Return to the Field, January 2018

It has long been my belief that sharing results and information with research participants is of the utmost importance. Working in a place like Tanzania, this is not always a simple task and it can easily be left undone. Through my joint degree with the University of Amsterdam (UvA), I received funds to print about 100 copies of my dissertation in bound book form. I decided, on the suggestion of one of the staff members at the UvA, to use a Tanzanian press, Mkuki na Nyota, for the layout and printing of the book. While I had most of the copies sent to Amsterdam in advance of my defense, held in April 2017, I requested that 25 copies remain in Tanzania with Mkuki na Nyota so that I could distribute them in-country to those who supported my research or might be interested in my findings. 

Last week I was able to return to Sumbawanga for the first time since the completion of my dissertation. I took with me several copies of the dissertation to distribute and need to send along several more. Though there has been nearly complete staff turnover on the maternity ward, the remaining few nurses who were there on the ward in 2014 and 2015, were happy to see the resulting book. One copy stayed behind on the ward for the nurses and any other passers-through. The hospital now is hosting medical students from a medical training college in a neighboring region and several of them were also interested in copies. As I watched one of the nurses carefully reading through one of the pages, she looked up, laughed, and told me to stop looking at her. I laughed and responded, "But when you're reading, it's like you're looking at me!" I felt exposed on the page in front of her. Dismayed at not recognizing any of the names in the book, she also asked me where she was. I told her her name was changed so that no one would come after her for the things she had told me. She nodded but said she would have been happy to see her name there. Balancing recognition and anonymity and protection is a hefty task. 

Throughout the writing of my dissertation and, now, articles about that work, I strive to leave the reader with a balanced impression of the hospital and its staff members--critical but compassionate. Watching those who gave so generously of their time, by participating in my research and allowing me to work alongside them, read what I wrote about them and their work environment made me feel supremely vulnerable. But, one of the doctors reassured me and, with an ironic laugh, said, "OK, it might be critical but, it's the truth!" Hopefully, in the end, there are some insights that resonate and a picture that reflects not just a particular moment in the hospital's past, but some of the possibilities for its future. 

Due new appointments in the wake of Tanzania's 2015 presidential election and retirements, much of the Rukwa region's administration has also changed. I introduced myself to some of these new people including the Regional Commissioner, the Regional Administrative Secretary, and the Regional Medical Officer, presenting them all with copies of the dissertation. My hope is that the books don't just go to sit in a filing cabinet somewhere but might help the region's new leaders learn something about the region's past (even if the way past of the colonial era reflected in the archival record) or that they gain some tidbits that might be useful to them. Most of all, this was an effort to demonstrate my gratitude and recognition of the support and help the region has given me. Not to be overly sentimental but, they have, in effect, given me my degree and my profession, which is no small thing. 

Putting Qualitative Research to Work

I have been continuing with my visits to a number of villages throughout the Rukwa region since the middle of February. Most recently, I was able to meet with one of the District Medical Officers and, in addition to getting his insight on the challenges he faces in his job, I was able to share with him some insight from my research. He was very receptive to some of my suggestions and asked me to help him design some questions that can be used with women and their partners in the communities to gauge the quality of education and counseling being given at prenatal clinic visits. He told me he has never done qualitative research, though he has a Masters in Public Health, and is familiar with other research methods. He also asked me to please read his thesis on low facility delivery rates in his district and offer some suggestions on how to design a qualitative study to partner with the numbers. I am very excited that he showed interest in expanding his skill set and I am more than excited to have the opportunity to teach some qualitative methods to people! There is definitely a lack of solid, well-designed qualitative research informing these health policies and programs. Some interventions seem to be so off the mark because they are designed in national or international offices far removed from the daily reality of the areas in which they are to be implemented. I'm also hoping to have a chance to work with the Wazazi na Mwana project as they finish up their end of project reports and start writing grants for future projects. I have already been asked by the country project director to contribute some of my insight from the hospital setting as a complement to their work in the villages.  

Community Discussions on Reproductive Health and Safe Motherhood

This past week I have started my first trips to villages outside of Sumbawanga Town. Through focus group discussions, led with the help of my research assistant, we learned an enormous amount about the needs of the community related to health care services and, particularly, health education. Additionally, we gained a great deal of insight into the relations between men and women and the ways in which these relations may be inhibiting male participation in reproductive health care services.

In addition to listening to the community members, we answered many questions concerning giving birth at the regional hospital, family planning, HIV testing, and community participation in health care services. We responded to concerns by parents related to what they view as problematic early pregnancies and the behavior of their teenage children that seem to be leading to these early pregnancies. We discussed with the Village Chairman about the dangers of childhood pregnancy and marriage for girls and some possible ways for managing these issues within his community.

In partnership with the health care providers at the village dispensary, I am now helping them to plan a health education seminar for the village's young people, as well as some health seminars for women together with their husbands. Women told us men were reluctant to go with them to the prenatal clinic, which has been widely emphasized by the government, and women said their husbands accuse them of lying about the information they are receiving at the clinic. By brainstorming some new methods of delivering health education within the community based on their current needs and interests, I have high hopes we may continue to increase men's willingness to participate in these important services and to support their wives, daughters, and daughter-in-laws. I'm also working with the District Medical Office to give them feedback from our meetings and to encourage them to more effectively communicate with and support the dispensary and the efforts of the health care providers in this village.

The boat is successfully being put to work!

As of the beginning of January 2014, the boat has been delivered to the villages along the shores of Lake Rukwa. On January 2, 2014 there was an official handing over ceremony convened by the Rukwa Region's Regional Commissioner. On March 15, 2014 I went to Mtowisa Health Center for a celebration of White Ribbon Day, which commemorates those women who have died due to pregnancy related causes as well as to advocate for increased efforts to reduce maternal mortality. This year, Tanzania's Minister of Health and Social Welfare was present at the ceremony as were a number of heads of party or country directors from a variety of non-governmental organizations working on issues of maternal and reproductive health care in Tanzania. I was asked to speak for a couple minutes about the boat and what purpose it will serve. I was warmly welcomed by the local community as well as district and regional officials, and the Minister of Health himself. It is my hope that this boat project will pave the way for further collaboration with these organizations and people in the Rukwa Region in the future.

Less than a week after White Ribbon Day, I was able to return to Mtowisa and see the boat in action. I traveled with the Assistant District Medical Officer and two other health workers to a village on the far shore of Lake Rukwa where there is a suspected measles outbreak. The children in the village have never received vaccines and many of the children, and some adults, have contracted measles. We went to collect blood samples to take to Dar es Salaam for testing to confirm an outbreak. The boat will also be used to bring much needed vaccines to the community in the near future.

The boat and lifejackets!

Rukwa Partnership for Health Boat Project

Since September 2012, I have been working with University United Methodist Church in St. Louis, MO, USA to raise funds to purchase a boat that will serve as emergency transport to health care services for five villages on the shores of Lake Rukwa in the Rukwa Region of Tanzania.  Currently, these villages have no direct routes of access to the nearest health care centers.  They are only able to access these centers via a dirt road.  Oftentimes the road conditions are poor and the communities are unable to coordinate vehicles or patients and their families are unable to collect the necessary cash to pay for such services.  This boat will be turned over to the District Medical Office of the Sumbawanga Urban District and will be used for transporting pregnant women and patients with health emergencies to care. By going across the lake, instead of around, the boat will cut crucial hours from these people's journey to potentially life saving health care services.

We are proud to announce that as of mid-July 2013 we have surpassed our $10,000 goal and have raised $11,224 for the purchase of a fiberglass boat, made in Tanzania (in Dar es Salaam), a motor, and six life jackets.  

 (This is not the boat that was purchased. I do not have a photo available, at this point in time, but will be tracking it down upon my return to Tanzania in January 2014.)