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Sarah Prager, MD, an obstetrician and gynecologist, is the director of the Family Planning Division and Family Planning Fellowship at the UW School of Medicine.

This past year, Prager was on a sabbatical to help strengthen family planning and run a fellowship program for physicians at St. Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia.

Reproductive care in Ethiopia

In 2005, Ethiopian laws were liberalized, allowing abortions for women who have experienced rape or incest, are under 18, or need an abortion for significant medical reasons.

“Until recently, there wasn’t much training for physicians performing abortions past the first trimester,” says Prager. “There are 108 million people in Ethiopia and roughly 500 to 600 OB-GYNs. We need to be training more than just OB-GYNs to make this care more available.”

She spent most of her time working with OB-GYNs who want to focus on family planning and then training fellows, residents and midwives to provide abortion care.

St. Paul’s is the busiest obstetrics hospital in Ethiopia. Prager estimates almost 1,000 babies are born every month at St. Paul’s — quite a lot when compared with UW Medical Center’s campuses, which deliver about 3,000 babies a year.

Prager and her OB-GYN colleagues hoped that creating a strong family planning program would help improve care for the high volume of OB-GYN patients in Addis Ababa.

Lessons from the clinic

As much as Prager was there to teach, she was also there to learn.

“One of the things that we rely on a lot in the United States is technology for diagnostics. It’s not easily available here in Ethiopia and we have to gather more information from physical exams,” says Prager.

She hoped to bring back a renewed sense of consideration on physical examinations when evaluating diagnostic modalities in her teaching and clinical practice at UW Medicine.

Prager also acknowledges the complicated relationship that the U.S. has with abortion politically, and she attributes some of that to the disparate maternal mortality rates between low-income and high-income countries.

“There is an appreciation in Ethiopia of how important abortion can be for maternal health,” says Prager.

Her colleagues at St. Paul’s see many cases, often for hypertensive disorders, where if the pregnancy couldn’t be ended, the mother would die.

“This care is critical in low- and middle-income countries,” says Prager. “And the faculty at St. Paul’s has seen the positive outcomes they were hoping for in women’s health since abortion care has become more available.”

Cultural immersion

When not working at St. Paul’s, Prager traveled with her husband and daughter around Africa, studying Amharic (the national language of Ethiopia) and training for a half-marathon.

Sarah Prager and husband training for half marathon

Along with learning the language, she attended religious ceremonies and toured historical mosques and churches.

“I wanted an opportunity to immerse myself in a global health experience and not feel like a medical tourist flying in and out,” says Prager. “It really has been a rewarding experience for me and my family.

The last flight to the U.S.

Prager, her husband and daughter were on vacation in Botswana when Ethiopia announced its first case of COVID-19.

“We were out of communication completely and as we were returning we learned that Ethiopia had a quarantine for anyone coming into the country,” says Prager.

Since the quarantine was announced only five hours earlier, they had missed the cutoff to be let back in the country without quarantine restrictions.

The family was required to go to a government hotel for 14 days unless they could show they were in transit and would be leaving Ethiopia within a 24-hour period.

Not wanting to risk contracting COVID-19 in quarantine, they booked a flight through Dubai, which then promptly shut down all flights to the U.S. With a stroke of luck, they were able to get three seats on the last flight leaving Ethiopia for the U.S. and made it to Chicago at the end of March.

“The sad part is that there was no closure or goodbyes at work,” says Prager.

She had three months left working at St. Paul’s and had a five-week, eight-country trip planned with her family before coming back.

“With Zoom I was able to keep working on projects. We had early morning check-ins and I was able to help the fellows move forward on their projects,” says Prager.

Prager has helped draft protocols on reproductive care during COVID-19, and with her colleagues at St. Paul’s, has started gathering data on the limitations placed on reproductive health services since the first case of COVID-19 was recorded in Ethiopia.

She is back at UW Medicine now and excited to see her patients here. She continues to do part-time remote work with the family planning program at St. Paul’s.

“Even from afar it has been an incredible experience,” says Prager.