A Rewarding Journey as ACOG’s President

When I started my term as ACOG’s 67th president last May, I wanted to make a difference in the lives of our members and patients, ensure ACOG’s continued growth, and lift our voice as the leading specialty organization in the nation. In many ways, what we have accomplished in 12 short months has far surpassed my expectations given the complexity of the issues we’ve had to deal with and the extraordinary circumstances we’ve had to navigate and overcome. So, in my last month, I’d like to revisit some of the things that have made this such an impactful year and taken me around the globe.

When I initially laid out my priorities for advocacy and global women’s health, there was no way to know the challenges we would face to protect women’s continued access to reproductive and maternal health care, both domestically and abroad. As my tenure progressed and new challenges presented themselves, increased member engagement became even more essential. So, we leveraged my All-in for Advocacy campaign, an effort to amplify and expand our voice with state and federal policy makers through our member stakeholders. In 2016 and 2017, I traveled throughout the country doing presentations at Grand Rounds and participating in state lobby days and was wowed by the energy and eagerness of our advocates to make positive changes in their home states.  Physicians led efforts to support our patients and our practices, successfully advancing legislation from maternal mortality to Zika and defeating legislation affecting the sacred patient-physician relationship and restricting reproductive health rights.

Also, because of ACOG’s excellent government relations team, we launched the State Legislative Action Center, where ob-gyns are able to learn more about their legislature and elected officials, search active legislation, and find opportunities to take action. And this certainly was the year for action! Ob-gyns had an important voice in the discussions on health care reform and urged policy makers not to turn back the clock on women’s health by repealing the Affordable Care Act. We fought for our patients to have continued access to affordable insurance coverage, comprehensive maternity care, no-cost preventive services such as contraceptives, and consumer protections that would prohibit insurers from denying coverage based on pre-existing conditions or setting annual or lifetime benefit caps. And while the fight is not over, the defeat of the American Health Care Act this past March is evidence that we made a tremendous impact.

We have also made great strides in ACOG’s efforts overseas. Through my own personal work to advance health care in struggling countries, I learned that we as ob-gyns can make a difference in global women’s health by sharing our knowledge and resources. However, extended time away from one’s practice is always very difficult and, for some, next to impossible. One of my goals was to make short-term projects easily accessible and identifiable for ACOG members and I am proud to say that we developed a database of non-profit organizations involved in two-week mission work that allows ob-gyns to get more information and sign up.

We’ve also grown the Alliance for Innovation in Maternal Health (AIM), which creates instructional and educational portfolios, or “safety bundles,” to fight high rates of maternal mortality in the United States. Through the hard work of ACOG’s Office of Global Women’s Health, the AIM safety bundle for postpartum hemorrhage has been instituted into practice in a low resource setting in Malawi at a community health clinic and referral hospital.  And it has meant so much to me to see the progress made and the lives saved because of this initiative. Additionally, ACOG helps educate and train local health providers in underdeveloped countries in various areas of obstetrics and gynecology through several programs, including Health Volunteers Overseas. I’m particularly proud of this work because I firmly believe that the same high standards we have for health care in the United States are the same standards that should apply to other developing countries around the world.

Lastly, another one of my goals this past year was to continue efforts to address the workforce and practice pattern changes we’ve seen in our specialty by improving ob-gyn resident education models. In 2016, the Council on Resident Education in Obstetrics and Gynecology Education Committee embarked on a complete overhaul of the learning objectives for residents. This effort resulted in the release of the Educational Objectives: Core Curriculum in Obstetrics and Gynecology, 11th edition. We are now surveying mid-career practicing ob-gyns to determine which of the core objectives they actually apply in their practices. Although this was an issue without an easy solution, we must continue to work together and discover ways to improve. And I truly appreciate all the hard work of ACOG’s education staff in helping to facilitate this endeavor.

As I pen my last blog, I feel that my time from president-elect nominee to president has been an incredibly rewarding journey that has literally spanned 400,000 miles, according to my frequent flier program. From trips to the nation’s capital to residencies across the country to small community health centers in Africa, each experience taught me so much and it was a great honor to be able to serve ACOG’s members in the process. If I had to impart any advice to ACOG’s incoming president, Dr. Haywood Brown, it would be to enjoy it because it will fly by. (No pun intended.) Enjoy the year, enjoy the people, and listen to their stories. Everyone has a story!

Four Ways ACOG Has Impacted Global Women’s Health in Just the Past Year

In 1994, my wife and I arrived for our first two-week mission in the Dominican Republic and were stunned by the line of people waiting outside of the hospital for us. Since medical school more than a decade earlier, we had dreamed of participating in mission projects around the world to help women in dire need of basic medical care. But then my wife began her career as a nurse, we started our family, and after residency I went into private practice. So, that goal went by the wayside. However, our trip to the Dominican Republic quickly reignited our hopes of providing necessary ob-gyn services in low resource settings. Living in the United States, it’s easy to forget that many countries around the world are battling poverty and disease and don’t have the same infrastructure and safety nets we do. After that first trip, I came home to a fully equipped operating room with the proper tools and lights that worked, my wife didn’t have to hold a flashlight during surgery because the power was out. We had carpeting and hot water at home. From that point on, my eyes were opened.

Since that first trip, I’ve continued to travel and offer my services to advance health care in struggling countries. This work has taught me that we can really make a difference in global women’s health by sharing our knowledge and resources as ob-gyns. As my presidential term at ACOG comes to a close, it is an appropriate time to reflect on what we have accomplished from my six-point plan, developed over a year ago, to help improve the health of women and children worldwide, with a focus on training and providing health care around the world.

The first step was to make these kinds of missions more easily identified and attainable. While it’s often not realistic to leave your practice for months; two weeks is doable. That’s why we developed a listing or database of non-profit organizations involved in two-week mission work in which some of our members had participated. Now on the ACOG website there is a global health resource center. ACOG members can discover more information about each organization, check these organizations’ calendars for potential projects, talk with ACOG fellows and junior fellows who have done projects, and sign up. And we must continue to get the word out so more members use and add to the database.

In partnership with the U.S. Department of Health and Human Services, we’ve also formed and grown the Alliance for Innovation in Maternal Health (AIM), which creates instructional and educational portfolios, or “safety bundles,” to fight high rates of maternal mortality in the United States and now Malawi. Women living in rural areas of Malawi give birth at community health centers that can’t perform operative vaginal deliveries or C-sections. When these situations arise or other complications occur, women are transferred to the central hospital in the city, most often without any attempts at stabilization prior to transport. They are often in poor condition when they arrive, which results in many otherwise preventable maternal deaths. The AIM postpartum hemorrhage bundle has been instituted into practice at both the community health clinic and referral hospital. To date, more than 130 local people have participated in vital simulations to help these patients. And while we do not have formal data on the program yet, we know that several women have received life-saving care because the teams were able to communicate and execute care in a way that they didn’t before. We anticipate many more successes that will hopefully mirror the kinds of gains we have seen here in the United States.

In addition, last year ACOG partnered with Health Volunteers Overseas, a nonprofit group that helps educate and train local health providers in underdeveloped countries in various areas of obstetrics and gynecology. It begins with local providers telling us what they need and then we come up with a plan and work together to make it happen. As of today, we have completed four site assessments and will begin offering global service opportunities for fellows in the four countries by May 2017.

Lastly, in Ethiopia, we received a five-year grant to develop a plan in partnership with the Ethiopian Society of Obstetricians and Gynecologists to strengthen their ob-gyn residency training programs and curriculum, improve continuing medical education, support the publishing and accessibility of clinical outcomes research, and develop an ob-gyn examination and certification program. Since its inception, the program has made great strides by working “shoulder-to-shoulder” with the Ethiopians. As a result of this program, there is now interest from other African countries to begin the same program.

The bottom line is, many women around the world are lacking access to quality, evidence-based health care and they are paying the price with their lives. As ob-gyns, we have the power to prevent this by using our skills to help reduce global maternal morbidity and mortality, as well as improved quality of life. These programs are a prime example of how we can achieve that by dedicating some of our time and effort to a cause that is greater than ourselves. While we’ve accomplished a lot, we still have much to do. So, even if you aren’t sure you have the time, consider any way you can contribute. Believe me, it will make a difference.