Community Impacts of Maternal Child Health Care in Kigali, Rwanda

Community Impacts of Maternal Child Health Care in Kigali, Rwanda

Guest Blog by Suzanna Larkin, T21 The Iranzi Clinic is a pioneering medical clinic in Kigali, Rwanda that focuses entirely on maternal and child health services. As an intern through DukeEngage-Rwanda this past summer, I worked directly alongside the midwives, doctors, and administrative staff that have made Iranzi Clinic their home. Only opened one year ago, the clinic is situated on the edge of the impoverished Nyabisindu neighborhood. Many of the women who visit the clinic are unable to pay for their services, and thus the clinic relies primarily on support from the Christian Life Assembly Church and donors. The commitment that the midwives and staff hold for their patients and clinic is clear. Every Monday, the clinic has a devotions session followed by a tea time, and the scene is joyous­–any observer can notice the deep and genuine friendships that grew between the staff members as they built the clinic from the ground up. Their anecdotes about the clinic’s history, from...
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Small Fish, Big Conference: Lessons from an early career researcher on navigating your first international conference

Small Fish, Big Conference: Lessons from an early career researcher on navigating your first international conference

Guest Blog by Konyin Adewumi, MSc-GH '17 Last month, I was given the opportunity to present my research work at the International Papillomarvirus Conference in Sydney, Australia. I submitted an abstract entitled, “Female perspectives on male involvement in a human papillomavirus-based cervical cancer screening program in western Kenya”; a qualitative analysis that was part of an ongoing study at Duke’s Center for Global Reproductive Health. After taking the time to reflect on my experiences navigating such a great opportunity, I found that I had learned a few lessons that may be beneficial to others who are in my shoes – anyone that is early in their research career, unsure where the path is headed, but eager to make the most of the opportunities presented to you.     So here are my five lessons: One. Similar to your fieldwork, what can go wrong will go wrong. Plan accordingly—and when all else fails, learn to pivot. From arriving to the airport to find out that I...
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A Frightening Global Truth: Domestic Violence Within Social Normativity

A Frightening Global Truth: Domestic Violence Within Social Normativity

In reviewing data from Demographic and Health Surveys administered in low and middle-income countries between 2005 and 2017, researchers at the University of Bristol have come to an unsettling conclusion; domestic violence against women often exists within the bounds of social normativity. These surveys evaluated the social acceptability of domestic violence when provoked by certain situations, such as when a woman goes out without telling her partner, argues with her partner, neglects her children, is suspected of being unfaithful, refuses to have sex or burns a meal. It was found that approximately 36% of survey participants considered domestic violence justifiable in at least one of these instances. Furthermore, in 36 out of the 49 countries studied, women were more likely to justify this abusive behavior than men, speaking volumes to the deep entrenchment of female subordination, even amongst women. The data regarding the social acceptance of domestic violence is highly variable, ranging anywhere from 3% of the population accepting this...
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The Devastation of Congenital Syphilis Amongst California’s Most Vulnerable

The Devastation of Congenital Syphilis Amongst California’s Most Vulnerable

As of twenty years ago, incredibly low prevalence rates made concern for congenital syphilis in California obsolete. However, in the past six years, the number of syphilis cases in California has augmented exponentially, jumping from 33 to 283 cases and wreaking havoc upon California’s most vulnerable: at risk mothers and their newborn children. Due to syphilis's ability to pass through the placental wall during pregnancy, an ever-increasing number of children are suffering from meningitis, anemia, organ deformation, pneumonia and neurological deficits. Approximately thirty stillborn babies in the past year were found to be infected with syphilis-- the highest number of infant mortalities attributed to syphilis since 1995.  Such statistics are incongruent with California's extensive health care system, especially since the horrific consequences of syphilis can be prevented by a single antibiotic shot. High levels of poverty, homelessness and substance abuse have been reliably linked to increased reports of syphilis cases. Although California law mandates that pregnant women receive mandatory screening...
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Ensuring Health Care for All in Kenya

Ensuring Health Care for All in Kenya

According to the World Health Organization (WHO), Universal Health Care (UHC) is aimed at ensuring that all people are able to receive medicine and treatment without suffering financial hardships. Kenya is working to implement this healthcare strategy, with the goal of allowing more Kenyans access to healthcare in public health facilities. Additionally, Kenyans will be able to access the same services in private hospitals without digging very deep into their pockets. Despite this bold move by the Kenyan President to create affordable healthcare for all, human resources, finance, essential medical products, technologies and service delivery remain challenges. The story of a woman under the alias of “Dorothy” exemplifies the financial challenge in assessing care at treatment sites. Dorothy was enrolled in a study looking at integrating HPV testing into community health campaigns, and was ultimately referred to a selected health facility in Kisumu where she was booked for treatment. After she received treatment, she further was referred for biopsy testing. But,...
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Oregon, a champion of women’s health, is one of states with abortion challenge on ballot

Oregon, a champion of women’s health, is one of states with abortion challenge on ballot

Guest Blog by Suzanna Larkin, T '21 Oregon, my home state, is a unique champion in women’s right to abortion. While more than 400 abortion restrictions have passed in 33 states in the past 7 years, Oregon remains a key state in support for reproductive health rights. It was the first state to allow pharmacists to prescribe birth control directly to women in 2015. More recently, Governor Kate Brown signed the Reproductive Health Equity Act in August 2017, which expands coverage of abortion and other reproductive health services to thousands of Oregonians by allocating nearly $500,000 of Oregon’s general fund to expand cost-free reproductive and abortion services for those who are ineligible for Medicaid. It also requires all private insurance companies to cover abortions for free. There is one caveat to this legislation: Providence Health Plan, a large health insurance provider in Oregon, is insurer exempt from providing abortion services—the only insurance provider in the state with an exemption. This is because...
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Notes from the Field: Dissemination Meeting for a Community Health Volunteer Study

Notes from the Field: Dissemination Meeting for a Community Health Volunteer Study

The Center for Global Reproductive Health's Research Coordinator, Yujung Choi, and I held a dissemination meeting on October 19th to share the findings from one of our studies. The study describes the characteristics, motivations, and experiences of community health volunteers (CHVs) in Kisumu county, and looks to understand CHV knowledge and self-efficacy of reproductive health counseling and services. The purpose of the meeting was to share the study outcomes with key stakeholders and elicit feedback in order to inform future interventions to measure CHV performance and increase CHV retention rates. Among those who attended the meeting were CHV supervisors who had participated in the study, Sub-County Community Health Strategy Focal Persons, a former study staff, and a Program Officer from the NGO Community Initiatives Concerns. We summarized the study findings on various topics, including: -CHVs’ reasons for becoming CHVs -CHV level of comfort in teaching health topics such as family planning -child care and nutrition -HIV, malaria, and cervical cancer -challenges in carrying out daily tasks -relationship...
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TEEN PREGNANCY IN KENYA

TEEN PREGNANCY IN KENYA

A United Nations Population Fund (UNFPA) report in Kenya shows 378,397 adolescent and teenage pregnancies for girls ages 10-19 between July 2016 and June this year. More specifically, there were 28,932 girls ages 10-14 and 349,465 girls ages 15-19 who became pregnant. The counties with the highest number of teenage pregnancies begin with Narok, where 40 per cent of its teenagers became pregnant. The list goes on to include the counties Homa Bay at 33 per cent, West Pokot at 29 per cent, Tana River at 28 per cent, Nyamira at 28 per cent, Samburu at 26 per cent, and Migori and Kwale both at 24 per cent. Teenage pregnancies have been linked to poverty. Many people believe girls in poverty engage in “transitional” sex to meet basic needs. Others blame “absentee parents” or a lack of parental guidance and exposure to information on the Internet - both which can lead to curiosity and therefore teenage pregnancy. Yet, others even say these...
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MY NEWFOUND AWARENESS ON SEXUAL HEALTH RIGHTS FOR PERSONS WITH DISABILITIES

MY NEWFOUND AWARENESS ON SEXUAL HEALTH RIGHTS FOR PERSONS WITH DISABILITIES

As a student physical therapist, my future career is primarily to serve individuals with short-term or long-term physical disability. Working with individuals of various forms of physical disability such as those with cerebral palsy, to stroke survivors, to amputees, I have become more aware and appreciative of buildings and spaces that are physically accessible with ramps, elevators, and ADA bathrooms. However, despite my acute awareness of physical accessibility for individuals with disability, accessibility to sexual and reproductive health for this population was not something that crossed my mind until I stumbled on the anecdote by Stella Chiwaka. Chiwaka, born with albinism, was denied contraceptives at a local health center in Malawi and was told by a health provider that “People like you should not have sex”. As a future health provider, I found this discriminatory act appalling. People with disabilities, just as those without disabilities, have the right to make their own choices--including choices regarding their sexuality and sexual health. To...
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A Seminar Focused on The Finance Behind Global Health Initiatives

A Seminar Focused on The Finance Behind Global Health Initiatives

The Seminar Series: Stories From Africa, Financing Health in Sub-Saharan Africa took place at Duke University on Thursday, October 18. Led by Gavin Yamey, the seminar featured a panel of speakers: Sarah Bermeo, Associate Professor of Political Science, Duke Sanford School of Public Policy; Charles Muiruri Program Director at Duke Global Health Institute and Co-founder Association of Research Administrators in Africa; Kaci Kennedy, Associate Research, Duke Center for Policy Impact in Global Health; Godfrey Kisigo, Masters Student DGHO, Physician at Kilimanjaro Clinical Research Institute, Tanzania; and Osondu Ogbuoji, Deputy Director, Duke Center for Policy Impact in Global Health. The seminar opened with an introduction to global health from a very optimistic perspective. Global health is a cutting edge field that focuses largely on improving the future for humanity. Initiatives in global health are making large and wide impacts, for example, in fields such as child wellness. However, there are also still huge numbers of people suffering from illnesses and burdens that...
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