Category: Zambia

Staying Connected

September 7, 2021 / Global Health

Melissa in a field of sunflowers at the NC Museum of Art.

Enjoying the colorful sunflowers, cosmos and zinnas at the NC Museum of Art.

As I was driving a familiar route on I-40, admiring the lit up American Tobacco Trail bridge against the various hues in a beautiful Carolina sunset. I wondered, “What does a sunset over Lusaka, Zambia look like?” if I were there for my practicum. I have only heard of my colleagues and friends’ experiences as they lived and traveled there. I understood it to be a place that drew someone I admired and respected back so many times that when we ordered her retirement party cake, it had the colors of the Zambian flag on it. I searched for images online, and as I scanned the landscapes, buildings, and people in photographs, in that moment, I wished that I could be there experiencing a universal, cyclic sunset that is familiar yet different everywhere you experience it. When I applied for this practicum, I knew that it would be understandably remote as we are still in a pandemic, but I still wished I could travel and meet with my colleagues in person. The past year has been a roller coaster ride of emotions through the challenges and opportunities while being remote pursuing an MPH with a concentration in Nutrition at the UNC Gillings School of Global Public Health and working full-time as a project coordinator also at UNC.

Prior to becoming an MPH candidate and returning to work in global health, I earned my culinary arts degree in New York City and worked as a line cook and sales account manager. I also have bachelor’s degrees in Anthropology and East Asian Studies from the University of Virginia. My partner and I moved to Chapel Hill, North Carolina so I could be an assistant cheesemaker and cheesemonger. It has been a long journey leaning on my support system of family, friends and mentors to get where I am today able to pursue my passion and studies in global health nutrition.

For my UNC Gillings Zambia Hub practicum, I am part of a qualitative research study funded by the UNC Center for AIDS Research (CFAR). The study examines the feasibility and acceptability of engaging male partners, grandmothers, and other family members to support HIV-positive mothers in Lusaka, Zambia, to practice recommended infant care and feeding practice and adhere to antiretroviral therapy. The data collectors are trained in Trials of Improved Practices (TIPs), which is a formative research technique, and they counsel women and their families. Data are collected during a series of three interviews with HIV-positive women, and two interviews with the women’s male partners or family members. TIPs is a consultative methodology that focuses on understanding what is adaptable and feasible for HIV-positive mothers and their partners and families to improve infant feeding and care, bridge the gaps between knowledge, and put improved health for mothers and infants into practice. I am particularly interested in learning from the Zambia-based team and my preceptor about conducting interviews and using TIPs as a research method and technique to give participants a voice in program planning. It is vitally important to understand the context and practice cultural humility with stakeholders, which assists with sustainability. I also like how the participants try out the agreed upon practice and I am eager to learn more about the support system of these women and its impact on their and their infants’ nutrition and prevention of mother-to-child transmission of HIV. During my practicum experience so far, I am learning how to use Ona, an online platform using Open Data Kit (ODK) to collect data and summarize participant characteristics and responses. I have also given feedback on the interview guides and written transcripts. I look forward to working with the team to create a codebook and code transcripts in Atlas.ti. and synthesizing what we will learn. I also continue to learn from the team on how to conduct qualitative research effectively in interviews and be faithful in translations while maintaining the dignity and privacy of the participants.

My summer days have been flying by as I started a new job within UNC Carolina Population Center (CPC) at the end of May and continued to work full-time in addition to my practicum. I meet virtually with my preceptor, Dr. Stephanie Martin, and a fellow student every week, and with the Zambia-based team frequently, which keeps me connected and moving forward. I am appreciative and grateful for the team that I work with for their flexibility and understanding. The silver lining that I have found in a remote practicum and hybrid work schedule is I am able to do both. Similarly, to what others have said in this blog space, I reflect upon my current situation daily and strive to change my mindset/perspective by practicing gratitude one day at a time. I recently watched Chef’s Table: BBQ featuring the James Beard Award winner, Rodney Scott on Netflix. He said, “Every day is a good day. It doesn’t always go as smooth as we want, but life is what you make it.” “My glass is going to be half full each time.” “What did I do yesterday that I can improve on today?” These words and his approach resonated with me to apply this to life and my practicum experience of doing qualitative research in a pandemic. All research activities in Zambia involving direct contact with participants were temporarily suspended for over a month due to the increase in COVID cases and only recently resumed on August 4. We have what we planned in the theoretical sense, and then we had to face real-life implementation. The safety and well-being of those in Zambia were most important. I learned more about communication and how to move forward even during these most challenging times. Due to the delay in completing data collection and changing timelines in project implementation, my practicum was slightly extended, and I will continue to work with Dr. Martin and the team through an independent study this fall.

Backyard beekeeping

Picture of a bunch of different vegetables picked from the garden.

Proud of the harvest from our garden.

In addition to a busy work and school schedule, I am finding respite by taking care of our four beehives and mini homestead garden with my partner, Michael. I am also spending time with my co-worker and cat daughter, Honey. She reminds me to get up and move away from my computer to pay attention to her and what is going on outside.

Brown, tan, white and grey cat sitting on a chair.

Honey, our amazing and wonderful cat

– Melissa

With goal-motivated fun, time flies

August 25, 2021 / Global Health

I have been privileged to work on a hugely satisfying and rewarding practicum with the Gillings Zambia Hub. It is qualitative research to assess the acceptability and feasibility of engaging male partners and other family members to support HIV-positive mothers to practice the recommended Infant feeding practices and Anti-Retroviral Therapy (ART) adherence.

My drive and interest in HIV research and the prevention of mother-to-child transmission stem from seeing the hardship faced by people living with HIV. Hence, I was glad for the opportunity to work on a subject matter I find interesting and relevant, so I have had no problem finding my footing or staying motivated, especially with the practicum being a virtual one.

For the project, we use the Trials of Improved Practices (TIPs), a formative participatory research technique developed by the Manoff group to pretest and improve the recommended practices on a small scale before introducing them broadly. Trained interviewers discuss current feeding practices and ART adherence with study participants in individual interviews. In addition, study participants are encouraged to identify home supporters. Subsequently, there is counseling on the recommended practices, and with the interviewer’s help, each study participant decides on specific practices to be adopted over a trial period. In follow-up meetings, the interviewer asks questions to assess the uptake of the recommended practices. By taking this approach, we draw from the experience of the study participants, who are members of our target population, to pilot test our recommendations. This approach enables us to recognize and determine the practicability or limitations of recommended infant feeding practices in the context of the local communities. Furthermore, using TIPs makes it possible to identify possible challenges that might impact the uptake of our proposed recommendations, provide solutions to these challenges, eliminate or modify practices that are not feasible.

As an intern, I support the team by reviewing the transcripts of the focused interviews and providing feedback. I also use Ona to assess and summarize the data and ATLAS.ti for qualitative data analysis. In addition, I am working on a secondary analysis of already coded data to determine the role of social support systems and couples’ joint decision-making in preventing mother-to-child transmission of HIV. Through my interactions with the research team, I am learning to be perceptive of cultural differences, be humble and respectful while giving feedback, and be open to responses that challenge my worldview and perspective. The opportunity to work on a diverse team has also afforded me a better appreciation of the interaction between individual social identities and power dynamics in a research ecosystem.

Sometimes, things do not go according to plan. A little over a month ago, the project had a slight hiccup when the Zambian government had to suspend all hospital-based research because of another wave of the COVID-19 pandemic. Data collection had to stop temporarily, affecting our deadlines for specific points in the study. Thankfully, the COVID-19 cases are dwindling, the suspension was lifted a week ago, and data collection has commenced again. Overall, I would say that this summer has been productive and a lot of fun. Through meeting other students, I expanded my Gillings community. I also explored more of North Carolina. Most of all, I am thankful for a fantastic opportunity to learn and grow my skills through the Gillings Zambia Hub. Now, my only grudge is the swift passage of time because it feels like I started the practicum a day ago, yet it’s been three months and more. Indeed, time flies.

While spending a summer day at Ft. Macon State Park, I couldn’t resist taking a picture of these lovely seagulls.

– Olu

Long days, short (summer) weeks…. Wrapping up a remote global health practicum

July 29, 2021 / Eric Brown

It’s hard to believe that my practicum experience is almost over and that the summer’s almost gone! I keep asking myself where all the time went. For my practicum experience, I have been working with UNC Gillings Zambia on the ARCH study. The goal of the ARCH study is to optimize birth outcomes in low-resources settings, by using household surveillance to gain a better understanding of the social and clinical factors that may affect pregnancy outcomes in women of reproductive age. I think that one of the best parts of the study is that it allows the study team to follow women of reproductive age, from preconception to at least one year after the end of their pregnancy, in the event that they become pregnant during the course of the study. In addition, the study also follows children under the age of 2, to gain a better understanding about factors that impact the health of young children. Thus far, I have learned quite a bit from the study, mostly related to the implementation of such a large-scale study.

One of the most important lessons that I have learned so far has been the importance of flexibility and being willing to adapt to a new situation. At the beginning of my practicum, my preceptor and I thought that it would be most helpful if I worked on developing standard operating procedures (SOPs) for various aspects of the study. As time progressed, it became clear that there were other aspects of study implementation that would be a better fit. As such, we have pivoted from working on SOPs to developing recruitment and training materials. It has been an interesting learning experience, thinking about how best to simplify the language from protocols, written for technical experts, to informationals that can be understood by study participants. I’ve also learned a lot about the seemingly small aspects of study implementation that I had only briefly thought about. As I’ve been charged with drafting some of the training materials and schedules, I find myself thinking about the most pertinent parts of the study protocols and how to engage study staff when they might have days’ worth of training in their future. All in all, it’s been a truly educational experience.

It might not come as a surprise that one of the most challenging aspects of the practicum experience has been my inability to meet most of the people that I’m working with in person. I have tried to keep in touch via email. My preceptor has also been wonderful, as we decided to meet on a weekly basis, just to touch bases. I think that the weekly meetings have been helpful and have provided more opportunity for direct feedback. At this point, we have talked about extending my practicum, but I still don’t think that I will be able to see the actual start of the ARCH study. That said, I plan to follow the study closely and look forward to learning more about the results of the survey.

Lastly, I’m looking forward to enjoying the last weeks of summer, prior to the beginning of the semester. I’m very excited about starting the second year and can’t wait to meet in person!

– ‘Desola

Global Women’s Health from Home

July 28, 2021 / Eric Brown

On the backend of my internship, I can now look back with an awareness of how much the projects I am working on have evolved since the beginning. I cannot believe that we are reaching the end of the practicum this week, it has flown by. I am truly grateful for the team I have been able to work with throughout this experience. It has been so helpful for my future career planning to interact with others in the field of global women’s health.

Work from Home Set-up

In the second half of the internship, I have spent the bulk of my time working on the division of Global Women’s Health website content and restructuring to convey the current research to wide audiences. I have particularly focused on producing written content for the page detailing the prevention of adverse birth outcomes. At first it was overwhelming to effectively summarize the work of so many different projects in various countries. But as I continued, I found greater focus and clarity as I emphasized the population impact that these projects carried. This reflective reminder came at an important time for me. I was feeling burdened down by the extensive complex problems, especially on a global scale (as that was the context I was working in). I was doubting the change I could affect on systematic and widespread issues. However, as I drafted material about the big picture, the why, and the goals of the division, it reemphasized to me the importance of individual contributions as a piece of the united effort.

Nightly walks at Lake Crabtree

As I conclude this internship I am grateful for the glimpse it gave me into the responsibilities of program managers, with an emphasis in communications. It was informative for me to see how a team of researchers, local and abroad interact to complete translational research for improved practice. This internship taught me the importance of not only performing research but also telling the story to a larger audience: funders, potential fellows, and the general public. I gained an understanding of the value in uniting teams towards a common vision while each person is focused on a unique aspect of the overall mission. I hope to transfer these skills into positions I will hold in the future.

-Renee

Maybe it’s nearing the end or maybe it’s just the beginning

July 22, 2021 / Eric Brown

When I started this practicum in the middle of May, I had originally planned for this coming week to be my last week. I recently decided, along with my team, to extend the end date since the really interesting part is just beginning. Although the past couple of weeks have been filled with data cleaning, I am finally ready to begin the analyses we proposed as the basis of my practicum. We are using data from a household survey and combining it with data from health facilities across Zambia in order to gain a more holistic understanding of the services, equipment, and patient satisfaction with the country’s health care system. To our knowledge, this comprehensive picture of health facilities and services has not been examined before; prior research has focused on either just the health facility capacity/readiness or just the consumer experience.

Although I will likely have more final thoughts in the coming weeks, I am grateful to have been a part of this project and team. At the start of the practicum, I learned about antenatal care/nutrition recommendations and health facility quality measures, as well as gained a better understanding of the amount of work and careful organization required to select the variables of interest. These variables are the basis for our exploratory analyses and due to the nature of real-life data, have provided me with an opportunity to learn about and practice more advanced statistical methods. Our ultimate goal is to run a series of statistical models to better understand client satisfaction with antenatal care as well as growth, monitoring and promotion services. We will then publish a paper to share our findings.

Perhaps the greatest lesson I’ve learned from this practicum is the value of “thinking outside the box.” Doing so has helped my preceptor, Dr. Stephanie Martin, and I, organize our thoughts about which variables to use and how to carry out the analyses, it helped us overcome some issues with a messy dataset and methodological concerns (e.g. missing values, yes/no questions, issues merging datasets, lots of interesting variables to explore, etc.), and it prompted our research questions. Although I am nearing the end of my practicum, I also feel as though it is just the beginning. I look forward to digging further into the data to see what sorts of discoveries can be made, and using those to circle back to the big picture of reducing childhood stunting and understanding health care satisfaction and quality in Zambia. I hope our findings will not only be informative and worthwhile to the Zambian government and USAID, but will help others conducting similar research.

– Liana

Key Lessons

July 8, 2021 / Global Health

Like many others who have contributed to this blog, my practicum experience has been fundamentally altered by the pandemic. It’s been great to read about others’ experiences and know that the separation from the communities we’re working with has affected everyone. For me, that community is nearly 8,000 miles away – in Lusaka, Zambia.

A little bit of background on my practicum: Zambia has one comprehensive cancer center, the Cancer Diseases Hospital (CDH), which serves the country’s population of over 17 million people. Since 2006, when the CDH was established, they have treated over 20,000 new cancer cases. The most common cancers seen at the CDH are cervical, breast, and prostate cancers. In recent years, in an effort to better understand determinants and outcomes of these cancers, doctors and researchers at CDH have prioritized data collection and exploration. They’ve developed a retrospective-prospective database to capture data on the cases of breast and cervical cancer at CDH. As part of my practicum, I am helping one of the data teams with data cleaning and validation, and conducting some research using the information in the database.

The distance to Lusaka fortunately hasn’t prevented me from being able to develop and practice data management skills. In my practicum search, I knew I wanted to get experience working with data, and the work I’ve been able to do this summer has been incredible for giving me opportunities to expand on concepts and techniques we’ve learned across in our first two semesters of coursework.

But the distance has also created challenges – divorcing the content of my work from the community I am meant to be working in. Our instructors at Gillings this past year have repeatedly emphasized that humans aren’t data points. A person’s story cannot be fully understood when it is distilled into a series of responses across a set of variables. But the separation from Zambia has left me feeling the absence of community interaction and the context of the of the data I work with day-to-day. I’d love to have been able to be safely face-to-face with researchers, co-workers, and patients at the CDH.

Other posts on this blog have wisely extoled the power of gratitude and searching for silver linings during these unconventional times. And I have a lot to be thankful for! I’m glad I’ve gotten to spend (virtual) time with the CDH data team over Zoom, learning snippets here and there about them – their academic and career interests, their thoughts about certain health topics, what sports they follow. Being remote also means that I’ve been able to see my family and friends and get to know Chapel Hill/Carrboro better! And, finally, this experience has instilled in me a key lesson I intend to carry throughout my career: some public health work can be done extremely effectively remotely, but the quality and value of this work can always be made better through connection with the community.

– Emma

Global Health Practicum in the time of COVID-19

June 30, 2021 / Global Health

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

Practicing gratitude in times of uncertainty

June 23, 2021 / Global Health

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.

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

Zooming to Zambia

June 17, 2021 / Global Health

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

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.

My (Global Health) Practicum During a Pandemic

June 16, 2021 / Global Health

My favorite running spot (Merritt’s Pasture)!

Despite having gotten used to all the Zoom meetings and working/going to classes remotely, it was disappointing to know my global health practicum would take place from the confines of my apartment in Carrboro. When I got the news I had the opportunity to work with the Gillings Zambia Hub, I was ecstatic. It was immediately obvious how much this practicum had to offer me. Not only could I continue exploring an interest in nutrition-related research, but it would also provide an opportunity to practice my skills as an analyst and learn from a small group of public health experts.

This summer I am grateful to be working at the UNC Gillings Zambia Hub with Dr. Stephanie Martin and Dr. Ashu Handa. We are working on the Scaling up Nutrition Learning and Evaluation (SUN-LE) project which provides survey, research, evaluation and dissemination services to the Zambian government. More specifically, we will be investigating various health facility quality measures and nutrition interventions as they relate to reducing childhood stunting/malnutrition.

So far I have begun a literature review and learned about antenatal care and health facility quality assessments. Next, we will finalize a list of variables to evaluate and move forward with some analyses. As the practicum continues, I look forward to expanding my understanding of global maternal and child health and nutrition, and applying some of the materials I have learned in class in a work-setting. Most of my prior experiences have been in U.S. healthcare, and while I enjoyed that work and learned a lot, I am excited to become part of a project that I feel has a more direct and greater impact on people’s everyday lives. After all, this is one of the reasons I wanted to pursue my MPH.

Now that classes are done and I have more free-time, I’m also looking forward to exploring the Triangle area running/hiking, spending time with friends, and volunteering at the community garden. Some of the biggest lessons I’ve taken away from the pandemic is the importance of creative thinking and making the most of every opportunity. This said, I’m looking forward diving into this practicum and hope to create a valuable experience!

– Liana