Author: nayavill

Key Lessons

Posted on by nayavill

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

Posted on by nayavill

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

Posted on by nayavill

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