Notes from Moshupa, Botswana

David Loutfi

In November 2015 and March 2017, I travelled to Moshupa, Botswana to carry out a survey on social networks with the goal of preventing HIV. My PhD work is part of the INSTRUCT project (http://instruct.cietresearch.org/) that aims to prevent HIV by empowering young women to make choices to protect themselves and by working with the community to create an enabling environment. It can be challenging to figure out how best to reach the young women that can benefit from the INSTRUCT project and so my PhD aims to use existing social networks (real networks of people, not Facebook or Twitter) to reach marginalized young women more effectively.

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Photo 1: Myself with our team of field workers in front of our minibus (November 2015).

As our research involves studying the social networks of marginalized young women, we hired and trained other young women from the district to carry out the interviews. They are trained as research assistants and in the training we cover all the questions in the survey as well as informed consent. Pictured is the team that carried out the field work in the pilot phase in November 2015. We spent much of our time in that minibus driving to our four selected communities for the interviews.

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Photo 2: However, there were some challenges such as this bridge that had been washed away by recent rains (March 2017).

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Photo 3: A view towards Moshupa town (pop. ~20000), the main town in the district we were working in (March 2017).

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Photo 4: Three interviewers off to find young women to interview (March 2017).

The participants were identified through a mix of asking key informants (social workers, health education assistants, etc.), young women themselves who pointed us towards others like themselves, and going door-to-door.

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Photo 5: Three of our interviewers (in the CIET bibs) talking with some participants at a clinic in a small village (March 2017).

The young women we are aiming to interview are aged 16-29, are not working and not in school because that group has a high incidence of HIV and can most benefit from access to structural support programs to help them go back to school or to start a small business for example.

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Photo 6: A participant being interviewed (March 2017).

The purpose of our survey is to understand who young women go to for support so that we can then spread information about available support programs to other young women. For example, if it turns out that young women go to their teachers when looking for support, we could provide information to the teachers so that it spreads to the young women more effectively.

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Photo 7: A participant being interviewed with our minibus and the clinic building in the background (March 2017).

Learning about their social networks will allow us to spread information about existing government support programs for young women, and, if they make use of these programs, they will be less reliant on transactional sex and will be able to make their own choices about safe sex and so prevent HIV.

Working at the Myungsung Christian Medical Center in Ethiopia

Angela Lee

My project was a practicum and a research project at Myungsung Christian Medical Center (MCM). MCM is a private, non-profit hospital, where I was under the supervision of a pediatric surgeon. I took part in both the clinics and the surgeries within the hospital, and I also participated in community outreach programs by MCM, such as the free of charge mobile clinics in rural communities. The research project was a retrospective study to calculate the backlog of defined pediatric surgeries at MCM, in order illustrate the gross lack of surgical accessibility in low and middle income countries in Africa.

Angela Lee was awarded the Medical Class of ’84 Student Bursary in Spring 2016. She is currently a 3rd year medical student who believes everyone has the right of access to quality health care. Angela chose to travel abroad because she wanted a better understanding of the social and medical struggles that both the people and the medical staff face in low resource settings.

Mental Health Recovery in Different Contexts: Lessons Learned from the Field

Jessica Maria-Violanda Spagnolo

The mental health recovery movement emerged in order to counter the overly biomedical view of mental illness that littered the era before deinstitutionalization (Anthony, 1993). After this era, community-based services for people living with mental illness were strongly encouraged, as illness is not merely the absence of disease, but a state of holistic well-being that goes beyond physicality (WHO, 1948). Therefore, mental health recovery includes ways of “living a satisfying, hopeful, and contributing life even with limitations caused by illness”; as well as finding “new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness” (Anthony, 1993, p. 527).

I have always been interested in understanding how this concept is seen and understood around the world. This post will report on examples of the cultural representation of mental health recovery in local communities where I worked.

At a shelter in a small village in the Caribbean, mental health recovery meant developing new skills by learning how to plant vegetables, pineapple, and flowers, as well as care for chickens. This manual labor encouraged the presence of a daily routine, which can easily falter when one is affected by illness; learning through trial and error, which promotes patience and perseverance; as well as interacting with others, which can often be a limitation caused by illness. Photo 1 shows the chickens that the residents took care of until they were either sold to local community members or were used to feed the residents at the shelter. These same residents highlighted the importance of religion in their lives, which helped them find new meaning after illness. For example, when asked what inspired them, the majority of the residents said “God.” This reality is also apparent when visiting the shelter, as the walls are painted with religious images and symbols by local artists (Photo 2).

In a small village in Central America, where many refugees sought protection after experiencing hardships in another country, often showing signs of post-traumatic stress, mental health recovery was seen through the development of new social ties. Arriving as strangers, women leaned on each other for support as well as hope for the future. Their children, through play, would do the same (Picture 3).

The beauty of the mental health recovery movement is that it ensures the focus is not solely on mental disorders or symptoms. Not once during my work in these 2 communities did the residents mention the word “sick” or “ill,” but spoke about what was important in their own, unique, personal recovery journey from illness: developing new skills; generating hope for the future, creating social support and networks. These things are what innately make us human, and are anchored in what can help people living with any type of illness enjoy a satisfying and fulfilling life, despite symptoms.

 

Jessica Spagnolo is a Doctorate Candidate at the School of Public Health at the University of Montreal. Her research focuses on building system capacity for the integration of mental health at the level of primary care in Tunisia. Jessica is funded by les Fonds de recherche du Québec – Santé (FRQS) and MITACS Globalink. Jessica holds a Bachelor and a Masters of Social Work from McGill University.