A Day in the Life of a Health M&E Volunteer

Welcome to the Day in the Life series, where you can get to know the volunteers and what they do every day in a more informal way!

 

My name is Katherine Wong, the Monitoring and Evaluation Officer of Health Team. I decided to volunteer with CDI because I wanted to gain some fieldwork and real-life experience on how to conduct research. As a psychology student, it is very difficult for us to apply what we learn in university to real life, and I think CDI provides me with a unique opportunity to do so. I also enjoy the process of working on a project from scratch, follow it through and evaluate the impact of our work at the end of the summer. I think this will be a challenging yet rewarding journey, I am looking forward to the things we could achieve as a team!

 

8:30 – Wakeup / Breakfast – I usually skip breakfast or have a few Digestives before heading out for work. (Totally not because I wake up super late every morning because I value sleep over everything.) When I do have breakfast at the canteen, this is what it looks like, plus some Nutella which my friends kindly share with me.

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9:00 – Work time!

When I’m at the classroom, I usually have a cup of tea or a cup of coffee to kick-start my day. The plan of my day really depends on the amount of work I have, but for today, it looks something like this:

  • Complete M&E a day in the life blog post (Top priority!!!)
  • Emotional well-being student baseline survey data analysis
  • Coding for emotional well-being teacher interviews #1 – #6
  • Plan and design sampling method for NCDs workshop, Then speak to the central M&E officer, Adi.   

 

10.00 – Emotional well-being student baseline survey data analysis

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There are currently two ongoing initiatives within the health team: emotional well-being and non-communicable diseases. For the emotional well-being project, we are collaborating with the Education team. I have been working closely with their M&E Officer for the past couple of weeks. Last week, we conducted our baseline survey with students from two different secondary school. We collected responses from a total of 114 students, and the survey consists of 18 questions, which means there are A LOT things to go through.

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You can probably tell from that pile of surveys, we are dealing with a relatively large set of data right here. Emotional well-being is a topic I am personally very passionate about, so this is very exciting for me!

11:00 – Emotional well-being data analysis with Simina

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It would be pretty tough if I had to go through all the surveys alone, so here is Simina – the M&E officer from the Education team, and together we have successfully finished analysing all the surveys! Yay!

Big shout-out to Simina for all her hard work despite the immense workload she is facing and thank you everyone on both the Health and Education team (Priyanka, Fatmah, Oliva, Florida, Nasma, Irene, Mahamudi) for going onsite to conduct these surveys and interviews. Also, a token of gratitude for all the Kite volunteers and our counterparts for translating the question and responses from Swahili to English, also for communicating with the schools – without you guys, none of this would have been possible.

 

13:00 – LUNCH TIME (WHOOP WHOOP!!!)

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After a morning of hard work, finally it’s FOOD TIME!!! I usually have wali (rice) and makange (beef), alongside with some oranges and banana. Sometime if we’re lucky, we get spinach and even some maharage (beans) on the side! It is always nice to sit and chill out with my team and friends from other projects, especially hearing about what others are working on at the moment. Occasionally, we will have weird, philosophical discussion such as the nature of chicken as a continuous verse a discrete concept. Other times, we would have a heated debate about whether the beans they serve are peanuts or not.

 

14:00 – Back to work! Coding teacher interviews

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After lunch, I’ll be working on coding the teacher interviews from the schools we surveyed. I learned about qualitative analysis at university, but this is my first time actually doing it myself. In the emotional well-being initiative, all the qualitative data will be analysed using a bottom-up/data-driven approach. As there are no prior studies on student mental health in Tanzania, this makes it difficult for us to form theories prior to research.

 

17:30 – End of work!

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We usually have our daily briefing at 16:30, where we come together as a team and update each other on the things that we have been working on during the day, plus our progress so far. Here is a group photo of the health team!

 

19:30 – DINNER TIME

I usually have street food at night, and whenever I have mishkaki (meat skewers), I often have to protect my food from the hungry cats in the canteen…

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23:00 – Bedtime!!

Today has been a very productive day – lot of work was completed, but I am exhausted. I will be working on more data analysis and drafting more surveys / interview question tomorrow. My days are generally quite different, as they really depends on the progress of the project. Some tasks might take days to finish, while others can be done within the hour. Although many may say that data analysis and drafting surveys seems to be quite dull, personally I find this quite exciting. It is exactly what I was hoping to do when I decided to volunteer with CDI. Through working on sensitive topics such as mental health and NCDs,  CDI also made me become more mindful of cultural differences between different countries.

Going through some of the responses we have collected from the surveys and interviews, there is often a sense of helplessness within me, but also an intense feeling of wanting to do more for the locals. Stepping back for a second, two months is a very short period and there are only a limited number of things which can be achieved. Yet in the face of this realisation, I still want to make the most of this summer, and hopefully, create some positive changes for various communities.

Let’s end this blog post on a lighter note, here is a cute kitten outside my room, AWWW!!

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Empowerment and Education: Advancing Women’s Health

This summer, the Health Project have been focussing their work on several different lines of research. Charlie Calver (second right), one of the Health Project Volunteers, here details how their examination into the state of women’s health in Tanzania has been translated into a series of workshops, with the aim of educating and empowering the local community.

Women shoulder a disproportionately large share of disease within Tanzania, with gender inequity, neglected maternal health, and sexual-based violence all acting as major obstacles to good health. As of 2014, Tanzania had failed to achieve the 5th MDG (Millennium Development Goals): to reduce the maternal mortality ratio by 75% between 1990 and 2015.[1] Moreover, although Tanzania was on track to achieve MDG 3 (gender equality in primary education) in 2014, it lags behind in the Gender Inequality Index, ranking 125 out of 155 countries.[2]

Whilst some progress has been made towards improving women’s health, maternal mortality remains high: there were 398 deaths per 100,000 births in 2015, with only 49% of births attended to by a skilled personnel.[3] UTIs, sexually transmitted diseases, access to contraception, and various forms of cancer also continue to be pressing issues for many Tanzanian women, and, as such, women’s healthcare stands out as a clear matter that requires evaluation, improvement, and investment.

In response, CDI’s Health Project decided to facilitate a series of Women’s Health Workshops within the informal settlement of Vingunguti in Dar es Salaam. Initially, we conducted focus groups with Community Health Workers, to ensure that our proposed workshops would effectively meet the needs of the community. The main issues identified primarily revolved around UTIs, contraception, breast and cervical cancer, and maternal health. The interviews which were later conducted at the Buguruni Health Centre confirmed these findings, therefore providing a clear curriculum around which to structure the workshops.

Working in collaboration with Childbirth Survival International (CSI), CDI successfully delivered the first of these workshops last Saturday (26th August), with two more to follow over the next couple of weeks. Over 30 women attended and reported positive feedback, particularly stating how pleased they were that international organisations were taking an active interest in their health, wellbeing and empowerment. Although the enthusiastic and engaging responses of the participants were a positive indication of the workshop’s success, they also indicate the lack of healthcare provision in settlements like Vingunguti, and the need for an established educational programme.

Good health is both a cause and a consequence of socioeconomic development. Although only part of a wider set of amelioration initiatives that need to be taken, CDI are focussing upon empowerment and education as methods with which to advance the quality of women’s health in Dar es Salaam. Women can be major agents for change, but are routinely denied access to the most basic tenets of information regarding their own health. Until such deficiencies are accounted for, women will continue to bear the brunt of weak health systems and inadequate infrastructures. As a WHO report into Tanzanian women’s health concluded, ‘the preferences and experiences of women should […] inform health system design.’[4] Through the Health Project’s workshops, CDI hopes to make a positive change that will liberate women, enabling them to take an active stance in their bodily choices and decisions.

[1] http://www.aho.afro.who.int/profiles_information/images/c/c8/Tanzania-Statistical_Factsheet.pdf
[2] http://www.tz.undp.org/content/tanzania/en/home/countryinfo/
[3] http://www.aho.afro.who.int/profiles_information/images/c/c8/Tanzania-Statistical_Factsheet.pdf
[4] http://www.who.int/bulletin/volumes/92/4/13-126417/en/

Health Project – A Brief Intro to Community Engagement

Our fifth video this summer looks at the Health Project’s focus upon community engagement.

In addition to the research they have been conducting, the team have been running surveys and workshops in the informal settlement of Vingunguti, in order to raise awareness about the most common diseases in this community, and the methods of prevention against them, particularly in the area of women’s health.

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Health Project – A Brief Intro to Malaria Diagnostics

Our next video looks at one area of research being conducted by the Health Project.

In collaboration with WaterScope (a Cambridge based organisation) and STICLab (a maker-space in Dar es Salaam), CDI are conducting field research upon a new 3D-printed microscope in order to bring cheaper, easier and more accurate malaria diagnosis to local communities in Tanzania.

If you are interested in working with CDI, then please see http://www.cambridgedevelopment.org/get-involved – committee applications are NOW OPEN!

Dual Communication: Bringing Together Community Life and the Healthcare System

As part of the Innovation Team on CDI’s Health Project, Lisa Schomerus (left) is one of the volunteers researching the current healthcare system in Dar es Salaam, and engaging with members of the community to ascertain how CDI can best meet the demands of a growing population. Here, she highlights the importance of how, in seeking to improve the accessibility and affordability of healthcare products, the Health Project must carefully consider the balance between the current healthcare system and the habits and needs of the community.

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Vingunguti is an informal settlement in Dar es Salaam, home to more than 100,000 inhabitants. Walking around the streets, the population demographic is dominated by young children, and the main streets are busy with street vendors and people running errands.

Conversing with local residents and healthcare providers the need to facilitate change for the healthcare provision in Vingunguti becomes clearer. Government publications are somewhat limited in providing a full picture of the problems faced by the community on a day-to-day basis. Our role for the past two weeks, therefore, has been to bridge this gap between what the healthcare delivery system should look like in practice, and what, in reality, we have found to be the current national standards.

So far, the main problems we have identified revolve around the poor availability of health-promoting products and services that are affordable. For instance, locals often bypass the healthcare system when they are ill due to the expense of diagnosis, and instead obtain medication from street vendors, without the need of a prescription. These street vendors are usually unqualified members of the public and sell items such as electronic accessories and peanut snacks along with these drugs.

Added to this, many patients tend to visit health centres only at the latter stages of a disease when other treatments – including traditional practices or consultations with witch doctors – have failed. Moreover, these health centres and other healthcare providers are overflowing with capacity; even if the typical habits of the community were to change, the provision would struggle to accommodate them.

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Yet, as a team, it is the community spirit and cohesion of Vingunguti that has struck us most. It is this which will lend itself as indispensable if we are, in cooperation with the locals, to make a sustainable impact on the healthcare system.

Last year, the Health Project saw the implementation of Afya Yetu, a business model which looks to sell affordable healthcare products via under-utilized healthcare workers (whose role it is to educate and advise residents on health matters). Whilst there are a lot of strengths to this model, we are looking to expand a product-range that better meets the demands of the community.

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Over the last two weeks, therefore, we have carried out two major pieces of primary research. Firstly, we approached the hospitals, dispensaries, pharmacies and health centres around Vingunguti to understand better the systems in place and the demographic of the population who use their services. Secondly, we have been conducting surveys in collaboration with the WaSH Project to assess the health-related habits and knowledge of the Vingunguti residents. As we now begin the process of evaluating our findings, we hope to establish the impact of the CDI-implemented latrine networks, which serve approximately 450 people, and to what extent this has improved the standards of sanitation in the community.

Adjusting the Afya Yetu model to better improve health outcomes in Vingunguti – and for communities like Vingunguti, in the future – will not be straightforward. For one thing, each community is unique and uniquely challenging. In addition, the role of Afya Yetu in developing better health outcomes is nuanced, and can only be informed by research and experience. Continuing to engage with both the pre-existing healthcare systems in Dar es Salaam as well as community members themselves is one way of achieving this. It is through maintaining this dual communication that we hope to bridge the current gap between the established structures of healthcare and the reality of daily life in the informal settlements of Dar es Salaam.

African Healthcare Challenge 2017

8th February 2017

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This was a weekend organized by the Kopfadeyemi Fellowship, held at the Google Campus. Our WaSH and Health Project Directors attended, and formed a team with other students from a variety of technical and scientific backgrounds, taking up the challenge of tackling the issue of non-communicable diseases in Africa. By the end of the conference, they proposed a solution of a mobile health system that empowers community health workers to tackle NCDs, aiming to initially set it up to combat diabetes in Tanzania and Kenya. It was a fantastic weekend for all involved, and our Project Directors particularly enjoyed being able to meet other students and discuss a variety of ideas and solutions as part of a wider team.

Team Health: A Day in the Life

Its day two under new leadership and possibly one of the busiest days for the health team. The following timeline recounts the day’s events, with approximate timings.

It’s worth briefly mentioning the three things that were schedule for that day:

  1. Health Ambassador Product training from a charity called WAHECO. These are the ambassadors from the engineering’s network who we are bringing into Afya Yetu alongside the community health workers. This is followed by some video training on key diseases.
  2. Children’s hand washing sessions, joint with engineering, teaching around 100 children how to wash their hands effectively. This is run by a charity TAI.
  3. Community interviews to be done by our Tanzanian volunteers, to get opinions on Afya Yetu.

7:30 am. Team emerge to catch the Dalla Dalla into Vingunguti via some morning Chapatis  (or in Jack’s case, 3 chapatis and 5 mandazi [giant dough balls], it’s a big day).

8:30 am. Arrival in Vingunguti, make it safely across the main road and head to ‘base 2’ aka the café.

8:45 am. Talk through the day. Plastic cups, condoms, sanitary pads and water are distributed to the right people as samples for the product training.

9:00 am. Jack has to print off more interview sheets as Natalie has forgotten to pick them up from her desk.

9:15 am. Nat and Sam go to the premises. Sam goes on to meet John from engineering  to wait for TAI (who are running the children’s day) and sort out the location whilst Natalie waits for Juhudi from WAHECO (who are running the product training). John also goes to confirm the training with the health ambassadors.

9:30 am. John returns with the news that one of the health ambassadors has ‘gone away, may be back in a few weeks’. This is particularly bad news after hearing earlier in the week that none of the 8 community health workers could make the training either.

9:52 am. The Health ambassadors turn up to be trained, albeit in the wrong place. They are relocated to the right place. Somehow there are three of them after all which is a bonus! Meanwhile Natalie is still waiting for Juhudi, accompanied now by the local children, three of which are called Nadia.

9:56 am. Still no Juhudi, begin to search for her number to call.

10:12 am. Juhudi is “20 mins away’”  The Health ambassadors are waiting in our premises.

10:20 am. Sam returns to the premises to drop the sample soap off (as we forgot earlier).

10:21 am. John arrives to show the Tanzanian students to the community interviews, however, they couldn’t leave until the training started so this was postponed until later in the day or next week.

10:40 am. Natalie leaves with Sam to go and meet the children to walk them over to the premises, leaving the Tanzanian students at the premises to greet Juhudi.

Walking the children to the hand-washing session.

Walking the children to the hand-washing session.

10:45 am. Jack has finished printing and takes over from Natalie to wait for Juhudi.

11.17 am. Decide to go ahead with the community interviews.

11.34 am. Juhudi arrives and training begins.

11:40 am. The children’s handwashing session is going well with the Tanzanian volunteers leading parts of the session and the children responding really positively. There is lots of singing and each child demonstrates and practises how to wash their hands.

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12.47 am. The training was a big success and is coming to an end.

1:20 pm. The handwashing finished (only an hour late). Natalie and Sam head back to the café for lunch.

1:30 pm. The training actually finishes.

2:01 pm. The two groups head to the café for lunch.

2:02 pm. The café doesn’t do lunch on a Sunday.

2:05 pm. Food is outsourced and brought back to the café.

2:10 pm. Other people’s food turns up at the cafe, we may have misunderstood.

2:20 pm. Sam goes to get set up for the afternoon’s video training session.

2:45 pm.  No sign of the trainees. Natalie and Carol go to find them and bring them back to the premises.

3:05 pm. The video session can start. The others wait in the café

4:07 pm. ‘Two videos to go’

4:25 pm. Bets are placed on the finishing time of the session with the optimistic (Natalie) going for 4:39 pm and the pessimistic (Jack) going for 4:45pm.

4:39 pm. Natalie accepts defeat.

4:45 pm. The bets are abandoned.

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4:46 pm. The playing cards come out.

5:00 pm. We begin to wonder what Fran’s contribution to the day has been, aside from keeping the chair warm in the Café.

5:05 pm. The videos finish and all that’s left to do is gather the contact details from the Health Ambassadors.

5:15 pm. We clamber into a Bajaji with some jack fruit (which, having never tried it before, caused much amusement among the locals as they had to show us how to eat it).

6:00 pm Arrive back at Ardhi with just enough light left to do some exercise on the field, with a few Tanzanian spectators and a lot of groaning.

Written by Natalie Fisk, Volunteer on the Health Project.