Dorit Erichsen

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The mandatory airport picture on route to WHO✈️ CPH -> Düsseldorf-> Abu Dhabi -> Manila

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Something about life on income support

It’s seven weeks since graduation and my last day at work as a student assistant at Copenhagen University. Well. It almost feels like a lifetime ago. The thing about time passing by fast when you’re having fun? I find the alternative version of that to be even more true; time passes by i.n.c.r.e.d.i.b.l.y slow when you, and only you, are responsible for filling out the hours in the day. Do I need to spell out the opposite of fun? Honestly, I was a little excited end of January to look ahead in my calendar. Lots of empty space that would allow me to sleep in, watch Netflix, and see all those friends that I don’t see often enough. A little Income Support Holiday, if you will, on my own couch. I know, highly politically incorrect to think that. Even more inappropriate to say out loud. The first few days the alarm clock didn’t go off were great. I went to the introduction meeting at the unemployment insurance fund. I booked an appointment at my dentist (which is a half-day adventure because I still go to the one in my hometown, and thus something I’ve been putting off for months). I paid full price for my cappuccino at Lagkagehuset (bye student discounts). I finished the books I got at Christmas. The list goes on. And YES, that was great for the first few days. It didn’t take long, however, before I sympathized with people who find themselves unemployed for a longer time. Or people who get depressed or even stressed during unemployment. The other side of the ‘great, more time for Netflix’ situation is of course that you have to find a job – and that you need to document that you’re trying to find a job. Not since my math teacher in high school checked that our class had done that day’s homework by flipping through each and everyone’s homework notes have I reencountered that feeling. It goes beyond checking. Monitoring? Controlling? Or maybe it’s more like checking rooted in mistrust. A scrutiny fostered by suspicion that someone is not doing their homework. Or that someone is not actively seeking a job. The burden of proof rests with you.

One thing I’ve re-learned about myself the last weeks is that I need things to have an end – a tangible end. Re-learned because I knew that, I just didn’t how important it actually was for me until walking that road of unemployment. I don’t do very well with the one-day-at-a-time mantra. I’m a planner - and all the synonyms of that word; organizer, arranger, preparer. I need my calendar to be full (not too full – there’s a fine line right there), I need to have things to look forward to and something to wake up to in the morning. So, when the dentist told me I had no cavities, when I got tired of Lagkagehuset’s cappuccinos and when Netflix lost its charm (that, by the way, is inversely proportional with availability. Like everything else in life, you might add), the first-day-back-at-work could not come soon enough.  

I’m leaving for Manila a week from today. There’s a consultancy waiting for me at WHO, and I can’t wait for the alarm clock to wake me up. I’ll surely look to this blog post whenever I regret having said that…

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Done with school (for now...)

‘Isn’t it weird to be done?’ people ask me, ‘I don’t really know’, I answer. I don’t FEEL done. Done with the Bachelor thesis, sure. But not done with studying, not done with public health, not done with preparing for exams and writing assignments. I’m still a student. Not at Metropolitan University College after graduation on Tuesday. But still a student mentally. Maybe the feeling won’t really kick in until I have to pay full price for my cappuccino at Lagkagehuset on Wednesday when my student card is no longer valid. Or when the insurance company calls again to remind me that the bi-annual fees for my homeowner and personal accident insurances will increase by 100 percent. Grown-up life is tough. Good thing I’m officially a student again from September (hopefully!)  Here’s the pretty picture taken after my Bachelor defense last Tuesday; thesis, flowers, the what-a-relief-smile. 

This is the behind-the-scene photo taken seconds later…

Thanks for reading!

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Ending the inappropriate promotion of foods for infants and young children

I received an email on Friday from my supervisor at WHO in Manila. It was a forward of the official email from the Publication Division, notifying that the ‘proposed WPRO information product’ (the publication I worked on in relation to resolution WHA69.9) had now been approved and cleared by the Regional Director, and was now ready for ‘reproduction and dissemination’. Below is a screen shot of the front cover - I'm excited that I can now finally share with peers, family and friends something quite tangible from the 12 weeks I spent at the WHO office in Manila.

I’ve been fortunate to be part of many things and work on many publications during my time at WHO, but this is the only project or publication I’ve been involved with from pre-conception all the way through birth. So to speak. And now it’s out there! Edited, routed, cleared, approved and on its own now, ready to advocate for restricting the inappropriate promotion of foods for infants and young children.

You can access a pdf-version of the booklet here. 

There are many different types of WHO and WPRO publications. A non-exhaustive list at the top of my head include heavy reports on status quo of a topic; regional action plans, frameworks and models, and advocacy material.  This publication (I initially wrote MY publication, but not too sure about the appropriateness of declared ownership here... ;-)) is categorized as an ‘advocacy booklet’, with the objective to inform governments and policy makers in WHO Member States about the existence and content of the resolution WHA69.9 and its significance in relation to The Code and ongoing global fight to protect children from aggressive marketing.

So what IS the significance of the resolution and why is there a need for advocacy material conveying its message? Answering that could turn this into a very, very long blog post, but I’ll try to make it brief. 

The Code covers marketing of breast milk substitutes up until the age of six months. It is up to Member States, with the support of regional WHO offices, to put the Code into national legislation as well as implementing enforcement and monitoring mechanisms. Furthermore, based on growing evidence linking childhood overweight and obesity to the marketing of foods and non-alcoholic beverages, countries are working to restrict targeted promotions to children – some with voluntary industry agreements, others with different provisions of laws. But what and who protects a seven month old? Or a two-year old? The guidance in the new resolution targets all commercially produced foods and beverages that are marketed as suitable for feeding infants and young children aged six months to three years. Closing the gap that begins after exclusive breastfeeding is no longer suffienct to cover infants' nutritional needs (at six months where WHO recommends complementary foods to be introduced) and up until marketing regulations protect children is fundamental for combating all forms of malnutrition.

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It’s Sunday afternoon here in Manila. My flight back to Copenhagen leaves tomorrow night. Friday was my last official day at WHO, but I have yet to give my final presentation to fellow interns and the Nutrition Unit - that is scheduled for tomorrow after lunch. So I still have one more walk to and from the office, one more time through security at the entrance gate, and maybe one more of the mediocre coffees from the cafeteria. I’m trying to figure out what to say in the presentation while initiating some packing (amazing the amounts and multitude of THINGS you can collect in four months) and running souvenir errands to the mall. Just wanted to share with you THE intern photo everyone coming through the WPRO office takes one of their last days; a picture in front of the WHO sign located on the top of the office building. So this was indeed supposed to be my cool ‘Look at me here at WHO’-picture, but as I defied the midday heat and headed for the roof, I found myself in the midst of bricks and construction work. Oh well, I guess this is as cool as it gets :-)

Thanks for reading!

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TORs, learning objectives, and a retrospective contemplation about finding the middle ground

So… Two weeks left here in Manila, and perhaps it’s about time to talk about the learning objectives specified in the contract for my internship at WHO. Honestly, the reason why sharing those objectives has not been at the top of my priorities list (some might argue they should have) is because it’s felt a little premature; both coming up with them back in April and posting them here on the blog. Sure, I know that having objectives is an important part of an internship; an important part of any study course, programme, or assignment. The world today is very focused on the outcomes, the goals, the reasons, the ‘what will I achieve from this?’ And hey, I’m all about transparency, shared expectations and knowing what is coming. Anyone who knows me will testify to my (at sometimes almost limiting) desire to know what comes next. In terms of an internship, I’ve learned that it’s about finding the middle ground; to know to some extent what you can expect, and what other’s might expect of you. Hypothetically, at one end of the spectrum all your days are scheduled and the projects drawn out before you’ve even seen the inside of the office. Not likely. What is also not likely is that you have no idea what you’re getting into. My guess is that most of my peers, and students venturing out on internships in general, will find themselves somewhere in the middle. But even the contentment to ‘know to some extent’ can turn out to pose difficulties or disappointments if all the stuff you assumed but didn’t discuss or put in writing is – well, all different than assumed. Conversely, if initial arrangements are regarded as something unalterable, drafted in stone for the new species of humankind to find in a thousand years, it might unwittingly put a constraint on your learning and work – more so if you’re in a busy and eventful organization (…WHO). Thanks to many things, including prior experiences at different places of the spectrum, my time here at WHO has thus far exceeded my expectations. With initial lukewarm feelings towards drafting and sharing the learning objectives, the process leading up to being able to do so, has no doubt been a solid foundation for my internship in Manila.  

My learning objectives were based on the TORs discussed and agreed upon with my supervisor in January. TORs, you ask? I had to consult with Google on that one, too. TORs means Terms of References - or another word for proposed duties. So whereas the school focuses on what I would learn, WHO focuses on what I would do. Looking for the outputs in the inputs, so to speak, gave rise to the following four learning objectives (LO) with relevant key skills (KS) to use and attain. However, as the objectives are based on dialogs and present state of affairs eight months ago, they have (inevitably) changed a little. For example, my work with resolution WHA69.9 is nowhere to be found in the list – it didn’t see the light of the day until mid-May (four months after drafting the TORs). In another blog post (quite possibly not before returning to Denmark), I will explore how the learning objectives would look if I were to draft them today, reflecting on the one-million-dollar question: What have I learned?

LO1. Gain an understanding of WHO’s work on a global, regional and national level.  KS1. Participate and support national and regional workshops.  KS2. Participate in brown bag meetings.

LO2. Acquire skills to develop policy briefs and communicate important nutritional informational to different stakeholders. KS1. Support development of policy briefs on Implementing and Monitoring School Food Standards and Nutrition and the Sustainable Development Goals.

LO3a. Work professionally in an international and intercultural environment. LO3b. Further develop communication and presentation skills. KS1. Engage in a variety of activities and work assignments with different WHO personnel and other interns. KS2. Submit a report by the end of the internship period. KS3. Present the report at a division meeting.

LO4. Increase my knowledge on marketing of food and beverages to children from a public health perspective. KS1. Support regional workshop on topic. KS2. Support development of policy brief on topic. KS3. Review various studies and reports on the topic.

Thanks for reading! 

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Part 2: Getting the terms and contexts right - the case of the resolution

This post is the second in a series (the first is here) I have planned about the International Code of Marketing of Breast-milk Substitutes, a new World Health Assembly resolution and the status of (the lack of) implementation of the Code globally. The posts will discuss a project that I’m currently working on at WHO, (inappropriate) marketing in general from a public nutrition perspective, and the role of industry on the status of global health anno 2016. Hanggang sa mule (see you later) from Philippines; a country where violations of the Code, inappropriate promotion, ludicrous heath claims, fast food restaurants and a forceful industry are lurking at every corner.

I Facetimed with my mom the other day, who wanted to hear more about what I am actually doing at the office. Both my parents are engineers, and although we talk vividly about almost everything whenever we are together, including my study programme and various health topics we run into in our everyday lives, the field of public health nutrition does lie quite far from their education background and work. 

It was actually harder to recount my hours at the office than I would have thought. Not because I can’t remember what I’m doing (luckily...) but because I feel the need to elaborate on WHY I’m doing this work and also put things into a context. Of course, had I been talking to Marie or Pernille or someone else from the GNH programme, I wouldn’t have had the urge to explain what the World Health Assembly is, what a resolution means in terms of a UN organization, or what the International Code of Marketing of Breast-Milk Substitutes is all about. But then again, maybe it’s a good opportunity to make sure that we all know what we’re actually talking about. A word that defines a lot of the work we’re doing here at the Nutrition Unit (and at WHO in general) is advocacy. If you translate that into Danish, it’ll give you something like to defend or to fight; not quite an accurate definition, I think – although some might contest that the unceasing job to emphasize the importance of nutrition (as well as global and national investments into this) both within the organizations and at country level, is actually an extensive struggle at some times.  

As I’ve mentioned in a previous blog post, I have spent many of my days here working on a policy brief based on resolution WHA69.9 Ending inappropriate promotion of foods for infants and young children. The publication, which takes form as a booklet, is right now routing for final clearance, and I’m excited to share it with you once it has been published and posted as a pdf on who.int (like all policy documents, publications, and technical materials are). But before diving too much into the topic of the resolution and my work with translating it into a comprehensible document for dissemination at Member States governments, it might be helpful to talk just a little about what a resolution actually is.

Google, the friend you can always depend on will come up with an answer to every possible question you might have (some more correct than others), says that a resolution it ‘a firm decision to do something’ or ‘the action of solving a problem, dispute, or contentious matter’. In a United Nations context, it’s more like a formal expression of the opinion or will of the UN organs - in this case World Health Organization. At WHO, resolutions generally come out once a year, when the World Health Assembly, WHO’s supreme decision-making body, gathers annually at the headquarters in Geneva. During this multi-day meeting, resolutions on key health issues are adopted to urge Member States and to request the WHO Director General undertake particular actions related to these key health issues. Similarly, regional resolutions are adopted at regional committee meetings. The next RCM is coming up this October at the office in Manila. I’m a little sad I won’t be here to for that - I think that would have been a great experience.

WHO resolutions can be quite technical or legal in their nature. They are written in a formal tone, operating with political lingo, can be classified in different ways, and contain several preambular clauses, operative clauses, recommendations, or calls for specific actions. I don’t want to say that no one reads the resolutions… But maybe let’s say, that if WHO wants to share the significance of a specific resolution, they can’t just attach it to an email to the government officials in Member States; ‘Hi. Please read this policy document. Thanks’. Well technically, yes, but that wouldn’t contribute to anything but confusion. In order to convey the message, to advocate for it, the resolution needs to be put in context and translated into something comprehensible for a wide range of people and parties. You wouldn’t just hand your seven-year old a copy of the Criminal Code as an answer to why he shouldn’t take other children’s toy cars at recess… Overstating it, yes. But I hope you get my point, and my argument about why disseminating the implications and importance of any resolution in a tangible matter is a crucial part of the work at WHO.

I think this lays the ground for talking about the implications of resolution WHA69.9 in a soon(-ish) upcoming post :-)

Thanks for reading! PS. It was my birthday on Tuesday this week, so I had baked Danish kringle after an old family recipe on Monday night together with my supervisor and a consultant in the unit. It didn’t taste exactly like it does at home (I blame the dry yeast), but it was good, I was happy - and so was everyone else in the office that day :-)

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Something about affluence, interns, and a justified red bottom line

I’m privileged to be an intern at World Health Organization. Extremely privileged, and not a day goes by where I’m not, in some way or another, grateful for this opportunity, for all the things I learn, and for how I feel the last three years of lectures, assignments and exams somehow all come together through these months at WHO.

Most of the interns here are about to finish their master’s degree. Others are doing a PhD, and some have been working a few years and are using an internship to try something new. Education programs are different from field to field and country to country, and sometimes it can be difficult to compare otherwise seemingly alike study programmes. I am pretty sure of one thing however; being an intern at World Health Organization without having already achieved a degree seems like an exception to the rule. I have yet to meet someone who are still in a Bachelor’s programme. With that said, and once I shook of the feeling of uncertainty about ‘being good enough’, no one seem to care too much about how many degrees you can list on your CV. Sure, the credentials are probably one of the reasons why the interns here were accepted in the first place, but on the other side of the gate, it’s all about what you can do this moment; how you can contribute meaningfully to the ongoing work within the office.

There are many perceptions of what WHO is or do - I’ve been faced with many of them myself. Some people think WHO is full of doctors (clinical doctors, that is). Others believe WHO holds just another bunch of politicians arguing for their own ways. Others see media coverages of Zika virus outbreaks, and think we’re all wearing hazmat suits and analyzing petri dishes. Before coming here, I hadn’t thought much of WHO as a whole. Nutrition and NCDs have always been the focus – but guess what? There are six other divisions under the same roof ;-) This is mirrored in the diversity of interns. Although there’s an overweight of specialized MDs or interns with or currently doing their Master in public health (MPH), the intern lunch table during the past few months have also held a Georgetown law student from the US; a student from Manila enrolled in a communications and visual design programme; a doctor in family medicine from New Zealand exploring whether clinical work is what she wants to do the rest of her life; an Egyptian girl with a Master in gender studies wanting to pursue a career in the field of academia; and a Korean studying administration and health finance - among others.

I appreciate the diversity of interns strolling the hallways at WHO everyday; a constant reminder that ‘health’ is many things – not just the absence of disease or remembering to eat you daily carrots. 

However, there is one common denominator for the interns here – an argument that is not only mine, but something we’ve been discussing quite a few times around the lunch table in the cafeteria. Affluence. The internship programme at WHO is unpaid, and except from a WHO driver picking new interns up at the airport and taking them safely to their destination of choice, all expenditures rests with the intern. It’s not a secret that being here is a somewhat large outlay for me. The rent eats all of my SU each month, and I’ve spent a monstrous amount of money on flight tickets, vaccines and visa. Top that with day-to-day expenses (I do have to eat and wear clean clothes…) and a missing paycheck from my student job that I’m on leave from these months. It doesn’t take more than primary school math classes to figure out the bottom line is red. And no, it’s not a small violin playing; it’s status quo - and a situation I knew I was getting into ever since the WHO/Manila process started. I regard these months as an investment into my future, my education, and not least myself. But I would never have been here had it not been for the SU that ticks into my account the last bank day in each month.

The other interns here are not all from a country like Denmark where welfare and equal opportunities for all (at least in theory) are one of the cornerstones of our society and national policies. However, as I’ve said earlier, the shared feature of the entire intern group, thus far, is affluence – either in terms of citizenship or family. Either from high income countries or high income families (again, not something I’ve investigated but rather put out there by the interns themselves), we all have the financial means to be here in some way or another. Some receive subsidies from the government (me; SU), others have their parents pay for their schooling and related activities such as an internship (a few lucky students from the US, for example), and some are enrolled in a prosperous study programme that grants students the means to go abroad. And so, however much I value the seemingly diversity of the interns, peaking behind the curtain reveals a group of ambitious young people and an intern programme at WHO that is not as varied or representative of the world today as it could be. Should be? I’ll leave the argument here – food for thought, indeed.

A photo from the intern lunch with the Regional Director of the WHO Western Pacific Regional Office, Dr Shin Young-soo, this Friday, along with interns from the UK, Australia and Korea. 

Thanks for reading!

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World Breastfeeding Week 2016 at WHO

This week is World Breastfeeding Week. First celebrated in 1992, the beginning of August each year has now for almost a quarter of a century been an opportunity for organizations and governments to promote breastfeeding globally.

Mom breastfeeding in a hut in the Philippines (from press release)

The picture is from the WHO media library which WHO staff can use for publications, press releases, videos etc. 

The Nutrition Unit at WPRO has developed a campaign lending from this year’s theme from the WHO HQ to “support moms to breastfeed anytime, anywhere”. The campaign calls for a shift in attitudes to build breastfeeding-friendly societies in order to optimize the development, health and well-being of future generations – in line with the objectives of the Sustainable Development Goals. A lot of work has been put into WBW2016 in the unit these last few weeks. As it is my first few days back from vacation, I’ve not been part of all the developments, but have instead jumped in where needed.

You can read the WHO WPRO press release here. The campaign is otherwise most present on social media, where WHO invites mothers to share a picture related to breastfeeding in public. The goal is to normalize breastfeeding, arguing that it can be done ‘anytime, anywhere’ addressing not only the moms but largely also societal attitudes and the barriers that result in a vast disconnect between ideal breastfeeding requirements and breastfeeding practices that occur in the Western Pacific Region. On the facebook page of World Health Organization Regional Office for the Western Pacific, you can see and read more about the campaign and WBW2016. 

A point I would like to make is how much work goes into a campaign like this. I’m not only talking about the actual production of posters, producing the video or writing the text for the press release; what really take time are the considerations and consultations behind every word, every picture, and every reference.  

This poster is created by an external layouter (artist? drawer? - There’s a reason why I’m not in that field… ;-)) but based on a draft and continuous feedback from the unit. Everything down to hair color, face expressions and breast visibility have been discussed. Now, there’s not a lot of text in this poster, but if you’re reading the press release linked to earlier in this post, know how much scrutiny is behind the choice of every word - not only within the unit and division, but also from the communications department and the people on the routing tour who have to sign off on the poster before it can be published. 

Below is a picture of me holding a plastic doll we borrowed from the MCH Unit (MCH is short for Reproductive, maternal, newborn, child and adolescent health - phew, long unit name). We had to provide clear instructions for the artist about how the baby in the picture on the bottom left in the poster above should be positioned. How do you do that? Well, our solution that day was to take pictures of our self and email them to the artist… The baby doll lies weird in this one, and the photo we sent the artist was of my supervisor. But just to add to the argument I’m trying to make; any document, publication, or product coming out of a WHO office - it takes time!

The campaign continues until end of August and concludes in our WHO office with a Brown Bag hosted by the Nutrition Unit focusing on WBW2016 in retrospect and the effect of the campaign on social media. 

Thanks for reading! 

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I’m back!

The blog’s been quiet for some time, and the simple reason is that I’ve been ‘out of office’ on a three-week vacation backpacking in Philippines. Before venturing out to explore something other than the dirty streets of Manila, however, the university commented on the ratio between chatty blog posts and the more professional ones… And so, I purposefully have not shared the (amazing!) experiences getting to know the rural, beautiful, clean-aired, beachy and mountainous Philippines.

I’m exactly half way through my internship at WHO (six weeks gone, six weeks to go), and have quite a few posts planned for the remainder of the time. 

Just finishing off this short ‘I’m alive’- post with a picture overlooking the Banaue rice terraces in Northern Luzon. 

Thanks for reading!

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Diary from a week’s work at the World Health Organization in Manila

I’ve been at WPRO now for five weeks. I know it’s such a cliché, but time really goes by so fast. Friday next week I will be half way through the internship, and it is also my last day before embarking on my three-week journey of exploring the Philippines. My supervisor is on leave (WHO word for vacation) all of July, which made a vacation in the middle of the internship period both possible and favorable.

I thought it would be interesting to take you through a week of work at WHO. I initially wanted to write ‘normal’ or ‘regular’ week, but I realized that my time and work here has differed quite a lot over the past month – so this is just ‘a week’s work at WPRO’.

MONDAY During the weekend I exchanged a few emails with my supervisor and a consultant in the unit about a policy brief that I’ve been working on in the form of an advocacy booklet about the new WHA69.9 resolution on Ending the Inappropriate Promotion of Foods for Infants and Young Children. We want to have it published in time for World Breastfeeding Week 2016 (the first week of August), so we had to have a final version by Monday morning to get to the designer who will create the layout and visuals. Two posters for governments and policy makers summarizing the seven recommendations of the resolution will be part of the publication. After finishing them I had a meeting with one from communications to talk about the message and layout of the posters before also sending those to the designer; an independent illustrator who has previously done publications for the unit.

After lunch I populated a meeting report with country data that I’ve been working with in excel from the Regional Workshop on Regulating Marketing and Sales in Schools (took during my first week here), and attended the Operations Meeting; an assembly every few weeks for the whole division lead by the director. Although some things here are very formal and most practices follow some sort of official WHO codex, there’s also room for a great lightheaded atmosphere – at the right times and in the right settings, of course. At five I closed down my computer and headed home to the studio, where I waited for maintenance to come fix my sink. Sunday afternoon while rinsing some beans for lunch next day (I sometimes bring my own lunch now; a varied diet is an official WHO recommendation, and my greens are a good supplement to the noodles and rice dominating the cafeteria…), the water flooded from the cabinet under the sink. Anyway, that was a detour – it got fixed and now it’s time for Tuesday.

TUESDAY I spent most of Tuesday at the Lemongrass Lounge; a room with couches and grass rugs on the floor and walls (artificial of course), with my supervisor, the unit consultant and another intern, a post-grad medical student from Australia who joined the unit on Monday. We left the cubicles behind for a more casual setting to go over country proposals submitted for acknowledgement at the Healthy Cities Best Practice 2016 end of July. WHO defines a healthy city as one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and developing to their maximum potential. There are many ways to approach that, which is reflected in the many thematic areas of the Healthy Cities Programme at WHO. Some examples are Towards a social movement for action on mental health and well-being: mentally healthy and resilient cities, Early Essential Newborn Care (EENC) Standards for Health Facilities Providing Delivery Services, Reducing food waste in urban areas, and Health Promoting High Schools. The Nutrition Unit was assigned to evaluate the latter two, which, as mentioned, took up most of Tuesday. It was a really nice learning experience to read the submissions from a receiving – or target – end point, which is the opposite situation from what we’re used to as students. The language used, the arguments applied, the data to support their project; while we tend to look at things as a whole (as students, as people, as citizens), we were forced to assess the many pieces of the proposal to evaluate the overall effectiveness and relevance of the different country endeavors. The skills attained through this are of course also the theory behind peer evaluation or review; something we might practice to little as a profession? – a thought I had afterwards. After finishing the work around four, I sat in on a skype call between WPRO and two NGOs discussing the WHA 69.9 resolution. A day full of new inputs; a little like the feeling you get when being introduced to a new chapter in the biology book or learning a new tense in French – a widening of the horizons.

WEDNESDAY Another thing that has been the subject of many emails and talks this week are the message and materials for World Breastfeeding Week 2016. Wednesday we had both a meeting with the suppliers of two of the products we are planning as handouts, and one with two communication officers about social media, how to best convey WPRO’s message and how to navigate between different themes proposed by WHO HQ and WABA (World Alliance for Breastfeeding Action), while still having a theme and products that are region specific and appropriate.

A little after four in the afternoon, we all left for the United Nations train station. A rare incidence that all computers are shut down at the same time in the unit; the reason was that my supervisor had invited everyone over for a casual dinner at her house. It was my first time taking the train here in Manila; long lines on the stairs to just get on to the platform, security scanners, and trains that are packed like sardines. It was a great night, which just emphasizes how fortunate I am to be interning in such a welcoming and inclusive unit – a circumstance that shouldn’t be taken for granted, but makes my time here about more than just the things I produce or the work I contribute to.

THURSDAY I walked to WHO in rain this morning. Until now, it has only drizzled in the afternoon, but rainy season is intensifying and the local supermarket have started to place boots at prime spots near the cashiers. I spent most of Thursday on two different publications; writing a foreword to one based on bullet points from my supervisor, and revising text, graphs and figures in another. Both have obesity as main topic.  

Last week I signed up for attending a brown bag on ‘The Impact of Alcohol Consumption on Adolescent Health and Development’ during lunch, but new developments on World Breastfeeding Week from WHO HQ prompted a meeting at the same time. Both Thursday and Friday was influenced by the fact that my supervisor will be on leave a month starting Saturday the 2nd of July; lots of coordination about the ongoing projects and who would be responsible of doing what and at what time. One thing that has really manifested itself to me this week is the structural procedures at WHO. Things have to be weighed, cleared, routed. Every product needs a formal proposal form; every word has to be considered; everything has a paper trail. I realize we cannot just spend all our time doing technical stuff, but formalities, practicalities and deliberations extends far beyond what I’ve experienced in former jobs or internships – but then again; it is a United Nations organization.

FRIDAY I started Friday out with attending an Internship Presentation. All interns are required by the end of their internship period to do a presentation on (some of) their work while being at WHO. The division in which the person has been interning is invited to come, and so are all the other interns walking the hallways that day - it is my impression, however, that it is primarily just the unit and interns attending these; people are busy(!) The presentation that morning was by an Australian who’d worked in the Violence and Injury Prevention (VIP) Unit. She had done research on violence and injury in the Region as a cause of disability. The topic is of course rather far from what I work with, but the suggestions for a way forward are largely the same across units and programmes; in order to develop interventions or policies to prevent, decrease or address an issue, we need data. We need to know why things are like they are; origins, implications, barriers, consequences. For example, (borrowing from one of the issues discussed at the presentation); if we want to address intimate partner violence, we need a multilevel approach. It’s not enough to create a hotline for victims of partner violence, empowering them to speak out, if the response from the police is disregard; ‘go home, it’s a family matter’. The same thing goes for public nutrition – we can’t tell people to not eat McDonalds if there’s no other option – geographically, financially, or culturally. The point is that we can’t solve or prevent problems by just focusing on one thing; addressing (the barriers to optimal) health requires a much bigger picture.

The rest of the day I continued my work on the two publications from Thursday. My supervisor and the unit assistant had ordered a cake that was delivered in the afternoon. Not counting wedding cakes, it was the highest and largest sugar-cream-meringue tower I have seen, I think. A good end to a good week, and with a picture of the cake, this concludes my (very long work diary of the) fifth week at WHO WPRO.

[doriterichsen]

Part 1 - The Code

This post is the first in a series (part two is here) I have planned about the International Code of Marketing of Breast-milk Substitutes, a new World Health Assembly resolution and the status of (the lack of) implementation of the Code globally. The posts will discuss a project that I’m currently working on at WHO, (inappropriate) marketing in general from a public nutrition perspective, and the role of industry on the status of global health anno 2016. Hanggang sa mule (see you later) from Philippines; a country where violations of the Code, inappropriate promotion, ludicrous heath claims, fast food restaurants and a forceful industry are lurking at every corner.

In May 1981 in Geneva at the 34th World Health Assembly, WHO adopted the International Code of Marketing of Breast-milk Substitutes (often just referred to as The Code), with 118 votes in favor, one against (the US) and three abstentions. The Code was adopted as a recommendation (Article 23 in the WHO Constitution) rather than a regulation (Article 21 and 22), in effect meaning that the 36-page publication is a health policy framework but not legally enforceable.

The document adopted that day in May 35 years ago, was the fourth distinct draft and a result of a long process of consultations with Member States - few issues had ever been the object of such extensive consultations. The Code was formulated in response to the realization in the 70’s that poor infant feeding practices were negatively affecting the growth, health and development of children. Besides being a major cause of mortality in infants and young children, sub-optimal feeding was a serious obstacle to social and economic development. I’m writing past tense, accrediting how that was the realization when the WHA in 1974 noted the general decline in breastfeeding related to different factors including the production of manufactured breast-milk substitutes. Put the sentence in present tense, and it would be just as relevant today. Unfortunately.  

Member States have the primary responsibility to implement and monitor the Code. WHO have urged governments in half a lifetime (well, a little less; the average global life expectancy is currently 71.0 years – lower for men and higher for women) to incorporate all provisions in national legislative measures, and emphasizes how the Code and subsequent relevant WHA resolutions are minimum requirements to regulate and reduce inappropriate marketing. A status report of the national implementation of the Code, prepared jointly by WHO, UNICEF and IBFAN, was just published this year. The report estimates that 135 out of 194 Member States have some form of Code-related legal measures in place. However, only 39 have legislation incorporating all or most Code provisions. It doesn’t take a mathematician to conclude that enforcement and monitoring of the Code is weak. So what does that mean? Where can we go from here? And what’s the new resolution all about when there still seems to be a long way to go with just nationalizing the Code?

Thanks for reading!

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Don’t talk to strangers?

When I arrived in Manila airport three weeks ago after two flights, a lay-over in Istanbul and with almost 40 kilos of luggage (I didn’t manage the ‘less is more’ – as expected) I was picked up by a WHO driver and transported to the condominium in Malate where I had found a studio through a former intern. The welcome gesture in the airport ensuring that the person on the incoming flight gets safely to the destination of their choice is standard procedure for everyone, I learned; whether it being a new officer, a consultant, a support staff member - or an intern. After the driver had fitted my two bags in the back of the car, I was handed a two-page document on security and safety and asked to put my signature on another paper attesting that I’d received the information. Very formal, was my initial thought, wondering about the necessity of it. 

More and more tourists these years realize the beauty of Philippines, its approximately 7500 islands (’approximately’ because no one can apparently agree on the exact number), UNESCO heritage sites and the nature that holds everything from volcanos and waterfalls, to rainforests, rice terraces, white beaches with turquoise water that would fit the front cover of any travel magazine, and an underwater world that excites scuba divers from the entire globe. But Manila? ‘Skip it if you can…’ tends to be the general attitude towards the city that is one of the most densely populated in the world. Some has heard of the poverty that dominates the streets, others of the heavy traffic, the lack of cultural to-dos – many of a high crime rate and wrongdoings against foreigners. As I tend to do with any new topic or area, I researched a little. I have an urge to place new knowledge in a larger context, most often expressing itself in Denmark through spending a few hours on google after finishing a movie based on factual events or a book depicting a time in history. When travelling I do the same. Why is the city like it is? Sure, it’s basic information too; like how much to tip, reading the introduction section that can always be found at the first pages in a travel guide, and knowing where to get some good local food. However, history tells the story of a city, which is named after a Tagalog name for a plant that grew in abundance along the shores of Manila Bay and the Pasig River, that in the beginning of the nineteenth century was the pearl of the orient; a gateway between Asia and the Pacific encompassing the best and most exotic from the two worlds, and had, despite (others might argue because of) one of the longest colonization periods in history found a way to flourish. After being a Spanish colony for almost four hundred years, the Philippines was in 1898 sold to USA and didn't gain its independence until after World War II. The colonial eras are the reason why Manila today both have John’s Bridge and lots of Avenues, but also road and areas named after Spanish Kings, and why the Filipino word for ‘how are you?’ is Kumustá (try saying that aloud - ringing a Spanish bell, anyone?)

Half a century of being a colony concluded with bombs falling from the sky. Warsaw was the most devastated city in the world after WWII. What most people don’t know is that Manila was number two – some will say that the city has never really recovered. Today, more than one fourth of the population lives under the poverty line.

Christian asked me the other day if I felt safe. I had just told him about a meeting I’d been to at the office about safety and security for staff. I later learned that the impromptu meeting with a ‘must attend’ figuring in the outlook invite subject field, was sparked by an episode happening to a staff member the day before. My reply to Christian was that I don’t feel unsafe. That no, I’m not afraid to get robbed every time I turn around a street corner or to get kidnapped because of my blond hair (someone at the office actually joked about that one of my firsts days there; that he would expect my kidnapping any day…) But I also try to not do anything that would put me in an unsafe situation – which actually could be a general set of street smart-ness pertaining to both the metropolises of Europe, the desert countries of the Middle East and Asia’s non-stop busy megacities. The degree to which precautions are implemented would vary, of course, but I don’t think it takes long to figure out how to (relative) street wise in new places. I walk determined rather than wondering about the streets, limiting the ‘where are you going?’s or taxi invitations. I don’t walk alone new places after sunset. I’m fine with streets around the studio and WHO at night, but there’s no reason why going on adventures new places can’t wait til the sun rises the next morning. I’ve never had so many hi Ma’am-s, good morning Ma’am-s, and how are you Ma’am-s as here in the streets of Manila. It’s a fine balance – do you try to respond with a ‘hi’, nod your way through it all, or do you simply ignore it? I was initially not inclined to do the latter; some of the approaches are out of courtesy and curiosity. For others, however, it’s a way to get in contact – a contact I don’t necessarily want to have. The message of the impromptu staff meeting was ‘don’t talk to strangers’. After that and largely also because of almost three weeks here, I tend to overlook the many greetings – they’ve become part of my everyday life here, just as you cross the street waiting for traffic to stop for you rather than the other way around (sorry, Mom!) Then there’s my height... The 1.80 meters that was way too much in my teenage years when all the boys were still just short children and the ‘fitting in’ was of utmost importance, provides a (possibly false) sense of security. I love my height today and would not give away any of the centimeters that make up me. And here, in the tropical capital of the world’s second largest Archipelago, it makes me taller than almost everyone and crowd overlooking is a piece of cake. The reason behind that is of course the high rate of stunting – affecting more than one third of the population. That’s topic for another blog post I want to write, also talking some more about the focus of a project that I’m working on at WHO the next couple of weeks. Stunting; the definition, the causes, the implications, and everything in between is a focus of my BA programme – but for others who would like to know more before I get back to this issue, here are three nice videos from WHO exploring the problem under the headings; ‘What is it?’ What causes it?’, and ‘It has consequences’.

A few pictures from the last week to finish off this post: 

I got my ID card last week, and Tuesday morning when I came in, the maintenance staff had made sure that I now officially can be found in cubicle 310-N.

This is a shelf in the local supermarket featuring sugary cereal, cocoa powder and other snacks marketed to children with the heading ‘Nutrition Power for Kids’... There’s so much I would like to say about this, that it deserves a post on its own. If you noticed on the previous picture, there’s WHA resolution on my desk entitled ‘Ending inappropriate promotion of foods for infants and young children’. I love when what I do here at WHO (or at work, or in school back in Denmark) makes sense on a larger and very TANGIBLE level. 

There’s a HUGE mall in the area between WHO and my studio. It tends to be rather overcrowded because well - there’s air condition and lots of (fast) food shops. The space at the main entrance is apparently so big that it fits four badminton courts. You really could live your life in the mall if you wanted to, I guess - I prefer not to :-)

A little street dog that I see almost everyday on my way to WHO. This one is kinda cute - there are other that almost causes me to change side walks.

I bought a little sukkulent last week from a lady sitting on the sidewalk of the UN Avenue every single day to sell her plants. I pass by her on my way to WHO in the mornings, but she is always gone in the afternoon. So last week when I went to get coffee from Starbucks outside of the WHO premises, I finally stopped by her to get some green for the studio. Most of the street vendors sell instant noodles, cigarettes and single wrapped candy - this is a first.

A grey and windy afternoon by Manila Bay.

Thanks for reading!

[doriterichsen]

Days at WHO

So, I guess it’s time to talk a little about what I actually do here when I’m not standing in line at the supermarket, getting cheap massages, or discussing with the other interns where to go for dinner on a given night. Let’s start from the very beginning to lay the ground work, and then move quickly to some more specifics in terms of my internship. There are currently 193 member states in the United Nations, which means there’s the same number of member states in WHO. As mentioned in an earlier blog post, WHO has six regional offices around the globe and headquarters in Geneva – WPRO (where I’m at) is short for Western Pacific Region. 39 members of the total 193 member states are assigned to WPRO.

Picture taken from the entrance area where all the flags of the member states are placed in the middle of a pond where exotic fish species and turtles enjoy their days.

I’m interning in the Nutrition Unit (a technical unit) under the Division of NCD and Health through Life Course – the lead of the unit is called the Technical Lead of Nutrition. The love for acronyms here is strong, and whenever referring to other units, divisions or officers, abbreviations are the way forward – and will leave you behind if you don’t know them. I quickly learned that NUT is short for Nutrition Unit (and has nothing to do with being nuts).

I meet in around eight in the morning. It takes me about 25 minutes to walk from the apartment building to WHO in the morning. I know another intern does in it 15 minutes to get her sweat going before locating her desk right under the air condition – I walk fast, but not THAT fast. After work, the (huge!) mall is open which enables a short cut home to Jorge Bocobo Street. Usually around noon, the interns have lunch in the cafeteria. I heard from previous interns of the division whom I was referred to by the unit assistant (to ask all the questions you don’t want to ask WHO personnel; Where can I stay? What should I bring? What should I prepare? – stuff like that) that the WHO community and intern group, although continuously experiencing comings and goings, are so great, supportive, welcoming, and helpful. They were right! However, I was initially anxious that because my intern period lies in the summer months (May to September), I would be one of the only interns in the office during that time. Ha! I was wrong. I didn’t consider that most university students don’t have the opportunity to take internships during their education program in place of regular classes, but instead have to fit it in during time off from school to get practical experience and add a nice section to their CVs. And so, this month actually witnesses a significant influx of interns, which allows for lots of people to chat with about ‘intern stuff’, bonding over our same (unpaid and sweaty) situation, sharing experiences about where to go for the weekends, and to get to know after office hours.  

I arrived Monday last week while NUT and the division were busy preparing the Regional Workshop on Regulating the Marketing and Sales of Foods and Non-Alcoholic Beverages to Children, that took place from Wednesday to Friday. Foods and Non-Alcoholic Beverages are shortened to FNABs (surprise). The first two days I helped out with a variety of different tasks; from providing input to one of the consultant’s presentation on food classification systems to create evaluation forms and collate information on preparatory questionnaires to the participating countries and the temporary advisors. As you can see in the picture below, I got to sit in the ring at the Conference Hall during the three days, and had to present myself (Hi! I’m an intern!) during the first hour of the meeting on Wednesday morning. I’ve never had problems speaking with people (I dare and share) or speaking in front of many people, but I have to say it was a little nerve wrecking seeing the presentation round getting closer and closer to my seat.

Okay, so obviously no one was in the Conference Room when I posed for this picture. If you zoom in (or just have really good eyes) you can see I’m pointing to my name. Also, I am really quite professional when I’m around other people! ;-)

Participating in the three-day regional meeting was such a good learning experience in terms of so many things; experiencing the work of WHO first-hand; getting to know the member states and the issues they deal with at a national level; recognizing the huge diversity between the countries in terms of growth and development, their economic and political situations, and their health systems; and exploring the possibility and barriers associated with regulating marketing and sales of FNABs ‘in the real world’ (in effect meaning outside the classroom in highly developed Denmark). Evaluating the regional meeting will define this week’s work at my brown corner desk on the third floor next to the unit assistant, such as summarizing prioritized country actions and current national situations which I have been working on since Monday (today is Wednesday).

A picture of the unit assistant (from the Philippines) and me, who have really been so helpful in the whole process of getting here (visas, contracts, airport transport etc.) - and she continues to offer great advice on where to eat, what to see, where to go.

There are lots of different tasks and ad hoc projects of different sizes and natures to dive into at NUT, and that could quite definitely keep me busy until September. However, at some point I will need to discuss and define the topic of my BA thesis, which hopefully will enable me to link it to some ongoing (or new!) project or program on campus ground. I think the ‘at some point’ will be by the end of this week or the beginning of next.

There’s almost always something going on at the office; brown bag seminars, presentations, technical program meetings, promotion events. Yesterday, I attended Core Training at 4.30 pm, and when I left the office about one-and-a-half hour later, the choir group was practicing on the terrace.  

Other larger upcoming and exciting events at WHO in the future are the three-day Regional Consultation on Achieving the Sustainable Development Goals in the Western Pacific in the last week of June, and World Breastfeeding Week the first week of August. Most likely more to come, but those are the two that are right in my alley and that I know off – there’s so much information being disseminated here through mails and intranet that I need to be awake to keep up. I try to be :-)

[doriterichsen]

Pictures are always a solution

It’s Monday night, and I have already been at WPRO for a full week now. I’m officially no longer ‘the new intern’ (although I still have to sign in for a visitor’s pass and sign out again in the afternoon at the main gate – my ID card is not ready yet because the printer producing them ran out of ink...) I’m looking very much forward to receiving my WHO WPRO badge, legitimizing my whereabouts at the white-walled office on the corner of United Nations and Taft Avenue until mid-September, but I already feel rather legit walking the hallways between the divisions, getting my omega 3 at lunch (the cook knows I prefer not to have my fish swimming in butter sauce), sending emails from my wpro.who.int account, and trying to remember the names of all the officers, consultants, assistants and interns that I run into on a weekly, if not daily, basis.

I initially wanted to share my experiences of the weekend exploring Manila’s history, and also discuss some of the work I am and will be doing at WPRO. It seems, however, like the little writer-wannabe in me is more blocked than driven tonight - only taking me thus far as to share a couple of pictures from the last few days.

A picture from lunch today sitting on the terrasse outside (with the member state’s flags in the background) - hot, hot, hot, but then we go in and get cooled down by the air conditioned offices and somehow it all equals out by the end of the day 😀

My instant coffee melted. I think? I’ve never ever tried anything like that, but when I wanted a cup of coffee yesterday, it looked like this; a caramel-like solid that couldn’t be broken nor dissolved. Oh, the joys of tropical temperatures and humidity ;-) On a side note; coconut oil is always a solid in Denmark, while here, it’s a liquid - the state changes above 25 degrees. And there you have it; your nerdy piece of information for the day.

The night sky from my studio overlooking Manila Bay, taken just before the (now almost daily) lightening and thunderstorm began.

Very, very small local bananas on my kitchen counter.

Fort Santiago; a historic site of Manila that we explored this weekend.

In front of the San Agustin church; tired from walking and sweaty from - well, just being. The latter is quite definitely going to define my time here on these tropical latitudes.

[doriterichsen]

Bullet point post #2

Another bullet point post featuring a few thoughts and reflections from this last week - of widely different length and significance as contemplations generally tend to be ;-)

Today is Friday, June 24th, which means I’ve already been here four full weeks. One third through my internship on paper. Definitely not one third through it mentally.

Met this tiny jungle cat on a trip out of Manila last weekend. What can I say? #crazycatladyforever 

In 14 days, I’ll pick Christian up at the airport! Although I feel like time is flying by too fast, I’m counting the hours till his flight arrives, just like a child is looking forward to Christmas Eve all of December or how the excitement of an upcoming birthday was evident weeks ahead - when the age was still single digits, that is ;-)

There are Bible verses on the tap water here. I shall not thirst forever, apparently ;-) On a side note; the Philippines is the only Christian nation in Asia.

I walk to around in my Birkenstocks in the city. My feet love me again after too many years in Havaiana flip flops. When I get to the office, I change into a ‘nicer’ pair of shoes – although they’re highly comfy bordering to a small little anatomic wonder, they are neither appropriate for office use, nor are they very sexy 😉 On the picture featured with a glass of halo-halo, a popular Filipino dessert with ice flakes, evaporated milk and a concoction of any other sweets that are available; fruits, gels, syrups, cereals, you name it. A little weird, indeed. Halo-halo literally means ‘mixed together’ in Tagolog.

Look who greeted me this morning in the bathroom. There’s been pest control in the building the past two days, which means an insect fighter company has treated common areas and apartments paying for the service (so not my studio or real estate agent). I guess this one fled the mass extinction event and looked for a sanctuary somewhere else. Well… It occurred to me that roach handling skills are not something I’ve developed in these first 25 years of life. Luckily, a creature like this is not common on Danish grounds, and whenever I’ve met one abroad, there’s always been someone else with superior talents in insect management or extermination – or just a little more adventurous (likely meaning less frightened) than me. Now I’m alone. The first thing that came to mind was trapping it inside a glass. I showered, ate breakfast and left for WHO – which means I’ve really just postponed the ‘dealing with it’ till this night. 101 in cockroach management coming up any day – soon!

[doriterichsen]

Something about tropical rain, duct tape and an upcoming chat with my supervisor

It’s a little after eight in the evening here, and I just sat down to eat dinner. It’s raining and lightening outside, but it’s still about 35 degrees C, and so walking in the rain home was actually quite refreshing - except for the fact that it’s pretty difficult to dry clothes here. Because of the humidity, drying clothes on the balcony is not an option, and the studio is really small. The first few days I had my towels on hangers in the window, but I decided yesterday to ask the broker if I could have something to hang my clothes on – a clothes horse perhaps (tørrestativ; don’t know where the ‘horse’ part comes from). She was surprised there wasn’t one already, and said she would get one from another studio she was preparing for someone to move in the next day. I guess that was her solution of fixing the problem; hoping that the other tenant would not also ask for the same thing. Well actually, she can have it back. It’s rusty and held together by so much duct tape that even my dad would be proud. I’m not so inclined to hang my office shirts there, so I think I’ll go back to using the curtain rod as the official studio clothes line... 

Anyway, I know I have not shared a lot of details about my work at WPRO – barely any, I think. I need to talk to my supervisor about how much and what I can post here. WHO is a specialized UN agency dealing with political situations and confidential information, and although I’m not sitting with reports of national security, I need to get her approval first. So why haven’t I taken care of that yet? I had my first day at the office Monday morning, and Wednesday (yesterday) a three-day regional meeting on regulating the sales of marketing of food and non-alcoholic beverages commenced at WPRO. It’s the division I belong to that’s ‘hosting’, and so the Nutrition Unit has been pretty occupied with everything pertaining to that. But next week, I think there’ll be time for a chat about the degree to which I can share my work online.

Netflix won’t load. The Wi-Fi connection has been relatively stable, so I think I can blame the weather for missing out on today’s episode of the new season of Bloodline. Bummer. I took a very short video of the weather from my balcony before sitting down to eat; the lightening is actually on the other side of the building, but you can still sense that the sky is lit up every few minutes. But either me or technology fail, cause the video won’t upload, so I guess you’ll have exciting 11 seconds of a black night sky some other time. I wanted to take pictures of the streets that are almost flooded from just a short period of rain, but my love for my iPhone matched with the massive amounts of water that dropped from the sky is a combination with possibly grave complications. However, there will come many more options for depicting the rainy season in the tropics; people at the office keeps telling me I’ll need to buy a pair of rain boots. Who would have thought that rain would be this fun after growing up in Denmark, where the phenomenon is more the rule rather than the exception most of the year. I’ve felt like a child on the first day of school much of this week – it’s a good feeling to revisit. I’ll end this post with a picture of rainy Manila and a few bullet point revelations of the day.