Gillings Around the globe – Page 26 – Local is Global. Global is Local.

Green Means Go: Wrapping up My Experience with an Obstetric Triage Intervention in Ghana

Posted on September 6, 2022September 2, 2022 by

Though this summer is coming to an end and my amazing practicum experience with it, rather than coming to a full stop, I feel like my work in public health is moving full steam ahead. Transportation references aside, my practicum this summer focused on the qualitative analysis portion of an implementation science evaluation of the national scale up of a midwife-led Obstetric Triage Intervention Package (OTIP) in high-volume hospitals in Ghana [1].

View of buildings and skyline in Accra — Accra, Ghana; Photo Credit to Caitlin Williams

The final stretch included analyzing and interpreting all the transcribed interviews and synthesizing the data into a report and presentation targeted toward a general policymaking audience. I had expected the most challenging aspect of the practicum to include the process of developing a codebook for the interviews and the subsequent coding process, but I was surprised by the work that came after—what did all of this data mean? How would this translate into something practical and applicable? There was a lot of floundering and panic on my part, but the process of creating this “results” report was an ultimately rewarding one—I learned so much more about qualitative research, maternal and child health, and implementation science, and more importantly, how much I still have to learn. I look forward to making the connections between what I learned during this practicum experience and the classes I will be taking in the Fall (I’m looking at you HBEH 784 – Implementation Science in Global Health).

Bibimbap food on a towel with the beach in the background — Bibimbap at the Beach; Photo Credit to Anamika Devi

Once again, this hybrid/remote practicum model has allowed me the opportunity to explore more of my new home. My last summer trip included a visit to the Outer Banks Beach area. As a Florida native, I thought I knew beaches but this trip was definitely a learning experience. All of my invertebrate biodiversity class experiences seemed to pay off – I had a great time examining all of the Mollusca specimens in between some nice beach naps.

Finally, thank you to my preceptors, Stephanie Bogdewic, MPH and Caitlin Williams, MSPH for all your patience and mentorship this summer! And thank you to our partners at the Kybele-Ghana organization and the Ghana Health Service for your collaboration and inspiring work in improving the health and well-being of mothers* and children in this project.

– Amy T.

* The author acknowledges and respects the lived experiences of birthing individuals with gender identities not exclusive to cisgender female identities. However, for the purposes of data collection/analysis and recognizing Ghanian cultural values and norms, individuals that give birth have been referred to with traditional binary terminology, including women, females, and mothers.

[1] Williams CR, Bogdewic S, Owen MD, Srofenyoh EK, Ramaswamy R. A protocol for evaluating a multi-level implementation theory to scale-up obstetric triage in referral hospitals in Ghana. Implement Sci. 2020;15(1):31. Published 2020 May 12. doi:10.1186/s13012-020-00992-2

Community-focused programs in Nepal

Posted on September 2, 2022September 2, 2022 by nayavill

Enjoying the fresh air while attending a nutrition workshop in Balthali

Hello again, this is Ellina Wood. As the summer is quickly fading and my internship is coming to an end, I have been reflecting on my time spent in Nepal over the past three months. I have the great fortune to complete an incredibly fulfilling and rewarding dietetic internship with Helen Keller International (HKI) on Suaahara II: a project that has been implemented in Nepal since 2016 and partners with local stakeholders to address the health and nutritional status of women and children across 42 key districts.

Green leafy vegetables, pulses, and eggs to be shared at a swasthya aama samuha (health mothers’ group)

I agreed to the internship with the premise that I would engage in cooking demonstrations, analyze the nutrition content of existing recipes, make recipe recommendations to bolster the micronutrient profile, and write success stories to be shared in the annual report. Although some of my time has been spent on these objectives, a larger aspect of my internship has been spent on other tasks. While collaborating with a local dietitian and the Ministry of Health and Population (MoHP), I conducted literature reviews to develop a new national nutritional management protocol to aid in the recovery of moderate acute malnourished (MAM) children using nutrient-dense foods in place of imported formulated supplementary foods. Whilst there is currently no international guidance that endorses the use of local foods for the treatment of MAM, emerging evidence suggests that providing local foods may be comparable to formulated supplementary foods for recovery rate and weight gain so long as quality sources are used for the appropriate duration. In fact, the World Health Organization (WHO) is in the process of developing an international guideline, focusing on locally available food, for the prevention and treatment of moderate wasting in children presenting at health facilities with acute illness. It is the MoHP’s goal that any learning generated through monitoring and evaluation of the rollout of the new nutritional management protocol will be a valuable addition to the evidence base for the WHO guidelines.

Materials used during growth monitoring and promotion pilot testing

I also provided technical support to my team as they conducted pilot testing for an upcoming revision to Nepal’s Growth Monitoring and Promotion (GMP) guideline. The field-testing process meant that I had the opportunity to travel to different regions across Nepal to meet with the municipality-level governments and to support my team in training/ observing health care providers at Outpatient Therapeutic Centres (OTCs) and Non-Outpatient Therapeutic Centres (non-OTCs). Following each GMP pilot test, my team conducted exit interviews and focus groups with participating health care workers and mothers. Our observations and the following discussions ultimately guided our revisions for the GMP protocol and model recommendations for local and national government-decision making. Being able to travel to several districts not only gave me the chance to engage in monitoring and evaluation exercises with various government agencies and communities but it also allowed me to gain a deeper understanding of the region-specific customs and beliefs (trying new foods and getting glimpses of new, breathtaking views was a bonus!). I gained knowledge about the value of adaptability, how to effectively communicate in a culture that differs from my own, and how to be receptive when my worldview is challenged.

Although it is difficult to leave, I do so knowing that I am far better equipped to handle public health challenges. Overall, my internship has left me feeling inspired to continue working in the global health space.

-Ellina

Learning in Lusaka

Posted on August 23, 2022September 7, 2022 by

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