Students and global health experts share their experiences working with communities.

Author: Eric Brown

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The End signals the Beginning of Something New

Summer has faded fast. The official end of my practicum with Colectivo Amigos Contra el SIDA (CAS) approaches, sooner than I might like – a gentle reminder that things outside the academia’s confines do not always obey the metronome of a school calendar. I began the summer preoccupied with how I might contribute from afar, in the virtual world, to CAS’s mission, carried out from their clinic in Guatemala City, to provide stigma-free sexual health services to gay and bisexual men. Yet as the summer has worn on, the virtual aspects of my practicum have become less significant. It’s not clear that anything would have been gained, for anyone, by me being present in Guatemala this summer, aside from frequent flier miles. Instead, the great reward – and challenge – became calibrating my expectations of what was feasible in the abbreviated course of this summer.

As I commented in my earlier blog post, CAS maintains a longstanding relationship with Gillings researchers, a collaboration whose current focus is understanding the provision and uptake of HIV pre-exposure prophylaxis (PrEP), a daily medication which is highly effective at preventing the establishment of HIV infection in those exposed to the virus. In Guatemala, CAS is the only provider of PrEP, which it offers free of charge – and remarkably, CAS has greatly expanded its pool of clients using PrEP since the onset of the pandemic. The original design of my practicum focused on developing and implementing data collection instruments, a survey for CAS’s clients and in-depth interviews with providers, that would inform the creation of a mobile app to share health information and coordinate services for CAS’s PrEP program. With delays in the Institutional Review Board (IRB) approval for this phase of the study, my focus shifted to analyzing and preparing to share qualitative and quantitative data from an earlier phase of the research partnership – that is, the dissemination of results.

Before coming back to UNC, I had been exposed to a variety of organizations in the nebulous patchwork that is “international development,” from small NGOs to government agencies. None had the commitment to research that CAS has, to cultivating and producing knowledge to better advance their mission. The accompanying ethical procedures, like IRB approvals, exist for the essential purpose of protecting the human subjects of this research. If anything, given its sometimes-troubled history, stringent ethical standards ought to be at the forefront of global health research and practice. Though I have had to be flexible in my practicum’s immediate aims, my core objective of striving to contribute to CAS’s mission, however modestly, has not wavered. Maybe this reflects my own inexperience in public health research, but I have gained a richer appreciation for the harmony of such community-based, action-oriented research partnerships.

Comparing PrEP users with non-users in the analysis of older study data has revealed differences between each group in the factors influencing PrEP uptake, differing perceptions of the stigma associated with its use, and differing reliance on technology to seek health information. The results of such comparisons will, hopefully, provide insight into how CAS might develop new initiatives to expand the reach of its PrEP program, including via a mobile app. Working through how to best share these results has presented the fresh challenge of how to integrate quantitative and qualitative data sets – and how to do so in such a way that proves most useful to the workings of a fast-paced organization with multiple programmatic objectives. With a keener appreciation for the value of such mixed methods research to public health programs, this is a process I would hope to replicate in future endeavors.

More immediately, I plan to continue as part of the CAS-UNC research collaboration beyond the official end of my practicum. Coming up are results to be shared and interviews to be conducted, both of which hopefully can coexist alongside my coursework commitments. Ten weeks may be a flash in time, but it’s certainly long enough to feel immersed in a project. And this seems only right to me. Exercising humility and creating relationships both call for, among other things, an investment of time. In my own practice, I aspire to be oriented by precisely these values, the foundation of lasting transnational ties that define global health at its best.

Ian

Ending with evidence-based decision making

One of the biggest takeaways from my first year as an MPH student was the importance of using evidence to inform the design and implementation of public health interventions – but what happens when there just isn’t enough evidence to make a concrete decision? This was a major practicum challenge that I didn’t anticipate. After sorting and screening and rereading titles and abstracts for hours upon hours, our article search process that started with nearly 700 publications narrowed down to only 11 – and among these, the majority only included child feces disposal practices nested as one small part of larger sanitation interventions. My research focused on the Asia-Pacific region, which has among the highest rates of open defecation globally, so I was surprised to find so few interventions targeting this behavior. Though perhaps this is due to the widespread perception that child feces aren’t as harmful as adults’.

Even large-scale sanitation interventions, like India’s Total Sanitation Campaign, have been notoriously unsuccessful at improving child health outcomes. Programs like these have focused mainly on providing hardware or subsidies for individual households to construct their own sanitation hardware (think toilets, pour-flush latrines, bathrooms) without actually working toward behavior change. Behavior-Centered Design is a new approach to solving environmental health problems and has been a major area of World Vision’s research, which is super exciting to be a part of! So maybe I didn’t find all the statistically significant effect sizes, confidence intervals or p-values that I was initially looking for to prove that yes, giving people toilets = safe child feces disposal = improved public health. But I did come across some rich qualitative data on what real communities perceive as their barriers to improved sanitation, why they engage in certain behaviors, and what they would prefer from a public health intervention. Using these determinants is the next step in designing an intervention that communities actually want.

It seems like I just blinked and the summer is gone and my practicum experience is wrapping up. Looking back to May, I now feel so much more prepared to work on real-world public health problems instead of just practicing in a classroom (but I am looking forward to being back in the classroom this fall semester to see everyone in person!). Even though I felt like my work wasn’t going as I originally planned, I learned even more than I thought I would.

Lauren

Communication, communication, communication

My practicum with NARAL Pro-Choice North Carolina was to take place over 10 weeks, the last of which began on August 2nd. I expected to enjoy my time with NARAL NC, but my practicum has surpassed my anticipations dramatically.

I believe my good experience centers around the way the staff treats me. They speak to me as an equal, not just as a student who needs supervision. While my preceptor helped me identify a few deliverables that I could work on at the beginning of my practicum, she was flexible and supportive when our goals shifted throughout the summer, allowing me to amend my deliverables as needed.

My last deliverable has been my favorite by far. In short, I have been working on a report on a specific public health problem that is meant to be consumed by the public. I started this project by receiving an abundance of raw data that needed to be analyzed, which allowed me to practice my STATA skills. I was able to take some of that raw data and turn it into an ArcGIS map, which I believe will be a valuable addition to the report. Lastly, I’ve been able to practice my graphic design skills by designing the layout and format of the report as I go.

However, my favorite part of this project has been the writing aspect. The MPH program typically requires us to write papers and such in scientific or academic voices, which certainly aligns with the audience they’re meant for. The NARAL NC report, on the other hand, is being created for a non-scientific audience, which has been an amazing challenge for me and my writing skills. I have enjoyed this type of writing more than I expected to. The unique combination of abilities it requires has exercised so many different tools from my toolbox, from data translation and choosing relevant statistics to creative writing and narrative formatting.

This report has really driven home the idea that our job as public health professionals is not just to partake in research and the scientific process, but to make sure our findings are accessible to the world. COVID has been a great example of this, especially now with the concerning Delta variant. The research is somewhat unclear, and while that is to be expected this early in the process, I do not feel that it has been communicated to the world in an organized manner. This, plus government mandates and the loss of progress on “opening back up” adds to confusion and alarm. I’m sure we would agree that the United States could have done many things differently throughout this pandemic, but communication would be towards the top of the list in my opinion.

While my practicum is wrapping up and COVID is picking back up, I will always remember the lessons learned at NARAL Pro-Choice NC.

Stay safe,

Abby

Long days, short (summer) weeks…. Wrapping up a remote global health practicum

It’s hard to believe that my practicum experience is almost over and that the summer’s almost gone! I keep asking myself where all the time went. For my practicum experience, I have been working with UNC Gillings Zambia on the ARCH study. The goal of the ARCH study is to optimize birth outcomes in low-resources settings, by using household surveillance to gain a better understanding of the social and clinical factors that may affect pregnancy outcomes in women of reproductive age. I think that one of the best parts of the study is that it allows the study team to follow women of reproductive age, from preconception to at least one year after the end of their pregnancy, in the event that they become pregnant during the course of the study. In addition, the study also follows children under the age of 2, to gain a better understanding about factors that impact the health of young children. Thus far, I have learned quite a bit from the study, mostly related to the implementation of such a large-scale study.

One of the most important lessons that I have learned so far has been the importance of flexibility and being willing to adapt to a new situation. At the beginning of my practicum, my preceptor and I thought that it would be most helpful if I worked on developing standard operating procedures (SOPs) for various aspects of the study. As time progressed, it became clear that there were other aspects of study implementation that would be a better fit. As such, we have pivoted from working on SOPs to developing recruitment and training materials. It has been an interesting learning experience, thinking about how best to simplify the language from protocols, written for technical experts, to informationals that can be understood by study participants. I’ve also learned a lot about the seemingly small aspects of study implementation that I had only briefly thought about. As I’ve been charged with drafting some of the training materials and schedules, I find myself thinking about the most pertinent parts of the study protocols and how to engage study staff when they might have days’ worth of training in their future. All in all, it’s been a truly educational experience.

It might not come as a surprise that one of the most challenging aspects of the practicum experience has been my inability to meet most of the people that I’m working with in person. I have tried to keep in touch via email. My preceptor has also been wonderful, as we decided to meet on a weekly basis, just to touch bases. I think that the weekly meetings have been helpful and have provided more opportunity for direct feedback. At this point, we have talked about extending my practicum, but I still don’t think that I will be able to see the actual start of the ARCH study. That said, I plan to follow the study closely and look forward to learning more about the results of the survey.

Lastly, I’m looking forward to enjoying the last weeks of summer, prior to the beginning of the semester. I’m very excited about starting the second year and can’t wait to meet in person!

– ‘Desola

Global Women’s Health from Home

On the backend of my internship, I can now look back with an awareness of how much the projects I am working on have evolved since the beginning. I cannot believe that we are reaching the end of the practicum this week, it has flown by. I am truly grateful for the team I have been able to work with throughout this experience. It has been so helpful for my future career planning to interact with others in the field of global women’s health.

Work from Home Set-up

In the second half of the internship, I have spent the bulk of my time working on the division of Global Women’s Health website content and restructuring to convey the current research to wide audiences. I have particularly focused on producing written content for the page detailing the prevention of adverse birth outcomes. At first it was overwhelming to effectively summarize the work of so many different projects in various countries. But as I continued, I found greater focus and clarity as I emphasized the population impact that these projects carried. This reflective reminder came at an important time for me. I was feeling burdened down by the extensive complex problems, especially on a global scale (as that was the context I was working in). I was doubting the change I could affect on systematic and widespread issues. However, as I drafted material about the big picture, the why, and the goals of the division, it reemphasized to me the importance of individual contributions as a piece of the united effort.

Nightly walks at Lake Crabtree

As I conclude this internship I am grateful for the glimpse it gave me into the responsibilities of program managers, with an emphasis in communications. It was informative for me to see how a team of researchers, local and abroad interact to complete translational research for improved practice. This internship taught me the importance of not only performing research but also telling the story to a larger audience: funders, potential fellows, and the general public. I gained an understanding of the value in uniting teams towards a common vision while each person is focused on a unique aspect of the overall mission. I hope to transfer these skills into positions I will hold in the future.

-Renee

Time Flies When You’re Having Fun!

It is pretty unbelievable to think that this summer has almost come to an end, but you know what they say: time flies when you’re having fun! Since my last blog post, I have worked diligently to create my practicum products. I have spent many hours playing with PowerPoint formatting on provider training materials and editing down my very long manuscript to a manageable length for submission. Entering the last week of my practicum, all that is left to do is cross T-s and dot I-s on the training materials and then present them on Thursday to Beacon Program staff. I am excited to share the work I have been doing all summer with them and also to use it as an opportunity to practice presenting the training module before I give my final presentation to a much larger group of hospital staff at a lunch-and-learn on August 10th.

In the short two-month duration of my practicum, I feel that I have learned an incredible amount about patient privacy and safety in the context of OpenNotes and my preferred work style, and my own strengths and weaknesses in a professional setting. This experience has solidified my desire to work in public health policy and has also demonstrated how policy work can be difficult and frustrating. Dealing with bureaucratic restrictions and relying on others to implement changes that you have deemed necessary and pressing can be stressful. Despite this, I have found this stress an incentive rather than a deterrent to my conviction to treat public health issues with policy solutions.

This summer has been one of growth and learning, and I am very grateful for the experience I have gained through this practicum. I thoroughly my work, but this summer has come to an end in the blink of an eye. I look forward to a short break in early August before things really ramp back up with the beginning of classes, preparing for MPH Comp Exams, and studying to take the LSAT (wish me luck!). I can’t wait to meet you all in person this Fall and hear about your practicums.

– Gabbi

Bittersweet endings, new beginnings

I cannot fathom how it is already almost August 2021. Nearly a year ago to the day, I moved to Chapel Hill, and somehow, I’m already wrapping up two months of work with the Institute of Alcohol Studies (IAS) and preparing for year two at Gillings.

It has been a wonderful, albeit very fast, two months of learning about alcohol harm and significant gaps in research regarding various issues in alcohol (I think this is a result of the industry’s influence and attempt to keep negative press away from their products). When I last wrote, I had just completed a briefing and was transitioning into work on a rapid review of calorie labelling for a parliamentary consultation— my work was going to potentially be shared with parliamentary members (how cool!) and I was going to have the opportunity to listen in on some of the discussions to gain a better understanding of how NGO’s initiate the policy-making process through the power of persuasion (backed, of course, with plenty of good old-fashioned evidence-based research). But things have taken a shift, and now I will be producing an interim report that will help IAS’ head of policy and the UK’s Alcohol Health Alliance to prepare for the consultation later in the year. Still pretty cool, and something I’ve worked hard on and will be proud of, but not as fast-paced, exciting, and in-the-moment as I was hoping to end my practicum.

Of course, I began my practicum very interested in alcohol issues, but as the summer has progressed, I’ve realized how very little I know about the world of alcohol and the alcohol industry. I’ve experienced a lot of anger and wonder (an interesting combination) about the relative dearth of research regarding the subjects I’ve been collating information on—but I’ve also experienced hope for a future that offers more transparency and publicly available information so people can make the healthiest decisions for themselves. Regardless of what my post-grad career may be (I can definitely see myself continuing work with an alcohol research organization, but I’m passionate about a number of subjects), I look forward to seeing research expand and alcohol knowledge and policies improve.

Beyond what I’ve learned in my literature reviews, I’ve learned a lot about myself. For the past year, I’ve been saying that I would love to work remotely from the comfort of my home for the flexibility, the lack of a commute, etc., but working remotely has proven to be an immense challenge in the second half of this experience. It is hard for me to find motivation from the place where I also relax and sleep, and it’s hard to find productivity without the buzzing energy of colleagues focusing alongside me. I have at times felt pretty disconnected from the larger picture, but at Tuesday meetings I am reminded of the impact IAS has in the sphere of alcohol policy and research and how my practicum products are meant to feed into that puzzle. While I usually pride myself on my writing skills, I have been fighting away feelings of self-doubt in the past few weeks. I need balance. I need people. I’ve loved the detailed learning that this position has given me, but I think I’m better suited for a community-facing role. This has been invaluable insight for someone who considers herself an introvert and a homebody, who finds herself content in a variety of situations.

All that being said, I am proud of the work I have done and I’m still confident that my report will turn out well. I’m incredibly grateful for this two-month peek into policy research and advocacy, and for the connections I’ve made with such wonderful people halfway across the world.

This past weekend, I escaped to Asheville to enjoy the summer for a brief moment as it was meant to be enjoyed; roadtrips full of music (a given), a day hike and swim, ice cream, good meals with loved ones—refreshing the mind to end my practicum strongly and start the new semester just as bright-eyed as when we began a full year ago.

Here’s to the incredible work we’ve all completed this summer and to a rewarding upcoming year full of learning and human connection.

– Keely

Maybe it’s nearing the end or maybe it’s just the beginning

When I started this practicum in the middle of May, I had originally planned for this coming week to be my last week. I recently decided, along with my team, to extend the end date since the really interesting part is just beginning. Although the past couple of weeks have been filled with data cleaning, I am finally ready to begin the analyses we proposed as the basis of my practicum. We are using data from a household survey and combining it with data from health facilities across Zambia in order to gain a more holistic understanding of the services, equipment, and patient satisfaction with the country’s health care system. To our knowledge, this comprehensive picture of health facilities and services has not been examined before; prior research has focused on either just the health facility capacity/readiness or just the consumer experience.

Although I will likely have more final thoughts in the coming weeks, I am grateful to have been a part of this project and team. At the start of the practicum, I learned about antenatal care/nutrition recommendations and health facility quality measures, as well as gained a better understanding of the amount of work and careful organization required to select the variables of interest. These variables are the basis for our exploratory analyses and due to the nature of real-life data, have provided me with an opportunity to learn about and practice more advanced statistical methods. Our ultimate goal is to run a series of statistical models to better understand client satisfaction with antenatal care as well as growth, monitoring and promotion services. We will then publish a paper to share our findings.

Perhaps the greatest lesson I’ve learned from this practicum is the value of “thinking outside the box.” Doing so has helped my preceptor, Dr. Stephanie Martin, and I, organize our thoughts about which variables to use and how to carry out the analyses, it helped us overcome some issues with a messy dataset and methodological concerns (e.g. missing values, yes/no questions, issues merging datasets, lots of interesting variables to explore, etc.), and it prompted our research questions. Although I am nearing the end of my practicum, I also feel as though it is just the beginning. I look forward to digging further into the data to see what sorts of discoveries can be made, and using those to circle back to the big picture of reducing childhood stunting and understanding health care satisfaction and quality in Zambia. I hope our findings will not only be informative and worthwhile to the Zambian government and USAID, but will help others conducting similar research.

– Liana

Wrapping Things Up and Reflecting

My summer practicum flew by and as we’re all getting ready for in person classes soon, I find myself reflecting on my practicum work. I’m working with the North Carolina Against Sexual Assault (NCCASA) on creating a toolkit on preventing and detecting human trafficking on college and university campuses. While I still have a long way to go in finalizing my writing, converting it to a final toolkit, and presenting to key stakeholders, I feel like I have learned a lot in the anti-human trafficking sector. Working with NCCASA has strengthened my passion for the type of work I want to pursue. It is enraging to see on the news and in personal connections the pervasiveness of sexual violence. Before beginning my practicum, my anger was my motivation to work in the reproductive and sexual health justice field. After meeting with anti-human trafficking specialists, program implementation managers, and my preceptor weekly, I’m inspired by the type of work they do in such a compassionate manner. It is eye opening to experience working with individuals that care so deeply about the communities they work with and the anti-sexual violence movement. I feel hopeful when I see all that NCCASA does, and after reflecting, I realize that hope has been my motivation the last month or so – admittingly, a feeling I haven’t felt in a long time.

I’ve learned a lot about human trafficking in North Carolina and on how to engage universities in creating prevention and response strategies. I was able to assess survivor and student needs and propose strategies and programs for key stakeholders to adopt or adapt for their campus communities. My preceptor and I also highlighted the importance of working with communities who are disproportionately affected.

I only have two more weeks of my practicum left and I still feel like there is a lot to do in a short amount of time. While I work to ensure my deliverables are complete in a comprehensive way, I’ve been taking advantage of working online and have been able to travel safely. I visited my friend in New York City for a couple of weeks and we then took some time to wind down and work from home in upstate New York on a beautiful farm. While I miss working in person, I’m glad that I was able to travel around and visit good friends this summer.

Drinking our morning coffee on the porch at the farm.

Overlooking Manhattan from Williamsburg!

Reading through my peers’ blogs, I feel proud and impressed! I am excited to get back into the groove in person this time and hear about everyone’s experiences this summer. Here’s to meeting everyone face to face soon!

-Hadas

Gratitude and Hope

As my practicum comes to an end and I reflect on the past three months, I am filled with so much gratitude. My practicum was not entirely what I expected but nonetheless, it was an experience that helped me grow as a public health professional and gave me insight into the field of global health in action. At the beginning of my practicum, I encountered some unforeseen challenges that stemmed from my lack of self-confidence. When given assignments and tasks with minimal instruction, I immediately thought, “How am I going to do this? Am I prepared for this?” I was terrified of doing a bad job and potentially letting someone down. In essence, I was doubting myself and my abilities. As I threw myself into my work, I quickly learned an important lesson: although I may not have all the answers, I have the skills to do this work. I had to remind myself that after a year of training through the MPH program, I have been equipped with a toolset of basic skills to get started with any task given to me. This realization gave me a life raft to keep me afloat through all the hard tasks and moments of doubt. Now, three months later, I am proud of the work I’ve done and have grown both personally and professionally through this experience.

A back porch bonfire with my roommates—a frequent tradition

Outside of my practicum work, life has been at a steady pace with many fun and memorable moments. Truly, the small things in life, such as back porch bonfires and long walks after work, are the sweetest! My favorite parts of the summer have been filled with self-care and time with friends and family. I am so thankful for the summer of 2021. Life is slowly becoming “normal” again and I am hopeful for a fun, fruitful school year to come!

-Paulina