University of Buea OBGYN Program, Cameroon

Overview:
We are seeking educational support for the obstetrics and gynecology residents at the University of Buea, Cameroon (UB). This training program is the first ever obstetrics and gynecology residency program in English-speaking Cameroon, and only the second obstetrics and gynecology training program in all of Cameroon.

The residency program, run by the UB, is supported by the Cameroon Arizona Partnership, a collaboration of physicians and educators from both Cameroonian and Arizona institutions. The goal of CAP is to reduce maternal mortality by training and retaining skilled women’s health specialists in Cameroon. We believe in training excellent professionals in Cameroon, rather than
removing them from their home country. This model has been shown to be much more effective in
providing professionals who stay and practice where they are most needed. Our program is new — the first class of four residents has just begun this academic year! The long term goal will be four classes of 4-5 residents each, with the graduates pursuing certification by the West African College of Surgeons.

Dr. Brady, having been a residency director for 17 years in Arizona, has seen the benefits of the Rosh Review Program for his American residents, and would love to extend this tool to help the Cameroonian residents pursue their goals. As we are rather early in the process, we don’t have specific “testimonials” yet, but we expect that will come with time.

Let us describe a bit about the challenge we seek to address, our model, and why it will work.

The Problem:
A woman in Sub-Saharan Africa is almost 100 times more likely to die from pregnancy or childbirth related complications than a woman in a developed country; a 1 in 39 lifetime risk compared to 1 in 3,800. In Cameroon, there are 596 maternal deaths per 100,000 live births (WHO, 2015). This is characteristic of sub-Saharan Africa, where most of the worst maternal mortality ratios, and the majority of maternal deaths, are found. Leading causes of maternal death are hemorrhage, hypertension, infections, and complications of preexisting conditions such as malaria (Filippi et al.,2016). Huge disparities in the level of neonatal mortality persist across countries. The first 28 days of life-the neonatal period-are the most vulnerable time for a child’s survival. In 2016, the number of newborn deaths per 1,000 live births was 3.7 in the U.S and 23.9 in Cameroon ( World Bank, 2016). Most deaths are caused by diseases that are easily preventable or treatable with proven, cost–effective interventions. Lack of resources drives these disparities. The key resource is medical expertise and leadership. Cameroon has a shortage of medical professionals, with fewer than two doctors for every 10,000 people. Much of the medical care is often provided by incompletely trained hospital staff. While poverty, AIDS, Ebola, malaria, and violence in Africa have rightly captured the world’s attention, the lack
of access to critical obstetric care has quietly devastated Sub-Saharan communities in a direct and personal way. These deaths, as well as early neonatal deaths and complications such as obstetric fistula, are almost all preventable with skilled obstetric care.

Putting an end to preventable maternal, perinatal and early neonatal mortality will only be realized when the most severe maternal complications can be comprehensively addressed with known obstetric interventions. Newborn lives can be saved when an at-risk fetus is identified and delivered before it is too late. To provide the high-impact interventions of modern obstetric care, and to provide leadership in women’s health, skilled professional obstetricians/ gynecologists are required as part of the healthcare team. Currently, the ability to train this level of practitioner is severely lacking in most countries of sub-Saharan Africa. However, many universities and tertiary hospitals are potential training sites for physicians who wish to become OB/GYN physicians. The Ghana-Michigan success has shown us that it can be done; that long-term partnerships can be sustainably create new capacity, and that trained
OBGYNs will stay in their country. The investment in training OBGYNs also reinforces institutions for certification and professionalism, building an engaged and global network of OBGYNs — ultimately strengthening the broader public health infrastructure.

The long-term goal is to serve maternal health across the country and the region, thus creating
significant public health gains and eliminating preventable maternal and neonatal morbidity and
mortality. It is important to note that the trainees themselves will also be providing care to the
community in hospitals as they train; those gains will begin to be realized almost immediately. The project’s success will be demonstrated by increased access to maternal and infant health interventions and reductions in maternal and early neonatal morbidity and mortality.