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

Category: Previous Blogs (2019) (Page 1 of 3)

Faculty in South Africa

Blog post by Kurt Ribisl, Professor and Department Chair, Department of Health Behavior

Greetings from South Africa!

I am spending 10 days in South Africa (Johannesburg and Cape Town) and Zambia (Lusaka) to meet our research and practice partners.

My days have been filled with meeting UNC undergraduate students taught by Alex Lightfoot in Cape Town and visiting their internship sites. I gave talks on e-cigarettes and vaping at the University of Witwatersrand and the University of Cape Town. I have also been meeting with researchers doing cutting edge work in HIV and gender-based violence. On Sunday, I fly to Zambia to meet with Dr. Ben Chi (UNC Gillings) and his colleagues at the University of Zambia including the dean of their School of Medicine, Dr. Fastone Goma who leads some exciting CVD and tobacco control work.

Alex Lightfoot and I also met with the leaders of Black Sash, a group started by a white middle-class woman who opposed apartheid in the 1950s. They are still going strong and now advocate for social policies to benefit vulnerable populations in South Africa. We then visited the Red Cross War Memorial Children’s Hospital in Cape Town, which is regarded as South Africa’s leading center for postgraduate specialist pediatric medical and surgical training. We met with a student who shadowed health care providers carrying out trauma surgeries to basic family medicine. She saw 30 burn patients and is the only specialized pediatric burns unit in Africa. Several were burned by hot water and others by cooking oils. She wants to learn more about public health and injury control programs that could prevent these devastating injuries. She saw two very young children were being treated for lipoid pneumonia, a condition brought on from inhaling oils in the home. I immediately thought of the 6 people who have died from vaping over the past 2 weeks, most of whom also had lipoid pneumonia from vaping THC and CBD oils.

Deborah Baron gave me her copy of Trevor Noah’s book, Born a Crime. I can’t recommend this book enough – it provides an insightful look at what it is like to grow up under Apartheid. Alex assigned this to all of her students taking her Apartheid class and we have referred back to it several times.

Just before I left, two events have shaken South Africa. First, there have been numerous xenophobic attacks against foreigners and their businesses. Many people are being forced to flee back to their home countries.

I met with Dr. Mutale from the University of Zambia the day before I left Chapel Hill and he mentioned that they had to repatriate all of their students from South Africa. Refugees filled the Scalabrini Centre on my visit there. Volunteers were creating resumes for them, helping them find jobs and fill out asylum paperwork. I watched a room full of migrants taking online courses at the University of Southern New Hampshire to earn their AA degree. One woman lost her livelihood when looters torched her business. Like others in our group, I bought one of her remaining 15 handmade bags to help her raise funds to start over. We were also saddened to hear of an African migrant whose asylum was rejected by a panel of 3 white male judges ‘because she had not been raped enough times.” Scalabrini workers are doing all they can to advocate for migrants during these tough times.
Finally, Uyinene Mrwetyana, a Univerity of Cape Town student was raped and murdered at a Post Office. Crowds of protestors are speaking out against gender-based violence. You can see images I have seen all over campus and town. I am so proud that many of our faculty also work in addressing gender-based violence. Like most of public health, this trip is exhausting and totally inspiring. I look forward to forging stronger ties with our colleagues and partners here in Southern Africa.

Warm regards,

A Glimpse into Humanitarian Work

This summer, I’ve been interning with Save the Children and the Interagency Working Group on Reproductive Health in Crises (IAWG), working on Adolescent Sexual and Reproductive Health in Emergencies (ASRHiE). Part of my position there was working on research to finalize the Training of Trainers (TOT) package on ASRHiE, which is delivered to people working in Sexual and Reproductive Health (SRH) in Emergencies. I was very lucky to be offered the opportunity to finish out my internship by going to Cox’s Bazar, Bangladesh to provide logistical support for a TOT lead by some of IAWG’s new trainers.

It was a bit tricky to arrange, since it meant missing about a week and a half of school, but I was very lucky to have supportive professors and supervisors. Thanks to them and to my amazing supervisor at Save the Children/ IAWG (and to some very quick processing by the Embassy of Bangladesh in DC), I got my visa and flight arranged, and arrived in Bangladesh on August 22nd. I spent the night in Dhaka, and the next morning caught my flight to Cox’s Bazar. On my way to the airport, I shared a van with a really lovely couple who had worked for Save the Children in more than 10 countries. We wound up going to dinner together later that week, and I heard all of their fascinating stories from their travels.

I had one or two days in Cox’s Bazar to explore, and was surprised by just how beautiful the town was. The beach is the longest one in the world (a fact that the country is very proud of), and some areas of it are very empty and beautiful. I took tons of pictures on my walks, and it was great to get a chance to see some of the less touristy areas of the town.

The traditional fishing boats that people in Cox’s Bazar use.

The traditional fishing boats that people in Cox’s Bazar use.

The main coordinator for the training works for UNFPA, so I spent Saturday at their office prepping all of the materials for the training. It was so interesting to get a sense of what the offices looked like, and to hear from the trainer on her experiences working with UNFPA.

Then the training began! It was only two days, but those two days were packed. It took some time to work out the kinks, but I think that the participants got a lot out of it. We had every person we invited attend, representing over 14 organizations working in Bangladesh. I met so many interesting people, and we got a lot of great feedback to continue to improve upon the training in the future. It was fantastic to get a chance to see the training in action after researching so many of the topics that were covered.

All of the participants and trainers

All of the participants and trainers.

Unfortunately, due to rallies in the refugee camps in Teknaf over repatriation, we had to postpone our scheduled field day until after I left. However, I was very lucky to have a colleague there willing to take me to see the camps in Ukhiya the following day so that I could see the health post and primary health care center there and get a chance to try out one of the tools we discussed in the training. It was interesting to see all of the steps required to visit the camps: I had to visit the government office to receive a camp pass (with a specific date and camp number to visit) and attend several briefings around security, child safeguarding, and media/communications. These briefings helped to ensure I understood the do’s and don’ts while in the camps, and to protect the refugees that live there. I wasn’t ever sure it would happen until finally, it was Wednesday and we were getting into the van to head down the coast!

It took about an hour and a half on winding side roads, as well as passing through several police checkpoints to get to the camps in Ukhiya. We first visited the Save the Children primary health care center (PHCC), which lies right at the entrance of the camps so that it is able to serve both the host and refugee communities. I got a tour from a staff member there, and had the chance to see all of the buildings within the PHCC. Everything was very clean and organized, and they are able to provide fairly comprehensive services there. The manager was one of the people who had attended the training, so she and I sat down to chat for about 45 minutes, going through items on the Adolescent-Friendly Facility Checklist. They’re doing really fantastic work there, and it was wonderful to see all of the steps they are taking to serve more vulnerable populations.

The family planning room at the primary health care center.

The family planning room at the primary health care center.

After that, we headed over to the health post in the closest camp. It was a quick drive, and then we had to get out and walk as the van couldn’t get the rest of the way. The camps were built in a flood-prone area with many hills and valleys, so steps and paths have been built into the sides of these hills as the camps expanded. We walked along the dirt path, with little shops, makeshift shelters, and learning centers on each side. All around us, kids were running and playing, men were chatting over tea, and people were carrying water and food back to their shelters. I was surprised to find that, in many ways, it felt like a more crowded village.

The health post was under construction, so I spoke with the manager (another person who had attended the training) in the temporary space that they are using, and again went through the Adolescent-Friendly Facility Checklist. They are serving so many people daily, each day speeds by and the midwives and family planning assistants have little time for a break. It was great to hear about their experiences at the health post, and to know that they are able to provide family planning assistance so many people.

The new health post that they are finishing work on.

The new health post that they are finishing work on.

After lunch back at the PHCC, we started our long trek back to Cox’s Bazar. The following day I did a bit more exploring, and met with the SRH Manager for Save the Children to talk through my feedback from the time at the PHCC and health post. She’s spent several years working in conflict zones, so I also took the chance to speak with her about her experiences. Between talking with her, the national staff at the Save the Children office, and the couple that I met on my way over, I got a much better sense of what working in humanitarian settings can look like.

Even though I only had a bit over a week in Bangladesh, I learned a ton between the training, meeting all of the amazing people working in these responses, and seeing the PHCC and health post in person. I am so grateful for the opportunity to put my learning into practice, and I hope to continue working with IAWG as I move into my final year at UNC’s Gillings Schools of Global Public Health.

– Erin

Mwauka bwanji to all our readers!!

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

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

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

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

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

Observing the doctor scanning the mother.

Enam scanning a mother with her permission.

Munguu scanning a mother with her permission.

Alan interacting with a mother who benefitted from FAMLI scans.

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

Enam learning to carry a baby with a chitenge.

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

Munguu with White Rhinos in the background.

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

– Munguu and Enam

Equity as a Public Health Priority

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

The short answer? Yes.

Urban hiking in the Melville Koppies

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

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

Rendani modeling her Right to Care jacket

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

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

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

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

Shadow Boxing by Marco Cianfanelli in the Joburg CBD

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


Hustler Nation & the Jack of All Trades

Visiting new places in Mauritius – Participating in Medical Camps

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

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

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

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

Talking about (dis)abilities

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

Youth with disabilities taking part in employability training

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

Free services at Medical Camps – prosthesis adjustments and reparations

– Yovania

The importance of a dream team

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

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

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

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

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

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

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

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

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

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

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

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

– Hunter

My last weeks in Kisii, Kenya

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

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

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

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

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

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

– Dana

Farewell (for now) Lusaka

Traditional Chitenge Dress I Had Made for a Bridal Shower

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

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

Victoria Falls

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

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

Sunset Over Zambezi River

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

– Taylor  

¡Adios, Guatemala!

“You just missed it, she gave birth while you were in the bathroom.” This is what one of the Casa Materna managers, Michelle, shared with me during one of my barrier analysis survey trainings in Tuzlaj, Guatemala. She assured me that I hadn’t actually been in the bathroom that long (which was a relief) and that the birth had happened a lot faster than anyone had expected. I was extremely lucky to share half of my experience in Guatemala this summer with fellow Gillings Student Emily Berns, who joined me moments later. Before we entered the room to visit the mother and newborn, Michelle told us that the girl who had given birth was thirteen years old. Having never seen a birth before, I began to feel fortunate for my poorly-timed bathroom break. This was one of many surprises that this summer held, including playing multiple games of dreidel with the staff and finding Philadelphia cream cheese in the rural highlands!

It rained most days in Calhuitz, but one day we were rewarded with a rainbow!

After completing a barrier analysis training at three different Casa Materna locations, I had some down time. I was able to observe the nurses at the Casa Materna as they did some routine prenatal consultations. Despite a slight miscommunication at first (the word for ultrasound in Spanish “ultrasonido” sounds a lot like the word for United States “estados uniods” when said quickly and made for some strange context clues), I was able to observe my first ultrasound. The nurse, Anne, told me to feel the woman’s stomach to see if I could tell what position the baby was in. I’m not a nurse, so touching this woman’s stomach felt strange and like I might offend her in some way, but she smiled at me and told me it was alright. I felt around blindly until I found a hard area, which Anne told me was the baby’s head. She then drew a small picture of the position of the baby on a form which she used for the rest of the consultation. Anne took out a small tablet-like laptop to begin the ultrasound and determined that the woman was 8 months pregnant.

In the United States, medicine is a very private matter. But in Guatemala, it’s a family affair. The exam room was only separated from the entrance to the Casa Materna by a curtain. In the sectioned off area for the exam room was the woman, the nurse, me, the woman’s three children, and her mother. “Look, that’s the baby’s leg” Anne said to the woman’s daughter who was watching the ultrasound intently, trying to decipher what was darkness and what was her future sibling. I was impressed how Anne had effortless made this a teachable moment and included this child in the experience. It was extremely powerful to see and I felt very lucky to have been there to experience this moment with this family.

Flore a “mujer de apoya” (helper woman, who is similar to a doula) at the Casa Materna getting a woman’s signature before beginning the barrier analysis questionnaire.

In addition to observing nurses in the clinic, I was able to go into the field with some of the community health educators to watch them survey women in the communities. Using records kept at the Casa Materna, the educators were able to identify women who reported using a method of family planning, so that’s where we started. This was an effective way to identify potential participants, but meant that women who may be using a modern method of family planning but did not already have children would probably be excluded from our sample size. As frustrating as this was, I understood that due to staff capacity, this was just a limitation that I would have to accept. Sometimes we would get to a house and a woman wouldn’t be home or it would turn out her child was too young to participate. Since exclusive breastfeeding for the first six months of life is a form a contraception, we decided to only include women who had children older than 6 months to ensure that she was she was using a modern method of family planning. Due to the size and close-knit nature of the community, we were also able to ask women if they knew of any other women who might be able to participate and use snowball sampling to find other participants. This allowed me to get a glimpse into the lives of the women who we were surveying and better understand what everyday life in Calhuitz was like. I also got to see a lot of kids chasing around chickens, pigs, and pigeons, which is always fun.

A goodbye photo with a few comadronas (midwives) from the surrounding communities and some of the Curamericas Guatemala staff who lent me a gorgeous huipil and corte for the picture. Can you spot me?

I am still in awe of the efforts by the staff to complete these surveys. It was a close call, but on my second to last day in Calhuitz, I received the last of the 96 surveys that we needed for the barrier analysis. Although the analysis and recommendations were supposed to be finished in Guatemala, as with most field work, we had a few setbacks that changed our timeline. Instead, I will be completing my analysis back in the US and will make a presentation to staff on the findings in order for us collaborate on recommendations in mid-August. I am deeply appreciative to the Curamericas Guatemala staff for their patience with this new type of study, their willingness to include me into their daily activities, and their politeness when eating my first attempt and making tortillas by hand.

¡Gracias y hasta pronto!

– Kay

From Thailand to India to Home

It’s been a whirlwind of a summer so far! About a week after my last exam, I flew to Thailand and then spent two weeks exploring in Thailand and southern India. I ate so much delicious food, met a ton of people from all over the world, and got to explore beautiful temples and palaces! I may have gotten the worst sunburn of my life but I think it was worth it to be surrounded by this much natural beauty.

The beach at Phi Phi Don.

After the two weeks were up, I went to Kalpetta in India to start my first practicum, which was with SEEDS, an organization working in disaster relief and recovery. I supported their Community Health Empowerment program, which serves tribal youth in the Wayanad district through community improvement programs. While I was there, I had a chance to visit several of the tribal communities and assist with documentation of their project activities. However, I spent the majority of my time researching Kudumbashree, as SEEDS was hoping to get more of the tribal communities involved in this program.  Kudumbashree is a program that serves low-income women in Kerala (the Indian state which Wayanad sits in) through financial opportunity—job training, business creation, and microloans—as well as health, environment, and community programming. It was really interesting to have a chance to both read about it and to interview local government officials within the Kudumbashree offices about their work.

A pre-school in one of the tribal communities which the adolescents of the community rebuilt.

I was lucky enough to be working with a UNC alum, and it was great to have a piece of home when I was so far away. I was also very lucky to be surrounded by kind co-workers who set up fun things for us to do, taught me more about their culture, and welcomed me to India. In my first week there, my co-workers band had a concert on the hotel rooftop, and afterwards they all sang traditional songs together. We were also invited to the home of another co-worker, Harris, for Eid, to break the fast after Ramadan. His mom cooked us a ton of delicious chicken biryani and spicy lamb and would not take no for an answer when she offered seconds. On my last day in Kalpetta, I almost missed my bus to start my trip home, and wouldn’t have made it if one of my co-workers, Abu, hadn’t chased down the bus on his scooter and made it wait for me, while another, Tonia, grabbed us an auto to speed over to the bus. Getting to know them was absolutely one of the best parts of my practicum, and I am so grateful for everything they did for me.

My coworkers breaking fast after Ramadan.

Now, I’m back at home in the Washington, D.C. area, working as the Adolescent Sexual and Reproductive Health (ASRH) Intern for Save the Children US. My primary job is supporting the Interagency Working Group on Reproductive Health in Crises (IAWG) on a revamp of the ASRH Toolkit for Humanitarian Settings. I’m also helping to update some resources, and I’ll be supporting a team in Cox’s Bazar, Bangladesh as they lead their first Training of Trainers around ASRH in Emergencies. As someone who is interested in working on sexual and reproductive health (SRH) in humanitarian crises, Save the Children is a really great place to be. I have access to information and updates on crises happening around the world and can follow the humanitarian response as it develops. I’ve also had a chance to complete a lot of e-learning courses focused around SRH in crises from various perspectives, which have helped me to get a better understanding of what this work looks like on the ground. It’s also been wonderful to meet people from all over the world who are doing the work I want to do, and to learn about their work. I’m excited to continue to learn and to be able to play even a small role in this very important sector of Public Health!

– Erin

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