In Guatemala City, Candace Jones found clinic waiting rooms afforded an opportunity for health education. She tested the responses of viewers to several videos on AIDS. Award-winning teachers Jim Setzer (left) and Dirk Schroeder created the opportunity for public health students to gain new knowledge in the field, designing and supervising student internships in Guatemala in collaboration with local publ ic health agencies.

by Rhonda Mullen ake no mistake about it: when the 14 students arrived for the beginning of their summer school class, they knew they weren't at home. These students - from the departments of international health and anthropo logy at Emory - formed the first class to get an opportunity to receive training and do research at an international field site in Antigua, Guatemala. In a country where poverty is the rule, not the exception, the ancient city of Antigua is beautiful, surrounded by mountains and dotted with ochre-colored buildings tucked into hillsides. On the streets, women from the indigenous Mayan culture wear bri ghtly colored dresses with designs that depict their villages and regions. The students quickly immersed themselves in the culture of the country, being enrolled in intensive language classes and living with families from the host country. During their second week in Guatemala, a volcano near Antigua erupted, sending a shower of ash and pebbles to coat the city. Dirk G. Schroeder, a faculty member of the Rollins School of Public Health, still has a jar of volcanic dust sitting on his desk in Atlanta. Schroeder, along with James Setzer, both of the Department of International Health, are two of the faculty members who made this education and mentoring experience possible. They are the kind of teachers who go the extra mile, both having received reco gnition for their teaching. Schroeder was the school's Professor of the Year in 1997, and Setzer received the 1997 Thomas F. Sellers Jr. Award for serving as a role model and mentor in the school. "This summer was filled with very practical learning opportunities for students," Schroeder says. "In our classes, we come as close as we can to that, but we can only get so far." Setzer adds: "In the field, our students see the applications of that classroom theory. They see that people really are using tools like epi info, for example." For many of these students, this experience was their first in a developing country. "When students are dealing with abject poverty for the first time, it is tough," says Setzer, "so it's especially good to have faculty there." In a series of afternoon lectures, through tours of local hospitals and health facilities, in presentations by public health practitioners, and most importantly, through individual research projects, students gathered a store of useful knowledge. Every day that student Matt Nims spent in Guatemala, he "added volumes to his knowledge of public health. Most of what I've learned cannot be taught in school, but rather here in the field, by experience," he says. "I believe that one of the strongest aspects of this program is the opportunity that students have to travel and do work outside of Emory, in the real world."

Hubert Fellow Beth Imhoff (left) worked with a translator to deliver the questionnaire she developed for women who had expressed an interest in family planning.

n deciding on where to set up their international teaching experiment, Schroeder and Setzer turned to Guatemala for very specific reasons. For one thing, Schroeder had contacts and a history of working in th e country. He spent three years living in Mayan villages while completing doctoral field research, and he has since served as the co-principal investigator with Reynaldo Martorell, the department's chairman, of an important nutrition trial, conducted for the Institute of Nutrition of Central America and Panama (INCAP). Setzer, by contrast, has done most of his work in Africa, a continent that hosts many public health initiatives that are spread out over many countries. Situating the field site in Guatemala offered Setzer a new foothold and new contacts for his resear ch. "There is a lot of quality work being done in public health and nutrition in a very concentrated area in Guatemala," he says. One of the most compelling advantages to training students in Guatemala is the multitude of language training schools. These schools also arranged for the students to stay in the homes of local people, immersing them in Spanish-speaking families and gi ving them a more personal understanding of the culture. "This was an invaluable experience, not least because we got to speak Spanish all the time," says student Dora Ward. "More important was the knowledge that the families we lived with were, by local s tandards, fairly well-off. Yet they lacked the resources we consider to be middle class." Ward's adopted family had a television and refrigerator, but they washed their clothes in a pila, a three-level concrete sink. Their grandmother headed the household of two parents and two children. The father was a carpenter, and the mother a teacher. While they were relatively affluent in Antigua, they were unable to afford a daily newspaper, which cost around 2 quetzals, or 30 cents.

In Solola, the organization MotherCare trains traditional birthing attendants to identify high-risk pregnancies. Beth Imhoff used MotherCare's database to tailor her project questionnaire. For some of the student fellows, this summer experience in Guatemala was their first in a developing country, where they learned about the challenges and opportunities for delivering health care to the public.

s the shape of the project started to form, Schroeder and Setzer knew they would need help in funding the teaching initiative. In the end, commitment to the project for one year came from a variety of source s, including the Emory Internationalization Fund and the University Teaching Fund. The Eugene J. Gangarosa Scholarship Fund supported two students, while a new fellowship at the school, supported by the O.C. Hubert Charitable Trust, gave eight students a chance to join the Guatemala class. Besides arranging funding, the faculty needed to match the interests of students with the needs of organizations in Guatemala. "We wanted to make sure this was a win-win situation for the students, faculty, and the organizations," Setzer says. Instead of assigning students to a particular research project, the faculty insisted on creative input from the students themselves. "This created some tension," Schroeder admits. "Often students want to know exactly what they are expected to do, but we avoided handing work to them on a plate. It is more important that they learn the process of setting up a research project." Beth Imhoff, a student on the epidemiology track, came to the Guatemala field site with an interest in a variety of public health interests. What she ended up doing and how she got there illustrates this creative process. MotherCare, whose goal is to decrease maternal and infant mortality, is one of the organizations that faculty had targeted for possible collaboration. Imhoff and Setzer attended one of MotherCare's meetings of traditional birth attendants, held in the green mountain town of Solola. During the meeting, Imhoff discovered that MotherCare had a database of all the women who had delivered babies with their help. The data included information about the baby, whether the women wanted more children, and whethe r they were interested in family planning. Brainstorming with her faculty advisers and the director of MotherCare, Imhoff decided to develop a questionnaire to determine whether the sample of women who wanted no more children and were interested in family planning were actually pursuing it. If they weren't, Imhoff wanted to uncover the perceived obstacles. Working with a Mayan translator, she delivered her survey this summer and will present her results at the school this fall. "This is how collaborations and research work," Schroeder says. "It is an unbelievable opportunity for students."

n contrast to Imhoff and many of the other students, who were visiting a developing country for the first time, Matt Nims is the pro. From 1994 to 1996, Nims worked as a Peace Corps volunteer in the Dominica n Republic. His experience as an environmental sanitation technician is proving useful in Guatemala. Currently, Nims is collaborating with Project Concern International (PCI), a private volunteer organization that has been a presence in Guatemala for 20 years. After the Guatemalan government signed peace accords in December 1996, ending its long civil war, the country received foreign monies to help restore the war-torn areas and to aid the Mayan people. PCI received one such grant from USAID, which they are using to bring health care to Mayan communities located in the areas where fighting during the civil war was heaviest. Specifically, Nims is preparing the background for a proposal from PCI to continue its programs. The organization wants to implement a water and latrine program, and Nims is investigating the type of program that would work best, the roles of the commu nity and partners, and general feasibility of the project. He's also determining the skill level of the community to build appropriate structures and gauging community interest. "If I get lucky," Nims says, "I will have laid some of the groundwork for a multi-million dollar health intervention using the PCI model and local resources."

Molly Counihan learned the complexities of study design while working with mothers in two hospitals in Guatemala. She conducted a questionnaire to test her hypothesis that there is an association between antibiotic use and persistent diar rhea in children.

his is important work," says Schroeder. He's referring not only to Nims's project but also those of the other students who have come to this field site to learn and to help. This first batch of students ha ve returned to Atlanta with mountains of data, the beginnings of their thesis research, knowledge of another culture, and the desire to learn more. Dora Ward, working with the director of external relations at INCAP, analyzed funding sources and trends for Guatemala from bilateral and multilateral international donors, compiling a detailed database to serve as a resource for those seeking funding in food and nutrition security. The information will allow clearer insights into the policy-setting and decision-making process of organizations that receive grants. Molly Counihan conducted a survey in two hospitals in Guatemala, interviewing mothers in the outpatient clinic and emergency room. She focused on the maternal decision to use antibiotics to treat diarrhea, hypothesizing that there is an association bet ween antibiotic use and persistent diarrhea. "I've learned the complexities of study design firsthand in the field," Counihan says. "I would like to return to continue similar research for a longer period of time." Her sentiments echo those of the other students. They've gotten a taste of research in the field. They want more.