Month: May 2017

Great Issues Scholars reflect on a term of global health programs

“This term opened my eyes to how much we take for granted in the medical field today. Now it’s just assumed that we’ll be able to identify a disease’s source and method of transmission within weeks of an outbreak, but none of that was obvious only a few centuries ago” observed freshman Katrina Keating. Katrina attributes her light bulb moment to a Great Issues Scholars event from earlier in the term, in which the scholars, guided by Professor Jonathan Chipman, analyzed maps of an unknown disease’s spread around an unknown city. The scholars wrongly attributed the scenario to a modern outbreak in the developing world, while in reality, the context was the 1854 Broad Street cholera outbreak in London. Now, three weeks later, Katrina and her fellows Great Issues Scholars shared a meal of seafood paella, fresh roasted vegetables, and an assortment of Spanish desserts reminiscing and reflecting on this and other global-health themed events from the past term.

For some students, the term solidified a preexisting interest in global health. Grace Li, an aspiring linguistics and Chinese double major, plans to pursue medical school after Dartmouth. Great Issues Scholars opened Grace’s eyes to a variety of ways a medical degree can be applied to a career. The discussion with Dr. Kate Horan from Doctors Without Borders particularly resonated with her. Similarly, Briana Beach appreciated how the term complemented her classroom experience. As a student in Abigail Neely’s “Global Health and Society” course, Briana came to GIS equipped with background knowledge that allowed her to be a leader in group activities and ask GIS guests challenging questions. She hopes to extend her participation in global health on campus next year through a different Dickey Center program, Global Health Fellows.

Program Director Casey Aldrich does not expect the global health focused term to inspire each and every Great Issues Scholar’s future career path – stories like those of Grace and Briana are just icing on the cake for her. What Casey does hope Scholars leave with, however, is an appreciation that global health cannot be isolated from the other international themes addressed by the program. Freshman Nate Neumann picked up on this idea without prompting. To illustrate his point, he cited the health effects of natural disasters and sanitation crises, and the emergencies that often emerge from political instability or war. “If a government is struggling to survive, it’s not going to prioritize scientific research or cleaning water,” Nate observed. “Even if you don’t plan on a health-related career, you can’t ignore it if you’re working on other big issues.” Briana chimed in, positing that issues of race and socioeconomic class are also tied to inequities in the provision of health services. GIS sophomore mentor Ally Block praised the introductory event of the term for prompting students to think about these connections from the very start, describing how Professor Colleen Fox wove issues of security, environment, and gender into a case study of refugee health.

The Great Issues Scholars of the Class of 2020 left their term-end reflection with bellies full and minds racing, chatting about their plans for their next three years of international exploration as they meandered toward the door, and toward their sophomore years.

All best to the Class of 1957– it’s been a delight reporting and sharing with you,

Freya Jamison ’17

Reflections on global health explorations in Peru

Dear Members of the Class of 1957,

I am in my last week here in Peru! How the time has flown by! I’ll share a story and some thoughts that have been on my mind as my time here rapidly draws to a close.

One morning, I set out with Stephani, one of the psychologists in the mental health team of Socios en Salud. When I started working here, there were five members of the team, but organizational budget cuts struck in my sixth week here cutting the team down to two: a harsh reality of the world of limited funding and seemingly unlimited need. We clamber out of the mototaxi, coated in sweat that the dust from the street promptly clung to, as we began our ascent up the mountain to a patient home. The role of the mental health team at Socios is to visit patients undergoing treatment for tuberculosis to evaluate their mental health status to ensure that they adhere to their treatment regimen. In the past, Socios has found that the patients who experience the most severe depression are most likely to develop feelings of hopelessness and abandon their drug regimens, leaving them at risk for Multi-Drug Resistant (MDR) or Extremely Drug Resistant (XDR) tuberculosis.

Stephani makes a small exclamation and points up ahead where a frail man is waving from a rooftop. We set off in that direction. He meets us at the door, his bony hands limply clasping ours in greeting. His clothes hang off of his body, as though he is nothing more than a temporary coat hanger, a life so very mortal and fleeting. His eyes sit deep in his skull, sunken into shadows of pain and exhaustion. We sit with him in his living room, separated from the rest of the apartment by a bed sheet. As his children stir from their sleep in the beds behind the curtain, I catch glimpses of them peering out at us with inquisitive sparkling eyes.

He begins to tell us his story and I listen while watching the children. His eldest son comes in from playing soccer and ducks behind the curtain. He is no more than twelve years old. I watch as he lifts his screaming baby sister from the bed, her shaggy hair standing up in every direction, and tugs off her sagging diaper, rooting through a pile of clothes and extracting a pair of underwear that he helps her into. She reaches for a bottle of yogurt on the dresser. He takes it from her and opens it, sniffing cautiously, then tossing it on the counter and handing her a banana in instead. A few minutes later, the little girl ducks out from behind the curtain and sidles along the wall, grabbing her fathers arm and finally clambering up into his lap, staring at us while her mouth works on the banana.

The man tells us about the darkest moment, when he held his son’s hand in the hospital and told him to be brave. Told him that he was sorry. I see the son in the other room frozen, listening, bent over clutching the counter. Tears are streaming down the father’s face but he brushes them away as his daughter turns to look up at him so she doesn’t see.

“I have hope now,” he says, “hope that I will live. Hope that I will watch my children grow up. But what father have I been for them? I can’t support them. I can’t give them a good life. How long will it be before I am strong enough to go back to construction? Their mother hates me. She works so that they can eat. She wants to be rid of me, but I can’t leave them. I love my children. I love them more than anything in the world. They are why I’m still here.”

Teaching English to the younger class of 5-9 year old students. Here we working on drawing pictures of their families and labeling all of the members with their English names.

There were many home visits I was able to accompany our team on during my time here, but this one was especially powerful for me. It is just one example of the devastation that tuberculosis leaves in its wake and it was a powerful reminder for me about why I am here, what I am fighting for – not just in my internship, but with my life.

Moving forward from this experience, memories like that will haunt me, the sorrow in his face seared into my memory. His children deserve a future. It’s not just illness we are fighting; it’s poverty and the structures in place that perpetuate it. Despite how far Socios en Salud and Partners in Health have already come in eliminating tuberculosis, there is still so much further to go. My time here has reinvigorated my desire to chase these kinds of goals, to reevaluate the “impossible” challenges and “unbreakable” barriers.

From a more practical standpoint, my internship at Socios has revealed to me many areas in which I still need to grow and gain experience. For example, I now know that I want to take more public policy classes to flush out the knowledge that I gained experientially here. Furthermore, I have also realized that in order to be most effective in these kinds of global settings, I need to gain more quantitative analytical skills. I also hope that I will be able to take some of what I learned here about to mental health into my senior honors thesis, particularly with regards to mental health stigma. I am also gratefully able to share that during my time here, I was accepted into Geisel School of Medicine, so I sincerely hope that I am able to continue working with Dickey in the future to pursue these goals.

This internship has shaped my life. Not just my career goals and my Dartmouth experience, but my person. I emerge from this crucible of the challenges a more refined version of exactly who I am and a clear vision of who I want to become. I thank you again, from the bottom of my heart, for helping to make this opportunity a reality.

Yours truly,

Kennedy

Brendan, my co-volunteer and I with Señor P., a homeless man living on the streets in Lima. Here, the three of us are in the Ministerio de Salud (MINSA – the Peruvian Ministry of Health) advocating for Señor P.’s rights to enter the government’s Vida Digna program for the homeless elderly population. He had previously been excluded due to a documented mental illness.
Three of my students and myself outside of Lois and Thomas, the school constructed by Socios en Salud for the education of youth in the Carabayllo community. These three were early every single week; in Peru, that is an anomaly. The kids here care about learning, care about making their families’ lives better, care about their futures.

Global Health Experience in Peru

Dear Members of the Class of 1957,

Hóla from Lima, Peru! I am currently working with Socios en Salud (the Lima branch of Partners in Health) on their Mental Health project. I am very grateful to have this opportunity. After reading Tracy Kidder’s biography of Paul Farmer, Mountains Beyond Mountains, I was inspired to study and work in global health and if possible, to work specifically with Partners in Health. I happened upon this opportunity after writing a research paper for one of my professors on maternal health in Peru. Recognizing my interest, she gave the contact information of one of her students who was working for a year with Socios en Salud as a Lombard fellow, a dream that is now taking root in my mind as well. I reached out to her and she helped me get in touch with the volunteer director here. After an extensive application and Skype interview, here I am. I am thankful everyday for the good fortune, or perhaps fate, that brought me here and allowed this opportunity to come my way.

This is my third full week of work and I am already much busier than I expected. I was pleasantly surprised by all that I will be able to help with in my time here – it consists of a wide variety of activities, but the I appreciate being able to work on different projects on different days. One of my main projects is working on the implementation of “Pensamientos Saludables,” or “Healthy Thinking”. It’s a new program created by the World Health Organization to combat perinatal and postpartum depression among women. I have a strong interest in maternal health, so I am grateful to be working on a project that is so personally meaningful and interesting to me.

One day of the week, I travel with another volunteer to the Ministry of Health where we are working to help compile, consolidate and organize the country’s mental health data. It has been ranked among the least organized systems in all of South America. We have certainly experienced a fair share of frustrations in getting access to data, but that challenge has become a part of the process that I recognize as making it so valuable and important. I have also begun teaching English along with another volunteer. On Mondays, we teach two classes of children, a younger age group and an older age group, and on Friday mornings we teach the other Socios employees at our office in Carabayllo. Along the way, I also work on random projects and tasks that the mental health team needs, whether it’s translating a grant, reformatting manual manuscripts for community health workers, creating posters, or helping with Excel.

When I embarked on this experience, my interests lay in the intersection between poverty and health and what changes can be made on a systems level to improve the delivery of healthcare. I view illness as one of the many barriers that can hold a person back from finding meaning in their life and being able to ask the bigger questions that are an essential part of being human: Why am I here? What is my purpose? What kind of life do I want to lead? Going hand in hand with health is poverty, so I am grateful to have been placed in an area where that intersection and my specific interests lie. I am stationed and living in Carabayllo, one of the poorest of Lima’s forty-three districts. It is quite a shock compared to Hanover. There was definitely an adjustment period as my body grew used to the pathogens in the drinking water and my mind overcame my initial shock at the living conditions of most of Carabayllo’s population. Really interacting with my neighbors though and the other members of my community has been one of my favorite parts of my brief time here thus far. It has made my work all the more meaningful because I can see, even in small ways, the lives that I am working to make better.

My deepest thanks to all of you for helping to me follow this passion.

Truly yours,

Kennedy

Playing with some of my
students before I start English class.
Behind the SES logo is an image of Carabayllo, the district of Lima where I am living and working.

The Human Toll of the Refugee Crisis

We are living through the greatest refugee crisis since World War II. According the UN High Committee on Refugees, 21.3 million individuals worldwide have been forced by war and persecution to leave their homes countries and seek refugee abroad, and this number grows by 34,000 every day. More than half of this 21.3 million come from three countries alone: Somalia, Afghanistan, and Syria. Milan’s work with the International Rescue Committee is a shining example of the work being done here in the United States to advocate for and support refugees on our own shores. Yet despite these incredible numbers and the work of dedicated groups like the IRC, many misconceptions about who refugees are, why they seek resettlement, and what can be done to facilitate their integration into host communities abound in political rhetoric and the media. The protection of human rights during wartime is particularly important to me, as civilians often lack functional law enforcement and legal systems to support them in times of crisis. With the generous support of the Dickey Center’s Lombard Public Service Fellowship, I will spend the year after graduation advocating for these rights at the International Refugee Assistance Project in New York. But I, and students with similar interests, do not have to leave campus or pursue careers in human rights to gain exposure to this critical international issue.

This spring, Dartmouth hosted two events highlighting the human toll of refugee crises. On April 7th, 22-year-old Sarah Mardini spoke to an overflowing Oopik Auditorium about her journey from Damascus to Berlin fleeing Syria’s civil war. On April 22nd, the Global Village hosted a screening of the film “The Good Lie,” which highlights the story of the “Lost Boys of Sudan,” and followed the film with a panel discussion featuring two Sudanese refugees from the Lost Boys community in Boston and a policy expert from the Enough Project. Although the Sudanese civil war that created the Lost Boys occurred nearly three decades before the Syrian crisis of today, the themes of resilience and community resonated across both events. Regardless of their personal beliefs about immigration policy, attendees left both events understanding how policy affects refugee lives in very tangible ways.

Before war broke out in Syria, Sarah Mardini was a normal teenager – she attended school during the day, and spent her evenings and weekends training and competing as a swimmer. When life in Damascus became unbearable, both because of the omnipresent fear of bombs and the threat of sexual violence that is so common during wartime, Sarah and her younger sister Yusra undertook a dangerous journey to seek safety in Europe. When the motor on the small raft that was carrying the Mardinis and twenty other refugees failed in the middle of the Mediterranean Sea, Sarah put her athletic training to use, swimming for three and a half hours to guide the boat to the Greek shore. Twenty-five days later, the sisters made it to Berlin, where they built a new life swimming for a German coach. In 2015, Yusra swam for the refugee team at the Olympic Games in Rio. Sarah, unable to forget the suffering of her fellow refugees, returned to Greece, where she now volunteers full time with the Emergency Response Center International, helping other refugee rafts land safely.

Both “The Good Lie” and the discussion with Lost Boys afterward impressed upon the audience the challenges of integrating into a new culture after losing everything. Viewers chuckled as they watched the boys in the film marvel at McDonalds and mistake a ringing telephone for an alarm on their first night in the United States. We thought critically about aspects of our own culture during a scene in which the Lost Boys are disgusted by the amount of “expired” food thrown in a dumpster daily by a grocery store owner. The panelists identified with these struggles, and emphasized the importance of having a community of other Sudanese refugees in Boston to share and process these novel experiences with. Brian Adeba, Associate Director of Policy at the Enough Project, reminded the audience that South Sudan remains incredibly fragile today, and that the international community and regional actors need to use their political and economic leverage to find a diplomatic solution to the conflict and prevent the creation of further refugees.

Not all students have the resources or skills to spend a term working with underserved populations, but through opportunities like these two events, Dartmouth equips all of us with the exposure, knowledge, and tools to be advocates in smaller ways. Meeting refugees in person dispels some of the myths surrounding forced migration, and allows us to connect to these issues on a human, rather than policy level. It also facilitates cross-cultural understanding, by shining a spotlight on aspects of culture that aren’t usually talked about.