During my time with Hanoi Medical University this summer, I created a descriptive analysis and evaluation of sexually transmitted infection (STI) screening activities within the Sexual Health Promotion Clinic’s pre-exposure prophylaxis (PrEP) program. While most of my work was done in an office space using statistical software (STATA), there were some opportunities to branch out and explore new methods and experiences. These included expanding our evaluation scope to include syphilis incidence among clients in the PrEP program as well as participating in meetings for future projects.
Something I learned from my practicum is the potential benefit of saying yes to opportunities and expanding project scope. Some of my most memorable experiences have come from agreeing to try new things. I was invited on a retreat to a beach town and historical sites with the CREATA-H staff and faculty. I was able to learn more about the breadth of programs that the clinic is implementing as well as more about my colleagues and their families who came along to the retreat. We visited the historical Three-Way Junction site and learned more about the history of the area we were staying in.
I am grateful for the opportunity to learn throughout my practicum experience and to meet and get to know the team at Hanoi Medical University. The team was the best part of my experience. They were incredibly supportive, and it was humbling to work beside brilliant researchers, doctors, and clinicians. I hope in the future there is an opportunity to collaborate again.
The outside of the Sexual Health Promotion Clinic.Mountains near Ninh Binh.The beach at sunrise where the CREATA-H’s retreat was held.
This past summer, I had the incredible opportunity to travel to Zanzibar, Tanzania, for my summer practicum. Coming from Senegal, West Africa, I was thrilled to explore a different part of the continent, immerse myself in a new culture, and understand a new healthcare system.
The primary goal of my practicum was to investigate the main drivers of imported malaria cases in Zanzibar. Despite a recent increase in local malaria cases, we observed that many positive cases were actually imported by community members who had traveled to mainland Dar es Salaam or neighboring countries, contracted malaria during their travels, and brought it back to the island. Our objective was to design a pilot study to inform us about general travel patterns and the acceptability of potential interventions. I began my practicum by designing traveler surveys that examined demographics, household malaria risk, recent and general travel habits, among other factors.
Once in Zanzibar, our team needed to disseminate the surveys in two key locations. Given that the ferry is one of the most commonly used modes of transportation between Zanzibar and the mainland, we targeted ferry travelers first. After meeting with representatives from the Ministry of Health, we were granted approval to set up a station in the ferry terminal waiting area, allowing us to reach a large number of travelers as they awaited their ferries. Our second target was Reactive Case Detections (RCDs), which involved community members who had tested positive for malaria. Zanzibar has a system in place where, when someone tests positive, district malaria surveillance officers (DMSOs) are alerted. These officers visit the household of the patient to test all members and provide free treatment if necessary. We aimed to distribute surveys in both settings and offer free malaria rapid tests, along with treatment for any positive cases. Together with two fellow UNC students, we trained the DMSOs on conducting the surveys and collaborated with them to adapt the study to their existing case detection systems.
Ferry going from Zanzibar to Dar es SalaamThis picture was taken during a household visit. The DMSO had collected dry blood samples, tested the participant for malaria and was conducting the survey.
I thoroughly enjoyed learning more about the Zanzibar Elimination Program and the systems they have established in their quest to eradicate malaria. One of the key lessons I took away from this experience was the importance of cultural competence and community-based approaches. The DMSOs were all public health experts who lived and worked within the communities, spoke the local language, Swahili, and had a deep understanding of the local culture and values. Their involvement made a significant difference in the study, facilitating trust-building with participants and tailoring the study to their needs and values. I loved being immersed in the community and experiencing the environment in which our participants lived. Although I didn’t speak Swahili, I quickly realized that even simple phrases like “jambo” (“how are you”) and “asante” (“thank you”) went a long way in connecting with community members.
Front gate of the Zanzibar Malaria Elimination Program
I will never forget the warmth and hospitality of the Zanzibari people. Everyone was so welcoming and kind. One of favorite memories from the entire summer was taking a local cooking class with the Mamas of Zanzibar. I wore their traditional attire, joined them at the neighborhood market to buy groceries, and fully immersed myself in the daily lives of Zanzibari women. From the stunning beaches and sunsets to the historic beauty of Stone Town, Zanzibar will forever hold a special place in my heart. This experience has reinforced my commitment to global health, particularly in capacity building and implementing community-led interventions to address healthcare disparities and advance the field.
Asante Sana, Zanzibar!
Cooking class with the Mamas of ZanzibarBeautiful beach during the Mnemba Island visit
~ Rokhaya Kane, 2nd year MPH Student in Global Health
On a Thursday night at Dan’s Hotel Restaurant in Kisii, Kenya, my fellow Kisii Konya Oroiboro Project (KIKOP) interns and I sat around a dimly lit booth with the KIKOP Project Coordinator, Anne. Our eyes were glued to the television screen across the room, watching the Kenyan Parliament’s second vote on the Finance Bill 2024. We had been to Dan’s several times – it was a quiet restaurant close to our hostel where we often enjoyed matoke (a dish of bananas and tomato sauce) and french fries – but never had we seen the crowd that then formed around the bar, faces drawn in concern as their MPs voted on whether to approve substantial tax increases across Kenya on necessities like bread. It felt like the entire city was collectively holding its breath.
“What will happen if they pass this bill?” I asked Anne as an MP on the television screen stood up to cast his vote. Riots will happen, Anne said. People will die.
Murmurs of displeasure rippled around the room as the Parliament’s decision appeared on screen. The bill had passed by over 100 votes. Now the Finance Bill 2024 only needed to pass its third reading before being signed into law by President Ruto.
As riots broke out across Kenya in the next week, we were asked to stay in our hostel. We watched from the roof as protesters marched past on the road in Kisii, their voices carried on the wind. From our removed bubble, we saw the news unfold and police brutality claim the lives of over 20 people six hours away in Nairobi, hearing pundits repeatedly chalk it up to Gen Z and their violent defense of their ideals, and President Ruto label it “anarchy.” It was simultaneously surreal and visceral – here was a movement of Kenyans protesting peacefully against a proposed 16% levy on bread, eggs, onion, and potatoes that would make it that much more difficult to get by, and they were met with water cannons and live ammunition.
Meeting poster for Kisii protest against Finance Bill 2024 that circulated on social media
In June of 2023, the Kenyan Parliament had passed a similarly controversial Finance Bill. This bill included substantial income tax increases, a mandatory housing levy, and an 8% increase in value-added tax (VAT) on petroleum products.1 Despite these measures, in December 2023, Kenya’s external debt had risen to over 6 trillion Kenyan shillings (Ksh), (about 45.5 billion U.S. dollars).2 Kenya’s Finance Bill 2024 is the latest attempt made by the Kenyan government to control the country’s debt. It includes provisions such as a 5% increase on all money transfers through Kenya’s primary mobile money service, M-PESA, a 25% excise tax on cooking oils, and a 16% VAT on bread and other staples.3
In response to the deadly protests against Finance Bill 2024, President Ruto refused to sign the contentious bill into law, and fired almost his entire cabinet. Nevertheless, Kenyans are calling for his resignation. Their discontent stems from decades of corruption in Kenyan politics, which has fostered an entrenched distrust in the government, and President Ruto in particular. In 2022, the National Ethics and Corruption Survey found that 64% of people in Kenya reported that they had paid bribes to access government regulated goods and services including procurement of business licenses, police protection, and accessing essential services like healthcare.4
Three posters for Total Shutdown Tuesdays, which have occurred every week since the initial protest against Finance Bill 2024.
In the scramble for a temporary solution, President Ruto has decided to initiate 177 billion Ksh (~1.3 billion U.S. dollars) in budget cuts to governmental entities, including suspending the office of Chief Administrative Secretaries and removing all extensions past 60 year-retirement for all civil servants.5 One thing is for certain: this is not a permanent fix.
As Kenyans continue to protest Ruto’s presidency, we are wrapping up the in-person portion of our practicum and getting ready to fly out of Nairobi. Something I have been grappling with is how to stand in solidarity with Kenyan youth, given that this internship position is a six-week visit in the midst of an issue that has spanned several years. Participating in the dissemination of information is a tangible action that I’ve taken part in, but this is bigger than a few weeks of riots – this is something that will likely continue for the next several months. Moving forward, I’ve realized that while this practicum has flown by quickly, the relationships I have built with the KIKOP staff, interns, and volunteers have nurtured a more permanent tie to Kenya, for which I am deeply grateful, and don’t take lightly. I am hopeful that the political shifts that ensue over the coming years will protect and support the health and wellbeing of Kenyans, but in the meantime, I will continue to stay on top of current events and work to support the changes that they seek in my capacity as a student, a voter, and a public health professional.
– Kait
MZALENDO TRUST ANALYSIS OF THE FINANCE BILL 2023. May 2023. Accessed July 18, 2024. https://mzalendo.com/media/resources/Mzalendo_Trust_Analysis_of_the_Finance_Bill_2023_cqmBhgN.pdf.
Cowling N. Kenya: External Debt 2023. Statista. March 18, 2024. Accessed July 18, 2024. https://www.statista.com/statistics/1223191/cumulative-external-debt-of-kenya/#:~:text=As%20of%20December%202023%2C%20the,of%20the%20country’s%20total%20debt.
Magale E. Kenya protests show citizens don’t trust government with their tax money: Can Ruto make a meaningful new deal?: University of Pretoria. Kenya protests show citizens don’t trust government with their tax money: can Ruto make a meaningful new deal? | University of Pretoria. July 17, 2024. Accessed July 18, 2024. https://www.up.ac.za/faculty-of-humanities/news/post_3242063-kenya-protests-show-citizens-dont-trust-government-with-their-tax-money-can-ruto-make-a-meaningful-new-deal.
Onyango G. Hotbed of corruption: Kenya’s elite have captured the state – unrest is inevitable. The Conversation. June 30, 2024. Accessed July 18, 2024. https://theconversation.com/hotbed-of-corruption-kenyas-elite-have-captured-the-state-unrest-is-inevitable-233562.
Nyamori M, Langat P. President Ruto announces sh177bn budget cuts. Business Daily. July 5, 2024. Accessed July 18, 2024. https://www.businessdailyafrica.com/bd/economy/ruto-announces-sh177bn-budget-cuts–4680590.
