Into Africa...
Aaron Baca
Global health expert Karen Gieseker goes to great lengths to make a point. Really great lengths. For instance, when assistant professor Gieseker was teaching Institute of Public Health students last spring about community-based health care interventions, the former Centers for Disease Control and Prevention epidemiologist could have staged a classroom demonstration. She could have shown a movie or displayed any of the hundreds of photographs she's collected through years of doing field research in desolate corners of the planet. Rather than bring a lesson to her students, Gieseker takes her students to their lesson whenever possible.
Last spring, that meant traveling to Tanzania in the southern hemisphere of eastern Africa. There, in a deeply impoverished country where electricity is often a luxury, running water is a myth and infant mortality rates rank among the highest in the world, Gieseker found the perfect laboratory for her students.
"I'm taking students over there to open their eyes because until they've ridden in a car for three hours on a road that's not even a road or walked into a health facility that's pretty much only a bare concrete floor, then they dont understand health.
"We as westerners don't always understand the challenges and the value in what we're trying to accomplish in health. Actually going to these places that brings it very close to home," Gieseker says.
Helping people help themselves
Gieseker led her team of four graduate students to northwest Tanzania for three weeks in February and March to cap off a two-year project to determine the success of an older intervention program that was designed to improve the health of the country's mothers and their babies.
Atlanta-based CARE International and the CDC managed that program, and, from 1997 to 2002, the organizations trained village health care workers, improved medical facility conditions and even recommended changes to the area's transportation infrastructure.
It's the very same type of thing Gieseker trains students to do every year. It is the same kind of work for which public health programs like Georgia State's were organized in the first place.
"It's like the whole thing about giving somebody a fish or teaching them how to fish," Gieseker says. "It's complex work. There are many components to making something work. But the overall goal is to transfer this knowledge we've built up in an effort to improve our global health.
For the Tanzania project, as it came to be known around the Georgia State campus, Gieseker obtained funding through the Georgia State Research Foundation and CDC to take a team of her graduate students to Africa to do nuts-and-bolts documentation and evidence gathering so that researchers could evaluate the earlier CARE/CDC program.
Investigators from the CDC shared some duties but headed to different areas of Tanzania. That left the chore of collecting data in several remote villages up to the Georgia State team.
CARE and project officials picked the four students Jamie Davis, Karen ChoCho, Adam O'Bryant and Dawn Arlotta after reviewing applications submitted by students interested in participating in the project.
Gieseker, who has done previous work in Tanzania through the World Health Organization, says she seized on the chance to include students when she wrote the grant proposal more than two years ago.
"This was an opportunity to do some great research and to train students in the field," Gieseker says. "It fit in with everything I've always tried to accomplish."
'The real and pretty harsh world'
Gieseker traveled to Tanzania to conduct preliminary work in 2006. But it was Gieseker's return trip earlier this year that raised eyebrows when the team began publishing excerpts about the trip in a series of Internet blogs.
"We went on this trip to do research, but in the end it turned into a more personal analysis where we probably learned just as much about ourselves," says ChoCho, one of Gieseker's four graduate student team members.
"When I came back [to Atlanta], there was just all this enthusiasm and excitement. You learn how to make sense of things when you're thrown smack in the middle of a different culture because you have to react immediately when you're in it. It was inspirational. It changed my life," ChoCho says.
During their travels in Tanzania, the Georgia State team's primary mode of transportation was a set of CARE-owned utility trucks, which carried them along dirt paths into the farthest reaches of the Tanzanian bush. In all, the group collected research data in nearly two dozen health clinics, medical dispensaries and villages.
Although a report of their work is still being compiled, the team ultimately found that the effects of the CDC/CARE program are waning in some places.
The obstacles Tanzanian women and their children face are nothing short of monumental when compared to the experience of American women and children. Women often give birth with no attending doctor, nurse or midwife. Those who do seek medical attention are often stopped short in their travels because of a near complete lack of transportation.
The CDC/CARE program, when it was started, recommended changes that could improve the care women and newborns receive, but cultural differences between the West and rural Africa often throw up other roadblocks.
"It's frustrating because you want to look at this research and figure out where we can do something differently to make things stick," ChoCho says.
Gieseker says despite what the research data may show, it is with continued study through projects like the Georgia State visit that change may ultimately occur.
"Just our being there and asking certain questions gets people [in the affected communities] thinking differently about how they do things," Gieseker says. "It's up to us to figure out the best way to approach a different culture to make community-based changes work."
Gieseker, however, says the successes of the team's venture into Africa go beyond the villages of Tanzania. She says Tanzania and similar research projects return profits that can't be measured immediately in how they change the students who participate in them.
"Ultimately what I want to do in my classes and with a project like this is open my students' eyes," Gieseker says. "They have to realize the world is not black and white. I can never accomplish in one of my classes all of the teaching that goes on when you do public health out in the open, in the real and sometimes pretty harsh world."