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Honoring Lives Lost in Buffalo with a Call to Action

The most recent racist mass shooting in Buffalo has left yet another huge hole in the fabric of our country. We honor the memory of the ten people who lost their lives in an act of white supremist terrorism and hope for the healing of not only those wounded but also those who loved the victims, the communities that will suffer for their loss, and the national and global community that bears witness. Please remember to care for yourself during this continually challenging time.

We hold in our hearts the lives, love, and humanity connected with the names that follow—as well as countless people in the Black community who continue to be re-injured by these acts of horrific violence.

The victims:

Roberta A. Drury, 32

Margus D. Morrison, 52

Andre Mackneil, 53

Aaron Salter Jr., 55

Geraldine Talley, 62

Celestine Chaney, 65

Heyward Patterson, 67

Katherine Massey, 72

Pearl Young, 77

Ruth Whitfield, 86

Zaire Goodman, 20, was released from hospital after being shot in the neck; Jennifer Warrington, 50, has also been treated; and Christopher Braden, 55, is in stable condition after being shot in the leg.

According to reports, the gunman was motivated by the so-called “Great Replacement theory,” the racist conspiracy theory that populations with white European backgrounds are being “replaced” by people of non-White, non-European descent. We must do more to combat this type of dangerous rhetoric and ongoing anti-Black violence in our communities. It is up to each of us to redress past and present injustices, find ways to meaningfully engage in work to reduce racism, and collectively contribute to safer communities and workplaces for Black people. Please see the resources below for immediate ways to take action.

Resources:

UW President Ana Mari Cauce’s statement: https://www.washington.edu/president/2022/05/16/we-can-all-play-a-part-in-working-to-end-racist-violence/

Democracy Now! (For independent, up-to-date information and interviews): https://www.democracynow.org/topics/racism

Verified fundraisers for the victims’ families and those affected by the shooting: https://www.gofundme.com/c/act/buffalo-mass-shooting-fundraisers

Feed Buffalo (all donations will be used to serve the communities affected by the shooting): https://www.feedbuffalo.org/

Racist Terrorism in Buffalo: How the Mainstreaming of White Supremacy Puts the Nation at Risk. Thursday, May 19, 1-2 PM PT. In this presentation, anti-racist educator Tim Wise examines how overt racism has increasingly penetrated American political discourse and has contributed to terrorist violence, most recently in Buffalo, Pittsburgh, Charlottesville, El Paso and Charleston. Hosted by SpeakOut: The Institute for Democratic Education and Culture. Register here ($5-250 donation; proceeds go to Black Love Resists in the Rust).

Reading about and watching the coverage of these events can also be extremely painful. Please take care of yourselves. Please find wellness and mental health information at Mental Health America.

In community,

The I-TECH DEI team

I-TECH Celebrates 20 Years

In 2008, I-TECH Mozambique celebrated I-TECH’s sixth birthday. “Sempre crescendo” = “always growing.”

On April 1, the International Training and Education Center for Health (I-TECH) celebrates 20 years since its founding. It has since grown into the largest center in the Department of Global Health (DGH) and one of the largest centers at the University of Washington (UW).

“We are proud to mark this milestone,” says Dr. Pamela Collins, Executive Director of I-TECH, Professor of Psychiatry and Behavioral Sciences, and Professor of Global Health at UW. “For 20 years I-TECH has helped to save lives through its support of public health systems in the Caribbean, Europe, Africa, and Asia. Over the years, our scope has broadened, but responsive partnerships with ministries of health, collaborating NGOs, and our donors have been central to the work.”

I-TECH comprises a global network, operating in 17 countries, that fosters healthier communities around the world through equitable partnerships in research, training, and public health practice. Its work is rooted in health care training and draws on a culturally rich community that includes UW faculty, global partners, and U.S. and global staff and students. This community of people with diverse backgrounds, experiences, and opinions encourages learning from one another while working toward high quality, compassionate, and equitable health care.

“COVID-19 has reminded me, and many of us, about the critical and life-saving role of health care workers, a group that often lacks proper support,” says Ivonne X. “Chichi” Butler, Associate Director at I-TECH. “At the same time, collectively, we have come to understand the urgent need for stronger and better prepared health systems to respond to the COVID crisis.

“At I-TECH, these concerns have been at the heart of our work for the past 20 years,” she continues. “We have invested–and continue to invest–in health workers and in the systems in which they work. I am proud to be part of a center that has transformed the delivery of HIV care and treatment in so many countries and that truly puts individuals and communities at the forefront to meet their particular needs.”

I-TECH began in 2002 with its first award, the International AIDS Education & Training Center (IAETC) grant. The IAETC was administered by the Center for Health Education and Research (CHER), within the Department of Health Services (now the Department of Health Systems and Population Health). This was one of CHER’s first forays into what would become known as “global health.”

“The IAETC award was the first of its kind at UW,” says Shelly Tonge-Seymour, Associate Director of I-TECH, who has been with the center for 20 years, “the first to translate lessons from the U.S. to improve the training of health care workers and delivery of care globally.”

With the advent of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, I-TECH’s portfolio expanded rapidly, reflecting the evolution of PEPFAR from “emergency” to a longer-term investment in health systems strengthening. I-TECH became an official UW center in 2008, a year after joining UW’s new Department of Global Health at the invitation of Dr. King Holmes, then-chair of DGH. “It became clear that we had grown so large that we needed our own administrative core,” says Tonge-Seymour.

Through its work with PEPFAR, I-TECH’s efforts have contributed meaningfully to the huge advancements in HIV prevention, care, and treatment seen across the globe, with a particular emphasis on groups that have been marginalized or stigmatized.

“One of the most powerful changes in the past 20 years in the Caribbean Region has been in the attitude toward key population groups,” says Natalie Irving-Mattocks, Executive Director of the Caribbean Training and Education Center for Health (C-TECH), one of I-TECH’s independent partner organizations. “Through the Key Populations Preceptorship Program, I-TECH has contributed significantly to better health in the Caribbean region by training healthcare workers to provide nonjudgmental, high-quality, comprehensive HIV care to men who have sex with men, transgender women, and sex workers.”

C-TECH is just one of the independent organizations I-TECH has helped to establish worldwide. Once operating as I-TECH Zimbabwe, the team at the Zimbabwe Technical Assistance, Training, and Education Center for Health (Zim-TTECH) has a long history of partnering with local organizations and community-based health care workers to increase access to care.

“I’ve been involved with I-TECH for its entire 20 years, and the most impactful thing for me has been the contribution I-TECH has made in Zimbabwe to supporting the development of lay cadres into primary counselors,” says Abisha Jonga, Senior Program Manager at Zim-TTECH. “This program created a career path for so many, made HIV counseling services more accessible to the general population, demystified HIV testing, and shaped the individuals’ lives.”

Dr. Batsi Makunike, Executive Director of Zim-TTECH, agrees that fostering local connection has been the key to success. “I am particularly proud of the fact that I-TECH has succeeded in nurturing local organizations,” says Dr. Makunike. “Providing full support without competition–that is huge. Without I-TECH, there would be no Zim-TTECH.”

Malawi has seen its health care landscape change dramatically in the past 20 years and is now close to meeting the UNAIDS 95-95-95 targets for the elimination of HIV. Since 2008, I-TECH has partnered with the Malawi Ministry of Health’s Department for HIV and AIDS and helped to generate pioneering policy initiatives such as the 2011 adoption of Option B+ for the prevention of mother-to-child transmission (PMTCT) of HIV. Option B+ provides universal, lifelong ART for pregnant and breastfeeding women. Based on Malawi’s documented success, the World Health Organization formally adopted Option B+ as a global policy in 2013.

“We truly believe that I-TECH has significantly contributed to the prevention of thousands of infant infections and AIDS deaths among children, adolescents, and mums and dads in Malawi,” says Dr. Andreas Jahn, Senior Technical Advisor with I-TECH Malawi. “We have walked this journey with a whole generation of Malawian HIV program colleagues, and we have learned a tremendous amount from each other.”

I-TECH’s funding has grown from $500,000 for its initial award in 2002 to a cumulative total of more than $1 billion. The center currently has 26 awards, harnessing UW technical expertise in multiple technical areas from mental health to electronic health information systems to global health security and emerging health threats.

As I-TECH has adapted to changing needs, at its core remains a commitment to creating equitable partnerships and facilitating knowledge sharing throughout the I-TECH network, which includes I-TECH’s own country offices, independent partner organizations fledged from I-TECH, ministries of health, academic institutions, community groups, and others.

“When I reflect on the success of I-TECH in reaching the age of 20, two observations keep coming up for me,” says Dr. Ann Downer, co-founder and former Executive Director of I-TECH and Professor Emeritus in the Department of Global Health. “One is about the power of unity. I believe that the ability of a diverse group of individuals and teams to hold a common vision and set of values generates resilience. This unity allows I-TECH to continue operating after 20 years with integrity and grace across enormous geographic, linguistic, and cultural borders and despite regular economic and social challenges.

“The other observation is about the importance of encouraging leadership from all parts of an organization,” she continues. “This requires us to embrace the value of humility and results in our ability to listen and learn. Both are critical actions for successful work anywhere but are essential for working ethically on a global stage.”

The I-TECH story continues to unfold. From a modest grant with limited staff to a vital, resilient, and animated worldwide network of more than 1,600 dedicated personnel, I-TECH will continue to work alongside its global partners in its commitment to stronger health systems and safer, healthier communities.

“There’s so much to celebrate and a wealth of lessons to light the way forward,” says Dr. Collins. “In this era of pandemic, war, and fractured communities, our vision for health is needed now more than ever.”

I-TECH Remembers Dr. Paul Farmer

Dr. Paul Farmer and Dr. Rachel Chapman during a discussion with UW students reflecting on equity, race, and global health.

Dr. Paul Farmer and Dr. Rachel Chapman during a discussion with UW students on equity, race, and global health. Photo by Maryska Valentine // Courtesy of UW DGH.

The International Training and Education Center for Health (I-TECH) and its partner network were saddened to learn about the unexpected passing of Dr. Paul Farmer. He was not only a leader in the field of global health, but an inspiration to those who knew him and an advocate for social justice. His work shaped the practices of global health and touched countless lives around the world.

As a co-founder of Partners in Health (PIH), a global health and social justice organization dedicated to strengthening health systems and providing access to high-quality healthcare, Dr. Farmer worked to reduce health inequities and provide care to those most in need. He is remembered for his compassion in his humanitarian work and dedication to the PIH mission.

“I am grateful to have known Paul, and like countless others, I benefitted from his kindness, intellect, and zeal,” says Dr. Pamela Collins, I-TECH Executive Director. “This is a devastating loss for the community, but I know that his work will live on as each of us works for compassionate, equitable, and quality health care wherever we may be.”

Dr. Farmer was an inspiration to the global health community. His legacy will continue through the work of PIH and the lives he touched around the world. We thank Dr. Farmer for his life of service and dedication to global health. He will be deeply missed.

To learn more about the impact Dr. Farmer’s work, see these tributes from PIH, NPR, and New York Times.

I-TECH Remembers Transgender Activist and Leader Brandy Rodriguez

Brandy Rodriguez gives feedback to a clinician during the pilot training of I-TECH’s Key Population Preceptorship program in Trinidad & Tobago. Photo credit: Lauren Dunnington/I-TECH.

In honor of Transgender Awareness Week (November 13-19), the International Training and Education Center for Health (I-TECH) pays tribute to Trinidad & Tobago transgender activist and esteemed community leader Brandy Rodriguez, who passed away in late October.

Ms. Rodriguez leaves a legacy of leadership as president of the Trinidad and Tobago Transgender Coalition and a member of the Pan Caribbean Partnership against HIV and AIDS. She improved countless lives among those she supported in her many years as a peer navigator at the Family Planning Association of Trinidad and Tobago. Countless more lives were touched – and perspectives broadened – through her tenacity and compassion.

Staff at I-TECH are honored to have worked with Ms. Rodriguez, who served as a patient-trainer for I-TECH Caribbean’s Key Populations Preceptorship program in Trinidad & Tobago.

“A tireless champion for the trans community, Brandy held an open door and a willing ear to any lost children of our LGBTQ tribe,” says Conrad Mitchell, I-TECH’s Program Coordinator in Trinidad & Tobago. “Her fiery tongue and sharp wit kept us all in check, whilst her warm heart overflowed with a love that was unsurpassed. Her fearlessness was legendary both within the community and across local, regional, and international platforms. We are shaken to the core by this loss. The world is forever a little less ‘fierce’ with Brandy gone.”

The Key Populations Preceptorship program’s intensive trainings use targeted role-play scenarios to build clinicians’ capacity to provide nonjudgmental, high-quality comprehensive HIV care to communities most at risk: men who have sex with men, transgender people, and sex workers. Through this work with I-TECH, Ms. Rodriguez contributed to critical efforts to break down stigma and barriers to care experienced by marginalized communities. The first physician trained as part of the program in Trinidad & Tobago, Dr. Vedavid Manick, shared his experience with Ms. Rodriguez beautifully in a Trinidad and Tobago Newsday letter to the editor.

To learn more about the impact Ms. Rodriguez’s work, see these tributes at Trinidad and Tobago Newsday and UNAIDS.org.

Kayla Cody-Lushozi Reflects on I-TECH’S Global Health Leadership Development Program

Kayla Cody-Lushozi

By Chelsea Elkins

For the past 10 months, Kayla Cody-Lushozi has served as the inaugural Global Health Program Officer for I-TECH’S Global Health Leadership Development Program. The aim of this program is to support the development of skills in global health program implementation, management, and leadership for recent master’s degree graduates with diverse backgrounds who are transitioning into the public health field.

This program is structured to directly support the programmatic needs of multiple I-TECH projects while providing the Program Officer with mentorship across the I-TECH network and supporting the transition into a non-temporary global health position. In 2019, Cody-Lushozi received her Master’s in Social Work (MSW) from the University of Washington (UW) and has used this background, along with her unique experiences and expertise, to inform her work at I-TECH.

During her time as a Program Officer, Cody-Lushozi has worked with three teams across the I-TECH network, plunging into a few of the many areas of work I-TECH implements and supports. In collaboration with partners from FHI 360 and leaders from the Cambodian Ministry of Health, Cody-Lushozi supported a health informatics program, working to streamline databases and strengthen health systems in Cambodia. Additionally, she explored how to revive Community Advisory Boards for people living with HIV (PLHIV) in Jamaica in a sustainable and community-centered way with I-TECH network partner the Caribbean Training and Education Center for Health (C-TECH). She worked with community partners in Zimbabwe, as well, exploring the support systems in place for case managers supporting young PLHIV. This work was done with I-TECH partner the Zimbabwe Technical Assistance, Training and Education Center for Health (Zim-TTECH).

September marks the end of Cody-Lushozi’s time with I-TECH. Below, she shares some reflections on her time in the Leadership Development Program, as well as what might come next.

What has the experience of being a Program Officer at I-TECH meant to you?

This has been an incredible experience, and it came at a perfect time. Right before I-TECH, I was working at the Washington State Department of Social and Health Services doing direct service social work with economically marginalized clients with mental and physical health needs. While I enjoyed this role and understood its importance, this was not the type of social work practice that I wanted to pursue in the long run.

My passion and interests lie in research, especially community-centered research that allows me to work directly with Black communities in improving access to health justice. I-TECH came along at the right time and allowed me to dive deeper into the world of global health implementation.

The projects I’ve done at I-TECH have been really varied, and I’ve gotten an inside look and experience across different areas. I am constantly learning at I-TECH. I-TECH does a million things, which might have been overwhelming to a new person entering the organization, but I always felt very supported by my teams. They made it clear that I didn’t need to have all the answers.

I also appreciate that this program aims to attract a diversity of experience, background, and perspective. It encourages more than just a singular lens. I’ve been able to share my unique background and experiences as a Black woman social worker in global health. I’m excited to see where this program goes and how it continues to support I-TECH’s evolution.

This has been a beautiful experience for me. Working at I-TECH served as a great affirmation that this is the area of work that I want to continue to grow in.

How has your background in social work shaped how you’ve entered the global health field?

Before getting my MSW I already had an interest in public health, even before I was calling what I was doing public health. I wanted to use the framework and the lens that social work provides within a public health setting. I always gravitate toward work that is community-centered and centers the voices and expertise of those in the margins. These are some of the values that I bring with me into the global health space and that I hold very close to my professional and personal practice.

These values have helped me in this field because public and global health work is not always operating from the pillars of anti-oppressive practice. There’s so much historical and contemporary discourse that needs to be addressed and often isn’t in this field. You can’t be ahistorical if you’re truly trying to get to the root causes of global health inequity and injustice. Many of the issues that we see in global health are connected to issues of global white supremacy, imperialism, and resource extraction. It’s a tension that I hold in this field but something I try to do my part to shed light on.

You have done a lot of meaningful work during your time with I-TECH. What does your life look like when you’re not working?

I’ve gone through a lot of life changes these past 10 months. I’m a newlywed; I got married in June to my now husband Mawande. Being a new wife is really exciting.

A big chunk of my husband’s and my time outside of work is dedicated to our small homemade skincare business, K+M Homemade Skincare, that we officially launched during COVID. We do a lot of farmer’s markets and pop-ups on the weekends. Ask anyone and they can tell you that we love making and talking about our skincare.

In what direction do you see yourself moving after I-TECH?

After I-TECH, I see myself continuing to engage in global and public health spaces that are truly committed to community work and radical racial and social justice transformation. I am not comfortable doing this work in the absence of working directly with community members and local stakeholders. Top-down approaches have colonial and imperialist roots. I believe in doing “with” and not doing “to” and actively partnering with communities for long-term sustainability and quality health care reform.

I will be packing up and moving to South Africa in 2022 and am currently open to a position that will allow me to continue to practice in this exciting field. My interests lie in research, project management, and implementation work related to HIV care and treatment, maternal and child health, and mental health. I am also contemplating pursuing an MPH or a PhD in global health and implementation science sometime in the future. It’s been an incredible past 10 months with I-TECH and I am excited to stay in contact with this global network. I thank everyone who has been part of this journey with me!

The I-TECH network thanks Kayla Cody-Lushozi for her work and wishes her well as she continues to forge her path in global health!

If you are interested in participating in the Global Health Leadership Development Program, more information is available here.

Despite COVID-19 Challenges, I-TECH Supports Progress Toward Cervical Cancer Elimination

The World Health Organization (WHO) Global Strategy to Accelerate the Elimination of Cervical Cancer, launched in November 2020, calls for a world where cervical cancer—which kills more than 300,000 women per year—is eliminated. To achieve this, the strategy proposes ambitious 90-70-90 targets over the next decade.

However, the COVID-19 pandemic has severely hindered critical work on cervical cancer interventions, including reduced clinic flow, training opportunities, and outreach.

Due to agile programs and dedicated staff, several teams within the International Training and Education Center for Health (I-TECH) network, despite the challenges presented by COVID-19, have continued to make strides toward the WHO cervical cancer elimination goal.

Record-breaking cervical cancer screening in Namibia

The I-TECH Namibia program focuses on cervical cancer screening services for women living with HIV (WLHIV). Namibia’s national antiretroviral therapy (ART) program has rapidly adjusted to COVID-19 and the need to decongest public health facilities through multi-month dispensing (MMD) of ART. While this has helped with ART access, it has significantly reduced opportunities for performing facility-based services, since the frequency of health facility visits by women on ART has declined rapidly.

In close collaboration with the Namibia Ministry of Health and Social Services (MoHSS), I-TECH is implementing enhanced facility-based screening campaigns to increase access and rapidly reach more women. For these enhanced screenings, clients within a district are mobilized and given paced appointment times at several facilities in-line with COVID-19 restrictions. Service providers are then assigned to the specific sites where they provide screening services.

From 8-12 February, 805 women were screened through visual inspection with acetic acid (VIA) or Pap smear, 95% of whom were women living with HIV (WLHIV). Of the 137 women screened VIA positive, 98% received treatment. This campaign broke national records by achieving the highest recorded number of women screened in a 5-day campaign, as well as the highest number of women screened in a single day (210).

“As the COVID 19 pandemic rages on, and preventative restrictions limit client screening, the downtime should be used in planning for catch-up screening activities,” says Dr. Laura Muzingwani, I-TECH’s Cervical Cancer Lead Physician in Namibia. “Resource and client mobilization are both key to prepare for any window of opportunity when COVID restrictions are relaxed to enable rapid mass screening.”

Mentoring and training continues in Mozambique via videoconferencing technology

In close collaboration with the Ministry of Health (MOH) and the University of Texas MD Anderson Cancer Center—a Project ECHO® “superhub” for oncology—I-TECH has continued its monthly cervical cancer ECHO sessions in Mozambique, with an additional focus on COVID-19 safety and risk reduction. An average of 40 participants attend each session, and topics have included cervical changes in older women; relevance of normal and abnormal colposcopic findings; and hygiene, disinfection, and asepsis of materials.

“Although the emergence of the COVID-19 pandemic was sudden, it was possible to adapt quickly using remote information and communication technologies,” says Dr. Ernestina David, Program Manager for the I-TECH Cervical Cancer Prevention Program. “The ECHO videoconference sessions made it possible to bring together providers across the country to address uterine cancer and diagnose and treat pre-cancerous lesions, using local cases and looking for ways to approach and treat them.”

In addition, the Mozambique team has continued its regional cervical cancer trainings in a blended format (both virtual and in-person components). I-TECH has implemented three trainings using a model spearheaded by MD Anderson, wherein a two-day LEEP and colposcopy training was adjusted so that trainers could join via Zoom in lieu of traveling to Mozambique.

While some participants join only the Zoom sessions, others are able to watch the sessions from a classroom setting and then work through skills-building demo stations, followed by practice on patients at a provincial hospital.

Access to services increase through health communication in Malawi

Despite the Malawi government indicating cervical cancer screening, care, and treatment as priority services, after the COVID-19 pandemic hit the country, most facilities did not include cervical cancer services on their priority lists. Facilities either completely suspended or heavily reduced screening and treatment. This, coupled with fears among targeted women about contracting COVID-19, marginalized access to services.

To combat these challenges, I-TECH delivered health talks within communities on how women can protect themselves as they access services (social distancing, hand washing, use of face masks, etc.). Those reached were encouraged to pass on information to others.

I-TECH also engaged district health officers and those in charge of affected facilities on the need to continue providing cervical cancer services, in line with MOH COVID-19 prevention guidelines. Presenters emphasized the burden of cervical cancer and how it would worsen should services be interrupted for the entirety of the pandemic. Discussion also touched on including cervical cancer providers on the rotation roster and ensuring that commodities were available.

In Malawi, 391 health facilities are currently providing cervical cancer screening services, and 80% of those health facilities are also providing treatment services. More than a quarter of a million women were screened between January 2020 and June 2021, 57% of whom were WLHIV.

Zimbabwe consortium takes measures to blunt the impact of COVID-19

I-TECH and its network partner the Zimbabwe Training, Technical Assistance and Education Center for Health (Zim-TTECH) implement cervical cancer screening and treatment via the local Zimbabwean consortium ZimPAAC.

By March 2021, ZimPAAC had achieved 53% of the annual target for the number of women on ART screened for cervical cancer. ZimPAAC implemented several measures to mitigate the impact of COVID-19 on continuity of cervical cancer screening services, including:

  • Training of all health care workers on COVID-19 safety and security, transmission, and prevention;
  • Support to ensure infection prevention and control (IPC) and triage at health facilities through training, procurement and distribution of personal protective equipment (PPE), hand washing stations/commodities, face masks for both staff and clients in need; and
  • Procurement and distribution adequate PPE for use by health care workers at facilities.

I-TECH Develops COVID-19 Vaccine Registry in Botswana

In March, the Botswana Ministry of Health and Wellness (MoHW), launched an online self-registration platform to allow eligible citizens to register for COVID-19 vaccination. The registration portal was developed by the International Training and Education Center for Health (I-TECH), in conjunction with the MoHW and the National COVID-19 Task Force. Since the launch, more than 60,000 people have registered for vaccination through the platform, and more than 45,000 people have received their first dose of the COVID-19 vaccine.

Screenshot of the COVID-19 registration portal

I-TECH assisted the MoHW to develop the following modules for the platform:

  • A DHIS2 tracker module tracks vaccinated clients for a follow-up dose. I-TECH trained MoHW health informatics and M&E officers to provide remote and on-site support to frontline health care workers across the country on application use. An interactive and intuitive dashboard shows vaccination trends across age and gender bands, geographical area and clinics/health facilities. The tracker module sends automated SMS reminders to clients regarding vaccination date, location, and time. Clients also receive a post-vaccination acknowledgment message.
  • An adverse events tracking module records any adverse events (AEs) due to COVID-19 vaccines. The module also automates reports on AEs and the correlation between AEs and any underlying conditions as disclosed by the clients.
  • A stock management module tracks the vaccine stock at facility, district, and national levels. This module is particularly helpful in projecting the vaccine demands at the clinics and vaccine availability against the vaccination bookings. The MoHW team closely monitors daily opening and closing stocks, to ensure optimal supply. Automated data checks and validations are built in to alert the facility management of any misappropriations in the vaccine stocks.

Available reports within the COVID-19 registration portal

Currently, I-TECH is working on a scheduling application that will be integrated into the portal for online booking of vaccination appointments. This will considerably reduce the number of “walk-in clients,” increase efficiency, and assist frontline workers in managing the workload at vaccination sites.

I-TECH will continue supporting this initiative until the end of the current funding cycle, while simultaneously capacitating the MoHW to take over the day-to-day management and maintenance of the portal.

This online, DHIS2-based platform is available here.

I-TECH’s work in Botswana is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U91HA06801, the International AIDS Education and Training Center (IAETC). The content of this post is the authors’ and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS, or the U.S. government.

I-TECH Says Goodbye to Longtime Executive Director Ann Downer

Dr. Ann Downer speaks at the I-TECH annual meeting in 2010.

On June 30, 2020, Dr. Ann Downer will retire from her post as the Executive Director of the International Training and Education Center for Health (I-TECH) at the University of Washington (UW).

Downer has had a 31-year career at UW; she founded I-TECH 18 years ago with a talented team of global health professionals at UW, along with her friend and colleague Dr. Michael Reyes, at the University of California, San Francisco. In that time, she has been the center’s trusted leader; a principal investigator for several awards; and a pioneering educator, mentor, and friend.

As is fitting for a hero’s journey, hers started on a boat.

After dropping out of University of California, Berkeley, as an undergraduate in the early ’70s, one semester shy of completing her degree, she worked as one of the only female commercial fisher-“men” in the Pacific Northwest for the lion’s share of her 20s.

Downer fishes in Neah Bay on the Makah Reservation in Washington, across the border from British Columbia.

“Mistake or not, [leaving UC Berkeley] set me on a path that school wasn’t setting for me at the time,” says Downer. “My experience fishing made me resilient, taught me how to work hard, and, above all, made me think about my future since I knew I couldn’t fish forever.”

But in order to finish school, she needed to set a new direction. On the advice of a female sailing instructor, she volunteered at Planned Parenthood Whatcom County in Bellingham, where she quickly secured a paying job.

“This one action — asking someone for advice — set my entire career in motion,” says Downer. “She prompted me to seek a new direction.

“And it was during my time as an education coordinator for Planned Parenthood that I gained the core skills that would serve me for the rest of my career,” she continues. “Teaching and instructional design, health education and curriculum development, comfort with discussing issues related to sexual health, and being in front of groups of people. Those years also solidified one of my core values — that people should have choice in regard to their own bodies.”

Downer finished her undergraduate degree while working at Planned Parenthood and then applied to the UW in Seattle. She went on to get a master’s degree in Health Education and Health Promotion at UW from a department (Kinesiology) that was later eliminated as duplicative with School of Public Health programs.

She again worked full-time during graduate school, exercising her entrepreneurial muscles helping to start a nonprofit program on prevention of child sexual abuse (the successful Committee for Children program has since expanded its work with parents and teachers to provide training on development of empathy and conflict resolution skills).

Downer and her team designed many of the first AIDS prevention campaigns in the state.

Following graduation and a year doing consulting work for clients such as the Washington State Office of the Superintendent of Public Instruction, Downer became the education coordinator in the mid-’80s for the first HIV/AIDS program at Public Health-Seattle and King County, where she and her team designed many of the first AIDS prevention campaigns in the state.

“I had learned by then that I really enjoyed working at the edge of emerging social issues,” she says.

Downer joined the UW faculty in the Department of Health Services in 1989. As a practice-focused educator working among researchers — and as a master’s-trained faculty member working closely with physicians, nurses, and PhDs — she had ample opportunity to call on the work ethic and tenacity she’d forged in the commercial fishing industry years earlier.

She eventually took the advice of her department chair, Dr. Bill Dowling, to continue her education. So, once again, she returned to school and worked full time while earning an advanced degree in educational leadership at Seattle University.

“The program wasn’t what I expected,” says Downer. “I thought it would concentrate on topics related to educational administration, like finance and law, but, while those topics were included in the curriculum, it was really a degree program focused on values-based leadership.

“I didn’t know it then,” she says, “but this was exactly what I needed in order to stay at UW and flourish.”

Values-based leadership became the foundation of two centers that Downer led at UW: the Center for Health Education and Research (CHER) and, later, I-TECH.

“I discovered that I could bring people together who shared certain values —  respect for others, belief in the power of education, maintaining an attitude of hope, the desire to integrate practice and research,” she says. “These were the core values that guided us at CHER and carried over to I-TECH.”

CHER’s programs were initially focused on domestic public health challenges but began to expand in the direction of global health, so Downer approached Dr. Stephen Gloyd, who led the International Health Program (IHP).

“With Steve’s help and encouragement, we aligned more closely with IHP and began to grow our global portfolio of projects” says Downer. “As new projects were funded, the metamorphosis into what would become I-TECH was rapid, but our values and principles always remained the same.”

Downer and mentor Dr. King Holmes, Chair Emeritus of the UW Department of Global Health, in 2017.

I-TECH was formally founded in 2002 and moved from Health Services into the newly created Department of Global Health (DGH) in 2007, at the invitation of Dr. King Holmes, the founding chair of DGH. Holmes was closely involved in I-TECH from its inception and has been instrumental in its success; he remains a mentor to Downer and I-TECH to this day.

Since 2002, I-TECH’s cumulative funding at UW totals nearly $1 billion. I-TECH currently has an international staff of 2,000, with 13 offices in low- and middle-income countries, several of which have now transitioned to become independent, local organizations.

I-TECH implements programs in more than 30 different technical areas that support strengthening of health care systems, including workforce development; HIV prevention, treatment, and care; laboratory systems strengthening; voluntary medical male circumcision; health information systems; health regulation and policy; and leadership and management.

Downer was recognized by UW in 2015 as the recipient of the “Distinguished Contributions to Lifelong Learning” award, in part because of her growing interest in promoting e-learning at UW. Downer’s pioneering 12-week online course, Leadership and Management in Health, had graduated 25,242 participants as of March 2020, with an 87% completion rate. More recently, partnering again with the DGH e-Learning Program (eDGH) on a second 12-week professional development course, Project Management in Health, graduated 6,197 participants in its first two offerings, with a completion rate of 88%.

“My work with eDGH has brought me back to my roots in education,” says Downer, “designing educational products that include content and voices from diverse cultural traditions and perspectives. This is critical learning for those working in public health systems throughout the world — and especially important for improving the leadership and management skills of people working in those systems.”

I-TECH staff past and present, as well as assorted friends and family, gather virtually to toast Ann’s career and retirement.

Though officially retiring on June 30, Downer, as an emeritus professor in DGH, will continue to work for a small amount of time from July through December 2020 in order to finish one global health project under way in Cambodia and two online courses before turning them over to others.

At the same time, Downer does plan to be a retired person and reports that she’ll be busy in her garden, as always, and returning to her early roots as she again takes up sailing. Her adventure began — and now continues, it would appear — on the vast waters of our beautiful Pacific Northwest.

Downer is truly excited to see I-TECH move into the next phase of its organizational life under the leadership of Dr. Pamela Collins, Professor of Psychiatry and Behavioral Health, Professor of Global Health, and Director of the Global Mental Health Program.

“We all welcome you, Pamela!” says Downer. “I believe with all my heart that you are the right person at the right time for I-TECH. You inherit one of the most competent, resilient, and ethical groups of people you will ever work with — and a vision, mission and set of operating principles that I know are consistent with your own.

“I-TECH has been one of the loves of my life,” she continues, “and I wish you the same sense of fulfillment and pride I have had working with this incredible team of people — past and present — at this incredible university of ours.”

We Stand in Solidarity

During the “Doctors for Justice” march on June 6, 2020, health care workers and others marched from Harborview Hospital to Seattle City Hall to protest police brutality.

Communities in the United States and globally continue to respond to the tragic murders of George Floyd and Breonna Taylor at the hands of police officers, as well as the death of Ahmaud Arbery, who was murdered by two White men, one of whom was a former police officer. We acknowledge the pain experienced by Black people and other communities of color. We acknowledge racism, police violence, and anti-Blackness as pervasive and systemic problems – and as barriers to the health and well-being of Black people and other communities of color. Racism and police violence are public health emergencies in the U.S., and we stand with Black communities in the fight against these public health and human rights violations.

Police violence against persons with black and brown skin is not new in the U.S. The United States were founded on racial violence – first through the mass destruction of indigenous communities and then again when the first ship bearing enslaved, captive Africans arrived in 1619. For hundreds of years enslaved people were bought and sold in the U.S. and, though slavery was officially abolished in 1865, the legacy of slavery lives on through the systemic racism, mass incarceration, and injustice that continue to impact our communities of color to this day.

I-TECH staffers and their families attend the “Doctors for Justice” march, which began outside of I-TECH headquarters.

I-TECH will continue to examine policies and procedures that foster safe workplaces for our colleagues of color, especially our Black colleagues; continuously examine and challenge our own biases; and strive to be purposely anti-racist in our actions. I-TECH remains committed to creating an environment where equity, diversity, and inclusion are core values and integral to our workplace and communities. We will hold ourselves accountable when those core values are not upheld.

Our thoughts are with Black members of the community, particularly the families of Mr. Floyd, Ms. Taylor, and Mr. Arbery and all of the other Black families who have lost loved ones to acts of racist violence. We will honor these individuals through our commitment to examining and reducing structural racism in our work.

If you would like to see how UW Health Sciences leadership have responded to these tragedies, read their message here.

Two-Way Texting Study Offers Innovative Model to Reduce Provider Workload while Preserving Patient Safety

The two-way texting research team.

This piece was first posted on the University of Washington Department of Global Health’s website.

Voluntary medical male circumcision (VMMC) safely reduces the risk of female-to-male HIV transmission by up to 60%. Few men have any post-operative VMMC complication. However, current practice in Zimbabwe and throughout most of sub-Saharan Africa requires VMMC patients to return for multiple, in-person post-operative visits. With low complication rates, and severe healthcare worker shortages, these required visits are a burden for providers and patients — threatening achievement of critical HIV prevention targets. A two-way texting model studied by University of Washington researchers in Zimbabwe offers a new way to address this barrier by reducing provider workload while also safeguarding patient safety.

“These visits can be a barrier to male circumcision uptake and expansion in countries with severe health care worker shortages, as well as negatively impacting patients who needlessly pay for transport, miss work, and wait for unnecessary reviews,” said Principal Investigator Caryl Feldacker, PhD, MPH, at the International Training and Education Center for Health (I-TECH) in the University of Washington Department of Global Health.

The study included 721 VMMC patients in two locations in urban Zimbabwe. In the study, patients communicated directly with a health care worker through interactive text messaging for the critical 13 days post-VMMC, rather than returning for required in-person visits. By giving men the option to heal safely at home, or return to care when desired or if complications arose, the method dramatically reduced in-person visits by 85%. Texting also reduced follow-up costs by about one-third while improving the quality of care.

As compared to routine in-person care, the study yielded twice the number of reported complications. “This increased identification and reporting is a positive result that is likely attributable to improved counseling and men’s engagement in care. Through texting, men were empowered to observe their healing and report potential issues promptly, before they worsened,” said Feldacker.

Currently, most text-based health care efforts blast pre-defined messages to many people simultaneously, removing patients’ ability to communicate back with health care workers. In contrast, two-way texting between providers and patients provides interactive care, and the short time frame heightened participation: in the study, 93% of men responded to texts. Both providers and clients reported confidence in the texting option, feeling safe and highly recommending it for scale.

“With the current system, Zimbabwe could perform millions of unnecessary follow-up visits over the coming five years. The workload burden for health care workers and time lost for patients who are healing without complication is a significant burden for health care workers and clients alike,” said Feldacker. “Potential gains in efficiency and reduced costs through using two-way messaging are large.”

With funding from the U.S. Centers for Disease Control and Prevention (CDC), and in partnership with the Society for Family Health, the model will soon be tested in urban South Africa. The new, field-based research will further test two-way texting in a different geographical and patient context to better inform the model for adaptation and widespread scale-up.

Feldacker added that “while our findings are grounded in studies on male circumcision, our results are largely attributable to the methods rather than to a specific disease or condition.

“With minimal adaptation,” she continued, “two-way texting could streamline other post-operative care contexts or be re-configured for other similarly acute, episodic conditions where continuity of care within a short period is critical for patients, such as short-course TB treatment, post-operative healing, post-natal care or early childhood illnesses — diarrhea, pneumonia, malaria — laying the foundation for generalizing to other diseases and contexts.”

For more on the study, see the paper pre-published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS):

Reducing provider workload while preserving patient safety: a randomized control trial using 2-way texting for post-operative follow-up in Zimbabwe’s voluntary medical male circumcision program

The study was led by Caryl Feldacker, and co-investigators are Vernon Murenje (International Training and Education Center for Health (I-TECH), Harare, Zimbabwe); Mufuta Tshimanga (Zimbabwe Community Health Intervention Project (ZiCHIRE), Harare, Zimbabwe); Scott Barnhart, Isaac Holeman, and Joseph B. Babigumira (Department of Global Health, University of Washington); Sinokuthemba Xaba (Ministry of Health and Child Care, Harare, Zimbabwe); and technology partner Medic Mobile (Nairobi, Kenya).

The Zimbabwe 2wT study was supported by the Fogarty International Center of the National Institutes of Health under Award Number R21TW010583.