Hi Everyone! My name is Tessa Carovich and I am a PharmD/MPH dual degree student. For my summer practicum, I am spending time on the Red Lake Reservation in Northern Minnesota with the Indian Health Service (IHS) doing both public health and pharmacy work. Over my past two weeks here, I have spent time getting to know what the reservation has to offer and getting background on the community that I am serving this summer. The Red Lake Reservation is north of Bemidji and has the tribal government located on it, an IHS Hospital, which the community utilizes for their healthcare and pharmacy needs, and multiple powwow grounds. English is considered a second language on the reservation as many members of the community speak Ojibwe, preserving the tradition and culture of the tribe. A unique part of the Red Lake Reservation compared to the other reservations in the area is that it is “closed,” meaning that few people who are not tribal members live on the reservation. Due to the “closed” status, the tribal government can limit who lives or visits. Because of this, the state courts and government have no jurisdiction on the reservation, and everything is run by the Tribal Council and Federal Courts. Another interesting aspect of the Red Lake Reservation is that it is considered a “dry” reservation meaning no alcohol is allowed to be sold, consumed, or had while on reservation grounds.
Red Lake Indian Reservation sign along the freeway when crossing into reservation land.
Since alcohol is not allowed, it has led to a major drug problem on the reservation. It is known in tribal communities that syphilis and hepatitis c are very common among drug users. To help mitigate the problem, kits are made within the pharmacy at the hospital to be handed out to community members. The kits include needles/syringes, a sharps container, a tourniquet, and condoms. Along with the kits, Narcan is also readily available to be handed out. Community members can come into the pharmacy to pick up the kits and/or Narcan. There is also a walk-up harm reduction clinic set up once a week on the reservation for people to come to. During the summer months, there is a community van that will drive the reservation also providing these same services along with a syringe exchange program. By going out in the van, it allows us to reach the more remote areas on the reservation and provide education to the community members. I am excited to continue immersing myself in the culture here and make a difference among the community.
The fight against Tuberculosis Tuberculosis (TB) is an infectious disease that continues to adversely affect lives globally. A major cause of ill health, it continues to be the second leading cause of death worldwide after coronavirus (COVID-19)[1]. Despite TB being a preventable and curable disease, over 10 million people contract TB every year1. Thirty high-burden countries account for 87% of the total TB cases, and a total of 1.3 million people died of TB in 2022 alone[2]. Continuous global efforts to fight TB have saved an estimated 75 million lives since the year 20002. Sustained funding to support research and innovative solutions are required to accelerate the fight against TB.
The TB Data, Impact Assessment and Communications Hub (TB DIAH) project, funded by the US Agency for International Development (USAID), is a cornerstone of the Agency’s Accelerator initiative to enhance existing TB data and knowledge sharing and to strengthen national TB programs worldwide[3]. The project supports governments, policy makers, and program stakeholders with the generation, analysis, communication, and use of accurate, quality data for decision-making and scale up. Furthermore, TB DIAH provides the technical know-how to ensure optimal demand for and analysis of TB data, appropriate use of that information to measure performance and to inform national TB programs (NTPs)[4]. From the Performance-based M&E Framework (PBMEF), to assessments, to data dashboards and other resources, TB DIAH offers a range of data-based tools and frameworks to help improve tuberculosis programs worldwide4.
Global with Gillings For over 100 years, the Union World Conference has brought together different stakeholders working to combat TB across the globe. These include the different ministries of health, and government agencies, researchers and academicians, funders, implementing partners and private sector. The forum provides a great opportunity for all stakeholders to showcase results outcomes, initiatives of evidence-based research and practice for prevention, treatment, cure, innovation and beyond in the fight against TB. After two years of virtual conferences sessions due to COVID, the four day-long Union World Conference on Lung Health, 2023 was held in-person between 15th – 18th November in Paris, France. With funders, implementers, policymakers, patient advocates, decision makers, bilateral agencies, and other industry stakeholders all under one roof, TB DIAH made a strong presence by highlighting the incredible work done to build and strengthen TB data use in national TB programs across different geographies from the 24 USAID TB priority countries.
Along with the TB DIAH team, I had the good fortune to attend and participate in this year’s Union World Conference on Lung Diseases. I have been supporting the project with the conceptualisation, design, and technical content development for a TB M&E eLearning course to build the capacity of professionals working in national TB programs (NTPs) on M&E of different programmatic and clinical TB indicators. The course will support understanding of TB M&E and surveillance systems and explore how USAID’s PBMEF, which provides standardized, high-quality indicators, can improve the generation of quality data, and support the analysis, interpretation, and use of that data to inform programming, identify gaps, and strengthen the overall system. With dedicated time allocated for the information session at the booth, conference participants stopped for an engaging discussion on upcoming eLearning courses, and PBMEF, with the team. During the conference days, I supported these information and knowledge sharing sessions at the USAID booth, where the project team highlighted TB DIAH’s work on the (PBMEF) and TB M&E eLearning modules.
TB DIAH – UNC team and partners at the conference
Experiential Learning After months of focusing on critical public health issues affecting the world, learning about cultural humility, and practicing research methods and measures, participating at a world conference which focused on tuberculosis, was truly an experiential learning opportunity. It was a firsthand experience of witnessing evidence-based interventions that were implemented in different health settings across the globe being showcased at a forum where funders and implementers, researchers, physicians, and decision makers were all under one roof. Partners, innovators, and implementers shared best practices and innovative solutions that showed tremendous impact in increasing access to TB services across TB high burden countries. Sharing space to showcase the ongoing work on the TB M&E eLearning module, engaging in knowledge sharing sessions, and getting feedback from fellow participants on our work, was exciting.
It gave a diverse exposure to the progress towards TB elimination in the world, discover breakthrough AI based solutions to improve TB detection and simultaneously cross learn from other public health researchers and practitioners. Furthermore, I took back the experience of sharing a common space and goal with the TB DIAH team and partners, former colleagues, new associations, and stalwarts in the field of Tuberculosis – all wrapped up in the backdrop of the City of Lights: Paris.
I am grateful to my supervisor Ms Ann Marie Fitzgerald for her constant encouragement and support. A big shout out to an amazing team-Rebecca Cornell Oser, Meredith Silver, Bridgit Adamou, Margie Joyce, David La’vel Johnson, and Darrell R Keyes without whom this experience would have been incomplete.
I am both grateful and excited as I continue my journey in Global Health!
[2] 10 facts on tuberculosis. www.who.int. Published October 26, 2022. https://www.who.int/news-room/facts-in-pictures/detail/tuberculosis#:~:text=About%20one%20quarter%20of%20the
This summer I had the opportunity to spend my practicum working with Ipas Latin America and Carribean, supporting abortion access in Northern Mexico. Though this was a completely virtual practicum it was still undoubtedly an international and cross-cultural experience. The team I worked on included members from Nicaragua, El Salvador, Mexico and Peru. As I mentioned in my first update, the biggest challenge of my practicum was working in Spanish. This was my first professional experience that was completely in a second language. It was an immense challenge to communicate complicated analysis ideas and navigate team dynamics. This experience gave me a newfound depth of respect for those that primarily work in their second language and a greater understanding of the immense advantage that native English speakers have in a world where English is considered the primary language of business.
I spent the second half of my practicum analyzing the existing evidence and writing a report on the ways in which Ipas can support abortion access along the Mexico-US border. It was interesting learning about how the different political and social environment on the Mexican side of the border influenced the needs of those communities. My pre-existing expectation was that my report would focus on meeting the needs of American’s crossing the border to seek abortion access. However, I ended up pivoting the focus of my report to addressing the needs of migrants from Central and South America that have been waylaid at the border due to US policies such as “Remain in Mexico.” This experience was eye opening as to the way different policies compound to negatively impact vulnerable populations.
Overall my practicum was a very valuable experience. Though I didn’t love working remotely, it did provide me an opportunity to work on an international team that I might not otherwise have had. I decided to take an ArcGIS course this semester in the hopes of being able to build skills in resource mapping that may be of use to organizations like Ipas. Through what I learned in my practicum I hope to build skills and experiences through my second year of my MPH that will make me more valuable to organizations like Ipas working in the reproductive justice and abortion access space.
Paddleboarding at Jordan lake.In my free time I got into sashiko-inspired embroidery.
