Tomorrow, I will be leaving from London Heathrow to fly down to Johannesburg, South Africa. It will mark the first time I've set foot on the African continent, and I am ever so excited!
This past month has been a flurry of making contacts, reading, reserving cars/hotels, and mentally preparing for a fantastic trip. My goal is to assess the nature of the current public-private partnerships in South Africa in the area of health services delivery. In India, a robust engagement of the private sector by the government has resulted in a thriving private sector that has not only retained, but attracted health personnel. I would love South Africa to carefully, but consistently develop similar partnerships. I could see this goal being a long-term personal goal for me.
South Africa is a country riddled with HIV/AIDs, TB, and inequalities in access to health care. It has a lower life expectancy than India. It's HIV and TB incidence rates are on the orders of 25 and 4 times the global averages, respectively, leading to an adult mortality rate that's roughly 3 times the global average. I find this absolutely shocking for perhaps the most Westernized country on the continent. There are a lot of problems with the health system in SA, and my intention is to analyze the health care delivery (personnel is perhaps the most important input of a health care system) and specifically look at the private sectors interaction with the public sector. On this brief one-month project, I intend to survey the current state of the department of the treasury-sanctioned PPPs (Public-Private Partnerships-not typically involved in service delivery) and more informal PPIs (Public Private Interactions).
What do I know? That there exist about 5 PPPs related to health care, and a limited, unspecified amount of PPIs in the country. My whirlwind tour will include stops at government departments, hospitals, universities, research institutes, and clinics. I hope to come away with a handful of information about current PPIs and to be able to describe the PPIs in existence.
Here's to my African Safari.
Cheers from London.
Wednesday, June 29, 2011
Tuesday, June 28, 2011
Travelling to Loliondo!
Hello again,
Tomorrow morning, I'll be heading out to visit Loliondo, the site of Babu's faith healing that attracts millions of followers. Located in a very rural area, it is interesting to see how infrastructure has begun to spring up in respond to the overwhelming demand for transport and accommodation - Babu's healing itself costs only 500 Tanzanian shillings (about 30 cents) but many have recognized the profit to be made surrounding him and the hordes of followers desperate for the chance to meet the faith healer. From the city of Arusha, the drive is about three hours - accompanying me is my good friend Alex Herman, a Tanzanian university student who is my teaching partner and translator during out village teachings. Having known many who have traveled to Loliondo for healing, Alex is also interested in understanding the phenomenon and graciously agreed to help me translate during my visit. Both of us have noticed Loliondo becoming a recurring theme brought up by the villagers we are working with, and we have struggled to find the appropriate way to respond to their inquiries. Many of our villagers expressed uncertainty about Loliondo, and we have done our best to emphasize the importance of continuing traditional ARV therapy regardless of their faith or disbelief.
While in Loliondo, I plan to observe the rituals and behaviors associated with the healing process, both for the healer and the follower. I plan to do a comparative analysis of these rituals with the Brazilian faith healer John of God, who I studied about and visited last year in a USC Problems without Passports class. Furthermore, I hope to conduct short interviews with other travelers to the site to better understand their health situations, beliefs about faith healing, and ultimately their motivations for traveling to Loliondo.
I am so excited to visit this site tomorrow, and I will let you know how the experience goes!
Badaai,
- Anu
Tomorrow morning, I'll be heading out to visit Loliondo, the site of Babu's faith healing that attracts millions of followers. Located in a very rural area, it is interesting to see how infrastructure has begun to spring up in respond to the overwhelming demand for transport and accommodation - Babu's healing itself costs only 500 Tanzanian shillings (about 30 cents) but many have recognized the profit to be made surrounding him and the hordes of followers desperate for the chance to meet the faith healer. From the city of Arusha, the drive is about three hours - accompanying me is my good friend Alex Herman, a Tanzanian university student who is my teaching partner and translator during out village teachings. Having known many who have traveled to Loliondo for healing, Alex is also interested in understanding the phenomenon and graciously agreed to help me translate during my visit. Both of us have noticed Loliondo becoming a recurring theme brought up by the villagers we are working with, and we have struggled to find the appropriate way to respond to their inquiries. Many of our villagers expressed uncertainty about Loliondo, and we have done our best to emphasize the importance of continuing traditional ARV therapy regardless of their faith or disbelief.
While in Loliondo, I plan to observe the rituals and behaviors associated with the healing process, both for the healer and the follower. I plan to do a comparative analysis of these rituals with the Brazilian faith healer John of God, who I studied about and visited last year in a USC Problems without Passports class. Furthermore, I hope to conduct short interviews with other travelers to the site to better understand their health situations, beliefs about faith healing, and ultimately their motivations for traveling to Loliondo.
I am so excited to visit this site tomorrow, and I will let you know how the experience goes!
Badaai,
- Anu
Saturday, June 25, 2011
Starting patient interviews
After getting acquainted with the clinic and hospital setting around Shirati, I started my first interview today. The plan for the day was just to visit the Sota clinic again because the two translators were both busy helping other students here. (The translators are apparently in very high demand because there are only two of them, while there are eight other students with various projects requiring their services. The students are very possessive about their translators, so since I am new, I have to work around other students in booking the translators) Fortunately, the mother of a Burkitt’s lymphoma patient brought her child in for a checkup, so Dr. Kawira arranged for one of her nurses to act as my translator. It was very interesting because the interview helped me understand a little more about the social and economic challenges for the mother and child during her treatment, and it showed me how I needed to edit some of my questions for future interviews.
I’m looking forward to doing more interviews, but as I’m arranging my translator and guide for tomorrow, I’m starting to realize that completing these patient interviews are going to be much more difficult than I had imagined. Originally, I thought that the majority of the interviews would be of patients that are currently receiving treatment and living at the Burkitt’s center down the street. It turns out, however, that currently there is only one patient there. For the rest of the interviews, Dr. Kawira has given us their old case files, and we are to rent motorbikes and search for them at the homes. The difficult part is that there is no system of addresses in the villages, so we are told that we have to find the village chairman, who will direct us to the subvillage chairman, to the head of homesteads, and finally to the parents themselves. It will be an adventure searching for them tomorrow and we’ll see how it goes, but I’m still looking forward to it nonetheless.
I’m looking forward to doing more interviews, but as I’m arranging my translator and guide for tomorrow, I’m starting to realize that completing these patient interviews are going to be much more difficult than I had imagined. Originally, I thought that the majority of the interviews would be of patients that are currently receiving treatment and living at the Burkitt’s center down the street. It turns out, however, that currently there is only one patient there. For the rest of the interviews, Dr. Kawira has given us their old case files, and we are to rent motorbikes and search for them at the homes. The difficult part is that there is no system of addresses in the villages, so we are told that we have to find the village chairman, who will direct us to the subvillage chairman, to the head of homesteads, and finally to the parents themselves. It will be an adventure searching for them tomorrow and we’ll see how it goes, but I’m still looking forward to it nonetheless.
Getting to know the clinics around Shirati
I spent these first three days in Shirati shadowing Dr. Esther Kawira at two of the local clinics, Sota and Roche clinic. Dr. Kawira is one of the two resident doctors in the district of Shirati and is the founder of these two clinics. I decided it would be a good idea to first understand what the basic healthcare structure is here for all patients before diving into challenges specific to Burkitt’s lymphoma patients. The first two days of at the clinic was a good orientation to the basic types of cases in the area. We saw quiet a few malaria cases, a typical case of schistosomiasis (a disease caused by a parasite), and some cases of urinary tract and vaginal infections.
Today though, it seems like all the cases were complex. There was one child with congenital heart and eye defects, a woman with a severe cancer causing her entire eye to protrude, and a woman coming in for shingles only learn that she had HIV. While it was a good learning experience, I couldn’t help but feel a deep sadness to how limited the clinic could help them. I don’t know how much better their outcomes could have been if they had presented in a developed country, but seeing how little we could do for them here now made all of us feel so powerless. It even made me rethink whether I should have picked a different project that impacted a larger population than Burkitt’s. However, Dr. Woodrum, one of the visiting doctors, gave me a good piece of advice. She said, “you can’t fix everyone, but you just try to do the most you can for them, and that’s enough”.
Today though, it seems like all the cases were complex. There was one child with congenital heart and eye defects, a woman with a severe cancer causing her entire eye to protrude, and a woman coming in for shingles only learn that she had HIV. While it was a good learning experience, I couldn’t help but feel a deep sadness to how limited the clinic could help them. I don’t know how much better their outcomes could have been if they had presented in a developed country, but seeing how little we could do for them here now made all of us feel so powerless. It even made me rethink whether I should have picked a different project that impacted a larger population than Burkitt’s. However, Dr. Woodrum, one of the visiting doctors, gave me a good piece of advice. She said, “you can’t fix everyone, but you just try to do the most you can for them, and that’s enough”.
Let there be power…
Electricity, like many other resources in Tanzania, is apparently in scarce supply. The hostel I’m staying in and the rest of Shirati have been experiencing blackouts the entire week. When they started at the beginning of the week, we were told by the locals that blackouts usually occur regularly once or twice a week, but not for longer than a day at a time. The reason why blackouts are so recurrent are not because of weather or structural damage, but it is because the government purposely alternates turning off power to certain districts in an effort to conserve energy. The regular blackouts have become a fact of life. This blackout, however, went on for 5 straight days and affected the entire country. The power just returned this evening, and it’s uncertain how long it will stay. One this is for sure though, the government has not released the reason for the extended blackout and local businesses are suffering.
Wednesday, June 22, 2011
Five Minute Blog Post!
Running out of time at an internet cafe in Arusha, Tanzania, where we have a break in our program. Our group has successfully started a soccer tournament in our village of Sangaiwe with hundreds of vollagers making the trip to watch the games. We hold HIV education teachings at each of the games and so far it's been an incredible success. So excited to visit Loliondo in the next week, will keep you updated on the progress with my research!
Thank you for reading my blog posts, please let me know if you have any questions or would like a postcard while I'm here!
- Anu
Thank you for reading my blog posts, please let me know if you have any questions or would like a postcard while I'm here!
- Anu
Monday, June 20, 2011
Welcome to Roatan!
The view from my front porch!I just made it to Roatan so here's my first post!
Some background: Roatan is an island off the north east coast of Honduras with a population of ~60,000 people. It is surrounded by the second largest coral reef in the world, making it a prime tourist destination. Though the resorts and beaches are beautiful, the deteriorating health status and poverty of its natives tell a very different story.
Over 65% of residents are living in poverty, with approximately 1 in 4 making less than $1 a day. On top of that, about 40% are unemployed.
The Honduran government has done little to help. There is one public hospital on the island that asks for a 8 L (~50 cents) fee to see the doctor, plus the cost of any medications and special supplies they may need. Though it seems like a small amount in America, that could be half a day's work or more for many Roatan residents.
Besides the public hospital, there are a few privately run clinics around the island, many of which are staffed and run entirely by volunteers. Because it is such a beautiful island, many doctors come to do a short rotation where they can work in the mornings and enjoy the beaches/snorkeling/scuba diving in the afternoons.
**
My project will be a basic needs assessment of stove quality in one small community called La Colonia, located in Sandy Bay where I'm living. Stoves can pose a significant health risk especially to women and children, putting them at elevated risk of acute respiratory illnesses, school absences, and chronic aches and pains. The WHO estimates that 1.6 million deaths each year are attributable to indoor air pollution, many of which are the result of using biomass burning stoves in developing countries.
That said, there is hope- several stove types have been shown to be effective and efficient at improving quality of life on multiple levels. First, the use of a chimney diverts smoke and harmful particulate matter outside. Second, newer models generally require much less wood, with some using only 25% of that of a traditional model.
I'm hoping to get out to La Colonia tomorrow as I'm going to spend most of today getting settled and finalizing details for the project. Hopefully by next week the study will be well under way!
Renita
Hello from Shirati, Tanzania!
Hi! I'm Grace, and I will be spending this summer looking at the available treatment options and any potential barriers to receiving treatment for Burkitt's Lymphoma patients in Shirati, Tanzania. I've been looking forward to this project since January, and I'm very excited to finally make it here.
After almost two days of traveling, Akil, Reishem, and I finally made it to our site in Shirati. The journey was a bit exhausting. We flew for nearly 20 hours to get to Nairobi and landed at 2 in the morning. Since we landed so late, we decided to spend two nights in Nairobi, but that turned out to be a good call because the drive to Shirati was 9 long hours. With our full day in Nairobi, we visited the animal orphanage, which is basically a zoo where they raise injured animals. It was a great experience because not only did we get to see the usual animals, we also got to hold a lion and cheetah cub! It was a great introduction to Africa.
The drive to Shirati was long but scenic. It’s amazing how you could see antelope and giraffes just looking out your window along the drive. Even though the past two days have been fun, I’m glad we’re finally in Shirati now. Shirati is much bigger and more developed than I imagined it to be. Our accommodations are also much nicer than I anticipated. There’s internet here. The only thing I wish we had, though, was hot showers, but I guess I have a whole month to get used to that. We got the basic tour of the town today while we’re waiting to for our final paperwork, but I’m looking forward to going to the clinic and starting my project tomorrow!
After almost two days of traveling, Akil, Reishem, and I finally made it to our site in Shirati. The journey was a bit exhausting. We flew for nearly 20 hours to get to Nairobi and landed at 2 in the morning. Since we landed so late, we decided to spend two nights in Nairobi, but that turned out to be a good call because the drive to Shirati was 9 long hours. With our full day in Nairobi, we visited the animal orphanage, which is basically a zoo where they raise injured animals. It was a great experience because not only did we get to see the usual animals, we also got to hold a lion and cheetah cub! It was a great introduction to Africa.
The drive to Shirati was long but scenic. It’s amazing how you could see antelope and giraffes just looking out your window along the drive. Even though the past two days have been fun, I’m glad we’re finally in Shirati now. Shirati is much bigger and more developed than I imagined it to be. Our accommodations are also much nicer than I anticipated. There’s internet here. The only thing I wish we had, though, was hot showers, but I guess I have a whole month to get used to that. We got the basic tour of the town today while we’re waiting to for our final paperwork, but I’m looking forward to going to the clinic and starting my project tomorrow!
Sunday, June 19, 2011
Survey and Data Collection
Soon, I'll be on my flight to Indonesia. I cannot wait. Over the past few days I have been preparing myself physically--buying 100% DEET lotion, receiving 5 shots and picking up my malaria prescription. I have also been preparing for my research project--translating and printing of surveys for mothers, developing excel sheets to organize my data, collecting previous anthropometric data for children nutrition and creating community-specific qualitative questions. I will be using four major anthropometric calculations to assess malnutrition: height-for-age (stunting), weight-for-age (underweight), weight-for-height (wasted) and BMI (overall assessment). Looking forward to filling the excel sheet in!
Sunday, June 12, 2011
Faith Medicine in Tanzania
Hi again,
I've been having an amazing time in Tanzania. I've met my homestay family and settled into my new home - the village of Sangaiwe in the Mwada district of Northern Tanzania. Over the next six weeks, I will be working with two other American volunteers and two Tanzanian partners to conduct a village-wide AHIV/AIDS awareness campaign. This involves teaching at the schools, meeting local organizations and community leaders, and spreading information about HIV transmission and prevention techniques. All of this work will culminate in a village-wide testing day, where we will try to have the whole village come out to get tested and take the steps to stay healthy and empower their community. After we leave, our work will be continued by peer educators that we will train as well as community health workers who will provide support and aid for those living with HIV in Sangaiwe. In the last week, we taught the primary school children about the basics of health and HIV transmission. We had such a great time working with the kids - they really are incredible. They've been so receptive and interested in learning, and it's a privilege to be able to work with them.
On another note, I have been continuing my research with the Mwada district. We have conducted household surveys to understand the information and misinformation this population has about HIV and its transmission, as well as important questions about the role of religion and stigma in the community. We are compiling the results now, but I'm excited to see the trends that emerge in our communities. I have decided to focus my reserach on a prominent emerging faith healer in Tanzania whose presence has proved an immense challenge for several NGOs in the area. Babu, which means grandfather in Swahili, claims to cure HIV by prescribing a certain special drink - the kikombe. Hundreds of HIV positive Tanzanians have abandoned traditional ARV treatment in favor of this healer, and it has caused a significant amount of worry among health workers in the area. I will conducting interviews with villagers to better understand this phenomenon and the reasons for Babu's rise in popularity, as well as travelling to Loliondo, the place of Babu's healing, to interview his supporters in an attempt to find a means of addressing the issue within my own village and the larger Mwada district.
I sincerely thank the Africa Fund at USC for helping me to fund this research project!
Until next time,
Anu
I've been having an amazing time in Tanzania. I've met my homestay family and settled into my new home - the village of Sangaiwe in the Mwada district of Northern Tanzania. Over the next six weeks, I will be working with two other American volunteers and two Tanzanian partners to conduct a village-wide AHIV/AIDS awareness campaign. This involves teaching at the schools, meeting local organizations and community leaders, and spreading information about HIV transmission and prevention techniques. All of this work will culminate in a village-wide testing day, where we will try to have the whole village come out to get tested and take the steps to stay healthy and empower their community. After we leave, our work will be continued by peer educators that we will train as well as community health workers who will provide support and aid for those living with HIV in Sangaiwe. In the last week, we taught the primary school children about the basics of health and HIV transmission. We had such a great time working with the kids - they really are incredible. They've been so receptive and interested in learning, and it's a privilege to be able to work with them.
On another note, I have been continuing my research with the Mwada district. We have conducted household surveys to understand the information and misinformation this population has about HIV and its transmission, as well as important questions about the role of religion and stigma in the community. We are compiling the results now, but I'm excited to see the trends that emerge in our communities. I have decided to focus my reserach on a prominent emerging faith healer in Tanzania whose presence has proved an immense challenge for several NGOs in the area. Babu, which means grandfather in Swahili, claims to cure HIV by prescribing a certain special drink - the kikombe. Hundreds of HIV positive Tanzanians have abandoned traditional ARV treatment in favor of this healer, and it has caused a significant amount of worry among health workers in the area. I will conducting interviews with villagers to better understand this phenomenon and the reasons for Babu's rise in popularity, as well as travelling to Loliondo, the place of Babu's healing, to interview his supporters in an attempt to find a means of addressing the issue within my own village and the larger Mwada district.
I sincerely thank the Africa Fund at USC for helping me to fund this research project!
Until next time,
Anu
Faith Medicine in Tanzania
Hi again,
I've been having an amazing time in Tanzania. I've met my homestay family and settled into my new home - the village of Sangaiwe in the Mwada district of Northern Tanzania. Over the next six weeks, I will be working with two other American volunteers and two Tanzanian partners to conduct a village-wide AHIV/AIDS awareness campaign. This involves teaching at the schools, meeting local organizations and community leaders, and spreading information about HIV transmission and prevention techniques. All of this work will culminate in a village-wide testing day, where we will try to have the whole village come out to get tested and take the steps to stay healthy and empower their community. After we leave, our work will be continued by peer educators that we will train as well as community health workers who will provide support and aid for those living with HIV in Sangaiwe. In the last week, we taught the primary school children about the basics of health and HIV transmission. We had such a great time working with the kids - they really are incredible. They've been so receptive and interested in learning, and it's a privilege to be able to work with them.
On another note, I have been continuing my research with the Mwada district. We have conducted household surveys to understand the information and misinformation this population has about HIV and its transmission, as well as important questions about the role of religion and stigma in the community. We are compiling the results now, but I'm excited to see the trends that emerge in our communities. I have decided to focus my reserach on a prominent emerging faith healer in Tanzania whose presence has proved an immense challenge for several NGOs in the area. Babu, which means grandfather in Swahili, claims to cure HIV by prescribing a certain special drink - the kikombe. Hundreds of HIV positive Tanzanians have abandoned traditional ARV treatment in favor of this healer, and it has caused a significant amount of worry among health workers in the area. I will conducting interviews with villagers to better understand this phenomenon and the reasons for Babu's rise in popularity, as well as travelling to Loliondo, the place of Babu's healing, to interview his supporters in an attempt to find a means of addressing the issue within my own village and the larger Mwada district.
I sincerely thank the Africa Fund at USC for helping me to fund this research project!
Until next time,
Anu
I've been having an amazing time in Tanzania. I've met my homestay family and settled into my new home - the village of Sangaiwe in the Mwada district of Northern Tanzania. Over the next six weeks, I will be working with two other American volunteers and two Tanzanian partners to conduct a village-wide AHIV/AIDS awareness campaign. This involves teaching at the schools, meeting local organizations and community leaders, and spreading information about HIV transmission and prevention techniques. All of this work will culminate in a village-wide testing day, where we will try to have the whole village come out to get tested and take the steps to stay healthy and empower their community. After we leave, our work will be continued by peer educators that we will train as well as community health workers who will provide support and aid for those living with HIV in Sangaiwe. In the last week, we taught the primary school children about the basics of health and HIV transmission. We had such a great time working with the kids - they really are incredible. They've been so receptive and interested in learning, and it's a privilege to be able to work with them.
On another note, I have been continuing my research with the Mwada district. We have conducted household surveys to understand the information and misinformation this population has about HIV and its transmission, as well as important questions about the role of religion and stigma in the community. We are compiling the results now, but I'm excited to see the trends that emerge in our communities. I have decided to focus my reserach on a prominent emerging faith healer in Tanzania whose presence has proved an immense challenge for several NGOs in the area. Babu, which means grandfather in Swahili, claims to cure HIV by prescribing a certain special drink - the kikombe. Hundreds of HIV positive Tanzanians have abandoned traditional ARV treatment in favor of this healer, and it has caused a significant amount of worry among health workers in the area. I will conducting interviews with villagers to better understand this phenomenon and the reasons for Babu's rise in popularity, as well as travelling to Loliondo, the place of Babu's healing, to interview his supporters in an attempt to find a means of addressing the issue within my own village and the larger Mwada district.
I sincerely thank the Africa Fund at USC for helping me to fund this research project!
Until next time,
Anu
Friday, June 10, 2011
Pictures from the First Trip
Margarita and me after I underwrote her nursing education.
Families from Margarita's village.
An elder Sumbanese from the Rua village.
This man's first pair of sunglasses.
I am sterilizing medical instruments.
A lady with teeth ravaged by betel nut chewing. The volunteer dentist and I pulled most of her teeth.
This is the beautiful west coast of Sumba.Pre-Trip Preview
Halo! An easy translation for “hello” in Indonesian. My name is Abbie Armstrong. I graduated from USC in May 2011 and I’m beginning my Master’s in Global Medicine in the Fall at USC. I will spend this upcoming July on a remote island, Sumba, off the coast of Bali to perform a malnutrition research study. I have been fortunate to have traveled to Sumba before when I was 18 years old. I volunteered at the medical clinics, painted murals with kids, and helped to develop a sustainable biodiesel power source. The Sumbanese people were most appreciative of the medical interventions that had the most direct impact on their well-being.
Sumba is an island of raw beauty. It almost seems as if the population lives in the past—the people cherish old traditions, perform ceremonies and Pasolas, and maintain relationships with ancestral spirits. Ever since I stepped foot off that island, I have always dreamt of going back. I am so thankful for the opportunity USC has given me to perform my malnutrition study on the island. Despite its beauty, Sumba is also home to a severely malnourished population. Drawn by its exotic location and pristine surf, tourists and surfers now support a private resort called Nihiwatu on the island. This has generated an influx of global dollars and attention to the struggles of the Sumbanese. This confluence of activity makes Sumba an ideal microcosm to examine the effects of international socially minded eco-tourism directed towards improving the health status of the Sumbanese people.
I plan to evaluate the effect of Western influence, improved farming and access to water on the prevalence of malnutrition rates in Sumba. My project involves investigating the three-year impact of the Sumba Foundation’s intervention in nutrition on the island of Sumba, Indonesia. Previous research concludes that 33.8% of Sumbanese children are underweight due to malnourishment. This cross-sectional study will use quantitative and qualitative methods to evaluate how farming techniques have improved the health status of the Sumbanese people. The relationship between malnutrition rates and sustainable farming techniques as introduced by the Sumba Foundation will be examined. This baseline malnutrition study will help to establish to what degree the intervention has or has not succeeded in reducing malnutrition on the island.
A huge thank you in advance to the USC Institute for Global Health, the Sumba Foundation, the Sumbanese people, the Quiksilver Foundation and the staff at Nihiwatu—Claude Graves, Dr. Claus Bogh, and Rainy Octora.
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