Epi Tales

Autumn arrives

2011-09-19T21:33:00.001-04:00

I've got an exciting new global health job that focuses on the well-being of women in low-resource settings (essentially my life mission), have been painting murals with an artist who is a fellow first gen, and have returned to my decade-long love of distance running. More updates to come.

Will B-ing the change

2011-09-03T01:24:00.002-04:00

I never decided whether to change my last name following marriage. No logical, convenient solution emerged, particularly given that hubby and I lack last names designating families. They're not names. Instead, we share our last names with every member of our father's religions! And we don't follow either faith.

You simply can't say, "go make Sikhism look good". It doesn't have quite the identity-driven parental pressure that, "you're a Walker, now go make me proud has", does it? This in- or lack of a decision confuses people, but a close friend handled it brilliantly, erasing neither half of my union. Read on:

What salutation should we use to address you and your husband on the save-the-dates (and later the wedding invitations)? The traditional formal format for such invites is Mr. and Mrs. [Husband's First and Last Name]. However, in the case of marriages where couples kept separate last names, or one has a hyphenated name, it's different.

I wanted to ask which you prefer: Mr. and Mrs. [husband's full name] OR Mr. [husband's full name] and Mrs. [first name + last name + husband's last name].

[Husband] said to address you all as: "[Husband's full name] and [Wife's full name]", which doesn't have any Mr/Mrs/Ms in it.

Is it really that simple? Yes, respecting an identity and not erasing someone is as simple as this quick e-mail before sending out invites. And, after all, we're not Mr. or Ms., just our names, right?

This post is dedicated to feminists Will (excited to be a part of your marriage beginning!) and Mr. Epi Tales (ha!).
Image credit weddinginvitations123.net

The First Lady of Public Health

2011-05-08T17:04:00.000-04:00

Michelle Obama is the perfect face of public health and prevention. Let her teach you how to dougie and watch her get Sesame Street's Elmo excited about exercise (and cute as ever)!

One thing I loved about George W. was that he was an amazing athlete as well. He ran marathon in under 3.5 hours and made a secret service agent break a collarbone trying to keep up with him mountain biking -- I wish he'd made that a talking point; what could possibly be negative about that?

Among America's 3-year-olds, a revolution is afoot

2011-04-15T14:35:00.000-04:00

Image from newautismcure.com

According to the latest issue of the Economist, “AMONG America’s three-year-olds, a revolution is afoot. Children of that age are turning the country’s demographics on its head.” The majority of them are now from groups normally considered minorities, chiefly Hispanics and blacks. Overall, the US Asian population grew by 43% to 15 million. Full Article

He is meticulous, has a girlfriend, and is doing well in school...

2011-04-14T14:03:00.000-04:00

...so what disorder does he have?

Why we hate our girls

2011-04-12T11:28:00.000-04:00

"The oft-quoted, and very real reason why daughters are not desired is dowry; but it goes much deeper than that. To even begin to address India’s skewed sex ratio requires vision, extraordinary empathy, and a leap of imagination. Simply quoting numbers, getting on the moral high ground and condemning the parents who kill their daughters is not enough. “Indian women have been raised to devalue themselves and we perpetrate this on our daughters,” says Lobo. “I get very irritated when women tell me that they won’t eat before their husbands. Do it if it’s important that you have a family dinner. But don’t do it because he is the man. Till we learn to value ourselves, we won’t value our daughters."

-From a piece by Shoba Narayan at Live Mint

Piece de Resistance

2011-04-05T21:50:00.000-04:00

Entirely too good -- thanks, James and APIC!

High 5: Hiding Divya is coming to JHSPH!

2011-01-15T20:08:00.000-05:00

This is the second Epi Tales High 5. The phrase means I've lovingly, painstakingly even, brought you five exciting links for your thinking pleasure.

First off, Hiding Divya is coming to JHSPH! It's a recently released independent film about an Indian-American woman (played by Madhur Jaffrey) suffering from a long-ignored case of bipolar disorder. The director, Rehana Mirza, will be speaking afterward, and we'll be serving South Asian food. Maria created the beautiful advert seen above.

Please join us in Sheldon Hall at 5pm on Thursday, February 17th, 2011!
And here are the rest of your links:

Almost as many American servicemen and women have died by suicide as on the battlefield
Folic acid and iron supplementation literally yields smarter babies, and folks from my department did this study in Nepal
The Big, Bad, Blond Bahu (4B) battles the invariably present dirty old man. Here's part 1: Old Coots, My Thighs, and Unsolicited Sex Advice
Unsustainable chains of taking loans to repay others end in scores of suicides in Andhra Pradesh, India

Model minority suicide, Smithsonian's homophobia

2011-01-04T21:56:00.000-05:00

This is the first Epi Tales High 5. The phrase means I've lovingly, painstakingly even, brought you five exciting public health links for your thinking pleasure.

Image by toothpastefordinner

Suicide in Asian-American Women: Sam at Hyphen Magazine just started a brilliant column called Ask a Minority Suicide, where she tells her story of surviving an attempt and its aftermath. I like her deeply human way of discussing alarmingly high suicide rates among Asian American women alongside the research delving into the devastating, and possibly avoidable, phenomenon.
Increasing mental health needs of college students: The support simply isn't there. What does this mean for colleges that are stereotypically mental health obstacle courses, such as MIT and Cornell?
-ism persism: So the Smithsonian is homophobic? Really? And my friends go home to racist relatives?
Zyprexa's egregious off-label marketing: Here are the startling legal documents that were part of the largest off-label marketing settlement in history, at $1.4 billion. But Lilly made $4.7 billion on Zyprexa in 2008.
Women think about food more than sex: According to a diet company-sponsored study reported in Time, 25% of women think about food every half hour compared to 10% who think about sex in that same time frame. I wonder how much those two groups overlap.

She works hard for the money...

2010-12-29T02:16:00.003-05:00

I am awash in the thoughts, perceptions, and day to day realities of 43 Nepali women who are chronicling their lives after 5 years of employment distributing vitamin A in their villages. I use the data to explore (carefully never saying "understand" or "determine"):

What empowerment means in this context
How to measure it
Did the job empower people?
Who got empowered? In what ways? What were associated factors, or who was empowered at the end of this 5-year study, and who wasn't?

In the meantime, I'm teaching myself to use Atlas TI (with the help of their fantastic online tutorials), reading empowerment research (particularly Naila Kabeer's incredibly helpful frameworks), and of course, writing and editing.

My friend Anne commented that, "sometimes the people in my data set are like people in my real life," and she's exactly right. While sweating over spicy noodles at a Nepali restaurant, I'll wonder wonder if they're anything like the chow-chow (street noodles) mentioned in an interview. Or during a conversation, I'll remember the woman who bore 11 children but was restricted to her home. Sometimes I wonder what they'd be like to meet, or how the disorienting the transition must have been for an unmarried woman in India to a married woman in Nepal, who immediately had a new culture to learn, a new family, children, and her job.

The wordle above visualizes words uttered most often. The bigger the word, the more often it was said.

Money, jobs, kids, and work were the highest -- I bet that would be similar no matter where you did this study.

Contemporary Heroine of Public Health

2010-12-12T18:38:00.000-05:00

"This is the true joy in life, the being used for a purpose recognized by yourself as a mighty one; the being a force of nature instead of a feverish selfish little clod of ailments and grievances complaining that the world will not devote itself to making you happy.

I am of the opinion that my life belongs to the whole community and as long as I live it is my privilege to do for it whatever I can.

I want to be thoroughly used up when I die, for the harder I work the more I live. I rejoice in life for its own sake. Life is no "brief candle" to me. It is a sort of splendid torch which I have got hold of for the moment, and I want to make it burn as brightly as possible before handing it on to future generations."

-George Bernard Shaw

This was shared by a true, contemporary heroine of public health, Dr. Ruth Lubic, who founded family and birthing centers for low-income women around the US. Her results are phenomenal, and playing the evidence-base aficionado you've grown to know and love, here's what her DC center has achieved:

Outcome	US (2006)	DC (2006)	FHBC (2006)	FHBC (2009)
Preterm Birth > 37 weeks	12.8%	13.2%	5.0%	2.3%
Low Birth Weight at Term	8.3%	11.6%	3.0%	1.9%
Cesarean Section		31.5%	10.0%
Ever Breastfed	77.0%	-	88.4%

*source: Lecture from Ruth Lubic in the JHSPH course Current Issues in Public Health

She started this DC center with the money from her MacArthur "genius" award. All of the negative birth outcomes occur half or one-third as often to mothers giving birth at the FHBC (Family Health and Birthing Center) compared to DC as a whole.

I learned of her work though an online class simply called Current Issues in Public Health. Her power and passion transcended the slides and voice emanating from my computer. What struck me is that she didn't speak of research, health outcomes, and community partnerships to get things done. She spoke of earning trust, having a sense of humor in the direst times, and her husband's support in moving to DC.

She says that “giving birth entails enabling the mother rather than the persons in attendance to be central to the arrival of her child. Even when the arrival, as is sometimes true, must be effected surgically.” She disdains research testing the model of birthing centers saying that no population should be treated as research subjects.

Her lecture began with the same quote that begins this blogpost. Shaw's quote, to me, is our individual aspiration that enables the collective practice of truly public health.

Gr-attitude

2010-12-01T11:19:00.000-05:00

Guess what I'm Thankful for? Well, loads of things, but the APIA blogosphere in a huge way. What's that, you ask? It's the Asian and Pacific Islander blogosphere, of course. Here's how you're a Disgrace to the Race, or Diagrasian puts it:

"Hardass Asian Family, thank you so much for decades of judging me harshly, undercutting my achievements, and scoffing at my pursuit of the liberal arts so that one day, my friend and I might bond over such upbringings, commiserate loudly, and start a pale yellow website barking about shit.”

And grateful we are for the pale yellow website. It's exactly this humorous solidarity that produces the High Expectations Asian Father:

Or what about the painstaking, 9-year, labor of love by Jenn at Reappropriate? Or the soul-fillingly insightful stories at Hyphen Magazine, like Ask A Model Minority Suicide, that strives to look at the issue of high suicide rates in Asian-American women beyond the statistics. Or 8 Asians? They're lucky, smart, and tell me about things like the Privilege Denying Dude.

So that's what's keeping a smile on my face these days (thanks, guys!). If you want to some of what's inspiring me nowadays, I made it easy - just shift your gaze to the right.

The Grad School Buffet: Eat Up!

2010-11-22T12:24:00.007-05:00

Image by Philadelphia Examiner

I'm a TA this year, and when my students began their graduate school, I warned them with a simple analogy: grad school here is a lot like an overflowing Chinese food buffet. Once you're in, you are tantalized by the dishes laid out in vast quantities before you.

You can go back for as many plates as you want. Your only limit is your gastronomical capacity, and perhaps your health. So how much should you take on? Me - I'm kind of a one, carefully-selected trip kind of person, sometimes pickily selecting sparse seconds.

I'm not necessarily saying I'm unambitious, just that I'm continually searching for the ever-elusive concept of balance.

This Modern Life: Death by Computer

2010-11-10T19:08:00.001-05:00

Sometimes I wish so much of my life wasn’t spent in front of the computer. At the ripe old age of 25, I worry when I hear about more things being done online, like classes and banking. There is a lethargy from spending the majority of your life behind a computer screen.

During my last job, I spent a full 10-12 hours per day in front of the computer. If I wanted to come home and find a recipe for dinner or pay my credit card bill, guess what I did? That’s right – when straight back to the computer. Too much time on the machine and words start to blur, the ridge between my neck and collarbone shrieks with tension.

Health effects
This may sound dramatic, but it is a new phenomenon: so many jobs render the majority of our existence behind a computer screen. So what is this doing to our health? Just isolating us socially? Yes. Wreaking havoc on our eyesight? Uh-huh. Decreasing our abilities to metabolize fat and sugar (utterly terrifying)? Absolutely.

At the risk of sounding like a terrifying PSA, here’s what I think you should do: kill your chair, because when you sit, fat metabolism slows down and body fat even becomes more centrally distributed (diabetes alert!). Then you (cliche, I know) take the stairs, and see if you can do some of your meetings while taking a walk.

And isn't some of this just common sense? Twelve hours a day, work and leisure, all in front of a computer screen just seems intuitively wrong.

Rakhi reflections

2010-09-02T00:35:00.004-04:00

I've always enjoyed the Indian (Hindu) tradition of Rakhi, or Raksha Bandhan. My memories center around wearing a salvar kameez, or whatever -- like the kameez-and-jeans when we did it in my high school dorm room. We took photos, ate cloyingly sweet Indian desserts from each others' hands, and tied the colorful threads on the guys' wrists. They responded with cash, usually given to them by parents in one instant, then passed to their sisters in the next. I've always found it strange that barely a cursory word about the protection the shiny thread symbolized, or the sanctity of the relationship being performed.

There was a hint of insincerity to the whole practice, like obligatory tears at a funeral. But something empowering and authentic turned it around for me -- my sister and I tying rakhis on each other, recognizing a strong, mutually protective relationship that already existed and would grow along with us. And that conferring real, lasting protection to someone was no longer solely the purview of males.

Rakhi from Rediff shopping

When you ask for secrets...

2010-08-15T02:01:00.005-04:00

...sometimes what you get is truly horrifying. While a secret perhaps carries some sanctity -- it's only secret because you're afraid of people's reactions -- I'm going to violate that sanctity and say this is incredibly and devastatingly racist. What you see below is the problem.

It's one thing to stereotype unconsciously, realize you're doing this, and reverse course. Sometimes people reverse course so much that their reaction, in itself, becomes offensive and racist (exoticizing, or idealizing). But this is far, far more sinister. This person did not realize or care that they were stereotyping, took action accordingly, then claimed not to feel guilty.

Maybe I need to preserve my ability to live in this world, but I think this person felt shame deep down. After all, this is a secret that made it into a postcard for Postsecret, not a cute anecdote for friends.

More food for thought, and perhaps some internalized racial self-hated (bottom):

Passionate discussion here.

There's a sufi saying that goes, "If you see with the heart, all masks fall."

Exploring Stigma through Film

2010-08-06T10:19:00.000-04:00

South Asian society, as a whole, carries strong stigmas against issues with which the "wild West" has made considerable progress. The problem of cultural fossilization is real and dangerous.

Note: cultural fossilization is when an immigrant keeps the social mores of the time and place from which they immigrated, making them more backwards than the new place, and more backwards than their old place.

Here's an example of former cultural ideas carrying over to the new world: Asian-Americans are more likely to abort their baby girls long after their immigration to the US, freedom from son-preference or one-child policies. The study showing that was done with census data.

There's a fantastic new film that deals with another thing often stigmatized among us: mental health issues. Hiding Divya is a film about a woman struggling with bipolar disorder. Appropriately (and inconveniently) it's debuting in places like Manhattan, Edison NJ, and Freemont CA. And Peachtree GA.

I learned of the film through Manavi, an organization that helps women in abusive domestic partnerships in the New Jersey area, with a focus on South Asians. Domestic violence is astoundingly high in this community, which faces unique barriers to addressing domestic violence: stigma, language, strong ideas of gender roles and preference, cultural expectations and shame, and the complicated legal status women may have due to immigration. I volunteered with them while in NJ.

How to Flirt in Seattle: Aren’t Indian Women Beautiful?

2010-07-12T21:29:00.001-04:00

After all the internet hoopla following Joel Stein's "My Own Private India", I am more confused than ever about racism I experience. The silver lining is wittiness, specifically Kal Penn's now-famous, incredibly sarcastic retort published on the Huffington Post.

Hold on, I’ve got some nostalgia, bear with me: all these mentions of Edison, NJ engender some serious gastronomical and linguistic longing. Walking into restaurants or sweet shops with my then-fiance, I was never addressed in English, only Hindi. It never felt presumptuous, rather inclusive, with the undertone of “I know you know this” and “we share something, whatever part of India you’re from”. Isn’t there some comfort in that?

Now I’m walking around Seattle, which is white enough to find an Indian interesting, yet cosmopolitan enough not to call me a dothead (I think this term is out of vogue anyway). Instead, I find hilariously, yet racist, moments. Last weekend, my mother and father-in-law were browsing jewelry in a booth at the Freemont fair. A kindly older man looks up and says, “Do you speak Hindi?” to which I answer, “yes”. He tries out a few phrases on us, and his accent is respectable. He tells us about his time in India. I groan inwardly – why is it that every non-Indian male who starts a conversation with me seems to have an insatiable urge to tell me about that one time they were in India? Or how they know Ravi Shankar? Or how I must eat ‘such spicy food’? Yes, one billion of us possess miraculous abilities to eat food spicier than anything you could comprehend. And we’re uniformly spiritually advanced yogis too. Then they want to go to India. And close the conversation by saying how I’m beautiful because I’m Indian. Oh, and throw in an Aishwarya Rai reference, as well as the one Bollywood flick they’ve ever seen.

I’m still rolling my eyes when we leave the dry shelter of the jewelry booth, pressing forward in the now-familiar Seattle drizzle. A curly brown-haired young hippie-looking guy, holding a guitar, loudly addresses us in Hindi, “NAMASTE! Sabkooh sapna hai” except that we could not understand his Hindi, due to his accent. We turn towards him, confused.

“I think he said, ‘sabkooch samne hai’ [everything is in front of you]”, I ventured, to my MIL.

“Wait, really? Not ‘sabkooch apna hai’ [everything is mine],” she responded. Apparently exhausted with our own conjecture, we turn back to the hippie-looking, guitar-holding guy, and ask, “wait, what did you say?”

“Do you guys speak Hindi?” whoa. There’s that line again. Is this how Seattle-ites greet strangers?

“Yes, of course. What were you saying?”

“Everything is a dream,” he responded. Oh goodness, I thought to myself, he’s starting to flirt, and I am standing here with my in-laws. Who hits on someone with her parents watching? (And, for the record, I wear a wedding ring on my left hand). Polite banter followed about – guess what – Ravi Shankar. Eager to end this rain-soaked insipidity, my MIL and I turn to leave. He then turns conspiratorially to my FIL and comments, “aren’t Indian women beautiful?” Really? This dialog actually took place out of a comic strip?

More comedy: at my office, anytime someone speaking to me refers to a project in India or Indian food, they gesture towards me.

While I’m grateful that these anecdotes are neither traumatic nor hate driven, they constitute racism in that I am viewed first and foremost as my race. Similar to how dripping water can wear away rock, or how well-being erodes when faced with verbal abuse (just ask the French government), these small barbs injure a sense of individuality and belonging over time. Place the idea of complete assimilation in this context, and it quickly becomes obvious that integration cannot happen without an accepting environment.

Looking back at the ill-placed Time piece, I can’t quite get angry at Joel Stein even though his piece does an astoundingly good job at missing the point. He opens with “I am very much in favor of immigration everywhere in the U.S. except Edison, N.J.” (italics added) where he explicitly condemns a particular branch of immigrants. He then insults them, saying:

In the 1990s, the not-as-brilliant merchants brought their even-less-bright cousins, and we started to understand why India is so damn poor.

Then he admits that Indians have helped his precious hometown survive economically.

Stein continues to demonstrate his complete ignorance, blessed as he may be with his titular “own private India”, by saying that one billion Indians are “familiar … [with] instruct[ing] stupid Americans to reboot their Internet routers.” If you ask the vast majority of Indians about routers, they might stare at you blank-faced. India is not all Bangalore and high-tech. Still though, reading about Stein’s sense of dislocation when his “town is totally unfamiliar to me [him]” draws real sympathy, even from a member of the group he feels so threatened by – but isn’t this the reason for all the aphorisms about change? And isn’t this perceived threat the most neatly circumscribed definition of xenophobia? And this is precisely why the scars of immigration remain, even two generations later. But this comes full circle: this is also what Stein and these immigrants share, in addition to the more tangible, crowded space of Edison, NJ.

Calling Stein’s perspective or my experiences offensive isn’t the right word – nothing that’s outlined here is blatantly mean-spirited, just severely misguided. To my boys, the idea any generalization can be made about Indian women, i.e., half of a billion people, is indescribably ludicrous. And Stein: nice blinders – are they hip right now? Because so is the other side of the story.

Third hand smoke

2010-06-27T19:38:00.002-04:00

Image by porbital on deviantart

We could use bans on smoking and taxes on cigarettes -- both are cheap, effective, and proven rates to cut down on smoking across all sectors of society. This means improved health (and lower medical bills) not only for those individuals smoking, but also for the rest of us.

A recent NYT article outlines the health issues caused by third-hand smoke, that is, the unseen, undetectable carcinogenic particles left in clothing and furniture after smoking. Tackling this issue would mean forbidding people in apartment buildings to smoke in their homes, among other restrictions. It would be more invasive than measures to reduce second-hand smoke. As expected, it produced knee-jerk negative reactions, who saw it as a form of personal discrimination:

Smokers’ rights groups immediately attacked the proposal, saying it was based on questionable scientific premises and represented an intrusion on the cherished right of people to do what they wish in the privacy of their own homes. “He wants us to believe we’re having an effect on people’s health through air ducts?” said Audrey Silk, founder of the group NYC-CLASH, Citizens Lobbying Against Smoker Harassment. “These people have an agenda — a smoke-free society.”

Well, yes - that is precisely the public health agenda. It's not personal. Unlike alcohol consumption, there's no safe amount for cigarettes. Oddly, the attack made by Silk reads like a mission statement for a tobacco control group!

There is a very real danger associated with third-hand smoke: "people do not always know they’re being exposed to passive smoke because some of the harmful compounds do not carry the telltale tobacco smell that alerts nonsmokers to their presence." But here's the disheartening, unjustifiable part that always makes me stop whenever I start pontificating about how a soda tax or Safeway health insurance system is a good thing:

Source: Data from Tobacco In Australia

This data is from Australia, but the same pattern can be seen in the US. Smoking, and other deleterious health behaviors, often run on socioeconomic lines. And, in a society that strives to act equitably, you can't advocate for policies that penalize people without providing an alternative.

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Unsung Heroes of Health

2010-06-16T20:38:00.001-04:00

This painstakingly done book explores each facet of the woman from whom HeLa cells come from, Henrietta Lacks. It is science at in its most visceral human place: everything is connected to everything else, and this book is a beautiful, if haunting, reminder. The Immortal Life of Henrietta Lacks brings up current and past legal issues, science, race, history, mortality, religion, and intertwined personal stories. In other words, nothing about being alive, or dead, is untouched. I wish we more often looked at technology and society the way Rebecca Skloot has done. Her journey, as well as Deborah (daughter of Henrietta Lacks and the center of this narrative), was one of great courage and persistence in this ten-year journey to answers.

Cassandra, a close friend at blogger at Ex Tempore words on bikes and books explores and opines on the surprising legal realities around your own tissues:

Mrs. Lacks's children did not discover their mother's tissues had been used to create vaccines and thousands of drugs until decades after the sample was taken without informed consent. Despite millions being made by commercial companies on the sale of Henrietta Lacks's cells, her children and grandchildren could not afford health insurance.

Of course, tissue collection, storage and use for research must be regulated now, right?

Wrong. Samples taken from you for tests are routinely stored and used for research. These, often identifiable, samples could be used in research resulting in the publication of damaging genetic information or that further a viewpoint anathema to your own.

Keep reading. And if you enjoyed this, leave a comment or share it through Twitter, Facebook, or Google Buzz :)

Worth More than a Thousand Words

2010-06-06T23:25:00.002-04:00

This photo was taken from International Public Health (via Google Books). The author includes it to illustrate mild protein energy malnutrition (PEM) vs. marasmus, a much more extreme version of the same disease. Both of these kids are 1 year old. The author's comment "Note: the child on the left is a boy; the child on the right is a girl," implies that he was preferentially fed.

I know that in societies which prefer sons, girls simply eat last. My Dad was preferentially fed over his 8 sisters growing up in India. But somehow it became real seeing these two children, both on the verge of failing nutritionally, whose parents made a choice about who would get the chance to succeed. And this same choice is made over and over. Is this anything short of a genocide against women South Asia?

Here's what 50 Million Missing says: "The mortality rate for girls under 5 is more than 40% higher than that for boys the same age and these girls are dying of starvation and deliberate medical neglect." 50 Million Missing is a campaign against genocide against women in India. It's named after the number of women who were killed through dowry deaths, infanticide, female feticide, and abortion complications.

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You are about to experience a precipitous decline.

2010-05-29T22:34:00.002-04:00

Even though finishing my Master's in Health Sciences next year will be my third graduation, I still find the process humbling and sacred. Education, particularly my parents' degrees and subsequent immigration, deserves my undying gratitude -- more than anything else, it is responsible for every incredible privilege I've enjoyed, like the fantastic schools I've attended.

But my day is later. Congratulations, Bloomberg School of Public Health Grads! PhDs, MPHs, MHSs of 2010, this day and these postcards are for you!

Next year, I hope to join you in the ranks of public health professionals carrying out our school's mission. Remember Tom Reed's advice: "you are about to experience a precipitous decline...and become a freshman again!" but only freshman get to say 'the emperor has no clothes'. So remain a freshman forever, never accepting "that's how we've done it for years" and always questioning. And asking more questions. Like why a certain rich, technologically advanced country cannot provide healthcare for all its people.

And finally, his rallying call: "Freshman for life, go get 'em!"

Congrats to everyone graduating and moving on -- your [kind, driven, inspiring, curious] presence will be missed!

Art from postsecret.blogspot.com
--
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Everybody, quick: Name three basic human rights.

2010-05-26T14:02:00.003-04:00

Meet Maria - a classmate in my International Health master's program at Johns Hopkins who, extraordinarily, manages to be an extremely courageous and incisive thinker while being one of the most relaxed, fun people around. She blogs at http://mariasundaram.blogspot.com and will be doing research in Bangladesh later this year. That's her Twitter picture on the right. Here's her on Health and Human Rights.

Everybody, quick: Name three basic human rights.

What did you pick?

Food, water, shelter? Those were the ones I knew about even in elementary school. (Mostly because when I was being an evil child, my parents assured me that the only things they owed me as a human being were food, water and shelter.)

I like that "food" comes first on that list. I mean, I love food, and yes, I'm one of those pretentious neo-hippie people that love trying weird new food, taking pictures of it, and talking about how delicious it was. But even for the non-foodies, it's obvious that food is a basic human right. It's so intuitive that we don't really think about it. And in fact, the UN backs us up: the Commission on Economic, Cultural and Social Rights officially recognizes the "fundamental right of everyone to be free from hunger."

OK, so what?

So malnutrition--in terms of vitamin deficiencies, but also straight-up chronic hunger--is still a gigantic problem. Worldwide, FAO estimates there were 848 million undernourished people in 2003-2005. Another oft-cited statistic: About every 7 seconds, a child dies because of hunger.

It's not just that people are starving to death, although that is an impressive part of it. Malnutrition affects the body's ability to defend itself against infection, so malnourished children get diarrhea and pneumonia more often. (These sicknesses prevent children from gaining weight like they should, and make children more malnourished.) It slows physical development (height, weight, bone growth) AND cognitive development (learning, motor skills). It increases the risk of death in pregnancy (both for underweight moms and their underweight babies). It's even been linked to poor mental health. Taken all together, the problems surrounding malnutrition are enough to handicap an entire community for generations and generations.

The Lancet Series on maternal and child undernutrition (headed by Dr. Robert Black, the head of the International Health Department at Johns Hopkins School of Public Health) recognizes that malnutrition is a significant, global problem. The series recommends improving education in low-income areas so that mothers know to breastfeed their infants and when to wean them; and in fact these things have been tried and found successful. That is, in areas when people have access to food and are rich enough to buy it.

However, in many countries where malnutrition is a problem, a significant portion of the population is "food-insecure", meaning they don't have reliable access to food or a regular income with which to buy food. WFP estimates that 1 in 4 people in Bangladesh is food-insecure. Surely this is something we should be paying attention to, especially when you consider that about half of the children in Bangladesh are stunted and/or wasted. Do we really think education is going to help here, where parents sometimes have to choose between feeding their son or feeding their daughter? (News flash: The boy usually wins.)

Food security relies pretty heavily on the movement of free markets (and to some extent, food aid). Yes, economics is a complicated field. Yes, there ought to be a balance of free trade and economic security. But seeing as how we've been guaranteed the right to food... it seems that we could argue for policy changes on the national level to regulate free markets and improve access to food for those who don't have it right now.

Let me put this more simply.

If food is a human right...
And people don't have access to food...
And governments can do something about it...
But they're not, because it makes the country more money another way...

Isn't this a violation of human rights?

Discuss.

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Societies have yet to make the decision that [women's] lives are worth saving

2010-05-18T14:54:00.013-04:00

"Women are not dying because of diseases we cannot treat... they are dying because societies have yet to make the decision that their lives are worth saving." -Mahmoud Fathalla

Janani Suraksha Yojana (literally "pregnant woman protection") is a voucher program led by the Indian government's Ministry of Health and Family Welfare. JSY pays women to deliver in institutions and is targeted at scheduled castes and poor families (1). The image below is a poster explaining the program in Hindi:

In Rajasthan, women receive Rs. 1,400 (~US $29) if they live in a rural area and Rs. 1,000 (~US $21) if they reside an urban area. This successful program has brought thousands of women into hospitals for delivering their babies, and maternal mortality in India and globally has declined overall. However, this program didn't stop women from having to pay for free services, wasn't always well-run, possibly caused neglect in other health areas, and hospitals could not handle all of their new patients.

Evaluating this program was part of a term paper I wrote recently. Sometimes I share my good grades, sort of like a mature, electronic version of sticking your A's on the refrigerator. I did just that, and my mother-in-law not only read it, but also commented "It's good to know that India is taking steps toward it. I only saw this happening in Mullanpur and nearby small villages -- how they still think this way." She referenced this section of the paper:

One of the most important aspects of JSY is that it sends a clear signal to families that prenatal and delivery care is vital. Families often feel that antenatal care or institutional delivery is a luxury that women do not need. Because of these attitudes, and the fact that 52% of Indian women do not have a say in whether they seek care, high maternal mortality persists (3). The root cause of maternal mortality is not a pathogen. Rather, it is a societal issue, where prevailing attitudes do not value the lives of women (2). Discontinuing JSY would send the worst possible signal to Indian society for decreasing MMR – it would reinforce the notion that these lives are unimportant, and make young mothers less likely to receive the care they need to deliver safely (sic).

She has seen this attitude with her own eyes. I think that attitude is the root cause of maternal mortality and must be addressed concurrently with programs like JSY. But the programs should be a stopgap measure as we work to bring societies forward in understanding that women's lives are worthwhile and maternal care is critical.

Further Reading
-NYT: Motherhood: Norway Tops List of Best Places to Be a Mother; Afghanistan Rates Worst

Sources
(1) Lahariya C. Cash Incentives for Institutional Delivery: Linking with antenatal and post natal care may ensure ‘continuum of care ‘in India. 2009.
(2) Singh S, Remez L, Ram U, Moore AM, Audam S. Barriers to Safe Motherhood in India. 2009.
(3) International Institute for Population Sciences (IIPS). National Family Health Survey - NFHS-3. 2006; Available at: http://www.nfhsindia.org/. Accessed 4/22/2010, 2010.
(4) Iyengar SD, Iyengar K, Gupta V. Maternal health: a case study of Rajasthan. J.Health Popul.Nutr. 2009;27:271-292.

Image from microkhan.com via Uttrakhand's government

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Walking the Epi Tales Walk

2010-05-13T07:39:00.001-04:00

Baffling health issues in the news lately, giving me a lot to think about:

How is there porcine virus in both GlaxoSmithKline's Rotarix rotavirus vaccine, as well as Merck's Rotateq vaccine? I suppose no quality checks are perfect, even in one of the most hot button health interventions. If you don't think vaccines are controversial, just ask Jenny McCarthy or go to Johns Hopkins and use the words "vaccine" and "autism" in the same sentence, and watch as hands are thrown up in the air and everyone starts to run in circles.
Astounding and saddening: the Maternal Mortality and Morbidity Study in 2008-2009 (pdf) in Nepal found that suicide was the highest cause of death among WRA (women of reproductive age). In International Health, we talk about saving newborn lives through exclusive breastfeeding, kangaroo mother care (uninterrupted skin-to-skin contact for 6 days in a hospital), and educating mothers about immunization - but are we taking the most disenfranchised members of society and giving them more to do?

While I haven't been talking the Epi Tales talk, as evinced by very light posting in April, I have been walking that walk all over Charm City:

My husband takes me for calf-muscle killing runs in "barefoot shoes" or Vibram Five Fingers (pictured), which are really catching on.
An NYTimes article "Is Marriage Good for Your Health?" reviewed eye-opening new research into marriage and psychoneuroimmunology. I am an even more improbable woman than I thought: marriage is undoubtedly enhancing my health although it normally only helps men.
Amazing eats and book browsing with old friends in the lovely, independent Baltimore neighborhood of Hampden. This activity is strongly correlated with happiness.
Hot, hot yoga and all the ensuing sweat. While I have no idea how much of a muscle-strengthener or calorie burner this is, I leave peaceful. I go with several women from my grad school program, and after work hanging out with coworkers is highly associated with well-being, according to David Brooks.

Picture by Mandeep

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