Duke Global Policy – Geneva – 2016

Journal: Summer in Geneva at the WHO by Rachel Folz Planning the summer in Geneva I was accepted to the Duke program in for Global Governance, and specifically to the global health track in December. While I thought that it would be smooth sailing from there to Geneva, in reality there was a marathon of hoops to jump through before landing in Geneva. First of all I had to secure an internship. This entailed several drafts of resumés and cover letters and meetings with our program director to strategize where I would fit well within the vast network of global health organizations in Geneva. After rewriting a draft to emphasize my interest in women’s health, I landed an interview, and the next day a position within the department of Reproductive Health and Research at the World Health Organization. I was elated at securing the job, but again I realized that there were many more obstacles to overcome before reaching Geneva- namely getting a visa, securing funding, and finding housing for the summer. For the visa process, it is necessary to obtain a Schengen region working visa if the stay will be less than 90 days- for me it was about 70. To do so, I had to first secure a letter of recommendation from my sponsors at the WHO. This had to be processed through multiple levels of WHO bureaucracy, which took several weeks. In the meantime I scheduled an in-person meeting at the embassy in New York. This type of visa requires a brief interview, during which all the (many!) required documents are transferred. I got my letter of sponsorship just in time, and compiled it with my other documents before leaving for New York. At this point, I had only 3 short weeks before my flight, and the embassy needed to process and mail back my passport with my visa inside, which I was told would take about two weeks. I was nervous that it wouldn’t arrive in time, but the next morning my buzzer rang with a delivery to sign for, and one more obstacle was out of the way. Apart from interviewing subletters to stay in my apartment in Philly for the summer, and my impending finals, I was most distressed about finding housing in the ridiculously expensive, summer-booming city of Geneva. I was very lucky in that my boyfriend was also moving to Geneva a few weeks before me for his work. He arrived in late May and stayed with friends for a week while he looked for, and successfully found a place for us to live- in the spare bedroom of a family who would be taking vacation for much of the summer. Though I didn’t go through this process myself- I would recommend that those looking for summer housing in Geneva rent a room in a hostel for a week, and find housing during that time. While stressful, I think that this is the best way to find a good situation for a reasonable price. Through connections at work, or just people that I met in my first few days in Geneva, I would have been able to easily find housing for the summer. Working at the World Health Organization and meeting with donors for global health After a couple of weeks settling into my new job at the World Health Organization, our department- Reproductive Health and Research - was having it’s annual budget meeting with donors. I was asked to attend the meeting, and to be the official note taker for one of the sessions. This conference was like nothing I have ever witnessed before, and gave me an interesting insight into the world of global health financing. The meeting was scheduled to start at 9 am sharp in the executive board room- the largest and fanciest space at the WHO. I arrived promptly, and twenty minutes later the chair was calling for order and wrangling people to their seats. In the inner circular table sat the chair, representatives from two WHO committees, representatives from the top country donors (which included US, Norway, Belgium, the UK, Sweden and Switzerland), representatives from 2 countries chosen from each of the world regions to sit on the board this year, a couple countries who have special situations (including Russia, who has said for the first time this year pledged to fund Reproductive Health and Research, and Brazil, who has special interest in RHR in face of the Zika virus epidemic), and some large donor organizations such as International Planned Parenthood Foundation and the World Bank. Outside this main circle were about 60 other representatives from countries or organizations that are interested in reproductive health- Bill and Melinda Gates Foundation, the CDC, Marie Stopes International, Pathfinder and many more. In the very back sat all of the researchers (and interns) for the department. The proceedings of the meeting were dry, but I found the most interesting parts to be the dance of diplomacy that I had never witnessed before, and the extreme networking that went on in the coffee breaks. The chair would introduce a speaker, the speaker (usually a researcher from the department) would give a presentation on some aspect of reproductive health, and then it was time for comments. Representatives would turn their name cards vertically and the chair would invite them to speak. They would turn on their microphones and say something along the lines of “Afghanistan would like to congratulate the department on its most excellent and impressive research, but would like to raise the concern of ….” Among the most contentious points was what most donors felt was not enough attention given to safe-abortion. Many representatives criticized the department on their lack of commitment to promoting safe abortion through official WHO recommendations. However, the department’s hands were tied by conservative donors who threaten to pull funds if money is spent on anything related to abortion. Watching the attacks and delicate responses surrounding this issue was very interesting. Also interesting was the predictably delayed proceedings, mostly due to the prolonged coffee breaks, during which researchers chatted with representatives to talk about funding upcoming research and bounced ideas around. At the end of three days of meeting came the official drafting of meeting proceedings and the pledges. The draft included notes (some that I had taken) that the entire board needed to agree on. It was basically like a team writing assignment, where a notetaker projected a word document onto the screen and everyone made edits… “I feel that we should change ‘congratulate to thanked, as it more accurately represents the tone of the esteemed delegate from Norway’s comment’”. Then came the time when some countries told the department how much money they would be giving, while others gave their support and said a number would be provided later and still others kept silent, preferring their deals to be made more privately. The PCC meeting in the executive boardroom at the WHO. You can see the inner circle where the board members of the meeting are sitting My project: a systematic review of characteristics of users of long acting reversible contraception (LARC) One of the largest projects I worked on this summer was a systematic review of the women that choose to use two different types of long acting reversible contraception or LARC: intrauterine devices (IUDs) or subdermal contraceptive implants. Many have called for this review to be done, so family planning projects can focus marketing efforts on certain populations in order to increase the uptake of LARC. I took a class at the WHO library to learn about systematic reviews and how to do them, and then I dove in. I developed a complicated search strategy to search medical and public health literature. I waded through more than 1,500 published studies about implant and IUD users from all over the world, and picked 83 most relevant papers to include in my study. I gathered quantitative data from all of them, and spent a lot of time reading and recording qualitative data as well. I analyzed my data and came up with results in the following areas: 1. what influences women to decide to use one type of LARC over another 2. the demographics (age, education level, number of children, marriage status, income level etc.) of women who chose IUDs or implants 3. how many women discontinue the use of these contraceptive methods and why In general, I found that women most commonly hear about LARC through their healthcare provider, though they can be swayed by women who are current or former users of the method, or mass media campaigns. Implant users tend to be younger, less educated, less commonly married and with less children than IUD users, but there is a lot of variation depending on where in the world they live. My favorite part of my analysis was the rates and reasons for discontinuation of LARC use. While data from all of the different studies varied greatly, when all the numbers were averaged the rates of discontinuation for implants and IUDs was about the same. However, the reasons for discontinuation were very different between the two methods. Menstrual issues was the most common for both methods, and wanting to have the device removed because they were planning pregnancy was also very common. Malaria vaccine project and Duke course week As part of the Duke program in global health, I was required to take a one week break from my internship at the WHO to attend a class run by an amazing expert in the field of global health- Dr.

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