Growing up in a rural mining town is where I founded my love for tall mountains, helping others, and baking. Here, and through my youth group, I also developed my want to make positive change – which ultimately led me to public health (in steps Gillings School of Global Public Health). Environmental health has remained my focal point due to my interest in our connection with the environment and from witnessing poor health outcomes due to environmental contamination from mining in my hometown.
Therefore, this summer, I am lucky enough to be able to expand my skills and knowledge in project design and implementation for my practicum through working on the Healthy Homes Program redesign with the Orange County Health Department, Environmental Health Division. I am helping to create and pilot the new Healthy Homes Program redesigned to identify and address all home hazards such as lead, mold, allergens, asthma, carbon monoxide, home safety, pesticides, and radon. This includes creating a job description for the Healthy Homes Director, developing policy and procedures, and going through and comparing all the resources and data from the previous Orange County Healthy Homes Program.
In addition to the task and work assigned to the Healthy Homes Program redesign, I have been able to shadow and attend environmental health home and site visits for wells, septic systems, new home or addition builds, soil sampling and testing, and pool permits. Thankfully, I have also been able to attend emergency management preparedness visits to the emergency operations center which was a great experience because I have been taking emergency management courses through UNC and have an interest in disaster preparedness. During the site and home visits, I have also been able to see the health inequities and health equity issues across Orange County.
From this practicum experience I hope to gain skills and knowledge on designing a robust health program (which I have already been exposed during first two weeks of work), steps for implementation and how to pilot a program, and what measures are taken to evaluate the program. I have already gained valuable knowledge on well and septic systems, home hazard prevention, health equity issues and barriers, and ways to mitigate environmental hazards that will be useful in both my life and professional career. I look forward to the remaining skills and knowledge I will gain and the people I will meet throughout the summer. I am also excited see the job post for the Healthy Homes Program Director vacancy.
Mitch on site of the new Cancer Center at Kamuzu Central Hospital
May has been a whirlwind of a month! Between finishing up final projects, work commitments, and packing my bags it was a bit of a stressful start. Nonetheless, I caught my flight out of Raleigh to begin my 13 weeks abroad. And since submitting my last assignment of the semester during a layover at the Addis Ababa, Ethiopia airport, I have been able to primarily focus on my practicum!
I am completing it with UNC Project-Malawi for 8 weeks in Lilongwe, Malawi. I will then travel to Nairobi, Kenya for 5 weeks as a Peacock Fellow with Carolina for Kibera (CFK) Africa in Kibera – one of the world’s largest informal settlements with population estimates of 250,000 to 1 million people, living in less than 1 square mile.
Even before our classes began last August, I have been looking forward to the practicum as an opportunity to apply skills from the classroom in the “real-world” and help me figure out my initial career goals. Since I am a Registered Nurse hoping to maintain clinical skills but also with interest in bigger-picture health systems strengthening, it is important for me to spend time in different settings around the world to determine how I can be effective in the huge field of “global health”.
Thankfully, the staff at UNC Project-Malawi and CFK have all been welcoming and encouraged me to identify areas of interest to explore. This is amazing but also difficult since I have so many interests. For my time in Malawi, I decided to focus on a few areas: clinical care, community health, and assisting on qualitative data analysis. I also am hoping to further strengthen a growing relationship between the UNC School of Nursing, UNC Project-Malawi, and other partners here such as the Kamuzu College of Nursing.
The data analysis that I am supporting is in relation to perceptions of cancer care in Malawi. I’ll specifically focus on the perspective and needs identified by healthcare workers in oncology. Therefore, some of my “clinical” time is spent observing and assisting in the newly constructed cancer center. My other primary focus is in the Intensive Care Unit (ICU) supporting staff and leading Continuing Professional Development (CPD) sessions.
Mitch leading an educational session with nursing students and ICU nurses in Kamuzu Central Hospital
To gain further context for data analysis and understand more of Malawi’s health system, I expressed interest in community health activities. Thus far, I went with UNC Project-Malawi’s community outreach team to deliver nutritional support to Dzama Orphan Care and School and participated in a course at Kamuzu College of Nursing focused on gender equality and gender mainstreaming.
We discussed representation of men and women, for example in government. Some of the Malawian students expressed that they thought of the U.S. as a leader in gender equality, so were surprised to hear that women only hold 27% of seats in Congress and approximately 31% at the state/local level. Conversely, Malawi has elected a woman to be president, Joyce Banda in 2012, while the U.S. has not. We all agreed there is much more work to do toward equity around the world.
Similar agreements have been reached in the clinical setting when I have been looked to as an expert since I trained in the U.S. I share my perspective but am quick to remind colleagues that I am only just beginning to learn best practices for provision of care here in Malawi. From the CPD sessions, I have recognized that knowledge gained in nursing education here is quite similar to the U.S., there just aren’t always as many resources available in the hospital, and there are systemic influences across the continuum of health, illness, injury, and care delivery, which negatively affect outcomes.
These systemic factors are what I’m most interested to learn about since they must be addressed if health outcomes are going to improve. It is honestly quite overwhelming to think about them though.
I’ve been reflecting on when I studied to become, and worked as, a nurse – I personally found it to be straightforward. Generally, we knew what to do in the hospital. And I felt that I was relatively good at it. Working in global health seems so different to me, because I often have no idea what needs to be done on a systems-level. Things are overwhelmingly complex and it seems there is not often a straightforward solution.
It’s so easy for us to criticize a system and identify issues and needs, especially from a classroom, or coming into a setting with lower-resources than we’re accustomed to working with. It seems much harder, though, to identify and implement effective and appropriate solutions.
In feeling overwhelmed, I have been reflecting on a quote from the late Dr. Paul Farmer (co-founder of Partners in Health) about what kept him motivated to work in this field. He said, “Doing hard things with friends.”
Mitch with UNC Project-Malawi colleagues: nurse-researcher Agatha Bula, PhD, MPH, RNM (center) and country director Innocent Mofolo, MSc (left)
Although all careers have challenges, I am lucky that in nursing I personally found a handful of “easy things.” All I can see right now entering global health is a whole lot of “hard things” and I have been caught up these last few weeks by focusing on the overwhelming challenges we face. Perhaps I need to begin focusing more on the other half of Dr. Farmer’s quote though; doing these hard things with friends. Because this is indeed when we can make progress, and I am inspired to do so with the amazing people I have met working here in Lilongwe. I hope that with these new friends, I can continue to learn, take on hard things a little at a time, and move together toward a more equitable world.
Standing in the university’s Quadrangle: a Tudor Gothic Style building made from local limestone. Fun fact: the university was founded by a Royal Charter from Queen Victoria as one of three Queen’s Colleges in Ireland!
As home to the largest Irish-speaking Gaeltacht in the nation, Galway has proven to be an ideal place to learn the Irish language. While my vocabulary is currently limited to bruscar (trash) and leithreas (toilet), I can thank my colleagues at the Health Promotion Research Centre for teaching me the slang that really matters:
what’s the craic? (what’s happening?)
The Health Promotion Research Centre (HPRC) is housed within the National University of Ireland, Galway (known now as Ollscoil na Gaillimhe). As a designated WHO Collaborating Centre, you can imagine that the reach of the HPRC spans globally – it also happens to be the only one of its kind in the entire country! I’ve been surrounded by some of the top health promotion researchers in Europe and welcomed with open arms and lots of tea!
My practicum consists of two primary projects: the first of which is the development of an advocacy tool for the incredible on-campus Student Food Pantry, and the second of which is the pilot report for the Health Behavior in School-Aged Children survey (HBSC – yes, another 4-letter acronym that starts with H). The HBSC survey is a WHO collaborative cross-national survey that is administered in 51 countries every four years and includes measures around (but not limited to) bullying, planetary health, and sexual behavior – all of which are used to inform policy and practice in Ireland. The final National Report will look something like this.
Fun fact #2: the Claddagh ring originated right behind me. Not pictured in the river are the baby swans (cygnets) who have been the talk of the town as of late!
To my luck, 2022 happens to be an HBSC year. Markers, parcels, and rubber bands fly across the room as we package and mail hundreds of surveys to primary and post-primary schools ranging from the rural countryside of Leitrim to the bustling cityside of Dublin. While I’ve begun to develop an understanding of Ireland’s vast geography from traveling up and down its rugged coasts and islands, I’ve gained an even better idea from being part of this mailing process. Who would’ve thought? The only complaint I can muster is trying to understand the Irish education system as an American: Class v. Year? Post-primary v. Secondary? Transition Year? Leaving Cert? I’m confused but trying.
Galway itself is a breathtaking and charming medieval city steeped in fascinating history and surrounded by lots of water. I firmly believe that the best way to understand the nuance of a city is to turn to its local art scene – and Galway is teeming with it: from ukulele flash mobs in the city centre to Seanchai sessions (ancient Irish storytelling) to modern Irish films (An Cailín Ciúin – highly recommend) to short plays at the National Irish language theatre – I am soaking it all in (and speaking of soaking, I’ve developed another layer of skin from cycling hundreds of kilometers through the rain and wind). The fastest city river in the continent, River Corrib, runs directly through the heart of Galway, along the Claddagh, and into the Atlantic (which is silhouetted by the gorgeous Burren Mountain range). This is often used to explain the charged energy harnessed in its people and translated into its charming and lively cobblestone streets.
I could get used to my bedroom window view!
In my short time here, I’ve heard multiple people refer to Galway as a magnet: no matter how far away you go, some internal force always brings you back. I have a feeling I might become yet another example of this!
