Global Health Travel Blog

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

Month: June 2018

Greetings from Australia

Sara, Rebeccah, and me.

(L-R) Sara, Beccah, and me.

Let me start by telling you a bit about the organization I’m partnering with and the work they do. Shifra is an NGO in Melbourne, Australia dedicated to increasing access to sexual and reproductive health services for refugees, migrants, and asylum seekers through the use of an app. Shifra was started by a Gillings alum, Beccah Bartlett, and is the only organization addressing this need in this way in the world. When refugees, migrants, or asylum seekers come to a new country, they often have a hard time accessing the resources that are available to them due to language barriers, an unfamiliarity with the host country’s health system, and unawareness about their rights as a patient- such as the right to ask for a translator. This is even more true when the health needs are sensitive, such as questions about contraception and pregnancy. The app allows women to access the information they need, whenever they need it, in their own language. It launched about a year ago and is currently available for Arabic speaking women in Melbourne.

Strategizing

Strategizing

When considering my options for a practicum this summer, I was drawn to working with a small organization because I would have the chance to practice a number of different public health skills. This has certainly proven true! In the two weeks that I’ve been on the ground, I have been a part of key partner meetings, evaluating existing resources, developing marketing materials, and laying the groundwork for a process evaluation that I’ll be completing during the rest of my time here.

My main project is evaluating Shifra’s use of human centered design to create the app. I love this project since systems and design thinking has been my favorite class at Gillings! While it is exciting to be on the cutting edge, it also requires a lot of cross-disciplinary research to learn how human centered design has been used with refugees, how it has been used with mhealth interventions, and how it has been used to address sexual and reproductive health needs. In the coming weeks, I’m looking forward to speaking with refugee co-designers and learning more about their experiences with the co-design process.

-Jess

Salaam aleekum from ‘The Smiling Coast of Africa!’

Women and their babies present at a health talk about fistulas at Sinchu Baliya Health Post.

Women and their babies present at a health talk about fistulas at Sinchu Baliya Health Post.

I am more than half way through my internship with United Nations Population Fund (UNFPA) in Cape Point, The Gambia. UNFPA does amazing work in the areas of family planning, sexual and reproductive health (SRH), gender-related issues (e.g., early marriage, FGM, GBV) and HIV prevention. They are currently working to accomplish the objectives of their Strategic Plan 2017-21. During my first few weeks, I participated in a sensitization campaign for obstetric fistulas on International Day to End Obstetric Fistula. UNFPA went to the Bundung Maternal and Child Health Hospital, a public hospital under the Ministry of Health and Social Welfare, and Sinchu Baliya Health Post, both facilities that garner a large population of pregnant women attending antenatal care (ANC) visits. During the event, messages regarding symptoms and treatment options for fistulas were delivered in three local languages (Wolof, Mandinka, and Fula) to accommodate for the group present.

UNFPA Programme Analyst for Family Planning Commodity Security, Mr. Alieu Jammeh, giving a health talk on fistulas at Sinchu Baliya Health Post

UNFPA Programme Analyst for Family Planning Commodity Security, Mr. Alieu Jammeh, giving a health talk on fistulas at Sinchu Baliya Health Post

Due to the lack of available data on fistulas in Gambia, UNFPA is hoping that the sensitization campaign will produce a fistula count of women who have the condition. By lifting the stigma and encouraging women to sympathize with affected women, hopefully more women will seek treatment and get registered through the fistula count camp. One of the most valuable lessons that I have been lucky enough to learn is how to deliver culturally sensitive messages and cater to the communities you are trying to serve.

UNFPA's National Coordinator for FGM and Gender speaking with men at Bundung MCH Hospital's weekly male clinic.

UNFPA’s National Coordinator for FGM and Gender speaking with men at Bundung MCH Hospital’s weekly male clinic.

This observation was made at a weekly male engagement clinic that Bundung MCH Hospital initiated back in 2012. The session is a discussion style program with men whose wives (or significant other) attended an ANC visit that week. These men are contacted via SMS and/or phone calls and encouraged to attend the clinic. Men who accompany their wives to ANC visits are given priority and allowed to bypass the long visit lines as incentive for their participation. Bundung’s investment in male involvement has inspired UNFPA to pilot similar programs in other organization supported facilities across The Gambia. I am currently co-writing a concept note that implements a pilot project strengthening Bundung’s male clinic and eventually developing a standardized programme to be applied to other health facilities.

Me (right) and fellow UNFPA intern at Gambia Family Planning Association (GFPA).

Additionally, since UNFPA works through Implementing Partners (IPs), I have been able to observe the operation of these organizations, including the challenges they encounter in fulfilling their goals. There are so many organizations in Gambia that are working to empower women and girls, including Think Young Women, a mentorship programme that is one of UNFPA’s Youth and Adolescent IPs. During the next couple weeks, I will be diligently laying the foundation for the pilot male clinic initiative and going on four-day upcountry visits to the more rural facilities. Since Bundung is a public hospital that began with funding, it will be an opportunity to compare rural vs. urban facilities and ways that male clinic would be incorporated while considering the existent financial situation of the facility. I’m a little sad that the weeks are going by so fast, but I feel a deep sense of gratitude for all the exposure I’ve been getting. Can’t wait to share more experiences!

-Fanny

Unequal Immigration

Karla.

As a 25-year-old, I naturally have not thought much about my retirement, much less where I would live if I ever were to retire. My practicum experience has forced me to think deeply about what it means to be retired and to be a contributing member of society, but it’s become complicated with the concept of immigration. I’m currently working on a study funded by the National Geographic Society to explore the impact American and Canadian immigrant retirees might have in Latin America. We are specifically studying how waves of retiree migration in two colonial cities are simultaneously changing healthcare systems, land uses and real estate practices, and social dynamics. It has only been a week and half in the field and the work is even more complex than I anticipated.

A church in Cuenca's historic district.

A church in Cuenca’s historic district.

Our first city is Cuenca, Ecuador—a UNESCO world heritage site located in the Andes in Southern Ecuador. There are estimates that anywhere between 8,000-10,000 retired expats are living in Cuenca, potentially making up about 1% of the population. Before arriving to Cuenca, I had the assumption that this small retired expat population had high financial and social capital that contributed to major changes in housing (and displacement) through price inflation in the past decade. To an extent, there is some truth there. However, our preliminary data are portraying a complicated story affected by a growing population of returning (or deported) Ecuadorians from the U.S.A. and Europe, and Venezuelan refugees. These three types of migrants (Ecuadorians, Venezuelans, retired expats) have provoked conjoined public sentiments about immigration and how they are all affecting life in Cuenca. No stakeholder really seems to agree on much except that at least one of these immigrant groups is partially responsible for the sustained economic struggle.

One of Cuenca's campaign materials outlining the city's cultural identity and values.

One of Cuenca’s campaign materials outlining the city’s cultural identity and values.

My feelings about this topic are muddled by my background as a Venezuelan American, who is frequently hearing xenophobic remarks about Venezuelans immigrating to Ecuador to steal jobs, commit crimes against natives, and overuse social services. It is always disorienting to think that these comments are heard all over the world against neighboring groups of people. Not surprisingly, this project has become fairly political the deeper we dive into it and how the results compare to our second stop: San Miguel de Allende, Mexico. We will find out soon.

The research team.

The research team.

Large-scale redevelopment in the historic center, where the City is building a tram to connect certain parts of the city to the airport.

Large-scale redevelopment in the historic center, where the City is building a tram to connect certain parts of the city to the airport.

More redevelopment.

More redevelopment.

-Karla

Greetings from Ghana…and Togo?

MAZA tricycles at the Bunkpurugu Health Center.

MAZA tricycles at the Bunkpurugu Health Center.

One of my biggest motivations in pursuing a public health career and degree is the opportunity to contribute to the existing efforts across the country to improve maternal, infant, and child health in the nation. MAZA has afforded me this opportunity with this summer practicum. MAZA is a social enterprise that provides safe, accessible, affordable and reliable transportation for urgent and emergency health care needs in remote rural areas of Ghana, with a focus on pregnant women and sick infant. They lease motorized tricycles to local drivers at a discounted price in exchange for their being on call for urgent/emergency health care transportation twice a week. For the other five days of the week, the drivers use the tricycles as taxis to earn a living and pay a weekly fee to MAZA. After two years, they own the tricycles outright. MAZA’s service is available 24 hours a day, seven days a week through a toll-free number or by direct contact with the local drivers.

A community in the Bindi Subdistrict of the Bunkpurugup Yunyoo District.

Another community in the Bindi Subdistrict of the Bunkpurugup Yunyoo District.

A community in the Bindi Subdistrict of the Bunkpurugup Yunyoo District.

A community in the Bindi Subdistrict of the Bunkpurugup Yunyoo District.

MAZA has been in the Bunkpurugu-Yunyoo District for a year now and has provided transportation during emergency/urgent health care needs for over 200 passengers since. My practicum is a field assessment focused on exploring the geographical limits of MAZA’s intervention in the Bunkpurugu-Yunyoo District. My first week in the Northern Region was spent in the field in Bunkpurugu-Yunyoo collecting location data of MAZA drivers and passengers to investigate the distance between drivers commute to pick up passengers and take them to a health care center during emergencies. Working in this part of Ghana – rural, open, bright, unlike what I’m used to in the capital city of Accra – has been nothing short of exciting.

about to cross the river behind me into Togo. The river acts as a physical boundary between Ghana and Togo in one of the communities in Bunkpurugu.

About to cross the river behind me into Togo. The river acts as a physical boundary between Ghana and Togo in one of the communities in Bunkpurugu.

Little did I know there are communities in this part of the country, that have existed for decades, are now divided by superficial international border lines delineating Ghana from Togo. There are literally families living in the same community with one family’s house in Togo and the other in Ghana. Wild right? That’s one of the most fascinating things I’ve encountered here. As such, there are families technically living in Togo that have benefited from MAZA’s services because they are a part of a community that is also Ghanaian and visit the health facilities in Ghana.

This week, I go back to the rural areas for the second part of the project – community assessment. Looking forward to sharing those experiences with you all.

 

-Edith

Muli bwanji?

Lone tree in the fields in the edge of town

Lone tree in the fields in the edge of town

Muli bwanji? In Malawi you hardly ever have an exchange without asking the other person how they are, and you can be sure you’ll always be asked back. The country is known as “The Warm Heart of Africa,” and all who visit have the opportunity to confirm this statement. Since 1990, it has hosted the UNC Project-Malawi (UNCPM), a collaboration between UNC Chapel Hill and the Malawi Ministry of Health. It is located on the campus of Kamuzu Central Hospital in the capital city of Lilongwe. The project’s mission is to identify innovative, culturally acceptable, and affordable methods to improve the health of the people of Malawi, through research, capacity building, and care. The scope of activities has diversified since then.

Lake Malawi on a Monday afternoon

Lake Malawi on a Monday afternoon

UNCPM New Annex Building

UNCPM New Annex Building

Before I moved to North Carolina and started the MPH program in the department of Health Behavior, I lived in Lilongwe from 2013 to 2016, working for the Brazilian Ministry of Foreign Affairs. In 2015, I met my wife when she was working at UNC Project-Malawi and because of her research in pediatric oncology we have kept in contact with the project since we moved. This summer I was fortunate enough to join the project to work on a research study called, “Mother Infant Retention-Promoting Mother Infant Retention along the HIV Care Continuum: A Comparative Effectiveness Evaluation of Three Models for Community Facility Linkage.” The study’s goal is to characterize widely adopted community-facility linkage models and assess the impact on mother-infant pair care retention and the Prevention of Maternal-to-Child Transmission (PMTCT) of HIV under “real world” conditions in Malawi.

Panoramic View of the Area 25 District Health Center

Panoramic View of the Area 25 District Health Center

My participation in the study involves a literature review describing issues of HIV linkage to care during the Universal Test and Treat area in Sub-Sharan Africa and other high-burden settings. The review should be published in a special supplement about linkage to care in the AIDS and Behaviour journal, and I will be included as one of the co-authors of the article. For the past week, I have been accompanying the study team during their last data collection activities in two sites near Lilongwe, before they move to other sites in the north of the country. For the rest of my practicum I will be working with an epidemiologist to conduct an interim data analysis and the study’s coordinator to prepare an interim report for the study funder, USAID/PEPFAR, and for key Malawian policymakers.

That’s me making sure I spell names properly

That’s me making sure I spell names properly

Part of the study team in Area 25 (L-R: Nicole Carbone, Blessings Chisunga and Godfrey Banda)

Part of the study team in Area 25 (L-R: Nicole Carbone, Blessings Chisunga and Godfrey Banda)

 

 

 

 

 

 

 

-Rigo