My Journey Through Mozambique: Innovating for Sexual Rights and Reproductive Health with Ipas Mozambique

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 Maputo
Seafood 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 meeting
Regional 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.

Ipas Niassa Team (and me) on the Lake

 

Alyssa Cooper

Working Toward Maternal Health in Zambia through Portable Obstetric Ultrasound

Lusaka, Zambia

Obstetric Ultrasound in Zambia

UNC Global Projects Zambia Headquarters

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.

Erin

Community Engagement in Tanzania with Nguzo Women and Youth Foundation

Jambo from Tanzania!

My name is Kelsey Cohn and I am a Master of Public Health candidate in the Global Health concentration at UNC Chapel Hill. I am working with Nguzo Women and Youth Foundation, located in Bombang’ombe in the Hai District of Tanzania, to fulfill my practicum requirements, but my intentions span far beyond checking a box!

You may have heard the phrase “Global is local, and local is global.” Why travel to another country when you can support your own community? I grappled with this concept for several months as I networked to find my practicum.

The responsibility of ethical participation in the decolonization of global health and discomfort from history are the fundamental reasons I chose to pursue a practicum in a different country. The first step in doing so was establishing the content of the practicum itself. I collaborated with the founder of the organization to inquire about Nguzo’s primary needs, identified ways that I could produce quality work for each of those needs, modified proposed solutions based on the organization’s feedback, and asked the founder to identify which solutions the team would like me to provide.

As I sat in the Nairobi airport during my 13.5 hour layover, I prepared myself mentally for the application of my global health skills that I have been working so intently to build throughout my first year of my MPH. I realized the next step in ethical engagement involved ensuring that I reflected upon my intentions. So I got out my journal and wrote until my hand hurt. I realized that it is not unethical to have personal growth objectives, as long as my primary mindset is supporting the organization and community in pre-existing efforts, and I live in such a way that I humbly contribute meaningfully and sustainably without exploiting any aspect of the community or experience. I would be lying if I said I was not nervous about making mistakes, but Gillings prepared me to ask for feedback early and often to ensure that I am on the right track and not creating new problems or participating in historic oppressive global health actions.

Where there is discomfort, there is an opportunity to recognize bias, beliefs, norms, inequality, injustice, and the reality of differing access to resources. Awareness is not enough, but introspection and a conscious choice to make changes within oneself and taking humble, community-led action is a vital part of facilitating peaceful, responsible, equitable, and sustainable global health work.

Now to the engaging on-site part:

I arrived in Moshi at the end of May and took a few days to adjust before starting my first week in the office. My host family greeted me at the airport and was enthusiastic about helping me orient myself to the culture, customs, public transportation, and layout of the town. The Nguzo Women and Youth Foundation team welcomed me and made it clear that I was genuinely a member of the team and assured me that I would not be treated as a tourist.

The team excitedly welcomed me as I signed their visitor log on my first day in the local Bomang’ombe office.

 

The core team is holding up the sign for the Nguzo Women and Youth Foundation. 

 

Nguzo partners with fourteen primary schools and three secondary schools in the Hai and Siha Districts of the Kilimanjaro region, along with several local organizations. Their programs include the following areas: reproductive health; Adolescent Sexual and Reproductive Health (ASRH); Water, Sanitation, and Hygiene (WASH); mental health; inclusion of differently abled children; entrepreneurship; Community Empowerment Programs (CEP); environment and climate change; and outbreak response. Nguzo works with children and women, who the organization chose to describe as female-presenting parents and guardians of the children.

We began preparing for World Menstrual Hygiene Day by composing hygiene kits for differently abled youth attending Kibaoni Primary School in the Hai District. The boys’ kits were composed of combs, mirrors, soap, and socks. The girls received similar kits that also contained razors and reusable pads that can be washed and last for four years. Nguzo educated the mothers of the children on usage of the pads and healthy hygiene practices. Menstrual stigma and a lack of resources for managing menstruation at a young age in schools often results in a sentiment of shame and embarrassment, which has led to many young girls dropping out of school. The distribution of hygiene kits is one of the core initiatives that Nguzo facilitates to ensure sustainability, inclusion, education, and equipping students with tools they need to stay in school and develop a strong education that provides a promising vocational outlook.

While the team facilitated the intervention in Kiswahili, the founder asked me to take photos and videos of the event. I was aware of ethical photography conceptually and had pondered this intensely before the event, but I was nervous about whether I was going to make an unethical mistake. The first part came naturally: I did not take out my camera until the team introduced me and explained to all of the mothers that they had asked me to capture content to support Nguzo’s online presence and ability to fundraise. The team then asked for consent and if anyone was uncomfortable with photos being taken. I tried my best to stay out of the way, prevent distraction from the program, and stayed vigilant for anyone who showed signs of being uncomfortable with photography. I consulted with the team to ensure that all content they desired was captured.

I began my next task, which was developing the website. The founder provided me with all the information and the vision of the website. I worked with her to translate testimonies from two mothers that attended the Menstrual Hygiene Day event, which proved to be quite challenging and required close collaboration. These can be found on Nguzo’s website (nguzofoundation.org) if you are interested in watching them! I also am working on maintaining and expanding their social media presence. They can now be found on YouTube and LinkedIn, as well as their pre-existing Facebook and Instagram profiles.

I want to ensure that everything I contribute towards Nguzo will be sustainable. To be certain this intention is met, I decided to develop a maintenance guide for the website with detailed explanations on modifying the format and information. The guide also includes details for managing various social media platforms and methods of content creation to support future community engagement, partnership building, fundraising, and recruitment. As I develop content, I also occasionally demonstrate the skills live so that the team members can feel confident in replicating them in the future without disrupting their workflow.

The team has expressed heartfelt gratitude for what my collaboration means for the organization. As they seek funding, volunteers, staff, and partnerships, it is essential to have a strong website and expansive social media that can be referenced, especially for background checks and to prove the organization actually exists. I am thrilled to have the opportunity to support Nguzo in their growth and maintenance of life-changing initiatives.

If you are interested in learning more about Nguzo Women and Youth Foundation and/or supporting their initiatives, please take a browse through their shiny, new website at nguzofoundation.org.

 

Asante sana! (Thank you!)

Kelsey Cohn