Notes from the Field:
SPH Students Report on their Summer Field Experiences

Asia

Schelomo Marmor is working in Japan with the Nagasaki Association for Hibakusha's Medical Care and the University of Nagasaki. He is conducting research on survivors of the World War II atomic bombs with the hope of caring for those who have been exposed to radiation in Japan and beyond. Marmor says the experience is showing him the most important aspect of an epidemiological study: the human element.

"Meeting and interacting with survivors is teaching me to never let my research and study stand in the way of respecting human dignity," says the public health administration and policy student. "Our research numbers represent people who suffered from the horrific tragedies of war."

Air quality in Vietnam is the focus of Jooyeon Hwang's work with the country's National Institute of Agricultural Planning and Projection. Hwang chose the field experience because it fits with her area of study, and for the timeliness of the project. Since joining the World Trade Organization earlier this year, the Vietnamese government has been charged with ramping up environmental policies. Currently, there are no governmental limits on emissions from Vietnam's 20 million motorcycles. Hwang is collecting air samples in rural areas and in Hanoi and Ho Chi Minh City.

"An inspiring experience" is how Kaajal Singh refers to her time in Bangalore, India. She's there with Ankur Sharma, a fellow student in the Master of Healthcare Administration program. The two are meeting with senior administrators of numerous hospitals and health care organizations.

"We spent time understanding the pressures that health care organizations face in a developing country and how globalization is changing the face of health care in India," says Singh.

Those changes are evident in the telemedicine lab at Narayana Hrudayalaya Hospital. The lab partners with the Indian Space Agency to reach Indians in rural villages. The hospital trains health care workers in the villages and provides them with telemedicine equipment, including electrocardiogram (ECG) machines. Hospital doctors are able to read the ECGs via the Web and determine the next steps for the rural patient. If a patient needs to be further evaluated, the hospital arranges for transportation to the hospital.

Mandi Proue's field experience is solidifying her ideas about the type of job she wants to pursue after graduation, and it's providing her with options of doing that work globally. Proue is working with Action, Research, and Training for Health, an NGO in the Indian state of Rajasthan. The maternal and child health major is helping to improve the continuum of care of women and children from pre-conception, pregnancy, childbirth, and infancy. The rural area where she's working in southern Rajasthan is characterized with low literacy and health care rates and high maternal mortality.

"Seeing the huge challenges faced by the country very well could have turned me into a pessimist, where I found it hard to feel like any change was possible," says Proue. "Yet, instead it has reiterated the importance of thinking optimistically, setting public health priorities and goals high, and doing your best to reach them, even if it takes time."

Neeta Shanbhag is in Delhi with the organization HRIDAYSHAN, where she's charged with helping to mobilize students of 300 schools and 10 colleges with the primary aim of tobacco control. India has some of the world's highest rates of tobacco use and some of the world's youngest smokers. Shanbhag is partnering with schools to form action groups centered on students, parents, teachers, and communities.

The project also sets policies for smoke-free schools and offers community-based strategies to enforce India's national tobacco control act of 2003. HRIDAY-SHAN works in collaboration with the World Health Organization and the Indian Ministry of Health and Family Welfare.

Europe

John Amuasi is in Geneva, Switzerland working with Drugs for Neglected Diseases initiative (DNDi), the first not-forprofit organization committed to fighting the most neglected diseases of the developing world. Before coming to the SPH, Amuasi witnessed the devastating effects of these diseases while working as a doctor in Ghana. This summer at DNDi, Amuasi prepared a paper on behalf of the executive director on one of the organization's 22 projects. The paper is slated to be published in the journal Global Forum for Health Research.

Amuasi has also conducted interviews with various partners in Geneva, Paris, and Rio de Janeiro via conference call, and synthesized the information for a manual on best practices in a public-private partnership.

"One important lesson I have learned is that regarding international health issues, things are not as simple as they initially appear, and strategic lobbying is an integral part of the system," says Amuasi.

Africa

The peaceful streets and green hills of Rwanda's capital city Kigali make it difficult for Erin Galegher to imagine the genocide that began there 13 years ago. She's learning how the country is working to address issues of torture and organized violence through her work at FACT-Rwanda. Established in 1999, the NGO marks a partnership among human rights activists, lawyers, physicians, and medical students of the National University of Rwanda. FACT works to prevent violence and advocate for victims of torture.

"My time in Rwanda has reminded me how humbling this part of the world can be," says Galegher. "Traveling has always shown me what I am capable of, and it creates a state of clear-mindedness for me to think. I am not always happy, nor am I always sad. But I am always thinking."

Memories of studying there as an undergraduate came alive as Katie Gruner stepped off the plane in the Tanzania. She returned to work with Minnesota International Health Volunteers (MIHV) on maternal and child health projects. The community health education major is in the northern town of Karatu, home to 4,000 people and the only paved road in the district.

The maternal mortality rate in Tanzania is one of the highest in the world. MIHV is working to change that statistic by training birth attendants, providing emergency assistance to pregnant women, and creating support groups for mothers that encourage healthy choices. Gruner's experience has shown her that "there is no cookie-cutter method" for developing, implementing, or evaluating public health programs.

"While Americans live so much in the future that they do not appreciate the present, Tanzanians live so much in the present that they do not consider the future," says Gruner. "Can we find something in between?"

Omar Fernandes has also returned to Africa, the continent his family called home for most of his childhood. A true world citizen, Fernandes has also lived in India, the United Arab Emirates, Saudi Arabia, St. Lucia, and the United States. This summer he brings his global view to Nairobi, Kenya, where he is working with the Nonviolent Peaceforce (NP), an international organization that partners with local groups to protect human rights and deter violence. Fernandes received a Walter H. Judd Fellowship from the University of Minnesota to organize NP's international assembly, set to take place in Nairobi this fall.

His work with NP goes back to 2005, when he planned the organization's first youth leadership conference on nonviolence in Minneapolis. These experiences are contributing to his goal to work in the field of refugee health.

"My ideal position out of graduate school would be to work as a humanitarian aid worker for an international health organization in a conflictridden country in Africa," says Fernandes.

On the west side of the continent in Mali, Amenah Babar is working in the Malaria Vaccine Development Branch (MVDB) of the National Institutes of Health. Experts estimate that Malaria kills 3,000 children each day in sub-Saharan Africa. MVDB has already developed several vaccines that are undergoing clinical trials in several sites in Mali.

Babar's primary role involves evaluating and developing databases for clinical electronic case reporting forms (eCRFs) for these clinical trials. She also trains researchers and data entry personnel collaborating with MVDB on how to develop eCRFs and how to navigate a Web-based database called OpenClinica.

"One of the most important lessons I will take with me throughout my studies is that epidemiology is not just some numbers we manipulate to examine theories or prove points in a paper," says Babar. "Living in Mali outside the laboratory, witnessing the lives of the children that will be affected, seeing the hope mixed with suffering, has brought the real meaning of these numbers to life."