Gratitude

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!

Lydia

Inter-Faith Food Shuttle – Raleigh, North Carolina

It is hard to believe my summer with the Inter-Faith Food Shuttle in Raleigh, NC has wrapped up! I partook in a wealth of experiences during my practicum as I worked within the Food Shuttle’s fast-paced environment, which feeds, teaches, and grows our local communities.

Cooking Matter, Cucumber Scooter Activity – Advantageous – Chapel Hill, NC

As someone not originally from North Carolina, my time with the Food Shuttle was so valuable in becoming part of my community here. Throughout the summer, I traveled around our 7 service counties, doing everything from meeting and speaking with neighbors at food distributions, teaching nutrition classes, building curricula, and recovering and redistributing food to local partners. Whether I was climbing and crawling (with impeccable grace, might I add) over boxes in a semitruck trailer to make sure recovered spinach in the back got delivered to Raleigh’s Salvation Army, or racing around cucumber scooters on table tops with kiddos from Advantageous in Chapel Hill at my Cooking Matters class, each engagement helped me gain a deeper understanding of our local food system, the many people and local partners who keep it running, and the people who are served by it.

Each month during my internship, we had intern meetings where we discussed various topics related to food security. During our last intern meeting of the summer, we opened it up with the question, “What is one thing that surprised you most about your experience with the Food Shuttle?” Mine was a relatively simple response, but it is something I can’t stop thinking about. During my 3 months with the Food Shuttle, I was constantly shocked by how wide the network of people is that keeps our communities fed. Even when only looking at the Food Shuttle, I was in awe of the constant movement among my colleagues, our volunteers, and our local partners, and how that translated into food getting to neighbors. This then made me think what our food system could look like if more entities within it chose to function or were able to function with the same vigor and with food justice as a driving principle. Perhaps, we could build a food system that not only ensures people are fed without undue hardship, but one that also protects people from environmental harms, one that invests in communities rather than gentrifies them, and one that uses community knowledge and experiences to set their agenda rather than agendas set by outside forces.

Community Health Education Academy – Webinar Series – Healthy Pregnancies While Experiencing Food Insecurity – Podia.com – Designed by Sara Cathey

With this in mind, through various learning opportunities, I learned more about food apartheid, and how white supremacy culture in nutrition continues to yield oppression and erasure in our local food system. Too, it was eye-opening to dive into how the history of colonialism plays into how I conceptualize nutrition, as well as how it molds our local foodways. This was extremely impactful in the way I approached developing my curriculum for my 3-part webinar series, Healthy Pregnancies While Experiencing Food Insecurity. To that point, I also learned more about trauma-informed nutrition education, and attempted to integrate concepts from it into the my curriculum. Specifically, I focused on integrating concepts like power, choice and strengths individuals have when interacting with food; overall wellness as opposed to strict, numbers-based nutrition suggestions; opportunities for skills-building related to food and adaptations of these based on various needs; and providing information in a non-judgmental manner to reduce stress or anxiety surrounding food.

Community Health Education Academy – Webinar Series – Healthy Pregnancies While Experiencing Food Insecurity – Recipe Budget – Designed by Sara Cathey

Practically, this looked like designing my lessons with a similar pattern. Each session started with one or two pregnancy-safe stretches to promote mental and physical wellness. We then transitioned into lesson content, with Session 1 being about using community food resources like WIC and SNAP, Session 2 being about managing pregnancy symptoms and nutrient needs, and Session 3 being about food safety during pregnancy. After that general information was presented, we then applied that knowledge to a recipe activity where we looked at how we could design our meals to maximize monthly WIC and SNAP benefits and the nutrients on our plate. With that, I displayed a recipe and any adaptations that could be made to it and then broke down a budget looking at the overall cost, cost in WIC benefits, and cost in SNAP benefits if a person made that particular meal once a week for four weeks. With these lessons, it is my hope that pregnant neighbors experiencing food insecurity feel equipped, inspired, and in charge of their food, their bodies, and their wellbeing.

There are so many other things I could talk about, but if I did, I think my fingers would fall off from typing. So for now, I just want to say that I am so very grateful for my time with the Food Shuttle this summer, and for the opportunity to learn from and work with a group of people who are so keen on feeding our neighbors with justice as a leading principle. I also wanted to say a special thank you to my mentor, Kylee McCombs, for all of her guidance and insight during the development of my practicum products, as well as a big thank you to everyone else at the Food Shuttle! Y’all are absolutely awesome!

 

Ag Education – Garden Signs – Rana (left) Sara (right) – Camden Street Learning Garden – Raleigh, NC

Sara C.

When One Door Closes (Or When You Intentionally Close That Door Because It’s Not The Right Door For You)

When I first started my MPH, I was excited by the opportunity to work globally. As a service-oriented person, I wanted to be a changemaker in tackling the world’s biggest problems. My solution, of course, was to go work abroad. In the U.S., these global problems – poverty, gender inequality, food insecurity, etc. – are commonly thought to exist outside our borders. Of course, it takes someone with a fairly big ego to believe that they have the capability to take on the “world’s biggest problems.” And sometimes that ego makes me think I understand more than I do, keeping me from questioning our vantage point.

Throughout the program here at Gillings, I was forced to challenge my goals. One of the most convicting moments came when we were assigned to look at another country’s healthcare system and compare it to the U.S. My team was assigned India. While we were reporting out, we noted the significantly higher out-of-pocket health expenditure (72.4% of total health expenditure in comparison to 17.2% in the US). Another student in the classroom, who is actually from India, jumped in to add that this is because people can see a doctor for a fairly small fee. Many prefer to do that rather than see one of the publicly funded doctors for a variety of reasons. I was reminded then that, while I can read hundreds of research article published on a particular country, the academic knowledge cannot replace the experiential understanding that comes with living in and being from that country.

My  summer practicum with RADS helped me further question my role in global health. RADS is a group that uses data-driven research to advocate for improvements to healthcare services in Pakistan. At the beginning of the summer, they asked me to develop a research question surrounding contraceptive use among Pakistani women. I was honestly really surprised that they trusted me enough to ask the right kind of question given that I have never been to Pakistan, let alone spoken to a Pakistani woman about her contraceptive use.

My initial research question (on whether lack of access to family planning was correlated with food insecurity) turned out not to be very fruitful, as we did not have a large enough population within the food insecurity categories. I then turned to examining family planning in relation to household economics and women’s income. In the end, the data analysis turned out to be insignificant when controlling for occupation. I must admit, it was pretty upsetting to spend so much time looking at the data for things to have turned up inconclusive. My preceptor helped me shift course by instead spending my time producing policy briefs on research they had already done, but I still felt like my practicum had failed in some way.

As I struggled through my practicum, I also had a summer GRA position with a doctor here at UNC. Dr. Shoenbill is an internal medicine doctor and was recently named Director of the UNC Tobacco Treatment and Weight Management Program. I worked on a project with the Weight Management Program, specifically looking at weight bias and weight stigma in the healthcare field. I have felt so much more confident in my ability to contribute to this research, not because I have any prior knowledge in the subject, but because this is a healthcare system of which I have been a patient myself. It was another piece of evidence that, while my many years as a U.S. citizen may not have necessarily prepared me for global health work, perhaps it has prepared me for something else.

While I was working on my summer research on family planning in Pakistan, the U.S. Supreme Court overturned Roe v. Wade, which guarantees a woman’s right to an abortion in every state. As a strong Christian, I recognize that abortion is an incredibly complex issue. But one thing I know is that this ruling will hurt people. Family planning means so much more than just contraceptive use. Abortion is one tool in the toolkit of allowing women the freedom to plan the families they desire and that freedom is invaluable.

I hope that women in Pakistan can get the contraceptives they need. I also hope that women in the U.S. can get the healthcare that they need. The question I must ask myself as I continue my public health work is where I am most likely to make an impact.

In the past several months, I have also realized something that makes me uniquely qualified to work in the U.S. And that is that I love this country. For all its challenges, I have a humble love and deep adoration for the place that I call home. My immigrant parents made it a refuge from the dictatorship they wanted to escape and it is against that backdrop that I often view the U.S.. And while I certainly appreciate the world beyond the U.S., no place will have the special resonance that my country does. I have lived in four different states and each of them has taught me something. It is these lessons, and the continual experience of being an American, that I will bring with me to my health policy work.

The photo below is me on the first day of my MPH. I am excited to take another in just a couple weeks as I begin year two.  This semester, I plan to make some shifts in my approach. I am taking an elective in the Public Policy department at UNC. The course is designed to  help students understand “the theories that explain the politics (who gets what, when and how) that result in the public policy we see at the local, state and national level in the U.S.” I am excited to begin thinking more about healthcare in the U.S., about what our challenges are, and how I can best serve the place I call home.

Me on the first day of my MPH program.

I am grateful to be at a place like UNC where I believe the right opportunities will present themselves. Thank you also to my preceptor, Muhammad Ibrahim, at RADS, and to Dr. Shoenbill for a great summer. Thank you to Ian Dale and Bridger Trap for helping me question my understanding of this field. And thank you to my roommates Andi and Kate, and to my church community at Love Chapel Hill for the continual support throughout grad school.

Ana