What was your background before enrolling in the PhD program at Gillings?

Sarah Lebu, MPH, MCP

Before I came to graduate school, I worked with the private sector and local governments in the Eastern Africa region to understand barriers to adequate access to safely managed sanitation services. My most memorable task involved a study to understand the sanitation challenge in a community where only 1 out of 7 people had access to some form of toilet. I rolled up my sleeves and got to work closely with the community. What I learnt surprised me. While the people understood the risks associated with open defecation and showed a willingness to pay for sanitation services, they did not own the homes they lived in nor possess land titles, and therefore, they could not make decisions on installing toilets where they lived. Their landlords who could make these decisions, lived away from the community and did not have the motivation to invest in an amenity they wouldn’t personally benefit from. My team launched a large campaign requesting the Kenyan government to require landlords of structures in informal settlements to construct a toilet for their tenants. The situation is now improving partly because of these efforts.

I received a dual Masters in Public Health and a Masters in City Planning from the University of California Berkeley. There, I collaborated with utilities and municipalities in Kenya and Rwanda to implement city-scale assessments on the status of sanitation. These assessments contributed to policy on acknowledging non-sewered sanitation option for low-resource communities. My work in expanding access to safely managed sanitation in informal settlements has grown. I am learning along the way that climate change is making it much more difficult for utilities and cities to provide services. I am interested in collaborating on solutions at this intersection.

How do you plan to combine your knowledge in city planning, environmental health and other interests throughout your career?

The intersection between city planning and environmental health may seem apparent, but potential benefits have been slow to materialize. Cities are made of interconnected communities. Poor health outcomes in one community can quickly affect a neighboring community. In low and middle-income countries, there are significant disparities in access to services such as clean water and sanitation are significant. This challenge is an environmental justice issue. My work involves creating awareness among decision makers within cities on this issue. I collaborate with communities to collect data and examine sanitation conditions in depth, then together, we present our findings to policy makers, making a case for investing in safely managed sanitation.

My PhD research is focused on modeling the impacts of extreme rainfall and flooding on sanitation services. I plan to use participatory approaches to map out community assets and hazards, focusing on how physical access can be cut off or fecal pathogens can be mobilized more into the environment when it rains heavily in a sanitation-challenged environment. I am affiliated with the Water Institute and my faculty mentors are Dr. Aaron Salzberg, Dr. Joe Brown and Dr. Musa Manga.

On the side, I am plugged into conversations involving decolonizing global health and water, sanitation and hygiene. I am working on a paper on strategies that researchers and practitioners in global health can apply in their work to move towards a more equitable and socially just practice. Look out for a publication in a few months! My motivation here lies in centering the most underrepresented voices in the global health agenda.

Will you tell us about your experience as a Peacock Fellow with CFK Africa?

Over the summer of 2022, I had an amazing opportunity to work with CFK Africa in Nairobi as a Peacock Fellow. The fellowship is a year-long, immersive experience that gives students the opportunity to design, collaborate and implement public health and development related projects with Kenyan staff and communities. I got attached to the health team, where I supported program activities on WASH. One highlight from my work was to create and test survey tools for evaluating CFK Africa’s handwashing in schools’ intervention. I worked closely with the staff and schools in their program areas to identify which indicators would tell the best story on the success of their handwashing program. The experience was rewarding. Part of the work that I did was accepted as a poster presentation at the NC Global Health Alliance Conference. The fellowship was a rewarding and learning experience for me. I would encourage students who are looking to contribute and learn from such an experience to apply to the Peacock fellowship.

What does “global health” mean to you?

Communities across the world are connected in so many ways, including through migration and technology. Global health emphasizes this interconnection and encourages public health solutions to transverse national and regional borders. I find that global health is currently structured in a way that involves moving funding, expertise and knowledge from high-income countries to LMICs. This predominantly unilateral transfer of resources, motive notwithstanding, has resulted in inequities and power imbalances in global health. Often times, local communities are not engaged in defining the global health agenda. I would like for this to change. An ideal global health sector should center the voices of the people living with health burdens and dismantle colonial power structures that have contributed to health disparities.

What has been a highlight of your time at Gillings?

I work with the Water Institute at the Gillings School of Global Public Health. My favorite thing about working with them is the UNC Water and Health Conference that they host every year. This year, the conference was hosted in-person and attended by over 500 participants from across the world who are working on various aspects of water, hygiene and sanitation. I was happy to network and connect with experts in WASH. I even met with colleagues from my work in Kenya a few years ago. It was promising to see that the global WASH community has the goodwill to find innovative solutions to improving access to WASH services. Voices of communities are being heard more through community participatory methods of research.

What are your favorite foods?

I enjoy Mediterranean and Thai cuisine. My favorite foods are falafel wraps and Chicken Tagine from the Mediterranean Deli down at Franklin Street. I also enjoy the Tom Kha Chicken soup with coconut mil, bamboo and mushrooms. My favorite food from my home country, Kenya is chai and mandazi.

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