The second day of August began in the sluggish morning haze when Mariana, Michela, and I made our way downstairs to have some of the hotel breakfast. At 8:15, everyone gathered their things and to head onto the bus, where Roy was waiting outside.

Our first stop of the day was Duke University, where we met with a representative from GPSA, Brittany Ploss. Since we arrived early, we of course had to seize the opportunity to take the classic GHF picture on the steps of the Chapel. It was interesting to hear directly from GPSA, since we work so closely with them. Brittany presented on her life work in part with neurosurgery in Uganda. She gave fascinating statistics: that Duke Hospital has 13 neurosurgeons to serve less than 300 thousand people, while Uganda has just 2 neurosurgeons to serve 39 million people. Mulago Hospital is the only national referral hospital in the entire country. However, while equipped with quality care in the ICU, the four beds are not enough to meet the demand. Patients often have to wait for access to ventilators to receive care, which could mean days or weeks on the waitlist. Beyond surgery, there is little to no acute monitoring of patients due to too much need and not enough nurses. The hospitals Mbarara and Gulu are also equipped to deal with neurosurgery, however, the deal with the same issues as Mulago in addition to nonfunctioning machinery and a lack of biomedical technicians and engineers. Innovation is a crucial component of hospital work in Uganda. For example, without access to bone drills, doctors and nurses working in orthopedics adapted a power drill to function the same way. Brittany’s next steps are to continue to plan for neurosurgery expansion to other sites and work on funding for CT scanners, service contracts, and local infrastructure.

Our next location was the Duke Clinical Research Institute, where we met with Dr. Kevin Watt and Dr. Kanecia Zimmerman . We had an interesting discussion about the meaning of clinical research, which involves the ways medicines work and how different bodies metabolize different drugs. In fact, 25% of all drugs prescribed to children are not approved by the FDA, which suggests there is not sufficient research to determine if they are truly safe for use in pediatrics. The Clinical Research Institute’s job is to appeal to the FDA following research to prove the efficacy and safety of doses. Study, design trials, collaboration, and data analysis are all critical factors of working in this field.

After driving to Orange County, we had a brief half hour window to find and eat lunch. Being a small town, the restaurants were all family owned and sit down. It was a bit of a struggle having to find a fast place, but we eventually settled on a grocery store on Weaver Street. 

Our final stop was the Orange County Health Department. We met with many representatives and discussed the public health system in North Carolina. Dental health, translating across different languages, opioid prescription lock boxes, and risk management were just some of the topics covered. It was interesting to hear about sanitation in public health: Pools turn out to be much more gross than they seem, especially when everyone carries about 0.14 grams of fecal matter with them when they go into the water. 

In the evening, Ells selected Blaze Pizza for dinner. Personally I had vegan dough with mine and it was very enjoyable. We concluded the day with roses and thorns, which is always a good time for laughing and bonding. Afterwards we left to our rooms to continue work on our case study competition for the next day. 

Overall, the days were long but the week was short. I enjoyed spending time with my fellow peers, amazing directors, and learning in depth about such an interesting field. I think my last retreat as a 2020 fellow was a success and I will definitely miss these trips. I’m so grateful for all the opportunities this program has given me, and it’s hard to believe that it’s already the beginning of the end.

Today was jam packed with four incredible sessions across the Durham-Chapel Hill area. After breakfast, we quickly headed over to our first stop: IntraHealth International. The leader of the day, Julia, briefed us all about the mission and work of IntraHealth as an organization focused on addressing the need for health workers around the world. As we started our day, Pape Gaye, the Executive Chief Officer, introduced us to IntraHealth, highlighting that there is an estimated global shortage of 18 million health workers. From there, we dove right into a discussion of HIV/AIDS and its key populations, particularly about the story of an LGBTQ man from Senegal who sought ARV treatment. We also covered IntraHealth’s role in advocacy, especially in Washington. On the national level, they reported that Congress introduced recognition for the global need of health workers. We also learned about their fellowships, which they offer to masters and doctoral students who seek to advocate for health workers in their own ways. Before we left, I had the chance to talk to one of our hostesses about the role of Community Health Workers in Belize, discussing their importance to a fragile and often informal healthcare system.

Our next stop was the Center for Health Promotion and Disease Prevention (UNC). Dr. Alice Ammerman welcomed us warmly and we began a discussion into her work in Nutrition, covering food access, GMOs, food deserts, and innovative solutions to break down the socioeconomic barriers to nutritious foods. Particularly, she talked about the initiative Good Bowls, which makes frozen, pre-made meals at an affordable cost. Dr. Ammerman also took a great interest in our projects in Belize. When we asked for advice about behavioral change, she mentioned an idea known as Behavioral Economics. In the simplest way put, she described it as a slight nudge through consumer incentive rather than simply telling those consumers what they should do. As we think about revising our projects, we plan to consider some of Dr. Ammerman’s advice on behavioral change. 

After lunch on UNC’s famed Franklin street, the Global Health Fellows made their way to the UNC Gillings School of Global Public Health, where we listened to presentations from four Gillings students. Dirk Davis, Director of the LGBTQ Health Disparities Research Collaborative, discussed HIV/AIDS in the context of the LGBTQ community. Specifically, Davis discussed a Guatemalan intervention to combat the hestancies that LGBTQ have when seeking healthcare: a health navigator who connects patients with the healthcare system. It was found that 100% of those who had a navigator received ARV treatment within three months. Next, we heard other presentations that addressed food labeling and taxes against obesity in Chile, research on the Emotional Burden of Type 2 Diabetes, and a career path toward addressing key challenges in clinical quality of care. From these four presentations, I strengthened my knowledge of key Global Health concepts, such as stigma and boundaries, behavioral change, and the poor-resourced setting of care. 

At the final stop of our day, we went back to Durham to an organization called FHI360, a nonprofit seeking to improve health worldwide through a variety of fields such as economics, education, and healthcare solutions. At this point of our day, I can speak for all of us when I say we were tired. But, this visit was perhaps the most engaging we have had. Splitting into focus groups of four, we were visited by five speakers in a “speed dating” sort of fashion. This approach let each group have a meaningful dialogue with each professional. Some ideas that stuck with me from this visit was creative forms of physical, dissolvable contraception, key factors in U.S. health disparities (ie location and income), and the importance of data collection. To conclude our visit, our visit coordinators brought in two students who gave us advice about college and academic pursuits, telling us to keep an open mind to explore topics and to “ always do your lecture readings.” 

Today was the busiest day we have had on this year’s retreat, but it was also my favorite. I learned so much from people who were incredibly passionate and hopeful about their work’s impact on the global community.