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Northwestern Students Tackle Global Health Across Cultures

HIV, polio, SARS, MERS and other viruses know no borders

By Crystal Yednak

EVANSTON, Ill.  --- Earthquakes, war, famine and disease know no borders. 

Much like first responders on a scene, professionals who devote themselves to combating entrenched public health problems need to know how to navigate cultural differences and negotiate solutions in less-than-ideal situations. Without respect for the complicated histories of the countries where they will work, their ability to make an impact — to “save the world,” so to say — is diluted.

For a decade, Northwestern University’s global health minor has trained undergraduate students to succeed in this arena, producing graduates who go on to tackle international public health problems through medicine, public policy and research.

“Whether working at the U.N., as a government adviser or at an international aid organization, what are the questions we should be asking?” said Devora Grynspan, the director of International Program Development and Global Health Studies at Northwestern and also an assistant to the president for global initiatives. “We want to teach students what are the important questions you must ask — no matter where you go.”

With study abroad programs established in Chile, China, Cuba, France, Israel, South Africa and Tanzania, the global health program is one of the largest and most successful minors at Northwestern and is poised to advance the University’s strategic goals of expanding its engagement with the world and finding innovative solutions to global problems. Global health partnerships strengthen the University’s connections to countries around the world, while Northwestern graduates pursue careers in many different fields and time zones.

Northwestern’s global health minor recently was recognized with the 2013 Senator Paul Simon Spotlight Award for Campus Internationalization from NAFSA, an association of international educators. The minor is distinct from peer institutions where programs often are rooted in a well-established graduate school of public health. Northwestern is a pioneer in creating an interdisciplinary global health program that draws undergraduate students from every major, including engineering and journalism.

Through their majors, students get grounding in a particular field with discipline-specific training in research methodology. At the same time, the global health minor allows students to come together across disciplines in the classroom and the field to gain a broader understanding of what they need to know to advance their studies and make a meaningful difference in the countries they study.

“We had courses taught by faculty in law, in medicine, in anthropology, in philosophy,” Grynspan said. “We were able to create courses for our students that were totally interdisciplinary, that had a strong emphasis on culture and economic development and religion and all the issues that you have to take into account to really understand a foreign country.”

The global health program now is deepening the experience for students by enhancing high-quality research opportunities at the undergraduate level. The Office of International Program Development is piloting a new research model in which faculty members on site supervise student research abroad. In the process, they help to foster strong institutional support abroad so that the evolving relationships and students’ research projects can be built upon by future groups of Northwestern students.

It’s a model that Grynspan intends to expand upon, moving beyond funding/research approaches in which students parachute into a small village for a research project and, due to the limited scope of the experience, sometimes ignore local needs and culture. The hope is that faculty-led research endeavors will cement international connections and generate higher-quality research while doing more good in the communities where they work.

“When you think about the bioethics of doing work abroad, you have to be very careful,” Grynspan said. “You cannot impose on a local population and engage in research practices that might be culturally inappropriate or offensive or would not be allowed even back in the United States. While the benefit of the new faculty-supervised research model is significant, the cost is higher than funding individual students to go abroad. We are very thankful to have obtained funding, in the form of Bhogaraju Fellowships, for our first such program in Tanzania."

New Field Research in Public Health: Tanzania program

In late June, global health lecturer Noelle Sullivan accompanied seven students to Arusha, Tanzania, for the new Field Research in Public Health: Tanzania program. Northwestern students are learning about conducting international public health research alongside students from the University of Dar es Salaam. Last summer, Sullivan and Mary Poliwka, global health program assistant in the Office of International Program Development, laid the groundwork by spending six weeks in Arusha, where Sullivan has worked for a decade, to negotiate with community organizations, clinics and the ministry of health about the student projects that would be helpful to the community. 

Among the topics the community wants them to investigate: the success of the new garbage collection service, initiated last year to replace the long-standing practice of burning garbage. Students also will learn about maternity care and dig into the cause of the country’s high maternal mortality rate. Upon arrival, students will be prepped through a two-week crash course in Swahili. They will tour government health facilities, private hospitals and missions and will meet traditional healers to get a sense of how the health system works. Then they will dive into their research, producing a report in both English and Swahili that will be provided to various political bodies and the local communities.

By working alongside students from the University of Dar es Salaam, students will learn how important collaboration in the international arena can be. “For global health this is really critical,” Sullivan said. “It doesn’t matter what careers they go into, they’re going to be dealing with people who have a whole wide array of interests and motivations in discussing a problem. The focus is not on the ideal outcome, but rather: ‘How do you negotiate with people and get things done?'”

Students also will get exposure to bioethics. “Ethical dilemmas often happen on the ground that you just can’t anticipate, and no amount of reading the ethical codes will help you deal with it,” Sullivan said. “They’re going to learn some resilience and flexibility in dealing with things they never imagined and have someone there to help them through it.”

For the University, establishing sustainable programs internationally helps create longer term connections, which communities and health centers often seek, Sullivan said. It also provides a foundation Northwestern can build upon with other entities and organizations abroad.

A matter of national security

In 2000, the University pointed to conflict and outbreaks of disease around the globe in its federal grant proposal to develop an undergraduate global health program. “It was a matter of national security for universities to be training people and to be studying global health, because disease has no boundaries,” Grynspan said. The U.S. was spending billions of dollars on HIV/AIDS, but if public health workers were arriving in Africa ready to treat patients in the same manner they were treating patients in San Francisco, the results would be disastrous, she added.

A $500,000 grant from the National Security Education Program within the Department of Defense helped Northwestern create new undergraduate courses, then to build accompanying study abroad programs. By 2004, the Office of International Program Development had developed enough of a core of classes, combined with study abroad programs, to be designated a minor. In 2009, the program received a grant from the National Institutes of Health (NIH) to further institutionalize global health studies across campus. Today, 270 students are enrolled as global health minors, and 69 graduated in June.

Keeping the program as a minor -- and not expanding it to a major -- was intentional. Students from across subject areas — from anthropology, biology, psychology and economics to language, music and engineering— enroll in the global health minor program. “We find the blend of different majors leads to interesting discussion in the classroom, as issues are not perceived solely through the lens of medicine,” said William Leonard, chair of anthropology in the Weinberg College of Arts and Sciences (WCAS) and academic director of the global health minor.

Since the early days, the Office of International Program Development has collaborated with Northwestern’s Feinberg School of Medicine to help develop more structured and supervised international opportunities for medical students. The University’s global health programming also is represented through the Center for Global Health at Feinberg and the Center for Innovation in Global Health Technologies at the McCormick School of Engineering and Applied Science, to name a few.

Since the University launched its strategic plan in 2011, the global health minor and programs like it have been exemplary student engagement initiatives that also are directly in line with several of the plan’s pillars. The programs underscore the University’s mission to “discover creative solutions” by working together through research and innovation to find answers to problems “that will improve lives, communities and the world.” They also evoke Northwestern’s priority to “engage with the world” through strategic partnerships in order “to heighten our global impact for the greater good.”

Minor requires public health experience abroad

Though the global health program at Northwestern is a minor, it requires a public health experience abroad, which often transforms the path of the students involved. “Nowadays, a graduate from Northwestern who has not been abroad is less competitive,” Grynspan said.

In Cape Town, South Africa, McCormick engineering students take on biomedical design projects, crafting devices or systems that can help medical personnel in resource-poor areas of South Africa serve their patients better. Through the Public Health in Cuba program, students observe socialized medicine in action and learn about tropical diseases. Students joining the new Public Health in Israel program take a course in disaster medicine while also investigating minority and immigrant health issues.

Claudia Leung (Public Health in China program)

For her study abroad experience, Claudia Leung, who graduated from the School of Communication in 2011 with a WCAS global health minor, selected the Public Health in China program. Lectures were complemented with tours of a traditional Chinese medicine apothecary and visits to a geriatric center that blended cutting-edge Western methods with Eastern therapies, giving Leung a firsthand look at how culture affects the delivery of medicine.

“Rather than having it segregated, where you have to pick one way or the other, this represented a novel approach to medicine,” Leung said. After her study abroad, Leung returned to China, to do health education work with an international medical services organization in a rural village in Southwest China.

Now a student at the Feinberg School of Medicine, she is interested in how health care is delivered to patients struggling with chronic disease in rural areas. In the region where Leung worked in rural China, doctors don’t “see people until they’re very sick, because there are no systems set up for long-term disease care,” Leung said.

When she arrived at Feinberg, Leung connected with Claudia Hawkins, M.D., assistant professor in the Division of Infectious Diseases and the Center for Global Health, who helped her design a study program to delve into how HIV care is managed in Tanzania. Because the system for delivering HIV care is one of the only structured systems for chronic disease care that exists in rural areas, Leung wanted to determine if the model might be successfully replicated with patients who have other chronic diseases.

Leung spent six weeks in Dar es Salaam visiting HIV clinics and talking with health care personnel. Her work with Hawkins was honored by the Infectious Diseases Society of America. Leung plans to return next year to continue her research and expects global health to continue to figure into her medical career.

Riley Smith (Public Health in South Africa program)

Riley Smith’s course also was altered by her experiences in the global health program. A premed student when she arrived, Smith (WCAS, 2014) spent 10 weeks on the Public Health and Development in South Africa program her junior year. Before she left, her global health professor Noelle Sullivan suggested Smith stay on in Cape Town after the study abroad program to pursue research. Smith worked with Sullivan on designing a proposal and won a Mabie Fellowship to study health care access for lesbians and bisexuals in Cape Town. Completing the structured study abroad program first gave her the background knowledge she needed on the South African health system, which proved crucial for carrying out her research. Smith presented her work at the American Public Health Association in November, an experience that underscored the importance of having the global health minor at the undergraduate level. “A lot of feedback I got was from people confused as to how I even got the opportunity to do that as an undergrad,” Smith said.

But a skim through the Northwestern Will: Strategic Plan 2011 shows that the University could not be more clear about the importance of global health studies at Northwestern.

“When members of our community actively engage beyond our campus borders, we change the lives not only of the individuals we touch but our own as well. As a University, we create even greater positive impact by pursuing a strategy of partnerships with other corporations, health and medical organizations, cultural and educational institutions, and government entities domestically and abroad.”
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