With the school not approving Summer travels, I knew it was highly improbable for me to travel to Lusaka, Zambia, for my practicum. Nevertheless, I had the tiniest hope that things would work out just in time to make the journey possible. I felt like I deserved the trip after a semester-long love-hate affair with virtual meetings and zoom (zoom fatigue). Somehow, my “tiniest hope” yielded nothing, as I am still here in the triangle, collaborating with the research team in Zambia via zoom. I call it Zooming to Zambia!
To cope with the disappointment, I decided to make a mental visit to Zambia. In my mind, I arrived in Lusaka (Zambia) on May 17, 2021, to commence my practicum, and since then, I wake up each day saying Zikomo kwambiri, a phrase in Zambia that means “thank you very much.” I say this phrase for a couple of reasons. First, it helps me stay focused on my practicum work. Waking up to this phrase gives me a mindset of rolling up my sleeves and working on my daily goals. Second, to express my gratitude for the opportunity to work on a project I am passionate about. I did not come about this latter reason arbitrarily. Having a heart of gratitude has defined my existence over the past year, and it has seen me through the endless days of zoom fatigue and feelings of isolation.
Taking in the scenery
My practicum is qualitative research to assess the feasibility and acceptability of engaging family members to support HIV-positive mothers to practice recommended infant care and feeding practices, and adherence to antiretroviral therapy. We are using a formative research technique- the Trial of Improved Practices (TIPs) for this study. So far, the work has been gratifying and deeply rewarding. On weekdays, I have a regular work schedule. In addition, I have virtual meetings with my preceptor, Dr. Stephanie Martin, to assess the progress of the study, and I also meet with the research team to review the data and troubleshoot the various challenges and hurdles experienced by the data collectors. Through the research, I look forward to gaining a thorough understanding of the role of partners and other support systems in the prevention of mother-to-child transmission of HIV.
To rejuvenate and recharge, I ensure my Saturdays are work-free. I use this time off to hike with international friends and pursue other interests. I recently took a hike at the Raven Rock State Park (see the goofy pictures). Upcoming hikes will be all-day hikes at the Hanging Rock and Appalachian Trail.
For now, even though I am stuck with zoom and virtual meetings, I could not have asked for a better practicum, preceptor, and research team. So I am grateful for the opportunity, and the tech that make virtual collaborations possible. For these reasons, I say Zikomo Kwambiri.
–Olu Adeniran
Zikomo Kwambiri is from the Nyanja language, which is spoken widely in Lusaka.
For my summer practicum, I am working at PHEAL-ED, a nonprofit research collaborative between UNC and Mbarara University of Science and Technology (MUST) based in Western Uganda. The collaborative is on the site of a government funded health center (think of something between an overnight clinic and a full hospital).
In 2018, PHEAL-ED received 200 Sickle Cell rapid testing kits as a donation from Biomedomics, in Durham, North Carolina. While the individuals who received the tests were not gathered from a statistically random sample, the results of the testing showed a significantly high proportion of individuals with Sickle Cell Disease (SCD) or Sickle Cell Trait (SCT), in some cases 2-3 times higher than has been found in the surrounding region. So, the government health center and PHEAL-ED began thinking about the possibility of starting a dedicated Sickle Cell Clinic, where individuals with SCD or SCT can come and receive treatment, counseling, and education on the disease.
Hiking to Kisamba Village
To assess the need for such a clinic and the feasibility of providing those services, PHEAL-ED needed some background information on the situation in Bugoye subcounty (the community this health center serves). My job is to assess the community and provider awareness of SCD and the current services available to those with SCD (clinics, drug shops, traditional healers, etc.). Then using this information, propose what is needed to conduct a monthly Sickle Cell Clinic and the community’s receptiveness to the service / likelihood of service utilization.
So far, my work has been based around assessing SCD awareness through household surveys in the 35 villages of the subcounty. As of this week we have surveyed 21 of the 35 villages. We have also visited 3 healthcare facilities in the subcounty to provider awareness of SCD, and then 5 healthcare facilities in the nearest large town to collect data from each of their Records Departments on the number of SCD cases each facility has received in the Inpatient, Outpatient, or Laboratory Departments.
Hiking to Mirimbo Village
The practicum challenges so far are mainly centered around the location. This area is right on the equator, and the strength of the sun here can sometimes be unbearable. Additionally, this subcounty includes portions of the Rwenzori Mountain Range and the valleys between the mountains. So much of my day in this survey portion of the project has been hiking up and down the mountains to reach each village. While I don’t know the main local language, this community also speaks and understands Rutooro, the language used just north of our location. Being able to communicate with the community as I travel and survey villages has been an enormous aid in the efforts of the project. Additionally, PHEAL-ED has graciously hired a research assistant for my practicum project to further aid me in more accurate translations and the establishment of community trust.
Meeting with a VHT from Rwakingi IA Village to discuss SCD and the reason for our survey. Both permission for photo and the explanation for its use was given before photo was taken
What I am most excited about is pulling all the information together and getting to present a case for a full Sickle Cell Clinic (or referral to other nearby SCD service, if one is found). We’ve already discovered dozens of children with SCD and the community is has expressed such a demand for this clinic. Since the project began, the word has spread like wildfire, and every evening when I return to the hospital compound (where my house is), they tell me that even more people have come, traversing the long distance to reach the hospital and inquire about this SCD Clinic. The community understands the dangers of SCD, its prevalence in their district, and are desperate for solution.
So I’m going to keep hiking and gathering data, doing whatever I can to finish this first step towards their solution.
When initially asked if I was excited about the new practicum I finally scored, I was only able to offer a sheep shrug and an inauthentic smile. My hesitancy was not at all due to the content of my practicum which I was, and still am excited by. I’m working as an intern with Kybele, Inc., partnered with UNC, on the Making Every Baby Count Initiative (MEBCI 2.0), along with my colleague, Sydney, who posted a few weeks back. This initiative is focused on reducing maternal and newborn deaths in four tertiary hospitals in Ghana through means of systems strengthening: emphasizing quality improvement, implementation science, and leadership. My personal role is to design a training manual and PowerPoint presentation targeting implementation and leadership efforts.
This practicum has turned out to be great for me for a number of reasons, a couple of which I wasn’t expecting. Looking back, I minored in Organizational Leadership Practice in undergrad and never knew if or how I would use the leadership tools I learned in my future, but with MEBCI 2.0, I get to implement what I already know in this realm and expand on it even further with hopes of providing training to build up strong implementation leaders. It’s rewarding to see my years of undergrad study being put to use in this capacity! Looking ahead, just before I accepted this practicum, I made the personal decision to apply to an accelerated nursing program (admittance pending) after I earn my MPH, so that I can become an RN. I have the goal of combining my MPH skills and nursing practice to enhance primary care for women and girls surrounding sexual, reproductive, and mental health, both in practice and systemically. What I did not know before joining MEBCI 2.0 is that much of our initiative is targeted towards the nurses who work in the maternal and newborn units; they are our “clinical champions” who are the feet on the ground of our initiative. This allows me to gain a small glimpse into working as a nurse in a low resource setting before I even begin to pursue doing something similar myself, and I’m finding this perspective to be invaluable.
I found the perfect practicum to help me use what I already know while learning new skills while developing my career goals… so why did I only have a sheep shrug to offer at first? Two words: Remote. Format.
Students have had a wide array of mixed feelings with remote learning ranging from absolutely loving it to absolutely hating it, and truthfully, I have deeply resonated with the latter. As a person with ADHD and OCD, structure, routine, and a fair amount of meaningful human interaction are highly beneficial to my mental wellbeing, as well as my academic motivation and productivity. When I moved from Michigan to Chapel Hill to start an entirely remote semester, which turned into two, I was lost when it came to finding and creating this structure for myself. Most of the time, I felt like I was fighting a losing battle when it came to keeping up with my academics, and by the end of the year, all I felt that I had to be proud of was that I simply passed. This took a huge toll on my self-confidence, as well as my confidence in my academic ability and capacity. I did not want my remote practicum to be an experience that ended with that same sentiment, just because of the challenges I face with remote learning.
Since I knew I’d generally be at home the whole summer, I decided to add a little joy and some healthy responsibility to my day-to-day and became a foster mom to a Mama cat and her five kittens! My babies moved in and started keeping me busy, and I thought well, at least I have them to get me through this summer of still being remote and at home.
I told Pepperjack (and Squeaks) they didn’t their business casual to work from home with me, but they insisted.I told Squeaks looking on point in their business casual attire.
Pepperjack laughing hysterically at me as I hopped around the house on one foot.
Then, a series of events occurred that quickly changed my views towards my remote practicum. A week before my practicum began, I fell on a set of stairs and severely sprained my ankle and ended up in a cast and on crutches. I couldn’t walk at all for over a week, and even when I could start to hobble around, I didn’t have enough stability to go out in public on my own. I attended my practicum’s weekly team zoom meetings from my bed with my foot propped up on a pile of pillows- a luxury and necessity I likely would not have been afforded had the practicum been in-person.
Just as my ankle was healing and I becoming more mobile, my energy began decreasing drastically and I found myself sleeping truly excessive amounts. Within a couple weeks I was diagnosed with mono. At the beginning stages, there were times I would be sitting and talking with someone and then my body would reach its energy limit and I’d need to put my head down on the table and nearly fall asleep- this happened in public once, and I was horrified by the thought of something like this happening during an in-person practicum meeting or presentation… and horrified by the thought of my practicum depending on me having to get out of my bed every day, which in the early stages of mono, was a no-go.
Meatball demonstrating what I feel like after doing 30 minutes of work while having mono.
I’m so grateful that outside of two scheduled weekly zoom meetings, I am able to complete all my work on my own time from my bed when I have the energy to, or maybe even with my rambunctious kittens by my side if I’m feeling really energetic that day ;). If you’ve never had mono before… my biggest piece of advice is to simply never kiss or share a drink with anyone ever again… you don’t want it.
Energy at 7pm?! Citronella candles and working outside it is!
In just a couple shorts months, I’ve learned to never let assumptions, preconceived ideas, or even past experiences determine what you think an experience might be- there are so many aspects of life that can change without our control or notice, and sometimes, these unexpected changes might just change our experiences for the better. Of course I did not want to sprain my ankle or get mono, but these experiences have allowed me to find immense gratitude for my remote practicum as working remote suddenly became a need rather than an option for me. It has also opened my eyes to the fact that for others who deal with chronic conditions, remote work is not just a desire but a necessity, and I feel encouraged to advocate more avidly for this. It has allowed me the flexibility to rest and recover, and has provided me with a strong virtual team of individuals who provide a balance of helping keep me on track and motivated while also showing understanding and compassion for my current decreased energy levels. I already know that at the end of my practicum, I will not feel the same sense of defeat I felt at the end my first year, even with the challenges I’ve been facing. Instead, I’ve found gratitude for the unexpected trials that changed my perspective, and am proud of myself for not just “surviving,” but for making the most of the circumstances I’ve been given to still find ways to learn from and give my best to MEBCI 2.0.
