Innovating to overcome challenges: A descriptive retrospective review of novel elements of a new Obstetrics and Gynaecology specialty training programme in Botswana
Main Article Content
Abstract
Introduction
In 2020 the University of Botswana launched a novel in-country Obstetrics and Gynaecology specialty training programme. Low and middle-income country programmes face inherent challenges due to resource limitations including unpredictability in access to services, system inefficiencies, and human resource shortages for training, especially subspecialists.
Methods
In order to meet training needs in the face of these challenges, we have utilized creative teaching methods, including novel technologies and maximizing sustainable international partnerships. We have encouraged the use of technology including online resources, simulations, and artificial intelligence to enhance training for ultrasound and minimally invasive surgery. Remote lectures and imaging review engage subspecialists in sustained academic partnerships to build skills and knowledge. Finally, we conceived a departmental wellness program to address provider burnout.
Results
Our trainees have gained needed skills in laparoscopy and ultrasound using technology. We are achieving subspeciality training through collaboration with our international academic partners. A new wellness program has started and been well-received.
Discussion
Using these methods we have not only met trainee needs, but improved patient care and service access. Challenges still remain to encourage programme sustainability. Implementation of laparoscopy and ultrasound will require adequate continued training and system support for quality assurance. Subspeciality training needs on-going bolstering and requires building in-country sub-specialization pathways. Wellness programs need to be broadened.
Conclusion
By utilizing creative solutions involving collaboration and technology, our trainees gain skills needed despite context limitations. We believe our programme has been successful in part because it has been dynamic during its initial rollout, and will continue to be as the programme continues to evolve.
Article Details
How to Cite
HANSON, Sarah Jean et al.
Innovating to overcome challenges: A descriptive retrospective review of novel elements of a new Obstetrics and Gynaecology specialty training programme in Botswana.
Medical Research Archives, [S.l.], v. 13, n. 5, may 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6533>. Date accessed: 21 june 2025.
doi: https://doi.org/10.18103/mra.v13i5.6533.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. World Health Organization. Health workforce. Published 2025. Accessed April 2025.
https://www.who.int/health-topics/health-workforce#tab=tab_1
2. Ahmat A, Okoroafor SC, Kazanga I, et al. The health workforce status in the WHO African region: Findings of a cross-sectional study. BMJ Glob Health. 2022;7:e008317. doi:10.1136/bmjgh-2021-008317
3. Crisp N, Chen L. Global supply of health professionals. N Engl J Med. 2014;370:950-957. doi:10.1056/NEJMra1111610
4. Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569-624. doi:10.1016/S0140-6736(15)60160-X
5. Graham WJ. Diversity and divergence: the dynamic burden of poor maternal health. Lancet. 2016;388(10056):2164-2175. doi:10.1016/S0140-6736(16)31533-1
6. Powell BL, Luckett R, Bekele A, Chao TE. Sex disparities in the global burden of surgical disease. World J Surg. 2020;44:1231-1239.
7. Holmer H, Oyerinde K, Meara JG, et al. The global met need for emergency obstetric care: a systematic review. BJOG. 2014;122(2):183-192. doi:10.1111/1471-0528.13230
8. Martey JO, Hudson CN. Training specialists in the developing world: ten years on, a success story for West Africa. BJOG. 2005;112(2):177-179. doi:10.1111/j.1471-0528.1999.tb08206.x
9. Rager TL, et al. Growth model for international academic medicine partnerships: Qualitative analysis of Ghana postgraduate Ob/Gyn training program. PLOS Glob Public Health. 2023;3(1):e0000546. doi:10.1371/journal.pgph.0000546
10. Small M, et al. Increased Rwandan access to obstetrician-gynecologists through a U.S.-Rwanda academic training partnership. Obstet Gynecol. 2019;134(1):149-156. doi:10.1097/AOG.00000000 00003317
11. Bachan V, et al. The financial cost of physician emigration from sub-Saharan Africa. BMJ. 2011; 343:d6817. doi:10.1136/bmj.d6817
12. Clinton Y, Anderson FW, Kwawukume EY. Factors related to retention of postgraduate trainees in obstetrics-gynecology at the Korle-Bu Teaching Hospital in Ghana. J Acad Med. 2009; 84(10 Suppl):S93-S96. doi:10.1097/ACM.0b013e3 181f09112
13. Luckett R, Nassali M, et al. Development and launch of the first obstetrics and gynaecology master of medicine residency training programme in Botswana. BMC Med Educ. 2021;21:42. doi:10.11 86/s12909-020-02446-1
14. Gokcen E. Sustainable orthopaedic surgery residency training in East Africa: A 10-year experience in Kenya. J Am Acad Orthop Surg Glob Res Rev. 2019;3(7):e035. doi:10.5435/JAAOSGlobal-D-19-00035
15. Kendig C, Tyson A, Young S, et al. The impact of a new surgery residency program on case volume and case complexity in a sub-Saharan African hospital. J Surg Educ. 2015;72(1):94-99.
16. Baqain L. Post-graduate urology training in low- and middle-income countries. Uro. 2021;5(5):53.
17. McCullough MC. Google Glass for remote surgical tele-proctoring in low- and middle-income countries: A feasibility study from Mozambique. Plast Reconstr Surg Glob Open. 2018;6(12):e1999. doi:10.1097/GOX.0000000000001999
18. Chinyepi N, et al. Four-year overall surgical mortality rate at Princess Marina Hospital, a tertiary hospital in Botswana. J Public Health Afr. 2023; 14(3):2262. doi:10.4081/jphia.2023.2262
19. Wilkinson E, et al. Barriers to training in laparoscopic surgery in low- and middle-income countries: A systematic review. Trop Doct. 2021;51 (1):8-15. doi:10.1177/004947552199
20. Campain NJ, et al. An evaluation of the role of simulation training for teaching surgical skills in Sub-Saharan Africa. World J Surg. 2018;42(5):1272-1281. doi:10.1007/s00268-017-4261-7
21. Beard JH, Akoko L, Mwanga A, et al. Manual laparoscopic skills development using a low-cost trainer box in Tanzania. J Surg Educ. 2014 Jan-Feb;71(1):85-90. doi: 10.1016/j.jsurg.2013.06.005.
22. Lee W, Hodges AN, Williams S, et al. Fetal ultrasound training for obstetrics and gynecology residents. Obstet Gynecol. 2004;103(2):333-338. doi:10.1097/01.aog.0000109522.51314.5c
23. Alrahmani L, Codsi E, Borowski KS. The current state of ultrasound training in obstetrics and gynecology residency programs. J Ultrasound Med. 2018;37:2201-2207. doi:10.1002/jum.14570
24. Abuhamad A, Minton KK, Benson CB, et al. Obstetric and gynecologic ultrasound curriculum and competency assessment in residency training programs: Consensus report. J Ultrasound Med. 2018;37:19-50. doi:10.1002/jum.14519
25. Wheatley RG. Maternal critical care: What’s in a name? Int J Obstet Anesth. 2010;19(4):391-392. doi:10.1016/j.ijoa.2010.07.008
26. Edwards M. Is training in obstetric critical care adequate? An international comparison. Int J Obstet Anesth. 2018;36:71-72.
27. Algodi M, Wolfe DS, Taub CC. The Utility of Maternal Point of Care Ultrasound on Labor and Delivery Wards. J Cardiovasc Dev Dis. 2022;9(1): 29. doi: 10.3390/jcdd9010029.
28. Moore CL, Copel JA. Point-of-Care Ultrasonography. N Engl J Med. 2011;364:749–757. doi: 10.1056/NEJMra0909487.
29. Nding'ori D, et al. Improving health equity through sustained academic partnership: development of a maternal-fetal medicine fellowship training program in Western Kenya. AJOG Glob Rep. 2024;4(3):100362. doi:10.1016/j.xagr.2024.100362.
30. Kirubarajan A, Got T, Park B, et al. Interventions to prevent and treat burnout in obstetrics/ gynaecology: A scoping review. J Obstet Gynaecol Can. 2021;43(4):490–496. doi: 10.1016/j.jogc.202 0.12.011.
31. Iorga M, Socolov V, Muraru D, et al. Factors influencing burnout syndrome in obstetrics and gynecology physicians. Biomed Res Int. 2017; 2017:9318534. doi: 10.1155/2017/9318534.
32. Sinskey JL, Margolis RD, Vinson AE. The wicked problem of physician well-being. Anesthesiol Clin. 2022;40(2):213–223. doi: 10.1016/j.anclin.2022.0 1.001.
33. Patel RS, Bachu R, Adikey A,et al. Factors related to physician burnout and its consequences: A review. Behav Sci. 2018;8(11):98. doi: 10.3390/b s8110098.
34. Agyeman-Manu K. Prioritising the health and care workforce shortage: protect, invest, together. Lancet Glob Health. 2023;S2214-109X(23):00224-3. doi: 10.1016/S2214-109X(23)00224-3.
35. Workneh RS, Tuyishime E, Mumbwe M, et al. Not a “first world problem”—Care of the anesthetist in east and southern Africa. Pediatr Anesth. 2021; 31(1):39–43. doi: 10.1111/pan.14054.
36. Dzeng E, Curtis JR. Understanding ethical climate, moral distress, and burnout: A novel tool and a conceptual framework. BMJ Qual Saf. 2018; 27(10):766–770. doi: 10.1136/bmjqs-2018-007905.
37. Stabnick A. “Once you get one maternal death, it's like the whole world is dropping on you”: experiences of managing maternal mortality amongst obstetric care providers in Ghana. BMC Pregnancy Childbirth. 2022;22:206. doi: 10.1186/s1 2884-022-04535-z.
38. Dubale BW, Friedman LE, Chemali Z, et al. Systematic review of burnout among healthcare providers in sub-Saharan Africa. BMC Public Health. 2019;19(1):1247. doi: 10.1186/s12889-019-7566-7.
39. West CP, Dyrbye LN, Sinsky C, et al. Resilience and burnout among physicians and the general US working population. JAMA Netw Open. 2020;3(7): e209385. doi: 10.1001/jamanetworkopen.2020.9385.
40. Ahart ER, Gilmer L, Tenpenny K, et al. Improving resident well-being: A narrative review of wellness curricula. Postgrad Med J. 2023;99(1173):679–686. doi: 10.1136/postgradmedj-2022-141541.
41. ALL-SAFE. African Laparoscopic Learners – Surgical Advancement for Ectopic Pregnancy. Training courses in laparoscopic surgery. 2025. Available at: www.allsafe.education
42. Obayemi JE, Ekeh AP, et al. The efficacy of a low-cost laparoscopic training curriculum for Nigerian surgeons. Glob Surg Educ. 2025;4:25. doi:10.100 7/s44186-024-00333-7
43. Hsu K, et al. Evidence for a case-based module in the low-resource setting to teach ectopic pregnancy management. Syst Implement Pract. 2023;2(1):10 0209. doi:10.1016/j.sipas.2023.100209
44. Queenan Global Health Awards. Society for Maternal-Fetal Medicine Foundation. Available at: foundationforsmfm.org/programs/queenan-global-health-awards
45. International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). Basic training. Available at: www.isuog.org/education/basic-training1.html
46. Volutracer Opus. Available from: https://www.volutraceropus.com
47. Chawla L, Kumar R, Rajaram E, et al. Capacity building in obstetric ultrasound: Impact of simulation based clinical teaching on resident training at a health facility in India. Int J Obstet and Gynecol. 2025;169:267-273. doi.org/10.1002/ijgo.16076
48. American Institute of Ultrasound in Medicine. Point-of-care ultrasound. Available from:
https://www.aium.org/practice-topics/point-of-care-ultrasound.
49. Grimes CE, Maraka J, Kingsnorth AN, et al. Guidelines for surgeons on establishing projects in low-income countries. World J Surg. 2013;37:1203-1207.
50. Riviello R, Ozgediz D, Hsia RY, et al. Role of collaborative academic partnerships in surgical training, education, and provision. World J Surg. 2010;34:459-465.
51. Global Surgical Expedition. Available from: www.globalsurgicalexpedition.org.
52. Council on Resident Education in Obstetrics and Gynecology. Available from:
www.acog.org/education-and-events/creog/curriculum-resources/wellness-curriculum.
53. Boughizane S, et al. (2023, September 9) AAGL23 Pre-Congress Webinar: Necessity is the Mother of Invention – How Cost and Environmental Mindfulness May Help Improve the Future of MIGS. AAGL. Available from:
surgeryu.aagl.org/view?m=otnQvrSrO
54. Riad AM, Barry A, Knight SR, et al. Perioperative optimisation in low- and middle-income countries (LMICs): A systematic review and meta-analysis of enhanced recovery after surgery (ERAS). J Glob Health. 2023 Oct 3;13:04114. doi: 10.7189/jogh.1 3.04114.
55. Kulesa J, Brantuo NA. Barriers to decolonising educational partnerships in global health. BMJ Global Health. 2021;6:e006964.
56. Oti SO, Ncayiyana J. Decolonising global health: where are the Southern voices? BMJ Glob Health. 2021;6(7):e006576. doi: 10.1136/bmjgh-2021-006576.
57. Airborne Lifeline. Available from: airbornelifeline.org.
58. Miller J. No. 282-Rural Maternity Care. SOGC Reaffirmed Guidelines. 2017;39(12):E558-E565.
59. Committee on Health Care for Underserved Women. ACOG Committee Opinion No. 586: Health disparities in rural women. Obstet Gynecol. 2014;123(2 Pt 1):384-388. doi:10.1097/01.AOG.00 00443278.06393.d6
60. Matshitsa L, Nassali MN, Hofmeyr J. Extended balloon labour induction: A single arm proof of concept trial. Eur J Obstet Gynecol Reprod Biol X. 2023 Aug 13:19:100226. doi: 10.1016/j.eurox.202 3.100226.
61. Jamieson M, Luckett R, Hofmeyr GJ. Novel use of local analgesia prior to intramuscular magnesium sulphate injection compared to mixed local analgesia with magnesium sulfate to reduce pain: a randomized crossover study in patients being managed for eclampsia and preeclampsia. Frontiers in Pain Res. 2024 July 10. doi:10.3389/fpain.2024.1376608
62. Hofmeyr J, Kime K. Novel Concepts for Intrauterine Device Placement at Caesarean Delivery: Description of Technique and Video Recording. Obstet Gynecol Int. 2023 May 5;2023:4410984. doi:10.1155/2023/4410984
63. Singata-Madliki M, et al. Suction tube uterine tamponade versus uterine balloon tamponade for treatment of refractory postpartum hemorrhage: A randomized clinical feasibility trial. Int J Gynaecol Obstet. 2025 Jan 24. doi: 10.1002/ijgo.16164
64. Gallos I, et al. Randomized Trial of Early Detection and Treatment of Postpartum Hemorrhage. N Engl J Med. 2023 July 6;389(1):11-21. Doi: 10.1056/NEJMoa2303966.
65. World Health Organization. Labour care guide. Published 2021. Accessed April 2025. Available at: www.who.int/publications/i/item/9789240017566
66. Nassali MN, Russell JC, Tsuaneng M, et al. Promoting respectful maternity care with the WHO Labor Care Guide and the checklist mnemonic ‘COPE’: a quality improvement project. IJGO, accepted. DOI: 10.1002/ijgo.70238
67. Hofmeyr GJ, et al. Improving postpregnancy contraceptive method choice and long-acting reversible contraception provision in Botswana: a quality improvement pilot. BMJ Sex Reprod Health. 2023 Oct;49(4):293-297. doi: 10.1136/bmjsrh-2022-201748
https://www.who.int/health-topics/health-workforce#tab=tab_1
2. Ahmat A, Okoroafor SC, Kazanga I, et al. The health workforce status in the WHO African region: Findings of a cross-sectional study. BMJ Glob Health. 2022;7:e008317. doi:10.1136/bmjgh-2021-008317
3. Crisp N, Chen L. Global supply of health professionals. N Engl J Med. 2014;370:950-957. doi:10.1056/NEJMra1111610
4. Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569-624. doi:10.1016/S0140-6736(15)60160-X
5. Graham WJ. Diversity and divergence: the dynamic burden of poor maternal health. Lancet. 2016;388(10056):2164-2175. doi:10.1016/S0140-6736(16)31533-1
6. Powell BL, Luckett R, Bekele A, Chao TE. Sex disparities in the global burden of surgical disease. World J Surg. 2020;44:1231-1239.
7. Holmer H, Oyerinde K, Meara JG, et al. The global met need for emergency obstetric care: a systematic review. BJOG. 2014;122(2):183-192. doi:10.1111/1471-0528.13230
8. Martey JO, Hudson CN. Training specialists in the developing world: ten years on, a success story for West Africa. BJOG. 2005;112(2):177-179. doi:10.1111/j.1471-0528.1999.tb08206.x
9. Rager TL, et al. Growth model for international academic medicine partnerships: Qualitative analysis of Ghana postgraduate Ob/Gyn training program. PLOS Glob Public Health. 2023;3(1):e0000546. doi:10.1371/journal.pgph.0000546
10. Small M, et al. Increased Rwandan access to obstetrician-gynecologists through a U.S.-Rwanda academic training partnership. Obstet Gynecol. 2019;134(1):149-156. doi:10.1097/AOG.00000000 00003317
11. Bachan V, et al. The financial cost of physician emigration from sub-Saharan Africa. BMJ. 2011; 343:d6817. doi:10.1136/bmj.d6817
12. Clinton Y, Anderson FW, Kwawukume EY. Factors related to retention of postgraduate trainees in obstetrics-gynecology at the Korle-Bu Teaching Hospital in Ghana. J Acad Med. 2009; 84(10 Suppl):S93-S96. doi:10.1097/ACM.0b013e3 181f09112
13. Luckett R, Nassali M, et al. Development and launch of the first obstetrics and gynaecology master of medicine residency training programme in Botswana. BMC Med Educ. 2021;21:42. doi:10.11 86/s12909-020-02446-1
14. Gokcen E. Sustainable orthopaedic surgery residency training in East Africa: A 10-year experience in Kenya. J Am Acad Orthop Surg Glob Res Rev. 2019;3(7):e035. doi:10.5435/JAAOSGlobal-D-19-00035
15. Kendig C, Tyson A, Young S, et al. The impact of a new surgery residency program on case volume and case complexity in a sub-Saharan African hospital. J Surg Educ. 2015;72(1):94-99.
16. Baqain L. Post-graduate urology training in low- and middle-income countries. Uro. 2021;5(5):53.
17. McCullough MC. Google Glass for remote surgical tele-proctoring in low- and middle-income countries: A feasibility study from Mozambique. Plast Reconstr Surg Glob Open. 2018;6(12):e1999. doi:10.1097/GOX.0000000000001999
18. Chinyepi N, et al. Four-year overall surgical mortality rate at Princess Marina Hospital, a tertiary hospital in Botswana. J Public Health Afr. 2023; 14(3):2262. doi:10.4081/jphia.2023.2262
19. Wilkinson E, et al. Barriers to training in laparoscopic surgery in low- and middle-income countries: A systematic review. Trop Doct. 2021;51 (1):8-15. doi:10.1177/004947552199
20. Campain NJ, et al. An evaluation of the role of simulation training for teaching surgical skills in Sub-Saharan Africa. World J Surg. 2018;42(5):1272-1281. doi:10.1007/s00268-017-4261-7
21. Beard JH, Akoko L, Mwanga A, et al. Manual laparoscopic skills development using a low-cost trainer box in Tanzania. J Surg Educ. 2014 Jan-Feb;71(1):85-90. doi: 10.1016/j.jsurg.2013.06.005.
22. Lee W, Hodges AN, Williams S, et al. Fetal ultrasound training for obstetrics and gynecology residents. Obstet Gynecol. 2004;103(2):333-338. doi:10.1097/01.aog.0000109522.51314.5c
23. Alrahmani L, Codsi E, Borowski KS. The current state of ultrasound training in obstetrics and gynecology residency programs. J Ultrasound Med. 2018;37:2201-2207. doi:10.1002/jum.14570
24. Abuhamad A, Minton KK, Benson CB, et al. Obstetric and gynecologic ultrasound curriculum and competency assessment in residency training programs: Consensus report. J Ultrasound Med. 2018;37:19-50. doi:10.1002/jum.14519
25. Wheatley RG. Maternal critical care: What’s in a name? Int J Obstet Anesth. 2010;19(4):391-392. doi:10.1016/j.ijoa.2010.07.008
26. Edwards M. Is training in obstetric critical care adequate? An international comparison. Int J Obstet Anesth. 2018;36:71-72.
27. Algodi M, Wolfe DS, Taub CC. The Utility of Maternal Point of Care Ultrasound on Labor and Delivery Wards. J Cardiovasc Dev Dis. 2022;9(1): 29. doi: 10.3390/jcdd9010029.
28. Moore CL, Copel JA. Point-of-Care Ultrasonography. N Engl J Med. 2011;364:749–757. doi: 10.1056/NEJMra0909487.
29. Nding'ori D, et al. Improving health equity through sustained academic partnership: development of a maternal-fetal medicine fellowship training program in Western Kenya. AJOG Glob Rep. 2024;4(3):100362. doi:10.1016/j.xagr.2024.100362.
30. Kirubarajan A, Got T, Park B, et al. Interventions to prevent and treat burnout in obstetrics/ gynaecology: A scoping review. J Obstet Gynaecol Can. 2021;43(4):490–496. doi: 10.1016/j.jogc.202 0.12.011.
31. Iorga M, Socolov V, Muraru D, et al. Factors influencing burnout syndrome in obstetrics and gynecology physicians. Biomed Res Int. 2017; 2017:9318534. doi: 10.1155/2017/9318534.
32. Sinskey JL, Margolis RD, Vinson AE. The wicked problem of physician well-being. Anesthesiol Clin. 2022;40(2):213–223. doi: 10.1016/j.anclin.2022.0 1.001.
33. Patel RS, Bachu R, Adikey A,et al. Factors related to physician burnout and its consequences: A review. Behav Sci. 2018;8(11):98. doi: 10.3390/b s8110098.
34. Agyeman-Manu K. Prioritising the health and care workforce shortage: protect, invest, together. Lancet Glob Health. 2023;S2214-109X(23):00224-3. doi: 10.1016/S2214-109X(23)00224-3.
35. Workneh RS, Tuyishime E, Mumbwe M, et al. Not a “first world problem”—Care of the anesthetist in east and southern Africa. Pediatr Anesth. 2021; 31(1):39–43. doi: 10.1111/pan.14054.
36. Dzeng E, Curtis JR. Understanding ethical climate, moral distress, and burnout: A novel tool and a conceptual framework. BMJ Qual Saf. 2018; 27(10):766–770. doi: 10.1136/bmjqs-2018-007905.
37. Stabnick A. “Once you get one maternal death, it's like the whole world is dropping on you”: experiences of managing maternal mortality amongst obstetric care providers in Ghana. BMC Pregnancy Childbirth. 2022;22:206. doi: 10.1186/s1 2884-022-04535-z.
38. Dubale BW, Friedman LE, Chemali Z, et al. Systematic review of burnout among healthcare providers in sub-Saharan Africa. BMC Public Health. 2019;19(1):1247. doi: 10.1186/s12889-019-7566-7.
39. West CP, Dyrbye LN, Sinsky C, et al. Resilience and burnout among physicians and the general US working population. JAMA Netw Open. 2020;3(7): e209385. doi: 10.1001/jamanetworkopen.2020.9385.
40. Ahart ER, Gilmer L, Tenpenny K, et al. Improving resident well-being: A narrative review of wellness curricula. Postgrad Med J. 2023;99(1173):679–686. doi: 10.1136/postgradmedj-2022-141541.
41. ALL-SAFE. African Laparoscopic Learners – Surgical Advancement for Ectopic Pregnancy. Training courses in laparoscopic surgery. 2025. Available at: www.allsafe.education
42. Obayemi JE, Ekeh AP, et al. The efficacy of a low-cost laparoscopic training curriculum for Nigerian surgeons. Glob Surg Educ. 2025;4:25. doi:10.100 7/s44186-024-00333-7
43. Hsu K, et al. Evidence for a case-based module in the low-resource setting to teach ectopic pregnancy management. Syst Implement Pract. 2023;2(1):10 0209. doi:10.1016/j.sipas.2023.100209
44. Queenan Global Health Awards. Society for Maternal-Fetal Medicine Foundation. Available at: foundationforsmfm.org/programs/queenan-global-health-awards
45. International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). Basic training. Available at: www.isuog.org/education/basic-training1.html
46. Volutracer Opus. Available from: https://www.volutraceropus.com
47. Chawla L, Kumar R, Rajaram E, et al. Capacity building in obstetric ultrasound: Impact of simulation based clinical teaching on resident training at a health facility in India. Int J Obstet and Gynecol. 2025;169:267-273. doi.org/10.1002/ijgo.16076
48. American Institute of Ultrasound in Medicine. Point-of-care ultrasound. Available from:
https://www.aium.org/practice-topics/point-of-care-ultrasound.
49. Grimes CE, Maraka J, Kingsnorth AN, et al. Guidelines for surgeons on establishing projects in low-income countries. World J Surg. 2013;37:1203-1207.
50. Riviello R, Ozgediz D, Hsia RY, et al. Role of collaborative academic partnerships in surgical training, education, and provision. World J Surg. 2010;34:459-465.
51. Global Surgical Expedition. Available from: www.globalsurgicalexpedition.org.
52. Council on Resident Education in Obstetrics and Gynecology. Available from:
www.acog.org/education-and-events/creog/curriculum-resources/wellness-curriculum.
53. Boughizane S, et al. (2023, September 9) AAGL23 Pre-Congress Webinar: Necessity is the Mother of Invention – How Cost and Environmental Mindfulness May Help Improve the Future of MIGS. AAGL. Available from:
surgeryu.aagl.org/view?m=otnQvrSrO
54. Riad AM, Barry A, Knight SR, et al. Perioperative optimisation in low- and middle-income countries (LMICs): A systematic review and meta-analysis of enhanced recovery after surgery (ERAS). J Glob Health. 2023 Oct 3;13:04114. doi: 10.7189/jogh.1 3.04114.
55. Kulesa J, Brantuo NA. Barriers to decolonising educational partnerships in global health. BMJ Global Health. 2021;6:e006964.
56. Oti SO, Ncayiyana J. Decolonising global health: where are the Southern voices? BMJ Glob Health. 2021;6(7):e006576. doi: 10.1136/bmjgh-2021-006576.
57. Airborne Lifeline. Available from: airbornelifeline.org.
58. Miller J. No. 282-Rural Maternity Care. SOGC Reaffirmed Guidelines. 2017;39(12):E558-E565.
59. Committee on Health Care for Underserved Women. ACOG Committee Opinion No. 586: Health disparities in rural women. Obstet Gynecol. 2014;123(2 Pt 1):384-388. doi:10.1097/01.AOG.00 00443278.06393.d6
60. Matshitsa L, Nassali MN, Hofmeyr J. Extended balloon labour induction: A single arm proof of concept trial. Eur J Obstet Gynecol Reprod Biol X. 2023 Aug 13:19:100226. doi: 10.1016/j.eurox.202 3.100226.
61. Jamieson M, Luckett R, Hofmeyr GJ. Novel use of local analgesia prior to intramuscular magnesium sulphate injection compared to mixed local analgesia with magnesium sulfate to reduce pain: a randomized crossover study in patients being managed for eclampsia and preeclampsia. Frontiers in Pain Res. 2024 July 10. doi:10.3389/fpain.2024.1376608
62. Hofmeyr J, Kime K. Novel Concepts for Intrauterine Device Placement at Caesarean Delivery: Description of Technique and Video Recording. Obstet Gynecol Int. 2023 May 5;2023:4410984. doi:10.1155/2023/4410984
63. Singata-Madliki M, et al. Suction tube uterine tamponade versus uterine balloon tamponade for treatment of refractory postpartum hemorrhage: A randomized clinical feasibility trial. Int J Gynaecol Obstet. 2025 Jan 24. doi: 10.1002/ijgo.16164
64. Gallos I, et al. Randomized Trial of Early Detection and Treatment of Postpartum Hemorrhage. N Engl J Med. 2023 July 6;389(1):11-21. Doi: 10.1056/NEJMoa2303966.
65. World Health Organization. Labour care guide. Published 2021. Accessed April 2025. Available at: www.who.int/publications/i/item/9789240017566
66. Nassali MN, Russell JC, Tsuaneng M, et al. Promoting respectful maternity care with the WHO Labor Care Guide and the checklist mnemonic ‘COPE’: a quality improvement project. IJGO, accepted. DOI: 10.1002/ijgo.70238
67. Hofmeyr GJ, et al. Improving postpregnancy contraceptive method choice and long-acting reversible contraception provision in Botswana: a quality improvement pilot. BMJ Sex Reprod Health. 2023 Oct;49(4):293-297. doi: 10.1136/bmjsrh-2022-201748