Bitten By the Global Health Bug

By Monica R. McLemore PhD, MPH, RN

As a Black American, nurse, preemie (at 32 weeks in 1969), and assistant professor of nursing, the irony of me taking my first trip to the African continent with the University of California, San Francisco (UCSF) Preterm Birth Initiative (PTBi) is not lost on me.

PTBi is a multi-year initiative, funded by The Bill and Melinda Gates Foundation and Lynne and Marc Benioff, aimed at turning the curve on preterm birth and to conducting transdisciplinary work differently, with a focus on place-based strategies. Larry Rand MD and Linda Franck PhD, RN lead the California arm (Fresno, Oakland, San Francisco) and Dilys Walker MD leads the East Africa arm (Kenya, Rwanda, Uganda). Each year, the PTBi hosts a symposium and one arm serves as host with rotating locations – this year, the meeting was held in Nairobi, Kenya.

During my trip, I was bitten by several bugs, and the most important one was the urgency for me to bring the synergies of my work in California to our global partners and to infuse my work in California with lessons learned from our colleagues in Africa.

For example, the research program of PTBi-CA centers on including women at socio-demographic-medical risk for preterm birth at all levels of the initiative. We have used research prioritization activities where women in San Francisco, Oakland and Fresno generated, ranked and prioritized research questions that are important to them. Also, our community partners are developing research infrastructure to allow for community-based participatory action research projects to be developed, led and conducted by community members.

When our California team spoke with physicians, midwives and nurses at the hospital in Tororo, Uganda, it was clear that the idea of surveying the women they serve was not at the center of their work, nor did they understand methods to engage the women to elicit their ideas and research questions. We explained that allowing community “experts by experience” to provide input on the research agenda would lead to more effective and sustainable interventions. Including community experts in research agenda setting would enable patients and the public to integrate ideas that would liberate women from oppression and build a pathway to justice.

Conversely, Kenyan investigators are using SMS/text messages and mHealth strategies to reinforce health education messaging with community health workers and able to stay engaged with women, particularly in the postnatal and postpartum period. This could be a novel and effective method to seek research input from community members in our California communities.

I have always avoided global work because of my status as an early career investigator – however, the stars have aligned and made crystal clear the intersections of my local and global work. Elimination of reproductive oppression and acquisition of reproductive justice knows no boundaries. Unleashing the power of women of color in the local and global contexts is a passion, a calling and an imperative.

Monica R. McLemore, PhD, MPH, RN, is assistant professor of family health care nursing in the UCSF School of Nursing and associate director for community-engaged research of the Preterm Birth initiative-California (PTBi-CA). Follow Monica on Facebook for reflections and notes and Twitter (@mclemoremr) where she live tweeted the entire symposium.