From the Field – Page 6 – Global Reproductive Health at Duke

Post-Abortion Care in Kenya

August 26, 2019December 9, 2024 by Jill HageyNo Comments

Abortion is a loaded term in the United States, conjuring up many years of history and debate from political, medical and social contexts. However, in Kenya, there are even more challenges around perception of and access to abortion and post-abortion care services. In 2010, the new Kenyan Constitution legalized abortion when a provider deems that life or health of a woman are in danger. Although this is less restrictive than previous legislation, abortion is generally considered illegal throughout the country. While post-abortion care has always been legal in Kenya, it remains stigmatized, particularly because most often post-abortion care occurs after unsafe abortions that are occurring in the community due to the current restrictive policies. Indeed, post-abortion care guidelines were restricted from use for a number of years due to worry that the post-abortion care guidelines would help individuals perform these services illegally and were just re-released in February of this year back to health facilities throughout the country. Despite the...

Learning Backwards

August 6, 2019April 3, 2025 by Emma MehlhopNo Comments

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...

Putting the Clinical Back in Research

August 2, 2019December 9, 2024 by Jill HageyNo Comments

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...

Three Tips for when Research Plans Change

August 1, 2019April 3, 2025 by Suzanna LarkinNo Comments

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 --...

Expect the Unexpected

July 18, 2019April 3, 2025 by Andrea ChalemNo Comments

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...

mSaada User Testing with Community Health Volunteers in Kisumu Kenya

July 2, 2019April 4, 2025 by Jacob StocksNo Comments

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...

A Qualitative Research Training Session at the Center for Reproductive Health in Kisumu, Kenya

July 2, 2019April 3, 2025 by Emma MehlhopNo Comments

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...

Stakeholders Meeting on Palliative Care and Treatment of Cervical Cancer

June 23, 2019April 4, 2025 by Jacob StocksNo Comments

By: Jacob B. Stocks & Sandra Yvonne Oketch - June 18th, 2019 On May 23rd, 2019, a stakeholders meeting on palliative care and treatment of cervical cancer for partners in Kisumu County was hosted at the KMET Complex in Kisumu. The main objectives of the meeting were 1) to share experiences on palliative care and cervical cancer services in Kisumu County and 2) to identify opportunities for networking and collaboration among partners. The 7-hour meeting began with a discussion of structural barriers to effective referral and treatment of cervical cancer in Kisumu County. The presenter, Brenda Otieno, discussed barriers such as the complexity of intra-facility referrals and client tracking, the lack of centrally located data on cancer patients (i.e. lack of a county-level cancer registry), and the lack of financial protection for clients seeking treatment. Following this session, Dr. Chemtai Mungo, an OB/GYN from UCSF, presented the evidence for cervical cancer screening via HPV testing by citing multiple studies discussing the cost-effectiveness...

Mhealth App User Training

June 17, 2019April 4, 2025 by Jacob StocksNo Comments

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...

Summer SRT team joins Kisumu office

June 4, 2019April 3, 2025 by Megan Huchko2 Comments

This summer the Center office in Kisumu will be hosting three students through a Student Research Training (SRT) summer program. They will be joined by a Masters in Global Health student, an ob/gyn resident and a post-doctoral fellow, all researching various aspects of cervical cancer prevention and health systems strengthening for reproductive health. They've just arrived in Kenya, and I've asked them to share some of their plans and expectations for the summer. Follow this page to see updates on their projects and reflections throughout the summer. Emma Mehlhop, T'21 Since this summer will be my first experience in field work of any kind, I have much to anticipate. First, I am looking forward to reflecting on not just why I am passionate about Global Health, but what I am personally able to contribute to the field. During the Global Health Ethics course, we spent time reflecting on the work of Boniface Mwangi, a Kenyan photojournalist, who asks Global Health workers and...

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