Targeting TB Care Through Civil Surgeon Continuing Education

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Hello! My name is Audrey and I am completing my practicum with the NC Department of Health and Human Services, specifically with the NC Tuberculosis (TB) Program.

Project Details: My practicum focuses on the completing the 4-phase project, “Civil Surgeon Educational Survey and Evaluation on Latent TB Infection (LTBI) diagnosis and treatment.” This project focuses on strengthening the partnership with the community to combat active tuberculosis by increasing treatment initiation and completion of latent tuberculosis infection for those at higher risk of LTBI.

One of the groups that is at higher risk for LTBI is immigrants from countries where tuberculosis is endemic. For example, some countries with a high TB burden include Vietnam, Mexico, and Ukraine. Whenever someone is pursuing a change in permanent resident status in the United States, they must be evaluated by a civil surgeon. Therefore, civil surgeons are in a unique position to address tuberculosis care since immigrants and refugees seeking a change in immigration status must complete a medical examination by a civil surgeon, which includes evaluation for tuberculosis. Civil surgeons are valuable partners in identifying individuals with latent tuberculosis and can be the first line of education surrounding treatment and referral to the health department, if necessary.

My practicum project builds off work completed by former students that assessed NC civil surgeon knowledge of tuberculosis care. The last phase of the project (which I will be completing) is the creation of a webinar that provides civil surgeons with the most updated information on TB and LTBI care.

Selection Process: This practicum role was posted in the Practicum Opportunities Newsletter, which is an email sent to MPH students that includes new opportunities that have been vetted by Gillings. I was looking for a role in the infectious disease space, and one that provided me with a new experience to practice my communication skills. I am a dual-degree pharmacy and public health student, and in my future career I want to feel confident when talking to multiple different people about health topics, including patients and providers. This experience provides me with an opportunity to directly talk to providers about infectious disease prevention!

This experience has already allowed me to work and grow independently as I plan the educational materials for this project. We are planning to hold 3 live webinars to present this information to civil surgeons around the state.

Thanks for reading!

-Audrey

Water, Food, and Climate Change at the Food and Agriculture Organization of the UN in Bangkok

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Hello! My name is Leeann, and I am an MPH student in the Global Health (GH) concentration. A little bit about myself: I was born and raised in Wilmington, Delaware and did my BA in International Affairs with a concentration in Conflict Resolution and a minor in Business Administration at the George Washington University. After I graduated from GW, I did a total 180 and worked in DC for nearly 4 years in business research for the financial services industry. I was always interested in designing resilient food systems since I served as the GW Garden Manager and also researched transboundary water policy and gender inclusivity in resource management at GW’s Sigur Center for Asian Studies.

Me sitting in front of a building in the Grand Palace compound

As a GH student at UNC, I want to dive deeper into the food-water nexus and build my understanding of how it impacts human health, especially against a backdrop of climate change. From outbreaks of diarrheal diseases due to increased flooding to worsened allergy and asthma seasons from longer pollen seasons to rising food insecurity attributed to drought and beyond, climate change has far-reaching impacts on public health. Thinking about public health through a “One Health” lens means recognizing that humans, animals, plants, and the environment are all connected, and the health of one affects the health of all (CDC, WHO).

This summer, I am working with the Water Program at the United Nations Food & Agriculture Organization’s Regional Office for Asia and the Pacific (FAORAP). This small team develops projects on water scarcity and resources management across the entire Asia and Pacific region, which includes 45 member countries. So how does this all tie into public health?

The office sign for FAORAP

Humans not only need clean, fresh water to drink and bathe, but we also need reliable water resources to farm. As climate change creates longer dry spells in some areas and wetter wet seasons in others, current food systems around the world are struggling against effects of global warming and the increasing demand for more and more varied foods. On top of the role climate change plays in communicable and zoonotic disease transmission, it also has dire implications for people’s nutrition statuses. The less food we can grow because of extreme weather events and dwindling or polluted water supplies, the less nourished people will be. The Water Program’s projects at FAORAP are all rooted in agriculture but focus on how member countries can better manage their water resources through methods such as accounting (e.g., assessing and projecting how much water a country currently has and will have in the future, how the water is used and distributed, etc.) and allocation (e.g., distributing and managing water resources across various sectors that use water based on calculated need). By improving water resource management, member countries can “halve the number of undernourished people in the region by improving agricultural productivity and alleviate poverty while protecting the region’s natural resource base” (FAORAP’s mission statement).

In one of my projects, I am developing a partnership between UNICEF and FAO’s offices in Asia and the Pacific to strengthen cooperation between the water for agriculture and water for sanitation and hygiene (WASH) sectors across island nations in the Pacific, Timor-Leste, and Papua New Guinea. The two sectors have traditionally been siloed and this can have negative consequences for water resources management, as the two critical sectors compete for water resources. Instead, this project proposes developing a partnership between UNICEF and FAO To support the priority countries in combining the strengths and goals of their WASH and water for agriculture sectors, applying a participatory approach by engaging water users to build an adaptive capacity to “climate proof” these solutions, and garner support for changes to water policy and regulations.

Photos from work field trip to a farming community north of Bangkok that took a community-led approach to managing water pollution from household waste and improving and diversifying farming outputs

Being in Bangkok has been super exciting. Every day is an adventure to get to the office at Maliwan Mansion along the Chao Phraya river. Bangkok traffic is notoriously bad and the buses run on vibes, not a schedule so sometimes I’ll take a boat to work because it’s faster. So many tropical fruits are in season here, and the street food scene is absolutely unbeatable. The weather has been unbearably hot, but the rainy season is about to come and cool the city down. The diverse architecture of old homes, grand temples, and glass skyscrapers makes Bangkok so unique and so beautiful. It’s been a blast so far, and I’m looking forward to spending more time getting to know this city and embarking on this adventure with FAO. Thanks for reading my blog!

Left: work commute views; Right: a conference room in the UN Economic and Social Commission for Asia and the Pacific building

 

– Leeann

Practicum Experience with the Infectious Disease Epidemiology and Ecology Lab, UNC

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Learning about having to do a practicum to satisfy MPH requirements here at Gillings during the application process got me excited because I thought it was a great way to ease us into public health practice. Little did I know that finding a practicum could qualify as a full-time job! It was definitely an eye opener for what is to come post-graduation. In retrospection, I think the timing was perfect because this was a great way for us to survey the market to see the most desired skills, come back to school afterwards and choose electives that will make us more marketable post-graduation.

I was very picky in the kinds of practicums I applied to because I wanted it to be meaningful to my chosen career trajectory. I nearly got swayed by some of the salaries advertised, but I’m glad they didn’t work out. Considering the series of events that occurred, it was almost as if an unseen hand was directing me right to this moment throughout the process. I think I ended up at the best possible place for me since it closely aligns with my research experience and interests.

 

The Organization:

IDEEL is a cross institutional collaboration of investigators with diverse backgrounds whose work focuses on infectious diseases around the world. Majority of their work is on malaria, delving into transmission dynamics, drug resistance patterns, diagnostic assays and tracking useful biomolecular markers to inform policies surrounding malaria control. I have already learnt a great deal so far from just joining their meetings and learning about their past work.

Having spent just over a week in the organization, I feel very welcome as all the members have been very nice and accommodating so far. The PIs in the organization, despite their busy schedules, have each made the time to connect and get to know me, creating a very inclusive environment that fosters learning and growth. My highlight so far was a potluck event organized at Jordan lake where I got to meet, socialize with and bond over food and games with members of the organization and their families.

 

Practicum Description:

Malaria is a very important cause of morbidity and mortality in sub-Saharan Africa, accounting for hundreds of thousands of deaths every year. According to the WHO, 95% of the 627,000 deaths caused by malaria globally in 2020 occurred in Africa. Given its deleterious effects on pregnant women and their unborn children, the WHO and its collaborators have come up with great strategies to prevent malaria acquisition in this population, primarily based on preventive treatment.

This practicum involves quantitative analysis on data generated from pregnant women receiving preventive antimalarial therapy to ascertain if said treatment is causing antibiotic resistance in certain strains of bacteria residing in their guts. Applying skills learned in my first year of MPH and previous work experience, together with newly acquired coding skills to be able to do the required analysis has been nothing short of exciting.

 

Expectations:

I look forward to understanding how research data is transformed into policies that guide medical practice. I hope to acquire new data analysis and bioinformatics skills relevant to the field, and to expand my network given my interest in infectious diseases in sub-Saharan Africa.

 

-Kofi O.