OB-GYN returns to NC from Zambia to find similar health needs in her own backyard

Recent Global Women's Health fellow and School of Medicine alumna Nancy Hancock returned to North Carolina to use her intense training in international medicine in service of the people in her home state.

OB-GYN returns to NC from Zambia to find similar health needs in her own backyard click to enlarge Left to right: Esnart Busiku, Nancy Nakweti, Rachael Ngulube, Likando Munalula, Lungowe Njobvu, Lucia Nkhata, Doreen Nambela, Queen Tembo. Dr. Hancock is seated.

Health is everywhere.

This dawned on Mooresville, N.C., native Nancy Hancock in the late 1990's in her medical anthropology class during a semester abroad while a student at Clemson University where she was getting her undergraduate public health degree. Her hometown had been small, but she realized the world was big and full of opportunities to serve. She wanted to be in the thick of it.

Driven by a desire to use her skills for those who need them most, Hancock, a 2009 UNC School of Medicine graduate and now a practicing obstetrician and gynecologist, has led a life of international health service. She's been a National Institutes of Health (NIH) Fogarty International Research Scholar in South Africa, a clinical volunteer in the Commonwealth of Dominica, a field researcher in Sri Lanka, and, most recently, a UNC OB-GYN fellow with the Division of Global Women's Health in Zambia.

"I've always been interested in working with the underserved, and that's what has guided my medical training," says Hancock. "But, I never forgot what I'd learned in medical school at UNC, that there were places in North Carolina that had limited healthcare resources, too."

In August 2015, at the end of her two-year fellowship in Zambia, Hancock decided to take an intense training in international medicine where she thought it might do the most good: back to her beloved home state.

The Road to Zambia

After graduating from Clemson in 2000, Hancock sought a master's of public health degree in international health and development from Tulane University in New Orleans. That experience set the foundation for how she would approach her career.

"As a clinician, you take care of the individual, but public health is population health – it's how can we change policy or implement new procedures that will help the masses," she says. "Particularly, when you look at global health, you are working on what can be done with limited financial, human or capital resources that can benefit the most people."

After a stint as a research assistant on an international health project with the NIH, she came to Carolina for medical school. Via the NIH Fogarty International Scholars Program, she met Ben Chi, MD, now an Associate Professor of OB/GYN and the Director of the UNC OB/GYN Fellowship in Global Women's Health.

"At first, I wasn't interested in OB/GYN, but we stayed in touch, and I followed his publications. I noticed a combination of OB/GYN and infectious diseases work, mostly from Zambia," Hancock says. "When I decided that was exactly how I wanted to specialize, I knew I'd want to follow a residency with that fellowship."

After a residency in OB/GYN at Wake Forest University, she applied for the fellowship and left for Zambia in August 2013.

"A two-year experience was exactly what I needed to really immerse myself in how to do research and serve in a developing country," says Hancock. "It was important for me to devote myself to the experience, to go and do and see."

In her time in Zambia, Hancock completed two major research projects in family planning. She also served as a clinician at the local public district hospital, performing surgeries like emergency cesarean sections and ectopic pregnancies as well as seeing patients on an outpatient basis.

For both projects, she collaborated with Zambian healthcare providers and public sector clinics to assess and improve family planning services. One study surveyed 7,000 Zambian patients taking antiretroviral therapy (ART) to manage HIV to determine if they would find it useful to combine family planning and ART visits, as preventing unwanted pregnancy is important to prevent mother-to-child transmission of the virus. Combining the services would potentially decrease wait times and increase adherence to both ART and contraception.

"Now many of the clinics are offering Depo-Provera injectable contraception at ART visits," says Hancock. "We know that women with poorly controlled HIV who become pregnant are more likely to have complications, and their babies are more likely to be born early or small. The goal is certainly not to prevent women who have HIV from having children; it's to help them maximize their health so they have healthy pregnancies and healthy babies."

Improving women's healthcare in Zambia is not about Americanizing it, says Hancock. It was important to become immersed in the culture in order to determine the country's needs and desires when it came to influencing patient care.

"I think it would be easy to walk into any developing country and say, 'This is what we do in the United States,' but that's not helpful. Doctors are working very hard in Zambia and doing the work of twice as many people," she says. "It was important to determine what would really work there in order to leave them with something lasting."

Chi feels Hancock's time in Zambia prepared her for a career as an OB/GYN clinician-researcher in any domestic or global setting.

"In her two years in Zambia, Nancy relied on her U.S. medical training to address important issues in women's health," he says. "The skills she honed in cross-cultural communication, community engagement, and project coordination will undoubtedly help Nancy in her medical practice anywhere, as she continues to bridge the gap between health systems and the people they serve. This is an overarching goal of our Global Women's Health Fellowship — to show promising clinician-researchers the common threads of medicine worldwide, so they can apply the lessons learned in settings at home and abroad."

Returning to Her Roots

As her fellowship came to a close this summer, Hancock made a call to John Thorp, MD, back in Chapel Hill.

"If anyone knew where in North Carolina could most use an OB/GYN, it would be him," Hancock says of Thorp, who is Division Director of Women's Primary Healthcare at UNC OB/GYN. "And, that's how I got to Rocky Mount."

Thorp said eastern North Carolina is in dire need of young physicians, particularly in women's health as the region has a high rate of preterm birth, genital cancers and sexually transmitted infections.

"By choosing Nash County, Dr. Hancock takes the next step on a journey to help those less fortunate that began with her service in medical school at the Bloomer Hill clinic, persisted in Sub-Saharan Africa during fellowship, and now culminates in Rocky Mount," Thorp says. "This is the first fruit of the relationship between the UNC Health System and Nash General Hospital."

Hancock joined Nash OB/GYN Associates, a private practice in Rocky Mount, N.C., with an expressed commitment to serving the community regardless of ability to pay and to serve the patients referred by the health departments of Nash and Edgecombe counties.

"International medicine taught me to be creative with what I've got and to work within a system knowing there are finite dollars, people and physical space. You can't always get more people, money or more buildings, but you're still going to have lots of needs, so you learn to optimize what you've got," she says. "I know I'll use that here."

Coming back to North Carolina has reminded Hancock that while the world is big, health is still everywhere. And, many of the needs are universal: the conversations she's having with patients in North Carolina aren't that different from the ones she was having in Zambia.

"As more and more people travel or do medical outreach, they are getting skills they can use not only to benefit the populations they serve, but that they can also use anywhere," she says. "I think that's one of the things that has come full circle for me through my education and training – you don't need to go halfway around the world to meet people who need you. Sometimes the needs are in your own backyard."


This story was featured in UNC’s new campus-wide global health e-newsletter Quarterly Global Health Happenings. Visit globalhealth.unc.edu to read more and click here to start receiving the newsletter.

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