Intern Megan Curtis presents at UC Global Health Day 2013

Megan Curtis, a LifeWrap was accepted to display her poster at the recent UC Global Health Day in Riverside, California. Her poster entitled “Rethinking the etiologies of maternal mortality: a retrospective cohort study investigating the association between HIV status and severe obstetric hemorrhage in Zambia.” stemmed from her internship experience in Zambia with the Safe Motherhood Program. Thank you Megan for your outstanding work and congratulations on a job well done!

Megan standing with her poster at UCGHD

See Megan’s poster below:

UC Global Health Day Poster

greetings from 2009…

It’s hard to believe it’s been 2 years since I was in Zambia! I am so thankful to have had this experience; it was pivotal in deciding my future career. Rather than recount all of the wonderful things other posts have mentioned, I thought I’d share a few emails I sent while I was there.

To current and future interns: safe travels and good luck!

Mari (Ndola: Oct – Dec 2009)

December 24, 2009: monkeys on my back

This past weekend I went to Chimfunshi Wildlife Orphanage – home to over 120 chimpanzees, 1 hippo and a variety of local birds. It used to be quite common for chimpanzees to be smuggled from the Congo to other parts of Africa through Zambia; the orphanage started in 1983 when a smuggled chimp in poor health (Pal) was brought to the founders Shelia and Dave Siddle. Through the years, people started hearing there was a place that could care for sick/abandoned/unwanted chimps and started dropping them off right and left.

Originally, the founders believed that every chimpanzee had a right to have a child, but when the population started to grow beyond the funds they had, that changed. Now the chimps practice family planning with female birth control implanted in their arms unless they selectively breed them. The organization is primarily run by private donations by individuals and local grocery stores (they donate their old vegetables, sodas, corn meal, biscuits… anything a human could eat, they’ll give to the chimps).

We (Emily, Debbie and I) took 5 of them for a bushwalk. These guys were all between 3 – 8 years old, although as you can see from the pics, 8-year-olds are about the same size as Emily! Was a little bit like trying to walk somewhere with a human 3-year-old. They come over to grab your hand, but soon forget they’re holding it while they try to do a somersault while holding on. The chimps wanted to be held when walking and were constantly looking for snacks. I particularly enjoyed it when one of the little ones (Dominick) snuck up on the largest one (Cindy), full-out slapped her in the back and then ran off to hide behind Emily and pretend it didn’t happen.

Chimps don’t natively live anywhere in Zambia, but they do find them just over the borders in the Congo, Tanzania and Uganda. These ones are being far too spoon-fed to be able to be re-released into the wild, but they hope to contribute to ongoing research that could help us continue to protect their species.

photos: (1) me, emily, debbie & chimp friends (2) me (3) emily

November 12, 2009: happy 1 month zambia

Today’s my 1 month anniversary of arriving in Zambia. I thought I’d do a little overview of unexpected trends I’ve seen. Please keep in mind I’ve still only met a fairly small slice of life thus far:

• Adults dress nicely wherever they go: often suits for men and colorful chitenge skirts for women
• Perhaps it’s the British influence, but language is often formal as well, women are “madams,” men are “sirs”
• Gender roles are very defined: women are generally expected to take care of the house and meals, men come home expecting to be served food (although there are always exceptions to this
• Homosexuality is not talked about (people tell me it’s illegal), abortions are difficult to have (they are legal, but called “criminal abortions” and require meeting with a doctor, psychologist and respected member of the community before completing), there are many counter-productive rumors about contraceptives (i.e. “condoms cause HIV”)
• Few women drink alcohol or go to bars, and if they do it’s cider, not beer
• When people talk about race they define the categories as “white,” “black,” or “colored” and then “black” is subdivided into shades
• Technology is popular, everyone owns a cell phone (even if they have to bike many kilometers to charge it). Some chitenge fabrics are patterned with laptops or cell phones

photos: (1) pumping water on the way home from luangua (2) a rainstorm outside my front door (3) kids playing with tires outside of a clinic (4) the start of nsonge and joseph’s school

November 7, 2009: mari on safari

That past few weeks have been wild, a few highlights:

• I went on safari in South Luangwa Park with Yi-Ling and Katie and saw just about every animal I would hope to (lions, leopard, hyena, elephants, giraffes, hippos, crocs).
• Our guides were incredible, we stopped by Andrew’s house so he could help try to fix (ie glue) our rental car. He’s seems like a pretty active member of the community, particularly in wildlife education. They recently had elephants come through and were scratching up against homes and eating crops, which often can result in elephant deaths unless someone like Andrew intervenes.
• I was able to visit our team in Lusaka to meet more of our team and see their facilities. It was interesting to see how a larger participant pool was being conducted and got some good ideas from Kelly about how to streamline forms in Ndola
• I moved into the spare bedroom of one of the doctor’s at Ndola – now I’m only a 10 min walk to the hospital!
• The weather has cooled down a bit and I’m ready to start baking cookies for the team!

We rewrote some of the lyrics to Toto’s “Africa” on our road trip to Luangwa:
It’s gonna take a lot to drive me away from Lu’ [angwa]
There’s nothing that a hundred men or more could ever glue
Pot-holed, dirt roads down in Africa
Gonna take too long before we’re back home in bed

photos: (1) katie, yi-ling, aminu and me relaxing at the lodge (2) giraffes (3) sleepy lion (4) family of elephants

October 25, 2009: births, deaths and chocolate mousse
This has been a week of firsts for me. I started my job at the Ndola Central Hospital where I witnessed my first birth of a healthy baby boy. I also directly contributed to the death of an animal for the first time, when Aminu and I killed a chicken for Nigerian pepper soup.

Some interesting things I’ve learned about birth and hospitals in Zambia thus far:

• When a woman gives birth successfully the doctors and nurses will congratulate her by saying “Mwa pusikeeni,” which means “You have survived”
• There’s no anesthesia unless you’re going in for a c-section or major surgery
• Diapers are nappies, napkins are serviettes; don’t ask for a napkin with your dinner
• To get a passport or drivers license, you need to have a doctor, lawyer or religious person verify your identity

I’m spending most of my time tracking down cases of obstetric hemorrhage to try to find out if we have applied the non-pneumatic anti-shock garment or not. And if we have, if we did it correctly and for the right reasons. This means I need to quickly get to know the nurses, midwives and doctors in the labor, ante-natal, post-natal, and gynae wards and their record keeping systems. Then, 2 days a week I head out to nearby clinics to see if they’re tracking patients or not and train them if they aren’t. In my head it’s all very straight forward, but throw in 100 different people, doctors’ handwriting, paper tracking, and 7 locations and it’s not quite as simple…

Luckily, everyone has been helpful (especially Yi-Ling and Aminu helping me acclimate!). I’ve been trying to learn a little bit of Bemba each day so I can at least greet people in their local language. This is a pretty continuous source of amusement for the native speakers, but I think (hope!) it’s helping. Outside of work we filled our time with visiting with friends, making food and trying out the local beers (Castle’s my favorite so far, although Mosi’s made in the brewery down the road). Last night we started to make dinner for Nsonge (and incredible lady that works in the hospital and is starting an orphanage on the side), then we added a few more people and a few more and ended up feeding 11 people a fabulous medley of Asian cuisine followed by coffee/chocolate/milo mousse with Amarula.

Shaleenipu until next time!

photos: (1) ndola central hospital (2) path to lubutu clinic (3) aminu giving a training on the nasg (4) yi-ling, aminu and me with the nasg (5) yi-ling’s going away dinner (6) downtown ndola

other: trips to victoria falls and tanzania

photos: (1) vic falls (2) angel’s pool at vic falls (3) climbing kilimanjaro after finishing up in zambia (4) summit of kili!

Kitwe Intern Continues Safe Motherhood Work in Lusaka

From Jessica Pettit:

Greetings from Zambia! I’m writing this to the sound of early morning rainfall (it’s now rainy season) outside my window, five months after I completed my work with the Safe Motherhood team in Kitwe – a small city/town in the Copperbelt Province. Yes, you heard me right. I’m still living and working in Zambia, but let me first tell you how I got here and why I stayed…

You see, I came to join this wonderful research team after already having five years of professional experience (including one year in Southern Africa) and a graduate degree in public health. For those of you familiar to the field of global health – you know that when a worthwhile opportunity to get back “in the field” arises, often you can’t pass it up. I jumped at the chance to move back to Africa, and it was an easy decision that I’ll never regret.

Let me first get it out of the way by saying that the NASG research program is truly an amazing project. I’m not going to go into the nitty-gritty details, but take it from someone who doesn’t accept every opportunity that comes along, but truly examines the motivation and sustainability behind international health & development initiatives. So, good news – the project itself is an extremely valuable contribution to emergency obstetric care and maternal mortality research, programming, and policy (literally, with a little bit of training – lives are being saved due to a relatively low-cost and re-useable device). If you have more technical questions, I’m sure the Safe Motherhood staff would be more than happy to respond. I’m also one of those people who loves to dive into the actual research protocols (I’ll embrace this dorkiness), but the purpose of my post today will take a slightly different approach. I’m also available for questions should anyone want to hear more on my perspective.

As other posters have described, I also moved here to Zambia not quite knowing what to expect. Interested in maternal and reproductive health, I craved more hands-on experience and this position provided just that. While working in a clinical setting may have been awkward at first – navigating the various maternity wards, trying to remember all of the midwives’ names, practicing a few of the local greetings in Bemba – it’s amazing how quickly you adapt to the new sights and sounds. It’s a humbling experience to be present when a new baby is born, or while listening to mourners outside your window audibly grieving after a loved one has passed away. This is the daily experience of one working at Kitwe Central Hospital (KCH).

I’d like to instead focus this post on the relationships I developed along the way, and some of the stand-out moments of my experience in Kitwe. I’ll try to be brief as to cover as much as possible.

Kitwe Central Hospital

My first day in Lusaka (before traveling to Kitwe), within two minutes of arriving at the UTH labor ward, I witnessed a baby being born on hallway floor of the extremely busy hospital ward (baby and mother were just fine!). In a country where maternal mortal is high, you’ll quickly realize the effects that HIV, malaria, maternal mortality myths, and resource and health care worker shortages have on women’s health. Learning from these situations and observing how others respond to such crises were some of the most important aspects of my experience.

I quickly developed lasting relationships with many colleagues while working at KCH. Whether it was the hospital bus driver who allowed me to hop a ride to local clinics, the midwives who were protective over me and advised me to come to them if I had any problems, or the hospital staff who would stop by the office just to say hi after having met me “out” over the weekend. I also developed relationships outside of the hospital. My first weekend in town, I was invited by Auntie Sue (a local guest house owner) to my first kitchen party (wedding shower). Being required to dance in front of 150 Zambian women certainly broke the ice. Her niece made me a card, months later after I had already moved to Lusaka.

Kitchen Party

No matter how fleeting they may seem, these interactions leave an impact on all parties involved. Similarly, after marching around town (with a little Zambian dance/flare in my step) during the celebration of International Midwifery Day – I had nurses from all over the Copperbelt remember and greet me when our paths eventually crossed again. Giving a little bit of extra effort (supporting the midwife parade on your Saturday off) and taking the time to show your appreciation for those you work among truly does wonders in terms of the development and maintenance of both personal and professional relationships.

And, yes, Kitwe is small, but there are things to do. Sunday braais (BBQs) at “the dam,” witnessing a rare lunar eclipse, spending the weekend at a nearby game park, and attending local reggae concerts are just a memorable few.

The Dam

Lunar Eclipse

Reggae

I now work in Lusaka, the capital of Zambia, about five hours by bus away from Kitwe. I travel to Kitwe frequently to visit friends. Recently, I ran into Mrs. Sovi, one of the District Health Officers, in a crowded Lusaka bus terminal. We embraced as though no time had passed. It means a lot to me that moments like these still occur.

Professionally, my work with the Safe Motherhood team was invaluable. Important questions, such as how to incentivize medical staff working on research projects expand into broader questions of interest, such as how to incentivize or compensate community health workers (CHWs) nationwide. I learned firsthand while working with midwives that there is a common misconception that women die during childbirth if they or their husbands have been unfaithful during marriage. Fortunately, I’m now working on a research project in Zambia that seeks to address some of these issues.  By combating such myths and researching whether education on maternal mortality (especially to men) can increase women’s utilization of family planning services and safe childbirth practices, I have taken what I’ve learned working on the NASG project and use it on a daily basis during my current interactions with the MoH, NGOs, community health workers, and community members in Zambia to help decrease maternal mortality. I still consider myself a part of the Safe Motherhood team and feel fortunate to have met many inspirational colleagues, all working toward this common goal.

I’ll leave you on a light note with an entertaining picture of a sign at a local clinic in Lusaka, Zambia. At first glance, I easily misunderstood the content… We all have those “Oh, Zambia” days, but eight months later – I’m still here and loving the work that I do.

Clinic Sign

Ndola intern Winter 2011

I was fortunate to be the intern during the month of January this year. It was my first experience as a research assistant and it was certainly one I would happily repeat. Before I left, I was grateful to have been put in contact with previous summer interns. It was super helpful to have the opportunity to communicate with them about their experiences and gain an idea of what to expect. Thus, I see such a great benefit in having this blog.

The highlight certainly was working daily with a dedicated team of women who are tireless in their desire to see a decrease in the maternal mortality so prevalent in this part of the world. As a midwife in clinical practice myself, I have a great deal of appreciation for their hard work and devotion. It was a privilege to learn from them.

At the time I was there, our office was shared with the HIV/AIDS counselors. They too are a devoted group of hard working women who are a wealth of information. I only wish I would have had more time to learn more about their work.

My time in Ndola was invaluable. I made friends I hope I will have for a lifetime. I now have a clear appreciation for the challenges faced in completing research in a developing country. The complexities are enormous. I was impressed with the organization and communication in place through UCSF. I felt well supported. I am so thankful I had this opportunity.

A Summer in Ndola

While I’ve been back in the States for a few months now, I thought I’d contribute and share a little about my experience with the Safe Motherhood team from this past summer.  I’ll start off by saying that I had an absolutely amazing experience and would highly recommend this internship!! I honestly wasn’t quite sure what I was getting myself into when I booked my flights to Lusaka, but I am so glad that I did!

Over this past summer, I spent 11 weeks in Ndola, Zambia working with the Safe Motherhood team.  As an intern on the study, I was stationed at the Ndola Central Hospital and 7 surrounding rural clinics, where my duties consisted of working with midwives and nurses from various wards to collect data and track cases in which patients received the NASG garment.  A good portion of the work involved strong diligence and persistence in order to clear up and finalize older outstanding cases.  It was a bit overwhelming at first, but you learn how to read those data collection forms surprisingly well within a few short weeks!

I learned to carefully balance my efforts in working with local staff so that they maintained a strong sense of responsibility for the study—after all, it’s just as much their study as it is ours.  In fact, the biggest work related challenge that I encountered was learning how be as supportive and productive as possible without overstepping my boundaries. For the sake of the study as a successful operation, it is essential that the local nurses and midwives take ownership of their work as data collectors.  At times it can be fairly tricky to balance the work that you do as an intern versus the work that you leave for the local staff to do.  Finding this equilibrium was something I struggled with at times, but the challenge of working side by side with the local Zambians is precisely why this internship was so rewarding.

Training at Lubuto Clinic

My day to day duties consisted of reviewing data collection forms, keeping supplies in order and stocked, and acting as a liaison for the researchers back in San Francisco.  I also had the opportunity to take part in several trainings, which added a fun and interactive dimension to my work as an intern.  These trainings essentially revolved around teaching midwives and nurses about the study protocol and how to apply the garment.  Sometimes, I was even lucky enough to be the model and roll around in the big blue NASG suit, while nurses learned how to place the garment!

As you can tell, the roles of an intern are pretty diverse.  There is never a dull moment and there’s always something to keep you busy!  Your role as an intern is invaluable in the sense that you are able to give a face to the study for so many nurses who are working so diligently on the study.  I think they really appreciate the hands-on involvement and face-time that an intern provides for the study.  As you can imagine, the labor wards in Ndola are extremely busy.  Because the nurses and midwives are so busy, it’s really important that they understand the strong impact and implications of all their hard work.  In this sense, being an intern is an extremely rewarding experience because you have the privilege of being the person who reminds them and thanks them on a day-to-day basis of the wonderful work they are doing.  It is truly an amazing feeling, and an equally amazing project to be a part of!

A Typical Sunday in Ndola

Apart from my work duties, I experienced and learned so much living in Ndola.  Everything from walking to work every morning to trying caterpillar—quite the delicacy— brought new and exciting challenges.  I learned something new every day and cannot even begin to put into words the personal growth that I experienced.  I also gained an unbelievable amount of perspective because there is simply so much need all around you.  But, one of the best parts is how welcoming and warm-hearted the local Zambians are, even when they have so little.

Returning home was definitely bittersweet.  But, something tells me I’ll be making my way back to Zambia before too long….

• Melissa Duncanson, Safe Motherhood Intern   May – August 2011

We want your intern stories!

We hope that this blog will soon fill up with fascinating anecdotes and inspiring stories from our Safe Motherhood interns who so generously give their time to our project in Zambia. We encourage interns to post photos and videos here. Feel free to add as many posts as you wish. Please keep topics relevant to your internship experience and time spend in Zambia. Thank you everyone for your future posts – we look forward to reading them and hearing all about your time with the Safe Motherhood team! To get this blog started I am including a recent favorite photo from Melissa Duncanson who spent most of her time in Ndola – thank you Melissa!