Well, dear readers, my time in Santo Domingo has come to a close. 11 weeks ago, I arrived to a new country in a region of the world that I had not had the opportunity to travel before. I came with little expectations and lots of ideas of how my time could possibly go. At the beginning of the summer, 11 weeks in a new country felt something like a lifetime, like something that would change me, move me. Now, 11 weeks later, I feel grateful and happy to share that this experience has been everything I could have hoped it to be. This experience has, indeed, changed me for the better, at the risk of sounding cliché. This is not to say that everything was perfect, or color de rosa, as I’ve heard folks say here. Working on a global project has been anything but straightforward. Managing communication between two teams, one in Santo Domingo and one in North Carolina, in two languages, has been complicated and tiring at times, not to mention working across various technologies. I had to interrogate my expectations from previous workplaces, where these barriers did not exist. But, as someone who wants to work globally, especially in other Spanish-speaking countries, this experience has been powerful in solidifying this interest.
As you can imagine, it is difficult to summarize, to communicate concisely, all the things that have happened over 11 weeks, both inside and outside of the workplace. So, instead of attempting to cover everything, I want to share about one experience attending a Kiki ball at the Spanish Cultural Center in Santo Domingo. This was my very first time attending a ball, actually. Balls, one of the defining features of ballroom culture, are historically Black and Latinx spaces where queer and trans folks perform to compete and win prizes. The 1990 documentary Paris is Burning is one of the most recognized films exploring ballroom culture in 1980s New York City. Having never been to a ball, when I saw the Kiki ball promoted on the Cultural Center’s social media, I automatically saved the date in my calendar.
Flyer for the Orgulloxa Kiki Ball.
At the Kiki ball, as with other balls, participants walked in different categories, which included face, runway, and voguing. This particular event was open to all participants, experienced performers or not, which isn’t always the case with other balls. Participants were then scored by a panel of judges on their performance in accordance with the category. What then unfolded, in my eyes, was a celebration of ballroom culture, of trans identity, of queerness, of community, creativity, and perseverance. I wish I had taken more photos – photos would describe the energy in the room much better than my words could. I walked away that night feeling full, grateful, and joyous to have been able to share that space with other community members. It is events like these that remind me why I choose to work with queer and trans communities, again and again and again. There, inside the walls of the Cultural Center, the hosts worked hard to create a space where there is no judgement, only celebration, of our diverse identities, a sharp contrast to what many experience on the streets, in their workplaces, in their homes. It is not lost on me the irony of this event being held at the Spanish Cultural Center, given the legacy of Spain’s colonization of the Dominican Republic. How would queer and trans communities be held and understood in the Dominican Republic, if the Spanish had never colonized the island? The legacy of colonization, alongside homophobia and transphobia, is what we must reckon with in our public health practice. After all, current public health trends, just like the significant HIV incidence among trans women in Santo Domingo, are often a result of what came before us.
I’ve been thinking about this post for a while now. I kept notes in my phone trying to write down small mementos I wanted to share. How could I possibly capture everything in one place? How could I possibly do my time in Bangladesh justice? It’s been difficult for me to convey my feelings with words but here goes-
In my previous post when describing Bangladesh as a “developing” country, I wrote, “I feel “developing” is a misnomer; it’s not the people but the systems that need development. The resilience of the Bangladeshi people is inspiring.” I had no idea the weight this would hold in the coming days.
Part I:
My practicum with Ipas Bangladesh was everything I could have hoped for and more. Working in an organization dedicated to improving sexual and reproductive health rights (SRHR) made me proud. In talking with my preceptor and other staff members, I would often share how much I loved the fact that public health work translates across the globe. We may have different backgrounds, speak different languages, eat different foods (holy spice), but we always share a common understanding and passion for ensuring people have access to services they deserve. It’s their right. Speaking of my preceptor, this was a note I kept in my phone following one of our many meetings:
“He is an angel of a human. He’d probably be embarrassed by me saying something like this. He has spent HOURS with me explaining and answering every question I’ve had. He comes off quiet and reserved but when you get him talking, he’s a wealth of knowledge and experience. I will forever feel indebted to this man as my first experience of leadership in public health. He told me public health involves being able to solve problems you don’t expect to solve. It includes logistical planning and people management as much as it does data collection and analysis. He taught me to be confident and assertive when necessary. Public health always involves pushes and reminders. This was definitely true as I initially had a hard time “bothering” people for help, even if it was their role to help me or provide me with information. I owe all these lessons to him.”
Ipas Bangladesh gave me an overview of the realities of life for many women in Bangladesh. I was able to do a deep dive in understanding the many challenges women face in seeking MR (menstrual regulation/abortion), PAC (post-abortion care), and FP (family planning) services. My focus was on the importance of empowering mid-level providers to bridge the global physician shortage and ensure these essential services are available and accessible at all public health facilities. Ipas is working to build the capacities of these mid-level providers, equipping them with the necessary skills to meet the needs of the women in Bangladesh. These trained mid-level providers are setting the example for task-sharing in reproductive health. I may be bias, but I think this is so cool. I had the opportunity to visit and interview some of these mid-level providers to understand their day-to-day responsibilities and the challenges they face within the current health system.
The lessons I learned are invaluable. I feel so incredibly fortunate that I had the experience and opportunity to work with Ipas Bangladesh. They set the bar high. I have a greater sense of confidence in myself and I’m thrilled about the possibilities that await me in international health.
My final presentation on midlevel provider empowerment for sexual and reproductive health services.
The road I would walk every day to get to the lunch room down the street from the main Ipas office.
My coworkers would bring new treats to the office for me to try. This is Laddu.
Part II:
The cute coffee shop workers would draw pictures in my coffee.
First time trying dragon fruit. This one was from Cox’s Bazar.
A local market selling hand-painted rickshaws and CNGs.
While my primary focus in Bangladesh was my summer practicum, I was also able to experience the culture, the sights, and the goodness of the Bangladeshi people. I was invited into homes for meals, coffee, chats, and experienced the absolute best fruit of my life (special shoutout to the mangos, pineapple, and lychee). At first, I was apprehensive to go outside alone because I was unfamiliar with the city and was briefed about my safety in Dhaka. However, once I finally got the courage, I found I was just fine. I became a “regular” at the nearby coffee shops and enjoyed visiting the local markets to look at all the different items and foods they offered. It was in these moments, at the coffee shops and markets, that I truly began to appreciate the subtleties of being human- a smile, a small gesture of acknowledgement. Despite my best efforts to become fluent in Bangla, there was often a slight language barrier. Yet, the gentleness and kindness of the people in Bangladesh is something I will never forget. These bonds and relationships are what made the next part of my experience so difficult.
Part III:
In early July, university students took to the streets in protest against a deeply flawed quota-based recruitment system for government positions. This system blatantly favored descendants of the 1971 liberation war, denying opportunities to qualified Bangladeshi students based on merit. Government jobs are highly coveted positions and this discriminatory policy created an impossible barrier for many. The protests, though initially peaceful, were met with a brutal response from the government. Instead of seeking peaceful dialogue, they unleashed violence, death, and hostility against their own people- their students, their future leaders. It was a heartbreaking betrayal of a country I had grown to love.
On the evening of July 18th, deafening silence. The government imposed a nationwide internet blackout. We were suddenly cut off from the outside world and the economy took a massive hit. People couldn’t pay their bills, add minutes to their phones, or even open their stores. Traditional media was heavily censored and my only source of information was the local newspaper or the hotel staff. Then things somehow got worse. A curfew was announced with “shoot-on-sight” orders. I felt fortunate to be in a hotel where my safety was a priority, but I couldn’t ignore the privilege that came with it. I struggled with my place in all of this. As an outsider, a foreigner, knowing I would eventually escape this tragedy, what was my role? I felt a mix of helplessness and rage. How could such violence be the response to students, like myself, making demands they had every right to make? The lack of humanity and empathy was overwhelming. It was a reminder of the fragility of freedom and the lengths some will go to silence individuals and maintain power.
I spent 24 hours inside a hotel for a week with no internet. I would go to the roof to see what was happening outside but it was quiet. No honking horns, minimal people, no street vendors- A stark contrast to the views I was used to seeing. I was able to get some text messages through and I joked with a fellow iPhone user about our texts being green. Jokes aside, it felt like we were living in a dystopia. There were foreign guests at my hotel and I watched as they left one by one. I was one of maybe 10 guests left. I had two weeks until I was supposed to go home. I wanted to stay, I wanted to see this through. I wanted to know my friends were safe. At the very least, I wanted to say goodbye to my Ipas team in person. So I waited. The Supreme Court did eventually reduce the quota for descendants of war veterans but at this point, it was not enough. Most of Bangladesh was fed up. They witnessed their friends and family being injured, or worse, killed, by their own government and associated parties. At this point, the movement was more than just quotas. It was a demand for freedom and justice.
A powerful article in the local newspaper.
The stunning view from my hotel rooftop. The sunsets were incredible the streets were so quiet during this time.
Part IV:
The internet slowly (emphasis on the SLOW) came back and I was able to return to the office for my last day. Things still felt eerie outside but I was thrilled to see my fellow Ipas team and say my “see-you-laters.” On August 2nd, I left Bangladesh. It was pouring rain and it felt somewhat symbolic. The rains were heavy, my heart was heavy but so full at the same time. The dichotomy of these emotions was something I was trying to accept.
I left Bangladesh having learned a multitude of things, some I did not anticipate. I was so incredibly inspired by the people of Bangladesh- a nation fighting for their rights at an unimaginable cost, yet emerging victorious. After I arrived home, many of my friends in Bangladesh reached out to inform me they had done it. They had overthrown their autocratic ruler.
So now, I can only hope for peace in the coming days for Bangladesh. I can only hope for a government that is built for the people, by the people. When I say, “it’s not the people but the systems that need development. The resilience of the Bangladeshi people is inspiring,” I mean it from the bottom of my heart. Their government system needed more than development, it needed complete transformation, and they knew it. The resilience and bravery of the Bangladeshi people will stay engraved in my heart forever. Until we meet again, Bangladesh. I am so proud.
The kitchen staff at my hotel gave this to me for breakfast on my last morning. It’s a mango! Unreal.
A skyline I will miss.
Other random mementos saved in my notes app:
“Everyone has their phone volume turned on. I know the ringtones by heart and oddly enough, I think I’ll miss it.”
“The honking of horns has become oddly therapeutic. The noise puts me to sleep at night.”
“The older I get, the more I’m learning just how much I appreciate human connection and the experience of being human. It’s powerful.”
“Every day I’m in a car, I’m surprised I’m not in an accident. The streets are wild but somehow, most people know what they’re doing.”
“It’s amazing what happens when people don’t have internet. The inability to live in reality, without distraction, seems impossible for some. I’ve come to appreciate it. It’s forced me to talk to folks here at my hotel that I may have not otherwise. It’s forced me to read that book I’ve been telling myself I’d start. It’s made me sit with my thoughts longer than I usually do. While circumstances for why this is happening are tragic, I’m trying to find an ounce of good in this reality we’re living in.”
(L-R) Sister Harriet, myself, Sister Dora, and Erin Harper standing in front of the Kanakantapa Rural Health Center. Erin and I are wearing Chitenge’s.
Time seems to have both crawled and flown by, and I now find myself in the final week of my practicum in Zambia. This internship has provided invaluable insights into the nuances of global health, offering both a broad perspective and hands-on, fieldwork experience.
I joined a small evaluation team at Global Projects Zambia (GPZ), comprising of myself and three others. This setting allowed me to gain an intimate understanding of evaluating a pilot research and implementation program. With the guidance of my mentor, I contributed to the creation of many implementation and evaluation tools, including in-depth interview guides, focus group discussion guides, a rapid qualitative analysis plan, community sensitization materials, a time-motion/flow mapping study, and inclusion criteria for every evaluation element. The meticulous process of drafting, piloting, revising, and finalizing each document involved close collaboration with my team. Regular meetings with the community team were also essential to coordinate piloting our evaluation tools, plan their rollout, and strategize on community sensitization and engagement efforts. This involved engaging with headmen, clinical staff, and women’s groups in rural communities to foster awareness and reduce apprehension about our study. These tools will long outlive my time in Zambia; and hopefully their impacts will be felt for years to come. The project itself which we have spent months (and the team at GPZ years) dedicated to is revolutionary, bringing hand-held ultrasound probes to communities that otherwise would not have access to ultrasounds. This helps detect gestational age and fetal abnormalities, allowing physicians to prepare ahead of a high-risk birth. While still in the piloting phase, it is inspiring to see first-hand the impact that it can have on rural communities across the globe.
A few baby elephants playing at the elephant orphanage in Lusaka.
Over the past few months, I have had the opportunity to visit four rural health clinics, one urban clinic, and one urban hospital across three districts in Zambia. Before these visits, our team gifted us Chitenge’s—multi-purpose, patterned fabrics used as wraps, baby carriers, and blankets—ensuring we dressed appropriately for the communities we visited. One clinic, near the Kafue River, introduced us to the local community, where we observed hand-made canoes, fishermen, and women sorting and selling fish. Each rural clinic we visited was situated along long, desolate dirt roads. Despite the varied geography and infrastructure, enthusiastic healthcare workers, many of whom were underpaid or volunteered, greeted us warmly at each site. An overflow of expecting mothers could always be found waiting in hallways, on benches, and under the shade outside the clinics, with some having traveled over 17 km to reach the facilities.
A highly frequented office space while working at Kanakantapa Rural Health Center.
At Kanakantapa Rural Health Center, I felt a deep connection with the team of nurses and midwives. Their eagerness to share their knowledge and experience was heartwarming, and they invited me to return and assist with their data. I have since returned twice, spending days learning from these incredible women, which has further enriched my understanding of the local communities and their languages. These visits have instilled in me immense respect and admiration for these healthcare workers who tirelessly serve their communities, seeing upwards of 200 patients a day, going into communities to administer vaccinations, and providing holistic care. Midwives and nurses prescribed antibiotics alongside traditional teas and soups, never dismissing a patient without treatment but always mindful of their limited resources.
Zambian sunsets are hard to beat and are a staple of every night.
Witnessing the work which I have long studied has been an experience I will always cherish. I learned that many clinics, despite their limited staff, often have volunteer midwives due to inadequate funding. This shortage is not due to a lack of need, training, or qualifications but rather insufficient funding. The shortage of clinicians across Zambia means many medical students complete their residencies unpaid, and there are not enough paid midwifery positions for graduates. This is likely due to funding allocation and the lack of prioritization of maternal and child health. It raises the question of why society does not prioritize women’s health, especially when every clinic is overwhelmed with patients. At Kanakantapa, the midwives had me assist with documentation and patient care. When I thanked them for the unforgettable experience, Sister Harriet stated, “Of course, what good is knowledge if you don’t share it?”
Every clinic we visited had open-barred windows letting in the breeze, broken furniture, peeling paint, piles of patient records, vaccination charts, posters hanging off the walls, playful babies, passionate healthcare workers, and resilient women banding together to share information and support each other. It is a beautiful testament to the strength and solidarity of women worldwide, no matter where you are, women will come together to create networks of support for one another. I am incredibly grateful to have called Lusaka home this summer, and I know I will carry this experience with me into all my future endeavors.
