The threat of climatic change and prolonged conflict is expected to displace millions in the Global South in the coming years. I hope to continue leading and designing health programs to improve access to health services in Africa, drugs, and vaccines for IDPs, providing policymakers with evidence-based policy options. I feel strongly that earning the MPH Degree in Global Health at the University of XXXX, a world-class institution invested in improving access to life-saving medical care for the world's neediest populations, is the institution that will best help me to realize my dreams.
I had worked in the development sector since 2013, when I began my first position as an Associate Pharmacy Officer with Howard University’s PACE Centre, helping to strengthen the Integrated Delivery of HIV/AIDS Services (SIDHAS) in my native Nigeria. In 2014, I was promoted to State Pharmacy Specialist in Borno State, in the Northeast of the country, the birthplace and central stronghold of Boko Haram, an insurgency which, in addition to murder, torture and disappearance, is also guilty of human trafficking, forcing boys to become soldiers and girls sex slaves, resulting in the incalculable misery and displacement of millions of people.
With the rise of this insurgency, the USAID-funded SIDHAS project was the only project with an active presence in the state at the time. Before being closed because of terrorist activity by Boko Haram, the SIDHAS project supported twenty-one health facilities in Borno state. All but three of these sites – located in Abuja, the fortified capital city - became non-functional due to attacks and community displacements by the insurgents. I led a team to trace our clients when they became displaced and found many of them in camps for internally displaced persons (IDPs). I also helped develop an implementation roadmap for HIV/AIDS interventions in the camps.
I was part of a small group of people who designed and set up a novel mobile antiretroviral therapy clinic, which was specially designed for our work at preventing and treating HIV/AIDS clients and other related services, particularly for IDPs living in camps. I coordinated the team to provide comprehensive HIV/AIDS services to fourteen designated IDP camps, visiting each center 2 to 3 times a month on average. I helped create culturally and linguistically appropriate HIV prevention messages, stigma reduction strategies, and the development of anti-discrimination materials disseminated in Kanuri and Hausa in the camps.
I coordinated continuous camp management engagement to encourage the seamless implementation of policy directives. I enjoyed networking with our partners in the IDP camps or health facilities and various organizations, including a mobile ART team. From its inception in October 2015 to December 2017, the ART mobile team screened 26,862 persons, of which 851 were diagnosed as positive. Seven hundred ninety clients were enrolled in care and initiated lifesaving ARVs; within the same period, 20,017 pregnant women were screened, with 105 diagnosed positive, while seventy-three clients were started on ART for PMTCT.
My research entitled "Evaluating mobile HIV/AIDS services for internally displaced persons living in IDP camps in Maiduguri: Success or Failure?" was accepted for poster presentation at the Liverpool School of Tropical Medicine's 6th Annual Research Symposium in Nov 2016. Mobile ART is one of the success stories of improving access to HIV/AIDS in the Boko-Haram-affected region of Northeast Nigeria. However, during the implementation process, I learned many lessons and raised many questions. HIV management requires lifelong adherence. Treatment interruption leads to the deterioration of clinical conditions and resistance, leading to treatment failure. In IDP camps, it was easy to monitor compliance. Since ARVs are provided in the camps directly, this eliminates many barriers to adherence. ARV adherence is significantly better in the centers than in the larger community, accessing ARVs from health facilities. One tough challenge we faced was the complete lack of data on health indices and the burden of diseases in the conflictive area, which was notably more challenging and more formidable where those records had been destroyed. Patients fled the conflict zones in all directions, seeking safe locations, and few carried health records. For most IDPs, we had neither an address nor a telephone number, preventing complex logistic challenges.
The rise in violence and conflict in sub-Saharan Africa threatens progress in reducing the disease burden. Further compounded by climate change, forced displacement makes it still more challenging to design effective health programs in the battle against chronic diseases like HIV and TB. We need to constantly rethink the programming of HIV initiatives and resources, for example, in the face of other infectious diseases and chronic conditions emergent in unforeseen ways in a rapidly deteriorating environment.
I learned much as a participant in the University of XXXX Global Health E-Learning Program. I now have certificates in 4 online courses: Leadership and Management in Health, Economic Evaluation in Global Health, Fundamentals of Implementation Science, and Clinical Management of HIV/AIDS. These courses have deepened my knowledge and contributed to my success so far. I have had the opportunity to learn first-hand from the most talented Professors at UW, especially Professors XXXX and XXXX. I find the work of Professor XXXX exciting since her unique position at the intersection of global health and conflict is incredibly close to my intellectual center.