Field trip – Diabetes in Northern Tanzania

Written by Kina-Kira Hiller

Edited by Zachary Gavry, DL Christensen & Helen Myrr


Part of the MSc Global Health program at KU is a five-week module in either Tanzania or Poland. I was part of the group that went to Moshi, situated at the foothills of Mt. Kilimanjaro in Northern Tanzania. During our stay, we gained insights and knowledge about the local health system through lectures at KCMUC, visits to different health facilities, interactions with people and working on research proposals. The topic my group decided to focus on was “whether diagnosed diabetes patients show specific socio-demographic characteristics compared to those who are undiagnosed.” Because of this, and in light of the recently celebrated World Health Day dedicated to diabetes, I would like to share our experiences and impressions on how the Tanzanian health system addresses this growing burden of disease.

The International Diabetes Federation estimated a 3.5 % national prevalence of diabetes in adults (20-79 yrs), with 5.8 % in urban areas and 1.7 % in rural areas of Tanzania. However, numbers vary and studies propose that most people who have the disease are unaware of it (up to two-thirds). In the whole African Region, around 20 million people are living with diabetes. This number is predicted to more than double by 2040. People of working age are particularly impacted as it affects their ability to work and more than 75% of diabetes deaths were in people under 60 years in 2013, threatening regional development and health systems.

In spite of this increase, even in reputable hospitals, screening for diabetes is rare. The main focus is on infectious diseases and reproductive health. Here, it is important to mention that diabetes is associated with infectious diseases such as tuberculosis probably due to a compromised immune function (diabetes leading to tuberculosis) or increased inflammation (tuberculosis leading to diabetes). These interactions influence treatment outcomes and mortality. In a specialized tuberculosis clinic that we visited, patients were therefore screened for diabetes. However, most often only pregnant women with gestational diabetes will be diagnosed due to the reproductive health focus. This is an important aspect since women with gestational diabetes are at increased risk of having manifest diabetes later in life as well as giving birth to large children (>4.5 kg) who are equally at increased risk of diabetes in adulthood.

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Patients waiting at a diabetic clinic at Sekou Toure Regional Hospital (World Diabetes Foundation)

Sometimes you find initiatives trying to integrate diabetes more into clinical practice. For example, we met a motivated team working at a big private hospital who screened 200 people at the Kilimanjaro marathon and provided weekly educational sessions for patients. However, their resources were very limited and we found little or no outreach to rural areas. They did not have a single nutritionist at the hospital and their diabetes unit only had one room, used as an office and for consultation. Examination rooms as well as nurses and doctors were shared with other units. It seems as if there is some progress but screening for diabetes is still too neglected and does not receive enough funding.

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Diabetic checks at Sekou Toure Regional Hospital (thecitizen.co.tz)

Furthermore, we noticed little or no awareness of diabetes and its risk factors in the general population. Tanzanian diet often includes a high daily sugar intake and consumption of starchy food. Many people working in the city do not prepare their own meals but rather eat in restaurants where white rice, beans, fries, and roasted meat are the most common and cheapest food choices. Juices and soda are offered everywhere and are highly consumed. Coca Cola is visible and sold on every corner, also in front of the hospital entrance. Even the most popular brand of water (“Kilimanjaro”) is owned by the Coca Cola corporation. The price per bottle is around 900 TSh or around 0.40 USD for water (1.5 l) and Coca Cola (500 ml) in stores, and around 1,500 TSh for 500ml of both in restaurants. The relatively low prices could be one of the reasons for the increased sugar consumption and the associated negative health outcomes.

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Fast food and fizzy drinks are cheaper alternatives to basic water and healthy food.

It is also important to note than many still see diabetes solely as a disease of the rich since in developing countries it is mainly prevalent in the urban areas where most of the middle and upper class people reside. However, in our part of the world, diabetes is associated with poor lifestyle and is therefore associated with the lower end of the socio-economic classes!Therefore, members of all socio-economic classes can be affected and in particular those who cannot a healthy diet and lifestyle due to money or poor education.

In Tanzania, treatment and prevention of secondary complications of chronic diseases are free on paper but, unfortunately, the reality looks somewhat different. Drugs in hospitals are often not in stock, requiring patients to buy them in pharmacies where the cost may be very high in relative terms. Patients might be eligible for social welfare but the application process can take a long time. Costs for transportation to the hospital and loss of income due to long waiting times pose additional barriers. The health care system is very diverse, and traditional and even Chinese medicine play an important role. One may find little stores next to busy roads where herbal medicines are sold, where sellers claim their  juices or products can heal all kinds of disease, including diabetes and hypertension. Patients often use these so-called ethno-medicines because they are less expensive than pharmaceutical medicine. The traditional medicine shops are, however, less regulated and some of the treatments can even be harmful. Hence, although diabetes is prevalent in all groups, it can still be seen as a disease of the rich because they are the only ones who can afford it.

Lastly, I would like to mention that we had the great opportunity to visit a Maasai village with our professor, Dirk Lund Christensen where we learned about their traditions, lifestyles and health situation. The Maasai have a high milk and meat consumption at least for certain periods of the year. Adult males, for example, may consume up to 2-6 l of milk per day, resulting in a 30% energy intake coming from saturated fat. However, the prevalence of diabetes and cardio-metabolic diseases as such is low, which is quite a contradiction to the perceptions of modern medicine. It could possibly be explained by high physical activity as well as seasonal variation in food intake. The Maasai seem to be left out of the public health care system, mostly because of financial and locational barriers to accessing it,  as well as stigma and discrimination. Official screening and treatment programs are therefore rare in the communities. Diabetes and other diseases are treated mostly with herbal medicine, which can be barks, branches, roots or leaves of trees and bushes. One of the days during our visit, we searched, for example, for branches of the Enjani engahe tree in the bush which are used for treating diabetes and hypertension.

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MSc of Global Health in Tanzania! Photo credit: Justin Yee

This text has hopefully made it clear that we learned quite a lot about diabetes perceptions, screening and treatment. Tanzania is developing its services but there are many challenges that need to be addressed in order to strengthen the health care system and battle the growing burden of cardio-metabolic disease. The Tanzanian government needs to improve screening and treatment, as well as make policies to prevent diabetes, e.g. by promoting a healthy diet and regular physical activity. There should also be a greater focus on equal access to health care for people with a lower socio-economic status as well as ethnic minorities such as the Maasai.

MScGH Class of 2017

by Justin Yee and Kina-Kira Hiller

Edited by Helen Jane Myrr

MScGH Class of 2017 gathers together outside the University of Copenhagen's Center for Samfund og Sundhed (Centre for Society and Health).
The MScGH Class of 2017 gathers outside the University of Copenhagen’s Center for Samfund og Sundhed (Centre for Society and Health).

So here we are, 42 new highly motivated students forming the third generation of the MSc program in Global Health. Not only are we a diverse group of individuals representing 14 different countries, but our previous undergraduate studies and work experiences set us apart from many traditional university programs.

This year, students from Canada, Denmark, Finland, Germany, Ghana, Ireland, Italy, Norway, Romania, Sweden, Uganda, UK, USA and Zimbabwe will represent the future generation as global health leaders.

In addition to the various nationalities within our program, many of us pursued degrees from a wide range of academic disciplines including economics, life sciences, medicine, molecular medicine, nursing, nutrition, paramedicine, political sciences, public health, and social anthropology.

This diversity promotes the interdisciplinary and international approach towards combating the many global health issues we encounter today and what we may face in the future. We look forward to sharing our knowledge and thoughts that we will learn from in-class discussions, group work, field studies and research. Not only will our academic and cultural diversity create an environment where we can learn from each other, but our fundamental passions and common interests in improving health around the world will be the ultimate driving force for us to enjoy these next two exciting years in the Global Health program.

Summer School in Global Health Challenges 2015

Written by Amrita Sankaranarayanan

Edited by Sinéad O’Ferrall & Helen Myrr


The Copenhagen School of Global Health hosted the 2015 Summer School in Global Health Challenges, a two week summer course seeking participation from 85 students from 27 different nationalities. The atmosphere was as vibrant as it could get with experts and beginners from various different strata, with backgrounds in medicine, engineering, law and politics to name but a few. The Danish sun also decided to show up to justify “the summer” in “summer” school.

CSSGH 2015 class
CSSGH 2015 class

Week 1:

Dr Flemming Konradsen, Director of the Copenhagen School of Global Health, gave an introductory talk on various job opportunities within the field and how to achieve a career in global health. This talk was followed by Dr. Alessandro Demaio, who highlighted the density and enormity of global health challenges in the 21st century. He talked about the complex landscape of the influences of the actors, the unprecedented opportunities for a transformational change, and highlighted how 2015 is an important year in global health. He put a special focus on climate change’s relation to global health and the growing concern about NCDs.

Dr Fiona Lander led the day forward by discussing the major actors in global health today, laying special focus on the structure and working of The Global Fund, Bill and Melinda Gates Foundation, World Health Organization, PEPFAR and the World Bank, civil society organizations and national governments. She also discussed state and non state actors and private vs. public actors and the way they work in unison. The takeaway message from this session was that goal setting and funding of initiatives do not necessarily reflect the needs or priorities of the recipient country.

Fiona’s energy and positivity, continued as day 2 began with a more serious lecture on Human Rights and clarifying concepts related to it. There was an interactive session on what human rights actually meant to each participant with ranging answers such as right to life, right to play, right to health, right to education, right to a fair trial, freedom of speech and freedom from torture. The session also involved a more extensive discussion on women’s right to abortion.

Alessandro then continued with an eye opening talk on NCDs, ascertaining that NCDS are not just diseases of the lazy, not just  diseases of the rich, not just diseases of the aged and do not just affect men. There needs to be a focus and attitude shift for NCDs in terms of prevention strategies and early childhood education. He also gave quite an animated explanation for whose responsibility is it to  prevent NCDS, suggesting  the government, the individual, and consumer companies. He asserted that food literacy is fundamental to navigate a healthy lifestyle.

The advent of technology was indeed used to the fullest as the day proceeded with two lectures over Skype. The first one was by Dr Gauden Galea, (Director of division of Non Communicable Diseases, WHO-EURO), on transitions in health. He explained reports from WHO and World Bank from 1993 to 2015 and their (lack of) focus on NCDs. He raised important questions such as why is there a system which neglects  NCDs, why is there a lack of investment in NCDs and is it a zero sum gain on investing in NCDs?

This was followed by another e-lecture by Dirk Christiansen focusing on epigenetics  and NCDs explaining the double burden of under and overnutrition. He explained the effects of foetal malnutrition giving the examples of the Dutch famine, sub Saharan Africa, Ethiopia and Somalia. He also mentioned about the correlation of intrauterine nutrition and the development of Type II Diabetes. His catchy take home message was “Stay in your local environment and you will not get diabetes!”

‘Food for thought’ dinners with some of the key speakers were arranged where the participants got involved in more in-depth discussions in smaller groups around a dining table filled with delicious foods..

Day 3 began with lecture from the mighty Ib Bybjerg with a very detailed pathology and public health concern of infectious diseases – HIV, Malaria and Tuberculosis. This was followed by an inspiring interview session.

How do you keep the drive after so many years? With his charming smile, he just pointed out to us, and mentioned that it’s the students and patients that keep him going. He mentioned that his first trip to India in his 20s proved as turning point in his transition in career from a clinician to a global health practitioner. Although he continued his clinical practice, global health and in particular malaria always interested him.

The afternoon was a fun session  (periodically  in the bright sun!) by Dr. Genevieve Bios who shared her experiences on political advocacy and lobbying. We had a simulation session where the audience was divided into groups and given a case study of a particular country, with a focus on coming up with country plans to control smoking and obesity.  Each team seemed so very responsible for their own country and passionately designed a program.

Class working outside in the sun
Class working outside in the sun

Day 4 was opened by Siri Tellier on public health demographics, explaining the 6 megatrends affecting demography- fertility, mortality, migration, growth, age and sex.  This was preceded by a simulation exercise where the student had to find alarming figures in demography of six countries with data from 1950, 2010 and an “estimated” numbers in 2050. The afternoon session was a peppy talk by James Michiel on social media and m-health and exploring its creative uses as tools in public health. A simulation exercise was carried out where students figured out health campaigns using technology and came up with some interesting examples.

The last day of week 1 was a thought provoking lecture by Peter Furu on the impact of climate change on global health. Addressing climate change is the biggest global health threat of the 21st century. But also the greatest global opportunity! He explained the in detail consequences of climate change on health shedding focus on infectious diseases, NCDs and the effect of migration to vulnerable populations and regions. He summarised the main projected trends of health effects related to climate change as malnutrition and related diseases, injury in extreme weather events, malaria, diarrhoeal diseases, heart and lung mortality and morbidity, dengue and deaths from cold.

Peter Furu lecturing on climate change
Peter Furu lecturing on climate change

Siri Tellier continued the day explaining the impact of disasters on public health. She explained the consequences of both man-made and natural disasters in terms of demographics and disease trends.

Week 2:

With renewed energy and enthusiasm, week 2 began with Britt Tersbol’s lecture on women’s and child health. She began by asking questions asserting the importance of  women and child health. Are women more fragile? Do men not experience illness, or sexual abuse, forced prostitution, socio economic inequality, educational and nutritional neglect, lack of access to quality life and knowledge, poorer care seeking behaviour?

Jo Jowell then gave his insight on the threats and opportunities of globalization in health especially in food and nutrition. He acquainted us with terms such as “Coca-colonization” and “Mc-donaldization” which are major global drivers of our eating behaviour. He also gave an insight how the government can support healthy food preferences. The following day, Andreas Bjerrum discussed about Universal Health Coverage and its economic challenges in the globalized world. Alarming statistics was flashed to us that the developing countries have a disease burden of 90% but only contribute to 12% of all health spending.

We then had a great panel discussion on careers in global health where a lot of questions were answered for us young aspirants. Absolutely motivating and valuable advice given such as follow your heart, keep applying, grab the opportunity that gets your way and don’t be afraid to get your hands dirty in the field. At the end of the day Maureen Wilkinson touched the sensitive topic of mental health affected by migration and asked us situational questions which put up the whole audience in awe and high in emotions.

Day 3 was no less in action packed. Nicolai Lohse lectured us on how drug companies think, how they act and what should be their role in global health? Who is responsible for making quality treatment affordable, accessible and available to patients? We had mixed reactions from the audience on do Pharma companies really care about global health or are they only interested in making profits? The industry must not only stick to development and manufacturing of newer and better drugs but must also continue to influence policy making, advocate public health issues and collaborate on the ground with public health programs.

Taking a quick break between sessions
Taking a quick break between sessions

This was followed by a great panel discussion on access to medicines where critical questions such as do we need a new incentive system than patenting for Pharma companies? What are the new ways of risk sharing while developing a new drug?  Why should companies manufacture essential medicines which have no scope of profit making but are for the betterment of millions devoid of its access? Maja Pleic then gave a broad overview on the social determinants of health and presented us with case studies concerning policies in different situations.

The penultimate day (we couldn’t believe the amazing two weeks were almost coming to an end), Jeffrey Lazarus gave an energetic take on health systems in a global contexts and the challenges it faces as we move from MDGs to SDGs. He questioned the WHO framework of the health system and where is the common man in this health system? A great discussion followed, on the need for a people centered health system where the patient (and the healthy) must be kept in focus.

Mike Rowson continued the day ahead with a lecture on health and development and explained the Preston curve and its implications and making us understand concepts such as GDP. The last day was also led by Mike explaining health care in poor markets and global health dilemmas. The afternoon comprised of case studies on is it feasible for the Tanzanian government to invest in and undertake local production of pharmaceuticals followed by an important topic discussion on human resources in health.

CSSGH 2015 class
CSSGH 2015 class

The blasts of information and different perceptions of lecturers and participants from an array of different backgrounds and experiences was no lesser than a joy ride. Activities ranging from a swim at Islands Brygge, to exploring Christania, to movie night at Faelledparken kept the spirits high even during the evenings. When  the weekend arrived, most participants got around the beautiful city of Copenhagen, said a little hello to the Little Mermaid and visited the majestic castles! It was two weeks of fun.

For just the second round since its inception, the program was perfectly placed, well managed and had no eye closers. The group seemed very energetic and well-read to throw questions at speakers, and wouldn’t settle for anything less than a perfect explanation. Focus was laid on various country contexts, often with real life experiences which indeed helped to shed light on real time global health challenges. It also seemed quite a challenge to leave behind the bright sun and to stay indoors for lectures, but it was completely worth it! 

Great experience! Greater global challenges to address!

Cultural sensitivity or an excuse for inaction? Field work reflection– Tanzania, post scriptum:

Writen by: Line Bager (@lbager87)

Edited by: Sinéad O’Ferrall (@sineadOFGH) & Helen Jane Myrr


Five weeks of fieldwork in Tanzania has concluded and we have returned back to our “comfort zones”. Reflecting on the challenges we faced during our time in the field is inevitable. This blog follows on from “To give or not to give? That is the question”. by Sinéad O’Ferrall (03/06/2015). Here I would like to focus on how we acted, and were perceived as a group, when we visited various health institutions. In these situations, whilst we were curious and naturally inquisitive, we were also concerned about the nature of the questions. It is essential to remain as sensitive as possible meaning I would rarely ask the difficult questions. However, one of my fellow students rightly raised the question: at what point does cultural sensitivity become an excuse for inaction?

Credit: Julia Manzerova (flickr.com)
Credit: Julia Manzerova (flickr.com)

Female genital mutilation – a universal wrong?

Who decides if a practice falls under the definition of cultural or harmful? Or can we define a practice as both? We had only been in Tanzania a few days before this question was raised. At a visit to a reproductive health clinic we learned that women who have been mutilated suffer from many complications and that the staff regularly encountered such cases. Many students were from a ‘western’ perspective, horrified and there was a broad consensus that such practice should not be written off as acceptable because of its cultural roots. Female genital mutilation (FGM) is an example of a practice, which we, as outsiders to the culture, consider as clearly violating human rights of girls and women. This is why I believe we, as students largely educated in northern Europe and America, did not quite appreciate the sensitive nature of this topic as we asked many critical questions about the continuing practice of FGM, despite it being delegalised in Tanzania. Our local teacher was clearly on the defence straight away, maybe surprised at the direct nature of the questions, which naturally led us to stop asking once we realised this. But does the apparent discomfort of our teacher mean we shouldn’t have asked these questions at all?

Striking the balance:

I’m tempted to ask if we sometimes hide behind a principle of cultural relativism to avoid stepping up when we see something as wrong? To what extent is it okay to ask sensitive questions and keep on probing when the answer is being refused or avoided? On more than one occasion, when visiting various health clinics, there was a discomfort among some due to the constant probing and lack of sensitivity in the questions and comments. After asking the same question several times, and being refused an answer, maybe it should be accepted that either the question is not understood, or is being deliberately avoided. Despite our pre-departure training we were still unable to appreciate that cultural differences needs to be respected. Some students felt that not asking these difficult questions would be to silently condone the practice and that we are obliged to ask the difficult questions – maybe that is one of the reasons we are here. But it must be done in a way so we do not disregard the cultural differences – there is rarely a right or wrong, rather many grey areas. As a famous scholar within development studies emphasised; going in to the field requires unlearning what you already know – otherwise you are pre-determined to see things in a certain light.

Who decides?

So what are we left with? Does everything fall in absolute categories of right or wrong? Or are all cultural practices and beliefs a matter of perspective? Who decides where the line is drawn between what differences should be accommodated and which should not? Personally I find it difficult to believe in absolute values. Even the idea of Human Rights is a paradigm that some parts of the world subscribe to more than others. It is hard for me to see concepts that are ‘culture free’ and if that is the case then it also true that our background will influence the way we approach an issue. Unlearning what you already know is near impossible. Even if you succeed you end up acquiring another relative perspective – it is simply not possible to ‘stay neutral’. Nevertheless, the attitude of unlearning might be the best way to stay open-minded and avoid snap judgements. This fieldtrip has shown us just how difficult it can be to study and critically consider what we are seeing while remaining culturally respectful.

¡Alto a la Violencia!

By Anika Ruisch

Hey y’all!

In January, the school of Global Health selected a group of six students from different faculties to represent Copenhagen University at the Emory Global Health Case Competition in Atlanta in March: Benjamin Ebeling (medicines), Amrita Sankaranarayanan (pharmaceuticals), Rasmus Skov Knudsen (statistics), Kamilla Amalie Bech Kofoed (psychology), Pernille Friis Jensen (comparative religion) and myself, Anika Ruisch (global health).

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For two months we prepared ourselves, given the fact that we had no clue about the case topic, this was quite an interesting process that involved a lot of speculation. Two weeks before the case was released, Emory came up with a bit of a game changer. They were going to release the case three days earlier! With our flights already booked, we found ourselves in the tricky position of being in three different places for the majority of the preparation time! We tried to make up for it by lots of skyping and google hangout time between Copenhagen, Brussels and Atlanta.

The release of the case was a total surprise… our speculations never came anywhere near the actual topic: reduce gun violence in Honduras. Since we had little knowledge of Honduras, or the relations between Central America and the USA, the pressure was on. By the time all the KU team members arrived, little time was left to admire Atlanta’s blossoming trees, sunshine and southern food. Instead we had to dive into pressure cooker modus! But not before attending an inspiring and humoristic speech from William Foege, former chief of CDC amongst many other achievements. (The man comes across like he is in his early 60ies, but will turn 80!) Work on a life philosophy instead of a life plan, stay optimistic and use science rather than worship it, were just a few of his giveaways.

It was time for long days, short nights and don’t even think about your jetlag: focus on Honduras! In two days, we managed to prepare a comprehensive package of strategies. Our plans included city planning, police training and youth employment initiatives, using the designated budget from the Honduran government, US government and European Commission. However different our backgrounds, I don’t think I have ever been part of such an extraordinary team. Critical discussions and intense research sessions were followed up by random goofiness.

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During the preparation of the case we were confronted many times with how our different backgrounds and educations have pre-programmed the six of us to think in particular ways. But over the course of the week we managed to think outside our different boxes and stand firmly behind our final result. We presented on Saturday morning to the jury, the consul-general of Honduras to Atlanta and a public health professor, and I can tell you that it was a nerve-wracking experience to present our strategies to a Honduran national; however, we managed to pull off a great presentation and come up with answers to all of the jury’s questions. The University of California at Berkeley won this year’s competition and went home with the 6000USD (congratulations!!).

After the reception and formalities we crawled back to our hotel for a much needed power nap, to get back up soon after: cause these folks wanted to go enjoy Atlanta’s nightlife a little!

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All Roads Lead to Krakow

By Larisa Damian

As half of the first year students of the Global Health programme at the University of Copenhagen are getting ready to embark upon the field trip to Poland, scheduled in May-June, everyone is anticipating the experience with a complex mix of feelings. After all, most of us are headed towards a month of novelty. What should we expect? What kind of a learning experience are we preparing for? Who are the people we are going to meet on our way? Of course, the underlying emotions are very positive, but there is also some anxiety lingering at the back of our minds. ‘Resfeber’ is a Swedish word that describes the turmoil a traveller experiences before starting a journey, when anxiety and excitement are woven together. I wish I had an English equivalent for it, because that would be exactly the word I’d have used to describe this contemplation.

For me though, going to Krakow is going back to one of the places that contributed to the person I am today. In 2009, I did an internship with the Community of Hope Foundation. This is an initiative that has developed a centre for adults with autism, and since the main goal of our trip is to get acquainted with the medical system of a middle-income Eastern European country, I thought it would be useful to share with my colleagues a positive story of  the great things that can be done, even in a system with little to no support.

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Rynek Główny: the main market square. Photo by Larisa Damian

In spite of the fact that over the past decades mental health care services have improved significantly, they are poorly integrated within the health care system, and there is a shortage of mental health care professionals. Moreover, the quality of health care provision differs tremendously across the country. Autism is a very good example of how the system may fail its beneficiaries. Although nowadays there are a number of facilities that provide services for children with autism, as soon as these patients turn 18 they become invisible, as psychiatric facilities are not prepared to mitigate their needs and the social system is incapable of integrating them.

The centre I worked for was created exactly to alleviate these problems. It is called ‘The Life Farm’ and provides accommodation, work options, and therapy and rehabilitation activities for all the beneficiaries enrolled in the program. The project began as a consequence of the inability of the Polish system to deal with autistic patients once they were no longer considered children. According to the European Autism Society:

“Life Farm is a kind of village community opened to adults with Autism from Krakow and surrounding neighbourhoods. As part of the long-term project, residents and other adults with Autism will be able to engage in vocational training to prepare them for the open job market, as well as participating in trade and handcraft workshops and an organic farm. Some people also benefit from professional training and apprenticeships conducted outside the centre.”

My job at The Farm was to guide the residents during the workshops and to assist in the creation of several educational tools and programs. I also had the chance to visit a few other facilities for people suffering from other mental health problems, such as a centre for children with autism,  a psychiatric hospital, and an asylum for men with both mental and physical disabilities. In each of these situations I was faced with two of the main features of the approach to healthcare in a country like Poland. On one hand there are the difficulties that both health care providers and patients encounter as a consequence of a medical system that is continuously changing, more than 20 years after the fall of communism. On the other hand, there is the resilience that characterises these people, and their ability to find answers to questions that have never been officially asked, such as what do we do with these people who don’t fit in any of the categories our systems are ready to serve, or can we do something even though nobody’s done it before?

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The Krakow Ghetto Memorial. Photo by Larisa Damian

So when you’re asking yourselves what it is going to be like, my experience says that while you’ll encounter quite a number of mind boggling problems and irregularities in health care provision, you’ll be amazed by the creativity of people and by projects such as the one I just mentioned. The Jagellonian University is located in a beautiful old building in the heart of the city, in the middle of all that Krakow is. As for Krakow itself, it’s nothing short of spectacular. Castles, rivers, hidden turquoise lakes,  legends about dragons, art cinemas, and, most strikingly, a reminder of the astounding survival skills of our species; both the old Schindler factory and the Nowa Huta district built during the communism years as a centre for heavy industries have left their prints on the collective memory of the city. And me? I am looking forward to being carried around the streets of Kazimirez once again, as the sun sets and some Klezmer music resonates outside a souvenir shop by a synagogue.

Student Perspectives of Global Health Internships

One of the attractive elements of the MSc Global Health course is the dynamism and diversity the particpatory students hold. Opportunities span the Global Health world, ranging from child and reproductive health in Mexico to a worldwide advocacy campaign focusing on chronic non communicable diseases.  However many students and future global health leaders may initially wonder which specific area will I follow amongst the complex and interdisciplinary global health spectrum. This article will hopefully give a snapshot of some of the routes which our current second years have taken at the start of their careers.

Anika Ruisch – Internship with ECHO – Coordination of the international response to the Ebola epidemic

I started my internship with the Emergency Response Coordination Centre (ERCC) of the European Commission’s department for Humanitarian Aid and Civil Protection (ECHO) in September 2014. When I arrived, the Ebola outbreak was one of the main occupations of our unit. With UNMEER not in place before the end of September, ECHO initiated the role of a central coordination hub in the first months, not only for the European response, but also for bringing the international community on-board.

European Commission DG ECHO
Flickr: European Commission DG ECHO

Since October, daily Ebola Task Force meetings were held in the ERCC, bringing together the relevant European institutions and services, EU Member States, humanitarian partners and relevant international actors such as the WHO and IFRC. The meetings in the ERCC sometimes had over a hundred participants, in person or via video or telephone links from all over the world – including colleagues in the affected region.

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Flickr: European Commission DG ECHO

With the global response gaining speed and substance, also the coordination became increasingly challenging. Big issues were addressed and the ERCC had a leading role in the coordination of several rotations of Dutch military vessel with in-kind assistance and the development of a medical evacuation capacity in order to address the lack of foreign medical teams in the affected countries.

Throughout my internship, I have been part of the ERCC’s Ebola Taskforce, supporting the team by putting the standard operating procedures for the EU medevac capacity on paper and by attending meetings and reporting on them to keep track of the overall disaster response. My internship is over, but I was offered to stay and work for the ERCC, which I will try to combine with finishing the MScGH program. I hope to learn much more about the work of ECHO and the key functions of the ERCC: coordinating disasters, monitoring hazards and matching offers of humanitarian assistance.

Flickr: European Commission DG ECHO
Flickr: European Commission DG ECHO

Nina Reichwein – Internship in the policy consultancy company BBJ Consult AG, Berlin.

In November/December 2014 I underwent a 6 week internship with the BBJ Consult AG in Berlin.

During the six weeks of my internship I was mainly assigned to the following tasks:

  • Research and participation in a seminar for a delegation from Moscow on the topic of barrier-free urban planning
  • Research on the new German prevention law
  • Development of options for financing a workplace disease prevention center

As I aspire for a career as a professional consultant to global actors in the health care sector and health care systems in the developing world, I decided to use the given opportunity of interning to gain insight into the field of consultancy work. Summing up the six weeks of my internship with the BBJ Consult AG, I can conclude that it had been an interesting experience and helpful to gain insight into policy consultancy work.

Henry Mark – Internship at Sight and Life

During my internship I was able to work on a range of different project revolving around implementation research and delivery science (IRDS) in nutrition. It’s an exciting time to be involved in nutrition with much of the discourse now around how we scale up effective interventions to meet all those who can benefit from them.

We often talk about programme quality and coverage as side notes or passive processes, yet at each aspect of programme implementation we need to have specific focus on what gives the best results. During the internship I learnt a lot about what IRDS is and how it can shape the future in nutrition programme implementation.

In general IRDS is a really important area for global health and in the coming years I hope it will start to get the attention and resources it needs. For example, beyond nutrition the chronic disease burden in all countries around the world is increasing, ensuring access to essential medications and treatments is going to be a major challenge that requires innovative thinking.

For me it’s the innovation in IRDS that makes it a fascinating area and one that I would encourage others to get involved in.

Flickr: European Commission DG ECHO
Flickr: European Commission DG ECHO

Anne Christina Gotfredsen – Internship at the Danish Research Centre for Migration, Ethnicity and Health (MESU)

For my third semester at the MSc in Global Health, I decided to apply for an internship. I have a strong interest in international migration, health and human rights so I contacted the Danish Research Centre for Migration, Ethnicity and Health (MESU).

I was assigned various tasks and responsibilities at MESU in an international study on child migration managed by Save the Children UK. Early in the internship, I was introduced to the possibility of going to India and conducting interviews for the project. Therefore, the assignments for my internship followed two different tracks; first, the literature and policy review on protective mechanism for children migrating from Bangladesh to India, and in addition the planning and coordination of the field trip.

My internship at the MESU gave me inspiration and a possibility to do profound research on an area I had little knowledge of six months ago, and I will continue working on the topic when writing my thesis this coming semester. During my internship I have tried to grasp the complexities of child migration, its causes and consequences, its risks and opportunities and finally the frustrating fact that despite numerous actors working with children’s rights in relation to migration, many children are left unseen and unprotected.

Danielle M. Agnello – Internship – Antimicrobioal Resistance(AMR),  Communicable Diseases, Health Security, and Environment, WHO Regional Office for Europe.

I am currently commencing my 3rd week at the World Health Organization regional office of Europe. I am an intern in the department of Communicable disease on the exciting Antimicrobioal resistance (AMR) team. The first few weeks have flown by and I have quickly began checking off the items on my list of main objectives for my time here. I don’t only get to work with an intelligent and amicable team, I also get to spend my days roaming the halls of one of the most carbon neutral buildings in Copenhagen!

While working here I get a great insight into the preparation of briefs, reports and updating country fact sheets, while still flexing my creative muscle with various design tasks. I also will have the opportunity to interact with and help facilitate a stimulating collaboration of microbiologists, clinicians and pharmaceutical professionals from almost 20 different countries during our upcoming AMR Workshop here in Copenhagen! I am enthusiastic about the upcoming months here and for look forward to our trip to Tbilisi, Georgia, where we will be performing exciting fieldwork!

Remember to wash you hands and follow these five tips on antibiotic usage so you too can participate in the antimicrobial stewardship movement! Feel free to follow our progress on my twitter account.

E-mail: dmarieagnello@gmail.com 

Flickr: United States Mission Geneva
Flickr: United States Mission Geneva

Health Systems Week

This week the @CSGH_DK blog is coming over all health systems! While initial thoughts may turn to doctors in white jackets and the aroma of disinfectant, health systems extend well beyond hospitals and clinics into the heart of every community, delivering many of the programmes and interventions aimed at improving individual and population health.

Kirabiti. Community health workers set off on their daily run dispensing medicines and checking patients recently discharged from the hospital's TB ward
Kirabiti. Community health workers set off on their daily run dispensing medicines and checking patients recently discharged from the hospital’s TB ward

“The sum total of all the organizations, institutions and resources whose primary purpose is to improve health” is how the World Health Organisation defines a health system. All countries have one, in some shape or form, yet there are vast inequities in access, utilisation and quality of care both within and between countries. Health systems are often highly politicised with debates on expenditure, structure and administration occurring the world over.

UC Atlas of Global Inequality
UC Atlas of Global Inequality

For health students and professionals it can be easy to take for granted the underlying systems that we rely on to deliver new and existing services. However, health systems themselves are in need of direct attention both from research and programmatic perspectives. This is especially the case in light of the post-2015 development agenda, where health systems need to be a central part of the debate in order to achieve the highly ambitious goals we should all be aiming for.

Throughout this week we will be bringing you student articles, guest articles and an interview from the Director of Health Systems Global, Professor Jeffrey Lazarus in order to shine a light on some of the hot topics in the field of health system.

We hope you enjoy reading them!

Henry and CSGH_DK blog team.

#iaru2014

By Julie Franck (@JulieFranck1)

PHOTO 1Group photo /Photograph by Nick Skenderian

Two weeks ago, the MSc Global Health class of 2016 had the opportunity to attend the Sustainability Science Congress 2014 hosted by the International Alliance of Research Universities (IARU). The conference, which was a follow-up from the Climate Congress held in 2009 during the COP-15, took place over three days in the Radisson Blu Falconer Conference Center in Copenhagen, and hosted nearly 140 speakers from various disciplines discussing climate change and sustainability.

It was an incredible experience for us students to participate in the debate on climate change with the big players in the game. One way we were able to participate was through the use of technology and social media at the conference. Attendees were encouraged to use Twitter to share their thoughts, and all tweets with the hashtag #iaru2014 were displayed on the big screen in the main conference hall, which gave us the opportunity to follow the thoughts of fellow tweeters.

PHOTO 2-1 Top 50 buzzwords from the first day of the IARU conference /Photo by Martin Jung

The aim of the conference was to focus on research related to climate change and sustainability challenges, and to bring together prominent speakers from science, business and policy to discuss solutions together and create an open dialogue between different fields. With topics varying from health and education to governance and social equity, and with speakers such as Johan Rockström, director of the Stockholm Resilience center, discussing the need for science to operate within planetary boundaries, and Peter Bakker, president of the World Business Council for Sustainable Development, addressing the role of businesses in the search for solutions in sustainable development, to mention a few, the interaction between the fields became very apparent.

Given the choice to attend different talks within the conference, and the wide variety of backgrounds we come from, it was fascinating to follow the interests of the Global Health students on Twitter. Below you can see examples of this.

PHOTO 4Global Health students tweeting from the conference /By Frederik Felding, Daniel Jeannetot and Sinéad O’Ferrall

In my personal opinion, one of the most interesting and attention-grabbing talks was given by Dr. Adil Najam, professor of International Relations and Earth & Environment Studies at Boston University. He had a very unique take on the climate change debate, in which he highlighted the need for a collective effort and the benefits of looking at the planet as a united entity. He asked the audience to think of the world as one big country – “it would be a Third World Country,” he said, as this view of the world forces people to acknowledge the massive inequalities and growing need for cooperation between different parts of the globe. He argued that, in order to fight the threats faced by our planet, we have to make the environment our own. To me, Najam’s way of addressing climate change as a global issue, was an eye-opener, in the sense that the problem does not just lie with the scientists and the politicians – we, you and me, are all in this together, and policies implemented in one corner of the globe may very well have impacts in another. Only by looking at climate change as one common problem faced by the whole world, will we be able to tackle it.

Throughout the conference, there was an overall consensus that climate change is very real, and sustainability should be a key driver of global development. According to the scientific representatives at the conference, we have enough evidence to know what is happening, how it is happening, and, more or less, what the implications will be. According to Dr. Najam “We now have the ability, both scientifically and financially, to think about a future that we haven’t thought of before.” In other words, the scientific debate about whether or not climate change is happening is officially over, and the next steps now lie on the shoulders of policy-makers and businesses. The IARU 2014 conference was an attempt to bring together different players and open up for the collaboration between them, and the resounding conclusion from the three days was: we need to work together to save our planet!

PHOTO 5Who are the politicians looking up to? From the talk by Tony Simons, Director General of the World Agroforestry Centre /Photograph by Julie Franck

Global Health Students – Who are we? What can we contribute?

By Louise Scheel Hjorth Thomsen

Nicolas Raymond - World Map - Abstract Acrylic
Nicolas Raymond – World Map – Abstract Acrylic

Since, I became a member of the master’s programme of Global Health at Copenhagen University, I have experienced that a lot of opportunities are given. But, it can be hard to find a niche and a track to follow, as the field of global health is multidisciplinary and includes a wide range of relevant and interactive health issues and future job positions. Many repeating questions arise with no easy answers. Should I choose Tanzania or Poland as destination for my field trip? Which study track is the most interesting for me? Where do I want to get an internship or go for exchange? Which electives are optional and fit my profile? For even further reflection; which topic do I want for my thesis? All these queries are floating in my head and constantly appear in conversations between me and my fellow students, as we are encouraged to consider our study plans and wishes for our future career. Personally, I feel a constant pressure to make career orientated decisions, which ideally are well structured, straightforward and follows a clear line.

This pressure also links to my search for a relevant student job. At our University’s newly held “Career Day”, it became clear to me that the majority of the labour market is not aware of our existence, what we can contribute, what our special skills are, and how we can fit into a specific work force. At the same time, friends and family are continuously asking what I will “become” when I have finished my studies and what I am a specialist in. Do I, as a new master’s student, know the answers to all these introductory questions? I am not that sure. But, I will try to provide clarity, starting with the one thing, which combines all the raised questions – “global health”. To clarify this field and to identify the goal of global health related work, I find it necessary to define it.

What is Global Health?

The three levels of health; public health, international health and global health, are all population-based and preventive focused, multi- and interdisciplinary approaches and put emphasis on vulnerable people. With regards to global health, I like to use the definition made by Professor J. P. Koplan MD, who determines global health as a transnational area of study, research and practice, that places a priority on improving health and achieving equity in health for all people worldwide. Well, it sounds ambitious and glamorous. Nevertheless, critics say that the field is characterised by colonialism and funding, for which reason the money sets the agenda. Answering the question of what global health is, leads to another with regards to the specific competences of global health graduates.

Which skills can we contribute to the labour market?

As specified at the Webpage of the School of Global Health, a graduate in global health will, for instance, be able to address scientific research and existing data, to expand and apply knowledge about a specific global health issue. Besides, we can address multifaceted practice and policy issues relating to global health. Furthermore, we contribute to evidence-based planning, communication and implementation of innovative initiatives and strategies to improve health and prevent and control diseases. Equally important, we tackle cross-disciplinary and complex problems by providing evidence-based solutions. These unique skills are definitely the reason why future employers should hire us.

An example of a study plan

Back to the “Career Day” – a repeating question occurred; “So, what are your special interests?”. This is indeed what the study planning and future career track is all about. Interests and excitement are the key drivers to answering these difficult questions. Although I had some difficulties answering them at the time, after further reflection, I will now try to answer all these questions founded on my personal interests and with the mentioned competences in mind.

I will choose the study track “Disease, Burdens, Changes and Challenges” to get specialised in prevention and control of non-communicable diseases like cancer. In this context, I have a particular interest in nutritional aspects and the influence of other health determinants, including physical, environmental, cultural and social factors, from individual to society level around the world. Therefore, my master’s study will preferably involve an internship and electives in the field of non-communicable diseases, health communication and nutrition, in relation to health promotion and disease prevention.

Meanwhile, I do also like to strengthen my practical experiences with regards to health challenges and organisational work in developing countries. This is why I started volunteering at the IMCC project “DanZania” and I hope to go to Tanzania on our field trip in the spring 2015. Ultimately, I hope this study plan will be rewarding and I will be able to test different aspects of the global health field, to be closer to an identification of my dream career.

In conclusion, global health professionals have a lot to bring to the labour market, but I know there is a general need for awareness about the profession and our unique skill and knowledge sets. By introducing you to the term “global health” and furthermore, which competences we develop under our master’s programme, I do hope that you are now slightly more aware of who we are and what we can contribute. By following this blog, you will be introduced to a lot of the interesting topics related to our studies.