News

Global Health is Local Too

August 08, 2019

By Vanessa Moss

When Duke senior Rachel Baber began her freshman year, she was under the impression that legitimate research had to involve a white lab coat and a microscope.

But this summer she worked to study human health without a pipette in sight, instead spending her time in a computer lab, which was empty besides her and two fellow interns. A few yards away from her shared workspace, blue metal double doors swing into a linoleum-floored cafeteria.

As she sits at a table near the entrance, dozens of men and women walk past in ones and twos, some with oil smeared on their jeans and others pushing carts with cleaning supplies, talking with one another and nodding to acknowledge Baber.

She’s been working all summer at the Triangle Residential Options for Substance Abusers, Inc., better known as TROSA, and everyone passing is a resident.

TROSA is acclaimed for their whole-person approach to substance-abuse recovery and trauma resiliency, with multi-year programming that provides treatment, educational opportunities, and vocational training for their clients. TROSA has been providing services for 25 years and, like most non-profit organizations, they have a running list of projects with limited number of staff hours to commit to them.

“It’s not that they’re back-burner issues,” explains Karen Kelley, the Chief Program Officer at TROSA. “It’s just that we don’t have enough front burners.”

This summer, Duke’s undergraduates stepped in to provide a little more stove space for TROSA’s needs.

Duke’s Global Health Institute (DGHI) requires all students to spend one summer in a research training program, which associate professor Sumi Ariely believes is a vital opportunity for students to “work deeply with a community partner and their vision, and to help disparities or inequities in their community.”

Program options range from looking at health impacts of gold mining in Ghana to screening for glaucoma in Honduras, but 2019 was DGHI’s first season offering TROSA as a research site, opening new avenues for students to give back to the Durham community.

“We have a responsibility to our neighbors,” Ariely says. “‘Global is Local’ holds two meanings. As a geographic term, it focuses on the Triangle or Durham area. It also holds philosophical value. We in high-resource areas don’t have all the answers, and entering global arenas flaunting our ‘solutions’ is just hubris,” she adds. “Working to solve pockets of deep inequalities in our state and our country allows for multi-directional learning.  Local is Global acknowledges that we are all fundamentally the same and in it together.”

Duke University and TROSA have had a long history of collaboration. TROSA moving services are a common sight on Duke’s campus, and Duke Health also contracts with providers who work on-site at TROSA to give primary, behavioral health, and psychological care for clients.

Having three DGHI interns allowed TROSA to begin answering questions that they’d long been speculating about: How does cigarette smoking impact the community as a rehabilitation center? How could the program integrate sustainable practices like recycling and composting on an institutional scale? How accessible are the classes that TROSA offers residents and how do they affect resident growth and recovery?

Baber spent her time tackling the last question, first classifying the full curriculum of TROSA’s courses into three major categories: Therapeutic, vocational, and educational. Looking at past courses that residents had taken, she began the process of setting course standards for residents – what number of therapeutic courses are expected to be completed at nine months into the program compared to 15 months, for example.

This number-crunching project also provided an opportunity for the administration to reflect on course access. Baber was able to find some patterns in curriculum, like how most residents register for more classes as they advance through the program, and how female residents often register for more therapeutic courses than men.

“I’d love to qualitatively look at residents’ impressions of the classes,” Baber explains. “Some people really enjoy a certain category of courses, while others benefit more from working on a job and dealing with problems as they come up.” Baber envisions that question, along with identifying which classes have the highest graduation rate and asking why that is, as possible projects for future interns.

Rebecca Graves, TROSA’s Director of Clinical Operations, sees data and demographic review like this as a critical means of assessment and improvement. “As a nonprofit, we use a quarterly review to pay close attention to demographic changes. If 80% of applicants were female and only 20% of our population was women, we’d need to review — What’s keeping people out of the door? Are we inhibitive in some way?”

After working with often-incomplete data, Baber and fellow interns Ashley Wilson (C’20) and Gabrielle Zegers (C’19) were able to realize what information is missing, refine what TROSA should keep collecting, and find what they could from the data they did have.

“Check them off as huge successes,” Graves reiterates. “They’re making marked achievements, finding new data, extrapolating new information, and creating new policies here. They all took ownership as self-motivated researchers, and my dream is that they’d all stay.”

Beyond working on their assigned projects, the three students were eager to invest themselves in the TROSA community, attending a dance with new women in the program, volunteering at the TROSA thrift store on weekends, volunteering at the medical center, and helping with GED tutoring each Tuesday evening.

“Getting to learn from residents about their recovery and what they’re doing to help themselves has been the best part of this job,” Baber says. In global health, students often face large and looming statistics surrounding the opioid epidemic. “It’s easy to dehumanize that problem. It’s easy in global health to think ‘Oh, these numbers are so huge. I’ll never make a difference.’ But talking to individuals personalizes the matter, it makes you realize that positive change can happen.”

For more information about TROSA, visit: www.trosainc.org

This article first appeared on the Duke Research Blog and was republished with permission. 

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DGHI interns stand by a bench that reads "TROSA" in Durham.
Left to right: Gabrielle Zegers (C’19), Ashley Wilson (C’20), and Rachel Baber (C’20) stand together at TROSA in Durham.

'Local is Global' acknowledges that we are all fundamentally the same and in it together.

Sumi Ariely, associate professor of the practice of global health

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