Flora Zhou, HSPH SM 2025, had dreamed of visiting Brazil for years, and the 2024 Cultural Bridge Fellowship enabled her to make this dream a reality. Though she’d read about aspects of the culture and spent months practicing Portuguese, her time there "revealed a country that is far more intricate and nuanced than any book could capture." And it enabled her to gain a powerful firsthand understanding of how socio-cultural factors influence health outcomes.
"This cultural exchange experience has been incredibly enlightening," she wrote in her internship blog. "I deeply believe in providing an equitable environment where everyone has the opportunity to pursue better health… this summer I had the chance to contribute to the development of a health system that [does this] by empowering mothers and children."
Flora, originally from China, spent her summer working on data collection with a maternal and child health tracking team at the Federal University of Ceara (UFC) in Fortaleza, Brazil.
The team collected data from programs around the city, including non-traditional initiatives focused on "local knowledge and community strength," like a community therapy project to combat gun violence and support healing for those impacted, and government programs to economically empower women by teaching cooking and traditional crafts like lacemaking. They also visited health units where Flora spoke with patients, community health agents, and nurses about their experiences seeking and providing healthcare services.
One of their key site visits was to the Instituto da Primeira Infância (IPREDE), a non-governmental organization serving children with malnutrition and cognitive impairments and their parents. At IPREDE, Flora noted the focus on empowerment of the whole family—not only do children receive classes tailored to their conditions, their caregivers meet with psychologists and take courses to empower them through skills like sewing and weaving.
"I gained valuable insights into how the Brazilian health system, [which is free to all], mobilizes resources to maximize health outcomes," she wrote.
"This experience has been incredibly enlightening. It has not only broadened my understanding of how different cultures tackle similar problems, but has deepened my appreciation for the nuanced ways in which cultural contexts shape systemic approaches."
Flora also learned more about social determinants of health in Fortaleza. She shared one example of a conversation she had with a pediatrician where she mentioned seeing many more mothers than fathers at health clinics.
"[They explained] many fathers were either incarcerated or had fallen victim to the cycle of drug addiction," she recalled. "So not only were the children traumatized and suffering from health conditions, but the mothers were overwhelmed, struggling to raise their children while desperately needing assistance and support. This revelation brought into sharp focus the link between poverty, violence, and the challenges of family development and maternal and child health in this region."
However, she added, "hope is never absent," noting the dedication of many individual health workers she met, as well as the government and other organizations funding and expanding programs.
Flora treated her summer as a true cultural exchange, reflecting on the similarities and differences she saw between Brazil and her native China. She was even able to visit the UFC’s Confucius Institute, a program focused on disseminating Chinese culture in Brazil.
One particular conversation with a data scientist at a local health surveillance center stuck with her, "illuminating the striking contrasts and surprising similarities between Brazilian and Chinese approaches to health management and data science."
"Both countries value data and evidence-driven policies," she explained, "but in Brazil, the focus is often on real-time data collection and rapid response… while in China, data is much less accessible, and emphasis is put on accurate calculations and long-term planning from data insights."
With health policymaking, systems in China are hierarchical, with centralized decision-making and top-down execution.
In Brazil, "the emphasis on family and community takes precedence, in a decentralized policy-making process where local bodies have autonomy to adapt strategies that best suit their community's specific needs," she wrote, "which fosters innovation and flexibility, but also sometimes leads to variability in effectiveness across regions."
This was a salient example for Flora, one that "not only broadened my understanding of how different cultures tackle similar problems, but deepened my appreciation for the nuanced ways in which cultural contexts shape systemic approaches."
She returned from Brazil with this broader, deeper knowledge in her field of public health—and an even stronger appreciation for the opportunity provided by a cultural bridge.
"As I continue my research, I carry with me these insights," she wrote in her final post, "reminded of the power of cross-cultural learning in enriching our professional practices and personal perspectives."