Why Do You Want to Study Public Health: Narrative Essay

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Why Do You Want to Study Public Health: Narrative Essay

I was born in a country in East Africa known worldwide as the land of a thousand hills. Despite its limited geographical expanse and dark and complex history, the Rwandan people and its government remain incredibly ambitious, undaunted by setting goals many may consider impossible. However, the resilience of the government and its commitment to health is demonstrated in its myriad substantive outcomes over the past ten years. Such achievements have occurred in the wake of the 1994 genocide and related sociopolitical turmoil. My country has inspired me to want to improve the health of society at large as a researcher and educator.

I grew up dreaming of becoming a bedside healthcare provider, making a positive difference through direct care and saving lives, but during my Masters in Global Health Delivery program and through learning about the social determinants of health, I have come to appreciate how research and a career in academia can improve lives on a broader scale. Through research, I will help to inform the creation and dissemination of policies that can assist populations at large. As a teacher, my students will be empowered to go out and save many more lives than I might ever be capable of with my own two hands. This desire to advance the health of the Rwanda people is my primary motive in applying to pursue a Ph.D. Program in Social and Behavioral Health Science at Rutgers University.

When I was a Pharmacy student in my Undergraduate education, most of the lessons were skewed toward the cure of people and dispensing medications in the hospitals. However, that represented only the tip of the iceberg as most of the public health problems lie outside the hospitals walls. As I started practicing in the Pharmacy, I began to realize that healthcare is complex; it stretches into patients homes, families, their ability to pay medical bills, laws, and policies. That was an important driver of my decision to apply to the Global Health Corps Fellowship- a leadership development fellowship founded on the belief that health is a human right; to gain experience on serving on the frontline of the fight for global health equity. During my fellowship, I worked with Project San Francisco/ The Rwanda Zambia HIV Research Group (PSF) where I chiefly worked on research studies among key populations. In this context, key population (KP) refers to groups which are disproportionately impacted by the HIV that include men who have sex with men (MSM) and female who are engaged in sex work (FSW). I worked with a number of advanced researchers to learn various methods. While collaborating with researchers studying the barriers to Antiretroviral Therapy (ART) compliance among MSM in Kigali, Rwanda, I gained skills in participant recruitment, informed consent, and data collection. I have had the opportunity to independently analyze data and partner with a statistician to review my methods and findings.

My devotion to addressing inequities deepened when I joined the Masters of Global Health Delivery (MGHD) program at the University of Global Health Equity (UGHE) in 2017. In addition to the various leadership, management, research, epidemiology skills that I have acquired from the MGHD program, the most important epiphany for me was the essence to tackle inequalities by focusing on the underlying socio-economic and psychological determinants that affect health. At UGHE, with mentorship from my research advisor; my thesis aimed to identify barriers to HIV Post Exposure Prophylaxis (PEP) utilization among MSM in sub-Saharan Africa. This study surveyed respondents across 16 LGBT organizations across 22 countries in the sub-Saharan Africa region to provide evidence of the challenges this high-risk population faces. My study was presented at the 20th International Conference on AIDS and STIs (ICASA) in Rwanda in December 2019 and was selected as a winner of the 2019 CONNECT Programs Data Science and SGM Health Equity Paper Competition organized by the Institute for Sexual and Gender Minority Health (ISGMH) at Northwestern University. I have authored an article related to this work in the Preventive Medicine Reports.

Currently, I work for the University of Global Health Equity, a Partners in Health (PIH) initiative in rural Rwanda founded in 2014 by Dr. Paul Farmer to radically change the way healthcare is delivered around the world, through education. I work as a Lecturer, and Coordinator of Community Based Education (or CBE) in the Department of Community Health and Social Medicine. In this role, I am responsible for overseeing the CBE program which complements the traditional classroom and laboratory experience by giving students a place to carry out learning, service, and research within a real-world setting. In these dynamic environments, medical students learn about health in the context of the environment. Most importantly, they learn how to follow community-based leadership, and how to partner with community groups or organizations that have more expertise than the clinician and a better understanding of solutions to systemic problems. I am also involved in a number of research activities, key among them being a research study to explore the risk factors for non-communicable diseases (NCDs) among MSM and transgender women in Rwanda. I have participated in the design, planning, and implementation, as well as recruiting and training local research assistants. The data analysis for this project is underway. Although my current roles as a University lecturer and public health leader provide me the venues to hone research, communication, public speaking, and leadership skills. I still lack the ability to independently design and conduct a robust research study incorporating rigorous study methodology. I believe that the curriculum taught in the Ph.D. program in Social and Behavioral Health Science will not only equip me with these skills, but also will teach me the essential skills on how social, and psychological determinants intersect with ill health, health care delivery, and disease prevention, and these are the same skills that I believe are fundamental to solve some of the most pressing health disparities affecting people within my community, particularly the most disadvantaged populations. Rutgers School of Public Health has reputation for being among the world-leading universities in delivering high-quality education; a primary reason why I have no doubt that a Ph.D. in Social and Behavioral Health Science program at Rutgers School of Public health will assist me in my academic endeavors and in becoming a reputable researcher capable of informing policy.

While I enjoy my experience as an educator at UGHE, my passion for advocating for underserved populations pulls into the field. It is the reason why I keep volunteering at Joint Actions for Bright Future Alliance. This is a community-based organization I co-founded with a mission to elevate the voices of LGBT people and to advance health promotion, and human rights in Rwanda.

In Rwanda and many countries in Africa, due to cultural beliefs, political prosecution, religious norms, and social homophobia. LGBT people continue to face barriers to access healthcare. For instance, a recent study in Rwanda has highlighted a high prevalence of human papillomavirus (HPV) infections and an elevated risk of anogenital cancer with MSM populations. I see my primary role as a Ph.D. prepared healthcare professional to play a front-line role in generating evidence to help implement programs and policies that will promote access to care among LGBT populations and underserved groups in Rwanda. For my doctoral studies, I would like to conduct a research study to understand the barriers, and facilitators to Human Papillomavirus (HPV) and anal cancer screening for People who identify as MSM, Bisexual, and Transgender women in Rwanda. A project like this will be essential in promoting population-level strategies, and policies that promote HPV, and anogenital cancer screening and care among MSM, Bisexual, and Transgender populations in Rwanda. Rutgers School of Public Health leaders in advancing access to health care services, and addressing disparities among LGBTQ populations are Dr. Perry N. Halkitis and Dr. Chongyi Wei. With their expertise and partnership, I do believe their mentorship will prepare me to become a shining representative of Rutgers School of Public Health advancing population health in Rwanda and other parts of the African continent.

Another essential reason for a Ph.D. from Rutgers School of Public Health is to improve the quality of public health education in Rwanda. This is a life calling for me. The advanced public health education at the graduate level in my country is in its fledgling stage. Only two schools for a population of 12 million provide advanced education in Public health, and there are not enough qualified faculty to fill the staffing needs in advanced public health education. If we are to improve the health of the nation in the long-term, we must improve the quality of healthcare education and the scope of their practice. A Ph.D. will equip me with the skills to contribute to the education of the next generation of public health leaders in my country.

My current roles continue to expand my horizons and prepare me to be an active doctoral student contributing to the diversity of the Rutgers School of Public Health Ph.D. in Social and Behavioral Health Science program. My understanding of health care delivery as a Community pharmacist, and my experience working with underserved populations has given me a unique understanding of how centering communities and their leadership in the search for sustainable solutions to public health problems can lead to a transformational change of health and healthcare delivery systems. I can bring these insights, as well as my networking skills to further engage with other students in my cohort through spending time sharing our experiences. This will spark interest and generate opportunities for future collaboration. I will endeavor to build and maintain lasting networks that will facilitate lifelong learning in the relentless pursuit of health promotion.

I care about public health because I firmly believe that health is a human right, not a privilege for the few. However, it pains me that there are still many people dying unnecessarily from preventable and manageable diseases. These unnecessary deaths are in large part due to social injustices in healthcare delivery systems that make some groups more vulnerable to poor health than other populations. Reducing health inequities requires transformative change, I would like to be part of leaders confronting these issues head-on and promoting critical analysis and reflection about systems and structures that influence health and the type of healthcare professionals needed to tackle inequity and injustice all across the globe.

Pursuing advanced education and developing a sustainable research career are rare opportunities in Rwanda. I have been blessed to build relationships with incredible mentors and continue to seize every opportunity available to develop my professional, interpersonal, research capacity, and public health leadership. I believe this Ph.D. program in Social and Behavioral Health Science at Rutgers School of Public Health is the missing piece for me to achieve my full potential and acquire the expertise I need to make a positive and measurable difference in the health outcomes of Rwandans, Africans, and the global population.

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