Laura Ruch

  1. Can We Craft a Livable Future? – Reflections From the Unite For Sight Conference

    May 7, 2012 by Laura Ruch

    Recently, I visited Connecticut for the first time to attend the annual Unite for Sight Global Health and Innovation Conference at Yale University. If you cannot already tell by the title, the conference covered an extremely broad range of topics – maternal and child health, design and architecture, social media and marketing, health policy, photography, and on and on. By the end of the weekend, I felt rather overwhelmed by the sheer scope of the ideas that I had been presented with. However, one session particularly stood out to me, perhaps because it touched on an issue I have limited knowledge of, yet one that plays a role in many of the most pressing matters of today’s world. It undoubtedly has broad implications for global health. The session discussed “hunger and food,” and admittedly, I chose it over the others because it was the final session of the weekend, and I just wanted to hear about something that was “basic” and “easy to address,” given my exhaustion level. But despite the often-mentioned fact that the world already produces enough food to feed everyone – if only distribution could be evened out – food and hunger issues remain complex, and food production practices, particularly in this country, have a lot of scary consequences for the wider world.

    My favorite speaker of the three in the session was Dr. Robert Lawrence, a professor of environmental health sciences, health policy, and international health and director of the Center for a Livable Future at the Johns Hopkins School of Public Health. He really got me to step back and ask, “Why does food production so often have negative impacts on the environment and on our health? Can this be changed?” I’d say the answers to those two questions are 1) because people have simplified the process – prioritizing product yield and ease of production over protecting consumers and the environment as a whole. Also, governmental policy has over and over promoted harmful food production practices. And 2) Yes, this can absolutely be changed.

    Here’s a list of some sobering facts related to food, health and the environment that I learned at the conference as well as some follow up reading:

    1. Most of the world’s poor are farmers, and most of them are hungry farmers. About 1.3 billion people are small farmers (World Farmers Organization), cultivating less than five acres of land. Farming is by no means a lucrative profession, in wealthy countries and poor countries alike. Farmers depend on an immobile landscape, and the globalization of food has prioritized large-scale producers of cheap, ‘efficient’ food. Farmers have been repeatedly encouraged to engage in harmful practices in order to make a decent income.

    2. Pastures now occupy 70% of previous forested land in the Amazon in Brazil, and feed crops cover a large part of the remainder (Livestock’s Long Shadow: environmental issues and options). The majority of that land farms soybeans, which are not a traditional crop in South America, and are mostly used to meet the demand for soy from China. To get an even broader picture, about half of the land on earth is devoted to farming today.

    3. The loss of species is estimated to be running 50 to 500 times higher than background rates found in the fossil record (Livestock’s Long Shadow: environmental issues and options).  To me, this is simply terrifying. As someone who studies biology, I’m well aware of the often hidden benefits and dependencies species have on each other. When a handful of species disappears, the whole ecosystem suffers, and often in a way that can’t be foreseen. A lot of today’s food production, particularly meat production (and production of livestock feed) uses practices that directly contribute to this species loss, including deforestation, land degradation, pollution, climate change, overfishing… you get the picture.

    4. Global demand of meat and cereal production will largely increase as populations increase in the developing world (the Soil Association). Despite a predicted future decline in the rate of growth of consumption of meat, it will not be enough to offset demand from population growth, and overall there will be a large increase in production. That means that the  environmental impact per unit of livestock production must be reduced by a similar proportion, just to avoid increasing the level of damage beyond its present level.

    5. Agriculture is the largest user of water, accounting for 70% of total freshwater use (Stockholm International Water Institute).  Already more than one billion people do not have sufficient access to clean water. Under a “business as usual” scenario (Rosegrant et al., 2002), global water withdrawal will increase by 22% in 2025.

    6. Policy makers are slow to respond to harmful practices. Environmental laws and programs are usually put in place only after significant damage has already occurred. The focus continues to be placed on protection and restoration, rather than on the more cost-effective approaches of prevention and mitigation. Perhaps this is partially because policy makers don’t realize how important these issues are to the public. I think that my peers, or just people outside of the political realm in general, tend to overlook the power of their political voice. Simple things such as writing a letter to a representative can have a big impact (another thing I learned at the conference).

    7. These issues are about more than just hunger and the environment – they are issues of security as well. By increasing the scarcity of natural resources such as land and water, environmental degradation increases the likelihood of violent conflict, particularly when there is a lack of governing institutions… A Pentagon report (Schwartz and Randall, 2003) suggested that global warming could prove a greater risk to the world than terrorism and could lead to catastrophic droughts, famines, and riots (Yet I wonder how much money has the Pentagon spent since 2003 on fighting terrorism versus address global warming…).

    8. The livestock sector is responsible for an estimated 51% of greenhouse gas emissions measured in CO2 equivalents. This is a higher share than transport (Worldwatch Institute). Virtually every step in the production of livestock contributes to climate change and/or air pollution. These include the livestock respiration, burning fossil fuel to produce mineral fertilizer, methane release from fertilizer and manure breakdown, land degradation, and fossil fuel use during feed and animal production, not to mention production and transport of processed and refrigerated animal products.

    9. Animal foods, as they are produced today, pose a risk to human health. Directly, they can lead to infectious disease. Animal foods are susceptible to pathogens (E. coli, for example) and they often still have chemical residues by the time they make it to a dinner plate. About 75% of recent emerging diseases are zoonotic (passed from animals to humans), according to the CDC. In an indirect way, animal foods (although this is true for other foods as well) increase human exposure to infectious disease due to climate change. Diseases such as malaria, dengue fever, and schistosomiasis are on the rise as the planet warms.

    10. Meat is often times deceptively cheap. Much of the cost of meat goes into externalities – soil degradation, water use, and greenhouse gas production. How much would a McDonald’s hamburger cost if the pricing of land, water, and use of waste sinks were taken into account? What if there were no subsidies that directly encouraged livestock producers to engage in environmentally damaging activities?

    11. “The food system is run by people who know nothing about health, and the health system is run by people who know nothing about food,” says Ken Lee of Lotus Foods (see below). We cannot keep pretending that the obesity epidemic and the increasing incidence of heart disease, diabetes, etc. in this country and most others can be solved solely through behavior change at the consumer level. It will require changes at the source of the issue — in food production as well and in the policies that govern food production, pricing, and distribution.

    Despite the seemingly onerous task of addressing any of the above issues, there are already many individuals involved in the effort to make food production healthier for people and the environment as well as more sustainable. Here are three examples of cool organizations and what they are doing to change the face of agriculture:

    1. Lotus Foods: Ken Lee, co-founder and co-owner of Lotus Foods, introduced his company’s business model, which uses sustainable agriculture practices. Lotus provides exotic rice varieties to small family farms in remote regions of the world, including Bhutan, Bangladesh, China, and the US. Since these heirloom rice varieties are very unique, the global marketplace for them is large, particularly given the superior quality, taste, texture, aroma, color, and nutritional value of some of the rice species. Lotus farmers use a methodology known as “System of Rice Intensification (SRI) or “One Crop per Drop”, pioneered by Cornell International Institute for Food, Agriculture, and Development (CIIFAD) in the mid-1990s. This method of farming reduces the amount of seed, water, chemicals, land, and labor needed to produce a given quantity of rice, and it produces healthier soil, and therefore healthier rice, at a lower cost. Read about SRI here. I really love the way that Lotus sums up the work that they do and their ultimate goals, “Eradicating poverty and promoting social and economic justice has to start with agriculture and it has to be accomplished in a way that protects and restores the natural resources on which all life depends. At the crux of this challenge is rice, which provides a source of living to two billion people, most earning less than $200 a year.”

    2. One Acre Fund: Tony Kalm, director of business development, introduced the One Acre Fund, an incredible organization that is changing the lives of “one of the largest groups of ‘forgotten poor’ in the world.” Concentrated on one-acre subsistence farms in Sub-Saharan Africa, the One Acre fund serves small-scale farmers and uses markets to achieve poverty eradication. Their ultimate goal is to make farmers more prosperous. One Acre Fund empowers and educates local farmers, provides environmentally sensitive seeds and fertilizers, facilitates crop handling and storage, and pays farmers in the event of crop loss due to drought or disease. The organization releases performance reports every six months; in the most recent report (fall 2011), 77% of their field costs were covered through farmer repayments on low interest loans. Today they serve 75,000 farm families in Kenya, Rwanda, and Burundi.

    3. The Center for a Livable Future: Directed by Dr. Robert Lawrence, the Center for a Livable Future (CLF) at Johns Hopkins School of Public Health was founded to address the interlocking relationships of diet and health, agriculture and the environment, food equity, and population issues. CLF aims to increase knowledge about these interconnections ‘in order to influence public policy toward more equitable and sustainable systems.’ CLF encourages public health professionals to collaborate and share discoveries to ultimately influence policy. They also raise awareness among individuals and institutions about environmental issues through classroom education as well as public events to ‘effect individual behavior and stimulate societal changes.’ The center puts out a list of research and program ideas for students that could make for some awesome independent study or summer research projects!

    As a recent Northwestern graduate with a degree in biology and global health, I’m left wondering why these issues were if anything a sidenote in my undergraduate coursework. I’m also wondering why my fellow students aren’t more up in arms about these harsh realities. Even more importantly, I’m wondering why I’m still not even sure how I fit into a solution – what I can personally to do be a part of the necessary change as someone who will be going into medicine and not public policy. I think it’s time that food production issues were discussed across departments rather than limited to environmental science and engineering. I know that creating renewable energy sources, a more sustainable environment, and new approaches to global health are all focuses of the 2011 Northwestern strategic plan, and I’m eager to see how the university will increase awareness among students, shaping future leaders who will be a part of the solutions to these urgent problems.

    Note: This post has been edited for accuracy. Many thanks to Jeff Anhang from the Worldwatch Institute for providing some helpful resources. Check out this report from Forbes about an analysis by Jeff Anhang and Robert Goodland if you’re wondering how you can be a part of the solution to climate change. 

  2. Dr. Evan Lyon on current projects at Partners in Health

    March 9, 2012 by Laura Ruch

    “Whatever it takes. Just as we would do if a member of our own family—or we ourselves—were ill.” This mindset lies at the heart of the mission of Partner’s in Health (PIH), a Boston, MA based non-profit health care organization founded in 1987 by Dr. Paul Farmer, Ophelia Dahl, Thomas J. White, Todd McCormack, and Dr. Jim Young Kim. On Thursday, March 1, 2012, Dr. Evan Lyon of PIH spoke to a class of undergraduate and graduate students enrolled in Prof. Michael Diamond’s “Managing Global Health Challenges” course.

    Dr. Evan Lyon - photo courtesy of the Media Co-Op (http://www.mediacoop.ca/)

    Dr. Lyon has been a part of the Boston/Haiti team of PIH for 10 years. He learned HIV medicine in Haiti, where he spent half of his residency. When the January 2012 earthquake struck, Dr. Lyon was working in rural Alabama, although he says that he was immediately pulled back into Haiti after the disaster. While the situation in the Caribbean nation was already very difficult before the earthquake, today the magnitude of the problems – from infrastructure damage to malnutrition, displacement of families to an outbreak of cholera – is much greater. The effects of deforestation include food insecurity, crop destruction, and flooding year after year. In addition, the complete failure of a public health intervention is evident through the prevalence of totally preventable diseases such as tuberculosis, malaria, tetanus, and measles.

    About 9 million people live in Haiti, and while the country lies very close to the US proximally, it is quite unique intellectually, politically, and culturally. To understand Haiti today, one must understand Haiti’s unique history. For about a century, from 1697 until 1804, Haiti was a colony of France, and many of the people living on the island were African slaves imported by French colonists. After the revolution, France began demanding “reparations” under threat of invasion, and Haiti was forced to borrow cash (from France) to repay this debt because no one else was willing to trade with a “combatant” country. This is the first example in history of foreign indebtedness, and it meant that Haiti had less control over its own development. The Haitian economy was created with financial policies geared toward the export industry instead of trying to protect the health and well being of the country’s own citizens. Considering years of other setbacks, including US occupations, a US backed Duvalier dictatorship, coups in 1991 and 2004, as well as repeated embargos and manipulation, one can understand why Haiti is in its current position.

    Dr. Lyon, unlike the majority of physicians in the US, strongly believes in the idea that “illness and most suffering that goes along with illness comes from the social conditions that push someone to be vulnerable and unhealthy.” Social and economic conditions are closely tied with health, and “social medicine” seeks to understand this relationship. “From a health point of view,” Dr. Lyon said, “medicine is a relatively weak tool…there is much we can learn from the social sciences.”  In addition, when the outcome of social and economic structures is greater suffering and early, unnecessary death, “it is right to call this violence,” said Dr. Lyon. “If the forces are unavoidable, as in they can’t move away from it—then it’s a structural thing.”

    Partners in Health started in Cange and more recently has expanded in the Artibonite river valley. At the heart of its model is a commitment to serving the poor through the public sector, granting access to basic primary health care, and removing barriers to health care and education for the poor. The organization will see about 2 million patient visits this year, and it employs 5,000 people, half of whom are community health workers. As the largest health care provider in Haiti, PIH also provides jobs for Haitians. 99% of PIH employees in Haiti are from the country. While PIH is Boston-based, it’s partner organization, Zanmi Lastante, is run entirely by local Haitian leadership. For the last decade, everything that the organizations have been doing has been in collaboration with the Haitian government and the Ministry of Health. Haitian leadership decides where the priorities lie for the organization.

    PIH has put heavy investment in community health work and a delivery mechanism that provides for people within the context that they are living. Rather than focusing on creating new technologies, PIH believes in the idea that there are many great technologies out there that aren’t reaching the poor because of delivery problems – not because those technologies are too high-tech. The idea of “accompaniment”, or sticking with a patient while they are sick or until they can stand on their own feet, is a central philosophy of PIH. Rather than having patients trek to the clinic when they are sick or need medicine, PIH employs local Haitians who know the patients and their community, who can get to their house every day, deliver medicine, make sure they take it, and check in with the patient. In this way a physical and emotional connection is created as PIH works side-by-side with they people they serve. This system also provides great adherence for following a drug regimen, and it provides a safety net so that sicknesses can be caught in their early stages before they become a major problem.

    Currently, the organization is creating a new teaching hospital in Mirebalais. After the earthquake destroyed many of the existing hospitals, the government asked PIH to make the existing project bigger. The hospital will include an ER, trauma center, and cancer care, among other types of care. It will provide high quality education for the future generation of health care providers in Haiti. The hospital’s electricity will be provided through 400kW photovoltaic roof-mounted solar collectors. “Really, this is all happening because of the leadership of the Haitian government and the generosity of donors,” said Dr. Lyon.

    Another current project is a cholera vaccination program aimed at easing the burden for the current outbreak. Nearly half a million cases have been reported in Haiti in 2011, and 6,600 Haitians have died since the onset of the outbreak. In addition to long-term solutions, such as providing chlorinated water, introducing hygiene measures, and improving the sanitation system, PIH decided to start an oral vaccine program in January of 2012. While there has been some apprehension about the program from other public health organizations – particularly because the vaccine has a limited supply and is not 100% effective— Dr. Lyon addressed this by pointing out that “If there was a cholera outbreak in Evanston, IL, there would be no question. You would get the vaccine. It’s one more tool that we have that will save lives.” Indeed, PIH sees the their friends in Haiti as deserving of the same standard of medical care as people receive in the states.

  3. Flexibility and Confidence are Essential – Tips and Recommendations from Global Health Student Researchers

    February 23, 2012 by Laura Ruch


    On Thursday, Feb 16th, 2012, a group of students, professors, and sponsors from a variety of academic disciplines gathered in Harris Hall on the Northwestern University Evanston Campus at the 2nd Annual Global Health Research Symposium. At the symposium, undergraduate and graduate students discussed their public health research and how they are connecting their Northwestern education to the global community.

    Student researchers outlined their projects and major findings during a mix-and-mingle poster presentation, which preceded a panel discussion featuring Ryan Lange, a global health alum and Fulbright Scholar (WCAS ’11). Other panelists included Marielle Meurice (WCAS ’12), recipient of the Radulovacki Global Health Scholars Research Fellowship, Christopher Miller (WCAS ’12), recipient of the John and Martha Mabie Fellowship for Global Health Research, and first-year Feinberg students Annsa Huang (WCAS ’11), Danielle Chun (WCAS ’11), and Gabrielle Ahlzadeh (WCAS ’11), recipients of the International Group Research Fellowship in Global Health.

    The diversity of student academic backgrounds was evident through the wide variety of global health research presented at the Symposium. From Sophie Ewald’s (WCAS ’12) Berlin study on the incidence of strokes in marathon runners, to Helen Gómez’s analysis of how the Cuban culture affects access to health care for
    those living in (and visiting) Cuba, the central themes running through all of the projects were creativity and ambition.

    Among the attendees at the Symposium was President Morton Schapiro, who reflected on how global health research can be a type of “experimental learning to complement the classroom.” Many of these students “gain a whole new appreciation for what they’ve learned in the classroom,” he said. “I think it’s a great idea.”

    Northwestern University Provost Daniel Linzer gave opening remarks before the panel discussion, during which he highlighted the immense interest Northwestern students have shown in the area of global health in recent years. “Every single school at NU has an interest in global health, through teaching or scholarship, or involved students,”  said Provost Linzer. Global health research, especially research leading to new affordable approaches for global health care, is one of the major pillars of the 2011 Northwestern University Strategic Plan.

    Prior to the panel discussion, Dévora Grynspan, director of the Office of International Program Development at Northwestern, emphasized, “the idea is to discuss the process of doing research above the research data itself…The process highlights the ethical challenges. That is the most important thing that our students learn.” During the panel discussion, the students discussed challenges they faced during the entire research process, as well as key takeaways from their experiences writing proposals, working in the field, and their advice for students looking to embark on similar global health research.

    For writing a stellar grant or research proposal, Ryan suggested, “Find the most critical person you know, the most creative person you know, and the best writer you know… Also, don’t become married to your draft.” Before applying for his Fulbright fellowship, he reworked every sentence of his proposal countless times. Ryan’s Fulbright project looks at how obesity metaphors affect policy support in the U.S. and Canada.

    Marielle detailed the invaluable resource of having supervisors she could count on while she was working in Kampala, Uganda. For students interested in pursuing global health research, she advised, “Find someone who’s going to be really dedicated to you when you get to your site.” Once you are in the field, “flexibility and confidence are essential.”

    In terms of where to begin in a project search, “Do something that you’re really interested in and passionate about,” stressed Annsa. She participated in a group project with Danielle and Gabrielle that looked at diabetes in Bolivia. The research was “really relevant to many of the things we are constantly talking about in medical school.”

    Finally, Chris Miller had some very important words of wisdom modeled after his own research with the Chicago Public Health Department this past summer. “Taking the first leap is the hardest part. After that,” he said, “you gain some confidence.” He also stressed taking advantage of the unique position Northwestern students are in. “Be aware of the incredible resources that you have…Don’t be afraid to talk to your professors.”

  4. More than Good Intentions: How a New Economics is Helping to Solve Global Poverty – Dr. Dean Karlan, Yale University, Innovations for Poverty Action

    February 3, 2012 by Laura Ruch

    Hundreds of thousands of programs exist throughout the world targeted toward solving some piece of the global poverty puzzle. How can we evaluate an individual program, and what makes some programs more effective than others? Dr. Dean Karlan, professor of economics at Yale University, spoke on the Northwestern University Campus at the Buffet Center for International and Comparative Studies on Tuesday afternoon, January 31, 2012. Dr. Karlan is the president and founder of Innovations for Poverty Action (IPA), a nonprofit dedicated to discovering what helps the world’s poor. At the onset of his talk, Dr. Karlan invited the audience to adopt the mindset of an economist when thinking about issues of poverty. He addressed three key questions that must be asked regarding any poverty program: firstly, what is the market failure? Understanding the underlying cause of the problem is key towards developing an effective solution. Secondly, does the solution solve the problem? Problems of global poverty are often context-specific, and what works in one area of the world might not work in a different place. Finally, is the problem worth solving, given the costs? In other words, in a world with seemingly endless good uses of a finite amount of money, is this program the most effective use of limited resources? “Good evaluations answer all three questions,” said Dr. Karlan.

    So why does one evaluate in the first place? Dr. Karlan prefaced this answer with a hypothetical scenario: say that you are on your way to a meeting, for which you will be paid $300 for your attendance. If you do not go to the meeting, you will not receive the money. Before you arrive at the meeting, you see a boy drowning in a lake. At this point, you are faced with a decision: you can go to the meeting and make $300, or you can save the boy, causing you to miss the meeting and lose out on the money. When asked what decision they would choose, everyone listening to the talk readily said that they would save the boy. Yet very few people are rushing out and donating $300 to a charity, say one that delivers bed nets to a child in danger of contracting malaria, even though those bed nets have been proven to effectively save lives. Why is there this discrepancy? Dr. Kaplan explained that, aside from psychological factors, people are also more wary of donating their money when they’re not totally sure what it will be used for. In the case of the drowning boy, there is the immediate satisfaction of knowing that the missed $300 was worth it because a child’s life was saved. However, when donating to an organization overseas, it’s less clear that the money directly effects people’s lives. Good program evaluations, therefore, can help to motivate people who might be on the fence to invest more money in an organization by assuring them that the program is effective and that the money is going towards what they want it to go towards.

    Evaluating programs has other benefits as well. It helps us to know where to spend our limited resources by figuring out which programs have a real impact. It also helps organizations to figure out how to improve their programs. Good program design and evaluation is therefore a vital component of addressing global poverty, and this is the main goal of Innovations for Poverty Action.

    Dr. Karlan also addressed some issues surrounding microcredit. Evaluations of microcredit programs can be misleading, he said, because they may introduce confounding factors. For example, one way of evaluating a microcredit program might ask questions such as “Are the participants healthier?” or “Do they have bigger businesses?” However, one cannot say whether the answers to these questions are the result of the microcredit program or some other type of intervention by the government or NGO. What we really want to know is what would have happened to these people had they not been in the program; in other words, we want to control for outside factors. Yet one cannot simply compare persons selected for microcredit programs to the general population because a selection bias often exists that can distort the conclusions. Microcredit specifically looks for hardworking people who are likely to succeed, and they may show more optimistic outcomes for microcredit programs than the general population would. Good evaluations of microcredit programs, therefore, utilize randomized trials, where all applicants have an equal chance of gaining credit.

    Dr. Kaplan admits that microcredit is not the magic pill for solving global poverty, but it is not inconsequential, either. Reported impacts include some increases in investment, and a lot of financial gains have gone into household things and/or paying other debt, which are important for families even if they aren’t great economy boosters. The strongest impacts on income have been found with consumer lending at high rates. Furthermore, microsaving programs, as opposed to microcredit or microfinance programs, have showed much more positive results, to date. One powerful method of increasing household savings is to create a savings account and label it with a purpose, such as “education” or “health”. IPA has demonstrated very useful programs in Ghana and Uganda using this simple method of saving.

    Next, Dr. Karlan discussed an economist’s method of achieving a particular goal. In order to achieve something you want to accomplish, you must “increase the price of vice”, he says. An example of using this method for a public health issue is smoking. In one study Dr. Karlan described, people trying to give up smoking agreed to have the amount of money they normally would spend on cigarettes in a year put into a savings account. At the end of the year, they would be tested to see if they had been smoke-free. If they were successful, they would receive all the money back. If not, the money would be donated to a charity. In this manner, the “price of the vice” (smoking) was increased because if they began smoking again, not only would they have to pay the cost of the cigarettes, but also the amount set aside in the bank account over the course of the year. Unsurprisingly, participants in this program had much higher success rates than the average person trying to give up cigarettes. Dr. Karlan and two of his colleagues at Yale University founded “stickK”, a company which follows this same logic. StickK empowers people to achieve their goals by creating incentives for them to stick to their guns. To learn more about stickK, visit their website: http://www.stickk.com/

    Dr. Karlan concluded his talk with an important point about program evaluation: not all organizations should measure their impacts. This may seem counterintuitive, but one must keep in mind that data collection costs money, and redundant data collection can be a waste of precious resources. For example, a company that says it will distribute bed nets should provide data that shows that they indeed distribute these bed nets and that people are using them, but they do not need to show that bed nets reduce mortality because this has already been proven.

    Finally, Dr. Karlan outlined a few things that we can do as people interested in helping to solve the problem of global poverty. First off, we can care. “Don’t let alarmists get in the way,” said Dr. Karlan. “And just because you don’t yet have good evidence doesn’t mean you shouldn’t do something.” Secondly, we can be humble about what we do. Lastly, we can create, incubate, test, incubate, test, scale… In other words, we should constantly be evaluating efforts that we are making to be sure that they are truly effective.

  5. 21st Century Life in El Péten, Guatemala

    July 21, 2011 by Laura Ruch

    by Laura Ruch, WCAS 2012, biology and science in human culture major, global health minor

    Dr. Paul Farmer once said, at a keynote address for the 2010 Northwestern GlobeMed Summit, “There are no first, second, third worlds.  There is one world.”  That line has stuck with me since I first heard it, and I think it offers a wonderful model for thinking about issues related to poverty, access to resources and health inequality.   We are all living in the 21st century, a time of seemingly endless technological capacities, and as members of one world, it strikes me as unacceptable that some communities continue to remain cut off from the resources and inventions that the “developed” world has at its fingertips.

    I recently had the chance to spend a week in El Petén, Guatemala, working  with an NGO called SewHope, based out of Toledo, Ohio (my hometown).   I’ve traveled to Guatemala five times before, but this trip rattled me even more so than the others, perhaps because I am older, but also, I think,  because the organization has developed strong relationships with the  people in Pueblo Nuevo.  The small village has only about 60 families, and  working among them, it felt like we were their extended family, their  friends, rather than outsiders with our own agenda.  SewHope is a  multifaceted organization comprised of physicians, teachers, farmers, and  students, both from the US and Guatemala.  While the American doctors  have expertise in diagnosing and treating illnesses, the organization would be nothing without the inside knowledge and connections of the Guatemalans who work there.  When we must board a flight back to the US, patients can return to the clinic for follow up visits and medication refills, the education programs continue to run, and the gardens and tilapia farms we helped to create aid in improving nutrition and bringing in extra cash for the community.  It seems intuitive that an organization working in community development and health care simply cannot be effective if it runs stop and go programs, dependent upon the travel schedules of foreigners.

    Many incredible moments came out of my week in Pueblo Nuevo, but I’ll limit myself to sharing three of the most poignant stories.  Firstly, while taking a medical history of a young woman, I commented on her baby’s lovely knitted red hat, and asked her why she used it in the middle of the summer.  As it turned out, the hat was not for sun protection so much as  for protection from “El Ojo”, or the Evil Eye.  The woman explained to me that the year before one of her other children had begun vomiting a green fluid after a man she had an argument with gave it “the look.”  The baby died suddenly.  After hearing this, I began to notice that almost all the babies had something red on them – a shirt, a blanket, a simple bracelet.  Beliefs surrounding Evil eye date back to Spanish folk religion, and children, especially infants, are believed to be most susceptible.  In a setting where many infants die of malaria, diarrhea, malnutrition, and other preventable illnesses, it makes sense that such beliefs are ubiquitous.  Rationalizing “stupid deaths” (another Paul Farmer phrase) by ascribing them to uncontrollable forces of evil is a much easier pill to swallow then recognizing that one’s child has been the victim of an unfair world, where some are simply cut off from basic healthcare, sanitation, and clean water.   Many women also continue to believe that their health care catastrophes are the results of the “susto”.  Susto is what happens when you experience a terrible “fright.” One woman described seeing a large snake in her home that terrified her while she was pregnant, and her baby immediately died.  Another woman witnessed a murder and afterwards began experiencing chronic back pain. Of course, these are not conscious things – the mothers have not had the privilege of learning about the mechanisms of disease and malnutrition, and they are not trying to replace science with non science-based cultural beliefs.  However, one can see how believing in the Evil Eye or “susto” might serve as a sort of coping mechanism for painful losses.

    Also on the trip, I saw first hand the importance of a community feeling  empowered and being able to collaborate to work toward big goals.  The  day after I arrived in Guatemala, we drove into the village in a van and found all of the kids and some of the community leaders gathered outside  the school and looking forlorn.  As it turned out, the school’s principal, Concepcion, had locked the gates to keep the students and teachers out. From what I understood, he felt angry at the way parents had been pushing him to create new education programs, and he thought that the  new spirit of empowering women and children would undermine his  authority.  He is frequently absent (the school was only open 1 day the  week before for no apparent reason).  Concepcion has been pulling these  sorts of stunts for years, but the community had decided once and for all they had had enough, and one of the leaders went off in search of something to break the lock with.  When he came back with a huge set of bolt-cutters, he spoke for a few minutes on camera about the unfairness of the situation, and then forcefully broke the lock while everyone clapped and cheered.  On July 1, a group of the villagers went to the Human Rights Commission, the Ministry of Education, and the newspaper (Prensa Libre) with the information, with the hopes of removing Concepcion from his position.  They were able to inform the authorities who have promised to replace Concepcion.  It was really cool to see the people of Pueblo Nuevo standing up for themselves and taking the initiative to demand a higher standard of education for their children.

    Finally, a very surprising event that we were privileged to take part in was the excavation of the body of the husband of one of the women in the village.  The man and his friend were the victims of random killings during Guatemala’s 36 year civil war (1960-1996), arguably the most brutal civil war in the history of Latin America.  More than 200,000 people were killed, about 83% of Mayan descent, and the U.N. Commission for Historical Clarification has issued a report showing that state forces and military groups inflicted the vast majority of human rights violations.  Now the government has started a program to offer some solace to families of those who have suffered the loss of loved ones. A team of two archaeologists, two forensic scientists, a psychologist, numerous policemen and others led the exhumation of the husband and his friend. The story was featured on the Guatemalan news for the Petén region.  The community eagerly included us in the very special event and even invited us into the area sectioned off for family members.  Our friend Orfe initiated the process, and she has also established a cemetery in Pueblo Nuevo.  For a community with very strong religious beliefs, having a proper place to bury and visit those who have passed away is very important.

    It took me a full day of traveling to make it back to Chicago, and, as  always, it was a somewhat surreal experience to step into an American  airport and have limitless restaurants, amenities, and services offered to me. The week in Guatemala truly flew by, and I’m eagerly looking forward  to my next trip there. In the meantime, there are lots of things to mull  over.  I can only imagine what sort of changes will take place in Pueblo Nuevo in the next couple of years and beyond the people are given the chance to make their lives better.