Author: nayavill

Life on the Red Lake Reservation

Posted on by nayavill

Hi Everyone! My name is Tessa Carovich and I am a PharmD/MPH dual degree student. For my summer practicum, I am spending time on the Red Lake Reservation in Northern Minnesota with the Indian Health Service (IHS) doing both public health and pharmacy work. Over my past two weeks here, I have spent time getting to know what the reservation has to offer and getting background on the community that I am serving this summer. The Red Lake Reservation is north of Bemidji and has the tribal government located on it, an IHS Hospital, which the community utilizes for their healthcare and pharmacy needs, and multiple powwow grounds. English is considered a second language on the reservation as many members of the community speak Ojibwe, preserving the tradition and culture of the tribe. A unique part of the Red Lake Reservation compared to the other reservations in the area is that it is “closed,” meaning that few people who are not tribal members live on the reservation. Due to the “closed” status, the tribal government can limit who lives or visits. Because of this, the state courts and government have no jurisdiction on the reservation, and everything is run by the Tribal Council and Federal Courts. Another interesting aspect of the Red Lake Reservation is that it is considered a “dry” reservation meaning no alcohol is allowed to be sold, consumed, or had while on reservation grounds.

Red Lake Indian Reservation sign along the freeway when crossing into reservation land.

Since alcohol is not allowed, it has led to a major drug problem on the reservation. It is known in tribal communities that syphilis and hepatitis c are very common among drug users. To help mitigate the problem, kits are made within the pharmacy at the hospital to be handed out to community members. The kits include needles/syringes, a sharps container, a tourniquet, and condoms. Along with the kits, Narcan is also readily available to be handed out. Community members can come into the pharmacy to pick up the kits and/or Narcan. There is also a walk-up harm reduction clinic set up once a week on the reservation for people to come to. During the summer months, there is a community van that will drive the reservation also providing these same services along with a syringe exchange program. By going out in the van, it allows us to reach the more remote areas on the reservation and provide education to the community members. I am excited to continue immersing myself in the culture here and make a difference among the community.

Tessa

That’s a wrap on RAP!

Posted on by nayavill

Hey everyone!

My time in Bangkok with the Water Program team at the Food and Agriculture Organization Regional Office for Asia and the Pacific (FAORAP) is finally coming to an end. While my practicum officially wraps up on August 11, I am confident that I’ll take the skills, lessons, and knowledge that I’ve gained here with me for the rest of my career.

This summer was certainly a busy one. I wrote 1 Letter of Intent to collaborate between UNICEF and FAORAP on strengthening cooperation between agricultural and water for sanitation and hygiene (WASH) sectors across the Asia and Pacific region, 3 Concept Notes on land-based sources of ocean pollution causing eutrophication in large marine ecosystems (LMEs) in China, Indonesia, and Sri Lanka, 1 policy brief on gender equality, disability and social inclusion (GEDSI) in water resources management, 1 mission brief on non-profits working in the agricultural and WASH sectors in Timor-Leste, 1 speech for World Food Day’s guest speaker, Princess Maha Chakri Sirindhorn of Thailand, and 3 partner contracts for the Water Scarcity Program (WSP). I also had the opportunity to attend 2 workshops hosted by the Asian Development Bank (ADB) and its partners, including FAORAP. Both workshops focused on water, but the one co-hosted between ADB and FAORAP was specifically on water scarcity and how to manage it from a policy level. Participating delegations came from various ministries (Water, Natural Resources, Meteorology, etc.) in Lao People’s Democratic Republic (Lao PDR), Vietnam, Cambodia, and Thailand. During the workshop, I took notes on the presentations from FAO technical experts and other guest speakers, and I had the opportunity to participate in and take notes for the breakout discussions of the Lao PDR delegation. I learned a lot about water-related issues in Lao PDR and how many of them stem not only from prolonged drought, but from poor collaboration between water-using ministries, which leads to overuse and competition. This has dangerous consequences for crop yield and by result, people’s nutrition, as many people living in Lao PDR depend on agriculture for their personal use and for their livelihoods: about 61% of people in the country live in rural areas and depend on agriculture for survival (IFAD, n.d.).

ADB’s workshop with Ramboll and the Stockholm Environment Institute on the Greater Mekong Subregion.
A member of Vietnam’s delegation presents at the FAORAP-ADB joint workshop on water scarcity.

Lao PDR’s main issue with water and agriculture is very similar to that of other Southeast Asian countries – rapid urbanization and population growth is putting pressure on dwindling water sources all while agricultural sectors must produce more food with less water to feed more people. This challenge will shape how countries develop agricultural and nutrition policy, and I recently learned that FAO also has a team that focuses on advising member countries on producing nutrition-sensitive crops. One root cause of many nutrition-related diseases, if you go back far enough, is decreased agricultural yield from water scarcity. While at first glance, the Water Program at FAORAP seems disconnected from public health, but its goal and mandate under FAO is to support better production, better nutrition, a better environment, and a better life for all.

Participating in this year’s United Nations Responsible Business and Human Rights Forum hosted by the United Nations Development Programme (UNDP)

Saying goodbye to Bangkok will be difficult, to say the least. I learned so much about the UN system here and got to meet so many like-minded interns from around the world. I ate the most delicious food every day, worked with incredibly passionate and determined people, learned a lot about Thai culture, and even had the opportunity to visit Tonle Sap Lake in Cambodia, which I researched for my assignments in SPHG 721! My perspectives on international, systems-level work were immensely shaped by my practicum experience, and getting to actually experience the funding mechanisms, agenda setting, and program development we read about in Gillings was invaluable to say the least. Living in Bangkok, a city where my own grandmother was born and lived in until she was 13, really had me feeling สบาย สบาย/sabai sabai this summer, and I feel extremely lucky to have had the opportunity of a lifetime to work in these spaces.

ขอบคุณค่ะ/kop khun ka, Thailand. It’s been a time and hopefully I’ll see you again soon.

~Leeann

Community-focused programs in Nepal

Posted on by nayavill
Enjoying the fresh air while attending a nutrition workshop in Balthali

Hello again, this is Ellina Wood. As the summer is quickly fading and my internship is coming to an end, I have been reflecting on my time spent in Nepal over the past three months. I have the great fortune to complete an incredibly fulfilling and rewarding dietetic internship with Helen Keller International (HKI) on Suaahara II: a project that has been implemented in Nepal since 2016 and partners with local stakeholders to address the health and nutritional status of women and children across 42 key districts.

Green leafy vegetables, pulses, and eggs to be shared at a swasthya aama samuha (health mothers’ group)

I agreed to the internship with the premise that I would engage in cooking demonstrations, analyze the nutrition content of existing recipes, make recipe recommendations to bolster the micronutrient profile, and write success stories to be shared in the annual report. Although some of my time has been spent on these objectives, a larger aspect of my internship has been spent on other tasks. While collaborating with a local dietitian and the Ministry of Health and Population (MoHP), I conducted literature reviews to develop a new national nutritional management protocol to aid in the recovery of moderate acute malnourished (MAM) children using nutrient-dense foods in place of imported formulated supplementary foods. Whilst there is currently no international guidance that endorses the use of local foods for the treatment of MAM, emerging evidence suggests that providing local foods may be comparable to formulated supplementary foods for recovery rate and weight gain so long as quality sources are used for the appropriate duration. In fact, the World Health Organization (WHO) is in the process of developing an international guideline, focusing on locally available food, for the prevention and treatment of moderate wasting in children presenting at health facilities with acute illness. It is the MoHP’s goal that any learning generated through monitoring and evaluation of the rollout of the new nutritional management protocol will be a valuable addition to the evidence base for the WHO guidelines.

Materials used during growth monitoring and promotion pilot testing

I also provided technical support to my team as they conducted pilot testing for an upcoming revision to Nepal’s Growth Monitoring and Promotion (GMP) guideline. The field-testing process meant that I had the opportunity to travel to different regions across Nepal to meet with the municipality-level governments and to support my team in training/ observing health care providers at Outpatient Therapeutic Centres (OTCs) and Non-Outpatient Therapeutic Centres (non-OTCs). Following each GMP pilot test, my team conducted exit interviews and focus groups with participating health care workers and mothers. Our observations and the following discussions ultimately guided our revisions for the GMP protocol and model recommendations for local and national government-decision making. Being able to travel to several districts not only gave me the chance to engage in monitoring and evaluation exercises with various government agencies and communities but it also allowed me to gain a deeper understanding of the region-specific customs and beliefs (trying new foods and getting glimpses of new, breathtaking views was a bonus!). I gained knowledge about the value of adaptability, how to effectively communicate in a culture that differs from my own, and how to be receptive when my worldview is challenged.

Although it is difficult to leave, I do so knowing that I am far better equipped to handle public health challenges. Overall, my internship has left me feeling inspired to continue working in the global health space.

-Ellina