Putting the Clinical Back in Research

Putting the Clinical Back in Research

Choosing to come back to Kisumu, Kenya for my resident research project was an easy decision. I had worked in Kisumu over multiple years in medical school through the University of California, San Francisco – Family AIDS Care and Education Services, and had always known I wanted to return to continue to build on those relationships I had formed over the prior years. My research project, “Clinical Knowledge of Essential Maternal and Child Health Services in Kenya” involved interviewing health providers in Kisumu, Homa Bay, and Migori counties in western Kenya about their commodities, training, and knowledge around four maternal and child health topics – pre-eclampsia, postpartum hemorrhage, post-abortion care, and neonatal resuscitation. As I was awaiting my elective block, I looked forward to transitioning back into a research role after primarily focusing on my clinical work for the past two years during residency. Once I arrived, I realized that untangling my research and clinical roles was not as easy as...
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Three Tips for when Research Plans Change

Three Tips for when Research Plans Change

This summer, I embarked on a trip to the lakeside city of Kisumu, Kenya to work with Dr. Megan Huchko and the Center for Global Reproductive Health on the development of a survey tool to measure cervical cancer and HPV stigma among HIV-positive women and health care providers. The first step in the research study would involve in-depth interviews (IDIs) to develop a framework for our survey tool. In preparation during the spring semester, fellow researcher Emma Mehlhop (T’21) and I produced four IDI guides which would lead the interviewers through our exploratory questions, and we even attended a training on qualitative interviews. I was eager to see our preparatory work come to fruition during the summer, as I was certain the study would continue moving forward at our intended pace. When our study on cervical cancer stigma had hiccups with the IRB approval and left us unable to move forward with the IDIs, Emma and I joined another study --...
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Expect the Unexpected

Expect the Unexpected

Exactly six weeks ago I spent my first full day in Kisumu, Kenya after a day’s worth of travel, an earlier than expected arrival, meeting my two Canadian housemates, and being so disoriented I didn’t even know where to get a meal or buy groceries. Now, with only two weeks of my time left, it’s almost laughable thinking back on how little I knew of how this city works. I now know which water to buy (the refillable 5L jugs with the handle), how much a tuk tuk from home to the office costs (100 KES, which is the equivalent of about 1 USD), and how to catch the best sunsets every night (rooftop of the building at our complex at 6:30pm). Despite my confusion on just about everything when I first arrived, the one thing I expected to be relatively straight forward was the research project I was set to be working on. I was told to be ready to...
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The Trump Administration’s Domestic Gag Rule

Since running for President and into his presidency, Donald Trump and his Administration have sought to undermine women’s access to reproductive health care. Last year, the Trump Administration proposed changes to Title X—which is federal grant program that provides funding for comprehensive family planning services. Known as the “domestic gag rule,” the proposed changes “gag” or bar healthcare providers from referring their patients to abortion providers. Moreover, the rule would drastically alter access to reproductive health care, including birth control and other family planning services, for millions of women who depend on Title X funded clinics. When the Administration released the final version of the rule changes, reproductive health organizations such as Planned Parenthood and the American Civil Liberties Union on behalf of the National Family Planning and Reproductive Health Association immediately challenged the rule. Despite a preliminary injunction that prevented the rule’s implementation, on July 3, a panel of three judges lifted the injunction. Devastatingly, last week by 7-4...
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Let’s End HPV-Related Cancers Briefing Coverage

Let’s End HPV-Related Cancers Briefing Coverage

    In the U.S. alone, over 33,000 HPV-related cancers are diagnosed annually among men and women and globally, there are over 630,000 cases. The theme of the briefing, “Let’s End HPV-Related Cancers” held in Washington, D.C. on June 27, 2019 centered around how to prevent the 6 cancers caused by HPV: cervical cancer, oropharyngeal cancers, anal cancer, penile cancer, vaginal cancer, and vulvar cancer. Representative Kathy Castor (D-FL-14) is a leader in the House of Representatives bringing legislation to the United States to meet the WHO goal to eliminate HPV-related cancers. The tools to eliminate these cancers do exist and Representative Castor expressed optimism for saving lives and never seeing these cancers again. Starting with cervical cancer, the approach of adding vaccination, screening, and treatment is necessary for elimination. Australia, Canada, and Rwanda are three countries which have declared they will be the first to eliminate cervical cancer and the U.S. must also show initiative with this mindset.     ...
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mSaada User Testing with Community Health Volunteers in Kisumu Kenya

mSaada User Testing with Community Health Volunteers in Kisumu Kenya

Together with Duke SRT students, undergraduate app developers, and Kenya-based members of the Center for Global Reproductive Health, I will be leading a pilot usability study of an integrated digital platform called mSaada. The goal of this platform, placed in the hands of community health volunteers (CHVs) during HPV-based cervical cancer screening, is to help facilitate the successful completion of the cervical cancer prevention cascade. This will be achieved by mSaada’s many features: patient education, protocol and counseling support for CHVs, results notification, service reminders, and patient tracking. Over the course of the summer, we will train CHVs on proper use of mSaada, allow them to use the app in a clinical setting, and gather periodic feedback through quantitative questionnaires and structured in-depth interviews. We aim to gain a strong understanding of user experience, acceptability, and feasibility of the mSaada platform within the context of Western Kenya. My interest in this project is multifactorial. First, by studying and working to combat...
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A Qualitative Research Training Session at the Center for Reproductive Health in Kisumu, Kenya

A Qualitative Research Training Session at the Center for Reproductive Health in Kisumu, Kenya

Last week the office at the Duke Center for Reproductive Health in Kisumu held a two-day qualitative research training session led by facilitators Cyrilla Amanya and Muli Emmanuel from ACE, Africa. Attendees included the Duke Reproductive Health Center’s Kisumu staff, a DGHI master’s student, and members of the Duke Global Health Institute’s (DGHI) Student Research Training Program (SRT). The members of SRT (Andrea Chalem, Suzanna Larkin, and I) are here in Kisumu, Kenya for 8 weeks working on two different studies concerning cervical cancer awareness, screening, and prevention. Andrea is working on an mHealth study with Jacob Stocks, a master’s student at DGHI, and Suzanna and I are working on a stigma study. We used the In-Depth Interviews (IDIs) created for the stigma project as a jumping off point for discussion and role play during the qualitative training session. On day one, we learned helpful tips on how to make interviews conversational and comfortable for the participant. These included using the...
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Re-building Rwanda’s Access to Ob/Gyn Services

Re-building Rwanda’s Access to Ob/Gyn Services

"In 2011 the Rwandan government embarked on a novel medical education program to improve their health care system.  Human Resources for Health (HRH) Rwanda, a partnership between the government of Rwanda and a consortium of 22 U.S. academic institutions, was designed as a 7-year training program to produce qualified medical personnel with the aim of increasing quality and access to health care for Rwandans."  As one of the earliest ob/gyn specialists to work in Rwanda with HRH, Duke's Dr. Maria Small led an evaluation of the first five years of the program with the aims of 1) examining the number of trained ob/gyn specialists who graduated from the University of Rwanda as beneficiaries of the HRH program, and 2) conducting a geospatial analysis of pregnant women’s access to Rwandan public hospitals with trained Obstetrics and Gynecology providers using a WorldPop data set. Study Results: "In 2011, there were only 14 ob/gyns in the country.  By the end of HRH year 5,...
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Important New Study Regarding Injectable Contraceptives

Important New Study Regarding Injectable Contraceptives

There is an unmet need affecting 47% of women in Africa who want modern contraception in order to prevent pregnancy. During the last few years, there has been an increase in the use of injectable contraceptives, such as Depo-Provera, across the continent specifically in Mali, Sierra Leone, Chad, Ethiopia, Kenya, and Uganda. Many African women rely on these types of shots because they are more easily concealable compared to other forms of contraception such as a daily birth control pill. Also, in some health clinics, these shots are the only method of contraception offered. Many women need secret protection due to men refusing condoms and the women wanting to avoid any social, physical, and mental consequences they may endure if they are found trying to keep away from pregnancy. A specialist in HIV at Britain’s Medical Research Council, Dr. Sheena McCormack, stated that African women’s, “husbands or partners, and their families, often want them to have children.” Along with the...
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Stakeholders Meeting on Palliative Care and Treatment of Cervical Cancer

Stakeholders Meeting on Palliative Care and Treatment of Cervical Cancer

By: Jacob B. Stocks & Sandra Yvonne Oketch - June 18th, 2019 On May 23rd, 2019, a stakeholders meeting on palliative care and treatment of cervical cancer for partners in Kisumu County was hosted at the KMET Complex in Kisumu. The main objectives of the meeting were 1) to share experiences on palliative care and cervical cancer services in Kisumu County and 2) to identify opportunities for networking and collaboration among partners. The 7-hour meeting began with a discussion of structural barriers to effective referral and treatment of cervical cancer in Kisumu County. The presenter, Brenda Otieno, discussed barriers such as the complexity of intra-facility referrals and client tracking, the lack of centrally located data on cancer patients (i.e. lack of a county-level cancer registry), and the lack of financial protection for clients seeking treatment. Following this session, Dr. Chemtai Mungo, an OB/GYN from UCSF, presented the evidence for cervical cancer screening via HPV testing by citing multiple studies discussing the cost-effectiveness...
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