Healthcare in the West African nation of Mali

Healthcare in the West African nation of Mali

     The West African nation of Mali is one of the world’s poorest countries and has extremely high rates of maternal and child mortality. The WHO has approximated that costs of healthcare are a force pushing 100 million people across the globe into extreme poverty every year. So, in the area of Yirimadio during 2008, the community implemented a free door-to-door health-care plan sponsored by the government in order to ensure wellness and combat health ailments. After 7 years of the trial, the University of California collected data from the region and discovered that child mortality in the region dropped by 95%—marking the program as extremely successful. After this news, the President of Malawi announced the goal for the entire country by 2020 to have localized, free health care for pregnant women and children under the age of 5 to fight maternal and child mortality. This program will focus on training community health care workers, providing door-to-door services, and...
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Let’s End HPV-Related Cancers Briefing Coverage

Let’s End HPV-Related Cancers Briefing Coverage

    In the U.S. alone, over 33,000 HPV-related cancers are diagnosed annually among men and women and globally, there are over 630,000 cases. The theme of the briefing, “Let’s End HPV-Related Cancers” held in Washington, D.C. on June 27, 2019 centered around how to prevent the 6 cancers caused by HPV: cervical cancer, oropharyngeal cancers, anal cancer, penile cancer, vaginal cancer, and vulvar cancer. Representative Kathy Castor (D-FL-14) is a leader in the House of Representatives bringing legislation to the United States to meet the WHO goal to eliminate HPV-related cancers. The tools to eliminate these cancers do exist and Representative Castor expressed optimism for saving lives and never seeing these cancers again. Starting with cervical cancer, the approach of adding vaccination, screening, and treatment is necessary for elimination. Australia, Canada, and Rwanda are three countries which have declared they will be the first to eliminate cervical cancer and the U.S. must also show initiative with this mindset.     ...
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The Irony of the Mexico City Policy

In his first days as President of the United States, Donald Trump reinstated the Mexico City Policy. Also known as the Global Gag Rule, the policy “gags” international NGOs receiving U.S. aid by not allowing them to “perform or actively promote abortion as a method of family planning.” First enacted by President Ronald Reagan, U.S. funding for critical reproductive healthcare abroad has been a partisan issue ever since with every Republican President instating the policy and every Democratic repealing it. President Trump’s reinstatement of the policy greatly expanded its parameters and includes a wide range of global health programs such as HIV funding through PEPFAR (President’s Emergency Plan for AIDS Relief). The expansion of the policy diminished the provision of services by international NGOS who weren’t previously affected by the policy and who feared losing critical funding from the U.S. Last week, a study published in the Lancet found that when the Mexico City Policy is instated, rates of abortion...
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mSaada User Testing with Community Health Volunteers in Kisumu Kenya

mSaada User Testing with Community Health Volunteers in Kisumu Kenya

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

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

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...
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Re-building Rwanda’s Access to Ob/Gyn Services

Re-building Rwanda’s Access to Ob/Gyn Services

"In 2011 the Rwandan government embarked on a novel medical education program to improve their health care system.  Human Resources for Health (HRH) Rwanda, a partnership between the government of Rwanda and a consortium of 22 U.S. academic institutions, was designed as a 7-year training program to produce qualified medical personnel with the aim of increasing quality and access to health care for Rwandans."  As one of the earliest ob/gyn specialists to work in Rwanda with HRH, Duke's Dr. Maria Small led an evaluation of the first five years of the program with the aims of 1) examining the number of trained ob/gyn specialists who graduated from the University of Rwanda as beneficiaries of the HRH program, and 2) conducting a geospatial analysis of pregnant women’s access to Rwandan public hospitals with trained Obstetrics and Gynecology providers using a WorldPop data set. Study Results: "In 2011, there were only 14 ob/gyns in the country.  By the end of HRH year 5,...
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Important New Study Regarding Injectable Contraceptives

Important New Study Regarding Injectable Contraceptives

There is an unmet need affecting 47% of women in Africa who want modern contraception in order to prevent pregnancy. During the last few years, there has been an increase in the use of injectable contraceptives, such as Depo-Provera, across the continent specifically in Mali, Sierra Leone, Chad, Ethiopia, Kenya, and Uganda. Many African women rely on these types of shots because they are more easily concealable compared to other forms of contraception such as a daily birth control pill. Also, in some health clinics, these shots are the only method of contraception offered. Many women need secret protection due to men refusing condoms and the women wanting to avoid any social, physical, and mental consequences they may endure if they are found trying to keep away from pregnancy. A specialist in HIV at Britain’s Medical Research Council, Dr. Sheena McCormack, stated that African women’s, “husbands or partners, and their families, often want them to have children.” Along with the...
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Stakeholders Meeting on Palliative Care and Treatment of Cervical Cancer

Stakeholders Meeting on Palliative Care and Treatment of Cervical Cancer

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...
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Mhealth App User Training

Mhealth App User Training

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...
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