by Valerie Gregg

nita McLees's first few months as a Peace Corps volunteer were like a roller coaster, as she fluctuated between states of ecstatic awe and miserable loneliness. She was assigned to live and work with the loca l midwife in a large village in the Ivory Coast in western Africa. Unfortunately, the midwife wanted neither her help nor her presence.

"The midwife was a difficult woman," says McLees, now working toward her MPH at the Rollins School of Public Health. "The Peace Corps was hard at first. I was lonely, and I had too much unstructured time. After a few months, I realized I had to tackle things from a different angle or my assignment was not going to work. After I moved in with a wonderful family and started doing more of my own thing, it was great!"

Taking the initiative made all the difference for McLees. She worked with the midwife to encourage mothers to immunize their children and receive prenatal care. But she also began to work independently -- teaching health classes at two village elementa ry schools, training teachers how to teach children about health, and visiting local families.

Her loneliness disappeared as she was warmly embraced into daily family life. Her host family's cinder block house had no electricity or running water, but McLees had a latrine and room to herself when she needed privacy. Her door opened onto a courtya rd where villagers, goats, sheep, and chickens wandered by. The house was full of children laughing and women chattering. The man of the house, his sister, and his two wives spoke French, so McLees, who is fluent in that language, had no problems communic ating. She quickly became part of the fabric and rhythm of the village.

"The culture sinks into you slowly, and one day you realize you are part of it," she says. "It really struck me when I came home. Everything was very communal there -- out in the open. That kind of outside living was hard at first, but after a while I enjoyed the fact that there was always someone to sit with, talk to, or walk with. People were everywhere, and they looked out for each other. It came to feel very comforting."

She ended up staying her full two years and signing on for an extra year to train AIDS educators in a nearby city.

Cultural adaptation, self-reliance, creative problem-solving, and risk-taking abilities are job requirements for international health workers. These qualities are also necessary to succeed and survive 27 months in the Peace Corps, says Jim Setzer, seni or associate and program coordinator for the RSPH Department of International Health.

In 1999, RSPH began offering an MPH degree that incorporates Peace Corps service. After three or four semesters of course work, students enter the Peace Corps and may use their experience for their master's thesis. Setzer and others in the RSPH are ava ilable for support and consultation during the students' time overseas. And because they have completed master's degree course work, they may receive a higher-level public health job placement in the Peace Corps.

Now in its second year, the RSPH program is already the second-largest Peace Corps health collaboration in the country. Six students enrolled in its first class will join the Peace Corps this summer. Setzer says the program is good for the school as we ll as the students.

"It helps us attract good students - a particular type of student - young, energetic, but inexperienced. They need some practical experience to get the kinds of jobs they want. These experiences show their future employers what they can do. Two years i n the Peace Corps is a real confidence builder. Students learn to deal with a lot of ambiguity; they roll with the punches; they're self-reliant."

Gross spent the summer between her first and second years of RSPH course work in a Bangladeshi brothel. She worked for a CARE group called "Shakti," which means "power" in Bangla. For the past five years, the group has trained Bangladeshi sex workers h ow to prevent HIV and other sexually transmitted diseases. Workers at the brothel clinic have also learned how to manage some sexually transmitted diseases.

"There were 700 sex workers between the ages of 14 and 50 in the brothel, which had its own clinic," says Gross. "It was a community of women. Some were sold into the brothel. Some chose to go into the brothel to pay for school for their siblings or to support their families. Many of these women were outspoken and opinionated, but some sat timidly with their heads down and wouldn't talk."

Gross' assignment was to interview sex workers and help evaluate the Shakti program's success. She found that more of the women demand that their customers use condoms now than five years ago. She plans to write her master's thesis on her summer experi ence and hopes to receive a Peace Corps assignment involving reproductive health. The lives of the women in the brothel could have been mind-boggling for a young American woman with no experience in a developing country. But the experience helped Gross le arn to set aside her personal angst, plow ahead, and do what needs to be done.

Kristie McComb, another MPH/Peace Corps student, spent her summer in Kenya, working on a child survival project for CARE. Her job was to find out why community health workers were quitting and find ways to keep them on board. The problem, McComb found, was economic. These workers - trained by CARE to prevent, diagnose, and treat the four major killers of Kenyan children, diarrhea, malaria, measles, and pneumonia - were not getting paid.

"Kenya has an agricultural economy," she says. "Time caring for sick community members takes away from time in the fields. It literally takes food from their families. I developed a system to find new ways to motivate and compensate community health wo rkers, to begin a dialogue on this issue in the community. We even considered in-kind payments such as chickens or rice. Ultimately, this issue will affect the sustainability of this project."

McComb says her summer field experience - funded by the Emory Center for the Study of Health, Culture, and Society - offered hands-on learning. "I had to identify the issues and figure out the dynamics," she says. "We had read all these case studies in class, and this summer I was a real part of a case study. It opened my eyes to what working in international health is all about. It's about finding out what the problems are and helping solve them too."

She hopes the longer stay with the Peace Corps will allow her to see the results of her work. She is especially interested in HIV prevention in east Africa, where prevalence rates are as high as 35% in some cities. She was profoundly affected by a grou p of young Kenyans she met that performs at schools and churches, spreading messages about HIV prevention.

"When I was in Kenya, there were funerals all the time -- every weekend," McComb says. "These were young people dying -- men and women with several children. People there don't talk about them dying of AIDS specifically. There's such a stigma. It's ver y depressing to think about how difficult it is to empower a community to fight something they can't even talk about."

"I think people who go in to save the world become overwhelmed and disillusioned," says McLees. "Those who do well want to make a difference, but you realize partway through that you may be getting more out of it than the people you're trying to help. You realize just how much you don't know, how much there is to learn about other people, other ways of life, and other ways of doing things."

Setzer started his own public health career with a 3 1/2-year Peace Corps stint in Zaire. He says the experience helps idealistic students learn some hard, but necessary lessons.

There are now more than 7,000 Peace Corps
volunteers serving in 76 countries around
the world, working to help fight hunger,
bring clean water to communities, teach
children, start new businesses, and stop
the spread of HIV. Since 1961, more than
161,000 Americans have joined the Peace
Corps and served in 134 countries world-
wide. The pay is only $6,000 for 27 months
of hard work under sometimes difficult
conditions.
 

"It's all part of a process," he says. "You probably learn as much about yourself as the people you're working with. That's the beauty of it."

Students in the RSPH Peace Corps Master's International Program must complete 42 semester hours of credit, including all core courses, and may apply to any department in the School of Public Health. The program requires about 18 months in resid ence at Emory and two years of Peace Corps service. Students receive three credit hours toward the thesis requirement for the MPH degree upon successful completion of overseas service. Students also receive priority for public health assignments in the Pe ace Corps. For more information, contact assistant coordinator Shannon Shelton at 404-727-5724 or sshel01@sph.emory.edu or check the web site.