Global Health Travel Blog

UNC Gillings students share their global field experiences around the world.

Life in Lusaka

I arrived in Lusaka, Zambia about three weeks ago, after a grueling 26 hours of travel, and jumped right into my internship with the UNC Improving Pregnancy with Progesterone (IPOP) Study. I spent my first week in the UNC Global Projects office familiarizing myself with the study and the issue of preterm birth in Zambiaand getting settled into my new accommodation and neighborhood. I am now working mostly in the University Teaching Hospital (UTH) to finish collecting and cleaning the datathat will be used to evaluate the cost-effectiveness of using progesterone during pregnancy as a way to prevent preterm birth among high-risk women.

UTH

It took me about a week to feel confident navigating the halls of UTH in Lusaka. A large hospital that also receives many transfer patients from other clinics, especially in the maternity ward where I am working. I recovered from my first day where I found myself locked in a bathroom for overthirty minutes before the door had to be broken in.This brought alot of laughter to the crowd of staff and patients that had gathered around the door to see if I would get outand is now one of my top embarrassing moments.Most of my time is spent in the NICU right now, observing preterm babies and recording allthe actions themedical staffperformto care for the infants,and the length of time spenton the care. There is a long list of activities we are following, including performing physical exams and setting up IVs to resuscitating babies and delivering oxygen. There are anumber of preterm babies in Zambia that never leave the hospital, these days are by far the most difficult.

The infants are regularly moved around and are difficult to keep track of and doctors and nurses are constantly in motion asI trail them with my notebook and timer. They work quickly and efficiently,movingvery much in sync. I am usually in awe with how effortlessly they move around each other, and me, in the often-crowded rooms. All of the staff are incredibly nice and accommodating andnever forget to start each day by saying “good morning” to everyoneandtheyare always willing to answer my many questions about the activities they are performing.It has been a great opportunity to not only learn more about the issue of preterm birth in Zambia but also about the local healthcare system more broadly.

Chaminuka National Park wildlife.

Outside of work there is plenty to do in Lusaka and around Zambia; so much that it would be impossible to see everything in the short ten weeks I am here. The winter weather here is very ideal and is a welcomed break from the North Carolina summer heat. Multiple national parks and animal nurseries are home to much of Zambia’s diverse wildlife, which the country is making a great effort to preserve. These are great day trips from Lusaka. I will soon be traveling to Livingston for a weekend to see Victoria Falls, one of the natural wonders of the world and a sight I hear is nothing short of amazing. In Lusaka, there are many restaurants and cafes serving food from all over the world. Local cuisine is heavily centered around nshima, a pounded white maize which is scooped up and rolled into a ball with your hands and eaten with different meats, beans and vegetables.

I have learned so much in the few short weeks I have been in Lusaka. Everyone has been incredibly welcoming and have quickly made me feel at home. I look forward to continuing to learn and collaborate throughout my internship and to see what life in Lusaka has in store for the next couple of months.

Chaminuka National Park.

-Taylor

Saludos desde Guatemala!

Saludos desde Calhuitz, Guatemala!  It’s nearing the end of a second week in the rural highlands of Huehuetenango.  For my practicum I am working with Curamericas Global and Curamericas Guatemala, who partner with the Guatemalan Ministry of Health to provide community-based maternal and child healthcare services, as well as basic health education, to remote areas which historically experienced high maternal mortality.  Over the years the project has constructed Casas Maternas, or birthing homes, which serve as clean, safe settings where women can elect to deliver according to cultural traditions, but with nursing supervision and referral to higher level care if needed.  The project also includes post-partum home visits for mother and child health, and community-run Care Groups focusing on women’s and adolescent health topics.

View from the walk to San Juan market.

The first week here turned out to be a more collaborative learning environment than anticipated, with the staff from the project’s three territories all coming together in Calhuitz for meetings and trainings.  A Haitian doctor from a potential partner organization presented on refining ultrasound interpretation skills for assessing potential pregnancy complications such as hydrocephalus, placenta previa, and placental abruption.  It was exciting to learn so much from his expertise in a health area unfamiliar to me, and then to immediately see these skills demonstrated during prenatal visits at the Casa’s clinic.  Another day focused on the project’s data management systems and future changes in reporting required indicators.  This presentation turned into an important opportunity for staff to share their perspectives on current challenges in their monitoring and evaluation systems, and to discuss their preferred strategies to improve the organization’s data and M&E capacities.

The following weekend, when most staff leave the Casa for their own homes, turned out to be a busy one for the Calhuitz Casa Materna with three births occurring.  It was remarkable to be in a setting where multiple new lives were beginning while simultaneously feeling so far removed from the rest of the world, and to witness a tiny newborn’s first cries while helping to dry and swaddle them.  As a nurse myself, it was humbling to recognize the variety of responsibilities and breadth of knowledge the staff here have in order to successfully run the Casas and programs.  The nurses are the primary providers and decision-makers during deliveries, with a doctor available via phone if necessary.  Role-shifting is clearly also an important strength, as the data manager and community educators have been quick to assist nurses with births or consults for pregnancy complications in the Casa.

As I focus on practicum-specific tasks centered around analyzing neonatal outcome data and staff focus groups on managing neonatal complications, I’ve been reminded of key lessons applicable to public health work in general and perhaps particularly to global work.  Challenges in locating and accessing data needed—not to mention understanding the organization of a new data system as a whole—have made me check my own assumptions about how much time certain work “should” take and the ease with which information “should” be available.  Being so used to having information at my fingertips via the internet and digitalized charting systems, I forget that that is a luxury.

Got internet? For internet, the prime office space is the roof.

The importance of understanding the perspectives of local health workers and their work-loads has also been re-emphasized.  Gaining more background knowledge of prior project changes, expansions, and funding has allowed me to better comprehend the work and program goals through staff’s eyes.  These conversations lead to a greater understanding of the challenges and power dynamics in global health work and the importance of maintaining a decision-making process based upon beneficiary impact.

I look forward to further learning and collaboration as my practicum continues, and am grateful that the staff here have been patient, open, and welcoming.  In the next couple weeks we will be traveling to other Casas in the region for data collection, focus groups, and home visits.  I am sure to continue enjoying the simple pleasures of life here—such as the staff’s sense of humor, fire-fueled hot showers, and the best homemade salsa I’ve ever had—and will be curious to see how the terms “communication” and “planning” continue to take on new meanings in new contexts.

– Emily

The Path You Must Take

4 a.m., May 24th, I began my approximately 18-hour long journey to Lusaka, Zambia. I had already begun to strategically think about which flights I was going to nap on and what shows to watch during my layovers. However, as life so often entails, I was not prepared for the unexpected curveballs that came my way on this journey.

From RDU Airport, my flight was intended to go through Washington Dulles International Airport to then Bole Airport in Addis Ababa, Ethiopia to then Lusaka via Ethiopian Airlines. What was meant to be a 4-hour layover in Washington Dulles International Airport turned out to be an 8-hour layover, causing me to miss my connecting flight from Addis to Lusaka.

While this sounds like a dreadful, prolonged awful story to my destination this was perhaps one of the best detours that could have ever happened in my life.

I am a first-generation American with my family’s countries of origin being Ethiopia and Eritrea. My family fled to the United States as asylum seekers in the early 1990s due to the communism uproar that had occurred in Ethiopia known as the Derg regime. Since then, most of my family have not returned back home either due to their family moving, passing away or due to fear of political persecution until recently with our most current change in our Prime Minister, Dr. Abiy Ahmed. That said, a country that I had felt so connected to by blood and spirit, that had driven me to pursue a career in public health and that had even led me to pursue an opportunity to work on my continent through the Zambia-Hub, was a country I had never been to for these reasons.

Effoi Pizza Restaurant in Addis Ababa, Ethiopia

Effoi Pizza Restaurant in Addis Ababa, Ethiopia.

Ethiopian Airlines was accommodating enough to provide me and the many others who had missed our connecting flights a free-stay at the Zola International Hotel overnight, and since I had a good friend of mine (thanks Meki!) staying in Addis for a fellowship, I reached out to her to experience as much as I could in an evening/night.

I perhaps slept a max of 1.5 hours that night (and yes I thoroughly enjoyed it!) and then arrived to Bole Airport to depart to Lusaka. The flight I was redirected to had an additional connection in Harare, Zimbabwe which was brief but also an interesting experience to observe and bask in.

Once I finally arrived in Lusaka (2.5 days later) I was exhausted but had felt so invigorated to experience the unexpected just on my way here. Moreover, once I had arrived in Lusaka I found out my neighbors were Ethiopian and was immediately (as in 30 minutes upon arrival to Lusaka) invited to a baby shower where I was fed full and met a community I could feel a part of while staying here.

The baby shower in Lusaka, Zambia

The baby shower in Lusaka, Zambia.

The African continent has always felt like home to me, but I must say Lusaka has surely welcomed me with open arms.

This has only been my first week in the office and I am super excited to begin working on some of the Standard Operating Procedures (SOPs) for the MP3 Study. One of my first tasks will be creating a SOP and training materials for the HIV self-testing kits used in this project and familiarizing myself with the REDCap platform which is being used to store our program data.

I can only imagine what other surprises Lusaka has in store for me and the impact I will be making with my work here because, as per my journey, it is clear that this was the path I was supposed to take.

-Rebekah

FAMLI already feels like FAMILY

As we walked through the UNC Women’s hospital doors last week, we were excited to be back in the clinical setting, but this time in a different capacity, as interns on the Bill and Melinda Gates Foundation funded Fetal Age and Machine Learning Initiative (FAMLI).

The Fetal Age and Machine Learning Initiative is a collaborative project being conducted by the UNC Global Women’s Health Division, NC State University and the University of Zambia School of Medicine. The overarching goal of the project is to develop a robust, inexpensive, widely deployable ultrasound device that can assess gestational age and other important obstetric conditions while requiring minimal operator skills.

We were welcomed by our preceptor and a friendly team of sonographers and researchers.

L-R: Dr. Rosenbaum (Preceptor), Munguu, Enam, Arieska (Sonographer) and Stephanie (Research Assistant)

L-R: Dr. Rosenbaum (Preceptor), Munguu, Enam, Arieska (Sonographer) and Stephanie (Research Assistant)

This summer, as interns, we will be contributing to this project by annotating ultrasound images that can be used to train machine learning algorithms to correctly assess gestational age and other diagnoses. Our experience will enable us to learn to properly identify and annotate ultrasound images of fetal parts, and assist in building a system that will help future annotators learn similar skills and perform the annotation tasks consistently.

Enam practicing reading ultrasounds.

Enam practicing reading ultrasounds.

Finally, we say this feels like family because we have a unique advantage of meeting with the team both in-person and virtually, and participating on conference calls that involves a diverse interprofessional team such as clinicians (OB/GYN, RN, sonographer), research staff (research assistants, managers), data managers, financiers (Gates Foundation), and collaborators (engineers and N.C. State and Google).

Watch out for future blog posts focusing on the second part of our internship where we get to travel and meet the team all in the way in Lusaka, Zambia!

-Enam and Munguu

Geneva, Switzerland!

Pont du Mont Blanc, Bridge Crossing Lake Geneva.

Greetings from Geneva, Switzerland! This summer my practicum is with the headquarters of the Migration Health Division (MHD) at the International Organization for Migration (IOM). It has been an eye-opening experience as I get the phenomenal opportunity to learn and contribute daily to the formulation of institutional policy, guidelines and strategy, quality-control, and oversight of migration health services globally. The health services conducted aim to meet the needs of States in managing health-related aspects of migration, and to promote evidence-based policies and integration of preventive and curative health programs that are beneficial, accessible and equitable for vulnerable migrants and mobile populations.

IOM Headquarters

Since my first week being here, which was last week, I have had the opportunity to assist with planning and implementing a three-day intensive Global Health Training for internal and external partners of the division. The training was conducted to inform and build a better understanding about ongoing policy developments and start thinking of strategic priorities the MHD would like to focus on in the years to come to address migrant health. In addition to assisting with the training, I am in the process of working on a policy brief on international health worker migration with my preceptor. This policy brief is a joint effort between IOM and the World Health Organization, and I have the honor of working on the first draft. In all, I am super excited about what is still yet to come while interning with IOM through the end of July.

If you are interested in learning more about the leading inter-governmental organization of migration, check out the short yet concise video below.

-Fatima Guerrab

Oh the places Gillings School students are going!

We are back for another summer of blogging!

We have 14 students blogging from 10 countries! Thanks to generous donors,  these students received travel funds to put what they’ve learned in the classroom into practice.

Follow our blog this summer to hear firsthand from our students about what they are working on and how their global experiences are going!

Now an introduction to our new bloggers and their thanks to donors for the opportunity to receive funding for their global practicum:

Hunter Davis – Exploring the social and emotional impact of living with Type 2 diabetes  among adults in the Galapagos

“I’m so excited to be using this funding to return to a country where I have spent a formative part of my life and made so many friends and connections. I have lived in the Amazon of Ecuador, the Andes, and now will be able to live in the Galapagos for a time. Ecuador is one of my passions, and I’m so grateful that thanks to the Global Practice Award I am able to continue learning about a new part of the country and culture I have grown to love. This has also allowed me to work with an incredible research team and learn from Dr. Clare Barrington, an expert in qualitative research, about the process and expectations for qualitative research.”

Fatima Guerrab – International Organization for Migration in Switzerland

“Being selected for a Global Practice Award has opened up many doors and removed many barriers. With these funds, I will be able to work with a leading United Nations agency and learn how to tackle the most pressing policy challenges on a global scale.”

Krista Scheffey – UNC-Wits-Right to Care Partnership for Cervical Cancer Prevention in South Africa

“This funding is incredibly helpful. There are a lot of upfront costs associated with going to South Africa, and knowing that I have this funding is hugely helpful as I make those preparations. Receiving funding has also helped me focus on being a student without worrying about financing my practicum. For a while I wasn’t sure if I was going to be able to go abroad, but ultimately I was able to choose a practicum that really aligned with my interests. I’m grateful for ​financial support to pursue this opportunity.”

Nicole Gonzalez – Health Future Program in China

“I feel really lucky to be selected for the Global Practice Award. My practicum would not have been possible without this funding. I would have had to take out loans if I did want to pursue this practicum. It’s definitely really helpful. I’ve always wanted to work in Asia, and it’s one of my careers goals. This is really meaningful and I feel privileged to have been awarded this money.”

Kay Schaffer – Curamericas Global in Guatemala

“Being able to work and travel abroad is really a privilege and having this financial support is going to enable me to do that. Working abroad in public health is something I’ve seen colleagues do and has been a dream of mine to actually get to do myself. This money is really meaningful to me and is going to make this experience possible. I’m excited for my practicum, as maternal mortality prevention has been an interest of mine, but getting to see how it is practiced in the field with vulnerable populations from different cultural backgrounds is going to be really informative to my education and allow me to bring best practices back to the Chapel Hill community.”

Yovania Dechtiar – Gender Links in Mauritius

“Receiving this funding is an incredible opportunity for me as it allows me to give back to my home country! I am excited to go back home and to use knowledge and skills that I developed in recent years and learn how to adapt them within the context of Mauritius. I will be working with Gender Links, an NGO that strongly advocates for the advancement of women. I left Mauritius since I was 18, mostly oblivious of the challenges that women face. As I have grown and developed into a woman myself within the North American context, I have often reflected on what being a woman means within the Mauritian context. I am especially grateful that the funding will allow me to better understand the realities of the Mauritian women and contribute to her advancement.”

Dana Corbett – Curamericas Global in Kenya

Dana Corbett“When I found out that I received the Global Practice Award to support my practicum, I felt an enormous amount of relief! I am so grateful for the generosity of funders so that I can prepare for and fully embrace my practicum in Kenya without being overly-concerned about finances.”

Erin Case – Save the Children in Washington, D.C.

“Receiving the Global Practice Award for my practicum with Save the Children allows me the space to truly focus on my work rather than worrying about working a second job. Knowing that I have the funding means I can put all of my energy into my work, take on additional projects, and professional development opportunities at Save the Children that will help me build towards the career that I want.”

Emily Berns – Curamericas Global in Guatemala

“Receiving the Global Practice Award is a major support and encouragement in accepting a practicum that excites me, develops a variety of public health skills, and offers the privilege of collaborating in new community and cultural contexts. It shows how the school and alumni value our opportunities and ambitions to engage in meaningful global health work.”

Casey Watters – National University of Ireland – Galway, Health Promotion Research Centre & WHO Collaborating Centre for Health Promotion in Ireland

“Receiving the Global Practice Award is incredibly meaningful. It has allowed me the opportunity to focus on my work in adolescent mental health while gathering the necessary quantitative evaluation skills for my continued career in global public health—and I couldn’t do that without this incredibly generous funding.”

UNC Gillings Zambia Hub students:

Gillings Global Hubs are meant to increase students’ skills, faculty opportunities and the Gillings School’s impact.  A consistent presence at particular sites, working with a select group of partners, allows us to provide quality experiences and deliver on strategic themes to improve public health. We are pleased to have the first cohort of students in the Zambia Hub this summer and blogging!

(L-R) Munguu, Enam, Taylor, and Rebekah

(L-R) Munguu, Enam, Taylor, and Rebekah

Enam Aidam – Chapel Hill, North Carolina and Lusaka, Zambia

“This practicum grants me the unique opportunity to meet, work and learn from the amazing team of researchers, clinicians and technicians working to advance women’s health in Zambia and other low and middle income countries. Additionally, I will benefit from their guidance and mentorship to publish what will be my first scientific paper!”

Taylor Craig – Lusaka, Zambia

“I am so excited to live in Zambia this summer and work on a cost-effectiveness analysis for the Improving Pregnancy Outcomes with Progesterone Study within the Zambia Hub. I am grateful for this wonderful opportunity and I am looking forward to all I will learn.”

Munguntsetseg Khuyag-Ochir – Chapel Hill, North Carolina and Lusaka, Zambia

“I am so excited to be an intern in the Zambia Hub FAMLI project this summer. I think  the Zambia FAMLI project will help me gain real-life maternal and child health practical experience in a global setting. I am sure that interning in the Mothers and Newborn hospital in Lusaka, Zambia will be a great experience for me to learn about challenges and solutions of global maternal and child health problems. I have two goals this summer. First, to gain more knowledge about implementation science and management skills of global public health programs. Hopefully, I will have opportunities to explore more about Gates Foundation projects. Second, I wish to improve inter-professional communication and collaboration skills, which are main competencies of a MPH degree. I am sure that during this internship I can strengthen these skills from senior public health, medical and other professionals in the Zambia Hub.”

Rebekah Daniel – Lusaka, Zambia

“This past semester I have delved deeper in exploring HIV prevention of mother-to-child transmission (PMTCT) interventions and am extremely excited to apply my background knowledge and course work in this topic in a real-world setting. Additionally, since I have an interest in monitoring and evaluation (M&E) work, being able to hop on board during the process stage of the Methods for Prevention Packages Program (MP3) has allowed me to monitor and review validated data collection instruments which are a great way for me to begin applying the M&E skills I hope to foster as a public health professional. Last but not least, I am truly excited to be in Lusaka, Zambia this summer! There is always something so invigorating and eye-opening when you leave your comfort zone and step into a setting you may not be as familiar with!”

 

¡Saludos desde Montevideo!

Greetings from Montevideo, Uruguay! This summer my practicum is with the Pan American Health Organization (PAHO), more specifically their Center for Latin American Perinatology and Women’s Reproductive Health (or in its more efficient Spanish acronym, CLAP/SMR). While PAHO is headquartered in Washington DC, the CLAP/SMR office is home to the region’s MUSA data base (the Spanish acronym for “women in situations of abortion”), which compiles data from 40 sentinel health centers across 13 countries in Latin America. (You can check out a quick video about MUSA here: https://www.youtube.com/watch?v=wxqt01BTQ6E).

Cheesin' in Montevideo overlooking Pocitos Beach.

Cheesin’ in Montevideo overlooking Pocitos Beach.

PAHO’s Perinatal Information System (SIP) maintains a wealth of data regarding maternal and neonatal health outcomes, including a specific database, SIP-A, that is dedicated to clinical information about abortion, miscarriage management, and post-abortion care. Unsafe abortion, while completely preventable, is one of the leading causes of maternal mortality globally, and contributes to 13% of maternal deaths in Latin American and the Caribbean. At the 40 sentinel health centers across the region, whether a person is accessing a legal abortion, seeking medical treatment following an unsafe abortion, or experiencing a miscarriage, their clinical and sociodemographic data will be collected in SIP-A. These data include the presence of any complications, a near miss or maternal death, as well as whether or not a pregnancy was planned, whether the pregnancy was a result of a contraceptive method failure, and whether the person begins a contraceptive method as part of their post-abortion care. My practicum this summer is focused on analyzing data from SIP-A.

In the office with Dr. Suzanne Serruya, director of CLAP/SMR.

In the
office with Dr. Suzanne Serruya, director of CLAP/SMR.

Thus far, I’ve had the chance to sit in on a meeting with the Uruguayan Ministry of Public Health and CLAP/SMR staff in order to see how SIP-A works with the Uruguayan health system’s protocols around abortion and miscarriage. As one of the only countries in the region where abortion is legally available without restriction as to reason (the other two are Cuba and Guyana), Uruguay provides a unique context both for my practicum and for working with the data in SIP-A. Using this regional database, I’ve been analyzing contraceptive counseling and service provision as a part of post-abortion care. This includes looking at what type of contraceptive method patients request, as well what methods doctors provide. Depending on the context, these contraceptive methods may include long-acting reversible contraceptives (LARCs), or other methods, such as pills, injectables, or sterilization.

As I wrap up my time in Montevideo, it is now clearer to me than ever before how important accurate data is in making informed public health decisions. Working alongside experts in reproductive health, research, epidemiology, and medicine over the past few weeks has been an incredible way to see how bringing together a wealth of perspectives and approaches can be used to improve health at every level, whether it is a patient-provider interaction or a region-wide policy change.

-Mallory

Learning from the best

Team photo at grant writing workshop.

Team photo at grant writing workshop.

Since my last blog post, I have jumped into the deep end of process evaluation. Shifra used a human centered design methodology to create their app. (As a reminder- Shifra uses mhealth technology to connect refugees, migrants, and asylum seekers with sexual and reproductive health services in Melbourne, Australia) Human centered design prioritizes empathizing with the end user and getting a deep understanding of their lived experience, designing solutions that arise from the insights gained through empathy exercises, and then prototyping those solutions with the target population. However, most evaluation work has focused on evaluating the solutions generated rather than the process itself. In exploring how to evaluate whether Shifra engaged in a true human centered design process, I did a lot of research and talked with experts in the field including public health professors at UNC and design experts at Monash University in Melbourne.

Enjoying a sunset at the Port Campbell National Park along the great ocean road.

Enjoying a sunset at the Port Campbell National Park along the great ocean road.

I ended up creating a checklist of requisite steps involved in a human centered design process and interviewed refugee end users, developers, and subject matter experts who all contributed to the creation of the app. My next step is to review Shifra’s records to help me understand the process and the steps they took. Then I’ll analyze the interviews to help me understand different co-designers’ experiences creating the app. Finally, I’ll synthesize the results and write up my findings. (Hello master’s paper!)

Team farewell dinner.

Team farewell dinner.

Throughout this evaluation process, I have been so impressed by Shifra staff’s openness and desire to learn from their experiences. They truly adopt several mindsets of human centered design: to learn from failure, embrace curiosity, and stay optimistic. I am so thankful for the chance to learn from this organization and I look forward to staying in touch with them in the future. 🙂

Snuggling a 2 year old baby kangaroo at an airbnb along the great ocean road.

Snuggling a 2 year old baby kangaroo at an airbnb along the great ocean road.

-Jess

 

Heading Home

Back entrance of Bundung MCH Hospital.

The conclusion of my UNFPA The Gambia internship has crept up on me. In the process, I have become very attached to, what some of my UNFPA colleagues affectionately refer to as “[my] second office,” Bundung Maternal and Child Health (MCH) Hospital. The tentatively named Male Change Agent Initiative we have been working on has become fellow UNFPA summer intern, Jalang, and I’s blossoming project. We have dedicated much of our remaining time developing a concept note that considers the multiple factors involved in replicating Bundung MCH Hospital’s current male engagement clinic at other facilities. Since our first attendance at the hospital’s male clinic, we have participated in each weekly discussion-style session to observe how UNFPA could increase the current clinic’s capacity while preserving the elements that make it successful. It was also critical that the overall objective of encouraging men to be more involved during their wives’ pregnancies was not lost within any potential changes or improvements.

Man with baby at Bundung MCH Hospital following a male clinic. There were concurrent antenatal and postnatal visits occuring.

Man with baby at Bundung MCH Hospital following a male clinic. There were concurrent antenatal and postnatal visits occuring.

First Lady of The Gambia (center), fellow intern Jalang (right), and I (left) taking a quick selfie before the First Lady departs from Bundung MCH Hospital.

First Lady of The Gambia (center), fellow intern Jalang (right), and I (left) taking a quick selfie before the First Lady departs from Bundung MCH Hospital.

The work at Bundung has been receiving much-deserved recognition for the implementation of the male health talk clinic. The Minister of Health and Social Welfare (MoHSW) and First Lady of The Gambia made a joint appearance at the hospital, along with the Global Alliance for Vaccines and Immunizations (GAVI) media team, to observe the initiated clinic and speak with families present. Prior to the event, Jalang and I were introduced to two representatives from the Gambia’s Extended Programme for Immunization (EPI), one of UNICEF Gambia’s governmental (i.e. MoHSW) implementing partners focusing on ensuring the timely vaccinations of Gambian children. The representatives were informed of UNFPA’s existing male involvement concept note and were interested in integrating childhood immunizations into the clinic talks and overall initiative. This has led to the Male Change Agent Initiative becoming a partnership between the MoHSW, UNICEF, UNFPA, and Bundung MCH Hospital.

Male clinic initiative meeting between UNFPA, EPI, Bundung MCH Hospital, and UNICEF to discuss a future partnership and changes to be made to the concept note (I am at the bottom right corner).

Minister of Health, Dr. Isatou Touray, arriving at World Population Day commemoration.

Minister of Health, Dr. Isatou Touray, arriving at World Population Day commemoration.

It has been interesting watching the project gain magnitude and essentially have other agencies “buy in” to the significant role that males play in not only improving maternal health, but child health as well.  The increased stakeholders in this project will allow for an increase in financial resources to implement male clinics in many other facilities around The Gambia. I intend to continue contributing to the project as it becomes a finalized proposal, and later, implemented initiative. Though male involvement became my internship focus towards the end, I have simultaneously ensured that I gained additional experience in other work that UNFPA supports. Experiences have included monitoring and evaluation treks to other facilities, trainings of community health workers on a variety of topics, and a march to celebrate World Population Day.

A representative of Gambian Family Planning Association (GFPA) setting out contraceptives during World Population Day events

To say that I have simply enjoyed working at a wonderful organization would be an understatement.  I have greatly appreciated the opportunity to observe and learn from such highly qualified and passionate mentors. Here’s to hoping (as UNFPA mandate goes) that we all continue working towards a world where “every pregnancy is wanted, every childbirth is safe, and every young person’s potential is fulfilled.”

-Fanny

Enjoy some pictures:

One of the marchers at the World Population Day event held on July 11th.

One of the marchers at the World Population Day event held on July 11th.

Me holding a mother’s baby. The mother was present for her well-child visit while watching the First Lady's interview with media outlet.

Me holding a mother’s baby. The mother was present for her well-child visit while watching the First Lady’s interview with media outlet.

(from l-r) My preceptor, Lamin Camara-Programme Analyst for Youth and Adolescents, fellow intern Jalang, me and UNFPA Country Representative attending the wedding UNFPA Programme Analyst-Communications.

(from l-r) My preceptor, Lamin Camara-Programme Analyst for Youth and Adolescents, fellow intern Jalang, me and UNFPA Country Representative attending the wedding UNFPA Programme Analyst-Communications.

 

Exciting month in Uganda!

It has been an exciting month for the Sayana Press team in Uganda – and, tangentially, an exciting month for me!

The PATH vehicle parked in the staff quarters at Kityeyera Health Center IV, Mayuge district.

The PATH vehicle parked in the staff quarters at Kityeyera Health Center IV, Mayuge district.

After successfully launching a nationwide scale up of the provider-injected Sayana Press drug in 2016, the PATH team has been focusing on introducing self-injection. After several months observing self-injection in four target districts, the team set out to conduct an evaluation with the goals of, 1) finding out whether self-injection is working for women in rural areas and 2) learning which variation is most cost-effective.

I joined the team as they were wrapping up their first phase of the evaluation: interviewing the providers who were training women to self-inject. In the second half of my internship, we were busy preparing to launch the second half of the evaluation: interviewing users themselves. Throughout both phases, the team also facilitated monitoring visits at each site to support the field teams. It turns out, starting when I did was a perfect time! I was able to observe the launches of both phases as well as join the team in the field for monitoring visits and jump in on some trainings.

Kirsten holds a case of Sayana Press to be delivered to field sites in Mayuge district.

Holding a case of Sayana Press to be delivered to field sites in Mayuge district.

The PATH vehicle loaded up with cases of Sayana Press for delivery.

The PATH vehicle loaded up with cases of Sayana Press for delivery.

One of the trainings was conducted in July. I joined the team’s Scale-Up Manager, Edson Twesigye, to travel to Mayuge district in Eastern Uganda to orient new providers to the program and “train the trainers” in self-injection. We visited two facilities, Kityeyera Health Center IV: a bustling, district-level referral clinic/hospital, and Muggi Health Center III, a sleepier, more rural center still serving a fairly large population. Observing how Edson facilitated the training sessions offered a lot of insight into PATH’s training methodology, and I enjoyed the chance to also facilitate my own sessions as well. I spoke to the groups about the procedure for using the self-injection register, a reporting tool developed by the team to ensure accurate data collection. The team had found in other sessions that the register was sometimes confusing for providers and was being filled improperly, particularly a few vital questions. I enjoyed the chance to discuss their challenges with them and we were able to clarify several key points. This exercise was an informative opportunity to improve my understanding of data collection tools, especially as we focused on data entry at the point of service delivery.

Conducting a training session with self-injection providers. (From left: Kirsten Miner, Violet Asiimwe, Lydia Namuganza, and Jaliya Nabirye.)

Conducting a training session with self-injection providers. (From left: Kirsten Miner, Violet Asiimwe, Lydia Namuganza, and Jaliya Nabirye.)

A key component of training is reviewing and practicing the self-injection procedure with each training team. Self-injection is a 10-step process which is led by a “job aid” – a series of pictures, each with a corresponding instruction, that guides a user through prep up to completion of the injection. There are four critical steps: mixing the solution by shaking the vial, activating the device, pinching the skin at the injection site (abdomen or thigh) to make a “tent”, and then pressing the reservoir slowly to inject the drug. It was exciting and illuminating to watch the training team in action!

Research Assistant Violet Asiimwe makes a model using a condom and salt which is used to simulate an injection site for a training.

Research Assistant Violet Asiimwe makes a model using a condom and salt which is used to simulate an injection site for a training.

After returning to Kampala from Mayuge I joined the team in completing our remaining duties to prepare for Phase II of the evaluation: client survey administration. This training offered even further opportunities for observation, learning and practice. Overall, I had an amazing internship with the PATH team in Uganda. I look forward to following the Sayana Press project further and delving into the results of the evaluations!

-Kirsten

 

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