Improving Maternal-Child Health in Limited-Resource Setting

After a nearly three-year hiatus because of pandemic-related travel restrictions, trainees from Johns Hopkins Children’s Center returned to the Philippines this fall for a one-month rotation in pediatrics.

Through a long-standing collaboration with the Philippine Children’s Medical Center, a chief resident, two pediatrics residents and a medical student spent two and a half weeks at the Manila-based hospital observing and attending rounds to gain a better understanding of pediatrics practice in a limited-resource setting. Then the trainees traveled to the southern Mindanao region to help teach midwives and nursing students about how to prevent birth asphyxia and postpartum hemorrhage in newborns and delivering mothers. Such efforts are crucial since neonatal and maternal mortality rates in the region are among the highest in Southeast Asia.

“It was so nice to work with the same folks and see familiar faces again,” says Nicole Shilkofski, pediatric residency program director, who led the expedition and has been a champion of the “train-the-trainer” model of health care capacity building.

Noting that the country still is on a modified quarantine, Shilkofski says that some of the 40 Filipino students in the class told her it was the first in-person course they had attended in a long time.

Shilkofski is now applying similar lessons toward a developing program in Sierra Leone, Africa, where maternal mortality is among the highest in the world, with about 1 in 20 women dying as a result of pregnancy or childbirth, according to the latest United Nations estimate.

Last year, faculty with Johns Hopkins’ departments of pediatrics and Gynecology and Obstetrics helped the West African College of Physicians and the University of Sierra Leone Teaching Hospitals Complex establish that nation’s first residency programs in pediatrics and obstetrics/gynecology, in collaboration with the Mama-Pikin Foundation, a Sierra Leone-based nongovernmental organization.

Now Shilkofski and Toni Ungaretti, director of the Master of Education in the Health Professions (MEHP) program at Johns Hopkins, are overseeing efforts to strengthen the curriculum in simulation-based education, “which is still in its infancy in West Africa,” Shilkofski says.

Using funding from a two-year health equity grant from Johns Hopkins’ Alliance for a Healthier World, the two are working to help equip a clinical skills center by purchasing teaching and simulation equipment. The program also will bring Johns Hopkins medical fellows and residents, as well as a student and instructional designer from the MEHP program, to Sierra Leone to teach.

Shilkofski and Ungaretti are working on implementing the program, and in the second year will focus on data collection about the program’s impact on maternal and child health equity and public health outcomes locally. This includes developing an advisory board of women who have been cared for at local hospitals and whose children have been patients at the Ola During Children’s Hospital in Freetown, the capital. The advisory board will help to inform the prioritization of clinical education needs within the training programs. The first trip likely will be in early 2023.

“We’re excited about this opportunity and the grant funding, because we really feel like we can help to start something from the ground up that I hope will have a huge impact on maternal and child health,” says Shilkofski.