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Table of Contents . Dearest Juxta Readers,

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Global Health Tidbits

Ali Vedadi, Naushin Ali, and Ravneet Padda

Outside a Zone of Comfort... and into Another:

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Challenges to Maternal Mortality in Ghana Anca matei

Books in Review India Burton


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Somalia: Famine, Terrorism and the “Dangerous Delay” in Humanitarian Relief Margaret Maheandiran

The Giraffe Project and Education in the Slums of Kenya Ailya Jessa, and Sarindi Aryasinghe

Sexual Health Information at Your Fingertips Michelle Chakkalackal

A Global Health Research Guide for Undergraduates Connor Emdin

The Graduate Student Alliance for Global Health (GSAGH): Creating a community for global health leadership

Christopher klinger, Beth rachlis, Sarah Higgins, Chloe McDonald, Nadia Fazal, and Judy Kopelow

Juxtaposition Staff . Editors-in-Chief Kadia Petricca, Maggie Siu Executive Division Editorial Division Administrative Director Jacky Chan Managing Editors Lisa Bauslaugh Administrative Assistant Molly McGillis William Fung Production Editor Michelle Lee Public Relations Jennifer Siu Sponsorship Director Raissa Chua Section Editors India Burton Sponsorship Associates Nymisha Chilukuri Jingwei Chen Meirui Li Athena Hau Publicity Director Sarindi Aryasinghe Louisa Hong Publicity Associates Meirui Li Yunjeong Lee Donald Wang Kathleen Nelligan Strategic Advisor Gretta Moy Jessica Oh Webmaster Andrey Mikhaylov Bing Wang Social Networker Molly McGillis Staff Writers Naushin Ali India Burton Ravneet Padda Ali Vedadi Our Sponsors Trinity College, Post-Graduate Medical Education, New College, Human Biology Department, University of Toronto Students’ Union @juxtamagazine Rm610, 21 Sussex Ave, Toronto, Canada M5S IJ6 Juxtaposition Global Health Magazine


Juxtaposition | Spring 2012

It is hard to believe that we are approaching a decade since the inception of Juxtaposition in 2003. While our group has certainly grown and evolved from our beginnings as an online magazine, our goal continues to be to present and inspire dialogue amongst University of Toronto students and the greater community on complex global health issues. Thus, as we reach this milestone, we are delighted to witness how interest in this field has grown over the years, and how opportunities for student involvement have become much more widespread. This issue focuses largely on the insights gleaned from student experiences and highlights learnings through their reflections of ongoing global health research and projects. As a tribute to our renewed partnership with the University of Toronto’s Department of PostGraduate Medical Education, we commence with a reflection from Dr. Anca Matei, an Obstetrics and Gynecology resident, who details her medical experience in Ghana and uses this story to discuss key challenges currently propagating poor maternal health outcomes within the country. In our feature spread, Ailya Jessa shares her summer working with The Giraffe Project through vivid and powerful photos, while Juxtaposition’s Sarindi Aryasinghe interviews the founders of the charity, Richard and Denise Baines. Together, they paint an eclectic picture of education in the slums of Nairobi, Kenya. Also in this issue, Michelle Chakkalackal, a cofounder of Juxtaposition, returns with a reflection on her current work with Love Matters, a web and mobile site dedicated to providing accessible sexual health information to young people in India. Margaret Maheandiran then reports on the ongoing issues of famine and political instability faced in Somalia, while Connor Emdin ends with a helpful guide for undergraduates hoping to conduct their own global health research. This issue then concludes with an introduction to the Graduate Student Alliance for Global Health, detailing some of their work over this past year. It is our hope that this issue will inspire you to get further involved with and to learn more about the field of global health. Through other student experiences, we hope to help you realize that the opportunities for doing so are limitless. As always, thank you for your continued support. We hope to hear your story soon. Sincerely,

Kadia Petricca Co-founder, Editor-in-Chief, Editorial Division Maggie Siu Editor-in-Chief, Executive Division

Global Health Tidbits

By: Ali Vedadi, Naushin Ali,

and Ravneet Padda

Lingering Cholera in Haiti The immediate casualties of war and natural disasters are usually well known and understood. The 2010 Haitian earthquake, for one, is infamous for causing over 300, 000 deaths. However, the proliferation of communicable disease is often another profound consequence. Post-earthquake assessments of Haiti have indicated a massive Cholera outbreak, affecting over 470,000 individuals. Cholera, an infection caused by the bacterium Vibrio cholerae, results from the consumption of contaminated water and food. As a result, Cholera mostly occurs in developing nations due to the deteriorated sanitation and hygiene conditions. Infected individuals go on to experience watery diarrhea that eventually leads to fatal levels of dehydration. A previous 2006 assessment of risk factors indicated that only 58% of the population in Haiti had access to clean drinking water, with an even smaller percent, 19%, having access to improved sanitation. Further exacerbating the problem is the lack of available treatment options. Treatment options are often simple and can range from drinking oral rehydration salts to receiving intravenous rehydration in cases of severe dehydration. With proper treatment, the risk of death is reduced to less than 1%. However, with a recent reduction in funding and in-country support from several organizations, including the British Red Cross and International Medical Corps, further downsizing of treatment initiatives for Haitians is resulting. With fewer local treatment centers active of December 2011, it remains imperative that strong efforts be made to control the spread of such virulent communicable diseases. Not such a Lonely Planet with 7 billion inhabitants According to the United Nations, the birth of the 7 billionth baby was on October 31st, 2011. While this is only an estimation, it remains a symbolic reminder of our everincreasing population and illuminates a myriad of important questions regarding the growth and sustainability of our planet. As the earth reaches its proverbial saturation point, one is left to question whether our global population is rising uncontrollably? We reached the 1 billionth mark in the 1800s, and managed to reach 6 billion in the last century. Hania Zlotnik of the UN Population Division believes that if it weren’t for the improvement in women’s rights and quality of living, the situation may have been more serious. In fact, on average, women bear half as many children compared to just 50 years ago. Although, birth rates continue to remain high in several developing areas of the world where limited contraceptive measures and education exist. Hence, the promotion of sexual health awareness should not be forgotten as a measure in curbing future growth rates. With a population of 7 billion and counting, we must continue to strive for dignity, safety and equal rights for all.

Above: Digital Illustration of cholera bacteria. From http://topnews. in/health/files/cholerabacteria_0.jpg Below: James Cridland From jamescridland/613445810/

The Birth of a City: Dadaab Refugee Camp Last time I checked a map of Kenya there was no city called Dadaab, but a famine in the horn of Africa has led to the creation of one. Dadaab, originally designed for only 90,000, is the world’s largest refugee camp now home to over 450,000 people. The refugees are mostly Somalians who have been displaced by a relentless drought in southern region of this war-torn country. However, the chronic food insecurity is not only limited to this small region. According to the United Nations, “more than 10 million people are in need of acute assistance in Djibouti, Ethiopia, Kenya, Somalia, and Uganda and the situation is deteriorating (June 2011).” In the Dadaab refugee camp, it is estimated that 1,300 refugees enter daily, most of them malnourished children exhausted from long and strenuous treks. For these refugees their battle does not end once they reach the camp. As a result of overcrowding, most incoming refugees are forced to the outskirts of the camp awaiting a tent and food rations. Regrettably, Dadaab may soon become the second largest city in Kenya, an unforeseeable possibility when the refugee camp was first designed. Spring 2012 | Juxtaposition


Voices of PostGraduate Medical Education

Outside a Zone of Comfort... And Into Another Challenges to Maternal Mortality in Ghana

By: Anca Matei It is the summer of 2010 in Ghana, and I’m in an operating room assisting the surgeon with the fifth Cesarean section of the day. Upon the delivery of a healthy baby, nurses sing and dance, which is definitively the most genuine and appropriate way to celebrate new life. But for many women throughout the country, this celebration of life is often impeded by illness, and in many cases, death for imminent mothers. After my second year of medical school, I had the opportunity to spend a month in a major teaching hospital in Accra, the capital of Ghana. This incredible experience through the International Federation of Medical Students Association (, was my first in the field of Obstetrics and Gynecology, and extremely forming for my future career, as I am now two months shy of residency in this specialty. Worldwide, the move towards improving maternal health has been impressive, particularly in the context of

with most of these deaths attributed to hemorrhage, hypertension, and unsafe pregnancy terminations. Although this rate improved from 731 deaths per 100,000 live births in 1980, it is still high compared to the Canadian MMR of 7/100,000,2 and far from the MDG target of 185/100,000 by 2015. So what are some important factors contributing to such a high maternal mortality rate in Ghana? While the issue is profoundly complex, four main factors have emerged in the literature as key in propagating poor maternal health outcomes. These include high health care costs, limited infrastructure and resources, limited training and staff capacity, and enduring ideologies in support of traditional medicine. Health Care Costs In 2008, maternal health was declared an emergency issue across Ghana, and obstetric care was included in the National Health Insurance Scheme, NHIS, along with publicly funded health services in Ghana. Today, prenatal, perinatal, and postnatal care are

Worldwide, estimates indicate that roughly 342,900 women die during birth (almost 1000/day), and 99% of these occur in developing countries. Millennium Development Goal #5 that aims to reduce maternal mortality by 75% by the target year 2015. Worldwide, estimates indicate that roughly 342,900 women die during birth1 (almost 1000/day), and 99% of these occur in developing countries.2 In Ghana, the maternal mortality rate (MMR) reached 409 per 100,000 live births in 2008;


Juxtaposition | Spring 2012

all covered, as are other emergency obstetric and gynecological cases and cancer treatments for breast and cervical cancer.1 However, many medications remain uncovered, and the NHIS imposes a nominal fee that many are still unable to afford. It is not a perfect system, but data from other medical areas in which public funding was instituted in the early

2000s show that overall mortality and morbidity rates decrease when cost is not a barrier to access.1 Infrastructure There are 124 districts in Ghana grouped into 10 regions and each district hospital has approximately 50-200 beds serving a population of 100,000-200,000 people. Within each region, there is a larger referral hospital; three of these are higher-level teaching hospitals. Among district hospitals, two thirds of major surgical procedures are obstetrical or gynaecological. However, only a minority of these hospitals are able to provide surgical care around the clock – an important obstacle for efficient emergency care in general and obstetric care in particular.3 Efforts have been underway to increase the capacity of regional and high-level hospitals throughout Ghana. For instance, the Korle Bu Teaching hospital in Accra, where I was based, was given a new Labour and Delivery floor that was in stark contrast to previous overcrowded wards, with little to no privacy. The unit was previously hot and humid, and women were at high risk for infection. The new unit, built recently with support from the local telephone company, had private and semi-private rooms and was better maintained. The difference between the two units showed how transitioning to better antiseptic techniques, larger units that can accommodate the high volume of women in labour, and better nurse-to-patient ratios helps improve maternal survival and reduce pregnancy complications. However, the major infrastructure issues remain in remote areas, both in

terms of resources and distance. Close to 50% of the Ghanaian population lives in rural areas,1 and almost half of it lives at or under the poverty level. At the sub-district level, there is little to no access to emergency transportation or public transportation. In addition, sub-district medical centres do not

have been developed, in Accra and in Kumasi, Northern Ghana. Since 2006, a majority of trained OBGYN stayed in the country. Postgraduate medical education was developed with contributions from the government as well as external bodies, and it continues to be highly valued as a sustainable way to reduce

a large portion of MMR, and are the leading cause of maternal death in some rural areas.4 Abortions are legal in Ghana under certain circumstances, but remain a culturally sensitive topic. Social factors remain the leading cause why women seek abortion in this country. Women who are young and unmarried are more likely to seek abortion, be it on their own or due to family pressures.7 Traditional remedies are an intrinsic Four main factors have emerged in the literature as key part of life in Ghana. Countrywide, use in propagating poor maternal health outcomes: of traditional healers is 4%, but in some 1. high health care costs, rural areas it is much more common. People will appeal to traditional African 2. limited infrastructure and resources, medicine, as well as religious healers (in 3. limited training and staff capacity, and Ghana this means either Christian or 4. enduring ideologies in support of traditional medicine. Muslim healers). Pregnancy is a special case. It is seen as an important moment filled with spiritual significance, provide access to surgeries (including MMR. Partnership with North American when women are Caesarean sections). For instance, and European universities are in place as prone to the district hospital in the Kassena- well. I found the medical training at Korle Nankana area of northern Ghana has Bu extremely dynamic. Medical trainees 140 beds serving 142,000 individuals.4 as well as staff are well integrated in a The obstetric and gynecology wards variety of exchange programs. Most of comprise close to a third of the beds, the trainees and staff who participate and the services offered here are the in these programs return home and are only ones available to women living fully committed to advancing patient within 15 km. The MMR in this district care in their home country. is about double the national average, and only a third of the women who need Traditional Remedies a Cesarean section could access it.5 Not The story of a pregnant woman I only is obstetric care hardly accessible in met during an overnight shift in Accra these areas, but it is also hardly sought by sticks to mind. She was in her 24th women. Delivery with a skilled attendant week of pregnancy when she (usually a midwife) is often seen as loss presented with abdominal of social status. This results in high rates pain. The surgeon of prolonged labour and subsequent fetal operated on her and maternal complications, including urgently and removed fetal death and obstetric fistulae. a lifeless baby out of the abdominal Skill Training cavity. The woman’s On average, there are 1.5 physicians uterus had ruptured. per 100,000 Ghanaians.3 Due to this Uterine rupture is shortage, in some district hospitals, a possible but rare none of the physicians are fully trained complication in surgical specialists. Most procedures are Canada. The Ghanaian performed by nurses or midwives. Often physician explained that the only trained physician is a Medical this woman’s risk factor Officer, a medical school graduate with consisted of two previous two years of postgraduate training. This terminations of pregnancy done phenomenon is the result of “brain with traditional remedies. drain” (physician emigration out of Pregnancy terminations are often Ghana), as well as social and economic done without medical care. Women factors. Over two thirds of physicians who do present to the hospital do so left Ghana in the 1990s, and a third in due to complications, such as retained the early 2000s.6 To promote retention products of conception, hemorrhage and of physicians, two residency programs infection. These complications underlie Spring 2012 | Juxtaposition


illness (called sunsumyare). In order to prevent sunsumyare, women will selfadminister specific herbs meant to promote a healthy, uneventful pregnancy. While most women attend at least one prenatal appointment with a medical doctor4, they are still likely to rely on local herbs for health and often choose

resilience. Their ability to carry on References 1. Kpakpah, M. 2010. Statement at the 43 Session of through hardship was amazing to me, the UN Commission on Population and Development and their inner richness, inspiring. Their on the Theme: Health Morbidity, Mortality and Development. New York. wellbeing and survival is important 2. Hogan, M. C., Foreman, K. J., Naghavi, M., Ahn, not only to their children and families, S. Y., Wang, M., Makela, S. M., Lopez, A. D., Murra, J. L., and Lozano, R. 2010. Maternal Mortality for but to their communities and society C. 181 Countries, 1980-2008: A Systematic Analysis of Towards Millenium Development Goal 5. The at large. I met women, young and old, Progress Lancet 375(9726): 1609:1623. from tailors to physicians, who show 3. Abdullah, F., Choo, S., Hesse, A.A.J., Abantanga, F., rd

In my travels I was amazed by Ghanaian women’s hard work and resilience. Their ability to carry through hardship is amazing to me, and their inner richness inspiring. to deliver at home. This choice can be based on personal beliefs, and perception that modern medicine is not culturally sensitive. And in many cases, women do not have a choice if traditional practices are the only ones available to them in remote villages. The challenge is to create a system in which women have access to free, geographically close, and culturally-competent obstetric and gynecologic care. Throughout my travels, I was amazed by Ghanaian women’s hard work and

Books in Review

incredible dedication to their families and communities. The only way they could do that is by first being healthy, carrying healthy pregnancies to term, and delivering healthy babies safely. And in my view, one key way to help them accomplish these goals is by expanding and strengthening the current efforts to improve medical care, residency training in OBGYN, and the population’s knowledge of modern medical treatment.

Sory, E., Osen, H., Ng, J., McCord, C.W., Cherian, M., Fleischer-Djoleto, C., and Perry, H. 2011. Assessment of Surgical and Obstetrical Care at 10 District Hospitals in Ghana Using On-Site Interviews. Journal of Surgical Research 171: 461:466 4. Baiden, F., Amponsa-Achiano, K., Oduro, A.R., Mensah, T.A., Baiden, R., Hodgson, A. 2006. Unmet Need for Essential Obstetric Services in a Rural District in Northern Ghana: Complications of Unsafe Abortions Remain a Major Cause of Mortality. Journal of the Royal Institute of Public Health 120: 421-426. 5. Bazzano, A.N., Kirkwood, B., Tawiah-Agyemang, C., Owusu--Agyemang, C., and Adongo, P. 2008. Social costs of skilled attendance at birth in rural Ghana. International Journal of Gynecology and Obstetrics 102(1): 91:94. 6. Clinton, Y., Anderson, F.W., Kwawukume, E.Y. 2010. Factors Related to Retention of Postgraduate Trainees in Obstetrics-Gynecology at the Korle-Bu Teaching Hospital in Ghana. Academic Medicine 85(10): 1564:1570. 7. Aniteye, P., and Mayhew, S. 2011. Attitudes and Experiences of Women Admitted to Hospital with Abortion Complications in Ghana. African Journal of Reproductive Health 15(1): 47:56w

By: India Burton

Half The Sky

Mountains Beyond Mountains

Half The Sky is a best-selling book written by Pulitzer Prizewinning journalists, and married couple, Nicholas D. Kristof and Sheryl WuDunn. Inspired by the Chinese proverb, “women hold up half the sky,” the book focuses on three primary abuses against women – maternal mortality, sex trafficking and violence based on gender – while offering plausible solutions to these problems; all of which centre around women’s empowerment. Hailed by Khaled Hosseini (author of The Kite-Runner) as being, “an unblinking look at one of the most seminal moral challenges of our time…at once a savage indictment of gender inequality in the developing world and an inspiring testament to these women’s courage, resilience, and their struggle for hope and recovery,” Half The Sky is a practical and earnest call to arms, urging readers to do their part in promoting gender equality as a means to reduce poverty and suffering worldwide.

Described as being, “inspiring, disturbing, daring and completely absorbing” by Abraham Verghese of The New York Times Book Review, Mountains Beyond Mountains is a biography of Dr. Paul Farmer, a medical practitioner and anthropologist written by Pulitzer Prize-winning author and fellow Harvard graduate Tracy Kidder. Detailing Dr. Farmer’s life and work through a series of anecdotes, Kidder traces the continued efforts of the aptly named “good doctor” to improve the health of the poor and marginalized. From fighting to curb the spread of infectious diseases in Peru and Haiti to the co-establishment of Partners in Health, an NGO which (in its own words) aims to, “bring the benefits of modern medicine to those most in need and work[s] to alleviate the crushing economic and social burdens of poverty that exacerbate disease,” Dr. Farmer’s extraordinary body of work is expertly showcased in Mountains Beyond Mountains, an informative read for anyone with an interest in the complex relationship between global health, poverty and social justice. For more information on Partners in Health (PIH), visit

Nicholas D. Kristof and Sheryl WuDunn Vintage Books (a division of Random House Inc.), 2009


Juxtaposition | Spring 2012

Tracy Kidder Random House, 2003

Somalia: Famine, Terrorism and the “Dangerous Delay” in Humanitarian Relief By: Margaret Maheandiran Introduction In 2011, East Africa faced the worst drought in 60 years and by July 20, 2011, the United Nations (UN) had declared a state of famine in Somalia. Since this By declaration, a surge of aid has been September amassed, with 75% of the $1.5 billion 2011, six Somali largely collected immediately after the regions were announcement. Consequently, the UN confirmed downgraded the condition in Somalia famine zones. to “emergency”. However, the radical Islamist organization, Al-Shabab, has been a barrier to the distribution of aid in southern Somalia, one of the worst hit regions of the country. Furthermore, thousands of deaths could have been avoided if prior warnings of increasing malnourishment from both Oxfam and Save the Children had been time, nearly heeded. The current situation in Somalia half the Somali remains precarious as refugee camps are population faced a overcrowded and 2.3 million people are humanitarian crisis still in need of assistance. This article and the International explores the consequences of famine Committee of the Red Cross and political instability in shaping the (ICRC) reported that around lives of and opportunities for Somalis 20% of Somalis were suffering at this critical time. from acute malnutrition.5 This spurred huge migration shifts as more than Worst Drought in Sixty Years 293,000 Somali refugees fled conflict Last year, the drought in East Africa and famine into neighbouring countries affected 11 million people across the of Kenya, Ethiopia, Djibouti and Yemen region.1 Prices of cereals such as maize from January 2011 to February 2012.1,6,7 and sorghum soared up to 150 and 200% Many others entered Somalia’s already higher, respectively, than in July 2010.2 overcrowded and violent capital, Livestock production also decreased Mogadishu. as a result of higher mortality rates, By September 2011, six Somali regions with 5 to 10% of the cattle perishing.3 were confirmed famine zones.9 Around In Somalia, 90% of agriculture is four million people were in crisis with dependent on its lush rainy season and 750,000 of them at risk of dying within current climatic droughts have yielded four months if aid was not received.10 The devastating consequences to livelihood “Food Security and Nutrition Analysis and food production.3 By July 2011, the Unit” (FSNAU) declared it the most UN announced a state of “famine” in two severe food insecurity situation in the regions in southern Somalia: southern world today.11 Bakool and Lower Shabelle.4 At this Aid officials have struggled to keep up

with the massive influx and some refugees have been forced to wait two to three days for assistance. The CARE-operated Dabaab refugee camps, the world’s biggest refugee camp, in Kenya was built to house 90,000, but was trying to accommodate almost 400,000 people. In spite of the overcrowding, an additional camp, I of 11, has remained empty and unused;1 possibly due to the Kenyan government’s apprehension over hosting more Somali refugees, thus placing a further burden on its country’s resources.12 However, ongoing issues of famine and malnutrition enveloping Somalia are not simply a result of natural factors such as drought, and cannot be viewed in isolation. The political instability that has plagued the nation for over twenty years is also a contributing factor and has resulted in Somalia being described as one of the most failed states of our time.

The current situation in Somalia remains precarious as refugee camps are overcrowded and 2.3 million people are still in need of assistance. Political Instability and Conflict The current problems in Somalia and delays in recovering from the ongoing famine have been directly tied to and influenced by over twenty years of political and social instability Spring 2012 | Juxtaposition


since the overthrowing of President Mohamed Siad Barre and the collapse of the central government in 1991.13 Since then, a struggle between clan warlords has resulted in the killing and wounding of thousands of civilians. While the UN provided troops for peacekeeping measures and aid delivery in the early 1990s, the mission was dealt a severe blow by the death of US rangers in the

In Somalia, 90% of agriculture is dependent on its lush rainy season and current climatic droughts have yielded devastating consequences to livelihood and food production. famous “Black Hawk Down” incident.14 Also known as the “Battle of Mogadishu”, it was a raid by the US in the effort to capture Somali warlords. Consequently, the international community withdrew from Somalia, leaving the nation to fend for itself. In 2006, Islamists gained control of the South, ending the 15-year rule of the warlords.15 By 2009, Al-Shabab, a terrorist Islamist group meaning “youth” in Arabic, had established itself as the most powerful group in southern Somalia.16 In the same year, a moderate Islamist, Sheikh Sharif Sheikh Ahmed, was elected as President of the central government of Somalia. However, this UN-backed government has no control outside a few areas of the country, including Mogadishu.17 The effect of the ban by AlShabab The UN declaration of a famine in Somalia caused a surge in foreign aid, with aid organizations receiving $1.57 billion US. Yet, only $70 million (4% of the total amount received) has yet been utilized.18 Al-Shabab may be a major obstruction to the distribution of aid to crucial areas. It has heavily banned several international aid agencies from operating within its territory. Late last year, Al-Shabab ordered UNICEF, the World Health Organization (WHO) and the Danish Refugee Council, among others, to leave. The WHO


Juxtaposition | Spring 2012

supports eight hospitals and 16 mobile clinics that cater to tens of thousands of people in the affected regions.19 The ban “can undermine the fragile progress made this year, and could bring back famine conditions in several areas,” said Pieter Desloovere, the WHO’s Communications and Donor Relations Officer in Somalia.20 Recently, the ICRC was included in the banned group due to accusations that they were distributing unfit food and hindering food distribution by the mujahideen (Al-Shabab fighters).21 The UN’s World Food Programme (WFP) says it withdrew from Al-Shababcontrolled areas of southern Somalia at the beginning of 2010 because of threats to the lives of UN staff and the imposition of unacceptable operating conditions, including informal taxes and a demand that no female staff work there.22 In addition, the presence of this group has resulted in the incursion of Kenyan and Ethopian troops seeking to protect their borders from what they see as an Islamist threat, heightening the level of conflict in this area and putting civilians at further risk and impeding aid.23 In addition, events such as the kidnapping of two Medicins Sans Frontiers (MSF) workers have made aid agencies wary of entering these areas.24 In these times of desperation, refugee camps such as Ala-Yashir have become fertile recruiting grounds for radical organizations such as Al-Shabab and AlQuaeda. Recent provision of aid to the Somalis in these camps from Al-Quaeda

Photo: New York Times, Ben Curtis / Associated Press

may increase popular support for this organization.25 Al-Shabab is alienating itself and southern Somalia from the foreign community by banning aid from several large international agencies. According to Somali analyst, Rashid Abdi, the ban further exacerbates the perception amongst Somalis that Western agencies may “side with particular political groups or clans, and bankroll warlords”, such as the UN’s funding of current president Sheikh Sharif Sheikh Ahmed.26 “The Dangerous Delay” of Aid Since the famine of 1984, “famine early warning systems network” had been organized by the US Agency for International Development (USAID)27 to monitor food security based on several parameters such as climate change and food prices28 and to therefore prevent unnecessary human casualties. In early 2011, the UN and other humanitarian agencies warned the international community of the imminent famine with reports that one in three children in Somalia were malnourished. Despite the warning, both Oxfam and Save the Children say it took more than six months for the international community to respond.29 Although the declaration of famine inspired a surge of aid (75% of the $1.57 billion in aid that was ultimately collected was received immediately after the announcement), an earlier declaration could have mitigated some of the harm. In a report titled the “Dangerous Delay”, Save the Children claims that the scale

of death and suffering and the financial Though droughts often occur cost could have been reduced if early annually, famine is an extreme warning systems had triggered an earlier, situation that can be avoided. more substantial response.30 Implementing measures such as more robust warning systems “We can no longer and earlier intervention can help prevent increases in the number of allow this grotesque refugees and unnecessary human situation to continue; casualties. As of January 2012, the where the world knows population in Dabaab has reached an emergency is coming 470,000. 13 The absence of a strong central government capable of but ignores it until meeting these responsibilities confronted with TV compounded by the ongoing pictures of desperately insuragnt forces places a greater malnourished children.” pressure on the global community to work with local communities Chief Executive of Save the Children, and humanitarian aid agencies to Justin Forsyth, said that clear warnings ensure that an effective sustainable had been ignored. “We can no longer solution for the Somalis affected allow this grotesque situation to by this crisis. continue; where the world knows an emergency is coming but ignores it References until confronted with TV pictures of 1. Ford, Elise. East Africa Food Crisis; Poor Photo: Rebecca Blackwell / Associated Press Photos desperately malnourished children.”29 Though droughts occur in the region Rains Poor Response. 978-1-84814-917-5 Vol. 17. “Famine Conditions in Somalia have ended UN Say.” BBC News Africa. 13/February/2012 2012.Web. every few years, it has been 20 years Oxford: Oxfam Great Britain, 2011. Print at page 1. <> 2. Global Food Price Monitor. Rome: FAO Worldwide, since the UN has announced a famine 2011. Print. 18. Office for the Coordination of Humanitarian Affairs. Humanitarian Funding Analysis for Somalia. New York, in Somalia. 3. “Somalia: displaced persons and residents are strugNY: OCHA, 2011. Print. gling with a severe drought.” International Committee During this period, only a few of the Red Cross, 2011.Web. < 19. Muhumed, A. “Somalia: Al Shabab Aid Ban Will Bring Disaster, Groups Warn.” Huffington Post 29/11 humanitarian emergencies have resources/documents/interview/2011/somalia-interview2011-02-10.htm>. 2011Print. qualified, including in Sudan in 1998, 4. Tran. Michael. “UN Declares Famine in Somalia.” 20. The Associated Press. “Banned agencies warn disaster in Somalia.” 11/29/2011.Web. < Ethiopia in 2001 and Niger in 2005.14 The Guardian UK Print. 07-20-2011 2011. CTVNews/World/20111129/aid-agencies-warn-disaster5. “Somalia: more life-saving feeding programmes The UN’s apprehension in declaring a launched”, International Committee of the Red Cross, somalia-111129/>. Web. < “Al-Shabab Bans Red Cross from Somalia “ Al“famine” and delay in aid has three main 2011. ments/news-release/2011/somalia-news-2011-08-24. Jazeera Print. 01/30/2012 2012. htm> drivers: (i) a fear of “calling it wrong”, 22. Drought and Conflict are Threatening Lives in “Farming prospects prompt some refugees to head Southern Somalia and Forcing Refugees to Stream (ii) a fear of premature intervention 6. back to Somalia temporarily”, The UN Refugee Agency, Across the Border into Ethiopia and Kenya. The World 2011. Web. <>. and undermining the nation’s own Food Programme, 2011. Print. Mahecic, Andrej. Fourth Camp for Somalis Open in 23. Gettleman, J. “U.N. Says Somalia Famine has coping mechanisms and (iii) a sense 7. Ethiopia, Arrivals to Dabaab Increase. Geneva, Switzer- Ended, but Warns that Crisis Isn’t Over.” The New York land: The UN Refugee Agency, 2011. Print. of “resignation” to droughts in the Times Print. 02/03/2012 2012. 8. “Dabaab Refugee Camps.” CARE, Web. <http://www. 24. Kidnapping Ongoing, New Non-Emergency Projects region.31>. on Hold. Montreal, Quebec: Médecins Sans Frontières, Significant augmentation of 9. Tran, Michael. “UN Declares Sixth Famine Zone.” 2012. Print. 25. Getz, L. Hearts and Minds: Al-Qaeda’s Visit to humanitarian aid in September 2011 has The Guardian UK. Print. 09/05/2011 2011. Somalia. New York, NY: American Security Project, 10. Drought in the Horn of Africa: Preventing the Next resulted in a downgrade in the situation Disaster. Geneva, Switzerland: International Federation 2011. Print. Stephanie Hanson, “Al Shabaab.” Council on Forin Somalia from ‘famine’ to ‘emergency’. of Red Cross and Red Crescent Societies, 2011. Print. 26. eign Relations. Web. 2011. < 11. The Food Security and Nutrition Analysis Unit. Yet, with 2.34 million Somalis still in need Famine Thresholds Surpassed in Three New Areas of al-shabaab/p18650> Somalia. Washington, D.C.: Famine Early 27. USAID. “What is FEWS NET?” 2012.Web. <http:// of assistance, this may be temporary. The Southern Warning System Network, 2011. Print.>. refugee camps in neighbouring Kenya 12. Kenya: Provide Land for New Refugee Camps. Nai- 28. Verdin, J., et al. “Climate Science and Famine Kenya. Human Rights Watch News. 2011. Web. Early Warning.” Philosophical Transactions of the and Ethiopia, and in Somalia itself are robi, < Society B: Biological Sciences 360.1463 (2005): land-new-refugee-camps > overcrowded. Even the onset of rain 2155–2168. Print. Kirui, Peter, and John Mwaruvie. “The Dilemma of 29. Tisdall, S. “East Africa’s Drought: The Avoidable brings with it concerns of typhoid 13. Hosting Refugees: A Focus on the Insecurity in NorthDisaster.” The Guardian UK, Print. 01/18/2012 2012. Eastern Kenya.” International Journal of Business and and cholera in the camps. According to 30. Lynch, ������������������������������������������������ C. “Oxfam Report Blames U.N. for Slow ReSocial Science 3.8 (2012): 161-71. Print. to Somalia Famine “ Foreign Policy 01/18/2012 Mark Bowden, the UN’s humanitarian 14. Bridger, J. “Kenyan Troops go where Others Fear to sponse 2012. Print. co-ordinator for Somalia, in southern Tread.” In Focus Transatlantic News Digest October 21 31. Slim, H. “Why East Africa’s Famine Warning was 2011: 5-8. Print. Not Heeded.” The Guardian UK, Print. 01/18/2012 Somalia alone, some 1.7 million remained 15. Somalia Profile.” BBC News Africa. 10/ 2012. 32 February/2012 2012.Web. < “in crisis.” Without sustained support, 32. “Famine Conditions in Somalia have Ended, UN world-africa-14094503> it seems that any fragile gains made can 16. Shinn, D. Al Shabaab’s Foreign Threat to Somalia. Says.” BBC NewsPrint. 02/03/2012 2012. Washington, D.C.: Foreign Policy Research Institute, soon be reversed. 2011. Print.

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Feature: Photo Essay

The Giraffe Project and Education in the slums of Kenya By: Ailya Jessa

I got involved with the Giraffe Project about 4 years ago through Mr. Baines (one of the founders) who was my high school science teacher at that time. I started by holding several school fundraisers and organizing a team of students to run the Brussels 20k to raise money for the Giraffe Project. When the opportunity came up to go to Kenya to work with the Giraffe Project medical team, I jumped on the opportunity and I am so glad that I did. Going to Kenya this past summer was one of the greatest experiences of my life.

1. (Left) “Tumaini” means hope and after spending my summer doing medical checks and playing with these children, I can tell you that there is no better word to describe the light that illuminates from their smiling faces. Correspondence by: Sarindi Aryasinghe Introduction Founded in 2005 by Richard and Denise Baines, teachers in International schools and colleges in Belgium, the Giraffe Project is a UK registered charity providing educational opportunities for children and young people from extremely deprived areas of Nairobi. It works closely with 3 schools in and around the slums, and also provides support for teenagers to complete their studies in boarding schools outside of Kenya. Graduates from secondary schools are sometimes offered places in vocational training colleges. All the schools are managed and run by local Kenyan. The charity has grown steadily since its inception in 2005. Juxtaposition was able to interview Richard and Denise Baines regarding their work in improving education in the slums of Kenya and the particular challenges faced by the children in attaining quality education. They were also able to provide insight into the inner workings of the Giraffe Project and creating sustainable change in the povertystricken slums.

2. (Right) We started off our trip in the Mathare slum where Tumaini and Neema schools are located. As we entered, we were greeted by smiling children who were waving furiously and calls of “Mzungu, mzungu” (which means white people) could be heard all around.

Why did you decide to focus The Giraffe Project on education, particularly in the slums of Nairobi?

BOTH: We are both educators – we have taught in international schools and universities for 25 years, and felt we had some expertise to offer. We also believe very strongly that education is the key to development. Without it people go on believing what the media tells them or what the village elders tell them or their grandmother has always believed, and in basic areas like health, hygiene, sexuality and so on we encounter a lot of ignorance. Politics is affected by tribal loyalties and family loyalties because people don’t have the education and haven’t been taught to think more widely, and this gives opportunity for exploitation and corruption. Also climate change and a fast growing population mean that Kenyans will have to begin to use modern sustainable farming methods and learn new techniques. The present drought, only one of several in the last few years, has led to food shortages, price rises and hunger, yet there are techniques that could be employed that would avoid a lot of this. How is the education system structured in Kenya?

BOTH: The school year in Kenya begins in January and


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ends at the end of November. Children enter the first year of primary school (Standard 1) at age 6. The language of instruction is mainly English, which is the children’s second or third language, and classes are also given in Kiswahili, the other official language in Kenya. There are 8 years of primary education; Standard 1 to Standard 8, at the end of which the children take exams in order to gain their KCPE, or Kenyan Certificate of Primary Education, marked out of 500. Their KCPE grades will determine which secondary school they can get into, with the best schools requiring the highest grades (over 400/500). Four years of secondary education culminate in exams in 7 or 8 subjects for the KCSE, or Kenyan Certificate of Secondary Education. Passes in an appropriate range of subjects enable a student to continue for a further 1-4 years in a college of higher education. Those achieving A grades in the KCSE can proceed to university. In 2003, Kenya’s president declared free primary education for all 1.6 million additional children enrolled

in schools, resulting in serious overcrowding, often with 80 - 120 children in a classroom with 1 teacher. In Nairobi’s slums, vast numbers of children do not attend school. This is primarily because the slums are “informal settlements” which means they are not officially recognised and enjoy no government services whatsoever. Kibera, the largest slum with at least a million inhabitants, is served by just 5 vastly over-crowded primary schools on its outskirts. This leaves the burden of education to private initiatives, which get no funding. In reality, even government schooling is not completely free. Parents may have to provide a uniform, text books, a desk, and basic supplies. What are your thoughts on the quality of education that is currently offered in Kenya?

BOTH: It is highly traditional, based on a lot of rote learning and much of it resembles the British system of the 1950’s. It is underfunded, so classes are usually large and materials few. There is little application of modern

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3. During our trip, we visited the Mathare valley which is one of the worst areas of the Mathare slum. Many of the students who attend Tumaini and the Neema School live here. There is a stream that runs through the houses. As our tour guide explained, this is a multi-use stream. This stream is the shower, the laundry machine, the source of water and unfortunately also the toilet.

pedagogical methods, in spite of the fact that some educators attend teacher training colleges, but classes of 50 in secondary and around 80-100 in primary make it impossible to implement. Individual attention is virtually impossible. A student who goes all the way through a good school and university, and is very bright, probably gets a reasonable education, but most people don’t. We have noticed that the level of English amongst primary teachers is generally poor and general knowledge is lacking also. That is not to say the teachers don’t care – they are just overwhelmed with


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numbers and have limited training themselves. What are some of the obstacles facing the children that prevent them from attending school in the slums?

BOTH: Money. Usually, there are costs even in a government school, which is technically free, but it’s not really free. You have to buy your own books, food and often provide a desk and uniform, and numerous extra costs. Some children have to work to get food to eat. Others are required to look after younger siblings, or work to help

4. We were also given the opportunity to visit the house of a patient with AIDs. The mother of the children had passed away from AIDs and the father was raising 4 children on his own, 2 of whom had HIV. Their house was a tiny little shack made of metal sheets and they slept on the floor, yet when we entered the house, we were greeted by smiles and the father thanked us for coming and for all of the work that we had done. After seeing this manâ&#x20AC;&#x2122;s optimist and gratitude I felt like I had lost the right to ever complain again.

invalid parents, or they are orphans living with relatives who donâ&#x20AC;&#x2122;t want to keep them. What are the living conditions like in the slums?

BOTH: Living conditions in the slums are extremely basic. Families of 8 or 10 live in crowded one-roomed homes made of mud, wood, and cardboard, with roofs and sometimes walls of corrugated metal sheets. More recently, concrete apartment blocks have been constructed in Mathare and Korogocho slums, but like the mud homes they have no running water or sanitation, and a family

will typically rent a single room. They cook over wood or charcoal fires in their homes or in the streets, surrounded by rubbish and sewage. When a parent finds work for the day, there is food to eat, but with prices of basic commodities such as rice, maize, beans and cooking oil rising all the time, their children know what it means to go to bed hungry. In Nairobi, wealth and poverty live side by side. Nobody knows how many people live in the slums, but estimates range from 2 â&#x20AC;&#x201C; 3 million and still growing, as hopefuls from the countryside arrive in the city to look for employment. Serious drought in parts of the country during 2005-2006,

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5. (Above) The third school we visited and worked at was the Green Pastures School. Green Pastures is located in the Kibera Slum which is the largest slum in Africa. The first weekend that we were at the Green Pastures School, the school hosted a parents day. At the parents’ day, each class gave a presentation. The most touching part of the program was one of the songs that the primary class sung. 6&7. (Above right) “I see you see me here. When I grow up, I want to be the best ____ of my country Keyaaaa”. We heard everything from astronaut to engineer to surgeon! 8. (Left) Since the Green Pastures School is much larger than the Tumaini and Neema schools, we spent the majority of our time in Green Pastures doing medical checks. That also gave us the chance to spend time getting to know the kids better.


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2008, 2009 and again in 2010-2011 meant that thousands in the more arid parts of Kenya lost their livestock and crops. Under these circumstances food prices become subject to soaring inflation. Some families move from their rural homes to the city slums specifically to find education for their children. They scrape a living doing casual work and running small businesses such as hairdressing, carpentry, or buying foodstuffs, timber or clothing and reselling them from market stalls and kiosks in the streets of the slums. During the post-election violence of December 2007 and January 2008, many of these businesses were looted and burned, and livelihoods destroyed. But Kenyans are hard-working and resilient, and they also have strong family ties. The high unemployment and large numbers of orphaned children mean that the average working Kenyan supports 10 dependents. Communicable diseases are also extremely prevalent in these slums. Officially 8% of Kenyans are HIV-positive, though those in the slums often do not know it until they fall ill with AIDS. Some agencies estimate the figure to be as high as 20%. Basic forms of anti-retroviral medication are available, sometimes at little or no cost, but the good nutrition and clean water essential for a patient to tolerate ARV treatment are often unaffordable to families living in the slums. TB is the number one killer of AIDS victims

in Africa. Many children are orphaned in childhood or adolescence, which usually puts a halt to their education and often leaves them begging for shelter and food from relatives or well-wishers. What sorts of educational initiatives does The Giraffe Project undertake in Nairobi, Kenya?

BOTH: We currently support three schools in Kenya. We have two schools in the Mathare slum, the Tumaini primary school and the Neema secondary school. In the Kibera slum we have the Green Pastures School which is a primary school. Giraffe Project funds have purchased an additional building for Green Pastures and a good supply of textbooks, and ensures lunch provision for all the children. They funded the construction of a security wall, water storage tanks, and a rainwater capture project, and donations of library books and computers. For students participating in the annual planned trips to Nairobi, how do they contribute to your initiatives?

BOTH: The students who come with us on our trip to Kenya have been involved in our fundraising initiatives in Brussels, so before coming on the trip, they have helped fundraise for our projects. Each year in Kenya, there are a number of projects that our student volunteers can participate in. This past summer, there was a medical team

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that helped local doctors with medical checks for the students in our schools. There was also a teaching team that helped educate students on water purification and dental hygiene, a construction team that helped with building of our new building for Tumaini School, and finally a business team that helped our Tumaini bakery and Tumaini bead shop. The Giraffe Project has also funded business initiatives, such as the Tumaini Beadcraft Group. What is the importance of these business projects?

BOTH: 8 families are supported out of the income the ladies receive from selling us their products. They are all families with children in Tumaini School who had no income at all, so were struggling to even feed their children or pay their rent. The other side of it is that we have something to sell here, which raises some money (though not a lot) but more importantly it gets people interested in the project and gives them something personal to connect with. Given the economic and social conditions in the slums, how can long-term change be sustained?

BOTH: Very good question ­— something we are working on. As far as our projects in schools go, sponsorship from local companies is one answer. For our new secondary school we eventually want 50% local fee-paying students (there are a lot of middle classes with money for education). Another thought in the long term is legacies that build up a capital fund. For Kenya, long-term sustainable development will only be possible if they deal with corruption and invest nationally. On a small scale things are possible – lots of little projects in villages and towns do well if run by locals, but in the grand scheme of things it will take bigger changes. The key is to remember that every individual we give an education to has the potential to make a difference in his or her community, and the sum of a lot of small ripples can make a big wave. What would you say is your biggest challenge as a charity?

BOTH: We face two challenges: raising money, especially in a time of recession and of high inflation in Kenya, and getting good volunteers here. Keeping a sharp eye on the management of the projects in Kenya is also extremely important, whilst at the same time managing the charity’s affairs here in Brussels and doing this in our spare time. How can our readers support The Giraffe Project?

BOTH: They can support us through donations and sponsoring a child individually. All the information is available on our website (


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9. (Above) Lavender was one of the sweetest girls that I met at Green Pastures School. She is in 7th grade and she hopes to become a doctor when she grows up and she wants to study at the University of Toronto. The day before we left, Lavender came up to me and gave me a picture of her, which she told me to keep in my wallet so that I would never forget her. She also gave me the a vey touching letter in which she told me to practice the Kenyan dance moves that she had taught me and she told me not to be sad that I was leaving because we would meet again in Toronto and then we would both become doctors and come back to Kenya. 10&11. (Right) Never before in my life have I ever met children who have so little, yet have hearts of gold. My trip to Kenya has taught me so much and it’s impossible to explain my journey in just few pages, but the most important thing that I can tell you is that we can never forget children like Lavender who value every little thing in life and every penny that you contribute to these children’s education truly makes a difference.

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Sexual Health Information at Your Finger Tips Love Matters is a web and mobile site that delivers sexual health information that young people can use, by putting the sexy back into sexual health. By: Michelle Chakkalackal The views reflected in this piece are that of the author and do not represent Love Matters or its primary supporter, Radio Netherlands.

We at ‘Love Matters’ had an idea to deliver sexual and reproductive health (SRH) information online in English and in Hindi to young Indians between the ages of 18 to 30 years old because they lack this information to make key decisions about sex, birth control and family planning.1,2 By offering SRH information online, we have the unique opportunity to reach people who have been neglected by traditional sex education programmes and family planning services, including married men and unmarried young people. Thus far there is no comprehensive sexual education in Indian schools. Schools and parents fear it would give young people the message that it was OK for them to have sex.2,3 Unfortunately, this fear extends to the SRH service sector so that few Indian family planning providers and NGOs actually talk about sex, birth control or family planning with young people.2 Yet, the need for SRH information in India is clear. The median marriage age is 17 for women and 23 for men.4 At least one woman in seven has her first


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child by the age of 19.4 Most women get sterilised by the age of 26, even though other family planning options are available,5 and women say they would have fewer children if they had the choice.4 But young people need to be informed to have choices. Even if birth control is widely available, young people are unlikely to use it without reliable information. The lack of access to information ultimately affects India’s ability to reduce the millions of unsafe abortions6 and the number of mothers dying because of pregnancy and childbirth related complications.7

who answered our survey, 91% owned a mobile phone, 57 wanted more SRH information, and the majority wanted this information to be available on their mobile. Some of the advantages of using a mobile site are that young people can access sensitive information anonymously, privately and at any time. Plus people could feel comfortable emailing us questions including ones often considered taboo such as penis size, wet dreams and masturbation. Thus, it appeared ideal to offer this type of service as well. While these questions may seem

The lack of access to information ultimately affects India’s ability to reduce the millions of unsafe abortions and the number of mothers dying because of pregnancy and childbirth related complications. It is one thing to say that young Indian people should have access to this information, and another to know for sure if they would actually want it. Last year, Love Matters, a web and mobile site that delivers sexual health information to young people, posed the above concerns to 300 young adults in Mumbai and Delhi between the ages of 18-24 (stratified sampling, equal number of men and women). Out of the 300

insignificant in a country where almost half of women and a quarter of men get married before the legal minimum age,4 they are equally important in terms of decision-making and sexual wellbeing. Why? Because often men who write to us about their penis size are also afraid of not being able to have sex or impregnate their future wife. Some may even falsely believe that having a small penis, having wet dreams or masturbating leads to

Screen shot of Love Matters mobile site.

infertility. These misunderstandings may sometimes lead men not to use condoms when they have sex.8 To date, one of the largest shortcomings in the field of sexual health is that most organizations tend to focus on the suffering caused by sex not the pleasure of sex.9 What I mean by this is that young people get to hear all the bad things that come with sex like sexually transmitted infections (STIs), unintended and unwanted pregnancies, and how they could die from either. But what they do not hear is how talking about pleasure can be a way to talk with your partner about wearing condoms, using birth control and avoiding pregnancy or STIs. While it may seem obvious to most of you reading this article, many people have sex because it feels good or are in love. So why not bring the sexy back when we talk about sexual health? One of our aims at Love Matters has been to actually highlight the pleasurable aspects of sexual health. We have been lucky to have the freedom to do so largely because we are part of the journalist organization called Radio Netherlands Worldwide who also views access to information on sexual health as

first comprehensive SRH information website and mobile site in India in Hindi.10 We believe a large part of this success is due to field research and consultation with Indian youth and involving local partners like TARSHI in order to make sure that we were translating our content in a sensitive and accessible way. For more information, you can find Love Matters online in English at and in Hindi at You can also check out our TedXChange Talk: http:// or on the Impatient Optimist blog http://www. Love-Matters-TBD

a sexual health right. We also follow the Dutch philosophies that young people should have access to comprehensive sex education and youth-friendly services. In the Netherlands, these philosophies are put into practise and do work. Young people in Holland have sex at a later age,10 compared to other more conservative countries where discussing sex is more taboo. Moreover, the Netherlands has some of the lowest rates of teenage pregnancy, sexually References transmitted infections and 1. distribution abortion worldwide.11 2. With that aim in mind, health_profile_young.pdf 3. wanted to translate these tion-in-indian-schools-the-need-of-the-hour/ philosophies into the Indian 4. pdf context. To make sure we 5. information that nothing-birth-control was culturally appropriate, we 6. pdf worked with a local Indian SRH 7. NGO called Talking about Reproductive Health_and_Development_(AHD)_MO_Handout07.pdf 8. Sexual Health Issues (TARSHI); who reckon-youre-infertile took our existing content in English 9. PIIS0140-6736%2806%2969810-3/fulltext and adapted it to fit the Indian context. 10. also helped us translate our and-reproductive-health.pdf 11. form English to Hindi. AndRelationships/Now-an-online-guidebook-on-safeTo date, we have had over 1 million sex/Article1-771325.aspx visitors coming on to the English and Hindi websites since they were launched November 2010 and November 2011 respectively. In addition to this success, we are the Right: Michelle Chakkalackal, Below: Love Matters logo in Hindi.

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A Global Health Research Guide for Undergraduates By: Connor Emdin Introduction For any undergraduate student in global or public health, doing research can be both personally fulfilling and a practical step towards a future career. Although it is rare as an undergraduate to have the resources and experience needed to uncover discoveries that one learns about in lecture, students should still feel that their contribution is still possible and worthy to the growing body of literature in global health. Therefore, undergraduate students should try to get involved in research as early as possible as it is a skill that can help you prepare for a variety of careers related to global health. For those interested in global health, many challenges may arise. While many structured programs are available for students interested in laboratory research, programs for global health research are much more limited, often a result of limited funding. As well, most global health work occurs overseas, requires intensive cross-cultural briefing and in most cases, extensive ethical clearance to conduct ones study. It is a field that definitely requires patience, partnership and persistence as students must be willing take initiative, propose their own projects and seek and acquire external funding. Based on my experiences, this article seeks to provide a step-by-step guide on navigating the waters of global health research as an undergraduate. Selecting an initial topic This is a critical step and typically the most important. You should begin by finding an area that you are extremely passionate about. Planning and undertaking a research project,


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especially in another context, is complex and arduous. Therefore, it is imperative that you have isolated an area of extreme interest that can and will motivate you to be persistent. If you haven’t yet identified a particular issue, reflect on topics you studied in your courses as that can open the door to a myriad of areas worthy of exploration. If you are interested in equity, ethics or human rights relating to health, you can also check out websites for different organizations working in that area that can foster new ideas as well. Such may include the Joint Centre for Bioethics at UofT, Partners in Health, or Human Rights Watch. Another pertinent variable is feasibility of completing research in that area. The topic should ideally be focused on a question that not only has not been researched, but that can be researched. Generally, issues such as HIV, maternal health, malaria and tuberculosis are well funded and will almost certainly have faculty researching various dimensions within your university. If you are having difficulty identifying a general idea, another strategy would be to peruse the faculty listing of the global health or public health department at your University. Most professors list their research interests on their department’s faculty profiles and these can provide a good starting point for a possible topic. For students at University of Toronto, the Dalla Lana School of Public Health website is a good place to start. Finding a Supervisor Finding a supervisor can either be very easy or extremely difficult depending on a number of factors. Professors generally prefer to work with students who have had previous research experience, so students attempting to start their

first research project are sometimes at a disadvantage. To get around these issues, it’s advisable to volunteer with an organization or group if you can to acquire such applicable skills. Once a Professor has shown interest, the interview can be a daunting and nerve-racking experience. It’s easy to show how enthusiastic you are about a topic in person and most Professors won’t interview students unless they are seriously considering supervising you. You should start by contacting professors which you’ve had a previous relationship with, whether through a class or a different connection. Professors are much more inclined to take you under their wing if they know who you are. So do make an effort to get to know your Professors in class and introduce yourself. Do keep in mind that Professors receive hundreds of emails daily. Therefore, in order to stand out from the crowd, you need to ensure that your interests align with theirs and have at least read some of their papers. Be specific and personal in your email and definitely do not send out mass emails. If you think that you can acquire external funding such as scholarships and grants to fund your activities, it would be wise to mention it. Not having to fund a student is a significant advantage for many Professors. Once you’ve found a supervisor, and committed to working with them, next steps can diverge. Many professors will have an existing project that they want you to work on. Other Professors may give you academic freedom to explore your own interests, which may appear daunting at first, but in many respects, can offer great practice for cultivating your ideas if you’re interested in research in the long-run.

Research Planning The planning stage can be broadly drawn up into two separate parts — administrative planning and research planning. Research planning is largely done between you and your supervisor and is topic specific, so it is difficult to give general advice. Above all, however, make sure that your plan is feasible for your situation and can be done in the time you are there. Qualitative research, which typically involves interviewing subjects can be extremely time consuming; particularly if you have culturally-sensitive questions that require preliminary review by local counterparts. Quantitative research, which can in many cases involve existing data from your Supervisor (whether through retrospective studies or simple observational studies) can be a bit easier to forecast timelines for completion. Randomized controlled trials on the other hand, can be difficult to plan in a short timeframe and may poses ethical requirements when done on human subjects. But for most primary studies, there will be some form of human interaction thus requiring an ethics review (even when analyzing secondary data). The University of Toronto offers a Delegated Ethics Review Committee specific for undergraduate initiated research projects. However, this accelerated review is contingent upon there being minimal risk (not only physical, but social, emotional and pyschological risk) involved to participants. Plan your research project so that any risk to participants will be minimized and remember to submit an ethics review well in advance. If you are conducting research overseas, you may have to a find a partner organization such as an NGO or university with which to conduct your research. However, before contacting any organization, make sure you have a solid proposal, detailing what you hope to accomplish and how it will benefit their organization. Administrative Planning The most difficult part of administrative planning is acquiring funding. While some Professors may be able to fund you through their own grants, it is generally preferable to acquire external funding. Before searching for scholarships and grants, however, draft

a budget. Include accommodations, flights, domestic transportation (buses), vaccines, cell phones, insurance and an emergency fund. Once you have a budget, you’ll know how many scholarships you’ll have to apply for. The following list includes some global health focused grants at the University of Toronto: • Center for International Experience offers a $5600 Students for Development internship. You’ll have to submit an application to work with a partner NGO and the project has to be development oriented. • Faculty of Arts and Science administers an Undergraduate Research Fund which awards up to $2500 for undergraduate initiated research projects. • The University of Toronto Excellence Awards for Social Sciences and Humanities (UTEASSH) are competitive but worth $6000 • The University of Toronto International Health Program awards the UTSU Discovery Fund. The application process is somewhat lengthy but the award will cover up to $3000 for accommodations and travel expenses. • Ontario Student Assistance Plan (OSAP) can offer funding for Ontario students conducting research for course credit who demonstrate financial need. This funding is often in the form of a loan, however. • Colleges often have discretionary funds that can be awarded to students. Contact the office of the Dean of Students at your college for further information. The End Result While the process of conducting the actual research was brief in this discussion, it is not to overshadow the importance for students to respect partnerships, maintain cross-cultural sensitivity and uphold overall respect for differences in any context. These are salient reminders, particularly in global health where students will inevitably encounter belief systems and practices divergent from their own. Upon the completion of your research and analysis, you will likely have to produce a final paper that synthesizes

and consolidates the data and conclusions you’ve identified. If you are undertaking research for course credit, you will write this paper as part of your course requirement. But also use this as an opportunity to disseminate it to a wider audience. Many student run journals such as the Journal of Undergraduate Life Sciences (JULS) actively solicit undergraduate student work or you can discuss with your supervisor to submit to a high-impact, peer-reviewed journal. However, it is important to consider the restrictions that can sometimes come with publication. Many journals, such as The Lancet, charge exorbitant subscription fees ,which restrict access to wealthier institutions such as the University of Toronto. If you are conducting research in a low-income country, publishing in these journals may inhibit interested practitioners lacking funds from accessing your work. I would argue that this is unethical. Consider publishing in open access journals such as BMC Health Services, PLoS Medicine or African Health Sciences, which are indexed on PubMed but also provide articles free of charge online. Additionally, you can also adapt your paper into a more conversational piece and publish it in a student magazine, such as Juxtaposition. Moreover, many global health scholarships such as the CIDA’s Students for Development program require you to complete outreach activities such as seminars and presentations. These can be a good way to showcase your work to the local community. Follow your Passion and Remain Humble Conducting international global health research is can be a serendipitous and complex undertaking. However, it can also be extremely rewarding if you are passionate about a particular topic and interested to uncover solutions to ongoing global health problems. As you go along in your career, it is extremely important to uphold a set of ethical principles rooted in values of humility, respect and cross-cultural learning. I hope that you found this article helpful and that your research experience will be as enjoyable as I have found mine to be.

Spring 2012 | Juxtaposition


The Graduate Student Alliance for Global Health (GSAGH) Creating a community for global health leadership By: Christopher Klinger, Beth Rachlis, Sarah Higgins, Chloe McDonald, Nadia Fazal and Judy Kopelow on behalf of

the 2012 GSAGH Executive Committee The Graduate Student Alliance for Global Health (GSAGH) is an interdisciplinary student initiative supported by the Global Health Division at the University of Toronto’s Dalla Lana School of Public Health. Since its launch in 2009, GSAGH’s mission has been to unite students with a shared passion for global health and build capacity for student research, education and professional development in the global health domain. The current 15member Executive Committee is led by masters, doctoral and post-doctoral students from disciplines including public health, laboratory medicine and pathobiology, health policy, management and evaluation, pharmacy, political science and global affairs. Major activities to date have included workshops, student research symposia and the Make World Change Program. GSAGH has also participated in global health conferences in Canada and abroad. Funding support to the organization has graciously been provided by a number of sources, including the University of Toronto’s Departments of Anthropology and Dentistry, the Factor-Inwentash Faculty of Social Work, the Faculty of Arts and Sciences, the Leslie Dan Faculty of Pharmacy, the Institute of


Juxtaposition | Spring 2012

Medical Sciences, the McLaughlinRotman Centre for Global Health, the School of Graduate Studies, the Graduate Students’ Union and the Global Health Division at the Dalla Lana School of Public Health.

...unite students with a shared passion for global health and build capacity for student research, education and professional development in the global health domain. Workshops and student research symposia Bi-annual symposia have focused on themes such as: critiquing G8/G20 policy impacts on global health, reflecting on knowledge translation and professional opportunities in global health, and addressing the ongoing burden and salience of non-communicable diseases. Each symposium has brought together University of Toronto global health leaders, has aimed to illuminate current

and relevant issues in global health research, and has provided a forum for students to share, present and receive feedback on their research. Workshops have further aimed to develop key skills such as group facilitation and publishing in global health as well as illuminate current and relevant issues such as social activism and community engagement in global health research. Overall, these types of events aim to facilitate knowledge exchange and network building among university students from a variety of levels, backgrounds, cultures and academic disciplines. The Make World Change Program To incite interest amongst undergraduate students, GSAGH initiated the Make World Change Program which consists of a series of seminars on global issues focused on the role of social determinants of health. This program is directed towards undergraduate students, and consists of a series of global healthrelated seminars that, among many other topics, seek to highlight the important role of the social determinants of health. In addition to benefiting the undergraduate participants, Make World Change provides valuable teaching and

mentoring opportunities for the graduate student members of GSAGH. Now in its fifth cycle, Make World Change (led by GSAGH and the Global Health Division at the Dalla Lana School of Public Health) has partnered with both Victoria College as part of the “Ideas of the World” series and Hart House. National and International Conference Participation In recognizing the importance of advocating for student engagement and curriculum development in global health, GSAGH participated in the 2011 GHEC-CUGH Global Health Conference (Advancing Equity in the 21st Century) in Montreal, Quebec. Here, an oral presentation was given within the Global Health Education at Home and Abroad session, which highlighted the organization’s goal: to build capacity for student research, education and professional development in the global health domain. At this conference, GSAGH also hosted a Student Networking Dinner at a local Montreal café in order to enable student networking and exchange. Attended by graduate students from universities across Canada and abroad, the success of this event has inspired the GSAGH leadership to participate in the organization of a similar event for the upcoming 2012 Canadian Society for Global Health Conference in Ottawa.

The ultimate goal is to take the GSAGH model nationally and internationally, linking with universities across the globe. Building on this momentum and supported through the Dalla Lana School of Public Health’s Global Health Division, GSAGH participated in the World Federation of Public Health Associations’ (WFPHA) Conference in Addis Ababa, Ethiopia, in April 2012. A discussion on transforming health in the 21st century between international students (undergraduate and graduate) and the Chief Public Health Officer of Canada, Dr. Butler Jones, was organized as part of the International Students’ Meeting on Public Health, a satellite event of the WFPHA Conference hosted by the Ethiopian Public Health Association (EPHA). Based on the amount of interest in the GSAGH model from the participants at both of these events in Addis Ababa, Ethiopia, and the positive feedback received, it is clear that there are many opportunities for international expansion, collaboration, and partnership.

Stephen Lewis Foundation and Murdin Consulting, a biotechnology consultancy agency, shared their career insights and provided networking opportunities with professionals in the field. The career speaker series aims to provide students with exposure to careers available in the global health field and provide guidance with their career paths.

Future Directions In the upcoming 2012-2013 academic year, the GSAGH executive leadership will aim to increase membership and to build a wider and stronger global health community of graduate students at the University of Toronto, across Canada, and internationally. For more information, please visit or email To read more about GSAGH please refer to the following recent feature in University Affairs: Siebarth, T. (2011) “Student-led alliance allows students to learn from each other”. University Affairs [Toronto, Canada] 2011 November 7. Accessed November 2011 Recent Activities student-led-alliance-allows-studentsRecently, GSAGH hosted a Careers to-learn-from-each-other.aspx in Global Health panel on May 30, 2012 at the University of Toronto’s Medical Sciences Building as part of an ongoing Speaker Series. Representatives from Grand Challenges Canada, The

Global Health Leadership Source: GSAGH Website

Spring 2012 | Juxtaposition


Special thanks to the following sponsors at the University of Toronto: Trinity College Post-Graduate Medical Education New College Student Council Human Biology Department University of Toronto Studentsâ&#x20AC;&#x2122; Union

The Global Health Specialist and Major Programs provide interdisciplinary undergraduate programs of study that include courses from the various medical departments, life sciences, social sciences, and humanities leading to an honours B.Sc. degree. The emphasis of these programs is to integrate the study of health sciences with select courses in the social sciences and humanities. Students will receive a solid foundation in life science FRXUVHVWRJHWKHUZLWKLQVLJKWVIURPWKHKXPDQLWLHVDQGVRFLDOVFLHQFHVDQGDWWKHVDPHWLPHIXOĂ&#x20AC;OOWKHLUGLVWULEXWLRQ requirements. 7KH*OREDO+HDOWKSURJUDPVDUHLQWHQGHGIRUDVSHFLĂ&#x20AC;FFRKRUWRIVWXGHQWVZKRDUHLQWHUHVWHGLQDSSO\LQJWKHLU

Juxtaposition 5.2  
Juxtaposition 5.2  

Youth in Action: Highlighting student experiences and opportunities in global health