Transforming maternal health in The Gambia

Lifesaving surgeries are not always accessible to everyone around the world. As an anesthesiologist at Baylor, Dr. Rahel Selassie understands the importance of advocating and improving patient safety not only at home but also in other countries.

Through The Gambia Project, an ongoing initiative established by Baylor Global Health, Selassie is able to help women living in areas with limited resources attain necessary surgeries and other medical needs. The project aims to transform the maternal health rate in The Gambia, a country in West Africa, through providing safer options for C-sections, childbirth, cancer screenings and overall healthcare.

“Providing healthcare should be a basic human right, no matter where you live,” said Selassie, associate professor of anesthesiology at Baylor College of Medicine.  “What we are going to accomplish in The Gambia will be impactful to the women who live there. Too many women die during childbirth and those who survive can develop complications from it, and both of those things can be prevented.”

Pregnancy-related deaths are common occurrences in Sub-Saharan African countries, Selassie explains. Providing access to reliable medical care will not only save women’s lives, but also allow them to return home to care for their families. 

“Women in these communities are extremely important to the family unit,” Selassie said. “This project will keep them in their communities and ensure that they can continue contributing to their households and serving as the matriarch of the family, which is important for people living in The Gambia.”

As the project’s lead anesthesiologist, Selassie assesses and selects the appropriate anesthesia equipment for the portable Smart Pods that will function as the medical facilities. She chooses the equipment by interviewing clinicians and healthcare workers who live in the area to determine what they will need while working in the pods. 

Along with supplying tools for medical procedures, she provides education and training on anesthesia use for a variety of local healthcare workers who will work in the pods. 

“I have to be mindful of the low resources, the barriers, limited drug choices and cultural differences that exist while making a training curriculum that is sustainable and easy for anyone to use or access,” Selassie said. “It might not be a doctor in these remote locations who will be helping with a possible delivery of a baby – it’s important to make it simple so that any healthcare worker can understand it and provide safe care.”

Anesthesia plays a major role in the success of The Gambia Project. Selassie explains that in order for the women to receive a safe operation they must have adequate anesthesia.

“In anesthesia, we serve as the guardian of the patient’s life throughout the entire surgery,” Selassie said. “We work collaboratively with surgeons.”

Plans for The Gambia Project first began in 2017 and will become fully established over the next few years. Although the COVID-19 pandemic delayed a visit to The Gambia in April, it has not slowed the goals for the project down. As of 2021, Baylor Global Health is currently working on the project remotely by training healthcare workers over virtual platforms, assessing how they will deliver the Smart Pods and evaluating medical needs at four clinical sites.

“The implementation of anesthesia for the maternal health programs in The Gambia is critically important if we are to improve labor and delivery outcomes and provide increased surgical and anesthesia capacity for C-sections,” said Dr. Sharmila Anandasabapathy, the director of Baylor Global Health. “Being able to train the African health workforce to offer C-sections will be essential to improving morbidity and mortality from childbirth and preventing debilitating fistulas in these young women.”

This is not Selassie’s first time participating in a global health project. She is also involved with the American College of Surgeons’ Operation Giving Back program where she has volunteered in different areas of Africa.

I have always been drawn to things that promote, improve and advocate for patient safety and quality,” Selassie said. “I do this a lot in my role at Baylor, so it naturally makes sense that I should do it in other parts of the world. I am trying to bring the practices that I do here to The Gambia so that the patient’s safety is a priority.”

Assisting with the education, training and delivery of anesthesia is Selassie’s first involvement with The Gambia Project, but she hopes to contribute more to it in the future.  “I feel we are doing something bigger and having an even larger impact – along with everything we already accomplish at Baylor,” she said. “That’s the nice thing about global health.”

By Kaylee Dusang Jackson