Health and Community

Spring 2007 Letters Home

Boston, USA - Letter Home
January 20 – February 2, 2007

Composed by IHP Trustees Fellow Adrienne Murray

Wearing bulging backpacks and nervous smiles, one by one the students arrived at the Health and Community Program Orientation where they were greeted by the IHP staff and a fabulous view of Boston’s South End from the 14th floor of the Boston University School of Medicine. During the next two weeks students became more comfortable with one another and the nervous smiles gave way to genuine ones, although it is still a bit hard to believe that we will become as close as the IHP alumni predict. One of our biggest strengths is our diversity. We were raised in a multitude of places such as South Carolina, China, California, New York, Taiwan, Colorado, Guatemala and Wisconsin. We have parents from India, Ethiopia, Ghana and China, and our professors have studied and worked all over the world from reputable institutions in Switzerland to remote Indigenous lands in Mexico. Collectively we have much travel experience ourselves and just last semester some of us studied abroad in England, Mexico, Australia and Kenya.

To welcome us to Boston, Joan Tiffany, the IHP president and long-time resident of Boston’s South End, hosted two dinners in our honor. On was held during the first weekend with over 45 alumni in attendance and the other was a Farewell Dinner just prior to our departure to India. At that second dinner, we reflected on all that we had accomplished during our two weeks in Boston. The first week began with a launch of our 4 courses: Stuff of Life; Globalization and Health; Culture and Health; Community Health Research Methods. In addition to our courses, we were introduced to the “IHP style” of learning: a mix of guest speakers, panel debates and site visits to relevant organizations and institutions around the city. Since Boston is the “Mecca of academic medicine” we heard from many reputed professors and medical personnel from the Boston University School of Public Health, Harvard Medical School and the Boston Public Health Commission. We watched a documentary entitled “Survivor, MD” about 3 Harvard Medical students, and had a discussion about the culture of biomedicine led by a professor from the Boston University Medical School and one of his students. To balance out the Ivory Tower perspectives, during the first week a panel discussion called the “Family Panel” was scheduled, where the panelists described their personal experiences seeking health care in Boston for themselves or loved ones.

After many hours in the classroom, students welcomed the opportunity to get out of their seats and explore Boston through an IHP scheduled Neighborhood Day. Drawing on information from two guest lecturers about Boston’s neighborhoods—Byron Rushing, a Massachusetts State Representative for the South End and Dr. Linda Barnes, founder of the Boston Healing Landscapes Project— students set out in groups of three or four to explore different areas of Boston. Because Boston has one of the most effective community health center networks in the country, anchoring the afternoon was a pre-arranged visit to a particular neighborhood’s Community Health Center. Students conducted interviews of the staff to learn about the centers’ target populations, funding sources, unique initiatives and the challenges of running an effective health center. After their visit, the students explored the surrounding neighborhood to complete a mapping exercise of the community’s available health resources, defined broadly from clinics to adequate green spaces, sidewalks and markets. In preparation for the more extensive case study presentations awaiting us in India, China and South Africa, students presented their findings from Neighborhood Day to the rest of the class. Because of these nine presentations, as well as their own investigations in different parts of the city, some students in Boston-area universities remarked that their opinions of some neighborhoods such as Roxbury, Dorchester and Jamaica Plain had become more positively informed.

In preparation for our departure to Bangalore on the following Friday, many students had a final visit from friends and loved ones over the weekend; others prepared for the journey by sorting through their suitcases and mailing home any unnecessary items. A group of students braved the cold to explore Chinatown and anticipate our stay in Beijing. We came together on Sunday evening for a delicious Ethiopian meal at Addis Red Sea Restaurant.

Monday afternoon’s field trip provided an entirely different perspective on Boston—literally and figuratively—when we took a bus to the Long Island Shelter in the Boston Harbor. The views of the Boston skyline looked like a postcard, yet those fortunate enough to see it are also Boston’s most disenfranchised citizens. The city operates a large homeless shelter there, busing up to 700 homeless men and women in every evening and out every morning. It also houses a handful of transitional programs, such as S.O.A.R. The site’s history as a quarantine facility and its removed location sparked some interesting debates among the students about the perception of homelessness in today’s society.

During the second week we had two guest panels. The first topic was “Markets or Populations at Risk: Fighting for Hearts and Minds in the Tobacco Wars.” In this panel, Cambridge City Counselor, Denise Simmons, talked about Cambridge’s recently passed smoking ban and its effect on the business owners she represented. We heard the global perspective on tobacco markets from Greg Connolly, a Harvard School of Public Health Professor and the United States’ national tobacco control policy from Edith Balbach, a Professor at Tufts University. The panel was integrated, lively and informative on a topic we will revisit again -- particularly in China, the world’s largest tobacco grower and Big Tobacco’s most lucrative emerging market.

Our second panel this was entitled: “Unpopular Science, Popular Press: How Media tells the Story of Environmental Health.” Our four guests represented different forms of media: TV, Radio and Print, and how each covered a local environmental health scandal. The environment's influence on health was a new topic for many of us, and it is one of the topics that will be revisited in every country. In India we will focus on water, water-related disease, and unequal access to potable water; in China our focus turns to air pollution and development, as well as smoking-related diseases; finally South Africa introduces the importance of healthy soils, the overuse of pesticides and fertilizer and the occupational hazards they present.

Later in the week, a few students continued to study this topic during site visits, particularly the 4 students who visited the Dudley Street Initiative, a collaborative effort by Roxbury neighbors to rid their area of hazardous waste dumping. Students split into small groups according to their interests for their first IHP-style site visits. In addition to Dudley Street Initiative, groups visited the following organizations:

Boston Healthcare for the Homeless; Birth Sisters Project; Center for Media and Child Health; Children’s Sentinel Nutrition Assessment Program; Entre Familia; The Family Van; Project RAP (Reaching Adolescents for Prevention). After gathering information about the organization through tours and interviews, students prepared presentations for the rest of the class.

After our site visit presentations, our two weeks in Boston were quickly drawing to a close. On our final day in Boston, we had a catered Indian lunch where the India student group gave us some helpful pointers such as currency rates and cultural practices. Then after a short break for last-minute errands and good-byes, we boarded a bus bound for Logan Airport…and Bangalore!

India - Letter Home
February 4 - March 9, 2007

Composed by IHP Trustees Fellow Adrienne Murray

At 5am local time, we stumbled off the plane and into the humid, fragrant air of Bangalore where our eager coordinators, Leo Saldhana and Bhargavi Rao, met us and helped us load our bags into vans for transport to our hostel. The darkness of the early morning lent an air of mystery to Bangalore and fueled feelings of disorientation after 30+ hours of traveling. Leo and Bhargavi provided maps and orientation books upon our check-in to the hostel, and advised us to use the day for rest rather than aggressive sight-seeing. Most heeded the advice, but some became restless and set out for near-by Cubbon Park or Vidhana Soudha or their first auto-rickshaw rides.

The next afternoon we met our first IHP homestay families! These families would not only house, feed and care for us for the next 18 days, but we soon found, they served as a vital link to understanding Indian culture and life in Bangalore. As if this transition was not exciting enough, on the day we moved to our new homestays, a verdict was decided in the highly contested Supreme Court case on the rights to the waters of the Cauvery River which flows almost equal distances in the neighboring states of Karnataka and Tamil Nadu. The court decided in favor of Tamil Nadu, causing Karnataka’s capital city of Bangalore, which receives much of its water supply from the Cauvery River, to prepare for possible turmoil. Schools and businesses closed early, and police took to the streets as a precaution. Because schools were closed, IHP could not hold formal classes; instead we stayed in our homestays reading the newspaper and watching the news to learn more about this Cauvery River dispute -- a timely, almost perfect introduction to the water rights debates and environmental health issues we would be studying throughout our stay in India.

When our classes resumed, we began with an intro on one of our favorite aspects of India…the food! Our coordinator, Bhargavi, gave a lecture on Spices, Herbs and the South Indian Ayurvedic cooking traditions. She assigned us each an ingredient, telling us only its name in the Kannada language, and sent us to various markets to procure it. It was both a humorous and informative assignment, as we went from stall to stall with our mysterious ingredient’s name. Vendors would laugh and point to a different stall, if for example, we were trying to buy bananas at a spice stand. These market trips were in preparation for our Cooking Expedition, held the following Saturday when we got together in small groups with homestay volunteers who taught us the in’s and out’s of the Indian kitchen: idlies, curries, dosas, dals, curds, raitas. For those of us without various digestive ailments, it was delicious! We had a longer weekend because the Cauvery River dispute continued, and another Bundh (“short strike”) was scheduled for Monday. The day in our homestay was helpful, as many of us were falling sick and needed extra time to recover. We rested, processed our first week in India and took a crack at the sizable IHP India Country Readers full of current health related articles provided by Leo and Bhargavi.

Our second week was packed with lectures. Dr. Tekur, who many of us came to know through his diagnosis of our stuffy noses and troubled stomachs, gave a lecture on Epidemics and Disparities in Development. We also had a lecture on reproductive Health from Dr. Kamini Rao, complete with slides of technology-assisted conception available to middle and upper income families in Bangalore who have trouble getting pregnant. In contrast, we heard from Dr. Poornima Vyasulu, also Adrienne Murray’s homestay mother, who conducted research on reducing maternal mortality in the rural areas of Karnataka. During this week we visited various hospitals in Bangalore including: the Sathya Sai Charitable Hospital, funded by the Sai Baba Foundation; the Sri Krishna Sevashrama, a hospice care facility; Sagar Apollo Hospital, a private facility associated with John Hopkins University; Wockhardt Hospital, a private facility associated with Harvard Medical School.

On Wednesday evening of this week our guest faculty member, Dr. Shiv Grewal treated us all to dinner at Bangalore’s famous eatery, the Mavelli Tiffin Room, where we enjoyed copious amounts of food and toasted to our two weeks with Shiv and his wife, Anne, a mid-wife and current MPH student. Shiv and Anne were then off to visit family in North India before returning to their work in Canada.

The next day we had one of our most memorable classes, a panel discussion entitled, “Where do I go when I fall sick?” Our three guests were employed as a barber, a vegetable seller, and a dhobi (“laundryman”). Through Bhargavi’s translating – or “cultural brokering” as we learned from our pre-departure reading The Spirit Catches You -- we heard candid answers about the cost and availability of health care for these residents of Bangalore. They discussed why they did or did not visit public clinics, where they bought medicines and past experiences with the medical establishment for them and their families.

We took advantage of the free weekend through small trips outside of Bangalore. Many students visited Mysore, a three-hour journey south, to see the famous Mysore Palace and the temple on Chamundi Hills. On the way to Mysore, some students got to stop, wade or even swim in the Cauvery River, giving a more visceral experience of these contested waters. Other students went West to the Chennakeshava temples at Belur and the ruins and Shiva temple at Halebid.

During our third week, we conducted brief case studies to four different sites. After experiencing Bangalore’s congested streets and chaotic traffic, some students explored the Comprehensive Trauma Care, a non-profit dedicated to providing free ambulance services in Bangalore, a city without any pre-hospital accident care. Others went to an organization called Suraksha, which means “to protect.” This is an organization which works in slum areas to promote healthy reproductive health for women and spread knowledge about HIV/AIDS. A third group of students visited the non-profit organization run by a homestay mother, who returned to India after practicing medicine in the United States, only to find that to promote health she needed to help women gain economic stability. Her organization is called Belaku Trust and is a micro-enterprise giving women the opportunity to earn a steady income through textile and paper production. Students who visited this site also got to see a local health center, something we had often talked and read about in India, but had not visited until this point. The final site visited was APSA, the Association for Promotion of Social Action, located on the outskirts of Bangalore. APSA runs a school, home, meal delivery and job skills programs for migrant students and street children. In addition to this monumental undertaking, APSA partnered with the Indian government to run a 24 hour telephone Child Abuse Helpline, and start a model program for sex and HIV/AIDS education. Students to this site also learned about land rights issues in Bangalore and the “land grabbing” occurring by developers as economic growth on the outskirts of Bangalore continues. One student, Nikki Meadows, found this visit so interesting, she returned for a day with her own mother, who came to visit Nikki during her vacation in India.

At the end of Week 3, we said good-bye to our homestay families and boarded a chartered bus that would be like a second home to us in the coming week. Our first stop was in Sittilingi, a very rural area of Tamil Nadu. Here we met the inspiring couple, Dr. Laitha and Dr. Regi who run the Tribal Health Initiative, a hospital they created in which they are the only two formally trained doctors; it currently serves a surrounding population of 80,000 mostly tribal people. Regi and Laitha trained women in medical skills that they could use in their villages, but they told us that they have learned more from their patients and the women they train than vice versa. Our talk and lunch with Laitha and Regi was inspiring, and we were disappointed to say good-bye in the early afternoon.

We had a long bus ride ahead of us, though, to Navadarshanam or “New Vision,” an equally inspiring place, peopled with other inspiring lives. What began as a Gandhi Peace Study Group a few decades ago is now 115 acres of regenerative land and lives exploring alternative possibilities of thinking, consuming and living. After a night of sleeping either on the floor of a beautiful guest home or out under the stars, we walked the grounds with the founders to discuss flora, fauna, permaculture, and renewable energy such as the small wind generator and bio-stoves on the property. Some discussed whether living life in a healthy, spiritual low-impact way was still considered activism, particularly if, as in the case of Navadarshanam, this meant one’s removal from the problems and conflicts of mainstream society. We perused the book titles in the library to feed our minds, and our bodies were nourished by the delicious foods mostly grown and produced on the property. Many of us purchased peanut butter, mango pickle and other products in Navadarshanam’s small store to fortify us through our upcoming vacations.

Then it was back on the bus, which meant…Bollywood movie time! Our bus was equipped with a TV and DVD player, and we alternated viewings of documentaries on water rights in India with the antics of Shah Rukh Khan. We arrived in Thissur, Kerala at 4am and sleepily stumbled to our hotel beds to catch a few hours sleep before our morning’s journey to Plachimada, Kerala and the site of a controversial Coca-Cola bottling plant. This plant had extracted such a huge amount of ground water that local wells became saline and contaminated with heavy metals. Further use of company solid waste as agricultural “fertilizer” seems to have added to local water and food contamination. Local peoples camped outside the company’s gates for over 1000 days, and we met with some of these community members to learn more about their struggle to secure potable water and the difficulties of a sustained action campaign. Like the Cauvery River dispute in our first two weeks in Bangalore, this visit highlighted the growing disparities in access to finite water resources across India. Again the questions arose: Who has access to water and for what purpose? Who should supply and maintain potable water supplies? Who is included in making these decisions and what does that decision-making process look like? Plachimada gave us much to discuss on the bus with the help of Leo’s temperamental microphone, particularly since some students attend US universities that have banned Coca-Cola because of their unethical activities abroad. The visit to Plachimada was brief because we had a much-anticipated dinner engagement, at the local family home of one student, Marissa Anto. We were graciously received by Marissa’s grandmother and an entire preschool of children ready with coconut water for us to drink and adorable songs for our enjoyment. After dinner, we gathered around a bonfire in the courtyard to hear about the history of Marissa’s family, then share songs, dance and “most embarrassing moments” with each other. From the funny gestures in Leo’s song to requests from Marissa’s grandmother for “the slender Asian girl to dance” we simply enjoyed getting to spend time together as a group in such a magical, meaningful place. We would return to a bonfire at the end of the week just before setting off on vacations, but this candid bonfire captured us in a moment of playful camaraderie.

The following day we had an in-house workshop with some Fishermen and women who had traveled very far, up from Thiruvananthapuram to discuss how their livelihoods—and thus their way of life—were threatened by global factors such as the rise of trawling and the arrival of cheaper fish, such as herring, on local markets. They feared their children would have to transition to a different lifestyle, or possibly seek employment in urban areas out of sheer survival: another example of the complex causes of urban migration. These fishermen came to Thrissur, not only to share their stories but to network with ESG and learn about the recently released predictions about global warming. Some students were so intrigued by the fisherman lifestyle, they accepted invitations to visit Thiruvananthapuram during their vacations.

Another highlight of our time in Kerala was our visit to the Gurukula Botanical Sanctuary, nestled in the Western Ghats Mountain range. Here we met Steffie, an ex-pat American who had been living in India for four years, two of which have been at the Gurukula. She showed us the startlingly beautiful plants that also make their home here and the efforts of the caretakers to preserve a bit of the incredible biodiversity of this region. The Western Ghats has approximately 6000 species of plants, 2000 of which are cultivated and preserved at this Botanical Sanctuary. This is quite an undertaking when one considers that all of Europe combined has less than 1000 different species of plants. The Gurukula does its work on a limited budget and the strict water conservation efforts that mountaintop life necessitates. Environmental education for Indian high school and college students, a fledgling field in India, is another important aspect of the sanctuary. Unfortunately, a couple of students (and a professor) fell sick during this visit, and the following morning a few more swelled the ranks of the infirm. Vacations were around the corner, though; after putting the finishing touches on their IHP Country Papers, students were off for much needed rest, time away from the whole group, a bit of adventure, and for three students, a visit with family members.

After vacation, we eagerly met again in Bangalore to share stories of our travels and reunite for one night—and a dinner at Bangalore’s Country Club—with our beloved coordinators and homestay families. The following afternoon we left for Beijing, eager for the next part of the adventure, but sad to leave so soon. As we sang ‘Chulte, Chulte’ instead of saying “good-bye,” we thought of all the parts of India we will miss: hot dosas in the morning; The Western Ghats Mountains of the Wayanad District; women in saris riding side-saddle on the back of a motorcycle; Kerala’s beauty; cows wandering in Bangalore traffic; the smell of Jasmine flowers; festivals with our homestay families; small, ripe bananas; Bollywood dance songs; Mallesh, Bhargavi, Leo and our homestay families.


Beijing, China - Letter Home
2007 Spring Semester

Composed by IHP Trustee Fellow Adrienne Murray

Hao yi duo mei li de mo li hua
Hao yi duo mei li de mo li hua
Fen fang mei li man zhi ya
You xiang you bai ren ren kua
Rang wo lai ba ni zhai xia
Song gei bier en jia
Mo li hua, ya mo li hua.

These are the words to “Mo Li Hua” or “Jasmine Flower.” It is a Chinese folk song that became a theme song for our group. We sang it with confidence on our last night in Beijing at a farewell dinner with our homestay hosts. After two rounds, the families joined us on stage. As we sang together it was hard to believe that only a month ago our coordinator, Hong Mautz, was introducing us to the unfamiliar tune.

Whether coming to China for the first time or returning to one’s birthplace or parents’ birthplace, our month in Beijing has been a transformative experience. Despite being surrounded by Chinese characters on billboards and neon signs, many students found Beijing less foreign than anticipated because of the large buildings, efficient subway system and familiar Starbucks and KFC fast food chains.

The IHP Beijing team welcomed us to China with an extravagant lunch. Delicious and exotic dishes arrived in succession, culminating in the infamous Peking Duck and condiments. An English-speaking student from the China Academy of Chinese Medical Sciences sat at each table and taught us how to fold up a scrumptious bite of duck inside rice paper; these students were to be our translators for the entire program, and they quickly became our good friends as well.

During this lunch we learned two useful Mandarin phrases: “Hao che!” and “Wo bao le!” meaning “Delicious!” and “I am full.” During our two-week homestays, our hosts constantly urged us to eat more, and so “Wo bao le!” became a punch line to many jokes and stories told amongst our group. Jeannia, a fluent Chinese-speaking student on IHP, graciously translated for her classmates through the month. She said, “All of the homestay parents would say the same thing over and over, like ten times…but then to my friends I would only translate it, maybe five times. I mean, there’s only so many times a person can hear, ‘Eat! Eat!’”

All the homestay hosts lived very close to the Academy where our lectures were held, a welcome change from the long rickshaw commutes to class through Bangalore traffic. Most of our hosts lived in the high-rise apartment buildings that dominate the skylines of Beijing. These enormous buildings are replacing the traditional housing style called hutongs; they are characterized by their one-story structure, central courtyards, public baths and communal feel. Four IHP students lived with host families in hutongs. Dora Johnson reports, “Public toilets give you a sense of humility that you couldn’t get in private toilet stalls. And public toilets force you to interact with your neighbors. It is amazing the skills you realize you can draw on when there is a language barrier. And just because you don’t speak the same language doesn’t mean you can’t connect with people on a meaningful level. We got really good at charades at our hutong, and we still felt really connected to our homestay family.” Another student, Cedric Bien added, “Living in a hutong near the Drum Towers was wonderful. It was amazing to be so close to the heart of the city in a historical and endangered neighborhood. Hutongs next to high-rises—what will the city look like in ten years?”

Somewhere between the dinner charades with our homestays over meals of hot jiao zi (dumplings), quick lunches of qie zi (eggplant) or chicken wings and snacking on ice cream bars or mangos, we did manage to learn quite a bit in class. We began each day with a Chinese language class for those who needed it…we are incredibly lucky to have 6 fluent speakers in our group. Our first two weeks consisted of site visits and lectures by guest speakers and faculty. Memorable guest lecturers included: Dr. Jiang Wenyue, a professor from Peking University who prepared an introduction to Traditional Chinese Medicine (TCM); Joan Hu from the NGO Medecins San Frontieres spoke about access to medicines for HIV/AIDS patients; Professor Wu Shangchun from the National Population and Family Planning Commission of China about the social ramifications of China’s family planning policies. She spoke about China’s “One-Child Policy” which would be a case study option for students during the third week of our Beijing program.

During the third week of the Beijing program, students said good-bye to homestay families and moved into the Jing Dong Guesthouse at the Academy. For most, it was a welcome return to the more familiar university lifestyle—studying late into the night with coffee and snacks and friends across the hall like in a dormitory. This environment was complementary to the small group case study research organized for this third week. Students split into four groups to pursue four different health concerns in China:

  1. The One Child Policy and resulting “one child syndrome” characterized by extreme family pressures on youth to succeed academically and economically.
  2. The Impact of Traditional Chinese Medicine on Foot Reflexology since in Chinese tradition the foot is regarded as the second heart of the person.
  3. The Childhood Myopia Epidemic, which students found was fueled in part by constant studying due to “one child syndrome.”
  4. The Role of the Government and NGO’s in HIV/AIDS Prevention, a complex network that also included illegal NGO’s and the oxymoronic GONGO’s (Government Organized Non-Governmental Organizations).

At the end of the week students made fantastic presentations on their week’s findings, and professors, coordinators and students felt the week was an enjoyable, informative success. Because the week’s format was student-driven, many students also pursued individual research. One student was Ashley Kay Fryer; she explains:

“IHP has given me the unique and wonderful experience of being able to conduct comparative thesis research on HIV/AIDS while studying abroad. I feel that I have learned more during our one week of case studies in China—listening to government officials, speaking with unregistered NGO program directors, attending a United Nations theme group meeting on AIDS where I sat at a round table with health experts from the World Health Organization, the Clinton Foundation and the Global Fund—it was more than I could have learned in an entire semester!”

Like Ashley-Kay, Talia Kostick and Sunny Lai also pursued their own research during this week. Talia wrote this about her experience in a Beijing cemetery researching aging and death rituals in China:
“Oh, you mean all of those people! Sunny exclaimed when she finally noticed the hundreds of people leaving the cemetery. Adrienne, Sunny and I made our way into the packed cemetery, previously unaware of the upcoming “Tomb Sweeping Day” Festival. Hundreds gathered in the expansive cemetery to clean the graves of their loved ones and leave offerings of peeled fruit, fake money, paper cut-outs, cigarettes, dumplings, candy and dozens and dozens of flowers. I was so surprised to witness a celebration almost identical to Mexico’s Day of the Dead halfway around the world.”

In addition to individual or small group visits, we also had academic field trips as a whole group. We went to the Beijing Planning Exhibition Hall, which housed the largest scale model in the world. Looking at this model, which covered an entire floor of the museum, it was hard to believe that this city was home to 13-16 million people. The museum also had an exhibit with scale models of the new stadiums for the 2008 Beijing Olympics. On another site visit we went to the Tai Shen Xiao He International Senior Home, an expansive, posh retirement community. Here we had a lecture on the History and Development of Healthcare Reform in China by Professor Wu Dazhen as well as an impromptu demonstration of Tai Chi exercises from two residents, aged 87 and 89. On Friday, March 23rd we visited the China Headquarters of the World Health Organization. Here we met Dr. Henk Bekedam, who answered our questions on healthcare delivery in China as we sat in an official WHO conference room.

Outside of the classroom, we made friends with our translators, especially Zinger, Andrew, Jim and Warren, who accompanied us on sightseeing trips, to dinner and dancing engagements and our infamous Karaoke night at KTV. For the majority of IHP students karaoke was a new experience, but we abandoned our self-consciousness—and any sense of tone or pitch—and belted out American tunes. We also became friends with Jack Beck, an IHP Health and Community alumnus from 2006. He is now studying in Beijing and working with the HIV/AIDS NGO community. In addition to hearing the formal lecture he prepared for us on the difficulties faced by fledgling NGO’s, it was inspiring for us to befriend a recently graduated alumnus so actively engaged in a cause close to his heart.

No Beijing experience is complete without a visit to one of the multiple markets around the city. Students bought knock-off designer brands and shiny silks at Silk Street. Others bought beautiful pearls at Hong Qiao Pearl Market, and a few even ordered tailored suits at Ya Show Market. The bargaining process of every purchase was in turns fascinating and frustrating and some of us had qualms about the dichotomy of studying the occupational health of factory workers in China, but then buying the under priced goods these workers produced. Alex Sable-Smith explains his own feelings: “In India I had this realization that you can be so happy without money, and I vowed to cut out the excesses in my own life. But then I went to China, and I went into the Ya Show market—it’s this multistory shopping mall of knock-off goods—and I was just overcome with consumer desire and the power of marketing. And this was me, someone who reads Paul Farmer! It’s easy to say to people ‘Why don’t you care about public health?’ but it’s harder to look at your own self.”

For the conclusion of the Beijing program we retreated to the “New Socialist Countryside” which was in Guan Di Village in Haui Rou County, two hours drive from Beijing. We stayed overnight in guesthouses, cuddled up against the cool night air, and during the day we wandered along an unrestored section of the Great Wall of China, our eyes and spirits revived by the picturesque countryside and our lungs thankful for unpolluted, crisp air. In retrospect, Nikki Kast remarked, “Seeing the Great Wall—it was right there! Something I had read about in the Seven Wonders of the World, and never thought I would go- and I was climbing it and it was astounding!”

On the evening we returned to Beijing we joined our homestay families and coordinators for a Farewell Dinner. Elaine Ruscetta and Anna Fendley performed a dance to Sunny Lai’s incredible talents on the violin. As Elaine and Anna twirled across the stage and Sunny brought her song to a crescendo, I thought of how many emotions and thoughts are swirling inside each student: excitement and anticipation of South Africa’s vibrant culture and violent recent past; sadness over leaving Beijing and the friends we’ve made here; confusion surrounding the myriad of topics, conflicts and inequalities we are encountering; anxiety about the fast-approaching end of our semester and our return home.

Our professor, Dr. Ellen Rosskam sees these emotions as part of the incredible learning process on IHP: “It is incredibly gratifying and exciting to witness on a daily basis the leaps through the learning curve—individually and collectively—students demonstrate. It is revealed through the types of questions asked, analyses made, the synthesizing of information and experience. There are the references made to what was learned in Boston, the paths walked in India, and the roads climbed in China. I think few professors get to experience this degree of gratification because you have to be with students day in and day out to notice the big jumps in retention of knowledge.”
One final big jump awaits us: we have over 25 hours of travel before reaching Capetown. We will remember Mo Li Hua, but our voices will try new songs; we will miss our daily “Beijing Breakfast” but we our taste buds are ready to try new foods. There are new, complex stories to hear from our hosts, coordinators and guest speakers, but the collective story of our IHP group awaits its next chapter. To the paths we walked in India and the roads (and Great Walls!) we climbed in China, we step onto South African soil, hearts open for the final leg of this journey.

South Africa - Letter Home
2007 Spring Semester

Composed by IHP Trustee Fellow Adrienne Murray

Before departing on our multi-day flight from Beijing to Cape Town, we reviewed our first impressions of South Africa that we listed in our pre-departure assignments: “HIV/AIDS. Apartheid. Nelson Mandela. Table Mountain. High-crime. Great wines.” We knew that our understanding of South Africa would expand infinitely in the coming weeks as we simultaneously explored health and justice issues around Cape Town while synthesizing the past 11 weeks of our incredible semester. Upon arrival in Cape Town’s international airport, we were greeted by our IHP coordinator, Chris Colvin, and his assistant, Phumzile. Over lunch, Chris oriented us to South Africa, describing Cape Town—with its mountains, beaches, gardens and wealth— as one of the world’s most beautiful cities, but given its political history and rich cultural layers, it was also one of the world’s most complex cities. Additionally citing it as a fascinating place to analyze public health challenges and successes. Our schedule in South Africa was heavily devoted to promoting a deeper understanding of the HIV pandemic, but we would also analyze occupational health hazards, the role of traditional healers, and barriers in access to care.

One of our guest speakers, historian Howard Phillips, explained, “In order to understand the health challenges facing South Africa today, you must understand something about South African history.” Dominating South Africa’s history of the past century was its transition from the racist Apartheid government to its current status as a democratic republic. To understand Apartheid’s legacy in South Africa, though, we did not need to consult history books, because its impact still reverberated all around us, visible even to our foreigners’ eyes. Under apartheid, the government passed a series of laws dictating where certain races were permitted to live. This culminated in the Group Areas Act, a policy designed to evict non-whites living and working in “white only” areas and move them into townships away from the city. Khayelitsha, one township we would visit later in the month, was home to over a quarter of Cape Town’s population and the third largest township in South Africa. While some government officials claim that conditions in townships have improved dramatically, informal or temporary housing with inadequate sanitation, electricity and roads dominate the landscapes of the townships we visited.

After two days of rest in Backpackers’ hostel in Cape Town, we boarded a bus and headed to Zwelethemba, a rural township about 2.5 hours from Cape Town, where we would be living with homestay families for 8 nights. In Zwelethemba we practiced speaking Xhosa, one of South Africa’s official languages; most of the 8 million Xhosa speakers live in South Africa’s Western Province. Fortunately, we did not have to rely solely on Xhosa—the ‘clicks’ of the language being difficult for beginners—as almost everyone also spoke English and Afrikaans, South Africa’s other two official languages. The children of the township, who were enjoying a break from school for Easter holidays, filled our free time with informal lessons in Xhosa, local games, music and dance. They walked with us to and from our classroom at the Zwelethemba library, and it was rare to see an IHPer’s hand unheld.

During classes in the library we learned more about the Khululeka Men’s Support Group, Phumzile’s organization for HIV+ men to support one another in disclosing their HIV status and seeking treatment. We also watched some films from the Steps for the Future video collection. This was a project where Southern African and international filmmakers, AIDS organizations and people living with HIV / AIDS collaborated to produce high–quality, professional films with provocative stories that reveal the effect of the HIV / AIDS pandemic on the lives of individuals, families and communities. Many students became intrigued by different mediums used for effective public health communication.

During the course of the South Africa program, we would not only explore creative films like those in the Steps series, but also: documentary films like China Blue at the Labour Film Festival; the Children’s Radio Diaries, a collaborative project designed to further appropriate public awareness about children in the context of the HIV pandemic by providing children themselves with the opportunity to produce radio stories about their lives, broadcast widely in English and Zulu; documentary photography used by Nick Henwood and Richard Jordi, two guest lecturers, to illustrate unacceptable working conditions for sub-contracted city sanitation workers in Cape Town. We also added our opinions to the on-going debate surrounding “LoveLife,” the expensive, multi-media public-awareness campaign aimed at delaying sexual activity in South Africa’s youth; much of its educational content was available online, although only a small percentage of South Africans had access to the Internet. Above the main street of Zwelethemba was a billboard depicting two trendy youth under the heading “Love Life.” While its bright colors and upbeat vibe caught the eye, especially in contrast to the nearby hand-painted advertisements for funerary and burial services, its message of safe sex was not clear. Many students felt it was an example of a top-down public awareness campaign with questionable results.
What was clear was Zwelethemba’s lack of resources. We visited Empilisweni Clinic in the township, which was much smaller and more poorly equipped than Ebon Donges Hospital located in nearby Worcester. While Ebon Donges also treated residents of Zwelethemba, it was often difficult for residents of the rural townships to skip work and/or find transportation to the larger hospital, a challenge we knew existed for rural, sub-urban citizens of India and China as well. Zwelethemba lacked markets that supplied fresh vegetables, fruits or meats, -- most likely because its residents could not afford to purchase such expensive food. Lack of accessible medical treatment and lack of nutritious affordable food is a double-burden for HIV+ patients to overcome, which we learned from members of the Treatment Action Campaign. TAC is an organization founded in Cape Town in 1998 that has successfully campaigned for nation-wide implementation of a mother-to-child transmission prevention program and free or affordable antiretroviral treatment programs. Since 1998, TAC has become a political force in South Africa, and back in Cape Town, seven IHPers would research this organization directly during IHP’s Case-Study Week, joining TAC in bright orange “HIV+” T-shirts at a political rally in front of the courthouse.

While TAC argues for free antiretroviral treatment and comprehensive care for HIV+ citizens, there are other prominent voices in the clamor against HIV infection. Different voices include: the Rath Foundation, which promotes the benefits of vitamin regimens and nutrition therapy above antiretroviral treatment; members of the federal government who also promote nutritious foods as AIDS treatment, yet these food are often beyond the typical South African’s budget. Some traditional healers promote drug therapy while others did not, and since up to 80% of South Africans have visited a “sangoma,” -- a traditional healer -- at some point, these mixed messages have only added to confusion about effective treatment options. One member of TAC told us that in the Eastern Cape, “people still need more workshops to understand that for HIV you must go to the clinic, not the sangoma.” Another influential and multifarious voice in the HIV treatment debate was the Church. One guest speaker, Monwa, explained: “Some churches say, ‘If you get HIV, it is a curse from God.’ Some students on IHP experienced the church’s message firsthand when their Zwelethemba homestay families took them to their local congregations. The Reverend at the Zwelethemba Assembly of God preached, “People are afraid of HIV because they only have condoms. If they had Jesus and the Kingdom of Heaven, they wouldn’t be afraid.” The debate was framed as “Kingdomization versus Condomization” and to some Christian believers you could not practice both.

Whether taking us to church, a local soccer game or the “shebeen” or informal tavern, our homestay families integrated us into everyday life. One IHPer, Sarah Richardson explained, “It sounds really cliché, but after a day, we were part of the family. We played with the kids in the yard in the evening, then we would eat dinner together every night and do our homework in the living room. You really felt like you were at home.” To show our appreciation, at the end of our week in Zwelethemba, we hosted a “braai” or barbeque, and while waiting for the meat to grill, we danced, kicked the soccer ball and had our hair braided by young fingers. The next morning we said good-bye to our families, bringing with us gifts of homemade muffins or locally grown grapes as well as fond memories of a tight-knit community the struggles against the enormous challenges of apartheid’s legacy, poverty and the HIV/AIDS crisis.

Back in Cape Town we immediately moved into our new homestays in the historic Cape Malay community located in the Bo Kapp neighborhood on Signal Hill, and we held our classes and lectures in the Bo Kapp Museum. This community is predominantly Coloured, a term that may sound offensive to American ears but is the official name for South Africans of mixed descent, and Coloured Capetownians comprise about 49% of the city’s population. Our homestays in the Bo Kapp spoke English and Afrikaans, but not Xhosa, and during this transition from one community—and culture— to another, we learned quite a bit about Cape Town’s racial politics. We discussed the impact of South Africa’s first fair elections in 1994, the transition from an apartheid government to a democratically elected one, and the challenges this created for providing comprehensive healthcare: “We’re seeing a drastic political change here that we can’t see anywhere else,” David Gumbiner said. “In one swoop, everyone’s roles changed instantly. It’s like colonialism just ended 13 years ago.” Although laws may have changed and pass books outlawed, living conditions and individual opinions are more difficult to change. Many Bo Kapp families were very open with us about their views on race and politics in the city. During an IHP discussion session, Cedric Bien said, “Blacks and Coloureds are very distinct. Things are not just about black and white; it’s much more complicated, and I didn’t realize that.” Nikki Meadows shared the opinions she heard in her homestay: “When I told my [homestay] family about our stay in the township, one member said, ‘Some blacks choose to live that way and choose not to get out.’ He didn’t want to connect the structural problems post-apartheid with the poverty, choosing instead to blame individual behaviors.” Our coordinator, Chris said “Your hosts can be an incredible window into South Africa, especially staying in a Coloured community immediately after a township community. You are experiencing the complexities, the layers upon layers that are South Africa.”
The Bo Kapp neighborhood was very conveniently located for us to explore Cape Town on our own. Nearby were Table Mountain, Lion’s Head Peak, the Waterfront District for shopping and seafood, and the infamous Long Street with its foreigner-friendly restaurants and internet cafes, where we spent many hours wrapping up our IHP academics. We had our final Case Study Week, where students worked in small groups to explore topics such as Pesticide Use, Birth Options, Men’s HIV+ Support Networks and South Africa’s Rape Crisis. After the Case Study Week, students finished their South Africa country papers and other assignments and began to reflect on the semester as a whole.

During these final weeks students were synthesizing experiences both academic and personal on topics explored in all four countries. Some insightful comments and probing questions from students include:
“Back at Harvard, I have always thought about TB and AIDS and the infectious diseases as the ‘sexy’ public health pursuits. But now I have a new understanding of what really matters—access to clean water, food, livelihoods.” -Theresa Cheng

“Everyone knows I am interested in nutrition, and in India we spoke with a doctor who told us about the Vitamin A deficiency problem and the intervention program to bring in bottles of Vitamin A. But Vitamin A is toxic if taken too much. I am learning that not every intervention is a good intervention.” -Elaine Ruscetta

“There is a huge lack of knowledge out there. So many in China do not know about HIV/AIDS. There are 50-60 ethnic groups in China and about 50-60 languages, but the HIV/AIDS literature is only just now starting to be translated into Mandarin.” -Seth Luxenberg

“More and more I realize we have to look at the efficacy of what we see as healing or a cure and the different ways of seeing a healthy body or a healthy life that exist around the world.” -Nikki Kast

“In Boston, India, China and South Africa, I looked at care for the elderly, but there are finite resources for care: caring for children, caring for the sick, caring for HIV, caring for the elderly. How do we allocate resources?” -Sunny Lai

To tackle such problems and questions in the face of returning to the United States and our more traditional college lifestyles, we said Good-bye to our Bo Kapp homestay families and relocated for the final days of our semester. Our retreat was held at the Goedgedacht Trust, a community-based retreat center outside of Cape Town. Here students not only continued their conversations about life post-IHP, but they presented their Capstones, or creative projects on topics explored in all four countries. The projects ran the gamut in scope, from monologues and poetry slams to a cookbook with the nutritional analysis of Indian, Chinese and South African food ways to a musical depicting “A Day in the Life of Johnny College.”

To conclude our final letter home, we would like to share an excerpt from one Capstone project that synthesizes not only the semester but different examples of activism we witnessed in each country. Written by Caroline McKeown and Pamela Pelizzari in the style of Chaucer’s Canterbury Tales, here is the Prologue and Epilogue to “IHP Tales”:

When hath a cold January noon,
A group of thirty-one college students met in a room.
In Boston, Mass, we planned to take a trip
So deep in our pockets our hands did dip.

It was soon worth it, sights all new,
India, China, and South Africa too.
We’ll study health care and have fun on the way
Eat delicious food and live in homestays.

Awkward at first, didn’t know a soul,
We would soon find the group together as whole.
What we also would see would change our view
Bottom up health policy changes are not few.

Activism is done with much variety.
Voices rise up from members of society.
Each country we visited did it right,
To change officials’ minds and put up a fight.
Before exploring we looked at our own,
Examined grassroots movements in our home.

Our journey is ending and much too soon,
The trip will be but a memory by June.
But from this experience we have learned much
And the lives of many we’ve surely touched.
The things we’ve seen have touched us just the same,
And in the end we’re so glad that we came.

But where are we going to go from here?
We’ve seen in the world there is much to fear.

The health of many is infringed upon
By governments, employers, the list goes on.
How can we help fix these problems severe
In faraway countries and neighborhoods near?
Through IHP we’ve repeatedly learned
Of the causes for which people have yearned.
A smoke-free Cambridge, clean water to drink,
All of these movements have caused us to think.

In Boston the people formed a small group
With various figures who were in the loop.
Politicians, doctors, and experts galore
Make the smoke free campaign less of a chore.
They used all their skills and worked together
To change the air in Cambridge forever.
In the process a social norm was changed,
A healthier lifestyle for all was arranged.

In India we learned of persistence.
They sat for 3 years, no one could miss it!
A small group of women, locally based,
Brought down Coca Cola with relative haste.
Their nonviolent ways, no experts at all,
Were able to make a factory fall.

In China, the workers used word of mouth
To empower their comrades north and south.
Knowledge and awareness of all their rights
Developed communities ready to fight
For payment and for a safer workplace.
These workers managed themselves with grace.

South Africa gave us even more views
Through an elaborate HIV ruse.
The government wasn’t caring at all
So member of TAC heeded the call.
Rising from nothing and learning to yell,
They composed themselves very well.
TAC was successful in using lawsuits
In spreading their message and planting roots.

As we move away from this group journey,
The prospect of the future may make us squirmy.
How can we effect change, we are so small
And insignificant in the scheme of it all?

If we can learn anything from IHP,
It must be that activism is the key.
Learn from what these groups did to unite,
And we can certainly put up a fight
Against the inequities we have seen
And the health hazards on which we’re so keen.
As we go home to the United States,
A shining opportunity awaits.
Learn from these people, it’s your decision
To see in this world a healthier vision.
We can make changes in our world today,

This journey has clearly shown us the way.

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Credits: 16

Duration: Spring, 16 weeks

Program Sites:
United States, India, South Africa, Brazil

Prerequisites: None. Coursework in public health, anthropology, biology, or related field recommended.

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