Student's Experience/ Bridget

Hi there!

My name is Bridget Morse-Karzen and I am a recent graduate of Columbia’s MPH program. While there I studied sociomedical sciences and health policy. I was not the “typical” so to speak global health certificate student that this practicum frequently attracts. That said, I think that this practicum has a great deal to offer students from all different departments and certificates.

For me, the gap between the on the ground, context-driven qualitative work and the way in which qualitative findings are translated into policy is a critical issue. Often-times, the voices of research participants are lost, left out, or re-shaped by those with more power. It was very important for me to fully immerse myself in qualitative work this past summer so that I could work towards my goal of being able to effectively take qualitative findings and apply them to policy-writing and implementation in order to create lasting, equitable, structural change.

But let’s get into it. First things first. What did I do?

I worked on the SSTAR Ethnography study, which took an in-depth, anthropological approach to exploring sexual and reproductive health access and availability among youth in Rakai. I had the opportunity to work under Dr. Erin Moore, who was a wonderful supervisor. I also was fortunate enough to be able to work closely with the Social and Behavioral Science team at RHSP, as well as two other interns, Lillian and Margaret, from Makerere University. The internship itself was broken into several pieces. The first part started while I was still in New York, where Erin and I met several times to create a plan for the summer. During this time, I also began a three-part literature review on access to reproductive healthcare in order to obtain a better understanding of the current Ugandan healthcare landscape so that we could hit the ground running.

I have to admit, the flight itself was not incredible ( two 8 ½ hour flights usually aren’t) but then again I needed the time- in typical me fashion, I had one last final to get in and 24 hours left to do it. So time flew.

We landed in Entebbe, but were immediately taken to the capital city of Kampala to begin our 3-day orientation. We were given mini crash courses on Uganda’s history, culture, political climate and healthcare system. We also got to visit the Uganda Museum, eat at delicious restaurants, go rafting in Jinja (highly recommend; but be warned they WILL make you tip the boat), and saw the equator.

After this whirlwind weekend, we made it to the small but lovely town of Kalisizo, where we were put up in a guest house. I’ll be the first to say we were very spoiled; our house mom, Grace, was hilarious, caring, and a fabulous cook. The fruit was fresh and delicious, and we ate copious amounts of chapatis, avocados, and fried plantains (a personal favorite). The house was also constantly stocked with Nutella, to my detriment. Grace was kind enough to help us learn how to make various Ugandan dishes, which was always fun and very filling. But back to the practicum. Our time at RHSP began with an orientation that was focused on meeting and getting to know the staff. Work began quickly thereafter; I started creating various tools including an interview guide for providers, a community mapping guide, and an ethnographic participant observation chart. I worked closely with Lillian and Margaret, the interns from Makerere University, to ensure that the guides were properly written and translated into the local language, Luganda. When the tools were prepared, Margaret, Lillian, and I went into the field to begin mapping the available reproductive and sexual health technologies. We decided that we would focus on one fishing village, Ddimu, in piloting the tools.

After we finished the observational mapping work, we moved on to conducting interviews with healthcare providers to determine what kinds of contraception were available, where each type of contraception could be obtained, what each form of contraception cost, and so on. Again, we were trying to identify the main barriers that young people face to accessing contraception. Next, we started transcribing interviews and performing

preliminary analyses, as we had a short turnaround window to gather our findings before we had to present to the Rakai Scientific Community ( it’s fun I swear!). The research was very interesting, and while there were many findings, I would say that two in particular have stuck with me. First, we found a very large sense of mistrust in the entire healthcare system; individuals pretending to be clinicians, counterfeit drugs, issues with drug stock-outs, adverse reactions to medications with no follow-up treatment, clinics closed when they were supposed to be open. Unfortunately, these occurrences are symptoms of much larger structural issues, but their effect is to decrease individuals’ likelihood of entering into the healthcare system. What this means for young people in Rakai seeking contraception is that often-times, they don’t. And if they do, obtaining contraception is frequently gone about in round-about ways, or ways that are at least one or two degrees removed from the biomedical health system.

Lastly, and this actually was the catalyst for the thesis that I am currently writing, we realized how the male partners of many of the women that we spoke with were their number one cited barrier to accessing contraception. Ugandan societal beliefs purporting that women on contraception are “promiscuous” or “disloyal,” and that men who reproduce more are more “manly,” provide a bare-bones framework for understanding why this barrier exists. These women said that they feared that their male partners might hurt them- whether that be emotionally or physically- if they were to go on a form of contraception.

Most of the time, women are the targets of public health interventions, especially those relating to reproductive and sexual health. And I certainly agree that this is for good reason; women have long been systematically denied access to resources. These interventions provide education, emotional support, and healthcare. They empower women. However, I would argue that they also place a kind of dual burden on women. Not only are women responsible for putting in the work to learn and educate themselves and others, but they are also deemed responsible for making their male partners use protection. But if their male partners aren’t receiving the same kind of intervention, and their very masculinity is in fact at odds with using contraception, why would they agree to do so? Further, under the threat of violence, why would a woman protest? I truly believe that men need to be the targets of many more interventions surrounding reproductive and sexual health. We need all parties on board; we cannot just let the entire burden continue to fall on women. But I digress.

I have probably gone on for a bit too long, so I will wrap things up. Overall, the internship was a great experience. I met wonderful people, got to better understand an amazing country, and learned quite a lot about ethnographic research and how it fits into the work that I want to do. I guess I will leave you with some lessons that have stuck with me from my time in Rakai: travel a lot if you can; the national parks are stunning. There are so many different ways of doing things. Different doesn’t mean less than. A lot gets lost in translation. It’s usually good to be a little uncomfortable. And finally, stay flexible- things change at the drop of a hat. That’s okay. Variety is the spice of life, they say.

Okay, y’all made it through- webale!

All the best,

Bridget