This Blog Has Moved

9 04 2013


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– The DGHI Team


Where Are They Now: Fulbright Scholar Studies Palliative Care in Malaysia

5 03 2013

By Lisa Deng
Duke Alumna, Global Health Certificate ‘12
Fulbright Researcher


Lisa Deng (middle) with an oncologist and radiographer at the Sarawak General Hospital Department of Oncology, Radiotherapy, and Palliative Care.

I was first exposed to palliative care during fieldwork in rural Uganda through the Duke Global Health Institute where I worked with a physician to assess the needs of terminally ill people in a community lacking treatment for life limiting diseases such as HIV/AIDS and cancer. Seeing firsthand the extreme and largely preventable human suffering, I became interested in efforts to support people facing the end of their life in resource-limited settings.

After graduating from Duke in 2012, my interests in palliative care and global health brought me to Malaysia through the Fulbright Program where I am conducting qualitative research in four government hospitals across two states. Under the mentorship of Duke Global Health Professor David Boyd, I am collaborating with two physicians pioneering palliative care services in Malaysia to explore the communication needs and preferences of patients with advanced cancer and their families.

In my interviews, I am gaining an Asian perspective on expectations at the end of life. The important role of family is a value shared across the diverse cultures of Malaysia. Family members, such as the eldest son, are often responsible for liaising with the doctor and making decisions for the patient. It is not uncommon for families to hide certain information from the patient, such as poor prognosis. On one occasion, I witnessed an older patient who thought she was renewing her prescription for gastritis when she actually had stage IV lung cancer. Family members tell me they wish to protect the patient from the truth, fearing their loved one would become depressed and lose hope.

Because death is taboo in many Asian cultures, I anticipated this phenomenon. To my surprise, many patients also prefer and contribute to this “conspiracy of silence.” During interviews, some patients tell me they see no value in burdening themselves with knowledge of poor prognoses if they cannot change the outcome. Rather, they prefer to live each day with optimism. It is unclear whether patients and families would favor open and honest communication if comprehensive palliative care services were more widely available to provide emotional and spiritual support. However, it does underscore the need for doctors in Malaysia to be sensitive to information needs and work with the patient and family as a unit.

These past seven months in Malaysia have been extremely meaningful and rewarding. I am thankful for my global health education at Duke, which has prepared me to transform compassion and empathy for other human beings into concrete ways of serving. The lessons that I carry with me from courses, fieldwork, and mentors guide me through the difficulties of this work. The grief and loss I encounter on a daily basis can be intense and emotionally exhausting. But amidst all of the suffering, I have seen love and hope. In our conversations, patients share with me their histories, their dreams and fears, and their thoughts about living and dying. From them, I have learned about what gives life value, about acceptance and fortitude, and I am reminded that even in the face of death, there is always hope– hope for meaning, for friendship, for wisdom, and peace.

Look at the person, not the disease: A model for holistic health

22 01 2013

By Caroline Hope Griffith
Research Analyst, Duke Global Health Institute


Dr. Sam Orach speaking to Institute participants.

Dr. Sam Orach, Director of the Uganda Catholic Medical Bureau (and Thursday’s plenary speaker), was trained to treat the whole person, not the disease. Diseases are influenced by a community’s economic, social, political, and religious context and to truly understand the cause of an illness, doctors must always examine this context.

Dr. Sabina Mtweve, our seminar moderator, introduced a model that helped us frame Dr. Orach’s approach. The model captures all of the different dimensions of a truly healthy community. First, there must be a balance between the mental, physical, emotional, and social health of individuals within a community. Second, spiritual life and the physical environment of the community also must be in harmony. Next, the community must practice equitable distribution of resources, offer access to education, and promote gender equity. Lastly, the community must embrace moral values, provide good leaders and equitable policies, and respect the environment. If all of these requirements are met, then the community will not only be healthy, but it will be peaceful.


Dr. Sabina Mtweve showing us a model of a health community in Swahili.

Cathy Groenendijk, Executive Director of Confident Children in South Sudan, gave a poignant, yet bleak, example showing the interconnectedness of these elements. The poverty in the slums where she works causes depression among many parents. These parents often resort to alcoholism and can’t care for their children. The children fall sick from poor hygiene, malaria, and cholera. They are also exposed to sexual exploitation and abuse and live in a polluted environment full of sewage and waste. All of these factors contribute to a breakdown of cultural norms and traditional ways of life, and the community loses its direction and hope.

These conversations make me think more deeply about the term “global health.” It is important to remember that global health refers not only to geographic diversity, but also to a global perspective that includes context and community.

Thanks to all of you for following along with my blog. After an exhilarating week, I’m headed back to the US. I am grateful for the time I spent in Uganda with these leaders and for the insightful dialogue and experiences we had together.

See my earlier posts from the conference:

Health is Greater Focus of 2013 Peace & Reconciliation Conference in Uganda
Building Healthy Communities in East Africa
Don’t give up, don’t ever give up
The gift of language: A little French goes a long way

The gift of language: a little French goes a long way

16 01 2013

By Caroline Hope Griffith
Research Analyst, Duke Global Health Institute


Dr. Philemon and Sister Marie-Bernard from the Democratic Republic of the Congo, two leaders who asked me to interpret for them in our community health seminar.

One of the many things I enjoy about this Institute on peace and reconciliation taking place in Uganda this week is hearing so many different languages spoken all around me. All of the participants either speak French or English, but many also speak other local languages. When the Institute first started, the dominant language for all presentations and communications was English. Over time, the conference organizers realized the importance of having interpretation between English and French to ensure that all of the French-speaking participants were able to fully participate.

Now, during all of the plenary sessions, an interpreter stands beside the speakers, who are free to speak in either French or English. I still marvel at the skill and talent of these interpreters. Being a French-speaker myself, I know how difficult it is to stand in front of a room and communicate an English lecture in French to an audience on the spot.

During this conference, I have had the opportunity to serve as an unofficial interpreter for members of my seminar group. Several of the members come from the Democratic Republic of the Congo and Rwanda, and while their English comprehension is high, they are more comfortable expressing themselves in French.

Over the past few days, I translated for these leaders so that they could share their reflections with the group. It is a humbling experience to be able to serve my colleagues in this way (especially because it has been a long time since I have spoken French!), and I have enjoyed the opportunity immensely. It is powerful to be able to offer this gift – albeit a small one – of communication to these leaders who have shared and taught me so much.

See my earlier posts from the conference:

– Health is Greater Focus of 2013 Peace & Reconciliation Conference in Uganda
– Building Healthy Communities in East Africa
– Don’t give up, don’t ever give up

Don’t give up, don’t ever give up

15 01 2013

By Caroline Hope Griffith
Research Analyst, Duke Global Health Institute

Today’s theme of the Great Lakes Leadership Institute was lament, which is the ability to see and truthfully name the brokenness in the world.

IMG_7739-croppedIn our community health seminar session, we heard the laments of women and men who have witnessed incredible brokenness. Participants talked about corruption, the vicious cycle of war, HIV/AIDS, the consequences of genocide, rape and sexual violence among women, and the abject poverty of too many communities.We don’t like to think too much about the brokenness in our lives; instead we constantly seek superficial quick and easy fixes. However, it is important to dwell in this brokenness for a time in order to understand and prepare ourselves to create a space for reconciliation and peace.

I thought about some of the laments we have in our communities in the US: so many people go hungry and are homeless, too many people are out of work, political and religious divisions impede the growth of our society, and there are so many fatal shootings in our schools.

Even among all of the brokenness, these leaders continue to rebuild lives and search for hope. My inspirational thought for the day came from our plenary speaker, a Congolese theologian who led efforts to reconstruct homes, hospitals, and lives in his hometown in eastern Congo after 2000 were killed there (the legendary Jimmy Valvano also lived his life this way): “Don’t give up, don’t ever give up, no matter how difficult the challenges are that you face.” If these men and women can continue to press on in the face of such great violence and sadness, then who am I to quit when the going gets tough?

See my earlier posts from the conference:

– Health is Greater Focus of 2013 Peace & Reconciliation Conference in Uganda
– Building Healthy Communities in East Africa

Where Are They Now: DGHI Alumna Shares Global Health Corps Experience

15 01 2013

DGHI alumna Alexa Monroy shares how her time at Duke prepared her for the Global Health Corps experience

By Alexa Monroy

Duke alumna with global health certificate
Global Health Corps Fellow

alexa monroy gh corpsWhen I read the description for the Global Health Corps’ Social Protection and Health Fellowship, it seemed like all my past experiences had suddenly fallen into place. The position was in Washington, DC at the Inter-American Development Bank (IDB), but I would get to travel often to Central American countries. We would be working on projects to improve maternal and child health markers for vulnerable populations in the region. As someone who was pre-med, interested in global health, and had strong ties to Central America, it seemed like the job had been designed for me.

To my surprise and complete delight, I was chosen as one of the two co-fellows for the position. The first step was to attend a two-week orientation at Yale, where I realized that this year was not only going to help me grow professionally – towards a career that fuses clinical medicine and health policy – but also bring me into an amazing community of people who want to build a “global health movement”. To achieve this, Global Health Corps (GHC) organizes retreats throughout the year that teach fellows to communicate their vision, become better leaders and learn from their peers. So far, both the IDB and GHC have allowed me to understand the day-to-day work of someone who is engaged in both international development and health.

At the IDB, most of my projects are part of an initiative called Salud Mesoamerica 2015 (SM2015). The initiative is funded by the Bill and Melinda Gates Foundation, the government of Spain and the Carlos Slim Institute (you can read more about it here: The main goal of the initiative is to assist Central American governments in addressing the maternal and child health issues that they prioritize. I’ve worked on many different projects, like a supply chain analysis in Chiapas, Mexico, and the revision of national guidelines for birth control counseling in Panama. I also co-authored a technical note that encourages regional cooperation to eliminate micronutrient deficiencies in vulnerable populations. All these projects have helped me understand the role of development banks in health planning and financing, and how their work can influence health policy.

My plan right now is to go to medical school next year, so it was important to me to gain experience working for a multi-lateral organization to have a clearer picture of the career I’d like to have. I ultimately see myself working in a policy position and traveling with medical teams to care for patients in low-resource settings and build capacity on the ground. This way I could interact with people and have the tools to cure disease, while also sharing information with key players in global health to put in place health interventions that are effective in the developing world.

Although I went to Duke knowing I wanted to be a doctor, the unique experience of being part of pre-med classes and the Duke Global Health Institute broadened my horizons and helped me carve out a particular niche in the global health field. I always appreciated Duke’s enthusiasm for multi-disciplinary career paths that tackled a real-world problem through innovation and service. If it weren’t for Duke and DGHI, I would never have understood the range and depth of what can be done to improve health around the world, and I would not be having the time of my life as a GHC fellow at the IDB today.

Check out another blog I wrote about my GHC experience. If you’re interested in applying to GHC, do it soon! Applications close February 3 (

Building Healthy Communities in East Africa

14 01 2013

By Caroline Hope Griffith
Research Analyst, Duke Global Health Institute

Today was the first meeting of our seminar, Community Health, Trauma and Reconciliation.  The goal of the seminar is to understand the relationship between trauma – which can manifest itself in afflictions of the body (e.g., HIV/AIDS), the mind (e.g., post-traumatic stress) and the spirit – the practices of reconciliation, and the health of communities in the face of this trauma.


The Community Health, Trauma, and Reconciliation seminar is co-led by Dr. Sabina Mtweve (pictured in forefront), a doctor and community health promotion specialist at Kilimanjaro Christian Medical University College (KCMC) in Tanzania and Dr. Peter Morris (back right), a doctor and Executive Director of Urban Ministries in North Carolina.

Participants of our group come from many backgrounds and include a doctor caring for HIV patients in Uganda, a palliative care chaplain in Tanzania, a medically trained doctor helping children in the slums of South Sudan, a Bishop in Rwanda training Congolese refugees in trauma counseling, and an advocate helping women who are victims of sexual abuse in Kenya.

Today, we centered our discussion around 2 questions:

What kind of healthy community would you like to belong to?

We all agreed that we would like to belong to a community that is holistically healthy. The community would not only have access to basic health services and work to reduce illness, but it also would have security, good schools, and respect for the environment. Community members would be peaceful, caring, accepting, trusting, loving and faithful and embody justice, peace, and equal opportunity.

Can a healthy community help to prevent conflict?

A healthy community can certainly help to prevent conflict. The opportunities and the future promise offered by such a community invite the younger generation to invest in their futures and resist conflict. However, without peace it is difficult to establish all of the components of a healthy community. One participant shared his experience working for the United Nations. He said that when his organization came into a conflict zone and asked the people what they needed most, the people said peace. Not food or shelter or schools, but they first asked for peace. So, if the community is in conflict, then efforts to build good schools, health centers, and establish trust and security – all important parts of a healthy community – will be very difficult.

So where should we start to help a community become healthy again? For me, it’s clear that a comprehensive response is necessary – providing food, clothing, and health care must be accompanied by peace-building, and reconciliation needs to be integrated with efforts to build housing, health care, and education.

See my first post from the conference:

– Health is Greater Focus of 2013 Peace & Reconciliation Conference in Uganda

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