Guinea: Pictures from Health Facility and Community Visits

My community and health facility visits were illuminating, but sometimes a picture is worth more than words. Here are some more pictures from the trip: 

A woman has her child weighed during the check-up.

Every room at this health facility in Dubreka had a tub of water
and soap for washing hands. 

Mother waiting for child's immunization appointment.

Me outside one health center in Dubreka.

One of the more rural facilities we visited. 

We are greeted by the mayor (far left), the Prefectural
Director (far right), and others before attending a community
engagement session. 

More than 100 women attended the community sensitatization event,
designed to teach women about the free health services available
during antenatal and postnatal visits. 

A woman participates in the game, where she
has to bravely cross the "bridge" to get to the
health facility.  

Me and Dr. Bangora, Coordinator of UDEC,
one of the local NGOs that works with HC3. 

During an immunization check-up in Kindia. 

All immunization records are hand recorded and stored.
The nurse informed me these were all the children who were
not brought in for their next vaccinations, so the health workers
will go into the community to find them.

Madame M. Komara (center) asks me to join her and the
other midwives for a picture. 

Visiting the family planning part of the clinic.

Next door to the delivery room, we can see
water damage on the ceiling.

One midwife describes how the training that
USAID/Jphiego have supported has changed
the way they work in the facility. She's holding
a prop (a large plastic container with a baby doll)
designed to help train midwives on how to
deliver a child. 

Dr. Bangora opens a large community brainstorming event
to encourage men, women, healthcare workers, and Imams
to talk about. 

For the small group activity, one group of healthcare workers
are supposed to discuss why people aren't coming to the
facility. (In the 10 minutes that I sat with the group, they
spent more time trying to figure out how to divide up the tasks.)

A special thanks to Dr. Daffe of HC3 for making this trip possible. 

Guinea: Health Facility and Community Visits to Dubreka and Kindia

“Ebola était un mal necessaire.” -Health official

After two weeks in Guinea, I can already see that I've learned a lot. Beyond the dozens of academic articles I’ve been reading about adolescent sexual and reproductive health, I also spent some time in communities this week. I came into this summer with some of my own research questions, but through my interactions, these have been refined. This past week led me to really question: 

1. What does it mean to be Ebola-affected?
2. How are things different now than before the Ebola outbreak?
3. What gaps still exist, especially regarding the well-being of young women?

What does it mean to be Ebola-affected?

• The stats about the Ebola epidemic are clear – it is a disease that rapidly and unexpectedly attacked and affected thousands of lives in Guinea, West Africa, and beyond. But what does it really mean for a country, or community, to be affected by such a devastating disease. I would argue that, as a biosocial framework can help us to understand, Ebola cannot simply be viewed as a biological condition. Instead, it must also be understood for its political, economic, social, and cultural consequences. 
• This past week, I accompanied the Health Communication Capacity Collaborative (HC3) and Jphiego’s Maternal and Child Survival Program on a two-day trip to visit some health facilities and communities to see the work they have been doing in Ebola response. During this trip, I toured a few health facilities, visited a nurse and midwife school, and met key stakeholders including a Prefectural Health Director, Regional Health Director, medical professionals (doctors, nurses, and midwives), community health workers, a mayor, and, most importantly, members of the local communities. 
• I learned that Dubreka, community that took us 1.5 hours by road to get to, had 142 confirmed cases of the Ebola virus that resulted in 52 survivors and 90 deaths. In Kindia, one of the largest cities in Guinea, a facility we visited experienced a decline from 60 patients per day in 2013 to <5 patients per day during the 2014-15 outbreak. Though these numbers may not seem huge on a global scale - and although these are certainly not the hardest hit communities here in Guinea - our conversations revealed to me that the Ebola outbreak really instilled a fear and distrust in community-health facility relationships. These sentiments must be addressed to effectively address the daily threats of malaria and infectious disease that remain common in these communities.

From left to right: Conkary, Dubreka, and Kindia

How are things different now than before the Ebola outbreak?

• Perhaps the most asked question during our site visits was: “What is different now?” At the health facility in Kindia, the medical director suggested that an average of 16 people are now seeking services daily, and we observed at least two dozen women waiting with their children to get vaccinated. The Prefectural Health Director also explained that the Ebola outbreak has also created an urgency surrounding the enforcement of the rules and regulations for infection and disease control, which were often disregarded before. One example he shared was that during the outbreak, a patient came from Sierra Leone and the chief doctor carried him, gave him IV without gloves, and sadly, eventually died. He also described that it wasn’t uncommon for those seeking emergency care to come to the facility by foot. 
• Now, following the Ebola outbreak, investments have been made in better disease control and prevention and in the training of staff. Facilities are clean and sanitized regularly, every room has a large bucket of water and soap for handwashing, and everyone’s temperature is taken upon entering the health facility, again for safety precautions. Ambulances and motos are available and equipped to handle emergency cases. And with initiatives like HC3, more community engagement is emerging to orient the community to some of these changes. 

Every person entering the facility is required to wash their hands
and get their temperature checked.

What gaps still exist, especially regarding the well-being of young women?

• What these visits revealed to me is that although some positive strides have been made in response to the outbreak, there are still a disheartening number of gaps that remain. The health systems and practices were not strong or consistent prior to the Ebola epidemic, and investments in some of these basic necessities still need to be made. Although each room had a large bin of water and soup, running water was not regularly available, to me, highlighting a key sanitation concern. In one of the non-renovated maternal and child health rooms that we toured, the water damage on the ceiling was evident from the constant rains, leaving questions in my mind about problems we couldn't easily see. And although the projects I observed are funded through USAID, who are all the stakeholders investing in building Guinea, and in what way are these activities sustainable?
• I was also struck by how generalized some of the approaches to increasing demand in health services seemed. Yes, there was some targeting of women, of men, of health care workers, of Imams (Islamic religious leaders), but no where did I see any explicit focus on youth. I wondered if culturally Guineans only recognize "young children" and "adults," and thus the category of "youth" resonates less in the context. But on the other hand, when I saw mothers at the facility who still looked half my age, I couldn’t help but think that a focus on young women, as I hope my research will reveal, remains important to improving health here.

One of many young mothers, which as I
observed, was not uncommon in the places
we visited. 

It is unfortunate, as the Prefectural District Director said, that "Ebola was a necessary evil" to see some improvements in the healthcare system. I am encouraged to see some of the ongoing responses and look forward to speaking with more stakeholders about the problems they see young women face. 

Guinea: A Day on the 'Job'

Curious what an actual day has looked like for me so far? Wonder what I really mean when I say: I'm doing research? Well here's an example of one of the more "typical" days so far:

7:00 am - Woke up after 5 hours of sleep. (Jet lag!) Quickly showered. Consolidated notes on my methodology and preliminary findings for an adolescent sexual and reproductive health (ASRH) literature review I've been working on, where I am looking for all the academic articles I can find that talk about teenage girls' thoughts, decisions, and behaviors around sex and childbearing.

7:30 am - Had a phone conference with a research scientist from Harvard to discuss my progress on the ASRH review. Realized that the U.S. is four hours behind, not ahead. Major oops! 

7:45 am - After making some tea, sat down at my dining room/work table. Checked my email and saw a draft of the translated version of my research project protocol, completed in less than 48 hours! (Thanks Patrick!) Started to review the French version and make corrections in preparation to submit my research proposal to Guinea's Ethical Research Committee, which is a first step before I can even get permission to do my research here. 

8:15 am - Identified two qualitative research guides in French in order to learn and apply the correct technical vocabulary for my research methodology. (For example, "Snowball sampling" has meaning to me as qualitative researcher in English, but there is a specific way to say "the method of sampling of the ball of snow" in French.)

9:00 am - Too much French! Switched gears and started revising and editing one of my related dissertation papers that looks at how the early marriage of girls affects health. 

9:45 am - Meeting to discuss some home/office logistics and to start identifying things I still need to purchase. Also took a moment to update the summer budget. 

10:15 am - As I was editing and updating my research protocol, some ideas for my research started to come to mind. I started drafting a research memo, which I often write to reflect on any ideas and processes so that I am aware of what (and how) I was thinking about any of the work I do at a given point in time. I was able to refine the introduction section of my research project and spent some time writing the intellectual, practical, and personal reasons I selected Guinea for this research. For example, the devastating impact of Ebola and limited research being conducted in Guinea made it an important country to learn and share more about, while my own interest and experience in Francophone African countries I hope will make the transition here smoother. 

11 am - Back to editing the French translation of the research protocol. Also took a quick break for a homemade mango and avocado salad.

1 pm - Catching up on emails, and might have a local research partner lead! Started updated updating my CV, as requested. 

2 pm - Final revisions to the protocol. Also made some phone calls in preparation for tomorrow. Treated myself to a cup of tea and some biscuits (the British form of a "cookie").

3:15 pm - The real conference call to discuss progress on the ASRH review. So far, it's been really useful to do some preliminary literature review on how marriage, contraception use, abortion, and abstinence following childbirth impact fertility and childbearing for teenage girls throughout the African context. I haven't found any articles from Guinea though. I can already see how this is influencing my thoughts about this summer's projects and gaps that can be filled. 

4 pm - I see another email from a potential local partner, which could be very valuable in furthering this summer's proposed project. Made notes on what needs to be done tomorrow, and took some time to jot down daily reflections.

4:45 pm - Took 45 min to start drafting my next blog post. Treated myself to a glass of wine while preparing dinner.

(I won't bore you with the details on the rest of the day, but I did a few more hours of article searching, watched some French TV, and had enough internet speed to make an international call.)

I'll update you on some of my findings as I go along, and will share some of my non-office days as those start to emerge.

Guinea: Reflections on Week One

I arrived in Guinea just over a week ago, and as you may have noticed, I really enjoyed those first few days. Though I spent several hours from my comfy hotel bed doing some preliminary research, it was on Monday that the real work began! Research can often become a 24/7 hour job - there's always a new thought, another task, one more idea. Although I strive to meaningfully engage in both "work" and "life," putting overtime in for a time-bound project is often a necessity.

I woke up early Monday morning to grab breakfast and do some preliminary online research, and then spent a few hours on Monday trying to get in touch with someone from the Ethical Research Committee at the Ministry of Health in order to ensure I was taking the right steps to get local research approval. Through the help of my contact here, I was able to schedule a meeting for the next day. I, then, spent a couple of hours buying some items for my new apartment and getting my phone activated. Though these tasks could have been relatively quick in Boston, or my hometown in Michigan, I began to experience the local pace of life due to the first (of many) torrential downpours and back-to-back traffic everywhere we tried to go!

The Ministry of Health and Sanitation.
One thing I learned was that several vehicles like this were donated
during the Ebola outbreak, which has had an unintended consequence
of more vehicular congestion.

The traffic!

On Tuesday, I met with the Director of the Ethical Research Committee first thing in the morning and had my first experience inside of the Ministry of Health! I spent most of the afternoon moving into a nice and safe apartment that will serve as my home and office base for the summer. I squeezed in a couple more hours of work, and thankfully, was able to get internet to send some emails.

Outside of the Ministry of Health

The new home/office space is amazing!

Later in the week, I met up with a colleague from the Centers for Disease Control and Prevention to learn more about their Ebola-related surveillance work and life as a foreigner here in Guinea. I also started making contacts with some other local organizations whose interests may overlap with my own and tried to get more acquainted with my home for the next 7 weeks. Irregular internet left me feeling stranded at times, not knowing my way around (or many people) was a little isolating, and figuring out how to get around in the rain was also a challenge that I'm adjusting too.

It's pouring (and I've been warned that this is just a "sprinkle"
compared to July). 

What you may have already started to gather is that no two days, especially in these early stages, are alike. 

Though I can already share 10 different lessons learned, the most important one so far has been exactly what Dr. Farmer told me at our check-in before I left Boston: Be flexible. I have a plan, and lots of ideas, but it will ultimately take patience, listening, and flexibility to see what direction my work will take. Truth be told, I'm a little nervous about what kind of progress I'll make this summer but I'm really pushing myself to keep an open mind.  

Guinea: This is 'Africa'? and Reflections on the First Few Days

Uncertainty. Stupidity. Fear. These were the sentiments I felt as I was wrapping up a lovely 24 hour layover in Paris, en route to my new home for the next two months. 

Heading out to the airport.

 

A stop-over in Paris to see the Euro cup-decorated Eiffel Tower by day and by night. 

"The last meal" in a French cafe before heading out.

Generosity. Luxury. Ease. I was overcome by all three of these sentiments on my arrival to Conakry, Guinea, as my local hosts completely transformed my in-country arrival. 

My hotel.

The view from my hotel room.

Argh. Crap. No! These are just a few of the [more PG] thoughts that passed through my head as Hour 24 of my time in Guinea had approached and I'd realized my boxed electronics had been stolen out of my suitcase. 

Points for creativity to the person who jiggered
my zipper, made this hole, and took my
electronics out. 

Now, you have to understand that this was not how I intended to start my blog series for the summer, but the range of emotions I have experienced thus far reminded me of some past conversations about my travels. So many people ask me what "Africa" is like: Is it dangerous? Do you live in a house? What is the language and food like? My response is always the same: it depends. In just my first few days of this trip to my now 10th African country, I can unequivocally confirm that this diversity, this indescribable experience that words never seem to do justice to, this is "Africa." But I'm getting ahead of myself...

There were two days and counting until I arrived in Guinea, and truth be told, I was starting to get a little worried.

"Where are you staying?" My parents asked.

"Um...not sure yet...But I sent some emails and at least have a phone number of someone to call there!" I exclaimed.

"What will your project be?" A friend asked.

"Well...the idea is that..." I began to explain, realizing that I had no idea if things would really go as planned.

The more questions I was asked - simple questions that I wouldn't blink about answering if I were back in Boston - the more concerned I began to get. 

What did I get myself into this summer? 

Guinea from above.

Call it serendipity, luck, or a blessing, but when I think of my first few days in the country, there's no way I can deny that things have happened as they are supposed to. I wasn't bombarded with a disorganized, stereotypical "African" airport or trying to negotiate down a taxi price. I was, instead, greeted shortly up disembarking from the plane, treated like a VIP, and aided through the immigration process, which is usually the most stressful part of airport travel. I was guided to a driver sent specifically to meet me, and aided with my luggage without the expectation of pay. And, for those who know my curious nature, I was encouraged as I practiced my French and asked questions about the different neighborhoods of Conakry. To be honest, I was prepared to stay in a modest hotel for a few nights, in order to get my bearings and to find a place to live. Instead, through the generosity of others, a week-long stay in a breathtaking hotel was organized, allowing me to focus on my work rather than where I go from here.

Waiting for my luggage outside the airport.

I'm always a sucker for a bathrobe and slippers.

Course #2 (of 3) for my first meal in Conakry. Very unexpected.

And then, on Day 2 in Conakry, when I went to pull out my spare phone from my suitcase, I realized that it (along with my other high tech gear) was gone. I immediately panicked – maybe I’d just misplaced it somewhere – but eventually realized that somewhere between Paris and Conakry, a hole had craftily been made in my luggage. I was immediately struck by the contrast of the feelings of having and not having, comfort and struggle, safety and fear. 

But the amazing thing is that just hours later, I was again kindly treated. A new phone was purchased for me, I was taken around the city to run errands and see some apartments, and I was introduced to others in the field of public health who I can learn from during my time here. I was even invited to a colleague's home, treated to roasted meat and wine while attempting to crack jokes in my own version of French. 

Beef is roasted for a long time over the open flame.

It may not look like much but when mixed with spices, onions,
and a little mayonnaise, it was yummy!

Before I left, Dr. Farmer shared some advice with me about being flexible, which I'm still working on (and is perhaps the focus of another post). Today, I realize that perhaps the first lesson of my trip is genoristy because that is exactly what I have been offered. Some of us have the ability to give a lot, like a driver, a five-star hotel stay, and assistance in navigating through a new place. Some of us have our time and service to give, like organizing an impromptu gathering of like-minded folks to help a newcomer start to form a community. Regardless, just an act that may seem so simple, an act that takes only a little time and energy, can complete transform someone's experience. And, in my world of research, it's the type of gesture that can alter someone's perspective, understanding of a context, and ultimately the path that they take. 

If you asked me how I was feeling about my summer plans 72 hours ago, I was seriously wondering if I could really do it. But as I sit here looking out at the ocean, reflecting on this African experience and preparing for the upcoming week, I can say that the possibilities look a little bit brighter. 

I admit that my seafood salad may have
something to do with my current state of being...

Or maybe it's this beautiful view!

Though I have been so fortunate to be so well taken care of thus far, I haven't lost sight of my goal. I'm here in Guinea because there are perspectives that have yet to be captured or that sometimes get lost. For example, this picture I've painted of my time in Conakry may sound different from the "Africa" on yesterday's news. But I am only able to start reflecting on these experiences in the way that I am now because of the generosity of others, who have thus far offered so much and surpassed my expectations. I have little idea what the rest of this journey will look like, and to avoid disappointment or inflexibility, I don't think I'll even try to imagine. Instead, I say thank you to those who have generosity has helped me begin to settle in and open my eyes to all of this summer's possibilities. 

This, my friends, is the "Africa" I look forward to sharing more about. 

En route from the airport in one of Conakry's neighborhoods.