Examining health inequities with a global lens

It was early February when Adriana Discher, now a rising senior from Philadelphia, landed in Vietnam to start the “abroad” portion of her study abroad experience, just after the country had concluded its weeklong New Year’s celebration of Tet. Arriving sleep-deprived, Discher not only had to manage a language barrier, jet lag, and life with a host family, she also had to contend with the fallout from the coronavirus epidemic raging across the border in China as it transformed into a worldwide pandemic.

“Is our entire curriculum going to be consumed by this virus?” Discher recalls thinking on the cusp of departing for Hanoi, a package of masks safely stowed in her luggage. 

A health and societies major with a concentration in global health, Discher had chosen her Semester Abroad program—the School for International Training’s International Honors Program (IHP)—specifically because its health and community focus meshed so well with her studies at Penn. Designed for students interested in a career in global health, the program takes students through four countries: an initial two weeks in the United States, followed by monthlong stays in Vietnam, South Africa, and Argentina, using a multidisciplinary approach to study health care, public health, and structural health inequities across the globe. 

The pandemic intervened, however, forcing Discher to return home midway through her stay in South Africa. She completed the rest of the program virtually. Although COVID-19 was an unwelcome part of Discher’s experience, it undeniably deepened her learning. As she and her peers moved about in the streets of Washington, D.C., Hanoi, and Cape Town, they witnessed firsthand the different responses of the nations’ health systems, uncovering sometimes unexpected strengths and weaknesses of each. In conversations, classroom discussions, and field trips, they also explored how socioeconomic factors influenced an individual’s risk of contracting the disease. 

“This experience made it super clear how the social determinants of health play into who is getting sick in the coronavirus pandemic,” she says.

Looming risk

Discher’s semester began in mid-January with two weeks in Washington, D.C. The stint was a whirlwind of visits with nonprofit leaders, social justice organizations, and community institutions like an elder home and a birth center, “seeing what health equity or inequities looked like in a U.S. context,” she says.

Quiet rumblings about the novel coronavirus were a backdrop of the group’s time in Washington, given that their next stop would bring them much closer to the epidemic, though to Discher, “it didn’t feel like that much of a threat yet.” Program leaders ensured they had masks and were well-trained in using them.

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In Vietnam, the university where Discher’s group was taking classes was closed to Vietnamese students but open to her study-abroad contingent. Members of her host family stuck close to home while she and other exchange students ventured out, always wearing masks. She noticed that vendors seemed disinclined to allow tourists to linger, perceiving foreigners as higher-risk patrons. Yet businesses were largely still open, despite schools being closed.

At the end of February, the group flew to Cape Town. “I was prepared to be questioned aggressively at the airport and to be very defensive of Vietnam because Vietnam didn’t have many cases of COVID-19 and we had been very careful,” she says. “But getting through was very easy, kind of upsettingly simple.” 

Some of the host families that were prepared to open their homes to the IHP students declined at the last minute, citing coronavirus risks, so Discher and the others spent more time in a hostel than expected before joining a new host family. “The hostel was very nice, but it was a little disorienting to learn that host families were afraid to house us because we had traveled through a country that bordered with China,” she says. 

Abrupt return

While in Vietnam, the IHP students spent most of their time in Hanoi but had also traveled to a rural area to draw contrasts between the two settings. Just before they were due to travel to a rural setting in South Africa, however, the threat of COVID-19 reached a head, and students were sent back to the U.S. “About a week before I was told I had to leave, Penn sent a message saying they would fully refund any tickets,” Discher says. “I ended up taking advantage of that and worked with Penn’s associated travel agency to get a ticket home.”

Flying into New York, Discher was again dismayed by the lax screening for coronavirus. Her mother drove her and two other program participants back to Philadelphia, where Discher then began two weeks of self-isolation, confined to the third floor of her home, to ensure that she didn’t have COVID-19 and wouldn’t pass it on. “This ties into what privilege looks like in a coronavirus world,” Discher notes. “I had a room and a bathroom that I could use without anyone else needing them. My brothers gave me a dartboard, a little basketball hoop, and a television. It was not a very fun experience for me, but it was relatively easy to do.” That’s not the case, she notes, for people who live in close quarters or are required to leave home to make ends meet.

Health care in context

After the period of self-quarantine, IHP program leaders prepared interactive lessons for students to complete the South Africa experience, as well as the entire Argentina portion of the program, at home.

Throughout, each time an assignment suggested that students “talk about applications to the world today,” Discher says, she could hardly help but note the impact of the coronavirus. “The assignments asked for a lot of self-reflection, which helped me grapple not only with my own experiences but also to get outside of that and begin to understand other people’s experiences.”

Throughout the program, classes in medical anthropology, globalization, research ethics and methods, and public health gave Discher and her fellow IHP students opportunities to compare and contrast countries’ health care systems, policies, and outcomes.  

“I don’t want to say that having this happen during a pandemic was important,” says Discher, “but in what other circumstance would I have been able to see both what was happening around the world as an American living in America? Seeing both the positive and negative reactions made me reflect on how there are so many ways in which the response plays out, across class lines, across access-to-care lines.

“With infectious disease there’s this idea that anybody can get it, and it’s this great equalizer,” she says. “But it’s not random. I think this pandemic is helping people come to a collective awareness of how social factors determine health in many cases.”