Global Health Blog

  1. Local communities, global connections

    January 18, 2015 by Janka Pieper

    The Global Health Portal recently spoke with Rebekah Williams (WCAS 2015) and Kaitlin Hansen (WCAS 2015) to learn more about how their study abroad experience in South Africa led to summer research and strengthened their career goals.

    Tell us about your project. What inspired your work?

    Kaitlin and Rebekah2In the past decade, post-apartheid South Africa has experienced an unprecedented shift in how the government addresses the prevention and treatment of HIV/AIDS. With the National Strategic Plan that rolled out in 2007, the public sector has taken dramatic steps in taking over much of the early treatment options for HIV/AIDS, which has expanded the reach of antiretroviral therapy treatment with more cost-effective options and increased access. While previous studies have looked at how the policy shift affects how individuals perceive access to health facilities in the civil sector, there are no studies from the perspective of the civil sector itself. The purpose of our research was to answer the following question: How does the HIV/AIDS policy shift in the public sector in South Africa affect the strategic action plan goals and daily work of Legacy, a community-based NGO, in terms of their prevention and treatment of HIV/AIDS in Kayamandi?

    We were inspired to conduct this research because we both studied abroad in Stellenbosch through IPD’s Public Health and Development in South Africa program. Additionally, both of us are interested in working in the civil sector after graduation, so this was a great opportunity to learn about the inner-workings of an NGO. As part of our study abroad program, we were placed with Legacy for the service learning portion of our curriculum, and we thought that it would be great if we could not only continue our relationship with the organization, but also extend our learning throughout the summer.

    We thought that Legacy would be a great organization to study for this research because Legacy focuses most of their work around the disproportionately high rate of HIV/AIDS in Kayamandi. Moreover, we knew that the new HIV policy had a direct impact on one of their programs, Ikhaya Lempilo. In 2014, Legacy changed Ikhaya Lempilo from an inpatient to an outpatient facility, shifting its focus from the treatment to the prevention of HIV through education and awareness. We wanted to explore why and how this shift happened, as well as the unintended consequences of the policy.

    What was your most meaningful experience abroad, and what did it teach you?

    Meeting the children in the after-school sex education classes that Legacy Centre offered was by far one of the most meaningful experiences we had while working on this project. The kids were full of energy, hope and curiosity. That experience truly motivated us and reminded us of the importance of our research and directly put us in line with the people or larger questions that our work would be affecting. It was a humbling and encouraging reminder of the meaning of our work now and the work we hope to do post-graduation.

    How did your experience on the ground vary from your expectations?

    One thing that we did not anticipate was the unresponsiveness of NGOs in Cape Town. After we finished our research in Stellenbosch/Kayamandi, we thought it would be interesting to extend our research to the Cape Town area, especially because we were living there during the summer. However, even with follow-up emails, only one out of the six organizations we emailed responded. Therefore, we kept our research as an isolated Kayamandi case study.

    Did you encounter any cultural differences that required getting used to?

    We didn’t speak the local language Xhosa that most of the locals spoke. While most of the executive staff whom we interviewed were fluent in English, it did provide a cultural barrier when we walked around the NGO grounds. We weren’t able to engage in conversations as easily with the children, parents and local community staff and had to resort to our (very, very, very) broken Xhosa lessons. Through a combination of English, broken-Xhosa and good old impromptu sign-language, we were able to meet this challenge as best as possible.

    Has your summer experience impacted your future goals and interests at Northwestern?

    At the start of our project, we both had hopes for pursuing global health work post-college. As rising seniors, this opportunity was invaluable in encouraging those aspirations. Working in an international field site strengthened our vision of the challenges, victories and reality that public health work abroad entails. Walking away from our time in South Africa, we are encouraged to pursue a future in the field and are eager to one day return to Cape Town!

    Do you have any advice for students wishing to conduct research in an unfamiliar location?

    BE PATIENT AND FLEXIBLE. It is crucial to have local connections, or your research will not go smoothly. Additionally, scour online reviews for housing because you definitely want to stay somewhere with people your own age for mental health’s sake, but you want to make sure where you’re living is safe and not TOO much of a party, because that might get tiresome after two months. Besides that, it’s important to take a step back from your research and remember that you are young and in another country so you should HAVE FUN!

     

     

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  2. An Irreplaceable Niche

    January 16, 2015 by Janka Pieper

    Rajiv Varandani’s health research in Singapore helped him discover cultural differences and his interests in endocrinology and nutrition. Rajiv is a senior, majoring in cognitive science and science in human culture.

    Last August,Rajiv7 I got onto the longest plane flight of my life. I was leaving Singapore after 9 weeks of beautiful experience. As I relaxed into the airplane seat, a steady stream of memories came to me as I recalled my life-altering summer.

    I mused upon the daytrip I took to Chinatown and Little India, seeing the most salient cultures of the country. I walked to one of Southeast Asia’s largest Hindu temples and one of the oldest Buddhist temples in the world. I spent one of the best weekends I had travelling through all of Singapore to see the culture. A few weekends later, I went to the Singapore Independence Day parade and fireworks. This was an awe-inspiring performance. It was remarkable how much time I had to reflect and think upon what I had seen – I fell in love with the people and the culture.

    Even though I was able to find my niche culturally by exploring the country and meeting new people, I ran into many challenges at the workplace. The Singaporean work environment was extremely different compared to what I expected. I was not used to the research workplace expecting close to 10 hour days. This was a vastly different change from what I was used to – four hour classes – to working full day. However, this was not what challenged me. The main challenge came from working out of a major government research organization (similar to the NIH) and with the university hospital. There was a major culture difference. I spent two entire weeks figuring out how to work with healthcare professionals in this country. It is nothing like the U.S. The feel is different, the approach to medicine and research is different, and most importantly, their approach to you is different. I still am a little confused about it…but I made do. I found some great mentors and leaned on them to learn how things worked.

    Overall, the research was amazing! I learned SO much about how obesity, diabetes and nutritional intake impact the human body. I discovered my interests in engaging in endocrinology and dietary intake because the overlap is HUGE. In the coming months, I look forward to working with the lab to help publish a paper on the project.

    Overall, my experience in Singapore was irreplaceable. From food to friends to work, I learned so much and grew even more. I hope that one day I can go back to see the country that helped change me.

     

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  3. Female Circumcision and Clitoridectomy in the United States: A History of a Medical Treatment

    December 8, 2014 by Lajja Patel

    Sarah B. Rodriguez teaches in the Medical Humanities and Bioethics Program and in the Global Health Studies Program at Northwestern University. Global Health Portal blogger Lajja Patel recently spoke with Sarah about her new book Female Circumcision and Clitoridectomy in the United States: A History of a Medical Treatment. Here is an excerpt from the interview.

    Source: University of Rochester Press

    Source: University of Rochester Press

    About the book (from the publisher): 

    In the nineteenth through the mid-twentieth centuries, American physicians treated women and girls for masturbation by removing the clitoris (clitoridectomy) or clitoral hood (female circumcision). During this same time, and continuing to today, physicians also performed female circumcision to enable women to reach orgasm. While the opposite purposes of these clitoral surgeries (to either contain a perceived excessive sexuality or to remedy a perceived lack of sexual responsiveness) may seem paradoxical, their use reflects a consistent medical conception of the clitoris as a sexual organ. In recent years both the popular media and academics have commented on the rising popularity in the United States of female genital cosmetic surgeries, including female circumcision, yet these discussions often assume such surgeries are new. In Female Circumcision and Clitoridectomy in the United States: A History of a Medical Treatment, Sarah Rodriguez presents an engaging and surprising history of surgeries on the clitoris, revealing what the therapeutic use of clitoridectomy and female circumcision tells us about changing (and not so changing) medical ideas concerning the female body and female sexuality.

    Can you tell us a little bit about your background, and your research interests?

    My background is in the history of American medicine and my research area of interest is in women’s reproductive and sexual health since the late 19th century. I’m interested in history for history’s sake but I’m also interested in how history frames how we think about current medical debates and issues. I came to be interested in global health via my work on the topic of this book. Almost everyone conceives these methods as nonmedical procedures that don’t occur in the U.S. unless it’s by immigrants, but this is not the full picture. Historically, in the United States, female circumcision and clitoridectomy were done on white, native-born women as medical therapy.

    Can you tell us about some of the history on female circumcision and clitoridectomy as discussed in your book?

    To give you a little bit of a background, clitoridectomy is the removal of the external clitoris, while circumcision is the removal of the clitoral hood. Some physicians in the U.S. started using these procedures (at least based on published documentation) in the mid 19th century. At that time, physicians were using it to treat masturbation in women and girls. Physicians believed that there were poor physiological outcomes from masturbation – poor outcomes not in the moral sense but in the sense that people would become ill. Some physicians used clitoridectomy as a therapy for masturbation until at least the 1960’s – that’s the last published reference I found. Physicians also used female circumcision to treat masturbation and they used that therapy until at least the 1960s as well.

    In addition to using female circumcision as a therapy for masturbation, however, beginning in the 1890’s physicians published reports of using female circumcision to enhance female orgasms. When I first discovered this use of the procedure, I didn’t think it made sense because physicians were (seemingly) performing female circumcision for polar opposite reasons: to enhance orgasms and to stop masturbation. After further research, I realized that both were being used for a similar goal: to treat culturally non-normative sexual behavior. Whether a woman was masturbating or not having an orgasm with her husband during sex, both behaviors were regarded as culturally inappropriate. If a woman was not having orgasms in the “appropriate” heterosexual manner with her husband, then the clitoris was seen to be at fault. The only “culturally appropriate” and “medically healthy” sexual behavior would have been to have orgasms with one’s husband. Female circumcision and clitoridectomy were medical therapies used to reinforce culturally normative sexual behavior.

    While there is no evidence to suggest these procedures were frequently used, they were also not anomalies. They were commonly known enough to end up in some pediatric and gynecology textbooks, for example. And the reason why practitioners were performing these procedures was very much embedded in cultural ideas (and ideals) of normative female heterosexual behavior.

    While you were writing this book, which populations were you hoping would read your book?

    Definitely other historians and medical anthropologists. But I hope that people who work on policy/outreach/ education surrounding the issue of FGM also read it. And I’d love for people more broadly interested in women’s health and women’s history to read it.

    Do you recall some challenges you had while writing this book?

    One challenge was finding sources – you have to work with whatever documents are left. The majority of my sources are the published reports of physicians, but then all of these documents are from the perspective of the physician. Women’s voices don’t appear until really the 1970s when a few women began publishing about their experiences.

    How long did it take you to write this book?

    I initially started exploring this topic while an undergraduate for my honors thesis. I took it up again for my dissertation, but then moved to other topics for a bit. I then wrote one article and again let it sit. So, you can say, I’ve had an on again, off again relationship with this project for a long time. The short answer is, it’s taken me several years.

    If you had this on and off- relationship what finally inspired you to go ahead and write this book?

    I felt the need to give a more full accounting of the history of these practices than what I was able to do in an article. Also, I suppose I did it for the challenge of it – others told me that I’d never have enough material for a book and I thought otherwise.

     

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  4. APEC Climate Agreement: Too Little Too Late?

    December 1, 2014 by Haley Lillehei
    pollution-changchun-net.jpg

    A power plant pollutes the air over Changchun, in northeastern Jilin province. Photo Source: South China Morning Post

    Last May I wrote a post on my experience with pollution while in China. The smog was, without a doubt, my least favorite part about spending a summer in Beijing. Not only are the extreme amounts of pollutants gross to breathe in and bad for the environment, they are also bad for our health. And since my 2012 trip, the problem certainly hasn’t been getting any better – a recent study estimated 670,000 people died from smog caused by coal consumption in 2012.

    These deaths were linked to a tiny particulate pollutant (PM2.5) in smog that contributes to premature deaths from strokes, lung cancer, coronary heart disease, and chronic pulmonary disease.

    To understand the level of pollution in China, it is helpful to look at a benchmark. According to the World Health Organization (WHO), the upper limit for safe pollutant levels of PM2.5 is 10mcg per cubic meter. In China, in the year 2012, hundreds of millions of people were living in areas with pollutant concentrations far above this level. In fact, 157 million people were living in areas with PM2.5 concentrations over 100mcg per cubic meter, ten times the WHO’s safety limit. Since 2012, the problem has only gotten worse.

    The researchers behind the study were interested in putting numbers on the social and environmental costs of the heavy Chinese reliance on the fuel and the resulting pollution. The results are even more dim than one might have imagined – they found the combined cost of damage to environment and health to be 260 yuan (~45USD) for each ton produced and used. For a country that uses approximately 4 billion tons of coal per year, the expense is massive.

    Despite the large monetary cost the researchers found, their estimate may still be too conservative. Although they took into account the health care costs of the aforementioned causes of death, they overlooked smaller but very common health issues caused by pollution, like asthma and other respiratory issues.

    Li Guoxing, from Peking University’s School of Public Health, remarked in an interview with South China Morning Post: “The health cost [of the study] is only based on the premature death figures due to the limitations of our research data. It could be way higher if we also include medical costs for other chronic illnesses.”

    Beijing clearly knows some work needs to be done. In lieu of the Asia-Pacific Economic Cooperation forum that took place a few weeks ago, the city tried to clean up its act in hopes it would help clean up the air. Flowers were planted, streets were swept, residents were encouraged to leave town, home heating was temporarily cut off, and factory production was ordered to be delayed or stopped, among many other measures. This was the biggest international event to take place in Beijing since the 2008 Olympics, and China was ready to pull out all the stops.

    Beijing’s clean-up may have foreshadowed what was to come. On November 12, Chinese President Xi JinPing and President Obama announced an agreement to curb pollution. This agreement is being hailed as landmark – the US and China represent the world’s two largest carbon polluters, together accounting for 45% of the world’s greenhouse gas emissions.

    Obama and Xi shake hands. Photo Source: Economist

    In the agreement, which has yet to be approved by the World Trade Organization, China pledged to put a cap on its quickly growing carbon emissions by 2030, as well as increase the amount of non-fossil fuels used to 20% of all energy used by 2030.

    These ambitious goals are the largest steps China has taken to reduce it’s pollutant levels in recent history and the agreement is being widely praised around the world. Some, however, fear it is too late.

    Can the agreement and the resulting goals make a real dent in the social and political costs of pollution in China, as well as around the world? It remains to be seen. What I am certain of, however, is that any move in the right direction is better than no move at all.

     

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  5. In Sickness and in Health: Panel Discusses Health Trends in Evanston and Skokie

    November 28, 2014 by Lajja Patel
    Courtesy of Sean Su"

    Courtesy of Sean Su

    Last Tuesday, the Evanston Public Library in collaboration with the Village of Skokie, the Erie Family Health Center, and NU International Program Development, hosted a discussion on current health trends in the Evanston and Skokie neighborhoods. The event was titled “In Sickness and in Health” and consisted of a panel of three speakers: Evonda Thomas-Smith, director of the Evanston Health Department; Dr. Catherine Counard, director of the  Village of Skokie Health Department; and Dr. Avery Hart, Chief Medical Officer of Erie Evanston/Skokie Community Health Center.

    Northwestern Global Health Professor Michael Diamond introduced the event as the first of many discussions that will be organized by the Hircules Health Hub, which is a project committed to providing easier access to health information by collaborating with other community health organizations. As a part of this new project, Northwestern global health students will be volunteering to operate desks at the Evanston and Skokie Public Libraries starting in Spring 2015 in order to provide information about the latest health concerns in the respective communities. The group will also be holding monthly discussions on various health themes, such as nutrition, cancer, etc. in order to empower local community members with knowledge about maintaining their health.

    In addition to introducing the concept of local community health desks at the Evanston and Skokie libraries, the event also served as an opportunity for the Skokie and Evanston health departments and the Erie Family Health Center to provide summaries of the latest health trends in Skokie and Evanston.

    The leading health concerns in the Evanston community was asthma for the youth and obesity for the older population, said Evonda Thomas-Smith, Director of the Evanston Health Department.  However, through a number of surveys distributed in the community, the Evanston Health Department found that the top pressing health concern in the community was access to health care. Similarly, Dr. Catherine Counard, director of the Village of Skokie Health Department, said that according to surveys, Skokie residents reported that access to care and health information was also the most pressing health concern in their community.

    Dr. Avery Hart, Chief Medical Officer of Erie Evanston/Skokie Community Health Center, said, “Every day I’m seeing new patients, and each one has his own story or her own story, but these are all stories that revolve around not having access to healthcare.” The mission of the Erie Family Health Center is to provide affordable health services to those in need. Due to its location on the border of Evanston and Skokie, which is comprised of various ethnicities, the Erie clinic is employed by culturally diverse employees and also offers interpreters for over two hundred languages. Prior to the launch of Erie in 2013, residents without health care had no way of receiving health services.

    Throughout the entire discussion, the three panelists continued to emphasize the power of libraries in serving as a resource for health information. The traffic of local residents that come through libraries in addition to various books and library resources available make it the perfect location to host community health desks. The idea of collaboration between health care providers, community health leaders, and local Health Departments is key in making information about health care more transparent and affordable to the public.

    The twenty-five audience members included medical providers, public leaders in healthcare, faculty and students from Northwestern’s Global Health Studies program, and the general public.

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