One student’s view of the UW global health and justice confab: Watermarks

 Over the weekend, the University of Washington held a student-run conference on global health. This was the 9th year for the Western Regional International Health Conference and this year’s theme was on social justice and health. Here’s one UW student’s perspective as she jumped from one session to another. 

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By Cyan James, special correspondent

Quick: tell me what’s watermarked on Angola’s 5-kwanza note?

Stumped? I thought so.

Turns out there’s a statue portrayed on every Angolan 5-kwanza, and it’s no Venus de Milo or David—it’s The Man Who Thinks Too Much, a bent, stylized figure who cradles his head in his hands (a little like Rodin’s ‘Thinker,’ but with more of a headache.)

www.randafricanart.com

In Angola, ‘thinking too much’ is an expression for depression. One of the panelists at the UW conference speaking on mental health, Dr. Paul Bolton of Johns Hopkins University, said jokingly: “Dumb people don’t get this disease.”

More seriously, Bolton pointed out that if Angola saw fit to watermark their currency with a symbol for depression, it could mean Angola takes depression seriously. Or at least knows about it.

It still surprises people to hear that depression is, in fact, one of the world’s biggest killers and causes of disability. Yet it remains neglected on the global health agenda. In 1990, health researchers — now based in Seattle — looked at the leading causes of death and disability and found mental illness was one of the most damaging diseases globally.

As I jumped from session to session at the University of Washington’s 9th Annual Western Regional International Health Conference, I found myself persuaded that mental health on a global scale remains both an important and largely invisible problem. One of the themes of the meeting was finding hidden paths to improving global health.

Like the watermark on Angola’s paper currency, mental illness is always there but often unseen.

I study mental health genetics in UW’s public health genetics PhD program. And I study a lot, so maybe I wasn’t exactly thrilled about spending a semi-rainless weekend back at school. But I went, mostly for the chance to talk about mental health and other ‘hidden’ global health subjects. 

Opening Day, Friday

International rights advocate Kavita Ramdas kicked off the conference by complimenting UW students on our eagerness to jump into global health without backing down. Then she reminded us that 15.4 million Americans – many of them in Seattle – live in poverty on what works out to be $6.85 per person per day.

That’s 15.4 million Americans! Do the math. That’s equivalent to the population of 25 cities like Seattle.

The gist of it is: We’ve got problems, too

In a conference supposedly dedicated to global affairs, Ramdas’ talk was the springboard for a number of speakers and sessions pointing to the problems in our own backyard, a backyard choked with the bungle known as American health care, crippled educational reforms and dozens other examples of our own malaise.

“We want to be first in the world,” Ramdas said, “But to think globally is no longer to think in those linear terms.” Instead, she proposes, why don’t we stand in a circle, acknowledging our connections without continually jockeying to be in first place. There is no first place in a globalized world, in a non-linear economy and international system.

Most U.S. students last studied geography in 5th grade, Ramdas said. Too frequently we can’t even point to the countries we claim we want to help on a map. We should wince when we hear that, she says. I discovered I was wincing. I was wincing hard, and I’m realizing that after three years of classes telling me over and over that the U.S. health system is a wretched disgrace, I’m yearning for detailed, doable solutions.

So, Kavita, I want to holler at her, Tell me what to do! Scanning the conference twitter feed (#uwghrc), I could tell others are fired up about her challenges, too.

Ramdas says many of the solutions to our problems start with the women, and she buttressed her points with a flurry of adeptly cited statistics and references. We need to “get out of the dreary sands of habit,” she said, in favor of hearing women’s voices, celebrating alternative methodologies and practices, and getting over our win-win-win, eyes-on-the-prize, Go-Dawgs mindset in favor of “things so small we cannot find them on a map.”

We can truly learn from others, in other countries, if we stop trying to be first.  When, Ramdas asked, did we last think about Cuba’s healthcare system? It’s health care indicators are, in many cases, superior to ours yet costs a lot less. Can we learn from them?

Next day, Saturday

Today is a terrifically global day. Global health organizations from across the Northwest lure me with pens, papers, candy and smiles. Pastries and health posters are neatly displayed in a conference break room.

I polish off a scone and head to a session on technology and global storytelling where I hear I-TECH Executive Director Ann Downer comment that both stories and food cross all kind of boundaries, and that “and people anywhere recognize an authentic voice.” One way to grab those voices lives in everyone’s pocket, panelist and photojournalist Keri Oberly reminds us: “Your phone is your visual journal.”

To round out the session, panelists showed clips from a video about HIV in Tanzania (www.wazifilm.com), and from a website collecting more than 330 short videos from global health leaders (www.everydayleadership.org.)

Downer points out how easy it is to hand stories out, but how hard it can be to stay vulnerable. If you’d like to hear deeply touching stories from others, she insists, it only makes sense open up yourself.

True, I think as I chew on her words. While the morning session doesn’t help me understand how to liberate people’s voices as much as I’d hoped, it does impress me, and it does remind me how much good stories can change things.

With an appetite for really meaty stories I jump back onto the mental health track (the conference is arranged into six different “tracks,” each focusing on a ‘hidden’ global health topic) with a session on stigma and mental health.

I’ve heard a lot about stigma, and what I hear in this session reinforces what I’ve heard: stigma is real, is really impacting, and can be directly addressed. The panelists give us a look at (mostly HIV-related) stigma in South America and Africa.

How do we undercut stigma? Form personal relationships. Again: be vulnerable, talk to people one-on-one, show respect, be culturally sensitive.

I also got gut-punched by this video Dr. Susan Graham shares about homophobia in Uganda.

Sobered, I take a break: most posters, more pastries. I wander around awkwardly, wanting to connect with others but not really knowing how to besides small talk. It’s a relief when the next session starts.

Again the session takes a long and hard look at mental health.

Deepa Rao tells us about developing mental health training programs and about working with domestic violence survivors and depressed diabetes patients in India. Dr. Jürgen Unützer advocates integrating medical providers so that mental health won’t stand so separate from other medical systems. Paul Bolton strung together a series of fieldwork anecdotes and hard-hitting statistics, focusing on the problem that  “everything we know about healthcare comes from the West.”

Paul Bolton talks with students at the UW about mental illness and global health
Cyan James

He flashes something that really lodges in my brain: a slide of a typical Ugandan school lesson portraying how to use the present tense, relying on sentences like “The people are crying because they’re watching the coffin being carried past.”

The other thing that sticks from this session is the need for carefully designed mental health research trials in developing countries, particularly trials that use control groups for comparing accurate differences between mental health that changes due to a particular intervention, and mental health that changes due to other factors. Right now controls aren’t used much in the mental health field abroad, raising the possibility that researchers may only notice what they already expect to see.

Again the session cycles back to the importance of really, really listening to others. “It’s rare we want to treat others on their own terms,” Bolton says. “But that could be what’s needed.”

Final day, Sunday

I start the day with a latte in the International District, and it’s so tranquil, so calming inside the Panama Hotel Café, I don’t at first want to dive back into conference land.

Grappling with the world’s mental health problems is, well, depressing me a little, and the next session is a heavy one.

We talk about war and trauma and the truly terrible consequences of living where guns are fired daily and few women escape rape or worse. You’d think I’d feel even more depressed now, but instead I’m excited because this session, this session right here and right now seems focused on answers.

First we get a sweeping picture of labor and sex trafficking in Seattle from the UW Women’s Center, helping us understand that 31.7 billion dollars gets collected in trafficking profits every year, and that trafficked people are brought to Seattle, too—sometimes as prostitutes, sometimes as mail order brides, sometimes simply as people promised a better life.

Servicing seven men a day, subsisting on one cup of noodles a day, and keeping your mouth shut because traffickers threaten to kill your children back home doesn’t so much add up to that ‘better life.’

Even being rescued doesn’t fix trafficking-induced problems. Rescued women don’t care about their own health or safety at first—first they want to call home to check on their family, and then they’re ready for help, though sometimes they’re so traumatized they can do little more than stare blankly in front of them without knowing why.

In this case, direct personal donations to area organizations like the Asian & Pacific Islander Safety Center (http://www.apisafetycenter.org/)  are the most helpful, because any government funding these organizations get can’t typically go for those vital calling cards or for other kinds of gift cards that help trafficked women make their own purchases and get their footing back.

We also hear about a project analyzing political violence and PTSD in the West Bank among Palestinian women. Panelist Cindy Sherman paints us a grim picture of a country where it’s not uncommon to live your whole day in constant view of walls that making traveling through Palestine extremely tiring. Still, Palestinian women cling to their goal of resisting stagnation and defeat by continuing to insist on taking their children to relatives’ gravesites and by continuing to navigate the constant barriers and checkpoints they fear could sever personal and cultural ties if they’re not careful.

Finally, Debra Kaysen presented the dramatic results of a project conducted in the Democratic Republic of Congo demonstrating that even in actively traumatic places, people, even those who had been raped or tortured, can improve with a group-based, culturally adjusted form of Cognitive Processing Therapy.

Here’s an earlier article on Humanosphere about Kaysen and her colleague Shannon Dorsey’s work, with Bolton, on this front.

After the project ended, Kaysen said, the Congolese women were trying group-based solutions like farming their fields together so they wouldn’t have to be as afraid of violence. Afterward, too, the women reported being bolder and less timid—and study coordinators said they glowed.

Again, we get the message that improvement depends on forming tight communities, and on really knowing one another.

But, audience member Jim Bernhardt asks, seeing as the emphasis had been on women so far, where do men belong in these kinds of communities? The panelists affirm that men definitely belong, primarily as allies and as peer advocates who can talk appropriately with other men.

This resonates with me, so afterward I ask Jim how men and women can talk honestly about the problems that divide our genders. He doesn’t know (and neither do I!) But he mentions a project where women who supported or opposed female genital mutilation regularly gathered over tea and snacks to talk to each other. No topic impositions, no time limits. Just talking.

Feeling more fired up and hopeful for future connections and public/mental health projects, I head into the day’s last session, which boils down to What next?

Panelist Dr. Shafik Dharamsi delivers a definite conference take-away: “Don’t be comfortable with yourself.”

Don’t be complacent, he means; don’t think that traveling to another country meaning to help them, or that diving into global health projects without closely examining one’s means and motives, is the best approach possible. “Maybe,” he tosses out, “its not so much where you go TO as where you go WITH.”

And if you do travel somewhere else to help, panelist Onyinye Edeh cautions, look for a community’s strengths as well as its weaknesses, and play to those strengths. Plus, leave something more tangible than promises or vague goodwill behind. Leave something concrete that matters.

“Why,” the final panelist, John Burbank, asks “as Americans do you feel the need or desire to help public health in other countries when we have some very bad public health here?”

It’s a good question, but it goes unanswered for the moment, as student organizers ask audience members to stand and circle up in a physical representation of Kavita’s opening challenge. Once we start talking to our circle neighbors, it’s tough for the organizers to rein us back to silence.

The session turns spirited again once audience members get the chance to lob their questions at the panelists.

They’re divided about venturing abroad in the cause of global health—is it better, as Dharamsi advocates, for those of us who care about global health to fix ourselves first, or is it better to venture outward where needs may be even more pressing? What if both answers could be right?

UW MPH student Luke Davies offers a compromise: “At the end of my life, I hope I can be in a community where I can say, ‘I did something here.’

Me too, Luke. Me, too.

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Cyan James is a freelance writer and graduate student at the University of Washington studying public health and genetics. More about her at www.cyanjames.com or @CyanJames.

 

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Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at]humanosphere.org, follow him on Twitter @tompaulson and/or send a comment below.