Category: 2021 Summer Blogs

With goal-motivated fun, time flies

Posted on by nayavill

I have been privileged to work on a hugely satisfying and rewarding practicum with the Gillings Zambia Hub. It is qualitative research to assess the acceptability and feasibility of engaging male partners and other family members to support HIV-positive mothers to practice the recommended Infant feeding practices and Anti-Retroviral Therapy (ART) adherence.

My drive and interest in HIV research and the prevention of mother-to-child transmission stem from seeing the hardship faced by people living with HIV. Hence, I was glad for the opportunity to work on a subject matter I find interesting and relevant, so I have had no problem finding my footing or staying motivated, especially with the practicum being a virtual one.

For the project, we use the Trials of Improved Practices (TIPs), a formative participatory research technique developed by the Manoff group to pretest and improve the recommended practices on a small scale before introducing them broadly. Trained interviewers discuss current feeding practices and ART adherence with study participants in individual interviews. In addition, study participants are encouraged to identify home supporters. Subsequently, there is counseling on the recommended practices, and with the interviewer’s help, each study participant decides on specific practices to be adopted over a trial period. In follow-up meetings, the interviewer asks questions to assess the uptake of the recommended practices. By taking this approach, we draw from the experience of the study participants, who are members of our target population, to pilot test our recommendations. This approach enables us to recognize and determine the practicability or limitations of recommended infant feeding practices in the context of the local communities. Furthermore, using TIPs makes it possible to identify possible challenges that might impact the uptake of our proposed recommendations, provide solutions to these challenges, eliminate or modify practices that are not feasible.

As an intern, I support the team by reviewing the transcripts of the focused interviews and providing feedback. I also use Ona to assess and summarize the data and ATLAS.ti for qualitative data analysis. In addition, I am working on a secondary analysis of already coded data to determine the role of social support systems and couples’ joint decision-making in preventing mother-to-child transmission of HIV. Through my interactions with the research team, I am learning to be perceptive of cultural differences, be humble and respectful while giving feedback, and be open to responses that challenge my worldview and perspective. The opportunity to work on a diverse team has also afforded me a better appreciation of the interaction between individual social identities and power dynamics in a research ecosystem.

Sometimes, things do not go according to plan. A little over a month ago, the project had a slight hiccup when the Zambian government had to suspend all hospital-based research because of another wave of the COVID-19 pandemic. Data collection had to stop temporarily, affecting our deadlines for specific points in the study. Thankfully, the COVID-19 cases are dwindling, the suspension was lifted a week ago, and data collection has commenced again. Overall, I would say that this summer has been productive and a lot of fun. Through meeting other students,  I expanded my Gillings community. I also explored more of North Carolina. Most of all, I am thankful for a fantastic opportunity to learn and grow my skills through the Gillings Zambia Hub. Now, my only grudge is the swift passage of time because it feels like I started the practicum a day ago, yet it’s been three months and more. Indeed, time flies.

While spending a summer day at Ft. Macon State Park, I couldn’t resist taking a picture of these lovely seagulls.

– Olu

Barreling Towards The End

Posted on by nayavill

My last practicum blog post, I expressed the slow-build experience making connections and forming relationships with the collaborators and community we were bringing together to support my practicum agency, Pitkin County Public Health, in executing deliverables for a grant addressing health inequities for the Latinx population of Roaring Fork Valley in Colorado exacerbated by COVID-19. Since that last post, I feel like the summer’s flown by, as our team of collaborators and stakeholders has barreled forwards towards the grant deadline next week. The experience has been both exhilarating and thought provoking, providing me many experiential lessons I will take forward into my second year of my MPH program and beyond.

First, I gained a greater appreciation for the challenge of balancing community-driven approaches that prioritize human relationships and creating shared spaces, with the logistical pressures and timelines of working within the institutional norms of grant-based financial infrastructure. For example, to support the Spanish Mental Health Media Campaign funded by the grant, we formed a Strategic Planning and Marketing Committee comprised of various community leaders interested and passionate to address the burden of mental wellbeing challenges in the area. While my preceptor and I prioritized ensuring that all members of the group were properly compensated for their time, as the grant deadline drew nearer, I felt the implicit pressure to increase the number of weekly meetings, and expectation for deliverables for the group to complete all campaign materials by the end of the grant period. I feel it can be so easy working within groups seeking to make a positive impact, and united by common values, to take advantage of these positive qualities. My practicum experience has left me reflecting on how easy it can be in the field of public health to succumb to prioritizing white supremacist norms, such as perfectionism, timeliness, and a sense of urgency, in the pursuit to fulfill the requirements of entrenched institutional standards.

However, my practicum experience also helped me gain a greater appreciation for how the field of public health can (and likely should) intersect with a broad range of other disciplines in its application. While I had the opportunity to participate in perhaps more traditional elements of public health work, such as delivering presentations to the state Board of Health, and developing monitoring and evaluation plans, I also was forced to step out of my comfort zone into other disciplines to properly support the efforts I was involved in. For example, I gained a crash course in budgeting and contract development for media campaigns, working with a county marketing specialist to solicit media purchase estimates from radio stations, public bus lines, and Internet spaces. Once our marketing committee had selected its primary forms of delivering the Mental Wellbeing Media Campaign, I coordinated directly with radio management and talent, and local social media influencers, to draft Scope of Work contracts; process media buys, and manage limited grant funds. There were several hiccups in this process, especially learning to navigate county rules around payment structures for contracted work, to be able to properly reimburse the media talent and campaign designers. I feel like I gained a lot of practical knowledge from these experiences, and I was reminded that in the gap between conceptual public health knowledge and the implementation of health promotion interventions and activities, there’s a variety of practical skills and leadership capacities that can be highly relevant. The varied experiences and skills I’ll take from my practicum have reinforced three lessons for me for my future public health practice: 1) to stay creative about the way public health can be combined with other disciplines 2) to continue developing varied skillsets not immediately incorporated in academic training 3) to seek out and value the knowledge and input of “expertise” from non-traditional sources and community leaders.

Also, I feel inspired to continue bringing my guiding value of creativity into my global health practice. I had the chance to bring my visual eye to my practicum in several respects, by creating logos and visuals for the campaign messaging that had been created by the Marketing Committee, and by building the formatting for resource guide for Immigrants and other Latinx families in the area.

It was a joy to help foster a creative space within the Marketing Committee meetings, cultivating an environment where everyone was sharing ideas and building messaging and campaign materials relevant to their own community. This Marketing Team developed a vision for a three-armed campaign, focusing on a local radio station, a local interview show, and social media pages on Facebook created during the pandemic, to direct limited campaign funding to the mediums with greatest reach and impact for the intended audience. I can confidently say these would not have been the mediums chosen by Pitkin County if left to their own devices, and are another example of the power of tapping into the expertise of community knowledge. I was very inspired to see the demographic-specific messaging the group devised for women, men, the older aged, and adolescents, as well as the compelling radio ads they drafted and moving video testimonials they produced. The unifying feature of the campaign the group devised utilized the imagery of a stoplight to encourage destigmatization, preventative action, and seeking help around mental wellness challenges. I honestly think this idea is super clever, and I can’t look at a stoplight now without being reminded to stop and check-in on my own mental wellbeing.

I also met with a myriad of community leaders, service providers, and other stakeholders, to conceptualize and produce a format for a community resource guide that would be inviting, useful, and accessible. Based on this input I devised a system using visual icons to aid in navigation of the guide and decrease the extent to which literacy is a barrier to access, also highlighting key potential barriers to accessing the services in the guide such as cost and documentation status.

 

Most of all though, the biggest thing I’ll be taking with me from my practicum experience are the positive memories, connections, and relationships I was able to form (albeit remotely) with so many wonderful individuals. I feel incredibly lucky to have had the opportunity to meet and become friends with the incredibly talented individuals in the Marketing Committee we formed, and I’m so excited to see all the positive work they produce in coming years.  It was difficult to say goodbye, it was a both a valuable reminder of the importance of the human element of public health work, and refreshing validation of my interest in pursuing a career in global health.

– Bridger

Three takeaways from my summer on TB

Posted on by nayavill

A map of North Carolina on a laptop in Jaclyn's backyard.I finished my practicum last week with the Tuberculosis (TB) Control Program at the North Carolina Department of Health and Human Services (NC DHHS) and wanted to share a few final reflections.

  1. Practica will inevitably change and evolve throughout the summer – but that’s not a bad thing! I originally thought I would be using surveillance data to estimate the prevalence of latent TB infections in the state. However, I was able to come up with a better strategy after consulting with the TB epidemiologist at DHHS. She illuminated some of the issues with the data reporting system we currently have and encouraged me to consult other estimates from the literature. This new direction allowed me to redirect my efforts to interpreting and assessing the quality of available estimates, which is ultimately an important skill for me as a budding “applied” epidemiologist.
  2. Practica can be a great opportunity to network and meet people outside of your normal circles. I got the chance to meet with some health departments from other states that had already done a similar educational outreach project around latent TB infections. It gave me the chance to see how other health departments structure their programs and often collaborate across states. I also got to peak into some of the case-level work that TB nurses do in North Carolina and how that feeds into the larger population-level work at the health department.
  3. Getting creative and taking initiative can help you get what you want out of your practicum. Part of my project involved compiling a list of doctors (called civil surgeons) that are active in providing medical exams for people seeking immigration status adjustment. I wanted to get some practice creating maps and my preceptor was on board, so I took some time to train on Tableau and then create a map of all active practices. This map was useful in presentations I gave to show where these doctors were concentrated, potentially helping to prioritize hotspots for the educational intervention. This map also illuminated that there were “deserts” in the state, where people might have trouble finding a nearby doctor and potentially get discouraged in the status adjustment process.

Overall, the practicum gave me an interesting look into the work that goes into planning an intervention at the state health department and learning how to use my knowledge and interests to potentially add value in unique ways. I am grateful for the opportunity to get some exposure to the government sector and practice some of the skills I’ve learned in the first year of the MPH.

– Jaclyn