A second-year student at the University of Arkansas Clinton School of Public Service, Liz Reich is currently in Quito, Ecuador, working on a combined International Public Service and Capstone Project with Novulis.
A business providing healthcare through mobile and stationary clinics on job sites, Novulis is working to bridge the gap of access to preventative healthcare services in Latin America.
Reich, who grew up outside of Chicago in Forest Park, Ill., used her connection with childhood friend and Novulis CEO Greg Krupa for the basis of her work.
“With the Clinton School project, I just gave him a call,” Reich said. “I asked, ‘Hey, I have to do an international project, what do you need? Is there a place for me?’ He said, ‘Of course. What’s your dream project?’”
Reich’s first-year experience at the Clinton School was different from the majority of her classmates. At a time when most were just beginning to research potential organizations and destinations for their IPSPs, she was securing long-term strategies for one connected project.
Making it even more unique, she postponed the start of her IPSP – typically a summer project – until the fall in an effort to improve her Spanish. She even considered picking up shifts at a local Cuban restaurant before enrolling in language classes.
“I knew going into the Clinton School that I wanted my project to be based in a Spanish-speaking country, because living in Austin, Texas, Spanish is so necessary,” Reich said. “I’ve always had a foundation for it but it needed some improvement.”
How did you know your IPSP and Capstone plans so early?
I grew up with Greg, who has been in Latin America for about 10 years. He founded a mobile health clinic, specifically focused on mobile dental health. It travels to rural areas in Ecuador‘s Andean highlands. I’d been discussing coming down here for a while to get involved in something with him, but the timing was never right.
I told him I was really interested in reproductive health but thought that he mostly focused on dental work. He said that they’d been thinking about trying to expand their core services and they’d seen a huge need for reproductive health.
What was the planning process like for this project? You knew what you wanted to do months before most students.
It was based on this conversation with Greg, which took place in September of my first year at the Clinton School. I immersed myself in research related to Ecuador’s indigenous populations, reproductive health outcomes, family planning, and trying to design my dream project. That was really neat.
I knew I didn’t want it to be just an IPSP. I’ve worked abroad before, and I know how difficult it is to get good work done and to really learn the context of a place. I spent a solid year researching everything—all my work for Dr. Bavon’s class was program planning for my actual program which made the stakes a bit higher. It was going to take some time to get used to things and feel comfortable.
Part one for me was sort of the research side of things, a formal needs assessment. Additionally, I knew I would be working with people and talking about really sensitive topics. I knew I was going to have an intern that was a local person who spoke Spanish. I didn’t want to be that person that just goes to a place and relies on someone else to do everything for them, so I decided to postpone my project even further and take a lot of Spanish classes over the summer in Texas. I just tried to find any opportunities I could to become stronger in conversational Spanish.
How did you improve your Spanish so quickly?
It was difficult. Originally there was this Cuban restaurant in my neighborhood in Austin. The guy was really nice, so I told my fiancé, “I’m going to get a job at the Cuban restaurant.” He was like, “What are you talking about?” I said, “I need to learn Spanish. I will wash dishes, I’ll do anything I just need to hear it all day long.” But this Cuban restaurant closed out of the blue, and my plan was foiled.
I went the more formal route and went through a language school. Through the school, I met a girl from Colombia that was learning English. She and I started having exchanges weekly, in addition to the classwork.
The school was great. My teacher was really supportive, and she knew I needed as much experience as possible. She would take me on little field trips around town. Her daughter came in from Mexico to visit, so she would take me out to lunch and introduce me to other native speakers to give me that extra experience outside of the classroom, which was super helpful. It certainly didn’t make me fluent or close to fluent, but it gave me more of that knowledge base.
What are some of the specifics of your research?
We did it in three phases. For the first part of our work, we did in-person surveys because literacy was a concern. We wanted to make sure that all the surveys were delivered orally, and we did just over 300 surveys across six farms. That included questions about health access, family planning methods, and some demographic information, such as number of children, their age, whether they want to have more kids, what that timeline looks like, and what their perceptions of the public health services are.
The last question was if they would be willing to talk to us in the future at greater length, knowing that their employer had agreed to it and of course they could change their mind if they wanted to. We got quite a few people who agreed, many more people than we could actually interview!
For the second part, we went back and did 56 in-depth interviews. We got into the specifics of what the communities were like where the people were living. The interviews were definitely more personal and sensitive in nature, so we made sure people knew that before they followed through. That was probably one of the most useful parts of the research, just getting some of the anecdotal qualitative data about peoples’ lives.
For the third part, we actually visited the public health services that people in those regions use. We would show up to the public health services and observe things, like how many people were in the waiting room, what the wait times were like, the process in general, if you could make an appointment right then, and how long would it take to get an appointment for a pap smear.
What does Novulis plan to do with your research?
Novulis is hoping to expand to other public health services and reinvest any profit into more mobile units. Right now, they have one big mobile unit. They also have some stationary clinics at some of the larger farms.
A lot of the farms that Novulis works with are fair-trade farms. A lot of them are interested in providing their workers more than just the work experience. They want to be socially responsible and help their workers. They use the fair-trade certification to do that.
Novulis also offers services to workers that are partially subsidized by the employer. With dental, the employer will cover the cost of preventive services, so a routine dental checkup and cleaning, the employer will pay for 100 percent. Depending on what follow-up work is needed, the employer can subsidize part of that and the worker pays for the rest of it over a period of up to six months. It’s a really cool model and ends up being really affordable.
It’s really high-quality care that’s brought to the workers at the job site, so they don’t have to ask for the time off work and deal with the rigorous process of dealing with the public health services. Not that the public health services are bad. They’re just not ideal for people who are working full time.
What my research found was that the same thing is true with dental as it is for routine reproductive healthcare. These are things like annual gynecological exams for women and any sort of testing around STDs or STIs. Generally, I found that the workers feel like if they don’t observe a physical problem, they don’t see the reason to go and get tested.
What I’m doing now is helping to create a pilot program that will expand Novulis’ services to bring routine preventive reproductive health care, specifically cervical cancer screenings, gynecological exams and some basic health assessments and screenings for common STDs and STIs.
What are your plans for the conclusion of your Capstone? Do you hope to return to Ecuador?
I don’t have immediate plans to return to Ecuador, but I know that I will return and I look forward to that day. It’s such a neat country that is not on many people’s radars—but it should be!
I know Greg and his organization well enough to know that they’ll take everything I’ve done and run with it and everyone is enthusiastic about it. Thanks to modern technology, I’ll always just be a call away as well.
The project is still in formation right now, but whatever shape it takes, something interesting is going to come from my research. That’s a really cool feeling, because I invested a lot of myself into the research. A lot of early mornings and late nights reading clinical articles that were slightly above my knowledge base! Everyone’s like, “Are you a doctor? Why are you interested in this?” It’s hard to not be a clinician but have the interest in promoting something like this.
I’m super interested in public health and program design and program planning. This experience has been really useful. At times I’ve felt like, “I can’t believe I’m doing this. I’m designing a real program.”
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