Research fieldwork about maternity care in Tanzania

Maternal mortality is one of the major public health issues in today¡¯s society and about 95% of all maternal deaths occur in low- and middle-income countries (WHO, 2023). Pre-eclampsia (PE) is one of the leading causes of maternal mortality in Sub-Saharan Africa, and in the Mwanza region it is estimated to contribute to 40% of maternal deaths.

¨C  Survivors of PE often feel let down by the care system because the experience is so traumatic and the system is not equipped for the long-term physical, psychological, social, and economic consequences, Merete Graneng explains.

¨C  I think it tends to be forgotten because it is usually not an immediate threat, but rather a condition or influence, says Merete Graneng.

Merete Graneng is a master student at International Community health at the University of Oslo. months She just came home from the Mwanza region in Tanzania where she lived and conducted research for three months.

During her stay she has spent most days at the hospital, conducting observations and getting familiar with the healthcare setting. Bugando medical centre is one of the largest medical centre in the area with specialized referral care serving eight regions. It also includes a university providing several different healthcare educations.

Collaborate with others in the field

¨C  Because my thesis has been affiliated with the PRESHA project, I was lucky to connect with project members in Mwanza. I had two local supervisors at the hospital who took me with them during surgeries and rotations to show how the maternity ward functioned on a daily basis.

Through morning meetings and my visits to the ward, I met interns and residents in the medical program who did not mind a chat or explaining ongoing scenarios.I also had two research assistants who helped me with my interviews when they needed to be conducted in Kiswahili. 

The opportunity to travel for fieldwork during your master¡¯s degree

¨C It is uncommon to devote half of your degree to your thesis, but I think fieldwork is a unique opportunity and it allows you to do a deep dive into a topic of your choice. I feel this gives you a closer connection to your collected data which makes it easier when you start writing, Graneng explains.

Following your own research from beginning to end is both new and challenging, but also rewarding. It provides a steep learning curve in research methods and how they actually work in the field versus on paper. 

¨C My thesis looks at how healthcare personnel and patients communicate. The study explores the experiences and perceptions of women with pre-eclampsia regarding shared decision-making. It looks at the relationship between patient and provider, and what the main barriers to the implementation of shared decision-making might be.

I chose to do this as a qualitative study because there have been few studies conducted in low- and middle-income on the experiences of women with pre-eclampsia, as well as the perspectives of women and healthcare providers in the shared decision-making process in maternal care. 

How did you experience doing fieldwork?

¨C Fieldwork was a new and challenging experience. As a person with a background in social sciences, it is a little scary to enter the medical field where research tends to look at the clinical aspect through quantitative studies. However, this means it was a new experience for all participants, myself included.

The interview objects were keen on sharing their experiences and perceptions of situations they encountered, and it seemed like they enjoyed the questions and discussions that followed. I also found the in-depth interviews very rewarding as they usually became more of a conversation which I learned a lot from and really enjoyed, she says.

Granengs' first challenge prior to the fieldwork was the time it took to obtain ethical clearance from the host country. This is a lengthy process and may take months depending on what country you do your fieldwork in and what they require. Another challenge during the data collection was the language.

¨C  I, unfortunately, do not speak Kiswahili and was very dependent on my research assistants for correct translations and interpretations of the answers to my questions, Graneng says.

A third challenge was finding women who experienced pre-eclampsia and were still around to interview after they had given birth. It is common for women to leave to stay with their extended families after birth, and she did not want to interview the women who were still in the hospital as it can be a very vulnerable and/or difficult time for them. 

¨C  I think the most important thing I learned from this process, which also helped me overcome the challenges, is that qualitative research is an ever-changing process. You kind of just have to go with the flow at some point and accept that things might take longer or end up looking completely different from what you expected. 

How did you collect your data?

¨C I collected my data through focus group interviews with healthcare personnel, and semi-structured, in-depth interviews with women who experienced pre-eclampsia as well as decision-makers in the healthcare system. In addition, I spent time in the maternity ward doing non-participant observations to get a feel of the daily life in the healthcare system. 

Why would you recommend others to do fieldwork?

¨C  I think having the possibility of doing fieldwork, whether it is abroad or in your home country, is a huge learning opportunity. It is a unique way of experiencing new cultures and systems. Unless you become a researcher I think it is a once-in-a-lifetime chance to live and work in a new setting, especially if you do it in a foreign country. It does push you out of your comfort zone but is also very rewarding.

It also sets you apart from others because you have gained experience in a specific area which may open doors for jobs and other opportunities later in life.