1 in 7

In October 1999, I was living in Angers, France. I was halfway through a rich study abroad program, spending my weeks mastering French literature and perfecting my French grammar while on the weekends I was jubilantly traveling around Europe hand in hand with my Eurail pass. Also in October 1999, the world’s population reached 6 billion.

Sometime in the next week, the world’s population will arrive at another milestone – 7 billion people. In just 12 years, another billion people have been added to our planet. As people continue to live longer and fertility rates are still quite high in many parts of the world, we are on track to continue this remarkable growth. But can we handle it? Can our environment handle it? Will there be enough food and water for billions more people when currently wells are drying up and famines are haunting thousands? Are there enough natural resources for another couple of billion people? What about people living in poverty, how can population growth possibly help alleviate those already struggling?

I cannot help but think about the importance of family planning when discussing demographics. Family planning has long been linked with aiming to reduce population growth, ease poverty, and address health and education inequities. Bolstered by the landmark 1994 International Conference on Population and Development (ICPD) in Cairo, the international health community also recognized that family planning programs must include the reproductive and sexual needs and rights of individuals. However, despite the enthusiasm of the ICPD, family planning strengthening efforts and funding for family planning programs have dropped on the lists of international development priorities.

I have a feeling some momentum will soon return to the family planning champions. Not only because of the growing population but also because in late November, the second International Family Planning Conference will take place in Dakar, Senegal. The 2011 conference will bring together participants to share research, best practices, and progress on national strategies to deliver family planning services, with the ultimate goal being universal access to family planning.

I found out this week that I will not be able to attend this conference. To say I am disappointed is an understatement. Not only did I want to present data from my Masters Paper (which was accepted by conference organizers), but also I wanted to participate in those rich discussions that so often occur in hallways or at cafes during international conferences. I am particularly interested in family planning gains in West Africa and what is being done to mitigate unmet need and demand for modern family planning methods. Too, I am keen to learn more about how the global health community envisions just how it will help developing countries meet family planning goals in light of severe shortages of health professionals. There have been so many gains through engaging community health workers – I want to learn more about how are we training these front line health workers to provide quality care and also, what is being done to provide quality family planning education for future health professionals in medical and nursing schools?

Despite my disappointment in not being able to attend the November conference, I do not have to be in Senegal to contribute to global family planning efforts. In fact, one of my activities at work these days is creating an innovative online refresher family planning course for faculty at a rural, private nursing school in Mali – in French. It’s a good thing that 12 years ago as the world’s population growth was setting records, I was studying French in Angers!

Va Ca Tion

va·ca·tion

 

–noun

1.

a period of suspension of work, study, or other activity,usually used for rest, recreation, or travel; recess orholiday: Schoolchildren are on vacation now.

2.

a part of the year, regularly set aside, when normalactivities of law courts, legislatures, etc., are suspended.

3.

freedom or release from duty, business, or activity.

4.

an act or instance of vacating.

For the first time ever, I did not check work email while on vacation! Here is what I was doing instead...

Observing gorgeous sunsets over the Adirondacks!

Going on covered bridge hunts all over Vermont!

Indulging in all of the in-season treats like apples!

Noting very weird things like a mushroom growing out of a tree in Woodstock, Vt!

Taking in the sites and lovely weather in Montreal!

Animal Love

London

Whether you are a dog or cat person (or both), our animals are good for our health. I know after a particular rough day, snuggles from my dog London make everything so much better. Here are some pictures of my favorite pets out there that make life much happier (and healthier).

Jaxson

Artistic Tucker

Ms Ellie Cat

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.