Sydney Bertram Reflection – Antenatal care in Togo: Implementing a quality improvement project in a private health clinic

Sydney Bertram is a College of Medicine student at MUSC. She was awarded a Center for Global Health Student & Trainee Travel Grant in the spring of 2023 to pursue a project with Global Partners in Hope in Agbélouvé, Togo. View more photos of Sydney's time in Togo in this Flickr photo gallery.

This spring I spent four weeks at Compassion Medical Center, a relatively new health center in the rural town of Agbélouvé, Togo. I lived on the campus of the health center and was immersed in the everyday life of the staff, a welcoming group of professionals and trainees eager to teach me about the health challenges their community faced and the tools the health center provided to improve each patient’s health.

In the mornings, I worked with the team to provide preventive care and develop treatment plans for everyone who walked through the clinic door. Much like in a U.S. primary care clinic, we saw many cases of headache, lumbar pain, hypertension, and UTI. However, patients also received comprehensive care for malaria, schistosomiasis, and Buruli ulcer—diseases that are rare to nonexistent in the U.S. In our free time, the Togolese trainees and I ran through practice cases and quizzed each other on pharmacology. One of the highlights of my time in Togo was teaching, and learning from, Togolese students who are as invested in their education as I am in mine.

The patients in my clinic were equally good teachers; they entrusted me with details about their homes, farms, and families, patient with my occasionally faltering French and almost non-existent Ewe. We were all speaking in our second language words that humans often prefer to whisper: a hospitalization that would cost a month’s income, a first trimester pregnancy, a moment of despair. Language holds power, and French in a country where the French occupied the people, land, and power structures for decades, when wielded improperly, still holds the power to engender fear and silence. Even with my non-fluent French, I know I represent colonialism to many Togolese: in my whiteness, in my American citizenship, in my western culture.

What made my experience in Togo so meaningful was the trust we all chose each day. I trusted my colleagues to interpret Ewe into French so I could communicate with patients, and my colleagues trusted me to contribute my knowledge of American medical practices in a way that translated to their unique setting. I trusted our patients to tell me the full story of their illnesses, and our patients trusted me to listen to their lungs, look in their ears, and tap for their reflexes. I was trusted to witness births, introduce newborns to their fathers, and stand watch with the team over children struggling to breathe. I expect these moments might come to feel routine as I move into the clinical phase of my education, but I am hopeful that my experience in these moments, when I was trusted even as an outsider, will always remind me of the weight—and the miracle—of becoming a physician.

Outside of the consultation room, I am proud clinic leadership trusted me to design and implement a new program meant to empower pregnant women to attend prenatal care appointments. With the feedback and cooperation of the staff who will be carrying out the new program, we introduced free transport to the clinic, appointment reminder telephone calls, and an up-front payment model for prenatal care. These interventions have been used in similar sub-Saharan African settings to increase attendance at prenatal care appointments, and we will be collecting data over the next year to determine their utility in the Compassion Medical Center.

It was a privilege to travel to Togo and become a part of the Agbélouvé community for a short time. It is my hope that I will be back before too many years pass, but until then I will carry it with me—into my patients’ rooms, into my studies, and out to the Charleston community.