University of North Carolina Center for Global Initiatives

This summer I had one of those rare experiences where the various interests in my life converged on one project.  For the last four years in North Carolina, I have worked in service-learning offices coordinating and supporting students who want to work in communities.  Currently, I am also working on a Masters in Health Behavior in the Gillings School of Global Public Health.  Supporting volunteers and working to improve people’s health at a population level had always been separate interests of mine until this summer when I learned about the powerful potential of volunteers to improve the health of the communities that they are a part of. 

With the support of CGI I was able to spend the summer in Thailand, where I did qualitative research with the Village Health Volunteers, the national community health workers of Thailand.

In Thailand there are almost a million Village Health Volunteers, or about one for every fifteen households.  The Village Health Volunteers provide basic clinical services, such as checking weight, blood pressure, and blood sugar to screen for diabetes.  They provide health education on diet, exercise, maternal and child health, and many other topics.  They help prevent infectious disease through providing resources and education to improve health outcomes, such as techniques to limit mosquito reproduction to decrease the incidence of Dengue Fever.  Despite the impressiveness of everything that the Village Health Volunteers do, what they do is not as impressive to me as how they do it. 

The Village Health Volunteers create change through long-term relationships and connections with the people they are serving.  They are neighbors and friends with the people they are responsible for.  They are able to offer advice and support that is tailored and individualized based on their knowledge of the community and relationships that have been built year after year.   An example of this is that when a Village Health Volunteer notices that you have abnormal symptoms and refers you to go see the doctor, they do not just stop with a verbal recommendation. If you forget about the appointment, they will remind you, if you need a ride they will take you, and in one instance that I observed this summer, if you are being stubborn and insisting that you do not need a doctor despite mounting evidence that something is wrong, they will go get a doctor and bring the doctor to you. 

I feel that I learned so much from being able to study the activities that the Village Health Volunteers perform and how the they accomplish their work.  As a person deeply interested in both supporting volunteers and improving health, the long-term relationships that the Village Health Volunteer program encourages and supports is a model that I think is applicable to many other health outcomes and community contexts.  This summer was an incredible experience and also provided me a direction of research and practice that I hope to continue to pursue in the future. 

Dane Emmerling

Dane Emmerling is a Masters student studying health behavior and health education in the Gillings School of Global Public Health. He received a CGI International Internship Award to investigate the effectiveness of Thailand's peer support interventions. Check out the Awards page of our site to learn more.

With the support of CGI through the Carolina Undergraduate Health Fellowship, I was able to travel to Ghana as a trip group leader with Project HEAL, a committee of the UNC Campus Y. I travelled in Ghana with a group of five other wonderful UNC students.

We began our journey in Accra but after just a few days in the capital and another large city, Kumasi, we travelled by bus to a small rural town called Lawra in the Upper West Region. Project HEAL has been returning to this same area for the last six years and has thus built relationships with the leaders, teachers, and people of Lawra. Without their collaboration and support, we would not have been able to implement our public health and educational projects.

First, we were able to complete and plan several sustainable development projects. Through the use of drip irrigation systems, we were able to help create a Moringa tree nursery with MOFA (Ministry of Food and Agriculture) and a local Peace Corps Volunteer. The nursery is located at the old MOFA fisheries site in Lawra and the goal is to restore it as a showcase for alternative livelihood projects. Furthermore, we have made plans to complete rainwater collection systems next summer at several potential locations. We met and spoke to administrative staff at the Lawra district hospital to hopefully install a rainwater collection system next year at a community health clinic. We also made contacts with several women from a small village named Tabier, where we could potentially install a rainwater collection system as well.

For health projects, every year Project HEAL performs first aid and dental workshops and distributes kits at various schools in the region. This year, we performed first aid and dental workshops at four primary schools and a women’s community group, totaling about 1000 individuals. We conducted presentations with the teachers of the schools to ensure that our workshops are culturally relevant. In many of the younger classes, the teachers translated our presentations in the local language of Dagaare. Additionally, we donated much needed medical supplies to the Lawra district hospital. Some people in our group were able to shadow doctors in the pediatric ward of the hospital.

Lastly, we completed educational projects. At the Eremon senior high school, where another local Peace Corps Volunteer teaches, we painted a world map mural on the side of the dining hall that includes all of the labeled countries. When we asked high school students to point to Ghana, they simply did not know and some did not know which continent was Africa. In many public schools in Ghana, geography is not often taught in schools because of a lack of funding and supplies.

What excited me the most while we were in Ghana was the people. In the harshest environments, I met some of the happiest people. Many days, the highest temperature was definitely over 100 degrees. Thunderstorms brought relief but came with the tradeoff of no electricity throughout the town. When we went to the village of Tabier, we were able to briefly experience village life.  There, people have to work so hard for basic necessities like food and water much of the time without the conveniences of infrastructure such as improved sanitation, running water, and electricity. For a women’s group in the village, we performed a first aid and dental workshop. After our presentation, the women thanked us with the most jubilant and energetic songs and dance. I will remember the places I saw but more importantly the people I met for the rest of my life. 

Mimi Caddell

Mimi Caddell is an environmental studies major in the College of Arts and Sciences. She received a the Carolina Undergraduate Health Fellowship for sustainable water use development and Health Education Projects in Ghana. Check out the Awards page of our site to learn more.

Looking back now, I would say that returning to Tanzania gave me a chance to see the place for what it is, rather than with the wide eyes of a newcomer eager to compare everything to my expectations.  Ironically, I was greeted by a large family of monkeys who enjoyed playing tag on my tin roof most mornings (which is stereotypical, but far from typical).  Still, I had a chance to live a relatively normal life for seven weeks among dogs, cats, chickens, books, daladalas, rice and beans, a massive doctors’ strike, and a mountain that never ceases to amaze me.  I did say “relatively.”

I need to first be clear about one thing: my summer internship was an office job.  With that said, it wasn’t a typical office job as one would define it in the US.  My second work stint in Moshi led me back to the country with a new focus on the inevitable issue of HIV and AIDS. 

The immediate area doesn’t have the highest HIV prevalence (6%) or the most disadvantaged citizens (it’s a tourist town) in sub-Saharan Africa, but for decades it has proven to be an effective research hub for scholars of many nationalities.  The HIV/AIDS epidemic is also not as formidable as it used to be.  Testing, counseling, and treatment services are widely available, often for little to no cost, meaning the disease is no longer a death sentence for those who test positive.  One of the major remaining barriers, though, is the fact that many people simply do not know they are infected.  In the country as a whole, only one-third of Tanzanian adults have ever been tested for HIV in their lifetime.  This means that there are still countless (literally) individuals who are contagious and likely won’t discover their status (or their partner’s) until it is too late.

With all this in mind, I came into my summer internship to assist with a survey that’s using innovative methods to ask ordinary citizens what would compel them to get tested.  One of the bigger challenges to this project, as I would learn, was finding a way to reach a random sample of these “ordinary citizens.”  It would have been straightforward to deliver the survey to a captive audience of hospital patients or visitors to a women’s clinic, but we wanted a pure and unbiased representation of the town as a whole.  Why not use addresses or random phone dialing or census data?  Enter the developing country effect.  These typical sources for population-based sampling range from non-existent to unreliable in a setting like Tanzania. 

After a lot of back and forth, we finally decided to choose random points throughout town as starting points for household recruitment.  Most of my days were filled with the process of developing and carrying out a systematic way to do this using maps, GIS technology, spreadsheets, screenshots, file converters, and other fun tools.  This work represented just one of many steps in the process of executing the study, and the study will be just one of many to investigate HIV testing strategies in Africa.  This summer’s work not only gave me new knowledge and skills, but it also gave me perspective and hope.  I now have a much better understanding of the vast scope of the HIV/AIDS epidemic, but I also have more hope that increased attention to health behavior will allow for further progress.  I really appreciate CGI and the International Internship for helping to provide an opportunity to do this work and think about how I want international research to play a role in my career.

Andrew Weinhold

Andrew Weinhold is a graduate student studying health behavior and health education in the Gillings School of Global Public Health. He received a CGI International Internship Award to develop a survey to inform HIV testing practices in Tanzania. Check out the Awards page of our site to learn more.

Cultures, traveling, and exploring have always been passions of mine. Maybe it was due to the fact that my extended family decided to take a vacation to Cancun, Mexico when I was only 6 years old. Or it could have been due to the influence of Alvin, Simon, and Theodore. Yes, the Chipmunks, and their race around the world in hot air balloons in the epic adventure “The Chipmunk Adventure." Either way, I had a strong fascination with the worlds outside America. After graduating from the University of South Carolina with a degree in chemical engineering, I moved overseas, first to Egypt and then to Lebanon. I spent two years abroad learning Arabic and working with university students. During my time overseas, I began to see the physical needs surrounding me in the Middle East. I wondered how I could use my engineering background to serve the poor in the developing world.

            In the spring of 2010, I began searching for job positions that combined engineering and international development. As I read the descriptions, I realized that even with my Bachelor’s degree, I was lacking key skills. However, the search enabled me to determine what kind of a career I wanted and helped me identify graduate school as a means to gain the necessary experience. When I was looking at graduate programs, the Gillings School for Global Public Health stood out due to its diversity of departments.  The unique placement of the Environmental Engineering program within the School of Public Health was a major draw for me because it provided the opportunity to learn about the nexus of water systems and health. I had also read about the Water Institute through the school’s website and was excited to work with researchers from diverse backgrounds that were all studying various aspects of Water, Sanitation, and Hygiene (WASH).

            When I interviewed with my advisor, Dr. Jamie Bartram, I emphasized how important fieldwork experience was to me. One of the skills I was seeking to gain through my graduate studies was the opportunity to experience WASH projects overseas firsthand.  Knowing this, Dr. Bartram was able to pair me with an internship with the University of Leeds to work on a collaborative project called “At Home Water Supplies” funded through the UK Department for International Development (DFID). The project was a joint cooperation led by the University of Leeds, and included the University of East Anglia and the University of North Carolina.

            The project itself focused around quantifying the health benefits of having water at home rather than using a shared public supply. One of the Millennium Development Goals (MDGs) is to “halve, by 2012, the proportion of the population without sustainable access to safe drinking water and basic sanitation” (United Nations, 2002). While the goal is a bold declaration, it lacks a definition of what “access” truly means. How much water should people have and how far away from one’s home? The DFID At Home Water Supplies study aims to further explore the relationship between distance to the water source and its impact on health. 

            As an intern for UL, my responsibilities ranged from stateside preparation of logistics to implementing the household survey data collection in Ghana over the summer.  One of my stateside responsibilities included writing an ethics application to submit to the UNC Institutional Review Board. I was also responsible for creating a projected fieldwork timeline, a budget and then purchasing the necessary supplies and equipment. Months before my departure, I had weekly skype calls with the team in the UK as well as our in country partners to plan out the necessary details of our research project.

            Before arriving in Ghana, my colleague, Dr. Mike Fisher, and I were able to spend a few days in Norwich with the rest of the research team. The time was invaluable for ensuring that we had a consistent understanding of our research instruments. Our study was to be carried out by the partnering universities in three separate countries. UNC would be responsible for data collection within Ghana while two other teams collected data in South Africa and Vietnam.

            On July 19th Dr. Fisher and I arrived in Accra, Ghana and were received by colleagues from our partnering institution, Kwame Nkrumah University of Science and Technology (KNUST). Immediately after arriving, our host Mr. Leslie Danquah, a KNUST doctoral candidate, escorted us to Kumasi where we were based during our 8-week data collection campaign.

            The first week in Ghana we spent becoming familiar with the culture and setting up our fieldwork. We needed to recruit at least 12 research assistants in order to administer our survey to 250 households within the allotted 8 weeks. Mr. Danquah assisted us by identifying roughly 20 candidates for us to interview as potential assistants. After reviewing their skills in math, English, written and spoken Twi, we hired 16 to work on our project. Once we were confident with the 16 candidates, we began training them on our household questionnaire and the specific equipment they would be using.

            At the end of training, we spent five days piloting our survey in a nearby rural community. This also allowed our research assistants to practice interviewing real households and for us to catch any errors they were making in recording the responses. In addition, it gave Dr. Fisher and I the opportunity to iron out logistical speed bumps that came up. Upon completion of the pilot, we transitioned to the first of four communities where we would be conducting our research.

            Since we only had 8 weeks to gather our data, we needed to work six days a week, beginning at 8am and concluding our interviews at 4pm. At the of the day, the research assistants then gave us their completed surveys and water samples. However, our workdays were far from over though! Dr. Fisher and I then checked each survey for completeness and consistency. We then had to process the water samples collected that day and read the results of the samples from the day before. Once the surveys were checked, they then had to be scanned to ensure a backup copy existed of all data collected. While the pace was sometimes overwhelming, we were able to accomplish the majority of the fieldwork before I returned to North Carolina.

            One of my favorite experiences happened during the first week, when Dr. Fisher, Mr. Danquah and I were visiting the study communities. Mr. Danquah guided us to the local water points where we were able to informally ask questions of the children gathered around the borehole for their evening water fetching chore. Mr. Danquah graciously translated for me so that I could ask the girls about carrying water from the borehole back to their house. In Ghana, it is customary for women to carry items on their head. We watched the women and children fill up their containers, lift them onto their heads, and begin the journey home. Dr. Fisher then decided that he wanted to see how difficult it was to balance that much water on his head! So with the help of the women, children, and Mr. Danquah, both Dr. Fisher and I attempted to carry a container full of water on our heads! It is as hard as it looks, especially since the water shifts as you move! The children applauded us and laughed heartily at the strange “brunis” (white people) who had come to ask them questions about their water.

            While working in the field, I gained highly valuable skills that have dramatically influenced how I view my second year of graduate school. My courses were interesting during my first year, but since my return to the classroom I have noticed a heightened focus. There is more of a connection between what I am reading and learning to what I have experienced overseas. Through my internship in Ghana, I have also learned how to manage a field campaign in a foreign country. Although at times it seemed like trial by fire, I appreciated the opportunity to make decisions in the field and have the responsibility of problem solving. One of the biggest lessons I learned during my time in Ghana is that fieldwork is never as clean as the published papers make it out to be! Data collection is messy and when dealing with a foreign culture, there will always be unanticipated cultural differences between researchers and subjects!

Ashley Rhoderick

Ashley Rhoderick is a graduate student studying environmental sciences and engineering in the Gillings School of Global Public Health. She received a CGI International Internship Award to determine the benefits of at-house water supply in Ghana. Check out the Awards page of our site to learn more.

As a Master’s student in the School of Public Health at UNC, I am very interested in the intersection of global health and chronic disease management. This summer with the support of CGI, I was fortunate enough to combine both of these interests by conducting research in Thailand on the Village Health Volunteer (VHV) program. As a little bit of background, the VHV are lay health workers in Thailand, who provide support to fellow community members on a variety of different health outcomes, ranging from Dengue Fever to Diabetes. In doing so, they perform a variety of different activities, such as blood sugar screenings and surveillance of stagnant water that could breed mosquitos.

Along with another colleague from my Master’s program, I was given the opportunity to conduct qualitative research on the VHV program. Primarily, we were interesting in assessing how they offered support to individuals and what factors influenced this. However, what I learned transcended these initial research questions, both academically and personally.

In an academic sense, I vastly increased my knowledge, understanding, and ability to perform public health research. While I was taught the basics of research methodology in the classroom, the skills that I learned over the summer far exceeded what could be theoretically explained. I learned how to create an interview guide in an international setting, how to collect data by working with translators, and what it means to engage with communities. I also learned about real-world barriers and challenges to conducting research, especially research abroad. There were linguistic barriers (e.g. there is no Thai word for empowerment), cultural barriers (e.g. hierarchies that determined to whom we could direct questions), and logistical barriers (e.g. lack of time).

In developing my skill set and encountering these challenges, I learned one of the most valuable experiences of all—the value of support. In fact, throughout the research, my classmate and myself explored how the Village Health Volunteers offered support. This would often take different forms. Sometimes, the VHV would do home visits and ask simple questions, such as “how are you doing today” or “have you had any problems recently?” In other instances, the VHV would act as liaisons between patients and doctors, helping to translate concerns or suggestions. In other cases, they would perform blood pressure and blood sugar screenings and help patients understand what the results meant. Thus, we observed that the VHV were influential to the health of both individuals and communities and that the support they offered was influenced by a number of factors.

However, in addition to the support we researched in the community, I also came to personally appreciate the value of institutional and community support from my own experience. Logistically, there was financial and academic support from UNC, CGI, and Mahidol University (our partner organization in Thailand). More than that however, there was an incredible amount of support from the communities in which we worked and the people with which we interacted. I feel so fortunate to have made long lasting relationships with the doctoral students and faculty that assisted our research. Even in our limited site visits, I felt an incredible amount of support and respect from community members. In the United States, we often value the “I”; this summer in Thailand, I learned to appreciate the “collective we” and the value that this adds to both research and personal experiences.

All in all, this was an incredibly rewarding experience that taught me important lessons regarding qualitative research, international settings, and community engagement. In doing so, it has informed my own research methodology and given me a greater perspective for my future pursuits.

Sarah Kowitt

My trip to Central Asia was not something that I had planned for the summer 2011. In fact, it was a spontaneous endeavor that turned into a life changing experience and helped me to reconnect with my family roots. My interest in the region stemmed from my diverse background and my upbringing in Russia, and I developed a passion for initiating efforts to encourage education in post-Soviet nations. To me, education is an essential part of international development and means of increasing living standards and the general welfare of any country.

It all began with the decision to take advantage of my summer and satisfy my passion for volunteer work. I always enjoyed community service and while participating in several projects at a time throughout Chapel Hill and the surrounding areas, I wanted to satisfy my wanderlust as well. I underwent the regular process of applying for internships to various NGOs, but after several months of silence, I took the matter into my hands and contacted professors and staff at UNC to aid me in my search for a summer project. Luckily, I was able to contact the U.S. Embassy in Turkmenistan and after several persistent emails, I received a reply and was recommended to American Councils. This particular NGO is funded by the U.S. State Department and deals specifically with aiding students in their educational pursuits, and I would be personally overseeing the academic progress of students in the capital of Ashgabat. It was truly the funding from CGI that secured my summer internship with the NGO.  Without the scholarship, I would not have been able to discover my new-found passion for Central Asia.  I recall daydreaming about the scorching sands and, according to State Department’s website, the abundance of scorpions. Sights I wanted to see and new sensations I desired to experience were all made possible by CGI.

Was I scared? Deathly. This was the first time I traveled by myself and without knowing a single soul in this exotic country, my expectations reached zero. As I waited at the airport in Turkey, I began to notice women in strange garbs lining up by the gate labeled “Ashgabat, Turkmenistan”. What on earth made me decide to go there? I recall my first few days as a blur. It could have been the heat or the unceasing tears. I am not afraid to admit that I was very scared to be alone and without a decent Internet connection and no way to contact my parents or friends, I sought comfort in my new surroundings. Over the next few weeks and months, I learned the bus routes and the taxi system. I began to pick up words and customs, and the sights that I dreamed about at night finally began to blend with reality. The people were curious about this new comer who spoke their language and was their only link to America. My host mother had to adjust to my Western clothes and addiction to the Internet while I had to adjust to sitting on the floor for every meal and my new style of living. I traveled across town and taught English and college prep classes every day and over time, I learned. I began to understand my students and how much they longed to improve their education and better their chances in this life. Talking to them and truly appreciating our differences and similarities made this experience invaluable. I put aside my ambitions and dedicated my efforts to help them become more proficient in English and improve their skills in essay writing and critical thinking. As I taught these students what it means to be educated in the United States, I understood what it meant to me. As an immigrant from Russia, I was truly lucky to attend such a great university and I hope to dedicate my time and efforts after my graduation to NGOs such as the American Councils.

The country of Turkmenistan is mostly considered to be one of the “-stan”s and its distinctive customs and traditions are completely different from the surrounding post-Soviet states. Indeed, I did not teach my students in my classes as much as they were able to teach me outside of the office. Girls of sixteen or eighteen years of age took me under their wing and allowed me to truly experience the country and its customs. I spend every waking moment adapting and that is the only way one can truly appreciate the country and its unique qualities. I was able to attend a traditional Turkmen wedding, travel to rural villages, and visit historic and religious sites. I began to blend into their world by adopting even the Turkmen dresses and eating with my hands at every meal.  With that, I was able to truly understand what it meant to live 6,500 miles away from all the comforts of home.  Shed your old self. Lose the fear, because in a way, the people of Turkmenistan were not so different from me and as I retrace my steps back to a region that is so exotic and unknown, I began to understand that it is closer to me than I previously believed.

Karina Ibrahim was awarded a C.V. Starr Scholarship. Check out the Awards page of our site to learn more.