Valantina is the granddaughter of my host family in Riobamaba.  The family is middle class and well educated, both parents having attended university.  As is common in Ecuador, Valantina’s parents started having children very young and continue living with their parents.  Before the recent death of my host mother’s mother, four generations had lived in the house.  Valantina is 9 months old and the delight of the entire family.  As you will note in the pictures she is generally healthy and adorable.  There are some things that her family does that help her grow and stay healthy.  Though her mother is in college full time, Valantina has never received formula.  Her mother frequently breastfeeds at the table or in public places.  This is common practice in this provincial capital and during the Easter parade, there were women openly feeding their children as they marched through downtown, an unlikely sight in the U.S.  After I moved to Cuenca I noticed that more babies were drinking formula from bottles.  Multiple people explained that this as a consequence of wealth.  Cuenca is more affluent then Riobamba and formula is considered proof of economic security, an unhealthy trend.  I was fascinated by these changes because they seemed opposite to what I have observed in the U.S. where it is often well educated, more privileged women who tend to have the control over their lives that allows them to breastfeed. 

The hospital has a well respected neonatal intensive care unit as well at both inpatient and outpatient services for women and children. One case in particular stuck with me. A woman came in after a failed home delivery. She had delivered her first 6 children at home but subsequently lost 2 of them to respiratory illness within the first 2 months of life. She had been laboring since the day before and kept saying, ‘I can’t, I can’t’. She knew something was wrong and that this did not feel like her other deliveries.
I spent one week at a Sub-Centro de Salud (public health clinic) in the town of E. Valle, about a 30 minute bus ride from Cuenca. The town is quite small but the catchment area includes a large number of families working small plots of land on steep slopes. The clinic itself is new and clean. It houses three general practitioners, one dentist, a pharmacy, a pediatrician, psychologist, vaccination center, and room for x-rays and ultrasound. In an office there is a map of all the households, their inhabitants and risk factors.
I was privileged to work in many different settings during my time in Ecuador giving me a wide range of exposures. First of all, there is private versus public medical care. The perception among those that seek care in the private hospitals is that they are receiving a superior service in exchange for paying for services that are free elsewhere. In some ways this is true. However, in the public hospitals international standards of care were followed.

Sadly, I am leaving this wonderful island tonight. I cannot imagine how the time has flown by so fast. The last week was intense; activities included inputting and analyzing the data we collected, preparing for the presentation, organizing the workshop for stress management, and saying goodbye to my dear friends on the island. 

After learning about the culture and lifestyle on this south pacific island by interviewing people, we started to actually collect data with the tailored survey that would give us ideas about the stress status of the people in American Samoa. This survey was designed analyze from multiple angles the stress status of the people, including stress level, stress symptoms, access to releasing stress, risk factors, and effective coping techniques. Also, it emphasizes the fa’alavelave which means funerals, weddings, and other gatherings in which people have to donate money due to social reputation and expectation.

The target population of this research was on students and teachers at American Samoa Community College. We collected a good amount of surveys back and then analyzed the data with statistical software. Although the most common statistical software in the USA may not be available here, we finally achieved preliminary findings. My preliminary findings were presented to the land grant staff, American Samoan Community College faculties, and the people I interviewed previously. I am glad that this research provided the American Samoans a new way to look at themselves.

Although some of the college students did not feel stress from fa’alavelave personally, they did put fa’alavelave as the answer for the question, “what is the most common stressful thing the Samoan people may have?” A possible reason for this is that the all the college students’ funds come from their family; however, their families may suffer from stress of Fa’alavelave. In American Samoan society, the family will support the children economically while they are still in school. Although the economy on the island is not well developed, people donate a large portion of money for fa’alavelave, which creates tremendous stress for them.

In my stress management workshop, I demonstrated some coping techniques such as music therapy, meditation, humor therapy, and other methods to the audience. The stress management workshop provided fresh ideas for the locals and opened a window for them to explore the opportunities to manage their stress in the future. In addition, I designed some programs for the wellness center which will open later this year. The wellness center will be the first integrated place that aims to support the public health for the islanders.

Coming to the island alone is definitely not a lonely journey. I am blessed to have the chance to embrace the culture and diversity. It is a blessing to come to this exotic place and meet friendly people, to experience a different culture and gain working experience, while at the same time contributing my skills to the community. I found myself falling in love with this island, even though my contribution may only make a small difference for the islanders. This experience made me aware of how often I take for granted the ease of access to expertise in the USA. Because the island is so resource-limited, each visiting field has only one expert, one dietitian, one psychiatrist, one entomologist, or no expertise at all in many fields. My preceptor commented on my study, saying it was a unique and promising study, and he would like to continue it as a long term program for the American Samoa population. I am glad to see what I accomplished here, and hopefully I will come back some day.

 

The past two weeks were full of activities. I conducted a series interviews with the people to obtain a better understanding of the culture and guidelines for my research, including professionals in stress and mental health, as well as people who work at healthy food promotion, obesity control, agriculture, and other various areas. After summarizing my findings, I did a presentation to inform my fellows working at land grant, American Samoa Community College, to get the staff involved with this program. The relation between stress and obesity is a novel concept to most of them. Even in Samoan language, there is not a direct word for stress, and they do not conceive of the tremendous influence of stress on health. Therefore, it is of great significance for land grant to incorporate this stress management program for the American Samoa Community College’s Wellness Center when it officially opens later this year.

Communicating with the local community made me aware of the friendly and hospitable characters of the local people. Gradually, I felt myself getting more and more used to the local culture and passionate about corresponding with the locals. Due to the culture difference, the reasons for stress and obesity of the local people vary from those in the United States. Designing tailored questionnaires for the local people provides better understanding of our research.

Diet is extremely important for obesity and stress management, especially for the population which over-consumes food. Every Sunday, Samoan people wake up very early to prepare the umu-- a traditional cooking method in Samoa. The foods from the umu are tasty and served in large amounts. Cooking food in the umu demands time and effort, so people usually overeat after they spend so much effort in preparing it. Last weekend, we had a health affair to promote healthy food and introduce the way to produce healthy food. In our venders, we made healthy smoothies and showed people the method to make it with milk, fruits, cereal, and oats. In addition, we encouraged people to get more involved with physical activities, so we held a dance contest in which people danced and had fun together and at the same time gained the knowledge of healthy behaviors. 

Next week, after finishing our tailored questionnaire, we plan to spread our survey to the target population to collect data.

Equipped with the knowledge of public health learned from my college and an enthusiastic heart, I came to American Samoa, the southern territory of the USA nearly three weeks ago. There are so much differences here, culture, family structure, work regulations, personal habits, traditional ceremonies, views of the world, just to name a few. Fa’asamoa, which means the Samoan way to do things, influences every corner in this place. In addition, the natural beauty is pristine and fabulous. However, behind the gorgeous attractions, there are tremendous public health problems here. 

From the first time I arrived here, I saw the trash spread around the road. This is not because of the residents, but the stray dogs. The stray dogs are almost everywhere. They knock down the trash can and look for food, leaving a mess and walk away. Also, being scared by bitten by the stray dogs is a main reason that people do not excise outside and do not allow their children to do it. There is one time more than 10 dogs tried to surround me! People here even joke as “if you never get bitten by a stray dog, you don’t really live in American Samoa”.

From my point of view, except for the most salient public health problem—obesity, people have stress behind their normal smiling face. One prominent culture burden is the Fa’alavelave, in which people have an obligation to show respect through gift-giving when involved in an event such as a funeral, a wedding. People here live in a bi-cultural environment that is reflected in the conflict between the traditional Polynesian life style and Americanized procedure. Furthermore, people have much more obligation in church than people in the USA mainland. The changing economy and family chores are other stressors for the local people.

Through talking and interviewing people, I collected valuable information to better know about the local culture and tailor interventions for the community. Dr. Biukoto in Lyndon Baines Johnson hospital is the only psychiatrist on the island (not anymore, because he already left). Last week I did an interview with him to get a depth insight about the mental health on the island. Besides, I went to community with my coworkers, serving food stand, promoting healthy diet and conducting interviews. 

In general, I am glad that my college and Hope Through Healing Hands Foundation provide me this fantastic opportunity to come and help the local people. I am looking forward to my next work.

The Frist Global Health Leaders (FGHL) program affords young health professional students, residents, and fellows the opportunity to serve and train abroad in underserved communities for up to one semester. In doing so, they will bolster capacity in clinics in need of support as well as offer training to community health workers to promote sustainability upon their departure from these communities. As part of the program, they blog about their expereinces here. For more information, visit our program page

Not too many things happened during this time period, I continued reading literature regarding baseline survey of early child development in developing countries, talked with people in the community, identify key issue which I need to add into the survey; attended monthly hub meetings, tried to understand their responsibilities for supporting our core mission: promoting overall health status of vulnerable children in Munsieville.

I went into several child care centers in shack area with Betty, to observe how they take care of young kids. There is an ongoing research project in Thoughtful Path. Similar to a typical case-control study, they select teachers from some child care centers, provide them professional training and materials (case group), in the meantime, only consulate were provided to teachers in other child care centers (control group). So we go into these centers, observe teacher’s, children’s action, document them and see if kids from case group have better performance in daily life and in school. I believe kids from case group will have much better performance for sure. Flyers, posters and books are everywhere, teachers always remind children to behave healthy, and use puzzle game for brain development. However, in  control groups, untrained teachers in these centers basically do nothing but just feed kids breakfast and lunch, children were playing on their own, and teachers (or you can say housewives) just watch TV or do their own stuff. It is really sad seeing these, as an international charity organization, we dedicated to do our best providing best service to promote local people, but for evaluation purpose, we can’t fully help some of them. This makes me feel so bad and heartbroken.

YiHi blog

One of the critical issues in shack area is fire. Paul told me that every week there is a shack burnt down, although we are focusing on early childhood development, we can’t just see people suffering and do nothing. So, in a weekend, collaborating with a Baptist church from Randfontein (a city near Munviesille), we brought many food and living essentials to families whose house have recently been burnt down, and build new home for them. I am not good at constructing, but was doing my part: painting and help moving stuff from here to there.  

Always feel good for helping people.   

YiHe blog

Many things have happened since the last reporting period. We have been able to facilitate more health education discussions for Proyecto Alerta Joven, which has been one of my favorite activities to do. We did a short course on values and how they are interrelated with occupations, like responsibility and honesty.

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