Nepal – I’ll be back!

Me (left) showing my husband the older neighborhoods around where I grew up
Me (left) showing my husband the older neighborhoods around where I grew up

I cannot believe that five weeks have already flown by with Nick Simons Institute (NSI). I have learned so much applying my baby public health skills and learning that things are always more complicated in the field. The majority of my time has gone towards the Advanced Skilled Birth Attendant (ASBA) report and associated policy brief. It would get discouraging when – once again – a variable was found to be confounding, or a survey respondent had to be contacted to clarify their response, thus changing all the analysis output. While working on the report, I would pull up old notes from the fall semester, trying to figure out which statistical test was appropriate for the data at hand.

The rice paddy fields as driving into Trishuli
The rice paddy fields as driving into Trishuli

In the midst of the ASBA work, the team took another field visit to Trishuli, a government hospital about three hours Northwest of Kathmandu. It has been designated the subsequential Hub hospital by the government, meaning that it will soon offer a wider expanse of specialist services so that people do not have to travel so far for healthcare. While there, we completed an ad hoc observational assessment to inform a Monitoring & Evaluation (M&E) framework for future like hospitals. We received a tour of the hospital facilities, completed interviews with staff, and surveyed patients. I spent much of my time surveying patients about the quality of care, their perceptions of the services, and their knowledge of the hospital. It was in these conversations that cemented the importance of the ASBA policy brief and reminded me how much of an impact that public health can have.

Looking back, I think that I learned the most during this summer in the small conversations in-between work with my colleagues and supervisors. Now that access to Cesarean section(s) (CSs) is more readily available, the work is shifting towards ensuring quality of care, although that has always been a goal. Conversations with people who have been in this work for decades brings up complexities, what Nepal’s future healthcare will look like, barriers and challenges, and of course, hope. So many people are working hard to make sure all people in Nepal, in the flatlands, the hills, or the Himalayas have quality and affordable healthcare. I was only here for a season, involved with one small project, but I am thankful for that I learned.

In my free time I have continued to polish my Nepali, visit old parts of town, and get back into painting. My favorite way to spend my days off is to walk to an old part of town and sit down at a public square and start sketching. You quickly make friends with kids, who jostle to ask to be painted next. Grandmas pose and remind you not to draw their wrinkles. It is a great way to chat and make new friends. In the end, I give them the painting, and take a photo for myself. I am fortunate enough that my husband has been able to visit and see the neighborhoods I grew up in. He is meeting a lot of family friends and eating even more daal bhat! We are going on a ten day trek before heading back to the states.

Paintings from Kirtipur
Paintings from Kirtipur

My time in Kathmandu is wrapping up after six weeks at NSI, but it isn’t over quite yet. Thanks to the magic of the internet, I will be able to stay in touch with my team and wrap up the evaluation of the ASBA program and its associated policy brief remotely. It is a humbling experience to have the opportunity to contribute to a project that will have real world impacts for policy and healthcare systems.

-Abby

Health and Access in the Himalayas

My view from work in the Kathmandu valley, overlooking the southern hills
My view from work in the Kathmandu valley, overlooking the southern hills

Hello! My name is Abby, an incoming second-year MPH student at UNC in the Global Health concentration. For my practicum, I wanted to experience public health work in the field. It was my priority to utilize my newly learned skills in public health to the benefit of my practicum site, while still being challenged and gaining skills that I could use in my career. I had the privilege of ending up in Kathmandu, Nepal. Having grown up here, I was all the more excited to return home and experience Nepal in a professional setting with the Nick Simon Foundation International in partnership with the Nick Simons Institute (NSI). NSI is a Nepali run NGO that works to innovate solutions in rural healthcare through training and hospital support and advocacy with the Ministry of Health and Population of the Nepali government. I will be assisting the Research, Advocacy, and Monitoring and Evaluation (RAM) team with Dr. Ruma Rajbhandari and Dr. Suresh Tamang.

This summer, I will be evaluating the qualitative and quantitative data for NSI’s Advanced Skilled Birth Attendant (ASBA) training program, culminating in a policy brief for the Nepali government. The ASBA training works to enhance the clinical skills of obstetric emergencies, specifically focusing on cesarean sections, in medical officers. The training has been designed in partnership with the National Health Training Center to fulfill the shortage of specialized human resources in rural Nepali hospitals where transportation in an emergency is often limited due to geography, infrastructure, and cost. Ultimately this work will inform government policy and the potential scaling-up of the program and the deployment of ASBA graduates.

Janakpur Hospital at sunset
Janakpur Hospital at sunset

Most days I come to the Kathmandu office, but I also had an opportunity for a field visit to Janakpur to observe the Minimum Service Standards (MSS) of a Secondary B hospital. It was an insightful experience that showed the differences between program plans and implementation. Although further work has not been finalized, I may assist in the development of a logic model for future monitoring and evaluation of NSI’s large Curative Service Support Program (CSSP) for the RAM team at NSI.

A full Thali plate with rice, lentils, veggies, ghee, aachar, and dahi
A full Thali plate with rice, lentils, veggies, ghee, aachar, and dahi

In my spare time I am catching up with family friends, eating all my favorite street food, refreshing my (very rusty) Nepali, and enjoying the heavy rains of the monsoon.

-Abby

Communication, communication, communication

My practicum with NARAL Pro-Choice North Carolina was to take place over 10 weeks, the last of which began on August 2nd. I expected to enjoy my time with NARAL NC, but my practicum has surpassed my anticipations dramatically.

I believe my good experience centers around the way the staff treats me. They speak to me as an equal, not just as a student who needs supervision. While my preceptor helped me identify a few deliverables that I could work on at the beginning of my practicum, she was flexible and supportive when our goals shifted throughout the summer, allowing me to amend my deliverables as needed.

My last deliverable has been my favorite by far. In short, I have been working on a report on a specific public health problem that is meant to be consumed by the public. I started this project by receiving an abundance of raw data that needed to be analyzed, which allowed me to practice my STATA skills. I was able to take some of that raw data and turn it into an ArcGIS map, which I believe will be a valuable addition to the report. Lastly, I’ve been able to practice my graphic design skills by designing the layout and format of the report as I go.

However, my favorite part of this project has been the writing aspect. The MPH program typically requires us to write papers and such in scientific or academic voices, which certainly aligns with the audience they’re meant for. The NARAL NC report, on the other hand, is being created for a non-scientific audience, which has been an amazing challenge for me and my writing skills. I have enjoyed this type of writing more than I expected to. The unique combination of abilities it requires has exercised so many different tools from my toolbox, from data translation and choosing relevant statistics to creative writing and narrative formatting.

This report has really driven home the idea that our job as public health professionals is not just to partake in research and the scientific process, but to make sure our findings are accessible to the world. COVID has been a great example of this, especially now with the concerning Delta variant. The research is somewhat unclear, and while that is to be expected this early in the process, I do not feel that it has been communicated to the world in an organized manner. This, plus government mandates and the loss of progress on “opening back up” adds to confusion and alarm. I’m sure we would agree that the United States could have done many things differently throughout this pandemic, but communication would be towards the top of the list in my opinion.

While my practicum is wrapping up and COVID is picking back up, I will always remember the lessons learned at NARAL Pro-Choice NC.

Stay safe,

Abby