Community-Driven Solutions in Global Health with Patrick Mbullo Owuor, PhD

• Owuor studied biocultural anthropology and public health, with academic training at Maseno University, York University, and Northwestern University.
• His career path has led him to exploring the impacts of community-based health interventions in Kenya, where he is originally from. In 2007, he co-founded Pamoja Community-Based Organization.
• While doing field work, Owuor found environmental stressors such as infrastructure development of dams contribute to housing and water insecurity that affect public health in East Africa.
• The integration of anthropology and medical sciences in global health research and implementation allow for deeper impact and understanding contributing to interventions that are culturally sensitive, contextually relevant and more likely to be effective and sustainable. 
• In collaboration with Dr. Lisa Hirschhorn and medical students, Owuor helped identify barriers to PrEP uptake among adolescent girls and young women in East Africa and provide practical interventions for HIV prevention in this population.
• Owuor is utilizing the term “hydro colonialism”as a framework to analyze the biosocial impacts of large-scale infrastructure projects on vulnerable populations. Specifically, looking at the environmental injustices and future of dam construction.
• Owour is also examining the cultural politics and ethical challenges of human biobanking in East Africa, including the export of biological samples to high-income countries, the need for equitable resource access and local laboratory capacity, and the importance of developing frameworks for global consent and fair participation of local researchers in clinical research.
• For those thinking of a career in Global Health, Owuor recommends finding a mentor, reflecting on the importance of community perspectives, and to have patience in learning about other cultures, ideally spending 6-8 weeks immersed in another culture.

[00:00:00] Dr. Rob Murphy: Welcome to the Explore Global Health Podcast. I'm Dr. Rob Murphy, executive director of the Havey Institute for Global Health here at Northwestern University Feinberg School of Medicine. Today we are delighted to welcome biocultural anthropologist Dr. Patrick Mbullo Owuor. To the podcast. He earned his PhD in anthropology here at Northwestern University in 2022, and he is currently an assistant professor of Anthropology and Public Health at Wayne State University in Detroit. His research explores how environmental stressors, infrastructure development, and social determinants like housing and water insecurity impact public health, especially among women and children in East Africa. Patrick, who is from East Africa, from Kenya to be exact, has a deep understanding of global health and community health programming. He's also co-founder and executive director of Pamoja Community-Based Organization, a nonprofit in Kenya that works with vulnerable communities to identify and address the most significant needs affecting their wellbeing. Today we're gonna talk about Patrick's career path and how his research priorities, real world applications and community engagement paved the way for innovative solutions to some of the most pressing challenges faced by populations in Kenya and beyond. Welcome Patrick .

[00:01:29] Dr. Patrick Owuor: Thanks for having me.

[00:01:30] Dr. Rob Murphy: Let's start at the beginning. Tell me about your childhood, where you grew up, and some of the experiences or important people in your early life that inspired you to pursue anthropology and focus on global health research.

[00:01:43] Dr. Patrick Owuor: So, going back to my childhood, back in Kenya, I grew up in rural Kenya. Kisumu to be specific, Kisumu is in the lakeside city Lake Victoria to be precise. While growing up, I went to an elementary school, which is like, just a day school. You'd go to school, come back home. Well, growing up as a young boy, I would graze cattle as most people in the rural area would do, go to the farm and get food as many people would do. But as I was growing up, I had a very passionate interest in community work. In my teenage youth, I did a lot of community mobilization for many people who wanted to participate in cultural activities within my community. So with this kind of interest I went to high school and later to university. I did my anthropology bachelor's degree at Maseno University, which is in Kisumu, Kenya, where I really focused on HIV and how people living with HIV can come together in support groups to help manage their life through maybe livelihood and through income and so on and so forth. So, working together with people from CDC, I organized groups to take up HIV testing voluntarily. So this really inspired me. Then it happened that in my area that is around 19 95 HIV programming was just coming up as one thing that was being opened to the public. Then an organization that is called Family AIDS Care and Education Services, FACES, opened up. This organization was being run by Professor Elizabeth Kuzi, together with a professor from University of San Francisco, Professor Craig Cohan, who came together to do research in HIV. And when they opened up HIV care for the larger population, I ended up working for the FACES program for a very long time. So through the work of Professor Kuzi and Professor Craig Cohan really inspired me to go deeper into knowing what community programs could help support the people of Kisumu. Then through that I met Dr. Jeremy Pena, who was from University of British Columbia, a medical doctor who really championed HIV rollout in Kisumu. So through Dr. Jeremy, I also gained a really deep interest in community programming. I worked at FACES as a monitoring and evolution officer. Then through this I really did learn that there were so many indicators that were not being reported. People would feel amongst themselves, things that numbers couldn't really get to account for. So through these collaborative work that we did with Dr. Jeremy Pena, we came up to you know, started a community based organization called Pamoja Community-Based Organization. Which is where I actually now started to like ground my global health interest when we started to receive students coming to do global health work.

[00:04:32] Dr. Rob Murphy: You have a very eclectic and international education. You had your bachelor's in anthropology from Maseno , as you mentioned. And then after that you went to Canada to earn a master's degree at York University. And then ultimately you ended up here at Northwestern where you received your PhD. How did you end up on that path and these different countries and institutions tell us how they shaped your approach as an anthropologist working in global health today.

[00:04:58] Dr. Patrick Owuor: I did my bachelor's whilst working at the same time. So I was a self sponsored student while doing my bachelor's at Maseno University. Then I happened to meet one researcher who was, in Kenya doing their postdoctoral work, trying to really understand the landscape of HIV clinical trials in Kenya. This researcher, Professor Danielle Elliot from York University, hired me to work with her as a research assistant. So while working with her as a research assistant, trying to understand the historical clinical trial and the landscape of clinical trials in Kenya. I really came to understand that, there was a difference in terms of understanding or perceiving how clinical trials are being implemented in Kenya. So I started leaning more towards implementation science and how they help the community. So through my collaboration with her, I ended up going to do my master's at York University. And when I was going to York University, my interest was basically to understand the infrastructure, so infrastructure and how infrastructure may structurally help shape health outcomes, whether they're through economic perspectives or through any other means. So it was really a culture shock in terms of how to go through, if you're talking about theoretical perspectives that shape education, theoretical perspectives that shape healthcare and healthcare uptake. So my being at York, doing my masters really was the grounding foundation for me to really push forward to see the cultural differences in the global South as someone who is receiving and implementing research and at the same time being, someone who is able to really maneuver through these two different worlds. So the stark differences between being in Kenya and being at York University was basically the cultural exchanges that happen between, when you cross borders and you know someone who's going for education. So I came to see this, and compare the people coming to Kenya for research, me going to Canada as a student, the cultural foundation that basically drives what I think and how I see Global Health now is basically based on that, cultural development, being able to understand what global North is and what global South is, is an intricate kind of a connection that really has shaped how I see the implementation of clinical research and other development programs that I engage in. So then, when I was coming back to Kenya, honestly after finishing my master's degree. I ended up working with Kenya Medical Research Institute, which is one of the largest research institutions in Kenya as an anthropologist, looking at ways in which aspects of community engagement can help programs. And I also came to meet with Professor Sarah Young, who is at Northwestern University doing water and working with expectant moms to really see the impact of household water insecurity in health outcomes. So with Professor Young, then I also started to gain a deeper understanding of how resource insecurities determine health outcomes of vulnerable communities, especially women and children.

[00:08:07] Dr. Rob Murphy: Your work has emphasized community based health research. As we mentioned, you co-founded Pamoja, the Community Based Organization in Kenya. Can you tell us more about Pamoja and the work that's taking place there now?

[00:08:20] Dr. Patrick Owuor: We founded Pamoja, a Community Based Organization in 2007 at that particular time, HIV and its impact in Kisumu region, as it has continued, the impact was really a phenomenon for lack of a better word. So while working at FACES, that is the Family healthcare And Education Services, we started to see community members really struggling to meet even the necessary expenses to go to clinic and meet their clinic appointments. So we wanted something that would leverage community strength and resources to help them overcome certain barriers. Barriers such as live use that would make them really participate in healthcare in healthcare programs and healthcare optics. So together with these other friends, we started Pamoja Community Based Organization really basically to strengthen community members to be able to identify the community needs that affect them and how to address those particular needs. Our role was basically to see how then can community members through their own efforts be able to bring in resources that might help them? So we started by identifying community health volunteers, currently known as Community Health promoters to really know the extent of HIV AIDS within these localities. So the locality that we were working at is sail in Kisumu. So we started by identifying the number of orphans and children that were left as a result of HIV. Through the work of Community Health volunteers, we came to realize that there were hundreds and hundreds of children and families that were affected by HIV. We rallied the community health volunteers together to start forming community support groups for people living with HIV and for caregivers. So through these community efforts, we came to realize that HIV interventions really required a lot more that would encompass many other things. So Pamoja continued to grow and we realized that our interventions would best be achieved through certain objectives. So we came up with about five objectives. One was community health programming, which currently has a lot of health programs that we run. We also came to realize that other than community health programming education was a greater need. So when we're talking about education, it's not only just the general conventional education, but also community education towards things that matter. Community education towards HIV community education towards public health. We also came to realize that things like water and sanitation, basically resources, are important to ensure that communities are able to prevent certain diseases. We also came to realize that as we do all this within the community, research and development remains a priority. So we also started to really enlarge our interest in research so that we could be able to replicate whatever we were doing. So over time, Pamoja just came to serve over 35,000 families within this particular area. As we continue to expand our community education and research through the help of Dr. Jeremy Pena, we started a collaboration with the University of British Columbia. Since 2009 University of British Columbia students have moved to Kenya through Pamoja Community Based organization to do electives to really understand community health programming. And also help come up with ideas in which we can enhance community participation towards health programs. So through that alone, I think up to date we have had over 40 or 50 students coming from University of British Columbia to the Pamoja Community program. So as we speak today, Pamoja has implemented programs through the former PEPFAR programs, the Dreams program, and I know orphans and vulnerable children programs. And we are also working with other universities to advance research, including Northwestern University. We have universities such as University of Kentucky, York University, and many others, so we've placed ourselves as a global hub where students can come and learn and participate in global health programs. So we call it global learning and service as we continue to advocate for other community interventions.

[00:12:23] Dr. Rob Murphy: So you've been involved in these very community oriented approaches as well as more top-down global health initiatives. Where do you see yourself in your career going at this particular point? You think you'll be in the more, the bigger, top-down ones, or will you continue to work with the community groups like Pamoja?

[00:12:42] Dr. Patrick Owuor: So as I continue working, in global health, I've come to realize that there is one thing that is lacking and that is community perspectives. So when I talk about community perspectives, it's basically I've seen a lot of top down kind of programming, in most of the years that have been in global health, where you have programs being channeled to grassroots organizations for implementations. And when we do those kind implementations, community perspectives are considered much later on. So as I continue with this trajectory, I see myself much more taking the community perspectives where you work with the communities to set the agenda for health programming and for development. And when talk about community perspectives, basically I'm looking at the stakeholders within the sites where global health, our practice happens whether they're the Ministry of Health, whether they're the Ministry of Education, whether there are any other relevant sectors that are required to make things move, and also the beneficiaries of most of these interventions. Whether we are having interventions for children, and where are the voices of children, women, and also the general population. So their perspectives, I believe, are quite important in setting the global agenda. This has become really very apparent if you look at the kind of political positioning and changes that are happening right now with PEPFAR withdrawing its support for many of the HIV implementation programs. We are starting to realize the community perspectives coming to really matter as they come together to leverage on the resources that they have to meet their health needs without necessarily looking at the top down kind of approaches that have been there before.

[00:14:24] Dr. Rob Murphy: That's such an important question, an issue right now with PEPFAR being drastically cut and USAID basically almost being eliminated. It's interesting to hear you talk about how the community groups are adapting. You wanna expand on that a little bit? I mean, a lot of people think here, oh, that has to be replaced by some other big entity. And what you've just said is maybe the community groups can actually take over more responsibility now. Can you elaborate a little bit more on that?

[00:14:52] Dr. Patrick Owuor: Yeah, definitely. And I can talk about this so passionately because I've lived in the communities where communities actually have come together to come up with ideas and innovations that work. For example, at Pamoji Community Based Organization where we are, we have initiatives that community members have started, including how they can generate income to help strengthen their household economics in order for them to meet certain health objectives. Or to meet certain health requirements or for example, to uptake certain services. And some of these initiatives are basically coming from little monies that they have actually collected amongst themselves. However, when you talk about community programming, the key players are local governments. And how the local government is reacting to the changes that are currently happening. We've seen the resilience of local governments as they try to incorporate services that were initially being run and led by these other organizations and they have come together to integrate services into the daily running of whether they are health facilities. So that integration, even though it had started really before the PEPFAR stopped supporting activities, integration of these services within public health programs has really now been the norm, as health promoters, healthcare providers coming together to really absorb this particular activity. So continuing with integration as one part and also continuing with community mobilizing resources to build their economic agenda to be able to access these programs. Other than that, there is the issue of policies. You know, how do voices within the community inform policies that can be able to drive the change? So we've seen a lot of community advocates coming up to say we have programs that work, including having safe spaces where people who are in need of certain services can actually go to get the services without really overbearing the government. We have seen communities coming together, raising their voices, advocating for those types of change.

[00:16:57] Dr. Rob Murphy: From 2018 to 2020, you worked with Dr. Lisa Hirschhorn, my colleague here at Northwestern from our Institute to study HIV prevention strategies, including PrEP uptake among young women in Kenya. Can you talk a little bit about that specific project?

[00:17:13] Dr. Patrick Owuor: Yeah, when I worked with Dr. Lisa, basically, we were working to support our students as well. So I remember there was Maya Gibson, who was a medical student then at Northwestern University who was also interested in looking at the uptake of services amongst adolescent girls and young women. And there were also some two other undergraduate students from Northwestern University who traveled to Kenya. So through the guidance of Dr. Lisa and also Dr. Sarah Young, the students went to Kenya and I was like the primary supervisor in Kenya. The PrEP program was basically to evaluate the barriers and facilitators of pre-exposure prophylaxis, but primarily amongst adolescent girls and young women. I would say, this particular project came at this prime time when there were a lot of other issues that were coming up in the community that were not really evaluated and there was no evidence including stigma to PrEP uptake. Because PrEP was generally considered an HIV drug. So young people were really very hesitant to look at PrEP as a remedy towards prevention of HIV. So this works for me, having students be in Kenya for more than two weeks. I think it was almost two months when we had Maya and the other students work in Kenya together with Pamoja Community Based Organization to help in designing an evaluation, sit within the community, participate in community everyday experiences, and document the experiences of young women going through health facilities to access PrEP was really the breaking point. So being able to spend time with students, for more than four weeks in the field documenting and basically participating in data collection for me was a very enriching experience because then you are able to work with the community and you're able to basically observe. I saw practically how anthropology, because I was coming in here as an anthropologist, Dr. Lisa and Maya were coming in, from medical school. So how anthropology and medical sciences can work together to really have this kind of evolution, that informs policy. I think the findings were published from this particular project. And basically what we see in these papers is that one, barriers to, PrEP, during this particular time were because of things like stigma amongst adults and girls and young men, and also lack of resources, simple resources, like, how people meet their clinical appointments and I think one of the biggest things was how community safe spaces can actually help improve access towards, certain interventions.

[00:19:49] Dr. Rob Murphy: You've published extensively on water insecurity and large infrastructure projects like the Thwake Dam in Makueni County in Kenya. Tell us about this work and about what you term hydro colonialism, which is a new framework being used to talk about water extraction and environmental stress.

[00:20:07] Dr. Patrick Owuor: That's a very broad question. So I'll break it up into three parts. So the first part is about infrastructure. Remember when I was talking about going to York University to look at infrastructure, at that particular time I was looking at roads as an infrastructure and how roads and concession of roads and the government getting financial aid to construct roads would impact economic and health outcomes. So it's through this interest that when I came into work with Dr. Young on household water insecurity, I started to see issues of infrastructure impacting housing insecurity. The first part was basically infrastructure. I saw infrastructure as an issue with the access to services such as, you know, so on and so forth. So the second part is when I was working with Dr. Young to really look at household water insecurity and its consequences primarily on expectant or lactating women. I did a lot of ethnographic work. I was primarily collecting data, going to households and interviewing women. And there were instances when I would walk with women long distances to see where they fetch water. This is when we were doing ethnographic methods such as, you walk with participants to collect data. So it happened that there was this one day that I was walking with some two women into a river, 30 minutes away to go collect water. It had rained. There were a lot of risks, going to this particular river because it was flooded. So one of the questions that I kept on asking them, other than just having, the other problems that they kept on mentioning like, lack of, piped water and so on and so forth. They did mention to me that it was quite strange that they could hear that the government was planning to build electric dams in response to water insecurity, but they didn't see how this construction would help them as women in a rural setup. I was like "oh". That is quite unique because, you know, someone in rural Kenya is thinking about the government constructing electric dams and those are not going to be helpful to them. So I started to really have this as a question that I would explore. How does construction of large infrastructure projects basically impact vulnerable communities? So when I was doing my PhD, this actually ended up becoming my dissertation project where I looked at the bio-social impacts of dam construction on women and children. So while undertaking this project, I was basically now interested from a biosocial perspective, in what are some of the biological impacts of infrastructure, construction, especially construction of dams. I was looking at environmental stressors and looking at the stress pathways of dam construction. So through this research, basically one of my findings suggested that construction of hydroelectric dams would basically increase, stressful situations for women and children because when they are moved away, when they're displaced from their rural homes where they would easily get water, they further moved away from where they can access water services and so on and so forth. So, throughout this project, I came to meet with another professor, that is, professor Craig Nemeyer from UC Berkley, who is an artist, looking at data and working with data as media. So when I visited where I was doing my research, we came to realize that through the use of pictures we could see much more the impacts of water, of dam construction, other than the things that I could highlight through, looking at the biology and so on and so forth. So through this prism where we are looking at the use of media, we came to realize that the concession of dams generally goes beyond a normal community. It goes beyond just the construction of a dam and the impact on women. But we started to actually see construction of a dam going through historical periods where dams were crafted as means of like really, making capital flow much more. Together with, Professor Nemeyer, we started to think of a terminology called hydro colonialism, which is a terminology that we were borrowing from, another Professor Isabel Hofmeyr, who basically first used the word hydro colonialism to really look at how the colonial apartheids traveled through the sea, particularly the Indian Ocean, to like really colonize certain regions of the world. So using this lens, we thought that we could actually use hydro colonialism as a framework to understand further the environmental injustices that come with the construction of dams. So up to this point, I think hydro colonialism is something that we're trying to champion as a new framework that can help us understand water insecurity through different dimensions. Looking at the environmental injustices and also looking at the future of some of these projects. We recently completed an exhibition where we are thinking of looking at the dams in 100 years. We used community perspectives to collect data, which we have used to project the end of the dam in 100 years and what do the community say? And we came to realize that through that framework, there are a lot of fears about the community when the dam is less functional and more water insecurity happens.

[00:25:24] Dr. Rob Murphy: Another research area for you that you're involved in is cultural politics and ethics of human biobanking, particularly in East Africa. Tell us more about this work and why it's such an important issue in global health as biobanking becomes more and more common worldwide.

[00:25:39] Dr. Patrick Owuor: Remember when I started, narrating to you how I came into looking at global health, how I met a scientist who was in Kenya trying to look at the clinical landscape of clinical trials, in East Africa. This is Dr. Elliot from York University. In my many years of participating in global health, I've also taken part in many clinical trials. Myself as a researcher, when I was collecting samples from my research site, I collected blood samples and I also collected saliva samples. The common thing that I came to realize is that most of the samples that researchers like me and other researchers collect, they're primarily not analyzed in Kenya or in East Africa, but they're transported or shipped to high income countries, that is Europe. Europe, at large, the US and Canada for further analysis. The reason that has been put forward is not because of lack of expertise but because there are so many other experts that have been trained who can perform this kind of analysis in Kenya, but as a research of lack of resources. Whether they are reagents or lab facilities that can run this analysis. So the biggest gap has been lack of reagents and a lack of equipment to do this analysis and not lack of expertise. There's so much expertise in the global South to do this analysis. When I was doing my postdoctoral fellowship I wanted to come back to my experiences as a researcher to look at politics around ethical issues when we do biobanking, when we collect clinical trials, specimens to, outside countries to analyze. And we are coming to realize that it is an important aspect of global health, particularly where we have to collect our samples. Of course, they are merits or collecting samples, but we came to realize that there's particular issues that are still not being addressed. For example, the issue of, global consenting where you are consenting or research participants are made to consent, to the use of their biological donations for future research, without really knowing what this future research would involve in. And one of the things is the participation of communities when either there is a breakthrough using their own research specimen that they had donated. So what basically we wanted to achieve, we wanted to come up with, a kind of a working group that would look at all the protocols that are available currently for biobanking, and see if we could create a certain framework that can help advance biobanking. I would say without really going against the ethical issues that would involve participants. So participants donating, their specimens for this wonderful work, but also we also wanted to look at the inequalities that are present in biobanking because we realize that in most cases, most clinical trials that were or that are currently being done in East Africa are primarily held by researchers from high income countries who are the primary investigators. So we wanted to see a platform in which researchers from the global South can also have equal voices where they can sit also as peers within this particular research and studies, so that they can direct the future outcomes and the future research that comes out of these primary studies. So this is work that is still going on. We are hoping that in the near future, we'll have a conference. We did one workshop in Kenya where we brought in laboratory experts. We brought in clinical trial experts, and we brought in social scientists to try and digest more about this program. We are still working on this. And we do think that we are able to come up with a framework that can guide researchers to make global biobanking a place that is equitable to researchers from both global North and global South.

[00:29:39] Dr. Rob Murphy: Where does KEMRI come into play in all this? I mean that's a pretty well-resourced research Institute. Do you see expanding or other facilities popping up?

[00:29:50] Dr. Patrick Owuor: KEMRI or the Kenya Medical Research Institute is, I would say, the leading research institution in Kenya, and most protocols for clinical research usually go through, KEM RI for approval. KEMRI has played a very vital role in oversight and ensuring that clinical research is done according to standards, however, most of the researchers that are done in KEMRI primarily, or most of them come from high income countries where the same inequalities that we are talking about are present. So, what we envision is an institution like KEMRI, and I'm glad that when we were having our workshop in Maseno, we had representatives from KEMRI and we also had representatives from CDC as well. So what we are seeing is institutions such as KEMRI and other institutions. Can come together and look at the way in which they review protocols because they play a very key role in reviewing protocols that involve multidisciplinary researchers that are coming from institutions that are either local institutions or and international institutions. So KEMRI as a regulator and other governmental regulatory bodies, we are thinking that, they'll come together to see the framework that we're trying to come up with as a platform in which they can try and first level the field where there are less inequalities. And two, look at ways in which, if it is a reagent and equipment that makers or make research from the global South ship the specimens. Then, if there are regulatory measures that they could think of to either lower prices for import and export such that, local researchers can have reagents available. We are going towards such a framework that would allow for bodies such as s KEMRI to relook at regulations that govern import of scientific apartheid, import of scientific infrastructure, and look at policies that inform, multi disciplinary collaborations and also, multi-institutional collaborations between global North and global South.

[00:31:52] Dr. Rob Murphy: You're working across multiple areas, HIV prevention, infrastructure, environmental stressors, and biobanking. What do you see as the most urgent opportunities in those areas for change? In other words if you could change something, which one of those areas would be the one that you would go for the most?

[00:32:15] Dr. Patrick Owuor: Well, if you look at all these things that you have mentioned there is one key aspect, which is resource insecurity, whether it's biobanking, remember I've just mentioned that when it comes to biobanking, it's all about resources. Researchers in the global South are not able to access certain reagents and certain facilities. When we talk about environmental stressors, it's all about our resources. And we are looking at a lack of access to basic needs such as water and sanitation. We are looking at poor air quality. We are looking at contaminants, such as microplastics. And so for me. Resource insecurity or resource security is the primary thing. I prioritize and I champion as a global health public health researcher. I believe that overcoming these barriers, come back to resources. If we can be able to reduce the level of inequalities, in global health and in distribution of resources, then we could have great interventions that would solve some of these problems. So if you look at my work currently it is geared towards more of resource insecurity as a terminology that encompassed all this. From a public health perspective of course with environmental changes that are currently happening, we are likely to see more environmentally triggered diseases coming up, whether things to do with mental health. They're going to be stemming from environmental stressors. And the environment is basically going to be looking at income. It's going to be looking at the quality of air we breathe. It's going to be looking at those basic public health amenities.

[00:33:51] Dr. Rob Murphy: I have one final question I ask everybody that comes on the podcast. What advice do you have for young people who are now just embarking or wanting to embark or thinking about embarking on a career in global health? They all ask, what's the pathway? What should I do? Everybody has a different answer. What would you tell them?

[00:34:10] Dr. Patrick Owuor: I'm glad that I've had an opportunity to work with young people for over a decade now, going to the global South, to try and advance their skills. One thing that I have come to learn is for any person who is thinking of getting into global health, there is patience, towards whatever field you want to undertake. For example, if you would want to look at the public health barriers in healthcare services in the global South. Do you have the time, for example, to work under someone who is experienced enough in that particular area who can guide you before you even think of going to another country or going abroad to undertake. either it's an elective or a field research. And when it comes to field research, the time you spend in the field is pretty much important. I have had students come in for one or two weeks and they end up having a back and forth kind of questions because they practically did not understand much more of what was happening at the site, when they were there. So my experience is that for those who are aspiring to go into global health, if you are fortunate enough to do a study abroad or go abroad to learn some of these things, ensure that you have sufficient time. For me, I've seen that anything below six weeks is really not enough because that is the time that you are starting to understand the culture of the people of the place where you are going to. One most important thing is as an anthropologist, understanding the culture of the people. And when you talk about culture, we are looking at the organizational culture, we are looking at institutional cultures, we are looking at the implementation culture of whatever it is that you are working on. So about eight weeks would be very sufficient, but anything below that, maybe six weeks. So patience towards the field that you'd wanna undertake. Having a mentor who is really well experienced in this particular area that you want to go into and being aware or what I would say being aware of the global politics of where you are going to, Global Politics and also local politics would really be very important.

[00:36:21] Dr. Rob Murphy: We agree with that last point, the longer, the better. Our students, the undergraduate and the medical students have like these four week blocks and mostly they can only do four weeks. Oftentimes they'll come back later in their medical school career if it's medical students and do another four week block. But we have found that certainly anything less than four weeks is really inadequate. And so four to eight weeks I think is really good and you could really see the difference in the people who've spent really quite a bit of time abroad.

[00:36:53] Dr. Patrick Owuor: Definitely, and I've worked with people who are coming for four weeks and less, and what I usually do in that situation is that we have about two months of Preparations where we have almost weekly engagements where we can be able to do certain things virtually in order for them to like really internalize certain things that would not be easy when they arrive. Time is a constraint and things are also changing rapidly. So sometimes, having to work virtually with interested individuals is also a good way to like, really, work on the time issue.

[00:37:26] Dr. Rob Murphy: Well, Dr. Patrick Owuor, we thank you for sharing all your experiences and I'm sure our listeners are very grateful as well. Thank you very much for joining us today.

[00:37:36] Dr. Patrick Owuor: Thank you for having me.

[00:37:46] Dr. Rob Murphy:  Follow us on Apple Podcasts or wherever you listen to podcasts, to hear the latest episodes and join our community that is dedicated to making a lasting positive impact on global health.