After a catastrophic 7.0 magnitude earthquake ripped through Haiti in 2010, crews posted signs warning against drinking contaminated river water. But since most of the population could not read, the caution went largely unheeded.
The well-intended crews lacked cultural understanding — a mistake that resulted in a devastating outbreak of cholera. By August 2013, more than 8,000 people had died in the ongoing epidemic — the worst cholera outbreak in recent history.
“In the realm of global health, the importance of understanding cultural contexts cannot be overstated,” said Erin Quinn, USC Dornsife’s new associate dean for science and health.
This is equally true within the United States, where language and cultural barriers account for 37 percent of health care access issues, outstripping the 18 percent of access problems caused by affordability. As the largest minority group in the United States, Latinos are among those most often affected.
When Joe Herrold arrived at USC Dornsife in 2002, the then-undergraduate realized he needed to gain a better cultural understanding of Los Angeles’ Latino population if he wanted to realize his dream of becoming a doctor.
He came to L.A. from rural Indiana.
“I didn’t speak Spanish, but soon realized I needed to learn the language if I wanted to join the USC healthcare community,” he said.
After earning a bachelor’s degree in biological sciences with a minor in international relations from USC Dornsife in 2006, and his M.D. from the Keck School of Medicine of USC in 2012, Herrold is now training as a surgeon at the Keck School.
In addition to learning Spanish, he familiarized himself with Latino culture, then sought to help others do the same. In 2006, Herrold and fellow USC Dornsife graduate Elise Wach, who earned her B.S. in environmental studies in 2006, created the nonprofit educational program Somos Hermanos (loosely translated as “We Are Family”). The group teaches the language skills and cultural competency required to provide quality health care to Latino patients.
“As a health care provider, the first and most important step is communicating with your patients,” Herrold said.
Somos Hermanos has trained more than 200 health care providers nationwide, combining intensive one-on-one Spanish language instruction and family homestays with cultural activities in Guatemala, El Salvador and Mexico.
“The patient-provider relationship is built on trust,” he said. “Without empathy and cultural humility, it’s unlikely you can establish that connection with those you are trying to serve.”
After earning his bachelor’s degree in biological sciences from USC Dornsife in 2006, Lloyd Cuzzo participated in Somos Hermanos.
“I hit the ground running,” said Cuzzo, an ophthalmology resident at the Keck School.
One patient Cuzzo examined during the first week of his residency reported experiencing flashing lights and eye floaters — signs of retinal tear or detachment.
“This patient — who didn’t speak a word of English — had come in for a routine follow-up, so would not normally have needed to have his eyes dilated,” Cuzzo said. “However, because I was able to communicate effectively with the patient, I did dilate them, and discovered he had a vision-threatening retinal detachment. The patient was taken to the operating room that night and luckily we were able to save his sight.”
Global health involves a holistic view, so dental care is also an important component. Some use their Spanish in that effort.
One is Erin Walker, now a pre-dental student. She was a senior majoring in neuroscience and human biology when she founded USC Global Dental Brigades in 2012. Her mission: to provide free dental care to those in developing countries.
Poor dental health is implicated in increased risk of heart disease, diabetes, lung disease and premature birth.
Walker collaborated with students from the Virginia Tech Global Medical Brigades chapter to organize a trip to Honduras to establish a medical and dental clinic.
In Honduras, Walker and her team rose before dawn each day and drove for two hours on dirt roads to schools or churches, transforming them into makeshift pharmacies, and consultation and operating rooms. They used a reclining lawn chair as a dentist’s chair and a flashlight to provide illumination. Walker, who speaks fluent Spanish, taught children how to brush and floss properly and provided fluoride treatments. The team served 1,111 patients in three days.
“Beyond the dental work, patients were touched and grateful that our volunteers had taken time to make them a priority,” Walker said.
Tackling global health also takes USC Dornsife faculty and students to the Pacific Rim.
John Strauss, professor of economics at USC Dornsife, is providing critical insights into the dramatic effects of aging on global health through research he has conducted on the country with the world’s most rapidly aging population — China.
Along with researchers from Peking University, the Hong Kong University of Science and Technology, and international partner institutions, Strauss last year released the first major report drawn from the China Health and Retirement Longitudinal Study (CHARLS) on which he is principal investigator. Focusing on data gathered from 17,708 Chinese adults over age 45 from urban and rural areas, the study provided a nationally representative sample of China, excluding Tibet.
Strauss found striking gender differences in how men and women age in the developing world, with older women more likely to have poorer measures of physical and psychological health — including high blood pressure, depression and cognitive decline — than men.
“Women generally report worse health than men, even though adult mortality is lower among women,” Strauss said. “Also, the biomarkers are generally worse for women than men. That’s borne in the U.S. and not specific to China.”
USC Dornsife students also have opportunities to explore alternative approaches to health. Students enrolled in USC Dornsife’s Problems Without Passports (PWP) course “The Global Performance of Healing,” taught by Erin Moore of the Department of Anthropology, traveled to Abadiânia, Brazil, home to renowned Spiritist leader John of God.
At the Casa de Dom Inácio de Loyola, students participated in the life of a “pilgrim,” meditating, visiting a sacred waterfall, obeying an all-white dress code, eating sacred soup and joining in at hymn and prayer sessions.
They witnessed how patients are able to benefit from massage, soothing music, crystal beds, and other practices that create a relaxed atmosphere that may enhance healing. Students collected healing stories from patients and mediums, and conducted a critical analysis of the Casa rituals.
The majority of the Casa’s pilgrims are educated Westerners who are disillusioned with Western medicine and seeking an alternative.
“Students can be shocked to see that so many people feel they are not being served by biomedical doctors and are seeking alternative help,” Moore said. “Our task as medical anthropologists is to suspend judgment and practice participant observation.”
Kausar Ali, a religion and neuroscience double major who traveled to Brazil with the help of USC Dornsife’s Summer Undergraduate Research Fund (SURF), was struck by the peaceful, meditative atmosphere at the Casa.
Dressed in pure white, visitors searching for spiritual intervention rested quietly on a deck overlooking the hills, on wooden benches scattered along garden pathways, or on stones at the sacred waterfall located deep within a nearby forest. Bathed in serenity, they meditated.
“I learned that beyond the tangible science of conventional Western medicine, spirituality can be a strong component in healing,” Ali said.
Alternative remedies, which focus on a healthy lifestyle, may have increasingly significant preventive value during worldwide increases in noncommunicable diseases, including cancer, diabetes and heart disease — what Quinn terms “the new game-changers” in global health.
In January 2014, the World Health Organization predicted “a tidal wave” of cancer cases over the next 20 years, with the number of cases worldwide predicted to soar by 70 percent, reaching 24 million a year by 2035. Many will be fueled by the same unhealthy living habits — smoking, lack of exercise and poor diet — also responsible for the global explosion in diabetes and heart disease.
“Traditionally, global health has focused on communicable diseases such as malaria and cholera. The new challenges we now face involving global chronic disease and cancer require a fresh approach and a fundamental change in thinking about how we ‘manage’ health across the globe,” Quinn said.
USC Dornsife is ideally positioned to help the medical field of the future find innovative solutions.
“We need broadly trained individuals, who understand health and disease from every angle, are able to critically analyze and interpret data, communicate effectively, incorporate social and cultural perspectives, collaborate to solve problems, manage economic resources and think proactively,” she said.
Quinn provides opportunities to realize those goals. For instance, she leads an annual monthlong trip to Oxford, England, for the course “Biology of Tropical Diseases.” Taught by experts in global medicine at the University of Oxford, the course is part of PWP.
The course teaches students global perspectives and alternative ways of approaching medicine, illustrating how procedures and resources that work in the U.S. and other developed countries are not necessarily compatible in developing countries.
“After three weeks, students are able to make a huge leap from their previously held belief model of ‘build large hospitals, prescribe pharma drugs,’ to understanding that finding a solution that is local, low-cost, culturally acceptable and readily available is perhaps the best choice in solving a health care issue,” Quinn said.
“Whether it is health care within the U.S., or globally, I learned there is no one way to treat every single patient,” said Saya Yusa, a biological sciences major who participated in the 2013 PWP Oxford trip.
Yusa and Quinn emphasized the need for cultural empathy in medicine.
“While health issues in Oaxaca, Mexico, may be unrelated to health issues faced by migratory Mongolian herders, both communities have developed and passed on valuable health practices over centuries that promote health and discourage disease for their population,” Quinn said.
“Now, diabetes is becoming a global issue. Our role is to use our advanced knowledge to help, while remaining respectful of culturally accepted health practices so that we can integrate them into the solution.
“Together, we can forge good decisions to successfully improve health for as many people as possible on our planet.”