The World of Public Health

Staying Active as You Age

As we age, our body goes through various changes. You may gain and retain weight more easily. Your bones may become brittle because of hormonal changes causing diseases like osteoporosis. You may develop osteoarthritis or even find that your joints are stiffer because of a lack of movement.

Exercise and physical activity are the keys to staying fit, mobile, and independent as you age. The recommended amount of exercise/physical activity per week is 150 minutes of moderate-intensity aerobic exercise.¹ With moderate activity, you are able to speak when in movement; however, with vigorous activity, which is an option for 75 minutes per week, you need to “catch your breath” before you speak. One hundred- and fifty-minutes sounds like a lot, but you can easily break it down to exercising 30 minutes a day, 5 days a week. Thirty minutes can also be broken down to three 10-minute intervals throughout the day.

Physical Activity vs. Exercise

The difference is simple. Physical activity is anything the involves body movement. This can include going for a walk, gardening, light cleaning, walking to the mailbox, or even walking down the stairs to get something. Exercise on the other hand involves strategic movement with a purpose. There’s a goal that one is trying to accomplish for a specific number of minutes, miles, repetitions, sets, etc.

All exercise is a form of physical activity, but not all physical activity is exercise.

Ways to Incorporate Physical Activity

Four Types of Exercise

Exercise can be broken into four different groups, Endurance, Strength Training, Balance, and Flexibility. Each type of exercise serves a specific purpose, and it is important to corporate a variety of each throughout the week.

Endurance (Aerobics)

Endurance exercise gets your heart rate up and your blood circulating, improving the health of your heart and lungs.²

Strength Training

Strength training builds and tones muscle, strengthens bones, aids in fall prevention and mobility. Exercises from this group may also prevent diabetes and help those with diabetes manage their condition.

Balance

Balance exercise aid in fall prevention and strengthens your core.

Flexibility (Stretching)

Flexibility exercises can prevent injuries, help you recover quicker if you are injured, and aids in agility.

Incorporating different types of exercise can help you stay active and independent as you age, and help to prevent and manage chronic diseases. Remember, speak with your healthcare team before starting an exercise regime, stretch before and after exercising, and go at your own pace.

First Picture by FFWPU from Pexels

Resources:

Go4Life

Go4Life is an exercise and physical activity program developed by the National Institute on Aging at the National Institutes of Health. Although their previous grant is over, you can still find information about ways to increase and maintain physical activity regardless of age and health conditions. For more information visit https://www.nia.nih.gov/health/exercise-physical-activity.

MOVE!

MOVE is a weight management program developed by the U.S. Department of Veterans Affairs. Countless individuals have participated in the program to manage and lose weight, increase physical activity, and as a means for support. The website includes information on nutrition, exercise, mindful eating, and more. Please visit https://www.move.va.gov/.

Sources:

Centers for Disease Control and Prevention. (2020). How much physical activity do adults need? Retrieved from https://www.cdc.gov/physicalactivity/basics/adults/index.htm.

National Institute on Aging. (2020). Exercise and Physical Activity. Retrieved from https://www.nia.nih.gov/health/exercise-physical-activity.

Older Adult Mental Health During COVID-19

It’s no secret that older adults have specific mental health needs. According to the National Council on Aging, one in four older adults experience a mental health disorder like dementia, depression, and anxiety; and that number is expected to increase to 15 million by 2030. ¹ With the unexpected impact of COVID-19, it is likely the mental health of older adults may have a significant impact on current data.

When we first learned of COVID-19, we heard about the effect the disease was having on older adults. Because of the number of older adults developing and dying from the disease, and the factor that having a chronic disease increases the risk of acquiring SAR-CoV-2, older adults were told to take extra precautions and shelter in place. There were videos of grandparents waving at their family and friends from windows, and even a viral image of a contraption a family constructed so that a grandmother could hug her grandchildren.

Isolation, financial issues, and uncertainty of the future can take a toll on one’s mental health. However, here are a few ways that you can take control of your mental health:

Teletherapy – Medicare telehealth services has expanded so that more older adults can have access to counselors.

Call someone – Simply picking up the phone to call someone may make you feel better.

Zoom – People are using Zoom more than ever to connect with their friends, family, and co-workers. There are even people who have celebrated birthdays and baby showers on the platform. It’s simple to use once you get the hang of it.

Picture by Andrea Piacquadio from Pexels

Go for a walk – Safely go for a walk outside. Getting some sun and exercise can give you a mental boost.

Exercise indoors – Although going to a local gym or fitness club may put you at risk for getting the coronavirus, you can safely exercise at home by doing chair exercises and using supplies in your home for strength training. Speak with your doctor about which types of exercises work best for you.

Take a break – Many of us have spent more time around people in our household like never before. Carve out some “me time” for yourself to help keep you sane.

Set goals – Set a few short- and long-term goals that you’ve always wanted to accomplish.

Limit alcohol consumption – Alcohol may be used to mask what you’re feeling, it can also negatively affect your health if you are drinking more than recommended amounts. It’s better to get to the root of the issue by speaking to a professional.

Eat a balanced diet – Stress leads some to over-eating and others to not eat enough. Make sure you’re eating a balanced diet and reach out to local food pantries and organizations like Meals on Wheels if you need help with food security.

Learn something new – It’s never too late to learn something new.

Turn off the news – Take a break from the news and focus on something positive.

Go for a ride – Go for a drive or ask someone to take you for a ride.

Mingle RESPONSIBLY – If you can safely spend time with others, or in public spaces, do so.

Times are steadily changing, and we have entered a new norm. Try your best to find ways to adjust and stay mentally fit.

Resources:

National Council on Aging Behavioral Health Webinars and additional information https://www.ncoa.org/center-for-healthy-aging/behavioral-health

AARP Article on teletherapy https://www.aarp.org/health/conditions-treatments/info-2020/teletherapy.html

National Crisis Text Line Mental health 741741

Substance Abuse and Mental Health Services 1-800-662-4357

National Suicide Prevention Hotline 1-800-273-8255

Source:

National Council on Aging. (n.d.). Behavioral Health. Retrieved from https://www.ncoa.org/center-for-healthy-aging/behavioral-health/.

COVID-19 & Breastfeeding: What You Need to Know

COVID-19 has shaken the foundation of the world and has left many with unanswered questions on how to navigate everyday life during a pandemic. This global crisis may have left some mothers wondering whether or not they should breastfeed, and if doing so would expose their baby to a virus we are still learning more about.

Here are the facts:

SARS-CoV-2, the virus that cause COVID-19, is primarily transmitted through droplets when a person sneezes, coughs, or talks.

A newborn can be infected with the virus if they are in close proximity with an infected person.

Limited data suggests that breast milk may not transmit the virus; however, more research is needed.

The Centers for Disease Control and Prevention recommends nursing mothers with COVID-19 to wear a mask while breastfeeding and wash their hands at least 20 seconds between feedings.

Mothers should not share breast pumps and should wear a mask and wash their hands for at least 20 seconds before handling supplies.

Plastic face shields and masks for newborns are not recommended.

Breast milk has been shown to provide a baby with antibodies to fight against viruses, but more research is needed to see if the same is true for SARS-CoV-2.

Mothers with influenza have been able to safely breastfeed.

Again, as we learn more about this virus, we will have a better understanding of its effects and its impact on breastfeeding.

Make sure you speak with your doctor about any concerns you may have.

Photo Credit: Diller from Freepik

Sources:

Centers for Disease Control and Prevention. (2020). If You Are Pregnant, Breastfeeding, of Caring for Young Children. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html

American Academy of Pediatrics. (2020). Breastfeeding During the COVID-19 Pandemic. Retrieved from https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/Breastfeeding-During-COVID-19.aspx

World Health Organization. (2020). Breastfeeding and COVID-19. Retrieved from https://www.who.int/news-room/commentaries/detail/breastfeeding-and-covid-19

The American College of Obstetricians and Pediatrics. (2020). Coronavirus (COVID-19), Pregnancy, and Breastfeeding: A Message for Patients. Retrieved from https://www.acog.org/patient-resources/faqs/pregnancy/coronavirus-pregnancy-and-breastfeeding#What%20is%20COVID19

Kids Health. (2020). Is It Safe to Breastfeed if I have Coronavirus (COVID-19)? Retrieved from https://kidshealth.org/en/parents/coronavirus-breastfeeding.html

Bottle Feeding: It’s Your Choice

After a traumatic delivery, a nurse hands you your beautiful baby girl. It’s time for her first feeding. You try to get her to latch, but she absolutely refuses to. You try again and again, but after several attempts, you become frustrated and weepy. You make the decision to formula feed instead.

There are mothers who can relate to the story above. They’ve tried breastfeeding their baby but were unable to get the baby to latch. There are other mothers who can breastfeed but discontinue before the recommended 6 months of exclusive breastfeeding. Other mothers are unable to breastfeed because of lactation failure (inadequate or absence of milk flow), a medical issue, or simply by choice.

The benefits of breastfeeding is what drives health professionals to push “breast is best,” but doing so may guilt mothers who are not breastfeeding. Bottle/formula feeding shame is just as bad as the shaming that breastfeeding mothers experience while breastfeeding in public or at work.

Although antibodies found in breast milk are not in formula, formula can provide a baby with nutrients (protein, fat, and vitamins) necessary for their development. Formula feeding may also work best for families because it is convenient, may require less feedings, and mothers who formula feed don’t have to worry about the effects of what they are consuming in regard to their baby’s nutrition.

Contrary to popular opinion, breastfeeding is not a sign of fidelity nor does it identify you as a mother. ¹ Weigh the pros and cons and figure out what works best for you and your baby. There is no shame in bottle/formula feeding.

Photo Credit: Pexels

Source:

La Leche League. (2018). How Often Does Breastfeeding Really Fail? Retrieved from https://www.llli.org/how-often-does-breastfeeding-really-fail/#:~:text=In%20my%20practice%20as%20an,that%20only%20one%20in%20a

Breastfeeding Benefits for Mama and Baby

After working, and speaking, with mothers over the years, I have learned that some mothers do not know about the benefits of breastfeeding. Yes, many can recall that breastfeeding is the “best source of nutrition for babies,” but there are other health benefits for both mothers and babies.

As a volunteer turned intern at the Breastfeeding Center for Greater Washington, and during my graduate studies, I gained insight into the importance of breastfeeding and its short- and long-term effects for both populations.

Benefits for Mama

Creates a Bond

Prolactin and Oxytocin are two hormones released during breastfeeding. The release of these hormones may make it easier for a mother to bond with her baby.

Reduces Postpartum Bleeding

A release of oxytocin can help the uterus return to size and reduce postpartum bleeding

Delays Menstrual Cycle

Exclusive breastfeeding increases the amount of prolactin in the body preventing ovulation. Breastfeeding may work as a method of birth control (Lactation Amenorrhea Method).

Lowers the Risk of Chronic Disease

Breastfeeding may lower the risk of breast and ovarian cancer by reducing long-term exposure to estrogen. It may also lower a mother’s risk from developing type 2 diabetes and hypertension.

Saves Money

On average, families spend $1,500 on formula. The cost of breast milk is free, but some families pay for supplies (nursing bras, breast pump, lactation consultant, nipple cream, etc.).

Benefits for Baby

Protects Baby’s Immune System

When a mother is exposed to germs in the environment, her body produces antibodies that can protect her baby’s immune system. The baby receives these antibodies through breast milk.

Colostrum, the first type of breast milk the body produces, coats the stomach lining and acts as a line of defense against bacteria. It also provides a baby with vitamins and protein.

Reduces Ear Infections, Colds, and Respiratory Illnesses

Antibodies produced in breast milk can reduce the rate of ear infections, colds, and respiratory illnesses.

Lowers the Risk of Sudden Infant Death Syndrome (SIDS)

Breastfeeding a baby for at least two months, regardless of exclusive breastfeeding, decreases the risk of SIDS.

Lower Risk of Developing Asthma, Eczema, and Allergies

One of the long-term effects of breastfeeding is that it reduces the chances that a child will develop allergies, asthma, or eczema.

There are even more benefits of breastfeeding that are not captured in this post. Mothers and babies are both impacted by breastfeeding. Breastfeeding has short- and long-term health benefits for both populations.

While there are benefits to breastfeeding, it is important to acknowledge that not all mothers choose, or are able, to breastfeed. Every family is different, and this post is by no means written to “push” breastfeeding as the only choice, but to provide education. Being unable, or choosing not, to breastfeed does not make anyone any less of a mother.

First photo by Dalila Delprat from Pexels

Sources:

Healthy Children. (2016). Benefits of Breastfeeding for Mom. Retrieved from https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Benefits-of-Breastfeeding-for-Mom.aspx#:~:text=Breastfeeding%20provides%20health%20benefits%20for,and%20can%20reduce%20postpartum%20bleeding.

Cleveland Clinic. (2018). The Benefits of Breastfeeding for Mom and Baby. Retrieved from https://my.clevelandclinic.org/health/articles/15274-the-benefits-of-breastfeeding-for-baby–for-mom

Office of Women’s Health. (2019). Making the decision to breastfeed. Retrieved from https://www.womenshealth.gov/breastfeeding/making-decision-breastfeed

American Pregnancy Association. (2019). Benefits of Breastfeeding. Retrieved from https://americanpregnancy.org/breastfeeding/benefits-of-breastfeeding/

Centers for Disease Control and Prevention. (2019). Breastfeeding for Cancer Prevention. Retrieved from https://blogs.cdc.gov/cancer/2019/08/01/breastfeeding-for-cancer-prevention/

National Institutes of Health. (2015). Breastfeeding may help prevent type 2 diabetes after gestational diabetes. Retrieved from https://www.nih.gov/news-events/nih-research-matters/breastfeeding-may-help-prevent-type-2-diabetes-after-gestational-diabetes#:~:text=Breastfeeding%20for%20longer%20than%202,account%20for%20these%20risk%20differences.

American Academy of Pediatrics. (2017). Study: Breastfeeding for at least 2 months decreases risk of SIDS. Retrieved from https://www.aappublications.org/news/2017/10/30/BreastfeedingSIDS103017

Cleveland Clinic. (2020). Ear Infection (Otitis Media): Prevention. Retrieved from https://my.clevelandclinic.org/health/diseases/8613-ear-infection-otitis-media/prevention

Best Practices When Working in Public Health Abroad

Volunteering and working abroad can be rewarding, and if you’re a public health professional nothing feels better than being able to use your skills to help someone else. While helping overseas may be fulfilling, it is best to do so responsibly, avoiding doing more harm than good.

Ten best practices for doing public health work overseas:

1. Assess the Need(s) – Don’t Assume

One of the biggest mistakes that someone working overseas can do is going to another country and assuming that they know what is best for the people they are serving. Never assume that you know what someone else’s needs are before assessing the situation. Speak with the people you are serving to find out how you can help.

2. Use Available Resources

Learn what resources are readily available in the community you are serving. Instead of bringing in outside resources and talents, find out what skills people you are working with already have. Maybe someone has experience as a community health worker, or maybe there is a local leader who can help you identify community members or local organizations that have skills and resources to help you carry out your project. There could also be someone in the community who would be willing to carry on your work. Sustainability is key.

3. Practice Cultural Competence

Cultural competence is respecting the language, attitudes, and behaviors of the population you are working with. Get to know the people and the culture as you are serving them. Think about ways that you can effectively execute your work without imposing your own beliefs and ideas on others.

4. Be Patient

You may be used to quickly checking off items on your to-do list but completing tasks overseas may not be as easy providing your resources, and culture and customs. Plan for obstacles, adapt to change, and always have a back-up plan.

5. Set Boundaries & Don’t Cross Any

Be okay with saying no. The last thing that you want to experience is burnout while working abroad. There are a million issues in the world that we as public health professionals want to solve, but we must know our limits. Also, only do what is in the scope of your profession. If you are not a medical professional, or have not received any medical/healthcare training, avoid providing medical care (i.e., delivering babies or administering medication) to the population you are working with.

6. Realize You Aren’t Anyone’s Savior

You want to change the world and help any and everyone. Nothing is wrong with that. However, the problem comes when the work that you are doing takes away from the people you are serving and their personal agency. It also becomes an issue when people begin relying on outsiders for solutions than considering what skills they have to help their own community. P.S. Unless otherwise led, you are not obligated to give more than the services you are providing. Yes, you want to help to make a difference, but speak with your supervisor before donating money or in-kind goods.

7. Pass Your Knowledge On

Simply, pass along the skills and knowledge you have to the people you are working with. Don’t just execute an assignment and keep what you know to yourself, educate someone else and be open to being educated.

8. Be Active – Use Your Skills

Use the skills that you have. Do not slack off. Do not procrastinate. Even if you are working in an environment that works at a slower pace than you are used to, put your skills to use. Even if the other volunteers are health workers are taking a day off to go explore, make sure that you have completed the tasks you committed to completing. Stay focused on the purpose.

9. Interact with Your Co-Workers & Other Volunteers

It can be hard opening up to strangers, but what’s worst is isolation and the feeling of loneliness that can occur when you are working abroad. There is no better time to get out of your comfort zone than when you’re in unfamiliar surroundings. Spending time with others can help you cope with what you are feeling. It also gives you the chance to learn about people from different backgrounds other than yours.

10. Hand-Off Your Work Before You Leave

Lastly, be prepared to hand your work over to someone who can carry it on. What purpose would your work serve if the people you are working with and serving aren’t able to benefit from it in the long run? You can easily leave a notebook, or send an email, with detailed information about the project(s) you’ve worked on, any contacts and relationships you’ve made, and potential next steps. Don’t leave without ensuring that someone is able to finish or execute what you’ve started.

My Experience as a Peace Corps Health Extension Worker – Part 2

After I became acclimated, it was time to get to work.

Each volunteer was tasked with collecting data, facilitating several group discussions, and writing a Village Analysis Report. The main reason volunteers were asked to do this was to see how we could be of assistance within the community; and what resources and skills were readily available.

Before executing the tasks, I had to find someone to help me; someone who could gather people and translate my version of Kiswahili. I asked Dada Agnes (Sister Agnes), a primary school teacher who spoke English. Because Dada Agnes was busy with her school schedule, she recommended that I work with Mama Gonsalva.

Mama Gonsalva was a Community Health Worker, and with the help of my homemade brownies, was able to gather several groups of people for our group meetings. I made the brownies and people showed up. We’d chat, laugh, and work until sun set. In undergrad, I learned about group facilitation and conducting assessments, but being able to put what I learned into practice was incredible. After several community meetings, I had enough information to write my report. Thanks to Dada Agnes, I was able to submit my report to the government of Songea.

While I had a great time executing the assessment, I quickly learned about the village hierarchy. Because my village contact kept putting the assignment on hold, I went around him and didn’t bring my concerns to the village chairman. I avoid procrastinating and because of that sometimes I tend to jump the gun. After explaining to the chairman why I went around my contact, he said that he understood and accepted my apology.

Time to teach:

Not long after I completed the Village Analysis, and presented it to others in my Peace Corps class, I began teaching at two of the primary schools, the local clinic, and throughout the community.

For my first time teaching in the village, I went to the clinic and taught women about Oral Rehydration Salts (ORS). The Mamas (the women in the class) looked on, some confused and others amused. Once Mama Gonsalva was able to help translate what I was saying, the Mamas laughed at me dancing as I shook the bottle with the solution, listened as I took them through the steps, and even asked questions. It was another moment cementing that I wanted to educate others for a living. Working at the clinic became a regular experience, and I was even able to assist with weighing babies and helping the doctor, nurse, or health workers with several tasks. My favorite part was connecting with the women and building friendships.

Because I enjoy staying busy, I also decided to teach at both primary schools. One of the great tools that Peace Corps provided was a handbook of lessons in Swahili and English. I was able to modify lessons based on age range and created games to help the children learn. I taught but I also learned from the children that I worked with.

As I mentioned in my previous post, it took time for me to adjust to my new surroundings. I would visit people’s homes, shops, and community hangouts to sit and speak with them about their healthcare concerns. During a visit at one person’s home, I was offered water which had not been boiled or treated. I returned to the person’s home after teaching them about the importance of boiling water and how wadudu (germs/bugs) can enter the body and make them sick. She offered me water again, but told me that she started boiling her drinking water before use. A small accomplishment with a major impact.

I would also sit and speak with the vijana (youth) who were not in school; speaking with them about health topics and answering the questions they had. Because I was open and spent time with community members, they began to feel more comfortable around me and started visiting my home to ask questions, to sit and talk, and to read health materials.

I continued to teach, but one day after teaching a group of Mamas, I decided to create a Mama Lishe (Mama Nutrition) group. The formation of the group came about because of an event that took place. One day, when I was teaching a group of Mamas, my meeting was interrupted by a leader in the community. I was cut off as I was teaching and the Mamas were scolded and spoken down to like children. As he walked off, the Mamas were whispering and looked helpless.

During training, volunteers were taught how women in Tanzania are oppressed; and volunteers were encouraged to work on women empowerment projects. I remembered how my Mama during training would walk around the house quietly when Baba (father) was around, and how her personality would shine through, and laughter would fill the house, when he was at work. I wanted to experience that with the women of Nakahuga, so I turned to Dada Agnes for help.

Dada Agnes quickly got the Mamas together and the nutrition group, which was created for the Mamas to learn how to cook healthy meals based on their resources, was a success. The Mamas were also able to use the group as a means to openly communicate with each other.

An unexpected departure:

After months of becoming acclimated, something seemed off. About two months prior, Stacy was moved from Ruvuma to another village in a different region. I had no idea of the impact it would have on me. We were friends from the beginning and were excited that we would be living in the same region and could meet up in Songea to hangout and regroup. I connected with other volunteers in the region, but Stacy was my Peace Corps best friend.

My Peace Corps Buddy & Hero (She guided a tarantula the size of my palm out of my bedroom)

The work also began taking a toll on me. There was so much that needed to be done and I wanted to change the world. I would wake up early and stay up late at night. I’ve always been a hard worker, but because of all that I saw and experienced, my mind was on overdrive and I experienced chronic insomnia for the first time. My mental health began to suffer.

I tried pushing through feelings of isolation, sleep deprivation, low-self confidence, and loneliness, but I was shutting down. I reached out to the Peace Corps nurse who connected me to a psychologist. After speaking with the psychologist, I was told that I would be returning home for a brief period of time to recover; however, when I returned home, I was told that it would be best for me to stay home for my mental health. I was heartbroken. I felt like I let everyone down, especially myself.

Lessons learned:

In retrospect, there are many things I would have done differently. I would have practiced patience, taken mental health breaks, spent more time with other volunteers, and spread out my work over the full two years.

Although I was only a volunteer for 10 months, I always think back to my time in the Peace Corps and the lessons I learned. I learned lessons that have impacted my career and how I work, how I see myself, and how I interact with others. My time in the Peace Corps is an unforgettable experience that I will forever hold dear to my heart; and I am forever grateful for all of people I met, and the heartfelt and hilarious stories I am able to recall, all of which would take a series of several posts to cover, as a Peace Corps Health Extension Worker.

My Experience as a Peace Corps Health Extension Worker – Part 1

Ten years ago, I embarked on a journey that would change the course of my career. This is my experience as a Peace Corps Volunteer Health Extension Worker.

The beginning:

This story would not be complete unless I explained why I joined the Peace Corps.

During my final year of undergrad, I decided that I wanted to work before attending graduate school. Because I originally wanted to become a child psychologist, I spoke with one of my professors about her career path and explained my career goals to her. After our meeting, she stated that I should consider a career in public health. I had no idea what public health even was. Not only that, but another one of my professors suggested the same career field without knowing what the other said.

I knew that I had always been passionate about health, loved teaching, and wanted to serve others. Because I enjoyed volunteering, I went ahead and applied for the Peace Corps.

The application process was a little tedious, but with the help of my Peace Corps recruiter, I was able to finish the first step in becoming a volunteer.

Kwaheri Amerika (Goodbye America):

Not long after returning home from Ghana, I attended a Peace Corps event with my mother. At the end of the event, it was announced that I would be going to Tanzania. I previously learned about Tanzania and even knew people who lived there, so we were overjoyed. In July 2010, my family drove me to Pennsylvania where I would meet up with the other volunteers in my class. We said our goodbyes.

Now I’m not shy at all. However, I’m reserved, even around my family, unless I’m teaching. Meeting everyone was a little overwhelming, but I knew that I wasn’t the only volunteer who felt that way. It was a reminder that we were all in it together. The next day, we went to New York, had two layovers (in Switzerland and Kenya where there was a giraffe within close distance to the plane), and finally landed in Dar es Salaam, Tanzania.

Training was for three months and took place in Dar es Salaam at the Msimbazi Centre Hostel, and Tanga where volunteers spent most of our time. Training opened my eyes to how non-Tanzanian Blacks were viewed. I already knew how some people would view me because of things I’d heard from my friends. There were two other Black Americans in my class, but at times it became hard. After one training, I spoke with the Program Manager about my concerns. I asked him why some Tanzanians looked down upon Black Americans. He told me that it was because of the stereotypes seen on T.V. I told him how I felt, and he reassured me that the Peace Corps was working to recruit more African Americans and incorporate training that would benefit people from different racial backgrounds.

After we completed training at the Centre, volunteers traveled to Tanga where we each stayed with a host family. I quickly learned how to adapt to my new living conditions, and my time in Ghana mentally prepared me to expect the unexpected. The only thing I wished I would have expected, was the mouse that decided to get in bed with me…that’s a story for another day.

My host family consisted of two parents and three children. The oldest child stayed with a family member so that I could stay in his room. When I arrived, they stared at me with smiles on their faces. All of us looked at each other and I began showing them pictures of my family and friends. The only person in my host family that could speak English was my host father. There was a language barrier as he wasn’t fluent in English and I could barley put together a short sentence. However, I think the language barrier pushed me to learn as fast, and as much, as I could. Kiswahili is one of the most beautiful languages and was easy to pick up on once I learned greetings, nouns, adjectives, verbs, and how to structure sentences.

Karibu Nakahuga (Welcome to Nakahuga):

After three months of learning about Tanzania, the culture, the language, and different health topics that affect Tanzanians, volunteers graduated and were sent our separate ways.

During the drive from Dar es Salaam to Ruvuma, I quietly sat in the front seat of the SUV as the other volunteers were in the back chatting. Being on the continent of Africa felt like a grounding experience. I looked on excitedly as we passed animals at a watering whole. I thought about what my late grandmother would think of me living across the world. It was the moment where it hit me that I would be living alone in an entirely different country, and that it was my opportunity to do as much as I could do to serve others.

Each volunteer was dropped off at their new home. Now, before we entered the village I lived in, we encountered a large fire that was on both sides of the road. The driver stopped the car and an Associate Peace Corps Director, Pascal, jumped out of the SUV. We waited for a few minutes to make sure it was safe then we proceeded to Nakahuga.

The drive was bumpy, and people stopped to see who the wageni (foreigners) entering their community were. When we got to my homestay, I was greeted by my village contact and the nurse whose home I was to live in. I said goodbye to Stacy, my Peace Corps best friend, and watched the SUV as they drove off.

The next day, I met almost the entire village. I don’t believe they expected their volunteer to look like me, but many of them eventually warmed up. It took a while for others to do so, and at times, I had to take a stance and respectfully voice my concerns when faced with opposition. I started attending events, showing up on community members doorsteps saying, “hodi hodi” (greeting when arriving at someone’s home), visiting schools, and hanging out in public spaces. Spending time with community members, asking questions and answering them, helped me to adapt to my new surroundings.

I experienced a range of emotions from the time I left my home state of Maryland to the moment it hit me that I was the only American in my village. Excitement, nervousness, frustration, and joy; a stillness and feeling of contentment. I was ready to make a difference and begin my job as a Health Extension Worker.

Organization Spotlight: Lifted Strong

Located off the beaten path, in the beautiful country of Tanzania, lies an organization that is supporting and uplifting the local women of Arusha. Lifted Strong was created by Eva Boaz and Joyce Beda to empower and educate women (Mamas) impacted by HIV/AIDS and life’s hardships.

What’s inspiring about the program?

The joy that the Mamas of Lifted Strong have despite the adversities they’ve faced is inspiring. The stories I’ve heard about their lives before joining the program was heartbreaking. But no matter what, and no matter how they’ve felt, the Mamas were welcoming, loving, and hopeful about their future. I was humbled.

What makes the organization unique?

Lifted Strong is unique in that it is not only an organization, but also a program with several purposes: providing health education to women based on their needs, equipping women with knowledge on how to develop a sustainable business, identifying skills that each participant has, connecting women to local resources that will help them succeed, and providing a safe place for women to share their stories and experiences to help others.

The organization even has a microloan program where Mamas learn how to write a business plan, pitch their idea, and receive funding if the group feels as if their business idea is marketable and sustainable.

What are some of Lifted Strong’s projects?

To help the organization generate income, two volunteers assisted the Mamas with developing a cooking class “Cook Like A Mama.” For a small fee, volunteers can learn how to make three types of sambusas (samosas) and coconut soup. It’s a hands-on experience. The Mamas also teach participants inspirational songs in KiSwahili.

“Mama Kuku,” which translates to Mama Chicken, is their chicken project. Mamas learn how to care for chickens so that they can sell eggs and chickens for the organization and for their own personal income. The chickens also provide a source of protein for the Mamas, to prevent protein deficiency which can weaken the immune system, and their families.

The Mamas learning how to use a condom and Mama Jane looking surprised

As previously mentioned, Lifted Strong has a health education component, and teaches Mamas about health issues related to HIV/AIDS, Tuberculosis, Stress Management, Exercise, Malaria, and more. After realizing that I didn’t want to teach one lesson and leave, I was given the opportunity to work with a nursing student, Stephanie, on developing and laying the foundation for Lifted Strong’s health education program.

Lastly, in partnership with Oyana International, the organization provides re-usable menstrual products for women and girls in the community; and provides community outreach and education.

My time at Lifted Strong is an experience I will never forget. To learn more about the Mamas, and the work that’s being done at Lifted Strong, please visit liftedstrongco.org.

First photo credit: Lifted Strong Website

Minority Mental Health Awareness Month

“Racial and ethnic minority groups in the U.S. are less likely to have access to mental health services, less likely to use community mental health services, more likely to use the emergency room department, and more likely to receive lower quality of care.” – U.S. Department of Health and Human Services Office of Minority Health, 2019

Note: Resources are listed at the bottom of this post.

In honor of Bebe Moore Campbell, a writer and mental health advocate, National Minority Mental Health Awareness Month was established in 2008 to bring awareness to the mental health barriers that minorities face in America.

What are the barriers?

Lack of insurance or being underinsured
Mental health stigma
Lack of adversity among providers
Language barriers
Distrust in the healthcare system
Inadequate support for mental health services
Misdiagnosis

Lack of insurance or being underinsured

African Americans and people of Hispanic origin are less likely to have insurance coverage compared to Whites; and a disruption in insurance, and a change in doctors, makes it less likely to develop a relationship with their doctor.² This can make them less likely to seek mental health care.

Mental health stigma

There’s stigma in seeking mental health care because of race, culture, masculinity, religious beliefs, discrimination, and other factors. Many of these factors are ingrained in our society and who we are as a people.

Lack of adversity among providers

A lack of adversity is probably something that people don’t think about. However, it has been shown that if a doctor is of the same race as a patient, the patient is more likely to report higher levels of trust and satisfaction.³

Source: Association of American Medical Colleges, 2018

Language barriers

Language barriers also pose a significant issue. Being unable to communicate effectively because of language and/or culture, or being unable to comprehend health information due to medical terms, is also another factor that can put a person’s mental health at risk.⁴

Distrust in the healthcare system

The history of the American healthcare system is steeped in racism, sexism, and classism; and because of that history, some minorities may feel uneasy from seeking mental services.

Inadequate support for mental health services

Access to healthcare is one of the biggest issues some Americans are faced with. Inadequate access to mental health services make it harder for people to receive the mental health care that they need.

Misdiagnosis

Minorities are more likely to be undiagnosed, misdiagnosed, or under-diagnosed because of cultural, linguistic, or even historical reasons.⁵ A Rutgers University study found that African Americans were more likely to be misdiagnosed with schizophrenia than their White counterparts.⁶

This post by no means discredits what White Americans may experience regarding mental health. However, it was written to address the barriers and issues that minorities are faced with. For example, White Americans have higher rates of depression, and are more likely to die from suicide, than Black and Hispanics. However, depression in Black and Hispanic Americans are more likely to be persistent.⁶

Source: American Psychiatry Association, 2017

Visit the National Alliance on Mental Health for more information.

What is being done, and what can be done?

Training for healthcare professionals on cultural competency and the barriers that minorities are faced with
Providing resources specifically designed to address the needs of specific populations/cultures/races
Advocating to address the needs, concerns, and inequalities of various populations
Providing mental health resources in religious settings and common gathering places
Providing access to healthcare in rural communities
Educating individuals and families on the importance of seeking mental healthcare, and providing education to break stigma
Connecting individuals and families with healthcare professionals they can relate to
Connecting individuals and families with resources that are appropriate for them
Providing access to tools and resources to healthcare professionals, individuals, and families
Developing relationships between healthcare professionals and patients

Right now, we don’t have a perfect solution on how to combat the issue of inequalities in the healthcare system and the disparities that minorities face regarding mental health. There are systemic issues that we will have to continue to uncover and address for us to make progress in providing adequate mental healthcare for all.

A big thank you to Bebe Moore Campbell and all the mental health professionals and advocates who have and are shedding light on minority mental health issues.

Books on culture & race in the healthcare system:

Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to Present by Harriet A. Washington

The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures by Anne Fadiman

The Immortal Life of Henrietta Lacks by Rebecca Skloot

Mental Health Resources:

Mental Health America https://www.mhanational.org/bipoc-mental-health

Resources for Black and African American Communities https://mhanational.org/issues/black-and-african-american-communities-and-mental-health

Resources for Latinx/Hispanic Communities https://mhanational.org/issues/latinxhispanic-communities-and-mental-health

Resources for Asian American/Pacific Islander Communities https://mhanational.org/issues/asian-americanpacific-islander-communities-and-mental-health

Resources for Native and Indigenous Communities https://mhanational.org/issues/native-and-indigenous-communities-and-mental-health

Sources:

U.S. Department of Health and Human Services Office of Minority Health. (2020). Minority Mental Health Awareness Month. Retrieved from https://www.minorityhealth.hhs.gov/omh/content.aspx?ID=9447

Sohn, H. (2017). Racial and Ethnic Disparities in Health Insurance Coverage: Dynamics of Gaining and Losing Coverage over the Life-Course. Popul Res Policy Rev. 2017 Apr; 36(2): 181–201.

Rothman, P. (2016). Diversity in Medicine has Measurable Benefits. Retrieved from https://www.hopkinsmedicine.org/news/articles/diversity-in-medicine-has-measurable-benefits#:~:text=Studies%20show%20that%20students%20trained,by%202.2%20minutes%2C%20on%20average.

Partida, Y. (2007). Language Barriers and the Patient Encounter. American Medical Association. Retrieved from https://journalofethics.ama-assn.org/article/language-barriers-and-patient-encounter/2007-08

American Psychological Association. (2017). Disparities in Mental Health Status and Mental Health Care. Retrieved from https://www.apa.org/advocacy/health-disparities/health-care-reform

Mental Health Today. (2019). Depression or schizophrenia? Black patients are more likely to be misdiagnosed. Retrieved from https://www.mentalhealthtoday.co.uk/news/awareness/depression-or-schizophrenia-black-patients-more-likely-to-be-misdiagnosed#:~:text=Black%20patients%20more%20likely%20to%20be%20misdiagnosed&text=Researchers%20examined%20the%20medical%20records,with%20schizophrenia%20than%20white%20patients.