Global Health Travel Blog

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

Month: August 2019

Mwauka bwanji to all our readers!!

Mwauka bwanji is Good morning in Nyanja, one of the most widely spoken languages in Lusaka, Zambia.

For the second phase of our practicum, we were privileged to travel to Lusaka, Zambia with our preceptor, Dr. Alan Rosenbaum. We went mainly to observe and interact with the Fetal Age and Machine Learning Initiative (FAMLI) project team based in Zambia.

With Dr. Kasaro (far right) and Project Coordinators in UNC GPZ.

We were welcomed by Dr. Margaret Kasaro, country director of UNC Global Projects Zambia (UNC GPZ). On our first day, we had the privilege to meet with the project coordinators who talked briefly about the various projects UNC had in Zambia. We discussed enrollment and retention strategies as well as barriers and delays usually encountered in the various studies ongoing in Zambia.

Over the next couple of days we visited the FAMLI project sites in both the University Teaching Hospital and the Kamwala Health Center. We were given a tour of both research facilities and had the chance to observe the process of delivering an informed consent to a participant, determining eligibility and actually receiving their ultrasounds. The data managers and research assistants also educated us on data entry and storage in ways that protected the identities of participants. The sonographers allowed us in their space and gave us an opportunity to scan some of the mothers with their permission (we are both medically trained doctors in our respective countries).

Observing the doctor scanning the mother.

Enam scanning a mother with her permission.

Munguu scanning a mother with her permission.

Alan interacting with a mother who benefitted from FAMLI scans.

The most exciting part of the trip was interacting with mothers at various stages. We had the chance to meet and talk with those waiting on their scans; those who were receiving their scans and could not hide their excitement when the gender of their babies was revealed; and even those who had benefitted from FAMLI scans and had their babies. They showed us how they carry their babies on their back with the chitenge. Mothers seemed happy to be a part of the FAMLI study because they had access to free monthly scans. Ordinarily they would have to pay about 70 Kwacha for an obstetric scan.

Enam learning to carry a baby with a chitenge.

Finally, we managed to do some tourism in Zambia on the weekends. We enjoyed great food, safaris and game drives in the Lower Zambezi National Park, visits to crocodile farms, taste of crocodile meat and, of course, the great Victoria Falls. Unfortunately, we did not see “Mosi oa Tunia” – “The smoke that thunders” because it was in the dry season, however, we saw the beautiful rock cliffs behind the Falls.

Munguu with White Rhinos in the background.

We cannot end this blog without saying a big Zikormo (Thank You) to our preceptor, Alan Rosenbaum, Dr. Kasaro, and everyone at UNC Gillings, Global Women’s Health Division and UNC GPZ for making this practicum experience successful!

– Munguu and Enam

Equity as a Public Health Priority

“Is cervical cancer a big problem in South Africa?” This is a question I get, in some form or another, from many people back home when I tell them about the project I’m working on in Johannesburg.

The short answer? Yes.

Urban hiking in the Melville Koppies

The long answer? Yes, cervical cancer is a major public health issue in South Africa and many other African countries. UNAIDS estimates that women living in Eastern and Southern Africa are 10 times more likely to die of cervical cancer than women living in Europe. Within South Africa, Black women are almost twice as likely to be diagnosed with cervical cancer compared to White women.

Over 90% of cervical cancers are preventable, and the UNC-Wits-Right to Care team is working to increase access to prevention services in South Africa. Routine vaccination against HPV, the cause of most cervical cancers, did not begin in South Africa until 2014. And, although cervical cancer screening is free, only a third of South African women receive screening at the recommended intervals.

Rendani modeling her Right to Care jacket

In our classes, we learn about criteria used by governments, organizations, and funders to determine public health priorities: the number of people affected, the magnitude of a disparity, the evidence in favor of intervention, the cost (in dollars, years of life lost…) of action or inaction. By any measure, cervical cancer is indeed a public health problem, and these statistics are important–they tell the story of a disease that is almost entirely preventable, yet continues to kill hundreds of thousands of women every year.

At the same time, I have been thinking about how we frame public health problems, and what larger dynamics these measures can obscure. Cervical cancer is a disease of inequities, and confronting the social conditions that give rise to unequal health outcomes (in the words of Link and Phelan, their fundamental cause) must also be part of addressing this problem.

Public health is not immune from reproducing the patterns of inequity that we seek to solve. As a student, I have concentrated on gender and other social inequities as they impact women’s reproductive health. These dynamics are also reflected in gender inequality in the global health workforce and geopolitical inequalities that influence public health priorities. If the goal of global public health is “real partnership, a pooling of experience and knowledge, and a two-way flow between developed and developing countries,” we have a long way to go until this vision becomes a reality.

Recently, leaders at the National Institutes of Health pledged to take steps to end the “manel”– all-male speakers panels–and increase diversity in global health leadership. In his statement, Dr. Collins, Director of the NIH (and UNC School of Medicine grad), writes, “it is not enough to give lip service to equality; leaders must demonstrate their commitment through their actions.”

Shadow Boxing by Marco Cianfanelli in the Joburg CBD

It is an incredible privilege to be in South Africa doing work that I find important, challenging, and fulfilling. I feel very lucky to be completing my practicum with UNC-Wits-Right to Care and learning from a team that truly demonstrates this commitment to promoting equality–from increasing access to Pap smears to building partnerships and creating opportunities in global health.

Krista

Hustler Nation & the Jack of All Trades

Visiting new places in Mauritius – Participating in Medical Camps

The island of Mauritius had no indigenous population. People from many countries settled in Mauritius during Dutch, French and English occupancy, and gained their independence in 1968. With land as their only natural resource, the strong development of Mauritius is quite a feat. Currently one of the most competitive economies amongst African nations, Mauritius has successfully diversified its economy to include a manufacturing industry, banking and tourism. Part of this success comes from Mauritians having a “hustling” spirit. With their sacrificial and entrepreneurial attitude, they have been able to create a thriving nation.

This is also this same spirit that has permeated my internships during the last six weeks. When I arrived at local agencies to complete my practicums, the intention was for me to strengthen their monitoring and evaluation processes. However, I have had a chance to gain experience in a variety of settings partly because one needs to be a jack of all trades in Mauritius. This is especially relevant in the non-profit sector, as staff often have to fulfill many roles because of the lack of funding. For about two years now, the Government of Mauritius has mandated that all for-profit organizations contribute most of their Corporate Social Responsibility (CSR) money to a national fund which is then distributed yearly amongst certain NGOs across the island through a competitive application process. The creation of a National CSR Fund was a way to address many concerns that NGOs (or Civil Society Organizations) were facing, such as:

  • Lack of focus on poverty alleviation and assistance to vulnerable groups
  • Lack of transparency in the allocation of CSR funds by companies
  • Difficulty in accessing funds by deserving NGOs
  • Lack of proper monitoring and evaluation of CSR programmes and activities
  • The proliferation of NGOs in order to obtain funds

Previously, NGOs were able to obtain funds directly from corporations — by law, corporations must give 2% of their profits back to society. The transition to this new way of operation has created or exacerbated certain challenges for NGOs. Many of them have had to reduce operations because of lack of funds, while others saw only part of their programmes funded. Both of the NGOs that I work with have had to dedicate more time and resources to securing funding. This has put a strain on existing staff who are attempting to serve in multiple capacities.

Talking about (dis)abilities

In my case, I was fortunate to be able to put my skills as both a social worker and a public health practitioner to use. I ended up acting as a project manager for a programme that empowers individuals with disabilities (the actual project manager was recruited to organize the Indian Ocean Island Games, an international competition that takes place every 4 years in July). Within the context of the empowerment programme, I was also able to facilitate employability training sessions for youth with disabilities and provide them with mental health support. I contributed to an advocacy session on ending child marriage in Mauritius. And interestingly enough, both of the NGOs that I am currently working with have decided to collaborate on a call for proposal, so I am now also grant writing.

Youth with disabilities taking part in employability training

This mode of operation can be challenging at times, since I am never sure how my day will unfold. I am learning to be flexible when I can, and have become creative in terms of when and where I do my work. This has led me to drive to many places in Mauritius that I had never been to. I have also discovered which coffee shops have the best combination of coffee, music level, pastries and WiFi connection — the basic requirements of any hustler nation.

Free services at Medical Camps – prosthesis adjustments and reparations

– Yovania

Salamat, Philippines

Guest blogger, Areej Hussein, undergraduate student in nutrition

Typical fruit vendor in the streets of Cebu city where the infamous and tasty Cebuano mangoes are sold.

As a recipient of the Class of 1938 Summer Abroad Research Fellowship, I had the opportunity to travel to the Philippines this summer to explore my Honors thesis research topic: the impacts of early childhood malnutrition on young women’s reproductive health and childbearing. I traveled to the Philippines extremely nervous at first because I had never done anything like this before. Deciding to spend two months in a country I had never seen before to pursue a research project was something that challenged my comfort zones. Nevertheless, I was excited to embark on this journey where I could meet new people, learn new things, and experience a new way of life.

While there, I was mentored by amazing researchers from the Office of Population Studies Foundation (OPS) at the University of San Carlos in Cebu, whose Cebu Longitudinal Health and Nutrition Survey (CLHNS) is a collaboration with UNC’s Carolina Population Center. My OPS mentor, Ms. Josephine Avilla, has been extremely supportive and a pivotal part of this research project.  Without her guidance and connections, this would not have been possible. My research included engaging in focus group discussions and in-depth interviews with young Filipina women on topics related to relationships and childbearing decisions, an effort to contextualize my quantitative data analyses.

The participants of the focus group were women from Ritazo, a community-based initiative run by women in an urban poor neighborhood in Mandaue City, Philippines. These talented women take scraps of materials donated to them by a furniture company and turn them into beautiful bags and merchandise to generate a source of income for themselves and families. These women, in addition to raising children and maintaining their homes, were earning money for their families and taking on leadership roles in their community. I am forever grateful to these women who trusted me enough to share stories of their livelihoods as they participated in this research project.

In addition to the focus group discussion, I conducted in-depth interviews with young women most of whom work as research assistants at OPS. Unlike the women of Ritazo, these women were closer in age to me and it amazed me how much I was able to relate to them in these interviews. These interviews felt more like conversations I was having with my friends rather than a research-participant style of interaction. These conversations were also insightful and brought to light many themes that would add perspective as I am analyzing the quantitative data. I am currently drafting a detailed summary of my findings, including these themes, intending to disseminate this information to all of the women who participated in this study. I strongly believe that the goal of research should be to benefit the community who graciously agreed to take part in it and who without the research would not exist.

During my stay, I also had the opportunity to attend a two-day data analysis workshop led by my professor and mentor Dr. Linda Adair. This workshop brought together researchers from different institutions across the Philippines to discuss data dissemination and analysis for a national population study carried out by OPS as an effort to better understand the “Filipino child”. It was inspiring to witness the excitement in the room for this kind of work and how invested these researchers were in bettering their country. In this workshop, I also heard stories about research field workers risking their lives to obtain research data. These dedicated researchers would travel to some of the most inaccessible and dangerous parts of the Philippines manually collecting data using pen and paper, which then students and researchers, like myself, have the convenience of accessing on a computer with just a click of a button. Learning about the risks involved in data collection and witnessing the effort that goes into editing and coding the data in the OPS office made me appreciate the research data more.

Akong Pamilia (“my family”) –celebrating my birthday at the office. OPS

While the purpose of my trip was to conduct research, what I gained was far more valuable than data. Here I gained a family that made me feel more at home than an outsider! Many greeting me with “Assalamu alaikum” (a greeting that Muslims use translating to “Peace be Upon you”) even when they were not Muslims themselves was one of the many ways that people tried to welcome me. I also gained a small glimpse of a beautiful culture that embraces everything that is love and community! I gained stories of resilience and faith that left me more than inspired! During a time where I longed to go home to Sudan but could not because of the political unrest, the Philippines became my home! I saw my people in their hospitality and their love for one another! I had an extremely positive experience and I am forever grateful to Dr. Linda Adair, the Class of 1938 Fellowship, and Honors Carolina for their immense support throughout this experience and making it possible!

Beautiful waters of Moalboal,Cebu, Philippines.

In addition to research, I had the opportunity to experience island hopping and explore as much as I can of this beautiful archipelago.

– Areej

The importance of a dream team

Standing outside of the rural health clinic in el Progreso after doing interviews one morning.

I came down to Galapagos worried about what my level of support was going to look like while on the island. I knew the internet wasn’t great and that cell service was spotty, so I was expecting the worst. I wasn’t wrong about my lack of access to wifi but what I found was an awesome research team to support us through our project. I’ve decided in this blog to introduce you to some of our team members, and explain how integral their role was throughout our entire data collection process.

1. U.S. Based Research Team: Our U.S. based research team has been incredibly helpful in this project. First, Dr. Clare Barrington is the principal investigator and thus, knows how everything should work. She was able to visit Galapagos for 10 days while we were doing the study, and organized important meetings with directors, healthcare providers, and community members. Her ability and knowledge of exactly who and how we should work with individuals is spot-on, and I was able to learn so much from her. For example, we were given a hospital tour on one of our first days, where we were introduced to every single physician (there are over 15 working in the hospital and health center!), taken to every single part of the facility including labs and x-ray machines, and then we arrived to the health center. Clare immediately realized that three physicians we were introduced to would be key in our project and immediately stopped them to explain our project and set up a time to further discuss. Her ability to act and know at that moment who we needed to be in contact with was key to getting the study started. Similarly, Humberto Gonzalez Rodriguez, a project coordinator for Clare’s research team, and my preceptor, visited for 10 days. His skill set was incredibly valuable, as he assisted in motivating the team with daily starbursts, encouraging us during times of uncertainty, and directing with every qualitative research related question we had. The guidance of the U.S. based team was incredible and invaluable- and working so closely with Clare and Humberto taught me a great deal about qualitative field work.

Humberto Gonzalez Rodriguez, Yearly (a rural nurse who was incredibly helpful in recruitment!) and myself at a patients property in the rural area of el progreso. Humberto executed an interview with this participant literally “in the field” while the family was collecting fruits and veggies to sell.

2. Physician and Nursing Ecuadorian team: Because of a MOU between the Galapagos Science Center (a joint center between UNC and USFQ- an Ecuadorian University) we were able to directly recruit and work through the local hospital and ministry of public health. We came across an amazing team of passionate doctors, health promoters, and nurses that were focused on their patients and willing to help us at all costs. They made us a list of diabetic patients, walked with us door to door, and organized appointments for us. Their team gave us constant feedback about our project and how different things would be received within the community. They walked us through rural sites, returned to houses three and four times if patients weren’t home, all while patiently answering all questions we had about their work and the healthcare system. Without this amazing team of healthcare workers, this project would not have been possible! We even were able to celebrate the hard work by providing the team with a cake on our last day together. The engaging community collaboration for the project was an awesome example of community assisted research.

Leading a preliminary results dissemination meeting for physicians and healthcare directors from the ministry of health for Galapagos.

3. Our Research Assistant, Paulina: Paulina was suggested to us as a research assistant by a previous UNC project that worked with her last year- and what an incredible suggestion it was! Paulina was born in Machala, Ecuador, a coastal city of the mainland, but her father moved to Galapagos over 20 years ago. She lived on and off in the islands growing up, but ended up staying in Galapagos when she met her husband 15 years ago. Now, she is studying environmental administration, but works with health projects on the side. After having experience doing surveys in a previous position, we were excited to encourage Paulina to execute interviews and assist with transcribing for our project. Paulina picked it up quickly and was a great interviewer! She is a hard worker, passionate about Diabetes, and loves working with her community. Paulina helped our project from every single aspect and quickly became my closest friend on the island. We even got to travel to another island, Santa Cruz together! I’m incredibly grateful for Paulina and excited to be able to work with her on the analysis portion of this project.

Paulina and myself during our weekend vacation trip to Santa Cruz!

4. Galapagos Science Center: It was amazing being able to work on a research project with an already existing research center. The GSC has infrastructure for projects like ours, and when it came time to meet with hospital directors and coordinators, the team at GSC was quick to assist and encourage us to make meetings with a variety of local leaders. The GSC team coordinated our offices and meetings, helped me learn how and where to print, helped us make coffee on long afternoons, and even coordinated dissemination events for us to be able to share our results with the community. Without the GSC team, our process of completing this project would have been incredibly difficult.

Through this summer research opportunity, I’ve learned the importance of key members working together in a team, and the cooperation of everyone to execute a successful project. While I have officially returned to the United States preparing to gear up for my last year of my MPH, I will continue to work on this research project and with Paulina and the community throughout the upcoming year to analyze the data we were able to collect. I learned a great deal from our research team, the community, and about life on an island while I was there, but I’m grateful to be back with my dog and family! Either way, the connections made in Galapagos are lasting and I’m grateful to have had the amazing opportunity to do research in such a unique setting with such a collaborative community.

Dr. Trajano Mediavilla (diabetes doctor), Myself, Paulina, before a radio show organized by the Galapagos Science Center team where we were able to discuss diabetes on the island and our research project, disseminating research directly to the community.

Paulina and I in the health center with Katty, a community health promoter who works both in the rural area and the city and was a major and key help in our ability to complete this project and recruit participants.

– Hunter

My last weeks in Kisii, Kenya

The remainder of my practicum in Kisii with Curamericas Global was a whirlwind. Since I was only in Kenya for one month, things moved very quickly in order to complete my projects on time. My first week was spent preparing for my qualitative research studies – writing research questions, preparing interview guides, and randomizing participants for my focus groups. I also visited and toured the Matongo Health Centre and familiarized myself with the facility and its services. In addition to beginning my projects, I enjoyed exploring Kisii. I familiarized myself with the local market to purchase fresh produce, located a grocery store for my other dietary staples, and determined the most efficient route to the KIKOP office at the Ministry of Health.

The maternity ward at Matongo Health Centre in Kisii, Kenya.

Focus group discussions began during my second week in Kisii. I quickly realized that my results would be richest if the focus groups were conducted in the local language by KIKOP staff. I held a qualitative research “crash course” for the KIKOP staff to familiarize them with the process of a qualitative study and the most important things to know about facilitating focus groups. Since I held about 10 focus groups during my practicum, I was extremely grateful for the willingness of the KIKOP staff to assist with my studies and facilitate the focus groups.

Davis and Esther, two KIKOP staff members, facilitate a focus group discussion with traditional birthing attendants in Matongo.

Following data collection came transcription. Local volunteers transcribed the focus group discussions into English for me, and I began data analysis shortly thereafter. Thus far I have completed analysis of transcripts for one of my studies – operational research on what constitutes a culturally appropriate birthing space and care at Matongo Health Center in Kisii. The preliminary results have been very informative and fascinating to read about, and I am looking forward to seeing the space that is designed as a result of my findings.

Life in Kisii was certainly challenging at times and different from my life back in the U.S., but it was a good learning experience. The KIKOP staff were helpful, members of my focus groups were welcoming, and I learned a lot from experiencing such a different culture. As I reflect on my month in Kisii, I feel grateful for the opportunity to experience life in a city so different from my hometown. I will always look back on my time here with gratitude and deep respect for all the individuals I worked with and will remain optimistic that they are able to obtain the positive health outcomes that Curamericas Global and KIKOP are working so hard to achieve.

– Dana

Farewell (for now) Lusaka

Traditional Chitenge Dress I Had Made for a Bridal Shower

It is hard to believe that my time in Lusaka, Zambia is already coming to an end and I have to say, while there are reasons I am excited to return home, I am not too eager to leave the life I have started to create here. The local community in Lusaka is very supportive, inclusive and genuine and is full of interesting professionals which I am glad I had the chance to meet. I am grateful for the opportunity to mingle with people working at some of the leading international development and global health agencies such as the United Nations, the Ministry of Health and the CDC at a weekend braii (what we would call a barbeque or cookout) and to be able to talk to them about their work and experiences living in Zambia and other parts of the world.

While it took some time, I feel like I have adapted to the more laid-back lifestyle in Zambia and have enjoyed that fact that it is less stressful than back home. I can understand why I have met so many people who moved to Lusaka for what was supposed to be a few months or a year and have now been here for multiple years, some over 20. There does not seem to be the same sense of competitiveness and hurry that I often find myself caught up in while living and working back in the States. Now, there have been times I wished for a greater sense of urgency; like when we were without running water for a week because of a broken pipe, or sitting in the dark for four hours a day while the electricity was turned off, or stuck on the side of the road for hours at night because our bus broke down. Back in the States, moments like these would have thrown a wrench into my entire day and launched me into action to try and rectify what are, at the end of the day actually pretty minor, inconveniences. But here I find myself, more often than not, finding humor in these situations, doing what I can to change my routine but otherwise, accepting these are things I have no control over. I believe I am leaving Lusaka more relaxed with greater patience and a stronger ability to accept the things I cannot control.

Victoria Falls

At work, I feel that I have learned so much about the healthcare system in Zambia and am better able to understand problems the local healthcare system faces. I am leaving with many things to think about in terms of my potential role in developing solutions to strengthening local healthcare systems in low-and-middle-income countries (LMIC). My work in Zambia had me at the University Teaching Hospital almost every day and while most of my time was in the neonatal intensive care unit (NICU) or the research office, I also spent time in the delivery ward (witnessing my first birth!) and the Kangaroo Mother Care unit. I had the opportunity to speak to many professionals who have been a part of the healthcare system for years. I have spent most of my time here collecting and analyzing data related to neonatal health outcomes in order to quantify the cost of care for preterm births. I was keenly interested to learn how the hospital collects and analyzes data in order to report statistics, primarily on patient outcomes, to the local government and Ministry of Health. This was a great opportunity to see the challenges faced in collecting quality data on health outcomes and how this data is used (or not used) to drive decision making.

Overall, my time in Zambia has been wonderful and I feel that I have grown both personally and professionally. I have learned to be more flexible and adaptable and how to overcome obstacles that came up during our research, critically thinking about how to course-correct and move forward. I also feel I have greater appreciation of the importance of understanding the local context when working in different communities. I gained the most insight when I took the time to observe and listen to others, and put my initial assumptions and opinions aside.

Sunset Over Zambezi River

It seems almost surreal that my time here is almost up and soon I will be back in class at UNC but I am sure that I will return to Zambia again.

– Taylor