Empowering Local Doctors to Expand Women’s Health Care in Ethiopia

One U-M professor is leading a medical training transformation — making her dream of growing access to reproductive care in her home country a reality.

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Author | Julie Halpert

Senait Fisseha, M.D., J.D. at Gandhi Memorial Hospital

When Senait Fisseha, M.D., J.D., left her native Ethiopia at age 18 to attend college in the United States, she dedicated herself to improving women's reproductive health in her home country.

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"The poverty is so pervasive. It was something that was palpable around me," Fisseha, an adjunct professor of obstetrics and gynecology at U-M, says of a place where women have little access to prenatal or general health care.

She has, after all, witnessed many young women in Ethiopia getting married and having children at 15 or 16 years old — with some bearing large families that negatively affect their health and quality of life.

"I had grown up watching the suffering of women all around me, knowing the high rate of maternal mortality and infant mortality, and always said, 'I'm going to medical school and try to bring the impact [back] home.'"

Fisseha's work eventually led to the founding of the Center for International Reproductive Health Training (CIRHT), a groundbreaking U-M initiative launched in February 2015 with a $25 million gift.

CIRHT aims to increase the number of medical professionals in Ethiopia who are trained in providing comprehensive, compassionate reproductive health care, particularly in rural areas.

The country lacks enough doctors who specialize in this field, Fisseha says, a shortage exacerbated by the fact that many leave Ethiopia to train and never return.

Meeting of minds

After completing medical school at Southern Illinois University, Fisseha in 1999 began her residency at U-M, where she met Timothy R.B. Johnson, M.D., chair of the university's department of obstetrics and gynecology.

Johnson had previously helped establish an OB-GYN practice in Ghana that is considered to be the country's most advanced. Since 1989, the program has succeeded in training 142 OB-GYNs; all but one still practice in the country.

"We demonstrated that there are substantial downstream public health benefits to training OB-GYNs," he said, noting that having students globally engaged is a U-M priority.

So when Fisseha told Johnson of her ambitions to contribute in a meaningful way to Ethiopia, the two quickly developed a bond.

"He gave me incredible support, from mentoring and advising to connecting me to global health leaders," Fisseha said.

Her vision became reality when Tedros Adhanom, then Ethiopia's minister of health, asked U-M to replicate the Ghana program. Johnson replied he could take on only one country.

But he was pleased to have Fisseha lead the effort.

We are integrating all reproductive health services and mainstreaming them into routine medical care, so it's not stigmatizing for providers or patients.
Senait Fisseha, M.D., J.D.

A dream realized

Within one year of Adhanom's request, Fisseha helped in the establishment of the first OB-GYN residency program at St. Paul's Hospital Millennial Medical College in Addis Ababa, Ethiopia, in 2012. The first residents graduated in July 2016.

The program expects 60 additional residents to graduate within the next three years.

CIRHT now works with 10 universities in Ethiopia to integrate comprehensive reproductive health training into medical and nursing education and help expand access to reproductive health services.

Known as Michu clinics —"Michu" is the Amharic word for "comfortable, suitable and friendly"— they are fittingly decked out in maize and blue.

The impact of CIRHT's work is to build capacity so reproductive services will become a mainstay, "not something siloed on the side," Fisseha says.

A part of that is providing family planning information and access to safe abortions for unplanned pregnancies. Gaining acceptance for abortion was no easy task because of a religious stigma around the practice.

"We are integrating all reproductive health services and mainstreaming it into routine medical care," says Fisseha. "So it's not stigmatizing for providers or patients."

Bahir Dar University Hospital is one of 10 universities that CIRHT partners with across Ethiopia.

Signs of progress            

Johnson praised his former student's fast success. Fisseha, he says, has accomplished in just three years in Ethiopia what it took him 12 years to achieve in Ghana. He has toured the CIRHT centers and views the progress as remarkable.

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Janet Hall, CIRHT executive director and chief department administrator for the OB-GYN department, agrees.

"The magnitude of the impact we had in Ethiopia was unanticipated," she says.

And the impact continues: Until 2004, Ethiopia had only one OB-GYN residency program; now, 10 programs train more than 100 OB-GYNs a year. According to a 2015 World Health Organization report, the percentage of women making four or more health visits during pregnancy tripled between 2000 and 2014, while contraceptive coverage for modern methods grew from 6 percent to 40 percent over the same period.

The maternal mortality rate declined from 743 deaths per 100,000 live births in 2005 to 353 per 100,000 live births in 2015, an average annual rate of reduction of 7.4 percent.

Fisseha, who left Michigan in fall 2015 to become director of international programs at the Buffett Foundation, credits several factors to a successful experience in Ethiopia.

Among them: strong support of local partners, including Tedros, the former health minister who is a staunch advocate for women's health, and the country's current health minister, Yifru Berhan Mitke, who has worked with CIRHT.

Fisseha remains closely involved in CIRHT's implementation to increase capacity and train doctors in other countries where women's reproductive health services are lacking.

The next targets: sub-Saharan Africa, Southeast Asia and, eventually, Latin America.

Lessons learned in Ethiopia will help guide the next chapter.

So, too, will Fisseha's resolve.

"We may face greater challenges in other countries," she says. "But that won't stop us."

This article was originally published by the Alumni Association of the University of Michigan and reprinted with permission from the winter 106 Michigan Alumnus.

More Articles About: Med-U Gynecology obstetrics Community Health Womens Health
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