Refining Perspectives: An Interview with Shilpa Modi from Laos

Shilpa Modi, playing with elephants in the Ou River

Shilpa Modi, playing with elephants in the Ou River

Tell us about yourself: what program are you in, what are you studying, and what made you choose this field for your Master’s?

I will start my second year in the International Development Studies program this fall with a concentration in global health.  I previously worked with HIV and Hepatitis C research and harm reduction interventions for injection drug users.  I chose international development instead of doing a masters in public health because I wanted to better understand the larger systems and determinants—education, gender, governance, income disparities—that impact access to health technologies and services, rather than just looking at health within a silo.

Where are you this summer and what are you doing? Also, how did you get this position/opportunity?

Last September I started interning with the Research & Metrics division of Population Services International (PSI), a large global health NGO headquartered in Washington, DC.  After hearing about the Freeman Foundation International Fellowship grant I brought up the opportunity to the research team at PSI.  I specifically was looking for experience in program design and implementation since all of my prior work experience was in research.  The Asia regional researcher connected me with the director of the Laos platform and it ended up being a good fit!

Before starting in Laos, I spent one-week supporting the research team at a writer’s workshop in Bangkok for PSI researchers from Laos, China, and Thailand.  Our aim was to complete four articles on PSI’s programmatic findings for submission to peer-reviewed journals. The experience really highlighted the importance of disseminating program results to increase the evidence-base around specific global health interventions.

Boats on the Ou River in Pak Ou Village

Boats on the Ou River in Pak Ou Village

I then headed to Laos on May 12 to begin my 12-week internship.  I have spent the majority of my time working on the project design, brand strategy, and formative research for a nutrition project.  We are working in partnership with other stakeholders to begin both public distribution and social marketing of a micronutrient fortification powder, or sprinkles, in three provinces in Southern Laos. I also recently started working on a water, sanitation, & hygiene project that is scaling-up social franchising of latrines in two provinces in Laos.  It has been a great experience to see all the steps required to move a project from design phase to implementation.

Wat Xieng Mouane in Luang Prabang, Laos

Wat Xieng Mouane in Luang Prabang, Laos

What are your initial impressions? Is this different than other Asian countries you’ve traveled to in the past?

Most striking about Laos is how warm the people are.  Everyone you pass on the street will greet you with a warm Saibadee!  Meals are always eaten together and shared.  Locals will go out of their way to help you around town.

The only other country I have been to in Asia is India.  My work experience in Laos has been very different from my experiences in India.  Urbanization and manufacturing in India has resulted in large urban slums.  Although rural-urban migration is increasing, the majority of Laotians live in peri-urban or rural environments, with much of the poor living in rural agricultural villages.

There are many development players working in Laos and its common to see JICA, World Bank, and UNDP signs, among many others, around the capital city of Vientiane.  Additionally, the influence of Chinese business, mining, and investment is quite visible in the areas where I have travelled.  Interestingly, I have heard from local development workers that Laos membership in ASEAN, the Association of Southeast Asian Nations, has begin to influence policies and development initiatives.

Will this experience change the coursework you take next year, or the types of opportunities you pursue in the future?

My experience this summer has most definitely changed the focus of my studies.   I find that my concentration in global health is too broad, and therefore will be focusing my coursework on child survival in my second year.  From working in the field I have realized the importance of gaining strong skills in a few areas versus surface knowledge of many areas.  Depth versus breadth.

Weaving of traditional Lao silk scarves on a loom in Pak Ou Village

Weaving of traditional Lao silk scarves on a loom in Pak Ou Village

What do you wish was different, either about the organization you work with, or the situations you are seeing on the ground?

One thing that has frustrated me is seeing the number of person-hours and resources that goes into all of the paperwork and documentation for donors. Although accountability is necessary, it is a big strain for NGOs to divert resources to fulfill all the donor requirements.

Another aspect that has been a learning experience for me is navigating the relationships and work processes of all the stakeholders. Through my internship with PSI Laos, I have worked in partnership with UNICEF, the World Bank, academic institutions, and a number of departments in the Ministry of Health.  Although the many partners are working towards similar goals, there are often differences on how best to get there.  If the roles and responsibilities of each stakeholder are not clearly laid out from the beginning projects can halt to a standstill. Additionally, flexibility is very important since each partner has its own timeframe and processes, which can make coordination tricky at times.

Has your perspective on development changed since being in the field? If so, in what ways?

I better understand how multifaceted development problems are. In global health we often discuss the importance of building local capacity and strengthening health systems.  But what does that mean on the ground? I have learned that we cannot break things down to one problem, and therefore one solution, as we do in the classroom.  In Laos it’s not just about increasing the number of health professionals.    Its not just about improving education and medical training. Or improving access to equipment and a life-saving medicines in health facilities.  It’s all of those things. Plus add ethnic tensions, such as the difference in access and quality of care for Lao Loum and Lao Hmong. Add political ideology and the restrictions on evidence-based medicine as result.  Add income disparities.  Add different levels of government, legislation, and regulation.  Add poor infrastructure.  So now where do you start?