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WONDOOR Makes an Impact at Home and Abroad

OB/GYN global health residency program offers model for improving maternal and neonatal health

Innovations in Obstetrics & Gynecology - Winter 2018 


Director of the WONDOOR Global Health Program, Department of Obstetrics and Gynecology, UH Cleveland Medical Center; Associate Professor of Reproductive Biology, Case Western Reserve University School of Medicine

As a developing South American country, Guyana has a high mortality rate for mothers and children. Physicians and specialists are also in short supply, meaning much of the country’s population of approximately 800,000 people has limited access to health care.

“There is no way 37 physicians graduating per year without specialized training could make a dent in the country’s health care issues,” explains Margaret Larkins-Pettigrew, MD, MEd, MPPM, FACOG, Director of the WONDOOR Global Health Program in the Department of Obstetrics and Gynecology at University Hospitals Cleveland Medical Center.

UH Cleveland Medical Center created the WONDOOR Global Health Program to help improve maternal and neonatal health in Guyana while providing valuable training to young physicians. WONDOOR (pronounced “one door”) is an acronym that represents the program’s emphasis and goals:

  • Women
  • Neonates
  • Diversity
  • Opportunities
  • Outreach
  • Research

The four-year, postgraduate program trains physicians in Guyana to specialize in obstetrics and gynecology. Residents and faculty from UH Cleveland Medical Center and many collaborative institutions also gain the opportunity to learn more in their fields while providing hands-on training to Guyanese physicians.

Physicians who begin their training in Guyana often apply to residencies abroad. Rarely do they come back and practice in their home country. Through WONDOOR, Guyanese physicians are encouraged to get more training in their country and continue practicing there. In addition, UH residents, a global health fellow and faculty participate as volunteer faculty, enhancing their own knowledge of the challenges in low-resource communities.

WONDOOR is open to physicians who have practiced in Guyana for two years and who will use their skills to fill the gaps in health care in the country, Dr. Larkins-Pettigrew says. As a national effort, WONDOOR also has support from Guyana’s government and coordinates with the country’s large tertiary hospitals.

“So far, 10 OB/GYNs trained by U.S. standards have graduated,” she says. “Our program has helped significantly reduce morbidity and mortality of mothers and babies.”

WONDOOR gets a lot of attention for the work it does abroad, but the residency program also helps physicians and staff from UH Cleveland Medical Center gain insight into health care problems closer to home.

“Outreach means we have to look across the water to help other countries, as well as in our own backyard,” Dr. Larkins-Pettigrew explains.

Many of the problems that mothers and their children face are universal, she says, adding that she would like to see physicians come back to Cleveland and apply all they learned to help women in our communities. That means understanding the barriers to health care women continue to face and providing family planning education to the people in their home communities.

“Whatever door a woman enters through, no matter where she is, she should receive the same quality of care,” Dr. Larkins-Pettigrew says.

WONDOOR operates in Guyana, but the program is designed to be replicated in other locations. U.S. physicians who have participated in WONDOOR are moving on to other institutions, and they are taking what they have learned with them. Other health care systems are showing interest in what WONDOOR is accomplishing as a sustainable global residency program.

Dr. Larkins-Pettigrew and others participating in the program hope to publish data to demonstrate the efficacy of the program.

“This model can be used in any community or country,” she says. “We are hoping to see the model expand so we can continue to better understand the challenges of women who live abroad and in our own backyards.”

View related video, "WONDOOR Makes an Impact"

Contact Dr. Larkins-Pettigrew at