Thank you, Heather Underwood, for sharing your story.
The problems we attempt to solve as ICTD researchers never exist in isolation. It is this complexity and vast possibility that make this field incredibly diverse, challenging, and appealing. I teach an ICTD fieldwork methods course at the University of Colorado, and while we cover methods like logframes, stakeholder analysis, surveys, and interviews, my goal is for students to leave this class with even more foundational tools: adaptability, awareness, strategic decision-making in conditions of uncertainty, and a deeper understanding of themselves as researchers in the field and how that impacts the research and the people involved.
Below are several excerpts from my initial fieldnotes on the PartoPen project that capture much of this uncertainty, excitement, surprise, confusion, bewilderment, and joy that accompany almost every ICTD project. I am glad to have the opportunity to share some of these stories for the first time, and to contribute to this dynamic and diverse community in a unique way.
March 2012 – “Dr. Kuria told me that they used to have disposable speculums, but they came with a non-profit project, and when the project was done (wipes his hands), ‘gone,’ he said. This seems to be a fairly regular occurrence, and something they expect. This will be good to keep in mind for the long-term adoption and success of the PartoPen project. Show up!”
March 2012 – “The partograph forms I saw in the charts were all incomplete or completely blank. I learned that there are several reasons for this (other than inadequate training or form complexity as originally thought): most of the patients at Kenyatta are referral patients from other hospitals and they do not come to Kenyatta with a partograph form. Most of these patients are in very bad condition upon arrival; many have already delivered. One of the doctors said that clinics often do not send the partograph with the patient because they are afraid of being reprimanded, and/or they want to keep the partograph for their own records to document that the birth took place at their clinic, and therefore get more money from the ministry of health. The same doctor (Kuria) also told me that many patients are electing to be transferred to Kenyatta now that most mothers are covered by a new insurance fund – women can now pay 160 Ksh per month and receive complete maternal care. This has resulted in an increased patient load for Kenyatta without increases in staff or resources.”
March 2012 – “Today was my last day in the labor ward. I spent tea time with the nurses and gave them a thank you note and some homemade chocolate-chip cookies. Apparently that is not a staple of Kenyan cuisine – I may have started a cookie craze at Kenyatta! I have truly appreciated their patience with me, and I have been inspired by the incredible work they do. I am really looking forward to working with them again in June.”
June 2012 – “On June 20, I arrived at the labor ward to conduct the paper surveys; however, a general strike had been initiated throughout the hospital, and patients were being turned away. The handful of nurses and doctors who were working in the ward were only accepting emergency cases. I witnessed a dozen laboring women being told to go elsewhere, and I know many of those children were born on buses or on the street outside the hospital.”
(One year later)
June 2013 – “The printer we had purchased for the KNH labor ward in 2012 needed a replacement drum, and the part was not available locally. A new printer had been purchased, which was capable of printing dot paper, but the installation of the software had failed … I learned from the records office staff that the original discontinuation of the PartoPens was a result of the printer running out of toner and replacement toner not being delivered in a timely manner. I watched as one of the records office staff members showed me how they “make the toner last” – he yanked the toner cartridge out of the printer and gave it a couple of hard shakes before reinserting the cartridge into the printer.”
June 2013 – “Overall, the PartoPen project was well maintained and sustained by the staff at KNH for nine months after the initial implementation, but complicated feedback loops between hospital departments, not a lack of enthusiasm and support, has made the process slow and inefficient.”
When I first began this work, I thought I was tackling one problem: low partograph completion rates. It quickly became apparent that there is no such thing as “one problem” in fieldwork. There will always be setbacks, but there will also be pleasant surprises, and gracefully navigating both is one of the best parts of working in ICTD; a lesson I hope I can pass on to my students and share with fellow researchers and practitioners.
Dr. Underwood is currently working as an Assistant Professor at the University of Colorado Denver’s Anschutz Medical Campus.