Lessons From Kilimanjaro

For more than a decade now, thanks to one of the longest-standing DGHI collaborations, Duke students have been making their way to Kilimanjaro Christian Medical Centre (KCMC) in Moshi Tanzania, to carry out field research. While in Moshi, students are guided by Professor Blandina M'mbaga,  the on-site coordinator for the Duke-KCMC collaboration, and her team, as well as Duke and KCMC mentors. They spend up to 10 weeks living and working in the city, situated in northern Tanzania at the base of Mount Kilimanjaro, Africa’s highest peak.

Judith Mwobobia, a student in the Master of Science in Global Health program who completed her field research in Moshi this summer, caught up with three fellow MS-GH students to see how their projects are going so far.

Kristen Stark: With assistant professor Julian Hertz and a local research team, I am studying and analyzing data on myocardial infarction (MI) in northern Tanzania. The team has been collecting data for the past five years from patients presenting with chest pain and shortness of breath at the Emergency Department at KCMC. The goal is to use the study findings to design an intervention to improve MI awareness and care. I will also be learning from the local practitioners what they think is the greatest opportunity for improvement in MI management in the region.

Mbi Obale: My research with assistant professor Joao Vissoci is on developing a harmonized and curated repository of injury data from KCMC. Our ultimate plan is to develop a guideline for injury database development in low- and middle-income countries.

Maeve Salm: I am working on two projects under the guidance of assistant professor Dorothy Dow. One is focused on eliminating barriers to sexual and reproductive health for young women living with HIV in Moshi. The second one is focused on developing youth Community Advisory Boards (CABs) in partnership with local experts across three towns in Tanzania. These boards are aimed at fostering environments where youth can offer insight about health needs of their peers to researchers and where youth can learn about their health from reputable sources.

Several weeks into your research, what new skills have you learned?

Stark: I've learned a whole lot about data analysis and data presentation, and I’ve realized just how much preparation and troubleshooting goes into designing an intervention. Now I get to actively participate in the process.

Obale: I would say document analysis. I didn’t know much about this before I got here. My communication skills have improved, too.

Salm: What haven’t I learned? Writing an IRB addendum – I am still mastering the art of designing a qualitative method instrument. I am managing a study and I have also learnt how to communicate effectively with key stakeholders in a project.

What has been your favorite thing about Tanzania so far?

Stark: First, there is the 10-minute walk home from KCMC with a view of the breathtaking Mt. Kilimanjaro. Then the warmth of the people. Everyone, especially my research team have been extremely patient with me as I learn Swahili.

Obale: Moshi is such a happy and peaceful place. I get daily views of Mount Kilimanjaro, the highest mountain in Africa, and it is quite a sight to see on clear days. Oh, and the tea! I am now a tea person. I don’t think I have drunk better tea in my life.

Salm: Must be the new friendships with my Tanzanian colleagues. I have loved the challenge of learning Swahili, and thanks to my new friends, that is coming along nicely. I also feel extremely lucky to be able to clearly view the great mountain from my backyard.

What has been the most challenging part of your field work?

Stark: That would be finding my place on the team. I was hesitant to help lead the design team because I don't speak Swahili. I am the newest person on this research project, and I'm the least familiar with Tanzania's health system and culture. I didn't want to be taking up space that a Tanzanian researcher should have had. Ultimately it came down to the fact that everyone else is too busy, and they needed someone who could dedicate most of their time to this part of the project, which I am happy to do. I try to continuously reflect on my position here and will make sure that the experienced voices on the team are heard and truly driving the intervention.

Obale: Being unable to speak Swahili is one of my biggest obstacles. I really wish I could speak the language.

Salm: I have had to honestly appraise my skills and learn to delegate where necessary. I have also struggled with communicating clearly and concisely. I would however say I have improved in my time here and there is still room for growth.

How do you think your research now will inform your future career? 

Stark: Initially, I wasn't sure if I would continue to conduct research after my studies at Duke, but I am now certain I will. I hope to integrate community-engaged, patient-centered research into a career in medicine in the future.

Obale: My research is preparing me for a career in data science. I want to pursue a PhD in epidemiology, and this is the background I need.

Salm: I have developed a love for partnering with communities to improve health and I have discovered that I quite enjoy implementation science research, particularly when it centers a community’s vision. I intend to integrate this into my long-term career.