Monday, June 30, 2014

Saying Goodbye


As my time in Maputo comes to a close, I cannot help but think about everyone who made this incredible experience. From USC to Maputo, I’m so grateful for the people I have met and everyone who helped me along my journey.
Saying goodbye is always hard, but with the friends that I made in Mozambique, I’m leaving Maputo with a heavy heart. I will never forget the hospitality of the families that I stayed with. The Zandamela’s treated me as if I were another family member, and I became friends with them. By the end of my stay, I did not want to say goodbye to my new friends. For one, they taught me a lot about family. In Mozambique, family is everything and they support each other through thick and thin. The Zandamela’s are the most kind-hearted people you will ever meet, and they went above and beyond to make me feel comfortable while I was 11,000 miles away from home.
Anisha and Salley
Horacio, Shanyll, Julietta, and Maida
For the people at Reencontro and Central Hospital, I will always admire their passion for their work. Olinda, Arao, and Reginald at Reencontro have taught me so much about caring for others and finding something you are truly passionate about. They dedicated their lives to improving the lives of others. I will never forget the families and children that who have benefited from Reencontro’s work, and I’m eager to see Reencontro’s future growth in Mozambique. 
I spent my last few days in Maputo visiting the other Reencontro site. This site is where over 200 children come before or after school to get extra help in school, psychological support from counselors, and vocational training such as computer skills and sewing. As soon as I walked in, so many children ran up to me to hug me and show around the facility. I have never encountered such loving children in my life. They would hold my hand, dance for me, play games with me, and they loved taking photos! It was great to visit this other facility because I was able to see another part of Reencontro and learn more about it. I saw how happy the children were, and I can see them growing up to become independent individuals. It was difficult to say goodbye, but I know they are in good hands.


Lunchtime!

Lastly, I would like to thank Dr. Ferguson, my faculty advisor, who helped me with my project from the very beginning. She has always been so supportive and I cannot thank her enough. I would also like to thank USC Institute of Global Health for allowing me to have this incredible experience that I will never forget. In addition, this experience would not be possible without Malena Ruth from the African Millennium Foundation who organized and connected me with Reencontro in Mozambique. Finally, thank you to my family for being so supportive for my entire life! 

Me with Anisha
Thank you and Fight On!

Wednesday, June 18, 2014

Maputo Central Hospital



Each day I wake up at 5am in order to get ready to leave at 6am. I carpool with my host family mother, Ines, and I learned that many families here do not even own cars. Therefore, they use public transportation called chapas (small vans) to get from destination to destination. Chapas can only cost around 18 meticals each way (equivalent to around 6 cents USD), but can cram up to 20 or more people in a small van. It is necessary to leave at 6am because there is only one road from Matola to Maputo, some 15 km from the city but takes up to two hours with traffic. The few roads do not even come close to providing enough room for the amount of cars in Maputo and the surrounding cities.
Catching a Chapa!
Central Hospital of Maputo is the largest public hospital in Mozambique. Julietta, Ines’ sister-in-law, works as a nurse in the pediatric ward of the Central Hospital. I was able to tour the hospital to get a glimpse of what goes on in this hospital. I found it to be vastly different than American hospitals. The buildings are run-down, and the rooms lack more sophisticated medical equipment. However, the hospital is organized and the medical staff is both knowledgeable and passionate about their work. The first few days, I observed several patients being treated for various ailments: from malaria to severe burns to HIV/AIDS. Malaria is a serious problem in Mozambique because many people do not have mosquito nets to protect them nor can they afford to pay for malaria pills to prevent it. A young girl came to Central Hospital with a high fever and was not able to eat for a few days. After more tests, they diagnosed her with malaria and treated her immediately. Malaria is deadly, and I was so surprised to see such a patient because you rarely find malaria cases in the United States.
Walking through the pediatric ward of Maputo Central Hospital
In addition, to understand more about HIV/AIDS in Mozambique, I shadowed a doctor in the HIV/AIDS clinic at the Central Hospital. I was shocked to see the waiting room completely filled with people, and each patient has their own story to tell. I worked with the doctor in the clinic, and after each patient, she would explain what happened. She emphasized the importance of education. There are many cases where men believe having sex with a virgin will rid themselves of the disease. Most commonly, people simply do not want to use a condom. This, along with many other complex issues, makes HIV/AIDS so prevalent in Mozambique and around the world. I have never understood nor witnessed the complexity of HIV/AIDS until now.
Me with Julietta, head nurse of Pediatric ICU

Tuesday, June 17, 2014

Reencontro


Reencontro is where I have been spending most of my time here in Maputo. It is located around 20 minutes from the Central Hospital. Olinda Mugabe is the founder of Reencontro, and I have seen, first-hand, the incredible work she has done for people who have been affected by HIV/AIDS. Olinda founded Reencontro to support orphans of HIV/AIDS victims, who were left to fend for themselves after their parents died. Starting out by supporting 15 families on her own, she has grown Reencontro to support over 7,000 children in Southern Mozambican provinces of Maputo and Gaza.

Me with Olinda Mugabe
Fighting On at Reencontro!
At Reencontro, they provide a variety of services ranging from psychosocial support, home-based care, vocational training, community-based health, and more. My work for Reencontro has been focused on community-based health and youth health education. I have traveled to several communities in and around Maputo and worked with the community activists. Community activists are a group of women in each community who educate and teach mothers about proper breastfeeding, as well as provide support and counseling for single mothers. On some visits, I helped prepare a meal for breastfeeding mothers so their babies can get the proper nutrition to grow. What I love most about the community visits is being able to see how the people of Maputo live, while also experiencing the impact that Reencontro has made in these communities. It has opened my eyes to single-mothers, many who are my age, working and supporting their children. Community visits are where I have met some incredible women and it’s humbling to hear so many of their stories!


Other days, I work with a Reencontro employee, Arao, to create programs for the children who attend Reencontro before school starts. My lessons include teaching about proper health behaviors and teaching English to the children. Through these lessons, we have done a number of activities that included playing Ultimate Frisbee to singing and dancing about brushing your teeth. I love working with children so being around these kids are both fun and refreshing!



 These next few weeks, I will continue to do community visits as well as my lessons for the children. If you want to learn more about Reecontro, their website is: http://reencontromozambique.wordpress.com

Saturday, June 14, 2014

Getting to Know Maputo, Mozambique


My first impressions of Maputo, Mozambique were the sights and sounds outside my car window: roads filled with pot-holes, bumper to bumper traffic that beats LA traffic, old Japanese cars, streets filled with vendors, ancient and run-down buildings depicting Portuguese colonialism, and overpopulated streets.
But there is one thing that I love so far about Maputo: the people. They will probably be the most friendly and most welcoming people you will ever meet. They love their country and welcome anyone who visits. Alongside the paradise beaches and the natural and untouched wildlife in the North, Mozambique is, in fact, a beautiful country. And Maputo, the Capital of Mozambique, will serve as my home for the next month.
Julietta and her grandchild, Shanyll
Upon arrival in Maputo, I was greeted by Horacio, who welcomed me with a smile and hugs upon hugs. He drove me to his home in Maputo. There, he lives with 3 of his 7 kids and his wife, Julietta. Julietta is a nurse at the Central Hospital, the largest public hospital in Maputo. This hospital is where I will visit many times during my stay. I met his children at their apartment: Maida, Arsenio, and Danny. Caita, who is their cousin, also lives in this 2-bedroom apartment. They immediately served some dinner that I realized is a staple meal in Mozambique: Chicken and rice. At first, the language barrier was difficult to deal with, but their children knew some English so we were able to get to know each other.
Myself with Karmen's cousin, Ercilia, and Caita
Afterwards, Ines, arrived to pick me up. I will be living at Ines’ house along with her daughter, Karmen, in a city outside of Maputo, called Matola. Ines is Horacio’s sister and works for the Ministry of Mineral Resources. I was truly grateful to have her open her home for the next month for me.
The next few days were all about getting to know the sights, sounds, and people of Maputo.  The day after I arrived in Maputo, it was Children’s Day. Karmen and her friends took me to Maputo to celebrate in the festivities. However, there were too many people there so we decided to visit Costa do Sol, Maputo’s beach. It was great to see the scenery of Maputo and touch the warm waters of Indian Ocean for the first time.
With my host family's children and cousins: Zaza, Shanyll, and Aneesha
The following few days was an introduction to Central Hospital and the non-profit organization I am going to work with, Reencontro. I will be focusing on HIV/AIDS in Mozambique. HIV/AIDS has a 16% prevalence rate in Mozambique and the second leading cause of death, behind malaria. Reencontro focuses on children affected by the disease, providing them with education and a safe haven. They not only reach out to children, but they also assist families and communities surrounding Maputo.
Through the African Millenium Foundation, I was able to create a partnership with Reencontro, and become familiar with their work. Olinda Mugabe is the founder of Reencontro and has dedicated her life in improving the lives of people in Mozambique. I will be working closely with her to develop my own program with her organization. I’m truly grateful and excited to be given this opportunity and cannot wait to experience what the next few weeks have in store for me. Keep checking this blog to read about my experience here in Maputo!

Friday, April 18, 2014

The Relevance of Global Health in the Post-2015 Era


(This post is based on a talk given at a Globemed USC event April 12, 2014)

Nearly 15 years ago the nations of the world came together at the dawn of the new century and took a look around them. They were not happy with what they saw. Hundreds of millions of people around the world continued to live in extreme poverty, millions of children were dying before they reached their 5th birthday and millions of those who did survive lacked access to education. Mothers were dying at alarming rates during childbirth, hunger and avoidable communicable disease ravaged communities, and sub-Saharan Africa stood in the midst of a horrific uncontrolled epidemic of HIV. Basic human rights—the rights of each person on the planet to health, education, shelter, and security—were lacking for over a billion members of the global community.
In response, at the Millennium Summit in September 2000 the largest gathering of world leaders in history adopted the United Nations Millennium Declaration, committing their nations to a new global partnership to reduce extreme poverty and setting out a series of time-bound targets, with a deadline of 2015. These targets have become known as the Millennium Development Goals, or MDGs. The MDGs gained international credibility and have facilitated laudable poverty-reduction outcomes.
Notably, health held prominence within the MDGs framework.  Four of the eight goals were health focused – eradicating extreme hunger, reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria and other disease. Moreover, a fifth goal, ensuring environmental sustainably, referred in practice to improving access to clean water and sanitation. Consequently, support for health work in low-income countries, particularity around those specific issues identified in the goals, has grown significantly over the past decade and a half with substantial increases in funding and political attention. This investment has even reached universities, with hundreds of new institutes and centers dedicated to promoting health in developing countries popping up around the world–including here at USC.
The investment in the health of the world’s poorest has yielded significant results. Between 2000 and 2010, mortality rates from malaria fell by over 25 percent, averting some 1.1 million deaths, and between 1995 and 2011, a total of 51 million tuberculosis patients were treated, saving 20 million lives. Globally, new HIV infections declined by 33% between 2001 and 2012 and in 2010, the world met the MDG target on access to safe drinking water. Between 2000 and 2010, over 200 million slum dwellers gained access to improved water sources, sanitation facilities, durable housing or sufficient living space exceeding the MDG goals of bringing 100 million people out of extreme poverty,
However, as the MDGs enter into the last year before their deadline, countries are falling short on other targets. Despite progress in the reduction of preventable infant and maternal mortality, limited access to antenatal care and skilled birth attendance remains problematic in rural areas, particularly in sub-Saharan Africa. 
There is clearly unfinished work from the MDGs to be carried forward into the next generation of global development. Today, the international community is actively engaged in consultations and conferences developing a new vision for global development.  This next generation of global development goals is often referred to as the post-2015 development agenda. The global context through which the post-2015 development agenda is being configured is markedly different from that which framed the MDG era. Key features of our changing world include the economic shift of many populous countries into middle-income status; the dramatic rise in life expectancy; ubiquitous connectivity through transportation and communications technologies; rapid urbanization; and the rise of environmental threats that affect every person on earth – the greatest among them being climate change.  
Given today’s pressing global challenges, the post-2015 development goals will speak to much more than just the completion of the MDG agenda. A key shift in the post-2015 development agenda is the mergence of the MDGs with the Sustainable Development Goals (SDGs)—based on the agenda articulated in the 2013 UN Conference on Sustainable Development (Rio+20).  Rather than focusing only on poverty-reduction in low- and middle-income countries, the new global development agenda, as framed through the SDGs, is global, addressing the global implications of development for all states, and integrating economic development, social inclusion, environmental sustainability, and good governance. While the work of the MDGs transforming low-income countries will need to be continued, and extended to meet the basic needs of the billion poor in middle-income countries, the emerging SDGs will also make universal claims to economic development, environmental sustainability, and social inclusion – implying the need to create change in even the richest countries on earth.
The question becomes, where will health feature in the new broader global development agenda? There is much speculation that health has had its moment in the spotlight and that it is likely to succumb to competition from other issues demanding attention.  In the final report of the High-Level Panel of Eminent Persons on the Post-2015 agenda, health was relegated to the annex – along with all other specific targets. Instead the report focused on five transformative shifts that were central to their vision of global change – equity, sustainable development, economic growth and jobs, peace and governance, and a new global partnership.
Of course, health can be readily subsumed within such a framework. However, if health is to retain its prominence in the post-2015 development era, it must be demonstrated to be integral to, and not merely an indicator of, social sustainability. In other words, not only does economic, social and environmental sustainability create health and wellbeing – but that the active protection of the health and well-being of a population is integral to its social, economic and environmental sustainability.
I often speak to USC students about what "global health" means. Is it the same as tropical medicine of the 1950s? Or international health of the 1970s and 1980s?  I argue, sometimes un-popularly within the broader global health community, the field of global health is fundamentally different from past international health work.  It is within the context of the post-2015 development agenda that the difference and significance of this definitional debate becomes apparent.
On the one hand, we have traditional international health approaches reflected in the siloed, disease-specific goals and targets encompassed with the MDGs.  Although this approach has served some specific areas of intervention well, approaches to sustainable organizational and individual behavior change have largely failed. The approach is often based on a traditional understanding of international aid – an understanding rooted in the dated and defunct notion of helping those who can’t help themselves – (people much different from you and me) and on delivering a technical "fix" off a checklist (think vaccines, nets, drugs, housing and water pumps). The inability of international health programs to integrate with broader sustainable development approaches threatens to sideline health within the emerging development agenda.
On the other hand, our understanding of global health as taught here at USC emphasizes the strategic shifts required to retain health within the SDG vision of the future. Global health reframes health in terms of social sustainability, addresses health universally in our inter-connected world, and demands close collaboration with colleagues in other technical sectors including energy, law, finance, and governance.  It is a natural progression in the way we have approached health over time – from clinical medicine in the 1800s, to public health in the 1900s, to sustainable development in the 21st century.
Students, you are graduating into a post-2015 world. Health must be integrated into each element of sustainable development – economic, social and environmental – not quarantined from them.  You must be ready to bring global health into this new paradigm – to present health and your training and skills as a precondition for social sustainability, critical for the natural environment, and key to progress and prosperity. You can start here at USC where every discipline comes together on campus – together our Trojan community can find the answers to the "World We Want."
I would like to close by emphasizing that environmental sustainability is under “severe threat” as growth of global emissions of carbon dioxide continues to accelerate. Emissions today are approximately 50 percent higher than in 1990. The 2013 UN report on the state of the world warned, “Forests continue to be lost at an alarming rate. Overexploitation of marine fish stocks is resulting in diminished yields […] birds, mammals and other species are heading for extinction at an ever faster rate, with declines in both populations and distribution.”  
With climate change and environmental degradation threatening global growth and security— and consequently all of our health—the global community must prioritize the issue and global health can and should strongly contribute to this agenda. To date, however, discussions on climate change have failed to prioritize the impact of climate change on health – particularly in least developed countries. This failure to anticipate climate-related disease burdens is likely to be extremely costly for health interests.
Recently many of you had the opportunity to meet with Stephen Lewis as part of the USC Institute for Global Health’s lecture series. Lewis is a key figure in global health and human rights, having spent his career fighting at the highest level of politics for women and those suffering from HIV. His message to you was clear – the earth is dying and as a consequence so are we all. He urged you, and I am going to echo his call, to focus your careers on ensuring that the earth and human kind survives. The global health community will not be able to do this alone. However, it will be an essential partner in collecting the evidence-base, translating the evidence into effective policy solutions, and advocating like mad to ensure that policy changes are made before human health as we know it is lost forever.  

Friday, February 28, 2014

Purnima Mane Event

On February 20, Pathfinder International CEO Purnima Mane came to USC as a part of the Global Health Lecture Series, hosted by the USC Institute for Global Health. I was particularly inspired by her words, and decided to write a post on my own blog summarizing Dr. Mane's points so I can collect my own thoughts and also share them with others. Click below to read more!

Balancing Idealism and Pragmatism—CEO Purnima Mane speaks at USC


One of my favorite parts about attending USC is the Trojan network—not only do we have access to a diverse set of professionals, but we are also offered countless opportunities to learn directly from the pioneers spanning many industries. Thanks to USC’s Institute for Global Health, I had the privilege of hearing global health leader Purnima Mane speak on campus. Read my blog »



Watch the lecture:


Sunday, August 18, 2013

The Last Day

As quick as my time in Nairobi had begun it was about to come to a bitter-sweet end. I had one final day in Nairobi to collect 93 more surveys for my study. Due to the error of the following day, the Changamka team helped me phone and confirm the participants that were misled about the date to come that night to the same venue. The early morning until the hour before the time of the meeting with the participants were filled with “hello”, “is this…?”, “are you still available today?” and “thank you very much”. By noon, the confirmation list still didn’t look very good. Many participants were reluctant due to the lateness in calling, the distance of the venue, and the importance to them. At this point, I knew there was only so much I could do. Rather then worry about what I had no more control over I decided to concentrate on the other piece of my research study—the stakeholder interviews. I spent the rest of the afternoon engaging in conversation with the stakeholders of Linda Jamii and I was happy to learn many intriguing new information about the company, its business model, and the environment in which it was created. More importantly to me, the stakeholders were very enthusiastic when speaking to me about Linda Jamiii and it’s potential to improve the health of their country. It was very uplifting to see the amount of pride that exuded from the stakeholders when speaking of Linda Jamii because they had so much high hopes for the future health and wellness of their country.

As 4 pm struck it was time for me and some of the Changamka team to head into town to the venue we had chosen. Once we got there we took a few minutes to set our station up and by 5 pm we sat nervously waiting to see if any of the participants we confirmed earlier that day would actually show up. Slowly, participants started to trickle in around 5:30 pm and as each participant sat down I came over to run over the protocol, gather their consent, and conduct the survey. Each time I conducted the survey I learned a little bit more about how to conduct it more smoothly so that the participant would be less confused over the questions each time. Also, since the survey was quite extensive, I had to try and keep the participant engaged and entertained in order to maintain their attention throughout so they would not give up on the survey midway. Luckily many of the participants spoke English as well so I did not have to utilize translators which also gave me the added opportunity to ask more in-depth questions beyond what the survey asked. If I were to do the surveys again I would definitely take out some questions that I found to not to be applicable to the population I was surveying since those questions tended to tire out the participant before we even got to the more valuable questions. From this experience I learned a lot about the target population and how to create better surveys to get at the real questions the study is interested in. Below is a picture of a few participants filling out the survey as I was reading the questions a loud.

At the end of my last day, I had only collected a total of 20 participant surveys for the entire week—13 participants showed up to the venue the last day. Yes, I am still 80 short of reaching my target goal however, I don’t believe the whole week was a total loss; rather it was an amazing learning experience. Since my arrival in Kenya, I have truly met some amazing and wonderful people at Changamka that have shown me nothing but kindness. I have learned so much about not only the company from Sam Agutu, founder and CEO of Changamka and Linda Jamii, and his talented staff but the culture and the people that call Kenya their home. All in all, I met, spoke, worked and built relationships with many people that have made my journey to Nairobi a wonderful one.

Following are a couple of pictures from the office that I worked in for the week I stayed in Kenya.
The first photo is with Sam Agutu, founder and CEO of Changamka Microhealth Limited, who made sure that I was provided anything I might need to conduct my study during the week I was there.

This is a picture with Scholastica who I worked closely with to develop strategies to find participants for the survey.

This is a photo with Colby who is an MBA student from Duke who was there to help Changamka analyze their data.

This picture is of Solomon who is in charge of the Changamka database and who also helped me a lot by explaining how the company operated.

This photo is of Edwin (right) and Mercy (left) who were both key to helping me call and gather participants for the study.
This photo is with Nehemiah who is the head accountant at Changamka.

Lastly, the final photo is of the amazing Changamka Microhealth Limited team who I truly am honored to meet and work with.

My journey to Nairobi is definitely one I will always remember and very fortunate to have; thank you to Heather Wipfli and the Institute of Global Health for making it all possible.