Duke in Global Reproductive Health

The Cervical Cancer Screening and Prevention (CCSP) Team hosted a series of health fairs in Gem of Siaya County, Kenya earlier this summer. The purpose of these fairs was to create opportunities for women living in Kenya to have access to human papillomavirus (HPV) screening and education, and to allow school-age girls to receive vaccinations against HPV. Cervical cancer poses a significant global health burden due to limited access to effective screening and prevention measures, especially for women living in low- and middle-income countries (LMICs). Invasive cervical cancer affects more than 661,000 women around the world, resulting in more than 348,000 deaths each year.1 Though cervical cancer is very preventable through HPV vaccination and screening and treatment of cervical precursor lesions, cost and infrastructural barriers prevent many women in LMICs from accessing these essential cervical cancer prevention services.2 The health fairs hosted by the CCSP Team directly address the lack of access to cervical cancer prevention and screening measures that many Kenyan...

It may have only been a few weeks since we departed Kisumu, but I already miss the peaceful walks to the office, cooking dinner with friends, and working with the best people I know. The summer started with us a bit confused and working on tasks that seemed a mile away, especially since the office was actively conducting surveys in the field and meeting with community leaders. Additionally, we came to Kenya with our focus solely on mSaada, the digital platform designed to boost cervical cancer screening rates. We were fortunate enough to learn about and contribute to several other initiatives concerning vaccination, HPV stigma, and biopsies. As we quickly learned, cervical cancer is just one piece of the puzzle, surrounded by numerous equally important initiatives that collectively drive forward the mission of improving public health.   "As we quickly learned, cervical cancer is just one piece of the puzzle, surrounded by numerous equally important initiatives that collectively drive forward the mission of improving...

A few weeks have passed since our departure from Kisumu, and as I reflect on our experience, I’d like to echo some key insights shared by Kelsey and Sahil in their final reflections.   Our work was characterized by its dynamic and multifaceted nature.  Kelsey emphasized the importance of laying foundational groundwork—an often-overlooked aspect that, though not always immediately visible, is crucial for a project's future success. While urgent and important tasks may appear different, they are equally vital for overall success. Sahil highlighted the necessity of workflow improvements, noting that in resource-constrained situations, adapting our tasks and optimizing workflow are not just helpful but essential. This became evident as we managed limited resources and numerous ongoing tasks. Streamlining workflow was critical to enhancing team efficiency and achieving our goals.   A key project where many of these lessons came to fruition was the U54 initiative, which aimed to screen women for HPV and vaccinate young girls across Siaya County through community health fairs....

As our summer project in Kisumu drew to a close on July 20, the SRT team reflected on a productive and enlightening experience. Initially focused on the mSaada app, we soon discovered a handful of ongoing projects that broadened the scope of our time in Kisumu. mSaada is a digital platform designed to aid community health promoters (CHPs) in cervical cancer prevention efforts. Features of the app include patient education, screening reminders, and screening result notifications just to name a few.     Beyond mSaada, we contributed to several other initiatives. The U54 project, centered on HPV vaccination and screening, saw us designing promotional materials for health fairs offering free services. We also participated in the Elimisha project, which explored community perceptions of HPV, HIV, and cervical cancer stigma. Our involvement in survey administration was limited due to language barriers, as we lacked proficiency in Swahili and Luo. A personal and team highlight was developing tools to streamline our colleagues' workflows, allowing them to focus...

It’s been a year since I first set foot in Kenya, and I’m grateful for the opportunity to come back. Last year, I dedicated my time to building an integrated version of the mSaada app, and over the past eight months, we've been piloting this app within the community. The pilot phase is now complete, and this summer we have been working to refine and improve the app based on user feedback in preparation for the cluster randomized controlled trial we’re launching later this year.   While we made some app-specific changes based on user feedback, it became evident that there was a significant need for further educational materials. Indeed, while technology holds great potential, in low-resource settings, the education that accompanies it is essential for successful implementation. Thus, I had the opportunity to collaborate with the SRT students to take the following initiatives this summer in response to the above feedback:   Clarifying HPV Results: Many users needed reassurance that a positive...

We were incredibly lucky to be working with the team during some crucial moments of their work. These were moments that had been in the works for months, finally coming to fruition. During our stay, the team was constantly looking to the next visit to the field, always another big day on the horizon. This, of course, meant that their focus had to be set in the short term.   With everyone’s attention on these big moments, we found it easy to lose sight of some of the work that, while no less important, was less pressing. It quickly became clear that this was an opportunity for us fill in. Much of our time became focused on preparing for the future. We did some of the groundwork for future phases of studies, building tools that will hopefully be integral to their work, but which will not be used for quite a while. We were able to work on the app that will...

We are rapidly approaching the end of our time here in Kisumu, and I can hardly believe it. It feels like just yesterday that we were meeting the team and getting our bearings. Skylar, Kelsey, and Sahil did a great recap in their posts, and I hope I can share a few memorable moments.   We were fortunate enough to have Dr. Megan Huchko and Christina Makarushka stop here in Kisumu before attending a conference in Eldoret. While they were here, we got the opportunity to see this incredible team in action—outside of the office. As you've heard before, the local team impressively manages multiple studies and coordinates with partners across the world. However, what is most impressive to me is how well they work with each other. Last Tuesday was a team-building session led by a facilitator, featuring games such as a sponge race, egg & spoon race, and a variation of ships & sailors. During these games, the competitive and...

We have officially passed our halfway mark here in Kisumu, and time has flown by! Picking right up where Sahil and Kelsey left off in their posts, our work on the Elimisha survey visits has continued to evolve.  From our first visit to our current fifth visit at different facilities, we've observed significant changes.  Starting with the clinics furthest from town, such as Kinasia and Nyakongo, we've gradually moved closer to Kisumu proper through Bunde and Ahero, and now to the Central and West Kisumu districts.  As we've moved closer, we've noticed discernible differences in the facilities and the time it takes for women to complete the surveys.  Women at the more distant facilities faced greater challenges with literacy and digital literacy.  The conditions of the facilities themselves also differ significantly.  This underscores the importance of adapting to the wide range of conditions and contexts that each site presents.  It has been a powerful reminder of the necessity of adaptability in...

This is my first time in Kenya, and it's wonderful. We've been making the most of our time here, spending our weekends on Safari, taking a boat trip on Lake Victoria, and eating some truly incredible pineapple from Jubilee Market. Outshining all of that though, is the team. We're so fortunate to be working with so many strong and joyous people who are doing such difficult and impactful work.    In his post last week, Sahil gave a great overview of the ongoing projects and daily work the team is responsible for. I want to zoom out a bit and provide some context for this work. Cervical cancer claims hundreds of thousands of lives every year, and the vast majority of these deaths are in low- and middle-income countries. With HPV vaccinations and screenings, cervical cancer is entirely preventable. But here in Western Kenya, the health system has no capacity for these services. So not only is the team's work helping to...