I am not sure how it exactly works, but humans somehow possess the ability to pick out a few tidbits of their existence that are worth their attention and consciously neglect others, often in a manner that suggests they are not sure what they really care about, or don't really care about what they claim to care about. It can be contagious and in worst case scenarios, festers into a myopia of an entire population such that they will ignore the pain of others' poverty, despite acknowledging the arbitrariness of their fortunes, or demonize those who hold views that differ from theirs, despite coming home to wives and husbands who disagree with them about whether it's appropriate to take their children out to Chipotle for dinner (it is) and whether foreplay should last longer than five minutes (I have no wisdom to offer in this department). I suspect it is this same capacity for selective processing and double-think that can explain how I drifted through much of this summer not doing a lot of critical self-reflection or meaningful engagement with pressing issues around the global community and still learned quite a bit in my area of interest. It's scary, really.
As an intern working for Neovita, a randomized controlled trial investigating whether Vitamin A supplementation for babies within their first two days of life improves their chances of survival at 6 months, I have had the incredible opportunity to watch a pretty important project unfold from backstage. Neovita is a massive effort orchestrated by the World Health Organization to obtain sufficient evidence to evaluate an intervention considered a cost-effective candidate for reduction of neonatal mortality. "Massive" and "sufficient" are really the key words here because the trial is simultaneously occurring at three sites chosen for their high infant mortality rates - Tanzania, India, and Ghana - each of which is slated to enroll a whopping 32,000 babies. 32,000! Just imagine the response you'd get from Vegeta.
The Tanzania project itself is grounded in sites at two major geographical areas: Dar es Salaam, the country's urban center with high population density, and Ifakara, the more rural neighbor to the north. I've spent all my time in the former, mostly working from a small office that serves as the home base for our trial management staff. The field operations are based in maternity wards at different hospitals around the city, where nurses consent delivering mothers for participation in the study and research assistants receive their daily assignments for follow-up visits. It is also at these hospitals that any data collected from women and babies are uploaded wirelessly from the field staff's handheld PCs to servers located at our office.
There was something that the professor who taught my health policy class last year emphasized over and over, and now I know it to be true: ideas and plans can sound great, but figuring out how to make them actually happen is often incredibly difficult. There is nothing mind-boggling about the design of our study - you recruit babies in the trial, you give some of them Vitamin A, and then you compare the health outcomes of the groups that got and didn't get Vitamin A. But to actually do it? Quite mind-boggling, it turns out.
I could dedicate an entire blog post just to problems encountered with Vilivs, which are the mobile devices nurses and research assistants use to fill forms when they interview mothers. A simple issue like reduced battery life or missing chargers, for instance, can actually cripple field operations. When research assistants set out to perform follow-up visits on the assigned households without adequately charged Vilivs, they may not be able to collect all required data from mothers in time. So they will either fill forms incompletely or use paper forms. In the latter case, someone has to go through the trouble of re-entering the data from paper to web. If the research assistants do it themselves, they lose time that could be spent on more follow-up visits. If the paper forms are given to data clerks and double entry is not used, data quality takes a hit. The Vilivs may also run out of battery while they are uploading entered data to the servers. The challenge is that the servers cannot tell you whether data are missing because data have not been transferred from paper to electronic form, the upload was unsuccessful, or research assistants actually failed to collect the data. So the data manager informs the RA supervisor about the missing data, the RA supervisor tries to ascertain the reason, and then the reason is communicated back to the management team so they can respond accordingly. At least that's what would happen in an ideal world, where servers are always functioning, electricity and gasoline in Tanzania are in good supply because government officials are feeling not corrupt, RAs are not fabricating data, and uh, RAs are not striking.
As for my niche in this complex ecosystem of humans, money, responsibilities, and feelings (is there anything else?) I have really just helped out in any way I can. For a while, that entailed organizing and storing all consent forms in numerical order and creating a database of IDs for which they are missing, in preparation for the WHO audit that happened just a week ago. All that means is if we held a contest to see who could more quickly pick out the bigger of two 6-digit numbers, I would beat you. Since then, my responsibilities have ranged from writing a Standard Operating Procedure about consent forms and doing site visits to make sure the field staff understand and follow it, to re-creating a staff contact list because the existing Excel spreadsheet has a virus. But mostly, I've learned a lot. And I've marveled at the many challenges and rewards that don't show up in the PubMed papers.
Some of these challenges and rewards, though, have been personal ones as well. My first official "global health" experience is one that had me feeling anything but global healthy, and it's not just because I was asked to perform tasks that feel small in the big scheme of things. It's the fact that when I am flipping through the consent forms and reading the names of mothers - or glancing at their thumbprints, in the case that they are illiterate - I know nothing about what it's like to be a mother in the district called Kimara, how many little kiddos already in broad daylight will be eating her ugali tonight, or what burgeoning hopes and brooding worries graced her mind as she walked back from the clinic. It's also the fact that global health, much less neonatal Vitamin A supplementation, does not come even close to getting at the heart of the matter, in Tanzania.
But disheartening moments like these seldom last long, thanks to my darker co-workers. Whether it's food, first dates, or Tanzania we prattle about in that stale, dingy 5th floor office, my data team bros are always reminding me, with their wit, compassion, and love, why I'm in this journey, exactly what and who is at stake here. And as for the daunting challenges beyond the realm of global health? We are taking a collective deep breath and tackling a small one together. Stay tuned, boys and girls.
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