In Guyana, Improving Health Care for Mothers and Babies

Even for Guyana’s healthiest citizens, it can be difficult to access medical care in this small coastal nation of 700,000 people, largely because of inadequate infrastructure and a limited  number of care providers.

For women experiencing childbirth complications in rural Guyana, the third-poorest country in Latin America and the Caribbean, the journey to the capital Georgetown and to its free state-run hospital can be especially harrowing. Some must traverse dense, narrow paths, walking for hours to get to the Georgetown Public Hospital. Others come ferried in wooden canoes, having to cross two rivers to get to the hospital. And, where there aren’t paths or waterways, some are picked up by small planes dispatched to remote villages when medical emergencies strike.

When patients arrive, they are sometimes greeted by Daniel R. Lattanzi, a faculty member at the University of Pittsburgh School of Medicine. For nearly three decades, Lattanzi, a board certified OB-GYN, has been caring for women’s reproductive health, delivering babies, and teaching future physicians at Pitt’s medical school to do the same. 

Since 2013, he has been among a network of physicians from a handful of top U.S. teaching hospitals who volunteer to treat patients at Georgetown Public Hospital. For one week a year, he takes his work 2,500 miles south of Pittsburgh. In Georgetown, Guyana, he says, the public hospital is like many medical facilities in underdeveloped countries—understaffed and under resourced to care for acute emergency cases. “It can be difficult to know who on the staff will be available to assist or whether blood will be available for transfusions or other procedures,” says Lattanzi. It is often a week filled with crises. 

In developing nations, he says, “the number of women and babies who die unnecessarily every year in childbirth is still incredibly high—about 400,000 a year in childbirth or from childhood-related complications; and as many as 5 million babies die mainly from infection and prematurity. These are typically deaths among poor women, and their voices don’t get heard.”

But his week in Guyana is also filled with rewards.

With every difficult delivery, Lattanzi, his small team of residents in training, and a handful of nurses, some who double as anesthesiologists, wait to hear the wail of a newborn baby taking its first breath. And they also look forward to seeing the smiling face of its mother when she first greets the newborn.

Lattanzi—who is codirector of the OB-GYN Global Health Program at Magee-Womens Hospital of UPMC— is also involved with a new OB-GYN medical residency program at Georgetown. The residency program, launched in 2012, is organized by Ohio’s Case Western Reserve University and aims to build a new generation of Guyanese physicians who are equipped to handle crisis maternal care. It is a service that is desperately needed in a part of the world where women don’t have access to regular or quality healthcare.

The Pitt physician and his team work with 24 medical residents—all of whom are on staff at Georgetown and who were carefully screened to step back into training. “They knew that they wanted to do better,” says Lattanzi, “and needed to provide better care for women and their infants.” 

Before the residency program, there was no specialized obstetrical and gynecological training for the country’s physicians. Now, after four years of “apprenticeship,” the first class of Guyanese residents is set to graduate this year and will become full-fledged obstetricians and gynecologists. 

Lattanzi is hoping the physicians will continue to work in their home country. Guyanese citizens who leave to attend medical school abroad often don’t return home, says Lattanzi, who worries that the country’s health outcomes could worsen if more physicians decide to leave the hospital to pursue better pay and opportunities once they earn their new credentials. 

In Guyana, the maternal mortality rate is high: 280 deaths for every 100,000 live births, which is 10 times that of the United States, says Lattanzi. Without improved care, even the most common pregnancy complications—gestational diabetes, preeclampsia and its link to high blood pressure—can lead to death for the mother or child. Mortality rates quantify lives lost, but they also tell stories about the health of a nation. Just three years after the residency program began, Lattanzi is happy to mark a milestone: “In 2015, no woman died of preeclampsia at Georgetown Public Hospital. And for that, doctors and staff are very proud of what they have accomplished.” 

In April, Lattanzi plans to return to Guyana. If he can save one baby, one mother, another trip is worth it. A relentless recruiter, he is in search of fellow Pitt physicians and medical residents to join him. 

“I feel that this work is a calling for me and a spiritual response,” he says. “I’m lucky to have the skills to teach and do this work, and I want to continue to try to make a difference.”