We received a number of great questions at our Kickoff Event during the Q&A portion of the program. If you missed the event, please check out the live recording. Since we were unable to answer all questions due to time constraints, below are the questions we received that we were unable to address. Please do not hesitate to contact us if you have additional questions!
Can you describe the content of the programs in a bit more detail for the truckers and fish traders?
All of our programs are developed and implemented using a three-staged approach which entails adaptation and design, monitoring and evaluation, and scaling up. We work closely with the populations throughout each stage in order to obtain continuous feedback so that we tailor the programs to ensure their relevance and impact on the ground.
Male Long Distance Truck Drivers:
Among migrant and mobile populations, truck drivers have been specifically noted as at-risk of both poor mental health and physical health outcomes. In collaboration with the International Organization of Migration, Zambia, MWP conducted a qualitative and quantitative needs assessment among truck drivers along three trucking routes in Zambia. In the study we found that long distance truck drivers are at an increased risk of: 1) trauma and ongoing daily stressors, 2) delays and long waiting hours at borders, 3) exposure to crime and violence, 4) poverty, 5) stress related to resisting temptation of sexual interactions with sex workers or migrant women, 6) traffic accidents and 7) other job-related safety concerns. Multiple psychosocial problems such as intimate partner violence, substance use, loneliness, anxiety and depression-like symptoms were noted to be related to HIV sexual risk behavior (specific behaviors included inconsistent condom use, multiple concurrent partners along their route, and transactional sex).
In addition to exposure to trauma and ongoing daily stressors as a part of the job as noted above, the COVID-19 pandemic potentially may exacerbate mental health problems and HIV risk among this population. Currently most truck drivers in Zambia are transporting essential goods from neighboring countries to Zambia. Upon arrival, truckers are forced to self-quarantine for 14 days. As this happens at every border, this may significantly delay the route for truck drivers who travel through multiple countries for one delivery, increasing stress, mental health problems and economic strain. Further, controls are weak at the quarantine locations (e.g., schools, hostels, stadiums), living conditions are poor and women who engage in transactional sex frequent the designated areas, increasing HIV risk behavior.
Our program for the truck drivers will adapt an evidence-based behavioral health program through a series of remote group support sessions to address HIV risk behavior, lack of HIV testing, mental health problems and stress, COVID health risk information, risk mitigation and other related outcomes of the COVID-19 pandemic.
Female Fish Traders:
In Zambia, about 1 million people are supported by the fishing industry. As a highly gendered occupation, women dominate the fish trading business, traveling long distances to the rivers and lakes to buy fish from fishermen and subsequently travel to sell fish in the marketplace. HIV prevalence among females between the ages of 15-59 in Zambia is 14.9%. Among women who spend time away from home for more than one month, HIV prevalence is 15.5% and 17.3% among women who have slept 3 or more times away from home in the past 12 months. Although limited data are available, it has been estimated that HIV prevalence is 24% or higher in some fishing communities in Zambia with no indication of decline. Based on a needs assessment conducted by the MWP team, the following contribute to an increased risk of HIV infection among Zambian female fish traders: 1) an inability to negotiate condom use, 2) gender-based violence, 3) transactional sex for transportation to and from fishing camps with truck drivers, 4) “fish for sex” deals with fishermen, 5) multiple concurrent sexual partnerships, 6) lack of economic alternatives and 7) easily accessible alcohol and substance use to cope with stressors. Based on the needs assessment findings, we have recently conducted a series of focus group discussions aimed to adapt an evidence-based, gender-specific and trauma-informed health and mental health program. Fish traders were actively involved in reviewing each component and stage of the program by providing ongoing feedback. In addition, discussions with the fish traders entailed soliciting information on additional components that should be added based on their specific needs.
Our program for the fish traders would entail an evidence-based emotional coping and problem-solving program using both in person and remote sessions, which addresses COVID-19 health risk information, post trauma symptoms, substance abuse, economic alternatives to fish trading during the pandemic and annual fish ban, HIV risk behavior and other related COVID-19 outcomes.
How is MWP linked to the Zambian local government (or any other Sub-Saharan African Government)? And how long have they done so? may you please give us examples. Are your programs linked to policy change in any way? If so, how.
Since Dr. Michalopoulos began her work in Zambia, she has worked closely with the local government. Throughout years of conducting formative research among truck drivers and fisherfolk, Dr. Michalopoulos has built relationships with the Ministry of Health, Ministry of Community Development and Maternal and Child Health as well as the Ministry of Transport and Ministry of Chiefs. MWP has had a long-term relationship with the former Chief Mental Health Officer, late John Mayeya and is currently working with the current Chief Mental Health Officer. MWP believes firmly in working collaboratively with the Zambian government so that information can be shared and effective programming can be integrated into policy. We recognize and firmly believe that MWP cannot, and should not, work in a silo. We have developed strong relationships with other NGOs, UN organizations, universities, and most importantly with trusted local leaders of the populations we work with in Zambia so that we may collectively inform sustainable change.
Why is MWPs objective focused on truck drivers and fish traders?
To date, we have primarily worked with labor migrants in Zambia (i.e. long distance truckers and fisherfolk). Our work with truckers and fisherfolk was largely informed by Dr.Michalopoulos’ mentor at Columbia University, Dr. Nabila El-Bassel, who conducted research aiming to understand risk factors for HIV among labor migrants in Central Asia. Dr. Michalopoulos was interested in this area of research as it applies to migrants in Zambia after having conducted other research projects there. In addition, Dr. Michalopoulos was most interested in the relationship between mental health and HIV risk. Working with truck drivers and fisherfolk was largely based on preliminary discussions with partners on the ground who knew these groups to be at high risk for HIV and trauma exposure. While MWP is dedicated to developing programs to address the health and mental health needs of truckers and fisherfolk, we are also keen to expand in time to other migrant populations (both forced migrants and other labor migrants).
What are some of your future research priorities? Which types of organizations are/would you consider partnering with for this work?
We are particularly excited to work with both governmental and non-governmental organizations that can provide services that align with, but may be outside of, the MWP wheelhouse. As such, we will then be able to partner to further provide services to help improve the well-being of migrant populations in Africa. We have had discussions with organizations to conduct a mapping exercise of the health and mental health services along a fish trader route in order to provide feedback to the government on the current state of available services. We also hope to expand our priorities to address the health and mental health needs of other populations such as cross-border traders, girls who are trafficked, refugees and asylum seekers. We’re willing to explore opportunities to partner with organizations that may focus on areas outside of our area of expertise if their overall goals are in line with our mission.
What was your inspiration behind creating the Moving Well?
MWP was formed based on many years of formative research among truckers and fisherfolk in Zambia. When Dr. Michalopoulos decided to transition from academia and pursue a professional opportunity at USAID, she did not want to let go of her commitment to developing programs to address the health and mental health needs of truckers and fisherfolk in Zambia. In addition, she had built strong relationships with both governmental and non-governmental organizations in Zambia that remain important to maintain in order to make a sustainable impact on vulnerable communities throughout Africa.
How difficult is it to deal with the trauma of the individuals you are standing for? What do you do to help manage the potential vicarious trauma?
A part of our mission is to build the capacity of local clinicians and other support staff. Clinical skill-development is not only based on strengthening techniques to address mental health problems, but on learning how to take care of oneself as a clinician who may be holding painful emotions and feelings for the client. As such, we believe that intentional self-care and strong, supportive supervision is critical in doing this work.
How can/will the work you are doing in Zambia be applied to other regions of the world?
We believe that our approach can be applied to multiple contexts in various regions throughout the world. At the same time, we believe that doing this work with a decolonization lens is crucial and requires taking the time to build relationships with community members and stakeholders in order to truly understand the needs of the population as well as their ideas for sustainable solutions. With that in mind, MWP hopes to serve communities in other regions, but we believe that the necessary steps to do this will take time.
In relation to the above mentioned, what other countries is MWP currently working in?
To date, we have primarily focused on working with fisherfolk in Zambia. We have also worked with long distance truckers from Zambia, Zimbabwe, The DRC, and Tanzania. We have relationships with organizations in South Africa, Malawi and Zimbabwe and are hopeful to expand.
How has your work been impacted by the pandemic?
We had just developed our website and were just getting our program off the ground when everything shut down. It was initially so disheartening to think we would not be able to work with the various communities in Africa in the way we had envisioned. But then we put our heads together and thought about the potential impact of the pandemic on the populations we work with in Zambia. We used that as an opportunity to share the aims of MWP with our friends, family and colleagues while at the same time running a small fundraising campaign to provide COVID-related health prevention packages to fish traders in Lusaka. We successfully raised enough funds to provide these packages and conduct a brief survey on the impact of COVID-19 on over 100 fish traders!
Does the work of MWP benefit the United States?
Our model can be applied to migrant populations within the US. Further, through our work with migrant populations in Africa we can build the knowledge-base of our understanding of health and mental health problems as they relate to mobile populations globally.