The objective of this internship is to give the selected interns field experience in implementing and documenting malaria related interventions at health facility and community levels in the Stop Malaria Project (SMP) districts. The interns will have an opportunity to work with Technical, Community Mobilization and Communication and M &E teams from both the strategic and operational level which will enable them to also understand the synergies within the project and the other programs in the country. The interns will acquire an overall understanding of the national malaria policies and the role of SMP as a project designed to support the MOH to achieve the set targets for addressing malaria morbidity and mortality. They will obtain practical field experience by participating in a range of interventions which include re orientation meetings for health workers in the various malaria technical areas, Communication and distribution of IPTp commodities and IEC materials; supporting community Radio listening group; guiding the malaria interventions in schools;, monitoring and evaluation and Operational Research including Cost analysis of the interventions. Specifically the interns will participate in Operational Research on Effectiveness of SMS and Community out- reach activities for increasing IPTp 2 Uptake, consistent use of LLIN for malaria prevention and Laboratory and RDT confirmation diagnosis prior to malaria treatment. The Interns will also participate in the Health Facility Assessment. Cost data on various technical interventions and target audiences will be shared with the interns for analysis to find out their cost effectiveness. A comprehensive report including recommendations will be made by the interns at the end of the assignment.

Personal Narrative

Preceptor Organization: Stop Malaria Project, Center for Communication Programs (CCP)

Placement Location: Kampala, Uganda

Intern: Hsin-yi Lee

            Upon my arrival in Kampala, the capital city of Uganda and the city I was to call home for the next six months, I was amazed how comfortable the weather was. I left Baltimore when it was blazing hot; I was expecting this East African country to greet me with similar manners. Located on the equator and an elevated plateau, Uganda enjoys stable and warm temperature throughout the year with just the dry and wet season alternating year round. The next thing I came to learn about the weather was that it was perfect for breeding mosquitoes and that whenever rain came down, all human activities were disrupted.

            These two facts played a surprisingly big role in the project I was working on – Stop Malaria Project. Our project was about the prevention and treatment of malaria, a disease spread by female mosquitoes at night. One of the behaviors the project was promoting through billboards, radio spots and talk shows, as well as interpersonal communications channels, was the importance for pregnant women to attend antenatal care timely to receive two doses of anti-malarial pills. According to health providers and the facilities, the antenatal attendance is high during the dry season. When the wet season hits, numbers drop immediately. A huge proportion of women walk for one to two hours to go to facilities. Others hire motorcycles and take public transport. Very few of them have the privilege to take private vehicles. When it rains, those who walk or take motorcycles are stuck at home, failing to attend antenatal care. When we plan for field visits involving community mobilization activities, we hope for a sunny day. If it rains, community members stay put and rush into their gardens to plow after the rainfall. Nearly no one shows up for the “not-so-important-session about another project working in the village” when they have crops to attend to. Rain is also a culturally accepted and widely used excuse for being late for meetings. So is horrible Kampala downtown traffic jams.

            This is just one of the many things I’ve learned about how something I regarded as petty can be a major factor influencing the outcome of a health program. Some of the factors is hard to change, like rain, but if taken into consideration, can avoid misunderstanding with locals and community members.

            Another eye-opening experience in Uganda was seeing people talking on cell phones in remote villages. They may live in mud huts and still need to walk five miles to find clean water. They sure do keep a Nokia handy. Not only did businesses see the opportunity of the technology leap occurring in developing countries around the world, health projects are also trying to carve a new generation of interventions based on mobile technology. I had the opportunity to participate in the development and implementation of a pilot SMS (Short Message Service) campaign for pregnant women. The first lesson I learned about a campaign like this was that if you wanted to send text messages to a women, you have to talk to the men first. I was awed at the responses men in the village gave us when we first introduced the concept, “How do we know the messages are sent by the project and not by my wife’s secret lover?” they exclaimed. To alleviate their doubts, we assured them that we will also send the same message to their phones (if provided) and that they are able to call back to confirm. Later on, it proved that a good level of male involvement had really positive impact on the program. One of the pregnant women’s husband told us “receiving the message also made me responsible for my wife’s pregnancy.” The men may be harder to convince at the beginning, but once they are involved, they go an extra mile to protect their wife. As a popular Nokia ad goes “we call this human technology,” in health campaigns relying on technology, I would say two-thirds of the success depends on the human factor. Accessibility of the technology, cultural acceptance, social structure and norms are all part of the human factor. The experience with the SMS campaign also opened up my interest for mhealth or mobile health¸ especially for the potential it has in low-resource settings.

            Understanding the cultural and social environment in the work place as well as in the community was an important part of my placement experience. Being the very few East Asians in the country, I had no trouble catching attention of the local people and striking up a conversation. It is through the many conversations, questions and home visits that I came to learn about the Ugandan’s way of living. The community mobilizing specialist at the office gave me a very simple yet useful tip to approaching community members, “Always accept the chair or seating place offered to you. Don’t judge.” I also devised a small tip of myself for blending in and gaining acceptance from fellow Ugandans: always accept the food you are offered and praise the food.

            I hesitate to crown the name “global health” for the project I was working on. To the Ugandans, it is their “national health.” Over the course of my stay, two of my colleagues have taken sick days off because of malaria. My boda-boda (motorcycle) driver disappeared for a week and later told me he caught malaria.  What I see working on the project and in the field, was that while the disease may be global and the eradication of global concern, the problems faced by the people is what is happening in their everyday life. While state-of-the-art health and medical advances are not to be over passed, to solve problems of everyday life, we may just need a little bit more of everyday solutions – such as understanding people’s behavior when it rains or sending a text message.