News Article
June 26, 2008
Hart Fellows Tackle Women’s Health in Cambodia, Tanzania
By Marsha A. Green
Grant Smith (right) and Sam Swartz (bottom right)
Women die from pregnancy-related causes at a rate of about one every minute, according to figures gathered by the World Health Organization and UNICEF. And 99 percent of those deaths occur in Africa and South Asia. Sam Swartz and Grant Smith are well aware of these statistics. And they hope to have a small part in changing them over the next year.
Both young men are part of the Hart Fellows Program for 08-09, a program that offers recent graduates ten-month fellowships with organizations in developing countries that are facing complex social, political, and humanitarian problems. Swartz is the first Global Health Hart Fellow, a pilot program offered jointly by the Hart Fellow Program (HFP) and the Duke Global Health Institute. Smith is one of the other two Hart Fellows chosen for the 08-09 year, who happens to have women’s health as his project.
Although Swartz and Smith will both be working to improve women’s health, they will be coming at it from different directions – literally and figuratively.
Swartz, who graduated in May with a degree in political science, a Global Health Certificate, and a minor in international comparative studies, will head across the Pacific Ocean in July to live in Phnom Penh, Cambodia. He will spend 10 months working with the Ministry of Health’s Reduction in maternal Mortality Project (RMMP).
Smith, who graduated with a degree in psychology and a minor in biology, will fly the other way in July, heading to Moshi, Tanzania. Once there, he will join up with the newly created Kilimanjaro Christian Medical Center (KCMC) – Duke University Women’s Health Collaboration.
Great Need in Both Places
Both young men are eager to make a difference, but exactly how the year will play out for them is a mystery. “As you go into these places, you are very conscious of not imposing solutions—of being aware of what you can and cannot do,” says Swartz. “I know that some people who go abroad and try to do good work end up being detrimental. But with the Hart Fellowship program, I’ll wait until I find out what the community needs are before I design the research—I won’t have designed my question before I even arrive.”
He does know, however, that he will be working in an area of great need. “Cambodia is one of the poorest countries in Asia, and decades of war and isolation have taken their toll on the Cambodian healthcare system,” he explains. Statistics paint a grim picture: for every 100,000 children born, 437 of their mothers die from birth-related complications. Where in neighboring countries such as Vietnam and Indonesia, more than half of women use contraceptives, in Cambodia, the rate is below 20 percent.
“The RMMP project is looking at how to educate more people about family planning, and looking at barriers to access to care,” says Swartz. From his preliminary research, he knows that, for example, although abortion is legal in Cambodia, it is not often available, particularly in rural areas. “Unsafe abortions and the inability of women to control their reproductive health are major problems.”
Smith will be tackling women’s health from a different angle, working with Jeff Wilkinson to establish a women’s health program at KCMC. “We don’t’ know exactly what I’ll be doing yet, but I really believe in the community-based research model that the Hart Fellow Program uses. I hope to help bring that perspective into the work, whether it is looking at how we can learn more about patient needs, or how they get to KCMC, etc.”
Challenge
Smith and Swartz will face the normal challenges of adjusting to local customs, local languages, and fitting in with their new colleagues. But there are some additional challenges. “One is my gender,” says Swartz. “I’ve always worked with children before because I felt I knew something about them, having been one. But dealing with women when I don’t know a lot about [their issues] will be a challenge. On the other hand, I believe I have something to offer, so there is insecurity but also knowledge.”
Smith admits that his biggest fear is facing issues such as death and poverty head on. “We don’t talk about maternal deaths here in the U.S. And I’ve heard that American poverty is very different than third-world poverty. I expect everything to be much more in my face when I am in Tanzania.”
Faculty Support
The Hart program is set up to provide support for challenges such as these. “We provide faculty mentors who not only help ensure that the research is scientifically well-designed and ethically done, but who also can help the fellows process their experiences,” says Alma Blount, director of the program. Smith will be working daily with his mentor, Jeffrey Wilkinson, who is moving his family to Moshi to spearhead the Women’s Health Collaboration. Swartz’s mentor is Kate Whetten, who has served for seven years as the Research Director for the Hart Fellows Program.
“We know we are not going to be alone,” says Swartz. “That’s one of the neat things about the Hart Fellows Program – you are really bringing a part of Duke with you.”
Coming Home
Swartz will also be bringing a bit of Cambodia back to Duke. As the first Global Health Hart Fellow, he will finish off his year by spending the final two months on staff at the Duke Global Health Institute. “The knowledge that I’ll be coming back to work at the Institute gives me a different way of thinking about my research,” he says. “I want to see not only what value I can add to the project in Cambodia, but how I can add value to the Institute in my final two months.”
And, he admits, it is nice to know what he will be doing when he gets home next year. “I know the transition home will be hard. But working with the global health faculty at Duke will be great – they are the coolest people I’ve met at Duke. I am so impressed by their combination of solid academics with activism.”
Just the sort of person the Hart Fellows Program hopes to produce.
