Month: January 2013

Access to health services is a crucial aspect of well-being and a key component of social and economic development. Poor health levels can be detrimental to welfare and development. It is therefore clear that the health sectors will play a key role in poverty eradication and development in Uganda. This is the major reason why I am telling a story about how poor health has been a major cause of poverty in Uganda. Also, I have been a part of a team that carried out the most recent Uganda Demographic and Health Survey (UDHS 2011). I listened to various people, visited several homes, and shared stories and experiences with people from different backgrounds and managed to learn alot.
Malaria in Uganda is one of the most common infectious diseases and is an enormous public health problem. The disease is caused by protozoan parasites of the genus Plasmodium. Only four types of the plasmodium parasites can infect humans — the most serious forms of the disease are caused by Plasmodium falciparum and Plasmodium vivax, but other related species (Plasmodium ovale, Plasmodium malariae) can also affect humans. This group of human-pathogenic Plasmodium species is usually referred to as malaria parasites. Usually, people get malaria by being bitten by an infective female Anopheles mosquito. Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken on an infected person.
Malaria is not just a disease commonly associated with poverty, but it is also a cause of poverty and a major hindrance to economic development. The disease has been associated with major negative economic effects on regions where it is widespread. Poverty is both cause and effect, and the poor do not have the financial capacities to prevent or treat the disease. The economic impact includes costs of health care, working days lost due to sickness, days lost in education, decreased productivity due to brain damage from cerebral malaria, and loss of investment and tourism.

I remember I was at a dinner party in New York on New Year’s Eve 2012 when I first heard about Global Health Corps. The dinner was hosted by a friend of mine – let’s call him David – who works in the music industry, and our dinner companions were friends of his at the intersection of music and social media. How did I come to be at this dinner? I had met David a few years ago at a party for a tech start-up and we stayed in touch. I was working in digital media at a major news organization at the time, and tech start-ups love inviting people from the media world to create buzz for their companies, so David and I had been among the guests.

There you have it. And you might be thinking: Where’s the global health in that? At David’s party, somewhere between hot new artists and champagne toasts, we began talking about New Year’s resolutions. I mentioned that it was getting to be high time for me to quit my job in news—which I liked very much—and pursue my true passion in development and social innovation. I was getting comfortable, and if I stayed in my job any longer, I’d be too far down my career as a digital media professional to switch tracks. What with my volunteer work in organizations such as Kiva and Accion and hours spent poring over this economic theory and that book about global poverty, I knew where my life’s real interests lay.

“But then, how do I break into development?” I lamented to my dinner companions. “I’ve scoured everything on Idealist.org and it’s impossible. They all want ‘three years’ experience in a developing country setting or some such thing, and I don’t have that. I’ve never worked in the third world, and I don’t have a background in health or economics. It’s like you have to be in development to get into development. But, I’ve been in news for the past five years. What’s that got to do with living in Africa?”

Someone piped up and said, “Hey, I know someone who’s been working in Malawi this past year and she loves it! She sent an email saying her organization is recruiting now. I can put you guys in touch.”

And that was it. Everything changed after that one night on the eve of 2012. That’s the funny thing about recruitment: you never know what you don’t know about what the people in your networks are looking for, and you won’t know unless you ask. One of last year’s fellows sent an email to her contacts in a most disparate array of fields – here, for example, was someone working in the music industry – and through the vast Venn diagram we call life, her email landed in my inbox and I ended up a 2012-2013 Global Health Corps Fellow, simultaneously fulfilling both my New Year’s resolution and my life’s dream.

You never know who around you is in possession of some knowledge or information that’s not particularly useful to them until they find out that it could be life changing for you. When you want something badly enough, whether it’s to attract the most exceptional applicants into a program like GHC, or to get recruited into it, just ask. Ask everyone you know, because you don’t know who might be in the room with you.

I read my co-fellow Jonathan’s post a few weeks back and thought to myself, “Dang-it! That was what I meant to say!” (Let’s be serious, I most likely did not say ‘dang-it’, but rather some less kosher version thereof. But it was that sentiment). Jon so perfectly conveyed the theory, ethics and emotions behind what we do and why, that I almost felt like there was no more to say, and no eloquent way to say it. How to write a post that compares to that?

I am lucky enough to work with people on-the-ground daily, which is something that I’ve learned is vital for me to feel fulfillment, motivation, and joy. Perhaps most importantly, it is those encounters that leave me recognizing that what we do is not only worthwhile, but vitally important. Let me elaborate…

We have one client, Donald, who I initially interacted with back in August. He is a daytime syringe exchange client; I fondly think of him as our “gentle giant” since he is over six feet tall, but has a soothing and serene voice. One day I noticed that he wasn’t walking with the same stride as usual. He didn’t have a heavy limp, but something was bothering him enough to affect his gait. During the exchange we chatted, and in passing conversation I asked if he had any open sores or wounds. “Actually, I do,” he mentioned, and he told me about a sore on his foot that had been bothering him. I asked if he might be open to going to see a doctor for it. He said, “Yes,” but that he didn’t know where to go. We referred him to a free local clinic run by Georgetown medical students, and gave him all the information with fingers crossed that he would seek the help he needed if necessary.

We saw him again a few weeks later and he was extremely thankful – he had gone to the clinic, they cleaned out his wound, and they gave him an open boot so it didn’t continue to get irritated. “Thank you!” he said. “It feels a lot better.”

We didn’t see Donald for weeks and weeks. I wondered what had become of him. I missed our interactions. Then, I saw him for the first time again in November. Again, he thanked us profusely, saying, “It is because of you that I went.” He told us that we had “saved his foot.” He pulled me around the back of the van and confided in me that the doctors had to amputate a small part of his toe (about which he seemed embarrassed). The doctors had told him that had he not come in, they may have had to amputate part or all of his foot. He repeated multiple times the thankfulness and, as an outreach worker, genuinely almost made me cry.

I thought a lot about my personal fulfillment after these encounters. My overarching question was, “Is it selfish for me to want our clients to achieve success if part of the result is that I feel like I helped?”

After contemplation and perhaps a few internal moral dilemmas, I realized that, no, I don’t think it’s selfish. People gain fulfillment from a number of different places – art, travel, money, family, a good ol’ challenge – among many others. As long as we remain focused on supporting our clients, the fact that we derive inspiration, contentment, and joy from successes is not something to feel guilty about.

I still think of Donald often. I look forward to when I see him next with the hope that his foot will be healed, but also with the pride that we were able to provide resources to meet him “where he was at” (harm reduction lingo) and to empower him in his decisions.

My experiences from the last six months as a Global Health Corps fellow and working at the Children’s Health Fund has been both empowering and inspiring.

I moved to the United States to pursue a career in public health after practicing medicine for four years in Nigeria. I felt discontent about the declining access to health care services, as well as the maternal and infant mortality rates which continued to increase. I was convinced that these issues were beyond the daily doctor-patient encounters, that there are more systems-based and efficient ways to improve access, and outcomes need to be sought.

Working at the Children’s Health Fund, an organization that provides comprehensive health care through an enhanced medical home model to medically underserved children on mobile medical units, has exposed me to efficient ways to ensure that  health systems work. This organization, though not comparable to a nation, operates a health system that encourages collaboration of vital players. I have been opportune to work with the policy and advocacy, development, IT, communications, and medical affairs teams on different aspects of health service provision to underserved children and populations.

At the Children’s Health Fund, I am presently working on the Referral Management Initiative, a program that assists underserved children to navigate the health system  through provision of preventive and clinical services, whether or not they have health insurance. Care coordinators ensure that obstacles to ‘closing the loop’ of care are overcome through provision of transportation options, identifying  and linking children with providers and government services where required. I also assist in evaluating these programs in order to ensure that programs are run as designed and that they provide value to the population served.

Participating in the immediate and continued post Sandy relief efforts added another twist to my experience at Children’s Health Fund. I was a part of the immediate assessment and relief response to Hurricane Sandy around the New Jersey and New York areas. A disaster management team from my organization met with County Health Department heads, rescue officials/volunteers, and victims to assess the extent of damage and understand their needs and challenges, in order to respond appropriately without duplicating resources.  During these assessments, I was able to fully comprehend the diverse effects of a disaster, particularly its direct impacts on  individuals and the community. Homes were lost, hospitals were flooded, clinics and pharmacies were also closed. Individuals with chronic health conditions could not renew their drug prescriptions, and those who could have gotten their medications from temporary shelters did not  have their prescriptions with them, which made replenishing the medications a difficult issue. As a result of waste due to loss of power and inability to maintain appropriate food safety levels, food supply was erratic and if not for efforts to assess food donated, there may have been an outbreak of food poisoning at one of the sites we visited.

The Global Health Corps fellowship connected me with the Children’s Health Fund, where service is rendered strategically and consistently to underserved and hard-to-reach populations.  I believe many more opportunities to learn and serve are in store for anyone who becomes a part of this movement.

 

 

“Action.”

Ayana opens the big red door to reveal Sori dancing in the background. We burst out laughing.

“Cut,” I say through my giggles. Even though we have a lot to do, we always have time for a little fun. Ayana and Sori have carved time out of their busy schedules as community health workers (CHWs) working with patients who have HIV – making sure they receive their medications, accompanying them to medical appointments, and helping them navigate the complex social challenges in their lives. Today, Ayana and Sori are modeling how a CHW might talk to a patient for a video that we will use in training sessions for new CHWs. We shoot several scenarios, with good and bad examples.

When I talk about my job at PACT with friends and family, they sometimes have a hard time understanding why CHWs are so important. How could someone who is not a doctor or nurse make such a big difference in health? I explain that well-trained CHWs can meet patients where they are, both physically and metaphorically. Unlike doctors, CHWs can travel to patients’ homes to provide health education and support adherence to medication, keeping those who might otherwise fall through the cracks connected to the health system. Moreover, CHWs, who share language and culture with patients, are able to achieve a high level of trust and understanding with patients.

At PACT, we believe that CHWs could transform the US health care system to better meet the needs of the marginalized and the underserved.  In 1997, PACT brought Partners In Health’s accompagnateur model from rural Haiti to urban Boston. For the past 15 years, PACT CHWs have worked with some of the sickest people with HIV/AIDS in Boston. We’ve found that patients with CHWs get healthier and need less expensive services than patients without CHWs. Hearing of our success, other groups have adopted our model. PACT has since founded the Training and Technical Assistance Institute to support other groups that wish to learn from our experience.

As a fellow at PACT, I have the pleasure of learning from a renowned direct service organization with 15 years of experience while also being part of relatively new efforts to drive change in the American health care system. In my role with the Training and Technical Assistance team, I explore potential opportunities for PACT, think through how a CHW model might work for potential partners, write research papers, and develop training materials for CHWs and associated staff.

The videos I am filming with Ayana and Sori are part of these training materials. For the rest of the afternoon, as I watch Sori demonstrate how she works with client, I am reminded of how valuable CHWs are. I am proud to be part of an organization that is affecting people’s lives and transforming the health care system. But this is just the beginning. What we need now is…

ACTION.

Today, many are inspired to serve in the health and social entrepreneurship sector such as the Global Health Corps. They do so due to various triggers and reasons. They convince themselves they need to serve because of reasons really known to themselves. They decide to go down that road because it is a calling, a necessity, a good thing to do, to explore various scenarios, or for personal gain. The possible reasons are quite a few too many if listed.

Logically, all one really needs is the correct and required skillset to serve in the health and social entrepreneurship domain. What are they trying to do at the end of their perceived endeavour? Provide solutions and do their job, some might say. However, the thing that might make one think and question their moral and ethical psychology is the question, does one need sympathy, empathic concern, empathy and compassion to execute their work objectives and goals diligently in this type of sector? I have thought this through and I think empathy and compassion should be one of the important attributes one poses. It doesn’t necessarily have to be an obsession, but it should be there floating within your core.

I have come to comprehend that when you are dealing with issues and working in a job or fellowship that concerns the wellbeing of a person or life itself, one has to care in a certain way.  For example, some individuals apply for the Global Health Corps fellowship for reasons that might not even be related to its vision and mission. Some think about what this opportunity can do for their future careers, how it can propel them in moving up in the world due to the affiliations and contacts that the corps has, educational purposes, somewhat lenient vocational purposes or voyage and vacation gains. Maybe they apply to prove a point to family, friends and themselves.There are many others reasons, all coming down to one thing: personal gain.

One might argue that this should not be a problem when lives are being saved, ideas are being brought up and implementations are being made at the end of the day. My counter argument is: although lives are being saved and good things are being done, how does one make progression and continuity after they are done with their fellowship escapade? If they return to their old comfortable life, what does this do for continuity? For all I know, the portion of your service would be reset and the counting dial retunes back to zero. So what would you have done then? Well, not much. Don’t misinterpret what I’m trying to put across- I’m not saying you can’t live a comfortable life and do the things that you enjoy doing and feel guilty spending on the things that you can afford and require, I’m only trying to justify my opinion.

I strongly think that sympathy and empathy are a combinatory factor in  serving in a leadership and health domain because the two are usually responsible for one’s passion and energy to embark on a journey in order to do something about the problem, continue to do so and make it a main focus in their life’s work.

Sympathy is important because it makes one realise and acknowledge the challenges and hardships of a person or particular group of people and puts them in a situation where they feel obligated to do something about it however best you can, through a donation, charity work, a long term fellowship leading to a long term career serving humanity and trying to reduce their hardships. Adding empathy, which puts one in a situation that enables them relate with an individual who is going through hardships they greatly relate to  because they have experienced and endured something similar.

With sympathy, empathy, compassion and others alike, one will attach them to the work they do and really understand the importance of why their work needs to be successful and it also makes them and others appreciate their efforts and service to a cause that will make life more hospitable for one, two and many people living hard and trying lives.

Combination of sympathy and empathy, plus the interest in serving, plus the skillset one possess and their willingness to help in the war against social injustice and healthcare inequity, indeed does make a great and robust social entrepreneur, which I know all the fellows in my GHC 2013 class are.

Six months ago, I declined a well-paying job offer with a renowned global development agency to become a Global Health Corps Fellow. At the time, I had been through several interviews and reached the conclusion that joining a movement of young professionals who possess a fundamental common belief that “healthcare is a human right” was the right decision for me.

As a child who had lost not just one but six members of my family to preventable diseases in rural Western Uganda, joining Global Health Corps would introduce me to a network of young and compassionate leaders who would only approach families such as my own, not as a number but as a community worth fighting for. Through this movement, I have had the opportunity to meet fellows, professionals, leaders, innovators, and most importantly my heroes and heroines, whose wisdom and guidance will be influential in my personal, professional, and future leadership decisions.

I once heard that “no great leader has a monopoly on ideas”, and those who ought to lead well must stand on the “shoulders of giants.” In my six months with Global Health Corps and Single Stop USA, I have been able to work with an incredible team that dedicates their lives to serving low-income families and individuals, both on the programmatic and structural levels. My team at Single Stop USA helps struggling families to secure access to essential and life-changing benefits such as health care, nutrition, legal and financial support. In addition, we work at the forefront of policy research and advocacy, all of which have a direct and indirect impact on economically vulnerable groups such as immigrants, disaster victims, and low-income students. It is through this kind of work that I have had the rare opportunity of being in the same room and listening to great leaders such as President Bill Clinton, civil rights leader Julian Bond, Dr. Paul Farmer, Dr. Cornell West, Deogratias Niyizonkiza, and author Tracy Kidder.Without wisdom, leadership, and commitment to social justice of these “giants”, my quest for global health equity and fundamental human rights would be more daunting.

Looking back and pondering upon my life experiences up to this point, I would not have imagined that ideas, skills, and experiences from someone with my humble background would add value both to administrative and programmatic initiatives of my placement organization and the people we serve.

My growth as a leader and contribution to our clients would not have happened without Global Health Corps and Single Stop, first by recognizing my potential, and then giving me the opportunity to serve. After six months with Single Stop, I truly resonate with Dr. King’s words, when he said, “Everybody can be great…because anybody can serve. You don’t have to have a college degree to serve. You don’t have to make your subject and verb agree to serve. You only need a heart full of grace. A soul generated by love.”

Through Global Health Corps, and my work at Single Stop, I have began to witness the true meaning and implications of “Ubuntu”, that our humanity and our destiny is so inextricably bound together, that when we serve others, in the end we indirectly serve ourselves.

 

You’ve checked the GHC website for the third time today, despite the resolution you made to yourself to restrain from pressing that looming “refresh button” mocking you in the top left-hand corner of your browser. Your eyes are glossed over and itchy. Surely you must’ve missed something: a necessary requirement you do not possess; the “real story”; or more likely, your pride. Remember how innocent it all began, you may be thinking to yourself, the hope GHC’s turquoise banner once inspired within the cockles of my heart?

Our bright, fresh, smiling faces probably offer little comfort, the smug confidence afforded to a current GHC fellow. As you peruse our many blog posts depicting the litany of our accomplishments (did you know that we have doctors and MPH’s and former White House employees as fellows?!), you may find yourself experiencing what I call “the ricochet effect.”

(Not to be confused with “the boomerang effect.”)

Now, Jonathan, what is this “the ricochet effect” of which you speak? I’m glad you asked, curious reader. It’s the constant companion of one applying to a fellowship. You may begin the application process with a fiery passion, with gusto, even! Those foolish editors on idealist.org had no idea what they were doing when they posted the perfect GHC placement, just for you. Pafah! You chuckled to yourself, Barbara Bush may as well hand me the job now to spare any broken hearts. Perhaps your initial reaction even invoked the popping of champagne bottles, for how on Earth could such a clouds-parting, perfect-french-fry-to-ketchup-ratio, serendipitous job description suddenly land right on your lap? You begin writing your application essay even before you get the whole story. How could you not apply?!

And then two and a half days pass. Your adrenaline is spent, your serotonin levels stable once again. It’s now a Tuesday afternoon and raining. And you begin to read (yes, reading: the downfall of us all). You read of the competition statistics, of fellows and alumni, of placement organizations, of “leadership” and “passion” and “creativity,” of language requirements and medical liability. Your stomach drops, and with it, your spirit. The inaudible grumbles that escape your mouth attempt to form questions—whywhahuhfuhhmmah?—yet even questions escape you, for what questions are you to ask first?

Do I have the right qualifications?

Should I have taken that intro to Chemistry class my sophomore year?

I should’ve read Paul Farmer’s book.

Who is Paul Farmer?

Why did I major in Comparative Literature?

Wait, how many Fulbrights should I have had before applying?

But most significantly, and most simply put, that underlying question that haunts the rest: Do I measure up?

This stage of the ricochet effect (TRE, for short), is usually accompanied by actions most public health enthusiasts would balk at: food, drink, and that secret cigarette no one knows you have stashed in your top dresser drawer (you know the one, right on the left next to your old Green Day CD). Besides, it’s “self care,” anyway.

This cycle is recycled over and over again, ad nauseum, for the greater part of four months. You may think the first ricochet is the most severe, the extreme highs and lows of the initial “freak out” tempering the ricochets soon-to-be. Sadly, the unpredictability of the TRE model does not lend itself to quantitatively-verified measurements. A ricochet may hit you while on a date with that cutie who sat next to you in that postmodern literary theory class (why wasn’t I a bio major?!). It may sneak upon you while taking your pet corgi on a leisurely jog at 6:00 a.m. (good for you to sticking to your New Year’s Resolution!). The fact remains that for most of us daring (or foolish) enough to apply to GHC, some form of TRE will impede upon our ability to act as functioning human beings for a short period of time.

So what can I—a disembodied, bright-eyed, smiling head on GHC’s blog—offer by way of advice?

Sadly, no medical intervention—public health or otherwise—yet exists to fight the negative side-effects of TRE. It is a (temporarily) chronic condition. There are ways, however, to manage this affliction. Most importantly, do not allow TRE to deflate your obvious passion. There are many for whom TRE immobilizes. With each re-read of one’s application rough draft comes the painful desire to simply, well, not. For others, it requires a speedy solution, like peeling off a Band-Aid or, more accurately, a quick foot amputation for a hang nail: submit as fast as possible so I never have to think about it again. And for others still, it requires an uppage in dosage for anti-anxiety medication.

However you choose to deal with your case of TRE (for it manifests itself differently in each body), remind yourself of that initial fireworks-inducing, damn-near-romantic moment when you first discovered what makes you come alive. Place GHC in the “maybe pile” for one moment, and re-focus your energies on answering a few questions: what inspires you towards action? What are you really, really good at (like, really good at)? What do you enjoy? What was your favorite class in college? Who is your favorite TV character, and how can you be more like her (always Amy Polher)? And really: what are you doing when you feel like your best Self?

Yes, GHC does result in existential crises, I’m glad you noticed.

The questions that swirl in our mind upon the initial ricochet moment usually probe our deepest insecurities: they ask us why we lack. So why not intervene into this line of questioning? Why not ask what we possess? Why not ask if GHC lives up to our potential, to our passion, and to our vision of a more just and equitable world? How can GHC be a vehicle to empower me to be the type of change I wish to see?

I deeply wish I could tell each one of you what it takes to be a GHC scholar, to offer a bulleted list of sure-fire statistics that will guarantee an accurate predictor of your application. The community GHC creates, however, eschews clear lines, embraces the ambiguous, and thrives within interdisciplinary ways of thinking about public health equity. While writing your application (or considering whether or not to apply), write from as authentic a place as an application will allow. For indeed, GHC does not “want” to hear anything. Or rather, they “want” to hear and see you.  And after all: you have a zero percent chance of gaining acceptance if you don’t apply, eh?

Consider applying, not simply because you think you “have a shot” based on easily measurable forms of calculating success. Consider applying because this work makes you come alive. Consider applying because you can’t imagine living life otherwise.