The Warmth of Connection: Practicum Reflections from Mozambique

Two months ago feels like a lifetime ago, before I fell in love with the vibrant, charming city of Maputo. Before heading to Mozambique for my practicum, I was filled with nervous anticipation, and I had set a goal for myself that no matter how the whole of my practicum goes, that I would advance my life-skills of flexibility, adaptability, and self-sufficiency through this experience. I wanted to confirm that I had the commitment and ability to enter the field of global public health and be able to make meaningful contributions to the communities I worked with. I knew that it was easy to say that I am interested in working in a global setting, but of course an entirely different story when I am in a new country, navigating cultures and experiences that are unfamiliar to me.

With gratitude, I owe it to my parents for raising me as a global citizen. They raised me in a bicultural household in the United States and Japan, encouraging my travels and experiences in different countries, and fostering my love and never-ending curiosity of people and their cultures. My bachelors in Anthropology gave me the tools to lovingly interact with the core of people’s identities and taught me grave warnings of how curiosity without boundaries, permission, or consideration of power-dynamics brings considerable, tangible harm to individuals and their communities. My bachelors in Women’s and Gender Studies taught me that no work is done in a vacuum and no research can be objective so long as the identities we hold move us in the work that we do and the products we create. Both fields showed me that it is crucial to understand and reflect on the identities and beliefs I hold and taught me how to acknowledge this in the work I do, qualitative research, whose heart lies in the connection between people. Now, my studies in Public Health give me the language and skills to navigate the culture and landscape of global public health and connect the gap between understanding problems and creating meaningful solutions.

All of these parts of my identity and education are what I brought along with me in my journey to Mozambique, but one crucial part was missing, which was my ability to speak Portuguese. I realized that in contexts where I understood the language, I was receiving so much connection daily with others, through small interactions, that I was unable to do in this setting. But I also discovered how much I was able to communicate through body language and context clues (my beginner level Spanish also helped). Gratitude bloomed at every interaction where patience and effort were afforded to me and I was never treated with annoyance for my inability to speak. So despite the language barrier that existed with many of those I interacted with in my time in Maputo and Lichinga, the work I did was informed by community workers and local staff, which I was able to build relationships with. The many conversations I had over translation apps warmed my heart, knowing that despite the difficulty of communication, my coworkers and community partners were willing to sit and patiently create a bond with me.

Photo taken at the end of a training day for qualitative research.

 

From these connections was I able to offer my services in qualitative research, always deferring to the knowledge and experiences of the community facilitators who conducted focus groups with youth to understand what they wanted and needed from the Center for Reproductive Justice. There was of course another barrier, culture, but similar to how I adapted questionnaires and materials based on feedback, once the community facilitators understood the intent of our questioning, was able to adapt the language to something that was more appropriate for the setting. So, although at times I felt alone during my time in Lichinga (less so with my furry friends!), connections are what drive the heart of public health work we do with communities, and I hope to see Maputo again after I graduate. Tchau tchau until then!

Pretest for questionnaires being conducted by Ipas staff and community partners.

 

Anselmo Matambo (Ipas community facilitator), me, and my research assistant, Dr. Sandra Mulumba.

 

The lap cat at my guesthouse who often kept me company.

 

Alyssa

Going Global with Gillings: Reflections on participating in the 2023 Union World Conference on Lung Disease, Paris

By Gunjan Dhawan

Gunjan at the USAID booth, Union Conference 2023
Gunjan at the USAID booth, Union Conference 2023

The fight against Tuberculosis
Tuberculosis (TB) is an infectious disease that continues to adversely affect lives globally. A major cause of ill health, it continues to be the second leading cause of death worldwide after coronavirus (COVID-19)[1]. Despite TB being a preventable and curable disease, over 10 million people contract TB every year1. Thirty high-burden countries account for 87% of the total TB cases, and a total of 1.3 million people died of TB in 2022 alone[2]. Continuous global efforts to fight TB have saved an estimated 75 million lives since the year 20002. Sustained funding to support research and innovative solutions are required to accelerate the fight against TB.

The TB Data, Impact Assessment and Communications Hub (TB DIAH) project, funded by the US Agency for International Development (USAID), is a cornerstone of the Agency’s Accelerator initiative to enhance existing TB data and knowledge sharing and to strengthen national TB programs worldwide[3]. The project supports governments, policy makers, and program stakeholders with the generation, analysis, communication, and use of accurate, quality data for decision-making and scale up. Furthermore, TB DIAH provides the technical know-how to ensure optimal demand for and analysis of TB data, appropriate use of that information to measure performance and to inform national TB programs (NTPs)[4]. From the Performance-based M&E Framework (PBMEF), to assessments, to data dashboards and other resources, TB DIAH offers a range of data-based tools and frameworks to help improve tuberculosis programs worldwide4.  

Global with Gillings
For over 100 years, the Union World Conference has brought together different stakeholders working to combat TB across the globe. These include the different ministries of health, and government agencies, researchers and academicians, funders, implementing partners and private sector. The forum provides a great opportunity for all stakeholders to showcase results outcomes, initiatives of evidence-based research and practice for prevention, treatment, cure, innovation and beyond in the fight against TB. After two years of virtual conferences sessions due to COVID, the four day-long Union World Conference on Lung Health, 2023 was held in-person between 15th – 18th November in Paris, France. With funders, implementers, policymakers, patient advocates, decision makers, bilateral agencies, and other industry stakeholders all under one roof, TB DIAH made a strong presence by highlighting the incredible work done to build and strengthen TB data use in national TB programs across different geographies from the 24 USAID TB priority countries.

Along with the TB DIAH team, I had the good fortune to attend and participate in this year’s Union World Conference on Lung Diseases. I have been supporting the project with the conceptualisation, design, and technical content development for a TB M&E eLearning course to build the capacity of professionals working in national TB programs (NTPs) on M&E of different programmatic and clinical TB indicators. The course will support understanding of TB M&E and surveillance systems and explore how USAID’s PBMEF, which provides standardized, high-quality indicators, can improve the generation of quality data, and support the analysis, interpretation, and use of that data to inform programming, identify gaps, and strengthen the overall system. With dedicated time allocated for the information session at the booth, conference participants stopped for an engaging discussion on upcoming eLearning courses, and PBMEF, with the team. During the conference days, I supported these information and knowledge sharing sessions at the USAID booth, where the project team highlighted TB DIAH’s work on the (PBMEF) and TB M&E eLearning modules.

TB DIAH - UNC team and partners at the conference
TB DIAH – UNC team and partners at the conference

Experiential Learning
After months of focusing on critical public health issues affecting the world, learning about cultural humility, and practicing research methods and measures, participating at a world conference which focused on tuberculosis, was truly an experiential learning opportunity. It was a firsthand experience of witnessing evidence-based interventions that were implemented in different health settings across the globe being showcased at a forum where funders and implementers, researchers, physicians, and decision makers were all under one roof. Partners, innovators, and implementers shared best practices and innovative solutions that showed tremendous impact in increasing access to TB services across TB high burden countries. Sharing space to showcase the ongoing work on the TB M&E eLearning module, engaging in knowledge sharing sessions, and getting feedback from fellow participants on our work, was exciting.

It gave a diverse exposure to the progress towards TB elimination in the world, discover breakthrough AI based solutions to improve TB detection and simultaneously cross learn from other public health researchers and practitioners. Furthermore, I took back the experience of sharing a common space and goal with the TB DIAH team and partners, former colleagues, new associations, and stalwarts in the field of Tuberculosis – all wrapped up in the backdrop of the City of Lights: Paris.

I am grateful to my supervisor Ms Ann Marie Fitzgerald for her constant encouragement and support. A big shout out to an amazing team-Rebecca Cornell Oser, Meredith Silver, Bridgit Adamou, Margie Joyce, David La’vel Johnson, and Darrell R Keyes without whom this experience would have been incomplete.

I am both grateful and excited as I continue my journey in Global Health!

Shining bright – the majestic Eiffel Tower
Shining bright – the majestic Eiffel Tower

[1] Global tuberculosis report 2023. www.who.int. https://www.who.int/publications/i/item/9789240083851

[2] 10 facts on tuberculosis. www.who.int. Published October 26, 2022. https://www.who.int/news-room/facts-in-pictures/detail/tuberculosis#:~:text=About%20one%20quarter%20of%20the

[3] TB DIAH – Capture data. Contextualize data. Strengthen TB programs worldwide. Accessed December 13, 2023. https://www.tbdiah.org/

[4] Project Overview and Objectives – TB DIAH. Accessed December 13, 2023. https://www.tbdiah.org/about/tb-diah-overview-and-objectives/

Summer of COVID-19 – Perspectives from a Barcalounger

The lounge lizard in all its glory.
The lounge lizard in all its glory.

I ended up having quite the busy summer from my parents’ basement barcalounger in Madison, WI. For about six weeks from mid-May until late June, I made a valiant effort to balance my time between keeping up with studying for my MCAT, and collecting news, social media, video blog, and other disseminated stories of North Carolina frontline health workers regarding their COVID-19 experience…along with the occasional Zoom trivia or game night with friends, Global Health Concentration social committee meeting, or meeting with the COVID Behind the Numbers project team. I only escaped my lounge lizard life for a few workouts a week, walking the dog, or a much needed socially distanced Sunday afternoon round of golf. While the effort was valiant, by early June, the MCAT had consumed my life, my mind, and my soul, as it does to so many pre-medical students.

Despite the preoccupation with the MCAT, I continued to follow video blogs, podcasts, and other social media posts from frontline healthcare workers through the up-and-downticks of the summer of COVID-19 in North Carolina. Obvious themes began to present themselves as I worked with my initial data: PPE shortage or surplus, preparedness, rural homecare facilities versus urban hospitals, and support and appreciation for frontline healthcare workers existed among others. However, underlying these themes were a few more compelling, yet unsettling themes. As I reviewed stories, no matter the position in healthcare from Emergency provider or administrator, to public health analyst, nurse, or homecare facility worker, I found a concern for mental health to be interwoven in the stories I read. Many healthcare workers described the stress of not knowing what is to come, if they were prepared, or if their PPE was effective in protecting them and consequently their families. Many used spending time outside during breaks, or keeping up with yoga, meditation, or other practices to alleviate the stress of the time.

While not always applicable to the specific healthcare workers telling stories, inequity flowed through aspects of almost every set of stories I analyzed. Throughout the data collection process, Latinx and African American communities in North Carolina bore the brunt of this outbreak in terms of disproportionate cases and deaths relative to the percentage of the population each group occupies in the state. The most promising aspect was that, from early on, public health and other healthcare workers acknowledged, or highlighted the importance of recognizing and addressing these inequities in their stories. However, the numbers have yet to even out, or even come close. Seeing the themes streaming from this project to this most recent Black Lives Matter movement and protests of police brutality, looking at two major historical events occurring at the same time, and analyzing how issues of ethics, equity, and empowerment overlapped was simultaneously heart wrenching and fascinating. One physician likened dealing with the pandemic to “building the airplane while flying it” and “knowing how to build the plane…[but] being thrown different parts at a time.” Once we recognize an equity issue exists – mid-pandemic or not – this part of the plane needs to take priority in design, build, and reinforcement before any other area.

Considering my interest in infectious disease and mixed methods research, it has been extremely rewarding to apply the skills I have acquired to this point in my public health career to such a pertinent project. It provided a fun twist in that we had the freedom to search and gather qualitative data from a variety of open sources, rather than more standard qualitative interviews, which hopefully will be done in the future. I feel this project has been extremely informative: from finding expected and unexpected themes, to the roller coaster of ups and downs seen in the pandemic, to looking at the pandemic in conjunction with a critical social movement, and more. During hard times, many people turn inward, and harbor their feelings, emotions, and opinions. With the social response and activism this summer, and throughout the pandemic, it’s incredibly encouraging to see so many facing outward, using their voices, and expressing their triumphs and hardships. Now, we need to turn to those whose voices remain stifled, amplify them, listen, and work to make real change.

Kris