Global Health Travel Blog

UNC Gillings students share their global field experiences around the world.

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Student Reflections on the 2019 Triangle Global Health Annual Conference

Six students received funding to attend the 2019 Triangle Global Health Annual Conference on One Health: Creating Our Shared Future — Humans, Animals, and the Environment. Here are their reflections on the day!

UNC Gillings students representing at the conference.

UNC Gillings students representing at the conference.

Madelaine Katz, MPH student:

My experience at TGHC 2019 conference was wonderful. I had the chance to learn a lot about an area of global health that I am not as well versed in, in the form of environmental health, which was a major topic on panels and plenaries due to the theme of the One Health conference. I was particularly engaged with Dr. Dennis Carroll’s keynote on major globalized trends and their impact on health. I’ve had a lot of opportunities to learn about climate change in general, but the trends such as population change, land use change, and transformative technology were fairly new perspective to me. The fact that the world’s population will be increasing so rapidly over the next 80 years has so many alarming implications for health, especially since people will also be living longer. I am motivated to try in my career to encourage programming that incorporates knowledge of these trends, perhaps most importantly by focusing on the sustainability of health interventions and policy, so that it has overreaching positive impact on future generations wherever possible.

Having the opportunity to present my poster was also very exciting. My poster was based on research of menstrual hygiene policy on a global scale, and suggestions of how it can be more frequently incorporated into policies and guidelines such as the Sustainable Development Goals. Quite a few people came by to speak with me about my poster, it was encouraging to hear from people who wanted to discuss the importance of menstrual hygiene in this multidisciplinary space. It was a great opportunity to practice my research presentation and dissemination skills, and I received some great feedback for future work in this area from other professionals, and was even able to make a few new connections!

I’m so grateful that Gillings provided funds that made it possible for me to be a part of the event, and that I received a chance to share my work on menstrual hygiene policy in this arena. I’m looking forward to following up on the new professional connections I have made, and attending future global health related events in the area.

Brandon Adams, MPH student:

I thoroughly enjoyed the content and wide range of scientific ideas and projects at the conference. For me, the most memorable talk of the day was surprisingly at the beginning. Dr. Dennis Carroll touched on the future state of the world and discussed subjects such as population growth, climate change, and advanced technology. From his discussion, he emphasized the immediate need for change and collaboration across disciplines, specifically in the form of One Health, where professionals that specialize across a range of fields of human health, animal health, and environmental health need to work together to solve the issues that are plaguing this world.

Overall, the experience was certainly a memorable one and a formative point in the development of my career interests and professional goals. In addition, it was great to contextualize the material I learn from the program courses at Gillings and apply it to findings and discussions in the real world from both a global and local context.  As an added note, this was my first professional STEM/global health conference, and I would never be able to attend it without the financial support that I received. I would like to thank the UNC Gillings School of Global Public Health and the respective departments for awarding me this rare and important opportunity.

Kris Sladky, MPH student:

On October 16, I had the privilege of attending the 2019 Triangle Global Health Annual Conference under the theme of One Health: Creating Our Shared Future – Humans, Animals, and the Environment. The format of the conference consisted of morning, lunch, and afternoon plenary sessions, a late morning and afternoon breakout session, and morning and afternoon mingle/poster/tabling sessions. With a variety of breakout panel topics and rooms at each session, over 45 poster presentations on various One-Health-Related topics, and a variety of organizations tabling, this format proved conducive to allowing participants agency in what exhibits, topics, and discussions they engaged in. As for the plenary sessions, each had a keynote speaker, panel, and storyteller, as well as an award presentation. While I thoroughly enjoyed both of the keynote speakers, Dr. Dennis Carroll’s talk in the morning entitled “Six Mega-Trends and Their Implications on Global Health in the 21st Century” really caught my attention. Flowing through statistics on six major areas that are currently experiencing rapid change including population, disease profile, urbanization, climate change, land use change, and transformative technologies, Dr. Carroll explicated how the “globe” is not ready to handle the magnitude of change coming by 2100 in all of these areas, which was frankly frightening. He urged us as public health practitioners to venture out of our “professional silo’s” and bridge the gaps among them in order to work toward solving, or managing many of these coming changes together in an interdisciplinary fashion.

For the morning breakout session, I attended Pathways to One Health Research in Vector Borne Disease. I was most intrigued by Dr. Natalie Bowman’s research on Chagas disease in Peru, and the socio-cultural aspects that contribute to spread of the disease from its triatomine, “kissing bug” vector to humans. In some of the periurban villages in Arequipa, Peru Dr. Bowman worked in, people like to live wall to wall with their domestic animals, which brings humans close to another source of food for the “kissing bugs.” Thus, the bug is drawn to the area of the homes with both their human and animal food sources, making it likely to bite, and infect humans, whereas animals do not show symptoms of the disease. Further, she discussed the difficulty of possible interventions including spraying and using physical barriers in the area, making prevention more challenging. As a trained anthropologist, and One Health enthusiast, I enjoyed connecting some of the more “micro” aspects of the disease covered by Dr. Bowman of an insect-vector-borne illness to the human and environmental challenges in the area.

The lunch plenary consisted of a “Company Showcase” for AgBiome, Locus Biosciences, and Sentinel Biomedical. As a pet lover and owner of multiple cats and dogs over my lifetime, essentially all of whom have passed away from cancer, this company provided incredible insight into their primary mission of advancing animal health by understanding the biological and environmental influences of canine cancer. As a kid, several of our homes were sprayed regularly with Round-Up weed killer, either by outside, private, landlord-hired companies, or by my father. With our cats and dogs constantly outside and exposed to these chemicals, my father (an exotic animal veterinarian and professor at UW-Madison School of Veterinary Medicine) and I have been discussing a theory that maybe exposure to these chemicals (among others on the ground in parks, on pathways, etc.) ultimately caused the cancer in our pets. Matthew Breen, the founder of the company, delineated what the company does specifically, and how they have been using surveillance, and dog tracking systems to keep in touch with the diseases animals come down with. Importantly, Breen made an excellent connection to humans as our pets’ counterparts, bringing up the point of possibly beginning to sequence, and gain more insight on the connections between animal and human cancer. As a cat/dog/animal lover in general, I thoroughly enjoyed Mr. Breen’s presentation, and appreciated his One Health connection, which was the most evident of all of the speakers over lunch.

For the afternoon breakout, I followed my passion for writing and communication and attended the “Reach the People: How to Communicate Global Health Issues and Solutions” session. The panel, mediated by Editor in Chief of Global Health NOW from JH Bloomberg School of Public Health, included Matthew Chamberlin (Director of Communications and Marketing from Gillings School of Global Public Health), Lisa Braziel (Senior VP Ignite Social Media), Leoneda Inge (Race and Southern Culture Reporter for NC Public Radio), and Gavin Yamey (Professor, Duke University). I thoroughly enjoyed Gavin Yamey’s speech. He was engaging and laid out insightful lessons about effectively communicating public health information, including making sure to know your audience. Further, at the end of this session, we discussed the difficulty, as public health professionals and academics, of communicating the results and important messages from our research to laypeople and other academics alike.

The final plenary of the day featured keynote from Dr. Linda Birnbaum focusing on environmental issues and their impacts on human and animal health, as well as a panel entitled “Trouble in Paradise – One Health in the Galapagos Islands.” This panel mixed human anthropology, nutrition, microbiology, environmental science, and veterinary medicine to discuss the conditions affecting humans, animals, and the environment in the Galapagos Islands. The flash talks covered consequences of ocean warming on the Galapagos biome, anti-microbial resistance, the dual burden of nutrition, the threat to sea turtles and marine ecosystems with climate change and human disruption, and the marine environment and how it affects human settlement. Having been interested in the Galapagos Islands since I was a kid, I really enjoyed this panel, and felt it provided the most comprehensive coverage of factors that play into One Health (biology and microbiology, environmental and marine science, anthropology, nutrition, socio-political issues, animal and ecosystem health, etc.).

I am extremely grateful to have been able to participate in this conference. I have developed a passion for One Health throughout my life based on my family background, academic endeavors, love for animals, and concern for the environment, and hope to carry this focus into my future career as a physician, public health practitioner, and professor. Every opportunity to gain knowledge from experts in such a variety of fields, especially in such a welcoming, interdisciplinary setting, should be embraced.

Stephanie Cleland, MSPH student:

Stephanie was selected to present a poster at the conference.

Stephanie was selected to present a poster at the conference.

Today, 23% of global deaths are linked to the environment, accounting for 12.6 million deaths annually. By 2100, 5 of the 10 most populous countries will be in Sub-Saharan Africa, resulting in increased urbanization, ambient air pollution, and non-communicable diseases. Currently, 9% of terrestrial species are threatened with extinction by 2050, caused by land-use change driven primarily by agriculture related to livestock production.

These are just a few of the alarming facts presented by speakers at the 2019 Triangle Global Health Conference. The speakers used this information to emphasize the importance and complex interconnectivity of the growing field of one health, a concept that extends beyond the health of humans, animals and the environment and into energy, trade, and urban planning. The conference was an incredible opportunity to learn more about one health and connect with students and professionals doing important global health work in the Triangle area. During my poster presentation, I discussed my research on the air quality and acute health impacts of wildfires with Linda Birnbaum, the former director of the National Institute of Environmental Health Sciences. Receiving feedback and guidance from one of the most notable scientists in environmental health is an experience unique to a setting like the Triangle Global Health Conference.

The plenaries and breakout sessions during the conference were particularly impactful for me because they highlighted that the future of one health belongs to youth, the current students and future workers. Speakers emphasized that with collaborative engagement, technical competence, and an enabling environment, we will be able design the next generation of multi-sectoral, community-level solutions to address increasingly complex one health challenges. After attending this conference, I am more motivated than ever to join the growing workforce of one health professionals, where I can lead by example, emphasizing that global health is local health and that developing solutions to complex one health challenges requires flexibility and adaptability.

During the panel on climate change, Juli Trtanj from NOAA made a comment that has stuck with me since the conference. She noted that we observe so much environmental data, from satellites to temperature to land use. Given this extensive access to data, she posed the question: “Why are we still surprised by outbreaks, both human and animal?” She emphasized the importance of leveraging the available environmental data to better predict and prevent outbreaks. Moving forward into my career in environmental health I believe this question will motivate much of the work I do.

Lein Soltan, MPH student:

Dr. Dennis Carrol set the scene for the day’s proceedings with his talk titled “The Future is Coming, Are We Prepared? Six Mega Trends and Implications for Global Health”. He described these six trends as population change, changing demographics, urbanization, climate change, land use change, and transformative technologies. The moral of his story: by 2100, this world will look entirely different. He poignantly preached how we must shift our paradigm from thinking about the world we were born into to the world those born of us will inherit. The major takeaways: Africa will be the center of these global trends and solutions will need to be multi-sectoral. We must revolutionize artificial intelligence to tackle the issues we have been unsuccessful at preventing. While I and likely the majority of the room felt an impending sense of doom at the close of his talk, Dr. Carrol reminded us: Do not panic! It was a wonderful introduction to a day of One Health filled presentations. What I found most sticking about Dr. Carrol’s talk was his insistence that we need to expand One Health to include energy, trade, urban planning, and financing in addition to animals, environment, and people.

Dr. Carrol’s introduction was followed by Rob Salerno from DAI who shared with us “Three Lessons for Moving into Journey”. We must lead by example, recognize that complex problems require flexible and adaptive management approaches, and we must measure impact, performance, and progress. While we are not expected to share the same views on how best to tackle these “wicked” problems, we must move unison towards the same goals.

The climate change panel offered insights into the critical need to advance and streamline disaster related research which is often delayed or missed due to difficulties in funding, slow review protocols by the IRD, lack of ready to go research tools and protocols, lack of inclusion of community stakeholders, and no formal way to coordinate research. The first panelist argues that research must prioritized as part of the public health emergency response in order to answers these two critical questions about disaster efforts: Is it safe? Did our efforts help? He shared how the NIEHS developed a pre-reviewed protocol in May 2015 that would be ready to launch during an emergency. This protocol was used after Hurricane Harvey blasted through Houston and allowed research efforts to commence within two weeks.

We also learned that while sugar beets and sugar cane benefit from increasing levels of carbon dioxide, most other crops suffer and we are seeing yields consistently declining. The panel wrapped up with a discussion on how ocean species are sentinels for climate change. We are not untouched by the issues we see in the ocean as was demonstrated by the recent salmon die off in Alaska and the increasing incidence of cholera and vibrio outbreaks.

After a brief poster session break, I attended the advocacy workshops led by two member of FHI 360. They shared FHI 360’s nine steps to developing an advocacy strategy. We focused on step three: identifying target audiences and participated in stakeholder analysis and power mapping activities using Zika in Puerto Rico as a case study. The major takeaways from this workshop were that you need to be flexible and systematic in your advocacy approach.

Throughout the rest of the day, I learned about the methods of tick surveillance in North Carolina, how we can use dogs as sentinels for human health, and finally, about One Health in Galapagos. In this panel, Dr. Adrian Marchetti shared the four major threats to ocean environments (climate change, invasive species, marine pollution, and over-exploitation of marine resources), Dr. Amanda Thompson enlightened us on the dual burden of disease among Galapagos residents (obesity and malnutrition), Dr. Jill Stewart alerted us to increasing antimicrobial resistance in the waters of the Galapagos, and Dr. Greg Lewbart virtually gave us insight into sea turtle wrangling to look for ingestion of plastics.

Dr. Linda Birnbaum closed out the day and shared her forty years of expertise on environmental air quality and predictive toxicology – that is utilizing organisms with common biological pathways to predict responses in humans. Here, we learned that 92% of deaths in low income countries are pollution related and that a healthier environment could prevent the deaths of 1.7 million children under five years of age.

Thank you UNC Gillings for allowing to engage in this wonderful day of learning how to tackle some of Earth’s most challenging and salient issues. It is truly exciting to see the how the One Health movement is at play across various disciplines!

Lilly Smith, MPH@UNC student:

Attending the Global Health Triangle Consortium annual conference expanded my knowledge of public health and excited me for a future career in this field. I found out about the conference through the UNC MPH email newsletter when the topic of the conference caught my eye: One Health. My interest in public health comes from the veterinary medicine field and previous studies had lead me to learn about this framework of looking at how the health of humans, animals, and the environment interact. Speakers at the conference came from a variety of disciplines but are all working towards improving global health. 

One of the keynote speakers, Dennis Carrol, laid the foundation for the conference by discussing six mega-trends and their implications for global health in the 21st century. I enjoyed the breakout sessions I attended on “Strengthening Human and Zoonotic Disease Surveillance in Burkina Faso, Mali, and Sengal” and “One Health Efforts Are Likely to Fail Unless Partnerships Are Gained with Agricultural Industries and Food Animal Veterinarians”, which both touched on areas in which I would like to work in the future. I learned about companies working on exciting new techniques such as using data collected on cancers in dogs in order to learn more about cancers in humans and using CRISPR techniques to kill bacteria as an alternative to antibiotics. 

I enjoyed reading posters about public health research and talking to students who have performed a variety of research. The conference afforded great opportunities to network with professionals and other students. As an online MPH student, it was exciting to meet a few of the other UNC students!

Faculty in South Africa

Blog post by Kurt Ribisl, Professor and Department Chair, Department of Health Behavior

Greetings from South Africa!

I am spending 10 days in South Africa (Johannesburg and Cape Town) and Zambia (Lusaka) to meet our research and practice partners.

My days have been filled with meeting UNC undergraduate students taught by Alex Lightfoot in Cape Town and visiting their internship sites. I gave talks on e-cigarettes and vaping at the University of Witwatersrand and the University of Cape Town. I have also been meeting with researchers doing cutting edge work in HIV and gender-based violence. On Sunday, I fly to Zambia to meet with Dr. Ben Chi (UNC Gillings) and his colleagues at the University of Zambia including the dean of their School of Medicine, Dr. Fastone Goma who leads some exciting CVD and tobacco control work.

Alex Lightfoot and I also met with the leaders of Black Sash, a group started by a white middle-class woman who opposed apartheid in the 1950s. They are still going strong and now advocate for social policies to benefit vulnerable populations in South Africa. We then visited the Red Cross War Memorial Children’s Hospital in Cape Town, which is regarded as South Africa’s leading center for postgraduate specialist pediatric medical and surgical training. We met with a student who shadowed health care providers carrying out trauma surgeries to basic family medicine. She saw 30 burn patients and is the only specialized pediatric burns unit in Africa. Several were burned by hot water and others by cooking oils. She wants to learn more about public health and injury control programs that could prevent these devastating injuries. She saw two very young children were being treated for lipoid pneumonia, a condition brought on from inhaling oils in the home. I immediately thought of the 6 people who have died from vaping over the past 2 weeks, most of whom also had lipoid pneumonia from vaping THC and CBD oils.

Deborah Baron gave me her copy of Trevor Noah’s book, Born a Crime. I can’t recommend this book enough – it provides an insightful look at what it is like to grow up under Apartheid. Alex assigned this to all of her students taking her Apartheid class and we have referred back to it several times.

Just before I left, two events have shaken South Africa. First, there have been numerous xenophobic attacks against foreigners and their businesses. Many people are being forced to flee back to their home countries.

I met with Dr. Mutale from the University of Zambia the day before I left Chapel Hill and he mentioned that they had to repatriate all of their students from South Africa. Refugees filled the Scalabrini Centre on my visit there. Volunteers were creating resumes for them, helping them find jobs and fill out asylum paperwork. I watched a room full of migrants taking online courses at the University of Southern New Hampshire to earn their AA degree. One woman lost her livelihood when looters torched her business. Like others in our group, I bought one of her remaining 15 handmade bags to help her raise funds to start over. We were also saddened to hear of an African migrant whose asylum was rejected by a panel of 3 white male judges ‘because she had not been raped enough times.” Scalabrini workers are doing all they can to advocate for migrants during these tough times.
Finally, Uyinene Mrwetyana, a Univerity of Cape Town student was raped and murdered at a Post Office. Crowds of protestors are speaking out against gender-based violence. You can see images I have seen all over campus and town. I am so proud that many of our faculty also work in addressing gender-based violence. Like most of public health, this trip is exhausting and totally inspiring. I look forward to forging stronger ties with our colleagues and partners here in Southern Africa.

Warm regards,

Salamat, Philippines

Guest blogger, Areej Hussein, undergraduate student in nutrition

Typical fruit vendor in the streets of Cebu city where the infamous and tasty Cebuano mangoes are sold.

As a recipient of the Class of 1938 Summer Abroad Research Fellowship, I had the opportunity to travel to the Philippines this summer to explore my Honors thesis research topic: the impacts of early childhood malnutrition on young women’s reproductive health and childbearing. I traveled to the Philippines extremely nervous at first because I had never done anything like this before. Deciding to spend two months in a country I had never seen before to pursue a research project was something that challenged my comfort zones. Nevertheless, I was excited to embark on this journey where I could meet new people, learn new things, and experience a new way of life.

While there, I was mentored by amazing researchers from the Office of Population Studies Foundation (OPS) at the University of San Carlos in Cebu, whose Cebu Longitudinal Health and Nutrition Survey (CLHNS) is a collaboration with UNC’s Carolina Population Center. My OPS mentor, Ms. Josephine Avilla, has been extremely supportive and a pivotal part of this research project.  Without her guidance and connections, this would not have been possible. My research included engaging in focus group discussions and in-depth interviews with young Filipina women on topics related to relationships and childbearing decisions, an effort to contextualize my quantitative data analyses.

The participants of the focus group were women from Ritazo, a community-based initiative run by women in an urban poor neighborhood in Mandaue City, Philippines. These talented women take scraps of materials donated to them by a furniture company and turn them into beautiful bags and merchandise to generate a source of income for themselves and families. These women, in addition to raising children and maintaining their homes, were earning money for their families and taking on leadership roles in their community. I am forever grateful to these women who trusted me enough to share stories of their livelihoods as they participated in this research project.

In addition to the focus group discussion, I conducted in-depth interviews with young women most of whom work as research assistants at OPS. Unlike the women of Ritazo, these women were closer in age to me and it amazed me how much I was able to relate to them in these interviews. These interviews felt more like conversations I was having with my friends rather than a research-participant style of interaction. These conversations were also insightful and brought to light many themes that would add perspective as I am analyzing the quantitative data. I am currently drafting a detailed summary of my findings, including these themes, intending to disseminate this information to all of the women who participated in this study. I strongly believe that the goal of research should be to benefit the community who graciously agreed to take part in it and who without the research would not exist.

During my stay, I also had the opportunity to attend a two-day data analysis workshop led by my professor and mentor Dr. Linda Adair. This workshop brought together researchers from different institutions across the Philippines to discuss data dissemination and analysis for a national population study carried out by OPS as an effort to better understand the “Filipino child”. It was inspiring to witness the excitement in the room for this kind of work and how invested these researchers were in bettering their country. In this workshop, I also heard stories about research field workers risking their lives to obtain research data. These dedicated researchers would travel to some of the most inaccessible and dangerous parts of the Philippines manually collecting data using pen and paper, which then students and researchers, like myself, have the convenience of accessing on a computer with just a click of a button. Learning about the risks involved in data collection and witnessing the effort that goes into editing and coding the data in the OPS office made me appreciate the research data more.

Akong Pamilia (“my family”) –celebrating my birthday at the office. OPS

While the purpose of my trip was to conduct research, what I gained was far more valuable than data. Here I gained a family that made me feel more at home than an outsider! Many greeting me with “Assalamu alaikum” (a greeting that Muslims use translating to “Peace be Upon you”) even when they were not Muslims themselves was one of the many ways that people tried to welcome me. I also gained a small glimpse of a beautiful culture that embraces everything that is love and community! I gained stories of resilience and faith that left me more than inspired! During a time where I longed to go home to Sudan but could not because of the political unrest, the Philippines became my home! I saw my people in their hospitality and their love for one another! I had an extremely positive experience and I am forever grateful to Dr. Linda Adair, the Class of 1938 Fellowship, and Honors Carolina for their immense support throughout this experience and making it possible!

Beautiful waters of Moalboal,Cebu, Philippines.

In addition to research, I had the opportunity to experience island hopping and explore as much as I can of this beautiful archipelago.

– Areej

Once in a lifetime learning experience

Guest blog post by Caroline Nelson, MPH-RD student, Kenan Foundation Asia Joan Gillings Public Health Intern

This summer I’ve had the opportunity to live in Bangkok, Thailand for ten weeks to participate in the Kenan Foundation Asia Joan Gillings Public Health Internship in Asia NextGen Healthy Aging Program. Though challenging at times, this internship has been a once in a lifetime learning experience that I am very thankful to have accomplished.

When I arrived in Bangkok, I was rather nervous to spend ten weeks in a completely new environment, surrounded by a different language, culture, and way of life . This soon changed once I was introduced to the incredibly warm and kind people that make up this beautiful country. As soon as the other interns and I entered the Kenan Foundation Asia office on our first day, we were immediately welcomed with open arms. My preceptor, nicknamed K. Pop, has been very supportive of this educational experience, and has included me on several important projects and events.

My favorite event was a community health event that took place in the Khlong Toei community of Bangkok. This district contains some of the largest wealth gaps in Bangkok and a goal of the Kenan Foundation Asia is to improve health disparities for refugees and lower socioeconomic citizens. This event was led by community leaders and change agents who are working to provide better public health resources to their elderly neighbors. Thailand will be a super-aged society by 2030 and the geriatric population already is struggling with obesity, type two diabetes, and hypertension, so Kenan is aiding communities in preventative healthcare education. The community leaders led aerobics classes, meditation sessions, provided blood glucose and blood pressure checks, and massages. It was very informative to observe this health event and see how engaged the community is on their collective health. Participating in this event helped me realize that listening to the community and understanding their personal needs is more impactful than instilling one’s own desires or goals as an outsider.

Khlong Toei Community Health Event sponsored by the Kenan Foundation Asia. Pictured are community leaders and their families, Kenan employees, and the Khlong Toei district representative.

My main project as an intern is to create a Health Literacy Training Event for key change agents in Khlong Toei. This falls under the Pfizer Healthy Aging Project in which Kenan has focused on providing preventative interventions to the super-aging population in Thailand.

When we are not in the office, the other interns and I travel around Southeast Asia. So far, I have visited Laos, Cambodia, and various cities in Thailand such as Phuket, Chiang Rai, Chiang Mai, and Ayutthaya. The other interns and I get along very well, and we have enjoyed traveling throughout the area together.

(L-R) Jack Deering, Andrea Prego, Jessie La Masse, Alexa Young, Caroline Nelson, Catherine Sugg. All are UNC students interning with the Kenan Foundation Asia. Alexa and Caroline are master’s Students at Gillings and the others are undergraduate business students at Kenan-Flagler. Here we are visiting the temple ruins of Ayutthaya in Thailand.

Here we are attending the ASEAN SMEs Regional Conference on Health Tourism in Bangkok. These are various employees of the Kenan Foundation Asia, including the President, K. Piyabutr Cholvijarn. We are making the Korean hand sign known as the ‘mini chi’, aka small heart, that is very popular in Bangkok.

(L-R) Catherine Sugg (Undergraduate Business Intern), Caroline Nelson (MPH Nutrition Intern), Alexa Young (MPH Health Behavior Intern).
Here we are attending the WATS conference in Bangkok.

– Caroline

Go raibh maith agat, HPRC! See you soon

Greetings from Corcaigh (Cork)! It’s hard to believe that I’m officially done with my internship in Galway and back with my partner in Cork. The 6 weeks with NUIG HPRC absolutely blew by and left me with so many meaningful, lasting connections. Things changed a bit since my last blog post—I was originally hoping to explore health outcomes among Traveller school-children and immigrant school-children, but due to a bit of a delay with the data cleaning around the immigrant variable, I ended up focusing solely on health outcomes among Traveller school-children. Although I’m disappointed I didn’t have time to explore the data on 1st and 2nd generation immigrant school-children in Ireland, the delay allowed me to dedicate all of my efforts to the Traveller data—and I got so much more out of it because of that. I was able to finish analyzing the mental health outcomes and had time to run bullying perpetration and victimization statistics, as well. I wrote up a report on Traveller school-children mental health outcomes compared to non-Traveller school-children, and am excited to hopefully get it published! We’ll be sharing it on the NUIG HPRC website and submitting it to the NIHS bulletin—unfortunately, I can’t tell y’all what we found until the National Report is published this fall. Check back into their website in October and read my report on Traveller School-Children Mental Health & Wellbeing to see what we found (  😊

Shout-out to the amazing team at HPRC!

With the newfound time I had without the immigrant data, I ended up reaching out to a few Traveller advocacy organizations around Ireland in an effort to find outlets for disseminating our findings. Their response was incredible—they’re hoping to get access to the infographics as soon as they can and use the data to spread awareness about health inequities in Ireland. I created about 20 infographics with a variety of data around bullying, social support, sexual health, and mental health. I can’t wait to share them with the community organizations once I’m allowed!

One of the (blinded) infographics about Traveller well-being.

Although I’m no longer in the HPRC office at NUIG, I know that it is not the end of my work with them. I am so incredibly grateful to the team’s dedication to improving the health and well-being of all of Ireland’s population. Their dedication to conducting research which ultimately informs policies and programs across Ireland is truly inspiring. Before my time with HPRC, I had conducted research in the private sector for pharmaceutical companies, and in the public sector at UNC. However, this was my first time working at the intersection of research and policy with an international organization, and I absolutely loved it. I’ll miss the friendly faces of the research team at HPRC, and the cows and horses I passed by each day on my walk to work. I’ll be back, HPRC! Until then, I’ve got one more Irish adventure camping on the coast of the Gaelic-speaking island of Cape Clear.

Camping in Clifden at Ireland’s only carbon-neutral accommodation.

Wish me luck!

– Casey

Oh the places Gillings School students are going!

We are back for another summer of blogging!

We have 14 students blogging from 10 countries! Thanks to generous donors,  these students received travel funds to put what they’ve learned in the classroom into practice.

Follow our blog this summer to hear firsthand from our students about what they are working on and how their global experiences are going!

Now an introduction to our new bloggers and their thanks to donors for the opportunity to receive funding for their global practicum:

Hunter Davis – Exploring the social and emotional impact of living with Type 2 diabetes  among adults in the Galapagos

“I’m so excited to be using this funding to return to a country where I have spent a formative part of my life and made so many friends and connections. I have lived in the Amazon of Ecuador, the Andes, and now will be able to live in the Galapagos for a time. Ecuador is one of my passions, and I’m so grateful that thanks to the Global Practice Award I am able to continue learning about a new part of the country and culture I have grown to love. This has also allowed me to work with an incredible research team and learn from Dr. Clare Barrington, an expert in qualitative research, about the process and expectations for qualitative research.”

Fatima Guerrab – International Organization for Migration in Switzerland

“Being selected for a Global Practice Award has opened up many doors and removed many barriers. With these funds, I will be able to work with a leading United Nations agency and learn how to tackle the most pressing policy challenges on a global scale.”

Krista Scheffey – UNC-Wits-Right to Care Partnership for Cervical Cancer Prevention in South Africa

“This funding is incredibly helpful. There are a lot of upfront costs associated with going to South Africa, and knowing that I have this funding is hugely helpful as I make those preparations. Receiving funding has also helped me focus on being a student without worrying about financing my practicum. For a while I wasn’t sure if I was going to be able to go abroad, but ultimately I was able to choose a practicum that really aligned with my interests. I’m grateful for ​financial support to pursue this opportunity.”

Nicole Gonzalez – Health Future Program in China

“I feel really lucky to be selected for the Global Practice Award. My practicum would not have been possible without this funding. I would have had to take out loans if I did want to pursue this practicum. It’s definitely really helpful. I’ve always wanted to work in Asia, and it’s one of my careers goals. This is really meaningful and I feel privileged to have been awarded this money.”

Kay Schaffer – Curamericas Global in Guatemala

“Being able to work and travel abroad is really a privilege and having this financial support is going to enable me to do that. Working abroad in public health is something I’ve seen colleagues do and has been a dream of mine to actually get to do myself. This money is really meaningful to me and is going to make this experience possible. I’m excited for my practicum, as maternal mortality prevention has been an interest of mine, but getting to see how it is practiced in the field with vulnerable populations from different cultural backgrounds is going to be really informative to my education and allow me to bring best practices back to the Chapel Hill community.”

Yovania Dechtiar – Gender Links in Mauritius

“Receiving this funding is an incredible opportunity for me as it allows me to give back to my home country! I am excited to go back home and to use knowledge and skills that I developed in recent years and learn how to adapt them within the context of Mauritius. I will be working with Gender Links, an NGO that strongly advocates for the advancement of women. I left Mauritius since I was 18, mostly oblivious of the challenges that women face. As I have grown and developed into a woman myself within the North American context, I have often reflected on what being a woman means within the Mauritian context. I am especially grateful that the funding will allow me to better understand the realities of the Mauritian women and contribute to her advancement.”

Dana Corbett – Curamericas Global in Kenya

Dana Corbett“When I found out that I received the Global Practice Award to support my practicum, I felt an enormous amount of relief! I am so grateful for the generosity of funders so that I can prepare for and fully embrace my practicum in Kenya without being overly-concerned about finances.”

Erin Case – Save the Children in Washington, D.C.

“Receiving the Global Practice Award for my practicum with Save the Children allows me the space to truly focus on my work rather than worrying about working a second job. Knowing that I have the funding means I can put all of my energy into my work, take on additional projects, and professional development opportunities at Save the Children that will help me build towards the career that I want.”

Emily Berns – Curamericas Global in Guatemala

“Receiving the Global Practice Award is a major support and encouragement in accepting a practicum that excites me, develops a variety of public health skills, and offers the privilege of collaborating in new community and cultural contexts. It shows how the school and alumni value our opportunities and ambitions to engage in meaningful global health work.”

Casey Watters – National University of Ireland – Galway, Health Promotion Research Centre & WHO Collaborating Centre for Health Promotion in Ireland

“Receiving the Global Practice Award is incredibly meaningful. It has allowed me the opportunity to focus on my work in adolescent mental health while gathering the necessary quantitative evaluation skills for my continued career in global public health—and I couldn’t do that without this incredibly generous funding.”

UNC Gillings Zambia Hub students:

Gillings Global Hubs are meant to increase students’ skills, faculty opportunities and the Gillings School’s impact.  A consistent presence at particular sites, working with a select group of partners, allows us to provide quality experiences and deliver on strategic themes to improve public health. We are pleased to have the first cohort of students in the Zambia Hub this summer and blogging!

(L-R) Munguu, Enam, Taylor, and Rebekah

(L-R) Munguu, Enam, Taylor, and Rebekah

Enam Aidam – Chapel Hill, North Carolina and Lusaka, Zambia

“This practicum grants me the unique opportunity to meet, work and learn from the amazing team of researchers, clinicians and technicians working to advance women’s health in Zambia and other low and middle income countries. Additionally, I will benefit from their guidance and mentorship to publish what will be my first scientific paper!”

Taylor Craig – Lusaka, Zambia

“I am so excited to live in Zambia this summer and work on a cost-effectiveness analysis for the Improving Pregnancy Outcomes with Progesterone Study within the Zambia Hub. I am grateful for this wonderful opportunity and I am looking forward to all I will learn.”

Munguntsetseg Khuyag-Ochir – Chapel Hill, North Carolina and Lusaka, Zambia

“I am so excited to be an intern in the Zambia Hub FAMLI project this summer. I think  the Zambia FAMLI project will help me gain real-life maternal and child health practical experience in a global setting. I am sure that interning in the Mothers and Newborn hospital in Lusaka, Zambia will be a great experience for me to learn about challenges and solutions of global maternal and child health problems. I have two goals this summer. First, to gain more knowledge about implementation science and management skills of global public health programs. Hopefully, I will have opportunities to explore more about Gates Foundation projects. Second, I wish to improve inter-professional communication and collaboration skills, which are main competencies of a MPH degree. I am sure that during this internship I can strengthen these skills from senior public health, medical and other professionals in the Zambia Hub.”

Rebekah Daniel – Lusaka, Zambia

“This past semester I have delved deeper in exploring HIV prevention of mother-to-child transmission (PMTCT) interventions and am extremely excited to apply my background knowledge and course work in this topic in a real-world setting. Additionally, since I have an interest in monitoring and evaluation (M&E) work, being able to hop on board during the process stage of the Methods for Prevention Packages Program (MP3) has allowed me to monitor and review validated data collection instruments which are a great way for me to begin applying the M&E skills I hope to foster as a public health professional. Last but not least, I am truly excited to be in Lusaka, Zambia this summer! There is always something so invigorating and eye-opening when you leave your comfort zone and step into a setting you may not be as familiar with!”


¡Saludos desde Montevideo!

Greetings from Montevideo, Uruguay! This summer my practicum is with the Pan American Health Organization (PAHO), more specifically their Center for Latin American Perinatology and Women’s Reproductive Health (or in its more efficient Spanish acronym, CLAP/SMR). While PAHO is headquartered in Washington DC, the CLAP/SMR office is home to the region’s MUSA data base (the Spanish acronym for “women in situations of abortion”), which compiles data from 40 sentinel health centers across 13 countries in Latin America. (You can check out a quick video about MUSA here:

Cheesin' in Montevideo overlooking Pocitos Beach.

Cheesin’ in Montevideo overlooking Pocitos Beach.

PAHO’s Perinatal Information System (SIP) maintains a wealth of data regarding maternal and neonatal health outcomes, including a specific database, SIP-A, that is dedicated to clinical information about abortion, miscarriage management, and post-abortion care. Unsafe abortion, while completely preventable, is one of the leading causes of maternal mortality globally, and contributes to 13% of maternal deaths in Latin American and the Caribbean. At the 40 sentinel health centers across the region, whether a person is accessing a legal abortion, seeking medical treatment following an unsafe abortion, or experiencing a miscarriage, their clinical and sociodemographic data will be collected in SIP-A. These data include the presence of any complications, a near miss or maternal death, as well as whether or not a pregnancy was planned, whether the pregnancy was a result of a contraceptive method failure, and whether the person begins a contraceptive method as part of their post-abortion care. My practicum this summer is focused on analyzing data from SIP-A.

In the office with Dr. Suzanne Serruya, director of CLAP/SMR.

In the
office with Dr. Suzanne Serruya, director of CLAP/SMR.

Thus far, I’ve had the chance to sit in on a meeting with the Uruguayan Ministry of Public Health and CLAP/SMR staff in order to see how SIP-A works with the Uruguayan health system’s protocols around abortion and miscarriage. As one of the only countries in the region where abortion is legally available without restriction as to reason (the other two are Cuba and Guyana), Uruguay provides a unique context both for my practicum and for working with the data in SIP-A. Using this regional database, I’ve been analyzing contraceptive counseling and service provision as a part of post-abortion care. This includes looking at what type of contraceptive method patients request, as well what methods doctors provide. Depending on the context, these contraceptive methods may include long-acting reversible contraceptives (LARCs), or other methods, such as pills, injectables, or sterilization.

As I wrap up my time in Montevideo, it is now clearer to me than ever before how important accurate data is in making informed public health decisions. Working alongside experts in reproductive health, research, epidemiology, and medicine over the past few weeks has been an incredible way to see how bringing together a wealth of perspectives and approaches can be used to improve health at every level, whether it is a patient-provider interaction or a region-wide policy change.


Learning from the best

Team photo at grant writing workshop.

Team photo at grant writing workshop.

Since my last blog post, I have jumped into the deep end of process evaluation. Shifra used a human centered design methodology to create their app. (As a reminder- Shifra uses mhealth technology to connect refugees, migrants, and asylum seekers with sexual and reproductive health services in Melbourne, Australia) Human centered design prioritizes empathizing with the end user and getting a deep understanding of their lived experience, designing solutions that arise from the insights gained through empathy exercises, and then prototyping those solutions with the target population. However, most evaluation work has focused on evaluating the solutions generated rather than the process itself. In exploring how to evaluate whether Shifra engaged in a true human centered design process, I did a lot of research and talked with experts in the field including public health professors at UNC and design experts at Monash University in Melbourne.

Enjoying a sunset at the Port Campbell National Park along the great ocean road.

Enjoying a sunset at the Port Campbell National Park along the great ocean road.

I ended up creating a checklist of requisite steps involved in a human centered design process and interviewed refugee end users, developers, and subject matter experts who all contributed to the creation of the app. My next step is to review Shifra’s records to help me understand the process and the steps they took. Then I’ll analyze the interviews to help me understand different co-designers’ experiences creating the app. Finally, I’ll synthesize the results and write up my findings. (Hello master’s paper!)

Team farewell dinner.

Team farewell dinner.

Throughout this evaluation process, I have been so impressed by Shifra staff’s openness and desire to learn from their experiences. They truly adopt several mindsets of human centered design: to learn from failure, embrace curiosity, and stay optimistic. I am so thankful for the chance to learn from this organization and I look forward to staying in touch with them in the future. 🙂

Snuggling a 2 year old baby kangaroo at an airbnb along the great ocean road.

Snuggling a 2 year old baby kangaroo at an airbnb along the great ocean road.



Heading Home

Back entrance of Bundung MCH Hospital.

The conclusion of my UNFPA The Gambia internship has crept up on me. In the process, I have become very attached to, what some of my UNFPA colleagues affectionately refer to as “[my] second office,” Bundung Maternal and Child Health (MCH) Hospital. The tentatively named Male Change Agent Initiative we have been working on has become fellow UNFPA summer intern, Jalang, and I’s blossoming project. We have dedicated much of our remaining time developing a concept note that considers the multiple factors involved in replicating Bundung MCH Hospital’s current male engagement clinic at other facilities. Since our first attendance at the hospital’s male clinic, we have participated in each weekly discussion-style session to observe how UNFPA could increase the current clinic’s capacity while preserving the elements that make it successful. It was also critical that the overall objective of encouraging men to be more involved during their wives’ pregnancies was not lost within any potential changes or improvements.

Man with baby at Bundung MCH Hospital following a male clinic. There were concurrent antenatal and postnatal visits occuring.

Man with baby at Bundung MCH Hospital following a male clinic. There were concurrent antenatal and postnatal visits occuring.

First Lady of The Gambia (center), fellow intern Jalang (right), and I (left) taking a quick selfie before the First Lady departs from Bundung MCH Hospital.

First Lady of The Gambia (center), fellow intern Jalang (right), and I (left) taking a quick selfie before the First Lady departs from Bundung MCH Hospital.

The work at Bundung has been receiving much-deserved recognition for the implementation of the male health talk clinic. The Minister of Health and Social Welfare (MoHSW) and First Lady of The Gambia made a joint appearance at the hospital, along with the Global Alliance for Vaccines and Immunizations (GAVI) media team, to observe the initiated clinic and speak with families present. Prior to the event, Jalang and I were introduced to two representatives from the Gambia’s Extended Programme for Immunization (EPI), one of UNICEF Gambia’s governmental (i.e. MoHSW) implementing partners focusing on ensuring the timely vaccinations of Gambian children. The representatives were informed of UNFPA’s existing male involvement concept note and were interested in integrating childhood immunizations into the clinic talks and overall initiative. This has led to the Male Change Agent Initiative becoming a partnership between the MoHSW, UNICEF, UNFPA, and Bundung MCH Hospital.

Male clinic initiative meeting between UNFPA, EPI, Bundung MCH Hospital, and UNICEF to discuss a future partnership and changes to be made to the concept note (I am at the bottom right corner).

Minister of Health, Dr. Isatou Touray, arriving at World Population Day commemoration.

Minister of Health, Dr. Isatou Touray, arriving at World Population Day commemoration.

It has been interesting watching the project gain magnitude and essentially have other agencies “buy in” to the significant role that males play in not only improving maternal health, but child health as well.  The increased stakeholders in this project will allow for an increase in financial resources to implement male clinics in many other facilities around The Gambia. I intend to continue contributing to the project as it becomes a finalized proposal, and later, implemented initiative. Though male involvement became my internship focus towards the end, I have simultaneously ensured that I gained additional experience in other work that UNFPA supports. Experiences have included monitoring and evaluation treks to other facilities, trainings of community health workers on a variety of topics, and a march to celebrate World Population Day.

A representative of Gambian Family Planning Association (GFPA) setting out contraceptives during World Population Day events

To say that I have simply enjoyed working at a wonderful organization would be an understatement.  I have greatly appreciated the opportunity to observe and learn from such highly qualified and passionate mentors. Here’s to hoping (as UNFPA mandate goes) that we all continue working towards a world where “every pregnancy is wanted, every childbirth is safe, and every young person’s potential is fulfilled.”


Enjoy some pictures:

One of the marchers at the World Population Day event held on July 11th.

One of the marchers at the World Population Day event held on July 11th.

Me holding a mother’s baby. The mother was present for her well-child visit while watching the First Lady's interview with media outlet.

Me holding a mother’s baby. The mother was present for her well-child visit while watching the First Lady’s interview with media outlet.

(from l-r) My preceptor, Lamin Camara-Programme Analyst for Youth and Adolescents, fellow intern Jalang, me and UNFPA Country Representative attending the wedding UNFPA Programme Analyst-Communications.

(from l-r) My preceptor, Lamin Camara-Programme Analyst for Youth and Adolescents, fellow intern Jalang, me and UNFPA Country Representative attending the wedding UNFPA Programme Analyst-Communications.


Exciting month in Uganda!

It has been an exciting month for the Sayana Press team in Uganda – and, tangentially, an exciting month for me!

The PATH vehicle parked in the staff quarters at Kityeyera Health Center IV, Mayuge district.

The PATH vehicle parked in the staff quarters at Kityeyera Health Center IV, Mayuge district.

After successfully launching a nationwide scale up of the provider-injected Sayana Press drug in 2016, the PATH team has been focusing on introducing self-injection. After several months observing self-injection in four target districts, the team set out to conduct an evaluation with the goals of, 1) finding out whether self-injection is working for women in rural areas and 2) learning which variation is most cost-effective.

I joined the team as they were wrapping up their first phase of the evaluation: interviewing the providers who were training women to self-inject. In the second half of my internship, we were busy preparing to launch the second half of the evaluation: interviewing users themselves. Throughout both phases, the team also facilitated monitoring visits at each site to support the field teams. It turns out, starting when I did was a perfect time! I was able to observe the launches of both phases as well as join the team in the field for monitoring visits and jump in on some trainings.

Kirsten holds a case of Sayana Press to be delivered to field sites in Mayuge district.

Holding a case of Sayana Press to be delivered to field sites in Mayuge district.

The PATH vehicle loaded up with cases of Sayana Press for delivery.

The PATH vehicle loaded up with cases of Sayana Press for delivery.

One of the trainings was conducted in July. I joined the team’s Scale-Up Manager, Edson Twesigye, to travel to Mayuge district in Eastern Uganda to orient new providers to the program and “train the trainers” in self-injection. We visited two facilities, Kityeyera Health Center IV: a bustling, district-level referral clinic/hospital, and Muggi Health Center III, a sleepier, more rural center still serving a fairly large population. Observing how Edson facilitated the training sessions offered a lot of insight into PATH’s training methodology, and I enjoyed the chance to also facilitate my own sessions as well. I spoke to the groups about the procedure for using the self-injection register, a reporting tool developed by the team to ensure accurate data collection. The team had found in other sessions that the register was sometimes confusing for providers and was being filled improperly, particularly a few vital questions. I enjoyed the chance to discuss their challenges with them and we were able to clarify several key points. This exercise was an informative opportunity to improve my understanding of data collection tools, especially as we focused on data entry at the point of service delivery.

Conducting a training session with self-injection providers. (From left: Kirsten Miner, Violet Asiimwe, Lydia Namuganza, and Jaliya Nabirye.)

Conducting a training session with self-injection providers. (From left: Kirsten Miner, Violet Asiimwe, Lydia Namuganza, and Jaliya Nabirye.)

A key component of training is reviewing and practicing the self-injection procedure with each training team. Self-injection is a 10-step process which is led by a “job aid” – a series of pictures, each with a corresponding instruction, that guides a user through prep up to completion of the injection. There are four critical steps: mixing the solution by shaking the vial, activating the device, pinching the skin at the injection site (abdomen or thigh) to make a “tent”, and then pressing the reservoir slowly to inject the drug. It was exciting and illuminating to watch the training team in action!

Research Assistant Violet Asiimwe makes a model using a condom and salt which is used to simulate an injection site for a training.

Research Assistant Violet Asiimwe makes a model using a condom and salt which is used to simulate an injection site for a training.

After returning to Kampala from Mayuge I joined the team in completing our remaining duties to prepare for Phase II of the evaluation: client survey administration. This training offered even further opportunities for observation, learning and practice. Overall, I had an amazing internship with the PATH team in Uganda. I look forward to following the Sayana Press project further and delving into the results of the evaluations!



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