I finished my practicum last week with the Tuberculosis (TB) Control Program at the North Carolina Department of Health and Human Services (NC DHHS) and wanted to share a few final reflections.
- Practica will inevitably change and evolve throughout the summer – but that’s not a bad thing! I originally thought I would be using surveillance data to estimate the prevalence of latent TB infections in the state. However, I was able to come up with a better strategy after consulting with the TB epidemiologist at DHHS. She illuminated some of the issues with the data reporting system we currently have and encouraged me to consult other estimates from the literature. This new direction allowed me to redirect my efforts to interpreting and assessing the quality of available estimates, which is ultimately an important skill for me as a budding “applied” epidemiologist.
- Practica can be a great opportunity to network and meet people outside of your normal circles. I got the chance to meet with some health departments from other states that had already done a similar educational outreach project around latent TB infections. It gave me the chance to see how other health departments structure their programs and often collaborate across states. I also got to peak into some of the case-level work that TB nurses do in North Carolina and how that feeds into the larger population-level work at the health department.
- Getting creative and taking initiative can help you get what you want out of your practicum. Part of my project involved compiling a list of doctors (called civil surgeons) that are active in providing medical exams for people seeking immigration status adjustment. I wanted to get some practice creating maps and my preceptor was on board, so I took some time to train on Tableau and then create a map of all active practices. This map was useful in presentations I gave to show where these doctors were concentrated, potentially helping to prioritize hotspots for the educational intervention. This map also illuminated that there were “deserts” in the state, where people might have trouble finding a nearby doctor and potentially get discouraged in the status adjustment process.
Overall, the practicum gave me an interesting look into the work that goes into planning an intervention at the state health department and learning how to use my knowledge and interests to potentially add value in unique ways. I am grateful for the opportunity to get some exposure to the government sector and practice some of the skills I’ve learned in the first year of the MPH.
When faced with difficult choices, I often come back to a central question: what is my intention, and how can this decision help me work toward that? In March 2020, I was happily living in Guatemala, serving as the on-ground Director of Operations for a small birthing center, run by local midwives and funded by a US organization. What followed that month is now well known to all of us, and I had a difficult choice to make about whether I would return home to begin my Master of Public Health. My final choice to start the program had many factors, but one thing became crystal clear in my mind: my home had become the global epicenter for a public health disaster. There was so much work to be done, and I needed to figure out how I was going to serve my home country.
Part of the reason I felt passionately about my work in Guatemala is that I believe that investment in healthier families is a critical in working to end poverty in the region, and ultimately a necessary factor to stem migration. No one wants to leave their home to embark on a dangerous journey; it is borne out of necessity. Issues affecting immigrants and refugees in the U.S. (especially Latinx communities) have always been one of my major interest areas, and I hoped that I would be able to integrate this into my practicum. As a student in the Applied Epidemiology concentration of the MPH, I also intended to use my summer to beef up my skills in data analysis.
Ending TB from my backyard in NC!
The pandemic has made it abundantly clear how public health departments are critical infrastructure in the US, and I was hoping to learn more about what it would be like to work for one. That’s why I was excited about the opportunity to work with the Tuberculosis (TB) Control Program at the North Carolina Department of Health and Human Services. For this project, I will be helping to strengthen community partnerships to prevent active tuberculosis. As part of the process to seek permanent resident status, applicants are required to undergo a medical exam which includes a test for latent TB. Latent TB can turn into TB disease, which requires much more difficult treatment and can spread to others. After COVID-19, it has become abundantly clear how important it is to prevent the spread of respiratory infections like TB and pay special attention to vulnerable populations who often bear the greatest burden.
This project will have two major components: compiling a database of all active practitioners that provide these exams (civil surgeons), and using this database along with existing data to estimate how many potential latent TB infections are detected annually, along with how many “status-adjusters” are seen each year. These data will bolster the case for funding for an educational program for civil surgeons on how to counsel those with latent TB and encourage them to treat the infection before it progresses.
I’m excited to dive into this project because it really embodies the reason I came back to the U.S.: global health issues are local issues. If the U.S. public health infrastructure was better equipped, we might have been able to stem the spread of COVID-19 in this country and around the world. TB is a growing threat globally and it’s critical to address it at home in North Carolina.