Notes from the Field: Exploring the global field experience

Lucy Cosgrove, Marie Wilson, and Julia Shumway (left to right) with some residents of a shantytown called abatey.

They are bright, curious, and determined—in short, they have what the world needs in budding public health professionals. This summer for their required field experience, many second-year MPH candidates took these qualities far afield; others used them closer to home.

Thirteen students jumped into a foreign culture. Although they prepared for that leap in their classes, they had to think creatively and improvise once on the ground. As Maternal and Child Health student Julia Shumway puts it, “we learned as we went along.”

Their education was enhanced by the wisdom of local people and of seasoned colleagues. And their time abroad left these students even more committed to the public health path. Many of the following quotes come from the students’ blogs at advances.umn.edu/f11/notes. On that site, you can read more about their travels and about the best way to eat a mango, the beauty of Uganda’s Sipi Falls, and Chinese hospital pharmacies.

The Geneva connection

The World Health Organization (WHO) is such a significant force in global health that Melissa Mueller doesn’t think “anyone can intern at WHO and not have it impact their future studies or career plans.” In Geneva, Mueller focused on a paper describing the bacterial infection leptospirosis identified during an outbreak of pneumonic plague in Africa. Using WHO data and guidance from her preceptor, Mueller continues to collaborate on the paper.

“Writing a scientific paper for a leading health journal has been a huge challenge,” she says. “When published, it will be my greatest professional accomplishment from this field experience.”

Joining her at WHO was Spencer Rudolf. He interned with the Health Action in Crisis Cluster, where he analyzed post disaster assessments and made recommendations for future reports.

What surprised them both was discovering that WHO is not above the political and financial challenges faced by any nongovernment organization or non-profit. But as support from donor nations declined and morale dropped at WHO, Rudolf noted that “team functionality remained intact, even in the midst of the Horn of Africa [drought] crisis, conflict in Libya, and ongoing [humanitarian] efforts in Côte d’Ivoire, Democratic Republic of Congo, and Liberia.”

Providing a better start

The slums of Mumbai could hardly be further from the glittering city of Geneva. When Molly Emerick arrived, they were almost too much for her. It was hard to reconcile the conditions in wealthy parts of the city, where she lived, with those in the slums, where she worked in a Teach for India school. (Teach for India puts committed Indians into poverty-stricken areas for two-year teaching fellowships.) At this school, children were often tired and many were consistently absent because of illness. Malnutrition was considered the culprit.

Emerick implemented three interventions for a class of 8- to 11-year-old children that she hoped might make a difference: health education, vitamin supplementation, and parent education.

“After speaking with students and their parents, it was evident that both were unaware of the nutritional value of the food they consume,” she says. The stakes are high for Emerick’s research—if data show that these interventions improve school performance and attendance, the children could continue to receive vitamin supplementation. What’s more, the nutrition awareness materials and parent/student curriculum she helped create could be used in the entire school and perhaps in Teach for India schools throughout the country.

Nurses are crucial for success Avantika Chaudhary worked in Beijing at the Dong Fang Hospital, which practices both traditional Chinese and Western medicines. Her challenge was to find a way for this inner-city hospital to attract more patients. After nearly three months of research, she concluded that it should strengthen and develop its nursing department.

“In my opinion, the majority of the care is imparted by nurses, and they can greatly affect a patient’s perception of the hospital,” she says.

Chaudhary found that nurses in China work long hours, are poorly paid, and stay on the lower end of the hospital hierarchy. With few opportunities for promotion or recognition, they feel unappreciated. Chaudhary introduced Dong Fang to the international Magnet Recognition Program that sets standards for first-rate nursing care and awards accreditation for meeting those standards.

“I don’t know if Dong Fang will be able to make its Magnet journey in the near future, but I am going to do my best to introduce them to the value in implementing some of its nursing standards,” says Chaudhary.

Changing long-held behaviors

Colin Gerber is using a tippytap, a hand-washing device that can be built in about 10 minutes from bits and pieces found around a village.

When Colin Gerber arrived in Bulamagi, Uganda, he found “almost no latrines, no trash pits…no taps for hand washing; people using unprotected wells…no one using mosquito nets; and water treatment pills unavailable at local stores.”

Gerber was there with the Uganda Village Project, a rural community health improvement organization. As the water and sanitation resource person, one of his jobs was to go house to house doing surveys. “I learned such valuable phrases as ‘Katulabe ku toi-yo?’ that essentially translates as ‘May I see your toilet?’” Gerber says. “On such ground is international understanding built.”

He also conducted “sensitizations,” or learning sessions, to introduce new healthy behaviors. He occasionally got glimpses of success.

“I went back to schools where we conducted hygiene days to verify the presence of a second tippy-tap and to see how the students used them,” he says. “In both cases, they swarmed over the taps to wash their hands. At one school, the sanitation prefect, a hard-working teenager named Robert, had redesigned our tippytap to make it sturdier and less likely to fall down. It’s little signs like these that make this work worthwhile.”

The effort to do what’s best

Lucy Cosgrove, Marie Wilson, and Julia Shumway got their field experiences in the Dominican Republic with the Batey Relief Alliance (BRA). BRA serves impoverished people, mostly Haitians, who live on the Haiti/Dominican Republic border in former sugar cane plantation shantytowns called bateyes.

The three of them visited homes to survey water quality, sanitation, and skin and diarrheal diseases. Cosgrove speaks Spanish, so she asked the questions; Shumway and Wilson took notes on the dwellings and their surroundings to help make associations between the environment and illness. Eventually, they created a profile of community health and living conditions in the batey communities.

Given the hardships residents face, their efforts to adhere to the advice of community health promoters made an impact on the three students.

“[Batey residents] followed the best practices of chlorinating their drinking water and taking time and care to assure their children’s produce was washed from clean sources,” says Cosgrove. “They used their knowledge to control potential dangers to their families’ health.”

Trusting her intentions

On her way to Sulaco in north central Honduras, Therese Genis thought about the ethics of international volunteer service. It had been a topic in three of her SPH classes, especially when discussing a 1968 talk by Ivan Illich called To Hell with Good Intentions. Illich maintained that Western volunteers in developing countries do more harm than good and disempower local people.

Genis was never quite sure what to think about his ideas, but when her group arrived at its hotel, community members surrounded the volunteers. “They embraced us, fed us, and told us how happy they were to see us,” says Genis. “And in that moment, my good intentions felt right.”

In Sulaco, Genis served as public health support for a four-year endeavor by the University’s chapter of Engineers Without Borders to improve the water system for nine communities in rural Honduras. She conducted hands-on conservation and sanitation seminars and explained how a municipal water system works, all the while developing a love of the place, with all its quirkiness.

“The other night, one of the engineers and I started playing a ‘how many unusual things will walk by the front door’ game,” she writes in her blog. “We had a piglet, a 2-year-oldgirl by herself, a three-legged dog, a chicken, a small boy on an adult-sized bike with two other kids chasing him, and a cow. Come to think of it, I guess none of these things is actually that unusual here in Sulaco.”

Old cloth, new purpose

Kate JohnsTon about to demonstrate how to brochure. use kanga cloth to purify water.

Like many SPH students, much of Kate JohnsTon’s work in Tanzania, as part of a Pennsylvania State University project, revolved around clean water. Knowing that sari cloth could filter out the plankton that cholera bacteria attach to, she showed villagers how to fold local cotton kanga material to get the same results. She also presented other options and their relative value in protecting against cholera infection. JohnsTon says that her first year at SPH gave her “new ears” as she explored the public health situation in the Pwani region along the Indian Ocean. “For example, when I was talking to a doctor about the unintended consequences of mandatory HIV testing, I had [SPH professor] Lynn Blewett on my shoulder saying ‘pay attention, this is where policy meets practice,’” she says.

Kate found something else new, and unexpected, during her stay—total acceptance by the Tanzanian people.

“I had always been told that as a mixedrace person, I needed to be clear that Africa wasn’t ‘my’ country, and I didn’t belong there—usually while also being told to go back there, because I wasn’t allowed to claim America either,” she says. “What struck me most in Tanzania was that people my age and older would simply ask me, in all sincerity, ‘Why don’t you come home? This is your place.’”

Building trust

Jessica Vig went to Sierra Leone to develop, implement, and monitor a maternal and child health curriculum for school-aged girls. Doing this kind of work with girls in America would be hard enough, but Jessica found a way to relate to these students half a world away.

“[I became] a trusted adult to whom they could ask questions, share information, and exchange ideas,” she says. “[This connection] was my greatest accomplishment and the thing I will miss most in leaving.”

The girls were in the Young Scholars of Sierra Leone Program that is part of West African Medical Missions. In family planning discussions, Vig was surprised to learn that the girls were unaware of readily available self-administered pregnancy tests. By not getting early confirmation of a pregnancy, they missed out on essential antenatal care.

As in many of the countries SPH students visited, relationship building is crucial in Sierra Leone. “Without the support of key stakeholders, nothing will move forward,” Vig says. “Earning trust and support is the first priority before any other steps can be taken to improve the health of a community.”

Communication is vital

When Myah Walker arrived in Nigeria, she was struck by the magnitude of environmental health issues.

“The sewage system was one of the most apparent hazards,” she says. “It consisted of shallow trenches along each side of the road where urine, feces, rainwater, etc., would run. There was no drainage system for these trenches. Either the contents would slowly seep into the earth or overflow into the streets during the rainy season.”

Walker worked with the African Community Health Initiative (ACHI), which conducts clinics and provides health education in poorly served rural areas. After learning the challenges of this effort, she devised ways that ACHI could be more organized and efficient, then worked to convey her ideas to her Nigerian partners.

“It took me the entire trip to begin to master a more effective way of communication, but I will be well prepared for my visit next year,” she says.

Walker’s final project for graduation will involve recommending improvements for ACHI’s 2012 intern program and designing a maintenance protocol for patients between clinic visits.

Lessons learned in Pacuan

What surprised Denice Tracy most during her field experience in Pacuan, a small mountain village in the Philippines, was how the people there guage their well-being.

“They measure their wealth in the relationships they have,” says Tracy. “Even though they are extremely poor and very hard working, they would never hesitate to share their time, food, and small gifts.”

As an RN and an MPH candidate, Tracy examined four areas during her field experience, among them was occupational health and safety issues for health care workers.

Tracy spent time with Lilibeth Bulabon, a midwife who works for the Filipino government, and discovered that she and her co-workers had no plastic gloves, and it was hard for them to properly dispose of used needles. Fortunately, Tracy had brought along 12 boxes of gloves and 500 special syringes, where the needle retracts after an injection or a blood draw.

Arriving back in Minnesota, Tracy found herself inspired by the people she met in Pacuan and vowed to “spend more ‘in-person’ time with my family and friends.” And she has started to do what other students found essential in the cultures they experienced: To acknowledge every person you pass, to smile, and to say hello.