GHDLP Coach Dr. Paul Pierre On Advancing TB Research in Mali and Niger
View this article in French here.
Back in February of this year, before COVID-related restrictions on travel were imposed globally, 30 participants from seven Francophone African countries arrived in Rwanda for a two week intensive training program as part of UGHE’s first French language Executive Education program; the Global Health Delivery Leadership Program (GHDLP) in partnership with The Global Fund. The program started with a two week intensive residency on UGHE’s Butaro Campus combining foundational skills in management and leadership with case-based and field learning. This would be the springboard for the following six months where participants, grouped by country, would head home to develop their ‘Breakthrough Projects’. These collaborative Breakthrough Projects are designed to identify, and address some of the greatest, yet unanswered challenges within the communities across different country settings.
Yet the last six months have not been normal. The global COVID-19 pandemic has undoubtedly changed the parameters of teaching and learning and presented hurdles to, for instance, the group work so critical to these projects. Yet, it has also offered some surprising areas for innovation and new direction. UGHE has embraced this time as an opportunity to advance its online learning capability to seamlessly, providing a seamless transition to the same quality learning for its learners in Rwanda, and overseas. Similarly, the GHDLP participants have looked at redirecting the scope of their project, finding new, more targeted areas of global health to explore and address, and new populations to consider.
Dr. Paul Pierre, UGHE faculty, Haitian physician and global health leader has been a GHDLP program coach for the past three years, teaching his first GHDLP class back in 2017. Over the past six months, he has been the mentor for two GHDLP country groups – Niger and Mali – both of whose breakthrough projects focus on analyzing the impact, and patient follow-up of Tuberculous in the two country contexts. He talks to us about his experiences negotiating the new parameters of project work in times of COVID-19.
Q. What type of challenges did you encounter, and collaboratively overcome in working with the groups during COVID-19?
Every year, the scope of their Breakthough Project changes after each session; it is a constantly evolving process. The participants are always enthusiastic about what they can do, but when they hit the ground and face reality, they need to adapt. There is change that can be expected in terms of adapting the Breakthrough project plan they conceive in Rwanda during the intensive two weeks of training to their respective country contexts when back home. Yet, from my three years’ experience with such country groups, this year the change has been more notable in terms of scope because of the global COVID-19 pandemic.
With my Mali country group, the initial plan was to look at improving TB detection for a very large area of the population living in the Segou region. Yet with the restrictions on travelling, they had to accept that they would limit this project to the district of Kati .
For the Niger project, the adaptation was more pronounced. They initially envisioned to study causes of loss of follow up among patients with MDR-TB in Niamey. However, once they started doing the review, a paper on the same subject was published by an ONG in Niger. COVID-19 of course also altered the direction. They planned to follow patients from a large catchment area in Niamey, Niger’s capital, but like Mali we agreed to reduced this to a single district of Niamey IV, focusing instead on increasing TB detection among the nomadic population there. This ‘Population flottantes’, as they are called in French, were an interesting population to characterize; going into the city in the day to sell products, and returning at night to the outskirts where they live.
Q. How did the unique country contexts of Mali and Niger inform how the project developed?
Group work during times of lockdown is a hurdle. Yet it wasn’t just COVID-19 that presented barriers. There was a coop in Mali as the President resigned, which made having a call to discuss the project difficult. Often, the team would congregate in one place, rotating use of the computer to respect social distancing but I could understand the difficulties setting up the logistics of this call, and also understood the context of the news and how difficult it must be.
Both Niger and Mali have had security issues with terrorists and kidnapping. In Mali, the President was arrested and detained in the very district within which they were trying to collect the data. The Mali and Niger populations are in the middle of not only a pandemic, but also an explosive and unstable situation which is impacting their work. It has been difficult, for instance, for some members of each group to access high speed internet, having to travel to places with better internet. In the past, it would have been different; everyone would have face-to-face meetings for group work, but now the feasibility of this is tricky.
Q. How does your role as coach support the development of the Breakthrough Projects of each country group?
As coaches, we provide participants with frameworks to better assess the limitations of the health systems where they work, and to do this in a holistic way. They are seasoned professionals, not researchers per se, so I share approaches to research with them such as understanding indicators common for TB and HIV. We also provide them with a lot of additional documentation such as articles, and research projects that are similar to the one they are working on to get inspired and see what a best-in-class end product looks like. This was the first year working with a Francophone group and it was fun to do some digging into French resources.
We also have a monthly call with all participants of the country groups which keeps them on track, and provides them the necessary timelines, and deadlines. In each call, I give them general feedback, and ask questions to encourage them to think about the context, and what we are expecting from them. One of the elements we discuss is developing a timeline; when they will start analyzing the data, and tracking progress made on a monthly basis. We are constantly exchanging ideas – over emails, or verbally. Rather than teaching them how to delegate work, as in their senior positions they might have been used to, I wanted them to be involved in the hands-on practical side of research.
Q. What have you yourself learned from the different country teams during the last six months?
I’ve learnt a lot from the different teams about how we can use virtual platforms to move a project forward. They have been innovative with their time and what is feasible to do online when site visits have been limited due to restrictions around the pandemic. From the Mali team, I’ve learnt about the nomadic population, the importance of this group in the epidemiology of TB. What was interesting for me was how you bring services to these people, and what is the best place for them to access them; in the town in the day, or where they sleep at night? What we know we can’t catch these people during the normal clinic hours. With the team we really had to think how to address this issue, and for me, this will inform a lot of the decisions I’ll make in the future when working with urban populations.
Find out more about UGHE’s GHDLP program here.