Running head: FINAL REFLECTION 1

Final Reflection

Sandra Adrianne Pena

Concordia University

Public Health Practicum

MPH 599

Dr. Jen Janousek

December 11, 2014

FINAL REFLECTION 2

Final Reflection

Abstract

The issues facing public health professionals at present are so vast and beyond even

comprehension for some so, at the conclusion of our Master’s education in makes sense that we

complete a practicum. The purpose behind a public health practicum is to bring together two

years of education, integrate those experiences with real-world public health problems, and see

where our future as professionals might fall after we have an understanding of these real-world

problems. When we willfully entered a graduate program two-years ago that specialized in

public health it was our first step towards wanting to do something and make positive change for

the future. My approach to this culminating activity was to split my 75 hours of practicum

experience between two countries in the third world. I traveled to Cuba in January 2014 and to

Belize in October 2014. After this time abroad, I was better able to understand the depth of

public health and provided me an experience that few will every have the opportunity to

experience and allow me to enter my professional future as the most rounded candidate for

employment are a public health professional.

Introduction

Although there were many options for how I could have spent, my practicum time

I chose to spend my time in medically underserved communities. When I looked up how to best

define what a medically underserved area (MUA) was it seemed that most of the federal

agencies only identified areas within the United States that were MUAs. Therefore, I chose to

take that definition and adapt it to work in third-world countries that face some of the same

problems as our poorest areas in the United States, but sometimes face problems that are

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different and worse and are oftentimes referred to as ‘forgotten communities’. According to

DC.gov MUA is defined as MUAs include, “groups of census tracts that have a population-to-

provider ratio indicating a shortage. Medically Underserved Populations (MUPs) may include

groups of persons who face economic, cultural or linguistic barriers to health care in the District

and reside in a specific geographic area” (DC.gov, n.d.) The result was astounding, eye-opening

experiences that left me excited about my future in public health. My first XXX hours were

spent in Cuba with  Medical Education Cooperation with Cuba (MEDICC) and the purpose of

MEDICCs week-long trips to Cuba is to open people’s eyes to a county that has essentially been

forgotten due to a long history of political turmoil between the United States and Cuba. After my

trip to Cuba in January of 2014 I went to Belize with Concordia University in October of 2014

and spent 34 hours working in similarly impoverished communities. I believe that the only way

to address the issue is to bring awareness to it and I believe that organizations like MEDDIC and

Concordia University that support global health initiatives to be at the forefront of addressing

these public health disparities.

Medically underserved populations is a current, relevant public health issue

because the health of our nation is only as good or a strong as the health in the worst area and

that includes the health of countries outside of the United States like Cuba and Belize. Poverty,

parasites, and preventable diseases are something that that are still somewhat prevalent in the

US, but these problems are something that is rampant in third world countries. I believe that

public health missions like my trip to Cuba and Belize bring awareness to these problems

because one person may travel, but that one person comes home a tells 100 and through the word

of mouth from people that participate in mission trips we can help make positive change in

health and communities happen around the world.

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During my time in Cuba we were quite busy going from appointment to

appointment with keep public health professionals, essential stakeholders within Cuba’s public

health that sought to help us understand what the problems are, what they are happening and

what they are doing to try and fix them. During my time in Belize, we went with one clearly

defined mission that turned out to be so much more. When we prepared to leave, we knew that

we were traveling to Belize to do community needs assessments and community outreach and at

the same time, another division of Concordia University was able to provide medical care to

communities that often go a year or more without a medical provider coming to their area.

MEDICC's goal is to give you the chance to share thoughts and experiences with the Cubans you

meet, and to return home with an insider's view of Cuba, its people and health care. and is

funded through donations and their professional Journal, MEDICC Review. My to Belize was a

partnership between Concordia University and Praying Pelican Missions. While Concordia

University is a private Lutheran University with a mission of providing excellent academic and

Christ-centered community equipping men and women for lives of learning, service and

leadership in the church and world. Praying Pelican Missions has been an established ministry

organization since 2003, and is funded through donations and through genuine partnerships with

churches in 13 different countries.

Discussion

During my practicum, my goals were to learn as much as possible and to possibly

find an area of public health that stood out to me as something that I could be passionate about

and something that I could build a career on. Therefore, for that I happen I believed that I had to

first learn which included being open-minded to the challenges that are faced by a variety of

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different communities and after I learned, I needed to apply that knowledge and see if I could be

a part of making a difference in communities around the world. Some of my other goals were:

1. Apply knowledge learned in the classroom to the real-world environment.

2. Learn about public health problems that exist outside the United States.

3. Give back to the global community while still learning about public health.

My time in Cuba was nothing short of enlightening, I was able to go somewhere

and experience something that not many other people will ever get to experience. At the end of

my experience in Cuba, I was surprised to see that even though they have so little and are on

such precarious ground with the United States that they have somehow found a way to make

their healthcare system work for their citizens. As opposed to talking about every event that we

participated in I am going to highlight a few that I know will carry with me for the rest of my

life.

I found to community-based polyclinics to be a fantastic concept. The community

based poly clinics where guaranteed to be one doctor and one nurse (in more populous areas they

might have two nurses) these clinic were located in all of Cuba’s municipalities and the

doctor/nurse teams live in the community that they serve so that have the inside track on the

community they serve. I don’t know if the US is too populated to make this concept work here,

but it goes a long way to help monitor the health of the community and make health care

accessible.

My trip to the HIV community center. I was in awe that a bright pink building

that was clearly labeled as the HIV community center is able to exist without repercussions form

narrow-minded individuals that target these people for alternative life styles. What I found to be

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most interesting about this stop was that a lot of the volunteers are HIV + people with powerful

stories and they go out into the community where people that participate in high-risk behaviors

congregate and offer education and rapid HIV testing at random location around Cuba. I loved

this stop and I loved seeing how passionate the community volunteers were in this center. This

stop kind of bleed over into our discussion on equality and a campaign to recognize all couples

as equal couples.

Trip to secondary school (children age 11-16). For this response, I want to quote

the reflection that I wrote nearly 12 months ago when I was in Cuba. “We walked on to campus

to be greeted by the children singing us an Adele song, when we asked why Adele? Why not

something native? We were told that we are taking our time away from our homes and our

families and they wanted to great us with something that we would find comforting” (how great

was that) I was shocked to walk into a physics classroom and see 14 and 15 year olds learning

electrical engineering. I specifically noted that I was surprised that even with Cuba having so

few resources that they seemed to be surpassing the educational programs that we have for

children of the same age group here in the United States. I ended my reflection stating that this

experience was a reminder to remain humble and grateful and to give back every opportunity

that I have.

Visit to maternity home. I liked this stop because it was for people of all ages and

all incomes, but specifically for low income families. In this well… for lack of better term

mansion they had 65 beds that were divided into three areas according to risk level. Those risk-

levels were twins or other multiples, teenagers and adolescents, and higher-risk pregnancies. The

women in these homes had 24/7 care that was everything from nutritional support to building

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interpersonal relationships. The importance of this home was because the geographical layout of

Cuba there are some very rural areas that have little to no medical care so some women that are

not classified into an above listed risk category choose to move into this home at 38-weeks so

that they will be able to deliver in a safe environment.

As for my time in Belize I believe that I was most able to reach community

members was during Vacation Bible School (VBS). I found people to be most receptive during

this time because it was a recurring event and it gave the children and parents in the community a

chance to get use to us and be receptive to the educational in-services that we wanted to provide.

The hands-down best interaction that I had was with a nine-year-old girl named Stephanie and

she did not know how to read and during VBS one day I was able to sit with her and work on her

reading from a book that Christy Burrows had brought with her for her dental hygiene

presentation.

Barriers

Although there were ten months and many miles between Cuba and Belize, I

believe the Barriers were similar. We were in a different county so there were cultural barriers

and language barriers. To address these barriers time was set aside before each trip was taken for

us to research and learn about the areas that we were traveling too. In Cuba, we had a dedicated

translator Yoyi that was provider to us by MEDICC and although we did not have a dedicated

translator for Belize Kelly and Marcus were happy to step-up when needed. I believe other

common barriers are willingness to be candid and to tell outsiders about the actual problems

within the community including the severity of those problems. I loved that our translator in

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Cuba was a native so when people around us were sugarcoating things she made sure to tell us

that from her experience what she viewed the problems to be.

Specifically for my trip to Cuba, I think that a barrier was that we were US

citizens. Another safety was never in jeopardy I do feel like there were hard feeling from past

interaction with Cuba and the US. I believe the only way to address this particular barrier is to be

the best role models and representatives of the US at all times. Also to know that these

community do not have to take time out of there days so set up these interactions for us so we

need to be grateful and appreciate that a lot of people are moving their schedules around our

visit.

Personal Assessment

Looking back on my time spent in my practicum I just have to stop and say, wow.

When I went into this experience I had an idea of what I was getting into since my undergraduate

practicum required a 300+ hour practicum and for that I up and quit my job and moved to a third

world country, two actually. However, those experiences were kind of, what I would liken to a

fly by the seat of your pants and figure out what you can and absorb what you can. If I were

honest in analyzing my undergraduate experience, I think I spent less than 50 hours learning

about public health during the three months that I lived abroad. What I loved about my graduate

experience that helped me learn, experience and love public and global health. So, for my

assessment of my graduate public health experience I am going to relate my experience to The

10 Essential Public Health Services (Centers for Disease Control and Prevention [CDC], n.d.).

Monitor health status to identify and solve community health problems.

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To me being able to monitor health status for the purposes of identifying community

health problems means studying the health statistics of an area, but also being active in the

community and having meetings with key stakeholders to see what the numbers do not tell us. I

believe that this is relevant because community leaders like teachers, community health workers,

and medical providers that see the everyday problems and have more involvement

Diagnose and investigate health problems and health hazards in the community.

When I think about key public health function number two I want to focus specifically on

the portion that states investigate health problems. Although, I think that my masters practicum

was fantastic there is no way that 75 hours would have been able to gain and practice in all 10 of

the functions of public health so I want to relate this to my current job that is in public health

where I function as a communicable disease investigator. I liken that to being a public health

detective where you have part of a puzzle and you need to be able to find all of the puzzle pieces

to have a complete picture.

Inform, educate, and empower people about health issues.

The epitome of health function number three was my practicum experience with

Concordia University, specifically my trip to Belize in October of 2014. When I think about

Cuba, it was a chance for me to learn about public health. When I went to Belize, it was my

chance to use what I have learned in School, in Cuba, in my career in public health to help make

a difference in disadvantaged communities.

Mobilize community partnerships and action to identify and solve health problems.

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I believe that are visiting communities away from our home encouraged us to lean on

community partnerships that have been built though Concordia’s ongoing relationship with

C.A.L.M.S. and the new relationship that Concordia built with Praying Pelican Missions. I think

it is important to acknowledge that public health is not a solitary activity rather a partnership that

requires many likeminded people that have a vision for wanting to improve health in one of the

many ways that a public health degree can help society.

Develop policies and plans that support individual and community health efforts.

During my time in my Master’s practicum, I do not believe that I was able to participate

in being able to develop policies. However, while in Cuba we were able to look at some of the

practices and policies that were already in place and see how they affect the community both for

the positive and for the negative.

Enforce laws and regulations that protect health and ensure safety.

During my time in Cuba and my time in Belize, I do not believe that I was able to enforce

laws or regulations as we were in each area for such a short period and as visitors to a foreign

country, we did not carry to authority to be able to accomplish this function. But in a broad sense

we were exposed to some of the laws that these countries do have in place and we got to see how

those laws affect everyday functions within these communities.

Link people to needed personal health services and assure the provision of health care

when otherwise unavailable.

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When I think about function number seven, I think we as a mission group effectively

accomplished this with our mission group in Belize because we were a unique team this time

around and we had goals to provide care and educate which was different from the global health

trip last year. I do not know that we were necessarily able to ‘assure’ anything because what

these days is guaranteed? Nevertheless, with tried with humble hearts and open-minds to do

everything that we could to help in the communities that we served.

For Key public health functions eight, which is, “assure competent public and personal health

care workforce” (CDC, n.d.). I do not believe I spent enough time in either area to be able to

assure competence, however I do believe that I was able to provide guidance and answer

questions that might have be able to help the communities that I served a better idea of how to

reach their goals to make their communities healthier.

Evaluate effectiveness, accessibility, and quality of personal and population-based health

services.

I never made a secret of how difficult I found program evaluation both during my

undergraduate and graduate experiences but I am smart enough to realize and acknowledge how

pivotal it is to public health. I know that this is an area that I could most certainly continue to

work on so that I can be a better overall public health professional. During my practicum, I

believe in, we were able to briefly able to cover these topics but this is an area that I could like to

revisit after the close of my mater’s program.

Research for new insights and innovative solutions to health problems.

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I believe that this public health function will happen for all of us after graduate from

school and most likely at some point during our professional careers. To me this means that this

is when we are member of public health organizations, sit on boards, and make recommendations

to make a change in public health and communities with a goal of building a stronger better

tomorrow.

Conclusions and Recommendations

During my time spent completing my practicum hours I was able to focus con community

needs assessments, key stakeholder meetings, and health education. However, since with all the

trips I have taken abroad in the last two years (Guatemala, Cuba, and Belize) we were movers

and shakers, every day we were on to a new community hand had close schedules we had to

keep. So to stay on track with our itinerary we were almost guaranteed that we would not work

with the same community members two consecutive days in a row if we were lucky we would

get a few minutes maybe a few hours. With that being said we could not really gauge existing

health beliefs, address a health problem or concern, and track changes in a 1-3 hours encounter.

In the future if I had my graduate practicum hours to do over again I would like to spend

them all in one area focusing on one health behavior or just one program so that I will be able to

see the positive or negative change that my efforts have in _________ community. However, it is

a fine line because I love the variety that the three trips provide because I got a little bit of

experience in so m any different areas of public health. Are more practicum hours possible?

Because there is, so much, I want to do and so much I want to experience and in all honestly I

am a little scared to be released out on public health because I feel that there is still so much for

me to learn to be the best public health educator possible.

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I would like to look back on Concordia University in five years and in ten years from

now I see the MPH program continue to grow (which I have no doubt it will). I know that I get

many alumni invitations from my undergraduate institution and I do not really pay them much

mind and I do not want that to be the case with Concordia because I had such an overwhelmingly

positive experience. The education that I received with Concordia will be the springboard that

will launch me into a successful public health career for many, many years to come.

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References

Centers for Disease Control and Prevention . (n.d.). The Public Health System and the 10

Essential Public Health Services. Retrieved from

http://www.cdc.gov/nphpsp/essentialservices.html

DC.gov. (n.d.). Medically Underserved Areas - Populations. Retrieved from http://doh.dc.gov

/service/medically-underserved-areas-populations