Dr. Debaldo, Dr. Indira Chakravarty, Dr. Petersen

Published by Amanda Gilmer
Copyright © 2009 University of South Florida. All rights reserved.

During Spring Break of March 2009, 22 undergraduate and graduate students went to the Dominican Republic to participate in several public health projects. Twelve of those students helped to carry out the first phase of our project. The 12 students spent the week administering water assessment surveys in three isolated mountainous villages that have limited access to potable water. Traveling house to house in each of the villages, the four groups, each consisting of three people, asked the heads of the households questions in Spanish about their water source, water treatment methods, water storage methods, and gastrointestinal health.  The purpose behind the survey was to determine whether a need and a desire exist among the village population to receive household water filtration units. After analyzing the results of the surveys, it was concluded that there is a community wide desire to implement a water filtration program in all three villages in which the survey was administered.  Furthermore, it was found that 99.2% of the households interviewed demonstrated knowledge about the importance of potable water. This reveals that the community’s desire for the implementation of a water filtration program stems from their belief that clean water is valuable. We intend to return to the three mountainous communities during the summer to install the filtration units in the homes of the individuals that expressed a desire for one.

Equally significant as the results of the study was the perspective the 12 students gained from the opportunity to collect data through in-person interviews in villages that lack resources that most of us take for granted and from living with families in the small town of Piedra Blanca. Being foreigners in a developing country that none of us had previously visited, it was surprising that we were readily welcomed into the houses of those we surveyed. The hospitality of the villagers was overwhelming and something very few of us have experienced in our everyday lives.  Each family was willing to share with us information not only concerning their health and water usage, but also about their everyday lives, struggles, hardships, accomplishments, desires, dreams and everything in between. Each individual was upfront and honest, sincere and compassionate, and completely willing to let us, students they had known for no more than 10 minutes, take a peek into their hearts. It struck all of us that the village families appeared more thankful that we wanted to learn from and listen to them than they were about receiving filter units.

None of us students on the trip were accustomed to the conditions under which we lived for one week in Piedra Blanca. However, even though we bathed with cold water everyday, brushed our teeth with bottled water to prevent infection, had electricity for less than half of our stay, and traveled in a motorcycles, donkeys, and open trucks, the warmth and kindness of the families with whom we stayed made it easy to immerse ourselves in and enjoy everything the culture could offer us. While all of us were in the Dominican Republic to accomplish our goal of administering the surveys, the carefree and lighthearted atmosphere made us feel as though we were on a relaxing vacation. We learned more than just about the current water situation that exists in resource-poor areas: we brought back with us lasting impressions and memories of an immensely generous culture. In the end, all of us students received more from the Dominican people than we would ever be able to offer them in return.  (Pictured:  Akash Parekh and Sarina Amin)

Dr. Etienne Pracht, Associate Professor, Health Policy and Management, College of Public Health,  provided his second teaching engagement June 1- 5 in Suriname, a small Caribbean nation located on the North coast of South America.

The training took place at the Suriname Ministry of Public Health and consisted of a hybrid between his courses in Health Economics and Public Health Data and Decision Making. The objective was to train officials at the Ministry of Public Health in empirical methods to conduct research and enhance the development of evidence-based health policy. Because data collection is limited in Suriname, Dr. Pracht (pictured - back row center) made use of publicly available U.S. data to conduct the training. The hope is to establish a consistent data collection effort in Suriname. Until recently, the Suriname Ministry of Public Health had been sending their students to universities in the U.S. to acquire MPH degrees.

Dr. Virginia Oostburg, the Deputy Director of De Ministerie Van Volksgezondheid (Ministry of Public Health) obtained her MPH in Health Policy and Programs in 2007 where she was Dr. Pracht’s student and advisee. She informed the faculty at the Anton de Kom University about Dr. Pracht and he was invited to teach Health Economics I in 2008. Dr. Pracht has been invited to return to Suriname to continue the training in November 2009.

On April 11th of this year I was lucky to be a part of a collaboration of 25 enthusiastic students from each of the USF Schools of Health as we left traditional work behind to work in Oma, Panama as a part of student run organization, International Health Service Collaborative (IHSC). After two flights and an interesting five hour bus ride we arrived in San Felix and met Steve Russo, an American Peace Corps volunteer who would be leading us for the remainder of the week. Our group was composed of medical, public health, nursing and University of Florida Pharmacy students. We worked for six days in the village of Oma completing several days of clinical work including eye exams with free glasses, physical exams, and health education. Teams also completed manual labor in the hot sun to help complete eight latrine tops and work with the community to break ground and lay aqueducts to provide water to the busy clinic and eventually throughout the entire community, which has not had running water in over 20 years.

IHSC is a well established group which was led by recent USF Medical School graduate Dr. Tania Velez. This group has also worked for several years in the Dominican Republic and Honduras completing similar projects. A decision was made to start a project in Panama in hopes that it will become a long term sustainable project. In order for this to work a survey was implemented to better understand the needs of the community. Although the lack of running water and infrastructure seemed to be obvious problems to us, we were able to better understand what the community wanted from their own experiences.

As a student who has been on several other service trips I knew to expect hard work, but had no idea the rough mountain terrain we would be working with as well as had little idea about how hard it really is to dig two feet into the ground across, down, and up a mountain in order to build the aqueducts. We quickly learned we would come back to the states with a little more muscle after the first day of climbing “the hill” several times. The village, set in the mountains, had little flat land to walk. Slipping on lose rocks became the norm while I noticed the women and children walking with ease, usually not wearing shoes and carrying loads using their heads. Most of us enjoyed the hard work joking about “team mule” who carried cinder block and stones down the mountain, and “team Everest” who felt they climbed forever in order to build a latrine in a remote area. Overall, we had a wonderful cultural experience as many of us saw for the first time what life is like in a lower developed area.

Our creativity was tested as we had little tools to carry objects or mix cement and our patience was also often tested as we tried to communicate with the community (through an obvious language barrier for most) and learn what “village time” actually means. Although I was excited to turn on tap water and know it would not make me sick when the plane landed in Miami, I am very anxious to get back to the community next year and continue our hard work and put what we have learned into practice.

Ms. Wendy Mussoline, doctoral student from the Department of Global Health, went to the United Nations Institute of Water Education (UNESCO-IRES) as part of the first group of USF students who will be carrying out their research and training at the UNESCO-IRES during a ten-week academic training in the Netherlands this summer. Wendy will work under the tutorship of Dutch faculty Drs. Amy Petrusevski, and Lens on her doctoral dissertation related with helminthes inactivation under anaerobic conditions and energy recovery. USF is the only university in the U.S. that has an existing Memorandum of Understanding (MoU) with UNESCO-IHE, Institute for Water Education to pursue opportunities to collaborate on research and education. The Institute is based in Delft, the Netherlands, and is owned by all UNESCO member states. It is established as a UNESCO ‘category I’ institute jointly by UNESCO and the Government of the Netherlands. The Institute is the largest water education facility in the world, The USF students will be fully financially supported by the International Research Experience for Students (IRES) Program, sponsored by the National Sciences Foundation.  (Pictured -  L to R: Wendy Mussoline, Michael Gerdjikian, Duncan Peabody, Hong Ting (Sam) Chiu, Robert Bair, Dipesh Dey)

We are pleased to announce the signing of a Memorandum of Understanding between the University of South Florida and the Central Maternity, Yaoundé Central Hospital in Cameroon. The Yaoundé Central Hospital is a University Teaching Hospital, and the Central Maternity is staffed by members of the Department of Obstetrics and Gynecology of the University of Yaoundé 1.

“The Memorandum of Understanding is an initial step that we hope will lead to several collaborative endeavors between USF and the institution in Cameroon. Under the agreement, we have already identified several areas of future collaboration that encompasses student and faculty exchange programs, as well as collaborative research in Maternal and Child Health. Already, the Department of Obstetrics and Gynecology at USF has indicated its interest in a number of international grant opportunities for which they will be seeking partners in Cameroon”, said Dr. Salihu.

If you are interested in being part of this initiative and you have specific ideas, please contact Dr. Hamisu Salihu at 974-7594 or e-mail hsalihu@health.usf.edu.

I am from the country of Barbados and I am at the College of Public Health on a National Development Scholarship from my government.  The scholarship is awarded every year to individuals who are pursuing studies in focus areas which are instrumental in the development of the country. I chose the College of Public Health at the University of South Florida because it was one of the few schools that boasted a Global Health Department.  I felt that as someone from outside the U.S., if I wanted to complete my degree in Public Health it should be with a global perspective.  Before I came to USF I was not involved in the public health or the clinical health field.  My interest was piqued when I was in completing my undergraduate degree and after that I spent some time volunteering in a hospital and helping out with the youth outreach HIV programme in Barbados. 

I have been thoroughly enjoying the programme so far. I have learned more that I ever thought I would and I am only half way through. I am anxious to see where this will all take me when I am done. I truly want my degree to take me all over the world.  I want to make a difference anywhere that needs help.  Be it the islands of the Caribbean or the deserts of Africa, I want to be at the forefront of the battle for better health for everyone. I want to spend a couple of months working with an NGO in Ghana or Calcutta after I graduate and then look for a job working with PAHO in Barbados and hopefully starting research for the Dr.PH programme.

My ultimate goal after I have possibly completed the Dr.PH is to remain at home to work in the clinics and hospitals to improve the quality of care received by the people in my country.  I also want to work closely with HIV/AIDS prevention not only in Barbados but the Caribbean and to coordinate a regional program from HIV testing and reporting.  (Pictured:  Shana Burrowes, Global Health Student)

Dr. P. Amina Alio, Research Assistant Professor in the Department of Community and Family Health, has initiated a research project on cervical cancer in Niger.  “Chronic diseases have been ignored in sub-Saharan Africa in favor of infectious diseases”, said Dr. Alio.  Yet, it is estimated that the rate of cervical cancer in poor countries is 15 times higher than industrialized countries.  According to the World Health Organization, cervical cancer is the most common type of cancer in sub-Saharan Africa. In Niger, specifically, the incidence of cervical cancer in women between 15-44 years of age is so high that it becomes the leading type of cancer, beating out breast cancer which holds the highest prevalence across the lifespan.  “These statistics are most likely underestimates, since they are based on hospital data alone. We know that in poor countries many are ill and die outside of the hospital.  In these cases causes of death are not recorded”, said Dr. Alio.  There is a lack of data on the state of cervical cancer in Niger.  To help bridge this informational gap, Dr. Alio is collecting preliminary data on prevalence, prevention and available treatment.  In addition, she is administering a survey on knowledge and attitudes towards cervical cancer prevention and detection.  “Screening exams such as pap smears, which are the primary mode of early detection of cervical cancer, are not part of routine physical exams for women in Niger”, said Dr. Alio.  Hence the high mortality rate due to a cancer that is highly preventable and curable. Dr. Alio traveled to Niger in November of 2008 and February of this year to begin data collection.  She aims to identify the gaps in knowledge of cervical cancer among healthcare workers as well as the general population.  “Preliminary findings reveal that healthcare providers are lacking in their own knowledge of the disease as well as in the training needed to perform a Pap test”, said Dr. Alio.  Another objective of the research is to identify socioeconomic and cultural barriers to cervical cancer screening.  “This information will aid in directing future research and in developing interventions”, said Dr. Alio. 

Participating in this initiative are Dr. Ellen Daley, Dr. Phil Marty and Dr. Hamisu Salihu, and MPH student Christina Barzelay.

Dr. Amy Stuart, Assistant Professor, Environmental and Occupational Health, and colleagues Dr. Trotz (Civil and Environmental Engineering) and Dr. Akiwumi (Geography) recently led a course trip to Guyana, South America, during USF’s spring break. The trip was the field research component of the graduate course, Sustainability Concepts and Methods: Mercury in Guyana, and was funded through a USF Sustainable Healthy Communities grant. Ten graduate students from public health, geography, and engineering participated in the trip, which gave the students and faculty hands-on experience in sustainability issues in a developing country setting. Students were introduced to three areas of the country where they collected data for the course case project. These included a nature reserve and sustainability center in the Guyanese rainforest that supports ecotourism and sustainability research, a remote mining town deep in the Guyanese jungle surrounded by Amerindian territories, and the populated coastal area and capital city of Georgetown. Research activities included water and soil sampling for mercury concentrations, population surveys and observation on mercury issues, and archival data collection. The data collected will feed into analyses for the student course papers and longer-term theses and dissertation projects of students working on the grant. “The experience was a fascinating, eye-opening, and sometimes disturbing look at both the challenges that confront solution of environmental and health issues in the developing world, and the resilience of the local people forging a living in these conditions,” said Dr. Stuart.

The following article provides a native Guyanese student’s perspective on experiencing his own country through the course trip.

Going home to Guyana, my native land, to conduct research on mercury and mining, I had mixed feelings regarding what to expect. On one hand, I was anticipating an empowering and enlightening experience conducting surveys. Guyanese are known as some of most hospitable people in the world and are generally not shy about giving their opinion. On the other hand, I envisioned a spectacle of tainted earth, and putrid, polluted waters in the mining district. You see, like the rest of my classmates, this was my first trip to this part of Guyana. You would think that having lived in Guyana for over 25 years before leaving for any prolonged period of time I would be an authority on anything and everything Guyanese. This is far from the truth. I was born, raised, and schooled on the coast of Guyana, a narrow strip of land stretching along the tip of the country, bordered by the Atlantic Ocean to the north, and the jungles of the interior to the south. About eighty percent of the population of the country lives on the coast, and as such, most, like me, have little or no inkling of the happenings of the interior, or ‘the bush’ as it is more commonly referred to. Going to these locations are reserved for adventurous fortune seekers, or the rich tourists who can afford to fly in for nature tours.

Guyana offers its wilderness visitors a truly inimitable experience with nature, a raw ruggedness that contrasts sharply with the more traditional fare of Caribbean tourism. Here, the spectacular, brochure perfect, blue waters of the Caribbean are replaced by a coffee brown hue the gets richer and darker the further inland you venture. Gaiety and tacit bliss is replaced by a dark brooding serenity that perpetuates a beauty of its own. Wilderness tours are the main attractions, capitalizing on the unique wildlife, mystic awe of its waterways, and untainted, unexplored nature of its jungles.

Conducting literature research on small scale gold mining in Guyana left me with a concept of family owned claims, with 6-10 persons, working the mines, more on a subsistence basis rather than entrepreneurial. Whilst some mines fulfilled that projection, most of the mines we saw can be classified as middle-scale business enterprises. Miners now employed the use of excavators to extract the ore, thus being able to process thousands of metric tons of ore in any given day. The ore is washed into a hole where a gravel pump, or five, pumps the slurry over a mercury-impregnated mat. This water is continuously being recycled for use in the process, by being held in a tailings pond, allowed to settle, and pumped back to the wash hole. This presents a greater possibility for the generation of hotspots for mercury pollution. They all had one common thread though. They were all owned by a single person, a single boss who had total control of the entire operation and was present on the mine site on a daily basis. These mines and the mining town that catered to their needs seemed far removed from the hustle and bustle of the city. Coming from Georgetown, there is a sense of complete isolation, both geographically and administratively.

This pervading sense of isolation was reinforced during my survey of the mineworkers. It was my opinion that few of them had any access to print media whilst working in the mines. There were no local news channels on television, thus there was no access to information regarding significant events in the country. They relied on travelers into and out of the area to convey news. There was a common thread of acute job speciation occurring in the mining camps, for example, the “jetters” whose task is to wash the ore into the feedhole for the gravel pump, had little or no idea about processing the amalgamated ore. Whilst some workers had a fair idea of how often they ‘washed the mats” it was mainly motivated by economics rather than a knowledge of the process. That is, they had more knowledge about how often washing was done and less about how it was done, since washing meant payday was close.

Washing of the mats and burning of the amalgam seems to be predominantly done by the owners themselves. Whilst retorts are prevalent in the mines, their use cannot be ascertained. I received mixed reviews from the workers and the owners concerning their use and perceptions of mercury. The same can be said of the general perception of mercury as a pollutant and toxic metal. Some miners considered mercury as a sacred ‘liquid’ that protects them from snakes and other evils associated with mining folklore, whilst others had a vague idea it could be dangerous to their health but had no point of reference with regard to disease, symptoms, or cure. Monitoring is done by the Guyana Mines Gold Commission, but the number of mines are vast, and they are severely understaffed. Thus, they are regulated to mainly settling land disputes and mining infractions rather than enforcing environmental protection.

I was left with a feeling of loss as to the overarching financial benefits of mining on the local community, and the country as a whole. The typical expectation of the boomtown associated with short-term wealth was not realized. I got the sense of a community and environment being raped at a sustained rate. Not even in the capital city of Georgetown could I identify proliferation of wealth that I can trace back to mining. Yet it remains a naturally rich and beautiful country, with a resiliency that I pray may enable it to face its future.

Ryan Michael
Doctoral Student
Environmental and Occupational Health

I completed my international field experience in San Felix, Panama.   San Felix serves as a city center for many of the health services provided for the Ngöbe-Buglé indigenous populations.  There is a hospital with a laboratory for medical services, ASASTRAN (an organization founded by the Ngöbe’s for traditional medicine), and the Ministry of Health.  The Ministry of Health has services similar to the Department of Health in the United States such as, Epidemiology, Nutrition, and Environmental Health. During my field experience I was able to get exposure to all of these agencies.  I was able to spend time in the hospital laboratory becoming familiar with parasite and tuberculosis diagnosis.  The Ministry of Health allowed me to spend time with their epidemiology department to learn about their disease reporting system.  Then one of my favorite experiences of all was the time I spent with ASASTRAN.  I was able to help them harvest one of their traditional medicines used for headaches.

During the field experience I had opportunities to go into the communities and learn about different health projects the Ministry of Health, the Peace Corps, and various independent public health workers were working on. Some of these projects include educational training courses for community members, the use and implementation of latrines, and a systems approach to reducing parasite infections. 

The main project I spent most of my time working on was a community training course.  The main focus of the training course was to teach community members how to use a microscope that was donated to the community. The course also included lessons on parasite lifecycles and diagnosis, prevention, and surveillance.  One of the key components in designing this training course was to make it sustainable with limited resources.  A few concepts that got implemented in the training course included: using matchsticks instead of applicator sticks, finding the appropriate ratio for saline solution using a standard plastic soda bottle and the cap, and using a grain of rice in boiling water to determine when slides have been sterilized. I also designed a teaching tool made of felt to demonstrate the parasite lifecycles and to teach different ways to break the chain of transmission.

For this type of community based field experience I would recommend courses that are hands on such as Global Health Applications in the Field. I felt well prepared with a concentration in the Global Communicable Disease and for this particular field site, Parasitology was especially useful.

Before deciding to embark on an international journey, you should know it is important to have developed problem solving and functional skills such as flexibility, adaptability, and creativity.  Getting things accomplished is difficult with limited resources and you may have to relearn many things.  Events you spend time planning for may fall through at the last minute and you have to figure a new way to achieve your goal, often times under time and money constraints.  No matter what type of situations you may encounter during an international field experience, it is always an adventure worth the waging.  (Pictured:  Amanda Eiden)