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Practical Advice from a Doctors Without Borders Nurse

Rebecca Singer, R.N., N.D., has been working with Doctors Without Borders since 2005, helping survivors of violence get the care they need in countries like Chad, Liberia and Papua New Guinea. Not only does she offer medical assistance, Singer has advocated for policy changes and helped develop better relations at places where health intersects with the government, law and society. Singer spoke to Professor Diamond’s Achieving Global Impact Through Local Engagement class recently, giving students some helpful tips about working in the global health field.

Know What You Want
In the realm of global health, you don’t necessarily need medical training to make an impact. “Anyone can do any of the things I did for the most part, and anyone can do and work on the types of projects that I’m talking with all different skill sets,” Singer said. In both the realms of development work and humanitarian work, there are plenty of options to get involved. Both have their advantages and disadvantages, according to Singer. It’s important to know what kind of a role you want. “[With] humanitarian response you are responding to a disaster of some variety, a crisis,” Singer said. “If you’re working in humanitarian work, it tends to be less comfortable. You have to be comfortable without internet, without access to phones, without a room of your own, without flushing toilets.” Humanitarian work is also normally shorter in duration from development work; responders typically get to see the impact of their work, saving lives or otherwise, and then leave. Assisting with developing systems requires more time and can get predictable, according to Singer, as building systems can last indefinitely. However, it has the added benefits of being able to live with a community and enjoy a more stable lifestyle.

Learn Before You Go
Always research the location of your future work, as well as the agencies you’ll be assisting before you go anywhere. “For me I think that the key step in any of the work that I have done is that assessment piece,” Singer said. “It’s the time when you’re going to learn about the context in which you are working in order to maximize the resources that exist and in order to be able to plan and implement an appropriate response.” While speaking with health professionals and workers in the area is helpful, try to go beyond the medical background. “Often times the doctors and nurses and health workers in general at the health center know all the statistics about who walks in the door – what sorts of problems they have and what sorts of medication they were given,” Singer said. “They don’t necessarily know the conditions under which people live, the things that might have happened, the health beliefs they have and the behaviors they might have engaged in prior to waking in that [hospital] door.” This kind of information will help you deliver a better response that can resonate with the community.

Include, Don’t Exclude
“It really does take a very wide net with lots of stakeholders with lots of people from lots of different professions and lots of different specialties in order to implement almost any program,” Singer said. When planning any effort, try to engage as many people as possible, from religious leaders to women’s groups. Singer described her experience trying to build a clinic to help respond to sexual violence in Papua New Guinea. As part of the project, the clinic workers developed relationships with court systems, law enforcement and community leaders to help women get referrals and strengthen laws and law enforcement in issues relating to sexual violence. They also spoke with safe houses and child care workers. “We could never do this work alone,” Singer said. Cutting out any group leads to a risk that the project could fail or not turn out as well.

Be Ready for Anything
“No matter what you do, all the good planning, all the good assessment, when the intervention time comes, you have to be patient, you have to flexible and you have to be ready for anything,” Singer said. “It almost never goes as smoothly as you think or as neat as it looks on paper.” Singer realized all this herself when working in the Democratic Republic of the Congo, helping plan and implement a large-scale vaccination campaign in which a caravan of cars would deliver supplies to a number of communities. “The night before we started it rained harder than I had ever experienced rain for about eight hours straight,” Singer said. The roads turned to mud, creating serious problems for the program. “We got to our sites three hours late and we dug the cars out how many times.” Singer said that the team stuck with the project, navigating the difficulties as best they could. “You’ve got to pivot, you have to figure out what to do, and you have to be patient,” Singer said.

Count Things Differently
“The key to evaluation is really asking the right questions – where do we want to go what do we want our outcome to be?” Singer said. “We have to know where we are going and right from the start how are we going to measure that, how are we going to tell if we are successful.” Sometimes the ultimate health outcomes of a project will not be immediately clear, which necessitates a different standard of measuring impact. Singer said to look to other indicators, from measuring comprehension to accessibility to get a better understanding of the benefits or disadvantages a program carries.

Speak Up
Doctors Without Borders has long been an organization linked to advocacy, according to Singer. The group is known for speaking out about human rights abuses, and refusing to operate in conditions where they believe injustice is occurring. Anyone working in global health can and should advocate for those they serve and their values. “It’s really important that you keep the reasons that you are doing this work – your true north – it’s not about the numbers,” Singer said. “Take a step back and remember the big picture and then use your voice to speak out.”

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A Chat with UNICEF’s Whitney Cross

Whitney Cross, the Global Citizen Fellow for Chicago’s regional UNICEF office, recently came to speak to Professor Diamond’s Global Health 390 class about the work that UNICEF does around the world, from trick-or-treat programs to vaccination campaigns. Cross first discovered UNICEF when she researched global efforts to alleviate the poverty in Haiti, after she witnessed the country’s situation firsthand in a brief visit to the islands. A 2014 graduate from Loyola University, Cross interned with UNICEF and served as a volunteer for many of their local projects. Today, she is in charge of helping organize volunteer efforts and promoting UNICEF in the area.

What you do with UNICEF today?
My role is a two-year fellowship. There are fellows in 12 cities across the country, and my role here in Chicago, similar to my other colleagues, is to support community engagement efforts in the markets we are in. So I focus on Chicago and the Midwest, other colleagues focus on Dallas and so on, but basically what that means is supporting all of our volunteer programs, which includes everything from Trick-or-Treat to Kid Power to our high school clubs to our campus clubs. Then also, it’s part of my role to kind of act as a grassroots spokesperson for the organization here in Chicago. Anytime someone is hosting an event and would like somebody to speak, or anytime a university needs someone to come and guest lecture, then I’ll represent the organization in that capacity.

What’s your favorite part about your job?

I really do love so many aspects of my job but I feel like the best thing is when you kind of see someone, just the lightbulb go off for someone and whether its in a presentation or through a meeting or after a phone call or even via email and you hear the excitement in their voice about the work that UNICEF is doing or their passion for helping kids in general. That is something that is really powerful and definitely keeps me excited to come to work every day.

What do you wish more people knew about UNICEF?
There are so many people who are immediately familiar with the name but not exactly what we do. I wish that everyone could have a better understanding of the scope of UNICEF’s work, I feel like I’m continuously impressed by the work that UNICEF does. It’s easy to think of large organizations as just slow-moving or [that they] don’t have the presence to move quickly, but I am so impressed by how quickly and efficiently the organization works. For example I think I touched on the fact that they can deliver supplies to any country in the world in 72 hours and are constantly leveraging technology and innovation. The organization actually has an entire division called the Innovations Unit, which tries to tackle global problems, from figuring out ways to structure new programs to creating new products and technologies I think that is really special and I wish more people knew [about it].

Can Northwestern students get involved with UNICEF?

We really do need the support of college students and people that are passionate about children’s rights, especially in a time where we are seeing so many horrible things happen to children. The best way that any student can get involved [with UNICEF] is definitely through the Northwestern campus club. They are doing so much great work, and it’s run by students. The members really do decide what to focus on and what events they want to host. I know they partner with a lot of other on campus organizations which is something that we definitely encourage. A year ago they hosted a “water walk” – on the beach they had students come to kind of experience what it is like to have to carry water or go search for water every single day rather than be able to turn on a faucet, which I think was an incredible experiential event. I know they’ve hosted film screenings regarding human trafficking and had me and other speakers come in to talk about anti-trafficking work. They’ve [also] partnered with global health-focused organizations on campus.


We talk a lot about trying to aid global health efforts and being a ‘global citizen.’ How do you think that Northwestern students can be better global citizens?

We say that a global citizen is “someone who understands interconnectedness, respects and values diversity, has the ability to challenge injustice and inequities and takes action in a personally meaningful way.” Northwestern students, at least the ones I come in contact with, already have a pretty clear understanding of diversity and have a great respect for that. I think that the hardest part for anybody is to actually take action around something they care about or an injustice that they see and so I would definitely encourage everyone to think about what issues you’re passionate about and how you plan to take action in a way that’s personally meaningful to you to make a difference.

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Five Northwestern Students Attend Emory Global Health Case Competition

This past March, five Northwestern students traveled to Atlanta, Georgia to compete in the Emory Global Health Case Competition. The diverse team, which was comprised of students hailing from Feinberg School of Medicine, Kellogg School of Management, and Weinberg College were tasked with creating an initiative to address mental health issues in Liberia. With a small budget and limited time constraints, the students had to pilot their mentoring program “Da Me” (Liberian English for It’s Me) in a nation ravished by mental health stigma, gender inequality, and a recent civil war. The team believed that Liberian women, survivors of rape and mourning the loss of family members during the recent civil war, would benefit the most from mental health programming . Thus, the program “put girls first” says Kellogg student Ferrona Lie, and worked to reduce mental health stigma and increase support for those who experienced trauma from recent events and those suffering from mental illness.

While the team did not place at the competition, Ferrona Lie and Sedoo Ijir both felt that they learned a lot from their experience. Lie, originally from Indonesia, felt that the skills she acquired from the competition furthered her goals to develop medical devices which will impact countries in need of better healthcare. While she commends American global health actors for their work in Africa, she urges key players to expand their impact to the far reaches of the world: namely, southeast Asia. But unfortunately, just as the case competition provided the team a limited budget, she feels that she does not currently have the financial resources to make an impact quite yet.

Sedoo Ijir, a Global Health Studies student, said herself “In our global health classes we critique…a lot. But when you are actually coming up with the initiative yourself, you have to take into account time constraints, target populations, government regulations, among other factors. Unfortunately, sacrifices have to be made. I think that is why no global health program is without flaw or need for critique.” Ijir said the team struggled over the budget and time constraints which forced them to develop only a year long pilot program in the city of Monrovia, which had minimal research efforts to ensure the program was effective. Ijir highlights that these issues reflect broader challenges in the field of global health. As she aspires to return to her parents’ home country of Nigeria to pursue global health work, she feels sure that the Emory case competition and her studies through the Global Health Studies program will allow her to more effectively address these obstacles.  “This is how it [global health] works” Ijir claims “but this is not to say that is how it should work.”

 

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“Let’s talk:” World Health Day 2017

Every year, the World Health Organization marks the anniversary of its founding with World Health Day. The organization, which officially came onto the international stage on April 7, 1948, uses World Health Day to call attention to important health issues impacting a large portion of the world.

Topics for World Health Day vary considerably, reflecting the vast number of health problems and related factors in an increasingly globalized environment. In past years, World Health Day focused on aging, high blood pressure and vector-borne diseases.Today, the WHO is highlighting depression.

According to the Mayo Clinic, depression is a “mood disorder that cases a persistent feeling of sadness and loss of interest.” The condition changes the way people feel and behave, touching many areas of emotional and physical health. 

More than 300 million people suffer from depression, according to the WHO. Between 2005 and 2015, the number affected individuals increased more than 18 percent. It is now the leading cause of ill health and disability worldwide. While mental health conditions can frequently be seen as a problem for the Global North, middle and low-income countries actually bear more than 80% of the disease burden.

The WHO’s tagline for World Health Day is “Let’s talk,” encouraging a global audience to have conversations about the causes, risks and treatment of depression. Clinicians don’t know the exact cause of depression, according to Mayo, but hormones, changes in brain chemistry and genetically inherited traits can play a role in the condition.

Outside the body, factors like traumatic events and social stresses can trigger or lead to the development of depression. Risks include poverty, unemployment, physical illness, problems caused by alcohol and drug use and difficult life events, like the loss of a loved one.

Campaign materials from the WHO emphasize that depression is not a weakness, can affect anyone and should be treated. An open approach to depression is key to addressing the issue. People suffering with the symptoms are often hesitant to come forward because stigma surrounding mental health conditions still exists in many countries. Adopting a more informed and understanding look at mental health disorders could increase proper diagnoses and get individuals the treatment they need, whether it is medication, talking therapy or another type of therapy.
For those who are depressed or think they may be depressed, the WHO recommends talking about their feelings, keeping connected with family and friends and reaching out for help. At Northwestern University, students can reach out to CAPS or connect with a trusted figure to seek assistance.

Around the world, individuals should take interest in others, and notice any loss in energy, changes in habits or statements of worthlessness that may indicate their friend or family member has depression. Communities should recognize the strain mental health conditions place on their members and advocate for better resources to assist and treat disorders and more information to help reduce any stigmas.

Additionally, it is important to address outside factors that exacerbate depression. Northwestern Global Health professor Noelle Sullivan calls specific attention to the world economic conditions that result in increased cases of depression in her piece for truthout. Advocacy should also be directed to removing social and economic burdens on populations worldwide to combat this issue. 

World Health Day challenges people throughout the globe to more thoughtfully consider their health and the health of the global community. Through education and action, the Northwestern community can observe World Health Day, changing the outlook on depression and becoming better global citizens.

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Northwestern takes a field trip to a Baby-Friendly hospital

Students in Professor Sera Young’s class met with some of Advocate Trinity Hospital’s staff as they toured the facility. (Photo courtesy of Advocate Trinity Hospital)

Early in March, a group of Northwestern students in Professor Young’s “Ecology of infant feeding” class had the chance to visit Advocate Trinity Hospital on the southeast side of Chicago. From the outside, it looks like a regular clinic, but the hospital is really quite special–it’s Baby-Friendly.

Shouldn’t all hospitals where mothers deliver be “baby friendly”? Turns out, out of thousands of hospitals in the United States, approximately 418 hospitals and birthing centers carry a Baby-Friendly designation, according to Baby-Friendly USA.
Trinity Advocate Hospital is one of 17 Baby-Friendly hospitals and clinics in Illinois.

So what does it mean to be Baby-Friendly?

“’Baby-Friendly’ means that the hospital has adopted the practices set forth by Baby-Friendly USA,” said Mary Ann Neumann, A.P.N, M.S.N., R.N.C.-O.B., an advanced practice nurse at Advocate Trinity Hospital.

Baby Friendly USA is an organization that helps implement the WHO’s Baby Friendly Hospital Initiative. Part of the initiative requires adopting ten steps for successful breastfeeding, including allowing the mother and baby to remain together in the hospital, educating women about the benefits and management of breastfeeding and helping mothers initiate breastfeeding within the first half-hour of birth. Through these steps, health workers aim to increase the number of women who breastfeed.

“It is a culture; it takes a lot of work,” said Michele Roe, R.N., B.S.N., M.B.A, N.E.-B.C, the nurse manager at Advocate Trinity Hospital. “Many of our patients come here adamant that they are not going to breastfeed because their families do not support it, in their culture they don’t breastfeed or [they] have never breastfed; so many times it’s a battle for us to change that perception from the family support system and their beliefs…it’s a way of life, so to speak, here at the hospital – you have to live it in order to maintain and sustain it.”

Advocate Trinity Hospital promotes breastfeeding as much as possible, even for babies that must spend time in the nursery, away from their mother. They give mothers recliners and chairs to assist them with breastfeeding. (Photo courtesy of Advocate Trinity Hospital)

Advocate Trinity Hospital was Baby-Friendly designated in January 2016. The process for certification took four years, according to Roe, but already, the community is seeing increases in breastfeeding rates. Such an increase means that more mothers and babies are experiencing the benefits of breast milk, including lower infection rates for babies and reduced cancer risks for mothers, among other benefits. In the long-term, breastfeeding is thought to decrease the risk of diabetes and obesity, two conditions that affect many people in the community surrounding Advocate Trinity Hospital, as well as other areas with limited resources. It’s one of the key reasons why the hospital decided to become Baby-Friendly.

“Where the incidence of diseases are highest and the resources are the lowest is where you see the least amount of Baby-Friendly hospitals and we just wanted to set about changing that in our community,” Neumann said. “If it can be done here then it can be done anywhere –and really that’s where we started – we wanted our community to be healthier from the very first moment of birth.”

Professor Young’s class had the opportunity to hear a little bit about Advocate Trinity Hospital before seeing the structure behind its mission, touring the site’s labor and delivery rooms, C-section recovery rooms and the level 2 nursery. On the path to becoming Baby-Friendly, the hospital had to make some changes, training nurses and physicians on new procedures, creating resources for mothers and modifying the facilities. The level 2 nursery is one example. Most of the windows are covered with pictures and quotes. Inside, the space contains only a few beds, and even fewer babies.

Mary Ann Neumann adjusts a baby warmer in a maternity suite. (Photo courtesy of Advocate Trinity Hospital)

“The most important thing is our goal of keeping moms and babies together from birth to discharge, so where you see on TV shows people going to the window and all the babies are lined up in their cribs at the nursery window – we try to do away with that,” Neumann said. “We don’t just send the baby to the nursery so mom can get a nap or things like that, we keep them together and we promote that bonding breastfeeding and family togetherness.”

Such a short trip, though it didn’t cover full array of resources Advocate Trinity Hospital gives women, before and after delivery both within and outside the hospital itself, provided a new perspective into the world of Baby-Friendly procedures and challenges for all the students. Many of them plan to go into the medical field, including Ann Oler, who wants to become a perinatologist, helping high-risk mothers and babies with the birth process.

“This was my first time being in like a labor and delivery ward and like a nursery which is super exciting because that is probably where I am going to end up spending most of my career,” Oler, a Weinberg sophomore, said. “I got emotional while we were there I almost started crying.”

Neumann and Roe said they appreciated being able to promote breastfeeding practices for another audience, expanding the number of people familiar with Baby-Friendly goals.

“I think for everyone to be exposed to what were doing, what we are trying to do with breastfeeding, it would not only normalize breastfeeding to the general population but [also] focus on health from the very beginning of life,” Neumann said. “Instead of trying to take care of it after the health problems start let’s start by preventing.”

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