I am so glad and grateful to have spent the summer working with the University of North Carolina at Gillings Zambia Hub and Dr Stephanie Martin. The practicum focused on analyzing and disseminating data from a formative research project focused on infant care and feeding practices among families affected by Human immunodeficiency virus (HIV) in Zambia.
The project had conducted qualitative research to examine the feasibility and acceptability of engaging male partners, grandmothers, and other family members to support HIV-positive mothers in Lusaka to practice recommended infant care and feeding practices, and women for continued antiretroviral therapy (ART) adherence. The practicum was a wonderful experience that combined my interest in maternal health, child health and Sub- Saharan Africa.
My role involved conducting quantitative analysis of the transcripts of the interviews conducted in Lusaka last summer. I worked using ATLAS.ti software to code the transcripts and create thematic summaries. Though I did not conduct the interviews, it was extremely rewarding to read the impact the education on ART adherence, infant feeding and care had on the study participants. There was marked improvements by the participants in infant health and increased confidence in their ability to care for their infants. Through the summaries, as a team we have been able to identify acceptable and feasible intervention components that will increase ART adherence of people living with HIV and family support with infant feeding and care. I also collaborated with the team to use the organization network analysis software to create descriptive data summaries of the demographics of the interview participants. My preceptor and team members were incredibly supportive in coaching and guiding me on how to use the various analysis software and they helped me work through the challenges of my learning process. This practicum provided me the opportunity to develop tangible skills and work in an interprofessional setting putting to practical use things I have learnt in class.
Before securing a practicum in the spring semester, I was very anxious about finding one and if it will be a good fit. I must say, I am happy with my practicum experience. There is still analysis to do, papers to write and dissemination to undertake on this research, this is a project I would like to be a part of till its completion. Because of this, I have decided to continue my practicum project as an independent study elective during the fall semester.
I genuinely appreciate my preceptors Dr Stephanie Martin and Tulani Matenga and the entire team for their support through out my practicum. I look forward to continuing work with them and providing positive impact in the lives of women living with HIV and HIV exposed-uninfected infants in Zambia and beyond.
Last summer was an immersive period of learning and discovery. I had been grappling with a lot of questions around decolonization and localization of global health.
The scars of colonialism in Africa can be found in the profound inequities in healthcare across the African continent. But much has been achieved. And much yet more is desired. To deny the progress made thus far in transforming healthcare across the African continent is shortsighted. But that does not absolve global health policy makers and industry leaders of responsibility to do even more to bridge the inequities.
For context, I would like to highlight the gravity of the issue confronting global health and why decolonization should be reprioritized. As recently as 2020, 85% of global health organizations were headquartered in High-Income Countries (HICs). In these organizations, Diversity, Equity and Inclusion remain elusive as the data show that about 70% of board representations are mostly men (not Black men!), and of the 70% board representation, 80% of them are citizens of HICs and mostly educated in these countries. It doesn’t end there. The real cause of the inequity is in the money and who decides how much should be spent, and where, and at what time, and for which population. Let me give you an example: the funding that goes to local organizations for humanitarian work is less than 2%. USAID awards about 80% of its contracts and grants directly to US organizations. The US and HICs enjoy on average 70% of NIH Fogarty funding grants. Ultimately, this translates to agenda setting by these organizations and micromanagement of global health work even if local institutions have their own expressed health needs and priorities.
Gender parity is critical to global health for the lack of it is a continued symptom of colonization and all the vestiges of privilege. On the gender score, the situation is even more grim with projections that gender parity in global health would remain a mirage until 2074. That is unconscionable. See, while 80% of global health work is in Low and Middle-Income Countries (LMICs), only 5% of women in these settings are represented in global health work. Meanwhile, women and children constitute the largest population who bear the health burden in this group of countries. Doesn’t it make sense that the people who suffer the inequity most should be given the opportunity to set the agenda and policies regards their own wellbeing?
Doing it the UNC way…
Are there institutions that are championing the change we desire to see in the global health space?
During my summer internship, I worked on an upcoming clinical trial called INSIGHT in Zambia. The Institution—UNC Global Projects Zambia (otherwise called Zambia Hub)— characterized a classic example of how decolonization looks like in some fronts. First, Zambia Hub was established by UNC in Zambia as one of a few centers for global health research in the world. This proofs a point. That global health institutions can also succeed where their services are needed the most. I witnessed how local capacity was strengthened using technology to facilitate inter-institutional learning and capacity development of local staff.
More to it, and even more impressive is the fact that the leadership of Zambia Hub including my own immediate supervisor, research assistants and other support staff were women who constituted the majority of the organization’s workforce. That affirmed something: that women too can run organizations and do so even better if given the opportunity.
I did not do a management audit, nor did I formally interview staff to learn about how the institution was funded and whether locals managed funds, or whether funds were micromanaged from the UNC at Chapel Hill. I am reporting my personal observations about how the setting up of the Zambia Hub and the empowerment of women to run the organization refutes fears I have often heard about mistrust from development partners about the capacity of locals to manage institutions and funds. Zambia Hub, like the rest of the hubs set up by UNC is self-evident and should be sustained.
Going by the hypothesis that decolonization is not an endeavor to take and that it is one that would not yield good returns for donors and funding partners, the success of the Zambia Hub partnership with UNC presents compelling evidence to reject the null for the alternative.
From a global health security standpoint, we all live in thatch houses. And so, when you don’t support your neighbor to put a fire belt around his house, when his house catches fire, your house is next. In other words, I am saying that if we continue to ignore the clarion call to meaningfully decolonize global health, the next bat bite in Africa will cause an outbreak of nose bleeding in the West. Think about it.
While you are thinking about it, I would like to thank Dr. Margaret Kasaro, my preceptor, for her leadership that sees the Zambia Hub grow from strength to strength and proving to the world that yes, locals and women, when given the opportunity can be equal partners in the global health leadership structures and boardrooms. My supervisor, Manze Chinyama, was sterling in her tutelage and experience in all phases of clinical trials and I would like to thank her for her mentorship. To Modesta, the community engagement nonpareil, Laston Zulu, Harold Banda, Chileshe Kasonda, Elizabeth Mubanga and all the Research Assistants I worked with, I want to say thank you for all the support I received during my stay in Zambia.
Please Note: This blog has been copied with permission from CFK Africa‘s site, “Stories of Progress.” CFK Africa is an international nongovernmental organization, a registered 501(c)(3) nonprofit in the US, and an affilated entity of UNC Chapel Hill. The organization was co-founded by Tabitha Festo (a Kenyan nurse living in Kibera), Salim Mohamed (a Kenyan community organizer), and Rye Barcott (a UNC student) as “Carolina for Kibera” in 2001.
CFK Africa went through a name change within the last year and so did I… Well, not a name change, but a change in my professional title as I expanded my scope, just as CFK is expanding its focus now from Kibera across other informal settlements in eight Kenyan counties.
In recent years, I’ve worked as an Emergency Medical Technician and Registered Nurse. Last year, I shifted from this primarily clinical focus toward considering how health is affected on a systems level and a larger scale through global public health. My interests in public health actually started at home, seeing members of my own community, including people living with severe mental illness and experiencing homelessness, struggle with health and its social determinants. I learned that these outcomes are inextricably linked with other determinants of health like poverty, access to care, and other systemic factors.
This is what CFK figured out back when it started as Carolina for Kibera, tackling issues of poverty, access, and other systemic influences on health and wellbeing in Kibera.
I was drawn to work in global health because, while I observed poor health outcomes and barriers to wellbeing at home, I also knew that in other parts of the world, the challenges might be far more overwhelming. I wanted to move toward the area of greatest need, hoping that I could make the largest positive impact. I think CFK may have similar motives, as it aims to translate the positive impact it has had at home – in Kibera – to a larger scale, advising in other areas with great needs.
As I have expanded my scope, however, I have learned about countless new challenges and seen firsthand how vastly health needs can outweigh available resources. I honestly have felt quite overwhelmed at times. So, as CFK pursues what I view as a parallel transformation to mine, I hope to learn from the organization about how to overcome what may seem to be insurmountable barriers. I’m interested to learn if CFK faces similar challenges as me.
The Power of Partnership
While here in Nairobi, I’ve been consistently asked whether I see gaps in the organization since I came in with “fresh eyes.” In order to lend perspective on this, I must reflect on why I have struggled with my own transition and my own pursuit of improving the health and livelihoods of others.
My first reflection is on an obvious challenge with careers in global health. As an outsider, I will never truly understand the challenges that communities outside of my own face. Even within my own geographical communities of my hometown and the “Triangle” in North Carolina, I will never understand the varied challenges and perspectives of all the different people with whom I may work in the hospital or who I may meet at a local coffee shop.
Realizing this, it would be foolish to assume that I could have a deep understanding of community needs in other countries across the world – at least not any time soon. I can only do my best to partner with community members, consume literature and media from those communities, and learn what my role is in working with local colleagues toward our common goal of improving wellbeing.
Perhaps this is an important consideration for CFK as well: to understand its role in collaborating with other communities as it aims to partner toward common goals. I do think that this is the mindset CFK is taking. As I talked to leaders within the organization, my understanding is that CFK is planning to partner with and assist existing organizations to better identify and address gaps in their own communities.
The Challenges We Face
Another great challenge for me, especially as I enter global public health, is narrowing my focus to one – or a few – areas of interest. I have just begun learning the importance of concentrating my efforts to yield higher quality results and to prevent myself from becoming burned out.
CFK is not one person, so this challenge looks different on an organizational level, but it will be interesting to see how CFK balances quality across its various programmatic areas in Kibera and while advising across multiple informal settlements.
This relates directly to another challenge I’ve faced: Am I neglecting my community at home while working abroad? For me, it’s family, friends, and the communities I served at hospitals where I worked. For CFK, I view Kibera as the organization’s family and friends.
While I’ve been away, I haven’t been able to support my people. I’ve even had moments where it was challenging to know how to support myself while I was out of my comfort zone. I am interested to learn from CFK as it expands to see how it still successfully meets the needs of Kibera despite also expending energy outside of its comfort zone.
In culmination of all the above challenges and their associated emotions come questions I have to ask myself: Do I want to face these challenges? Do I think I can overcome them? Am I willing to make sacrifices in order to achieve my goals?
This brings me to the words of CFK’s late co-founder Tabitha Festo, a fellow nurse, who I’ve been told spoke of “sacrificing for success.” As CFK grows, and as I expand my scope, I think it is important that we all ask ourselves what it means to sacrifice for success and if it is something we are willing to do; to at times put aside our own needs in order to address those of other communities. Or, more importantly, how do we find a balance between meeting our own needs at home while also addressing the needs of other communities?
I don’t yet have an answer to this. There were times when I felt profoundly far from answers, asking myself why I am even here in another country and worrying that I am taking up more resources than what I am contributing. There were other moments when I felt so grateful to be engaged in projects with like-minded people who I could partner with to improve the well-being of individuals and communities near and far.
My time as a Peacock Fellow with CFK Africa was certainly an insightful experience in this slow process of my own career “expansion,” and I am excited to see how CFK overcomes similar challenges to what I am facing. All staff members have been gracious, welcoming hosts as I briefly entered their world, and I am grateful to have spent time with so many amazing people in Kibera.