Almost home, Hart Fellows reflect on challenges and research

They slip effortlessly into the jargon of their fields, brimming with excitement as they discuss research design and data collection. They’ll readily explain the intricacies of the accepted distinction between economic migrants and refugees or the challenges of seeking approval from the National Ethics Committee for Health Research in Cambodia.


But when asked what they will miss most about their 10-month Hart Fellowships, Corey Sobel, Grant Smith and Sam Swartz talk about the people they’ve encountered.


“This place is full of quietly remarkable people and stories, some of whom and some of which I have been fortunate enough to get to know and be let into,” Swartz said. He is serving with the Reduction in Maternal Mortality Project (RMMP) in Phnom Penh, Cambodia.


Sobel, who works for the Karen Human Rights Group in northern Thailand, emphasized the variety of life stories he has heard from recent Burmese refugees and NGO workers. These life stories have informed his research, he said, as he examines the existing international law on economic migrants, refugees and internally displaced persons.


“Your social life is sitting in tea shops and talking for hours. It’s very cool, you get to meet a whole range of people-people who’ve been here 10 or 15 years, people who’ve just fled camps, all kinds,” he said.


Indeed, fellows say they learn as much from the people they work alongside as from the research they are conducting.


“Take the Tanzanian chair of OB/GYN. It’s so clear how much he cares about all his patients here,” said Smith, a fellow at Kilimanjaro Christian Medical Center (KCMC)-Duke University Women’s Health Collaboration in Moshi, Tanzania. “It’s amazing that he has sustained that level of care despite all the challenges he faces. He’s working more hours than any U.S. physician should work.”


An aspiring doctor, Smith is conducting research on obstetric care as part of a large study conducted by Professor Kate Whetten of Duke.


“I really wanted to try and find out some of their stories and what happens when women deliver their children. How does family play a part in the decisions they make about medical care, their access to care, and costs?” Smith said. For his study, he’s interviewing 40 to 50 Moshi women in their homes about their experiences during their pregnancy and after their delivery.


Swartz is also looking at women’s health in his research, studying reproductive health and contraceptive use through participatory ethnographic research. Instead of conducting interviews himself, he and his team are training local women to conduct interviews, a research design he said creates trust between the interviewer and interviewee and increases the quality of the data collected.


“If I were to approach a woman in a rice field and ask her about sexual relationships and habits of contraception use she would promptly run away,” Swartz said.


In both their research and their daily lives, the fellows have had to contend with serious challenges.


For Sobel, part of the challenge in his work is to avoid seeing the people he’s advocating for-the Karen, an ethnic minority in Burma-as nothing more than victims.


“I’m trying to make sure I don’t see the Karen people as passive, as an enormous group of victims with no say in their situation,” Sobel said. “It’s tempting to say that because of how they’ve been treated, but refugees here are incredibly resourceful and creative when it comes to protecting their rights and making sure their families get what they need. They’re much more actively engaged in their situation than I or many other people give them credit for.”


The up-close, intimate nature of Smith’s work has exposed him to the sometimes disheartening reality of maternal care in the developing world.

“At the hospital a lot of complications happen that could be preventable even in this setting, and some women die or fetuses die. One of the challenges for me is to sift through that and understand why-to see that there’s a national shortage of physicians, that they’re overworked and underpaid. I have to try to see the system as it is,” he said.


Swartz said he struggled with isolation at first, in part because of his determination not to rely exclusively on the expatriate community for relationships.


“I’m very much someone who is charged by people,” he said. “At the beginning, I imposed on myself a separation from the white/expat world here, thinking that becoming enmeshed in the expat world too early on would keep me from developing meaningful relationships with Cambodians. But, unable to make good Cambodian friends immediately, I was without the connections that I am used to, that keep me vital.”


For Swartz, the Hart Fellowship has been a chance to forget his previous expectations and learn from his experiences and challenges.


“I’m less expectant or rigid, maybe, in terms of having a clear notion of what I want and subtly pushing things toward comporting with this vision, and being disappointed, or angry, when they don’t.  I think I’m now more comfortable with not intervening, stepping back and watching things develop,” he said.