Dr Dominic Edwards is the Principal House Officer for the Department of Obstetrics and Gynaecology at Mater Mothers’ Hospital in South Brisbane.

In 2025, despite significant advancements in medicine and global efforts to improve maternal healthcare, the stark reality remains that many developing nations continue to grapple with alarming rates of poor maternal and neonatal outcomes ¹. While some regions have seen progress, significant barriers to sustainable improvements persist, such as corruption, resource (mis)allocation disparities, infrastructure limitations, gender-biased attitudes, and the cultural influences of religions. Consequently, socio-economic factors ² persistently undermine the quality of obstetric and gynaecological care available to women in these areas. Preventable complications during pregnancy, childbirth and the postpartum period continue to take a devastating toll, leading to unnecessary suffering and loss of life ³.

You Have to Start Somewhere…

Responding to the O&G Magazine callout for contributions regarding global women’s health initiatives in low to middle-income countries, I am sharing my initial experiences from two distinctly different locations over the past two years.

As a junior doctor, I have decided to supplement my career development in the Australian medical system with experiences in developing countries. I aimed to contribute to better maternal outcomes both in developing nations and at home. At the end of my degree, and in the first two years post-graduation, I started this pathway with experiences in Uganda and Cambodia. The exemplary mentorship of Professor Judith Goh AO and Professor Hannah Krause AO ignited my passion for this approach to my career and guided my choice of initial locations.

My Experience in Uganda

After completing medical school at the end of 2022, I travelled to the Kagando Mission Hospital to work in the obstetrics and gynaecology ward. Kagando Hospital is in rural Western Uganda, about 30kms from the Democratic Republic of Congo border and an eight-hour drive from the international airport in Entebbe. As I arrived, Uganda and the World Health Organisation declared an outbreak of the Sudan variant of the Ebola virus in the central provinces—a concerning development. However, given that over 40% of people in Uganda are HIV positive, the need for medical support is constant. The only slight relief was that the Islamist militias on the Congo side of the border were unlikely to cross. Apparently, even militias fear Ebola!

Professor Judith Goh AO, Prof. Hannah Krause AO, Dr Edwards and Sarah Macculloch (Medical Student) at the Khmer Soviet Friendship Hospital, Phnom Penh

To put my work into context, the first thing to know is that Uganda is one of the most fertile countries in the world, with women on average giving birth to 4.6 children ⁴ (for comparison, the rate in Australia is 1.74). The second is that in Western Uganda, women only go to the hospital to give birth if there is a problem; otherwise, they give birth in their village. Third, every aspect of the system is under-resourced and the infant mortality rate is 31.2 per thousand live births ⁴ (for comparison, the rate in Australia is 3.2). Also, many children don’t survive birth–those statistics are not readily available in Uganda, so the mortality rate is likely to be much higher.

In Western Uganda, women only go to the hospital to give birth if there is a problem; otherwise, they give birth in their village.”

In this environment, from Monday to Friday, I was one of two doctors managing sometimes over 60 maternity patients daily in a 30-patient ward. The resource-poor setting presents many challenges; even the supply of surgical gloves and masks was uncertain despite the HIV (and now Ebola) risk.

After work each day, I worked on data collection and analysis for a research project I led, and I played football with the staff. On the weekends, I accompanied a retired nurse from the UK on various health and outreach programs that were established by the hospital and funded by various charities. I ran the Nyabirongo Prison Health Screening Clinic twice, providing care to about 75 prisoners living in terrible conditions with typhoid fever, malaria, and wound infections. Every month, the team put on a breakfast for children with HIV and their caregivers, followed by an education session about living with HIV.

With the Rwenzori Women for Health Outreach team, I travelled to four remote villages in the Rwenzori Mountains to educate the villagers regarding various stigmatised topics such as puberty, the menstrual cycle, drug and alcohol abuse and homelessness. Given the Ebola outbreak, health promotion and education about Ebola and other infectious diseases was essential during these community visits. I also conducted a malnutrition workshop for young mothers with severely malnourished children—a problem I noticed in postnatal clinics where newborns returned with poor growth rates, infections, and mortality.

My research project at Kagando Hospital represented the first comprehensive assessment of obstetric and perinatal outcomes at this hospital. It enabled evidence-based decisions to address the specific needs of the diverse patient population, optimise resource allocation, enhance the quality of care, and ultimately improve maternal and neonatal health outcomes. Additionally, training the local doctors in data collection and analysis hopefully promotes continuous quality improvement efforts, maximising the impact of limited resources in resource-constrained settings. I have also been appointed to the Board of Trustees of Kagando Hospital, helping facilitate medical student and junior doctor placement at Kagando and continuing to mentor quality improvement and research projects at the hospital with a specific focus on women’s health.

Dr Edwards pictured with a prison guard and his family after attending the Nyabirongo Prison Health Screening Clinic

My research project at Kagando Hospital represented the first comprehensive assessment of obstetric and perinatal outcomes at this hospital. It enabled evidence-based decisions to address the specific needs of the diverse patient population.”

Ebola Health Promotion in a remote town in Western Uganda with the Rwenzori Women for Health Outreach Team

Despite the tough operating environment, it would be remiss of me not to mention the dedication of the people I worked with, the extraordinarily moving experiences of being literally sung into the mountain villages by the children, and the warmth of my colleagues at the hospital. My time was marked by both joy and sadness but was overwhelmingly rewarding.

My Experience Working in Cambodia

In my Intern (December 2023) and SRMO (June 2024) years, I accompanied Professor Goh and Professor Krause on a trip to Cambodia, running an Obstetric Fistula and Pelvic Organ Dysfunction Camp at the Khmer Soviet Friendship Hospital in Phnom Penh. These two specialist urogynaecologist and vesico-vaginal fistula (VVF) surgeons selflessly spend up to three months every year travelling the developing world, teaching complex gynaecological surgery, and making a profound difference to the local patients, clinicians, and communities. It is difficult to quantify the debilitating and ostracising effect VVF5 has on women in these developing nations. However, after reviewing them post-operatively, the marked change in these patients’ moods and dispositions highlights why such initiatives are so vitally important and how inspiring the commitment of these surgeons to improving global women’s health is. We know from work done across Africa and Asia, by doctors such as Dr Catherine Hamlin AC, Dr Andrew Browning AM, Professor Goh and Professor Krause, that the lives of these women post-surgery are significantly improved as they are reintegrated into society. I am fortunate to be accompanying the team in August 2025, to Uganda to assist in the VVF/prolapse camp, education workshops, and lectures.

It is difficult to quantify the debilitating and ostracising effect vesico-vaginal fistula has on women in these developing nations. However, after reviewing them post-operatively, the marked change in these patients’ moods and dispositions, highlight why such initiatives are so vitally important”

Looking Ahead

Regarding the future, I am just at the beginning of my career as a doctor and still have so much to learn. Fortunately, I am surrounded by inspiring mentors such as Professors Goh and Krause, and the many consultant obstetrician gynaecologists at the Mater Mothers’ Hospital. It is a privilege to deliver high-quality care to women in the developed and developing world.

It’s a start.