Global Health Travel Blog

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

Month: June 2019

Research in Collaboration in Galapagos!

This summer, I was given the opportunity to work with Dr. Clare Barrington and her research team out of the Health Behavior department at UNC Gillings to execute a qualitative research study on the emotional burden of living with and managing Type 2 Diabetes among adults in Galapagos. Clare and her team have done a similar study in the Dominican Republic across three summers, and were excited to expand to a new site- with seemingly good infrastructure. Before I arrived, we had received IRB approval, prepared our interview guides, done everything it seemed we could do without being here- but everything still felt very vague. Other researchers with years doing work here assured us “it will all make sense when you land!” but I was hesitant, as I was arriving in San Cristobal before Clare to begin doing some research on the place alone. Having spent two years living in Ecuador I was fairly confident about my trip, but not knowing the island itself was daunting. I reserved a seemingly nice Air B&B with a kind family, read up on things to do in San Cristobal, and asked my Ecuadorian friends all about the best places to go. Little did I know, the motto of “it will all make sense when you land!” truly became reality! When I arrived in San Cristobal, I immediately went with my host mom on a tour of the island and realized that it really is as small as everyone says.

The town of San Cristobal and a few of the animals I share the place with!

The Galapagos Science Center, where I work and collaborate with researchers from Public Health, Anthropology, and much more.

To give a little context about where I am specifically, in the Galapagos there are 4 inhabited islands, of which San Cristobal is the farthest west and has about 8,000 residents. It’s small, so within the first week I was already running into people I know! I arrived the first day to the actual Galapagos Science Center (GSC) building, which is a collaboration between UNC Chapel Hill and the University of San Francisco in Quito, excited to get some direction. It is located directly in front of a gorgeous sea lion filled beach with large patios and beautiful facilities and truly seemed like a researcher’s dream. I walked in and was directed towards an empty GIS lab where there were really no researchers. I asked the Ecuadorian-based employees if or when other people are coming and they warned me that over 100 individuals from UNC alone were coming this summer- but it was hard to believe at that time! I got to work building connections with physicians in the community and getting to know the health landscape, while I waited for Clare’s arrival the following week. After about a week, I noticed a few new researchers trickling in and introduced myself, but still wasn’t able to believe how many people would be coming. Having little experience in research and more experience in day to day work, I filled my days with tasks like printing, editing, and making meetings.

(L-R) Meeting with hospital lead epidemiologist Dr. Juan Ochoa and Dra. Clara Rodriguez, Clare Barrington, myself, and Trisha Dant, Associate Director of the Office of Research of the UNC School of Medicine (who is here on a research site visit).

This week, I woke up Monday, went to the office and walked inside to, I kid you not, 50+ people in the science center! Overnight the place had gone from empty to at capacity! I wasn’t sure what to expect but this week has taught me a great deal about research in collaboration. Since our project has started slow (I’m on week three with no interviews!) we have had the opportunity to learn from all of the researchers who have been coming to Galapagos for 5+ years. We have asked questions, listened to presentations, and the discussion doesn’t stop when the clock hits 5! It’s been really interesting to work with Clare and learn how to begin a study of this nature and begin it at a completely new site. I’ve seen her collaboration with Dr. Amanda Thompson, who has been doing research here on health for years, and it has shown me how important collaboration across fields really is. I’m beginning to learn how important community relations are in this type of work, and realize that without the support of the Galapagos Science Center, none of the research we hope to do would be possible.

Clare and I after the 5K we ran across the Island “Yo Vivo Sin Drogas” or “I live Drug Free.” The race is on it’s ninth year of a country-wide campaign against drug use.

I’m really excited to begin our first interviews next week and continue living on this beautiful island. I’m lucky to have already started to make some great connections and have had the opportunity to participate in a variety of talks and activities on the island. Clare and I were even convinced to run a 5K last weekend! So far, my three weeks in San Cristobal have been a great learning experience in flexibility, adaptability, and learning before acting. We’ve had to patiently gather information about this community for two weeks before being able to start our research, which requires a lot of patience, but is also incredibly important. Everything really is making more sense now that I’m here, and I can’t wait to see what else San Cristobal has in store in the next month!

– Hunter

“Because sometimes it makes us fat”: Communication triumphs and challenges in Guatemala

I had a choice to make: to eat the unidentifiable cooked insect that was being offered to me or not. I had just arrived at Curamericas Guatemala’s project site in Calhuitz, Guatemala after being picked up at 4:30am and driven up countless mountain switchbacks by the project’s head doctor. Needless to say, charred mystery bug was not my first choice for breakfast. However, the staff had offered it to me and I wanted to make a good first impression, so I went for it. I still have no idea what I ate, but it wasn’t so bad!

This summer, I will be spending 8 weeks in Guatemala working with Curamericas Global and Curamericas Guatemala. In partnership with the Guatemalan Ministry of Health, Curamericas runs five community-operated Casa Maternas (or birthing homes) throughout the rural highlands of Northwestern Guatemala that are open 24-hours a day, seven days a week. Additionally, the Casa Maternas provide a host of maternal and child health services including antenatal care, postpartum visits up to 2 years after birth, adolescent health education groups, and maternal care groups. Curamericas has also developed relationships with comadronas (or midwives) in their partner communities, who often accompany women to the Casa Maternas to give birth. This community-based care model provides women with a space to receive care from skilled medical professionals in a culturally competent setting.

A painting outside of the Casa Materna in Calhuitz, Guatemala.

During my first few weeks in Calhuitz, I had the opportunity to go on a 6-month postpartum home visit with a community health educator. After verifying some demographic information with the new mother, Nancy, the community health educator, asked her if she could remember four warning signals for an at-risk pregnancy, postpartum complications, and if her child was sick. I was struck by the interactive and almost quiz-like nature of the home visit. I was reminded that these postpartum visits may be one of the few opportunities that this woman has to learn about her health for future pregnancies and her child’s health. With the nearest hospital almost 4 hours away and often only accessible by a costly ambulance ride, being able to identify when you need to seek care is of the utmost importance.

The birthing room at the Casa Materna in Calhuitz, Guatemala.

For my practicum this summer, I am working with Curamericas on a barrier analysis to help the organization better understand what is preventing women in the communities that they serve from using a modern method of family planning. This analysis is designed to assess behavioral determinants within communities in order to create more effective programming to promote behavior change. I have been working with staff to develop a questionnaire for community health educators to take into the field during their postpartum home visits. Part of my job has been to go to each Casa Materna and train the health educators on how to administer the barrier analysis survey. Working with these educators has re-emphasized how difficult and important their work is for the communities they serve. With over 25 different indigenous languages spoken throughout Guatemala, most educators spoke at least three languages and will have to translate the survey into Chuj or Akoteko for the women while recording their responses in Spanish for me to analyze. I was humbled by their willingness to participate in this labor-intensive process on top of their already mountainous workload and their graciousness towards my sometimes clunky Spanish during our training. I was also impressed by their positive attitudes and willingness to let me, a stranger, come and teach them something new.

My favorite moment so far happened during my training last week at the Casa Materna in Santo Domingo. The training had started off a little rocky because the staff had some difficulty understanding my Spanish. Part of the training involved practicing the barrier analysis interview in pairs, with one health educator pretending to be the woman being interviewed and the other conducting the interview. When one of the male health educators pretending to be a woman who wanted to use a modern method of family planning was asked what he thought some disadvantages of using birth control might be, he replied “because sometimes it makes us fat.” We all laughed really hard and the group was more relaxed for the rest of the training.

Need internet access? Step into our office on the roof!

In the coming weeks, I’m looking forward to more creative responses during our trainings, the data collection process, getting to spend more time with incredible Curamericas Guatemala staff, and eating more delicious tortillas than I thought possible.

– Kay

Preventing Cervical Cancer in South Africa

My practicum is with the UNC Global Women’s Health Division, specifically the UNC-Wits-Right to Care Partnership for Cervical Cancer Prevention in Johannesburg, South Africa (SA). In SA, cervical cancer is the leading cause of cancer death among women. Although cervical cancer is largely preventable through HPV vaccination, routine screening, and treatment of cervical precancer, there are significant disparities in access to these life-saving prevention strategies within and between countries. Currently, approximately 90% of cervical cancer mortality occurs in low- and middle-income countries. While SA is considered an upper-middle income country, it is also one of the most unequal societies in the world.

Overall, health outcomes in SA remain poor relative to the country’s economic development, and cervical cancer disparities by race and socioeconomic status are stark. According to the recently published SA Demographic and Health Survey, approximately 78% of White women in SA have had at least one Pap smear (to screen for cervical cancer and precancer) compared to just 32% of Black women. Not surprisingly, Black women in SA are also more likely to be diagnosed with cervical cancer. In 2014 the cervical cancer age standardized incidence rate (ASIR) in SA was about 27 per 100,000 Black women compared to 10 per 100,000 Asian women (the group with the lowest ASIR).

Staff at the cervical cancer team meeting
Top row (from left): Kopano Kgopa, Tafadzwa Pasipamire, Dr. Masangu Mulongo, Krista Scheffey, Patricia Mofokeng, Boikie Mohamme
Bottom row (from left): Bawinile Njoko, Sophie Williams, Rendani Nenzhelele, Ntombiyenkosi Rakhombe

The UNC-Wits-Right to Care team is working to reduce disparities in cervical cancer morbidity and mortality by providing free Pap smears and precancer treatment to thousands of women in SA. I’ve joined an amazing team of clinicians and researchers who have been extremely generous with their time and expertise as I get up to speed (and ask a million questions). Over the last few weeks I have been shadowing in clinic to better understand how the program operates and how clinicians educate and counsel patients. My main project this summer will be creating and updating patient communication materials to raise awareness and convey key educational messages about cervical cancer prevention with the goal of improving Pap smear screening coverage in program sites.

Observing Boikie and Bawinile at work on the mobile van in Diepsloot.

In addition to my time in the clinic, I’ve also been exploring Johannesburg and continuing to learn about SA’s history. This country provides a vivid example of the way that social factors, particularly historical and contemporary patterns of oppression, impact population health. While I’ve been doing a lot of reading, the opportunity to live and work in this city is a daily reminder that reality is much more complex than can be captured in journal articles. When I’m feeling guilty about spending time at one of Johannesburg’s downtown markets instead of working on my master’s paper (which I am also planning to write while I am here), I remind myself that closing the data visualizer, leaving the office, and taking time to learn first-hand about the community with which I’m working is also a critical part of public health practice.

Johannesburg from above. The Carlton Centre is the tallest office building on the continent and its observation deck is known as the “Top of Africa.”

I feel very lucky to be a part of a team that is doing such important work here in Johannesburg. Stay tuned for more journal articles, statistics, and photos in my next update. (To tide you over, here’s bonus reading: while cervical cancer is much less common in the United States compared to SA, disparities by race persist.)

Inside the Constitutional Court of South Africa.

– Krista

At home in Mauritius

It has now been three weeks since I landed in Mauritius, together with my husband and our two children. Many of you may know Mauritius as a tourist destination; Mark Twain is often quoted to have said: “You gather the idea that Mauritius was made first, and then heaven, and that heaven was copied after Mauritius.” Surrounded by stunning coral reefs, Mauritius spans less than 800 square miles and is home to over 1.3 million people. Beyond its flourishing tourism industry, Mauritius is often cited as a model of democracy amongst African nations and an example of social cohesion where people from African, Indian, Chinese and French heritage have created a peaceful co-existence.

Although I have been back several times to visit my family and on holidays, it has been 15 years since I first left to go study abroad. I have lived in different countries during that time, and when the possibility of completing my practicum in Mauritius arose, I knew that this was something that I should do. I was curious about how I could apply what I have learnt during my time at UNC to the reality here, and learn about the ways that I could give back to my home country.

Being a dual degree student with the School of Social Work and Public Health, I am working with two different organizations in order to complete all my required field hours: Gender Links (GL) and the Global Rainbow Foundation (GRF). Gender Links is a South African Women’s Right Organization with offices in ten Southern African Development Community (SADC) countries including Mauritius.

On the second day of my internship with GL, I was asked to be on a jury at the Voice and Choice Summit, which regrouped NGOS, local government councils, media organizations and individuals who are creating change in their communities across the island. The goal of the summit was to create a learning platform where each one came and presented their best practices for promoting gender equality through their current work. The presentations were made under various categories such as gender and climate change, gender and governance, sexual and reproductive health and rights, and others. A winner would then be chosen within each category to represent Mauritius at the African Regional Voice and Choice Summit in South Africa. For me this was an incredible opportunity for networking and for learning about the work of over 20 organizations in one sitting. I appreciated learning about how gender is intersecting with various issues such as poverty and education in Mauritius.

The jury.

GRF is dedicated to the service of those who live with a disability in their life, be it mental or physical. Their approach is to provide a one stop shop, where someone interacting with their foundation can receive all the services necessary to be a fully functional member of society. To this end, GRF makes and provides prosthesis to its clients, provides employability training, provides medical services by a team of doctors which includes an occupational therapist, psychologists, and a physical therapist. It also engages in advocacy work in order to promote the rights of individuals living with disabilities.

The bulk of my work with both organizations consists of strengthening their internal capacity for monitoring and evaluation. While there is a strong emphasis on regular monitoring of activities, the evaluation component is often minimal, in part because organizations are strapped for staff and resources.

I am looking forward to the coming months as my family settles into the rhythm of the island (which is sometimes not so slow) and as I gain more field experience through both of my practicums. Beyond that, I am also excited to be meeting various individuals and talking about future ideas for collaboration such as strengthening and standardizing the practice of Social Workers in Mauritius and encouraging more research around gender issues, so that NGOs can more frequently engage in evidence based practices. There is so much happening and I am loving it!

– Yovania

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