Can food assistance help socioeconomically disadvantaged people adhere to their medication? This is the question 2019 Christianson Fellow Alicia Leong seeks to answer in her year-long service project in Eswatini (formerly Swaziland) with the Baylor College of Medicine’s Eswatini Tuberculosis Centre of Excellence.
With the support of the InterExchange Foundation, Alicia will examine whether a monthly food basket program for children living with HIV and HIV-uninfected children under five helps them better adhere to preventative therapy for tuberculosis (TB).
“The World Health Organization recommends the use of social support in the form of food as a TB treatment adherence intervention, based on the links between poverty and food insecurity and TB incidence and treatment,” Alicia told us.
Alicia is one of three ambitious young women who’ve been awarded InterExchange Christianson Fellowships to embark on health and community development projects in Eswatini, Malawi, and Mexico. The InterExchange Foundation awarded $26,000 in fellowships to this third cohort of 2019 fellows! Read on to learn more about their inspiring projects.
Alleviating poverty and empowering communities
University of Colorado – Boulder
After serving in the Peace Corps for two years in Cambodia working on community development projects, Cheyenne Polk wanted to continue helping others abroad. This led her to volunteer with the Development Initiative Network in Malawi, a non-profit whose mission is to alleviate poverty and create lasting change in vulnerable communities.
Cheyenne is implementing “Sewing Seeds for Healthy Living”—a tailor training and community garden project for individuals affected by HIV/AIDS in Chikwawa, Malawi.
“Chikwawa struggles with high HIV rates and unemployment, gender inequality, and soil nutrient depletion. I thought it would be best to target all four of these issues, showing that simple solutions like female job empowerment and home gardening can be interwoven to improve all three,” Cheyenne told us.
The sewing initiative seeks to empower more women to join the workforce and establish financial independence by providing training for a future career in tailoring.
Since locals in Chikwawa find it difficult to access fruits and vegetables, Cheyenne is also helping them start their own produce gardens. She’ll provide garden, nutrition, and organic composting training to the community.
“I was so ecstatic to receive news that I was selected for the Christianson Fellowship. I now have the unique opportunity to work side-by-side with Malawians to empower community members in the Sewing Seeds for Health Project.”
Providing specialized healthcare to rural Mexico
Jaltenango de la Paz, Chiapas, Mexico
University of Virginia
Aspiring physician Madalyn McLennan will spend one year volunteering with Compañeros en Salud (CES) to provide healthcare to 10 rural communities in the difficult-to-reach, southern mountainous region of Chiapas—the most impoverished state in Mexico with some of the poorest health outcomes.
CES supplies each community with a clinic, a social-service-year physician (Mexican doctors must complete one year of social service), a clinical supervisor, medical equipment, and financial support. Patients that need more specialized care are referred to the Right to Healthcare Program, where Madalyn will assist.
The Right to Healthcare Program team ensures that more than 1,000 patients receive the secondary and tertiary care they need. When rural primary clinics can’t adequately treat the diagnosis, which could range from a broken bone to cancer treatment, they are referred to the program.
The Right to Healthcare team schedules appointments, updates patients, transports them from their rural communities to their specialty appointments in distant hospitals, provides food and accommodation, and explains the next steps. Some patients have to travel 13 hours for their specialized appointments.
In addition to long distances, patients also face low literacy rates. Around 60% of the adult population in Chiapas never learned to read, let alone navigate the public health care system. Without the Right to Health Care Program’s assistance, the majority of patients would not be able to access vital healthcare.
“Receiving not only health care, but quality health care beyond a basic level should be ensured for all—no matter their economic status,” said Madalyn.
Improving adherence to preventive tuberculosis medication
Mbabane, Eswatini (formerly Swaziland)
In the summer of 2019, Texas-native Alicia Leong volunteered as an early childhood nutrition intern at community-run pre-schools in Eswatini. While providing dietary advice, Alicia realized that the schools were doing their best to provide students with nutritious meals. They had knowledge of healthier options, but lacked access to them. Alicia also learned that there was a lack of awareness about health services in the community.
“The experience showed me how it’s important to consider not just the biomedical aspects, but also the social aspects—what’s going on in a child’s life—when trying to understand healthcare maintenance,”Alicia told us.
Alicia decided to defer medical school at Mount Sinai to return to Eswatini and continue working in healthcare, specifically on improving adherence to TB medication through a pilot food assistance program with the Baylor College of Medicine’s Eswatini Tuberculosis Centre of Excellence. Mount Sinai’s “flex-med” program allows aspiring physicians like Alicia to gain early admission and then take a gap year of service.
TB is a common, often fatal, infectious disease caused by bacteria that usually attack the lungs. Most TB infections remain latent and asymptomatic (also known as latent TB), however, among children with vulnerable immune systems—including those under five, HIV infected, or severely malnourished—more than 10% are at risk of latent TB progressing to TB disease. Eswatini has a high burden of pediatric TB, largely driven by its HIV epidemic. In addition, initiation to TB treatment is very low.
“They are long treatments and can have serious side effects (e.g. vomiting every day) and it’s understandable why people stop medication, but this is dangerous. It can lead to drug resistance,” Alicia said.
The food basket distribution pilot program has the potential to inform the development of context-specific interventions to improve initiation and completion of TB treatment by helping to mitigate the socioeconomic costs associated with having a household member with TB, improving the nutritional status of children potentially infected with TB, and offering a safety net for food-insecure households affected by the disease.
“I’m working towards becoming a pediatrician with a focus on improving the well-being of local and global underserved and vulnerable populations. Specifically, I’m determined to serve beyond the traditional realm of clinical practice, collaborating with parents, social workers, teachers, civic leaders, policy makers and other stakeholders to advocate for systemic changes to advance child health and development.”