Adriana Gaona – Page 3 – Gillings Around the globe

Making Progress Towards Universal Obstetric Ultrasound Access – Reflecting on Two Months in Zambia

Posted on August 2, 2024 by Adriana Gaona

*Watching the sun set over grazing Giraffes on safari at Lilayi. Zambian sunsets are unbeatable.*

It’s hard to believe that I am at the end of my practicum here in Zambia. It has been a whirlwind of nine weeks, with high highs and low lows. While here, I have learned so much about public health in a global setting, about the beautiful country of Zambia, and about maternal health here.

This summer I helped to develop the training slideshows and handouts to instruct the Ministry of Health Nurses in regional clinics on how to use portable ultrasound probes, learning about sonography in the process. I have been able to practice with the handheld probe myself, determining gestational age and finding a fetal heart rate. Many women here do not have the opportunity to have even one ultrasound during their pregnancies, which is concerning given how important ultrasounds are to identifying risks to maternal and fetal safety, and how high the maternal mortality rate is in Zambia (278 per 100,000 live births)¹. This project aims to incorporate ultrasounds into routine antenatal care in six clinics, which will greatly improve these communities’ access to obstetric ultrasound. Although training for the new ultrasound at these clinics was set to begin during my time here, delays in getting Ministry of Health approval have pushed the start date back until late summer or early fall, after I leave.

Visiting Chongwe District Health Center with the UNC Research Project Manager, Rassil Barada, (center), and my fellow MPH Practicum Student, Madisyn Parker, (right). On site visits, women wear traditional chitenges to be respectful.

During this summer, we have also been able to visit the regional clinics where the PIKABU Study will take place. It has been so exciting to meet the incredible teams working at these busy clinics to provide care for moms and babies, but also hard to see the limited resources with which they must serve so many people. Many of these clinics are remote, and none of them store blood if women were to hemorrhage during labor. I am so grateful we had the opportunity to visit, but I also am aware that our presence in these clinics can be an intrusion, and how our positionality of white women who enter these spaces for only a short amount of time influences the way we interact with the staff and patients.

*Walking into the MCH Department in Kanakantapa, Rural Health Center*.

Preliminary training (the training of trainers) wrapped up in my last few weeks and I was able to interview each of the four nurse/midwives and the nurse lead trainer on their experiences with the training. These women are so passionate about what they do, they have been so sweet to me since I arrived in Zambia, and their responses in the interviews moved me. One woman said she thought this project would bring a lot of benefit to Zambia overall, especially if it is scaled up and able to reach more women. One woman said the training had boosted her self-confidence, because she did not think she would ever be able to perform ultrasound, let alone teach it. While I am disappointed that the project training will not begin while I am here, I am so glad that these women get to inspire others and help improve access to ultrasound here in Zambia.

*A photo of the portable ultrasound probe on its charger, taken for instructional training materials.*

Before I began my practicum, I thought a lot about decolonizing public health, and the implications of doing work with a US-based organization in a global south setting. Although there are always going to be challenges with US funding and backing for projects like these, I have been so privileged to learn from the large, diverse, talented team of Zambians while I have been here. It is frustrating that projects like this one, that will make a large difference in the lives of pregnant women, require western funding to exist. The ultrasound probes that are being used, 14 in total, cost over $2500 each. It’s still hard to sit with the disparities in access, and the inequities in research.

*A giraffe walks through a field at Lilayi.*

As I finish this last week, I am excited to know that the project will continue and begin starting in earnest (and one of the midwives promised to keep me updated on the project status via WhatsApp), but sad that I won’t be here to watch the follow through. A challenge of the practicum experience is I really feel like I only just started, I only just got settled, but I am excited to bring these experiences back to Chapel Hill with me to begin my final year of the MPH.

Erin

The Trip of a Lifetime

Posted on July 29, 2024 by Adriana Gaona

As my time in Kenya comes to an end, I can’t help but reminisce on all the adventures I was able to go on while working here. One of the most unforgettable experiences I had was getting to go on a safari through Maasai Mara National Reserve. This trip had no shortage of beautiful landscapes and wild animals that I never thought I would see up close.

The trip started in Kisii, Kenya where our driver picked us up at 5am and drove us to Narok. My excitement picked up when we saw a harem of Zebras trotting by on the side of the road. This was my first time seeing Zebras up close and they were just as beautiful as I had pictured them to be! Our driver slowed down the car so we could get a better look.

*We saw a harem of Zebras on the side of the road while driving through Narok.*

Once we got to Narok, we were greeted by our tour guide, Samson. Samson was the best tour guide we could have asked for. With over 30 years of experience giving tours, we knew he would be the best person to show us around (we were right!). After switching over to the safari van that was going to take us the rest of the way, we got started on our long and rocky journey to the Mara!

After eight hours of travel, we got to our lodge and had a chance to freshen up, eat lunch and put our things down. We stayed in large tents complete with full sized beds and a bathroom with a shower.

After lunch, we got back into our safari van and got started. Samson had extended the roof and rolled down our windows so that we could stand and get 360° views throughout our game drive.

*We were able to get 360° views from our van as we drove!*

Once we entered the reserve, we saw many animals including buffalo, more zebras, gazelles, antelopes, land cranes, and ostrich! Everywhere we looked, there was a new animal I had never seen before. It was truly a once in a lifetime experience.

*We saw so many types of gazelles and Impalas.*

Ostriches were a lot bigger than I imagined!

There were Giraffes all throughout the Reserve.

Within the first 30 minutes of our drive, we saw a herd of giraffes. Samson taught us how to recognize male vs female giraffes and stopped the car so that we could watch them as they walked past. They are much larger and more beautiful than I ever imagined.

As we drove further into the reserve, we kept our eyes peeled for cheetahs, lions and elephants. We were determined to find them during this trip. After a few hours of driving we saw a group of other safari vans driving past, so Samson decided to follow them. To our surprise there was a whole heard of elephants walking by! It was incredible to see these majestic animals up close. Elephants are my favorite animals so seeing 12-15 African elephants all walking together was a great privilege.

*We saw many elephants throughout our drive.*

Just when I thought the safari couldn’t get better than this, we stumbled on a pride of lions. Samson drove right up to lions as they were basking in the sun. I always imagined that they would be active and curious if we ever ran into to them, but they did not seem to care that we were there watching them. We turned off the car engine and just watched them in silence. The pictures below are unedited and not zoomed in. We were so close! I still cannot believe we were able to experience this.

*Two of the six lions we saw in this pride. There were two males and four females.*

We then kept driving and looking out for more animals. We saw more elephants and Giraffes. Samson surprised us by taking us to Tanzania where the Serengeti begins and Maasai Mara ends.

*Border between Tanzania and Kenya. Where the Serengeti begins and Maasai Mara ends.*

As the sun began to set, we drove to the final spot-the Mara river. We saw hundreds of crocodiles and hippos swimming in the river. We were told that as soon as the sun sets, everyone has to leave the area as all the hippos come out of the water and roam around on land. The colorful hues of the setting sun made the river look both alluring and terrifying.

*We saw crocodiles, hippos, and the most beautiful sunset at the Mara River.*

There aren’t enough words to explain how this experience changed my perspective of nature and the world. While we came to Kenya for a practicum, we also gained adventure and a list for more travel in the future. I am so grateful to have gotten this experience and especially to have gotten to do it with my incredible friend, Kait, who also interned with me this summer!

The view as we were leaving Maasai Mara National Reserve.

Shriti

A Unique Journey: Pharmacy and Public Health Internship on the Red Lake Reservation

Posted on July 22, 2024 by Adriana Gaona

My time on the Red Lake Reservation in Northern Minnesota was very rewarding and eye opening. I had the opportunity to immerse myself within the Native American community and interact with members of the tribe who live both on and off the reservation. I spent my time at the Indian Health Service (IHS) Hospital located on the reservation. For one of my deliverables, I made a community summer newsletter based on pertinent information that affects the tribe during the summer months. These topics included seasonal allergies, poison ivy, and tick bites. The newsletter was laminated and posted in all waiting areas of the hospital and was also published on the hospital’s Facebook page. The hospital uses Facebook many days to communicate with the reservation what is going on that could affect patient care and the health of the public.

Drug use on the reservation is very common among many community members. IHS does a good job making sure community members are equipped with services and resources to help those in need. It was eye opening to see how many community members feel comfortable coming up to the pharmacy asking for Narcan or drug use kits to have on hand. It is huge for members of the tribe to not feel the stigma surrounding drug use and have a safe place to come to get the care and resources they need. For my second deliverable, I created a Narcan handout that will be given out during community events to educate the community on how to use Narcan and where it can be obtained. It was meant to serve as a high-level overview to the community on what to look for in someone who may be experiencing an opioid overdose and what steps should be taken in that situation. By making sure the community has access to Narcan, it can save a life.

I have appreciated my time on the Red Lake Reservation and have gotten to have so many conversations with the natives. It was rewarding to see people continuously and get to learn their story and the way they were raised. Learning from those in the community about events that have impacted the way they view themselves and their family was hard to hear. I am glad IHS is fostering relationships with the members who are home to the Red Lake Band of Chippewa Indians. I was able to witness first-hand how the relationships take a slow amount of time to build and that there is still work to be done to continue growing the relationship and trust in the community.

Tessa