Adrienne Strong

Medical anthropology, maternal mortality, hospital ethnography, and dignity in women's health care

I am a medical anthropologist with a joint Ph.D. from Washington University in St. Louis, USA and the Universiteit van Amsterdam in the Netherlands. I study maternal mortality and women's health in Tanzania, currently in the Rukwa Region, and conducted my dissertation fieldwork from January 2014- August 2015. From September 2010 through July 2011, I conducted research on access to healthcare services during pregnancy, birth, and the postpartum period in the Singida Region of Tanzania. My doctoral dissertation project focused on the inner workings of a government regional referral hospital, examining how institutional structures related to hierarchy, bureaucracy, historical precedents, communication and other factors, may influence the capacity of the institution to provide effective maternal healthcare during times of obstetric crisis. My research focused on biomedical healthcare providers and administrators, groups that are often overlooked in the context of medical anthropology in sub-Saharan Africa. I contextualize the hospital ethnography with interviews, participant observation, and focus group discussions in communities throughout the region, as well as through the use of primary archival sources from the colonial and post-independence eras. 

This is my personal website, which includes updates on my research, collaborations, conference presentations and papers, publications, teaching, and critical responses to current events related to women's health and reproduction.  

Mentions and Public Anthropology

Paper Prize

Washington University Feature

Feature on Anthropology Department Website

Research Report on Global Health Hub

Photoessay on SAPIENS.org

This past week, a plethora of new experiences

I've now been hanging out here in Dar es Salaam for the last week and it has been alternately very busy and full of boring downtime. I started out, last Sunday, with the determined plan to work on some analysis of a questionnaire I'd had the nurses all finish before I left Sumbawanga and then I thought I'd catch up on typing up all my field notes since last June. Well, I'm happy to report I did manage to do the analysis, I have not yet typed even a single sentence of old notes. It's one of those jobs that seems to become intimidatingly huge the longer I let it go and, of course, I don't keep up with it on a daily basis because after 8+ hours at the hospital and interacting with people, the last thing this "outgoing introvert" wants to do is rehash it all through hours of typing up the handwritten scribbles of the day. I did, however, have several productive and fun meetings. I have been giving a Tanzanian friend some tips on developing a research proposal for his application to some PhD programs abroad and we met for a couple hours to discuss research design and methods, which I really do love. I then did some shopping for things I can only buy in Dar or for those that are about half as expensive here as they are in Sumbawanga due to the distance. I was also searching for an elusive A4 size side spiral bound notebook of more than 100 pages. It felt sort of like searching for a unicorn. A very nice Indian guy, whose company sources what sounded like pretty much all the office supplies in the country, told me people here don't like spiral notebooks because they get too hot in the sun. Hmm… but they are commonly used in India. I was hoping to find a more durable replacement for the maternity ward's admission book, which has been in use for over a year now and currently looks like this: OK, never mind, I'm not seeing at the moment how I add a picture in here. I guess that means I should include pictures more often so I don't forget how… Suffice it to say, the book is literally falling apart and has created some big problems on the ward. The ward Nurse In Charge was asked to collect data on a number of things from throughout the whole year and the state of this notebook meant she was unable to find data from whole months because all the pages had fallen out and been irreparably lost. 

So, at any rate, the notebook needs to be replaced, badly, and is nearly full. The In Charge sent one of the medical attendants from the ward to request a new notebook for this purpose, approximately two weeks ago. Therein ensued a long quest that was, ultimately, unsuccessful. I tried to help out by taking this old notebook to the supply office and the hospital's Assistant Matron to plead the case for a new notebook. Well, the Asst. Matron decided that we didn't deserve a new notebook because we had proven ourselves unable to "take care of the data," as she put it. First, before being granted a new notebook (which costs about 2000 TSH or less than $1.50), we had to prove we could "take care of the data" and preserve it for future use. She wanted us to somehow repair this dilapidated notebook before she would be willing to give us a new one. Yeah, right. First of all, there is no tape or glue that can sufficiently accomplish this task. Second of all, who the heck is supposed to use their valuable work time trying to put Humpty Dumpty back together again? I asked, nicely, if perhaps she had some clear tape that we might use for the purposes of reconstruction? She sent me to her office to ask the young woman assisting there to give me some. What does this woman come back with? Masking tape. Definitely not going to be able to read any data through that stuff! So I gave up. While I was in the office, I saw an entire box of unused AA batteries, like the ones we requested more than 2 months ago for the purposes of the fetal doppler/heart monitor and the wall clock. I'm willing to bet that while we wait for batteries, the ones in that box will be expiring, unused. Such is the state of things. That is all to say, if anyone has a creative idea of how to keep this notebook in better order, please do let me know. A ring binder with loose leaf that gets changed every month? That's what the guy at the stationary store suggested. Maybe we might just try it. We handwrite every patient's name, along with a variety of other info, for each person who is admitted to the ward, which amounts to somewhere between 300 and 600 women per month. Just think of how much use that means that notebook gets! Another case of the hospital administration not being willing to adjust existing parameters and bureaucratic guidelines to accommodate the reality of the maternity ward.

After that unicorn quest, I bought some new sandals at Woolworth's and ruminated on the cost of baby clothes that include locally (from South Africa) sourced cotton and how much better they looked and felt than all the super cheap stuff flooding the market from China. I then walked for several kilometers, eventually found the right daladala (hurray!) and made it to Muhimbili National Hospital to visit my friend who works in the Safe Motherhood Division of the Ministry of Health and Social Welfare and whose office is on the Muhimbili campus. We had a good conversation about several issues related to women's health and I got to see some of the upcoming things they are working on with other partners. Then is was the bus odyssey back to the hotel. I sat next to a very chatty guy who told me I could call him Pastor David and is looking for someone to help him grow his ministry outside of Tanzania. Any takers? Boy was he a talker. But he did have some interesting things to say about how women are treated when they go to the hospitals to give birth and why he felt nurses don't treat patients well. He told me what several other community members have, which is that nurses sometimes had few other career options and therefore do not really have a heart for their work but just do it for the salary. I can't even tell you the number of times I've heard this as a reason for the lack of compassion and caring on the part of nurses. I'm not convinced it's entirely true, though. Another friend, Canadian, told me she thinks the nurses who were trained during the Nyerere era have a much better attitude and work ethic because, back in those days, being in the health professions was valued and brought benefits with the position that no longer exist. People in those days entered into the profession because they felt called to do that work. I certainly think there's something interesting in that statement. We'll see if my upcoming interviews might lend any more credibility to that thought.

On Wednesday, I went to the US Embassy for my security briefing (don't go on Toure drive at night, you WILL be robbed, 100%) and to talk to the Fulbright coordinator and Public Affairs section people. I was also able to meet with the USAID contact I've been exchanging emails with for months. In the end, I came out with my security ID, a Fulbright Tanzania t-shirt (that everyone really likes, for some reason), a plan to join the American Club just for the use of the lovely, lap-size swimming pool, an invitation to dinner, and another for sundowners at the Dar es Salaam yacht club. Oh and a possible contact for someone who might want to rent my car while I'm not around. Great conversations all around and some good possibilities for future presentations and information sharing. And next time I'm allowed to bring my phone and my purse inside. I was caught entirely off guard when the security woman asked me if I needed anything from my purse. Fortunately I grabbed a pen. 

Thursday I hung out, went shopping for unnecessary things like a muffin tin and then ate gelato and watched a movie in a movie theater for the first time since the end of July. It was nice. And Hussein was back from Egypt, finally. Now, I am just waiting for my car from Japan to be ready to go. I certainly would have been drowning in this whole car extraction process if it hadn't been for Hussein and his friend Ally. It's overwhelming enough as is! Today we are trying to scramble around and get temporary plates, the registration card, insurance, and a once-over by the mechanic. Sounds overly ambitious for one day in Tanzania even to me, but fingers crossed I'll be on the road tomorrow for the 2015 cross-country road trip! Too bad I've already eaten most of the snacks I bought for the road… probably have to make another stop for some more of those. 

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