Helping Rwandan women survive childbirth

By Karen Crowley Metzinger, MA ’97 / Photography courtesy of Lisa Nathan ’98

RwandaDeep in the “Land of a Thousand Hills,” LISA NATHAN ’98, M.D., M.P.H., works diligently to help prevent the deaths of hundreds of Rwandan women giving birth in the landlocked African country. Nathan, an assistant clinical professor of obstetrics and gynecology at the Albert Einstein College of Medicine of Yeshiva University in New York, was awarded a 2009–2010 Fulbright Scholar grant through the African Regional Research Program for work aimed at reducing Rwanda’s high maternal mortality rate. The team’s research will be completed this September.

A first-generation Chicago-born American, Nathan’s family hailed from South Africa, where she traveled many times as a child. Her parents, Norman Nathan and Jumuna Patel [Nathan], both physicians, raised their three children in Peoria. While acknowledging that her roots played a role in her interest in the continent, Nathan noted, “South Africa is a night-and-day difference from the rest of Africa.” In retrospect, working in a Kenyan HIV/AIDS orphanage while earning her master’s degree in public health inspired Nathan’s decision to focus on maternal health issues. “The Kenya experience left me with the thought that what those children needed more than anything else were healthy, living mothers. They were all starved for attention,” Nathan said. “Although I didn’t realize it at the time, those thoughts and feelings, coupled with my love of the field, eventually led me to choose obstetrics and gynecology for my residency.”

Lisa Nathan

Nathan hikes the hills surrounding the new maternity center to gauge the typical walk a pregnant woman makes to deliver there. Pointing to the small building on top of the hill at the horizon she said, “I couldn’t believe how far away my maternity center was, and it is closer than what the women were dealing with earlier.”

The United Nations identified the need to improve maternal health as one of its eight Millennium Development Goals. It’s estimated that 540 Rwandan women die each year for every 100,000 live births — compared to 11 deaths for every 100,000 live births in the United States. The adult lifetime risk of maternal mortality in the U.S. is 1 in 2,100; however, in Rwanda it’s 1 in 35. The Fulbright grant of up to $36,000 allows Nathan to compare the effectiveness of mobile reproductive health care teams and community-level birthing services in rural areas of Rwanda, a country the size of Maryland. Her research will impact a population of 29,000 people in 50 villages in the Kibogora area.

Last year the Fulbright winner spent six consecutive months in Rwanda, but this year she will be there for at least three months, working one month at a time. “My heart is in Rwanda,” Nathan said. “The goal of our team is to provide a study that will lay the groundwork for improving health outcomes. In nearly all cases, tragic deaths from pregnancy and childbirth are preventable. Women come in with their uteruses ruptured, and we don’t see that often in New York. I’m learning different skills here because it’s so survival based. It hit me the first time I came back to New York how every single day we are saving people’s lives on our labor floor, and we just don’t realize it. What comes up on a busy labor floor in New York that you don’t blink an eye at, kills people all the time in other countries. You learn to appreciate what you have, your resources, and the people around you. Last year my sister and sister-in-law were pregnant for the first time, and I was thinking about them all the time.”

Decentralizing maternal health care

Mother waiting to be seen.

Mothers wait to be seen during a prenatal care and family planning day at one of Dr. Lisa Nathan’s other health posts in Rwanda. The legal marriage age in Rwanda is 18, and most women start their families in their early 20s. Most carry their babies on their backs from birth to 18 months. Due to high infant and childhood mortality rates, the average fertility rate is five children, but most women have experienced many more pregnancies. Nathan’s work focuses on increasing the capacity of Rwandan providers to offer quality care to their own people.

Nathan and her research team are evaluating and comparing the effectiveness of different interventions at two health posts or ambulatory care centers, which comprise the most basic level of the Rwandan health system. They created a birthing center with a waiting room, a delivery room, and a postpartum recovery room at one post; provided mobile birthing services at a second post; and monitored a third location operating under conventional methods. The team is determining which method provides the best chance of survival for Rwandan mothers.

“The idea was to bring care closer to the population,” said Nathan. “The maternity center we built is literally a few yards from the rural health post in an area that’s prone to dangerous thunderstorms. Since our new maternity center was damaged by lightning in 2010, the government recently gave us a much stronger building about a hundred feet away, showing its level of commitment and investment. The end goal is to turn this maternity service over to the government.”

Rewards of a teaching physician

Although Nathan did not expect to teach while working on the project, she found herself training doctors at the local district hospital and encouraging safety initiatives on the maternity ward. “I saw a real tragedy unfolding and witnessed extremely poor care,” said Nathan, who lives in a house next to the hospital. “I was just horrified by it. I found myself realizing I’m a board-certified Ob-Gyn, and I should be utilizing that more, so I started teaching and found it very rewarding. It’s now become more of my focus than my community work in both Rwanda and New York.”

After earning her medical degree from Rush Medical College in Chicago, Nathan completed her residency at Einstein. A biology major at Bradley, she was involved with Dr. Robert Fuller’s honors program and played in the orchestra. She and her husband PETER BAZELI ’98, senior vice president of The Weltzman Group, live in New York City. “Peter came to Rwanda last May,” Nathan said. “He’s been involved and helps me with a ton of the work that I do all the time. In this day and age, it’s funny. You have Skype and e-mail, so he had seen so much of the project already.” 

Rwanda is home to nearly 11 million people, and three quarters of the population live below the international poverty line. The country received international attention in 1994 when about 800,000 people were killed in genocide. Since that time, major strides have been made in the small, densely populated country. In 2008, Rwanda became the first country to elect a national legislature in which a majority of its members were women. President Paul Kagame is leading the effort to improve life as part of the Vision 2020 development program. “Rwanda is unique because of the way the health care infrastructure works with the Ministry of Health,” Nathan said. “The government knows that improving health care is the first step if the country is to be a stable and middle-income country by 2020. I spent so much time in Kenya, and I always thought I’d be working there; however, I can’t imagine leaving Rwanda, but you never know what life’s going to deal you. At this point, I feel like it’s going to be a lifelong relationship.”

Nathan is the associate director for the global women’s health and primary care program in the Department of Obstetrics & Gynecology and Women’s Health at the Albert Einstein College of Medicine and Montefiore Medical Center. She is one of about 1,100 U.S. faculty and professionals who traveled abroad through the Fulbright Scholar Program in 2009–2010. The Fulbright Program is sponsored by the U.S. Department of State, Bureau of Educational and Cultural Affairs.