Summer 2022 – Page 10 – Gillings Around the globe

Really Remote Research

Posted on July 28, 2022July 27, 2022 by

I spent most of my summer living out on the family farm in Western Nebraska/Wyoming. Here is my favorite hen!

Hi again! As a quick refresher, my name is Joanne, and I am working on my MPH in Global Health. For my practicum, I am working with an interdisciplinary team of practitioners and researchers at UNC Family Medicine and Duke’s Med School (the enemy I know!). We are conducting pilot research in collaboration with the national Respite Care Providers Network, that aims to investigate Medical Respite Care (MRP) for persons experiencing homelessness (PEH). Our ultimate aim is to develop a protocol and collect mixed methods data to investigate the relationship between MRP characteristics and care experience outcomes.

My role over the summer has been as the primary data collector, getting participants to complete online surveys, phone interviews, medical chart reviews, and facility censuses. While I have experience professionally in IT project management, implementation, and training in healthcare settings, this is my first time doing qualitative research with patients, providers, and staff. This is a completely different role for me, as in past jobs I was the one directing others and designing workflows, now I am the investigator looking to learn from the participants. While the people I am interviewing are often suffering from burn out, physical, financial, and emotional stressors, they have all been enthusiastic about actually being asked about their own opinions and experiences. This has made me reflect on how marginalized populations like PEC are so often left out of the decision-making process. I hope that with this work and throughout my future career, I can continue to elevate marginalized voices in healthcare.

Since my work conducting interviews, sending emails, creating spreadsheets, and writing protocols & methods has been all remote, I have been spending quality time out on the family farm in Western Nebraska (10 miles from Wyoming). Surrounded by huge bluffs, crazy sandstorms, grazing cattle, and corn and soybeans, it can feel a little surreal that with a simple internet or phone connection I can conduct national healthcare research. From the farm, I have been working with MRPs ranging from Ohio to California. This has allowed me an interesting look at how quality and types of healthcare can vary so drastically state to state. In California, a state with more robust social services, virtually all patients have state Medicaid that helps cover the cost of MRP treatment. Contrasted to states like North Carolina, that still have not expanded state Medicaid, far fewer PEC have any way to seek care. By shining a light on these disparities, I hope this work can promote calls for action and healthcare expansion nationwide.

The final learning moment of this summer has been around flexibility. Unfortunately, I was not able to collect enough data for analysis by the practicum end date. This was a nice dose of reality that when it comes to getting poorly resourced MRPs and marginalized individuals to participate in research, the investigators need to be flexible and understanding with timelines and commitments. However, I would not trade this experience for a more cut and dry one with more traditional health care settings, since it has allowed me to highlight marginalized peoples and gaps in current healthcare systems.

-Joanne

Sailing into the Semester

Posted on July 27, 2022July 27, 2022 by

Myself and my partner exploring Cccoquan, Virginia

Wow! I cannot believe this is the final week of my practicum. This summer has flown by and I find myself working to finish my final deliverable for the UNC Friendship Bench Adaptation to Improve Mental Health & HIV Care Engagement Outcomes Among PLWH and PWID in Vietnam (VITAL) team. This project is basically a narrative/ literature review summarizing the existing literature on the topic of if/how psychotherapy impacts antiretroviral therapy adherence in people living with HIV. While there is a lot of information and research on the importance of addressing mental health among people living with HIV, there are fewer projects that have specifically looked at the impact on adherence and whether these changes are maintained overtime. I have enjoyed diving into the literature as it has helped me gain a better understanding of the population and barriers to mental health treatment.

I was initially drawn to the VITAL team due to my interest in global mental health and as this practicum draws to a conclusion, I have to say I have learned a great deal about common mental disorders, other comorbidities and how they are bidirectional in nature. This project is especially interesting because in one arm the Friendship Bench intervention is delivered by professional counselors and in the other lay counselors are utilized. This practice of task shifting is of great interest because of the huge shortage of professional mental health providers in many low-and middle-income countries (LMICs).

A short sailing trip on the Piankatank River

As I move into my final year at UNC Gillings School of Global Public Health, I am more confident and excited to gain practical skills that can be implemented in the field. My main takeaway from the VITAL practicum is that while some skills can be taught in the classroom, for the most part, you have to jump in and figure things out. Ask questions and don’t be afraid to make mistakes along the way. At this point, I plan to continue to work with the VITAL team during the upcoming semester and dive more into the results that we have been working to collect during the pilot study.

Cheers!
-Sage

Nepal – I’ll be back!

Posted on July 26, 2022July 25, 2022 by

Me (left) showing my husband the older neighborhoods around where I grew up

I cannot believe that five weeks have already flown by with Nick Simons Institute (NSI). I have learned so much applying my baby public health skills and learning that things are always more complicated in the field. The majority of my time has gone towards the Advanced Skilled Birth Attendant (ASBA) report and associated policy brief. It would get discouraging when – once again – a variable was found to be confounding, or a survey respondent had to be contacted to clarify their response, thus changing all the analysis output. While working on the report, I would pull up old notes from the fall semester, trying to figure out which statistical test was appropriate for the data at hand.

The rice paddy fields as driving into Trishuli

In the midst of the ASBA work, the team took another field visit to Trishuli, a government hospital about three hours Northwest of Kathmandu. It has been designated the subsequential Hub hospital by the government, meaning that it will soon offer a wider expanse of specialist services so that people do not have to travel so far for healthcare. While there, we completed an ad hoc observational assessment to inform a Monitoring & Evaluation (M&E) framework for future like hospitals. We received a tour of the hospital facilities, completed interviews with staff, and surveyed patients. I spent much of my time surveying patients about the quality of care, their perceptions of the services, and their knowledge of the hospital. It was in these conversations that cemented the importance of the ASBA policy brief and reminded me how much of an impact that public health can have.

Looking back, I think that I learned the most during this summer in the small conversations in-between work with my colleagues and supervisors. Now that access to Cesarean section(s) (CSs) is more readily available, the work is shifting towards ensuring quality of care, although that has always been a goal. Conversations with people who have been in this work for decades brings up complexities, what Nepal’s future healthcare will look like, barriers and challenges, and of course, hope. So many people are working hard to make sure all people in Nepal, in the flatlands, the hills, or the Himalayas have quality and affordable healthcare. I was only here for a season, involved with one small project, but I am thankful for that I learned.

In my free time I have continued to polish my Nepali, visit old parts of town, and get back into painting. My favorite way to spend my days off is to walk to an old part of town and sit down at a public square and start sketching. You quickly make friends with kids, who jostle to ask to be painted next. Grandmas pose and remind you not to draw their wrinkles. It is a great way to chat and make new friends. In the end, I give them the painting, and take a photo for myself. I am fortunate enough that my husband has been able to visit and see the neighborhoods I grew up in. He is meeting a lot of family friends and eating even more daal bhat! We are going on a ten day trek before heading back to the states.

My time in Kathmandu is wrapping up after six weeks at NSI, but it isn’t over quite yet. Thanks to the magic of the internet, I will be able to stay in touch with my team and wrap up the evaluation of the ASBA program and its associated policy brief remotely. It is a humbling experience to have the opportunity to contribute to a project that will have real world impacts for policy and healthcare systems.

-Abby