GRANT'S DESI ACHIEVER

A PRESCRIPTION FOR GLOBAL HEALTH

By SHAGORIKA EASWAR

Vandana Sharma is a global health researcher with expertise in designing and implementing impact evaluations, randomized controlled trials, and capacity building efforts in development and humanitarian contexts.

She is director, Evaluation of the Disasters and Emergency Preparedness Program (DEPP), Harvard School of Public Health, and conducted an impact evaluation to strengthen local capacities in ten countries to respond quickly to humanitarian crises. The British government invested 40 million pounds to improve response at national levels and her team evaluated the implementation of programs and conducted research to see whether they helped change outcome.

Her public health and medical work focuses primarily on HIV/AIDS, maternal and child health, and gender issues. Currently based in Paris, she is conducting randomized trials of interventions to reduce maternal mortality in northern Nigeria and to reduce HIV transmission and intimate partner violence (IPV) in Ethiopia in Somali refugee camps.

As a research consultant at the Abdul Latif Jameel Poverty Action Lab (J-PAL) at the Massachusetts Institute of Technology, Dr Sharma conducted impact evaluations of programs run in partnership with governments or NGOs across the world. In India, smoke from cooking stoves called chulah affects health of women and babies and she developed tools to measure health in families which used the traditional stoves and in those where new stoves that emit little or no smoke were introduced.

Measuring Health Outcomes in Field Surveys, an innovative online course she developed that uses documentary footage from Kenya and India to provide an immersive learning experience, has been accessed by people in over 100 countries. She also worked to build capacity to measure health outcomes, training staff, standardizing steps to collect data in safe, respectful and ethical ways.

She conducted a J-PAL study in Nigeria. “The levels of maternal death there are extraordinarily high – among the top 10 highest in the world,” she says. “The main reason being that most of the deliveries are at home and if a complication arises, they don’t know what to do. Skilled medical help is not always accessible and even where it is, families tend to go for spiritual or religious guidance first, losing valuable time.”

The intervention there involved training community health workers to teach women proper nutrition and hygiene, how to spot danger signals and encourage them to deliver in a health facility, accompanying them there if needed. For those who would not or could not go to a health facility, they provided a safe birth kit consisting of gloves, sterile blades and clean sheets.

“Things as basic as these can help save lives,” says Dr Sharma.

As husbands make most decisions in these societies, it was important to engage them, as well as elders in the family, mothers-in-law, etc.

“Our focus was to change community norms around pregnancy,” she says. And they did this in innovative ways, by putting up short plays with local actors. They conducted question and answer sessions during traditional coffee ceremonies, inviting both men and women to participate.

“Traditionally, only women make the coffee, there are certain tasks men will not do. Male members of our  team made coffee, helping break that taboo, showing new ways of household task sharing.”

They conducted the project in 64 villages, involving over 12,000 people and from there, applied the findings to refugee camps in Ethiopia. Over 23,000 Somali refugees live in these camps, some have been there for eight years or more.

IPV prevalence is likely higher during humanitarian crises, when women and girls, men and boys, are more vulnerable to violence in the family and community, and during displacement, Dr Sharma wrote in an op-ed. “In fact, a growing body of evidence suggest that IPV is the most common form of violence in humanitarian settings but that it often receives less attention than non-partner sexual violence during conflict or humanitarian crises. Evidence suggests there are a number of factors which contribute to the increase in violence, in particular within the family unit: the trauma of displacement, disruption of gender norms, additional stresses due to loss of livelihood, and isolation from community and family support systems.”

Many of these factors come into play in immigrant communities, too, and Dr Sharma, who is implementing a project with World Bank funding among Somali refugees to prevent and reduce intimate partner violence, hopes to see a wider implementation where needed.

“It is such a huge problem and affects every country, but it’s an almost invisible problem because it happens behind closed doors. Globally, one in three women have experienced physical and/or sexual violence by an intimate partner during their lifetime. In Ethiopia, according to a WHO study, a staggering 71 per cent. We are engaging with refugees in the camp to develop a series of podcasts on the topic, hoping to change norms, attitudes and behaviours that contribute to the issue. We are conducting a series of in-person group sessions, building skills through dialogue. Topics range from how to negotiate sexual relationships with a partner to the concept of consent.

“IPV has significant immediate and long-term health, social, and economic consequences and is also linked to an increased risk of HIV. In many ways, violence is seen as a socially acceptable way for those with power. We show them passages from religious texts that talk about male-female equality. We ask, is there ever a situation when it’s okay for a husband to beat his wife? The answer most often, even from women, is that yes, if she burnt the food or for a similar ‘misdemeanour’. We help them realize what IPV actually is. We discuss alternative strategies to deal with disagreements. In Ethiopia, neither men nor women value the work women do. By conducting experiments in which they keep track of the hours women spent working for the family, we help shift the perspective, teaching them to value their contribution.”

Dr Sharma was born and raised in St. Thomas, a small town near London, Ontario, to parents who moved to Canada in the mid-70s.

“My dad came first, his sister sponsored him. Mom was nervous about moving, specially about the weather! But they made a good life in Canada and have been happy here.”

At the time, there were just a handful of desi families in town and not any at her school, but she faced no major issues or challenges.

“It was a beautiful, safe community with lots of outdoor space. My teachers were incredible.”

A medical doctor by training – she earned her Doctor of Medicine (MD) from the University of Western Ontario – she had decided very early that she wanted to work on international health.

“I imagined myself working with Doctors Without Borders, in conflict settings and in humanitarian crisis situations,” she says.

But electives in Ethiopia and Guatemala had her leaning towards population health and public health. “I felt I could help make a greater change there,” she says of her decision to do her Masters in Public Health from the Johns Hopkins Bloomberg School of Public Health where she was a Sommer Scholar. “I found my passion, I found my calling.”

Her parents were supportive of her choices, but when she began to go to places where the terrorist group Boko Haram is active, they worried.

“It made them nervous,” she admits. “Specially in the beginning. But I’ve been doing it for so many years now and they are proud of what I do, happy I am working in a field I am passionate about.”

Dr Sharma enjoys cooking, travelling, hiking and spending time with her family. But much of her spare time right now is devoted to a documentary she is working on.

“It’s about gender issues and IPV. There’s a difference between sex and gender that people don’t think about. Sex is your biological parts, gender is about what social rules and norms society deems appropriate. I’ve interviewed a woman taxi driver in Ethiopia – one of only three in the country. I want to contribute to global dialogue in these issues. Talk to people, not just the academic community and film is a superb way to reach a wider audience.”

She tells young women who ask for her guidance on how to succeed to follow their guts.

“There could be pressure from family and others about what you should be doing. I was asked even by my medical professors why I was not practising medicine. It’s ‘not normal’ some said! But this is what I wanted to do. Think outside the box. There are millions of opportunities out there – pick wisely abut what you want to do with your career and life.

“And get out there and meet people. Talk to them. Learn. My greatest learning comes from those around me. A woman in a village in India or a research expert, they all make me who I am.”

Dr Sharma finds being able to help change people’s lives very rewarding.

“I went back to Ethiopia and talked to people who had participated in our earlier programs and when they get emotional, telling me how it has improved their condition, then I know my work, my life, has a purpose.”

• Grant’s is proud to present this series about people who are making a difference in the community. Represented by PMA Canada (www.pmacanada.com).