This summer, we have 5 Duke Scholars working with the Duke Center for Global Reproductive Health in Kisumu, Kenya. We have 3 undergraduate students joining the Center as part of the Student Research Training Program (SRT), a Masters of Global Health Student, and a 3rd year OB/GYN resident all conducting research in Kenya. Read below to learn a bit about these passionate students and hear about their work and what they are most looking forward to. SRT Students: Sydney Chen (she/her) Sydney is a double major in Global Health and International Comparative Studies with a Biology Minor. She calls Herndon, Virginia home. When asked about what her time spent in Kisumu looks like, she reflected that “The team and I are working on various ways to improve an app called mSaada which helps women in East Africa receive screening for cervical cancer. I’m specifically working on the FAQ portion of the app by making sure that the answers are clinically accurate and using...
Be an Outlier for Change Next week marks almost five months since the Supreme Court handed down their decision in Dobbs versus Jackson Women’s Health, overturning the constitutional protection for abortion enshrined by Roe v Wade in 1973. Although the past fifteen years have seen an incredibly successful assault on reproductive rights and access to essential health care for pregnancy, the Dobbs decision led to the enactment of trigger bans in thirteen states, with an additional thirteen states having restrictive or very restrictive laws that are anticipated to lead to bans in the near future. In the first 100 days post-Dobbs, much has been written about the legal climate, how individuals and families have been affected and the legislative victories on both sides of the debate. One of the most striking things I’ve read, however, was a policy analysis by the Guttmacher Institute classifying the US as a global outlier on abortion rights. While the US has often taken pride in...
Emily Herfel, DO, Msc-GH, FACOG (Fellow of the American College of Osteopathic Obstetricians and Gynecologists), is an assistant professor at Duke Department of Obstetrics and Gynecology, an affiliate at the Duke Center for Global Reproductive Health, and a volunteer professor at Kilimanjaro Christian Medical Center in Moshi, Tanzania. Dr. Herfel completed her undergraduate work at John Carroll University in Cleveland, Ohio followed by a Doctor of Osteopathy at Heritage College of Osteopathic Medicine in Athens, Ohio. She completed residency at OhioHealth Doctors Hospital in Columbus, Ohio. She then went on to receive her Masters of Science in Global Health through a Women’s Global Health Fellowship at Duke University. During that fellowship, she received an NIH-Fogarty grant to complete her project in Kisumu, Kenya. I had an enriching conversation with Dr. Herfel to learn more about her experiences within the global health sphere and her passion for reproductive health care. “Right in the heart of COVID, in July 2020, I moved to...
I recently landed back home in Boston after spending most of my summer in Nairobi, Kenya researching cross-cultural early childhood development with Universal Baby. Universal Baby is a public health, caregiver coaching intervention that creates videos to share current neuroscience and child development information across the globe. Towards the end of my time in Kenya, I visited a Maasai Village in Kajiado South sub-county, about 5-6 hours outside of the Nairobi. The Maasai are one of Kenya’s ethnic tribes, originally from the lower Nile Valley. I embarked on this journey, acutely aware of how the injustice and violence of colonialism has shaped the education systems and subsequent socioeconomic advancements in Kenya. We stopped for the night in the rural town of Bisil before starting off early the following morning for the village, passing giraffes and ostriches on the drive there. Our first stop was Loolkair Primary School, a K-8 school with nearly 400 students and only eight teachers. As we arrived, hundreds of...
The Center for Global Reproductive Health and the Center for Policy Impact in Global Health recently partnered to convene a webinar on “The unfinished agenda of maternal and child health in Africa and Asia: promising directions to address maternal mortality challenges.” The panel, moderated by Dr. Megan Huchko, included: Dr. Mariam Claeson, former Director of the Global Financing Facility for Every Women Every Child at the World Bank and now at the Karolinska Institute
Dr. Qjan Long, Assistant Professor at Duke Kunshan University, formerly worked at the Department of Reproductive Health and Research, WHO
Ms. Jacquelyn Caglia, Director of Learning, Communications for Merck for Mothers Experts discussed the historic and current challenges in addressing maternal and child mortality in the region, and brought up some promising innovations and strategies with the potential to effect these disparities in the future. The webinar can be seen here, with a fill description of the background and discussion on the CPIGH website....
It is hard to believe I have called Kisumu home for almost a year, with time cut short by the elections set for early August. Our team is busy, skillfully orchestrating multiple studies concurrently. The stigma education study, looking at the impact of a stigma-responsive educational video on cervical cancer screening behavior, is in full swing. The six health facility sites are offering research-supported HPV self-testing as part of their cervical cancer screening program, led by community healthcare volunteers (CHVs). Our three intervention sites are also showing the HPV stigma-responsive education video. The team then visits each site once a week to ask women to participate in a validated HPV/cervical cancer stigma measurement tool. Jeniffer, our study clinician, is leading the project with grace, balancing the day-to-day activities with each facility. Getting positive feedback from the CHVs and women of the community about a cervical cancer screening technique that avoids a speculum helps to keep us motivated. Some of the sites are...
As we start our eighth and final week in Kisumu, the SRT team is finishing up the last stages of our on-the-ground research, and preparing for our trip back to the US! At this point in time, we are almost finished with our clinic observations. Despite several scheduling changes, we will complete our project with five to six observation sessions at each of the six clinics. Additionally, we have set in motion the plans for the Kisumu team to conduct focus group discussions (FGDs) at the intervention clinics after we leave. The purpose of the FGDs is to understand women’s opinions about our educational intervention, and how they feel about incorporating peer navigation services into the clinics. Unfortunately, we will not be here to witness the FGDs as we originally anticipated, but we’ve been working on setting everything up so that they will run smoothly in our absence. That includes getting participant recruitment up and running, going over our questions and...
Pictured above: People marching in Boulder, Colorado for Reproductive Health Rights in May of 2022 with signs that say “Your right to abortion should not depend on your zip code.” Unfortunately, though, zip codes shaping access to abortions may very much be more of a reality with the overturning of Roe v. Wade. The New York Times reveals how the Supreme Court’s ruling on the Mississippi law could weaken or even overturn Roe v. Wade which could ultimately lead to legal abortion access dramatically decreasing, particularly in the American South and Midwest (Bui et al., 2021). This geographic discrepancy is even more reinforced through social class differences and communities that are “disproportionately Black, Latina, teenagers, uninsured, and undocumented immigrants” (Miller & Sanger-Katz, 2022). Ultimately, leading not only to be a social justice issue and human rights issue, but also a racial justice issue. Bui et al. quotes Caitlin Knowles Myers saying, “A post Roe-United States isn’t one in which abortion isn’t...
First and foremost, we have passed the halfway point of our time in Kenya! Time flies by, and we are discussing what we want to get out of the next four weeks. Insofar, we collected more than 20 observation data to evaluate the workflow of stigma education at the clinic. During this process, we faced multiple hiccups, especially scheduling a visit and clearing up logistics. Three of our observation clinics had a twelve-day-long CHV training, so we had to flip our schedule to ensure we could collect the data we initially planned. We spent the last couple of days creating a contingency plan so that our time in Kenya could contribute to the depth of our data. Listening to what other teammates thought helped us, as a team, solidify the future direction of our study, such as what variables to analyze in observation studies, codes for focus group discussion, and the focus of our manuscript. Besides working on an observational study,...
We have made it through week three of our time in Kisumu, Kenya! The weeks are truly flying by because our research is progressing, and we are enjoying our time in the city. The other SRT students and I officially started our workflow analysis observations at each of the six clinics this past week. There are three intervention clinics, at which community health volunteers (CHVs) display an educational video about human-papillomavirus (HPV) self-screening, and three control clinics, where CHVs provide health education talks about HPV and offer the self-screening. Through our observations so far, it is clear that all the CHVs are quick learning, adaptable, and passionate about increasing HPV screening for women in Kisumu! We have enjoyed our first week of observations because of all the positive aspects we have seen with our study. Fortunately, many women are opting into HPV self-screening, and we are able to increase prevention of cervical cancer in many of the Kisumu sub-counties! We...
