Irene Murungi is a technical advisor for gender at The AIDS Support Organization (TASO) Uganda and the Uganda AIDS Commission. In 2018, she participated in the Global Health Delivery Leadership Program (GHLDP) 2.0 at the University of Global Health Equity in northern Rwanda. The intensive, six-month executive education course helps global health leaders address complex challenges in their fields, share experiences and strategies, and create solutions. The program includes a two-week residency on campus, six months of distance coaching to support the execution of a breakthrough project, and then a final, three-day reconvening in Rwanda, where country delegations present their projects.
Can you share some of your reflections from your time in Rwanda, during GHDLP 2.0?
First, GHDLP 2.0 was great exposure. Getting to challenge myself and see what my peers from other countries were doing. Learning from them, and comparing with what is happening in my own country, helped me relate to what we were learning.
Second, it was an opportunity to do an on-site check of my leadership skills and interpersonal skills, vis-a-vis what I thought I really had. So it was a time for me to really learn about myself, and to reflect on what I've been doing, how I've been doing it and how I can do it better.
Third, it was a value addition. Because I believe that I really didn't remain the same after leaving Rwanda. Most importantly, I had an issue with trusting people—I think it's something on which I scored lowest when we were doing a personal assessment. But recently, I think I've really tried to pull through. Now, I give a benefit of the doubt in whatever I do. And I think it is improving my work relationships.
How are you applying some of the skills you learned when you were in Rwanda, now that you're back home?
One is on trust, which I've just talked about. Two is the fact that as we're making decisions at the leadership level, we'll always have to disagree. But I think, from Rwanda, I learned that even when I disagree, I should be able to offer solutions.
What were some other things that you learned when you were in Rwanda?
I learned more about the different interventions that Rwanda as a country has taken up, compared to Uganda, where—in a closely related setting—we have the same challenges. But I realized and learned that, depending on how the government provides assistance, it can be really hard to deal with some of the so-called challenges now in our country. From the interactions we had in Rwanda, I realized that their success has had a lot to do with integrity—where there is zero corruption, because of the systems in place.
I also appreciated the effectiveness of Rwanda’s community-based structure—that is, getting to the household, including for treatment of malaria, testing, and many health interventions. In Uganda, it's only counseling and referrals. Looking at our village health teams that are really not doing the same as their counterparts in Rwanda. I think I learned that there is need for community health workers to be self-driven, and for communities to do more to appreciate their contributions.
The idea of being self-driven—and not just looking up to an implementing partner to keep on pushing for results—really is key.
And then, also realizing how social determinants affect health outcomes. You find that children and wives have been abandoned. So you realize that gender issues are really affecting the systems put in place. Coming back to Uganda, I’ve started really looking at how best I can focus on changing the gender-interrelated challenges that affect successful implementation of the different projects at hand.
Can you talk a little about your breakthrough project?
Initially, when my colleague and I left Rwanda, our breakthrough project was looking at hearing loss among patients with multi-drug-resistant tuberculosis (MDR-TB). As we began the research for our project and consulted our mentor, we realized that we really needed to focus on defaulting; on the lost-to-follow-up patients on MDR (multi-drug-resistant) treatment.
So we changed our project, which now is focusing more drug-resistant TB patients who become lost to follow-up. We are focusing on the period from June 1, 2015, to June 1, 2018, to look at those who defaulted and what was the cause, as well as comparing with those that stayed in treatment—what was so special that kept them in treatment?
What have you learned in your research?
Our suspicion as we set out for the project was that there likely would be factors relating to finances, in terms of patients lost to follow up. While we found that financial factors can be involved, the majority of factors really are social problems. People who are feeling frustrated and take to drug or substance abuse, for example, such as alcohol and smoking habits.
We also realized that there are aspects of co-infection, such as HIV and TB. That can be associated with loss of immunity and other factors, relating to waiting times at hospitals and limited transportation, among others.
We found those are really critical issues that are leading to MDR-TB patients becoming lost to follow up.
How has your UGHE advisor, Dr. Paul Pierre of Haiti, helped you through this process?
He has really been helpful. We had so many ambitions and we kind of had failed to zero down to what we really wanted to do. He helped us focus. He also provided technical assistance when we were developing the tools to submit for ethical review and approval. He gave us the guidance to help us prepare for that submission. He has really been supportive.
Is there anything specific that you've learned from him, apart from mentorship and guidance?
I think, giving time to my mentees. Although he was busy, he made sure that he gave us time. There was a time when he had to go to Congo, but he made sure that at least if we could not do calls, that we could email, and we were exchanging emails every other day. And when he returned, he continued to support us. He made sure that we were on the same page. I learned that prioritizing my mentees is key, as I grow to be a mentor in the future.
Also, having a wide wealth of knowledge is vital. He is well-informed. I learned that every time I’m presenting something, I must have enough information to fully inform my discussions, rather than just citing hearsay or making sweeping statements. Those are just some of the lessons and attributes I learned from our mentor, Dr. Paul Pierre.