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About My Trip

My name is Simar Bajaj, and I am a senior at Harvard College, Marshall Scholar, and award-winning journalist. This summer, I'm planning to travel across different parts of the world, reporting on stigmatized diseases — conditions where patients are blamed for their conditions. I have chosen the following 10-12 countries based on two criteria: 1) a setting that is an exemplar for addressing a stigmatized disease, or one that has struggled in response and 2) a setting where I have some global health connections.

My interest is primarily journalistic: I will be writing stories about my travels and these various stigmatized diseases. I have spoken with editors at the New York Times, NPR, Smithsonian Magazine, New Scientist, STAT News, and The Guardian, all of whom are interested in publishing my stories from these two months of travel. Ultimately, however, I hope to bring together my insights about stigma into a book I write during the Marshall Scholarship, which is tentatively titled "Stigma is a Disease." I have spoken with two literary agents interested in the idea, and they envision how each chapter could explore a different stigmatized disease and how countries have successfully (or unsuccessfully) sought to address the crisis.

In terms of my methodology for calculating the below costs, I used Google Flights to check prices, electing for direct flights and red-eyes where possible (to reduce chance of missed connections and hotel use, respectively). I used Expedia to see hotel prices, choosing places that were nearby the relevant clinical sites and ones with good reviews but in the bottom 25th percentile of cost. I used the U.S. Department of Defense Travel Management Office's website to calculate per diem meal rates by country, although I plan to eat as cheaply (but safely) as possible. Whatever I don't spend on meals from this per diem rate will likely be spent on transport and incidentals. Finally, I used embassy websites to check for the relevant visa fees.

Copenhagen, Denmark

Mental Health + Obesity

Flight to Denmark: Leave KEF 1:10 AM on 6/6, Arrive in CPH 6:20 AM on 6/6 (FI 202) — $239

Lodging: 6/6 Night — Stay in Where to Sleep Hostel — $41 a night

Per Diem (Proportional Meals): $62 (total $124)

Planned Reporting

  • MENTAL HEALTH — Denmark is the only country in the world where a campaign against mental health stigma has been integrated into the federal health department. The program, ONE OF US, is made up of ambassadors (people with mental illness) and promotes social contact as a foundation for destigmatization. What explains the program's success over the past decade, and what can other countries learn from the Danish Model? I have already met with Anja Kare Vedelsby, the project manager of ONE OF US, and she has connected me with staff in their Capitol Region (i.e., Copenhagen) so that I can interview Ambassadors and sit-in on activities happening over my two days.

  • OBESITY — Denmark is home to Europe's most valuable company, Novo Nordisk. I plan to tour their offices in Bagsvaerd, Denmark (just outside of Copenhagen) and report on how this company is working to make access to Ozempic and Wegovy more equitable, especially as over half the world will have obesity by 2035. HIV medications offer an attractive model — selling drugs at-cost in the Global South and at significant profit in the Global North — but is Novo Nordisk preparing for that global model, or relegating low-income countries to an obesity prevention regimen alone? Through an introduction by the President of the World Obesity Federation (Johanna Ralston), I have met with Anna Myrup, Associate Director of Global Obesity Policy at Novo Nordisk, and she is helping me set up interviews with senior leadership and working to set up a tour of the company's headquarters.

Pro Bono Interpreter: Sahar Reihaninia

Visa: None

Total (Flight + Lodging + Meals): $404

Travel Plans

June 1  - June 5

Reykjavík, Iceland

Mental Health + Obesity

Flight To Iceland: Leave SFO 7:30 AM on 5/31, Arrive in KEF 8:25 AM on 6/1 (WS 1521 + WS 38) — $426

Lodging

  • 6/1 Night — Stay in house of fellow Harvard College student Kristín Hákonardóttir — FREE

  • 6/2 + 6/3 + 6/4 Night — Stay in Bus Hostel Reykjavik — $57 a night (total $171)

Per Diem (Proportional Meals): $84 (total $84 because food at conference is covered and first night is at Kristín's house)

Planned Reporting

  • OBESITY — Iceland has one of the highest obesity rates in Europe, with its rates even higher than that of the United States. How have rates become so high, despite Icelandic food choices being ranked one of the healthiest in the world with fish, lean meats, and plenty of their yogurt skyr? How does the environment, with frigid winters with only few hours of sunlight, make physical activity difficult? And how is the this island nation trying to stem this rising tide of obesity? I have already connected with Sólveig Sigurðardóttir, President of the European Coalition for People Living with Obesity, and she is connecting me with patients and healthcare professionals in Iceland to interview and shadow, respectively. 

  • MENTAL HEALTH — The Together Against Stigma Conference from the World Psychiatric Association is being held at the University of Iceland from June 3-5. I am attending as a journalist because some of the world's most innovative mental health experts will be presenting. I have already met with Bernice Pescosolido and Sigrún Ólafsdóttir, co-chairs of the conference, and they've waived the registration fee for my attendance. The full conference schedule is expected to come out within the next few weeks.

Pro Bono Interpreter: Kristín Hákonardóttir

Visa: None

Total (Flight + Lodging + Meals): $681

June 6 - June 7

June 8 - June 15

New Delhi, India
Leprosy + Obesity

Flight to India: Leave CPH 8:45 PM on 6/7, Arrive in DEL 7:35 AM on 6/8 (AI 158) — FREE (already booked via airline points

Lodging: WHOLE TRIP — Stay in grandmother's house — FREE

Per Diem (Proportional Meals): FREE

Planned Reporting

  • LEPROSY — Despite being one of the oldest stigmatized diseases, leprosy afflicts more than 200,000 new patients each year. The majority of these occur in India, partially the product of prematurely stopping the eradication campaign in 2005. I plan to spend time in the Satya Jeevan Leprosy Society, the largest leper colony in New Delhi, to meet and speak with these patients. (The colony is closely associated with a local Hindu temple, and I think there is an interesting opportunity to explore the intersection of faith healing and stigmatized diseases, with leprosy seen as a punishment for sin.) I am also planning to spend time shadowing India's leading leprosy specialist at the All India Institute of Medical Sciences. How has the healthcare system failed these patients, and how does leprosy stigma continue to preclude access to care and social services today?

  • OBESITY — India is now the most populous country and thus the most promising market for the fast food industry. Much like the world saw with the tobacco industry, when public sentiment and regulations turned against cigarettes in the United States, fast food executives are turning to emerging economies like India as demand has stalled in the West. As Hanneke Faber, the outgoing head of nutrition at Unilever, put it “India’s on fire,” saying that the nation is a “fantastic growth engine.” Correspondingly, the country's obesity rate is set to increase by 80% by 2035. I'm interested in writing a story about how hospitals are already started to be overwhelmed by spending time with the bariatric surgeons at Medanta Hospital, how the Professor Monika Arora and the Public Health Foundation of India is shaping regulations, and what it will take to turn the tide on skyrocketing obesity rates.

Pro Bono Interpreter: N/A (I speak Hindi)

Visa: Obtained Already

Total (Flight + Lodging + Meals): $0

June 16 - June 20

Nairobi, Kenya
Mental Health + Breast Cancer

Flight to Kenya: Leave DEL 4:50 AM on 6/16, Arrive in NBO 1:15 PM on 6/16 (EY 211 + EY 767) — $238

Lodging

  • 6/16 + 6/17 Night: Stay in Fedha Residences — $34 a night (total $68)

  • 6/18 + 6/19 Night: Stay in West Wood Hotel — $30 a night (total $60)

Per Diem (Proportional Meals): $36 (total $144)

Planned Reporting

  • MENTAL HEALTH — Kenya has increased its mental health capacity by 85x between 2017 to 2020 (from 0.18 to 15.32 per 100,000), but there are still significant shortages. Given Sub-Saharan Africa's median age is 19 and the disproportionate burden of mental illness among young people, Kenya's famous Shamiri Institute has created a for-youth by-youth lay counseling program and deployed it across schools in the region. I'm planning to spend time chatting with these youth counselors and sitting in on their training and counseling sessions, with the goal of understanding how they've created a culturally appropriate program given that most existing ones are tailored for the Global North.

  • BREAST CANCER — The WHO estimates that that cancer cases are expected to surge 77% by 2050, the product of tobacco, alcohol, obesity, pollution, and various other factors. Breast cancer is the most prevalent cancer type on the African continent, but no country has a national mammogram program, which is important because early detection and treatment is the key to reducing mortality. Kenya is one of three in Africa, where the World Health Organization is piloting an effort to increase cancer screening. I have connected with the country's leading breast cancer surgeon, Miriam Mutebi at Aga Khan University, and the WHO to spend some time in the hospital and the community, understanding how the program is working. I am also curious about how these efforts are faring given well-recognized stigma against women's cancers in the country but also a recent surge in pharmaceutical company funding to roll that stigma back?

Pro Bono Interpreter: TBD

Visa: Kenyan Electronic Travel Authorization — $34

Total (Flight + Lodging + Meals + Visa): $544

June 21 - June 24

Kigali, Rwanda
PTSD + Cervical Cancer

Flight to Rwanda: Leave NBO 8:50 PM on 6/20, Arrive in KGL 9:30 PM on 6/20 (WB 403) — $240

Per Diem (Proportional Meals): $41 (total $164)

Lodging: 6/20, 6/21, 6/22, 6/23 Night: Stay in Yambi Guesthouse — $35 a night (total $140)

Planned Reporting

  • PTSD — This year is the 30th commemoration of the Rwandan Genocide, when nearly one million ethnic Tutsi and moderate Hutu were killed within 100 days while the international community stood by. From this horrific trauma, however, has come one of the most progressive mental health programs in the world. In 1995, just one year after the genocide, the Rwandan government established a mental health division within the National Ministry of Health; more recently, it has focused on the decentralization of care and group counseling services — to make mental health more accessible. What other countries can learn about how a country can recover from unspeakable tragedy? What does the situation look like on the ground in Rwanda today, and what are the continued challenges? I have already connected with the outgoing Director of Mental Health in the Rwandan Ministry of Health, and I am in the process of getting introductions to sit in on some group counseling sessions and speak with genocide survivors who are suffering from PTSD, as well as their children, reflecting the weight of intergenerational trauma.

  • CERVICAL CANCER — Rwanda is the first country in Africa to develop a national cervical cancer program to prevent, screen, and treat women with the disease, and they are on track to be the first country in the world to fully eliminate cervical cancer. Community health workers go door-to-door in villages encouraging vaccination and screening, as well as dispelling myths around infertility. There is a well-recognized stigma against women's cancers, but Rwanda has been able to navigate around it, a combination of over a decade of trying (from 2011, when the national HPV vaccination program was started), a society where women are seen as the hearts of the family, and the dogged advocacy of the country's first lady. I have already connected with Dr. Christian Ntizimira, one of the country's leading oncologists and a key architect of the cervical cancer outreach program.

Pro Bono Interpreter: TBD

Visa: Visa on Arrival — $50

Total (Flight + Hotel + Meals + Visa): $594

June 25-26

Capetown, South Africa
Lung Cancer

Flight to Capetown: Leave KGL 10:30 PM on 6/24, Arrive in CPT 8:15 AM on 6/25 (WB 102, SA 303) — $459

Lodging: 6/24 and 6/25 Night: Stay in The Villa Rosa Bed and Breakfast — $39 a night (total $78)

Per Diem (Proportional Meals): $42 (total $84)

Planned Reporting

  • LUNG CANCER — This disease is the most prevalent and deadliest cancer in the world, killing more people than the next two combined. However, South Africa is the only country on the continent where lung cancer is the deadliest cancer. Why are smoking and lung cancer rates uniquely high in this country, how is this linked to the legacy of colonization/Apartheid, and how is the country struggling to take care of its lung cancer patients? I plan to go to Capetown because the Western Cape has the highest lung cancer rate in the country and because I have already connected with Dr. Abba Malloum, a radiation oncologist who has offered to let me shadow him so that I may speak with patients and understand their stories. I also plan to report on South Africa's fledgling attempts to start a national lung cancer screening program, essentially going it alone because only 10 countries have established such programs and none in Africa. How is stigma playing out in terms of dedicating the societal resources for lung cancer screening, and what is the plan to ensure uptake — given that the U.S. program's uptake is only at 5%?

Pro Bono Interpreter: None Needed (Former British Colony)

Visa: None

Total (Flight + Lodging + Meals): $621

June 27-28

Mbabane, Eswatini
HIV/AIDS

Flight to Eswatini: Leave CPT 6:05 AM on 6/27, Arrive in SHO 10:50 AM on 6/27 (4Z 926 + 4Z 82) — $149

Lodging: 6/27 and 6/28 Night: Stay in Emafini Country Lodge — $48 a night (total $96)

Per Diem (Proportional Meals): $30 (total $60)

Planned Reporting

  • HIV/AIDS — Eswatini, formerly known as Swaziland, is a landlocked nation inside South Africa. It's also the country with the highest HIV rate in the world at 27.9% but, remarkably, one of only six countries worldwide to reach the 90-90-90 AIDS treatment target. This target refers to 90% of all people living with HIV knowing their status, 90% of people with diagnosed HIV infection receiving sustained antiretroviral therapy, and 90% of people receiving antiretroviral therapy having the virus suppressed in their bodies. It's a remarkable achievement and a reflection of the success of PEPFAR program. I want to tell the story of why Eswatini has the world's highest HIV rate, how this country has been so successful treating this disease, and what the future holds with PEPFAR not being reauthorized by Congress.

  • Pro Bono Interpreter: None Needed (Former British Colony)

Visa: None

Total (Flight + Lodging + Meals): $305

June 30-July 2

Singapore, Singapore
Drug Use

Flight to Singapore: Leave SHO 8:10 AM on 6/29, Arrive in SIN 6:10 AM on 6/30 (4Z 81 + SQ 479) — $579

Lodging: 6/30 and 7/1 Night: Stay in Bliss Hotel Singapore — $64 a night (total $128)

Per Diem (Proportional Meals): $64 (total $192)

Planned Reporting

  • DRUG USE — Singapore has some of the world's strictest anti-drug laws, with the death penalty applying for trafficking of more than 15 grams of heroin or more than 500 grams of cannabis. While much attention has focused on harm reduction models in the U.S., how has this zero-tolerance, criminalization approach fared in Singapore? What does treatment and rehab even look like in this country — is there a model beyond detox? What does that portend for stigma? I am interested in exploring these questions, and how Singapore as a small, wealthy island nation may be the only place where this kind of approach is even possible.

Pro Bono Interpreter: None Needed (Former British Colony)

Visa: None

Total (Flight + Lodging + Meals): $899

July 3-July 9

Philippines (Miscellaneous)
Drug Use + Obesity

Flight to Philippines: Leave SIN 1:30 AM on 7/3, Arrive in MNL 5:40 AM on 7/3 (5J 804) — $99

  • Flight to Cebu: Leave MNL 6:20 AM on 7/4, Arrive in CEB 7:50 AM on 7/4 (5J 561) — $32

  • Flight to Clark: Leave CEB 8:15 PM on 7/4, Arrive in CRK 9:45 PM on 7/4 (5J 156) — $59

  • Drive from Clark to Manila: TBD

Lodging:

  • 7/3 night: Stay in Studio 89 Katipunan QC — $32 a night

  • 7/4, 7/5, 7/6, and 7/7 night: Stay in ABC's for Global Health student lodging — FREE

  • 7/8, 7/9 night: Stay in Manila Prince Hotel — $38 a night (Total $76)

Per Diem (Proportional Meals): $47 for Manila, $41 in Cebu, FREE for Clark (total $182)

Planned Reporting

  • DRUG USE — Under former President Duterte, over 6000 suspects died in anti-narcotics sting operations, although Human Rights Watch expects the number is actually double official estimates. The Philippines has had a new President (Marcos Jr) since 2023, one more "geared towards community-based treatment, rehabilitation, education, and reintegration" in his own words. It's one thing to say these things, but what's the situation on the ground? How has the country build back trust for treatment? I intend to spend some time in the slums of Manila (with the Arnold Janssen Kalinga Foundation), understanding the aftermath of the "War on Drugs" and how people perceive treatment. I also intend to make a day trip to Cebu to visit IDUCare, a harm reduction program in the Philippines. How is such a liberal approach to substance use possible in a country with one of the most violent approaches to the problem?

  • OBESITY — In the Philippines, rates of overweight and obesity have nearly doubled over the past 20 years, among both adolescents and adults. I want to understand the drivers of this rapid increase, from growing McDonaldization of the country to the impact of the Filipino diaspora on shifting cultural attitudes. I am also interested in the country's seemingly whole-of-government approach to addressing the obesity epidemic, particularly with its National Policy on Addressing Overweight and Obesity. I am also interested in how any anti-obesity programs intersect with the continued malnutrition problem in the Philippines, which is one of President Marcos Jr's key priorities. In a society where under and overnutrition are serious problems, can they be tackled simultaneously? I will spend time with Stanford professor Julieta Gabiola in Pampagna (region where Clark is) to see patients with metabolic disorder with her mobile clinic, as well as University of Philippines professor Elizabeth Paz-Pacheco to see patients at the endocrinology outpatient clinic.

Pro Bono Interpreter: Ranielle Gallego in Manila, Julieta Gabiola in Clark, TBD in Cebu

Visa: None

Total (Flight + Lodging + Meals): $480

July 10-July 14

Ho Chi Minh City, Vietnam
HIV/AIDS + Mental Health

Flight to Vietnam: Leave MNL 6:45 AM on 7/10, Arrive in SGN 8:30 AM on 7/10 (PR 591) — $124

Lodging: Staying with research collaborator Kevin Nguyen's house - FREE

Per Diem (Proportional Meals): Free

Planned Reporting

  • HIV/AIDS — Stigma in healthcare settings is one of the biggest obstacles to ending AIDS, and Thailand is a pioneer in combatting this issue. Back in 2018, Vietnam piloted a stigma and discrimination reduction program in Ho Chi Minh City, following the Thai model and translating it for the local context. I want to investigate how successful this pilot has been for destigmatization because it suggests how translatable this program might be for other contexts. Nguyen's father is a physician-leader at University Medical Center in Ho Chi Minh City, and he is helping connect me with some local AIDS physicians in the city, as well as the leaders of this destigmatization campaign. More broadly, I am curious about Vietnam's policy evolution on HIV  from punitive control measures to a more harm reduction approach, especially given the government's national strategy to end the AIDS epidemic by 2030.

  • Mental Health — My collaborator Nguyen is on the board of a global health program to Sóc Trăng, a rural province south of Ho Chi Minh City. One of their four projects is focused on mental health, given the significant stigmatization in the Vietnamese context — where these diseases are seen as a punishment for improper behavior in a previous life, or the possession of angry ancestral spirits. Correspondingly, many patients struggle on their own, with little support from their families and friends. With Nguyen's program, I am eager to speak to patients about their struggles navigating the healthcare system and seeking care, hoping to assess both interpersonal stigma and self-stigma. How is the WHO working to better integrate mental health into primary healthcare, and will it even matter given such cultural resistance and psychiatrists being seen only as “Bac si tam than,” or “doctors who treat madness"?

Pro Bono Interpreter: Kevin Nguyen

Visa: Vietnam eVisa — $25

Total (Flight + Lodging + Visa): $149

July 15-July 17

Taipei, Taiwan
Lung Cancer

Flight to Taiwan: Leave SGN 1:25 AM on 7/15, Arrive in TPE 5:55 AM on 7/15 (VJ 840) — $134

Lodging

  • 7/15 and 7/16 Night: Stay at Hotel Riverview Taipei — $58 a night (total: $116)

Per Diem (Proportional Meals): $52 (total $156)

Planned Reporting

  • LUNG CANCER — In Taiwan, over 50% of lung cancers occur in never-smokers, with the rate even higher among women with lung cancer (93%). The country is also home to the world's first effort to screen people who have never smoked for lung cancer, the TALENT study. In U.S. for reference, you have to be a heavy smoker to be eligible for screening, leaving the 20% of Americans who get lung cancer as never-smokers behind. What does stigma against lung cancer look like in a country where most people who get it never smoked? What does this portend about the future as air pollution increases while smoking rates decrease — one where the never-smoker lung cancer rate may climb higher and higher?

Pro Bono Interpreter: Ewen Sheng-Yao Huang

Visa: None

Total (Flight + Lodging + Meals): $406

Flight to Boston: Leave TPE 11:40 PM on 7/17, Arrive in BOS 7:55 AM on 7/18 (BR 26 and AS 536) - FREE (paid for by Schmidt Awards so that I can attend a conference at MIT)

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