Students and global health experts share their experiences working with communities.

Author: Global Health (Page 2 of 12)

SPH - Research, Innovation and Global Solutions Operations

Addressing global threats in our own backyards

When faced with difficult choices, I often come back to a central question: what is my intention, and how can this decision help me work toward that? In March 2020, I was happily living in Guatemala, serving as the on-ground Director of Operations for a small birthing center, run by local midwives and funded by a US organization. What followed that month is now well known to all of us, and I had a difficult choice to make about whether I would return home to begin my Master of Public Health. My final choice to start the program had many factors, but one thing became crystal clear in my mind: my home had become the global epicenter for a public health disaster. There was so much work to be done, and I needed to figure out how I was going to serve my home country.

Part of the reason I felt passionately about my work in Guatemala is that I believe that investment in healthier families is a critical in working to end poverty in the region, and ultimately a necessary factor to stem migration. No one wants to leave their home to embark on a dangerous journey; it is borne out of necessity. Issues affecting immigrants and refugees in the U.S. (especially Latinx communities) have always been one of my major interest areas, and I hoped that I would be able to integrate this into my practicum. As a student in the Applied Epidemiology concentration of the MPH, I also intended to use my summer to beef up my skills in data analysis.

End TB pin

Ending TB from my backyard in NC!

The pandemic has made it abundantly clear how public health departments are critical infrastructure in the US, and I was hoping to learn more about what it would be like to work for one. That’s why I was excited about the opportunity to work with the Tuberculosis (TB) Control Program at the North Carolina Department of Health and Human Services. For this project, I will be helping to strengthen community partnerships to prevent active tuberculosis. As part of the process to seek permanent resident status, applicants are required to undergo a medical exam which includes a test for latent TB. Latent TB can turn into TB disease, which requires much more difficult treatment and can spread to others. After COVID-19, it has become abundantly clear how important it is to prevent the spread of respiratory infections like TB and pay special attention to vulnerable populations who often bear the greatest burden.

This project will have two major components: compiling a database of all active practitioners that provide these exams (civil surgeons), and using this database along with existing data to estimate how many potential latent TB infections are detected annually, along with how many “status-adjusters” are seen each year. These data will bolster the case for funding for an educational program for civil surgeons on how to counsel those with latent TB and encourage them to treat the infection before it progresses.

I’m excited to dive into this project because it really embodies the reason I came back to the U.S.: global health issues are local issues. If the U.S. public health infrastructure was better equipped, we might have been able to stem the spread of COVID-19 in this country and around the world. TB is a growing threat globally and it’s critical to address it at home in North Carolina.

-Jaclyn

Global Health Practicum in the time of COVID-19

For most people, myself included, the pandemic upended our way of life, from the way we socialize to the way we work. Currently, I work as a pediatric surgeon, so prior to starting my MPH, I figured that I would have to find a practicum experience that would be flexible with regard to my work schedule; allowing me to meet my clinical responsibilities while fulfilling my practicum requirement. More importantly, I wanted an experience that would allow me to marry my research interest in access to prenatal care and neonatal outcomes in sub-Saharan Africa. For all these reasons, I was extremely excited when I got the opportunity to work with the UNC Gillings Zambia group which focuses on “improving public health, locally and globally.” Specifically, I was selected as a practicum intern for the Antenatal Care/ Postnatal Care Research Collective – Household Survey (ARCH), a multinational collaborative that aims to optimize birth outcomes in low resource settings. I don’t think that I could have asked for a better practicum opportunity, as it aligned perfectly with my interests.

In my role, I will be working to help with study start-up and implementation of a new longitudinal household survey of 5,000 households in Lusaka, Zambia. The goal of this survey is to gain a better understanding of the behavioral and reproductive health of women of reproductive age. Ultimately, the results from the study will provide estimates of the burden of maternal, newborn, and infant disease; and provide information regarding key risk factors and social disadvantages that contribute to adverse maternal and neonatal outcomes. I am excited to be part of this study, albeit in a small way, because I think we know little about factors related to preconception and antenatal care of women in resource-limited areas. This area of research is particularly important because I think better understanding will provide information not only regarding factors affecting maternal health, but also regarding the burden of birth defects and help to inform planning for and improving neonatal outcomes.

During my practicum experience, I will be working to develop training materials for field research staff and recruitment materials for study participants.  Over the last few weeks, I have been working on getting acquainted with the study protocol, and meeting key personnel for the study. I have also started working on some of the participant recruitment materials.  It has been really interesting having meetings on Zoom to discuss the study and its initiation. It has made me long more for in-person meetings, because I think that it would have been great to meet some of the people with whom I’d be working. I also think that it would have been an amazing opportunity to be on ground in Lusaka. I am still hoping that I will be able to visit the Zambia Hub in the future.  In spite of the challenges regarding not being in-person, I have been fortunate to have a preceptor who has been available and easily accessible.

There are number of things that I am looking forward to in my practicum. Firstly. I am looking forward to learning how to carry a research study from a concept, to one that is actualized in practice. I am also looking forward to developing the training schedule and materials that will be instrumental in initiating the study. I feel that this project will allow me to think critically about an important part of research study implementation, in which I have little experience. Lastly, I hope that this experience will provide opportunities to build relationships with researchers who have similar interests, in improving prenatal access to care and neonatal outcomes, in resource-limited settings.  As a physician who is interested in global surgery and research, my involvement will therefore provide me with the skills to develop study management tools, train research staff in international settings, and establish methods to monitor data quality. Given that the study is still in the early stages of implementation and initiation, I believe that I will gain valuable experience regarding the successful implementation of a research protocol.

Although I expect to have a busy summer, I’m planning on making the most of the sunny days by doing as much work as I can outside :).

‘Desola

Silver Linings – Completing A Global/Local Practicum in the Times of COVID-19

Since I graduated with my bachelor’s in International Studies last Spring, I have been in somewhat of a state of limbo. I enrolled at UNC in the Global Health concentration of the MPH, but have struggled to find my true passion within the global health space. Compared to the impressive drive and expertise I see in my peers; I have felt comparatively directionless. I struggled this year, in part, I think, due to the online format of our courses, to feel like I have found my place in the global health space. However, despite reinforcing my passion for public health, I had not quite found my niche when it came time to begin the practicum search process.

It would be a lie to say I am disappointed to be completing my practicum online this summer. In fact, quite the opposite, I honestly feel that this experience could not have worked out more perfectly in my favor. My primary anxiety surrounding the practicum experience, for essentially as long as I can remember, has not been the practicum itself, but rather finding an opportunity that would not only be practically feasible, but which would align with my interests and career goals. I ideally wanted a policy-focused placement, working on women’s health issues, which would allow me to keep my RA position over the summer. I was so concerned during the search process, after facing rejection after rejection from viable opportunities, that I would end up with a loosely-global-related placement where, although I would still gain valuable experience and skills, I would not be doing work in which I was genuinely invested. So when we all received the email saying that due to COVID-19 travel restrictions, the global requirement of the practicum would be waved, I breathed a massive sigh of relief.

With this parameter eliminated, I was given the freedom to search for opportunities in North Carolina, tackling pressing health concerns locally. I feel fortunate to have been accepted at my current practicum position with the UNC Hospital’s Beacon Program. The program provides comprehensive, coordinated care to UNC Health System’s patients, families, and employees experiencing a variety of interpersonal abuse and includes services for children, victims of domestic abuse, or intimate partner violence (IPV), human trafficking, sexual assault, the elderly, and vulnerable populations. In my role as a policy intern with the Beacon Program, I am spearheading efforts to investigate, create policy recommendations, and bring awareness to patient safety and privacy concerns arising from a new federal statute, the 21st Century CURES Act, that requires health systems to make medical records more widely available to patients.

Implementation of the CURES Act has led to new safety concerns for patients whose family members or other caregivers may access their medical records via online portals and has reinforced existing patient safety and privacy vulnerabilities surrounding the MyChart and OpenNotes portals. For example, provider notes detailing child abuse or domestic violence may cause family members to retaliate and cause further harm to the patient. There are grave patient safety concerns for victims of sexual assault and stalking, whose records of abuse or location information may be more readily available to their abusers. In addition, standard-of-care issues exist for patients with stigmatized diagnosed conditions (mental health issues, STI status, etc.) recorded in MyChart. There should also be serious questions asked about the process of obtaining informed consent for these portals.

My work in the first few weeks of my practicum has been exciting and engrossing, as I have found that many of these issues have not been addressed or even discussed at all in academic circles, let alone translated into practical solutions in a clinical setting. I even spent the last week investigating how difficult it is to make a fraudulent MyChart account (read: attempted to do so) and found it to be shockingly easy. I am so excited to continue this practicum doing what I find meaningful and fulfilling work and begin working on policy avenues for protecting patients put at risk by this statute at UNC and elsewhere. I will also create materials for provider education on harm reduction and draft a commentary on the issue for submission to peer-reviewed journals.

I am happy to say that there has been more than a bit of serendipity in the way things have worked out during this practicum. Despite my previous worries, the opportunity to do a remote, non-globally-focused practicum has helped me discover my passion in the public health space and feel that I am contributing to work that will positively impact my own community. This format has also allowed me to continue to work as an RA part-time, and I have also had the added benefit of being able to work from my home office and spend a little extra time with my pandemic puppies (pictured above). This experience has so far taught me that sticking it out through anxiety and discomfort can often result in a surprising silver lining. I look forward to finishing the practicum to see what else I will learn from this opportunity.

Gabbi

Leveraging monitoring and evaluation for strong water, sanitation and hygiene programs in India

At the shoreline of a beach.

Taking some time to visit the coast

Happy Summer! My name is Katie Hammer a current MPH candidate at the Gillings School of Public Health, concentrating in Environmental Health Solutions. Before beginning my studies at UNC, I worked for three years at Abt Associates as a member of several health system strengthening project teams. I discovered the water, sanitation, and hygiene (WASH) sector while working as a Monitoring and Evaluation Analyst on a $150 million USAID- funded private health sector project. Through our work, I began to see how poor WASH infrastructure and systems impacted all areas of public health, from maternal and child health outcomes to the spread of infectious diseases like malaria and cholera. I quickly realized this was the area I wanted to specialize in moving forward. It’s actually part of the reason I chose to study at UNC – I couldn’t miss out on the opportunity to learn from and partake in The Water Institute’s great work!

Working as a Monitoring and Evaluation Analyst also taught me the value of data. I managed the project’s monitoring platform, Newdea, for 11 field countries and 3 core teams, ensuring the project had a high-quality data monitoring system. I empowered country teams to look across their past data to find trends and patterns through effective data management. I fell in love with working with teams to facilitate data-driven implementation and impact.

As part of my practicum, I will have the opportunity to build on those experiences. I’ll have the privilege to partner with Gram Vikas, an Indian NGO, Gram who has been operating in the Odisha district in Eastern India for the past 50 years. They partner with rural communities to enable them to lead a dignified life by building their capabilities, strengthening community institutions and mobilizing resources. Gram Vikas has been working to understand the piped water supply and sanitation infrastructure as well as the institutional systems for community ownership and management of the systems since 1997. Their hard work has culminated in massive amounts of data, over 40,000 households worth.

I will collaborate with Gram Vikas and The Water Institute at UNC to evaluate their piped water and sanitation interventions for sustainability and impact. We will also look into how other variables are impacting these sanitation systems. We will be using local rainfall data, Indian Census data, and Odisha’s State of Environment data to get a broader picture of Gram Vikas’ impact.

Two computers full of data looking out into the Carolina sky.

Office with a view

I am excited to learn how to use new analysis processes to get more in-depth insights into programmatic impact. I am particularly interested in learning more about the use of geospatial analysis when manipulating large datasets. I hope that through these analyses, we will be able to provide Gram Vikas valuable insights that will inform their work for years to come! I am deeply grateful to both Gram Vikas and The Water Institute at UNC for this opportunity. This practicum wouldn’t be possible without The Water Institute at UNC, as the expertise this institute provides was key in making the connection for this practicum.

Katie

 

Gaining Experience and Prioritizing Self-Care

For my summer practicum, I am working with the North Carolina Coalition Against Sexual Assault (NCCASA) to create and present a toolkit on how to detect and prevent human trafficking on college and university campuses.

I have always been interested in the anti-sexual violence movement, starting at UNC Asheville where I went to undergrad. I was able to work with the Center for Diversity Education in creating a presentation on the importance of bodily autonomy on college campuses. This experience catapulted my passion for sexual and reproductive health justice which is what I’m most interested in focusing on professionally at Gillings and after graduating. However, I have never worked in the anti-human trafficking field, so I was nervous that the onboarding experience would be way too overwhelming to turn into a toolkit in such a short amount of time. During my first two weeks, I spent most of my days conducting literature reviews, watching recordings of presentations, and meeting with my preceptor to talk through the several pages of resources. While it was (and still is sometimes) overwhelming familiarizing myself with the history and language, I enjoyed talking through this new material with my preceptor. The anti-human trafficking movement is a very politicized movement and there are disagreements on how to address human trafficking between different types of organizations. For example, sometimes right-wing anti-human trafficking organizations focus on criminalizing sex work, while public health based anti-human trafficking organizations (like NCCASA) understand that victim blaming is harmful and rather focus on outer-layer solutions and prevention models that are more helpful for survivors and community members.

As you can imagine, the topic is emotionally difficult to read about, so self-care is discussed quite frequently at NCCASA. It is really refreshing to experience an organization that takes self-care and mindfulness seriously. I am looking forward to gaining experience working with an organization I admire so much and having these very difficult, and necessary, conversations.

I was also apprehensive of working from home this summer on a project that would benefit to work hands on with other people in NCCASA. I want to make sure that this toolkit acts as a useful resource for NCCASA and other stakeholders, and not just something to check off for a grade at the end of the summer. My preceptor has been so supportive and easy to talk to that I feel really lucky to be able to work with them as they continuously check in to make sure I am getting the most out of my practicum experience, which in turn is helping motivate me to do the work. They have also been really great at making sure I get to meet with important anti-human trafficking advocates who work at NCCASA. While I would love to work in person and directly with the community, I am really grateful to still be able to meet people who work in a field that I find extremely important. Hopefully I get to meet them in person next time!

River, my dog!

River keeping me company on my Zoom meetings.

While working from home has its challenges, I am able to spend time getting ready for my move to Chapel Hill in July (finally!), work outside, and enjoy new coffee shops with friends which has been fun now that I am fully vaccinated!

Sydney (in the MCFH concentration) and I working on our practicum deliverables.

Sydney (in the MCFH concentration) and I working on our practicum deliverables.

I have also been able to take this as an opportunity to dog sit which is the best way to spend work breaks 🙂

River (smiling) and Duce (sleeping) on the garden bed… their new favorite spot.

River (smiling) and Duce (sleeping) on the garden bed… their new favorite spot.

Looking forward to continue truly connecting with this work and with the anti-human trafficking community.

Hadas

Practicing gratitude in times of uncertainty

A lookout from a mountain and looking into the forest.

Taking in some views.

As most others can relate, it is disappointing to have an online program after a year of online coursework. However, this last year I have become well-acquainted with practicing gratitude in times of disappointment or uncertainty. I have found many things to be grateful for. First, I am grateful to be learning from and working alongside with many committed individuals through the UNC Division of Global Women’s Health. This is one of the Zambia Hub internships that focuses on program management and administration. Additionally, the flexibility of a remote practicum has allowed me to visit family and friends that I otherwise would not be able to! The flexibility has made it possible to pursue other interests as well without feeling like I am neglecting the valuable internship experience.

There are two projects I will be working on this summer, one for cervical cancer in low-resource settings and the other to address adverse birth outcomes. My responsibility is to design a suite of communication materials to indicate on a larger level how UNC is contributing to the body of research and clinical practice in novel and innovative ways. This has consisted of an orientation period in which I reviewed program quarterly and annual reports, proposals, and the literature from the researchers and others.  I have worked with my preceptor, the program manager, to interview the country leads to understand their need for communication materials as well as central themes and gaps in the research or practice. The website content I drafted will be up on the website somewhat soon!

Flowers looking out into the vast forest.

Nature.

Lighthouse from a grassy area.

Lighthouse.

Overall, I am excited to gain some valuable insight into how a multi-level research program operates and how one manages several different projects at once. One of my favorite things I am learning is how important it is to keep perspective in how individual programs contribute to the overall goals of an organization. That being said, I know I have a lot to learn and look forward to that over the next several weeks!

Due to the remote format, I have been in the Triangle area rather than in Zambia. But I am happy to be able to explore some more of the beautiful state of North Carolina.

–       Renée

Global is Local (and on Zoom).

Bridger making a peace sign in front of some large dinosaurs

A positive side-effect of doing a practicum remotely practicum: getting to visit your parent’s new home in Utah (and making some new friends).

In some ways my 2021 practicum summer, like many things in a school year defined by the pandemic, is a lot different what I would have expected before enrolling. Having been unceremoniously removed from my life in Panama at the onset of the pandemic, I had always envisioned my practicum as a chance to dive back into working overseas, forming and learning from international partnerships in community settings. Instead, I’m conducting a practicum entirely via Zoom, working remotely with a public health organization based in Colorado.

However, in other ways, my position has been providing me the exact kind of experiences and challenges I was always hoped for in a practicum. My interest in Public Health and global practice began during four years of service with the Peace Corps in Panama. This form of grassroots development and health education has shaped the way I view and engage in Global Health work, learning and working alongside community-driven programs. However, in partnering with the United Nations Development Programme in the Darien gap, I became interested in developing the skills to identify ways to leverage large-scale resources to support community-driven efforts. My practicum so far has placed me at this nexus of community outreach and institutional power.

I’m interning with Pitkin County Public Health in Colorado, filling a position through a Preventative Health Block Grant seeking to address significant health inequities in their health and community infrastructure exposed by the pandemic. Specifically, the grant and the team I’ve joined of members of three neighboring public health departments and community stakeholders, is intended to improve health equity, especially for the Latinx and immigrant population in the area. As an intern I’ve taken on facilitating the development of deliverables such as a mental health awareness and promotion campaign, resource guides, and internal trainings for county organizations to apply an equity lens towards their services.

There’s a clear equity gap in Pitkin County and the surrounding area. Aspen, the largest town in the area, is a well-known resort community with high cost of living, and a population that more than doubles during the winter ski season. However, there’s a significant population of service and industry workers who support this resort lifestyle, including a large Latinx and immigrant population. Many locals struggle with high cost of living and services in the greater Aspen area, and many live in neighboring counties of Garfield and Eagle—however, the pandemic has helped illuminate the level of existing inequity in many regards, including access to health services and information.

It’s been an interesting challenge gaining contextual knowledge around the Pitkin County area and going through the process of making connections and building relationships all remotely. The virtual format has pushed me well out of my comfort zone, cold-joining lots of Zoom meetings with different agency partners, sending out emails to make connections with individuals, and not ever visiting the spaces I’m attempting to serve. It has struck me as an odd sensation to be discussing programs for a community I haven’t visited since I was 3 years old, but strangely enough, Global Health organizations do that all the time—as such, I’ve taken this challenge as a way to practice combining a community-centered approach to program development within the types of higher up, NGOs and Government agencies I could find myself working in someday after my degree, far removed from the field.  While many of the mediums I’ve been using have been out of my comfort zone, when in doubt I’ve relied on some practices learned the hard way during my time with Peace Corps: 1) ask an endless stream of questions, 2) prioritize relationships over producing results, 3) defer all expertise to my local partners.

Applying these approaches has definitely come into conflict with larger realities of my practicum position at times. For one, there’s simply limited time to share and learn in the punctual and itemized Zoom meetings of a government agency. Secondly, the grant I’m working under has very real deadlines around deliverables and progress. With June about to be over, time limitations have forced relationship building and production to be a simultaneous process. The organizational practices fueled by fiscal infrastructure are something I’ll need to be able to navigate effectively, and I think this practicum is giving me great preparation in that regard.

Running from a T-rex

(Note all of them play nice).

It’s exciting after a year of school to be facilitating the development of materials with the potential for real world impact again. Even though just on Zoom, I’ve enjoyed the early relationships with work and community partners in this position. I’ve also appreciated the opportunity to apply skills acquired in Peace Corps to work with international populations in a domestic space. While so much is different than I would have expected a year ago, an early takeaway for me from my practicum is that core elements of learning exchange and collaborative partnership are universal with work addressing gaps in health equity, regardless of miles traveled or hours zoomed.

Bridger

Finding the light in a remote internship

One of my co-workers for the summer

One of my co-workers for the summer

As a mother I am so passionate about children and their rights, when I was looking for a practicum, I was hopeful to be working with an organization whose mission is like mine. I believe that all children have the right to be safe and to access to basic needs especially water; this intersects with the UNICEF vision statement which is “to create a world where the rights of every child are realized.” My dream became true, and I was accepted to do my summer internship with the UNICEF where I am currently working with their Water and Sanitation team focusing on the Middle East which is the region where I came from. Since the beginning of the practicum, I was hoping that it will be in person, I miss meeting new friends and learning about their work experiences and networking. I feel being online makes it harder to open new conversations and its more challenging to deal with the online technical issues.  Despite those challenges I promised myself to make the best use of my time and to make my internship a fruitful one. Since the first day of the practicum, I set myself daily reminders which are:

  • Every day is a new day.
  • I will do the best of what I can.
  • I am always proud of my accomplishments
  • I will reach out and ask questions.

An opportunity to work with the Sanitation and Water for All (SWA) team is unique. This practicum is a great opportunity for me to use the knowledge and skills I gained from the first two semesters of my graduate program to help communities around the world. Through my 200 hours training I will be working with the Country Engagement team at UNICEF to develop an engagement strategy so we can expand UNICEF’s work in the Middle East. I will also write a report about the role different UNICEF partners play in different region and how we can expand their work beyond water Sanitation and Hygiene to focus on other areas such as COVID-19. In the first two weeks of the practicum, I enjoyed attending SAWA’s teams’ meetings and webinars on important topics. I have also participated in discussions on how to engage more countries from the MENA region (Middle East and North Africa) in SWAs’ work. It was very interesting to learn about the great work those teams are doing all over the world. I am so hopeful that by the end of the internship I will gain more practical skills which I can apply in my future career.

– Alaa

Zooming to Zambia

Out in nature

Out in nature

With the school not approving Summer travels, I knew it was highly improbable for me to travel to Lusaka, Zambia, for my practicum. Nevertheless, I had the tiniest hope that things would work out just in time to make the journey possible. I felt like I deserved the trip after a semester-long love-hate affair with virtual meetings and zoom (zoom fatigue). Somehow, my “tiniest hope” yielded nothing, as I am still here in the triangle, collaborating with the research team in Zambia via zoom. I call it Zooming to Zambia!

To cope with the disappointment, I decided to make a mental visit to Zambia. In my mind, I arrived in Lusaka (Zambia) on May 17, 2021, to commence my practicum, and since then, I wake up each day saying Zikomo kwambiri, a phrase in Zambia that means “thank you very much.” I say this phrase for a couple of reasons. First, it helps me stay focused on my practicum work. Waking up to this phrase gives me a mindset of rolling up my sleeves and working on my daily goals. Second, to express my gratitude for the opportunity to work on a project I am passionate about. I did not come about this latter reason arbitrarily. Having a heart of gratitude has defined my existence over the past year, and it has seen me through the endless days of zoom fatigue and feelings of isolation.

Taking in the scenery

Taking in the scenery

My practicum is qualitative research to assess the feasibility and acceptability of engaging family members to support HIV-positive mothers to practice recommended infant care and feeding practices, and adherence to antiretroviral therapy. We are using a formative research technique- the Trial of Improved Practices (TIPs) for this study. So far, the work has been gratifying and deeply rewarding. On weekdays, I have a regular work schedule. In addition, I have virtual meetings with my preceptor, Dr. Stephanie Martin, to assess the progress of the study, and I also meet with the research team to review the data and troubleshoot the various challenges and hurdles experienced by the data collectors. Through the research, I look forward to gaining a thorough understanding of the role of partners and other support systems in the prevention of mother-to-child transmission of HIV.

To rejuvenate and recharge, I ensure my Saturdays are work-free. I use this time off to hike with international friends and pursue other interests. I recently took a hike at the Raven Rock State Park (see the goofy pictures). Upcoming hikes will be all-day hikes at the Hanging Rock and Appalachian Trail.

For now, even though I am stuck with zoom and virtual meetings, I could not have asked for a better practicum, preceptor, and research team. So I am grateful for the opportunity, and the tech that make virtual collaborations possible. For these reasons, I say Zikomo Kwambiri.

Olu Adeniran

Zikomo Kwambiri is from the Nyanja language, which is spoken widely in Lusaka.

 

Just Keep Hiking

Road to Ibanda Village

Road to Ibanda Village

For my summer practicum, I am working at PHEAL-ED, a nonprofit research collaborative between UNC and Mbarara University of Science and Technology (MUST) based in Western Uganda. The collaborative is on the site of a government funded health center (think of something between an overnight clinic and a full hospital).

In 2018, PHEAL-ED received 200 Sickle Cell rapid testing kits as a donation from Biomedomics, in Durham, North Carolina. While the individuals who received the tests were not gathered from a statistically random sample, the results of the testing showed a significantly high proportion of individuals with Sickle Cell Disease (SCD) or Sickle Cell Trait (SCT), in some cases 2-3 times higher than has been found in the surrounding region. So, the government health center and PHEAL-ED began thinking about the possibility of starting a dedicated Sickle Cell Clinic, where individuals with SCD or SCT can come and receive treatment, counseling, and education on the disease.

Hiking to Kisamba Village

Hiking to Kisamba Village

To assess the need for such a clinic and the feasibility of providing those services, PHEAL-ED needed some background information on the situation in Bugoye subcounty (the community this health center serves). My job is to assess the community and provider awareness of SCD and the current services available to those with SCD (clinics, drug shops, traditional healers, etc.). Then using this information, propose what is needed to conduct a monthly Sickle Cell Clinic and the community’s receptiveness to the service / likelihood of service utilization.

So far, my work has been based around assessing SCD awareness through household surveys in the 35 villages of the subcounty. As of this week we have surveyed 21 of the 35 villages. We have also visited 3 healthcare facilities in the subcounty to provider awareness of SCD, and then 5 healthcare facilities in the nearest large town to collect data from each of their Records Departments on the number of SCD cases each facility has received in the Inpatient, Outpatient, or Laboratory Departments.

Hiking to Mirimbo Village

Hiking to Mirimbo Village

The practicum challenges so far are mainly centered around the location. This area is right on the equator, and the strength of the sun here can sometimes be unbearable. Additionally, this subcounty includes portions of the Rwenzori Mountain Range and the valleys between the mountains. So much of my day in this survey portion of the project has been hiking up and down the mountains to reach each village. While I don’t know the main local language, this community also speaks and understands Rutooro, the language used just north of our location. Being able to communicate with the community as I travel and survey villages has been an enormous aid in the efforts of the project. Additionally, PHEAL-ED has graciously hired a research assistant for my practicum project to further aid me in more accurate translations and the establishment of community trust.

Meeting with a VHT from Rwakingi IA Village to discuss SCD and the reason for our survey. Both permission for photo and the explanation for its use was given before photo was taken

Meeting with a VHT from Rwakingi IA Village to discuss SCD and the reason for our survey. Both permission for photo and the explanation for its use was given before photo was taken

What I am most excited about is pulling all the information together and getting to present a case for a full Sickle Cell Clinic (or referral to other nearby SCD service, if one is found). We’ve already discovered dozens of children with SCD and the community is has expressed such a demand for this clinic. Since the project began, the word has spread like wildfire, and every evening when I return to the hospital compound (where my house is), they tell me that even more people have come, traversing the long distance to reach the hospital and inquire about this SCD Clinic. The community understands the dangers of SCD, its prevalence in their district, and are desperate for solution.

So I’m going to keep hiking and gathering data, doing whatever I can to finish this first step towards their solution.

Tiffany

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