Pictures from Peru

Caroline Shermoen & Carolina Gomez Grimaldi

“What most stands out from my time working with La Liga Peruana Contra el Cancer is the people who we met and helped us along the way. While the research knowledge we gained was valuable, it was an ever greater privilege to talk with women in the community and see life from their perspective, all while working for an NGO comprised of passionate, service-orientated people dedicated to reducing the burden of cancer in Peru. I learned that culture, geography, and economics are extremely important to gain a deeper understanding of a person’s individual knowledge and attitude surrounding cancer and health in general. ” – Caroline

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This photograph was taken at one of the mobile clinics we visited to conduct interviews with Liga patients. Liga owns several of these pink vehicles and rotates their location weekly to reach the many different need areas around the city. The clinics start around 9:00 AM and anyone can get screened for cervical and breast cancer for free. A line usually forms outside the truck as women wait for their turn. Several Liga employees were there to assist patients including a nurse who conducted the exams, a promoter who stands outside the truck to both sign people in and answer any questions, and another health care worker who enters the patient’s data and asks pre-screening questions. We personally visited two separate locations: Independencia and San Agostino. Liga coordinated a private car to drive us as some of the areas we drove through are not safe to people unfamiliar with the area.

Our days started around 8:00 AM and ended around 1:00 PM. Patients were informed about our research by one of Liga’s employes and given the option to talk with us. The variations in patient’s answers and eagerness to participate differed depending on their age, education, location, and other factors. Being able to talk with these women firsthand put context around the state of cervical cancer in Peru. All these interviews were conducted in Spanish which means we spent a lot of time afterwards translating them to English for future reference.

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This is a picture of Carolina outside of La Universidad de San Martín de Porres (USMP) when we finally got our IRB approved! The Peruvian IRB process was lengthy and confusing at times, so we were so excited when we got our yellow folder of approval. This picture was taken in mid-June after waiting two weeks for the Ethics Committee to review our protocol, consent forms, and interview questions.

USMP’s Ethics Committee is where Liga does all their ethics reviews. It is located in La Molina which is only a 20 minute drive from Central Lima but takes around an hour to arrive in traffic (which is essentially all day in Lima). By the time we got approval, we had made the trip there and back many times to submit paperwork, pay the IRB fee, or adhere to other requirements. The day this picture was taken, the Peruvian National Futbol team was playing in the World Cup, so we ran into no traffic! It seemed the whole city had shut down to watch the game. Unfortunately they lost, but we were happy to start our research!

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This is an image of one of the typical Peruvian dishes we ate. Meals usually were from a set menu consisting of rice with a vegetable or meat accompaniment and drink. One of our favorite parts of Lima was the variety of healthy food options as we both are vegetarian. It was a welcomed surprise that almost all the food had flavor for only a low price. At first we were surprised by the high quality of Peruvian food, but we quickly learned Lima is globally known as one of the best food cities in the world (Lima alone is home to 3 of the 50 best restaurants in the world). When we were not doing research, we spent a lot of time searching for restaurants to eat our next meal.

This specific picture was taken at a restaurant owned by a local family. Although it’s not shown in the photo, the meal also included keke or what we would refer to as a cakey bread. The restaurant doubled as a bakery and vegetarian restaurant and was tucked away in a quiet neighborhood. This was one of the first restaurants we tried in Lima, and it was a good culinary start to our trip.

On a typical day, we would wake up and make breakfast at our apartment. Lunch would usually be at a local vegetarian or vegan restaurant with a pre-set menu. For dinner, we would be a bit more adventurous and travel to different parts of the city. Some of our favorite memories involve people we met at restaurants and the food we ate. Sharing a good meal is something that defines Peruvian culture, and we were lucky to get a small taste of Lima and its people through the places we ate.

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Liga Contra el Cancer in Peru

Caroline Shermoen and Carolina Gomez Grimaldi 

In the fall of 2017, we met with Natalie Kessler at a Charlottesville coffee shop to discuss our application for a CGH grant in order to continue the work she and Thrisha Potluri had started in Peru a year earlier. The main advice we took away from that meeting was to be flexible and expect the unexpected. This advice proved extremely apt, as the twists and turns our project took both before and during our travels were numerous; nonetheless, the experience was invaluable. The changes and our adaptations to them were part of the learning process – and learn we did.

Our first mission upon arrival to Peru was to establish contact with our NGO, Liga Contra el Cancer, and get to work on our local IRB approval. We were lucky to have our predecessors’ help getting some of the required format and information ahead of time, so we showed up to Liga’s offices with a copy in hand. We soon found out, though, that the formatting and content was stricter than imagined; luckily, our dedicated coordinator Yenny Bellido spent the next 8 hours with us reworking the proposal to fit requirements, ask more streamlined and intentional questions, and create a timeline. Spanish skills were absolutely essential here. As a team, we are extremely comfortable with our Spanish skills in everyday context, but the academic writing the procedure required challenged us.

Our next step was IRB approval. We took our proposal to the Universidad San Martin de Porres Medical School on Liga’s recommendation. We were told the approval process would take 1-3 weeks, so we decided to explore as much of Peru as we could while we waited, as IRB approval was necessary before beginning any aspect of our study. During this time, we were able to see the work of another NGO, Hands on Peru, which operates out of Huanchaco, Peru. Their community clinic in the low-resource Los Angeles neighborhood provides everything from health services to economic enrichment workshops for women. Seeing the grassroots, holistic work this organization and one of its founders, Katie Baric, does with such dedication and constant responsiveness to community needs was invaluable.

Finally, we received the call that our protocol was approved! We returned to Lima, and after a brief meeting with Yenny to figure out logistics, our interviews of Liga administrative employees, doctors, and mobile clinic patients began. The receptiveness and openness of each of these groups helped make each interview extremely informative. People were overall very happy to hear that work on preventative cervical cancer care was being done, recognizing the need in their communities. As we embark on the next journey of analyzing the data we have collected, we hope to come to meaningful conclusions which will help Liga better reach its patients and elucidate for us some key aspects of global public health initiatives. This way, we can begin to bridge the gap which has resulted in the untimely deaths of many women from a largely preventable cancer. Peru welcomed us with open hearts, and we hope our work will please those who worked so hard to support us.

“What stood out most to me through this opportunity was the complex texture of Peru and how it affected healthcare. While many of the issues that plague the system there are the same as the US (socioeconomic gaps, concentrations of healthcare in cities, misinformation), many are unique consequences of Peru’s history, culture, and most interestingly to me, its geography. While much of my time in undergraduate studies was spent talking about factors that prevent equitable access to healthcare, I had not until this experience truly understood the impact that barely surmountable mountain peaks, dense rainforests, and complicated waterways have. I really did learn something new every day and I am forever thankful for that.” – Carolina

Tohoyandou, South Africa (Piper)

Piper Shifflett

This summer, my partner, Sara, and I were privileged to assist with the PhD project of Mukhethwa Munzhedzi, a student at the University of Venda (univen). Since we were part of a new project focusing on malaria, most of our work this summer was focused on making community connections and gathering preliminary data that will serve as the groundwork for the sample collection during the upcoming malaria season. Our main objectives for our time there were both to master and optimize our lab techniques, and also work locally in the Ha-Lambani region to gain permission from local leaders and recruit and train field workers and nurses to collect data during the season.

One of the really unique aspects of our project was that it was a very hands-on and honest representation of what it takes to establish a health research project. Since it was just the three of us, Sara and I got really close with Mukhethwa and learned a ton from her about each stage of our work and what was going into the process. We were able to work pretty independently on projects like the pamphlet and analysis of the clinic data, but she also took the time to walk us through unfamiliar lab techniques, or local greetings and common phrases, and provide us with opportunities to practice and improve these.

I think the most important thing this project taught us was the importance of connections and all of the people who were there to help us when we encountered challenges. In the lab, this meant being there to give feedback, and attending events to support the other researchers, who in turn were always willing to help teach us to prepare buffers or proof-read our pamphlet. But beyond our research, the lab also became our friends as we made endless cups of tea together, attended presentations, and even got totally surprised by an amazing going away party. So, in lab we learned a lot about the human side of research, and the importance of supportive colleagues with shared interests and expertise to lend.

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Our first meeting with the head of the Masetoni sub-head and his family. This was our first time in the Ha-Lambani region, and we were really nervous to be practicing our greetings and proper etiquette when meeting with such important community members. Pictured are Prof. Bessong and Dr. McQuade, along with the sub-head, his wives, one of his daughters and her son. We ended up good friends with the family, and would frequently come to spend time with them when we were in the field. He also brought us to meet with the regional chief, and worked with us to gather population data and anything else we needed for the project.

These lessons extended beyond the lab to the field as well. The nurses and manager of the clinic provided us with records from the previous years, and walked us through what they had seen in treating patients and speaking with them. A head of one of the sub-villages negotiated an audience with the regional head chief on our behalf, and pledged his support of the project, which helped us gain ultimately gain permission from the chief. When we were struggling to map the boundaries between the sub-villages, several members of the community spent the afternoon working with the software to map them for us, and helped us track down demographic data from each place. Although we only knew basic greetings and pleasantries, through Mukhethwa’s translations and a generous amount of improvised hand-motions, we made connections with more and more people as we worked through each of our roadblocks.

The best part of our experience in the field wasn’t directly tied to our research on the surface, but were the chances we had to just spend time with the people we were meeting in the community. The sub-head’s family became friends, and we would stop in just to visit and chat with his daughters and play with the younger kids whenever we were nearby. We attended church, and afterwards would joke with the little kids in the village about our bad dancing. We met Mukhethwa’s extended family, who took us down to the river to explore and let us pick fruit every time we came. While these interactions weren’t specifically linked to our research, we made friends and learned from everyone we met, which made our project that much more personal. On paper this summer was about establishing the foundation for Mukhethwa’s project and learning more about malaria research. But, I think in reality it was a summer of growing under mentorship, learning from colleagues, and understanding and appreciating the importance of community contacts, and how vital they are for global health research.

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Me, Mukhethwa and Sara in our matching shirts that were part of our going away surprise. We ended up getting incredibly close over the summer as Mukhethwa was a combination of both a mentor and a friend. This was our last day in the lab, which was our second home for the summer, and we had both cried several times by the time this picture was taken.

Even outside of work, it was an absolutely surreal summer, full of incredibly welcoming people and beautiful new places to explore. We got really close with the Univen Volleyball Club, and traded learning about Tohoyandou and how to throw a proper South African braai for endless s’mores. We had the opportunity to travel and see gorgeous landscapes and incredible animals – including all of the big 5. It was a summer that was sometimes challenging and frustrating, but made amazing and unforgettable by the people we met and the friends we made. I feel like I’ve come away from it with a new perspective on the next steps I want to take after UVA, but also a renewed sense that Global Health is the right field for me and an excitement about my future in this work.

The biggest thing I can take away from this summer is what a privilege it was to work with Mukhethwa on her PhD project in her home village, and how that helped us become closer to both the work we were doing and the people we were helping. Being involved with laying the groundwork for data collection was a really unique experience with its own challenges, but every time we were stuck there were always leaders from the community willing to provide advice, resources, or a fresh perspective. In an unexpected but incredible way, we left this summer not only with a study site and colleagues, but also a community of friends who add another invaluable layer to our research.

Thohoyandou, South Africa

Olivia Jones

For eight weeks, I worked on the MadiTrial Project where I studied access to clean water and its relation to childhood pathogen prevalence in Thohoyandou South Africa. We were partnered with the University of Venda and this collaboration shaped much of my work experience. Our work was a continuation of the MadiTrial work that was conducted in previous summers. Also the two year time period of the study was coming to a close so we were tying up some loose ends. I gained some valuable lab experience and confidence in my physical skills. Beyond that I learned how to collaborate with new people in spaces where I am not privy to the way everything works. I interacted with participants in the field and saw firsthand their interest and enthusiasm for the study. These conversations truly made me understand the importance of this study to the communities with which we worked.

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What in the Botanical Garden: Piper, Sarah, LaChrisha, Merly, and I sat at the Thohoyandou botanical gardens with Kelly early in the summer. We had seen a sign for Botanical Gardens but had no idea if it was the same kind found at home. To our surprise it was a park where groups were having cookouts and birthday parties.

Thohoyandou is a smaller city about five hours away from Johannesburg and very close to the Zimbabwe border. The landscape is breathtaking, as it is in the tropics region of South Africa. This unique location brings the University a ton of students from Zimbabwe and other countries nearby. I was able to have a great group of friends that attended Univen and was not limited to South African students. Everyone we met was extremely accomadating. I worked in two Univen labs alongside students on different projects. From these peers I learned about other research efforts and personal goals that mirrored my own. Outside of work I was able to connect with one of my hobbies back in the states, volleyball! The Univen volleyball team became close friends to my group, and I attended their practices regularly.

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In the Lab: Merly, Marc, and I took a selfie after a long day in the extraction lab at Univen.

I was extremely fortunate to see multiple regions of South Africa during my summer. I went on every weekend excursion that my schedule allowed. These experiences allowed me to bond with other students who worked on different projects and to appreciate more of South Africa. I visited Kruger National Park twice and had some quality time with elephants, giraffes, and hippos. I explored the cities of Johannesburg and Pretoria. I even checked off all of the big five when I saw lions on a game drive in Hammanskraal. I loved seeing different regions because of the diversity of people and landscapes that I could easily identify as belonging to one place. I remember the sigh of relief I always let out whenever I returned to Thohoyandou and saw our familiar home mountain range. After an incredible eight weeks, it was difficult to leave Thohoyandou and I was brought to tears at the end.

Summary quote: My experience in South Africa has changed me for the better, and I I absorbed everything I could to carry it with me. I now know how to identify common links across cultures that has helped me make lifelong friends.

Malaria Research in South Africa

A lot goes on behind the scenes of a study far before even the first data point is collected. Lab techniques are perfected, questionnaires are developed, permission from community stakeholders is obtained, and sometimes an entire platter of cheetos is reluctantly but politely consumed. These were some of the goals I achieved this summer (winter) while working on a Malaria research study in the Limpopo Province of South Africa. Piper, a fellow UVA student, and I worked together with Mukhethwa, a microbiology PhD candidate at the University of Venda, to prepare a study determining the prevalence and genetic characterization of Malaria in the Ha-Lambani region.

Working on the preliminary stages of a research project allowed me to understand the realities and logistics of implementing studies in low resource settings. Many moving parts are involved during this important stage, from university ethics committees to village chiefs and from local clinics to major hospitals. No two days were the same, as our team juggled various aspects of laying groundwork for our study. Some days were spent driving around to local clinics and collecting informational pamphlets on Malaria while others comprised of many hours in the lab hood, perfecting our DNA extraction from dried blood spot protocol. Other days were spent entering data from the Lambani clinic or meeting with Village chiefs to explain the study. One particular morning found us in the head chief of Lambani’s living room where we spent what seemed like hours chatting with his family while continuously being encouraged to eat more and more of the endless cheeto platter they had graciously prepared for us. The great diversity of goals and the challenges that came with them made me more patient, flexible, and resourceful. Resilience and determination are key whether you are facing difficulties in the lab or a ginormous platter of cheetos.

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MHIRT and CGH students with the Univen Volleyball team. During our down time in the evenings we went to volleyball practice and made many incredible friends that we will never forget.

“I will always cherish the lifelong friendships formed with the incredible people I met in South Africa. Despite vastly different cultures and backgrounds, similarities always trump differences. Connections like these serve as a reminder that humanity is the greatest common denominator.”

What really made my experiences in South Africa as rich and beautiful as they were was the many amazing people I connected with. Most mornings would start with a simplistic but heartfelt Tshivenda conversation with Mama Mavis, one of the employees at Vevisa lodge. She often walked me around to other employees, holding my hand and laughing. I later found out she thought I resembled another employee’s daughter, justifying my frequent tours around Vevisa. Then we would head to the lab at Univen, where Piper and I would share stories and joke around with the many intelligent, witty, and incredibly kind members of the HIV/AIDS and Global Health lab. The lab even threw us a surprise party on our last day! In the evenings we went to practice with the Univen volleyball team, who became our second family. They showed us how to have a Braai, a traditional South African barbeque, and taught us how to cook many traditional dishes including pap, a staple food made of maize meal, and mopane worms. We all got Univen Volleyball club jackets to remember the time we spent together. I will always cherish the lifelong friendships formed with the incredible people I met in South Africa. Despite vastly different cultures and backgrounds, similarities always trump differences. Connections like these serve as a reminder that humanity is the greatest common denominator.

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The HIV/AIDS and Global Health research lab at Univen on one of our first days there. We grew to become very close friends with many of the brilliant and supportive people in our lab.

 

Sisseton, South Dakota

Claire Kirchoff

Picture this: you’re sitting in a field surrounded by plants you’ve never seen, learning their individual names and purposes, while discussing important issues in the environment.

That’s what our first week in Sisseton, South Dakota looked like. Wrapping up week 1 in on the Lake Traverse Reservation felt like a whirlwind. The week flew by, starting on Monday with special talks from Dr. Howard Epstein in the Environmental Science department at UVA, and Jeremy Redeagle, a local Native plant and Dakota language aficionado. Before long, our students were passionately discussing prominent environmental issues facing their ecosystem and creating posters aimed at building awareness of an issue of their choosing. We’ve discussed topics related to health, sustainability, and the importance of bison to the grasslands ecosystem and Dakota community. Our mornings start off with group discussions and reflection time, and quickly evolve into small group discussions, projects, and individual journaling with provided prompts. Afternoons were spent in the field placing plot markers, collecting plant data, and practicing plant identification.

As an ongoing component of the lessons, we incorporate service learning and social justice into our discussions and activities through creating posters of environmental causes, writing speeches about mental and social health, developing plans to encourage recycling, and building awareness of the methods of reducing waste.

Student poster: “This is Earth. On the left side is how Earth used to be. On the right side is how Earth is now. See the difference? This was before and after pollution became known.”

With cultural differences constantly present, our group has learned so much about the history and culture of the Sisseton Wahpeton Oyate tribe. Over the weekend, we traveled 2 hours south of our home base to an annual traditional powwow. Members of the Sioux tribe from all over the Midwest and Canada were present. Dances and songs were performed, including a tribute to the community of Native American armed forces veterans.

A local family has opened their home to me for the duration of our time here. I have enjoyed getting to know this family, their stories, and the challenges they face. Living with a family and spending time in their home has provided me with a glimpse of their place in time and within this country.

As a student and academic who is greatly interested in cultural differences and similarities, the experiences I have had over the last 7 days have been nothing short of eye-opening. With as much preparation, reading and researching as you can do, you’re never really ready for that cultural shift, even within your own country.

Limpopo, South Africa

Charlotte Brake

I had an incredible experience–thanks to the UVA Center for Global Health–studying alcohol-related sexual risk and intimate partner violence in Limpopo, South Africa this summer. Limpopo is home to the University of Venda, a rural-based university that UVA has collaborated with for years. Dr. Karen Ingersoll–from University of Virginia–and Dr. Angelina Maphula–from the University of Venda–led our team of ten students. Eight of us came from the United States, and two of our team members–Raymond and Tovho–attended the University of Venda.

            I spent each day paired up with one of our South African students in the rural village of Ha-Mangilasi, where we would walk door-to-door and ask people between the ages of eighteen and forty-four if they wanted to participate in our study. Observing Raymond and Tovho greet and interact with people gave me an authentic view of Venda’s traditions and customs. For example, before entering a person’s front gate or fence, they would yell the traditional greeting–”aa” for a woman, or “ndaa” for a man. If no one responded from inside, they would scream it a little louder, and then usually we would just walk in, with Raymond or Tovho repeating “aa”/”ndaa” until someone came out to greet us. Before anything else happened, the homeowner would pull together several plastic chairs so we could all sit down and talk. Tovho told me that was because it is seen as disrespectful in Venda culture to have a conversation while standing.

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A giraffe spotted on our drive out of Kruger National Park.

            If someone agreed to participate in our study after we explained the consent form, we sat with them for about forty minutes and administered one or two surveys on our phones. The surveys asked personal questions about things like alcohol consumption, sexual behaviors, and experiences with abuse. Despite the intimate nature of the questions, people were very open. Many participants expressed gratitude, thanking us for opening up conversation about topics that they perceived to be important, and sometimes even offering us fruit from their trees as a token of their thanks. One woman picked me and Tovho eight basketball-sized grapefruits at the end of her interview. Two sisters even invited us back to eat a traditional dinner at their home.

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Kelly McCain and Mukhethwa Munzhedzi walking through Leshiba Wilderness in their UVA Center for Global Health t-shirts.

The village we worked in daily–and Limpopo in general–felt very unfamiliar to me, but there were so many times when I was welcomed with open arms, which made me feel at home. For example, one family in Ha-Mangilasi invited us to park our car in their yard every day. When we returned to pick up the car at the end of each day, the grandmother brought out chairs for us to sit down and told Raymond and Tovho stories in Tshivenda–the local language–that they would translate to English for me. The woman’s husband tried to converse with me in Tshivenda each day, telling me how to respond and expecting me to come back each time able to communicate a little bit better. “We learned English and Afrikaans,” he told me, “Now it’s your turn.” He walked me to one of their fruit trees and picked nine or ten clementines for me to take home. They told me I need to come back someday to live with them so I can learn Tshivenda.

This was an amazing experience because I was able to develop true relationships with Raymond and Tovho, the South African students on our team, as well as many of the people I met while working in the village. I felt more welcomed into their culture than I ever could have anticipated, which I am so grateful for.

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Megan and Charlotte looking out over the mountains at Leshiba Wildern.