Global Health - Here, There, and Everywhere

BRAZIL!!!!

2007-05-22T19:00:00.000-05:00

Boa Noite from Rio de Janeiro! I am here teaching Global Public Health Law with my colleague Becky Jacobs, JD - a Law Professor from the University of Tennessee, Knoxville. We have 17 US Law and Public Health students and 1 Brazilian Law student in our class. Classes started on Monday and we have begun to merge the basics of Public Health and Law. Our first speaker was Jose Nascimento who works for EBG (basically the Brazilian census board) and he set up the rest of the class by showing that the geographic distribution of social economic status, geography and disease (morbidity and mortality) are all related! Completely amazing talk! Today we took the class up to Corcovado, after discussing the Model of Disease (host, agent, environment) to really give them the opportunity to see (from a birds eye view) the geography and environment of Rio. Tomorrow we are discussing several documents on Global Health and Economic, Social, and Cultural Rights.

Lots more to share - will try to get some pictures up too!

Asanteni Sana!

2007-03-09T23:40:00.000-05:00

In just over a week and a half of being in the field we managed to get data from 18 different Health Facilities. Yesterday we turned the Treehouse into data central – 5 computers humming as data was entered. At 1pm we were joined by our CARE colleagues and spent the next 6 hours discussing what we learned, how we did what we did, and then our thoughts and impressions of each Health Facility that we visited!

A powerpoint presentation of data, pictures and qualitative points is in draft form and reports will be written. More work will be done next week by Jamie and Karen as they begin their internships and eventually we will have a picture of what is happening within the Health Facilities with regards to Maternal Health.

I am pleased with what we have accomplished and once again in awe of a country and colleagues that have limited resources compared to the US but do so much!

Thank you! Asanteni Sana!

The Data Will Be Collected!

2007-03-08T17:36:00.000-05:00

What is the postal motto – through rain or sleet or snow we go…. Our teams will out do the US Postal service any day – no flat tire, or thick mud or washed away bridge could stop our teams. GI illness, mosquitoes, no running water and no electricity – they couldn’t stop us either! The bush – roads that left us aching, meals that were…well different, and accommodations that weren’t quite home – but… what an experience. No matter the challenges we faced – each of us has been deeply moved by the amazing individuals we have interacted with! We saw clinicians that deliver babies almost non-stop, mama’s who had just delivered, sick kids and worried family members. We had children great us, sing to us and play with us. Our CARE colleagues have opened their hearts and homes to us and have shared their passions, knowledge and experience with us and we have learned a lot. Field work is not for the weak - just read the our stories and check out everyone’s photos! The good news is we actually went to Hospitals, Health Centers and Dispensaries and interacted with clinical staff to collect data on the number of deliveries, complications, use of HIV counseling and testing and the documentation of these and other indicators.

The lowest level health facilities, DISPENSARIES, usually serve 2 villages and we visited several very remote Dispensaries. We learned that many are very busy, especially delivering babies. Interestingly, these Dispensaries only have 2-3 staff (a clinical officer and maybe a nurse mid-wife), often serve a population of 5000-8000, deliver over 20 babies a month and often do not have the equipment and supplies needed. Look at the pictures to get a sense of what one might see at a Dispensary.

A Health Center is the next level up of the Health Facilities – usually they receive referral from the Dispensaries. They are bigger, more established and serve more people.

The Hospitals are the highest level health facilities and again have more trained staff, received referral patients in critical condition.

The data analysis begins in a few hours and then report writing and powerpoint generation will occur. The goal is to have a near final draft of a report covering each of the health facilities that we visited by tomorrow evening!

Out to the Dispensaries….Out to the Villages

2007-03-04T22:24:00.000-05:00

It is 6am and the team is preparing for an adventurous week of data collection. The team will split into two today - one group will go to Kwimba District which is over 2 hours away on rather rough roads. We will meet with the District Medical Officer and others to help identify which health facilities we will go to. This team will be Adam, Jamie, Dr. G, Jane and Ellen. The other team, Dawn, Karen, Julianna, Benedetta and Victor will stay in Misungwi District but will be a long ways from Mwanza city. Both teams will stay out in the field tonight and return to the Treehouse Tuesday night. From Atlanta to Dar to Mwanza to the bush. The level of infrastructure changes at each level and I am excited to see and hear what the students find most interesting!

Tough Day - Everyone is Tired

2007-03-04T22:20:00.000-05:00

Today was a tougher day - probably for all of us - we have been gone for a week - we are tired and we are all pushing.

Today we went to Missungwi District Hospital - met with the Dstrict Medical Officer and started data collection.

The coolest thing today was sitting in the District Medical Officers office - one on one trying to put the logistics for the data collection together for the next week - when we switched to the outbreak - I gave him a Outbreak Investigation 101 training and quickly created case data collection forms and a summary table for him and put them on his compuer and printed out some copies - within 30 minutes he had gone into the wards and started collecting data from the cases and had called his colleugues in other health facilities where there are more sick patients and has encouraged them to use the same collection forms.

My Students...My Colleagues...My Teachers!

2007-03-01T16:59:00.000-05:00

How often do we open ourselves to the wonder of the people around us? Bringing 4 students half way around the world… to AFRICA? Some say I am a little crazy (not only for this but always) and others just shake their heads but…. the gift of creating opportunities and watching others – often times unsure of the situation or even themselves – take the step and grow – ABSOLUTELY AMAZING! For the last month Karen, Dawn, Adam, and Jamie have met with me – they have learned about Tanzania, maternal child health, and the data and design of the research grant that created this opportunity. Fear, anxiety, excitement – I have watched each of them go through the continuous cycles. Honestly – my hat is off to them for taking on the challenge and for taking on each new day with a smile and an adventurous heart! With that attitude I have no doubt that we will be successful at what we are here to do.

Tuesday we flew from Dar to Mwanza – arrived at our wonderful HOME (The Treehouse) http://www.streetwise-africa.org/ which is a guesthouse that uses its proceeds to support the street children of Mwanza. Our living conditions are beautiful and with 5 of us we have taken over the entire guesthouse – so we are one big happy family!

So – students - yes but colleagues as well. Yesterday morning we took 7 years of Zonal Data and created tables and graphs about population and births on the 7 districts in Mwanza region. We talked about the challenges of working with information in Swahili, the challenges of missing or incomplete data, how to use tables and graphs to understand and/or ask the question – “does this data make sense”. By 1pm these same four students were then creating relationships, sharing their knowledge and expertise about the same data with our CARE colleagues. Their ability to set the corner stone of very powerful, cross cultural relationships was unbelievable to watch! By the end of yesterday – 2 unique groups GSU and CARE were joking and laughing together. Today only strengthened those bonds. Clearly – our CARE colleagues are amazing individuals – and I am humbled by their passion and drive!

Student – Colleague – Teacher….having four personalities, four unique individuals with differing passions, dreams, backgrounds, etc is flat out fun! Mostly they make me laugh and have provided me with the opportunity to see Tanzania through naïve/new eyes once again - WOW! At dinner tonight Jamie and Adam ate ugali, which is one of the main staples – it is a corn based porridge that honestly doesn’t have much taste. Anyway – it is somewhat stiff and is eaten with your hands – they had a different idea – use it like play-do and make African huts out of it – the picture should make it up on someones flickr account - definitely worth finding!

Mini Outbreak

2007-03-01T16:56:00.000-05:00

As we sat with the team this morning we learned that several people had died (not confirmed) in the past several days at Misungwi District Hospital from an illness of diarrhea and vomiting and that there were more in the hospital and outside the hospital that were sick. Clearly my interest was peaked! As the day went forward I actually forgot about this fact until I was asked, as we were standing with the Medical Officer at Misungwi District Hospital, if I wanted to go see the ill patients? Of course – absolutely!!! My poor students – not sure they were interested in venturing into the sick wards hung out outside while several hospital staff appeared and came into the same ward filled with really sick individuals.

Those of you who know me know that what I am about to share has touched me deeply and I can only pray for those lives already lost and I am afraid for those that linger on the edge. How many sick? I am not sure – I think a few have passed and I saw 6 patients in the ward – sometimes 2 to a bed – fortunately with fluid replacement and mosquito nets (much better off than the outbreak I worked on several years ago in Kenya). Clearly these individuals are not well. The Medical Officer has already sent samples to the Regional Hospital and sent a team to investigate the area that these individuals live (they are not related but they do live near each other). As I was talking with the patients and the hospital staff I talked about putting the information about each patient together in a way to help understand why and when they got sick. The idea of a line list and an epi curve are foreign concepts but …. as I started asking about the first person to show up at the hospital the story began to take shape. The first person an adult female came to the Hospital after passing though a Dispensary (a lower level health facility) – from what I could gather she got sick initially over a week ago – the date of onset of symptoms is not something being collected (that I could ascertain). I spoke with another patient and asked him what he thought made him sick – unclean water from a pond maybe? Definitely a possibility – so many pathogens and huge opportunities for serious illness! So – the staff did not have gloves (although I do believe that there are gloves in the hospital) and while the ward was clean and they had set up an area at the door to wash one’s hands it really brings to light the challenge that infectious diseases bring here! So far no staff have become ill which is a good sign! We will be back at Misungwi District Hospital tomorrow and I will speak with the Medical Officer again – I will take a basic line list form and an epi curve outline. Maybe I can even get a chance to speak with the team that went to investigate!

Misungwi District Hospital

2007-03-01T16:53:00.000-05:00

Nearly 2 years of planning really hit home today as I sat in the District Medical Officer’s office surrounded by CARE colleagues, District and Hospital staff, and my 4 students. My colleague, Julianna, and I described the purpose of the visit: to inform the In-Charge of our presence in the District and to share our plans to collect data from the health facilities – Hospitals, Health Centers and Dispensaries regarding # of deliveries, live births, still births, maternal complications and types, maternal and newborn deaths, EmOC and PMTCT data to help describe the impact and sustainability of a study done from 1997 – 2002 by CARE and CDC. Yesterday, we put together tables and graphs of population and delivery data for the seven districts within Mwanza Region. Misungwi is one of those districts. We brought hard copies of the data and tables to share with hospital staff and to congratulate them on the steady drop of the Maternal Mortality Ratio over the past 10 years (data compiled from 6 years of data spanning 1997 – 2005). Births at a health facility are collected on Ministry of Health reports but… approximately 50% of births occur outside a health facility – some with a TBA (traditional birth attendant) and some without anyone. How are these births captured? TBAs keep records that are then given to the health facility – the other births, with no attendants, are not formally captured in a defined surveillance system. During the original study – VHWs (village health workers) who know the people in their villages documented these births and reported to the health facilities and through community boards kept track of # pregnancies, # births etc. Our goal is to look for evidence that this still occurs. The goal is to look at the individual health facility data and merge it with community data that we recently collected to see if we can describe the factors associated with any sustained components of the original study.

Anyway – I am honored to be here and to have the opportunity to work with such amazing colleagues and especially to provide Adam, Karen, Jamie, and Dawn with the opportunity to see another way of life and the challenges and the beauty that encompass it!

Tanzania Round Two

2007-02-24T03:01:00.000-05:00

Hello from Amsterdam! Four students and myself are on the way to Dar es Salaam and then on to Mwanza, Tanzania. We are all excited and looking forward to learning lots! The fact that we ahve made it half way is exciting for me - the work was the logistics in making this happen. Thanks to all of you who had a part in that! So - please check the blogs frequently as I hope to have new entries at least daily if not more often!

TZ OR BUST!!!

2006-11-11T11:24:00.000-05:00

Tanzania trip on the horizon! Goals are to develop, translate and beta test data collection tools.

Tanzania Preparation

2006-11-11T10:42:00.000-05:00

Background
Inadequate health care and long delays in obtaining care during obstetric emergencies are major contributors to high maternal death rates in Tanzania.
Intervention study by CARE and CDC from 1997-2002 addressed 1) volunteer village healthcare workers 2) community-based maternal and peri-natal surveillance systems, and 3) emergency medical transport systems in northwestern Tanzania

Overview of Current Study
Assess sustainability of community-based public health initiatives in northwestern Tanzania.
Multi-partner collaboration between CDC, GSU, and CARE

Picture 1 – Sign for Clinic for Moms, Dads and Babies (in Swahili)