Developing Sustainable, Culturally Sensitive, Health-Based Interventions in Ecuador

My name is Yianni Ellenikiotis. I’m from San Francisco, California. I’m currently studying Oral and Public Health at the Harvard School of Dental Medicine. I’m planning to work with the pediatric population in the future and also hope to develop health-based interventions on a community- and population-based level.

I’ve always felt pressure growing up, mostly internal but also some external, to succeed at everything that I do. I always felt like I needed to be a top performer, so my life was always focused on getting the best grades; being the best at sports; getting to the next stage in life, the best college, and the best jobs; and being a top athlete and top student. I never really focused on actually discovering what I wanted. I felt one of these potential admirable jobs would be something in the health profession, so I always thought that I would do that, but honestly, I have no clue why. I never did anything outside of work hard and do well.

I had a lot of different experiences in undergrad that have shaped where I am now. I didn’t know at the time. I focused on studying and on doing well. I joined the rowing team at the University of Michigan. It was great, but forecasting the future, I realized nothing really changed about these pressures. They always existed; they caused a lot of stress. Some things happened. Some transformative experiences happened during undergrad that have shaped the trajectory of my life—those being becoming a resident adviser and volunteering abroad. I bring these up because the people and experiences that I surrounded myself with in those specific experiences changed the way I looked at myself and the way I looked at the world. I knew what I wanted to pursue in the future.

To talk just a little bit about where they’ve led me to a career in dentistry and hopefully public health, as well, I realized that more than anything, the people that I’m working with are going to matter, as well as the way we frame the job that we’re in. I want to be in the service profession. I want to work with people. This type of career, to me, is very ideal for that. It is reaffirming another thing that I believe and that I want to have, which is finding meaning in a job. Any time talking about health, whether oral health, physical health, mental health, emotional health, or spiritual health, is a foundation for everything else and something that I believe everyone has a right to.

For each of the past four summers, I’ve volunteered in another country; I worked focusing on education and health. Mostly it was just going out, hanging out with children, working with them, but I didn’t have an end goal; it was more, “Let’s do this. Let’s enjoy ourselves, get to have fun.” I loved it, and I felt like I was doing something really productive and making a difference in these children’s lives, but there was no end goal. This past summer, though, I went to Ecuador and worked on a public health intervention project. The project was founded by a professor at UC Berkeley with some other students that focused on child malnutrition and childhood oral health. It was called “Alli Kiru” (which means “beautiful teeth” in the Kichwa language), which are specifically the indigenous tribes that she wanted to work with. She’s a pediatrician, but the reason she did this is that she’s been to so many different countries, but essentially, there are so many problems out there and this is one that is often overlooked. For her, it is something that we can work together with local communities to make it better. That’s where I found this opportunity. I jumped on it, with her and another very important mentor, to try to find researching connections between things there to hopefully make it more sustainable and allow this to be transferable to other countries in the world.

The main problem is just health. Health encompasses so much, and we focus specifically on malnutrition and oral health and how to attack that at an early age by working with the children and with their mothers for, hopefully, long-term benefits.

I believe health is the foundation for everything in life. I look at Abraham Maslow’s hierarchy of needs, and the most basic and foundational need is physiological, including breathing, sleeping, and eating. And oral health and nutrition affect all of those. If you are not able to establish the base of a pyramid of anything in life, you won’t be able to have anything to grow upon, whether that’s just feeling safe and secure or feeling true love, belonging, or self-esteem. There are so many. They are all built on one another, and health is at the core and the center of that. I want to make sure to put in the time and commitment necessary to work for the health of all people.

Honestly, I actually haven’t stumbled across too many resources describing malnutrition and oral health despite how prevalent and pervasive these are around the world. Oral diseases, specifically dental caries, are actually the most prevalent medical condition in the whole world, and that was out of and that was out of 291 diseases found by the Global Burden and Disease Study 2010. That was the most prevalent. There’s such a big problem here. I don’t know too much about it. I could have found resources about it. For me, there’s this TEDx talk by this UC Berkeley professor, Dr. Karen Sokal-Gutierrez, who was actually my mentor as well. She is this amazing woman who is actually a pediatrician who focuses on oral health, which is very unique. She details her experiences creating this project: why she does it, the need, the resources that she wants to devote, and have the whole process surrounding oral health and malnutrition.

I think more so than anything, probably engaging with the populations and communities directly that we worked with, especially the children. Our target audience was the children and their families, their mothers and their fathers. I love working and interacting with children more than anything else. That’s what I hope to do in my future. Whether that’s teaching them something specific—whether brushing their teeth, describing stories, having fun, goofing off—all that is essential to this whole process. It’s connection, and connection with children. By having this connection, I was able to engage with them, get their attention, communicate the importance of oral health, the importance of brushing teeth, what fluoride is, what happens without oral health and hygiene, and malnutrition.

With all these things, to me, I was able to come across better because of this connection with them. At the same time, conducting interviews with mothers and gathering data to get evidence to, hopefully, write about this to come up with connections between malnutrition and oral health and connections between oral health and the quality of life. It’s a kind of a post-experience, but It’s something that I think will be of benefit in the future.

In the morning, we ate breakfast. I bring this up specifically because it was with other medical students, other dental students, other public health students, other undergraduate students, other dentists, other doctors, and community health workers. We all came together every day over a shared meal. Looking at each other, interacting with each other, knowing that what we’re working for and who we’re working with is central to all this. It’s not just one person or from one field; it’s a collaboration between so many people. To me, that was very special. We didn’t directly say this every morning, but it’s the feeling I got.

After that, we went to pick up some more community health workers. A lot of this project was very focused on allowing the communities themselves to put out these interventions—and with the community—because they have more credibility. They have the knowledge, they have the dedication, they have the wisdom, and they’re able to connect. They speak the Kichwa language where sometimes it’s harder for us. We know some Spanish, and we can get by someone, but it’s not their primary language. After we picked them up, we drove to anywhere between one to three indigenous communities per day.

At these communities, we focused on tooth decay and malnutrition prevention through community education techniques that could, hopefully, support sustained behavioral change. What I mean by that is something as simple as storytime. Having a children’s book where they’re describing an interesting story, but the plot focuses around how one takes care of himself and one doesn’t, and the negative consequences that can result by eating a ton of sugar, or not brushing your teeth, or eating junk food, whatever it is. They were able to be very engaged with it and, hopefully, take away something like, “Oh no, I want to be like this kid who is able to play sports, who is able to sleep properly, eat properly, and play with his classmates.” That was our take on wanting them to get this message, even if it’s just unconsciously.

Then, there was a “How-To” station: how to eat properly, how to brush your teeth properly, how many times to brush your teeth properly, how many times per day. We showed images of healthy and unhealthy teeth. They’re smart individuals. They could, even at three, four, five years old, realize that this is unhealthy. This is a disease, and we don’t want that.

I taught them how to counter that. We interview the mothers because I think working with children six and under is great, but it takes the whole family to change, not just an individual. So we’re working with the mothers, interviewing them, and discussing habits—healthy and unhealthy habits—and how to ameliorate the negative effects of poor oral hygiene and poor nutrition. Then playtime, which is to keep the kids engaged. They’re at school. They’re rowdy, and they see a bunch of people and want to play. So, it’s just playing games with them.

The dentists themselves put fluoride varnish on every single child’s teeth. Fluoride varnish remineralizes the teeth, strengthens them, and basically protects them from cavities or other oral diseases. a. We did this again as a preventative measure, so they hopefully won’t develop severe decay and nerve problems, everything else that goes with mouth pain and dental caries.

Then, we additionally caught the data because we want to take this to the next level, and right now, we’re analyzing the data. We analyzed it after the project, and we continue to analyze it now. Most of these activities were carried out by the community health workers themselves. We were more so a passive role, and we wanted them to take the lead. We were doing what we were told as we think that this is going to lead to something more sustainable.

On site, I think being personable and willing to engage with the people that I worked with and worked for changes everything. I didn’t want to be stubborn. I wanted to get to know them. I wanted to work with them. I wanted to believe in them. I wanted to have them share their knowledge with me because I only have so much and they have so much to give, and I wanted to experience that. I was creating a connection, creating ties to these people around me. That allowed everything else to fall into place. I think reflection is a skill. It’s taking a step back, acknowledging what we can and can’t contribute and how we can learn and grow from it, focusing on certain strengths, and learning from the people around us.

I think another skill is just the actual care or desire for what you’re doing, and because I cared about this so much, especially the children and health, every single day, I give it my all. For me, another skill is just putting in the work. You have to work, and if you love it, it pays off. Post this experience, actually, I think the experience is still ongoing within me. But entering the data, analyzing the data, and thinking of how to best communicate this to others in the world for something in the future to take effect is another skill that I am constantly working on with my classmates and my mentors because this is just one experience and we want to branch this out.

My mentors, first and foremost. I had two of the best mentors that I’ve ever had, and they were there with me every step of the way: during, before, afterwards. Honestly, my knowledge in this area was decent but somewhat limited. These mentors, one at the Harvard School of Dental Medicine and Public Health and one at UC Berkeley School of Public Health and Joint Medical Program, imparted so much knowledge and motivation within me. Any time I had a question or was thinking of something, I ran it by them, and we just dialogued and discussed. This really encouraged me to see that this was such an important problem. My fellow classmate, Andrew and I, worked on ways to address that and how we can come up with solutions together. I think one of the things that really helped me is my classmates and other people I brought this up with. They’re constantly motivating and encouraging me to pursue this opportunity.

I honed in on what I knew I loved, which is working with children and focusing on anything related to health and global communities. By word of mouth, by my mentors, my professors, and my friends, I became connected to the right people. By being connected, I explained myself and the vision or idea of what I liked to do, and they put me in the right place. It was more like I was conveyed to what I loved, and they arranged for it for me.

Through my mentors, again. For the first half of the project, I lived with my mentor, the medical dental students, the public health students, the undergraduate students, all under one roof within the indigenous community, which was really nice because we were relatively close to everything. In the second half, (Andrew and I) lived with lived with an Ecuadorian dental student and his family, who were extremely hospitable. He didn’t know us. He took us in and explained so much about Ecuadorian culture, his own reasons for entering dentistry, and then connected us with the rest of the dental students and other communities.

It may be weird, but I don’t really have specific expectations going into things, except that I always expect the best. I always have high expectations and actively seek to ensure that those expectations are achieved. I used to be the opposite. I used to have low expectations, and if it didn’t work out, it was more of a psychological defense mechanism. But I have high expectations, and no matter where I am, even if it’s in a situation that I don’t want, I’m going to frame it in the way of, “How can I make this the best of where I am now?” I think, in everything we all do in life, we will not be able to love every role that we have. I think if we can change our approach to it, we can love the experience, love the people, and believe in what we’re doing.

One big takeaway from my experience is reaffirming my thoughts on the importance of health and how I want to strive for the health of all people. I think health and the lack thereof take on many forms and can manifest in many different ways. To me, oral health and nutrition is just one of those ways. However, it is something that I find very valuable.

I think an even bigger takeaway is that I want this to be incorporated into my future life, specifically working with communities and populations on a bigger level despite also wanting to be a daily clinician, working with patients as I find value in both.

Another takeaway from my experience is that it opened my eyes into this public health realm. I was always just focused on working with patient after patient, but the ability to work for something greater than that is very inspirational to me. For me, I find that it will be a disservice if I don’t incorporate that somehow in my future.

I think it’s hard to figure out everything on your own, so first, keep an open mind. I can’t overstate the importance of that. Then, look within yourself to discover what you care about, what you’re passionate about, and what you love. Then, by having the open mind in discovering what you care about, seek out opportunities. This is also something difficult, but don’t do it alone. Most of the things that have happened in my life is because I’ve consulted mentors, professors, family, and friends, and they’ve pointed me in the right direction. I’ve learned so much from them. We don’t need to do this alone.

Right now, working first instantly and working collaboratively with those around us to come up with innovative and sustainable solutions to these important health problems. The specifics, I think, come in time; they come with work. But doing the right research, backing ideas up with evidence, and pursuing these opportunities will start pointing us in the right direction.

I never used to read or watch videos that made me think because I always thought that my pain was too active during school even though I didn’t really learn a ton of valuable information from school itself. I learned a ton from the people around me and from what my friends actually introduced me to. One of those being TED talks, which I was introduced to halfway through my college career. It’s crazy to think that just these videos can have a big impact, but actually they had a significant impact on my life and had a huge role because they actually challenged me to view the world in a different way and view myself in a different perspective, a different light. I became enlightened on issues around the world, about how truly amazing people are, like trying to come up with solutions to solve these problems that so many people face.

Specifically, Brené Brown’s talk on “The Power of Vulnerability” also led me to read her book The Gifts of Imperfection.

These changed my whole approach to life, to relationships, and to work because for the first time, I actually started being my true, authentic self. I stopped being fearful of my shortcomings, my mistakes, and my imperfections and started embracing the person that I am even with all the idiosyncrasies. And retrospectively, I realized that I was unable to truly enjoy my relationships, my work, and my daily activities until I embraced this mentality. I obviously didn’t change overnight; it’s a process, but by first focusing on myself in relationships, I changed the way I felt every single day. I continually worked at it, but this has led me to meet the most amazing people in my life. I have so many relationships that I cannot begin to imagine without.

The connections that I made within the working environment are another thing. This idea of connections and relations and being vulnerable applies to so many sit

I honestly don’t really think I could do anything that I strive to unless I have balance on my life, and it took me a while to figure that out. Having balance allows me to recharge and re-energize my mind and body. If I’m not healthy up top, mentally, everything else that I do is negatively affected. For me, the key was finding out what I enjoyed doing the most and to fill my life or maximize my life with those experiences.

More than anything for me, it’s about mentoring and teaching. For the last four or five years, no matter what I’m doing, I’m always finding a way to mentor or teach, whether that’s middle school students, high school students, college students, or graduate students. It’s one of my greatest passions. I’m always looking to help another individual or friend out. Some think that mentorship or teaching is just more work, but it’s not. For me, it’s just one of the greatest satisfactions knowing that I, hopefully, can contribute positively to someone else’s life. Whether that’s just listening or offering advice, there are so many ways to do that. Being there and knowing that they have someone that they can learn from is a big joy, and it balances out everything else that I do, especially study.

Outside of work, I love having experiences to share with other people, and a big balance is just hanging out with friends. It’s another thing, whether it’s playing board games, which I love, or watching TV, or watching TED talks, or going for a walk. I think any time I’m with other people, I’m growing and connecting and developing a meaningful bond, which also allows me to recharge.

On the other spectrum, I also value personal time. I like to journal because that allows me to clear my mind, express my feelings and thoughts in my own way, and analyze them in a world that seems to never stop going, that is too chaotic and does not seem to not value this. To find this process of alone time that allows for introspection and reflection is key.

I think exercising every day, or trying to, is very important. I just feel different after exercise. Even though I feel so invigorated, I still don’t do it all the time. But just the combination—probably of the release of endorphins and other chemicals when you work out, the fun that I have doing it, and knowing that different neural paths in your brain are activated when you exercise—enhances learning and enhances everything that you do afterward. It’s something that I try to make in my daily routine. My new approach to working out is essentially like brushing your teeth; just fit it in every day, whether it’s 10 minutes or 30 minutes. That’s something I just do: create habit. I realized that when I started doing that, other parts of my life started getting better as well.

Also, I try to read. I mentioned some books that I love to read, nonfiction books where I’m able to learn and grow every single day because for me, at the end of the day, we can either get better, or we can get worse. And I always want to get better.

Love is the first thing that comes to my mind. It’s the central, the core, to me. To love my family, to love my friends, to love the people around me, first and foremost, whom I interact with daily. I love those people that I’ve developed a relationship with in the past. Even though I don’t get to see them often, love transcends any boundary, which is amazing to me. Every time I do get to interact with these people—family, friends—in my same location outside, that is all that matters at that point in time. To me, life is about connection and love, and I didn’t really discover that until a few years ago. And that’s where my life changed. At the center of relationships, work, and outside activities, love and connection is always the most important thing to me.

Additionally, also loving what you do, loving your work, the activities that you surround yourself with because if you’re not intrinsically motivated by love for what you’re doing, then the people that you’re serving are not going to get the maximum out of it. It’s a disservice to everything. So love what you’re doing, care about it, and pursue that.

I feel that my education had a tremendous influence on my life in so many ways, but not to the specific classes that I took, but more so the people that I was able to surround myself with and the opportunities that were available to me when attending my educational institutions. I think that there are so many facts that we learn every day, but I don’t remember them. Some stick out, yes, but what do you remember? You remember conversations with people. You remember a mentor helping you out. You remember a specific extracurricular that you were involved in and what you are working toward, probably that improv or dance or teaching or mentoring, whatever that is. These opportunities are available at these educational institutions, and I think you have to take advantage of it. You have to be active about everything because if not, it will just sit there and be a wasted opportunity. But if you open your eyes, you can find something that really resonates with you, find people that really resonate with you, and that could change the direction of your future.

People and connection makes me happy. The most meaningful, memorable, and transformative moments in my life can all be related to another person or multiple people. I enjoy hanging out and getting to know friends and my family more than anything else—and in a meaningful way because I actually really care about them. I want to be there for them through thick and thin and be a source of support during these hard times in life, supporting them during failures or mistakes and at the same time celebrating all the successes that they have.

One additional thing that makes me happy is personal growth and development. At the end of each day, we’ve either gotten better or worse than before, and I want to get better. What I mean by that is kind of building up resilience—emotional resilience, mental resilience, intellectual resilience, physical resilience, and spiritual resilience—because that is what’s going to guide us throughout our entire life.