Dr. Winkler’s projects to improve public health in Africa


submitted by Dr. Winkler

Winkler and Plumhoff pose alongside their friend Alimwenda and her son Mjuni in Tanzania.

A Wilkes University professor is leading projects that aim to improve public health in sub-Saharan Africa.

Dr. Linda Winkler, professor of anthropology, has been working to improve health care in rural Tanzania since 2002, through a combination of both research and public education. She is especially focused on ways to reduce infant mortality in areas with few medical resources.

Tanzania is a country in East Africa where the landscape is characterized by vast plains, dense forests, and tall, snow-capped mountains, including the famous Mount Kilimanjaro. In a developing nation with a predominantly rural population, this geography helps to create isolated communities with limited infrastructure, posing a challenge to health care workers. The country’s under-5 mortality rate, according to UNICEF, was 54 per 1,000 live births in 2018. While these rates have improved significantly in recent decades, they are still much higher than those in developed nations like the United States.

So, how does one lower infant mortality in a country where an estimated 68 percent of the population lives on less than $1.25 per day? One way is to conduct research on low resource methods of infant care to determine their effectiveness, while another strategy is to improve the public’s knowledge of infant nutrition and various types of medical care.

Kangaroo Mother Care (KMC) is a technique that involves the carrying of an infant, ideally by the mother, with continuous skin to skin contact. Intended to be used in cases of low birth weight and/or premature birth, Winkler led a study into KMC’s effectiveness beginning in 2014. With the aid of Agnes Stypulkowski and Shana Noon, two since graduated Wilkes nursing students, many Tanzanian medical records were statistically analyzed and compared with observations in rural hospitals.

“Our study indicates the value of KMC in rural low resource environments,” said Winkler while describing the project’s findings. “Results are comparable to KMC programs in urban areas where newborns begin KMC after stabilization and better than outcomes reported for comparable populations not practicing KMC in rural sub-Saharan Africa.” Today, the World Health Organization recommends that KMC be implemented globally. 

However, uncovering an effective method for improving infant health is only half the battle. Healthcare workers and the general public must be educated on advances in medical science if they are to actually implement them, a task easier said than done in the isolated, often Internet deprived communities of rural Tanzania.

That’s why Winkler is leading the Vitamin K Project, alongside a native medical team. This team is affiliated with the Nyakahanga Designated District Hospital (NDDH), a hospital that services over 400,000 people in the remote Karagwe District. The project’s goal is to improve public awareness of the benefits of Vitamin K treatments when it comes to preventing neonatal diseases.

In the summer, Winkler traveled to the NDDH to set up and film a public service video about the importance of Vitamin K. Accompanying her was Maddie Plumhoff, a junior honors student hoping to complete an anthropology concentration for her major in Medical Laboratory Science. The student in charge of editing the video upon their return was Madi Hummer, a communication studies major who had previously edited an informational film about Kangaroo Mother Care.

submitted by Dr. Winkler.
Plumhoff poses at a sign marking the Equator, which runs through the far south of Uganda.

Their journey began with a flight to Entebbe, Uganda, located on the shore of Africa’s largest lake, Lake Victoria, which lies within the borders of three different countries. They then hired a vehicle to drive them south to their final destination in neighboring Tanzania. Two weeks were spent working with hospital staff to write a script and film the video, using equipment provided by the Wilkes Department of Communication Studies, before the pair returned to the United States in mid-June.

Plumhoff spoke fondly of the trip.

“I have traveled abroad before, but this was the first experience that immersed me in the culture. It was amazing to learn about a completely new culture from a tiny rural hospital on the opposite side of the country where tourism spots are. I was able to learn how to handle healthcare in a culture I’ve never experienced, which can help me in a future career in public health.”

That’s not to say there were no challenges in creating and editing the video. Chief among them was the language barrier. Swahili is the lingua franca (common language) used by most Tanzanians, who usually speak it as a second language alongside their native tongue. While many healthcare professionals speak fluent English, most of the general populace in rural regions does not, meaning the video had to be made entirely in Swahili.

“The most difficult part when editing the footage together was the language barrier,” said Hummer of her work on the project. “I, personally, don’t know much Swahili. My only experience with the language prior to this project came from editing my first project with Dr. Winkler. I had to teach myself some key words as reference points to make sure all the footage was edited properly.”

While the process of adding English subtitles to the final cut is still ongoing, Hummer is overall proud of how Project Vitamin K has turned out.

“The most enjoyable part of the project was the knowledge that something as simple as an informational video could bring about such a positive outcome,” she stated. “It means so much to me that our work has the ability to create such a valuable impact on the lives of Tanzanian mothers, their children, and their community at large.”

In March, Plumhoff and Winkler will present their video at the 2020 Annual Meeting of the Society for Applied Anthropology in Albuquerque, New Mexico. It will be shown as part of a discussion on the vital importance of communication in the field of public health.

Editor’s note: Madi Hummer is the current Design Editor at The Beacon.