Levy, Stephanie

Public Health



Peru- Survey of Osteoporosis

This study will examine the hypothesis that high altitude individuals due to the increase of sunlight and presence of Vitamin D will have lower rates of osteoporosis. We will examine examine osteoporosis prevalence in different age groups starting at age 40 years of age. Blood will be taken for Vitamin D levels and bone marker proteins. Four populations will be compared, a high altitude population in Puno , split between urban and rural communities, Lima periurban slum at sea level and also a rural village population at sea level in Tumbes. The study will use dexascan technology in each of these areas. In addition, we will using pedometers measure daytime activity.

I was very excited upon my arrival to Peru.  I knew some information about the country due to my longstanding interest in Latin America, but I was looking forward to experiencing life in a new country while working on an important public health project.  I had just spent the previous two months working in rural Guatemala, so my language adjustment was not terribly difficult.  Another Hopkins MSPH student was actually working on the same study and had arrived 6 weeks before I did, so it was nice not only to have her as a coworker but also to explain the workings of the office and the work that had been done prior to my arrival.

While living and working in a developing country was not a new experience for me – I have lived in China, Bolivia, and Guatemala –, this was my first time working for an extended period on a public health research project in a developing country.  Even though I had spent 6 months in 2010 working at a health clinic in neighboring Bolivia, there were still significant cultural and linguistic differences between the two countries. Adjusting to those (and learning a whole new set of study-related vocabulary) was interesting.  I also had to readjust to the slower pace of life (e.g., 2 hours for lunch in the middle of the work day) and “Peruvian Standard Time,” which meant that nothing started on time. I did get the opportunity to travel around southern Peru quite a bit: the amazing geography and the friendly disposition of everyone I met made it a really wonderful experience.

I learned a lot from my field experience. One of the biggest overall lessons was about the general pace of research projects and their multiple and inevitable delays. I thought that I would spend the 6 months of my practicum working on a study that would have started prior to my arrival. However, I left mid-March with the study just beginning its baseline data collection activities. I learned that a delay of 6-12 months is apparently normal for a research project. The fact that we switched study sites in January also contributed to the delay.  Having never worked on one in the field, it was a new lesson for me; I would make sure to let any student applying for a similar experience know to expect the same.  I also learned more about all the elements that a successful and functioning research project requires: they extend far beyond a sound research proposal and sufficient funding.

Another lesson I learned with respect to global health projects is that coordinating a multi-site, multi-country study is rather difficult. In addition to the logistical issues, there are a host of cultural and geographic peculiarities of each site that need to be taken into account and incorporated into instrument design, staff training, etc. In my case, Peru is way ahead of the other two sites, which may not start the study until June and September of this year.  This means that the Peru team was responsible for “dictating” the format and content of the data collection instruments.  We did incorporate comments from the other sites, and I think the instruments definitely benefitted from our pilot testing; that being said, it will be interesting to see what issues, if any, arise in the other two sites.

I learned how vital local staff can be to the success of a project. Our staff in Ayacucho had two main advantages over foreign or even non-local staff. The first advantage was their familiarity with the region and their previous positive experiences with other nearby communities. This allowed them easier access to our participant communities and a generally warmer reception to our research project. The second major advantage is that they all speak Quechua, the local indigenous language. I am fluent in Spanish and have spent some time studying Quechua, but the women in the communities speak Quechua almost exclusively. Simply put, there is no way I could participate in any data collection activities. I think this is an important lesson because so many of the most underserved populations have additional barriers such as language; while we are trained public health professionals, sometimes we are less qualified in some critical ways than local workers to achieve our public health goals.

Finally, I learned that I genuinely enjoy training. It might stem from my years as an English teacher and general tutor, but regardless training is something I’d like to continue to incorporate in my career. While my primary interest remains health communication and education, qualitative/behavioral training can now be added to my interests.


Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

January 2019



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