I look forward to completing a global maternal health rotation at Clinique El-Elyon Sante in Lomé, Togo. I will have the opportunity to work alongside the obstetrician-gynecologists, midwives, and other healthcare staff who provide comprehensive women’s health care to this underserved population. Clinique El-Elyon Sante, located in the heart of the capital city, has 52 beds and is staffed by 18 employees and 20 volunteers across ten medical specialties. Since 2023, this hospital has also partnered with World Telehealth Initiative, a non-profit organization that connects medical professionals at academic medical centers and hospital systems in the United States with hospitals and clinics in low-resource settings around the world, using a high-definition telehealth technology. Through my OB/GYN residency program at Orlando Health, we have led multiple virtual teaching sessions over the past year with Clinique El-Elyon Sante, and I am grateful to have participated in all of them. Through these teaching sessions, we have built relationships with the clinical staff and reviewed topics that they have requested, including ectopic pregnancies and vaginal infections.
Through this international experience, I will have the opportunity to observe obstetric and gynecological healthcare delivery in urban Togo through in-patient rounds, out-patient visits, management of labor & delivery, surgical procedures, and teaching. I will also learn, first-hand, how maternal health disparities are addressed in Togo, and identify factors that contribute to the burden of maternal morbidity and mortality within this community. I am also grateful for the more than 10 years of academic and professional global health experiences that inform my perspective. My goal is to support the clinical staff who are navigating resource limitations while providing vital care to this community, which I hope will make a difference through improving health promotion and disease prevention.
According to the World Health Organization and World Bank, Togo is home to a population of more than 9 million, and is among the countries with the lowest physician per capita ratios at 0.1 per 1,000 population. Additionally, it has a significant burden of maternal mortality at 349 per 100,000 live births, when compared to the global average of 197 per 100,000 live births. West and Central Africa account for about half of all global maternal deaths (51%), and according to a recent publication in the Lancet, this region has experienced the slowest decline in the maternal mortality ratio, among African regions. Not only does Clinique El-Elyon Sante positively impact the immediate community in Lomé, it also serves those that are traveling far distances to receive care at a higher-level facility. This population is particularly meaningful as I have formed relationships with the clinical staff through our virtual teaching sessions, and look forward to building on this through in-person experiences while working alongside them.
This global maternal health experience will provide invaluable insights into the system of healthcare delivery in Togo, the needs of this community, and the delivery of obstetric and gynecological care in resource-limited settings. Additionally, I speak intermediate French, have had the opportunity to build on my language skill through the large Haitian population we care for in Orlando, and look forward to building on this further in Togo. Successfully working in global health requires anticipating the unanticipated, creating contingencies, and being both calm and dynamic to meet the needs of a particular situation. There is so much to learn from different models of maternal healthcare delivery, and I will bring back the lessons ––from clinical management and techniques to leadership and team dynamics–– and will incorporate them throughout the remainder of residency and beyond. As an OB/GYN resident on the Global and Community Health track, I also look forward to sharing what I have learned with the OB/GYN residency program and our faculty.
I am very grateful to the Doximity Foundation for their support, which helped bring my global maternal health rotation to fruition. I spent the first half of each day at the Centre Hospitalier Universitaire De Tokoin (CHU Tokoin), a tertiary care center and the largest hospital in Togo. At any given point, there were 10-15 women in labor, and I had the opportunity to share pain management strategies, as all vaginal deliveries were unmedicated. Simultaneously, there were patients requiring c-sections, laparotomies for ectopic pregnancies, and blood transfusions for symptomatic anemia, among other cases. Patients were also transferred from lower-level outlying facilities for obstetric complications such as eclampsia and fetal malpresentation. In addition to my time on Labor & Delivery, I also rounded with the Antepartum service, which cared for multiple patients with pathologies including severe preeclampsia, hyperemesis gravidarum, and preterm premature rupture of membranes. I worked closely with the resident physicians who were instrumental to the workforce that cares for the high volume and acuity of patients seen at CHU Tokoin, and was inspired by their work ethic, camaraderie, and judicious use of limited resources.
The second half of each day was spent at Clinique El-Elyon Sante, a private hospital. I had the opportunity to work with two midwives and an OB/GYN, seeing patients with a variety of obstetric and gynecological concerns in an out-patient setting. These included Well Woman exams, pelvic pain, prenatal visits, contraception counseling, and patients who were trying to conceive. Patients also came for routine obstetric and gynecological ultrasounds performed by the OB/GYN. The hospital has worked to keep costs low and minimize financial barriers to accessing care. Additionally, we discussed topics for future teaching sessions through World Telehealth Initiative. I am extremely grateful for this experience and everyone’s warmth, and look forward to building on these partnerships.
