The remainder of my practicum in Kisii with Curamericas Global was a whirlwind. Since I was only in Kenya for one month, things moved very quickly in order to complete my projects on time. My first week was spent preparing for my qualitative research studies – writing research questions, preparing interview guides, and randomizing participants for my focus groups. I also visited and toured the Matongo Health Centre and familiarized myself with the facility and its services. In addition to beginning my projects, I enjoyed exploring Kisii. I familiarized myself with the local market to purchase fresh produce, located a grocery store for my other dietary staples, and determined the most efficient route to the KIKOP office at the Ministry of Health.
The maternity ward at Matongo Health Centre in Kisii, Kenya.
Focus group discussions began during my second week in Kisii. I quickly realized that my results would be richest if the focus groups were conducted in the local language by KIKOP staff. I held a qualitative research “crash course” for the KIKOP staff to familiarize them with the process of a qualitative study and the most important things to know about facilitating focus groups. Since I held about 10 focus groups during my practicum, I was extremely grateful for the willingness of the KIKOP staff to assist with my studies and facilitate the focus groups.
Davis and Esther, two KIKOP staff members, facilitate a focus group discussion with traditional birthing attendants in Matongo.
Following data collection came transcription. Local volunteers transcribed the focus group discussions into English for me, and I began data analysis shortly thereafter. Thus far I have completed analysis of transcripts for one of my studies – operational research on what constitutes a culturally appropriate birthing space and care at Matongo Health Center in Kisii. The preliminary results have been very informative and fascinating to read about, and I am looking forward to seeing the space that is designed as a result of my findings.
Life in Kisii was certainly challenging at times and different from my life back in the U.S., but it was a good learning experience. The KIKOP staff were helpful, members of my focus groups were welcoming, and I learned a lot from experiencing such a different culture. As I reflect on my month in Kisii, I feel grateful for the opportunity to experience life in a city so different from my hometown. I will always look back on my time here with gratitude and deep respect for all the individuals I worked with and will remain optimistic that they are able to obtain the positive health outcomes that Curamericas Global and KIKOP are working so hard to achieve.
Traditional Chitenge Dress I Had Made for a Bridal Shower
It is hard to believe that my time in Lusaka, Zambia is already coming to an end and I have to say, while there are reasons I am excited to return home, I am not too eager to leave the life I have started to create here. The local community in Lusaka is very supportive, inclusive and genuine and is full of interesting professionals which I am glad I had the chance to meet. I am grateful for the opportunity to mingle with people working at some of the leading international development and global health agencies such as the United Nations, the Ministry of Health and the CDC at a weekend braii (what we would call a barbeque or cookout) and to be able to talk to them about their work and experiences living in Zambia and other parts of the world.
While it took some time, I feel like I have adapted to the more laid-back lifestyle in Zambia and have enjoyed that fact that it is less stressful than back home. I can understand why I have met so many people who moved to Lusaka for what was supposed to be a few months or a year and have now been here for multiple years, some over 20. There does not seem to be the same sense of competitiveness and hurry that I often find myself caught up in while living and working back in the States. Now, there have been times I wished for a greater sense of urgency; like when we were without running water for a week because of a broken pipe, or sitting in the dark for four hours a day while the electricity was turned off, or stuck on the side of the road for hours at night because our bus broke down. Back in the States, moments like these would have thrown a wrench into my entire day and launched me into action to try and rectify what are, at the end of the day actually pretty minor, inconveniences. But here I find myself, more often than not, finding humor in these situations, doing what I can to change my routine but otherwise, accepting these are things I have no control over. I believe I am leaving Lusaka more relaxed with greater patience and a stronger ability to accept the things I cannot control.
Victoria Falls
At work, I feel that I have learned so much about the healthcare system in Zambia and am better able to understand problems the local healthcare system faces. I am leaving with many things to think about in terms of my potential role in developing solutions to strengthening local healthcare systems in low-and-middle-income countries (LMIC). My work in Zambia had me at the University Teaching Hospital almost every day and while most of my time was in the neonatal intensive care unit (NICU) or the research office, I also spent time in the delivery ward (witnessing my first birth!) and the Kangaroo Mother Care unit. I had the opportunity to speak to many professionals who have been a part of the healthcare system for years. I have spent most of my time here collecting and analyzing data related to neonatal health outcomes in order to quantify the cost of care for preterm births. I was keenly interested to learn how the hospital collects and analyzes data in order to report statistics, primarily on patient outcomes, to the local government and Ministry of Health. This was a great opportunity to see the challenges faced in collecting quality data on health outcomes and how this data is used (or not used) to drive decision making.
Overall, my time in Zambia has been wonderful and I feel that I have grown both personally and professionally. I have learned to be more flexible and adaptable and how to overcome obstacles that came up during our research, critically thinking about how to course-correct and move forward. I also feel I have greater appreciation of the importance of understanding the local context when working in different communities. I gained the most insight when I took the time to observe and listen to others, and put my initial assumptions and opinions aside.
Sunset Over Zambezi River
It seems almost surreal that my time here is almost up and soon I will be back in class at UNC but I am sure that I will return to Zambia again.
“You just missed it, she gave birth while you were in the bathroom.” This is what one of the Casa Materna managers, Michelle, shared with me during one of my barrier analysis survey trainings in Tuzlaj, Guatemala. She assured me that I hadn’t actually been in the bathroom that long (which was a relief) and that the birth had happened a lot faster than anyone had expected. I was extremely lucky to share half of my experience in Guatemala this summer with fellow Gillings Student Emily Berns, who joined me moments later. Before we entered the room to visit the mother and newborn, Michelle told us that the girl who had given birth was thirteen years old. Having never seen a birth before, I began to feel fortunate for my poorly-timed bathroom break. This was one of many surprises that this summer held, including playing multiple games of dreidel with the staff and finding Philadelphia cream cheese in the rural highlands!
It rained most days in Calhuitz, but one day we were rewarded with a rainbow!
After completing a barrier analysis training at three different Casa Materna locations, I had some down time. I was able to observe the nurses at the Casa Materna as they did some routine prenatal consultations. Despite a slight miscommunication at first (the word for ultrasound in Spanish “ultrasonido” sounds a lot like the word for United States “estados uniods” when said quickly and made for some strange context clues), I was able to observe my first ultrasound. The nurse, Anne, told me to feel the woman’s stomach to see if I could tell what position the baby was in. I’m not a nurse, so touching this woman’s stomach felt strange and like I might offend her in some way, but she smiled at me and told me it was alright. I felt around blindly until I found a hard area, which Anne told me was the baby’s head. She then drew a small picture of the position of the baby on a form which she used for the rest of the consultation. Anne took out a small tablet-like laptop to begin the ultrasound and determined that the woman was 8 months pregnant.
In the United States, medicine is a very private matter. But in Guatemala, it’s a family affair. The exam room was only separated from the entrance to the Casa Materna by a curtain. In the sectioned off area for the exam room was the woman, the nurse, me, the woman’s three children, and her mother. “Look, that’s the baby’s leg” Anne said to the woman’s daughter who was watching the ultrasound intently, trying to decipher what was darkness and what was her future sibling. I was impressed how Anne had effortless made this a teachable moment and included this child in the experience. It was extremely powerful to see and I felt very lucky to have been there to experience this moment with this family.
Flore a “mujer de apoya” (helper woman, who is similar to a doula) at the Casa Materna getting a woman’s signature before beginning the barrier analysis questionnaire.
In addition to observing nurses in the clinic, I was able to go into the field with some of the community health educators to watch them survey women in the communities. Using records kept at the Casa Materna, the educators were able to identify women who reported using a method of family planning, so that’s where we started. This was an effective way to identify potential participants, but meant that women who may be using a modern method of family planning but did not already have children would probably be excluded from our sample size. As frustrating as this was, I understood that due to staff capacity, this was just a limitation that I would have to accept. Sometimes we would get to a house and a woman wouldn’t be home or it would turn out her child was too young to participate. Since exclusive breastfeeding for the first six months of life is a form a contraception, we decided to only include women who had children older than 6 months to ensure that she was she was using a modern method of family planning. Due to the size and close-knit nature of the community, we were also able to ask women if they knew of any other women who might be able to participate and use snowball sampling to find other participants. This allowed me to get a glimpse into the lives of the women who we were surveying and better understand what everyday life in Calhuitz was like. I also got to see a lot of kids chasing around chickens, pigs, and pigeons, which is always fun.
A goodbye photo with a few comadronas (midwives) from the surrounding communities and some of the Curamericas Guatemala staff who lent me a gorgeous huipil and corte for the picture. Can you spot me?
I am still in awe of the efforts by the staff to complete these surveys. It was a close call, but on my second to last day in Calhuitz, I received the last of the 96 surveys that we needed for the barrier analysis. Although the analysis and recommendations were supposed to be finished in Guatemala, as with most field work, we had a few setbacks that changed our timeline. Instead, I will be completing my analysis back in the US and will make a presentation to staff on the findings in order for us collaborate on recommendations in mid-August. I am deeply appreciative to the Curamericas Guatemala staff for their patience with this new type of study, their willingness to include me into their daily activities, and their politeness when eating my first attempt and making tortillas by hand.
