​Global health research in Haiti improves prenatal care back home

Sometimes, global health research can help us provide more effective health care right here at home. Sarosh Rana, MD, MPH, now section chief of maternal-fetal medicine at the University of Chicago, is proving the case.

After her residency at the University of Chicago Medicine and fellowship at Brown, Rana embarked on a career at Harvard’s Beth Israel Deaconess Medical Center. She was passionate about reducing pre-eclampsia, a complication of pregnancy in which women develop high blood pressure and organ damage, sometimes with lasting cardiac problems. Early symptoms of pre-eclampsia, such as swelling, nausea, and headache, are common in normal pregnancies, but the high blood pressure commonly associated with the condition can come on suddenly. Once the condition progresses to full-on eclampsia, the only treatment is to swiftly deliver the baby, no matter the gestational age.

In Boston, where the vast majority of women have regular pre-natal care, clinicians were using a battery of questions and regular clinical observations to anticipate pre-eclampsia. Rana was convinced there must be biomarkers—something that would show up on a blood test—to better identify women at risk.

A mentor of Rana’s at Harvard suggested her expertise in pre-eclampsia could be really useful in Haiti, where incidence was particularly high. Rana took up the challenge, traveled to Haiti, and was shocked by what she found: over 17 percent of pregnant women in Haiti had either pre-eclampsia or eclampsia, and some mothers actually died of the condition—unknown among her patients in Boston. Even more worrisome, many of the mothers in Haiti continued to suffer from high blood pressure and its effects long after their babies were born, putting entire families at socio-economic risk.

One reason for these poor outcomes was clear: few mothers in Haiti had regular prenatal care, so clinicians could not pick up the clues of pre-eclampsia early enough to make a difference. Developing a set of biomarkers that could be assessed and addressed quickly—even remotely—offered a way of deploying limited resources to do the most good. Rana started traveling to Haiti every year to advance research on the issue.

After she returned to the University of Chicago as a faculty member, Rana continued her work in Haiti. Last year, through support from the University’s Center for Global Health, several UChicago students joined her. They were also amazed at what they saw, “wards with 20 to 30 beds on each side, filled all day every day, with women sitting on buckets waiting for a bed to open,” according to Eleanor Kang, who graduated last year with majors in biology and public policy.

“The experience opened our eyes to the conditions and need in Haiti,” agreed Rebekah Sugarman, a 2017 graduate in international studies. One of these was a new, more efficient way to predict pre-eclampsia. Together with Rana, Hadi Ramadan (a medical student from Lebanon working in Rana’s lab), and clinicians from Haiti, the group published a paper to set out the specific needs in Haiti and the opportunities to improve care there.

Back in the U.S., Rana brought together a team of four professional school students, from the Pritzker School of Medicine, Harris School of Public Policy, the School of Social Service Administration, and the Booth School of Business. Their goal was to develop an education, surveillance, and intervention program tailored specifically to rural Haiti. The protocol arms nurses to take early action, with training, prepared order sets and medications, and monthly Skype sessions with an expert like Rana. The plan also provides education for family and community members to recognize early warning signs of pre-eclampsia and a mobile tracking system to follow patients at risk as they return to the community.

Maternal mortality is on the rise in United States. The upshot of Rana’s work is that the biomarkers to identify women at risk for pre-eclampsia in Haiti can also simplify diagnosis here in Chicago and across the U.S., leading to improved outcomes while lowering health care costs.

Rana clearly relishes spreading her enthusiasm to the younger generation. She is currently training Sandra Anazor, MD, from Nigeria. “I’m learning so much from Dr. Rana,” notes Anazor. “She’s very passionate, believes so deeply in what she is doing, and her hard work has led to much success.”

Rana’s influence extends to her own daughter, Sana Shahul. The 15-year-old UChicago Lab School student worked with her mother’s research team in Haiti last summer and was inspired to start MissionBlueAqua, a foundation to support clean water there.

Kang and Sugarman are now both ready to start medical school; their experiences in Haiti have inspired both to embrace careers that include both research and global health. “Dr. Rana is brilliant and the work she is doing is making such a difference in the lives of women and their families,” says Kang.