Courtney Massaro
Frist Global Health Leader

Reporting from Les Cayes, Haiti

November 15

Most days (or I should say nights rather)—I forget I’m working in Haiti. We have normal, beautiful deliveries with happy, healthy moms and babies. I got to catch twins the other day (!!), and the first was breech—which was quite exciting/stressful for me, as breech babies typically are sectioned in the U.S. and so the breech delivery skill-set is a dying art. Sure we have the occasional loss of power, or we run out of gloves, but overall things at the maternity run in a manner pretty similar to how they would back in the U.S.

And then there are nights where I am harshly reminded that I’m in a developing country, in a hospital with limited resources, where standards of patient care are—at times—very different, and where things happen that wouldn’t occur in the developed world. Below is a sad, frustrating, and a bit graphic example of such a case.

Last night a woman was carried into the delivery room with an IV already in place and fluid dripping. She had been brought from another hospital that was about 45 min away from Cayes. She had had an obstructed labor for the past three days. As a result, when she arrived her baby’s head (the baby had died—how long ago no one knows) was right at her perineum, but wouldn’t come out. Her vulva was terribly swollen and she looked incredibly worn out (which was more than understandable given what she’d been through). She was still having contractions—probably due to the fact that she was getting pitocin through her IV—but they weren’t doing anything but cause her pain.

We called the doctor on call to see what he wanted to do about this woman. It was clear to me—and the nurses—that no amount of pitocin was going to make that baby come out (unless the baby decomposed enough to be able to be pushed out with the pitocin induced contractions). I was concerned about her increasing risk for infection and for fistula formation—among other problems—and so was hoping the doctor would come in to perform a c-section (given that we had no vacuum or any other way I could think of to try to extract the baby vaginally). The doctor however, got mad at the intern for calling him, and said that the woman just needed pitocin and that was that. After the call, the nurses all lamented the doctor’s decision, but said that this was just how it was in Haiti—that women suffered. They were much more laisser-faire about it than I was—in large part I think because this is normal/expected to them, and (obviously) not for me.  I think also because I knew what materials we didn’t have, and how they could have changed the situation—and the nurses probably didn’t as well—that it made it that much more frustrating for me.

I struggled with trying to think of something we could do for her—but I couldn’t think of anything. (Being a new/inexperienced midwife is hard at times because I wanted to help this woman so very much, but have never been taught about how to address obstructed labor—I’ve only read about it and its consequences—and don’t have any experience with it (until now), or anyone to offer me advice as to the best treatment plan.)

In the end we—tragically—monitored the woman all night. She made no progress and didn’t get any rest because of her contractions. I happened to be at the hospital this afternoon (around 3pm) and saw her finally heading back for a c-section. I can only hope that she has no long-term consequences of this birth—though I’m not too optimistic about that.

I realize this is not an uplifting post, but it is a reality that any healthcare worker who has the privilege to work—or wants to work—in the developing world will have to continually confront. My hope is that with time the norms will change, and appropriate resources/trainings will be provided to decrease the frequency of such cases, and ensure that women don’t have to just suffer.

Courtney Massaro
Frist Global Health Leader

Reporting from Les Cayes, Haiti

November 9

Haiti—or at least what I’ve seen of it—is a very religious country. Although religion in Haiti may make people think of Voodoo—which is certainly still practiced—I however, have seen it mainly in the Christian incarnation. A significant number of the buses and trucks, as well as the stores around Cayes have Christian Bible verses/words on them/names, and there are churches (of various denominations) all over the city.  Women at the maternity often pray and sing through their labor/contractions, and many of the women—immediately after giving birth—say a prayer in thanks to Jesus. Two nights ago—at 3am—one of the laboring women started signing a song talking about “needing God”. Shortly after she started singing other people picked up the song and began to sing as well. For a good 5 minutes I’d say there were 15+ people singing this song (beautifully I might add), and then after the song faded they each started praying their own prayers. I seemed to be the only one who was astonished that everyone seemed to know the song and wanted to sing it, and that no one else thought it an inappropriate time (3am) to belt out a song and then start to pray loudly. I mention this story only because it was—for me—an incredibly unique experience, which gave me a better appreciation for the norms and beliefs of some (most, possibly) of my patients.

Sometimes—despite all our efforts to the contrary—women don’t make it to the delivery table in time to have their babies. This happens all over the world; babies get born in hospital beds because the nurses/doctors/midwives aren’t able to get there quick enough or the mom doesn’t realize the birth is so imminent, or any number of other factors. The difference however, is that here the births don’t just happen in the beds, but they also happen on the (not so clean) tile floor. We’ve had two such births on my recent shifts—both women trying to make it to the birthing room and falling short without properly notifying us of the fact that they were pushing.  Both times I’ve been the “baby nurse” after the birth and have apologized to the babies for having their entrance into the world be falling onto the cold tile. Luckily, they won’t remember it and neither were worse for the wear.

Apart from my work at the maternity I’m doing some less exciting—though I think still very important—work with one of the doctors in the Infectious Disease Department. I’m compiling a list of all the women who been diagnosed with HIV/AIDS at the hospital and who have been pregnant within the last couple years (I’m start from 2010 until the present, but hope to get to 2008). From that list I’m trying to find all the women who should be taking their HIV/AIDS medications, but aren’t. The hope is that with such a list the community health workers—who work not only in Cayes, but in the surrounding areas—can track these women down and make sure they receive the (free) medications that they need to not only prolong their lives, but hopefully decrease the risk of transmission to future children and/or sexual partners.  Again not the most glamorous work, as it involves me sorting through two large registration books and trying to decipher the not-always-legible cursive Haitian names, but it will hopefully prolong and better some lives.

Frist Global Health Leaders

East Tennessee State University

College of Public Health

Munsieville, South Africa

November 2012


Courtney and I had the unique experience of helping a family in Mshenguville relocate their home. Mshenguville is an informal settlement within Munsieville, and the houses there are built on a hill. The houses at the bottom of the hill are in a flood-prone area with poor sewage facilities, and the families in these homes recently got permission from the local municipality to relocate to a different street near Mshenguville and move out of the flooded area. Mshenguville is sometimes referred to as a squatter’s camp because people come to the area to settle, claim an area of land, and build houses out of any available material. Because Mshenguville is an informal settlement, there is no government assistance in providing houses and resources for the community. The government simply gave the families permission to move and would not be providing new houses for the families, so anyone that wanted to move would have to do so on his or her own.


We had the opportunity of helping a woman named Celine and her mom with the moving process. We knew Celine’s mom from the GardenSoxx® class, and when we heard they were relocating we volunteered to help. We started by preparing the site for the new house. We smoothed out the ground, cleared away the rocks, and leveled the dirt in order to create a solid foundation before the house could be physically moved to the new site.


A few days later, Celine, her family, and a group of men started the relocation process. They first had to disassemble the house piece by piece. Then they moved all the furniture, clothing, and pieces of corrugated metal that would be used to reconstruct the house to the new site that Courtney and I helped clear. By the time we arrived in the afternoon to help rebuild the house,  a great deal of progress was already made with the men doing the majority of the physical labor. Courtney and I helped hold a few pieces of metal in place while the men nailed it together, and we watched as the last side of the house was completed. Some of the metal pieces used to construct the house had corroded and could not be used in the reconstruction. The house had to be rebuilt smaller than originally intended because of a shortage of corrugated metal pieces to rebuild the house to its original size. Celine, however, remained positive that she could one day get more materials and expand her house, and she was glad to finally be moving away from the flooded area of Mshenguville.


This week we are compiling health education information and creating pamphlets for the community that will be kept at the Children’s Embassy. We had a meeting with the women in the Health Promotion Unit and discovered that there is a great need for the community to have general health information. Our preceptor asked us to create a series of brochures that would cover health topics such as nutrition and exercise, proper hand-washing technique, HIV/AIDS information, puberty, tuberculosis, and drug and alcohol abuse. We gladly agreed and will be creating different brochures for different age groups and making sure the information is culturally sensitive to the community. We will be writing the information in English and then people at the Children’s Embassy will translate the information to the various tribal languages spoken within Munsieville.


Also, this week we will be conducting part three of our research methods class. This will be the last part of the class, and we will be teaching Excel skills. After the last class, we asked the students to come up with their own short survey and then distribute it to people so that real data could be obtained. If all goes well, they will return with their survey results and we can input the data into Excel to be analyzed. We hope that the students in the class will leave with a better understanding of how to correctly develop and distribute a survey and use Excel to analyze the results. This way they can better understand the community in which they live.


It is hard to believe that Courtney and I have just over a week left in Munsieville. Our time is quickly coming to an end, and I want to savor this last little bit of time before we have to leave this wonderful community. Our sincere “thank you” to the Hope Through Healing Hands and Niswonger Foundations for helping make this incredible experience possible for both Courtney and me.    We hope we made you proud.


Sarakay Johnson



Courtney Massaro
Frist Global Health Leader

Reporting from Les Cayes, Haiti

November 1

Last week I started working nights. I work three nights, then have three off. I’ve decided that despite the fact that I’m not a huge fan of the night shift, that this is the way that I can be the most useful to the Maternity staff. During the day there is an overabundance of staff: 3-4 nurses, 1-2 interns, and 6 (or so) nursing students from the nursing school associated with HIC. At night however, there’s one intern and 1-3 nurses. As a result, at night I’m actually able to not only use my skills as a provider, but decrease the patient burden that each provider has—thus (I hope) improving the care those women/infants receive.

When I arrived to work last night I was immediately clear that we had more patients than beds (we have 20 beds in the maternity—and moved back to HIC Sunday during the day to a cleaner and dry hospital). There were pregnant women and their various friends/family outside on the benches, sitting on chairs in the back of the ward and on any available floor space, and generally milling about.

Most women stay in the Maternity about 6 hours after delivering, so I typically don’t get to see the women I’ve labored with/caught after the end of my shift. So I was delighted to be hailed by a woman I recognized from the night before occupying one of the beds. I had labored with her for a while and had had broken conversations in French/Creole trying to encourage her through her labor (although I speak French, my Creole level is about that of a 2 year old and she only spoke Creole, so you can imagine how profound my encouragement was). She was a G8P7 (meaning she’d be pregnant 8 times, and had 7 living babies, she’s now a G8P8), and just seemed tired, and (from what I can gather) didn’t think she was going to be capable of pushing her baby out. I reassured her that I knew she’d be able to—and of course she had—as I saw her beautiful baby girl lying next to her. I admired the baby and congratulated her, and then went to see about the other patients.

Among them I found a women who had arrived sometime in the early morning of the previous day—as I recognized both her and her husband. At some point during the day she had been given a bed, and was receiving a Pitocin infusion to help move her labor along. This woman was a trooper—she labored hard and long all night.  Despite finally dilating to 10cm the head nurse and the doctor on call that night didn’t think that her pelvis was going to be large enough for the baby to come out (I disagreed, but didn’t feel I could argue my case to them, as it wasn’t my decision) and so around 5am we told her and her family that at 6 she was going to get a c-section. I’d talked a lot with her family members and the woman throughout the night as I encouraged her through her labor and helped her find ways to relieve her back labor pain. As a result, it was always me that her family came to to talk about her case. They were distressed about her having to wait until 6 to give birth, as she was so tired from the sleepless, painful night. I couldn’t say much to that, only that I thought she was doing a great job laboring and that her baby was going to come soon (one way or another). Around 5:30 she finally got the urge to push, and push she did. I was lucky enough to have been able catch her baby girl. She and her family were thankful and overjoyed at the birth, and I was really happy that she got to deliver vaginally—as I though she could all along—and that I got to participate in the birth.

So I left off Blog #1 at my arrival at Samaria clinic on the Kaburu family compound near Ndathi in the Kubaru region.

Susan Kaburu      

Susan is a RN midwife and like her private clinic colleagues acts more as a family nurse practitioner. She assesses and diagnoses and prescribes medication or other treatments and now refers out for deliveries and more complicated cases.


The so-called road to Samaria clinic


Susan tells me that off the road to Samaria Clinic live about 20-30 families or about 100-150 individuals. Most are subsistence farmers. Today the crops are spinach, carrots, cabbage, arrowroot, beets, and potatoes. A big bag of carrots goes for 500KS or $US 5.50 but the carrots being grown here are a variety that is “too fat”” for the hotel and grocery store market, so that the carrots are sold for cow feed at 70 KS a bag. We also see beautiful heads of cabbage left to rot because lack of transportation to a marketplace.


The clinic patients speak the tribal language of Kukuye . Most children are taught English in school so some understand it but they are somewhat not willing to go out on a limb and talk to me. I don’t blame them. I felt the same about my French. Susan encourages them to speak to me in English but does translate for me, especially when the patient has the “deer caught in the headlights” look when I talk to them.

The Samaria Maternity Hospital was established about 10 years ago and up to somewhat recently had three midwives, a lab tech, and four maternity beds for overnight stays. Women came at all hours to deliver. When not delivering, the nurses tended to the

general illnesses or trauma events that happened in the community. It was an exhausting schedule. Susan had also been known to enlist the services of her daughters Njeri and Anne. Njeri tells a hilarious story of being stopped on the road by a delivering mother and having to find a wheel barrel to transport the mother to Samaria in time for delivery.                                                                                                                 

A few years ago a public maternity hospital was opened a few kilometers away and at the same time the exhausting schedule had taken its toll on Susan. She no longer delivers babies and now refers mothers for deliveries. She does still provide antepartum and postpartum care, just not the deliveries. She is the sole practitioner at the clinic and works 9-6pm Monday –Friday and half day on Saturday. This is now my schedule.



Courtney Massaro: First Report from Haiti

Hurricane Sandy and I Arrive

Oct 29 2012

Courtney Massaro
Frist Global Health Leader

Reporting from Les Cayes, Haiti

0ctober 26

Hello. My name is Courtney and I’m a Certified-Nurse Midwife and Family Nurse Practitioner who arrived in Haiti on Monday (the 22nd). I’m working and living in a town called Les Cayes (or just Cayes for short), which is in the south of the county about a 4-hour drive from Port-au-Prince. I’m working at the Hospital of the Immaculate Conception (HIC), which is the main public hospital for Les Cayes (and for a significant portion of the surrounding areas).

I’m quickly getting settled into life in Cayes, and think that I’m really going to enjoy my work and time here.

As some of you may know however, Hurricane Sandy developed this week, and certainly made my first week here interesting.  Cayes is right on the ocean—meaning at sea level—meaning that with lots of rain (i.e. daily, hard rain for 3 days straight) much of the town floods. The hospital—tragically—is not at all elevated, so it succumbed to the same fate as much of the town (see photo’s of me walking to work and the hospital). The largest building—which currently houses the maternity and men’s and women’s surgical post-op—is the lowest of them all. “Luckily” in order to get into that building there are ~1.5 foot high concrete walls (dams of sort) build into the doors—meaning you have to step over them to get into the building and that they prevent water from entering the building even if the hospital grounds are flooded. Despite these barriers (which were working) the maternity and the birthing room still had an inch of water covering it (I was told it came from underground and seeped through the floor tiles). We (the maternity nurses and doctors) worked for a day like this, but eventually the hospital closed and moved the maternity patients to a Canadian ophthalmology hospital on higher ground. It’s finally stopped raining today, so hopefully things will dry out quickly and we’ll be able to get back to HIC soon.

Despite the rain and the craziness with moving hospitals I’ve thoroughly enjoyed meeting and working with the nurses and doctors that I have. They provide the best care they can, given the resources they have available to them (which are pretty limited by American standards).


Hospital Entrance with Flooding

October 28

One of the things that has struck me about my work thus far in the maternity (we’re still at the Canadian hospital, although the town has dried out completely) is how family friendly it is. There is one woman on the service who has been hospitalized for at least 4 days, and 3 of her female family members (including a 1 year old) have basically moved into the hospital with her. They sleep in spare beds right next to the woman (who is hospitalized because at 20 weeks she’s been having contractions) and seem to just spend there entire day hanging out with her.

When I got to my night shift last night that woman’s family were there—as always—and there must have been 15 other visitors (of both genders) who had come to see their respective friends/family members who were at the maternity.

Most of the time the visitors are women—but we’ve had a couple husbands come to support their laboring wives. Those men have dutifully walked up and down the hallway with their wives supporting them when they have contractions, and in general have just been with them. Although the women are alone in the delivery room those husbands who are present are typically waiting anxiously outside and peer in as soon as we open the door (after the birth).

I think that it’s great that the nurses and doctors don’t mind family members sleeping in the spare beds, and on the floor when there aren’t spare beds (as was the case with the number of patients/visitors we had last night). Additionally, I really like that family and friends are so involved, supportive of the woman while she’s hospitalized, and in the case of births so excited about the new baby.


Elizabeth Harris

Frist Global Health Leader

Reporting from Ndathi, Kenya

With the assistance of VIGH staff and faculty, I was introduced to a VU School of Nursing alumna, Poppy Buchanan. Poppy among other pursuits and after extensive world travels established a 501(c) 3 called Burning Bush Inc. (BB).  Since inception BB has supported local community efforts in the Kabaru area of central Kenya. The organization has supported establishment of a private maternity hospital in Ndathi and support of the WAKA Maternity Hospital and establishment of the WAKA Continuing Education Center in Nyeri. Additionally, BB has provided grants to establish micro-lending organization in the Kabaru location. Since my interest is rural family practice, the opportunities to work with BB grant recipients seemed to offer me a wonderful opportunity to begin to realize a long-held vision of working in Africa. More on Burning Bush later.

It is my understanding that Kenya’s government health care system requires that healthcare professionals retire at 55 years old. This undoubtedly leaves a pool of experienced professionals with a bit more mileage yet to be realized in the health care arena. Nearing that age, I must admit that it feels a bit too young to be told you are done. I suppose on the other hand, it does offer a way to be nudged into other occupational or advocational pursuits; or perhaps just a chance to enjoy the “fruits of your labors”. At any rate, some nurses establish private health clinics in their “twilight years”. It may often be the case that these clinics are the only healthcare facility accessible for a community that may cover several square miles. Unless it is an emergency, most clients walk to the clinic and receive any number of health services, depending on the clinic capacity. I will learn more about this system and community issues and will add information in future blog entries.

Kenya! Finally!

I have been talking, reading and writing about Kenya since April and I have finally arrived. Arriving late night October 22nd at Kenyatta airport in Nairobi I was met by Mina (Peter) Kumanya and promptly taken back to his home where I met my host and Minar’s mother, Rosemary, and Minar’s girlfriend Brenda.  Despite my late arrival, Brenda had prepared supper and we all sat down and ate well and visited. Rosemary gave me a review of my schedule and we agreed to meet after her morning meetings to go to the Kenya Nursing Council to pick up my temporary nursing license.

Rosemary a nurse midwife is among other things provides training under the auspices of a JHPIEGO program run out of Nairobi. She and her late husband also established and run the WAKA Maternity Health clinic and Continuing Education Center in Nyeri. Rosemary splits her time in Nairobi, traveling for JHPIEGO around Africa and in Nyeri.  Rosemary has been my primary point of contact and has graciously helped arrange my clinic site stays and generally my maneuvering around Kenya. A well-travelled and experienced midwife, I look forward to learning much about and from her, .More later.

October 23rd

Today I went to the Kenya Nursing Council with Rosemary. It is clear that Rosemary is well received by the staff and Registrar of the Council. After paying my temporary license fee Rosemary and I went to speak with the Standards Officer where we discussed my plans for the next three months. She was quite interested in the Frist Fellowship and the mission of service and collaboration to improve global healthcare. She was open in saying that my site visits were among the best in delivering care in Kenya. We also met with the KNC Registrar who also welcomed me to Kenya and was also interested in the purpose of my visit.

I might point out that the expedited way I received my temporary license, a process that I have heard take months, in days was quite impressive. I am told that during October the Council is busy processing the 3,000 + nursing licenses for the new batch of nurses, so the fact my application was processed so quickly reflects the organizational prowess of the KNC, or that of Rosemary’s willingness to shepherd my application through the process for me, or both. At any rate, I am the proud recipient of a Kenyan temporary nursing license.

Later that afternoon, Mina and I went to a safari walk in Nairobi, akin to the San Diego zoo. Few fences and lots of open spaces. Saw my first albino zebra. Then on to do some errands for me. I had to change some money and pick up a wireless thumb drive for connection to safaricom, Kenya’s largest wireless internet provider. For 3,000 Kenyan Shillings (KS) or about US$33, I have internet access and up to 4 GB of downloads which expires sometime in January. In Tennessee I paid US$60 per month for internet access at home only.

Before I left, my kind cousin Shirley Wayne gave me the phone she uses in Africa which included a SIM card for use in Kenya. Shirley and her husband Scott have a consulting business to help promote tourism in developing areas and are often in Africa. Anyway, through Airtel, a wireless mobile provider, I can prepay for my phone usage. Whenever I run low for minutes, I can “top off” at any number of authorized vendors, including the sundries shops in rural villages. I am told KS$1,000 (US$11) will keep me going for unlimited text and calls for over a month. Kenya is way ahead in ease of use of mobile telephones. No pesky two year contracts or limitations. Is that free market or protectionism?  Unlike US control, SIM cards are not locked so phones can be used many more places with the use of a new SIM card for the local phone network. Although you may not have electricity, many have mobile phones which they use for banking transfers and bill paying.

October 24th

After a stop at the grocery store for supplies in Nairobi, Minar and I headed up to Ndathi about a 3ish hour journey north of Nairobi. I am told that the road from Nairobi to Nyeri was recently built under the direction of the Chinese and meets the standards of the discerning traveler. Up until a few months ago it was a bumpy ride. At Nyeri the road to Ndathi becomes dirt and is under renovation; bit bumpy but an easy passage in comparison to the road to Samaria Maternity Hospital. It is a kilometer of mud holes and crevasses. It is the rainy season and were told to get to the clinic before 1PM lest we wanted to get stuck for the foreseeable future. Despite Mina’s stellar driving, we got stuck in a mud crevasse and had to enlist the assistance of neighbors and passerby to push us out. My host Rosemary Kaburu walked down to meet us and despite her dress shoes and lab coat assisted in the pushing. I can tell she is a can-do- kind of woman. By the way, dry brush under wheels can act as tire chains. When Mina picks me up he will use the 4 wheel drive.

Samaria is on the grounds of Susan’s family’s compound. We were greeted by Susan’s sister Nancy. After having dropped my bags in my room in Susan’s home, I was offered a bit of sustenance of chapatti (a wheat flour thick crepe) with cabbage and carrots. The fields are bursting with beautiful big cabbage and carrots that would make Whole Foods green with envy. Everything is delicious. No rest for the weary so we walk the 50 feet or so over to the clinic and began seeing patients.  

Sarakay Johnson
Frist Global Health Leader

East Tennessee State University

College of Public Health

Reporting from Munsieville, South Africa



Greetings from rain-soaked Munsieville! Over the last two weeks, several storms have doused the Gauteng province, but the rain is necessary to turn the landscape green again and help usher in spring. While the intensity of the thunderstorms is unlike anything I have previously experienced, I am not letting the rain put a damper on my work in Munsieville.


Last week Courtney and I led part two of our surveying and research methods class, and we taught the class how to format and administer a survey. We included lessons on the layout and visual design of the survey, how to format questions and avoid bias, and the different methods used to administer questionnaires and interviews. There were eleven people in attendance, and everyone seemed engaged in the lessons. The best part of the class was teaching about interviewing techniques and conducting mock interviews to demonstrate the process. Courtney and I exemplified both a good and bad way to interview someone and then asked the class to name some positive and negative aspects of our demonstration. Next, Courtney and I paired up everyone in the class, gave them a mock interview scenario, and had them act out a good and bad interview based on what they had just learned. Everyone demonstrated understanding of what Courtney and I were teaching. All the groups really expressed their creativity, and I was pleased that the class was so engaged in the activity.


Courtney and I also got to conduct two Garden Soxx® training classes in Mshenguville. Because Safira had some trouble contacting some of the families, the training had to be rescheduled several times. It was exciting to finally have not one, but two Garden Soxx® classes in the community. After so much interest was shown in the project at the first class, Safira, Courtney, and I decided that a second class would be beneficial so that more people could learn about the Garden Soxx® project. Because Courtney and I had already created our own Garden Soxx® sock and knew how to assemble it, we went to the first class and demonstrated how to create the sock. Once we did the demonstration, we let the ladies there work together to assemble a new sock. At the second class, Courtney and I let the ladies from the first class teach the new members who were at the second class, and the ladies created three new socks together. We felt this was a good way to encourage the women of Mshenguville to take ownership of the project because they are now the ones instructing others on sock assembly. I am excited about the future of this project, and I think that it will be sustainable in the community of Mshenguville.


I am also happy to report that some of the ladies at the Children’s Embassy are starting to use the vegetables from the keyhole garden to made salads for the community! Our preceptor said she enjoyed a tasty salad of vegetables grown from our garden and commended Courtney and me on our work with both the keyhole garden and the Garden Soxx®. It is exciting to get to see the bountiful results of a small initiative that was started at the beginning of my internship.

To conclude this post, I want to mention that one of the highlights of this reporting period was getting to spend an afternoon with Mama Gloria, the sister of Archbishop Desmond Tutu. Desmond Tutu is the patron of The Thoughtful Path and a respected social rights activist who has earned several awards and recognitions for his work. His sister lives in Munsieville, just down the street from the Children’s Embassy.  It was a pleasure to spend the afternoon with Mama Gloria and hear her talk about her daily life and the people in Munsieville. She is truly an inspiring lady, and I am fortunate to have had the chance to meet her!

Courtney Stanley

ETSU College of Public Health

Frist Global Health Leader


These past two weeks have been absolutely amazing, in terms of experiences here and the work that Sarakay Johnson and I have been able to accomplish.  We have been organizing many different projects since we have arrived.  This past week we have been able to implement several of these projects.  The majority have been focused on health education, which is an area that I particularly enjoy.

One of the programs that we have been working on for some time now is the three-part workshop on survey design and data interpretation.  This project was not one that had originally been planned for.  However, once we began working with The Thoughtful Path and their various hubs, it became evident that this was an area that was ready for improvement.  The lack of a complete census in Munsieville, along with the creation of the Health Promotion Unit (HPU), has created a strong need for evidence based programs.  The Thoughtful Path is currently completing a community mapping program and they have already collected data from over 300 households using a survey created by a previous intern.  This is an amazing beginning and I believe with further training key stakeholders working with The Thoughtful Path will be able to create their own surveys and conduct basic interpretations of the data.  To this end, Sarakay and I decided to construct a workshop to address this need.

The first class was conducted this past Tuesday.  This class focused on constructing different types of surveys, developing questions, and wording the questions with clarity, simplicity and neutrality.  Our preceptor identified six volunteers that have been assisting in the mapping project of Munsieville, one member of the Health Promotion Unit (HPU), and two employees of The Thoughtful Path (one including herself) to participate in this class.  After the workshop is completed, they will be able to instruct any others working in Munsieville that will benefit from this information.  The first class was amazing.  I will admit to some nervousness about teaching a class like this.  I was using my public health skills, not in a classroom for some grade, but in a real life setting with people who truly need this information.  There was no professor with a critique afterwards, no one looking over my shoulder to help guide me in this process.  It was just Sarakay and I, using the skills gained from various classes to provide this needed information to people who will be utilizing it to affect, not just the people residing in Munsieville, but also The Thoughtful Path organization.  I feel that it went very well.  Everyone was engrossed in the topics discussed.  We spent the first hour lecturing over the topics for that day’s class and then we organized groups of three to work on a project.  The participants chose their own health topics and constructed their own short survey to obtain information.  After the surveys were completed, a member of each group presented their survey.  This part was absolutely amazing!  Everything we had discussed that day they were able to utilize in their project.  Not only were they able to use the information we gave them, but they went on to explain why they had used a particular method and not the other, why they had constructed a question in a certain way, and how they would chose to conduct an interview over administering a questionnaire. Needless to say, I found this quite inspirational and am working to make the next class even more challenging and provide more information.  I have complete faith that these individuals will use everything we can give them to make The Thoughtful Path that much stronger.

The next project we worked on was a two-fold educational class for a youth camp.  The camp was for a group called the Young Ambassadors.  These kids range from 14 to 18 and are a part of The Thoughtful Path.  Part of their work with The Thoughtful Path is hosting monthly fairs for the younger children living in Munsieville.  This camp was a week long, and during this week they attended different classes on topics such as preventing teen pregnancies, STDs/STIs, nutrition, exercise, along with creating goals and action plans for their group.  Sarakay and I taught a class about exercise, and then another about proper nutrition.  During the course of this week I was informed of something that I found to be quite surprising.  The schools that these children attend do not offer formal health classes.  So, much of the knowledge that these kids had was largely inaccurate.  Also, some of the topics discussed were something they had never heard of.  During my portion of the nutrition discussion, I talked about carbohydrates, sugar, sodium, proteins, fiber, calcium, fats, and calories.  Most of the kids had no idea what these were, and a few could accurately define one or two of them.  What I did find to be most concerning though, was their knowledge on sugar and how it affects diabetes.  These kids had heard of diabetes, but only a handful could tell me what it was, how you get it or what happens when you have diabetes.  Some of the questions were “Can you die from diabetes?” “Is there a cure?” or “I eat sugar does that mean that I have diabetes?”  And diabetes is prevalent issue here.  This culture consumes much sugar and refined carbohydrates, and very little protein and vegetables.  When we said that the recommended amount of sugar was less than five servings a week and one teaspoon equals one serving, the kids were shocked.  One even spoke up and said it was a regular occurrence for him to add at least ten teaspoons of sugar to one pot of tea.   What really inspired me though is that these kids want to learn so badly.  They had no hesitation in asking questions.  Anything they wanted to know more about, they were not scared to ask.  They definitely put my knowledge to the test.

 The other class we taught that week was the exercise class.  This class was so much fun!  We began by conducting a 30 minute lecture.  I discussed why it was important to exercise and the health benefits from a regular exercise program, and Sarakay talked about how much exercise is appropriate and the health risks from not exercising regularly.  We were adamant of emphasizing that everyone has different body types and that they should exercise to be healthy, not just to look a certain way.  Here, as it is in America, these kids have a certain body type that is upheld to them as the “ideal” image.  We were asked many questions on “fad” diets, if they really do work, and what they could do if they wanted to look a certain way.  We were sure to stress that a proper exercise and nutrition regiment would optimize their health.  After the lecture portion, we went outside for the hands on portion.  We demonstrated stretches, cardio, and strength training exercises that could be performed at home without any equipment.  After the demonstration was my favorite part: a competition between the kids to see who could either remember all the different exercises or exercise the longest, whichever came first!  So, we turned on some loud dance music, put them in a circle, and started yelling out different exercises.  After several songs had played through, we had our top three winners which we awarded prizes to.                   

The third project that we worked on was the training for the GardenSoxx.  The vegetables we will be planting are tomatoes, spinach, and lettuce.  These were chose because of their nutritional value, the relative ease of growing them, and the cultural acceptance.  We worked with two members of the HPU learn how to properly create and care for the GardenSoxx, and we will be going into Munsieville with the members of  the HPU to assist them in teaching the selected families.  This project has taken longer than I expected to get off the ground, so to speak.  This is largely due to the structuring of Munsieville.  Even after we were able to locate all the families selected to participate in the program, there is the issue of coordinating a meeting.  We can not ask the families to walk to the Children’s Embassy and walk back with their GardenSoxx.  So, Mama Safia has been attempting to identify a central location where everyone can meet, and then set up a day and time that is convenient for everyone.  This is more complicated than it sounds, considering that not everyone has a source of communication.  Therefore, much of this has to be done by word of mouth.   

This internship continues to be a challenging but rewarding experience.  I cannot believe that the time is going by so quickly.  In the next five weeks, we have many projects to complete.  Soon, time will become the biggest obstacle to work around.  There are so many projects I would like to begin, but the timeframe is just not feasible.  I know that any future students wanting to complete their field experience with The Thoughtful Path would be able to continue projects that we have started here and initiate many rewarding ventures to improve public health in Munsieville. 

Courtney, reporting from Munsieville, South Africa

Sarakay Johnson
Frist Global Health Leader

East Tennessee State University

College of Public Health

Munsieville, South Africa


Class, Camp, and Compost.  What do these three things have in common?  They all relate to the work Courtney and I completed last week.  We have been working hard on three different projects, and I am very excited about what we were able to accomplish.  


Our first big project of the week was to teach part one of a surveying and research methods class.  In September, Paul Brooks, the director of Project Hope, visited Munsieville with some Project Hope board members in order to check up on The Thoughtful Path’s operations.  He discussed the importance of community mapping and surveying in order to better understand the Munsieville community.  He stressed the need to get quantifiable survey results so that statistics could be interpreted and the needs of the people addressed. After hearing this Courtney and I talked to our preceptor and suggested putting together a three-part research methods class that would help teach volunteers and workers from The Thoughtful Path how to design their own surveys and interpret the results. In this way they would be better equipped to assess the needs of the community.  We presented the first class on Tuesday of last week.  There were nine people in attendance, including our preceptor, and I am happy to report that it was a great success!


In this first class Courtney and I discussed how to design a survey and covered the different types of surveys, types of survey questions, and emphasized clarity, simplicity, and neutrality in wording of questions.  We also had everyone participate in a group activity in which they had to choose a survey topic, design survey questions that would address that topic, and then explain how they would conduct a survey on that topic.  One lady in the class was so inspiring as she got up to present her group’s work.  She demonstrated understanding of all the topics that Courtney and I had covered in the class and gave an excellent presentation! It was encouraging to see that the first class went well.  Courtney and I have already scheduled the next class for the middle of October and we will be teaching ways to format a survey.


The next big event was participating in a youth camp where Courtney and I taught lessons on exercising and nutrition.  This was an unexpected project, but it turned out to be a pleasant surprise and a lot of fun.  The youth camp was a weeklong event for youth in Munsieville that range in age from approximately 15 to 18 years.  There were 18 participants at the camp and they were learning different life lessons so that they could then teach these lessons to other younger kids in the Munsieville community.  This really is an amazing group of youth and it was so fun to get to spend time with them.  Surprisingly, most of them do not receive any formal health classes in their schools, so they were really listening to the exercise and nutrition lessons that Courtney and I were teaching.


For the exercise class, Courtney and I spoke about the importance of exercise on a daily basis and what happens to the body when it does not get enough regular physical activity. We demonstrated some basic exercises that the youth could do at home without any formal workout equipment.  After doing the various exercises with them, we played a game called The Last Man Standing where Courtney and I called out the different exercises we just taught, and the youth had to continually do them until there was just one person left doing the exercises—the last man (or woman) standing.  This was a lot of fun and it was interesting to see how competitive everyone got with each other.


On Thursday of last week, Courtney and I taught the nutrition class.  This was highly relevant, as most of the youth had never heard about the food pyramid, portion sizes, or the importance of a balanced diet.  Everyone seemed very engaged in the lesson and quite a few questions were asked about diabetes and low-sugar and low-sodium diets.


The final project of last week involved creating our own Garden Soxx® so that Courtney and I could better understand how to create the “sock” once we train the families.  Courtney and I cut the black mesh material, filled it with compost, and tied off the ends of the material to create the “sock.”  We then planted nine starter vegetable plants inside the sock.  This involved cutting holes in the sock and digging away a small hole with our fingers in order for the starter to have a place to grow.  Now that we better understand how to create a proper Garden Soxx® garden, Courtney and I can teach the families how to grow these gardens in their homes in Mshenguville.  The small keyhole garden that Courtney and I planted at the Children’s Embassy at the beginning of our time here is thriving.  It is exciting to see a garden full of leafy green vegetables that once started out as small starter plants.  All the mamas at the Embassy are excited about getting to eat these vegetables in a few more weeks.  I believe that the Garden Soxx® project will be just as successful, if not more so, as people learn to grow their own gardens for themselves.


I remain positive that the actual process of teaching the families and talking to them about the gardening initiative will happen soon.  The training process was supposed to happen last week, but it is now rescheduled for this coming week.  Mama Safira, who walked through Mshenguville with Courtney and me to help us find the houses a couple weeks ago, has had trouble contacting the five families and getting them together to meet.  This actually made me aware of how often I take for granted the ease of communication that is available in the US.  Not everyone in the township has a cell phone, and it is not like Mama Safira can simply e-mail a Google calendar or send an event reminder on Facebook.  She has to go door-to-door and speak with everyone and make the families aware of what we are planning.  Hopefully we can get all the families together soon so that they can start growing their own gardens.


Last week was a busy week of work, but it is exciting to know that Courtney and I are getting things accomplished and making a difference in the Munsieville community.  I look forward to my next report and giving details of further work.

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