Learning Backwards

Learning Backwards

I traveled this summer to Kisumu, Kenya expecting to work on a project we had poured hours of work into through the Center for Global Reproductive Health. After much time spent discussing our project, conducting literature reviews, and finalizing on our in-depth interview guides, it was disappointing to learn that we would not have our necessary IRB approvals for our project until after our departure from Kisumu. While we are glad to know that our project is in amazing hands here at the Center for Global Reproductive Health, it was frustrating to come to terms with the fact that we would not be the ones to carry out the interviews we had worked so hard on. As I look back on my summer, I am compelled to reflect on why this change of plans changed my trip for the better. Much discussion around research, especially when it comes to global health research, focuses on the importance of flexibility. Figuring out what...
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Welcome Back!

Welcome Back!

With classes back in session, the halls are flowing with students talking about the trials and triumphs of their summers—whether they were in the field, interning in DC, trying out consulting work or just had an amazing vacation. The new school year brings with it a sense of new beginning and purpose—and sometimes an overwhelming feeling of everything needing to get “scheduled” during these first weeks of September.  A colleague recently started an email with the greeting: “did you have a relaxing or productive summer?  I feel like it’s either one or the other.”  It made me reflect on how we take advantage of being out of the classroom, trying to fit in various opportunities for travel, fieldwork and writing time that become harder during the semester, while also taking time to regroup and relax with family and friends. I hope everyone was able to have a little balance this summer, and come into the new school year with renewed...
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Learning Lessons the Harder Way

Learning Lessons the Harder Way

Fieldwork is all about learning, and sometimes that means learning things the hard way. My summer in Kenya taught me a lot about app development, about the process of global health research, and, of course, about myself.  My apologies to those of you who have been following the student pieces throughout the summer, but I’ll give a quick summary of my thesis project for first time readers: mSaada is a mobile phone application intended for use by community health volunteers (CHVs) during cervical cancer screening in Western Kenya. The app has multiple features including patient education and counseling materials, protocol support for CHVs, and patient data collection capabilities, to name a few. We hope the app will increase patient understanding of HPV and cervical cancer and act as an efficient and effective resource for CHVs throughout the screening process, leading to greater uptake of cervical cancer screening and treatment services and ultimately improved health outcomes for Kenyan women. Since the app...
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Learning Backwards

Learning Backwards

We came to Kisumu, Kenya expecting to work on a project we had poured hours of work into. After much time spent discussing our project, conducting lit reviews, and finalizing In-depth Interview questionnaires, it was disappointing to learn that we would not have our necessary approvals for our project until after our departure from Kisumu. While we are glad to know that our project is in amazing hands here at the Center for Global Reproductive Health, it was frustrating to come to terms with the fact that we would not be the ones to carry out the interview guides we had worked so hard on. As our time in Kisumu comes to a close, however, I am compelled to reflect on why this change of plans changed my trip for the better. Much discussion around research, especially when it comes to global health research, focuses on the importance of flexibility. Figuring out what to do when plans change and how to...
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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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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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Mhealth App User Training

Mhealth App User Training

In order to ensure participants had a strong understanding of mSaada and the planned pilot usability study, members of the mSaada study team hosted a two-day training, June 6th and 7th, at the Kisumu Office of the Center for Global Reproductive Health. Twelve study participants, four researchers, and two research assistants were in attendance. The first day of the training began with a general overview of research, its importance, those involved, and a lengthy discussion of informed consent. After a tea break, we proceeded with a discussion of HPV and cervical cancer, and prevention, screening, and treatment strategies. In addition to lively audience participation during a session of review questions, each study participant displayed their understanding of the steps necessary to successfully complete HPV self-collection by demonstrating how to explain the process to a female client. Finally, the first day of training concluded with a 2-hour session on mhealth strategies and details of the planned mSaada pilot usability study. Day two of...
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