This edition of the IWF’s “In the Lead” blog features a Q&A with Leadership Foundation Fellow, Nawal M. Nour, MD, MPH. She has established a career in promoting women’s health in underserved populations nationally and internationally. We are proud to feature her in honor of Women’s History Month, designated to commemorate and encourage the study, observance and celebration of the vital role of women in the global community.
Dr. Nour serves as Founder and Director of the African Women’s Health Center and Global Obstetrics and Gynecology at Brigham and Women’s Hospital, Harvard Medical School in Boston, MA, USA.
The New York Times has called you a “crusader against female circumcision.” What inspired your clinic, the first center of its kind in the U.S. that focuses on the physical and emotional needs of women who have undergone female genital mutilation/cutting (FGM/C)?
When I was an Ob/Gyn resident, I cared for women from countries where FGM/C was prevalent. So many of them were nervous and hesitant even to seek health care because they had previously experienced shock, confusion, and even disgust from providers. Practitioners were unfamiliar with FGM/C; this lack of knowledge combined with an inability to overcome their own strong emotional reactions prevented them from providing culturally competent reproductive care. I’m afraid that many women undergoing these uncomfortable and unpleasant experiences have opted not to seek medical attention again; our poor preparation and conduct actually harmed these women and their health. My goal when opening the African Women’s Health Center was to create a haven for women and their families. They could come and receive care from providers who looked beyond their scars and treated their pertinent ailment. Our mission is to provide culturally and linguistically appropriate obstetric, gynecologic, and reproductive health care to African immigrants and refugees. We strive to give women the best clinical care available, providing a variety of services to help them before, during, and after their care.
How has the center evolved since its establishment in 1999? Have you experienced unexpected obstacles, challenges or surprises in the work you do?
The biggest obstacle was simply getting us off the ground in the first place. The motto “if you build it, they will come” did not apply to the African Women’s Health Center. For the first few months, patients were skeptical and distrusting. I returned to the community and conducted educational outreach workshops so that women could meet me and evaluate my intentions. Showing them that we genuinely cared about them and were not overly focused on the fact that they had undergone FGM/C seemed to make all the difference. Over the years, the Center has become a model for others interested in serving this population, both nationally and internationally. My biggest surprise continues to be the amount of recognition that we have received. One would never imagine that a clinic dedicated to caring for refugee African women would be relevant or valued in our world.
Does your work with underserved women and their families affect you in personal ways?
Every day! My patients are refugees, survivors of war and famine. They have endured and overcome horrors and injustices that no woman should ever experience. Their stories are both heartbreaking and inspiring. They motivate me to become a better doctor, leader, mother, daughter, and friend.
You recently published a book, Obstetrics and Gynecology in Low-Resource Settings. Can you tell us about it? What compelled you to write it?
When I started working in low-resource regions of the world, I took various medical books with me. But what I really needed was a resource that would address the “what ifs.” What if the medications have expired? What if an anesthetist was not available? How could I save a newborn’s life? We are never trained to cover all the fields of medicine, but when we are in these remote areas, and we are the only health provider around, patients look to us for help in as many ways as possible. Referring them to experts is simply not an option.
A few years ago, we held several global women’s health conferences at Harvard Medical School that brought pioneers and world leaders to speak about some of the most challenging diseases facing women and children in developing nations. Many of these diseases have been dramatically reduced and even eliminated in western nations but continue to affect women in regions with few resources. Some of the major killers in developing nations include cervical cancer, injury or even death while giving birth, HIV, and malaria during pregnancy. I saw that the conference participants included a variety of health providers (obstetricians, midwives, family medicine, primary care, pediatricians, and general surgeons) who had either worked in low-resource settings or wanted to start global-health work. Their questions helped me recognize that there was still a great need for a practical book to assist providers when they travel. Luckily, many of our preeminent speakers agreed to contribute chapters.
Since the book’s publication, I have been delighted to receive small grants that have enabled us to provide it at no cost to medical schools and residency programs in low-resource countries. In addition, I am so touched that this year’s IWF Fellows (aka my close friends) have generously donated this book to a residency program in Africa. Our goal is to have the book become an integral part of every women’s health curriculum both here and abroad.
What do you hope to achieve next?
Women’s and girls’ health and human rights are integral to every element of my work and mission. I have strived to raise awareness of FGM/C and global women’s health. However, I am constantly aware of what remains to be done. Approximately 800 women die every day from labor and delivery. Cervical cancer is responsible for over 270,000 deaths per year. One quarter of pregnancy-related deaths are caused by HIV. My dream is to build a compassionate army of health providers trained to tackle the many persistent threats to the health of women and children worldwide.
For more information on Obstetrics and Gynecology in Low-Resource Settings, please visit this link.
To learn more about the African Women’s Health Center, please visit this link.
Interested in making a donation to the Center? Click here to make an on-line donation by filling in the Brigham and Women’s Hospital On-Line Donation Form. In the field marked “please use my/our gift,” note that your gift is directed towards the African Women’s Health Center.