Notes from the Field: Uganda

Notes from the Field: Uganda

This summer, after a long, solo trip across the world, I arrived in East Africa for the first time. As a Master of Science in Global Health student at Duke University, I spent my first year paired with a mentor, Dr. Megan Huchko, working as a research assistant. During that time we worked together to design a research study which I would conduct the following summer in Kenya. Dr. Huchko and I chose to interview HPV positive women from her ongoing cluster-randomized trial to find ways to reduce the substantial loss to follow up seen with a two-visit screen and treat strategy.  Upon entering this program, I knew I wanted to work in women’s reproductive health. Cervical cancer is the leading cause of cancer in women in Africa, so having the opportunity to have a hand in research being conducted to reduce that burden is a privilege. Our goal was to improve treatment acquisition among HPV positive women, to reduce...
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Let’s Talk About Sex: Peer-Led Comprehensive Sexuality Education in Rural Kenya

Let’s Talk About Sex: Peer-Led Comprehensive Sexuality Education in Rural Kenya

What is the function of the clitoris? Before I began teaching comprehensive sexuality education (CSE) at WISER Girls’, a secondary school located in Muhuru Bay, Kenya, I never imagined that this would be the most frequently asked question. Especially among a class of female third-year high school students. When I was first asked, I gave a cursory – and yes, somewhat bashful – reply, explaining the clitoris as the “anatomical source of sexual pleasure in females.” But this answer did not satisfy the students, and they probed for more information. As we engaged in a discussion, I learned that many weren’t familiar with an external representation of the female genitalia – especially one with a “non-reproductive” function. As my answers became more justificatory about the significance of the clitoris, I realized that my attitudes about legitimized female sexuality had begun to leak into my responses. While I tried to remove any bias from my answers, I struggled with leaving my...
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Recap of Women’s Health Symposium

Recap of Women’s Health Symposium

On Friday, October 20th, public health professionals from around the Triangle gathered at Duke to discuss how best to advance women’s health in the current political environment. Keynote speeches were given by Jen Kates, Vice President and Director of Global HIV Policy at the Kaiser Family Foundation, and North Carolina Congressman David Price. Women’s health right now is in an era of uncertainty. Jen Kates focused on this as she outlined many of the questions that remain regarding how the Trump administration will implement many of its proposed changes to global health policy. Unfortunately, this uncertainty extends to women’s health domestically as well. Congressman David Price described expected and potential changes to the Affordable Care Act and the devastating effect these could have on women and girls across the United States. After hearing a broad overview, the afternoon concluded with two panels which honed in on specific impacts current and proposed policies will have. Lindsay Robinson of Planned Parenthood South Atlantic reminded...
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We Make Inroads

We Make Inroads

This year, we will host a series of reproductive health talks. These talks are designed to expose audience members to a broad range of reproductive health topics, organizations, researchers, and projects. The first talk of the semester was facilitated by the co-conveners of Inroads. Kati LeTourneau and Katie Gillum gave an engaging presentation on their work and how individuals and organizations are combatting abortion stigma around the world. Rather than being a network of organizations, the Inroads network is comprised of individual members. Gillum and LeTourneau stressed the importance of this, because “we interact with stigma as humans and individuals first” so transforming and dismantling stigma must start on an individual level.  One of their goals is “to transform (stigma) by bringing people together who don’t often get together.” Each member brings their own expertise to the community, provides support to other members, and asks for guidance and feedback from the network. So why stigma? As Kati said, “Stigma is a barrier...
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Can we translate the multilateral strategies for cervical cancer prevention to address other global health disparities?

Can we translate the multilateral strategies for cervical cancer prevention to address other global health disparities?

Cervical cancer is an example of a glaring health disparity between wealthy and poor countries, and remains an immediate health threat to many women in low- and middle-income countries (LMICs). Evidence-based, cost-effective protocols recommended by the World Health Organization have not been widely implemented due to limited health care infrastructure augmented by a lack of funding and political will. Although there are some unique factors contributing to the disparity in cervical cancer outcomes between high and LMICs, there are some common root causes shared across health systems: poor health care infrastructure, lack of awareness of early signs or symptoms, lack of funding prioritization within local governments, and limited operationalization of proven technologies used in high-income countries. These root causes must be addressed through both innovation and adaptation of successful interventions to fit the target community and the priorities of local governments (i.e. be both low-cost and cost-effective). To achieve this, clinicians and researchers need to partner with policy experts and...
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Where are the Women in Global Health Leadership?

Where are the Women in Global Health Leadership?

Dr. Nandini Oomman gave a riveting keynote speech at the Triangle Global Health Consortium on September 28 in Raleigh. She opened with a photo of the current European health ministers, highlighting only 9 out of 27 are women. She then flipped to a picture of only men sitting around a table deciding the fate of US health care, provocatively labeled “American Health Care: A Handmaid’s Tale in the Making?” Following that, a photo of an all-male meeting at the World Bank and WHO, which had been tweeted as an example of the exciting brainstorming sessions about the future of global health by leaders in global health. When asked where the women were, organizers said they had all left the room before that photo was taken. Dr. Oomann raised her eyebrows and said dryly that it seemed unlikely. What are the numbers of women in global health leadership? Dr. Oomann presented some stark statistics. Among the main UN agencies, professional organization, global...
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Visualizing the Risk

Visualizing the Risk

When I landed in the airport in Kisumu, Kenya, I was brought back to the day I first left Kenya for the U.S. as a young girl. Although I have returned to Kenya since then, I was overwhelmed by this particular experience as I never envisioned returning to my home country as a college student pursuing research in a field I always knew I was passionate about. From an early age, I found myself burdened by the needs and suffering of women. Women who never put themselves first so I can be where I am today. After committing to the Global Health major at Duke, I began searching for a mentor to engage in a research project with that would challenge my problem-solving abilities, and provide me with ample support to learn independently. I connected with Dr. Megan Huchko, and spent a few weeks this summer with her Cervical Cancer Screening & Prevention study based in Migori, Kenya, while also shadowing...
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Reproductive Health at Duke

Reproductive Health at Duke

When you hear the words ‘reproductive health’ what do you think of? Some may think of pregnancy, others the prevention of pregnancy. Maybe you think about the risk of HPV and cervical cancer, or the choice to decide your reproductive future. These are among the most important facets of reproductive health for both men and women. However reproductive health has much broader implications, and achieving optimal reproductive health can be challenging in many parts of the world. Pregnancy, contraception, safe motherhood, cervical cancer prevention, fertility goals, abortion, and gender-based violence are all facets of reproductive health that impact women throughout their lifespan.  Access to education and youth-friendly health services help young women navigate the transition through adolescence to educational and economic empowerment while avoiding early pregnancy and exposure to STIs and HIV.  Economic empowerment and respectful prenatal care ensure that women have a greater chance of deciding when to reproduce and doing so safely.  Strengthening and streamlining health care infrastructure through innovative...
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