Fall 2018 iVein® Health and Wellness Scholarship Winner

Mathew Nokes, MD

Twice a year we award a student the iVein® Health and Wellness Scholarship. Students must write an essay that promotes a practical approach to a healthy lifestyle in college and how these habits can be sustained over a lifetime.

This year’s fall scholarship was awarded to a student from Yale. Here is the winning essay:

APIA, Samoa—In the early heat of the morning rush-hour, a line wraps around the corner for 10 sene panikeke, small buttered doughnuts donning the check-out lines of markets. A woman hands her children plastic bags filled with panikeke as they each pop one into their mouths, wiping streaks of frying oil on their lava lavas. She hands them each a bag of Bongos, the Pacific’s most popular brand of cheese puffs, for a lunchtime snack and sends them on the public bus as vendors try the perimeter with bags of chips and soft drinks.

I looked on in confusion. A papaya tree stood tall directly behind me, ripe with its orange-red fruit. Avocadoes, limes, pineapple, and oranges… I envied this tropical oasis placed directly before those who preferred canned Vienna sausages or corned beef. Yet, as much as I tried to search for answers, I began to find an innate similarity between the choices made by the Samoan people and those made by college students.

Why do these food preferences exist? What has caused this epidemiologic transition from fresh produce to high-fat diets?

These questions formed the crux of my research questions this summer as I traveled to Samoa as a Wilbur Downs International Research Fellow to investigate the chronic disease burden in Pacific Islanders. The Pacific faces the highest rates of obesity and diabetes globally, in which up to 93% of adults are overweight or obese and nearly 47% have diabetes. Lifestyle changes, nutrient-poor diets, and a lack of physical activity have contributed to significant noncommunicable disease morbidity and mortality. On top of these existing challenges, geographic isolation from the nearest specialty care centers in Hawaii and New Zealand, which are more than 2000 miles away, has created a system where many cannot access proper care. Medical supplies are limited and the cost of diabetic care is unsustainable.

In 2011, the Pacific Islands Forum even issued the statement, “The Pacific is in an NCD crisis.” How did the Pacific get here? What will the chronic disease burden look like 10 years from now?

Traveling to remote villages, I was hoping for an answer that would address the unique challenges of Pacific Islanders. I collected anthropometric measurements, blood pressure, hemoglobin A1C values, and even screened for eye complications. Yet, as much as I expected that these would deliver me the answer I was looking for, it was through conversation with the Samoan people that I gained remarkable insight into the difficulty to achieve healthy living.

“It’s affordable and pre-packaged,” some of the villagers noted. Others commented, “Those with larger stature are viewed as more beautiful, wealthier, …more Western.” And others would note, “We don’t have time to sit down for a long lunch. There is no such thing as ‘lunchtime’ here. You grab what you can and continue to work.”

As I listened to their recounts, I realized that despite traveling across the world, I had uncovered some of the very same tenets that I—and other college students—encounter at home. Affordability, time, and social perception—these three factors weigh heavily in food choice and the ability to live a healthy lifestyle. As a Master of Public Health student, I was familiar with the role that external factors, including cultural norms and social variables, play in the rise of the obesity epidemic in the United States, but did not anticipate the similarity among these variables that exists on a global scale.

I boarded the plane from Samoa to Boston, considering what I had witnessed and what I had discussed with those from some of the most remote villages. I questioned my lifestyle choices as a college-aged female student, acknowledging that affordability, time, and social perception often dictated my food choices while living at college. Pursuing a rigorous curriculum and course-load, I found that many of my peers and myself often allowed healthy food choices to suffer at the expense of attending class, staying in the laboratory until 11:00 pm to finish an experiment, or skipping lunch to attend an organizational meeting.

As a first-generation college student, I experienced the challenge that cost and social perception plays these decisions—between choosing less expensive snacks versus more expensive fruit or vegetable options. Just as Samoans expressed that many of these factors began to control their decisions, I found that I had also fallen victim to these variables.

I was frustrated. I felt that these choices had to be black or white…for myself, for Pacific Islanders, for first-generation or low-income students, and for all college students.

Seeking to address just a few of these healthy lifestyle barriers—affordability, time, and social perception—I approached healthy living with a community I could support and would support each other in turn. As President of A Leg Even, the First-Generation and Low-Income Student Network at Yale, I have worked closely with first-year students encountering the challenges of college-life and how to balance an academic lifestyle with personal health. I have worked with students to obtain PDF versions of textbooks to avoid the cost, to create a community that shares professional clothing for interviews and meetings, and to openly discuss questions related to choices during their first year.

Recognizing the inherent need for earlier guidance and intervention with regards to healthy living, I implemented the first Yale First-Generation Speaker Series, inviting professionals to speak about how they managed their finances as a first-generation or low income college student, and how these relate to healthy living. I witnessed the powerful underlying causes that tied my work with first-year students at Yale and the community of Samoans who generously invited me into their homes and villages, making healthy living far from a narrow but rather a global endeavor.

I have learned to approach public health and community work with the provision that you cannot judge the condition of another without providing equity in resources and the empowerment to sustain them.