Public Health Leadership Program Practicum Spotlight

Darren Hearn working with General Leonard Wood Army Community Hospital, Ft. Leonard Wood, MO

Molly Jordan working with Reproductive and Child Health Alliance (RACHA) in Phnom Penh, Cambodia

Mara Howard-Williams working with Smiles on Wings in Thailand

Kate McNabb working with Ashoka Innovators for the Public in Arlington, VA

HanFu Shi working with Chinese Center for Disease Control and Prevention in Beijing, China

Manny Hignutt working with the Granville-Vance District Health Department

Sarah Hoffman working with the FDA in Silver Spring, MD

Zinaida Mahmutefendic working with Center for Public Health Quality

Heidi Harkins working with Jacaranda Health in Nairobi, Kenya

Darren Hearn

I am an Army physical therapist currently stationed in North Carolina pursuing my Master of Public Health Leadership with a focus on program development.  My practicum effort occurred while stationed at General Leonard Wood Army Community Hospital, a small military hospital in south-central Missouri.

Darren Hearn

The intended outcome was an evidence-based, employee-driven wellness program available to all (approximately 1200) employees that decreased or eliminated barriers in order to enhance wellbeing.  Using survey techniques with statistical analysis, we identified the barriers employees faced and used that knowledge to develop a program aimed at reducing or eliminating those barriers. We also investigated perceived barriers to individuals’ own perception of their health status.

The final product of this yearlong practicum was the development of a Health Promotion Team within the hospital, an approved proposal to initiate the program, and a contract with WellPeople to begin individualized wellness programs for any and all interested employees. An added blessing was that, due to our solid research techniques in development, we received an $8,400 grant to fund the first year of this program.

The effort was born of necessity and a consistently recognized but often neglected need.  We knew our employees understood the need for enhancing their wellness but also realized that multiple barriers existed and simple education was not enough.  The Health Promotion Team-to-be at the hospital developed the idea for the program, and the idea gradually came together over a period of approximately eighteen months.

Despite the difficulties, including required governmental authorization and questions, lack of funds, and consistently changing personnel, the idea eventually reached fruition.  As this idea has the potential to forge life-changing results, I highly encourage students to pursue a program they may think improbable or even impossible to implement.  You may be surprised, as I was, at the level of support and encouragement you receive from the population that you are attempting to serve.


Molly Jordan

My advice for students for their practicum is to not wait for work to be given to you but take initiative and try to anticipate work that you can do (i.e. background research).  Also familiarize yourself with other people in the organization as you can learn a lot from other people on the team. Many times the best mentor is not your assigned preceptor but another person on your team.  I encourage students that are interested in global health to do their practicum outside of the US so they can have first-hand experience.  This experience gained by working overseas is worth the effort and cost and will be a life-changing experience.  RACHA and Cambodia are great places to do a practicum as English is widely spoken and it is a beautiful country with lovely people.

Molly Jordan traveling on the Tonle Sap River in Cambodia, en route to a TB contact investigation with a colleague (in front) and a local midwife/boat driver.

In May 2014, my family moved to Cambodia for my husband’s work in microfinance.  I contacted multiple international NGOs about the possibility of doing my practicum with them but these organizations either did not have an internship program or had limited options.  A friend suggested that I contact RACHA, a local NGO, as she was on the board.  She helped connect me and I had an interview with the Executive Director.  During my interview with the Executive Director, she offered me a practicum and said that I could choose my subject area.

My practicum with RACHA started in the area of Emergency Obstetrics and Newborn Care by assisting my preceptor in her work as a manager for a midwife clinical mentoring project.  During my practicum I wrote and performed a survey on mobile phone use by midwives working in rural Cambodia. During my practicum, RACHA received a large grant from USAID in community health systems strengthening.  So I switched to help with project start-up and assisted with preparation and writing documents including the monitoring and evaluation plan, work-plan, and budget for this 5 year project.

The most challenging part of the project was that the organization was understaffed and there was lots of work to do.  Many times my preceptor was too busy and was unable to give me work to do so I tried to anticipate work that would be helpful to my preceptor by doing background research.  I was asked to assist with non-public health work including reviewing policy documents that were written in English. As the organization needed help, I was glad to assist with these other tasks.

The most surprising aspect of this experience was how much confidence that they had in my work.  I am a mid-career public health professional and had done extensive consulting and work in global and US public health.  However, they did not know me and they trusted me and gave me lots of important work to do once the USAID grant was signed.

The most rewarding part of my experience was working with the team.  I came to appreciate the differences in working for a local NGO as compared to an international NGO.  It was ideal to get to know the team and organization before beginning my work with them. After my practicum finished in November, RACHA offered me a job as monitoring and evaluation adviser and I started my job in December.


 

Mara Howard-Williams

Two to three times a year, Smiles on Wings goes to one of two sites in Thailand to conduct dental repair for children. One of their sites is the R35 orphanage, built in response to the Tsunami in 2004. They have informally educated the children on past mission trips, but they wanted to get a better understanding of what the children already know about oral health care, since the organization had no baseline.

Mara Howard-Williams in the R35 Dental Clinic in the Khao Lak area near Phuket, Thailand.

I found out about the organization from a dentist who was attending the mission. I had worked on cleft lip and palate repair previously, and from that learned quite a bit about the importance of oral healthcare, so I spoke with the executive director about the program and what they needed. When I learned about their education project, it seemed a natural fit for me, given my background in survey development and research with children.

The best advice I can give is to use the practicum as an opportunity to learn and expand skills you actually want to use in your career. Shy away from finding something that you already know how to do, but at the same time don’t pick a project that you know absolutely nothing about and doesn’t interest you. I created my own practicum specific to my interests and the organization’s needs, and I couldn’t be happier with how it turned out!

My role was to develop a short survey to be administered to the children to figure out their access to toothbrushes, toothpaste, if they know how and how often to brush their teeth, and what does and does not cause tooth decay. Then, I assessed the results and delivered a report to Smiles on Wings with recommendations on how to conduct a more formal educational program in future missions.

I was surprised by how much the students actually knew about oral healthcare, and how much public health is built into the Thai education system. The majority of students actually brushed their teeth three times a day, and the teachers hosted class by class competitions to encourage students. Additionally, there are a small number of students at the school who live at home with their parents, and represent the lowest income population. These students actually had poorer dental health than those who lived at the school, which was not what I had anticipated!

Another part of my responsibilities was to track the number of procedures, and who had been seen. It was most rewarding to see the sheer volume of high priority procedures that we were able to accomplish in such a short amount of time, both in terms of immediately needed care and preventative care.

Developing an IRB that required information from a school I was unable to get in touch with in Thailand was definitely a challenge! Additionally, Smiles on Wings had raised enough money to build a small permanent dental clinic at the orphanage, and this was the first mission trip since the building was finished, so there was a lot of unexpected time spent in setup and resolving unanticipated problems. In the end, it all worked out, and the clinic will be ready and waiting for the next mission!


 

Kate McNabb

 Ed. Note–David Aylward, Kate’s preceptor, had wonderful things to say in his final evaluation.  He was particularly impressed with her people skills, her openness to new ideas, her attention to detail, and her knowledge base “both at the practical and theoretical levels.” He also had praise for the PHLP, saying that Ashoka “would be delighted to have additional students of yours” and encouraging us to “send more, just like Kate.”

Kate McNabb and her preceptor, David Aylward.

For my practicum, I wanted to support an innovative organization that was working in global health, but one that was doing so in a role beyond that of a traditional donor implementing partner.  Ashoka posted a summary of the type of support that the Nutrients for All initiative was looking for on their website. The skills they required (experience with metrics identification and monitoring and evaluation) were a fit with my background. I happened to call David (one of my preceptors) to learn more. We got to talking, and he offered me the position during that first phone call!

I served as a part-time public health adviser. My work primarily related to Ashoka’s desire to shift the paradigm of nutrition metrics toward more meaningful indicators, in order to stimulate public demand for wellness. One way in which Ashoka hopes to accomplish this goal is by implementing these more meaningful metrics and evaluation into their burgeoning Healthy Schools program. Healthy Schools seeks to promote wellness in education settings, in resource-constrained environments (India, Kenya). I worked with my preceptors and in-country stakeholders to identify strategic indicators; developed measurement protocols for Healthy Schools field pilots; and developed an Implementation Handbook and Measurement Plan for Ashoka field teams.

I found my practicum experience to be rewarding on several levels. The practicum enabled me to further develop an existing skillset (monitoring and evaluation) and provided me with an opportunity to expand my global public health technical knowledge into the areas of nutrition and wellness. I also really appreciated that my work with Ashoka provided an opportunity to gain experience in a different professional environment (non-profit versus private sector) without having to leave my current job with Deloitte Consulting.  Ashoka is an extremely well-connected organization, and I knew I would be building relationships with my preceptors, but I had no idea how many others I would meet through my practicum. I ended up making connections with non-profit managers, doctors, professors, and global health practitioners across three continents!

By far the most challenging aspect of my practicum was balancing it with my full-time job. At the end of the day, stretching my practicum across two semesters helped manage my time; build relationships with my preceptors; and observe the evolution of Ashoka’s ideas. That being said, it was really tough to always feel like I was behind in my contributions to Ashoka because of ongoing Deloitte responsibilities, priorities, and travel. At times, I wished I had dedicated a continuous period to the practicum, but I think being engaged over a period of several months ultimately provided a more meaningful professional experience.

Advice? Use the practicum as an opportunity to strengthen your CV; expand your professional network; or get experience in a new area! Avoid taking on a practicum role that simply “checks the box.” In the end, any extra work will be worth it.


HanFu Shi

As a student in public health, I have visions and insights about the public health system in China. At the same time, I have a dream to learn the public health system in the United States and try to adapt it to China. Learning the differences between China and America can lead to improvements in  the public health system, based on the strengths I will find in the comparison.

Dr. Yu Wang, director of the China CDC, and HanFu Shi

In summer 2014, I had a great opportunity to take my practicum overseas at the Chinese Center for Disease Control and Prevention in Beijing, China. My preceptors at China CDC designed a wonderful practicum plan for me.

At China CDC, I worked with six different departments: the Political Center; Immune Planning Center; Education and Training Office; Chronic Diseases Prevention and Control Community Health Office; Control and Prevention of Chronic Non-communicable Disease Office; and Control and Prevention of Infectious Diseases Office. I worked in each office for two weeks, which enabled me to form a clear overall view of China CDC.

The most surprising aspect of the experience was that I also experienced all four levels of disease control institutions in China during my practicum at China CDC. In Beijing, I visited central disease control and prevention institutions at the state, county and community levels, as well as a few countryside institutions in Henan, China. These experiences expanded my overall knowledge about the general Chinese Public Health and Disease Control systems.

My duties at China CDC were to participate in all kinds of public health and disease control work training, as well as to arrange lectures, interviews and probation observations. These experiences let me understand the Chinese public health and disease control systems in general, the function and main duties of the Four-level disease control institutions, as well as the working and running situation of the local health institutions. At the same time, I also learned about the situation of infectious disease, chronic disease prevention and control system and management, and the expansion of the national immunization program management in China.

I have to say that my practicum not only helped me to gain knowledge but also provided me a clear mind for future career goals. Therefore, it is always great to take the valuable opportunity at UNC Gillings School of Public Health to find a practicum that relates to your professional goals. It is worth it!


 

Manny Hignutt

Manhy Hignutt

Manny Hignutt

I served my summer 2013 practicum as a Public Health Leader in Practice with the Granville-Vance District Health Department located in Oxford, NC.  Granville-Vance is a combined department serving a diverse population of 105,000 in a mostly rural region of North Carolina.    The Public Health Leaders in Practice Program, sponsored by the North Carolina Institute for Public Health, places students in local health departments throughout the state where they spend 8 – 10 weeks working on specific projects of interest to the department.

Deaths from opioid analgesic overdose is a growing problem both in North Carolina and nationwide.  My initial work with the department focused on assessing the extent of opioid overdose mortality in Granville and Vance Counties, and investigating the available options for policy interventions.   I participated in fact-finding conferences with policy experts with Northern Piedmont Community care, gathered background information from health providers, and worked with the Health Director to evaluate the department’s capacity to implement an intervention.

While working on the opioid overdose issue I became intimately familiar with local health department operations and observed how Health Directors lead their organizations.  WIC (Women, Infants and Children), Home Health, Care Coordination for Children (CC4C), Maternal and Child Health, and Health Education are just some of the many community service programs I worked with during my practicum.  I participated as an active member of department’s Quality Improvement team, where I provided research support to improve efficiency and customer service.  An important function of health department leadership is maintaining links with outside organizations.  The Health Director enabled me to accompany her to meetings state health officials, partner agencies, and physicians’ groups where I gained a deep understanding of communications and leadership skills.

Mid-way through the practica I found myself assigned to an exciting new role:  Project Manager for the department’s initiative to obtain a state license to operate a Home Hospice within Granville County.   As Project Manager I directed the work efforts of the department staff and coordinated with a team of consultants, attorneys, financial analysts and private sector partners to assemble a competitive application on a very short time scale.  The work was not exclusively internal to the department.  As part of the effort we assembled a team of department staff to meet one-on-one with health providers in the community to garner their support and commitment to use the department’s Home Hospice if approved.  Thanks to strong efforts on the part of the entire team the application was delivered on schedule.

Before I started the practicum I expected to focus my efforts on a single project and produce a written deliverable at the end of the process, much like an academic course.  Luckily this expectation was dispelled almost immediately as I was drawn into multiple programs and slowly became an integral member of the health department staff.  The most rewarding aspect of the practicum was the Project Management experience; working with a group of motivated professionals dedicated to the success of the project proved to be an outstanding lesson in team dynamics and leadership.

I feel very grateful that my practicum experience far exceeded my expectations.  My good fortune was not solely due to my own efforts; I spent time talking with my advisor and other professors when researching practicum opportunities.  I credit their advice in steering me to a program that matched my background and interests.  I recommend to my fellow students to start your practicum search early!  Many programs are very competitive, draw many applicants, and have strict submittal deadlines.  Starting your search 12 months prior to your desired timeline is not too early!


 

Sarah Hoffman

Sarah Hoffman and colleagues

Sarah Hoffman (center left) and colleagues with FDA Commissioner Margaret Hamburg (center right) standing in front of Sarah’s poster.

Over the summer, I worked on multiple projects related to post-market surveillance of medical devices.  I learned how to work with hospital discharge and claims data, and contributed to two systematic literature reviews.  I gained hands-on experience while helping to implement the National Medical Device Postmarket Surveillance Plan and FDA’s Sentinel Initiative.

I went to usajobs.gov and saw a Pathways posting for a position at FDA.  They were looking for public health students to help work on systematic literature reviews and various studies.  Each intern was assigned a specific mentor and project.  I was offered the opportunity to work on the uterine fibroids study under a fabulous mentor, and I gratefully accepted!

I was surprised by how large FDA is!  I worked in in the Center for Devices and Radiological Health (CDRH), Office of Surveillance and Biometrics (OSB), Division of Epidemiology (DEPI) where I was a Medical Device Fellowship Program (MDFP) Summer Intern.  Every employee I spoke with cared deeply about their work and the mission of their division or center. I was inspired by the atmosphere cultivated by the employees.  I learned a lot about teamwork and leadership through this immersion.

The most challenging aspect of working at FDA, it seems, is keeping in mind the impact of each decision we make in our day-to-day work.  The stakes are much higher when you work for a national regulatory agency, and everyone experiences that pressure.

I worked on two systematic literature reviews, including one for a reclassification panel regarding Extracorporeal Membrane Oxygenation (ECMO) therapy.  In September 2013 the results of the ECMO systematic literature review were presented at a panel meeting.  The FDA Advistory Panel recommended  ECMO to be reclassified from Class III to Class II with special controls.  I also used hospital discharge data from the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) to compare robotic and non-robotic assisted hysterectomies, and presented my work in a poster session attended by FDA Commissioner Margaret Hamburg.  In addition, I began working on a comparative effectiveness study that compares surgical treatment options for uterine fibroids using claims data.

My advice for students beginning to look for practicum opportunities is start early!  I started looking for summer internships in the fall semester.  I attended the NC Master’s and PhD Career Fair, and information sessions offered by SPH and Career Services.  I also did a lot of research online.  I kept an ongoing list of opportunities that captured my interest, ranked the opportunities, and applied for as many as I could by order of rank and deadline.  I spent my winter break filling out applications and writing essays.  In the end, I was offered four of nine paid internships I applied for.


Zinaida Mahmutefendic

Having worked on quality improvement projects in health care prior to graduate school, I was curious about how quality improvement (QI) is applied in public health practice.  I applied for the Cappie L. Stanley Public Health Quality Improvement Internship at the Center for Public Health Quality (CPHQ) in Raleigh in spring of last year.

Improvement map

The After Action Review flip chart Zinaida assembled.

One thing that really drew me in were the innovative projects on the CPHQ website, especially the Improvement Map (iMap), which helps health departments and other public health organizations choose evidence-based interventions based on the resources they have. Some iMap initiatives focus on improving internal processes within the organization and others focus on improving community health outcomes.  During my practicum, I helped design and test a user-friendly interface for entering evidence-based interventions.  I also wrote an After Action Report for the Wake County Community Health Assessment (CHA) team to summarize the lessons learned from the first joint CHA process between the health department, local hospitals, and other partners.

In addition, I had the chance to attend QI training sessions and visit several health departments in our state.  During a visit to one health department, I attended a Community Action Advisory Board meeting; I subsequently reviewed proposals for Childhood Obesity community action plans and provided recommendations to the Director of Community Initiatives.

My advice for other students is to start looking for practicum options early, especially in global health, as many travel scholarships have Fall semester deadlines.  Look at job postings and websites of organizations in your area of interest to learn about their work and the skills those organizations are looking for, and use the practicum as an opportunity to meet the team. While high profile internships have their appeal, I found that it’s equally beneficial to think smaller for your practicum and choose an organization where you can build a relationship with a good mentor. Some of the most rewarding aspects of my practicum were learning from and working with a fun and supportive team at CPHQ and building relationships with local public health professionals (including several UNC-MPH alumni!).


Heidi Harkins

Heidi Harkins, Evelyne Shiyenzi (Clinic Manager) and Radha Karnad (Director of Clinic Programs) at the entrance to the Jacaranda Health clinic.

Heidi Harkins, Evelyne Shiyenzi (Clinic Manager) and Radha Karnad (Director of Clinic Programs) at the entrance to the Jacaranda Health clinic.

I wanted to use my practicum as an opportunity for an international experience. I also wanted to expand my business analysis and quality improvement skills.  I contacted several Gillings School of Global Public Health professors to consider options and learned about Jacaranda Health from Dr. Rohit Ramaswamy.

Jacaranda Health is a social venture to create a scalable model of maternal health services providing high-quality, low-cost care for women in urban East Africa. Success within this model relies on implementing proven low-cost interventions and efficient business processes. Jacaranda Health aims to incorporate continuous quality improvement into clinical and business processes to meet the goals of high quality and low cost care.

As a quality improvement consultant at Jacaranda Health, I collaborated with clinical and business leadership to identify three high-priority process areas for improvement: (1) inventory management & ordering, (2) housekeeping & infection control, (3) dietary & food safety. Through interviews, shadowing and observations, I documented a future state for these process areas. The documentation included supporting process documents, such as checklists, sign-off procedures, inventory logs and order forms to improve process integrity, oversight and sustainability. I developed an implementation plan for the inventory management process and continuous quality improvement will be incorporated into the new inventory management process.

Getting to know people living in different cultures is always fun. Doing that in the context of improving maternal health doubled the fun. It was highly fulfilling to watch Kenyan mothers leave the clinic with their one-day-old healthy babies and think that maybe I played a small role in making that experience better for those mothers.

Two challenges were important to address for success of the project. Prioritizing my goals so that I could accomplish tangible work within a six-week time frame required effort. There was a lot that I wanted to do with only a limited amount of time available, so continually focusing on specific goals was important. Also, identifying a project owner who would be responsible for sustained implementation once I returned to the United States was critical.

My adviser, Dr. David Steffen, gave me great advice: before deciding on a practicum, take some time to thoroughly consider what you want out of the practicum. Is it a step forward for your professional exposure within public health? Is there a personal experience you would like? There are lots of options…take a risk and have fun!