The Project Film...

Swansea-Gambia Link Project 2010 from Jimmy Hay on Vimeo.

The project finishes...

This week has seen the Swansea-Gambia Link Project 2010 come to an end, but has also seen the completion of an 86-page report that we hope will provide a working-practice structure for future multi-disciplinary partnership projects.

The project has been hugely successful, on both a professional and personal level, and has convinced us all that partnership projects are a hugely beneficial way to approach global health care and international development.

This week has been all about finishing the report, and so on both Monday and Tuesday we gathered once again at CIAM’s offices to work with the Gambian students. Having finished the bulk of the report last week, it was largely the small but time-consuming details that needed to be finished; referencing, formatting etc. After two long days, the report was finished, polished and ready-to-distribute by Tuesday evening.

With this major milestone complete, we decided to host a thank you meal on Wednesday evening for all of the people who have helped us during our time in Gambia, from senior health officials to our amazing drivers, Ebrahim and Soreba. We arranged for a local chef to prepare Chicken Yassa and barbequed goat, and decorated Dana Lodge with welsh bunting and flags.

It was a great evening, not only for the chance to see everyone one last time, but to have everyone together in order for ourselves and the Gambian students to offer our thanks and appreciation for the great amount of work and assistance that has helped us succeed for the past four weeks.

We hope that the success of this project will enable the Swansea-Gambia Link to develop further with yearly projects, and so the myriad relationships we have developed during our time in Gambia will be integral to that, and hugely beneficial to future project leaders and participants.

Tuesday 10th August

On Tuesday, the International Relations and Development students were invited by the Governmental Department of Community Development to visit an ongoing, sustainable project in Brufut. The project (funded by the Government) is aimed at local women who as part of the scheme collectively own a vegetable garden with different plots. The project has been successful in presenting a source for a sustainable diet and an additional income for families within the local area. The garden also contains a Day Care Centre for children to attend whilst their mothers work the gardens. The Centre, whilst great in its positioning and availability, is very small and pupils range up to 250 per day. There was also a communal hall for women to develop other skills such as tie-dye, sewing and crafts.

For our understanding of malnutrition, one of the most interesting aspects of visiting this community project was the fact that the women emphasised that they use and eat rather than sell most of their vegetables and only sell what is left over. As one of the major problems identified throughout this research has been the unavailability of fruits and vegetables for children this was a really positive development to see as developing effectively.

Such projects, whether funded by the government or private organisations should be supported wholeheartedly, to further health promotion with local communities.

- Lella Nouri

Sunday 7th August

On Sunday, the International Relations and Political Science students involved in the project, set out on a search to further explore the wider determinants of health within The Gambia. As a small group of students guided by Sait Matty Jaw, Political Science student at the University of The Gambia, we were able to experience public transportation both in Banjul and the North Bank as well as visit a rural village off the coast. We began the day by taking a public bus to Banjul and then made our way through the city to the ferry crossing over to Essau. On the way we chatted with a number of local people who were keen to tell us of the challenges of public transport within the Gambia and crossing the river to and from work on a daily basis.

On arrival in the village, we were invited in to numerous family homes and were able to see and hear for ourselves how healthcare within the rural community is incredibly limited. The villagers were more than welcoming, providing us with a local concoction called ‘Sour Milk’ straight from the cow and mixed with water. A delicious but interestingly textured drink that broke the ice for further interaction with the locals. We then visited the Muslim schools within the village and were able to learn what the pupils were learning and the conditions of the school environment.

After a lengthy and thorough walk around the village; meeting uncles and aunties as we went, we arrived for an unplanned lunch with some members of Sait’s family. We were made to feel incredibly welcome as we shared their communal meal of broken rice and fish. We all dived in, eating with our hands in the traditional manner, and were able to see the importance that is placed on sharing within both Islamic and Gambian culture.

At the end of the day we travelled back to the ferry crossing and decided to cross in the local manner; by small wooden fishing boats which travel at twice the speed of the ferry. After much bartering we all climbed on and were instructed that lifejackets were a necessity. The experience was exhilarating, being so close to the river and travelling with local tradesmen crossing the width of the river sometimes over four times a day.

Overall, the day spent on the North Bank enabled a greater understanding of how policies and health promotion is translated to the rural environment. Furthermore we were able to comprehend the polarisation of conditions between the urban environments already experienced around Banjul and those in the rural villages.

- Lella Nouri

Week Three

This week the Gambian students and ourselves have completed the last of our visits to health organisations and clinics. On Monday morning we met with senior officials at CIAM, a public heath research and development centre that has expanded from merely researching and tracking malaria in Gambia, to monitoring and evaluating HIV and Malaria, capacity building (training individuals on monitoring and evaluation techniques) and public engagement.

The medical students then visited the case study and her mother at their home, as the case study was discharged from the Royal Victoria Teaching Hospital last week. It was incredibly interesting and helpful to visit them at home, as we were able to gather more information on the feeding habits of the mother, details of the case’s siblings and the home environment itself – all vital information for evaluating the broader social, environmental and developmental determinants of malnutrition.

Yesterday we were able to go on a ward round with the medical team at the MRC (Medical Research Council), which for our medical students in particular, was a great experience. The ward round was extremely beneficial to our project, as almost all of the patients on the ward, though suffering from different conditions such as malaria, pneumonia and diarrheal illness, had a background of malnutrition – highlighting the severity of the problem in Gambia, and the need for alternative approaches in tackling malnutrition, such as ours.

Further visits to the case study and her mother are planned for this week, which we are really looking forward to. The mother has been so incredibly welcoming to us, and to being interviewed for the project. These visits aside, the writing of the project is now our main focus. We were able to start writing this afternoon, which has been a real boost to all of us, as we can now begin to see all of our hard work and research during the past two and a half weeks start to take shape in a written form. Numerous health organisations and international bodies will see the final report, and we’re hopeful it will make a real difference not only in the approach to tacking malnutrition, but to encouraging the formation of multi-disciplinary, partnership projects in the future.

Week Two Recap - Jane Thomas

Week Two - Out and About

Yesterday Team Gambia made the long and occasionally arduous journey across to the North Bank of Gambia, via a ferry from Banjul. Our earliest start of the project so far was compounded by having to wait for almost two hours at the terminus to board a ferry. Once on board, however, we climbed to the top deck to enjoy some well-earned breeze for the fifty-minute crossing.

Just a short drive from the North Bank port is the Esau Major Health Centre. Esau Major serves a large rural catchment area and can cater for all but the most serious of health conditions. The centre boasts a large maternal ward which accounts for the majority of its patients, delivering on average three babies a day.

We then travelled further north to visit the Cherno Baba Traditional Healers Association in Berending. The head of the centre and his two senior practitioners offered us a warm welcome, and were happy to answer all of our questions. It was incredibly interesting to hear about their traditional treatment methods and the large number of the North Bank population who still rely on them.

More interesting, however, was how keen the head of the centre was to stress the “progressive collaboration” that exists between themselves and the Royal Victoria Teaching Hospital, freely stating that many illnesses cannot be cured by traditional methods alone, and instead require modern medical treatments.

This morning our first visit was to the Brikama Health Centre, though it could perhaps be more accurately described as a district general hospital. The centre runs numerous clinics, including a baby clinic at which any child under the age of five can be weighed and immunised for free. It also has several wards, including paediatrics, separate male and female wards, a labour ward and theatre, and a laboratory for testing.

From Brikama we travelled to Gunjur, to meet three traditional birth attendants operating out of Gunjur, but who serve the large number of rural villages in the Kombo South District. Whilst being specifically focused on maternity and birthing, the birth attendants are committed to women’s health in general, and health practices from a specifically female perspective.

Travelling to different health centres, clinics and organisations is proving extremely helpful in developing the focus of the Swansea-Gambia Link project, as we are seeing first-hand the various methods by which health care is being delivered and accessed by people across Gambia, and furthermore how much health education is already a considerable part of health care here, and yet still such an area for improvement.

Week Two - Day One Video Diary

Week Two Begins

This week we are visiting a variety of health organisations throughout Gambia, in order to develop and broaden our knowledge of the health systems ad services already established here.

We had a high-energy presentation first thing this morning, as the Nova Scotia Gambia Association (http://www.novascotiagambia.ca/) treated us to a powerful performance from their peer-to-peer drama troupe. The organisation runs numerous health education programmes in the country, one of which uses the drama troupe to deliver issue-based theatre sketches to villages and towns throughout Gambia, using young people to target and educate fellow young people.

This education programme, and its focus on using drama as a key vehicle to disseminate information, has been incredibly successful in educating young people in Gambia through its ability to tackle sensitive issues such as HIV, domestic violence and sex-education in an engaging and accessible manner.

We then visited Concern Universal (http://www.concernuniversal.org/), a British NGO that specialises in offering education, support and treatment for HIV, Malaria and Tuberculosis. They have a particular focus on capacity building, setting up organisational structures and frameworks for governmental and non-governmental services.

Concern Universal receives financial support from the Global Fund, and has offices in several countries throughout Africa. Their Gambian office also serves large sections of Senegal, particularly in the south of the country, where they have primarily been involved in peace-building operations.

Finally, we met the several members of staff at the Gambian Family Planning Association (GFPA), before having a tour of their clinic, in which they offer family planning advice seven days a week, as well as also carrying out comprehensive medical services, including anti-natal care, vaccinations and infant care.

It was extremely useful to meet with the three organisations and see the work that they do, as all three are relevant to out infant-malnutrition project, in particular through their focus on health education. Seeing first-hand other organisations and the methods by which offer health care, education and treatment is enabling us to better assess and develop our own methodology, and will hopefully help to positively influence the outcomes of our project.

Day 5

We made an early start at the hospital this morning, as Fridays are traditionally half-days in Gambia. Having had a really good week so far – we have a very good case study, whose mother and father have fully consented to participate in the project, and have both assured us that they are looking forward to us visiting their home just outside Banjul – we decided to stay in the classroom to discuss the final written report. We have a structure in place for the report as a whole, but felt we should focus closely on the main body of the report.

After a long discussion, we have broken the body of the report down to four sections: Pregnancy, Birth, Feeding, Treatment.

Encompassing all of these will also be a fifth section; Discussion. This will be a consideration of the cultural, local, regional, national and global factors that effect the four main sections. This will also include substantial consideration of the pre-birth factors that can lead to malnutrition, such as the education of the mother and father, and the mother’s health from birth.

We have organised ourselves in to two groups, and on Monday each group will approach two of the four main sections. We will then come together as one group to talk about the Discussion section in relation to Pregnancy, Birth, Feeding and Treatment.

All in all we feel the project is progressing extremely well so far. Next week we will be visiting various health organisations, clinics, governmental and non-governmental organisations and rural health centres throughout Gambia, which will give us a far better insight to the Discussion section of our report. It will also enable us to consider our case study, and thus malnutrition generally, within a far wider health context.

Days 3 & 4 Video Diary

Choosing the Case Study

Project Mission Statement

Yesterday we had a really productive morning session with the Gambian students. We decided it would be helpful for ourselves, and extremely beneficial for the project, if we composed a mission statement for the whole project. Together we came up with five key points that we all wanted to complete within the project time-frame. This way we would have a working structure in place, and a set of goals to work towards, which as we are only here for four weeks will enable us to set a daily itinerary specifically focused to completing these goals.

The Mission Statement is:

To explore the multidisciplinary factors which contribute to the pathway of a child with malnutrition

1. To develop and maintain a cohesive international multidisciplinary team.

2. To gain the trust and participation of the case

3. To understand the past and current medical history of the case, and the future expectations.

4. To explore the social, economic and cultural history of the case.

5. To understand the link between the global, regional, national and local influencing factors and their application with the case and the conceptual model of globalised health.

View the mission statement in the video above.

Day 1 Video Diary

Day 1

Yesterday was our first day at the Royal Victoria Teaching Hospital, and we finally met our Gambian colleagues who we will be co-running the project with. It was great to get underway with the project, and brilliant to exchange ideas and research with the Gambian students. It was also extremely productive as in just a few hours together we were able to organise a structure and methodology to work to for the next four weeks.

We arrived at the Royal Victoria Teaching Hospital at 9am, and after meeting several hospital dignitaries we had an introductory session with the Gambian students and tutors, where we all introduced ourselves, our areas of study and our individual aims for the project. It was particularly pleasing to see that the Gambian group were as diverse as ourselves, with students from medicine, nursing, politics and international relations, as its inter-disciplinary nature is exactly what makes this project so innovative.

We then had a tour of the hospital, before moving to one of the hospitals many teaching rooms to discuss the project in detail.

Arranging ourselves into three groups, with equal number of Gambian and Swansea students in each, we discussed the three core elements of the project: The case-study, the project methodology, and the various project outputs. Choosing the case study is going to be one of the most culturally sensitive parts of the whole project, and one that until today, discussing the matter with the Gambian students, we didn’t know how exactly to approach. Their knowledge of hospital protocol, however, and in particular their familiarity with the cultural sensitivities of Gambian families, was invaluable in this discussion.

Working collaboratively for the first time with the Gambian students has really set the tone for the whole project, as we were all able to combine our respective experiences of health and cultural practices in our own countries to form the overall direction and structure for out time together in Gambia.

It is this sense of cultural partnership that was paramount at the inception of the Swansea-Gambia Link, and it’s fantastic to finally be a part of it in a practical and tangible manner.

Read the Blog in Welsh here

Arrival

Team Gambia touched down on Gambian soil on Friday, and are now nicely settled in at our accommodation for the next four weeks, Dana Lodge. Cold showers have quickly become a luxury in the 32 degree heat, and the lodge’s two mango trees are providing us with fresh mangos for every breakfast!

Arriving on a Friday has been great as we’ve been able to find our feet and explore the surrounding areas this weekend, before getting started on the project on Monday. Yesterday we visited Bakau Market to pick up some fresh fruit, before heading to a local crocodile park. After a guided tour of the museum, we were led to the crocodile pen where we were assured all the crocodiles were so well fed they could happily be touched and stroked! Sure enough, after some initial trepidation, the team, one after another, approached a particularly lethargic looking croc who nonchalantly ignored them as they stroked his back, patted his sides and posed for photos.

The day then took a further eccentric turn as we had the rare pleasure of seeing the presidential procession on our way home. President Jammeh has been touring the country and our guide Bob informed us this was at best a once-yearly event, so not bad for our first full day in Gambia!

Today the team are relaxing a little in order to prepare our presentations for meeting the Gambian students tomorrow, who will make up the other half of the project. It’s exciting to finally be at this point, to be meeting the students that we’ve been liaising with so much but as yet haven’t met.

We have a guided tour of the hospital planned for the morning, and will finish by visiting the nutrition ward. It is here that the project will really begin to take form, and where the hard work can begin.

Read the Blog in Welsh here

Team Gambia at Gatwick, shortly before departure.

Meet the Team

Wales for Africa Annual health conference 2010

(Left to Right) Tomos Watkin, Debbie James, Katherine Devonald, Charlotte Dix (International Office), Lella Nouri, Sr. Rachel Wilson (ABMU Health Board), Lucy Hammond, Dr. David Abankwa (ABMU Health Board), Steve Allen (School of Medicine)

On the 8th July, representatives from Swansea-Gambia Link 2010 continued theire pre-departure research by attending the Wales for Africa Annual health conference at SWALEC Stadium, Cardiff.
The conference involved talks from Welsh Assembly Member John Griffiths on the importance of sustaining the Wales for Africa health links despite the economic downturn, as well as films and interviews with partners across Africa identifying the need and success of such links. Team Gambia (above) were involved in a number of workshops related to the Millennium Development Goals such as Maternal Health (MDG5), End Poverty and Hunger (MDG1), Child Health (MDG 4) and Education (MDG2). This was a great opportunity to meet and obtain valuable input from health workers, government officials, NGO's and other students, and to share ideas and perspectives on how to meet the MDG targets.

Read the Blog in Welsh here

Pre-departure Research

Having decided to look specifically at malnutrition as a point of research for the project, Swansea University students have been working on pre-departure research looking into cases of malnutrition in Wales. As the departure date draws near, the team have been finalising their UK malnutrition findings and preparing presentations for the Gambia University students. The presentations outline the UK focus of the project and the kind of research they hope to carry out with the help of their Gambian partners over the four week project.
The preparation began with a series of discussions in which the students from the Schools of Medicine, Human and Health Sciences and Arts and Humanities researched and shared respectively on their areas of expertise, and presented the findings that they believe are suitable for the Swansea-Gambia Health Link pilot project this year. Since then the team have held further meetings, presenting their research on malnutrition, dietary illnesses and varying medical treatments and prevention approaches to malnutrition in both Wales and Gambia.
Upon arrival in The Gambia, the Gambian students will assist in allocating a malnutrition case study within the Royal Victoria Teaching Hospital. This will enable interesting and innovative correlations to be made between the Gambia and Wales, regarding malnutrition and interrelated illnesses.

3 weeks to go!

With less than 3 weeks to go Team Gambia is getting increasingly excited about getting started on the project in hand.

Tomorrow the team are heading to Cardiff to attend the annual Wales for Africa Health Links conference (http://www.wales.nhs.uk/sites3/events.cfm?orgid=834&id=3978) which is based around the Millennium Development goals making it extremely relevant to our project. The Team is also looking forward to having an opportunity to talk to other Health Links projects and finding out some methods of best practise.