My Global Health
Leaving Home by Sarah Gutin
In 2005, when I was 25, I moved to South Africa for two years to do my MPH at the University of Cape Town. My parents—especially my father—thought this was a distinctly bad idea. A lot of that came from a place of fear—the fact that I was moving to a country I had never been to, a country with a very high HIV rate, which was also known not to be the safest of places. I had never been to Cape Town or South Africa, never been on the African continent. But I took this leap of faith and said, "I want to do HIV and reproductive health work, this is a fascinating place, and this is where I want to go."
I was one of the youngest people in my program. Almost everyone else was from South Africa or sub-Saharan Africa, and they were being sent by ministries of health or by NGOs, and they brought an amazing wealth of experience. That was part of what made the program so challenging and enriching. Also, I had the opportunity to get out into some of Cape Town's townships and do community health outreach, and I was able to conduct research about a reintroduction of the IUD into the contraceptive-method mix in South Africa.
I sent regular e-mails home to a wide listserv I'd created. A few months after being there, my father sent me an e-mail that came from a colleague of his. He had forwarded one of my e-mails to this colleague, and the colleague had written back, "What a wonderful e-mail. You must be so proud of her. What amazing things she's getting to do!" And my father forwarded it to me, and above it he wrote two words: "I agree." I realized that was my father's way of saying, "I'm proud of you, and I think you made the right choice." Since then, my father has been exceptionally supportive of my global health research and career.
Sarah Gutin received her MPH from the University of Cape Town in 2007. She is a PhD student in the Department of Health Behavior and Health Education at U-M SPH, specializing in the intersection of reproductive health and HIV care.
Finding a Family by Sarah Ketchen Lipson
From July 2009 through June 2010, I lived in the Republic of the Marshall Islands, a Micronesian atoll nation about halfway between Hawaii and Australia. When I first arrived, I was scared. I was constantly on the brink of tears. Mostly I missed having people who really cared about me, and I wondered if I would find that sense of connection so far from home.
Though my immersion into Marshallese life was subtle, there were certain turning points. One occurred on a weekday afternoon in December. I was walking home from the high school where I worked, when a dog ran up behind me and clenched its teeth into the back of my left knee. I fought back as best I could, and the dog eventually released its grip and retreated. As I limped to find help, blood dripping down the back of my leg towards my ankle, I felt defeated—like somehow this stray dog knew that I was weak, that I was running on empty and had been for quite some time. I had been living on a tiny island with intermittent electricity and a sporadic supply of running water, and my head was crawling with lice (which I had for eight months total). That night as I lay in my cockroach-infested makeshift hut, my knee bandaged to the best of my ability, I thought, "I don't know how much more I can take."
The next day, I was awoken by a young Marshallese boy. I recognized him from the village but didn't know his name. As he walked towards my bed, I sat up, startled. He smiled and extended his hand expectantly. I hesitantly received his hand and allowed him to escort me silently through the neighborhood. I followed in a daze, focused primarily on protecting my wounded knee from branches that came across our path. After about five minutes, we came to a house that backed up against the lagoon. There, a group of women were meticulously setting up what looked like a séance. One woman motioned for me to lie down. So I did. Lying on my stomach, face down on a mat of woven coconut husks, I could hear all sorts of commotion above me. Then another woman knelt down beside me and, in broken English, told me that she and her family would be caring for my injured leg. They—and most of the island, I would soon realize—had heard about the dog attack. That morning, and every morning thereafter for the next week, the same young boy, Ayden, would escort me through the village to his family's home, where they would treat my wound and feed me breakfast. By the time I was fully healed, I had found myself a Marshallese family. Sometime in February I moved out of my vermin-infested hut and into their home by the lagoon.
Sarah Ketchen Lipson is a joint-degree doctoral candidate at U-M, studying health management and policy at SPH and higher education at the School of Education. She is also assistant director of the Healthy Minds Network for Research on Adolescent and Young Adult Mental Health. She holds a master's in education from Harvard University and is a former Fulbright scholar.
Power Dynamics by Amruta Bahulekar
At one event, I met an African-American artist who had developed an installation involving different types of crowns of historical figures. At the exhibition opening, there was a discussion about the issue of power. It gave me a space to reflect about my public health work in India, because if I’m trying to reach out to every child, I need to take into consideration the power dynamics. That includes issues of deprivation. Reaching out to someone who does not have food is difficult—a health worker needs to go in with different methods. Or when an adverse event happens after immunization, a health worker needs to know how to deal with the emotions—it’s not just statistics. So the discussion helped me broaden my perspective. The whole experience of absorbing lessons from a new culture taught me a lot.
Amruta Bahulekar is a researcher with the Immunization Technical Support Unit of the Public Health Foundation of India (PHFI). She is part of a collaborative U-M SPH/PHFI research project examining immunization performance at the state level in India.
Turning Point by Emily Renda
I came to U-M SPH thinking that I would be doing global health, especially in Latin America, where I’d just spent six months traveling. At the end of my first year at SPH, I got a summer internship with an international aid relief agency in the Dominican Republic. I think I had a fairly typical experience—it was tough at first with the language and cultural barriers, but the internship itself was great. I learned a lot and hope I contributed to the organization. I helped develop and pilot an STI-prevention workshop with a group of teens at a retreat, and that was a blast.
But there was a moment where I realized that maybe global health wasn’t for me. One day we were at a support group for people living with HIV/AIDS, and I just had this moment where I looked out into the group and saw a lot of children’s faces, and it hit me. It made me think about their future and how limited their options were likely to be, especially living with a stigmatized disease, and how uncomfortable I felt about the notion that I could leave that place that afternoon, if I needed to. I could leave that entire island that day if I needed to, I could leave that place and never return. It profoundly impacted me. I could hit the escape hatch at any point, and that somehow didn’t feel right to me. Being a white North American woman with an education, and the means to travel through these spaces—which is of course a privilege—this notion that I could come in with these identities and say, OK, I’m going to help you all. For me, I couldn’t reconcile that.
I very much support global health, and in my job I support students in finding global health internships and careers. Global health can be done very well when you’re going in and engaging with the community, finding out what they want, rather than saying what you think they need. But for me in that moment and that time of my career, I didn’t feel like I was adding more than I was taking away. Public health is about finding your niche and finding the place where you feel comfortable giving back.
Emily Renda, MPH ’09, was director of student life at U-M SPH until spring 2016.
Identities by Jhordan Wynne
Chile was very isolated for a long time because of the Pinochet dictatorship, and Chileans views themselves as homogenous. The perception of “other” to them is very salient. They also don’t have much of a concept of black Americans. One day a friend and I were at a museum, and a Chilean woman approached us and asked where we were from and if we had experienced discrimination in our lives in the U.S. I kind of laughed to myself because it’s, like, “Yes. Every day as a black woman.” But this woman was getting her PhD in global injustice and genuinely had no concept of what race relations are like in the States. All they know, or see, of us, is President Obama, Beyonce, and Will Smith—which is fine, but obviously we’re not all like that, and our lives aren’t identical to theirs.
I want to be some place where people look like me. I don’t want everyone to look exactly the same, but I want to be somewhere where there isn’t shock and awe every time I walk into the room.
Jhordan Wynne, MPH '16, is a recent graduate of U-M SPH.
Palms Up by Amaal Haimout
I always knew I was interested in global health and had traveled abroad several times before, but had never worked abroad long-term. Working in Mongolia for three months on my SPH internship was an incredible experience, but also had its challenges. A lot of the time when we think of global health, we forget about the daily living involved, which entails navigating the political system, roads, and language. Even something as simple as grocery shopping becomes more disruptive than it normally would when you don’t know exactly how the currency works and you have difficulty asking for assistance selecting your food due to language barriers.
Cultural norms are another challenge. In Mongolia, you hand people gifts—or any item, for that matter—with both hands and palms facing upward. I learned this when I accidentally handed out baby wipes with one hand as a thank you to participants in our study. I continued handing the wipes in this fashion until my mentor noticed and pulled me aside to inform me this was considered rude. She then showed me how to hand items to individuals, and I quickly changed what I was doing. I now value the importance of observing cultural customs before interacting with individuals in another country!
Amaal Haimout, MPH '16, is a recent graduate of U-M SPH.
24 Hours by A.Z.
On the first day of my first visit to the United States, I got this very interesting method for testing for measles. I never knew about this. To test for measles in Afghanistan we collect blood from the baby. Getting blood from a very small baby is not easy work—it’s like puncturing your heart. But at U-M SPH I got samples of a paper you can use to collect blood spots. Every time you do it, the result is the same. It’s very cheap. Storage is very easy. It doesn’t need instruments for blood collection, storage, and shipment, and it doesn’t need culturing or a centrifuge. Even more important, the biorisk and biosafety is zero. Because when you puncture a baby you can puncture yourself, and when you deliver the serum specimen it can infect many people. But with this paper for blood spots, you can’t infect anyone.
In just 24 hours in the U.S., I already had something that can change the whole system in Afghanistan. The blood spot method is very efficient in a field situation where no health expert is available to do phlebotomy, and in countries with scarce resources, like Afghanistan. We can now run a whole study and collect samples from a big population. Before, during outbreaks, we could only collect from five or six people. But now we can collect from thousands.
A.Z. is a physician who serves as a disease early-warning system surveillance coordinator in Afghanistan. He visited U-M SPH in 2015 as part of a CRDF Global, a fellowship program that brings scientists from developing nations to the U.S. to study, conduct research, and work with U.S. colleagues.
What Strikes Me by Eyoel Berhan
I’ve visited different cities in America, and one thing that strikes me every day in the conversations I have with cab drivers is that they’re part of their country. They are proud of the freedom, they are proud of the opportunities, and they have a firm belief that they can work and get whatever they want. It’s really American. That is something which your media always tells us, but we think it’s exaggerated. But I’ve found that it’s really true.
The second thing that strikes me is that, when you think of America being the largest economy in the world and having the strongest army in the world, and then you actually start living among the people, you see that there are millions of people without insurance and millions who don’t even have the means to live. When I see the meaning of equity distorted amongst hard working and successful people, it always makes me wonder about the reality beyond being the strongest country and economy in the world. And it makes me question the path my country is following, as I foresee the same phenomena if we do not figure out the values and principles that can take us to the real promise land.
Eyoel Berhan, MPH, is a member of the public health faculty and Vice Provost for Business Development, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia. He and his colleagues visited U-M SPH in January to explore potential research and educational collaborations.
Differences and Similarities by Scott Greer
Half the people who end up doing comparative global policy work get interested in it through academia, and the other half because they have personal, lived experience with global settings, and I’m the latter. I lived and went to school in England for part of my childhood, which was an interesting contrast with my life back in Wisconsin. I started making cross-cultural comparisons naturally, because I wondered why certain things were done in one way in one country and differently in another. When I started getting interested in policy specifically, I realized that health policy and health governance were important in people’s lives in a way few other policies are, and also are fascinating windows into how societies work and make their decisions. Not to mention that after experiencing the expectations people in Europe have of their health care systems—for access and quality, of course, but also for simplicity and coherence—it’s hard not to get interested in explaining how they did it when we haven’t.
Often when we speak about working in international health, we talk about working in and with countries that are poor. Most of my work is in Europe, which many people like to visit on holiday. There’s a perception that there is less of a need to examine such places, because they’re so nice. But the U.S. health care system needs all the help it can get, and European countries have a lot to teach us. An example being: they’re facing economic issues similar to ours, but their health systems are running much better. The U.S. spends twice as much per capita as most European Union countries on health care, and spends as much tax money on health care per capita as the United Kingdom, and gets a product that is still, despite the ACA, mediocre by international standards and inaccessible to millions. We have a lot to learn.
Scott L. Greer is an associate professor of health management and policy at U-M SPH and Senior Expert Advisor on Health Governance for the European Observatory on Health Systems and Policies.