Omara Afzal, DO, MPH, training community health workers in South Africa.
I have spent much of my career involved in global health care. I am an obstetrician/gynecologist, and the massive scale of maternal morbidity and mortality globally has humbled me. I have traveled to villages in South Sudan, refugee camps in Jordan, rural areas of South Africa, and a post-war post-Ebola Liberia among others, to train, educate, and increase health care capacity of areas in need. And yet, when I return home to New York, I see a country with advanced medicine and resources–and also the highest rate of maternal deaths among developed countries. I have come to the startling understanding that women at home in New York and the United States are also suffering in and around pregnancy at alarming rates, and something needs to change.
Sixty percent of maternal deaths in the United States may be preventable with better access to prenatal and postpartum care and self-management of chronic diseases. The United States has an overall system of care that focuses intently on a healthy baby and perhaps not as much on the mother, particularly in the postpartum period. Mothers are taught to take their prenatal vitamins, avoid unpasteurized products, and count belly kicks, but are often unarmed in knowing when and how to seek care for their own illnesses. Women also often do not receive the health maintenance and disease management that they need in the postpartum period. For example, very few women with gestational diabetes return for the recommended postpartum glucose testing to make sure blood sugar has returned to normal, and many others do not seek care for blood pressure checks, depression screenings, and other support that can help women get their health on track after childbirth.
At the Obstetrics and Gynecology (OB/GYN) Ambulatory Practice at The Mount Sinai Hospital, we have worked hard to provide comprehensive and evidence-based medicine while also offering a network of support services. However, the current care model depends on clinic-based counseling, requiring the patient to come to us. This really does not hit where the most impact may be made–in the patient’s home. Chronic diseases and evolving medical conditions require a holistic approach to manage and address issues, and office visits alone in a medical setting are just not enough.
A common health approach used globally, but especially in areas of low resources, is using community health workers (CHW). These are non-medical people who live and work in the same communities as the patients. They connect with the patients in a way that medical professionals may not be able to. This model, though used widely outside our borders, is now catching on within the United States and right here in New York City. Community health workers, or “health coaches,” bring much needed support into the home, through education and care coordination. Health care providers will often work closely with CHWs to connect patients who may need additional management and liaison with the medical system. These workers are trained to help women gain the skills to successfully self-manage their health and navigate medical and social services through one-on-one coaching and ongoing check-ins.
As a Fellow in the Clinical Scholars Program of the Robert Wood Johnson Foundation, I found an opportunity to engage in research around community health worker programming for maternal health. Collaborating with organizations that work with the model of CHWs, our team aims to train coaches in the prenatal and postpartum period, to increase health literacy, and improve outcomes for especially high-risk patients with diabetes or hypertension during their pregnancy. The health coaches will also continue to support patients postpartum with goal-directed health promotion and disease self-management counseling. Health care providers will be in close contact with CHWs to ensure that patients are on track in-between visits and after their deliveries. We are hoping a program such as this will improve rates of preventable maternal morbidity and mortality by empowering women for self-care and management of high-risk diseases. Through ongoing research and program development, we have the ability to change the statistics and improve a woman’s outcome during pregnancy and beyond.
Omara Afzal, DO, MPH, is a member of The Blavatnik Family Women’s Health Research Institute, the Medical Director of The Mount Sinai Hospital OB/GYN Ambulatory Practice, and an Assistant Professor in the Department of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai.