Global Health Travel Blog

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

Author: Global Health (page 1 of 4)

Dear, Zambia

Victoria Falls

This summer, I have been working as a research intern for the NIH-funded Methods for Prevention Packages Program (MP3) study. This multi-component intervention study is at its formative stage and primarily aims to explore if the secondary distribution of HIV self-test kits (SD-HIVST) to pregnant women will increase HIV testing among their male partners. It also plans to explore if the integration of adherence supporters and integrated next step counselling will improve ART and PrEP adherence among pregnant women in Lusaka, Zambia. As a result, I’ve spent most my time here strengthening data collection instruments, assessing questionnaire items, designing semi-structured interview guides, creating training materials for study protocols, and outlining the study’s logic model and timeline plan.

That said, I’ve learned a lot in terms of research design and HIV prevention of mother to child transmission (PMTCT) in Zambia, but have also learned a lot about Zambian culture over the past 6 weeks.

If you read my first blog, The Path You Must Take, it may have seemed as though my bad luck with a missed connection flight turned into an amazing unexpected journey and phenomenal arrival to Zambia, which it did. However, if I tell you that this was not an isolated incident you may begin to think that I just have bad luck with transportation.

Well, this was not an isolated incident (ha ha).

12 p.m., June 21 – Two friends and I began our supposed 8-hour bus journey to Livingstone, Zambia, more famously known as one of the cities bordering Victoria Falls. Victoria Falls is one of the seven natural wonders of the world and being in Zambia, it was a given that I must go to visit.

8 p.m., June 21 – This is the moment where I should be detailing my first impression of the city, but given my adventurous destiny, this is actually the moment where I realize we are in a conundrum.

At around sunset, our #1 recommended bus company breaks down. Now you may think “well these things happen all the time”, apparently not (which is probably a good thing in general but a bad thing for us).

Wall from Café Zambezi – Livingstone, Zambia

Where I have circled in yellow is approximately where I believe the bus broke down and what also appears to be the halfway point between Lusaka and Livingstone.

The bus.

As I mentioned earlier, it is around sunset when the bus breaks down so what you see here is about all I could see in person as well (I promise this story has a happy ending).

At this point, it’s pitch black outside with nothing nearby, extremely cold given its winter season in Zambia, poor signal and to top it off my friends and I hadn’t eaten for approximately 7 hours. The bus company informs us that they are trying to dispatch the nearest bus but that it would be a couple of hours. That said, the bus drivers attempted to help all of us get on passing buses that were on the way to various destinations.

My friends and I befriended a man by the name of Isaac who helped us drastically when it came to which bus to hop on and where to get off. By the time we arrived to Livingstone it was close to 1 a.m. and Isaac called us a cab to make sure we got to our hostel safely.

In front of the Devil Pools at Victoria Falls

This trip as a whole has not only shown me how to improve my analytical research skills but has also shown me the amazing familial-like ties people in Zambia are so quick to form. From being brought in to a baby shower like family, to being called “mama” out of respect everywhere I go, to then being protected and escorted by new friends on the bus – Zambia has been a phenomenal place with phenomenal people. I will truly miss it but let this not be goodbye forever.

Toki sio [see you later].

– Rebekah

Two Weeks of Fancy Research at Stanford University

It’s getting close to the end of my practicum and I’ve had a well-rounded experience to what global health research is like. My practicum began in Palo Alto, California where I became part of the REAP, Rural Action Education Program, research team at Stanford. This team of talented individuals works on policy change and research to help the poor communities in China. As part of the team for the summer, I focus on building and adding new material to the Healthy Future curriculum, a program to be given by Community Health Workers in rural China to improve maternal and infant nutrition as well as prevent infant injury. China’s rural infants too often suffer from malnutrition but providing such an education program will help improve conditions for them. With this in mind, I’ve enjoyed working on the curriculum knowing that it will make a difference for many individuals once it is implemented.

City view from Twin Peaks.

Outside of the practicum work and research environment, I enjoyed exploring northern California for the first time. I definitely got to feel what it’s like to live locally and stayed two doors down from Mark Zuckerberg! I was also lucky enough to have a bike rental during my time there so that I was able to travel to and from Stanford as well as around town! The flexibility of the work allowed me to work at coffee shops where I ordered my first mint mojito, a sweet and creamy latte with mint, at the very popular Peet’s. Lastly, I was able to rent a car and travel to San Francisco and visit the many well-known places such as China Town, Fisherman’s Warf, and of course the Golden Gate Bridge. I greatly enjoyed my time in Palo Alto and would definitely recommend considering a practicum on the West Coast!

The Golden Gate Bridge.

While I was scheduled to travel to China for the rest of my practicum, my trip has been delayed, I continue to work and will hopefully be able to visit the university in the future. While, I’m saddened that my trip has been delayed, I have received a well-rounded experience of global health research and I know that the work that I have been doing this summer will make a difference in foreign communities and I believe that I have gained global experience to prepare me for future endeavors.

– Nicole

Highlights from the Highlands in Guatemala

It’s hard to believe another month has gone by and that I am wrapping up my practicum very soon!  During the second half of my time with Curamericas in Calhuitz, Guatemala, I continued collecting and analyzing data on neonatal outcomes, modifying my interview guide, and then conducting and analyzing these group interviews with the nursing staff to collect their perspectives on managing and improving neonatal outcomes.

I am lucky to have shared most of my time in Calhuitz with another Gillings practicum student, Kay, and for both of our projects we needed to visit the neighboring Casas Maternas of Santo Domingo and Tuzlaj.  This was a great opportunity to learn first-hand about the different catchment areas covered by the organizations’ projects, meet more staff, and switch up the scenery.

We were told the Casa Materna in Tuzlaj had a different feel, that the area was more remote and unaccustomed to seeing foreign volunteers, and that it would be close quarters due to the Casa’s small size.  After a jostling two hours up and down rocky mountain roads, it’s true we found a cozy atmosphere, but with welcoming vibes.  We walked into what felt like a data-organizing party serenaded by Romeo Santos and reggaeton.  There was hot chocolate for breakfast and Philly cream cheese.  Dogs sprawled lazily on the grass rather than lurking fearfully for scraps.  A 13-year old was admitted to the Casa, and rather than experiencing a prolonged and difficult labor, delivered a healthy baby within a couple of hours.  Tuzlaj was full of surprises.

Entrance to the Calhuitz Casa Materna.

One of the main objectives for visiting Tuzlaj, and one of the most engaging parts of my practicum, was to conduct these group interviews with staff about their perspectives on neonatal complications and deaths.  I continue to admire these nurses and mujeres de apoyo for their hard work with limited resources.  These conversations convey a strong initiative and sense of responsibility to prepare and educate oneself due to their isolation and limited access to cell signal.  They share a holistic view of health and social determinants that’s at the heart of nursing, but which we hospital-based nurses can lose during hectic days.  As with many public health issues, it was clear these neonatal and maternal health challenges we were discussing had deep roots in longstanding gender and socioeconomic inequities, discrimination, and language barriers.  The staff knew the solutions still lie in preventive measures such as continuing to strengthen their health education outreach, community engagement, and garnering more support from civic and government partners.

View of Calhuitz and the Casa (tall green building) at dusk.

At the end of my time in Calhuitz, we were pleased to step fully back into tourists’ shoes for a couple days and visit Lake Atitlán on my way back to fly out of Guatemala City.  It’s one of those places that pictures don’t do justice and distance perception must be altered due to the enormity of the volcanoes and the beauty of the water.  We walked to a popular lookout and cliff-jumping site and after Kay confidently took a birthday jump, I of course had to follow. Only afterwards we learned that it was almost 40 feet—twice what it had looked to me.

Numbers that balance at Lake Atitlán, unlike in spreadsheets.

Back in NC I am continuing to work with both the quantitative and qualitative data in order to report back findings to staff and discuss next steps.  It is interesting to see how the data complement each other and also the amount of information available from a data set that was a bit confusing to piece together.  It’s been very meaningful having a practicum that places a foot both in global health and nursing, and hopefully this research work will offer the organization some insight into their outcomes and assist in determining next steps for reducing neonatal mortality.

– Emily

A seat at the table

Since starting my practicum at the Migration Health Division (MHD) at the International Organization for Migration (IOM) in May, I have worked on and/or am currently working on the following major deliverables:

  • Partnered with the MHD Logistics Team to plan and implement a three-day global health training where current migration health needs and strategic priorities for MHD were discussed amongst IOM leaders across the globe
  • Data entry and cleaning of IOM’s Health in Emergencies training program evaluations
  • Drafted content for the following reports:
    • UN Report of the Secretary-General on what IOM can offer through the development cooperation with middle income countries
      MHD Annual Report 2018
    • United Nations (UN) Interagency Task Force on Noncommunicable Diseases (NCDs) Report on IOM’s response to the challenge’s migrants and mobile populations experience when dealing with NCDs
    • Policy brief on international health workforce mobility
  • Assisted in the preparation of presentations on emergency response for new IOM employees serving in country offices
  • Community-based participatory research (CBPR) toolkit for IOM country offices to use when engaging with communities to tackle health challenges

(L-R) UN agency interns, Farhaa, Mikayla, and I taking a selfie right before catching a bus to meetings with colleagues from the World Health Organization.

In all, being an intern at a UN agency this summer in Geneva, Switzerland, has been such a rewarding experience. I have had a seat at tables I would have never imagined myself to be offered an invitation; for example, I got a seat at the 72nd World Health Assembly – the world’s highest health policy sitting body – where I got to meet Ministers of Health from around the world discuss and come together on new global health policies they want to set. In addition, this month I am preparing myself for a meeting I will have with diplomats from the US Mission to International Organizations in Geneva to learn more about their daily role of advancing U.S policy and job opportunities. Thankfully, my internship is still not over. This means I still have about 4 more weeks in Geneva to continue to take advantage of every opportunity that I can grab as I strive to enhance my global health portfolio.

– Fatima

Dia dhuit from Galway

Dia dhuit! It’s hard to believe that I’m already halfway done with my practicum with the National University of Ireland at Galway Health Promotion Research Centre (NUIG HPRC). Although I still haven’t quite mastered Gaelic, I have been fortunate enough to have already been exposed to so many of NUIG HPRC’s critically important health promotion activities. As a WHO Collaborating Centre for Health Promotion, their work spans the small, rural communities of Ireland’s coast, to the management of global research projects that span over 45 countries.

HPRC itself is tiny—a small, two-story building on the north end of NUIG’s campus with only 5-10 people in the office on a given day. But what those 5-10 people have been able to accomplish is truly incredible. My practicum consists of two primary tasks: the first is the development of content for the new Mental Health Promotion online postgraduate degree, and the second is data analysis and dissemination of the 2018 Health Behavior in School Aged Children (HBSC) survey data (details on that to come below!).

‘What do children need to be healthy?’ youth engagement workshop hosted by NUIG HPRC at a school in Galway.

For the first two weeks, the majority of my time was spent working on the mental health promotion content. The program is unique in its focus on positive mental health versus the more traditional understanding of mental health as the mere absence of mental illness. Even so, I consistently found myself instinctively leaning towards language of traditional models of prevention of mental illness rather than promotion of universal mental health, and I’ve been really pushed to challenge my own assumptions and understanding of wellbeing.

Now, with the majority of the mental health promotion content behind me, I’ve switched full gear into data analysis and dissemination for the HBSC study. For context, the HBSC study is a global survey-based research study of school-aged children across the world. Surveys are administered to students in schools every four years, and the questions includes items around mental, physical and social health, as well as key demographic factors such as ethnicity, religion, and socioeconomic status. (Interestingly, some countries have specific rules on what you can and cannot ask children about—particularly when it comes to sexual orientation and sexual health! But that’s a discussion for another time).

Although I had a high-level understanding of the HBSC study before my first day, I wasn’t expecting to have so much freedom in the direction of my analyses. My first day at NUIG HPRC was intimidating—while sitting at a table of some of the top health promotion researchers in Europe, I was asked ‘what populations specifically are you interested in?’ If we were in America, I would know how to answer: indigenous and immigrant populations. But sitting at the table in Ireland thinking of evaluating mental health among Irish school children, I found myself lacking the necessary cultural context to answer that question. So I started reading. After a few days of background reading and close inspection of prior HBSC, I found myself increasingly interested in two key populations. The first is the Irish Travellers—a historically nomadic ethnic minority indigenous to Ireland with a long history of social isolation and discrimination. Irish Travellers are often mistakenly grouped together with the Roma community but they are in fact two completely distinct populations, though they both share a history of discrimination. The second population I am deeply passionate about is the study of UK immigrants vs. non-UK immigrants. Prior studies in Ireland have found disproportionately poor health outcomes among non-UK immigrants in Ireland, and I am interested in digging deeper into how health among first generation and second generation immigrant children in Ireland varies by their country of origin.

Although I’ve just begun digging into the data, I am already finding myself with so many more questions I wish I had the time to answer. My ultimate goal is to complete two short reports: one on mental health among Irish Traveller school children, and another on mental health among immigrant school children in Ireland. I’ll be writing a few ‘academic’ reports to post on NUIG HPRC’s website, but will also have the opportunity to use more creative means of communicating our findings to local non-profits such as infographics and brochures. I’m so excited to be able to pull together the findings and start disseminating them—NUIG HPRC’s work is critical to informing national policies and programs around childhood health and well-being. Drawing awareness of inequities is so critical for policy development, and I’m psyched to be part of the team!

Commuting buddies from my rural Irish home to the NUIG HPRC office.

Stay tuned for more updates on the data!

– Casey

Home is where the chapatis are

Kisii, Kenya is a city that is full of life. Less than one mile from the city’s center, I wake up to the sound of a rooster crowing at the small farm across the street and fall asleep to local music playing in the city. The streets are populated by locals walking, driving, or riding “boda bodas” (small motorcycles) around town. Vendors line the streets to sell their delicious, locally-grown produce, grains, meats, and clothes. I quickly learned that the staple food in Kisii is “chapatis,” which are basically glorified flour tortillas to accompany meat, vegetables, or beans. You will not find a single restaurant without them! Thank goodness, because I was hooked on day one.

Part of the urban center of Kisii, Kenya.

Walk just a few miles from the city center in any direction and you will find yourself surrounded by trees and small farms. Here, cars and boda bodas are replaced by cows, goats, chickens, and local farmers transporting their goods to the city.

The view from my room overlooking small farms and the urban center.

For my practicum, I am working with Curamericas Global to conduct operational research on an intervention in Kisii aimed at encouraging healthy behaviors for prenatal, postnatal, and newborn care. Curamericas has partnered with the Kenyan Ministry of Health to form what is called the Kisii Kenya Oroiboro Project (KIKOP), which has implemented health education programs in two catchments (called Iranda and Matongo) thus far. KIKOP initiated a Care Group training cascade in each of the two catchments and expanded the hours of each catchments’ health center so that they are now open 24/7.

Through my qualitative research on the project, I will meet with various stakeholders to determine what is going well so far for the project and what can be improved going forward. I am also conducting qualitative research on what constitutes a culturally appropriate birthing space for women in Kisii. Many mothers chose to give birth at home with a traditional birthing attendant rather than at the local health centers with nurses who are trained to handle birthing emergencies. My research will be used to create a birthing space at the Matongo Health Center that mothers in Kisii are more comfortable using.

One of the buildings at the Iranda Health Center in rural Kisii.

I have only spent one week in Kisii, but I am enjoying the city, culture, and my projects here already. My first day began with an orientation of the project and meetings with individuals at the Ministry of Health. I also visited the Iranda Health Center and observed a training that KIKOP staff were conducting for community health volunteers, clan elders, and traditional birthing attendants who are involved with the project. I was greeted with many warm smiles and a local song and even given my very own Kisii name (Betuku)! The rest of my first week has been spent on preparing for focus groups, qualitative interviews, and training sessions for KIKOP staff so that they can assist with data collection. I am excited for next week when I will begin field work to collect data and meet with local community members to hear about their experiences with the KIKOP project.

– Dana

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

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