Que Ondas from Honduras!

Rafa, our driver, and I in Yamaguare

For the past few days, I've been going out to the community, Yamaguare, and surveying the adults living there. My GB partner, Rachel Gutierrez, and I have been getting great responses to our survey and all of the community members have been eager to participate.

Our survey is a collection of questions measuring different forms of empowerment. It covers economic empowerment, decision making capabilities, self-image, differences in perceptions of gender, educational opportunities, and communication within households and between the women in the community. We use a mixed methods approach, having some of the questions being multiple choice and others free response.

On a typical day, Rachel and I have breakfast at 8 with our driver and then head out to the community. There, we walk around to neighboring homes and conduct surveys with the residents. Each survey takes between 20 - 30 minutes, depending on their capability to understand us and their willingness to share their insights. Usually, we break for lunch around noon and then continue working until 3-4 P.M. In a day, we survey on average 12-15 households. By 5:30 to 6 p.m., we are back at the compound and ready for dinner. The rest of the night is spent transcribing the responses and inputting survey answers. I've begun to fall into the Honduran rhythm of life!

Rachel and I hanging out at one of the houses we surveyed

However, we have encountered a few obstacles during our visits so far. One problem we experienced early on was ensuring that the community members understood our questions and concepts. For example, many had difficulty answer questions due to the higher level of vocabulary used in the surveys. Therefore, after the first couple of days, we sat down with our driver, Rafa, and revamped the survey to cater to the audience. I've also had difficulty surveying the men since they are usually out working in the fields until sundown. However, on Sunday we managed to interview quite a few, since they do not work that day.

Today, we successfully finished surveying in Yamaguare and will be resuming work on January 1st in Zarzal, a neighboring community of a higher economic status. Since we finished early, we stopped by one of the homes in the community and spent the afternoon hanging out with the kids. They taught us an extremely competitive version of hopscotch and I helped the older son with his English homework.

Walking through the community, Rachel and I also noticed that there were many preparations being made for the New Year fiestas. We stumbled upon a particularly grisly scene of the men killing and preparing cerdo, or pig. Throughout the day, there were various community members proudly walking around with their portion of the pig. After talking to our driver, we also found out that is customary for Hondurans to stay up until sunrise on New Years Eve, so I'm preparing for a crazy celebration tomorrow night!

Some of the men in the community with their New Years Eve dinner

Mas gordo en Mexico

There is a growing problem in Mexico with obesity, and the country is beginning to resemble its rotund neighbor to the north.  Citing the OECD, the Economist notes:

"The statistics are impressive, and alarming. According to the OECD, Mexico is now the second fattest nation in that group of 30 countries. A health poll in 1999 found that 35% of women were overweight, and another 24% technically obese. Juan Rivera, an official at the National Institute of Public Health, says that the combined figure for men would be about 55%, and that a similar poll to be carried out next year will show the fat quotient rising. Only the United States, with combined figures of over 60%, is ahead."

The article cites many factors fueling this precipitious balooning. Some of it found in diet, some in urbanization and the lack of manual labor or excercise (the country side has not seen the same increases), and a major factor is the amount of soda consumption. The aforementioned Economist article notes that Mexicans consume nearly 100 litres of soda per year, second only Americans and three times as much a Brazilians. Meanwhile, all the sugary soda consumption has caused type 2 diabetes to skyrocket. A Time Magazine article cites that from 2000 to 2006, Mexico saw a 31 percent increase in type 2 diabetes.

From San Cristobal de Las Casas

While traveling through Mexico, it is hard not to notice the ubuiquity of cola. Signs are everywhere for "Tome lo bueno," have a coke. In part, soda is so popular because there isn´t always access to clean drinking water. But soda consumption also seems to be part of a socialized norm, albeit an unhealthy one.

Back to the overall problem of obesity in Mexico, the Mexican government has realized it has a problem and has begun carrying out a domestic public diplomacy campaign to get its citizens to lose weight. In 2008, the Calderon government announced the national campaign "Vamos por un Million de Kilos," Let´s lose a million pounds. Time notes that the crux of this campaign includes:

"[...] working to mandate more physical education in public schools and encourage employers
and unions to give workers time for exercise. The administration of President Felipe Calderon says it has built or renovated more than 800 public sports facilities around the country. The National Institute of Public Health is promoting food education and healthier choices in schools, such as fruits and vegetables instead of chips and soda."

That Mexico is aware of its weight problem and is carrying out a public diplomacy campaign is a good first step, but it will take some serious work to shed the added kilos and socialize a real lifestyle change.

Mediterranean studies of Cardiovascular disease and Hyperglycemia: Analytical Modeling of Population Socio-economic transitions (MedCHAMPS)

I realize that it may be important and/or useful to describe what it is exactly that I am doing in Aleppo, Syria and then in Birzeit (near Ramallah) in West Bank/Palestine, and Tunis in Tunisia in the upcoming weeks. During my time in the Global Health track I have gained a great appreciation for the Eastern Mediterranean and Southwestern Asian regions. The interest is personal, as well as professional, and I am continually surprised and fascinated by the depth and complexity of the history, culture, politics, and religion of the diverse peoples who inhabit this area.

As I’m sure you all follow my every move, you are probably aware that Sonny Patel and I developed our own research project last year in which we spent a month in Istanbul investigating the transition of the public health care system in Turkey to a privatized model. It was an incredibly unique and eye-opening experience, but I realized that Turkey was not quite where I wanted to focus my career. Ever since Istanbul I have been planning for my return to the Middle East and had originally decided to look into completing my practicum in Beirut, Lebanon. However, in speaking with Dr. Heather Wipfli last summer, she brought to my attention a new European Union-funded project studying and modeling cardiovascular morbidity and mortality, directed in part by a former colleague of hers, working at the Syrian Center for Tobacco Studies. Hearing this, I was understandably intrigued and upon learning that three of the other sites were in Turkey, Palestine, and Tunisia, I was in love. I signed on immediately and started sending the many, many emails it would take to confirm my stay at all four sites. So here I am.

As will be described in the upcoming video series explaining more about MedCHAMPS, the study involves several “work packages”, which involve both qualitative and quantitative data gathering and analysis. The goal of the project is to address the emerging issue of non-communicable disease in low-middle income countries (specifically in the four mentioned) and to improve the health of these populations by reducing the burden of Cardiovascular Disease (CVD) and diabetes. The overall objective is to achieve this goal through the development of culturally appropriate policy initiatives, both inside and outside the health sector.

These specific countries were chosen to participate primarily because they all have a large portion of the population who is affected by CVD and diabetes. However, they also share a number of additional attributes which makes studying them together appropriate. All four countries have sufficient data on both conditions that is available for model development, they are socioeconomically, ethnically, and geographically diverse, they all share a similar religious bond, and have several of the same risk factors in common, namely obesity, hypertension, diabetes, and tobacco smoking. That last one is indeed a major problem. Having to spend time in cafes to write, I can tell you that Syrians smoke nearly as frequently as they breathe. With the U.S. as the land of the smoker-as-social-pariah, it is amazing to realize just how far we have come with near-eradication of public tobacco use. Here, unless you are outside, you must sit in a cloud of cigarette or narghile (hookah) pipe smoke.

However, I am merely an outsider and will leave it up to the incredibly hard-working, passionate, and driven individuals with whom I work to provide the details for what currently plagues the health situation in Syria. Over the next several posts I will provide brief interviews with the people that are most intimately involved with the MedCHAMPS project and who also all pull double-duty with the Syrian Center for Tobacco Studies (and often a third or fourth job). Please feel free to send me your questions and/or comments and I will happily answer as best and as quickly as I can. Thank you for reading and enjoy!

salaam alaykum,

Luke
lmanley@usc.edu

Gender and Development in Honduras

Hola from Honduras! I just landed here in the capital city, Tegucigalpa, and I'm about to head over to a friend's place for Christmas dinner, but I thought I'd give a quick introduction. My name is Stacey Chiu and I'm a junior at USC majoring in Sociology and minoring in Public Health. I'm currently working on my undergraduate thesis, a transnational comparative study of the differences in the gendered division of household labor in Honduran families and Honduran immigrant families living in Southern California. I'm also developing a gender component that will be added to existing Global Brigade (GB) programs.

What is Global Brigades?

"Global Brigades is the world’s largest student-led global health and sustainable development organization. Comprised of secular, international service programs, we mobilize student volunteers and professionals to empower communities in developing countries with programs that improve quality of life while respecting local culture.
Between 2008 and 2009, more than 4,000 volunteers from 110 university chapters in the U.S., Canada, U.K. and Ireland traveled to provide health and economic development solutions to more than 50,000 beneficiaries through our teams in Panama and Honduras. "

This winter break, my GB partner and I will be conducting preliminary research to get a better sense of the gender heirarchy and power structures within the rural communities that GB works in. After doing much research on gender programs, we've realized that there is no "one size fits all" model. Rather, programs are only effective if they take into account the local culture and current conditions in the area.

Ok, well my ride is here so I have to go. Happy Holidays!!

Keeping the lungs of the city clean

Well, I said in my last blog that I would be writing at the intersection of public diplomacy and public affairs, but this may be more on the outskirts of both. I am addressing the novel attempts at keeping Bosque de Chapultapec (Chapultapec Park) clean as a means to provide the choked, polluted Mexico City with some breathable air (Pub Health) via Public Diplomacy. Mexico City is one of the most polluted cities in the world, some days a grey-almost tan haze covers the city. You can see this in the picture below, I did nothing to doctor the photos, it is really that smoggy.

From Road to DF & Chapultapec Castle

Bosque de Chapultapec is a sprawling verdant green park area in the heart of Mexico City, dotted with fine museums and the Chapultapec Castle- the former stomping grounds of the Spanish Viceroys and Emperor Maximilian, as well as a military academy and host to major battle in the Mexican-American War in 1847. The 400 hectare park serves as the lungs for the city, and as such, those lungs need to be protected.

From Road to DF & Chapultapec Castle

While I was walking up to visit the castle, I saw a band of performers dressed in costumes that resembled trashcans, as well as actors in doctors clothing. Curious, I stopped and watched the performance for a bit and chatted with the actors about their project.

From Road to DF & Chapultapec Castle

I chatted with "Dr Lurias," the white labcoat and large spectacle-sporting physician. Dr Lurias mentioned that they were a project sponsored by CICEANA (The Center for Information, Communication and Environmental Education in North America- translated), the troupe was performing educational theater to teach people to care for and respect the resource that is Bosque de Chapultapec. The aforementioned association is a civic organization that has been working for 5 years teaching environmental education. The costumed troupe, an independent theater group called "Ecolurias," does theatric interventions to educate the people on the importance of and how to maintain the gift that is Bosque de Chapultapec.

I also found out the the two girls in different colored trashcans were meant to teach people the difference in organic and inorganic refuse and how to spot the different recepticles for each.  While I got it correct in this picture below, on my first attempt, I boffed putting my garbage in the correct bin.  Write it off to my gringohood and being colorblind.  But I quickly learned which was the correct bin for each type of garbage.

From Road to DF & Chapultapec Castle

Ecolurias can be found on various social networking sites like Facebook, YouTube and their blog.  They are performing an important aspect of educational public diplomacy to further public health in city that really needs increased understanding of environmental protection if it is to continue to function.

At the interstection of public diplomacy and public health

A quick hola from Oaxaca before I get down to serious blogging business. My name is Paul Rockower, I`m a USC grad student currently traveling in Mexico, and on my way down to the Panama Canal.

My background is not in public health, but rather public diplomacy. However, there are some important aspects that overlap in both fields. The basis of public diplomacy is predicated on the transmission of ideas in the global sphere, and requires both advocacy and listening to be succesfully employed. The best definition of public diplomacy comes from USC Prof. Manuel Castels:

"Public diplomacy is the…projection in the international arena of the values and ideas of the public…. the aim of the practice of public diplomacy is not to convince but to communicate, not to declare but to listen. Public diplomacy seeks to build a sphere in which diverse voices can be heard in spite of their various origins, distinct values and often contradictory interests."

In this regard, public health requires the similiar tenets to be succesfully carried out. I will be writing about the intersection of public diplomacy and public health as I venture through Mexico and Central America.

I will also be taking plenty of photos that will be used in an upcoming exhibit for the Institute for Global Health`s Global Health Week. I currently have an exhibit up at the USC Annenberg School for Communication, entitled The 21st Century Family of Man. I will be blogging here, as well as my regular Levantine blog. Some blogs will be up shortly, but first I need to get over a long night bus to arrive here. Hasta luego.

Come to Think of it, I Did Allow an Unknown Person to Pack My Bags, Is that a Problem?

I hadn’t thought I would have anything to blog about on the first leg of my journey from LA to Aleppo, yet somehow I had forgotten about all the mental and physical tolls that travel itself entails. Just the stress of making sure that you arrive at the airport at least 2 hours early can be daunting enough. In fact, it reminds me a great deal of insurance. Surely you could show up 2 hours early and there could be huge lines and lots of luggage, ticket, and gate-change issues. In that instance you would congratulate yourself on your responsibility and foresight. On the other hand, you could arrive that early and sit twiddling your thumbs, listening to Muzak for 2 hours.

Perhaps I am the only one, but no matter how much I prepare to go through the security process, I still notice my anxiety levels rise considerably the closer I get to that conveyor belt. I realize that a lot of it stems from a fear of being that guy who has that thing in his bag or his pockets that holds up everyone. I remember being initially stubborn when they first came out with the shoes-off “recommendation”, but after having to have my feet wanded enough times I usually have them off faster than you can say “Sir, can you please step aside”. Do I still have anything in my pockets? Does my laptop case have to be unzipped, open and with it’s case, or in it’s own separate bin altogether? Am I going to be the one “randomly screened”? Years ago this may have been laughable as a health concern, but most of us are now aware of the range of health concerns that can result from prolonged periods of high stress. Even if you’re not showing outward signs of emotion, stress can still take its toll.

Then there is the expense of airport food to consider. It’s bad enough as a single guy traveling alone. Especially now, in the worst economic downturn since the Great Depression, if you are a parent with small children (who surely didn’t have time to go shopping because you’re trying to get an entire family to the airport 2 hours early) it must be a near impossibility to purchase anything in the airport without annihilating your budget. I just spent $2.75 on water! You want me to pay what for a bottle of carbonated water with caramel food-coloring and fake sugar-substitute? It’s the same grim acceptance as when you end up paying $15 on a small popcorn and soda at the movie theater.

Depending on your income level, price may or may not take a toll on mental health, however, there is no question about the quality of the food’s affect on physical health. Assuming that you are actually offered a free meal during a flight, it is nearly guaranteed to be a main course of sodium, fat, and carbohydrates with a side of fat and carbohydrates, and fat, carbohydrates, and sugar for dessert. Somehow there is a hidden mechanism for ordering “special meals” that can be low-sodium or low-fat (but not both – trust me, I asked). My “normal meal” consisted of 3 large, round noodles drowning in a sea of condensed tomato paste and melted cheese (gouda I’m sure), with a shrink-wrapped dinner roll, and what appeared to be literally 4 shards of iceberg lettuce and ranch dressing with more fat than a Big Mac. Dessert was a “Three-Fudge Brownie”, which proudly proclaimed that it contained zero trans-fat. Then, an hour before landing we were provided a “light breakfast” of a white roll the size of my fist with a slab of cheddar cheese in the center. Extra butter on the side was provided of course, as well as yogurt that contained as much sugar as a can of Coke.

Let’s be honest, with over 60% of Americans overweight or obese and skyrocketing obesity rates worldwide, it’s about time the “normal meal” more closely resembled the “special meal”. It already tastes awful, so why not at least have it taste awful in a healthy way? In the meantime my flight to Istanbul serves dinner and I can hardly wait for my quadruple peanut butter fudge brownie with zero grams trans fat, but as for the Big Mac dressing, I’ll take mine on the side.