PCLT Student Research Spotlight

Tuesday, January 2, 2018
By Julie Rivo

The Institute for Clinical Effectiveness and Health Policy (El Instituto de Clinica Efectividad y Sanitaria, IECS, www.iecs.org.ar) is a leading research organization in Argentina. Notably, in November of this year, its most recent Director General just became Minister of Health for the country! I was fortunate to receive a scholarship through the Fogarty International Center of the NIH to spend 11-months working in the Mother and Child Health Research Department at IECS. My research primarily focused on the epidemic of cesarean sections in Argentina. Regionally, Latin America has the highest cesarean section rate in the world, with Argentina high up in the mix (along with Brazil, the Dominican Republic, Chile, Colombia, Cuba, Ecuador and Mexico). I was fortunate to be mentored by two obstetrician-gynecologists-researchers in Argentina who have been contributing important research on this issue for many years on an international and regional level.


Essentially, there has never been a rigorous (randomized controlled) trial comparing planned caesarean section and planned vaginal birth in low risk women with singleton pregnancies and thus, there is no objective data to guide evidenced-based clinical decision-making. A fellow Fogarty doctoral student designed a study evaluating the feasibility of this trial in low-risk pregnant women in Argentina through surveys with pregnant women and their obstetrical providers.  I worked to prepare for the implementation of this study at a hospital site in the north of Argentina. This hospital has one of the largest volumes of deliveries in the country, and thus is an important place to contribute to this body of knowledge. In addition to study implementation and monitoring, I was involved in the analysis and dissemination of study results. I presented an analysis on the preferences and attitudes of the obstetrical providers surveyed at four hospital sites at the Society for Obstetrics and Gynecology of Buenos Aires’ XXXV International Conference, as well as for colleagues at IECS. Manuscripts are pending acceptance to international journals.


I was fortunate to participate in additional research activities within my department and the Institute. I took classes within the Institute’s Masters program in Clinical Effectiveness: Systematic Review and Meta-analysis, Clinical Investigation, Developing Questionnaire’s and Evaluating Results and Implementation Research. I worked with departmental colleagues on a grant to an international funder for a proposed trial to reduce pregnant women’s exposure to second-hand smoke, and on two systematic reviews, one related to the primary topic of planned caesarean section versus planned vaginal delivery and the other on the metabolic effects of calcium supplementation with colleagues trained in nutrition. Apart from the incredible mentorship and learning opportunities, I am grateful to have become a more fluent speaker and writer in Spanish, as I hope to use Spanish in my everyday life as a physician. I had the opportunity to grow personally through life in the vibrant city of Buenos Aires and adventures traveling within the country and the region. Emblematic highlights include hiking the ‘O Circuit’ in Torres del Paine National Park in Chilean Patagonia, attending the World Family Medicine Conference in Rio de Janeiro, sharing a Christmas meal with people from over 10 countries on an island in southern Brazil and marching in #NiUnaMenos protests against gender violence (specifically, machista violence with the complicity of the state) in the historic Plaza de Mayo in downtown Buenos Aires.