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‘Merck More Than a Mother’campaign coming to Botswana in 2019

Dr Rashakelej

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Pharmacist and CEO of Merck Foundation Dr RashaKelej, has made it her mission to raise awareness about the discrimination, stigma and ostracism women undergo for their inability to have a child. Here she discusses with SunHealth how her foundation is empowering women across Africa and other developing countries.

Dr Rasha Kelej, you are CEO of Merck Foundation, can you start by introducing the Foundation for us?

Merck Foundation is the philanthropic arm of Merck KGaA Germany. It is non-profit organisation that aims to improve health and wellbeing of people and advance their lives through science and technology. Our efforts are primarily focussed on raising awareness about non-communicable diseases, empowering women and youth, improving access to innovative healthcare solutions in under-served communities, building healthcare and scientific research capacity in the fields of diabetes, hypertension, cancer and fertility care in underserved communities. Our vision is to see a world where everyone can lead a healthy and fulfilling life.

You will be launching the ‘Merck More Than a Mother’ campaign in Botswana in 2019. Can you discuss when this launch is expected to happen and what it will entail?

We will launch in Botswana sometimes in the first quarter of 2019 in partnership with Her Excellency First Lady of Botswana Madam H.E. NEO JANE MASISI, and ministry of health of Botswana. We will first launch the Merck more than a Mother campaign with Her Excellency as the Ambassador with the aim to empower infertile women through information, health and change of mindset.
As part of the campaign we will call for application for media recognition award of Merck more than a Mother. And we will also train media about health reporting and sensitive issues reporting such as infertility. We will also launch the start of producing a song about infertility stigma and sensitising the community to break its stigma.

In addition to providing training to doctors in the fields of fertility care and oncology we will also launch a pilot project called blue points where we will provide one year diabetes diploma to doctors to build Health care capacity in the country. Our vision is to develop a strong platform of specialised doctors to improve access to quality and equatable healthcare solutions in Botswana.

When did this campaign start?What makes “Merck more than a mother” such a unique campaign and how do you hope it will be embraced by relevant stakeholders?

We started Merck more than a mother campaign in 2015 first in Kenya then Uganda and the rest of 35 countries in Africa and Asia.The campaign is an exponential success, the ambassadors of Merck more than a mother, The First Ladies of many countries, are very active and increasing every year. We have partnered with ministries of health and academia of many countries who are working closely with us.

The social media followers and videos viewers are in millions. Merck Foundation has trained more than 100 fertility specialists over the last two years in more than 30 countries in Africa and Asia. Thousands of women are sharing their stories of suffering  every day; African media has started to discuss the issue every day, and we also worked with singers to write songs and produce video clips about infertility and delivering the message to all communities, since in many cultures infertile women suffer discrimination, mistreatment and physical and psychological violence. We have also supported the establishment of first ever Public IVF centres in Rwanda, Ethiopia and Uganda.

The Foundation seems to be so fond of Africa why the interest, many will ask? How do you settle on the choice of health needs or area and the countries that you engage with in Africa?

Prof Frank Stangenberg Haverkamp, the Chairperson of E-Merck KG and Merck foundation is very fond of Africa and believes in its potentiality.  Furthermore, there are many challenges in Africa with regards to healthcare and this is our speciality we can help, and this is what we do and we do it well. But we also focus on Asia, we have programmes in many countries such as Sri Lanka, Bangladesh, Nepal, Myanmar and Cambodia; and we will expand to Latin America in 2020.

There was also the first Merck Health Media Training in Kenya to break the stigma around infertility in Africa, may we know the reason behind the focus on infertility and liaising with the media?

According to WHO data 2016, one in every four couples in Africa and developing countries are infertile which means that there are 180 million couples that are infertile. Incidence is much higher than in Europe and developed countries which has around maximum 8% to 9%, very high percentage of infertility due to untreated infectious diseases which result from child marriage, unsafe abortion, unsafe delivery, STDs and genital mutilation. Hence prevention is very important.

More importantly, in many cultures women suffer discrimination, mistreatment and violence due to their inability to bear children, although 50% of infertility cases are due to male infertility, therefore we need to create a culture shift to respect women whether they are mothers or not, encourage men to speak up about their infertility and support their wives through the treatment journey. I strongly believe in the power of art and media.

They are critical partners to address such sensitive topics. We have produced many projects of songs, and now we are going to produce drama (plays and documentaries) with African talents across the continent. It will be the first and we will be creating a culture shift, raising awareness and exploring African talents.

We started “Merck More Than a Mother” campaign in 2015 now it is in 35 countries in Africa and Asia. In partnership with First Ladies who are the ambassadors in their respective countries, academia, ministries of health and international fertility societies, the initiative also provides medical education and training for fertility specialists and embryologists to enable them to help and treat infertile couples in their countries.

Also, part of the campaign is our Merck Embryology & Fertility Training Programme, a three-month hands-on practical course to establish the platform of fertility specialists across Africa and Asia. Merck Foundation provides clinical and practical training for fertility specialists and embryologists in more than 35 countries across Africa and Asia such as: Chad, Niger, Central African Republic, Cote D’Ivoire, Ghana, Ethiopia, Uganda, Kenya, Tanzania, Zambia, Nigeria, Benin, Mali, Burkina Faso, Senegal, Guinea Conakry, Sierra Leon, Liberia, Cameron, Rwanda, Botswana, DR Congo, Congo Brazzaville, Gambia, Nepal, Sri Lanka, Bangladesh, Myanmar and Cambodia. So far more than 80 candidates have taken the training.

How do you envisage the future of health care in Africa and the partnerships that Merck Foundation is forging across the continent?

I think the future will be brighter if we cooperate together. The magnitude of the health challenges are very big to be addressed by one organisation. The secret is in the private public partnership and to really get things done by being hands-on. No time for talking anymore. We need to talk only when we talk about our impact and way forward.

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Know Your Specialist

Caroline Gartland speaks on Children and Mental Health

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Tell us about yourself and your background
I’m originally from the UK but have been in Botswana for eight years so this is now home! I have a Combined Honours degree in Psychology an MSc in Mental Health and have had a pretty varied career.
I started off working with offenders doing rehabilitation programmes; went on to support the victims of domestic violence then ended up working in Child and Adolescent Mental Health Services for the National Health Service.
I’ve done a lot of work, mainly voluntary, in different fields since being in Botswana but my passion is now Early Childhood Mental Health.

What does your work entail?
Early childhood mental health is mainly working with parents, caregivers and teachers to help them understand how children develop and the best ways to support their mental health and brain development as they grow. It’s about providing training and opportunities for families to bond with their children and introducing new ways of playing and interacting.

What sparked your interest in early childhood mental health?
Quite simply, having my own children! My daughter was born five years ago and I was fascinated watching her develop and grow. It occurred to me that the younger you begin to consider mental health and provide tools for resilience against life’s adversities, the better outcomes you are likely to have.
I began reading everything I could get my hands on, and completed a diploma in Infant Mental Health. I’ve worked down the lifespan but I feel I’m now where I belong, working with babies and young children.

What mental health issues have you observed in children in Botswana?
Mental Health is still stigmatised around the world and Botswana is no exception. Most people immediately think of mental illness, but mental health is about so much more; we all have mental health and some days we are fine and able to deal with life’s challenges and some days we need more support and tools under our belt to help us cope.

Young children can experience mental health problems. Anxiety is a common one, but we are more likely to focus on the behaviour we see rather than how the child is feeling. An anxious child who refuses to go to school may be labelled as ‘difficult’ or ‘naughty’ but what they are expressing is a painful emotion that they need help dealing with.

Describe one thing you find fulfilling and challenging about working in this industry.
Working with children and families is a pleasure and a privilege. To make life a little bit easier for someone is all that matters, you don’t have to be out there saving the world to make a difference.
My major challenge is time. I would love to do more, I’d love to do an MSc in play therapy and a couple of other therapeutic techniques I’ve come across in Europe but that gets put on hold as I focus on my own family and business.

Can you share an anecdote about how mental health consultation works?
I think that education, understanding and connection are the three keys to giving a child the best start in life. Led by that, SensoBaby provides classes in the community for parents and caregivers to connect with their infants.

We offer workshops on parenting and play to foster understanding of child development and wellbeing and we are available to troubleshoot specific problems an individual or agency has with the young children in their care or the systems they have in place. When it comes to individual parents, mostly what they need is to feel heard, supported and guided in their parenting choices.
You can read all the baby books in the world but they won’t give you the answers you need for your child, through responsive parenting and connection, you’ll find you have the solutions you need.

What advice do you have for child-care providers or early childhood teachers who are at their wits’ end over a child’s challenging behaviour but don’t have access to a consultant?
Empathy is an important and undervalued skill – the ability to consider another’s viewpoint. What is that child feeling? Their behaviour might be challenging and hard to deal with but often the root cause is an unmet need. There’s a famous quote from an American Clinical Psychologist, “The children who need love the most, will ask for it in the most unloving ways.”

Does a mother’s mental health affect her foetus? How important would you say is paying attention to women’s well being during pregnancy as with their physical well being?
100% yes. It is so important to support a woman’s wellbeing during pregnancy. As an example, if the mother experiences significant stress and rising levels of cortisol (the stress hormone) during pregnancy, the foetus will be affected and in some cases will be more sensitive to stress in childhood or later in life.

Pregnant women and new families (Dads as well!) deserve nurturing care themselves and shouldn’t be afraid to ask for support. SensoBaby run FREE monthly coffee mornings to support pregnant and new mothers because we understand the importance of maternal wellbeing.

Do smart phones and television make our children mentally ill as is often purported?
I don’t think technology is always the villain it’s made out to be. The key is in the relationship with that technology. Moderate use of TV’s and smart phones are fine, as long as they aren’t a substitute for outdoor play, imaginative play and meaningful interactions. If a child is crying or upset and we hand them a device to keep them quiet then we have missed an important opportunity for connection, helping them process what is going on and supporting them to calm down and settle themselves.

Now, I know you are involved in an exciting programme that helps caregivers and children to bond and get the children off to the best start in life through play. Can you say a little bit about that work and just how you are seeing it play out?
SensoBaby is our baby; a project born from passion and a desire to support families in Botswana. We offer play-based classes for children and their caregivers that are underpinned by the principles of child wellness as well as early foundations for learning.

When you provide developmentally appropriate opportunities to play, you learn so much about your child. That understanding and observation builds strong connections, which will form the basis of that child’s future relationships and self esteem. Play is so much more than ‘a fun activity.’

We offer a number of trainings and workshops for parents, nannies and community stakeholders and hope to increase our offerings this year. Our community partnerships and voluntary programmes have been successful so far and we hope to see more impact in 2018.

We currently serve the Gaborone community but would like to expand throughout Botswana as opportunities arise. The response to SensoBaby has been fantastic so far and we can’t wait to see how far we can go with the concept!

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Know Your Specialist

Terence Mohammed explains intricacies of clinical trials

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What does a lab manager do?
As BHP laboratory manager, I am responsible for providing an oversight in the technical operations of the laboratory, including the clinical trials processing and testing labs. As part of the laboratory management, I also provide leadership in planning, implementing and completion of research activities and to ensure that laboratory operations and data generated is in accordance with Good Clinical Laboratory Practice. The lab manager is also expected to provide an oversight on the laboratory quality management system and laboratory expenditure.

Describe your career trajectory. How did you get to where you are now?
I joined BHP in 2007 as a laboratory research assistant. I worked for two years in various BHP clinical trials for diagnosing and monitoring of HIV/AIDS in clinical trials participants. In 2009, I got transitioned to the BHP research laboratory to work as a research fellow where I got assigned to work on various basic science projects. In 2014, I worked as a research laboratory coordinator where I was mainly involved in day to day routine management of the research laboratory activities including; conduct of research projects, preparation of education activities and mentoring of new research fellows, students and interns. In 2015, I got promoted to the position of deputy laboratory manager where I assisted the lab manager in overseeing the technical operations of the lab. In 2017, I got promoted to the position of lab manager.

What’s a typical day/week at the Botswana Harvard Partnership (BHP) for you?
I participate in a lot of weekly meetings; laboratory management and departmental meetings. I am also expected to attend meetings for the various clinical trials which we provide laboratory services to. These include local site meetings and international conference calls with study principal investigators and sponsors. I also review and authorise laboratory orders ensuring continuous operation of laboratory work and within allocated budgets. In addition, I also allocate time to walk around the different laboratory departments on a regular basis in order to interact with staff and learn more about their challenges. This facilitates discussions on how to improve our laboratory operations and working environment.

What are the main health and safety issues for lab technologists?
Exposure to blood, bodily fluids and tissues, which may contain infectious agents and also exposure to ultra-cold materials such as liquid nitrogen and dry ice. However, all necessary laboratory safety trainings are mandatory and staff has access to personal protective equipment including lab coats and gloves which are a requirement for certain tasks.

What aspects of your role do you enjoy the most?
I enjoy the daily interaction with researchers in the field of HIV/AIDS, both locally and internationally. It makes me proud to be part of a team that is working towards ending the HIV/AIDS pandemic in our region as it has decimated the population for over two decades now. With our work, I hope Batswana become increasingly cognisant of the task ahead of us and unify to bring an end to the pandemic.

What would you say the biggest challenge in your field is? Discuss one thing in particular?
Supply of laboratory reagents and consumables can be challenging as sometimes we experience supply stock-out and delays in delivery.

On a basic level, what skills does your job demand?
A lab manager should be able to organise and run effective meetings. It is important to set up an effective meeting agenda and be able to assign key action items to staff
-To be able to communicate effectively and create a positive atmosphere in the working environment. It is also important for the lab manager to be able to motivate staff and also be approachable to staff whenever required.
-A lab manager is expected to have leadership skills in order to provide direction to team members and ensure that the institution goals are effectively met.
-To be able to manage budgets and always be alert to ensure that the laboratory current spend does not exceed target spend.

You have done some research on HIV-1c gp120 in recently and chronically infected individuals in Botswana. For starters what is HIV-1c gp120? A brief background on the research and what the findings were?
Gp 120 stands for glycoprotein 120. This is a protein found on the outer surface of HIV and it used by the virus to enter human cells thereby causing infection. Previous research has shown that gp120 characteristics and properties could be susceptible to change overtime during the progression of the disease. Therefore, we used two groups of study participants at various stages of disease progression (i.e. recently and chronically infected) to see if there are changes in structure and properties of gp120 during the course of the disease. This research highlighted the need to further investigate gp120 in order to get information that maybe useful in the development and designing of an effective vaccine

What advice would you give someone interested in becoming a research fellow?
I would advise them to read a lot in their field of interest and also be aggressive enough to seek opportunities of attachment to a relevant institution. Furthermore, they should seek to interact with experts in the field in order to keep themselves in the loop should a research fellowship become available.

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