Gillings Global Health Blog

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

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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

Practicum Reflections in Preparation for the Start of Year 2

It seems crazy to think that we are all signed up for courses and getting ready for the second year to start. My practicum flew by and I am excited to have the opportunity to stay involved with the work as we start next semester. I am working with Kybele on a project called MEBCI 2.0 (Making Every Baby Count Initiative) which aims to improve quality of newborn care by using quality improvement, systems thinking/strengthening, and leadership trainings. Check out this paper to learn more about the first iteration of MEBCI! For my deliverables I am creating PowerPoint presentations and training manuals for (1) Models for Improvement and (2) PDSA (plan, do, study, act) for clinical providers in Ghana.

We were told from the start of practicum searching that there is no such thing as a “perfect practicum,” so I definitely feel like I lucked out. My work with Kybele, using quality improvement (QI) and systems thinking to improve neonatal and maternal outcomes, is exactly what I want to do in the future and gave me irreplaceable insights on the field. The best thing that came out of the practicum was being able to see the program design process from early on, from brainstorming competencies and training topics to drafting training materials. I’ll be working over the next few weeks to finalize these materials. Throughout, I have used materials from the Ghana Health Service and the National Healthcare Quality Strategy along with information from our project partners, mostly the American Academy of Pediatrics, in order to make sure that our trainings are the most relevant, usable, and built upon previous training experiences opposed to being redundant. I also spent a lot of time making sure that language was appropriate and consistent with materials that were already in circulation throughout the tertiary hospitals that Kybele is working within.

Although I was a little intimidated at the start of the practicum and felt like there was so much literature I needed to read in order to get myself speaking the same language as the team, I learn best by actively doing things and am grateful that the team allowed me to jump right into this project, consistently providing me with critical feedback along the way. It was also great to meet the team that I have been working with (in person!) before the practicum officially began and to have another Global Health student, Erin, working on the same MEBCI project. I’m excited to start next semester with this new perspective on program design and material development and look forward to continuing to work on similar projects in the Fall!

the best thing about practicums being remote? Getting to check off some major bucket list hikes/climbs, this is peak three of Olomana in Oahu!

The best thing about practicums being remote? Getting to check off some major bucket list hikes/climbs, this is peak three of Olomana in Oahu!

Hope everyone has a good rest of the summer!

Sydney

Key Lessons

Like many others who have contributed to this blog, my practicum experience has been fundamentally altered by the pandemic. It’s been great to read about others’ experiences and know that the separation from the communities we’re working with has affected everyone. For me, that community is nearly 8,000 miles away – in Lusaka, Zambia.

A little bit of background on my practicum: Zambia has one comprehensive cancer center, the Cancer Diseases Hospital (CDH), which serves the country’s population of over 17 million people. Since 2006, when the CDH was established, they have treated over 20,000 new cancer cases. The most common cancers seen at the CDH are cervical, breast, and prostate cancers. In recent years, in an effort to better understand determinants and outcomes of these cancers, doctors and researchers at CDH have prioritized data collection and exploration. They’ve developed a retrospective-prospective database to capture data on the cases of breast and cervical cancer at CDH. As part of my practicum, I am helping one of the data teams with data cleaning and validation, and conducting some research using the information in the database.

The distance to Lusaka fortunately hasn’t prevented me from being able to develop and practice data management skills. In my practicum search, I knew I wanted to get experience working with data, and the work I’ve been able to do this summer has been incredible for giving me opportunities to expand on concepts and techniques we’ve learned across in our first two semesters of coursework.

But the distance has also created challenges – divorcing the content of my work from the community I am meant to be working in. Our instructors at Gillings this past year have repeatedly emphasized that humans aren’t data points. A person’s story cannot be fully understood when it is distilled into a series of responses across a set of variables. But the separation from Zambia has left me feeling the absence of community interaction and the context of the of the data I work with day-to-day. I’d love to have been able to be safely face-to-face with researchers, co-workers, and patients at the CDH.

Other posts on this blog have wisely extoled the power of gratitude and searching for silver linings during these unconventional times. And I have a lot to be thankful for! I’m glad I’ve gotten to spend (virtual) time with the CDH data team over Zoom, learning snippets here and there about them – their academic and career interests, their thoughts about certain health topics, what sports they follow. Being remote also means that I’ve been able to see my family and friends and get to know Chapel Hill/Carrboro better! And, finally, this experience has instilled in me a key lesson I intend to carry throughout my career: some public health work can be done extremely effectively remotely, but the quality and value of this work can always be made better through connection with the community.

Emma

A global practicum in times of COVID-19 doesn’t feel as new as expected

Hi! My name is Keely and I’m an MPH candidate at Gillings School of Global Public health with a concentration in nutrition. This summer, I’m working with the London-based Institute of Alcohol Studies (IAS) to develop reports which will be used to help guide future alcohol research and inform evidence-based alcohol policy in the UK.

Prior to my studies at Gillings, I received my bachelors in German studies and taught English with Fulbright Austria before working for a short time with a major health insurance company as a health advocate—I’ve jumped around a bit in fairly different areas, but the accumulation of all of these experiences is what led me to pursue public health nutrition. This past year has taken a slight turn, however, as my interest in nutrition education and community involvement has shifted to one of bringing change through policy advocacy. I’ve also grown more interested in alcohol consumption and misuse as a public health issue—two of my major projects last year focused on alcohol misuse. As a result, I’ve reflected a lot on alcohol’s role in my life and in my surrounding community, and on the social responsibility of the alcohol industry. When it came time to search for a practicum, I fortuitously stumbled upon my current position with the IAS and knew that it was the perfect fit for my developing interests.

Over the past three weeks, I worked on a briefing for alcohol use and harms among UK-based LGBTQ+ people, intended to identify gaps in knowledge (spoiler, there are a lot), and guide future research. Ultimately, this should help tailor health messaging and provide evidence behind advocacy for safer, more inclusive spaces for queer people within healthcare and alcohol treatment services. I had a slower start than I’d planned for—my job is fully remote, and I meet with my team for only one hour per week. Because of this, I found it really difficult to feel like a part of the organization and find the momentum to start during my first week (luckily that didn’t last long!). Aside from a slow start, my practicum hasn’t felt so out of the ordinary as I was expecting; I’m learning new things and my work is meant to contribute to more than a grade on my transcript, but I feel comfortable and confident working from my living room. Now that I’ve settled in and finished up my first product, my attention has turned to my second project, which will be a rapid review on the calorie labeling of alcoholic beverages.

Currently, the alcohol industry is not required to label beverages with nutritional information; UK government has announced a consultation to consider requirement of calorie labeling on alcoholic beverages as part of their new Obesity Strategy. The review that I’m putting together will be used to guide IAS’s work on the consultation. I thoroughly enjoyed my areas of research in alcohol use for last year’s academic, skill-building projects, but it is such a different (read: more enjoyable) feeling to begin work on something that will hopefully help create real societal impact. It’s somewhat intimidating, but in a good way that also makes me incredibly excited to begin a career in less than one short year.

For both projects, my days have consisted of and will continue to consist of literature reviews and writing. I’m excited to continue learning about this topic and the alcohol industry, and how the UK parliamentary system works. I’m considering pursuing a career in alcohol research/policy following graduation, so it’ll be interesting to build this base of knowledge and identify potential areas for alcohol research and policy advocacy within the US. I’m very grateful for the opportunity to improve upon my research and writing skills and work within a small, female-run research organization that has significant influence in the UK policy sector.

The rest of this summer will be quite busy, as I’m working a second job atop my practicum, but it’s already shaping up to be one of the best I’ve had— from the meaningful work and connections I’m building, to making the most of my free time and weekends. I’m looking forward to what’s to come!

Keely

Nutrition Lessons from Peru

Well, just like that, June is coming to an end and so is my internship. You’ll recall that I spent my spring and summer Working from Home with the World Bank. During my practicum I performed a literature review of several low- and middle-income country’s health care systems and how they are working towards universal health care for all and incorporating nutrition services within these models. There are a multitude of learnings and moments of insight I could expound on, but I’ll focus on Peru’s efforts to reduce stunting in youth under-five years of age.

Stunting is a form of malnutrition that results from chronic undernutrition. Broadly speaking, undernutrition can present in four forms: wasting, stunting, underweight and micronutrient deficiencies. Stunting is diagnosed when a child presents with low height-for-age two standard deviations below the WHO Growth Standard deviation median. Wasting is low-weight-for-age and a sign of acute undernutrition; by definition one is wasted if he or she is more than two standard deviations below the WHO Child Growth Standard deviations weight-for-age median. Globally, the prevalence of under-five stunting and wasting are on the decline, but an unacceptable number of youths still suffer from undernutrition. In 2020, 149.2 million of the world’s under-five youth were affected by stunting and 45.4 million were affected by wasting. Among the global health and nutrition community, Peru is best known for its achievements in reducing the prevalence of under-five stunting from 28% to 13% in just eight years (2008-2016).

Stunting affects physical and mental growth. Early deficiencies in cognitive development can be catastrophic for an individual’s lifetime quality of life, educational opportunities, and economic earning potential. This has implications for the prosperity and development of nations at the population level. The economic cost of undernutrition is projected to be 2-3% of gross domestic product (GDP) on average and as high as 11% of GDP in some African and Asian countries each year. Figure 1 shows the effects of stunting on white matter tracts in the brain of a stunted infant (left) versus brain development of a healthy child (right) at two to three months of age. The density and richness of neural networks differ in the images and by the time a stunted child gets past their first thousand days they have up to 40% less brain volume compared to non-stunted children.

Figure 1: Representation of Neural Networks in a Stunted and Non-Stunted Infants.

Figure 1: Representation of Neural Networks in a Stunted and Non-Stunted Infants.
Source: Nelson, C. 2016. Brain Imaging as a Measure of Future Cognitive Outcomes: A study of children in Bangladesh exposed to multiple levels of adversity, Presentation at the Grand Challenges meeting, London, October 2016 and 2017

There is no silver bullet that fully accounts for Peru’s success in reducing under-five stunting. It can be attributed to a combination of grassroots advocacy, political commitment, and systemic changes in how nutrition services are prioritized and delivered. The details of this effective combination are too nuanced to delve into during a blog post, but the short version is: Peru’s government and leaders recognized the need to reduce stunting, it allocated money and resources to this end, and it iterated on programs and policies to reach its goal. One of my biggest learnings from the Peru case study is that health care is about trade-offs! I’ve read that health care is a triangle of tradeoffs between health, wealth, and equity. I certainly believe that to be true and it should be front-of-mind as more countries explore the means to provide a basic level of healthcare to their citizens.

Signing off,

Ashley

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