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

Flexibility, Prototypes, and Male Contraception

In human-centered design work, we expect the unexpected, quickly adapt our plan when needed, and fail fast – meaning we quickly realize what doesn’t work and pivot to something that might work better. My work this summer has provided valuable insight into the real [public health] work application of human-centered design, providing valuable lessons in adaptability, creativity and teamwork.

As a refresher, I am working with YLabs, a global design and research organization working to improve health and economic opportunity for young people aged 10–24 years. For most of the summer, I’ve been working on a project called Ask Frankie. Ask Frankie is a platform that supports young people to make informed decisions about their sexual health and wellness through tailored digitally-based decision-support tools and seamless connection to the sexual health products and services they need most. For the first portion of my practicum, I led about 25 expert interviews with a variety of stakeholders, from OBGYNs and leaders of youth-serving organizations to Instagram-based sex education influencers and school-based sex educators.

One of my deliverables was a synthesis of my expert interviews. Some key insights from these interviews include:

  1. Youth don’t understand how to use health insurance to pay for sexual and reproductive healthcare, especially if they’re on their parents’ insurance.
  2. Youth in the Central Valley struggle to access youth-friendly healthcare services close to where they live, while maintaining their confidentiality.
  3. School-based sex education is inadequate and highly variable. Youth aren’t given the tools or knowledge to navigate queer sex, identity exploration, boundaries, and safe sex.
  4. Youth turn to social media (TikTok, Twitch, Discord, Reddit) and each other to learn about sexual health and wellness and troubleshoot their needs.
  5. Youth struggle to manage their mental health, and seek out care for a physical ailment, when the underlying issue is psychosocial or emotional.

Once I was able to synthesize those data, we were able to use many of those insights to inform the development of rough prototypes of products that might be most helpful to youth we’re working with to develop Ask Frankie. These prototypes, or rough sketches, included a situation-based decision tool, a healthcare service finder, and an online shop for contraceptive products. I was able to apply my knowledge of adolescent and youth sexual and reproductive health (AYSRH) and contribute to rough prototypes meant to be tested out with young people in co-design sessions in the Bay Area and Central Valley of California.

Here are some of the rough prototypes I helped create:

This is a rough prototype of our online shop feature to make it easier for youth to access a variety of contraception options
Rough prototype of an infographic for Nexplanon, a implant. This rough prototype was created during in-person co-design and rough prototyping sessions. The team found that youth really want accessibly, youth-friendly information on different contraceptive options.
Rough prototype of our service finder that is able to filter by location, identity of provider, form of payment and more.

Remember how I said that, in human-centered design work, we expect the unexpected? Well, about a week before I was due to fly out to California for in-person field work, leading co-design and rough prototyping feedback sessions with youth, I broke my foot and had to have surgery. As a result, I could no longer travel to California to complete the last portion of my practicum as planned. This was a major inconvenience both for myself and for the Ask Frankie project. While I recovered, the Ask Frankie team had to quickly adapt and find someone to take my place in the research team. Luckily a colleague was able to fill in, and I was able to give my time to another project looking at male contraception in high income countries.

My work on the male contraception project has been fascinating, and quite a change from exploring the sexual health and wellness needs of youth in California. I got to play with a mixed-method data set of 3,549 adults ages 18-50 from the US, UK, Canada, Germany, Switzerland, France and Spain. The data set examined contraceptive preferences and opinions toward the development of novel male contraceptive options, beyond the market’s current options of condoms and vasectomy. The report is still being drafted, but I hope to be able to direct folks to the report when it is available by the client. It’ll be a fascinating read! Thanks for reading! I am looking forward to the second year of my MPH and being able to walk again!

Zach

Unforgettable Summer

Seowoo

Hi all! I hope you all are having a great summer. This summer went by way too fast for me. I cannot believe it’s almost time to go back to school! I wish I had a little more time to travel and just relax, but I regret nothing about how I spent my summer. Working with the Occupational and Environmental Epidemiology Branch (OEEB) in the Division of Public Health within the North Carolina Department of Health and Human Services (DHHS) has been a wonderful experience. My main work was to write a manuscript on health and climate impacts of traffic-related air pollution to describe the potential health benefits the NC Clean Transportation Plan will bring to people in North Carolina. To do this work, I have read many papers and articles, attended environmental health conference and webinars, and have joined NC Clean Transportation Plan work group meetings. I was given opportunities to be involved in different meeting groups that helped me learn more about air pollution, as well as other environmental health issues in North Carolia that I have not previously paid attention to. Although I was not directly involved in the NC Clean Transportation Plan development, it was very interesting to see how those big state plans are developed. I have learned how multiple stakeholders, such as NC Department of Transportation, NC Department of Environmental Quality, NC DHHS, and many more, work together to develop actionable strategies to improve air quality in North Carolina. It was like seeing everything I have learned in the first year of MPH actually taking place in real life.

During this summer, I was really into this project. Every time I drove, all I thought of were the cars emitting gas exhaustion, the houses near highways, and the lack of electric vehicle related infrastructures. One time, I was driving and talking about these for too long, my husband had to stop me few times. I still have some things to wrap up before this practicum ends. I am at the stage of revising the manuscript and preparing to give presentation on my learnings to people in the OEEB. The work will soon be over, but I will not stop digging up on this topic as I have gained so much interest throughout. Overall, I have had a valuable experience working with NC DHHS. I especially want to thank my preceptor, Dr. Guidry, for being a great support and helping me gain as much experience as I can.

Seowoo