Hard Science, Safe Motherhood

From commercial greenhouses in Florida to rural villages in Ethiopia, doctoral students investigate ways to protect women and their unborn children.

Valerie Mac

Valerie Mac is helping develop an education program to reduce health risks for women who work in nurseries and ferneries in Florida.

Assessing health risks of female farmworkers in Florida

Inside the commercial greenhouses of central Florida, farmworkers, mostly young Latina and Haitian women, work in oppressive conditions tending and harvesting plants to be sold in retail stores across the country. The repetitive motion of bending over to cut the plants often causes chronic lower back pain. Skin irritations also are common, resulting from heat and exposure to pesticides and fungicides that the women apply to the plants, sometimes with nothing more than a garbage bag wrapped around their bodies for protection.

"These women are doused in these chemicals because of the direct contact that they have with the plants," explains Valerie Mac 07N FNP 19G, a doctoral student specializing in environmental health nursing. "Many of these chemicals haven't been studied in women of childbearing age, so we don't know the risks for them and their unborn babies."

As part of a four-year study funded by CDC's National Institute for Occupational Safety and Health, Mac works with a team of researchers in Florida to assess occupational and environmental health risks for female farmworkers in four counties. Led by Emory nursing Dean Linda McCauley, the study is providing information to develop an education program to help these women better protect themselves. The study is one of several research projects under way in the Lillian Carter Center for Global Health & Social Responsibility.

More than 260 women working in nurseries and ferneries are taking part in the study. Surveys are conducted by leaders in farmworker communities or who have worked in these settings in the past. This approach, says Mac, is essential to building trust so that the women feel comfortable participating in the study.

Through focus groups and surveys, researchers seek to understand the womens' attitudes and beliefs toward risk associated with their work. Urine samples also are being collected to identify biomarkers of pesticides. Some studies have suggested that repeated exposure to pesticides might be harmful to a developing fetus.

Mac and the team find that women often lack information about the health risks of handling the chemicals used in their work. Safety labeling on the products typically does not describe risks for pregnant women. In addition, employers may not provide appropriate personal protective equipment or adequately train women to minimize their risks.

A key component of the study is understanding how health care providers perceive the environmental and occupational health issues facing female farmworkers of childbearing age. Through interviews with providers working in various clinical settings, the study team learned of the need for doctors and nurses to receive training and continuing education, especially on how to address occupational exposures in the care of these women.

"Some pregnant women work all the way up until the day they give birth," says Mac. "We are buying the plants that these women are producing for us. Thus, we have a responsibility to take care of their health needs and those of their unborn children."

Building teamwork for safe deliveries in Ethiopia

Michelle Dynes

Michelle Dynes is working in Ethiopia to fill a gap in research on teamwork in health care systems. This area of research is relatively new even in Western countries.

That concern is utmost for Emory nursing researchers in rural Ethiopia. All too often, when a pregnant woman goes into labor but starts experiencing complications, her traditional birth attendant, accustomed to working alone to assist with deliveries, doesn't know or feel compelled to call on a skilled health extension worker for help. The woman and her unborn baby later die.

Preventing such scenarios is the focus of the Lillian Carter Center's Maternal and Newborn Health in Ethiopia Partnership (MaNHEP), which partly aims to bring more frontline health workers together to provide safe maternal and newborn health (MNH) care.

Doctoral student Michelle Dynes RN CNM 17G is helping shed light on attitudes and beliefs about teamwork among various cadres of health workers. This information will inform MaNHEP as it works to scale up interventions to build community-based MNH care systems throughout the country.

In rural areas, traditional birth attendants and health extension workers primarily provide care to mothers and newborns. But the disparity in experience, training, and education among these groups necessitates a team approach to safe delivery.

"Each of these groups has something significant to contribute to community MNH care," says Dynes. "Health extension workers have extensive training but lack hands-on experience, while traditional birth attendants have deep experience but lack formal training. Ultimately, the goal of community-level MNH care should be to tap into the knowledge and skills of each health worker group to maximize the quality of health services."

Using an anthropological approach in her study, Dynes found that health extension workers feel that they are a part of MNH care teams and have a sense of strong teamwork. Most traditional birth attendants, however, do not see themselves as team members, even though health workers and families trust them to provide MNH care.

"Without having a sense of 'we are all in this together,' individuals may act only for their own interests," says Dynes. "But if health workers are all working toward a common goal—such as safe delivery—then they will not hesitate to engage with each other."

Dynes describes this belief in a common goal as "oneness," which Ethiopian health workers consider an important element of trust. Tapping into this shared sentiment, she says, could be an effective approach for harnessing teamwork among health workers.

To develop her research, she interviewed health workers on local concepts of trust and teamwork and used the data to design culturally relevant instruments to measure trust and sense of team. Now she is conducting a social network study of 165 health workers from each cadre to gauge their level of trust in each other and identify other factors influencing teamwork. She also is measuring distances between health workers' homes to understand how physical distance influences teamwork.

Dynes' work fills a gap in research on teamwork in health care systems. "Most research on trust and teamwork has been conducted in Western countries and only recently has been investigated in the context of health care," she says. "In addition to guiding MaNHEP, I hope the findings from my study will inform other projects that are being implemented in rural, low-resource settings."—Poul Olson

Table of Contents

Cover of Emory Nursing Magazine