Caring for Ourselves While Continuing to Reach More Communities

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.

The post was written by Mitch Kimber, a CFK Africa 2022 Peacock Fellow, Registered Nurse, and MPH student in Global Health at Gillings.

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.

Mitch standing near height and weight measurement scales
CFK Africa Peacock Fellow Mitch Kimber supporting nutrition efforts

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.

Why Expand?

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.

Mitch standing in front of a screen to give a presentation on Health Facilities Data
Mitch gives a final presentation to CFK Africa staff about his project health facilities data to inform expansion

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.

Finding Balance

Mitch at the CFK offices in Nairobi

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.

Learning About Sustainable Collaborations in Global Health

When writing my first post, I had just started to settle into life in Lilongwe, Malawi. Time flew by and I am already back at the airport, about to embark on my second learning experience of the summer, working as a Peacock Fellow with Carolina for Kibera (CFK) Africa in Nairobi, Kenya.

Relaxing during a weekend trip to Cape Maclear (Lake Malawi)
Relaxing during a weekend trip to Cape Maclear (Lake Malawi)

I’m so grateful that I was able to work with UNC Project-Malawi the past eight weeks for my MPH practicum. Malawi is known as the “Warm Heart of Africa” and I was pleased to be welcomed there by beautiful scenery and so many kind people. UNC Project-Malawi was really a special place for me to learn about sustainable academic partnerships. This is important to me because in our classes we have learned about the mistakes made in previous generations of international health work including groups from high-income countries doing harm in low-income countries despite often proclaiming they were there to help. We discussed in class the difference between intentions and impact. I have feared the possibility of making negative impacts in this field despite having good intentions.

I think that one key to working toward positive impact is long-term sustainable collaboration. UNC Project-Malawi seems like a good example, including having experienced UNC clinicians and researchers mentor early-career Malawian clinicians and researchers who may have historically not had accessed to the same caliber training that UNC is able to provide US-based trainees.

Sunset at Lake Malawi
Sunset at Lake Malawi

A major focus of my practicum became supporting partnerships in nursing across the UNC Chapel Hill School of Nursing (UNC SON), UNC Project-Malawi, Kamuzu Central Hospital (KCH), and the Kamuzu University of Health Sciences (KUHeS). Since nursing and midwifery makes up nearly 50% of the global health workforce, I was surprised to initially find that there was not more nursing collaboration happening between the UNC SON and UNC Project-Malawi. Focusing on this seemed like a great opportunity!

Luckily, there has been collaboration with the UNC SON since 2018 but the COVID-19 pandemic had largely stunted growth of the collaboration. Being on the ground in Lilongwe, I was able to be a catalyst to get things going again. I helped coordinate many meetings including with KUHeS nursing leadership, oncology nurses at KCH, faculty from the UNC SON, and staff from UNC Project-Malawi.

Taken from the UNC Project- Annex, the sun sets over the recently constructed Cancer Center at Kamuzu Central Hospital
Taken from the UNC Project- Annex, the sun sets over the recently constructed Cancer Center at Kamuzu Central Hospital

A previous goal of the collaboration was to hold regular Grand Rounds. One area of interest for KCH nurses from a prior needs assessment was Interprofessional Education and Practice (IPEP). I know the importance of this topic from my experience working clinically so was excited to make this a focus area. Thankfully, Dr. Meg Zomorodi – UNC SON professor and Assistant Provost for IPEP at UNC – agreed to lead the Grand Rounds! The first session focused on interprofessional education and then two weeks later a second session focused on interprofessional practice. Feedback from KUHeS faculty and KCH staff was very positive. Dr. Zomorodi and I hope to continue supporting IPEP initiatives in Lilongwe.

Finally, my other major focus was qualitative data analysis relating to perceptions of cancer care in Malawi and healthcare worker preparedness to work in oncology. Stay tuned for the findings to be published in coming months!

I look forward to continuing to support my practicum collaborators and projects as I am able, and hope that I can return to Malawi at some point. I am so grateful that pursuing my MPH at Gillings gave me this opportunity. For now though, on to Nairobi!


Lilongwe (‘A long way’) Away from Home

Mitch on site of the new Cancer Center at Kamuzu Central Hospital
Mitch on site of the new Cancer Center at Kamuzu Central Hospital

May has been a whirlwind of a month! Between finishing up final projects, work commitments, and packing my bags it was a bit of a stressful start. Nonetheless, I caught my flight out of Raleigh to begin my 13 weeks abroad. And since submitting my last assignment of the semester during a layover at the Addis Ababa, Ethiopia airport, I have been able to primarily focus on my practicum!

I am completing it with UNC Project-Malawi for 8 weeks in Lilongwe, Malawi. I will then travel to Nairobi, Kenya for 5 weeks as a Peacock Fellow with Carolina for Kibera (CFK) Africa in Kibera – one of the world’s largest informal settlements with population estimates of 250,000 to 1 million people, living in less than 1 square mile.

Even before our classes began last August, I have been looking forward to the practicum as an opportunity to apply skills from the classroom in the “real-world” and help me figure out my initial career goals. Since I am a Registered Nurse hoping to maintain clinical skills but also with interest in bigger-picture health systems strengthening, it is important for me to spend time in different settings around the world to determine how I can be effective in the huge field of “global health”.

Thankfully, the staff at UNC Project-Malawi and CFK have all been welcoming and encouraged me to identify areas of interest to explore. This is amazing but also difficult since I have so many interests. For my time in Malawi, I decided to focus on a few areas: clinical care, community health, and assisting on qualitative data analysis. I also am hoping to further strengthen a growing relationship between the UNC School of Nursing, UNC Project-Malawi, and other partners here such as the Kamuzu College of Nursing.

The data analysis that I am supporting is in relation to perceptions of cancer care in Malawi. I’ll specifically focus on the perspective and needs identified by healthcare workers in oncology. Therefore, some of my “clinical” time is spent observing and assisting in the newly constructed cancer center. My other primary focus is in the Intensive Care Unit (ICU) supporting staff and leading Continuing Professional Development (CPD) sessions.

Mitch leading an educational session with nursing students and ICU nurses in Kamuzu Central Hospital
Mitch leading an educational session with nursing students and ICU nurses in Kamuzu Central Hospital

To gain further context for data analysis and understand more of Malawi’s health system, I expressed interest in community health activities. Thus far, I went with UNC Project-Malawi’s community outreach team to deliver nutritional support to Dzama Orphan Care and School and participated in a course at Kamuzu College of Nursing focused on gender equality and gender mainstreaming.

We discussed representation of men and women, for example in government. Some of the Malawian students expressed that they thought of the U.S. as a leader in gender equality, so were surprised to hear that women only hold 27% of seats in Congress and approximately 31% at the state/local level. Conversely, Malawi has elected a woman to be president, Joyce Banda in 2012, while the U.S. has not. We all agreed there is much more work to do toward equity around the world.

Similar agreements have been reached in the clinical setting when I have been looked to as an expert since I trained in the U.S. I share my perspective but am quick to remind colleagues that I am only just beginning to learn best practices for provision of care here in Malawi. From the CPD sessions, I have recognized that knowledge gained in nursing education here is quite similar to the U.S., there just aren’t always as many resources available in the hospital, and there are systemic influences across the continuum of health, illness, injury, and care delivery, which negatively affect outcomes.

These systemic factors are what I’m most interested to learn about since they must be addressed if health outcomes are going to improve. It is honestly quite overwhelming to think about them though.

I’ve been reflecting on when I studied to become, and worked as, a nurse – I personally found it to be straightforward. Generally, we knew what to do in the hospital. And I felt that I was relatively good at it. Working in global health seems so different to me, because I often have no idea what needs to be done on a systems-level. Things are overwhelmingly complex and it seems there is not often a straightforward solution.

It’s so easy for us to criticize a system and identify issues and needs, especially from a classroom, or coming into a setting with lower-resources than we’re accustomed to working with. It seems much harder, though, to identify and implement effective and appropriate solutions.

In feeling overwhelmed, I have been reflecting on a quote from the late Dr. Paul Farmer (co-founder of Partners in Health) about what kept him motivated to work in this field. He said, “Doing hard things with friends.”

Mitch with UNC Project-Malawi colleagues: nurse-researcher Agatha Bula, PhD, MPH, RNM (center) and country director Innocent Mofolo, MSc (left)
Mitch with UNC Project-Malawi colleagues: nurse-researcher Agatha Bula, PhD, MPH, RNM (center) and country director Innocent Mofolo, MSc (left)

Although all careers have challenges, I am lucky that in nursing I personally found a handful of “easy things.” All I can see right now entering global health is a whole lot of “hard things” and I have been caught up these last few weeks by focusing on the overwhelming challenges we face. Perhaps I need to begin focusing more on the other half of Dr. Farmer’s quote though; doing these hard things with friends. Because this is indeed when we can make progress, and I am inspired to do so with the amazing people I have met working here in Lilongwe. I hope that with these new friends, I can continue to learn, take on hard things a little at a time, and move together toward a more equitable world.