by Jonathan Platt, MPH ’13 in Epidemiology
When I arrived in Maputo, the capital city of Mozambique, in July 2012, I was immediately delivered to the doorstep of a colleague who had been gracious enough to offer her spare bedroom. Her house was filled with children fully engaged in a game involving balloons and screaming, as well as several women cooking dinner, tending to children, and chatting too rapidly for me to follow. Armed with the Portuguese capacity of a 2-year-old (that was my limit; I tried and failed to chat with 3-year-olds), I attempted to introduce myself to my understandably confused hosts. After convincing them that I was not a misguided backpacker, I staggered my jet-lagged self into bed.
I was there as part of a six-month global health practicum with ICAP, the Mailman School’s world-renowned global health organization, where I have been working as a fellow as I complete my MPH in Epidemiology. From the first day, I hit the ground running, immersing myself in the culture of Mozambique and my work there, often both simultaneously. I studied Portuguese for several hours a day and was regularly tested by colleagues, market vendors, and children, who had a pleasantly high tolerance for my mistakes.
The entire ICAP team in Mozambique was tremendously welcoming and helpful. I worked closely with a team of three ICAP staff (two data clerks and one database manager) to complete the preliminary analysis of a set of surveys aimed at improving HIV care by identifying significant factors that affect adherence to drug regimens. I also assisted with the pre-implementation steps of an intervention aimed at improving the retention of newly diagnosed HIV patients in treatment programs. Though the study won’t begin until mid-2013, a lot of preparatory work was needed. I helped write protocols that will be used throughout all project phases, from staff hiring, to patient interviews, to data analysis and reporting. I also visited each of the twelve proposed health facilities to identify viable study sites.
The process of building a study from the ground up is a satisfying mix of integrating the best practices from previously successful research, adapting that research to the realities of the local context, and developing and identifying the knowledge and capacity to innovate and challenge accepted paradigms within your field of work. Since I was based in the field office, I saw how challenging but critical the element of local adaptation can be at every stage of the research process. It affects everything. Budgets, timelines, deliverables, long-term planning, etc. will cease to matter without key input and agreement among local partners. As someone who plans to continue to work within academic public health research, these negotiations imparted valuable knowledge and skills and were among the most important experiences I had while in Mozambique.
In my relatively short time there, I came away with a good number of valuable skills, gaining proficiency in the design of longitudinal studies and randomized control trials related to building better health-system interventions. I also got an excellent view of research and program implementation covering the whole arc of the process from pre-study activities to ongoing monitoring and evaluation, and concluding data analysis and reporting. As a result, I have a better understanding of how studies fit together and how results and lessons from one can impact others, both retrospectively and prospectively. More broadly, the experience helped me to develop a cross-cultural consciousness of social and structural determinants of health.
Everything I gained during my practicum was made immeasurably richer thanks to the quality of mentorship and team-building provided by my colleagues at ICAP, both in New York and Mozambique. Dr. Laurence Ahoua, the Director of Strategic Information and Research, provided support and encouragement and was genuinely interested in helping me gain new experience during my time in-country. We have had several discussions about my professional goals, which she took to heart when considering my role in new and ongoing projects.
Saying goodbye to friends and colleagues, I left Mozambique deeply appreciative of my experience. I grinned and said, “até breve!” (see you again soon), not only to show off my Portuguese acumen (now at a 7-year-old level), but because Mozambique is a country where I hope to return someday to continue to work for effective community health services and to celebrate the richness and complexity of place, which cannot be understood from afar.