Tackling the stigma of ill health through education


What’s the best way to ignite change in medicine? It’s a complex question with complex answers, but forgive my somewhat trite and very Zen phrasing when I say “change comes from within”. I believe there are few better places to bring about change in medicine than within the hospital/medical setting itself. Peeking into the profession from the outside proves to be difficult; it’s hard to challenge the experience of doctors, nurses, health professionals and patients. But what if we target physicians, patients and most importantly medical students in ways that change the way they see their profession? Rather than continuing with rigid ways of studying, what if we teach through sharing knowledge and resources more widely? 

Untapped resources in the university setting

Let’s step back and take a look at our universities. In a single institution, there are massive amounts of resources. Every discipline is there for the asking, experts in practically every field, peer-reviewed literature at the tips of fingers, and then there are the students – hundreds of thousands of students who are revving to delve into their fields and use what they’ve been learning. 

Doesn’t this look like a hotbed for social change?

Educational facilities— check. Manpower— check. Resources and interest—check and check.

Yet what a majority of college and medical school social change clubs tend to do is simply link to external organisations and volunteer or fundraise. This is not to minimise the importance of these clubs; the experiences that the students collect are no doubt invaluable. But it seems like a key link seems to be missing. Academics. Merging academia with social responsibility is a synergistic relationship that has scarcely been explored.

There have been pilots of this sort of work. Just recently there was an article on a collaboration between the New York Academy of Art and the city’s medical examiner’s office to give faces to unknown individuals who met brutal deaths and whose skeletal remains were found on the streets of New York. In 2013, UCSF medical students were highlighted for editing Wikipedia pages for medical school credit. But we shouldn’t stop there. There is an opportunity to tackle an issue that has been hotly debated and is difficult to conquer. The issue of stigma in health.

Social stigma is the hidden burden of many, if not all, illnesses and can lead to limited access to health services and shame patients into avoiding treatment of curable disorders. The repercussions are huge. Take mental health, for example. An estimated 3.8 million people in the United States live with untreated mental illness in any given year. This includes around 40% of people with untreated bipolar disorder and 51% for untreated schizophrenia. And the consequences of this are, of course, extreme. According to the National Institute of Mental Health, 13,000 suicides are committed each year by adults in the US with untreated schizophrenic, manic or depressive symptoms.

There is serious power in using education to reduce the effects of stigma. A study conducted in 2003 analysed the efficacy of intervention with young people aimed at increasing mental health literacy and found positive attitude scores rose significantly after a short educational workshop.

More accessible information

Educating the public on the underpinnings of mental illnesses can have a tremendous effect and can reduce many preventable tragedies that the world faces today. And medical students are the perfect people to do it. Students serve as the ideal link between the “lay-man” and the world of pure academia as they themselves are amidst the transition. What if they translated that hard-to-understand peer-reviewed literature to make it more accessible? Not only does this benefit the students by assuring that they understand the content thoroughly (if you can’t explain it simply, you don’t know it well enough”, right?), it also gives medical professors the opportunity to clarify evidently hard-to-understand topics. Doctors within the institution can share these articles with patients, and before you know it the entire hospital is involved in a multi-faceted way.

That’s the basis for The Humanology Project, an organisation I founded based at Stony Brook University. Students translate peer reviewed literature into readable blog posts with professors doing the fact checking. The process has been illuminating, fulfilling not only for the readers but for the students themselves. With my eye to the future, I hope to integrate the organisation more seamlessly with Stony Brook Medical Center and eventually begin to collaborate with other university hospitals. Communicating the specificities of science can have a tremendous effect on the way we view and interact with patients. The potential to bring about social change is trapped inside our educational institutions. It’s up to us to unlock it.

*Neha Kinariwalla [2014] is doing an MPhil in Modern Society and Global Transformations. Image courtesy of ddpavumba at FreeDigitalPhotos.net.



Pakistan finally wakes up to the Taliban threat


One thing is clear after the Peshawar Massacre: changing the status quo in Pakistan is no longer a choice, it’s an absolute necessity. 

Nine Taliban gunmen from the Taliban party formerly deemed “good” by the government entered an army public school in Peshawar, barbarically killing at least 145, with 132 being students aged between 12 and 16. The death count continues to rise as some students admitted to the nearby hospital ICU have begun to succumb to their injuries. Survivor reports indicate that the gunmen began by shooting aimlessly – then targeted students and teachers, riddling each with multiple shots and even setting some staff members on fire. They looked under tables and benches to ensure there were no survivors, even shooting those lying lifeless on the floor between books, blood and dust. When commandos from the army’s elite Special Services Group moved in, some gunmen had killed themselves; others fell prey to the army forces.

The 16th of December 2014 heavily burdens our collective conscience. For millions of Pakistani students, it was the most normal of ‘normal’ days: waking up, getting ready between hourly energy cuts due to electricity load shedding, and hastily glancing at the news headlines about shutdown threats. I was attending a lecture in Lahore, some 326 miles away from the victimised school, when Twitter alerts and RSS feeds began beeping on cell phones, and my friends’ display pictures began changing to pure black. Even though we’ve lost more than 70,000 people to terrorist attacks in the past 13 years, this one hit hard.

One reality

I wouldn’t call it apathy, but it seems that for most Pakistanis I know in the big cities, the government’s military operation against the Taliban on the Pakistan-Afghan border and North Waziristan, and their cold-blooded backlash, has seemed far removed from our daily lives. When my friends abroad questioned me about anti-terrorism offensives, I would tell them my information portals were the same as theirs, and the Pakistan I experienced was a different space from another conflict-ridden Pakistan – creating a Pakistan within a Pakistan. But in recent times, the assassination attempt on Malala, the attack on the Wagah border  and the Peshawar school attack have merged the stream of militant reality with that of our everyday lives.

Now, there is only one reality. It’s not merely the armed forces fighting terrorism in the country, but all of us: and this requires, nay it demands, that there be a change of perspective. Writing in the Express Tribune, Manzoor Ali prompts us to regard this as the 9/11 of Pakistan. We are beyond qualifying arguments on whether this is Islamic or not, because this is cold-blooded murder, supported by no religion in the world, including Islam. We had put too much faith in our division of the Taliban into “good” and “bad” and continued under a false veneer of security. We incorrectly assumed that negotiations with the Taliban were measures of safekeeping, that we were winning this war. Perhaps the most gullible of us even told ourselves that the Taliban were still humans, capable of humanity, that they would not cross the line and attack innocent children. We now know how deluded we have been this whole time.

School response to terror

Being called the bravest nation by Newsweek, we are not ‘terrorised’ by the terrorists – yet to overcome this war is not merely to voice resentment, but to consistently speak out for education and security in Pakistan. Following the massacre, the provincial government in Punjab ordered schools to immediately close for the winter break because of the security threat. I heard a seven year old asking his mother if he too would be shot if he attended school. These are instances of an educational reality that is severely handicapped by terrorism.

Though the massacre was an instance of pure revenge on the children of army officers, the Taliban have been attacking other schools in Pakistan’s northwest region. This is because educated children will not be brainwashed by their warped religio-political dogma, threatening the sustainability of their efforts. In my research on how students perceive Islamic fundamentalism across various types of Pakistani schools, I discovered that post 9/11, schools of a religious nature are hyper-cognisant of how they are seen as Jihad factories and are therefore emphasising the need to cultivate enlightened, critically-minded youth. Our education system, then, may be the strongest weapon we have to combat terrorists.

Political parties, though divided, have united to push Afghanistan into handing over the man behind this ferocity, Maulana Fazlullah. Citizens’ outrage has prompted the Prime Minister to lift the temporary death penalty ban, followed by public executions of terrorists who had been previously imprisoned. In short, it is a time of minimal to zero concession. A major shift in policy is needed, but it is more critical that this be sustained.

Though I cannot speak for all us, many of us have been rendered, albeit unwillingly, apathetic to the attacks on humanity suffered in Pakistan because of their frequency. This was the weak argument we were using up until now as we slumbered on in a chaotic world. But there’s a time for all of us when we awaken and that wakefulness of our conscience is a blessing in itself that must be grasped, nurtured and fedand I believe Pakistan has suddenly awakened. Finally. Thankfully.

*Saalika Mela [2013] did an MPhil in Educational Leadership and School Improvement and is currently pursuing a course in religious instruction at Al Huda International, while working on research on Islamic Fundamentalism. Picture credit of man escorting schoolchildren after they were rescued from the Peshawar school:  Express Tribune and Wiki Media Commons.


Education after a crisis


Countries which have been through deep trauma and crisis caused by violence and war need to prioritise conflict-sensitive approaches to education, an international meeting heard earlier this month.

The High-Level Symposium on Conflict-Sensitive Education took place at the UNESCO headquarters in Paris and ended with a joint declaration emphasising the importance of such approaches for countries’ long term recovery from conflict. I attended as part of my own research work on the role of education in promoting reconciliation following violent inter-group conflict.

Speakers talked about how education, although central to countries’ development, receives much less funding and attention than health which has more immediate results. The event also served to launch a new set of tools to help educators working in conflict-riven societies and to share good practice on integrating conflict-sensitivity in education systems.

Co-organised by UNESCO’s International Institute for Educational Planning (IIEP) and the Inter-Agency Network for Education in Emergencies (INEE), the event attracted 250 international participants, including over 100 delegates representing national Ministries of Education, UN agencies, national and international research institutions, funding agencies and NGOs active in the field of education in conflict-affected and fragile contexts.

Quality, safe education

Opening statements by INEE members underscored the need of children and young people for quality, equitable, relevant and safe education and emphasised that conflict-sensitive approaches to education contributes to peace-building in important ways: “frustrated youth” can be constructively engaged; resilience can be built in states, economies and communities; and conflict and fragility can be mitigated. Panel discussions centred on “Building peaceful societies in a post-2015 world” and “National initiatives and plans to develop conflict-sensitive education policies and programmes”.

In the first panel, Qian Tang, Assistant Director General of Education at UNESCO, emphasised that education is a pillar for all development goals. He drew attention, however, to two oversights in international development cooperation concerning the immediate and longer-term importance of education. First, educational responses in post-disaster and post-conflict situations should be immediate, but humanitarian budgets allocate very little towards education. Mr Tang observed that the international community still does not recognise how important education is to post-crisis recovery.

Second, the value of education is not merely technical but civic. The ultimate objective of education is not to read and write in Mr. Tang’s words, but to raise responsible citizens who respect human rights and can live peacefully with other cultures. The second panellist, Carol Bellamy, former Executive Director of UNICEF and current Chair of the Board of Directors of the Global Partnership for Education, underscored the importance of pursuing post-2015 education goals in an integrative manner. She pointed to the tendency among the international community to “pick low-hanging fruit”, meaning getting children into schools without looking at the broader and deeper needs in the education sector. She claimed that a mood of “complacency” has overtaken the international community with regards to education, as evidenced by the levelling off of financial investment. Unlike public health interventions, such as immunisation programmes whose value-for-dollar is easy to prove, educational investment is a longer-term process and is harder to assess. She called upon humanitarian and development sectors to collaborate more deliberately for the sake of increasing the quality of educational investment in post-crisis settings.


Between panels, Maria Lucia Uribe, Coordinator of the INEE Working Group on Education and Fragility, launched the INEE Conflict-Sensitive Educational toolkit, explaining its structure, contents and purposes. It includes a Guidance Note which introduces key concepts related to conflict-sensitive education; offers strategies for implementing programmes and policies in a conflict-sensitive manner; features conflict analysis activities and tools; and offers case studies on the application of conflict-sensitivity in education from Sierra Leone, South Sudan and Colombia. A Reflection Tool provides a comprehensive framework of questions for reflection on the interaction between conflict and educational policies and programmes, and opportunities for conflict-sensitivity and peace-building in intervention planning. It is designed to aid the integration of conflict sensitivity at all stages of the educational project cycle: assessment, design, implementation/management, monitoring and evaluation.

Martha Hewison from Save the Children UK then shared her organisation’s experience piloting the tools for conflict-sensitive education in several countries, including Somalia, Mali and South Sudan. Lessons learned from field-testing were used by the Working Group to refine the tools.

In the second panel, case studies on the provision of conflict-sensitive education in conflict-affected and fragile contexts were offered by the Minister of Education of Palestine Lamis Alami, the Minister of Education of Liberia Etmonia Tarpeh, and the Minister of Education of Mali Bocar Moussa Diarra. In Liberia, for example, the Minister explained that due to the country’s long history of armed violence, there is widespread trauma among teachers and students. In her words, children are exposed to violence, “antisocial activity” and “negative values” from an early age, resulting in them “involuntarily” and prematurely becoming adults. In such a context, she said, the challenge before the education sector is “huge”. She said the need for peace-building and state-building in Liberia was paramount. In this context, the involvement of UNESCO in the training of 1,300 teachers and the delivery of a values-based education curriculum sponsored by the government of Japan has been a welcome step forward. The Minister concluded her remarks by stating Liberia’s need to “restore dignity and sanity to the education sector for the benefit of the next generation”.

Psychosocial damage

Challenges raised by delegates included the need for greater attention to the longer-term psychosocial impacts of mass violence on communities and the need for more attention to the substance of education in post-conflict and fragile societies. The representative of the permanent mission of Algeria to UNESCO, Professor Noureddine Toualbi-Thaalibi, cited the largely unaddressed psychosocial damage resulting from Algeria’s history of violent conflict. As in other violence-affected countries, he explained that the symptoms of the destructiveness of violence are not fully evident in the immediate post-crisis phase; rather, they emerge over time. He argued that without systematic attention by the international community to the psychological reconstruction of children, youth and teachers, the achievement of other educational objectives in violence-affected societies will remain elusive. In response, panellist Carole Bellamy offered that “psychosocial issues are real” and that the traumatic impacts of violence “need to be kept in mind”.

The tools produced by the INEE on Conflict-Sensitive Education do indeed point to the importance of violence-prevention and psychosocial wellbeing of children, but at this stage make little reference to the importance of violence-recovery. Another important issue, raised by the Ambassador of Norway to UNESCO Tore Erikson, concerned the content of education. He acknowledged that while getting children to school in fragile contexts is a very challenging task, even more important is the substance of the education they receive once there. He asked what the implications of conflict-sensitive approaches to education are for such topics as the teaching of conflict histories, the design of language policies in divided societies, the uprooting of ideologies and the cultivation of tolerance.

The main programme was followed by a narrative concert by Peter Yarrow, former member of the American folk music group Peter, Paul and Mary which was actively involved in the American Civil Rights and Peace movements. Since 2000, Peter has dedicated much of his time to the organisation Operation Respect that offers programmes on bullying and violence prevention. Through the use of creative pedagogies, Operation Respect’s “Don’t Laugh At Me” programme cultivates empathy and solidarity among young people. Sharing songs and anecdotes from the programme’s experiences in Israel, Palestine and the United States, Peter drew attention to the critical importance of social and emotional learning as a key to community resilience and peace-building. In his words, educators should “nurture the hearts of children in non-political ways”.

Peter underlined that how students are taught is as important, if not more important, than what they are taught. The academic growth of children is impossible, he argued, if their fundamental social and emotional needs are neglected. It was an important reflection on which to end the event.

*Sara Habibi [2011] is doing a PhD in Post-Conflict Reconciliation. Photo credit: Ambro and http://www.freedigitalphotos.net.

A new approach to education


The lines on the graph were flip-flopping across the printout more than the election results of a losing politician. I couldn’t understand how my repeats of identical blood tests, designed to show me if the donor had been exposed to bat-borne pathogens, could be so variable.

It made no sense. I’d done the tests following the protocol, doing the same thing that my fellow PhD students had done before me. I’d processed the data using the right procedure. I’d done everything I was supposed to do. And yet all I had was a mess of meaningless scribbles that completely failed to provide me with what I needed for my research.

Science, frankly, is a mess like this 90% of the time. It comes with the territory of pushing the frontiers of knowledge. But my laboratory tribulations scarily mirror challenges facing graduates across the US today. Students follow what students before them, including probably their parents, have done to get jobs: do well in high school, go to a good college, graduate with decent grades. The story is supposed to finish with them landing a solid, secure job – but like me with my scientific headaches – far too many graduates are finding themselves holding pieces of paper with scribbles that mean little in today’s job market and a process that has given them nothing to prepare them. In fact, over one half of recent grads are unemployed or working jobs that don’t need the degrees they’ve just spent four years and thousands of dollars earning.

I knew something was wrong with my scientific approach. And people are starting to realise that there is something just as wrong with how we do education.

Sir Ken Robinson gave the most watched TED talk of all time (over 15 million views) on how schools kill creativity – the exact skill that our students desperately need to survive in today’s constantly changing economy. In the US, we have an industrial-age education system constructed to train students in rote memorisation and obedience, while our employers and leading companies depend on analytical skills and innovation. A number of studies, carried out by an array of groups from Kent Careers Co and Microsoft to the Wall Street Journal, say that the leading skills desired by employers are initiative, innovation and creativity, communication and teamwork and flexibility.

The problem is, where exactly in our rigorous programme of multiple choice tests, fact memorisation and pursuit of the right answers as defined by a teacher or a textbook are we training our students in these skills?

Back in the lab, I had to admit that what might have worked for the researchers who came before me certainly wasn’t going to work for my new samples. I had to develop my own way of tackling these new challenges. My PhD gave me the chance to start learning and practising creative problem-solving. But there is absolutely no reason that students need to burn 15 years until they get to explore the skills that really matter. Still worse, not everyone can afford a graduate degree, or be as insanely lucky as I was through the generosity of the Gates Cambridge Trust. And that is why, as much I as I love science, I have decided not to stay in academia and instead took the incredible experiences I’ve had in Cambridge and launched a non-profit to offer the same valuable learning opportunities to anyone who wants them.

Black Mountain SOLE is the first residential, self-organised learning community for students who want to become self-experts, unleash their passions and creativity, unlock their innovative and world-changing problem-solving skills and learn by doing. We couple the open-access knowledge available online from Coursera, Udacity, edX and other revolutionary organisations with personal coaching and real-world projects. Students identify their passions and focus on the skills that they need to succeed in their chosen field, while our faculty supports them in their personal development. Forget scantrons, pop quizzes and formulatic essays. Our students will consult with real companies. Tackle community issues. Publish novels.  Our Geronimo Gap Year will help students learn how to maximize their time at university, if they choose to attend later, or jumpstart them in crafting a satisfying, successful career straight away.

Perhaps best of all, in building this unique school, I’m pushing my own limits, from tackling the fear of failure to developing a programme that’s never been done before. I will be able to stand beside our students, having walked in their shoes, and I will know that they really can do anything they want to.

*Alexandra Kamins [2009] studied for a PhD in Veterinary Science. Picture credit: Danilo Rizzuti and http://www.freedigitalphotos.net

Why aren’t you married yet?


After the Chinese New Year, I will officially become a 30-year-old woman. Chinese New Year used to be a fun-filled time: having endless food, visiting relatives, and hopefully, at my age, still getting red envelopes (with money inside, of course!) However, ever since I started to be asked questions like “When are you going to get married?” (after I get my PhD), or “When are you going to finish you PhD?” (you will get a more precise answer from my supervisor), I feel fairly reluctant to see my relatives and less joyful during this festive season. Why has my marital status become a kind of illness for which everyone either feels sympathy or annoyance because of the impression that I am not taking responsibility for my life? With this question in mind, I started my PhD project on investigating Taiwanese people’s marital expectations.

Marriage in East Asian societies used to happen at an early age and was universal. Yet, nowadays, marriage tends to occur during an individual’s late 20s or early 30s. Last year, the mean age for marriage in Taiwan was 31.8 for males and 29.2 for females (see, I am only a bit above the average!). The delayed timing in marriage contributes largely to the lowest fertility rates among many East Asian societies. We hear people saying that late marriage is due to the fact that women are becoming more economically independent and more individualistic (or selfish in terms of wanting to enjoy their single life without the burden from family for a longer period of time). Yet this only explains a very tiny piece of the whole picture. Looking at the survey results, we found that more than 80% of the population still expects to get married at a certain point in their lives. What is keeping them away or postponing them from doing so is more complicated and results from factors founded in both micro-individual situations and macro-social environments.

People in different age groups provide different reasons for why marriage is not an option for them at that life stage. “Too early” and “still in education” are the two most common answers from individuals in their early 20s. As people move into their late 20s, they start giving responses about their continuing single status which reflect more economic concerns, such as “not having got a stable, long-term job”. When they reach their 30s, “having not met someone suitable” takes precedence over the other reasons. These responses depict three important signs of late marriage: first, the expected timing of marriage has been postponed to the late 20s partly due to the prolonged time modern people spend in educational institutions; second, their reasons for not being able to get married change along with the development of different life stages, and third, nowadays it takes longer for young adults to achieve the traditional adulthood markers in terms of attaining economic independence. The term “emerging adulthood” has been coined to describe these younger cohorts, many of whom are stuck in between adolescence and adulthood and struggle to establish their adulthood identities.

Studies on marital timing in the region have so far paid exclusive attention to women’s marital timing. Yet gender is like a coin with two sides. When there are women postponing the timing of their marriage, there are going to be men doing the same (this may be different if civil partnership without limitations to just heterosexual couples becomes universal). While scholars have argued that the patriarchal tradition in these societies, which requires women to be submissive to their husband and sacrifice their careers for their families after marriage, has meant many younger women see marriage in an unfavourable light, the economic requirement on men from this traditional ideology has made it equally difficult for men to make the commitment.

Last December, in the space of one month I attended four weddings of friends around my age. This somehow signals that marriage has not been totally abandoned (or I am about the age to get married) but just happens a bit later. Next time, instead of questioning someone about when he or she intends to get married, why not be patient and just wait for their wedding invitations to surprise you or toast to their bravely-chosen forever singleton status?

*Yen-Chun Cheryl Chen [2010] is currently a PhD student studying Sociology. Picture credit: Danilo Rizzuti and http://www.freedigitalphotos.net