Category: 2021 Summer Blogs

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

Leveraging monitoring and evaluation for strong water, sanitation and hygiene programs in India

Posted on by nayavill
At the shoreline of a beach.
Taking some time to visit the coast

Happy Summer! My name is Katie Hammer a current MPH candidate at the Gillings School of Public Health, concentrating in Environmental Health Solutions. Before beginning my studies at UNC, I worked for three years at Abt Associates as a member of several health system strengthening project teams. I discovered the water, sanitation, and hygiene (WASH) sector while working as a Monitoring and Evaluation Analyst on a $150 million USAID- funded private health sector project. Through our work, I began to see how poor WASH infrastructure and systems impacted all areas of public health, from maternal and child health outcomes to the spread of infectious diseases like malaria and cholera. I quickly realized this was the area I wanted to specialize in moving forward. It’s actually part of the reason I chose to study at UNC – I couldn’t miss out on the opportunity to learn from and partake in The Water Institute’s great work!

Working as a Monitoring and Evaluation Analyst also taught me the value of data. I managed the project’s monitoring platform, Newdea, for 11 field countries and 3 core teams, ensuring the project had a high-quality data monitoring system. I empowered country teams to look across their past data to find trends and patterns through effective data management. I fell in love with working with teams to facilitate data-driven implementation and impact.

As part of my practicum, I will have the opportunity to build on those experiences. I’ll have the privilege to partner with Gram Vikas, an Indian NGO, Gram who has been operating in the Odisha district in Eastern India for the past 50 years. They partner with rural communities to enable them to lead a dignified life by building their capabilities, strengthening community institutions and mobilizing resources. Gram Vikas has been working to understand the piped water supply and sanitation infrastructure as well as the institutional systems for community ownership and management of the systems since 1997. Their hard work has culminated in massive amounts of data, over 40,000 households worth.

I will collaborate with Gram Vikas and The Water Institute at UNC to evaluate their piped water and sanitation interventions for sustainability and impact. We will also look into how other variables are impacting these sanitation systems. We will be using local rainfall data, Indian Census data, and Odisha’s State of Environment data to get a broader picture of Gram Vikas’ impact.

Two computers full of data looking out into the Carolina sky.
Office with a view

I am excited to learn how to use new analysis processes to get more in-depth insights into programmatic impact. I am particularly interested in learning more about the use of geospatial analysis when manipulating large datasets. I hope that through these analyses, we will be able to provide Gram Vikas valuable insights that will inform their work for years to come! I am deeply grateful to both Gram Vikas and The Water Institute at UNC for this opportunity. This practicum wouldn’t be possible without The Water Institute at UNC, as the expertise this institute provides was key in making the connection for this practicum.

Katie