In the Field in Zambia: ‘I Want to Do Your Story Justice’.

Off the main highways the roads in southern and eastern Zambia are rarely smooth, says MPH student Kalpita Patel. Traveling between 10 maternal waiting homes every day for two weeks, for up to eight hours and hundreds of kilometers at a time, she says, “I swear my tailbone is broken.”

Still, Patel says the journey has been nothing compared to what the Maternity Homes Access Zambia (MAHMAZ) project is working to prevent: pregnant women walking 10 kilometers to reach care after their water has already broken or something has gone wrong.

“According to UNICEF, Zambia has 591 maternal deaths per 100,000 live births, which is an extremely high number,” Patel says.

To curb maternal mortality, MAHMAZ and its partners, SPH and the Zambia Center for Applied Health Research and Development (ZCAHRD), have engaged the Zambian government and local communities to build 12 maternal waiting homes, known as “mother shelters” within Zambia. Expecting mothers can go ahead of their due date and wait with basic  emergency obstetric and newborn care close at hand at 10 of the homes, and comprehensive emergency care at the remaining two. The project’s implementation effectiveness  and process are being monitored by a team of researchers led by Nancy Scott, assistant professor of global health.

Patel’s public health focus is on health communication and program management, and in her internship with MAHMAZ she is gathering the material to create a compelling narrative about the program and its importance. “It’s such a powerful tool, translating the research being done into impactful stories,” she says. “All of us in the public health world know the immense number of organizations doing incredible work on a global scale, but the ones that we end up hearing about are the ones that have honed their narrative storytelling skills to get the information to the public.”

In Zambia, she hit the ground running. “I touched down, and I didn’t sleep on the entire flight, so I got to Zambia in a haze,” she says. “From that first Monday I got to the office and they said, ‘All right, you’re headed to Choma,’ which was hundreds of kilometers away.”

Traveling to 10 of the 12 shelters, Patel is interviewing mothers and the community members who run the waiting homes. “All of these shelters have community-based government and management systems,” Patel says. “These systems show just how much the communities have embraced the shelters. They run them on their own, and they take ownership and accountability for these shelters and the mothers visiting them.”

She is also interviewing health directors, hospital directors, and traditional leaders. “When you think about district directors of health or the chief of an entire area, you don’t think that they would be open to meeting with an MPH student,” she says, “but I go to their homes or their offices and they welcome me with open arms and tell me the difference that maternal waiting homes have made in their communities. It’s incredible to see how they’ve embraced these shelters and how much they want them to succeed and help the people in their communities to ward off maternal death.”

Sustainability is a key part of the MAHMAZ project, Patel says, and that means more than waiting happens at these waiting homes. In addition to a bed and a kitchen to cook their own meals, the waiting homes provide training in sewing and tailoring. “Each shelter has at least two sewing machines,” Patel says, “and with those sewing machines they sew their own baby clothes, they sew school uniforms to sell, and they also make maternity pads and sanitary pads—local schools will put in orders for their girls from these mothers.”

Each waiting home also grows its own food, selling excess, and chooses other income-generating activities. Some have hammermills to grind corn for community members, others have agricultural supply stores, and others raise goats—Patel’s favorite of the activities.

The maternal waiting homes also provide childcare and child health instruction, Patel says. “Some of the mothers have been 14 or 15,” Patel says, “and for the most part they’re very young and they’re having their first child with no real idea of how to take care of that child outside of what their mothers or their aunts and fathers are telling them.”

Patel has met and talked with more than 40 people in Zambia in this two-week project, but says the person who particularly struck her was one of those young expecting mothers. “This 15-year-old girl is giving birth to her first child—and I can’t even imagine what my life was like at 15, I think I was re-reading Harry Potter religiously,” Patel says. “I asked her to tell me about her experience in the mother shelter, and if there was anything we could change about this facility to make it better and suit her needs, and she said, ‘Sugar.’

“’I said, ‘Sugar?’ and she said, ‘Yes—before you go, can you bring me sugar for my morning porridge?’”

They both laughed about her answer, but Patel says it stuck with her. “Her answer just made everything else feel so small,” she says. “I would have so many concerns, knowing the maternal mortality rate in the area, but her concern was so simple, and it gave me a lot of hope that we’re working in the right direction.”

Patel’s summer is only just getting started: Next, she is off to spend two months in South Africa, completing a practicum helping with communications and classes at the University of the Western Cape School of Public Health. Her summer is a whirlwind, Patel says, but she won’t soon forget her time in Zambia and the work she has been able to do.

“We’re putting stories to faces and putting faces to the incredible work being done in Zambia by SPH and other managing partners,” she says. “I hope that these stories will eventually lead to more interest from outside donors and change-makers who want to get involved in similar work.”

That, she says, is more than worth a few bumpy roads.

—Michelle Samuels

Kalpita Patel is taking over the SPH Instagram account from June 19 through 23 to share photos from Zambia and South Africa. Follow along at Instagram.com/BUSPH/.