Adrienne Strong

Medical anthropology, maternal mortality, hospital ethnography, and dignity in women's health care

I am a medical anthropologist with a joint Ph.D. from Washington University in St. Louis, USA and the Universiteit van Amsterdam in the Netherlands. I study maternal mortality and women's health in Tanzania, currently in the Kigoma region on a birth companionship program and the notions of ideal comfort, care, and support for pregnant women in labor. I am a National Science Foundation Postdoctoral Research Fellow with Columbia University's Mailman School of Health, in the Averting Maternal Death and Disability (AMDD) Program in the Heilbrunn Department of Population and Family Health. 

I worked in the Rukwa Region for my dissertation fieldwork, which I conducted from January 2014- August 2015. From September 2010 through July 2011, I conducted research on access to healthcare services during pregnancy, birth, and the postpartum period in the Singida Region of Tanzania. My doctoral dissertation project focused on the inner workings of a government regional referral hospital, examining how institutional structures related to hierarchy, bureaucracy, historical precedents, communication and other factors, may influence the capacity of the institution to provide effective maternal healthcare during times of obstetric crisis. My research focused on biomedical healthcare providers and administrators, groups that are often overlooked in the context of medical anthropology in sub-Saharan Africa. I contextualize the hospital ethnography with interviews, participant observation, and focus group discussions in communities throughout the region, as well as through the use of primary archival sources from the colonial and post-independence eras. 

This is my personal website, which includes updates on my research, collaborations, conference presentations and papers, publications, teaching, and critical responses to current events related to women's health and reproduction.  

Mentions and Public Anthropology

Paper Prize

Washington University Feature

Feature on Anthropology Department Website

Research Report on Global Health Hub

Photoessay on SAPIENS.org 

Mention on Anthrodendum

Mention on Anthrodendum for fieldwork blog

 

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!

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.)

 (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.)

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