The Passion of Brazil

I use this video as an introduction. This is an introduction to the passion that surges through Brasil. This video was take at a local soccer game, but that same passion is resonated in every other aspect of their  lives.

Just to introduce you all to some of these passionate people, I have to start with my adopted aunt and uncle. We stayed with these beautiful people for the entire summer and they showed us nothing but  love and sincerity. They treated us like their own sons and showed us the template for the passion for kindness that every Brazilian that I met shows. You guys are already missed.

These two men right here are guys that I truly consider my brothers. Of course Ketan and I were together through the entire summer and got to know one another to a level that only can be considered brotherhood. I consider him to be a lifelong and close friend of mine. Now this other guy connected with both me and Ketan on a level I never thought possible with such drastic communication barriers. Even before Ketan or I became better at our Portuguese, we found it oddly easy to communicate with and understand him and he us. He told us one night that he had a feeling that he was going  to become great friends with  some American guys. He said that he felt that even before we arrived in Brazil. All I can say is that this man has a huge heart and exemplifies this passion of Brazil to the utmost. He is another lifelong friend of mine. 

As we flew out of Belem, we had the privilege of seeing this amazing view of the Amazon River. While in the air, I reflected on all of the beautiful personalities that I met up there. Somehow the outstretched and seemingly endless length of this river reminded me of the seemingly limitless passion for life, doing right by others, and ability to accept strangers as brothers that the people of Brazil demonstrate. This was probably one of the mist beautiful views that I have seen in my life. What a fitting time for such beauty.

Getting the opportunity to attend the Olympic Games was definitely a once in a lifetime opportunity that I will never forget. From the beautiful beaches of Copacabana to the extensive beautiful parks created just for the games, it was an eye-candy of an experience. Although, I cannot help but wonder how or even if all of this revenue that is put into events for the people who can afford it to watch, is affecting those who can not afford it. 

Once again I end my post with the half shown sun. Only this time it is the rising of the sun. Although this picture shows one of the last images that I took in Brazil, the sun rising behind the beautiful landscape of Rio De Janiero assured me that I was not leaving Brazil on a sad note, but on a start of new beginnings and with much gained experience and knowledge. as the brilliant sun revealed itself more and more, I knew then where the people of this country get their passion. They will be missed while I am gone. 

Sitting on my first of two transoceanic flights, I found my mind wandering as much to what lay ahead of me as what I was leaving behind. At the end of my journey awaited comprehensive exams - the unfortunate yet necessary right of passage all graduate students must endure. Mine are next Tuesday; a less-than-friendly welcome home from Uganda. These exams are supposed to measure our mastery of the core knowledge and skills within our fields of study. Have you really learned what you were supposed to learn? Do you deserve the mantle of Master? Of Doctor? Can you prove it?

As I began to consider (read: totally freak out about) those questions, I realized the same could be asked about my summer in Uganda. Did I accomplish what I was supposed to? Did I contribute meaningfully to the team's research efforts? Have I gleaned more from the qualitative data we (literally) painfully collected, or rather from the process of collecting those data? I know that I learned a lot this summer, but what did I learn about most?

I learned the war in northern Uganda has left lasting wounds not likely to heal soon. I know the suffering caused by losing a loved one to murder does not end once they're buried. Our respondents described the spiritual, physical, and economic maladies that result from both improper burials and a lack of accountability for crimes committed during war. And I learned much and more about the struggle of conducting in-depth interviews and focus groups in cross cultural, international, impoverished settings. 

But despite all of those lessons and more, I think the real value of an experience like MHIRT - the reason the National Institutes of Health continue to pay for minority students to gain international research experiences - is a little more personal. I believe travel, international travel especially, provides us with an unparalleled opportunity to expand our own perceptions of what we're capable of.

The opportunity we're provided is less an investment in our CV and more an investment in us, as humans. The friendships we forge, the languages we pick up, the different ways of being we witness, all unleash our capacity for empathy and creativity - traits invaluable to those who seek a place in as dizzyingly broad of a field as "health." I know I speak for all my fellow MHIRT Summer 2016 participants when I extend my sincere and deep gratitude to the program directors at Christian Brothers University and to the administrators at the NIH who made these incredible adventures possible. Thank you so very much. Apwoyo matek.

I have Nothing but Gratitude

Upon conclusion of our exit interview, my mentor, Dr. Risoleta, asked me "so, other than the 'no rules of the sidewalk' and the avocado with sugar," which are some things that I had reported as different from the United States in the very beginning of my trip, "what else have you noticed that is different here in Brasil, perhaps something bigger?" Now, normally I'm not the type to have much to say when asked to have on-the-spot philosophical analysis of society and culture, but this time the answer was easy. It's something that I noticed very soon after arrival and could give an example of for every single day I've lived in Floripa. The most striking difference for me between Americans and Brasilians is their attitude towards foreigners. I can't tell you the amount of times that I've told someone that I don't speak Portuguese only for them to try and continue to have an entire conversation with me in Portuguese. At first, I thought it was annoying, because I thought they wanted a response from me, but soon I realized it was just their funny way of trying to make me feel welcomed. The generosity and care Brasilians give people they have never met before is truly unparalleled to anything I've experience in the US. Everyday as disjointed Portuguese stumbles out of my mouth as I try to order food I am incredibly grateful for the amount of patience and willingness to help that complete strangers have given me here. It's truly amazing how quickly you can make friends with someone here, even if you don't speak the same language. In the United States I feel like most people have this attitude about people who move or travel to the US without having mastered English before hand, and almost an unwillingness to help. If that were the case here in Brasil, my stay here would have been much more lonely. 

When I would have these experiences with my coworkers or on hikes or on the bus or at restaurants or on campus or whereever I may be all I could think about is how I would never get a chance to fully repay these people for their kindness. For making me feel so welcome, for inviting me on their family roadtrips, for making Floripa feel like home, all I have is gratitude. 

I am very sad to have to leave this place, but eternally grateful for the experience I've had and how its allowed me to grow. Now, back to Memphis and onto a new adventure! 

Bendiciones (Blessings)

The internship experience with AMOS Health & Hope has drawn to a close. The past six-weeks were filled with real-world experience of conducting research in a rural community and training Madres Voluntarias (Volunteer Mothers) to help improve the maternity and child health outcomes. Throughout the internship period, I have been able to better understand the knowledge that I learned during the global health practicum and put that knowledge to work. Simultaneously, you learn and become more accustom to the seeming small moments of a day in Nicaragua like meals.

                 Breakfast consisting of gallo pinto, scrambled eggs, fruit (watermelon and pineapple), juice, and coffee.

It was a tremendous pleasure and gratifying experience to be present at the graduation for the Madres Voluntarias and the final meeting with the health committee of La Danta. It was those two moments that alluded to the importance that the community places on its partnership with AMOS.

The health committee of La Danta, Madres Voluntarias, and the AMOS Women's Empowerment team following the final health committee meeting of the summer

The final big moment of the internship in La Danta would have to be the celebration that the community had in our honor. It was a beautiful representation of their gratitude for the work that AMOS does in partnership with their community. It was here that the "bendiciones" of working in La Danta for the six-week perios was felt the strongest.

Members of the community of La Danta that had active roles in the celebration (band, singers, and minister).

The Balance Between Research and Beneficial Action

After six weeks immersed in two projects for the women of La Danta, Nicaragua, the results were finally in. Knowing La Danta, a community that by flooded rivers and unpaved roads was the most isolated district in Nicaragua's rural areas, had struggled in the past with women's health issues, the AMOS foundation assigned the summer's Women Empowerment team to the people of this community. In this Community-Based Participatory Research (CBPR) effort, I and a group of four other women addressed behaviors surrounding prenatal health as well as promoted Maternal and Child Health (MCH) through the training of Voluntary Mothers. Through meticulous statistical analysis, the first objective, in which barriers to prenatal care were documented in order to promote four or more prenatal visits among pregnant women, produced definitive, actionable, and surprising results. Variables such as lack of husband approval, of perceived self-efficacy, of perceived severity, of time or money, and of an understanding of the services offered during a prenatal care visit were found to influence La Danta’s mothers’ going to four or more prenatal visits. Once these barriers were identified, the mystery of how to ensure MCH in a place where emergency care could be over four hours away was no longer so difficult to tackle. Because of this research effort, AMOS staff can now train Voluntary Mothers within the community on how to address these barriers when talking to women in their community. With these future goals in mind, the Women Empowerment team also achieved a second objective in these weeks—to recruit eight new Voluntary Mothers and recruit them in home visits. Through a balanced combination of research and tangible action within the community, this summer has successfully built a solid foundation on which MCH outcomes can be improved among some of the most powerful, compassionated, and brave women I have ever known.

empowerment

Graduating college is terrifying, relieving, yet exciting all at the same time. Given the opportunity to live in Brazil has made the transition a little easier. Living in Brazil hasn't been perfect. I've been forced out of my comfort zone many times, It was harder to make local friends than I expected. It was harder to understand the bus system and get around. Eventually, you just have to go for it. You have to allow yourself to butcher portuguese and maybe you just need to ride the bus and see where it goes. You also meet other travelers who have come from many different paths! This trip has motivated me to continue traveling. For example, I am in Rio de Janerio seeing the olympics and after i'm going to Chile! Places i've always wanted to visit but had no idea when I would actually go.

In another aspect, going to Floripa and having three women as our mentors has been a great motivation. Seeing strong, successful and independent women run their own lab is awesome. Especially in a place like Brazil where it is so machismo. Not only do they exemplify strong women, they were all so laid back and personable. This has led to a very different lab experience than my others. 

Overall, this has been a totally new and great experience that I will forever be thankful for.

WARNING: IMPORTANT ADVICE FOR FUTURE MHIRT FINALISTS

I've looked like a complete idiot everyday in Brazil. But I really needed to. I had no choice! Every friendship made, every conversation I ever had with native Brazilians happened only because of my ability to speak Portuguese. The ONLY way to create meaningful relationships here is to be able to have an open mind to learning. I know what you're thinking 'how could I possibly learn an entire language in only two months?' I'm not asking you to learn it all! But just to try and master certain situations. Google translate, talk, mess up, and keep persisting. The trick is to mess up frequently and consistently. AND TO NOT BE SHY ABOUT IT. I've asked a million questions, googled translated practically every word I can think of, and sounded like a complete idiot a thousand times. But it allowed me to grow as a person, increase my vernacular and navigate busses, supermarkets, bars and general day to day conversations with people. I've met many Americans here who have varying levels of Portuguese fluency. Tomi for example has kept an open mind to learning Portuguese and has managed to pick up the language very rapidly here. Where as other people I've met haven't been as open to learning the language, or rather may have been too intimidated to even begin. And that's ok! But this lead to poorer relationships with native people who may not speak English well or at all. So do your research on the language! Try and learn the basics of how the rules and grammar function and build from there. I know it's tough. I studied two years of Portuguese and I felt lost so many times in Brazil. Now I've arrived at a point where some may consider me fluent. But I only achieved this through constant errors and sounding like a complete idiot. DAILY.  But it has been so worth it. So for the best trip possible, try to become fluent in the language of your country. Never feel bad about messing up and sounding dumb. That's all I've been doing here and it's definitely paying off now. Oh! I don't know about other countries but Netflix in Brazil has Portuguese options. So I watch everything dubbed in Portuguese. You can use subtitles in either Portuguese or English.

As my friend Tomi once wisely told me "you need to sound dumb before you can sound smart"

That was deep.

On Beginning Journeys and How to End Them

“What’s the difference between a researcher and a scientist?” I distinctly recall being caught off guard by this question, unsure if this was the start of a serious conversation or the beginning of some witty banter. “I don’t know,” I said, “a scientist looks for concrete evidence of something and a researcher just seeks more knowledge.” Dr. Linder, who insists that I call her Beth, seemed satisfied with this answer and then offered me another perspective: a researcher starts their journey by thinking of an answer to a problem, and a scientist seeks only to ask a good question. “So,” she asked me, “what do you want to know?”

This question became the start of my 11-week journey to think of the best question I could ask, specifically about female sexual dysfunction. This topic, of course, was partly inspired by my mentor’s previous work and partially inspired by my interest in the recently FDA-approved female viagra (flibanserin). In line with Beth’s previous work, I decided I wanted to know about the effects of fluoxetine, an SSRI, on sexual motivation in female rats. Beth was insistent on providing me with the opportunity to engage in all parts of the scientific process, from the beginning conceptual stages all the way up to data analysis and report writing. Needless to say. my experience in this lab has been beyond phenomenal. I have truly grown more independent as a person and, as a result of working closely with two medical students who were also on a research exchange for a short time, my mind has grown to incorporate other perspectives as well.

As my final stance on the unique experience of traveling like a local, I think goodbyes are always easier when we travel like tourists. Goodbye as a tourist means eating at your favorite place or maybe visiting your favorite beach one last time; however, this goodbye is much different. I am saying goodbye to the outstanding people I have met just as much as I am saying goodbye to Floripa. I will be returning to Memphis entirely content with my experience. I will also return to Memphis and get back-to-the-daily-grind with the humbling knowledge that this place and the people I have met have made more of an impact on me than I have on them.

Final Week of Maternal Health in La Danta

We arrived back to our community, La Danta, for our final visit. It was definitely bittersweet. This was our third trip to the community, and we had all developed friendships with the community members we had been working with. We had also mastered getting down to the shower by the river without falling down the hill which can be really tricky---even in our trendy Nicaraguan rain boots.  It had rained a lot right before we came, so the mud was as thick as ever. We actually had a short delay while driving to the Casa Base (our home away from home in the community) when we got stuck in a huge hole. Thankfully, we had a winch on the front of the AMOS ambulance and were able to hook this to a nearby tree and pull ourselves out. 

                                              

 We arrived on a Saturday in order to survey as many community women as possible the following day at church. We reached our goal of 90 surveys completed for our barrier analysis. We also had two training days with the Madres Voluntarias (Volunteer Mothers) during which time we taught and discussed topics such as communication skills, the three delays to receiving medical care, the danger signs during pregnancy, and how to do a home visit to mothers in the community. The last day we split into two groups and went to supervise the home visits that the new volunteer mothers were conducting. They taught mothers in the community about the danger signs that can occur during pregnancy and explained that the women should seek emergency medical attention if they experience one of these symptoms.

If a woman does experience an emergency situation during her pregnancy, it´s very important to act quickly. Most people in the community do not have a car, but the community has a system in place to locate a car or ambulance as fast as possible to rush the woman to El Ayote (a town 2 to 2.5 hours away). However, if the woman has a very serious complication, she may need to be taken to the better-equipped hospital located in Juigalpa, another 3 hours away. From our own experience in the States, we know that people do not always receive immediate attention, which also happens here in Nicaragua. Therefore, this additional delay can further complicate a very delicate situation.  

These are a few of my favorite things...in Uganda

1) The Town of Kabale

Living in Kabale for over the past few months has been great. I have found Kabale as my second home. The town always has something going on from an impromptu soccer game to trade show selling local crafts. Here you can see mountainous terrain and the field in the center of town where all the major events occur.





2) Hiking and Exploring Uganda

Every weekend trip’s journey has had its unique story. For example, to travel to Ssese Islands we took a car for 6 hours, a ferry across Lake Victoria, a motorcycle ride across an island, and finally a small boat ride to the island. Most if not all of our travels have involved some sort of hiking. In this picture we went hiking in Kisoro, Uganda near the three corners where Uganda, Rwanda, and the Democratic Republic of Congo meet.

3) Beautiful Sunsets

The sunsets in Uganda seize to amaze me. No matter where we are we always make it our mission to catch the beautiful sunsets of Uganda. My favorite is pictured over the Rwenzori Mountains in Fort Portal near the Kyaninga Crater Lake.

4) The Ugandan People

The Ugandan people are very generous and kind people. I have been very lucky to have the opportunity to live with them, and they are always willing to lend a helping hand. Because I truly consider them my family I have not yet experienced homesickness. The first group of students were researchers from Mbarara University of Science and Technology (MUST) that lived and worked with us for the entirety of the summer.

ShaCoria and I with Dr. Esau and the dentist Frank at the general clinic on our last day in Uganda. We will miss them, and we can’t wait to see them when they visit us in the U.S.

 5) My research team

This summer the research team consisted of Kara, ShaCoria, and I and our wonderful research assistants Brenda, Joan, Margaret, and Blessings. Without them we couldn't have completed our research. Kara and ShaCoria made my summer better than I could have ever imagined. Throughout long trips on the bus and hours of transcribing interviews they always made me laugh. I have and continue to have the most supportive colleagues and friends. I learned an immense amount of valuable information from them including research methods, anthropological theory, and about life in general. I will be forever grateful for my time with them and my CBU MHIRT experience.