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!

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.

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.

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!

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Explore the questions and their Krio translations below:

1. How familiar are you with cervical cancer (cancer of the womb) and its causes? How familiar you dey wit cervical cancer (cancer of the womb) en wetin  dae cause am?
2. Have you heard about the HPV vaccine? If so, what do you know about it? You don hear about di HPV vaccine? If so, wetin you sabi about am?
3. What are your perceptions or beliefs about the HPV vaccine? Wetin you belief about di HPV vaccine?
4. Do you think cervical cancer is a significant health concern in Sierra Leone? Why or why not? You feel say cervical cancer na big health wahala inside Sierra Leone? Why you feel so or why you nor feel so?
5. What are the cultural or societal factors that contribute to the perception or understanding of cervical cancer in your community? Which cultural or societal factors dey make people understand cervical cancer na u community?
6. What are some of the misconceptions or myths about cervical cancer or the HPV vaccine that you’ve come across? You don meet any misunderstanding or myths about cervical cancer or the HPV marklate?
7. Do you or anyone you know who received the HPV vaccine? You or anybodi way you sabi don take di HPV marklate?
8. Do you think there is a need for more education and awareness programs about cervical cancer and the HPV vaccine in Sierra Leone? You feel say need dey for more education en awareness programs about cervical cancer en the HPV marklate inside Sierra Leone?
9. Do you think cervical cancer is a significant health concern in Sierra Leone? Why or why not? You feel say cervical cancer na big health wahala inside Sierra Leone? Why you feel so or why you nor feel so?
10. Have you or someone you know been affected by cervical cancer? If so, how has it impacted you or your community? You or person way you sabi don get any issue wit cervical cancer? If yes, how e don affect you or u community?
11. How do you think the government or healthcare organizations can improve efforts to prevent cervical cancer and increase HPV vaccine uptake? How you feel say government for make effort for stop cervical cancer en make people take di HPV marklate more?
12. What role do you think community leaders and organizations can play in raising awareness about cervical cancer and the HPV vaccine? Wetin you feel say community leaders en organizations for do for make people know about cervical cancer en the HPV marklate?
13. What are some of the challenges related to cervical cancer prevention and the HPV vaccine that are unique to Sierra Leone? Which problems dae prevent cervical cancer in stop wan en taking the HPV marklate inside Sierra Leone?
14. Would people shame or treat a woman differently if she had cervical cancer? If yes, how does it affect a woman’s willingness to go to the doctor? People kin shame or treat woman diffren if she get cervical cancer? How dis go affect in decision for see doctor?
15. How do you envision the future of cervical cancer prevention and the HPV vaccine in Sierra Leone? How you feel say the future go be for stop cervical cancer en taking the HPV marklate inside Sierra Leone?
16. Are there any cultural practices or beliefs in your community that affect women’s attitudes toward cervical cancer prevention or the HPV vaccine? You sabi any cultural practice or belief nar you community wey dae affect women attitude for stop cervical cancer or the HPV marklate?
17. What sources of information do you trust when learning about cervical cancer and the HPV vaccine? Which source of information you dey trust wen you wan learn about cervical cancer en the HPV marklate?
18. Do you have any fears about the HPV vaccine? What would make you feel better about the HPV vaccine? Yu get any fia bot di HPV marklate? Wetin yu tink say e for hap’n for reduce dem worrie ya?
19. Do you think doctors have a lot of knowledge about the HPV vaccine? Yu tink se dokto dem get plenti sabi bot di HPV marklate?
20. In your opinion, can the media raise awareness for cervical cancer and the HPV vaccine? Pan you tinking, yu tink se media fit du som tok-tok for mek pipul sabi bot cervical cancer en di HPV marklate?
21. Are there any programs in your community that aim to prevent cervical cancer or promote the HPV vaccine? If yes, how effective are they? Den get any program we dey na yu community wey dem dey try for stop cervical cancer or mek pipul sabi bot di HPV marklate? If yes, how effective dem bi
22. What are the main reasons why women in your community may not prioritize cervical cancer screening or the HPV vaccine? Which main reason you feel say di women nar you community nor dey put befo cervical cancer test or the HPV marklate?
23. How do you think the government can encourage more women to get tested for cervical cancer and receive the HPV vaccine? How you think government for encourage more women for do test for cervical cancer en for take the HPV marklate?
24. Do you believe that women get equal  chances in accessing healthcare? Yu bi-lef say women get equal chance for receive healthcare?
25. Would you be willing to vaccinate yourself or your child with the HPV vaccine? Yu go allow for, make yu or you pikin for take the HPV marklate?

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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.

The game after, versus Jake Feuerstein of the Sickle Cell Education & Diagnostics team… Red wasn’t so lucky. Everyone’s getting a lot better!

Thank you for tuning in today.

Until next time, yours truly,

Ukweli 2023

Howdy! Today is Wednesday, August 9th, 2023. This was the Ukweli 2023 team’s third full day in Sierra Leone.

It was yet another day waiting for Institutional Review Board approval for our team’s cervical cancer research, but we are plugging along! 

Sierra Leone is not only about long stares, flying kisses, and welcoming waves that we get from strangers–it is about learning to transcend languages and create an impact. The morning was as normal: wake up, breakfast, and out the door. At the start of the day, we met with Edwin Abu, the director of the cervical cancer screening department of World Hope International. We began reviewing our bank of twenty-five interview questions with him. but we realized it was best to have our translators–Alieu and Memunatu!–join us as well. As they are going to be relaying all of the questions day to day, we wanted their input and expertise in Krio to truly ensure women will understand the questions we are asking.

We reached out to Alieu and Memunatu, and they joined us for a second meeting around noon today. Together, we went over each one of the twenty-five questions individually. It was an arduous three-hour process, but incredibly fulfilling. Our group ran into some difficulties at the beginning with translating the English questions in real-time, so we pivoted our approach to translating each question. We wrote the translations for each question directly on our preparation documents, rather than needing the two to commit each complicated translation to memory. With the difficulty and abstraction of many of the words, as well as with the need to be mindful of the interviewees we will engage, this was certainly the right move.

Each of the questions was read through in English, and edited to ensure they were in straightforward, simple language. This makes the translations more accurate. Next, we inputted each question into ChatGPT. Though not perfect, the artificial intelligence translations from English to Krio were great. Memunatu and Alieu felt they were generally really accurate. They were strong enough that each of the questions could be better understood. Edwin, Alieu, and Memunatu were in constant collaboration about the translations they were doing. It was awesome to see. They spoke in fluent Krio, exploring common words that would or would not translate best in Krio. Sometimes, words might be better understood by other dialects like Limba or Timne. When they struggled with the selection of a word to Krio, we all stepped in and attempted to rearrange the question’s phrasing so that it could be translated better. The entire process was enlightening. I don’t think any of us have engaged in something like this together before.

What was especially fulfilling about our translation work was that it felt like our first full step diving into our work here in Makeni. The long hours in the hot office pass by when we know that we are able to work together and create an excellent research selection. We all believe the work we do here is so valuable and ripe for opportunity to make strides in the development of cervical cancer screening methods in low- and middle-income settings, as well as improving maternal awareness of health. It is great to have two motivated, friendly, and college student translators on our side, as they share our curiosity and gratitude.

After we meticulously went over each question, the group brainstormed locations we could visit for each of these interviews. Choosing locations that are different from the locations the team visited last year was important to us. This ensures a wider demographic and range of people we can include in all of our data. 

We agreed so far upon six locations: Kabombeh (Safroko Limba), Talent Town (Gbanti), Old Mabanta (Gbanti), Patevana (Bombali Shebora), Manonkoh (Bombali Shebora), and Maboileh (Bombali Shebora).

Ideally, we will have ten locations total so that we can interview approximately twenty women per location. This helps vary the local setting, as well as potential other factors such as income disparity and wealth concentration, to give us as holistic an understanding as possible of cervical cancer awareness in Sierra Leone. Edwin and we decided that this list is a good start, and we will ensure we constantly add to it. A great connection we’ve enjoyed is Mohammed Jawara. Jawara is very familiar with Makeni and introduced us to our translators. We plan to speak with him tomorrow, as he might be able to contribute places that would get us diverse interview subjects.

When we returned back to our workspace, the room was full with the smell of banana bread. We again missed buying snacks from our local vendors! Hurriedly, we visited the gateman and asked him to get us some roasted peanuts from the store right across the street. Almost every team is moving in and out of the office constantly, but we’ve stayed put. Quick snacks have been a great way to get immersed in Makeni life before our cervical cancer research gives us a direct opportunity to do so. It downpoured in the afternoon, and it was absolutely beautiful.

Our team is excited to visit local tailors in the Northern Bombali area soon! They are able to stitch dresses with local fabric. A standout part of Sierra Leonean culture is fashion; it’s lovely to see people wearing so much color! They reflect the same color and vibrancy in their hospitality. Everyone here is very kind and welcoming. 

Our team is geared up to engage in a series of mock interviews with the women who work in World Hope International tomorrow. Recognizing the need for accessibility and inclusivity, we are committed to reworking the questions at hand. Their input will be incredibly valuable in finding our flow and refining our content. We’ve noticed our questions possess a level of sophistication that aligns with well-educated individuals, and those who have invested considerable time in thinking over the intricate political details of healthcare accessibility in Sierra Leone. The importance of democratizing this knowledge and making it graspable for everyone does not go unchecked by us. Our research helps a diverse range of voices be heard, and we aspire to contribute to an ethical, richer understanding of health matters that concerns us all.

The rest of the day went pretty smoothly. We enjoyed a new meal tonight: white rice, curried chickpeas, okra, and bread–delicious! We rode back to the hotel in a rainy truck bed. The fresh air of Makeni will never get old.

Our program-wide meeting happened right as we got back, giving us the night to finish up work and relax. Sterling taught Reeza how to play chess tonight. Allegedly, it ended in a stalemate, although it was anyone’s game.

Until next time, yours truly,

Ukweli 2023

Hi! Today is Tuesday, August 8th, 2023. This was the Ukweli 2023 team’s second full day in Sierra Leone. 

The morning began earlier for every team; we woke up at 7:30am, grabbed our breakfast, and headed over to the World Hope International office in Makeni. Our team had an early meeting with two prospective Krio translators for our cervical cancer research interviews. Their names are Alieu and Memunatu, and they are incredibly friendly. Both are university students–Memunatu is studying arts, and Alieu would like to pursue law.

Mohammed Jawara and Professor Khanjan Mehta accompanied us for the introductory negotiations of our meeting. It was important for the terms of payment to be established, as any ambiguity on payment may lead to discrepancies and issues when we arrive home to compile our research. Khanjan and Jawara’s experience with the Ukweli 2022 team allowed us to clearly outline the job duties required of each translator. Alieu was a translator for last year’s research effort, and his experience is very valuable in tuning up our questions and expectations for fieldwork!

We are determined to hit two-hundred interviews during our time in Makeni. Today, we received the update that our International Review Board approval is progressing. It may hopefully be approved within two to three days… it is a bit frustrating to not have the opportunity to dive into our research. Despite this, we are making the most of this downtime and preparing our question translations to be as refined and informative as possible.

Once our research approval lands, we are ready to hit the ground running! Our interviews will be an all-day everyday activity, spanning over a ten to fourteen-day period. Based on Ukweli 2022’s work, we discussed with Alieu and Memunatu that each interview should be no longer than twenty minutes and that the transcribing and digitizing will take about thirty to forty minutes after. We aim to conduct up to twelve interviews a day.

We also got the chance to plan our team division; Lorraine Rwasoka will be joining us on Friday evening, which is amazing news! Reeza Chaulagain, Brooke Lee, Sterling Salmini, and Lorraine will split into two groups, each with a translator, surveying in different parts of Makeni.

After contract terms were agreed upon with our translators, we spent a bit of time reviewing the interviewee’s consent forms and extensive questionnaires with them. Alieu and Memanatu gave valuable advice on what answers we may expect to cervical cancer questions from Sierra Leonean women based on their experience, as well as what questions may be a bit difficult to effectively translate into Krio. Our team spent the rest of the morning reviewing questions, simplifying many.

In the afternoon, Brooke made a lot of progress on developing the Artificial Intelligence Strengthening Healthcare Access team’s crash courses. Utilizing ChatGPT, she was able to generate several direct paragraphs of information for each of yesterday’s one-hundred crash course topics. Although the tool is incredibly useful, you must be careful when using it; it’s important to input several very specific questions that can translate into a digestible lesson. She is halfway through the courses!

Brooke has been a wonderful contributor to both the Ukweli and AISHA team this year. Healthcare workers and curious cats will be able to not only answer hundreds of basic, essential questions about health, but the crash courses will be part of a “Test Your Knowledge” feature that provides even more in-depth information across one hundred topics. The Amazon Alexa technology will hopefully make for a great educational tool and healthcare assistant down the line.

For their afternoons, Sterling and Reeza made progress on the Ukweli Test Strips’ subteam grant proposal. It was a rainy afternoon today, and it made for some beautiful scenes on the verandas of the World Hope Office. During downtime, our group played some games on the second floor’s balcony, overlooking the forests and far mountainous of the Northern Province. We tried a fish empanada this afternoon, but unfortunately missed out on the coconut saleswoman who strolled by! 

Sterling got the opportunity to travel with other teams to a peripheral health unit too. The rain didn’t stop people from hopping in the back of World Hope International’s pickup trucks. Kids wave and holler at us as we drive through town, it’s lovely. Every student got a chance to visit the supermarket today, and it is strikingly different from the ones back home (as everything is)., Friendly families were selling fresh fruit out front.

After shopping, we headed to dinner–same as last night–and got to taste a new fruit! Sierra Leoneans call it a plum, although it is much more like an apple. Many people like to dip theirs in salt. The routine follows from yesterday: come home after dinner, shower, hold our program-wide debrief, and finish up the day’s work.

Tomorrow at 9:30am, our team has an interview with Edwin Abu of World Hope International. We will be going over our interview question drafts and getting his input. Edwin will be going over each of the questions with us to give us feedback, especially in terms of ensuring that they translate well, et cetera. From there, we are going to be running “mock interviews” with him and some other individuals in the office. We want to keep practicing these questions and get down to our interview style. 

We need to ensure that each of us is fully confident talking about the topics of cervical cancer, so the women may feel comfortable talking about health issues that are generally regarded as private. Our team hopes to visit a peripheral health unit altogether as well tomorrow. The experience would be super helpful in seeing the clinics where Ukweli Test Strips are sold in person. It also gives us a sense of the medical care system we are actively trying to engage in and improve!

It’s been a new experience every day here in Makeni; we’re excited to see what tomorrow holds.

Until next time, yours truly,

Ukweli 2023

Hello, and welcome to our blog!

Today is Monday, August 7th, 2023. This was the Ukweli 2023 team’s first full day in Sierra Leone, along with the rest of the Global Social Impact Fellowship groups. Our team members embarking on the trip are Reeza Chaulagain, Brooke Lee, and Sterling Salmini. We hope to be joined by Lorraine Rwasoka in the coming days.

Our home for the next nineteen days is the Makambo Village Resort, a comfortable compound with plenty of bedrooms, a dining hall, and–gratefully!–running water and electricity. Makambo Village Resort is located in Makeni, the largest city in Sierra Leone’s Northern Province, and capital of the Bombali district.

The day kicked off with an early wakeup and an 8:30am breakfast. Breakfast was a small pancake, a little omelet, bread, and a sausage. There was tea available to brew with hot water, as well as packets of instant coffee and powdered milk. Most everyone made their way to the dining hall by 9:00am. Teams had the opportunity to mingle and prepare for our work days–nobody was quite sure what to expect!

Two students collected cash from all teams to be exchanged and personally used over the next ten days. Another helped collect the numbers of everyone whose phone was unlocked and could use a SIM card. Two students, including Reeza, volunteered to be the transportation coordinators for the trip, taking the role of collecting team agendas and ensuring drivers were tuned to where they needed to be and when. A program-wide meeting was held at 10:00am. Professor Khanjan Mehta relayed the day’s agenda, gave insight into the day-to-day life and social expectations of Sierra Leone, and fielded all of our first-day questions. At 10:30am, it was time to head off to World Hope International!

World Hope International’s office in Makeni is lovely. The ride was our first daytime experience diving into Sierra Leonean life. Eight of us packed into a land cruiser which was actually quite comfortable, despite being squished together. Sierra Leoneans were out and about their marketplace and homes. There were motorbikes everywhere. The temperature was hot and humid, as it is most days, but the clouds cooled the city down a lot. Ukweli 2023 arrived at World Hope International’s office before everyone else. The gated office building is beautiful and sunny, with organization vehicles packed in the compound’s front lot. A big tree bedded with flowers shades the courtyard, and makes it extremely comfortable! Our team headed into the office, setting up at the desk, and spending the day there.

Ukweli is dedicated to saving the lives of women in Sierra Leone. Our 2023 team spent the spring semester navigating a new era in the project’s lifetime. Ukweli is divided into two subteams; Ukweli Test Strips and Cervical Cancer Research.

Ukweli Test Strips are affordable, accessible, and efficient urinary tract infection test strips that have been onboarded to fifty-six peripheral health units around Makeni and Sierra Leone’s Northern province. The Ukweli Test Strip subteam has developed a unique business model which allows each party involved in strips’ manufacturing, shipping, distribution, education, and use benefits to earn a living and help their community. The technology and launch effort goes back to 2017 and has been massively successful, with thousands of tests being administered.

Sterling and Cindy Tran have lead the Ukweli Test Strips subteam, creating an exhaustive business model, which plans the program’s expansion across all of Sierra Leone and into neighboring Liberia as well. Ukweli’s valued funder Grand Challenges Canada backed the test strips’ launch back in 2019; we have been invited to transition to scale. The multi-year journey to scale will make affordable urinary tract infection and preeclampsia test strips accessible to millions of women.

Although this subteam’s grant proposal writing and business model development are not the focus of our fieldwork this summer, our team will visit partnered peripheral health units across Makeni to assess the lasting demand, accessibility, and popularity of the Ukweli Test Strip.

The Cervical Cancer Research subteam is the more newly established sect of Ukweli. The subteam researches effective methods of cervical cancer screening implementation in low- and middle-income countries. Reeza and Lorraine have lead this team’s work through the semester. Surveying Sierra Leonean women’s awareness of cervical cancer and their perceptions of receiving human papillomavirus vaccination is an essential part of creating a repeatable, game-changing process for screening across low- and middle-income settings. This local surveying will make up the vast majority of our team’s fieldwork time this summer.

Our team spent the first part of the morning creating contracts for the translators we will need to conduct live interviews and transcribe audio recordings. We are still waiting on Institutional Review Board approval for our interview protocols, which will allow us to engage in fieldwork research with the women of Makeni. The approval will be on its way soon! We took the rest of the morning to develop an agenda for our fieldwork.

We estimate each interview will be around fifteen minutes, and take a minimum of a half hour to transcribe. Forty-five minutes for an interview’s conduction and transcription means we are looking at a maximum of nine to twelve completed interviews per day. We took this into consideration when developing our translator contract’s pay rate, and expectations for what an average day of intensive fieldwork may be like. Although we are uncertain of the actual interview dates, a day’s routine of early wakeup, translator hiring, and transportation coordination has been figured out.

We had a video call with Lorraine, who ran into international visa issues on the date of our departure flight. Lorraine spent the summer at Mountaintop, developing our fieldwork and interview protocols, making her (and a fellow student’s) travel complications especially detrimental. We miss her a bunch! Nevertheless, we coordinated with her and got the information we needed to prepare today.

Brooke finalized her list of crash course topics for the Artificial Intelligence Strengthening Healthcare Access team’s education tool. Brooke is developing one-hundred short courses that introduce and inform on essential health topics that can be accessed with AISHA’s technology in Amazon Alexa. She has been collaborating with their team for the whole semester, providing their entire database of questions, answers, information, and translations used for AISHA’s educational technology. She will be working alongside their team to create infographics that demonstrate the technology’s use this week as well.

Our team was introduced to everyone in the World Hope International office–everyone was incredibly kind, welcoming, and grateful for our presence. Likewise to them, it is through our amazing local partners that life-saving work is possible. The afternoon was spent planning and exploring local shops. Around 6:00pm, everyone finished up work and headed off to dinner. Our team got to ride in the back of a flatbed truck today to dinner! The breeze was lovely, and the locals were incredibly friendly and humored to see American college students packed together in a truck bed.

Dinner was the same as our last night’s arrival meal: rice, beans, cassava leaf stew, and bread. We’ll definitely get used to having these meals every day. It is delicious! After dinner, everyone headed back to the Makambo Valley Resort and freshened up before an 8:00pm debrief. Everyone had an exciting first day.

Tomorrow morning, Ukweli is going to interview and negotiate with translators. We are also going to fully familiarize ourselves with interview protocols and conduct mock interviews with friends, so we can get a comfortable feel for the flow and tune of our fieldwork. We are hoping to buy fruit from some street vendors as well!

Until tomorrow, yours truly,

Ukweli 2023

Today was similar to yesterday in that it was mainly transcribing. Grace, Kayla, and Noah met Alieu at World Hope and began the transcription process. Noah and Kayla rotated with each other while Grace worked on a document regarding finances. Noah and Grace had spoken with Hassan and the logistics manager at World Hope to get Hassan’s bike situation settled.

Matt Samara and Wara went to Magbenteh Community Hospital with the cervical cancer team from World Hope. They got 12 interviews for Part A of our cervical cancer study. When they returned to World Hope, they continued inputting the demographics of the 200 interviews into the Excel sheet. The team continued transcribing with Wara and Alieu and have almost transcribed all the interviews!

Our time in Sierra Leone is coming to an end as we are leaving Friday but, so far, the Ukweli team has accomplished a lot both for Ukweli and the cervical cancer study. But each member has also learned a lot from our time here; we have grown a lot as a team and have developed communication and leadership skills.

Noah Grace and Alieu went into the community  and completed an additional set of 18 interviews to make up for the ones lost yesterday to the broken recorder. This concluded the interview process and now

The rest of the team stayed at World Hope with Wara and did a large quantity of transcriptions while analyzing the data.

Once Noah, Grace, and Alieu returned to World Hope, our lovely Alieu and Wara had revealed that they made an African dish for us: foofoo! They worked together to make us this dish and we all shared it as a team; it was an amazing experience and we are grateful they shared their culture with us.

  

This week has been highly educational and productive for the Ukweli team. The team members went into both rural and urban communities within Makeni and were grateful enough to have sit down interviews with around 200 women. The women of the communities shared their experiences and knowledge of cervical cancer, its causes, HPV, and the incoming HPV vaccine.

 

As of now, around 130 interviews have been translated into English and transcribed. The team is working diligently to complete the remaining transcriptions. However, there will need to be an additional number of interviews recorded, around 30, as one of the audio recorders stopped working as the files were being uploaded, and yesterday’s work got deleted.

 

The team has seen substantial strides in their ability to efficiently finish the vast amount of work needing to be done– their ability to work together has improved dramatically throughout their time in Sierra Leone. Conducting these interviews has allowed the team to really learn about the Sierra Leone culture and appreciate the beautiful geography within each community. The team also continues to express gratitude for the support of their translators, Alieu and Wara, as these interviews would not have been possible without their assistance. They are giving us their best efforts and are just as passionate about this research as we are, and this doesn’t go unnoticed.

 

Grace, Samara, Matt, and Noah woke up early to meet with their translators, Wara and Allieu, who would help the team conduct interviews today. They set the goal of 50 interviews for the afternoon after which the rest of the day would be spent transcribing the interviews.. Kayla arrived this morning after completing her summer internship; the team happily greeted her and caught her up on the plan for the day. She would spend the rest of the day traveling with other teams to PHUs to see Ukweli operations.

 

The interviewers showed the team a good location to begin the interviews. They split up with Samara, Matt, and Wara going into the neighborhood on one side of the road and Noah, Grace, and Allieu going into the neighborhood on the other side of the road. Both groups went along the smaller streets of the communities on their respective sides of the road, approaching women and informing them about the study to see if they would like to participate and consent to voice recording. The team saw a great variety of responses among the women of this community, and the data seems of excellent quality. By the end of the afternoon, the groups had a combined total of 46 interviews done! Right before dinner, each group sat down with their respective translator to translate and transcribe the interviews. This is a tedious process, and it can take about an hour to transcribe just two or three interviews. It is important to transcribe every word as closely as possible to what was said in order to make sure the data is accurate. After dinner, Grace and Noah invited their translator to come to the hotel to help them translate the interviews. They were awake until almost 1 AM. Matt and Samara went to bed early because their translator was scheduled to arrive early the next morning to help them. 

The team learned a lot today in terms of efficiency and planning accordingly. The cell phone service shut down during the day and the groups that split could not contact one another. Next time, they agreed to create a meeting spot in a landmark location to check in if they were lost. They also programmed the coordinates of the World Hope office on their phones in case they needed to walk back to the office from the communities. After dozens of interviews, the team learned what methods of communication (including phrasing of questions) are more effective than others. For instance, each team found that the women were confused when they were asked about vaccines. They noted this and rather said “injection” or “marklate” (Krio terminology) in addition to the term “vaccine”. The women were more receptive to this diction and the answers reflected as such. In other words, the team affirmed that they must be good listeners, adaptable and personable.

Today we began conducting interviews for Cervical Cancer Research. Samara, Matt, Noah, and Grace arrived at the World Hope International Makeni Field Office and met with the translator, Suiluman. The consent form, demographic survey, and interview guide was discussed so Suiluman was better informed about what and why we are asking such questions. The team walked to a nearby village where the mock interviews began. The purpose of the mock interviews was for each interviewer to practice their interview style, ascertain which questions needed to be reworded, and probing questions that could be useful for deeper insights within a semi-structured interview. Each member conducted two interviews– the first set of four interviews was within one community, and the second set of four interviews were conducted further down the road within another neighboring community. 

 

Once the interviews were complete, we walked back to World Hope to work with Suiluman and transcribe the interviews verbatim. Individually, each member worked with Suiluman to translate and transcribe two interviews each. This was a very time-consuming process that we will collectively work on in order to improve the efficiency of transcribing. Once the interviews were transcribed, they were analyzed and placed into an Nvivo where cross tabulation can be performed. 

Hassan, our distribution manager, arrived to World Hope and had discussed how he went about his onboarding and training processes throughout the day. Today, Hassan focused on Class A pharmacies and conducted a training at a previously onboarded PHU. His week will be filled in regards to training and onboarding.

Tomorrow, two translators will be joining the team and we will be conducting a total of ~200 interviews in a variety of communities and/or villages within Makeni. We also have our teammate, Kayla Miller, joining us in Sierra Leone tomorrow!

 

Today, Samara and Matt went to Panlap Community Health Center. There was a great turnout of women from the local community to be screened. This was the largest group they had seen. Some women waited almost an hour to be screened. During each screening, Nurse Janet was able to complete three or more consultations. Samara and her team are hopeful that they will have enough interviews for the cervical cancer study. And for some good news, the Sierra Leone Ethics and Scientific Review Committee and Lehigh’s IRB gave the team approval to start the interviews! After the team heard the good news, they went to the printing store in town and printed the consent forms, surveys, and interview guides. They are hoping to interview women tomorrow! 

Grace and Noah spent majority of the day at the World Hope office familiarizing with the Cervical Cancer Study so that they are more than prepared for the beginning of interviews tomorrow. This consisted of reading over the submitted IRB and discussing the interview questions. Going over the process of interviewing was highly beneficial. Additionally, Grace had updated the Ukweli website and created a team email so that all data collected by Hassan may directly to one place. During this time, Hassan was sent to preform for sales and engagements with new and existing clients. Once Hassan returned to WHI, the team discussed how the day went and how to move forward. We decided that tomorrow Hassan should aim to onboard pharmacies and utilize the log book we created and printed for him, as it is a could way to retain data.