Last summer, when Hamdi Ali MPH'19 started a 10-week practicum in Kenya as part of her public health graduate program, she never imagined she would develop nationwide training manuals to help local healthcare provider's respond to violence against young women and children. Or, have an opportunity to mentor at-risk adolescent girls and empower them to be resilient, determined, safe, and AIDS-free.
"I met a number of smart and ambitious young women who live in conditions and environments that present unimaginable challenges," recalls Ali. "Working with our partner organization, LVCT Health, we provided these girls with mentors, school uniforms, and cash allowances that helped alleviate the barriers for them to attend school. That moment is really when I saw the difference public health work can make."
This year, Ali is continuing to work with other partner organizations and her St. Catherine University faculty mentor, Leso Munala, MSW, PhD — a Kenyan native — to explore the issue of sexual violence against school aged girls in Kenya. According to Munala, this is a problem in numerous low-income countries where the stark inequality of women persists and violence against them is fueled by social challenges, economic hardships, and tribal traditions.
These are just a few examples of how St. Kate's faculty and students are addressing pressing global health challenges — and the "global" part is central at the University. "You have to be thoughtful. You have to step back and look critically at the needs of individual communities and diverse populations in order to understand the issues and how to help," says Mary Hearst, MPH, PhD, director of the Master of Public Health (MPH) in Global Health program at St. Kate's.
Hearst joined St. Kate's six years ago when talk of starting a master's program at the University had just begun. There was no other MPH program in Minnesota with a true global focus. Having a mission that so closely aligns with the fundamental priorities of global public health — social justice and women — and a diverse student body made up of 34 percent students of color (68 percent in the undergraduate public health program) — who better to build this? "Our goals for this program are about equity and achieving diversity in the workforce," adds Hearst. "We need to be educating the students who will be working in the communities they represent."
Thanks to a generous grant from the GHR Foundation — which addresses global development, education, and health — the first cohort of St. Kate's students pursuing an MPH in Global Health degree kicked off the program in 2016. This spring, 21 students in the program's second class will graduate, continuing to temper a severe shortage of skilled public health professionals to meet the needs of global populations. According to the Association of Schools and Programs in Public Health, three times the present number of students will need to be educated over the next 11 years to meet the needs of the U.S. population alone, and the shortfall is estimated to be 250,000 professionals by 2020. Public health needs on a global scale are even more considerable.
St. Kate's public health students are currently working with faculty to advance research in Kenya, Ghana, Thailand, Bangladesh, Zambia, Chile, New York, and Minnesota. In 2018-2019, students will conduct an estimated 43 practicums exploring public health issues in 12 countries across five continents — including several working with immigrant and refugee communities locally in Minneapolis and St. Paul.
Building a Foundation
Hearst and her faculty agree the intentional focus on global health and social justice is what draws students to St. Kate's and elevates their education and training to a level necessary for them to navigate complex global health issues. Like Ali's work in Kenya, students have invaluable opportunities to collaborate with partner organizations and faculty to gain practical knowledge and real-world experience. And true to St. Kate's values, and commitment to the liberal arts, the program engages students to draw from their own diverse perspectives to understand how to work effectively and ethically with populations all over the world. Personal experiences, current events, and articles on culture, race, and privilege fuel discussions in the classroom, where students and faculty check judgment at the door and create a safe space to learn, take risks, and offer differing opinions.
"Because we have institutionalized our mission, we can raise the tough, ethical questions that lead to productive and respectful conversations about what social justice and equity really mean," says Hearst. "That's what we're talking about with global health: basic human rights and the opportunity for everyone, regardless of lineage and geography, to lead full and healthy lives."
Public health faculty member Liz Allen, MPH, PhD, has spent much of her career exploring disparities in access to healthcare and related issues. She adds, "The focus on social justice in this program is huge. You can't talk about public health without talking about disparities. It opens the students' eyes to the world outside of themselves and they begin to understand how varying perspectives shed light in different contexts."
Giving the Unheard a Voice
It's easy to relate public health to the issues we hear more about on a global scale, like infectious disease, clean water, and disaster relief, for example. But St. Kate's public health faculty and students under stand the real X-factor when it comes to fostering the health of global communities: listening.
Where Munala is working in the Lua community — the third largest tribe in Kenya — widows are often subjected to violence as part of a traditional cleansing ritual. Usually, this is at the hands of a male family member who is "inheriting" them, and the widow endures this as the perceived way to remain in her home with her children. Munala spent time interviewing widows who underwent the sexual cleansing ritual, and met with community leaders to better understand their knowledge and attitudes about it. Ultimately, she hopes to work with the Kenyan ministry of health and local health management team, using this information to explore how they can support widows moving forward.
"Widows in this community believe they are only important when they are attached to men," adds Munala. "When I meet with them, they are touched that someone even recognizes this as an issue and asks for their opinion about it. Someone just needs to start the conversation for change to happen."
About 800 miles away in a Rwandan village, second-year student Inga Mumukunde MPH'19 partnered with the American Refugee Committee in summer 2018 to address rapidly growing teenage pregnancy rates and a lack of adolescent sexual health resources. Amidst cultural barriers of shaming for contraception use and perceptions of promoting promiscuity, Mumukunde worked with community members to understand their perspectives and how to address this issue.
"By the end of our focus group sessions, key community and church leaders agreed to start regular sex education with their congregation and committed to encouraging parents to have these conversations with their children," recalls Mumukunde. “This experience really demonstrated the importance of working directly with a community and listening to their needs in order to develop a sustainable program."
Bringing it Home
While the profound public health needs of low-resource countries can't be denied, St. Kate's students are also applying their global lens to serve and strengthen growing diverse communities in the Twin Cities. When People's Center Health Services in the Cedar-Riverside neighborhood of Minneapolis—home to one of the largest Somali-American populations in the U.S.—developed plans to build a new community wellness center in their clinic, Megan Precht, MPH'18 and her practicum partner jumped in to seek the community's input.
"Involving the community in these discussions was incredibly important because it offered them a chance to articulate what their needs are and how the wellness center can address them," explains Precht. “My partner also had a number of community connections and spoke the language, which was incredibly valuable to the work we were doing. We often said how grateful we both were to have the opportunity to work together, because we brought different viewpoints to the table."
Precht graduated in May 2018 and is still working in the Twin Cities with populations from all over the world who now call Minnesota home. She says her understanding of global health helps her both serve and advocate for these communities in a comprehensive and culturally-aware way.
Collaboration is Everything
The global impact of the St. Kate's public health program wouldn't be possible without the work of partner organizations who are committed to supporting underserved populations both in developing countries and here in the U.S. St. Kate's public health department works with nine international partners and seven who serve the Twin Cities area. The programs that these organizations lead serve as practicum sites for students and also as a conduit to organically mine relevant issues for academic research.
*Our partnerships are carefully and strategically cultivated with the intent of developing long-term, mutually beneficial relationships," says Christina Bliss Barsness, MPH, RD, program and fieldwork coordinator. "We evaluate them regularly to ensure we have the right balance of organizations and locations to meet student and program needs."
The Catholic Medical Mission Board (CMMB) is one such organization. Its focus on the global health of women and children, and faith-based service mission, fosters a viable partnership with St. Kate’s. For over 100 years, CMMB has been working in some of the most remote and underserved corners of the world, providing health and wellness services to millions of people. Volunteers and partners like St. Kate's students and faculty provided more than 90,000 hours of service in 14 countries.
With such a robust global impact, the partnership with CMMB is rife with opportunities for meaningful work. In 2014, a grant from the GHR Foundation allowed CMMB and St. Kate's to partner on the Kusamala Child Protection Project, which seeks to improve the lives of disabled children and their families living in Lusaka, Zambia. Over the last three years, Hearst and an interdisciplinary team of faculty from programs such as occupational therapy, physical therapy, social work, and physician assistant studies, as well as colleagues from the University of Minnesota, collected data about the challenges these vulnerable children face in order to discover what community-based programs can help them stay in their homes with their families, reduce stigmas, and improve quality of life.
"We interviewed 760 community members and 560 families who have a child with a disability and learned a lot," explains Hearst. "Often disabled children in Zambia are put in orphanages, are hidden from society due to stigmas, and can be subjected to abuse and very deep poverty. We want to create systems of support to promote stable family environments and reduce institutionalization of these children."
The second phase of the Kusamala project launched in 2017 and provides opportunities for graduate students to help test interventions designed to mitigate these challenges, these challenges, including family and community engagement, education, advocacy, and skill-building. St. Kate's faculty will also develop a curriculum for training local health professionals.
"It's amazing how a partnership with a university can open the eyes of an organization, shining a light on the most vulnerable, and responding directly and effectively to their needs," said Batuke Walusiku-Mwewa, CMMB country director, Zambia. "St. Kate's students are gaining valuable experiences while improving the lives of children with disabilities and their families."
CMMB representatives from four countries will be on the St. Kate's campus in mid-April to share the impact of another project called the Children and Mothers Partnership, which provides medical care for pregnant women and newborns fighting disease and poverty.
"The partnership with CMMB is reciprocal based on our shared values of pursuing social justice and the commitment to sustainable, community-based global health work focused on those most in need," explains Bliss Barsness. “It has been a great fit for St. Kate's and the MPH program on many levels. CMMB has been extremely welcoming to our students and open to exploring various ways our organization could collaborate."
By Jill Braun from St. Catherine University Magazine Summer 2019 issue