Beyond borders

The following is an excerpt from Caring for Women, Changing Lives, a report written for the Department of Obstetrics and Gynecology at McMaster University. 

Working Beyond Borders
McMaster as a centre for global health

by Glen Herbert

“I’ve just found that there are so many students these days that are interested in international health, and there’s not place to bring them together. Where do they get career counselling? Where do they get ideas? Where do they get content for the things that they want to do? It’s nice to say ‘I want to go overseas’ but how do you get from here to there?”

In her work at McMaster  and around the world, those are the questions that Dr. Jean Chamberlain wants to help students answer. She is an associate professor in the department of obstetrics and gynecology, co-director of the McMaster International Women’s Health Program and founder,  and executive director of Save the Mothers (STM) International, an organization dedicated to saving some of the 525,000 mothers who die in childbirth every year. She can spend half of her year overseas advocating for the health of women, McMaster is her home base, the locus from which she works to help others do the same.

“That’s been the focus of our conferences, really giving multi-disciplinary students here at McMaster and other universities as well—we invite people from Queen’s, Toronto, Western—because a lot of these universities now have centres for international health.”

The reasons are vast, and the details of international health, especially for women, can be stark. Chamberlain wrote a piece in the National Post recounting something she experienced Uganda. She wrote about Helen, a mother who had been in labour for two days with no chance of delivering naturally. “The only thing that stood between Helen and a safe delivery was the $60 that this government health facility required from her—after all, she needed to pay for the gloves, medicine and anesthesia required to surgically deliver her baby. Her alternative was to hop on public transit — in this case an overcrowded minivan — and risk a two-hour drive followed by numerous hours of waiting at the national referral hospital, where she would queue up behind the many other mothers trying to access free services.”

Chamberlain advocated for Helen, provided the funds for the procedure, and within an hour a healthy baby was born. Afterward, when approaching the operating room, Chamberlain found ten men waiting, “all lined up in a row, clutching their medical files with sheepish looks on their faces. They were scheduled for male circumcision — an approach to reducing HIV/AIDS transmission that shows some benefit in decreasing men’s susceptibility to infection.”[1] That procedure, unlike emergency C-section, was entirely funded by the government, who also advertised it nationally through billboards and radio campaigns.

“Because I have a medical background, I have a certain platform that I can work from” in order to affect change, and largely that’s what she’s doing when she is working in countries outside Canada.

A vision for women’s health

While she spends months at a time away from the university, the work that she does is nevertheless central to the vision that Dr. Leyland, as chief, has for the department. Of Chamberlain’s work, he says that, “I think that is a perfect example of what we ought to be doing as a department.”

“Part of what we do at the university, in addition to trying to expand our knowledge, is trying to improve the care of women, and that’s not limited to Canada or anywhere. And what Jean has been able to do is to use her skills as an obstetrician/gynecologist plus her own personal skills and abilities to make significant changes as an outreach in global health.”

Leyland himself is involved in global outreach, including giving workshops and talks in the middle east this past spring on the surgical treatment of endometriosis, something for which McMaster is particularly known.

But, there are lessons that those doctors bring home with them in order to advocate for women in this country. Says Leyland, “around the world there are places where women are still treated as second class citizens, where they are not considered to be full human beings. And we find that abhorrent. But even in Canada there are differentiations between how women are managed based on gender differences in health care. … People don’t know that there is a huge gap for women in many areas” including the approach and funding for the treatment of endometriosis.

What it takes is advocacy

“It isn’t only resources, it’s also people expectations,” says Chamberlain, including expectations around the frequency of maternal mortality, which in some settings remains shockingly high. “You know, if you shed a tear when your wife dies but there’s really no [recourse], you know, asking ‘What could I have done differently to save her life. …. What it takes is that advocacy, and mobilization of people, helping people to see things differently.’ Nobody wants their mothers to die, whether your in Africa or here, but we’ve put the infrastructure in place, and the expectations.”

The focus Chamberlain sees for the international women’s health program isn’t just to capture the desire to affect change, but also to guide students to the skills that they can best bring to the improvement of women’s health both at home and abroad. It’s a big task, perhaps, when you look at it in the broadest sense, but change begins here. Dr. Leyland says that, at it’s simplest, “that’s part of what our role is as a department.”


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