In the process of searching for a medical professional who could provide greater insight into their particular field of scientific study, I was fortunate to have been presented with the opportunity to converse with Dr. Sonia Go Perez – a retired obstetrician-gynecologist with over forty years of clinical experience. Our discussion was centered around pertinent issues confronting her field of medicine: universal access to healthcare, disparities that arose in the clinical setting as a result of socioeconomic division, as well as women’s reproductive health and the staggering rates of infant and maternal mortality experienced among relatively poorer areas around the world.
Our conversation was rooted in Dr. Perez’s background. Raised in the Philippines, a relatively poor country in comparison to the United States, she pursued her undergraduate and medical school education at the University of Santo Tomas’ School of Medicine. Shortly after, she elected to complete a gynecological residency in a rural Philippine hospital. Dr. Perez immigrated to the U.S where she would establish her practice at Lutheran Medical Center, a hospital located in a bustling urban center of Brooklyn. She noted many obstacles that she encountered during her transition to America. This included numerous licensing exams required of foreign physicians and the struggle to secure a foothold in a country experiencing a surplus of newly graduated medical school students entering the workforce – an environment seemingly unwelcoming towards foreigners such as herself.
After exploring her roots, our discussion directed itself to an analysis of the similarities and differences within the clinical settings across two distinct spheres of the world. Dr. Perez noted that her patients, although stemming from inherently different cultural and social atmospheres, persisted with similar problems. In her words, “the women [she] treat[s], regardless of their identities, will experience similar problems…because from a biological standpoint, women are women”. Unsurprisingly however, the most notable differences she accounted were access to healthcare services and the quality of healthcare services that physicians, in poorer countries like the Philippines, are able to provide. Financial resources and healthcare services are stifled by constricting hospital and insurance policies. According to Dr. Perez, “…50% of the battle [is] ensuring that these women have access to health equitable services”. Sadly, certain areas of the world lack access to such care. Evidently, these disparities may explain the elevation in infant/maternal mortality rates among areas of low socioeconomic standings. According to a worldwide survey, nearly 800 mothers die every day due to complications during pregnancy and childbirth. Over ninety-nine percent of these deaths occur in developing countries (Girum and Waise, 2017). This guided our discussion towards the factors that contribute to this trend.
When prompted on such, Dr. Perez noted that while working as a physician in the Philippines there was an evident lack of resources. She said that hospitals, particularly those located farther away from urbanized centers, were understaffed and understocked. Providers were often discouraged from providing referrals or specialized visits to reduce expenses – a tactic used to exclude those to whom care was unaffordable. In a health care setting, this practice often results in misdiagnosed conditions and undiagnosed life-threatening complications. According to an analysis of maternal deaths in India, one-fifth of deaths could have been prevented had treatment been initiated sooner and a proper referral been made (Gupta et al., 2018). The sheer lack of physicians causes a delay in initiating treatment and the lack of resources leads to a decline in the quality of care.
Another area of concern had been the emphasis towards evidence-based antenatal services and prenatal care. Deep-rooted cultural practices and a lack of education facilitated inadequate health among the mother and child. In her experience, a significant number of the women she served were malnourished; within these cases women lacked nutrients such as folate due to misconceptions influencing diet during pregnancy. Although some of her patients may have benefited from the educational aspect of frequent and routine prenatal visits, the primary issue at hand had was not illiteracy. The main issue was inability – the inability to access or afford care. The majority of women who visited her clinic were relatively young women who, more often than not, did not achieve a high level of education. Characteristically, these women worked laborious jobs that offered minimal pay, providing little freedom. These women tended to miss routinely scheduled ANC visits seeking care only in emergent situations – prioritizing work over their health. Examining this issue closer, there was a definitive link between antenatal care adherence and positive health outcomes among pregnancies. According to a 2018 cohort study examining this connection, researchers found that women who had failed to adhere to regular ANC visits had experienced four times the number of stillbirths and premature neonatal death. In terms of pregnancy health, mothers who had not received counseling were nearly twice as likely (10%) to experience low birth weight (Haftu et al., 2018). In Dr. Perez’s opinion, prenatal care is an invaluable asset for mothers living in developing countries. Making care readily and easily available for those women is a large step towards eliminating maternal mortality.
Dr. Perez acknowledged that reducing the socioeconomic gradient between populations may, as a result, eliminate disparities in maternal and infant mortality rates. In her experience, free or cost-reduce gynecological resources and programs designed to guide and educate women on their reproductive health is an extremely effective method. She hopes that programs and initiatives such as “The Door NYC” will become more readily available across poorer areas of the world, especially to the benefit of younger women. Moreover, this conversation with Dr. Perez was extremely stimulating as she shared a great deal of insight into her field of expertise, pointing towards real gaps in healthcare systems both nationally and abroad.
Works Cited
Sonia Go Perez, M.D., Personal Interview. April 20, 2019.
Girum, T., & Wasie, A. (2017). Correlates of maternal mortality in developing countries: an ecological study in 82 countries. Maternal health, neonatology and perinatology, 3, 19. doi:10.1186/s40748-017-0059-8
Kaur, M., Gupta, M., Pandara Purayil, V., Rana, M., & Chakrapani, V. (2018). Contribution of social factors to maternal deaths in urban India: Use of care pathway and delay models. PloS one, 13(10), e0203209. doi:10.1371/journal.pone.0203209
Haftu, A., Hagos, H., Mehari, M. A., & G/Her, B. (2018). Pregnant women adherence level to antenatal care visit and its effect on perinatal outcome among mothers in Tigray Public Health institutions, 2017: cohort study. BMC research notes, 11(1), 872. doi:10.1186/s13104-018-3987-0
