“As a freshman, I was on a pre-med track, ready to make a difference in the world as a doctor,” says Alexandria Schmall ’15. Now an International Agriculture and Rural Development and a Development Sociology Double Major, Schmall was inspired to change direction by a course: Experience Latin America (IARD/LATA 4010) with Debra A. Castillo, Comparative Literature/Hispanic Studies, and Peter Hobbs, associate director of the College of Agriculture and Life Sciences International Programs. A crucial component of the course is a summer internship experience in Chiapas, Mexico, which engages students to experience the topics discussed in the class for themselves, in the field. Schmall decided to work with an organization called Sanut, a name that combines the Spanish words salud (health) and nutrición (nutrition) to represent the nonprofit’s holistic approach to public health. “Taking that class, I realized the best way for me to be a force for good was to go into international health policy," says Schmall.
A lot of the work Schmall participated in for her internship involved talking to mothers in rural communities about the causes of malnutrition and diarrhea, two very prominent and harmful health issues in the area. “In talking to so many moms,” Schmall says, “I realized that I couldn't bring myself not to continue the work I was doing, beyond my internship.”
Upon her return to campus in the fall, Schmall looked for opportunities to continue her research in Chiapas. She contacted Julia Finkelstein, Nutritional Science, whose interests aligned with her own. Finkelstein focuses on randomized trials and cohort studies in resource-limited settings—essentially, longitudinal studies that incorporate life histories of specific segments of a population based on shared characteristics or experiences within a given time period. “Dr. Finkelstein really helped me set up a research project to pinpoint areas where knowledge was most limited about these issues,” Schmall says.
With her professor’s guidance, the student researcher decided to direct her study more toward qualitative than quantitative data, focusing on mothers and infant health. “I found that there was a lot of quantitative research on international public health, but there was a disconnect between data collection and application,” she says. One of the reasons for this, she believed, was that many of the studies that were conducted hadn’t looked at the social determinants of health issues—instead of breaking with quantitative research, however, she decided to use it as a foundation to build upon with qualitative research techniques.
Learning to Work within the Community
The two indigenous Mayan communities Schmall studied in the mountains of Chiapas had populations of about 1,500 people and were relatively isolated from larger urban areas. “In these traditional communities, culture is very distinctive and important, which we paid special attention to in order to create lasting, sustainable change,” she says. Bearing this in mind, Schmall determined to interview mothers with children under the age of five, conducting focus groups, individual interviews, and door-to-door surveys (which often led to interviews). That summer, she interviewed 100 women, and the winter after, 60.
“Taking that class, I realized the best way for me to be a force for good was to go into international health policy," says Schmall.
In her research, Schmall has identified practices that lead to poor health in the communities she studied, especially in the very young children. The first practice is seen right as children enter the world: mothers, Schmall discovered, breastfeed their babies for only one month after birth, after which they switch to watered-down beef broth or Coca-Cola. Schmall has linked this to lack of education for recent and expecting mothers on the health benefits of breastfeeding—namely, that breastfeeding for one to two years (the latter of which is the World Health Organization’s recommended length) after birth significantly reduces the chances of health problems such as stunting, malnourishment, and diarrhea, all of which can be fatal in infancy or later on in life.
Educating for a Healthier Future
“It’s, of course, not that these mothers don’t want what’s best for their kids—it’s that they don’t know they could be doing things like breastfeeding that would improve their kids’ chances of being healthy. It’s up to nonprofits and government agencies to work with communities, following their leads to create education programs.” Already, between the summer and winter Schmall spent in Chiapas, she noticed that the women she first interviewed had started to change their practices, and their babies were healthier for it.
Now Schmall is working under Finkelstein’s guidance to compile her findings. She hopes her qualitative findings can be used in conjunction with quantitative data to address the issues of lack of health education and poor infant nutrition. “We’re going to try and disseminate this information as widely as possible so that groups with the resources know how to help the communities create education programs that suit their needs and cultural context, which we believe will create meaningful and lasting change.”