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

Spring 2010 Letters Home

Switzerland Letter Home
It is amazing that we have been on this journey little more than a week. It seems months ago now that we excitedly and apprehensively first glanced at each other’s faces and silently compared suitcase sizes. After two long days in Washington D.C., full of icebreakers and orientation sessions, we boarded the plane for Zurich, Switzerland and felt like the trip had finally begun. We were met at the airport by our wonderful Switzerland country coordinator, the 7 month pregnant and dressed in many shades of purple, Dr. Caroline Stierle, who led our sleepy-eyed bunch to the quite luxurious YMCA in Basel.

Basel, just a stone’s throw from the borders of France and Germany, is an easily navigable city. Daily, we all piled into the tram to head to our classroom at the University, trying not to be as noisy as such a large group can be. Our time in Basel was divided between learning about the Swiss health care system, getting a sense of the global players in the health world, deconstructing the words “health,” “culture,” “community” and “medicine,” and eating copious amounts of cheese and chocolate.

One highlight of the week was the day we broke into small groups and spread out around Basel, Freiburg, Germany and Mulhouse, France. We went with university students, who acted as translators and local experts, to interview community members on various health related topics. Though some people were a little surprised to be stopped and asked questions on the street, others were very open to sharing. Many were also interested in discussing the American healthcare system with us (and they had thought Swiss healthcare was expensive!). Some of our new friends from the university invited us to join them the next night for Basel’s annual Museum Night, where all Basel museums are free and open until 2 a.m. We checked out the fine arts museum, which featured live music for the occasion, and wandered into some other interesting museums unique to Basel, like the pharmacy museum, the anatomy museum and the doll museum.

We also took a look at a popular Swiss alternative system - anthroposophy, the spiritual theory of Rudolph Steiner. Steiner is famous for founding the Waldorf schools, which some of us had experienced firsthand as students in the United States. It turns out that Steiner applied his spiritual views beyond education to the arts, architecture, and even medicine. Anthroposophical medicine views health as the balance between two extremes and uses both conventional techniques and alternative ones. We received a tour of a local anthroposophical hospital where we experimented with mustard powder on our arms, a technique used to treat chronic pain. It turns out mistletoe is not just for Christmas smooching, but also can be used to treat cancer!

The following Monday, after a restful weekend, we piled into the tram one more time to visit two of the world’s top pharmaceutical companies, Roche and Novartis, to learn about drug development, intellectual property rights, and HIV and Malaria treatment programs. Though some members of the group left feeling conflicted about the position of big pharma in the global health agenda, they clearly have made major advances in medical innovations. Those of us who visited Roche were even lucky enough to get a tour of the production plant and watched the production of hundreds of thousands of Tamiflu pills firsthand.

Later that same day we had an intriguing and comprehensive guest lecture from Jean François Rischard, the former vice president of the World Bank in Europe, about some of the most important global issues we are facing, from the credit crisis to climate change, and how we are the generation who must tackle these issues urgently. According to Rischard, “turning off lights and fixing your bicycle is only about 5% of the solution… we need to change the system.” Hopefully this trip will provide us with creative solutions and tools to use as we move forward.

We rounded out our time in Switzerland synthesizing what we had learned and coming up with more questions than answers as we began our global tour. We felt lucky to get a glimpse of such a well-organized health care system (and well-organized society, in general) which will serve as an interesting comparison as we continue on our journey. It is with both great enthusiasm and a little trepidation that we will board the plane, unsure of what is to come, but we have made the beginnings of wonderful friendships, even in this short time together. As we examine health and community in the places we visit, we have promised to remember that we are also a community and must take care of our own personal and group health. We have even started group yoga sessions which will continue in India and have made self-care goals for ourselves to work towards during the semester.

It has been an amazing kick-off to what is definitely going to be an amazing semester. We are packing up our winter coats and our stashes of Swiss chocolate and heading off to India. We may not have the daily internet access we are all used to, but we will certainly be in touch as the journey progresses.

Sending you lots of love,

Mira Silverman, IHP Trustees Fellow
and the IHP Health and Community Spring One Program

India Letter Home
From the moment we entered India, we were swept away by its magical chaos and its stark contradictions.  Wafting scents that switch without warning from jasmine flowers to sun baked garbage; tastes that range from the sweetest syrup to the spiciest curry; lavish luxury out of the reach of most of its billion people- India is a mystery to unravel.

During our stay in Bangalore, we had the incredible opportunity to live with host families in South Bangalore, the supposedly “posh” part of the city. Bangalore is known as the Silicon Valley of India, and a few of our families worked in the IT field. Though everyone’s homestay family was unique, we all got to experience the water-saving techniques of the bucket shower, the paper-saving techniques of the Indian squat toilet, and the general desire of our families to have us leave a little rounder than we came in- making it their goal to stuff us full with delicious, spicy South Indian dishes.  Many students picked up a few phrases in Kannada, the local language, as well as bits of Tamil and Malayalam, other South Indian languages between which many locals switch with ease.  Some also had opportunities with their families to attend traditional events, from weddings to naming ceremonies, to pick up a little Bharanatayum dance (typical of the state of Karnataka), and to visit Hindu temples for special celebrations like Shivaratri. Within a few days, all of us were decked out in colorful Indian salwars and kurtas (and the occasional sari!), bargaining with rickshaw drivers over transport fare, and fitting into the noisy Bangalore street scene about as well as a group of 33 Americans could hope to.

With an incredibly rich schedule set up by our Indian host organization, Basic Needs India, we attempted to get a handle on the complexities of health issues in the vast sub-continent.  One prominent theme that emerged from our guest lectures and site visits was that of maternal and child health.  Meeting with women’s self-help groups both in urban slum areas and in rural villages, we learned about issues like microcredit, barriers to accessing quality healthcare, government pressures to institutionalize childbirth, and the dangers of being a woman in a dowry-based marriage system.  Though the self-help groups we visited showed mixed results in their effectiveness, some people we met, such as Dr. Saraswathy Ganapathy and her organization the Belaku Trust, were inspirational in their accounts of women’s empowerment.

Though the health concerns in India are great- from the environmental hazards of solid waste management, to malnutrition, to the social determinants of health, such as poverty and education- the creative efforts to address these concerns are great as well. While listening to illiterate women speak about empowerment in their villages, we felt inspired about the power of grassroots change.  And while listening to Ravi Narayan, a leader of the People’s Health Movement, talk about lobbying the WHO, we felt inspired for macro-level change too. Several of our guest lecturers urged us to challenge the system that creates health inequities and to actively play a role in community health from the ground up.

Leaving the now comfortable routine of life in hectic Bangalore, we headed south on an overnight train (trying to get some rest amidst the calls of the chaiwalas and snack vendors) to the heat and lush beauty of Kerala, India’s southernmost state.  Kerala is known for its communist state government, high literacy rates (almost double that of the rest of the country!) and high life expectancy.  It is also known as a stronghold of traditional ayurvedic medicine. We got to visit an ayurvedic hospital and see firsthand some of the treatments, such as hot oil massage (which many of us tried out in our free time) and medicated milk applications.

After a packed full month, a week-long vacation was a welcome time to do some personal synthesis of all we had seen, as well as time to care for our own health with some needed R & R. A few of us took advantage of the time to do brief internships at an AIDS clinic and a women’s economic empowerment organization, and one group traveled north to Delhi, Agra and Jaipur.  This group was able to participate in and celebrate Holi, the Hindu festival of colors that marks the arrival of spring. During Holi, Hindus throw powdered dyes at each other with the goal of covering as many people as possible in a rainbow of colors. Needless to say, the group was unrecognizable after a few hours (and some still have green and pink streaks in their hair days later!). Most of us decided to stay in the South, spending the first few days on a houseboat on the beautiful Kerala backwaters and then doing some serious beach-bumming.

A week later our big family was united once again, a little more tan and with suitcases a little harder to close, ready to begin the year of the tiger in China. We’ll keep you posted…

Written by Mira Silverman, IHP Trustees Fellow and Nora Hirozawa, Elizabeth Thayer, Drew Eberts , Elie Adler, Laura Van Tassel, Namrata Patel, Annajane Yolken, Sam Hodges, IHP Health and Community Students

China Letter Home
It is a rainy day here in Shaoshan, the birthplace of Mao Zedong. We had a great morning at a local high school, followed by a warming ginger soup- perfect for the weather- and now the group has closed ourselves away in our rooms for the afternoon with green tea or Nescafe to finish up our country papers for Emily’s public health class. Shaoshan is a rural pilgrimage spot of sorts- a place where large groups circle Mao’s massive statue three times, Mao paraphernalia is available in every form from cigarette lighters to baby rattles, and every restaurant claims to be run by members of Mao’s family. It seems the perfect spot to be reflecting back on our time in China before once again making big moves across our planet. 

We didn’t know quite what to expect arriving in China. There were a few of us who had been here before and tried to prepare the rest of us with some basic Chinese words and a few cultural clues, but for many of us China was a mystery. China and India are often grouped together as the two growing world powers, but the contrast we felt in moving from one to the other was dramatic. In some ways China felt so familiar- the modern, orderly city life; the food and markets many of us know from Chinatowns visited back home. But in other ways it still felt like a far off land, and the language barriers we faced were a challenge to be overcome.

But these challenges were made easier thanks to the help of our hosts at Changsha’s Central South University. After a quick tour in Hong Kong and an overnight train ride, we arrived in Changsha, the southern city known for its spicy food and variable weather patterns. These we experienced firsthand as we watched the weather shift from the icy cold that shocked our systems upon arrival to the spring sun that had us all sitting on the campus lawn in our Indian summer dresses. But the spicy food they warned us about was nothing after the burn of some of those Indian curries. The food did come with its own set of challenges though, as we watched our competitive sides emerge around the table’s Lazy Susan, or as we found our tablecloths (and laps) stained by our novice chopstick abilities.

In our first days we met Mrs. Zhang and Mr. Li, our China program coordinators, and the Chinese students that would be our translators as well as become our friends during our stay (even accompanying us to KTV to practice our karaoke skills). They patiently answered all our questions and guided us as we got our bearings in Changsha. Our homestay families also acted as “cultural brokers,” giving us a glimpse into everyday life on a Chinese university campus, and showed us firsthand the warmth of Chinese hospitality. They taught us how to make dumplings, joined us on visits to Orange Island to see the giant statue of Mao’s head and on hikes up Yuelu Mountain, and navigated the oftentimes difficult questions we had about government policies.

During our time in Changsha we had a range of guest lecturers and site visits. We learned about the philosophies behind the ancient system of Traditional Chinese Medicine, and then visited hospitals and clinics to see how TCM is integrated into Western biomedicine (or vice versa). We learned about neoliberal economic policies and the creation of special economic zones for free trade. We learned about issues such as ageing, nutrition (the food pagoda!), chronic disease, and urbanization, and how each of these is affected by/ addressed in a state-run healthcare system.  

In Emily’s Research Methods class we looked at study designs, as well as examples of qualitative research methods. After examining other people’s illnesses over the course of our journey, we had the chance to turn the lens on our own group when we each acted as both a participant and researcher in the construction of an illness narrative. This was a rewarding experience, allowing us to give deeper meaning and context to events in our own lives, and to gain a greater understanding (and therefore, hopefully, compassion) of the health issues of other members of our traveling community.

Another highlight of our Research Methods course in China was the few days we spent doing a self-directed case study. We broke into small groups and spread out around the city looking at a range of topics from occupational health, to smoking, to maternal and child health. Though our research was made more challenging because of the language barriers we faced, the help of English-language students at the university and the synthesizing of all our skills gained over the semester enabled us to do some firsthand preliminary investigation and come up with thoughtful research questions.

In Stefi’s Health, Culture and Community class one highlight for many of us was our assignment to practice a form of “embodied” ethnography- using all our senses to experience a place. Inspired by the Chinese practice of Yangsheng (cultivation of the spirit), we tried to put aside our analytical minds early every morning to enter the slow body power generated by Tai Chi practice. Some of us also exercised our senses wandering around Wal-Mart-- the epitome of globalization, as well as the only place in Changsha to search for American comfort foods, or as we took in the sounds and smells of the downtown walking street- a sort of Times Square replete with live turtles and frogs (and not necessarily for sale as pets).

It is through the mist of the rain and the shadow of Mao Zedong that we look back now to these incredible few weeks that have whizzed by. It is with new friendships, developing culinary skills, amazing experiences, and a plethora of questions that we will embark on the final leg of our journey.

Mira Silverman, Trustees Fellow
Jamie Cohen, Sydney Greenberg, Shristi Pandey, Lauren Okano, Nancy Dong, Stan Rivkin, Corrina Wainwright

South Africa Letter Home
After almost two days of traveling from Changsha with a day layover in Hong Kong, we arrived in South Africa a little tired but enthusiastic to begin the final leg of our journey. We had a weekend of rest and exploration in Cape Town, eager to shed our winter coats, communicate freely in English once again and fulfill some of those food cravings we’d been conversing about for awhile. We then moved to Zwelethemba, a rural black township in the beautiful wine country landscape outside the small city of Worcester.

But the beauty of the landscape is not enough to erase the history that took place on its land. It has been 16 years since apartheid officially ended here in South Africa, but the stark evidence of it remains. Democracy and a rights-based constitution has not been enough to unite the “third world” conditions of the townships with the “first world” luxuries of other neighborhoods, and South Africa has one of the biggest divides between the rich and poor in the world. Though we certainly stood out in the all black township, we felt very safe and were well taken care of by our warm homestay families who shared incredible stories of their lives under Apartheid and the struggle against it.

Our ten days in Zwelethemba were full of incredibly informative and inspiring talks from a range of speakers and groups.  We learned about traditional and symbolic forms of healing in our anthropology class and then had site visits in the afternoon with two local healers. One, an herbalist, crammed us all into his small shack with the walls covered head to toe with posters and photographs and regaled us with passionate stories about the healing properties of herbs but also about his adventures and perspectives on life.  Our second visit was with a iSangoma, a traditional African diviner. The iSangoma, a very large woman seated on a goatskin mat in her dark hut, explained to us about how she came to realize her gift and what sorts of ailments she treats.

Another highlight of our time in Zwelethemba was the day we spent with an organization called Women on Farms. Female farm workers in South Africa face difficult living conditions, lower wages and less permanent contracts than men, high levels of domestic violence connected with the high levels of alcoholism on the farms, and little possibility to find other employment. Women on Farms, a group of incredibly wise and dedicated women, talked to us about the different programs they are running such as a Labor Rights Program and the Women’s Cooperative Program, and took us in the afternoon to view firsthand the living conditions on one vineyard.

We celebrated our last night in Zwelethemba in the South African fashion with a braai, a barbecue. All of our homestay families were there and we enjoyed performances from the local Arts and Cultural organization and even shared our own gumboot dancing skills we had picked up in a few classes that week. Then we loaded up the bus the next morning and headed back to Cape Town to move in with our new families in the steep-hilled, brightly colored Bo Kaap neighborhood. The Bo Kaap, a working class Muslim neighborhood, is inhabited by the descendants of slaves brought over from India and Malaysia in the 18th century, and our families had an interesting perspective to share.

One of our first days in Cape Town was dedicated exclusively to looking at issues of HIV/AIDS. Though we were all expecting HIV/AIDS to be a pervasive theme in the public health field in South Africa, the actual numbers- reaching as high as 18% among certain groups- were particularly striking actually being there. The complexity of the issue was also made clear by many of our guest speakers, who talked about the connections between HIV and poverty, domestic violence, alcoholism, tuberculosis, and women’s empowerment- to name a few.

Much of our time in Cape Town was also spent working on our final projects for our academic courses. Our Globalization and Health final projects were amazing, ranging from beautiful dioramas to board games to an interactive competition representing the players and trends of globalization. We were all really proud of what we produced and how much we had learned throughout the semester.

We also did our final Case study, using all of the skills we learned in our research methods course throughout the semester to do independent research on topics ranging from HIV peer education, to midwifery, to urban planning, and to create a plan for a successful health intervention. This week was a definite highlight, allowing us to explore our own interests, to work together in small groups, and to synthesize all the skills we had gained this semester.

We also had time to have some fun! - eating at Cape Town’s great restaurants, going dancing, and visiting some of the great museums and historical sites. The city of Cape Town is absolutely breathtaking, spreading out between the beach and the base of Table Mountain and Lion’s Head peak.  We took advantage of the area’s natural beauty by hiking Lion’s Head at sunset, biking to the Cape of Good Hope via quaint colonial towns and beaches full of African penguins and two of us even ran the famous Two Oceans Marathon from the Atlantic to Indian Oceans.

The semester has been both packed full and gone by so quickly. It’s hard to believe that it was just four months ago that we were seeing each other for the first time in Washington. Since then we have visited four countries around the world, shared amazing experiences, learned about pressing health issues in the countries we visited, and learned perhaps equally as much about ourselves. Our last few days in South Africa we left Cape Town for a beautiful rural retreat center to begin the process of saying goodbye. We told stories and made up songs and danced and talked about making the transition back into the U.S. and how to bring home all that we have learned. We will miss each other a lot, but are also so excited to be home and to share our stories with all of you.

Mira Silverman, IHP Trustees Fellow

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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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