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23 July 2018 -
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Daily Reflections
23 July 2018
Today we visited the ZiCHIRe campus. There we met some of the people who run the program, such as the infamous Rachel, as well as recEIved some cultural lessons. Dudu provided lessons on the Ndebele culture, and unfortunately Nori, wHo would provide lessons on the Shone culture, was unable to make it due to a sick baby. Learning about the Ndebele culture was fascinating and extremely relieving for me in many regards, but mostly the fundamental kindness engrained into every value was what I loved. The selflessness, humility, hospitality, and honesty engrained in the culture is fascinating coming from my American perspective, as there (especially now) is so much hate and selfishness around us at home. Learning how to show respect in the Ndebele culture was also fascinating, for example, receiving gifts with two hands or grabbing your elbow and curtsying when you give a handshake. The role of music within the Ndebele culture is exciting for me as well, as I grew up learning music, but I've always wanted to experience music being a part of my everyday life as an expression of life and emotion! Although I could have created that environment, American culture doesn't welcome music in the same way the Ndebele people do. This makes me really excited about visiting Matabeleland.
Not only did Dudu teach us about the culture, but she also taught us some basic Ndebele. This language is the most impressive and intriguing language I have ever heard. The clicks incorporated into the language are entrancing, but of course they are also extremely difficult for my tongue to even attempt creating. My brain has not worked that hard in a long time, and I'm super excited to practice with the other Zim 2.0s at breakfast.
Additionally, some employees from the US Embassy in Harare also came to visit and talked about Zimbabwean culture which we should know as visitors, as well as things that may be shocking to Americans. The Zimbabwean people are not PC, which was mainly pointed out in regards to being described by race as well as being assumed your perceived gender and being heterosexual. This I had expected. Important facts about visiting rural villages were provided as well and were interesting to hear. In many of the villages we visit, people haven't met an American or seen people like us, meaning we will be receiving a lot of questions and hair touching. Additionally, which I find fascinating, there is an idea among children about favoritism, that if one person gets a hug but another doesn't, it means that one is better than the other. This is especially important with gift giving, as everyone must receive the same amount.
Overall, today was extremely fascinating and a great foundation for the trip. Excited for the days to come!
Not only did Dudu teach us about the culture, but she also taught us some basic Ndebele. This language is the most impressive and intriguing language I have ever heard. The clicks incorporated into the language are entrancing, but of course they are also extremely difficult for my tongue to even attempt creating. My brain has not worked that hard in a long time, and I'm super excited to practice with the other Zim 2.0s at breakfast.
Additionally, some employees from the US Embassy in Harare also came to visit and talked about Zimbabwean culture which we should know as visitors, as well as things that may be shocking to Americans. The Zimbabwean people are not PC, which was mainly pointed out in regards to being described by race as well as being assumed your perceived gender and being heterosexual. This I had expected. Important facts about visiting rural villages were provided as well and were interesting to hear. In many of the villages we visit, people haven't met an American or seen people like us, meaning we will be receiving a lot of questions and hair touching. Additionally, which I find fascinating, there is an idea among children about favoritism, that if one person gets a hug but another doesn't, it means that one is better than the other. This is especially important with gift giving, as everyone must receive the same amount.
Overall, today was extremely fascinating and a great foundation for the trip. Excited for the days to come!
24 July 2018
This morning we had a lecture at Shilo from Thoko, a nurse with ZiCHIRe. She discussed VMMC, a circumcision program for men in Zimbabwe. There were a lot of overlaps with information we learned in the HIV/AIDS class, but also some new information. Going over the HIV/AIDS information again was also beneficial. Some things that were especially interesting and new to me were that reaching the 1.3 million mark for circumcised men has meant 212,000 infections averted as well as 13 billion dollars in financial savings. Another interesting thing she discussed is the shift in view of male circumcision. Previously, if a male were circumcised, ,people would laugh; it would be embarrassing. Now, if a male is not circumcised, people look at them funny and concerningly
talk about why they aren't circumcised and how irresponsible it is. The cultural perspective is shifting! Something that Nori also touched on in our discussion after the lecture was why churches don't support male circumcision. This is not true: churches support male circumcision, but fear that in their advocation of it, individuals would take it as an encouragement for promiscuity. This point of view was really interesting to hear, and highlights how complex beliefs within Zimbabwe reside.
After lunch, we went to the Harare Central Hospital and spoke with Dr. Nyasha Masuka, the CEO of the Hospital. The Harare Central Hospital is the largest hospital in all of Zimbabwe, and doesn't turn anyone away form care. This, along with them not charging pregnant women any hospital bills, is incredible especially due to the low funding, staff and resources at every hospital. Despite it putting the hospital in debt, they still value this care as a moral obligation; the United States would charge thousands for pregnant a woman's hospital stay after and during labor.
It was incredible that we were able to talk to and receive a tour from the CEO of the hospital; this would never happen in the United States, and it made me feel incredibly special and grateful. I really appreciated how honest Dr. Masuka was as well; he told us the bitter truth about the hospital system. Seeing the hospital was also an amazing experience. We visited the maternity ward, renal unit, and adult ICU. My favorite was the maternity ward. Seeing so many babies in one room was incredible, and watching mothers provide kangaroo care to their premature babies was also amazing.
One thing I did notice in the hospital was that is was entirely paper-based. I remembered reading that in one of our pre-departure readings, but it was still crazy to see in person. I asked Dr. Masuka about this after our tour, and he said that they are working to move to a digital system. Currently though, when a patient is discharged, they receive a brown card that has all their medical information from their stay. This card they are supposed to keep themselves to add to their entire medical record. It is the individuals responsibility to bring their cards when they go to the hospital. However, of course, they get destroyed, individuals forget them, etc. Learning about this information system was very interesting, especially because everything is digitized in the western world in regards to medical data and records.
Addition: In the hospital, we spoke with some nurses. They said that one of the hardest things about their job was that many times they would know exactly what they need to do to save a life, but they don't have enough machines or resources to do so. This loss of life due to their limited resources was difficult to hear.
talk about why they aren't circumcised and how irresponsible it is. The cultural perspective is shifting! Something that Nori also touched on in our discussion after the lecture was why churches don't support male circumcision. This is not true: churches support male circumcision, but fear that in their advocation of it, individuals would take it as an encouragement for promiscuity. This point of view was really interesting to hear, and highlights how complex beliefs within Zimbabwe reside.
After lunch, we went to the Harare Central Hospital and spoke with Dr. Nyasha Masuka, the CEO of the Hospital. The Harare Central Hospital is the largest hospital in all of Zimbabwe, and doesn't turn anyone away form care. This, along with them not charging pregnant women any hospital bills, is incredible especially due to the low funding, staff and resources at every hospital. Despite it putting the hospital in debt, they still value this care as a moral obligation; the United States would charge thousands for pregnant a woman's hospital stay after and during labor.
It was incredible that we were able to talk to and receive a tour from the CEO of the hospital; this would never happen in the United States, and it made me feel incredibly special and grateful. I really appreciated how honest Dr. Masuka was as well; he told us the bitter truth about the hospital system. Seeing the hospital was also an amazing experience. We visited the maternity ward, renal unit, and adult ICU. My favorite was the maternity ward. Seeing so many babies in one room was incredible, and watching mothers provide kangaroo care to their premature babies was also amazing.
One thing I did notice in the hospital was that is was entirely paper-based. I remembered reading that in one of our pre-departure readings, but it was still crazy to see in person. I asked Dr. Masuka about this after our tour, and he said that they are working to move to a digital system. Currently though, when a patient is discharged, they receive a brown card that has all their medical information from their stay. This card they are supposed to keep themselves to add to their entire medical record. It is the individuals responsibility to bring their cards when they go to the hospital. However, of course, they get destroyed, individuals forget them, etc. Learning about this information system was very interesting, especially because everything is digitized in the western world in regards to medical data and records.
Addition: In the hospital, we spoke with some nurses. They said that one of the hardest things about their job was that many times they would know exactly what they need to do to save a life, but they don't have enough machines or resources to do so. This loss of life due to their limited resources was difficult to hear.
25 July 2018
Today we went to the University of Zimbabwe, College of Health Sciences. First, we received a lecture from Thoko on the Research Support Center and Research Infrastructure. This research office is relatively new, beginning in 2010 and has managed 21 grants and fellowships as of 2017. Some of the challenges the RSC faces include having older researchers who will be retiring soon, and therefore need to obtain younger individuals for research support. This office is a research management office, therefore there are many individuals who apply and present their research proposals for research support. The challenge of limited funding makes this selection process competitive, as they can only support so many projects.
Next, we had a lecture from Gift on medical (doctor) student training in Zimbabwe. This lecture was the most interesting to me from the day, as well as the most surprising. The training program is extremely extensive, spanning five years of school and two years of internship. The level and quality of education provided was surprising to me given the resources and funding of the school. I have been continually surprised by the level of education provided in Zimbabwe as a whole, and how valued education is by the Zimbabweans. Abby said that the literacy rate of Zimbabwe was the highest in the world in the 1980s. I am now curious as to how much the quality of education differs between the urban and rural areas.
Not only was learning about the quality and extensiveness of the education for medical professionals in Zimbabwe interesting, but so was the story of these professionals after school. Many doctors leave Zimbabwe for better conditions and salaries. Conditions and moral are low in hospitals due to under funding, resources, and staff. The exitus of staff doesn't help this problem. There are also huge disparities in doctor placement; many reside in Harare, as there aren't the incentives for doctors to move to other areas in Zimbabwe.
Some other interesting points Gift talked about were that there is not enough capacity in the school fro the demand, and therefore there are many students leaving Zimbabwe to pursue a medial degree somewhere else such as China, Ukraine and Russia. However, the schools there are sub-par and therefore Zimbabwe has had to put in place a doctors practicing test to ensure that returning students are actually qualifies to practice. Additionally, Gift spoke about the low resources of the medical field and how they have to teach students how to save money and use less resources but still provide quality care. This requires taking a long history and short labs, whereas in the United States, people take short histories and long labs. I think the US could learn a lot about resource efficiency from Zimbabwe.
Finally, we had a lecture from Clara Haruzirishe on the Health Care Delivery System and the Education of Nurses in Zimbabwe. Here, she reiterated a lot of the information we had read and learned about previously on the Zimbabwe Health Care System; four levels, Primary Health Care Model, Disease Burden, and challenges. The challenges of the health system, in regards to human resources, tends to place a lot on the nurses, such as the job of a doctor. Training of nurses therefore incentivizes nurses to stay in Zimbabwe, specifically through subsidized housing, etc -- could they try this with doctors?
Next, we had a lecture from Gift on medical (doctor) student training in Zimbabwe. This lecture was the most interesting to me from the day, as well as the most surprising. The training program is extremely extensive, spanning five years of school and two years of internship. The level and quality of education provided was surprising to me given the resources and funding of the school. I have been continually surprised by the level of education provided in Zimbabwe as a whole, and how valued education is by the Zimbabweans. Abby said that the literacy rate of Zimbabwe was the highest in the world in the 1980s. I am now curious as to how much the quality of education differs between the urban and rural areas.
Not only was learning about the quality and extensiveness of the education for medical professionals in Zimbabwe interesting, but so was the story of these professionals after school. Many doctors leave Zimbabwe for better conditions and salaries. Conditions and moral are low in hospitals due to under funding, resources, and staff. The exitus of staff doesn't help this problem. There are also huge disparities in doctor placement; many reside in Harare, as there aren't the incentives for doctors to move to other areas in Zimbabwe.
Some other interesting points Gift talked about were that there is not enough capacity in the school fro the demand, and therefore there are many students leaving Zimbabwe to pursue a medial degree somewhere else such as China, Ukraine and Russia. However, the schools there are sub-par and therefore Zimbabwe has had to put in place a doctors practicing test to ensure that returning students are actually qualifies to practice. Additionally, Gift spoke about the low resources of the medical field and how they have to teach students how to save money and use less resources but still provide quality care. This requires taking a long history and short labs, whereas in the United States, people take short histories and long labs. I think the US could learn a lot about resource efficiency from Zimbabwe.
Finally, we had a lecture from Clara Haruzirishe on the Health Care Delivery System and the Education of Nurses in Zimbabwe. Here, she reiterated a lot of the information we had read and learned about previously on the Zimbabwe Health Care System; four levels, Primary Health Care Model, Disease Burden, and challenges. The challenges of the health system, in regards to human resources, tends to place a lot on the nurses, such as the job of a doctor. Training of nurses therefore incentivizes nurses to stay in Zimbabwe, specifically through subsidized housing, etc -- could they try this with doctors?
26 July 2018
Today we went back to the University of Zimbabwe to receive a lecture on FETP: Field Epidemiology Training Program. Through this program, students receive six months of in-class training, and 18 months of field training. The University provides the academics, however the University of Zimbabwe maintains a close partnership with the Ministry of Health which provides better communication and collaboration of research based policy change. This is what makes Zimbabwe's FETP so successful and unique; most programs are just investigation based, instead of integration based. The Zimbabwe FETP is one of eight current globally accredited FETPs -- this has continues my surprise of education level in Zimbabwe. Even though I become more and more aware of this, the westernized perception of Africa as a whole in regards to education as poor keeps to the back of my mind, despite my previous and current understanding that this is not true and that western teachings are consistently false and stereotyped. I regret the presence of that engrained ideology, and am working to overcome it and my western ignorance.
Many of the studies resulting from the FETP are published and presented upon (some of which we will be hearing tomorrow!). Many countries look to attend these presentations, as they are looking to see how Zimbabwe is so successful (such as Rwanda, Zambia, and Nigeria). Of course one of the main challenges for this program is funding, but also accommodations for students, transportation, and laboratory in the field.
During lunch we received a lecture from Walter, a ZiCHIRe employee, on the ZiCHIRe behavior change programs. These programs take place in the Mashonaland East Province, and the Harare Province. There were more programs in place than I expected, many of which are interconnected and therefore result in positive effects across the board; one success helps another success. The two programs I found most interesting were the Sista2Sista and Brotha2Brotha programs. The S2S program targets vulnerable young women and increase their self-efficacy and connect them to programs which can help them further. The B2B program targets young men and teaches them how to be responsible. This is in regards to how they treat women, teaching them to share the housework with their sisters and wives, instilling that a woman's education should be placed about marriage and starting a family. Incentive to reach the boys is through soccer and providing soccer legends at meetings. The hope is that this intervention will aide in future gender based violence and reduce the burden placed on women and girls in the household.
There are so many great programs ZiCHIRe has implemented, however they only reach so far. With only serving two provinces in Zimbabwe, they are missing a large portion of the country. However, reaching the rest of the Zimbabwean population requires more funding.
Finally, today we travelled to Lake Chivero to attend the quarterly review for many programs. Although we arrived late and only saw part of the last presentation, it was really cool to see this meeting in action. Afterwards, we walked (I crutches) around to lake which was incredibly beautiful. I'm excited to head back there for the bird watching!
Addition: The most shocking thing I learned today was the story of a Sista2Sista girl. She was raped by her stepfather consistently with the help of her mother; the stepfather would pay the mother ten dollars every time he raped the daughter. Eventually, the mother would be asking for him to rape her child.
Many of the studies resulting from the FETP are published and presented upon (some of which we will be hearing tomorrow!). Many countries look to attend these presentations, as they are looking to see how Zimbabwe is so successful (such as Rwanda, Zambia, and Nigeria). Of course one of the main challenges for this program is funding, but also accommodations for students, transportation, and laboratory in the field.
During lunch we received a lecture from Walter, a ZiCHIRe employee, on the ZiCHIRe behavior change programs. These programs take place in the Mashonaland East Province, and the Harare Province. There were more programs in place than I expected, many of which are interconnected and therefore result in positive effects across the board; one success helps another success. The two programs I found most interesting were the Sista2Sista and Brotha2Brotha programs. The S2S program targets vulnerable young women and increase their self-efficacy and connect them to programs which can help them further. The B2B program targets young men and teaches them how to be responsible. This is in regards to how they treat women, teaching them to share the housework with their sisters and wives, instilling that a woman's education should be placed about marriage and starting a family. Incentive to reach the boys is through soccer and providing soccer legends at meetings. The hope is that this intervention will aide in future gender based violence and reduce the burden placed on women and girls in the household.
There are so many great programs ZiCHIRe has implemented, however they only reach so far. With only serving two provinces in Zimbabwe, they are missing a large portion of the country. However, reaching the rest of the Zimbabwean population requires more funding.
Finally, today we travelled to Lake Chivero to attend the quarterly review for many programs. Although we arrived late and only saw part of the last presentation, it was really cool to see this meeting in action. Afterwards, we walked (I crutches) around to lake which was incredibly beautiful. I'm excited to head back there for the bird watching!
Addition: The most shocking thing I learned today was the story of a Sista2Sista girl. She was raped by her stepfather consistently with the help of her mother; the stepfather would pay the mother ten dollars every time he raped the daughter. Eventually, the mother would be asking for him to rape her child.
27 July 2018
This morning we went to the Ministry of Health for the monthly meeting for the current FETPs. We listened to seven presentations of FETP students work around Zimbabwe. I have become very confused on my opinion of this meeting -- I'm having trouble determining how I feel. Entering the presentations, I had very high expectations, not only for the material quality but also the quality of the presentation itself. However, the professors were very very blunt about the content quality, giving great feedback, which is wonderful for the development of the student, but reduced my confidence in the material presented. I am not an expert in the field of epidemiology or in what they were researching, so my perspective may be skewed easily. Additionally, there are students, and they are supposed to make mistakes -- that's why they have these monthly meetings and supervisors: so they can make mistakes and be corrected quickly. This was not in my mind entering the meeting, which I think is why I had unrealistic expectations.
In terms of the quality of the presentations themselves, I also expected higher quality. However, now that I've been thinking about it, I think that there may (possibly) be a difference in opinion of what a "good" presentation is. In my opinion, a good presentation is fluid, the presenter doesn't use notes (or at least doesn't read directly from their notes), the presenter doesn't read from the slides, looks at their audience, talks a normal speed, and slides are easily followed and don't contain a lot of words. Overall, a presentation should be engaging. However, what engages me may not be what engages the Zimbabweans.
Overall, I believe this meeting was important to see. I definitely think these students are learning a lot and they are definitely held accountable for their work. I can see why the program is accredited, and I definitely don't think it's my place to judge the quality of the presentations. That was solely a position which I could not form an opinion due to uncertainty on differences between my and Zimbabwean educated opinions on a "good" presentation. This meeting did cause me to wonder about the Zimbabwean education system and understanding the differences in teachings between here and the US. We have been taught the Zimbawean education is amazing, but what does amazing mean? Something to ask.
After the meeting we had lunch at the Ministry and I spoke with a FETP student named Paul. This was the first time I've been asked in depth about why I'm here, and it was a super fun and engaging conversation for me. I also asked Paul about the digitization of information systems, and he said they have begun to transfer medical records. However, there are a lot of challenges in regards to utilization of technology, especially due to spotty electricity. Through the presentations as well there were a lot of problems that arose due to the paper-based information system, specifically with the reporting of diseases and illnesses. This was very interesting to hear and talk about.
Something somewhat shocking for me about the Ministry of Health was the state of the building. The bathroom toilets didn't have toilet seats or toilet paper, one stall didn't have a door. The building also, like many others I've seen such as the hospital, are very run down. It is obvious that every cent of funding goes into the health care system and not into infrastructure.
Finally today we went to the Avondale Flea Market which I am definitely returning to and buying a painting -- they were incredibly beautiful. Tonight we're hanging a barbecue and watching the (full) lunar eclipse!
In terms of the quality of the presentations themselves, I also expected higher quality. However, now that I've been thinking about it, I think that there may (possibly) be a difference in opinion of what a "good" presentation is. In my opinion, a good presentation is fluid, the presenter doesn't use notes (or at least doesn't read directly from their notes), the presenter doesn't read from the slides, looks at their audience, talks a normal speed, and slides are easily followed and don't contain a lot of words. Overall, a presentation should be engaging. However, what engages me may not be what engages the Zimbabweans.
Overall, I believe this meeting was important to see. I definitely think these students are learning a lot and they are definitely held accountable for their work. I can see why the program is accredited, and I definitely don't think it's my place to judge the quality of the presentations. That was solely a position which I could not form an opinion due to uncertainty on differences between my and Zimbabwean educated opinions on a "good" presentation. This meeting did cause me to wonder about the Zimbabwean education system and understanding the differences in teachings between here and the US. We have been taught the Zimbawean education is amazing, but what does amazing mean? Something to ask.
After the meeting we had lunch at the Ministry and I spoke with a FETP student named Paul. This was the first time I've been asked in depth about why I'm here, and it was a super fun and engaging conversation for me. I also asked Paul about the digitization of information systems, and he said they have begun to transfer medical records. However, there are a lot of challenges in regards to utilization of technology, especially due to spotty electricity. Through the presentations as well there were a lot of problems that arose due to the paper-based information system, specifically with the reporting of diseases and illnesses. This was very interesting to hear and talk about.
Something somewhat shocking for me about the Ministry of Health was the state of the building. The bathroom toilets didn't have toilet seats or toilet paper, one stall didn't have a door. The building also, like many others I've seen such as the hospital, are very run down. It is obvious that every cent of funding goes into the health care system and not into infrastructure.
Finally today we went to the Avondale Flea Market which I am definitely returning to and buying a painting -- they were incredibly beautiful. Tonight we're hanging a barbecue and watching the (full) lunar eclipse!