Cleaner Air, Better Life

Seowoo
Seowoo

When I first joined MPH program, I did have a pretty specific area of interest. Through my clinical experience in the past, I wanted to focus more on the non-communicable diseases. Specifically, I wanted to work to reduce cardiovascular health disparities that are disproportionately affecting certain populations. However, a year of studying at Gillings made me feel a bit less clear about what I hope to do in the future, but in a good way!! Throughout the courses and from the peers, I was able to learn about many different public health issues that have not paid attention to. All the issues were important, and I wanted to know more about them. For this summer practicum, I will also be exploring the topic that I am not too familiar of. I am already very excited to see all the things I will be learning and gaining throughout!

For my practicum, I am currently working with the Occupational and Environmental Epidemiology Branch (OEEB) in the Division of Public Health within the North Carolina Department of Health and Human Services (DHHS). OEEB identifies and quantifies environmental and occupational hazards, conducts risk assessments, evaluates health effects, and provides health-based guidance relating to contaminants and health effects across the state. Among multiple projects the team is working on, I will be supporting DHHS contributions to the NC Clean Transportation Plan. The NC Clean Transportation Plan is being developed in response to Executive Order 246, “North Carolina’s Transformation to a Clean Equitable Economy”. Specifically, I will be working on a literature review about the health effects of transportation-related air pollutants, a short manuscript about the potential health benefits of implementing the NC Clean Transportation Plan, and a presentation to OEEB about the findings. To gain more insights and knowledge on environmental health, especially on air-pollution and climate change, I will be attending the Health Effects Institute Annual Conference and related virtual sessions. I may also assist with other related products or additional projects in OEEB, such as summaries of air pollution exposures associated with biogas or research to support environmental justice activities.

My goals for this practicum are to gain practical experience in a professional public health work environment, learn more about air pollutants and their impacts on health, and develop professional writing skills. I am also looking forward to participating in presentations and events that are relevant to environmental health and justice and engaging with public health practitioners from various sectors. Things are going great so far! Hope everyone else is having an amazing summer as well!

-Seowoo

Red, Yellow, Green: Reducing Maternal Mortality with an Obstetric Triage Intervention in Ghana

Me at the Biltmore Estate; Photo Credit- Kjersta Unzen
Me at the Biltmore Estate; Photo Credit- Kjersta Unzen

I am Amy Tran, a student in the Global Health concentration who is moving steadily towards the second year of the MPH program. My public health interests primarily revolve around issues of maternal and child health, particularly in low-resource settings, though I am also interested in aspects of data analysis, both quantitative and qualitative, and the applications of GIS in public health.

For my summer practicum experience (to which I was introduced by my former faculty advisor, Dr. Rohit Ramaswamy), I am working with a joint team of UNC Gillings researchers and the Kybele-Ghana organization. My preceptors are also Ph.D. students here at Gillings—Stephanie Bogdewic, MPH, and Caitlin Williams, MSPH. This collaboration is centered on the scale-up of the midwife-led Obstetric Triage Implementation Package (OTIP) in Ghanian hospitals and tertiary health facilities, which was developed in 2013 and since 2019, has been scaled up to a national level to be implemented in six other high-volume hospitals [1].

School of Nursing and Midwifery, University of Ghana; Photo Credit- Caitlin Williams
School of Nursing and Midwifery, University of Ghana; Photo Credit- Caitlin Williams

This obstetric triage intervention is aimed at reducing maternal mortality by addressing the third delay in referral hospital settings, or the delay in a patient receiving the appropriate health care once it has been sought [1, 2]. Midwives are central to the OTIP intervention, as they are the ones responsible for assessing mothers* once they arrive at the delivery facility with green, yellow, and red bands that indicate the risk level of the pregnancy [1]. At this stage, the research team is concerned with assessing the “know-do” gap in regards to implementation theory, as well as the leadership dynamics and development tied to the program.

COVID-19 Signage at the University of Ghana; Photo Credit- Caitlin Williams
COVID-19 Signage at the University of Ghana; Photo Credit- Caitlin Williams

I have limited “professional” experience working in global public health settings, generally relegated to a Peace Corps volunteer experience that is more aptly described as a community health outreach “stint”, that ultimately motivated me to pursue formal education and qualifications here. Therefore, being able to work with a research team on a project with clear and direct practical applications to maternal health has given me an extremely valuable opportunity to look at a public health issue and intervention from a different perspective. In addition, my responsibilities include the development of an interview guide for a series of in-depth qualitative interviews with leadership in the OTIP intervention, as well as the qualitative data analysis and presentation of findings to a specialized stakeholder audience. I’m thankful for the introduction to qualitative research methods I received from Dr. Suzanne Maman and the teaching team in HBEH 753 Qualitative Methods in Health Behavior (highly recommend!), in addition to the other synthesis/interprofessional skills introduced in other core courses. My preceptors have been nothing but supportive and accommodating—they are great motivating mentors and I look forward to the rest of this practicum experience!

As an added note, due to the hybrid/remote nature of this practicum experience, I have been able to benefit from the freedom to better explore the local sights. Recently, I have taken a trip to Asheville, including the iconic Biltmore Estate, as shown (above). As a Florida native, I am excited for this opportunity to explore a brand new place!

-Amy T.

* The author acknowledges and respects the lived experiences of birthing individuals with gender identities not exclusive to cisgender female identities. However, for the purposes of data collection/analysis and recognizing Ghanian cultural values and norms, individuals that give birth have been referred to with traditional binary terminology, including women, females, and mothers.

[1] Williams CR, Bogdewic S, Owen MD, Srofenyoh EK, Ramaswamy R. A protocol for evaluating a multi-level implementation theory to scale-up obstetric triage in referral hospitals in Ghana. Implement Sci. 2020;15(1):31. Published 2020 May 12. doi:10.1186/s13012-020-00992-2

[2] Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38(8):1091–110.

Behind the Numbers: Using Data

Me (back & center) at Trivia Night at Vecino
Me (back & center) at Trivia Night at Vecino

Howdy! My name is Ana Jafarinia and I am a current MPH student in the Global Health concentration. Before coming to UNC, I actually got my BS in mechanical engineering and worked in a corporate setting. Through a winding and unconventional road, I began to realize that my career trajectory was not one where I would find fulfillment or purpose. I made the decision to make a big switch and I am so grateful that Gillings gave me the opportunity to do so. The first year of my program has been delightful. As someone who is new to public health, I have enjoyed being introduced to new fields, new people, and new ways of thinking.

But the engineer in me still lives on! This past year, my love of numbers has continued to guide my work, albeit in a different discipline than I thought. One of the ways that I have used math and science in public health is through statistics. I really enjoyed Data Analysis for Public Health (SPHG 711), one of the first semester MPH core classes that we take. I decided to further develop those skills in my second semester by taking Working with Data in a Public Health Research Setting (BIOS 669). I learned how to use SAS to perform data manipulations.

My love of data is how I ended up finding my practicum. Dr. Ilene Speizer had a colleague in Pakistan with survey data that he wanted to make sense of. Ilene, knowing that I was passionate about statistics, asked if I would be interested. I am incredibly grateful to have been welcomed to Dr. Adnan Khan’s team at Research and Development Solutions (RADS). The Pakistan-based research and evaluation group conducts rigorous analysis using multiple data sources to identify health issues in Pakistan and advocate for evidence-based policies. One of the biggest priority areas for them is Family Planning. The government of Pakistan has expressed a commitment to raising the contraceptive prevalence rate (CPR) to 50% by 2025. However, through past research, RADS has found that Pakistan’s CPR has stagnated around 30- 35% since 2007. Additionally, 1 in 4 married women of reproductive age in Pakistan experience an unmet need for family planning. My research will help generate more knowledge on the experiences of women who have an unmet need for family planning to hopefully advocate for effective policy solutions that meet those needs.

Printed observation from the Pakistan Social And Living Standards Measurement (PSLM) Survey
Printed observation from the Pakistan Social And Living Standards Measurement (PSLM) Survey

Doing quantitative research comes naturally to me. I love using the numbers to identify trends and associations. What is more difficult is seeing the numbers as individuals. The data I am using comes from the Pakistan Social And Living Standards Measurement (PSLM) Survey, which collects information on social indicators from households at the national level. The roster of all individuals represented by the dataset has 175,690 rows. I have used large datasets like this before, but often it is dummy data that is generated for classroom use. While looking at this data, I have tried to challenge myself to see each row not as a number but as a person with unique experiences.

For example, I was trying to identify the number of married women of reproductive age in each household. I decided to look at a certain household with more than one woman of reproductive age to get a better picture of what these households might look like. For household code “7301200104”, I found that one couple lived with their three children, as well as their son’s wife and four grandchildren.

Andi, Kate, and I (left) eating yummy pasta at Tesoro in Carrboro
Andi, Kate, and I (left) eating yummy pasta at Tesoro in Carrboro

I am naturally curious about other people and their experiences. I love meeting all different kinds of individuals and asking them about their lives. I would love to know more about this family and their relationships with one another. Unfortunately, the nature of quantitative research means I will never know the whole story for this one group. However, having that perspective and remembering what lies behind the numbers will help me as I conduct my analysis. While we must identify trends and work with the numbers we have, we must never simplify one person’s story into a group of variables.

Outside of my practicum, I have been spending the summer with my roommates Kate (Health Behavior concentration) and Andi (Maternal, Child, and Family Health concentration), as well as my church family at Love Chapel Hill. I have also been hosting the trivia for Vecino Brewery in Carrboro on Wednesday nights at 7pm. If you are local, please come by and play a couple of rounds!

Thanks for reading and until next time!

-Ana