Author: nayavill

The second part of my time in Malawi was meant to be spent working on the second objective of my practicum experience, which is to help to create an interim report (“results brief”) for the partners, funders and key policymakers, using the study’s protocol information and the data collected thus far. Since mid-January 2018, the study team has been gathering data from participants who were referred to and/or enrolled in the national Prevention of Mother-to-Child Transmission of HIV (PMTCT) Program between July 2016 and June 2017 at 11 different facilities in Lilongwe district. The plan was for me then to work with the Head of the Analysis and Manuscript Writing Unit of the UNC Project-Malawi, to analyze the data and produce the report. The study’s timeline projected that all data in Lilongwe would be collected by May, and that after a couple weeks the study team would move north to enroll participants from the Mzimba South District. I would then work on the interim report and perhaps spend one of my last weeks with the study team up north.

After a slight delay, the study moved to the Mzuzu Health Center, a five-hour drive from Lilongwe. Unfortunately, two weeks later, half of the team had to come back to Lilongwe because as we crosschecked information and started data cleaning for the statistical analysis, we discovered that there was some missing data. There had been issues related to data collection and recording methods, and we would need to return to some sites. The study design proposed the collection of retrospective data on each woman and her infant from PMTCT enrollment through the child’s second birthday, but several logistical difficulties have delayed the team’s efforts. The challenges include reduced time to access the electronic medical record system and the lack of electrical power in the facility. Furthermore, in Area 25, the biggest site in Lilongwe, 307 Mother-Infant Pairs (MIPs) were sampled for the study’s nested cohort, but about a third of those could not even be contacted or traced because their location information was not enough to enable my colleagues to find them.

While that is being sorted, I have been continuing to support the research team with data entry and management tasks, such as quality control, tabulation of information and the improvement of different control tools used for the study. Towards the completion of my second practicum objective I have been working on analyzing some of the data with STATA and summarizing information from our study protocol to be relevant to our audience. You can see the first two pages of the draft results brief below. The report is formatted according to pre-determined design guidelines.

As my departure approaches, I can say that the last two months have been extremely significant to me. I have been able to combine my previous professional experience and my MPH knowledge and skills, and have a positive impact in very meaningful and interesting work. I now very much look forward to being back home (my heart is in Chapel Hill/Carrboro) to complete the program and to work with an amazing Capstone team for the next academic year!

My deepest thanks to the UNC Project-Malawi SOAR PMTCT study for hosting me, to the amazing Health Behavior faculty and staff who have been so supportive, and of course to the Research, Innovation and Global Solutions team who helped make the trip and stay here easier. I look forward to sharing more details about the study and my work during Practicum Day!

See you! Tiwonana!

-Rigo

Let me start by telling you a bit about the organization I’m partnering with and the work they do. Shifra is an NGO in Melbourne, Australia dedicated to increasing access to sexual and reproductive health services for refugees, migrants, and asylum seekers through the use of an app. Shifra was started by a Gillings alum, Beccah Bartlett, and is the only organization addressing this need in this way in the world. When refugees, migrants, or asylum seekers come to a new country, they often have a hard time accessing the resources that are available to them due to language barriers, an unfamiliarity with the host country’s health system, and unawareness about their rights as a patient- such as the right to ask for a translator. This is even more true when the health needs are sensitive, such as questions about contraception and pregnancy. The app allows women to access the information they need, whenever they need it, in their own language. It launched about a year ago and is currently available for Arabic speaking women in Melbourne.

When considering my options for a practicum this summer, I was drawn to working with a small organization because I would have the chance to practice a number of different public health skills. This has certainly proven true! In the two weeks that I’ve been on the ground, I have been a part of key partner meetings, evaluating existing resources, developing marketing materials, and laying the groundwork for a process evaluation that I’ll be completing during the rest of my time here.

My main project is evaluating Shifra’s use of human centered design to create the app. I love this project since systems and design thinking has been my favorite class at Gillings! While it is exciting to be on the cutting edge, it also requires a lot of cross-disciplinary research to learn how human centered design has been used with refugees, how it has been used with mhealth interventions, and how it has been used to address sexual and reproductive health needs. In the coming weeks, I’m looking forward to speaking with refugee co-designers and learning more about their experiences with the co-design process.

-Jess

I am more than half way through my internship with United Nations Population Fund (UNFPA) in Cape Point, The Gambia. UNFPA does amazing work in the areas of family planning, sexual and reproductive health (SRH), gender-related issues (e.g., early marriage, FGM, GBV) and HIV prevention. They are currently working to accomplish the objectives of their Strategic Plan 2017-21. During my first few weeks, I participated in a sensitization campaign for obstetric fistulas on International Day to End Obstetric Fistula. UNFPA went to the Bundung Maternal and Child Health Hospital, a public hospital under the Ministry of Health and Social Welfare, and Sinchu Baliya Health Post, both facilities that garner a large population of pregnant women attending antenatal care (ANC) visits. During the event, messages regarding symptoms and treatment options for fistulas were delivered in three local languages (Wolof, Mandinka, and Fula) to accommodate for the group present.

Due to the lack of available data on fistulas in Gambia, UNFPA is hoping that the sensitization campaign will produce a fistula count of women who have the condition. By lifting the stigma and encouraging women to sympathize with affected women, hopefully more women will seek treatment and get registered through the fistula count camp. One of the most valuable lessons that I have been lucky enough to learn is how to deliver culturally sensitive messages and cater to the communities you are trying to serve.

This observation was made at a weekly male engagement clinic that Bundung MCH Hospital initiated back in 2012. The session is a discussion style program with men whose wives (or significant other) attended an ANC visit that week. These men are contacted via SMS and/or phone calls and encouraged to attend the clinic. Men who accompany their wives to ANC visits are given priority and allowed to bypass the long visit lines as incentive for their participation. Bundung’s investment in male involvement has inspired UNFPA to pilot similar programs in other organization supported facilities across The Gambia. I am currently co-writing a concept note that implements a pilot project strengthening Bundung’s male clinic and eventually developing a standardized programme to be applied to other health facilities.

Additionally, since UNFPA works through Implementing Partners (IPs), I have been able to observe the operation of these organizations, including the challenges they encounter in fulfilling their goals. There are so many organizations in Gambia that are working to empower women and girls, including Think Young Women, a mentorship programme that is one of UNFPA’s Youth and Adolescent IPs. During the next couple weeks, I will be diligently laying the foundation for the pilot male clinic initiative and going on four-day upcountry visits to the more rural facilities. Since Bundung is a public hospital that began with funding, it will be an opportunity to compare rural vs. urban facilities and ways that male clinic would be incorporated while considering the existent financial situation of the facility. I’m a little sad that the weeks are going by so fast, but I feel a deep sense of gratitude for all the exposure I’ve been getting. Can’t wait to share more experiences!

-Fanny