Health inequities hurt, whether in the U.S. or abroad

Liz Futrell is an old hand at volunteering. During college at DePaul University in Chicago, she offered her services to projects in Baltimore, in Mexico, and on an Apache Indian reservation. Later, she worked in New Orleans after Katrina. She taught high school for a year after she graduated — and she was glad for the work experience — but she’d known for awhile that volunteer work abroad — in the Peace Corps — was where she really wanted to be.

She applied to the Corps in June 2001, but because of the tragedies of Sept. 11 that year, she didn’t get clearance to travel until March 2002. She went through the usual well-planned initiations — a three-day orientation in Philadelphia, followed by 10 weeks of training with her group in Morocco — before being on her own for 24 months.

That’s how it was supposed to be, at least. Eight months after she arrived, the U.S. invaded Iraq, and Peace Corps volunteers were pulled out of Morocco. Two months later, more than 40 people were killed in a suicide bombing in Casablanca.

Futrell was disappointed, but her memories of the period are all the more intense for having been cut short.

She taught English to middle school and high school students and to a group of men aged 12 to 60. Teaching allowed her to have a naturally formed community and a way to structure her time.

“Education is important, but it can only accomplish so much if public health infrastructure isn’t in place,” she says. “Until that happens, there is no way to improve the developing economies.”

At one point, she remembers, the rudimentary sewage treatment plant broke down, contaminating the drinking water. “That explained why I’d been constantly sick for weeks,” she said.

Futrell describes how situations that would be minor inconveniences in the U.S. could turn into lifelong disabilities in Morocco.

“The father in my host family had an injury that caused him to lose his foot,” she says. “People lost teeth and faced infections for lack of dental care. Mothers and infants were compromised by lack of prenatal care. As you’d imagine, all these indignities had a great affect on mental health, as well. It’s so unfair that these inequities exist, that there are places — in developing countries and in the U.S. — where full advantage is not taken of the resources that are available.”

Some of her most rewarding work was with Operation Smile, a group that provides surgery for people born with a cleft palate. Her job was to locate those who could benefit from the corrective surgery. She spoke only Arabic, and the people she interviewed spoke a local dialect. Through gesturing and a tiny shared vocabulary, she was able to describe the type of person she was looking for. Amazingly, her group collected 15 people from one relatively small area.

It was a five-hour trek to Marrakesh, and the volunteers had assurances from the hospital that the patients could be received comfortably, fed, and could undergo surgery and follow-up with no problems.

When the group arrived, there was no food available for people to eat. The candidates were taken into surgery with no explanation of what was going to happen, and once they were out of surgery, there was insufficient medication to keep them comfortable.

The patients were confused, angry and in pain. Because of the language barriers and their inexperience with surgery, they did not know that they would heal. They thought they had been disfigured even further.

The situation is what Futrell regrets most about being pulled from her village early. She wishes she and her colleagues could have followed up with those who had the surgery and seen them as they healed; instead, she was evacuated from the country a week after the surgery. “I learned in so many ways that you can’t think you’ll swoop in and change everything overnight,” she said. “There are many things that have to be handled respectfully when you’re in another culture. That early withdrawal was very unfortunate.”

After her eight months in Morocco, Futrell spent a year in Japan, where a company had hired her to teach English. When she finally returned to the U.S., after two years away, it struck her how big Americans are.

That’s when she became interested in local health issues also, engaging in work with the Eat Smart, Move More program, an initiative to help North Carolinians be healthier by eating better and exercising more.

“In developing countries like Morocco, the people aren’t healthy because the necessary resources aren’t available,” she says. “In the U.S., we have all kinds of resources, but still our citizens aren’t healthy. That needs to be addressed right away; there’s no excuse for people in a rich country to be without support for being healthy.”

Futrell hopes to find work with an organization like Family Health International or Intrahealth when she completes her master’s degree — a group that will allow her to travel periodically and work globally while also staying involved in local health issues like obesity.

Carolina Public Health is a publication of the University of North Carolina at Chapel Hill Gillings School of Global Public Health. To view previous issues, please visit www.sph.unc.edu/cph.