September 18, 2012

Reflections on Ghana

Micah Johnson,
GHLI Fellow

My summer in Ghana went by in a flash. Now that I’ve traded the tro-tros and fufu of Accra for the campus shuttles and dining hall food of New Haven, I’ve had time to step back and reflect on my experience as a GHLI Fellow.

My most salient thought is that the work I started in Ghana is nowhere near complete. Even as my own projects were finalized, I came to appreciate that my summer in Ghana was just one slice of an effort to improve mental health care that has gone on for years and that will continue on for many more. The fight is not over—despite the tremendous progress that has been made, there is so much more to do. I hope to see a transformation of mental health in Ghana over the coming months and years, and I’m already thinking about ways I can help, and hopefully, return.

I’ve become even more impressed with the members of the Ghanaian delegation. Even though they are only a small group, they are able to make a large impact on mental health in Ghana. With so many challenges continuously facing countries around the globe, it is crucial to have a committed group of champions to ensure that important issues such as mental health do not get ignored. We can all take inspiration from the passion and dedication of the Ghanaian delegation.

Finally, I feel extremely fortunate to have had this experience. This summer gave shape to what was initially a vague interest in global health, as I am now beginning to see what it is actually like to be involved in this kind of work. Most distinctively, because GHLI connected me with high-level officials, I was able to get a behind the scenes view of how health policymaking works.

As I continue pursuing a career combining medicine with health policy, I will always be able to look back at my summer in Ghana as the formative experience that inspired me to continue down this path.

September 17, 2012

After Liberia

Janeen Drakes, 
2012 GHLI Fellow 

Almost a month after returning to New Haven from Liberia, I still find myself reflecting upon my time there. My stay in Liberia was a whirlwind of activities, emotions and experiences which were, at times, seemingly insignificant, confusing and conflicting. However, they were profound in the fact that they challenged me, my outlook and abilities, and my professional and personal aspirations.

Working in a setting with limited resources taught me to not only temper my expectations, but to also do the most with what I was given. I learned that simply observing and interacting with others can be as great of a learning experience as working continuously. Forming relationships with colleagues and strangers turned out to be eye opening and crucial for adapting to a new place and culture.

Most of all, being in Liberia confirmed my desire to work in developing countries. I have always included that goal among the numerous lists of things I would like to do in my career. After my summer in Liberia, I’m comfortable in my ability to return to a similar setting and to thrive. In this way, this past summer has been undeniably important for me on a personal and professional level.

Returning to school, work and the distractions of life in New Haven, it is a little easy to forget some of these lessons – but I try to find ways to stay connected to Liberia and the experiences I had there. I stay in contact with those colleagues and continue some of the work I started there as I explore ways to return. In these ways, I hope that I will be consistently reminded of my time spent in Liberia.

Parting Thoughts from South Africa

Testing a community well during household 
visits with a community care giver (CCG) 
Heather Fosburgh,
2012 GHLI Fellow

My final weeks in South Africa were spent on site visits documenting the piloting of the National Health Insurance initiative. This work allowed me to see the many different facets of the South African health care system and two things in particular that stood out to me: First, while talking with the pharmacy staff at the anti-retroviral clinic in the district hospital, I learned they filled an average of 500 prescriptions a day. While you cannot visit, work or live in South Africa without being constantly reminded of the HIV and AIDS crisis, it took standing inside the pharmacy looking at the large queue of people waiting for prescriptions to fully comprehend the volume of people affected.

Second, I realized the extensive role of the community care givers (CCGs). Previously called community health workers, it took only a few household visits to see why these invaluable community members were considered care givers. While these women do cover all aspects of community health, they also serve as quasi social workers, advocates, and administrators. With the CCG, donned in her winter coat and me, woefully underdressed for the chilly weather, we went from house to house where she knew all of the details of the families under her prevue. It was very impressive.

Overall, when reflecting about my time in South Africa, I think the most notable aspect of my experience was the constant excitement I felt being involved in public health work. A year ago, I was enthusiastic but also nervous embarking on the MPH program as I was leaving my successful career to essentially start over. Having been out of school of a number of years, I encountered some academic challenges I had not anticipated. Sometimes I wondered if I had made the right decision. However, my time in South Africa reinforced that I had made the right decision and I cannot wait to start a career in global health.



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Farewell, Ethiopia!



Sudhakar Nuti,
2012 GHLI Fellow

My stay in Ethiopia has been one of the most enriching, educational, eye-opening and humbling experiences of my life. I have not only accomplished my tasks as a GHLI Fellow but also forged lasting relationships with some amazing people.

In our short time there, Lexy (GHLI Fellow) and I worked on the advancement of the Ethiopian Hospital Alliance for Quality (EHAQ). We conducted site-visit trainings, visited hospitals across the country and started to put together the next Change Package to improve the hospital performance nationwide. We have accomplished many of the goals we set before we left New Haven, and it is fulfilling to know we helped make a difference.

I have also learned a lot about myself in the past six weeks. My Ethiopian adventure has shifted my thinking on all levels, whether it be my career plans or how to carry myself on a daily basis. I know that I would like to work in international health -- treating patients as a physician, conducting research, doing global health world or all of the above. There is something special about working in Ethiopia and I have a strong feeling that I will be back there soon.

While this door may be shut, I believe that so many more have opened. I am more aware of the health problems that people face in the developing world and am even more inspired to tackle them. And I have Ethiopia and her people to thank for that.

My Ethiopian Experience

Lexy Adams,
2012 GHLI Fellow

As I reluctantly packed my bags to come back home, I reflected on many adventures, eye-opening experiences and friends made during my time in Ethiopia.. I carefully wrapped my traditional clay buna, or coffee, set in my new silk scarves and squeezed other souvenirs into my suitcase.

Stepping back into the States didn’t feel real. It was like awaking from a dream, reentering the developed world filled with an excess of wealth, cleanliness, big cars, electronics, watery coffee. I dreaded powering on my Blackberry, which immediately began buzzing with months of missed communication. I missed the free feeling back in Ethiopia, where phones aren’t smart, service is spotty and wifi is scarce, where I could exist as a single entity not plugged into a massive network. I missed injera.

Whenever someone asks me about my summer, I always hesitate. My experience doesn’t sum up nicely into a concise answer; I struggle to find the right words. Fantastic, overwhelming, eye-opening, a massive learning experience, an incredible adventure. But, the most fitting word is inspirational. This summer convinced me that I was on the right path, and global health would be my future. I love traveling, meeting new people, and exploring cultures too much not to work internationally. I also decided that I needed to go to medical school. I walked through too many hospitals filled with suffering people that may never receive the care they need. I was heartbroken that I couldn’t personally do anything to alleviate their pain beyond a friendly smile. I need to invest in medical school in order to help people as I wish I could.

I effectively fell in love with Ethiopia, and I hope to return in the near future. Of course, there are many other countries to explore, but I think Ethiopia will always hold a special place in my heart, with its vibrant culture, breathtaking country landscapes, and loving people.

Ethiopia Sets an Example on Strengthening Primary Health Care Efforts


Erika Linnander,
Director, Field Programs, GHLI

In 2004, the Federal Ministry of Health in Ethiopia (FMOH) established the Health Extension Program (HEP) to improve access to sanitation, vaccinations, family planning programs, and pre- and post-natal care services across a diverse country of over 84 million people.

HEP has been a great success, but based on similar programs in other countries, a high profile start-up is often followed by a gradual decline in effectiveness and efficiency. Additionally, the benefits of the HEP have not been felt uniformly across Ethiopia, and there is room for improvement.

The FMOH is setting an admirable example on how to maintain the enthusiasm for such programs, by acting early to create a long-term development strategy for primary care that builds on the initial successes of the HEP. Together, with our colleagues at the Bill & Melinda Gates Foundation and the Harvard School of Public Health, the GHLI brought together policymakers and practitioners from around the world to share their experiences and with a delegation of Ethiopian policymakers as they develop their strategy. You can read more about this meeting here.

At GHLI, we apply problem solving methods and research on the science of scale-up to inform the FMOH’s long-term strategy for primary care, working closely with Ethiopian policymakers to ensure alignment with the country’s broader development plans. Our hope is that this long-term strategy will result in a model for primary health care that is flexible to meet the needs of Ethiopia’s urban, agrarian, and pastoralist communities; robust to withstand the country’s transition from low- to middle-income status; and effective to ensure continued health gains for more than 80 million Ethiopians.