Profiles
Josephine Ensign: The Global Informs the Local
Josephine Ensign is an associate professor in the University of Washington School of Nursing, Department of Psychosocial and Community Health. She has adjunct appointments in the School of Public Health and Community Medicine and in Women's Studies. A family nurse practitioner, Ensign has a doctorate in international public health from John's Hopkins. She has done clinical work and research for the past 24 years focusing on underserved populations and homeless youth. She also teaches nursing and conjoint courses.
Ensign has a special interest in applying practices and approaches from international health to U.S. undeserved populations. In 2003, she received a Fulbright Fellowship to spend six months at Chiang Mai University in Thailand. During her time there, she worked with faculty to develop advanced research practices and learned about Thai policies and perspectives on high-risk adolescent health issues and community-based research.
Recently, she took a few minutes from grant-writing to talk about her work.
Where do you do your clinical work?
I work at an evening drop-in homeless youth clinic on Wednesdays and Thursdays at 45th Street Homeless Youth Clinic.
How did you become interested in working with homeless youth?
I was a home health aide for awhile in Boston while in public health school and I got involved with a group there that was working on health care for the homeless. I continued with that when I went back to nursing school. I also opened a clinic for homeless people in Richmond, Virginia. And then I got into the more kind of hidden homeless population and got really interested in homeless youth.
What led you to international work?
Working with pockets of poverty in the Boston neighborhoods and in Virginia, I realized that we're not doing a very good job with our U.S. health care system of reaching people who need basic primary healthcare. I wanted to learn from other countries that have fewer resources but are actually doing a better a lot better job than we are.
How does your work in other countries inform your work in the United States?
The U.S. has lots of laws and regulations to protect young people under age 18. But in Thailand there is a lot of grass roots action where they just go ahead and try things, bypassing the kind of red-tape bureaucracy we have here. There are really exciting creative programs in Thailand that get off the ground relatively quickly. Some could be applied in the U.S., but still with the necessary safeguards.
Also I've learned a great deal from the Thai experience about cross-generational help for youth and the genuine respect the Thai have for elders. I realized how important that is for a lot of our homeless kids here in Seattle, and that we can work to increase their links with grandparents. A lot of times, the kids get along better with grandparents than with their parents.
What is an example of an exciting creative program in Thailand?
One program that I am really very fascinated with and in awe of is a husband-wife team in Issan in the very northeastern section of Thailand. Using their social work backgrounds, they opened up their home to homeless and very poor starving young people in Khon Kaen. Their activity has now grown into a nonprofit, with a children's home across the street from their home that houses 30 young people. These are kids from 6 to 18 years. The couple anticipates different kinds of issues for the young people they work with, developmentally and otherwise. For instance, they offer home schooling for the young people at the children's home. Most of the time, the homeless children have had incomplete educations or they're from another country and the Thai language is difficult for them; as a result, they can't really send them to regular school and these children get teased by other children. So the husband-wife team anticipates these different things and makes things happen, helping the teenagers to start developmentally moving away on their own while supporting them.
Are there different reasons for homelessness in Thailand compared with the United States?
Some reasons are the same and some are different. One reason that is a bit different in Thailand is the lack of a birth certificate for a lot of the kids. For some of them, their families might be long-term Thai residents but they're from ethnic minority groups like the different Hill Tribe groups. It can be difficult to get a birth certificate; without that in Thailand, you have no real access to education, health care or jobs. And a lot of the young people are from migrant Burmese families who are moving around for work. They often don't have documentation papers and they're discriminated against.
In fall quarter, you and your colleague Michael Kennedy took 12 BSN students to Thailand for an immersion experience. You described that teaching experience as the best teaching experience of your life. What made it that?
It was a confluence of different things. We had an amazing cohort of extremely diverse students. Out of 12 students, six were either first or second generation Asian-American, including one student who was Thai-American. It was fascinating learning from them. A fair number of them had been back to their country of origin to see families or as tourists. This was a much different immersion experience of getting to know different aspects of Thai culture. All of them were extremely mature and reflective and they were very cohesive as a cohort and willing to share experiences with their fellow students. That was very rewarding. Also my co-instructor, Michael Kennedy, who was teaching the psychosocial component, and I did a lot of integration of community and psychosocial health.
The other thing that was a highlight for the students was a four-day educational trek in the mountains on the border between Thailand and Burma. We stayed with the village headman and met people like the spirit men who are in charge of many health issues. The students learned about traditional herbal medicines, water and sanitation issues, and the considerable strengths of very poor communities firsthand. That part was really quite rewarding.
Were you doing research as well?
I was finishing up my research; I had a little bit of funding from Puget Sound Partners for Global Health to do research with a Thai NGO and a Thai nursing faculty on the outskirts of Bangkok; this was research with street children. But my primary responsibility in the fall was teaching.
You combine research with your clinical practice. What are the challenges of doing that?
For me personally, there are more advantages than challenges, because research and clinical work mutually reinforce each other. My research is very much practice-based; my doctorate is a practice-based doctorate. One reward is just the fact that that you can wear two hats at the same time. But that can also be a challenge in terms of ethics and boundaries and being clear about what your role is so that there's not confusion
What research are you doing right now?
I'm finishing up two grants on homeless youth in Thailand. I'm trying to get additional funding to move more into community-based health literacy work with homeless and disconnected young people here in the greater Puget Sound area. I'm also involved with a national advisory panel that works with street youth across the U.S., helping young people learn how to access health information, understand it, and navigate our crazy health care system.
What do you find rewarding about your international work?
I learn so much about myself and also about us as a country; from the good to the bad and ugly—things that I'm proud of and things that can be reflected and improved upon.
What is the significance to you of the Department of Global Health starting up?
I'm excited about the UW having a definite entity that crosses over at least some disciplines in global health. I hope that the department is integrated and inclusive of some of the wider underpinnings of health across the globe. I'm hoping that lots of people will be at the table—human rights, social work, and others.
Interview by Marjorie Wenrich
