Last January, Hanna Amanuel ’16 arrived in Sierra Madre de
Chiapas, Mexico, with a strong interest in maternal health. Four months later, when
she left the region, she had witnessed a home birth. “It was a very magical
moment,” she recalled. “It’s different when you hear women’s stories about
birth and when you actually see it in real life.” Amanuel was one of the first
two Harvard undergraduates who spent their spring semester in rural southern
Mexico as part of the Global Health Equity Option (GHEO) Scholars program, a
new study-abroad opportunity that enables undergraduates with an interest in
global health to learn in the field.
This past spring, Amanuel and Ishani Premaratne ’15, the other GHEO
Scholar, juggled service in the local clinics, ethnographic fieldwork, and four
virtual courses that Harvard professors tailored specifically to their
experience abroad: a clinical ethnography course from Rabb professor of
anthropology Arthur Kleinman, a health and human rights course from Harvard Medical
School associate professor of global health and social medicine Joia Mukherjee,
a political economy course from Florence professor of government James
Robinson, and a religions in Central America course from Rudenstine professor
for the study of Latin America David Carrasco. On top of the program’s
requirements, Amanuel and Premaratne, who are both pre-med anthropology
concentrators pursuing a secondary field in global health and health policy
(GHHP), had to adjust to a new culture, community, and environment. Said
Premaratne, “It was a perpetual learning experience.”
Administered by the Harvard Global Health Institute, a University-wide
platform for global-health initiatives, the GHEO Scholars program promotes a
combination of coursework and experiential learning. “What I hope is that
students can integrate what they see on the ground with what they learn in the
classroom and thereby develop a greater appreciation for health problems and
potentials,” wrote Eckstein professor of applied economics David Cutler in an e-mail
to Harvard Magazine. Cutler, a health-economics expert who received a
grant from the President’s Innovation Fund for
International Experiences to develop the study-abroad program, was also instrumental in
establishing the undergraduate GHHP secondary field in 2010. (The secondary
field replaced a certificate in public health that had been in place at the
College since 2007.)
The study-abroad opportunity arrives at a time when interest in
global health is burgeoning among undergraduates. According to data provided by
GHHP program coordinator Christy Colburn, 103 students graduated with a
secondary field in GHHP in 2014—approximately twice the size of the first cohort
who fulfilled its requirements in 2011. Last year, GHHP was the largest
secondary field at the College, with 117 members of the class of 2013 completing
the required courses. Expanding Harvard’s global-health program has also been
one of President Drew Faust’s stated priorities in the last few
years.
The GHEO Scholars initiative in Sierra Madre de
Chiapas resulted from a partnership between the Harvard Global Health Institute
and Compañeros en Salud México
(CES), a regional branch of the Boston-based umbrella organization Partners in Health—co-founded
in 1987 by Kolokotrones University Professor of global health and social
medicine Paul Farmer. Officially launched in 2012,
CES now operates six clinical sites throughout Chiapas and collaborates with
the Mexican government to improve healthcare access and delivery. Although Mexico
offers universal health insurance, CES co-founder and chief clinical strategist
Daniel
Palazuelos noted that remote regions like Chiapas are largely
excluded from the healthcare system. In addition to delivering primary care to
the local population, half of whom live in poverty, his organization provides
on-site training and mentorship to pasantes,
recently graduated Mexican doctors fulfilling their mandatory social-service
year. (The Mexican government requires all new physicians to spend some time
serving a local community.) The pasantes
who fulfill their requirement at one of the CES clinics work in partnership
with Harvard medical residents interested in learning about primary healthcare
delivery in a rural setting.
Palazuelos, who is also the assistant director of
the Global Health Equity Residency at Brigham and Women’s Hospital (BWH) and an
instructor at Harvard Medical School, said that CES profoundly transforms the pasantes’ conception of medicine. “They
understand the social determinants of diseases,” he explained, adding that the
CES training involves understanding the legal and economic factors affecting
people’s health. Unlike other global-health organizations, “[CES] is very much
designed and based on improving the existing healthcare system and making the
existing healthcare system stronger,” noted Andrew van Wieren, a primary-care
resident at BWH who has worked with CES for the past few years.
As Amanuel explained, the GHEO program is unique
in that it allows students to work closely with the CES doctors as they provide
patient care, an opportunity that is difficult for undergraduates to find in
the United States. Both women, who lived near two different CES healthcare
delivery sites, spent their mornings at the local clinics, observing and
assisting the physicians. The study-abroad experience reinforced Amanuel’s
commitment to promote reproductive health in Eritrea, where most of her family lives, and in
neighboring countries.
Reflecting on her time abroad, Premaratne said that one of the
most valuable aspects of her experience was being able to apply information
from the virtual courses directly to her fieldwork. During her time in Chiapas,
for example, she conducted primary research on health-seeking behavior among
local women, which will be the topic of her senior thesis. “We know that [GHEO] is kind of an unorthodox program,
but I think it’s really part of the greater move toward experiential learning,”
she explained. “We hope that we are evidence of just how valuable [this
program] is.”
According to Hugo Flores, CES co-founder and
on-site director, the organization taught the GHEO Scholars the important role
that familiarity with the local context plays in effective healthcare delivery.
Flores described the women’s experiences as extremely successful, adding that
programs like GHEO allow students to use the principles of global health to
analyze real problems. Palazuelos said the GHEO program is a great way to
provide undergraduates with a transformative educational experience, adding, “Who
is a more powerful potential change agent than a Harvard student?”
As they learned about global health, Amanuel and
Premaratne forged friendships with both the CES staff and members of their host
communities. The two women mentioned that one of the biggest challenges they
faced during their time in Chiapas was saying goodbye. “It’s so hard,” Premaratne said, “to leave an
environment and a family you’ve become so close to.”
Francesca Annicchiarico ’16 is a summer editorial intern at Harvard Magazine. The Dunster House resident and social studies concentrator comes from Portogruaro, Italy.