Book Review: Join the Club, by Tina Rosenberg

Join the Club, by Tina Rosenberg, W.W. Norton and Company, 351 pages (plus bibliography and notes), 2011.

Join the Club, by Pulitzer Prize winning journalist Tina Rosenberg, is the latest in the currently vogue genre of Pop Social-Psychology/Pop Sociology. The genre, for which Rosenberg’s fellow New York Times writer Malcom Gladwell is probably the best-known populizer, typically takes a rather academic topic for which there has been recent research that either contradicts the conventional wisdom, or is profound in its societal implications.  The best works, such as Sunstein and Thaler’s Nudge or Gladwell’s Tipping Point, do both.  The journalist-author then acts as a medium, distilling the social science for the general audience, as well as forging an engaging story that can hold that audience’s attention.  Join the Club is Rosenberg’s first full foray into the genre and is highly recommended to anybody concerned with human behavior.  Though the book ultimately suffers from poor organization and the examples have all been presented with greater analytical rigor elsewhere, Rosenberg nevertheless synthesizes these stories in a new and fascinating way.

Trans-theoretical Moldel of Behavior Change: Presentation

Human behavior is at the center of global health challenges today.  Whether trying to decrease smoking, increase hand washing, or advocating more balanced diets, changing a few key behaviors holds more potential to improve overall human health and wellness than just about any treatment-based solution.  Consequently, it occupies a key place in public health - the core preoccupation fueling the growth of the entire sub-field of health education.

Likewise, behavior change campaigns - or in the case of youth, often negative behavior prevention campaigns - are at the center of Peace Corps Moldova's Health Education program.  Everything we do, from classes to community initiatives, is essentially part of a broader strategy tackling the slow and difficult process of helping people to take control of their own health for the better.

Needless to say, I've spent a lot of time thinking about behavior change these past couple years (after all, it's also key to Vitality In Action Foundation's work).  I'll have some thoughts on the broader process of behavior change in a future post, but in the meantime, last month I had the pleasure to lead a 5 day In-Service Training on community-based behavior change campaigns for 33 Health Education Peace Corps Volunteers, Moldovan nurses, and community partners (social assistants and teachers).

Below is the presentation I gave on behavior change theory, primarily focused on the Trans-Theoretical/Stages of Change Model.  Contact me if you'd like to use; slides also available in Romanian.

This entry is cross-posted here to "The Vitality Blog".

Small Victories: my favorite moment of the week

My favorite moment of today happened when I was sitting next to my nurse partner, working on a plan for a health education program.  Laying open next to us was the book* where the Medical Center is required to record all of the health education activities it does, as health education is a required component of every nurse and doctors job.

The Chief Nurse poked her head in the door and started chastising my partner, "You haven't written in the book yet!"  To which my nurse partner Galena replied, "You all write, but we actually do."

SNAP.  Well said Galena.

*Most of what's written in that book is fiction.

Medical Center Success – pairwise ranking session!

My Program Manager recently asked me to lead this summer’s training sessions on medical center work for the new health volunteers.  Thus, while the events of this post took place a couple of months ago now, it constitutes one of my bigger successes here in Moldova and is something I’m thinking about a lot while preparing to teach the new volunteers.

One of the hard parts of the Health Education program is that we straddle worlds – we must work in both the highly structured educational system, and the much more fluid world of community medical centers.  Work at the school begins very quickly after arriving at site, and similar to English Education (EE) volunteers, the fruits of our labors become quickly visible.

Facilitating a needs assessment session at the med center.

At the medical centers, however, our job is much closer to that of Community Organization and Development (COD) volunteers – work at the organization goes in fits and starts depending on how busy they are and how effective we are at identifying projects they are motivated to collaborate on.  These two cultures can often be hard to bridge, with the fast pace of the school making it harder to be patient with the incremental change at the medical centers.  This is one reason I think so few healthies work at their medical centers for the entire two years of service.

As a result of the less structured environment of medical centers, the needs assessment stage is a much longer process.  Facilitating good needs assessment, in fact, is not just necessary to choosing the best health education topics, but is in of itself a key skill we need to transfer.  Good needs assessment is also the first step of any long term planning process.

After coming up short for months in trying to get my medical center to write a one year health education plan, we’d had a number of needs assessment discussions that fizzled.  I finally decided it was time to try a different approach, and reached out to my COD friend Craig.  One of the downsides of bridging programs is it doubles the number of competencies a successful volunteer needs to possess; one of the upsides of Peace Corps is that we have colleagues like Craig who bring the perspective of a different program.

As part of its heavy emphasis on local sustainability, Peace Corps teaches the PACA  approach to needs assessment, (Participatory Analysis for Community Action).  More than a set of tools, PACA is a whole philosophy that calls for empowering community members instead of the development worker to set the agenda through participatory activities.  It also includes a toolkit of creative needs assessment activities.  The results are better needs assessments and thus an increase in the number of stakeholders, which lays a stronger foundation for resulting actions.  The analysis itself helps build consensus amongst participants by demonstrating that the agreed upon needs were not a foregone conclusion.

For my medical center, Craig recommended we try an approach known as Pairwise Group Ranking,

Small Successes: the Mahala Boys

Mahala is a word deceptively simple given the complex construct it houses.  In fact, it is probably this complexity that makes the word so thoroughly Moldovan.  In Moldoveneşti, mahala means neighborhood.  It is descended from the Turkish (and in turn Arabic) word mahalle, a term introduced throughout the Balkans during the period of Ottoman rule.  In literary (i.e. Romanian) Romanian, however, mahala has come to mean more of a slum.  Before even arriving at the complexities of the actual Moldovan mahala then, the word itself is a signpost showing the historical fork between Romania and Moldova.  It is a very Eastern European dark irony that the word for neighborhood in Europe’s poorest country means “slum” in the same language spoken by its richer neighbor to the west.  If Romanians often point out politely that Moldovan Romanian is an archaic and rural dialect, then the word mahala captures the subtler unspoken chauvinism between these richer and poorer neighbors.

Even in Moldova, however, a mahala is so much more than a geographical boundary.  It’s an agricultural system, a living map of generations of familial histories, and a complex network for the exchange of gossip and information.

One never really leaves their mahala in Moldova.  The village knows where you grew up, and if you move, somebody has relatives there too.  Even if one moves to the city, they might well choose to live in an apartment next door to somebody else from their village – it simplifies the flow of fresh produce coming in daily from relatives on the morning bus from the village.  Our own small village has a mahala reaching as far as Billings, Montana.

We volunteers, on the other hand, come from outside the system – we arrive mahala-less.  So often, we are reminded of the frustrations that implies when trying to work with our adult colleagues – not knowing the right person to talk to in order to cut through the red tape, not knowing a particular history that prevents two potential partners from working together.  But our tabula rasa also grants us some potentially powerful freedoms, particularly with students.

March Wrap-up and my Great Trek North! aka, Site Visits (slideshow at end)

Well, March was certainly an action packed month!  At site, school had a week of spring break, my nurse partner and I held our second public health education activity for the community, my work with the soup kitchen has been going full speed ahead as we finished off a grant application, I planned my first seminar for the teachers at my school, and I facilitated a raft of needs assessments with partners.

A lot of these projects were long on the to do list, so spring break came at a welcome time to do some catch up.  Break it was not, and come to think of it, neither was it spring (though the latter was finally making some progress this past week, with the exception of last Monday’s rather unfortunate snow…)

Both for better and for worse, action packed also meant a month when I was away from my site far more than normal – a full third of the month by my tally. Previous posts have already covered the exciting 50^th Anniversary Kickoff  and even more exciting visit by Vice President Biden.  Aside from that, other travels that pulled me away from my non-routine routine at site included facilitating two GLOW seminars (Girls Leading Our World, a global Peace Corps girls empowerment program) and an extended trek through the north of Moldova to 5 other volunteers’ sites during the final week of the month.

“Site visits” are a practice heavily encouraged by Peace Corps.  There are a number of reasons for site visits, but they generally involve some combination of work, learning through observation of fellow volunteers, and cultural curiosity/travel. I’ve hosted a number of volunteers on visits at my site.  Melissa came to facilitate a Schimb de Experienta for my youth club – twice, in fact, as the you may recall the first one was snowed out.  Craig came out of a general curiosity in the HESC program, and another time just to keep me company when my host family was away.  Most recently, Lindsay (my BFF here in Moldova) spent the night after we co-facilitated a GLOW seminar in a neighboring village.  Yet despite all my own hosting and Peace Corps’ encouragement, I had yet to pay visit to other volunteers.

My own trek north was an odyssey of long-overdue social visits, youth programs, and classroom observations.  It was my first time north of Chişinău, and in the space of a week I doubled the number of raions (districts) I’ve visited, from four to eight.

Youth Club Blog

Hey readers!  It's been almost a month, and I've been heckled a bit for that vacation update.  Well, instead, today you get a whole new blog: http://carahasani.cetatenieactiva.com/

This blog follows my youth club at the school (described in general as a program objective here, tangentially here, and by Melissa here).

The youth in my club are 10th - 12th graders, the age group I've probably enjoyed working with more than any other.  Back in PST when my Program Manager was interviewing us for site placements I stressed that I wanted to work with high schoolers.  Only a few of us healthies teach students this old, and most of the health clubs are for 5th and 6th graders.  She listened to my request and it's been one of the best decisions I've made in "making my service my own," (a mantra emphasized by our Country Director).

My youth chose the very descriptive title "Club de Sanatate" for our group, which can literally be translated as "Health Club".  Since choosing the title, however, we've gone more in a civic engagement direction.  In the HESC program objectives, these clubs are designed to teach youth to be peer health educators, but with this age group, I find it important to give the youth leadership over their group's direction.  For me, as long as they're learning, we're succeeding.  And as they take control over activities and lead their own projects, there is no doubt they're learning.

Their first activity was organizing a Halloween party.  After that, my partner and I attended a training on Public Achievement, a program designed in the U.S. but now used around the world. The training was organized by awesome second year COD volunteer Vince N., his wife Jessica (a fellow Healthy), and his partner NGO Speranta as part of their Active Citizenship Initiative ("Cetatenie Activa" in Romanian).  The youth agreed to give the Public Achievement method a try, and now they're working on a community project they initiated: building a park where local students can sit and relax next to the school.

Unfortunately for readers back home, this is a Romanian language blog - it's designed as part of our reporting requirements for the Public Achievement program.  But it will also include lots of pictures and even the occasional video of the club's activities.  So, if pictures know no languages, and we combine that with another cliche, then there are thousands of words there that anyone can understand!  So, check it out and watch our progress from project idea to completion!

One more time, here's the link: http://carahasani.cetatenieactiva.com/

Double Feature! Guest blogger pens rejoinder on "What I Do"

My friend and colleague Melissa visited my site last week, braving the first Moldovan blizzard we've had down here in the South in order to facilitate a youth experience exchange between my youth club and a neighboring village.  Melissa is a COD (Community Organization and Development) volunteer, so she has a bit of an outside perspective on my job.  Not being me, she also has the amazing ability to take photos of yours truly while he works.

So, for those wanting some pictures ranging from work to a surprise masa, head on over to Melissa's blog and check out her post on her visit to Carahasani!

p.s. - the youth exchange comes with a (not so) surprising ending.

My job, pt. III: A view of my desk is a day in my [work] life

This is the final part of a three post series introducing the work component of my life as a Health Education Specialist in Peace Corps Moldova.  The series has moved from the broad to the specific, so Part III will conclude by a look at what my work actually involves on a daily basis.  Part I is a general introduction to the public health situation in Moldova, and Part II examines my different projects at the general level.

When I started writing this series at the end of October – yeah, it’s been a long time in the making – I had just passed the point where I had been at site longer than in training, and it was really starting to show in my work life.

The soaring towers of paper accumulating on my desk are only the most visual sign that this work life is finding traction.  Those who have lived around me know me to be a crowded desk person.  Some say “crowded” is just a euphemism for “messy”, but in my opinion the difference is that there is a logic to my system.  That’s probably in the eyes of the beholder…my dad claims the same thing.  My desk hasn’t yet reached the state of his fire hazard, but then I also don’t have many bills to pay.

In what may have been an indication of concern, my host family recently put a second desk in my room.  This was one of the happiest days of my life, though they didn’t seem to understand the natural logic of the law of desk space: desk piles will expand to occupy the space available.  (On the other hand, my host family probably considered it a victory simply that these piles moved out of my bed and off the floor…)  What might concern them more is the fact that what’s going on in my head at any given moment tends to resemble my desks…  It also, however, provides a glimpse at my daily work life.

Starting our tour a desk #1, we find the computer in the dominant position. 

My job, pt. II: So what do you actually DO?

This is Part II of a three post series introducing the work component of my life as a PCV, in which we’ll look at my program’s objectives and major projects at the general level.   The series is moving from the broad to the specific; Part I is a general introduction to the public health situation in Moldova and Part III will conclude by a look at what my work involves on a daily basis.

Every Peace Corps Volunteer worldwide works in a program; here in Moldova, I work in the Health Education in Schools and Communities (HESC) program.  My formal title is Health Education Specialist – yes, even as a volunteer one gets a snappy title.  In PC Moldova parlance, I’m referred to as a “Healthy.”

As a HESC PCV my primary work focuses on building local capacity for the educative aspects of a public health program.  As I explained in my previous post, Moldova has one of the highest health care provider ratios in the world, but the concept of public and preventative health is still taking root here.  It also has a decent public education system, considering the local resources available.  But again, health education is still struggling to be integrated in an intentional and coherent manner.  The local providers, in short, aren’t yet accustomed to being educators, and the local educators aren’t yet accustomed to the specifics of health education.  I’m here to facilitate that step.

That step is broken down into two overarching goals and seven objectives:

• Goal 1: Improved Health for Youth
• Objective 1.1: Develop School Health Educators (i.e., teachers)
• Objective 1.2: Improve Students’ Learning
• Objective 1.3: Promote Peer Education in Extra-curricular Activities
• Objective 1.4: Increase Parental Involvement in Schools
• Goal 2: Improved Community Health
• Objective 2.1: Develop Community Health Educators (i.e., medical staff)
• Objective 2.2: Enhance Community Involvement in Community Activities
• Objective 2.3: Improve Use of ICT to Support Community Health and Education

My job, pt. I: Moldova’s Health Profile

I’ve been getting more questions recently about what the work side of my life actually entails.  It’s a huge topic, so I’m tackling it in three parts.  The series will move from the broad to the specific.  This is Part I, a general introduction to the public health situation in Moldova.  This article is by far the lengthiest, and if the background is boring, I won’t begrudge you for skipping it.  But it also contains the roots of the problems I struggle with daily, so it’s an important part of my work here.  Part II will look at my specific projects, and Part III will focus on what I do on a daily basis.

Moldova has what’s known as a “dual health profile,” meaning that it has elements of a health care system of a fully developed nation, but simultaneously struggles with problems typically associated with less developed countries. As an example, while Moldova has high vaccination rates and one of the highest doctor and nurse to patient ratios in the world, it also faces a high prevalence of TB, and access to safe drinking water and sanitation standards remain a pressing problem in rural areas.

Moldova is often summed up as “Europe’s poorest country.”  Obviously, this depends on a lot of definitions, but based on GDP per capita and given the broadest possible conception of Europe, only Kyrgyzstan and Tajikistan are poorer, so the general point is well taken.  Despite this fact, however, at Moldova has a higher life expectancy (by 2 to 5 years) than other significantly richer post-Soviet states.

• Life Expectancy: 68.5 years (WHO, 2007), 70.8 years (CIA World Fact Book, 2010)

On other key indicators of health such as infant and maternal mortality, Moldova is also outperforming the rest of the Eastern European WHO region (WHO 2005).

• Infant Mortality: 13.13 deaths/1000 live births (CIA World Fact Book, 2010)

Arguably, then, Moldova is doing pretty well given the context – it’s significantly below the global economic average, but nevertheless can boast health outcomes somewhat above the global average.  This fact is impressive, because wealth is a key predictor of health outcomes – though not by any stretch the only important indicator, remember the U.S. has a lower life expectancy than Bosnia and Herzegovina.  The point is, clearly systems and public policy matter too.  And “doing well given the context” isn’t much consolation to those people dying at young ages from preventable causes.