Global health research in rural Zambia

An african village in rural Lundazi with a small mountain in the backgrouns and beautiful trimmed headgerows and small huts in the foreground
A rural village in Lundazi District

Jason Park is a medical student from Boston University.As a Fogarty fellow he was part of a research team studying the impact of Maternity Waiting Homes on the rate of facility delivery of mothers living in rural Lundazi, Zambia. This program supports fellows from a range of US and international universities to undertake global health research in low and middle income countries. Jason recounts his experiences of his global health research and provides a little insight into living with the locals.

 

We received an unexpected resignation two weeks before the scheduled start date of endline data collection. I was already headed to Zambia for an independent research project when my advisor mentioned this open position: field team coordinator on a cluster-randomised controlled trial. I signed on with little hesitation; despite having no experience, but jumped at the opportunity to discover the fundamentals of field work. Our plan was for me to undergo two weeks of training and then lead a research staff of 7 people.

An Insight in Public Health Research

Yet the night before our departure, I found myself tossing and turning. The week before, a visa mishap led me to miss three days of training.  Then, a logistical issue expanded my team to 19 people, three times more than initially planned. My prior research experience was at a big academic hospital in Lusaka, the metropolitan capital of Zambia, so working in a rural setting for the first time was daunting. Thinking about the past setbacks with training and unknown future, I stayed awake with anticipation.

beautiful purple blossom from the Jacaranda tree in Lusaka Zambia
Jacaranda trees in bloom

After experiencing fuel challenges and car breakdowns on our 800 kilometer trek, we finally pulled into Lundazi, a small town in the Eastern Province of Zambia located about 20 kilometers from Malawi. Farming is the main industry in the Eastern Province, and Lundazi embodies a quiet, idyllic atmosphere. There is one main tarmac through town, mostly occupied by refrigerator trucks. Bicycles and pedestrians pass through the peripheral unpaved dirt roads, where street vendors sell fritters and small green bananas from baskets on their heads. Our September visit saw the slow transition from winter to summer, with scorching days soothed by cool evening breezes. For three weeks, our seven cars roamed around the district to visit 200 villages, and collect over 600 household surveys.

An image with a large clay tarmac road blue sky and some trees
The main tarmac through Lundazi town

I found early on that field work is like monsoon season; a serene day punctuated by unexpected bouts of excessive, aggressive rain that needed diligent mending throughout the day. Each day, the teams returned with dozens of surveys and consent forms to double-check and file, receipts from various cash reserves to track, audio interviews to review, and various other unexpected problems that arose. Spacing out the work for later was tempting, but letting it pile up would lead to even more fatigue and errors. I learned how crucial it was to keep the workload organised and avoid procrastination.

The key to staying organised was having a system. I created a checklist with daily responsibilities and different approaches for handling new issues. This quickly became my bible, and consulting it gave me confidence that I wouldn’t forget anything important. Other tasks became easier with time; filing consent forms became efficient thanks to muscle memory. During my last week, we found a discrepancy in our inventory of chitenges, African fabrics presented to villages as tokens of gratitude. These gifts had wandered off during previous projects, but I used my organised system to review all previous work and track down the missing pieces.

An african village in rural Lundazi with a small mountain in the backgrouns and beautiful trimmed headgerows and small huts in the foreground
A rural village in Lundazi District

A few troubles along the way

Things still went wrong, despite our best efforts to plan ahead, so it was crucial to stay flexible. Missing equipment was a frequent concern, as replacements were challenging to find in a small rural town. Bad internet reception and load shedding (when specific electricity grids turn off to save energy) were also common. The power disappeared for short periods of time every day, and my longest streak without electricity lasted eight hours during working hours. I grew to appreciate and optimise golden windows of running water, Internet, and power. Furthermore, we encountered numerous vehicle issues, as the road conditions were often hazardous. It was important to develop rapport with people who could advise us on institutional protocol and basic car maintenance. These contacts helped me through many late night and weekend phone calls. Finally, the importance of safety could not be overemphasised. There was one car accident in the field, and luckily everyone wore a seatbelt and came away unscathed.

African town, Lundazi, a few huts can be seen inthe background with sparse green trees
Lundazi Town

Beyond the numbers and figures of field work, the most rewarding aspect of the experience was the cultural immersion. In Lundazi town, food was not bought at grocery stores, but from farmers selling at small kiosks near highways. Familiar brands were absent from the local convenience stores. Scarcity was evident in the surrounding rural villages; we often saw kids approaching cars to sell bushrats or village people crowded around a single well to take turns on the water pump.

two large bulls pulling a wooden carriage in rural Zambia acting as an ambulance
Cow drawn carriages transport sick people to health centres

Local Culture

I was also introduced to the foreign concept of chiefdoms. Lundazi is composed of the Tumbuka, Chewa, and Ngoni tribes, and there were multiple chiefs who presided over the areas of data collection. As study coordinator, I had the unique honor of representing the research team and pay homages. We observed a diverse range of chief formalities during our visits; some preferred a ritual entrance with rhythmic claps and chanting, while others were happy to lounge in their palace or under a tree shade while conversing with the induna, the chief’s group of advisors. In addition to conversing with leaders who were passionate about improving the lives of their community, they taught us the importance of adhering to cultural customs. There had been stories of villages panicking during foreigners’ visits, and the chiefs’ influence and reassurances carried much weight in calming their people.

Jason a medical researcger from the US bows to the tribal chief of a rural Zambian community who is in traditional dress
Paying an homage to chief Magodi

Finally, a global health project can help us broaden our horizons, and we should try to remember to appreciate our unique environment. On evenings with load shedding, we lacked power for miles, but were rewarded with a vibrant night sky. I’ve learned to greet people in Tumbuka from the lodge staff. The last weekend, our study team had a braai, an African barbeque party with various grilled meats where we danced to music from car speakers. My experiences have been incredibly memorable, and I won’t forget how to greet with Muli Wuli, or meeting the schoolteacher-turned-chief who hopes to provide safer births. The true blessing of field work is building relationships in a new cultural environment with people who are passionate and full of life.

 

The author of this post was supported by the Fogarty International Center and National Institutes of Health. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health

If you are currently working in global health or doing any expedition & humanitarian work and would like to contribute to our website please get in touch by emailing support@escapemedic.com

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Jason Park is a medical student from Boston University.As a Fogarty fellow he was part of a research team studying the impact of Maternity...
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