Global Health Travel Blog

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

Month: August 2018

¡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.