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

Category: Lauren

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.


Remote work on remote regions

If you had asked me a year ago what I planned to do for my practicum experience after the first year of my master’s program, I probably would have laughed and said that I was just happy to have finished my undergrad degree and to have survived the final few weeks of online classes. I wasn’t expecting to spend the past year fully remote, and I definitely wasn’t expecting to be working on a globally focused practicum from the comfort of my Chapel Hill apartment. What I did know a year ago, however, is that my passion for environmental health, clean water and sanitation, would drive me toward a career that allows me to work with communities on global projects for the purpose of improving public health overall.

Even as a child I felt a deep sense of belonging to the natural world around me – growing up in rural North Carolina, I always felt safest surrounded by trees and bugs and the smell of wet leaves. I felt it was my duty to protect this place that also protected me. I now know that our relationship with the environment is symbiotic: by protecting the environment and improving environmental health, we also improve human health. Perhaps the most important resource to sustain this human-environment relationship is water; without it, we would simply not exist. Global access to clean water and sanitation is of utmost importance; for this reason, I decided to take on this practicum opportunity researching interventions targeting sanitation-related behavior change in the developing world – particularly the safe disposal of child feces in the Asia-Pacific region. Poor child feces management is a public health problem of particular importance in this region, especially due to the high risk of enteric infections among children, whose immune systems are not fully developed. Some of the health outcomes associated with these unsafe disposal practices may include diarrheal disease, soil-transmitted helminth infections, and stunting. This project will involve collaboration between Gillings and the humanitarian organization World Vison, which works closely with communities most impacted by the health outcomes associated with inadequate water and sanitation. Thus, I will be exposed to real-world interventions that incorporate the type of community engagement that I want in a career.

My three cats – Grandpa (top left), Franklin (right), and Rosemary (bottom left)

My three cats – Grandpa (top left), Franklin (right), and Rosemary (bottom left)

I always feel proud to tell people that I’m working on my MPH at Gillings, the top public school of public health in the nation, though I never really know what to say with regard to what I actually do on a daily basis. I typically tell people that I work in environmental public health, which is usually met with an “Oh! That’s a really important field nowadays!” Which is especially evident in the era of COVID-19, but I would argue that public health is always important, or was perhaps even more important just before the pandemic as we failed to protect our most vulnerable from this deadly disease. Plus, “I work with child feces” doesn’t really make for good dinner table conversation.

Although I used to dread all this remote work, I’ve actually found it more rewarding to set my own schedule and goals. I also get to spend a lot of time with my cat and foster kittens! With three cats I’ve definitely gotten a lot of real world experience with feces management.

Feeling hopeful for a productive and rewarding summer!