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

Behind the Numbers: Using Data

Me (back & center) at Trivia Night at Vecino
Me (back & center) at Trivia Night at Vecino

Howdy! My name is Ana Jafarinia and I am a current MPH student in the Global Health concentration. Before coming to UNC, I actually got my BS in mechanical engineering and worked in a corporate setting. Through a winding and unconventional road, I began to realize that my career trajectory was not one where I would find fulfillment or purpose. I made the decision to make a big switch and I am so grateful that Gillings gave me the opportunity to do so. The first year of my program has been delightful. As someone who is new to public health, I have enjoyed being introduced to new fields, new people, and new ways of thinking.

But the engineer in me still lives on! This past year, my love of numbers has continued to guide my work, albeit in a different discipline than I thought. One of the ways that I have used math and science in public health is through statistics. I really enjoyed Data Analysis for Public Health (SPHG 711), one of the first semester MPH core classes that we take. I decided to further develop those skills in my second semester by taking Working with Data in a Public Health Research Setting (BIOS 669). I learned how to use SAS to perform data manipulations.

My love of data is how I ended up finding my practicum. Dr. Ilene Speizer had a colleague in Pakistan with survey data that he wanted to make sense of. Ilene, knowing that I was passionate about statistics, asked if I would be interested. I am incredibly grateful to have been welcomed to Dr. Adnan Khan’s team at Research and Development Solutions (RADS). The Pakistan-based research and evaluation group conducts rigorous analysis using multiple data sources to identify health issues in Pakistan and advocate for evidence-based policies. One of the biggest priority areas for them is Family Planning. The government of Pakistan has expressed a commitment to raising the contraceptive prevalence rate (CPR) to 50% by 2025. However, through past research, RADS has found that Pakistan’s CPR has stagnated around 30- 35% since 2007. Additionally, 1 in 4 married women of reproductive age in Pakistan experience an unmet need for family planning. My research will help generate more knowledge on the experiences of women who have an unmet need for family planning to hopefully advocate for effective policy solutions that meet those needs.

Printed observation from the Pakistan Social And Living Standards Measurement (PSLM) Survey
Printed observation from the Pakistan Social And Living Standards Measurement (PSLM) Survey

Doing quantitative research comes naturally to me. I love using the numbers to identify trends and associations. What is more difficult is seeing the numbers as individuals. The data I am using comes from the Pakistan Social And Living Standards Measurement (PSLM) Survey, which collects information on social indicators from households at the national level. The roster of all individuals represented by the dataset has 175,690 rows. I have used large datasets like this before, but often it is dummy data that is generated for classroom use. While looking at this data, I have tried to challenge myself to see each row not as a number but as a person with unique experiences.

For example, I was trying to identify the number of married women of reproductive age in each household. I decided to look at a certain household with more than one woman of reproductive age to get a better picture of what these households might look like. For household code “7301200104”, I found that one couple lived with their three children, as well as their son’s wife and four grandchildren.

Andi, Kate, and I (left) eating yummy pasta at Tesoro in Carrboro
Andi, Kate, and I (left) eating yummy pasta at Tesoro in Carrboro

I am naturally curious about other people and their experiences. I love meeting all different kinds of individuals and asking them about their lives. I would love to know more about this family and their relationships with one another. Unfortunately, the nature of quantitative research means I will never know the whole story for this one group. However, having that perspective and remembering what lies behind the numbers will help me as I conduct my analysis. While we must identify trends and work with the numbers we have, we must never simplify one person’s story into a group of variables.

Outside of my practicum, I have been spending the summer with my roommates Kate (Health Behavior concentration) and Andi (Maternal, Child, and Family Health concentration), as well as my church family at Love Chapel Hill. I have also been hosting the trivia for Vecino Brewery in Carrboro on Wednesday nights at 7pm. If you are local, please come by and play a couple of rounds!

Thanks for reading and until next time!

-Ana