Barreling Towards The End

Posted on by nayavill

My last practicum blog post, I expressed the slow-build experience making connections and forming relationships with the collaborators and community we were bringing together to support my practicum agency, Pitkin County Public Health, in executing deliverables for a grant addressing health inequities for the Latinx population of Roaring Fork Valley in Colorado exacerbated by COVID-19. Since that last post, I feel like the summer’s flown by, as our team of collaborators and stakeholders has barreled forwards towards the grant deadline next week. The experience has been both exhilarating and thought provoking, providing me many experiential lessons I will take forward into my second year of my MPH program and beyond.

First, I gained a greater appreciation for the challenge of balancing community-driven approaches that prioritize human relationships and creating shared spaces, with the logistical pressures and timelines of working within the institutional norms of grant-based financial infrastructure. For example, to support the Spanish Mental Health Media Campaign funded by the grant, we formed a Strategic Planning and Marketing Committee comprised of various community leaders interested and passionate to address the burden of mental wellbeing challenges in the area. While my preceptor and I prioritized ensuring that all members of the group were properly compensated for their time, as the grant deadline drew nearer, I felt the implicit pressure to increase the number of weekly meetings, and expectation for deliverables for the group to complete all campaign materials by the end of the grant period. I feel it can be so easy working within groups seeking to make a positive impact, and united by common values, to take advantage of these positive qualities. My practicum experience has left me reflecting on how easy it can be in the field of public health to succumb to prioritizing white supremacist norms, such as perfectionism, timeliness, and a sense of urgency, in the pursuit to fulfill the requirements of entrenched institutional standards.

However, my practicum experience also helped me gain a greater appreciation for how the field of public health can (and likely should) intersect with a broad range of other disciplines in its application. While I had the opportunity to participate in perhaps more traditional elements of public health work, such as delivering presentations to the state Board of Health, and developing monitoring and evaluation plans, I also was forced to step out of my comfort zone into other disciplines to properly support the efforts I was involved in. For example, I gained a crash course in budgeting and contract development for media campaigns, working with a county marketing specialist to solicit media purchase estimates from radio stations, public bus lines, and Internet spaces. Once our marketing committee had selected its primary forms of delivering the Mental Wellbeing Media Campaign, I coordinated directly with radio management and talent, and local social media influencers, to draft Scope of Work contracts; process media buys, and manage limited grant funds. There were several hiccups in this process, especially learning to navigate county rules around payment structures for contracted work, to be able to properly reimburse the media talent and campaign designers. I feel like I gained a lot of practical knowledge from these experiences, and I was reminded that in the gap between conceptual public health knowledge and the implementation of health promotion interventions and activities, there’s a variety of practical skills and leadership capacities that can be highly relevant. The varied experiences and skills I’ll take from my practicum have reinforced three lessons for me for my future public health practice: 1) to stay creative about the way public health can be combined with other disciplines 2) to continue developing varied skillsets not immediately incorporated in academic training 3) to seek out and value the knowledge and input of “expertise” from non-traditional sources and community leaders.

Also, I feel inspired to continue bringing my guiding value of creativity into my global health practice. I had the chance to bring my visual eye to my practicum in several respects, by creating logos and visuals for the campaign messaging that had been created by the Marketing Committee, and by building the formatting for resource guide for Immigrants and other Latinx families in the area.

It was a joy to help foster a creative space within the Marketing Committee meetings, cultivating an environment where everyone was sharing ideas and building messaging and campaign materials relevant to their own community. This Marketing Team developed a vision for a three-armed campaign, focusing on a local radio station, a local interview show, and social media pages on Facebook created during the pandemic, to direct limited campaign funding to the mediums with greatest reach and impact for the intended audience. I can confidently say these would not have been the mediums chosen by Pitkin County if left to their own devices, and are another example of the power of tapping into the expertise of community knowledge. I was very inspired to see the demographic-specific messaging the group devised for women, men, the older aged, and adolescents, as well as the compelling radio ads they drafted and moving video testimonials they produced. The unifying feature of the campaign the group devised utilized the imagery of a stoplight to encourage destigmatization, preventative action, and seeking help around mental wellness challenges. I honestly think this idea is super clever, and I can’t look at a stoplight now without being reminded to stop and check-in on my own mental wellbeing.

I also met with a myriad of community leaders, service providers, and other stakeholders, to conceptualize and produce a format for a community resource guide that would be inviting, useful, and accessible. Based on this input I devised a system using visual icons to aid in navigation of the guide and decrease the extent to which literacy is a barrier to access, also highlighting key potential barriers to accessing the services in the guide such as cost and documentation status.

 

Most of all though, the biggest thing I’ll be taking with me from my practicum experience are the positive memories, connections, and relationships I was able to form (albeit remotely) with so many wonderful individuals. I feel incredibly lucky to have had the opportunity to meet and become friends with the incredibly talented individuals in the Marketing Committee we formed, and I’m so excited to see all the positive work they produce in coming years.  It was difficult to say goodbye, it was a both a valuable reminder of the importance of the human element of public health work, and refreshing validation of my interest in pursuing a career in global health.

– Bridger

Three takeaways from my summer on TB

Posted on by nayavill

A map of North Carolina on a laptop in Jaclyn's backyard.I finished my practicum last week with the Tuberculosis (TB) Control Program at the North Carolina Department of Health and Human Services (NC DHHS) and wanted to share a few final reflections.

  1. Practica will inevitably change and evolve throughout the summer – but that’s not a bad thing! I originally thought I would be using surveillance data to estimate the prevalence of latent TB infections in the state. However, I was able to come up with a better strategy after consulting with the TB epidemiologist at DHHS. She illuminated some of the issues with the data reporting system we currently have and encouraged me to consult other estimates from the literature. This new direction allowed me to redirect my efforts to interpreting and assessing the quality of available estimates, which is ultimately an important skill for me as a budding “applied” epidemiologist.
  2. Practica can be a great opportunity to network and meet people outside of your normal circles. I got the chance to meet with some health departments from other states that had already done a similar educational outreach project around latent TB infections. It gave me the chance to see how other health departments structure their programs and often collaborate across states. I also got to peak into some of the case-level work that TB nurses do in North Carolina and how that feeds into the larger population-level work at the health department.
  3. Getting creative and taking initiative can help you get what you want out of your practicum. Part of my project involved compiling a list of doctors (called civil surgeons) that are active in providing medical exams for people seeking immigration status adjustment. I wanted to get some practice creating maps and my preceptor was on board, so I took some time to train on Tableau and then create a map of all active practices. This map was useful in presentations I gave to show where these doctors were concentrated, potentially helping to prioritize hotspots for the educational intervention. This map also illuminated that there were “deserts” in the state, where people might have trouble finding a nearby doctor and potentially get discouraged in the status adjustment process.

Overall, the practicum gave me an interesting look into the work that goes into planning an intervention at the state health department and learning how to use my knowledge and interests to potentially add value in unique ways. I am grateful for the opportunity to get some exposure to the government sector and practice some of the skills I’ve learned in the first year of the MPH.

– Jaclyn

The End signals the Beginning of Something New

Posted on by nayavill

Summer has faded fast. The official end of my practicum with Colectivo Amigos Contra el SIDA (CAS) approaches, sooner than I might like – a gentle reminder that things outside the academia’s confines do not always obey the metronome of a school calendar. I began the summer preoccupied with how I might contribute from afar, in the virtual world, to CAS’s mission, carried out from their clinic in Guatemala City, to provide stigma-free sexual health services to gay and bisexual men. Yet as the summer has worn on, the virtual aspects of my practicum have become less significant. It’s not clear that anything would have been gained, for anyone, by me being present in Guatemala this summer, aside from frequent flier miles. Instead, the great reward – and challenge – became calibrating my expectations of what was feasible in the abbreviated course of this summer.

As I commented in my earlier blog post, CAS maintains a longstanding relationship with Gillings researchers, a collaboration whose current focus is understanding the provision and uptake of HIV pre-exposure prophylaxis (PrEP), a daily medication which is highly effective at preventing the establishment of HIV infection in those exposed to the virus. In Guatemala, CAS is the only provider of PrEP, which it offers free of charge – and remarkably, CAS has greatly expanded its pool of clients using PrEP since the onset of the pandemic. The original design of my practicum focused on developing and implementing data collection instruments, a survey for CAS’s clients and in-depth interviews with providers, that would inform the creation of a mobile app to share health information and coordinate services for CAS’s PrEP program. With delays in the Institutional Review Board (IRB) approval for this phase of the study, my focus shifted to analyzing and preparing to share qualitative and quantitative data from an earlier phase of the research partnership – that is, the dissemination of results.

Before coming back to UNC, I had been exposed to a variety of organizations in the nebulous patchwork that is “international development,” from small NGOs to government agencies. None had the commitment to research that CAS has, to cultivating and producing knowledge to better advance their mission. The accompanying ethical procedures, like IRB approvals, exist for the essential purpose of protecting the human subjects of this research. If anything, given its sometimes-troubled history, stringent ethical standards ought to be at the forefront of global health research and practice. Though I have had to be flexible in my practicum’s immediate aims, my core objective of striving to contribute to CAS’s mission, however modestly, has not wavered. Maybe this reflects my own inexperience in public health research, but I have gained a richer appreciation for the harmony of such community-based, action-oriented research partnerships.

Comparing PrEP users with non-users in the analysis of older study data has revealed differences between each group in the factors influencing PrEP uptake, differing perceptions of the stigma associated with its use, and differing reliance on technology to seek health information. The results of such comparisons will, hopefully, provide insight into how CAS might develop new initiatives to expand the reach of its PrEP program, including via a mobile app. Working through how to best share these results has presented the fresh challenge of how to integrate quantitative and qualitative data sets – and how to do so in such a way that proves most useful to the workings of a fast-paced organization with multiple programmatic objectives. With a keener appreciation for the value of such mixed methods research to public health programs, this is a process I would hope to replicate in future endeavors.

More immediately, I plan to continue as part of the CAS-UNC research collaboration beyond the official end of my practicum. Coming up are results to be shared and interviews to be conducted, both of which hopefully can coexist alongside my coursework commitments. Ten weeks may be a flash in time, but it’s certainly long enough to feel immersed in a project. And this seems only right to me. Exercising humility and creating relationships both call for, among other things, an investment of time. In my own practice, I aspire to be oriented by precisely these values, the foundation of lasting transnational ties that define global health at its best.

–Ian