Out of Zion, better health

For a growing number of public health professionals from 90 countries in Africa, Southeast Asia, South America and other parts of the developing world, the road to career success and influence runs through Jerusalem. More than 750 physicians, epidemiologists, nurses, pharmacists and other medical personnel have since 1971 received their International Master’s of Public Health (IMPH) degree at the Braun School of Public Health and Community Medicine at the Hebrew University’s Faculty of Medicine.

Some of the IMPH alumni have become health ministers or directors-general of health ministries or have taken up other influential positions from Albania to Kenya, Nigeria to Russia and Tanzania to Uganda during the past 42 years. But they have not forgotten their distinguished professors and lecturers at the Braun School who, they say with gratitude, provided them with the tools to get ahead and to alleviate disease and poverty and promote health and development.

More than 60 alumni and almost 30 current IMPH students came to the capital’s Jerusalem Gardens Hotel earlier this month for a nine-day reunion and workshop in the capital to learn about cutting-edge research in the field while exchanging professional experiences, challenges and successes. It was the second Pears Foundation alumni event, following the first one held three years ago.

Students from low-income countries are awarded scholarships by the British Pears Foundation and other donor institutions, including the Foreign Ministry’s Department for International Cooperation (Mashav) and the British Friends of the Hebrew University.

“The foundation, established by British businessman Trevor Pears, is a strategic partner in our IMPH program,” said Braun School dean and former IMPH program director Prof. Yehuda Neumark, who handed over responsibility for the program to his colleague Prof. Ora Paltiel. “In providing support for IMPH scholarships and follow-up alumni activities, it aims to build a network of scholars in low-income regions of the world who benefit from academic expertise in Israel. Its support also helps strengthen relationships between Israel and Africa through building strong academic cooperation.”

Among the IMPH graduates at the reunion and workshop was Prof. Cui Fuqiang, a widely published research scientist serving as deputy director of China’s national immunization program and director of the hepatitis division of the Chinese Center for Disease Control and Prevention. After graduating the IMPH program in 2004, he moved to Beijing to join China CDC, and was granted over $3 million in research support.

“I will never forget the IMPH program’s courses in epidemiology and community-oriented primary care. I learned so much that helped me develop my research model when I returned to China,” he said, adding that the program “gave me both epidemiology skills and the self-confidence to pursue my career.”

Another IMPH graduate is Dr. Josephine Ojiambo, ambassador and deputy permanent representative of the Kenya Mission to the UN, who has played a leading role in women’s organizations, UNICEF and public health non-governmental organizations in areas such as HIV/AIDS and malaria.

KIOKO KIILU, an epidemiologist from Kenya who earned his master’s degree in public health in 2007, told The Jerusalem Post during the reunion that he was thrilled to return to Jerusalem. “I was on a full scholarship from the Pears Foundation and enjoyed my time studying and touring Israel so much. I like the quiet of Jerusalem, and Israelis in general are very nice and open. My country and Israel have had very good relations for as long as I remember. There’s even a place called Kenya Israel in my country.” He added that “especially as I am a Christian, I loved touring the holy sites and also learning about Jewish culture. I even got used to the food, including the humous and the shwarma.”

“There are other countries that offer an MPH, but the Jerusalem program is unique, with a focus on disease prevention and control and population and health using a community-based approach.”

After earning his degree, he returned to Kenya to work in the local Red Cross Society and elsewhere. He is now involved in malaria prevention and control and research into the disease, which is one of the biggest problems on the continent.

Kenya has a population of 38 million, and the people are constantly exposed to malaria-spreading mosquitoes. According to Kenyan government figures, 25 million residents are at risk of malaria. It accounts for 30 percent to half of all outpatient attendance and a fifth of all admissions to health facilities. An estimated 170 million working days are lost to the disease each year. It’s a killer, and causes 20% of all deaths in children under five; the group most vulnerable to malaria infections are pregnant women and pre-school children.

Even HIV is less of a threat to the population than malaria.

“It’s an epidemic. We use rapid diagnosis kits that give the answer on the spot of a person is infected, and if it’s positive, we give medications called SETs. But there are problems of compliance,” said Kiilu. “The best way to fight malaria is prevention, by making sure that everybody – children and adults – goes to sleep under nets. The mosquitoes are most active at night. Public health efforts also try to minimize standing water, spray insecticides that do not harm humans and take other mosquito-control actions. The coastal zones are very hot and humid, and at Lake Victoria, it’s also warm – weather that is conducive to mosquito infestation. But at least higher and cooler regions such as that around Mount Kenya are free of mosquitoes.”

Kiilu himself recalls having been infected with the disease a decade ago. “I took antimalarial drugs and slept for two days. Someday, Kenya will be free of malaria, but for now, everybody in the country gets infected.”

RENE GALERA, who works for the Philippines health ministry, and Ksenia Kubasova of Russia are current IMPH students.

“I studied medicine at the University of Philippines and am a general practitioner. I had never been to Israel before. We’re studying Hebrew and live on the Ein Kerem campus. The teachers at Braun are all great. I want to continue working in the ministry after completing my degree, but I also to to strengthen new fields in public health such as genetic epidemiology,” Galera said.

A sociologist who comes from a town not far from St. Petersburg, Kubasova was working in HIV/AIDS prevention. “My relatives were rather nervous about my coming to Israel, but everything has turned out very well. We have four courses a day from 8:30 a.m. to 4 p.m. and many tests. The studies are wonderful. I hear Russian everywhere and feel at home. I am determined to implement in my country what I have learned,” she said. “I’m sure that all of us will become different people than we were before we came to Israel.”

Abimbola Kola-Jebuti of Nigeria earned his master’s degree in Jerusalem five years ago and returned for the reunion with great excitement. “The level of students is even higher now, and it was exciting to meet my former teachers again,” he said.

Today he works in his country’s capital at Family Health International, a USAID project the employs 600 people around the country.

“I had thought of teaching public health when I returned home, as I saw in Jerusalem the passion of students exposed to international health. This was missing in Nigeria. Now I want to improve the system.”

Kola-Jebuti noted that while infectious diseases such as malaria and HIV remain major health problems, non-communicable diseases such as cancer, hypertension, diabetes and stroke are growing.

“But we are starting to teach residents how to live better, with less fat and sugar and more fish and chicken. There are even vegetarians. We are encouraging people to exercise and creating bicycle and jogging paths in cities. We are trying to control sewage dumps and promote a better environment. There is so much to do in my country of 160 million people, Christians and Muslims. I am a Christian Pentecostal, and Israel is the land of the Bible.”

The Nigerian, a physician who also did a residency in public health and is married to a dentist, said openly that eventually he would like to become health minister of his country so he can directly influence the health of his countrymen.

“I want to be at the top and make beneficial changes, but to join the government, you first have to join a political party. I have to find people interested in me. In Africa, most health ministers are physicians.”

He was rather shocked to hear that (except for one in the past) Israeli health ministers are not, but rather politicians, and that one can head the ministry in Jerusalem without even having gone to high school.

The average life expectancy for Nigerian men is 46 and 47 for women, “but these are averages. My wife’s grandmother died at 95, so there is a lot of variation. More must be done to fight infection and poverty and to promote education. I will give lectures on what I learned at the workshop when I return,” he said.

Another graduate who returned to Jerusalem for the reunion and workshop was Ose Okoye, a Nigerian who decided at the age of four to become a doctor after seeing photos of a starving boy before and after being cared for by UNICEF. One of 10 children whose parents encouraged them all to graduate from college, Okoye received her MD degree from the University of Benin in 1995 – one of 15 women in a class of 127. Although she initially thought of pediatrics, she decided to go into public health, a field in which Nigerian doctors go to the poorest, least educated patients in the field rather than sitting in pleasant offices and having well-off patients come to them.

When she returned from Jerusalem, she went to work in a faith-based organization in the southern part of the country whose physicians set up tents in such poverty-stricken areas and treat patients who flock to them. Some 300,000 Nigerians have benefited from the program over the past decade. More than half of women now give birth in hospital, and vaccination programs have taken off.

The tall, striking-looking physician is now devoting much of her time to preventing rape and helping rape victims.

Sexual attacks on women and even young children are commonplace in her country.

“Some men claim women who are ‘not dressed modestly’ deserve to be raped. There is also a myth among men with HIV/AIDS that if they have sex with a virgin, the virus will disappear. So this too results in many rape cases. There are also widows and grandmothers who are gang-raped. The victims have begun to strike back by putting their experiences and photos on the Internet.”

NEUMARK, WHO was actively involved in the workshop, said that the investment in the foreign students is clearly worthwhile.

It promotes public health in the Third World, and graduates take up prominent positions while becoming informal Israeli ambassadors.

“The curriculum is regularly upgraded, and when students request lectures on new fields such as geographic information systems, grant writing or disaster management, we obliged. And they are so pro- Israel after living here. One student from Sudan named his child Mordechai, while another chose Israela and a third Hadassah.

As they can’t afford to return to their homes during the year of studies, some wives have given birth while their husbands were in Jerusalem. There was a Muslim from Albania who felt so close to Judaism that he wanted to convert, but he was turned down by the rabbis because they felt he had an idealized vision of Judaism.”

The dean recalled an Ethiopian woman working for the World Bank who when interviewed was warned that working under heavy stress was a requirement.

“She replied that while doing her IMPH, she participated in seven different groups in different courses. She told her interviewer that “if I could manage that, I can manage anything.”