Center for
Global Health

Dr. Victoria Mui - Advancing Global Women's Health through Leadership, Education, and Advocacy

Inspiration and Career Path:

Can you share what inspired you to pursue a career in obstetrics and gynecology, particularly in women’s global health?

I was raised by strong women – my mother worked full-time as one of the few first female computer programmers and my grandmother was the traditional matriarch of our Chinese American family.  They were both powerful forces in my life and I was in awe of the female lived experience. I pursued OB/GYN because I wanted to support and advocate for women through all stages of life, especially during the most personal and challenging periods, such as pregnancy and menopause. I found a passion in global health because I watched my immigrant parents and grandparents navigate our medical system and wanted to understand how one’s circumstances impacted their health outcomes.  Global work has continued to renew my passion in the field because it is a constant reminder of the shared female experience and the shared goal for health and equity.

Leadership and Role at Penn Medicine:

As the director of the Global Women’s Health Fellowship at Penn, how has your role evolved in addressing healthcare disparities in both local and international contexts     

I started getting involved in Global Health through surgical mission trips as a student. I thought that flying in and providing “free” care was the answer to closing the outcome gap. I quicky learned that this was neither sustainable nor did it address the basic needs of communities we worked in. Working in the US felt similar. There is so much overlap in the patient experience for those living in limited-resource countries and those living here in the US with limited resources themselves. Access to healthcare has been identified as a major predictor of health outcomes and the barriers to access are the same whether a woman lives in West Philadelphia or northern Uganda. My work focuses primarily on improving access to quality care for those who are at systemic disadvantage. For example, my work in Tanzania is focused on training health care providers in rural facilities to perform safe Cesarean deliveries to prevent maternal death. My work locally with our student-run medical clinic and the Center for Surgical Health is to streamline and provide specialty Gynecologic care to the uninsured immigrant population.

Your department at Penn Medicine has a strong emphasis on global health, particularly through the Global Women’s Health Fellowship and international partnerships. How has the department’s support for global health initiatives influenced your work, both clinically and academically? Could you share examples of how this support has enabled you to further your impact on women’s health globally?

The OB/GYN department is dedicated to addressing health equity, specifically at the intersection of race and gender.  The department works very hard to integrate this mission into everything it does, including medical education. I think global health is just one component of this commitment. On the fellowship level, they want to cultivate leaders in the field by providing them the foundation for vigorous research with the Masters degree, clinical mentorship, and protected time abroad. On the residency level, the department has supported a Global Health Equity Track that provides residents academic time, elective time, and a fully-funded Advancing Health Equity course at Penn. Working with team members at different stages of their training has been enabled me to build international training programs for various skill levels.

Clinical Practice and Integration of Global Health:

Your expertise spans a wide range of women’s health issues, from prenatal care to pelvic surgery. What are some of the most rewarding and challenging aspects of working across such diverse areas of women’s health?

This is my favorite part of OB/GYN! I love the variety and the fact that I can care for women at different points in their lives. The most rewarding aspect is the continuity: I love that I can see a patient for preventative care, help them through a pregnancy, perform surgery for a gynecologic issue, and then follow them through menopause. It is also so rewarding to provide comfort and reassurance for women through difficult times, such as loss and cancer, and to normalize feelings and experiences that society tells us is wrong. The most challenging aspect is the time commitment to do all these things. Labor happens at all hours of the day (and night!) and if it weren’t for my google calendar, I would be lost.

How do you integrate global health perspectives into your everyday clinical practice at Penn Medicine?

Penn Medicine takes care of a diverse population, which I really value. It regularly challenges me to re-evaluate my preconceptions and biases and requires that I practice with cultural awareness. My global health experience has taught me to practice with limited resources. For example, I am conscientious of the cost of tests and try to avoid wasting supplies in the operating room. I’ve also learned to trust the human body; for example, that birth is physiologic, and that medical intervention is not always necessary or better.  

How do you balance your clinical duties with your global health leadership and research commitments?

It is really hard! I am fortunate to have a supportive Chair (Dr. Howell) who has provided me with the protected time to work on my global health initiatives, which includes both the fellowship and research. Dr. Howell and Dr. Polite (my Division Chief) worked hard to find creative ways for me to spend time abroad while also fulfilling my clinical responsibilities. The PSOM Center for Global Health has been an invaluable supporter as well. They have provided me with mentorship and facilitated interdisciplinary relationships. I don’t think I would be able to do both without the financial and administrative support of these departments.

Global Health Disparities and Fellowship Focus:

The Global Women’s Health Fellowship supports advanced degrees in areas such as Public Health and Clinical Epidemiology. How do these interdisciplinary studies prepare future leaders in global health?

Medical education is inadequate for training physicians on how to be competent researchers and effective leaders and policymakers. These advanced degrees not only legitimize the training, but also provide the formal education needed to implement projects successfully. For example, courses like Public Health Law and Ethics and Human Rights help build the skills to work with governmental agencies and communities within a conscientious framework. We want our fellows to be positive representatives of Penn and the US when they go out into the world.

International Partnerships and Sustainable Healthcare Models:

How do international partnerships with countries like Vietnam, Mexico City, and Tanzania enhance maternal health and preventative services, and what are the key learning outcomes for your fellows from these collaborations?

A key component of global health work is finding an equitable invested partner.  Honestly, developing these partnerships is the most difficult and important part of my work and the key learning outcome for the fellows and residents. It has been my experience that international partners are very agreeable, and it can be easy to start a project that you proposed but isn’t needed or feasible. My most successful outcomes are from projects that were initiated by my international counterpart. For example, the project in Tanzania was born from the observation that as Cesarean delivery rates were rising, surgical complications were also rising.  The local team hypothesized that this was due to inadequate surgical training at rural health centers and based on this, we developed a needs assessment study and are in the process of designing a Train-the-Trainer program. Likewise, my fellow, Dr. Ruth Woldemichael, built on connections with Doctors Without Borders in Mexico City. Through this relationship, they identified a need for reproductive and sexual health education in the migrant population and Dr. Woldemichael’s in Mexico supporting their pilot project right now!

You emphasize sustainable healthcare models in your fellowship program. Can you provide examples of successful initiatives that have made a lasting impact on global women’s health?

I think the long-term goal of global health is to help institutions and governments provide quality healthcare, which means that my presence should be temporary. Successful initiatives have focused on medical education and training up the workforce. For example, I worked with midwives in Guatemala to teach breech deliveries to reduce complications associated with these deliveries. In Uganda, I taught medical students and house staff how to manage obstetrical emergencies such as postpartum hemorrhage. The goal is that these trained providers will continue to disseminate the knowledge and skills as they grow their careers. Lastly, I am fortunate to have the opportunity to work with the Center for Global Health

Future Vision and Advice:

What do you envision as the future of global women’s health, particularly in policy, research, and clinical practice?

I am really excited for the future of global women’s health. Maternal health and Gender Equality are key goals of the Sustainable Development Goals and I think that the world is starting to understand that those two measures are closely linked. Policies will have to focus on uplifting women, both economically and socially. There are still many countries where women are not culturally or legally allowed to make their own decisions about their health. When women can access quality care and live healthy lives, everyone benefits-  communities are stronger and children succeed. I think our role as physicians is to help support the health systems and advocate for the policies that enable this.

What advice would you give to young medical professionals passionate about making an impact in global women’s health?

I would tell young medical professionals to be patient and ignore the distractions, because your impact might take years to reveal itself. When I worked in Uganda as visiting faculty, I struggled with the systemic barriers to providing care (corruption, lack of working equipment, absent healthcare providers, etc). For the first 6 months, I was so busy being angry because I couldn’t “change” it, that I completely overlooked the positive impact of showing up every day. I most certainly didn’t change the culture, but I worked hard teaching medical students and interns and they carried that knowledge forward. Now, almost 10 years later, I still get updates from my former students on how they learned XYZ from me and are teaching others.

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An Interview with two CGH Scholars on the REACH Project

The Resuscitation Education and Acute Care Help (REACH) project is a significant initiative aimed at reducing the high mortality and morbidity rates associated with sepsis in pediatric patients in Ghana. This project, spearheaded by Dr. Vanessa Denny from the Children's Hospital of Philadelphia (CHOP), in collaboration with Ghanaian institutions, has been pivotal in addressing the challenges of sepsis care in resource-limited settings.

Understanding the Challenge

Sepsis is a leading cause of death in children worldwide, particularly in low- and middle-income countries like Ghana. The situation is exacerbated by late presentation, inadequate training, and limited access to necessary medical interventions. The REACH project addresses these challenges by conducting thorough assessments of the barriers and facilitators to sepsis care in Ghana. A recent study conducted under this project highlighted the significant challenges faced by caregivers and healthcare providers, including financial constraints, delays in referral, and cultural beliefs​.

Innovative Solutions Through Collaboration

Dr. Denny's work with the REACH project exemplifies the power of international collaboration. "We performed an audit at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, which revealed a >50% mortality and morbidity rate for sepsis," Dr. Denny explains. "Through our needs assessment, we identified key barriers to timely and effective sepsis care and have since developed contextualized interventions, including a tele-simulation training program in collaboration with Penn’s Annenberg School of Communication".

This tele-simulation tool is particularly innovative, allowing real-time training for healthcare providers in Ghana, helping them to recognize and treat sepsis promptly. "Our project has expanded into a multi-center study, reflecting the significant impact we are making in Kumasi and beyond," Dr. Denny adds​(CHOP Cornerstone Blog | July 18, 2024).

Spotlight on Princess Ruhama Acheampong, PhD

One of the key contributors to the REACH project is Princess Ruhama Acheampong, PhD, who has made notable strides in global health. Dr. Acheampong's journey into public health was deeply personal, inspired by the loss of her brother to malaria at a young age. "My quest to finding a solution to my questions motivated me to pursue a course that would help prevent children from dying from preventable diseases," she shares​.

Her involvement in the REACH project began after her participation in the Summer Visiting Fellows (SVF) program at the University of Pennsylvania, an experience she credits with opening doors to valuable collaborations. "My experience at SVF is the reason for my involvement in the REACH Project. Our bios indicating our research interests were shared among other CGH scholars, which helped to get into this useful collaboration," Dr. Acheampong explains.

Dr. Acheampong has been instrumental in leading the qualitative research component of the REACH project, which examines the cultural and spiritual barriers to healthcare in Ghana. "The REACH project aligns very well with my research interests in maternal and child health and implementation science," she notes. The project’s findings are expected to inform policy recommendations and strategic leadership initiatives aimed at improving child health outcomes in Ghana.

Inspiration and Ongoing Commitment

Dr. Denny's passion for global health stems from her Caribbean roots and her experiences working in regions with limited healthcare resources. "It's my personal mission to ensure that critical care has no boundaries and that children globally have access to the care they need," she says. Her commitment to improving pediatric outcomes in Ghana, alongside the dedicated contributions of professionals like Dr. Acheampong, are driving forces behind the success of the REACH project​(CHOP Cornerstone Blog | July 18, 2024).

Looking Ahead

The REACH project is a shining example of how collaborative efforts can lead to meaningful improvements in global health. As the project continues to evolve, its impact on sepsis care in Ghana will undoubtedly save lives and set a precedent for similar initiatives worldwide.

(READ THEIR RESEARCH ARTICLE HERE)
(MORE DETAILS ON THE REACH PROJECT HERE)

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AN INTERVIEW WITH YULIIA KOVACH

Tell us a little bit about your background and what inspired you to enter the field of Reconstructive Surgery.

There are two pediatric surgeons who inspired me to focus my future in Plastic and Reconstructive surgery, both are women. Both women started a new chapter in medicine for me and demonstrated how versatile the field of Plastic Surgery can be. Working with Dr. Oksana Jackson both in Ukraine and now here at CHOP has been instrumental in leading me toward the path I am currently on. These female role models were crucial, not only providing a model of talented and qualified female professionals in the field, but also providing a model that you can be an excellent mother and wife too.

How does your research and work here in the United States affect health in Ukraine – or elsewhere globally?

The greatest injustice in the world is that children, depending where they live, do not have equal access to advanced and evidence-based treatment methods. Cleft lip and palate are not rare pathologies worldwide, but in some resource-limited countries, treatment remains ineffective and insufficient. Children's Hospital of Philadelphia (CHOP) is unquestionably a global leader, and I believe that the strength of a leader lies in the sharing of its strength. CHOP possesses the world's best expertise and capabilities to not only demonstrate ideal results in its patients but also to disseminate knowledge to colleagues worldwide, from Guatemala to Ukraine.

With this purpose in mind, people write publications, hold conferences, and conduct international missions, which connects doctors and researchers with their international colleagues. I feel fortunate to be part of this, and I consider my work an investment in patient equality, even in parts of the world where I have never been.

What opportunities or initiatives do you think could improve access to medical care for children with cleft lip and palate in Ukraine or elsewhere globally?

In the United States, I often observe the work of local doctors, clinical psychologists, orthodontists, speech therapists, nurses, medical assistants, and social workers. It is precisely the collaboration of a comprehensive, diverse team of different specialists complementing each other that yields such high results. Discussion, mutual respect, and the absence of fear in asking questions reduces the likelihood of errors, which we cannot afford when working with children.

I believe an excellent option would be to have international internships for entire teams like these.

Perhaps if these care teams learn together, in an intensive regimen, with a wealth of both theoretical and practical tasks it could significantly improve access to quality care.
 

Does your research and work here have an impact on the state of medical care in Ukraine?

The quality of the healthcare system in Ukraine has never been at a sufficiently high level. Now, with the onset of a full-scale war, the situation has deteriorated. For the citizens of Ukraine, survival, and the defense of personal values, right, and freedom have become the priority. As a result, a substantial number of civilian doctors, including pediatricians, are on the front lines. While these physicians and some in our hospitals spend time treating the wounded and returning them to the war, we cannot forget about the treatment and care of children and people with issues unrelated to the war.

Ukraine recognizes the knowledge and experience gap between us and highly developed countries, so we are ready to learn and work hard for the future of our nation. My goal in the United States through this fellowship is to absorb all of the knowledge provided to me here to use back in Ukraine. I am immensely grateful for this opportunity.
 

In what ways do you believe international collaboration can play a role in addressing medical challenges in Ukraine, particularly in the field of plastic and reconstructive surgery?

Plastic and reconstructive surgery is just beginning to develop as a field in Ukraine. The priority has shifted from the aesthetic aspect towards comprehensive functional restoration. Considering the volumes and numbers of injuries in both the pediatric and adult populations, the significance of education is invaluable, and it should be organized quickly and efficiently. We fully trust the years of experience of Penn, CHOP, and other global medical centers. The knowledge shared with us not only helps improve the system but also significantly accelerates the scientific development of Ukraine.
 

How does the conflict between Ukraine and Russia affect access to medical care, particularly for individuals with conditions like cleft lip and palate?

From the news, we can all learn that hospitals in Ukraine are constantly subjected to rocket attacks. These attacks can make it nearly impossible to provide qualified medical assistance there. Within the country, many specialists have mobilized into the Armed Forces, where they are now treating the wounded on the battlefield or near the front lines. In the occupied territories, people are essentially without rights, including to medical care. In cities close to the East, patients often find themselves without access to the most basic care, and complex care required for conditions like cleft lip and palate. This is further compounded by internal migration and emigration abroad, making it challenging to form teams of highly specialized practitioners.
 

What kind of support, whether it be resources, funding, or collaboration, do you believe is most crucial from the international community to improve medical interventions in Ukraine?

Despite the grim loss of life, the Revolution of Dignity 10 years ago became a catalyst for progress, and now the current war has proved that time is sparing. I have always firmly believed that we will never overcome this violence with weapons alone and it will only lead to even more violence. The key to peace and security is knowledge.

Over the past 2 years, I have been lucky to meet hundreds of people, some of the brightest minds in the world, who are willing to share their experiences with me. The United States possesses the largest amount of both theoretical knowledge and experience (both civilian and military) that they are ready to share and teach us, Ukrainians, thereby providing us an opportunity to succeed and survive. I hope that the quantity of training, international internships, courses, and educational missions will only increase. This is invaluable for us.
 

What is the impact you hope to achieve through your work?

When the revolution started in Ukraine, I was 11 years old. I do not remember much from that time, except questioning why it was all happening. Now, 10 years later, I finally comprehend why people didn't flee from the protests.

A close friend once said, "Since there's no queue behind us to make changes, it's obvious that we'll have to make the changes ourselves." It's true. The future of my country lies with those who don't wait for someone to come and save us, who understand that we are the ones shaping the future. Myself and many other conscious citizens feel that we are the people influencing the future through our actions. It instills a sense of responsibility.
 

Do you see a role for advocacy in raising awareness about these issues on an international scale?

I've been fortunate to be given the opportunity to speak, represent Ukraine, and be heard. It's an honor for me, but at the same time, it's a responsibility. I consider it my duty to do this now and in the future. Perhaps someday, I'll be able to advocate for other countries facing challenging situations.

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an interview with Stephen Avery

You have a leadership role in the Global Health Catalyst Summit which took place last year at Penn. Please tell us about this initiative.

I’m co-Director of the Global Health Catalyst (GHC) Summit. The goal of the yearly GHC Summit has been to catalyze and strengthen high-impact win-win international collaborations with stakeholders in curbing the growing global burden of cancer and other diseases, with a major focus on collaborations to address disparities. Outcomes include establishing cancer centers in Africa, telehealth initiatives, bi-directional learning with the training of thousands of health professionals to strengthen healthcare systems, and fecund research collaborations like multi-center/country clinical trials to increase access to care. One policy outcome of the summit has been a Lancet Oncology Commission for sub-Saharan Africa, which was launched last year highlighting a growing cancer emergency in Africa. This served as a reference for new actions that were announced by the Whitehouse during the U.S.-Africa Leaders’ Summit in December 2022 aimed at Reducing the Cancer Burden in Africa. Building on the foundation of those efforts the theme of the summit at UPenn in May 2023 was “Cancer Moonshot 2.0: win-win collaborations to advance global health and development”, with a focus on mobilizing further actions to extend the Cancer Moonshot globally via win-win collaborations that benefit the USA and Africa.

Participants at the summit come from all across North America, Europe, Africa, and other world regions interested in advancing disease prevention and control, and establishing collaborations for global health and development. Participants also include leaders from the World Health Organization or international health agencies, industry, World Bank, LMIC country ministers, ambassadors, policymakers, USA congressional leaders, Nobel Prize Laureates, health institution leaders, hundreds of Diaspora organization leaders, religious institution leaders, students, residents, oncology health professionals, and sports celebrity advocates, amongst others. 

When did you become interested in applying your expertise in other countries?

Dr. Jim Metz (Chair, RadOnc) started a program in 2011 to train Radiation Oncology Nurses in Dar es Salaam, Tanzania. They created in-person trainings, online modules, and a certification program for nurses. From this work, two classes of nurses have been trained and certified. He mentioned there was a huge need for medical physics support.  In September of 2013, I began working with Jumaa Bin Dachi, a Therapy Physicist at the Ocean Road Cancer Institute in Dar es Salaam, Tanzania. We hoped to develop a working Quality Assurance (QA) program that could be easily implemented from abroad. QA in radiation therapy helps to ensure correct radiation doses are being delivered to patients, mainly through the checking of radiation output and field shape, patient positioning systems and alignment systems, along with image verification systems. I am still working with Jumaa and plan to serve as one of his PhD advisors.

What is your favorite part about working globally/ most difficult part of working globally?

My favorite part about global work is learning about different cultures and their approach to healthcare. I enjoy sharing knowledge and discussing innovative ideas such as using phytomedicines to enhance the therapeutic effects of radiotherapy while mitigating the damaging effects – over 60% of people around the world rely on plant plant-based medicines. I get to network with policymakers, LMIC country ministers, and government leaders – recently I had the opportunity to meet with the Asantehene (Ghana King). The most difficult part of working globally is navigating through the multiple pieces that entail global health. Sometimes there are moving parts that require adapting plans, since capacity building is needed identifying local champions can take time and you need to understand how the decision-making process works for each project. It’s important to do a thorough assessment so your project has focus for optimum impact and you are aware of the available resources for the project.

Congratulations on your recent promotion to full professor! As an underrepresented minority in the field, could you share some insights into your journey and any challenges you may have faced along the way? How do you think your unique perspective contributes to your role as faculty at an Ivy League institution?

I like to reference an article written by UPenn Provost John L. Jackson Jr. (former Dean of the School of Social Policy & Practice) 8 years ago titled “What it feels like to be a Black Professor”. His story is all too familiar to me and many of my colleagues – these summative effects can be difficult to overcome for underrepresented faculty resulting in a lack of recruitment and retention. To be successful you have to stay persistent; to be persistent you need a sense of belonging and a network of people who care about your success. I was a sophomore in college when I first met a black physicist – he was trained at Stanford and MIT - it had a profound effect on me to see someone in this role. Now as a professor, I think of the role I play by just being present, sharing my experience, and letting students know it is possible to grow up in West Philadelphia, attend an HBCU, and be the first (but not the last) black full professor in the department of Radiation Oncology at the University of Pennsylvania. Coming full circle – I recently had the opportunity to speak with the Social Justice Scholars in the School of Social Policy & Practice to share my experience in hopes it helps them to persevere.

Given your expertise in quality assurance and safety in proton therapy, could you elaborate on the significance of these aspects in advancing cancer treatment? How does your research in this area contribute to global efforts to ensure access to safe and effective radiation therapy, especially in middle to low-income countries?

Radiation therapy (RT) is an essential part of a successful cancer treatment, with more than 50% of all patients receiving RT for the management of their cancers. There has been a steady gain in the five-year survival rate for cancer patients, with an improvement of 66% across all cancer types. This increase has been attributed in part to technological advancements in RT, which now allow better targeting of radiation dose to the 3D shape of the tumor and minimization of dose to surrounding healthy tissue. With each RT treatment being delivered over the course of 20-30 fractions, it is estimated that cancer patients will make over 23.4 million RT visits to hospitals and freestanding therapy centers this year.

During each RT visit, a series of complicated patient-machine processes will take place to ensure that radiation is delivered safely to the tumor and not to nearby healthy tissues. These processes involve many degrees of complexity, sophisticated human-machine interactions, and decision-making steps that in some cases are repeated hundreds of times per day at busy clinics. Due to this high level of complexity and high degree of repetition, serious accidents can occur resulting in either patient injury or death. As a result, RT has been consistently listed as a top 10 health technology hazard by the ECRI (Emergency Care Research Institute). Safety concerns have been recognized by many national and international organizations including IAEA (International Atomic Energy Agency), NRC (Nuclear Regulatory Commission), and AAPM (American Association of Physicists in Medicine). Many clinical treatment errors have been attributed to technological error-based miscalibration or technical component failure. With cancer incidence increasing across Africa, the scarcity of radiation oncology resources becomes more evident. As more African facilities begin to invest in radiotherapy services, it will be crucial to develop a regional clinical auditing system that improves radiation oncology practice and assures an accurate dose delivery from radiotherapy equipment to ensure all African cancer patients receive safe and high-quality treatment delivery.

For students aspiring to enter the field of medical physics or global health, what advice would you offer based on your own experiences and the evolving landscape of these disciplines?

I would tell aspiring students to talk to someone actively working in the field to find out what their job entails. Try to spend some time shadowing them or applying for a summer program to get more experience. This is a multi-disciplinary field that is consistently changing so it’s important to have an open mind when trying to find your niche. You can focus on research, teaching, and/or clinic; you can start your own company, become university faculty, or work in industry or government. As a student explore your options, build your network, and seek mentors that can help you move your career forward. Ultimately, this is your career – you make the decisions don’t give up this power. Everyone has a unique path that reflects his or her interests, skills, talents, and environment – don’t compare your path with others. Remember effective habits can help you achieve your goals and be more successful in whatever career path you choose. The personal sacrifices you will make to achieve success will be burdensome, there will be long work hours, job insecurity, lower salary, and delayed gratification. If you find yourself saying, “I don’t want to do this or work like this,” then ask yourself whether this is the best career choice. But if you find something you enjoy that gets you up early and makes you stay up late then you may have identified your passion – go with it.

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