IHP Health and Community: Globalization, Culture, and Care (Spring 2)

2010 Letters Home

Washington, DC Letter Home
Written by Heather Fukunaga ’05, Trustees Fellow ’10

Whew! Our program launch in Washington, DC has been a whirlwind of learning, making friends, and getting to know the city in just two short weeks. The 2010 IHP Health & Community program began at historic Eastern Market in the Southeast section of DC. After orientation we said good-bye to our parents and walked a few blocks to our home for the duration of the DC program, the William Penn House.

We started off the DC program with a keynote speech by Dr. Claudia Morrissey, the Senior Director of the Saving Newborn Lives program at Save the Children. She discussed infant and child mortality rates in developing countries and shared recent success stories from her work. The students had some great questions for her, and they have continued to question all of our speakers very thoughtfully. We began faculty lectures in our four regular courses: Sara Bergstresser teaches Public Health and Research Methods, and Shanti Avirgan teaches Health, Culture, & Community and Globalization & Health. We have also heard from several guest lecturers: Ruth Levine from the Center for Global Development, Stan Dorn from the Urban Institute, and Robert Hecht from Results for Development. They have shared their insights on topics including funding streams for global health, the US health care reform bills, and the changes that have occurred in global health since the 1993 World Development Report.

It has not been all lectures though! On “NGO day” we had a great time, splitting up into small groups and visiting two local non-governmental organizations. Then we all reported back to our peers on what we learned. The work of these NGO’s ranged from HIV/AIDS advocacy and prevention services to housing/rental assistance to anti-domestic violence work to a neo-conservative think tank to LGBTQ advocacy work. We were impressed by many, surprised by some, and enjoyed visiting all of them. On “neighborhood day” we split up again to visit six different neighborhoods around DC and investigate the ways in which health is intertwined with the social, cultural, environmental, political, and other elements of one’s neighborhood. All of the neighborhood groups’ presentations and photos were insightful and interesting.

Between all of the fantastic academic activities organized by our DC Coordinator, Jeremy Ogusky, and the faculty, some of us also found time to visit the Mall (it’s only a few blocks from the William Penn House) and DC’s numerous museums, and to go to (and participate in) a spoken word/poetry jam and a South African hip hop concert. Different student groups were responsible for three group meals; from planning the menu, to shopping, to cooking. One night was Italian food, another was curry, and we finished up with a great taco night. We all agree that the students have outdone themselves!

Our final day in DC was “civic engagement day.” We began with a morning-long training with advocacy and public policy experts from SIECUS (SexualityInformation and Education Council of the US), the International Women’s Health Coalition, CARE International, and the International Center for Research on Women. We learned about how to engage with our elected officials and about the specific legislation we would be discussing with policymakers. The bill we advocated for is the “International Protecting Girls by Preventing Child Marriage Act of 2009,” which would prioritize funding for organizations that work to eradicate the marriage of girls under the age of 18 in developing countries. The talking points we used included human rights concerns, gender equity issues, and health issues; one statistic is that girls under the age of 15 are five times more likely to die in childbirth than women in their 20’s (showing that this bill will help address one of the root causes of high maternal mortality rates). SIECUS set up meetings for the students to talk with their legislators (or their aides) in both the House and the Senate, so we all had the opportunity to lobby policymakers from the state where we are registered to vote. While we received mixed responses, all of us agree it was a really good experience. SIECUS is optimistic that our efforts may really help move this bill forward.

Cate says, “Our time in DC was packed! But we still found time to enjoy many restaurants, especially the great Thai food. I was also able to visit many museums and Arlington, VA. It was great to start the program in such a historic, diverse, and politically active city.” And now we depart DC for our adventure around the world- we can’t wait to share with you all that we see, taste, smell, learn, and experience in Bushbuckridge, South Africa!

South Africa Letter Home
Written by Heather Fukunaga, IHP Trustees Fellow and South Africa Country Group

Imagine your commute home from school or work each day. Does it involve passing elephants and zebras? Ours did during our time here in South Africa! Our amazement at daily wildlife sightings was only a small part of the incredible amount of experiential learning that occurred for all of us in this country.

After touching down in Johannesburg after the long flight from DC, we were greeted by Jan Vermeulen, our country coordinator, who whisked us away in our two vans (which became very familiar during our month here) to Wilgespruit, a Christian conference center located on the outskirts of Johannesburg (alternatively referred to as Joburg and Jozi). While some of us wished we were closer to the city center, we all appreciated the green space and relaxed atmosphere at Wilgespruit. It was not always so peaceful there though; in the past, Wilgespruit was a site of organization and resistance to apartheid, with its legacy represented by the symbols of peace donated by South Africa’s four Nobel Peace laureates: a piece of limestone from Robben Island from Nelson Mandela, a cross of nails from the Coventry Cathedral in Dresden from Desmond Tutu, a piece of the Berlin Wall from F.W. de Klerk, and the ashes from Albert Lutuli’s burned passbook, a form of identification South Africans were required to carry during apartheid. Wilgespruit was the perfect place for our introduction to South Africa. We learned about people’s experiences of apartheid through panels and guest lectures and went on visits to the Apartheid Museum and Soweto, one of the biggest black townships in the country. The time we spent in Joburg and Soweto was very intense and emotional, and we learned an enormous amount in a very short time.

Apartheid Museum
We departed Joburg excited to begin our homestays and to finally see where we would live and learn for the next three weeks. Joburg is located in Gauteng province, so we drove northeast through Mpumalanga province to Limpopo province, where our classroom at the Southern African Wildlife College (SAWC) is situated (right on the border of Limpopo and Mpumalanga). All of our homestays were just across the border in Bushbuckridge municipality, Mpumalanga province, in the three villages of Welverdiend, Hlvukani, and Islington (they were a mouthful for us too!). We all agree that the homestays were a highlight of our South Africa program: our families were amazingly warm and welcoming and we are truly going to miss them.

Our families involved us in their everyday activities and shared with us many of their cultural traditions. “I danced at a muchongolo, a Shangaan traditional dance….everyone stopped dancing and stared at us and laughed at the mulungu (white person), but it was still an amazing experience!” - Eliza

“My family prepared 10 chickens for a church luncheon, and I actually killed and plucked one entirely by myself. I’ve never felt so close to my food in my life.” - Casey

“I was able to make shugugu, which is traditional peanut butter, and amarula jelly, which is a fruit famous in South Africa. It was really nice to be able to bring this with us after we left our homestay families.” - Chibuzo

While we learned so much just by living in the community with families, we also gained important perspectives on the local health care system through our guest lectures and site visits. Since they were numerous, we will just mention a few of the most enlightening. We visited the local hospital, Tintswalo, where we learned about its operations before being given a tour of the maternity, mental health, and children’s wards. We had read and heard about resource scarcity in this area, but we found it was quite different to see in person the ramifications of a lack of resources. We were particularly struck by the lack of privacy. In the mental health ward, we were taken into spaces where people slept, and in the maternity ward, we passed doors that opened onto rooms with 10+ beds, where we could clearly see the patients. It elicited discomfort for many of us, but as Amaka pointed out, it is through the uncomfortable moments that we can often learn the most. Tintswalo was certainly an important learning experience here in Bushbuckridge.

One of our favorite guest lecturers was Derick Du Toit from AWARD (Association for Water and Rural Development), partly because he was a dynamic and fantastic speaker, but also because we have been experiencing firsthand the issue of water scarcity in our homestays. Most of us have been taking bucket showers and using outdoor latrines, and many of us have been helping our families haul water from communal taps in our villages every day, so it was good to learn about the reasons why our families must fetch water each day instead of having it delivered to their houses. Derick told us that while there is a complicated network of water pipes under Bushbuckridge, they are in poor condition and were often not properly installed or have degraded over time, as have the communal pumps that are now over-used by the growing population. The health ramifications of these issues are many: the degraded pipes can contaminate the water, there are opportunity costs to fetching water each day, and the ubiquitous pit latrines are dug close to water sources, so the waste can leach into the drinking water. Luckily, the SAWC has a clean water source, so we could fill our bottles there each day and supplement that with bottled water from the grocery store.

Besides water, we learned a lot about HIV/AIDS in South Africa. A few startling statistics: HIV prevalence in SA is 11%; in Limpopo province it is 20.7%, and in Mpumalanga province it is 35.5%. Hard to even imagine, yet there are funeral homes everywhere, and several of our guest speakers have mentioned that weekends in SA are often centered around funerals because they occur so often. Half of all deaths in this country are due to HIV/AIDS.

During our last week in Bushbuckridge, we engaged in case studies, which gave us the opportunity to conduct independent research projects in small groups. We investigated six topics: health-seeking behaviors, youth health education, language and meaning of HIV/AIDS, pregnancy and childbirth, water resources and effects on health, and President Jacob Zuma’s status as a (bad) role model for healthy sexual behavior. We used a variety of methods in our research, but primarily relied on interviews with our host families and other community members in our villages. The case studies culminated in a day of presentations, where we had the chance to hear about what other students learned in the course of their research.

We have definitely been busy with academics here in Bushbuckridge, but some of us also participated in optional weekend outings. We visited the Moholoholo Wildlife Rehabilitation Center, where we got to pet a cheetah, and some of us held (and got attacked by) vultures. We took a day trip through the Blyde River Canyon, the 3rd largest canyon in the world; we visited many beautiful lookout points and swam in the Blyde River that runs through the canyon. We attended a muchongolo in Hlulvkani, which features traditional music and dancing. Deeba won some beads for her fabulous dancing skills! And our amazing assistant coordinator, Thema, arranged for us to go on a game drive in Kruger National Park, where we saw lions, elephants, zebras, giraffes, hippos, and impala.

We’ve had a wonderful time in Bushbuckridge, and it was very sad to say goodbye to our host families here. We thanked them with a farewell braai (South African BBQ- one of many that we attended). But we are off to explore more of the country during our vacation week; some of us are headed to Cape Town, others to the Indian Ocean coast to visit Durban and Port St. Johns, and still others will meet up with family during vacation to go on safari and other adventures. And then it is off to Vietnam!

Vietnam Letter Home
By Heather Fukunaga, IHP Trustees Fellow, and the Vietnam Country Group

Xin chao! This phrase (“hello” in Vietnamese) was one we all managed to learn; some of us picked up quite a bit of the language while we were in Hanoi, while others of us struggled a little more! Often, we were challenged by more than just language barriers; as Eddie puts it, “The cultural dynamics in Vietnam were really different from what I am used to; however, I learned that seizing uncomfortable moments could be learning opportunities.” Amaka adds, “Our Vietnam experience was tremendously terrifying and edifying in the most bizarre ways. While family life was charming, quaint, and culinarily satisfying, the country as a whole presented logistical and social challenges on a daily basis.”

After the peaceful wilderness of Bushbuckridge, our arrival in the immense city of Hanoi was something of a shock to the system: there are over 2 million motorbikes that clog the city’s streets, creating a blanket of air pollution over our heads and a cacophony of revving motors and honking horns. It proved to be an interesting (and exciting- our daily commutes were marked by constant vigilance) backdrop for our month of living and learning in Hanoi.

It’s difficult to capture the feeling of walking through Hanoi’s streets; besides the traffic (which sometimes encroaches on the sidewalks), there are street food vendors every few feet who feed their customers noodles at child-size plastic tables and chairs, there are motorbikes parked on nearly every sidewalk, the store owners beckon tourists to come see their wares, xe om (motorbike taxi) drivers offer rides at every corner, and the smells of street and restaurant foods change with each step. We were all very susceptible to these scents- Vietnamese food was definitely a highlight of living in Hanoi for a month. We all gorged on pho (noodle soup), rice in many different forms, seafood, meats, sandwiches, spring rolls, and more. As Crystal put it, “From streetside pho to bubble tea and the bakery across the street from the HSPH, Hanoi’s food was delicious and different.” It was not always our palates that led us though; as one case study group found by surveying IHPers, convenience was the #1 factor in how we chose where to eat (followed up by the telling statistic that half of us had gastrointestinal issues during the month).

After our arrival in Hanoi, we began by spending several days in the Old Quarter before moving into our homestays. The Old Quarter is situated on the northern edge of Hoan Kiem lake, and is a huge shopping and tourist district. Previously, each street featured one type of good (i.e. silk, shoes, ceramics), so the streets are named accordingly, although now there is a more diverse selection of shops. After a few days to rest and become accustomed to urban life, we began our faculty classes and guest lectures at the Hanoi School of Public Health. “The Hanoi School of Public Health was incredibly accommodating and put us in great contact with professors and researchers from Hanoi and beyond,” says Sophie.

Each week had a theme: environmental health, reproductive health, HIV/AIDS, and then a rural visit. During the first week we learned about the effects of urbanization on health, including the “urban penalty”: despite better access to medical facilities, living conditions for the poor in urban areas result in worse health outcomes than for their rural counterparts. While all of our families were fairly well-off, we still felt the effects of the air quality, and a visit to a waste treatment plant exposed the inability of Hanoi’s government to properly treat the majority of the waste created by its citizens. Another guest lecturer informed us of the health ramifications of the spraying of Agent Orange during the Vietnam War (intended by the US government to destroy large tracts of forest to prevent the Viet Cong from hiding there). AO contains dioxin, a dangerous chemical that has been linked to a number of diseases and is a suspected cause of many more; the US sprayed 76 million liters of this and other chemicals over southern Vietnam. Since Hanoi is in the north, we witnessed fewer of the effects of AO than if we were in the south, but the lecture was still a sobering reminder of the long-lasting effects of war.

During our first week we also visited the National Hospital of Traditional Medicine. In Vietnam the public health system is pluralistic and embraces both biomedicine and traditional medicines, so citizens are able to access both at public facilities. Our tour of the hospital included a visit to the pharmacy, where we saw pharmacists mixing and boiling dried herbs into medicinal remedies, and a walk through the massage and acupuncture departments. And on the wall of the hospital’s museum was a photo of last year’s IHP group! We wound up the first week with a visit to the national Ministry of Health. Masha remarks, “One of the academic experiences I found most valuable in Hanoi was meeting with Dr. Tien of the Ministry of Health. He laid a thorough framework for our discussions of how economic reforms have influenced the public and private healthcare sectors.”

During our three-day weekend, many of us ventured outside of Hanoi to see more of Vietnam. A large contingent of us visited Ho Chi Minh City in the south (including some of us who visited family there!), while others went further north to Sapa. A few of us went to central Vietnam to Hue, the former imperial capital. Wherever we were (and some of us stayed in Hanoi to enjoy a weekend with our host families), we all had a fantastic time (and went totally crazy buying souvenirs! Family and friends, expect to see lots of new scarves when we return).

The next two weeks of academics covered the reproductive health situation in Hanoi and HIV/AIDS. We were lucky enough to have a guest lecture from representatives from the US Consulate, who enlightened us about how PEPFAR funding (US tax dollars) goes towards HIV/AIDS treatment and prevention in Vietnam. We split up into small groups to visit an obstetric hospital and a reproductive health clinic, where we learned firsthand about the services available to Hanoi’s women and young people. It was interesting to find out that women can deliver in the obstetric hospital for only US$20, but if they want their husband/partner present and a choice of doctors, then the price increases to US$200.

On our third weekend in Hanoi, our fabulous coordinators, Ngoc Anh and Nguyen, arranged for us to visit nearby Halong Bay, a UN World Heritage Site. Caitlin sums it up perfectly: “During our visit to Halong Bay, we ate seafood feasts and spent the night on a boat. Kayaking around the enormous rock formations was the most peacefully beautiful experience- I loved just listening to the lapping of the water on the side of the boat and watching the monkeys climbing on the vines.” And Sophie adds, “Halong Bay was an absolutely beautiful escape from the city. We enjoyed our first chance to spend time together as a group since South Africa, especially in such an amazing setting.” The bay is dotted with green islands, many of which are filled (or empty, depending on how you look at it) with caves. “Halong” translates to “where the dragon descends into the sea” and the Vietnamese legend about how the bay was created is that a dragon charged toward the sea from the mountains and while doing so, its tail gouged out valleys and crevasses; when it reached the sea, the displaced water filled the valleys. It is an incredibly mysterious and beautiful place.

Just before leaving Hanoi for our rural visit, we had our case studies, which ranged from food safety to gender-based violence to traditional medicine to public vs. private healthcare to rural vs. urban healthcare to Vietnam’s two-child policy to air pollution. All of the research and presentations were great, but the best quote was probably “the dirtier you eat, the longer you live,” given by one student’s host sister in response to the high prevalence of consuming street food. Another interesting, but disturbing, statistic was that Hanoi ranks is the top 20 cities in the world for most polluted air, resulting from a mix of traffic, industrial pollution, cooking fires and burning garbage.

We were all relieved for the respite from urban life afforded by our week-long rural visit to Mai Chau valley. As Crystal succinctly puts it, “The rural visit gave us a refreshing opportunity to take a break from the hustle and bustle and honking motorbikes of Hanoi, as well as a chance to enjoy nature, fresh air, and quality group bonding.” We stayed in a Thai stilt house in Lac village, about 5 hours outside of the city. We visited traditional craft-making villages and many of us hiked up to an amazing cave- located at the top of a 1250 step staircase! A highlight of the week was a volleyball competition against the villagers; despite our best efforts, they managed to eke out a victory (but barely!). The friendly competition was followed by an awards ceremony, where each team received a commemorative trophy, and a delicious dinner, complete with the local rice wine, ruou xeo, which comes in a huge ceramic jar that multiple people drink from at once with long bamboo straws. In Lac village we were surrounded by rice paddies (did you know that each little rice plant, which looks very similar to grass, produces 2200 grains of rice?), streams, and many more stilt houses, so it was an idyllic place to end our time in Vietnam.

Brazil Letter Home
By Heather Fukunaga & the Brazil Country Group

Hoi!  This Portuguese greeting (hey!) quickly became second nature to us upon arrival in São Paulo, or Sampa as the locals say.  After a wearying flight from Hanoi to Paris to São Paulo, we were all relieved to be greeted by Glenda (Brazil Coordinator) and Silvia (Brazil Facilitator) at the SP airport and get whisked away to our hotel.  Tired as we were though, we were intrigued right away by our new home city.  Most of us picked up right away on the ubiquitous graffiti art decorating nearly every empty outdoor wall, while it took us a little longer to notice that São Paulo has completely banned outdoor advertising.  It has been refreshing not to be bombarded with billboards, especially for those of us who hail from big cities filled with ads. 

After a thorough orientation and a little time to explore the city, we moved right in with our host families.  As they arrived to pick us up, we were all immediately welcomed with hugs and kisses (the usual greeting here, as we quickly came to learn and love).  Our families were so accommodating; some families even began to eat as vegetarians for the first time!  “I really enjoyed learning to cook with my host mom, especially Brigadeiro and banana cake!”  - Cate  (Brigadeiro is a dessert made from condensed milk and chocolate- richly delicious!)

We began classes almost immediately, which were held at Santa Casa, a medical school located in the centro (or downtown) of SP.  Our first day of guest lectures enlightened us on Brazil’s current political and economic situation, as well as its history, in particular how all of those relate to its health system.  “I appreciated learning about the historical and political background of SP and Brazil as soon as we arrived to SP.  That really gave me a foundation for health implications in SP.  Especially learning about the history of military dictatorship and how it still resonates in Afro-Brazilian communities such as in Cidade Tiradentes, on the outskirts of SP.” - Thuy Ann

As we learned about Brazil’s health system, we were struck immediately by the stark comparison to the United States: Brazil’s universal health system (abbreviated SUS) is based on a human rights approach to health, in which everyone is entitled to healthcare provided by the government.  SUS was written into the Constitution after Brazilians overthrew a military dictatorship to form a democracy, and we learned that the solidarity inherent in the popular resistance to the dictatorship was crucial in the public’s support for SUS.  After just having heard about the US healthcare reform bill from afar, the difference in attitudes towards healthcare systems made for very interesting discussions.  “It was so good to learn about SUS as a relatively developed national health program following South Africa and Vietnam.  To me it seemed the first system that worked.  The community health agents model within SUS was super important to learn about as it emphasizes a proactive element missing in many cases in US healthcare.  It shows a broader level of social responsibility.”   – Xander

SUS is far from perfect though, despite its lofty rhetoric; we also learned about its many challenges and failings.  “Through my experiences in Brazil, I have come to the realization that it is a human rights violation to deny someone healthcare.  This applies not only to explicit denial, but through creating barriers to care that keep some out while allowing only the privileged to enter.  Our guest lecture about SUS and our visit to public hospitals painted an idealistic picture of universal access to a comprehensive system in which socioeconomic status makes no difference in care and treatment.  It wasn’t until students in our group got sick that I realized there were barriers to care.  They went to private clinics rather than public ones, so they didn’t have to wait in line all day.  The lines themselves act as barriers because those who can afford it go to private doctors, and those who can’t pay are often also in jobs where they cannot take an entire day off work to wait in line at a hospital.  Socioeconomic status and health status are strongly correlated despite the unified system of SUS that exists in Brazil.”  – Sara

Our second day of classes was an exciting one- we visited the Butantan Institute, a premier biomedical research center that uses venoms from snakes, scorpions, and spiders to design new pharmaceuticals.  Yes, we got to see lots of snakes.  BIG snakes.  Some of us enjoyed this part more than others, but we all definitely learned a lot about biomedical research in Brazil.  In later guest lectures, we also found out that the Brazilian government manufactures many of its own pharmaceuticals to avoid the exorbitant costs charged by private companies.  We could all relate, after having paid so much for our own travel vaccines and anti-malarials, and it was especially poignant to learn how Brazil makes an effort to provide expensive anti-retrovirals (ARVs) to HIV positive people here.  While the sentiment is there, in practice there are still marginalized groups that cannot access ARVs and that often production cannot keep pace with demand.  A few of us attended a recent protest that was organized to publicize the government’s inability to provide a specific ARV that has been promised as part of SUS’s medication coverage.  We were interested to see that none of our guest lecturers who work for the government mentioned this lack when they showed us the list of ARV drugs provided under SUS.  But despite the drawbacks, Brazil’s provision of ARVs is still a model that countries like South Africa could follow. 

We finished up our first week in São Paulo with neighborhood day; like in DC, we split into small groups to each visit a local neighborhood and assess its health indicators by visiting clinics and hospitals, shadowing health agents, and visually taking stock of things like the availability of nutritious food, walkable sidewalks, and homelessness.  “I learned from the neighborhood day when I visited Cidade Tiradentes that economic empowerment involves geographic and physical access to industry.  Some places have been created to keep certain groups of people, such as poor, black, working-class people, outside of city centers while simultaneously siphoning their opportunities for economic advancement with long transit times and fewer resources around them in general.”  – Akinyi

The following weeks we began our studies of maternal and child health and HIV/AIDS in Brazil.  From several speakers and site visits, we learned about topics like the illegality of abortion in Brazil, domestic violence, and birthing practices.  “Something that really stood out to me in Brazil was the high rates of c-sections.  The structural implications (c-sections take less time and thus cost less than a natural birth) which have fostered this rate were very alarming and made me question the goals of doctors and hospitals in terms of the health of their patients.  Do doctors really care for the overall health of their patients or do they care more about profits?”  - Mija

“My site visit to the Women’s Police Station taught me  how well São Paulo is combating issues related to violence against women.  The breadth of programs and services available to women and the work they do was really inspiring and showed me that change was possible.”  – Mija

A highlight of the second week was a panel called “Experiences of Birthing in Brazil”, which featured local women who talked to us about their personal experiences with giving birth in the Brazilian health system.  It was an amazing and touching learning opportunity, especially since our coordinator, Glenda, was one of the panelists.

In learning about Brazil’s response to HIV/AIDS, we were very impressed by the government’s candid and comprehensive response to the epidemic.  “Brazil’s proactive approach to HIV/AIDS that balances prevention and treatment has reduced the spread and impact of the epidemic and serves as an exemplary model for other countries.”  – Crystal

“Learning about harm reduction programs in Brazil really changed my perspective on how to deal with people who engage in risky behaviors.  I learned that no matter what you say or do it is really difficult to change long-standing behaviors.  Harm reduction in this way avoids changing habits and judging a person based on one behavior, but at the same time can be helpful and create better health for that person.”  – Mija

After so learning so much in just a few short weeks, we set off to our rural visit in Ituverava, a small town on the border of São Paulo state and Minas Gerais.  We had a packed schedule there that included a visit to a sugar cane factory where we learned about the production of biofuel and farm labor, a lecture and site visit about safe pesticide use, and the chance to shadow community health agents as they visited migrant families in the area.  “Visiting families and learning about how health agents work in a community like Ituverava was one of the most inspiring things I have ever done.  It was amazing to see how health agents actually work, have interactions with the community, and help effect changes in their health outcomes.”  – Naika

“The migrants in Ituverava are placed in vulnerable situations with regards to their health while working on the sugar cane fields, and once the fields switch to mechanization in 2014, many will lose their jobs.  One laborer we spoke with planned on moving back home to northeastern Brazil in 2014.  The health agent said many families send remittances home to families, even on the small wages they’re earning.  The laborer moving home in 2014 will have to find work in low-scale manual labor; breaking this cycle by getting a technical skill is difficult.   – Alison

In Ituverava we were lucky enough to visit during their annual rodeo festival, featuring traditional rodeo activities during the day and all-night outdoor concerts.  We were the fortunate guests of the mayor of Ituverava, who gave us all-access passes to the rodeo, which we were more than happy to take advantage of!  “The rodeo has just opened my eyes to the dynamic and lively culture of Brazil.”  - Mija

Upon our return from Ituverava to São Paulo, we began our independent case study research.  “For the case studies, I learned about immigration, citizenship, and how it relates to health consequences.  It is important to advocate and try to integrate and engage Bolivian immigrants in the community to know about their rights to improve labor conditions in sweatshops, improve education, community cohesion, and overall better health conditions for immigrants.”  – Thuy Ann

“Through doing my case study, I was especially struck by the large role that religion plays here in Brazil.  Despite outward appearances of openness regarding sexuality, the reality is much more tempered by the pervasive influence of Catholic (and growing Evangelical and Pentecostal) churches often censoring discussions around sexuality and sexual health.”  – Julianna

Other case study groups explored the mental health of trans communities in São Paulo, the social marketing of condoms, and violence as a public health issue.  For the first time in our program, several community members who assisted with our research were invited to watch our case study presentations and give feedback.  It was wonderful to feel like we could give something back by sharing our research. 

And now we are all together one last time in Guararema, the site of our semester-end retreat.  We sadly said goodbye to our Sampa host families a few days ago, and now we are in the process of saying our goodbyes to each other and preparing for our bittersweet homecoming.  While we are excited to see our families and friends again, it will be hard leaving the 33 people with whom we have learned and experienced so much.  We will miss each other, but we have vowed to keep in touch and support each other in taking what we learned on IHP and applying it at home. 

“I’ve learned from my stay here to just continuously try.  Sometimes I would feel defeated about speaking Portuguese with my parents, but I knew that they appreciate the effort.  I also learned to keep an open mind and be always willing to talk to people, because there is so much I can learn from everyone; this inspires me to want to keep learning and gaining knowledge.”  – Winnie

“I have pushed myself out of comfort zone in many ways and have already begun to see the benefits of this.  I am used to being around people who are ideologically similar to me, yet being around IHPers and being open to discussion has forced me to question my own ideals.  In this way I have strengthened my core, and realized more concretely who I am and who I want to be.”  – Sara

“I have gained the understanding that participating in this program has given me perspectives in each of these countries that the citizens may not always have.  Thinking about how this applies to me within my context in the US makes me question why people are not aware of their surroundings.  It motivates me to try more to engage within my community and make an effort to understand the larger context in which I live.”  – Chibuzo

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Credits: 16

Duration: Spring, 16 weeks

Program Sites:
USA, Argentina, South Africa, Vietnam

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

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