By Anne Papantonio
Parent of alumni and former development officer, 1999-2002
(The Internationalist Spring/Summer 2020 Vol. 64)
In the words of NIS founder Tané Matsukata, “Our ultimate goal is that every Nishimachi student learn to live harmoniously in, and contribute to, world society.” Like so many Nishimachi alumni, Chika Hayashi, class of 1991, embodies that vision.
By way of background, Chika graduated from Nishimachi in 1991 and went on to ASIJ for high school. She did a bachelor’s, and then a master’s, degree in global disease epidemiology and control at Johns Hopkins University. After working in labs as a student, her first office job was with the World Bank in Washington, D.C. From there she joined the World Health Organization (WHO) for three years in Geneva, where she analyzed the cost effectiveness of interventions to prevent and treat HIV and explored how nutrition could improve maternal and child health outcomes. A year in East Timor with UNICEF followed. She returned to Geneva in 2004 to work again with the WHO, where she monitored and evaluated the global HIV response until 2017. She then moved to New York and now works for UNICEF, where she leads the team that collects, monitors, and analyzes data on nutrition around the world.
Although she is currently working from home, like much of the world, she finds there is little down time in a day. During the COVID-19 pandemic, it is very much all hands on deck for UNICEF, and much of her day is now spent on the disease, trying to quantify the impact it will have on the lives of children and women. Hundreds of millions of children are already malnourished, and even more may be pushed over the edge. Better data can support governments, UNICEF offices, and emergency operations around the world.
The Nishimachi Years
We talked about Chika’s years at Nishimachi, how they influenced her decision to pursue a career in social action and how they put her on the trajectory to where she is today.
Chika was born in Tokyo, her father Japanese, her mother Taiwanese. Many of her mother’s friends were non-Japanese, whose children went to international schools, and it seemed natural to send Chika and her sister to Nishimachi.
She remembers the words of the school song, “Let There Be Peace on Earth,” which she and her classmates sang for ten years. Tané Matsukata was still alive at the time, and she would address the student body at school assemblies, impressing upon the students the fact that they were all global citizens.
They were in an extraordinary situation at Nishimachi, Chika says, with students coming from all over the world. Her classmates, regardless of their backgrounds, were her extended family. She believes that, although everyone has natural bias, Nishimachi students have an advantage in that they are able to look beyond. Now that she has been living in Europe and in the U.S. for the past twenty-five years, and visiting many lower-income countries, she realizes that they lived in a bubble during those years at Nishimachi. She works with international colleagues from various corners of the globe, most of whom did not attend international schools. Not everyone is able to shed their preconceptions, but Nishimachi, as a microcosm of the greater world, better prepares its students.
Nishimachi enabled her to be at ease almost anywhere. “I feel very comfortable talking to anyone in an international context. A lot of people at the UN say it’s an adjustment working with so many international people, but I feel right at home.”
Chika thinks she must have first heard about the UN at Nishimachi, and, though she had only a vague sense of what was involved, she thought she might want to be part of it. She also remembers vividly a commercial that aired in Japan showing severely malnourished children—and how shocked she was. A summer during high school at Tufts University’s Fletcher School, where she took international relations classes, further spurred her on to seek a career in an international organization.
She started in pre-med as an international relations major at Johns Hopkins University. After taking an introductory course in international public health, she decided that this was what she really wanted to do. Public health brought everything together, the possibility of working on the issues that attracted her to medicine as well as a potential career at the UN. She chose global disease epidemiology and control as her specialty because she is a quantitative person, and “epidemiology involves applying quantitative skills to the study of the spread of diseases.”
Chika completed her master’s at Johns Hopkins and went on to spend the next twenty years with international organizations, the World Bank, the WHO, and UNICEF.
UNICEF in New York
Chika moved to New York City with UNICEF three years ago, where she leads a team that monitors child nutrition globally. “We are facing a double burden of malnutrition, with hundreds of millions of children around the world without enough food and nutrition, while, at the same time, the number of children who are overweight is increasing.” Although infectious diseases are still a major problem in developing countries, the dynamic is shifting. More people are surviving them, and many people are now living with untreated chronic diseases (such as diabetes and cardiovascular diseases). Nutrition and diet play a significant role in those.
At UNICEF Chika has been developing global reports and guidance on indicators that can help monitor progress towards the Sustainable Development Goals (SDG)—the set of goals the UN, the international community, and individual countries have agreed to strive to meet by 2030. Nutrition is in SDG number 2—zero hunger by 2030.
She also works on new areas for data collection. UNICEF traditionally collected data on healthy eating (whether children were getting enough to eat, and from which food groups) for many years. However, given the growing obesity epidemic, Chika is introducing unhealthy eating to this framework to monitor diet—tracking the consumption of sweetened beverages and junk food in children around the world.
COVID-19 and Nutrition
I asked Chika about the coronavirus, which is front and center for every citizen on this planet, in light of her expertise in infectious diseases. At the WHO her work centered on HIV, where she monitored mother to child transmission and established criteria to certify that mother to child transmission of HIV, in a given country, was “under control.” If they were preventing the spread of HIV in the population, if they had testing, if they were treating, if they had a specific health care and data system in place, and if the number of cases fell under a specified threshold, then the disease was no longer considered a public health problem.
She explained that when talking of an epidemic and a pandemic, the flip side is eradication, meaning the disease is gone from the planet (like small pox). The step before eradication is elimination, when the disease has been eliminated from a specific region of the world. But it is not eradicated. That is where polio is now—eliminated in many places but circulating in Afghanistan and Pakistan, for example.
That brings us to the coronavirus. At the peak of the global pandemic, control, elimination, and eradication, appear a long way off. Certain characteristics make diseases especially difficult to eradicate: there are cases where the disease shows no symptoms or can live in a nonhuman host, and there are no vaccines or treatment.
“What is really scary about COVID-19 is that we don’t know—we actually don’t have a lot of information about it yet. What worries me is that we are seeing younger people in New York definitely getting seriously ill, and we are starting to see conditions even in children now which may be associated with COVID-19. Of course we’re worried about immuno-compromised people, those with pre-existing conditions, or those who are over sixty-five, but the fact that some younger people who seem generally healthy are getting very severe forms of the disease is worrisome. Fortunately, we are learning more about COVID-19 at a record pace.”
Chika worries too about the millions of people unemployed as a result of the pandemic. The U.S. government is at least taking steps to get some financial aid out to help those who have lost jobs or businesses. In developing countries, governments do not always have the resources and structures to do that.
“People talk about overcrowded refugee camps, but at least many camps are organized, and governments, the UN, and other agencies are providing soap and water and other support. We have people in very crowded conditions elsewhere who can’t do physical distancing, and we don’t know what measures their governments are going to put in place and for how long.
“New York implemented a stay-at-home policy for non-essential work. In developing countries, many people are day workers, and their jobs cannot be done from home. If they can’t go to work, we could end up with hundreds of millions, even a billion people, out of jobs. So we have to look carefully at the secondary consequences of protective measures to reduce COVID transmission and at the same time implement plans to counteract any potential negative consequences.”
Chika is particularly concerned with child nutrition vis-à-vis the coronavirus. First and foremost, people are going to be more susceptible to the virus in food-insecure areas through multiple pathways: their immune systems are weaker to begin with because they’re malnourished and many live in poor households with less resilience when crisis hits.
“We’ll potentially have more orphans; more people without jobs; closed markets; a disrupted food supply; and prices will increase. That leads to food-insecure households. We already have high levels of food insecurity in many countries, and we’re going to have more. People won’t be eating enough. Here in the U.S. it’s often about the quality of meals, but the real issue for millions around the world is not having enough to eat. And there won’t always be financial assistance for those families.”
While many of the models public health experts cite focus on COVID-19 numbers (number of cases, number of deaths), UNICEF and others are currently working through their country offices, and with governments, to determine what systems or policies can be put in place to mitigate some of the secondary effects. It is not one size fits all, so Chika and her colleagues have to think about what makes sense in different settings, to quantify the problems and to come up with interventions and policies that will help support, and protect, the most vulnerable children.
Supplies are a big issue globally (as they are in the U.S.). For developing countries the needs are much more pronounced. For the last few weeks, UNICEF and others are mobilizing to send PPE (personal protective equipment) to developing countries. It will not be enough. “Many hospitals will not have ventilators and do not have enough experience in using and maintaining them. COVID-19 has laid bare the inequities in health care not only within countries, but across countries.”
The Power of Communication: A Nishimachi Legacy
In terms of other earlier outbreaks, Chika thinks there are definitely lessons to be learned from Ebola, as well as from HIV. In the earlier days of the latter epidemic, things really went out of control because there were so many unknowns. We are at that stage for COVID-19. “We don’t have the total picture on how COVID spreads, on a person’s prognosis once infected, and on treatment strategies. There is a lot of misinformation we have to correct on COVID so communication is, and will be, important.”
UNICEF and the WHO are looking at the transmission of the virus through breast milk, which was an issue with HIV. Women did not know whether or not the disease could be transmitted through breast milk so they would just stop breastfeeding their babies, which created other problems. In some parts of the world, a child’s chance of survival is higher if that child gets breast milk containing maternal antibodies and nutrition than if they are fed formula, which is expensive and unsafe when clean water is not available.
Communicating the correct information in a way that resonates with the audience is critical.
Another important lesson gleaned from Chika’s experience with HIV relates to human rights. HIV came with a lot of discrimination. “It’s different from COVID. I do think if we don’t look at human rights and equality, we won’t be able to mitigate it. If people are scared and think they have COVID—let’s say they’re an illegal immigrant in the U.S.—they won’t go to a hospital. When you’re trying to mitigate the spread of an infectious agent or disease, you need to put in place measures where you treat everyone equally and reduce discrimination, in other words, reduce any barriers to access or risk-reduction behaviors.”
That is where communication within a community comes in. “It worked for HIV, it worked for Ebola, and I think it’s going to work for COVID.” Especially in developing countries. “We have to bring in communities to get the right information communicated. If we are talking about an illegal immigrant population, we have to be sure that people speak to each other and can say, ‘Listen, we can trust them, we’re going to get tested and treated so we don’t spread this virus.’ Clear communication is needed to spread the word on social protection measures so that it reaches those who need it.”
Herein lies the difference between a public health approach to an epidemic or pandemic, where one looks for the best outcome for the population, and an individual medical approach, where health professionals do everything they can to treat an individual patient.
At the end of the day, Chika says “you go to school to study infectious disease epidemiology, and it looks as if solutions might lie in models and numbers. That’s the easy part. I’ve learned it’s really about understanding communities. We can’t do it the old way anymore—where development experts go in to a country, and say, this is what you have to do.”
Ebola is a good example. “The solution to mitigating it came from the communities affected. We did that by involving the community, realizing that the solution isn’t always what we think, but what they want.”
When there is a vaccine, when it is understood how the virus works, we will find solutions. The UN’s role is to translate that science into something that can be scaled up and delivered. “We have to put funding back in some of the basic science. Without that, you can’t do much.”
And for Fun?
“I love to eat!” Chika says she definitely eats out a lot (or used to before the coronavirus). She has been working so much that she has not had time to explore New York as much as she had hoped, and that is something she definitely wants to do more of. She also likes to watch tennis and ski, thanks to all the practice from Nishimachi skip trips.
Now that restaurants are closed and she stays at home, she has online happy hours, chats, and movie and game nights with friends. She cooks more. She thinks of starting a blog on the food she has eaten all over the world but never got around to setting up.
“I really hope when the coronavirus is over we can have a little Nishimachi reunion in New York because there are quite a few of us here or in the surrounding area.”
Looking ahead to the future, Chika says she is open. She wouldn’t mind going back to a country or a regional office. She thinks she will always work in data, setting up information systems and preparing global reports and advocating for areas needing improvement.
“I am convinced more and more that while solving the science is important, we need to pay more attention to improving communication to better translate the science so that people understand what needs to be done. It’s not as easy as it seems.”