Indicating what exactly?

I’ve been thinking a lot lately about data. We spend so much time, not to mention tax payer dollars, traveling to the field and collecting a heck of a lot of information about health. DHS anyone? Recently it has really hit me how important it is to not only collect the data but to collect the right data and ask the smart questions so we can properly monitor progress. One of the best quotes I recently heard was, “You don’t improve what you don’t measure.” Suddenly, indicators have become quite attractive but they are only useful if they measure the right variable or outcome and people use them. Of the gazillion guidebooks and handbooks for M&E, I wonder how often those (hopefully) well thought out indicators are actually used. And if we are all using different measurement tools, are we really measuring the same things?

I work in a world of human resources for health and health systems strengthening. Metrics for progress in these areas is difficult. Our work and innovative interventions are not as cut and dry as a lot of service delivery projects i.e. providing vaccines or ARVs. The past few weeks I’ve felt like a student again as I’ve participated in a multitude of webinars and conference calls related to various HRH topics. A recurrent theme: measuring our work and linking health successes to our health system and HRH interventions. HSS and HRH are no longer new – we’ve been doing this for quite some time and it’s time to show the world that what we are doing indeed is improving health outcomes for populations in developing countries.

What does an indicator really look like for measuring health workforce development? My project recently released a compendium of HRH indicators (http://www.capacityplus.org/hrhic/content/introduction), which proves to be a useful guide. I recently suggested to my team that before finalizing a simple progress report template for a health training program in Uganda, I wanted to consult this compendium to make sure we were capturing any data satisfying HRH indicators. In my own little way, I’m committing to using the right indicators so that any data I can collect can be properly measured and evaluated in the HRH world!

Summer Lessons

I thought my summer would consist of an easy transition back into the 9 to 5 world. I was fortunate to have a job, working for a company that I truly adored and on a project that felt inspiring and important. This new transition meant that I would not have to balance the weight of school and work, something that was so hard during the past two years of graduate school because I was equally fulfilled and committed to both endeavors. My post graduate life meant that I would at last have time for the gym and happy hours. Finally I could forego the required reading (that I never skimped on) and the weekend papers, which I meticulously crafted so they were perfect. I could always attend the staff meetings, never having to leave for a class or lab. I thought everything would be grand during this transition, after all, now I’d made it into the club of colleagues with the esteemed MPH. No longer an imposter, I had succeeded (in my mind) and certainly everyone would recognize that my years of hard work and now a graduate degree meant that new doors would open and bigger paychecks would ensue.

Just two days after graduation, I returned to work with enthusiasm and a chip on my shoulder. To my surprise, apart from the water cooler congratulations, the only real difference was that I was working 40 hours a week instead of the 20/25 I’d been holding down in graduate school. There were no shooting fireworks, no gold plates with my name in big, bright letters and not even newly printed business cards showcasing one of the biggest accomplishments of my life. Something felt very out of place. It was like for two years I had been cresting the large hill of a roller coaster and there was no exciting decent. I was just there, like it hadn’t happened at all. Had I expected too much?

After a few weeks, I emerged into a sort of depression. I had put two years of my life on hold, having completely succumbed to graduate school and the world of public health. Old friendships faded. I missed family holidays. I bailed on girls weekends with college friends. And what did I have to show for it except a piece of paper and thousands of dollars in student loans.

This melancholy perspective continued for weeks. Never did I regret plunging into public health or dedicating two steadfast years of my life in pursuit of an advanced degree but something was off. By expecting some monumental shift, I was loosing my grip on why I do what I do.

Then one week, in late August, I had some inspired conversations. Perhaps meaningless to those around me, these discussions revealed something I needed to see. Public health – or specifically reproductive health – was alive, and I was a part of the mix. There are women needing services and I had good ideas on how to help them. People asked me about my opinions and they listened when I talked. This passion that I have for family planning emerged and suddenly I was alive again, regaining that grip that I was frightfully loosing. There was no big bang that was going to happen post graduate school but the culmination of little yet important fireworks to light the fire in me.

About this time I started conducting some data analysis of DHS reports, looking at trends in unmet need, fertility rates and contraceptive use. I was running numbers alongside health worker density ratios and making scatter plots to see what kind of story emerged from the intersections of these data. This was work, it was fun and I could physically feel the knowledge I’d gained in graduate school put to good use.

There is no exciting ending to my summer. Despite some really lovely vacations (Chicago, Outer Banks), I let my summer slip by. There were days I felt inspired but most days I just felt that professionally something was empty. I’d rather be honest than share glossy tales of exciting workdays post grad school. Not to say there were not good moments - there were and I have learned a lot in these transition months. I know there will be more exciting days ahead in my career and certainly more woes.

In a final reflective moment, I don’t recall caring as much about how I felt about my career before graduate school. I think I learned to care so much more after dedicating myself to pursing my MPH and holding down a job that is so important to me. The knowledge I gained over the past two years both in school and on the job was extremely motivating to me so that I could do my best to improve health, especially in developing countries. This is a powerful revelation. I have developed quite a relationship with this world of public health and it is so much more than a job. This summer I learned that I really care about my career and what contributions I can make to better the lives of my fellow global citizens. I learned to get off my “high-horse” about what I expect the big man owes me just because I have a Masters degree. I know in my heart that I am a much better worker and far better person because of the work I have done the past two years. Who would have thought that I had to experience a blasé of a summer to learn just how much I care about my career?

Master Amanda

I am a Master of Public Health...

And have the best, brightest MPH friends in the world!

Ode to the Graduate School Experience

Leaving campus today after my last class on my last day of graduate school, I was unprepared. As I walked on the old, brick sidewalks along South Columbia toward Franklin Street, I took in a deep breath, enjoying the Carolina moment. The flowers were still in bloom, the sun was shining, students were bustling to and fro like any mid-day hour on campus and the residents in the houses in frat court were gearing up for pre-exam parties. I walked down that street smiling, enjoying the quintessential late-April, Chapel Hill day. I got to my car and pulled out on Rosemary Street to head back to the office and then “it” hit me. And I uncontrollably sobbed. I had no Kleenex so I am sure the people at the stop light next to me thought I was one hot mess.

On my first day of graduate school I felt like an imposter. Surely, they made a mistake and I was not meant to receive an acceptance letter to this program, this esteemed School of Global Public Health. What was I doing here? Among me were medical professionals and people with smart sounding accents. There were women, who when they talked, really brilliant things came out of their mouths. There was a pharmacist from Nigeria for goodness sakes. Would they notice little me and could I possibly fly under the radar?

It took no time for the imposter syndrome to dissipate. I had too much to do to worry about anyone’s radar.

There were journal articles to read, papers to write, confidence intervals to calculate, fertility rates to ponder….

There was so much to Google Scholar and look up in PubMed….

There were class debates on VBAC (vaginal birth after Cesarean)…oh and new acronyms to learn…

There were presentations and posters to present….

There were new topics to explore and old ones in which to apply innovative approaches…

So much happened in the blink of an eye. And if I am honest, I will tell you that I have loved every minute of it (except Epi, sorry Vic).

This journey has been a dream that I am afraid to wake from. I have learned so much about maternal and child health and public health. I have found confidence inside of me that I didn’t know existed. Never did I imagine I had so much inner-strength and ability to focus. Me, the imposter, mastering public health, albeit on less sleep than a new mother. This school, this city, this university – it was home and I felt such comfort in spreading my wings.

And, the indisputable best part of the journey? The MCH girls.

I recently read a poignant quote: “Truly great friends are hard to find, difficult to leave, and impossible to forget.” I tear up reading that quote and thinking about my MCH girls. Without a doubt, I have encountered some of the most deep, meaningful friendships that will last throughout the rest of my life. My MCH girls make me a better public health professional and bring out the best in my character. This world is a far better place because in it we have these intelligent, motivated and inspirational women. I am truly blessed that our lives intersected at this time in my life and in this beautiful place. I did not know a piece of my heart was missing until you all embraced me and filled my soul with such support and love.

Chapel Hill, Carolina, the SPH, my MCH girls – you have taken care of me the past two years and given me the beautiful gift of a graduate school experience. I am so grateful. For the next week I will need to carry tissues in my purse so I am better prepared for the days leading to graduation.

Mon coeur est plein d’amour aujourd’hui. Je suis béni.

Masters Paper Check!

1 IRB exemption approval from UNC.

1 literature search.

8 key informant interviews.

Countless acronyms.

7 Recommendations.

35 written pages (10,221 words).

50 references.

2 department signatures.

My Masters Paper, "Strengthening Pre-Service Education for Family Planning Services in sub-Saharan Africa," is signed, sealed and delivered to the UNC SPH MCH Dept!!

My First Wordle...can you guess my topic?

A Blog about a Really Good Blog - Must Read!

In less than one month, I will graduate from UNC Chapel Hill with a Masters in Public Health. It is inconceivable that time can seamlessly pass so quickly. While I scramble to finish my Masters Paper and other assignments, I have been afforded very little time to reflect on this monumental accomplishment of completing a Masters at one of the country’s top public health schools. I am sure that I’ll have more reflection time down the road, but yesterday I read a blog that made me step back and truly appreciate why I love what I do. Too I am reminded that what I do is intensely importantly. As much time and energy (and money) as I have put into my higher education degree, what I do in global public health is really not about me at all. Not in the slightest. And I am just fine with that because what all of this is about is saving lives and ensuring that men, women and children in every corner of the world are afforded the opportunity to lead a healthy life.

I’d like to share this with you but be advised, the blog sets the bar for high-quality, simple, eloquent and powerful writing. Thank you Maurice for evoking such deep and meaningful emotions from a stressed out graduate student. I was worried that in the midst of the final weeks of school, I’d become a little bit too emotionally detached from the realities of working in developing countries. I was fearing that due such a narrow focus the past few months, I was missing the "big picture" of the phenomenal successes the global health community has achieved in the past few decades. Thank goodness I am still very much emotionally connected.

From the ONE campaign: http://www.one.org/blog/2011/04/08/global-health-and-american-moral-power/

Global health and American moral power

My parents survived the Holocaust; they were Jewish children who spent the war in hiding in France. After the war, they received CARE packages from America. The Marshall Plan helped rebuild France. I once asked my mother what this meant to her. She said, “After all we had been through, it reminded me that there were still good people in the world.”

At its best, our country is the most powerful force for good the world has ever known. The force of our values has shaped the world since my parents were children. Military might and economic preeminence rest upon the foundation of our values.

Budgets are moral documents. They say what is important and unimportant to us as a people and as a nation. Some believe America can no longer afford to be a force for good in the world.

I disagree. I’m old enough to have lived through multiple cycles of economic distress. American ingenuity and resilience have revived our country every time. That will happen again. We must keep our moral compass on the road to economic vitality.

Because the American moral compass is unwavering during good and bad economic times, the United States has led the fight against disease and death among the world’s poorest people. The results have been miraculous. Between 1990 and 2009, the number of deaths of children under five declined from 12.4 million to 8.1 million. This means 12,000 fewer children die every day. Maternal deaths have dropped by a third—1,000 fewer women die every day. Thanks to the United States, over 3.2 million people are receiving treatment for HIV/AIDS. This record of success is replicated in family planning, malaria, tuberculosis, and other tropical diseases.

Miracles are not free. They cost eight cents a day. That is the average cost to each American citizen for the US government contribution to saving lives among the world’s poorest. Eight cents. That is about one-fifth of one percent of the US government budget.

Some people say eight cents is too much. They want to cut it to six cents. Really. Their proposal is to save the American taxpayer two cents a day at the cost of lives and claim a fiscal victory. Make no mistake—the cost of “saving” two cents a day will be that children will die, mothers will die in childbirth, and AIDS sufferers will be cut off from treatment.

The decency of Americans does not wane in hard times. Even in the depths of economic crisis, over sixty percent of Americans think that the US is either spending the right amount or too little on assistance for health in developing countries; only twenty-eight percent think we are spending too much.

The American people are both good and sensible. They understand that building a better world is in our best interests. So they support joining a global effort to save lives that brings together many governments, charities, religions, nonprofit organizations, and businesses.

The American force for good is on display in every village where the burden of disease is alleviated. Global health joins American values to our national interest at very low cost. The exercise of American moral power and decency ripples through generations. My family is testament to that.

-Maurice Middleberg, head of global policy at IntraHealth