Hey y’all! Today is Monday, August 22nd, 2023. This was the Ukweli 2023 team’s sixteenth full day in Sierra Leone.
Another day, another successful set of interviews. Today, we went to Binkolo. It was another early morning, but it’s been necessary to get our early starts so we can finish up our interview transcriptions by the afternoon. Everything went straightforward and smooth today–a rare moment for us. We hope your day was just as simple!
Until next time, yours truly,
Ukweli 2023
Hey! Today is Sunday, August 20th, 2023. This was the Ukweli 2023 team’s fourteenth full day in Sierra Leone.
Today felt like one of our longest days yet; it was a truly packed work day. Our team woke up at 6:30am today, hopping on board a 7:00am ride to Gladys Hospital with the Sickle Cell Education & Diagnostic team. Gladys Hospital is a great facility that we have not had the chance to see yet, but have heard about a great deal. A lovely thing about Sierra Leone is how people allow their day to flow naturally; the day begins when the sun rises, and all work is done an hour or two before the sun sets. 7:00am felt feverishly early for us, but kids were up and playing hopscotch, using their washboards, and eating breakfast.
Brooke Lee and Lorraine Rwasoka join in for hopscotch.
The head matron of Gladys greeted our team and showed us around the facility as we waited to begin our interviewing. As usual, the kids were very interested in us. Lorraine Rwasoka and Brooke Lee hopped in a 7:30am game of hopscotch… Sterling Salmini needed some time to wake up on the bench. By 8:00am, all of us and our translators were on our way in four directions through the town, introducing ourselves to locals, getting to know women, and speaking with many. Sundays are great days for interviewing because of how many women are around and available. It is a day of relaxation before the work week. Although it probably doesn’t seem so relaxing to talk about cervical cancer in the morning, we think the women have felt it has a nice part of women’s days to have the opportunity to speak about private issues and get a sense of support for reserved topics.
The beautiful community of Mombolleh that we visited in the afternoon.
The people in town were talkative today—although we only had about two hours to talk, we logged over thirty-five interviews collectively! During a bit of waiting for a ride home, we had some fried beans and snacks under a palm tree. Reeza Chaulagain gave the translators their own photo shoot. Photography has become an unlocked passion of Reeza’s this trip.
We headed back to the World Hope International office for photo day. The program and all teams got photos together. Translating took all afternoon for us, as it usually does. We all agree that the translating is definitely much more draining than the interviewing itself, as we aren’t interacting with anyone, and it’s quite meticulous and tedious. Sterling and Memunatu were incredibly tired today from no breakfast, so went out to grab bananas, apples, popcorn, and an energy drink for the rest of the afternoon. They powered through most of their interviews, but nobody was able to finish up today.
Around 4:00pm, most Fellows headed over to Mambolleh to attend a memorial for Samara Everman. Samara, a two-year Ukweli member, passed away last month. She was planning to join us for this trip. Words on a blog post do no justice to detail the character, love, and determination of Samara. Her memorial at the Mombolleh peripheral health unit shines a tiny light on how caring she was to her core.
💙
All smiles and great energy at Mombolleh.
Tonight, our team began working on our presentation for the General Hospital staff on cervical cancer. The valuable information we are providing from last year’s interviews, research paper, and this year’s findings are something we greatly hope can motivate more stakeholders to invest in cancer education and HPV vaccination throughout Makeni. Memu came to the hotel tonight to help Sterling wrap up today’s interviews. We all have some to finish up tomorrow.
It was another long and tiring day, but a greatly appreciated one. Every day we are here is a beautiful opportunity to meet new, bright minds, play with children, and foster a great passion and work ethic to exercise our dedication to maternal health. On the hardest of days, we have the most love for Sierra Leone. We know tomorrow will be busy and we are excited to see the new connections it holds.
Until next time, yours truly,
Ukweli 2023
Welcome back. Today is Thursday, August 17th, 2023. This was the Ukweli 2023 team’s eleventh full day in Sierra Leone.
Today was the team’s first day of research. We divided into three groups: Brooke Lee with Alieu, Reeza Chaulagain and Lorraine Rwasoka with Suleiman, and Sterling Salmini with Memunatu. Today was dedicated to conducting pilot interviews so we could assess the quality of our interview questions by looking at the responses we got from the women in the communities near the World Hope International office.
Everyone agreed that conducting five pilot interviews, so that not too much time was lost to these tests, would be most productive. Following that, we planned to feel out the process of translating after the interviews were finished. Moving forward, because we lost so much time waiting for the Institutional Review Board’s approval, we need to make sure that we nail in our questions. We wanted to take today to ensure that our questions will be understood in a way that doesn’t require over-explanation from our translator, while also taking advantage of our translators’ bilingual skills and ability to express the questions comfortably. Most of all, we wanted to ensure questions would not be misinterpreted, and that they will be very direct questions; this way, we can get very direct data that can support our research paper, and have the largest sample size possible.
We decided to have ten “core” questions in our interviews. Those questions came from the question bank we created and shared with our blog. We are not at around thirty in total. The approach Brooke and Alieu took was to start with these questions but adjust course in the event the women didn’t know what human papillomavirus or cervical cancer was. The team would need to switch up which questions should be asked, or the order they were asked in that it would be a productive interview. What we all found was that even when all ten questions were asked, the interviews were only around six to seven minutes max. Instead of cutting the interviews short at these pilot questions, we decided it would be more productive or beneficial for this first day to experiment with other questions from our word bank. This way, each interview was able to hit closer to fifteen minutes, and we got more data and information that we could use later when we re-convened to decide how we move forward for these next interviews.
After each group finished about five interviews, we all walked back and met back at the World Hope International office to start the daunting transcribing and translating process. Each team member sat down with their translators, munched on some food, and whipped out the earbuds that would be shared by translators and team members. We dove into the audio recordings. The ideal process we wanted to go through was transcribing (meaning writing the audio in Krio first), then translating that transcribed text to English. We found that our translators weren’t very experienced or skilled with typing, so every time they were asked to transcribe, they would have to look for the individual letters on the keyboard before typing each letter of a word. Meaning, that when we tried transcribing just one sentence it took well over twenty minutes. This would not work whatsoever.
We decided that wasn’t a sustainable strategy, especially because we lost so much time waiting for our approval. How we are now approaching this process is translating the audio directly into English. So each team member will be on typing duty, and our translators will be in control of the audio. As they will listen to fragments of the sentence at a time, they’ll translate to us what is being said verbatim into English. Even with skipping the transcribing process, Brooke, Lorraine, and Reeza all experienced those translations that took up to five hours to conduct just for the five pilot interviews. Sterling had a slightly different experience and conducted thirteen short interviews with more yes or no results, so the translations didn’t take as long. All of this was valuable insight so that we could compare all the data and make sure that we discussed what we thought went well and what didn’t go well with each audio.
After translating, we went to dinner and we had delicious spaghetti that Professor Khanjan Mehta cooked for us. It was Sterling’s favorite meal of the trip. After the program-wide meeting, we met with Khanjan. The purpose of this meeting was to go over our data and see what did and didn’t work. We found the first four questions were good and got good results. We decided these are valuable questions that would offer concrete data for our paper. The next problem we had to address was that our current question set didn’t yield any unique data; we had a lot of the same responses that Samara Everman had. Khanjan emphasized that we needed to think about the current literature about cervical cancer and human papillomavirus in Sierra Leone, providing something unique.
We asked ourselves what is missing from this information and what we thought we could offer insight on as we are here in the country. We were all intrigued by the idea of cultural concepts on health; specifically, how people perceive sex in their community, male authority, Muslim modesty, and community beliefs.
This, we believe, is valuable insight that there isn’t a lot of data published on. We have tuned our questions a great deal and are super excited to collect some new data. Our team also wanted to address the issue we were running into when we were interviewing when women did not know anything about either cervical cancer or human papillomavirus–how do we continue the interview from there? We decided to format our new document in two sections. The first listed our core questions, then if women did not know anything about the two topics, we followed up with a short script briefly explaining each of those. Sexual education is a pivotal part of our project, as human papillomavirus is caused by sex and leads to cervical cancer. It is crucial then that we address the knowledge issue at the source if we want to impact the preventable problems that eventually snowball into the development of cervical cancer.
Today held many lessons and much progress for our team. We are excited to excel and find our flow with the interviewing. Hopefully, we can hit our goal of two hundred!
Until next time, yours truly,
Ukweli 2023
Why hello again! Today is Wednesday, August 16th, 2023. This was the Ukweli 2023 team’s tenth full day in Sierra Leone.
We finally got Institutional Review Board approval! Before we get ahead of ourselves, we will catch you up on our morning leading up to the exciting news. Our morning kicked off with a dose of anticipation as we geared up to join Edwi Abu’s screening team for a firsthand look at the cervical cancer screening process in various peripheral health units. Bright-eyed and bushy-tailed by 7:30 AM, we eagerly awaited the adventure ahead. However, fate had other plans; our hopes were dashed when the driver failed to show up. A disappointing start, for sure, but we are not new to this game. We decided not to let this setback hold us down.
With our plans for the morning unexpectedly freed up, Reeza Chaulagain, Brooke Lee, and Lorraine Rwasoka took the opportunity to tag along with the Fighting Nutrition in Sierra Leone team. Sterling Salmini took the morning to rest. Their team’s goal was to gather ingredients for some delicious muffins. The first stop was Mohammed Jawara’s shop, followed by a quick grocery store visit. The journey then led to their bakery which was a fascinating glimpse into another team’s everyday world. We struck up conversations with the friendly neighbors next door. The neighborhood aunties, kids, and even a baby who wasn’t quite sure about us made us feel very welcome. Kudos to Lorraine for soothing the baby who was terrified of Brooke, a superhero moment for sure.
Reeza made the most of the change in scenery. She teamed up with Abby Schwartz to peel ginger for their muffins. Crossing the road, the team discovered a bench area that doubled as a massive checkers board. As it turns out, checkers is called “draft” in Sierra Leone. Despite our best efforts, the local pros had us beat. The day took an exciting turn as the team reunited with Sterling, who brought fantastic news: the Institutional Review Board had given us the green light. With that hurdle cleared, we dove headfirst into preparations for our interviews tomorrow. Time is of the essence, considering we’re on a tight seven-day schedule to wrap everything up. Recognizing the challenges ahead, we made a strategic decision to bring in the Sickle Cell Education & Diagnostic team’s translator. With three translators in our corner, the four of us can navigate interviews and transcriptions more efficiently. We are ensuring no stones are left unturned before our departure tomorrow morning.
In some final preparation this afternoon, we went over how to use each recording device and firmly solidified our interview questions–pretty good for a single day’s work. As for dinner, we hear Khanjan is cooking up chickpeas again, which we always look forward to because it’s his specialty. On top of everything, we get to pick up our shirts and skirts from the tailors. We can now conduct our interviews in style, haha. While the morning didn’t go as planned, it unfolded into an unexpected journey of small connections and flexibility. As the pieces fell into place, we discovered the true essence of adaptability and teamwork that we’ve grown in navigating Sierra Leone. These lessons are invaluable in our mission to make the most out of every situation.
Until next time, yours truly,
Ukweli 2023
Hi again! Today is Tuesday, August 15th, 2023. This was the Ukweli 2023 team’s ninth full day in Sierra Leone.
Have you ever been showered with so much love and attention that you’re left wondering if it’s all even real? Today was that type of special day for us. In the morning, our team headed to the Makama Hospital. Lorraine Rwasoka and Brooke Lee were making their second visit, and Reeza Chaulagain and Sterling Salmini got to join as well. It was antenatal Day at Makama, a day when mothers bring in their little ones for check-ups. And let us tell you, it was pretty busy and fascinating to watch! We observed kids being weighed on a standing scale, with a bucket and pulley attached so they could float–got to admit, that is pretty ingenious. Moms and children were relaxing in the waiting room, while nurses traveled back and forth, checking boxes and babies with practiced speed.
For the first part of the morning, we found ourselves in the nutrition room. There, we had a chat with a new mother and got to know her and her home a bit. Once she left, we stepped outside for a moment. We were met by a bunch of children all around! We had a blast getting to know these energetic and bright kids. Sometimes, we find that adults are–understandably–more apprehensive to immediately connect with us. But kids have been a great joy to get to know. Often, with the difficult context of our project, adult conversations stay serious. It is with kids where it is them asking the questions instead of us, wanting to know every little thing about our home. We played games, taught each other dance moves, and swapped favorite songs. Children loved Brooke’s hair, giving her a fancy new design (that will not make its way back to the States). After a couple of downtrodden days, their energy was contagious.
For example, Reeza got to know a boy named Daniel. When we asked about his future ambitions, he replied that he wanted to become a bank manager, and loved mathematics. It was very impressive because not a lot of kids in Sierra Leone choose such a clear-cut career path at a young age. The most striking thing about children in Sierra Leone is how bright they are. They are better at English than most adults, are creative with the ways to pass the time and have a love of learning. Yet often, children do not speak of Sierra Leone with the ambition they see America with. It highlights the great need for our support and research contribution to happy, healthier lives here. There are so many beautiful minds all around us, it has been a great gift to be the recipient of much knowledge and affection
As the morning winded down, the multitude of our interactions began to weigh in. Those heart-to-heart talks with the kids made us realize the tough realities of opportunity and privilege disparities so many face. It was also a testament to the deep interplay of economic, health, education, social, and career stagnation that we have peeked into firsthand through our Institutional Review Board troubles. In all the love was a reality check that hit us hard. The mix of humbling experiences and surreal moments left us reflecting for a while after our morning, and we carried that for the rest of the day
Back at our second home, the World Hope International office, we had hours of downtime to kill. We skimmed through some research papers on cervical cancer, read our approval board letters again, and coordinated with Edwin Abu for a potential fallback plan to visit a cervical cancer screening site later this week. For the rest of our afternoon, we did some team bonding. Brooke introduced Reeza to the grapevine/karaoke dance move–our security guard Abu joined in too! We played Simon Says, and Ninja, and feasted on coconuts. Brooke’s continuing multi-day effort on a photorealistic drawing rounded out our time until dinner.
Today was an introspective day for the Ukweli 2023 team. We took on the day’s opportunity and gave ourselves some emotional momentum. We appreciated the day we spent.
Hello. Today is Monday, August 14th, 2023. This was the Ukweli 2023 team’s eighth full day in Sierra Leone.
We are still awaiting our Institutional Review Board Approval. Professor Khanjan Mehta traveled to Freetown today and was able to meet with personnel there to get context on what can be done to push the amendment through or get an expedited look at a new protocol. We are hoping to begin our research on Friday, giving us the last six days to work. Although the circumstance of today was no different than the last week, it was a much more down day. All of us are in a bit of a funk.
We’re just about halfway done with our trip. Today felt like we were not here in Sierra Leone–exploring, enjoying, and learning. Instead, we remained at the office all day. Yet, it takes a day like this to dig deep into our gratitude and find things to appreciate about our surroundings. It takes energizing ourselves to make an opportunity out of the one-of-a-kind place we are in. Even amid challenges, Ukweli is special because we know how to pick each other up and get each other moving.
Gratitude will always lead to opportunity; tomorrow is ready for us if we are ready for it.
Until next time, yours truly,
Ukweli 2023
Hi. Today is Sunday, August 13th, 2023. This was the Ukweli 2023 team’s seventh full day in Sierra Leone.
Slow days are bound to happen when you are handling a big team project. These days are when your stamina as a group is tested. It is when your motivation that is typically natural is no longer apparent. Everyone could be frustrated and tired. Our Institutional Review Board is taking much longer than expected for approval. Keeping our fingers crossed and hoping for the best is getting a bit tough–yet it is during the emptiest days that our strength in creativity shines.
At breakfast, Professor Khanjan Mehta came to our table quietly. We could tell from the look on his face that something was frustrating him. He asked us if we wanted to hear the good or bad news first–how great. The good news was that the Sierra Leonean Institutional Review Board office had gotten back to us with some word–finally! The bad news was that they claimed our protocol was different from last year’s. This is a huge issue as we submitted our protocol under an amendment ($100), which is a less costly and busy update process, rather than a whole new study ($400). So from what we’ve heard, our study should have to be treated like a new protocol and not like an amendment. Paperwork, new cover letter, Lehigh’s verification, et cetera–do these things matter? Of course. But from the tone in Khanjan’s voice, and with a confirming nod from Lorraine Rwasoka, they knew what the barrier truly was: the bottom line is we have to pay more.
Lorraine says this is Africa. This is what happens when you are engaging with a bureaucratic system. They will frustrate you and delay everything until you pay up. It is all about paying, paying, and more paying. You have to force your way through, often with dollars. This is what is always going to happen when trying to implement change. It is never going to be easy, but that is the whole point, right? It sustains uneven power structures, although the work we are pursuing is so wholly important for the health of Sierra Leoneans that the painful process evidences how all issues, from systemic health crises to poverty, are rooted in the extractive institutions of bureaucracy.
Nothing about this is not easy–but that is exactly why we are here. Slowly but surely, we will accomplish our goal because it was never meant to be easy. That is why our issues exist! Today evidenced how deep the systemic crises of a low-resource setting are at interplay–health, government, education, poverty, and all.
Today, Brooke Lee and Lorraine took an exciting journey and took us to Makamba Hospital alongside the Mothers of Sierra Leone documentary team. While we anxiously await research approval, they took the opportunity to explore the heart of a healthcare facility in a rural area. They get to engage with a healthcare professional, and grasp the essence of healthcare in this distinct environment, helping us understand the education and healthcare resources we can anticipate to hear about from our interviews.
The contrast between Makamba Hospital and the wealthier Holy Spirit Catholic Hospital was immediately apparent. Makamba’s three rooms spoke volumes: one was dedicated to nutrition and checkups, another was bustling with the presence of dedicated nurses, and a third was a haven for women’s health and childbirth. The sight of a bed equipped with leg stirrups in the women’s health room stood as a testament to the multifaceted care provided within these walls, often doing so much with not enough. Makeni has been a deep lesson in the privilege and luck we are afforded, simply to be born in a different setting. The hospital’s patient manager relied on a comprehensive booking system, emphasizing the importance of appointments. When the hospital is an uncharted journey for a new expectant mother, the compassionate nurses seamlessly guide them to the main general hospital. This procedural synergy ensures that every woman receives the care she requires, full of love.
Care room at Makamba Hospital.
In the central part of the building, there were a few benches that each team utilized as an opportunity to have a conversation and ask questions with the healthcare professional there. Her name was Sister Makbenti. Amidst the diverse questions raised by the Sickle Cell Education & Diagnostic team and the Mothers of Sierra Leone documentary team, our Ukweli 2023 team was focused on human papillomavirus A glance at the wall poster revealed a plethora of disease statistics, including human papillomavirus, which made the group hope that the hospital conduct testing. The hospital’s testing focus encompassed hemoglobin levels, human immunodeficiency virus, and urinary tract infections, surprising us with a poignant connection to our work.
The Ukweli Test Strips we created are utilized for testing at Makamba Hospital! This was a full-circle moment for us. It was so surreal to see all the years of hard work and dedication by each team member through the history of our project pay off and help women. Next Tuesday is antenatal day at Makamba. On this day, the nurses will demonstrate the application of Ukweli Test Strips. However, this timing might conflict with our research approval and interviews (hopefully).
We enjoyed some coconuts today.
First, the coconut is chopped. Next, you drink the water. After, you split it in half, scoop the coconut meat, and enjoy!
Lorraine and Reeza got a chance to head to the market today, for Lorraine’s first experience. They said it was a busy Sunday! Sterling Salmini and Brooke were able to write the foundation of our eventual cervical cancer research publication. We began by outlining our abstract, going in depth to the background of the cervical cancer crisis in Sierra Leone, as well as the value that our quantitative and qualitative data will provide in forming effective education initiatives for low- and middle-income country governments and non-governmental organizations. They were able to get about seven pages in, which is a great start. We cannot wait to fill it with data.
The rest of the day was quite mundane. We went to dinner, saw a beautiful sunset, and had a long program-wide meeting tonight. The weather in Makeni tonight was lovely. It didn’t rain so much today, but it was still cool without being too cloudy. It’s the first night we can remember seeing a sunset this week! All the teams got an opportunity to give pitches of their project with a stakeholder audience in mind. Everyone had the opportunity to receive feedback on problems they are confronting, ways to present their value proposition stronger, and actionable steps to complete our goals. After that, we shared some drinks and played card games, having a great night and laughing. The nights make it all worth it!
Our first sunset in Makeni!
Despite difficulty, today was a productive day to be grateful for. Reeza and Lorraine got to experience the excitement of the marketplace, Lorraine saw a Sierra Leonean hospital as well, and Sterling and Brooke made great progress on the cervical cancer research paper. We are hopeful to see what tomorrow holds, and if Khanjan and Professor Michael Kramp’s expedition to Freetown (that has a stop at the Institutional Review Board Office!) can get our research approval through. Fingers crossed, yet again. Regardless, tomorrow will be a great day!
Until next time, yours truly,
Ukweli 2023
Hey! Today is Saturday, August 12th, 2023. This was the Ukweli 2023 team’s sixth full day in Sierra Leone.
Our first weekend in Sierra Leone, woo! The program slept in yesterday, with a later breakfast and departure time than the weekdays. Following a night of chess games and engaging discussions, we added a touch of relaxation to the day. The morning greeted most of us with an unexpected chill. Initially attributing it to the air conditioner, we soon realized that the persistent cold was due to the rain pouring all night long. It was the most rainfall of any day yet.
Our pop-up plans to visit a nearby health clinic today were shelved due to bad weather. However, we compensated with a delightful pancake breakfast and a cozy yet crowded ride to World Hope International. Six of us were squeezed into the back of a pickup truck. Reeza Chaulagain found herself on Brooke Lee’s lap, and Lorraine Rwasoka sat on Olivia Soder’s. The World Hope International office is empty on the weekends.
Global Social Impact Fellows Olivia Soder and Hannah Falatko.
Last night, Lorraine Norman Zvenyika finally arrived in Bombali. Their arrival in a vibrant yellow taxi last night felt like it must have been smoother than the bus we took. Their presence transformed the atmosphere of our day, giving us some life and excitement into what would have been an otherwise slow day. The delay with the Institutional Review Board approval has been very tedious. We do not have control over the situation, unfortunately. Still, we have found ways to make progress on our ultimate goal of improving the lives of mothers in Sierra Leone.
Yesterday, we gave Lorraine a whole breakdown of our project and questions so far. She loved the look of everything. From the question bank (over thirty now), we narrowed our first draft of questions to the best ten. We feel as though the ones we selected will give us the most holistic understanding of Sierra Leonean women’s perception of cervical cancer and receptiveness to human papillomavirus vaccination.
Here are the ten we chose to ask:
Exercising flexibility and using our intuition to see the depth to which a woman is responding to the questions, as well as listening to her awareness level surrounding cervical cancer, will open up doors to other questions that require more information to analyze. These are typically questions about government protocols, community leadership, and cultural stigmas.
United Nations truck spotted at World Hope International.
We dedicated the rest of our early afternoon to crafting explanatory blurbs on cervical cancer and human papillomavirus. Noah supported our idea to prepare information to educate anyone who responded they did not know about these things at the beginning of the interviews.
Additionally, we delved into previously published papers on cervical cancer and women’s health. We explored the outcomes of research experiences similar to our in-country immersion, finding ways to collaborate information and arrive out of this year’s fieldwork journey with actionable steps towards mending the crisis. To even be here itself is a step towards our goal, of being able to speak with so many bright minds and kind Sierra Leoneans about our work. People in Makeni are interested and receptive to the research we are pursuing so far, and we hope this continues as we branch out to more rural areas for the official interviewing.
As the hours passed, we ate coconut cookies and chatted with each other. There is not much more that may be done now to prepare. The flooding subsided after a few hours, and it was surprising how fast the sun dried up the rain. In the afternoon, the program embarked on an adventure to the village of Magbento. Magbento is not too far out from Makeni, but it is certainly a rural village.
The village of Magbento.
Despite the tight quarters of the pickup truck, our view of swamps and majestic palm trees was a beautiful experience. Stepping off the truck, we were attacked by wild ants, promptly mitigated by our insect repellent. A dozen bottles of bug spray lingered as we ventured into the forest, guided by charming local kids, on a hike to the river! Their kindness is heartwarming. We were met with half a village at the river. The Magbento residents are incredibly kind. The children enjoyed singing, dancing, mimicking, and playing games some of the girls showed them. This experience felt surreal–how many opportunities may we have in our lives to hike to a Sierra Leonean river?!
Magbento is a quaint village and became the stage for a lively soccer match with the women of the village. Their competitiveness was palpable. It is amazing how athletically gifted the children were. They’d never lose stamina or energy after hours of running. Mohammed Jawara treated us to some pine wine, and the flavor was great. It’s straight from the trees!
They kept up for over a mile behind our truck.
Reeza squares up for a free kick against Sofía Espinoza.
After that, we returned to our usual dining spot for dinner, then visited a nearby local tailor to purchase some beautiful fabric. Everyone then gave our measurements for custom tailoring. The experience was awesome–we engaged in negotiations and selected some lovely African prints. Lorraine, Reeza, and Brooke bought dresses. Sterling bought a skirt.
We came home tonight, and everyone needed a bit of time to relax after the long hike. Our team eventually came to Reeza’s room, playing Egyptian Rat Screw and chatting for a while. When the main hall opened up after a meeting, students met in there, played games, laughed, and enjoyed each other’s company all night. It is lovely to be around each other. It is crazy to think we’ve all been in class with each other all this time without really interacting, yet here we are, five teams, twenty-five-ish people, spending each night together in West Africa, playing games, sharing drinks, and laughing.
With nights like these, it makes us not mind our missing research approval so much. It reminds us that we are here. We are in Sierra Leone. And there is so much to be grateful for.
Our friends in Magbento!
Until next time, yours truly,
Ukweli 2023
Good evening!
Today is Friday, August 11th, 2023. This was the Ukweli 2023 team’s fifth full day in Sierra Leone.
Today was a lowkey day, allowing us the time to dive deep into our interview questions after observing yesterday’s mock interviews. It is important to make sure each question is crystal clear in its intent, simple, and easy to grasp. We sat down for a couple of hours this morning to review our questions. We also took time to think forward, brainstorming about potential paper topics that could bloom from our research focus.
A few of our yes or no questions (e.g., “Have you heard of cervical cancer?”) are simple and the most pivotal in commanding support for health crises. Looking at last year’s research, Sierra Leoneans who were aware of cervical cancer universally agreed that educating about cervical cancer is paramount–yet barely anyone gets proper education on it. We are very mindful not to expect what we may hear from women. Yet, given the urgency our connections so far have discussed the cervical cancer crisis with, the depth we anticipate hearing about the issue with is undeniable.
The World Hope International office in Makeni has become our second home.
Our team also got to add new locations to our planned list! We aim to get ten locations locked in, and with two groups, that’s ten interviews each at all locations. Mohammed Jawara gave us a great hand in picking new spots! Jawara knows the local scene like the back of his hand.
After our review, we had another meeting with Edwin Abu. He is a multilingual cervical cancer expert. Edwin helped us navigate the translations that were originally generated with ChatGPT, refined by us, and tested in the mock interviews with Memunatu and Alieu. We used the feedback from our session to ensure the questions were simple enough for anyone to understand.
A common issue is that while our translations from Krio to English are technically correct, sophisticated language led to some uncertainty in our mock interviews yesterday. The ladies we spoke to were incredibly gifted in English, so we could jump in to further explain what we were thinking through each question. But most people we interview will not have the same bilingual abilities. We hope to get a holistic understanding of what cervical cancer knowledge looks like for each woman.
The last two days have been a long process of sharpening our interviewing ability for fieldwork. We also recognize that nothing will give us experience quite like the first day as well, and more changes are to come!
Beautiful mountainside visible from the office.
This afternoon, we had a fantastic catch-up with Ukweli legend Noah Weaver. As a team member and having done over one hundred interviews last year, Noah’s insight on preparing for the experience was very helpful. Noah is doing great, by the way! He graduated this last semester and is very enthusiastic about his new job in chromatography.
We had questions for Noah centered on the techniques he and Ukweli 2022 employed during their interviews. A great piece of advice Noah signified was to be mindful of our non-verbal cues, as English will not be very useful during our introductions. Noah emphasized our body language should be warm, friendly, and caring without becoming overwhelming. Noah has a fantastic mindset when approaching research; he told us to remember that we are visitors and treat every interaction with the anticipation that we must approach everyone with kindness and openness.
Noah stressed the importance of recording verbal consent which is more culturally appropriate than written consent in Sierra Leone. Written consent for these semi-structured interviews is inappropriate and intimidating. It would almost certainly compromise the authenticity of our findings, or stunt the interview capacity as a whole.
From our short experience here, it makes sense. There are often no written or signed agreements made, unless for specific governmental business. Striking a balance between avoiding coercion and ensuring that we don’t leave participants uninformed is something we are cognizant of.
The birds are smaller, louder, and chiller in Africa.
Our team had an important discussion today about what to do when women do not know about cervical cancer or human papillomavirus. Noah said the approach employed by the previous team if a woman was not aware of cervical cancer was delivering succinct information on its danger and symptoms. Sometimes, we catch ourselves thinking that women not be forwardly engaged during our research, but Noah assured that people are generally extremely interested and grateful to learn about key health information when the information is delivered mindfully.
The sequence of our questions also came up in our conversation. It is essential to structure the interview in a neutral manner that avoids leading to preconceived outcomes. With practice, we will be able to actively recall the questions and facilitate organic, unrehearsed conversations, which is particularly imperative given the topic’s sensitive nature.
Torrential downpour in Makeni.
Overall, getting to this stage is super exciting. We all are very antsy to get out and do our research! Sadly, today was another day of waiting for the Institutional Review Board’s approval of our study. There is no sign of when things may move along. The process of paperwork is very bureaucratic in Sierra Leone. All we can do is hope and be grateful for the experiences of each day.
Today, we got to have delicious banana bread! We enjoyed a truck bed ride through torrential downpours. We danced on the veranda. Best of all, our fourth team member, Lorraine Rwasoka, arrived tonight! It is such a joy to see her. We played chess and cards all night together, laughing and happy. We’re grateful that nearly the whole Ukweli family is finally together.
Brooke Lee is an champion at Egyptian Rat Screw.
Until next time, yours truly,
Ukweli 2023
Hello there! Today is Thursday, August 10th, 2023. This was the Ukweli 2023 team’s fourth full day in Sierra Leone.
A trend of the last two days has been cooler temperatures at nighttime and early morning. Wake-ups seem to be getting colder and colder. This never seems to matter as the sun rises in the morning, though. It is remarkable how consistent the temperature has been throughout the entire trip: high eighties, humid, and rainy. Rain is almost always interspersed, coming in short bursts in which the sun shines to evaporate and soak the air within the hour.
Today began the same as always: 7:45 am wake up, breakfast, then off to the World Hope International Office. Our team was excited because we had our first true fieldwork opportunity together! Around 10:00 am, we drove over to the Holy Spirit Catholic Hospital. This is a privately-owned Christian hospital with very plentiful and modern medical supplies and systems. Holy Spirit has a beautiful property and many different halls, as well as incredibly friendly staff. It certainly doesn’t fully represent the majority of health centers in the area or our project’s main demographic, yet we knew the setting itself could provide a lot of insightful information about a Sierra Leonean hospital.
Rather than exploring each wing or talking to multiple doctors, we thought it was important to first introduce ourselves and talk a bit about who we are and what our project focus is. We got an introduction to the Deputy Matron, a young woman who was supportive of our research into cervical cancer awareness in women’s communities. It was great to have a conversation with a direct stakeholder of our project, someone whose community and own hospital inherits the direct effects of lacking cervical cancer education. If we find our data particularly interesting or have any questions regarding common threads we are seeing, we will get an opportunity to speak with her next week.
Despite her enthusiasm, there was an important lesson we experienced today in our first true on-site activity; it is imperative to have a value proposition and plan with each conversation that we take on. For a role as busy and essential as hers, just having a few minutes together was something we are incredibly grateful for. The meeting might not have been as mutually productive as we’d like though, because we still have no concrete research due to not being able to start yet. Nor actual physical content to show. Yet the realization that was demonstrated to us in respecting our own time–even without data, aiming to enter and exit a meeting with a set goal apart from introductions–was an important lesson that only could come through experience. We exchanged numbers, and she was incredibly cordial, so we hope to connect again if it would mutually benefit us. Maybe around the one-hundred interview mark, we can show her some of our findings!
Holy Spirit Catholic Hospital’s entrance.
The hospital’s maternity ward.
Lively garden within the maternity ward.
We passed by a bustling marketplace on our way to the Holy Spirit Catholic Hospital. Local vendors were selling clothes and snacks all over. It was so interesting to see people carry their goods: they balance baskets on top of their heads! Shoes were displayed on the front porches of nearby crowded stalls, and we even spotted jewelry being kept safe inside a glass display. People all over are making their daily living. It’s a surreal experience to navigate these marketplaces in a vehicle, let alone on foot, and we’d get the chance to do just that this afternoon.
We returned to the World Hope International Office a bit before noon. Today, we held a mock interview session with Memenatu and Alieu. We invited two women from the office to hear the questions in Krio and let us know if they were understandable. It gave our translators great experience in what the fieldwork protocol will be like in action, consent protocol, and everything. Overall, we reviewed each of the twenty-five questions twice, giving each Memunatu and Alieu a chance to explore and explain each. Their enthusiasm and ability to nuance each question, providing analogies to make them more understandable, was awesome to see in action. We took a bunch of notes about which questions weren’t as clear as others. Because the questions were written in English and then translated into Krio, with a Krio answer being given and translated back into English, it is essential to be precise and explicit in the interviewees’ understanding of exactly what we are asking. When the questions use sophisticated medical language, it makes it especially difficult for what is being asked to be understood. There were a few standout questions that raised difficulty in Krio.
A look inside our office space!
We finally caught the banana saleswomen!
The first hard question was “What are the cultural or societal factors that contribute to the perception or understanding of cervical cancer in your community?”
The “cultural and societal factors that contribute…” section needed clarification and analogous explanation. This question is not intended to ask about sex practices or other habitual factors that directly cause human papillomavirus infection, but rather what stigmas, perceptions, and social influences may lead to a lack of engagement with understanding the health threat. We will figure out a way to ensure the proper questions are relayed–Memunatu and Alieu stepped up in helping get the right idea across. Their proficiency in both Krio and English is so useful!
The second difficult question was “What are some of the challenges related to cervical cancer prevention and the HPV vaccine that are unique to Sierra Leone?”
Due to the question’s phrasing, it does not translate very smoothly into Krio. The negatives of “challenges” and “prevention” make the question a bit tough, as well as “unique.” We believe it is important to understand if Sierra Leone faces her own troubles in fighting cervical cancer, but it can be asking quite a bit to have Makeni women (who may not have any knowledge of cervical cancer whatsoever) compare national challenges and describe them with distinction.
There’s perpetual rain in Makeni.
The last toughie was “Do you believe that women get equal chances in accessing healthcare?”
Speaking of inequality is difficult in Krio, and already difficult itself due to stigmatization. We were told that women would not always be openly willing to speak of these issues. In cases like ours, it is the priority to ensure privacy in our discussions. Regardless, the reason we chose “equal chances” rather than “equality” or “inequality” is because of the difficulty of translation. This question consistently needed an explanation, which is perfectly fine, however between our two mock interviews, there was such a significant disparity in the answer (one an enthusiastic no to any semblance of care disparity, the other a sorrowful yes that this is an issue faced). It is lastly important to make sure that when explained, these questions are not asking the women about their personal experience with inequality. While that is important and would certainly influence the answer given, we are not intending to ask “Do you believe you have experienced inequality as a woman,” but rather a broader examination of society. You can see where so many difficulties arise!
Explore the questions and their Krio translations below:
After our interview practice, Professor Khanjan Mehta informed us that we had a special project to take care of. We have never been involved in a special project before, and I do not think anything could have prepared us for what was about to happen. At 4:15pm, rain poured down, we hopped in a truck and were off to the town square marketplace. Our mission: buy chives, eight onions, six small limes, eight avocados, a patch of peppers, and garlic.
Can you guess what for?
The marketplace was an unbelievable experience. Being a visitor to Sierra Leone, there are no ways to describe the sensory stimulation and concentration of personal interaction you experience in the packed alleys. You are shoulder to shoulder, stall to stall, trekking through mud, groceries in hand, and smiles all around! The vibrancy, noise, hollers, haggling, rain, and sea of eyes meeting Khanjan and his chef squad of Sterling Salmini, Reeza Chaulagain, and Brooke Lee… we have never experienced anything like it. What a one-of-a-kind blessing it has been to be immersed and welcomed into the richest parts of Makeni’s life. Generally, we are welcomed, met with hospitality, and immense interest. Our journey around every corner of the marketplace was unforgettable.
After we picked up our food and explored a bit, Khanjan directed us to the kitchen nearby our nightly dining space. The outdoor kitchen was in the backyard of a nearby family home. It had a charcoal stove, beautiful awning, clotheslines, empty buckets collecting every drop of rainwater, and an incredibly kind family who have been the gracious chefs of our nightly dinner down the road, something none of us knew. Precious, an eighteen-year-old daughter to the secret head chef, lent a hand in our task. No more perfect could the environment have been; we grabbed our chairs, set out bowls, and got to work peeling, chopping, mashing, mixing, and preparing the best guacamole we’d ever have.
There’s only one right way to do it, and that is in Sierra Leone.
Our guac was served with dinner and the teams loved it. Cooking in Sierra Leone was a fantastic experience. It built up with the sensory experience of our day, being in so many interesting locations that command all of our attention and immersion. It’s in being able to interact in the environment, scouting out the best-looking onions and vendors who carry the peppers we need. It’s in the hands-on effort we get to share with others in preparing dinner. Efforts like these, from the hospital to the interviews to the market to the cooking, foster immense gratitude within us. It illuminates that every piece of the day we are accustomed to and the successes we often habituate to are not given: they are earned through someone’s dedication, and often their kindness. From the Deputy Matron to our translators, to Precious, every step of today showed that so many hands come together to craft our happiness. That is, undoubtedly, what Sierra Leone has taught us the most: there is an endless amount to be grateful for, and the most significant gratitude you can exhibit is getting your hands dirty, putting the work in, and sharing a laugh and smile.
Dinner went well, and so did our program-wide meeting upon coming home. Reeza and Sterling rematched in chess, and Sterling’s red side took it home this time.
One for the good guys.
The game after, versus Jake Feuerstein of the Sickle Cell Education & Diagnostics team… Red wasn’t so lucky. Everyone’s getting a lot better!
Blunder!
Thank you for tuning in today.
Until next time, yours truly,
Ukweli 2023