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| Interdisciplinary Fellowship Program |
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Past
Fellows of CHCS Program |
 Ethan
Joselow
I came to Rollins School of Public Health's department of Global Health with an intellectually "global" approach to tackling the world's development and public health programs. With my background in domestic health policy, I puzzled over the delivery and systems issues related to nations' public health infrastructures; asking questions related to the equity and efficiency of healthcare resource allocation. This led me to explore how corruption impacted primary healthcare services in resource-poor settings. The question of how demands for a seemingly small bribe would affect the usage, and ultimately the life and death of a poor, struggling individual became central to my thinking on health systems. What does someone who makes a dollar a day do when their doctor asks them for five dollars to give them an injection? My masters thesis took me to south India where I worked with Karnataka state government officials, local NGO leaders, doctors and nurses to survey and interview users of nominally free government health services in rural areas. Visiting remote hospitals and health clinics, I found that the story was more complicated than a simple bribe. Doctors were underpaid, and expectations of care were low. The issue of corruption was only one of many aspects of the state health system I was observing. In my year as a fellow with the Center for Health, Culture and Society, I've been lucky to take these broad and scattered interests and give them the intellectual backing that will go into a better-informed, more rigorous and hopefully useful thesis on health sector corruption. Through the Center's opportunities, I've examined health corruption from many points of view; taking classes in Medical Anthropology, Medical Sociology, the Sociology of Crime and Criminal Behavior, a class on Organizational Theory and Bureaucratic Institutions, as well as a literature review that has allowed me to learn who the experts are on these topics, and what the body of knowledge has to say about them. On top of my own studies, the Center's lectures have been stimulating experiences, where I have learned more about how health and people interact with one another from a number of disciplinary points of view. As someone who is interested in international health policy, I believe that my experience with the Center for Health, Culture, and Society has given me new ways of thinking about some of the issue I hope to be involved with in the coming years. I think that this year's experience will help me to add something substantial to the world's health needs. |
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I applied to the fellowship program with the Center for Health, Culture and Society toward the end of my first year of the MPH program in Global Environmental Health. For me, this fellowship was the ideal opportunity to explore my interest in the evolution of antibiotic resistant pathogens. I approached this year of interdisciplinary study with two goals: attaining a deeper understanding of the two driving forces behind antibiotic resistance, human behavior and bacterial ecology, and gaining some insight into possible interventions. My coursework, therefore, took place in both the Department of Anthropology and the Department of Biology, specifically in the Department of Population Biology, Ecology, and Evolution. My anthropology courses included a seminar in medical anthropology and one in globalization theory, as well as a directed reading in the area of antibiotic use in cattle and the potential for resistance transfer from commensal to pathogenic bacteria in this setting. My courses in biology covered quantitative ecology and biological systems modeling, and gave me a large dose of hands-on mathematical modeling at both the within-host and between-host levels. The anthropological portion of my studies introduced me to a range of brand-new theories and debates; of notable value was my exposure to critiques of patient “compliance” with drug regimens and of ethnographies of the pharmaceutical industry. These topics speak specifically to the individual and macro-level human behaviors that influence antibiotic resistance dynamics. My biology courses, on the other hand, were emphatically quantitative, and it was a particular challenge for me to connect the more complex linear algebra concepts presented by professors to my own questions about bacterial ecology. After one year of attempting to integrate these two seemingly interrelated yet practically disparate areas of study, I have not answered my supposedly straightforward initial question: what is the public health intervention that can successfully stem the spread of antibiotic resistance. Instead, upon realizing the breadth of the endeavor, I have decided that my personal interest lies closer to the role of bacterial evolution on antibiotic resistance than to the complex relationship between human behavior and this important public health outcome. I have also learned useful mathematical skills and computer modeling languages that will enable me to explore the evolution of resistance but can also be applied to many other questions relating to my broader interest in infectious disease dynamics. Finally, I was able to make valuable connections to professors, students, and researchers in the Department of Anthropology and especially the Department of Population Biology, Ecology, and Evolution that may develop into future interdisciplinary collaborations. |
I cannot overstate my appreciation for the fellowship that the Center for Health, Culture and Society (CHCS) provided me to pursue one year of MPH at the Global Health Department (GH) of Rollins School of Public Health (RSPH). This academic year has been very rewarding for my intellectual, professional as well as personal development. I had entered the Women’s Studies doctoral program at Emory in order to understand and apply feminist scholarship and praxis to the field of women’s health. Coming from Nepal where women’s health is constructed and constrained within an overall developmental apparatus, I am developing my dissertation to explore the intersections of gender, development and reproductive health. Because of my interest in women’s health I was already taking classes at RSPH as a part of my Women’s Studies course work and was naturally inclined to apply for the CHCS fellowship. Therefore, I began my fellowship year with lots of excitement. However, for the first few weeks there were some adjustments to make at RSPH where the structure and content of courses were different from that of the Graduate School of Arts and Sciences (GSAS). It took me sometime to be comfortable in big lecture halls with over eighty students compared to smaller groups of GSAS seminars. But soon I saw the importance of larger class room settings where students expressed a variety of ideas and asked questions while distinguished guest speakers shared their experiences in lectures. During this year I also had ample opportunities to work on smaller groups which gave me a sense of team work—this opportunity was lacking in graduate school where each student worked on individual projects. Another highlight of Rollins had been the interaction with a number of international students who came from various parts of the world. True to its name the Global Health department offered me valuable opportunity to learn about global health issues from students and scholars who have worked and lived in Africa, Latin America, and Asia among other places. Although I knew that the CHCS fellowship had been beneficial, I had not realized the expanse of knowledge and skill I had acquired this year until a month ago while I was helping a friend in Nepal. As an assistant professor for community medicine in a hospital in Eastern Nepal, my friend was developing a research/program proposal to promote reproductive health among women in that region. When she wanted my ideas we started brainstorming for this project. It was during those discussions I realized the importance of detailed exposure regarding the planning and implementation of public health programs around the world, which I received at Rollins. Different courses that I took this year have equipped me with skill sets that enable me to plan and design health programs. Methodological courses such as survey methods and qualitative research methods have helped in research design. Furthermore courses such as “Proposal Development”, and “Monitoring and Evaluation” have given me insight in developing and evaluating projects. Additionally, biostatistics and epidemiology courses have provided me with analytical skills as well as knowledge in using certain computer software such as Epi Info. Apart from this skill development courses, I also had ample chances of broadening my knowledge about international health issues. Courses like “International Policy”, “International Strategy” and “International Health Financing Policy and Method” helped me to critically explore global politics and bureaucratic structures that have huge implications on local health policies of a developing country like Nepal. Even as I reflect on my achievements I must also reveal to confronting certain confusions and challenges. Despite the fact that both Women’s Studies and public health are committed towards uplifting women’s status/health in resource-poor settings, they seem to be at odds due to different orientations. For example public health seems to overestimate the structural barriers to the point of neglecting the women’s agency, especially in developing countries. Consequently it often treats women of developing countries as uneducated victims who need to be taught right behaviors to uplift their health status. Public health discipline also tends to favor more top-down approach towards health and development, which often results in aligning with the local elites and perpetuating the status quo. Women’s Studies, on the other hand, tend to overemphasize women’s agency and underestimates the structural barriers that women in developing countries face. Often times, feminists (Western) call for entitlement and rights with the assumption of stable socio-political and economic structures. Unfortunately many women activists in developing countries who are negotiating various structural constraints may not identify with such notions of rights and entitlements. Another point of contestation between public health and Women’s Studies is that like any professional field, public health seeks solutions to the global misery to the extent that many times underlying factors of problems are not adequately analyzed. While Women’s Studies, like any other academic discipline, is bent on problematizing all the issues which can lead to academic cynicism. In this dialectic of agency vs. structure and solutions vs. problem analysis, I feel challenged to find a middle path by bringing both my public health solutions oriented skills and feminist critical thinking to work on the gender and health activism project. Thus, I think that my CHCS experience will have a profound and lasting impact both on my overall development, and I am deeply grateful for this opportunity. |
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I had a specific plan when beginning graduate studies: a plan that integrated anthropology with public health. My undergraduate advisor, the applied anthropologist Erve Chambers, cautioned me about applying to graduate anthropology programs that would look unfavorably at cross training in public health. I applied to Emory’s anthropology department because of its leadership in medical anthropology linked to public health, as in the Center for Health, Culture, and Society. My goal is to balance a strong theoretical orientation in medical anthropology without losing perspective of its practical socio-political, epidemiological, or clinical implications on the ground in terms that practitioners and policy makers find useful. Anthropology and public health are fundamental to my passion for work in social justice and especially the alleviation of suffering. In particular, I am interested in research and practice that focuses on the social origins of disease and suffering. While I am most fond of cultural anthropological perspective, I am acutely aware of both its highly particularistic methodological limitations and its limited ability to persuade policy makers. Furthermore, many anthropologists feel their job is over when they have assessed a situation, leaving praxis to community activists or professionals. Yet, more often than not, no one follows up on the problems identified. On the other hand, even when participating in multi-disciplinary teams, anthropological data is often ignored or devalued in relation to “hard evidence.” When I managed a research study at the University of California San Francisco Center for AIDS Prevention Studies, I learned about the power of statistical models both in explaining a situation and in convincing decision makers of their validity. Statistical analysis allows a description of the situation among a sample to be generalized to a wider population. Furthermore, its brevity and abstraction through numbers gives it a mystical aura, one that the average reader can neither penetrate nor contest for lack of training. Unfortunately, this high level abstraction is often reified. Variation, which should be a focal part of the analysis, is often smoothed over to make a sanitized assertion. The polyvocality and crosscurrents that anthropologists typically idolize are subsumed or dropped from the analysis. Anthropology can be just as mystifying. Participant observation means that the anthropologist becomes an instrument of measurement and analysis. Somehow, all those observations, conversations, and activities coalesce inside the anthropologist, mingling with theories, beliefs, and emotions to produce an ethnography. Factors such as the positionality of the researcher and the serendipity of life events prevent findings from being replicated. Thus, ethnographic accounts are often denigrated as merely “anecdotal evidence” with no generalizability or utility. I strongly believe that critical consumption of both quantitative and qualitative methods can improve both the data that is produced and any interventions that follow from it. My previous work in HIV reminds me how much public health could benefit from an increased infusion of anthropology and community participation. Both anthropology and public health provide analytical tools that can inform social justice action in the form of programmatic and political action. Thus, integration of each other’s respective strengths can only improve our ability to combat the social origins of disease and suffering. |
Kathryn
LaFond 
Prakiti
K.C. 
Dredge
Byung’chu Käng