Eve Puffer: Poverty, the Underlying Challenge That Can't Be Ignored

New Psychology & Neuroscience/Global Health faculty member integrates interest in psychology and medicine

Part of the World Population Day Series
Eve Puffer's work in Kenya is building links with local communities and families to strengthen children's health.  Photo by Megan Morr/Duke University Photography
Eve Puffer's work in Kenya is building links with local communities and families to strengthen children's health. Photo by Megan Morr/Duke University Photography

Growing up surrounded by poverty and discrimination may have been a good thing for Eve Puffer.

In her hometown of Hartsville, S.C., population about 7,500, half the children continually live below the poverty level -- twice the state average.

"I think growing up you see things that impact how your interests develop," Puffer says. "Growing up in the rural South, I saw how much poverty and discrimination played into people's everyday lives. If you are poor -- and especially if you are in a minority group -- you just don't have the same opportunities. I knew I wanted to work with rural populations."

That desire never left Puffer, through undergraduate and graduate school and multiple trips to Kenya and other parts of the poverty-stricken world where she has been working to help strengthen communities to promote better life choices to improve quality of life and prevent HIV.

Duke undergraduates will soon get the chance to learn about such efforts when Puffer in the spring begins teaching as an assistant professor in Duke's Psychology & Neuroscience Department, with a joint appointment at the Duke Global Health Institute. She will teach a course on global mental health, which will focus on the burden of mental health disorders around the world and the efforts that are going into addressing them.

"I haven't had a chance to teach since living in Kenya, and I'm eager to share my experiences with students," Puffer says. "I think hearing about the realities of international research is what puts the reading and theory into context for students so it makes more sense. This is especially important when you are teaching students with backgrounds in either psychology or global health, not necessarily both. Giving examples of how these two fields can interact will make it more concrete."

Puffer's goal of helping to improve people's lives gained traction while she was an undergraduate at Furman University, a private liberal arts school in her home state she describes as having a "strong social justice bent." There she learned how closely related social and economic issues are to health.

That led her to begin searching for a way to develop a service-oriented career that integrated her interest in psychology and medicine. She found the answer in behavioral neuroscience, her major at Furman, where she graduated magna cum laude.

Puffer went on to earn a Ph.D. in clinical-community psychology from the University of South Carolina, completing her clinical internship in pediatric psychology at Duke University Medical Center.

In August 2008, Puffer became the Duke Global Health Institute's inaugural Global Health Postdoctoral Fellow, a position she held for two years.

During this time she began working in the Muhuru Bay area of Kenya, implementing a family-based intervention for HIV prevention and improved mental health with a focus on adolescents. Through a Fogarty International Clinical Research Fellowship, Puffer lived in Muhuru for 10 months, hosted by WISER, a Duke-affiliated non-governmental organization. Following her fellowship, Puffer also evaluated humanitarian programs for refugees as a research adviser with the International Rescue Committee.

While preparing to teach next spring, Puffer is also evaluating the program she designed in Kenya. She has a team of 20 local community members she's trained who work on the project as full partners in the research, including an area chief, teachers, HIV counselors, pastors and representatives from community organizations.

The underlying challenge that can't be ignored, she says, is poverty.

Young people are desperate for money to buy food and other necessities, so they take money for sex, multiple times, which further spreads HIV and AIDS. In addition, adults send mixed messages to youth: the explicit message is abstinence, while the cultural norm is that sex is a step to adulthood. Condom use is seen as a sign of distrust within a relationship, which further spreads disease.

"The more I learn about the problems we are trying to address in global health, the more I recognize the magnitude and complexity," she says. "It can be discouraging and daunting, you sometimes feel like what you're doing is just a drop in the bucket."

Puffer plans to return to the village in summer 2013 to work more with her local research team and area churches she says have strong potential to support families and to challenge the local norms influencing risky sexual behavior.

"Research is about experimenting -- figuring out what's been done, what's most likely to work, and then trying it, improving it and trying again," Puffer says. "The process is stepwise and slow, but it's exciting to be part of developing and testing new ideas, new approaches that could take us in the right direction in supporting people in the poorest parts of the world to prevent disease and improve mental health in their communities."