Orrin Luc posted an articleIn 2019, Peace Corps Response launched Advancing Health Professionals. Then the pandemic hit. see more
In 2019, Peace Corps Response launched the Advancing Health Professionals program. Then the pandemic hit.
By Sarah Steindl
Advancing Health Professionals (AHP) is designed to strengthen health systems in five countries. Photo courtesy Peace Corps
Bolstering public health in communities where Volunteers serve has been part of Peace Corps since the beginning. In 2019, under the aegis of Peace Corps Response, the agency launched Advancing Health Professionals (AHP), a refocused effort to train healthcare professionals and improve healthcare systems in the African nations of Malawi, Tanzania, Uganda, Liberia, and Eswatini. The program came online just months before COVID-19 swept the globe. Healthcare disparities were exacerbated, scarce resources further stretched.
The value of AHP — to improve healthcare education and strengthen health systems at a societal level — became even more pronounced, notes program manager Dawn Childs. “The pandemic highlighted the need to help the countries grow their programs,” she says, “so that they can educate more nurses, pharmacists, and more physicians.” Yet the pandemic also interrupted the AHP Volunteers’ in-person work, as they had to be evacuated from their sites around the globe.
A training session with Advancing Health Professionals, Malawi — a program Towela Nyika has managed since 2018. Courtesy Peace Corps Malawi
For Volunteers with AHP, there is no age limit, nor is prior Peace Corps experience required. AHP staffs non-clinical assignments with individuals who have backgrounds in medicine, nursing, pharmacy, mental health, pre-clinical education, healthcare administration, healthcare services delivery, and midwifery.
“There’s going to be another pandemic in our lifetime. We’re one connected world. So we’re going to have to be a global program, strengthening health systems.”
— Anna Vecchi
Childs has worked with the Peace Corps agency for a short time, but she brings extensive experience in Africa with the CDC and the U.S. military. One member of the AHP team who brings experience as a Volunteer is Anna Vecchi, an outreach specialist who served in Malawi 2015–17. After that, she served as national malaria coordinator for Peace Corps Response in Malawi 2017–18.
“It’s the transfer of knowledge that the AHP program highlights,” Vecchi says. Along with bringing technical skills, Volunteers lean hard on their abilities as communicators, teachers, and students — learning about communities where they’re serving and how local healthcare systems work.
More broadly, Vecchi says, “It’s not enough to think in terms of public health. From now on we need to think in terms of global health. There’s going to be another pandemic in our lifetime. We’re one connected world. So we’re going to have to be a global program, strengthening health systems.”
This is part of a series of stories on and by Crisis Corps and Peace Corps Response Volunteers and staff who have served in the past 25 years.
Orrin Luc posted an articleInsights from the program manager for Advancing Health Professionals in Malawi see more
Peace Corps Staff in Malawi (2013–present)
As told to Emi Krishnamurthy
I began with the Peace Corps in 2013 with the Global Health Service Partnership, a public-private partnership to place healthcare professionals as adjunct faculty in medical and nursing schools. When that program ended in 2018, I helped start Advancing Health Professionals, which combines volunteer work with strengthening health systems. In Malawi, we bring in highly skilled health professionals from the U.S. who work with institutions of higher learning, training the next generation of health workers. We focus on bridging health theory into practice, and promoting skills and quality health services.
Healthcare is a huge need in many countries in sub-Saharan Africa. In Malawi, our few healthcare workers are always overworked and overwhelmed. Now we have COVID-19 in the mix. AHP enables us to work with institutions training healthcare workers — nurses, pharmacists, medical doctors, lab technicians — and to develop skill sets to offer better services to the population.
Towela Nyika, center front — program manager for the Advancing Health Professionals program in Malawi. Photo courtesy Peace Corps Malawi
In colleges, COVID-19 has presented a challenge to how classes operate. Volunteers have helped students find research portals and download videos. Internet access is slow, so pre-downloaded material is like gold. Institutions are embracing technology, but students may not be able to afford laptops or don’t have enough data to join a class online. We’re discussing creation of a digital library. If a student has a smartphone, they might be able to tap into hundreds of thousands of videos, PDFs, research papers, and other resources without needing internet access.
When Volunteers leave, they often say, “I have learned much more than I taught.” There’s a lot to learn professionally, culturally, and socially. Volunteers work in an environment with limited resources; they have to get creative to deliver quality lessons. They make lifelong friendships. I can’t wait for the Volunteers to come back. I would love to see AHP grow. Ultimately, we are trying to achieve health for all.
Students work with a Peace Corps Response Volunteer in the Advancing Health Professionals program. The goal: health for all. Photo courtesy Peace Corps Malawi
This is part of a series of stories from Crisis Corps and Peace Corps Response Volunteers and staff who have served in the past 25 years.
Pandemic Lessons: A nurse in the nation’s capital see more
Pandemic Lessons: A nurse in the nation’s capital
By Rose Conklin
Illustration by Maria Carluccio
The end of March, April, we were getting hit hard with COVID in Washington, D.C. It was really still an unknown illness, but it was everywhere. I had started a float position as a registered nurse at George Washington University Hospital, working on the medical surgical units and in the ER, sometimes helping out ICU nurses, wherever they needed me most. I was on the COVID medical surgical floor a lot of shifts in those months. A lot of nurses were scared in the beginning — having to put on the PPE and wear a mask the whole day, not something we were used to doing before the pandemic.
Like many working with COVID patients, I was worried about my family — my partner and our daughter, who was three at the time. We were living in a one-bedroom, one-bath apartment. A doctor I worked with told me about someone with Airbnb in our neighborhood; she hadn’t been able to rent it out, and she wanted to help. Another nurse and I took her up on it. Deciding to move away from one’s family during a time like this is a very personal decision. We were there for five weeks.
I didn’t really see my family much during that time — because of concern that we could get COVID and be asymptomatic, then pass it on. It was hard, not seeing my daughter except through FaceTime and in a socially distant way. She couldn’t hug me, and I couldn’t hug her.
It was hard, not seeing my daughter except through FaceTime and in a socially distant way. She couldn’t hug me, and I couldn’t hug her.
By the end of those five weeks, I had gotten tested several times: nasally, through saliva, and through a study in the ER for antibodies. I came back negative for all. In May, my family moved together into a two-bedroom, two-bath apartment.
We were learning more about COVID, even though we were getting mixed signals from the CDC. That is frustrating, because the hospital makes changes based on those guidelines. For patients who were alone and not allowed visitors, it was hard. Some were depressed. In general, even before the pandemic, as hospital nurses, we spend most of the time with patients, and that was similar during the pandemic.
We were the main ones going in while on contact and airborne precautions. Doctors make decisions based on daily or as-needed in-person evaluations, and on the vital signs, blood work, and clinical observations that are obtained from nurses and techs. COVID patients can decompensate really quickly. You have to be aware of that. We had patients on continuous cardiac monitoring and continuous pulse ox. The concern for COVID is oxygen level going down too quickly. We were able to monitor that.
The ICU is where COVID patients were intubated. When a patient was really decompensating, they did the Hail Marys — including the meds like President Trump got, but also tPA, tissue plasminogen activator — a med for patients who have ischemic strokes, because COVID can produce clotting. There were patients getting 100 percent oxygen on ventilators, yet the patients’ oxygen level would be in the 60s or 70s for days. At that point, staff start to talk with the family; letting them come and look at the patient through the window in the door while a nurse puts a phone to the patient’s ear, even though they’re intubated and sedated.
What you need to get through it
Before the pandemic, I would talk to loved ones about the importance of hygiene. They would say, “Oh, that’s Rose — she’s a nurse, and she’s all about the hand washing!” Now they’re all about it.
I served with Peace Corps in Guatemala 2008–11, as a Healthy Schools Volunteer and then a Volunteer leader. We would travel to smaller schools to help with healthy habits: getting access to clean water, and education with teachers and mothers. The director and founder of the program was Sergio Mack, a pediatrician and public health specialist. He planted the seed of this public health community program some 10 years prior and saw it grow.
Right now this pandemic seems never-ending, but it is very temporary in the grand scheme of things.
Working with Peace Corps and interpreting with medical missions deepened my interest in healthcare. Back in D.C. I got a job working with a nonprofit organization focused on early intervention: visiting families with children under 3 who were getting physical therapy, occupational therapy, speech therapy. Often they were Spanish-speaking. It was like I had taken my world experience home. And I went to nursing school at Johns Hopkins, thanks in part to a Coverdell Fellowship.
I talked to my site mate from Peace Corps when the COVID pandemic was starting to ramp up. I told her that it was strange, but the isolation when I left my family kind of felt similar to the Peace Corps experience. It’s very different in another sense, being socially distant within the community. But similar in the sense of what you need to get through it: to be resilient, tenacious, hardworking, patient.
The months ahead
Right now this pandemic seems never-ending, but it is very temporary in the grand scheme of things. Just like Peace Corps, it’s one to two years of your life — depending on how it’s managed — and then it’s over. We can take away from that experience how to live a healthier lifestyle; it’s knowledge-building.
I got the first dose of the vaccine on January 4, and I plan to get the second dose on January 27. At the same time, after the holidays, we’re bracing ourselves for infections that might come before the vaccine kicks in. If it hits, what are we going to do?
Pandemic Lessons: A vaccine trial participant see more
Pandemic Lessons: A vaccine trial participant
By Tia Huggins
Illustration by Maria Carluccio
For the past six years I’ve served as director of care coordination at Imperial Beach Community Clinic, south of San Diego. Last year one provider at the clinic put out an email about the trial for the Pfizer COVID-19 vaccine. I thought, I want to do that. It’s a contribution to your community, and participants were paid. A lot of people think it must be scary to do this. I wasn’t worried. To put it in stark terms, I’ve worked in hospice, and I think suffering is a lot worse than death.
I was sure I got the vaccine; I had side effects for about three days after both times — headache and fatigue. Two weeks after the first vaccine in October, I had diarrhea all day. After the second one I felt nauseated. I don’t have that good of an imagination.
First time I went in, one doctor asked, “When are we going to find out whether we got the vaccine or the placebo?”
The vaccine administration took place at the California Research Foundation. It’s sort of like an assembly line; there are a lot of people, and they ask if you’re having symptoms. The first time they draw blood, the second time you come in just for the vaccine. I go back for a visit in February. In between, we have an app where we register once a week. If you are having symptoms, they call.
A lot of doctors came in to do it. First time I went in, one doctor asked, “When are we going to find out whether we got the vaccine or the placebo?” Two years, they said, when our part of the trial would be done. “I’m withdrawing,” that doctor said, “if that means that when the vaccine comes on the market, and I don’t know whether I got it or not, and that I won’t be able to get it.” They said hold on; they checked, then said when a vaccine comes on the market, we’ll tell everybody. At the end of December they told me: I had received the vaccine.
Peace Corps and the pandemic
I was an older Volunteer when I went into the Peace Corps in 2007. For years I taught Spanish at Iowa State University. I turned 50 in Guatemala, working with the Healthy Schools program. Rose Conkin was in the group that followed me, and I thought she did a wonderful job. After serving in Peace Corps, both Rose and I became nurses.
In 2020, for about four months, my daughter wouldn’t let me get near the grandchildren because she was afraid I would give them COVID from somebody at the clinic. Mostly I’m working from home, though at our clinic, anybody who goes in has to get tested.
Taking the vaccine was a volunteer opportunity, too, which is just the mentality that you take into everything that you do after Peace Corps, that sense of shared humanity as you go through the rest of your life.
In terms of day-to-day living, the pandemic hasn’t seemed so hard. Peace Corps was more difficult. We learned key coping skills. Taking the vaccine was a volunteer opportunity, too, which is just the mentality that you take into everything that you do after Peace Corps, that sense of shared humanity as you go through the rest of your life.
Bring the solution
Community clinics are part of the safety net for people in need. Our providers are dedicated; they want to take care of people. During the pandemic, most of our providers go in once a week to see patients in person. A couple providers who are older have not gone in; they’re trying to see patients over the phone. Medicare won’t pay for virtual visits unless it’s video — but those patients are often older and can barely use a phone, much less video. Our providers said, We don’t care whether we get enough money or not.
But you can’t give a vaccine over the phone, take blood pressure over the phone. One thing we have been doing, especially for people diagnosed as positive for COVID: ordering pulse oximeters, which will monitor oxygen saturation level, and home blood pressure monitors. We have a drive-by area, tarps out in the parking lot, for COVID testing. We’re going to continue to be part of this important work taking care of people. We’ll be giving out the vaccine. I’d like to be part of the system that will bring the solution.
Epidemiologist Anne Rimoin on listening to community — and bringing global understanding back home see more
Pandemic Lessons: Epidemiologist Anne Rimoin on the importance of listening to community. And how a public health problem anywhere can be a public health problem everywhere.
From a conversation with WorldView editor Steven Boyd Saum
Photo by Peter Israel
In epidemiology, you have to look at things holistically. And in the midst of this pandemic, as an epidemiologist whose whole career trajectory was shaped by my experience with the Peace Corps, I find myself asking: What does Peace Corps have to do with how we respond to COVID — and how we need to do more? Peace Corps is all about working in a community; my work, whether related to COVID or not, is really about having your ear to the ground in the community and understanding the community’s perceptions — and understanding how important local community is in terms of being able to effectively run public health interventions.
A case in point: We’ve learned over and over again with Ebola outbreaks that you have to pay attention to local community leaders and understand their perspective. Having empathy and creating relationships to reach that understanding, and targeting communication to what’s really happening — that’s critical.
The window that Peace Corps Volunteers have into that — that we have to bring our experiences in working in communities globally back home locally — is so important now. It is going to be critical in terms of being able to get to the other side of this pandemic, whether we’re talking about vaccine hesitancy, wearing masks, social distancing, or basic public health measures. In public health, everything that I do, I lead with listening to community.
This is a matter of life and death. Bringing the world back home has never been more important.
This pandemic has shone a light on how we are no different than anywhere else.
We always think that this is the “Third Goal,” the last thing out there in the Peace Corps experience. But our country has never been more vulnerable. This pandemic has shone a light on how we are no different than anywhere else. And that an infection anywhere can be an infection everywhere; a public health problem anywhere is a public health problem everywhere.
The whole idea of “global is local, and local is global” has never been more important. We have not been paying attention to the community here in the same way that we do overseas.
Information and misinformation
Whenever you have lack of information and lack of communication, you open the door for disinformation, misinformation, and misconceptions. We’ve seen this happen over and over again in the United States.
I served with the Peace Corps in Benin in the 1990s, in the village of Bopa. As a Guinea worm eradication volunteer, my job was disease surveillance and health communication. The lessons I learned there are important today: You must be able to have direct and open conversation and communication with community leaders. Those leaders are not just the politicians; they are people who are key to the community. In a place like Benin, they could be traditional healers. Here, they’re religious leaders, sports figures, celebrities — where people get their information.
When I was in Benin, there was a Guinea worm song contest: Every village had a contest to come up with the best song about how to avoid getting Guinea worm — which you do by filtering your water and some basic public health steps. That sounds quaint, but it’s really a perfect example of great public health communication stemming from grassroots communities and finding creative ways to get the message out. Beninois culture really embraces music, so it was a genius idea that every community got involved in.
The human experience
We in the United States have always felt like we were different. We’ve held ourselves as being so much more sophisticated and that these things don’t apply to us here. But they really do. And isn’t that one of the big lessons of Peace Corps? The hubris that we feel as Americans might be tempered a little; we might be a little more open to learning about other cultures — and what we can learn from them to do better here.
The three goals of Peace Corps are essential. Training people in low-resource settings and helping promote better understanding of Americans — both of those are certainly important. But bringing home the understanding of what’s going on in the world is so critical going forward. “What do countries want and need? How can we be of assistance?” Answering those questions takes a lot of listening. As Americans, we’re really great at talking. We haven’t always been so great at listening. This last year of the pandemic just demonstrates how critical listening is.
Public health work in Lomela, Democratic Republic of the Congo. Anne Rimoin, left, is currently stateside, but an entire team of Congolese and UCLA field director Nicole Hoff are there full time. Photo courtesy Anne Rimoin
So is community. In the United States, people are not used to public health crises affecting their daily lives. In Africa, people are — and they understand the need to pull together as a community. That definitely has had an impact. Los Angeles County, where I am, is the most populous county in the United States. It’s extremely diverse; you have a lot of frontline workers and multigenerational households; and a lot of pandemic fatigue. Together, that has probably created the perfect storm, possibly in addition to a more contagious strain circulating. And it has created a situation where we have a public health emergency on our hands.
How the pieces fit together
As a professor at UCLA, I have continued to run my research here in Los Angeles: working on asymptomatic infection, immunity, and occupational exposures for healthcare workers and first responders, as well as studies for veterinarians and veterinary clinics. Our team in the Democratic Republic of the Congo has been continuing work as well, which is extremely important: with Ebola survivors from outbreaks in 1976 and 1995 to the recent outbreak, working with healthcare workers and trying to understand exposures. An entire team of Congolese and UCLA field director Nicole Hoff are there full time. So we’re continuing to collect samples and do studies in DRC — where COVID hasn’t hit as hard. That needs to be studied as well. And we’re continuing studies to understand population immunity to vaccine-preventable diseases.
At the Center for Global and Immigrant Health, which I direct, we’ve been continuing to support global health, locally and globally. That includes learning from people working overseas and what their experience with COVID has been. At the same time, we’re trying to reimagine what global health is going to look like in the future, how we’re going to get back to working in partnership overseas; many projects have been grounded.
In public health, having the long game in mind — the essence of Peace Corps — is key.
Global public health work is changing profoundly. In the time since I was a Peace Corps Volunteer, a lot of capacity has developed on the ground, as well as the ability to build more capacity. This pandemic has shown how important that is. People in a country should be able to do the work themselves on the ground, so that it really becomes a collaborative partnership — not a situation of people from high-resource settings going to low-resource settings, doing the work, and leaving. Having the long game in mind — the essence of Peace Corps — is key. The pandemic will definitely have an impact in that global health will be reimagined: by growing grassroots capacity, thinking through a new way forward.
When I started as a Volunteer in Benin in the early 1990s, in terms of public health there was very little infrastructure. The internet and cellphones have completely changed the landscape in terms of public health communication. I was in a village where there was one phone that didn’t really work. It’s very difficult to do surveillance in those circumstances. There are now good schools of public health in Africa, and people who have been trained elsewhere and come back and are able to lead public health and scientific work.
In the months ahead, I’m hoping to see vaccines rolling out with equitable distribution globally, since that will be an important way forward. What’s also going to be important is monitoring variants of COVID that are cropping up, and how that may impact vaccine effectiveness and treatment effectiveness. Viral surveillance is going to be critical: being able to collect samples globally and sequence them to see if the virus is continuing to mutate — which it will.
Debt and investment
I feel a debt to Peace Corps; it changed my life and how I think about the world. The experience informs everything that I do. And while I know “the toughest job you’ll ever love” is no longer their tagline, it’s so true! It really was the hardest thing I ever did. Why? Because it’s dealing with culture: listening and understanding and trying to respond to the needs of a local community. That’s really hard.
At Middlebury College I was a history major, focused on Africa — though I didn’t know what I would do with it career-wise. As a musician, I was interested in the music industry; I actually interned at IRS Records and thought I would become a music entertainment lawyer. I was going to take the LSAT while I was in Peace Corps. Because I spoke French, I was offered a position in Benin with this perfect public health program. My dad was a respected medical geneticist and scientist. I didn’t think I would go in that direction; really, I was intimidated. But instead of going to law school, I ended up getting a master’s in public health. My dad used to say I avoided science like the plague — and became a scientist studying plagues. That was all because of my Peace Corps experience.
In a very real sense, the investment in Peace Corps is an investment globally and an investment locally. It does change how Volunteers view and interact with the world. We need a lot more people who have that perspective.