Dr Stacie Geller

Doctors are working to deliver misoprostol— known as the “abortion drug”– to women in developing countries to prevent thousands of deaths due to postpartum hemorrhaging.

“We have the answers. This is not a complex question… We know how to get women, in most cases, to have a healthy delivery,” said Stacie Geller, professor in the Department of Obstetrics and Gynecology at University of Illinois-Chicago.“We need governments and we need governments engaged in spending money to do this.”

She shared her experiences delivering misoprostol to women in India and Ghana Tuesday at a forum at Prentice Women’s Hospital.

Postpartum hemorrhage– or excessive post-birth bleeding– is one of the leading causes of death for women across the world. Ninety-nine percent of those deaths occur in developing countries, according to Geller. Poorly trained (or non-existant) birth attendants, rudimentary health facilities and lack of prenatal care contribute to the disparity between high-resource and low-resource settings.

“That’s something we don’t think about a lot in the U.S., but it’s a huge global problem” said Sharon Green, executive director of the Women’s Health Research Institute at Northwestern University.

It can be prevented by taking oxytocin– the U.S.-preferred hormone– but it is expensive, requires refrigeration (which is not available in places with limited electricity) and can be difficult to administer. misoprostol is an alternative that many doctors prefer in low-resource settings due to its affordability, long shelf-life, ease of delivery and non-invasiveness.

But use of the drug has been fought by government officials who contend women will misuse the drug for abortions or sell it on the black market.

“This is about fear that women will control their reproduction and have abortions,” Geller said.

In Ghana, where she conducted her most recent research, Geller’s team distributed misoprostol to women in their 7th month of pregnancy to use in case of excessive bleeding during labor.

“I was convinced that women would not misuse it. Women don’t want to die,” Geller said. “They’re not going to give it away, they’re not going to lose it and they’re not going to sell it.”

She proved the naysayers wrong. Her team tracked 98 percent of doses given to women. All doses were either properly used or returned, convincing the government to distribute the drug to women on a limited basis.

“Women just want information. They want to take care of their families and they want to take care of themselves,” said Katie Doyle, a clinical nurse manager who attended Tuesday’s forum. “It’s always going to be their first goal–no matter where you live and how much money you have in the bank.”

Geller urged health practitioners Tuesday to translate their medicine into real-world outcomes.

“Do you do your science, do you publish a paper in the Lancet…and do you go home happy?” Geller asked the crowd of 65 health practitioners. “Well we could have. But it’s important that the work then be heard elsewhere and translated into policy changes.”

Her message hit home.

“It allows us to…have an awareness of the luxury we have in providing healthcare and resources we have,” said Doyle, whose clinic regularly uses misoprostol. “I really appreciated the fact that there’s so much work being done globally to ensure something that is at a low cost and high value can be used elsewhere.”

Those were the words of Dr. Ricardo Araya, MD, PhD, speaking to approximately 50 people on Northwestern University’s Chicago campus recently about how mental illness is increasingly being treated—and perceived—around the world.

Dr. Araya, a professor of psychiatry at the University of Bristol’s School of Social and Community Medicine, has spent nearly 30 years studying mental health, with projects and large randomized controlled trials everywhere from South America to Africa and India to the United Kingdom.

Citing a 2010 study on the global burden of disease, Dr. Araya explained how nearly a quarter of the world’s “disability burden” is due to illnesses like schizophrenia, Alzheimer’s disease, bipolar disorder, depression, and anxiety, with the two latter increasing by almost 40 percent in the last two decades. The rate of Alzheimer’s disease, he said, has skyrocketed by 80 percent.
Around the world, he said, people may be living longer lives, but those lives are plagued by chronic ailments.

Dr. Araya has been doing his part to help alleviate some of those ailments in multiple countries. He said the key to earning acknowledgement of and treating mental health problems in places where such illnesses may be stigmatized, misunderstood, or viewed as insignificant compared to other issues is about knowing the patients.

“People have a tendency to oppose change,” he said. “We’re trying to improve what is already there, rather than trying to reinvent the wheel.”

Dr. Araya said that that approach, which he said he has used in all of the countries he has worked, means taking advantage of local resources, combining mental health treatment with existing health programs (such as those for HIV, hypertension, and pregnancy), and bringing the right technology (such as cell phones) into the fold.

For instance, in Nigeria and Ghana Dr. Araya said that patients were treated for depression by technologically inclined community health workers. In Pakistan, postnatal women worked through their depression with “lady health workers.” In Uganda, depressed patients participated in group therapy led by villagers-turned-health workers, an experiment that Dr. Araya said was “one of the most successful trials in low-income countries, as well as in the whole field overall.”

One particularly moving example of the importance of cultural insight in treating mental illness came out of Zimbabwe, where locals who were trained as health workers would simply sit on a bench—dubbed the “Friendship Bench.” That casual, non-threatening atmosphere encouraged people to just come, sit down, and share their concerns.

Dr. Araya said that such approaches to mental health treatment—similar ones of which he has helped conduct in Chile and Brazil—have taught him the importance of “equity, efficiency, effectiveness, and empowerment.”

“Culture is a huge thing,” he said. “We tend sometimes to dismiss it. Thinking about how people function is essential.”

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!

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.

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/

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.

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.

Photo Credit: Jennifer-Leigh Oprihory

How did the Northwestern Global Health Case Study Competition Team first get started?

We were chosen by the Center for Global Health to be part of the team.

How are members chosen (i.e. are they recruited or do they try out)? Who advises or coaches?

We were chosen because we all applied to be a part of the team. A committee of people from the Center for Global Health chose us. Dan Young, inter um [sic] director of the Center for Global Health is our main advisor. We’ve also solicited advice and critique from various faculty members who have watched us do practice presentations.

Photo Credit: Jennifer-Leigh Oprihory

How would you describe the international competition at Emory to someone who’s never experienced it?

The competition consists of about 20 or so other teams from other schools in the world. It’s an intense experience where you get less than a week to prepare your solution to a global health problem and present it in front of judges at Emory in Atlanta.

What kinds of cases are tackled in the competition?

All cases are global health problems that could or have been faces. Topics range from malnutrition to smoking to refugee care and sanitation.

How many years has NU sent a team to the competition at Emory?

This is the second year.

What goes into preparing for the competition? Does it culminate in a presentation, debate, etc.? How are teams judged?

We prepared by practicing past cases and presenting them in front of faculty members. We met at least once a week to learn our methods for solving cases and working together as a team. All the teams will be judged by a panel of experts in the field of our case once we get to Emory.

How would you describe this year’s team dynamic, in 5 words or less?

Photo Credit: Jennifer-Leigh Oprihory

A passionate focused well rounded team [sic]

What unique perspective/angle/talents does the NU team bring to the table? How has the mix of different team member talents and skill/knowledge sets affected the team’s approach to the case study competition?

Our team is diverse and that gives us strength. From our anthropologists, biologists, medical and business students, we all share a passion for global public health.

What does your team hope to gain the most from its experience in Atlanta this year?

We hope to learn how to solve real world problems in creative ways.

How do you feel the competition and your team’s contribution to it is impacting the greater field of global health?

I think experiences like this, and hopefully the ideas our team contributes, will help us prepare for the field, and potentially help develop new and fresh ideas to long standing problems.

What can NU students gain from an opportunity like this one?

There is tons to gain from this opportnity [sic]. Working on real life global health problems in which there is no right or easy answer is huge. Learning to weigh risks, benefits and tradeoffs [sic] really helps make the scenarios real and helps us think about what real practitioners and politicians face.

Photo Courtesy of the Northwestern University Global Health Case Study Competition Team

[UPDATE: The team didn’t place at this year’s competition. However, the Global Health Portal would like to congratulate the team for its wonderful efforts before and during the Atlanta-based event.]

Photo Courtesy of Caleb Hsieh

Name: Caleb Hsieh
Hometown: Carlisle, MA.
Age: 27

Hsieh, a fourth-year medical student at Northwestern’s Feinberg School of Medicine (and a 2008 NU graduate with a degree in Materials Science Engineering), wrote that he first got involved with the team through the Student Committee for the Center for Global Health. He wrote that his interest in global health stemmed from his involvement with the Northwestern University Alliance for International Development (NU-AID) — “a student-run global health interest group at Feinberg.” He cited his favorite global health topic as that of health-outcome disparities (“especially among minority groups and social/structural determinants of outcomes”) and wrote that he was looking to the Global Health Case Competition as “learning experience” which he hoped would “challenge” him “to think about global health problems in new and different ways.”

In your opinion, what gives the NU team a unique edge going into the event or sets it apart from other teams?

I think we draw from a wide variety of backgrounds. We have global-health majors, MPH students, Business students, and Medical or Pre-medical students. We also have people that have lived and served in other countries. I think the diversity helps broaden our collective understanding.

What the biggest thing you’ve learned from your experience as part of the team?

Communication within a team setting is critical.

How can students interested in being a part of this get more information or become involved?

I would contact Daniel Young and express interest. If there is enough interest next year, we would like to expand the competition to include an internal competition within NU.

The question was about the benefits in thinking of health as a human right, and those words were the answer of Dr. Evan Lyon, during a guest lecture he gave recently to Northwestern University students. Lyon’s day job is spent as a professor of medicine at the University of Chicago. But for the past 15-plus years, he has gone and above and beyond that title, ever-working to bring, maintain, and constantly improve the health care and health conditions in Haiti.

Lyon first started working in the impoverished country in the mid-nineties, after he graduated from college, out of what he called during a pre-lecture interview, “a desire to do advocacy and social justice-type work.”

“I thought I would spend a couple of weeks there,” Lyon said. “It turned out to be a year.”

Now, as a doctor for Partners in Health — a nonprofit organization that works to improve health care both domestically and abroad — Lyon devotes a large majority of his medical knowledge to addressing the health issues in Haiti. The roots of those issues, Lyon said, go in many different, yet interconnected, directions.

During the aforementioned lecture to Professor Michael Diamond’s biomedical engineering class, Lyon urged the students to think beyond the obvious medical roots of health care — such as microbes, genetics, and age — and to the social aspects — such as poverty, inequality, gender, access, and the environment.

“People like me work on the assumption that health is a right, not a commodity,” Lyon said. “It needs to be an accessible, justly distributed basic right.”

One of the problems, Lyon said, is the lack of medical education in Haiti. Hence his and Partners in Health’s work to build a new teaching hospital. After the devastating earthquake in 2010, the country’s old teaching hospital was all but destroyed, so the government asked the organization to build a new one. Now, thanks to donations large and small, from ordinary people and large organizations, the hospital is set to open later this month. It will provide basic services and will soon have a cardiology department, an oncology department, and an obstetrics department, which Lyon said was greatly needed.

“A lot of health issues in the world are hard to approach, but allowing for a safe pregnancy and delivery? We know how to do that,” Lyon said.

That sentiment, Lyon added, should be applied to many more health conditions. Noting how Haiti has high numbers of “regular things” such as high blood pressure, heart attacks, and stroke, Lyon stressed that medicine would do a great service by focusing on what is understood.

“We need more programs that deliver on what we know how to do, rather than focusing on the next new vaccine or wonder drug,” he said. “One of the biggest problems we have to solve is how to deliver on what already works.”

Although he said that Haiti has a long way to go in terms of meeting the basic health needs of its citizens, he also said that the work he is doing with Partners in Health is the kind that drew him to being a physician in the first place.

“There are a lot of upsides to doing this kind of work as compared to being a well-paid doctor in the suburbs,” he said. “I can be hands-on, can see the change that’s been coming from building clinics, from supporting the work. There is quick feedback, and you can accomplish a lot. It’s really satisfying work.”

Nicole Araneta counts out medications in the Pop Wuj pharmacy.Courtesy of Nicole Araneta

Since August of last year, Feinberg student Nicole Araneta has been working in a medical clinic in Guatemala, honing her Spanish and immersing herself in a community in need of medical care. Asociación Pop Wuj, the non-profit cooperative where Araneta spends her days, offers the services of a primary care clinic for free to families involved in their community projects. Clinic services are available at a low cost to everyone else.

When the Global Health Portal recently spoke with Araneta, she was just finishing up her time at Pop Wuj, before going on to spend her final few months in Guatemala volunteering with a hospital in another city. She said that Feinberg has been “very supportive” of her work, and that the experience has cemented her desire to be a primary care physician. She will be entering her fourth year of medical school later this year.

Q: What made you want to study medicine abroad? How did you decide on Pop Wuj?
A: Progressing through medical school, it became apparent to me that I want to be family medicine doctor for the underserved. This meant that making my Spanish better was a necessity as well as an aspiration. I also wanted to see medical care in an underserved setting for an extended period of time. The Global Health Office assisted me and provided a list of programs that Northwestern students had attended in the past and spoke well of. Asociación Pop Wuj, a non-profit Spanish School with community outreach projects including a primary care clinic, was on the list.

Q: Tell me a little bit about Pop Wuj.
A: Pop Wuj uses a holistic model in its outreach. It’s an organization that’s trying to make a difference with the communities it works with in various ways. They have a before-and-after school program, provide scholarships, build stoves for families to replace cooking over open fires, and have on-site and mobile clinics.

One of our chronic patients is “Manuel,” a two year old with a seizure disorder. We were helping pay for specialist appointments and providing his medication. Several months ago he got sick with pneumonia when our clinic was closed. One of our health workers took him to another outreach clinic. The pediatrician there prescribed an antibiotic regimen. She also diagnosed him with chronic malnutrition, which our organization had missed. We are now working the whole family comprehensively – they will receive nutrition supplements, counseling, scholarships for the older children, a new stove, and of course continued health support for Manuel.

Q: How is Guatemala?
A: My experience here has been exceptional. The people are welcoming, friendly, and patient with me. I’ve seen and learned a lot. Pop Wuj has ties with several communities, so I’ve been able to do home visits where I see how different people live. Something that I didn’t know about Guatemala before coming here is how varied it is. For example – with respect to only the climate – this one small country spans mountains, coast, and tropical jungle. Through this variety of landscape and terrain have evolved many different ways of living.

Q: Do people view medicine differently in Guatemala than people do in the U.S.?
A: People’s ideas of illness and cure are different. There is a long history of traditional Mayan medicine that has been at odds with the western medicine in which I’ve been trained. Many Guatemalans will go to a traditional curandero before a western-trained physician (Guatemalan or foreign). If they finally get to a physician, their ailment may have advanced and the physician may scold them for “waiting it out”. But in their minds the western physician is the last resort. Only recently have the two systems started to learn to work together and respect one another – I was told that, if a patient refuses western medical care, I shouldn’t push it and to respect their decision. I also read a text by a curandera who said she used Mayan medicine for everyday aches and ailments, but that for anything acutely dangerous she would send her patients to a western physician.

Q: What are some other common health problems that your patients experience?
A: Most of the common diseases here are not medically complicated. They are malnutrition, diarrheal issues, and a variety of infections. In some populations there is also a notable amount of diabetes and high blood pressure, where junk/fast food and a sedentary lifestyle are becoming more common.

What is complicated is the social context of these diseases. Malnutrition is common because of poverty, and perhaps because of some eating practices. Diarrheal infections are common because of poor water sanitation. In rural communities with the mobile clinic, I’ve seen many more advanced infections and growths that have gotten out of hand (one woman had a mass growing over her eye which she left for two years) because of lack of access to care. From some villages you would have to travel for hours and hours to get to an already busy health post.

Q: What is a typical day like for you?
A: A typical day is clinic from 8am-1pm then Spanish class from 2-6pm. I go home and spend time with my host family and do work for Pop Wuj’s other projects. I’ve also been a de facto health advocate for our chronic patients. “Isaías” was one of my most memorable patients. I helped him and his mom navigate the somewhat labyrinth health care system here, taking them to different diagnostic tests and specialist appointments.

Q: Have there been any surprises?
A: Something I was ignorant about before I came to Guatemala was the circumstance of languages. I thought everyone would speak Spanish. However, many Guatemalan’s don’t speak it as a first language. They have one of the existing 21 Mayan dialects as a native and primary language; Spanish is learned in school.

This language situation has complicated effects. For example, parents typically keep their sons in school longer than daughters. So often men speak better Spanish – the language of government, achievement, and power here. Once, during a mobile clinic in a rural community, I was working with a female patient. All the translators helping us that day were male. I thought the patient’s clinic visit was almost over, but then the translator had to step out for a second. Immediately the patient started telling me about her gynecologic concerns, which she ostensibly was too shy to mention in front of the male translator. I had to scramble to find a woman in the village who could translate for me.

Q: Besides medical knowledge, what have you gained from this experience?
A: Good communication between patients and their physicians is extremely important. As is training physicians to be sympathetic of their patients’ beliefs and understanding of their ways of thinking. Being removed from my comfort zone – seeing the resilience people have developed to deal with massive poverty; simply being exposed to different points of view and approaches to life – has helped me well on my way to becoming a more culturally competent doctor.

Q: Now that your experience with Pop Wuj is coming to a close, how do you feel?
A: It’s sad and scary and exciting to move on to do something else. Whenever something new is on the horizon I’m nervous about it, but usually I’m glad that I did it. I will miss Pop Wuj. It’s been a good community for me. But I am excited to see how hospital medicine is practiced in Guatemala, after having spent so many months in a primary care clinic.

To learn more about Nicole’s experiences, visit her blog at naranetacrossing.wordpress.com.

Photo Courtesy of Alina Dunbar

Northwestern University will send a team to Atlanta to compete at the 2013 International Emory Global Health Case Competition hosted by Emory University over the weekend of March 23rd.  Alina Dunbar – one of the students set to rep NU as part of the 2013 team – recently talked to us about her journey to global health, the experience of being on the team and her hopes and fears for the March competition in an email interview.

 Age: 22
 Hometown: San Antonio, TX
 Major: Anthropology & International Studies / Minor in Global Health Studies

How did you first become interested in the subject of global health?

My interest in global health began during my sophomore year. I was working with a professor in the African Studies department as part of the Fellow Assistant Research Award program through the Office of Residential Colleges and   analyzing the HIV/AIDS epidemic in Africa. Out of that project I was able to apply for an Undergraduate Research Grant and spend two months in South Africa in 2011, which undoubtedly has been the best part of my Northwestern experience (even though I was ironically out of the country at the time).

What are your favorite aspects and/or areas of study within the context of global health?

As an anthropologist, I’m fascinated by the social and cultural aspects of disease. My senior honors project is about the metaphors of HIV/AIDS in South Africa, and more generally about how diseases become laden with all sorts of socioeconomic and cultural markers. (I’m a big fan of Susan Sontag’s work, incidentally).

What do you hope to get out of the experience of being on the team?

Even though we’ve only been working together for about a month now, I feel like I’ve already learned so much from everyone on the team. The range of experience and background is amazing, and I enjoy learning how other people unpack problems and design solutions. I’m hoping this experience will push me to participate in similarly collaborative projects in the future.

What are your biggest expectations and, on the flipside, fears going into the national competition?

The competition is a little intimidating, of course! We’ve heard many tales of overqualified judges and innovative presentations by this point, so I think the important thing is that we remember to stay grounded. Regardless of what place we receive, I hope that we genuinely enjoy our stay in Atlanta.
In your opinion, what gives the NU team a unique edge going into the event or sets it apart from other teams?

I think it’s wonderful that Northwestern has such a variety of schools to pull from–we have a Kellogg student, an MPH candidate, three undergraduates, and a medical student on the team. I think this range will help us create a dynamic presentation. We might have other advantages, too, but probably won’t realize them until we’ve had the chance to observe some of the other teams in action!

How has the experience of being on the team changed/shaped you academically, personally and professionally?

This is really the first time I’ve had the opportunity to work with a team to this extent. Sure, I’m involved with a variety of student organizations, but that’s not quite the same. This requires collaborative decision-making, and already I’ve found that I’m more receptive to others’ ideas.

For more information, visit http://globalhealth.northwestern.edu/announcements/GHCaseTeam2013.html.

Photo courtesy of Jackie Hansen.

Jackie Hansen described a scene straight out of a nightmare.

Nestled in the grass, a metallic ball looks like a shiny new plaything to a child. But it’s actually a remnant of war—a cluster munition, a close cousin of the landmine—just waiting to explode when the child tosses it to a friend.

“Kids might think, ‘This is fun!’ Until all of a sudden, the pin slips out, and it’s not.”

On February 8, Hansen, the Landmine and Cluster Munition Monitor Program Manager for the International Campaign to Ban Landmines-Cluster Munition Coalition, was the featured speaker at “Land Mines & Cluster Munitions in a Public Health Context.” The lecture was sponsored by the Buffett Center, Program of African Studies and Office of International Program Development.

Landmines are weapons buried in the ground, designed to explode under the pressure of a person passing over it. “It’s indiscriminate,” Hansen said. “It can’t tell the difference between a child and a soldier.”

Cluster munitions are launched and are designed to explode on impact, but many do not detonate and thus become de facto landmines. Over the past decade, there have been 80,000 casualties in 119 states.

“Their impacts last long after wars have ended. There’s this terror these weapons cause in their communities,” Hansen said. “There are millions of people who farm their land and don’t know whether they’ll become the next casualty. This feeling that you don’t know what’s in the ground, that’s a pretty powerful thing.”

Hansen has served in her current position since 2005, but she’s been in the business of fighting landmines for even longer—13 years. During that time, Hansen has visited some of the most heavily mined countries in the world, including Colombia and Laos.

In Laos, Hansen recalled a T-shirt featuring an image of an amputee Hello Kitty, saying “Bye Bye Bombies.”

Landmines are so prevalent in Laos that Hansen said, “You fly over and look down, and you just see these craters.”

And in Colombia, despite the presence of well-equipped hospitals in Bogotá, landmine survivors have trouble accessing proper health care.

“I know people who were carried on hammocks through the jungle for two to three days,” Hansen said. “Even if there are systems in place in a country, those may be very, very difficult for marginalized people to access them.”

Landmine survivors sustain long-term health problems and need lifelong care, far past prosthetic limbs.

With 500,000 survivors around the world, landmines and cluster munitions continue to pose a significant global health problem, even after the Mine Ban Treaty of 1997 and the Cluster Munitions Convention of 2010.

Hansen said these agreements illustrate how public health imperatives can drive the treaty process, and how survivor-driven advocacy can drive change.

“Treaties are tools. They’re not just pieces of paper,” Hansen said. “We use them to hold governments accountable and make sure there’s victim assistance.”

Victims are defined as survivors as well as their families and their communities. Victim assistance can include physical rehabilitation, psychosocial care and help in getting education and employment.

Hansen told inspiring stories of survivors advocating for the ban of landmines around the world. In many ways, the campaign has been successful—Central America was the first region of the world to be declared mine-free. But they still face challenges.

“Yeah, the mines are clear, but now it’s a challenge getting funding to help all the survivors,” Hansen explained.

Other challenges include the 35 countries who have not joined the Mine Ban Treaty, including China, Egypt, Finland, India, Israel, Pakistan, Russia and the United States.

“It is really, really silly that the U.S. has not banned this weapon,” Hansen said. “The U.S. is the biggest donor by far in clearing landmines.”

Although there are many frustrations in her field of work, Hansen says one of the most satisfying aspects is stockpile destruction, when cleared mines are detonated in an enclosed area.

“It’s the fun of pressing a button and there’s a very big boom. Very fun,” Hansen said. “It’s the pleasure of knowing millions of mines are never going to be able to be used on a person.”

Hansen’s career will soon be moving on to broader human rights issues, but she remains passionate about clearing landmines.

“It has been really cool to work on, because stuff has happened. We have seen change,” Hansen said. “We’re getting there. It’s going to happen in our lifetime.

“Change is possible in this crazy world we live in.”

Lucía, 22, holds her son Erick, 8 months, who was born with a cleft palate and without eyes.

In the beginning of November, I hiked for hours through the rural mountains of southern Mexico during a downpour. As I tried to protect my camera while slipping down the muddy trail I only hoped that I would get the stories that I came for—and not ruin my camera in the process.

As a graduate student at Northwestern’s Medill School of Journalism focusing on health and science reporting, I was in Mexico during a week off from classes this fall, where I got to shadow a scientist whose work interested me.

Since I’m hoping to write about global health during my career as a journalist, I decided to shadow someone in the field. After months of back and forth phone calls and emails between myself, Paul Farmer and Partners in Health’s media relations team, I managed to organize a trip to Chiapas, Mexico. As PIH’s newest location, the staff had a lot of capacity to support a journalist visiting for a week, and gave me extraordinary access to the work they are doing in southern Mexico.

My interest in global health started when I was an undergrad at Northwestern minoring in global health studies. Keeping in line with what many global health professors at Northwestern will tell you, global health is truly interdisciplinary and can take you down many roads. When I declared the minor as a sophomore, I was a Weinberg student with absolutely no thoughts of becoming a journalist. Global health became the thing that eventually led me towards writing as a career.

I went to Mexico prepared to write a few stories about the patients that Partners in Health was working with in Chiapas. Once I arrived, I met Jafet Arietta, the Director of Operations for Partners in Health Mexico, and immediately had at least 10 stories that I wanted to pursue. I arrived around midnight at PIH’s office, where I mulled the story ideas over in my sleep, ready to start working the next morning.

The next day we headed into Soledad—one of the rural communities about 3 hours away from the office where PIH works. Until February, when PIH started working in Soledad and the surrounding areas, the community had never had a doctor.

During the three days of my trip that we spent in Soledad, I accompanied Jafet and two other doctors on trips around the village to visit patients. There I met Lucía, a young mother struggling to care for her 8-month-old son who was born with a cleft palate and no eyes.

I relied on Jafet to help translate and make sure Lucía was comfortable with my recorder, notebooks and camera. As she began to tell me her story, I sat with my camera in my lap, hoping she would eventually allow me take photographs of her and her son, Erick. After about 20 minutes Jafet translated for me, and said that Lucía’s only worry was that she hadn’t done her hair nice enough to be photographed! But otherwise, it was okay.

The second patient that I decided to profile was more difficult. He was a schizophrenic man, Uvaldo, in his early 30s who was confined to a small wooden shack next to his family’s home. He had become violent during a hallucination, threatening to kill his family members. Putting him in those living conditions was the only way that his family knew how to protect themselves.

After I came back to the US, I’ve kept in touch with Jafet and her colleagues in Mexico. They tell me that Uvaldo and Erick are doing better, and that especially for Uvaldo, they are hopeful that he will soon be able to interact with the community.

Caitlin Callahan (WCAS 2012)

Caitlin Callahan, Global Health alumna ’12, is a Global Health Corps fellow at Public Health Solutions in New York City.  Public Health Solutions has programs addressing maternal and child health, nutrition, access to health insurance, HIV prevention and care, and smoking cessation. The organization also provides capacity building services to public health government agencies and nonprofits.

What did you do after graduation and where are you now?

Upon graduating in June 2012, I immediately began my position as a GHC fellow in July at our two-week Yale orientation. It was a very quick turn-around, but I was excited to begin working so soon after graduation.

How did your global health studies at NU influence your career choice?

I originally began my undergrad career as a pre-med student, but quickly changed courses to a more policy-oriented, rights-based approach during my sophomore year. The courses I took as a global health minor changed my understanding of the multi-dimensional factors that contribute to public health issues. With this inter-disciplinary background, I was motivated to contribute more directly to this field- to find solutions, to initiate change, and to work towards global health equity.

Where did you study abroad?

I was fortunate to study abroad with the IPD Public Health program in Paris. This program, in collaboration with Sciences Po, transformed the way I thought about policy work and public health modeling. It was one of the first times I studied with students of different cultural and personal views, which allowed me to create an entirely new understanding of how health care systems should function, as well as the dramatic role politics plays in their design and implementation.

Do you have any advice or suggestions for current global health students on how to get involved or how to choose their career path in global health?

Take as many classes as you can! Global Health Studies offers such a diverse range of classes in terms of topic and region; I learned the value of that academic variety my senior year and only wish I had had more time! Similarly, start brainstorming your summer plans early- internships, research experiences, and fellowships expose you to the realities of working in the global health field and allow you to apply and develop those skills you learn about in the classroom. As an upperclassman, I was also fortunate enough to create strong relationships with professors through research projects and independent studies. Those professors helped me identify many post-graduation opportunities; they were amazing mentors, and I encourage students to connect with professors directly- they are more than willing to help!

What’s one life lesson that you have learned since you started working?

Perseverance is incredibly valuable. Tackling the world’s economic and social issues is not an easy task; it’s important to stay grounded and consider the big-picture. If not, it’s easy to become discouraged by the day-to-day and slow progress that your work may entail. Your contribution to this work is critical, and it’s important to remember your motivation for choosing this field in the first place!