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.

Hand Washing for Children, by Children

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 Sarah Lebu, a CFK Africa 2022 Peacock Fellow and Ph.D. student in Environmental Science and Engineering at Gillings.

This story begins with the dong of a school bell. Immediately after, young learners, aged between six to thirteen years fill the school compound. Playgroups begin to form, lunch boxes are popped open, and happy shrieks are heard. Not too far away, a few children are washing their hands at a handwashing station by the school administration building.

Children washing their hands
Students washing their hands in school

Handwashing is one of the most effective ways to help prevent diarrheal-related diseases among children. In Kenya, the prevalence of diarrhea among children under 5 is 15%. The rate is even higher (18.7%) among children who live and go to school in informal settlements

Behavior Change Communication is an approach to hygiene promotion that uses an in-depth understanding of people’s behavior to design persuasive communication. At CFK Africa, children are engaged as equal and active participants in designing messaging around handwashing in schools. The design process starts by trying to understand on a deeper level how children think and feel and what motivates them to practice or not practice a behavior.

A Collaborative Design Process

Sarah holding a poster while talking to a group of children
Leading a focus group discussion with students on hand washing murals

Through focus group discussions with five to six children each, we created a research experience that is respectful, safe, and allowed children to share their views without fear. The groups had a varied composition: mixed-gender, mixed-age, and mixed-grade. We asked children to share their perspectives, needs, and motivations around handwashing. The process also captured nuances in design preferences around color, fonts, and choice of images used. As a CFK Peacock Fellow, I had the opportunity to facilitate two focus group discussions.

We learned that having mural designs with simple messaging, bright colors, and playful images of children were appealing to children and created a positive learning environment. The color white and sparkling hands were associated with cleanliness, while some children thought the color brown was akin to dirt and germs. The responses from children were compiled and shared with the design team to produce a child-friendly mural design.

Children as Agents of Change

To date, CFK Africa has facilitated the painting of collaboratively designed, child-friendly murals in 10 schools across two counties. The reception of the message on the murals has been positive so far. In the schools with the mural paintings, children are washing their hands more often, as often as required. We are also seeing evidence of children becoming agents of change. Young learners in schools are sharing positive hygiene messages with their near-peers (e.g., siblings and friends in the same age group). These messages are further cascading to households and communities. Such is the power of child-centered design.

Hand washing mural commissioned by CFK Africa in a school

However, the challenge is far from over. CFK Africa plans to work with public health officers and education officers from county governments to encourage more conversations around proper handwashing among children. For example, a training was held for members of school health clubs, dubbed WASH champions, to equip them with tools and knowledge to create more awareness among their peers on handwashing. Educators and partners working to improve hygiene among children can learn some valuable lessons from this process.

Exploring Malaria, Anemia, and Helminth Infection in Benin

Amina
Amina

I have recently completed my practicum and conducted research with a team from UNC and the École des Hautes Etudes en Santé Publique in France. Together, we have worked on a qualitative sub-study based in a semi-rural area of Benin.

Over this summer, I developed a codebook to analyze thirty transcripts on maternal depression and knowledge and behaviors associated with anemia, malaria, and helminth infection among women and children. Additionally, I have learned to use a new qualitative analysis software, Dedoose, to facilitate the analysis process. Through my practicum, I have further developed my qualitative analysis skills and acquired new tools to expand my research scope. Focusing on the experiences of women during their maternal health period has also allowed me to gain a more nuanced understanding of maternal health challenges associated with infectious diseases and mental health. I hope to further these insights in future projects on maternal health, specifically in sub-Saharan Africa. Through my data analysis, I have also gained insight into social and structural factors that impact adherence to treatment plans and health promotion, such as challenges with the affordability of treatment and lack of knowledge surrounding treatment options.

This practicum experience has been incredibly rewarding and informative and has set me on a path toward further exploring maternal and child health!

– Amina