By Mary Brophy Marcus
Second-year global health master's student Yihuan Lai deepened her understanding of mental health resources in Kenya last summer. She saw a few lions and zebras up-close, too.
As she prepared for a summer research internship in Nairobi, Kenya, last May, Yihuan Lai says she felt butterflies. Which might sound surprising since Lai is a seasoned traveler. At age 18, she headed to the U.S. to attend college at St. Lawrence University in New York, halfway around the world from where she grew up in Shenzhen, China. After studying psychology and statistics there, she moved to Durham to earn a master’s of science in global health at Duke.
But Lai says the idea of living alone in Nairobi—a city of more than 4 million people—outside of the cocoon of an academic community, was a whole new step for her. Also, the transition from conducting digital research to delving into the real-life experience of talking with perinatal women in Kenya about their mental health seemed a bit daunting. But when she arrived in the East African nation, her concerns melted away as she immersed herself in her work, as well as the rich culture, generous people, and natural beauty of Kenya.
DGHI recently spoke with Lai about the 10 weeks she spent in Kenya last year and about global mental health, a field that is overwhelmingly in need of tools and treatments. Now wrapping up year two of her program, the soon-to-be graduate shared some thoughts about her short- and long-term plan to help improve mental healthcare access in communities around the globe.
Evolving an education into a career
Initially, as an undergraduate student, Lai thought she wanted to become a clinical psychologist and had planned to begin working on her Ph.D. after graduation. A growing interest in global health brought her to Duke Global Health Institute’s (DGHI) master’s degree program where her mentor Eric Green, assistant professor of the practice of global health, introduced her to his work in Nairobi.
In her first year at Duke, Lai worked with Green on a pre-pilot study that used a chatbot called Zuri, a digital cognitive behavioral tool that “talks” with users via SMS. They gathered preliminary data on the Healthy Moms perinatal depression intervention, recruiting pregnant women and new mothers from public hospitals outside of Nairobi. Participants were asked to use the messaging tool to help improve their mood in order to take better care of themselves and their children.
“I didn’t really need to be in Nairobi to conduct the initial research. But we decided I would do an internship and interview some of the women from our study in person, to get some qualitative data,” says Lai.
In Nairobi, she also had the opportunity to write a book chapter with her on-site supervisor, Christine Musyimi, who is with the Africa Mental Health Research and Training Foundation, a non-governmental organization operating in Kenya and East Africa. She also traveled outside of the city to conduct focus group discussions with other health professionals, patients and their caregivers to learn about peoples’ perspectives on dementia.
Lai knew before going to Kenya that there was a lack of mental healthcare, including a big treatment gap for depression, dementia and other mental health issues.
“I was quite mentally prepared before going. But it’s very different to know mental health is not accepted and then to go and actually experience it—two very different things. For example, when I conducted focus group discussions, I learned that a lot of people still think dementia happens because you did some evil things. There are a lot of stereotypes. Mental healthcare is still a taboo and a lot of people are not aware of the benefits,” Lai says.
The experience shifted Lai’s career plan trajectory away from a clinical-focused path. Now she thinks she can do more good if she digs into and enhances her understanding of healthcare systems.
“Right now, I’m trying to find a job in consulting. I’m applying for jobs at firms both in China and the United States. I want to go into more general training at a big firm for several years and expose myself to as many different industries as possible and then eventually specialize in healthcare, and more specifically mental healthcare,” she says.
Global mental healthcare is a very new field at the cusp of big growth, Lai believes. She points out, for example, that people who go through epidemics—such as the current coronavirus pandemic and recent Ebola outbreaks—have been through a lot of trauma and will need help.
“I think it’s very important to incorporate mental health care into these emergency situations. There’s no health without mental health, and there’s no global health without mental health,” she says.
But there are hurdles to overcome. “I do feel a little discouraged sometimes. It’s so hard, there’s a lot of resistance in mental health research. Sometimes studies will last for many years and it’s very easy for you to lose hope in the process. But I think what is really helping me try to still have hope is to focus on a shorter period of time instead—such as the 15 women from Kiambu County, right outside of Nairobi, who I interviewed,” Lai says, noting that many of them expressed positive attitudes toward Zuri and said they’d made positive changes in their lives.
Advice for other students heading off on an internship
Step out of your comfort zone, Lai says. Find time to explore the local culture, talk to people.
“In Nairobi I think I connected to people really well. They are very funny. I got their sense of humor and they got mine,” says Lai.
During weekends she traveled often. “I went on safari in Maasai Mara National Reserve. I also went to Mombasa, a coastal city of Kenya along the Indian Ocean. I went with another Duke student, an undergraduate who was doing an internship with Jacaranda Health, the same institute I worked with to do interviews with pregnant women and new mothers.”
Lai also enjoyed the international feel of her neighborhood in Nairobi, and while she learned some basic Swahili, many people spoke English. She also recommends staying in touch with your supervisor. Green was not in Nairobi at the time of her internship, but Lai and he kept connected.
“He provided me with a lot of support while I was there. I’d just text him and he’d text me back really quickly,” she says.
Lai hopes to travel around the globe and plans to continue pursuing ways digital tools can help more people gain access to mental healthcare. But first, later this month she will defend her thesis, which highlights her work in Kenya. It’s title: “Feasibility, Acceptability, and Perceived Impact of Automated Psychological Support on Perinatal Women in Kenya.”