From June 26, 2005 to August 31, 2005 I interned with the University Research Co., LLC (URC) in Asmara, Eritrea.  Under the supervision of Waverly Rennie, and in collaboration with a UNICEF consultant and a Michigan Population Fellow, I worked on three projects while in Eritrea.  The first project was a pilot Integrated Community Health (ICH) program.  The premise of this program was to encourage program sustainability and non-reliance on non-governmental organizations (NGOS) by using existing personnel and structures within the Eritrean Ministry of Health.  Three Sub-Zobas were selected to participate in the program, and local health personnel and village administrators (both already salaried by the government) were selected to be trained as trainers. They, in turn would go out into their respective communities and train community health workers in three areas: prevention and treatment of diarrhea, prevention and treatment of acute respiratory infections, and family planning/child spacing.  I participated in two of the training sessions, at first as an observer and then as a facilitator and evaluator.  This program encountered many obstacles to successful implementation at the community level since it added work to government employees without providing them with additional compensation.  While ICH was a noble attempt at working with existing personnel, infrastructure, and resources, it does not appear that this program will be expanded to other areas without the support of outside funding and leadership.

The second project that was handed to me involved conducting research and developing a transition plan for traditional birth attendants (TBAs) to slowly decrease the number of home deliveries they perform and instead utilize their connection with local communities to encourage pregnant women to seek skilled delivery care at a health facility.  Options to use TBAs for community-based distribution (CBD) of contraceptives, iron-folate, and vitamin A were also explored through interviews with current TBAs and TBA trainers.  In addition to researching the role of TBAs in Eritrea, I also conducted literature searches for similar transition plans in other developing countries and best practice reports for increasing safe motherhood.  In the end, this project was cut short by the Eritrean government’s request that USAID halt all activities in the country, but I was able to sum up my findings in a working notes document that was submitted to the Ministry of Health.

The last major project I was involved with was the evaluation of a community-based safe motherhood peer education program.  I tried to meet with national and local level administrators to obtain background information on the program and then I developed questionnaires designed to elicit information regarding the current status of the program.  I conducted site visits to four villages and interviewed program participants.  Unfortunately I conducted my last interview on the final day of my internship and thus was only able to produce a short report documenting my findings.

I also had the opportunity to work on smaller projects, like producing client brochures and education material, field testing print material, and developing emergency management of obstetric care job aids.  While many of my projects were cut short since USAID was ordered to halt activities, it was still a fulfilling and very educational internship. 

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During the summer of 2004 I was privileged to complete a 10-week internship in Asmara, Eritrea with the Ministry of Health and the Technical Assistance Support Contract 2 (TASC 2) team. The University Research Co., LLC of Bethesda, Maryland was awarded this contract by USAID. The goal of TASC 2 is to help Eritrea's public sector to improve the quality of primary health care services, improve health behaviors, and increase demand for health services in three "zobas" (provinces) of Eritrea.

Malaria is currently Eritrea's largest public health problem, with 67% of the population living in malaria endemic regions. It is the first cause of death of children ages 5 and up, the third cause of death of children ages 5 and under, and is also responsible for over 10% of all yearly deaths in Eritrea. Moreover, malaria is a main cause of morbidity and mortality among pregnant women. Just prior to my arrival, the Health Promotion Center (HPC) of the Ministry of Health started producing educational materials on malaria such as radio-spots and brochures, in collaboration with the Eritrean Social Marketing Group (ESMG). The goal was to produce these materials in eight of the nine languages spoken in Eritrea. The minute-long radio spots discussed the importance of various malaria prevention activities. The malaria brochure illustrated the correct malaria treatments and danger signs of severe illness.

Using the radio-spots and brochures the HPC and ESMG had already produced in Tigringna as a guide, my main responsibility was to oversee the production and pre-testing of the malaria brochures and radio-spots in the languages of Tigre, Saho, Afar, Bilen, Arabic, Nara, and Kunama. The goal was to ensure that the primary target group of low-educated/illiterate mothers could understand the pictorial messages of the brochure. In addition, the radio spots were pre-tested mainly among men to ensure their understanding and the clarity of the messages.

During my internship, the HPC was also involved in the production of a documentary on Female Genital Cutting (FGC) in Eritrea. According to Eritrea's 2002 Demographic and Health Survey, nine in ten women (89%) reported they had been circumcised. In preparation for the launch of the documentary, I developed an advocacy fact sheet that included information about FCG practices in Eritrea, success stories on overcoming FCG practices, and what can be done in Eritrea to stop the practice of FCG.
My internship in Eritrea was a life-changing experience that reinforced my goal of pursuing an international public health career. I hope this experience marks the beginning of my contribution towards the improvement of health and quality of life among underserved populations at home and abroad.

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