Category: Around the World & Back Again


I will be heading off to Ethiopia the day after Thanksgiving to do some teaching for the American International Health Alliance (AIHA).  That should be an interesting exchange related to quality improvement in health care, and I will be working with partners from Ethiopia.

I am also going to attend the 16th Annual Conference on AIDS and STDS in Africa (ICASA).  I”ll be involved in two sessions, one about quality of care and one about care for orphans and vulnerable children. I expect to learn a lot about HIV/AIDS and the most current issues and challenges.  (See ICASA website http://www.icasa2011addis.org).

While in Addis I have also arranged to visit some sites related to my work with Save the Children.  I’d like to identify a community to participate in the Wisconsin Without Borders Marketplace.  The hope is that we can support a community micro-enterprise effort designed to benefit vulnerable children (due to AIDS or other causes) by buying and reselling their products — scarves, jewlery, baskets — these are some of the crafts that I expect to find.

A few friends and students have suggested that I cover my field work and the conference on my blog www.globalhealthreflections.wordpress.com  so that I can share what I am learning with the UW community, especially our growing community of global health students. Please feel free to visit and see my posts about previous trips to Ethiopia.  And sign up to follow the blog if you want to get updates by email!

On September 22nd, after 3 years of writing about it, talking about it, and trying to walk the talk, my UW-Madison colleagues and I launched our global service learning program, Wisconsin Without Borders.  What’s the big deal, some might say. Aren’t their already Doctors without Borders, and Engineers without Borders?  The answer is yes.  There are also teachers, lawyers, architects, nurses, sociologists, builders and acupuncturists. I had planned to end this post with the idea of starting a Clowns without Borders, but they are already active, spreading laughter and joy.  And the Knitters without Borders are making blankets and sweaters and sharing their dyeing and design techniques. I tried everything to find a new idea, but struck out again and again….Bloggers, Dentists, Geeks, Monks…they are all out there, without borders.  I stopped playing fair when I found a web reference to Mariachi without Borders! Cynically, I searched for Fence Makers without Borders. That would reveal the hypocrisy, show that the term was losing its meaning, would it not?  But the Without Borders world held, there are no Fence Makers without Borders, at least not yet….

Why do so many of us want a Life without Borders? What are we trying to say about ourselves?  Perhaps simply that we are open to the world.  We like to travel.  We want to make a positive difference in the world, to be part of the solution, at least for a moment.  But there is some kind of poetry at work here also. The phrase evokes the wild beating heart, a sense of freedom, sunlight, a loosening of chains.  It expresses a desire for union with people who are different from us, it says we are willing to risk ourselves to explore the differences, celebrate them, and watch them dissolve.

Even now, when there is so much need for healing in our own communities, my students and colleagues and I are finding a lot of support for the idea that reaching beyond the boundaries of our state is both a duty and a privilege.   Our students can be global leaders, they can act both locally and globally to promote justice, human flourishing, and care of the earth.  Our event featured 13 projects from around Wisconsin and the world that are inspired by the “Without Borders”  spirit.  Posters can be viewed at: http://centerforglobalhealth.wisc.edu/389.htm

You can see my brief Intro Remarks Explaining Wisconsin Without Borders  (Hi Mom!):

www.youtube.com/user/MorgridgeCPS#p/u/14/QnbZNOoO-SU

Also, see one of our student leaders, Megan Hall, talk about our Women’s Health and Microenterprise Program in Ecuador:

http://www.youtube.com/user/MorgridgeCPS#p/u/13/cmiTyv5HtHM

The program also featured remarks by John and Tasha Morgridge, who have generously supported The Morgidge Center for Public Service for the past 15 years, and Bob and Sara Rothschild, who presented their work in Botswana, where they are working with communities to build public libraries. Their presentations and the entire event can be viewed at http://www.youtube.com/user/MorgridgeCPS

To blog or not to blog?  For me that wasn’t even a question!  As a life long diarist, I believed that the best place for my private thoughts was  a notebook tucked between my mattresses.  Blogging seemed narcissistic –all that living out loud seemed to contradict everything I believed about the inward life, the importance of the unobserved moment, the value of words in ink on paper–just one original that can be hidden or crumpled or burned.  You can even write in code, which I did for the better part of 1979….

Why would anyone trade the raw authenticity of journaling for the prettified blog, that revises as it records, and distorts as it edits. I held my travel journals close to my chest…. Blogging seemed like a recipe for self-deception and vainglory.  (Would I ever say vainglory in a journal?)

So why am I here now, blogging, imagining you?

It began when (Oh God I just found myself making something up … luckily I caught myself and deleted it) a colleague asked me to blog at a Global Health Conference over a year ago (see September 2010 posts).    I didn’t dislike what I wrote, and I found that a number of my students had followed and enjoyed the blog… I did a mildly clever one where I pretended I met Bono, and people got it.  I found that I was more focused in the conference sessions because I knew I had to blog about them.  And when I nervously pressed “publish” for the first time, I realized that accountability comes along with the admittedly “selfy” act of blogging.  I began to see that there is discipline and courage here too.

During the course of the following year, as I wrote in my journal about my global health work in Ethiopia, Ecuador, and Mexico, it occured to me that some of those entries, as well as older travel journals and  more local reflections, might be worth sharing if I had a blog. I was learning through the writing, challenging myself, and sensing life more fully.  I realized that if I could muster up the courage to let others read and write along, my writing had the potential to create a voice and space for the people and places and issues that I care deeply about.

Can I combine the rush of blogging with the introspection and raw truth of my journals?  Probably not.  But I can try.  I can share my experiences and honest reflections with family, friends, students, and even readers who I don’t know…  I can try to blog like there’s nobody watching.  Of course I know the reader is there, and because of that I will polish and edit and censor a bit (not a bad thing, actually),  but I hope always to write  (almost split that infinitive, but no, not here!) with my whole self, whatever that means and whatever the cost.

We all carry so many identities, and we don’t always realize the cost of keeping them separate and expressing them selectively.    As a writer-teacher-learner-mentor-mother-wife-daughter-sister-friend-seeker, I want to explore what it means to speak from the core of my whole self.  In spite of the fact that my three children have forbidden me to blog about their lives (and I will honor that within reason), the well-being of the world’s children, beginning with my own, but by no means ending with them, is my life compass.  I blog to better understand what this all means.  I have this foggy notion that if I try to blog out what I believe I may actually behave better….

I hope that I can be a witness to beauty and joy, and I hope I am kind and generous in my words.  I may also get angry about suffering or injustice, and speak uncomfortable truths about myself and my world.

In case you are trying to remember the rest of that quote about dancing, and you don’t already own the T-shirt, here is the full text:

“You’ve gotta’ dance like there’s nobody watching,
Love like you’ll never be hurt,
Sing like there’s nobody listening,
And live like it’s heaven on earth.
(And speak from the heart to be heard.)”
-William W. Purkey

NCDs: The Silent Killer in Low-Income Countries

Don’t smoke.  Drink in moderation.  Eat right.  Exercise….  Many of us have, at one time or another, written such messages on a post-it note and stuck them to the bathroom mirror…but what just happened at the UN Summit on NCDs is bigger.  This was only the second time a UN summit addressed a health topic, the first topic was HIV/AIDS, and now this second summit addressed non-communicable disease.  The meeting achieved broad consensus that we must address these “big 4” causes of NCDs,  and laid out priorities and strategies.  It also described what  global NCD partnerships might look like –shared learning rather than large-scale donor funding from rich countries to poorer ones.  Some participants were disappointed that the meeting fell short of defining targets, indicators or criteria for progress.

This CSIS video summarizes the meeting well, featuring Nils Daulaire,  Director of the Office of Global Health Affairs at HHS,  Ambassador Ebrahim Rasool  (South Africa), and Medtronics Senior Executive, Trevor Gunn.http://bit.ly/pZP8ti

The resolution, which was passed at the summit,  is actually a great read!  http://bit.ly/qmouea.  It gives an overview of the global epidemiology of non-communicable diseases, discusses causes, advocates a whole of government approach (South Africa, in particular is walking this talk) and gives a concrete sense of what good policy might look like.  It recognizes the need for health system strengthening, and the global importance of anti-tobacco efforts (like smoke free workplaces and cessation initiatives that use text messaging), and it includes guidance about food systems, advertising, healthy environments.  It’s all there, and I have a feeling that it will be as challenging to implement this agenda in the US as in some of the lower-income settings.  The global effort will target  cardiovascular disease, cancer, respiratory illness and diabetes, focusing on four drivers — tobacco, alcohol abuse, poor diet, and physical inactivity.  There was and will continue to be tension and debate around balancing prevention  and treatment.  The CDC will serve as the point organization in defining this along with WHO the FDA,  NIH and others.

In attendance at this high level meeting was Dr. Jim Cleary, an international expert on pain policy, and the UW-Madison Global Health Institute’s Special Advisor for NCDs.  See his blog at  http://painpolicy.wordpress.com/.  In conversations at UW-Madison, Jim has challenged us all to think comprehensively about care for NCDs,  and remember that the lifetime death rate for human populations is 100% and holding steady!  Everyone dies, therefore, in addition to thinking about prevention, we must also think about what it means to have a healthy death, and that means compassionate care and pain management for all.   This one is for you Jim———>

Low-Tech Solar “Liter of Light”

Ethiopian Masinko and other Traditional Instruments

I made it home from Ethiopia yesterday. It was a wonderful trip in so many ways.  I was so busy and with the time change and limited internet access I did not have a chance to write the usual news from the field to family and friends so I thought I would do so here now while everything is fresh in my mind.

I have been to Ethiopia before, so I had a good sense of what to expect and I knew it was a very interesting and hospitable culture.  However,  all the good expectations were doubled by the fact that I already knew 8 of the Ethiopian colleagues that we were working with since they had had fellowships at UW, and because the QA advisor working with me, Roman Aydiko, a UW-Madison student who I really enjoy working with, is from Ethiopia herself.  We trained 60 hospital leaders in quality improvement and followed up on 8 projects that were already underway. There has been good progress on all the projects but two have been very successful, one related to infection control (improvement from 33% to 69%)  and one related to fully implementing triage (from less than 10% to 100%).

The Black Lion Hospital is the largest hospital in the country, and serves the most serious cases and has the most active emergency department.  We are working with the emergency department and the pediatric emergency departments in particular.  During my first day I visited those wards which I have been hearing about for months.  I think you can imagine that visiting these sites is a powerful experience, with such serious resource limitations and lines of patients hoping to get care.  The health care providers are among the most talented people in the country –chosen for medicine because of their intellectual abilities.  It is hard to see them struggle to provide care in a ward where water systems for basic sanitation are not always working and there are shortages of basics like sheets, gloves, face masks, etc.  Roman and I brought 4 suitcases full of sheets and gloves and masks and hand sanitizer as a gesture of solidarity.  We thought this made sense because we know the hospital is working to get these things in place so jump starting them on something like sheets helps — they can manage replacement as they wear out etc.  We also brought scrubs which they were delighted with because they can use them as uniforms.  It was a very joyful thing for us to give them things that we know will be put to immediate use.

In addition to working very hard I got a chance to get a feel for Addis Ababa.  I went shopping and really enjoyed buying some beautiful scarves, wonderful Ethiopian coffee, and a drum and masinko — two traditional instruments.  I also visited the national catherdral and an old orthodox church.  Spent time strolling around Addis which is a really nice African City — so much that is ancient right along side modern buildings and city bustle.   In addition to eating great Ethiopian food every day at lunch time we also went to a traditional ethiopian restaurant that had all kinds of cultural dancing going on during dinner.  I loved the food and music and dancing!

The other wonderful and unexpected aspect of my trip was that two very good friends from the DC area  happened to be there.  Tessie and I had worked together and spent lots of time together when our children (now in high school) were babies.  Marie Eve and I had shared some very important work related to vulnerable children but we had lost touch -what a gift to reconnect with her.   She is now working for Save the Children and we enjoyed reconnecting as friends.  She, Tessie and I are hoping and planning to do more work for vulnerable children together  in the near future.

There were extremes to digest in all this as you can imagine.  It was quite something to be working in solidarity with the mothers in line at the pediatric ER by day, and dining at the what is reputed to be the best Italian restaurant outside of Italy with old friends in the evening!

One thing that has always bothered me about development assistant projects (and I have worked on many) is the way the money flows, as they are very strict about procuring items on the local economy, yet they give very generous allowances for hotels and lodging.  I decided to deal with this by using the food allowance for a local cause, and then I can buy my own food, which I would have had to do at home anyway.  A girl’s gotta eat, right?   I shared my plan with Roman who, through her Ethiopian network, knew a very worthy young man who is trying to get funds together to pursue a masters in development with a focus on environmental sustainability.   He is very smart but “behind” some of his peers because he had to help raise his 8 siblings before he could consider this.  He still has lots of family responsibilities, but is getting started with his studies.  I am using the food money that I got for the week to help him out (in installments with reports from him) and I am also going to find him an academic buddy at UW who has similar interests. We met twice during my visit and he is so appreciative of the help and so hard working and deserving. And the only cost to me is a cleaner (but not totally clean) conscience about how development assistance money is used.

This trip was full of things that I expected and I did not expect, both named and unnamed here.  I am considering it a message from the universe about my life and what I am doing and what I should be doing.  Unfortunately, I cannot actually decipher the scroll in my hand !   I am hoping that continued reflection and finding the right balance between planning  and being open to life will help me find out what it all means …

It was great to get home where job one is to decorate for Christmas and make a big pile of potato gnocci for my family!

Based on email December 2010.

 Yesterday I was really moved by a presentation about an effort in the Congo that is addressing the needs of  communities who are trying to rebuild after conflict situations where rape was used as a weapon systematically   and livelihoods were destroyed.  The program includes HIV screening and care, mediation for families who are trying to come together and integrate family members who have experienced atrocities, and economic strengthening.  A pig breeding program is taking off and providing hope and a fresh start for many.  There are now 700 families on the waiting list and you too can be a partner in pig farming by contributing at Pigs for Peace.  Nancy Glass, who presented the work gave us a very real sense of the suffering of the women she is working with, but also showed us that there is hope and that universities can be partners for change.

You won’t believe want happened to me in the Madison Airport on the way to the CUGH conference!  I had a great exchange with Bono himself (sort of) about the MDGs! You can get a good sense of what he said in the Sunday  NY Times this week …. In fact those were pretty much literally his words to me if you know what I mean… He shared his thoughts about what needs to be done and it was really consistent with the things I have been reading from Gates and the UN. He thinks the UN meeting will be important and successful and suggests tuning in for the plenary sessions especially.  So do try to check out those CUGH webcasts and slides.

I know a lot of people are wary about the Bono dynamic, and  feel that we should listen more to African leaders, rather than having Bono do all the talking.  Today I had the feeling that Bono kinda gets that… The critique has more to do with the choices we make as listeners, right?….  So I had no reason to dis Bono. I believe in caring and working for change and justice like he does.  With all the voices coming at me though, I am going to make a special effort to listen to leaders from Africa and other low income countries as I attend these events.  Remember to tune in to the tedxchange event tomorrow online at 10am Madison time (CDT)!  Hope to see some comments here from UW students and faculty.

I am just setting off for Seattle, Washington to attend the Conference of the Consortium of Universities for Global Health.  The theme of this years meeting will be, “Transforming Global health:  The Interdisciplinary Power of Universities.”  My colleagues and  and I will be presenting a poster poster entitled “Interdisciplinary Global Health Education at the University of Wisconsin-Madison: Unique Responsibilities and Contributions of the Public Land Grant University.”  I will also be reporting back to faculty and students through this “real time” blog so that they can follow the meeting and contribute comments from campus.   If you want to see the program, which includes a number of webcast sessions, visit http://www.cugh.org/.  Our poster is entitled “Interdisciplinary Global Health Education at the University of Wisconsin-Madison: Unique Responsibilities and Contributions of the Public Land Grant University.”

While the CUGH meets about Global Health in Seattle, the United Nations Summit on the Millennium Development Goals will be held in New York.  That meeting includes six sessions with statements from almost every country, and also concurrent roundtables on 1) poverty, hunger and gender equity, 2) health and education, 3) sustainable development, 4) emerging issues,  5)  the needs of the most vulnerable populations and 6) widening and strengthening partnerships.  You can read background papers, country statements, and sign up for notification of webcasts at  http://www.un.org/en/mdg/summit2010/ … I am not suggesting that you pad your resume by pretending that you were invited to a UN Summit, but you can follow on line so well that no one would ever know you were not there!

Wait …there’s more.  The Gates Foundation TedxChange is also hosting a global web-based event which is on Monday, September 20th on the MDGs.  They will ask the questions “What has worked?” and  “How can move forward?”  This event is going to be webcast live at http://www.gatesfoundation.org/tedxchange/Pages/default.aspx on Monday from 10 to 11:30am  CDT.  They also sponsored a video contest which includes several hundred 5 minute videos about the MDGs from all around the world.  You can check them out at http://www.viewchange.org/.  There are over 50 on health care alone, not to mention important health related topics like food, water, and the environment.  The winners are going to be announced on the 20th at 2:00pm CDT.

I know this might seem like too much information…that’s why I am going to cover all three events on this blog!  I am going to attend CUGH meetings live, monitor UN webcasts and country statements as they are posted, and I can’t resist the TedxChange… I have already watched at least 15 of the video shorts on the MDGs.

While this all sounds busy, I am hoping it can be a time for synthesis and discernment for me personally.  There is so much need, so much potential, so much information, so many directions we could take… What is the best way to act on my values and identity as a woman, mother, sister, friend, public health professional, blogger (confession: this is my first blog post ever) and member of the UW community.   I will be reflecting on the global health education that we offer, the kinds of field work our students do, and I hope that some students and colleagues will explore these events with us and post their comments and insights as well.

This entry was posted on September 19, 2010 at 7:29 pm at the CUGH Conference

Harvesting Maize

Dona Margarita, an indigenous woman from La Calera, Ecuador, graciously gave me permission to use this beautiful photo. University of Wisconsin students visit Magdalena’s village each year to learn about indigenous culture and work with the community. I join this field course, led by anthropologist Frank Hutchins, as a public health instructor, exploring determinants of health and well-being alongside the students, and addressing topics that range from access to water, to gardens and family nutrition, to basic first aid, to micro-enterprise for women.

This visit took place around the time of the harvest of quinoa and maiz.  Margarita and her granddaughter are shelling maiz. As she explained the local agricultural cycle to our students, one of them knelt down to help, and before we knew it we were all on our knees, working and listening.  During such moments students learn about health problems that communities face, the resilience of women like Margarita, and the efforts that the community has made to move forward.

One year students helped Margarita plant her potato field. The next year she was behind a closed door in a dark house, grieving. One of her sons, who she had worked so hard to nurture and educate, was killed while working in Quito with at risk youth.  While the details of his violent death were murky, it was clear that, in addition to facing the challenges of rural poverty, Margarita and her family live with a double burden, as they are also touched by problems associated with rapid urbanization a struggling national economy, insecurity and political unrest.

The young man in the photo is Margarita’s other son, Luis, who serves as a guide in our community work, in addition to working the land himself, he is committed to preserving his culture, and earns a living as a guide and leader in the local eco-tourism movement. Luis and his neighbors hope that they can find ways to share their culture, and at the same time create economic alternatives to destructive mining, the rise of the flower export industry, and other practices which may not be sustainable, healthy or equitable, and do not embody indigenous values.

Maragarita’s life is intimately intertwined with the life-cycle of the maize and quinoa that she grows.  Quinoa, a high-protein grain touted as a miracle food, is the staple of the indigenous food tradition in this region of Ecuador. The year this photo was taken, the quinoa crop had failed. The climate is changing, members of the community observed, and they felt sure it had something to do with how we, all of us, are living. There is a growing body of research suggesting that people like Margarita are the first to notice the effects of climate change, and perhaps can help to identify early warning signs. During their time in Ecuador, the students are encouraged to compare their environmental footprint with Margarita and the other residents of La Calera. We all return to Wisconsin with the awareness that, in addition to working side by side with Magdalena’s community to address poverty, we in Wisconsin need to change some things about how we are living.  Together we discover and rediscover the importance of learning from, standing with, and when necessary standing for, people like Margarita.  People who we are privileged to share the world with. People who are a lot like us.

Based on Remarks from UW-Madison Global Health Retreat, May 2010

Photo: Abriana Hau Barca, 2008