January 2016: Celebrating three years of PHWB

It is hard to believe that a Public Health without Borders (PHWB) group from the School of Public Health at University of Maryland took its first trip to Compone, Peru three years ago. I was on that travel team, collaborating with UMDs Engineers without Borders.  And I started this blog to capture the stories.  We’ve grown. PHWB continues to travel with EWB, and has two independent projects. We now have a vibrant Student Government Association (SGA) approved group which meets each and every Monday night, dividing into project teams – Peru, Ethiopia, Sierra Leone and Bangladesh. We continue to plan projects that meet the needs of communities, as defined by communities. We have successfully raised nearly $20,000 for supplies and travel. We conduct needs assessment interviews and focus groups, we apply for and receive Institutional Review Board (IRB) approval for all research that involves human subjects. We train students to focus on cultural competency, reciprocity and relationship building.

Undergraduate PHWB students lead "MyPlate" workshop

On that travel team three years ago, I learned from Engineering student, Kevin Hogan, that hardworking undergraduate students can step up to be leaders when given the opportunity. Three years later, I made my first trip to Ethiopia with 3 undergraduate and 2 graduate students from PHWB. The PHWB-Ethiopia January 2016 team worked together to develop an Ethiopian “MyPlate” educational workshop to pilot in elementary schools, a teacher evaluation of the workshop, and survey on food safety and nutrition. Doctoral students presented seminars on urban agriculture and food safety at  Debre Berhan University. 

What I love about mentoring students in Public Health without Borders is that they are energetic and committed, and are learning to be flexible, culturally sensitive, critical thinkers. I am teaching a new course this spring titled, “Global Health Projects: Addressing Health Needs with a Focus on Reciprocity and Relationships.” The course emerged out of a hope that students who want to help others in need will listen and learn from the experts – in most cases, the people who they plan to serve.

I am confident that members of this Ethiopia travel team will continue to seek collaboration. They will follow a path fraught with challenges and frustrations, where luggage gets lost for days, but life stories are more interesting. They will continue to seek opportunities with potential for improving health outcomes where they are lifelong learners who listen to the needs of the communities they serve.

On the long journey back from Ethiopia, I reflected on the value of relationships.  We were greeted by DBU president, deans and directors. We were embraced by Sodere in Health Sciences, Tsige in Agriculture, Getachew, Public Health lecturer in nutrition, Hymanot and Afework – angels of the school gardens, and Hiwot Menbere, retired horticulturalist from UMD with nonprofit Good to Grow dedicated to sustainable agriculture and nutrition education -- to name just a few. And mostly, I think about the impact of students who commit to PHWB – our future public health leaders making a difference now.

The importance of engaging community experts in public health

Prior to coming to the University of Maryland, my career and education was steeped in community work. When I learned I was going to Ethiopia to work with our colleagues in Debre Berhan, I was intent on continuing this pattern. After all, I could do all the literature searches in the world and still not have the expert knowledge of this community that would be needed to effectively carry out our work. I did my research but also prepared to interface with our colleagues and the community to see what they felt was important and hear what they had to say.  

Engaging the community and learning what they think is important and what they perceive as challenges is critical to effectively developing interventions. Since we were interested in branching out into food safety work from our work with gardening and nutrition, we needed to ask the community what actions they took to ensure the safety of their produce, what actions they took to prevent microbial contamination in the garden, and in what areas of food safety and gardening did they want education and training. The results from these surveys will be critical to developing education and outreach that is in line with what the community wants and needs.

I also had a great opportunity to speak to our DBU colleagues at a seminar. I spoke on food borne illness, and I shared information regarding the epidemiology, risk factors, and risk management techniques for foodborne illness here in the US. I also presented the results of my own literature review of food borne illness in Ethiopia.  Sharing the challenges we face in our own nation was a key aspect of my presentation, and this resonated with the audience. One faculty member noted that his community didn’t think that the US had a problem with foodborne illness, and hearing about our own difficulties made it easier for them to share their own challenges. A productive discussion of the challenges Ethiopia faces regarding food borne illness resulted.

I think one of the best examples of why this kind of community engagement is critical is a culturally important food in Ethiopia – Kitfo. Kitfo, and other foods like it, are dishes where meat is served raw. If our group had simply come in handing out meat thermometers and saying that everyone must cook their meat to a certain temperature, we might have missed the opportunity to ask key questions about food preparation practices, cultural relevance of ingredients and typical dishes, and to learn about how best to open a dialogue with the community and work together to improve health. I look forward to continuing to work with our Ethiopian colleagues!

Avoiding Volunteer Tourism

As a student who is passionate about global public health, I face a lot of ambivalence. On the one hand, I am commended for my dedication to helping others. On the other hand, however, I am ridiculed for the lack of impact my efforts have. During my trip to Ethiopia, I received the following comment on the picture below: “Take plenty of pictures with underprivileged children,” as if my only motive for joining Public Health Without Borders was for the photo opp. This is a widespread societal mindset as “volunteer tourism” is gaining speed. People travel to developing countries to satisfy their own needs, rather than actually helping the communities they touch. This is a huge problem – it not only undermines the credibility of public health professionals, but it does nothing to help those in need.

Admittedly, I have fallen victim to volunteer tourism in the past. I visited a Burmese refugee clinic in Thailand for three days. Did my time there change the situation at all? No. What actually came of that experience? I was selfishly exposed to extreme poverty and distress. My life was enriched at the expense of refugees. I did absolutely nothing to better their situation, and this is a source of embarrassment for me. After joining Public Health Without Borders at UMD though, I realized that interventions should be ongoing, and collaborations need to be strengthened in order for real progress to be made.

I loved that PHWB has been working with the communities in Debre Berhan for three years now. I love that we have people to contact continually, and projects to expand upon. Although each member of PHWB may not travel to the community each year, the club aims to prevent volunteer tourism that could potentially cause harm. This trip was so much more satisfying than my trip to Thailand because I know that continual strides are being made to actually benefit the community. Obviously, a lot more work needs to be done but we have a good platform to build on.

Pictured above: an elementary school garden that PHWB has been helping to develop. Fortified seeds were brought, and proper cultivating techniques were taught. This is now a "demo" garden for future elementary school gardening programs that PHWB is helping to foster. 

Importance of Sustainable Commitments

Importance of Sustainable Commitments Although I have travelled to a few countries over the past years, both for public health work and vacation, Ethiopia is the only destination I have returned to for a second time. The return to East Africa meant a number of things for me as a student and travel lover. For one, I had a sense of familiarity with the environment of Ethiopia. As soon as we landed in Addis I immediately recognized the distinct faces, colors and smells of the city. I felt a strange sense of comfort that doesn’t normally come when exploring a place for the first time.

During the two-hour journey from Addis to Debre Berhan, our project site, I was able to enjoy the beauty of the landscape, rather than focus on taking pictures of the donkeys and acacia trees. More than anything, the “otherness” of Ethiopia was gone for me; it felt present and real. As a student, the second trip meant the expectations were higher and more specific. The sense of “observe and report” was replaced with an obligation to produce. The trip focused on our implementation of workshops, seminars and project goals and the majority of our nights were spent brainstorming around a table. The first trip afforded us the luxury of being newcomers, however visit number two required us to focus our activities, and synthesize our previous trips into a meaningful visit. I could definitely feel myself having to push.

Most international trips seemed fun and lackadaisical to me; more about the cultural experience and personal development. As a student, this trip was a 180 for my professionally and academically. For example, I had to present my research interests to a group of international teachers and students. We were tasked with creating presentations within just two days time, and I felt like the experience really highlighted actually how much I had learned in my field. By pushing outside of my comfort zone, I was able to grow as an academic. My second time visit Ethiopia turned out to be the most productive international health experience Ive had thus far. The trip combined real-time experience with project management, and I had to act on my feet more than once to produce meaningful results for our stakeholders. The sense of familiarity and responsibility that I felt during this trip really helped my gain insight into my future career as a public health practitioner working in global settings.

Moving Forward in Debre Berhan - Research and Outreach Collaborations

Written by Dominic Hosack

There are a number of positive outcomes of our planning trip to Ethiopia.  We got some great pictures for Instagram, witnessed a beautiful procession celebrating Ethiopian Timkat (Epiphany), and ate delicious spicy tibs and shiro entirely with our hands.  

However, for a first year doctoral student, one of the most important parts of the trip for me was the opportunity to conduct community-based research. The various meetings and discussions we had during our trip with a variety of Debre Berhan University affiliates and community members led us collectively decide on conducting an intervention addressing child nutrition and food security using vegetable gardens at two primary schools in the community.

One school that we visited has an expansive garden run by students in an after school program. Students who work in the garden take produce home to their families, and many also use their knowledge to grow additional vegetables at home. Another school has a smaller garden and is excited to expand. Both schools welcome teacher training, parent engagement, and integrated nutrition education using the garden. 

The project, which will include curriculum and survey development, community engagement, and school capacity building, presents a broad range of opportunities for data collection, evaluation, and dissemination of new knowledge and best practices. Debre Berhan University stressed their desire to conduct research and publish with foreign university collaborators and expand their outreach to the community, and this unique opportunity fosters collaboration for such a purpose.  

As a doctoral student and graduate student mentor for PHWB, I plan to actively engage in the writing process and data management for the Ethiopia project. It is my hope that PHWB can begin a long commitment to collecting and disseminating evidence-based research to support each project being conducted.

Rapid Development in Ethiopia's Amhara District

Written by Jenni Young

One of the first things I noticed upon my arrival in Ethiopia was scaffolding. Scaffolding made of thin eucalyptus trunks wrapped precariously around enormous empty concrete structures. The blocks around our hotel in Bole were littered with half-constructed high rises and sidewalks covered with sand, dirt, and rocks. These signs of skyward movement were just one indicator of how quickly Ethiopia is developing…one of many that I observed. 

The city of Addis Ababa is building its’ first light rail which is to run north to south and east to west, connecting the city’s sprawling population. One hot highland day we decided to take a trip to a beautiful lakeside resort and hired a van and driver to take us there as well as a few other touristy sites. On the way out of the capitol, we hit a crowd of standstill traffic. Hundreds of busses packed with people, double loaded semi-trucks, and family-sized economy cars alike were stuck in the dusty heat for over two hours. We later learned that this traffic jam was unusually long but was partially the result of detour around a giant highway construction project that was being undertaken by the Ethiopian government. The massive and empty four-lane highway was a stark contrast from the crowded dirt road that served as the temporary on-ramp. 

Other surprising sights included brand new tolls booths erected next to wooden huts on the side of the road, and a city comprised of almost completely finished apartment buildings that was completely, and eerily, uninhabited. Even the university campus that we visited in Debre Berhan was showed signs of rapid development. Debre Berhan University covers a sprawling area of hillside with brightly colored school buildings and cobblestone pathways. The university itself is only seven years old, but the number of students enrolled has soared to 18,000 individuals. I was pleased to see the spacious campus because its continued construction and bustling student life represented an optimistic outlook on the growth of the university and the emphasis on building a reputation as one of the best colleges in Ethiopia. 

Despite the modernity and rapid development that I witnessed in Ethiopia, there is a beautiful juxtaposition of old and new in all of the construction. The campus buildings still seemed to be made of a mixture of straw and cement, the cobblestones were hand cut by local students and workers, the construction of 10-story buildings still relied on eucalyptus tree truck scaffolding wrapped with twine and hand-mixed concrete. Rarely would I see a construction crane or cement mixing truck. The lesson I learned through these observations is that Ethiopia is definitely pushing forward structurally, economically, and societally, but it still retains many traditions and elements of its beautiful culture through the use of local products and ancient practices.

Community-Based Team Projects in Debre Berhan

Written by Jesse H. Wilson III

In Ethiopia, abundant development and cultural traditions and roots are mixing. Debre Berhan is an exceptional example, a rapidly growing city nestled among the mountains and  farmland that characterize its recent past. Since the founding of Debre Berhan University (DBU) just seven years ago, the once-small farm town is growing faster than ever. 

The growth in the city is perfectly reflected just through the gates of DBU, in its speedy construction and devotion to the quality of its education amidst rapid increases in student enrollment. The students and staff are as resilient and eager as any to learn and grow while working towards the development of their city and nation. What drives these individuals is the goal to one day contribute all they can to their families, communities, and Ethiopia as a whole. Many seek to become medical doctors to prevent disease and bring efficient and accessible healthcare to all Ethiopians. Others seek to strengthen the economy, infrastructure, or government. But all exhibit a national pride that rivals any other. 

The DBU administration and faculty we met place a high value on research and community service, making it a general requirement for all public health students and a core responsibility of faculty and staff. In brainstorming ways that UMD PHWB students and DBU students could work together, one specific DBU program expresses the most compatibility for collaboration. The Community Based Team Project (CBTP) in the College of Medicine and Health Sciences is a practicum course for 3rd year public health students that trains them to apply their knowledge of community health issues such as nutrition, disease prevention, and sanitation. The program incorporates research techniques, data collection, analysis of community strengths and needs, intervention development and implementation, and evaluation. This comprehensive program is everything that the PHWB team could wish for. 

When PHWB returns in the late spring, the students at DBU and UMD will work in tandem in the community of Debre Berhan to prevent malnutrition. Both the PHWB team and DBU are extremely excited to be working together on this project. But I believe that the team is most excited to contribute to the development of this flourishing community.