It's been far too long since I've updated this. After I finished my data collection in the villages in Rukwa, I quickly rolled straight into conducting the interviews with the hospital staff members and administrators, as well as with regional and district administrators. I had about one week to breathe a little bit before packing up and moving to Dar es Salaam where the race then started to finish collecting data from the National Archives and to start (and hopefully finish) transcribing more than 58 individual meetings and interviews, in addition to the over 45 recordings my research assistant and I collected during our visits to eleven different villages. I now have almost exactly three weeks left here in Tanzania.
Since moving to Dar, I have been feeling a diversity of emotions related to all of these transitions- the end of my time in the field, leaving behind beloved friends and colleagues, and, soon, reintegrating to a country and culture I haven't been a part of for nearly two years. Somewhere in there, as I try to process all of this, the words for writing about my research seem to have gotten stuck inside. I'm not going to attempt to relive the last three months since I last wrote, so you'll just have to be happy with what comes out. I will, eventually, write more about the experience of interviewing the nurses and other hospital staff because I think reflecting on that experience is an important part of thinking through not only my data, but my own subjectivity here.
I wouldn't call it writer's block, but it seems to be something else. Currently, I'm sitting in a meeting discussing Respectful Maternity Care, which has become a (relatively) new initiative or target for intervention on the part of USAID and, subsequently, is being incorporated into new programs and being evaluated where it was a part of longer-standing projects. I am awash in a stream of numbers and P values. And I'm seriously wondering why these people don't get some social scientists (OK, to be fair, I haven't surveyed the crowd on their educational backgrounds, but they all talk like public health practitioners, clinicians, and monitoring and evaluation people). This was particularly apparent when I heard, once again, a question from the meeting attendees about why women are reporting more abuse that occurred when they were at the hospital to give birth when they are interviewed at home 4 to 6 weeks after the fact as compared to when they are asked 3-6 hours after giving birth, while still in the hospital. The one person's hypothesis was that women have had more time to reflect on the events; another person's interpretation was that women are relaxed at home and they were not relaxed at the hospital. What we're missing here is an admission that women are afraid of retribution and the chance that they would receive intentionally neglectful care if they return to the same facility another time. I think some of them, particularly the Tanzanians, know this but no one was particularly saying it in the straightforward manner I was hoping for.
At our lunch break, one of the people wanted to know if I'd taken all of the health systems information from the hospital, too. She wanted to know if I'd collected all of the stats and all of the data entered into the health data system every month at the hospital. I said no, I hadn't, but I knew it was available if I needed to go back for it. She seemed a tad disappointed, exemplifying their love of quantitative data. One of the repeated refrains is that we need more information on the "contextual drivers in different environments" of abuse and needing more information on the perspectives and motivations of the health care providers, and all those working in the health care setting. And I just sat there and nodded and nodded and thought "Gee, that's exactly what my dissertation looks at; it will beautifully contextualize everything they're talking about." Now, hopefully these people present will all read some of the information I will on day eventually publish. Day 2 I did have two people talk to me enthusiastically about the work of Lynn Sibley at Emory and Stacey Langwick, the anthropologists they know.
On the other hand, I did find it very interesting to hear about some of the implementation research and I really enjoyed the time we spent discussing issues in groups. On the second day, we spent time in groups trying to design a program to address one aspect of disrespect and abuse in a fictional district in Tanzania. Interestingly, all of the groups chose independently to focus on verbal abuse. My group had some very interesting conversation and we largely agreed on many of the factors influencing the presence or use of bad language or disrespectful language by providers. What we did not necessarily come to a consensus on was what might be done to most effectively address those factors and then reduce verbal abuse. I would have been happy to sit there and discuss the nitty gritty of planning interventions for several hours based on the information I've gotten from health care providers in Rukwa. I'm hoping that, at some point, it will be possible for them to really work on addressing respectful maternity care in all of Tanzania.
I also happened to be sitting next to the President of TANA, the Tanzania nurse's association and he and I had a wonderful conversation at the end of the meeting and over lunch. I was also geeking out a little bit because I was introduced to Dr. Mbaruku whose papers I have been citing for some time. They are looking at starting a project in Rukwa and I would be so thrilled to work with them in any way on that! I also had two of the USAID, Washington DC Senior Maternal Health Advisors tell me they were very much looking forward to reading my work and seeing the results. I was trying to rep anthropology these two days and I think, maybe, it worked! It was very interesting to be in a room with such quantitative people, though I did have one public health researcher tell me that he really respects anthropologists so much because of the depth of data we are able to collect. Fuzzy feelings for anthropology ensued. Overall, I was very pleased that I sort of fell into this meeting. I was invited by someone I have been in contact with due to the Wazazi na Mwana program that was going on in Rukwa but I was sort of the only unaffiliated person present, everyone else came from organizations and head offices in DC and the Ministry of Health and the like. It was great for networking and I hope I still have more business cards that I left somewhere in the U.S…. Look for another post soon on respectful maternity care in my "From the News" section where I'll write my thoughts on the new study that came out from the World Health Organization and that was covered in the NY Times at the end of June. Next up, my presentation for USAID and CDC on August 4th before I leave. Now, I just have to figure out how to present some things that will be useful and interesting to more public health people. Wish me luck!