Every month, Fulbridge interviews Fulbrighters around the world (both current grantees and alumni) to get a sense of what life is like in different placements. For this Spotlight, Megan Gleason, a 2018-2019 ETA to Latvia, spoke with Karen Kwok, a 2019 Fulbright Specialist to Kosovo, about her time working with the Kosovo Ministry of Health.
1. Why Kosovo?
I was selected by the Kosovo Ministry of Health, so Kosovo actually picked me! I was invited to apply for a Specialist assignment with the Kosovo Ministry of Health and their strategic planning division.
2. What motivated you to apply for the Fulbright Specialist Program?
I always believed that the Fulbright program was a beacon in peer professional exchange. However, it seemed unattainable for me because the minimum 9-12 months of time for the Fulbright assignment would have been near impossible for a mid-career professional.
A friend demystified it for me: Fulbright participation didn’t always require a full 9-12 months or terminating your job. I learned about the Fulbright Specialist roster with shorter assignments ranging from a couple weeks to a few months, in partnership with a ministerial or academic institution. Compared to other Fulbright programs, the host country requests specific skills with a uniquely tailored Specialist assignment. I could maintain my clinic position, travel abroad, and achieve global health impact by sharing my family nursing expertise.
The Specialist program is pragmatic, tangible with maintaining my clinical career, and much more attainable. It’s a common assumption that the Fulbright experience is limited to an English teaching assistantship or a professorship at an academic institution.
3. What was your first reaction in learning that Kosovo had a position for you?
I welcome traveling anywhere I haven’t been before. It was exciting to learn more about Kosovo and the Balkan region. Similar to my approach with other global consultancies, I research the history, the economics, the politics that shaped a country’s current state of affairs. These facts absolutely affect the design and the delivery of healthcare services; thus, my understanding of the facts will help ensure my public health recommendations are relevant and realistic. I was honored to serve Kosovo, as previous consultancies had not involved the Balkan Region for global nursing work.
4. 3 weeks isn’t very much time. What were some of the goals that you had during your time in Kosovo, and what were you able to accomplish during that time?
I knew the short 3 week assignment would be packed. In preparation for the assignment, my research included Kosovar history, politics, and economy as it shapes ministerial affairs and program budgets. While I was there, I linked up with people on the ground, including the Peace Corps network. Connecting with the Peace Corps network, along with the NGO network and other cultural events, gave me puzzle pieces to view the entire picture, piece by piece. With their Kosovar expertise, I better understood the complex history of Kosovo’s founding and the challenges with ensuring an inclusive health system. At the heart, the community, whether Albanian, Serbian, Ashkali, Egyptian, or Roma, was at the center of identifying public health problems and their solutions.
Working with the Kosovo Ministry of Health, I facilitated a training of trainers (ToT) in strategic planning. The training entailed learning about program outcomes with a return demonstration on teaching principles and rationalizing selection of program indicators. Through this iterative training, other division health care professionals learned how to train their staff in scaling up and in measuring national impact of their nutrition program and roll-out of their health insurance scheme. The insurance scheme was designed to better subsidize health services, with prevention services at the primary level and improved integration of secondary and tertiary care coordinated with referrals from rural centers.
5. What are some of the challenges you faced in accomplishing these public health priorities?
There were definite challenges for funding of vaccines in Kosovo, and I tried to highlight it, but because the World Bank classified Kosovo as an upper middle-income country, Kosovo was ineligible for vaccine subsidies that designated low-income countries received.
The complexities of regional geopolitics and economic designations are set forth by the World Bank and IMF. [These] country designations limit funding available for regional problems. For middle-income countries, challenges still exist for funding vaccines, preventative health services, and government health staff salaries as in Kosovo.
6. You have a background in nursing and public health, and currently serve as a family nurse practitioner at Howard University. How would you describe your work, and what inspired you to pursue this career path?
Since I was young, I have been inspired to serve communities in a meaningful way. Health care allows me to merge my passion in health education, patient care, community empowerment, and social change.
Nursing and public health are on a continuum. I appreciate nursing because it gives me a name, a person’s story, and frontline insights to a public health issue. For my patients with diabetes, their successful treatment depends on how expensive insulin is and the policy changes needed. These patient scenarios help inform the public health solutions required for a more responsive health system.
Public health is the health system approach for promoting healthy communities by providing safe, quality, respectful, and equitable access to health care services. Public health gives me the system framework in which health services are delivered on an individual level. Simultaneously, the challenges an individual encounters with accessing health services demonstrate how the health system can be more accountable to communities.
COVID best illustrates how that continuum from nursing to public health needs to be seamless. Particularly in the U.S., the health system is broken at every single dis-synchronous level, and in the global setting, the challenges are even greater.
7. When you envisioned your grant period, what did you expect to have to adapt to within the culture, life, or society? How did your actual experiences in Kosovo compare with your expectations?
For the 3 week Fulbright Specialist assignment, I envisioned a packed work schedule and I was open to a different culture, life, and society. I was able to still enjoy the culture and lifestyle after work hours.
Kosovar society is an incredibly hospitable and welcoming community with individuals helping with directions, sharing company on walks, or treating for coffee. My network of Peace Corps volunteers provided insights into Kosovar history, culture, and community. I also learned about local events such as the FemArt Festival and tourist attractions like Prizren, Gjakova, and Peja. The Prishtina Museum also housed an artpiece of Mother Theresa, a celebrated Albanian native, made of millions of staples. My actual experiences in Kosovo were similar in comparison with expectations for a unique immersion in a different culture, life, and society.
8. Tell us about a day in the life during your grant period – daily commute, work, meals, free time, etc.
Daily commute: 30 minute walk to work
Meals: Liburna mezza foods, a former Polish canteen now renovated restaurant Menza Ramiz Sadiku, bookshop culture with tasty croissant Dit’ e Nat’
Free time: connection with current Peace Corps Volunteers for tour of Prishtina capital, history of the region, tourist spots with weekend visits to Prizren, Gjakova, and Peja
9. What different languages are spoken in Kosovo?
Albanian, Serbian, Bosnian, Turkish, German, and English. During the Balkan conflict of the 1990s, many Albanians fled to Germany with some recent repatriation. Thus, many Albanians can speak German after 10-20 years there. There are also many Croatians, Bosnians, and Turks. With the US involvement in Kosovo’s liberation, many speak English as did my counterparts.
10. What advice do you want to pass on to current and future grantees?
- Seek the learner’s mind. With the Fulbright mission as a cultural exchange, it’s also the responsibility of the selected Fulbrighter to seek and to promote learning in the exchange. Being open to learning, sharing, asking to listen, and observing to hear the unsaid, Americans can still improve in this practice. We can mistake ourselves in the teaching role, when we actually learn more as students of the world.
- Avoid the single story fallacy. There are always many perspectives of the same story. I have to constantly remind myself with the question, “Do I really have the entire picture? Who else needs a seat at the table to share their side of the story? Would they agree with how the public health problem was defined? Would they also invest in the same public health solution?” With Kosovo’s complex history, I was careful to be receptive and to seek information from the various community members. In war, there is no winner. Although my counterparts and the new majority of Kosovo are Albanian, I was also curious about perspectives from the Serbian, Ashkali, Egyptian, and Roma communities. With their limited ministerial representation, the Egyptian, Ashkali and Roma perspective were important to highlight.
11. Which aspects of Kosovo’s culture would you want to bring back to the US?
The region has seen much suffering, loss, and violence in this past century alone. I want to bring back to the US the lessons learned through hardship: the hope of a new country with the history of civil war, the current challenges for redemption and reconciliation, and the resilience of its ethnic communities. I hope this history will bring reflection for the healing from COVID loss and inspiration for the anti-racism efforts here.
Karen Kwok, MSN, FNP-BC, MPH, is an advocate, educator, and collaborator in public health and family nursing. With over 20 years committed to patient health advocacy in resilient communities, she serves as a Nurse Practitioner at Howard University. Her team-oriented position draws from mentoring in shared leadership and passion for health equity in resilient communities. Karen’s areas of scholarship include improving access to primary health care and community-based partnership development with recognition from American Nurses Credentialing Center, Robert Wood Johnson, Bill and Melinda Gates Institute, California Governor Gray Davis, President Obama, and Fulbright Specialist for her service. Her contributions to global health initiatives include capacity development, strategic planning, and program evaluation with Ministries of Health spanning Latin America, Central and Southeast Asia, and Sub-Saharan Africa. Karen is enthusiastic about advancing the discussion on community health with domestic and global perspectives.