Notes from the Field 2011-2012

By Mike Priebe
Global Health Institute: Thailand

Today is my final day inThailand. The Global Health Institute concluded last night with a celebration dinner featuring traditional Thai dancers and drummers and lots of "thank yous" and "good-byes". Last week was for me an intensive study of cross-species surveillance, a topic about which I knew very little before the course. I enjoy studying new areas, mainly because it gives me ideas about my own work and career. All the priniciples we learned about One Health the first week and then learned to apply during the second week make perfect sense--everything is interconnected; many problems are so complex than no one person, discipline or nation can fix it; and often our attempts to fix the problem result in unanticipated and unintended negative consequences. It doesn't matter if the problem is emerging infectious diseases or limited economic opportunities for people with disabilities. The path to a solution is the same--One Health. By expanding our team beyond its usual boundaries we can use the expertise of whoever is needed to address the issue. By thinking systematically, we are able to identify the underlying component problems that must be dealt with first. And by focusing on incremental improvements we can chip away at the problem. How do you eat an elephant? One bite at a time. That may not be the best saying to use after spending two amazing weeks in a city known for and symbolized by elephants, but its the best my fatigued brain can do right now!
Yesterday I had the privilege of meeting colleagues from the Department of Rehabilitation Medicine at Chiang Mai University. I gave a presentation incorporating my thoughts on One Health with Grand Challenges facing people with disabilities. Thanks GHI for great a opportunity to learn and grow!

By Milena Gross
Global Health Institute: Thailand

I am writing from a beautiful city of Chiang Mai in Thailand. The mission of Chiang Mai University-"Where nature nurtures beautiful intelligence" was just a beautiful statement to me prior to coming to Thailand GHI 2012. Now I am starting to understand the importance of Chiang Mai University mission statement that captures the importance of nature and how it relates to Thai culture and one health approach. The world is interconnected and nurturing global connections and learning from different cultures is the key to prevention to global complex "wicked" problems.

I am currently pursuing Executive Program in Public Health Practice, some of my previous experience includes years of working with children's issues focusing on international adoption and a Master's degree in Public Affairs with concentration in Health and Leadership.

GHI has presented to me a great opportunity to continue strengthening my understanding of global health complex problems in a multi-cultural multi-country professional environment. Complex global health problems require multi-discipline team work, multi-cultural approach and working from the heart. I have made many friends and have great professional networking opportunities across the globe and looking forward to staying engaged with my new colleagues to work on one health.

By Mike Priebe
Global Health Institute: Thailand

The week has gone by so quickly. I have met colleagues from all around Southeast Asia and gained insights into the public health issues they are facing. Yesterday we took trips into the field to see various public health initiatives taking place in Chiang Mai and the surrounding area. My group visited the Don-Keow Subdistrict Administration Office and heard about three environmental waste management strategies. My group saw a community based solid waste recycling project in which local communities deposit recyclable materials at a central site where they are separated and sold to a recycling dealer. Two important things about this project that allow it to succeed are the high rate of community engagement of volunteers and leadership, and the collaboration with the bulk recycling industry. The money earned is returned to the communities, thus creating an economic incentive to recycle.

People in the community also collect reusable items and fashion them into handicrafts that have a potential for reuse or sales. Another group observed strategies for composting of wet waste to brew a solution that contains "effective microorganisms," used for pest control, especially for the apple snail. They also saw a composting project to raise earthworms. A third group learned about converting pig manure from a community problem to a source of biogas for cooking for an entire village, including the local noodle shops. The pig farmer was about to be chased out of town because of the odor, but instead a creative solution was found that met many needs. All three show how creative thinking, communal problem solving and collaboration can solve problems for a community. These projects have become models for other districts in Thailand, and now for Southeast Asia through this experience. Maybe the phrase, "one man's trash is another man's treasure" is coming true in Thailand.

By Mike Priebe
Global Health Institute: Thailand

Look deeply into the paper--what do you see? Only paper? Or do you see the tree, the cloud, the rain? Do you see the wood cutter and even the wood cutters mother? We are all connected through time and interdependent in all aspects of life.This is one illustration used by Professor Lertrack Srkitjakarn, Dean of the Faculty of Veterinary Medicine at Chiang Mai University and the theme of the first couple days of the One Health Leadership Training. Human health is connected intimately with animal health and the environment. Therefore, what happens in a distant rain forest can have a dramatic impact on human health in Minnesota or wherever we live.
The Grand Challenges of our times cannot be solved in isolation--poverty, HIV/AIDS, climate change, or antibiotic resistance, for example. These problems must be addressed through collaboration across boundaries and across disciplines. These problems require a systems approach, which understands that all parts are interconnected. Systems are alive and change, even as we attempt to intervene. They are not linear--a small change here can lead to a large change there. However, our interventions can have important unanticipated and unintended consequences. One Health is an approach to addressing one of these Grand Challenges--that of emerging zoonoitic diseases. This week we are learning specifically about this infectious disease problem, which occurs along the interfaces of human health, animal health and the ecosystem.
This same approach using complex adaptive systems thinking is necessary to address any of the world's problems that occur along the interface between typical boundaries and disciplines. For example, I think it can be equally applied to health disparities, disability rights, and full engagement of people with disabilities in society. Transdisciplinary team work is essential to address these sorts of problems.  "Go as a river, not as a drop of rain. Go in harmony and in community and you will reach the ocean and not evaporate along the way."

By Mike Priebe
Global Health Institute: Thailand

Well, I made it, late start to packing and about 26 hours of travel in all. As I said in my first blog that when I have time I'd introduce myself and share some of my goals for the Global Health Institute. I had got a couple hours in the Incheon/Seoul International airport waiting for my next flight I got a start.
I am a physician in the Executive Program in Public Health Practice. My specialty area is physical medicine and rehabilitation and I have cared for people with various disabilities over the past 20 years of my career. As a result I have developed a great interest in disability-related issues, including health disparities for people with disabilities. I am also very interested in global health issues. I've had the privilege to travel quite a bit in my career and have visited both developed and developing countries for professional meetings and "medical mission" work.
I am always quite aware of physical accessibility issues when I travel. In the US we recognize the presence of accessibility needs for people with disabilities and have, as a society, made attempts to improve the physical accessibility of our built environments. In many parts of the world, however, even recognizing that there are people with disabilities in society is lacking. Thus, the built environment is often very inaccessible for anyone with mobility impairment or who doesn't have full hand function.
But every once in a while it is fun to see some place that really does accessibility right. I transferred planes in the Incheon/Seoul International airport. Here I saw both technology and philosophy of accessibility clearly made a priority. The restroom has a fully accessible toilet area, not just an extra-wide stall often tucked past some corners that are impassable in a wheelchair. They also recognize that there are various degrees of disabilities. Not everyone needs the fully accessible toilet, so they installed a grab-bar frame around one of the urinals to allow men who are unsteady on their feet to use the urinal. They also installed a sink at wheelchair height (which is also nice for kids--that's why it's often referred to as universal design!). I also saw a drinking fountain at wheelchair height with a sensor switch to start the flow of water when anyone approaches. Hand function is not needed to get a drink.
I suspect most people don't notice these sorts of things in public spaces. I challenge you to look at the built environment in public spaces as well as in your own home. Imagine what it would be like trying to negotiate that space in a wheelchair. Seeing is the first step to understanding. Understanding is necessary to develop compassion. Compassion is essential if we are to advocate for accessibility for people with disabilities throughout the world.
I don't think this has much to do with the Global Health Institute, which will focus on Emerging Pandemic Threats. All that starts tomorrow morning. I can't wait!

By Mike Priebe
Global Health Institute: Thailand

I am very excited to be participating in this year's Global Health Institute in Chiang Mai, Thailand. I'll be blogging about my experience throughout the next 2 weeks. I hope to provide a glimpse of the exciting things we are learning at the GHI. When I have a little more time I'll introduce myself, but right now I have to pack (my flight leaves in 12 hours)!

By Megan Mueller
New York City Department of Health and Mental Hygiene

My summer with the NYC DOH Health Research Training Program provided an invaluable experience in community nutrition and public health research. I made some great connections, got first-hand accounts of the efforts at NYC DOH through program workshops, and learned what it means to work in local public health. Working with the Stellar Farmers Market program gave me insight into the challenges facing low-income New Yorkers and the strategies needed to address access to healthy foods in these populations. All in all it was a great experience!

For SPH students (current and future) interested in this research topic and others, I would definitely recommend HRTP as a potential field experience! The application for the summer program is due February 15, 2012. More information can be found here.

Best,

MM

By Megan Mueller
New York City Department of Health and Mental Hygiene

In New York City public health campaigns and programs are in the streets, on the subways, on television, in the parks, everywhere! The DOH is tackling every issue imaginable: hurricane recovery, the food environment, HIV/AIDS, smoking, health disparities, mental health, diabetes, obesity, etc. and with gusto! In fact, according to Laurie Garrett author of Betrayal of Trust: The Collapse of Global Public Health, New York City was the place where modern public health was invented. Though the "elements of science and policies that form the core of public health also arose in London, Paris, Berlin, and Boston" it was in NYC that "bands of sanitarians, germ theory zealots, and progressive political leaders created the worlds first public health infrastructure." Whether as a result of the city's stance in the history of the field or as a result of NYC's progressive nature in the field today, one area where the DOH is currently particularly thriving is in public health messaging. To give you a taste of that (and to get my final hurrah in the city before I left) I decided to go on a little scavenger hunt (pre-Irene). One hour in the New York City streets/subways. Go!

Here's a sampling of what I found:

Other campaigns from NYC DOH:

By Molly Emerick
India

This is my last day in Mumbai. It has been raining for three days straight, perhaps the result of changing weather patterns due to global warming. In the past, Monsoon rains tended to be more off and on with bits of sunlight dispersed here and there.
The nutrition project seems to have started off well, we shall see how the rest of the year goes as the kids learn more about what they can do to improve their health. I wish we could've done more with the time we had, but I suppose that is usually the case. This season due to Monsoon, Ramadan and various Hindu celebrations wasn't ideal for launching a study/intervention, however it did paint a very realistic picture of how difficult it is to start a project amidst cultural and geographical barriers.
I can't wait to see if our pilot will expand into something bigger! Goodbye Mumbai!

By Avantika Chaudhary
China
Program: Healthcare Administration

One of my most favorite things to eat for lunch in my office is Jaiozi or dumplings.
I wanted to add the Jaiozi -making-skills under my belt and Mrs. Zhang, who works in the other insurance office, was kind enough to show me how to how to make them. Did I tell you that we made them in our office, with ingredients from the cafeteria.I do not know the english names of the ingredients so those who speak Mandarin can chip in!

Here we go:
Mix the following with some sesame oil to make a sauce:

Now, add all these ingredients to minced pork along with 1 egg. Season with 5-spice powder.

Add a handful of finely chopped leeks and some chopped shrimp and ginger.

Now for the dough: Mix flour with salt and water. Knead your knuckles off and set the dough aside for 3 hours. Roll the dough in the shape of a rope and break off small pieces

On a floured surface, roll the small pieces of dough into small tortillas. If possible, do this is in a location where a computer is not within spilled-some-flour-on-your-keyboard distance.

Add some of the pork mixture into the tortillas and fold the jiaozi such that there are no open edges. Also thank Mrs. Zhang for taking time out to make these beauties.

Add the jiaozi to boiling water and cook for about 20 minutes. Eat with vinegar and chilli oil.