Insight Out Spring 2005 and Marsha Benjamin Seo 12 Icebreakers Melissa Gilkey 16 One American’s...

The University of North Carolina at Chapel Hill

Insight Out

Volume 9 Spring 2005

A journal dedicated to exploring the value of community service

In this issue: Coaching LessonIcebreakersTsunami StoryThe Best Medicine

&Winner of the “Best Photo Award”

InsightOut

Spring 2005

Editorial Board

Jenny Frenzel, public health, co-editor Josh Henson, dentistry, co-editor

Morgan Johnson, public health, co-editor Katherine Savage, MA, faculty advisor

Lynn W. Blanchard, PhD, faculty advisor Hallam Gugelmann, medicine

Janaka Lagoo, economics Katya Roytburd, public health

Erin Scharling, international studies Michaela Tighe, social work

Reviewers

Marissa Walker, social work Melissa Gilkey, public health Emily Burrows, public health

Insight Out is a publication of students at the University of North Carolina at Chapel Hill.

The purposes of Insight Out are to recognize the community service work of UNC students and faculty

together with members of the community; to serve as a source of information on current challenges in

health and social service delivery; to feature possible approaches to meeting the needs of underserved

populations; and to provide a medium for discourse on relevant health and social issues in the context of community service. In addition, the journal hopes to

encourage students to explore community service as a means of gaining the valuable human insight that is so

essential to the art of health care and social service.

http://www.med.unc.edu/insightout/

Designed by: Claudia Fulshaw Design

5500 copies of this public document were printed at a cost of $____ per copy.

Direct correspondence to Insight Out, University of North Carolina at Chapel Hill, Campus Box 3142, Chapel Hill, NC 27599-3142.

© 2005

Insight Out Spring 2005 1

EDITORS’ VIEWPOINTS2

TAKING ACTIONIf I Could Do SomethingAbout HIV/AIDSBrooke Morgan4

Volunteering at theAlamance Open-Door ClinicCraig Miller6

Listening:The Best MedicineAndy McWilliams24

OUTLOOKSA New ? Perspective onDevelopment and AidJohn Reed22

Two Worlds in OneAnthony Fleg27

POETRYLet AIDS Be Our Mortal EnemyMohammed Adams5

Halting HandsMatt Griffith10

Soul FoodAnthony Fleg17

Seeds of ChangeAnthony Fleg17

PHOTOGRAPHYSummer in IndiaLauren Collins7

Habitat for Humanityin ThailandElizabeth Pratt,Andrew Shapiro14

ENNEADJonelle Grant18

Service in South AmericaMatt Saldana, Stacey Isaac26

Table of Contents

REFLECTIONSCoaching LessonAnthony Fleg3

A Shared LifeNicole Kiefer8

A Reality CheckBrooke Morgan11

Winner of the “Best Reflection Award”Rusty and Marsha Benjamin Seo12

IcebreakersMelissa Gilkey16

One American’sTsunami StoryMelissa McMahon19

&

Cover Photo Credit: Laura Gibson Winner of the “Best Photo Award”

Table of Contents Photo Credit: Elizabeth Pratt

&

Insight Out Spring 20052

Jenny Frenzel, Josh Henson, Morgan Johnson

C arolina has a rich tradition of serving the community. In its very mission statement, this university clearly displays its commitment to “improve the condition of human life through service.” Insight

Out offers a medium for sharing personal stories and reflections by those within the Carolina community who carry out this mission. Each year, readers are inspired by stirring accounts of life-changing service experiences, insightful perspectives on social justice, and passionate commitment to improving the lives of others. This year is no exception. Essays, poems and photographs throughout this issue capture the nature and value of service, showing that while Carolina’s students may labor tirelessly in pursuit of academic and professional excellence, they are also intensely committed to the greater good. As you read this issue, you will likely also notice a certain theme emerging, that often the greatest impact that service has is felt by those on the giving end. Time and time again, this year’s submitters reflect on this realization: as they work so hard to serve others—to give them hope, to provide tangible aid and services, to be a mentor to those who need it most—their own lives are enriched in ways they never expected. As you read this issue of Insight Out, we sincerely hope you are inspired by these thoughtful reflections.

T hose who participate in community service play an integral role. Service helps so many, whether it be through Meals on Wheels, building a house for a family, extracting teeth for free on a patient who

can’t afford it, spending time with patients who are terminally ill and making them feel more at ease and at peace, or picking trash up on the side of a road. We can all do more to help our communities by donating our time, energy, and minds. I know that I can do more and I will do more to help out in the community. After I graduate from dental school this May, I will be entering the United States Navy. I will be serving my country and providing dental care to Marines, sailors, and other branches of the military and their families. After my Navy career is over, I plan to donate my time and skills to the needy in the community. Whether it be extracting hopeless teeth or restoring decayed teeth with amalgam restorations, it will be the least I can do. The University of North Carolina at Chapel Hill is a great university with highly rated schools

(medicine, pharmacy, public health, dentistry, etc.) that produces gifted and well-trained students who will inevitably go out into communities in this state, other states and possibly abroad, and provide care and services to those who need it. As a health care student at UNC, I, along with my colleagues, have many opportunities to help people out in the community. It is a great feeling when you treat a patient at the clinics in school, or a clinic such as the Burlington walk-in clinic, and the patient thanks you for making him want to smile again. I have been a part of Insight Out now for three years and am extremely proud of what it represents and what it stands for: service. Insight Out is a great window into the world of UNC students who are out there helping others in communities. It is a small window, and this publication obviously cannot display all that our students do, but it is a start. So, as this is my last year here at the University of North Carolina at Chapel Hill, School of Dentistry, I would like to issue a challenge to all out there who read this. Please carry the torch of those who have come before you and participate in community service projects. It really does mean the world to those whom you are helping.

S erving one’s community is a skill that comes naturally to many of us here at Carolina. Whether serving communities close to home, or lending a hand in projects abroad, we share a feeling of

responsibility for the world we live in. This feeling is evident in the products of our professional lives, our education, and our volunteer experiences. In this year’s issue of Insight Out, authors express this need to give back to the world through their creative writing in Taking Action, Reflections, Outlooks, Poetry, and Photography. As diverse as the projects described in this issue, as varied as the backgrounds of their authors, and as different as the approaches taken to express their ideas, it is clear that each one of these submissions reflects the passion and dedication to service that is so much a part of the Carolina experience. We send thanks to all of our authors for helping to share their part of this experience with us, and we hope that everyone reading this issue may not only be given insight into the culture of community service here at UNC, but that you may also walk away with a positive outlook on service in the world around you.

Editors’ Viewpoints

Jenny Frenzel is a graduate student in the Department of Health Behavior and Health Education in the School of Public Health.

Josh Henson is a fourth-year student in the School of Dentistry.

Morgan Johnson is a graduate student in the Department of Health Behavior and Health Education in the School of Public Health.

EDITORS’ VIEWPOINTS


Coaching LessonAnthony Fleg

“coach, what now?”Here we were, at the state meet for track and field. June is a month where the usual weather concern is the heat. Unfortunately, we had a different dilemma, as the skies opened, wind gusted, and the temperature dropped. This was a day that conjured up cozy mental images of sitting by the fire, not running track and field. I moped, groaned, and before 9am, I was as gloomy as the weather itself.

When I got out to the track, already soaked and hoping for news of postponing the day’s events, athletes came up to me, one by one, smiling and greeting me as they rubbed the rain from their eyes and hair from their faces. Shivering, some even found strength to hug me. Did they not see how horrible this was? An entire season of training culminating in a day more conducive to a swim meet than anything involving running shoes—and they were unfazed?

It wasn’t until hours later, as the rain and winds continued to pound away at our spirits, that I saw what I was to learn from them that day. It was time for the 200-meter dash, an event that could be quite a feat even on a good day. The athletes, many of whom could not walk more than 50 meters just two months ago, had learned to run the distance and stay in their lanes. But in this weather, all I could do was pray. I ran out to the end of the track where the 200 began, far from the comfort of the cheering parents and others in the stands. It was a lonely place to be on such a day. Yet there stood my athletes, proud and determined, crouched down just as I had taught them, anticipating the gun. It didn’t matter that they were shivering. It didn’t matter that they stood in large puddles as they prepared to race. It didn’t matter that they were alone. They each gave me a look that said “Coach, we’re ready—how about you?” and stuck to my heart. The gun sounded and their proud little feet splashed away.

These athletes of the Howard County (Maryland) Special Olympics Track and Field Team coached me that day. In their innocence, in their gratitude for the chance to run, they were blinded to the grim realities of the day that preoccupied me and many others present. They had come too far, overcoming obstacles that the rest of us would never have to hurdle. Fear of the starting pistol, the difficulty of focusing on running and staying in a lane at the same time, physical handicaps that make each stride labored—it was truly a victory of grand proportions for them to be at the state meet, and it was not to be interrupted by rainfall or a coach’s negativity. Humbled, I realized that the “special”

in Special Olympics doesn’t refer to disability; rather, it points to the special ability to strive for what others considered impossible, the special ability to live with a saintly graciousness and infectious warmth on a day that was neither, and the special ability to teach those like me how to live likewise.

The beauty of service is learning from those you thought you were helping, and in making this connection, realizing that service is a two-way tutorial on becoming human. My past four years coaching these track athletes has brought me more understanding of life than books could ever provide.

Anthony Fleg is a second-year student in the School of Medicine.

REFLECTIONS


I f I could do something about HIV/AIDS I would educate people, especially [the] illiterate about how HIV/AIDS can be acquired; that is, the way to which

one can get this disease and also how to protect ourselves from acquiring this deadly disease. I would advise them not to turn away from those living with the HIV/AIDS because one cannot get AIDS when he/she chats with an affected person.Kponu Christiana

If I could do something about HIV/AIDS I would form a group in my society or community to go out and educate people who are not aware of HIV/AIDS. I would tell them how deadly the disease is and [that] it can kill if one should be affected by it. I would also make them aware about how one is going to suffer if he/she is affected…and about the affected ones also, I would reach out to them so that they might not feel neglected.Sylvia Quartey

These are a few inspiring words expressed by the HIV Ambassadors from the Ada Secondary and Ada Technical School students during the Student National Medical Association (SNMA) 4th Annual Medical Mission Trip to Ada, Ghana. These students clearly articulated their ambitions to positively impact their communities concerning the HIV and AIDS epidemic.

With well over 40 HIV Ambassadors from Ada, Ghana, our SNMA Team was ready for our training meeting to be power-packed. The team members got acquainted with the Ambassadors by introducing themselves and opening up with an icebreaker game called “Transmission.” The Ambassadors were given cards and instructed to have their fellow Ambassadors sign them after exchanging personal introductions. The objective of the game was to allow the Ambassadors to get to know their peers and to realize that HIV can be transmitted from a single encounter with someone who appears healthy. Once each person had a card

If I Could Do Something About HIV/AIDSBrooke Morgan

signed by three people, those who possessed a card with a star on the back were asked to remain standing while the others sat down. Much to their surprise, those with a star were told that they were HIV positive and that anyone who had signed their card was also considered to be HIV positive! The floor was then open for questions as we separated the HIV Ambassadors into small groups to educate them about HIV transmission and prevention.

In our lessons, we discussed transmission through body fluids, the ABC’s of sex, the signs and symptoms of HIV/AIDS, and more. After the small group sessions, the Ambassadors were separated into two teams for the HIV and AIDS Bowl Game, a quiz to gauge their learning about the topic. To our amazement, the HIV Ambassadors were able to answer most of the questions correctly. For those they missed, the SNMA Team returned to the groups to share with them the correct information.

One of the last activities we did with the HIV Ambassadors was to have them write a short essay in which they completed the thought, “If I could do something about HIV/AIDS...” As a few of the Ambassadors read their thoughtful responses, some were quite strategic about the implementation of organizations; others reflected a genuine desire to care for people with the disease; and still others wanted to teach as many people as possible about HIV and AIDS and their prevention. While HIV and AIDS are devastating, and the possibility for a cure seems far away, the Ambassadors show that there is still hope for Africa through her children—the young men and women committed to join the fight against this disease.

In the days that followed, the HIV Ambassadors utilized the knowledge they learned from our SNMA Ambassador team by creating poems, songs, and skits about HIV and AIDS to educate other Ada citizens. The Ghana HIV Ambassadors always came prepared and were extremely creative and talented. All we had to do was organize how

As an active member of the Student National Medical Association (SNMA) and advocate for HIV/AIDS education and prevention, I decided to participate in SNMA’s 4th annual medical mission to Ada, Ghana in the Summer of 2004. SNMA started this annual trip in 2001 because of the increased prevalence of HIV and AIDS in West Africa. According to a UNAIDS report, there were 30,000 AIDS deaths in Ghana by the end of 2003, and 350,000 adults and children are living with HIV. The mission trip includes several teams: education, evaluation, clinic, nurse counseling, publication, and HIV Ambassadors. As an HIV Intervention and Prevention Corps (HIP Corps) Site Co-Coordinator, I thought my experience would be best utilized on the HIV Ambassador team. This team was responsible for educating the Ada, Ghana secondary school students selected to be trained as HIV Ambassadors in Ghana. After training, these students return to their home villages and educate others about HIV and AIDS.

TAKING ACTION


the groups would make their presentations. I was impressed to see the excellent work produced when ambassadors collaborated with one another. Each student was respectful; I realized that the term “Madam” referred to authority and not to age. They also asked impressive questions and continuously volunteered to participate in SNMA’s activities.

Ultimately, the diligent work of the SMNA team and the students was put on display when the HIV Ambassadors from Ada Technical School gave an exceptional performance at the Better Best Academy in Tema, Ghana. The HIV Ambassadors not only astonished their peers, but the teachers as well. Through their skits, s o n g s , and poems, they conveyed a clear and precise message about the dangers of HIV and AIDS. After the performance, the HIV Ambassador Team Leaders held small groups and played the HIV and

AIDS Bowl Game with the students from the Tema academy. We were most impressed when the students answered every HIV and AIDS Bowl question correctly. The HIV Ambassadors had successfully created a fun and educational program that achieved our goals.

On our last day in Ada, Ghana, the HIV Ambassadors performed at the Community Reception. The audience received them with cheers. For our team, it was a pleasure to impart HIV and AIDS education to the HIV Ghana Ambassadors. With their help, we were able to give the students at the Better Best Academy a close-up look at the reality of HIV and AIDS. I believe that the HIV Ambassadors are invaluable, because they

possess a vision of a more healthy and prosperous future for Ghana. It is my desire to see the HIV Ambassadors continue to impact their communities for years to come.

Brooke Morgan is a third-year student in the School of Medicine.

Let AIDS Be Our Mortal EnemyMohammed Adams (submitted by Brooke Morgan)

I am HIV

I don’t know where I come from

But my aim is to steal, kill, and

destroy,

Therefore go ye into the world

And tell man to expect me

Tell man I hunt from cottage door to

palace gate

For I am a respecter of no person

So he should abstain from

unprotected sex,

The usage of unsterilized materials

And things pertaining to blood.

Then it walked like a freeman.But to you and me, I stand boldly and say,Let AIDS be our mortal enemy.

Mohammed Adams is an Ada (Ghana) Secondary School HIV Ambassador. Brooke Morgan is a third-year

student in the School of Medicine.

POETRY

Insight Out Spring 20056 TAKING ACTION

Volunteering at the Alamance Open-Door ClinicCraig Miller

As you pull into the clinic parking lot, you see a long line of people waiting to be treated in the Alamance Open-Door Clinic. The group is made up of men and women, all different races and ages, and a variety of different socioeconomic classes. The clinic provides free dental care to the low-income population of Burlington and the surrounding areas. Three nights a week, this clinic utilizes the facility of the Alamance County Children’s Dental Clinic. Two nights a week are devoted to extractions and the third night to restorative procedures. Occasionally the clinic is open on Saturday, to serve those who cannot make appointments during the work week. Because time and materials are limited at the clinic, more complicated procedures are referred to the UNC Dental School or local general dentists and specialists.

To become a patient at the Open-Door Clinic, patients have to fill out an economic disclosure form to show that they have significant financial need. Once need has been established, the patients call a hotline to schedule their appointment. The number of patients who can be scheduled for a given night is governed by the number of volunteers who are available. Although all treatment rendered at the Open-Door is free, donations are welcome. Nothing tugs at the heart strings like watching a little elderly man quietly slip a weathered five dollar bill into the donation jar after having a tooth extracted.

Where do the volunteers come from? The clinic is overseen by local dentists, a number of whom are also adjunct faculty of the UNC School of Dentistry. The other volunteers are a mixture of dental auxiliaries, students, and lay people. The students include UNC dental students, UNC and Alamance Community College assisting students, and aspiring dental, hygiene, and assisting students. Though many of those who volunteer at the Open-Door Clinic do so out of a desire simply to serve the community, the clinic offers many additional benefits to the volunteers. For those considering a career in the dental field, volunteering at the clinic is a great addition to an application and shows an interest and knowledge of the dental field, separating the volunteer from the mass of other applicants. For current students, the clinic offers a chance to enhance their patient

skills and build confidence through repetition of procedures. No matter how much a student learns in school, nothing can compare to hands-on experience. Additionally, volunteering at the clinic offers dental professionals an opportunity to network with one another both on a personal and professional level.

Why do I volunteer at the Alamance Open-door Clinic? I was hooked after treating my first patient at the clinic. More than just the opportunity to enhance my clinical skills for free, volunteering at the clinic offers me the chance to help the community in a unique and meaningful way. Volunteering allows me to provide a valuable service to someone with few, if any, other options for treatment. I truly believe that these patients appreciate the volunteers. But even more, I know I receive twice as much from being a volunteer as I give to the patients. I am not sure what type of practice I will have in the future, but I know that even if I can’t provide every possible service to the indigent, I can still give back to the community through clinics like the Alamance Open-Door Clinic.

Craig Miller is a fourth-year student in the School of Dentistry.

WELCOME!

Insight Out Spring 2005 7PHOTOGRAPHY

Papoo is a 13-years-old orphan who lives in the Ashram (a place of worship) in Anjanisain. Papoo made more of an impression on me then anyone else I met in India. Even though we did not speak the same language, he befriended me and took me on a hike around the village. Before we left, he gave me a piece of candy that he had just bought from a local vendor. As I unwrapped the small candy, I thought about Papoo’s immense generosity. As an orphan, he had very few possessions and very little money. Yet, he was willing to share what little he had with someone he had met just days earlier whose language he did not understand. It was a true gesture of friendship. His gift remains one of the best that I have ever received.

Summer in IndiaLauren Collins

T hese photographs were taken while I was in India during the Summer of 2004. My trip was arranged through Child Family Health International, a non-profit organization that provides funding and medical supplies to needy clinics in five different countries. This organization also provides health science students with an opportunity to shadow

physicians in other countries. I spent all of June 2004 in Uttaranchal, a state in Northern India that borders Nepal and contains part of the Himalayan Mountains. Each week, I visited a different clinic and observed office visits, conducted patient exams, and watched babies being born. What made my trip so special to me were the people that I met in the clinic and in the community. They were warm, honest, and welcoming, and their spirit was what I hoped to convey with these photographs. It was an experience that I will never forget, and I am thankful to have the opportunity to share it with others.

Inside one of the two rooms of the Nature Quest Clinic in Than Gaon.

This picture of a nurse holding a newborn baby was taken five minutes after the baby was delivered by cesarean section.

Lauren Collins is a second-year student in the School of Medicine.

Insight Out Spring 20058 REFLECTIONS

A Shared Life – A Reflection on Nine YearsNicole Kiefer

“Here, Pii Nicole* – I made this for you!” Awn thrust a drawing in my hands and backed away. It was a beautiful landscape of the sea, carefully drawn and framed, offered to me as a going-away present. Awn is 16 and has spent most of her life living in the streets. Living conditions under the bridge where she sleeps are harsh and precarious, and Awn and her friends are regularly harassed by police. She has been in and out of juvenile detention centers, usually on charges of vagrancy. Drugs, violence, and HIV/AIDS have claimed many of her friends and are a constant threat to her own survival. Awn sniffs glue to escape, and although she regularly joins in activities, she is often high and cannot concentrate. This drawing showed all the creativity and talent we knew she possessed. She made a frame from a scrap of red cardboard found in the trash and outlined the drawing with a bit of colored yarn. There was a hook on the back for hanging, as well as a fold-out stand so I could put it on a table. The drawing was in pencil, except for a few blue birds; she explained that a blue marker was the only color she could find.

When I first joined the Fourth World Movement (FWM)1 in 1994, I never dreamed that I would be a member of their full-time volunteer corps for nearly ten years. Over the course of my time with the FWM, my responsibilities have ranged from running street libraries in New York, to organizing respite stays and supporting families in England, to coordinating, planning and evaluating projects in Bangkok. But contrary to what my 23-year-old self would have thought, it is not the projects that have been important. First, it was children like Gemma and Daniel in England or Awn and Ploy in Thailand who reeled in my heart with their smiles, love, and easy acceptance. Gradually, I met their parents who fight every day to create a better future for them, and they too became part of my reason for wanting to stay. All of these people—the children and parents—opened their lives and shared with me. They are the people who have given me the courage to stay and who have taught me so much.

In 1997, after a little more than two years in England, I joined the team of volunteers in Bangkok. In Thailand, the main objective of the FWM is to be a bridge, to make links between the poorest families and mainstream society in order to break down chronic poverty and social exclusion. We worked in two communities: Saphan Phut, a slum community with approximately 65 families, and Bangkok Noi, a group of about 15 homeless adults and children living under a bridge. Very poor families and individuals, even those who are the most broken by the situations in which they live, have dreams and plans to improve their lives. They are the first to want their situation to change, and like Awn, every day they fight to survive. One of their primary concerns is for their children to learn and have opportunities. The FWM’s regular art workshops and outings with the children are a means of establishing relationships with members of the community and working together in trusting, respectful ways.

During my six years in Bangkok, I asked myself a lot of questions about our presence in the face of such extreme poverty. What good are a few books and craft materials when faced with the reality of run-down housing, poor health, unemployment, and hunger? One mother whose children participated regularly in the art workshops explained to me what the Movement meant to her: “Here, there are a lot of organizations who come. They ask us many things and tell us that they have projects for us. But if it doesn’t work, they just disappear. You, you don’t ask us anything, but you are always there.”

“Everything is born from a shared life.”

Insight Out Spring 2005 9REFLECTIONS

as a Fourth World Movement Volunteer

This was the first time I began to understand what the founder of the FWM, Joseph Wresinski, meant by, “Everything is born from a shared life.” We did not give money, and we never fixed their housing problems. But they called us when someone was in the hospital, and we went to visit. When a child drowned, we went down to the river with his mother so she could make an offering to the spirits. We stood alongside families for other important events such as births, ordination ceremonies, first days of school, and visits to relatives in prison. Often we could not do anything, but we could be there.

Even though we did not live in the slum, our long-term presence and activities allowed us to establish links of friendship and trust sufficiently strong for the people in these communities to share their concerns, pains, and joys with us. Such a privileged relationship naturally changes how people act and understand the world around them, and it was a continuous challenge for us to find ways to share this knowledge and understanding with our supporters who could further create bridges between the very poor and wider society. Whether through participation in art activities, meetings, or special events, this “shared life” transforms and brings people closer together. It is these human connections based on mutual trust and respect from which partnerships are built and change becomes possible.

I joined the FWM volunteer corps to put my commitment to social justice into practice. My experiences as a volunteer, and the relationships I have built with Awn, Paa Noi, and many others, have strengthened my dedication to the fight against poverty. As a next step, I am currently pursuing a master’s degree in social work at the University of North Carolina at Chapel Hill. It is a challenge to return to academia. However, I hope to find ways to integrate my belief in human relationships as a vehicle for change with current social work practices and theories, so I may ultimately build better partnerships and ensure the full participation of people living in poverty.

Sometimes it’s hard to see what we are doing or to know if our presence and daily activities make sense in the face of such extreme poverty. Awn’s painting was a precious gift—an expression of a relationship built up slowly over six years, an indication that our presence and the act of “sharing life” can make a difference.

*Pii means older sister in Thai and is used as a term of respect for people older than oneself.

1The FWM is an international non-governmental organization (NGO) dedicated to overcoming extreme poverty. For more information, visit http://www.4thworldmovement.org.

Nicole Kiefer is a graduate student in the School of Social Work.

“Everything is born from a shared life.”

“This ‘shared life’ transforms and brings people closer together.”

“I hope to find ways to integrate my belief in human relationships as a vehicle for change...”

Insight Out Spring 200510 POETRY

Halting HandsMatt Griffith

This poem emerged from reflections on my first experience “in the field.” That is, after my first year of MPH instruction, I attempted to apply what I had learned outside the house—away from the University.

…while rock-throwers assembled arsenals

and lovers tapped halting hands

and TV’s balls flew distractions’ course,

I sang my song;

I sang my song to burst their ears

I sang my song to catch their tears

I sang my song with shotty lungs

and chapped lips and ground teeth

and swollen gums—I sang my song

with academic vacations

and community motivations

to hide frustrations

with me and him and you and them

and in PC’s name

and diversity’s cover

I sang my song

in a language misunderstood

by the audience intended and distended

and extended I did

my privileged hands—in the eyes of another

man another woman and held clout—

with no experience, just a name

of the Flagship and for that was deemed

universally good-hearted,

kind, smart and though

I sang my song with tuneless melodies,

trite stanzas and played-out metaphors

the tired taste wasn’t fried enough

to enter the old wooden doors

of these senior wooden floors

and though I could not sing

they had come, nonetheless,

to teach me the chords

with smiles and wrinkles

and lives sprinkled with

time and vinyl chlorides,

yet never raising fingers

only arms

to rejoice and hug and

teach this boy to sing,

and as I turned to leave

knowing better how to sing

I felt perperplexed

that perhaps per chance

person-to-person I

should not sing per se

but instead should perch the ears

and listen perfectly

to what their songs

have to say…

Matt Griffith is a graduate student in the Department of Health Behavior and Health Education in the School of Public Health.


A Reality CheckBrooke Morgan

I t was the second day in the field for the Student National Medical Association

(SNMA) Evaluation Team (the field being the term used to describe the visiting of a local village in Ada, Ghana). However, Azizanya was the farthest thing from a “field” I have ever seen. The beachside locale featured old fishing boats teetering on the shore’s edge, piglets milling about, and the melodic sounds of a women’s chorus floating softly on the ever-present breeze. Sitting on benches under the palm trees and a cloudless sky, we met to interview a group of young boys and girls. The girls sat together on one side with the boys on the other, and the relaxed nature of

the village became apparent as passersby continued to join our expanding group. Be it by leaning on one another, holding hands or resting a chin on a shoulder, both the boys and girls challenged my notion of personal space. There was no shyness among the girls or boys, but there was a definite boundary drawn between the two groups. While their giggles and subtle glances were familiar, I was struck by their outward display of affection towards each other. The loss of inhibition was a beautiful sight to behold as the youth embraced human contact.

The lack of material possessions was obvious, yet not obtrusive. Although the need for everything from a simple writing instrument to healthcare was apparent, there was something holding these people together in harmony. While living without worldly goods, the village was anything but empty. It was, in fact, full. These boys and girls were aware of resources they lacked, yet they were not bitter because of it. If anything, they had taken their deprivation and used it to empower themselves with love for one another, knowledge of their surroundings, and appreciation for the benefits of a cohesive nature. Their strength of character and fervor for life was beyond impressive. Their lack of assets did not cancel their passion for a fruitful existence.

As I looked into the eyes of these boys and girls and listened to their impeccable English, I was in awe of their zest, their stamina, and their strength. As I observed their interactions with us and with one another, I was amazed at the way they created an electric atmosphere of wonder. Their fearless gumption, juxtaposed with their innocence, was quite a force to behold. Even though I was there to educate and impart my teachings to them, I felt as though it was an uneven exchange; what they gave me seemed above and beyond anything I could ever bestow to them.

In reflection, I only wish I could have captured the spirit of Azizanya and bottled it up to bring back to the United States. Owning all the riches in the world couldn’t match the wealth of these boys and girls. Their material effects are few and far between, but they have something many people are missing. They have a spirit that soars and surpasses the imaginable. They have the belief that their fishing boats, their piglets, their sandy shores, and their touch will bring them happiness. A visit to Azizanya was more than a reality check. It was a priceless gift everyone should be so lucky to receive.

Brooke Morgan is a third-year student in the School of Medicine. In this project, she served as the HIV Intervention and Prevention Corps Site Coordinator Region IV ARD to the North for the Student National Medical Association.

SMNA members with the people of Azizanya.


Rusty and MarshaBenjamin Seo

W hen I first met Rusty and Marsha, I think that they were understandably a bit skeptical about taking part in my project. After all, they did not

know anything about me other than the fact that I was a UNC medical student with the outlandish idea of making an educational documentary about end-of-life care. It probably did not help that, despite being given detailed instructions on how to find their place in rural Fayetteville, I became hopelessly lost, and they had to drive out to find me.

Rusty had been diagnosed with an advanced stage of melanoma and was facing the very real possibility that his remaining time was short. However, he was responding to treatment and had already survived much longer than anyone had predicted. Nevertheless, at the point where his path intersected with mine, he and his wife Marsha faced an uncertain future. When they first heard about my project through Rusty’s physician at UNC, they were not interested. I was not about to press anybody to participate in this sort of project and had, by this point, just about given up on finding an appropriate patient willing to talk on camera.

However, Rusty unexpectedly changed his mind and agreed to allow me to visit them at their home. I had already recorded conversations with people who had experience with end-of-life care either as a caregiver or as a family member, but had not interviewed anybody facing these issues personally. On my way to see them, I was not sure how things were going to go.

This project grew out of my days as a volunteer in a cancer patient support program at another hospital before I entered medical school. My role was to spend time with patients on the oncology wards, many of whom were facing end-of-life issues. I came upon this program by chance and was initially

a little hesitant to sign up. At that point, I had had no direct experience dealing with this sort of thing and was not sure I would know what to say when interacting with someone confronting the stark reality of his or her own mortality. I discovered that on the contrary, it was not too difficult to make a connection with most of the patients I encountered. There existed a sort of purity in our interactions. There were no agendas, just two people in a room sharing in fellowship for whatever time was available. Whether we addressed the person’s illness directly or talked about anything but, there was an underlying awareness that no matter how different our circumstances may seem on the surface, we are all ultimately in the same boat. I think those experiences had a deeper effect on me than I fully appreciated at the time.

The other thing I took away from this time were the stories that many patients told about feeling let down by a caregiver encountered at some point during their experience with cancer. Most of these stories centered around individuals who were probably well-intentioned but were perceived to have acted in an insensitive manner. Later, after talking with a number of physicians and caregivers, I came to realize that many of them felt that learning how to help patients at the end of life had not been a significant part of their training. It seemed a terrible shame for any patient to feel let down simply because his caregiver had not received adequate preparation or exposure. Thus, the seed for this project was planted.

Once I got set up at Rusty and Marsha’s place and started talking with them, they quickly warmed up and became very open to the camera. Perhaps they were reassured that I was

“It is only in the face of death that man’s self is born.”~ St. Augustine

“When they first heard about my project through Rusty’s physician at UNC, they were not interested. “

“Their first doctor opened a medical textbook, turned it around for them to read, and basically told Rusty he only had a few months to live, so he should go home and ‘have a good Christmas.’”


Winner of the “Best Reflection Award”

not completely clueless about what I was doing, or maybe they sensed that I was truly interested in hearing what they had to say and what they had gone through. As it turns out, they had their fair share of horror stories. Their first doctor opened a medical textbook, turned it around for them to read, and basically told Rusty he only had a few months to live, so he should go home and “have a good Christmas.” In addition to having their lives turned completely upside down, Rusty and Marsha had a number of experiences where they felt abandoned by caregivers, their insurance company, and many acquaintances.

On a more positive side, Rusty described a newfound appreciation for life, his family, and the time remaining to him. He talked about how the trivial, unimportant things in life became once again trivial, while the important things in life became more important. He also seemed to have discovered a new zest for life and a sense of urgency. In the previous few months, Rusty had made a point to do things he never would have tried before—like bungee jumping, dyeing his hair orange, getting his ear pierced with his grandson, and going on several trips with his family.

Along with the fact that he was doing well clinically, I think it was this newfound boldness and urgency to spend his time meaningfully that prompted Rusty to change his mind and take a chance on this project. I am thankful that he and Marsha chose to share such a personal experience with me not only because of their contribution to the impact of the documentary, but also because of the lessons imparted to me

personally. It is an old idea, well-delineated by existential philosophy and other schools of thought, that death paradoxically enhances life and infuses it with poignancy and meaning. It is by confronting death that we are often spurred to live a more authentic life. Most of us are familiar with this idea on an intellectual level, but it is human nature to be forgetful and prone to distraction by the day-to-day. In this respect, I am no different than anybody else. But seeing Rusty’s example, sharing in his experience to the limited extent I was able, drove the point home better than anything short of direct personal experience. It is a precious gift to me and to all future students who may watch the documentary some day.

I recently returned to Rusty and Marsha’s home to preview a rough cut of the documentary for them. Rusty had lost a considerable amount of weight but was still his usual jovial, warm self. I told them that an entire class of UNC medical students had seen their segment of the documentary as part of their education. I think it meant a great deal to Rusty and Marsha to see their story presented in this way and to feel that perhaps there was some meaning to what they are going through—that by sharing their story perhaps others might not have to go through similar hardships they have gone through. It has been a unique privilege for me to get to know Rusty and Marsha, to witness and record their story, and to play a role in transmitting it to others.

Benjamin Seo is a fourth-year student in the School of Medicine.

“I am thankful that he and Marsha chose to share such a personal experience with me not only because of their contribution to the impact of the documentary, but also because of the lessons imparted to me personally.”

“I told them that an entire class of UNC medical students had seen their segment of the documentary as part of their education.”

&

Insight Out Spring 200514 PHOTOGRAPHY

The photographs on these pages and on the cover were taken during a UNC Habitat for Humanity service trip to Thailand in May of 2004. Eleven UNC students participated in the trip and built three houses in villages outside of Khorat, Thailand.

Cover photo by Laura Gibson, a senior in the Department of Romance Languages. She wrote, “The village children made quite an impression on everyone.”

The following four photos are by Andrew Shapiro, a junior in environmental science who co-led the UNC team studying in Thailand during the 2004-2005 academic year.

Habitat for Humanity in Thailand

“The Digger”Laura Gibson, stuck in a hole used for installing a septic tank in Thailand. The noonday sun pounds as Laura has another half meter to dig.

“Hole in the Wall”UNC student Katie Robinson smiles at a job well done. With the mortar setting, there is a small break time before the next concrete block is added.

“The Bricklayer”UNC-CH Habitat for Humanity

Thailand leader Brian Hunt gets a last view of the inside of the home

as bricks keep piling higher.

Insight Out Spring 2005 15PHOTOGRAPHY

“The Homeowners”While only Nui (center right) owns the home being built by Habitat in the rural outskirts on Khorat, Thailand, the entire village will call her house home.

The following three photos are by Elizabeth Pratt, a junior in environmental science who also studied in Thailand during 2004.


IcebreakersMelissa Gilkey

As I entered my final semester as a master’s student in the School of Public Health, I knew that there would be one thing that I could count on during the first week of class: icebreakers. Now it may be true that nationally the Department of Health Behavior and Health Education is known for its emphasis on community-based research, but among master’s students within the halls of Rosenau Hall, it is known for icebreakers. And while I have done my share of eye-rolling when asked to draw my personal mandala or to form a human knot, I have to admit to having become rather fond of these little trials over the past year and a half. For all their silliness, icebreakers are, after all, a chance to form bonds with people, and if these bonds are largely based on shared annoyance toward the facilitator, it seems like a small price to pay.

So this semester, on the first day of a class I expected to be challenging, I was not surprised to be presented with crayons and asked to draw a picture of my favorite place. I dutifully set about sketching a scene that I hoped would reveal me to be someone who was well-traveled yet down-to-earth, discerning yet optimistic, clever yet accessible. As we went around the room offering introductions and interpretations of our work, I noticed that I, like almost everyone else in the class, had drawn a tropical, faraway scene, a place I visited rarely and knew fairly little about. Certainly, the attraction to natural beauty is strong, but even so, why wasn’t my favorite place the Nook Snack Bar or the running trail behind my apartment or any of the other places that I go on an almost daily basis when I need a

break? Are we really so discontent with our daily lives and so estranged from our favorite places? The answer, I imagine, is no; we are simply so accustomed to our routines that, good or bad, we rarely give them much thought and turn our attention instead to the dramatic and novel. Who would have guessed that a seemingly trivial icebreaker of crayon drawing would be responsible for bringing such a profound insight to light?

I believe that the same phenomenon I discovered through my icebreaker experience is often at work in our conceptualization of community service. At the very mention of the words, our thoughts turn to exotic places and extreme circumstances. I know that as I scan my resume for clues to my future employment, I have to smile at these tendencies in my own work. As a native of a small southern town, what was I looking for in West Africa or the Sonoran desert or San Francisco? What did teaching English or community gardening or classroom cooking really have to do with service?

As countless others before me, I have come to the realization that service is based not so much on location or content, but in the possibility for interaction between people. I believe that we find value in community service work because it is one of very few opportunities we have to form meaningful relationships outside of our own, socially prescribed worlds, and this desire for escape, often unrecognized, is the reason that we so often find ourselves packing our belongings, changing our addresses, and buying unconscionably expensive plane tickets.

My intention is not to criticize traveling, but rather to wonder for a moment if it is still necessary for me. If what I wish to overcome is rigid structure, there is surely as much work to be done in a small southern town as anywhere else, and perhaps it is only my routine and not my address that needs changing. Perhaps as I consider my future work, my focus should now shift from what I will do and where, to who I will meet and how. Perhaps I will need my HBHE icebreakers after all.

Melissa Gilkey is a second-year MPH student in the Department of Health Behavior and Health Education in the School of Public Health.

SPRING2005CH

APEL H

ILL, NORTH CAROLINA, U.S.A.

SPRING2005

Insight Out Spring 2005 17POETRY

This poem was written as I saw the beautiful faces of the village children in Humjibre, a small rural village in western Ghana.

so many

children

clamoring

for

morsel of love

bite of attention

nourishment in hearing

“You”

“You are”

“You are someone”

“You are someone great”

maybe I am here

simply to make them smile

and in doing so

feed us both

This poem reflects the joy in seeing young people begin to believe in themselves as they create change in their community. My work in Humjibre, Ghana was with teenagers enrolled in a camp “Empowering Youth to Health” where the students chose an extensive clean-up and education project that would make their community healthier. They began to see their abilities and potential as they spoke in public and prepared to lead the clean-up. On the big day, they gathered and organized the village’s children to assist in cleaning the town’s street gutters. Their pride in their work, and in themselves, glowed in their smiles.

Cleaning streets’ gutters we stooped swept shoveledothers stared standing startledIn a week’s time leaders had begun to sprout, Speaking to community’s leadersannouncing to their churchesmaking signs and “homemade” trash bins

There is joy at being close to the soil as it breeds germinating seedsAnd though they have only begun to break soil’s surface,I already see grand trees in their faces


Soul FoodAnthony Fleg

Seeds of ChangeAnthony Fleg

Gutter at edge of street.


ENNEADJonelle Grant

The idea of four students and a dedicated professor Birthed a group of nine. A group of nine Propels a group of over thirty-five To promote oral health, Improve quality of life, And help eliminate oral health disparities. This is our call to action. This is ENNEAD: Dental Volunteer Society.Jonelle Grant is a tiird-year student in the School of Dentistry and is the co-founder of ENNEAD Dental Society.


One American’s Tsunami StoryMelissa McMahon

T wo of my senior year college roommates were married on December 24, 2004 in Colombo, Sri Lanka, and I was a delighted guest. The bride’s

parents had arranged for an overnight trip, starting the next day, to a beach a couple of hours south of Colombo in a town called Bentota. On Christmas day five of us—Nora, Danielle, Penny, Ron and I, all friends from college—piled in a van and headed south. Our hotel, called Ceysands, was a two-story building directly on the beach and separated from the mainland by a river about 100 meters wide. We took a small boat across, checked in, and spent a pleasant evening swimming, sitting beside the beach, watching the sun set, having a nice dinner and laughing at the cheesy American music played at night over the sound system. Our rooms were on the ground floor facing the ocean, with floor-to-ceiling windows and sliding glass doors.

The next morning we woke up early for breakfast, which, we were told, would be over by 9:30am. After breakfast we changed to swim and were standing outside our rooms talking about the morning when we noticed the tide. The seawater was lapping up against the vines that marked the inland side of the beach. The night before, the water line was at least 15 to 20 meters further out. We thought it was strange, and watched as the water crept up through the bushes to the small path between the beach and the hotel property. We continued to watch as the water reached the fence that marked the edge of the hotel grounds, and it began to seep in onto the lawn and under the lawn furniture. We asked the people around us if they had ever seen anything like this before. Some of the hotel guests stood in the water ankle- and then calf-deep, watching in amusement. One man stood in the water recording with his video camera. Our group of five had moved from the grass up a set of outdoor stairs, a few feet above the water, to watch.

No one recalled ever having seen anything like this before, and no one at this point had heard anything about an earthquake. We made guesses that this could somehow be caused by the moon, like a very high tide. After barely reaching the doorways of our first-floor rooms, this tide went out again. It was a remarkable sight, because the tide went out farther and faster than I had ever seen a tide recede in my life. Soon, it was hundreds of feet from the line of brush that marked the back edge of the beach, hundreds of feet further than it had been the night before. A few of us darted into our rooms thinking in a practical way that if the water did begin to seep into our rooms we would want our belongings up on our beds and shelves, not sitting on the floor. After moving most of our stuff up a couple feet, we ran excitedly back out to the beach to watch the water. On our way out to the sand, we stopped to speak to a local man who was walking along the path near the fence in front of the hotel. We asked him specifically if he had ever seen anything like this before. I was quickly distracted by the marks the water had left behind in the sand, but I caught him saying that he thought the tide would come back, and it would come back stronger than the first time.

Looking back on it, had we heard what he was trying to tell us and not what we expected to hear, we might have done a few things differently from this point on. What he had told us was that the tide would be back very soon, and it might be very high. What we heard was perhaps the next regular tide of the day will also be high like this one, and many hours later it might begin to flood the lower rooms of the building. Given the story that we thought we heard, we all proceeded to walk out on the beach, along with a number of other tourists, to explore the changes the water left in the sand. We even tried to help some fish find their way back to the ocean. The possibility that the water would come back soon never really entered our minds. It was fascinating and exciting, but not scary. Fifteen minutes later, however, the first waves began pulling the tide back in, and we turned back to the hotel. The tide was moving inland about as fast as we could jog up the beach.

continued on page 20

“No one recalled ever having seen anything like this before, and no one

at this point had heard anything about an earthquake.”


We hopped up the stairs on which we had retreated during the first tide, and this time almost all the hotel guests and staff had done the same thing, many watching from their second-story rooms. This time, the water poured through the fence and tore it down in many places, picked up the lawn furniture, and flowed quickly up to the first-floor rooms. Instead of diverting around the pool, this time the salt water flowed right into it, filling the sparkling blue with a murky brown and with many of the nearby chairs and bushes. It was absurd and exhilarating, and strange because all we could do was watch. We looked toward our room while the water filled the walkway two feet below the lawn, churning and filling up against the sliding glass doors.

At this point there is a gap in my photo journal of these moments. All I could physically do at the time was watch the glass doors of our rooms and repeat in my head, “Please don’t break. Please don’t break.” Less than 10 minutes after the tide had turned, the water against the first floor of the hotel was too heavy for the doors to withstand and one by one they burst inward with a crash. I would call this one of the low points in our day because, while we had thought that water might get into our rooms, this was unimaginable. Our first thoughts were for our plane tickets, passports, and money, most of which were somewhere in the water in those rooms, now three to four feet high against the walls. The water crashed and swirled with such power, I had this sinking and sickening feeling that our papers were completely lost. I remember feeling both horror and excitement, and happy that I was watching from above, safely out of our rooms and dry. My photo journal picks up again minutes later when the water began to recede again, but I only got a few more photos before I decided I needed to try to find the important things in our rooms, if anything was still there at all.

Soon after the water subsided, we saw a man wading out of the wreckage of his first-floor doorway. Amazingly, he and his wife were in their rooms when the water came through, and while he sustained a rather nasty gash on the top of his foot, they were stunned but okay. Before we could move, many hotel staff were already in the water, barefoot, helping the man up the steps and taking stock of the situation all across the property. I decided that since I was wearing my Chackos sandals I was dressed much more appropriately than the staff to be walking in that water, so I walked over to our rooms for whatever I could find. With the water already receding, some of our things were floating out of the room. As we saw these things, we snatched them up and handed them to people on the stairs. The hotel staff was able to help me with one suitcase before whistles started to signal that the tide was coming back in. I ran back to the stairs to wait, and then I repeated this procedure with Ron’s help until, a few “tides” later (maybe 30 minutes), we had retrieved most of our belongings. We were very lucky; four of us were able to recover the majority of our things, waterlogged and muddy, but mostly intact. Nora, however, lost virtually everything. We searched the room multiple times, but of the things I was able to retrieve for her, I found most crammed into the bathroom at the back of the hotel room, under pounds of mud and pieces of wrecked furniture.

While this sounds like the end to the story (and we thought it was, too), the next three to four hours we waited anxiously for boats to evacuate us. A river still separated the hotel guests and staff from the mainland, and in the first large surge of tide that broke the doors to our rooms, the river also swelled and washed away or destroyed all the boats that belonged to the hotel. This was also about the time when we overheard stories that an earthquake had hit near Indonesia and was the cause of it all. Amazed and tired, we lugged our soggy suitcases upstairs to the second-floor restaurant to get them out of people’s way.

The highest tide we saw wasn’t in fact the one that broke all those doors and windows, but one that came some time afterward. It is kind of funny now to see the photos we took of us in the restaurant smiling as a group, smiling because

Tsunami Story continued from page 19

REFLECTIONS

“All I could physically do was watch the glass doors of our rooms and repeat in my head, ‘Please don’t

break. Please don’t break.’”


we thought we had seen the worst of it and the rest was just a long wait until we could leave. Shortly after our group photos, the tide came in again, and this time it reached almost to the eaves that mark the transition from the first to the second floor. That wave crushed my confidence that we had seen the worst of it, and as a group, we began to contemplate what our options would be if the water reached us before help did. Our biggest problem was that Penny couldn’t swim, and while many hotel guests and some staff had managed to get their hands on life preservers, we didn’t have one for Penny. Realistically we had no hope of being able to hold on to her while crossing the river. We sat around a table thinking about this, poking at food, pushing away water, and I tried to ignore the nauseous feeling in my stomach. I mentioned wanting to do something productive, to keep my mind occupied, and Nora became really upset at me for not being able to just deal with it. Every single one of us was on edge. I couldn’t speak, really, or look her in the eyes, so I got up and left the room.

I spent most of the time that followed sitting silently with Nora out on a roof patio on the river side of the hotel, watching to see if anyone came with boats to help us. For me the river was easier to watch than the ocean, less unsettling, but it still wasn’t a pretty sight. The height of the river fluctuated with the tides from the sea, and it was full of trees, pieces of boats, chairs, barrels, and other debris. Further down the river, we could just see a whitewater area where the ocean had broken across the peninsula, making a new inlet. Danielle and I had walked that stretch of public beach the night before. Sitting there, Nora and I heard what sounded like thunder, but after asking the staff who sat nearby, we were told that it was the sound of buildings

collapsing. Soon a cloud of dust stretched out across the river to confirm it.

A few hours later we started seeing small boats on the river. That moment felt like waking from a dream, blood circulating again, my mind able to focus. We talked as a group, and Nora and I agreed that we would try to get across the river on a boat first because Ron and Penny wanted to stay with the bags. Danielle decided to stay with them. It would be Nora’s and my job to try to find our van and driver when we reached the other side. The hotel staff were extremely efficient and helpful getting women and children on the boats first, though I was shocked at the number of hotel guests who tried to carry their large suitcases with them immediately, with no regard for other people who needed to get across. They lined up on the river side of the hotel, piling their international-sized luggage in the walkways and talking, forgetting that every 10 minutes or so the tide would surge again and wash all the way up those very walkways.

The story ends with all of us making our way across the river by boat, our luggage coming later. It’s hard to describe the feeling of having my feet touch land on the other side. Amazingly, our van and driver were waiting right there for us, and he had been in touch with the wedding families to update them on the situation. Soon we were on our way, a four- or five-hour van ride the long way back to Colombo. (The fast road had been washed away by the sea.) We were fairly quiet and numb in the darkness, moving to get comfortable, Danielle and Ron sharing energy bars they had packed that had made it through the water unscathed. We arrived in Colombo around midnight, a dry, 33rd-story hotel room beckoning far above the ocean. Melissa McMahon is a graduate student in a dual degree program in City and Regional Planning and Health Behavior and Health Education.

“The tide came in again, and this time it reached almost to the

eaves that mark the transition from the first to the second floor. That wave crushed my confidence that we had seen the worst of it.”

“A few hours later we started seeing small boats on the river.

That moment felt like waking from a dream.”


T he paradigm governing aid to poor areas of the world has recently shifted, but for parts of the world that once suffered colonial rulers, huge obstacles still exist. Unfortunately, many inhabitants and rulers of poor areas learned poor habits and attitudes from either

their former colonial rulers, or the cultures birthed from an often not so pleasant mixture of tradition and colonization.

What did colonialism teach them? It taught them that most people have no value, that few are to be trusted, and that when trust is given, it is based not on character or achievement, but on some other trait such as skin color or political connections. They also learned that to get ahead one must lie, cheat or steal, because experience has shown them that hard work, kindness, and integrity count for little. Tough lessons and, unfortunately, millions of adult men and women who should rule their own destinies feel like helpless victims as a result of such a history and the leaders it often fosters. While this feeling may be justified, it cripples a person’s self esteem and stifles one’s drive to improve one’s own life. This can be seen in the constant brain drain of trained professionals and scientists from poor areas of the world. More unfortunately, aid to developing countries has traditionally taken the form of doling out food and necessities and has perpetuated and encouraged the victim mentality in people who need a different kind of help.

The new paradigm arising in the development community emphasizes the need to empower people who were once victims. Empowering people means teaching them how to better their own lives, those of their families, and those of other community members. This strategy contrasts with previous patterns of giving people the things we (or they) think are necessary for bettering their lives. The former is sustainable; the latter is not, because the world will not always be in a position or of a disposition to give in support of the needs of others. There is not enough being given now to keep people from starving or dying of preventable diseases. The ‘new’ idea is to help people gain the knowledge, practice and confidence to change their own lives, communities, and, eventually, countries. The result is not only a better lifestyle (also a possible result of giving stuff ), but a

better life more under the individual’s control. Importantly, material aid alone encourages people to think of themselves as victims, which is ultimately very bad for self-esteem and leads to the need for perpetual, unsustainable aid. People lose confidence in their own ability to make positive change in their lives.

As a Peace Corps volunteer in Guatemala, I saw first hand the danger and damage that aid based on giving away material aid could do. Some of the people I tried to help through teaching and example

were only interested in the things (food, money, equipment) I could give them. While I was working in partnership with CARE, our local coordinator told us stories of going into villages and starting work, only to be expelled when another agency came in and offered more supplies, money, or infrastructure as an enticement. The more work an agency has, the more people it can employ, which leads to more responsibility and, possibly, pay for the managers. Obviously, the result can be counterproductive competition, instead of productive cooperation, among agencies.

A New? Perspective on Development and AidJohn Reed

“...aid to developing countries has traditionally taken the form of

doling out food and necessities and has perpetuated and encouraged

the victim mentality in people who need a different kind of help.”

“The ‘new’ idea is to help people gain the knowledge, practice

and confidence to change their own lives, communities, and,

eventually, countries.”

continued on page 22

OUTLOOKS


As an aid organization, the Peace Corps, laudably, is only involved in teaching and working within communities. Therefore (as I tried to explain to my neighbors and friends) I did not have anything to give them other than my own knowledge, hard work, and friendship. My service involved teaching soil conservation, composting, and crop variation to farmers. It was immensely rewarding to watch, over time, as farmers gained confidence in their abilities to master new techniques that would lead to improved yields and more healthy land. Unfortunately, much of the Guatemalan population still lacks the confidence and knowledge required to change their own lives for the better.

In spite of the much-needed paradigm shift, instances remain where donations of food, medicines, and infrastructure are entirely appropriate, particularly in the case of emergency disaster relief, or aid directed solely towards children. While working with USAID (US Agency for International Development) in Mozambique, I became aware that, although the practice of giving stuff away as a means of aid in development was waning, it was not dead, nor should it be. During the terrible floods in 2000, the necessary exceptions to this general paradigm shift crystallized. Even if all aid agencies changed their perspective and practiced an educational or partnership role in helping others, natural disasters and war would often stifle development progress by throwing populations into a state of panic and desperate need, requiring them to battle for immediate survival without regard to what might be in their, or their children’s, long-term best interests.

Mozambique’s floods wiped out housing, transportation and crops for hundreds of thousands of people. How can an aid organization ask people to work with them at the same time victims are scrambling to feed and find housing for their families? The floods in Mozambique were so extensive that people often could not even see land and were forced to live in trees for weeks. One famous scene was of a woman who had recently given birth in a tree handing her newborn baby to an aid worker in a helicopter. Would a woman or her family living in such circumstances be amenable to educational aid? More importantly, would it really be of any value to a population in such dire circumstances? A similar argument applies to aid directed towards children. As children mature they must take on growing responsibilities, but children cannot be expected to provide everything for themselves.

The intellectual and ethical foundation upon which aid to the poor is based is gradually shifting to more of a partnership role as the world realizes it can either help perpetuate a victim mentality among the underprivileged or it can help them be productive, happy, informed members of the world community. I believe it is obvious which strategy is better for everyone.

John Reed is a first-year student in the School of Medicine.

A New? Perspective continued from page 22

“How can an aid organization ask

people to work with them at the same time victims are scrambling

to feed and find housing for their families?”

“I became aware that, although the practice

of giving stuff away as a means of aid in

development was waning, it was not dead,

nor should it be.”

OUTLOOKS


D uring the hot, lazy summer days of my childhood, I vividly remember leaning back in

an old lawn chair under the shade of the dogwood tree and propping my feet on a nearby stump. There I would lounge sometimes for hours at a time, letting my thoughts drift back to another time, as I listened to the southern drawl of my next door neighbor telling me story after story of “the good ol’ days.” I heard about the hard days of the Depression, when food was difficult to come by and money was scarce. I imagined the echoing sounds of hound dogs hot on the trail as I heard a narration of an exciting night of coon hunting. These were the stories of a man who had seen the world change and grow for better and worse over nearly a century. For me, this was a priceless glimpse at the colorful history and strong roots of another generation.

Over the years my neighbor’s health slowly deteriorated, and my family began to take on an increasing role as his primary caretaker. Having heard so many anecdotes of strength and survival through life’s hard times, I found it hard to cope with the fact that this man and his wife were now becoming so dependent on us for even the simplest of everyday tasks. The next five years were a struggle as my family members attempted to balance our lives with taking care of my neighbors. It seemed that we were the only ones there to help them. They could not afford home healthcare or assisted living, Meals on Wheels did not deliver to our rural neighborhood, and they had no family to care for them. I found myself wondering how it could be that society could simply ignore people as they grew old. The simplest of interventions could have made a huge difference for this couple. They needed a railing on the stairs to prevent falls, someone to sort through their many confusing medications, and a helping hand to find community resources. But these things were not available.

I took from this experience two important lessons that have stuck with me to this day. First, I now realize that everyone has a story, an intricately woven history that makes each of us such a unique individual. Only through listening to these stories will I ever truly begin to understand who a person is. Second, it is essential for a society to embrace and care for its weakest and most vulnerable individuals. Unfortunately, the number of individuals who slide through the cracks of our society’s feebly created safety network is growing exponentially today. Many people, like my neighbors, live on fixed incomes, oftentimes alone, in unsafe environments, and without transportation to access the outside world. One of society’s biggest challenges in the coming years will be to find a way to provide adequate care for these individuals.

Healthcare professions provide the extraordinary opportunity to live out both of these lessons, to hear people’s stories and to embrace and care for patients when they need help the most. As a first-year medical student, though, I began to find that the daily routine of lectures, books and tests had begun to wear away at this passion that had attracted me to medicine in the first place. I began to search for an experience that could fill this void.

I found such an opportunity with a relatively new, student-run organization called Mobile Student Health Action Coalition, MSHAC. MSHAC’s mission is to improve the lives of the community’s most weak and vulnerable individuals. By March of my first year, I had been selected as the program’s general coordinator. It was time to get to work.

TAKING ACTION

Listening: The Best MedicineAndy McWilliams

Volunteer and friend.

Insight Out Spring 2005 25TAKING ACTION

Over the next few months, I began to make the many phone calls needed to contact all of the old MSHAC patients and the new referrals. I had expected each of these calls would be brief, getting either a yes or no from each person, and then moving on to the next. Instead, I spent hours on the phone, listening as each person I called related to me his or her joys, sorrows, and needs. As I jotted notes and corrections in the medical charts, I felt the passion of why I was here begin to return.

MSHAC currently combines the knowledge and energy of over 95 volunteers from UNC’s six health professional schools to serve the needs of 17 patients in the

Orange County community. Four to six students work together on a team that is assigned to one of these patients for the entire school year. Teams were challenged to accomplish three objectives: learn to work together as a team, build a personal relationship with the patient, and in some way make a difference in the quality of that patient’s life. The caring, compassion, and vision that the teams have put forth thus far have been exceptional.

Taking advantage of the rare opportunity to work with other disciplines, team members quickly learn the challenges and benefits of working on an interdisciplinary healthcare team. This year teams have impacted many aspects of their patients’ lives. One team instructed their patient on how to better control her diabetes by giving her dieting suggestions and making trips to the grocery store with her. Another team has played an integral role in helping their patient become established at an adult daycare. She is now no longer stuck in her home all day long. Many teams are regularly bringing

their patients dinner or taking them out to eat—something that often becomes the highlight of the patients’ weeks. Others have done such things as building a new deck, purchasing blood pressure cuffs and diabetic monitors, and assisting with yard work.

Through these experiences and developing relationships, volunteers learn the depth and complexities of each patient’s life, complexities that are so often missed from the confines of an office. In the future, we must remember: as we diagnose and prescribe, many of our patients will return home to a place where they cannot afford food much less the five prescriptions just given to them. The only way we can know is to ask, and the only way to truly treat a patient is to hear his or her story. May we as future healthcare professionals, as a community, and as a society never forget to care for those who need it the most. And remember, take that extra minute to stop, sit back, and simply listen to our patients.

More information about MSHAC can be found at www.med.unc.edu/shac.

Andy McWilliams is a second-year student in the School of Medicine.

“As I jotted notes and corrections in the medical charts, I felt the passion of why I was here begin to return.”

“The only way we can know is to ask, and the only way to truly treat a patient is to hear his or her story.”


Service in South AmericaMatt Saldana

Stacey Isaac

“When life serves you lemons, make limonada!” Luis Fernando (center of picture) works on the streets of Santa Cruz, Bolivia washing cars and bus windows. Here he shares some lemonade that he made with two friends.

Stacey Isaac is a second-year graduate student pursuing a Master’s of Public Administration.

I took this photo while volunteering as a music teacher at Jesus El Buen Pastor school in Quito, Ecuador

during the spring of 2004.

Matt Saldana is a junior majoring in Latin American Studies.

Insight Out Spring 2005 27OUTLOOKS

Two Worlds in OneAnthony Fleg

This piece comes from my months of struggling with the inequalities that I saw in Ghana. Service forces me to fight with issues that are less cozy and touchy-feely, to fight with the hard questions of “Why are things as they are?” and “How can I do something to change things for the better?”

What would you do for a handful of rice?If you live in the USA, you might give a penny or two, if you had not eaten recently.If you live in this African village, you might steal for it or fight others for it because you would not have eaten recently.

What would you do for a cup of clean water?In the USA, you would first check to see if it said “Aquafina” or “Crystal Geyser” before taking a sip.In this African village, you would look for things crawling or floating in it, and pray that it is safe.

What would you do for a pair of shoes to wear?In the USA, you would choose the style you like and head to the mall to get a pair or two.In this African village, you might share a pair of third-hand shoes with a friend, though you probably would stay barefoot.

What would you do to go to high school?In the USA, you would joke about the alternative: not having to go at all.In this African village, after failing to collect the $20 required entrance fee, you would vow to do anything for the opportunity.

What would you do to prevent yourself from getting malaria?In the USA, you would avoid visiting the “developing world.”In this African village, you would pray after each mosquito bite.

What would you do if you got HIV?In the USA, you would quickly get on medications and hope to live for two to three decades before developing AIDS.In this African village, you would let the virus take its toll.

What would you do to be truly happy?In the USA, you would find family, friends, balance and harmony.In this African village, you would find family, friends, balance and harmony.

We are two worlds in one.



Instructions for Contributors

Submissions for Insight Out may take the form of essays, poetry, photography, art, and other creative works inspired by community service. All text should be submitted in hard copy with accompanying Microsoft Word file on diskette. Recommended length of entries is 1000 words maximum for essays and 250 words maximum for letters to the editors. For photographs, glossy prints are preferred. Each submission should include a cover sheet with the contributor’s name, address, telephone, e-mail address, year in school, and field of study. Interested contributors should contact:

University of North Carolina at Chapel HillCB# 3142Chapel Hill, NC 27599-3142919-843-7568

The publication of Insight Out is made possible by the following contributors.

Department of Allied Health SciencesGraduate and Professional Student FederationStudent CongressWhitehead Medical Society of the School of MedicineUNC-CH Medical Alumni Loyalty Fund

InsightOut

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