The women leading the work of WHO country offices in Poland and Armenia: interviews with Dr Nino Berdzuli and Dr Marthe Everard

Within the WHO European Region, across 32 country offices, there are 17 female leaders, including acting heads and special representatives. We speak to 2 of them to find out what drives their passion to improve health.

A lifetime of service to women's health: Dr Nino Berdzuli

Dr Nino Berdzuli clearly remembers the moment when she knew she wanted to be a doctor: receiving a toy stethoscope for her fifth birthday, she pretended to listen for a baby's heartbeat. As a third-generation female medic, her clear commitment to women's health was borne out by her decision to specialize in obstetrics and gynaecology.

A qualified obstetrician-gynaecologist, Dr Berdzuli had initially planned to work only in a patient-facing role. But the health inequities she witnessed in her native Georgia changed her perspective.

"When I started working, Georgia had one of the highest abortion rates in the world," says Dr Berdzuli. "I saw patients who had up to 25 abortions. Competence for providing contraception and family planning fell exclusively under obstetrician-gynaecologists, and as abortions commanded higher fees, OB-GYN had little incentive to provide family planning. Many women had mistaken beliefs about modern methods of contraception and, combined with the absence of services in rural areas, the challenge seemed to be enormous."

She continues, "I was one of the people at the forefront of liberalizing family planning services in the country back in early to mid-2000s and I led a process for policy change and the introduction of capacity-building and training for health-care providers, so that women could get these services through their family doctors. It was not easy, but the formula of patience and persistence meant that we succeeded."

Having seen first-hand how a lack of sexual and reproductive health services can impact women's lives, Dr Berdzuli regards this issue as a primary focus of her role as World Health Representative to the Republic of Poland. "I want to see every single Polish woman having access to the tools to plan their pregnancy and the right to do so," she says. "Whether that is funding for fertility treatment, or over-the-counter emergency contraception to prevent an unplanned pregnancy, all the data shows that, when women have agency in planning their families, this has a transformative effect on society as a whole."

Throughout her career, Dr Berdzuli has always sought to bring her decision-making back to one overriding factor: how this will affect the patient and their access to medicine. Working in low-income settings, whether in Africa, southeast Asia or the United States of America, has opened her eyes to the stark reality of inequities.

In one place, where the health system was much less developed in rural areas than in urban areas, Dr Berdzuli visited remote areas where community health workers attended the majority of births and the nearest maternity services were a 2-day walk away. She was surprised to see people who were not trained health professionals administering certain drugs which, if not properly used, can have complicated side effects.

"It was an impossible situation," she explains. "I had never seen such a magnitude of mortality from post-partum haemorrhage. Drugs exist that can help prevent women from dying, but when the nearest facility where they can be safely treated by a trained doctor or midwife is a 2-day walk away, then your perspective shifts completely."

"Perhaps the most surprising experience for me was during my clinical fellowship in Atlanta, Georgia, in the United States. Although there are incredibly well-equipped hospitals and a high level of care, the health disparities in the United States were just as prevalent as in less developed countries," says Dr Berdzuli. "I worked with communities where there were high rates of mothers who had prenatal care at a very late stage of pregnancy, or no prenatal care at all. This experience further cemented my understanding that, as a policy-maker, it is my duty to know well the communities we serve, to understand drivers of the inequities and help to address them."

Dr Berdzuli sees it as her personal mission to have cervical cancer eliminated in Poland and everywhere.

"I will never forget one patient with late-stage cervical cancer, who was mother to a 6-year-old daughter. Her little girl asked me whether I could save her mother, and it broke my heart that, despite having the tools to vaccinate, detect and treat at an early stage, the cancer was too far advanced. There have been so many big achievements and advances in technology for the early diagnosis and treatment of this condition, I see my role as a policy-maker to ensure that we optimize these technologies so that no more children lose their mothers."

A commitment to easing suffering: Dr Marthe Everard

Although she is Dutch by nationality, Dr Marthe Everard, the WHO Regional Director for Europe's Special Representative in Armenia, was born in Singapore. She eventually studied pharmacy in Amsterdam, but knew she wanted to work internationally. "I always had an idea that I wanted to do something useful, whatever that might be, and that I would like to go abroad," she says.

Early research into leprosy evolved into a passion for public health. Dr Everard was accepted as a WHO Junior Professional Officer in the Essential Medicines Programme as a pharmacist. Posts to east, west and north Africa followed, working on the medicines distribution system, integrating the rational use of essential medicines into the primary health-care programme, and coordinating WHO studies on how medicines tolerate climates in desert areas.

"As a woman, I never had any problems in the countries where I worked," she adds. "I was always respected. Even as a woman, I had the status of a male expert, so I have never found myself in an awkward position. That gave me the drive to continue."

Nonetheless, she is glad that, over the last 10 to 20 years, there has been a drive for greater gender inclusivity within WHO.

"If you make a discussion inclusive, involving women and men and all partners, you get to where you want to go together," she says.

In her first role as a WHO Representative, to Somalia, an abiding passion was ignited -pain management. "At that time, there was no decent pain medication, and when people were operated on, they just had to bite a stick between their teeth," she says. "The anger I felt about this situation gave me so much internal drive. I was so angry that it put me into a mode of 'I have to do something here'."

In Somalia, she witnessed first-hand how, in emergencies, women and young girls can be especially vulnerable, but she was also struck by women's innovation, their care for their children, and the importance of community. More experience of emergency settings followed when, as WHO Representative in Ukraine, she oversaw the provision of emergency supplies to the then-frozen conflict in the Donbas region.

After a long career, Dr Everard retired at the end of 2018, but was called back for a short-term WHO Representative assignment in Tajikistan (2019), and then in Armenia (2023-24). She has overseen the emergency health response to the recent Nagorno-Karabkah conflict, including WHO's support for the care of burn survivors who were caught up in the explosion at a fuel depot. Backed by a strong, predominantly female team, she ensures the continuation of the WHO Armenia Country Office's health programmes and development activities, while supporting much-needed mental health and psychosocial services throughout the country.

"It really gives me energy to work in this country team, to see their ambitions, to listen to their stories," she says. "It is a very complex country, historically and geopolitically. It gives me a buzz that every day is different."

She continues, "The role of a WHO Representative is very interesting - working closely with the ministry of health, supporting them in their activities. Working with health partners, other UN agencies, the interaction with donors. I like it very much."

After her assignment in Armenia, she plans to pursue her passion for increasing access to pain management, particularly in palliative care. She is also a mentor to young professionals, both male and female, drawing on her rich professional experiences to help them navigate their future careers with WHO.

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