A couple days ago, I returned home from Thailand and will now resume my courses at Berkeley. During my three months in “the land of the new king,” I observed a country in a one-year mourning of their beloved former monarch, a country under military rule in a political state of transition, and a county experiencing rapid economic development. Despite the black-colored attire that government workers and civilians wear to express their sadness for the passing of His Majesty the King, there is an enthusiasm and optimism for the future.

I was fortunate to have the opportunity to work and learn from the dedicated members at the Ministry of Public Health. I received a tremendous amount of support with my antimicrobial resistance project and I hope that the results can be used to implement safer agriculture and food production policies. I did leave with more questions than I started with, but I intend to use those questions to guide my future work.

Outside of working on my project, I learned flexibility by serving in other roles with the Bureau of Epidemiology. I was the Master of Ceremonies at two different international conferences in Thailand (The TEPHINET Conference and The Southeast Asia Regional Zika Conference). A highlight for me during the Zika Conference was introducing one of the distinguished speakers, Director of the CGPH and Cal professor – Dr. Eva Harris.

I would like to thank the CGPH and the Thailand Bureau of Epidemiology for providing me with this wonderful opportunity to work in Thailand these last three months.

Thank you and Sawadee Khrap!
Royce Tsukayama

After completing two months in Thailand, I (Royce), I will share my updates and some photos here:
 
I am humbled by the genuine kindness of the Thai people. The generosity especially extends to the staff at the Bureau of Epidemiology (BOE) who welcomed me warmly from day one and have adopted “Nong-Royce,” as a younger brother to their family.
 
My home base is Nonthaburi, an urban satellite of Bangkok, in a small apartment complex just one mile from the BOE and Ministry of Public Health. The inescapable traffic jams of the capital city extend to Nonthaburi but fortunately I can commute by walking or by waving down one of the ubiquitous orange-vested motosai taxis, who (providing a helmet) get me to work in two minutes for just 15 Thai baht (~$0.40 USD).
 
One of the cool aspects about interning at the BOE is the exposure to other ongoing national and international projects. I observed Field Epidemiology Training Program (FETP) events and also traveled with BOE staff to Phang Nga and Tak provinces for a migrant health project. This allowed me to briefly revisit the Thai-Myanmar border town, Mae Sot, where I spent some time in 2016.
 
The current rainy season in Thailand presents spontaneous onslaughts of thunderstorms (an unfamiliar weather pattern for a Northern-California boy), ensuing flooded roads making for an interesting commute, and persistent humidity and being sweaty. Rainy season also brings about the deluge of tropical fruit available at markets and fruit stands, especially the king of fruits, durian. I have been fortunate to visit some durian farms thus far.
 
For my project, I have just completed the sample collection phase in the pig farms of Sisaket province. I enjoyed spending several weeks in rural Isaan. Everywhere I went, I was greeted by endless stretches of green rice fields and smiling faces. And of course the food was delicious as I devoured my share of som tum pla ra (an exciting variation of papaya salad), gai yang (the famous Lao-Isaan style grilled chicken), and larb.
 
The local public health and livestock officials assisted with my project a tremendous amount, especially with navigating though the countryside to visit all of the farms. One of the officials invited me to stay in a spare bedroom for the duration of my time there, located on the second floor of an animal clinic/pet store. As a result, I saw many dogs receive their rabies vaccinations and even watched an emergency dog C-section. I will post another update soon! Thank you for your support.
 
Royce Tsukayama

Marhaba!

My name is Melissa Carlson, and I am a PhD candidate in the U.C. Berkeley Political Science Department. This summer I will be in Jordan examining how Syrian refugees living in urban areas perceive health care providers, and whether their perceptions influence their willingness to use services offered by particular providers. I plan to capture refugees' perspectives through a variety of different ways: first, through an in-person survey experiment and an experiment conducted through Facebook, both with Syrian refugees; and second, through in-depth interviews with both Syrian refugees and various health care providers in the country, ranging from public officials to private clinics, aid workers, and refugee doctors practicing informally in the country.

My project is motivated by puzzling behavior I have observed amongst refugee communities during my previous research on refugees and rights access in Greece, Jordan, and Iraq. Despite minimal access to financial support, Syrian refugees in urban areas and informal camps often use costly, private clinics even when host governments and aid organizations offer free or subsidized services. Similarly, refugees often turn to informal health care providers, such as doctors, pharmacists, and nurses who are refugees themselves, but practicing without a work permit. Lastly, Syrian refugees have crossed the border into Syria to access health care services there, then returned to Jordan, rather than access closer, and relatively safer, services in country. Many refugees forgo accessing health care services, even in emergencies, because they fear that interaction with public officials and aid workers may have negative repercussions. 

I expect to find that refugees' level of trust in, and perceived credibility of, health care providers directly influences whether they use that provider's services. Through the experiments and in-depth interviews described above, I hope to identify factors that influence Syrian refugees' trust and perceived credibility of health care providers, and assess how refugee perceptions influence their behavior. 

I am very excited to conduct this research, particularly because I believe that my findings can have direct, positive policy implications for aid organizations and governments responding to crises. I am extremely grateful to CGPH for making my research possible, as well as Dr. Nour Abdo and Amer Abu Shakra from the Jordanian University of Science and Technology, who will provide critical support on the ground.

I will be posting updates regularly, so stay tuned!

Melissa Carlson

 

​Bom Dia!
 
My name is Dan and I am a student in the UC Berkeley-UCSF Joint Medical Program. This summer I’m heading to Salvador, Brazil to study healthcare access and utilization for folks living in urban slums. Brazil is a vast, dynamic country, the birthplace of samba, bossanova, capoeira, and home to some of the world’s most fervent football fans. Brazil’s size and history make it complex as well as vibrant, particularly with regards to health. It is wealthy and socially conscious enough to have universal healthcare, but also has one of the world’s largest GINI coefficients (a measure of income inequality) and has nearly a quarter of its population living in slums.
 
My research is a qualitative project focusing on barriers to health care experienced by slum residents, particularly with regards to rheumatic heart disease, a condition that should no longer exist in Brazil. Rheumatic heart disease is a sequelae of strep throat infection that causes valvular dysfunction and death. It exists in Brazilian slums to a degree seen in much less developed countries, despite there being a universal healthcare system. My job is to help shed light on why and how this is (following up on the pilot project I did last summer in Salvador). By 2030 a quarter of the world’s population will be living in slums and we will need to understand how to better provide care. Brazil gives us an interesting and important case study.
 
I am equally excited and grateful to CGPH for making this research possible. Finally, many thanks to Drs. Lee Riley, Melissa Burroughs-Pena, and Ndola Prata for all their guidance and advising the past two years.
 
Ciao!
Dan

Hola! I’m Amanda Keller, a first-year PhD student in Molecular Toxicology with an emphasis on environmental exposure health. At the end of April, I will fly to the Atacama Desert in northern Chile, the driest habitable place, where I will be working alongside a team of epidemiologists, biologists, and physiologists from Cal, UC Davis, John Hopkins, as well as local Chileans.

​Our study site is unique in that the individuals living in this region of Chile had high level exposures to the toxic metal arsenic. Between 1950-1970, the residents in Antofagasta, Chile consumed water from a single source tainted with naturally occurring arsenic. Fortunately, a large treatment plant was installed and the exposure ended. Now over 40 years later, the population is suffering from arsenic-related diseases most prominently lung, bladder, and kidney cancer.

My team and I have been working with this population for many years and will be traveling down to Antofagasta to collect a variety of biological samples including blood, urine, and exhaled breath. We hope to use these samples to better understand how arsenic causes disease onset and progression. Ultimately, this data will significantly contribute to possible prevention and treatment options as well as provide valuable knowledge for other arsenic contaminated sites (like the US!).

I am very excited to travel to Chile. I learned Spanish from living in Guatemala for 13 months and am looking forward to living in a different region of the world that shares the same language but has a different culture. I anticipate that there will be a learning curve in trying to understand their accents and daily phrases. ​Time will also be one of the larger challenges as we are working in an unfamiliar setting with different resources available to accomplish an ambitious task in the short time frame we have given ourselves. Challenges will present themselves every day in all shapes and sizes, that is one of the joys of living abroad and conducting field work. I plan to embrace them head-on, take the days one at a time, breath, and know I have the skills to persevere.
​
To say I am grateful to join in on the very beginnings of a study would be an understatement. I have no doubt that I will gain an incredible amount from being a member of this team and project. Thank you to my mentors and cheerleaders at Cal, Dr. Martyn Smith and Dr. Craig Steinmaus, and  Dr. Fenna Sillé at John Hopkins. As well as Dr. Jim Mansoor, my roommate to-be and in-country colleague, and Dr. Ed Schelegle from UC Davis. Lastly, a huge thank you to CGPH for believing in my project and I and for helping make this experience possible.

Cheers to a new adventure full of learning and explorations! Come follow along on this wild ride we like to call research. 

Hasta luego, 
Amanda 

Hello! My name is Lee Lemus, and I am so excited to be gearing up for my research this summer. I am currently a first year medical student in the UC Berkeley-UCSF Joint Medical Program, where we pursue a research master’s in science alongside our MD degree. While many i4Y/CGPH Fellows are traveling all over the world, I will be conducting research on the topic I’m passionate about right here in the San Francisco Bay Area. I’ll be interviewing transgender homeless youth on the health issues they experience.
 
Why trans homeless youth? Well, first and foremost, because I’ve witnessed the devastating effects of homelessness and housing instability on my LGBTQ community. In my previous work as a health disparities researcher, I was mostly involved in studies on food insecurity, including for people living with HIV in the Bay Area and Latino immigrants. As I got deeper into that research world, I came to realize how little research there was on the social and structural issues influencing transgender health, and I also realized the degree to which housing instability affects both food insecurity and health. We know that about 40% of homeless youth are LGBTQ (compared to about 5%-10% LGBTQ folks in the general population), and that a disproportionate number of homeless youth in that 40% are transgender – but outside of anecdotal evidence, we don’t even have good numbers describing how many homeless youth are trans. I want to help physicians, nonprofits and policymakers understand the extent of the homelessness crisis for transgender youth. Also, by describing what factors lead to poor health outcomes for trans youth, I hope to outline points where we can best intervene.
 
In this last month before my i4Y/CGPH Summer Research Fellowship begins, I am getting all the pieces of my research plan together to start interviewing youth. I am meeting with leadership and employees at Bay Area nonprofits and clinics that serve trans homeless youth, drafting questions to ask during youth interviews, and running all my research materials by the UC Berkeley Committee for the Protection of Human Subjects for approval of my study. I am also meeting a lot with my fantastic research mentors, including Dr. Coco Auerswald, who has really helpful expertise on youth homelessness.
 
All in all, I am really looking forward to spending a summer deeply immersed in trans youth communities. I am also really grateful to i4Y and the CGPH for supporting me in this research, and for supporting trans homeless youth!

Hello, my name is Royce Tsukayama and I am a first-year MPH student in the Infectious Disease and Vaccinology program at Cal. In May, I will be flying to Thailand, where I will be interning with the Thai Ministry of Public Health for three months. I am writing this blog about a month and a half prior to my departure.
 
My project will primarily take place at the Ministry of Public Health in Nonthaburi, a city just north of Bangkok. My contacts at the MOPH have graciously arranged an apartment for me, which is conveniently walking distance from work. While at the MOPH, I hope to gain an understanding of how Thailand confronts its unique health challenges. Thailand is viewed as one of the leading influences within Southeast Asia, and it will be a great opportunity to see how Thailand addresses health and diseases beyond its borders as well.
 
My project also involves me traveling to the province of Sisaket, in the Northeast region of Thailand. This region, known as Isaan, is largely rural, and has a diversity of cultural influences including Lao, Khmer, and other ethnic groups. I will be in the Khun Harn District where I will visit swine farms to collect pig feces. These samples will be sent in to test for antibiotic resistant E. coli. I have not been to Isaan before, and I am excited to see a different part of the country, develop a deeper understanding of the culture, and gorge myself in the local Isaan food.
 
            I will be in Thailand during the heart of the rainy season, so it will be hot and humid. I will definitely miss the Mediterranean climate of Berkeley, and will be scavenging for air-con. I plan to block out chunks of time to take refuge indoors anyways, as I will be deep into the application and essay-writing process for medical school. However, this will not prevent me from exploring unfamiliar areas, discovering new smells, and blessing my taste buds with wonderful Thai food. Whether it is the diverse shapes and colors of fresh tropical fruits and vegetables or the simmering aromas originating from a food cart, I am looking forward to each and every meal. As an infectious disease student and a self-proclaimed street food advocate, I face a dilemma and will have to make compromises between what my heart tells me to eat versus what my brain tells me is safe to eat.
 
Before I depart, I would like to point out that I have been fortunate to receive a lot of support. I am lucky that a great university like Cal offers a beginning Thai language course, which I have been able to audit. My ajarn (professor) has been extremely gracious and my fellow nak suk sa (classmates) have made it fun to learn a difficult language. One of the former CGPH fellows (Sam) who interned with the MOPH last year, has shared his experiences with me and provided me with the advice to stay flexible and open-minded throughout. The CGPH has done a great job preparing its fellows to ensure that we all have successful internships. Finally, I would like to thank Dr. Lee Riley for making this experience possible for me.