Q&A with Dr. Rachel Hall-Clifford (MPH ‘05, GRS ‘09)
Rachel Hall-Clifford (MPH ‘05, GRS ‘09) is a medical anthropologist and global health practitioner with research interests in accessible health care for marginalized populations, health systems strengthening in post-genocide contexts, and global health fieldwork ethics. She is currently an Assistant Professor of Human Health and Global Health at Emory University. She is co-founder of the Emory Co-Design Lab for Health Equity, which is dedicated to community-led solutions to health issues. As part of this work, she is co-founder of a social enterprise called safe+natal, a low-cost perinatal monitoring toolkit developed with lay Maya midwives in Guatemala to promote culturally sensitive maternal care and maximize health system resources. Rachel founded the Women in Global Health Georgia Chapter, a partner organization of the World Health Organization promoting gender equity in global health, and she is currently President of the National Association for the Practice of Anthropology, an AAA section.
Q: Welcome Rachel! Thank you for meeting with us today! To start can you tell us a bit about your time after Boston University? What year and program did you graduate in? If you can take a quick trip down memory lane, what jobs/projects have you had since graduating?
A: I finished my MPH in Global Health at BU in 2005, then went on fieldwork in Guatemala and finished the PhD program in Anthropology in 2009. I stayed in Boston for a year and taught medical anthropology for the department and was a postdoctoral research assistant in medical anthropology at Harvard. I then did a global health postdoc position at the London School of Hygiene and Tropical Medicine and a research scientist position in medical anthropology at the University of Oxford. All along, I continued to work and support projects in my dissertation fieldsite in Guatemala, and I was really happy to move to Atlanta to be closer to that work and take a faculty job at Agnes Scott College that could support those interests. (I have the classic “two-body problem” and am married to another academic. The challenge of finding two perfect jobs in one place is real!) I loved my time at a small liberal arts college, but I decided a few years ago that the focus of the next phase of my career was going to be more intensively research-focused, so I moved to Emory University. It’s been a process to find the right-fit opportunities at the right points in my career and to recognize that careers, and lives, have phases.
Q: How has the experience of doing fieldwork in Central America impacted your current research? What is the most memorable part of doing fieldwork abroad?
A: I’ve now worked in Guatemala for nearly 20 years, which is hard to believe! What started out as a few responses to actual airmailed letters that I sent from Bay State Road to set up my dissertation research has turned into a lifetime of research partnerships and friendships. Over the years Guatemala has become a second home, where my kids have godparents and where I have countless memories. During that time, I have done more traditional ethnography, but I have also contributed as a global health practitioner to applied health and development projects. I have seen so many failures in this space – some of them admittedly my own! Strangely, it’s the failures that have most shaped my work. For example, I now use anthropology research methods to work through a co-design process for global health program design, and I absolutely refuse to take on projects that are not led by and co-designed with end-user communities. Experience has taught me that projects that don’t do this are not only unethical, but they simply don’t work.
Q: Alongside her current position as Assistant Professor of Human Health and Global Health at Emory University, Dr. Hall-Clifford also serves as the President of the National Association for the Practice of Anthropology (NAPA). Could you explain how you joined that organization and what some of your missions are? Can current students or faculty get involved?
A: I became involved in NAPA through the NAPA-OT Field School in Guatemala, which teaches applied anthropology research methods and applications of the human right to health. This is the only field school supported by the AAA, and I saw an organization committed to doing the work to build deep relationships within communities I cared about. I was hooked! As an organization, NAPA is dedicated to using anthropology to address real-world problems. The section offers opportunities for mentorship across the career span, hosts the annual Careers Expo at the AAA meetings, and hosts skills-building and applied ethics workshops and online toolkits. I wish I had known about NAPA earlier in my training, and I would love to have more involvement from our BU Anthropology network.
Q: NAPA is part of the larger American Anthropological Association, of which you currently serve on the Members’ Programmatic, Advisory, and Advocacy Committee (MPAAC) as the Gender Equity Seat. How have you seen gender equity change throughout your membership in the AAA? Have you noticed changes in anthropology as a discipline?
A: I became committed to promoting gender equity in anthropology when I returned home to BU from dissertation fieldwork and realized that my dear friend and classmate Dr. Lindsay Gifford (now at University of Chicago) had experienced many of the same challenges, even though our fieldsites were half a world apart. I have published on gender-based violence in fieldwork and remain committed to increasing the visibility of challenges women and other marginalized gender identities face while on fieldwork. I have contributed to methods and fieldwork training at my own institution, and I’m now serving as the elected Gender Equity representative for the AAA. In this role, I am coordinating revisions to the AAA Policy on Sexual Harassment and Sexual Assault. No one wants to think about these things or do this work, but I see it as my responsibility to pay forward the support that I’ve received in my career and to try to make the way a bit smoother for those who are coming along behind me. I am always happy to be in touch with anyone about this work!
I have published on gender-based violence in fieldwork and remain committed to increasing the visibility of challenges women and other marginalized gender identities face while on fieldwork.
Q: You’ve co-founded the social enterprise safe+natal. What was the process of founding safe+natal and can you tell us more about your mission?
A: safe+natal began as a pipedream! Based on my long-term work on child nutrition and growth among indigenous Maya communities in Guatemala, we knew that health disparities begin in utero. I had partnered with an incredible health provision organization Wuqu’ Kawoq in Guatemala on previous work, and they were interested in working to improve maternal and fetal outcomes. My husband Gari Clifford, a biomedical engineer, was conducting research on intrauterine growth restriction and realized the potential for taking high-quality perinatal metrics from low-cost Doppler ultrasound devices. We started playing around with devices when I was pregnant with our oldest son, who is now 10—we joke that he is Patient 0! After a lot of prototyping, we were convinced we could take high-quality measures of blood pressure and fetal heart sounds to detect preeclampsia, hypertension, and intrauterine growth restriction.
We ran an NIH-funded clinical trial and found that the safe+natal toolkit was effective in improving needed referrals for facility-based care and maternal and infant outcomes. My role in the project was to co-design the user interface and the toolkit protocol with lay indigenous midwives in Guatemala. The result is a pictogram-driven app that has audio directions in the local Kaqchikel Maya language that supports traditional midwifery while breaking down barriers to facility-based care. The work has been successfully adopted as a standard of care and is being scaled within Guatemala and beyond. The most exciting part of safe+natal has been the ownership of the innovation by the lay midwives, many of whom had never used a smartphone before the project. This pushes back against the received wisdom that health innovation is only for certain kinds of end-users and opens exciting prospects for equitable health service delivery.
Q: In your past research and degrees you’ve shown an interest in the intersection between health and anthropology. With our new track in Anthropology, Health, and Medicine many young anthropologists are following in your footsteps here at BU! Do you have advice for any students trying to integrate these two fields- or general advice for students interested in applied anthropology?
A: There is so much need for your work to integrate anthropology, health, and medicine! I have been so grateful for my training in both anthropology and public health. Sometimes it’s challenging to see where you fit when you work across disciplines. Beginning when I was the first BU Anthropology PhD/MPH student, my work doesn’t neatly fit a box—I’m both an anthropologist and a global health practitioner, but by being both, I’m somehow neither in a traditional sense. This has given me incredible freedom to define my own work and goals, but it has also taken effort in making sure my work is legible to different audiences across anthropology, public health, and medicine. Sometimes it’s hard to work on teams where other team members don’t immediately “get” your work and contributions – but keep going, it’s worth it! In my role working on low-cost technologies in global health, my anthropology skills often help me translate across disciplines and bring teams together.
I’m both an anthropologist and a global health practitioner, but by being both, I’m somehow neither in a traditional sense. This has given me incredible freedom to define my own work and goals, but it has also taken effort in making sure my work is legible to different audiences across anthropology, public health, and medicine. Sometimes it’s hard to work on teams where other team members don’t immediately “get” your work and contributions – but keep going, it’s worth it!
Q: Speaking of your research experience, can you tell us about your upcoming book, Underbelly: Childhood Diarrhea and the Hidden Local Realities of Global Health? How have your past publications informed this project?
A: So much of my career has been devoted to applied work in global health, and it’s really been the opportunity to contribute to projects that improve health and health experiences that motivate me. I confess that writing an ethnography has not been a priority—there always seem to be more urgent deadlines, projects, and data to disseminate more rapidly. Honestly, until now, I wasn’t sure I had anything new or interesting to say to our anthropology community in an ethnography. Underbelly is an ethnography of global health, building on nearly 20 years of my work as an anthropologist in global health. It explores how the neoliberal structures of global health are navigated by individuals and communities who are positioned as recipients and considers new approaches for building more equitable relationships in global health. Underbelly will be released in April 2024 by MIT Press, and it includes a foreword by Maya physician-activist Waleska López Canú and an afterward by medical anthropologist Arthur Kleinman.
Q: What has been the most unexpected way Anthropology has impacted your life and research?
A: Anthropology has shaped my life and the family I’ve been fortunate to build. My two children are growing up on fieldwork in Guatemala, Rwanda, and beyond, and they understand that there are so many ways to live and be in the world. Being able to include them in my work as an anthropologist has been one of the most surprising and expected benefits of being an anthropologist. I was recently at the Society for Applied Anthropology meetings, and I realized how wonderful it felt to be “home” with anthropologists. I ran into friends from grad school days at BU, former and current colleagues, and inspiring leaders in our field. As much as I love interdisciplinary work and applied projects in global health, I realized how much I rely on anthropology theory, techniques, and communities to keep me centered.
Q: Thank you so much for your time today! Is there anything else you would like our readers to know/keep an eye out for before we end today?
A: Thank you so much for the conversation – and even more, thank you to our BU Anthropology faculty and community for launching and shaping my career!