GO MOMS in India 2020: Andrea Henkel

1. Andrea Henkel
GOMOMs India 2020
GoOMOMs was approached by a Stanford neonatologist faculty member Dr. Nilima Ragavan
who runs programs in Dharampur and Yavatmal through an NGO called Teach to Heal. As part
of improving neonatal outcomes, she was interested in collaborating with an obstetrics team.
Our first site was Shrimad Rajchandra Hospital in Gujarat. This charitable hospital is funded and
run by the associated Dharampur ashram. The first few days at this site were spent at the
hospital, getting a sense of local practices. We started with a day with the community outreach
team to get a sense of the local population and general themes encountered in prenatal care. We
were immediately impressed by the level of malnutrition and anemia. Pre-pregnancy hemoglobin
of 6 or 7 was not uncommon and pre-pregnancy weight rarely exceeded 40kg. This immediately
impressed upon us the danger of postpartum hemorrhage and cephalo-pelvic disproportion.
Additionally, I had the opportunity to spend times on Labor & Delivery and the operating
theater. Labor & Delivery was covered with government-sponsored checklists .With this short
pre-conference exposure to the wards, we were better able to last-minute curate our program to
match local needs.
Our trip was scheduled to align with the Third Annual Gujarat Evidence-Based Perinatal Care
Symposium which typically hosts around 50 doctors. Given the Stanford team’s anticipated
presence, over 150 OBs, midwives, and nurses signed up to attend. We planned a three-day event
with a series of lectures by Stanford OBs plus local obstetric leaders. The topics identified as
most pertinent were postpartum hemorrhage, perinatal sepsis, maternal anemia, birth spacing,
pre-eclampsia, growth restriction, delayed cord clamping, and placenta accreta. I presented on
birth spacing and postpartum contraception.
It was clear from the needs assessment that their medical training and continuing education does
not focus on team-based simulation so we planned to gradually introduce team based skills
stations, thru Stanford-lead simulation scenarios, as we had included RNs in the simulations, it
gave them a voice to explain how they often do not know what is going on in emergency
situation and needed more closed-loop communication from MDs. This appeared motivating to
the participating MDs and seemed to be new information. on the third and final day we staged a
“train the trainer” event which was used to train 50 of their faculty both RNs and MDs to
continue simulation based education at their respective sites.
We then moved to Shri Vasantrao Naik Government Medical College in Yavatmal. This Medical
College houses 18 OB house staff and is a main referral center in the District. Similarly, we
spent the first day rounding to supplement our pre-trip needs assessment to prepare for our
one-day Department of Health sponsored conference for 50 local OBs and medical officers. We

2. split this conference into a half day of lectures and half skills stations. We spent the remaining
week observing in the hospital on different wards.
I intentionally chose this GOMOMs trip because I was specifically interested in working on
initiating and ongoing collaboration with an international site. Ultimately, my goal is to find an
academic position that would allow me to take trainees abroad. This experience in India has
given me unique insight into what it looks like to start a collaboration with an international
hospital. I better recognize the need to identify local leaders prior to departure and the value of a
pre-trip needs assessment to better utilize a short experience to make it valuable to both the
hosting institution and personally fulfilling. There was a lot of last minute additions that required
flexibility and accommodations from our group. This experience added in my preparation to
independently establish collaborations and exchanges.