Not An Ending but a Continuation…

On a Catamaran in Cancun #EndOfSummer

Hi! The practicum really flew by!

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.

– Eni

Decolonizing Global Health: A UNC Experiment That Shows the Way

Simon standing in front of two paintings
Simon Aseno at the Lusaka National Museum

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.

Researchers sitting at desks
Simon Aseno leading an ICT Capacity Development Seminar for Research Assistants at the Kamwala Health Center in Lusaka

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.

– Simon

Learning in Lusaka

Mia standing in front of SUN-LE banner
Mia at the Scaling Up Nutrition – Learning & Evaluation Office

Hello! It’s hard to believe that its already time to share a final update on my practicum experience. This summer I’ve been working with Scaling Up Nutrition – Learning and Evaluation (SUN-LE) and Dr. Stephanie Martin as a communications intern through the Gillings Zambia Hub. While I spent the first 7 weeks of my practicum working virtually, I also had the opportunity to spend the last 3 weeks in Lusaka, Zambia collaborating with colleagues in-person and sharing more about the projects I was working on.

When I checked in last, I had been making exciting progress on an evidence gap map of maternal and child nutrition research in Zambia and was looking forward to getting feedback from the team at SUN-LE. The process of editing and finalizing the evidence gap map has proven to be one that is both deeply iterative and sometimes challenging. Over the past two months we have worked as a team to significantly refine the information presented in the map. At times, as with many global and public health endeavors, this process required a degree of patience and flexibility. It was often an important reminder that the practicum experience provides opportunities to learn and grow beyond tangible skills. While this data visualization remains a work in progress, I was grateful to be a part of a team that was thinking so critically about the utility of this tool and am excited to continue being a part of finalizing the map.

Mia giving a presentation in a classroom setting.
Giving a presentation on the Evidence Gap Mapping process at the University of Zambia

In addition to working on the scoping review and data visualization components of the evidence gap map, being in Lusaka also provided the opportunity to share more about the tool and the process of generating the visualization. As a part of disseminating information about the map, I was able to deliver a presentation for students and staff at the University of Zambia (UNZA). It was a great opportunity to share my passion for this project and engage with an audience who was not only interested in the final product, but was also interested in learning more about the process of creating this type of data visualization. While much of the technical work may have been able to be completed virtually, being in-person at SUN-LE and UNZA was a welcome reminder of not only the importance of, but also the joy in, relationship building in global and public health collaborations. I hope that I can bring some additional intention to personal relationship building with mentors and colleagues as we continue to navigate a mix of in-person and virtual learning and collaboration.

Group of people standing outside during sunset.
Visiting Lower Zambezi National Park

I am so grateful to my preceptors Dr. Martin and Tulani Matenga as well as the team at SUN-LE and the Zambia Hub for facilitating opportunities for me to be involved in this project and offering their support and mentorship throughout the process!

Mia