A Rural Fellow’s Experience: Challenges & Opportunities

A blog post written by Niki Euhardy, 2017-2019 Fellow

There are many definitions of “rural,” and I would argue in the case of the fellowship, “rural fellow” more or less describes fellows located outside of Wisconsin’s two largest cities, Madison and Milwaukee. During the lifetime of the fellowship, rural fellows have been placed in locations such as Shawano, Menominee, Wausau, Stevens Point, Eau Claire, Chippewa Falls, La Crosse, Lac du Flambeau, and Wisconsin Rapids - where I am placed. These are not all small towns - Wausau is the largest city in northern Wisconsin with almost 40,000 residents, while La Crosse has a population of 51,834, and Eau Claire boasts 68,587 residents. Even the smaller towns are still located near larger cities. I say this because I think sometimes “rural fellow” might scare people off a bit by leading them to think they’ll be in a town of a few hundred people with nothing to do for 2 years, but this is far from reality.

Okay, I’ll stop with my geography lesson of fellowship placements now, and talk about something I know more about - my own experience as a rural fellow. Let’s start at the beginning. I grew up in the Northeastern region of Wisconsin in an unincorporated town and attended high school in a town of about 7,000 people. It was my experience growing up in a rural area and seeing the various issues affecting my community that led me to pursue a degree in public health. To be clear, I am by no means “against” big cities - I actually lived in Madison and Milwaukee for 6 years for undergrad and grad school before returning to rural Wisconsin, and I loved every second of it and I still get excited when I get to visit those places. But even after those experiences, my heart remained in rural Wisconsin which is why I was so excited about the opportunity to be a rural fellow.

My placement site is the Wood County Health Department, which is responsible for serving about 73,000 residents throughout the county. To provide a bit more context for those who might be unfamiliar, Wood County is smack dab in the middle of the state - Pittsville, a town located in Wood County, is actually the geographical center of Wisconsin (you’re welcome for the fun fact). I work in the health department, which is located in Wisconsin Rapids, a beautiful city along the Wisconsin River, home to 17,806 residents. As my time as a fellow is quickly coming to an end, I’ve learned there’s both opportunities and challenges that seem to be unique to rural fellows, and I’d like to share what I think has been my biggest challenge and biggest opportunity so far along my journey.

In my experience, the most challenging part of being a rural fellow is not being located close to other fellows. For example, some of the Madison-based fellows get together regularly for lunch and some of the Milwaukee-based fellows occasionally meet up for coffee or activities. I’m located at minimum a 2 hour drive from the locations where other fellows are currently placed, including the other rural fellow. This is challenging because it would be great to get together regularly in-person to share our experiences, have reflection time, carpool, and just enjoy some fun, social time together. Luckily, we have our monthly Learning Community meetings where we all get together for the whole day, and this has definitely been one of my favorite parts of the fellowship because of the relationships fostered during these days.

On the flip side, one of the biggest opportunities of being a rural fellow who’s not located close to other fellows is you’re often provided more leadership opportunities since you’re the only fellow in the region. I was fortunate to have been placed at the Wood County Health Department where they are looked to as a statewide leader in public health and are very progressive in their work. Two of my biggest projects during my fellowship have been focused on advancing health equity and incorporating a health in all policies (HiAP) approach within the City of Wisconsin Rapids by conducting health impact assessments. These are big projects the health department needed a fellow to take the lead on due to limited internal capacity. Health equity and HiAP are newer concepts within the local health department context in Wisconsin and few local public health workers are proficient in these areas, so this was a unique leadership opportunity for me. Had I been in a larger organization with more capacity, it’s unlikely I would have been given such a big leadership role in these projects. I definitely was not an expert in either of these areas when I came to Wood County, but I was eager to learn as much as I could about these topics, and I learned how to be proactive, independent, and brave in the process of leading the health department’s health equity and HiAP work.

I want to keep this blog brief, so I’ll wrap it up, but the main things I want people to know about being a rural fellow are 1. It definitely doesn’t mean living in a remote place with nothing to do; 2. Not being located near other fellows can be challenging; and 3. Unique leadership opportunities are abundant. My fellowship experience has been incredible, and I wouldn’t trade my time as a fellow for ANYTHING.


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Reflecting on September

Blog post by Masami Glines, 2018-2020 fellow

Now that it is early November already I feel so behind to post this blog on this topic, but I would like to reflect on September Northern Wisconsin Trip to visit Menominee and Oneida tribes, and also the Ho-Chunk tribe in the Kickapoo Valley area.

It was eye-opening for me to see the historical damage done to the tribes over many decades.  They are still in the process of recovering and trying to find inner peace in their hearts.  As a Japanese who didn’t grow up in the US and didn’t learn US history in school, it was almost shocking.  I didn’t know that Native American children were sent to boarding schools, being separated from their parents at young age, being forced to learn English and forget their own language.

Language is such an important part of cultural heritage.  The longer I have not been using my own language regularly, the more I feel this way.  There is so much subtlety you can manipulate at ease with your mother tongue, and good feeling coming from being able to do that.  How terrible it must have been for parents of those children.   Their children missed the opportunity to learn this subtlety while they were forced to learn the language that was not theirs.  How bad the children must have felt when they grew up and realized that they didn’t know what the elders were talking about.   Not to mention other cultural traditions, way of thinking, ceremonies and values that might have been lost due to these interruptions. 

At least what we humans can do is to learn from the past.  We should be smart enough not to repeat the same mistake.   We have to keep working on directing the society to be equitable, liberating, and just, not to be divided and hurt from oppressing/marginalized relationships.  And this work is part of Public Health. 

Reflecting on the 2 years: Perspective from an Alum

I listened to an episode of the podcast “Hidden Brain” last week about parenting and they used a metaphor I want to share. The idea is that there are 2 styles of parenting, one is the carpenter and the other is the gardener. According to Allison Gopnik, a psychology and philosophy professor at UC-Berkeley,

The "carpenter" thinks that his or her child can be molded. "The idea is that if you just do the right things, get the right skills, read the right books, you're going to be able to shape your child into a particular kind of adult.”

The "gardener," on the other hand, is less concerned about controlling who the child will become and instead provides a protected space to explore. The style is all about "creating a rich, nurturant but also variable, diverse, dynamic ecosystem."”

I don’t parent. But I do spend a lot of time thinking about career goals. So when I heard this, I thought, “the fellowship is totally a garden.”

We arrive at Fellowship orientation after having gotten through grad school by doing all the right things. We read and critiqued the articles, nailed presentations by using a bunch of buzzwords, and networked with all the right people. But then we got to the Fellowship, looked around, learned that there are people who don’t like chocolate, and other people who only have like 2 cousins, and realized that sometimes things just don’t make logical sense.   

For someone who has historically found success by doing what I’m told, accepting that achievements aren’t always linear hasn’t been easy. But it’s been necessary. Perhaps I’m alone on this one, but for me, the Fellowship is where I learned that careers aren’t always like Legos, they are more like flower beds. What I once saw as building blocks, I now see as seeds. This idea works for me, not just because I have already seen some flowers from my Fellowship seeds, but also because my preceptor, Mary, is a gardener.

I’ll back up. As a new Fellow, I immediately wanted to take a class. Like I said, I have deep rooted ideas that taking a class leads to knowledge which means success. Do x and get y. Mary was in support of me sitting in on a GIS class so I could learn mapping skills, so by the end of August, I was back in the classroom. About halfway through the semester, I realized that this wasn’t a good use of my time and that knowing abstract concepts about satellite images wouldn’t do too much for me or my work. Also Google eventually gave us fusion tables, so who needs a GIS class anyway? When I talked to Mary about this and asked how she felt about me abandoning the GIS class, she told me about how she once took a master gardener class and found that knowing plant taxonomy wasn’t helping her keep her greens alive. She said that sometimes, it’s better to just do the work. And to me, that’s what the fellowship is all about. Getting your hands dirty, moving from concepts to actions, trying, failing, and just doing the work. 

When I look back on my time as a Fellow I think about things like that GIS class. Ideas I had and things I started, finished, or decided to walk away from--- which isn’t easy for me. Everything I did was a seed planted. There were a lot of false starts, or things that felt like one-off projects, with nothing building off of each other. At the time, it felt discouraging. Despite our efforts to find “the thing” I would do, the project that I could make my own, Mary and I ended up scattering seeds. In the moment, it felt like I was just running up against a bunch of bad luck. A couple of small grants we applied for weren’t funded, there was no clear direction to take when trying to build structured community partnerships, one training was enough for another group and no follow-up was needed, and so it went. I never found my thing. But by the time I left the fellowship, I left with a portfolio of work that carried me into the job I have now. In trying to take on large projects, I left with about 3 pages of small projects that hit all of the CALs and landed me a job that, after 6 months, I can confidently say that I love.

As a Fellow, I worked with Community Health Workers (CHWs). Sure, the grant we applied for wasn’t funded, but I was welcomed into their meetings and built relationships that had me creating program materials, helping with survey recruitment, then designing and presenting a poster with a CHW at WPHA.

Earlier this year, I facilitated an HIV training at the Mexican Consulate office here in Tucson with CHWs who work on the US-Mexico border. I even got to do it in Spanish. Prior to that, I conducted HIV trainings with CHWs and healthcare professionals from a couple of American Indian tribes in Northern Arizona. It is because of the work I did with Sherri Ohly and the CHWS in WI that I understand the crucial role CHWs play in engaging people in care.  

While spending time in these tribal communities, I thought about the Lac du Flambeau tribe who welcomed our Fellowship community into their work in my early days as a Fellow. After that first Fellowship meeting learning about tribes in Wisconsin, I tried to find a way for Fellows to partner with one or several of the tribes, with little success. But here I am, building partnerships with other tribes in a very different place, but who face some of the same challenges I learned about in Northern WI and then in all of the meetings that followed in which I was tested on cultural humility, patience, and bureaucracy. As much as I can understand these issues from the lens of a white lady, I think I get it. And that’s because of the Fellowship.

It is also because of the Fellowship that I’m able to have conversations about pronouns and  gender identity, which is great because I’m currently coordinating and helping to facilitate sex positivity trainings with HIV care and service providers.

I could go on and on. The data visualization lessons we had in Fellowship meetings and the poster and fact pages I made with CHWs gave me design skills that my team here has come to rely on, and I love that. I’m also able to answer questions about state health departments. And this time around, I was on the application end of the grant cycle instead of the review side. Turns out it’s helpful to have reviewed applications at the state level. The monthly Fellowship meetings I planned gave me an understanding of event planning tasks that I use every day. My participation in the WI Women in Government seminar, all of Alan’s storytelling sessions, and helping to create a podcast gave me the boost I needed to go to an op-ed workshop for women. I’m working on drafts of op-eds and, more personally, essays and stories for a local monthly storytelling event for women.

In summary, the post-fellowship life is full of color. Like in a garden, I’ve found that with the Fellowship, timing and pace don’t always work the way you expect them to, and that’s ok. You can plant two things right next to each other and they will grow in different directions at a different pace. You can’t control the weather or which way the wind blows, just as much as you can’t change who becomes the president, whether or not your work will be funded, who leaves your organization, or who might randomly drop in on a Fellowship meeting unexpectedly. So no, you can’t always control things. But you can plant seeds, be patient, and grow through what you go through. And then one day, you’ll find a blossom from something you forgot you even planted. For those of you in the middle of your Fellowship, know that growth is happening, even when the seeds feel scattered, the conversations feel random, and the buds are hard to see. The longer I work in public health, the more I realize the value of the Fellowship. I learned and grew more than I realized I would. And I hope that the Fellowship community and the CPDU sees some fruits from my time as a Fellow too.  

Thank you all for being there and creating a supportive, rich environment that allowed me to explore my interests and find my way on the path, even if that path took me somewhere unexpected. Thank you to my cohort for your unconditional kindness and support over the past two years. And mostly, thank you Mary, for always showing up and showing me how to do the work.

All my love from Arizona,

Britt

Britt Nigon, MPH 2016-2018 cohort (Preceptor - Mary Pesik, DHS)

Outreach Coordinator. Arizona AETC & Petersen HIV Clinics

Infectious Disease. University of Arizona College of Medicine

Learning Community Reflections: Tribal Health

“If you have come here to help me, you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together.” – Lilla Watson, Aboriginal activists group, Queensland, 1970s

In September, our learning community ventured up to northeastern Wisconsin for an engaging two-day monthly meeting where we learned about the culture and health of the Menominee and Oneida tribes.   

An important theme was the powerful role that the US history of colonization and systematic oppression of native communities has played in causing the current health concerns of these communities today. Just as salient was the resilience and innovation of the Menominee and Oneida peoples and how they incorporate their culture for improved health and wellness. Jerry Waukau and Diane Hietpas of the Menominee Tribal Clinic explained how compulsory boarding schools, in which Indian children were forced by law to attend government and church run schools for assimilation, caused loss of language, culture, disrupted family ties and community structure, and often resulted in child neglect and abuse (aka ACEs) which is at the root of some of the cyclical family trauma in community. The work that the clinic and its partners are doing around culturally appropriate and person-centered trauma-informed care is making a huge difference in the community, has drastically improved their high school graduation rate, and led to their Culture of Health Prize recognition by the Robert Wood Johnson Foundation. At the Menominee Cultural Museum, Dave Grignon informed us of the success of ongoing family culture camps in improving substance abuse issues in the community. He also told us about the unjust Termination (I.e. loss of sovereignty) of the Menominee Tribe in 1961 and the major losses of land control, jobs, access to health care, and wealth that resulted, taking a major toll on their quality-of-life. I find it an atrocious abuse of power how the Federal government has stopped recognizing the sovereignty of tribes or forced them off of their land whenever the existence of the tribe was inconvenient for government or corporate profits.

Fellowship Learning Community learning about food sovereignty, heirloom seeds and community rebuilding from Menikanaehkem.

Fellowship Learning Community learning about food sovereignty, heirloom seeds and community rebuilding from Menikanaehkem.

Personally, I was most inspired by our visit with the grass roots, culture-centered group, Menikanaehkem. I was moved by their guiding philosophy when planning community events, which is, “Is this event going to bring hope, belonging, meaning, and purpose to this community?” As a way to resist the deficit-minded, consumerism culture of our time, this group is refocusing on their traditional cultural practices, values, and spirituality that guided their way of life for thousands of years. Guy Reiter of Menikanaehkem embodied that traditional spirituality with his peaceful presence and conviction to do what is best for the community. He verbalized this mindset when he said things like, “the creator loved us so much that he gave us our language and culture,” “we’re adding to the beautiful story of our people,” and “what matters more than everything is that we connect with each other right here in this moment.” It was easy for me to see how reconnecting to a mindset of gratitude, beauty, and connection with the land and their ancestors can build personal and social resilience and improve the health of their community.

Our discussion with Menikanaehkem has got me pondering. In many ways, Menikanaehkem is the opposite model of governmental public health: grassroots vs. hierarchical institution, culture vs. science, personal connection vs. systems and processes. How should authority, decision-making power, and resources be distributed among these models? How can our rigid institutions be more responsive to the needs of the people in the way that grassroots movements are? What can governmental and academic agencies learn from grassroots groups, whom are closest to the largest inequities, about how to improve the social and physical environment of the communities we live in and serve? How can those of us who work in governmental public health support or collaborate with grassroots groups like Menikanaehkem in a way that honors their history, expertise, culture, and way of life?

Mr. Dave Grignon at the Menominee Cultural Museum as the Fellowship Program is hosted by the Menominee Indian Tribe of Wisconsin.

Mr. Dave Grignon at the Menominee Cultural Museum as the Fellowship Program is hosted by the Menominee Indian Tribe of Wisconsin.

I don’t anticipate having all of the answers anytime soon, but we were able to discuss that last question a bit more than the others. During our visit with Menikanaehkem, one memorable piece of advice was that “if you don’t understand us, recognize our strengths, and know your own, then you can’t help us.” Melissa Metoxen from the Native American Center for Health Professions (NACHP) and the Oneida Reservation gave similar advice. She said that the key to working with tribes is to enter into relationship with members from the tribes. That means building trust over time by putting the tribes’ interests first, meeting face-to-face, and working hand-in-hand.

~ Cory Steinmetz

365 Days Later...

We have all heard the phrase “time flies,” but man does it! Lately, we have found ourselves asking “where did the year go?” As first--almost second year--fellows, this question has forced us to pause and reflect on the ups, downs, and everything in-between. Over the span of this seemingly fast-paced year, we have gained insight intothe interdisciplinary and multi-sectoral world of public health, become more intimately acquainted with the communities we serve, and grown as public health professionals. Therefore, as the first year fellows get ready to jump into year two, we wanted to share some insight with the upcoming cohort and give others a snapshot of how the fellowship encourages growth and stimulates learning in the first year. 

What tips do you have for incoming fellows?

  • My tip for first years would be to be vocal about what sounds exciting (or not) to you! If you learn about an initiative at your placement that sounds really interesting, ask about what you might be able to contribute. More likely than not, they will be grateful for your enthusiasm and contributions.

  • I found it helpful to make a short list of what I want out of the fellowship. This meant prioritizing Core Activities of Learning (CALs) and thinking about areas I’d like to improve on. I have this list in the back of my mind and think about it often when taking on new projects. Knowing what you want is the first step to thinking about how to get where you need to be at the end of the fellowship. It sounds very Stephen Covey, but “beginning with the end in mind” has been helpful for me.

  • I learned that the fellowship community--particularly the staff-- are on your side. They want you to fully explore the world of public health and find your fit. Make a wish list that includes everything you would like to do over the 2 years, no matter how extreme the items may seem. The fellowship staff, faculty, and other fellows are great at helping you figure out how to get the experience/skills that you want and need.

  • Try to temper expectations about how quickly you will feel integrated into the work. Learning the organization and projects takes time, but you'll get there! Eventually you will feel ownership over your work, and in the meantime-- fake it til you make it! Show up, offer your time and effort, and show interest. Soon enough, everyone will be asking for your ideas and input.


What opportunities should fellows take advantage of during the first year?

  • Think outside of the box and take advantage of UW classes, trainings, or seminars that interest you. I mean when else will you have a full time job that encourages learning and experimentation as much as the fellowship! You have time and funds, so use them.

  • If possible, be a discussion section leader for a public health course! Leading a discussion section this spring was one of my favorite experiences in the fellowship thus far. Not only will you gain experience in facilitating discussions and teaching others but I guarantee you will also learn a lot from your students. Plus, it is just fun! Dr. Remington typically offers a course in the spring. I would suggest talking to him about other opportunities.

Is there anything else you would like to tell first years OR that you would have liked to know before you started?

  • Conduct informational interviews with people who are doing work that interests you. Learn how they got to where they are now, what they do on a daily basis, what motivates them to continue the work, etc. This is a great way to explore public health careers and to give you ideas for work you can do during your fellowship to prepare you (and your resume) for future employment!

  • Be flexible and adaptable – more likely than not, your outlined project plan from when your site applied will morph over the course of the fellowship and in some cases, may even look entirely different by the time you’re done.

  • Get involved with projects outside of your site such as fellow driven projects. It’s a great chance to interact with other fellows, give birth to an innovative idea, or even dive into an area of work not associated with your site projects.


Curious to learn more? One of our fellows could not have said it any better -  

“Have coffee with a former Fellow! Our fellowship community is very welcoming and wants you to succeed. Meeting with former Fellows was helpful and encouraging.” 

The invitation is always open - We hope to connect with you! 

Stevie and Janine

Zoonotic Disease, Up Close and Personal

Sometimes our work in public health and our personal health collide.  This month, I tied up my soon-to-be published report of a tickborne illness called babesiosis, and I visited our future home in wooded and beautiful Ithaca, NY for an up close and personal encounter with tickborne disease risk.  

We often joke that my eldest daughter Quinn “turns feral” when she encounters nature.  I love watching her transformation from a quiet, somewhat anxious child into a forest sprite, running through the woods without a care in the world.  Unfortunately, as a parent, I have to consider the risks of this outdoor activity, especially in an area endemic for Lyme, Babesiosis, Powassan Virus, and Anaplasmosis.  On our last day of our upstate NY trip, we took a trip to our future house and its wooded land and pasture. Out of our family of four, only Quinn ended up with a dozen nymph deer ticks on her head and body, presumably because she got closer to nature than the rest of us.  After a lengthy head and body check at the airport before our Sunday evening flight, we felt confidant we’d pulled all the ticks off.  On Thursday, we got a call from her principal at school who reported Quinn had the engorged tick on her ear. We took advantage of a free University of Rhode Island lab service, and, using an emailed picture, they identified it as an adult female deer tick and estimated it had been feeding for 3.5 days.

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Specimen discovered on Quinn's ear, under the microscope

Lyme is transmitted by the spirochete Borellia burgdorferi. Its vector is the black legged deer tick, which becomes infected by mammalian hosts such as deer and white-footed mice.  Initially discovered in the 1960’s in Lyme, CT, it is endemic to the upper Midwest and Northeastern US but cases have considerably increased in recent years, both in number and in geographic range (see below).  The causes of this marked uptick (pun intended) are likely multifactorial and include the warming climate and patterns of deforestation, with homes being built closer to wooded tick habitats (more exposure) and breaking up forests (fewer predators to keep down animal reservoirs of Lyme, such as the white-footed mice).

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Not surprisingly, these same trends can been seen with other tickborne diseases such as babesiosis, which is the topic of the report that I have been working on.. However, knowing that 20-50% of upstate NY ticks have been found to carry borellia burgdorferi, and that children can develop disabling and chronic symptoms from severe infection, I was most concerned about Lyme.

Lyme disease may develop when people are bit by an infected blacklegged tick that attaches for at least 36 hours. Within 3 to 30 days, individuals may develop early stage infection of a classic erythema migrans rash (bulls-eye in appearance), fatigue, fever, and muscle and joint pain. Some infected individuals do not display early symptoms. If not treated with antibiotics or if an individual does not display early symptoms, people progress to the early disseminated phase of infection, marked by symptoms that may include neurological effects (severe headaches, facial nerve palsy, poor cognition, inflammation of the brain and spinal cord, and/or nerve pain), cardiac effects (inflammation of the lining of the heart), and joint problems (arthritis with severe swelling of large joints). Treatment with antibiotics is usually effective for these severe complications, although there is a lot of controversy about this among the medical community.  The medical literature describes patients that go on to suffer persistent symptoms of late Lyme diseases that have not been shown to be treatable with antibiotics.  

What is a worried parent to do?  Like any good public health practitioner, I first checked the CDC website, which directed me to the 2006 Infectious Disease Society of America 2006 Guidelines. They state prophylactic treatment is warranted when the following criteria are met: 

1.      The tick is indeed a deer tick. Check.

2.      The tick was attached for at least 36 hours. Check.

3.      At least 20% of the ticks in the area are known to carry Lyme.  According to the University of Massachusetts Medical Zoology department surveillance data, exactly 20% of the ticks they have tested from the Ithaca zip code tested positive for Lyme. Check

4.      Treatment can be administered within 72 hours.  Close enough, check.

Next, I looked into having the tick tested. Our new friends at the University of Rhode Island recommended University of Massuchetts Medical Zoology lab for testing the tick. UMass has great marketing for an academic lab, using a branded name “TickReport” with the motto Because of a piece of data is peace of mind. I was a sold customer.  In addition, they boast highly sensitive and specific testing for properly collected ticks, and the test includes internal quality control checks.  We paid $50 and sent our little arthropod off in a ziplock bag on Friday and got the report back on Wednesday, complete with a picture of our tick under the microscope and the full panel of possible diseases:


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Hooray! Negative for Lyme among other things.  The CDC cautions that one should not equate the negative tick with negative infection because the individual could have had other unrecognized bites.  Also, a positive test does not mean the spirochete was necessary transmitted from tick to human.  I still enjoyed contributing to the lab’s nationwide surveillance efforts.  Our tick joined their sample of 140 ticks from our future zip code, of which 20% were positive for Lyme.   


When I first encountered the harrowingly large tick population surrounding our new house, I felt overwhelmed and disheartened by the fact that enjoyment outdoors could come at a price.  But Prevention is Power, right?  Unfortunately, the prevention of Lyme Disease at a population level involves interventions beyond my control (reduced deforestation, halting globing warming).  However, I can employ the best methods for individual prevention (clothing and hats treated with permethrin, DEET, tick checks including looking in ears) and educate my patients. These ticks don’t know who they are dealing with.


Beth Stein

PSA: Violence Against Women is Still Happening

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I’m angry.  Honestly, we- as public health professionals, as citizens, and as human beings- should all be angry. 

Lately, it seems like we actually need a reminder that women still experience violence at an alarmingly high rate.  BetweenRussia decriminalizing domestic violence and Trump’s new budgetthreatening to completely eliminateall Violence Against Women Act (VAWA) grant programs, you could be forgiven for thinking maybe it’s not an issue anymore.

But the numbers don’t lie.  in 3 women and girls across the globe experience gender-based violence[*] (1). That is over 30% of our world’s women and girls who will experience sexual, physical and other abuse in their lifetimes.  Here in the United States, more than in 3 women have experienced “rape, physical violence, and/or stalking by an intimate partner in their lifetime” with 1 in 4 experiencing severe intimate partner violence.  And nearly 45% of all American women (almost in 2)have experienced sexual coercion, unwanted sexual contact and other unwanted sexual experiences at some point in their lives (2).  What’s heartbreaking is that this already too-high number goes up for lesbians (46.4%) and bisexual women (a staggering 74.9%) (3).  And keep in mind that rape and sexual violence are some of the most underreported numbers we have (4).

In Wisconsin alone, there were 5,609 injury hospitalizations and ER visits for women 15-44 because of intentional assault in 2014.  In that same year, in one single day, Wisconsin domestic violence programs “provided services to 1,949 victims and had 367 requests for services that went unmet due to lack of resources” (5). 

In short: violence against women is not only still an issue but happening to a distressingly large percentage of American women.  (I also want to take a quick moment to recognize that sexual and gender-based violence is not exclusive to women.  This affects men as well and especially affects the LGBT+ and gender nonconforming communities.  The fact that I chose to focus on women in this blog is not meant to detract from the realities of violence to these populations.)

So, how does the fact that almost half of all American women will experience some form of sexual violence victimization in their lifetime lead to the decision to eliminate all VAWA grant funds?  Funds that Kim Gandy (President of the National Network to End Domestic Violence) said “is truly the foundation of our nation’s response to domestic and sexual violence, stalking and dating violence” (6)? 

But this issue is about more than just numbers, shocking though they may be.  Just volunteer your time at any local domestic violence shelter, sexual assault agency, or any other organizations that work with survivors[†].  Words cannot do justice to the experience of listening to their stories of pain and fear and the lifelong ramifications (higher levels of depression, suicide attempts, anxiety, PTSD, as well as poorer physical health) that come with their experiences of violence, as well as their successes in their personal journeys of healing (7). These women have been through so much and have fought so hard.  They shouldn’t have to do it alone.  They should have spaces like DAIS or the Rape Crisis Center to go to for medical help, legal help, for shelter, and for empathy and support from those who understand.

Then there’s the economics.  The CDC estimates that intimate partner violence costs us $8.3 billion dollars a year (8).  Each rape costs approximately $151,423 (9).  Some of the best research we have identifies rape as our country’s most costly crime, at an annual cost of $127 billion (this is excluding child sexual abuse) (10).  Yet we may be losing one of the only sources of federal funding that works to prevent these crimes- the 25 Office of VAW grants.  These grants provide evidence-based direct services, intervention and assistance for victims of sexual assault as well as training and prevention programs.  They cover everything from training law enforcement agencies to be more effective, trauma-informed responders, assisting with transitional housing for survivors, direct services to marginalized and underserved populations, providing legal assistance to survivors, and specifically supporting children, youth and elders experiencing violence and sexual assault (11).  Without the critical, life-saving work of VAW grants, what is going to happen to the 74 million women who have or will experience some sort of sexual violence in their lifetimes (2)?  We NEED these services. 

Many others have written about this (like this onethis one, or this one or even this one). But I truly believe this is an issue worth elevating at every opportunity.  We need everyone to understand that so many women suffer in the United States but our current government wants to completely eliminate a huge source of federal funding. 

Can we all at least agree that sexual assault and intimate partner violence (as two examples) remain a serious problem in the US?  If the answer is yes, why would we eliminate the funding?  In what world is that good math?  In what world is that the humane choice?  So YES.  I’m angry.  And you should be too.


1.            Ellsberg M, Arango DJ, Morton M, et al. Prevention of violence against women and girls: what does the evidence say? Lancet (London, England). 2015; 385(9977):1555-66. doi:10.1016/s0140-6736(14)61703-7

2.            Black MC, Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick, M.T., Chen, J., & Stevens, M.R. The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control2011.

3.            Center NSVR. Statistics About Sexual Violence2015.

4.            Thomas E. Rape Is Grossly Underreported in the U.S., Study Finds. In: The Huffington Post. 2013. http://www.huffingtonpost.com/2013/11/21/rape-study-report-america-us_n_4310765.html. Accessed February 23 2017.

5.            Violence NCAD. Domestic Violence National Statistics. In: NCADV, editor.2015. p. 2.

6.            Gandy K. Intimate Partner Violence Report Proves VAWA Works. In: Post TH, editor. The Blog. The Huffington Post2012.

7.            Carlson BE, Mcnutt L-A, Choi DY, et al. Intimate Partner Abuse and Mental Health

The Role of Social Support and Other Protective Factors. Violence Against Women. 2002; 8(6):720-45.

8.            Prevention CfDCa. Intimate Partner Violence: Consequences. Atlanta, GA. 2015.https://www.cdc.gov/violenceprevention/intimatepartnerviolence/consequences.html. Accessed February 23 2017.

9.            DeLisi M, Kosloski A, Sween M, et al. Murder by numbers: monetary costs imposed by a sample of homicide offenders. The Journal of Forensic Psychiatry & Psychology. 2010; 21(4):501-13.

10.          Miller TR, Cohen MA, Wiersema B. Victim Costs and Consequences: A New Look. In: Justice UDo, editor.: Office of Justice Programs; 1996. p. 35.

11.          Justice TUSDo. Grant Programs. United States DOJ. 2017.https://www.justice.gov/ovw/grant-programs. Accessed Feburary 23 2017.


[*] As defined by the UN: gender-based violence is “physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or private life”[†] But really, you should probably look into volunteering because they are going to need all the help they can get if their programs are defunded.

Leslie Tou, MPH

Population Health Service Fellow, 2nd Year

Wisconsin Department of Health Services

UW-Madison Lifecourse Initiative for Healthy Families

Madison, Wi