Development Practice Q&A with Sarah Snidal MPA-DP ’13

By meshing her communications, systems, and health interests, Sarah Snidal MPA-DP ’13 is bringing mindful accountability to urban development. Building upon her experiences in Niger, India, and Uganda and her time at SIPA, Snidal is now completing a Global Health Corps Fellowship with LifeNet International. She spoke with Sarayu Adeni MPA-DP ’15 about her current work in Burundi and shared insights on urban public health and responsible communications for practitioners.

What does being a Global Health Corps Fellow involve?

GHC is a really great opportunity for younger professionals who want to work in health, but aren’t necessarily health experts. The idea is to bring together a group that is really committed to social justice and to correcting systems that leave so many marginalized, but can add expertise from management to architecture.

GHC goes against the standard model by requiring that half of the fellows come from the country where work is being done. They also place international fellows in the United States, which leads to a lot of cross-cultural exchanges and intellectual challenging of a lot of the perspectives about “Africa” and development.

What projects have you worked on?

[My placement is] with LifeNet International. We work on health systems strengthening in existing clinics through medical and management trainings, pharmaceutical supply chain support, and a new equipment loans program. My current role is Monitoring and Evaluation Officer, so I support the existing program. Additionally, I get to work on more creative opportunities like designing a qualitative M&E program to run alongside our existing programs. I’m also designing a set of health impact metrics to determine our actual impact in the community and what working with the existing health centers does for community health – especially since we don’t actually see any patients. I also do some communications work.

I’ve been here for a little over nine months now. I live in housing provided by LifeNet, with a mixed group of other NGO workers, including my Burundian GHC co-fellow. It’s a really interesting experience of learning from each other and forming bonds through a mélange of English, French, and occasionally Kirundi.

What are your thoughts on the importance or challenges of media skills for MDPs and health-focused SIPA graduates?

As development practitioners, we need to talk about the issues to get supporters and funding to run our projects. We can’t do development without some lobbying through communications. But the big challenge I see is doing respectful, dignified media. If we’re discussing improving lives of marginalized populations, how do we do it so that we aren’t talking over their voices and cutting them out of the discourse?

This is especially true of photography! A few weeks ago I opened my Facebook to see a girl that I knew from my work in India complaining about international tourists in her hometown taking pictures of her. I couldn’t help but roll my eyes—she’d been the type of person that would snap photos of children left and right and post them on her Facebook.

The news stories make Burundi out to be this dangerous, poverty-stricken, corrupt country that is at the brink of war and will arrest you for jogging. But I’m trying to reconcile those stories and the truly painful challenges some people are facing here with the fact that Bujumbura is becoming a thriving city with a population that is optimistic about overcoming its past and challenges. It is not yet Kampala or Accra, but you can feel that it is making steps to get there.

Within every context that we work—from the urban poor in Chicago to the villages in Burundi—there are brilliant people who come from there, and they have thought about all of the issues we are trying to address with an invaluable understanding of the local context because it is their own and they need to be included. I’m excited to see that there’s a push for respectful communications, yet we have a really long way to go.

You’ve written a lot about addressing tuberculosis in urban health initiatives. What do you think is most noteworthy about this issue?

It’s a disease that I find fascinating. It’s curable, but requires proper care or it can have a high rate of becoming drug resistant. Having TB also comes with a lot of social stigma, from its association with HIV co-infection, to the fact that it’s airborne, and so on. In many countries people believe that women who have had TB should never get married.

I’ve been really excited to see that new drugs are being tested and there are new diagnostic tools being developed in the last few years. I’m hoping for a greater emergence of healthcare accountability when it comes to following up with patients, and trying to make the process of supporting all patients as easy as possible for hospitals, clinics, community health workers, and most importantly the patients themselves. I’ve gotten to work on some of these initiatives, including with the Earth Institute and Dr. Yanis Ben Amor while I was a student at SIPA, and it’s been really exciting to be at the forefront of it.

Urban and rural communities have incredibly distinct challenges when it comes to healthcare, especially when it comes to diseases like TB. With rural populations it’s often about the lack of money and infrastructure to get the care to the whole community. With urban populations the infrastructure is often there so it’s often more about behavior change. But what really fascinates me is that I sometimes think urban populations are more invisible or more heavily blamed. People think that it’s the fault of the individual if they aren’t getting the care, but they aren’t considering that in the city it becomes a choice between ‘do I spend multiple days’ wages on the rides to the TB center, or do I earn an income to feed my family?’ Worse, what if they get caught and are stigmatized for having TB? These are the challenges I want to talk about. This is where supporting patient adherence with TB treatment becomes critical. I want to know how we overcome these barriers and bring the treatment and care as close to the patient as possible, while respecting privacy and trying to combat stigma.

What were some of your most worthwhile experiences as an MDP at SIPA?

One of the courses I’ve consistently referenced was Tony Barclay’s management course. It touched on so many parts of international development work and I still check his slides sometimes when I’m working on a new project. Similarly, I did a capstone with Jessica Fanzo which was really great! It was nice to work on a project that would actually have some real-world significance, and simultaneously learn more about nutrition and its intersection with health and changing population trends, such as urbanization.

Beyond classes, my biggest recommendation is to utilize all the other great minds on campus. During my second semester, Dr. Ben Amor came to guest lecture our MPA-DP global health class. He’s a TB and HIV expert, so I introduced myself to him, expressed my interest in working on TB and infectious disease initiatives, and asked him if I could talk to him about it more. Taking that chance led to some great research opportunities with him and even changed the course of my summer placement to work with him in Uganda. Stepping out and getting to do practical learning projects is the best part of MPA-DP, if you do it right.

— Sarayu Adeni MPA-DP ’15

Learn more about Columbia SIPA’s MPA in Development Practice.