Category: Summer 2023

CONTINUING GILLING’S LEGACY OF COMMUNITY ENGAGEMENT AND COLLABORATION WITH TRANS WOMEN IN THE DOMINICAN REPUBLIC

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¡Hola! My name is Tiffiany Portacio and I am an incoming second-year MPH student at UNC Gilling’s School of Global Public Health in the Health Behavior concentration. This summer I have the privilege of completing my summer practicum in Santo Domingo, Dominican Republic (DR) along with HB classmate, Sophia Mus.

Tiffiany Portacio (middle left) and Sophia Mus (right) reviewing a study survey with
Dr. Yeycy Donastorg at IDCP.

I am currently working with the Instituto Dermatologico y Cirugia de Piel (IDCP), which is a private non-profit institution, located in the capital city of the DR, Santo Domingo. Their mission is to provide specialized integrated services in dermatology, mycology, leprosy, sexually transmitted infections, among other conditions. IDCP also offers accessible health services and education for the local community. Dr. Clare Barrington, professor and director of doctoral program in the Department of Health Behavior, had established a collaboration with the HIV Vaccine and Research Unit at IDCP, led by Dr. Yeycy Donastorg, nearly twenty years ago. This partnership has served as a pathway for several Gillings students to have completed practica and other research collaborations with IDCP.

Tiffiany and Sophia with team of psychologists at the office of investigations at IDCP.

 

For general public health context, the DR has experienced an epidemiological transition, where the burden of non-communicable disease is increasing, while the country continues to struggle with ongoing burden of infectious disease, including HIV. Populations who disproportionately experience worse health outcomes are transgender women and cisgender female sex workers living with HIV and type 2 diabetes. My practicum experience will support two ongoing applied research studies led by Drs. Barrington and Donastorg focused on HIV and other chronic conditions, including type 2 diabetes and hypertension.

Colonial building on the notable street, Calle El Conde.

The first study is to develop a model of integrated care for HIV and noncommunicable diseases, specifically Type 2 diabetes and hypertension, tailored for cisgendered female sex workers. The other study will determine preliminary efficacy of a multilevel intervention (called GAP – Gender Affirming Abriendo Puertas) to improve HIV outcomes among transgender women by reducing stigma and increasing social cohesion as well as provide insight into the use of sequential implementation at the individual and community levels. My two practicum deliverables, which will support each study respectively, will be to conduct qualitative interviews with healthcare providers who work on HIV and/or noncommunicable diseases and to develop a detailed plan for monthly community support sessions to guide implementation of the community engagement component of the intervention.

It has been about a week since Sophia and I have arrived to Santo Domingo, and I believe we have acclimated quite quickly. We both are fluent in Spanish and have traveled extensively throughout Latin America. Nonetheless, novelty fills our day – from getting familiarized with new vocabulary and the neighborhood, to taking public transportation and the general pace of life. The team at IDCP have been incredibly sweet and accommodating both in and out of work. In just a matter of a couple of days, they have dedicated many hours to proofreading and providing feedback for an important survey we have been working on in RedCap, which will allow us to jumpstart on our practicum deliverables. I have done data entry work on RedCap before, yet this is the first time I have dived into the deep end on this software and it has been quite exciting to be able to dissect questions and think of more efficient ways to gather data while still capturing key measures. It has also been especially rewarding to be able to implement survey method skills, with my favorite so far being thinking through and executing code for branching logic. Outside of nerding out to study intervention logistics, many of our colleagues have also made themselves available to give us a tour around the city and even take us out to do a beach-front Zumba class!

We are lucky to live right in the middle of the colonial city in Santo Domingo. Sometimes I find it hard to wrap my head around the history that is dripping from every corner of the city – from the first church and hospital built in the new world to Christopher Columbus’ son’s living quarters just around the corner from our apartment. It is wild to know that in the shores of this island is where the cancer of colonization in the new world would set its foundation to then metastasize its turbulent and bittersweet fate onto the rest of Latin America. The effects of this on the health of populations across the region are seen to this day. However, that is an idea I hope to explore on my next blog entry.

As a pastime and coping mechanism against the infernal summer heat, I have taken it upon myself to jot down intriguing typical sayings colleagues and neighbors have shared with me. The Dominican culture is rich in expressions and idioms that reflect the culture and people’s values, humor, and outlook on life. One that I will leave you all with, which has been sitting on my mind lately as I have commenced my practicum experience, is “El que busca, encuentra”. This saying translates to “She/He who seeks, finds.” It highlights the idea that effort and persistence can lead to successful outcomes and, to me, symbolic of my time here. Although I am working in a new country and with a population I have not worked with before – I seek to learn and, collectively, define and reach success for all parties involved.

¡Hasta pronto!

– Tiffiany

Let’s Start Now: Social Innovation as a Slow, Deliberate Process

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About two weeks into my fellowship at FHI 360, I had the opportunity to participate in an event series on innovation from FHI’s Strategy and Innovation Office. The series was designed to engage external innovation practitioners to inspire discussion about innovation culture as FHI sets out to develop an innovation strategy. Kippy Joseph, Senior Advisor to the Global Innovation Fund, spoke extensively about managing innovation for development impact. As a global public health student pursuing the Certificate in Innovation for Public Good (CIPG) at UNC, I often ask myself how social innovation in global development is held accountable. While drug trials adhere to rigorous standards, social innovation for impact often relies on guesswork, hindering progress in advancing the public good. It is imperative that managing innovation for development impact becomes a constant pursuit of excellence in designing impactful systems worldwide, even if the process may be slow or deliberate. The cost of getting it wrong is simply too high.

Sometimes, the field of global health fails to redesign systems solely because one solution has worked temporarily (often for at least 30 years), even when it does not achieve maximum impact. The innovation space for certain diseases is limited or not challenged enough.

As an FHI 360-UNC Global Health Research Fellow this year, I have the privilege of supporting the Total Quality Leadership and Accountability (TQLA) team within the West Africa and Middle East Regional Office (WAMERO). TQLA, FHI’s innovative and adaptive management approach, has demonstrated its ability to drive performance, enhance implementers’ accountability at all levels, strategically prioritize local solutions using data, and ultimately address development challenges to improve outcomes. As a research fellow, I will be responsible for documenting TQLA’s impact over the years, starting with the evidence generated from its application to the Global Fund’s National Aligned HIV/AIDS Initiative (NAHI) in 13 states in Nigeria. The evidence we gather will be instrumental in developing technical guidance for strengthening local organizations’ capacity. It will be widely disseminated to catalyze policy dialogues centered around strengthening the leadership and capacity of individuals in Nigeria and other regions. Additionally, this evidence will contribute to creating technical tools to promote social innovation and learning, transparency, and accountability, and foster local leadership and ownership in health development assistance.

As an innovation strategy, TQLA is spearheading greater accountability within social innovation to reduce guesswork in our approach to global development challenges, including global health threats like HIV/AIDS. I would like to thank my preceptor, Dr. Robert Chiegil, for the opportunity to be part of this team and to experience the importance of accountability in social innovation and policy.

-Sena Kpodzro

My Practicum with Casa Alitas in Tucson, AZ

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Hello! My name is Quintin Van Dyk and I am an MPH student in the Global Health concentration at UNC Gillings. I grew up in Northern Arizona and completed my bachelor’s degree at Lewis & Clark College, where I studied biology. One of my main interests within public health is at the intersection between migration and health. This interest is in large part motivated by my upbringing in Arizona, where I saw firsthand how migrants in my community encountered barriers to accessing health services and experienced lower quality healthcare than the general population. As I continue studying public health at UNC, I hope to further develop my understanding of migrant health and the barriers facing migrant populations in our country.

A few weeks ago, I returned to my home state where I am currently completing my MPH practicum by working with Casa Alitas in Tucson, AZ. Casa Alitas is a humanitarian aid organization dedicated to supporting and providing shelter to migrants and asylum seekers. The organization has a network of shelters and hotel spaces in the Tucson area where people can come after they have been processed and released by U.S. Customs and Border Protection (CBP). Casa Alitas’ mission is to prevent street releases of asylum seekers by CBP, something that has been a huge problem in other U.S. border communities like El Paso, TX.

In the two-and-a-half weeks that I have spent here so far, I have already learned a lot. I have been splitting my time between an ongoing research project and working on the floor in the shelters to help provide the guests with food, clothing, and to assist them with their travel arrangements. I have met people from all around the world, including folks from Mauritania, India, Brazil, Colombia, Nicaragua, Guatemala, Mexico, Ecuador, Bangladesh, and many more countries. I have unfortunately heard many sad stories of family separation and violence that our guests have experienced during their arduous journeys through the Sonoran Desert. I have also learned more about the different global factors that force people to migrate, from climate change to political unrest and violence.

Last week, I was fortunate to have the opportunity to participate in a migrant health service-learning trip that was organized by the UNC School of Medicine. I joined a group of 12 people including medical students, public health students, medical residents, and a Family Medicine physician. Together, we volunteered at Casa Alitas on projects including creating art and decorations for the newest shelter, hanging clotheslines for the guests to dry their clothes, and creating a medication catalog for the medical staff. We also volunteered with other local humanitarian aid organizations including Tucson Samaritans, Green Valley Samaritans, and Humane Borders. With these organizations, we went on trips into the desert to see the border wall, check on water-drop tanks, pick up trash and left behind migrant belongings, and offer food and water to anyone that we encountered in the desert.

Seeing the border wall in person was an intense and impactful experience, not just because of its size but because of what it represents. The wall is about 30 feet tall and stretches across 190 miles of the Arizona-Mexico border. I was struck by the contrast between the beauty of the Sonoran Desert and the inelegance of the border wall built on top of it. The wall has created a lot of trash and discarded pieces of steel that lie cast into the sand on the American side. It is a manifestation of American immigration policies, which have evolved to make crossing the border increasingly difficult and dangerous for people across the globe, especially those coming from countries like Cuba, Venezuela, Nicaragua, and Haiti. The woman who led our trip to the border wall had a powerful quote that resonated with me, describing the wall as “a scar on the environment and a scar on us as people”.

Overall, I am really enjoying living in Tucson so far and am thankful for the opportunity to work with Casa Alitas. I have already become fond of the amazing Mexican food, endless hiking trails, and incredible sunsets that make southern Arizona famous. Moving forward, I will be spending more time working on a research project to better understand the impact of immigration policies like Title 42 on migrants and asylum seekers attempting to cross the border. Thank you for reading my blog!

– Quintin