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Welcome to the McGill Global Health Blog!

blog logo 4This blog will feature posts covering many different global health topics, written by a variety of McGill students, faculty, and guest writers.

Today marks the official launch date, with our first post coming from a PhD student from the McGill Division of Social and Transcultural Psychiatry. For the first week of the launch, a new piece will be posted each day. The blog will then continue to make one post every Friday. These posts will give a snapshot of what is happening in the broad field of global health, within and outside of the McGill community. The blog is linked with an Instagram account – photos will be posted along with links to the associated blog posts each Friday.

We encourage submissions from the wider McGill community. If you have a post you wish to share, please refer to our Submit Page for instructions.

Subscribe to the blog and follow us on Instagram to keep up-to-date with the latest posts.

Happy reading!

New Numbers On Tuberculosis Burden Must Galvanize India To Act

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Dr. Madhukar Pai

Last week, WHO released its 2016 Global TB Report. The news, unfortunately, is not good. The report shows that the TB burden is actually higher than previously estimated, mainly because of new data from India. In 2015, there were an estimated 10.4 million new TB cases worldwide. Six countries accounted for 60 per cent of the total burden, with India accounting for 27 per cent of the global cases, followed by Indonesia, China, Nigeria, Pakistan and South Africa.

An estimated 1.8 million people died from TB in 2015, of whom 0.4 million were co-infected with HIV. Gaps in testing for TB and reporting new cases remain major challenges, as they have in the past. Of the 10.4 million new cases, WHO estimated that only 6.1 million were detected and officially notified in 2015, leaving a huge gap of 4.3 million cases that are “missing” — either not diagnosed, or managed in large unregulated private sectors and not notified to TB programs.

Global TB elimination is an impossible goal without significant progress in this emerging superpower.

India continues to bear the brunt of the TB epidemic, with 2.8 of the 10.4 million new TB cases that occurred in 2015. TB is also a major killer of Indian people. The latest Global Burden of Disease estimates from Institute of Health Metrics and Evaluation, published earlier this month, show TB to be the sixth leading cause of deaths in India. In 2005, TB was the sixth leading cause of deaths in India, and ten years later, in 2015, it holds its place as a leading killer of people in India.

These new estimates from WHO and GBD are disappointing and underscores the need for greater investments in global TB control. In particular, India really needs to wake up to the enormity of the epidemic in the country, and put some serious money behind its under-funded TB program. Global TB elimination is an impossible goal without significant progress in this emerging superpower.

It is worth comparing China’s TB situation with that of India. China had 0.9 million TB cases in 2015, while India had over 2.8 million. The number of drug-resistant TB cases in China was 57,000, while India was estimated to have over 79,000. TB is no longer a major killer of people in China, and does not make the top 10 most important causes of death.

It is remarkable that China more than halved its TB prevalence over the last 20 years. Marked improvement in quality of TB treatment, driven by a major shift in treatment from hospitals to the China CDC public health centres (that implemented the DOTS strategy) was likely responsible for this effect, which has been demonstrated by repeated national TB prevalence surveys.

So, why does India struggle with a much higher TB burden? There are many reasons. For one, India has many social determinants that fuel the TB epidemic — poverty, malnutrition, smoking, and indoor air pollution. Secondly, India has under-funded TB control for a very long time. And much of the focus was only on the public TB program. It is only recently that the national TB program has seriously started to address the problem of TB in India’s large, dominant, private sector.

With new research, our understanding of the true burden of TB in India is improving. We are now aware that private sector manages over half of all TB in India, new research suggests that enormous quantities of TB drugs are sold in the Indian private market.

For a long time, India ignored TB patients managed in the private sector, and national prevalence and drug-resistance surveys were not periodically done (unlike China and other high TB burden countries). Furthermore, the Indian national TB program was (and still is) heavily reliant on insensitive diagnostic tools such as sputum microscopy. India is “fighting the TB war with 19th century cannons.” All of this meant that India has been under-diagnosing and under-reporting the burden of TB for a long time.

With new research, our understanding of the true burden of TB in India is improving. We are now aware that private sector manages over half of all TB in India, new research suggests that enormous quantities of TB drugs are sold in the Indian private market.

In addition, although India made TB notification mandatory in 2012, it has taken a few years for private sector notifications to accumulate. Now, thanks to several public-private partnership programs, significant increases are being noticed in case notifications from private sector.

Overall, the path forward for India is very clear — acknowledge the reality of a massive TB epidemic, collect better data on true burden of TB, deaths, and drug-resistance, and allocate greater funding to tackle this huge problem. This will not happen without high-level political commitment.

Last week, on the same day of the WHO TB report release, The Lancet published a comment by the Indian Health Minister Mr Jagat Prakash Nadda and Dr Poonam Khetrapal Singh, head of India’s WHO Regional Office for South East Asia.

Overall, the path forward for India is very clear — acknowledge the reality of a massive TB epidemic, collect better data on true burden of TB, deaths, and drug-resistance, and allocate greater funding to tackle this huge problem.

In their Comment, they acknowledged that TB is a bigger problem than imagined in India and other Asian countries, and suggested that TB should be made a top priority on national agendas. They also argue that political commitment should be translated into a comprehensive national TB control plan, and such a plan must be fully funded and implemented promptly by an empowered body that reports to the highest levels of government.

These statements by the Indian Health Minister is very impressive and progressive, as is the commitment from Dr Soumya Swaminathan, India’s Secretary of the Department of Health Research about India’s plans conduct prevalence surveys, develop innovative new tools for TB, address social determinants such as malnutrition, and create an India TB Research Consortium.

Hopefully, these leaders will deliver on the vision that they have articulated, and make TB a national priority in India. In fact, India has already started the process for creating the National Strategic Plan for TB Control in India (2017-2023). This plan must be ambitious, and fully funded by the Indian government. Otherwise, future TB reports will continue to bring bad news.

Madhukar Pai is the Director of McGill Global Health Programs, and the Associate Director of McGill International Tuberculosis Centre. (@paimadhu)


This article was originally published in The Huffington Post. See the original article here.

Photo Essay: Working at the Myungsung Christian Medical Center in Ethiopia

Angela Lee

My project was a practicum and a research project at Myungsung Christian Medical Center (MCM). MCM is a private, non-profit hospital, where I was under the supervision of a pediatric surgeon. I took part in both the clinics and the surgeries within the hospital, and I also participated in community outreach programs by MCM, such as the free of charge mobile clinics in rural communities. The research project was a retrospective study to calculate the backlog of defined pediatric surgeries at MCM, in order illustrate the gross lack of surgical accessibility in low and middle income countries in Africa.

Picture 1: Myungsung Christian Medical Center which is located in Addis Ababa, the capital of Ethiopia. The hospital consists of 2 wings: Shalom Wing and Grace Wing. The Shalom Wing is the original hospital complex. The Grace Wing was build in 2011, in order to accommodate more patients.

Picture 1: Myungsung Christian Medical Center which is located in Addis Ababa, the capital of Ethiopia. The hospital consists of 2 wings: Shalom Wing and Grace Wing. The Shalom Wing is the original hospital complex. The Grace Wing was build in 2011, in order to accommodate more patients.

Picture 2: The operating rooms at Myungsung Christian Medical Center and surgical team. Far left – Pediatric surgeon. Middle – 4th year medical student as first asssist. Right middle – Scrub nurse. Far right – Anesthesiologist. There are currently no medical residents affiliated with Myungsung Medical College as the medical program is only 4 years old. Therefore, it is not unusual to have the 4th year medical student as the first assist in non-complicated surgeries.

Picture 2: The operating rooms at Myungsung Christian Medical Center and surgical team. Far left – Pediatric surgeon. Middle – 4th year medical student as first asssist. Right middle – Scrub nurse. Far right – Anesthesiologist. There are currently no medical residents affiliated with Myungsung Medical College as the medical program is only 4 years old. Therefore, it is not unusual to have the 4th year medical student as the first assist in non-complicated surgeries.

Picture 3: Mobile clinic in Hawassa: Day 1. Patient triage and blood pressure readings. Volunteers with the help of interpreters take down the chief complaint and basic patient information. I was the designated team member to take blood pressure measurements on Day 1.

Picture 3: Mobile clinic in Hawassa: Day 1. Patient triage and blood pressure readings. Volunteers with the help of interpreters take down the chief complaint and basic patient information. I was the designated team member to take blood pressure measurements on Day 1.

Picture 4: Mobile clinic in Hawassa: Day 2. Dressing change of an infected ulcer under the supervision of Dr. Shin (center).

Picture 4: Mobile clinic in Hawassa: Day 2. Dressing change of an infected ulcer under the supervision of Dr. Shin (center).

Picture 5: Mobile clinic in Hawassa: Day 3 Ethiopian medical students teaching the children about hand washing and dental hygiene. More than 125 children participated in the teachings and activities.

Picture 5: Mobile clinic in Hawassa: Day 3 Ethiopian medical students teaching the children about hand washing and dental hygiene. More than 125 children participated in the teachings and activities.

Picture 6: Interventional angiography inauguration ceremony. Opening address by Reverend Kim (far left). I served as Korean to English translator (second from the left).

Picture 6: Interventional angiography inauguration ceremony. Opening address by Reverend Kim (far left). I served as Korean to English translator (second from the left).

 

Angela Lee was awarded the Medical Class of ’84 Student Bursary in Spring 2016. She is currently a 3rd year medical student who believes everyone has the right of access to quality health care. Angela chose to travel abroad because she wanted a better understanding of the social and medical struggles that both the people and the medical staff face in low resource settings.

Post-Travel Perspectives: Working for the Kigezi Health Foundation in Kabale, Uganda

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Neil Verma

I traveled to Uganda and joined the Kigezi Health Foundation primarily to expand my knowledge of global health disparities, community empowerment and rural medicine. Adequate nutrition remains a challenge for several families in the Kabale area with several diseases having clear associations with malnutrition. My work involved studying the impact of rabbit breeding in low-income families as a means to provide adequate nutrition and additional income. The ultimate goal remains to expand knowledge and resources to address public health issues and maximize population health.

My father and grandmother were born and raised in Kabale and these personal ties to Uganda have specifically drawn me to this community. My family’s experiences have provided me perspective on the impact of disease within this community while fostering my desire to provide medical service to the local population.

My experience with the KIHEFO reinforced my desire to engage in rural medicine and global health, addressing healthcare issues through improving the social determinants of health and community empowerment.

I had limited proficiency in Ruchiga–the local language–and a greater proficiency with the local language would undoubtedly help address the cultural and linguistic barriers and build rapport with patients. Local medical professionals are already faced with a demanding clinical workload, and learning the language and cultural practices partially alleviates the ethical responsibility of having the clinical staff host foreign medical trainees. Cultural attitudes towards medicine also have an impact on healthcare delivery in Uganda, particularly given that 80% of the population exclusively seek out traditional healers as their primary care providers. The KIHEFO has attempted to partner with traditional healers in order to encourage Ugandans to seek out modern medical services. The differences in particular disease treatment protocols and regimen add to the ethical conflict between my own perspective on healthcare and the approach in Kabale. To cope with these realities, I have relied on a network of former global health students and local professionals to better understand Ugandan healthcare along with their unique approach to addressing disease and suffering in a resource-limited setting.

My work with the KIHEFO will contribute to an academic relationship with McGill University and provide a mutually beneficial opportunity to expand knowledge and resources to address public health issues such as malnutrition and HIV prevention. Furthermore, an ongoing partnership between both parties will allow for expansion of available medical resources, services and additional opportunities for knowledge exchange and learning. The benefits of partnering with North American universities are already visible in the KIHEFO’s maternal clinic, which enjoys the use of a donated portable ultrasound machine. As services continue to grow, medical trainees and residents rotating through Kabale will provide additional training to local staff and counselling to community members in order to improve quality of care and maximize population health.

As a practicing physician, I will be able to use the knowledge gained working with the KIHEFO to advocate for policy changes locally and globally that also focus on the social determinants of health including food security and housing that will reduce health inequities. Learning the practice of rural medicine in Uganda allowed me to develop my awareness of the organization of healthcare in a resource-limited setting. It will give me the skills to strive to become a physician who remains conscious of the challenges of healthcare delivery and to provide the most efficient patient care.

As I have embraced the significance of public health to communities, I am optimistic that I will continue to engage in global rural medicine initiatives and devote myself to career and life as an advocate for global health.

My work with the KIHEFO presents challenges and learning opportunities that will improve my understanding of the disparities in global health, the value of community empowerment in healthcare and the challenges of rural medicine in a developing nation. These skills will serve as a foundation for my desire to pursue a career focusing on global health service and the development of global health policy.

Neil Verma was the recipient of the Ashworth Student Travel Award. Neil is a third-year medical student primarily interested in understanding the social, cultural and economic aspects of health and disease to improve global health.

Understanding the Past and Future of Infectious Diseases: A Book Review of Laurie Garrett’s The Coming Plague

Claire Styffe

Laurie Garrett’s The Coming Plague: Newly Emerging Diseases in a World Out of Balance is a worthy read for anyone interested in either an account of infectious diseases or future global health threats alike.   While the text is very in depth, it cannot be called narrow; with reports on a range of infectious diseases from Bolivian Haemorrhagic Fever to Hantavirus to Lassa fever, the author succeeds in providing a rich and comprehensive guide on multiple major illnesses.  Drawing tales from a number of different countries including Brazil, Zaire, India and the United States, Garrett creates an account that examines infectious diseases from a truly global point of view.

The Coming Plague presents pathogens and viruses in an interesting and detailed manner, but the true strength of the book lies in its ability to showcase the human side of global health.

“The Coming Plague” by Laurie Garrett

Chapters are devoted not only to the mechanisms of the disease, but more prominently to the outstanding efforts of the “infectious disease cowboys” [1], the researchers and the nurses who interacted first hand with the illnesses.  Reports are written in an almost story-like manner, with physicians and patients presented like characters and dramatic cliffhangers at the end of chapters.  At times, it is easy to forget that this text is not fiction, but rather a detailed work of research that took ten years to compile [2].  While the sheer size of The Coming Plague may first appear daunting, it reads easily and is often interjected with humour, making for a book that is not only highly informative, but also one that is extremely enjoyable.

 

While The Coming Plague was published in 1994, much of the information and insights provided still hold true over twenty years later.  Garrett’s warnings about unsterilized needles, antibiotic resistance and unpurified drinking water are not echoes we can resign to the past, but rather public health challenges we face today.  In fact, what was once considered controversial when first published is now viewed as conventional [3].

 The Coming Plague is a text that masterfully intertwines both infectious diseases and human endeavour, providing a rich framework for understanding not only our past efforts combatting communicable diseases, but also those we must take in our future.

 

Claire Styffe is a U2 student currently pursuing a degree in Cell and Molecular Biology as well as Urban Systems Geography. She is fascinated by global health and has a particular interest in preventing and minimizing the spread of infectious diseases.  

References

[1] Laurie Garrett, The Coming Plague: Newly Emerging Diseases in a World Out of Balance (New York: Farrar, Straus and Giroux, 1994), 29

[2] “The Coming Plague”, Laurie Garrett, http://lauriegarrett.com/the-coming-plague/

[3] Ibid.

Canada is Leading the Fight to End AIDS, TB and Malaria for Good

 

Introduction by Patrick Bidulka 

McGill University was fortunate to participate in the Global Fund Replenishment conference held in Montreal this September. The Global Fund side event at McGill, organized by the McGill Global Health Programs office, saw a high turn-out of world-class global health researchers and students. With its contribution of nearly $800 million, Canada has repositioned itself as a key contributor to the field of global health, and a stakeholder in the mission of the Global Fund to end HIV/AIDS, TB, and Malaria for good. However, as the Honorable Jane Philpott said as she addressed the event, these goals will not translate into tangible results until society collectively deems current health disparities as “outrageous, and solvable”. It is outrageous that a third of the world is infected with TB, with the majority of those infected being in developing countries. It is outrageous that here in Canada, we have a TB epidemic concentrated in our Aboriginal communities, where the rate of TB in Indigenous populations is 34 times higher than in non-Indigenous Canadians. It is outrageous that here in Canada, there are 50 new infections of HIV every week, and this rate has not changed in the last two decades. And so, it is these glaring inequalities that must be recognized, and deemed outrageous by more than just researchers and health care workers, but collectively by the global population. Progress has been paralyzed by barriers such as stigma, racism, gender inequality, and prejudice against LGBTQ people. It is not until these basic issues surrounding human rights are resolved that we can truly put an end to AIDS, TB and Malaria. As Mark Dybul, CEO of The Global Fund said at the McGill side event, “To end these diseases, we must become better humans”.

Panelists at the McGill event (from left to right): the Honourable Jane Philpott, Mark Dybul, Lucica Ditiu, Peter Singer, Mark Wainberg, Philippe Gros, and Marcel Behr.

Panelists at the McGill event (from left to right): the Honourable Jane Philpott, Mark Dybul, Lucica Ditiu, Peter Singer, Mark Wainberg, Philippe Gros, and Marcel Behr.

_____________________________________________________________________________________

Dr. Madhukar Pai & Dr. David Eidelman

As Montreal gears up to host the biggest leaders in global health, it is our hope that Canada will go well beyond provision of international aid, and find a way to harness the abundant scientific talent in Canada. Doing so will not only amplify the financial contributions by Canadians, but also show our global solidarity.

The past year has seen the re-emergence of Canada in the international development arena. In addition to maternal and child health, if there is one area where Canada is showing tremendous leadership, it is in the fight against the “big three” — AIDS, tuberculosis, and malaria — infections that kill over 3 million people each year.

To tackle the big three, The Global Fund to Fight AIDS, TB and Malaria was created in 2002. The Global Fund raises resources, engages a variety of partners, and invests funds in supporting programs to tackle the epidemics. Programs supported by theGlobal Fund have saved 20 million lives, by providing 9.2 million people with antiretroviral therapy for HIV, 15.1 million people with testing and treatment for TB, and 659 million mosquito bed nets to prevent malaria.

Canada is blessed with some of the best academic researchers and innovators working in global health.

If the Global Fund is to continue making progress towards ending these epidemics for good, it needs to be replenished by donor governments, private foundations, corporations, and philanthropists — and Canada is showing the world how to get this done!

On September 16-17, 2016, the Government of Canada will host the Fifth Replenishment Conference in Montreal that will bring world leaders to set funding for the next three years. The Global Fund has set a target of raising US$13 billion. Canada has already pledged CAN$785 million, a 20 increase compared to the last round. The USA has pledged up to US$4.3 billion, France has pledged €1.08 billion, and Germany has pledged €800 million. These pledges, hopefully, will inspire others to contribute and meet the target of US $13 billion which can save an additional 8 million lives.

In addition to supporting the Global Fund, the Government of Canada has made a renewed investment of CAN$85 million for the Stop TB Partnership’s TB REACH initiative, to reach, treat and cure many of the 3.6 million people affected by TB who every year go without proper care. The Government of Canada has also invested inGrand Challenges Canada, an agency that is funding several innovative projects in TB, HIV and Malaria.

We can be proud of all these developments that show commitment and leadership from the Canadian Government. However, in addition to providing development assistance, Canada has much more to offer. Canada is blessed with some of the best academic researchers and innovators working in global health. For example, an experimental Ebola vaccine developed by Canadian scientists has already attracted international attention.

In the area of HIV, TB and Malaria, Canadian researchers are making valuable contributions. Canada has led the way in identification of anti-retroviral drug targets, development and promotion of the Treatment as Prevention strategy, development and evaluation of new diagnostics, treatment of HIV and hepatitis co-infections, and leadership roles in prestigious societies to influence policy and advocacy.

Epidemics such as SARS, Ebola and Zika have shown us that infectious diseases respect no boundaries.

Canada has a rich history of research in tuberculosis, a disease that still affects our Aboriginal communities. Canadian researchers have identified the genetic basis of susceptibility to TB, used innovative DNA fingerprinting methods to track the epidemic, evaluated novel tests for TB, conducted clinical trials to develop shorter drug therapies, and contributed to international policies. Canadian researchers have identified promising malaria drug targets, documented malaria strain variations, and developed a global molecular surveillance system for drug-resistant malaria.

McGill University and its affiliated hospitals are home to several teams that focus on HIV, TB and parasitic diseases. With over 100 scientists working on infectious diseases, McGill has much to offer in global health, from fundamental science to policy, and, in particular, training of the next generation of researchers. McGill Global Health Programs coordinates the University’s global health work, and is making strategic investments and partnerships to make sure McGill’s faculty and students are actively engaged as global citizens, in solving the biggest global health challenges.

Epidemics such as SARS, Ebola and Zika have shown us that infectious diseases respect no boundaries. We are excited that Canada is showing impressive leadership in global health, and particularly thrilled that the Global Fund Replenishment Conference is being held in Montreal. We hope the Global Fund replenishment targets will be met, and Canadian researchers will be actively engaged to translate the dollars into saved lives.

Madhukar Pai is the Director of McGill Global Health Programs, and the Associate Director of McGill International Tuberculosis Centre. (@paimadhu)

David Eidelman is the Vice Principal of Health Affairs at McGill University, and Dean of the Faculty of Medicine. (@VPDeanEidelman)

This article was originally published in The Huffington Post. See the original article here.

Notes from the AIDS2016 Conference in Durban, South Africa

Kara Leigh Redden

In July, I had the amazing opportunity to not only participate in the AIDS2016 International AIDS Conference in Durban, South Africa, but to also present my research on the prevention of mother-to-child transmission of HIV with my Haitian co-investigator.

Kara and her co-investigator presenting their work at the AIDS2016 conference in Durban, South Africa.

Kara and her co-investigator presenting their work at the AIDS2016 conference in Durban, South Africa.

It was our first time in South Africa and our first time at such an internationally organized event focused on HIV/AIDS. The weeklong conference was jam packed with activities, events, speaker series, presentations and much more—so much more that it was impossible to fit everything in the five days we were there.

Among the many leaders speaking, we heard from Charlize Theron on the importance of recognizing HIV/AIDS as a human rights issue.

Actress Charlize Theron speaking on human rights issues surrounding HIV/AIDS.

Actress Charlize Theron speaking on human rights issues surrounding HIV/AIDS.

We also heard from Elton John and Prince Harry remarking on the importance of recognizing youth’s voices and vulnerability in efforts to end the burden of HIV/AIDS.

Sir Elton John speaking at the AIDS2016 conference.

Sir Elton John speaking on youth vulnerability at the AIDS2016 conference.

Most impressive was the participation of some of the most vulnerable groups affected by HIV—healthcare workers, trans-men and -women, sex workers, homeless populations, and members of aboriginal communities as well as the lesbian and gay community. While we still have a long way to go to ensure that the voices of these groups are represented, it was refreshing to be among those who are the most affected by HIV and the barriers that affect access to HIV care and services.  Because of this, we were graced by many leading HIV/AIDS activists who have spent their life standing up to big corporations and governments to make sure that those who need care the most can get access to that care.

Any trip to South Africa would not have been complete without paying homage to the great Nelson Mandela. We visited Mandela’s capture site where a monument was erected in his honour, constructed out of the very bars that held him captive for over 27 years.  I hope that he would have been proud of the great work being done in his country.

The monument marking Nelson Mandela's capture site in the South African province of KwaZulu-Natal.

The monument commemorating Nelson Mandela’s capture site in the South African province of KwaZulu-Natal.

Kara graduated in May 2016 with a Masters of Nursing and a concentration in Global Health Studies. During her studies, she travelled to Haiti to conduct research on the prevention of mother-to-child transmission in collaboration with their partner site, Zanmi Lasante. Kara has been involved in various Global Health activities since 2012 and hopes to continue to contribute to this field as a nurse.

MEDLIFE McGill presents MICC 2016: Access to Water Conference

Access to clean water is an issue that afflicts hundreds of millions of people around the world and is one of the barriers that prevent communities from escaping the constraints of poverty. In an effort to bring awareness to this problem, MEDLIFE McGill chose Access to Water as the theme in this year’s MEDLIFE Interchapter Conference Competition (MICC).

MICC, which was started by MEDLIFE McGill in 2015, is a weekend-long annual case competition where delegates from MEDLIFE chapters across North America are invited to learn how to make real change in impoverished communities.

This past March, MEDLIFE McGill hosted MICC 2016: Access to Water in Montreal. Participants had the opportunity to learn about the challenges related to access to water through talks given by experts in the field and a number of interactive workshops.

Medlife photo 1

Participants listening to talks given by experts in the field of access to water.

Participants were then given a chance to incorporate what they learned through a case competition based on Kilimanswaki, a real community in the Moshi District of Kilimanjaro, Tanzania. In Kilimanswaki, there is one well that serves as the water source and some families must travel up to 2 hours to reach it. MEDLIFE is actively working with Kilimanswaki community leaders to provide medical, educational and developmental support.

Medlife photo 2

Kilimanswaki, Tanzania

Participants were tasked with the development of a four to six year plan to address the lack of access to water in the community, as well as a development plan for the future that would improve the quality of water. There were numerous considerations to keep in mind, such as budget, community statistics, and major ongoing health crises.

Medlife photo 3

The winners of MICC2016 were McGill’s own Timothy Cheng, Andrew Kim, Jessie Ouyang and Amber Zhao!

Over the weekend-long event, students had the chance to learn from experts, apply their own problem solving skills and collaborate with others to address the real-world problem of the lack of access to water. More information on MICC 2016 and other events hosted by MEDLIFE McGill can be found on the MEDLIFE McGill website.

Follow MEDLIFE McGill on Twitter, Instagram, and Facebook!

“Tīng bù dǒng”: Reflections on conducting international field work with language barriers

Sierra Clark

While conducting my Master’s thesis field work in rural China this Summer, the most common string of Chinese-Mandarin words that were either said to me, said about me, or I said myself, were “Tīng dǒng”, which roughly translates to “I hear you but I don’t understand you”. That phrase most concisely characterizes the communication challenges I faced, while also reflecting mine and others willingness to communicate across a difficult language and cultural barrier. My blog is a reflection on the challenges, but also unique opportunities that arise, when conducting research based international field work in the context of a language barrier.

Photo 1

Sierra standing in front of one of her favourite views in the region. The study site is 1000-13000 meters above sea level on the edge of the Tibetan Plateau.

To provide some context: I arrived in China in May 2016, equipped with a lonely planet guide book to Chinese, a translation dictionary on my phone, and an undergraduate research assistant who was fluent in both languages (she was with me for 1 month out of 3). I had also prepared this year by playing Chinese language games, keeping a journal in Pinyin (way of writing Chinese using the Roman alphabet) and I listened to Chinese podcasts (with little success). Needless to say, I felt pretty good about myself and ready to take on Zhōngguó [China]. My confidence in my abilities was soon shattered after I arrived. I had been teaching myself the wrong pronunciation for almost every letter (or combination of letters), and I was utterly failing at enunciating the tones correctly. When I reached my small village in Sichuan Province, an additional barrier arose as I now had to translate from English, to common Chinese-Mandarin, to the local dialect spoken in Sichuan. I had the help of my research assistant for one month (she literally saved my life), and I lived with a Chinese colleague who was functional in English, but soon enough I was on my own with the challenge, but also the amazing opportunity, to tackle this communication conundrum and hopefully learn something from it.

I am now a master of the game Charades

Standard communication when there is a language barrier is difficult to overcome, and trying to communicate research terms, research equipment, and research protocol is even more intricate in this context. When communicating with the field staff in Chinese, I was at a loss for how to ask for things like: “where is the flow-rate calibration Rotameter” or “does the grease on the impaction surface have any air bubbles in it?” (the grease catches the larger Particulate Matter (PM) particles so that we can collect PM in aerodynamic diameter <2.5 μm on our filters for analysis). Additionally, I implemented a questionnaire that asked questions about participants use of the intervention cook stove (1) and their likes, dislikes, and preference for it over other stoves in the household. It took me and the team a week of piloting, and five iterations, to finally get a questionnaire that could be translated into the local dialect and the questions were locally and contextually relevant. However, even months after the piloting phase, I am still finding that some questions and responses are interpreted differently then I intended them. For example, a stoves “a. cleanliness” was meant that the surface was clean (i.e., devoid of grime) but many participants interpreted that to mean the stove emitted less smoke. Troubleshooting these issues in the field with the team required patience and persistence, and an ability to find creative ways to communicate the solution to each other (did I mention phone translation dictionaries are amazing).

I also ran into troubles when I was the one collecting the data directly with the participants. Often I took on the task of taking blood pressure measurements. Our standard protocol was that participants had to sit quietly in a restful state for five minutes before the measurement began. Sometimes when I tried to communicate this, I ran into more trouble when when I said to the participants xiūxí wǔ fēnzhōng [rest five minutes] or bù shuōhuà [no talking] as they would get more excited because a wàiguó rén [foreigner] was talking to them in Chinese! I found using my body to indicate what I wanted was very effective. I could direct someone to stand on the weigh scale, sit down and put their right arm on a pillow, rest for 5 minutes, and tell them that their blood pressure was low [bù gāo]/ a little high [yidiǎn gāo]/ high [gāo], all by becoming a master at the game Charades.

Both lǎoshī [teacher] and xuéshēng[student]

Photo 2

The field staff are preparing the equipment for the day. They are cleaning the Personal Exposure Monitors (PEMs) and placing filters inside them. When the PEMs are attached to an active pump and worn around the waist in a waist pack, they collect data on how much air pollution (PM2.5) someone was exposed to over 48hrs.

I took the ease and convenience of casual conversation in a familiar environment for granted before I came to China. I now know that when you are the one speaking the foreign language, the time that people give you is precious. My perspective changed after I asked my neighbors to repeat their sentence for the 4th time, when they patiently listened while I tried to stumble my way through a terribly pronounced sentence (which likely made me sound like a child), and every word was enunciated wrong so when I was really asking for the toilet they probably heard me say “why is the dog wearing my t-shirt”? The village became my classroom and the villagers were my teachers.

I also came to appreciate the way that I was learning Chinese in Sichuan. If I was working with a tutor in Canada, or speaking to someone who had excellent Chinese and English, there would be no mutual benefit (except for the monetary transaction for their services). Recently, two of the field staff I work with have really taken to learning Yīngwen [English]. When I first arrived, they could say a total of three phrases: “hello”, “goodbye”, and “it’s lunch time!”. Two months later, if I talk slowly, enunciate purposefully, refrain from using jargon, and play a little game of Charades, I can get almost any point across. When we hop into our van and head out to do our work for the day, we each come equipped with our “how to learn Chinese/ English” books. If I ask a question in Chinese, they will try to respond in English. If I want to know the Chinese name for something, they then need to know what it is in English. I love this mode of learning. Neither of us are experts in both languages, we are Lǎoshī in one and Xuéshēng in the other. Its fun, its playful, and its mutually beneficial. The other day one of the staff told me (written on her phone translator) that she was “gradually learning to love the English language”, and I could have jumped for joy I was fēicháng gāo xíng [E: very happy].

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Sierra and the field team head out for the day to collect air pollution and health data in the Tibetan Plateau. Car rides are a prime time to practise Chinese and English for the team.

 

Acknowledgements: Much thanks to the wonderful field staff who continue to teach me new words every day, the villagers whom have included me into their lives, and my research assistant who helped me survive my first month. Funding for my research this Summer was provided by McGill Global Health’s “Norman Bethune Award’, The National Geographic Societies “Young Explorers Award Program” and Mitac Canada’s “Globalink Research Award Program”. Funding for the larger project was provided by the US Environmental Protection Agency (EPA) STAR program. The opinions in this blog are entirely my own and do not reflect those of the granting agencies.

 

Sierra is a second year Master’s student in Epidemiology and an Institute for Health and Social Policy graduate intern at McGill University. She is currently in rural China collecting data for her thesis on the air pollution and health impacts of a clean cook stove intervention which is aimed at reducing household sources of pollution. Sierra received her BA (Hon) in Geography from McGill, focussing her research on climate change and infectious disease in rural Uganda. Sierra is currently a National Geographic Young Explorer and a Mitacs Globalink International research award holder, and she is an active member of the Baumgartner Research Group at McGill. 

 


(1) Among a study population of 204 homes in 6 rural villages in Sichuan Province, we installed intervention semi-gasifier biomass burning cook stoves that take processed biomass pellets (processed at a nearby factory) as fuel into 117 homes (the other homes act as controls). The intervention stove emitted less PM2.5 during lab tests. We are now testing how the intervention preforms in real life conditions in the field: i.e., whether people use the intervention stove, whether people are exposed to less, the same, or more air pollution, and if their cardiovascular health is improved.

The Global Engagement Summit: Inspiration and Innovation in a Community of Global Leaders

Vivienne Walz

From April 3-10, I attended the Global Engagement Summit at Northwestern University in Evanston, Illinois. The annual Summit connects and empowers young leaders from across the US and around the world to inspire and nurture social innovation. In a mix of workshops, seminars and speakers, the Summit deeply inspired me, allowed me to build my networks, connected me with mentors and gave me opportunities to build specific skills important for working in global health.

The GES is not an academic conference. Rather, young innovators bring projects to share, workshop and improve with the help of GES staff, guests and peers. The project I have been working on is called Skátne Ionkwatehiahróntie’ (“Our families grow together”).

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Vivienne (centre) with fellow attendees at the Global Engagement Summit.

The Summit was an opportunity to find solutions to project-related challenges, especially through our small group sessions. In groups of 4-5 Delegates and 2 Facilitators, we each presented our projects, answered others’ questions, and received feedback on project strengths and weaknesses. On another level, the GES was also an opportunity for personal and professional development. In particular, I developed my public health skill-set by learning about social impact assessment and practicing my public speaking and grant-writing skills.

For the first few days of the Summit, the International Delegates toured Chicago in a pre-conference session called Engage. We toured the underground Pedway, visited the Shedd Aquarium, appreciated the modern art collection at the Art Institute of Chicago, and learned about past activists at the Hull House. I took this opportunity to get acquainted with my fellow Delegates before the rush of the conference started and to reflect on my intentions for the GES.

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Vivienne gets the chance to tour Chicago, snapping this shot at the famous “Cloud Gate” sculpture at Millennium Park.

After three days of Engage, we kicked off the Summit by getting to know each other through theatre exercises. This set the stage for the rest of the Summit: we all came from different places, with different experiences, and at different points in our projects. I soon realized that despite all these differences, what we all had in common was our willingness to make a positive change in our communities.

For the next three days, I attended many workshops, seminars and talks. In our session on Asset-Based Community Development (ABCD) with Seva Gandhi, we learned how to look for solutions by focusing on community strengths rather than deficits. In my reflections on this workshop, humility and respect were central values in this approach. It’s easy to perceive a problem when we are looking from our particular perspective – especially when we are trained to assess the social determinants of health. When we take the time and make the effort to question our own position and put the preferences and needs of those we wish to serve first, we can arrive at more sustainable and ethical collaborations. Asset-Based Community Development is one tool we can use to engage with communities. More tools like ABCD can be found at the University of Kansas’ Community Tool Box.

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Vivienne (second from left) with her small group at the Global Engagement Summit.

I also took away valuable lessons for global health work in a seminar on Social Impact Assessment, led by Joanna Cohen. Here we learned about how to build measurement mechanisms into the design of our innovations in three steps: by understanding our issue, by determining our approach to solving the issue, and by identifying our intended results through a results framework. Here my biggest take-aways were not to impose my own beliefs on other people, to redefine my own concepts of success, and to always hold respect at the centre of my work.

A highlight of the GES was my mentorship session with Erica Colangelo. The Summit staff match each Delegate to a Mentor with relevant experiences and passions. Erica connected me to excellent resources, and helped me develop ideas to generate sustainable funding for my project. Another memorable part of the Summit was the Pitch Competition. The GES staff selected three outstanding project pitches to compete for a $500 prize before a panel of judges and Delegates.

There are so many more moments from the GES that I could write about. If you would like to read more about this year’s facilitators and speakers, you can check out the GES blog.

I am grateful to have been able to attend the GES, with the generous support of Global Health Programs and the Office of the Dean of Students. I connected with incredible young change-makers who share my values, I got thoughtful feedback on my project, and I deepened my understanding of global issues affecting health. To top off an amazing week, I also returned to McGill having won the $700 Open Shutter award for Skátne Ionkwatehiahróntie’s engagement of media and arts. I encourage anyone with an idea or with an existing social change project to apply!

 

Vivienne Walz is a Masters in Public Health student at McGill University.

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