One message resounded clearly at the Conversations in Global Health Services Delivery forum on Thursday evening: One person really can make a big difference. The forum, part of 2018’s ’DEIS Impact social justice festival, featured four panelists who described the challenges and opportunities they encountered during their time abroad.

Two main topics emerged from the discussion: how to efficiently and effectively provide healthcare to the international community and how to avoid destructive practices during time spent abroad. All panelists agreed that there is great potential for harm when providing health care internationally. They emphasized the importance of ‘cultural competence,’ an industry term for understanding the values and needs of a community before trying to provide assistance.

The youngest panelist was Vineet Vishwanath ’18, who founded the Brandeis chapter of the Foundation for International Medical Relief of Children. He talked about his time working in La Merced, Peru, with the Brandeis chapter of FIMRC. Street vendors are an integral part of the city’s culture, he found, but the vendors often weren’t very sanitary. 

In the past, he said, health organizations tried to minimize the risk of foodborne illnesses by urging locals not to eat the street vendors’ food; however, this advice ignored the role street vendors play in the community. When Vishwanath worked there, FIMRC instead spent time educating the vendors about food safety and sanitation, so residents could continue to enjoy the food without the risk of disease.

Wayde Dazelle, a postbaccalaureate student and a member of the Brandeis YourStory International executive board, provided another example of the importance of cultural competence when he talked about his experience studying female genital mutilation in Sierra Leone. He found that when health workers visit communities to better understand the practice of female genital mutilation, many individuals don’t respond to their surveys out of fear of prosecution and exclusion from their community. 

This perception, driven by community reactions to prior attempts to curb the practice of female genital mutilation, has been hugely detrimental to their health community, Dazelle observed. He explained, “Criminalization without conversation, without dialogue … only drives things to the shadows.”

Dazelle also criticized other flawed attempts to provide foreign aid, including the Caribbean Basin Initiative, a 1984 program drafted by then-President Ronald Reagan. The program gave $11 million in food aid to Haiti, then increased that amount to $54 million annually for the following three years. As imported rice became cheaper and cheaper to buy, Haitian rice farms couldn’t compete, ruining the Haitian rice market. Dazelle said this program was antithetical to the central tenets of global health work: assisting communities and countries while enabling them to become sustainable and independent.

Richard Pulice Ph.D ’86, a psychiatric epidemiologist, provided his own perspective on cultural competency when he described the different communities and countries he served in his nearly three-decade long career. Pulice has worked with refugees in the Netherlands, Romania and, since 2011, Uganda. There, he had to examine what it means to be mentally ill in Ugandan society and how Ugandan families deal with mental illness.

John Paul, a native Ugandan who worked closely with Pulice, spoke about his experience with maternal health in his home country. He explained that in Uganda, the threat of malaria means that maternal health is often neglected by policy, despite the fact that on average 16 women die every hour in Uganda while in childbirth. 

In Uganda, women in rural communities typically give birth in the presence of traditional birth attendants. The birth attendants are often important figures in their community, but a lack of knowledge about sanitation and proper delivery procedures can lead to high maternal mortality rates. In an effort to combat this high maternal mortality rate, the Official Ministry of Health threatened imprisonment if a woman died delivering a child in her own home. The great distance between hospitals makes it risky and time-consuming for women to give birth in hospitals. Paul explained that he was able to have an impact by educating traditional birth attendants about safe habits and practices so they can serve their communities while minimizing the risk of maternal death.

Despite all these challenges, the panelists still remained optimistic about the opportunities to effect change abroad. Pulice described an “important moment” that made him understand the importance of helping a community become sustainable when he worked in Uganda. He said he met a small group of women outside of Kampala who were working on improving literacy in more rural communities. 

They said they were trying to cultivate a community garden to grow healthier vegetables for the area. Pulice gave them some money to help, and when he visited the following year they presented him with that year’s crops. There was enough the next year they gifted his group with that year’s community garden harvest.