Organization Spotlight: Tiyatien Health

A worthy organization recently brought to the chapter’s attention is Tiyatien Health, a not-for-profit that works to rebuild the failed health system of Liberia.  Liberia is still struggling to recover from a horrific civil war that ended in 2003. Tiyatien Health, headed by the liberian-born doctor Rajesh Panjabi, strives to provide what it terms “justice in health”, health equity for all Liberians.  It focuses on providing free medicine and health care to those who need it. Rajesh and all involved place great importance on teaching Liberians how to care for themselves and administer to others in order to create a health system that won’t only help those in need, but will sustain itself. Tiyatien also works with the Liberian Government to create a permanent, functioning health system and supports sustainable economic ventures in order to combat poverty. Check out Tiyatien’s website at http://www.tiyatienhealth.org/, or the GlobeMed website for the chapter at University of Michigan, who partners with Tiyatien Health, at http://www.globemed.org/[uofm] .


Short Term Relief Trips: Point and Counterpoint

Students are presented with a wide array of opportunities to engage with global health issues. As exciting as it can be to jump into an experience abroad, it is important for us, as discerning students of global health, to be extremely critical of our own intentions and the intentions of organizations with which we work. Not all programs with abroad opportunities are conducted with the best intentions for local communities. So, as you sort through your options for summer opportunities, consider how best you can use your skills and position as a student, but be cautious of working far beyond your means, particularly when it comes to administering medical care and advice.

To further illustrate this point, check out this article about Global Medical Brigades and GlobeMed Executive Director Jon Shaffer’s response to it.


A perspective from Paris

In many ways, Paris is not so different from New York, Chicago, or any major city in the United States. There are all the modern amenities, locals are chic and cosmopolitan and pop culture in Europe has largely molded itself around American media. The one thing people tend to point out is that the French tend to take their time to enjoy the ordinary. The lifestyle is slower, whether it’s how long it takes a waiter to bring over a check or the way Parisians linger over three-hour dinners of bread, wine, cheese and espresso even on weekdays.

In time, I realized that this way of life reflects the lengthy scope of European history and, in turn, the principles around which many European societies are organized. Unlike the United States, many EU member states have over a thousand years of history, have waged countless wars with their neighbors, and have often redrawn messy national borders. With this sense of history comes a sage understanding of the life course, of personal success, and of mortality; not everyone is exceptional, and no one is exceptional when it comes to death at the end of one’s life.

There seems to be more of a collective sense of the past, a true focus on the present, and generally less anxiety about the immediate future. The socialist redistribution of wealth and development of the welfare state demonstrate the importance of enhancing the lives of all citizens in the present rather than focusing on future gains trickling down from a small elite. The French welfare state ensures that one has the tools to be a productive member of society, and, in the case of illness or unemployment, that he or she will be offered social assistance.

It would be essentializing to say that there is only to live, work and enjoy in France. But I think the U.S. as a state and as a culture has a lot to learn from France in terms of approaches to life, success, and an individual’s place in the society. It is a preoccupation with being the best and having it all that has characterized and shattered the American economy. So while we bemoan the demise of American exceptionalism, Americans need to understand the falsehood of individual exceptionalism and rethink the notion of what it means to live a happy life. The sooner we realize that the vast majority of us are ordinary, that it’s good to be ordinary, and that–even in a capitalist society–ordinary people deserve protection from market failure, the sooner we can start working towards reducing health and other inequalities in America. –TIFFANY WONG

Tiffany Wong is a former co-president of GlobeMed at Northwestern and is studying on the Northwestern International Program Development Public Health in Europe Program.


GROW 2010 Team: Margaret Asante’s thoughts and impressions

The members of the GlobeMed at Northwestern GROW 2010 trip with Margaret Asante. Photo courtesy of Reema Ghatnekar / GlobeMed at Northwestern.

When I received a mail from the outgoing executives of GlobeMed 2009 introducing the next batch of students who will be visiting Hope Center in Ghana in 2010, I was really thrilled and at the same time curious. I wanted to know the caliber of students and how they can fit into our activities at the center like their predecessors. Mails were exchanged and my anxiety heightened by each day.

Between 13th June to 25th June Allyson arrived first, followed by Kathleen and Reema, then lastly Joey.

Allyson Westling
I christened Allyson, “Mother Allyson” due to her humility, wisdom and her approach to work; my anxiety and fears evaporated immediately as Allyson, the first to arrive quickly, grasped the whole concept of activities at the center. She soon took charge and started planning activities of her colleagues with such an ease that surprised every staff at the center. Her main objectives were to help develop the phase four of the nutrition program for the center and also help revise the partnership agreement between GlobeMed and Ghana Health Service. She worked tirelessly to achieve the objectives.

Reema Ghatnekar
The ‘wide-eyed’ Reema was full of enthusiasm, zeal and have a great passion to work with us at the center. Her objectives were community mapping, and help with the continuation of phase three of the nutrition program. Her passion for the community work brought her closer to the two rural communities we serve, Ando and Kodzobi where she did a lot of interviewing to project the work at the center to the communities. Her final work is being used as a guide for our programs.

Kathleen Leinweber
Adorable Kathleen’s volunteering spirit brought enthusiasm and youthful exuberance into our work at the center. She was always asking questions that helped her to achieve her objectives in helping to evaluate the Sexual Reproductive Health for Adolescents program and community-mapping. She braced the odds and worked among the rural communities we serve, and also made friends among the children.

Joey Gill
Baby Joey, as I nicknamed him during his stay was the youngest. He continued with the electronic medical records and the community-mapping. He also worked hard among the two communities to bring out the way the community live, type of housing, water and sanitation, food, fuel used and family size. This information is essential for the center and we are using them to guide us in preparing community profile for the rest of the communities we serve.

The GROW 2010 team not only worked on their individual project but helped in most of the child welfare clinics by weighing babies and updating their records in the registers. They really fit into our system and worked very well. How we wish we could have them all year round

Yes, they did really had fun alongside their busy schedule, a trip to Wli waterfalls in Hohoe District, Kakum Park, the castles in Cape Coast, Kpetoe kente weaving town and of course, Kathleen’s birthday party at Sky Plus Hotel.

They were also ardent supporters of Black Stars, our national football team during the world Cup in South Africa 2010. Notwithstanding their “temporal” Ghanaian citizenship, they never forgot home whilst here. On the American Independence Day, I visited them in the house where they lived and we all sang the national anthem of their Home Country, USA. It was really a nostalgic moment!

I can still hear their voices giggling and their crazy music as I look forward to welcome GROW 2011, I really missed them. -MARGARET ASANTE, NURSE IN-CHARGE, HOPE HEALTH CENTER, HO.

Photo courtesy of Allyson Westling / GlobeMed at Northwestern.


Lessons learned from Sotero del Rio & Common ground: public health in Chile

Laura studied abroad in Chile this summer. Photo courtesy of Laura Ruch / GlobeMed at Northwestern.

This summer, 2010-2011 GlobeMed at Northwestern globalhealthU co-coordinator Laura Ruch studied public health abroad in Chile and blogged for The 195. Below are excerpts from Laura’s blog, which covered her experiences this summer.

LESSONS LEARNED FROM SOTERO DEL RIO

Six weeks, dozens of women, and numerous hour long metro rides later, my research has wrapped up, and I realize I’ve learned about a lot more than what I set out to understand. Our project focused on how women can have a positive labor experience and what can be done to alleviate excessive pain during childbirth. Some of our “findings” were pretty obvious – epidurals do the trick, so long as they are administered quickly enough. The most painful part of labor is the “big shabang,” the dar de la luz. Also, when they are holding a brand new, healthy baby in their arms, most women will tell you they were pretty happy with their labor experience. However, I couldn’t help but notice the staggering inequalities between the public and private hospitals here. Chile has the 10th worst rating in the world for countries with the biggest income gaps, so it comes as no surprise that the quality of healthcare shows a broad range. While the upper class women give birth in meticulously clean hospitals with all the latest technology, similar to those in the US, the public hospitals have a whole different standard of care.

While nothing like so called “hospitals” I’ve seen in Guatemala, public hospitals in Chile don’t have that antibacterial, iodine smell that I’ve grown so used to in US hospitals. There are no potted plants, no automatic doors, no soft melodies playing out of mounted speakers to lighten the mood in a place often filled with mourning. Exhausted and alone, new mothers generally wait five hours or more until they can hold and feed their newborns. To me, the salasde postpartum feel crowded and stressful; the nurses go down the factory line of unadjustable beds, doling out dinners of pan and powered jugo.

There is a new option, however. A team of truly amazing public health workers has managed to get the funding to build a new ward in the hospital through a program called MASIP. Here, each patient has her own brightly painted room, complete with a Jacuzzi, private bathroom, adjustable bed, boom box, and scented candles. Perhaps even more importantly, her family can visit her almost all day long, and the nurses are highly trained in giving emotional support. The benefits of this program are tremendous, although right now it only admits “low risk” women. While many women here don’t receive any anesthesia, all of those we talked to gushed about their experience in the program. Their mothers affirmed that there was simply no comparison between their own labor experiences, in a normal public hospital setting, and those of their daughters. And the best part? The program actually saves the hospital money because women don’t have to keep changing rooms, the same health care workers treat them during their entire stay, and they are almost always able to go home sooner due to a quicker recovery time.

To summarize, I came to a few perhaps basic, yet still personally interesting realizations. First of all, pain is relative. A woman who knows the feeling of say, dislocating a shoulder, will likely not describe childbirth as being as painful of an experience as a woman who’s never dealt with serious pain before. Secondly, just like with our other senses, we can distract ourselves from the feeling of pain. Here is where the calming environment and supportive staff at MASIP play an important part for women going through labor. Finally, I was reminded that our life experiences, and the way we perceive them, are shaped in a large way by our mindset going into them. Those women with higher self-esteem and confidence, and those who really wanted to have a child, ultimately had a more positive, comfortable labor experience, no matter how many of their nerve endings were fired in the process.

Reflecting on these observations, I’ve realized that I’ve been thinking about health care the wrong way for a long time. I’ve always believed in the power of medicine, in the power of the physician, to serve as the backbone for a healthy society. I’ve forgotten about the power of the patient. What Chile really needs, and perhaps what lots of societies need, in order to improve the health of its people, is to empower them even before they require medical attention. It’s going to take a long time and a lot of economic development before the Chilean public hospitals will mirror the extravagance of the private ones. In the meantime, great strides can be made in improving the health care system by altering the mentality of the community. For the particular issue of maternal health, this means addressing the social forces behind the medicine. Women need to be treated as persons deserving of high quality, individualized care. They need to develop, at a young age, the self-esteem to realize they should ask for, or rather demand, that their needs be met. Finally, society should set the bar high for women, encouraging them to develop lofty goals and pursue their dreams rather than burden them with raising a family at a young age. That way, when a woman is ready to have a child, she will be excited and prepared, more confident and more capable.-LAURA RUCH


Photo courtesy of Laura Ruch / GlobeMed at Northwestern.

COMMON GROUND

Breaking news: time travels faster in Chile. According to my American watch, I’ve been here for three weeks, but I’ve definitely only been here for one MAX. All I can say is that I hope my returning flight ticket works on Chile time, because only five more weeks here just won’t do.

Yesterday was rather ironic. I began my morning meeting with my research group and going to one of the public hospitals for the first time. We learned about our project, which explores different methods of labor and postpartum care for mothers. Essentially, there is a push right now to convert to a more modern style, where the woman stays in the same room through labor, delivery, and recovery, and she can have family and friends visit as she wishes. In contrast, in public hospitals here, women are in one room for labor, another for delivery, and yet another for ~48 hours afterwards. Rather than having their own room, they share one large space with 10 or so other new mothers. When I walked into one of these rooms yesterday, I was shocked to see six new mothers on either side of me, of all ages, all total strangers. As I talked to them, rather than dwelling on their lack of privacy, they celebrated being surrounded by other women all in the same boat. They laughed with each other and admired one another’s guaguas (Chilean for “babies”). They all had that aura of pride and hopefulness in the possibilities for their child’s future, even though many of the mothers were poor, young, and single.

After class the same day, we went on an excursion to the Cementerio General, the oldest and largest cemetery in Chile. I normally hate cemeteries (who doesn’t?), but the overawing beauty of this place overrode the creepiness factor. Almost all the graves were above ground, made of stone, and impressive looking. There were wide paths, palm trees, and colorful flowers and vines. A four meter wide stone wall separated the graves of Catholics from the non-Catholics, for fear of uncleansed souls contaminating the pious ones (I’m glad they decided to err on the side of caution – everybody knows that the souls of the deceased can cross three, but not four, feet wide stone walls). Almost all of the Chilean presidents were buried in this cemetery, including Salvador Allende, the first democratically elected Socialist. He was overthrown in 1973 (with the help of Nixon and the CIA) by Pinochet, and committed suicide on September 11. Beside his majestic white grave, where his wife and daughter were also buried, a plaque read a few lines from his farewell speech, given hours before his death, in which he said, ”They have force and will be able to dominate us, but social progresses can be arrested by neither crime nor force. History is ours, and people make history.”

However, just like at the hospital, space was limited in the cemetery. Only a few inches were left between tombs, so it again felt like the emphasis lay in the collective whole, in the memory of the entire community, rather than the individuals. Only this time, corpses rather than newborns lay side by side. In a broader perspective, this speaks to me about the cultural differences between Chile and the US. At home, I value my privacy. I like to spend a bit of time every day by myself- reading, running, playing music, etc. While I still do that here, the culture places a bigger emphasis on being with family and working in groups. I’ve always heard that Americans tend to think of themselves as individuals, while in other countries, individuals view themselves in light of their community, and for the first time, I have really felt that difference. -LAURA RUCH

Photo courtesy of Laura Ruch / GlobeMed at Northwestern.


A smoggy day in Beijing town: public health in Beijing

Traditional Chinese herb-picking alongside the Great Wall. Photo courtesy of Chi-chi Uichanco / GlobeMed at Northwestern.

For the past seven weeks, I’ve had the amazing opportunity to study in the crazy, crowded capital of the most populous country on earth: Beijing, China! The IPD program in Beijing is designed to allow us to witness the lasting impressions of Traditional Chinese Medicine (TCM) and learn about the basic public health structures in the country. Meanwhile, this lively, bustling city is our oyster to explore; it’s not too hard to blend in with a population exceeding twenty-two million.

The TCM half of the program was …interesting, to say the least. I came into this program with an open mind, excited to learn how other cultures viewed common health practices. After the first lecture we learned that, essentially, TCM revolves around the basic tenets of Yin-Yang Theory, the Five Elements, and Visceral Theory. Interestingly, they have quite a hold on modern Chinese culture as well. For example, Yin-Yang Theory dictates that every single entity on Earth exists as Yin or Yang, where Yin and Yang are two opposite but inter-related areas of life. Yang can be daytime, hot soup, or summer; yin can be night time, ice cream, or winter. Whether something is considered yin or yang will dictate how you treat it — that is, in TCM, whether a symptom is considered a yin or yang-symptom dictates whether you prescribe a yin or yang treatment. A common occurrence in China (especially for older people) is to refrain from drinking hot soup in fear of upsetting the body’s balance of yin and yang. Of course much of Chinese traditional thought has made way for modern habits, but much of the older generation is still quite resistant to complete westernization.

For a more hands-on experience, several students got to try out some traditional methods, such as acupuncture, moxibustion and cupping. All these practices serve to remedy imbalances of the body’s qi (or the energy which flows throughout channels in the body), but it seemed that acupuncture was China’s answer to every problem possible — migraines, cramps, even cervical cancer. Myself, I subtlety avoided the needles and opted for two small cups on my back which suctioned off a large portion of my skin for thirty minutes, branding me with got two large, red welts. I’ll tell you how my qi feels in a month. All this only scratches the surface of TCM — these practices go back ages in history!

Getting cupping done in the TCM ward of a Geriatric/Rehab Center. Photo courtesy of Chi-chi Uichanco / GlobeMed at Northwestern.

The second half of the program moved on to public health in China. This consisted of several hospital/health center/clinic visits, where we got to experience firsthand what Chinese citizens undergo to receive health care. Most practices were pretty standard, save for the occasional TCM ward or herbal pharmacy — it was great to see the growth of such an integrative approach, where doctors combined both Western and TCM techniques with their patients. Moreover, it was cool to see how the Chinese population worried about such different health problems than America does. Of course, we learned of the soaring number of cases of infectious diseases rampant in third world China. However, the leading causes of death area changing, especially in the more developed areas of China. For example, one of the most prevalent preventable risk factors in Chinese adult health is hypertension, or high blood pressure. This is due to certain aspects of the Chinese lifestyle, such as the enormous daily salt intake inherent in the cuisine. Equally as surprising was the lack of privacy in all the hospitals. Imagine, you’re prepping to receive a handful of acupuncture needles on your tender behind, and in comes a crowd of loud American students, furiously scrawling observations into notepads and snapping pictures. This was a fairly common occurrence wherever we went, but most patients didn’t seem to mind. Funny, how Chinese street decorum translated so seamlessly into Chinese hospital decorum…

I’m also excited to jump back into the health care debate going on States-side. Interestingly enough, there’s a health care reform currently under development in China as well. The majority of Chinese citizens are presently under government insurance programs, which are separated into rural and urban populations. However, the problem is that the majority of Chinese live in rural areas, while the majority of government health spending is allotted to urban health centers. Also, analysts have recognized a gap in health care coverage affecting the large population of migrant workers in China. Furthermore, the allotment system has suffered from inefficiency, requiring most health financing to come from out-of-pocket expenses. Currently, reforms are underway to alleviate these problems, but it will be interesting to see how these unfold in the coming years.

Aside from the academic setting, I think the true appeal of this program is tapping into the Chinese mindset. At first, my silly American manners prevented me from recognizing charm on the trash-ridden, polluted Beijing sidewalks: the fountain of loogies, public urination, exposed beer-bellies… it’s definitely an acquired taste. But after a while, you begin to realize that there’s nothing wrong with throwing politeness out the window. Of course, nothing’s personal; human interaction in this high-energy city is just very simple and straightforward… and simplicity can be a beautiful thing.

Of course, when I return to the States in a week, I’ll have to get re-accustomed to my ‘thank you’s,’ ‘excuse me’s’ and astronomical American prices. After weeks of painstakingly honing my bargaining skills (a cute flowy top down from 300 kuai to 80 kuai, fake Louboutins down from 4,000 to 250 kuai — how I’d love to bargain for my college tuition) I guess I’ll just have to accept that I’ll be paying four dollars for a cappuccino and there’s absolutely nothing I can do about it. -CHI-CHI UICHANCO


Deepa’s updates from Spain

A view from Plaza de Colon in Madrid, Spain. Photo courtesy of Deepa Ramadurai / GlobeMed at Northwestern.

Over the summer, the GlobeMed Grapevine will also feature updates from GlobeMed members traveling abroad. GlobeMed at Northwestern Director of Individual Giving, Deepa Ramadurai, recently returned from a six week study abroad program in Barcelona, Spain. While in Barcelona, Deepa studied Spanish language, conversation, modern culture and other political issues; Deepa also had the opportunity to briefly visit Madrid, Valencia and Milan while in Europe.

The healthcare system in Spain is really interesting. For one of the classes I was taking we had a special unit on immigration within Spain because it has a huge effect on Barcelona (since Barcelona is very much considered a commercial city and not necessarily as “Spanish” as some of the other cities in Spain). Specifically, it’s really interesting that a lot of foreigners, even from the United States, come to Spain to have big medical procedures done/have expensive treatment done because the Spanish government covers healthcare for foreigners. It was really interesting thinking about that system versus the system we have here and what it would be like if we adopted a similar system.

Other than that I couldn’t have asked to be in Spain at a better time — especially with the World Cup. It was incredible! Seeing the country unite behind their team was something I am never going to forget. I was in Madrid at the time in the Plaza de Colon, which is what they probably showed on TV a lot here in the U.S. There were thousands of people there and the atmosphere was incredible. Something even more incredible was how divided the whole country was over the win. There is a lot of separation between regions in Spain so the celebration in Barcelona (the capital of Catalonia) was practically nonexistent compared to that in Madrid because of Catalonia’s general anti-Spain sentiment at all times. It was actually really sad to see how 40-year-old sentiments of anger are still carried over today. It really makes you realize how much internal struggle a lot of other countries are going through and how they idealize the American government and American legislation. A lot of my teachers would tell us that the American policy of governing was ideal for Spain and they wished Spain would adopt our system. It just made me think how much the actions and practices of each nation affects those of another and how we might not even realize this among countries we believe are considered significant world powers.

The experience all around was something I will never forget. Experiencing the Spanish culture and lifestyle firsthand was something I have always hoped to do and I’m so lucky to have been able to do so this past summer. I’m hoping to go back to Spain sometime very soon and getting more familiar with their healthcare system and the practice of medicine there as compared with what we do here. -DEEPA RAMADURAI