The Burdens of a Heavy Load

Photos Courtesy of Jillian Kadota
Photo: Meeting with local community leaders about the project.
Meeting with local community leaders about the project.

MPH student Jillian Kadota came to UC Berkeley determined to make an impact in the fields of global health and women’s health. Soon after her arrival on campus, she learned of an emerging project that dovetailed her two passions – a study of the health impacts of women in Africa who carry heavy loads of water and food on their heads for long distances – a cultural tradition in developing countries.

Encouraged by mentors Michael Bates, adjunct professor of Epidemiology, Carisa Harris-Adamson, director of the UCSF/UCB Ergonomics Research Graduate Training Program, Sandra McCoy, assistant adjust professor of Epidemiology, and Ndola Prata, professor and director of the Bixby Center for Population, Health and Sustainability, Kadota applied for and won a fellowship from the Center for Global Public Health (CGPH). The award gave her the opportunity to spend the summer of 2016 collecting field data in Tanzania, located in Eastern Africa.

“From there things just fell into place,” said Kadota. Operating from an existing study site led by her academic supervisor, Sandra McCoy, she travelled to Tanzania and began interviewing local women with the help of research assistants fluent in both English and Swahili.

New to African culture, Kadota’s first learning curve was enrollment. She learned, “The respectful thing to do was to speak with the village leader before we set-up camp and started asking people randomly if they would enroll in our study.”

After identifying sites where women gathered – watering holes, markets, and mills where they grind wheat and corn – she starting asking locals, "Who is the village leader of this area?" From there, she and her research assistants went to their homes to ask for their support. “Because of this protocol we were welcomed,” says Kadota. “I think that really played a major factor in our success.”

Photo: Bundles of wood are often carried for long distances.
Bundles of wood are often carried for long distances.

She surveyed 82 women to record what they carried, the method they used to carry their load, and if they were carrying anything else, such a baby. They recorded their weight and height and the weight of their load. Almost exclusively women carried wood, water, or agricultural products in a bucket or bag.

“Then we did a photo and video assessment of their gait and posture with and without the loads they were carrying," reported Kadota. Finally, a subset of the women wore a personal monitoring device that measured their gait, heart rate, the duration of their trip, and other biometric data that identified how hard they were working while carrying their load.

The average age of the women that enrolled in the study was 31 years, but it ranged from ages 18 to 64 years. “There were a number of women that didn't know their age,” noted Kadota. Most estimated they started carrying loads at the age of eight.

They also assessed pain and its impact on daily living. Approximately 61 percent of women reported having neck pain, 48 percent had back pain, 42 percent had knee pain, and 47 percent had feet or ankle pain in the last 12 months. “I brought back the data and showed it to my advisors. They were all just floored by how, in combination with how young on average the women were, just how much pain this represents on a day-to-day basis.”

Kadota is now analyzing her field data to investigate, among other health impacts, a possible link between pelvic organ prolapse and heavy load carrying. A portion of the survey asked about incontinence, pain while urinating and during intercourse, and heaviness and dullness in the pelvic area – symptoms related to uterine prolapse. Sixty-one percent reported pain while urinating. "It was certainly eye opening,” added Kadota.

Before leaving Tanzania, Kadota presented her preliminary findings locally. “It was really special to share it with a lot of the stakeholders in the community that definitely knew what I was talking about.” She learned that, although load carrying is associated with pain, it's also culturally significant. “At watering sites, women gather to talk and socialize. You gather wood with your friends. Even though you have to walk many hours, you do it with the women you associate with.”

When Kadota first went to Tanzania she did not know a soul. “I was the only student there at the time, and I was nervous. But it ended up being, hands down, the greatest learning experience of my time as an MPH student. I made really great friends this summer, and I miss them. Honestly, I can't wait to go back to Africa.”

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