Assessing Community Health Workers in Rural Guatemala and Charlottesville

Hi! My name is Natasha Koduri and I am a rising fourth year in the College of Arts and Sciences. My research partner is Spencer Moore, a rising second year in the School of Medicine. Both of our projects (part of the UVA GI group) are on community health workers (CHWs). My part of the project took place in Guatemala and Spencer’s took place in Charlottesville.

Community health workers have been shown anecdotally and in the literature to be an effective way to improve access to healthcare in underserved populations. They are used both abroad (Guatemala) and domestically (Charlottesville). Our main goal is to come to a greater understanding of how to use the CHW current resources more effectively. At the end of our analysis we will try to understand if the ways that CHWs in each respective community are being used can benefit the other community.

Spencer and I talked with our in-country coordinator, Jessica Gonzalez, about our CHW project during the second week of June. As with any project, especially international projects, things change. My project shifted to focus more on cross-cultural benefits. As previously mentioned, CHWs have been cited in literature to be an excellent resource for dispersing health education to the community, and many times have a positive effect on the population they serve. Amanda Below (a former UVA MPH student) did her thesis on CHWs so she has laid a base foundation from which Spencer and I can work off of. Specifically her thesis was on the problem of attrition in CHW programs. My survey will take what I have learned from her thesis and expand on it. Specifically, I am going to survey CHWs on their interest in incorporating successful components/resources found in American CHW programs and how feasible this is. For example, there are many health fairs in America in which CHWs attend, meet other CHWs, and learn more information that they can give out the community. In my survey I ask about their interest in incorporating this into their programs and how feasible this would be in Guatemala. If CHWs are interested but do not have the funds, Jessica Gonzalez (our in-country coordinator) said she would be willing to help me and the CHWs find possible funds to make this happen. I am hoping that these cross-cultural benefits will be pinpointed, assessed to see if CHWs would like to incorporate them, and how feasible this is. I also asked other questions that will be for the general purpose of gathering more data on CHWs.

After spending so much time in a country like Guatemala, you really get a greater appreciation of the culture and the people which makes the project we do that more meaningful. Look out for more blogs with our results and more details about our time both in Guatemala and Charlottesville!

Spencer and I in Guatemala looking over the city of Xela

Spencer and I in Guatemala looking over the city of Xela

Lake Atitlán where Tasha did her research for two weeks!

Lake Atitlán where Tasha did her research for two weeks!

Tasha plus many team members from UVA-GI on the top of Tajamulco (the highest peak in Central America)

Tasha plus many team members from UVA-GI on the top of Tajamulco (the highest peak in Central America)

Advertisements
Standard

Reflections on Conducting Laboratory Research in an International, Cross-Cultural Setting

Hi! My name is Cam Elward, and I just graduated from UVa this past May with a degree in biomedical engineering.

Before arriving here in Fortaleza, I had no idea what to expect. I had never conducted laboratory research in an international setting before, so I was not familiar with how universities do science outside of the United States. I also had a very limited grasp on the Portuguese language and was uncertain of the level of language immersion in lab. Would people understand Spanish? And to add to the craziness, I arrived here in Fortaleza during the second week of the World Cup, where the country literally shut down and declared it a national holiday whenever Brazil was competing.

For my proposed project, I’m working with a mouse model and collaborating with PhD candidates and undergraduate Pharmacy students working in Dr. Reinaldo Oriá’s lab. We’re populating the gut flora of ApoE knock-out (KO) mice with stool samples from mice raised in a barrier vivarium (São Paolo facility) versus a non-barrier vivarium (UFC facility). The hypothesis is that the non-barrier-raised (more exposed) population will develop more atherosclerosis. Unfortunately, we’ve experienced some hold-ups to starting the proposed study due to 1). delays in the required diet arriving at Dr. Reinaldo’s lab, and 2). delays in obtaining the antibiotics necessary to deplete existing gut flora. In the meantime, I’ve shadowed animal surgeries in lab, helped with Western Blot analyses for a PhD student in Oriá lab, accompanied field studies, and taken one-on-one Portuguese classes 4 hours/week.

At first, I struggled to find new competence in this foreign setting, and I found that my limited Portuguese knowledge only exacerbated that. However after 4 weeks of Portuguese classes, I’m developing enough confidence in my language skills to help move things forward with my project. Additionally, since I might not have time to make legitimate progress on my proposed, CGH-funded study in Dr. Reinaldo’s lab, I’ve been helping with the final analysis of a PhD student’s project in lab that explores the effects of malnutrition on protein expression in the gut in a population of ApoE KO mice.

Lastly, I couldn’t comment enough on the incredible hospitality of the Brazilian people. My experience so far has been universal among the people I’ve encountered: they’re intrigued by foreigners, especially since it’s rare to have students visiting here, and they are a proud people that eagerly welcome and share their lives with people they meet. A lot of this culture inevitably spills over into the laboratory environment. In the United States, students, for several reasons, are possessive over their research projects. It’s not uncommon to hear, could you help me with the data for my project? What I’ve encountered in the Oriá lab in my time here in Brazil is that projects become a collective, our project. What a beautiful people, and exceptionally good sharers I might add!

Tchao e até mais!

Me and some of my labmates making high cholesterol diet one day in lab

Me and some of my labmates making high cholesterol diet one day in lab

LABICONTE: the Oriá lab

LABICONTE: the Oriá lab

FIFA FanFest Fortaleza: the large outdoor theater for watching world cup games and enjoying post-game concerts

FIFA FanFest Fortaleza: the large outdoor theater for watching world cup games and enjoying post-game concerts

the Gringo tries to assimulate into Brazilian beach culture

the Gringo tries to assimulate into Brazilian beach culture

Standard

Adventures in Guatemala: Xela & Lago Style

Hi all! Our names are Rachel Dihle & Christina Li. Rachel is a 2nd year Clinical Nurse Leader student at the University of Virginia and Christina just graduated from UVA with a degree in Psychology. We are working on a project here in Guatemala regarding perceptions of Mayan women and their reproductive health. We have been here in Guatemala for a little over three weeks now. For the first three weeks, we spent our time in Xela, Quetzaltenango loving Spanish school at Celas Maya. While at Celas Maya we were able to study hard to improve our Spanish significantly, as well as learn about the culture here in Guatemala. Jessica (our in-country program director) and Amanda (who works with Jessica) were able to give us great insight and information about the culture and health within Guatemala as well as help tremendously with the formulation of our survey.

Celas Maya Days

Celas Maya Days

We arrived at the Lake Atitlan Region to begin our project a few days ago and met with our mentor, Leticia, today to formulate a plan for our research. We will be traveling to 5-6 different cities around the lake within the next 2-3 weeks to discuss reproductive health with individual Mayan women. Our current mission statement is as follows:

“Within our research project on women’s reproductive health in Guatemala, we hope to survey individual women directly to gain knowledge regarding what kinds of education, services, and access to treatment they have received within the reproductive health care system. Through this, we are striving to compare the information received from women with what is said to be offered by organizations in order to understand if the services offered by organizations are being utilized and/or understood by women, and whether there are services that women would like to receive that are not available.”

A little history regarding women’s health in Guatemala:

Women around the world, specifically in the developing world, struggle to find information and access to reproductive health resources. Guatemala is the most populous country in Central America and the country continues to have a high fertility rate (an average of 3.6 children per mother, 4.5 for indigenous women) and one of the highest infant mortality rates in Latin America. The high rates of infant mortality are impacted by the high fertility rate, low levels of education, limited access to information about reproductive health, the relatively lower percentage of women who use a form of family planning (54.1%), and the percentage of women with an unmet need for family planning services (20.6%).

The fertility rate remains high particularly in indigenous communities because of many long-standing cultural customs that male household heads with many sons are highly regarded by community members and males will often abandon their female spouses for seeking family planning services. Women have long been in a subordinate position in Guatemalan culture and continue to lack decision-making abilities because of the ‘machismo’ (male dominant) aspect of the culture. Civil war and decades of political and social turmoil have lead to many human rights issues in Guatemala with violence against women and the social stratification impacting the indigenous population being important and ongoing challenges for the developing nation. Many Guatemalans are also influenced by religious beliefs with the majority of the population practicing Roman Catholicism, Protestanism, or traditional Mayan beliefs. Many individuals see high fertility as a blessing and do not believe in family planning methods due to religion.

The literature has studied the lack of family planning resources available in Guatemala with a specific focus on the rural and indigenous community. However, Guatemala also lacks services in other realms of women’s reproductive health (WRH) including unsafe abortions, early disease prevention and screening (including cervical, uterine, mammarian, and STIs), maternal and infant health, as well as intimate partner violence and abuse. Reproductive health services fall under the Ministry of Health’s Maternal and Infant Program but remain limited and focus mostly on prenatal, birth, and postnatal care. The public healthcare system is divided into three levels: hospitals, health centers, and health posts with hospitals being the largest with only one or two per region. For example in terms of disease prevention and diagnosis, pap smear tests to detect cervical and uterine cancer are available outside of hospital, but testing for sexually transmitted infections are only available in health centers and hospitals. Breast cancer screening is also limited and is only available in hospitals. Access to these very important tests is not widely available and even more geographically limited to indigenous population who do not have the resources to travel to hospitals.

The University of Virginia-Guatemala Initiative (UVA-GI) has been collaborating with several towns in the Lake Atitlan region of Guatemala inhabited by people of Mayan descent over the years. Most of the indigenous populations in the area that we will be studying receive their care from the small health posts, which do not provide many of the essential reproductive health services women need and access to contraception and family planning facilities is limited by distance and lack of information. We have developed a survey that we will begin administering orally to women tomorrow with the help of Letecia. We are very excited! We will post another blog with the results of our project! Hasta Pronto!

Rachel at Volcán Tajumulco

Rachel at Volcán Tajumulco

Christina at Monterrico

Christina at Monterrico

Standard

Identifying & Combatting Psychosocial Stigmas Towards Children with Special Needs in Ecuador: Reflections on Flexibility

photo-3

“Family Day” at the school in Quito where I’ll be completing my project

Flexibility is something I was cautioned to take with me before I had even purchased my plane ticket to this beautiful country. I embraced advice along the lines of, “it’s always different than you expected once you arrive on site, so be prepared to adapt,” but could not fully envision just how true that wisdom would prove for me.

I anticipated working in a clinic. I’m working in a school for children with intellectual disabilities.

I hoped to interact with parents and families as they came through a waiting room. The only time I see parents is when they pick their children up from school (that is, if the child does not take public transportation home).

I realize I expected clinicians to function outside of cultural norms. I’m now learning that they, too, are not only knowledgeable about but perpetuators of the very psychosocial attitudes I came to learn about.

These are not necessarily bad things. With a little flexibility, my project is turning into a fantastic opportunity for collaboration with the teachers, therapists and professionals at the school where my research will take place. It has also cured me of the mindset that a student coming into an Ecuadorian educational setting will produce any drastic change. Rather, I am learning to appreciate that my findings will be a small first step towards better understanding the underlying beliefs that drive these families and clinicians to care for the children in particular ways. I am learning to personally appreciate that profound change can start with just a few good questions and conversations.

Finally, I am learning that collaboration with people working within the healthcare and educational system here is key. In six weeks, not much will change in cultural and psychosocial attitudes that are rooted in centuries of history. But the willingness of the professionals here to collaborate, and to adapt new ideas and practices so that they are more truly Ecuadorian, will be more beneficial to students here than any foreign practice that is superimposed on the system. As I’m adapting this project to fit the setting I’ve found myself in, I am looking forward to reflecting on how what is learned here can be applied in the U.S. to better serve families in a way that is culturally familiar to them, while redirecting attitudes that inhibit progress.

¡Chao!

Caitlin

Standard