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Global Health

ExperiencesI N T E R N S H I P S A B R O A D

GEORGETOWNUNIVERSITY

Department of International Health


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Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Internship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Australia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Brazil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Burkina Faso . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Ghana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Philippines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

South Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Tanzania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Uganda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

TABLE OF CONTENTS


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The Department of International Health at Georgetown University offers oneof the few undergraduate programs in international health in the United Stateswith unique opportunities for hands-on learning locally, nationally, andinternationally.

The Bachelor of Science in International Health program focuses on public healthand health systems management, specifically emphasizing how the environment,culture, economics, and politics interact to influence health status of populationaround the world.

In the dynamic landscape that influencesglobal health, Georgetown University is

situated in an ideal location. Washington, D.C.offers outstanding opportunities to ourstudents, with access to some of the pivotalplayers in the field, such as the World Bank,PAHO, and USAID. In fact, many of ourprofessors come from these same agencies,after many years of service, and bring withthem a depth of experience that enhancesclassroom education with their personalinsights and knowledge.

We are constantly striving to broaden our

students perspectives and to expose themto a range of dynamic learning experiences.As part of the International Health program,our students are offered the opportunity ofexperiential learning through severalinternships. As juniors, students are placedat local non-government organizations thatdeal with health care provision to underservedpopulations and immigrants. More uniqueand most important for a prospective careerin global health is a semester long internshipabroad in research sites located in Africa,

Asia, Australia, Latin America, and SouthAmerica. Students actively undertake fieldresearch supported by local institutions,working on current health issues andexperiencing first hand what it means towork in global health.

When it comes to global health,there is no them . . . only us.

Global Health Council

Reference:1 Country statistical data retrieved during the summer 2009 from Population Reference Bureau (www.prb.org)2 Retrieved in January 2010 from World Health Organization (www.who.int)


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As one of the few undergraduate programs of its kind, this semester-long practical experience abroad is an extraordinary opportunity forsenior students to apply the skills and concepts learned in internationalhealth courses to working with underserved populations. This 14-weekinternship is designed for the student to gain first hand experience witha foreign health system, develop an in-depth understanding of thechallenges of providing culturally sensitive services in an internationalhealth setting, and obtain a basic understanding of field researchmethodologies as applied to public health programs.

During their fall semester, seniors are placed at one of thirteen differentinstitutions in ten countries: Australia, Brazil, Burkina Faso, Ghana,India, Mexico, Philippines, South Africa, Tanzania, and Uganda.

Over the course of the internship, the students will familiarize themselveswith the theoretical and practical organizational set up and mode ofprovisions and services by a foreign health care system. Students mustcomplete two research papers. The first research paper will investigatethe organization, provision, and/or services of the host countrys healthcare system. The second research paper is a formal, empirical researchpaper produced from either a field study or a health promotion projectundertaken while working with underserved populations.

The Internship

We drive past Guanabara Bay and see Pao de Acucar (Sugarloaf mountain) rising out of thewater or when we emerge onto the elevated highway and look to my left to see Rios bustling

port and the unbelievably vast bridge to Niteroi. The feeling intensifies when I look to my left

to see the sun-colored buildings that form Cidade da Samba (samba city) which is set against

one of Rios characteristic hills covered in favelas. The essence of this view sums up my feelings

of RioI cant help but be marveled by all of Rio, the good and the bad.

Akite Daniel, Student Participant

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On the drive from Tamaleairport to Navrongo,

passing through vibrant

green landscapes, zipping

motorbikes, women gracefully

carrying large loads perfectly

balanced on their heads,

and buses passing with an

indiscernible amount of

people packed in and hangingoff the side, it hit me. So I am

in Africa for the semester . . .

Grace Dann, Student Participant


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I nhabited by more than 21 million residents1

, the Commonwealth of Australia is best describedas the worlds smallest continent and also the worlds largest island. This constitutional

democratic country has a multicultural society and is highly developed economically. Much of thepopulation and development is concentrated along the coast and in cities where the majority ofthe population lives. The countrys high ranking on socioeconomic and development indicatorsdoes not reflect the socioeconomic difficulties experienced by Indigenous Australians who areaffected by high employment, poverty, crime, and income inequality.

Australias healthcare system has made Australians one of the healthiest people in the world andranks fifth worldwide for life expectancy. However, Indigenous Australians have not benefitedfrom the healthcare system and their health status are worse than other Australians in nearlyall health indicators, with expected life expectancy around 20 years less than non-Indigenous

Australians2

. A history of inactions, broken promises, and discrimination have led to the drastichealth disparities, yet the governments effort to improve the health of Indigenous Australians isimpeded by the lack of health care professionals and infrastructures in indigenous communities,cultural differences in healthcare services, inadequate funding, poor health data, and mistrust ofthe government due to past racial discrimination policies and bad governance. The top five causesof Indigenous deaths are circulatory diseases, injuries, diabetes, cancer, and respiratory diseases.

AUSTRALIA

The sunset across the bush expanse took my breath away; the open sky and never-

ending landscape gave me the overwhelming sense of the magnitude of nature andthe relative small scale of each individual. I knew I was in Australia when the bus

driver warned us to watch out for dingos and truck drivers, since both are vicious

biters. The outback town was hardly unique to the majority of Australia; as soon as

you leave the Eastern coastline there are more kangaroos than people, but it was a

breath of fresh air for me.

Gabrielle Schecter, Student Participant


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In contrast to textbooks, lectures and exams, the learning medium in Australia has been

the many people I have met, supervisors, classmates, readings, events, trips, and projects.

I have learned about the Australian health care system, local health services, rural health,

Aboriginal and Torres Strait Islander health and culture, project development, data collection

and analysis, and the inequity and racism in Australias history. My head is still spinning fromall I have learned here. I do not see leaving Australia as an end; rather, it is a beginning of new

questions and new ways of seeing the familiar.

Dominique Pinata, Student Participant

R E S E A R C H S I T E S

Curtin University of Technology, Perth, Western Australia

Perth, situated on the south-western coast of the continent, is the capital of Western Australia and the fourth-largest cityin the country. It is home to Curtin Universitys School of Public Health (SoPH), which was established in 1979 withthe mission to significantly improve community health and well-being through innovative and dynamic leadership inteaching, research, service, health policy and best practice. SoPH has strong ties to the WHO and is a WHO CollaboratingCentre for Environmental Health Impact Assessment. Through its relationship with the local public health and Indigenouscommunities, previous Georgetown University students have researched at the South Metropolitan Public Health Office,Aboriginal Health Council of Western Australia and at the Derbarl Yerrigan Health Service, Inc.

James Cook University, Townsville, Queensland

Adjacent to the central section of the Great Barrier Reef and surrounded by national rainforests, Townsville is locatedon the north-eastern coast of Australia and is home to James Cook University. The School of Indigenous AustralianStudies (SIAS) was created in 1998 and the School provides support for Indigenous students as well as conducts teachingand research programs at the undergraduate and postgraduate levels. SIAS interacts and liaises with the surroundingIndigenous community in conjunction to conducting research and development projects. Previous Georgetown Universitystudents have researched at the Townsville Aboriginal and Islander Health Services (TAIHS) and participated ingovernment-funded Palm Island Project. Students will also have an opportunity to observe rural and remote healthservices in Mount Isa, a mining town in the outback.


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This past weekend, I had a most welcomed opportunity to venture into the Outback.

The road to Laverton begins in the quiet mining town of Murrin Murrin, where the

earth turns an infectious red, wild grass gathers in hysterical clumps, and trees grow

the way black water might bleed into the sky.

Lana Worobec, Student Participant

P REC EP TORS

Dr. Helen Fairnie

Dr. Helen Fairnie is an Associate Professor in the School of Public Health at Curtin University.She teaches courses in Health, Safety and Environment, cross cultural communications, andzoonoses at the undergraduate and graduate level. Her research interests include occupational healthand safety in veterinary practices and zoonoses including Q fever and the Human Animal bond.She also consults for the WHO Collaborating Centre for Environmental Health Impact Assessment.

Prof. Jacinta Elston

An Aboriginal woman of the Kalkadoon people, Associate Professor Elston has both a Masters andDiploma in Public Health and Tropical Medicine and is currently the Acting Head of School ofIndigenous Australian Studies at James Cook University. Her current research interests includeindigenous models of care in health service delivery and breast cancer in Aboriginal and Torres StraitIslander women. Professor Elston is a current member of the Research Committee of the NationalHealth and Medical Research Council, having previously served on the NHMRCs Research AgendaWorking Group for Aboriginal and Torres Strait Islander people during the last triennium.


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Poverty of the Spirit: Aboriginal Antenatal andMaternal Health in the Context of Derbarl Yerrigan

Aboriginal Health Service, Inc.

Melissa Kyriakos

Yorgas Yoga: Aboriginal Womens Health,The History and Health Promotion Program

Mae Pugeda

Empowerment of Aboriginal People in TwoRemote Communities in Western Australia forHealth and Educational Outcomes

Alex Borys

Aboriginals, Alcohol Abuse and Stereotypes in

Remote Communities and the Way ForwardAlex Tran

A Summary Analysis of the Health Status andSelect Social Determinants of Health for theIndigenous Population in the Townsville HealthService District 20012005

Britton Stuart

A Review of the TAIS Adult Health Check:An Analysis of Completion Rates and HealthOutcomes

Adrienne Burachinsky

Acute Rheumatic Fever and Rheumatic HeartDisease Among the Indigenous Population of

Australia

Julie Cerza

R E S E A R C H P R O J E C T S

STATI STI C S ON A USTRA L I A 1

Population, mid-2008 (millions) 21.3

Rate of natural increase (birth rate death rate, as a %) 0.7

Life expectancy at birth, both sexes (years) 81

Infant mortality rate (deaths per 1,000 live births) 4.7

Literacy rate (% of females ages 1524, 200004) N/A

GNI PPP per capita, 2007 (US$) $33,340

HIV/AIDS (% of adult population ages 1549, 2007) 0.2

The interaction of white and indigenous

Australians is both fascinating and atrocious.

Their civil rights status is decades behind the

civil rights movements of black Americans and

women in our own country. It's really appallingand has resulted in cyclical poverty as well as

enormous health inequalities between the

white population and the indigenous

population.

Alexa Uhrig, Student Participant


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The largest and most populous country in South America, the Federal Republic of Brazil isalso the largest national economy in Latin America and one of the worlds fastest-growingemerging markets. The multiethnic society of 195 million people1 is home to a diversetopographical landscape with the Amazon Rainforest in the north and the famous Copacabanabeach on the eastern shoreline. Despite major economic improvements in the past few years,income inequality remains a development challenge where it is still high and unequallydistributed among region, race and gender. Recent government efforts to address thesedevelopment challenges include decreasing income inequality through rural development,increasing literacy among neglected population, and implementing social programs such asBolsa Familia. Furthermore, Brazil is still on track to meet the Millennium Development Goals.

The extensive public and private health services ensure high health care coverage of the

population but there are still great health disparities between the poor and the rich, especiallyin maternal and infant mortalities. Chronic diseases are the leading causes of death in Braziland the continued prevalence of communicable diseases in the poor north and western regionsof the country contribute to health inequality. Recent health achievements include reducing

infant mortality from 48 per 1000 live births in 1990 to 19 per 1000 in 20062, the eliminationof poliomyelitis in 1994, and the success of the Bolsa Familia Program in reducing poverty andinequality.

R E S E A R C H S I T E

Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro

With a long history dating back to 1900, the Oswaldo Cruz Foundation (FIOCRUZ), Rio de

Janeiro, was first established as the Federal Seropathy Institute before changing its name to theOswaldo Cruz Institute in 1908 in honor of its then-namesake director and then again in 1970to Oswaldo Cruz Foundation (FIOCRUZ). The original mission of the institute was to produceserums and vaccines against the plague, but its mission was later expanded to include researchand experimental medicine. Current activities that the institute engages in include productionof vaccines and drugs, hospital and ambulatory care services, education and training of humanresources, health information and communication, and the implementation of social programs.With several locations throughout the country, FIOCRUZ is linked to the Ministry of Health andaffiliated with the Brazilian Unified Health System.

BRAZIL


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As a country in transition, Brazil has a major

potential for development. Its population is

young, its birth rate is stable and its life

expectancy is steadily improving. However,

Brazil cannot fully maximize its potentialwhen the majority of its population still lives

in poverty. Living in Brazil has made me

realize it is not a poor country, but it is a

country with many poor.

Anh Vuong, Student Participant

P REC EP TOR

Dr. Else Gribel

Dr. Else Gribel is Chief of the Public Health TrainingCenter Germano Sinval Faria at the National Schoolof Public Health, FIOCRUZ, Brazil. She is also a memberof the team for Specialized Training in Management of

Basic Health Units for the Health System SUS/GERUSas well as of the team for Specialized Training in PublicHealth at the National School of Public Health/ENSP/FIOCRUZ.

We attended a community meeting with several directors of the public health system and

members of the nearby favela (shantytown, or more politically correct communidades).

The meeting became a four-hour debate on how to better the primary health care system,

community development, and the communitys role in the health care system. The meeting

brought meaning and contextualized everything we have learned in international health.Michelle Buchholz, Student Participant

Evaluation of Health Promotion Activities atPrimary Health Care Center CSEGSF/ENSP inRio de Janeiro, Brazil

Michelle Buchholz

Voices of Women of Manguinhos: Perspective onFamily Planning

Akite Daniel

Public Health Approach to Domestic Violence inBrazil in the Context of the Family Health Program

Danielle Toth


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STATI STI C S ON B R A Z I L 1




Infant mortality rate (deaths per 1,000 live births) 24

Literacy rate (% of females ages 1524, 200004) 98




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Apoor landlocked sub-Saharan country, Burkina Faso is home to 15 million inhabitantsbelonging to two major West African cultural groupsthe Voltaic and the Mande. Burkina halimited natural resources and rainfall, an economy that is strongly dependent on cotton exports,and a vulnerability to natural disasters and regional instability. Burkina has nonetheless achievedeconomic growth with the gross national income per capita increasing from $530 in 1990 to $1130

in 20061. Despite the economic growth, the country has low rankings on many socioeconomic anddevelopment indicators. Burkina Faso was ranked 176th out of 177 countries in the 2007 UNDPHuman Development Index (HDI).

Despite some positive trends in social welfare such as a decrease in infant mortality rate, maternalmortality ratio still remains high at 700 per 100,000 and contraceptive prevalence at a lowly 25.7

percent2. The life expectancy at birth is 47 years2 and the top causes of death are lower respiratory

infections, HIV/AIDS, malaria, diarrheal diseases and perinatal conditions. However, total healthexpenditure as a percentage of GDP has increased from 4.9% in 2000 to 6.4% in 20062. Thegovernment has also improved access to primary health care by increasing the number of villageclinics. The prevalence rates for HIV/AIDS and tuberculosis are lower than many other Africancountries, but the rates are still higher than worldwide averages.


West African Multi Disease Surveillance Centre (MDSC), Ouagadougou

The West African Multi Disease Surveillance Centre (MDSC), Ouagadougou, was created in2002 to serve as a centre of excellence for disease surveillance in the Africa Region. MDSC wasestablished in the offices of the Onchocerciasis Control Programme (OCP) in Ouagadougou.

The Centre inherited the facilities of OCP, including the buildings, laboratories, library,and telecommunication equipment. It currently supports countries in the surveillance ofonchocerciasis and meningococcal meningitis. As the Centre is strengthened, the rangeof targeted diseases is to expand to include communicable diseases of major public healthimportance such as HIV/AIDS and malaria. The Centre also supports international developmentpriorities since it will be part of the Global Outbreak Alert Network aimed at rapid containmentof epidemics that threaten regional or global security.

BURKINA FASO


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P REC EP TOR

Prof. Kader Konde

Professor Kader Konde is the director of WHOsMulti-Disease Surveillance Centre and leads the vaccineintroduction strategy for the Meningitis Vaccine Project(MVP) in Africa. He is responsible for establishing astrong network with African officials, public healthauthorities, and practitioners who will implement and

budget for vaccine introduction at the national andlocal levels. He was involved in the response to Ebolaand Marburg outbreaks in Kikwit and Watsa-Durba(former Zaire) and the meningitis outbreak in BurkinaFaso from 20012003. He earned his medical degreeat the University of Conakry in Guinea in 1976.He received post-graduate education in the areasof public health, preventive pediatrics, and health indeveloping countries (University of Nancy 1, France);nutrition (Institut Scientifique et Technique de laNutrition, Paris, France); and health care economicsand management (Boston University, USA).

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Burkina Fasos Experience with theInternational Coordinating Group (ICG) duringthe 2008 Meningococcal Meningitis Epidemic:Success, Challenges, and Future Outlook

Aki Niihara

Factors Influencing Repeat Epidemics ofMeningitis on the District Level in Spite ofMass Vaccination in the Previous Year

Emma Hurst


After spending two days meeting people from the Multi-Disease Surveillance Center and

the WHO regional office, we were told that we would be leaving for the field to accompany

Ministry of Health and MDSC epidemiologists in an evaluation of the meningitis epidemic

that struck Burkina Faso last spring.

Aki Niihara, Student Participant

It took us well over two hours on a

bumpy dirt road to arrive in Ouaragaye

from Fada. It was a beautiful drive,

though. The countryside is very flat

and you could see green grass and little

sparse trees and blue skies for miles.

Emma Hust, Student Participant

STATISTICS ON BURKINA FASO









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Located in West Africa along the Gulf of Guinea, the Republic of Ghana has one of the best-performing economies in Africa and the country is on track to exceed the 2015 MDG ofhalving poverty. Following the successful HIPC debt relief in 2004 and further debt cancellationsby donors, Ghanas external debt is almost entirely written off. Positive results from the Growthand Poverty Reduction Strategy have led to a stable economy with inflation and interest ratesnearing single digits. Education, health and development still require major improvement,especially in rural areas whereby seventy percent of the countrys poor live with limited accessto basic social services, safe water, electricity, and telephone services.

Ghanaians made remarkable health improvements in the 1990s, but the overall health statusof the population remains poor. Communicable diseases are major causes of mortality andmorbidity with malaria, upper respiratory tract infections, tuberculosis, diarrhea (includingcholera), yellow fever and meningococcal meningitis being the top causes of death. AlthoughHIV/AIDS remains a problem, the national median prevalence has declined in the past decade.In 2004, the government instituted the National Health Insurance to reduce the financial barriersto health caused by the user fee system and this has resulted in increased accessibility and uptaketo health services. Total government expenditure on health has also increased from 8.9% in 2000

to 15.8% in 20062.

GHANA

Shadowing the RRV-TV unit was fantastic, not only because I love working withbabies and want to go into pediatrics, but also because we got to spend a lot of time

with the study doctors, who were very willing to explain things about the research

and Ghanian health system in general. The whole time I was with the unit, I was

thinking that Id never be able to have this much access to a clinical study in the U.S.!

Silpa Thaivalappil, Student Participant


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After talking with Madame, we were able to watch her examine a mother, filled to bursting

at 39 weeks, who was complaining of fever and pain in her abdomen. When I heard that

the woman was feeling sick, a huge, glaring list of all of the causes of maternal mortality

appeared in my head. Luckily, Madame reassured the woman (and me) that everything

would be fine.Catherine Burke, Student Participant

R E S E A R C H S I T E S

Navrongo Health Research Centre (NHRC), Navrongo

The Navrongo Health Research Centre (NHRC), Navrongo, began as a field site in Northern Ghana to study the impactof repeated large doses of vitamin A supplementation on child survival. In 1992, the NHRC was appointed by the Ministryof Health to investigate health problems of the Sahelian ecological belt of northern Ghana and to advise policymakers.The mandate of NHRC has been broadened to include population and health problems of national and international

significance. NHRC is primarily focused on the major causes of illness in the northern regions and related problems ofhigh fertility and maternal morbidity. Ongoing projects include research on cerebro-spinal meningitis, malariamanagement and treatement, and community-directed treatment of schistosomiasis.

Kintampo Health Research Centre (KHRC), Kintampo

The Kintampo Health Research Centre (KHRC) was set up in 1994 in collaboration with the Maternal and ChildEpidemiology Unit of the London School of Hygiene and Tropical Medicine. Its mandate was to provide a base for fieldepidemiological and other health research in the forest-savannah transitional ecological and cultural zone of the country.KHRC has particularly been focusing on the development and evaluation of public health nutrition interventions and iscurrently exploring emerging issues relating to micronutrient interventions. It has also carried out research projects underthe Safe Motherhood Initiative. KHRC is currently expanding into clinical research and has recently participated in twomulti-centre clinical trials on malaria and pneumonia.

Dodowa Health Research Centre, Dodowa

Dodowa Health Research Centre, Dodowa. Dodowa is the district capital of the Dangme West District of the GreaterAccra Region and although the district is rural, it is gradually catching up with the rapid urbanization of the peripheralareas surrounding the city of Accra. The Dodowa Health Research Centre was set up as part of an agreement with theBritish Oversees Development Agency in the early 1990s and has developed into one of three main health research centersof the Ghana Health Service. The Centre focuses on developing and evaluating community and district-based healthinterventions and obtaining information to improve the process of health policy, planning, and service delivery in theGhana Health Service.


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P REC EP TORS

Dr. John Gyapong

Dr. John Gyapong received his medical training from the University of Ghana and a PhDin Public Health Epidemiology from the London School of Hygiene and Tropical Medicine.He serves as the Director of Ghanas National Health Research Unit and is an Associate Professorin Epidemiology and Infectious Disease Control at the University of Ghanas School of Public

Health. Dr. Gyapong leads Ghanas National Lymphatic Filariasis and Onchocerciasis ControlProgrammes and conducts research on health systems and financing, HIV/AIDS, malaria, andreproductive health, among other topics. He has served as a key member on multiple academicand WHO missions.

Dr. Margaret Gyapong

Since 2004, Dr. Margaret Gyapong has served as Director of the Health Research Centre Dodowaof the Ghana Health Service. She is a Medical Anthropologist by training and holds a PhD inCultural Epidemiology from the University of Basel in Switzerland. Dr. Gyapong is serving asan advisor to the WHO/TDR in Lymphatic Filariasis, as well as on health sector reform andquality of care issues. She is a facilitator for the National Health Research Unit on Health SystemsResearch and qualitative research methods. Dr. Gyapong also works as a Senior Lecturer for theSchool of Public Health at the University of Ghana.

Dr. John Williams

Dr. John Williams is the Senior Medical Officer/Reproductive Health Physician at the NavrongoHealth Research Centre in Navrongo, Ghana. He has held the position since 2000 and is amedical doctor by training. Dr. Williams also holds a postgraduate degree in Population Studiesfrom the University of Ghana and a Postgraduate Diploma in Genitourinary Medicine andVenereology from the University of Liverpool in the UK. Dr. Williams focuses his research onHIV/AIDS, maternal health, adolescent sexual and reproductive health as well as on communityand family health.

Even though we were tired from the flight and from waking up so early, we

couldnt help but stare out the window in awe of the vast stretches of green beyond

the little brown huts lining the one long road. Watching the women in colorful

dresses balancing buckets of water on their heads and the barefoot children chasing

goats with sticks, I could instantly feel myself falling in love with the country.Christina Sperle, Student Participant


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A Study of the Utilization of Obstetric Services inthe Kassena-Nankana District

Laura Bluntzer

Inequality in Household Decision-Making forEarly Treatment of Malaria in Young Children:

A Case Study in Northern Ghana

Sophie Cowen

Understanding and Improving the DemographicsSurveillance of Epidemiological Events in theDeveloping World: A Study of the Methods ofMonitoring and Morbidity in Dangme-West

Jesse Patterson

Assessing TB Care and Control in theKassena-Nankana District, Ghana

Jill Jensen

The Effects of Breastfeeding Beliefs, Knowledge,and Practices on Child Nutritional Status in theKassena-Nankana District, Upper East Region,Ghana

Catherine Clansky

Demand-Side Factors Affecting Health-SeekingBehaviors in Ghana

Stephen Russell

Success in a Challenging Environment: Barriers toSustaining Community-Based Health Planningand Services, Lessons from Navrongo, Ghana

Canita Brent


STATISTICS ON GHANA 1








Sleeping under the mosquito net in a

treehouse and waking up to the cry of the

hippos and songs of more than 200 birds was

an unforgettable experience.

Christina Sperle, Student Participant

While infrastructural issues hinder the

acceleration of work, I can say that the staff

working at the Dodowa Health Research

Centre has a lot of experience in performing

research and performing locally. They are a

wealth of knowledge as was displayed last

week when we got constructively ripped

apart in our project proposals . . . but theopportunity to do work specifically here and

with this staff as a professional support is an

indispensable resource.

Sonnet Gaertner, Student Participant


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An emerging global player with one of the worlds fastest growing economies, the Republic ofIndia is the second most populous country and the 12th largest economy in the world withan average growth around eight percent in the past three years. The 1970s Green Revolution andthe 1980s economic reforms revitalized the Indian economy and improved development. Yet,India faces development challenges such as disparities between the rural and urban areas, foodinsecurity brought upon by increased population, and inadequate infrastructure. Opportunitiesfor India, however, include the emergence of the information technology sector that have resultedin major growth in cities, strong investments in higher education that have given rise to a huge

young, technology-savvy population, and increased investments in rural and developmentalsectors.

Health-wise, inequitable access to health care, high maternal and child mortalities, femaleinfanticide, the rise in HIV/AIDS infections, extreme poverty in urban and rural areas, andthe prevalence of infectious diseases still plague the country. Despite the challenges, healthimprovements include the near elimination of several communicable diseases such as leprosyand polio, more human resources for the public health system, and the growing private healthcare sector that compensates for the inadequacy of public health care. Also, the rise in incomelevel enables more Indians to financially spend more on their health and increase access to healthservices and provisions.


Vector Control Research Centre (VCRC), Pondicherry

Established in 1975 at Pondicherry, the Vector Control Research Centre (VCRC) is part of the

Indian Council of Medical Research under the Department of Health Research in the federalgovernments Ministry of Health & Family Welfare. The goal of the research center is a world freeof vector-borne diseases; therefore, the research center primarily focuses on vector-borne diseases,such as lymphatic filariasis, malaria, dengue fever, and Japanese Encephalitis. The objectives of theinstitute include finding new vector-control tools, conducting epidemiological surveillance, anddeveloping disease intervention strategies. In recognition of the important role VCRC has playedin disease control, the WHO has designated the center as a Collaborating Centre for Research andTraining in Lymphatic Filariasis (LF) and Integrated Methods of Vector Control.

INDIA


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P REC EP TOR

Dr. Sabesan Shanmugavelu

Dr. Sabesan Shanmugavelu is currently the Chiefof Division of Environmental Science and HumanResources Development at the Vector Control Research

Centre in Pondicherry. He received his PhD in zoologyfrom Annamalai University, India and his fields of interestare epidemiology, vector control, environmental impactassessment, and risk mapping. Dr. Sabesan is a lecturer inseveral Indian universities and has conducted consultan-cies for WHO and Lymphatic Filariasis eliminationprograms. Dr. Sabesans contribution to research includesadvancement in vector control of vector-borne diseasesand strategies for Lymphatic Filariasis elimination.

Knowledge, Attitudes, and Practices RegardingVector-borne Diseases among Patients at PHCsin Pondicherry, India

Lauren Dunec

Factors Affecting the Decision to Seek Healthcarein Primary Health Centers in Pondicherry, India

Sarah Jenkins


We went to a village just outside Pondicherry armed with GPS locators and questions

regarding Chikungunya (a mosquito-borne disease pertinent to India). We made our way to

15 homes throughout the village, and, at each stop, tested for mosquito larvae in standing

water and questioned the homeowners as to whether anyone in their home has been sick with

Chikungunya . . . while the data points we had were obviously exponentially smaller than anystudy the VCRC would conduct, it was really interesting to get to use the software firsthand and

tie it back to the interesting public health implications technology like this can have.

Sarah Jenkins, Student Participant

STATISTICS ON INDIA 1

Population, mid-2008 (millions) 1,149.2




Literacy rate (% of females ages 1524, 200004) 65GNI PPP per capita, 2007 (US$) $2,740


We watched from on top of a caf asthousands of people paraded along the

beach road accompanying maybe 50 Ganesh

statues. The statues of the Hindu elephant-

God of wisdom were huge and elaborately

decorated with garlands of flowers and

neon-colored paints, and pulled by either

trucks, tractors, or oxen with painted horns.

Lauren Dunec, Student Participant


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The fifth-largest country in the Americas by total area and the most populous Spanish-speakingcountry in the world, the United Mexican States is home to an estimated 107 million1 peopleand has the second-largest economy in Latin America. Although it is an upper middle-incomecountry, income inequality is a grave problem with some states having similar levels of economic,educational and life expectancy development as Germany or New Zealand, while other states arecomparable to Syria. Nonetheless, the population in poverty has decreased during 2000 to 2004in the general population, especially in rural areas. The governments continuing effort to reducepoverty includes the Oportunidades program which has improved health, education and nutritionfor the poorest and most vulnerable families in the country.

Mexicos medical infrastructure is largely very good and can be excellent in major cities, butincome inequality has also translated to health inequality and inequities in healthcare access.

The poorer states are in the countrys southern region and have the highest disease prevalenceand mortality rates for preventable causes. In addition, rural areas and indigenous communitieshave poor medical coverage requiring travel to the closest urban area in order to get specializedmedical care. Urban areas also possess their own health problems as obesity and noncommuni-cable diseases have increased. Despite the health problems, general mortality, infant mortality,maternal mortality, and communicable diseases have all decreased.


El Colegio de la Frontera Sur (ECOSUR), San Cristobal, Chiapas

Located in the southern state of Chiapas and beautiful city of San Cristobal, El Colegio de laFrontera Sur (ECOSUR), is a multidisciplinary research institute that engages in postgraduate

level education. ECOSUR focuses on the development and problems of the southern border regionof Mexico in the spheres of economic development, production systems, human well-being andconservation of biodiversity. Its programs are geared to the generation of scientific knowledge,human resources training and the design of technologies and strategies that contribute tosustainable development. The health aspect of the program focuses on the health conditions of themost marginalized populations, particularly the indigenous communities.

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P REC EP TOR

Dr. Hector Ochoa Diaz-Lopez

Dr. Hector Ochoa holds the position of SeniorResearcher at the Department of Health, ECOSUR,in Chiapas, Mexico. He has a medical degree fromthe University of Mexico and received his PhD in

Epidemiology from the London School of Hygieneand Tropical Medicine. Dr. Ochoa has served aslecturer in PhD and Masters courses in severalMexican universities and has conducted consultanciesfor PAHO, GTZ, and various branches of the Mexicangovernment. He teaches and conducts research inepidemiology, health planning and evaluation, healthsystems development and social and environmentalissues related to public health.

Neglecting Nutrition: Socio-economic, Cultural, andBehavioral Influences on Childrens Nutritional Statuswithin the Indigenous Community of Oxchuc, Chiapas

Christy Knese

The Role of Nurses in the Cervical Cancer Screening

Program of Mexico in the Rural Communities of ChiapasEmily Lawson

Knowledge, Attitudes, and Practices of TrachomaProgram Health Workers in the Highlands Region ofChiapas, Mexico

Katelyn Perna

The Knowledge of Midwives in the Highlands ofChiapas about Pre-eclamplsia/eclampsia in Regards toTheir Identification of Risk Factors

Cassandra Distefano


The city of San Cristobal had filled the center with lots of red, green, and white decorations

lining the streets, wrapping the trees, and covering the immense stage built for the night.

We knew we would be celebrating in style and in the same manner as all the locals. We ate the

traditional food, drank the spicy Micheladas, listened to the various bands, danced to the quick

steps of salsa music at a local bar, met tons of new friends, and of course cheered VIVA MEXICO!Christy Knese, Student Participan

STATISTICS ON MEXICO 1








I greatly enjoyed the ride uphill to Chamula,riding in the back of the pickup truck with

Maria Martin and Dr. Hector Javier. It was a

breathtaking view and I loved being in the open

air the entire way. When we arrived, the city was

full of life and we were greeted by the sight of

men dressed as donkeys shooting out flames,

dancing, fireworks, and food everywhere.

Maria Tabbaa, Student Participant


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An archipelago-nation of 7,107 islands in the Pacific Ocean, the Republic of the Philippines isthe 12th most populous nation with 90 million residents1. This diverse country has a longhistory of colonial rule that dates back to the 16th century when Spanish explorer FerdinandMagellan claimed the islands for Spain, which was then ceded to the United States in 1898,occupied by the Japanese during World War II, and attained independence in 1946. In recent

years, this newly industrialized countrys economy has grown and poverty has decreased as aresult. However, income inequality has increased, poverty in rural areas and urban settlementsstill persist, and the increased urbanization has strained the public service. The government hasset up poverty reduction programs and is committed to achieving the Millennium DevelopmentGoals.

The governments health sector reform produced mixed results with the targets of the Health

Sector Reform Agenda of 1999 largely unmet, but the National Health Insurance Programme hasincreased coverage of the general population. Noncommunicable diseases remain the largest causeof death and tuberculosis persists as a high burden to society along with dengue, JapaneseEncephalitis and lymphatic filiariasis. An increasing problem is the shortage of staff to run healthservices due to the emigration of health professionals that have resulted in the Philippinesbecoming the biggest supplier of nurses. To address these challenges, the government hasundertaken various health programs under the framework ofFormula One (F1) for Health.


World Health Organization, Western Pacific Regional Office (WPRO), Manila

Located in Manila, the World Health Organization, Western Pacific Regional Office (WPRO)

represents the WHO in the Asia Pacific and 37 Member Statesfrom China in the north andwest, to New Zealand in the south, and French Polynesia in the east. The mission of WHO is tosupport all countries and peoples in their quest to achieve the highest attainable level of health.WPROs purpose is to lead the regional response to public health issues on all frontsmedical,technical, socio-economic, cultural, legal and politicaltowards the achievement of WHOsglobal health mission. Working together with a broad spectrum of partners from all sectors ofsociety, WPROs role is to act as a catalyst and advocate for action at all levels, from local to global,on health issues of public concern.

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P REC EP TOR

Dr. John Ehrenberg

Dr. John Ehrenberg is the WHO Regional Adviser inMalaria, Other Vectorborne and Parasitic Diseases.Previously, he was the chief of the Pan American Health

Organizations Communicable Diseases Unit, focusingon tropical diseases and spearheading a multi-countryeffort to fight lymphatic filariasis. Prior to PAHO, hemanaged a $6 million Carter Center project to eliminateriver blindness from six Latin American countries.He holds a Doctorate from the Johns Hopkins School ofPublic Health, a Masters from the London School ofHygiene and Tropical Medicine, and a medical degreefrom the National Autonomous University of Mexico.

Mapping Malaria in Asia and the Pacific:Improving Risk Maps, Burden Estimates andImpact Monitoring

Mackenzie Henderson

TDR Regional Consultation on Infectious Diseasesof Poverty in Western Pacific Countries

Sascha Meijers


So I was in this high tech room with a video conference television the size of an entire wall

and those intimidating executive tables we all know and love from Ihealth get-togethers.

But it was just me and my boss, Eva, so it was not as intimidating as it could have been.

We were on the phone with people in Geneva, Cambodia, Laos, India, Bangkok, and London . . .

it was seriously an organization of world heath officials. It was amazing to be a part ofsomething that is, dare I say it, so Ihealth.

Mackenzie Henderson, Student Participant

STATI STI C S ON P H I L I P P I NES 1





Literacy rate (% of females ages 1524, 200004) 96GNI PPP per capita, 2007 (US$) $3,730

HIV/AIDS (% of adult population ages 1549, 2007)

Our unit is in the midst of organizing severalregional meetings and I have been assigned

to help with the logistics for two meetings

that are being hosted in Vientiane, Laos. My

preceptor also told me that there is a possibility

I will get to go to the meetings with him and

some of the other professional staff, so I am

really excited for that.

Sascha Meijers, Student Participant


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Located at the southernmost region of Africa, the Republic of South Africa is a middle-incomecountry with a diverse population of 50 million people1 and has Africas largest economy.Following the countrys transition from apartheid to constitutional democracy in 1994, thecountry enjoyed a robust economic growth from 1994 to 2003. The country still faces challengesin the form of high unemployment, low job growth, and a huge income disparity between raceswhere the top income is concentrated primarily among the minority-whites. However, thegovernments attention to social development in recent years has led to better access to servicesand education in addition to progress on some of the Millennium Development Goals.

The HIV/AIDS epidemic is a major challenge for South Africa because of its impact on theeconomy and health of the population. The shift in HIV/AIDS policy from superstition-basedto science-based has resulted in stabilizing the rate of new infections, although South Africa

still has one of the highest prevalence rates. South Africa suffers from an impoverished healthsystem, the emigration of medical workers to developed countries, increased burden fromnon-communicable diseases, and falling life expectancy. Despite the challenges, the health sectorremains a high priority as the government spends more on health than any other country inAfrica.


South Africa Medical Research Council (MRC), Cape Town

Located in the coastal city of Cape Town, the South Africa Medical Research Council (MRC)was established as an autonomous research institute of the federal government in 1969 with amission to improve South Africas health and quality of life through promoting and conducting

relevant and responsive health research. Since then, the organization has expanded to 41 researchunits, groups and programs covering the various health priorities of the government, includingHIV/AIDS, malaria, tuberculosis, infectious diseases, and maternal and child health. Public healthand research achievements of the MRC include establishing the link between Hepatitis B andliver cancer, major policy changes as a result from research on smoking, the establishment ofHIV antenatal surveillance system, and epidemiological projects on health inequalities.

SOUTH AFRICA


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P REC EP TOR

Dr. Priscilla Reddy

Dr. Priscilla Reddy is the Director of Health PromotionResearch and Development Group at the MedicalResearch Council in South Africa. She received her MPHfrom the University of Massachusetts and her PhD in

education and health promotion from MaastrichtUniversity, The Netherlands. Dr. Reddy was a VisitingAssociate Professor at Georgetown University in 2004and she is currently a Visiting Associate Professor atthe Rollins School of Public Health Emory University.Her research portfolio focuses primarily on HIV/AIDSand she is the principal investigator of multipleinternationally-funded health research projects, withthe most recent project on HIV/AIDS vaccine.

Vaccine Campaign Awareness and Preservation:Immunizing Inequality and Sustaining Success

Catherine Johnson

An Examination of the ARV Delivery Program inSouth Africa

Molly Ward


We have been working on strengthening the training program, developing protocols and

figuring out how to develop the map. In order to accurately survey the area, we commissioned

a detailed map of the town area. This map will allow us to see where each house is exactly

and then we will randomly select which houses will be administered the survey.

Molly Ward, Student Participant

STATI STI C S ON SOUT H A F RI C A








I had my first experience commuting by plane,

flying somewhere and back in the same day,

when we went up to Johannesburg for a

meeting with research coordinators at the site

of the vaccine trials. The actual site is an hours

drive outside of Jozi, so it was a lot of traveling

for one day, but very productive.

Catherine Johnson, Student Participant


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With Africas highest peak at Mt. Kilimanjaro and one of the worlds most idyllic beachesoff the eastern coast at Zanzibar, the United Republic of Tanzania is home to 40 millionresidents1 and many of Africas exotic animals. This low income country is one of the mostaid-dependent countries in the world and has a gross national income per capita of $1,200 in

20071. Agriculture remains the most important sector of the economy. A series of comprehensiveeconomic reform has resulted in high economic growth and low inflation in the past few years,but development challenges persist as water and electricity infrastructure is inadequate andpoverty remains substantial in rural areas.

The health of the population is marked by high infant mortality rate and low life expectancyresulting in Tanzanians having one of the poorest health statuses among African countries.HIV/AIDS is the single biggest threat not only to the health but also to the socioeconomic

development of Tanzania as the disease is the leading cause of death. Other disease burdenin the country includes malaria, tuberculosis, reproductive disorders and diarrheal diseases.The government has begun reforming the health care sector to improve the quality of services,ensure adequate medical supplies, and increase access to services in the rural areas.


National Institute for Medical Research (NIMR), Dar es Salaam

Established by the Act of Parliament No. 23 of 1979 and became operational in 1980, NationalInstitute for Medical Research (NIMR), Dar es Salaam, is a parastatal service organizationunder the Ministry of Health and is tasked with conducting medical research designed toalleviate diseases among the people of Tanzania. The headquarters is located in Dar es Salaam

and oversees ten research centers throughout the country. In addition to medical researchdesigned to alleviate the disease burden in Tanzania, NIMR also trains research personnel,disseminates information to and from research centers throughout the country, and examineslocal traditional medical practices. It is through scientific data and information generated by theNIMR that the development of better methods and techniques would lead to enhancing diseasemanagement, prevention and control in the country.

TANZANIA


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P REC EP TOR

Dr. Mwelecele Ntuli Malecela

Dr. Mwelecele Malecela is the Director of Researchand Coordination at the National Institute for MedicalResearch, Director of the National Lymphatic FilariasisElimination Programme in Tanzania, and an adjunct

lecturer at the Morehouse School of Medicine whereshe teaches an international health course. She earnedher Masters degree and PhD from the London Schoolof Hygiene and Tropical Medicine, U.K. in medicalparasitology. She has served on numerous advisorycommittees for international and national healthorganizations such as the Global Alliance for theElimination of Lymphatic Filariasis, WHO Strategicand Technical Advisory Group for Neglected TropicalDiseases, and International Lymphoedema Framework.

Provider Determined Eligibility Barriers:Are ADDO Dispensers Restricting Access toContraceptives for Young Unmarried Women?

Alex Scott

Peoples Knowledge and Treatment SeekingBehavior of the Neglected Tropical Diseases:

A Case Study in Kilosa and Kilombero

Samantha Tsang


We would walk around to between 10 and 15 households and survey the family. Questions

focused on food and diet, level of schooling and education, knowledge of the most prevalent

diseases in the area (including NTDs, HIV, and malaria), number of livestock, and names and

ages of all family members in the home. At the end of the survey the researcher (Ceci) would

distribute containers for stool and urine samples to each family member.Alex Scott, Student Participant

STATISTICS ON TANZANIA 1








At night, the team drew blood from the peoplewho did show up (about half who were surveyed,

in each village). Douglas would draw the blood

and Charles (another technician) tested its hemo-

globin count, as an indicator of the presence of

hookworm or other similar parasites. The rest of

the blood was then saved to test later for other

diseases, specifically LF (lymphatic filariasis).

Samantha Tsang, Student Participant


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Landlocked in East Africa with a population of about 30 million people1

, the Republic ofUganda is one of the fastest growing economies in Africa with strong growth since 2000 and

gross national income per capita of $9201. The country has made tremendous strides in recoveringfrom the economic breakdown of the 1970s, but socioeconomic and development challenges stillremain. Poverty headcount has dropped since 1992 as a result of high and broad-based economicgrowth, yet poverty remains indisputably high in rural areas and in northern and eastern Uganda.Ugandas economy has great potential with significant natural resources, including ample fertileland, regular rainfall, and mineral deposits. With a strong commitment to poverty reduction, thecountry is moving towards meeting some of the Millennium Development Goals.

The health status of Ugandans has improved along with the economic growth, but there are

still many health challenges to overcome. Life expectancy at birth is around 48 years1 and the

top causes of death are HIV/AIDS, malaria, lower respiratory infections, diarrheal disease andtuberculosis. Although the country was hit hard by HIV/AIDS, sustained efforts at the highest leveof government have resulted in a dramatic decline in the HIV prevalence rate from approximately

18.5 percent in the early 1990s to 5.4 percent in 20072. Improvements in infrastructure have alsoresulted in the majority of the general population now having access to safe drinking water.


Ministry of Health, Vector Control Division, Malaria Control Programme (MCP),Kampala

Recognizing that malaria is responsible for more illness and death than any other single disease inUganda, the National Malaria Control Program (MCP) was established in 1995 by the Ministryof Health to direct and guide the day to day implementation of the National Malaria ControlStrategy. MCP is a key partner in the Roll Back Malaria Partnership, which was launched in 1998by WHO, UNICEF, UNDP, and the World Bank. The role of the MCP at central level is to supportthe implementation of the National Malaria Control Strategy such as policy formulation, resourcemobilization, capacity development and technical support, malaria epidemic control, andcoordination of malaria research. The main intervention strategies implemented are: casemanagement, vector control, epidemic preparedness and response, and intermittent preventivetreatment during pregnancy.

UGANDA


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P REC EP TOR

Dr. Richard Ndyomugyeni

Dr. Richard Ndyomugyeni is an experienced scientist andadministrator specializing in tropical diseases control,particularly onchocerciasis, malaria and schistosomiasis,as well as community health. He is currently the programmanager for malaria control in the Ministry of Healthand he was the former national coordinator for theOnchocerciasis Control Programme. Dr. Ndyomugyenialso lectures part-time on malaria and onchocerciasis toMS of Clinical Epidemiology students at the Institute ofPublic Health, Makerere University. He received his MS inTropical Diseases Control from the University of Dar esSalam, Tanzania, and his PhD from the Department ofInternational Health, Copenhagen University. He haspublished his research widely in tropical medicine journals.

Seasonal Variations in the Morbidity andMortality of Malaria in Pregnancy in HoimaDistrict, Western Uganda: A Hospital-Based Study

Meredith Davis

A Look at the Seasonal Variation of LBW inHoima District: A Hospital Record-Based Study

Monique Giumond

The Impact of Organizational Capacity on theTargeted Mass Distribution of Free Insecticide-Treated Bed Nets Through the Public Sector inRural Uganda

Darwin Young

A Descriptive Study of Home Management ofMalaria in Rural Populations in Uganda

Tim Egan


Our first glimpse of Uganda was on the drive from Entebbe to Kampala. During the drive, we saw

glimpses of the immense poverty that is typical for many Ugandans. Shacks, huts, and lean-tos line

the street; all lit by candle light. This surreal poverty was interspersed by the familiar Shell gas station

or a Coca-Cola billboard, creating a fairly disorienting blend of cultures and classes in my mind.

Darwin Young, Student Participant

STATISTICS ON UGANDA 1






GNI PPP per capita, 2007 (US$) $920


The people at the hospital were so kind and

helpful. Although the medical records were in aless than desirable state, the nurses, midwives

and record-keepers went out of their way to

help us find everything that we needed. They

also gave us good insight into how the hospital

functions, what the major issues are affecting

health in this region, what they lack, and how

they relate to the Ministry of Health (MOH).

Meredith Davis, Student Participant


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GEORGETOWNUNIVERSITY

Department of International Health

http://internationalhealth.georgetown.edu

(202) 687-2781

IH Internship Broch 1 27

Documents

Transcript of IH Internship Broch 1 27