A Glimpse into Humanitarian Work

Posted on by nayavill

This summer, I’ve been interning with Save the Children and the Interagency Working Group on Reproductive Health in Crises (IAWG), working on Adolescent Sexual and Reproductive Health in Emergencies (ASRHiE). Part of my position there was working on research to finalize the Training of Trainers (TOT) package on ASRHiE, which is delivered to people working in Sexual and Reproductive Health (SRH) in Emergencies. I was very lucky to be offered the opportunity to finish out my internship by going to Cox’s Bazar, Bangladesh to provide logistical support for a TOT lead by some of IAWG’s new trainers.

It was a bit tricky to arrange, since it meant missing about a week and a half of school, but I was very lucky to have supportive professors and supervisors. Thanks to them and to my amazing supervisor at Save the Children/ IAWG (and to some very quick processing by the Embassy of Bangladesh in DC), I got my visa and flight arranged, and arrived in Bangladesh on August 22nd. I spent the night in Dhaka, and the next morning caught my flight to Cox’s Bazar. On my way to the airport, I shared a van with a really lovely couple who had worked for Save the Children in more than 10 countries. We wound up going to dinner together later that week, and I heard all of their fascinating stories from their travels.

I had one or two days in Cox’s Bazar to explore, and was surprised by just how beautiful the town was. The beach is the longest one in the world (a fact that the country is very proud of), and some areas of it are very empty and beautiful. I took tons of pictures on my walks, and it was great to get a chance to see some of the less touristy areas of the town.

The traditional fishing boats that people in Cox’s Bazar use.
The traditional fishing boats that people in Cox’s Bazar use.

The main coordinator for the training works for UNFPA, so I spent Saturday at their office prepping all of the materials for the training. It was so interesting to get a sense of what the offices looked like, and to hear from the trainer on her experiences working with UNFPA.

Then the training began! It was only two days, but those two days were packed. It took some time to work out the kinks, but I think that the participants got a lot out of it. We had every person we invited attend, representing over 14 organizations working in Bangladesh. I met so many interesting people, and we got a lot of great feedback to continue to improve upon the training in the future. It was fantastic to get a chance to see the training in action after researching so many of the topics that were covered.

All of the participants and trainers
All of the participants and trainers.

Unfortunately, due to rallies in the refugee camps in Teknaf over repatriation, we had to postpone our scheduled field day until after I left. However, I was very lucky to have a colleague there willing to take me to see the camps in Ukhiya the following day so that I could see the health post and primary health care center there and get a chance to try out one of the tools we discussed in the training. It was interesting to see all of the steps required to visit the camps: I had to visit the government office to receive a camp pass (with a specific date and camp number to visit) and attend several briefings around security, child safeguarding, and media/communications. These briefings helped to ensure I understood the do’s and don’ts while in the camps, and to protect the refugees that live there. I wasn’t ever sure it would happen until finally, it was Wednesday and we were getting into the van to head down the coast!

It took about an hour and a half on winding side roads, as well as passing through several police checkpoints to get to the camps in Ukhiya. We first visited the Save the Children primary health care center (PHCC), which lies right at the entrance of the camps so that it is able to serve both the host and refugee communities. I got a tour from a staff member there, and had the chance to see all of the buildings within the PHCC. Everything was very clean and organized, and they are able to provide fairly comprehensive services there. The manager was one of the people who had attended the training, so she and I sat down to chat for about 45 minutes, going through items on the Adolescent-Friendly Facility Checklist. They’re doing really fantastic work there, and it was wonderful to see all of the steps they are taking to serve more vulnerable populations.

The family planning room at the primary health care center.
The family planning room at the primary health care center.

After that, we headed over to the health post in the closest camp. It was a quick drive, and then we had to get out and walk as the van couldn’t get the rest of the way. The camps were built in a flood-prone area with many hills and valleys, so steps and paths have been built into the sides of these hills as the camps expanded. We walked along the dirt path, with little shops, makeshift shelters, and learning centers on each side. All around us, kids were running and playing, men were chatting over tea, and people were carrying water and food back to their shelters. I was surprised to find that, in many ways, it felt like a more crowded village.

The health post was under construction, so I spoke with the manager (another person who had attended the training) in the temporary space that they are using, and again went through the Adolescent-Friendly Facility Checklist. They are serving so many people daily, each day speeds by and the midwives and family planning assistants have little time for a break. It was great to hear about their experiences at the health post, and to know that they are able to provide family planning assistance so many people.

The new health post that they are finishing work on.
The new health post that they are finishing work on.

After lunch back at the PHCC, we started our long trek back to Cox’s Bazar. The following day I did a bit more exploring, and met with the SRH Manager for Save the Children to talk through my feedback from the time at the PHCC and health post. She’s spent several years working in conflict zones, so I also took the chance to speak with her about her experiences. Between talking with her, the national staff at the Save the Children office, and the couple that I met on my way over, I got a much better sense of what working in humanitarian settings can look like.

Even though I only had a bit over a week in Bangladesh, I learned a ton between the training, meeting all of the amazing people working in these responses, and seeing the PHCC and health post in person. I am so grateful for the opportunity to put my learning into practice, and I hope to continue working with IAWG as I move into my final year at UNC’s Gillings Schools of Global Public Health.

– Erin

Mwauka bwanji to all our readers!!

Posted on by nayavill

Mwauka bwanji is Good morning in Nyanja, one of the most widely spoken languages in Lusaka, Zambia.

For the second phase of our practicum, we were privileged to travel to Lusaka, Zambia with our preceptor, Dr. Alan Rosenbaum. We went mainly to observe and interact with the Fetal Age and Machine Learning Initiative (FAMLI) project team based in Zambia.

With Dr. Kasaro (far right) and Project Coordinators in UNC GPZ.

We were welcomed by Dr. Margaret Kasaro, country director of UNC Global Projects Zambia (UNC GPZ). On our first day, we had the privilege to meet with the project coordinators who talked briefly about the various projects UNC had in Zambia. We discussed enrollment and retention strategies as well as barriers and delays usually encountered in the various studies ongoing in Zambia.

Over the next couple of days we visited the FAMLI project sites in both the University Teaching Hospital and the Kamwala Health Center. We were given a tour of both research facilities and had the chance to observe the process of delivering an informed consent to a participant, determining eligibility and actually receiving their ultrasounds. The data managers and research assistants also educated us on data entry and storage in ways that protected the identities of participants. The sonographers allowed us in their space and gave us an opportunity to scan some of the mothers with their permission (we are both medically trained doctors in our respective countries).

Observing the doctor scanning the mother.
Enam scanning a mother with her permission.
Munguu scanning a mother with her permission.
Alan interacting with a mother who benefitted from FAMLI scans.

The most exciting part of the trip was interacting with mothers at various stages. We had the chance to meet and talk with those waiting on their scans; those who were receiving their scans and could not hide their excitement when the gender of their babies was revealed; and even those who had benefitted from FAMLI scans and had their babies. They showed us how they carry their babies on their back with the chitenge. Mothers seemed happy to be a part of the FAMLI study because they had access to free monthly scans. Ordinarily they would have to pay about 70 Kwacha for an obstetric scan.

Enam learning to carry a baby with a chitenge.

Finally, we managed to do some tourism in Zambia on the weekends. We enjoyed great food, safaris and game drives in the Lower Zambezi National Park, visits to crocodile farms, taste of crocodile meat and, of course, the great Victoria Falls. Unfortunately, we did not see “Mosi oa Tunia” – “The smoke that thunders” because it was in the dry season, however, we saw the beautiful rock cliffs behind the Falls.

Munguu with White Rhinos in the background.

We cannot end this blog without saying a big Zikormo (Thank You) to our preceptor, Alan Rosenbaum, Dr. Kasaro, and everyone at UNC Gillings, Global Women’s Health Division and UNC GPZ for making this practicum experience successful!

– Munguu and Enam

Equity as a Public Health Priority

Posted on by nayavill

“Is cervical cancer a big problem in South Africa?” This is a question I get, in some form or another, from many people back home when I tell them about the project I’m working on in Johannesburg.

The short answer? Yes.

Urban hiking in the Melville Koppies

The long answer? Yes, cervical cancer is a major public health issue in South Africa and many other African countries. UNAIDS estimates that women living in Eastern and Southern Africa are 10 times more likely to die of cervical cancer than women living in Europe. Within South Africa, Black women are almost twice as likely to be diagnosed with cervical cancer compared to White women.

Over 90% of cervical cancers are preventable, and the UNC-Wits-Right to Care team is working to increase access to prevention services in South Africa. Routine vaccination against HPV, the cause of most cervical cancers, did not begin in South Africa until 2014. And, although cervical cancer screening is free, only a third of South African women receive screening at the recommended intervals.

Rendani modeling her Right to Care jacket

In our classes, we learn about criteria used by governments, organizations, and funders to determine public health priorities: the number of people affected, the magnitude of a disparity, the evidence in favor of intervention, the cost (in dollars, years of life lost…) of action or inaction. By any measure, cervical cancer is indeed a public health problem, and these statistics are important–they tell the story of a disease that is almost entirely preventable, yet continues to kill hundreds of thousands of women every year.

At the same time, I have been thinking about how we frame public health problems, and what larger dynamics these measures can obscure. Cervical cancer is a disease of inequities, and confronting the social conditions that give rise to unequal health outcomes (in the words of Link and Phelan, their fundamental cause) must also be part of addressing this problem.

Public health is not immune from reproducing the patterns of inequity that we seek to solve. As a student, I have concentrated on gender and other social inequities as they impact women’s reproductive health. These dynamics are also reflected in gender inequality in the global health workforce and geopolitical inequalities that influence public health priorities. If the goal of global public health is “real partnership, a pooling of experience and knowledge, and a two-way flow between developed and developing countries,” we have a long way to go until this vision becomes a reality.

Recently, leaders at the National Institutes of Health pledged to take steps to end the “manel”– all-male speakers panels–and increase diversity in global health leadership. In his statement, Dr. Collins, Director of the NIH (and UNC School of Medicine grad), writes, “it is not enough to give lip service to equality; leaders must demonstrate their commitment through their actions.”

Shadow Boxing by Marco Cianfanelli in the Joburg CBD

It is an incredible privilege to be in South Africa doing work that I find important, challenging, and fulfilling. I feel very lucky to be completing my practicum with UNC-Wits-Right to Care and learning from a team that truly demonstrates this commitment to promoting equality–from increasing access to Pap smears to building partnerships and creating opportunities in global health.

– Krista