Building Better Obstetric Care in Africa

When Sierra Washington, MD ’05, started her clinical rotation in obstetrics and gynecology during medical school, it was like a puzzle piece clicking into place. She had found a specialty that would allow her to combine a newfound desire to care for pregnant women with a preexisting interest in global health.

“I loved the highs of delivering babies and being part of the most important moments in a woman’s life,” Washington says.

In OB-GYN she also saw opportunities to provide compassionate, equity-focused care to people in underserved and underinsured communities. She’d arrived at HMS with an interest in global health that was bolstered by her coursework. She found a mentor in the late Paul Farmer, MD ’90 PhD ’90, and a social medicine course he co-taught with Jim Yong Kim, MD ’91 PhD ’93, and Kenneth Fox was especially life-changing.

“That class helped me see the social and structural impacts that society can impose on people’s health,” she says. She adds that HMS allowed her to embrace her idealism and become a global-minded, equity-focused physician. Indeed, Washington paused her training to earn a master’s degree in public health. Since then, she has focused her career on “building health services for the bottom rung,” she says, “particularly for pregnant women in Africa.”

An elective rotation in Cameroon during medical school showed Washington the difference she could make as an OB-GYN, as she treated childbirth complications she had only read about in textbooks. “I remember feeling like, ‘What the…?’ It’s the year 2000, so why are women still dying in childbirth from complications that are actually pretty simple to fix with antibiotics, blood, and a skilled surgeon?” she says.

The experience led Washington to focus her career in Africa, in countries such as Zambia, Kenya, Rwanda, and Tanzania. In addition to obstetric care, she began teaching and providing abortion services — a decision spurred by seeing entire inpatient wards full of young women suffering complications, and sometimes dying, from unsafe abortions.

Over time, Washington realized that while it was important to deliver high-quality medical care in places in need, it was even more important to offer high-quality training to doctors living and working in those places. To that end, Washington is now the director of the Center for Global Health Equity at Stony Brook University. The center collaborates with the Hospital Central de Maputo and Universidade Eduardo Mondlane in Mozambique to train medical residents in OB-GYN, surgery, and emergency medicine.

“It’s rare to have a global health program that’s focused primarily on improving resident education,” Washington says, adding that the program is based on building capacity through bidirectional exchanges, so residents and faculty from the United States and Mozambique spend time in both countries. The center also provides support for medical equipment and supplies. 

Washington, who lives in Mozambique, hopes her work there will transform residency education, in turn improving the quality of medical care. She also sees the program as a model of global medical education for other institutions. “I know that creating doctors who have the best training possible is going to have a generational impact,” she says.

Washington adds that even as her work has evolved, her motivation is still captured by the same three concepts: equity, social justice, and positionality: “As a woman with a platinum education from a rich nation, I feel a moral and ethical obligation to use my position to fight for people with less.”

Catherine Caruso is a science writer in the HMS Office of Communications and External Relations.