The group of visiting Ghanaian scholars had gathered in the home of Cheryl Moyer to socialize with each other and a few UM colleagues. They were in Ann Arbor for a research training program – many on their first visit to the United States – and Moyer, an Associate Professor of Learning Health Sciences and Obstetrics and Gynecology, hosted a gathering to break the ice.
“I’ll never forget watching this group come into the house, timid and a bit awkward. And then witnessing the warmth with which Cheryl embraced them,” said Joseph Kolars, UM Medical School Senior Associate Dean for Education and Global Initiatives. “There was this complete transformation. Pretty soon, they had turned this gathering into a dance party, moving furniture around, hauling out their Ghanaian music.
“It was such a warm, spontaneous moment for me. I don’t think I’ve ever seen Cheryl happier, or more in her element,” he said.
Since coming to the University of Michigan in 1997, first as staff and then as faculty, Moyer has cultivated a reputation as a leading collaborator among both UM and Ghanaian counterparts. She has channeled her warmth and willingness to listen into an impressive body of research focused on confronting maternal and neonatal mortality in sub-Saharan Africa that has improved health and care access for Ghanaian mothers and babies in some of the country’s most remote areas.
As part of the 2021 Annual Meeting of the Consortium of Universities for Global Health, Moyer has been selected for the Mid-Career Leadership Award named for Drs. Tom Hall and Nelson Sewankambo. The honor is given to researchers in the middle of their career who have exhibited extraordinary leadership in global health.
“I am so glad to see Cheryl recognized for this award,” Kolars said. “The bridges she’s been able to build for us have been terrific, not just with people in professional roles or academics, but with communities. That requires deep understanding of the region, a sustained effort, and an authenticity. These attributes are what has helped her succeed and really thrive in global health.”
From local disparities to a global career
Moyer didn’t initially aspire to a career in health – global or otherwise. She earned her bachelor’s in journalism at the University of North Carolina, Chapel Hill and went to work for small paper in a rural part of the state, the kind of place where cub reporters write about different topics from one day to the next.
“Right away, the beat that clicked with me was the health,” Moyer said. “I’d go to the health department and write about whatever was happening.”
She started reporting on health disparities across demographics, including the stark differences in infant mortality between Whites and African Americans in the region.
“I was asking people why. What was behind these differences? Nobody really had a good answer,” she said.
Talking through the issues with colleagues and family members – Moyer’s husband was at that time a medical student and her in-laws both worked at the Centers for the Disease Control – prompted Moyer to seek a master’s in public health UNC, Chapel Hill. Even then, global health was not on the radar.
“I came to this global thing very late. If you had asked anyone in my master’s cohort whether I would be a global person, they would have laughed. Hard,” Moyer said.
After earning her MPH, Moyer moved to Ann Arbor when her husband took a surgical residency at the Michigan Medicine. She accepted a research associate position in the Department of Internal Medicine, working with physicians on outcomes research. She helped write grants, craft surveys, analyze data – whatever needed to be done. The job gave her broad exposure to many types of projects and helped Moyer build a network of colleagues across the institution. In 2001, she was approached by a physician, David Stern, who was starting a new global health-focused unit in the medical school; did she want to help facilitate global health research?
“I told him I had never done anything global. He said, ‘Think about it. You would be good at this,’” Moyer said. “I jumped in and started learning as much as I could.”
Helping define the ‘Michigan Model’
Much of the early efforts in the newly formed Global REACH office were concentrated in Ghana, where Michigan Medicine’s Obstetrics and Gynecology Department had longstanding collaborations and had helped establish in-country training programs for Ghanaian doctors. Moyer made her first trip in 2007 as part of a group working on a project to expand the kind of training partnerships pioneered by Ob-Gyn into other disciplines.
“Almost immediately, Ghana just felt like home to me. It felt like where I was meant to work,” Moyer said. “I am more relaxed there in some ways than I am here. It’s hard to explain, but my partners in Ghana are quick to laugh – the kind of deep belly laughter that can make you tear up. That openness and ability to see the humor in things fits me very well.”
In 2008, UM was awarded a $3 million Gates Foundation grant to partner with the Ghanaian Ministry of Health and others to pursue more training based on the Ob-Gyn model. Facilitated by Global REACH, the grant was a watershed moment for the UM Medical School global health community, expanding in-country Ghanaian training collaborations to include Otolaryngology, Emergency Medicine, Psychiatry, and other disciplines.
“Cheryl did a lion’s share of the work and really drove the completion of tasks to secure that grant,” said Professor of Ob-Gyn Frank Anderson. “She was part of a team that really helped us define the Michigan model for global health: integrating research, data, and training a broader partnership. A lot of the work she’s done has really been an authentic expression of that idea.”
What set Moyer on the path to building her own research collaborations in Ghana was a conversation that echoed some of the stories she’d written as a newspaper reporter in North Carolina. The group was in Ghana discussing a project that the local researchers were pursuing: looking at clinical causes of infant mortality in the northern part of the country.
“He was explaining that the first week of an infant’s life was a particularly dangerous period. A lot of babies die,” Moyer said. “I asked him why that is. What was going on in the home during the first week? No one really knew the answer.”
A focus on Ghana
The first grant Moyer wrote for herself as a PI was for seed funding to help answer this question. Conducted with Ghanaian collaborators on a shoestring $10,000 budget, the Stillbirth and Neonatal Death Study (SANDS) combined available quantitative data from a decade of birth records with qualitative information derived from 200-plus interviews with Ghanaian moms in and around Navrongo, in Ghana’s rural north.
“Part of what makes Cheryl so special is that she goes to the distant areas where care is actually happening on the ground,” said Professor of Ob-Gyn Tim Johnson. “So much of success depends on showing up. That’s why her collaborators in the community health centers are drawn to her, and also why the people at the Central Ministry of Health respect her – because she’s out there doing the work at the ground level. It reflects what a caring and curious person she is.”
Johnson, who served as Chair of Michigan Medicine’s Ob-Gyn Department from 1993 until 2017 and forged many of the University’s earliest collaborations in Ghana, helped Moyer expand her network of in-country collaborators and encouraged her to seek a PhD in Health Services, Organization and Policy from the UM School of Public Health.
Research conducted through SANDS formed the foundation of Moyer’s PhD dissertation. It also led to a larger, $1.4 million USAID-funded project to collect quantitative and qualitative data in Ghana about neonatal and maternal deaths and “near misses” (i.e., situations in which someone almost died). Then the team integrated that data into mapping software local health officials could use to spot trends in real time.
PREventing Maternal And Neonatal Deaths, PREMAND for short, helped local communities identify mortality hot spots and delve into the specific causes, many of them cultural and variable by region. That work, too, was focused on northern Ghana.
“Cheryl has been steadfast about the fact that Ghana is the place in the world where she wants to focus her attention,” said Professor of Nursing Jody Lori, who has collaborated on a number of projects in Ghana. “Some people work in ten different places. You can make a difference doing that, but you can’t have a personal kind of impact like Cheryl has had.”
A sought-after mentor
As Moyer’s network of community collaborators expanded, so too did her impact. She garnered the attention and admiration of some the country’s top health education leaders. Dr. Richard Adanu, the former Dean of Public Health at the University of Ghana, served on Moyer’s doctoral committee. He traveled to Ann Arbor in 2012 for her dissertation defense.
“There are many Ghanaians that I’ve gotten to know only because I know Cheryl, which tells you something,” said Adanu, who was recently named the Rector of the Ghana College of Physicians and Scientists. “One thing that makes Cheryl a good partner is the fact that she is always looking out for the good of the people she’s working with.”
In all of her projects, Moyer has taken care to help her Ghanaian colleagues hone their research skills and build a portfolio. In recent years, she has co-authored nearly 60 scientific papers with colleagues in Ghana. At the same time, Moyer has become a sought-after mentor at UM, working with more than 80 students and trainees in the Medical School and other health science disciplines.
Her reputation as a generous teacher helped earn her the University’s 2018 Sarah Goddard Power Award, recognizing contributions for the betterment of women at the University. Emma Lawrence, a Global Women’s Health Fellow with the Ob-Gyn Department, has counted Moyer as a mentor since she arrived as a medical school in 2011.
“Throughout med school, Cheryl kept me really engaged and excited about global health when my head was in the trenches of med school,” Lawrence said. “In the past two years, she’s become my primary research mentor, reading every word that I’ve written, helping me revise manuscripts, helping me submit.”
Lawrence was supposed to have spent much of the last year in Ghana as part of her Fellowship, but the pandemic forced to change those plans. Moyer helped Lawrence switch gears to plan research that could be done virtually, even while helping her apply for another fellowship experience through the Fogarty International Center in order to return to Ghana when the pandemic subsides.
“Particularly this year, with all the struggles of COVID and things changing with the pandemic, Cheryl is so positive and enthusiastic,” Lawrence said. “It’s easy to feel pretty down, but one conversation with Cheryl always lifts me up.”
Global Health, post-pandemic
A typical year would find Moyer in Ghana 2-3 times, a travel routine that ground to a halt in wake of COVID-19. Thanks to her deep connections – and to rapidly expanding infrastructure in the parts Ghana where she focuses – Moyer has been able to move some of her work forward in the past year despite the travel restrictions. A project with Dr. Lori, from the School of Nursing, exploring the benefits of group-based prenatal care for new mothers has continued.
“We have photos of the women sitting outside – six feet apart, masks on – participating together in these group classes. It’s amazing,” Moyer said. “And I’ve been able to sit in my kitchen with my laptop, taking part in a Ghana Health Service research dissemination meetings because practically overnight they started using Zoom. Also amazing.”
The travel restrictions have prompted a lot of reflection, Moyer said, on what the future of global health could like when the world emerges from the COVID-19 pandemic.
“I think COVID made two things very clear. First, we’re all connected. Second, we in the west don’t always know what we’re doing, as our vaccine roll-out might illustrate,” Moyer said. “I think there’s an opportunity learn from our partners and build back collaborations that begin on a footing that is more equitable for true mutual benefit.”
The Mid-Career Leadership Award, to be presented to Moyer during this year’s (virtual) CUGH conference next month, is reflection of that ethos, said Kolars.
“Cheryl carries herself with a confidence and humility that is unique and essential to forming lasting collaborations,” Kolars said. “So many people go into these relationships trying to impose an agenda. But Cheryl has a way of getting people to talk about what they want. It’s refreshing, and something we need more of in global health.”