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.

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!