Author: nayavill

Addressing global threats in our own backyards

Posted on by nayavill

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.

End TB pin
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.

-Jaclyn

Global Health Practicum in the time of COVID-19

Posted on by nayavill

For most people, myself included, the pandemic upended our way of life, from the way we socialize to the way we work. Currently, I work as a pediatric surgeon, so prior to starting my MPH, I figured that I would have to find a practicum experience that would be flexible with regard to my work schedule; allowing me to meet my clinical responsibilities while fulfilling my practicum requirement. More importantly, I wanted an experience that would allow me to marry my research interest in access to prenatal care and neonatal outcomes in sub-Saharan Africa. For all these reasons, I was extremely excited when I got the opportunity to work with the UNC Gillings Zambia group which focuses on “improving public health, locally and globally.” Specifically, I was selected as a practicum intern for the Antenatal Care/ Postnatal Care Research Collective – Household Survey (ARCH), a multinational collaborative that aims to optimize birth outcomes in low resource settings. I don’t think that I could have asked for a better practicum opportunity, as it aligned perfectly with my interests.

In my role, I will be working to help with study start-up and implementation of a new longitudinal household survey of 5,000 households in Lusaka, Zambia. The goal of this survey is to gain a better understanding of the behavioral and reproductive health of women of reproductive age. Ultimately, the results from the study will provide estimates of the burden of maternal, newborn, and infant disease; and provide information regarding key risk factors and social disadvantages that contribute to adverse maternal and neonatal outcomes. I am excited to be part of this study, albeit in a small way, because I think we know little about factors related to preconception and antenatal care of women in resource-limited areas. This area of research is particularly important because I think better understanding will provide information not only regarding factors affecting maternal health, but also regarding the burden of birth defects and help to inform planning for and improving neonatal outcomes.

During my practicum experience, I will be working to develop training materials for field research staff and recruitment materials for study participants.  Over the last few weeks, I have been working on getting acquainted with the study protocol, and meeting key personnel for the study. I have also started working on some of the participant recruitment materials.  It has been really interesting having meetings on Zoom to discuss the study and its initiation. It has made me long more for in-person meetings, because I think that it would have been great to meet some of the people with whom I’d be working. I also think that it would have been an amazing opportunity to be on ground in Lusaka. I am still hoping that I will be able to visit the Zambia Hub in the future.  In spite of the challenges regarding not being in-person, I have been fortunate to have a preceptor who has been available and easily accessible.

There are number of things that I am looking forward to in my practicum. Firstly. I am looking forward to learning how to carry a research study from a concept, to one that is actualized in practice. I am also looking forward to developing the training schedule and materials that will be instrumental in initiating the study. I feel that this project will allow me to think critically about an important part of research study implementation, in which I have little experience. Lastly, I hope that this experience will provide opportunities to build relationships with researchers who have similar interests, in improving prenatal access to care and neonatal outcomes, in resource-limited settings.  As a physician who is interested in global surgery and research, my involvement will therefore provide me with the skills to develop study management tools, train research staff in international settings, and establish methods to monitor data quality. Given that the study is still in the early stages of implementation and initiation, I believe that I will gain valuable experience regarding the successful implementation of a research protocol.

Although I expect to have a busy summer, I’m planning on making the most of the sunny days by doing as much work as I can outside :).

‘Desola

Silver Linings – Completing A Global/Local Practicum in the Times of COVID-19

Posted on by nayavill

Since I graduated with my bachelor’s in International Studies last Spring, I have been in somewhat of a state of limbo. I enrolled at UNC in the Global Health concentration of the MPH, but have struggled to find my true passion within the global health space. Compared to the impressive drive and expertise I see in my peers; I have felt comparatively directionless. I struggled this year, in part, I think, due to the online format of our courses, to feel like I have found my place in the global health space. However, despite reinforcing my passion for public health, I had not quite found my niche when it came time to begin the practicum search process.

It would be a lie to say I am disappointed to be completing my practicum online this summer. In fact, quite the opposite, I honestly feel that this experience could not have worked out more perfectly in my favor. My primary anxiety surrounding the practicum experience, for essentially as long as I can remember, has not been the practicum itself, but rather finding an opportunity that would not only be practically feasible, but which would align with my interests and career goals. I ideally wanted a policy-focused placement, working on women’s health issues, which would allow me to keep my RA position over the summer. I was so concerned during the search process, after facing rejection after rejection from viable opportunities, that I would end up with a loosely-global-related placement where, although I would still gain valuable experience and skills, I would not be doing work in which I was genuinely invested. So when we all received the email saying that due to COVID-19 travel restrictions, the global requirement of the practicum would be waved, I breathed a massive sigh of relief.

With this parameter eliminated, I was given the freedom to search for opportunities in North Carolina, tackling pressing health concerns locally. I feel fortunate to have been accepted at my current practicum position with the UNC Hospital’s Beacon Program. The program provides comprehensive, coordinated care to UNC Health System’s patients, families, and employees experiencing a variety of interpersonal abuse and includes services for children, victims of domestic abuse, or intimate partner violence (IPV), human trafficking, sexual assault, the elderly, and vulnerable populations. In my role as a policy intern with the Beacon Program, I am spearheading efforts to investigate, create policy recommendations, and bring awareness to patient safety and privacy concerns arising from a new federal statute, the 21st Century CURES Act, that requires health systems to make medical records more widely available to patients.

Implementation of the CURES Act has led to new safety concerns for patients whose family members or other caregivers may access their medical records via online portals and has reinforced existing patient safety and privacy vulnerabilities surrounding the MyChart and OpenNotes portals. For example, provider notes detailing child abuse or domestic violence may cause family members to retaliate and cause further harm to the patient. There are grave patient safety concerns for victims of sexual assault and stalking, whose records of abuse or location information may be more readily available to their abusers. In addition, standard-of-care issues exist for patients with stigmatized diagnosed conditions (mental health issues, STI status, etc.) recorded in MyChart. There should also be serious questions asked about the process of obtaining informed consent for these portals.

My work in the first few weeks of my practicum has been exciting and engrossing, as I have found that many of these issues have not been addressed or even discussed at all in academic circles, let alone translated into practical solutions in a clinical setting. I even spent the last week investigating how difficult it is to make a fraudulent MyChart account (read: attempted to do so) and found it to be shockingly easy. I am so excited to continue this practicum doing what I find meaningful and fulfilling work and begin working on policy avenues for protecting patients put at risk by this statute at UNC and elsewhere. I will also create materials for provider education on harm reduction and draft a commentary on the issue for submission to peer-reviewed journals.

I am happy to say that there has been more than a bit of serendipity in the way things have worked out during this practicum. Despite my previous worries, the opportunity to do a remote, non-globally-focused practicum has helped me discover my passion in the public health space and feel that I am contributing to work that will positively impact my own community. This format has also allowed me to continue to work as an RA part-time, and I have also had the added benefit of being able to work from my home office and spend a little extra time with my pandemic puppies (pictured above). This experience has so far taught me that sticking it out through anxiety and discomfort can often result in a surprising silver lining. I look forward to finishing the practicum to see what else I will learn from this opportunity.

Gabbi