Today I’m excited to launch a new feature called Profiles in Health. Every week I’ll interview a woman (and maybe even a couple of men!) working in women’s health. I’ll talk to clinicians, activists, policymakers, public health professionals, midwives, writers and more.
For my first interview, I’m profiling my former colleague and friend, Sarah Harlan. She’s currently a Program Officer for Knowledge for Health at the Johns Hopkins Center for Communication Programs.
Sarah has a BA from Grinnell College in Iowa, and an MPH from UNC Chapel Hill. She’s worked for Planned Parenthood, Ipas and Family Health International, and has traveled to six countries – including Nicaragua, India and South Africa – doing reproductive rights work. She’s a calm, focused presence with a knack for making order out of chaos, a much needed skill in a field that is often filled with frantic deadlines and hectic schedules!
I talked to her last week about reproductive rights, HIV and what it means to be a woman working in international public health.
You have an MPH in Maternal Child Health, and you’ve been working in the reproductive health field for about ten years. What do you do in your current job?
I work on the research, monitoring and evaluation of the Knowledge for Health Project (K4Health) at the Johns Hopkins University Center for Communication Programs. It’s a USAID-funded 5 year project that’s working to improve the dissemination and uptake of current knowledge on reproductive health, family planning and HIV in low and mid-income countries.
I analyze the needs of various countries in order to inform the materials that are produced, like eLearning courses and online toolkits. Once we produce the materials, I help evaluate them, asking questions like: How do people like them? Can they be improved? What can we do better in the future?
It’s important to know whether what you are doing is actually working, and figuring that out is part of my job.
What do you do on a daily basis? What does an average day look like for you?
Even though I work for Johns Hopkins in Baltimore, I’m a remote employee: I live in North Carolina! That means there are a lot of phone calls; I’m often on the phone for two or three hours a day with different colleagues. I do a lot of writing reports, online publication, a journal manuscript and blog posts. I also look at data about the tools that we are using and analyze it, drawing conclusions about the success of the project and reporting that to our funder.
One great part of my job is that I get to travel to see what our offices are doing in the field. Most recently, I went to Addis Ababa, Ethiopia for a week and a half. We had done a series of needs assessments in 5 countries, looking at the information needs of family planning and reproductive health providers. I went Ethiopia to facilitate a dissemination workshop on the study we did there. We invited about 50 health professionals and had a daylong meeting to talk about the results of the needs assessment. We got to hear their ideas about what to do, based on that information.
The project I’m working on now is based in Indonesia, so I’ll be traveling there some time in the new year.
You were a Religious Studies and Latin American Studies major in college: what made you decide to pursue public health?
I first became interested in women’s health while I was studying the Catholic Church’s effect on women’s reproductive rights in Latin America. I thought about going to graduate school in Latin American Studies, but that didn’t seem right. Then, at one point I thought of becoming a nurse or nurse practitioner, but I wasn’t sure that the focus on science was going to be the right fit for me.
Before I went to graduate school I worked at a Planned Parenthood clinic as a health care assistant. At the time the health care assistants were doing everything from answering the phones, to providing intake counseling, to doing injections. I speak Spanish, and we had a lot of Latino patients, so it was a great opportunity. One thing I liked about Planned Parenthood was that it was a woman-driven organization. That’s not that it didn’t have men employees, but the priorities were set by women, and that was really nice.
I knew I was interested in reproductive health and family planning. After working at Planned Parenthood, I realized I was more interested research and policy than in being a clinician, and I thought public health would be a good balance of the topic area and the methods that I was familiar with as an undergraduate. Public health is so interdisciplinary. You have to know about history, anthropology, and you have to be a good writer.
When people think of the health fields, they mostly envision doctors and nurses, the actual health providers, they don’t usually think about public health. What is the difference do you think? Why is public health important?
There are a lot of things that go into health and medicine. That larger view of health on the population level is such a compliment to science and clinical work.
I’ve been reading Tinderbox, the book about the AIDS epidemic in Africa by Craig Timberg and Daniel Halperin. In it, they talk about the things the West has done to combat AIDS that actually made it worse, and much of it has to do with neglecting the bigger picture.
During the Bush administration when PEPFAR was created, the administration appointed clinicians who were focused on treatment but weren’t trained in population level care and programmatic and policy issues. They didn’t really consult anthropologists or public health professionals – if they did, it was minimal. That was a real weakness of PEPFAR at the beginning – that public health people weren’t helping steering the priorities.
If clinicians and public health folks were working together more, there would have been a more comprehensive plan that focused on the bigger picture, not just on treatment. The book is a great illustration of why it’s so important to have a social science approach and a clinical or “hard science” approach to addressing health issues.
I’ve written about the gender gap in both clinical medicine and in medical research, but haven’t addressed gender issues for women working in the public health sector. What is it like being a woman working in this field? From your perspective, does it seem like international public health is a field where women can succeed professionally?
From what I can see, public health seems to be dominated by women, and the trend is that women are having more positions of power. Or maybe this is just the case in reproductive health, but I think it’s happening in HIV too, because of a renewed focus on women’s prevention options like microbicides and pre-exposure prophylaxis. Whatever the reason, it seems like more and more primary investigators and spokespeople are women.
At the same time, in every organization I’ve ever worked, there are more women than men, but the men tend to be in charge. It can be frustrating, but I think it’s starting to change.
A lot of this work is grant funded, which means that organizations tend to focus on what Bill Gates thinks is important, or what presidents of various nations are important. That’s one reason why family planning issues fell of the radar for a while in the 1990s: funders decided there were other health priorities that didn’t focus on women. HIV has traditionally been given a male face – even though women and children make up such a huge population of new infections – and a lot of that is because decisions are made and funding is men.
What do you like the most about the work that you are doing now?
Too often, organizations jump into planning an intervention without knowing if there’s a need.
K4Health is research-based advocacy: you’re going and collecting the evidence, finding out where the needs are, planning an intervention around that. I like that I know we’re evaluating whether things are effective. To me, it just makes more sense: it leads to a better use of resources, and ultimately can do a lot more good.
What advice would you have for women who are thinking of pursuing a degree in public health?
Before you do the degree, look around and see what public health organizations are actually doing. When I went into the Maternal Child Health program, I was very idealistic. I don’t want to tell people to curb that, but you have to realize the limitations of working within institutions and structures.
Remember: unless you get to be at the very top of the field, you’re not setting the priorities or determining the focus of a project. You can put your own personality and creativity into it, but you need to be realistic about where the jobs are.
That said, there are a lot of unique and interesting opportunities in the field. I’ve learned how to use a video camera and do video editing and given professional presentations. I’ve published in journals, taken photographs, and gained some public health programmatic and research skills at the same time. These are things I didn’t predict I would be doing. There is so much new energy in family planning and reproductive health, with the London Summit and (hopefully) renewed funding, and it continues to be an exciting field.
Thanks Sarah! Best of luck in your work, and we’ll be sure to check in with you again sometime. If you’d like to be profiled or know someone you think I should talk to, send me an email at jcmoffett at gmail dot com.