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Maintaining Passion for Public Health during Residency: An Alumna Interview with Divya Mallampati (Weinberg 2009)

Divya Mallampati graduated from the Weinberg College of Arts and Sciences in 2009. She was a pre-medical student majoring in Anthropology and minoring in Global Health Studies. She discovered her passion for anthropology in her Freshman Seminar, “The Anthropology of Violence.” That course spurred a curiosity–one that would resonate till today–about the treatment of women’s bodies and how that affects the way they receive health care. Her thesis explored the use of contraceptives by women in India’s urban and rural areas, which was later expanded into a Fulbright Fellowship to focus on family planning initiatives for HIV-positive women in southern India.

After spending a year in India, she attended medical school at Harvard. Maintaining her passion for global health, she obtained a Master of Public Health. After graduation, she volunteered at the World Health Organization in the Department of HIV/AIDS. She is now an OB/GYN Resident at the McGaw Medical Center of Northwestern University.

 

Q: How were you able to balance your academic, social and extracurricular involvements during your time as an undergrad?

A: It’s always tough to integrate all of those things, particularly for people with many different interests. To see those interests coming to the fore. Something that I continue to remind myself is that people truly matter. People very much matter. In moments when you don’t know where you’re going with your life or when you’re stressed out or you’re falling behind, I center myself by reaching out to people who matter to me.

 

Q: Take me through what a normal day is like for you.

A: If I’m on an inpatient rotation, my days will start super early, around 5 or 5:30AM. You have to round on your patients, check on the people who were already admitted into the hospital. Then you get together with your team and talk about any issues that those patients may have. Then you may do work for those patients, go into surgeries, if you’re on labor and delivery, you go deliver babies and take care of those women. If I’m on an outpatient rotation, the days are a little nicer because the hours are more nine-to-five. It’s all clinics and all office work.

 

Q: How did global health at Northwestern influence you?

A: I think there’s a difference between the global health minor at Northwestern and global health at Northwestern. The minor is a set of classes and a group of students and faculty. It’s built to give you a solid foundation. What I loved most about that experience was that it was very multi-faceted. They did a wonderful job gathering a diverse set of topics, the professors were very knowledgable and they gave us a lot of independence to think. It wasn’t formulaic. It wasn’t boring lectures. They pushed you to think about issues beyond just numbers and facts.

As a result, that influences the way global health is done at Northwestern. You get a lot of creative minds, people who are willing to engage in a variety of discourse and a community. I came out with a group of friends who taught me more than I ever taught them. I still keep a lot of those friendships, and those are still the people I turn to today to discuss global health issues.

 

Q: What study abroad program did you go on, and what was that experience like for you?

A: I did the Mexico program in 2007. It was the first time I had been out of the country, so it was the first time I was dealing with these issues through the lens of global health and social justice. I approached it like an anthropologist, like an observer. I spent most of my time in Mexico taking in what I was seeing. We took classes, did a little bit of research and visited rural clinic sites. The biggest thing I took away was designing a schema to think about these issues rather than memorizing a bunch of facts and statistics.

 

Q: How has living close to a city–Chicago for undergrad, Boston for medical school, and now back to Chicago–influenced your education and career?

A: As an undergrad, I grossly underappreciated how much Chicago has to teach us about inequities and public health. I don’t think I was truly analyzing what was happening in Chicago because I was so focused on my interests in other healthcare settings. By the time I moved to Boston, I had solidified my interest in how healthcare systems worked and appreciated Boston in a way that I wasn’t able to do with Chicago. It is a city that deals with a lot of race discrimination and inequality. Now that I’m back in Chicago, it has been really wonderful to explore the city, now ten or eleven years later. Now, I’ve been trying to understand Chicago through a different lens.

 

Q: Any words of advice for Global Health students at Northwestern?

A: First, to be very flexible in life. Be open to things that happen to you because you will find many beautiful things in paths that you didn’t imagine taking. That is a scary piece of advice to receive, but it is so important. Second, figure out what people mean to you. Understand how you value people and how you work with people. It’s okay to make sacrifices for people you care about.

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Revitalization of Traditional Systems of Medicine in Rural Rajasthan

Not all forms of effective medical treatment come in a pill bottle or are administered through a sharp injection to the forearm. Despite economic and medical progress in urban India, many rural villages and communities lack access to any form of health care. Access to healthcare in rural areas is an issue that the U.S. and India share, and the impressive medical advancements in cities provide a stark contrast to the impoverished, resource-poor villages and towns where people still die from preventable and curable illnesses.

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Overlooking fields in the village of Valli

It is easy to romanticize village life when you watch it fly past you from the car window. Rural Rajasthan, a northern state of India, becomes a blur of rolling hills of green, cows churning fresh dirt and women’s saris blowing in the wind against misty-blue mountains. It is monsoon season, so everything in this usually dry and arid land is made green and growing. Only 3 months ago, Rajasthan was suffering from a severe drought, where 17,000 villages were facing a water crisis that required government support. In this region, droughts affect water and food supply as well as people’s livelihoods since farming and drinking wells are dependent on a constant supply of rainwater. The life of a farmer is very physically demanding as well, resulting in many health complications later in life; oftentimes, farmers are unable to afford treatment at a hospital or private clinic due to their insufficiently small income. Last year, due to weather-related crop loss, 11 farmers committed suicide in 45 days, a small reflection of the thousands of farmer suicides that occur in India every year.

In 1989, 15 children in a rural Rajasthan village died from Diphtheria, a highly infectious nose and throat infection that is easily preventable and curable. Jagran Jan Vikas Samiti (JJVS), the NGO that I currently work at through the GESI program, was alarmed by this horrible tragedy and the lack of mobilization by the government to prevent or control it.

It is difficult to provide a successful and sustainable healthcare delivery system for the marginalized of any community, and even more so in rural areas. Healthcare tends to be located in urban and more affluent towns and cities, as healthcare providers tend to set up clinics in areas of social mobility and development where their patients are able to pay for their services, and the doctors have access to more resources and better accommodations. Indian government programs providing healthcare and other necessary services to rural areas have so far been lacking in resources and man-power, and the government has a concerning lack of interest in the welfare of the rural poor. Of the public government clinics that exist in Rajasthan, 56% of them are absent of any health care provider. Often, the closest biomedical, or allopathic, care is hours away by bus, which can become expensive, inconvenient and dangerous in the case of medical emergencies.

Traditional healers, unnoticed and unrecognized, have been treating common illness in rural villages for hundreds of years, passing down knowledge of medicinal plants from generation to generation. Allopathic medicine from a pharmacy or hospital is inaccessible and expensive – medicinal plants, however, grow easily in rural forests and gardens. JJVS, after realizing the dangerous lack of access to healthcare and unjust lack of interest in rural village welfare, has partnered with these traditional healers to improve the health of rural Rajasthan. Titling them as “Gunis”, JJVS identifies, trains, and provides resources to Gunis by widening their knowledge base of medicinal plants and human physiology, teaching them new techniques in Ayurveda, an ancient Indian system of holistic and natural healing, and Myotherapy, a manual therapy that deals with the musculoskeletal system, and building medicinal gardens and Guni treatment centers.

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Guni Roti Bai treating an ear infection with local medicinal plant

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Guni Pratapi Bai setting a broken foot

While collecting Guni Life Histories for my internship with JJVS, I have been able to observe Gunis at work. I was able to watch Pratapi Bai, a renowned female Guni and bone-setter, massage a broken foot back into place with her strong and weathered hands.

These competent healers have a lifetime of knowledge that is now complemented by JJVS resources and trainings and shared with the wider community. By providing safe, affordable and effective care, Gunis, trusted local healers, have the potential to change the health of rural Rajasthan for the better. Through talking with these Gunis, I have gained a new appreciation for what it means to be a healer and the benefits of Ayurveda and Naturopathic medicine in this rural context.

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Ebola in Kailahun

On August 8, 2014, the World Health Organization declared a Public Health Emergency of International Concern. Reports of the rapidly spreading Ebola virus in western Africa convinced WHO’s Emergency Committee to alert the international community of impending danger. However, according to Krista Johnson, an assistant professor at Howard University Graduate School, Ebola’s warning signs were clear long before 2014.

“We certainly didn’t prepare the population to respond to this, but the United States government was doing research on this and had samples,” Johnson said. “It was not as though Ebola was off of the radar. In fact, they were looking to implement programs and have strategies that would combat disease–specifically Ebola and other diseases like that.”

Health professionals originally discovered the Ebola virus in Sudan and the Democratic Republic of the Congo in 1976. They considered it a tropical ailment, similar to the Lassa fever discovered in Nigeria in 1969. WHO estimates that more than 1500 people lost their lives to Ebola between the 1970s and 2012. It was not until the 2014 outbreak that Ebola gained international attention.

Johnson specifically researched the outbreak of Ebola in the Kailahun district of Sierra Leone. With her colleagues, she noted the effects of both the virus and the community and international responses to its dangers.

“When Ebola struck in 2014, Sierra Leone was a country that had recently recovered from an 11-year civil war [and] gone through political transition from a one-party state to the reintroduction of multiparty democracy,” Johnson said. “The healthcare system was very weak and ill-equipped to handle a disease of this nature given its rapid spread throughout the country.”

It is difficult to pinpoint the first case of Ebola in the district, but given its close proximity to both Liberia and Guinea, other key hotspots of Ebola, Johnson stated that Ebola probably arrived in Sierra Leona at about the same time as it appeared in the other countries. Yet, the government was slow to respond.

“Although its believed that Sierra Leone had Ebola cases as early as March of 2014, the government of Sierra Leone only declared a national health emergency at the end of May,” Johnson said. “Its initial plans only focused on quick fixes and not addressing the root causes of the epidemic.”

With a healthcare system left in shambles from a civil war that ended in 2002, the country was faced with a lack of basic supplies to fight the disease. Citizens ignored health measures adopted by the government and avoided treatment centers, believing them to be dangerous.

Despite the adverse situation facing the country, President Koroma remained adamant that Sierra Leone would not “export Ebola” to the international community. The illness became an issue of security, as Koroma called on the military and international organizations for help. He also set up NERC, the National Ebola Response Centre, to fight the illness.

“NERC had United Nations and WHO representatives on its highest level,” Johnson said. “It was largely being run out of the international agencies headquarters, so the response was largely ceded to the international community.”

In contrast, response to Ebola in the Kailahun district was local and swift. Doctors Without Borders helped create volunteer task forces throughout the region to alert officials to new cases and deaths. Leaders in the region quarantined certain villages and temporarily banned traditional social gatherings to stop the spread of the virus.

As a result of these measures, the region became one of the first to successfully beat Ebola. Sierra Leone as a whole was not as lucky. According to data from WHO, nearly 4000 people in the country died from Ebola as of March 2016.

Johnson suggested that the high number of deaths from the outbreak could have been prevented if the government had considered more of the strategies used by the Kailahun district.

“The community response really highlights the importance of democratic participation and respect for human rights,” Johnson said. “It’s a long process in terms of gaining people’s trust and getting people on board in terms of what an effective strategy is going to be, but that’s what is required for people to be informed and to understand.”

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Alumni Discuss Post-Graduation Experiences in Panel

The Program in Global Health Studies welcomed back five alumni for a panel discussion to discuss their post-graduation experiences on Thursday, May 19.

“This year, we have one of our biggest graduating classes of minors. We’re in the early stages of developing plans for an adjunct major in global health. In addition, there’s an ongoing conversation with our colleagues in the graduate school about a dual-degree program,” said William Leonard, Co-Director of the Program in Global Health Studies. “The tremendous growth in the global health program reflects on the extraordinary efforts of all our alumni.”

The panel featured Sophia Blachman-Biatch (WCAS ’13), Isabel Garcia (SESP ’15), Divya Mallampati (WCAS ’09), Emery Alden Mathieson (WCAS ’11), and Gene Schwartz (WCAS ’08).

These alumni all embarked on different paths after graduating Northwestern. Blachman-Biatch pursued public relations in San Francisco, Garcia became a fellow of the Princeton in Latin America Program, Mathieson obtained a master’s in public health. Both Mallampati and Schwartz attended medical school._MG_3271

“Sometimes the real meaning of being a doctor gets lost in the rigorous academics of college and medical school requirements,” said Schwartz. “The Global Health minor reminded me why I want to do this and challenged me to think outside the box.”

Schwartz is currently an internal medicine hospitalist physician at Echo Locum Tenens, an affiliate of Sounds Physicians. He is also a candidate for a Master of Science in Clinical and Translational Research.

While Schwartz completed his residency last year, Mallampati just began her OB/GYN residency at the McGaw Medical Center of Northwestern University.

After graduation, Mallampati extended her work in anthropology through a Fullbright Fellowship. Then, she obtained her Doctor of Medicine and Master of Public Health at Harvard University.

“The study abroad component of the minor really makes you take into account the cultural and social factors that influence how primary care is provided. Also, it was an introspective experience for me. My learning from that abroad program has carried me through, even ten years later,” Mallampati said.

Not all global health minors aspire to become practicing physicians. Garcia is currently working in Mexico City at an education policy think tank.

“The minor first exposed me to the idea of being a culturally-competent provider, which was incredibly important to learn before moving to Mexico. It taught me to see people as people, not as subjects or patients. Working with dialogue-based learning was the biggest takeaway for me,” Garcia said.

Like Garcia, Blachman-Biatch did not take the route to medical school. She fused her studies in Integrated Marketing Communications, Psychology, and Global Health into a public relations career in San Francisco. Realizing that agency life is not for her, she is now working at Xerox Community Health Solutions as a Project Analyst in Client Services.

“The creativity and diversity of how health plays a role in today’s society has been instrumental in what I’ve been able to accomplish so far in my career,” said Blachman-Biatch.

Mathieson continued his global health education after Northwestern by obtaining a Master of Public Health at Emory University with a focus on community health and development.

He has worked for the Center for Disease Control and Prevention, Environmental Services group within Delta Airlines, and Evolent Health.

“In my time as a global health minor, I realized this is my no means a narrowly focused field. There are, truly, boundless opportunities.”

The five panelists agreed that global health is a dynamic, interdisciplinary field that opens doors to divergent paths. And seeing these divergent paths come to life through the experiences of alumni was incredibly inspiring.

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Vaccination Crisis: 80% of children under 2 without vaccinations in Guatemala

More than a year ago, I was sitting with my grandparents on the morning of the New Year eating a champurrada and reading the Guatemalan newspaper Prensa Libre. We had celebrated the previous night at a nice restaurant in the colonial city of Antigua where we watched the sky light up with fireworks at midnight. I was reading the newspaper with the intention of practicing my reading comprehension skills in Spanish, as I had not taken a formal class in years, when I stumbled upon an emergency that has largely been ignored in the Western press.

In August 2015, almost 400,000 children under the age of one did not receive vaccination against measles, a disease that was eradicated from Guatemala 20 years ago. There are 328 health posts in the country, however 26 of those are closed, and the rest of them are understaffed and under-resourced at epidemic proportions. I heard about this first-hand from the Guatemalan women who I interviewed for my research project on diabetes this past summer, as they described stories of arriving at the health post at 3 AM and waiting in line to receive medicine that would run out by the time it was their turn. The health post catered to the growing population of diabetics, but only on one day of each month.

Shortly after that article was published, Prensa Libre published another article describing how 602,357 vaccinations were lost in the transition between the Ministry of Health and the health posts due to robbery, improper refrigeration and lack of coordination in 2014. This resulted in a loss of almost a million dollars, but more than anything, it created a growing risk for thousands of infants now vulnerable to dying of preventable diseases in the near future. The incoming Director of the Ministry of Health, Luis Monterroso, said that 45% of children in Guatemala were not vaccinated in 2014. Data shows that the most rural and impoverished regions of Guatemala did not receive any vaccinations for the entire year.

Prensa Libre

Prensa Libre

Fast forward to April 2016. It is now one year after the former President of Guatemala, Otto Perez Molina, was impeached and arrested for insurmountable charges of stealing money from the health system, several months after the national hospital ran out of food for their patients, the same month in which six newborns died at the National Hospital of Sololá due to lack of medical attention, and the same month when the recently elected president, Jimmy Morales, failed his promise to fix the health system crisis within 100 days of being in office. In Guatemala today, 800,000 planned vaccinations were not completed in 2014 and 2015. According to the Alliance for Nutrition (Alianza por la Nutricion), 81.5% of children under two years old do not have the recommended vaccinations. On top of everything, the Guatemalan government owes millions of dollars to the Pan-American Health Organization – a sum that rivals what is needed to immunize the thousands of children lacking vaccinations in Guatemala today.

While local actors are combating this national emergency, I could not find any information about this crisis in an English-speaking source. In fact, this emergency has only received attention from Prensa Libre, the Guatemalan newspaper that I happened to read on a dining room table in Guatemala two years ago. Both UNICEF and WHO had data on vaccination coverage for Guatemala. The percentage of coverage was in the 90’s for most of the immunizations on UNICEF’s profile of Guatemala. Looking closer, I noticed that the data on the home page was from 2013, and more recent data showed vaccinations had fallen by 10% across the board. Going back to the Guatemalan newspapers and a report published by the Ministry of Health, Hepatitis B and Pneumococcal vaccine were administered to 21.86%, and 59.87% of children in 2014, respectively. Statistics from the WHO matched these results. Rotavirus vaccine, which prevents vomiting and severe diarrhea in infants, had percentages of immunization coverage varying from 81% in 2013 (UNICEF) to 54.27% in 2014 (Prensa Libre and WHO). The international standard for all vaccinations is 95% – so no matter, Guatemala is very much below the standard, and with each passing year this problem becomes more dangerous.

A family walking outside Antigua, Guatemala

This past summer, I saw two cases of Hepatitis B – one in a private pediatric clinic in Guatemala City, and the other in an NGO-funded health clinic open once a week in rural San Martin Jilotepeque. They were both boys no older than five with scared brown eyes and thin limbs. The boy from the urban private clinic had just returned from Disney World and was accompanied by his two parents, both dressed in American brands, while the boy from the rural public clinic was accompanied by his mother, dressed in a Mayan huipil with his younger baby sister strapped to her back. Looking back, I found it a strange coincidence that I had seen two Hepatitis B cases in boys of nearly the same age but from vastly different worlds. And yet, how much of a coincidence was it in a country where only 22% of children were vaccinated against Hepatitis B in 2014? Hepatitis B has a higher likelihood of resolving itself in children above the age of 5, but for younger children and infants there is a 50/50 chance of chronic life-long infection of the liver. For a family living in poverty, this is devastatingly costly condition in a young child. Thus, like most health problems in the world, the vaccination crisis in Guatemala falls most heavily on the most vulnerable in society – children, and the poor.

In a crumbling health system in crisis, 80% of children under the age of two cannot afford to be without all the necessary vaccinations. Amid debate on national sovereignty and governmental requirements from international bodies, what is to be done about this national emergency, and by whom? While some parents in the US benefit from the luxury of “herd immunity” and do not vaccinate their children, Guatemalan parents have neither the choice to vaccinate their children nor are able to prevent their children from dying of preventable causes. What can be done against the systematic invisibility of long-term global health emergencies in Western media? Without proper attention to this public health emergency, nothing will be done in the near future.

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