How Peace Corps Volunteers in Senegal address gaps in health delivery systems

This post does not reflect the opinions of the US Government, the US Peace Corps or Peace Corps Senegal.


There is usually a general misunderstanding of what Peace Corps volunteers do or are capable of doing in field. This misunderstanding comes from families and friends of volunteers back home, the communities the volunteers serve, and sometimes, in the earlier stages of service, the volunteers themselves. How much impact can a volunteer make? How can the most impact be made during such a short service? What are the limits of a volunteer and how is their work truly sustainable?

While I can not speak on behalf of the entire Peace Corps (PC) community, I believe I can shed a light on how Peace Corps Senegal Health volunteers work to provide basic trainings and services to improve the health status of the communities they serve.

Currently PC Senegal health volunteers work in the areas of Malaria, Maternal and Child Health and Water, Sanitation and Hygiene. Our development approach ensures that initiatives are sustainable, that they exhibit long term vision, that they are from the bottom-up and that they are participatory and inclusive. Along with guidance from PC leadership, volunteers use these guidelines to creatively impact their communities.

The PC Senegal health sector works to address 3 delays in health care:

  1. Delay in the decision to seek care
  2. Delay in reaching care
  3. Delay in receiving adequate available health care and correct diagnosis.

The first delay is addressed at the household level. When signs and symptoms of disease begin to manifest themselves, we ensure that people have the knowledge they need to seek the care that is required. The delay in reaching care is addressed through several initiatives that range from planting gardens, training more community health workers, working in supply chain to ensure the health structure has the medicine and equipment it should have, rallying up the community to contribute towards an ambulance, or building a health structure. The last delay can be addressed through a series of trainings for community health workers, working side by side with health processionals to ensure that tests are being administered and being administered correctly, and empowering the patient to ask questions about disease stages treatment and medication.

Baseline assessments, barrier analyses and volunteer reporting tools are beginning to show us where exactly the needs are and where the obstacles to the behavior change exist. A lot of work is focused on strengthening the capacity of community health workers, clinical staff and health structures as a whole. We come in with fresh eyes to identify ways health care can be done better and in many cases, solve complex with simple solutions. I like to think that we help people think outside of the box to identify their problems and solve them with as little help from the outside as possible.

But the work is not easy. In a process that begins with intensive language, cultural and technical training, PC Senegal Volunteers must learn how to integrate into their communities and develop meaningful relationships with potential work partners before their own projects may actual begin. Volunteers spend a good amount of time learning the lay of the land in their communities. What development groups have worked here in the past? What have they done? Who exactly did they help? Where did they succeed or fail? Was there a former volunteer at this site? What did they do? What relationships did they build? Who did they work with and who did the intentionally avoid? Then the research and programming questions begin. What does the community know about these heath issues? What does this community need?  What can I do to address the need? How I can do it with the least possible resources? How will I monitor it? How will it be sustainable? So when we finally figure out-with the help of community members- what project we want to implement, we design it, we justify to our community leaders and to our PC leaders. When necessary, we write grants, we rally the community behind the project, we implement, we monitor and we evaluate.

So what is it exactly that volunteers do? Well, we do not claim to change the world. This is not why we’re here. We will not eradicate malaria nor will we completely bring an end to the deaths of children under 5. But if we can reduce those incidences, if we can provide much needed trainings, if we can build a health structure that otherwise would not have existed, if we can get just 20 more moms to wash their hands when they’re supposed to, if we can improve sanitation practices, if we can get that many more mosquito nets out there, if we can prevent malnutrition in a handful of infants and children, if we can keep addressing these gaps that cripple health systems, then, we would have contributed to a much a larger picture of global health and we would have served.


taiwo adesinaTaiwo Adesina is a MPH candidate at Loma Linda University in southern California. She is also a Masters International student, completing the final part of her Masters in Global Health with Peace Corps Senegal. In Senegal, Taiwo works in the areas of Malaria, WASH, maternal and child health and nutrition-helping health structures and groups better address these issues through the use of community health workers. Her interests also include project design and management, grant writing, and M&E. She has working/living experience in Nigeria, Honduras, the Philippines, the Bahamas and Senegal. She blogs at travelgiveworklove.

HOW TO DEVELOP YOUR NETWORK AND CREATE GLOBAL HEALTH OPPORTUNITIES

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Making that transition from student to employee or entrepreneur is a daunting task for most of us. And it’s even a bit more challenging when trying to make your way overseas. Nevertheless, we have what it takes to become involved in our dream career wherever it is, perhaps not immediately in the capacity that we desire, but overtime your dream can be attained: First, have an open mind. Second, be creative. Third, be tenacious.

Being a social butterfly can be helpful when trying to identify opportunities. I say talk to anyone and everyone; it’s surprising how much information is available from just talking with your colleagues. Also, don’t forget your professors and your school’s Career Services Department.  For instance, I was in the College of Public Health, but was fortunate to hear about a professor in the Geography Department who was working with Geographical Information Systems. I introduced myself and am now working on an ongoing project in Zambia (see my previous blog, click here.

Furthermore, this is your opportunity to take advantage of early career professional discounts offered by most organizations, such as the American Public Health Association. However, don’t just pay dues; reap the maximum benefits of all that knowledge and available resources.  Attend the annual conference and participate on general or section committees. Moreover, submit an abstract for a poster or oral presentation. This offers you an opportunity to demonstrate your talents to a plethora of professionals in positions of hiring or making recommendations for your future career. At the very minimal you may receive guidance or improving your Curriculum Vitae (CV), interviewing skills, or direction on untapped venues for opportunity.

It is very important to not discount volunteer experience, as there are many rewards from volunteering. For example, helping underserved communities, placing into practice classroom theory, and collaboration. Thus, these experiences should be placed on your CV as if it were a paid position, under “Research Experience” or “Program Experience” or other appropriate categories. Of course, most of us would prefer to be paid for our services. Fortunately, there are numerous organizations that offer opportunity to work in numerous settings, and some even offer stipends, housing, and/or food at no cost for your commitment.  I have provided links to a few options, but there are many more available.

Global Health Fellows Program II:  https://www.ghfp.net/internships/apply-for-an-internship/

Catholic Relief Services: www.crs.org

World Wide Opportunities on Organic Farms – WWOOF: www.wwoof.net/

International Cultural Youth Exchange – ICYE: www.icye.org/
Peace Corps: http://www.peacecorps.gov/

Just changing your environment can place you in a land of opportunity. I have been fortunate to develop friendships with individuals from many geographical locations, and when I travel to visit them opportunities arise. In 2013 my fellow classmate invited me to Kenya. While on a safari I met a teacher from Taiwan who asked if I would help her with providing sex education for youth who reside in Deep Sea Slum (Nairobi, Kenya). With that collaboration, I returned the following May 2014, and with the support of Victoria Sports Association, a local humanitarian organization, I developed and implemented a program focused on self-awareness, hygienic care, and health promotion. It is nice to have big “power” names on your CV, but you have a lot more freedom and opportunity to use your talent with smaller groups, as I learned with this experience.

In conclusion, any opportunity, paid or voluntary is worth the valuable space on your CV. Keep your CV current with all experiences. Employees and potential collaborators are seeking those who want to develop and utilize skills to make a difference in improving health globally. As you grow and expand your networks and comfort space, opportunities begin to emerge. Go after them!

Putting People First

“If we’re going to create resilient health systems, we have to move away from just focusing on commodities, abstract interventions. We have to remember that health is about people. It’s about protecting our populations and creating a workforce that serves those populations. So let’s think about how we build a people-centered health system.”
-Richard Horton, Director, The Lancet

The quote above is from a Global Health Workforce Alliance video which uses key stakeholders such as Richard Horton and WHO Director General Dr. Margaret Chan to make the case for a global strategy on human resources for health – the current Health Workforce 2030 campaign that you may have heard about.

So why the 2030 date? Well, based on current trends in low- and middle-income countries, it’s estimated that by the year 2030 there will be a major shortage of health workers due to country capacity to produce and retain qualified workers. At that point, the workforce (supply of health professionals) will not be able to match the need (provision of essential services).

The Ebola outbreak in West Africa has clearly demonstrated the importance of looking at a health system through the lens of people. Affected countries have lost almost 500 health workers to date (including my aunt) and these are countries that were already suffering from health worker shortages and brain drain. It’s clear that a focus on human resources is critical for these countries and others to strengthen their health systems and become resilient. Having the best supplies and medicines, cutting-edge innovations and interventions, and state-of-the-art facilities without a strong health workforce is not going to advance positive health outcomes.

The Health Workforce 2030 summary brochure is available here on the WHO’s website and the full strategy will be completed by May 2016 for consideration at the 69th World Health Assembly.

It will be interesting to see how this “people focus” plays out and influences the post-2015 development agenda.

If you’d like to learn more about the global workforce crisis in more general terms, check out this TED Talk from human resources expert Rainer Strack. It’s not about health workers or low- and middle-income countries, but he tells a good story.

Environmental monitoring data as “development”: The far-reaching effects of the Beijing embassy’s air quality monitor

When we think of “development” or “development projects,” environmental monitoring technologies are not typically the first things that come to mind. While data is (rightfully) gaining importance in the global health and development landscape, we usually default to primary health care interventions, vaccination drives, or agricultural technologies. However, in a guest editorial in Wired last week, former USAID advisor David Roberts puts forth the American Beijing Embassy’s PM2.5 monitor as precisely that:

As the former Regional Strategic Advisor for USAID-Asia, I have seen first-hand that doing international development is incredibly difficult. Billions of dollars are spent annually with at best mixed results and, even with the best intentions, the money often fails to move the needle. That is why I was so inspired by the story of the US embassy’s low-cost, high-impact development project. They tapped into the transformative power of democratized data, and without even intending to, managed to achieve actual change.

He goes on to tell the story of how, in 2008, embassy staff installed a rooftop air-quality monitor for the price of “a nice car.” The monitor was linked to a Twitter account that automatically tweeted air quality readings every hour. The catch (which is why I question framing it as a “development project”) is that the readings were originally only intended for American expats and travelers – the Great Firewall (that is, China’s nationwide internet restrictions) blocks access to Twitter and other social media – including Facebook, YouTube, and pretty much any blogging platform out there – by its citizens. (Having developed a major smartphone addiction during my time in South Korea, being blocked from just about everything I wanted to access during one day in Shanghai last March drove me batty. But I digress.) Internet users can only access such technologies via a VPN service – commonly used by expats, but much less so among Chinese nationals.

Predictably, however, a few savvy Chinese netizens got ahold of the information anyway.

can't stop the signal

They began distributing it through China’s own (permitted) social media channels, retweeting the readings on Sina Weibo (Chinese Twitter) and incorporating the readings into homegrown air-quality apps. The Chinese government starting taking heat from its own citizens about poor air quality, a ongoing social tinderbox reignited by the availability of impartial (read: not official Chinese government numbers) data. Predictably, the government got upset and ordered the US embassy to remove the device, claiming that the dissemination of the information was somehow “illegal.”

Given the Chinese government’s sensitivity on environmental issues—and it’s irritation at anything viewed as foreign meddling in domestic affairs—it shouldn’t be surprising that the @BeijingAir account would eventually draw an official response. And that’s what happened on June 5, [2012] when China told foreign embassies to stop publishing their own reports on air quality in the country. (The U.S. consulates in Shanghai and Guangzhou also post readings of the air quality of those cities on Twitter.) As of now the @BeijingAir account is still up and running, and it’s important to note that the American embassy has always said that the readings—which come from a single monitoring device on the roof of the embassy—were only meant to inform Americans living in the city.

Naturally, the embassy refused, and so Big Brother was forced to set up its own monitoring stations – and to be held accountable for air quality around the country. Roberts continues to extol the virtues of the expanded “program,” which the State department has now decided to implement at embassies in other countries in Asia (much like China, some of them are rather unhappy about it).

This little air-monitor-that-could also directly inspired other like-minded efforts. In India, the US government has now begun tweeting data from air monitors at its embassy and consulates. In Mongolia, non-government groups in Ulaanbaatar, one of the world’s most polluted cities, ran with the Beijing example by monitoring and tweeting out air-quality data; some even saw the possibility of repurposing the concept for flood warnings. And aqicn.org, which started as a way to share US Embassy – Beijing’s data, has transformed into the go-to site for hourly air-quality information at 4000 monitoring stations stretching from Hanoi to Honolulu.

Honestly, this sort of phenomenon is less about “development projects” and more about the power of information in the hands of an internet-savvy populace. The Beijing air quality monitor does not look like a development project as much as an example of successful government subversion – passive-aggressive actions that boost the credibility and favorability of our image abroad at the expense of the home country’s (foreign policy at its cleverest). The air quality “revolution” in China is certainly not something the US government can take credit for – that belongs to Chinese citizens.

But then again, that is what we believe development should ultimately be about anyway, so I guess I can’t complain.


Note: This was cross-posted to my own blog.

APHA IH-MCH Working Group Conference Call: Wednesday, March 11 (12-1 p.m.)

All section members are invited to attend the next Maternal and Child Health (MCH) Working Group conference call this Wednesday, March 11 from 12-1 p.m. (EST)

GUEST SPEAKER ON THE TOPIC: Global Strategy for Women´s and Children´s and Adolescent Health for the Post-2015 Agenda

Our guest speaker will be:
DR. OSCAR CORDON
Health Practice| Director, Chemonics International
Governing Councilor – APHA International Health Section

Call-in information:

USA/Canada (toll free): 1-888-757-2790
For those calling from outside of the US: +1-719-359-9722
Guest Passcode: 424573

This conference call is being organized by the IH-MCH Working Group of the International Health Section of APHA, but all section members are invited to attend!

For more information and supplemental materials, please contact Laura Altobelli, MCH Working Group Co-chair, at laura [at] future [dot] edu.

Now Accepting Nominations for this year’s Section Awards!

Our Awards Committee is now accepting nominations for this year’s Section Awards, to be presented at the Awards Ceremony at this year’s Annual Meeting of APHA, which will be held in Chicago in October. Each year, our section recognizes outstanding contributions of its members through four awards:

  • The Lifetime Achievement Award for Excellence in International Health honors the visionaries and leaders in APHA who have shaped the direction of International Health.
  • The Mid-Career Award in International Health recognizes outstanding emerging professionals in our section.
  • The Gordon-Wyon Award for Community-Oriented Public Health, Epidemiology and Practice rewards outstanding achievement in community-oriented public health epidemiology and practice.
  • The Distinguished Section Service Award honors outstanding service to the International Health Section.

The Lifetime Achievement Award in International Health was created by the IH Section to honor the visionaries and leaders in APHA who have shaped the direction of International Health. The evaluation criteria for the Lifetime Achievement Award include: (1) the quality, creativity, and innovativeness of the individual’s contributions to the field of international health; (2) the individual’s contributions to the development of APHA or the IH Section; (3) application of the individual’s work to service delivery (as opposed to primarily theoretical value); (3) the individual’s contributions as a leader, visionary, or role model; (4) the volunteerism or sacrifice associated with the individual’s contributions; and (5) membership in APHA (preferably with primary affiliation with the IH Section), a State affiliate, or a national public health association that is a member of the World Federation of Public Health Associations. No self-nomination is allowed.

The Mid-Career Award in International Health is intended to recognize outstanding emerging professionals in the IH Section. The evaluation criteria for the Mid-Career Award include: (1) the individual’s commitment to the promotion and development of primary health care in a cross-cultural setting over a period of 5-15 years (with primary health care encompassing a broad array of public health issues, including HIV/AIDS prevention and environmental health); (2) demonstrated creativity in expanding the concepts pertinent to the practice of public health with an international focus; and (3) membership in APHA (preferably primary affiliation with the IH Section), a State affiliate, or a national public health association that is a member of the World Federation of Public Health Associations. No self-nomination is allowed.

The Gordon-Wyon Award for Community-Oriented Public Health, Epidemiology and Practice is intended to reward outstanding achievement in community-oriented public health epidemiology and practice. This award was established in 2006 by the IH Section and is administered by the Community Based Primary Health Care Working Group. John Gordon and John Wyon were pioneers in this field, so encouraging and recognizing others in this field is one important way of honoring their memory. The evaluation criteria for this award include: (1) a central role in an outstanding achievement in community-oriented public health and practice; (2) demonstrated creativity in expanding the concepts pertinent to the practice of community-oriented public health with an international focus; and (3) membership in APHA or one of its affiliates (either a State affiliate or a national public health association that is a member of the World Federation of Public Health Associations). No self-nomination is allowed.

The Distinguished Section Service Award is intended to honor outstanding service to the IH Section. Award criteria are: (1) dedication to the IH Section mission and goals as demonstrated by continuing exceptional contribution to its activities; (2) service on the section elective positions or chairing its committees with remarkable or unusual effort and achievements; (3) distinguished achievement in the international health field with a remarkable career; and (4) excellence in leadership and strong ability for team work with peers in the IH Section and APHA. Current membership in APHA is essential.

Award nominations should include a detailed letter explaining why the individual nominated should receive the award, addressing the criteria for the specific award and the curriculum vitae of the nominee. Both documents (the nomination letter and the curriculum vitae) should be submitted electronically as a Word document or PDF. Only nominations with the required documentation will be considered for the awards. Nominations should be submitted by e-mail to the Awards Committee chair, (currently Gopal Sankaran, gsankaran@wcupa.edu).

Tools of the Trade: GPS Assisting in Exploring the Challenging Environments by Mary Louise Tatum

The expansions of peri-urban environments are occurring without any strategic development or management which places its inhabitants at risk for environmental hazards.  In 2013 I was fortunate to develop a partnership between Kent State University (Geography Department) and The University of Zambia (Public Health Department) (please look for my next blog discussing in further detail creating international opportunities). As a result, I was able to observe various environments in Lusaka in close detail. This included illegally settled peri-urban areas on the outskirts of Lusaka, Zambia.

Zambia is a landlocked country with a population of approximately 13.1 million located in southern Africa. The capital of Lusaka has a population of 2,191,225 and has seen disproportionately higher growth compared with the national average: Lusaka has an annual population growth rate of 4.6% compared with 2.8% nationally (Central Statistical Office Ministry of Health; 2013 Zambia Demographic and Health Survey). As a result, there has been rapid growth in illegal settlements. Due to rural urban drift many people have settled in unoccupied land in the peri-urban areas. “Six-Mile” is one such peri-urban community in the outskirts of Lusaka.  As residents of an unofficial settlement, residents lack municipal support and basic needs conceivably leading to increased disparities in environmental health related diseases.

Assessing and documenting public health risks have proven to be a challenge in such environments.  Minimal information is currently available regarding Lusaka’s peri-urban environments. Fortunately, advanced technologies, such as, Google Earth and cameras equipped with a Global Positioning System (GPS) can be used to capture, analyze, manipulate, and understand patterns and relationships between people and their environment. Geography and public health unite to utilize geospatial techniques to explore the construct of a specific peri-urban environment. Utilizing a vector-based system, a real world (Local Map) map will be created demonstrating the “real” environment for analysis. This is important as currently there is no paper map documenting this settlement. Data was collected using cameras equipped with a GPS during walks and drives through the area in August 2013 and July 2014.

Preliminary data collection demonstrates Six Mile residents may be at risk for exposure to malaria, cholera, and other bacteria, as a result of the pools of stagnant water and piles of waste observed during the walks and drives through the area. The one closet-size toilet, shared by a community of approximately seventy-five people, is a tiny areas surrounded by discarded plastic pieces that rest on wooden posts of various dimensions. The toilet, which also doubles as a bathing area, is in close proximity to the source of water collection for drinking and household use. During the walk-through and drive-through it was noted that children played in the stagnant pools of water and piles of trash without interruption.

Our partnership is planning to continue data collection this year and to add to our evolving map. Our goal is to develop a visual tool that may be used by agencies to educate residents in healthier practices and for improved development practices that will mitigate environmental hazards that lead to infectious disease.

With advanced technological tools, such as GPS, Google Earth, and other mapping systems we can capture real-time information to analyze how the environment impacts residents and vice versa. As noted during this field study there are numerous hazards which may be mitigated with government and/or nonprofit environmental organization involvement. Promoting behavior change is one aspect of addressing this issue, but the stark lack of adequate water, sanitation, and hygiene facilities is a major public health threat that needs simultaneous attention for risks to be alleviated.

The expansions of peri-urban environments are occurring without any strategic development or management which places its inhabitants at risk for environmental hazards.  In 2013 I was fortunate to develop a partnership between Kent State University (Geography Department) and The University of Zambia (Public Health Department) (please look for my next blog discussing in further detail creating international opportunities). As a result, I was able to observe various environments in Lusaka in close detail. This included illegally settled peri-urban areas on the outskirts of Lusaka, Zambia.

Zambia is a landlocked country with a population of approximately 13.1 million located in southern Africa. The capital of Lusaka has a population of 2,191,225 and has seen disproportionately higher growth compared with the national average: Lusaka has an annual population growth rate of 4.6% compared with 2.8% nationally (Central Statistical Office Ministry of Health; 2013 Zambia Demographic and Health Survey). As a result, there has been rapid growth in illegal settlements. Due to rural urban drift many people have settled in unoccupied land in the peri-urban areas. “Six-Mile” is one such peri-urban community in the outskirts of Lusaka.  As residents of an unofficial settlement, residents lack municipal support and basic needs conceivably leading to increased disparities in environmental health related diseases.

Assessing and documenting public health risks have proven to be a challenge in such environments.  Minimal information is currently available regarding Lusaka’s peri-urban environments. Fortunately, advanced technologies, such as, Google Earth and cameras equipped with a Global Positioning System (GPS) can be used to capture, analyze, manipulate, and understand patterns and relationships between people and their environment. Geography and public health unite to utilize geospatial techniques to explore the construct of a specific peri-urban environment. Utilizing a vector-based system, a real world (Local Map) map will be created demonstrating the “real” environment for analysis. This is important as currently there is no paper map documenting this settlement. Data was collected using cameras equipped with a GPS during walks and drives through the area in August 2013 and July 2014.

Preliminary data collection demonstrates Six Mile residents may be at risk for exposure to malaria, cholera, and other bacteria, as a result of the pools of stagnant water and piles of waste observed during the walks and drives through the area. The one closet-size toilet, shared by a community of approximately seventy-five people, is a tiny areas surrounded by discarded plastic pieces that rest on wooden posts of various dimensions. The toilet, which also doubles as a bathing area, is in close proximity to the source of water collection for drinking and household use. During the walk-through and drive-through it was noted that children played in the stagnant pools of water and piles of trash without interruption.

Our partnership is planning to continue data collection this year and to add to our evolving map. Our goal is to develop a visual tool that may be used by agencies to educate residents in healthier practices and for improved development practices that will mitigate environmental hazards that lead to infectious disease.

With advanced technological tools, such as GPS, Google Earth, and other mapping systems we can capture real-time information to analyze how the environment impacts residents and vice versa. As noted during this field study there are numerous hazards which may be mitigated with government and/or nonprofit environmental organization involvement. Promoting behavior change is one aspect of addressing this issue, but the stark lack of adequate water, sanitation, and hygiene facilities is a major public health threat that needs simultaneous attention for risks to be alleviated.