Wednesday, June 24, 2015

Global Health Immersion

It is a great honor to be awarded this year’s JSI Fellowship, a grant that supports student driven public health and international immersion.  USC has partnered with Twezimbe Development Foundation, a nonprofit organization that seeks the socio-economic transformation of rural communities in Uganda.  As part of my fellowship, I will work with Twezimbe and its stakeholders to lead my own student driven health program.  The chance to travel and work in Africa is something I’ve dreamt about since seeing my first National Geographic as a child.  With the opportunity to represent my University and Country, and to make an economic and health impact on the people of Uganda, my role as the JSI Fellow is a responsibility I take very seriously. 

Although I have been in Uganda for a little over one week, “the Pearl of Africa” as Churchill coined it, is already starting to feel like home.  Actually this is the longest I’ve stayed in one location since leaving Los Angeles on May 15.  It’s been a dizzying month traveling to Geneva, the Swiss Alps, Southern France, Paris, Mount Kilimanjaro and Zanzibar.  From the apex of global health at the World Health Assembly (WHA) to the putrid aromas of poor sanitation in Tanzania, my studies in public health and development have literally come alive.  
Summer reading list

My curated reading list on Africa, Global Health, and Economic Development has added background and context to my experiences thus far.  With stories of Paul Farmer, James Oribinski and Jeffrey Sachs, I feel inspired and empowered to take up the challenges of addressing poverty and suffering in the developing world.  The obstacles they faced, and the reoccurring themes associated with working in vulnerable populations played heavily in my mind, especially as I transitioned from high income Europe to low income Africa. 

Much has been written on the WHA so I won’t spend a lot of time discussing it here, but to summarize, the experience was both educational and challenging.  Geneva felt like a crash course in global health governance, international relations, and health current events.  As a graduate student lightly treading water in a sea of health leaders and experts, it was easy to feel confused and intimidated.  Topics such as WHO reform and Ebola response were casually discussed like they were new office dress policies.  With only one year of public health schooling under my belt, it was easy to feel detached from the issues at hand.  I'm appreciative for the unique opportunity to participate in the WHA and to witness a world not many people see.  However, I knew this was not where I belonged, at least not yet – I needed to be in Africa facing these challenges head on. 

From Europe I jetted off to Tanzania to accomplish a life’s dream of summiting the tallest mountain in Africa, Mount Kilimanjaro.  It was a marathon of physical and mental endurance, hiking for six days, camping in primitive tents, and enduring sub-zero temperatures at night.  It was also the adventure of a lifetime, passing through five life zones on the way to the summit – the cultivated zone, rain forest, heather/moorland, highland desert, and arctic summit – and in the process witnessing some of the most pristine, unique landscapes on our planet. 

Kilimanjaro day 1 through the African rainforest
Because the peak is so high (19,380 ft.), altitude sickness is the main obstacle to completing the trek.  Guides have near-perfected a climbing strategy that ensures adequate acclimatization by stretching the ascent over several days, and zigzagging from high to low altitudes in the same day.  That being said, it is impossible to know how your body will react to high altitudes, and the risk of nausea, headache, shortness of breath, and even death weighed heavily on everyone’s minds.  Three people from my climbing party succumbed to altitude sickness having to turn back in painful defeat.  Many more suffered through the final days of the trek, turning a pale shade of green resembling zinc-faced tourists at the beach. 

Looking up at Kilimanjaro summit from 14,000 ft.
On the final summit day I was terrified of failure.  Kilimanjaro was such a commitment, both financially and logistically – I might not get another chance to achieve this goal I’ve dreamt about for most of my life.  An hour from the peak, realizing the finish line was imminent, I couldn’t help but break down into tears of joy.  It was the second time in my adult life I’ve cried, and I did it all the way to the top.  It was one of the happiest moments of my life.  Reaching the summit at ten minutes past six, just in time to see the sunrise over the African continent, will be a memory I never forget. 

The roof of Africa
After roughing it on Kilimanjaro for six days, the white sand beaches and slow pace of Zanzibar was a welcome reprieve.  I booked a cheap hotel in a remote fishing village called Matemwe on Zanzibar’s northeast coast.  For four days I slept, caught up on emails and mentally prepared for my work to come.  Matemwe had some of the most beautiful watercolor skies I’ve ever seen, coupled with idyllic, endless white sand beaches and a pastoral maritime way of life.  The photo opportunities were plentiful.  I made friends with villagers, getting personal tours of small huts and family communes.  I lost myself among the ancient labyrinthine streets of historic Stone Town, a medieval amalgam of Arabic and Swahili cultures and ex-center of East African trade.  It was a nice rest, but it wasn’t Africa.  It was a dream, not real.  I was ready for Africa, to begin my work, to finally be…”immersed.”

Dawn low tide in Zanzibar
On Sunday June 14 I left Zanzibar for Uganda to begin my fellowship at Twezimbe Development Foundation.  My host Charles Buwembo and his lovely girlfriend Karima were waiting for me at Entebbe International Airport.  We traded introductions over the hour-long car ride to their home in Uganda’s urban jungle Kampala.  They live in a beautiful, spacious apartment in a gated community in one of Kampala’s most posh neighborhoods.  I have my own large bedroom and bathroom, access to a communal pool, gym, and restaurant.  Needless to say I was not expecting to live so lavishly my first summer in Africa.  I can’t complain though, as my hosts have been incredibly warm, gracious and accommodating.  Charles has gone to great lengths to make sure I am comfortable and enjoying myself.  He has taken me out to experience Kampala by day and the night, integrating me with his friends and family, and even giving me a Ugandan name – Kagimu.  By the end of the summer I know that Charles will be more than a colleague and host, but a close friend.  I hope that when the time comes to return the favor I can be one half the host he has been to me. 

Charles Buwembo: my host, colleague and friend
Living in Kampala is both overwhelming and exciting, as any good city should be.  Traffic is lawless with cars commanding any lane they choose, even the sidewalks.  Like most cities in the developing world, rapid urbanization and congestion outpaced any chance for urban planning.  I asked Charles if there were traffic rules, he jokingly replied, “of course, anything goes if you don’t get caught.”  What I find striking about Kampala is that despite its cramped streets and urban bustle, there is a verdant undercurrent that runs through the city.  There are explosions of green growth and alien trees between buildings, and a wildness is present, reminding us that this was all dense jungle not too long ago.  You only have to open your window to hear the most exotic and haunting birdsong, resembling microbursts of sonar, a cackling band of Alvin and the Chipmunks, and tookie tookie from George of the Jungle.  The energy is strong here, both from its people and from something deeper.

Twezimbe’s headquarters are in a quiet, upscale neighborhood of Kampala.  There is a handful of staff managing communications, programming, and administration.  In the morning a Twezimbe truck waits outside our apartment, ready to shuttle us around the city to complete whatever development tasks are on the day’s docket.  My first week at Twezimbe is spent familiarizing myself with their programs and interventions.   I am eager to find my work focus and get out into the field.
Madame Amelia

Twezimbe was founded by Madame Amelia Anne Kyambadde, the Ugandan Minister of Trade and Industry, as well as the Member of Parliament for rural Mpigi District outside of Kampala.  Through her organization Madame Amelia runs a diverse portfolio of interventions encompassing health, poverty alleviation, infrastructure, security, and economic development, all aimed at improving the socio-economic outlook for the people of Mpigi.  It is her vision that the work Twezimbe does in Mpigi will become a model for other districts, and that Twezimbe will lead grassroots interventions for the betterment of rural communities throughout Uganda. 

Twezimbe is unique in that it targets needs often outside the scope and budget of the federal government and the UN.  Her position as a politician and her on-the ground connections to the people of Mpigi give Madame and Twezimbe a direct link to community leaders and important institutions.  Twezimbe’s strengths are in its ability to mobilize the Mpigi communities and empower them to take ownership in the interventions affecting them.  Additionally, Madame’s influence in government serves as a catalyst allowing the NGO to achieve results quickly while circumventing bureaucratic tangle.

Our daily transportation
Charles and the rest of the Twezimbe staff have been keen to ensure my work with them is both enriching and meaningful for all parties involved, and I can’t thank them enough.  Because of my background and expertise in business and marketing, Twezimbe initially wanted me to investigate ways to improve the awareness and engagement of their interventions using digital marketing.  As the week progressed it became clear that I needed to get out into the field to observe Twezimbe’s constituents and interventions in action. Being in the field would bring clarity and direction to my area of focus. 

On Thursday we toured Twezimbe’s four field offices, meeting with staff, and learning about the various challenges that the people of Mpigi face.  Leaving Kampala, passing its outskirts, urban chaos abruptly melts into peaceful countryside.  As one of my seasoned classmates told me, “it gets rural really fast in Uganda.”  We drove through fields, forest, and villages, mostly on pothole ridden ocher dirt roads.  The countryside was lush, bucolic, with undulating green hills like a serpent’s back.  Most homes detached from the main roads do not have electricity.  The majority of these people live on less than $1.25 a day, below the UN’s international poverty line.  They survive through subsistence farming, eating whatever their gardens produce, and selling any surplus for small change.  Malaria is rampant, and high fertility rates coupled with low healthcare utilization equate to an abysmal maternal mortality rate. 

Bucolic Ugandan countryside
The highlight of my trip to the field was visiting Mpigi Health Center and meeting with its Director, Dr. Jubilee.  Staffed with just four doctors, nine nurses, and seven midwives, Mpigi Health Center serves a population of over 200,000 residents.  As we walked, Dr. Jubilee gave me a detailed tour of his facilities and introduced me to various staff.  I vigorously asked questions and took notes, trying to get a grasp on the overall health system and health challenges facing Mpigi District.  Dr. Jubilee manages several smaller health centers throughout the district, as well as a team of community health workers.  His challenges are great, including a lack of staff, inadequate medical supplies and medications, and low spatial capacity for his patients.  I was thrilled when Dr. Jubilee invited me to come back and work with him several days a week.  Returning to Kampala that night, I realized that I needed to be in the field, that immersion in Mpigi was where I would truly learn global health and make an impact. 
Dr. Jubilee and Me at Mpigi Health Center

Apparently Madame Amelia agreed with me.  In our first meeting of my second week she scrapped all plans to involve me in marketing and decided to send me out to Mpigi for complete immersion for 14 days.  Her mandate: spend time with the youth, observe youth interventions, interview them, interview health workers, meet with Dr. Jubilee.  “How can we improve their economic outlook, how can we improve their access and utilization of healthcare?”  So my work is solidified, a clear mission to guide me: deep immersion, research, and strategy development for improving the economic and health prospects of Mpigi youth.  Am I excited?  You bet.

Thursday, June 18, 2015

Zilinga?...How Much (Are Your Experiences Worth)?

Last week happened in a rush of greens and blues - mostly because I spent so much time in cars, going from one town to another. The highway here is a single paved road that connects each district in a long strip of land hugging Lake Malawi. It is more of an ocean, about three-fifths the size of the country itself.
First, we attended a mobile-health (mHealth) and health information system (HIS) meeting at the Center of Health in Mzuzu. I remembered my professors referencing such meetings during lectures: they are generally drawn-out and tedious, but a (debatably) necessary part of development. Perhaps because this was my first meeting, I found it all very exciting. Important people filed in and took their seats around my own. An important man opened the proceedings with a speech, to which another important man followed with his own speech. Needless to say, I felt as though I had just won the lottery and could not stop smiling like an idiot; it was all so important.

The first order of business was to discuss and edit a document that would become the backbone of a new HIS program to be launched in the coming weeks. Our job was to go through the entire piece, line by line, and determine where a standard operating procedure (SOP) should be written in. It was difficult, given that there were only two copies: one, floating around on paper and the other being projected onto the far right wall. Everyone took turns reading a paragraph aloud while simultaneously scribbling down any recommendations. At first, I felt lost and nervous, only able to focus on counting down the people until it would be my turn to read. The modification process was monopolized almost immediately by a handful of people, forming a sort of collective style of SOP recommendation: data breach, access, confidentiality. It was easy to pick up on, and my heart pounded when I had finally found my first SOP: should I say anything, what if they laugh at me? I’m just a nobody kid… 

Twenty minutes later, my voice was chiming in frequently with those who had enough energy to join the discussion. We would bounce back ideas:

“Is there an SOP for when new staff join the hospital and have not been trained to work with the program… And what if someone forgets how to do something?”

“How about we create one for capacity training then?”

“What about an SOP for when a clinic feels that they are ready to upgrade from a paper-based system to the digital one, is there a sort of timeline for progression or process for confirming ability to shift record-keeping?”

“We will make an SOP for determining upgrade status.”

I had SOPs coming out my ears and people were actually listening! I felt as though I was back in class, offering up ideas for a project or hypothetical activity and the anxiety slid off in the excitement of mutual understanding.

Even if the plans made in that meeting do not amount to much in the coming year in terms of development, it was everything to me. In that moment, I felt confident that I belonged with the best of public health, that my ideas were valid, and that what I bring to the table is, well, damn important. I have a lot to learn, but I know that I am capable of becoming better. I guess I was not sure of my abilities before coming here; there was always this little voice of doubt in the back of my mind about making my dreams a reality. I chose to major in Global Health because I wanted to do something good for people everywhere (total Messiah-Complex, I know…). 

Maybe this is God telling me that I can actually find my little niche in all of this. Hooray, I’m not a total wipe-out!
A few days later, the HIS team hopped the LIN mini-bus over the mountains (of cattle) to arrive in the district of Chitipa. From the boardroom to the classroom, it was time to put the mHealth and HIS meeting plans into action! There, we hosted a four-day training program that would transition the District Hospital’s (DHO) Outpatient Care Unit from a paper-based system to a digital one. It was exactly what we had been discussing a few days ago in Mzuzu. Now, I had the opportunity to be a part of the education component of development. You can imagine how annoyingly elated I was the entire car ride…

In my mind, it was going to be totally awesome, like the Lego Movie theme song, but reality was a bit less exciting, to say the least. On the first day of our arrival, we spent two hours unpacking and setting up the conference room. There were wires and delicate hardware materials everywhere, AKA a clumsy person’s nightmare! I almost stepped on an extension board and tripped on cables. 
The next day, I became a waitress and spent nearly the whole day running back and forth between soda shops purchasing refreshments and returning the empty glass bottles. I would also help anyone who had a question or got stuck, but mostly I was passing out crackers and picking up trash. Michiko, one of the MPH interns, deemed us Managers of Logistics, but I am not positive that the fancy name helped at all. I think it showed me how absolutely terrible I am at serving people, I mean, I always thought that I was a kind and humble person, but a few hours of “logistics” really brings out a person’s true colors. Kevin, another intern and co-Manager of Logistics, and I felt pretty unappreciated and useless. After talking - complaining - together for a while, I realized what a terrible attitude I had. I don’t blame me, I mean I had spent thousands of dollars to fly here in order to learn real Public Health stuff, and here I was, trash lady. I promise that there is a reason to why I am spending so much time on this… not just venting ladies and gentlemen.
It was easy to get miffed at first, but then I realized, this is an experience that I could only get by being here. Logistics, as inglorious as it may seem, is actually pivotal to successful conferences. In Malawi, and perhaps anywhere, the quality of refreshment and service provided are a big political message. Most of the people in the program were physicians or nurses, and everyone knew the price of each item offered. In this culture, we would be insulting their status if we gave any old generic brand good or made them buy their own snacks. The attendees would soon become unhappy and unwilling to participate in this very important capacity training seminar. The snacks and therefore my duty may not matter in the long run of sustainability for the hospital, but they were the gateway to the information that is. The HIS training that the staff received is priceless, but to them at this point in time, it is an inconvenient four days of not doing their job at the hospital at the expense of patients. They can’t all see the benefit yet, but when free Cocopina and fresh samosas are on the table, the sacrifice is a bit more digestible.
So, this was field-work. Humbling and tedious and even physically demanding (those glass bottle crates can get heavy), but worth it. It is day-by-day and uncomfortable for westerners like myself. I had to step out of my culture and get real(ly dirty) before I could see the end of the program: hospital staff with a new skill that would save lives.  

Thursday, June 4, 2015

What We Can Take Away From the WHA

These past two weeks encompassed a whirlwind of emotions ranging from excitement, inspiration, and passion to doubt, frustration, and anger. For some of us, the WHA was a shocking revelation of the frustratingly slow and political nature of public health on a global scale, where bureaucracy can trump progress and minimize idealistic notions of how health should function worldwide. Many of us have expressed deep frustration and even depression over these politics and shallow representations of public health issues and solutions. Others, however, were captivated by the opportunity to attend the WHA and stimulated by the side events, technical briefings, or committees to pursue their public health passions. Nevertheless, there was a fragile balance amidst a fray of emotions, making it easy to tip the scale and lose oneself in either the negative or positive ends of the spectrum. Some of us have reflected on these negative emotions in conversations and some have been so bothered they had trouble getting to sleep. I want to address these feelings of devastation and lack of hope because I believe there is an imperative message of public health here that must not be forgotten by future leaders in the field.

Overall, the WHA caused us to grapple with the field of public health, question everything, and confront our ignorance in many ways. We were forced to evaluate where we stand on certain issues, what we want to learn, and where we wish to see the world go from here.  Many of us were challenged in why we hold certain beliefs or passions, and pushed to analyze and defend these beliefs. In the process, opportunities arose for us to engage with global leaders and hear their perspective, as we began really evaluating our own perspectives and even discovering new passions. Because of this, the past couple of weeks represent a huge culmination of all we have learned/haven’t learned, expected/ didn't expect, along with our passions, fears, hopes, and anxieties. The complicated entanglement of all these aspects makes the World Health Assembly experience both the most exhausting yet relevant and rewarding experience we could ask for.

Although what each person walks away with is a highly personal and subjective, I really believe it is critical to see the whole picture of what we just experienced. This was an incredible, unforgettable opportunity that most students do not get to have. Yes, it was frustrating to stare global health problems head on and feel as though countries were dancing around the crux of the issues. Yes, it was frustrating to see how human rights and obvious public health concerns are essentially non-existent or not addressed in certain regions. Yes, it was frustrating to hear delegates talk of their countries’ vague ideas and plans that don’t seem to have tangible goals or outcomes.
It is important to acknowledge and accept that there are many problems in public health and in addressing critical issues worldwide. However, if the conversation stops here, then these negative feelings stew inside us, impeding progress. If we let global issues dismantle us, then what is there to say about those actually suffering the atrocities we are so enraged about? Where is the hope for these people, if even those with the duty of addressing these issues cannot handle the reality? These issues SHOULD bother us and shake our world. They should enrage us and make us question everything. This means we are in the right field! Instead of letting these issues tear us down and stir apathy or hopelessness, we must re-channel our energy into passion, advocacy, and commitment to making global change. 
Letting these global issues discourage or jade us only lets the evils of this world win. I’m not saying public health strides in on a white horse to “save the world”, but it recognizes and shoulders the burden of harsh realities in order to achieve the good it sets out to do. Part of being in this field is knowing and accepting you will carry a burden for the rest of your life, but letting this fuel your passion to create change. Hope cannot be lost, no matter how hard the journey becomes. I believe this is an essential concept to grasp at the core of what it means to work in public health, as we are trained to identify and address core problems from a holistic perspective. Understanding and accepting this responsibility is what will ultimately lead to real, tangible change.
We must also remember how incredible it is that these countries are meeting in the first place. How amazing is it that every country in the world can come together annually and agree on health priorities for the world? They bring together diverse cultures, languages, and beliefs and agree to resolutions and programs to address some of the worlds most challenging public health problems. While these discussions and progress might be slow, the alternative of not meeting is far worse.

It is also important to realize that the WHO has very little power to implement programs and enforce guidelines, but the meeting of countries sets the agenda for the entire world. The WHA has also stirred countless ideas and discussions that delegates will take back to their countries and consider when setting their health priorities. In addition, some of us have been discouraged with the WHA without realizing that we did not have the opportunity to see the working bodies debate these issues. Working groups and regional meetings were conducted every morning and multiple times throughout the day. This is where the real blood, sweat, and tears over global health problems and priorities were revealed. While we saw very little of this work in action, progress was made daily.
Despite some feelings of discouragement, our USC group has also made progress. The WHA meetings and organization visits spurred us to have continual conversations about public health issues- from late night arguments in bars to early morning discussions annoying the fellow Swiss bus riders. As students and emerging professionals in this field, these conversations are essential to not only process our ideas and feelings, but also figure out our passions and where we will enter the conversations upon graduation. Countless times in the midst of these conversations, we saw each other swell up with anger and excitement. This is something to celebrate. 

We must also keep in mind that so much progress has already been made, and we cannot be shortsighted by forgetting to take joy in all victories in the midst of pushing for further action. For example, we have been afforded the privilege of seeing public health for what it is today. By definition, public health addresses health concerns in a multi-dimensional, holistic approach. I remember my first day of college when my professors defined public health as “meeting people where they are”. It accepts rather than judges, creating an atmosphere in which public health professionals can work with people to better their lives. Because of this, I went through college believing public health by definition must address the social injustice that fosters vulnerability among populations. These concepts are all integrated into what public health means today.

However, this is just the standard of present day, and it actually took years of growing to get to this place. Public health by definition used to be coercively quarantining and isolating people with no regard to social conditions, inequalities, or human rights. Now, we have the privilege of seeing it as an accepting, non-judgmental and holistic approach to health. It wasn’t always obvious that human rights concerns were relevant and morally reprehensible. It wasn’t always obvious that everyone should have universal, non-discriminatory access to health services. It wasn’t always obvious that those with HIV should be guaranteed universal access to ARVs.

In fact, Jonathan Mann’s work through the Global Program on AIDS helped set the stage for our current definition of public health. Human rights became a very relevant concern in the 1980s, as evidence emerged depicting how discrimination drove people away from essential HIV services. Thus, it was important to rule out discrimination in order to better control the epidemic. Although the solution to address discrimination was initially just the most pragmatic way to improve health, it helped set the current foundation for public health. Over time, addressing social determinants such as discrimination became a moral obligation of public health rather than just a pragmatic method to control disease. Other, like-minded individuals furthered this progress by addressing public health through the lens of social conditions that foster health concerns and vulnerability, leading us to where we are today.

When you consider these aspects, it is absolutely amazing to see how UN member states signed international human rights treaties, or agreed on issues of universal health coverage and access to care for everyone. The fact that the post-2015 agenda was even created is incredible, since it is really the first global commitment and shared acknowledgement of the critical role social determinants play in health. There were countless WHA meetings prioritizing the most marginalized, forgotten communities for the first time in an overall theme of  “leaving no one behind”. This is amazing, as the burden of disease typically falls on the most marginalized groups. Because social determinants play the largest role in health outcomes, the global consideration of the SDGs are a HUGE step forward in our field.

Yes, it will come with many challenges, as many have already pointed out how the SDGs are overly broad, have way too many components, or are unrealistic. We cannot let this discourage us. Instead, we need to understand limitations and capitalize on strengths as we continue to strive towards progress in the field in public health.  While attending the WHA and absorbing all the information we hear, whether it is good or bad, it is important to remember people like Jonathan Mann and Paul Farmer dedicated their lives to seeing the world acknowledge the social determinants and rights-based components of public health. They were enraged with the injustices they saw, just like we are enraged now. This anger fueled dedicated commitment to seeing the world change, as they spent years working to define public health the way we learn it today.
Thus, seeing public health in its current state is both a privilege and a curse, as there has been so much progress yet always much more that needs to be done. We are fortunate enough to be able to analyze current issues of our world and see major problems as intuitively wrong, as the way we identify, analyze, and approach these problems was not intuitive just a short time ago. Concurrently, these analyses enable us to dig even deeper into health issues, exposing great injustices in the world that shake and enrage us. Good! Again, we are in the right field.
As Former Ambassador Lange described, those that leave the field are those that get frustrated and let it take over their morale. Others, however, use this energy to create change using the system. Lange argued that making change is easier to do in the system than outside of it. For instance, with well-respected and established organizations like the WHO and the UN, the guidelines for the entire world are set and change can be made. 
Furthermore, when three of us spoke privately with Dr. Claudia Garcia-Moreno, she reiterated the idea that frustration must fuel passion. We discussed the role of women in the world relevant to gender-based violence, equality, and rights, and how there seems to be little progress despite a global acknowledgment of the need to empower women and improve their status. She spoke of the frustrations in her own work, and how she ultimately needed to use her anger to inspire her commitment to see change. She advised us to do the same, letting the anger motivate us to make a difference rather than dishearten us. If we can learn to harness our sadness and frustration, we can empower ourselves and others to move forward and resiliently fight and advocate for public health and equality for all.

As emerging leaders, we can be heartbroken or frustrated with the politics of global public health, but it has to be what enrages us and energizes us to keep working. It needs to be fuel to the fire.  Public health is a collaboration of everyone enraged about health issues throughout the world in an effort to address them. It is an entire community of people willing to deal with the politics, slow progress, and lack of understanding in order to make improvements in the world and promote health. Together, we work hard every day to further progress in this field, and maybe the next generation of public health students will define public health in an incredible way that seems unfathomable to us now.

If we can really grasp all of this, we will be strong global leaders in our field, as we dedicate our lives to creating positive change as those before us have done, letting the anger and frustration inspire passion and hope. Then, we really can make a difference.

Tuesday, June 2, 2015


Reflecting upon these past weeks in Geneva, I can genuinely say that this experience has been enlightening. My eyes have been opened to both the political structure and bureaucracy of the World Health Assembly. I have learned that decision making from an international standpoint is a slow and tedious process. Diplomacy is vital as delegates from across the globe must come together to communicate their perspective and point of view effectively. While positions on various topics may differ, member states must be open to understanding the perspective of others in order to make progress on a global scale.

Power relations may be unequal outside of the assembly, creating opportunities for countries to become tactful in developing strategies to form alliances that can push for policy. Whether during coffee breaks at the Serpentine Lounge or in side events at the Intercontinental Hotel, people are constantly in conversation about issues that matter. During these interactions people come together to network and form alliances. Perceptions change and friendships form.

From my observations of these interactions –both formal during committee meetings and informal during side events—I have taken away many topics of discussion. Most importantly, I have recognized the value of cultural awareness and disease surveillance.

Cultural awareness is a theme that was discussed throughout the assembly. For example, it was emphasized that having access to cultural knowledge is critical in order to communicate and facilitate change globally. This was illustrated with the Ebola outbreak. Due to cultural and religious practices, Ebola spread rapidly becoming more difficult to control. The handling of the deceased in some of the impacted African regions led to the exchange of bodily fluids catalyzing the spread of disease amongst human vectors. Questioning the cultural norms of these burial practices contributed to the native populations’ distrust of public health officials. Ultimately, community leaders and those who understood the culture well had to be used to educate and inform the public about safe practices to prevent the further spread of disease.

Furthermore, the importance of understanding cultural norms was emphasized in side meetings as well. For instance, we met with the retired ambassador John Lange who worked in Botswana on HIV/AIDs during the 1990’s. He discussed how in Botswana, individuals did not want to get tested for HIV because of fear that they would lose sleep over discovering that they were HIV positive. At the time, HIV affected approximately 30% of the population. While common, it was still culturally stigmatized and therefore, difficult to get people to be tested. People viewed this disease as either a death sentence or something that prevented someone from working and supporting their families. Over time these views changed, but progress was slow as it was necessary to truly understand why people would not get tested as well as any cultural or social barriers to doing so. Thus, when trying to create behavior change it is important to understand perceptions and views from the population of interest. Therefore, it may be useful to live in the country of interest for an extended period of time or to consult a cultural anthropologist.

Another theme that was emphasized over these past weeks was that of surveillance. It was repeatedly stated that disease knows no boundaries. This is exacerbated by the fact that globalization and modern technology have contributed to the increasing movement of people across borders. We live in an interconnected world with a rising exchange of goods and services. The outcome is potentially hazardous, as with travel comes disease. It is impossible to stop this movement absolutely as no one power or country can account for every single potential vector in exchange. Therefore, surveillance is crucial, along with the global sharing of information worldwide. Countries must work together in assessing and tracking the landscape during current outbreaks as well as for potential epidemics in the future. Data should be collected frequently and then shared for the well being of populations overall. The problem then arises in moving from theory to action. A global system of efficient and effective disease surveillance and information sharing is no easy feat and requires complex and coordinated efforts. There will be many challenges and work to be done now and in the future. However, raising awareness to the next generation of policy members and public health officials may be the first step forward in creating positive change. #WHA68

Behind Serpentine Lounge
Cultural awareness bringing animals together

Technical Meeting on Ebola