The Bixby Summer Internship funding made it possible for me to intern with a longitudinal cohort study on pregnancy and childhood malaria, called MOMS (Mother-Offspring Malaria Study). The 5 year study is being carried out in an endemic region of northeastern Tanzania, called Muheza. The study is following 1000 mother infant pairs from before delivery until the end of the study. The goal of MOMS is to determine the epidemiological, immunological, parasitological and social risk factors involved in severe malarial disease and malaria related mortality in children and pregnant women. The endpoint of MOMS is to inform the development of an effective malaria vaccine. The cohort is being used as a model design for future worldwide vaccine trials.

Malaria kills over two million people in the world annually and 90% of those deaths occur in sub-Saharan Africa. One million of those deaths are children under the age of five and pregnant women are the adult group most at risk for severe malarial disease and death. The study takes place at a district hospital in the semi-rural town of Muheza, and at satellite field clinics in the study villages within Muheza district. The study is funded in part by NAID and the Gates Foundation. MOMS is led by a multi-international team of researchers, scientists, clinicians, field workers, laboratory technicians, East African Graduate students and computer experts. My preceptor, Dr. Patrick Duffy, the Principal Investigator of MOMS, is a parasitologist and physician who works for the Seattle Biomedical Research Institute, a nonprofit in Seattle Washington, and is an associate faculty member of the University of Washington Seattle. The Tanzanian Project leader, Dr. T K Mutabingwa is a well-published clinical researcher in pregnancy and childhood malaria who heads a malaria research institute at the hospital and helps shape national malaria control policies

My role in the study was to manage the Access database, and monitor and provide quality assurance of the data collection and data entry. I worked on a preliminary descriptive data analysis of the cohort to date for a major grant proposal. I went out in the field to problem solve flow of data and collection issues, helped with day to day administrative tasks, organized the collection and entry processes. I taught myself how to use Access software. I spent a great deal of time entering over nine months of data into the database.

My internship lasted for approximately 10 weeks with an average of six work days a week. My goals for the summer were to learn about public health research in a third world context, to gain skills in data analysis, and software applications, data collection techniques and research evaluation, and to contribute to a project of international importance. I also wanted to learn the culture of my study community, develop good working relationships with community members and develop models for future interventions. The internship provided the opportunity to work with leaders in the field of Malaria research, and enhanced my understanding of research methods and design. I gained knowledge in reproductive, maternal and child health and infectious disease. As my internship was based at a hospital, with a state of the art laboratory, in a community with numerous other research projects going on, I got a broad exposure to the research field, and to other public health programs addressing issues such as HIV/AIDS, and nutrition. The majority of my co-workers were Tanzanians, and as a result, I learned to speak Kiswahili.

KCMC was built and equipped primarily by the Good Samaritan Foundation. It is both a referral hospital for over 11 million people in Northern Tanzania and a national teaching center. The hospital is a huge complex with over 450 beds and hundreds of daily outpatients. In 1997 the medical college was opened, and last year KCMC begun offering one year MPH programs sponsored by WHO. I helped the students prepare to defend their research theses projects, putting my newly developed skills to use in critiquing their work and helping them finish. Being able to apply what I have learnt was highly rewarding.

I was also encouraged to participate in a schistosomiasis community follow-up intervention study at two elementary schools in a rural area 45 miles west of Moshi, along the Moshi to Dar-es-Salaam Road. Their small minority community of Muslims lives in an extremely impoverished area where schistosomiasis is endemic. I assisted the researchers to assess knowledge and awareness of the parasitic infection, and to recruit students interested in participating and developing an instructional film on schistosomiasis eradication within their community.

I was also able to volunteer at KIWAKKUKI, a community-based nongovernmental organization founded in 1990 by a group of women in northern Tanzania, including a few physicians teaching at KCMC, who felt compelled to join the fight against HIV/AIDS because the negative effects of the epidemic were rapidly increasing in their community. I spent my last month doing a rotation in several of KIWAKKUKI's programs: the Orphan Support Program (established 1998), the Home-Based Care Project (2000), the HIV/AIDS Education Program, and the Center of Hope (1992). The Center of Hope is a support group for people living with HIV/AIDS to share their experiences, be open about their serostatus, via their Voluntary Counseling and Testing Program, and receive assistance in caring for their children. Although the Home-Based Care Project could only provide minimal symptomatic relief to the disease, KIWAKKUKI has accomplished a gigantic baby step in the fight against HIV.

It was my first time in over five years that I had spent considerable time in Moshi. I got to experience the town's way of life that I had so missed and remembered fondly, not just as a visitor but as a returning public health researcher filled with enthusiasm and excitement about how I could contribute to improving the health situation there. Some of the goals that I achieved were:

1. creating further awareness through education and better communication,
2. gaining an understanding of how public health is applied to HIV prevention and care of PLHAs in the local community,
3. informing the community about community mobilization, so as to bring about change and make the local government more accountable, and
4. gaining exposure to the local current public health community's approach to infectious disease.

All of which are essential in refining my research experience especially since I plan on returning to work in Tanzania. Thank you very much to both the Drabkin and Bixby Programs for helping me achieve this.