Matt Hodges ’19 — I spent this summer working at a Little Flower Clinic, a homeless clinic in Hazard Kentucky. Hazard is the county seat of Perry County, located in Southeastern Kentucky in the heart of Appalachia. Working in this setting with this population allowed me to experience the immense value of a liberal arts education in rural healthcare, and in healthcare in general. While at Little Flower I prepared health education presentations on type II diabetes and naloxone overdose intervention, engaged in community outreach, and accompanied the clinic’s case manager on her home visits to patients with chronic medical conditions. In all of these situations it felt as though Dr. Gelbman’s Sociology in Healthcare course had suddenly come alive, and seeing so vividly the real-world implications of what I learned in the classroom at Wabash stretched my critical thinking skills and left me exhausted at the end of each day.

The history and economy of Appalachia are both important in understanding its current health profile. For decades the economy of Perry County (and Southeastern Kentucky in general) was entirely dependent upon the coal industry. When the coal industry started to die, so did the economy. Now downtown Hazard resembles something along the lines of a ghost town that happens to have some people in it. Many people who worked in the coal industry lost their jobs and since many coal workers began work before they graduated high school, they don’t have the education necessary to find a new job that pays well. As a result of this, unemployment rates are through the roof and people have a hard time accessing healthcare.

In addition to this, Southeastern Kentucky has a sizeable dose of warranted medical skepticism. This region was the epicenter of the Opioid Crisis that currently raging through the United States (in fact, the heroin outbreak in Scott County Indiana was traced back to Hazard Kentucky). Many of the blue-collar workers in the area either experienced chronic pain as they aged, or required back surgery as a result of years of physically demanding work. Many doctors put their patients on liberally prescribed and poorly supervised painkiller regimens that got the patient hooked on opioids. Soon these high-powered drugs were being prescribed to almost anyone who complained of pain. A few (but not as few as you would like to think) corrupt physicians opened up methadone or suboxone treatment clinics so they could profit from not only getting their patients addicted, but also from weaning them off. This led to a physician distrust that can be felt in the community and many clinics (like Little Flower) are run instead by nurse practitioners, who are generally more trusted within the community.

A lot of the work I did involved health education regarding naloxone overdose reversal and the local Good Samaritan laws that protect individuals who try to help in the event of an opioid overdose. The wound left by opioid over-prescription is still very fresh, and a decent portion of the population still abuses pain pills (fortunately heroin has not hit the area quite as hard as it has hit some parts of Indiana yet). The local health department has also been providing great education in this area, but I discovered that active drug users weren’t likely to attend these events, but active drug users are the most likely to be the first responders to an overdose. So I set out to provide education to this demographic, and made several trips down to the local homeless shelter for that purpose. I unfortunately cannot go into detail on the life stories I heard there and still call this a blog post of reasonable length, but the impact it had on me was immense.

The other part of my experience that was the most eye-opening was accompanying our case manager Helen on her home visits. No matter how good the trust between a healthcare provider and a patient is, there is still a wall that goes up between them in a clinical setting. Visiting a patient at their home tears that wall down. It also gives valuable insight into things that might complicate their treatment plan that would have been entirely unknown otherwise. For example: it is a lot more difficult to eat diabetic-friendly meals if your oven has been broken for eight months. But the broken oven will likely never come up in a yearly checkup. Following Helen around showed me that even if a diagnosis is the same between a group of patients (hypertension, diabetes, alcoholism, etc.), no two patients are alike in their needs and have very unique social and economic situations that impact their medical care.

My liberal arts education at Wabash was instrumental in my perception of the health issues in Appalachia and their underlying causes. However, lessons I learned from the wonderful people at Little Flower could not have been taught in a classroom, and I will be forever grateful to them and to the Wabash GHI for allowing me to spend this summer in Appalachia. The experiences I had will continue to weigh on my mind as I continue along my career path as a health professional.

Ben Grubbs ’20 — Durban, South Africa was an experience like none other. The city rich with history and culture is more than just a typical African city. It is a city not to be fully understood unless immersed into the different lifestyle. While abroad during the month of June, I learned what real struggles were. These real struggles involved not knowing if you were going to have electricity, clean water, or even food for dinner. In a city rampant with HIV, tuberculosis, and poverty, everything in life is quickly put into perspective. Our “first world problems” are suddenly not problems at all, they are actually privileges. Durban is faced with all of these challenges and still manages to thrive off of community and family relationships. Their culture revolves around one another and building those relationships. It is so unique and not one to be found anywhere in the United States.

While culture was a daily learning experience for me, it wasn’t the only thing. My mission while abroad was to learn about the problems associated with HIV/AIDS. With over 60% of adults testing positive for HIV, it is a problem that needs to be handled. Each of the weeks while I was there, I worked in a different hospital/clinic/pharmacy in order to see the problems from all aspects. I was lucky enough to ride along with a hospice company to homes and see the problems faced by millions of Africans first hand. Many patients lived in one room, tin-walled shacks that did not have running water or electricity. They lived with family and were unable to do anything due to cancer, TB, and other common diseases. While working in a pharmacy, I was able to pack and help distribute antiretrovirals (ARV) to those in need. Since ARV’s are free to the public, it is a very busy business. In the hospitals, I saw tuberculosis secondary to HIV which is rarely seen in an American hospital. The challenges they faced daily were not having the correct medicine to treat patients, not having the technology, and also not having the funds to continue to run the hospitals. The first week while I was in South Africa, the last oncologist for public hospitals in the whole province quit, leaving millions of patients out to dry. The wait list to see an oncologist was over six months and that was just a guess on the hospitals part. My whole time abroad, they were unable to hire any more so the oncology field was nearly nonexistent.

My trip to South Africa was truly an eye opening experience that changed my outlook on healthcare and life forever. I learned more than I could imagine that I will take with me for the rest of my life. I hope to translate what I learned abroad to a more local level in Crawfordsville in order to help us achieve the goals in the healthcare field.

Jade Doty ’18 — This past summer was an incredible learning experience that I know will hold many benefits in the years to come. I cannot thank the Wabash Global Health Programs, enFocus, and the St Joseph County Health Department enough for guiding me during my internship in South Bend, Indiana. During my stint as an enFocus intern, I worked closely with the St. Joseph County Health Department in the fight against low food access in South Bend. Additionally I worked with a team of other enFocus interns on a project that consisted of raising funds for a county wide mass CPR training event that will take place in the fall of 2017 and finding the best ways to locate and catalog all Automatic External Defibrillators (AEDs) in the St. Joseph County area.

During my main project with the Health Department, I did a thorough analysis on all the census tracts in South Bend that were labeled as Food Deserts. In short, a food desert consists of an area where there is an abundance of low income residents, limited amount of food resources, and the spacing of residential living and food resources are far apart. I compiled a report of these census tracts which included the number of residents living below the poverty line, the number of SNAP (food stamp) recipients, Health statistics (such as number of residents with type 2 diabetes, high blood pressure, and high cholesterol), and the average cost of providing food for a household in a given census tract. This analysis held many interesting findings that showed that these census tracts were definitely food deserts and how poor health statistics were the results of this problem. The census tracts held a poverty percentage average of 35.6% (the national average is 14%), an average of two SNAP distributors, per census tract, and health statistics that soared above national averages. I hope that these specific findings give the city information that helps identify the problem of low food access in South Bend and helps them see a clearer way to solving this issue.

After this analysis, I conducted focus groups, researched several case studies, and found recommended next steps for the city of South Bend to take on their fight against low food access. One possible next step I found very interesting was providing a special shuttle system that would provide direct transport to several grocery stores for South Bend residents. I compiled all of these findings into a single 40-page report that I delivered to the Robin Vida, the head of the St Joseph County Health Department, and Samuel Milligan at the end of my internship.

My second project garnered some great learning experience because I had to create a business plan with a team of interns. Myself and two other interns were required to find the best practice to catalog AEDs in St. Joseph County. We believed that if we went out into the city and actually did some hard ground work in high dense areas, we would be able to produce results that would identify whether there is a lack, surplus, or moderate amount of AEDs in public spaces. These results were recorded and will be used to show a sample of the number of AEDs in public areas, which will further the county’s plan on whether to pursue cataloging more AEDs or creating a more strict AED policy for other businesses.

I enjoyed my time and learned a lot while working for enFocus and the St Joseph County Health Department. I was fortunate to work for an organization like enFocus, where the company is small enough to see the ins and outs of all their work from the top down, but still make a large impact with various projects in the St Joseph County area. While working with Robin Vida at the St Joseph County Health Department, I gained the perspective of how health departments work and how much they have the potential to benefit the cities and towns they are in. Robin was a tremendous mentor, as well as everyone at enFocus. I strongly suggest that the Wabash Global Health Program continues to keep ties with South Bend, enFocus and the various Health Systems in the St Joseph County area. I was blessed to have such a great learning experience.

Evan Hansen ’19 — Over the past eight weeks I have been working with the IUPUI Fairbanks School of Public Health. Each year the Your Life, Your Story summer camp supports up to 30 low income campers in a program, designed to reduce their risk of poor health outcomes. The 5 day camp took place from June 19-23 and it was one of the most fulfilling weeks of my life. This camp provided teens (ages 12-18) the opportunity to learn problem solving skills and develop their sense of identity and sense of self through creative outlets such as storytelling, music, art, and sports.

It has been a while since I was last at a summer camp, but I quickly felt the same enthusiasm. The three sessions I went to on a daily basis were storytelling, music, and theater. I am certainly not gifted in music or theater but I wanted to show the campers I could learn just like them.  Each camper highlighted their interests on an initial survey, and the professional storyteller was a very popular choice. In addition to the three activities there was a resilience building session led by community leaders. For about two hours each day, the resilience building involved various individual and group activities. As a mentor I was responsible for organizing events, observing the campers, and of course having a great time by participating in the games.

Our staff of ten mentors was comprised from all across the country. Since most of the campers spoke Spanish as well as English, it was very useful to have a couple mentors that were fluent in Spanish. From Colombia, Alabama, Georgia, Indiana, and North Carolina we all shared a similar passion for working in health careers. Some of us have medical school ambitions while others have recently graduated from IUPUI with degrees in public health. The interactions I had with the campers, mentors, and activity leaders affirmed my interest in physical therapy because I was able to witness the importance of serving others. The camp was a very fulfilling opportunity for myself because I was able to practice Spanish in a very active setting.

Throughout this internship I have developed my leadership, teamwork, and communication skills. Since this was the fourth year of the camp, a former mentor trained myself when I arrived back in May. With only a couple days before she was leaving for Swaziland, we had a lot to cover in a short amount of time. Over the next several weeks I attended various public health meetings with Dr. Bigatti and aided her with a couple other projects. Sitting at a desk planning events and training other mentors is all worth it for the incredible fun that awaited at Your Life, Your Story.

Pat Azar ’19 — I have spent the last seven weeks working with the Fountain & Warren County Health Department in Attica, Indiana. This internship has given me great experience in the broad world of public health. One of the main projects I worked on was giving a presentation to the medical staff at the St. Vincent Williamsport Hospital on how to properly fill out the cause-of-death portion of a death certificate. This project really helped me bridge the gap between public health and clinical health as I was tasked with explaining to the medical staff not only the proper way to fill out a death certificate but also why correctly filling them out is crucial for public health. Presenting in front of several physicians was a challenge. I was worried about how I would be received, being a twenty year old undergraduate student presenting to a room of physician who probably had patients waiting on them. They responded well to my presentation. I went through some cases and gave them time to fill out mock cause-of-death certificates and we discussed each case in detail and I explained to them how they should be thinking through each case. My nerves quickly subsided as I was able to facilitate a constructive conversation with the medical staff. Presenting in front of physicians was a success and it really boosted my confidence in my own public speaking abilities.

Working with the public health office showed me the importance of knowing and being involved in your community in the health care world. My post graduate plans include attending medical school and practicing medicine. While working and talking with host Wabash graduate Dr. Sean Sharma and others at the St. Vincent Williamsport Hospital I learned how important being aware of the issues in your community is to practicing good medicine. Luckily, I was able to spend a lot of time in the communities of Fountain and Warren counties. I frequently visited the local parks programs in the cities and towns and along with the nurses would talk to the children about head lice. Also, for the county fairs I made a display on various pest bugs that people may come into contact with during the summer months like mosquitos, ticks, scabies, head lice, and bed bugs, and I talked with people about those issues as they visited our booth at the county fairs. The community interaction was one of my favorite aspects of this internship and public health in general.

I would like to thank the Lilly Endowment for making this opportunity possible. It was an amazing experience and the knowledge and skills I’ve taken away from the past eight weeks will surely help me in my future career.