational endeavors is difficult,” she says. “Now that the faculty have been doing this for a while, we are moving to the next level to ensure that we are testing that which needs to be tested and evaluating not just individual students but the curriculum itself.”
And, she admits, she just loves the people she gets to work with in South Africa.
“I am enormously proud of the relationships we’ve built over the past seven years. It is those relationships that elevate the work of any single person and instead has multiplied what we have been able to accomplish,” Dr. Sayre-Stanhope explains. “Perhaps it sounds odd to be proud of relationships, but I guess having been party to some partnerships that suffered for its relationships, I am sensitive to how positive the impact has been here.”
Rightly pointing out that capacity building requires us to delay gratification in pursuit of the desired healthcare outcome, Dr. Sayre-Stanhope says, “I know that it isn’t glamorous, it isn’t fast, it isn’t easy, and it sure isn’t cheap. Yet this profession will reach a critical mass in a few years and the impact on the delivery of healthcare to South Africans will be huge — especially in the prevention and care of HIV/AIDS and TB.”
In addition to these high-burden diseases, she says that ClinAs will positively impact maternal and child morbidity and mortality, diabetes, and hypertension. “The list goes on and on because they are trained as generalist medical providers,” she explains.
Dr. Sayre-Stanhope says her vision is pretty pedestrian. It is also bold.
“I want lots of competent ClinAs serving the patients of South Africa. I want their work to be respected as demonstrated by an autonomous scope of practice, the full support of the Department of Health and the Pharm Council, and appropriate remuneration with opportunities for advancement,” she says, concluding: “I want young people to choose to become a ClinA because it is an excellent career, not second-class choice to medicine.”
As one of the first women to graduate with a degree in biomedical engineering from the Jimma Institute of Technology at Jimma University in Ethiopia and one of the first three women to become biomedical engineering and technology instructors at the Institute, she proves that belief every day.
“The challenge is the mentality of people who often expect that girls can’t handle the work in engineering,” Ms. Alemitu explains, pointing out that even some of her own classmates still believe that women cannot work at the same level as men.
Positing just the opposite, she says, “I think women are perfect for biomedical engineering and technology because it requires multilateral thinking, which is a natural gift for most women.”
Since Ms. Alemitu started working as an Assistant Lecturer at Jimma Institute of Technology, the number of women instructors has increased there, but also at other technology schools, such as the Addis Ababa Institute of Technology.
“We are still small in number, but I do feel proud to be one of the few female instructors in the field of biomedical engineering,” she says. “I’m also happy that Jimma has a policy to promote gender and equal opportunity, which means the ratio of female staff is increasing over time with women currently accounting for about 21 percent of the Institute’s workforce of 33.”
According to Ms. Alemitu, medical equipment is the backbone of every healthcare system. In Ethiopia, about 95 percent of this equipment is imported, either through donation or direct purchase by the government. Because there are only around 300 biomedical engineers working in Ethiopia today — a far cry from the 3,000 that are needed for optimal operation — some 40 percent of the country’s medical equipment is not functioning properly or inoperable.
“That’s why it’s so critical to train biomedical engineers. This will help to improve the quality of healthcare delivery and save resources,” she stresses.
Explaining that she was drawn to this multidisciplinary field because it helps in understanding how the human body works, making its functions more visible, Ms. Alemitu says, “Biomedical technology sheds a light on how the internal body can be visualized for a variety of purposes. For me, there is nothing more exciting than seeing a mother watch her child growing healthy in her womb.”
Because the profession is so young in Ethiopia, one of the biggest challenges is ramping up training to produce engineers and technologists to meet the country’s needs, Ms. Alemitu says, noting that a lack of materials and laboratory space, coupled with a dearth of skilled instructors, further impedes this process.
Despite these challenges, however, Ms. Alemitu has a bold vision for the future of biomedical engineering and technology in Ethiopia.
“My hope is that Ethiopia’s biomedical engineering and technology is going to be one of best in Africa. We are going to resolve our current problem, which is mainly maintenance, and move in the direction of innovation and entrepreneurship in medical technology,” she says. “The best thing is that I get to teach biomedical engineers, which gives me a perfect platform to influence the development of this exciting field.”