“The degree will definitely help me as someone from a developing country to get a career in working on Malaria, TB, and HIV” – Henry reflects on the MSc Tropical Medicine and International Health

Henry Za Lal Lian, from Myanmar (Burma), spoke to us about his time studying the MSc Tropical Medicine and International Health (TMIH), our specialised programme for doctors interested in practicing medicine in tropical and low- and middle-income countries. He shared the skills he’s learned, some tips for successful studies and the fun times he has had at LSHTM.

With classmates outside the LSHTM gates

Hi Henry, can you please tell us a bit about your academic and professional background, and why you decided to apply for the MSc TMIH?
After three years of providing family planning services in the most underdeveloped state in Myanmar, I needed a year to cool off and focus on crafting my skills as a medical professional dwelling in wider public health issues. I chose the MSc TMIH at LSHTM, because as a medical doctor, I didn’t want to leave clinical life completely just yet, and still wanted the chance to explore all the international public health tools, skills and knowledge.

Can you talk us through how the programme is structured, and tell us about the teaching on the course?
The first term was for a Professional Diploma in Tropical Medicine and Hygiene. The three months were filled with exciting lectures from people who are actually working on the ground, some of them flying into London just to give us insightful lectures. The lab sessions with Claire and her team on Tuesdays and Thursdays have got to be the highlight of each week. The second and third terms are where you can customise how you want your year to go, with a very wide range of modules to choose from. I steered away from the clinical modules at this point but really it’s up to the students, which is great asset to have in such an intensive year.

Henry wraps up warm in London

What are you planning to do next, and how will the course help in your career?
The degree will definitely help me as someone from a developing country to get a career in working on Malaria, TB, and HIV; in a broader sense, sexual and reproductive health. These are the areas in dire need of development for moving towards the sustainable development goals.

What skills have you gained from the course?
If I had to single out a few, I would have to say reviewing literature, practical research skills, designing a study protocol and designing control programmes.

First day of school

What will you remember most about your time at LSHTM?
I think it has to be my course mates. They’re the smartest lot I’ve seen and I couldn’t help but be inspired by them. Plus, the TMIH course had our own lunchtime frisbee competitions in Russell Square and we also did “On Wednesdays, We Wear Pink”. We had one cricket tournament but surprisingly, it turned out so bloody and rough that we never repeated it!

What advice would you give to anyone considering studying the MSc TMIH?
Personally, it was the most intense educational year for me and I made the mistake of not taking it slow and socialising in the first term. My one piece of advice would be that although it will be intense, engaging and challenging at times, make some time for cooling off, kicking back and relaxing with a good friend or two. Also, communicate with module organisers when you’re at the module fair. The key is in you getting the most out of your year and it all depends on your decisions during that module selection. The main library gets busy quickly by term 2 and 3, but don’t worry – just get your headphones and head over to one of the computer rooms scattered across LSHTM to avoid having to race for a free table in the library!

If you’re considering studying the MSc Tropical Medicine and International Health, you can find out more, register your interest and apply on the course webpage: bit.ly/2o6FpA3

19 September-2 October 2019

LSHTM’s decision to add the names of Florence Nightingale, Alice Ball and Marie Sklodowska-Curie to our Keppel Street frieze – and our video announcing this – appeared on Canadian television, featuring on breakfast show Your Morning.

Jeremy Brown and Ian Douglas’s study suggesting that younger children in the UK school year may be more likely to be diagnosed with depression by 16 than their older peers was covered widely around the world, appearing in the Independent, Evening Standard, the Spiegel Online, the Chicago Tribune, Biobio Chile and elsewhere, appearing in over 450 outlets.

Speaking to the Independent, Ian said: Just 1 per cent of the youngest quartile in a school year will be diagnosed with depression by age 16, and fortunately there is an increasing awareness about mental health as a priority. However, we should focus on reducing the number of children affected.”

Sam Martin features in BBC documentary Vaccine Wars (at 7:56), tracking the online global spread of vaccine hesitancy. Sam said: “When social media platforms stop misinformation on one social network, users spread this information across other networks.”

Sam’s comments also appear in a Daily Mail review of the documentary.

Heidi Larson speaks to the Guardian about a marked decline in childhood vaccination rates in England among many diseases. Heidi said: This is not a blip, but an incremental, persisting decline over multiple years.”

Heidi also appears on BBC Radio 4 (at 13:58) speaking about vaccine hesitancy, and her work on vaccine confidence in the Philippines was cited in Wired and Esquire Philippines stories on dengue vaccine.

James Logan’s comments in a Lancet report on West Nile Virus appear in an Independent story on a case of the virus being reported in Germany. James said: “There is still a bit of a mindset that mosquito-borne diseases tend to be a tropical issue – actually they are coming much closer to home these days.”

Alison Grant provides expert comment in a New York Times story about the challenges of treating and preventing TB. Discussing the low completion rates of drug courses and some doctors’ reluctance to prescribe antibiotics, Alison said: “[Doctors] just stay away from it, despite the evidence showing otherwise.”

Rachel Lowe talks to CNN about setting up early warning systems where dengue is present to help prepare for potential outbreaks. Rachel said: “Climate change is altering weather patterns across the globe…making it harder to predict where epidemics occur.”

Mishal Khan speaks to the Bureau of Investigative Journalism about her work interviewing ‘invisible’ pharmacists in Cambodia, calling on international health organisations and the pharmaceutical industry to provide more support to these informal sellers of antibiotics. Mishal said: “We can’t say you can only access antibiotics with a prescription…there aren’t enough doctors to prescribe and only 1 in 10 people arrive with a prescription.”

Martin McKee’s previous comments on the UK’s “out of step” position on vaping in comparison with other parts of the world appear in a Daily Mail story about vaping-related lung injuries, as well as appearing widely across the regional UK press.

The work of Serge Mostowy and team featured in a BBC story on bacteria ‘stripping off’ in order to evade antibiotics and survive.

Kaye Wellings’ May 2019 BMJ study on declining sexual activity in adults was cited in a Telegraph story about Gucci fashion designer Alessandro Michelle, discussing the role that his ‘demure, geeky aesthetic’ may have played in this decline.

On social media:

This week’s social media highlight comes from Twitter, as we celebrate the School’s 120th anniversary by sharing just five of our innovations since 1899:

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Happy 120th Birthday to LSHTM!

2nd October 2019 marks exactly 120 years since LSHTM first opened its doors to students in the autumn of 1899. We’re going to be celebrating all year in London and around the world with 120 events.

But today we’re asking you, our alumni and friends, to download this #LSHTM120 image (above) and to send us a picture of you holding it wherever you are in the world.  Extra points for making it into a flag and waving it.  Submit your image to us on Twitter or Facebook or email us.

Here‘s your alumni team in London getting into the #LSHTM120 spirit and showing you how it’s done!

Origins of LSHTM on our 120th birthday

120 years ago today, on 2nd October 1899, the School opened its doors to its first students. LSHTM has been celebrating our 120th anniversary with a number of events, more information is on our LSHTM 120 page on our website.

Here is a short history of how the School was established and what happened in our early years.

HMS Dreadnought docked on the Thames

Albert Dock Hospital

The London School of Tropical Medicine, as it was called until 1924, began as part of the Seamen’s Hospital Society and was initially located at the Albert Dock Seamen’s Hospital, in London’s East End. The Society dates back to 1821 and was borne out of the Wilberforce Committee as a charity to help people employed in the Merchant Navy or fishing fleets and their dependants. Their hospital was initially housed in quarantine ships moored on the Thames at Deptford. In 1870 the Society was granted the lease to part of the Royal Greenwich Hospital and set up onshore as the Dreadnought Seamen’s Hospital. In 1890, the Society opened another branch at the Albert Dock.

 

Sir Patrick Manson

The London School of Tropical Medicine owes its origins to Sir Patrick Manson, ‘the father of tropical medicine.’ Manson trained as a doctor at Aberdeen, qualified in 1865 and received his Master of Surgery in 1866. Shortly after his training, he travelled to Formosa (Taiwan) as a medical officer to the Chinese Imperial Maritime Customs. After 5 years he transferred to Amoy where he remained for 13 years. Manson spent much of these years studying filaria and he made important discoveries relating to mosquitoes carrying filariasis and the presence of filariae in the blood stream. Having moved to Hong Kong, after six years Manson retired to Britain in 1889 and set up his own practice in London. During his time abroad as a medical officer Manson had learned about tropical diseases and was frustrated by the lack of knowledge in this field among his peers. In 1892, Manson was appointed physician at the Albert Dock Hospital and began to formulate his ideas for a national school devoted to the study of tropical diseases.

Joseph Chamberlain

In July 1897 Manson was appointed Chief Medical Officer to the Colonial Office. Here he worked with Joseph Chamberlain was a high-profile businessman and influential politician, who was Secretary of State for the Colonial Office during the period of the School’s establishment. In December 1897, a Colonial Office memorandum was circulated to all medical schools on the need for special education and research into tropical medicine. This was followed by a fundraising circular sent to colonial governors, stressing the importance of research into malaria and the need for a school to provide specialised training for Medical Officers. In 1898 the Colonial Office invited the Seamen’s Hospital Society Committee of Management to establish a School of Tropical Medicine in connection with their hospitals.

The School opened on 2nd October 1899 with 27 students enrolled. Its objective was

‘not only to acquaint the student with the diseases of the Tropics and teach him how to treat the various ailments he may meet with but also to put him in the way of investigating tropical diseases, to train him to observe, to record and to study scientifically the great tropical disease scourges’ (Report for 1899-1900)

London School of Tropical Medicine

The proximity of the School to the docks allowed for the immediate admission of patients from returning ships for treatment, and for the observation and study of tropical diseases in their acute stages.

There was one course: the Diploma in Tropical Medicine & Health (DTMH), which ran for three months, with a final exam. Sessions ran three times a year: October to December, January to April and May to July. Over the course, students were taught about the geographical distribution, clinical history, diagnosis and treatment of a large number of tropical diseases and also about hygiene in the tropics. To take the course, it was necessary to be medically qualified, although the School Committee had the power to admit other applicants under special circumstances.

During its first year, 76 students attended the School. Students, both male and female, came from all branches of the profession including Medical Officers of the British and Indian Armies, the Royal Navy, Colonial Service, Foreign Office Service, Missionary Societies, railways, trading corporations and private practitioners. On leaving the School, students worked all over the world, with a large number working in Africa, Asia and the West Indies.

Information from our student registers shows that 24 students enrolled for the 2nd session January-April 1900, including four women:

  • Anne Helen Crawford, 26 from County Derry. She went on to work in Manchuria in Northern China and then in Zenana Mission House, Bombay, India
  • Emily Crook, 24 from County Antrim. She went on to work at the Irish Presbyterian Mission Church in Bombay and then Manchuria in Northern China
  • Maria Sharp,35, who went to work at the Lady Lyall Home, Lahore, India
  • Hon. Ella Campbell Scarlett-Synge, 35 from London. Dr. Scarlett-Synge became a physician to the Emperor of Korea, worked in South Africa, Canada (where she established the Women’s Volunteer Corps) and in 1917 became a Medical Officer of Health in Northern Serbia.

Staff and students, 1901

In the first year of the School, there were 165 cases of tropical diseases admitted to the hospital, including malaria, dysentery, beri-beri, liver abscess, leprosy, guinea worm, filariasis, blackwater fever, plague, Malta fever and hepatitis. As part of the course, students would see cases of the diseases on the wards.

Great and important work was undertaken in the School’s early days, most notably through a number of ground-breaking discoveries and expeditions.

  • Perhaps the most significant of these was the expedition to Italy in 1900 regarding the prevention of malaria. GC Low, Louis Sambon and AJE Terzi,

    Pen drawing by A. Terzi, ca. 1900.. Credit: Wellcome Collection.

    went to the Roman Campagna, near the mouth of the River Tiber, and spent three months from July to October inside a wooden hut in the malaria-infested region. By staying inside the hut from dusk until dawn they all escaped infection.

  • In 1900 G.C. Low, along with Manson and Thomas Bancroft, discovered the emergence of filarial larvae from the proboscis of the mosquito intermediary.
  • Dr. CW Daniels sailed to Calcutta to verify Ross’s 1897 discovery of the mosquito as the transmitter of malaria.

There were also expeditions to work on beri beri on Christmas Island; the study of blackwater fever in Central Africa, and Robert Leiper established the life-cycle of the guinea worm in Ghana.

For further information on the history of the School or to find out more about the LSHTM’s Archives, please contact:

Why neglect of STIs and infertility could be undermining family planning programmes

In a new blog comissioned for BMJ, DEPTH team member Professor Cicely Marston and Dr Suzanna Francis argue that neglect of STIs and infertility undermines family planning programmes worldwide.

Copyright: LSHTM

Why do people still not use effective contraceptive methods?

One reason is that many women and their families in low- and middle-income countries fear the most effective contraceptives can cause infertility.  A conventional response to this is that people simply need more information to put them on the right track – that women who, for instance, are using injectable contraceptives simply need reassurance that any fears of infertility are unfounded.

But what if the risk of infertility in some lower income countries is all too real – but the real cause is hidden? This, our paper argues, may well be happening with infertility caused by undiagnosed, asymptomatic STIs.

Chlamydial infection in particular is an important cause of tubal factor infertility. So infertility caused by undetected, asymptomatic chlamydia may well be widespread in areas where it is prevalent – including among women who have recently stopped using contraceptives.

All of this may contribute to a sense that it is the contraceptives causing the infertility – simply because their use coincides with less or no condom use, and undetected STI infection.

An indicator of the scale of the threat STIs pose to women’s fertility comes from recent work (here and here) in South Africa, showing a major, uncontrolled chlamydia epidemic among young people. It seems reasonable to assume that this problem, and any resulting infertility, is not confined to one country.

Copyright: LSHTM

We hope our commentary will encourage more research into the global prevalence of STIs and the degree to which the associated infertility could be undermining people’s trust in family planning programmes. Counterintuitively it is possible that by addressing fertility problems in programme settings, fertility may even be reduced as more people trust that they can use contraception without experiencing devastating infertility.

More broadly, we call for research and programmes that address women’s own priorities as a starting point to develop sexual and reproductive health programmes that are more attractive and win people’s trust.

To address complex problems, programmes and research must be co-produced with the communities concerned, and break down disciplinary boundaries such as those between family planning and STI prevention and treatment.

Crucially, programmes must address women’s right and desire to control their fertility in the fullest sense – in other words having children when they want them as well as avoiding births when they do not. In high fertility settings, infertility – so often personally devastating and socially stigmatising for the people affected – may not even be considered a problem by funders. This needs to change.

Copyright Daniel McCartney

by Cicely MarstonDEPTH research group (Twitter), and  Suzanna Francis

This post was first published online at BMJ Sexual & Reproductive Health on September 26 2019.

You can read the full paper here in BMJ Sexual & Reproductive Health, open access and free to read: Neglect of STIs and infertility undermines family planning programmes

Alumni Innovators: Carlos Chaccour

LSHTM alumnus Carlos Chaccour studied for his MSc in Tropical Medicine and International Health in 2007/2008. He is Chief Scientific Officer of the BOHEMIA project, Assistant Research Professor at ISGlobal, Barcelona Institute for Global Health, visiting scholar at Ifakara Health Institute, Tanzania and Associate Professor at Universidad de Navarra, Spain.

“After a few years of clinical practice in the amazon region of Venezuela, I realized that I needed more than just field experience to make a difference for the people I was working for. So when the NGO I was working for offered to pay for the tuition of my MSc, I started to look for tropical medicine courses and LSHTM was the stand-out choice. It had the history, the leadership, the location and the recommendation of my friends. It was an easy and fortunate choice.

I had a medical degree from Venezuela and three years of experience working in indigenous communities. I had seen and managed a good share of “tropical” diseases. LSHTM gave me structure, method and a global perspective to public health problems. It was a humbling experience for a young (and cocky) MD.

LSHTM was definitely the start of my research career. Using ivermectin to kill malaria vectors was my MSc project, later turned into my PhD and has recently resulted in a key Unitaid grant to fully develop the idea from evidence to global access.”

What does innovation mean to you?

“Innovation can solve challenges in global health. Simple ideas bring new light. We must push our limits to come up with scalable solutions, many lives depend on us doing so. Global health is a formidable challenge with room for new light in many aspects, from molecules to funding mechanism. The world however, is not often kind to new ideas, this new light needs savvy advocates to open the windows for it.

Malaria is a very complex problem. The parasite and the mosquitoes are in constant evolution, sometimes at a truly accelerated rate that causes pushbacks. I work with a drug that kills mosquitoes that could complement efforts to eliminate malaria. Hopefully this approach will be simple enough to be scaled up and contribute to ease malaria-driven suffering.”

Do you have any advice for current students?

“Persistence is the true force behind positive change in this world.

If you know that you can make a difference for the good of those in need, do not let setbacks along the road to stop you for long.”

“The best outcome of my year at LSHTM was meeting my wife. Julie, now Chaccour then Oetzel, (Immunology of Infectious Diseases 2007-2008). We have been married for 10 years now and have five children. A completely undeserved turn of events for a cocky young MD.”

For more information on BOHEMIA please visit http://www.bohemiaconsortium.org/

AMNET at ECTMIH 2019

AMNET’s abstract, titled “CNS INFECTIONS IN AFRICA : EPIDEMIOLOGY, DIAGNOSTICS, AND TREATMENT IN 2019” was chosen for an Organised Session at the ECTMIH 2019 Conference from 16 – 20 September 2019 in Liverpool, UK.

Network CHAIR, Professor Mosepele Mosepele and Steering Committee Member, Dr David Lawrence attended the conference on behalf of the Network and gave a stellar presentation.

ECTMIH brings together more than 1,500 scientists and experts from across the world and provides a platform for sharing research and innovation in the field of tropical medicine and global health. We are excited to have been a part of this excellent conference!
More on ECTMIH here.

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2nd AMNET Face-to-Face Meeting, Cape Town, July 2019

The 2nd African Meningitis Trials Network Face-to-Face Meeting was held on the 09th of July in Cape Town, South Africa at the University of Cape Town (UCT).

The meeting brought together researchers and practitioners from the AMBITION study sites in the same physical space for discussions and collaboration on Network Deliverables. The 1 day meeting made it possible to develop activities to address next steps for the Network.

Network members met to review milestones achieved and specifically;

a)Reviewed AMNET’s deliverables in the 4 years of the AMBITION Trial.
Members looked at progress made on the 2 key projects undertaken thus far (the Situational Analysis and the Meningitis Aetiology Project), shared updates and challenges from all sites, and discussed ways to harmonize information collection.

b)Discussed the legacy of AMNET, ways to boost its exposure and grow its membership. Members encouraged junior investigators from across the sites to apply for grants, especially  EDCTP applications or Wellcome Trust Fellowships.

c)Discussed the Network’s upcoming project – IRB/Ethics Liaisons & Standardized Templates For Future Trials – and timelines for completion.

The level and diversity of discussions resulted in an effective, successful and productive meeting.

Click here to see the meeting agenda and a gallery of pictures!

The 3rd face-to-face meeting will be in June 2020 in Uganda! Look out for the dates!

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National Fitness Day

25th September 2019 is National Fitness Day, where people participate in yoga and pilates classes, treadmill challenges, “plank-offs”, dance-offs and group walks in a spirit of fun and celebration. National Fitness Day seeks to highlight the benefits of being active for individuals, communities and society as a whole.

Books in LSHTM Library about fitness and its role in public health are found on the east wall of the main Reading Room, shelved in classification SK.


Strong beautiful modern by MacdonaldStrong, beautiful, and modern : national fitness in Britain, New Zealand, Australia, and Canada, 1935-1960” by Charlotte Macdonald. (Vancouver : UBC Press, 2013)

Classmark: SKF.D 2013

Describes what led governments in the 1930s and 1940s to decide that their citizens must become more healthy and active, and what the subsequent waves of national fitness programmes achieved.


McKenna Perspectives on health and exercisePerspectives on health and exercise” edited by Jim McKenna and Chris Riddoch. (London : Palgrave Macmillan, 2003)

Classmark: SKF 2003

Investigates the relationship between health and exercise, looking at topics such as how much and what type of exercise is beneficial, barriers to being active, and promotion of physical activity through schools.


Weinberg Foundations of sportFoundations of sport and exercise psychology” by Robert S. Weinberg and Daniel Gould. 3rd ed. (Leeds : Human Kinetics, 2003)

Classmark: SKJ 2003

Covers psychological concepts relating to sport and exercise, such as competition and cooperation, burnout and overtraining, and character development and sportspersonship.


MacAuley Evidence-based sports medicineEvidence-based sports medicine” edited by Domhnall MacAuley and Thomas Best.  2nd ed. (Oxford : BMJ Books, Blackwell Publishing, 2007)

Classmark: SKF 2007

Uses evidence from systematic reviews and controlled trials to inform the management of acute and chronic sports-related conditions and strategies for injury prevention.


Biddle Physical activityPhysical activity and psychological well-being” edited by Stuart J.H. Biddle, Ken Fox and Steve Boutcher. (London : Routledge, 2000)

Classmark: SKJ.PX 2000

Looks at the relationship between physical activity and mental health, and the role of exercise in the promotion of psychological well-being.


Bouchard Physical activity and healthPhysical activity and health” edited by Claude Bouchard, Steven N. Blair and William Haskell. (Leeds : Human Kinetics, 2006)

Classmark: SKF 2006

Describes the role of physical activity in preventing disease and enhancing quality of life, and provides an overview of research findings and limitations.

 


Top image from National Fitness Day.

Book cover images from Amazon.co.uk.

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Gender quotas: Foe or friend for health leadership?

By Kui Muraya, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya

My colleagues and I recently published a paper discussing the experiences and career trajectories of male and female health managers at sub-national level in Kenya. The published data was collected through in-depth interviews with sub-county level managers. What was striking to me in conversations with these individuals was the influence of the so-called ‘2/3 gender rule’.

What is the 2/3 Gender Rule?

In 2010, Kenya, promulgated a new ‘gender-sensitive’ constitution that moved the country from a centralized to a devolved system of government with 47 semi-autonomous counties, and the decentralization of many functions to county level including health functions. The new constitution explicitly references gender representation in leadership spaces stating that “no more than two-thirds of the members of public elective or appointive bodies shall be of the same gender”, (i.e. the ‘2/3 gender rule’). Although the law does not make explicit reference to women, given the prevailing dearth of women in leadership positions both in the legislature and in the public service, it has in effect been interpreted to mean that there should be at least 1/3 female representation in the various government leadership bodies and agencies. This law applies to all sectors and directly impacts on all national ministries, counties and sub-counties. It has also been embedded in the human resource and diversity policies of the Public Service Commission, which in turn impacts on the public workforce including in the health sector.

Use of Quotas

The use of quotas is not unique to Kenya and is a common strategy that many governments and institutions put in place to increase the proportion of underrepresented groups – in this case women in leadership spaces. In addition to raising consciousness of female representation and engagement in leadership spaces, quota systems have been observed to have additional positive societal benefits including in low-and middle-income countries (Beaman 2007, Burnet 2011, Bauer & Burnet 2013, Bhalotra and Clots-Figures, 2014). Nonetheless, they can potentially deflect from more nuanced examination of gender barriers such as social and structural factors that impede equity, as the focus is primarily on gender parity in terms of numbers. In our work in Kenya for example, gender was not explicitly identified as having any influence on leadership experience or career progression with one respondent (drawing on the 2/3 gender rule) stating:

“[Gender] is not even a side issue. . .it’s a non-issue. Both our CECs [county executives for health] so far have been ladies. . .I do not think it’s an issue for our department. If you look for example at the balance of our [management] team, we have about 5-6 females from a team of about 17.”

However, closer examination of responses in the Kenya data revealed that gendered factors played an important role. Most fundamentally, women’s role as child bearers and gendered societal expectations including child nurturing and other domestic responsibilities can influence their ability to take up leadership positions and their selection and appointment as leaders. Concerns around maintaining a work–life balance were primarily raised by female respondents, with many stating that they sometimes struggled to juggle between full-time work and domestic responsibilities. These gendered influences were then seen to intersect in relatively invisible ways with other factors more readily identified by respondents to influence their progression and experience. The most dominant of these factors was professional cadre, with medical doctors more likely to be selected into leadership roles, and whose career progression was well-defined and distinct from other health cadres. Preferential selection of medical doctors could also result in unintended gender inequity in health leadership, given that the medical profession in Kenya was historically a male-dominated field, with women mostly being in health professions such as nursing. Although there has been a gradual shift with equal numbers of men and women now getting into medical school in Kenya, it is less clear whether this has translated to better gender-balance in higher level categories and decision-making spaces.

Conclusion

This illustrates that gender quotas can be a double-edged sword. Whilst they play an important role and should be cautiously encouraged; their focus on numbers have the potential of crowding out recognition of, and discussion around, other important barriers that hinder gender equity. As such, implementation of quotas should be done in tandem with other strategies that enable women to take up leadership positions whilst still managing ‘domestic obligations’. These strategies can include family friendly policies that for example institutionalize: adequate maternity and paternity leave; flexible working hours and breastfeeding-friendly spaces that enable a smooth transition back to work post-maternity leave; requirements for on-site or subsidized child daycare; allowing work away from the worksite e.g. working from home and so on. More importantly, in contexts such as Kenya where there is still a prevailing belief that “a woman makes the home”, resulting in the disproportionate over-burdening of women with childcare and domestic responsibilities; we need to start engaging in conversations that challenge these gendered norms with the hope of more transformative changes. As one my favourite authors Chimamanda Adichie Ngozi aptly put it: “Policy is important, laws are important, but changing cultural norms and mindsets matters even more…” I personally look forward to a day in Kenya when both men and women will make the home!