Hello! It’s Maria Esposito, again. Here with a practicum update!
A little bit of Jamestown, NY.
I wrapped up my practicum in the beautiful and peaceful Jamestown, NY while visiting family. My practicum was focused on a soon-to-be implemented study examining differentiated care models for transgender people in Johannesburg, South Africa regarding their HIV care, led by Dr. Audrey Pettifor and Dr. Tonia Poteat in partnership with UNC and Wits Reproductive Health and HIV Institute. As part of this practicum, I reviewed several journal articles, interview questions, and compared clinic checklists on LGBTQ+ health and their quality of HIV care to assist in the creation of my practicum products: a facility-level checklist, and two interview guides (one focusing on patients at local clinics, and the other focusing on key informants – clinic providers and supervisors). The trickiest part of creating these products was figuring out the proper wording of questions and cutting down questions to make the interview shorter. I also received feedback from Wits IRH folks, which was extremely helpful considering they have more insight than I do about transgender folks in Johannesburg, South Africa.
More Jamestown, NY.
However, the study isn’t over but just beginning. Dr. Pettifor and Dr. Poteat will be sending out my practicum products to be assessed by clinic supervisors and folks at Wits IRH before implementation begins. The study is expected to be piloted this Fall – but it may start in the New Year. And I am excited to see where it goes!
With that being said, I am thankful for this practicum opportunity and the mentorship Dr. Pettifor and Dr. Poteat provided. Before starting this practicum, I knew I wanted to re-engage with research again, specifically qualitative research. This experience has only confirmed that I find qualitative research extremely compelling and informative of a person’s individual experience. I am excited to see what the next step of my Public Health journey will be!
Wrapping up the summer, I feel exhausted but fulfilled and excited to put the work of this summer into use in the future. These past months have been filled to the brim with various projects, the largest of which of course being my practicum project, but also my Haitian Creole (kreyòl) courses and my work with the Humanitarian Health Initiative.
There are a million and one things I would like to say about my practicum, and what I’ve found researching the barriers, risks, and social determinants related to poor sanitation in the United States. I would like to rail against the injustice that is a high-income country that allows millions of residents to rely on, for example, straight pipes, the system by which waste is directly conveyed, untreated, onto adjacent land or into nearby surface water (though, to be clear, the United States is not the only high-income country home to such methods.) I would want to highlight how many communities lack safe sanitation, a basic human right as delineated by the United Nations Resolution 64/292 (and common sense), because they are afraid of revealing their documentation status; how many communities of color still lack municipal water and sewer services due to under-bounding, the municipal annexation equivalent of red-lining, even though, in some cases, water and sewer pipes run through their neighborhoods to serve majority white neighborhoods.
Price Lake
But if I had to select a single thing (and, really, I don’t, because I’m currently writing a literature review on these barriers, risks, and social determinants!) it would be that there are indeed sanitation issues in the United States. In my readings, I came across a quote from a law review, that states: “indoor plumbing and sanitation are taken for granted in developed countries. … approximately 43 million Americans are in rural areas unconnected to public supply systems, but are nonetheless able to rely on clean water … and utilize on-site sewage facilities such as septic tanks for sanitation” (Hartley & Van Meter, 2011). This is an all-too-common misconception. Millions of Americans simply cannot “rely on clean water” and safe access to sanitation. In fact, Catherine Coleman Flowers, an eminent environmental justice advocate, calls the state of sanitation in areas of Alabama “the final monument of the Confederacy.” And lack of safe sanitation will become an increasingly pressing problem as climate change increases flood risk and incidence, leading to septic tank malfunction and increased spread of possible pathogens in flood waters. This is an issue that can no longer be ignored by various levels of government, by public health professionals, by our nation as a whole. I look forward to continuing this work as an Environmental Justice Graduate Research Fellow with the UNC Institute for the Environment this upcoming academic year.
Paddling on Jordan Lake
Other than compiling this work, I’ve enjoyed my six weeks of Haitian Creole (kreyòl) classes through the Florida International University, where I had the amazing opportunity to take basic and intermediate kreyòl and a course on Haitian culture (kilti Ayisyen). I hope in the future to visit Haiti (Ayiti) and work with community-based organization working to address the environmental justice and sanitation issues wrought by centuries of colonization and US occupation. And, finally, I’ve loved getting to know some North Carolina lakes! See y’all in the fall, or, in kreyòl, n a wè talè!
Garden display outside a restaurant on Cape Hatteras Island, NC
I feel so grateful to have spent the past several months working with the Sisonke Ntwana Project for my practicum. The project is a research intervention aimed at providing arts and play-based therapeutic interventions for pregnant and postpartum adolescents in Johannesburg. For me, this has been amazing, because it combines my interest in mental health, art therapy, and global populations, while also setting me up to learn qualitative research skills.
The study uses a developmental perspective, relying on psychological, biological, and social changes. With my background in social work, this is especially fascinating and important because it provides a critical perspective to look at how the life stage intersects with exposure to violence and mental health. Moreover, there is a systems approach to the study since the project examines how social stigma within healthcare settings affects mental health, barriers to reporting assault, transportation, and housing.
My Contribution:
Throughout my practicum, I was able to develop interview guides for the art interventionists, researchers, and the liaison who works with the project and as a nurse. The interview questions are aimed at gathering qualitative data about perspectives on the project, experiences, training, and other observations that are not typically captured during the session recordings. The goal of gathering this information is for evaluative purposes so the project can make sure its goals are appropriate and adjust if necessary.
After I developed the questions for each group or individual, I began the interview process! Scheduling these interviews was a bit hectic since we had to accommodate for the time difference (Johannesburg is 6 hours ahead of NC), but it was fascinating to hear the different perspectives and ideas people had about the project. There were many topics about community-wide social challenges, racial dynamics and how they can play out in-session, and ethical issues that can come up. Each of these topics shifted depending on the role the person had in the project, and I felt so lucky to be the person that was listening and interviewing folks about their experience. I also think people were appreciative to have a place to talk about their experiences.
Kayaking on Falls Lake sometime in July
Wrap-Up Reflection
Part of me is surprised that my practicum experience is already over, and the other part of me feels like it’s been much longer than 3 months. I genuinely feel like I’ve learned so much throughout my practicum experience, it’s funny to think about before it all started. Throughout my involvement in this project, I’ve worked on qualitative data analysis using Dedoose, cleaned mental health interview transcriptions, created a spreadsheet to organize data, created multiple interview guides and interviewed 6 team members, and much more. When I look at all the work I’ve done and the new things I’ve learned, it does feel like much longer than 3 months (but in a good way).
Zucchini harvest from my garden
Key Takeaways
This practicum experience was so rich for me and there were a lot of key takeaways.
Some takeaways revolve around research practice and my interests. One interesting thing for me was how different, and more pressing, ethical challenges come up while practicing intervention-based research. Some of our MPH classes talk about ethics in research, but it is tricky to imagine the exact ethical scenario or challenge one might face until you’re in it, so this was a good way for me to see that better. This project also brought up to me how interesting I find interventions that use some sort of art or play-basis and how different modalities are appropriate for specific. For example, art and play therapy are especially useful for adolescents or folks with autism. I’m keen on exploring more about creative modalities and how they can be used for specific groups
Additionally, some of the most important key takeaways revolve around how I will approach my future job search. This practicum did make me realize how much I enjoy doing qualitative research and how I plan to look for a job than has that role. It also highlighted something that will be important for me and my future job search which is finding the right balance of community-based work and computer-based work. On top of each of these things, working on this project highlighted how pivotal it is to have a strong team and supervisor relationship. Lastly, this project team has such great rapport, and they work so well together which is something I think everyone that engages with it notices and it changed the dynamic of the work.
I am truly appreciative of all of the skills and takeaways I learned throughout my practicum and can’t wait to apply them in future work!
