2009 UCSF-UCB Global Health Framework Program

MUHAS _Tanzania project student team photo

2009-08-04T07:20:00.000-07:00

TEAM TANZANIA

2009-07-31T05:59:00.000-07:00

Jambo,

The team is all together now, as our remaining teammates have finally arrived. With this, we have been very busy for the past week. We have been working with our MUHAS counterparts, faculty advisors, and staff to revise the study questionnaires. We have also been meeting to figure out the study protocol, procedures for the pilot study, and organizing the logistics for implementation.

Although there is much to be done, it has been a rewarding experience to work with such a diverse group of students and faculty. Since our teams are comprised of people from various professional backgrounds, we have been able to learn a lot from each other. One of the most rewarding experiences is to be able to get to know our student counterparts from MUHAS. As a group, we have worked to identify challenges and solutions. One of the greatest challenges has been how to locate participants for the surveys, since there is no overarching governmental board that maintains official records of its health professionals. We have also had opportunities to review the key professional competencies needed to deliver effective health services throughout Tanzania. Next week, we will begin training and piloting the tracer study in preparation for launching the study.

Dar es Salaam, which translates to ‘haven of peace’, is nestled on the east coast of Tanzania, right on the Indian Ocean. It is the largest city in Tanzania, making it the unofficial capital of the country. The location of the city lends itself to many places for exploration. Our team has been able to discover Dar and its surrounding areas; we have gone to nearby beaches, fish markets, local artists co-ops, to visit health centers in near Kilimanjaro, community trachoma projects in nearby districts, and accidentally run into the President of Kenya, Mwai Kibaki. Our experiences have given us a richer understanding in which to contextualize our work. We are looking forward to gaining new experiences as we travel into various districts during the tracer study.

INDIA: Oh rain!

2009-07-25T04:01:00.000-07:00

When we first came, there was not enough rain. No hydro-power means no electricity. Then there was copious amount of rain which somehow also meant no electricity. In the past few days we've been dealing with mold and fungi that have infested in our home due to the high humidity. Now it is clear, full of sunshine. Good news? or so we thought. Well, we've been told it means higher frequency of infections. There is no win.

Dengue fever incidents are high in our hospital and within the last few days, they have been an influx of school children admitted for viral infection. They suspect it is the seasonal flu. Kenchanahalli is a 10 bed hospital but they've been holding 20-25 patients in the last few days. Hopefully it is just part of the season. Here's a pic of us at the Kabini dam. Posing for the rain Gods!

TEAM TANZANIA

2009-07-21T03:53:00.000-07:00

Introduction

Our team of UCSF and MUHAS students is currently congregating at the MUHAS campus in Dar es Salaam Tanzania to work with the Academic Learning Project.

UCSF and MUHAS have an established collaborative partnership aimed at enriching and improving medical research and training on both campuses. The Academic Learning Project (ALP), which we will be helping with while in Dar is a research initiative founded by the Bill and Melinda Gates Foundation. The long term goal of the ALP is to improve the health of the Tanzanian people by increasing the numbers of health care professionals in the country. There is currently a critical shortage of trained health care providers in Tanzania, with only 3 physicians per 100,000 people and 13 nurses for 100,000- well below the WHO recommendations. The ALP is intended to be a three year project that will produces revised undergraduate and graduate curriculums that will allow practitioners to meet the health needs of Tanzanians. It is hoped that the ALP will serve as a model of a successful and mutually beneficial partnership between African and American Universities.

We will be working on the Tracer Study for which we will be interviewing recent MUHAS graduates, their employers, co-workers and patients in order to identify competencies and deficiencies in their training from MUHAS. This needs assessment will serve as the basis for future curriculum revisions and development.

While working on the Tracer Study we will be partnering with current MUHAS students, and will be paired according to discipline (for example a UCSF dentistry with a MUHAS dentistry student etc). Our team consists of students from all faculties- medicine, dentistry, pharmacy, nursing and public health.

Kwaherini,

Molly, Evan, Lin, & Joy

india - mysore and water

2009-07-19T22:15:00.000-07:00

(written July 2, 2009)

The monsoon rains have been delayed this season and reservoir levels are dropping, affecting accessibility of drinking water in the region, crop production, and the hydropower on which this area depends. We have been mostly without electricity here in Kenchanahalli.

According to the Deccan Herald, Wednesday July 1, 2009, power cuts will continue across the Karnataka state as we await the late arrival of the monsoon rains. The delayed rains are having an impact on power shortages throughout the country, and many states have banned private producers from selling power out of state. The Deccan Herald further reports that with the current reservoir levels (see chart below), power can only be generated for another week; if the low water levels cause generation from the hydroelectric power stations to cease, Karnataka state will need to purchase at least 30 million units of power (units not specified) daily and will be facing further power outages.

Note: adapted from the Deccan Herald, July 1, 2009, p5

In addition to the reservoirs that serve Karnataka listed in the chart above, the Kabini Reservoir and Dam were constructed in the 1960s, providing hydropower to the growing areas around Mysore. The Swami Vivekananda Youth Movement (SVYM) clinics in Saragur and Kenchanahalli where we are working serve tribal communities, many of whom were displaced through the development of the Kabini Dam and the designation of the surrounding area as a tiger protection reserve that forbids human habitation. For 30-40 years, these tribal communities have been living on the margins of modern society, attempting to maintain cultural traditions in displacement. Tribal communities is the term used by local NGOs, the government, and community workers to refer to the populations that were traditionally forest dwelling. These displaced populations are particularly vulnerable to exploitation and poor health in the forced transition from traditional ways of life to surviving in a modernizing society (source: SVYM brochure and video).

[see later blog entry for an update about the arrival of monsoon rains]

TEAM KENYA...to do list

2009-07-19T01:40:00.001-07:00

The fisherfolk hotline aims to improve fisherfolk’s ability to sustain their HIV treatment, both medication administration and appointments, and therefore improve the effectiveness of treatment. The implementation of the hotline will be continually monitored and then evaluated six months after the start date on the basis of the number of calls, the type of service rendered by the hotline, feedback from an interim focus group of fisherfolk, and the number of missed appointments/medication pick-ups compared to the number missed before the hotline’s implementation.

One of our tasks is to locate a list of all the clinics in Suba and create directions to each one. This is no small tasks considering that there are over 30 clinics and traditional addresses in Kenya are rare so directions will have to be based on landmarks. This information will be available to call receivers so that clients can be informed of clinics they can visit in the area they are working.
Another task is to create medical cards for all enrolled clients that may use the hotline. This way when a client is referred to another clinic, that clinic knows the client’s allergy information, latest CD4 count, current medications, and co-morbidities.

Once we create the clinic list and medical cards we will hold a focus group with fisherfolk and role-play how the hotline will work so that we can get feedback, make adjustments, and publicize the line. This is not an exhaustive list of what needs to take place in order to implement the hotline but these are our focus at the moment.

Our work-day pace tends to go like this: motorbike from our home stay to the clinic, help with vitals and client triage in the mornings, take lunch with FACES staff, work on our fisherfolk hotline project in the afternoons, and then taking a 1 hour walk back to the home stay.

TEAM KENYA

2009-07-19T01:29:00.000-07:00

The three of us, Teja, Michelle and Diana are based on Mfangano Island, Kenya where we are collaborating with Family AIDS Care and Education Services (FACES). You can read about this organization and watch their documentary on their website, www.faces-kenya.org/

Our focus is to get a hotline running for fisher-folk in the region. FACES has asked us to work on this because the fisher-folk in Suba, which includes Mfangano Island, are a particularly vulnerable group of clients within FACES. This is in part because they are migrant and their schedules are highly volatile, making them subject to weather conditions and migration of fish within Lake Victoria. The nature of their work makes it difficult to keep up with Antiretroviral (ARV) treatment and clinic appointments and causes them to suffer from HIV complications. Secondly, there are jaboya, a subset of fishermen that solicits transactional sex from women in exchange for their high-value catch. This increases the incidence of HIV.

Chas Salmen who has spent much time with the communities on Mfangano and who will meet with us here on the island at some point provides an interesting perspective for understanding the epidemic in this region. In his thesis, “Towards an Anthropology of Organic Health,” he writes that HIV in the region “represents the dynamic intersection of microbes moving across time and space, a colonial history of marginalization, structural violence imposed by a global whitefish industry, local political structures of competition and rivalry, and the embodiment of desperate economic conditions.” His writing gives context to the HIV epidemic on Mfangano Island, demonstrating how, in his words, “powerful socioeconomic forces and deteriorating ecosystems contribute to illness as much as any pathogen.” In order to convey more context on HIV on Mfangano Island we will try to link the intro and first chapter of his thesis to this blog.

The goal of the fisherfolk hotline is to facilitate fisherfolk’s ability to pick up their medications in a timely fashion and keep their clinic appointments even when work takes them far from their usual clinic. Through the hotline clients will be able to find clinics close to where they are working, reschedule appointments, and arrange medication pick-ups at nearby clinics.

The following blog entry will better detail what tasks we have ahead of us.

out apartment in Dares Salaam

2009-07-13T01:04:00.000-07:00

took me ages to upload this picture !!! My 'beloved' Africa Time Internet. T_T

Lin

we are living at lantitude 6°48'13.61"S longitude 39°16'33.18"E

2009-07-11T10:26:00.000-07:00

My very first weekend in Dares Salaam. NO WORK TODAY:)The temperature hits 90F today
but I still made the trip to national museum and city tour. I could
not find a city map here so did some homework with google map. The
downtown is not far from where we live, approx 1 miles.

Walking on the street is not a pleasure experience in Dar. In general,
there's no sidewalk attaches the street, and even though it exists,
usually are sandy or dusty. Plus you have to be careful with the cars
pass through. I was scared once when almost hit by a car that appears
drive fast rather than well. Ouch!! The modern national museum locates
next to the botanical garden, but has few collections includes
ethnographic, historical and archaeological items. The old photographs
of Tanzania, coastal colonial history are particularly interesting to
me. Living in civilized society, it is hard to image the slave trade
of this country. In the museum, there's a whole floor exhibits the
national football league's achievements, they are on show dating from
the 50' to the 2007 FIFA world cup. I was the first visitor of the day and
the only one during my entire visit. I was very much enjoy the
peaceful moment which can be a luxury in Dar :).

Maybe it's weekend, I don't see any foreigner on the way to fish
market that locates along ocean road, past old post office, its a
well-knows place to watch fishing ships come and out, as well as the
fish trading. The market densely packed by locals, fortunately i met a
South African visitor accidentally on my way to the market so got some
accompany to enter into the market (to be honest, I won't go into the
market by my own). It turn out to be a great experience, the smell of
fresh fishes and prawn mingles with the scent of the sea, the heart
and main activity of ordinary people, and the view of coastal and
fishing vessel.

To be continued......

Lin

Photos to set the scene -- India

2009-07-08T00:48:00.001-07:00

Local map

The landscape

Our bungalow

SVYM hospital at Kenchanahalli

Hello from India

2009-07-08T00:32:00.000-07:00

Namaste!

We’re writing to you from the rural clinic campus of Kenchanahalli, outside of Mysore, in southwestern India. We are working with the Swami Vivekananda Youth Movement (SVYM), a grassroots organization that promotes public health and community-based healthcare in the surrounding 110 villages. From SVYM’s mission statement and our own observations, there is dedicated attention to sustainability, community participation, and serving the needs of the rural poor.

Our projects include:

Documentation of Ayurveda procedures and preparations, which will contribute to a one-year nursing program
Creating a standardized protocol for sickle-cell screening, hospital treatment, and community outreach
Development of training materials for community health workers who will conduct a gestational diabetes population risk assessment

We are also thrilled with the opportunity to attend weekly mobile health clinic visits that serve remote communities in forests near the Kerala border.

Outside of these projects, we are learning Kannada, sipping on lots of chai, going for walks in the rain, running away from spiders (the size of your haaaand!), practicing yoga, snapping photos of wild elephants, and eating delicious vegetarian food. SVYM has a great website at svym.net if you want to read more. Also, we will be posting more reports, stories, and reflections – along with photos – so keep checking in.

Shubah ratri,

Team India – Sarah, Kimmi, Kallista, and Mara

Greeting from Tanzania

2009-07-07T00:14:00.000-07:00

This is my very first blog so forgive me if this sounds like an email :)>. (have several photos but internet here is extremely slow~~~~, will upload later)

take care all when you are working in the field!!!!

Lin

Currently only Evan, Joy and me settled in our destination, MUHAS university in Dares Salaam, Tanzania. There're several focus for us all at this stage, some pre-tracer study data collection and input, to understand the tracer work to date and think about and creating interview guides for the qualitative prortion of the tracer work.

After few days of living in this new city, i would like to share some personal experience with all of you of this city. I started to write diary since left country, here some pieces of them.

It is ‘winter’ in Dares Salaam but the temperature is still up above 80c. the apartment we rent doesn’t have hanger that could hook the mosquito net, but Ive not had trouble with mosquito so far. But it’s is raining today so, hard to tell what will happen in next few days (fertile mosquito eggs in the water). The apartment locates at the ground floor and no fence outside the window (which is mostly recommended). But the apartment has 24/7 guards and most residents are foreigners. To certain extent, it’s okay now. I’ve been thinking where to hinder my passport and visas :)

The nursing student (Liyuka) I am pairing with from MUHAS university took me to the market to buy the essential daily things like pillow. We took public bus that is my very first time. The mini bus(daladala in local Swahili language) has about 20 seats but jammed by over 30 people plus the crew. There’s no bus stop sign on the street and the drive was very rough, as the Dar streets are crowded with people in most places you visit who doesn’t follow the street rules. It was raining at lunch time, so the street was muddy along unaccountable little retailers on the streets. As a foreigner, I was amazed by the popularity of the cellphone in Tanzania, maybe caused by the unbelievable cheap price of the network. 1s cost 1Tsh and people by seconds (yes, not minutes) through voucher price range from Tsh 1,000 to Tsh 5,000. (1USD to 1300TSH Tanzania Shilling).

I went to the student canteen with Liyuka for lunch, the canteen is unpretentious. Students or other visitors line up to get orders, the choice of foods, is expected limited, bake beans, rice, beef, cooked or fried banana, chips, chicken and of course, world beloved soft drinks. Cost from 1,000 to 2,000. Portion are very small compare to my experience in canteen in other countries. Food are usually blended and people use either spoon or hand to eat. I picked cooked banana (raw banana cooked in tomato sauce and beef. Taste like potato) and beans. Those the carbohydrates in the lunch are really filling so I don’t feel like to eat meal for dinner, but some milk . My roommates already started sick of canteen food after few days of try….will I? I started miss bagel and cream cheese.

Tell you something about the little culture I have learned so far in these two days. Dares Salaam ( learned from internet today Dares Salaam means heaven of peace named by the founder of the city back in 19^th century) that in local appears to have considerably large proportion of Muslim and Indian populations. At least from the distribution of satellite TV channels at the resident. We have about 50 channels but ¼ of them are Indian languages ( you can tell from the ethnicity features of the TV program). In the building I am staying has 13 floors and I see Indians very often at the entrance. In regard to Muslim population, it makes up 50% of the population. The consciousness of this group is like everywhere I have been. Most residents at the house have their own cars and apparently are employed by international company.

In Dares Salaam, there is a marked contrast between the conditions of most local ordinary people (crowded on buses, living in ramshackle dwelling, making small retail business for living on the street), on the other hand, the business and international community and travelers are enjoying much higher living standard (living in an airconditioned apartment cost equal to the SF price, and I saw BMW and Benz cars on the street as well the relevant car retailer nearby the airport). Since I am not a casual observer and meant to stay here for quiet amount of time, I plan to discovery a little bit more of this city at least.

There was a scenario from me which was I tried to photo the open vegetable market and central bus station. I was almost caught by the locals and found there’s two guys on the street seems very unhappy with this action. Lucky I was with Liyuka and she helped me explained in Swahili word to them. Later on, I was told a lot of Tanzanians don’t like foreigners taking the photo of their ‘ street culture’ and try to stops me. For people like me traveling from another culture, this was a great lesson that to be very sensitive is crucial and try to minimize your curiosity.

I started feel paralyzed in Dar as I don’t speak Swahili but very few greeting words, plus took a while to remember local people’s name. This is frustrating because not remembering people’s name is either something you’re not supposed to do or a polite manner. The only way to overcome this embarrassment might be taking a small note book with me and keep recording everything. Everyday, I bring the camera to recorder those images which I found reflects the local culture and norms along my way. But taking a photo in public as mentioned, should be very cautious, that is something could bring me into troubleL.

to be continued.......