Global Health Travel Blog

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

Category: Zambia

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

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  

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

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 Zambia and 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 data that 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

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

FAMLI already feels like FAMILY

As we walked through the UNC Women’s hospital doors last week, we were excited to be back in the clinical setting, but this time in a different capacity, as interns on the Bill and Melinda Gates Foundation funded Fetal Age and Machine Learning Initiative (FAMLI).

The Fetal Age and Machine Learning Initiative is a collaborative project being conducted by the UNC Global Women’s Health Division, NC State University and the University of Zambia School of Medicine. The overarching goal of the project is to develop a robust, inexpensive, widely deployable ultrasound device that can assess gestational age and other important obstetric conditions while requiring minimal operator skills.

We were welcomed by our preceptor and a friendly team of sonographers and researchers.

L-R: Dr. Rosenbaum (Preceptor), Munguu, Enam, Arieska (Sonographer) and Stephanie (Research Assistant)

L-R: Dr. Rosenbaum (Preceptor), Munguu, Enam, Arieska (Sonographer) and Stephanie (Research Assistant)

This summer, as interns, we will be contributing to this project by annotating ultrasound images that can be used to train machine learning algorithms to correctly assess gestational age and other diagnoses. Our experience will enable us to learn to properly identify and annotate ultrasound images of fetal parts, and assist in building a system that will help future annotators learn similar skills and perform the annotation tasks consistently.

Enam practicing reading ultrasounds.

Enam practicing reading ultrasounds.

Finally, we say this feels like family because we have a unique advantage of meeting with the team both in-person and virtually, and participating on conference calls that involves a diverse interprofessional team such as clinicians (OB/GYN, RN, sonographer), research staff (research assistants, managers), data managers, financiers (Gates Foundation), and collaborators (engineers and N.C. State and Google).

Watch out for future blog posts focusing on the second part of our internship where we get to travel and meet the team all in the way in Lusaka, Zambia!

-Enam and Munguu