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Northwestern brings women’s health expertise to Ethiopia
By Bonnie Miller Rubin , Chicago Tribune

Gelila Goba hasn’t forgotten where she came from.

Instead of joining a comfortable practice in the U.S. after completing her residency in obstetrics and gynecology at Northwestern University, Goba instead will be caring for patients in her native Ethiopia, where in many communities light and heat qualify as luxuries.

After she graduates in May, Goba plans to move back to Ethiopia to implement a new initiative that she hopes will improve the state of women’s health in the desperately poor country of 90 million.

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“A lot has been given to me,” said Goba, during a break at Prentice Women’s Hospital. “I must make sure that I use those gifts wisely.”

The Mela Project is a partnership between Northwestern and Mekelle University in Ethiopia. It provides medical education, clinical training and research in sub-Saharan Africa, where acute doctor shortages and women’s health continue to be vexing problems.
In Ethiopia, the maternal mortality rate is twice the global average, and the rate of death from cervical cancer is almost seven times higher than in the U.S., according to the World Health Organization. The entire country has about 220 OB-GYNs nationwide — roughly the same number as Northwestern Memorial Hospital alone, according to university officials.

Residency programs are rare in Ethiopia. After students earn medical degrees, they often become general practitioners and work in district hospitals, experts said. OB-GYN subspecialties such as oncology, high risk obstetrics and fertility are virtually nonexistent. Some doctors seek training abroad, but it has not been standardized. The Mela Project aims to raise the bar and formalize residency training.

“This is not medical tourism, but about something that is truly sustainable, about training the trainers,” said Dr. Magdy Milad, professor of obstetrics and gynecology at Feinberg School of Medicine. “With Gelila as the steward of this program, it will not fail.”

The Mela Project gained traction when Ethiopia’s foreign minister, Tedros Adhanom, visited Northwestern in 2012 to rally global resources for women’s health. Goba credited Adhanom with setting up programs to train health workers who provide care in nearly every community across Ethiopia — especially for women and children, the most vulnerable and underserved.

Northwestern embraced the idea and moved forward with the collaboration with Mekelle University, under the direction of Goba.

Dr. Keith Martin, executive director of the Consortium of Universities for Global Health in Washington, praised such partnerships.
“Building and retaining human resources across a broad range of medical and nonmedical skills is vital to saving lives and reducing disabilities in developing countries,” Martin said. “Universities like NU are an excellent and underutilized way to build access to the public health, primary and surgical care systems needed to do this.”

As noble as the cause may be, Goba not only will be making professional sacrifices, but also personal ones.

Her husband and two children — a 9-year-old daughter and 7-year-old son — will remain in their Lakeview home while she spends six months of the year at Mekelle, located in Tigray, about 400 miles north of Addis Ababa, her hometown.

“I want them to be proud of me and proud of where they came from … but I’d be lying if I told you that it wasn’t hard,” Goba said. “When I talk to my daughter, she gets very emotional, but I want both my kids to know and understand that the world is bigger than just ourselves.”

The physician has seen the world’s dichotomies firsthand.

In her native country, only 10 percent of deliveries occur in health care facilities, and more than half of women giving birth are assisted by an untrained relative or friend, according to the 2011 Ethiopia Demographic and Health Survey.

Goba recalled the first time she stepped into Prentice Women’s Hospital, with its marble floors, tasteful art work, “brilliant” teachers and state-of-the-art equipment — all just a stone’s throw from Michigan Avenue and Lake Shore Drive.

“I felt like I was Cinderella and this was the land of make believe.”

As the oldest of four children and the only daughter, she was encouraged to cultivate more than her domestic skills — something that set her apart from other girls in the country’s patriarchal society, where 63 percent of women are married by age 18, according to government data.

While most girls are taught to stay inside, taking care of the house and younger siblings, Goba said she was encouraged to spend her time reading and studying.

Her grades were good enough to get into Jimma University in Ethiopia, where she entered a five-year program to become a physician. There, she saw girls barely in their teens having babies, and women dying from diseases and complications from labor that could have been prevented.

“It opened my eyes. I realized how easily that could have been me,” she said.

After graduation in 1998, the newly minted general practitioner spent five years as head of maternal and child’s health in Addis Ababa. If she was going to elevate the level of care, Goba realized she needed to acquire more business and administrative skills.

She was accepted for a fellowship from the Gates and Packard Foundations for young leaders at the University of Washington, where she met an American graduate student Kenneth Divelbess. Their friendship soon blossomed into something more.

“I told him I have no plans to marry or have children,” she recalls, “that I was focused on saving the world.”

He followed her back to Ethiopia and changed her mind. They wed in 2004 and honeymooned in the groom’s hometown of Juneau, Alaska.

After earning her master’s degree in public health, she applied for an OB-GYN residency at Northwestern, unaware she was one of 900 vying for a mere 12 slots in the prestigious program.

“I just saw the Northwestern part … and thought it was in the Pacific Northwest,” she said.
Dr Gelila Kidane Goba on Strong Leadership on Vimeo

Milad recalled interviewing Goba and being impressed by the slight, young doctor from the other side of the world.

“She articulated this desire to develop a partnership, which was very effective and very attractive to us as a department,” he said. “We had been sending residents all over the world — to Guatemala, Hong Kong, Honduras — but we were looking for a more sustainable relationship.”

Northwestern’s Feinberg School of Medicine and Center for Global Health is investing $100,000 in the Mela Project, while Mekelle has contributed $386,000 and the IDP Foundation of Chicago has pitched in with a $25,000 grant. They are committed to the initiative through 2021 and hope to contribute some 20,000 training hours to this region over the next four years.

The Northwestern team has made two visits to Ethiopia since October and plans to leave Monday for another trip.

Milad marveled at how patients walked miles to be seen and at their overwhelming gratitude for the smallest intervention, such as an IV line.
“I met a woman with diseased Fallopian tubes who related what it was like to live with infertility — to be ostracized, beaten and threatened with divorce,” he said. “I was stuck by how I could make a difference … even save a life. But it’s not just me. … Everyone who has come over returns as a changed person.”

The Northwestern delegation pays its own way to Ethiopia and uses vacation time. But it is “beneficial on so many levels,” said Joan Tankou, a fourth-year medical student who traveled there in October.

“It allowed me to experience medicine practiced in a resource-limited setting, where a lot of the diagnostic tools we have are not available,” Tankou said. “As a result, I learned alternative ways to evaluate patients, relying primarily on a thorough physical exam, a dying art in the U.S.”

With creative minds working on scientific and technological breakthroughs, Goba envisions a collaboration so close that X-rays taken in Tigray can be read by doctors in Chicago; where every woman and newborn gets the same chance at a healthy life.

She’s also relying on technology to keep her close on the homefront, using Skype to connect with her husband and children, staying on top of their schoolwork and activities.

“I know I’ll be homesick … that it will be a struggle,” she said. “But I also hope they understand … that if I can make a change in just one person’s life, that’s a day worth living.”

brubin@tribpub.com

Twitter @bmrubin

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