It’s truly astonishing that nearly three weeks have passed since I arrived in Lusaka. My journey began on a Wednesday in late May, departing from my hometown in Alaska. After a day layover in Chapel Hill and a night in Cape Town, I traveled almost 10,000 miles to finally reach Zambia, feeling a mix of excitement, exhaustion, and being completely overwhelmed.
We are living in a city of almost 3 million people! Here is one of the busy roads outside of our neighborhood.
The first week was a bit challenging. I landed at an airport with no power, no working Wi-Fi, and no cell service. Fortunately, with the help of a few locals, I found my ride and was warmly welcomed. However, my card didn’t work at the ATM, and the local SIM card I purchased was malfunctioning. I was quickly introduced to “load shedding,” which involves prolonged power cuts throughout the day and night to conserve electricity, a necessity due to the severe drought affecting Zambia’s dam-dependent power supply. Despite these bumps, they seemed minor in comparison to the larger issues, and I was eager to get to work.
Overlooking the Zambezi River
This summer, I am serving as the Mixed Methods Data Analyst Intern for the PIKABU study through UNC Global Projects Zambia. Our goal is to integrate AI-generated, hand-held ultrasounds into regular antenatal care across six clinics in three districts in Zambia. The amount I learned in the first week alone was incredible. I had the opportunity to draft several documents, which we field-tested and finalized within days for use in our study conducting interviews. Work here moves fast, and it has been an amazing opportunity to learn about the logistics of the study and collaborate with the team. We visited one of the local clinics to meet with the community outreach team, aiming to improve communication and collaboration between teams. It has been insightful to see how work is accomplished here and how a study is accepted into the community.
In addition to working with the wonderful Zambian team, I’ve enjoyed doing independent research and learning, then applying this knowledge to tasks such as rapid qualitative analysis or time-motion studies. I’m excited to delve deeper into these activities in the coming weeks, particularly coding our responses!
Hippopotamuses popped up out of the water everywhere! We got to fall asleep listening to them in the river and wake up to see them lined up sleeping on one another as they floated down the river.
Work keeps me busy during the week, but my fellow UNC practicum student and I try to explore as much as we can on weekends. Our first weekend, we drove to Lower Zambezi, where we enjoyed river cruises at sunset and sunrise, spotting impalas, crocodiles, kudu, dozens of hippos, and three magnificent bachelor elephants. We even watched one cross the Zambezi River from Zimbabwe back into Zambia as the sun set behind us. This weekend, we hope to visit local markets and an elephant orphanage.
Over the past few weeks, we have settled into a nice routine and sorted out the initial challenges. We’ve bought candles, obtained our work visas, and mastered a makeshift charcuterie board for dinner. I’m excited to continue learning alongside my team. I feel incredibly fortunate to be here, actively engaged in improving maternal care for birthing individuals while working to increase access to antenatal care in rural areas.
What a journey I’ve had since arriving in Mozambique 2 weeks ago! This is my second time visiting a country in Africa (my first being Uganda in 2019 for a summer internship through the Campus Y) and I was anticipating flight delays or missing luggage and had booked a flight directly from Lisbon to Maputo, following a week-long trip in Portugal with my mother, to ensure that my belongings would arrive safely with me. The predicted incident happened when we were scheduled to arrive in Maputo at 5am, but were diverted to Johannesburg, an hour flight away, because the city was too foggy for the plane to land. There, the sleepy passengers who had taken a red eye were taken to a lounge (after a few hours of waiting) and after more waiting, were loaded onto a different flight that arrived around 2pm. Our luggage of course was left in Johannesburg but was delivered promptly (shockingly) the next morning. I had no idea what to expect from Maputo, as I had observed photos and videos but was imagining a city such as Kampala (the capital of Uganda) which was entirely overwhelming for me when I had visited as a 19-year-old. However, Maputo proved to be a lovely, slow(er) city with its sunsets at 5:30pm and delectable seafood.
Sunset in MaputoSeafood in Maputo
I was warmly welcomed to Maputo by my colleagues at Ipas Mozambique, and as an intern, spent the week getting oriented to the NPO and reading grant reports about the work I would soon be doing in Lichinga, Niassa, a northern province of the country (of which I am now on week two of six). Ipas is an international organization focused on safe abortion access, reducing gender-based violence, and promoting sexual health and reproductive rights (SRHR). Through a grant received by SIDA (Swedish International Development Cooperation Agency), a Reproductive Justice Resource Center is to be established in the Lichinga Ipas office, to foster healthy attitudes about SRHR and provide engaging activities for participants, including local feminist and girls-led groups, enabling them to learn about their physical and mental well-being. Additionally, the Center would assist these women in developing essential social skills including effective communication, self-advocacy, and healthy relationship building. My task has been to help Ipas create a plan for the future development of this Center, which would include its design, creating rules for the space, what activities will be needed or wanted by community members, and imagining how the space will be utilized.
In front of Ipas Mozambique’s Maputo Headquarters Office
My week whisked by as colleagues took me to various food and scenic spots around the city. I enjoyed salsa and kizomba nights, which struck me deeply, when I realized that so long as there was a salsa/bachata/kizomba (usually all mixed-in during a social) dance group, I had a community anywhere in the world. Two days before I was to leave Maputo, I received a call from the Niassa regional director, and was asked if I would want to tag along on a sight-visit to the Lago district, to see how Ipas worked in communities and regional health facilities. I of course agreed, and the day after I arrived in Lichinga by plane (three hours with a quick stop in Nampula), we were on our way to the Lago district by car. It was around a two-hour drive, on bumpily paved roads that transitioned to unpaved roads, that proved treacherous to my motion-sickness. Our skilled driver maneuvered around and honked at adults, children, motorbikes, chickens, dogs, and goats (I was told that if you hit a goat, you would have to pay its market price because they are prized) so that they would move out of our path, and I realized that cars were the right-of-way on Mozambican roads (at least to an extent of where I would never consider to have my American-college-campus-pedestrian attitude: “I dare you to hit me”). Another thing that I had realized in Maputo and had reaffirmed in Lichinga, was that the distance pedestrians kept to cars was much closer to what I was used to, and I felt my pulse quicken whenever a person came into proximity of our vehicle. (Entertainingly for a colleague in Maputo on a day when we walked to lunch, I had squealed and jogged to get across the road through traffic while they strolled after me and was told “you don’t have to run, they’re not going to hit you. Now walk on the right side of me.”)
We spent three days in Metangula, where I came to learn how Ipas worked in communities and felt a thrill of seeing public health in action. On our first day, there was a three-hour meeting with various community members, hospital administrators, healthcare workers, traditional midwives, and other stakeholders, where my Ipas colleagues facilitated dialogue on issues of SRHR. The emphasis was placed on community-led discussions and those gathered identified issues such as unsafe abortion methods used (mixing many different liquids to ingest), child-brides for the financial benefit of parents, and gender-based violence. All information I received during this meeting was through my regional director, who was translating the Portuguese discussions to me in English, while an older nurse translated Portuguese into a regional language and back again. As a native Japanese-English speaking person, I know how much energy it takes to verbally translate discussions on the spot, and although my middle/high school Spanish skills afforded me a few words here and there, I was immensely grateful to the director for the effort he was putting in for me to learn and be a part of this work. The following two days, we visited the regional hospital where the doctor working for Ipas (of whom the regional director and I were tagging along with) and the Niassa Provincial Director of Maternal Health for the Mozambican Ministry of Health (she must accompany Ipas whenever the NPO interacts with public health facilities) looked over abortion record-keeping methods and correcting errors, trained health workers in vacuum aspiration, and made sure that abortion medication was supplied at the hospital. There was also a task force convened for the healthcare workers that again was facilitated by the Doctor, but was lead largely by the medical staff, to continue to promote safe abortion. Finally, I was also able to visit a local radio station that has 40,000 listeners in the region that Ipas has partnered with to create educational content that promotes Ipas’ mission of expanding reproductive justice.
Dr. Nkulu facilitating a community meetingRegional Hospital in Metangula
During these three days, I realized how complicated and multi-layered the work Ipas does, working at all different levels of healthcare and working to tie in community members and local organizations to their work. I also learned about the barriers that exist at every step, including cultural stigma, corruption (the illegal medicine-selling business in Mozambique is big), and the retention-issue of medical workers. I even was able to experience Mozambican medicine, up close and personal, when upon returning to Lichinga, I fell ill with diarrhea, vomiting, and body aches, and was taken to the local hospital where they took a blood sample to see what the issue was (they suspected food poisoning or water contamination) and received an IV. Now that I am feeling better and am sticking to bottled water only (I was using filtered water instead, not tap water!) I am ready to get back to work and am excited to see what else I learn during my time here.
It has been just over two weeks since I arrived in Lusaka, Zambia, to begin my MPH Summer Practicum with UNC Global Projects Zambia (GPZ). I am working to develop training materials for a project providing portable ultrasound probes to 6 different antenatal clinics in regions surrounding Lusaka. While here, I have had the opportunity to meet with midwives working with the project to train clinic staff in ultrasound technique, observe the ultrasound probe in action at the local hospital, and soon head to the regional clinics to help implement the training on how to use the probes. As a Maternal, Child, and Family Health student, I know how important access to obstetric ultrasounds is for maternal safety, for delivery planning, and for diagnosing stillbirth. It’s been so great to get to use the device and learn about its implementation in antenatal care here in Zambia, and to learn about Zambian maternity care from the incredible team here.
Living in Lusaka has been quite an adjustment, with load-shedding (deliberate power outages to reduce demand) about half the day, limiting the electricity to the fridge and stove in the apartment I share with another UNC practicum student working at GPZ. We have begun to explore the country in our spare time, heading to the Lower Zambezi River last weekend where we were able to watch wild hippos sleep in the river, and elephants cross from Zimbabwe into Zambia. We are hoping to continue exploring on our weeks throughout our time here!
An elephant crosses the Lower Zambezi River from Zimbabwe back into Zambia
I am looking forward to watching the implementation of our training in the coming weeks, and feel passionately about the importance of maternal health in low and middle income countries, and hope to continue to learn from the joint UNC/Zambian team working on this project in my remaining 7 weeks here.
