Green Therapy

The teens in the rehab program can’t have drugs, so they use the waterfall instead.

That’s how Lily Mank BSLA’15 explains the fact that when patients first visit the healing garden at the Rosecrance Griffin Williamson adolescent substance abuse facility in Rockford, Ill., they choose to sit near the cascading water.

“I think the drugs numb their emotions, and when they don’t have access to drugs, they become very raw, very sensitive to their thoughts,” says Mank. “They need the stimulation of the waterfall, the white noise, to quiet themselves down.

“They move away from the waterfall as they become more comfortable with their thoughts and more able to be balanced within themselves,” she says. “That’s a sign that they’re getting ready to leave the program.”

Mank doesn’t know if her explanation is right, but she plans to find out in her ongoing research of nature restoration.

The five-acre garden, designed by master Japanese landscape designer Hoichi Kurisu, is incorporated into every part of the highly successful 12-step addiction treatment program at the Rosecrance facility. It’s a powerful tool for clearing the minds of the 12- to 18-year-old patients.

It was also powerful for Mank. Since working in the garden as an intern in her junior year of the CALS landscape architecture program, she has made healing landscapes her career focus. She went on to do a senior thesis focused on improving nature access at a Wisconsin mental health hospital. She also earned a certificate in health care garden design at the Chicago Botanical Gardens and interned at Ziegler Design Associates, a company owned by Steve Ziegler BS’83 and Joan Werner-Ziegler BS’78, CALS alums who specialize in designing healing spaces.

Mank still thinks about the waterfall. How, exactly, she wonders, does spending time in the Rosecrance garden—or in any peaceful outdoor space—help settle an unsettled mind?

That’s a great question, says Sam Dennis. It’s right at the heart of what he studies as a professor and director of the Environmental Design Laboratory (EDL) in the CALS Department of Landscape Architecture (LA). While the LA department is best known for its work on environmental restoration—techniques people can use to heal damaged natural environments—Dennis and his team at the EDL flip that around. They’re finding ways to incorporate nature into human-made environments to restore the health of people. Dennis’s projects employ thoughtful outdoor design to help people eat better and get more exercise and to create safer, calmer and more cohesive neighborhoods.

Health-conscious design has always been on the department’s radar. In 1981, 10 years before the passage of the Americans with Disabilities Act, Steve Ziegler was encouraged to do his senior thesis on barrier-free design in elder care facilities. But today the topic is getting much more attention.

As one example, assistant professor Kristin Thorleifsdottir has been reworking the curriculum to make sure students get a good grounding in the burgeoning area of science that looks at connections between health and the built environment.

The native Icelander offers three classes on the topic, including a new sophomore-level design class in landscape architecture and a graduate seminar that attracts students from landscape architecture, interior architecture, urban and regional planning,health care and other disciplines. She touches on history—from the cities of the ancient Greeks to the urban squalor of the Industrial Revolution—but most of what she covers starts in the 1980s.

In a 1984 study, Texas A&M design professor Roger Ulrich found that postsurgical patients who had a view of trees from their hospital windows were released sooner, took less pain medication and experienced fewer complications than did patients who had a view of a blank wall.

“Ulrich’s study was the first that looked at health and design,” she says. “Since then there have been a lot more.” Those studies span diverse disciplines—urban planning, public health, pediatrics, psychology, gerontology, neurobiology, art, horticulture and forestry, to name a few—which means those who study the topic must learn several lexicons.

“The fields of public health and design speak very different languages,” Thorleifsdottir notes. “Design researchers tend to take a more qualitative approach—they look at how people experience the environment. Public health is very much into quantitative measures.”

Her own research focuses on health at the community level, including studies on neighborhood design and children’s outdoor physical activities. She’s embarking on two new studies, one of them on the quality of public city parks and the availability of settings for mental restoration, a collaborative project with research partners in Sweden and Serbia.

Sam Dennis has become pretty fluent in the language of public health. As part of UW–Madison’s campus-wide Obesity Prevention Initiative, his partners include researchers in nutritional sciences and family medicine. Body mass index (BMI) is a common research metric, and a recent study involved drawing blood. That project, a collaboration with the Madison-based nonprofit Community Groundworks, used a garden-based curriculum to teach young people to eat better.

“Rather than ask how much the students eat, the researchers took a blood sample. You could tell by levels of serum carotenoids in blood whether they were eating fruits and vegetables,” Dennis explains.

Dennis doesn’t wield the syringes. While his collaborators collect data on human health, he assesses how well the urban landscape supports it. He works with residents of underserved urban neighborhoods to identify features that either facilitate or impede physical activity, healthy eating and safety.

To collect the data, the EDL team has developed an innovative (and now widely replicated) tool that they dubbed “participatory photo mapping.” The researchers ask neighborhood residents—often kids—to photograph things that they see as barriers to healthy living, and then ask them to write stories explaining the photos.

“They tell the stories, then we geo-locate the stories and photos with GIS, so we can overlay their stories and images with, say, traffic data, or data about pedestrians and bicyclists getting hit by cars, or crime rates.”

Often the stories lead to simple fixes, such as repainting crosswalks, adding pedestrian signals or hiring a playground supervisor so that parents feel reassured about their kids using a local park.

But residents also point out problems that are pretty surprising—and tough to solve. Dennis recounts what Latino kids in South Madison had to say about a nearby city bike path.

“They say they’re not welcome there because the bike path is for white people—that you’ve got to be rich and have a special kind of bike,” Dennis says. “The literature says the presence of a bike trail significantly reduces the body mass index of everyone around it, but the kids aren’t using it because they don’t see it as their space. Instead, they ride on busy streets.”

“They’re very sensitive to where they feel welcome,” Dennis notes. “Mapping that is part of mapping their well-being.”

Stories like these are important, Dennis says, because they point to health problems that can’t be diagnosed by calculating body mass or drawing blood.

“Physiological things like body mass index are important, but so is our mental well-being,” Dennis says. “There’s a lot of research suggesting that chronic stress experienced by people with low incomes helps explains disparities in health across different environments. As environmental design researchers, we try to figure out the source of that stress and then see what we can do to reduce it through changes in the built environment.”

Spending time in a natural setting can relieve stress, but that’s not guaranteed. That was underscored by another of Dennis’ projects, a survey that looks at the benefits of natural outdoor classrooms at more than 200 early childhood care facilities across the U.S. and Canada.

Rapid staff turnover is a problem among early childhood care providers, due to low wages and very high stress. But according to the teachers surveyed, spending time in a green, natural environment during the workday helped compensate for the downsides.

“Their mental well-being is better supported when they can spend time in these natural settings,” Dennis says. He attributes this to a process known as attention restoration: We become mentally exhausted in situations where we have to make ourselves pay attention; our minds recover when doing things that are so inherently interesting that paying attention is effortless. Engaging with the natural world fits the latter category. But you really have to engage.

“The natural environment supports attention restoration if the teachers were using all of their senses to experience the natural environment in a loosely focused way, as opposed to the tight focus they give to their indoor lessons,” Dennis says. “It’s important that they aren’t ‘traffic cops’ or hypervigilant monitors like they typically are in a traditional playground setting—that they can engage with kids as they play in nature.”

Job stress is part of the job for caregivers at the UnityPoint Health–Meriter Child and Adolescent Psychiatric (CAP) Hospital, even though there’s plenty of nature nearby. The facility sits on a secluded wooded hilltop on the western edge of Madison. But while things outside are quiet and serene, inside a very different story plays out. The young patients who come here struggle with attention and impulsivity disorders, anxiety and depression—conditions that have made it hard to function in everyday life. Many, especially the teenagers, are at risk for suicide.

“We hear a lot of hard stories here,” says Karen Larson, the CAP program nurse manager. Mental illness in children can be as hard on families and staff as it is on the children, she points out.

Hospital staff members were excited when the program moved to this bucolic spot from its former downtown location in 2004. But they soon realized that there wasn’t a way to incorporate the green surroundings into the treatment of their emotionally fragile patients.

“We started looking at the evidence about the impact of a natural environment on depression, anxiety and well-being, and what it could mean to our patients,” Larson says, “and we realized how much better it could be.”

With research in hand, the Child and Adolescent team contacted their employer’s philanthropic partners—the Meriter Foundation and Friends of Meriter—about raising funds to create a healing space for the patients. She emphasized that she wasn’t asking for landscaping.

“I compared it to purchasing an orthopedic tool that would allow somebody to have their hip replaced,” Larson recalls. “In psychiatry, one tool is the engagement of patients and staff in their environment. The more beautiful, less stressful and skillfully planned the environment, the better the tool.”

After a successful fundraising campaign, Meriter hired Ziegler Design Associates to create the healing garden. It was a good fit. The firm has worked extensively with caregiving facilities and has developed many creative outdoor spaces for youth for schools.

“It was a very special opportunity, to be able to bring healing into the landscape for kids and families and staff who needed it so badly,” says Steve Ziegler. “But it was also a complicated design challenge. A typical hospital healing garden wouldn’t work here.”

“In a psychiatric population, safety is a primary concern,” Larson says. “And a psychiatric population of minors is vulnerable on so many levels. We needed to make the space beautiful and usable and child-friendly and calming—and also safe and secure.”

This garden wouldn’t have secluded spots for quiet contemplation. There couldn’t be any trees big enough or grass tall enough to screen a staff member’s view of patients. No sharp edges, no loose objects that could be thrown (bricks were glued together). Joan Werner-Ziegler, the firm’s perennial plant specialist, researched plants for toxicity and potential reactions with medications. Steve Ziegler spent several days looking for nicely rounded boulders with serene colors.

“I stayed away from bright colors,” he says. “If you’re under psychological stress, abrupt changes can trigger a lot more emotion than they would in you or me. Our colors are wonderful, but not jarring. We chose pavements that didn’t reflect glare, because some drugs make patients’ eyes sensitive.”

They ended up with a space that’s compact enough for careful supervision while offering a variety of places to be or wander. There’s a “traditional” garden (to remind patients of home), a stepping garden with pathways through the plants, a grass garden, a prairie sensory garden and a separate garden for horticultural therapy.

You can tell the space works, says Larson, by watching the patients: “They just naturally settle. They settle into the chairs, they sit on the boulders, they sprawl on the ground, they kick balls around. They just settle into the space.”

More important, Larson adds, the garden helps get the kids talking.

“When you work with kids who are psychiatrically hospitalized, you’re trying to help them express their feelings,” she says. “If you just start asking questions, they are likely to shut down.

But if you go for a walk, they’re more likely to start talking. It’s true for all of us: If we’re feeling comfortable, we can talk about things that are really hard to talk about. And that’s what we have to do here.”

The healing garden also works wonders for the staff.

“When you work in a caregiving field, you give so much,” Larson says. “Your successes can be small and the challenges can be huge. You have to bring your best self every day. And then many of us go home to stressful lives. So if part of your workday can be restorative, it’s a wonderful gift.”

Meanwhile, Lily Mank is still intrigued by that waterfall. Now a CALS grad student, she’s teaming up with Sam Dennis and Kristin Thorleifsdottir on research to understand how all elements of a garden ease patients’ minds as they address their addiction issues.

Her goal is to help designers view healing gardens not just as a collection of streams, pathways, plantings and benches, but also in terms of how those features allow patients to interact with nature. At the waterfall, a patient may simultaneously be sensing rushing water, the breeze, the coolness of shade, light dappling through the leaves and fish moving in the nearby pool. There are many possible interactions with nature, she says, and they can combine in many ways to evoke different emotions.

“I’m trying to find out how different interactions with nature make patients feel. If I understand that, it can be another way to think about garden design,” she says.

And if patients have a better understanding about how their interactions with nature make them feel, they can use that to continue healing when they get back home.

“They won’t have access to a garden like the one at Rosecrance, but they can still seek out places that let them encounter nature in ways that make them feel calm,” Mank says. “A healing garden can be anywhere.”

SIDEBAR—Healing With a Hoe

When Mike Maddox MS’00 signed on as Rock County’s UW–Extension horticulture agent in 2003, he thought gardening was about growing plants. Some tough-talking convicts convinced him otherwise.

Maddox was leading gardening workshops at Janesville’s Rotary Botanical Gardens when he got a call from the Rock County Jail asking if he could he teach some inmates. He figured he’d be working with some tough customers, and he was right—to start with.

“The first time these guys came out, they had this machismo attitude,” Maddox recalls. “They were too big and bad to be out there gardening. But after a few weeks, they were talking about how they used to work in the garden with their grandmas. And if they had kids, they were saying, ‘I need to get my kids out here doing this.’”

At the same time, Maddox was getting good news from the jail. On the days they’d been gardening, the prisoners were better behaved.

The experience was a career-changer for Maddox. It showed him that working with plants could be a powerful restorative tool, and he wanted to learn more. He got some formal training, first in Minnesota, and then in Colorado, where he earned a certificate in horticultural therapy. Now, as director of UW–Extension’s Master Gardener program, he trains 3,000 volunteers, and horticultural therapy is one of his favorite and most popular workshop topics. He’s also helping the Meriter Child and Adolescent Psychiatric Hospital staff incorporate horticultural therapy into their treatment program.

Maddox doesn’t usually lead horticultural therapy sessions himself, but he likes to keep his hand in it. So on Thursday mornings during the growing season, you’ll find him in a courtyard garden at the William S. Middleton Memorial Veterans Hospital in Madison. It features waist-level planting beds and wide walkways to accommodate the patients— many of them grizzled men leaning on canes or sitting in wheelchairs—who are busy planting and watering.

“It’s kind of a phenomenal process,” says Diane Neal, the hospital’s recreational therapist. “There is a positiveness that comes with being able to plant seeds and have them sprout. If the patients enjoy gardening and participate while they’re rehabbing, it raises their self-esteem and keeps them from being depressed.”

Nearby, Maddox is getting an earful. A U.S. Army veteran named August grew up on a Racine County truck farm, and he’s adamant that the VA garden is too small for corn. Maddox loves the give and take. He’s thrilled that August is so engaged.

“In this kind of a closed setting, where depression and isolation can be high and self-esteem can be low, you’ve got to create a spot where they can feel wanted and needed and purposeful,” he says.

It’s a lesson he learned from the jail inmates. “I thought it was going to be about growing carrots,” Maddox recalls. “No. It wound up being about growing individuals, just using carrots as the tool to do it.”

SIDEBAR—Why Nature Makes Us Feel Better 

The notion that nature can ease our minds is not new. It’s reflected in Japanese Zen gardens (an idea that goes back at least 10 centuries) and was espoused by writer Henry David Thoreau and by landscape architect Frederick Law Olmstead, who designed Central Park as an antidote to the stresses of urban life. But in the past 30 years or so, researchers have been digging into the science behind it.

A hardwired love of life. In 1984, Harvard biologist E.O. Wilson theorized that biophilia, our affinity for nature, is bred into us. He noted that the human race has been in close contact with nature for almost all of its 200,000-year history. Only in the past three centuries of industrialization have we separated ourselves from nature. Until then, a keen awareness of the natural environment was a trait that helped the fittest survive.

Restoring attention. A theory advanced in 1986 by University of Michigan psychologists Rachel and Stephen Kaplan holds that our most exhausting mental work is “directed attention”—when we have to force ourselves to concentrate. The way we recover is to give our minds over to things that are so fascinating that paying attention is effortless. The natural environment fits the bill because it’s immense in scale, full of fascinating things and usually removed from the places where we tax our minds.

Reducing rumination. Research published in 2015 by Gregory Bratman of Stanford University and others looks at how exposure to nature influences rumination— repetitive thought focused on negative aspects of the self—which is linked to depression and other mental illnesses. They found that a walk in a natural setting decreased self-reported rumination as well as neural activity in a part of the brain that’s associated with behavioral withdrawal linked to rumination. Walking in an urban setting had no such effect.

SIDEBAR—Tips for Creating Your Own Healing Garden 

Make it personal. Start by thinking about what it is that draws you into your yard, mentally and physically, advises landscape architect Steve Ziegler BS’83: “What’s healing for one person may not be healing for another.” For example, one of Ziegler’s clients likes to walk in the garden at night, so her garden features flowers and paving materials that reflect the moonlight. Another’s healing garden includes an attractive, custom-made clothesline, because she relishes the ritual of hanging out clothes. “That’s her Zen,” Ziegler says.

Mike Maddox MS’00, director of UW–Extension’s Master Gardener program, seconds that: “Don’t get caught up in magazine images of gardening or what’s on HGTV. Go with what’s fun. Work with plants you like and that have meaning to you.”

Make it lush. A rich diversity of plants leads to a diversity of animals—especially birds and insects—and a variety colors, aromas, textures and shapes. “You want to awaken all of your senses,” Ziegler says.

Create transitions. Moving from one area to another should be easy and inviting. That’s especially true for transitioning from your house to your garden. “You want it to be easy, not jarring,” Ziegler says. “If you have to walk out a south-facing door into the blazing sun, for instance, you might want to add a pergola that provides partial shade.”

Offer choices. We get stressed when we feel like we don’t have control over our daily lives. That’s huge for hospital patients—they can’t do much about their situation—and it’s true for the rest of us as well. A healing space can ease that by offering a choice of where to sit—in the sun or shade, in a secluded spot or a more social one—and of things to smell, feel, hear and look at.

Add a focal point. A well-composed photo draws your attention to a certain spot, and so can your sanctuary. It could be a water feature. Running water is therapeutic, and there’s a wonderful selection of easy-to-maintain fountains available, Ziegler says. A bench or gazebo can serve as a focal point as well as a place to sit. So can a tree or sculpture.

Take care of yourself. “If you want to garden, find tools that fit you well and learn about body mechanics and appropriate techniques for lifting, bending, cutting and pruning to make it easier on your body,” says Maddox. And pick tasks that are appropriate to your age and abilities. Pain is not therapeutic.

To Eat It—Or Not

Food engineer Sundaram Gunasekaran, a professor of biological systems engineering, works with gold. But you won’t find the shiny yellow stuff in his lab; instead, the vials on his bench are mostly purple and red. Gunasekaran works with tiny pieces of gold—nanoparticles—that come in almost every color except gold. And those colors can tell a story.

Gunasekaran’s research focuses on food safety concerns, such as whether a food product was transported and stored properly or whether it has become contaminated. But how can a producer or consumer easily know a product’s history and whether it is
safe to eat? That’s where gold nanoparticles come in handy.

“The color of gold nanoparticles will change depending on the size and shape of the particle,” explains Gunasekaran. “At different temperatures, depending on how long you let the particles grow, they acquire different sizes and shapes. And that changes their colors.”

Gunasekaran’s lab is using those color changes for a difficult task—tracking the time and temperature history of a food product as it is packaged, transported and stored. Up to now similar sensors have given consumers some of this information, but they can miss such critical events as, for example, a short temperature spike that could be enough to kick-start the growth of a dangerous microorganism.

The sensors that Gunasekaran and his team are developing provide a more complete and accurate story. The new sensor can differentiate between food stored at high temperatures first and low temperatures second versus a product stored first at low temperatures and then at high temperatures. And that’s thanks to the properties of the gold nano-particles. The color of the first sample would be different than that of the second because of how and when the particles changed size and shape.

“We’re able to do this because the nanoparticle synthesis is affected by how the particles grow initially versus later,” explains Gunasekaran. “We call this the thermal history indicator, or THI.”

These gold nanoparticle sensors are being patented through the Wisconsin Alumni Research Foundation (WARF), and students in Gunasekaran’s lab won a UW–Madison Discovery to Product award. The student team also won a People’s Choice
award in the 2014 Agricultural Innovation Prize competition.

They are now working to further develop and optimize the system. Since different food products travel through different channels, some sensors will be best used to track long-distance travel over the course of a month, while others will track history for only a matter of hours. Some sensors will work best in frozen storage and others will be optimized for various room temperatures.

The goal of optimization is a simple-to-use biosensor customized for any given food product. Gunasekaran envisions the sensors—now being developed as self-adhesive dots or stickers—being used anywhere along the food production channel. Producers, packagers, transporters and even consumers could easily use the biosensors to understand the thermal history of their product, saving time and money and avoiding recalls and health issues.

“There are a number of ways to use this technology, and making a food product’s history easy to see is the key,” says Gunasekaran. “Food is being wasted because people are throwing it out according to an expiration date, or people are getting sick because they eat food that’s gone bad. Those things can be avoided by having a better product safety indicator.”

Getting to the heart of a problem

When Marion Greaser set out to study titin, the largest natural protein known to man, his goal was to answer some basic questions about its role in the body. A major protein of skeletal muscle that’s also found in heart tissue, titin gives muscle its elasticity and is known for its massive size, which ranges from around 27,000 to 33,000 amino acid residues in length.

“Initially we were just going to look at whether titin was related to muscle growth in animals,” says Greaser, a CALS professor of animal sciences.

Working in rats, his team looked at changes in the size of the titin protein over the course of animal development—and immediately came across something strange. In most cases the titin protein shifted from a larger form to a smaller form during development due to natural changes in protein processing known as alternative splicing. But in some rats the titin didn’t change. It stayed big.

The team wondered if they’d mixed up the samples. “But we’d kept good track of things and, in fact, all of the weird samples were from the same litter of rats,” says Greaser. “Then the light bulb went off: There must be some genetic reason why these samples are different. These rats had a genetic mutation affecting the alternative splicing of the titin.”

But where was the mutation? They first checked the titin gene itself, but it was fine. With hard work, they were able to pinpoint the mutation to a little-studied gene called RBM20, which had been previously linked to dilated cardiomyopathy and sudden death in humans.

Dilated cardiomyopathy affects approximately one in 2,500 people. Sufferers have enlarged hearts, with thin walls, that don’t pump blood very well. People with the RBM20 mutation need heart transplants and, without them, tend to die quite early: between ages 25 and 30.

Scientists first linked RBM20 to hereditary dilated cardiomyopathy in 2009, but they hadn’t yet figured out how a faulty RBM20 gene worked—or didn’t work—to cause disease inside the body.

Greaser’s accidental discovery, as described in Nature Medicine, filled in the blank. In healthy individuals, the RBM20 protein is involved in the alternative splicing that helps trim titin down to its smaller, adult form. Without it, titin doesn’t get processed correctly, and the presence of extra-large titin in heart tissue leads to disease.

“Now doctors can analyze people showing symptoms of dilated cardiomyopathy, see if they’re carrying this mutation and factor this information into their treatments,” says Greaser. That treatment would probably start with careful monitoring to catch any further deterioration of the heart condition, Greaser notes.

It Takes a Village

IT WAS A SHORT WALK FROM the village of Biwolobo, deep in the Ugandan countryside, to the pool where villagers got water for drinking, cooking and bathing. But the trip, a mere daily errand for locals, would have profound consequences for the CALS study abroad students who accompanied them.

After a few minutes they arrived at the narrow pool, which was set in a rock with steep walls on three sides. Slippery dirt stairs led down to the water’s edge. The water was brown and murky, with scum and bits of garbage floating on it. In a country where few people know how to swim, the pool invited tragedy. In the past month alone, two children had drowned while fetching water, then-student Jenna Klink BS’07 recalls learning.

Klink was shaken. “In spite of the drownings, kids were still fetching water from that pool.
It was the only source of water for their village,” she says. “And the water didn’t look at all safe
to drink. We later found out that it wasn’t.”

It was but one of many stories that would change the way Klink and 13 other UW students saw the world. Most of them came from small towns in Wisconsin and had never before left the country. They were part of a new CALS study abroad program in Uganda, in its third year when Klink’s group went in 2005. There they would spend three weeks over winter break experiencing things seldom seen by tourists.

Two nine-hour flights took them to steaming, bustling Kampala, the nation’s capital. There they attended lectures on such topics as AIDS and malnutrition at the Makerere University School of Public Health before heading out to rural villages to see how people dealt with those problems. In one village, Lyantonde, they observed and learned from a Ugandan nonprofit that was planting vegetable gardens, building rainwater collection tanks and getting mothers and infants off to a healthy start with nutritional education.

The entire time they soaked in the sights, the sounds, the smells—sometimes the aroma of foods they’d try for the first time, other times the stench of human waste and illness. They were delighted by people’s disarming friendliness—so different from the guarded stance of people at home—and by the children who would wave at their bus from the roadside. There were lush, rolling hills, the beauty of zebras and elephants in the wild.

And there were moments of despair. During a visit to Mulago Hospital—the nation’s referral hospital, meaning it offered the best treatment in Uganda—they were jarred by the dilapidated beds and equipment, the reek of urine, the open windows letting in dust and insects, the understaffing, and, above all, the suffering. The AIDS/HIV wards were full to bursting; children with extreme malnutrition and other conditions were waiting long hours to be seen.

Eric Monroe BS’05 was struck most by the malaria patients, many of them small children. They lay dying, a sense of futility engulfing patients and caregivers alike. “It made you sad but also angry because there are effective treatments out there,” says Monroe.

The weeks flew by, the students flew home. Small wonder that the world they returned to didn’t look quite the same. “We were shown all these things, then we came home to our beautiful Western lives, with our showers and toilets and sinks and washing machines,” says Kim Isely.

Around Madison, the students met up often and talked about their times in Kampala, in the villages. They reminisced about sitting around at the end of the day sipping Nile Specials, laughing at their mistakes and trying to make sense of it all.

And they started thinking of ways they could give back to Uganda, a country where people had much to offer but also needed many simple things. There must be something they could do. As they tried to resume their lives, they found that something had changed. They had left Uganda, but Uganda hadn’t left them.

That was exactly the kind of impact CALS had hoped for when starting the program in 2002. Biochemistry professor James Ntambi had been talking about undergrads in the life sciences with Ken Shapiro, then associate dean and director of CALS International Programs, and John Ferrick, then director of CALS Study Abroad. Sure, students were getting a top-notch education. They were learning all about cellular cycles and endocrine function and gene expression.

But the students needed more. They needed to know not just how biochemistry worked, but how the world worked. “It’s not just the biology of health,” says Ferrick. “There are many, many other factors that influence people’s decisions about health. Nutrition. Economics. Politics. Culture. All of those things are what we were trying to get at.”

Moreover, they wanted to respond to student demand. Students were eager to learn about conditions in the rest of the world. They wanted to get beyond their classrooms, beyond their borders.

Uganda seemed like a good way to get them there. Ntambi, a Ugandan native, had grown up in a small village and still had many connections at Makerere University, where he’d arrived to study science in 1971—the same year that dictator Idi Amin took power. Ntambi kept his head down and moved through the university system as Amin grew more outlandish in his rule, as people around town began to disappear.

By the time Amin was overthrown in 1979, Ntambi was finishing his master’s degree and working as a lecturer at Makerere. The following year, out of the blue, he got a Fulbright scholarship to do his Ph.D. at the Johns Hopkins University School of Medicine, an opportunity that brought him to the United States.

At one point he ran an exchange program with Uganda that he thought could serve as a model for CALS. As it happened, UW–Madison and Makerere University had recently renewed a Memorandum of Understanding for such partnerships. Shapiro, a CALS professor of agricultural and applied economics, had done research in East Africa and Ferrick had extensive experience in Africa as a Peace Corps volunteer in Lesotho.

The trio hammered out the program. A fall semester class about global health would be followed by a trip to Uganda over winter break. During the trip each student would work on a health-related research project. Ntambi and Ferrick would teach the class and accompany the group to Uganda.

Uganda study abroad was an immediate success—so much so that Makerere set up similar programs with other universities. In Madison, each year the program was improved upon—and each year it got more popular. By 2005, Ferrick was getting three and four times more inquiries than he could accept. Before long, he stopped publicizing the program. Word of mouth was more than enough.

After returning to Madison, the students from ’05 continued thinking of ways they could help the people who had opened their homes and lives to them.

And it was here that the local link provided by James Ntambi proved
crucial. Several of Ntambi’s former colleagues at Makerere University were committed to improving health and nutrition in Uganda’s rural communities. The students realized they could have the greatest impact by contributing to those efforts.

The most impressive was the work they had learned about in Lyantonde. The Community Based Integrated Nutrition program—CoBIN for short—was led by John Kakitahi, a physician and professor of community health at Makerere. CoBIN had trained 150 volunteer “family care workers” from various villages around Uganda to provide basic health services and education in their communities—an effective, low- cost way to address key public health challenges. Activities included health and nutrition counseling, garden planting and distribution of vegetable seeds, basic infant care and weight monitoring and building rainwater collection tanks.

The water tanks struck the students as especially important. Jenna Klink remembered the children drowning in Biwolobo. Eric Monroe recalled the many stagnant pools that were breeding grounds for mosquitoes carrying deadly malaria. The collection tanks being built by CoBIN often offered rural communities their only reliable source of clean water, especially during the dry season.

Even better, the tanks were conceived of and designed by a Ugandan. Engineer and Makerere University lecturer Moses Kizza Musaazi, through his company Technology for Tomorrow, specialized in simple inventions using local materials, all aimed at improving living conditions in rural Uganda.

In order to raise money, the students began selling necklaces made by Reach Out, a group promoting awareness about AIDS in Uganda. They gave some profits back to Reach Out and the rest to CoBIN to build more water tanks. It was a good start, but more was to come.

“We’d never talked about forming an organization,” says Klink. “Then we heard about the Wisconsin Idea Undergraduate Fellowship program, and we decided to apply.” Soon the group found themselves with $7,000 and a growing list of things they wanted to do. They formed a student organization and incorporated as a 501(c)3 nonprofit.

The fledgling Village Health Project (VHP) took on a life of its own. Fueled by passion, Klink, Monroe, Isely and the other founders applied for more grants and hit up friends and family. Their parents caught the fever and helped the group network in their own professional circles. Soon the students were visiting Rotary clubs and other service organizations and making their pitch.

With CoBIN as their boots on the ground, VHP started sending over funds. The projects they supported grew to include:
• Provision of natural water filters for use by village households. The filters use gravity to move water through layers of organic matter that absorb or kill many water-borne pathogens.
• Provision of “MakaPads,” affordable sanitary napkins made from papyrus—a simple innovation (also by Musaazi) that allows girls to attend school while menstruating, a barrier that impedes young women’s education throughout much of Africa.
• Building repairs and school supplies for Lweza Primary School in the village of Mukono, where Ntambi began his education.

The Village Health Project had an early opportunity to prove its mettle. In 2006 CoBIN’s funding from USAID dried up, and suddenly a group of undergrads in Madison became the organization’s sole source of revenue. Not surprisingly, CoBIN’s funding went from some $75,000 a year to around $15,000, which is roughly what it gets now, depending on donations. But CoBIN continues to thrive with its fleet of family care workers providing vital services in rural communities.

The Village Health Project, too, continues to grow and works in an easy exchange flow with Uganda study abroad. Study abroad students work on some VHP projects in Uganda, and many get involved with VHP after coming home, replacing students who graduate and move on in their lives. James Ntambi and John Ferrick sit on VHP’s board of directors to help make the flow even smoother. A half-dozen years after VHP’s founding, one thing seems clear—students returning from Uganda will continue feeling the need to do more.

Students who perform service abroad hope to make positive changes in that country. Less tangible, but just as real, are the ways in which the experience changes them.

Susan Mawemuko, a program officer with the Centers for Disease Control and Prevention at Makerere University, sees those changes in the waves of UW students who come in and out each year.

“When you meet them again at the end of the program, you think they have been living in Uganda for a very long time,” Mawemuko says with a smile. “It’s just three weeks, but it changes them forever—and you can see that on their faces.”

There is much evidence for the benefits of study abroad. Living in other countries helps students in everything from their general maturity to self-reliance and their ability to tolerate ambiguity, holds one study by the Institute for the International Education of Students. And spending time in another culture increases a person’s baseline creativity, found a study published in the Journal of Personality and Social Psychology (2009).

Employers increasingly recognize not just the value but the necessity of having a globally experienced workforce.

“A significant portion of our growth will come from international markets, whether through expanding the exporting of our products from the United States or establishing manufacturing bases overseas,” says Joel N. Krein, vice president–operations with Leprino Foods Company, Inc., a Colorado-based company that recruits CALS graduates. “The key to our success will be in recruiting and developing our future leaders with the skills and knowledge to excel in this international market.”

Certainly students are mindful of the job market when they opt to study abroad. “I recognize that to get the kinds of jobs I want, I need international experience and I need to know how to interact with other cultures. And I think that’s true of all students at this point,” says Rebecca Gilsdorf, who went to Uganda in 2009.

But what students experience runs much deeper. It’s a transformational experience that changes hearts as well as minds, and it’s not unusual for students to choke up when they talk about it. “Almost every single day I teared up,” says Liz Hill BS’09, recalling her trip to Uganda in 2009. “Just seeing how with so little they can give so much, and still be happy. I feel like they gave more to me than I gave to them.”

“It was one of the most pivotal experiences of my life,” says fellow ’09-er Douglas Stewart, who now works as a medical researcher and plans to go to med school. “You think you have a sense of what it will be like. But once you’re actually there, the visceral experience is much more powerful than simply reading about it.”

The experience has changed life plans for many students. “Before the trip, I was pre-med,” says Jenna Eun BS ’07, who now serves as president of the Village Health Project while earning her doctorate in biochemistry. “But afterward I realized I didn’t need to go into medicine, that a lot of what people need is not getting drugs or seeing a doctor. The issues there are usually more fundamental. It’s water and electricity. It’s public health issues. It’s civil engineering.”

Eric Monroe, from the 2005 group, had the opposite reaction. “I’d been kicking around the idea of medical school, but I wasn’t quite sure. I was thinking about maybe going into research or business,” he says. “But Uganda was one of the things that sealed the deal for me.” Monroe graduated from medical school in 2009 and is now a resident in radiology at the University of Washington.

Abby Stepaniak, also from 2005, was drawn to Africa for the long haul. After graduating she did the Peace Corps’ Master’s International program in South Africa and then shipped off to Sudan, where she works as a partnership coordinator with GOAL, an Ireland-based nonprofit. Study abroad continues to inspire volunteering for Peace Corps. Elizabeth Chadwick, who went to Uganda earlier this year, has signed up for a posting in West Africa after graduating this summer.

As for Jenna Klink, the Village Health Project’s first president, she took her community service gifts to post-Katrina New Orleans, where she earned a master’s degree in public health and serves as a program evaluator with the Louisiana Public Health Institute.

This year, Klink and Kim Isely returned to Uganda to assess impacts of the Village Health Project so far. They evaluated use of nine of the 13 VHP water tanks, and found that they are serving about 340 people, including 43 households and a school. Residents say the tanks save them up to four hours a day they would have spent fetching water, and that they are grateful to have water that tastes clean, gets their clothes clean and is free of water-borne diseases. This is an impressive achievement, especially considering it was the spare-time work of undergraduates.

But many of the group’s accomplishments defy quantification, Klink notes. “A lot of our impact can’t be measured. For example, the number of malnourished kids brought to the hospital and lives saved because of the family care workers’ presence in the villages.” Not to mention village children who have not drowned while fetching water.

Another thing that can’t fully be measured: the program’s impact on the students themselves. Because one thing no class can teach you is that when you set out to help others, the life that you change may be your own.

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Some material in this story comes from the documentary “Destination Uganda,” produced by the Big Ten Network in association with UW–Madison and CALS. The video is posted at