From the field in Guatemala
By Ashley Fehringer

Ashley Fehringer is completing her Peace Corps service and will graduate from Tulane SPHTM in May 2018 as a Master’s International student with an MPH degree in maternal child health.

When I entered my MPH program at the Tulane School of Public Health and Tropical Medicine in 2014, I did not know exactly how I would focus my public health career. That changed in my first semester when I had the unique opportunity to hear Dr. Vincent Felitti (co-principal investigator of the Adverse Childhood Experiences (ACE) Study describe his study’s findings of the many bad health outcomes that could be correlated to an ACE. This blew me away.

Fehrninger800From that day on, I dedicated my public health work to the study, evaluation, implementation, and advocacy of early childhood development (ECD) programs and initiatives to ensure that all children have the opportunity to reach their full potential. My two years of Peace Corps Service as a maternal and child health (MCH) specialist with the Ministry of Health in Guatemala is coming to a close, and I am searching for work in ECD program implementation and advocacy in the US. This is the time to reflect on my experience in Guatemala and how it has added to my knowledge and skills in the field of ECD.

ashley_youngwoman_GuatemalaIn Guatemala, the family is the most important unit. Children live with their parents until they are married. The typical house complex consists of mom, dad, aunts and uncles, cousins, and grandparents, among other relatives. Everything is done for the sake of maintaining the family. This culture of “family first” creates a unique network for young children and provides them with a “village” of supportive caretakers. In their first years of life, this low-stress, safe environment allows for optimal brain development leading to more successful individuals later in life (CDC).

However, as Guatemala continues to develop and the need for better work breaks families apart, I have seen a breakdown of this supportive system that disproportionately affects low-income, rural, and indigenous families. As a MCH Specialist, I work with nurses, social workers, and other health professionals to help them deliver healthcare to families in rural Guatemala, including improving home healthcare delivery. In this work, I have witnessed families living in poverty where parents cannot afford to stay home to care for their children but instead work the coffee fields just to make ends meet; daycare or in-home care is not even an option.

In other families, the need for work has become so intense that one or both parents have been forced to migrate (usually to the US) to find work. They must then leave their children behind with whoever can care for them. These conditions leave young children unattended or neglected and without needed stimulation during the day, leading to stunted physical and psychosocial development (ACE Study). What’s more, they may not be getting the nutrition they need to develop. Guatemala has one of the highest rates of chronic malnutrition in the world, compounding the developmental delays brought on by neglect and adversity (World Food Programme).

Unfortunately, these children often fall through the cracks, due to a lack of programs designed to meet the needs of young children aged 0 to 3 throughout rural Guatemala. My service in Guatemala has focused on addressing this need in my community. In the past two years, my colleagues and I have implemented new house visiting protocols with the nursing staff to ensure that families with children under the age of 2 receive regular visits to measure development and improve education for families using a tool created in partnership with USAID and the Ministry of Health known as the Wheel of Practices for Living Better. We now have around 100 families receiving house visits with positive initial outcomes in development.

I have also had the opportunity to work with the teachers of pre-school and kindergarten students at local institutions to train them on RULER (a Yale-developed early childhood social emotional development program) methodologies to help their student’s social emotional development. With my guidance and feedback, the teachers have been able to implement these practices into the classroom to help their students learn to self-regulate and work well with their peers, ultimately allowing them to focus better and attain better success. I am also in the process of developing a training program for the parents of these students to help them understand the importance of their child’s brain development and what simple things they can do at home to help their child grow.

Ashley_Feringer_screen.pngI have learned so much from working in Guatemala that I will take into my next public health job. Although Guatemala and the United States have many differences, many of the trends I see in child development here are also affecting children in communities throughout the US. Unfortunately, poverty and race have a large impact on early childhood development in the US. In both countries, families living in poverty a stressful environment for their children under the age of two that affects brain development. And many impoverished communities lack access to basic support services that would help their children thrive (Webinar: Race, Place, Poverty and Our Youngest Children).

I know that I have learned so much from my experience in Guatemala, which has prepared me to work in advocating for and improving the lives of our most vulnerable citizens, our children.

Last semester, Tulane University held an event to recognize the university’s Gates Millennium Scholars (GMS). The GMS program, established in 1999, is an initiative funded by a grant from the Bill & Melinda Gates Foundation to promote academic excellence, and provide an opportunity for outstanding minority students reach their highest potential.

Nine students were recognized – all public health students, including undergraduate, master’s, doctoral, and MD/MPH students.

We caught up with a few of these scholars to find out how they learned about the program, what it means to them, and what they hope to pursue in the future.

Tylar Williams02272018_GatesScholar_TylarWilliams
Hometown: Chicago, IL
Undergraduate degree: Health Education (MCH) from Howard University
SPHTM program: MPH in maternal and child health

How did you find out about the Gates Millennium Scholarship, and what does it mean to your education and future career?

My high school was really big on scholarships and, the year prior to my selection, had five scholars, so I had no choice but to know about this program. Being a Gates Scholar has allowed me to attend both of my dream schools without being saddled with a lot of debt. For that I am so grateful! Knowing that my tuition is paid leaves me with room to really focus on my course work and not spend time worrying about how my education is going to get paid for.

Would you have been able to attend Tulane SPHTM without becoming a Gates Millennium Scholar?

Yes, but it would have been a lot more expensive. The majority of my education would have been funded by student loans without Gates.

Alisha Monnette02272018_GatesScholar_AlishaMonnette
Hometown: El Paso, TX
Undergraduate degree: Management Information Systems from University ot Texas at Austin
Graduate degree: MPH from University of Miami
SPHTM program: PhD in Global Health Management and Policy

How did you find out about the Gates Millennium Scholarship, and what does it mean to your education and future career?

I found out through my high school counselor in the beginning of my senior year. With the help of my counselor, parents, and family friends, I had a support system to help me draft the application, read and edit my essays, and assist me with gathering references. Without this scholarship, I would not be in this same position. I would have been forced to attend a community college in my hometown of El Paso, Texas or attend a small junior college up north for a track scholarship. Becoming a Gates Millennium Scholar opened the doors and gave me access to any university of my choosing, there were no longer financial barriers in my way hindering me from chasing my dreams. For the first time in my life, I now only had to focus on my academics, making sure I achieved in and outside the classroom, with no worries as to how I would attend the University of Miami for my master’s or Tulane University for my doctorate. As long as I was a standout in the classroom, I knew I could go anywhere and be anything because I had the Gates Millennium Scholarship to support me.

MiguelAngel Lopez02272018_GatesScholar_Miguel
Hometown: Forth Worth, Texas
Undgraduate degree: Nutritional Science – Coordinated Program in Dietetics from Texas Christian University
SPHTM program: MPH in Epidemiology

How did you find out about the Gates Millennium Scholarship, and what does it mean to your education and future career?

I first discovered the scholarship by accident. I was writing an article for my high school’s newspaper and stumbled across the scholarship’s website. At the time I didn’t know the impact it would have on my education. I didn’t expect to receive it (I had already received multiple denials to lesser scholarships at that time) but decided to apply to it because I met all of the eligibility criteria.

I remember coming home from track practice and seeing a large white envelope post marked for me. My mom was sitting in the living room watching a telenovela. I remember opening the envelope and telling my mom I had been awarded a full ride. Her response was a little anticlimactic – “Oh, ok. Congratulations.” But, I can’t blame her. I would become only the second person in my family to ever attend college so both of us were a little ignorant as to how expensive school was and the impact the program was going to have on my life.

Today, I am one of about a dozen of people in my family to graduate from high school, one of three to graduate from undergrad, and the first to pursue an education beyond a bachelor’s degree. This summer, I plan to apply for a doctorate in epidemiology. I hope to eventually develop community-level chronic disease management programs that target low socioeconomic and immigrant communities.

Who inspires you?

Growing up, I was always very attentive of my sister. She was unfortunate to be born first and had to learn to navigate America by trial and error. I remember her struggling to learn English and having a hard time in school. She cried almost every day because she didn’t understand her homework or the material being taught in class. There was one time when she got sick and was prescribed medicine but would only pretend to swallow the pills in front of our mom so that she wouldn’t get better and have to return to school.

However, it was her struggle that paved an easier transition for me. When I started school, she had a good grasp of English and would help me practice it at home. She could read the English instructions on my work sheets a lot easier than I could and would translate for me when I didn’t understand. In short, I cried a lot less as a child because of her.

How do you plan to make a difference in global health?

I want to implement an evidence-based international community chronic disease preventative and management program accessible to anyone who can benefit from it. A single program like this will be hard to manage because it will have to be adapted for the specific community it is serving at any given time, but that is also what will make it successful and effective.