Obstetrics, Fellowships and Global Health

Dr Charlotte Patient is a consultant obstetrician at the Rosie Hospital, Cambridge, with a particular interest in caring for women with high-risk pregnancies. She is the Head of School for Obstetrics and Gynaecology in the East of England, with responsibility for the education, provision and quality of training in the region. She is the new Associate Dean of Health Education East of England, working within the international office to promote global health activity and to improve the experience of international medical graduates in the region. Working with Cambridge Global Health Partnerships, Dr Patient is involved in the partnership with two large public maternity hospitals, and Makerere University in Kampala, Uganda.

This story was written by Dr Sarah Arunachalam, who took part in a taster week with CGHP in January 2022.

How did you become interested in global health?   

I became interested in global health as a medical student when I went on my elective to Zambia, to a small mission hospital in the rural part of the country. It was quite frightening as it was in the early days of HIV and there were many complications and other diseases that we were not seeing in the UK. I had a fantastic experience; the country was beautiful, and the people were really friendly. I still keep in touch with the hospital.

My second experience was when I was a senior registrar, working in camps in rural parts of western Nepal. These camps would consist of overseas doctors and an anesthetist working with local doctors, nurses and pharmacists going to fairly rural places for 7-10 days at a time and a lot of people would get seen and treated! The teams mostly did operations that would not require follow up such as cataracts, prolapse repairs. These operations and interventions improved patients’ quality of life and the type of operation we were doing would have a low risk of complication in a setting where follow up was not available.

Could you tell us a bit more about the Kampala Cambridge partnership you are involved with?

This initially started as a research collaboration between Cambridge and Ugandan researchers, Professors Annette Nakimuli and Ashley Moffett looking at pre-eclampsia in the Ugandan population in comparison to the UK. They wanted to include clinical collaboration which is when Dr Jane McDougall and I got involved, working with a multidisciplinary team, to develop specific guidelines for obstetric emergencies, such as pre-eclampsia, sepsis and post-partum hemorrhage.

I had pre-eclampsia at 32 weeks in my first pregnancy. It is quite a sobering thought: what happened to me almost 20 years ago, if it happened to me in Uganda even now, could have a very different outcome for both myself and my baby. It is important that we work hard to be a mutually beneficial partnership, supporting our partners and the Ugandan health workers in the way in which they want to be supported.

The last time I visited Uganda, almost three years ago, was to work on a book called ‘Principles of Obstetrics in Africa’ that is being written by Ugandan authors. We had planned to go again in March 2020 with an illustrator, but this visit was stopped by COVID-19. Thankfully, we have Zoom and WhatsApp that have enabled us to keep the partnership going.

Charlotte (second left) with partners in Uganda.

What would you say to newly qualified doctors who are interested in getting involved in global health?

Look out for any opportunities you can! What is needed first is enthusiasm. If you are enthusiastic, just look around to see what is going on. The East of England region is interested in global health, and there is a lot of teaching and training happening in global health within the region. There are currently seven global health fellows working on different projects and developing teaching. These fellowships are for doctors at ST3+ level, with opportunities to work within ongoing health partnerships. There are also fellowships available for FY3/ST1 & 2 with 4–6 month overseas placements available.

One of my focus areas as Associate Dean working in the international office, is getting more trainees involved in the global health. COVID-19 has shown us that health is global, and I hope to enthuse and encourage more people to get involved. Our other main focus is trying to better the experience for international medical graduates arriving in the UK. We are also looking at differential attainment and equity of all trainees.

How do you see your project moving forward from the pandemic?

We are hoping to support Ugandan partners in the establishment of a microbiology lab within the hospital and a phone triage system. What we hope to be funding and working on are the set-up and the proof of concept for these activities. I have been involved in little bits of fundraising and publicity such as sponsored running.

When UKAID withdrew all funding last year, the grant we were working on fell through. But, we are working to get started again with other funders to continue our guidelines work. There is no doubt that developing and implementing clinical guidelines will improve and save lives. We hope that if can get something set up in the largest national teaching hospital where most obstetricians are trained, and where our partners are based, we can get other people involved and support the spread and implementation of guidelines in other hospitals.

CGHP is running an Urgent Appeal in order to fund partnerships such as this. Please consider donating today.