Research in Collaboration in Galapagos!

Posted on by nayavill

This summer, I was given the opportunity to work with Dr. Clare Barrington and her research team out of the Health Behavior department at UNC Gillings to execute a qualitative research study on the emotional burden of living with and managing Type 2 Diabetes among adults in Galapagos. Clare and her team have done a similar study in the Dominican Republic across three summers, and were excited to expand to a new site- with seemingly good infrastructure. Before I arrived, we had received IRB approval, prepared our interview guides, done everything it seemed we could do without being here- but everything still felt very vague. Other researchers with years doing work here assured us “it will all make sense when you land!” but I was hesitant, as I was arriving in San Cristobal before Clare to begin doing some research on the place alone. Having spent two years living in Ecuador I was fairly confident about my trip, but not knowing the island itself was daunting. I reserved a seemingly nice Air B&B with a kind family, read up on things to do in San Cristobal, and asked my Ecuadorian friends all about the best places to go. Little did I know, the motto of “it will all make sense when you land!” truly became reality! When I arrived in San Cristobal, I immediately went with my host mom on a tour of the island and realized that it really is as small as everyone says.

The town of San Cristobal and a few of the animals I share the place with!
The Galapagos Science Center, where I work and collaborate with researchers from Public Health, Anthropology, and much more.

To give a little context about where I am specifically, in the Galapagos there are 4 inhabited islands, of which San Cristobal is the farthest west and has about 8,000 residents. It’s small, so within the first week I was already running into people I know! I arrived the first day to the actual Galapagos Science Center (GSC) building, which is a collaboration between UNC Chapel Hill and the University of San Francisco in Quito, excited to get some direction. It is located directly in front of a gorgeous sea lion filled beach with large patios and beautiful facilities and truly seemed like a researcher’s dream. I walked in and was directed towards an empty GIS lab where there were really no researchers. I asked the Ecuadorian-based employees if or when other people are coming and they warned me that over 100 individuals from UNC alone were coming this summer- but it was hard to believe at that time! I got to work building connections with physicians in the community and getting to know the health landscape, while I waited for Clare’s arrival the following week. After about a week, I noticed a few new researchers trickling in and introduced myself, but still wasn’t able to believe how many people would be coming. Having little experience in research and more experience in day to day work, I filled my days with tasks like printing, editing, and making meetings.

(L-R) Meeting with hospital lead epidemiologist Dr. Juan Ochoa and Dra. Clara Rodriguez, Clare Barrington, myself, and Trisha Dant, Associate Director of the Office of Research of the UNC School of Medicine (who is here on a research site visit).

This week, I woke up Monday, went to the office and walked inside to, I kid you not, 50+ people in the science center! Overnight the place had gone from empty to at capacity! I wasn’t sure what to expect but this week has taught me a great deal about research in collaboration. Since our project has started slow (I’m on week three with no interviews!) we have had the opportunity to learn from all of the researchers who have been coming to Galapagos for 5+ years. We have asked questions, listened to presentations, and the discussion doesn’t stop when the clock hits 5! It’s been really interesting to work with Clare and learn how to begin a study of this nature and begin it at a completely new site. I’ve seen her collaboration with Dr. Amanda Thompson, who has been doing research here on health for years, and it has shown me how important collaboration across fields really is. I’m beginning to learn how important community relations are in this type of work, and realize that without the support of the Galapagos Science Center, none of the research we hope to do would be possible.

Clare and I after the 5K we ran across the Island “Yo Vivo Sin Drogas” or “I live Drug Free.” The race is on it’s ninth year of a country-wide campaign against drug use.

I’m really excited to begin our first interviews next week and continue living on this beautiful island. I’m lucky to have already started to make some great connections and have had the opportunity to participate in a variety of talks and activities on the island. Clare and I were even convinced to run a 5K last weekend! So far, my three weeks in San Cristobal have been a great learning experience in flexibility, adaptability, and learning before acting. We’ve had to patiently gather information about this community for two weeks before being able to start our research, which requires a lot of patience, but is also incredibly important. Everything really is making more sense now that I’m here, and I can’t wait to see what else San Cristobal has in store in the next month!

– Hunter

“Because sometimes it makes us fat”: Communication triumphs and challenges in Guatemala

Posted on by nayavill

I had a choice to make: to eat the unidentifiable cooked insect that was being offered to me or not. I had just arrived at Curamericas Guatemala’s project site in Calhuitz, Guatemala after being picked up at 4:30am and driven up countless mountain switchbacks by the project’s head doctor. Needless to say, charred mystery bug was not my first choice for breakfast. However, the staff had offered it to me and I wanted to make a good first impression, so I went for it. I still have no idea what I ate, but it wasn’t so bad!

This summer, I will be spending 8 weeks in Guatemala working with Curamericas Global and Curamericas Guatemala. In partnership with the Guatemalan Ministry of Health, Curamericas runs five community-operated Casa Maternas (or birthing homes) throughout the rural highlands of Northwestern Guatemala that are open 24-hours a day, seven days a week. Additionally, the Casa Maternas provide a host of maternal and child health services including antenatal care, postpartum visits up to 2 years after birth, adolescent health education groups, and maternal care groups. Curamericas has also developed relationships with comadronas (or midwives) in their partner communities, who often accompany women to the Casa Maternas to give birth. This community-based care model provides women with a space to receive care from skilled medical professionals in a culturally competent setting.

A painting outside of the Casa Materna in Calhuitz, Guatemala.

During my first few weeks in Calhuitz, I had the opportunity to go on a 6-month postpartum home visit with a community health educator. After verifying some demographic information with the new mother, Nancy, the community health educator, asked her if she could remember four warning signals for an at-risk pregnancy, postpartum complications, and if her child was sick. I was struck by the interactive and almost quiz-like nature of the home visit. I was reminded that these postpartum visits may be one of the few opportunities that this woman has to learn about her health for future pregnancies and her child’s health. With the nearest hospital almost 4 hours away and often only accessible by a costly ambulance ride, being able to identify when you need to seek care is of the utmost importance.

The birthing room at the Casa Materna in Calhuitz, Guatemala.

For my practicum this summer, I am working with Curamericas on a barrier analysis to help the organization better understand what is preventing women in the communities that they serve from using a modern method of family planning. This analysis is designed to assess behavioral determinants within communities in order to create more effective programming to promote behavior change. I have been working with staff to develop a questionnaire for community health educators to take into the field during their postpartum home visits. Part of my job has been to go to each Casa Materna and train the health educators on how to administer the barrier analysis survey. Working with these educators has re-emphasized how difficult and important their work is for the communities they serve. With over 25 different indigenous languages spoken throughout Guatemala, most educators spoke at least three languages and will have to translate the survey into Chuj or Akoteko for the women while recording their responses in Spanish for me to analyze. I was humbled by their willingness to participate in this labor-intensive process on top of their already mountainous workload and their graciousness towards my sometimes clunky Spanish during our training. I was also impressed by their positive attitudes and willingness to let me, a stranger, come and teach them something new.

My favorite moment so far happened during my training last week at the Casa Materna in Santo Domingo. The training had started off a little rocky because the staff had some difficulty understanding my Spanish. Part of the training involved practicing the barrier analysis interview in pairs, with one health educator pretending to be the woman being interviewed and the other conducting the interview. When one of the male health educators pretending to be a woman who wanted to use a modern method of family planning was asked what he thought some disadvantages of using birth control might be, he replied “because sometimes it makes us fat.” We all laughed really hard and the group was more relaxed for the rest of the training.

Need internet access? Step into our office on the roof!

In the coming weeks, I’m looking forward to more creative responses during our trainings, the data collection process, getting to spend more time with incredible Curamericas Guatemala staff, and eating more delicious tortillas than I thought possible.

– Kay

Preventing Cervical Cancer in South Africa

Posted on by nayavill

My practicum is with the UNC Global Women’s Health Division, specifically the UNC-Wits-Right to Care Partnership for Cervical Cancer Prevention in Johannesburg, South Africa (SA). In SA, cervical cancer is the leading cause of cancer death among women. Although cervical cancer is largely preventable through HPV vaccination, routine screening, and treatment of cervical precancer, there are significant disparities in access to these life-saving prevention strategies within and between countries. Currently, approximately 90% of cervical cancer mortality occurs in low- and middle-income countries. While SA is considered an upper-middle income country, it is also one of the most unequal societies in the world.

Overall, health outcomes in SA remain poor relative to the country’s economic development, and cervical cancer disparities by race and socioeconomic status are stark. According to the recently published SA Demographic and Health Survey, approximately 78% of White women in SA have had at least one Pap smear (to screen for cervical cancer and precancer) compared to just 32% of Black women. Not surprisingly, Black women in SA are also more likely to be diagnosed with cervical cancer. In 2014 the cervical cancer age standardized incidence rate (ASIR) in SA was about 27 per 100,000 Black women compared to 10 per 100,000 Asian women (the group with the lowest ASIR).

Staff at the cervical cancer team meeting
Top row (from left): Kopano Kgopa, Tafadzwa Pasipamire, Dr. Masangu Mulongo, Krista Scheffey, Patricia Mofokeng, Boikie Mohamme
Bottom row (from left): Bawinile Njoko, Sophie Williams, Rendani Nenzhelele, Ntombiyenkosi Rakhombe

The UNC-Wits-Right to Care team is working to reduce disparities in cervical cancer morbidity and mortality by providing free Pap smears and precancer treatment to thousands of women in SA. I’ve joined an amazing team of clinicians and researchers who have been extremely generous with their time and expertise as I get up to speed (and ask a million questions). Over the last few weeks I have been shadowing in clinic to better understand how the program operates and how clinicians educate and counsel patients. My main project this summer will be creating and updating patient communication materials to raise awareness and convey key educational messages about cervical cancer prevention with the goal of improving Pap smear screening coverage in program sites.

Observing Boikie and Bawinile at work on the mobile van in Diepsloot.

In addition to my time in the clinic, I’ve also been exploring Johannesburg and continuing to learn about SA’s history. This country provides a vivid example of the way that social factors, particularly historical and contemporary patterns of oppression, impact population health. While I’ve been doing a lot of reading, the opportunity to live and work in this city is a daily reminder that reality is much more complex than can be captured in journal articles. When I’m feeling guilty about spending time at one of Johannesburg’s downtown markets instead of working on my master’s paper (which I am also planning to write while I am here), I remind myself that closing the data visualizer, leaving the office, and taking time to learn first-hand about the community with which I’m working is also a critical part of public health practice.

Johannesburg from above. The Carlton Centre is the tallest office building on the continent and its observation deck is known as the “Top of Africa.”

I feel very lucky to be a part of a team that is doing such important work here in Johannesburg. Stay tuned for more journal articles, statistics, and photos in my next update. (To tide you over, here’s bonus reading: while cervical cancer is much less common in the United States compared to SA, disparities by race persist.)

Inside the Constitutional Court of South Africa.

– Krista