Monday, July 24, 2017
Sunday, July 23, 2017
I only have a couple more days left in Florianopolis, Brazil.. my, has time flown by! I can honestly say, this has been an amazing summer! I explored a lot, learned a lot, and smiled a lot! I'm so grateful for this experience, a big thank you to the MHIRT program and the NIH!
I enjoyed trying all the popular Brazilian food dishes, such as pastels.
Joaquina Beach, closest beach to our home.
Working in the lab!
"It's always hot in Brazil" Haha, think again. It does get cold here, but majority of the summer has been nice and warm! Future MHIRT participants: don't forget your coat and maybe some boots when traveling to this city! (:
--- Winter B.
Class of 2018
Saturday, July 22, 2017
Hello from Uganda! Our MHIRT team has been keeping busy the past few weeks, and we have finally wrapped up our HPV and cervical cancer research for the summer. We have talked to 118 healthcare workers and community members, both through individual interviews and in group interview settings. While we may be done with field work, the next week here in Ishaka will be spent analyzing our data and getting started on the research paper. Though we are still synthesizing our data, there have been some common themes that have been repeated throughout the summer. For example, among healthcare workers, there is great discrepancy in their knowledge about the appropriate age for HPV vaccination and cervical cancer screenings. Additionally, there is also a lack of knowledge about the cervical cancer screening process among community members. On multiple occasions, we have spoken to community members that have mentioned incorrect beliefs about the screening process. In the US and other developed nations, Pap smears are the most common way to get screened for cervical cancer. However, in Uganda, like other developing countries, VIA screening (visual inspection with acetic acid) is the gold standard. This is because the results of the screening can be relayed to the patient just one minute after acetic acid is applied to the cervix, compared to Pap smears which require advanced and expensive laboratory services. Some women believe that in order to get a VIA screening, the uterus must be removed from your body. They think that the acetic acid will be applied to the uterus and any changes will be noted, then the uterus will be re-inserted. The fear that results from this incorrect understanding of the cervical cancer screening process is one factor that prevents women from getting screened. This in turn may contribute to women reporting to health centers when their cervical cancer is already late stage.
Outside of field work, we’ve also had the chance to travel quite a bit. This summer we have been on safari at Queen Elizabeth National Park, toured Kampala, and most recently visited Kigali, Rwanda. In Rwanda we had the opportunity to learn about the 1994 genocide and its lasting effects when we visited the Kigali Genocide Memorial.
It’s hard to believe we have less than 10 days in Uganda. I’ve made some great friends in this country (many of them pictured in the photos attached to this post), and it’s going to be difficult saying goodbye next week!
Daryl, Moreen (our friend and the caretaker of the guesthouse), Me, Hermon, Kinnon and Dixon
One of my favorite photos with our translator and good friend, Sam!
Our research team in Kigali, Rwanda
Spending the day with co-workers and friends, Anthony and Susan in Nyakashebeya. His family grows the most delicious pineapple I've ever eaten!
Outside the home of an IHP Chairwoman who arranged a focus group for our team in Kizinda
Thursday, July 20, 2017
Nicaragua is well known for it's amazing volcanoes. Here, my friend Danielle and I went to go see Masaya's active volcano! We are only allowed to be there for about 10 minutes because the volcano can erupt at any time!
We were currently at Lago de Apoyo eating a traditional plate (except for the pancakes). For breakfast, Nicaraguans will most likely eat scrambled eggs, gallo pinto (mixed rice and beans), fruit, and a fresco (natural fruit water). It is so delicious!
Las weekend we went to San Juan del Sur which is a beach city and we tried learning how to surf!
P.s. Reapply sunblock every 30 minutes.
At Laguna de Apoyo we kayaked! Also, don't forget the sunblock.
Here is some work we have been working on this past week. As a chronic disease intern, we will be conducting a nutrition fair for the community in Nejapa, Nicaragua. There will be lots of nutrition activities to raise awareness about excessive sugar consumption and good health overall. The fair is happening next week on the July 27th and I am so excited!
Sunday, July 16, 2017
|Just me and my choco-caramel waffle. Can't you tell I enjoyed?|
|Entering the "Land of Thousand Hills" (Rwanda)|
|By far one of my most personal experiences in East Africa.|
|Chilling with the Samosa Man.|
|The sunset view exclusive to our home on the hill.|
It has been about 7 weeks already! We have done and been almost everywhere in South of Uganda, even to Rwanda, as well as compiled a lot of data for our research. As our stay comes close to an end here (two weeks left!), here are few things of MANY that I have learned from my time here.
1. Enjoy Moments of Simplicity in Life
I love our workdays and being able to talk to people! However, there Is nothing like a calming morning to start out. My favorite moments begin with a hot cup of African milk tea laid beside me on the front steps of the patio. I sit where I can feel the sunlight warming my face as if the day wishing me a good morning. After my cup, I stretch facing the sun to bask in its glory and sit in silence to live in my experience. It is living and appreciating these simple moments in life that help maintain a beautiful perspective on life.
2. Importance to Cherish & Cultivate Love and Friendship
This week we visited the Rwandan Genocide Memorial in Kigali. This wonderfully-created memorial documented one of the world’s most violent ethnic cleansing/genocide. It was a time in Rwanda where neighbors killed neighbors, friends killed friends, family members killed family members based on ethnic status. Leaving me in tears, I left in a status of shock of the violent capacity reached from the persecution of the Tutsis. It not only gave me a perspective on the harsh effects of colonialism in African countries and government-enforced ethnic division, but also stressed the importance to cultivate and cherish the love of family and friendships. Our time in Ishaka has been exceptionally wonderful solely because of the love of our close friends here. We work with some of them as coworkers but we also set aside times to share stories, laughs, and devour food J together. Fostering close friendships. This is what makes experiencing another culture and place worthwhile to me the most.
3. Barrier to Screening & Treatment for Cervical Cancer
When we were in Kampala at a market that sells many local tourist merchandise, I stayed in one shop a little longer than the rest partly due to their ability to speak Swahili. When explaining that we were in Uganda for research on cervical cancer and HPV to the vendor. She shrugged off her own concerns for cancer by saying that she’d rather not get screened like her mom (who was diagnosed with bone cancer) because she would not have enough money for treatment and travel. She’d rather not know. “Treatment does not exist for those who do not have enough wealth” were her words of concern. Unfortunately, this is a concern prevalent among many individuals we have interviewed. Treatment services for cancer are not as widely-available for Ugandans. If diagnosed here, patients are referred to far locations for treatment. For some it is so much of a barrier to pay for cost of travel and treatment that hope is lost and individuals are skeptic about treatment opportunities. This is one of many of our research findings. Our research has been able to uncover a lot on how cervical cancer and HPV affects and is perceived by members of communities.
Stay tuned for much more! J
Saturday, July 15, 2017
This week has been a huge learning experience for me because all of the things that I talked about in my last post that I love about community based public health are exactly the things that have caused me some difficulty and frustration in the last couple of weeks. Listening to the community in trying to design and implement these interventions means that everyone has a voice, and sometimes those voices supersede epidemiological concerns. At the beginning of the internship, our plan was to modify an existing sexual health curriculum and teach it to youth leaders to address the high rates of adolescent pregnancy in Nicaragua (the highest in Central America). However, after presenting the curriculum to the community leaders, they decided that they would prefer for us not to talk to the youth in detail about sex, sexually transmitted diseases, anatomy or reproduction. On the one hand, I am frustrated and a little disappointed because I was really excited about the curriculum and the information is so important for these teens and young adults to have. On the other hand, I’m forced to think about this situation in the context of its past and its future.
After learning that we would not be able to do the full curriculum that we had planned, we also learned the reason for that decision. The community leaders decided that they would rather go with less detail than more because another group from another organization entered that community without understanding the social context. Although the group was probably very well intentioned, their actions made the community reluctant to accept our intervention program. In the context of the future of the program and this organization’s relationship with the community, I am forced to put aside my disappointment that lasts for this one moment in time and think about the work that others will be able to do long after I left. My hope for the last three weeks is that our group will be able to rebuild the trust within the community so that the Youth Empowerment program continues to be strengthened and improved. Although I am still a little worried about how our completely re-designed curriculum will serve the community, I have learned a lot this week about the importance of always collaborating with the community, listening to community members and involving them in every step of the process. Now I’m off for another two weeks in the campo!
Thursday, July 13, 2017
Five weeks into my internship and I am so heartbroken it is almost coming an end! My time here has truly been a learning experience .Not only because of all the fieldwork I have been doing but because of the things I am learning about myself. My biggest discovery so far is how passionate I am about public health and how this is the only type of work I see myself doing in the future.
After the three-week practicum, last week we officially started our projects. After an 11-hour truck ride, 1 exploded tire and helping a fellow truck go up a steep, muddy hill we made it to our destination, El Bambú, an ultraconservative rural community in La RACCS (South Caribbean Coast Autonomous Region). For the week, we stayed at one of the health committee member’s house, which is also used by the Ministry of Health (MINSA) doctor and nurse to sleep over and for the health promoter to follow up with the community. The project I have been working on is based on positive deviance to identify the nutrition and health practices that keep babies healthy for the first 1000 days, which is from the time of conception to their second birthday. We are focusing on this critical period because it is when most change regarding malnutrition can be accomplished.
The day after our arrival, the nutrition team (my team, the best team!) hosted health stations where we completed surveys, tested anemia and weighted and measured all infants less than 5 years old and pregnant. This data is the baseline for our positive deviance (PD) study on underweight and anemia. Unfortunately, there were certain limitations to the data and we had to change the standards of PD and include children that wouldn’t be included in a classic PD study in order to have a big enough pool of children to proceed. The following day, we split into groups of a community member, an intern and AMOS staff to visit our positive and negative deviants to complete the interviews. Although I was quite nervous, the interview went great and I even stayed almost 2 hours after I finished just talking to the family about my childhood, my family and my aspirations. The owner of the house to whom I talked to the most and has a reputation of being very serious and hard to be friends with, says hi to me and shakes my hand every time he sees me and greets me with a smile. That helped me cope with the feeling of being a foreigner in a vulnerable community which I was struggling with during my first few days. The days after that we spent them analyzing the data and presented it to the Madres Voluntarias (volunteer mothers). We identified the practices of the positive deviants and what was lacking in the case of the negative deviant. From that data, we were able to identify themes which will be training the Madres Voluntarias in and they will be leading the sessions to their care groups. On our last day, we hosted a cooking competition where each of the Madres Voluntarias created a recipe for a child younger than 2 years old rich on protein and iron to tackle the overwhelming amount of cases of anemia. Then the mothers shared their recipes and while the interns shared the calorie, protein and iron levels per plate. Everyone (the community, the interns and AMOS staff) was very satisfied with how the activity worked out and made us very excited about the upcoming weeks.
This week we have been working on developing lesson plans for each theme we identified with the community and flipcharts for the mothers to use with their care groups. Our lesson plans are filled with activities and questions to keep the participants as involved as possible. Next Sunday, we will be heading out to El Bambú again and will be there for two weeks. I can’t wait to see the Madres Voluntarias teach all the knowledge we are going to share with them!