MUSC College of Medicine graduate completes prestigious GE/NMF International Medical Scholars Program

Necessity—truly—is the mother of invention. Consequently, practical and successful interventions are, in most cases, found in the poorest settings around the world where resources are strained. The results of public health and medical interventions abroad account for many best practices for health care systems in the developed world. Treating rare diseases, applying cost-effective tests and procedures, use of appropriate technologies in low-resource regions have produced gains in life years and overall health worldwide. Many unmet health needs remain, but are not unique to any region of the world; however, the acuteness of need is widespread in low resource settings.

Global health practitioners pursue solutions to these issues to minimize the conditions (socioeconomic, cultural, political, etc.) that largely cause adverse health in comparable settings, whether they are in developing or developed nations. Elena Gore, M.D., MPH, a recent graduate of the Medical University of South Carolina (MUSC), has seen first-hand the need for practical solutions in improving conditions in resource-poor settings, particularly among women and children.

Gore’s interests in population health were born by a fellowship she completed through the University of Michigan that allowed her to conduct HIV/AIDS outreach programs to Tanzanian youth with Family Health International. Gore continued her work to improve population health at Yale University – School of Public Health where she was involved in a public health service trip to El Salvador and research in Nicaragua while completing her Master of Public Health in global health. “The summer before my senior year as an undergraduate, I opted to pursue global public health before medicine because of the life-changing experience I had in Tanzania,” said Gore.

While completing her Doctor of Medicine at MUSC, Gore was selected to participate in the prestigious GE/National Medical Fellow - International Medical Scholar program in Axim and Apam, Ghana. Gore is no stranger to adapting to cultural norms and understanding how perceived barriers to accessing healthcare, given the location, might add to already disparate conditions. “It’s challenging moving past culture to treat patients—it is harder with women when their children are at risk,” said Gore. “The perception of life and death due to longstanding culture and tradition compounds the issues that exist in underserved communities across the world.” Gore was tasked with a project at a hospital in Ghana that required her to answer a question with socioeconomic and behavioral implications: why do mothers receive prenatal care at the hospital but delivered elsewhere?

Gore and her colleagues found that nurses treated mothers harshly, sometimes resorting to physical and verbal chastisement in their efforts to communicate urgency and often as a manifestation of their own anxiety. Otherwise, women in the hospital birthed in silence, making facial expressions or snapping their fingers periodically when the pain was too much to bear as a way to avoid the verbal assault from nurses in the maternity ward. The nurses’ attitudes and behaviors drove expectant mothers away from better care to the community, where unskilled and untrained traditional birth attendants oversaw births. “Why do traditional birth attendants exist?” Gore asked. “What’s the scope of your practice? What can we do to help the overall coordination of care? These were questions that I needed answered. I found that their existence, even given the Ghanaian national health insurance system, is largely cultural.” There were also issues of perceived cost, access, and other cultural barriers that drove women to use traditional birth attendants for obstetric care.

Confronting these issues was challenging for Gore, especially treating patients whose traditions took precedent over medical care. This, however, is a universal problem with solutions rooted mostly in building trust in the host community. Gore and her team were able to build trust using what they were taught: to do no harm. Taking full care to prescribe regimens for the good of patients, Gore did so with special regard for the mothers and their children in Ghana. Gore and her colleagues worked assiduously to provide better options to the hospital. Kangarooing, stimulation, and sanitation techniques were taught to the Ghanaian health workers to keep children and their mothers healthy, safe, and alive. Gore and her team reached a point where they began to upend the tradition of accepting preventable death as divine planning. These changes—some temporary—saved lives and reduced the overall knowledge deficiencies among the health workers in the hospital.

At issue to Ghana’s healthcare delivery system is the appeal of Ghanaian physicians working in the West. It’s been reported that there are more Ghanaian doctors in New York than in Ghana. In fact, 54 percent of Ghanaian physicians train in Ghana but work elsewhere. This has left roughly one physician for every 11,000 Ghanaian citizens. “The allure draws many physicians to the U.S.,” said Gore. Gore’s final day was bittersweet, knowing that her group impacted the community for seven weeks, but fully understanding that longer-term health programs are important in changing the circumstances for the unborn. Growing the overall partnership models between MUSC and institutions around the world and keeping the exchange of ideas fluid are important in creating lasting solutions to global health issues. “Increasing MUSC’s global presence is very important,” remarked Gore. “Even more important are the collaborations with institutions around the world to improve care. There’s so much to be learned from working with partners abroad. This cannot be overstated.”

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