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

Julia during her 3rd year clerkship at Soroka University Medical Center in Beer Sheva, Israel

I graduated in 2007 with a degree in Anthropology (Human Biology) and a minor in Global Health. I was pre-med, but I was not sure exactly what I wanted to do. I took the MCAT after my junior year and managed to get out a few med school applications right before I graduated. I knew that if I didn’t do the apps while in an academic environment I would never apply. What was more important to me at the time was to attempt to really work in some capacity in the global health world. So, I went to Brazil. I was born there and have a Brazilian passport, so I was able to get an internship at the National School of Public Health. I had an amazing experience. I split my time between research and shadowing a doctor who was doing a residency in public health. Public health is not a residency option in many countries; in American terms it’s a bit like family medicine mixed with an MPH. The public health residents ran a clinic located in the School of Public Health which serviced the low income communities who live in favelas surrounding the campus. In working at this clinic I had the opportunity to see the implementation of a primary care focused public health care system from multiple angles. I saw the process from policy making, to home visits and even clinical medicine. It was a phenomenal experience that really tied together the knowledge base I gained in undergrad and made me realize I really wanted to be a physician. I felt my inadequacies. I wanted a distinct skill set that could allow me to better serve the population and I decided I could do this best through the pursuit of an MD. It’s a great day when you suddenly know what you want to do, even if you know it’s going to take a lifetime to get there.

I was accepted to the Medical School for International Health while I was living in Brazil. This school is a 4-year American style medical school located in the deserts of southern Israel and was established in association with Columbia University. I graduate on May 23^rd, 2012 and will be working as resident physician in Obstetrics and Gynecology in Philadelphia at Drexel University’s Hahnemann Hospital.

Just a quick plug, cause I love my med school and it really is the perfect place to go if you want to go into medicine and global health all at once. My med school integrates a global health perspective into its curriculum and allowed me the opportunity to go to other countries such as India and Ethiopia to work in hospitals in a variety of interesting settings. Additionally, the day to day life here in Beer Sheva, Israel is quite diverse. The population served by our tertiary care center (where we study) is 50% Arabic speaking, predominately Bedouin. The other 50% is made up of immigrants from Russia and Ethiopia, refugees from Sudan and of course the Jewish population.

Which IPD program did you choose for your studies abroad and how has it influenced you?

While at Northwestern I studied abroad a few times, all along the lines of global health. I went on the Northwestern global health program to Mexico City the summer after freshman year. This really opened the doors for me. I was exposed to public health research, I shadowed doctors in a clinical setting, and I lived on my own in a foreign country for the first time. I had such an awesome time and realized that I could really pursue global health as an undergrad. This experience inspired me to continue to go abroad. In the summer after sophomore year I went to Buenos Aires to study Spanish and do a research internship at a public hospital. Then I went to South Africa on a global health SIT trip for the fall semester. During this trip I got involved in HIV/AIDS education and decided to return to South Africa to do my senior thesis. I was lucky enough to get an Undergraduate Research Grant (URG) which made the whole trip possible. Northwestern has so many opportunities for students who are interested in global health, as long as you are personally motivated people will get behind you and help you run after whatever dream you have (within reason).

Every single one of my experiences abroad took me further into the world of global health. There are so many lessons to learn from cultural sensitivity (trust me I have committed every faux pas) to one’s own limitations in language, in academics, and personal boundaries. Every time I put myself out of my comfort zone I learned so much about myself. I became totally addicted to the thrill of landing somewhere completely new and having to figure it out. I also loved learning about a country through its health care system. Working in the health care field allows you a certain intimacy with people that perhaps we do not deserve. For instance as a physician I have been able to enter peoples’ lives, peoples’ homes and through them I have been exposed to such amazing cultures, languages and life lessons. However, I must say as a disclaimer two very important things. Firstly, I have learned that one does not need to leave the US to accomplish what I just described. It is completely possible to experience a diversity of cultures in the US. There are people lacking access to health care and good health care policies everywhere in the world. The second disclaimer I have to offer is that despite my training I am not sure I am the person to bring health to the world. No matter how culturally sensitive you attempt to be, walking into a clinic somewhere in a developing country you will never have all of the skills to truly understand the culture of those you are treating. That being said I do think that global health leads to an amazing and fulfilling life and career no matter how you approach it, I just think that one has to be realistic. It’s great to want to change the world and help people but know your limitations and be humble. I will relate a small story to express what exactly I mean to say.

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

Julia taking blood pressure of a woman in a rural town in central India called Bhidi, where she was running a clinic during her 4th year elective

I had the opportunity to do an elective in rural India during my last year of medical school. I was shocked by what I saw. I felt that the Hippocratic Oath was being ignored left and right because the best medicine, which I had learned to administer was not being practiced. The innumerate barriers that existed to giving what I believed to be appropriate eventually revealed themselves. One day a man was brought in bleeding from a motor vehicle accident. My med school colleague and I were the only ones trained in CPR and we did our best while surrounded by a crowd of screaming villagers to save this patient. We then jumped in a van “ambulance” and continued our CPR while standing and travelling over 120 kilometers per hour towards the nearest tertiary care center. We were not successful. I was so angry about the lack of CPR training and the prevalence of such situations that necessitated it. Then I realized that the cost of training a nation in a technique that is overwhelmingly not successful and often results in a patient with great medical needs may not be financially beneficial. If I were the minister of health in India I may decide that investing in CPR is not my biggest priority or an efficient investment of the limited funds available.

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?

I have loved the great majority of my international life for the past 9 years but there are ethical debates every day that I have with myself. I attempt to abide by the Hippocratic Oath and do no harm to those I have the privilege of treating or working with. However, despite my plethora of global health training I will on occasion do wrong. I will give patients treatments that do not mesh with their cultural or religious beliefs or I will accidently say things that offend and alienate my patients or colleagues. If you choose to work in global health I think it is best to remember that you are a guest in someone else’s world and it is your duty to learn from your hosts in addition to lending a hand.

If you want a career in global health you have to make it happen. Spend time finding a place, a project or a community that really inspires you and go. There are always people who need or want volunteers but if you want to really make a career in global health it involves a long term commitment, stepping out of your comfort zone and finding the right people who can open doors for you. It is always best to find an expat or an English-speaking person who has made his/her life as a foreigner successfully integrated into wherever it is you are trying to go. The right contact can be everything. OK that’s all I got, the rest is just a little bit of luck and a lot of perseverance.

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. 

This year’s conference theme was innovation. Clearly, innovation is a key to the future of global health. Take for example, Laura Stachel, Co-Founder of WE CARE Solar, who described her journey in “bringing light to maternal health care”, literally. Studying maternal mortality in Northern Nigeria after serving many years as a doctor in the U.S., she found that many state facilities only had sporadic electricity that was rationed among the various communities. Without the ability to predict when they would have light, doctors and nurses often found themselves unable to work at night, putting delivering women and critically ill patients at severe risk.  Her husband, a solar energy educator, designed an off-grid solar electrical system (the size of a suitcase) in response to this need. Put to use in a Nigerian hospital, the self-sustaining system was instantly successful and quickly led to improvements in local health outcomes. Demand for their product grew rapidly and now they supply their Solar Suitcases across the developing world.

Perhaps the most important takeaway from this conference was learning how one can pursue global health work without being a doctor or a nurse.  I was quite surprised to hear many speakers talk about how they had worked in medical practice for many years but then decided that global health was their next step. In fact, Laura Stachel was one of them. Actually, at the career panel I attended I was intrigued to learn that all five speakers had not originally pursued public health but either encountered the need in their current positions, such as with USAID, or altered their career trajectory down the line to pursue this interest. While I have felt concerned about my ability to impact health outcomes without pursuing medicine, here were all of these very accomplished men and women who were doctors and decided it wasn’t enough! So, to all of you global health students out there who are not pre-medicine, feel confident that you are also critical to advancing healthcare around the world.

But how you ask? There are so many avenues a global health practitioner can pursue! The conference’s speakers included engineers, designers, educators, environmentalists, energy and food experts, film producers, photographers, and artists, health policy and advocacy leaders, infectious and non-communicable disease specialists, and maternal and child health experts, organizational managers, researchers, philanthropists, social entrepreneurs, social media and marketing professionals, technology specialists, and water and sanitation authorities. Clearly, you should not limit yourself to the confines of direct service delivery! All of these presenters are working towards sustainable, significant, and culturally appropriate improvements to the health of populations across the globe with their diverse work. Through collaboration across sectors and specializing in specific interests, these individuals advance disease prevention and lessen the social, financial, and environmental factors that negatively impact access to care in very different ways.

Another conference-inspired insight to leave all of you readers with: if the professional opportunity you seek does not exist or is out of your reach, either create it or look elsewhere. To create it, you may pursue independent research in your interest or begin to mull around ideas about the practicality of starting your own organization with the global health emphases that are missing. You may also consider collaborating with an organization that already exists and developing an interest area that is lacking. When I say look elsewhere, I am referring to unconventional places for internship placements. You may want an internship with NIH in Washington D.C., but you are competing with many, many other like-minded applicants. So what should you do? I would suggest directly contacting lesser-known non-profits here and abroad or foreign public health government agencies. Offer to volunteer your time and contribute your skills. Perhaps you can work for a start up with a small staff; it may be less prestigious, but because it is small you may achieve more responsibilities as an intern. After speaking with many global health students both at Northwestern and at this conference, I find that many successful students took the path less traveled. Again, this approach takes initiative and time, but it is worth the effort when you gain unique professional experiences and real world insights that you may have otherwise missed out on.

Furthermore, if there is a need to be addressed and you know a solution, take the initiative to make a change. It doesn’t take millions of dollars and a large cohort of people to make a difference. If this conference taught me anything, it is that notion. All it takes is a simple idea plus perseverance and resilience. Plenty of college students start their own companies and non-profits with due diligence of research coupled with professional networking. Plenty of college students have also developed products that are either created by impoverished individuals in the developing world or aimed at reducing environmental damage and supporting local farmers. The difference between one of these inspiring conference speakers and you is not intelligence or money, but rather the idea, the persistence, and open-mindedness.  To further back up my claim, let me point out that many of the conference’s speakers were undergraduate, master’s, and PhD students presenting their own cutting-edge ideas and affecting change.

The Unite for Sight Global Health Conference is an annual event bringing together hundreds of people from all professional backgrounds and academic disciplines. As a Northwestern global health minor graduate and future health professional, I found it to be an extremely worthwhile experience and I know the other NU undergraduate attendees felt the same. Be sure to check out the event next year and consider contacting IPD/Global Health Studies for financial assistance in attending this inspiring conference!

Only a few weeks after graduating from Northwestern University in the Spring of 2010, Jorie Larson was already on her way to Mali to work as a health education specialist with the Peace Corps. Two years later she is back in the US, temporarily, while getting ready for her next big step in her career: the Peace Corps Response Program in Burkina Faso. Read an interview with global health studies alumna Jorie Larson about her professional and personal experiences in various stages of her career.

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

Jorie organized a training for 16 local traditional birth attendants in her village Malinke, Mali

A: While at Northwestern, I completed my BS in Social Policy from SESP and a global health minor. Within weeks of my graduation ceremony I was en route to hot, dry Mali, West Africa to live in a small rural village as a health education specialist with the Peace Corps. My experience living there, up until recent weeks when the program was evacuated due to political instability, was one of the most valuable experiences, personally and professionally, in my life. I was posted in a village of 1,000 ethnic Malinke in a difficult-to-reach area of western Mali. My primary work revolved around maternal/child health, since up to 1 in 5 children in Mali dies before age 5 due to malnutrition, malaria, diarrheal disease, and other preventable illnesses. I primarily worked in conjunction with the local community health center, conducting a behavioral health survey of the community; standardizing a malnutrition outreach and infant growth monitoring program; creating Information, Education and Communication opportunities within and outside of the center; and working with both formal staff and informal, locally-chosen community health educators on preventive and health promotion efforts including vaccination and family planning education. While there, I also collaborated with the district hospital doctors to organize a training for the staff of 36 health centers on the visual inspection method for cervical cancer prevention in low-resource environments; on the local level, the doctor at my clinic worked with me to organize a training for traditional birth attendants, whose services were heavily relied upon in my area, on basic principles of safer home births. Next month, I’ll be moving to Burkina Faso to begin a year-long post with the Peace Corps Response program, focusing on combating child nutrition with the Center for Nutritional Rehabilitation and Education there. After that, I’m considering pursuing an MPH/MSW program…but that’s for the future.

 Q: How did your global health studies at NU influence your career choice and your life in general?

A: Global health studies and my minor had a huge influence on my chosen path. As a social policy major, I did not plan to pursue clinical medicine but was very interested in health and access to health care as a social justice issue, and I knew I wanted to work on a global scale. I loved that the minor offered the chance to delve into global health from a variety of angles, from the policy side, the programmatic side, the epi side, and from the perspective of various sub-fields within global health. One of the favorite courses I took was “Community Health Program Planning,” where we did case studies of various health issues being tackled all over the world through innovative approaches, many of which were at least partly socio-behavioral in nature. It was really that class that got me thinking about what it might be like to work with an NGO or international organization on broad health issues, on finding locally-appropriate ways to increase access to health information and health care. As my time at Northwestern progressed and I was able to take a variety of GH courses, it became more clear to me that a career combining public health and social justice would be a good fit for me.

 Q: Which IPD program did you choose for your studies abroad and how has it influenced you?

Jorie on the Northwestern IPD Public Health in Uganda Program in 2009

A: But it wasn’t until I went on the IPD study abroad program, Public Health in Uganda, that I really made a decision to pursue international health work immediately following graduation. I had been to Ghana on a brief HIV/AIDS related service trip before, but this was my first time to spend a significant amount of time in Africa. The program, which provided classroom experience in public health in the developing world as well as practical experience with an NGO, taught me a few things. 1)  I had to find some way back to Africa, to live, for some substantial amount of time, 2) I wanted to get a better sense on the scope of health challenges in rural Africa, where most Africans live–there were many public health resources in the capital of Kampala, but I knew the difficulties and the need must be even greater in villages and in harder to reach areas, and 3) There was no need to choose between my interest in social justice/concern for the most vulnerable and my interest in public health. While in Uganda, I worked with an NGO for current and former street children, and we developed an educational drama on HIV/AIDS to share at a local school. It was in many ways the best of both worlds, as I got to work with vulnerable youth–which I’d done quite a bit in the States–and also to work on a very real and salient health challenge. I also had a great opportunity to see firsthand the anthropological aspects of public health, and how effective public health messages have to be culture- and resource-appropriate. I left Uganda after that spring quarter of my junior year knowing that I would look for international opportunities in health following graduation, and I applied to Peace Corps within two months of being home. In that sense, the Public Health in Uganda program had a major influence on my choices.

Q: 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?

A: My only piece of advice would be to be open-minded and try to take advantage of taking courses in a variety of different areas while you’re still at NU. One of the greatest things about the program, I think, is that it is broad and designed to be extremely flexible to your interests. We all have to take core GH courses, but really take a good look at courses in other disciplines, such as gender studies, anthropology, or international studies, and even look at seminars that may be salient to global health issues. For those minors who are not planning on going into any kind of medicine and are instead coming from a sociology, social work, anthropology, policy, or other background, know that there are so many ways to find meaningful work in global health; you needn’t be a doctor or nurse. Much of the public health work I’ve seen going on in Mali is preventative in nature, and public health needs social workers, policy makers, anthropologists, health educators, and development specialists just as it needs clinical medicine practitioners. If you’re on the fence about which direction you want to go, getting some grassroots experience, especially internationally through a volunteer program or with an NGO, might give you a good sense of what areas interest you–being in the Peace Corps gave me a chance to see different health issues at the ground level, and solidified my interest in maternal/child and reproductive health. Whether international or in the US with underserved populations, a good health field experience will  make decisions about further study or a career path much easier, and many grad programs now prefer several years’ experience, so it will only be an advantage.

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

A: One life lesson I’ve learned from my work experience post graduation, so far, has been that having a sense of humor  and remembering your purpose, is invaluable. Any kind of work in the developing world often goes at a glacially slow pace, and there will inevitably be ridiculous setbacks and moments when the enormity of the fight you’re fighting seems impossible–but there are also beautiful moments when you realize that each person that you can influence positively, be it a colleague at the health center  or a mother of a malnourished child or a secondary school student in a health class–is one person empowered to be healthier, and one by one is how real change occurs and is sustained. Laugh at yourself, do it often (Mali taught me that) and remember that each relationship that you build is important–though you may not see the effects right away.

Panosian, a Feinberg alum, co-founded the global health program at UCLA, where she is a professor of medicine. She spoke about her career in global health Tuesday at Northwestern Memorial Hospital.

What do malaria, global health and main street journalism have to do with one another? Dr. Claire Panosian Dunavan, a Feinberg alum, wove together her experience in these three fields Tuesday morning for the annual alumni lecture at Northwestern Memorial Hospital.

Panosian had no medical expertise when she spent the summer of 1972 in Haiti. Little did she know the images of malaria, malnutrition and severe diarrhea she encountered would lead her to a career in global health.

Panosian, currently a professor at UCLA in the infectious disease department,
recounted stories from her experiences studying malaria in Africa and Asia. She also talked about her accidental role as a medical journalist and how it enables her to spread awareness about global health.

In 1993, Panosian was invited to participate in a major malaria policy report that recommended subsidizing artemisinin drug combination treatments for the entire global market.

“To see how the policy played out, both perfectly and imperfectly, has shaped my education,” she said. Subsidies for these drugs remain crucial for malaria control today.

Experts underestimated mortality from malaria, according to a February report from The Lancet. “The study shows that mortality from malaria is about twice what we thought it was,” Panosian said. “It’s very worrisome.”

During Panosian’s work with control policies, she noticed a surge of interest in the field of global health from young doctors. She co-founded the global health department at UCLA, where she teaches an introductory course every year.

“I expect my students to understand health and finance indicators, such as life expectancy and fertility rates,” Panosian said. “We should all understand these statistics as global citizens.”

The public, inundated with blogs, single-source articles and short health clips on the nightly news, is uncertain about what’s happening in medicine. “There’s a traditional role of medical experts to assist and advise professional journalists,” Panosian said.

She encouraged fellow medical professionals to harness their expertise and use their voice to help the public understand health issues. “It isn’t as hard as you think to write an op-ed for your local paper.”

Panosian writes about global health and other medical issues for Los Angeles Times, Scientific American and Discover Magazine. “Starting with a local audience is a great way to expand and to introduce global health,” she told the crowd of doctors and medical students. “People will turn to trustworthy sources and you are those sources for certain topics.”

Drawing teams from both American and international universities, the competition called for participants to offer solutions to fictional health case study.  This year’s scenario was set in post-war Sri Lanka in 2009, said team member Kaushik Seethapathy, an MBA candidate at the Kellogg School of Management.

“One big challenge was prioritizing the ideas which we felt strongly about,” Seethapathy said.  “The case was open-ended and we came up with a lot of ideas!”

The team’s proposal focused on both short and long-term solutions for the Sri Lankan people, Seethapathy said, which included addressing gaps in the area’s health workforce as well as improving surveillance and business start-up processes.

Northwestern's Global Health Case Competition team (from left: Kaushik Seethapathy, Melissa Latigo, Chris Miller, Mitra Afshari and Shantanu Jani). Photo courtesy of Mitra Afshari.

Emory staff released the case study information only days before the weekend competition, said Shantanu Jani, a dual degree student at Kellogg and the McCormick School of Engineering.  Each team member then did some individual brainstorming before coming together as a group to discuss ideas, Jani said.

While competition judges did not select the Northwestern team as finalists, they did recognize the group’s achievements.

“The judges congratulated us during a meet and greet later on having done a good job.  They liked our child health brigades idea and appreciated the work we had put in,” said undergraduate student Chris Miller.

The team was composed of students across the university’s individual schools and undergraduate and graduate programs, all with different backgrounds and expertise.

“My favorite part of participating in this competition was learning from my incredible teammates,”said Mitra Afshari, a 4th year MD-MPH student at the Feinberg School of Medicine. “Everyone brought their own unique strengths to the table based on their talents and backgrounds.”

The team brainstormed ideas individually before coming together to discuss as a group. Photo courtesy of Mitra Afshari.

Miller was excited for the opportunity to learn from the experiences and knowledge of the team’s graduate students.

“For instance, by working with Kellogg students, I learned something about how health issues can be managed with business solutions,” he said.

The competition was a significant learning experience for each team member, ranging from presentation skills to group cooperation to eventual careers in global health.

“I hope to be able to address health challenges from a variety of different angles,” said Miller, who aims to get a dual MD/MPH degree in the future.

“From this competition I’ve learned the importance of simplicity and brevity, said Feinberg medical student Melissa Latigo.  “The delivery of an idea may be more important than having a good idea in itself, and if you have an idea, know how you are going to execute it– someone just might ask!”

Cheng plays with children at the "guarderia," a daycare center, while their mothers work. Source: Joanne Kim

When Anthony Cheng and Joanne Kim arrived in Guatemala at the end of January, they knew their trip wasn’t just another hospital rotation. The fourth year Feinberg students spent a month at the Pop Wuj Spanish School, where they worked in a clinic, practiced medical Spanish, lived with local families and participated in various community projects.

“The program pushes you beyond your comfort zone,” Cheng said. Pop Wuj, located in the highlands of Guatemala, has a medical clinic that primarily serves indigenous people who live in the surrounding rural areas.

Kim and Cheng took medical Spanish classes and worked in the clinic two to three times per week, performing triage, filling prescriptions and shadowing doctors.

“The biggest health challenge facing the community was malnutrition,” Cheng said. “Everyone was stunted, and the condition was not genetic.”

Although residents grow diverse plants and vegetables for export, their diet mainly consists of beans, potatoes and tortillas. “They had all these eggplants but didn’t know what to do with them,” Cheng said.

The pair helped lead a cooking class and taught residents how to prepare eggplant ratatouille, encouraging participants to incorporate local nutritional products into their diet. “You have to show them what you’re doing in order to have the greatest impact,” Kim said.

Outside of the clinic, the Feinberg students helped locals build stoves in their homes to replace fire pits. Most people used open flames to cook in their one-room homes, Kim said. She volunteered to talk to the community about the health benefits of stoves.

Guatemalan women unload supplies for the stove project. Source: Joanne Kim

“They reduce smoke-related illnesses such as chronic obstructive pulmonary disorder and acute respiratory illness, and they make homes safer places for children,” she said.

Cheng told locals about the economic benefits. “We would see 6 year old boys hiking up the mountain with firewood strapped to their heads,” he said. “The stoves are more efficient and use half as much wood, so people make fewer trips and there’s less deforestation.”

While the stove project is an ongoing effort, Kim and Cheng helped install about 15 during their stay.

In addition to practicing language and medical skills, the students learned about Guatemalan history and culture to help them better understand their patients. “The people of Guatemala have had such an awful history,” Cheng said. “I felt a sense of obligation to help, and I understood that each patient wasn’t just another human body.”

While Kim and Cheng have settled back into their courses and are preparing to graduate, they both hope to maintain a connection with Pop Wuj. They served a benefit dinner last month and invited guests to donate money they would have used to splurge on a night out. They raised $430 to send to their colleagues in Guatemala.

Kim and Cheng, both specializing in family medicine, said their experiences will help them work with minority populations in the future, whether in the United States or abroad.

While Pop Wuj is not currently affiliated with Northwestern, the pair said they would recommend the program to other Feinberg students.

Kim, left, and Cheng, right, share a moment with their Spanish teachers. Source: Joanne Kim

The solution to population growth issues lies in respect for women's rights, said Petroni in her keynote address at Northwestern's Summit on Sustainability.

Population growth speeds climate change, we are often told. Linking these two phenomena is complicated and could lead to population control strategies that jeopardize human reproductive rights, said Suzanne Petroni in her keynote address at the Northwestern University Summit On Sustainability.

“We want to make sure that if we make this connection between slowing population growth and slowing climate change we are careful to advocate only for rights-based programs that enable people to make their own choices,” she said.

Engineers for a Sustainable World held its 2012 summit, “Public Health and the Environment,” from March 30-31. Petroni, vice president for global health at the Public Health Institute, criticized efforts to control population growth at the cost of human rights in her speech, “A World of Seven Billion: What Does it Mean?”

China proudly announced that it reduced carbon dioxide emissions by 1.3 billion tons by preventing 300 million people from being born, Petroni said. “But this so-called simple solution had devastating effects on human rights, resulting in coerced abortions and forced sterilizations.”

Policymakers have long feared that overpopulation will lead to a “tragedy of the commons,” straining resources and stifling economic development. In the 1950s and 60s the United States created a population policy that set targets for fertility rates at home and overseas, Petroni said.

In the 1970s and 80s, women’s rights organizations began to associate such policies with dictatorial restrictions on human rights. “If the planet was overpopulated, they asked, who were the excess people? And who had the right to control everyone’s reproductive laws?” Petroni said.

The dialogue shifted in 1994 as a result of the International Conference on Population and Development, which stated that people should have the freedom to decide responsibly the number, timing and spacing of their children. This “rights-based approach” represented a radical change in attitude and shifted the focus from control to empowerment.

“When individuals are given the information and access to comprehensive health care, education and information they will usually choose to have smaller families,” Petroni said. “Respect for and attention to women and their rights is the solution for population issues.”

What does this mean for the environment?

“If we want to discuss links between population growth and climate change, we have to first acknowledge that slowing population growth may only play a limited role in mitigating climate change as long as resource use continues unchecked,” Petroni said.

Even if the population stabilizes, which experts predict might happen when we reach nine billion people, resource consumption will continue to rise as individuals demand a higher quality of life. Petroni asked the audience to look at the “whole elephant” of climate change, not just population growth.

“Urbanization, consumption and development are important factors for our planet’s survival – maybe more so than a few more babies being born in a rural village in Ethiopia,” she said.

Ellen Gustafson co-founded FEED, a company that creates consumer goods like satchels. Much of the revenue from the products goes to feeding school children around the world.

Ellen Gustafson, named Inc Magazine’s “Top 30 Under 30” in 2010, spoke Friday night to approximately 60 Northwestern students and visitors.

She was the opening keynote speaker to Northwestern University’s 7^th annual Summit on Sustainability, a two-day event. This conference brings students and the community together so people could exchange ideas on how to improve social justice and work towards a sustainable world.

(Watch 5 minutes of the keynote)

The problem year: 1980

According to Gustafson, 1980 was when America’s obesity problems began.

Genetically modified crops first became patentable in 1980, Gustafson said.  The oil crisis at the time eliminated many small famers, which led to larger agricultural companies.

Manufactured food has now been around for more than 30 years. Although “many people herald [it] as the answer to all the world’s problems,” it has created problems without solving world hunger, she said.

About 60 people came to Harris Hall to listen to Ellen Gustafson speak about changing our food choices and working towards a more sustainable food system.

The solution starts now, and it starts with you

Referencing two of today’s most popular college startups, Gustafson said, “The only way that we are really going to fix these challenges is to find the Google, find the Facebook. It doesn’t exist yet. That doesn’t mean that it’s not going to happen. It means that we have to build it.”

Change starts with individual consumer choices. People who want to improve the food system today should buy products from companies that treat their employees well or from ones that have good environmental practices, Gustafson said.

Other than that, she advises people to surround themselves with like-minded individuals who are interested in changing the world. Doing so “is one of the best things we could do to help our own personal development,” she said.

Some people left with a parting gift 

This keynote has “re-inspired me in my own job,” Humecki said.

Humecki, who is an intern for Northwestern University’s food service, said she really enjoyed Gustafson’s “3.0” food idea. People need to discard the outdated system and welcome the new one, she said.

A sustainability intern at the University of Illinois at Chicago left the keynote with mixed ideas.

“Sometimes I get very cynical about what we can do as an individual,” said Charmi Shah, 27. She didn’t know “how much of an impact we could have on a larger group, in a community, in a country or globally,” she said.

Yet, she said she hoped to speak to others at the reception afterwards, especially those who have tried to bring about change. She wanted to network and work towards becoming “part of the solution,” she said.

Guest lecturer Richard G. Parker spoke about his most recent work, a study of the political history of HIV, AIDS and sexual matters and the invention of global health in a keynote address Thursday.

Parker, a professor of sociomedical sciences at Columbia University, kicked off a two-day event, Libidinal Investments, organized by the Sexualities Project at Northwestern.

Global health is a “boom” industry; there is nothing hotter on U.S. college campuses, Parker said. In order to unravel the meaning behind this popular label, Parker looked back on 50 years of history.

He identified three key sets of processes leading to the invention of global health:

Professor Richard G. Parker discussed his latest work, the invention of global health against a background of political history, at Northwestern University Thursday. Source: Rian Ervin

- Population control, demographic thinking and the politics of international development

- The politics of HIV, sexual difference and the imagination of the global

- The struggle for reproductive rights

Each of these three processes emerged during a specific period of political change. Increased health research, the invention of international health organizations and social advocacy formed and shaped politics.

At the end of World War II, the concept of “developed” and “underdeveloped” countries emerged, resulting in the notion that international health problems existed, Parker said.

International organizations such as the World Health Organization and UNICEF were created to solve these problems, and the field of international health was born.

At the same time, an increased fear of population explosion placed new emphasis on the desire to develop third world countries, Parker said.

Population dynamics and research became central units of investment. Three large surveys analyzing fertility, contraceptive use and demographic health circulated the world for the first time.

The emergence of HIV in the 1980s resulted in a second wave of change.

HIV took on an essential role in the shift from the programmatic to the global vision of health, said Parker. Instead of creating organizations to solve health problems, cultural activism emerged, he said.

Population research shifted to sexuality research, bringing new focus to discussions of gender, sexuality and power. The HIV outbreak gave a voice to minorities, women and the LGBT community, Parker said.

The creation of international HIV and AIDS organizations, along with a global network of those living with the disease truly connected people across the world.

While Parker attributes HIV as the main historical element responsible for the invention of a global health community, he said there is still a long way to go in perfecting social and political mobilization.

The struggle for reproductive rights is the latest issue, according to Parker, and has been evolving over the past 15 years.

The ongoing abortion debate and 9/11 have caused huge shifts in how people think about health security and health rights, Parker explained.

While he isn’t sure how this issue will evolve, Parker said women’s empowerment is at the center of debate in the international arena.

Moving the ideas of feminism and LGBT sexual diversity across ethnic and cultural boundaries “is not simple,” said Parker. However, these fields are being discussed globally. “There is an expanding notion of inclusion,” he said.

One of the main problems patients around the world often encounter is the lack of education or awareness among oncologists about new treatments and possibilities in the world of oncofertility.

Doctors are often concerned that delaying cancer treatment for fertility preservation procedures will harm the patient, said Dr. Melissa Hudson, director of the Cancer Survivorship division at St. Jude Children’s research hospital.

“Our perception as oncologists is that almost all options are still investigational. Because of this, fertility preservation is not really a priority. Those feelings can be easily transmitted to the patient,” she said.

However, she notes that especially in the cases of children with less aggressive cancers, a brief delay could be okay. It may only take a few days to harvest ovarian tissue that could enable an otherwise sterile young girl to have children later in life, something that is not widely accepted.

While physician education is ideal, patient awareness could ultimately solve this problem.

Many times patients go to their doctors after reading something in the media regarding oncofertility and that is how they learn about treatment options, said Johan Smitz, a fertility specialist and laboratory head at UZ Brussels.

“It all starts by educating the profession about the huge growth reproductive medicine has had over the last 30 years,” Smitz said.

Doctors now routinely take ovarian tissue samples and oocytes and freeze them as a method of preserving fertility. “I think it is now 17 live-births resulting from tissue culture,” said Prof. Teresa Woodruff, Ph.D., of Northwestern University’s Feinberg School of Medicine and  founder of the Oncofertility Consortium.

But awareness alone will not be enough to overcome the international barriers facing oncofertility. Coordinating national efforts is key in addressing this problem, Smitz said.

“There are approximately 1.4 million people in the world that will have a fertility threatening treatment. And globally, everyone needs to be aware that fertility preservation is a problem,” Woodruff said.

In some European countries, funding is largely dependent on publishing papers that impact the field of research.

“[In Belgium], the government provides funding for four years and they expect to see a lot of output from that, but the problem is, putting gonadal tissue in culture requires long-term research because it can take months to grow one mature, human oocyte,” Smitz said.

In an effort to address this issue and better coordinate research efforts, the European Society for Human Reproductive Embryology partnered with America’s Oncofertility Consortium to share information across borders.

Despite these efforts, one thing is clear, more research and awareness are required before fertility preservation becomes a mainstream global effort for cancer patients.

Reproductive endocrinologist, Dr. Teresa Woodruff  pioneered the field of oncofertility. Source: Woodruff Lab

A pioneer in the world of fertility preservation for young cancer patients, Dr. Teresa Woodruff of Northwestern University’s Feinberg School of Medicine, coined the term oncofertility and champions the idea of looking beyond the lab bench to the cancer patients affected by the studies.

Her research in reproductive endocrinology has increased awareness of fertility management and the role it plays in quality of life for the increasing number of women who are also young cancer survivors.

Woodruff addresses the main concerns and issues facing the field and the patients it is built around.

Q. What is oncofertility and what exactly does that encompass?

A. Oncofertility is a term to describe a new area of work that is used to provide fertility options to young cancer patients. It involves all the dimensions of a patient’s decision process and provider’s information. It is the ethics, the law, the religious constraints, and the multi-dimensionality of fertility management in the case of a young (ages zero to 40) cancer patient.

Q. What advice do you have for cancer patients concerned with fertility preservation? Where should they start and how can they find specialists that will work with their own doctors?

A. I think one of the main things is that cancer patients should really ask their doctors about the threat of their treatments to their fertility, because not all treatments are going to result in sterilization. Getting that information upfront is really important.

If their doctors don’t know, they should consult with a fertility specialist. Our oncofertility hotline can give them information about fertility management and their local experts. They don’t have to come to Chicago. There are 60 sites around America and we have partners in Europe, China and throughout the world that support fertility management.

Q. What options are there for cancer patients who are concerned about preserving and managing their fertility?

A. If you were able to protect your gametes before, it depends on what you protected. You might have gone through IVF and frozen a mature egg. Those mature eggs and ones that are fertilized with a husband’s, boyfriend’s, or a donor’s sperm can be re-transplanted into the patient.

For those who didn’t have their gametes protected, live births have also occurred after re-introducing preserved tissue transplants. However, there is the potential to reintroduce the cancer they just survived so we are working on ways to grow the tissue in culture and produce mature eggs that can be fertilized.

I think it is now 17 live births resulting from tissue culture.

For patients who were not aware or did not have time to access these options then adoption is now an option for them.

Q. What is the most common misconception regarding cancer patients and oncofertility?

A. The most common misperception is that cancer is a genetic disease and that if a person has cancer that they are going to pass that disease onto their child.  Some cancer is heritable, but those cancers only represent 5 percent of the overall cancer burden. What this means is that 95 percent of cancer is spontaneous.

Q. What is your fertility preservation organization called and what was the impetus for its creation?

A. It is called the Oncofertility Consortium and the impetus for its creation was originally a grant offered by the National Institutes of Health, which asked the scientific community to tell them what the most intractable problems of our day are and how we would solve them.

The origin of the term oncofertility was for that grant and the idea was that fertility preservation, particularly for female cancer patients, was not something that was not being provided at all.

We realized we could intervene by using emerging basic science principles and developing protocols that address the multi-dimensional ways of treating fertility preservation.

Q. Prior to the Oncofertility Consortium, what options existed for cancer patients concerned about fertility preservation?

A. Actually, not very many. If you were a male you could have sperm banking, but most young women were not being provided that same opportunity or information.

There could have been options for emergency procedures that preserve fertility, but because the oncologists and fertility specialists rarely spoke, getting those two communities to really be engaged in the process became one of the biggest hurdles.

Q. What are the major barriers or challenges facing your cause?

A. For some cancer patients, fertility preservation means delaying treatment, which is a really difficult decision to make. And of course, preserving an ovary is experimental and invasive, so being at the early stages of this field is an issue because of uncertainty, but really that will come with time.

Q. Are there any specific cases over the years that have continued to resonate with you?

A. There are many. One involved a young girl who was 16 years old when she was diagnosed. Her family flew to Chicago from Los Angeles to protect her fertility and she is now in college and doing well. During the process she really made a point to advocate with her oncologist that fertility was important to her, which is not always common in young cancer patients.

We are working really hard to remember that there is a real and tangible person on the other end, which is different than the mentality of traditional science.

Q. You have an awe-inspiring number of appointments and accolades, is there one you are most proud of? Why?

A. I was asked to give a commencement speech for the Young Women’s Leadership Charter School a couple of years ago for their graduation. That was really exciting to me because I was the first scientist to give the commencement speech.

Oprah Winfrey was their first speaker and the second was Michelle Obama, so the two before me were really impressive.

Looking over those young women, it was clear to me that we needed more women in research and health care and that those women are the future leaders in science. That was something I was really proud of.

Q. What do high-school students do at the Oncofertility Saturday Academy?

A. We started it to provide a line of opportunity for Chicago Public School students, particularly young women, to basically see themselves as potential participants in health care or research.

When you are in high school you don’t really know what the opportunities are even if have a subtle interest in science. We are providing the opportunity to see real live scientists, doctors and nurses at work.

We have a total of 32 students every year. There are 16 in the junior oncofertility program and 16 in the senior Oncofertility Saturday Academy, plus over 100 faculty and staff that are involved.The junior program is geared towards learning basic science and really trying to understand the fundamentals of reproductive biology. The senior program applies the basic science, and students have the chance to be a doctor for the day.

Q. What advice do you give to girls who might want to get involved in advanced sciences at the high school level, but do not have access to a program like the Saturday academy?

A. We have a lot of people who really want to come into this program from all over the world. What I tell them is to go and find someone at their school and be persistent. Email them for the opportunity.

I try to encourage faculty to start their own programs. In fact we have started programs around the nation. One in San Diego, Colorado, Oregon and, of course, in Chicago.

We have been able to build this curriculum and share it. Now we are trying to build our curriculum to work with the curriculum of Chicago Public Schools.

This summer, Northwestern University’s Engage Chicago program is unveiling an exciting new concentration for undergraduate students who are thinking just that.

The Health & Medicine concentration will include site visits, seminars and internships for students interesting in pursing careers in medicine. Source: http://www.engage.northwestern.edu/

During the new 8-week Health & Medicine concentration, students will study the dynamic and contentious issues that affect American healthcare today.

“We believe that the experiences students will have during the Engage Chicago program will truly help them better understand the complexity of the issues in the health care system,” said Heidi Gross, assistant coordinator of Engage Chicago.

Northwestern University offers its Engage Chicago program to outstanding undergraduates from schools all over the country.  Students are exposed to a variety of urban issues in Chicago, such as homelessness and public schooling, through internships, classes and site visits.

The Health & Medicine concentration will debut in Summer 2012, and will be open to a pilot group of 12 to 15 students, Gross said.  The program developed out of feedback from past students as well as faculty advisors, who felt that the experience would be great learning experience for students interested in going to medical school, she said.

The concentration will include much of the same general curriculum as the other Engage Chicago programs, but with additional classes that focus specifically on national healthcare issues.

“The strengths and weaknesses of the entire US health care system, recent debates over President Obama’s health care reform, issues around insurance and access to care, effective public health campaigns, how poverty impacts health and wellness – just to name a few!” Gross said of what students will be learning about and discussing over the course of the summer.

The city of Chicago will play as important a role in this newest concentration as it does in all of the other Engage Chicago programs.  Weekly site visits will take students to hospitals, free clinics, health care advocacy organizations and insurance companies all over the city, Gross said. In addition to classes, participants will also have the opportunity to intern at a health-related organization.

“We believe that doctors can more effectively practice medicine if they better understand the context of the lives of the patients they treat, and we hope that Engage Chicago will help shed light on that context,” Gross said.

Applications are already flying in, she said, but the final deadline isn’t until March 30.

For more information, or to apply online, visit http://www.engage.northwestern.edu.

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.

Psychometrician Chih-Hung Chang, of Northwestern University, said data collection and analysis could lead to more holistic patient treatment.

If you ask a medical doctor what psychometrics is, you might see a blank stare.

Yet Chih-Hung Chang, an associate professor at Northwestern University Feinberg School of Medicine, said he thinks patient diagnosis and treatment would benefit from having this type of quantitative psychology become common practice in medicine. He talks about how people-reported data, electronic devices and data analysis could bring about more holistic patient care.

Q: What is psychometrics?

A: It’s basically one of the disciplines of psychology which has more of a focus on numbers. The important thing about psychometrics is it converts latent, unobservable traits into numbers and uses those numbers for comparisons.

Psychometrics actually has to do mostly with how to design good assessment tools. Without the tools, the numbers you get from the responses of the patients might be meaningless. So psychometrics uses a lot of statistical modeling in order to determine whether this ‘good’ assessment tool could be applied to different populations.

Q: What’s the story behind this science?

A: It actually was originally developed for educational testing or psychological measurement, but I think it is mostly applied to do personality assessment. For instance, if you want to measure people’s depression or their anxiety or some other psychological trait, you use a questionnaire or test items. Ask them a list of items, and based on their responses, you create a score and then create a profile to compare [them] to ‘normal people.’

Right now most of the instruments have been developed for assessing health-related quality of life. Researchers or clinicians could use those numbers to understand whether [patients] need further treatment or a referral to a specialist.

Q: How does psychometrics help doctors see patients more holistically?

A: Most of the instruments are capturing mental health, physical health, social health and, sometimes, spiritual health. [Psychometricians are] making sure that the whole picture of the patient can be profiled with some numbers so that the treating physician could utilize that information and decide what might be the best treatment options available.

Q: How do computers and the Internet assist you in this process?

A: Using large databases, you compare your patient’s characteristics to the [patients in the] large database. You know with his characteristics, he might be more likely to benefit from one specific treatment. You could also integrate laboratory data or some other clinical data utilizing electronic medical records. So you compare [all] that in real time.

You sort of have an integrated system: from the patient’s perspective, from the clinician’s perspective, from data’s viewpoint. And you generate a report specifically tailored to that particular patient, so clinicians could utilize that printout or chart.

Q: Is the ultimate goal for patients to use their smartphones, tablets and other electronic devices even while they’re healthy in order to improve their future doctor visits?

A: The overall goal is to allow the use of technology so that patients could enter their information. That information gets analyzed and summarized and delivered to a treating physician to sort of open up the communication channel.

It sounds simple but you want to make sure that information that gets entered is valid and reliable because sometimes a patient or some other people [such as caretakers of incapacitated individuals] might try to report data that is not valid.

We build in some validation questions in the questionnaire, so we could sort of detect whether that person is responding inconsistently. For instance, if you respond ‘very much’ to most of the questions but you respond ‘not at all’ to one of the related questions, we know there must be something going on. And then we could detect whether the person is lying or making the responses up.

Q: Don’t we already have health-related apps like ones that measure body mass index and fiber intake?

A: We do, but in order to provide a holistic picture of the patient, not only do you have to report some of the daily indicators like vital signs, [but] you also need to use some of the tools, like measuring particular aspects related to quality of life.

Q: How could psychometrics help a patient’s treatment and diagnosis?

A: Once clinicians utilize this tool, with the information provided to them, they could spend their time more efficiently. They could try to target the area or the problems from the patients’ [perspective].

Clinicians need to spend a lot of time trying to deal with issues and problems, but time is always a concern. With this type of information presented to them with the patient’s condition, they could use that information to sort of facilitate their communication and to make more informed decisions.