IHP Health and Community: Globalization, Culture, and Care (Spring 1)

Spring 2009 Letters Home

Switzerland Letter Home
Wrapping up the Geneva, Switzerland part of the program will be short. We have barely been here more than a week. But, measuring time in weeks, days, and hours is just one way of looking at things. For instance, just ten days ago, we were at home; George W. Bush was the President of the USA; discussions with the United Nations, the World Health Organization, the Red Cross, Group SIDA (AIDS), and UMSCO mobile unit had not happened; we had not teased apart the meanings of words like "culture", "nature", "medicine", "food", and "health" Ten days ago, the Atlantic Ocean was to the east!

Things have changed, and they will undoubtedly continue to change. We will arrive in Bangalore, India the day after tomorrow. This may be daunting, but we are prepared—we have discussed culture shock, cultural sensitivity, and have committed to support each other in all circumstances. Navigating London's airport security when we switched planes gave us our first glimpse into the dynamics of sticking together, staying aware, and persevering through hectic crowds. We passed that test without a glitch. Since then, we have enjoyed peaceful ease of Geneva's lovely, free-to-tourist, public transportation.

On a recreational outing on the weekend, from a nearby mountaintop, the clear skies made no distinction between the Swiss Alps and the French Alps, the French-speaking Swiss villages on one side, and the French villages on the other. The political boundaries were invisible from 1000 meters above sea level, but they were also invisible on the ground, because the border guards take Sunday off! Every day has not been so picturesque. We have weathered rain and snow, and steady clouds. This has presented an opportunity for the southern and Californian students to practice adapting to unfamiliar places!

The people of Geneva speak French, but most of our guest lectures have been in English. One lecturer required a translator, but every once in a while, she would correct the English translation! Go figure. For those of us who do not speak French, stores and museums where English is not spoken have been challenging, but we often have found a common language by speaking Spanish, Italian, German, or Portugese. Then, there has also been lots of charades and miming. Practicing these skills in Geneva will surely come in handy in the coming months.

Dr. Earl Nolte, the country coordinator for us here in Switzerland, quickly got on our good side by arranging a lakeside fondue dinner for the whole group. He has sought to expose the group to various representations of Geneva. This has included a tour of the Old City (beautiful buildings and churches squeezed into pre-automobile sized stone streets), visits to the international community headquarters, and gripping lectures on topics including night life, family culture, social space, the concept of refuge, the concept of race, the co-mingling of 188 ethnicities in Geneva, crime, medicine, and law. Eloquently presenting decades of experience and academic investigation, Dr. Nolte's presence was like a dancer floating across the stage, bringing form to the music, lights and scenery around us.

If there were a jetlag vaccine, perhaps we should have taken it before the trip, but the immunologists seem to have missed that one. The first few days were exhausting. One late afternoon a couple days into the program, some of us found ourselves in the basement of the Red Cross museum, learning about the hazards of land mines. Although the lecture was interesting, more than one of us was day-dreaming of a bed in the hostel. Somehow, the next day at the World Health Organization, the energy of the group changed. It was as if one of those immunologist had come and retroactively found that pill. (Perhaps the pill is really just good old sleep). With renewed spirit, the group engaged in discussion about Intellectual Property Rights, reducing our ecological footprint, the social determinants of health, the layers of culture, the convergence of peak oil, climate change and health, the complexities of food, and comparative health care systems.

I suppose a lot did happen in one week. Maybe it wasn't so short. Wow! Imagine if every week were this eventful. We have exciting times ahead in India, China, and South Africa. Wish us luck and send us love. Ours goes out to you!

And by-the-way, Happy Chinese New Year--the year of the ox.

Yoshua Fattal
Trustee Fellow
Health and Community
Spring 2009
Track 1

India Letter Home
Namaskara from India! Coming from the chilly streets of Geneva, we teleported to India. I say teleported because we stepped into this metal box, closed our eyes, sat quietly for hours, opened our eyes, changed our watches, and stepped onto a foreign land, a very foreign land. Through the owl night we drove past street signs tall enough for three languages and arrived by 4AM at our temporary rooms. We were immediately enthralled by the hustle, heat, and aromas that greeted us in Bangaluru (known in English as Bangalore). Our first huge challenge was navigating the traffic, which caused an adrenaline rush for those of us whose lives flashed before our eyes. Some of us used the sprint-for-your-life strategy, others cunningly wove through the sea of rickshaws, and some walked much farther than necessary to avoid crossing the road at all. Eventually, most of us decided it was easiest to find an Indian stranger and shadow him as he deftly and safely crossed the roads.

In India we teleported, walked, sprinted, took buses, trains, boats, and rickshaws, but it was our homestay experience that was the foundation and gave depth to our time in India. Our homestay families took care of us—they helped us navigate Indian culture, politics, current events, and food. Some families took us to concerts, weddings and temples. After a few days in the homestay, one student said “suddenly the chaos did not seem too much to handle, but rather a sensible and intricate set of actions regulated by none involved.”

During our first week, we went to the market, bought vegetables and cooked with our hosts. Participating in the details of cooking helped us gain an appreciation for the complexity of various Indian cuisines. Throughout our stays, every dish was an adventure – we didn’t know if it would be sweet, bitter, salty, or any of the other Ayruvedic elements that make up the balance of cuisine. At first, we weren’t sure if we would like it, but to our surprise we all found most food quite delicious. Curd (yogurt) rice, masala dosa (curry/vegetables in a crepe), dahl and sambar (lentils and pea sauce), rice, chapati (flat bread) were our staples—not to mention chilis, cumin, fenugreek, tumeric. For twenty-five cents, tender coconut, fresh from the trees to the roadsides, provided hydration, minerals, vitamins, and “meat” (not to mention the other 44 uses of the coconut tree). Each meal mixed so many plants, with so many healing properties…

Our country coordinators, Leo and Bhargavi, always kept us up-to-date, well-fed, and in the company of great lecturers. Our IHP family of almost forty people split up into five groups for rural case studies. Leo and Bhargavi arranged encounters with inspirational people and organizations. One student enthused, “being in the case study was amazing, because we felt connected to India and the land in a way we’d never experienced. Where else could you till vegetables by day, discuss homeopathy over organic meals, and guard mango orchards from marauding elephants at night?!” In addition to learning about the connections between health and food, some of us tried Kalari (a martial art), visited tribal clinics, and met with participants in community health movements.

In indigenous India, I could not help reflecting on the absurdity that in America the indigenous population was labeled “Indian”. In India, there are over 70 million indigenous Indians, and we visited an indigenous school that is managed by young men and women. They welcomed us with song; we reciprocated. Then they welcomed us with dance, and we followed along—85 degrees, humid, ecstatic, dancing at night to what became known by our group as the “tribal rave.” This was just the introduction. We then spent two nights at their school discussing the impact of lifestyle and culture on health.

Last but not least, the coursework provided ongoing inquiry into health and its social determinants. We grappled with abstract questions like: “what is health?” “what is community?” “who represents the community?” “what are the pros and cons of the modern lifestyle?” and “how does traditional medicine co-exist with biomedicine?”. We also heard some grounded voices of alternative health practitioners, sexual minorities, factory workers, the founder of the People’s Health Movement, urban planners, tribal health workers, self-help groups, and environmental activists. This varied exposure helped us see India with eyes different from those we came with.

But health is not solely an abstract issue. As part of our curriculum, we are focusing on “self-care” which can be tough in an ever-changing environment, and India has a notorious reputation amongst western gastrointestinal tracts. We tried to be strong, but some of our best were forced to sacrifice some of their days and meals to the rituals of catharsis. Care and love, time and antibiotics are what these rituals demand, and we propitiated. Our quest for Health and Community has become very personal.

To summarize what we have learned and experienced in India is an impossible task. But after spending our final evening together singing, telling stories, and sharing, we are finding that there are ways to communicate our experience. As we move on, we hope to stay connected to the vibrancy expressing itself through each of the many Indias that exist.

China Letter Home
It seems that our time in China has come to an end. For the past four weeks, many unique experiences of discovery have graced our time in China. This place, mythologized as the destination at the bottom of the sandbox, has become real. Some students were calling it China-Country to contrast it to China-Towns known to us in the USA. Arriving in China feels like arriving in a distant land on the underside of the earth’s sandbox. Simultaneously, there is a familiarity to those of us who’ve visited Chinatown (or China itself) before.

Challenges and opportunities are two sides of the same coin. The great distance over which language acts as a bridge became apparent to many of us. (The root of the word “communication”—to commune, to find communion—became evident to us.) Beyond a mere “hello” English was generally not understood. The language barrier provoked feelings of isolation and frustration but these same feelings served as a motivating force to learn to communicate. Slowly, “nihow” replaced “hello” and the thirty minute daily course added up to a formidable repertoire of phrases for bargaining, salutations, and family relationships. A major difficulty lay in remembering the importance of intonation.

After spending a few days in Beijing, we took a beautiful overnight train ride to the province of Hunan, the city of Changsha. Hunan is known for its a) changeable weather b) its spicy food, and c) being the birth province of Mao. Mrs. Zhang and Mr. Li hosted us and generously settled us into the guesthouse and then homestays at Central South University. We were dazzled by the manicured lawns, the youthful atmosphere, and university comforts. With a huge smile and straight from the textbooks, Chinese students approached us and asked, “hello, where are you from?” “how long have you been here” “what is your name?”. Then they proceeded to say their two names: first their Chinese name and then their English name. For example, “my name is Xinhua, but perhaps this is difficult for you to say, so you can call me Dave.” While their parents carefully chose the Chinese name for their one child, the students got to pick their English names (sometimes on the spot, or rotating every few days). One Chinese student who helped us out a bunch introduced himself as, “Socrates.”

Changsha lived up to expectations. The weather shifted from a paradisiacal spring sun that prompted laying on the lawn to dreary sideways rains clouding our moods. The food was spicy, but we were consistently sheltered from the heat and spice as foreigners. Homestay families paid careful attention not to overload our taste buds. And surprisingly, the spices in India did little to prepare us for the Hunan hot peppers.

Finally, the specter of Mao Zedong has condensed into the atmosphere. One student took a weekend trip to see his birthplace and hear the glorified, government version of his life story, his rise to power, and his policies (while reading Jung Chang’s critical expose of the “unknown story” on the bus). Mao’s face shows up everywhere including two centimeter lighters and twenty meter paintings. His policies molded the China that we see and hear about. One homestay father openly discussed his experience in the Cultural Revolution in the 1960s (contrary to the myth that nobody will talk about the Cultural Revolution). Social pressure had forced him, as a 12 year old, to condemn his school teacher whom he liked. It was the homestay families that provided our main portal into the cultures of China.

Before going to China, the general group fear centered a lot on the “unknown foods,” particularly meat. Several students became vegetarian converts in the days preceding the flight to Beijing. The Chinese word for vegetarian is “su shi” but it seems there is not a big su shi movement in China. Many Chinese were quite confounded by the idea of not eating meat. They are rather fond of meat, and will, seemingly, eat it in absolutely any form. Many streets are lined with vendors selling lives turtles, snakes, and fish out of plastic buckets. One of the authors of this letter personally dined on dog, fox, donkey, snail, duck brain, and frog. Meanwhile, those seeking to avoid these delicacies (the vast majority of students) had no problem doing so.

Illness within our community put our knowledge of “Health and Community” to the test. Some brought traditional Chinese herbs to class to share, others did Tai Chi in the mornings, some organized exercises in the afternoons, a few went to the clinic for antibiotics, we all shared our “joys and concerns” with each other, and group health was restored by the end of the country program.

The highlight of the China program for me and many other group members was the three-day independent case study where we were allowed to conduct a field research project of our own design. There were five different groups with topics such as: new rural cooperative health system and maternal and child health. One group studying occupational health visited and interviewed at a construction site. The Traditional Chinese Medicine (TCM) group made some visits to TCM wards. A group studying school nutrition conducted a written survey with school kids.

China is rising and many say this is her century. Recent data says the growth rate is 6.1% in the first quarter of 2009 (down from 12% in 2008), but the government declared that it needs 8% in 2009 for employment. What will come of all the political and economic dynamics remains to be seen. Our four weeks has given us a glimpse of something that no numbers or predictions can hope to convey. This is something we will struggle to communicate (even without a language barrier) because of the profoundly different perspective one has when one looks from the depths of the American sandbox.

Josh Fattal, IHP Trustees Fellow
Eric Koenigsberg, Student, IHP Health and Community Track 1

South Africa Letter Home
As the program is winding down and our time in South Africa is coming to a close, we’re excited to come home and share all that we’ve learned.

Upon stepping out of the airplane into the sunny autumn South Africa air, our shoulders relaxed, our digestion improved, our breathing became easier, and the comfort of English surrounded us. We set off right away to explore Capetown—the city created by the “Cape of Good Hope” for its strategic location along a European spice route. Some of us headed straight for the calming effects of the ocean while others tackled the awe-inspiring vistas of Table Mountain. We spent the first few nights at a hostel in a neighborhood called Sea Point (yes, it is as idyllic as it sounds).

Only a few days after arriving in Cape Town we left Sea Point for our homestays in the Bo-Kaap. The Bo-Kaap is a working class Muslim neighborhood inhabited by the descendants of the Indonesian, Malaysian, and Indian slaves and workers brought over by the Dutch in the 18th century. The neighborhood is located up a steep hillside, making for an arduous walk home. All the houses in the Bo Kaap are painted bright colors, which makes it easy for us to identify our new homes.

After spending a week in the Bo Kaap and acting like tourists on Long Street, the trendy dining and shopping district, we traveled north of the city to a rural township called Zwelethemba – “the place of hope” – whose appearance is untouristy, whose people are largely unemployed, and whose goats roam free through the garbage. We spent ten days in homestays in Zwelethemba around the time of the national elections. Many of us experienced a South African style political rally- what we would describe a 24 hour block party hosted by the African National Congress (ANC – the leading party in South Africa) the weekend before the elections. Many ANC supporters were surprised to see the group of Americans dancing in the street alongside local ANC leaders.

While in Zwelethemba, we also finished up our final projects for our health and globalization class. The days leading up to the project presentations were spent collecting trash, super-gluing cardboard, setting up dominoes, making board games, and scrambling to finish our models on time. We presented these 3 dimensional models, summing up all aspects of globalization and its effects on health, in an open forum at the Zwelethemba library. Our presentations coincided with Election Day (which is a national holiday), with all the music and fanfare of elections as background noise.

After our projects were wrapped up, we were free to focus on Zwelethemba once again. It’s a vibrant community of 20,000 that was created during apartheid as a black neighborhood outside of the white city of Worcester. The families we stayed with were incredibly welcoming and open to discussions about politics and life in the townships. Amidst all the realities of poverty, our group stood out like a banana in row of apples. We encountered no threats or problems (contrary to common fears in non-black neighborhoods). We were embraced as sisters and brothers; our host families and those in the neighborhood told us stories of migration from Zimbabwe, told us stories of combating the police during Apartheid, and told us stories of family and separation. Whether we were playing soccer in the street with our host siblings, talking to the Rasta artists, planting fruit trees at the library, or dancing at the ANC block party, we really felt like a part of the community, and were sad to leave.

Back in Cape Town, we returned to the now familiar Bo-Kaap. Classes started up again with case studies and country papers. We were given a lot of freedom for our case studies; we set out with only a topic and a contact. We spent five days exploring Cape Town in the context of our case study topics; which varied from midwifery to xenophobic violence to HIV/AIDS to traditional healing. Our experiences were as varied as our topics; some students embedded themselves in a Rasta community to study traditional healing, while others made pamphlets about the right to health for People’s Health Movement South Africa. Most students agree that these case studies are where the real “experiential learning” that we long for actually takes place.

We’re wrapping things up at a farm and retreat center outside of Cape Town. After hiking a mountain, playing some music, and watching a slideshow, I am starting to feel that perhaps it really is the end of this journey. On this retreat, I’m learning more about everyone every day. Katie sings so well. I’ve never seen Komal dance like that before. Emily has some soccer skills. Shannon is a poet. Serg and “the dark horse” are brilliant at interpretive dance. I found out that I don’t need shoes to run on the earth. We’re thankful for our time, our friends, and our home we will return to. Have we changed at all? Have you changed, Mom? It has only been four months, but it seems lifetimes and lifestyles away. What are we having for dinner tomorrow? Maybe Masala dosa?

Emily Knapp
Helena Turner
Josh Fattal

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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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