When Dr. Claire Kendal-Wright first stepped inside the labor and delivery unit at LBJ Tropical Medical Center in American Samoa, the challenges facing physicians there became immediately clear.
“There was one OB and a resident covering labor and delivery,” Kendal-Wright recalled. “I started asking questions about preterm birth and outcomes, and you realize very quickly how dedicated the health providers are despite how limited the resources are.”
Now, with support from a grant from the Department of Interior Grant to the Lydon Baines Johnson Tropical Medical Center, the JABSOM researcher is working with clinicians in American Samoa to strengthen maternal-fetal care through sonography training, telehealth collaboration and improved access to expertise.
The effort focuses on helping local physicians and healthcare workers manage high-risk pregnancies.
“When this grant ends we aim to put in place a care pipeline that has not been available to these mothers,” Dr. Kendal-Wright said. “This will enable more mothers to gain the vital information required to make important care decisions about the health of their babies. For the mothers of A.S, this is not possible right now.”
According to a study published in Obesity, American Samoa faces some of the most challenging maternal health conditions in the Pacific. High rates of obesity, hypertension and diabetes contribute to complicated pregnancies, while limited access to specialists and diagnostic technology can make early detection of problems difficult.
“You’re dealing with a population where many women have significant risk factors during pregnancy,” Kendal-Wright said. “Having the ability to identify complications earlier and make informed decisions is incredibly important.”
Kendal-Wright made this visit with Dr Lowery and Larenda Casey (lead sonographer) La-Tisha Frazier (MD and also a 2nd year fellow in JABSOM’s MFM fellowship program.)
During their visits, Kendal-Wright observed how clinicians often work with minimal resources. As an example of the improvisation that’s needed, Kendal-Wright remembered ultrasound images being shared informally through cell phone photos to seek outside opinions.
“We want to provide support, training and tools that help them make the best possible decisions for their patients,” she said.
A key part of the project is training local providers and sonographers to strengthen prenatal screening and monitoring. Kendal-Wright and her collaborators, Curtis Lowery, MD, Ginger Porter PhD, Bethel Muasau-Howard MD, plan to conduct additional training sessions in June and September.
Beyond the technical challenges, she said practicing medicine in American Samoa also requires deep respect for cultural values and family decision-making.
“In many cases, decisions are truly family decisions,” she said. “You see how culture, faith and community play a central role in how people approach pregnancy and healthcare. Seeing the disparities up close is eye-opening. At the same time, it makes you realize how meaningful even small improvements in resources or training can be.”
For Kendal-Wright, the project inherited from Dr. Men-Jean Lee, JABSOM’s former Associate Chair of Research and Innovation, reflects the medical school’s broader mission of supporting and bolstering health equity across the Pacific.
“It’s incredibly rewarding work,” she said. “These collaborations help ensure that mothers and babies have access to the best care possible, no matter where they live.”