(IAP’17) Maggie O’Grady, ’17
Maggie O’Grady (’17, Biological Engineering)
Maggie O’Grady will be traveling to Kara, Togo this IAP to work on a monitoring and evaluation project for Hope Through Health (HTH), a nonprofit organization that manages five HIV health clinics in northern Togo. She will be retrieving, cleaning, and analyzing mortality data over five years for a group of patients who are enrolled in Hope Through Health’s HIV treatment program to determine the mortality rate for patients in this program. At the end of IAP, she will prepare a report that will allow staff at the clinic to replicate the analysis with future data sets and track the impact of HTH’s HIV treatment program on mortality. The results of this analysis will enable HTH to better assess their strengths and weaknesses and improve their HIV treatment model going forward.
Check back for her updates!
Entry 3: Wrapping Up
January 29, 2017
Our trip has come to an end, and in only three short weeks our project has had a huge impact on the MEQ team at AED, Hope Through Health’s main clinic in Kara. The MEQ team is in charge of collecting, maintaining, verifying, and using patient data to help improve programming at the clinic, in line with Hope Through Health’s commitment to providing quality, data-driven healthcare to people living with HIV/AIDS in northern Togo. Working with the MEQ team this month has shown me exactly how much work goes into the process of data collection and verification. Before coming to Togo this January, I was aware that HTH conducts extensive research to design and refine their programming, but I had no idea just how much work goes into verifying the data.
Through our data verification process, I found out that almost every staff member keeps their own database of patient information, which makes it easier for the MEQ team to cross-check data later on. I also learned that survey data here is checked three times by three separate staff members before it’s finalized. During our first week at AED, Emily, a Princeton in Africa Fellow and member of the MEQ team, spent three full days reviewing survey data and comparing paper surveys line-by-line with data in the computer to ensure it was accurate. Etonam, the MEQ Director, and Jacob, a former Peace Corps volunteer who monitors AED’s four satellite clinics, also spent several days in our office each week comparing paper records with electronic information to verify data for each of the satellites. Since Jacob’s position is new at AED, they only recently started conducting this verification, but he said that they are going to start verifying and updating the satellite data monthly. As AED expands, data collection and verification will only become more extensive and high quality.
Our project fit in nicely with the work of the MEQ team, but they simply didn’t have the time to go through all 1,500 patients at AED and talk to staff members to verify their information. We left the MEQ team with an Excel spreadsheet containing the status (Active, Deceased, Lost to Follow-Up, or Transferred) of each patient who was active in the antiretroviral therapy program between 2010 and 2015, and the person or database through which each status was verified. We also designed a flowchart with the steps that will be required to complete this verification each year, so that it can be used to calculate HIV mortality annually and track HTH’s progress in treating HIV. Finally, we created a list of suggestions for data collection and maintenance that can be done throughout the year to make the year-end verification easier, and we discussed ways to implement these recommendations with the staff at AED. Although it was only a small contribution in the grand scheme of HTH’s work, I was happy to be able to work on a project that lightened the workload for the MEQ team at AED.
I have been working with HTH both directly and indirectly through GlobeMed for the past four years, but continue to be amazed by their high-caliber work. A small NGO, they are rapidly expanding and have completely transformed healthcare for patients living with HIV/AIDS in northern Togo. My work with HTH over the years and this IAP has completely changed my outlook on development and my place in it. I am planning on leaving for Peace Corps in April, a program that I never would have considered without the guidance of Jenny, the Executive Director of HTH. After Peace Corps, I am planning on pursuing an MPH, another decision that resulted from extensive guidance from Jenny, HTH staff, and GlobeMed alumni, all of whom are passionate about global health and improving the lives of people around the world. Now that I am leaving MIT and Togo, I am excited to take with me the lessons that I’ve learned about high quality research and use them to make an impact on communities like Kara through my career.
Entry 2: Data Verification
January 20, 2017
Mads and I completed our first two weeks of work at the clinic (AED) and are excited to keep making progress on our project. Before getting to Togo, I was a little bit nervous about the scope of our project, because we kept making changes to the project plan over the course of the semester. Originally, we were intending to analyze HIV mortality data for patients enrolled in Hope Through Health’s antiretroviral therapy program, which would give them direct information on how well they are doing in terms of treating HIV. However, after reviewing the project with the CSO of HTH and the research team here at AED, we decided to spend more time focusing on verifying the patient data with patient records and with the community health workers to make sure that the analysis would be as accurate as possible. We really wanted our project to be of value to the clinic in the long-term, so we were flexible in modifying our project to make it better suit the needs of AED and HTH.
We spent most of last week digging through the notebooks that patients carry with them to their appointments in order to verify which patients were still alive and active members of AED at the end of 2015, the endpoint of the mortality study that HTH will be conducting. In all, we looked through around 1,000 notebooks out of the 1,481 patients enrolled in the antiretroviral therapy program between 2010 and 2015. After looking through the notebooks, we talked directly with the CHWs and with other clinic staff members who come in contact with patients frequently to see if they could tell us the status of the remaining patients. This project is probably not what people would consider “sexy,” like building a clinic or implementing a new technology, but it is much needed work that the clinic staff don’t currently have the time to carry out on their own. When we updated the CSO of HTH on our work last week, he responded back that this project is just what they needed at the clinic, which was really encouraging.
Though this data verification won’t directly impact patients at HTH, it will have two long-term effects. First, because we are finding and documenting the most efficient way to perform this verification each year, this project will reduce the workload for the staff in the future so that they can focus on patient care. Second, this verification will help improve the quality of every annual mortality analysis calculation that will help HTH track the progress of their antiretroviral therapy program and improve upon their programs in the future. Our project will have the largest direct impact on the M&E team, which is generally flooded with other tasks at the end of the year, when this mortality data will need to be verified. Ideally, the staff won’t have to spend a week each year looking through all 1,000 (and growing) patient notebooks every year as a result of our work trying to optimize this procedure. We’re going to try and outline the best method for verifying the data throughout the year so that they can better prepare for this annual study. In all, we are making a tangible contribution to ease the workload at the clinic and improve the quality of care that HTH provides to their patients in the long run.
Entry 1: Introduction
January 12, 2017
I’m spending this IAP in Kara, Togo working with Hope Through Health (HTH), an NGO that manages five HIV health clinics and runs maternal and child health (MCH) programs at four public clinics in northern Togo. HTH was founded in 2004 by two Peace Corps volunteers, Kevin Fiori and Jenny Schechter, who joined together with an association of community members living with HIV/AIDS called Association Espoir pour Demain (AED-Lidaw). Together, they began providing services to patients living with HIV/AIDS in a region where affordable care was previously nonexistent. HTH’s healthcare delivery model focuses on community-driven care and is centered around their community health workers (CHWs), who are community members trained to provide care to patients at home. HTH currently serves a region of over 30,000 patients, and is working with the Togolese Ministry of Health to expand their CHW model throughout the country.
I have been working with HTH since my freshman year at MIT, when I joined a student group called GlobeMed at MIT. We maintain a long-term partnership with HTH, which involves raising money throughout the school year to help stock the pharmacies at their clinics and sending students to Togo over the summer and IAP to implement capacity-building projects. Our work on the ground in Togo is made possible by generous grant funding through organizations like MIT’s PKG Center. My involvement with HTH has grown from organizing fundraisers during my freshman year to implementing a mobile health platform at the main clinic in Togo after my sophomore year, and organizing a benefit gala in 2015 that raised over $3,000 for HTH. In 2015, I took the fall semester off from MIT to work at HTH’s New York office, where I learned more about their programs in Togo and got to know our partner organization on a more personal level.
HTH strives to maintain a data-driven approach to development, and has recently been expanding their M&E programs to improve the quality of care that they provide to their patients in Togo. They are currently working on four large studies in addition to their routine M&E: a return on investment analysis, child mortality calculation, process evaluation for the new maternal and child health program, and HIV survival analysis for patients enrolled in antiretroviral therapy. This IAP, I am working with Madeline Jenkins ’17 and contributing to the HIV survival analysis by verifying patient survival data and creating a workflow for cleaning the data after it is exported every year. This will ease the workload for the M&E team each year and provide them with a simple procedure for analyzing HIV mortality over time.
We arrived in the capital city of Lomé on Friday afternoon after a 10-hour flight from Newark, then took an 8-hour bus ride up to Kara, where we are staying for the month. We started work at AED on Monday morning by meeting with the research team, which consists of Etonam, the Monitoring, Evaluation, and Quality (MEQ) Director; and Emily, a Princeton in Africa Fellow who arrived in Togo this summer. We also met with Koffi, the Community Health Worker (CHW) Director, to arrange meetings with the CHWs to verify the data for their patients. CHWs know their patients very well, so they can tell us whether a patient is still living, and if so, whether they have been following their treatment regimen. The patient data is stored in a government database called ESOPE, and Etonam already extracted the 2015 data for us to work with. We have started meeting with CHWs and so far the data verification is going smoothly. We are on track to finish the verification by the end of the week, and then will begin documenting our process so that it can be easily replicated. Later this month, we’ll also observe Etonam as he completes the extraction of the 2016 data from ESOPE so that we can help determine and document the most efficient way for the data extraction and verification to be repeated each year.
My biggest concern for this IAP was the language barrier; I took French in high school but haven’t had much practice since then. However, I was surprised by the number of English speakers at the clinic who were able to show us around the city and help us get situated during our first weekend here. In addition to Emily, there is a former Peace Corps volunteer who stayed in Togo after his service to work for HTH, as well as two fellows from the NGO Construction for Change. I was also originally concerned about the trajectory of our project, because it underwent several iterations over the course of the fall semester. After much discussion and modification of our project goals in collaboration with our partner in Togo, I am hopeful that our project will have a lasting impact on HTH’s MEQ program and make work a little bit easier for the research team in the future.