Data Analysis and Advocacy Storytelling: Occupational and Environmental Health of Fishermen Communities in Salvador, Bahia Brazil

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Oí gente (Hello, everyone!). My name is Jaquayla Hodges, and I am an approaching second-year MPH student at UNC Gillings School of Global Public Health in the Applied Epidemiology concentration. Within my public health career, my main foci are health inequities that exist across the African Diaspora, Latinx, and rural communities.

My first day on the campus of Universidade Federal da Bahia at the Institute of Math and Statistics.

 

A plate of traditional Bahian food from a Candomblé fest following a celebration of the Orixá Xangô.

This summer, I began working with the Entre Mares Research group based in Salvador da Bahia, Brazil for my practicum. Our project was created following a mysterious oil spill that occurred in 2019 along the northeastern coast of Brazil. The team sought to analyze the effect of the oil spill on the fishing industry and communities of Salvador da Bahia, Brazil. Salvador is an incredibly historic city in the Brazilian state of Bahia. It has strong association of Portuguese colonization in Brazil and dark involvement in the Trans-Atlantic Slave trade. The detrimental effects of slavery are still seen socially and economically, especially in low-income and Afro/Black communities. Fishing communities include many people who work multiple jobs to support their families.

I love churros and stats!

The 2019 oil spill highlighted the disparities that existed within Salvador. Fishing communities are an important piece of the growing economy in the area. In Salvador, the ocean is everything. It sources seafood for their traditional dishes like Moqueca (seafood stew), unifies people across all socio-economic backgrounds on the beach for a day of relaxation, and is honored through the practice of Candomblé (an Afro-Brazilian religion of Orixá worship). These small-scale businesses prioritize the use of artisanal workers and contribute to more sustainable modes of fishing.

The first month of my work involves data analysis of responses collected from a questionnaire distributed by the research team of fellow UNC and Universidade Federal da Bahia professors and students. Though most of this experience has been through virtual and in-person meetings with the team, I have actively made efforts to engage with the fishing communities and Bahians daily. This practice is an important aspect of data collection and sharing. Epidemiology is often depicted as an independent aspect of public health; however, it is important to interact with and understand the lives of the people you observe for studies.

A community (comunidade) near the Bahia Museum of Modern Art in Salvador. Some people in the community fish for profit.

Current approaches to data analysis asks the questions: Who were affected by the spill (demographics including gender, socio-economic status, etc), What mode of exposure (skin, respiration, consumption) has been most frequent and may cause the most adverse health implications? At the moment, I am creating a table for the demographics of each region of the collected data to further determine inequities. My team consists of Universidade Federal da Bahia undergraduate students who work alongside Dr. Veronica Maria Cadena Lima. I assist the team in approaches to data analysis. Currently, I am observing a cluster analysis done to determine which mode of exposure has the most adverse health outcomes. This has been my favorite part of analysis so far! Results from this analysis will help protect communities from future occupational and environmental disasters.

The Entre Mares Research Group has grown to observe, engage and protect fishing communities in Salvador, and other affected communities in northeastern Brazil. Soon I will travel to Conde, another community in Bahia that has been affected by the spill. Conde is one of the areas that I am observing the data. This experience helps solidify the reality of the data we analyze apart from those involved. I am forever thankful for the opportunity to engage and collaborate with these passionate communities.

 

 

 

 

 

 

 

 

“Ádh mór na Gaeilge” – The Luck of the Irish

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“Dia duit ó Éirinn” – Hello here from Ireland! As I embarked on my adventure to Galway, Ireland, I anticipated continuous cloud cover, sporadic rain, and lush green landscapes. However, only one of those statements proved correct thus far. Since my arrival in Dublin, I have been greeted by nothing but sunshine and warm weather. As I write this post, I am hoping I don’t jinx this fortunate fate. The team I’m working with for my practicum at the Health Promotion Research Centre (HPRC) in Galway shares my awe of the climate and blue skies. They jokingly tell me, “You must have brought this weather and are never allowed to leave.” Although I’ve never been a spiritual or religious person, this journey, and the experiences I’ve had, make me believe my Irish ancestors are guardian angels watching over me. As you read on, you might find yourself believing it too.

View from right next to NUI Galway campus!

From the beginning, including during the initial planning phase, I have felt a sense of serendipity. I became acquainted with the HPRC in early March and swiftly secured support, funding, housing, and even managed to replace a lost passport in less than two months! Upon my arrival, the HPRC welcomed me with open arms, just like Ireland itself. The people and the atmosphere here have far exceeded my expectations, and I never imagined such extraordinary experiences could unfold in just a few short weeks. The seasoned researchers such as my preceptor, Dr. Colette Kelly and mentor, Ms. Aoife Gavin, have been guiding me through potential and exciting new avenues for my future career in public health. Witnessing their passion has been truly inspiring. Despite the diversity in their backgrounds and research fields, they work harmoniously to explore the social and physical health determinants impacting young children’s behaviors.

The focus of my work here revolves around the World Health Organization’s (WHO) cross-national study, “The Health Behaviors of School Children,” which includes 51 different countries. I am primarily analyzing the survey responses and running analyses on the data specific to Irish children ages 10-17, to evaluate their priority concerns. This task can be quite amusing, as I come across responses like “I hate cold showers”, “No homework, no problems!” and “find the space not the face!” It’s fascinating to observe how children express what matters to them and how their daily lives influence their health. By identifying priority concerns to the children, themselves, such as mental health, vaping/smoking, obesity, and period poverty, it can directly help impact future program development. I am creating factsheets, infographics, and a comprehensive report that will be disseminated to policy makers, health promotion researchers, schools involved in the study, social media, and others interested in this research!

The second focus of my practicum is a qualitative research study called “Reducing the exposure of children and adolescents to digital marketing of unhealthy foods” alongside Dr. Elena Vaughan, where I help develop data protocols for interviews with children ages 2-16. This study analyzes the association between digital food marketing on social media platforms such as Tik Tok and Instagram and children’s relationships and attitudes towards food. Through learning about protocol development, I have been studying existing literature on food behaviors and social media exposure. We brainstorm specific sampling techniques including prompts (stills and videos) and a ‘talkback’ method by viewing ads and describing what they see to assess recognition of foods and their perceptions of ad narratives. The challenging part of this work is catering interview questions to the learning and communication capacities of children from different age groups. Luckily, my colleagues on this project share my same passion to examine fast pace and ever evolving social media trends and how it influences long term behaviors.

Cliffs of Moher hike

What has truly made this journey special are the outdoor adventures and people I’ve met along the way. This includes my colleagues at the HPRC, but also individuals I’ve met during spontaneous and unexpected moments. For instance, I biked along the coast of Inishmore Island, where the Award-winning movie, The Banshees of Inisherin was filmed. I’ve marveled at the ancient, stoned walls, some of which have existed for over 3,000 years. Listening to colleagues share Irish mythology, such as Tír na nÓg, the land of everlasting life, has been an enriching cultural experience. A life-changing highlight was hiking 10 miles along the Cliffs of Moher, guided by a local cattle farmer named Pat where he said “This is amazing! This is the real local experience of the Cliffs of Moher, all along here” as he peered too closely for my comfort over the cliff’s edge.

Tour guide, Pat overlooking the cliff’s edge!

Two notable lucky encounters I’ve experienced during my time here include obtaining free tickets to see a concert in Dublin from a kind stranger who was leaving town early. To my surprise, the Lumineers were performing, who were born and raised in my hometown of Denver, Colorado. Despite not knowing anyone in Ireland at the time, I accepted the offer and invited new “Galwegian” friends to make the long 12-hour journey in a single day! During a solo day tour to Connemara National Park, the tour bus had overbooked seats, prompting a last-minute change. Luckily, five of us solo riders were transferred to a smaller car. As unfortunate fate would have it, the tour bus ended up crashing on its way up, and passengers had to be taken to the hospital back in Galway. The small car I was in, however, remained untouched, allowing us to continue the journey to the National Park. Through this shared experience of narrowly avoiding a terrible crash, we created a unique bond and friendship.

Coworkers and friends from Lumineers concert!

My newfound friends here refer to me as one of the luckiest girls they have ever met. They even insisted I scratch a lotto ticket, unfortunately yielding no winnings. My belief in luck extends beyond strange coincidences, but as cheesy as it sounds, through the incredible people I have the privilege meeting and learning from. I genuinely feel that guardian angels are watching over my journey as I continue to learn more about health promotion, folklore, and the rich traditions here in Ireland.

“Go dtí an chead uair eile” – until next time!

Solo travelers and new friends from bus tour!

– Dawn

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