One survey at a time: An Internship Update

Unjali shares her childhood happy accident:

When I was younger, my dream was to become a doctor. I always knew that I wanted to help people improve their lives, and I was interested in healtcare, therefore I figured a career in medicine would be the best option for me. I made becoming a doctor my goal and I worked really hard to make it happen. Everything was going according to plan until one fateful day in the 2nd grade. A freak accident during a routine art project caused me to staple a piece of construction paper to my left index finger. My teacher promptly sent me to the nurse’s office and it was on the walk up that I discovered I would never become a doctor. At the first sight of blood oozing from my wound, I began to feel nauseated. I fainted right on the spot. So there I was, a scrawny seven year old, passed out on the grass in front of the nurse’s office, with a shattered life’s dream and a piece of freaking construction paper stapled to my finger.

Fast forward approximately twenty years later. My desire to help people improve their lives through the betterment of their health still remains. Only now, the approach is much different. Instead of through treatment, the improvements come through prevention. To find answers to the questions that need to be asked, however, is a daunting and tedious task. As students of public health, we inveribly read study after study about this or that. Sometimes we might scoff at a sample size that we deem too small, or wonder why the researchers didn’t take a closer look at something. It is not until we, ourselves, actually try and complete these studies that we realize just how much work actually goes into them.

A study that I am currently working on calls for data to be collected on 200 patients via written survey. Easy enough….or so I thought. At any given day in the clinic, the doctors may see 40 patients. Half of them, however, usually are not eligible to participate. Out of the remaining 20, half have already completed the survey at a prior visit. That leaves maybe 10 eligible patients, some of whom don’t want to participate, and some of whom I miss because I am busy interviewing someone else. Most days in the clinic, I spend 8 hours on my feet, running back and forth, trying to talk to people, only to come away with maybe 5 interviews. And that’s if I’m lucky. As harrowing as it is sometimes, I always leave the clinic feeling really happy. In my mind, each and every survey is like gold. While one survey alone may not be that big of a deal, each one is a part of something that is much bigger than myself. Each one is a contribution. Each one is a piece of the puzzle that will eventually serve to unlock the answers to questions that may help people improve their heath and wellbeing. And the best part is, I can do it all without seeing a single drop of blood. That is of course, provided I don’t staple the surveys to my finger.

[Don’t forget to send in your update to get posted on the blog! E-mail your story to Ji!]


Acumen Fund Student Leaders Workshop

Earlier this summer, 17 students from across the US and around the world came together in New York City to talk about one thing: social entrepreneurship. I was privileged to participate in the Acumen Fund‘s inaugural Student Leaders Workshop and the experience was insightful, exciting, and humbling all at once.

While the workshop focused on poverty alleviation and development through “patient capitalism,” many of the lessons I took away from the program have significant implications for all things public health. (It seems, after all, the more public health courses I take, the more I recognize the importance of well-structured, well-managed, sustainable interventions that truly address the needs of the people served.) The solution? More focus on market mechanisms.

While market mechanisms may not work for everything (read: health care in the US), there is definitely something to say for the empowerment of the underserved by supporting a long-lasting business economy, not providing charity and aid alone. Organizations like Kiva, Ashoka, Skoll Foundation, Echoing Green, and Acumen Fund are recognizing the potential for growth, and “social returns” in a new and emerging market populus: the poor. By targeting the “base of the [economic] pyramid,” companies can find new opportunities for profit while including underserved populations in to the global economy. And not just as consumers, but producers too. It’s worth looking up if you haven’t done so before. Check out #socent on Twitter if you really want to see what’s going on.

Our student group was also fortunate enough to hear the enthusiastic words of businessman, marketing guru, best-selling author, and activist Seth Godin. He offered a lot if interesting wisdom and a challenge to young students to fight against the status quo and truly make a difference in the world. One of his pearls worth listening to: “Don’t go to medical school.”

The group of passionate, out-spoken, intelligent students (of whom I came across clearly by mistake) came to the workshop each offering their unique skills, vision, and ideals. Each left with enthusiasm to continue the work of creating positive social change and each left with a determination to continue the push for a social movement to end global poverty.

Currently, the group is working on developing a new product that will help spread awareness for the ideas of social entrepreneurship in bringing about change in poverty alleviation, health, and sustainable energy. Additionally, a viral film is in production to bring people together from all over the world to see what changes can be made through social enterprise (Find out more here or get involved here)

Let’s get to work.

SoCal Stories – An internship update

Unji Gujral shares an update from Southern California…

Greetings everyone from sunny Southern California!  Not to brag, but the weather here is absolutely amazing!!!  I hope everyone is enjoying their summers and having a wonderful time at their respective internships.  I have been working at the Chao Comprehensive Cancer Center at the UCI Med Center for about a month now.  The Med Center is located in the heart of Orange County, California (or as many people know it, “The OC”).  I am just a stone’s throw away from Disneyland and Angel Stadium, although I have yet to visit either place since being back home.   My job here consists of interviewing patients in the clinic, completing retrospective chart reviews, attending lectures and symposiums, and working with our dear friend, SAS.  To be honest, the retrospective chart review aspect sucks.  While looking through these charts, I am forced to sit in a frigid room, by myself, for hours on end, with nothing but boxes of illegible medical records to keep me company.  While the chart review is rather miserable, my favorite part of the experience by far is interviewing the patients in the clinic.  All of the women I speak with have had some sort of gynecological cancer, ie cervical, ovarian, uterine, etc.  The majority have had complete hysterectomies, and have gone through multiple rounds of chemotherapy and radiation as a part of their treatment.  What amazes me about these women is their strength.  Despite their circumstances, they are happy.  They approach what is dealt to them with amazing attitudes and brilliant outlooks on life.  Perhaps my favorite patient thus far is a woman named Monica.  I had the pleasure of meeting her when she came to the clinic for a follow up after her last round of chemotherapy.  Monica can best be described as a vibrant Hispanic woman in her 40’s who exudes an aura of warmth and kindness.  The second she walked into the clinic she gave hugs and kisses to all of the nurses and smiles to all of her fellow patients.    Like most patients, she was more than happy to sit and chat with me.  She told me that she loved coming to the clinic because she got to see her “boyfriend” (the attending physician that she admittedly has a crush on).  When I asked her how she was feeling after her treatment she replied with a smile and said “I feel great!  I am not going to let this disease get me down.  Oh, and girl, I know I still look good, with hair or without!”  After our interview, she left me with a warm hug and a kiss on the cheek.  I only spent 20 minutes with her, but I know I am going to remember Monica for a very long time.

I am not sure what I was hoping to get out of this internship.  Going into it, I think I was looking for some research experience, data for my thesis, and perhaps a publication.  While I hope that I do attain those things, the lessons I am learning from the women I talk to are the things I will value the most.  I am learning that the human spirit has a remarkable capacity to overcome.  I am learning that strength comes in many shapes and forms.  I am learning that if you want to find out what people need in order to improve their health and quality of life, all you have to do is be sincere in your caring, and ask them.  I am learning that laughter and a good attitude really is the best medicine, preventative or otherwise.  Most of all, I am learning about what I value in terms of a career in public health.  I love putting faces to, and interacting with, the people whose lives we aim to improve through our work.  While the chart reviews and the SAS may not always be so favorable, its all worth it when the Monicas of the world live to thrive and smile another day.

 [Don’t forget to send in your update to get posted on the blog!]

Rolling on…

Dear friends,

It’s been a while since I last reported and I have been mostly waiting for something eventful to have happened. I have been to a few museums already, celebrated a few holidays with the locals, and proceeded with my research plan. The people at the NGO have been extremely helpful assisting me with certain logistical issues. The NGO does a lot of work with commercial sex workers and I will soon be going in their van to observe some outreach work. On Thursday I finally got IRB approval here and so I am good to go with my research. Tomorrow I will be going to a narcology clinic (basically a clinic where they treat drug abuse) to deliver my survey and informed consent forms as well as compensation for participating in the study. It’s kinda crazy how all of this stuff that was once all jumbled in my head a few months ago is now coming to reality. I suppose that is one of the greatest aspects of doing research. In the mean time, I thought I would share this video of a few Russian kids and one conspicuously larger, older, and bare-chested Russian kid dancing the night away (btw – the video was taken at 9:00 pm. Since St. Petersburg is so far north, the sun sets very late in the summer for a period known as “beliy nochi”, or “white nights”). I am curious to hear how everyone else’s summer is going so please post something.
Thanks and hope all is well wherever you may be!

Innovative uses of condoms, as reported by UNFPA country officers

Note: the stories here won’t be found in official UN country reports, as they are transcribed from a night out drinking with my colleagues, but I assure you they are true…

It is UNFPA/UN Cares/UNAIDS policy to have condoms available at all office bathrooms. A friend at the office who used to work in Paupa New Guinea noticed that every time a new supply was put out, it would be gone. So she finally asked the women working in the office, “where are all the condoms going??”. She looked over to see her colleague with an opened wrapper, using the condom’s lubricant on her arm – as a moisturizer. 🙂

Similar stories began to unfold this evening, out to dinner with friends. Here’s a brief summary:

UN Papua New Guinea: women use lubricant from the condoms as moisturizer

UN Jordan: women open up condoms to store their earrings and other jewelry in transit

Thailand: male students use the lubricant covered condoms to shine their shoes for their school uniform

Vietnam: youth catwalk fashion shows w/ outfits made of condoms & pills (see photo)

Thailand National AIDS Seminar, 27-29 May 2009

Hello friends!

To continue in Javi’s footsteps, here’s an update from my summer in Bangkok, Thailand. I arrived at BKK late Friday evening and spent Saturday and Sunday exploring my neighborhood and even managed to navigate the mall to get my cell phone service set up.

Monday was my first day at the UN – I finally got to meet my preceptor, whom I’ve been corresponding with via e-mail for the past 6 months, and other friendly colleagues. I sit at a cubicle in an office with members of the UNFPA Thailand country office and the East Asia/Southeast Asia regional office. I’d say one of the most notable bits to share from here is that the food is DELICIOUS and SO inexpensive! The UN building has 2 cafeterias with international cuisine and traditional Thai dishes, and then there’s a café with sandwiches, salads, etc. I’d say I pay an average of $1-2 for my meals (good sized portions, too!)- with a drink, dessert, and after-meal coffee, I’ll probably pay max $4 in all. 🙂

Now onto the more important stuff…! Today, I was fortunate to attend the Thailand National AIDS Seminar, held at a huge convention center in Bangkok.

Photos: archway at the convention center. ‘Walking condoms’

This is the 12th annual seminar, originally started in conjunction with the US CDC, the International Epidemiological Association (IEA), and other leaders in HIV/AIDS in the Asia Pacific region, but has now grown into a large scale 3-day event, expanding beyond members of the HIV community to the general population (elementary school to college-aged students, clinicians, people living with HIV, political leaders, celebrities…. everyone, really!).

photo: Prime Minister of Thailand

The seminar is organized into plenary sessions of leaders discussing key issues in HIV (female condoms, ‘staying negative’, etc.) and a large exhibition room with over 100 booths from community based organizations and NGOs, providing blood tests, screenings, and information on counseling, medication, and prevention. Posters from recent investigations and journal publications were on display. There was also entertainment provided by local dance troupes and musicians.

The opening ceremonies featured remarks from the ministry of health, a woman living with HIV, and the prime minister of Thailand. I got a quick translation after the audience erupted in laughter when the woman living with HIV looked to the prime minister and asked “Sir, can you please be a good role model to our country and have one partner?”. Later in the opening session, the PM did respond directly to her question and said that it would be no problem to stay with only his wife.
The UNFPA had a booth next to UNAIDS, UNICEF, the World Bank, and other UN agencies. The UNFPA Youth Advisory Panel was on board to distribute information, host a quiz game with prizes, and get people to sign up for the online HIV/AIDS Solution Exchange program. There were booths sponsored by pharmaceutical companies, sex worker and MSM advocacy groups, and youth organizations. One of my favorite sites was of a traditional Thai farming basket carrying exotic fruits and… condoms! They gave them out to everyone. 🙂

Oh, another quick note… I almost forgot about my ‘encounter’ w/ swinefluness during my voyage over the pacific. It looks as though several airlines and airports have taken (in my opinion) more extreme cautions concerning H1N1. I took ANA from DC to Tokyo then Tokyo to Bangkok. All flight attendants working for ANA are required to wear facemasks at all times on board. I also noticed several passengers sporting the masks. Every passenger on the flights arriving in Japan and in Thailand is required to fill out a medical form, stating the purpose of travel, prior stays before travel to destination, and a series of yes/no questions on H1N1 symptoms. A few hours before we landed in Tokyo, an announcement was made that ‘a passenger on board has reported potential symptoms and the flight will be inspected upon arrival. Thank you for your patience with the delay…”. When our flight landed, health officials and quarantine inspectors came on board to look at the passenger ‘with symptoms’ on board, and also to test everyone who sat within 5 rows in either direction. Lucky for me, I was sitting just a few rows before the inspection zone and was able to deplane with just a 15-minute delay.

Whoops, didn’t mean to write this much! Hope everyone has had a great start to the summer!


Greetings from St. Petersburg!

From Javier with love…

It’s hard to imagine that just last week I was studying for my last final, packing my things, and tearing it up on the dance floor at Black Bear with fellow YSPHers; A lot can happen in one week. I arrived at Pulkovo International Airport in St. Petersburg on the 10th of May (by the way, anyone planning on transferring thru Heathrow this summer, expect horrendous lines making connecting flights); After grabbing all my bags, I exited customs and “officially” entered St. Petersburg.

I looked around for my contact person, Vitali, a middle-aged physician that my oldest brother met fortuitously in Moscow. As Vitali would later say “I drank beer for 20 hours with your brother on the train from Moscow to St. Petersburg”. The train was only supposed to take a few hours but due to a bombing on the rails, the train had to take a tortuous detour. I am guessing that they became good friends on that train. In any event, after looking around the horde of people and sticking out pretty bad, a comely bespectacled man pointed his finger at me – “Javier!” he exclaims. I highly doubted that there could possibly be two Javiers; Vitali drove me around the city for a bit, showed me some of the historical sites, and then took me to my new “home”. I live about a 5 minute walk from the NGO that I am working for on the southeastern part of the city about a 15 min metro ride to the city center. The vast majority of the buildings constructed during this period are from the Stalinist era and are hardly worth describing. Some of you have already asked “how’s your apartment?” Well it’s quite cozy and as Vitali assured me “there are totally no cockroaches”; The neighborhood is quiet and sometimes I wonder if anyone lives in this building; Recently, both pigeons and stray cats have greeted me as I am locking the door to my flat; Further, there seem to be stray dogs EVERYWHERE; Knowing my luck, it will only be a matter of time before sitting in a doctor’s office waiting for the dreaded rabies shots; This past week I was lucky enough to meet a few Yale researchers as well as a professor from the George Washington School of Public Health; They were in town giving lectures on psychological metrics and models at the St. Petersburg State University; I on the other hand have been sitting in the office of the NGO translating my survey into Russian; This has been a somewhat arduous task since my knowledge of Russian grammar is still shaky, however several of my colleagues have offered to help; Yesterday I received the official email from the HIC that my protocol had been approved; This is terrific and now I just have to get Russian IRB approval (kak uzhas!); Everyone at the NGO is really friendly and helpful; Some speak excellent English, but I am quickly weaning myself off English and shifting to Russian only; One fellow who works there, Dmitri, always cracks me up; No matter what he is doing, if he spots me he always comes over to shake my hand and greet me very courteously; Other people are a little more reticent in talking to me and I have almost developed a sixth sense when people are talking about me.

Today was the first day that I had an opportunity to walk around the city and take some photos; St. Petersburg is quite an amazing city; For more than 200 years it was the official residence of the czar and the capital of Russia; The city houses some of Russia’s most important cultural sites; Moreover, the sun sets really late here; This peaks during the summer solstice (or “White Nights” as they are known here) when the sun doesn’t set at all; I am definitely looking forward to stumbling around the city during these few days; I have attached a few of my favorite pictures that I took today, but I have yet to explore the “other world” that exists in St. Petersburg; Before the professor from GWU left, she told me that during her first visit to St. Petersburg, she witnessed IDU (injecting drug user) outreach work; She said that watching these outreach workers interact with the IDUs was analogous to a composer writing a symphony; “They just seemed to flow in and out of the crowds talking to people that we don’t even notice; Another world is out there that we have no clue exists. It was really incredible watching them.” She told me; I hope that I too will get a chance to step into this “other world” before the end of the summer.