Category Archives: MPH news

Women’s Health in Gaborone, Botswana

Botswana UPenn office

Botswana UPenn office

The week of Thanksgiving, 2015, was warm and dry in Botswana as the season turned toward full winter that is, full summer, here in the Southern Hemisphere). I am fortunate to have this time for fieldwork experience with the Botswana-UPenn Partnership, the Fellowship in Family Planning, and the Penn Master of Public Health program, immersed in women’s health care in Gaborone, the country’s capitol city under the mentorship of Dr. Chelsea Morroni.

Botswana

Botswana

Maternal and child health, particularly cervical cancer prevention and pregnancy planning, has been a key issue here. Botswana has been strongly affected by the HIV/AIDS epidemic, with 23% of the adult population infected, including 30.4% of reproductive-age women. Human Papilloma Virus (HPV) co-infection has made cervical cancer the leading cancer among women. The Cervical Cancer Prevention Program (CCP), established by Dr. Doreen Ramogola-Masire at Princess Marina Hospital, provides excision of precancerous lesions of the cervix for women referred from one of several cervical cancer screening clinic sites in Gaborone. The Women’s Health Clinic at PMH provided care to over 1300 reproductive age women in 2014, only 10% of whom were using a World Health Organization (WHO) tier 2 or 3 (moderately effective) contraceptive method, and CCP is a well-established and widely accepted part of preventative health care in Botswana.

In fact, unintended pregnancy is estimated at 44-50% of all pregnancies in Botswana, even though the Ministry of Health provides free family planning services. A significant barrier is that family planning services are not available in many gynecology clinics, including the CCP sites; women must visit a specific FP clinic for contraception. Visits to both clinics cannot be done the same day, due to scheduling conflicts. Women who lack access to education or are from rural areas have borne the brunt of the burden of unmet contraceptive need in Botswana: although they have been able to receive care through the CCP, making the long journey to Gaborone on a separate day to obtain family planning has limited contraceptive access and service utilization.

Group from Contraceptive Training

Group from Contraceptive Training

My visit is focused on the initial steps for integration of cervical cancer prevention and family planning services. During my stay, I am working with key stakeholders who lead the CCP clinics, provide expert family planning consultation to the Ministry of Health, and direct the inpatient and outpatient OB/GYN services at Princess Marina Hospital. I am training the CCP staff on contraceptive counseling and intrauterine device (IUD) and contraceptive implant insertions, based upon the WHO’s Decision-Making Tool for Family Planning Clients and Providers.

This work will form the foundation of an upcoming clinical intervention and implementation study. The study will assess the acceptability and feasibility of incorporating family planning services into CCP care, and will measure the effectiveness of the contraceptive counseling, plus on-site IUD and implantS availability, on uptake of highly effective contraceptive methods for women seeking cervical cancer prevention who wish to delay pregnancy.

The “IUD at CCP” program will help fill the gap in contraceptive access in Botswana, by focusing on the importance dual method use (condoms for HIV prevention plus a highly effective contraceptive method for women not seeking pregnancy) at the time of cervical cancer screening. This will bring services to a setting that is convenient for the women with the highest need. Provider training in contraceptive counseling, and clinical training in IUD insertion techniques, as begun with this work, lays the groundwork for this program. A long-term, comprehensive implementation strategy including ongoing community education and garnering of public buy-in, with continuing provider trainings in shared-decision making and IUD and implant insertion techniques, will be needed for the continuing growth and success of this program.

It is my hope that I, and future public health practitioners and physicians, will be able to visit the warm, welcoming city of Gaborone in coming years, to participate the growth and witness the success of the IUD at CCP program.

Written by Elizabeth Gurney, MD, 2nd year Family Planning Fellow at the University of Pennsylvania

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Travel Blog: Summer 2015 Public Health Work in Chicuque, Mozambique

Check out the Travel Blog of our amazing MPH/MSN student, Joshua Littlejohn.  He is working in Mozambique with Y-Center, a social innovation company that operates in Mozambique and India, for 12 weeks during the summer of 2015. The larger project that he is a part of is called Connect The Dots and is an SMS text-based system for disease reporting and supply inventory designed to connect community health workers (CHWs) with the central Ministry of Health. Josh’s project will be to work with the CHWs and local resources to create new visual media for use in education campaigns. These materials should be low-cost, easily reproducible, low-tech, and locally relevant.

He just uploaded his 2nd post: Map to Nowhere


 

First, I’ll give the basic run down of my week and then we’ll talk about some of the more existential stuff, that’s the fun part anyway. My week is pretty structured for not having a formal schedule or anything. Since I can’t sleep with all this friggin sunlight (hey, I’ve almost only ever worked night shifts, even before I was a nurse) I get up between 6 something and 7 something every morning, even without an alarm clock. My bucket bath in the morning is a great eye-opener and by the time I’m done with that I *almost* don’t need coffee… almost…

This week was the first actual week of work since Dr. Arlindo (the director of CoH) was back from Maputo (the capital) and the three missionaries were in the office. Actually, I think only two of them, Rose and Elfie, are missionaries and the third woman, Pastor Marcia, is local and works for Dr. Arlindo. Elfie is a nurse and Rose did a degree in health sciences and management. They are with the Methodist Church and Rose does the accounting and such for projects while Elfie works on developing the health projects that CoH conducts.

They get here between 7:30 and 8:30 and we have a small breakfast together usually. I’ve most likely had two cups of coffee by that point. Dhairya and I take our stuff into the work room down the hall on the work-side of CoH and make camp for the day at the collection of tables down there. I’ve been working on prototypes of the materials and gathering information about the area, thinking about the realities of life here, and how best to integrate what little information I have collected so far into some sort of meaningful messages.

UNISAF Y Center Banner

UNISAF Y Center Banner. The inside of the University. It is basically a giant O shape/square

Maria, who works at CoH in a general-help kind of position, usually puts out a small lunch of bread and cheese, tea, and maybe some boiled eggs. We eat together and chat a bit, then back to work and maybe a meeting with either Dr. Arlindo or the public health team (PHT – Elfie, Rose, and Pastor Marcia) The official work day ends about 3:00 and they actually kick us out of the work-side of CoH so that Manuel (Maria’s counterpart) can lock everything up. Sometimes he’s a bit over zealous and locks things up like the silverware … or dishes… lol.

I’m most likely not done doing whatever it was that I was working on, so I move back to my room and use the desk in there to work some more. I’ve thoroughly spread myself out over the entire room and used every surface that I could. In fact, I’d probably go crazy if there was another person in here with me to share the space… it’s been a long time since those undergrad years when I actually had to share a *room* with someone (not just an apartment).

UNISAF Y Center Banner1

UNISAF Y Center Banner1 UNISAF. The University in Maxixe that we work with sometimes.

I’ve taken a few afternoon trips

 

Fear and Safety at Penn: A Collaborative Student Research Exhibit

Check out Penn WIC’s new blog post about Dr. Rosemary Frasso’s Qualitative Methods graduate course for Social work and Public Health Students!


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Dr. Rosemary Frasso, Allison Golinkoff (TA) and graduate student research team – Qualitative Research Methods for Social Work (SW 781)

Research seldom happens in silos.  Be it through the literature review, data collection, or publication, group collaboration is the ingredient that brings new ideas and perspectives to the research process.  It is with this spirit that Dr. Rosemary Frasso (Rosie), Allison Golinkoff (TA), and the student researchers of the Qualitative Methods graduate course for Social Work and Public Health students took teamwork to new heights this spring in theVan Pelt Collaborative Classroom.

From the start, the student researchers employed qualitative methods (Nominal Group Technique) to collectively determine the research topic of “fear and safety” at Penn. Next, each individual student-researcher conducted 5 intercept Freelisting interviews across campus to explore the topic. Using the full 360 degrees of writable whiteboard surfaces in the Collaborative Classroom, students began the process of analyzing Freelisting data to identify salient themes.

FreelistingFrassoCCSpring2015

Student researchers begin organizing Freelisting data in the Van Pelt Collaborative Classroom

Inspired by the work of Drs. Carolyn Cannuscio,Mariana Chilton, and Gala True, Rosie designed this class project employing Photo Elicitation interviewing.  Students later made use of this same technique to further explore the meaning of fear and safety across the Penn community.  As a team, the class selected a sampling strategy and each student-researcher was tasked with recruiting a participant from within the Penn community to explore how she/he perceives fear and safety.  Over the course of one week, research participants used their smartphones or cameras to take photographs of any aspects of their daily lives that made them think of fear or safety.  The photos were then used to guide an interview between the researcher and the participant about those topics.

Dr. Frasso turned to group collaboration in the Collaborative Classroom as a strategy to help the student researchers make sense of the sizable amount of data they all collected.    Through collaborative analysis, student researchers found that their participants’ views on fear and safety revolved around eight thematic categories: vulnerability; sense of belonging; fear of failure; surveillance; physical and mental health; fear of the unknown; sources of comfort; and spaces and places.

The student researchers of Dr. Frasso’s class see their research findings as a potential catalyst for change at Penn.  To this end, they have made their work visible in many ways.  You can view their research exhibit, complete with photos and participant quotes, just outside the Van Pelt Collaborative Classroom (right before the WIC entrance, to the right).  Students also plan to share their findings with key members of the Penn community such as President Amy Gutmann, CAPS, and GAPSA.

For more information on displaying your students’ work or using Van Pelt’s Collaborative Classroom for enhanced teamwork and engagement, visit: http://www.library.upenn.edu/facilities/collab.html.

Freelisting2FrassoCCSpring2015exhibit-1500px

Written by: Catrice Barrett

Arrest on the Run: How a Penn MPH Student Saved a Life Using CPR

On Sunday, May 3, 2015, Kelsey Sheak, a 2015 Master of Public Health Candidate at the University of Pennsylvania, woke up and prepared to run the 10K Broad Street Run.  Shortly after starting the race, she noticed a crowd gathering around a collapsed man. Upon arriving at his side, Kelsey immediately put her CPR training into action.  Kelsey was one of the many bystanders who helped this fallen runner survive from his cardiac arrest.  Read her full story below.


 

Kelsey Sheak, 2015 MPH Candidate

Kelsey Sheak, 2015 MPH Candidate

CPHI: We heard you performed a life-saving procedure at the Broad Street Run on Sunday, May 3, 2015.

Kelsey Sheak: I did!  I was running and between miles 2 and 3 I saw a crowd of people. There was a gentleman in the center of the crowd and he was clearly having a medical emergency.  Shortly after I arrived, he lost his pulse.  Once he lost his pulse, a group of bystanders and I started administering cardiopulmonary resuscitation (CPR).  We communally performed CPR – one person would start, another person would step in, and so on.  After about ten minutes in, the Philadelphia Police Department came with an automated external defibrillator (AED). The police are trained on how to use AEDs and to provide emergency medical care. They took over for all the bystanders and the patient was shocked and taken to the hospital.  We were sent on our way and told to continue running. It was a little weird!

CPHI: Let’s back up for a minute. You are a Master of Public Health (MPH) student, but clearly you are well trained in CPR. What is your background?

KS: It’s crazy because 40,000 people ran the Broad Street Run and for me to come upon this is just mind-blowing – really serendipitous.  My background is in cardiac arrest research and education.  By profession I spend my days learning as much as I can about CPR and ways to improve it, ways to disseminate it, and ways to make survival much better.  To come across this situation where I needed to use it was crazy.

CPHI: Who were other bystanders?

KS: Most of the people that were helping the collapsed runner had medical backgrounds: nurses, a physician, and me.  The most important take-home message is that he didn’t need a medical professional; he just needed someone to recognize that he was in cardiac arrest and that he needed CPR.  Anyone who is trained can do that.  If you’re not trained in CPR, you should be!

CPHI: How was it meeting the collapsed runner the next day in the hospital?

KS: I went to the hospital after he arrested and I was able to meet his family.  They were very nice and very thankful.  I’m happy to know that he will go back to having a normal life.

CPHI: I want to take a moment to address a common misconception: many people think a heart attack is the same as a cardiac arrest. Can you help clear up this confusion?

KS: A cardiac arrest is when your heart stops and blood flow stops to the entire body.  With a heart attack, your heart doesn’t stop; rather, there is a blockage. Generally, people who have a heart attack have chest pain, they go to the hospital, and they can recover.  Cardiac arrest generally happens with little to no warning and people are generally healthy when it happens.  It can happen for a lot of different reasons and everyone’s reason is different.

CPHI: Is there a most common reason why cardiac arrest happens?

KS: There isn’t a most common reason – but there are situations that are most savable.  The gentleman at the race had a savable arrest because he had a shockable arrest.  This means that his heart was in a rhythm that a defibrillator could recognize and turn into a healthy heart rhythm.  Places like airports, casinos, and races are places where lots of cardiac arrest victims do well – there are numerous educated people around and these places are heavily watched. But there are also places where people don’t do well – like low-income neighborhoods, which are less likely to receive bystander CPR.

CPHI: After you helped save a fellow racer, did you continue running?

KS: Yes, I finished the race!


 

For more information about CPR and cardiac arrest, please visit the Penn Medicine Center for Resuscitation Science website.

Event Recap: The State of the State: Opioid Use and Misuse in Philadelphia

It was a pleasure to hear two inspirational people – Dr. Brian Work (MD, MPH) and Ms. Samantha Gross (JD, MPH) – talk about their paths to and work in community health at the Service Link, MedX, and Wharton Undergraduate Healthcare Club (WUHC) speaker event on Friday, April 10, 2015. My reflection can best be captured by the following lessons in career paths and working with community health.

Brian Work & Samantha Gross

Brian Work & Samantha Gross

On your journey to community health, remember:

  • Take advantage of serendipity
  • Nothing is irrevocable
  • Appreciate conversations / advice from people (even if unsolicited)
  • Participate in community work now! It’s called “practicing” medicine for a reason – it needs to become a habit. Life will already be full if you don’t prioritize community work now.

Community work embodies how medicine can improve with an interdisciplinary approach:

  • Community work makes Brian a better hospitalist
  • Community allows for engagement with a more diverse setting with more collaboration (e.g., medical-legal partnerships) instead of becoming too focused on a comfortable setting and subsequently isolated
  • Both medical treatments and legal policies are about harm reduction!

speaker event aprilAll of these insights and more were facilitated by our smooth moderator – Matthew Kearney – and packaged through Brian’s exuberant charm and Sam’s calm confidence. Look out for more at Service Link’s next speaker event (once per semester).

 

Written by: Neel Koyawala, Class of 2015 College of Arts and Sciences and the Wharton School at the University of Pennsylvania undergraduate student