School of Public Health
Nepal-Nepal Nutrition Intervention Project Sarlahi (NNIPS)
A randomized trial of a food supplement given to pregnant women and through 6 months of lactation to assess the impact on infant nutritional status at birth and growth through 12 months postpartum.
PI Mentor: Joanne Katz
A few years ago, I spent a month in Ethiopia studying human-centered water engineering design. In particular, I spent some time with a small business and NGO, who in addition to their engineering staff, had anthropologists on board. The connection between technicalities of mediums and percent-filtration-levels and the marketing and community connection required to bring products to fruition was clear from this combination, and our discussions reflected that. We talked often about the iterative cycles of product envisioning, creating, testing, and discarding that occur to move a design closer and closer to one needed, wanted, and utilized by a community. We talked about how failure is a necessary part of the process: some steps will be futile and produce no results, and a good designer must be able to shrug off the failed trials and move on to new ideas. It was sometimes messy, it required humility, it required good communication, it required lots of work and willingness to persist until a design was close to perfect for the people who are going to be using it.
I certainly expected my experience in Nepal to be the opposite of this. In my mind, research was reserved for the most scientific of public health practitioners, those most adept at biostatistics and epidemiology. I “knew” it would be rigid, it would be regulated, it would be systematic and clear-cut. I was interested in research and understood its value, but I anticipated my learnings in the field with NNIPS to be purely methodological and mathematic. The team had, after all, produced research for no less than a few ground-breaking interventions that are now global policy. I was convinced the rigor required for that level of inquiry would be highly structured and very different from my more free-flowing, artistic experiences with the Ethiopian anthropologists.
What I found, however, was nearly the opposite, and I was surprised how often human-centric design thinking was required in our project. Global health research, as I quickly discovered, is a deeply context-aware and culturally tailored process. Throughout my practicum, most of my work centered on the period directly preceding research initiation. This meant that my role was to assist the team and be responsible for data collection tool refinement, data collector training, and logistics management of small details in preparing the project to begin. Interestingly, the cross-cultural and cross-community discussions required to bring these pieces together were anything but the rigid, mathematic, and clear-cut expectations I had. Developing data tools took tens and twenties of iterations as we developed the instruments in our sterile office, threw questions and revised with our field supervisor team, threw questions out and revised with our community-level data collectors, and then again threw questions out and revised once the tool was piloted in our study communities. Similarly, training data collectors began with initial designs for a two-to-three week training schedule and quickly branched to a multi-month process requiring layers and iterations of training depending on the needs and challenges of our team.
Together, this experience with NNIPS, and the marvelous team of brilliant and effective people who work in both the US and Nepal, demonstrated to me how deeply artistic and anthropological research is, in addition to being scientific and methodological. It absolutely requires cultural acumen and sensitivity. It absolutely requires failure and iterative processes of design. It absolutely requires good communication and willingness to persist until a product or tool is close to perfect to the people who are going to use it. I’m thankful for this experience that opened my eyes and made it clear all the functioning cogs necessary to study, learn, and impact the health of those around the world, and I’m thankful for finding my place in the middle of it.