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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Healthcare in the West African nation of Mali

Healthcare in the West African nation of Mali

by Emily WoodrowNo Comments
     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

by Emily WoodrowNo Comments
    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

by Molly PaleyNo Comments
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

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...
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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

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...
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