Alumni Profile: Kate Cerwensky, Program Associate at the Boston University PMTCT Integration Program and former UVPer

Kate Cerwensky is a 27-year-old public health professional and UVP alumna. She currently lives and works in Zambia for the Boston University PMTCT Integration Program and the Zambia Center for Applied Health and Research and Development. She travels on the side as much as she can.

Uganda Village Project (UVP): Tell us about your involvement with the Uganda Village Project – when were you involve and in what capacity?

Kate Cerwensky (KC): I served as the Safe Water and Sanitation Project Coordinator for UVP during the summer of 2008. We were based in rural Kalalu Parish in Iganga. My team of five was tasked to promote WaterGuard, a water-chlorination product developed by the CDC. We also coordinated two side projects: 1) establish a relationship between the community and partner organizations to build five shallow wells within our parish, and 2) mobilize the community for mass distribution of insecticide treated nets.

From 2008-2009 I served as UVP's publicity chair on the executive board. I helped to create promotional materials, including orientation and project area manuals, as well as pursued and established relationships with external partners.

UVP: What was your biggest challenge working in Iganga? How did you deal with it?

KC: The biggest challenge, but the most fun as it turned out, was learning how to live like your rural community. My team had the most rural placement, and therefore we did not have electricity, running water, indoor plumbing, washing machines, air conditioning, etc. It was quite the learning experience, and extremely humbling. We dealt with it as a team - took turns fetching water from the borehole, handwashing our own clothes, etc. Most of all we learned from the community, which helped gain their trust.

UVP: What is your favorite memory about your time in Uganda?

KC: Too many. It could have been coming home after a really hard day in the field to no fewer than 30 children between the ages of few months and 10 years waiting for us in our front yard excitedly. It could have been the shallow well commissioning ceremony (the "ribbon cutting" celebration) after the construction of one of the community wells, with all of the singing and dancing. It could have been the morning I left my village - I was so sad to leave, and one by one my community members gave me a last token of appreciation - an orange, an egg, maize, sugarcane, a live chicken... etc. My bags were already bursting and then I had to find places for 40 random food items, which was incredibly touching. Or maybe it was white water rafting the Nile with the other volunteers :-)

UVP: How has UVP shaped your career today and what you aspire to do in the future?

KC: UVP solidified my desire to get my Masters in Public Health (International Health and Epidemiology). I always knew I was keen for international work, but wasn't sure exactly what that was until my time in Uganda. Since Uganda, I have worked in rural Kenya, and now have been living in urban Zambia, providing technical support and program implementation and evaluation services. I am extremely happy with where I am now, and can see myself staying in Zambia for years to come, growing with my current organization.

UVP: Tell us more about your work - what are you working on and who are you working with?

KC: I currently live in Lusaka, Zambia, and have been working for Boston University's Center for Global Health and Development's local affiliate - the Zambia Center for Applied Health Research and Development (ZCAHRD) - since January 2011. The Boston University Center for Global Health and Development (CGHD, previously CIHD) has been engaged by the U.S. CDC Global AIDS Program/Zambia to provide technical, logistical and limited financial support for the provision of prevention of mother to child transmission (PMTCT) services to eight District Health Management Teams (DHMTs) in Southern Province, Zambia, through the Boston University PMTCT Integration Program (BUPIP).

UVP: What are the goals of the Boston University PMTCT Integration Program?

KC: BUPIP has two interrelated, overall goals, 1) to make prevention of mother to child transmission (PMTCT) services accessible and affordable to women in 80% of the urban and rural areas of the covered districts in Southern Province; and 2) to enable the rapid scale-up of early infant diagnosis (EID) services in the same areas (MOH 2010 testing target for exposed infants was 80%). These goals are being accomplished by continuing our support of the Government of Zambia (GoZ) (Southern Province) in scaling up quality PMTCT services within maternal and child health programs in accordance with the national PMTCT and EID Strategic Objectives.

Secondary essential goals are 1) to provide quality palliative care to HIV-affected children; 2) to implement innovative approaches to reach hard-to-access rural populations through the use of community workers (Trained Traditional Birth Attendants (tTBAs), Community Health Workers (CHWs), and PMTCT Lay Counselors); and 3) to develop effective community networks for increasing awareness and program participation.

UVP: What has your role been at the organization?

Personally, I am a Program Associate for the greater BUPIP, but within the organization sector, I serve as Program Coordinator for our Antiretroviral Therapy in Antenatal Care (ART/ANC) Program Evaluation.

Within six pilot sites in Southern Province, we are working with the District Medical Officers and Maternal and Child Health (MCH) nurse in-charges and staff to provide ART in the MCH wards for HIV-positive pregnant mothers during their antenatal care and throughout the infant's period of breastfeeding (up to 18 months). By providing ART services in the MCH wards, rather than referring these pregnant women to separate ART wards on the premises or to even farther ART facilities, there is a more streamlined service. Additionally we are assigning each HIV-positive pregnant mother presenting at first ANC booking their own Lay Counselor (volunteer community health worker, trained in ART adherence, Adult and Pediatric ART, and Opportunistic Infections) to follow up with the mother-infant pair to provide ART adherence counseling and PMTCT support, as well as remind them of existing appointments to help decrease lost to follow up.

Lastly, my team is attempting to introduce new point-of-care testing technology into Zambia to be used within MCH in obtaining CD4 counts and creatinine levels. It is hoped this will create same day ART initiation as the HIV diagnosis (rather than the current 3 week timespan). In short, the pilot's primary objectives are: 1) Increase the amount of HIV+ pregnant women initiating ART, 2) Decrease the time it takes from HIV diagnosis to ART initiation for pregnant women, 3) Improve adherence for daily ARVs for HIV-exposed, breastfeeding infants, and 4) Increase adherence to MCH and EID services for the mother-infant pairs.

UVP: That is great and so exciting. Knowing what you now know from your experiences in both Uganda and Zambia, what advice do you have for future interns/volunteers? What was one thing you wish you knew before volunteering in Iganga?

KC: I would suggest going into it with an open mind - not a top-down imposing mind. Take the time to slow down your own lifestyle to foster relationships with the community. Remember patience and flexibility is key.