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. 

We greeted each other bright and early this morning at 7:15 am. Feeling a little bit groggy, we were anxiously awaiting our next 3 days in Durham, getting to explore the expansive field of global health. With Sahib as our leader of the day, we endured a 3 hour drive and arrived in Durham in time for a wonderful lunch on 9th Street. Instead of the usual Panera or Chipotle, we were challenged to try the local cuisine. With that in mind, our 2021 cohort ate a surprisingly delicious lunch at the Mad-hatter Cafe. With full stomachs, our group set off to the Duke Global Health Institute where we were welcomed by Dr. Clements, the director of undergraduate global health studies and medical school programs, as well as a professor in many different subjects. He was assisted by Ms. Erin Degerman and Ms. Lysa Mackeen, who were both crucial factors in creating an awesome day for us. We began with a briefing on global health challenges, as well as small group discussions about the factors and issues of diabetes, heart disease, obesity, and respiratory diseases. We were all given character to play of all different ages and ethnicities, challenged to provide a unique perspective to each disease. Following this simulation, we were given characters within our own context of Norfolk, VA and were given a scenario of a major influenza epidemic, tasked with being able to communicate a feasible plan to the public. Our characters soon sorted into groups based on job similarities, such as government, medicine, and education, and we began a heated debate filled with lots of loud people and wild ideas.

Eventually, the mayor of Norfolk, played by Ells, was able to communicate our plan appropriately to the rest of the city. We ended up learning a lot about real life situations and leadership skills that adults today are still challenged with. I really loved being able to figure out our own solution in a situation where we didn’t know the end result, and I think it was very beneficial to everyone to see how people actually deal with crisis. After thanking and saying goodbye to the wonderful individuals responsible for our day at Duke  Global Health Institute, we left, checked into our hotel, and headed out for dinner. Of course, we all stuffed ourselves full of ice cream for dessert, and convened in Mrs. Goodson’s room for our daily reflection. Sahib led us in our regular roses and thorns, and then we split up to work on our case study competition that will be taking place throughout the retreat. After about an hour of preparation, we enjoyed quality time together before heading to bed for another early morning, beginning the second day of our 2019 GHF adventure!

As July comes to a close and August sneaks around the corner to surprise us, the fellows commenced their annual retreat when the ‘20s and ‘22s gathered in the gloomy, windowless room called Lyons at 8:30 in the morning and filled it with smiles and enthusiasm for the upcoming week. Dunkin donut holes and coffee fueled us through our tradition of the beach ball ice breaker where everyone got two chances to toss the beach ball covered with fun questions made by former fellow Gabi Diskin. Many interesting responses later, Sahib and I split the whole group in half and lead a discussion geared toward the ‘22s to help them get a sense for the vast field of Global Health as well as how it ties in with the work that we do in Belize. This activity was done in hopes of defining the term “global health” for themselves before we explained key global health concepts and terms in a presentation. However, before the long period of lecture, Mrs. Goodson asked the ‘22s to write a candid letter to themselves about their experience in Belize which is a longstanding tradition in this program. After the seniors and I had readied the powerpoint and the sophomores had handed in their letters, the long presentation began. To quote Mrs. Goodson, the process was best described as “taking a sip from a fire hydrant”. We began giving the youngest fellows much information to be absorbed, such as the difference between communicable and non-communicable diseases, important health determinants, and the global health trends of today. And because that wasn’t enough to take in already, we dived into an explanation of the six elements of success that we use to help guide our analysis of case studies. ‘22s, I promise that everything we presented to you today will sink in and soon enough, you’ll be spouting the terms you learned today as if it should be in anyone’s regular vocabulary. 

After a short break where we restocked on energy through donuts and Oreos, I lead the second ice breaker of the day. The rules are a bit complicated so I’ll save you the confusion of trying to figure them out. However I will say I named it the Animal Name Game. Following this was a reading and discussion of a case study about HIV/AIDS prevention in Thailand lead by Laura. We broke out into small groups to read over the case and pick out the six elements of success in the outside air first before convening back in Lyons and holding a discussion about the important takeaways from this case. The ‘22s stepped up to offer their interesting insights and the ‘20s naturally steered the course of the conversation with. Soon after, Sahib and Connor stepped out to grab our Chick fil a lunch of the day. As the rest of us waited, we reflected on why we were Global Health fellows and our journey with the program so far. Each of us, even the ‘22s, presented our small pitches of reflection to the group in hopes of making sure everyone had an idea of what to say in the event that they were asked by a stranger. Next was lunch. The usual fun atmosphere migrated with us to the Oliver lounge as we ate chicken nuggets and welcomed the ‘21s who trickled in at 12:30. 

A pause in narration: Sahib just relayed to me that my blog was quite lengthy so from now on I’ll try my best to leave out the details and cover the important activities of the day. 

After lunch, Sahib lead a Random Fact guessing game. We learned that Anaiya has never broken a bone, Avery knows all of the US presidents by heart, and Sahib, the vegetarian may I remind you, likes the taste of pepperoni. Once the laughs had died down, the seniors and I held a formal debrief of this year’s trip to Belize. Every leader of each project had the chance to speak up about stressors and successes that they met on the ground and how they plan on moving forward. A seed of brainstorming was planted in all of us and this school year will serve as a tweaking time for our projects. Next was the book discussion for our summer reading book, Mountains Beyond Mountains by Tracy Kidder. The seniors all came up with thought provoking questions prior to this day and the ‘21s and ‘22s split into groups and rotated through discussions with each senior. Personally, as the discusser, it was intriguing to see how responses would differ between groups. As a big fan of ethical questions, I posed many during my ten minutes with each group and the contrasting opinions shocked me. I guess that only proves how different we are from one another. 

And the final event of the day was planning for the upcoming week. We were handed the case which we are using for the case competition and were informed of the simulation we would be put through tomorrow by the Duke Global Health Institute. We were all given a role which I know all of us are excited to play in a mock pandemic. Once the housekeeping things were taken care of, we all headed home to pack, read the case, or research our role. I’m sure I speak for everyone when I say that I am looking forward to spending my week with 17 other passionate students and 3 dedicated teachers.

After spending a day of lasts on Friday, Abby, Julia and I woke up at 5:15am to watch the sunrise in honor of Julia’s last day travelling internationally with the Global Health Fellows Program. Despite being cloudy, the sky turned a bit orange and served as a breathtaking backdrop to the Belizean mountains. Inside, we packed our bags and soaked in our last moments with Chelsea, our home-stay little sister, Ms. Dorita our home-stay mom, and Sasha (who we like to call our GPSA sister). When the van arrived, our unconventional family parted ways with promises to keep in touch. Looking back on our time spent together over this trip, I now realize how lucky the three of us were to have shared so many laughs and made friendships that will serve as well during the rest of our time in the Global Health Fellows Program.

On our long van ride to the airport, a few of us played a game called “contact” which is basically trying to guess the word a person is thinking of. Ells stumped all of use with the word “angiophobia”. When we arrived at the airport, we were handed our phones and passions and said our final goodbyes to the GPSA staff. Immediately after our reunion with technology, the dynamic of the trip shifted away from what it had been for the past 7 days. We were all getting back into our normal routines. The group cleared security, boarded the plane and watched as the plane flew closer towards the sky and further away from San Antonio. Landing in Charlotte, there was a mad dash towards our next gate, because we had to get through customs, immigration, recheck our bags and get through security in less than an hour with Mr. Hurley leading the way. My group of 4 got to the gate in time for them to hold the doors for the rest of the group. Finally, we were settled in and ready to get home to our families. Bringing back memories that wont easily fade, the Norfolk Academy Global Health Fellows were ready for a great summer and a successful school year after an exciting adventure in San Antonio, Belize. We were greeted by parents and siblings and I know all of use were so happy to see the smiling faces of our loved ones. I went home thinking about everything I have to look forward to with these wonderful people in this program.

Today was a day that was jam-packed with festivals. In the morning, we worked at the community health fair where we gave out our routine vitals such as blood pressure, blood glucose, respiration, pulse, BMI and temperature. We provided the vitals in the waiting area of the community center as people waited to vaccinate and take physicals of their babies. Before people left, we invited them to have their vitals taken free of charge. We also handed out our nutritional pamphlets and exercise pamphlets that groups made to encourage healthy living. Many of the attendees were pleased that the pamphlets were written in Spanish. Since many mothers were spending their time waiting, we also took the opportunity to conduct our needs assessment with those who were willing. The new data from San Antonio should compliment our data from the surrounding rural communities. We also brought our health services to a group of people waiting outside the community center.

Overall, I felt like people were very apt to having their vitals taken. A particular man asked me what his blood glucose number meant, as I explained to him that his reading was normal. And, for the kids we had a station with crayons and health related coloring books (i.e. nutrition and dental hygiene) to keep them busy. The next big festival was the cultural day at the United Pentecostal School where students, dressed as different cultures performed. Some were dressed in the white creole clothing, the white and red dresses of the mestizos or the flower patterns of the Mayans. The gathering was a time for us to enjoy the community and play with all the kids that we have taught for the past two weeks. Our goodbyes to the kids were filled with high fives and hugs.

After lunch, we went to the San Antonio Women’s Co-op for an afternoon of reflection of our experiences over the week. Andrea asked us to reflect on our expectations, assumptions, and future plans for our interventions. She also asked us to draw a picture of our most memorable or impact moment from the week.

To close our reflections, we spent a fun filled hour at the school with some water balloon fights. We became so soaked that this was the first time that I felt remotely cold. We finished the day with a final feast at Mrs. Antonia’s house. We spent dinner full of laughs and reflection as our Belizean adventure came to a close.