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 the cervical cancer burden. Our plan was to conduct this study in Migori County, Western Kenya; but as often happens in international work, plans needed to change. I quickly changed course and traveled to Kampala, Uganda where Dr. Huchko had a very similar ongoing study.
The Infectious Disease Institute at Makerere University is the home of the Uganda-based study team and where I would spend the next seven weeks on an extremely ambitious work plan. In seven weeks, we would work as a team to train research assistants on the study tools, and budget for and plan a trip to Kiboga, where we would spend five days interviewing HPV positive women. Kiboga is a rural town approximately 75 miles northwest of Kampala. We would conduct questionnaires with 50 women, and in-depth interviews with 11 women. That data would be collected, cleaned, transcribed and translated all before returning to America. To put those accomplishments in perspective, prior to my arrival to Uganda the study team and I had limited interaction. The team had not planned on my arrival, and was exceptionally busy working full-time as nurses and a clinical OBGYN.
During my first three weeks at the Infectious Disease Institute at Makerere University, I met with the study team regularly to explain the study aims, review the study tools, translate the study tools from English to Luganda, and create a timeline for study completion. Due to the last minute nature of the study, we determined we could reach the most women by conducting the treatment acquisition survey over the phone, and then spending a few days in Kiboga to conduct the in-depth interviews in person. The overall goal of the survey was to identify the psychosocial, health belief and logistical factors related to treatment acquisition following a positive HPV diagnosis. The in-depth interviews would further explore many of the factors from the survey.
Weeks four and five were spent making phone calls to HPV positive women from the existing study database; both women who underwent cryotherapy and women who were lost-to-follow up were surveyed. We reached enough women in those two weeks to have a well-deserved pizza party celebration in the veranda. On Monday morning of week six, we grabbed breakfast from the university food dispensary; fresh cooked banana bread and rolex’s were on the menu (a rolex is egg rolled in chapatti). We packed up our study vehicle, and took off for Kiboga. Driving away from the city and traversing rural Uganda were my favorite summer experiences, and I took the opportunity to do so every single weekend.
In Kiboga, women were mobilized with the help of community health volunteers. The three research assistants and I met most women at the local health dispensary, where we greeted the women with beverages and snacks, and conducted the interviews inside the study vehicle, or on a small piece of pavement outside the dispensary. The study vehicle provided a quiet and private space for the interviews to take place. We met some women at a local Catholic church, a long and bumpy car ride up in the hills of Kiboga. The language barrier was challenging for me considering all conversations, including the interviews were conducted entirely in Luganda. One of the most important aspects of this process for me was to meet the women, and let them know that I support them, a very difficult task to complete with a language barrier. The women were kind, and incredibly generous with their time and provided important feedback. We returned home to Kampala with 50 total surveys and 11 in-depth interviews, a true accomplishment for our team. My final week in Kampala was spent coordinating the transcription and translation of the in-depth interviews, and wrapping up study odds and ends.
I came home feeling grateful for the opportunity to conduct my study in both Kenya and Uganda. I feel grateful for the chance to analyze the data, and advocate for improved screening and treatment strategies. It is imperative that more awareness is raised on the burden of cervical cancer among women in Africa. I believe that continued awareness and further research will inevitably make access to screening and treatment easier for women globally.
-Carissa Novak, second year Master of Science in Global Health student