May 2013

M a y

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BARD Science Journal

TABLE OF CONTENTS

Ferg Bids Farewell

The Fly Room

page 3

page 6

The Mars One Mission

Dolphin Captivity Installation page 8

page 4

Journey to SPROJ

Teach for America page 10

page 12

In the Evenings (poem)

Haitian Health Care Workers’ Perceptions of Technology Used in TB Treatment

page 18

Paradox Pie

page 20

page 19

Editor-in-Chief: Diana Crow

Smith or: Erin it d E te Associa Layout: Charlotte Ames & Diana Crow Vulakh Polina & a s o R ael Di : Mich s r o t a r Illust

Staff Wri ters

/Junior E d

itors: Jen nifer Gille n

& Polina

Vulakh

,

Garrettson iora, Marne s: Nina Bar-G Contributor Alexia Motal, Gavin Myers & Coli n Radc liffe.

Send all questions, comments, and submissions to bardsciencejournal@gmail.com. cover art by GAVIN MYERS Senior Reflection Contributors: Jasper Weinrich-Burd, Joy Sebastia, Hannah Mitchell, Doug Gazarian, Katharine Dooley, Liana Perry & Emily Carlson

DIANA CROW

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Bard Science Journal May 2013 Volume 2, No.5

Ferg Bids Farewell:

Bard Biology Says Goodbye to John Ferguson

by ERIN SMITH

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n April 25th, the RKC’s Bito auditorium filled with the dozens of students enrolled in Biology Seminar, as is the case on most Thursdays. [The timing of the sentence is a little awkward. Find way to work idea that it was a typical Thursday into the main clause, instead of just adding it to the end.] A lecturer from Ithaca College named Ted R. Heimowitz was set to give a lecture titled “The biomechanics of fern spore dispersal.”

However, at noon, when the course commenced, students were surprised to find no lecturer present. As it turns out, Ted R. Heimowitz does not exist.

The lecture was a ploy. Professor Felicia Keesing, with the help of other biology faculty, scheduled the fake seminar as a guise for a real event—the going away party for Professor John Ferguson. “Ted R. Heimowitz,” the pretend speaker, was actually a play on words for Ferguson’s choice organism of study—the ciliate Tetrahymena. Instead of hearing about spore dispersal, the students listened to various stories about Ferguson from alumni and faculty alike as the seminar room filled with laughter and well wishes. Sophomore Georgia Doing, a biology seminar attendee, called the lecture both “sentimental” and “light-hearted.” In place of the typical response sheets handed out at biology seminar, students were given blank sheets of paper to write farewell notes to Ferguson. Keesing plans to collect the notes into a book as a parting gift for Ferguson.

According to Doing, the farewell party exemplified the respect and admiration the biology department has for John Ferguson. After decades of teaching at Bard and overseeing countless advisees and senior projects, John Ferguson, affectionately called “Ferg” by both students and faculty, is going into retirement after the semester ends. As the current pre-health advisor, he supports students wishing to go into medicine, in addition to teaching such foundational courses in the department as Subcellular Biology. Senior Cara Black, an advisee of Ferguson’s, has taken several classes with him. Black spoke of the rigor of some of Ferguson’s laboratories. “He would always make us do the most embarrassing and grueling labs. For example, one time in physiology laboratory, he made us perform experimental assays on each other’s urine. Another time he had us test each other’s gag refluxes with tongue depressor.” However, Black went on to praise his teaching. “While his explanations of labs were excruciatingly meticulous…in the end he taught me nearly everything I know about biology.”

While Ferguson’s teaching itself is widely acclaimed, it is his humor and enigmatic personality that many faculty and students remember. Black describes Ferguson as making wisecracks and jokes often, and says that while he can be “brutally, painfully honest”, her favorite thing about him is his “humility and stability.” Despite his reputation for wisecracks, Black describes Ferguson as “an incredibly comforting presence.” Students have long been fond of Ferguson’s wisecracks and jokes.

As Black suggests, his humor often plays a key role in making

students feel at ease. Professor Ferguson often used humor to aid his students along through rigorous coursework. Professor Philip Johns remembers Ferguson remarking, “I could get a bucket of clams with a pencil through senior project!” and Johns is not alone in his recall of memorable quotes from Ferguson. Senior Brandon Beecher enjoys Ferguson’s humor so much, he has diligently compiled a list of quotes, or “Ferg-isms” from his time in Ferguson’s biochemisty and prokaryotic genetics classes. As Beecher notes, Ferguson often tells his classes three basic rules: 1. Do not fall in love 2. If you are stupid enough to fall in love do not get married 3. If you are dumb enough to get married, do not have children Ferguson’s demeanor is also appreciated by his fellow faculty members. Reflecting on her personal relationship with Ferguson, Professor Keesing spoke of her early days teaching at Bard under the guidance of Ferguson. “He took a detached and bemused anthropological perspective on me and my various change-oriented shenanigans,” said Keesing. “At what he saw as key moments, he would drop sly and witty observations to help me find my way. In the years since, I’ve learned to ask his opinion more and wait for it less.” While Ferguson may be leaving Bard, he will be remembered in the department and beyond for years to come, leaving a lasting impression through his teaching, as well as his countless stories.

According to Ferguson he “will miss the students the most,” in leaving Bard. However, he embraces retirement with the same wisdom and wit he exudes in his courses. He reflects, “I [won’t] miss grading exams and lab reports…exams and labs are fun to make up, but grading is tedious--I’d rather do anything else, even exercise. Sometimes I self-motivate by rewarding myself with a cookie after I grade a page of all the students’ exams. Sometimes it’s a six-page exam…this partly accounts for my current size. I have to retire to prevent myself from turning into a blimp.”

Bard Science Journal May 2013 Volume 2, No.5

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The Mars One Mission:

An Interview with Mars One Applicant Sam Osborn

by CHARLOTTE AMES Bard Science Journal: What is Mars One? Sam Osborn: Mars One is a program with the goal to establish a permanent human settlement on Mars by 2023. It’s a private company, that is not for profit, and they own 90% of the stocks of a for profit company, called the Interplanetary Media Corporation, who owns all of the rights to broadcast media from Mars back to Earth, which is how they’re going to pay for the Mars One human settlement program. This program aims to have humans on Mars by the year 2023. They’re going to launch their first satellites in four years, and then they start assembling a Mars base with robotic rovers in 2018. During this process they’re training a team of 40 astronauts for ten years, and then they break those astronauts into teams of four, based on their chemistry and synergy. And they send one team of four to Mars every year with more equipment to expand the base. So the base is four pods, that resemble the lunar lander from the Apollo missions, but they’re a bit more heavy duty and technologically advanced. These are linked together, one of them acts as a life support chamber, and the rest are basically living quarters. And then there’s an inflatable component that opens up in the back, where they’re going to grow everything hydroponically. All of the food they eat will be grown on Mars, especially after they can get the farm going.

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BSJ: So even if you’re selected there’s a chance you wouldn’t leave for 20 years?

SO: Basically, and they’re keeping a retinue of 40 astronauts in training on Earth. Because chemistry is a priority, if one person in the team of four decides that they don’t want to go to Mars or becomes physically incapable of it, they withdraw then the entire team from the program. So once you get selected for training, you are basically regarded as a four-person unit that functions together. It was the same set-up in the Apollo missions.

BSJ: Since chemistry is so important, if you could have any three people in your team, living or dead, who would it be?

SO: A trained astronaut would be great – Neil Armstrong would be cool, but he’s already had his go at that. I would have to go with the Duke of Wellington he seems competent and has good war stories to tell.

BSJ: Going up to Mars, do you think you would have any expectations for what you would find there? Because my perception is that you’re going out to do hardcore geology.

SO: Somewhat. It’s not strictly speaking a science mission; the

MICHAEL DI ROSA

program is more focused on settlement. Colonization is the first priority, and they aren’t in it for the science the same way NASA was. The Martian astronauts will be trained in exo-biology and Martian geology for the sake of human science, but the first team out will be struggling to survive. Realistically, the first year is going to be a shit show of people building things out of duct tape to stay alive. No science will be done. But eventually, I really want to do geology on Mars.

BSJ: You seem pretty sure that Mars is the next frontier for humans, do you think at some point we’re going to have to leave the Earth?

SO: Absolutely. I think we’ve been expanding and exploring since we evolved somewhere in Africa, and I think that’s part of what makes humans humans, and not some other hominid species. We’re really good of moving out of the area we lived in, especially in the face of climate change. I think Mars is the next step.

BSJ: Do you think the future of mars colonization is terraforming the planet or adapting to Martian environment?

that there’s no science to be done I probably won’t end up going, because that’s my first priority.

BSJ: It’s funny that you do a lot of archaeology, that’s more about the history of humans, and then this Mars program is focused on the future of humans. It’s a nice parallel.

SO: If I could I would do archaeology on the first people to go to Mars. That would be the second best thing, behind being the first people to go to Mars. I think the biggest way this could go wrong is if they run out of funding or motivation and leave four people on Mars with minimal equipment.

BSJ: Yeah, there are multiple sci-fi movies this could turn into.

SO: I would really rather put my life into the hands of NASA than in some Netherlands based private company that owns almost all the shares in the Interplanetary Media Corporation.

I would be exploring for the rest of my life on a planet no one has stepped on before.

SO: I think it far more practical and exciting to explore the other earth-like planets in the Goldilocks zones around other stars. Mars is an important step toward interstellar travel, and a permanent Mars base will enable huge advancements in science. However, we should look to settle planets that support liquid water before terraforming Mars. Mars offers a great deal of information about cold rocky planets in its current state, I would not want to destroy that.

BSJ: Can you talk a little bit about just the monumental choice of leaving the Earth without ever being able to return?

SO: The plan is to have an internet contact between Mars and Earth that has a four to six minute delay due to the speed of light, that would make a conversation like this impossible. So in a lot of fundamental ways on Earth it would be like I was dead.

But that’s part of the trade you’re making, you don’t get to see trees or the people you care about anymore, but in return you get to be on Mars. For most people that’s not worth it, especially because being on Mars involves a lot of physical suffering, especially early on. But I’ve decided I want to commit the rest of my life to exploration.

BSJ: Does that include the stuff coming back from the Mars rover? I’m following @MarsCuriosity on twitter and there are some really good panoramic shots.

SO: That’s one of the reasons I want to go to Mars. Early in the Apollo missions they launched these probes with cameras on them, basically like rovers without wheels. One of the later Apollo missions with lunar rover landed close enough to one of these probes that one of the astronauts went to it and picked up the camera and brought it back to Earth.

It would be awesome to walk up to the Mars rover and wave to the people back home, because it was put there without any expectations of getting it back.

BSJ: Any other things plans for the surface?

SO: The plan is to use electrolysis with power from solar panels on the ice on Mars to get oxygen to breathe, and hydrogen to use as fuel. And there are engineers that want to compact Martian soil into air-proof igloos so you could create an artificial atmosphere.

The hope is that in twenty years there will be a stable community on Mars that is entirely self-sufficient. 3D printers also help.

BSJ: And this is basically the farthest you can go in exploration.

BSJ: There’s this group that’s created the Global Village Construction Set, that’s open source blueprints for the fifty different industrial machines that it takes to build a small, sustainable civilization with modern comforts. The very first machine is a 3D printer. [opensourceecology.org]

SO: Yeah. It’s the easiest, well not the easiest, that’s the whole point, but it’s one of the best ways, and I would be exploring for the rest of my life on a planet that no one has stepped on before.

SO: Yeah, even if I’m not directly involved in it I’m very excited that it’s happening in my lifetime. This is definitely the next step in human exploration.

Science is really my first priority, and as this program is picking up steam if it looks like it’s more some sort of ark experience where they’re just putting humans on Mars to procreate and start a farm, that’s not what I want to do or be. If it turns out

To watch Sam’s application along wtih others’, and to find more information on the program, visit http://bit.ly/ZNjhlF. Personally if I could choose one person to represent humankind and go to Mars and explore for the rest of their life, it would be Sam. Bard Science Journal May 2013 Volume 2, No.5

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COLIN RADCLIFFE

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Bard Science Journal May 2013 Volume 2, No.5

The Fly Room: Genetics-Inspired Feature Film Will Be Shooting at Bard This June

by DIANA CROW

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n June 6th, the Manor dining room will be transformed into the site of a surrealist-inspired party. Deconstructed bicycles will dangle from the ceiling and paintings come to life will meander through the room, while guests in colorful costumes dance the jitterbug to music that isn’t really there. This scene might sound like an experimental Summerscape performance project or an elaborate post-graduation shindig, but it’s actually part of Bard alum/science filmmaker Alexis Gambis’ (’03) first feature film, The Fly Room.

Gambis, who is both a Rockefeller-trained molecular biologist and a NYU-trained filmmaker, has attracted a lot of attention for his ability to incorporate scientific concepts and scientific imagery into stories about human relationships. The Fly Room tells the story of Calvin Bridges, a key member of the team that developed gene theory through the memories of his estranged daughter Betsey. The film will interlace scenes from Betsey’s childhood, where she learns about her father’s scientific discoveries but also about his sex addiction and philandering, with scenes from the night when college-aged Betsey learns that her father has just died.

That’s where the surrealist party scene at Manor comes in. Gambis based his script for The Fly Room with a series of interview he did with the real-life Betsey, now 94. In his talks with her, she described the liberal arts scene at the college she attended as being incredibly colorful (both literally and figuratively) and full of young artists who were very into surrealism and self-expression and told him the story of how she learned about her father’s death by picking up a newspaper and stumbling across his obituary headline in the middle of this liberal arts/surrealist party setting. Initially, Gambis wasn’t sure where he wanted to film this scene. He said, “I wanted a place that I felt comfortable shooting in.

I mentioned it to Todd Solondz (director of Welcome to the Dollhouse), who is one of my advisers, and he immediately suggested Bard.” Gambis realized that his alma mater, where he first learned about The Fly Room lab in Mike Tibbetts’ genetics class, would not only be a great location but also a great way to bring things full circle.

For the past few months, Gambis has been juggling setting up filming locations in New York and getting ready to shoot here at Bard. To help coordinate the Bard operation, Gambis recruited sophomore film major Alex White to serve as a production assistant/intern. White’s responsibilities include location scouting and recruiting Bardians and locals who can serve as extras or help behind-the-scenes with set building or hair & makeup. “The more people who can help, the better,” said White.

The Bard portion of the filming will take place over four days between June 6-9. The party scene will be shot over two nights on the 6th and 7th and will be the busiest part of the Bard shoot.

White emphasized the need for “lots of college-aged extras”. Any-

one who’s going to be in the area that week is encouraged to sign on by sending their name and a headshot to aw2027@bard.edu. In particular, they need people who know how to jitterbug but all are welcome.

People who are going to be in New York City will be able to get involved too. Gambis and his production team are currently building a replica of the original Fly Room in Red Hook, Brooklyn.

The set will double as a historical exhibit that is open to the public, and proceeds from the exhibit will go toward funding the film. But those who are interested in helping with set building or filming are welcome to contact the production via theflyroom.com and ask how they can get involved.

From the beginning, Gambis has been explicit about his desire to make The Fly Room a Bard community project. “I want to work with both Bard science majors and film majors and get a lot of people involved in the film,” he said in an interview during Citizen Science. “Not only as actors but also as crew members and science advisers.”

Several Bard film students and graduating seniors have been recruited to help with the cinematography, and a few students are getting involved with the production design. White also mentioned that the production might need help building surrealist sculptures to feature in the background of the party scene.

Bike Co-op is already helping out by putting together the bicycles that will hang from the ceiling.

Everyone I talked to emphasized the unique perspective that Gambis brings to his films. “In terms of the way science is represented in films, there aren’t many films that incorporate the science frame of reference with the human drama and looking at emotional, intuitive things, and I think that this movie will integrate them in an interesting way,” said White.

Even though the budget for the production is tiny, everyone involved has big hopes for the project. “It’s a very ambitious for such a low budget,” said White. “The fact that people are volunteering [to help with the production] shows how people are invested in this. I’ve never seen anything like this before.”

Spike Lee, one of Gambis’ advisers at film school, has signed on as a producer and is contributing $10,000 to the budget. ”He loved the story,” said Gambis. “It’s one of those things where you get a totally different perspective on a science story and pitching it to Spike Lee is just unreal.”

While it’s impossible to know how the film will be received, there is a sense of cautious optimism that The Fly Room could be part of a cultural shift in how science is represented in film.” I think that the best films are the ones that don’t go to exotic worlds but expose things that are right in front of you and you see it again in a new way,” said White. “Stan Brakhage called that ‘the adventure of perception’, and I think that the Fly Room will be an adventure of perception.”

“I think The Fly Room will be an adventure of perception.”

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Fenced In:

A Dolphin Installation Created to Simulate a Dolphin’s Life in Captivity

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by JENNIFER GILLEN

hile most seniors were using their last few weeks to frantically finish their senior projects, Samantha Rosenbaum spent a week building a dolphin installation, a large wooden box surrounded by mesh fencing, on Ludlow Lawn.

Most of us walked by the construction of the installation, probably wondering what new sculpture would soon greet us around campus. Sam Rosenbaum, however, is an environmental rights major focusing on animal rights, not a studio arts major. The major is her own creation — a combination of human rights and environmental and urban studies. And the dolphin installation was not a required component of her senior project; it was simply an additional creative piece to help raise awareness about dolphin rights and the problems associated with dolphin captivity. Sam explains, “I think art has the ability to challenge animal injustices and to notify humans about these important issues.”

Dolphins are cetaceans, an order of marine mammals that also includes whales and porpoises. They are known for their high level of intelligence and consciousness, meaning they are self-aware animals. A dolphin can look in the mirror and recognize itself in the reflection. This self-awareness is, for Sam and many other dolphin rights advocates, one of the primary reasons they should not be kept in captivity. For anyone that has seen The Cove, a documentary about the secret slaughter of dolphins in a Taiji, Japan, one of the most memorable moments is the interview in which former dolphin trainer-turned dolphin rights activist Richard O’Barry explains that he witnessed a dolphin commit suicide. He says that this dolphin, one of the trained dolphins that played Flipper on the famous TV show of the same name, came into his arms to hug him and then purposefully did not take another breath. He explains that dolphins are not only self-aware, but they are also very social animals, and without the freedom of the open ocean and their complex social structures, they become depressed and do not have what they need to live. Sam first saw the documentary her freshman year at Bard, and it was this that inspired her to become a dolphin rights activist and create a senior project about bottlenose dolphins: “After seeing The Cove, I knew that was what I wanted to do for the rest of my life.”

Sam’s dolphin installation consisted of a mesh enclosure and a small wooden structure within the enclosure. The purpose was not only for awareness, but to simulate a life in captivity.

As Sam explains, “I really wanted people to know how awful it is for a dolphin to be in captivity.”

To experience this captive life, one stepped into the enclosure and then into the wooden structure, which felt like being trapped in a box. Inside, the floor was covered with water, the walls were covered in a metallic, mirror-like paper, there were knives hanging from the ceiling, and

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there was a small television playing videos of dolphin slaughter.

While some may misinterpret projects like Sam’s dolphin installation as radical animal rights initiatives, visitors to the installation appeared engaged and impressed. Junior Margaret Gushue attended the opening of the installation, and thought, “it was very well done, and what stood out the most to me was the caged-in area before the tank, and how uncomfortable that space was for me.” Often people are afraid to question common practices, like animal captivity, because they have been in existence so long, and because change is not easy. Bard is a place for those who want to question the status quo, for those who want to better the world around them, and Sam’s dolphin installation reinforces this notion.

The installation forced students, if only for a few minutes, to imagine the horrific nature of captivity. The idea is not to turn every person into a dolphin rights advocate, but simply to open people’s minds and compel them to think about issues that they probably don’t always concern themselves with—like animal rights. Nothing can change if people are ignorant of the issues, so public awareness is the first step. According to Sam, “Ignorance allows cruelty to continue. That is why raising awareness is so important. This installation is a form of advocacy, a voice for dolphins, and a protest against the captivity industry.”

And through this awareness and new way of thinking, Sam’s hope is that we will opt out of buying that ticket to SeaWorld and other captive dolphin exhibits, and begin spreading the word ourselves.

Bard Science Journal May 2013 Volume 2, No.5

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Teach For America:

Alexia and Cara on Education Opportunities and Science after Bard

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by POLINA VULAKH

wo of Bard College’s very own 2013 graduates, Cara Black and Alexia Downs, prepare to embark on a life-changing journey into the education system of America. Both had been accepted to work with Teach For America. According to their website, this non-profit organization’s mission is to “eliminate educational inequity by enlisting high-achieving recent college graduates and professionals to teach” for at least two years in low-income communities throughout the United States. “It worries me how something so essential to my life – the quality education I received through schooling – isn’t available to a large portion of American residents,” says Black. “I’m going to try my hardest to change that.” TFA began in 1989 as Princeton undergraduate Wendy Knopp’s senior thesis, which focused on the achievement gap – the staggering difference between the education system in low- versus high-income areas. Knopp was so inspired by her findings that, after earning her Bachelor’s degree in Art, she took a year off specifically to found TFA, visiting other Ivy League campuses to recruit members. By 1990, 500 college graduates joined TFA’s charter corps. Since then, the organization has included 28,000 people in working throughout urban and rural areas alike to make the United States a nation of equal educational opportunity.

Like Knopp, President of Student Government and biology major Cara Black was deeply moved by research on the achievement gap. As a freshman at Bard, Black’s plan was to enter medical school directly after graduation. However, because of Bard’s intense involvement in the education system, with the Bard

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Prison Initiative (BPI), which provides men and women in New York State prisons with what to earn a Bachelor’s degree while serving their sentence, and Bard’s Early High Schools, which incorporate rigorous college-level education into the standard high school experience, she became interested in educational reform. In cultivating this interest, she attended TFA’s summit in NYC during the summer of 2012. She read many studies on racial prejudice and socioeconomic inequalities which showed national statistics of how large a disparity there is in the USA’s education system – specifically how much money is spent per student in specific regions of the country: “It’s drastically different depending on where you are in the States. I knew that the achievement gap existed, but I couldn’t even imagine to how high a degree…I was sort of put into shock after I learned from TFA how severe this problem is.”

The scientific achievement gap in high schools – the time when students are first introduced to “hard” sciences – struck her most, for it was even more severe than that of literature and social studies. Referring to this as the crisis in STEM (science, technology, engineering, and mathematics) education, Black explains that “it all starts in the beginning. If you can’t acquire the critical thinking skills when you’re a young student in elementary school, or even kindergarten and preschool, you’re not prepared mentally to learn hard sciences in the same way as someone who grew up in a more privileged community and attended a school that had greater resources.” After learning what she had from the summit, she was set on applying to TFA. “It was the only teaching program I considered. I even decided to forego applying to med school until after I did this. It was kind of scary, honestly! The med school applications would have been in before I applied to this, so I took a giant risk. Thank goodness it worked out, or I would be living at home next year,” shared Black.

Conversely, fellow biology major Alexia Downs was specifically looking for a program that involved teaching, since that was something she had lots of experience in. She mentions that “the jobs I’ve liked most in the past have been jobs where I’ve been able to interact with people. In classes at Bard where we’ve done presentations and led class discussions or seminars, I’ve really liked coming up with the lesson plans and working with people to translate ideas or coming up with activities.” She found a non-profit organization that worked for a cause she passionately believed in – for someone who loves science as much as she loves working with kids, there couldn’t have been a better match. From tutoring to a music program called the Upbeats, Downs has done it all. During the application process, Downs remembers that the main thing courtesy of nsf.gov/statistics TFA was interested in was this very music program:

Bard Science Journal May 2013 Volume 2, No.5

Alexia Downs

“I’ve been with the Upbeats, a program that offers free music lessons to deserving families “What most of the corps in the area for children anywhere from 5 to 13, since freshman year. They liked this sort of members I’ve spoken to long-term dedication. I’ve also talked to some told me is that teaching just charter schools with similar free music programs, and because funding’s been cut down becomes your entire life. But for the arts, TFA could sympathize with that.”

I’m ready to do that.”

However – and this concerns any prospective applicants – barely any corps members have formal teaching experience prior to working with TFA itself. Throughout the application process, it’s emphasized that teaching is one of the hardest jobs around, so the organization looks for determined, passionate, and committed individuals to edge our country closer to TFA’s goal of equal ed“ It worries me how someucational opportunity for all. Black mentions thing so essential to my life that the skills she anticipates will be most isn’t available to a large poruseful are those she acquired through Student Government. “[Student Government] tion of American residents; requires a lot of cooperation in an environI’m going to try my hardest ment where cooperation isn’t easy. So for me, learning how to assess myself, seeing how I’m to change that.” acting in a professional situation or how the group is acting, learning how the group can best achieve a concrete goal or how the group can best come to a consensus: these are the kind of skills that I think pushed me into havdiscern what’s been fluffed up in the news to make the public feel a ing the confidence to think I’m going be able to do this [TFA].”

With Black stationed in Chicago, IL and Downs sta- certain way from what’s the pure, scientific fact that will help them tioned in Los Angeles, CA, they know that life will become dras- in everyday life. Because these students come from poor economic tically different from what they’ve been used to over the past communities, they can pass on information about how to be enfour years. Of course, as with any life-changing event, there’s vironmentally sustainable or how to use preventative health care some nervousness with regards to the transition from spunky measures – in general, how to be safe in a world that’s full of bioBard student to being a new teacher in a lower-income com- medical dangers.”

When asked what they will miss about Bard College, both munity. “Just like with any job, I think there’s the apprehension of going from a college schedule – when you’re surrounded by future TFA members were caught off guard by the question. “Um, your friends all the time and doing your homework but hanging everything? Almost everything about Bard,” says Downs. Black out mostly on your own schedule – to a beyond-fulltime job,” mentions that she’ll miss the way everyone accepts each other, and explains Downs. “And I think it’s exactly that: way beyond-full- “people acting crazy in Blithewood. I’m really going to miss Blithetime. How else can you describe a job when you’re up at 5 in wood.”

As senior year draws to a close and the 2013 graduates the morning and probably working until late every night? What most of the corps members I’ve spoken to told me is that teach- go their separate ways, Black would like to thank Professor Ferguson, Professor McGrail, “Mom, my cat Furball, my best friend Una, ing just becomes your entire life. But I’m ready to do that.”

Regardless of the challenges their future presents, our who I’ve known since L&T, and Dr. Washington,’96, who I did my two new TFA members are really excited to handle an issue senior project with. He taught me a lot of the critical skills I talked so incredibly vital to society. In a few months, after a 5-week about. He’s a professor at Columbia medical school and helped me summer intensive that consists of giving them the teaching do [TFA].” Downs would like to thank “my adviser Brooke Jude skills necessary to the job, they’ll dive in with both feet and im- for doing literally everything in helping me apply, from the recommerse themselves in teaching. “I’m especially looking forward mendations to helping me calm down during the process. I’d also to teaching biology,” says Black, staying loyal to her major. “I like to thank Katie Simon and Cara Black who are also doing the can just imagine my classroom having models of cell, zygotes, program: it was really good to have them as peers.” and all sorts of things. I think the thing I’m looking forward to most is being able to explain to someone how to use data and other scientific information to evaluate the world around them in the most educated way. I want my students to know how to

Cara Black

Bard Science Journal May 2013 Volume 2, No.5

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Journey to SPROJ

Stories, Work, and Advice From This Year’s Graduating Class illustrations by POLINA VULAKH

Hannah Mitchell, EUS

I am an Environmental and Urban Studies major, and after coming in contact with carbon forestry programs while studying in Tanzania, New Zealand, and Mexico, I was inspired to delve deeper into the social and political consequences of an emerging environmental policy called REDD+.

Reducing Emissions from Deforestation and Forest Degradation (REDD+) has recently emerged as a policy response to address deforestation and climate change. REDD+ uses a market mechanism to compensate reforestation and afforestation activities in forest-rich nations by linking these activities to emissions reduction commitments in industrialized nations. In the absence of an international treaty to regulate greenhouse gas emissions, and thereby coordinate the market functions of REDD+, a variety of voluntary demonstration activities and pilot projects have taken off. One such program is the evolving relationship between Chiapas, Mexico and California, USA that began in November, 2010. Little research has been done to date on the role of non-state actors in the formation of REDD+ projects. First, using the theoretical frameworks of regime construction, transnational politics, and political ecology, I investigated why this unexpected relationship formed, how it is playing out, and what lessons it can impart for future REDD+ and climate policy. Second, using a review of primary and secondary literature, I synthesized critiques of REDD+ in general that mirrored the reality playing out between Chiapas and California.

As exemplified by the California-Chiapas case, subnational REDD+ programs are heavily influenced by non-governmental actors.

Furthermore, lessons from pilot programs are not necessarily being captured and transmitted to policy crafters. In spite of pockets of resistance on the part of rural groups and transnational environmental rights organizations, REDD+--as exemplified by the California-Chiapas case--is setting an alarming precedent for market-oriented forest governance that contributes to an increasingly globalized conception of carbon sources and sinks.

Writing the paper was more of an exercise in re-writing than anything else. While I had a clear idea of what she wanted to explore, I had to re-frame her argument many times over, due to the information she was able to uncover and the academic confines of the senior project. My analysis could have been augmented by field research in Chiapas. Contacting government agencies in Mexico by email proved to be difficult and time consuming (though not impossible). If you know your research will rely on interviews, it is important to apply for approval with the Institutional Review Board (IRB) early in the first semester. I also found it helpful to take a class related to the themes of her senior project during the first semester to help frame her argument. Most importantly, don’t panic, don’t be afraid to read a lot before you start writing, and be prepared to re-write everything several times over.

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Joy Sebastia, Mathematics

This is just the beginning! Joy’s full poster can be found in the RKC with her results and more on Bard Bipartisate Sprouts.

What’s your favorite thing about majoring in math?

The challenge.

How did you decide what to do your SPROJ on?

I met with Maria Belk and she gave me several options. Once she showed me the game called Sprouts, I knew what I was going to do.

The research part of if it was so much fun, but the write up was horrid! So many edits!

Your Senior Project will be one of the hardest things you will ever do. It will run you through every emotion you have ever had. The sense of pride and accomplishment when you hold it in your hands with the binding on it is worth every bit of heartache and grief you went through to get there.

Katharine Dooley, Biology

What’s your favorite thing about majoring in biology?

Introduction to Physiology with Ferg was really fun. The labs involved a lot of measuring different vital signs after running around and sprinting up stairs, or pinching and tapping our lab partners to test our reflexes. There was the infamous pee lab, too, where we had to drink different things to see the effect it would have on the volume, pH, density, and salt concentration of our urine. I had to drink a solution of sodium bicarbonate and it was pretty gross (but awesome).

Getting started in the lab (and finding things in the lab) was the most difficult part of senior project by far. At first, designing experiments about something I knew so little about seemed almost impossible. I guess that’s where my advisor helped a lot. During our sproj meetings, my advisor would suggest doing such-and-such experiment, and explain the details really fast, and I would leave feeling pretty confused. But a couple of days later, after doing some more reading about the methods and past studies in the field of my project, what he said would click. By the beginning of the second semester, I really felt confident with my lab work and could come up with ideas for possible future experiments.

Start familiarizing yourself with the literature in the field of your project really early on in the year. It will help immensely for when you start writing your introduction. Also, the introduction is the hardest part of the final paper, so start writing it early and the month before sproj is due will be way more stress-free.

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Journey to SPROJ Doug Gazarian, Psychology

What’s your favorite thing about majoring in psychology?

The psychology faculty at Bard will periodically offer “Advanced Methodology” courses in their research specialization (e.g., cognitive, neuroscience, social, or developmental psychology) These “lab classes” enroll a handful of students interested the research process of a given field. Professors involve students at every level of their studies, from designing experiments, to data collection, analysis, writing, and presenting at conferences. This professor-student collaboration and lack of power differential facilitates a mentoring relationship not as easily formed in the standard classroom.

This past January, Professor Kristin Lane organized for the Bard social psychology lab members to attend a conference in New Orleans. I’d bet it’s quite rare for a professor to use her vacation time to expose undergrads to the field (and New Orleans). I also think there’s a certain amount of trust in doing that (for obvious reasons).

My project investigated implicit cognition about people with mental health problems. I compared negative stereotypes about ADHD and depression (e.g., blameworthiness) and assessed the degree to which students endorsed these stereotypes on standard questionnaires compared to their performance on the Implicit Association Test (a measure of “”automatic”” cognition, see implicit. harvard.edu for more information).

I still was not set on a clear idea in early September. I had trouble narrowing my interests. It was clear that I wanted to do a project that dealt with implicit social cognition - the study of social thought and behavior that occurs without conscious awareness, but I also wanted to make use of the many clinical psychology courses I’d taken.

I landed upon studying mental illness stereotypes as a means to combine both of these interests in a way that was feasible for data collection at Bard. This idea arose from many long discussions with my advisers and a bunch of reading I probably should have done over the summer. Importantly, however, this idea was never my “dream” senior project. That didn’t really exist for me.The studies I would have been interested in doing were infinite, so I just needed to decide on one.

I collected data in the campus center from Bard students willing to devote 20 minutes to performing some word-categorization tasks and filling out some questionnaires. This was more time-consuming and stressful than it may sound. The last month of writing was rough at times, too, and finding support for my hypothesis in the data added some extra motivation during some sproj-writing “lows.”

Any advice for underclassmen?

1. You can still have a life outside of sproj.

2. Read someone’s senior project from your major.

3. If you have a friend that you can be productive around, make plans to go off somewhere secluded and drink coffee and make a day of it

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Jasper Weinrich-Burd, Mathematics What’s your favorite thing about majoring in math?

I like math.

How was working with your advisor?

Jim Belk scheduled 16 hours of meetings with his senior project students on the WEEKEND before projects were due. He had some really interesting research that was fun to be a part of.

Any advice for underclassmen?

Work on your senior project as follows: Sept-Oct: 1-2 days per week Nov-Dec: 3+ days per week Jan-Feb: 2-3 days per week Mar: 5 days per week April: 6+ days per week The point is, NEVER go a week without working on your project, there is always more work to do. You will not “finish” your project by the deadline. Rather, you will have done some work, and have a nice write-up of what you’ve done.

Diana Crow, Biology and STS

What’s your favorite thing about majoring in biology?

I like being a bio major, but f***kin’ love being an Science, Technology, and Society concentrator. One of my favorite things about Bard is the fact that you’re not locked into always taking one type of class; when you take classes in different disciplines, you end up always encountering these unexpected overlaps.

Like one time, in my animal behavior class, we were talking about what constituted “communication”. My prof was saying that limping could be considered communication, because other animals could see the limp and know that the first animal was hurt. I argued that limping was not communication because an animal doesn’t limp with the intent of letting other animals know, “Hey! I’m injured!”; even though the fact of the limp is an observable detail that could convey information to other animals. My prof responded that we really can’t tell what animals “intend” and that the fact that other animals understand and respond to the meaning of the limp shows that something has, in fact, been “communicated”. It really reminded me of conversations we’d been having in my journalism class (waaay over in the writing department) about the role of observable details in journalistic writing. Two radically different contexts, but some of the same ideas circulating. Makes for lots of new neuronal connections.

I had a lot of petri dishes. Seventy-two times four trials, to be exact. These are their labels.

I really don’t get why anyone would confine themselves to one discipline.

You’re cutting yourself off from so many new ideas or alternative frameworks for old ones.

I had a really hard time picking what I wanted to do [for senior project]; I ended up deciding to investigate the effects of a chemical that I’m personally terrified of, but if I had a time machine, I would definitely spend more time during my sophomore/junior years talking to profs about their research and thinking about, “Okay, who do I want to work with and what can I do in three-four months in a lab here at Bard?”

Any advice for underclassmen?

Accept Google Scholar as your Lord and saviour.

And join Bard Science Journal, obvs.

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Journey to SPROJ Erin Smith, Biology

I think my favorite thing about majoring in biology is definitely the community. It might sound strange talking about an academic major in such informal or social terms, but thats the best part for me – definitely the community and the support from that community. Some of my best friends at Bard I met in biology classes.

You can pop into professor’s offices pretty much whenever. Everyone is willing to help each other out, and theres no sense of cut-throat competition. We are genuinely interested in what our fellow biology majors are up to, and want to learn from each other. When I got here, I was amazed that I was able to have weekly PIZZA PARTIES with my fellow biology majors every week. But the community didn’t stop there...there are surprise parties for retiring professors in the middle of seminars, goody bags delivered to our student mailboxes from the biology department during finals week, and a support system that I know will be there for us long after we graduate.

Any stories about science faculty?

One time I think I heard Bill Maple talking to his plants.

How did you decide what to do your SPROJ on?

I knew that I wanted to something in microbiology, and got talking with Brooke. I also knew I wanted to do something with broadscale, and possibly ecological or public health implications. Therefore I decided to focus on this really specific interaction between fungus and bacteria, which turns out to have pretty huge implications for amphibian health and ecology.

I think the hardest part was this weird transition from doing primarily data collection to doing primarily writing. It happened in April-most of the year I had been focusing on lab work, and doing a bit of reading and writing on the side, and then all of a sudden I had to switch gears and crank out a huge amount of writing. I love writing, and I love research, but it was weird going from doing one to the other quite quickly.

Try to do some science outreach....volunteer for CitSci, do science experiments with kids, or hey, even write for the science journal.

When you talk about science, and teach it to others, you realize how much you know, and how much there is still left to learn. __________________________ I have not always been a frog lover. I suppose for most of my life I appreciated them as much as anyone. However, I never really thought about the day-to-day goings-on in the frog ponds of the world. Sure, there was once a time when I thought the stories about frog princes were true, and my favorite childhood book was “Frog and Toad.” But as those early days faded, so did any real attention to the slimy animals.

That was then.

Now, I find myself tracking worldwide amphibian populations on Internet maps, and perusing blog posts on “savethefrogs. com” (yes, that is a real website). My desktop picture is a photograph of two tiny tree frogs. My new frog mania has not arisen out of some quarter-life crisis. Rather, my senior project year has made me incredibly accustomed to thinking about these little creatures—a lot. For my project I worked on using purple-pigmented bacteria to combat a deadly disease faced by many amphibians, chytridiomycosis. This disease is killing off frogs, and fast.

I could go into the details of my senior project, but that’s beside the point. I think though, that my newfound immersion into froggy trends and literature exemplifies something important about the senior project: full immersion. Its not that I am particularly devoted to frogs or think they are “cute” or something. It’s mostly that through senior project I became immersed so greatly in one small realm of science, it has become second nature to me. While it may seem quirky to others, checking frog population declines is simply an average way to pass time, akin to checking my Facebook or reading the “LikeSomeBardian” blog.

So through a year (a sometime tedious, sometimes stressful year) I became so accustomed to something that it became integrated into my life. That’s pretty cool, and I think what its all about. Whether our research succeeds or fails, by immersing ourselves we can become experts. Even if we just know about one tiny phenomenon in ecology, or microbiology, or genetics really really well, full immersion makes us experts, and it makes science less intimidating.

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Emily Carlson, Math & Physics

What’s your favorite thing about majoring in psysics and math?

The comradery amongst the students -- because of the small class sizes I’ve had up to 2 classes a semester with the same people who I love and respect and go crazy laughing about insanely geeky things with when staying up till all hours doing Quantum Mechanics homework or a Dynamical Systems project.

How did you decide what to do your SPROJ on?

I’ve always been interested in renewable energy, and recently also became quite intrigued by chemistry and numerical analysis, so I decided to do a project on dye-sensitized solar cells and to model the charge transport of the electrons, electrolyte, and cations in the solar cell.

The hardest part was figuring out when it was time to stop researching and writing code and start writing my project since it essentially felt like I was giving up but in reality I was just stopping research briefly because of a deadline. Also balancing working on SPROJ and still having a heavy courseload.

The most rewarding part happened recently, when looking back on the overall experience and thinking about all that I accomplished over the last year. I did A LOT of work even though I didn’t get many results I still did a lot. But I guess that’s just science for ya.

Any advice for underclassmen?

Ask for help from professors if you need it! They’re awesome and oh so knowledgeable. Also it’s easy to be overly ambitious when it comes to senior project and that can lead to disappointment because you couldn’t do everything you set out to do, so I’d say start small since you can always add elements to your sproj.

Liana Perry, Biology

What were the hardest and most rewarding parts of Senior Project?

The hardest part of this whole project was crunch time. At the end when you’ve got most of your project in front of you, still some sections to complete, but you know that you’ll never be totally, 100% satisfied with it (maybe this is just my experience) but eventually you’ll have to let it go, cut the cord, and it is so, so, so difficult at that last moment to just admit defeat and be finished. It’s like giving birth (not that I would know.... but I imagine).

Honestly, being done is the most rewarding part. Not just because you’re done, but because you’re finally at a point where you can take a minute to look back on the past year and see what might have been a small little dream become a reality, however mutated it may have become along the way. I was amazed at the sheer amount of work I was able to accomplish in what felt like a short amount of time, and I’m really proud of myself for how efficiently I was able to do it. It’s moments like that, where you’re impressed with yourself for being able to do something that seemed so impossible at one point, that made the experience rewarding.

Any advice for underclassmen?

START EARLY. Especially with your writing. Also, take as many classes as you can before your senior year so you don’t have a bunch of distribution requirements hanging over your head. And make sure you’re doing something that you like, not just something that’s convenient or easy. BADGER YOUR ADVISER AND PROFESSORS about ideas and help. If you’re interested in something, show it! Don’t let good opportunities pass you by.

On that note, get out there and enjoy yourself! The years I spent here flew by so quickly, get as much as you can out of your time here!

Bard Science Journal May 2013 Volume 2, No.5

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In the evenings, I’m uprooted - I take myself aside and grapple with the facts and wrestle with the view.

I slip down the trail, tripping over roots and grasping at tree trunks.

I salute the mountainous masses, edges rough with trees, like brushstrokes peppering the horizon.

I welcome the shy crescent moon and watch as it climbs towards the zenith.

I notice that I can’t notice. I can’t feel my toes anymore.

They’ve started to numb over – I should have worn warmer shoes.

But you always say people shouldn’t wear shoes, That shoes deform your feet.

You’re always telling me what’s “bad” for us.

Like how my lack of sleep will take me down, that my body dilates time when at its most exhausted.

You tug at me with constant tension, always spelling out what’s bad for me.

You, who takes up hours of my every day – to whom I’d give all night – You leave me choking on inaction.

Because I can’t take your tapering fingers off that sun-drenched bench and into mine My hands are always shaking.

There’s trumpeting blood marching through my veins and blushing snippets of the wildest thoughts jumping off the tip of my tongue, diving into wintery streams, dispelling spider webs of ice, breaking up perfect, crystal structures.

But I can take you to the reddest of skies, to velveteen grass and glossy, gilded lakes – and I can tell you why the softest metal is the one most valued: there are only 36 hundred cubic feet of gold on earth and you need just 2 ounces to cover an entire billboard!

2 ounces is rull tiny, in fact, one-third of the amount I would take in were I to pour myself a drink and pour this out to you.

Per your request, I’d make myself bedazzling.

I’d go so far as to weave rhinestones in my hair.

You’d shake it loose and make it rain beads of amber, each drop a world whirling as it went by, blinking conifers and snow banks at me.

Leaves of the birch no longer gems but burnt out, tired old women, soaring towards the ground, recklessly falling out of and onto my head: polyrhythm upon polyrhythm. I won’t move for fear of sound escaping.

Warmth pours out of me in plumes.

And threads of coral color the sky.

Do whirl me downwards with your song, Your patient, honeyed breath and murmur – no, purr preludes.

I’ve always been a listener.

But lately all I’ve heard is that you still don’t see my churning, gear-turning heart.

So I take myself aside and grapple with the facts.

And wrestle with the view.

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In the Evenings

by POLINA VULAKH

Paradox Pie

by NINA BAR-GIORA

Cherry tomato pie drove Mahler crazy. The world is not enough, he thought, forever ungrateful. Teardrop-shaped lullabies spread across his forehead as he wept for his last tantric tantrum.

Outside, the sheep rumbled in longing for purple corn. The children rode them like donkeys and laughed as they threw musical timbres at each other.

Each day that passed, another went by. Each hour that passed, time stopped. But it was never really “going” anyway.

Silent quivering wormholes parasitized the gravitational neighborhood. Each lunar day that passed, the flesh of spacetime was gouged by more wormholes, wiggling their ways through dense energetic medium adeptly, like maggots through tofu. Sheer evolutionary programming played out in wavelike motion, scattering into infinite trains of thought that manifested as branching realities. Time and space were now riddled with tunnels. Was. Everyone on the planet became psychotic and no one knew why. Which is a paradox, because psychotics are acutely aware of wormholes. This is what it is to be “psychotic.” Furthermore, you must be psychotic to understand a paradox. Do not believe people who claim to understand paradoxes. Until you are able to become the mind of everyone around you, you cannot occupy two places at once. There only is one electron.

The reason this was a paradox is because the afflicted, suffering from the epochal infection, were not actually psychotic. If fact, they weren’t psychotic at all. Not in the least. They were simply normal human beings experiencing the infiltration of their system by parasitic wormholes. But no one believed the psychotics who were actually psychotic and always had been when they told people “You are not psychotic.

You are floundering in the wake of the abrupt shatterings of your rippling spacetime. The gods are shaking your snowglobe. You are like fish who do not know they are in water.” It was making everyone crazy to hear such admonitions. But not literally crazy, for they were not ready to be free.

The psychotics, being acutely aware of the wormholes, were the first to venture out. But not really the first. An archaic indigenous human artifact known as a “Shaman” was actually the first of the Homo sapiens to step outside of human-demarcated reality and to look upon the paradigm as an astronaut gazes at the blue planet from space. Shamans had been galactic travelers for eons. Eventually they forged relationships with mostly benevolent beings of netherdimensions. These beings alerted the Shamanic disciples to the presence of compounds in the human’s own planet that could be of use. The beings scoffed at the Shamans for not getting wise earlier. The world is a bucket full of chemicals.

Thus in these day-years, the mind was the way in and the way out, but the mind was also cherry tomato pie, which the Shamans had known all along. The served up slices of paradox pie for those who were tired of suffering from not being psychotic. There is only one electron in the whole universe.

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A Senior BSJ Layout Person Shares Experience

by DIANA CROW One of the most common (and aggravating) misconceptions about scientists is the idea that they don’t communicate.

I get it all the time from my non-science major friends (“What do you mean you have a twenty page paper for your bio class? Isn’t that, like, not supposed to happen?”). Science, popular wisdom tells us, is the esoteric realm of people who are more interested in reducing the world to numbers than actually interacting with and conveying ideas to the rest of the species.

Nothing could be further from the truth.

Scientists are (and have to be) master communicators; their jobs depend on it. To be a research scientist, you have to put together grants so compelling that they convince funders to fork over tens (sometimes hundreds) of thousands of dollars to try to find answers to questions most people wouldn’t even think to ask.

Once they have the funding, scientists have to find ways to reduce the jumbled mishmash of life into observable, verifiable numbers that answer those questions. And then convert those numbers back into narratives that show why these answers are important and what new questions they provoke. And then convince other skeptical scientists that these results are worth publishing in scientific journals. Working scientists are expected to successfully complete this cycle 3-4 times per year.

So given that science is governed the “Publish or Die”, it’s not surprising that our professors spend a lot of time teaching us how to write and how to edit, but it’s always shocked me that we spend so little time on how to put together figures.

We learn to do stats, but we don’t really spend much time learning how to make the graphs that look nice. We read papers that have been published in professional journals and have long discussions about why we think this figure works and this figure doesn’t. But we don’t spend time learning even the basics of how to make well-designed, meaningful graphs that clarify statistical jumble rather than adding to it. That really bothers me.

Film students have to learn how and when to use different camera angles, and theater students spend hours and hours working out how to stage their productions. Graphs and visual organization are just as important to the presentation of scientific arguments as camera angles and staging are in films and plays; humans are visual learners and we can extrapolate a lot of information from a well-thought out visual structure. That potential venue of powerful communication shouldn’t be ignored or left to the last minute.

A lot of the rant above is fueled by the fact that I’ve been in charge of laying out the research papers in this journal for three semesters now. I’ve seen a lot a figures and worked with a lot of authors on making their arguments more visually clear. So without further ado, here is my list of do’s and don’ts regarding scientific figures.

1.Be prepared to spend time on them. There’s a reason why professors don’t like to spend class time going over how to make and export figures- it takes time. It’s easy to get bogged down in technical issues (particularly when you’re working with a semi-ob-

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scure program that you’ve never used before without the benefit of massive online tutorial forums), and professors don’t want to risk sinking a ton of class time into grappling with a program that won’t run certain computers or going over the finer points of deciding which type of Excel line graph to use. I wish I could give you guys a list of quick and dirty tips that will revolutionize your figures with five minutes of effort. But making scientific arguments visually is not a skill you can learn instantly or fake by pushing the right combination of buttons. It takes some time.

2. Take photos of your experiment while you’re carrying it out.

Even if you’re not the greatest photographer in the world, images of you what you did can be really useful to people who are trying to conceptualize unfamiliar research techniques or understand what variables you were measuring. Plus, even a less-than-great photo can do wonders for breaking up an overly “text-heavy’ layout.

3. Sketch your figures out ahead of time. I actually started sketches of the figure above before I even started in the lab. Why? I was having a hard time working out what my lab protocol would be without visualizing it. Diagrams you make for yourself when figuring out your experimental design often make good figures because they help people see the logic of it. And even if you’re not someone who doodles when they’re thinking things through, it makes sense to plan out what you’re going to do before you spend hours staring into a computer, trying to make that figure look right.

4. Figure captions are not an afterthought. In my experience, figure captions are invariably the weakest aspect of the papers that get submitted to BSJ. A figure and its caption together should form a cohesive unit that conveys a complete thought about the results. Figures show trends. Captions clarify which variables are used in the figure and can be a place to give key stats. They’re not something you tack on at the end of the project. You should write rough drafts of captions while sketching things out.

5.Show sketches to your friends and ask them if they make sense. Communication isn’t measured by the effort the communicator puts in to the signal; it’s measured based on whether or not the receiver gets the idea. So don’t be afraid to consult with your friends and make sure the figures still make sense to someone who isn’t immersed in your project.

5. Make a list of the main points you want to make with your paper. Make sure there is at least one solid figure for every single one. A commonly cited scientific rule-of-thumb is that you should be able to get the main ideas of a paper from looking at just the abstract and figure captions. The best way to make sure your paper achieves that is to be systematic about what you want to convey and make sure you have figure for all your main ideas.

Figure 1. A diagram explaining the methodology of my senior project in methodology. I created it in Illustrator using basic

images that I downloaded from Creative Commons.

6. Creative Commons is your friend. Confession time: I didn’t draw the Erlenmeyer flasks in my figures above. I downloaded graphics from an open access site, imported them into Adobe Illustrator, changed the colors, added the dots that represent my chemicals, and arranged them on a page with arrows. Voila!

7. Vector graphics editors (programs like Adobe Illustrator) are not always the easiest programs to learn, but learning one pays off in spades. Seriously, even if all you know how to do is add arrows to existing figures, that can be a huge help. Illustrator is the industry standard, it kind of reminds me of KidPix but for professional adults. It’s expensive, but computer in the Old Henderson Mac lab and the Avery third floor lab have it, and it’s worth knowing basics. There are other analogous programs you can use, too. Just don’t rely on MS paint. It’s actually an awful program.

8. Computer programs do not always spit out great figures.

Some data analysis programs are very user-friendly; others are very not. Some take into account the fact that you might need to use their graphics in your papers; others don’t. It’s tempting to just cut and paste the figures you get immediately after crunching the numbers, but it’s worth stopping and thinking about whether or not the figure actually clearly conveys what you need it to convey.

You might need to edit it with a graphics editor before it’s ready for primetime.

9. If you add something to a figure, make sure it’s something that clarifies the main idea of the figure. A simple well-placed arrow pointing to one of the key nucleotides in a sequence printout or a circle around something you want people to notice in a photo can work wonders. Adding really complicated features that don’t clarify the main idea is just counterproductive.

10. If you don’t know what the figure means, no one else will either. A lot of people are often tempted to put in a complex, convoluted graphs into their figures to make them seem more impressive. It doesn’t work. Presenting figures you don’t fully understand is like presenting stats that you don’t know how to interpret. You won’t be able to make a crystal clear argument, and people will either be confused or think that you’re covering for data that don’t quite add up. Don’t do that. It’s better to be concise and honest, even if it means telling people that your results were kind of inconclusive.

TL;DR: Making good scientific figures is difficult, time-consuming, and often frustrating. But it’s a hugely important skill set for scientists. Thinking through what figures you’ll need before crunching your data is the best way to make sure your figures will get the job done. Favor clarity over complexity. Also, don’t panic.

You can do it. :)

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Perceptions of the Use of Point of Care Medical Devices to Diagnose Mycobacterium tuberculosis in Haiti

By Marne Garettson1

Advisors: Susan Mechanic-Myers and Michael Bergman

Abstract. Tuberculosis is a disease of poverty. 98% of deaths caused by this infection occur in the developing world, and one third of the world’s population is infected with TB bacili. The pathogen responsible for causing Tuberculosis in humans is Mycobacterium tuberculosis. The purposes of the study were to: provide more information about the currently available therapeutics for Tuberculosis; the use of point-of-care diagnostics in low resource settings; and their efficacy in the diagnosis of Tuberculosis. This study was significant because of its potential to advance research in the development of innovative medical devices to be used in resource limited settings. The clinical implication of the study was its impact on global health by potentially saving the lives of the some of the approximately 1.3 million people who die annually from TB. The gap in the literature was the lack of scholarly research that linked the impressions and opinions of healthcare workers with the development and use of innovative medical devices. This study involved health care workers in Haiti and their perceptions of the use of point of care medical devices to diagnose Mycobacterium tuberculosis. Data was collected from healthcare workers in Haiti through observations, surveys and interviews. In this exploratory study, three interviews were conducted and 19 surveys were completed. Although the study is limited by its sample size, the value of it lies with its influence on health policy through the identification of the need for further research in the use of innovative diagnostic devices to diagnose TB in Haiti. The study revealed that current TB care is inadequate, and more resources are needed in the use of medical devices by health care workers. The following recommendations regarding existing gaps/weaknesses were identified as needs: the development of a community based treatment and diagnosis of TB in Haiti; the development of a national policy on TB diagnosis and treatment; the development of novel approaches to diagnose and treat TB in Haiti; and the provision of training to healthcare workers in the diagnosis and treatment of TB. Introduction In September 2012, I began an exploratory study of health care workers in Haiti began in September 2012. The global health implications of using portable medical devices to diagnose Tuberculosis in Port-Au-Prince, Haiti was the focus of the study. This study was conducted in order to fulfill the Senior Thesis Graduation Requirement at Bard College at Simon’s Rock.

Tuberculosis is a major health concern in Haiti. The country is ranked 46th out of 212 countries in terms of its prevalence of the disease (Cultural Competence and Tuberculosis Control Report). The Pan American Health Organization has identified Haiti as a priority country for Tuberculosis control (USAID, 2009). Socioeconomic conditions that exist in Haiti have negatively impacted the access to health care in the country. In Haiti, eighty-percent of the population lives below the poverty line and there is also a 70% unemployment rate. The 2010 earthquake has also negatively impacted the access to healthcare. Patients who had TB stopped taking their medication and patients who once lived in the sanitarium now live in tent cities where they are probably spreading the disease to other people. Estimates regarding its prevalence and incidence vary by source and date. Dye (1999) found that there are 190 cases of TB in Haiti per 100,000 people. However, in 2012, The Center for Global Health at the Weill Cornell Medical College estimates 331 cases per 100,000 people (Ocheretina, 2012).

Tuberculosis is transmissible through the air, with symptons including bloody sputum, fever and weight loss. The bacteria responsible for this chronic infection tend to infect the lungs causing pulmonary TB. However, other organs may be affected, causing extra-pulmonary TB. The current method used

to diagnose TB takes weeks to confirm. Most doctors identify the disease on the basis of symptoms such as night sweats, coughing and weight loss. Dr Megan Coffee, Director of the Ti Kay Clinic in Port-Au-Prince said “Everyone is thin, everyone is coughing from the dust and everyone is sweating from the heat”. Not only is TB a health burden in Haiti, but there is now a concern of cases of multi-drug resistant Tuberculosis (MDR-TB). A study conducted in 2012 revealed that at least 2.9% of approximately 1,000 patients newly diagnosed with TB had MDR-TB. The study recognized the growth in MDR-TB cases since the 1990s (Ocheretina, 2012). Haiti also has a high incidence rate of patients who are infected with both HIV and Tuberculosis. In 2006, it was estimated that 7% of patients were infected with both diseases. Burgess and Fitzgerald (2001) found that the use of HIV voluntary counseling and testing centers were effective in providing tuberculosis screening to a larger number of patients.

The World Health Organization recommends that patients who come to seek HIV testing and state that they have been coughing are also tested for tuberculosis. The Burgess & Fitzgerald study found that 32% of the patients evaluated for TB were found to have pulmonary Tuberculosis (Burgess & Fitzgerald, 2001).

The Haitian health system consists of care provided in three sectors: a public sector, a private nonprofit sector and a private for profit sector. The public sector provides health care, but services are generally limited. The private nonprofit sector consists of care provided by religious organizations and non-governmental organizations. The private profit making sector consists of private practice doctors and hospitals that are mostly located in the capital. Most TB patients in Port-au-Prince receive treatment at one of the following facilities: Ti Kay Clinic, Grace

1- Senior Thesis, Bard College at Simon’s Rock Advisors: Susan Mechanic-Myers and Michael Bergman **This senior project has been abridged. For full methods and data, contact the author.** Contact: marnealexandra@aol.com

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Children’s Hospital, the Haitian State Sanatorium, GHESKIO Center, and the Mennonite Mission of Croix des Bouquets. The most common drugs used in Haiti to treat Tuberculosis are: Rifampin, Isonaizid, Pyrazinamide, Ethembutol, Streptomycin, Ethionaide, and Ciprofloxacin.

months but treatment time increases depending on the degree of drug resistance infection or a HIV co-infection.

January 1st, 2013; Second Day at Ti Kay Clinic at l’Hopital de l’Universite d’Etat d’Haiti I observed some challenges experienced at Ti Kay including the need for data management for medical diagnostic Methods devices. Patients are sick and seem to seek care later in their I. Observations illness. The budget for a treatment center in New York City is Observations were conducted in December 2012 at the significantly higher than the budget for Ti Kay clinic (despite Ty Kay Clinic in Port-Au-Prince, Haiti. The logistics of the trip the fact that Ti Kay sees more TB patients here than in the entire were arranged by Shauna King of International Medical Relief. state of New York). Data turnaround needs to be quicker even Human Subject Research Approval was provided by Bard Colwith GeneXpert testing since the results take a couple of hours to lege at Simon’s Rock in Great yield and it is hard to track down Barrington, Massachusetts. patients to inform them of results.

Transportation costs are excessive.

December 31st, 2012; First Day The patient needs to be able to be at Ti Kay Clinic at l’Hopital de mobile in order to live their lives l’Universite d’Etat d’Haiti (especially those living in rural The Ti Kay Clinic areas). The cost prevents most consists of a one mobile (trailer) families from travelling within with medical supplies and a the country. Ti Kay clinic sees seating area for the medical approximately 800 patients per staff with one adjoining tent year and treats about 40 inpatients (tarp-like structure on the right per year. Each day, patients are side of the mobile trailer) and weighed on a scale and recorded a roofed garage-like structure (there is a need for accurate and (on the left side of the mobile adequate patient records filed trailer) for inpatient and outpausing electronic software). Health tient care. In Haitian Kreyol, Ti care workers and volunteers Figure 1. Patients in the waiting area at the Ti Kay clinic.

Kay can be translated as “Little actively engage patients via exercise House;” Tuberculosis was known as the “malady of the little or other kinds of movement (i.e. patients moved outside in the house,” which means a disease of the small houses where people sun instead of lying in bed all day). If patients (especially those were quarantined. Ti Kay Inc. is a medical non-profit organizawith HIV/TB co-infection) do not exercise, there is a potential tion that aims to treat (and hence prevent) TB in Port-au-Prince, of the patient developing DVT (deep vein thrombosis) in their Haiti that is based at the General Hospital HUEH (l’Hopital de legs. Approximately 25% of inpatients at Ti Kay are co-infected l’Universite d’Etat d’Haiti). After the earthquake on January with HIV due to the longer treatment time. Other than this per12th, 2010 when the state sanatorium was not functional, the centage, Ti Kay treats a significant amount of outpatients yearly. head nurse of the TB program and Megan Coffee (US Doctor) There is a significant amount of patients at Ti Kay that weigh less established an inpatient program for the care of Tuberculosis than 50 pounds. Depending on the severity of their illness, the patients (the outpatient treatment program was expanded as well patient’s weight may fluctuate; however, patients with HIV/TB after the earthquake). Ti Kay supplements the work of the state co-infection tend to weigh less than other TB patients. I noticed Hospital and nurses by providing an on-site medical doctor and that there was a tendency for patients with HIV/TB co-infection additional nursing care as well as ensuring that all care is free to request a facial mask at times (especially when interacting to both inpatients and outpatients. The PNLT (the national TB with other patients) to prevent worsening their own condition. program in Haiti) provides all TB medications free to patients; Some patients needed to have their medications (especially HIV and the Hospital’s PEPFAR-funded HIV clinic provides free HIV medications) crushed in order to take them. Some HIV patients medications. The state-run hospital provides medications and develop sores in their throat which makes it hard/more difficult food. When feeding patient’s, Dr. Coffee cares that they receive to chew/swallow (the solution was to administer crushed pills in food rich in calories and less about the amount of nutrient rich a liquid form). (Maladtbyo Renmen –W Dr. Coffee). Dr. Coffee food in order to make sure patient’s have enough energy to get receives a lot of help from non-medical volunteers in terms of up from bed. Each day, patients were brought out of their beds feeding patients, weighing patients, and maintaining up-to-date to walk around and to enjoy the sun outside. As a side note, a patient records (also, with the logistics of running a clinic dayfemale patient with MDR-TB walks in healthy after completing to-day). Workers call outpatients for follow-up daily (to check if treatment and now serves as a volunteer at Ti Kay. This wompatients have been following the proper course of treatment and an was Dr. Coffee’s first MDR-TB patient in Haiti and she is a to check on their wellbeing). Ti Kay clinic was established on shining example of the power of TB treatment to restore lives.

January 26th 2010 (14 days after the 2010 earthquake) and has Dr. Coffee states that the minimum treatment time for TB is 6 been in operation since then.

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Day 7 – January 2nd, 2013; Third Day at Ti Kay Clinic at l’Hopital de l’Universite d’Etat d’Haiti Dr. Coffee’s suggestions for improvement include the: automated recording of results yielded by diagnostic devices, and the development of diagnostic devices that cater to the illiterate and low-skill level population of Haiti. Low-resource treatment centers see more TB patients than those seen in major treatment centers in the US but there is a significant budget deficit. There are approximately 100 volunteers per year at TiKay (medical and non-medical). Many families with small children currently live at the clinic because the primary family member is sick and is receiving treatment on-site. However, there is not enough room to house patients and their families (i.e. there is an issue of having an overcrowded facility with extremely ill patients in close quarters). In Haiti, there is a big concern for access to care (and effective and adequate care) specifically, TB care. Many Haitians perceive that they do not have access to adequate health care or

Questions about Global Health:

Questions about Medical Devices:

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that there is an inability to find proper treatment and care for illnesses. This mentality is caused by various factors including living conditions, religious and cultural beliefs, transportation costs, and an unfamiliarity with the medical system and its ability to adequately treat illnesses.

II. Interviews An excerpt of the protocol I utilized is listed below.

Questions were translated into both French and Creole, where necessary. (See Table 1).

III. Surveys The survey consisted of: 10 background questions; 24 closed ended questions and 6 open ended questions. The closed ended questions are listed below. The instrument was translated into both French and Creole. The closed ended questions were answered using a five point Likert Scale. (See Table 2).

Close Ended Survey Questions: 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

I believe that there is a need for additional medical devices to diagnose patients in Haiti. [F1] I believe that there is a need for a portable device to diagnose TB in Haiti. [F2] I believe that there is a need for a low-cost medical device to diagnose TB. [F1] I believe that there serious disadvantages to the current method of diagnosing Tuberculosis. [F1] If my hospital or clinic had a rapid, point of care medical device to diagnose Tuberculosis, I would support its use. [F1] If my hospital or clinic had a rapid, point of care medical device to diagnose Tuberculosis, I would expect to have training on its use. [F1] I believe that the use of a rapid, point of care medical device to diagnose Tuberculosis may result in a reduction in the morbidity rate associated with TB in Haiti. [F2] I believe that the use of a rapid, point of care medical device to diagnose Tuberculosis may result in a reduction of the morbidity rate associated with MDR TB. [F2] I believe that the Ministry of Health should develop a national policy on health technology. [F4] I believe that the Ministry of Health should conduct a health technology assessment. [F3] I believe that healthcare workers should receive additional training of the use of medical devices. [F6] I believe that additional funding is necessary to reduce the incidence of Tuberculosis in Haiti. [F2] I believe that Haiti should adopt the World Health Organization Assembly Resolution WHA A60.29 which was the first resolution on the use of health technologies. [F1] I believe that there are limitations to the current system of treating Tuberculosis in Haiti. [F1] I believe that there is a need for additional health care workers to treat Tuberculosis patients.[F2] I believe that community health clinics provide a significant role in supporting the overall TB plan of diagnosing and treating TB patients. [F3] I have either had or known patients who have died from HIV TB co infection.[F5] I have either had or known patients who have died from MDR TB. [F5] I believe that the World Health Organization’s DOTS Strategy is being implemented in Haiti. [F4] I believe that the World Health Organization’s DOTS Strategy is effective in improving the level of care for TB patients in Haiti. [F4] I believe that Haitian patients have a social stigma associated with being diagnosed and treated for TB. [F5] I believe that this social stigma has some impact on the number of patients who seek treatment. [F4] I believe that HIV co-infection complicates the diagnosis of TB because it limits the sensitivity of the sputum smear. [F6] I believe that there is a shortage of hospital beds in Haiti for the treatment of TB. [F3]

disagree). Survey questions were divided into factors for statistical analysis. The factor each question belongs to is annotated in brackets.

Results Factor 1: Current TB care is inadequate Data collected from a group of seven questions from the Health Care Worker Survey were tested for overall reliability and an exploratory factor analysis was conducted in order to assess the adequacy of current TB care in Port-au-Prince, Haiti.

A scale consisting of the mean of scores on these seven items displayed significant internal reliability and consistency, as α = .897, in conjunction with reasonable correlation values.

Factor 2: There is a need for more resources such as medical diagnostic devices and health care workers Data collected from a group of five questions from the Health Care Worker Survey were tested for overall reliability and an exploratory factor analysis was conducted in order to assess the adequacy of current TB care in Port-au-Prince, Haiti.

A scale consisting of the mean of scores on these five items displayed significant internal reliability and consistency, as α = .877, in conjunction with significantly high correlation values.

Factor 3: There is a need for Community assessment measures and TB treatment Data collected from a group of three questions from the Health Care Worker Survey were tested for overall reliability and an exploratory factor analysis was conducted in order to assess the adequacy of current TB care in Port-au-Prince, Haiti.

A scale consisting of the mean of scores on these three items displayed significant internal reliability and consistency, as α = .854, in conjunction with significantly high correlation values.

Factor 4: Determining the benefits in national policies regulating TB diagnosis and treatment Data collected from a group of four questions from the Health Care Worker Survey were tested for overall reliability and an exploratory factor analysis was conducted in order to assess the adequacy of current TB care in Port-au-Prince, Haiti.

A scale consisting of the mean of scores on these seven items displayed significant internal reliability and consistency, as α = .823, with reasonable correlation values.

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(F1)

(F2)

(F3)

(F4)

(F5)

(F6)

(F1) Current TB Care Not Adequate

1

.49

.52

-.10

-.07

.25

(F2) Need for More Resources

.49

1

.29

.19

-.13

.27

(F3) Need for Community Treatment

.52

.29

1

.13

.06

-.01

(F4) Benefits of National TB Policy

-.10

.19

.13

1

.34

-.28

(F5) TB’s Associated Negative Effects

-.07

-.13

.06

.34

1

-.27

(F6) Health Care Worker Training

.25

.27

-.01

-.28

-.27

1

Table 3 & Figure 1. Pearson’s Product Moment Correlations among Factors 1-6. The x-axis corresponds to the p-values for the correlations, while the y-axis corresponds to the Factors 1-6. Note. * p < .05, ** p < .01, *** p < .001. N = 19 for all analyses.

Years of Experience

Years of Education in Field

(F1) Current TB Care Not Adequate

-.17

.03*

(F2) Need for More Resources

-.30

-.11

(F3) Need for Community Treatment

-.31

-.17

(F4) Benefits of National TB Policy

.24

.16

(F5) TB’s Associated Negative Effects

.28

.22

(F6) Health Care Worker Training

-.10

.01*

Figure 2 & Table 4. Pearson’s Product Moment Correlations among Years of Experience and Years of Education in the Field between Factors 1-6. The x-axis corresponds to the years of experience or education in the field for the correlations, while the y-axis corresponds to the Factors 1-6.

Factor 5: TB has associated negative effects with diagnosis and treatment Data collected from a group of three questions from the Health Care Worker Survey were tested for overall reliability and an exploratory factor analysis was conducted in order to assess the adequacy of current TB care in Port-au-Prince, Haiti. A scale consisting of the mean of scores on these three items displayed reasonable internal reliability and consistency, as α = .799, in conjunction with relatively high correlation values.

Factor 6: Health care workers need more basic training in TB diagnosis and treatment Data collected from a group of two questions from the Health Care Worker Survey were tested for overall reliability and an exploratory factor analysis was conducted in order to assess the adequacy of current TB care in Port-au-Prince, Haiti. A scale

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consisting of the mean of scores on these two items displayed a low value for internal reliability and consistency, as α = .395.

This low alpha value in conjunction with a low correlation value indicates a violation of reliability model assumptions and must be re-analyzed.

Correlations The majority of the respondents’ scores on the six computed subscales did not correlate with each other; these correlations developed from data collected from surveys can be visualized in Table 4. Statistically significant values were not obtained for the majority of these correlation tests; however, general positive trends can be identified between each of Factor (s) (1-6) using the Pearson correlation values.

T-Tests

t

d

An independent-samples T-test was conducted to compare the differences in female and male perceptions of the use of point-of-care medical diagnostics and treatment of TB in Haiti (Table 3). The variables of Factors (1-6) were used in this analysis to measure the differences in the means of scores between females and males. These results tentatively suggest that there is a trend for females scoring higher than males.

ANOVA

A one-way ANOVA test was conducted to test for preferential differences among three types of health care facilities, community health clinics, public hospitals, and private hospitals for variables associated with Factors (1-6) (Table 4). The first one-way ANOVA analysis was conducted to test for differences among the three health care facilities for the variables associated with Factor 1.

A one-way ANOVA test was conducted to test for preferential differences among four different forms of professional roles for health care workers in Haiti for variables associated with Factors (1-6) (Please refer to Table 5 for a table of relevant data). The one-way ANOVA analysis was conducted to test for differences among the four different professional roles for the variables associated with Factor 1.

Discussion Current TB Care is Inadequate The study revealed a positive correlation between the inadequate treatment of Tuberculosis and the need for more resources including medical devices. Health care workers who had more education in the field tended to recognize the inadequacy in the current method for diagnosing and treating TB in Haiti.

Male health care workers were more likely than female health care workers to find current TB care in Haiti to be inadequate.

More Resources are Needed in the Use of Medical Devices by Health Care Workers Health care workers who had more education in the field recognized a need for more resources such as medical devices and additional health care workers. Health care workers with fewer years of education in the field identified the need for additional health facilities in Haiti. It is important to note that the study was conducted in Port-au-Prince, and did not address the perceptions of health care workers in other regions. Male health care workers were less likely than female health care workers to believe that additional resources were needed. My observation at the Ti Kay Clinic revealed a shortage of in-patient hospital beds; thereby indicating a need for additional health care facilities.

Need for community-based treatment and diagnosis of TB There was a positive correlation between the inadequate treatment of TB, and the need for community based health clinics to diagnose and treat Tuberculosis. Male health care workers were less likely than female health care workers to believe that community based treatment and diagnosis of TB was needed.

My observation revealed the effectiveness of a community based health care clinic in seeing over 400 patients in a day. My

Females

Males

df

t

(F1) Current TB Care Not Adequate

4.44 (.50)

4.45 (.51)

.35

17

(F2) Need for More Resources

4.58 (.59)

4.54 (.60)

-.143

17

(F3) Need for Community Treatment

4.58 (.38)

4.57 (.74)

-.05

17

(F4) Benefits of National TB Policy

3.52 (.42)

3.50 (.94)

-.07

17

(F5) TB’s Associated Negative Effects

2.86 (.91)

2.95 (.51)

.18

17

(F6) Health Care Worker Training

3.58 (.51)

3.57 (.45)

-.05

17

Table 5. Results of independent samples t-test between responses by male and female healthcare workers.

Community Health Clinic

Public Hospital

Private Hospital

F

(F1) Current TB Care Not Adequate

4.54 (.55)

4.32 (.41)

4.42 (.52)

.26

(F2) Need for More Resources

4.78 (.39)

4.30 (.74)

4.53 (.81)

1.02

(F3) Need for Community Treatment

4.63 (.35)

4.67 (.39)

4.89 (.19)

.66

(F4) Benefits of National TB Policy

3.52 (.34)

3.13 (.78)

4.08 (1.18)

1.85

(F5) TB’s Associated Negative Effects

2.70 (.92)

2.42 (.63)

4.33 (.67)

5.45

(F6) Health Care Worker Training

3.61 (.49)

3.63 (.48)

3.00 (0.00)

2.33

Table 6. One Way ANOVA to test for preferential differences among three types of health care facilities. Reponses were divided into groups from community health clinics, public hospitals, and private hospitals and ANOVAs were performed for variables associated with Factors 1-6.

MD/ DMD

Nurse

Volunteer/ EMT Student

F

(F1) Current TB Care Not Adequate

4.25 (.51) 4.59 (.48) 4.47 (.58) 4.21 (.30)

.53

(F2) Need for More Resources

4.45 (.62) 4.60 (.64) 4.63 (.60) 4.50 (.71)

.08

(F3) Need for Community Treatment

4.42 (.96) 4.71 (.30) 4.56 (.40) 4.50 (.71)

.28

(F4) Benefits of National TB Policy

4.25 (.74) 3.18 (.64) 3.46 (.10) 3.38 (.18)

3.61

(F5) TB’s Associated Negative Effects

4.08 (.74) 2.76 (.76) 2.39 (1.09) 2.50 (.71)

3.52

(F6) Health Care Worker Training

3.25 (.50) 3.64 (.48) 3.75 (.42) 3.50 (.71)

.93

Table 7. One Way ANOVA to test for preferential differences among four different forms of professional roles for health care workers in Haiti for variables associated with Factors 1-6.

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observation also revealed the effectiveness of a triage practice where TB treatment is provided at the community based clinic and only patients with complications are referred to hospitals.

On Day 5, I observed a successful case of TB treatment in a community based health clinic. A former MDR TB patient was successfully treated for TB and now works as a volunteer in the Ti Kay Clinic.

Need for the Development of a National Policy on TB diagnosis and treatment Health care workers with more years of education in the field recognized the need for a national TB Policy. Male health care workers were less likely than female health care workers to believe that a National TB Policy was needed.

Need for Novel Approaches to Diagnose and Treat TB My observation on Day 3 revealed the need for a better approach to treating patients who are not taking their TB medication. I observed a 40 year-old male who stopped taking his TB medication. This patient is at risk for being retreated inappropriately and also the development of MDR-TB. A novel approach to diagnose and treat MDR-TB is needed. This patient also came to the clinic with his children. He was also concerned with ensuring that he did not transmit the disease to his children. Further research is also needed for an improved TB vaccine which could have been provided to his children to prevent the transmission of TB. On Day 6, I observed the limitations of the GeneXpert Testing. The results took approximately two hours to generate, and by then it was difficult to locate the patients to inform them of their results.

Provision of Training to Health Care Workers in the Diagnosis and Treatment of TB Female health care workers were more likely than male health care workers to believe that training in the diagnosis and treatment of TB was needed. Dr. Coffee, the Director of the Ti Kay Clinic, stated that there was a need to develop diagnostic devices that required little or no training from health care workers.

Recommendations Further testing is needed to determine the feasibility of EXPAR and implementation into a fully integrated point-ofcare device as an alternative means of diagnosing Tuberculosis.

Further testing is also needed to identify an effective TB vaccine, however, in the interim, the use of the BCG vaccine should be expanded to 100% of all infants. TB culture and drug susceptibility testing should be expanded to all clinics/hospitals that treat TB patients. The use of the drug Rifampin should be used in both the initial and continuation phases of treatment. A strategy to ensure that patients adhere to their treatment plans should be developed. TB treatment typically takes 6 months to complete, but the treatment time for HIV-TB cases is longer. Haiti should consider participating in the World Health Organizations Global Survey of TB Drug Resistance. This would yield more accurate data of MDR-TB cases in Haiti and hopefully lead to more effective treatment of MDR-TB. In the area of medical devices, there are a number of recommendations based upon the World Health Organization’s

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Global Forum on Medical Devices. Haiti should conduct a health technology assessment and develop a health technology plan that provides details regarding the regulation, procurement and maintenance of medical devices. Haiti should develop a national health technology policy that promotes the attainment of the Millennium Development Goals and incorporates: research and innovation, regulation, assessment, and management. Haiti should promote collaboration among community health providers, hospitals, government agencies and NGOs while providing training to healthcare workers in the use of medical devices.

Further research involving health care workers is needed to ensure that the point-of-care medical device utilized meets the needs of practitioners is in the field. Research using a larger sample size of health care workers from all regions of Haiti will be needed thereby preventing what is known as the “mismatch between the design of the device and the context in which it is used (WHO, 2010)”.

Acknowledgements

I would like to acknowledge the following individuals from Bard College at Simon’s Rock: Michael Bergman, Anne O’Dwyer, and Sue Mechanic Meyers. I appreciate the immeasurable support and guidance from the members of my thesis committee at Bard College at Simon’s Rock.

I would also like to recognize the financial support in terms of my receipt of a partial travel award which enabled me to travel to Haiti to collect data. I would like to acknowledge the following individuals from Keck Graduate Institute of Applied Life Sciences: Angelika Niemz and Tanya Ferguson. I would like to recognize their efforts in serving as mentor scientists during the summer of 2010. I appreciate the opportunity to work under their direction in Claremont, California. I would like to acknowledge the following individuals from International Medical Relief: Shauna King, Dr. Zervos and Amy Jordheim. I am grateful for the support of IMR which coordinated the logistics of my trip, assisting in securing my research site, and for the level of care they provided me during my travel to Haiti. I would like to acknowledge the following individuals from Haiti: Dr. Megan Coffee of the Ti Kay Clinic. Her efforts in enabling me to visit her clinic to collect data are sincerely appreciated.

Bissonnette, L. & Bergeron, M. (2012). Infectious disease management through point of care personalized medicine molecular diagnostic technologies. Journal of Personalized Medicine 2, 50-70.

Burgess, A. & Fitzgerald, D. (2001). Integration of Tuberculosis screening at an HIV voluntary counseling and testing centre in Haiti. AIDS, 15, 14.

Dye, C., Scheele, S., Dolin, P., Pathania, V. and Raviglione, M. C. (1999).

Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. JAMA. 282(7): 677-686.

Southeastern National Tuberculosis Center. Haiti: Cultural Competency and Tuberculosis Control: A practical guide for health professionals working with foreign born clients. (2009).

Back Cover Art by Alexia Motal