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

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

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

13 01 2013

IMG_7739-croppedBy Caroline Hope Griffith
Research Analyst, Duke Global Health Institute

Hello from Uganda! I am here to attend the annual Great Lakes Leadership Institute organized by the Center for Reconciliation at the Duke Divinity School and its African partners. I will be blogging about the five-day conference, which brings together Christian leaders from East Africa (and a select few from the U.S.) working to promote peace and reconciliation in their communities. The week will be full of plenary sessions, discussion seminars, and time for worship and reflection.

I attended the 2012 Institute and came away inspired and awed by the work of these amazing leaders. (See last year’s blog posts compiled here.)

My three goals for this year’s Institute are to:
1. Learn,
2. Connect, and
3. Be present

Learn: This year, for the first time, we will have a seminar on reconciliation, trauma, and community health, which I helped to organize. In this seminar, we will hear directly from leaders working in the trenches about how they address health – physical, mental, and spiritual – in their communities and the role reconciliation plays in building healthy communities.

Connect: At Duke I manage research projects that connect faculty and students in global health, theology, business, and environmental studies to address difficult global health challenges. Over the next week, I will continue to serve as a bridge-builder, looking for ways to connect participants with each other (and possibly with my colleagues back at Duke) so they can support one another in their work.

Be present: One of the wonderful things about this Institute is that it takes the participants away from their daily routines and struggles. It is a place of rest, reflection, and rejuvenation and provides space to build and nurture relationships. I also plan to use this time to be present; to stop rushing from place to place and task to task and to focus on the conversations, the relationships, and the insights that the week is sure to bring.

My Visit to DGHI’s Student Fieldwork Site in Tanzania

6 09 2012

By Melissa Watt, DGHI Assistant Professor

When you pull off the paved road toward the village of Mwika, the first thing you see is the Lutheran church nestled at the bottom of the hill among the groves of banana plants. The church serves as the center of the community, and we first paid a visit there to meet with the community’s leaders and the partners of DGHI’s Student Research Training (SRT) program.

It was serendipitous that I was in-country this week, since I recently agreed to serve as the new faculty mentor for the SRT site in Tanzania. Vera Mushi, the on-ground coordinator of the site, and Trish Bartlett, who has served as the mentor for the past several years, graciously accompanied me to the site to show me the setting and help facilitate the introductions.

The primary partners of the SRT program are the pastor, the staff of the Mwika clinic and Mama Nancy, who provides the homestay experience. These three partners work together to welcome and support the group of Duke students who go to the village each summer. Their summer experience includes cultural immersion, a clinic-based project and a household survey on the knowledge and needs of the community.

Mwika partners shared with me how successful the student projects were this summer. Duke students completed two large projects. (READ THEIR BLOG.) They organized all of the patient files in the clinic to create an electronic database to link medical record numbers with patient names, and they completed a household survey on major health issues that culminated in a community workshop and a colorful brochure to share the findings. In addition to these accomplishments, the pastor praised the students for how enthusiastic and kind they were during their stay. Mama Nancy told us about how the students became part of her household during the two months they lived with her.

I feel grateful that I was able to visit Mwika during this trip, get to know the location where the Duke students live and work, and meet our kind and committed partners. I look forward to supporting Duke students in the years to come, in order to continue to build this relationship and build upon the very strong foundation that has been built. I hope to return to Mwika someday to breathe in the cool air and visit again with these warm people.

Working to Improve the Lives of Women With Obstetric Fistula

31 08 2012

By DGHI Assistant Professor Melissa Watt and DGHI Doctoral Scholar Sarah Wilson

We just hosted a workshop in Moshi, Tanzania on the psychological and social issues among women who have obstetric fistula. We sought to share our study findings with doctors, nurses, nongovernmental organizations (NGOs) and public health workers to facilitate discussion and action that can ultimately lead to improving how we care for these women.

The workshop was the culmination of a two-year study, funded by DGHI to examine the mental health of women with fistula who are receiving fistula repair at Kilimanjaro Medical Center (KCMC) in Moshi. KCMC is one of the few health care centers in Tanzania that has the capacity to repair obstetric fistula.

Obstetric fistula is a terrible condition and embodiment of disparities in society and health care. Women who develop a fistula often spend days in labor – either failing to get to a health care setting or being neglected by health care workers at a time when they desperately need a caesarean section. They often wait years with a fistula before they reach repair, due to poverty, lack of knowledge and poor access to health care.

A fistula develops when the fetus is stuck in the birth canal, eroding the vaginal tissue, and produces a hole between the vagina and bladder or rectum. A woman who has a fistula experiences uncontrollable leaking of urine and/or feces and a persistent bad odor. The psychological impact of their condition can also be devastating. Women are often isolated and stigmatized in their communities, and they may have severe pain and gynecological infections. In addition, they are dealing with the painful memories of the labor experience that led to the pregnancy, the loss of a child and the possibility of never being able to give birth to another child in a culture that highly values childbirth.

During the workshop, we shared our finding that – not surprisingly – women with obstetric fistula had higher levels of depression and more symptoms of post-traumatic stress disorder compared to women without fistula. We also found that they had lower social support, which may either be because they had low social support before the fistula or lost support due to the fistula. Quite interesting and unique to this study, we learned that women with fistula had high levels of shame. They felt worthless and unacceptable, and they commonly used negative coping strategies like self-criticism and giving up.

However, we were surprised to find that disclosure was a big issue in the study. Despite their obvious physical symptoms due to leaking, women spent years hiding their condition from others, keeping themselves sequestered in their homes and denying themselves food or water to try to prevent it. As we reflect on these findings, we can’t help but put ourselves in the shoes of these patients – to imagine what a terrible impact this must have on their lives.

As we shared these findings, workshop participants noted how this resonated with the experiences of fistula patients they care for at their health facilities. We talked about what it would mean to provide “holistic” care to these patients (taking care of the whole person, not just the hole in the vagina), and people had ideas about the need to address the multiple needs of these women in care. One suggestion was to collect information on the patient’s life history in addition to the physical and clinical history. Understanding the woman as a whole person would help to identify an individual care plan that includes mental health counseling, pastoral services, referral to other clinical services and linkages with relevant NGOs.

Of course, the glaring challenge is health care resources. Tanzania, like most African countries, experiences a severe shortage of health care workers. It makes the implementation of anything beyond the basic clinical services difficult to provide. However, participants kept coming back to the definition of a “cure” for fistula, and what “care” means. There seemed to be consensus that if the broader psychological and social needs of these women were not met during the time she was in care, then the health care setting was not providing the best care for the woman.

We spent the next few days at KCMC, working with the Department of Obstetrics and Gynecology to talk about how our study findings and the workshop discussion can inform both the provision of obstetric fistula care, as well as the next important research step.

It is wonderful to be here and humbling to work with people who have dedicated their careers to caring for this vulnerable population.

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