Category Archives: APHA IH Section

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.

Tips for students and young professionals embarking on their first international health experience

Guest blogger: Geoffrey Horning

As members of the APHA and specifically as students in the International Health section, none of my colleagues find the thought of living and working overseas all that strange. In fact, they quite often find the thought exciting, intriguing and something they aspire to do. Many of us, myself included, already have work experiences outside of American borders. In this two part posting, I thought I would share a little of the perspective that I have developed as a “westerner” currently working in the Middle East and North Africa.

On November 11th 2011, I boarded the first of three flights from St. Louis Missouri that would ultimately land me in Riyadh, Kingdom of Saudi Arabia. News media, YouTube and the rest of the internet do not do Saudi Arabia justice, but I thought I had some idea of what to expect from my previous travels…I was wrong. Here are some of the things I’ve learned about living in another culture, and especially one completely different from your own.

First Things First: Know your surroundings and be aware of your situation at all times. The last thing I want to do is scare you or encourage you to stay inside. Neither of those things is necessary, and in fact they are both counterproductive. However, it is important for your safety that you remain alert. Failure to do so can make you the target of groups looking to exploit your naivety, whether it be for a simple street hustle, unlicensed taxi ride that keeps getting more expensive, bribes or more nefarious robbery and kidnapping. Always make sure someone knows where you’re going and when you will be back, register with your embassy in the countries you’ll be visiting, and always keep an eye on a possible exit.

Roll with the punches: Nothing is what it seems, you are a foreigner, a stranger in a strange land, and you learn daily. If you crave the stability of familiar things, this is going to be rough. Every time you think you’ve figured something out, it changes, or more likely, you realize you were just wrong about your previous assumptions. When you laugh things off, or regroup and try a different approach, when you finally realize the “punches” aren’t directed at you and in fact are simply cultural differences — then you’ve made it.

Know the Law-BEFORE you arrive: Two of the “silliest” things I see here are people who have no knowledge of the laws, and worse, people who flagrantly violate the laws and then expect a United States Passport to get them out of trouble. This doesn’t work; it understandably annoys the State Department, and reflects poorly on all of us from your home country. Please follow the law of the land.

Know your health status-and respect it: Consider any medical conditions that you have that require specialized treatments and or medication. Do a quick internet search and see what you have to do in order to get those treatments or those prescriptions filled in the host country. Never, stop taking a medication without a doctor’s advice. Items of specific concern are analgesics/painkillers which may be considered illegal narcotics where you’re headed and psychotropic medications that may just not be available. If you have a history of cardiac problems, it would behoove you to look into the state of cardiac care in the country and region you’re going to.

Learn the language: A vast majority of people in Saudi Arabia are already bi or tri-lingual. English, French, and of course Arabic are commonly known. My Arabic is probably best described as “atrocious”, and the Saudi dialect of Arabic can be quite a bit different from Modern Standard Arabic, which is what you’ll usually get from a language program. That being said, I know enough to get around, and it helps. Start working with it from day one. Your supervisors, co-workers, cashiers, waiters, driver and hotel bellman all speak two or three languages; you might want to go ahead and try to catch up. It’s appreciated.

Check your privilege at the customs counter: The idea of “privilege” is a contentious topic in modern day America. However you feel about it, I assure you that it exists. You’ll see it up close as you process through customs and immigration the first time, and you will probably realize that you have more travelling money in your wallet than some of the people in that line make in a month. If a customs officer recognizes that you’re American/Canadian/British (i.e. “Westerner”), he might pull you out of line and take you to the front, bypassing the 100 people in front of you. Don’t argue with this man – but don’t act like you deserve it. If you’ve been recruited as I was for your abilities in a specific area, then prove it through your performance, but do not act as though you deserve it just because your first moments of life were in a Western hospital. As you learn, as time goes on, you’ll figure it out. Keep the great aspects of your home country and culture, leave the rest: Remember, you just became an unofficial ambassador!

Hurry up and wait: Life in the United States and other Western nations is often a little more: go! go! go! than it is elsewhere in the world. Whether you call it the “rat race” or “climbing the corporate ladder” or what have you, many parts of the world don’t do this. Time is more fluid here, and as an example, work starts at 8 for me which, means I arrive between 7:30 and 8:30. For the first year, I was vigilant about being on time. Now I make sure I’m within reason, which is what my co-workers do. This is what makes me part of the group, rather than an outsider. Learn to interpret signals, take things as they come, and just relax. You might find that you really enjoy the more relaxed pace.

Watch what you say, watch what you write: You should be culturally sensitive anyway, but sometimes it takes a little bit to figure out what’s culture and what’s not. I actively wrote a blog the first 18 months I was here; I really enjoy going back and reading it now, as I can see my development and change over the months and year. There’s nothing wrong with doing this, and I actually encourage it. The reason I gave it up was the time commitments of work and school, not fear of Saudi government intervention. That said, it is always a good idea to be aware of what you say. Not every country in the world, including some western ones, recognizes your “right” to say whatever happens to pop into your head today. Insulting a nation’s government or royal family may be illegal, insulting the culture is poorly regarded, and insulting the state religion and/or proselytizing is treated as blasphemy and can be punished severely. If you make it public, anyone can read it.

These are some tips to get you started in your planning process, In my next post, I’ll talk a little bit about the steps to cultural adjustment that you’ll be taking, as well as give some real life examples of people who’ve been both successful and failed miserably in their transitions.

GHorning

Geoffrey Horning is an Emergency Medical Services (EMS) Training Consultant at the Al-Ghad International Colleges for Applied Health Sciences in Riyadh, Kingdom of Saudi Arabia. His expertise is in EMS/Fire and EMS/Fire Training with specialization in HazMat and Disasters. Geoff’s objective within the Department of Academic and Educational Affairs is to improve and assure the quality of the educational processes and thereby provide the best possible learning environment for students and faculty alike. A veteran of the United States Marine Corps, Geoff is simultaneously working on his MPH at the George Washington University which he will be complete in August 2015.  

Lancet reminds us to include health in #humanrights analysis

This should go without saying, but it is always nice when a respected, high-impact journal reminds us that health should be a central consideration in every human rights discussion and “necessary component of resilient human security.” In its most recent issue, British health journal Lancet published an editorial on HRW’s World Report 2015, lauding it for drawing attention to health-related human rights failures around the world while expressing disappointment that it “did not identify health as a core element in its analysis”:

In his opening essay, HRW’s Executive Director, Kenneth Roth, writes, “The world has not seen this much tumult in a generation…it can seem as if the world is unravelling”. Indeed, this 656-page report is a grim read in a year marked by extensive conflict and extreme violence. But when one delves deeper, there is a hidden story that often does not make the headlines. That story is the health dimension of human rights. Viewed through the lens of health, the report contains several compelling and disturbing themes.

The editorial noted numerous examples in the report of attacks on healthcare facilities, both in conflict zones and in the areas of West Africa struck by the Ebola outbreak, as well as spotlights on gender-based violence, a dearth of mental health services, targeted killings and persecution of health workers, and inadequate access to palliative care. While the report contains valuable analysis, the editorial contends that it does not go far enough in incorporating health as a human rights foundation:

This latest HRW report is an important call to arms to protect health as a fundamental human right. It is a pity that HRW did not identify health as a core element in its analysis, not only as part of a comprehensive package of human rights protections but also as a necessary component of resilient human security. Their analysis should prompt all governments and international health organisations to reflect carefully on their actions to make health a core responsibility and right of all citizens.

Agreed.


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

The Dark Side of Chocolate: A Story of Child Slave Labor in West Africa’s Cocoa Plantations

With the holidays approaching, I can’t help but notice one of my favorite sweets making an appearance in almost every store I visit. Chocolate is an indulgence most of us in America can’t consider living without. However, after joining the team at the international non-profit, United Aid for Africa, I was motivated to take a second look at how and at what cost, we get our chocolate.

Continue reading

Band Aid 30: Celebrities Strike Again

Over the weekend the song These Days by UK pop group Take That made it to number one on the UK Official Singles Chart. So why is that good news? Because the song took the number one spot from Band Aid 30’s Do They Know It’s Christmas?

Do They Know It’s Christmas? was first released in 1984 to raise money for the famine in Ethiopia. It was re-recorded twice (first in 1989 and then again in 2004) to raise more money for famine relief. The latest version was released last month and has undoubtedly caused a lot of controversy as it aims to respond to the Ebola outbreaks in West Africa.

While the celebrities involved may have had good intentions, their delivery is shoddy and the result is a condescending attempt at charity. Do They Know It’s Christmas? portrays West Africa as a single, poverty-stricken country in peril. The sensationalist message the title, imagery, and lyrics send is that Westerners need to save Africa because it is a place of famine and disease without any joy or hope. The lyrics read:

There’s a world outside your window and it’s a world of dread and fear
Where a kiss of love can kill you
And there’s death in every tear
And the Christmas bells that ring there are the clanging chimes of doom
Well tonight we’re reaching out and touching you
Bring peace and joy this Christmas to West Africa
A song of hope where there’s no hope tonight

The lyrics alone are insulting and erroneous, but coupled with the video, the whole thing is so patronizing. I’m utterly appalled that the producers of the music video decided to show footage of a female Ebola patient being removed (practically dragged) out of her house as the opening scene. How is that okay? Did they get her consent? Was her family involved? Also, the lack of transparency around donations and proceeds is problematic. Money is being kept in the Band Aid Charitable Trust, but the website doesn’t provide any information on exactly how the money will be disbursed and used.

As someone who has suffered a heartbreaking personal loss to Ebola I support all awareness, aid, and relief efforts, but I cannot comprehend how this whole thing came together and I’m quite disappointed in all the celebrities involved. They had the potential to do much better. They could have used their fame and influence to create something like Africa Stop Ebola which provides accurate educational information and gives all proceeds to Medecins Sans Frontieres (an organization that has been on the front lines of the Ebola outbreaks since March). But then again, celebrities and development don’t usually mix well, right? Share your thoughts below.

P.S. – check out this Band Aid 30 spoof created by the Norwegian Students’ and Academics’ International Assistance Fund

Students: The Importance of Making Meaningful Connections

As Dale Carnegie once said, “You can make more friends in two months by becoming interested in other people than you can in two years by trying to get other people interested in you.” The importance of making meaningful connections, or networking, cannot be emphasized enough. However, many people mistakenly think that networking is simply to attend various meetings and hand out business cards. Networking is more than that; it is an art form. In his book How to Win Friends and Influence People, Carnegie highlights several important networking skills we often tend to ignore, such as smiling, listening, asking questions, and saying a person’s name. These are the “soft” or interpersonal skills that need to be practiced and often reinforced. Knowing how to and being able to network can be the single most powerful way to develop one’s professional network, make connections with people who share similar interests, and build long-last friendship.

Continue reading

Making Social Justice the Ultimate Goal

In the global health field, we generally understand that investing in health is critical for a nation to prosper. But would you consider a lack of investment in health to be a social injustice?

The United Nations’ Under Secretary-General Michel Sidibe thinks so. In this short interview with CCTV News, he talks about how the Ebola outbreaks in Guinea, Liberia, and Sierra Leone have exposed global health failures and explains why health is an investment, not an expenditure.

Prior to watching his interview I’d never really labeled a weak health system as a social injustice in my mind. But health is a right and a shortage of health workers, the inability to provide basic health services, and lack of infrastructure – all of which have become very apparent in the Ebola outbreak – are in fact social injustices. So I think this is a very apt way to label the current situation as it puts a broader lens on the issues and ties everything into the bigger picture of the role of health in society.

His interview made me think of universal health coverage (UHC) because the definition of UHC requires social justice. It addresses the issues of access, equity, and capacity. I wonder if there will be an increased focus on moving towards UHC for the three Ebola-affected countries as part of their rebuilding efforts.

What do you think will be the biggest social justice issues coming out of the Ebola outbreaks? And how do you think we can best address them?