Week 7-8 internship reflections

The past couple of weeks have been pretty busy here in Guatemala. Probably the most notable thing I did, although unrelated to my internship, was climb a volcano! It was an extremely challenging and fun day, and totally worth the week of soreness I experienced afterwards. If you’re interested in reading more about the hike and seeing pictures, I wrote a full blog post about it on a different site that can be found here: https://itsrightunderyournose.com/2016/08/23/volcan-acatenango-or-up-and-down-again/.

As far as work goes, I’ve been moving along on the research project and paper we figured out for me. The final topic we decided upon is migration and the knowledge/use of contraception in adolescent girls in Mexico, Guatemala, and Belize – three countries in which Population Council is in some stage of developing a community group/after-school ”safe space” program for adolescent girls. Internal migration from rural to urban areas is huge in these countries, as people move to cities in search of better educational or employment opportunities and/or freedom from hardships such as violence and poverty in their areas of origin, among other reasons for migrating. While migrating can ultimately improve the lives of adolescent girls, it is obviously not without risk. Migration can not only put girls in physical danger, especially during transit and if they end up working in risky work environments such as factories, but can also harm their health in other ways. Most notably, migrating to a new area disrupts girls’ social networks, potentially leaving them without reliable sources of health information or services. Because of this isolation and disruption of social network, our hypothesis is that girls who migrate will have lower rates of usage of modern contraceptive methods and less knowledge about these methods. So far the paper is coming along nicely and I’m thankful my supervisors are flexible and allowed me to research a topic that is interesting to me, despite being a little outside of their expertise. For more information on this topic, I encourage you to read the Council’s report on adolescent girls’ migration called Girls on the Move. It’s a little long, but worth the read!

I have two weeks left here in Guatemala and they are going to be full! I will be presenting my work on this paper and a few other side projects I’ve worked on to the rest of the office soon, and at the end of my last week here I’ll be accompanying my supervisor on a field visit to Sololá, a rural Mayan community where the Council is conducting its randomized control trial to measure the impact of the Abriendo Oportunidades program. I’m excited to finally meet some of the human beings behind all the data I’ve been working with and see just a little bit more of this beautiful country before I go!

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Managing expectations and communicating concerns

One of the main challenges I’ve experienced during my practicum this summer has been the fact that none of the employees in my office have public health backgrounds. The people with whom I work closest are anthropologists and/or economists. While we all have the same goal in mind – empowering girls to make decisions about their lives, set and achieve goals, and ultimately realize their full potential – we approach the problem from different perspectives. We use different terminology (often to unknowingly refer to the same things) and methods. I think we also came into the summer with slightly different expectations about my duties and interests, so it’s definitely been a learning experience in communication thus far.

I spent most of the first few weeks at my placement site getting deep into a few datasets that needed some serious cleaning, organizing, and merging work. During that time, I learned a lot about performing data quality checks and using Stata, which are valuable skills, but I wanted to make sure I didn’t get stuck doing these data-heavy tasks all summer with minimal deliverables to show for it. One of my supervisors in the office is a remarkable data analyst, from whom I’ve learned a lot already; however, her interests, and therefore her responsibilities, revolve more around data quality and monitoring than mine and as such I was assigned a lot of tasks in that realm as well, which began to feel a bit monotonous and not helpful to me or my career goals. After some debate and advice-seeking on how to handle the situation, I decided to express some of my concerns to my supervisors. Through this conversation, we were able to come up with a different project direction for me to go in during my time here and things have been much better. I’m working on a research project and paper with a specific public health topic in focus (although it’s still a bit tough getting guidance on the public health aspects of the project – thankfully I have a great research boss and advisor back at UCLA who have been able to advise me via e-mail when I have pressing questions). I will have a report to show for my hard work over the past few months that will be a great learning experience and beneficial to my future career goals. It’s not the topic area that I really expected to be reading and writing about prior to coming down to Guatemala, but so far I have really enjoyed this shift in my responsibilities and I’m thankful for supervisors who are willing to listen to my concerns and help develop an experience that meets all of our diverse needs at the same time!

machismo (n): strong or aggressive masculine pride

Time is flying by! Today marks the halfway point of my internship. This week’s prompt asks about cultural differences and difficulties we have experienced during our practicum. I had to think about this for a bit because to be honest, the adjustment process hasn’t been too difficult as far as cultural aspects go. I’ve spent a fair amount of time in Central America before coming here to Guatemala so I knew what to expect. Guatemala City itself is very modern and urbanized. It actually reminds me a lot of Los Angeles – terrible traffic and rush hours, perfect weather, tons of little neighborhoods that combined make up the city proper. Yes, I can’t flush toilet paper and going to the grocery store on foot is not my favorite, but those are not things that I would consider issues of “cultural competency”. When I’m actually at my placement site I don’t think about it too much either because I’m in an office, with quite a few people near-ish to my age who have all spent quite a bit of time in the U.S. I’m still hoping to be able to get out into the field in some of the more rural areas where the Council works here to see that side of the country, but for now it’s been a pretty easy cultural adjustment.

One thing about Guatemalan culture in general that has been a bit challenging during my time here is what they call machismo. There isn’t a direct English translation for this word, but it’s similar to chauvinism. If you search the definition you’ll probably see something like “exaggerated masculinity”. It is a cultural undertone that exists in some form or another across Latin America, but I have never felt it as strongly as I do here. When I’ve discussed this feeling with other people – both Guatemalan and friends/family back in the states – I am careful not to condescend Guatemala or its people as a whole. Most Guatemalans are very warm and welcoming, and I know it’s not the only place where machismo occurs (we’ve got a ways to go with this idea in the U.S. even!). But when I walk places I am constantly getting whistled and/or honked at. I’ve had moms tell me their daughters won’t move away from home because “girls can’t do that” and women tell me they can’t go anywhere without their husband’s permission. A man called me a “modern woman” because I work and study things related to women’s health. Perhaps working with an organization focused on girls’ empowerment has made me hypersensitive to the issue, but through all these little interactions I’ve really been able to see the need for building girls up. The narrative that there is anything girls “can’t” do is a dangerous and limiting one, and I think about the girls who have been led to believe it almost every day here. My experiences thus far have only given me more encouragement to continue challenging these ideas for girls everywhere!

From the classroom to the real world

I am now almost halfway through my field studies experience here in Guatemala City! This week I further refined my work plan for the rest of my time here. Last week I mentioned that my research focus and responsibilities have changed from what I originally expected. At first I was a bit discouraged and flustered by this, to be honest. I am still a little anxious about how everything will come together, but I’m happy to report that things seem to be moving in the right direction.

My supervisors have given me quite a bit of flexibility and liberty as far as developing a research question goes (which at first seemed intimidating). I knew they wanted me to shift my focus to something in the general topic area of migration, but taking this idea the rest of the way – to a full-blown research question – was left up to me. I decided to dig into the literature in order to start exploring topics related to migration that would also relate to Population Council’s mission of giving “voice and visibility to the world’s most vulnerable people” and improving the health and well-being of girls around the world. Throughout this research question development process, I thought about all the things I have learned in my global health classes, both at UCLA and during my undergraduate career studying public health at Ohio State. I thought about topics we have covered in classes such as Community Health Sciences 200 that could be relevant to migrant adolescent girls in developing countries such as Guatemala: violence and injury; maternal and child health; sexual and reproductive health; how social factors such as education and social support can affect health. I’ve learned to always consider populations and public health issues in context, so I made sure to think about everything with Latin America and the unique challenges that migration may present here. Once the paper starts to take shape and I start to formulate some potential policy or programming recommendations to present to the Council, I expect a lot of topics we discussed in my global health research ethics class will be helpful to consider as well. Adolescent girls and migrants are both vulnerable populations on their own, especially in developing countries, so I expect to see that adolescent girl migrants are especially burdened by some of the health issues I’m planning to explore.

Through a combination of doing some literature searches and thinking about my own prior knowledge and research interests, I ended up coming up with a question that I think is both interesting and important, relating migration and sexual/reproductive health knowledge. I’m working on outlining the paper now and then I’ll start digging into data. As always I will keep you all updated!

The importance of interdisciplinary collaboration

This past week at the Council has been a little irregular for me because I spent Monday-Wednesday working from Antigua, Guatemala. It’s a bit hard to get around and out of the city here, so when I had the opportunity to take a trip to Antigua I took it! I had heard wonderful things about that city and it definitely did not disappoint – check out some of my pictures below!

I really like the flexibility of my placement and the fact that my bosses encourage me to explore and experience Guatemala while I’m here. The flexible work flow style works well for someone who enjoys working independently and is a self-starter like me. The office is quiet, as other employees come in and out from the field a lot, so I can be pretty productive while I’m here, but not feel like I’m under intense pressure or anything. So far I’ve really enjoyed the opportunities I’ve had to get out of the office as well and learn more about Guatemalan history and culture (see last week’s post) in order to really understand the context in which the Council operates.

Something that has been surprising to me about working here is that no one else in the office has a public health background. I know in the organization as a whole and in regional offices that are bigger than the Guatemala branch, the distribution of disciplines is different. But here, most of the implementation people have backgrounds in education, and the monitoring/evaluation/research folks, with whom I work the most closely, are anthropologists and economists with specializations in international development. While this fact is not a big deal in the grand scheme of things – at the end of the day, we’re all still working towards the same goal of empowering and educating adolescent girls – it has definitely steepened the learning curve for me a bit. I was surprised to realize how different our perspectives, methods, and terminology can be. It’s been a good exercise in learning to work with people who think and approach problems differently than I do – public health is all about interdisciplinary collaboration!

My projects and responsibilities here have also turned out a little differently than I expected. At the end of last week I was able to sit down with the rest of the research team and talk about what concrete deliverables I should plan to complete during my time here. Unfortunately, the data we have from the Abriendo Oportunidades program is not as extensive as I was expecting and I was struggling to find a research question I could explore with it. However, we have some new data coming in and I was asked to shift gears a little and work on a project related to adolescent girls’ migration. I think this new project will turn out to be a blessing, especially because I’ve helped write a manuscript on the topic of migration in the past. I’m excited to see how my skills and knowledge can contribute to the Council’s work in this new capacity!

Datasets and merging and Stata, oh my!

Here’s an update about my second week in Guatemala!

Here at PopCouncil Guatemala, there are quite a few quantitative datasets that haven’t been processed yet including information about girls’ school enrollment, marital status, parity, and other demographic information. I have been getting knee-deep in these data over the past couple of weeks, involving a lot of trial and error and Googling Stata commands in order to merge, clean, and explore all of it. Once I get past these steps and have the data in a more usable form, I will be able to do some analyses and write up a report giving a better understanding of how to best target the Council’s programming in order to have the greatest impact on as many vulnerable, indigenous girls as possible.

Yesterday I was able to attend 2 discussions at a local university (above) with my preceptor and some co-workers. As much as I love working with data, it can be easy to lose sight of the fact that these numbers represent actual people – these events were very helpful in putting things into perspective. The first one was a screening of the movie Ixcanul, which depicts a fictional story about a young indigenous girl who gets pregnant out of wedlock and her family’s struggles around this event. The movie, although not a documentary, touches on real issues in indigenous communities in Guatemala including arranged/child marriage, machismo, and structural barriers in the health care system such as a lack of medical professionals who speak local languages. There was a Q&A session with the producer, a representative from the United Nations Population Fund (UNFPA), and my preceptor. There were several indigenous men and women in the audience, and hearing their viewpoints after watching the film was great!

The second event was a panel with members of a transdisciplinary project called the Maya and Contemporary Conceptions of Cancer (MACOCC). The goal of the research was to gain a better understanding of how cancer is understood and treated in traditional Mayan medicine and identify commonalities between this perspective and the Western biomedical perspective. The panel included two anthropologists, a Mayan doctor, and two oncologists. It was a perfect complement to the discussions we heard earlier in the day about the exclusion of Mayan people – who still comprise 40% of Guatemala’s total population – from the country’s public health and medicine systems. I was moved by how genuinely the “Western-trained” doctors believed in the importance of creating a bridge between the two paradigms of health in order to create an inclusive, united front against major health problems like cancer.

I could go on about these two amazing opportunities, but I’ll leave you with a (translated) quote that struck me during this second discussion: “Western medicine is very good at dealing with illnesses. But what we don’t do very well, that Mayan doctors are experts in: dealing with sick people.” I’m excited to keep humbly learning about and from professionals of all kinds in this culturally rich, unique country!

Population Council: Guatemala City

Well, it’s been a long week filled with Spanish, data-cleaning, and Guatemalan coffee, but I am happy to say I’ve officially completed my first week at work with PopCouncil Guatemala!

I’ll admit that I was pretty nervous on Sunday before going in for my first day – especially because I had to reserve a taxi over the phone in Spanish and I was worried I did it wrong and might not even make it there. My Spanish is pretty good, but I haven’t used it much at all over the last year or so and I started out pretty rusty. I can already tell I’m a lot more confident speaking it again even after just a week here, but that first weekend involved a lot of uncertainty. Nonetheless, my taxi arrived at my apartment on Monday morning just fine (a few minutes early even, which is NOT common in Latin America) and I was off to work.

 

When I got there I met my preceptor, the country director for Population Council’s operations in Guatemala, who showed me around the office and introduced me to the rest of my co-workers. The introduction process didn’t take long because our office is one of the smaller PopCouncil country offices, with only 13 employees (plus a couple consultants and 2 interns including myself). I like the small office feel because it will give me a chance to get to know everyone better! Overall, the atmosphere is very relaxed, which I appreciate because Guatemala City itself is pretty hectic. I have been surprised at how sprawling and urban this city is – it reminds me of Los Angeles a lot, actually (right down to the perfect weather, except it actually thunderstorms here thankfully). It’s a bit difficult to get around without a car, so I haven’t done much exploring yet unfortunately. Now that I’m more comfortable with the whole taxi thing that will hopefully change!

 

The office itself is in a pretty, relatively quiet, residential zona (one of 22 zones – basically mini-cities that make up Guate proper) and is in a beautiful Spanish style house with little courtyards in the front and back (pictures below).

 

I chose to do my internship with PopCouncil Guatemala specifically because it’s going to be a great blend of all my varied research interests, which are kind of a mix of epidemiology and community health topics/methods. The main program around which operations at this office revolve is called “Abriendo Oportunidades” (“Opening Opportunities”), a community program targeting adolescent indigenous girls that aims to empower them in part by matching them with mentors and teaching them new skills. The Council is currently in the midst of a randomized, controlled trial to evaluate the AO program and the impact it has on girls’ school retention rates. I’ll be helping with this data analysis and evaluation process. I’m excited to dive into the project even deeper this upcoming week. I’ll keep you all posted!