2021 Summer Blogs – Gillings Around the globe

Staying Connected

Posted on September 7, 2021 by nayavill

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.

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

Learning practical data analysis for strong sanitation programs in India

Posted on August 30, 2021 by nayavill

Picture of Katie in a kayak on a lake. — Enjoying my summer kayaking whenever I got the chance.

I worked with Gram Vikas (GV), an Indian NGO, based in Bhubaneswar, Odisha, India for my practicum this summer. GV has been working in the Odisha state for the past 50 years. GV partners with rural communities to enable them to lead a dignified life by building their capabilities, strengthening community institutions, and mobilizing resources. Gram Vikas has been working to understand and expand access to piped water supply and sanitation in the communities it reaches, as well as to understand and strengthen the institutional systems for community ownership and management of water, sanitation, and hygiene (WaSH) systems since 1993.

Gram Vikas recently completed a sustainability assessment survey capturing data on water and sanitation access, functionality, and management status for over 40,000 households in areas of India where Gram Vikas has worked between 1993 – 2020. Household survey data were collected between August 2018 to January 2020 covering a total of 10 districts across the Odisha state. The sample frame for the survey was a census of communities served in these districts (n = 41,586), meaning that GV attempted to collect data from each household in each community across these districts in which GV had worked.

Working with this dataset from GV has been an incredible learning experience. I have been able to learn Stata in a way that I could not have been able to otherwise. Using data collected by GV across a diverse geographic region, in combination with additional publicly available secondary data, we undertook additional analyses to support GV’s efforts to better understand what variables and factors influence service delivery, service quality, access and use, and sustainability, to strengthen service delivery, enhance equity, and expand access to sanitation across the Odisha state

Some of the challenges that came up from working with this data included my learning curve using Stata in an applied way for the first time and determining how to clean up the variables to get an accurate read. My previous class experience taught me the basics of how to use Stata, but this dataset allowed me to learn in an applied way. Using some of the resources from those classes, the expertise of Cathy Zimmer from the UNC Odem Institute, and assistance from my team I was able to get the support I needed to tackle this dataset. Some of the variables in the dataset needed to be edited to provide the best possible outcome. For example, each household answered a question what type of phone they had, but the outcome of no phone was not included in this variable. It was important that I combine them to have the full picture of what type of phone outcome each household had. I will be grouping this variable with other variables in order to create a wealth quintile in the coming months to see how wealth impacts households ability to have a toilets and bathing rooms in their home and other sanitary dependent variables.

Gorgeous sunset during my vacation to Hilton Head Island.

I have been given the opportunity to continue working on this data in the fall semester and look forward to learning more about what impacts sanitation and how GV’s interventions are helping to close these gaps.

– Katie

“On my feet” Adaptation Skills

Posted on August 30, 2021 by nayavill

A Tableau map we constructed from geotagging ourselves once in each of the 35 surveyed villages.

Hello again!

I hope everyone’s summer went well. Ours was … honestly… a bit chaotic, but it taught me a lot of patience and “on my feet” adaptation skills! While I was always safe and cautious, we did encounter some challenges with COVID-19 during our Sickle Cell Awareness Survey and Community Needs Assessment in Western Uganda. The national policies on travel were changed a few times, and usually with little notice – which made planning our daily work nothing short of challenging.

– However-

I’m really really proud of the work that we did and am very thankful for the help and support that I had along the way!

We [surprisingly] were able to interview ALL 35 villages in the sub-county. This ended up being a little over 200+ individual household interviews. It was not an easy feat but was extremely important, as we wanted to establish the baseline awareness of sickle cell in the area. So far, we are finding an unexpected spatial distribution of sickle cell awareness, which will be interesting to dig into later.

To estimate the current burden of disease, and service utilization in the nearby municipality we visited the records department of four different hospitals and mapped the five-year trend of in-patient, out-patient, and laboratory visits for sickle cell – a bit of grunt work, digging through a lot of loosely-organized dusty papers, and broken binders, but the recovered information is really going to give us some great insight into the current situation in the area.

Most importantly, we got a good look at the service availability and challenges for families with sickle cell from 19 family interviews, and visits with local and national stakeholders in sickle cell care. We looked more deeply into resource availability by surveying 23 area drug shops and traditional healers. And identified some gaps in provider knowledge and awareness of sickle cell, areas for improvement, through 51 health provider surveys.

Overall, the last three months have been really busy – but really rewarding – because I know the efforts of that work won’t end here. We expect this Community Needs Assessment will lay the groundwork for a future monthly clinic day dedicated exclusively to sickle cell. A day where individuals in this sub-county can come to test for sickle cell and where those with Sickle Cell Disease or Sickle Cell Trait can receive regular health visits and support within their own community.

– Tiffany