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EP16 Individual Capstone Project with Anne Mattson
Deborah Onakomaiya: Hey guys and welcome to another episode of I AM GPH. I am your host, Deborah Onakomaiya. On the show today we have a student of GPH, Anne Mattson who's a second year Global Health student and currently works as an Interim Prevention Coordinator at the NYC Alliance Against Sexual Assault. She's also an academic advisor at the Red Tree Study, which hosts classes in public health and peace building missions in Bogota, Colombia. Her public health interests are in women's health and sexual violence prevention. A fun fact about Anne is that she's a classically trained vocalist and briefly she played in a band. Let's go to our conversation with her. Thank you so much Anne for coming on our show today. It's awesome to have you.
Anne Mattson: Yeah! Thanks for inviting me.
Deborah Onakomaiya: So I mean, we've heard so much about you. You have an awesome resume, you're part of a Fellowship Program that turned into a Capstone Project, right? How did that happen? Can you explain a little bit about what that Fellowship is about and how you found out about it?
Anne Mattson: Yeah. So in May of this year, 2017, I got an email from the Global Research Initiatives. They were saying that they were doing another call for applications. So initially they had called for Fall 2017 applications in January and I didn't apply. But when this came around, we had just found out about the Projects that were going to be available to us for Capstones and none of them really were speaking to me. So I decided to apply for GRI and I figured I was going to ask if it could be switched to my Capstone and if not, I still wanted the opportunity to do my own research. So I figured it was kind of a win-win.
Deborah Onakomaiya: And what exactly is the Global Research Fellowship about? As opposed to you turning it into a Capstone for a regular person. What's that? What does that look like for people that don't want it to be a Capstone?
Anne Mattson: Yeah, for most people it is a thesis or a Capstone Project. That's one of the requirements, but some of the students that I was talking to when I was Prague had slightly different, they kind of tailored it to be a little bit what they wanted. So if it wasn't a total thesis, it might be related to their thesis or things like that. And yeah, that's the original intention of the GRI fellowship. So students come usually in their graduate program, but it is open to undergraduates as well.
Deborah Onakomaiya: You know, you said a lot of the Capstones didn't speak to you. So generally people do Capstones in a group, why did you choose to really go alone on this one?
Anne Mattson: Yeah, my primary interest is reproductive health across the board for women and for men. But I focus on women's health in my personal endeavors like volunteer work and internships that I've done in the past and none of the Capstones for this year were specifically related to reproductive health. There was a maternal health in Guatemala, but I tend to focus on before pregnancy, its my range of expertise and so I wanted to pursue that and kind of deepen my knowledge of reproductive health prior to pregnancy or after, between pregnancy, whichever.
Deborah Onakomaiya: So more importantly, you gave a general overview but what exactly was this particular project on?
Anne Mattson: Yeah, so I initially headed to Prague with the intention of researching women who travel for more restrictive countries to the Czech Republic for abortion services. Technically, this is illegal in the Czech Republic. Kind of depends who you talk to. There was definitely a different understanding across the board within my interviews of what was legal and what wasn't. But it was my understanding prior to arriving that legally in black and white on paper in the Czech Republic, you are not supposed to provide abortion services to women who are not residents or citizens of the Czech Republic. So I knew this, but I was hoping that I could get some information still. You know, I had mentioned in our Capstone class, a couple of weeks ago that in public health, we know it doesn't matter what's legal, it matters what's happening. So, I knew that it was happening, I knew that women were coming from other countries to get abortion services and so it didn't matter that technically they weren't allowed to, they still were finding loopholes. I found upon getting there that nobody really wanted to talk to me about this. And I get it, I'm coming in, I'm this American graduate student, no one's ever met me, and I'm like, "Hey, would you like to tell me about the illegal activities that you are partaking in?" And they're like, "No, I really don't want to tell you about that, you nark!" So I did not readily have anyone who wanted to meet with me on that. So I kind of had to think really quick on my feet down there. And I decided to broaden my scope to cover all reproductive health services in the Czech Republic. And I found that people were a little bit more willing to talk about women who had traveled for assisted reproduction, whether that be artificial insemination or IVF services, which is in vitro fertilization. It kind of was easier to segue into discussing other topics that might be a little bit more in the gray area, like providing abortion services, if we started talking about services that are legal. So I had to broaden my scope a bit, but it did end up being fruitful.
Deborah Onakomaiya: How were you able to prepare for this type of research? We're here in New York, we have our preconceived notions of what we should be finding in the field. So how were you able to prepare for that and when you were on the ground, how, how were you able to adjust?
Anne Mattson: I would say here in New York, most of my research was literature reviews and things like that that were more academic and a bit more clinical in that sense. Reading published reports and what I really had to adjust for when I got there was the reality of what's actually happening. Like I said, it doesn't matter what's legal, it matters what people are doing...in public health not in the rest of the world. So, when I got there I definitely had to adjust for cultural differences and just the element of being an American coming into a Czech space where I don't speak Czech, I'm not of Czech origin ethnically or ancestrally, so definitely that element was not prepared for. But otherwise preparing was largely reading papers of prominent researchers in the Czech Republic, reading their legal statutes, which involved a lot of Google translate.
Deborah Onakomaiya: Thank God for that, right?
Anne Mattson: Just generally like having Czech people that I knew helped me through some of the translation process as I was putting it through and I was like, this isn't making sense as it comes out of Google. Our colleague and classmate Mehreen Arif connected me with some Czech speaking individuals, that was awesome.
Deborah Onakomaiya: Wow, that's really cool. And I mean for a touchy subject like abortion, how was that IRB process, did you need some type of IRB approval? How did that work out for you?
Anne Mattson: Initially I wanted to interview patients, but in talking to some of my mentors on this project, it became really apparent that it was first of all going to be very hard to get a hold of patients because I was not going to be in the Czech Republic for very long. So that would be difficult. And secondly, that's a hugely vulnerable population, especially people who are traveling for services. That means that in their native country that they don't have access. So you know, they might be in a situation where they are lower income, where there might be stigma or there might be risk socially to them being outed in any way, if anyone found out that they were talking to a researcher. So I decided to switch my scope to talk to activists, academics and medical doctors about my subject. So I did need IRB approval, but it was a bit of an easier process because I was talking to people who were already a public face of the issue in the Czech Republic.
Deborah Onakomaiya: Talk about adjusting in the field guys, she is so awesome! I can't believe it. So far, you've talked about your research, you've given us what it looked like. What was the day to day like? What activities were you engaged in everyday? So, how was your sampling process? When you woke up in the morning, how did you figure out who you should be talking to? You know, because it's a very touchy subject, especially in a place where abortion and things like that is illegal. So what was the day to day like?
Anne Mattson: So the Czech Republic is a very liberal country. It is not a touchy subject for them at all. I had no problem finding people to talk to about reproductive health services. It was a snowball sampling technique for sure. So I started really by looking up feminist organizations in the Czech Republic that dealt directly with reproductive health rights or services. And I started by cold emailing them, and people were so receptive. I was so lucky, almost everyone I emailed replied to me and if they couldn't help me then they would pass me along to someone who could, almost everyone ended up replying with a CC of a colleague or a friend or just a person they'd heard of that they had the email of. It was amazing. So, it definitely snowballed that way. And as I talked to academics, I found more colleagues of theirs that were in another niche of reproductive health. And then when I spoke to doctors, they would have colleagues that were in another hospital or another clinic that could help talk about the issue. I was really, really thankful for that. I also found academics by reading papers that were published in the Czech Republic in English and emailing them because since I did not have a translator on the ground, I did need interviews to be conducted in English. So a huge barometer for that was whether or not the papers were published in English and at that point I knew that the writer probably had at least an understanding of the English language.
Deborah Onakomaiya: Wow, that's really cool. And for the people that you were just emailing that were not necessarily academics from the papers you read, were you writing the emails in English or you had to write in?
Anne Mattson: I had a translation of my recruitment email done for me by a friend. And so, I did send out the email in English with the Czech translation underneath. And then if I, I have an extension on my Chrome that automatically translates all of the Czech that I have in my browser to English. So if I received emails in Czech, I was able to tell whether or not they were responding to me and letting me know that they spoke English or not. And if they said that they didn't speak English, then I would basically struggle Google translate my way through, thanking them for their time.
Deborah Onakomaiya: Ah, thank God for Google translate. Like wow. I mean, I'm sure in your references or in your acknowledgement page, you should just have "thank you Google translate".
Anne Mattson: Yeah, I know. Thank you Alphabet Inc. for your amazing Google translate function.
Deborah Onakomaiya: You were out there for a month, right? So how was that for you as a student, living in a different country for a month? How was that? I mean, you said there were definitely cultural differences, coming from America. So how were you able to cope with, how were you able to adjust there in terms of food, living conditions, things like that?
Anne Mattson: The biggest cultural differences actually were not what I would've expected. So the only other European country I had spent any time in was Italy, and Italy is an island unto itself. I think a lot of Europeans will tell you. And the Czech Republic is very integrated with European Union in terms of their setup of transit and kind of everything's really cohesive. I was able to visit a couple other countries on my own money, while I was there and it felt very cohesive, unlike Italy, which is very, it's so much older and it has a much more, do you know.... You were in Italy with me? It’s different.
Deborah Onakomaiya: Yeah, it's definitely different.
Anne Mattson: So, the Czech Republic, the differences were nothing major. It was honestly just kind of things that ended up being a little bit funny. Like, in the United States we say, "Hi, how are you?" Like that's your greeting. And in the Czech Republic everyone actually fully tells you how they are. They give you a complete rundown of their day. And so this reflex that I had of being American and saying "Hey, how are you?" got me a long list of the reason that their son was late to school and they think they're catching colds and they're just very tired. And I was like, oh, I need to adjust this reflex because this isn't a common change here. And then in terms of food, Czech food is really good. It's very, very hearty food, a lot of potatoes and root vegetables and stuff. It's delicious! And so I had no problem with that. They have their grocery stores are set up exactly the same as ours, everything like that. So I didn't have a major adjustment like that. I think if I had come from any city other than New York, maybe I would've had a harder time. But the Czech Republic felt, Prague felt suburban compared to New York City. So I didn't have a hard time.
Deborah Onakomaiya: That's really, very interesting. And just going back to your research, what type of data did you collect? And you spent a month there collecting all these types of data. So was this mixed methods, was this qualitative/quantitative and what do you hope to do with this information? So bigger picture.
Anne Mattson: It was a qualitative process entirely. There is decent data available in a quantitative form on reproductive health services in the Czech Republic, so you can find numbers on patients accessing certain services. But I wanted to know a bit more about people in the field’s understanding of the cultural and legal landscape. There isn't a ton of information on that that I found. And there's a deep, deep well of information on the history of the Czech Republic. The Velvet Revolution where they overthrew Communism was in 1989 and the country's undergone a lot of changes since then. They're now a representative democracy. And I wanted people's understanding of how that change, 1989 wasn't that long ago, especially for people who are medical doctors at this point. They were most definitely alive at that point in order to have already gone through medical school and be practicing. So I really wanted people's understanding of how the country had changed and what that meant for Reproductive health and the culture around those issues. So I wanted a qualitative perspective.
Deborah Onakomaiya: All right, so you've gone over your project, your activities, can you summarize, what were the biggest takeaways from your experience there? What did you learn? What did you have to unlearn coming from the public health background?
Anne Mattson: Yeah, I would say the biggest thing that I unlearned was the impact of Communism on the country. I think that the Eastern block has a very diverse history that we don't learn about in the United States, at least not in suburban public schools like where I went growing up. So I think that there are some countries that are more heavily impacted by their history with Communism and that impacts their social standards, their culture in different ways. And in the Czech Republic, especially Prague, which is very metropolitan, I really did not find that people referenced their time under Soviet influence as an indicator of their current cultural status or as an indicator of their current public health status. They definitely identified very much with being a Western representative democracy and saw the majority of their public health initiatives and their public health goals as being instigated by the people and being instigated by an educated medical field. So I had come in and I had really expected a bit more of a divide between our experience in the United States or even countries in the EU that were never under Soviet influence or under communist rule. And the Czech Republic very much feels identified with the "Western" way of thinking, which I heard a lot of. People spoke a lot about being Western, which was the only thing in their lexicon that felt kind of antiquated and solely related to their time under communist rule. So that was both a big unlearning and a new learning process and then really learning what was taboo and what wasn't. Topics that are taboo in the United States such as abortion are not an issue in the Czech Republic, medical professionals, academics, activists. It's not considered something that is honestly worthy of a lot of discussion. People feel that it is how it is and if you don't agree with it, then you can vote in the future. And so far they haven't seen a large uprising of people voting against women's reproductive health. So they just consider it- it's good the way it is- clearly because people are not trying to change it. In the United States, I think we have a lot of warring factions.
Deborah Onakomaiya: Oh wow. Let's talk about the news, right? Looking back, you've more or less done the most part of your Capstone. Now is the analysis phase and it sounds like preparation, getting that data, it's a huge amount of work for one person. For someone that decides that, I want to do this Capstone alone, what advice would you have for them? You know, are you going to tell them to run for the hills and find a group or what tangible advice do you have for someone that decides, I want to go this alone. You know, I want to do my own thing.
Anne Mattson: Definitely you talk to your advisors first. That's what I did. I wanted to make sure I wasn't biting off more than I could chew. I know that the big Capstone groups can get some really incredible stuff done in their time abroad because they have more people, more manpower, so to speak, and I had to kind of have a realistic expectation of what I could get done while I was abroad. So I had the option of going for one to three months, three months was not possible with my school schedule, I was very lucky that CGPH was willing to kind of bend for me and let me go for a month. And you just have to be really realistic about how much time it takes and how much preparation it takes. So, I started planning for this capstone in May. I was accepted in June and I immediately started researching and putting together a literature review and all of that. So it's not an overnight process at all, you're going to put in the same amount of time as anyone else if you're doing it alone. And you might end up with a smaller sample size because you don't have four people that can help you do interviews or you don't have four people who can help you do outreach. So have a realistic perspective of what you can take on and how it's going to integrate with your academic life because you don't get to put your whole life on hold when you're doing a Capstone. You do still have to possibly have an internship or work or be in school. Be sure to have a clear idea of what you want to do, but still have a bit of room for flexibility because when you're by yourself, you are the person calling the shots, but that's also a lot of pressure. So if you get on the ground and you realize that some of your questions aren't working or some of your ideas aren't actionable, you have to be willing to adjust that and be open to change.
Deborah Onakomaiya: Wow. Thank you so much. And finally, where are you going to be in five years? Are you going to still be involved with reproductive health? Where do you see yourself Anne?
Anne Mattson: I would really like to continue doing reproductive health. I haven't decided yet if I want to go global or if I want to stay in the United States. I'm born and raised US citizen, so part of me feels kind of obligated to stay here and help make things better, whatever that means in my perspective or in your perspective for whatever. So I feel that, but at the same time, I love traveling, and I love experiencing a different way of looking at things, bringing that back, whatever country I've been to. People do things even slightly differently. And then you can bring that back to the United States and say, well, how could we implement that here? And so perhaps in five years I'll be abroad and then in 10 years I'll be back.
Deborah Onakomaiya: Yay. Thank you so much, Anne, for coming on our show. It was amazing to hear about your work.
Anne Mattson: Yeah. Thanks Debbie.