Global Health Blog

Global health and journalism: Meeting the Rwandan Minister of Health
May 9, 2013 by Stephanie Novak
The author and the Honorable Minister of Health of Rwanda, Dr. Agnes Binagwaho, stand in front of Rwandan flags hung in the Brigham and Women’s Hospital in honor of the Honorable Minister’s visit to Boston.

When I first interviewed the Rwandan Minister of Health, Dr. Agnes Binagwaho, I had no idea that one phone conversation would take me to Boston, Hanover, New Hampshire and Washington, DC. A year ago, I was interviewing her for an entirely different story—one about a new exchange program between Harvard Medical School and the Rwandan Ministry of Health that helped train African professionals within the Ministry.

Since I’d studied global health as an undergraduate at Northwestern, I remember that first conversation as being incredibly interesting—I spoke with the Honorable Minister about why it was important for these kinds of exchanges to happen, and how it would help Africans rebuild their countries, which is one of the most sustainable ways to work towards global health goals. But this story wasn’t about her, and our conversation was mainly focused on the benefits of the program about which I was writing my story—not about the role she has played in helping achieve Rwanda’s extraordinary successes in global health after the country’s 1994 genocide.

Nearly a year later, while back at Northwestern pursuing my Master’s degree in journalism at Medill, I started thinking about the Honorable Minister again. After our first conversation, I’d looked at her blog and her Twitter feed, but when a fellow classmate began talking about a reporting trip that she was taking to South Africa over spring break, I revisited all those sites. It soon became very clear to me that I had a great story in front of me—a profile story of the Dr. Binagwaho. I contacted her team, and after many conversations, we decided that the best way for me to tell Dr. Agnes’ story would be to shadow her as she visited the United States to meet with her colleagues at Harvard and Dartmouth about partnerships between both schools and the Rwandan Ministry of Health and then traveled to Washington, DC, where she would be a keynote speaker at the annual Consortium of Universities for Global Health Conference.

As someone who minored in global health studies while an undergraduate at Northwestern, the trip was incredible. I was able to connect with some of the most innovative thinkers in global health, especially Dr. Agnes herself. In a world full of challenges for the global health community, I was awed to witness the optimism from everyone I met. From the initial days in Boston meeting faculty at Harvard and employees of Partners in Health to the final conference in Washington DC that was a meeting of healthcare professionals from around the globe, everyone seemed excited about the possibilities for global health, and I was constantly reminded of the famous Margaret Mead quote “Never doubt that a small group of committed people can change the world. Indeed, it is the only thing that ever has.”

After my trip I headed back home to Chicago where the real work begins. After spending a week with the Minister I had countless recordings of my interviews, her lectures and interviews with people who work with her. After organizing all of these recordings, I’m now working to freelance the story. It’s an exciting process and I can’t wait to see where it ends up!
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NU alum “Engage”-ing Chicago with global health
April 30, 2013 by Lyz Hoffman
Courtesy of Christina Cole

For Northwestern University alumna Christina Cole, graduating with a degree in global health (as well as political science) was not enough—she wanted to continue exploring it. Since last year, Cole has been a part of PIH Engage, an all-volunteer movement from Partners in Health spearheaded by Cole’s fellow alum and PIH’s community engagement coordinator, Jon Shaffer. Since the fall, PIH Engage has spanned to about 50 cities across the country, with local activists aiming to bring greater awareness to global health issues.

Cole is one of those activists. Recently, she talked to the Global Health Portal about her work, what it means for Chicago, and what she’s enjoyed about it so far.

How did you get involved in the local branch of PIH Engage?
I originally became involved about a year ago in the beginnings of the program. The Chicago community was a pilot community. Before the program launched, Jon Shaffer gathered individuals he knew in Chicago to bounce ideas off of us. When the program launched in September, he had more defined roles evolved. I applied to be a community coordinator.

How does the Chicago program work? Is it the city as a whole or multiple neighborhoods?
Ideally we wanted to do multiple communities in Chicago. We realized that building a community of 25 people that came regularly was actually quite difficult. It’s a young professional movement. We meet once a month. The meeting locations vary, but we host them at houses, so there’s a little personal touch. I have a couple other community coordinators, who are all based in Chicago. I met them through this group. I didn’t know them before. Part of the movement is connecting like-minded people. I’ve become really good friends with them, which is nice.

There are national goals for all of the Engage locations, right?
There are national goals, but setting goals for our community was really important as well. It’s also about setting goals for yourself. One of our meetings was about that. Another meeting was about the story of self, about creating your story about why you’re connected to this movement and why are you here. Most community members said they had observations of inequity.

What are the goals for the Chicago program?
In order to be a community member, we’d like you to commit to an advocacy action and be able to fundraise. Our goal-setting meeting we established what we could personally give. We’re volunteering—this isn’t our job. It’s about really being honest with how much hours you could give, because all of this takes a long time. We’re trying to commit to at least one advocacy action per week. Fundraising, we left broad. Advocacy actions: In general, the term advocacy brought to mind more policy-minded actions, and it has developed from there into more awareness actions, such as sharing a TED talk on Facebook, having a conversation about an article with a friend, or tweeting at someone about a certain policy. It’s a really loose term. We wanted people to interpret it the best way they could.

If you had to sum up PIH Engage, what would you say?
It’s a movement to create passionate communities advocating and educating and fundraising around the right to health.

What does community organizing mean to you?
I think truly community organizing, for me it means more of like a grassroots movement to connect equally minded people. I definitely don’t see the downward side. For me it’s more about really creating these relationships with people. Aside from even PIH’s goals here, I’ve created such great friendships and insights into what’s going on in Chicago’s global health community. This has really been an eye-opening experience, seeing people who are 35 and still involved in global health and in what capacity. That’s been great.

This program is all-volunteer, right? Does it intersect with your work?
Everyone’s volunteering. I work at a large PR firm, doing healthcare PR. I work at Edelman and they have a community investment grant, which is an opportunity for Edelman to recognize the work their employees do outside of Edelman. I filled out the grant for PIH, talking about the work I did, and got almost $1,500. It’s really exciting. My worlds are kind of colliding.

Why did you want to be a part of this?
I think I was missing the piece of giving back. Connecting the people was missing for me. Getting on the ground and saying why you’re passionate about something. I have totally seen value in connecting with the people that I’ve met.

Why is this an important thing to do, especially in Chicago?
Something like this doesn’t really exist yet—a group where young professionals can talk about global health. I’ve been looking for this. There’s Northwestern, lots of medical schools, lots of students interested in global health, and a ton of medical students who want to be more involved. Global health is sort of a hot topic right now. We’ve seen a lot of interest.

What has the response been so far? Any negatives? What are the positives?
One negative aspect is just organizing people and realizing that we’re all volunteers and that comes with a lagged response sometimes, which can be really frustrating. It’s about balancing that and also communicating meetings well in advance. It’s all stuff that you have to give and take, because we are volunteers. But there are huge positives. Not only are we talking and communicating about global health, but we’re also finding that conversation starts. The group is constantly expanding. The more people hear about it, the more people want to get involved.
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Offering Culturally Appropriate Solutions to Global Problems: Northwestern SCS Students Conduct Diabetes Research in Palacios, Bolivia
April 24, 2013 by Mary Poliwka
Ashley, Marc, and Brooke outside of Centro Médico Humberto Parra (CMHP)

Brooke Bachelor, Ashley Thorne, and Marc Deheeger embarked on a research trip to Palacios, Bolivia this past spring break to study diabetes. Their research took place at the Centro Médico Humberto Parra (CMHP), a primary care clinic created by Northwestern University physician Dr. Mark Molitch and his wife, Dr. Susan Hou of Loyola University Medical Center. The clinic provides free health care, medication, and health education to about 40,000 residents of communities surrounding Palacios, Bolivia, located about 75 miles outside of Santa Cruz. CMHP is funded entirely by private donations and is the only free clinic in the region.

Q: Why diabetes?

We chose to target diabetes because it is a major public health concern around the world. When left untreated, the condition carries risks of serious complications like heart disease, stroke, blindness, kidney failure, foot amputation, and nerve damage. These partially preventable complications contribute greatly to the morbidity and mortality rates resulting from diabetes.

The community gathered at CMHP to be educated on diabetes

Q: Why did you choose Bolivia?

We chose Bolivia as a place to work with educating patients on diabetes because the incidence of diabetes is growing rapidly in Bolivia, where the estimated number of diabetes cases is expected to double by 2025. A previous study done by NU students showed that this population would benefit greatly from additional education and identified in their time at the clinic that about 11% of the CMHP’s patients have been diagnosed with diabetes in the past.

Additionally, Bolivia is one of the most resource-poor countries in South America and has one of the smallest expenditures of all South American countries on diabetes prevention and care. As we found during our time at the clinic, many patients at the clinic were not aware of the symptoms and consequences of diabetes, and therefore, some did not know they were affected by it.

We learned at the clinic that a diagnosis of diabetes generally occurs when the disease is in its later stages. Of the lucky few that have been diagnosed, only a small amount actually received treatment before they received care from the clinic. The clinic has been instrumental in helping much of the local population be even well controlled.

Our aim was to help patients be more vigilant and aware of symptoms before this chronic disease progresses to its more detrimental later stages.

Q: How did you conduct your research?

Surveying community members & staff

We surveyed 20 CMHP patients over 5 full clinical days. Our goal was to evaluate their knowledge of diabetes and diabetes treatment, to see what current treatment strategies were being employed by patients, and evaluating their educational levels. We found many people could not read and some were nearly blind due to poorly controlled blood sugar levels, making the current diabetes education supplies difficult for some to understand. With many patients, including some newly diagnosed patients with diabetes, we reviewed when, how, and why they were taking certain medications and reviewed potential side effects of these prescribed medications. During these private education/interview sessions with 20 CMHP patients, we found a system that used colored stickers to identify medications made it easier for patients to know what to take at what time.

Q: What are the outcomes of your work?

Brooke giving a powerpoint presentation on diabetes at CMHP

Our final project is an improved medication sheet and general healthy living guide on the back with images promoting healthy eating, exercise, and consequences of diabetes. We included a “how- to” video in Spanish to help educate the clinic staff on this new, more efficient system. We kept in mind efficiency for staff, as they see many patients, but we wanted to make sure all needs of patients were being met. Our idea was to help make a more efficient process for the staff and simultaneously have the material easier to understand for the patients.

Additionally, we did 2 days of group education at the clinic via Powerpoint, complete with samples of a diabetic-friendly version of a traditional dish called “sopa de mani”, or peanut soup. We created the soup using low cost, locally sourced ingredients purchased from a market near the clinic to ensure audience accessibility to these ingredients. We would call our own sopa de mani a success because all the patients ate it all during our presentations! We were so happy to offer this using local and cost-conscious ingredients.

We found it helpful to be at the clinic itself to gain a better understanding of the cultural implications of diabetes as part of the eventual goal of creating a sustainable, effective, and culturally sensitive program to increase prevention and improve outcomes.

Q: Do you have any closing thoughts?

Making friends at the clinic

Our trip came to an end way too quickly. It flew. We had just started to feel comfortable in our new work environment, and we hope to come back to pick up where future volunteers will have built on our projects. We hope that further endeavors at CMHP will involve and continue our work in diabetes education and that the clinic continues to be an educational site for Northwestern University Pre-health Professionals, as this is a mutually beneficial experience for the clinics with which we work and for the patients involved.

[Of note, the clinic is looking for some of the following supplies to be donated. We can collect them locally and send them down with future volunteers. Please contact Brooke at brookebachelor2012@u.northwestern.edu if you or anyone you know would like to contribute these supplies or donate funds for the following materials: otoscopes, pen lights, laptop computer for very busy social worker, lancets, alcohol swabs, blood glucose machines, toothbrushes, condoms, prenatal or general multivitamins, funds for: photocopy machine, new roof for clinic and attached house for staff. ]

For more details on our adventures:

http://centromedicohumbertoparranupp.blogspot.com/
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NU alum gets Fulbright to help make Indian textile factories more eco-friendly
April 12, 2013 by Lyz Hoffman
Courtesy of Ben Shorofsky

Recent graduate Ben Shorofsky came to Northwestern with a passion for the environment. After getting a bachelor’s degree in environmental engineering last year, Shorofsky went on to complete the Master’s degree program of the same field, and earned a certificate in global and ecological health engineering at the same time. In his work for the certificate, Shorofsky worked with an NGO in the Rajasthan region of India last summer to help find solutions to the textile industry’s pollution of wastewater.

He took such an interest in the topic that he applied for a Fulbright grant to continue researching solutions—and he got accepted. Before he leaves for his nine-months-long stint in August, Shorofsky spoke with the Global Health Portal about his work, what needs to be done, and what he is looking forward to.

Q: Why is this especially a problem in India?
A: In India especially, the textile industry is huge. The difference is a lot of that textile industry is for local use.in the developed countries—most of our textile products have been exported. That’s because of how difficult it is to treat these dyes and remove these dyes from wastewater. Where we have regulations, they don’t. In India there’s a decent amount of lack of oversight over the textile industries and now the government is stepping up and saying it’s time to do something. These are all small factories, so it makes it hard for them to afford treatment themselves. They send all their wastewater to a common effluent, central treatment plant and pool their money. But it’s not always maintained to the highest standard.

Q: How is this affecting the environment?
A: It’s an arid environment, a desert. The textile industry is located there because the water’s actually very salty and is good for the dyes in a certain amount. They were able to use that water for a long period of time. But now they’ve extracted so much water that the water table has sunk numerous feet. Nothing lives in that water. Nothing lives in the soil right below that water. It’s black from the dyes. They used to have a yearly cattle sale, where thousands upon thousands of cattle would be brought to the region. It was a huge event in the region, and that has actually died because of a lack of clean water. The farmers know that if their cattle drink from that water, they’re going to die. Certain plant species won’t grow there anymore. It’s very agrarian. But the water is incredibly salty, so it hurts the fields. The farmers are obviously the ones who are hurting the most.

Shorofsky, left, in India last summer
Courtesy of Ben Shorofsky

Q: Is it possible to restore the ecosystem to what it once was?
A: It’s going to take them a long time to actually figure something out and restore their ecosystem to what it was. There are a number of problems. They need to stop polluting. Where we’re stepping in is in trying to push for some low-cost ways to improve the treatment they already have, and methods for alternative treatment that may be better. That’s what I’ll be doing—testing one of those alternatives. The point of that would be to remove some of those contaminants, and have a system that maintains itself.

Cleaning up the river is important. Presently when the river flows—if it flows at all—it’s stagnant. It’s generally flowing green and red. In the United States that would all be dredged to a hazardous waste facility, but obviously they can’t do that. They don’t have the money, resources, equipment, or training. What can happen is a lengthy recovery process for the ecosystem where they flush the water out. And just not polluting it for a long period of time.

Q: Why has this been going on?
A: There are a lot of societal problems that factor into this. There’s corruption; the pollution control board really lacks staff and the ability to control what’s going on. There are roughly six pollution control board staff members for about close to 1,000 facilities. They don’t have the time to really monitor and inspect these facilities. There needs to be more oversight by the government by these industries, especially when it’s been riddled by corruption in the past.

Q: This is bad for the environment. Is it bad for the employees in the factories too?
A: The health conditions there aren’t great. There are dyes that are leaked out all over the place. The facilities are not the best kept facilities. The area hasn’t used that water for drinking for a long time because of the dangers of it. They presently truck in water and set up a reverse osmosis system.

Shorofsky, center, in India last summer.
Courtesy of Ben Shorofsky

Q: How did you feel when you got accepted? Are you excited?
A: This was the only Fulbright I applied for. It was exciting. I think I actually had an interesting conversation about whether or not what I was doing here was enough that I was going to continue this research, but it’s very beneficial for myself and for that part of India. I spent a month there last summer, so I’m pretty used to being outside of the environment I’m used to. Never for this long however. I think it’ll be nice. I’ll put in some roots and some foundation.
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Talking global health equity with NU alum and PIH employee Jonathan Shaffer
April 11, 2013 by Lyz Hoffman
Jonathan Shaffer, in Haiti, visiting patients with community health workers.
Courtesy of Jonathan Shaffer

While a student at Northwestern University from 2005 to 2009, Jonathan Shaffer made his passion for health-as-a-human-right known. For two years, he served as the president of the school’s GlobeMed program, increasing the student involvement threefold and helping to raise more than $12,000 for medical efforts in Ghana. After he graduated with a bachelor’s degree in biomedical engineering and global health, Shaffer became GlobeMed’s executive director and helped the program expand both in the United States and abroad, including in Africa and South America.

For nearly the past two years, Shaffer has been the community engagement coordinator for Partners in Health, a nonprofit organization that strives to provide better health care to impoverished communities both domestic and foreign. Shaffer recently spoke to the Global Health Portal about his work, including the unique program he’s leading to improve the health of people across the country.

Q: What drew you to working for Partners in Health?
A: Partners in Health has been a dream job of mine for a long time. My experience has been really just focused on how to build collective impact and collective effort in global health. How do we think about a broad-based movement that can advance human rights and health for people? What is the role of the average person to advance the right to health?

Q; What are you working on at PIH right now?
A: What I’m doing at PIH now is very similar in a lot of ways to GlobeMed. What we’re trying to do is engage young professional communities, such as churches and universities, and create broad-based structure through which average people can really plug in and work with Partners in Health. It’s a pilot program called PIH Engage. We started this in October. We’ve already grown to more than 50 communities across the country. It speaks to a huge overwhelming grassroots interest in global health. The goal of PIH Engage really is to bring many more people into working alongside Partner in Health through education. We’re raising the profile of health and social justice, working to advocate.

Q: How does PIH Engage work?
A: It’s a volunteer effort. There are 12 regional organizers. They are supporting these communities in their region. Community coordinators themselves are average folks who’ve signed up through our website, stumbled upon us via social media. They have digitally raised their hand and said, ‘I’d like to be involved in this movement for health as a human right.’ We get them going on whatever their community may be. Really what we want is for people who care deeply about global health equity to really have a clear structure and outlet through which to participate in this movement. I think there’s a huge opportunity to imagine a new way for civil society to participate in this movement.

Q: Where is PIH Engage focusing?
A: There is a team in Chicago, a team in Madison, a team in Columbus. The Midwest is really hitting hard for community organizing. People are really excited in the Midwest. There are also teams in Portland, Seattle, and D.C. We need to up the ante in south and southwest. The way we’ve thought about is, ‘Let’s put this out into the universe and see who bites and jumps at this opportunity.’ That’s where we are. It’s a yearlong campaign between October 2012 and June 2013. By the end of June, we hope to have a much clearer sense of what worked, and what didn’t work. We’ll use the summer as a period of reflection and revamping. We’ll re-launch the program in September with the lessons we’ve learned.

Q: What does global health mean to you?
A: For me, I think global health isn’t really enough. I think we need to think more about three words: global health equity. I take the term global to mean anywhere on the globe, including the United States. Global health, to me, is not international health. It’s not about us and them but much more about disparities where they exist. And we have tremendous disparities right here. Take a ride down the Red Line. We have inequitable systems currently. How do we build systems that can reduce and remove unjust disparities wherever they may exist on the globe? We’re working hard to imagine, fund and the ultimately build the systems necessary to remove unjust disparities around the globe.

Q: PIH is headquartered in the Boston area—what’s going on there?
A: Partners in Health exists through sister organizations, and serve and are led by local people. Our program in Boston is PACT, a small project, working to show and demonstrate that community health workers are able to provide much higher level and quality care to people living with HIV in the city of Boston. There are overwhelming barriers that prevent people living in poverty from accessing good clinical care: lack of transportation, opportunity costs of getting to the clinic, and childcare. Over and over again, we see these things. In those contexts, how do you provide good clinical care to those individuals? To us, that’s where community health workers come in. We train them, give them jobs. They go to patients’ homes and watch them every day, make sure they take their medicine. It’s to show that in the setting of a very wealthy country, we can provide good clinical care to poor people.

Q: How would you say this country does in terms of health care?
A: The United States does pretty badly, broadly, in terms of equity of outcomes in terms of health care. We spend a lot, there’s no doubt about that. The percentage of GDP spent on health care is enormous, it’s extraordinary. Why is this the case? You have to look at it in terms of equity. We don’t have health insurance, especially for the poor. There are significant barriers for many Americans. It’s true in Boston, it’s certainly true in Chicago, it’s true in every city in the United States. There are some really incredible lessons that we can be learning from Rwanda, from Haiti, that can be brought and have a ton of value in the U.S.

Q: What got you interested in this field?
A: A few experiences drew me to wanting to work on global health. My parents have had a big influence on me. They’ve always pushed me to think about my own experiences, my own skill set, the opportunities kind of handed to me by their hard work but also by circumstances that I’ve grown up in, and pushed me to really think hard about where to invest my time and energy. My mom was a teacher, and my dad worked for a nonprofit for a long time. I studied biomedical engineering. I chose community organizing and collective activism. My parents set the tone. When I got to Northwestern, a few experiences enabled me to commit to this work. I had an undergraduate research grant to travel to Ghana, and seeing that work—the challenges and complexities… All of those experiences helped shape a way of looking at the world.
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