Final Reflection - Concordia University Individual...
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Running head: FINAL REFLECTION 1
Final Reflection
Sandra Adrianne Pena
Concordia University
Public Health Practicum
MPH 599
Dr. Jen Janousek
December 11, 2014
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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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FINAL REFLECTION 5
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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FINAL REFLECTION 10
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