Learning Lessons the Harder Way

Learning Lessons the Harder Way

by Jacob StocksNo Comments
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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Links Between Hormone Replacement Therapies and Increased Risk of Breast Cancer

Links Between Hormone Replacement Therapies and Increased Risk of Breast Cancer

by Emily WoodrowNo Comments
Hormone replacement therapies (HRT) are often prescribed to women facing menopause to help relieve harsh symptoms like hot flashes and dryness. The transition of menopause often begins for women around the ages 45 and 55 and is caused by a shift in the body’s sex hormone production. Estrogen and progesterone are two of the most commonly used hormones and there are currently around 12 million users of HRT. A study recently published in the journal The Lancet based on an analysis of data from 58 other studies on HRT, revealed that the longer a woman uses HRT, the greater the risk she has of developing breast cancer. It also concluded that in comparison to women who use estrogen-only hormone therapies, women who use estrogen-progestogen hormone therapies have greater risks for breast cancer. This research is important for both doctors and women to take into consideration before deciding to begin hormone replacement therapy and Dr. Janice Rymer, gynecologist and vice president...
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Post-Abortion Care in Kenya

Post-Abortion Care in Kenya

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...
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Federal Funded Family Planning Program New Rule

Federal Funded Family Planning Program New Rule

by Emily WoodrowNo Comments
Title X is a federally funded family planning program for birth control and reproductive healthcare and it is particularly aimed at people with low incomes. Enacted in 1970 as part of the Public Health Service Act, Title X helps more than 4 million Americans each year. Under the Trump administration, a new rule would mandate providers receiving Title X funds to be separate from any providers that perform or refer to abortions. In regards to Planned Parenthood, this rule would prohibit all Planned Parenthood health centers from receiving Title X funds if any Planned Parenthood health center counseled on abortions or performed abortions. Legal challenges to this rule have led to injunctions; however, Planned Parenthood released a statement saying it will formally withdraw from the Title X program on August 19 unless a federal court intervenes. Officials from Planned Parenthood believe it is wrong to keep complete medical abortion information from clients, which the rule would require, and acting president...
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Learning Backwards

Learning Backwards

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...
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Putting the Clinical Back in Research

Putting the Clinical Back in Research

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...
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Three Tips for when Research Plans Change

Three Tips for when Research Plans Change

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 --...
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Three Ground-Breaking HIV Studies

Three Ground-Breaking HIV Studies

by Emily WoodrowNo Comments
Three ground-breaking studies published in the New England Journal a few weeks ago reveal the benefits of door-to-door health workers, mobile clinics, and whole community testing in reducing the rate of new HIV infections in African Countries. The first study, the Ya T’sie trial, provided HIV testing, linkage to care, and early antiretroviral treatment to communities of Botswana; the second study, Search, focused on universal HIV treatment for communities in Uganda and Kenya; and the third study, PopART, implemented combination prevention intervention with ART in communities of Zambia and South Africa. The conclusion of these workings points to a 30 percent decrease in HIV incidence proving the success of these testing and treatment efforts. The key to the success is the idea of the “warm handoff” implemented in all three studies in which the health care workers ensured anyone who tested positive for HIV followed up at a clinic and did not forget. These studies are so important considering that...
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Expect the Unexpected

Expect the Unexpected

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...
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The Trump Administration’s Domestic Gag Rule

by Molly PaleyNo Comments
Since running for President and into his presidency, Donald Trump and his Administration have sought to undermine women’s access to reproductive health care. Last year, the Trump Administration proposed changes to Title X—which is federal grant program that provides funding for comprehensive family planning services. Known as the “domestic gag rule,” the proposed changes “gag” or bar healthcare providers from referring their patients to abortion providers. Moreover, the rule would drastically alter access to reproductive health care, including birth control and other family planning services, for millions of women who depend on Title X funded clinics. When the Administration released the final version of the rule changes, reproductive health organizations such as Planned Parenthood and the American Civil Liberties Union on behalf of the National Family Planning and Reproductive Health Association immediately challenged the rule. Despite a preliminary injunction that prevented the rule’s implementation, on July 3, a panel of three judges lifted the injunction. Devastatingly, last week by 7-4...
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