In Mexico, Students Tackle Cavities, Pesticides, Sex Ed, and More.

As they check in via Skype with Veronika Wirtz, the instructor of the Mexico field program, students Alicia Martin, Linette Duluc, and Carlos Sian keep one eye alternately on the clock and on something on the floor of their apartment.

Now in its third year, the field program is a collaboration between SPH and the National Institute of Public Health (INSP) in Cuernavaca, Mexico. Each of the three SPH students is working with a different team of INSP students out in the field, conducting health assessments of communities in the area and implementing interventions in Cuernavaca.

“Just a heads up, we have about 25 minutes left, and then we have a fumigator who’s going to be stopping by because we’ve been battling some scorpions in our house,” Martin tells Wirtz, who is both associate professor of global health at SPH and a visiting professor at INSP. “We’re at a high altitude so the scorpions are only about that big,” Duluc says, holding up her thumb and forefinger to suggest a scorpion an inch long, “but there are tons of them.”

Despite their scuttling roommates, Duluc, Martin, and Sian are making tremendous progress, Wirtz says.

The three agree they have been productive, and say working alongside INSP students elevates the experience. “They’ve been working on this since September, since they started their MPH, and we come into this setting to help them get the job done,” Sian says of the INSP teammates and their projects. That comes with a lot of pressure, he says, and a lot of honesty to make sure they are really being helpful.

The INSP students are also a huge help for understanding the ins and outs of health and life in Mexico, the SPH students agree. The three are native Spanish speakers—although they have each had a pitfall or two with Mexican slang—and Sian says the they have been complimented on integrating so well. “As they know more about us and we hang out there’s this growing trust,” he says, “and they trust us to take on more complex parts of the projects. That allows us to learn even more.”

Wirtz applauds when Sian says he will be one of the people presenting the results of his team’s work to the community they are studying, a small town called San Andrés Hueyapan.

Sian is spearheading the social mapping portion of his team’s community assessment with maps that show the relative location of households and institutions and the distribution of different demographics and features within the population. Social maps of Hueyapan now hang on the walls of the students’ apartment.

Sian’s team was also tasked with conducting 345 surveys and 30 key informant interviews — in one month — in Hueyapan, a town about halfway up the southern slopes of Popocatépetl, the second-highest peak in Mexico. That provided valuable information for a health diagnostic of the community, and to plan interventions.  Sian says conducting 10 interviews in four hours in 90-degree heat was so strenuous, several interviewees sat him down and gave him water.

Sian’s group also ran an intervention in Cuernavaca, now completed, teaching middle schoolers about different methods of contraception and STI prevention.

Next on this check-in call with Wirtz, Duluc shares her team’s progress as they conclude their community health assessment in a small city called Atlatlahucan, about 30 miles from Cuernavaca. With the data mostly collected, Duluc is helping to clean up, analyze, and graph the findings. The team will also be meeting with the local director of Mexico’s National System for Integral Family Development, known as DIF.

Duluc’s team is now moving on to their intervention, working to help prevent teenage pregnancy at a middle school in Cuernavaca. “Mexico as a whole has a big problem with teenage pregnancies, and at this middle school the rate of teenage pregnancies is high, about two or three every school year,” she says. “We asked them, ‘Raise your hand if you know anyone ages 13, 14, or 15 who has gotten pregnant,’ and almost all of them raised their hand.”

The team is running a three-session workshop with 90 students at the middle school. “There were a couple of myths that the students thought were true, and one was that using two condoms is safer than using just one,” Duluc says, “or if you use a condom it means you don’t trust your partner.” Those myths, and other knowledge gaps revealed by a survey and a follow up questionnaire, are now being tackled in the intervention. The workshop will include the classic exercise of putting a condom on a banana, because the questionnaire showed none of the 90 students knew the correct order of steps. The team is also leading the workshop with a psychologist, who helps handle the tougher and less technical questions, Duluc says: “‘How do I tell someone when I don’t want to have sex with them?’ ‘How do I know when I’m ready?’”

Martin’s team is also working in a school community, to improve dental health at a kindergarten in Cuernavaca. “At exactly 2:00 pm, when the students are being picked up from school, there is an infinite amount of vendors selling chocolate, candy, churros, everything sweet you can think of,” she says. Cavities are a big problem in this part of Mexico, she says, so the team is teaching parents about the importance of brushing their children’s teeth, and providing toothbrushes and tooth paste.

Her team’s community assessment is in Tlalnepantla, a very small community where 78 percent of the families work in agriculture, particularly growing nopal, a type of cactus. The big public health issue in this community, she says, “is where the agricultural workers come back home from the field with these fertilizers and pesticides and store them in their homes. Not only are they exposed but so are their wives and their children, and it’s creating a lot of issues with their health.” The team is now preparing to present their findings to the mayor and other community leaders.

As if the intervention and community assessment weren’t enough, the three students are also working on another project. Sian and Duluc are investigating preventable hospitalizations among diabetic patients, and the cost to the individual and system. Martin says she has a 9 to 5 job: “I was appointed to the largest maternal health project here in the Institute, which I’m incredibly excited about,” she says. Martin is the second biostatistician on the project, a partnership between INSP and Emory University’s Rollins School of Public Health to design, implement, and evaluate an integral model to improve maternal and perinatal health services. Maternal mortality is high considering the economic development of the country, she says, and one of the problems is accurate reporting. “There have been women who have to travel a long distance to get to a referral center and die along the way,” she says. “Many others experience miscarriages.” The project is now working to promote having midwives run a local clinic, so women can find care closer to home, and hopefully to save lives, Martin says.

“I am beyond thrilled to be a part of this project,” she says. “As sappy as it sounds, this project has really changed my life.”

All up to date, Wirtz tells the students she is very pleased. “You really have the three-pronged approach,” she says. “You are part of an ongoing research project, you are implementing and evaluating a community health promotion intervention, and you are conducting a community assessment. You have a lot of things on your plate, but it really sounds exciting and like it’s going very well.”

Before ending the Skype call—the exterminator will be there any minute for the scorpions—Duluc sums it up: “It’s a fantastic experience.”

—Michelle Samuels

Linette Duluc, Alicia Martin, and Carlos Sian are taking over the SPH Instagram account to share photos from Mexico from June 12 through 16. Follow along at Instagram.com/BUSPH/