Master of Public Health Series-Do I Recommend an MPH, Post 3

Welcome back!

One year ago today I graduated from USC with my Master of Public Health degree. It was an exciting day filled with celebrations and happy memories but I also couldn’t help thinking about my next steps in life. I know I’m not alone in feeling this way and that once the celebrations end we know it’s time to get back to work.

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In honor of closing chapters and beginning new ones, here is the final post in this series. I really hope that the information is beneficial and that regardless of what you all decide, celebrate your accomplishments and keep your head up.

Would you recommend a Master of Public Health Program?

I usually get asked this question by pre-meds and every once in a while someone interested in a career in public health. I’ll answer this question in a way that will hopefully help people considering either option (a career in medicine or a career in public health).

For pre-meds:

Pre-meds considering an MPH are doing so for a variety of reasons. These reasons may include: 1) Wanting to obtain another degree while simultaneously applying to medical school, 2) Wanting an MPH to enhance the way they practice medicine in the future, or 3) Wanting to pursue an MPH because it may be an opportunity to improve their medical school application academically or otherwise.

If your reason is number one, you want to obtain another degree while applying to medical school so that you’re actively doing something during your gap year, it’s a great idea to do an MPH if you’re interested in public health. If you’re not too interested in public health and want to save the tuition money, there are other options. For example, you can consider doing a research fellowship, develop your hobbies, or get a job. My message is, consider the cost of tuition of an MPH program in addition to medical school tuition. If it’s worth it, go for it! If you’re hesitant about going through more schooling but want to actively do something during your gap year, there are options. I know of someone who went to Johns Hopkins to do research for a year before beginning medical school. I know a lot of people are told to consider an MPH after undergrad if they’re not going directly into medical school, especially because more schooling is the easiest option but really do think about what it is you want to do and search for the opportunities that fulfill your needs (there are an unbelievable amount of things to do, it just requires you to actively look for these opportunities).

If your reason is number two, you want to pursue an MPH because you believe it will make you a better doctor, good for you! I am of the opinion that every physician should have extensive public health training/education, especially because healthcare is changing so much and will change even more in the years to come. It is so important to be able to understand policy changes and how these policy changes impact the communities you seek to one day serve. An MPH will only serve to make you a better, more well-rounded doctor. I’ve also noticed that so many physicians in positions of leadership have an MPH degree and that an increasing amount of medical students are choosing to pursue an MPH degree in conjunction with their medical degree. In this scenario there are a couple options, you can choose to get your MPH prior to beginning your medical education or you can get it sometime during your medical training. Each option has its own set of pros and cons but both will allow you to obtain an MPH and a valuable set of skills.

Thought I’d make a couple charts for you all of the pros and cons of each option haha.

 

MPH PRIOR MEDICAL SCHOOL

PROS CONS

More time to engage with the field of public health and participate in more activities and research opportunities.

Lessons and skills you learn can be applied to your medical education and the activities you choose to participate in from the beginning.

Pay for 1 ½ to 2 years of tuition.

Spend 1 ½ to 2 extra years in school as opposed to just one extra year (consider doing a cost/benefit analysis since that comes to one year of lost income and more loans you might have to pay off).

MPH DURING MEDICAL SCHOOL (AFTER 2ND OR 3RD YEAR)

PROS CONS

Spend 1 extra year in school.

Pay for only 1 extra year of schooling rather than 1 ½ to 2 years.

“Break” from the intensity of medical school.

You can better contextualize your medical education and an MPH gives you a chance to further develop yourself personally and professionally and to better figure out what kind of doctor you want to be.

You don’t have a chance to take as many, if any, class electives meaning you take just the track requirements (every program has different tracks including epidemiology/biostatistics, global public health, public health communications, etc).

You don’t have as much time to participate in various public health activities.

 

 

If your reason is number three (you want to improve your overall application), you actually have several options in addition to pursuing an MPH and your decision will ultimately be based on where you want to be in the future and what your short- and long-term goals are. Your options include an MPH, a Master of Science program (there are a lot), a post bacc program, or a non-traditional post bacc. Each option comes with its own set of benefits and drawbacks. I’ll discuss each option briefly but before you make a major decision, I urge you to consider what it is you want to accomplish and to do your research.

Doing research includes one or more of the following actions: doing online research about medical school statistics/mission statements/etc (get a better sense of where you stand in the application process), talking to the pre-med adviser at your school, talking to college professors aware of the medical school application process, and/or reaching out to people on the admissions committees of the schools you are interested in. Keep in mind that it helps you make a more informed decision if someone has a comprehensive idea of your application.

Post Bacc– If you think that you need to improve your medical school application significantly academically or otherwise, consider doing a one year post bacc program. The grades you receive in your classes (which are similar to undergrad courses) will help improve your GPA. Additionally, post bacc programs provide its students with resources geared at helping students succeed throughout the application process. From MCAT assistance to interview prep, you’ll have an opportunity to improve your application and become a more desirable candidate.

MPH– An MPH can improve the overall look of your application if you’re purposefully obtaining the degree. Once again, I think an MPH is great and only serves to improve your approach to medicine and healthcare administration. Moreover, depending on the school, a couple of your MPH classes (ex: biostats) may count towards your science GPA.

Master of Science– There are so many Master of Science programs, all in a variety of topics. Some are offered for the sole purpose of helping pre-med students get into medical school (ex: USC Master of Science in Global Medicine, clinical track. Some medical schools, like Rosalind Franklin, have M.S. programs where if you do well throughout the program you get offered a medical school interview or admission into the medical school. Be sure to ask about and look into these programs because there are several, each with different requirements and standards).

Like traditional post bacc programs, a significant amount of M.S. programs offer students resources to improve their medical school application as well as opportunities to either participate in interesting research projects or medically relevant extracurriculars.

One thing to keep in mind with M.S. programs is that you should be more or less committed to pursuing medicine. I say this because, unlike an MPH program, the functionality of some (not all) of these M.S. programs is limited once you graduate. This means that if you do decide that medicine is no longer for you, an MPH might better prepare you for the workforce than an M.S. program (either way, finding a job is tough). I’d definitely consider talking to alumni of both types of programs to make an informed decision.

Non-traditional post bacc– Some students choose to do a non-traditional post-bacc, meaning they don’t enroll in any programs but they take extra undergraduate classes (specifically upper level science courses) through extension at a four-year university. These courses will factor into their undergraduate GPA so take classes you know you can do really well in. This isn’t a highly recommended option but it it is an option. Oftentimes the students who choose to do this reach out to an admissions counselor at various medical schools they’re interested in to see how an admissions committee might perceive these extra classes. If you prefer this option, I’d definitely consider talking to schools before proceeding.

For pre-med/medical students set on obtaining an MPH degree and aspiring public health professionals:

If you decide to pursue an MPH, I suggest you do some research and look for the program that offers you with the best academic, personal, and professional environment. I really wish I had done more research prior to applying to MPH programs but I am happy with how things turned out overall.

The best way to do your research is to start off by doing some self reflection in order to figure out what areas of public health you’re interested in and to begin thinking about what sort of public health career you want. Once you’ve decided what area or areas of public health you’re interested (areas include but are not limited to biostatistics/epidemiology, public health communication, public health education, public health policy, maternal and child health, environmental health, global health, etc) begin looking at each school’s curriculum, classes, and resources. No two public health programs are alike and each program specializes in different areas based on the research they’re actively involved with. When choosing a program, also consider the location. For instance, if your school is close to the state capitol you can probably get more opportunities to engage in public health policy work (so important!). Or if your program is located in a major city like Los Angeles, you can better engage with the numerous public health issues impacting Los Angeles communities. The same concept applies for programs located near rural areas. It really depends on what sort of public health issues and areas interest you.

Once you’ve looked into different programs and decided on a few programs you’re really interested in the next step is to talk to alumni and current students of each program. Most schools will have student ambassadors or a directory with contact information you can use to network. Be sure to ask questions like:

  1. What resources are available to students?
  2. What does the program’s professional development look like?
  3. How diverse is faculty and staff?
  4. What does the faculty-student relationship look like? Is there an open door policy and chances for mentorship?
  5. Are there research opportunities? How many students do you know engage in research?
  6. What sort of opportunities are present through the program (ex: extracurriculars, fellowships, community engagement, etc.)?
  7. Is there financial support (ex: travel grants) for traveling to conferences or participating in public health work abroad?
  8. What is the quality of the education? Do professors spend time teaching the subject well? Is it independent study? Are the professors invested in their students? What are the priorities of faculty and staff?

Another great resource for answers regarding each program is the Council for Education on Public Health (CEPH) report. It’s usually a long document (the document should be on a program’s website) but it will detail where each program falls short or what aspects of the program need improvement. The report results are based on several factors from faculty and staff interviews to anonymous and randomized student interviews (they will ask alumni and current students). CEPH is the accrediting body of all public health programs, it’s important that the program you’re considering is CEPH accredited.

I’d also consider identifying whether the program is offered through the school of public health on the campus you’re looking into or nested under a much larger school alongside several other programs (ex: UCLA has the Fielding School of Public Health; USC has the Department of Preventive Medicine which is housed under the Keck School of Medicine). This is important to determine because it hints at the priority level of the program. Priority level can determine allocation of funds and resources which, in the case of campuses like USC, will be divided amongst several graduate programs.

Prior to applying you might also think about visiting graduate school fairs that are hosted by college campuses near you. These graduate fairs will give you an opportunity to interact with program admission representatives so that you can ask about the application and admission process.

The last thing I want to mention regarding MPH programs is that a lot of schools have or are beginning to create an online version of their programs. This allows students to learn at a particular institution from another city or state. This option is convenient for individuals already working full time jobs or have other commitments and require the academic flexibility. The experience is completely different and I can’t speak much about it but if this option interests you or you want more information I know someone who completed their MPH online.

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I’m sure that there’s so much more to say about my experiences and the decision making process but I hope that the answers provided in these posts help you figure out what to do. Don’t be harsh on yourself if you don’t have everything figured out, I know I didn’t but asking questions and doing some self reflection and research will get you to where you need to be sooner. And if you’d like to discuss more, I can be reached at goingbeyondtreatment@gmail.com. I’m always happy to help!

 

 

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Master of Public Health Series-What I Learned, Post 2

This post includes my answer to question 2! (Check out post one of this series here)

What did you learn from your program or what did you value most from your experience?

There are so many aspects of my experience that are worth mentioning. For the sake of simplicity, I made a list of the three most important aspects along with a brief explanation below.

  • The field of public health is vast and diverse.

Public health is an incredibly vast field with a variety of opportunities. From academics to research to community advocacy to policy work at the local, state, or national level, a career in public health can look like so many different things. This concept is simultaneously amazing and daunting because it means you have to quickly figure out what you want to do with your public health degree. And although it can seem like a stressful process, it is rewarding.

I personally really value that public health is so diverse professionally. It means that public health work is active in several aspects of our lives and I think that is really wonderful. Also, the opportunities that individuals in public health seek are not divorced from their personal backgrounds meaning that you’ll have the opportunity to interact with people from so many different ethnic, racial, social, and professional backgrounds. Personally, I’ve met people who worked on political campaigns prior to pursuing an MPH and people who are pursuing an MPH alongside their Master of Social Work or Doctor of Medicine degrees. There’s also a lot to learn from the people you meet in this field; there is absolutely a wealth of knowledge in public health and it’s so exciting! Basically, there’s something for everyone interested in improving public health. 

  • This graduate program and field, like so many others, requires you to be an active participant in your personal and professional development.

 It’s not enough to go to class and do the assigned work to succeed in this program/field. Any job you look into, especially ones in public health, require you to have a significant amount of experience. So it’s important to really consider what your interests are and where your passions lie.

Your success in this program and in the public health field is really what you make it. It’s tough to get a job upon graduation, but it’s critical that you leave having gained valuable experiences and skills. No public health program is going to provide you with a method, tailored specifically to you and your goals, to get you to where you personally want to be. A program may provide you with various avenues and options to pursue, however, they may not be what you want. There is an endless amount of possibilities in public health so don’t be afraid to get creative. Take the time to research, self reflect, and apply to programs that interest you. Ultimately, the program’s job is to enhance your current skillset and provide you with the tools necessary to reach your goals.

  • Networking is so important!

 I think this point speaks for itself. As I mentioned earlier, there are several ways to create a public health career. And honestly, there may only be one other person in your program who is interested in the same things you are. Because of these conditions it’s really important to find people (in the nation or internationally) who are doing work you’re interested in or are in the position you want to be in three, five, or ten years from now.

It really doesn’t matter if you’ve met or know these people personally but it does matter that you reach out and establish connections because they will help (I promise)! When you reach out to people start with an informational interview; learn more about what they do and how they got there. You can also engage in meaningful conversations around current public health issues and ask them for their thoughts. This is a difficult process because the people you admire are also really busy so be sure to keep that in mind but be persistent. And once you do connect, ask them to be your mentors! Regardless of what stage you’re at in life, it is so so important to have mentors, people who can help you focus and can help you keep your eye on the prize.

  • Public health and health care administration is a team effort.

This is something I truly value in public health. There’s really only one end goal, create and maintain healthy communities, and everyone is working towards it. People may have different opinions on how to reach that goal and different methods may be tested but the end goal always remains the same. I personally always loved the team aspect of public health because I love interacting and learning from different people with different backgrounds; it really does take several voices to make positive change and positive change only happens when everyone has a seat at the table.

I also wanted to briefly discuss a few experiences that are significant to my personal and professional development from my graduate studies.

  1. The first experience I want to mention is my trip to Sacramento which was set up through one of the elective courses (course name: Public Health Policy and Politics) I decided to enroll in. For two days, my class and I went to Sacramento to attend the Insure the Uninsured Project (ITUP) conference, tour the capitol of California, and meet with policy makers. The purpose of the trip was to better contextualize public health politics and policy, the law making process, and advocacy through policy. It was a very informative trip!
  2. The following experience was also set up through one of my other elective classes (course name: Program Evaluation). My professor wanted us to apply the program evaluation concepts we learned in class to a real life public health program. So while we simultaneously learned how to use STATA (data analysis software) we also evaluated a medical legal partnership program offered to families with foster kids through the USC+LAC Medical Center. We collected data as a class but individually evaluated the data as our final class project. The program’s idea was amazing, I think offering foster families legal and medical advocacy together is a great idea. While the mission of the program was great, collecting data and evaluating it to assess its effectiveness was difficult. It wasn’t that the concepts we learned in class were hard, it was that dealing with other institutions and several people made the process slightly more difficult. In addition to learning how to evaluate the program, the experience offered me a glimpse into how work gets done in the real world and that proper communication is key (it may seem like a straightforward concept but trust me, you need the experience to be able to claim communication as a skill).
  3. The last experience I want to mention is one that was not offered or mentioned through my program but was one I researched and referred to me by a friend outside of my MPH program. The Albert Schweitzer Fellowship is hands down the most valuable experience I’ve had. The fellowship gives graduate students an opportunity to create a community service project. With the help of my mentor from college, I organized and implemented a yoga program that provided survivors of sexual violence with a safe space for healing and a space to regain self efficacy. If you’d like to learn more about my experience and what I did, check out this blog piece published on the Albert Schweitzer Fellowship site: http://www.schweitzerfellowship.org/news/healing-from-abuse-through-yoga/. I also submitted an abstract regarding my fellowship project and results for presentation to the American Public Health Association (APHA). Thankfully, it was accepted and I got the chance to present at the annual APHA conference in Chicago. I mentioned this experience mainly to highlight that your public health program experience is what you make it, be sure to take the time to find the opportunities that will help you develop your personal and professional self.

Master of Public Health Series- Why I Pursued an MPH, Post 1

Recently I’ve had a few undergraduate students and individuals considering graduate school ask me a few questions regarding my Master of Public Health program experience. There are usually three main questions that I get asked:

  1. Why did you pursue a Master of Public Health  Program?
  2. What did you learn from your program or what did you value most from your experience?
  3. Would you recommend a Master of Public Health Program?

I thought it might be helpful if the answers to these questions were made available to anyone interested in an MPH or medicine. I’ll be answering the questions above over a series of three posts, beginning with question one here (my initial one post was really long so I figured breaking it up would make the information more digestible and easy to read).

I hope that my answers are beneficial and if anyone reading this post has any further questions, feel free to send me an email at goingbeyondtreatment@gmail.com. I’d love to help in any way I can!

Why did you pursue a Master of Public Health Program?

When I graduated college I was not 100% committed to going into medicine. I was still interested in becoming a practicing physician but I wasn’t sure if being a physician was something I wanted to do for the rest of my life. My issue back then was that I didn’t see the connection between public health/community/social justice and the practice of medicine. This disconnect was extremely frustrating to me, and it still is.

The one thing I knew for sure when I graduated undergrad was that I wanted my career to be focused on social justice, community, and advocacy work. I also really loved the sciences and epidemiology. So based on my interests and professional desires, pursuing a Master of Public Health degree was the logical next step.

To me, the public health field presented itself as a platform where I could learn about and address the complexities of healthcare administration, food insecurity, green space access, violence, and so much more. Living in Los Angeles, interacting with people from so many different walks of life, and being the daughter of immigrant parents compelled me to transform my vision of healthcare. Throughout my life and my studies, I quickly came to learn that health and disease are not divorced from our social contexts. In order to adequately address the healthcare needs of any individual, one must have a comprehensive idea or understanding about how an individual’s economic and social background impacts their health behavior and ultimately their well-being.

At the conclusion of my first semester in the program I made up my mind to pursue medicine. I recognized how the field of public health seeks to go beyond the dichotomy of hard sciences and social sciences in order to create solutions that will improve the health of others. One of my goals is to challenge the conventional approaches of medicine and I’m hoping to implement the interdisciplinary knowledge and methods I learned throughout my graduate education to my practice as a physician.

I think that obtaining an MPH and working exclusively in the field of public health is beyond amazing and rewarding (I’ve seen peers do incredible things), however, based on the goals that I have in mind, an MPH alone is not enough to get me to where I want to be. Moreover, a medical degree alone is also not enough for me to achieve my goals. I have no doubt in my mind that my MPH education and experience was an integral part of my personal and professional development. I continue to be so grateful that I had the privilege of pursuing an MPH.

Public Health & The Built Environment – Flint, Michigan

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The environment in which we are born, grow, live, and age impact our health, wellbeing, and quality of life.

I often wonder and question how effective healthcare delivery can be without a comprehensive understanding of the factors that impact and drive disease. In an effort to continuously educate myself about how the environment contributes to various public health issues as well as to inform others, I’m beginning my first series on this blog titled “Public Health and the Built Environment.”

The built environment refers to all of the physical parts of where we live and work, including homes, buildings, streets, open spaces, and infrastructure. Largely, the construction and development of the built environment is not controlled by communities but by policy makers, businesses, architects, and engineers. Because community members are not consulted or involved in the creation of their environment, we can imagine that what non-community individuals believe is ideal may not actually be ideal for members of the community.

Currently, we’re seeing a myriad of preventable health issues arise as a result of dysfunctional built environments that house and employ communities, particularly low socio-economic communities and communities of color. The most disappointing thing about these emerging public health issues is that their impact is long lasting. Oftentimes, it takes years to resolve the source of the issue. However, even if the environmental problem is fixed, the damage is usually irreversible. After all, what happens to you early in life will impact the rest of your life and can have adverse effects on families.

For the first post in this series, I want to discuss the Flint water crisis. I want to focus on this issue as not only a public health emergency but a result of a built environment that failed to secure the health and wellbeing of the community.

When the news first broke out, we were alerted that several children had lead poisoning as a result of being exposed to contaminated water. I say “exposed” because we not only use water for drinking, but for cooking, brushing our teeth, bathing, agriculture, and the list goes on. It’s clear that water is essential for sustaining life which also makes it one of the most important mediums through which disease is transmitted.

The Centers for Disease Control and Prevention (CDC) states that there is no safe blood lead level in children. The CDC also states that 5 micrograms per deciliter of lead in the blood is considered “elevated” and public health interventions must be initiated. In Flint, blood lead levels were found to be more than seven times higher than the level classified as “elevated”.

How crazy are those levels?! Lead is an extremely detrimental environmental toxin. High levels (or any level) of lead in a child’s system is associated with increased behavioral problems, delayed puberty, and decreases in hearing, cognitive performance, and postnatal growth or height. These outcomes will most likely result in lower academic achievement; and it is documented knowledge that education is intimately linked to income. In adults, the presence of lead in the blood could result in increased blood pressure, a degenerative disorder of the central nervous system, and decrease kidney function. Pregnant women need to be particularly careful as any presence of lead in the blood can reduce fetal growth.

Dr. Hanna-Attisha said it best in the NY Times article titled Flint Weighs Scope of Harm to Children Caused by Lead in Water, “If you were going to put something in a population to keep them down for generations to come, it would be lead.”

It’s clear that the adverse health outcomes linked to lead poisoning will likely impact an individual socially and economically (think education/academics, income, and spending).

So, what happened to Flint’s water supply? And what does that have to do with the built environment?

In April 2014 Flint changed its water source from the treated Detroit Water and Sewerage Department (which is sourced from Lake Huron, one of the largest bodies of fresh water in the nation) to the Flint River (a source of water which was found to be highly corrosive). The corrosive nature of the water from the Flint River caused the lead from aging pipes in the water infrastructure to leak into the water supply. And without an effort by the city to control corrosion, high levels of lead-contaminated water reached Flint residents.

Flint’s poor water system pipes, included in the city’s built environment, impacted the community in permanent and irreversible ways. And as I mentioned earlier, the built environment largely determines how healthy and successful our communities are.

It may seem shocking to see this crisis unfold because many of us would like to believe that this would not happen in a first world country. And although we have made significant improvements to water quality through the development of sewer systems, regulations for the treatment of sewage, and sanitation methods, our water quality is still jeopardized when water systems are not carefully monitored or regulated by the institutions responsible for water quality maintenance.

So, who controls water supply safety and quality?

The federal government relies on states, local governments, and water providers to monitor and maintain the safety of their water infrastructure. Due to budget cuts in the first decade of the 21st century, water quality maintenance became more self-regulated. Unfortunately, as we see in Flint, there are some critical gaps in the regulatory system of our water.

In his book, titled The Built Environment and Public Health, Russ Lopez states that “many violations go unreported or if they are reported, a simple promise to remedy the situation is all that may be required of a water provider.” The failure of monitoring protocols alongside inadequate infrastructure can lead to disease outbreaks and poor health outcomes. Basically, our public water systems are vulnerable.

And the aging water infrastructure does not help. Lopez continues to say that “despite the fact that almost all systems charge users fees and most receive public funding, the overall ability to meet the fiscal challenge of infrastructure remains constrained.” But my question is, doesn’t it place a much bigger economic burden to fix a problem as large as Flint?

To prevent what happened in Flint it would have only cost $100 a month for three months. That’s $9,000. But now, with Flint’s public health crisis, the State may have to pay upwards of $1.5 billion. The difference in cost is extremely significant! And not only for the State but for the residents of Flint who are going to be required to pay for additional resources like medical care.

What’s happening in Flint is not over; there is a new piece of information or news that arises almost everyday. In an effort to keep this post from getting much longer than it already is, I’d like to highlight a couple news stories that I believe are relevant to a deeper understanding of this public health crisis.

  1. http://fusion.net/story/258628/undocumented-immigrants-flint-water/ . Undocumented citizens are impacted by this public health crisis in a unique way. At first, they were unaware of an issue with the water and, unfortunately, several kept drinking tap water until about a couple weeks ago. Once they became aware of the issue and tried to access cases of water from local institutions, they were unable to because they were asked to present ID or social security. Recently, the requirement to show ID has been lifted allowing undocumented families to access water.
  2. https://www.washingtonpost.com/news/energy-environment/wp/2016/01/27/how-cases-like-flint-destroy-public-trust-in-science/ . I thought this was an extremely interesting piece about public trust and government science agencies. It puts a lot into perspective and suggests potential solutions for how to proceed in order to 1) prevent another crisis and 2) restore or preserve public faith in science.

One last thing I want to mention is that Flint is not the only community impacted by poor water infrastructure and terrible regulatory practices. Our water systems (thus our water quality and safety) are vulnerable and I believe it’s important to advocate for proper systems maintenance and regulation.

I would like to continue and discuss the importance of public health and community advocacy but I’ll save that for another post. If you made it this far, I hope this post was informative! And I hope you continue reading the next posts in this series that will highlight other aspects of our built environment and their impact on community health.

Recognizing the International Day for the Elimination of Violence Against Women

I know many people would like to believe that violence against women is becoming a thing of the past as we continue trying to create a world of equality. However, that is not the case; violence against women is a significant and often neglected public health epidemic.

I am pleased to see the discourse around violence against women slowly begin to change as campaigns like NO MORE are launched in America. But it is not enough. Especially when rights to reproductive health resources are threatened (reproductive coercion is a form of domestic violence and is probably exacerbated as the discussion around Planned Parenthood continues). Moreover, we rarely have discussions on how violence against women can be compounded based on a women’s race, sexual identity, ethnicity, class, and age. The lack of discussions integrating knowledge about women’s intersectional identities can lead to lower rates of reporting and/or a decreased likelihood to seek resources. An individual’s perception of trust, safety, and community are critical factors that help an individual determine their best course of action.

Having said all that, I’m glad that today, November 25, is the International Day for the Elimination of Violence Against Women because it means that we can initiate this important conversation (on the blog).

According to a new report released by the World Health Organization, more than one third of all women globally will experience violence in their lifetime. The type of violence experienced by women can take on many forms and, unfortunately, knows no boundaries. Here are just a few of the ways that violence against women can manifest itself:

Domestic and Intimate Partner Violence – Domestic violence is also known as intimate partner violence because the perpetrator is often the husband, ex-husband, boyfriend, ex-boyfriend, or partner. Domestic violence can be physical, emotional, and/or sexual. In some cases, partners are coerced into having sex because they’re manipulated into feeling like they owe their partner sex (this situation is a clear example of rape).

It’s not easy to leave an abusive relationship. And the process can be further complicated if children are involved, there is limited access to resources, the husband/partner/boyfriend is a stalker, and/or it’s culturally deemed unacceptable to leave a relationship.

Emotional Abuse – Oftentimes we don’t recognize emotional abuse as a form of violence because we consider violence to be a strictly physical experience. Emotional abuse is an attempt to belittle, control, and/or isolate a woman. In any relationship this can be done through the use of a woman’s financial resources (or lack thereof), children, religion, male privilege, and social network (including friends, family, and community leaders). It can be hard to identify emotional abuse but its impact is significant as it can strip a woman of her connection to resources, education, work, and more. It’s also important to note that emotional abuse can be an indicator of future physical abuse.

Violence Against Immigrant and Refugee Women – I think it’s important to acknowledge that rape and sexual assault is a popular weapon used by oppressive forces during wartime and in regions of conflict. Sexual violence effectively tends to break apart families and communities in these situations.

Many immigrants and refugees will have already experienced trauma. What makes this group’s sexual traumatic experiences unique is their displacement and isolation from home and anything familiar. Immigrant and refugee women may also find it harder to report or seek out resources because they are concerned about their legal status. Moreover, immigrant and refugee women have diverse cultures, backgrounds, and languages. Any resources provided in the countries they locate to may not adequately provide them with assistance they need.

Violence Against Women with Disabilities – Compared to women without disabilities, women who are disabled experience abuse and violence that can be more severe and long lasting. Women with disabilities also face a unique set of challenges because the perpetrators are usually their caretakers. Caretakers, the individuals who have the responsibility to provide assistance, can withhold medicine and/or assistive devices. They can also neglect to fulfill daily required tasks such as bathing, changing, and feeding. As a result, disabled women feel trapped. This abuse can worsen mental and physical disabilities as well as inhibit/delay the body’s natural ability to heal.

Additional forms of violence against women that are not listed above include stalking, dating violence, sex trafficking, same-sex relationship abuse, and sexual assault/harassment.

Regardless of how long I’ve been trying to understand violence against women as a phenomenon, it never fails to surprise me that there exists so many ways to violently traumatize women. And from my perspective, violence against women does not only disenfranchise women, but whole communities, cultures, and futures.

It’s difficult to begin addressing violence against women without addressing global gender inequality which allows this public health epidemic to continue. Gender inequality impacts all aspects of life including economy, politics, health, and education. Inequality in the domestic and social spheres marginalize women and leave them with little to no resources or ability to feel empowered, in control, and independent.

The following are some of the ways that violence against women can be eliminated according to UN Women:

  • Effective prevention strategies that address the root causes of gender inequality.
  • Improved resources for women who are survivors of violence including shelters, legal aid, counseling, and health services.
  • Collecting more accurate reporting rates and strengthening analyses of risk and prevalence factors.
  • Increased support for the organizations that often respond to violence against women. This support can be financial, political/structural, etc.
  • Including more men and boys who seek to end violence against women. Although I believe a woman’s voice alone should be enough to end violence, male allies and leaders can be helpful in combating this public health issue. I think that the support given by male allies can be used in a manner that does not detract but amplifies the voices of women.

I’d also like to add “increase community education and awareness about violence against women” to the list. I’m sure organizations make an effort to educate communities and populations about the epidemic but a comprehensive education campaign administered in places like schools could go a long way. They can definitely help raise children who are able to recognize and dismantle systematic forms of oppression against women.

As an aspiring physician and public health advocate, I would be remiss not to include information about the mental, physical, and emotional impacts of violence against women. Here are some key pieces of information from the WHO I believe are important to highlight:

  • As many as 38% of murders of women are committed by an intimate partner.
  • Violence against women can lead to injuries, 42% of women report having an injury as a result of physical or sexual violence experienced at the hands of a partner.
  • Intimate partner violence and sexual violence can result in unintended pregnancies, induced abortion, gynecological problems, and STIs including HIV.
  • Intimate partner violence experienced during pregnancy can increase the likelihood of miscarriage, stillbirth, pre-term delivery, and low birth weight babies.
  • Violence can lead to a variety of mental and physical health complications including, but not limited to, headaches, back pain, GI disorders, limited mobility, depression, PTSD, attempted suicide, eating disorder, and anxiety.
  • Sexual violence experienced at a young age can lead to poor health behaviors in adulthood including smoking, drug and alcohol abuse, and risky sexual behavior.

Although these statistics are overwhelming, reports say that abused women seek out more medical services than non-abused women. Abused women are also more likely to identify a healthcare provider as someone they would trust most to disclose their abuse. This information is critical because it means that healthcare providers are likely to encounter many survivors of violence. It also means that healthcare providers should make an effort to thoroughly understand the impact of violence and sexual trauma.

In my future practice as a physician I hope to implement the following practices when treating a survivor of violence. Firstly, I intend to make a constant effort to create a safe space for my patients. A space that is free from stigma, victim blaming, and judgment. Secondly, I’m going to recognize that each survivor’s lived experiences are unique and that healing processes are equally as unique. To me, that means that each survivor will require different resources and it will be my responsibility to identify and connect them to those resources. Thirdly, I’ll make every effort to be educated on the experiences of different communities and trained at recognizing the signs of abuse. Lastly, I’ll be an advocate outside of the clinic/hospital setting. I don’t believe that a doctor’s work begins and ends within the boundaries the clinic/hospital. One of the most unique aspects of being a doctor is that you have the ability to be a leader in the healthcare field; you can make positive changes to the health of communities through advocacy work. I know it will be difficult but I’ll definitely be using that platform to ensure that political, economic, and social systems work to empower and support women.

(This is a neat reference created by the WHO that details guidelines for responding to intimate partner violence and violence against women in a clinical environment).

So on this day, I’d like us to remember that violence against women crosses race, ethnicity, age, economic status, region, and more. I’d like us to consider the public health impact that violence against women can have, its downstream effect on children, families, communities, and cultures. I’d also like us to remember that the trauma experienced by women globally is rooted in inequality, perpetuated by misogyny, and experienced in very unique ways based on an individual’s lived experiences.

Please feel free to let me know your thoughts, what you liked, and didn’t like. Thanks for reading this piece!

 

Public Health as a Movement: My Time at APHA 2015

I’m finally back and settled in from my trip to Chicago where I had the opportunity to present and attend the American Public Health Association’s (APHA) 143rd Annual Meeting and Exposition. I’d like to think that it was the experience I needed to once again jump start this blog and my plans/ideas for my future as a health professional. Can’t wait to begin!

Why I Went…

As I previously mentioned, I went to the APHA conference because the abstract I submitted in February was accepted for publication and presentation at this year’s conference. When I got the news in June I was extremely excited because it was a public health program that I was not only passionate about but that I had also invested a lot of time towards. I was grateful for the opportunity to share this project, titled Yoga as Healing, and converse with like minded individuals. Here’s my abstract for anyone who’s interested! Also, be on the lookout for a future post further detailing this project, how I started, and what I’m currently doing to improve the program.

Yoga as Healing: Evaluating How Trauma Informed Yoga Can Assist Survivors of Sexual Violence in Healing

Sara Abdelhalim, B.S. Biological Sciences, MPH, Zahabiyah Khorakiwala, B.A. Psychology and Social Behavior, M.A., R.Y.T., Jessica Lizardo, B.A. Psychology and Social Behavior

Background: Sexual violence is a significant public health threat. 1 in 5 women will be sexually abused during her lifetime. Such a traumatic experience can cause lasting harmful changes to the body’s physiology, nervous system, and brain chemistry. Healing from sexually traumatic experiences can be a lengthy and complicated process. Research has found that trauma sensitive yoga can help regulate emotional and physiological states and allow the body to regain natural movement while simultaneously imparting the critical use of breath for self-regulation.

Objectives: To propose a trauma-informed method of healing for survivors of sexual violence. To propose a program that creates a safe space for survivors of sexual violence that will assist and encourage them to maintain healthy mental and physical lifestyles.

Methods: The program spans the length of eight weeks with each week focusing on a specific theme that will guide each session. Themes include: (1) Intention, (2) Safety, (3) Mindfulness, (4) Boundaries, (5) Assertiveness, (6) Strength, (7) Trust, and (8) Acceptance and Community. Each session includes both a yoga and activity portion that will allow survivors to reflect upon the impact of their experiences. A pre-test and post-test are administered to participants to evaluate program impacts and outcomes regarding the healing process, personal safety, and physical and emotional stability.

Conclusions:  This method promotes safety, health, and well-being. The program aims to empower survivors of sexual violence to re-gain control of their lives by providing them with the knowledge, tools, and environment to engage in self-care and help-seeking behavior.

Learning Areas:

Administer health education strategies, interventions and programs
Implementation of health education strategies, interventions and programs
Social and behavioral sciences

Learning Objectives:
Define trauma-sensitive yoga. Describe the potential of trauma-informed yoga practice as a method of healing for survivors of sexual violence. Identify critical components of effective trauma-informed yoga interventions for use in assisting survivors of sexual violence. Design trauma informed yoga interventions for individuals who have experienced traumatic sexual violence.

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The Conference…

IMG_4855I’m not exactly sure what I expected going into the APHA conference but what I did experience was nothing short of overwhelming. The program alone is about 400 pages, detailing presentations, events, film screenings, workshops, organizations, and exhibits! Aside from presenting, I wanted to make sure that I took full advantage of the conference to learn and expand my network.

Initially, I was all over the place running from one session to the next. I wanted to try to cover all the public health topics I’m interested in from sexual and reproductive health to racism and the social determinants of health to the health of refugees abroad. I definitely think there’s a skill to attending this sort of conference and here are a few of the lessons I learned that week:

  1. Pick only 1 or 2 public health topics you’re interested in (probably best to attend sessions related to the work you’re doing.)
  2. Plan for the conference ahead of time and do searches using the APHA app and the website.
  3. Research the speakers before attending a session to see if their work and background are of interest.
  4. Attend the sessions that don’t have a very broad title. Consider attending the sessions focused on leadership, I really enjoyed going to “Women Leaders in Pubic Health: Policy Influencers and Change Makers” (blog post on this to follow soon as well!).
  5. Make sure you enough energy for socials! They’re a really fun and laid back way to meet new people. Seriously, the platform is already set up for you and it’s super easy!
  6. Get your business cards ready beforehand and make sure you have your elevator speech down.
  7. Don’t get overwhelmed by everything around you! Once you do it becomes so much harder to focus on the sessions you’re attending and it becomes to difficult to enjoy the conference. You also get super exhausted if you’re consistently overwhelmed.
  8. Have an action plan post conference. You’ll be exchanging several business cards and you’ll want to be sure that you keep in touch/follow-up. Tip: Quickly write down something on their business card that may help you better remember who they are later when you review your conference material at home.

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(When you and your friend are low on funds and she’s an extremely resourceful, talented individual! My friend, Melissa, made this awesome business card holder and it was the best thing ever.)

Having said all that, I really enjoyed the conference! I got to met some great people doing similar work or work that I’m interested in. For example, I met Dr. Alice Rothchild, a retired physician and assistant professor of OB/GYN at Harvard Medical School. Dr. Rothchild uses her clinical skills and expertise to document the Palestinian narrative and work in solidarity to further human and civil rights. I also met Dr. Julie Morita, commissioner at the Chicago Department of Public Health, who does significant work with infectious diseases and vaccines.

Witnessing how diverse and dedicated the public health workforce is, was extremely inspiring. From physicians to social workers to dentists to tech professionals to individuals working in entertainment, we all had one goal; create the healthiest nation in one generation. And it makes sense to have so many people from different fields and with different backgrounds come together to work as a team; health isn’t created and maintained solely within the boundaries of clinical medicine, it’s impacted by a variety of factors.

Additionally, every community was represented and there was an effort to have every narrative heard at the conference. We had discussions about gun violence, police brutality, the refugee crisis in Syria, etc. This was truly my favorite aspect of the conference. Primarily because I perceive public health as a collective movement that seeks to advance the health of all communities. When we discuss health equity and social justice, we emphasize that all people should reach their health potential while focusing on the communities that have farther to go.

Hopefully I’ll be able to attend the APHA conference again in the years to come so I can continue learning, growing, and developing into a clinical health professional and advocate.

Thought I’d share a few clips from the conference that really resonated with me. Enjoy!

Interview with Camara Jones, APHA President-Elect at APHA 2015

2015 Annual Meeting Opening Session – Dr. Freeman Hrabowski (The best! Seriously, give it a listen)

2015 Annual Meeting Opening Session – Dr. Vivek Murthy

Also, check out www.thephlu.com! I was featured on their most recent post recapping #APHA15.

Chicago…

Visiting Chicago was definitely a huge bonus on this trip! I was also pretty happy that Chicago’s weather in early November was bearable for a SoCal gal like myself. Here are a couple things I loved about Chicago:

  1. It has large green spaces (parks, bike trails, etc)! I always knew and understood the significance of green space and the benefits it brings to communities, especially with regards to mental and physical health, but experiencing it is something else. I really haven’t felt this sort of calm, peace, and serenity in a long time. As much as I love cities (because I love being surrounded by people, diversity, and culture), green spaces are so crucial to the health and wellbeing of the communities that reside in/near large urban environments.
  2. The buildings in Chicago are beautiful! Each of them are unique and it’s clear that each holds an enormous amount of history and untold stories. I loved witnessing that. Chicago seems to do a good job of preserving its past.

I hope you all enjoyed this post! I’d love to hear your thoughts about your experiences at APHA or in Chicago.

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(Happy I got to spend my week with these lovely ladies from my MPH program. Tiffany in the middle and Melissa on the right.)