Partnerships in Global Health: The Accessing Safe Deliveries in Tanzania (ASDIT) Project

December 1, 2015 Maria Wilson Leave a Comment

Zabron Abel of the TTCIH pictured on his last morning in Halifax (with snow on the cars).

By: Maria Wilson

Global Health Office Outreach Assistant

Funded by Global Affairs Canada, Canada’s International Development Research Centre (IDRC), and the Canadian Institutes of Health Research (CIHR), Dalhousie University is one of 20 teams of Canadian and African researchers, alongside African decision makers who will join forces to identify, test, and deliver life-saving interventions to secure the future of pregnant women and children.

Dalhousie University researchers are collaborating with partners from the Tanzanian Training Centre for International Health (TTCIH) and the Morgoro Regional Hospital in Tanzania. The 5-year project entitled “Accessing Safe Deliveries in Tanzania (ASDIT)” aims to improve access to, and the performance of, emergency maternal care across the country.

The team of Dalhousie University researchers is led by John LeBlanc and comprised of Doug McMillan, Heather Scott, Ron George, Marsha Campbell Yeo, Gail Tomblin Murphy and Shawna O’Hearn. The project has incredible support from Pat Rodee, Jennifer Morawiecki, and Chris Wirz with International Research and Development and Suzanne Sheffield at the Centre for Teaching and Learning.

TTCIH is a health training institution, established under a public-private partnership between the Ministry of Health and Social Welfare, the Novartis Foundation and the Swiss Tropical and Public Health Institute. The main goal of the TTCIH is to support the Tanzanian government’s national health reform policy for strengthening human resource development through providing quality health training, facilities and services.

Each month, the Global Health Office blog will be profiling one of our partners. We were fortunate enough to have Zabron Abel from TTCIH join us in Halifax for two weeks. I had the opportunity to have lunch with Zabron last week and asked him a few questions about the ASDIT project and his time in Halifax. I am including some of the information from our discussion, as well as from the launch of the ASDIT project on Monday November 23rd.

Could you briefly describe the history of the TTCIH?

TTCIH is the Tanzanian Training Centre for International Health located about eight hour drive from Dar es Salaam in a town called Ifakara. Established 50 years ago, TTCIH provides quality training programs, facilities and support services for the strengthening of human resource development in Tanzania

What is your role with the TTCIH?

I am the e-Learning and Marketing Manager which involves coordinating marketing, promoting the TTCIH and attracting new partnerships. The e-Learning part of my role includes designing, developing and delivering training using information and communications technology. We use these materials to train health workers in a variety of disciplines.

You have partnered with Dalhousie before. How would you describe your previous experience?

TTCIH has had a long-standing partnership with Dalhousie University since 2005. TTCIH believes that the driving force of success is partnership. There have been a number of successes in this partnership, including training through faculty development, microresearch, and hosting Dalhousie medical, nursing and pharmacy learners as part of their training.

Could you describe the current ASDIT project and your role within the project?

The ASDIT project is focused on maternal and newborn child health. The project aims to evaluate the scale up of a training program for emergency obstetrical and neonatal care in Tanzania. The training upgrades the skills of associate clinicians, midwives and nurses to perform emergency care. The project will explore the barriers and enabling factors to scaling up CEMONC which will assist in policy and planning at the regional and national level. My specific role is to provide post-training support and mentorship by creating e-learning resources for the health care team to use when they return to their rural clinics.

What is your favorite thing about Halifax, and Dalhousie University?

Halifax is a really cool city. The people are humble and there is not as much pressure as you see in bigger cities. As for Dalhousie University, I like the organization, faculty and programs.

Other than seeing snow (the last time Zabron visited was in the month of April so he didn’t get to experience Halifax in the winter), what are you excited for on this trip?

The TTCIH believes in partnerships, and I am excited to be able to explore more areas of partnership, and expand our current partnership with Dalhousie University.

Is there anything else you would like to add?

I would like to thank Dr. Pemba (Director of TTCIH) for his vision, and believing that partnerships are instrumental to success. He has been key in the success of both the TTCIH and myself. Dalhousie University should keep thinking of developing countries for open collaboration, partnerships, visibility and benefits for students on both sides.

Thank you to Zabron for having lunch with me (at Pete’s in the SUB – yum), participating in an interview, and for braving the cold to take a brief tour of Dalhousie upper campus.

Safe travels back to Tanzania, and hope to see you again in the future as the partnership between the TTCIH and Dalhousie University grows!

For more information on what we at the Dalhousie Global Health Office do, visit our Facebook, Twitter, Instagram or Website.

International Development Cooperation in Global Health – Global Health Rounds

November 24, 2015 Maria Wilson Leave a Comment

By: Maria Wilson

Global Health Office Outreach Assistant

November Global Health Rounds attendees.

The latest session of Global Health Rounds took place on November 18^th, 2015. Global Health Rounds is a free public lecture series, focused on highlighting and discussing the global health activities at Dalhousie, as well as contemporary global health challenges, with leaders in the field. These sessions are offered monthly and anyone is welcome (and encouraged) to attend. Speaker and location details will be posted on the Global Health Office Website, Facebook, Twitter and Instagram.

The November session was titled: “Global Health from an International Development Cooperation Perspective: A North-South Approach.” The facilitator was Manfred Egbe, a visiting PhD student-researcher from Universitat Rovira I Virgili in Tarragona, Spain. Led by Manfred, attendees (pictured above) learned about upstream approaches to improving health in rural areas of Mali.

This project is taking place in several communities in rural areas of the Koulikoro region, such as Diedougou, Kolonia and Tyékouméla. The Koulikoro region is pictured below on the map of Mali in seafoam green. Some of the many partners involved in this project include OSALDE (Association for the Right of Health) a Spanish NGO, ASACO (Community Healthcare Association), CSCOM (Community Healthcare Centre), community members and other NGOs in the region.

A map of Mali for all the geography buffs, with the Koulikoro region pictured in green.

Manfred’s role within the project has been as a project evaluator and medical anthropologist. His ethnographic portion of the study involved identifying problems and challenges in the community related to health by consulting health directors and community members. As part of this research, he conducted a range of in depth individual and group interviews using both quantitative and qualitative methods, reviewed OSALDE documents and examined WHO data. Through these methods, Manfred was able to identify a tree of problems that needed to be addressed in Mali.

The central problem was identified as high infant and adult morbidity and mortality. To gain a more in depth look, the project next asked – what are the causes of mortality and morbidity? The top three causes of death were identified as malaria, lower respiratory infections and diarrheal diseases. This is accompanied by high costs of medicine, and a shortage of medicine for treating these diseases.

Instead of stopping there, they next asked – what social, cultural and environmental conditions are leading to a high burden of disease and death? These are referred to as the upstream causes of disease. This term comes from a metaphor used in the public health approach to disease prevention. The metaphor describes a dangerous river that runs through a community. Several people have been seen floating down the river, struggling and drowning. Rescue workers try to save those in danger; however, no matter how hard they work, they do not have the resources to save all victims. A straightforward, “downstream” solution to the problem may be to hire more staff, to try to save the people who have fallen into the river. However, traveling upstream to determine why people are falling into the river in the first place may be more effective. Perhaps they need to cross the river to access a food supply, but there is no safe crossing point and they are being swept away in the process. An “upstream” approach would be to build a stable, sustainable bridge, allowing people to cross the river and preventing them from falling in the first place.

Several factors were identified as upstream causes of morbidity and mortality. Environmental factors play a role in the burden of disease in Mali, where there are essentially two seasons: wet and dry. During the wet season, there is extensive flooding, leading to breeding grounds for mosquitoes. Furthermore, extremely wet conditions favor the transmission of waterborne diseases. This is paired with poor access to health care and health services in rural areas. Through the interview process, the community identified their upstream issues as contaminated wells, droughts during dry season, women being undervalued, difficulties accessing education (particularly for women) and poor sanitation in health facilities and the community.

To address the upstream issues, OSALDE has worked with community partners to support training of nurses, improving access to clean drinking water, building capacity by increasing literacy and working to improve the status of women through education.

The project also aimed to improve access to healthcare services (including the elimination of financial barriers) and improve healthcare system quality. In the Diedougou commune this involved offering a minimum healthcare service package including clinical activities, preventive activities, obstetric activities, medico-technical activities, pharmaceutical activities and management activities. They have also improved the healthcare centre, which now has a maternity ward, surgical unit and a general practitioner’s office.

The take home message from Manfred’s presentation: there are many determinants of health. These include, but are not limited to social, economic, genetics, political, and cultural factors. Straightforward approaches such as treating disease to decrease mortality are important when undertaking projects to improve health. However, most projects undertaken in resource poor countries have a fixed term (i.e. two years, five years, etc.). If we do not take the time to address sustainable solutions to health problems, and work with community partners, improvements in health status will not last.

I will leave you with a quote I really enjoyed from Manfred’s presentation: “the platform of global health accommodates people from different disciplines.” Many different minds with many different approaches can and should come together in global health to address issues that affect us all, and arrive at a sustainable solution.

Thank you to Manfred for sharing your experiences at this month’s Global Health Rounds. There will be no Global Health Rounds in December so as to not conflict with holiday plans and exams. We look forward to seeing you in January!

Community interventions: what is mHealth, and how can it help to improve maternal and newborn child health in developing countries?

November 10, 2015 Maria Wilson Leave a Comment

By: Maria Wilson

Global Health Office Outreach Assistant

From November 5-7, 2015 Montreal hosted the Canadian Conference on Global Health. A delegation from Dalhousie participated in the many opportunities, and we will be publishing a series of blog posts from the students who attended.

Before I begin this blog post, I must disclose something to everyone reading – until November 5^th 2015, I had never heard of the term “mHealth.” In fact, if you go look at my Twitter feed from earlier this week (shameless plug @_marianicole), I improperly stylized it as “MHealth.” Somebody had already re-tweeted my tweet (thanks @QueensGlobalHealth) by the time I recognized my error, so I didn’t want to delete and correct it. Fun fact: you cannot edit a tweet.

Sure, I had (briefly) heard of using mobile technology to address global health issues in one of my classes; however, mHealth as a concept is new to me. But hey, that’s what conferences are for: learning new things and gaining new perspectives. On the off chance that you, the reader of this post (if there are any of you out there), also have no idea what mHealth is, let me attempt to enlighten you! Because hey, conferences are also for sharing ideas and information (essentially, conferences are full of benefits).

Last Thursday at the Canadian Conference on Global Health (CCGH), there was a group of oral presentations on mHealth interventions geared toward improving maternal and newborn child health (MNCH) in developing countries. For this post, I’ve tried my best to blend information from this session, along with background information from a brief literature search on the topic of mHealth to pass along one of the many useful things I learned today, to all of you (hi mom, thanks for reading).

The first question that I know is burning in your mind: WHAT DOES THE M STAND FOR?!?! I may have spoiled that earlier in this post (sorry), when I talked about mobile technology to address global health issues, because the “m” is for “mobile.” The large photo of various mobile devices at the start of this post also probably gave that away (again, sorry).

mHealth is an emerging field of global health in which mobile and wireless devices are used to generate, aggregate and disseminate health information. Around the world, mobile networks are keeping people connected daily, even in the most rural of areas. mHealth is particularly important in the context of developing countries, where cost-effective solutions are necessary to improve healthcare systems and delivery.

One of the presentations, given by Kristy Hackett, at the CCGH outlined community health workers’ (CHWs) motivation during an mHealth intervention trial to improve MNCH in Singida, Tanzania. CHWs, who have enormous potential to improve MNCH in hard-to-reach communities, were provided with either a smartphone or paper-based protocols to use in household visits. The smartphone used an application that would guide and support CHWs throughout each visit with prompting questions, tools to help calculate important indicators such as gestational age, and help them decide if a clinical referral was necessary. Findings from qualitative interviews indicated that mobile phones initially incentivized and simplified the CHWs’ work, but difficulties arose with charging and airtime. The study findings highlight the need to continue to refine and improve mHealth approaches in order to move toward more efficient health delivery and better health outcomes.

Some of the many other applications of mHealth include reminding patients to take medications through notification systems and conducting disease surveillance. The 2015 mHealth Summit is currently underway in Washington DC (November 8-11). You can check out their website here: http://www.mhealthsummit.org/.

Look for more blog posts from Dalhousie delegates at the 2015 CCGH over the next few weeks. As always, for more information on the Global Health Office you can check our Twitter, Facebook and Website. We have also recently started an Instagram account, and I am going to shamelessly and directly ask (beg) you to follow us because (a) we have been and will be posting some really awesome pictures and (b) we currently only have 13 followers, which is an increase of 225% since Thursday when we only had 4. Happy Tuesday everyone!

Global Outreach Course: Anesthesia in Challenging Environments

June 9, 2011 jf255033 10 Comments

by Abena A-Tuffour from the Global Health Office of Anesthesia

Try and learn the language. Aim for quality over quantity. Be prepared to ‘look a fool’. These are a few of the lessons Dr. Sarah Hodges has learned while working in Uganda. Dr. Hodges, a UK-trained anesthesiologist, presented at the 2011 Anesthesia in Challenging Environments Global Outreach Course for the first time. Her presentation aimed to stimulate discussion about why people want to work abroad and how best to approach such missions.

So was the nature of the course: honest, social and packed with demonstrations and practical advice on practicing and teaching anesthesia in challenging environments.

The four-day course, held May 21 – 25, brought together 25 presenters and 35 participants from the UK, the US, Uganda, Indonesia, New Zealand and Canada. One repeat participant and presenter described some of the presentations as “a wake-up call.” Lauren Zolpys, a 2nd year Dalhousie Anesthesia resident appreciated the insight and examples given that could not be found in a textbook. “The best part has been the practical knowledge shared.”

Dr. Tom Coonan, Dalhousie University Department of Anesthesia, heads the Anesthesia in Challenging Environments Global Outreach Course. His efforts and those of the course organizing committee, the Department of Anesthesia’s Office of Education and the Global Health Office of Anesthesia, resulted in a course that some presenters and repeat participants described as “the best so far.”

Archives for Research

From November 5-7, 2015 Montreal hosted the Canadian Conference on Global Health. A delegation from Dalhousie participated in the many opportunities, and we will be publishing a series of blog posts from the students who attended.