Zambia – Gillings Around the globe

Staying Connected

Posted on September 7, 2021 by nayavill

Melissa in a field of sunflowers at the NC Museum of Art. — Enjoying the colorful sunflowers, cosmos and zinnas at the NC Museum of Art.

As I was driving a familiar route on I-40, admiring the lit up American Tobacco Trail bridge against the various hues in a beautiful Carolina sunset. I wondered, “What does a sunset over Lusaka, Zambia look like?” if I were there for my practicum. I have only heard of my colleagues and friends’ experiences as they lived and traveled there. I understood it to be a place that drew someone I admired and respected back so many times that when we ordered her retirement party cake, it had the colors of the Zambian flag on it. I searched for images online, and as I scanned the landscapes, buildings, and people in photographs, in that moment, I wished that I could be there experiencing a universal, cyclic sunset that is familiar yet different everywhere you experience it. When I applied for this practicum, I knew that it would be understandably remote as we are still in a pandemic, but I still wished I could travel and meet with my colleagues in person. The past year has been a roller coaster ride of emotions through the challenges and opportunities while being remote pursuing an MPH with a concentration in Nutrition at the UNC Gillings School of Global Public Health and working full-time as a project coordinator also at UNC.

Prior to becoming an MPH candidate and returning to work in global health, I earned my culinary arts degree in New York City and worked as a line cook and sales account manager. I also have bachelor’s degrees in Anthropology and East Asian Studies from the University of Virginia. My partner and I moved to Chapel Hill, North Carolina so I could be an assistant cheesemaker and cheesemonger. It has been a long journey leaning on my support system of family, friends and mentors to get where I am today able to pursue my passion and studies in global health nutrition.

For my UNC Gillings Zambia Hub practicum, I am part of a qualitative research study funded by the UNC Center for AIDS Research (CFAR). The study examines the feasibility and acceptability of engaging male partners, grandmothers, and other family members to support HIV-positive mothers in Lusaka, Zambia, to practice recommended infant care and feeding practice and adhere to antiretroviral therapy. The data collectors are trained in Trials of Improved Practices (TIPs), which is a formative research technique, and they counsel women and their families. Data are collected during a series of three interviews with HIV-positive women, and two interviews with the women’s male partners or family members. TIPs is a consultative methodology that focuses on understanding what is adaptable and feasible for HIV-positive mothers and their partners and families to improve infant feeding and care, bridge the gaps between knowledge, and put improved health for mothers and infants into practice. I am particularly interested in learning from the Zambia-based team and my preceptor about conducting interviews and using TIPs as a research method and technique to give participants a voice in program planning. It is vitally important to understand the context and practice cultural humility with stakeholders, which assists with sustainability. I also like how the participants try out the agreed upon practice and I am eager to learn more about the support system of these women and its impact on their and their infants’ nutrition and prevention of mother-to-child transmission of HIV. During my practicum experience so far, I am learning how to use Ona, an online platform using Open Data Kit (ODK) to collect data and summarize participant characteristics and responses. I have also given feedback on the interview guides and written transcripts. I look forward to working with the team to create a codebook and code transcripts in Atlas.ti. and synthesizing what we will learn. I also continue to learn from the team on how to conduct qualitative research effectively in interviews and be faithful in translations while maintaining the dignity and privacy of the participants.

My summer days have been flying by as I started a new job within UNC Carolina Population Center (CPC) at the end of May and continued to work full-time in addition to my practicum. I meet virtually with my preceptor, Dr. Stephanie Martin, and a fellow student every week, and with the Zambia-based team frequently, which keeps me connected and moving forward. I am appreciative and grateful for the team that I work with for their flexibility and understanding. The silver lining that I have found in a remote practicum and hybrid work schedule is I am able to do both. Similarly, to what others have said in this blog space, I reflect upon my current situation daily and strive to change my mindset/perspective by practicing gratitude one day at a time. I recently watched Chef’s Table: BBQ featuring the James Beard Award winner, Rodney Scott on Netflix. He said, “Every day is a good day. It doesn’t always go as smooth as we want, but life is what you make it.” “My glass is going to be half full each time.” “What did I do yesterday that I can improve on today?” These words and his approach resonated with me to apply this to life and my practicum experience of doing qualitative research in a pandemic. All research activities in Zambia involving direct contact with participants were temporarily suspended for over a month due to the increase in COVID cases and only recently resumed on August 4. We have what we planned in the theoretical sense, and then we had to face real-life implementation. The safety and well-being of those in Zambia were most important. I learned more about communication and how to move forward even during these most challenging times. Due to the delay in completing data collection and changing timelines in project implementation, my practicum was slightly extended, and I will continue to work with Dr. Martin and the team through an independent study this fall.

Picture of a bunch of different vegetables picked from the garden. — Proud of the harvest from our garden.

In addition to a busy work and school schedule, I am finding respite by taking care of our four beehives and mini homestead garden with my partner, Michael. I am also spending time with my co-worker and cat daughter, Honey. She reminds me to get up and move away from my computer to pay attention to her and what is going on outside.

Brown, tan, white and grey cat sitting on a chair. — Honey, our amazing and wonderful cat

– Melissa

With goal-motivated fun, time flies

Posted on August 25, 2021 by nayavill

I have been privileged to work on a hugely satisfying and rewarding practicum with the Gillings Zambia Hub. It is qualitative research to assess the acceptability and feasibility of engaging male partners and other family members to support HIV-positive mothers to practice the recommended Infant feeding practices and Anti-Retroviral Therapy (ART) adherence.

My drive and interest in HIV research and the prevention of mother-to-child transmission stem from seeing the hardship faced by people living with HIV. Hence, I was glad for the opportunity to work on a subject matter I find interesting and relevant, so I have had no problem finding my footing or staying motivated, especially with the practicum being a virtual one.

For the project, we use the Trials of Improved Practices (TIPs), a formative participatory research technique developed by the Manoff group to pretest and improve the recommended practices on a small scale before introducing them broadly. Trained interviewers discuss current feeding practices and ART adherence with study participants in individual interviews. In addition, study participants are encouraged to identify home supporters. Subsequently, there is counseling on the recommended practices, and with the interviewer’s help, each study participant decides on specific practices to be adopted over a trial period. In follow-up meetings, the interviewer asks questions to assess the uptake of the recommended practices. By taking this approach, we draw from the experience of the study participants, who are members of our target population, to pilot test our recommendations. This approach enables us to recognize and determine the practicability or limitations of recommended infant feeding practices in the context of the local communities. Furthermore, using TIPs makes it possible to identify possible challenges that might impact the uptake of our proposed recommendations, provide solutions to these challenges, eliminate or modify practices that are not feasible.

As an intern, I support the team by reviewing the transcripts of the focused interviews and providing feedback. I also use Ona to assess and summarize the data and ATLAS.ti for qualitative data analysis. In addition, I am working on a secondary analysis of already coded data to determine the role of social support systems and couples’ joint decision-making in preventing mother-to-child transmission of HIV. Through my interactions with the research team, I am learning to be perceptive of cultural differences, be humble and respectful while giving feedback, and be open to responses that challenge my worldview and perspective. The opportunity to work on a diverse team has also afforded me a better appreciation of the interaction between individual social identities and power dynamics in a research ecosystem.

Sometimes, things do not go according to plan. A little over a month ago, the project had a slight hiccup when the Zambian government had to suspend all hospital-based research because of another wave of the COVID-19 pandemic. Data collection had to stop temporarily, affecting our deadlines for specific points in the study. Thankfully, the COVID-19 cases are dwindling, the suspension was lifted a week ago, and data collection has commenced again. Overall, I would say that this summer has been productive and a lot of fun. Through meeting other students, I expanded my Gillings community. I also explored more of North Carolina. Most of all, I am thankful for a fantastic opportunity to learn and grow my skills through the Gillings Zambia Hub. Now, my only grudge is the swift passage of time because it feels like I started the practicum a day ago, yet it’s been three months and more. Indeed, time flies.

While spending a summer day at Ft. Macon State Park, I couldn’t resist taking a picture of these lovely seagulls.

– Olu

Long days, short (summer) weeks…. Wrapping up a remote global health practicum

Posted on July 29, 2021 by nayavill

It’s hard to believe that my practicum experience is almost over and that the summer’s almost gone! I keep asking myself where all the time went. For my practicum experience, I have been working with UNC Gillings Zambia on the ARCH study. The goal of the ARCH study is to optimize birth outcomes in low-resources settings, by using household surveillance to gain a better understanding of the social and clinical factors that may affect pregnancy outcomes in women of reproductive age. I think that one of the best parts of the study is that it allows the study team to follow women of reproductive age, from preconception to at least one year after the end of their pregnancy, in the event that they become pregnant during the course of the study. In addition, the study also follows children under the age of 2, to gain a better understanding about factors that impact the health of young children. Thus far, I have learned quite a bit from the study, mostly related to the implementation of such a large-scale study.

One of the most important lessons that I have learned so far has been the importance of flexibility and being willing to adapt to a new situation. At the beginning of my practicum, my preceptor and I thought that it would be most helpful if I worked on developing standard operating procedures (SOPs) for various aspects of the study. As time progressed, it became clear that there were other aspects of study implementation that would be a better fit. As such, we have pivoted from working on SOPs to developing recruitment and training materials. It has been an interesting learning experience, thinking about how best to simplify the language from protocols, written for technical experts, to informationals that can be understood by study participants. I’ve also learned a lot about the seemingly small aspects of study implementation that I had only briefly thought about. As I’ve been charged with drafting some of the training materials and schedules, I find myself thinking about the most pertinent parts of the study protocols and how to engage study staff when they might have days’ worth of training in their future. All in all, it’s been a truly educational experience.

It might not come as a surprise that one of the most challenging aspects of the practicum experience has been my inability to meet most of the people that I’m working with in person. I have tried to keep in touch via email. My preceptor has also been wonderful, as we decided to meet on a weekly basis, just to touch bases. I think that the weekly meetings have been helpful and have provided more opportunity for direct feedback. At this point, we have talked about extending my practicum, but I still don’t think that I will be able to see the actual start of the ARCH study. That said, I plan to follow the study closely and look forward to learning more about the results of the survey.

Lastly, I’m looking forward to enjoying the last weeks of summer, prior to the beginning of the semester. I’m very excited about starting the second year and can’t wait to meet in person!

– ‘Desola