Digital Health Interventions in Sichuan, China, continued

Sam in San Francisco, CA
Sam in San Francisco, CA

It has been only five weeks since my last blog post, but it feels like it’s been months. To recap: my practicum project involves interviews in rural China with community health workers, supervisors (for the community health workers), and caregivers (who are either pregnant or caring for a baby 0-18 months old) who receive home-based educational lessons on topics like breastfeeding, maternal and baby nutrition, injury prevention, maternal mental health, and hygiene. When I last wrote, I was working on the interview guides. Since then, I have recruited interviewers, held an interview training session, managed the interviewers as they conducted my interviews, transcribed the recordings, and translated the transcripts.

In many ways, this practicum has felt like my own mini research project (a project within a project, if you will) – mine to manage and lead to the charge on, with mentors to offer guidance when needed. The first thing I have learned so far is that my expectations regarding timing were unrealistic: The interview guides were an iterative process, but that also meant that they took nearly twice as long to complete. I still am translating transcripts and haven’t gotten to coding or analyzing anything yet, even though I should be in my last week. The second thing I have learned is that logistical problems are impossible to predict. For example, I never suspected the difficulties that would come with using a Chinese transcription service when you don’t have a Chinese cell phone number or a Chinese bank account. I’ve also discovered the difficulties in managing a team of people in a different time zone, and the importance of clear, written communication. Through reading the interviews, I have learned about Chinese culture like newborn practices and childrearing customs.

Marten Van Purren the best practicum helper I’ve ever had!
Marten Van Purren the best practicum helper I’ve ever had!

My next step for this practicum is to finally (after almost two weeks!) finish translating the interviews and begin coding. I suspect that coding will be easier since I feel as if I know all the transcripts by heart after double checking the transcription and translations line by line. Once the analysis is complete, I will compile it all into a report, which I will present to Stanford’s Rural Action Education Program (REAP). I hope that my findings will help inform future steps in this program, which nearly every interviewee enjoys immensely and finds extremely helpful with childrearing. Though the intervention is scheduled to end soon, I think the findings from both this small project and the larger intervention could have larger impacts on rural families all throughout China.

-Sam

The Little Things and Practicum Mid-Point

Maria
Maria

Hello blog readers!

My name is Maria Esposito and I am a rising second year MPH student in the Global Health Concentration. I am almost two months into my summer practicum working with UNC Professors, Dr. Audrey Pettifor and Dr. Tonia Poteat, through the UNC-Wits Reproductive Health and HIV Institute (RHI) partnership based in Johannesburg, South Africa. My practicum is focused on an implementation science research study, which will examine differentiated care models for transgender people in South Africa with regard to their HIV care.

Before starting my MPH at Gillings, I was working in USAID’s Office of Population and Reproductive Health as an Administrative Program Assistant. Most of my work consisted of project and financial management for international family planning projects. Beyond that, for most of my public health career, I have conducted and contributed to a range of research projects on global and local reproductive health issues, menstrual equity, qualitative analysis, and engaging with community stakeholders.

While looking for a practicum, I knew I wanted to explore different aspects of reproductive health, specifically outside of family planning. After a lot of reflection, I realized I had never been involved in the initial stages of a study. I see my practicum with the UNC-Wits RHI as an opportunity to build upon this, my interests, create deliverables for the study (a clinic checklist and an interview guide), while also learning significantly more about global HIV inequities, transgender care, and implementation science research in Johannesburg, South Africa. Ultimately, I am thankful to be given this practicum opportunity and be tangibly closer to UNC-Wits RHI’s research work.

Rho (gray cat on the left) and Taylor (senior dog on the right) are the two pets that I have taken care of this summer. They have both been great companions while I recovered from COVID
Rho (gray cat on the left) and Taylor (senior dog on the right) are the two pets that I have taken care of this summer. They have both been great companions while I recovered from COVID

With that being said, the first few weeks of my practicum were challenging. I was recovering from back to back COVID infections and a pulled nerve in my back, which has made adjusting to a schedule difficult. Thankfully, I have fully recovered and I have been able to catch up with some friends, pets like my friend’s cat (Rho) and a senior dog (Taylor), and I made friends with an Eastern Bluebird fledgling. With that being said, I am still trying to build structure in the same way that classes and working provided me, but for my practicum workflow instead. This is still a work in progress!

I certainly did not see all of the unexpected hurdles when I started my practicum, but I continue to try to find the little things that keep me energized when it comes to my practicum work.

Cheers to finding the little things this summer!

-Maria

Mildred Blueberry - the Eastern Bluebird fledgling that flew directly up to my roommate and I. And he made himself at home for 4 days before flying off my balcony. Truly the highlight of my summer so far!
Mildred Blueberry – the Eastern Bluebird fledgling that flew directly up to my roommate and I. And he made himself at home for 4 days before flying off my balcony. Truly the highlight of my summer so far!

 

 

Honesty | Assertiveness | Dialog

Adam Aicha Hanne at her family’s farm outside of Bamako city
Adam Aicha Hanne at her family’s farm outside of Bamako city

The beginning of the week was frustrating. The cycle of going home early due to the lack of work assigned to me perpetuated for three days. I felt like my time and money were being wasted as I would catch a taxi to work every morning to find out that there was no work for me to do. Although my preceptor-student meeting was coming up on Thursday, I decided to approach my supervisor on Wednesday with my concerns. I first asked my supervisor if he’d be joining the student-preceptor meeting set for Thursday. He expressed that he’d like to attend if he gets invited by the head director. Due to my uncertainty about his attendance at the preceptor-student meeting, I decided to share my meeting content with him because the information would be useful to him when considering future international interns. I shared with him some pros and cons I had experienced thus far at Mali Health and possible solutions for future interns. The pros I shared with him were how pleased I was with the work Mali Health was conducting and how I loved the work atmosphere and the individual characters of my colleagues. The cons I shared with him were how I was displeased with the slow pace of the work being conducted and how I felt like my time and money were being wasted every time I came into work and left early due to the lack of work being assigned to me. I explained to him how I expected to contribute to the Sustainable Community Project (SCP) every day, but instead, I come to work early and leave early due to the lack of work being conducted. I thought sharing my thoughts and feelings with him would make him upset, but instead, he listened and smiled with acknowledgment. After expressing my thoughts with him, he explained to me how Mali Health was backed up in work due to the hiccup we experienced last week with the office being shut down. He said that currently he and the financing team were working towards approving the finances of the SCP project and that once the financing was complete we could move forward with the project. He also acknowledged my concerns by agreeing with me about the slow pace of the work. Thus, together we came up with several solutions to avoid this in the future. Together, we agreed that interns should be assigned weekly assignments ahead of time that focus on their projects. We also agreed that the workload should be average with several onboarding meetings held before their arrival to Mali, thus allowing Mali Health and the student to plan their weekly activities together. After speaking with my supervisor, I was excited for my preceptor-student meeting as I was initially nervous to open up and be honest with my team. My dialog with my supervisor allowed us to grow closer as a team with a level of respect that was previously absent.

Embrace

Let’s Get To Work

Mali Health team and teams of investigators at the waste composition orientation
Mali Health team and teams of investigators at the waste composition orientation

On Friday, we finally started working on the Waste Composition Analysis by hosting an orientation with our team of investigators responsible for conducting the in-the-field research on physical waste generation by households, and marketplaces in our three target peri-urban communities. The orientation was successful, and we were able to identify possible challenges with our strategic plan for conducting the in-the-field research through demonstrations on how to analyze waste generations. During the orientation, I loved how the Mali Health team and the team of investigators engaged with each other. There was this familiarity between them like that of a family. Seeing this was humbling as this is not something I feel is highly valued in the United States. It’s rare to work with an organization or company that centers its success around the chemistry of its employees.

May Your Trash Be My Treasure

Adam Aicha Hanne with the Mali Health team at Cicoroh separating the waste by category
Adam Aicha Hanne with the Mali Health team at Cicoroh separating the waste by category

Our goal at Mali Health is to turn waste into a profitable commodity. To do so we borrowed the Sustainable Community Project from Green Africa Youth Organization (GAYO) in Ghana. Like GAYO, we want to work with peri-urban communities to convert everyday trash into reusable products. But our very first step towards achieving our goal is to conduct research. Our research is composed of five analyses, three of which I am currently working on; waste generation analysis, social norms analysis, and stakeholder analysis.

Mali Health Team at Kalababougou conducting the physical waste generation investigation
Mali Health Team at Kalababougou conducting the physical waste generation investigation

This week we focused on the waste generation analysis as it is the most time-consuming and physically demanding one. Along with our team of investigators, we went into our target communities–i.e. Sabalibougou, Ciscoroh, and Kalababougou– to physically analyze the waste generated by our participating homes. Investigators were provided with a spreadsheet that categorized the different types of waste that are typically found in waste sacs. Teams of investigators were responsible for adequately weighing the waste sacs and identifying the waste found in the waste sac along with weighting each category of waste found. Later, this information will be used to identify which waste products are recyclable and the total waste per category will be quantified. Through our analyzes, we will understand the types of waste generated by our targeted communities, and how their waste can potentially benefit them.

-Adam